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r' <br /> BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �• 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> p BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> a<iFbR��o- <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: 0e,,r OL10 0 EQu l p ut Nr-0 _re nnec. "",7 Aj oq S-A a t <br /> Project Address: <br /> Project Valuation: 100 , 600 Contact E-mail: PC,)g°pa , it Ife jYe?5 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �c�wf c� 1� Name: <br /> Address: ��� �C4 !v\D!� Address: 0p do 'rvrb�y�m {'��fa ✓ 77j <br /> City: files J� State:: OA, City: � q A State: CA <br /> ZIP: {� �O Ph#(i2j���� - ZIP: <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: � Company Name: Aa ( <br /> (f-�V_,8� <br /> Address: ZS 2s E. ao e �acity: , sa St: zip: 9563cC <br /> LENDING AGENCY Ph#(9(6) qS"I 12;O1c:> <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No a 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 /> !-am ❑ a California licensed contractor or E[the property owner oriN 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 certify the information I have provided is correct. I also agree to comply <br /> with all applicable county yqatinny <br /> art es ands to laws which govern this project. During the course of construction I will also <br /> takes steps to preserve aleyn numn s In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspur ose�. <br /> Applicant's Signature " Date jib t <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-!!st. <br /> F:\Hpplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc- Page 1 of 2 <br /> (Revised(01-28-15) <br />