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BUILDING PERMIT APPLICATION <br /> w SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> aCiFouf'` 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 /> �allcl Q <br /> Scope of Work: /lJ�Gly <br /> Project Address: � � �� L' ' <br /> Project Valuation: _,F 170,. ong >v Contact E-mail: j7& Z�7 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: y Name: <br /> 71w-7v :2z-z— <br /> Address- _ Pi00 Address: 6K '6 V <br /> City: State: elftCity., W7 State:'ate& <br /> ZIP: Ph#( f}7 Z �/ ZIP: Ph#(ZX 2,16 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> L ic. No: Company Name: <br /> Address:. City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic, No:5CL Zg J' Company Name: D• y G <br /> Address: City: ba ' St: S ZIP. /v <br /> LENDING AGENCY Ph#(Zd�j 3 O/ <br /> Company Name: r <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yeslt4 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 owners <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 /> ' am <br /> California licensed contractor or gl the property owner or El authorized to act on the property owner's <br /> beha f(requires written approval and Ow er uilder Verification Form signed and submitted). <br /> I have Tead this construction it ap Ic tion and the'nformation I have provided is correct. <br /> i agree to comply with applicab un din c and state la ws relating to building construction. I authorize <br /> representatives of this ity or count to e bo d property for inspection purposess.. <br /> Applicant's Signature Dat! <br /> �( <br /> For your convenience c rsts detailing any dditional submittal requirements for various buil ng permit Types <br /> are available at the Buil i Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:1Appllmflon Forms&Handouts\HANDDUTS1Bu1ld1ng Permit Applimflon.dDoPage 1 of 2 <br /> (Revised(07-08-10) <br />