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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST -24 HOUR RECORDER:(209)468-3165 <br />Scope ofwork:7Att <br />Project Address: <br />QWNeR NAME AND AQDRESS ,. <br />Project Valuation:Contact E-mail: <br />Name: <br />CON:rRACil'OR INFORMATION <br />Company Name: <br />Lie.No: <br />Address:City:St:ZIP: <br />Ph#( <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 <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. <br />By my signature below,I certify to one of the following: <br />I am E>3a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />beha7i1'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 this ci y or county to enter the above-identified property for inspection purposes. <br />Applicant's Signatur~_~~~=----\.Ao~n~~~=-Date~_~_...:..\....:.t _ <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 />F:\Application Forms &Handouls\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07·08-10)