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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 />Scope of Work:Ntt-U rO\.~()Co'J e-r: <br />OWNER NAME AND ADDRESS <br />Project Valuation:'3,DO?'Contact E-mail: <br />APPLICANT NAME AND ADQRESS <br />Name:/HC;KS/>'??1/!a)dV <br />Address:2-ZgS ()tU ILioA ~su- <br />City:~t State:C4-City:tp.,Sq c,State:C4--1 <br />ZIP:~$2L(O Ph#(~3£'f-_l'26Y <br />CONTRACTOR INFORMATION Ph#(q(6)2-s-«-O(c;o <br />Lic.No:9'-18.so B Company Name:WClJ1!- <br />Address:2785 <br />OESIGNER INFORMATION <br />Lic.No:Company Name: <br />Address: <br />~Ph#() <br />LENDING AGENCY <br />Company Name: <br />City:W.J't;,..e-.si:['A ZIP:ct56 7 ( <br />St:ZIP: <br />Address: <br />City: <br />Ph#( <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />City:St:ZIP: <br />.'. <br />OFSICIAL USE ONL.;V .. <br />Identification Number: <br />By my signature below,I certify to one of the following: <br />I am ~California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />beh~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 co~~tra?~~eS and state laws relating to building construction.I authorize <br />representatives of this city ;-countv to ~re rOVe-identified property for inspection purposes._J, <br />Applicant's Signature ~'f-.-.../Date y /1t?i!! <br />For your convenie~cklists detailing an~.I submittal requirements for various ~uildin~permit types......• <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:lApplication Forms &Handouts\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07·08·10)