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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 COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work: <br />Project Address: <br />Project Valuation: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />City: <br />ZIP: <br />Lic.No: <br />Lic.No:Company Name: <br />LENDING AGENCY <br />City:St:ZIP:Address: <br />Ph#( <br />Company Name: <br />OFFICIAL USE ONLY <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No ~ <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I am lK1 a California licensed contractor or 0 the property owner or 0 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 th ve-identified property for inspection purposes. <br />Foryourconve <br />are available <br />fist. <br />~~~~~~Date 6Lij2QIj <br />a itional submittal requirements for various building permit types <br />Demolition permit and mobile home on foundation require check- <br />F:lApplication Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07·08·10)