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BUILDING PERMIT APPLICATION <br /> Q IIS SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> yi. -- •� _ 4810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> c�<fkoR `P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> .PERMITS. <br /> Scope of Work: G) J l�i ^�Oi t °� Gr� / <br /> Project Address: <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: � ' v r�� Name: <br /> Address: ; . 2 Address: �d <br /> City: :il State: 4A City: State: C' <br /> ZIP: Ph#(v�I7) $� d(� •02 71P: Ph#• ,l'Z) 66 cl,� <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: Owh �2 �� City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( <br /> _Lic.. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY r Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP <br /> Permit will be issued to an "Owner-Builder" Yes D4No ❑ 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 /> am F-1 a California licensed contractor ort property owner-or E] 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 certify the information I have provided is correct. r also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature * z2u (/� Date <br /> Por 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-list. <br /> • Mon Forms&Handouts\HANDOUTSOuilding Permit Application 1-2015.doc Page 1 of 2 <br /> '(0148-15) <br />