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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENU E,STOCKTON CA 95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />ScopeofWorlc (N)511\.lC.1LE..f'AMIL' <br />Project Address:(,00 N /"1Vf f.~'}r(0 <br />Ph#(ZtJ1)q~0~ <br />Contact E-mail:G <br />Name:Name: <br />Address:p.O <br />City:City:51CC'(-rON State:a.,q <br />ZIP: <br />Ph#() <br />Lic.No: <br />St:ZIP:Address: <br />Lic.No: <br />ZIP:qSZ/Address:'33W <br />Company Name: <br />Address:sr ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No txI <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 />Identification Number: <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or D the property owner or j&J 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 ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to e ter the above-identified property for inspection purposes. <br />Applicant's Signature--;7.2S~f::::t..~~:::jC:ID.:~~:-Date_-'-I0-lJc....:Z=-tf-,/(........I....:/O"--_ <br />For your convenienc che lists detailing nyad itional submittal requirements for various building permit types <br />are available at the Building Division counte.e olition permit and mobile home on foundation require check- <br />list. <br />F:\Applicatioo Forms &Handouts\HANOOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)