Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> U ,ry •u{ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> ' BUSINESS PHONE: (209)468-3121 <br /> 9'•—. INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> �reoR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Z 140 jeyn Foc�Kcfc lti6v� <br /> Project Address: 5�( 3aw F �tVee1 ti, C6 85304 <br /> Project Valuation: Contact E-mail:d&ve(F) eUztric, Cove, <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: –DpJ t-> -k Mor CA jEPS� Name: 5 q <br /> Address- _5740 FoR,0 j4 Address: <br /> City: 'bo-o+c— State: CA City: State: <br /> ZIP: gs30 ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. 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 ❑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 owners <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 RL 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 /> 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 <br /> ,city <br /> (�o_r county to enter the above-identified property for inspection purposes- <br /> Applicant's Signature �'1 ok.'4— Date <br /> For your convenience ch cklists d ailing 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 /> FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br /> J <br />