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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: <br />OWNER NAME AND ADDRESS <br />Ph#() <br />Name: <br />Address: <br />City: <br />ZIP:CA Ph#(ZIP: <br />CONTRACTOR INFORMATION <br />Company Name: <br />City:rr~...-t:::\~St:CA ZIP:9.J"":).Os-'"Address:, <br />DESIGNER INFORMATION Ph#() <br />lic.No: <br />Address: <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No ~1-"'-__.....:o:.--"'''-'-'-''--....:::O''"'f.E="lJ''''!f~I=:~''''~-'"'·.u:"''''"S'-f;''-''~Q~N,'-~.l;;!~'---;1._'·.=.::..-"-"-"-~---i <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 />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 enter the above-identified property for inspection purposes. <br />Applicant's Signature ~9::?~Date 17--f'1-J /0- <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:lApplication Forms &Handouts\HANDOUTS\8uilding Pennit Application.docPage 1 of 2 <br />{Revised (07-08-10) <br />7