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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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:AG /G4~AG Gu t LD (N U. <br />Project Address:'Jb l/t D £M ~f.4 o 'V P..D J 17~c IG I 0 ~,CA 9~1~U <br />Project Valuation:YOJ 6r:ro Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:fJo c:l~r;.-p-()VV N '"Name:{20Qif (L (.Lo WH t--' <br />Address:'1/(,1;~(,11ri tJ ~I')<lvlh\Address:41 D i '::0 \)tJ D ~(2 S ~ <br />City:1'Y1(.10~~\"L.'State:rH J City:iN1 D Of"~\1)State:CA J <br />ZIP:q<:;qs-{Ph#CZc~Y3D -i 7 c-o ZIP:qt;~"Ph#Q)9 )~3b ~i7to <br />CONTRACTOR INFORMATION Ph#() <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 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 ~the property owner or D authorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Form siqnedand 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 s;gnature~~Date <br />For your convenience che klists detailing any additional submittal requirements for various buildlnq 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 Permit Appiication.docPage 1 of 2 <br />(Revised (07-08-10)