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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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:t!...o}...l.V -e--{0~(\.J-:,..,b i.'10...,'L ~DtLS <L~u)J'()f\v'-( <br />Project Address:~1 .o~.£.WrIJ 'n(W':f rJ)~y )';>,.LJ 0 ')7))..'\);...J b (l,..OOJ..J"I <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:t:1 Gv~7/AI bJ4lt.G6-n 5 Name;..)UClfl rIlr \O~D l "e (i',~ <br />Address:q./D q J~,A4;J.lRoP PD Address:~l ~5 ~p e Ie VJ',+h R& <br />City:tL1Pr.-~cr~/'Ll State:I.B'City:m nr\e:\-hJ State:c»: <br />ZIP:ct5'?3~Ph#(Uq)f3 2-3 -7713 ZIP:q~3SR,Ph#(/J));)/;)!;;2\.\ <br />CONTRACTOR INFORMATION Ph#() <br />t.ic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D 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 0 a California licensed contractor or ~the property owner or D 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 Ql,loZhdD <br />For your convenience che lists 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)Page 1 of2