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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS.' Scope of Work: 2 CLC Project Address: k"roC T d Project Valuation: (D O ) Z� ' Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:. ' Name: j C n Address: Address Cl , fg Cjq j 0-7 C, City: State: City: " J State: C ZIP: Ph#(za) ` `�� ZIP: �` j 'Z ( c Ph#(-z r,) ` �t _ f�A � �Z-� C� CONTRACTOR INFORMATION : . Ph#(z, {) c, ,c-1 1 Lic. No: Company Name: Address: City: St: C ZIP: .6 DESIGNER INFORMATION Ph#( ) Lic. No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#(zQr) 13 7 2, � Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: 1 am [tea California licensed contractor or❑ the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). have read this construction permit application and the information 1 have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above-identified property for inspection purposes. Applicant's Signature �' Date 6 For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. F:1Application Forms&Handouts\HANDOUMBuilding Permit Application.docPage 1 of 2 (Revised(07-08-10)