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BUILDING PERMIT APPLICATI J y .COG SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT' ' K 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 cg4FOR`a`4 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: Cao �04 c_ Project Address: I `m Ss,� k �- a)-,,,— Project Valuation:- 15-000 ContactE-mail ��( Q�� i.�Q V �6t au" OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: Name: Address: S7 t d1t� Address: J j� f City: State: C City: YON/, 1� State: ZIP: -1 Ph#( ) ZIP: (9-, )j Ph#( ) CONTRACTOR INFORMATION- Ph#Q6P,) Lic. No: '66L5 Company Name: C;L4' < � 1-,c Address: City: ij o Std r ZIP: P_ DESIGNER INFORMATION Ph#O, -�) S j Lic. No: -Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: Y 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 sign ture below, I certify to one of the following: I am 2/aCalifornia licensed contractor or❑ the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form 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 purposes. J Applicant's Signature ✓----, _ Date KS For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. F:\Application Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)