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 />". <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS.I <br />'"Scope of Work:$p,1~t...ov~}s})'O)~)OJ)-1"0 Lq,()1ft I '\..J 1L1 L '1 .«L.Q}J'I ~f\~lor. <br />Project Address:'l)OV Y 1·~:0..,.('1 f75!?V I "Curl V£..~\\.-so ')) <br />Project Valuation:~)<11)0 Contact E-mail:cOj.JVb'v?5~III <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:LovE DE..E~<:;,t)\--tl.../Name:')"11 G-t:IJ7Z .Sf V/1u <br />Address:~L>0 ~'So ~L-bDlRu ST'Address:'6 bt)Y ),£1--po0 ~, <br />City:j::!fifiC/1 c IV1 (J State:C--IC}City:I:::j2..,lJ C /r CCj)L((J State:CtllJ... <br />ZIP:9 S:2 ~I Ph#(~df):2-07-8"621,ZIP:q S-:2.~(Ph#(t.vy)'2-07.Jt62..6 <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name:~r1~?Jv L..~d <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:SI:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:T SI:ZIP: <br />Permit will be issued to an "Owner-Builder"~~No 0 OFFICIAL USE·ONL Y' <br />If yes,a completed Owner-Builder Verification orm 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 />PECLARATION 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 ~authorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification rm 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 ~!Jtt/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 />F:lApplication Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)