Laserfiche WebLink
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 <br />BUILDING PERMITS. <br />Scope of Work:L;1/i1\..f\t<~.r!-~J ~B ,,\i~A.4-!yalcA Ad/'~/~ <br />Project Address:3723 Gu.",.L.~y.L C({.A1 B/v <br />v <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:MIA h DI H1 W\0\j ,,,AQ Lei L7 ,Q..y.,Name:~tAha.M MC\J S lAc;,{",L .L>J)'" <br />Address:-:5 3 0 I E M.11.p..,.fl-v.~Address:"5 ~(5 ,E"l'1,h'p"Av-e <br />City:<..fo0k+a--n State:C A--~5"2.D~City:~~t/k~State:~rt <br />ZIP:~)2-£>5 Ph#(261)b 5~-2-~b~ZIP:9 ~2-a~Ph#(~4~{j'1-'2...86 :) <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:st:ZIP: <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 />Permitwifl be issued to an "Owner-Builder"Yes ~0 .OFFICIAL USE ONL Y <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 APPUCANT <br />By my signature below,I certify to one of the fZ <br />I am 0 a California licensed contractor or the property owner or 0 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 enter the ~entified property for inspection purposes. <br />Applicant's Signature rVlu.L ~Date za /to <br />For your convenience checklists detailing any additional submittal requirements for various building permit types <br />are available at the Building Division counter.Demolition pennit and mobile home on foundation require check- <br />list. <br />F:\BUILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of 2