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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 /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER To APPLY FOP <br /> BUILDING PERMITS, <br /> Project Address:, <br /> Project Valuation:_ Contact E-mail: JT?Vj2—C 4-rK (Z 40 L CC 4-1 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Address: Address: 7�'7 <br /> CONTRACTOR INFORMATION rl,#( <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION ph#� <br /> Address: ly <br /> Company Name: tJ, 4. <br /> Address: Citv: St: ZIP. <br /> OFFICIAL U'3E ONLY <br /> Permit will be issued to an"Owner-Builder' Yes F1 No L� —------- <br /> If yes,a completed Owner-Builder Verification Form must Identification Numbei: <br /> be signed and submitted along will,copyof lhe owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION 13Y CONSTRUCTION PERNA11T APPLICANT <br /> By my signature below, I certify to orx,of the foliowii1c <br /> I am []a California licensed contractor or[-] the property owner or E 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 /> 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 /> F:'Niplication Forms a HandoutsVIANDOUTSkl3uilding penno Application.docPage 1 of <br /> (Revised(07-08-10) <br />