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jp <br /> BUILDING PERMIT APPLICATI®SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN1810 E.HAZELTON AVENUE, STOCKTON CA 9520BUSINESS PHONE: (209) 468-3121 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: ��� � <br /> Project Address: x <J <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: 11ll? 1 f !i/!/ " Name: <br /> Address:o `f OW Address: . <br /> City: fJ State: <br /> Clty: <br /> State.- <br /> ZIP: <br /> tate:ZIP: q U Ph#( ) ZIP: Ph#( ) <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 /> 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 /> 1 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 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 above-identified property for inspection purposes. <br /> Applicant's Signature Date <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> 'st, <br /> R:Applicaflon Forms&Handouts�HANDOUTS\Building Permit Applimtion.docPage 1 of 2 <br /> (Revised(07-08-10) <br /> y. <br />