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BUILDING P IT APPLICATION �N m j 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 L1FpR THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. rc . . . • Scope of Work: alc-/. dY w, _eQ Y s l .� Pro ect Address: - — _. I t v J. M t,im Y c� ✓�e '�.cic 20S_ Project Valuation: C) p — Contact E-mail.- OWNER -mail:OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: �tic�S2 U ,� Name: Address: �o o 2 Address: q ISS ) C Y-v t,v eW woj City: UJO- key Lr;[(e4Ph e: City: q,( e 6 VW,� State: �w ZIP: t) b (��g) �i 10 - } '0 ZIP: j 2 Ph#( 6 -7 92 S CONTRACTOR INFORMATION Ph#( ) Lic. No: GIS19 b Company Name: I P Lt-t Address:q(, City. (�li 1C C St: Cl- ZIP: �61� DESIGNER INFORMATION Ph#(Cil6) 7�S Y2 tic. No: Company Name-.— Address ame: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 ❑ a 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 certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date Z/2. /2 / For your convenience checkli s detailing 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. F:tiApplication Forms&ldandoutsV ANDOUTS1Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)