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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT_ <br /> .i •°, 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> r BUSINESS PHONE: (209)468-3121 <br /> <'r S 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: <br /> Project Address: <br /> Project Valuation: Contact E-mail: j (✓( I��rIC p1 GSI. c�s�,h� <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: )Aso -)('/LE Name: <br /> Address: /l II o y v Address: <br /> City: WLt �IRLZ State: City: State: <br /> ZIP: S Ph#C7o,/) 3Z7 -SOV ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#(2,�;o yok(q <br /> He. No: 3() T-9 Company Name: rJ K, H f jze <br /> Address: Q 0 uk S t( City: (� + <br /> 2 I�ucc, St: <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 i]No❑ OPFICIAL USE ONLY <br /> If yes, a completed Owner-Bullder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owners <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 ama California licensed contractor or the property owner or[I authorized to act on the property owner's <br /> behalf requires written approval and Owrter/Bullder 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-identifled properly for Inspection purposes. <br /> Applicant's Signature �� J <br /> Date_ Z- •21- I'3 <br /> For your con von ian a chedkiisis detailing any additional submittal requirements for various building permit types <br /> ,re available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> 'sL <br /> F:1Applicetton Forms&HandoulsMANDOUTS16uliding Penh Applicatlon.docPage 1 of 2 <br /> (Revised(07.08.10) ' <br />