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Application - Building Permit <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.HAZUTON AVENUE,STOCKTON,CA 95205 <br /> BUSINESS PHONE(209)468-3123 <br /> REQUEST FOR INSPECTION PHONE(209)4663165(24 HOUR RECORDER) <br /> THIS SECTION IS TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF. <br /> SITE LOCATION INFORMATION Technlclan: rC 6c Date: 3, —�� <br /> EPrecise <br /> ess: 17 2 APN: <br /> City: ZIP: <br /> tion: 41 <br /> e, Zl,/— c <br /> THIS PORTION OF THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR PERMITS <br /> REQUIRED TO BUILD A COMMERCIAL STRUCTURE. <br /> 5 <br /> 1.-/CTT_ <br /> Scope of Work: 5� u <br /> r <br /> Business Name(DBA): c. No: <br /> OWNER NAME AND ADDRESSAPPLICANT NAME AND ADDRESS <br /> OV Name: Z C r% ✓ �6 ,v (— Name: <br /> Address: Address: <br /> City: <br /> State: City: f 0 N�V T— State: C <br /> ZIP: Ph:( ) ZIP: PhP b.-) ..)_3 1 ] l I <br /> CONTRACTOR INFORMATION Ph:( ) <br /> Llc. No: C)Wv1P_r �'LJ CL� �Y Vie: <br /> I <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph:( IS) O a <br /> Lic. No: Company Name: P L' <br /> Address: 1`112 ' J L City: ( V E?X__ln�EL— St: ZIP: <br /> FACILITY WFORMAT10N <br /> Water Supply Existing On-Site Well: New On-She Well: Public: <br /> Sewage Disposal Existing Septic System: New Septic System: Public: <br /> Storm Drainage No Change: New On-She System: Public: <br /> Driveway/Access Existing Driveway: New With Curb Gutter: New Without Curb Gutter <br /> WHO MAY APPLY 4 <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. <br /> Owner-Builders must submit the following with their application: <br /> A property tax statement or a recorded deed <br /> A completed and signed'Owner-Builder Verification'form <br /> A completed'Authorization for Application'form if other than the owner applies. <br /> Contractors must submit the following with their application: <br /> Current license numbers and a worker's compensation insurance certification (this is not necessary If this information Is already <br /> on file with the Department) <br /> A waiver form if the contractor is not subject to worker's compensation laws <br /> A completed'Authorized to Sign'form if other than the contractor applies (this is not necessary if this information is already on <br /> file with the Department). <br />