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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 />THE APPLICATION; MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br />PERMITS. <br />Scope of Work: Ofad OWSTIZVC-71-tal�: N rMrL i( L <br />Project Address: GI Z <br />Project Valuation: 3�5 a®O. � <br />Contact E-mail: -rWo^L-ocP—rAQj1 <br />OWNER NAME AND ADDRESS <br />APPLICANT NAME AND ADDRESS <br />Name: U VA A <br />Name: W OA K1 <br />Address: aS3 U-ro6Z-N1A 45-t . <br />Address:zJ C&I F0R0Ak S-. <br />City: AL '" <br />State: M <br />City: e�,C-^L j� <br />State: 64 <br />ZIP: S3Z-0 <br />Ph#M) m®oZ&& <br />ZIP: :jZO <br />Ph#1&J 83S-0Z&l0 <br />CONTRACTOR INFORMATION <br />Ph#( ) pj <br />Lie. No: <br />Company Name: <br />Address: <br />City: <br />St: ZIP: <br />DESIGNER INFORMATION <br />Ph#( ) <br />Lie. No: g�y�QS j Company Name: C®o�6T <br />Address: " F V FU S Avr- - <br />City: OI�DrA <br />St: CA ZIP: ;jZ a <br />LENDING AGENCY <br />Ph#Voq 6213 ®� <br />Company Name: <br />Address: <br />City: <br />St: ZIP: <br />Permit will be issued to an "Owner -Builder" Yesy@��No ❑ <br />If yes, a completed Owner-BuiideFVerifi-- - Fbrm must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />OFFICIAL USE ONLY <br />Identification Number: <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 orVithe 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 certify the information I have provided is correct. I also agree to comply <br />With all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br />takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above - <br />identified property for inspection purposes. <br />Applicant's Sig re Date 2 _ <br />For your nvenie the fists detaili any additional submittal requirements for various building permit types <br />are avails a Buil ng Divisi counter. Demolition permit and mobile home on foundation require check -list.' <br />F:1Applicatlon Forms & Handouts\HANDOUTS1Building Permit Applic <br />(Revised (01-28-15) <br />