BP-1500498 - Laserfiche WebLink

Home Browse Search

BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT jj• 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: -r .fn Vn,J 'Doo n a Project Address: v : e' ZU a /}c e, 52Z 0 Project Valuation: K t7 Contact E-mail: 5 ,tu5 Fool S na, c n. OWNER NAME AND ADDRESS APPLICANT NAME AND DDRESS Name: ( Kc�r 4 5�� Name: [e,, &c L,, Address: 22 904 Af I�� ewG I?d Address: 1113 ' 1,'.v 2cl City: ACaM State: C City: ' (� C n State: 0,4 ZIP: UT2210 Ph#(ZPu )3A- so3o ZIP: RiZ31 Ph#(,-o$ ) Soy -7SH( CONTRACTOR INFORMATION Ph#(2,,a ) Su . -)YS-t( [ Lic. No: Company Name: onC C n 6 A Address: 5 Ft ,,^ Qom( City: Franc [' V St: C4 ZIP: 9 SZ 3 } DESIGNER INFORMATION Ph#( ) Lic. No: Company Name: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: Address: City: St: ZIP: Permit will be issued to an "Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am da California licensed contractor or❑_the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit applicatiorr and certify the information l have provided is correct. I also agree to comply with all applicable county ordinances and state-laws which govern this project. During the course of construction I will also takes steps to preserve all survey m uments. In addition, I authorize representatives of this county to enter the above- identified property for i spection p poses. Applicant's Signature Date vZ 113/1 S For your convenience checklists d4dailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. FAApplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 (Revised(01-28-15)