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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:11 l].k Pllt2Lof<.f-X j/..4-1\/\I ()/J (011/(2 r) <br />Project Address:Q..,4-c;-c,Z ;1.1 At</fJ oJ'A-e ()AD Be Au AJ cA-q~2 0 <br />Project Valuation:Contact E-mail:.Jr~~rJ q vl/~~J~Tl-""dU·NuI?t.-C_U•....~ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:,J-(')e O~s:v~Name:O~10J j)V)I~.o re«.We5"feu..D'I;~}?"A-~, <br />Address:2 4-6 6'6 ;11~,...rl?~((4RoCllv/?/I r F .~fj,-~v <br />Address:IA/'• <br />ESc-~/0\/1 <br />,C-A OCfkrJ r;f r e.cA-City:State:City:State: <br />ZIP:CJS J20 Ph#(2iff)bS2 -36/8 ZIP:953£(Ph#(2'f)9 L.J $-'gt7'r <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#(), <br />Company Name: <br />Address:City:St:ZIP: <br />COO "OFFICIAL.USE ONLY 'v "Permit will be issued to an "Owner-Builder"Yes 0 No 0 <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 />..f ''>1 ,,,•...c <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT I~:"';,'.:!~,'.~>,",;',.••.•"...i'l,,~, <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 0 authorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Form 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 for [)1411;J AliI).,,:Date 7 -2 S--}.tJ J I <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:\Appiication Forms &Handouls\HANDOUTS\Buiiding Permit Appiication.docPage 1 of 2 <br />(Revised (07-08-10)