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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. Scope of Work:r;{?(Jp f!;:.r Ap/.?I,r/p.v r~/l-(/(//1ftlC//,t/us a.AI,()/'1.$'/"~/V?.:;4 JJi1 Project Address:/o 2 0 I ;:,).J{/h tJ /?k ~'?j L<)/P c »:rc-'/V C/fZ Project Valuation:Contact E-mail:/J1 /-//1/l/V/1(JC(uJ/&,I..,rJ..v/?C6',G!I"/ OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:CvIlTU/,,tt-(cl h./l rlV/Z~'L r'Name:A?/)t..AIt-//7 C",oAJ ('r,/h1 ~//tl/V Address://2tf'2 p,/1t /;,!IIU/,A~I Address:hA 0:<?t,;7 t) City:.)rp/}(rt)/IJ State:C r?City:6'/"~"<'.~/./ro/V State:C4 ZIP:9 rJ-l-z.Ph#~~)ee»--~I Of-I ZIP:?r~(.J(Ph#,kt"f')~6.2~~c f 7 CONTRACTOR INFORMATION Ph#(.zty)--?c .2-..z 6 e 7 Lic.No:4fJ7~}..y Company Name:~A.R'AlI1 C LYAJ .•r;ll.~1"//d,CI Address:/..:0 A c/'~y G.7 a City:.5'Irp c:A::-»:~se L./)-ZIP:9(-2 L:/&' DESIGNER INFORMATION Ph#1z.:'o/').J 3 ~-J..:?3 Z Lic.No:C()~C;'>~<?a Company Name:4/1"/<.r;5"/Ulr/r £A.I/./JU /.:/f./Z/"Uc. Address:..cI AJO/l rr?/77/51 //1....1 SF City:,.(?)///St:ZIP: LENDING AGENCY /f/J9 Ph'"'/A'lV/I Company Name: Address:City:St:ZIP: Permit will be issued to an "Owner-Builder"Yes 0 No kJ 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 my signature below,I certify to one of the following: I am IZfa California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's behalf (requires written approval and Owner/aullder Verlflcatlon 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 th above-identified property for inspection purposes. Applicant's Signature,@~~Date .3 -22 -/L For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter.Demolition penn it and mobile home on foundation require check- list. F:lApplication Forms &Handouts\HANDOUTS\Building Penni!ApplicatJon.docPage ':of 2 (Revised (07-08-10)