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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT I 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 o INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 9ClF°R�\P THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR ` BUILDING PERMITS._ Scope of Work: rA I ED PAA iZ Dii r IR'—(-W44EQ lj 30 r=te Pw, +46Z Project Address: (O 194 F , f4t,/i 12, LoiD( CA 15-24-0 Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: 91COP'r'r-P 4 5 1414Za l RLr,�i� Name: WL-1 Address: /01,5 + E HQf l I Z (pD( IA , 75-2gt Address: 2330t N 5C-WL(-3 IZ- city: f7 I [State: r4 City: A"- )) c State: CAZIP: G/$Z�{� ( ) ZIP: 522 b Ph#( 2-152) 96-9-Z431 CONTRACTOR INFORMATION Ph#( ) Lic. No: 564- (o3 Company Name: `w _ (.e mcl?F%L e-b-�r, Address: 2-3701 A/. 58uW 12..7, City: St: C,4 ZIP:17SZ�U DESIGNER INFORMATION Ph#( ) Lic. No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder' Yes ❑ No ❑ OFFICIAL USEONLY , If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION-BY.CONSTRUCTION PERMITAPPLICANT By my signature below, I certify to one of the following: 1 am 111(a California licensed contractor or❑the property owner or❑authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information I have provided is correct. I agree to comply with all ap !ca*detailig sand state laws relating to building construction. I authorize representatives of this city or oove-identified property for inspection purposes. Applicant's Signature DateFor your convenience checklisdditional submittal requirements for various building permit types are available at the Building DiDemolition permit and mobile home on foundation require check- list. FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 (Revised(07-08-10)