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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.d/. Scope of Work:BVIL-DjAJ6-PEf<..-M (T.5 rOI<2 HoM£~/?<tJlJ .1 I;J/(cEL Project Address:89L5 E.I-tIlAfiley 1-N."LOJ)~C./t CJS21.jtJ #-Project Valuation:JfsLff3 S-60 Contact E-mail:GGjj}.itJN@f£,'Bf/(1N£5.{.'tlfr!~ OWNER NAME AND ADDRESS L~u APPLICANT NAME AND ADDRESS Name:(JoWE]J I3eIlIl f.I1-Iv'CH ,P;W;JEJ<,7lCJ:Name:r;:e-(}Jt..6£1:-,tHIYolJ Address:S"D8S ..f~~N/.fHIlllY CJ,eCL-£Address:~08S-JPA-NI.JI/BAY'elecL/:. City:st.a {K-7fJ AI State:eft City:Si (Ir...er.0J/State:C-I)- ZIP:9f2-/1 Ph#('~f>'17/-()0 '11./ZIP:q S-2-/9 Ph#(2tJ!)tl71 ~tJ cf'j CONTRACTOR INFORMATION Ph#() Lic.No:h 2Cf 8tJt,Company Name:~~~~)e LlJAlj)C{)41jJ/1'A//ES Address:IlJ/{)()T)zI IJf7Y FIf/l.,KfV/I('i:City:...$72Jt/K7lJN St:AZIP:952/7 DESIGNER INFORMATION 'f20 Ph#(2{)'1 'i Y tf -2-tJ OtJ (~2-827) Lic.No:C-2-'f 009 Company Name:Ac J2oPoL/5 J)b/671J /Lk.&/f 7l0N Address:7_~L/)J,SA-AlTI.46-0 ST,City:SAN?;4 AIJA-St:CA-'ZIP:9Z 701 LENDING AGENCY Ph#() Company Name:NolJir 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 Efithe 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 a counp ent ir:':property for inspection purposes ___- Applicant's Signature ~.../V T v -1 /ViAtf/A6-CIL Date /2 :28-1tJ For your convenience chel klists detailir 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.I ..cr.i'~d()-4R..YUAJ /TF.lAppllcallon Forms &HandoulslHANDOUTSIBulldtng Permit Application.docs'aqe 1 of 2 *-)11!-1}/\'£( (Revised (07-08-10)»A-AJD C GaLlLf}-J2r@ FeE ilo1t1C5,colt1 -z:»: