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APPLIOATION FOR PERMIT <br /> SAN J_OAQUIN COUNTY FINAL DATE 1�O 45 8 1419BUILDING INSPECTION QEPT. GiveThis Number Whence ' <br /> INSPECTOR Calling for Inspection <br /> 1810 E.HAZELTON AVE.,STOCKTON, CALIFORNIA-PHONE(209)944-2153 CALL 24 HOURS IN ADVANCE <br /> • DATEISSUED <br /> APPL. DATE__ z, <br /> APPLICANT [ per �+ <br /> JOB LOCATION l y�7, <br /> PHONE <br /> A.P.# Q /- 41Y 6 ate_ <br /> OWNER <br /> ADDFIESS <br /> SCOPE OF WORK PHONE <br /> Acc. B tv` '`' APP• By �� Date js 1 BUILDING <br /> Remarks <br /> Permit Fee <br /> z Plan Check $, <br /> BY TA.$ $ 'O <br /> S.M.I.P. (State of Calif.) $ <br /> r Microfilm <br /> Size Const. Val. $ '� <br /> E MOBILEHOME INSTALLATION # — <br /> Plan. Dept. _Ref. # Zone <br /> PW Dept ' Drain/Flood FLU_ MBING <br /> Own. Rel. Att. —Fixtures—GD—DW SJLHD A-,Fire # Excay. # City —Water Heater <br /> THIS SECTION TO BE COMPLETED BY APPLICANT: DEPT. USE ONLY Water Line <br /> I am the owner of the property. CI Ins Cert on Gas Piping <br /> • _I will do the work myself. If I hire anyone File, Exp Date: Sewer/Drain Line <br /> without complying with Workers Comp- Sewer/Water Conn. <br /> ensation Laws, my permit will become I — <br /> void. ❑ Owner ❑Contr <br /> _My employee(s) will do the work. <br /> _I will have a Licensed Contractor do the OR (Conn. # ) Maint. Dist. <br /> work. <br /> Contr. f�'Contr. No-hire MECHANICAL <br /> Address Stmt. on File <br /> City Ph. (_) —Comb. Unit/Heat Pump $ <br /> Lic. Class Number Labor Code 380 Furnace/A,C. _ <br /> I am a Li ensed Contractor: _ Gas/Water Piping <br /> Name- �r��y Phone (� f Range/Dryer <br /> Address `r!1 �✓ i City/l�Ci�✓l/ Hoo /Fan/Ven <br /> License Class r> `f Number. f�r7/ L $ <br /> Arch/Eng Phone (! <br /> Address 1 ELECTRICAL <br /> City Fixtures:—Incand. <br /> Construction Lender Fluor. —Flood ood <br /> Calif. C.C. P. #1193 Outlets: Light o/,II ;f7 <br /> I hereby acknowledge that I have read this application and state that the —Switche,z' Re apt. <br /> content is correct. 1 agree to comply with all applicable laws and Motors HP <br /> ordinances regulating building construction/plumbing/mechanical/elec- Service_`Am <br /> trical installations. p <br /> I UNDERSTAND THAT THIS PERMIT BECOMES VOID IF WORK IS —Range/Oven <br /> NOT STARTED IN 180 DAYS, IF WORK IS ABANDONED FOR A Dryer/Wtr. Htr. <br /> PERIOD IN EXCESS OF 180 DAYS, OR IF NO INSPECTIONS ARE Temp Pole—Yes—No <br /> CALLED FOR IN A PERIOD IN EXCESS OF 180 DAYS. IF WORK IS <br /> NOT TO BE DONE REFUND MUST BE APPLIED FOR WITHIN 180 Panels—Amp <br /> DAYS, _.Feeders_Amp <br /> Oigned <br /> ❑ wNEa UJ CONT OR OTHER FEES_ Sub-Total <br /> Rec# Amt $ Plan Check $ 13 �20 <br /> BY ✓✓�'f TNORt o nc Rec# Amt $ J <br /> – Rec Amt $ TOTAL FEES$./ 3 9 16 <br />