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BUILDING PERMIT APPLICATION <br /> ( j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTONCA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> actF 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: h� chw <br /> Project Address: J <br /> Project Valuation: dd Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: > Rq S <br /> Address. e (/s2 Address: <br /> City: -�dti O state: City: State: <br /> ZIP: Ph# f r7_ C7� ZIP: Ph# }h III- <br /> CONTRACTOR INFOMATION Ph#( ) <br /> Lic. No: D ame: <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 wAo ❑ 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 fl 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 the information I have provided is correct. <br /> I agree to comply with all applicable c ntyordinances and state laws relating to building construction, I authorize <br /> representatives of this city or count enter the above-identified property for inspection purposes <br /> Applicant's Signature Date <br /> For your convenience chec fists 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- 4 <br /> list. <br /> rAApplication Forms&Handduts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br /> Fti.. ✓ <br />