Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> N` <br /> ,I :{ <br /> e: �� j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> F t . 4810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> ° BUSINESS PHONE: (209) 468-3121 <br /> oy• ``4 INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> <IFOR� <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> .PERMITS. <br /> Scope of Work: /� f/S ETA <br /> Project Address: —�j IdO <br /> Project Valuation: Contabt E-mail: <br /> OWNER NAME AND ADDRESSAPPLICANT NAME AND.ADDRESS <br /> Name: C (' 2 i`;; Name: ) n[t> <br /> Addres rj 6 R S_ � . Address: ' G <br /> City: Statef City: xa� State: <br /> ZIP: Ph#( ) ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( Q -7 c—n L4 I <br /> Lic. No: Company Name: h�S S . vim r✓ <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> -Uc_ 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-ownerngy�y authorizes to act on the property owner's- <br /> behalf(requires written approval and Owner/Builder Verification Fo pa signed and submitted). <br /> I have read this construction permit application and certify the information I have provided is correct. r 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 suruey numents. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspecti poses. <br /> Applicant's Signature Date —? — l �f <br /> For your convenieV a checklists detailing any additional submittal requirements for various building permit types <br /> are available at th6 Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> F:N,pplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />