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APPLICATION FOR PERMIT Q <br /> BUILDING INSPECTION DIVISION 139��6 <br /> FINAL DATE — Give This Number When � <br /> SAN JOAQUIN COUNTY PLANNING ANDCalling for Inspection <br /> BUILDING INSPECTION DEPARTMENT INSPECTOR CALL 24 HOURS IN ADVANCE <br /> 1810 E. HAZELTON AVE., STOCKTON, CALIFORNIA-PHONE(209)944-3701 <br /> DATE ISSUED <br /> ! ( 3APPL. DATE ` 'V— <br /> APPLI NT r i...F`.'I 1 L�� = ` <br /> UV ADDRESS i PH E <br /> JOB LOCATION r' <br /> A.P.S <br /> CONTACT PHONE <br /> OWNER <br /> ADDRESS PHONE <br /> SCOPE OF WORK „ , <br /> Ace. By App. By Date I�„ _ BUILDING <br /> r Permit Fees $ Sch. HE $ $ <br /> Remarksl��r(%�-- 1 Plan Check $ <br /> BY: TA.S S <br /> S.M.I.P. (State of Calif) �/� ffv <br /> n <br /> Microfilm Ilk <br /> IL„ i�IJ <br /> Cent. H/AC �►aj S <br /> Size Cont. Vel. $ tq � $ I <br /> Plan. Dept. Ref. p Zone <br /> CLIMBING HEALTH <br /> PW Dept—Drain/Flood Own. Rel. An. P Fixtures—GD—DWI"'��,RpPJIT i SER ICES <br /> ILR - <br /> SJLHD Fire per:-.�Excay. X City Water Heater <br /> THIS SECTION TO BE COMPLETED BY APPLICANT: DEPT. USE ONLY Water Line <br /> Gas Piping <br /> — I am the owner of the property. CI Ins Cert on <br /> ,._I will do the work myself. If I hire anyone File, Exp Date: Sewer/Drain Line <br /> 0. without complying with Workers Comp- Se er/Wateff Conn. <br /> enation Laws, my permit will become _ t/ Ei'' S <br /> void. ❑ Owner ❑Contr <br /> _My employee(s) will do the work. <br /> I will have a Licensed Contractor do the OR (Conn. p 1 Maint. Dist. S <br /> work. <br /> Contr. ❑ Contr. No-hire MECHANICAL <br /> Address Stmt. on File Comb. Unit/Heat Pump $ <br /> City Ph. (_) Labor Code 380 Furnace/A.C. <br /> Lic. Class Number ' <br /> _ZI am a Ucen C tractor: _ Gas/Water Piping <br /> 1 n / � / � <br /> Range/Dryer <br /> Na mei - "/ / .y�'S/� Phone }'� % <br /> Addre l Uzi Citv. ) Hood/Fan/Vent <br /> License Class_Number .�44�.7c 7 S <br /> ELECTRICAL <br /> Arch/Eng Lic# <br /> Address Phone ( 1 Fixtures: Incand. <br /> Fluor. Flood <br /> Construction Lender Outlets: Light o/I <br /> Calif. C.C.P.#"7 Switches Recept. <br /> I hereby acknowledge that 1 have read this application and state that the _ ilotors HP <br /> content is correct. I.agree to comply with all applicable laws and Service_—Amp <br /> ordinances regulating building construction/plumbing/mechanical/elec- <br /> Range/Oven/Dryer/Wtr. Htr. <br /> trical installations. <br /> I UNDERSTAND THAT THIS PERMIT BECOMES VOID IF WORK IS Temp Pole—Yes No <br /> NOT STARTED IN 180 DAYS, IF WORK IS ABANDONED FOR A —Panels----Amp <br /> PERIOD IN EXCESS OF 180 DAYS, OR IF NO INSPECTIONS ARE <br /> CALLED FOR IN A PERIOD IN EXCESS OF 180 DAYS. IF WORK IS Feeders-,-Amp <br /> NOT TO RE DONE REFUND MUST BE APPLIED FOR WITHIN 180 <br /> DAYS. <br /> it�ic/.il ( fT— <br /> r OTHER FEES Sub-Total <br /> NER CONTRACTOR <br /> lip Rec p Amt S lan Check $ <br /> Flee x�—Amt b T77 � <br /> By A VHOAI C"�IGENT Rec p Amt 8 i� TOTAL FEESS <br />