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"Gut" BUILDING PERMIT APPLICATION <br /> v. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> •.-.:: <br /> BUSINESS PHONE: (209) 468-3121 <br /> <tFosrT' ' INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS- <br /> ScopeofWork: // '75?-fb(L k�rodYL <br /> Project Address: <br /> Project Valuation: 1'1/_S_000 M Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> /I'' <br /> Name: S �Gfl '� C///7 J Name: �7 JK C S'S'c ILS, ?/--,c <br /> Address- _ Address: cfyj <br /> City: State: City: AcAoA _ State: CA <br /> ZIP: Ph#( ) ZIP: O Ph#( } <br /> CONTRACTOR INFORMATION Ph#(3Ci) g7l_yd�� <br /> Lic. No:t, 99 Company Name: 2 C <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <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 owners <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 /> 1 am ❑a California licensed contractor or❑ 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 applicablemy ordinances and state laws relating to building construction, I authorize <br /> representatives of this city or cou Pante h above-identified property for inspection purposes, <br /> Applicant's Signature — <br /> f <br /> Date /b <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:NApplication Forms&HandoutsViANDOUTS18uilding Permit Appllcation.docPage 1 of 2 <br /> (Revised(07-08-10) <br />