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BUILDING PERMIT APPLICATION <br /> {' SAN JOAQU(N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> u; :{ <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> "<icsuN. ' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: 0 Be&oovl-, w 13caf i close.} lea 1 f <br /> Project Address: 3� 2Cj S �6S �� V �A <br /> Project Valuation: sjpppG ContactE-mail: Wes@CVSiGry�u <br /> ' oY ft l 1(cN K4 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: 50hY\ ­t Reece. Name:t)fi.Ui lD <br /> Address: _ 30q25 S Kds �eV PJ Address:p &0X �C�Q�IQ <br /> City: �r l� State: C fl City: State: <br /> ZIP: �{5 JJG Ph#( ) ZIP: �i Ph#( <br /> CONTRACT ORINFORMAIION Ph#(q�6) �( - ?9q7 <br /> Lie. No: Company Name: SUS\om CUfS Co rr1C. <br /> Address: (p3 ko e City: -jmc st: C/c zIP:95 6 <br /> DESIGNER INFORMATION <br /> Lie. No: Company Name: v i� Wv V W LI Vl e 2 D eS L <br /> Address: t b iB <br /> Amcur�cla CA . city: 5Aoefe:-tcYt St: CA zIP: 95 2oq <br /> LENDING AGENCY--N — — -Ph#(_—)— -- -- <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑NoJx� 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 (Lquires <br /> California licensed contractor or[l the property owner or(] authorized to act on the property owner's <br /> behalf written approval-and Owner/Builder Verification Form signed 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 oorr�county <br /> yto enter the-above-identified property-for inspection purposes_ <br /> Applicant's Signature U r' <br /> Date <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 /> FMpplication Fonns&HandoutsWANDOUTS\Building Permit Applic flon.docPage 1 of 2 <br /> (Revised(07-08-10) <br />