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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 />Scope of Work: <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Project Address: <br />Project Valuation: <br />ZIP:Ph#( <br />APPLICANT NAME AND ADDRESSOWNERNAMEANDADDRESS <br />Name:"T]rn J-/.(//cl~rJ ~..- <br />Address:7r/1f 15'1 Pc/h~Address: <br />State:City: <br />Ph#(ZIP: <br />CONTRACTOR INFORMATION Ph#() <br />ue.No:~f~070 Company Name: <br />DESIGNER INFORMATION <br />City:A c:,?P7/~o St:ZIP:1"6z-zvAddress:I 5/w n d c£::/ <br />Ph#() <br />Lic.No:Company Name: <br />LENDING A<3ENCY <br />;,. <br />City:L-c:/d I St:ZIP:Address: <br />i Ph#( <br />Company Name: <br />Address:.,OFFICIAL USE ONLY <br />City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT r, <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and Owner!uilder Verification Form signed and submitted). <br />I have read this construction permit appli tion and the information I have provided is correct. <br />I agree to comply with all applicable nty ordinances and state laws relating to building construction.I authorize <br />representatives of this city or COUlJt/enter the above-identified property for inspection purposes. <br />Applicant's Signature 1/Date 'ihIf / <br />For your convenien/e checklists detailing any additional submittal requirements for various building permit types <br />are available at th/Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)