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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 FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS.\iL Scope of Work:BVI L-D/AJ6-PE~MITS rOt<2 HoM€S;r..1J1J .t ?/f/ecEL Project Address:8'10/E.H/llUtley L-N.~LObI.C/)9S2lfl/#-Project Valuation:Jls¥£3 5""60 Contact E-mail:(i(}IBJtJN@FCBIII))1£5.etJfl1 ~ OWNER NAME AND ADDRESS Ll4.~APPLICANT NAME AND ADDRESS Name:GOWCA)lXli/l J!.t1-AlCH P;u;,tJEf<,7!EJ.Name:6i?o!l.615 je.,tf-t er.0 IJ Address:S-OBS frMJlfH !JAY CI.IeCL-e Address:~08S-fPANI.J1/8~Y C/.e.cLt. City:sr.~t)':...7()AI State:vI'!City:S;~fA(I'O,v State:C;:}- ZIP:'1~'Llq Ph#(1{)f>'17j-()o'll.J ZIP:'1>2-/'/Ph#(2tJ!)t/7 j -I}tJ l/~ CONTRACTOR INFORMATION Ph#() Lie.No:C,2Cf BCJt,Company Name:F~J/Tl&/l,L-!JAlt>ctJ41iJ/rA/llir Address:/f)/()()TIZ/AJ/TI FA-.£KW/I('#City:.-!WvK7lJAI StCA ZIP:9'52/7 DESIGNER INFORMATION '120 Ph#(2(),'-i if Lf -2..f}oa (~2827) Lie.NO:C.-'2-'f 009 Company Name:Ac 12..OPo L/.5 J)Er/6-A)l C"et/f71oAJ Address:'l~1./N,SA-IJTlA60 Sr.City:SAN?;4 AAlA-StCA-ZIP:92701 LENDING AGENCY Ph#() Company Name:NoJJir Address:City:St ZIP: Permit will be issued to an "Owner-Builder"Yes 0 No 0 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 0 a California licensed contractor or %ethe property owner or 0 authorized to act on the property owner's behalf (requires written approval and Own r/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 0 count~:xl-bove-;dent;fied propertyfor inspection purposes._ Applicant's signatureh~v -)/vtA1f/-A6f;/L Date /2 :2 8--1 () For your convenience chel klists detailil g 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.t ..e w(),4R..YVA//r: F .\Applicatlon Forms &Handouts\HANDOUTS\BUlldlng Permit Apptication.docftaqe 1 of 2 *)1IffAl ,.i.'E~ (Revised (07-08-10)N-A-IJD CG-OLlLItJ2r@h 13ifO;UtS,.M -z:»: