Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> y 2� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> �A�IFOR��P• INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATIW MUST BE COMPLETELY FILLED OUT BY THEA IN ORDERT O AMPLY FOR y; <br /> HUlLDING PERMITS ' <br /> Scope of Work: <br /> Project Address: p G <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS , gPPLICAN( NAM'IIE qN4 ADDRESS <br /> Name: S Name: <br /> a <br /> Address: o. i3d ic>ao Address: <br /> City: �n� State: (1cl City: Lih State: <br /> ZIP:C .�3 Ph#(20$) ,< 79 j ZIP: 95-'2, Ph#(_per `54 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER IT�F,ORMATION �j Ph#( ) �6 i _ ;1(11 <br /> Lic. No: Company Name: <br /> Address: 3)2 S Cl y: a St: c ZIP: � z tyv <br /> LENDING, ENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes,KNo ❑ 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 CONSTRUCjIONf?ERMIT APPLICANT,, . ; . <br /> . , <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor ors he 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 cou Xordinances and state laws relating to building construction. I authorize <br /> representatives of this city or contfiter the above-identified property for inspection purposes. <br /> Applicant's Signature Date <br /> For your convenience ecklists detailing any additional submittal requirements for vaPous ding permit types <br /> are available at the ilding Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />