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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 />TffE Al':p'6fe;~'t((!}'N~t!!S~~8'G~);1l~~~f:6 <br />.-t ,.~.~••.,.",r,...#~••.-:.:••••J#~;..•...i.~""-.!_.~~;i.; <br />Scope of Work: <br />State:()k: <br />Ph#(Zfj )~34-~~ <br />Lic.No: <br />Address:st.ZIP: <br />Address:St(A-Zlp:q1. <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <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 />Identification Number: <br />By my signature below,I certify to one of the fol/owing: <br />I am 0 a California licensed contractor or D the property owner or dauthori:;ed to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Fo~gned and submitted). <br />I have read this construction per It application and the information I have provided is correct. <br />I agree to comply with al/app/i e county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or 0 nty to enter the above-identified property for inspection purposes. <br />Applicant's Signatur,_-r'-Date __~-'----_("-1"_-f_____'O=__ <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:lApplication Forms &Handouts\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-1 O)