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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 /> c4i;F e INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: �Q p„' �• c; ( C iNt i �. v� �.: <br /> Project Address: 2 S Fk <br /> Project Valuation: 3Uv Contact E-mail: i' ��r O . <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: f� C UH 1N r Name: - — <br /> Address: Z 0 ,>, TcJ s }, Address.- <br /> City: <br /> ddress:City: e- State: C4 1 City: State: <br /> ZIP: 9q70Ph#(zc<r) qQ6. cf7t6 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: !�� f Company Name: C I- ( U yR l,' <br /> Address: �Q�Q .xt, City: e () St:C ZIP: L S3 S <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <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 signature below, I certify to one of the following: <br /> am ❑ a California licensed contractor or❑ 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 /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinan es and state laws relating to building construction. I authorize <br /> representatives of this city or to enter ove-identified property for inspection purposes. <br /> Applicant's 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 arid mobile home on foundation require check- <br /> list. <br /> F:1Appltcalion Forms&HandoutsWANDOUTS1801ding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />