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BUILDING PERMIT APPLICATION <br /> e ? 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 FOR <br /> BUILDING PERMITS. <br /> Scope of Work: ` <br /> Project Address: <br /> Project Valuation: Contact E-mail: z <br /> c <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �� � c. Name: c. <br /> Address: c' t G n - c Address: <br /> City: �, r �p,V State: City: State: <br /> ZIP: ef5 Ph#(. - c; ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: � t� Company Name: cf�� y4 'C 4f <br /> Address: City: / o 'e°r- St• ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <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 [fl/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 owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature <br /> sig/nature below, I certify to one of the followi <br /> 1 am L{f.'a California licensed contractor orthe 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 tto enter the above-identified property for inspection purposes. <br /> Applicant's Signature,/ Date <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 /> list. <br /> FAApplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />