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BUILDING PERMIT APPLICATION <br /> ).•SEE coG <br /> N {•y^ 21 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468.3121 <br /> c•`t'ikoR`''P 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: vw� ibo' ti <br /> Project Address: (0 3 ( <br /> Project Valuation: Contact E-mail <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: t�y�Cs <br /> Address: Address: <br /> City: State: <-- City: State: <br /> ZIP: Gj j2/ S Ph#( ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) 31 -Z/(J c7 <br /> Lic. No: f j�j�C� Company Name: %./ 61 <br /> Address: u 36 c ze-Lei I <br /> City: 1 l St: ZIP: `i.5 Z( 2 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <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 /> I amp9la California licensed contractor orphe 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 a lication and the information I have provided is correct. <br /> I agree to comply with all applicabl ounty ordin no s and state laws relating to building construction. I authorize <br /> representatives of this city or co to enter th ove-identified property for inspection purposes. <br /> Applicant's Signature Date z <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available ot'the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> ` F Wppllcitlgn Forms&Handouts\HANDOUTSTuilding Permit Application.docPage t of 2 <br /> =``(RevisQd(QT68 f e} <br /> r <br />