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BUILDING PERMIT APPLICATION <br /> �+('I' u { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> sir a•' 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> ai+FOR INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165' <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: VAS <br /> Project Address: 2 t O T <br /> Project Valuation: L - 6 -6 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> -Name: ( - Name: 'C`IG6\i n��- <br /> Address. E0 J Address C <br /> City: State: _ C1 F , u State: OCAL <br /> ZIP: 5' Ph#( ) ZIP: S�/ Ph#( ) <br /> CONTRACTOR INFORMATION Ph#% A/Z <br /> Lic. ompany Name. <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Llc, 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' Yes4Q No ❑ 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 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 am❑a California licensed contractor or 0 the property owner or4!54uthorized 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 a pplicable county orylinances and state laws relating.to building construction, I authorize <br /> representatives of this c or con tyfo enter e above-identified property for inspection purposes- <br /> Applicant's Sianatur �� Date O/ C <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:W,pphi tion Forms&Handouts\HANDOUTMBuilding Permit Appllmfion.docPage 1 oft <br /> (Revised(07-08-10) <br />