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oa0. d.• oG 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 /> o�4koa`'�P INSPECTION REQUEST-24 HOUR RECORDER: (209)..468-3165 <br /> THE ARPL1CgTiON M ST E COMRLTELI�FiLLt D (�U '$ THE APP�L1CATt� tPIO DERCOAPPL ak O <br /> Scope of Work: <br /> Project Address: w ��- C Lt 0 <br /> Project Valuation: lAlo aO0 Contact E-mail: �i yyai )L c�i ciE�oa+ 't7( <br /> OWNER'tyAME P Nn ADDRESS° PPPI ICA,NrTNA(Vl�,AND <br /> $6RES$ <br /> -- <br /> Name: - �t� Name: ✓ <br /> Address: 3 �J A W{ Address: 1 ( d � /4" <br /> City: State: City: L State: t' <br /> ZfP: �-d () Ph#VOq() G67 377 ZIP: o Ph#�20/) 6() q 13717 <br /> t� <br /> CONTRACTOFj51NOR(NATIO(J Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> D)=SiONE12')NFO,RIVI`.4`iTIONh .s Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes No ❑ - <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 /> ., �DECL/�t�FlTI'0� BV CO133,TRUCTlOTa1rQ,E MIT/,�P��LI'�iHtk!>)-�t s �s; � �4�� s' <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or (g 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 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_4� 7 J1�i <br /> Date —/ <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:1Application Fors&HandoutsWANDOUTS1Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) - - - - <br />