Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> <•R�,i. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> 9 . <br /> 4FOR`' 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 /> BUILDJNG PERMITS. <br /> Scope of Work: Cj 5 p� <br /> 1 11 <br /> Project Address: <br /> Project Valuation. t-E D ODD) Contact E-mall: S f ec p- <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRES <br /> Name: S i!Y/ eAj Name: �G N QJ(lfJ <br /> Address: /� <br /> -� 5 '`�<—Ar'j lJt'� Address: <br /> City: �Ij State: (y' City: <br /> ZIP: j Ph#( ) ZIP: S P #(<�lJ� <br /> CONTRACTOR INFORMATION, Ph#( ) <br /> Lic. No: Q C <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: 14 U4 <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 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 /> 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 /> 1 have read this construction per pplication and the information I have provided is correct. <br /> I agree to comply with all applica county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or co ty o enter the abov id ntifed 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 /> list. <br /> I`Mpplication Forms&Handouts\HANDOUMBuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />