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°°'k 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 THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> ScopeofWork: uY �U�1pG <br /> Project Address:13 Iq Z , Awl <br /> e h . U6 ( O o <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: <br /> Address: Address: <br /> City-. State: Gty VOCState: C� <br /> ZIP: Ph#( o Z _W3 1 ZIP: CEJ 2 1(7 Pr (d 32, 1 -SSS-1 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St 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"„Y6s'0 Nq E OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder'Venfir,.atjdn Form rnas Identiflcation Number <br /> be signed and submitted along with copy,pfthe owner's <br /> identification prior to issuance of the building``permd r <br /> DECLARATION BY CONSTRUCTI(3N pE�tfvttT APPLiC¢NT <br /> By mysignature below, I certify to'one of the following: <br /> I am❑a California licensed contractor or{]the propeaufllarized fo oat ate tEie-property owner's <br /> behalf(requires written approval and OwnerlBuilder Venfrcatioti Form signed and submrtfed) <br /> i r i <br /> I have read this construction permit application and the informafion Kave pfovid�d is cerrGct ` <br /> r <br /> I agree to comply with all applicable county ordinances and state I4Ws retatt1t to bu idlhg¢ansfntc}rop }authorize <br /> representatives of this city or county to enter the above-identified pfoperty+[or ifYspeetton parposes <br /> r <br /> r r r <br /> Applicant's Signature ` 'Datg =-ry <br /> For your convenience checklists detailing any additional submittal regtt[finenfs foTuadous building permit types' <br /> are available at the Building Division counter. Demolition permit andYo [le Ji`dne on foundation require check- <br /> list. <br /> F.Mppiip5on Fonns&HandoutsWANDOUTMButlding Permit ApPllcation.docPage 1 of 2, <br /> (Revised(07-06-10) <br />