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BUILDING PERMIT APPLICATION <br /> r�p SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> etaGY , 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: 6 <br /> Project Address: u r eA ( Lr h r* <br /> Project Valuation: ?2, Contact E-mail: rl<C 2 4 h Q Q oc-fu <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: !%Il e ( YJ/c< fil, c,t,p Name: 7Aiz �¢f cq lug G <br /> Address: �L� � r 2� Address: <br /> City:/—rh/3t ^ State: CGS City: -,r- State: (� <br /> ZIP: '�SSz,3(, Ph#( ZIP: 2;3L Ph#( 209 `EJ-(-(LTb <br /> CONTRACTOR INFORMATION Ph#( 6�j <br /> Lic. Noy{ (,(r-) Company Name: , z C� /a �t�• Cc <br /> Address: Q-&'. ( v City: P: 9-r 2 <br /> DESIGNER INFORMATION Ph#( 7)0 .-G(, <br /> Lic. No: Company Name:3F( J215 <br /> Address: City: 4 U( StA-- ZIP: (jJ2y�,, <br /> LENDING AGENCY Ph#( ) <br /> i <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes❑ No ❑ OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form 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 sign lure below, I certify to one of the following: <br /> I am a Catifom(a licensed contractor or❑the property owner or❑ authorized to act on the property awner's- <br /> behalf(requires written approval and Owner/BuilderVeriflcation Form signed and submitted). <br /> I have read this construction permit application and certify the Information I have provided is correct I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature Date `! <br /> For your convenience checklists J6411lig any additional submittal requirements for various building permit types <br /> are available at the Building Division c unter. Demolition permit and mobile home on foundation require check-list. <br /> FAApplication Forms&Handouts\HANDOUMBuiiding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />