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f4 pry 38 <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 /> c'fCl..... � 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. <br /> Scope of Work: <br /> Project Address: >de <br /> Project Valuation: / g-6) i)e ContactE-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �, l> 10441 Name: <br /> Address: r1,3_3 � ; LLL Address: <br /> City: r 0o•f State: (LACity: State: <br /> ZIP: Ph#(2ce1) 7/2 -7J�E,j ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) I <br /> Lic. No: Company Name: ( . �,' � L& j� <br /> Address: P& L: r'D City: Li,,c-i St: C_A ZIP:='j`5 2�(� <br /> DESIGNER INFORMATION Ph#(Zj7q) 1f2.-- 893 <br /> LiaNo: Company Name: ����j ` Dc�-(" �0 <br /> Address: City: St:0AZIP: <br /> LENDING AGENCY Ph#(qq) of 7 -- 27- 2-0 <br /> Company Name: # <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes [Po ❑ 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 /> I am a California licensed contractor or�the property owner or E] authorized to act on the property owner's <br /> behalf equires 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 ordinances and state laws which govern this project. During the course of construction I will also <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 Date 2,7 <br /> For your convenience c ecklists detailing any additional submittal requirements for various building permit types <br /> are available at the Buildirig Division counter. Demolition permit and mobile home on foundation require check-list. <br /> I'Mppiication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />