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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 /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: Wvrlf lj <br /> Project Address: j �/, o u'j w r 6 j t,,f,` <br /> Project Valuation: 3 0oContact E-mail: Jdb, r <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDR SS <br /> Name: TO Jw,k Name: <br /> Address: 1737-3 k flvejc, CJ Address: <br /> City: 64w,, State: C.9 City: State: <br /> ZIP: _1.A �� Ph#(,t,,y) A g . o yS t ZIP: Ph#( } <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder' Yes[9 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 /> identificationprior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, 1 certify to one of the following: <br /> I am ❑a California licensed contractor or® the property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and certify the information 1 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 zr . . Date /S~ <br /> For your convenien a 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 /> a <br /> F:Wpplication Forms 8 Handouts\HANDOUMBuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />