Laserfiche WebLink
�. <br /> "0.u`"• BUILDING PERMIT APPLICATION <br /> y• � � SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :•. 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE:-'209 468-3121 <br /> °Q4 e INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> Ltao RN <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: g f�_o 0 0 <br /> Project Address: 67,0 ti N) <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: U`d rU V" l'o r-- rJ Name: A� <br /> Address: c—C)(7�.� (^I Nfv v ��[V) Address: <br /> City V/Lt A1,v (t- State: ' ' R- City: State: <br /> ZIP: Ph#(apl qW-g7Lgi ZIP: Ph#( ) <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: <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 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 ❑ a 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 certify the information I have provided is correct. I 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 inspecti Fr rposes. <br /> Applicant's Signature Date <br /> For your convenie ce checklists de ailing any additional submittal requirements for various building permit types <br /> are available at tl� Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> F:1Application Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />