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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 />Scope of Work: <br />Project Address: <br />;,,' <br />Name:00.../1/ <br />Address:Address:S.-J-;.-eu.... <br />City:State:Cq <br />ZIP:Ph#<;U()qlL/-OD5l.Ph#~t1~) <br />Lic.No: <br />6 r.s <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />Ph#( <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes 0 No D <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or D the property owner or 0 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 unty ordinances and state laws relating to building construction.I authorize <br />representatives of this city or cou t~0 ter th bove 'den'd property for inspection purposes. <br />Applicant's Signature Date S/L/j;( <br />For your convenience checklists detailing any additional submittal requirements for varioCs bUi~ng permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)