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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:;=0..'V 'f'f\.f M.pl •.v ',,,,••Ho4kJ,';..(I <br />Project Address:JO 27,'/.5 ~9~c.L......,..r MO."" <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:V.',..k ~.-.u..f Name:,~.-.I..oM.LI <br />J/O I){)S I"••••.V',/.r oM.'J..11'I Q\-Address:Address: <br />Go-!'-f'.•. <br />City:fr-~c..u State:City:State: <br />ZIP:Cf~-'3 0 ~Ph#(l~)~3 1-5 z..8 3 ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <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 D No D 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 <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 ~/-l-~-IL <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:\Application Forms &HandoutslHANDOUTSIBuilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)