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 BYTHEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: 10ee/1,1ad44eQ 1 <br /> Project Address: '20q 2,1) V.// s C CGLGIa,2 5 Z Z O <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: t ' Name: M d.(!_, -ev cz— <br /> Address: 2-6 5 ore. Address: . s&- L ''e�L <br /> City: CG State: City: w0 a6 C , State: cN <br /> ZIP: 95 2Z Ph#(26q) 27. j S-7 ZIP: 61575�1 Pn <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic, No: Company Name: RD vl QAC/I,eIZ <br /> Address: 402� A Y City: �j�OCKy ) St:6A ZIP: q5?C T <br /> L <br /> LENDING AGENCY Ph#(2ljj) 5 g 21 <br /> Company Name: <br /> Address: City: St: ZIP: <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 owners <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 ❑a California licensed contractor or❑ the property owner or❑ authorized to act on the property owner's <br /> beffalf(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 /> representatives of this city or county to enter the above-identified property for inspection purposes, <br /> Applicant's Signature (/GOI Date A0 • L�. /3 <br /> For your convenience chec lists detai ng any additi nal submittal requirements forvarious building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check. <br /> list. <br /> R%Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 oft <br /> (Revised(07-08-10) <br />