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V7,hl) '" BUILDING PERMIT APPLICATION N I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 cgCP INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: 1VfV1 -51#41f FAJILV 9C S 10414 Project Address: Z Z DC- V 1 C Project Valuation: Sp aDG• 60 Contact E-mail: V►� . �� F� v G M A t(. OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: b&%,1D S M h-* Name: N ZE- Address: 1&6o 47, '7 2ND2. Address: S 1 Vr(L-SST City: State:ek. City: bd 5"�0 State: ZIP: Ph# ) V,1,9 23 5 ZIP: 1S f Ph#U41) CONTRACTOR INFORMATION Ph#( ) Lic. No: t7Z l CD$' Company Name: a.&is F. <-,wo s vt A4Ti41 Address: 7_3 G'3 2 HA G/f'A/Dot— City: CA-NP6 St: G/ zip: 7 ?Zd DESIGNER INFORMATION Ph#(Zp ) 37 • Lic, No: G- 33 v1>V r Company Name: AJ A% tJ ZF.FF J%A-GMiTeG) Address: /s/ I? /Z ST2E 4--r City: 46 SZ St. G/`' ZIP: f f LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder" Yes ❑ No OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am ❑a California licensed contractor or❑ the property owner or authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Fo m signed and submitted). I have read this construction permit application and certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection pur oses. / Applicant's Signature Date 6 For your convenience checklist etailing any additional submittal requirements for varioi4s building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. FAlApplication Forms&Han doutslHANDOUMBuilding Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)