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°ARU±" BUILDING PERMIT APPLICATION <br /> x <br /> �� ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f <br /> 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> -., BUSINESS PHONE: (209)468-3121 <br /> 4�1Foszi�� INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILD]NG <br /> PERMITS. <br /> Scope of Work: �,fj OvL D ct,, f <br /> Project Address: 2 2 u r•er� l L r-,j'��,, c/1- <br /> Project Valuation: �" S-� Contact E-mail: j�� 2 4 Q 6?(K lu <br /> //,OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: fill Ke (4 h e i'1�l u�O Name: ! 11'0 <br /> Address: �2 u r Address: <br /> City:L State: C.04-- City: State: <br /> ZIP: c2S2_3 Ph#( ZA41 4fT, 6'� ZIP: 952 3P h#( 2CI Y 7 <br /> CONTRACTOR INFORMATION Ph#( T_4—)c <br /> Lic. N(J S w--) Company Name: /a <br /> Address: d- �` ( v City: 6t-ii1 Q St: ( ZIP: <br /> DESIGNER INFORMATION Ph#( L(,71f `t'"(2 Z <br /> Lic. No: Company Name:JF( P,.St��S <br /> Ar�r st:�-- ZIP: <br /> Address, city: <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 mysign ture below, i certify to one of the following: <br /> I am a California licensed contractor or❑the property owner or-E] 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 certify the information I have-provided is correct. I also agfiee to comply <br /> with ail 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 a ai')ir,g any additional submittal requirements for various building permit types <br /> are available at the Building Division c qunter. Demolition permit and mobile home on foundation require check-list. <br /> F:Application Forms&Handouts\HANDOUTSOuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />