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 COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work:~tOJl (G)<GP(2.IJ'I l N f)JJ MH Ilq{Li ??PJP-/~ <br />Project Address:flflqq b.Wa-faloo (2d.=I (P{p1V,e-t?l.~~~I ~MUYI <br />OWNER NAME AND ADDRESS APPLICANT tiAME AND S <br />Name:t2a~t<tfJ WlC-Vt VC!lll::y •~Name:1';00 Discovery Bay !3~~~".:: <br />fO·B.v Discovery \::lay,v,":,".,...,..., <br />Address:lttOJ Address:'".11 "l'\ermltS.COm <br />City:tAndtn State:fA City:State: <br />ZIP:~~/}_~/"Ph#('ZD6J)QS2 ':312-'1 ZIP:Ph#(U1)Q'Z-3 ~"J' <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lie.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 0 No 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 APPLICANT <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner oNlf 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 c?unty t enter the above-identified property for inspection purposes. <br />Applicant's Signature r~~"--\/(J C:l Date \.~I\\10 <br />For your convenience checklists dett'ling 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 />F:\8UILDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of 2