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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 /> <<FO <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: Gtir.ver••4- ey ls-t-,. 1—ab +� 1 G b tti O c t .c <br /> Project Address: Z-L7:j-(o ff �- F3� er lzCl <br /> Project Valuation: ContactE-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: )D, ��q <br /> Address: 1951 V.1. 'Tud�e.x Address: <br /> City: p cum State: c_,4 City: c� State: C A- <br /> ZIP: Ph#( ) ZIP: �( 2 O Ph#(j ) 33�(. O`3\at> <br /> CONTRACTOR INFORMATION Ph#(20cV _2 7G4 v X13 <br /> Lic. No: 'aaq o0 Company Name: De ({-e�j g" i 13 IvN S 1 n a- <br /> Address: t5t w . "T- cj le`t led city: Ist: CP,ZIP: 9g220 <br /> DESIGNER INFORMATION Ph#(201) a, 1 -q2.41(p <br /> Lic. No; _3�X301 Company Name: /fit e-x n �. <br /> Address: Ejc[ v4 i k m U r city: ZIP: C1321'Z <br /> LENDING AGENCY Ph#( )- <br /> Company Name: <br /> Address: City: -St: ZIP: <br /> Peen 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 signature below, I certify to one of the following: <br /> 1'am El a California licensed contractomr ❑-the property owner or❑authorized to act on the property owner's <br /> behalf(requires written approval-and Owner/Builder-Verification Form-signed-and submitted). <br /> 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 /> Applicants Signature Date <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> FAApplication Fortes&HandoutsXHANDOUMBL ilding Permd Appricatlon 140i5.doc Page 1 of 2 <br /> (Revised(off-Mim . <br />