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BUILDING PERMIT APPLICATION <br /> ?.�ag64'CO4 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r <br /> 1810 E.HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> Ltkosi <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of W ork: o., of <br /> Project Address: (� 7jup tVX-\'N <br /> Project Valuation: A(?., poo I Contact E-mail: oSSC ere K ��51 s. <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: <br /> Address: lb 6,-4 poAAs vllk� Address: etV e- ��f rein <br /> City: 0A� State: CA City: r State: CN <br /> ZIP: Ph#( ) ZIP: gsN,.1, Ph#( (,$') SZI'-(' 3I 12 <br /> CONTRACTOR INFORMATION Ph#(ZA) 591 - 55V2 <br /> Lic. No: 1�q-c \\ Company Name: I X, � - <br /> Address: 9��t City: t ° P St: CA 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, I certify to one of the following: <br /> 1 am 9-a-'California licensed contractor or❑the property owner or❑ 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= erttiff d property for inspection purposes.111112-15 <br /> Applicant's Signature Date "J <br /> For your convenience checklists detailing an ads m <br /> ditionittal requirements for various building permit types <br /> are available at the Building Division counter. emo[tion permit and mobile home on foundation require check- <br /> list. <br /> F:Wpplication Fortes&HandoutslHANDOUT&Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />