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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> r: <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: VV V <br /> Project Address: 7C' '1°j - t'c"/4e c %��/ -------"- <br /> Project Valuation Contact E-mail:Q`el-l-<, /jv. A"<,./,cam• T <br /> � O—W—NEER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: GdelName: i,7�.�< ?�,,/C/��� ��-7 <br /> Address: <br /> i — <br /> City: A e'<,i11'-­�'O State: cry City: State: <br /> ZiP Ph#( ) ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> `Lic No C)-7c Company Name: , P .9 <br /> Address: kv S /i? <br /> City:Cit <<< ��a�� y <br /> St: ZIP`1 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lir_. No: Company Name: A` <br /> Address: City: L i d i St: ZIP: <br /> i <br /> LENDING AGENCY Ph#( ) <br /> Company Name: f'ICj2� <br /> Address: City.. 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 /> I am ❑a California licensed contractor or❑the property owner 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 c "nty ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or county enter the above-identified property for inspection purposes. <br /> 1_ <br /> Applicant's Signature _ Date j�A? <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 /> F:\Application Forms&Handouts�HANDOU 1 S\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />