Laserfiche WebLink
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 <br />BUILDING PERMITS. <br />Scope of Work:'~<.-hl_tn fi'r\v\.?l MH ~\-vv"v\O -fruVltio.t1em(f2eolauJ11P//1) <br />3055':J-.E~f2iver 12c1.',, <br />Project Address:<C.s CAJ!fJY'\ <br />OWNER NAME AND .t\DDRESS APPLICANT NAME AND ADDRESS <br />Name:11m Mrtir1.c..e vi o'~iY CItYCn-*Ll nName:V~ <br />Add ress:"-?nS S 1 f-.~.V Q,(k:.v Address:ID~5/nYI ,'(}Il1~t1K'r1 a. <br />City:~WftY1 State:City:[;X:S aJYeM 0J.Jj State(A <br />ZIP:~S-~~D Ph#(2D1)6fOf~3 \~~ZIP:qt.f <o r;U J Ph#~qJ~:JOIcrycy <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#()I <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 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 0 a California licensed contractor or 0 the property owner o~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 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 />represenlalives of Ihis city or county to enter the above-identified property for inspection purposes.r ~ <br />Applicant's Signalure--O'Lc:--='l RS Date !!hi 1/ <br />For your convenience checklists detailing any additional submittal requirements for vario~'buhding permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\8UILDING\HANDOUTS\Building Permit Application.doc <br />(Revised 1-23·09) <br />Page 1 of2