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BUILDING PERMIT APPLICATION <br /> �.•'�,(�'hoc <br /> a 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: a�„' t•G L C V i �. u,c_ c l t _ <br /> Project Address: 2 S <br /> Project Valuation: C)C) Contact E-mail <br /> DOWNER NAME AND ADDRESS APPLICANT NAME AND ADDRES <br /> Name: f� C U" el.- Name: --- --- - - — - <br /> Address: T1 2 C) r', Address: <br /> City: c-h State: City: State: <br /> ZIP: 9y70Ph#(tay) YQ� �7Y( ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: 701 /9',7 Company Name: Ce <br /> Address: 7�C City e (j St:(, ZIP: S3 5 <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❑ No ❑ <br /> 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 /> am ❑ a California licensed contractor or❑ the property owner or[]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 ordinanges and state laws relating to building construction. I authorize <br /> representatives of this city orto enter ove-identified property for inspection purposes. <br /> Applicant's Signature Date / -_20 <br /> 2 <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:1Applicawn Forms 6 HandoutsWANDOUTSOuilding Permit Applicalion.docPage t of 2 <br /> (Revised(07-08-10) <br />