Laserfiche WebLink
... <br />j • <br />BU·ILDING PERMIT APPUCAT~O <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT nn:PAR1MENr <br />1810 E.HAZELTON AVENUE,STOCKroN CA 9521)5 <br />-BUSINESS PHONE:(209)468·1121 <br />INSPECTION REQUEST •.24 HOUR RECORDER:(209)468-3165 <br />lliE APPLICATION 'MUST BE COMPLETELY FILLED OUT BY THE Af:'PLICANT IN ORDER TO APPLY FOR~.BUILDING PERMITS .•,/,1 <br />Scope of Work: <br />Project Address:/q /4-~G.~'~A f2-ct.CI~i3 eA-Cf.5"2-2-i,~ <br />Project Valuation: <br />, <br />Contact E-mail: <br />OWNER NAME AND ADDRESS APPUCANTNAMEANDADDRESS, <br />Name:h"hc<fq h~Name:(fjVrfrAtCf ~£dCM((L <br />Address:lq\S"~6 u'belh ~Address:~B CI....'-HZ-- <br />City:C ~wet,d~State:eft City:CIIJ'r/J....L State:CA <br />ZIP:qr:;2-2--7 .,Ph#~7SQ-»u:«ZIP:QC;z;z,-1 Ph#() <br />CONTRACTOR INFORMATION Flh#QzA r791 ~&o ~ <br />Lic.No:Company Name: <br />Address:City:St:ZIP: <br />'. <br />DESIGNER INFORMATION Ph#()~ <br />Llc.No:Company Name: <br />Address:i·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 0 No 0 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 />tdentification prior to issuance of the building permit. <br />.~..",•DECLARATION BY CONSTRUCTION PERMIT APPLICANT ,-.. <br />By my signature below,I certtfy to one of the following:. <br />I am 0 ;californ ia ncensed -contractor or 0 the property ow""r or Ii,authorized to act on the property owner'. <br />behalf (requires written approval and Owner/Builder Vermeation Fo m signed and submitted). <br />I have read this construction permit application and the intofmatfon 'I have provided is correct. <br />I agree to comply with all applicable county ordinances and state letws relating to building construction.I authorize <br />representatives of this city or county to enter the above-ideh ifietl property for inspection purposes. <br />Applicant's Signature ~Date <br />For your convenience C~I submittal requirements for various building permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)