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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 />LlCATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />/ork:GoAJ~T/Luc:rJo,v 0':'V/3...w eis I Ol!.aE <br />.Address:S372 L.fJfHA~lto4()TR..Ac..'I CA c;S.3 04 <br />.ect Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:t'.A'1 MISFELDT Name: <br />Address:~SO E.f.JTc...pfl.lsa P'-AGt.Address: <br />City:TR.Ac;y State:t:A City:State: <br />ZIP:CiS3ot)Ph#(Zoq)8J8 -8 ZZ 8 ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name:API ..7oS,tPI-I Sf1Jn./ <br />Address:l~o"1 J2>r~S.r soite c City:rtooesr»St:~ZIP:q~.3S4 <br />LENDING AGENCY Ph#(2~)57 7 -4 "I <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes ~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 D a California licensed contractor or lRJthe property owner or D authorized to act on the property owner's <br />behalf (requires written approval and OwnerlBuilder 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 a~Date~\I <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\Building Pennit Application.docPage 1 of 2 <br />(Revised (07-08-10)