Laserfiche WebLink
aR•'A�u`" BUILDING PERMIT APPLICATION <br /> �ee>a•''flo\ <br /> ' ,t t, 'Kt SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 11, 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> L✓g <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: S l u L <br /> Project Address: Z� V �S�al�v�. <br /> Project Valuation: Contact E-mail: J b\�)i ud-(,4v# CD <br /> OWNER NAME AND ADDRESS APPLICANT NAME' AND ADDRESS <br /> Name: Name: O <br /> Address: Z d Address: 41454V, YYtrzr1 !1U. <br /> City: State: City: j State: e:�Ot. <br /> ZIP: sj?s/n Ph#V9) J�lYlo� ZIP: 9 S3 S� Ph#2,0 <br /> CONTRACTOR INFORMATION Ph#(2 S j/ / <br /> Lic. No: 3 p (� Company Name: DULY' Ut J (INCL , <br /> Address: City: 'J. St:4, , ZIP: <br /> DESIGNER INFORMATION Ph#(&'� <br /> Lic. No: Company Name: Q oC-1 <br /> Address: SCJ City:-, St: ZIP: 3 <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No 91 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 /> 1 am 19a 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 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:\Application Forms 8 Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br />