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0o- �o BUILDING PERMIT APPLICATION <br /> 3V SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> U,k �A1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> 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: ✓ + (� ��y� 9) ��( 7 ee <br /> V <br /> Project Address: // yt�I WL$/ Lc(HG Lvnl Cc' I Cl4 Zc a <br /> Project Valuation: Contact E-mail: 'T C C r60( .Cid l <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: 1� (e tsLle 0(a0i Name: TvK 7-m / o l ck <br /> Address: 40 Address: <br /> Tn <br /> City: / State: City: S te� <br /> ZIP: Ph#,Z5-1 73 j,; ZIP: Ph#(:Z�Ij v2-71 " -17 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Com any Name: <br /> Address: % City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: _L -5 ' r�Ja/ PH � <br /> Address: City: l ec St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: I <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 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 /> 1 am ❑ a California licensed contractor or the property owner orauthorized to act on the property owner's <br /> behalf(requires written approval and Ow er/ uilder Verification F rm igned 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 counner toe above-identified property for inspection purposes. <br /> Applicant's Signature � � Date <br /> For your convenience the lists detailing any additional submittal requirements for vari us building permit types <br /> are available at the Build'fng Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:C4pplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />