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r <br /> 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 /> C9�1FO�a`R 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 RMITS. <br /> Scope of Work: a <br /> Project Address: <br /> Project Valuation: Contact E-mail: z1yjf <br /> OWN R�N,AME AND ADDRESS APPLICANT NAME AND ADDRESS, <br /> Name: Name: <br /> Address: WN <br /> Address: <br /> City: �, State: �� � City: ��� : State: <br /> Ph#01F, ZIP: r` Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: �t Jy tis am <br /> Address: City: 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 ❑ 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❑the 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 ounty ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or cou to enter the above-iderltified property for inspection purposes. <br /> Applicant's Signature < . {t % Date <br /> For your convenience c ecklists 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 Foms&Handouts\HANDOUTS1Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />