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BUILDING PERMIT APPLICATION <br /> y jI� 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 /> <lFOR� <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: 1? z /' erl <br /> Project Address: <br /> fir¢r" <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: <br /> Address: Address: <br /> City: State: City: State: <br /> ZIP: Ph#( ) ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION I-Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION -Ph#( ) <br /> Lic. No: zf2 / Company Name: e <br /> Address: /`7t- 2- City: 'ice, � 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 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 /> am ❑ a California licensed contractor-or - <br /> rthe property owner or E] authorized to act-on the property owner's <br /> behalf(requires written approval and.Own the <br /> Verification Form sigtled and submitted). <br /> I have read this construction permit application and certify the information I have provided is correct. I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature Date <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-list. <br /> F:Wpplication Fors&Handouts\HANDOUTSOuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised.(01-28-15) <br />