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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br />BUSINESS PHONE:(209)468·3121 <br />INSPECTION REQUEST ·24 HOUR RECORDER:(209)468·3165 <br />Scope of Work:N e uJ H-ou S E <br />Project Address:~S ~O '1 N.-I 0 ~t-~Lan~ <br />Contact E-mail:Project Valuation: <br />OWN6R NAME AN£;>ADDRESS <br />e.rName:J t::A l..()~ <br />Address:N .To S+c:=.La.n<!.. <br />Qc..aCity:State: <br />Ph#\Zd7)&'10'()'1K?ZIP:QS ,;),,0 <br />COf.fTRACTOR INFORMATION <br />Name: <br />Address: <br />State:City: <br />ZIP: <br />",.",-~Ph#(.. <br />Ph#( <br />Company Name:Lic.No: <br />Address: <br />Lt:NDING AGENCY <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes l'&l No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />City:St ZIP: <br />Lod I StCA.ZIP:Q5d40 <br />Ph#~ <br />Identification Number: <br />I am 0 a California licensed contractor or ~the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and OwnerlBuilder Verification Form signed and submitted). <br />I have read this construction permit application and the information I have provided is correct. <br />I agree to comply with a/l applicable county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature a......1-/--:d~."tvr Date -;.-~-;>,o II <br />For your convenience checklists detailing any additional submittal requirements for various building permit types <br />are available at the Bui/ding Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &HandoutslHANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)