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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />TAE Al?Pbfc.~1"J(ra~tJ,S~~~~MI?,h~~~ <br />..~:_''''~:~''h~'''''AIa.o.{'''''_'h~';.~,,:.•..J,. <br />Scope of Work: <br />Project Address: <br />Project Valuation: <br />Name:Name: <br />Address: <br />City:City:State: <br />Ph#(ZIP:ZIP: <br />Ph#( <br />Lic.No: <br />St:ZIP:Address:City: <br />Ph#( <br />Lic.No: <br />Address:St:.ZIP:City: <br />Ph#( <br />Company Name: <br />Address:St:ZIP: <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 />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or ~the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and owneVsuilder 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 co nty to enter e bove-identified property for inspection purposes. <br />Applicant's Signature Date I~/10, <br />ditional submittal requirements for various ;ildi~9 permit types <br />Demolition permit and mobile home on foundation require check- <br />F:\Application Forms &Handouts\HANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)