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BUILDING PERMIT APPLICATION <br /> ya�E.coc <br /> ' ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> " 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> �gYlk'o' .P 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: /1 G d✓' Cyo .Lrrw <br /> Project Address: -76 ) 5'Z61, <br /> Project Valuation: ey 7Contact E-mail: S�7G /� d <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ✓1 Name: <br /> Address: 7 Address: �67v <br /> City: O wl State: 1-,V city 2 064 State: <br /> ZIP: 9J�d Ph# ) �q' O0ZS ZIP: Ph#( ) 42- V97 <br /> CONTRACTOR INFORMATION / Ph#( ) L dz Zd <br /> Lic. No: Company Name: j� <br /> Address: City: St: ZIP: G,U <br /> DESIGNER INFORMATION ' Ph# <br /> Lic. No: 313 9Ij Company Name: <br /> Address: 4Sf City: st: ZIP: 6 <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 owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my sig ure below, I certify to one of the following: <br /> I am a California licensed contractor or❑ the property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> Ihave 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//r the abov -identified property for inspection purposes. <br /> Applicant's Signature / Date <br /> --E <br /> For your convenience checklists detailing any additional submittal requirements for various building(permit types <br /> are available at Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. . <br /> FMpplicatlon Fortes&Handouts\HANDOUTS\Building Permit Application.docPage;1 of 2 <br /> (Revised(07-08-10) <br />