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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work: <br />Project Address: <br />Project Valuation: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />City: <br />ZIP: <br />Lic.No:jZ/ <br />ZIP:c:s-320 <br />DESIGNER INFORMATION <br />Lic.No:Company Name: <br />Address:ZIP: <br />LENDING AGENCY Ph#( <br />Company Name: <br />Address:City:St:ZIP: <br />OFFICIAL.USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes 0 No ~ <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 />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I am 'fXI'a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behaTi(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 city or county to en he above-identified property for inspection purposes. <br />Applicant's Signature_-",\,_~...l..L..J..L-~Date 0-2-c .;(;( <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 &Handouls\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07·08·10)