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BUILDING PERMIT APPLIPATIGN <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />4890 E. HAZELTON AVENUE, STOCKTON CA -95205 <br />BUSINESS PHONE: (209) 468-3929 <br />INSPECTION REQUEST -24 HOUR RECORDER: (209) 468-3965• <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br />PERMITS. <br />Scope of Work: = i� De A (r - <br />Project <br />Project Address: Cc t T i 4� <br />Project Valuation: <br />OWNER NAME AND ADDRESS <br />Y��%lC <br />rj <br />Contact E-mail: <br />APPLICANT NAME AND.ADDRESS- <br />Name: S A'M G1 U U Name: `t ' S t G h- CV'v 1) e C T nn�-141�- 7z. <br />Address: G S t) Address: v; U { ;�, �'; -rc } o <br />City: CPI-M(l State: G A City: L. �� S v � c :� S State: <br />ZIP: Ph#02 1) Lf1� -- c C S"3 ZIP: QC11 ��' Ph#(`7�)} 2 8 -7-�- <br />CONTRACTOR INFORMATION ­7-r,� .-) Ph#( ) -- - <br />Lic. No: -j Company Name:. <br />Address: City: <br />DESIGNER INFORMATION 'Ph#( ) <br />1i- No: 6 -5 2 s �. Company Name: <br />`; ? '� w° M e_ - <br />Address: ! v c.i S' r { eG City: L <br />LENDING AGENCY Ph#( ) <br />Company Name: <br />Address:/ City: <br />Permit will be issued to an "Owner -Builder" Yes ] No <br />St ZIP: <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 />- <br />s DECLARATION BY CONSTRUCTION PERMITAPPLiCANT m <br />'.._: _ <br />My signature -below, I certify to one of the following: <br />!� 0 a California licensed contractor or ] the property -owner aC[ti. <br />half (requires written approval and Owner/BuilderVerificalion Forrn;s' i <br />Lave read this construction permit application and certify the inforrnatton I ha�i <br />#h all applicable county ordinances and state laws which govern this prpje <br />kes steps to preserve all survey monuments In: addltioc, l authonz� fEPCe� <br />sntified property for inspection purposes <br />ip6canfS Signature <br />u ^k <br />�r your convenience checklists detailing any:Witidrt suliiitI req�l�t'et <br />e avaliable at the Building Division counter, Demoiitiori,pgini and mobil <br />- ... - <br />So15s kandoutsWANDOUT'S1Budding Permit PD 0atlOn=t 2015.doc page 1 cit- - <br />3s <br />alsoaag#ee k_'comply <br />anstruct►pn I.wIII also <br />enter the above- <br />