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. WLDING PERMIT APPLICATION <br /> r ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> 4tlkoaHtt INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. _ <br /> Scope of Work: ��qy� � Qy- AOv J <br /> Project Address: � 7 f j Z �- qP L 9 <br /> Project Valuation: /—lllge 0 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Wo IF amhName: LOU d rr <br /> Address: 106 Address: 10070 AI .T II d <br /> City: Lin <br /> n State: City: Stete: <br /> 17 <br /> ZIP: q S2 3 �o Ph#(Z61 - 1 j 7 6V,1( ZIP: 4-i Ph#(�d )(o4 - C) J <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) _ <br /> Lic. No: Ca l % Company Name: n,(c r � o <br /> Address: 2).9/ W•�t91 G 0200 C S Glciron St:CGc ZIPS S ZQ <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes No El OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification F)m 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 /> 1 am E]a California licensed contractor or he property owner or authorized to act on the property owner's <br /> behalf(requires written approval and Own riBuilder Verification F rm 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 applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of thi Ginty to enter the- -i ntified property for inspection purposes. <br /> Applicant's Signa q Date <br /> For your convenience checklists detailing any additional submittal requirements for va lous buil ng permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:Application Forms&HandoutsUiANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />