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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 />Scope of Work: <br />Project Address:2-~rlft.7 '). <br />Project Valuation:1f (,o()o,Do o <br />@WNBR N~M:E A~D'ADDRESS..-.".,.~ <br />Address:2....7"337 7.~"'1-~Pc-A, <br />Lic.No: <br />State:(II City:---rva c.~State:oqCity: <br />ZIP:ZIP: <br />Ph#(2Cl'J)~o 2 -S'7S <br />Address:City:TI"Ci.C '-St:61 ZIP:1s?cJy <br />Lic.No: <br />Address:St:<i'4 Zlp:q~?>() <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes 0 No gJ <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 />By my signature below,I certify to one of the following: <br />I am,t!J a California licensed contractor or 0 the property owner or 0 autnorlzed 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 prov.ided 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 ---::;;Z,."c-_~=__.!..:~:....=::.._=~:........:::~=__~_-Date i_o_~__'I&-=--7....<..0=----_ <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:lApplication Fonns &Handouls\HANDOUTS\8uilding Pennit Application.docPage 1 of 2 <br />(ReviSed (07-08-10) <br />.•~."!..';"-t."-~:.