Laserfiche WebLink
BUILDING PERMIT APPLIGATI®N <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> m, { 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> R BUSINESS PHONE: (209 468-3121 <br /> <I FpR <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHE APPLICANT IN ORDER-TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: j�JL Stts \� <br /> Project Address: <br /> Project Valuation: Contact E-mail: nS \Vvv <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �j� Name: \ <br /> Address- _c} (k TU L Address: F �s Z7 C);—a=w_ C— <br /> City: U N ,0C---Vj State: c4 City:C;ryc ��J State: <br /> ZIP: c�Z�4� Ph#( ) ZIP: Ph#('Loi 0( (& - g&6 <br /> CONTRACTOR INFORMATION PhN <br /> Lic. No: Company Name: <br /> Address:. City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No:G„ 2 U• y Company Name: G1 `jc vl\d <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 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 /> 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 Date <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 /> FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />