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r.' <br /> BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y, 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> Q<I FOR�`P <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 BUILDING <br /> PERMITS. <br /> Scope of Work: C1,-1,� <br /> Project Address: fJylccro-A- j Zf,-i13-r i/, <br /> Project Valuation: S� Contact E-mail: <br /> OWNER NAME AND ADDRESS TA <br /> NAME AND ADDRESS <br /> Name: jIl! e /c 4n-e ;' l c{t�� 1 Name: " F 44 i(A � <br /> Address: uJ Address: C), � <br /> City:�r yat State: C- City: 2-i'16-c State: ('c4 <br /> ZIP: ?SzZG Ph#( � 4 T-e6 l ZIP: 2;3L Ph#( 2V9 YJ--f-Fd r <br /> CONTRACTOR INFORMATION Ph#( f. J- rib <br /> Lic. N W--) Company Name: - Cg // t �- <br /> Address: o-&P` (tea City: ( r 1-74J Q St: (J ZIP: �X 2 <br /> DESIGNER INFORMATION Ph#( <br /> Lic. No: Company Name: F( Stf 11� <br /> Address: City: 20 St:C4— ZIP: `?-r-2,y ,, <br /> LENDING AGENCY Ph#( ) <br /> i <br /> Company Name: <br /> i <br /> Address: City: St: ZIP: <br /> Permit 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 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 o.--❑ 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 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 purpo7// <br /> Applicant's Signature Date <br /> For your convenience checklists efaili g any additional submittal requirements for various building permit types <br /> are available at the Building Division c unter. Demolition permit and mobile home on foundation require check-list. <br /> F:Wpplication Forms&Handouts\HANDOUTSOuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />