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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 COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />City: <br />ZIP:Ph#( <br />CONTRACTOR INFORMATION <br />Lic.No:Company Name: <br />Address: <br />DESIGNER INFORMATION <br />Lic.No:Company Name: <br />Address: <br />LENDING AGENCY <br />Company Name: <br />Address: <br />APPLICANT NAME AND ADDRESS <br />City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />OFFICIAL USE ONLY <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or D the property owner o~uthorized 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 pe application and the information I have provided is correct. <br />I agree to comply with all app .e county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or.co ty to enter the above-identified property for inspection purposes. <br />Applicant's Signature+-~p--======-oate._=fL::...•.._1_l.....:."fO-=--_ <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:\BUllDING\HANDOUTS\Building Permit Application.doc <br />(ReviSed 1-23-{)9) <br />Page 1 of 2