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°p4"'"_ BUILDING PERMIT APPLICATION <br /> y {, SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> (!r ` 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> � '� BUSINESS PHONE: (209) 468-3121 <br /> ;�..le <br /> °a�' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHE,AP,PLICANT IN ORDER TO APPLY FOR <br /> BUILDING PER_ MIT& - <br /> /� <br /> Scope of Work: — ') <br /> Project Address: ��' /� <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME ND ADDRESS <br /> Name: Name: �( <br /> Address: Address: <br /> City: &— =Ph# <br /> City:ZIP: �%a ZIP: Ph# - <br /> CONTRACTOR INFORMATION Ph# ) <br /> Lic. No: Company Name: t n i <br /> Address: 7 City: al St: ZIP: %✓U <br /> DESIGNER INFORMATION' Ph# <br /> Lic. No: Company Name: r`/ <br /> Address: 5, dlz/ City: St: ZIP: j <br /> LENDING AGENCY Ph#( <br /> Company Name: 1 <br /> Address: City: P St: ZIP: Q <br /> Permit will be issued to an"Owner-Builder" Yes No.< OFPIC(AL USE,O,(Jt,Y T <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, l certify to one of the following: <br /> I anr'ga 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 the information I have provided is correct. <br /> I agree to comply with all applicable county or ' ces and state laws relating to building construction. I authorize <br /> representatives of this city or coun to ter he a ove-identified property for inspection purposes. <br /> Applicant's Signature_ (4 Date CZ <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 /> F:Vlpplication Forms&HandoutstHANDOUTMuilding Permit Appiication.docPage 1 of 2 <br /> (Revised(07-08-10) <br />