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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> e ° 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: (WD n z e) U G. cc - <br /> Project Address: 7,9 z <br /> Project Valuation: 72p 0 1 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: 1Y (,4h (� �KName: 7-APF- Z��tui Cv <br /> Address- _ wL-f !) {f J Address: C) ppm (Z�J <br /> City: State: City: � - State: rr(- <br /> ZIP: Ph#( 0,+ ZIP: �.S2� b Ph#pv�/} <br /> CONTRACTOR INFORMATION Ph#(2 rcC �0(- /J'6 <br /> Lic. No: �S� \� Company Name: C <br /> Address: P(�_ (Z3v City: Cr <br /> cD,ESIGNERINFORMATION Ph#�dCf) �� � o2, (a <br /> Lie. No:-j`Z`{S 1 Company Name: fu v,� urs N <br /> Address: K �R rS� \ City: � c St ZIP 9S j�� <br /> LENDING,AGENCY Ph#( ) <br /> Company Name: h <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 Farm must Identification Number: <br /> be signed and submitted along with copy of the owners <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 county ordinances and state laws relating to building construction, I authorize <br /> representatives of this city or countyknter. <br /> ove-identif roperty for inspection purposes- <br /> Applicant's Applicant's Signature Date <br /> For your convenience checklistsdditional submittal requirements for various building permit types <br /> are available at the Building Divisemolition permit and mobilehome on foundation require check- <br /> list:- <br />" F.Upplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> iR�eiaed taz os dol <br /> u� <br />