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�urN 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 /> c��rFoa��P INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: j <br /> J✓ r, <br /> Project Address: <br /> Project Valuation: f <br /> 1 0 Contact E-mail: �• �, <br /> WNER NAME AND ADDRESS <br /> APPLICANT NAME AND ADDRESS <br /> Name: I <br /> b �� fl� <br /> �L'. Name: Pq <br /> Address: Address- - <br /> �,, J <br /> City: ) State: City: Stater <br /> ZIP: c3 Ph#(qq f Zip: Ph# ) b <br /> CONTRACTOR INFORMATION Ph ( ) <br /> Li . No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( } <br /> Lic. No: any Name: <br /> Address: <br /> City: <br /> St: ZIP: <br /> LENDI G AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes❑ 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 below, I certify to one of the following: <br /> I am ❑ a California licensed contractor--or Q the property-owner or /authorized to act-on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form=sigped and submitted). <br /> I have read this construction permit application and certify the information I have provided is correct. I also agree to l <br /> compy <br /> with all applicable county ordinances d state laws which govern this project. During the course of construction 1 will also <br /> takes steps to preserve all surveym uments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection p oses. <br /> Applicants Signature Date Z1j l <br /> For your convenience checklists detailing any additional submittal requirements for varlou building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> F:\Application Forms&Handouts\HANDOUTS1Building Permit Application 1-2015.doc <br /> (Revised(01-28-15) Page 1 of 2 <br />