Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> `K 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 /> 'QLt FORM <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: !l 6 <br /> Project Address: /O f/`f j` L12 -s C Mt-7 " O(,t',r CA 95el 10 <br /> Project Valuation: Ho Contact E-mail: L C6 v%co Ir^e4 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: _ �1q Name: <br /> Address: `Oy?S /ow(9q /9C FXIrO Address: 6 <br /> City: state:- Cry City: C/C Q v state: 2,A <br /> ZIP: F5alo Ph#&,o9 )rj 8- 59Z ZIP: 97-c;L-)6 Ph#od?) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: I Company Name: C 6vt1 ST/lUC��N <br /> Address: ff/4/ A City: SOCK St: (7,q ZIP: <br /> DESIGNER INFORMAT3— -9-3el- 3 <br /> Lic. No: Company Name 57_1eC'4mUAA5 �. / P� <br /> Address: ZY7 CT t City: �)_00 .]_6N St: /9 ZIP: ;n /o <br /> LENDING AGENCY Ph#�jpy) ® _ <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-F] a California licensed contractor or❑ the property owner orlauthorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Fofm signed and submitted). ' <br /> I have read this construction permit application and certify the information I have provided is correct. I 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 survey monuments. In addition, I authorize representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> 2 <br /> Applicant's Signature Date <br /> �-w <br /> For your convenience chec rsts detailing any additional submittal requirements for various building permit types <br /> are available at the Build' g Division counter. Demolition permit and mobile home on foundation require check-list <br /> FWpplication Fortes&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> -(Revised(01-28-15) <br /> r <br />