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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 />THE APPLICATION MUST BE COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work:\'\t\.fl~"".~\\(")\\.1\'C.,,%--\C ~,<~~~~0.\:l.·r-.)~W ~~~-.J <br />Project Address: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:-;f{)1 i r,Ce Set r'.f\)a.\j a Ira Name::-r (I Vn CeSa.y NCA\JarYO <br />Address::;(y;;"?4 /J.e.rct~TY\~cL Address:-;2 4 Co 7Cf IV .G fo.h.0I.fY\-/Zd. <br />City:Aro..\'V\on State:CA·City:Aca.JY)PO State:CA·.\ <br />Ph#Al~7lQg-O(~0 ZIP:qC09..~O Ph#(f /0)=jq ~-()/~C,ZIP:958-.9..0 <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:}Jjf\Company Name: <br />Address:I City:St:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name:l..1 -A <br />Address:I <br />City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 OFFICIAL USE ONL Y <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 0 a California licensed contractor or 0 the property owner or 0 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 ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature (job c.#cJ..AI?J,ryeJ -11~/IJ~Date q-o3-oqv <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- <br />list. <br />F:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2