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�p 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 /> °Qi`irvR�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 <br /> BUILDING PERMITS. <br /> Scope of Work: 7TL4 4 G C;--L A4, OF'PIC$ do t I L <br /> Project Address: j g CoUAC�o <br /> Project Valuation: ContactE-mail: 60RDoa, &OCC-COR�P,Cowl <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: S(ATFE-9 14 UJQVC& WC, Name: L I !M <br /> E Kir CO 114 <br /> Address: O. d Address: 53VLAAJE 61,d6 <br /> City: et g ,U State: Ci. City: _g4AiM Q US State: Cry <br /> ZIP: 9Lf q Ph#(7( 4763- 3I0 ZIP: s Ph#(7o7)S2-7!> " I7ZZ� <br /> CONTRACTOR INFORMATION Ph#(�p7) 3al ^7Sd V�K�OIUKI <br /> Lic. No: 7)1670 CompanyName: - �� n/ <br /> Address: SL S &V,0 City:,�'d%AlbA-KU.S✓_ St:GA-. ZIP:Q� <br /> DESIGNER INFORMATION Ph#(�0� j77-� p8 E L W l\j <br /> Lic. No: Company Name: <br /> Address: )a Sl City: I St:61 ZIP: 9J3J <br /> LENDING AGENCY Ph#( ) <br /> Dompany Name: <br /> address: City: St: ZIP: <br /> 3ermit will be issued to an "Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY <br /> f yes, a completed Owner-Builder Verification Form must Identification Number: <br />)e signed and submitted along with copy of the owner's <br /> Jentification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> S; my signature below, I certify to one of the following: <br /> am ❑ a California licensed contractor or he property owner or❑ authorized to act on the property owner's <br /> ehalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> have read this construction permit application and the information I have provided is correct. <br /> agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize <br />,presentatives of thiscity,r cou ty to ant t eM <br /> entified property for inspection purposes. <br /> pplicant's Signature Date �r <br /> or your convenience checklists detailing any additional submittal requirements for various building permit types <br /> re available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> 5t. <br />,pplication Forms&HandoutsViANDOUMBuilding Permit Application,docPage 1 of 2 <br />✓ised(07-08-10) <br />