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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 6 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> °q P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> �IFOft� <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: e r <br /> Project Address: a (� O '� C G <br /> Project Valuation: Contact E-mail: COR <br /> �/ylrpy{zpoMARN�z�a C°'hOfi <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> '> A <br /> Name: Aft? d olc0 M&4 Name: . <br /> Address: NSCAJ 902d Address: <br /> City: —r , State: 0.4 City: State: <br /> ZIP: Ph#(Jo5p) 5ZIP: 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, 1 certify to one of the following: <br /> I am ❑ a California licensed contractor-orDRtheproperty owner or❑ authorized to act-on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification FormsigAed and submitted). <br /> I have read this construction permit application and certify the information.) 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 ey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for spectio purposes <br /> Applicant's Signatu Date 05 <br /> For your convenience ch Icklists 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 /> FAAppl cation Forms&HandoutslHANDOUTS\Building Pennit Application 1-2015-doc Page 1 of 2 <br /> (Revised(01-28-15) - <br />