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ip <br /> 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: Jhajli(.t✓Cjtp-LAO-tii iM, ar100rL outGt©6lr kifcke-vif(w-- locCe__ <br /> Project Address: a1 �(p (�, I �0� � �l t 1 t C-,n- 61'-3`3 (19 <br /> Project Valuation: 146,000. bo ContactE-mailre � 1 Cr22{ (,t0(0c) Lb <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:CJt(✓Vec* �Gt i V _ l 'C)U h Name: �jp Y 1 inci CVee_K 0Utct(5DI LIVI <br /> Address';2- G(o �_R( C}{ 12 Address z), Pt yw5t"', <br /> City: State: 0121, ` ` City: RI plf5n State: <br /> ZIP: Gjj(o(P Ph# !j0fCJ_(,J6Z ZIP: 01 •J(P6, Ph#(OCq Cj�G( jQ <br /> CONTRACTOR INFORMATION Ph#( ) .�+ <br /> Cic. No: G�7jl O( ( � Company Name: rj {^l n G(^Q �D(,(,`door L. vi n -Cnc- <br /> Address: ,??-b f P61n(�, - City: (R(`son st:iazlP:R5 34(10 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: city: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: t`.(A <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 amoa 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 applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or cou5y to eryt r the ove-identified property for inspection purposes. <br /> Applicant's Signature Date 5__-50-)4 <br /> For your convenien the s detailing any additional submittal requirements for various building permit types <br /> are available at th in vision counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:%Application Fonns&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08.10) <br />