Laserfiche WebLink
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 />INSPECTION REQUEST -24 HOUR RECORDER:(209)468-3165 <br />THE APPLICATION MUST BE COMPLETEL Y FILLED OUT BY THE APPLICANT IN ORDER TO APPL Y FOR <br />BUILDING PERMITS. <br />Scope of Work:~PUJ QpSlb12:A.hfA.L <br />Project Address:2?-3CfS N,KeflvteR'c.l ~.WLI rA P.fI,3L <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:V\A'C\:4 ArE L X)u"""Name:VV\lL~A-~\......Uu,vtJ <br />Address:"2 ~39 s:IJ.K-et'\I'1~C.k..~J.Address:-;t 1-~9 S N.~AJ IJ~F-'Cc 1<c!, <br />City:(OA cr:State:(!.A City:(;AL.T State:Crt- <br />ZIP:9S"fo3L Ph#(Z01)11 Z.-310 -Ie.ZIP:9St..3L Ph#(lbf)'1-f2-Sb Vb <br />CONTRACTOR INFORMATION Ph#() <br />Lic.No:Company Name: <br />Address:City:st:ZIP: <br />DESIGNER INFORMATION Ph#CZIJj}51:.8--~/II~ <br />Lic.No:SCL 2$'¥bcfr Company Name:~vGlA.5 \1'CI-I ;=-,L c,~AJST,5'G€'VICE"S <br />Address:City:LOD I st:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes D No D OFFICIAL USE ONL Y <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 D a California licensed contractor or D the property owner or D 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 county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature Date <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:\BUILDING\HANDOUTS\Building Pennit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2