Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f s? 1810 E. HAZELTON AVENUE, STOCKTON CA 85245 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER:(209)469-3165 <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: 2 9 -7 Lf <br /> Project Valuation_ Contact E-mal: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: vot,-,� T Name <br /> Address: 2-qq -71-t S �< e �e � Address: 5 f3 ,ter-t c .�t-c <br /> City_n c , State_C—A City: MaJole State: <br /> ZIP: 337 Ph#( ) '5"I-3- 'S6c5f&' ZIP: Ph--A( ) Llee,_ 3y2,9 <br /> CONTRACTOR IPI€ORNAIATIQN Ph#{ } <br /> Lic. No: yC)p ,3 j �AA Company Name: � Krc <br /> Address: `S 1 , v F v v ,c�,, Cityjvt� �,y S024 ZIP:O, 5- L <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, t certify to one of the following: <br /> I ani'Q 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 certify the information I have provided is correct. i also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. in addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. n <br /> Applicant's Signature lnzz/ ---, <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-list. <br /> F.LApplicatioff <br /> rms t&HandoutMHANnOUTS\euilding Permit Application 1.2915.doe Page 1 of 2 <br /> z:�ReVise6 16) <br />