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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:5cLCV\&tYvi Y\'ypn~r+VVed Not'N.--Df\'P-e.v v'Y\••~VV\.d <br />Project Address:3Ma <«.luro:::Q bv rc\Ae ~ <br />Project Valuation:Cont~t E-mail:~M~2.(0)V\:o\c C N'Y'\ <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:~·M ~V\C\l\o..<,Name:('(")/""\~()...(.~/ <br />Address:,~~£l ,~'ov\dY<VLd Address: <br />City:~lvvv~State:LA v City:State: <br />ZIP:C1.S22:0 Ph#(~(j~)'i~2 -~5q ~ZIP:Ph#() <br />CONTRACTOR IN FORMATION Ph#(1..J)~)~()t..\-oaLa <br />Lic.No:~c..J5E)r~~Company Name:tYT"d v1A.I',kv--(t'/l,<;"-Wa C+r1o/1 <br />Address:V.0 Boi--~Co City:Mo v-.pl u,'N\N ~l \~St(A ZIP:q ~2'\cs- <br />DESIGNER INFORMATION Ph#() <br />Lie.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 ONL Y - <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 a~California licensed contractor or D the property owner or D authorized to act on the property owner's <br />beh (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 ~~t -Date '11 \1 I I 2-I <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 &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)