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PaU`" 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 /> °gprFORii�P 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 /> + t-BUILDING PERMITS. <br /> Scope of Work: ' rj R Nj�IQ� T�ct,�i if -� 1 l tom.//�� � <br /> Project Address: a 4 ce(P (� . DI 'PA , tffc i o 9 53&(p <br /> Project Valuation: 2a 06D,oo Contact E-mail:gi P5 � rt tree Utrfoar,Ctm <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ��P�VC'� (�P �OIV\�I { Vl Name:6 (h Cie Ib0( <br /> Address:�1}[p(10 �(, }�� Yl Address: �j�j( <br /> City: }2( pl State: City:'R(p6y-) State: La <br /> ZIP: Ph#(;) ZIP: 01 C5--D <br /> CONTRACTOR INFORMATION Ph#(D6q) _GjcjFj� <br /> Lic. No:(9L (pjo2?] CompanyName: � rior) L'Ic�k�p�l �j a_ri1C <br /> Address tJ--3) City: St:CCk.,ZIP:01,5�3 6 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: Nf Pr <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: LIZA <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 California licensed contractor or E] the property owner or El authorized to act on the property owner's <br /> be alequires 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 /> 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 /> yy <br /> Applicant's Signature Date J`� 14 <br /> For your convenience a krisetailing any additional submittal requirements for various building permit types <br /> are available at th uildi g Di ion counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> R\Applicatron Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />