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 /> T <br /> Pp. LYTILLED OUT,BY THE APPLICANT IN -FOR <br /> .,:'BUILDING PERMITS. k <br /> Scope of Work: <br /> Project Address: <br /> t-n!Q-4rA 02AQ <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADpRE§S7 <br /> 777, 7777PPo;CAWNAM2 <br /> Name: Name, <br /> Address: 'Z,7,337 S? /3.,�. 7317 S. <br /> City: Tre-,z I State: city: kZ; I State: <br /> ZIP: Ph#(ewt) qHj-,�y' ZIP: Cl jp Ph#(-I,:-,) <br /> CONTRACTOR IN) RMATIPN: Ph#( <br /> LIc. No: Company Name: <br /> Address: City: St: ZIP: <br /> Ph#( <br /> _77.7 <br /> DESIGNER <br /> Lic.No: Company Name: <br /> Address: city: St:C'4 zip: <br /> Ph#( <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit Will be Issued to an"Owner-Bullder' Yes El No El <br /> If yes,a completed Owner-Builder Veriflcatlon Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> Identificatlon prior to Issuance of the building permit. <br /> DECLARATION BY CONSTRUCTjON PERM A <br /> IT PR <br /> I _ <br /> By my signature below, I certify to one of the following: <br /> I am [:1 a California licensed contractor or 10 the property owner or El authorized to act on the property owner's <br /> behalf(requires written approve]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 Date . q-10 - 13 <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,Mpplloatton Forms&HandoulsWANDOUT&BOdIng Permit ApplIcation.docPage I of 2 <br /> (RoAsed(07-08-10) <br />