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P° BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :.� 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:TQ:APPf Y, <br /> BUII DJN© PER61ns.,,.i,;„, — - <br /> Scope of Work �i„' -. , <br /> Project Address: <br /> Project Valuation- Contact E-mail:fiv`t ooc�"(bga <br /> OWNER NA711E AND ADDRe” APIP11,46ANT NAME AND ADDRESS <br /> Name: 5 Name: 1� <br /> Address: G},5 �, `) Address: AC <br /> City: _ — State: City: (_Z f. State: <br /> ZIP: ����%., Ph#(Lc'S�) � �- �;�' '. zip: '�? ( Ph#(2. ) �? '2'2,, <br /> _—_ _ x. <br /> CONTRACTOR 1NI <br /> Lic. No: ,Company Name: <br /> Address: City: St. ZIP: <br /> Lic. No: C O Company Name: - _boo +-,C <br /> Address .. City: ( SC - ZIP: 'l <br /> ___ ...-. Ph#( <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes[] No❑ �__ <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 /> By my signature below, I certify to one of the following: <br /> i <br /> am []a California licensed contractor or❑the property owner or authorized to act on the property owner's <br /> behalf(requires written approval aril Owner/Builder Verification Fo signed and submitted). <br /> I <br /> I have read this c/checklists <br /> er plication and (tie information I have provided Is correct. <br /> I agree to complyl' county ordinances and state laws relating to building construction. I authorize <br /> representatives oor <br /> h ty to enter the above-identified property for inspection purposesr. -Applicant's Signa �' Date (aFor your convenlists detailing any additional submittal requirements for various building permit types <br /> are available at t Division counter. Demolition permit and mobile home on foundation require check. <br /> list. <br /> F:\Applic hw Forrns&HandoulsWANDOUTSU3uilding Peontt Applleetion.docPage 1 of 2 <br /> (Revised(07-08-10) <br />