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Project Address:~05s?;\Cf -b~~:.;.~~-tvre pro pb~lltl "'~#lnnJm ~110tf ta FLJYt1'"., <br />Project Valuation:$j~.n 0 &lflruJm Contact E-mail:vallel/\perm'l n@ tUJl .~"OtI/Z/3Ii <br />OWNER NAME AND ADDRESS APPLICANT'NAME AND ADDRESS <br />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 THE APPLICANT IN ORDER TO APPLY FOR <br />1--BUILDING PERMITS," <br />Scope of Work: <br />Address:1i:1{n 1&1 S·~,~n \2c/.Address:ID{PJir r'VlI fltihtLffl d . <br />City:--r--Yltt1J:r State:C A City:f)J£Ctfy fJ A1/)rjJy);;,State:CA <br />,,- <br />CONTRACTOR INFORMATION Ph#( <br />Lic.No:Company Name: <br />St:ZIP:Address:City: <br />Ph#(DESIGNER INFORMATION <br />Lic.No:Company Name: <br />St:ZIP:Address:City: <br />Ph#(LENDING AGENCY <br />Company Name: <br />Address:City:St:ZIP: <br />OFFICIAL USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes ~NO D <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or D the property owner or [QiIuthorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Formsigned 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 county to enter the above-identified property for inspection purposes. <br />Applicant's Signature_--\:CX\-T-----I>'Q~'__Date 5/1ll ),1 <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 />F:\Application Forms &Handouts\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)