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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 COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR BUILDING PERMITS. Scope of Work:110tJ05Pd l>1oJu c:y ~pst(ooYV"\.. Project Address:50 c)/U.Ya.c t:Tor1-€7<01.J L t'helen,en- OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:MO'ClJ.3 ~(odu.c~Name:Mid-red (on Sf-ni c/o r S Address:-=r.D.~o y Address:34/1/New 10)I ?c/ City:L,'I)d .f?h State:C /4-City:Sft>c~fo}\State:C 14 ZIP:q S?J2(p Ph#()ZIP:.q S;J.()5 -;;2L{15 Ph#t;2~q L//-'i'C!2/ CONTRACTOR INFORMATION Ph#(..:zd()qtj /-?{'li 2/ Lic.No:0/30c.-('1 Company Name:MJci-{al C{)Yl;3 f r cc cfOY.5 Address:34f{f AJfW~6v)K~dd City:S toe t-/o Y}se OJ-ZIP:95;2()5 DESIGNER INFORMATION Ph#(:?b4).~84 -J..33 L- Lic.No:C.-0 L{LfS1()Company Name:!VI;k:«SvYt ,+it t::.ht?\I /l ~.p (I '"q. 4 fI)o(th Mt31 r1 r...<)/r.{J-e +:Lo~;v v Zlp:q5;2L!~Address:City:se ell- LENDING AGENCY Ph#() Company Name: Address:City:st:ZIP: Permit will be issued to an "Owner-Builder"Yes D No D OFFICIAL USE ONL Y 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 m~ature below,I certify to one of the following: I am a California licensed contractor or D the property owner or D 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 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 or county to enter the above-identified property for inspection purposes. Applicant's Signature ~a ~Date ~~,9 For your convenience checklists de mg 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:\BUILDING\HANDOUTS\Building Penn it Application.doc (Revised 1-23-09) Page 1 of 2