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amu'" BUILDING PERMIT APPLICATION <br /> off'•" c <br /> �•E�••.oma <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` 1810 E. HAZELTON AVENUE,STOCKTON CA 96205 <br /> BUSINESS PHONE: (209)468-3121 <br /> c�i 1; Figs'P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT ICY THEH APPLICANT IN ORDER TO APPLY PO <br /> BUILDING PERMITS. <br /> Scope of Mork: <br /> fi � ��,v <br /> Project Address: I.( !� <�-,�; � �"_ �C1�Tc3� c <br /> OWNER NAME AND ADDRESS APPLICANT NAME.: AND ADDRESS <br /> Name: Or)H••1I+Uaam Name: N�- <br /> Address:t(02,CO5 Address: <br /> City: &� �^j State: City: State: <br /> ZIP: Ph#( meq,_046, ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Phi;~( ) <br /> Lic. No: Company Name: tltJlri6 f 6U1 LA , <br /> Address. City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( <br /> Lic. No: Company Name: ,,J.,4t#j 1'!•-; <br /> Address: . _ �(�-e�G1,.? ems,• .Imo. City: z ; e,�Tri St: ZIP: <br /> LENDING AGENCY <br /> Company Name: <br /> Address: Cii-y St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ _ 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 owiser 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 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 Date <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 /> FABUILDINGWANDOUTS18uilding PeRnit Application.doc Page 1 of 2 <br /> (Revised 1-23-09) <br />