Laserfiche WebLink
"gut" 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 /> • �''' `ia` INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> 4��FOR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: NJ n e ( S` c:5y,k< <) <br /> Project Address: 7o -1-i E-- Te 14, c <br /> Project Valuation Contact E-mail:cle*4 Al✓:/diP74 s <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ✓tJ o C���1 C Name: <br /> Address: —70f f E, ����C� /2-1-V Address: <br /> City State: 411Q City: State: <br /> ZIP. Ph#( ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: j JGd7v Company Name: 7 I el .0-7 <br /> Address: / tv' �! efet�--i City: A St: ZIP7hZ <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: L v St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: fiat-, <br /> Address: City: S : ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes ❑ OFFICIAL USE ONLY No ❑ ---------If yes, a completed Owner-Builder Verification Form must Identification Number.- <br /> be <br /> umber:be signed and submitted along with copy of the owner's <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 /> 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 /> have read this construction permit applicption and the information I have provided is correct. <br /> I agree to comply with all applicable my ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or county- enter the above-identified property for inspection purposes. <br /> Z- <br /> Applicant's Signature_- 1/ Date Z_ <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 8 HandoutMHANDOUTSOuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />