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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />Scope of Work:I~C.D~~~{ <br />Address:City: <br />Project Address:70Y ~E /174 1r1 57 <br />State:ca <br />,. <br />Project Valuation:Contact E-mail: <br />Name:Name: <br />Address:70 '-I tg'Address: <br />City: <br />Ph#( <br />State: <br />ZIP:95)..1 S Ph#~)c../ba,-07S b ZIP: <br />CONtRAC:fOR INFORMATION •Ph#( <br />Lic.No:Company Name: <br />Address:City:SI:ZIP: <br />Ph#() <br />Lic.No: <br />City:S:.1ZX'lC'tDI+SI: <br />Ph#(~406 3~1 <br />Company Name:~ <br />Permit will be issued to an "Owner-Builder"Yes No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />""--.r.,".. <br />Identification Number: <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 county to en er the above-identified property for inspection purposes. <br />Applicant's Signature-+~:cti~IJ.---J.L!:!:.*=-----____________Date 2 ~q -I I <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 &HandoulslHANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)