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 ofWork:lPt1vuf3~~/OOO6Al L.t5'~i\+IAC,1)ltSe I to ~C(sl,t1{.1nsk113-)o DOo6\~L A-sr ~ift.,"'Drt:se/. <br />Project Addr~'"l:'":'C ~~.Thorfl-M,t"\JRJ..LDJ i cA q~d-~d-- <br />Project va~ion::t SOD 1000 ")Contact'E-mail:!krOf't.bictenS'o({;)Pilof4m.llel(e,tlu~·.CorV1---OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:P;/lI +-'PItA II\~0·Name:P,/Ot-F/~tAa,\T. <br />Address:S5 D~ULt)~qs U.Address:Set m e.V ~s.OWfler <br />City:lLh o'){vi l\.e State:TN City:State: <br />ZIP:37 ,D~Ph#(J>65)588 ~7'1 ~F ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:i't?h Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#('foi)1../fa7.?7 tJ 7 <br />Lic.No:c:.~IDY7 Company Name:C6r~6~i-e5 6:roLA.D <br />Address:'1Yt)l C '€.-""-I 're JCtk~~.s/e.\j3D City:Dnkn (),St:C,+-ZIP:11'7~I <br />LENDING AGENCY Ph#() <br />Company Name:tJ/if- <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No ~OFFICIAL USE ONL Y <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 D a California licensed contractor or D 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 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 ~tJaLV Date 3/"/JI <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:\Application Fonns &Handouts\HANDOUTS\Building Penn it Application.docPage 1 of 2 <br />(Revised (07-08-10)