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BUILDING PERMIT APPLICATION �'�� a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT N9hlc �,, 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 a BUSINESS PHONE: (209) 468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: FA ISfLo PIAU, /z'_ Df� Df-t 44E_,J P"w,c.,/L Project Address: 16 1 ,44- 14w-) I W iD` (A Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: Ij Name: Address: 10 f4 I�f��'% 1 2 (,v(�I ��1 . 7SZ � Address: 3 t N' iC LC^� Iz� City: -fe)P 1 State: City: State: �r1 ZIP: Gf S � Ph#( ) ZIP: 5��Z Ph#( L",-H) %9 -74-1 CONTRACTOR INFORMATION Ph#( ) Lic. No: fj �_ 10 3 Company Name: Address: 23)0 j N 56wbo City: AC4h1�e St: CA ZIP:fS 22 c) 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 USE ONLY 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 PERMIT APPLICANT By my signature below, I certify to one of the following: I am ka 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 icable c nt ' r �n n sand state laws relating to building construction. I authorize representatives of this city or ounty o e 6 a o e-identified property for inspection purposes. Applicant's Signature Date For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division c¢unter. Demolition permit and mobile home on foundation require check- list. F:1Applicalion Forms&HandoutsWANDOUTSOuilding Permit Applicalion.docPage 1 of 2 (Revised(07-08-10)