Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9, 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: /(fesx11,41 o �� �r/vn�� 7`7419� <br /> Project Address: 1 q gV 1 5 , , yv E:5"Z 0W 1.� 6 334 <br /> Project Valuation: �e7 Contact E-mail: <br /> OWNER NAM AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ® S!. VC Name: ! tF( f clw <br /> Address �y () ( N(� f2-67 Address: .14 O $a <br /> City: r-L6 d y'! City: 5a( e d State: CA <br /> ZIP: ZIP: ctS 3 G $ Ph#( W) 37 —`1 7 7 <br /> CONTRACTOR INFORMATION Ph#( --©q 3 <br /> Lic. No: �{/�, m)any Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: C)mp y 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 /> 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 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/Bu iiderVerification Form signed 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 Signat���� Date "/i!� <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 /> HApplication Forms&Handouts\HANDOUTStBuilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />