Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> w A K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> Q�f ``.. P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 FOR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work; { . <br /> Project Address: npyback. ,� <br /> Project Valuation: Contact E-mail: My 2L6mo(D\ .Cc V � <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: ��22 LLCA)' p Name: V Ql <br /> Address: Address: <br /> City: - State: CA City: State: <br /> } ZIP: Ph# j ) ZIP: <br /> CONTRACTOR INFORMATION Ph#(Zoq) 3() C O <br /> Lic. No: q6'�)l 0. 4- Company Name: Vim( <br /> Address: To '-Box C( G City: UVB? Lt St�A .ZIP: q � <br /> DESIGNER INFORMATION <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 ❑ 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 /> rvy;my signature below, I certify to one of the following: <br /> k G3 <br /> a California iicemed contractor or❑ the property owner or❑ authorized to act on the property owner's- <br /> (requires written approval and Owner/Builder`Jerification Form signed and submitted). <br /> et <br /> atl this construction permit application and certify the information I have provided is correct. I also agf=ee to comply <br /> pplicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> Party for inspection purposes. <br /> t9nature Date <br /> t hience checklists detailing any additional suMrmttal requirements for various building permit types <br /> tttte Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> d°p \HANDOUTSOuilding Permit Application 1 2o15.dog- Page 7 of 2 <br /> - 9 <br />