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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 />Scope of Work: <br />Project Address: <br />Project Valuation: <br />State:CA <br />QWN~R NAME AND ADDRESS <br />Name:Name: <br />State:CA <br />Ph#( <br />CONTRACTOR INFORMATION \Ph#( <br />Lic.No:Company Name: <br />st:ZIP:Address:City: <br />ZIP:~ <br />Lic.No: <br />Address: <br />Company Name: <br />City:.St:ZIP:Address: <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 />Identification Number: <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 0 inances and state laws relating to building construction.I authorize <br />representatives of this city or co ty t r e above-identified property for inspection purposes. <br />Applicant's Signature._-S-4,.....,.~.......,:.---;.p _ <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:\Application Forms &Handouls\HANDOUTS\Suilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)