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�p4u`" BUILDING PERMIT APPLICATION <br /> c <br /> �•' ''•.off <br /> zf t--rri <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> } BUSINESS PHONE: (209) 468.3121 <br /> �"+(jQ•RiN�p INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING' <br /> PERMITS. <br /> Scope of Work: Ya U \ n <br /> Project Address: �) jC)-7 �, VA�1'� ) �i 1 1f a � � �j ?,04 <br /> Project Valuation: Contact E-mail: �� : , LSV 1Q,1C P 1 taux r cavi,,, <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> g1� <br /> Name: �V 4'�1n ti OI LA� oU Av cC ri\ Name: St1 1 i 1 1 c v� WO AVX( _ ✓ <br /> Address: X07( S, \\V\C',) S , Address: ,2"10-)C) S, 1r�\\V'`-(..,) S-VV <br /> City: 1�tz State: C6 City: ­�_GLCAAState: <br /> ZIP: CtS �tJ 1 Ph#(at>+) L °ISL' 0-1y5 ZIP: G(GJ2J(3 Ph#(ZU`i) +$ tp 677q <br /> CONTRACTOR INFORMATION Ph#I <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#(q-_ 5) <br /> Lic. No: 777777_CO_mpanyName: S\\CW,, <br /> Address: ," W02tAv i c C S i �tG City: i j)C,✓\ 'VCLq ,k,,, St: LiA ZIP: C(gSn <br /> LENDING AGENCY Ph#( ) <br /> Company Name: (J {h ! <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 M the property owner or ❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owneuilder Verification Form signed and submitted). <br /> I have read this construction permit application and certify the information I 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 all survey monuments. in addition, I authorize representatives of this county to enter the above- <br /> identified property forinspectionpurposes. --- <br /> Applicant's Signature / i Y I �Ir Date <br /> For your convenience c lists d4 tailing 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 /> F:\Application Forms&Handouts\HANDOUTMBullding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) - <br />