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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE:(209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLEt>:OUT BY lfHE AI?B.t;IC~NT·IWQ~OE:R"·1fQip;Pf!LY EOR --,..BVlLOING,PERMfT$~,.-•d;I.,_=\i.~'::i:......_" Scope of Work:/!f.J.I(...P A CtA~Toc-.J\.Hl)f't\ri: Project Address:2-7/53 e.7 JPFA-tVl L.lr-lJc..€S.cA~C-A <1S?Zo Project Valuation:Contact E-mail:('l c..k @ ~~~.1t'\U T.<:"'OM OWNER NAME AND ADDRESS APPLICANT NAME AND ADQRESS,..... Name:?,t:..HA-/20 L.V4t,vStJ-J Name:K/~P{L DA-wS V\.. Address:~L/d .if -ntlt-/Jl)e-o ",,5 Dr<...Address:'J.4 0 'I City:6'ScALo,..j State:C-Pt City:State: ZIP:453'20 Ph#(.'l0CY 81cg -7.10&57 ZIP:Ph#() <Z.-'1/2 J~O~JRACTOR INFORMATION"Ph#(zc>9)~q5 -9037 -''-'VI flAt-CON5rn.utc....77()..)Lic.No:!J gG;2 3 3-Company Name: Address:'P.O ,~b}C 337 City:~'SC~St:c::!A ZIP:1~~ •..... ~"7Q I Q~S!GNERINFORMATION Ph#(UI1)Ljqs -9037__IJ....,c...o,.J~~'-nu..-,Lic.No:~:3 69 B J;.Company Name:Vo (l...A L- Address:'P;o.~'Q'.l (537 City:Gsc.ALa-J St:'c.~ZIP:C,S 52.....<:> LENDING AGENCY Ph#() Company Name:f3BV/4.c..oMPft~S <::c 0 V\l\PI\-S~r;~~) Address:City:~~St:CA;ZIP:1S~~-.~.,.t 'J ':~ Permit will be issued to an "Owner-Builder"Yes I}g'No 0 '..•..•~_.I O~EIQIAl;.U~~..Qf}.!l.r~;. 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. . "- .,\ D.EC[~A !i'6~lY.fON~Ru~~~~~~~~jfAR·8LICAN1."'l:;:~!fI~L~{~~;~::i "c'••"""~~~.,:,,""".,"'•••••-~.:,."•- By my signature below,I certify to one of the following: I am 0 a California licensed contractor or ~he property owner or 0 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 applicable county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above-identified property for inspection purposes. Applicant's Sign~(~Date "2..~z..o --to I b For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter.Demolition permit and mobile home on foundation require check- list. F:\Application Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 (Revised (07-08-10)