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BUILDING PERMIT APPLICATION <br /> �.••Et••.off <br /> 'a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> koRt'`P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> ,,;THE APPLICATION MUST BE COMP..LETELY FILLED OUT BY,THE APPLICANT IN ORDER TO APPLY FOR BUILDING'' <br /> Scope of Work: vL ,✓Z ,Jb <br /> Project Address: y¢ '�S <br /> Project Valuation: Od Contact E-ma': <br /> OWNERNAME AND ADDRESS>- .-' � '' ' ' w `,APPLICANT NAME AND ADDRESS <br /> Name: Name: <br /> Address: rJ'y E Address: <br /> City- <br /> State:' <br /> 4&4-- City: State: <br /> ZIP: ct i Ph#(6/X4 ZIP: Ph#( ) <br /> z CONTRACTOWINFORM,ATION` ''` l 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 /> LENDINGAGENCY � � rv: Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> x OFFICIAL IJS,E ONLY • ,_ ,, <br /> Permit will be issued to an "Owner-Builder" Yes❑ No ❑ <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. Verified owner's identification: <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 orl authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification For,61 signed and submitted). <br /> 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, 1 authorize representatives of this county to enter the above- <br /> identified property for ins rposes <br /> Applicant's Signat re 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-list. <br /> F:\Application Forms&Handouts\Building Forms and Handouts\Building Permit Application 10-17.doc(Revised(10-6-17)Page 1 of 2 <br />