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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 /> c'<ikoR `P INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY-THE'APPLICANT IN ORDERTO APPLY FOR <br /> BUILDING PERMIS. - <br /> Scope of Work: �I <br /> Project Address: L7 <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: vee Name: <br /> Address: Address: <br /> City: , - State: City: _ State: <br /> ZIP: Ph!Ph#( ) ZIP: e ) � G <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: sf Company Name: S' �.-� 41— G4r-1 <br /> 41 <br /> Address: / City: J Stc,�— ZIP: --_- <br /> . . <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 ❑ 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 theproperty owner's <br /> behalf (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 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- <br /> list. <br /> FMpplicetion Forms&Handouts\HANDOUTS\Building Permit Application.docPage i of 2 <br /> (Revised(07-08-10) <br />