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BUILDING PERMIT APPLICATION <br /> c <br /> G <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I ` <br /> 1810 E.HAZELTON AVENUE, STOCKTON CA 95205 <br /> .. BUSINESS PHONE: (209)4683121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> 4C%FOM1� <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPP.LICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: TU Y? 7rcwz5 11 <br /> O / L,Vol y2N� <br /> Project Address: i s �✓{� 1jL�!(� 7e, of <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ^e/14(j IJ0 2t:�t> ( !/J G/• Name: ) ,1/1at2 �r2 mss_ <br /> Address: / — err[ o ( Address: ra .0 K 2� 1 <br /> City: ar<< State: C/A City: - State: �/f <br /> ZIP: Ph#UPh#� <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: 14 Ili Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#(ZOc}' 74 .. �– <br /> Lic. No: Company Name: )A 11/;W GGA:'- <br /> Address:,24;, /< L. _ �; City: /� St:/'/f ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes❑ No ❑ OFFICIAL USE,ONLY ­ <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or El the property owner or E]authorized to act on the property owner's <br /> behalf(r(quires written approval and Owner/Builder 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 all 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 Date <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F\Applicalion Fortes&HandoutslHANDOUTSOuilding Permit Applicafion.docPage 1 of 2 <br /> (Revised(07-08-10) - <br />