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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 />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 />Scope of Work.:Co r'J S+nA.~-f 6-f).eu)/4-:pc)Ir"l-I<p-II a ltM:'J (-BfJI ~(M a <n~ <br />g6o{;N.~q1~.F.--t1Y}~p -441~~/L-Project Address:R.d .S';-Ot;/~ <br />Project Valuation:2.,S i'YI,'1/i ~Contact i-mail:c.t rYlGl\h m ~~d <?4m5 .j r«ciu~ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:M~.s·dd UW)t{y FtJ...r(?~(/Name:5 c::t V>-1 e. <br />Address:13 oJ¥--~.J-/-"~fY1~L';..it 7 Address: <br />City:5jv c:k....~State:C4 City:State: <br />ZIP:CjS2-IO Ph#()ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name:.-Be de I-er fY)t'v1ecl10 <br />Address:City:st:ZIP: <br />DESIGNER INFORMATION Ph#(zoop '-I7?-fos-Ll't <br />Lic.No:S-3lo'31 Company Name:A W1 slY fA.c fu r"d I f)e.5 i~"i.»: <br />Address:60[0y N.i£L-OtIY~Jo ffD City:S f-t:>v J:-~-St:%-ZIP:Cf s ~7 <br />LENDING AGENCY Ph#1 - <br />Company Name:NA <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No [B'.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 D a California licensed contractor or D the property owner or D 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 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:lApplication Forms &HandoutslHANDOUTSIBuilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)