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o.~9.Yo!N.'.C'BUILDING PERMIT APPLICATION <br />!~1 ~t\'O?,SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205."..-:.\BUSINESS PHONE:(209)468-3121.. <br />~:.,.~::::>(~INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165(iFo\il.~ <br />THE APPLI(ATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work:~6"L.oCA'~MOi)lLt:::W 0 "'""-l.orv .5 ~\M.li \)ao»5'fl'1 <br />Project Address:~I .~r»:~:-\u V -r;-,pJ {;:Q.J'..(r)AF\1I&c'~ <br />Project Valuation:/.0 tc Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:\lo..l{\C,Vl\hl in().PVl $=""lq(,",·~C Name:\J f1 V\~-1Ir ()\J\)irYlfY\<?t {~OVI S-. <br />Address:r37C{Q ~tY\.\Address:\~,qq S.~(,vr+-OYl-\n..w <br />City:R\OOA State:t¥\City:1<.I0 (')V\State:C)C} <br />ZIP:qV5~lO Ph#()ZIP:C1~2>L..Q LP Ph#() <br />CONTRACTOR INFORMATION Ph#(~)L{q \-~~O() <br />Lic.No:q~\l3~Company Name:\)I\/PVS ~~I~r\M (Y';l I flY,Inr '- <br />\OU.\c:...e=-A~City:~fA ,,lY) <br />, <br />ZIP:q~~QA)Address:\~L\'J...\....\Stt¥\ <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 0 No 0 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 0 the property owner or 0 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 county to enter the above-identified property for inspection purposes. <br />Applicant's Signature ~l...1YJcct{}'(J{'(jJ5=Date )'2/3 I JIG1I <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:\Appiication Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07 ..08 ..10)