Laserfiche WebLink
l <br /> BUILDING PERMIT APPLICATION <br /> z ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> < :< <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 � <br /> BUSINESS PHONE: (209) 468-3121 <br /> " • 'N`" INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> 59.6 <br /> a <br /> c <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: s <br /> „' Project Address: ” 1 € .� Z Co- <br /> Project Valuation: ContactE-mail:At -IAA- zCl� ,te n C<7-u51 <br /> OWNERiNAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:, v �T7 � Name: <br /> Address: } s , v j�,a y u Address: ;?l, e) ,, 4 <br /> City: XX� State:- City: 'r l Ll v ./ State: e,154 <br /> ZIP: ZIP: 4,;5;2, <br /> CONTRACTOR 14POAMATION Ph# ) <br /> Lic. No: 976 S Company Name:/ t,A,r 0 G x 17 y !! <br /> Address; JG City; !, � t ll ✓ St P_ ZIP:c% - 4r <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No:C '4 0 1 Company Name: /�rjf P-rz-, /h' Z/,_ 6 /Ii-' <br /> Address:,</ /,y; 15�17/31,0 City: � �� St:,�'/ ZIP: <br /> LENDING AGENCY <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 amCalifornia licensed contractor or❑ the property owner or E] authorized to act on the property owner's <br /> beh If(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 enter the above-identified property for inspection purposes. / <br /> Applicant's Signature ,,144 v f Date <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available of the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:Wpplication Forms$Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />