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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 /> `P INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> gtipo'R� <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> ii <br /> BUILDING PERMITS. <br /> Scope of Work: O' �CI� G n V\• �� <br /> Project Address: `176L-1 L1 C k. O Z l <br /> Project Valuation:1113Uoo. cry Contact E-mail: <br /> OWNER NAME AND ADDRESS yy APPLICANT NAME AND ADDRESS <br /> Name: ew ` � Name: 4a^ay✓' cn � tw�i c <br /> Addressy (7 L Al Address: 'Z'Ll -7 L L con 0, <br /> City: State: Com. City: , Vz- State: ( 'A <br /> ZIP: Ph#(Z") � (o (e(�(c ZIP: 6J Ph#("Lc ,) <br /> CONTRACTOR INFORMATION Ph#(Zbel) _elgI e, <br /> Lic. No: G L, L+S"7 L' Company Name: �Y. 0V\ i t\6 Z <br /> Address: •Z q'•71- Wia City: k19i 1 St:6A ZIP: 9-5�'ZO <br /> DESIGNER INFORMATION Ph#( 0(„ . 'Z 3 y4 <br /> Lic. No: (,C 6-3 Company Name: L WX5 5', , rev w <br /> Address `Z1Z �. �LnG �,j �,� City: St:(—A ZIP: -ZOg <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 /> I am ❑ 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 cou ty to enter the above-identified property for inspection purposes. <br /> Applicant's Signatu;r � 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 /> FA\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />