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3 <br />Contact E-mail: thAt_cdp":"Vo na. •CM <br />APPLICANT NAME AND ADDRESS <br />Scope of Work: <br />Project Address: <br />Project Valuation: 70.g: lef?icr° <br />OWNER NAME AND ADDRESS <br />City: St: <br />St: Cid9 ZIP: <br />Za.tio-e___ E")1,0 .0 <br />City: Linajhfrbe,A2 -1 <br />Ph#(97-0q) oZ Y9- Z203 4,44Ita Ja - <br />cityq/n <br />OFFICIAL USE ONLY Permit will be issued to an "Owner-Builder' Yes 111 No <br />If yes, a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owners <br />identification prior to issuance of the building permit. <br />Company Name: Lic. No: 4 1 2'3 <br />Name: <br />Address: <br />1 A. Al.& ZIP: 9,6 3 ph#(4 ,109 ) ys)6 <br />Ph#voq L/O3 -.37m (2.00 sqQ--0/97 R I <br />1Y3,13 Q5:34oe o p <br />CONTRACT <br />Phit(t09) 599 -99 7 ZIP: <br />Company Name: 10 <br />Identification Number: <br />533 <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below, I certify to one of the following: <br />I am El a California licensed contractor or MI the property owner or LI authorized to act on the property own <br />behalf (requires written approval and Owner/Builder Verification Form signed and submitted). <br />I have read this construction permit application and certify the information I have provided is correct. I also agree to corn <br />with all applicable county ordinances and state laws which govern this project. During the course of construction I Will els <br />takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above <br />identified_ Property for inspection purposes. <br />Applicant's Signature 410 f.ifit. AA 0' Date <br />For your convenience checklists detailing any a. •= onal submittal requirements for various bui ding permit type <br />are available at the Building Division counter. Demolition permit and mobile home on foundation require check-It <br />F:\Applicatiofl Forms & Handouts\HANDOUTS1Building Permit Application 1-2015.doc Page 1 of 2 <br />(Revised (01-28-15) <br />Name: <br />Address: <br />City: <br />Address: /q733 io <br />DESIG RMATION ph#(49) <br />Lic. No: <br />Address: <br />ENCY <br />Address: AA.A. -x9irted <br />Company Name: <br />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 BUILDING <br />PERMITS.