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oe4U'"- BUILDING PERMIT APPLICATION <br /> u SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i _ t 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> car ` BUSINESS PHONE: (209) 468-3121 <br /> cq C'iFo'SR�` INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDERTO APPLY FOR <br /> " � BUILDING PERMITS. <br /> Scope of Work: �✓ `'`4 �l ) �v <br /> Project Address: <br /> r <br /> Project Valuabon: J } Contact E-mail: <br /> j}r(' <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ` k W( \ Name: \V-fl JNv4 N�il9� 11 t <br /> Address- <br /> '5 b � �fl Address: E6, <br /> City: State: City: State: <br /> ZIP: �� Ph#( ) ZIP: <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address:. City: St: ZIP: <br /> DESIGNER INFORMATION Ph#(2g�) 2j L <br /> Lic. No: �Cf1, O Company Name: k <br /> fr r <br /> Address: �}, �j �9K City: ( St:(A- <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 owners <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❑the property owner orauthorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Fo m signed and submitted). <br /> I have read this constriction permit a licafion and the information I have provided is correct. <br /> I agree to comply with all applicab unty ordinances and state laws relating to building construction. ] authorize <br /> representatives of this city or co o enter the above-identified property for inspection purposes_ <br /> Applicant's Signatur Date_ (0-1 <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:�Appllcation Fortes&Handouts\HANDOUTSSuilding Permit ApplicationAmPage 1 of 2 <br /> (Revised(07-08-10) <br />