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BUILDING PERMIT APPLICATION <br /> e' } SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N` x 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> ,. P. 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: �r=� { <t'J E cMo _� <br /> Project Address: -:?q 2-D <br /> Project Valuation: Contact E-mail: CS w , I i s QE <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:_ P\MTC) Name: <br /> Address: 3cf 2-0 o fir. Address: X12 �� YAC! <br /> City: SV0 rN State: C6 City: ,L State: CA <br /> ZIP: `� S 21 � Ph#(20V `1� 0 -6 2.1'? ZIP: 9S2-( O Ph#(2&7) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( 26$ _ �3 <br /> Lic. No: Company Name: G�x1T� Ph#( <br /> 2 GSY <br /> Address: It I \rk ct fl : c oh st: zlP: SL !o <br /> LENDING AGENCY ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes dNo ❑ OFFICIAL USE ONLY 77 <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 county ordinancesand state laws relating to building construction. I authorize <br /> representatives of this city or county to enter the above-identified property for inspection purposes. <br /> Applicant's Signature Date <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\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) . <br />