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�PRUr" BUILDING PERMIT APPLICATION <br /> i'• u',{ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 181b E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> . .a BUSINESS PHONE: (209)468-3121 <br /> 4Cico �' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165- <br /> THE <br /> 68-3165THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDER O APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Aloe V.- 6 c <br /> Project Address: <br /> Project Valuatio Contact E-mail: <br /> OWNER N E AND ADD S APPLICANT NAME AND ADDRESS <br /> -Name: 5 Z Name: <br /> Address: _ l Address: <br /> City State: City: State: <br /> ZIP: PW(-( !-61'J�Jb0ZIP: Ph#( ) <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- <br /> Permit <br /> ityPermit 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 owners <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I cerfifyto 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 /> I have read this construction permit appfication and the information I have provided is correct <br /> I agree to comply with all p icable county ordinances and state laws relating.to building construction. I authorize <br /> representatives of this c'. or cou ty to e ter the e-identified property for inspection purposes- <br /> Applicant's Signatu Date <br /> For your convenience checklists detailing any addition I sub itta! requirements for various building permit types <br /> are available at the Building Division counter. Demolitio mit and mobile home on foundation require check- <br /> list. <br /> FVapplimbon Forms&HandoutsWANDOUTSft lding Permit Appllmfion.docPaga 1 of t <br /> (Revised(07-OB-10) <br />