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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 />Address:IBIOc./Jl/zel-lOvt,4~~ <br />OFFICIAL USE ONLY <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:R [R e,+,.sit~~VlolNle i.0-1V~e 1~~1t}ce u.?/neu..:>{6~5 IJlhou5~f 11~r;.tI~. <br />Project Address:flf3t(8 ~{LItv-c.'-1 t~~l\tAu.!C4 9.530'1 <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS. <br />Address:It e 'i B LVe5t L~V'c1t '0Ad Address:(8l0£.H4u.Ho\l\ <br />City:lVl-\-o.\State:C A City:s1ocl<to V1 State:C4 <br />ZIP:9.6jOl-{Ph#(~)81t{-.53YO ZIP:CfbW5 Ph#(~)LI('B-~3L(5 <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:539-108 Company Name:YfIAVSlI)ql/!,.../t ~evev-&1116 ftI'Uc:hOt1 <br />Address:g.{f-O /...,E~t~evoPD 115 RoA-d City:Lt £.icleLA StCft ZIP:9562-36- <br />DESIGNER INFORMATION Ph#()r-; <br />Lic.No:Company Name:S.J C{)(JV{tc..1 t[)el~lAl1at?~~etv.4+10 l.1 <br />Address:J810£.IJ/.fle./~oV{Ave.t-tV'f>Cit1:/;-\oc.l{iO 11\StCA ZIP:cr.G~06 <br />LENDING AGENCY Ph#(~)LJh9 -0-3'46 <br />Company Name:SqV\~,qa(»tV{Lou /,t iLl <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <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 0 a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behalf (requires 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 or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature.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 />F:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1·23-09) <br />Page 1 of 2