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BP-1600368
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BP-1600368
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Entry Properties
Last modified
5/24/2021 10:32:10 PM
Creation date
12/2/2017 8:04:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
BP-1600368
STREET_NUMBER
31011
Direction
S
STREET_NAME
KOSTER
STREET_TYPE
RD
City
TRACY
APN
25529001
Supplemental fields
FilePath
\MIGRATIONS\K\KOSTER\31011\BP-1600368.pdf
QuestysFileName
BP-1600368
QuestysRecordID
3287630
QuestysRecordType
1
Tags
EHD - Public
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BUILDING PERMIT APPLICATION <br /> e fl al SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> nq <br /> BUSINESS PHONE: (209) 468-3121( )INSPECTION REQUEST-24 HOUR RECORDER: (209 468-3165 <br /> L,FBR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: I vL o CS i o T DJ T <br /> Project Address: _ <br /> Project Valuation: Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:_J01'... v K Name: U C <br /> Address: 3�Q © � —c�/L Address: l S C� v x <br /> City: State: City: � State: <br /> ZIP: Ph#(ql(a) Saj _7T,5-LI ZIP: GtG36L4 Ph#( ) <br /> CONTRACTOR INFORMATION- Ph#(may t�,`j _ U <br /> Lic. No: . Company Name: <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 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 construc(ion 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. <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-list. <br /> I'Mpplication Fonns&HandoutslHANDOUMBullding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />
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