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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 COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:14rCBe'V /2EYVoO~ <br />Project Address:7~7~/~f!!..p Contact E-mail:..../o/yJ S/,.oI"'G e ~.-YJC4~t:/}.~ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:/ItM;;:N or~ce Name:--Jo#.A/S'Uo/4~S <br />Address:707-0 H4a~~Address:?7oZ~PUCK-02.. <br />City:,c:j26/vCF ~State:~City:5~ce:.7'iJ"-,/State:G~ <br />ZIP:q?2~i Ph#(U;f)'JBZ 03qr.o ZIP:ef'5~7 Ph#(:2?~957 ?fe.i!>/ <br />CONTRACTOR INFORMATION Ph#(~g '5'-Ttf-1~-3</ <br />Lic.No:qZ2~7 Company Name:1ZJ\TU f:.?(AJ (!D U$~tJC,770A..J <br />Address:LfZ5 81'/f2.17T~W A '-I ::#»City:/t1~~B7D St:{'If ZIP:9S-3..s-b <br />DESIGNER INFORMATION Ph#() <br />Lic.No:'2-':?07 <f Company Name:e.~/j S CIdt2/.At.t'L ft}(J..Ct;'17~C7~CLJd/--r} <br />Address:3-;;Cyt:;7 £7~/J+,A.~0/2..~.51i=f,f-City:-5?Oeld'~St:(j1--ZIP:Cf'5'2-IQ <br />LENDING AGE~CY Ph#('lo'fj CJ?0-4?Go~ <br />Company Name:r-I/kJ- <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 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 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 signe~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 Date <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 <br />F:\8UILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised (07-22-Q9) <br />Page 1 of 2