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" .. BUILDING PERMIT APPLICATION <br /> r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> J 18140 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> `- BUSINESS PHONE: (209)468.3121 <br /> Y co INSPECTION REQUEST-24 HOUR RECORDER:(209)468.3165 <br /> E <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT[N ORDER To APPLY FOR <br /> BUILDING PERMIT, <br /> Scope of Work rt/ j y MOjJUGAQ 8lf/�Oi v�,- CAMPvS <br /> Project Address: /Zpa/ S IIPVY 99 /230/ S. !/k/y 95' AL71141- <br /> Project Valuation, 004 Contact E-mail /•r6 m <br /> Ile , Coln <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> -Name: UAL/GATD F,QJ`//G y Ur.vE} (2DS Name: vsy BiYL�Z I <br /> Address. /ZOO/ 5 /✓GVy Address: , PO ,fpx 39< ' <br /> City: P Ax-27,,G City: L!/LLoGC State: <br /> ZIP: 533 Pn#( ) ZIP: 538/ PNWO9) &3Z 377__ 9 <br /> CONTRACTOR INFORMATION Ph#( } <br /> Lic.No: Company Name: <br /> Address: City: St. ZIP: <br /> DESIGNER INFORMATION Pb#( ) <br /> Lie,No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGE CY Ph#( ) <br /> Company Name: <br /> Address: City: St ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes E]No E7 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 mysignature below, I certify to one of the following: <br /> I am Ej a Califomla licensed contractor or E)the property owner or El authorized to act on the property owner's <br /> behalf(requires written approval and OwnerlBuilder Verification Form signed and sgbmitted)- <br /> t haveTead this construction permit application and the Information I have provided is correct t <br /> 1 agree to comply vAth all applicable county ordinances and state laws relating.to building construction, I authorize <br /> representatives of this city or county to enter the above-identfed property for Inspection purposes. <br /> t <br /> Applicant's Signature Date <br /> For your convenience checkli der cling any additional submittal requirements for various building permit Types <br /> are available at the Building ivisi counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> ;. F:Wpplkaibn Forms&HandattlsWMDDUTB1Building Permit ApplicaUm.docPagel ot2 <br /> t <br />