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°�0.° " BUILDING PERMIT APPLICATION <br /> ?a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> " " 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> m� `` BUSINESS PHONE: (209)468-3121 <br /> °4"Y'-•`-`p INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> GfF°a <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: kgc o4l <br /> Project Address: a-),75�, )t/, f2IZW <br /> Project Valuation: Contact E-mail: S <br /> hG a. o. Oren <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Ptik Name: <br /> Address: a a? N !?t Address: <br /> City: IQ� State: City: State: <br /> ZIP: CA '15D66 Ph#()4)1) ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#(2pI) 11 <br /> Lic. No: ��a �� Company Name: SC_ CooI c-- -'d,l-. <br /> Address: a p 2 Al AV City: Ri St<n ZIP: 75') 66- <br /> DESIGNER INFORMATION Ph#( ) <br /> c f to: z c d 'mac <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> ompanyName: ort <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 U 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 applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or cou ty 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:Wpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />