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BUILDING PERMIT APPLICATION <br /> �:•.�=•foo <br /> 2 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 /> Scope of Work: C� <br /> Project Address: �j , <br /> Project Valuatio Coo Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Q Name: UfO\\on0 �`U5 <br /> Address: Vo w9\K -* 9 Address: [ S (_ <br /> City: Lcd State: C City:, C 1 State: ca I <br /> ZIP: co� 02,1-10 1 Ph#(qOq 73 ZIP: ZI Ph# ) 8 - 16 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: C, 7 Company Name: <br /> Address: „ City: � St: ZIP: <br /> --LENDING AGENCY P h# ) {j10 <br /> Company Name: <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 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 ❑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 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 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:1Application Forms&Handouts\HANDOUTS\Building Permit Appiication.docPage 1 of 2 'I <br /> (Revised(07-08-10) <br /> 1 <br />