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BUILDING PERMIT APPLICATION <br /> S.•'�,L.cOG <br /> �.imm. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> u,�g8 L ,•'{ 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> -0'--`' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165- <br /> �1 F°A <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: �v,\,S L- �� E Gt/`Qs CC <br /> Project Address <br /> Project Valuation: G C-6 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: S ( ��VL� Name: rl4G 6U YtCe—;'-- <br /> Address: _ Q 2- So oCi V Address: L <br /> City: 11,.E State: _ Gi State: CC)- <br /> ZIP: <br /> C)ZIP: S Ph#( ) ZIP: S ` Ph#( ) <br /> CONTRACTOR INFORMATION <br /> Lic. 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<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 fl the property owner or4!5.authorized to act on the{property owner's <br /> behalf(requires written approval and OwnerlBuilder Verification Form signed and submitted)_ <br /> 1 have read this construction permit application and the information I have provided is correct. <br /> I agree to complywith a pplicable county or inances and state laws relating.to building u,nstruction. I authorize <br /> representatives of this c - or county to enter e above-identified property for inspection purposes, <br /> Applicant's Signatur X, Date :o f L <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:�Apphi tion Forms&Handouts\HANDOUTMBuilding Pevnit Appiicefion.docPage 1 of 2 <br /> (Revised(07-08-10) <br />