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y� BUILDING PERMIT APPLICATION <br /> (¢ ,\ <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1610 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)466-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)466-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> I Scope of Work: -Lsi{ �, G S Lt <br /> Project Address: I, ____.. _.... <br /> ___ 4= , . <br /> Project Valuation: Contact E-mail: � "1 .� ���� - <br /> OWNER NAME AND ADDRESS APPLICANT NAMEAND ADDRESS, <br /> Name: K ( -� („�Vti' Narrle: <br /> ] Address: 4 Address: �,') '' � <br /> �. , <br /> City: State: (�� City: •� ,t State: /f <br /> ZIP: P h# .)�3) f , !t Ci ZIP: s �� Ph ? 2. y j ' <br /> -._-�+..-......._-._ f I. <br /> CONTRACTOR INFORMATION Ph# <br /> Lic. No: Company Name: <br /> ! Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( "F <br /> Lid�c. No: — Company a <br /> Address' /� <br /> LENDING AGENCY Pt1#( ) <br /> Company Name: <br /> { Address: City: 6t. ZIP: <br /> OFFICIAL USE ONLY <br /> Permit will be issued to an"Owner-Builder" Y _ No <br /> if yes, a compieted 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 /> I <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> 1 am ❑a California licensed contractor or 2he property owner orE�authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification 17& 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 o�wnances and state laws relating to building construction. 1 authorize <br /> representatives of this city or county to en_tef the above-identified property for inspection purposes. <br /> Applicant's Signat _ <br /> Date- <br /> For your conveniencothecklists detailing arty 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- <br /> list. <br /> N.',Apphcation Forms&HandoutsNHANDOUTS1Buildiny Permit Apphc;aVon.docPage 1 of 2 <br /> (Revised(07M-10) <br />