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BUILDING F'ERi1l117 APPLICATION <br /> ..e <br /> wa SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> { <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> '<iFOR INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN 0 IER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: <br /> Project Address: Y �G ��� �nNl� (VA . <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: A, All ZFVA/_0 Name: SAIme- <br /> Address- C AV(, Address: <br /> y fi�c �� State•-�%t. m,_._._ ___.-Cify:.e. _ State: <br /> ZIP: j' h Pn#Y' ) f6q/1� zip: Pn#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lie. No: Company Name: <br /> Address:_ City: St: ZIP: <br /> DESIGNER INFORMATION 77 Ph#( ) <br /> Lic, No: Company Name: <br /> Address: City- St: ZIP: <br /> LENDING AGENCY Phil( ) <br /> Company Name: <br /> Address: <br /> 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 owners <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 am ❑ a California licensed contractor or❑ the 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 app c io and the informati I have provided is correct. <br /> I agree to comply with all applicable inances and sta law relating to building construction, I authorize <br /> representatives of this city or county t the above-identi d pr party for inspection purposes_ <br /> Applicant's Signature ^oo Date <br /> For your convenience checkli s ailing any additi al submittal requirements for various building permit types <br /> are available at the Building D v'si n counter. Demo iti n permit and mobile home on foundation require check- <br /> list. <br /> F:Wpplicafion Fonns&Handouts\HANDO S\Building Permit Appiication.docPage 1 of2 <br /> (Revised(07-08-10) <br />