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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:~/i ~dA!-/&L/-/4~7/7~/-I'7t~/~~.Z3 1".«.a .", <br />Project Address:~~...,...2~//l/C A <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:J"",AC~AI Name:.e«'~.D.......v4('"./~~/4,:i) <br />Address:2Vt~~£~...,"';'LJ IY u "--Address:J/6 .z:"f/~.l=Ji g~/d~ <br />City:a-:..tt~A/St~te:fA CitY:d,/~k State:~~~ <br />ZIP:.itf'2d Ph#~)ClMtB4,(/ZIP:.f's:36/Ph#~)ik/e '~7~ <br />CONTRACTOR INFORMATION <br />//Ph#() <br />,. <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lie.No:h 33S"'/a Company Name://~I'L~~/"'~~/~ <br />Address:3/t.U/.~J£f -&-/aJ City:a':.L L/..St:~ZIP:k~/ <br />LENDING AGENCY Ph#() <br />;' <br />Company Name: <br />Address:City:St:-ZIP: <br />Permit will be issued to an "Owner-Builder"Ye~NO 0 OFFICIAL USE ONL Y <br />If yes,a completed Owner-Builder Verification orm 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 0 a California licensed contractor or 0 the property owner or ~uthorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Fo m 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 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 Signature ~•U.&.,Date 2&4 &2i6 <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:\BUILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2