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BUILDING PERMIT APPLICATION <br /> agu�W . <br /> i°•��poG <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> c'�l' `P 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: Nnv^ " O L bi-�ni(_ 6�A-y- <br /> ProjectAddress: i�yj ( � Cj� r—IDC 9�-S51--k-g <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �CJAi'(W 4 } (A Name: <br /> Address: ��3 Pl (n, V9✓. Address: <br /> City: VC/I State. 0__A_ City: State: <br /> ZIP: C 140U-3 Ph# 4n'&2-,b15 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <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 /> I am ❑ a Caiiforriia licensed contractor or a property owner orE 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 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 N Date 4- <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 /> F:1Application Forms&Handouts\iANDOUTS1Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />