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op�vlN BUILDING PERMIT APPLICATION <br /> y' r <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i. ur5, 4810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> cat)FORi+`• 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: ( <br /> 1 <br /> Project Address: 5;l 0 3 <br /> 1 <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND.ADDRESS <br /> Name: Name: <br /> Address ., Addres g <br /> City:'11 _ o. Stater City: State: <br /> ZIP: Ph µ ) z .� ZIP: P ) <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#( ) <br /> Company Name: u v <br /> Address: City: St: ZIP: <br /> - <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 /> am `LJ a California licensed contractor or® the property owner-or ❑ authorized to act on the property owner's- <br /> behalf(requires written approval and OwnerlBuilder Verification Form signed and submitted). . <br /> I have read this construction permit application and certify the information I have provided is correct. r 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&Handouts4HANDOUTS�Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />