Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> Q SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> c4 P INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> 4FpR <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS.. r <br /> Scope of Work: 0all.,9c0 /C �'ae s f yy� , i� �✓sr�i ��/ ,fir' <br /> Project Address: �/ 4 eft Z L✓t� /ZC✓ash 1�[ <br /> !7 <br /> Project Valuation: �/�? �� � �.— Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: 2 r� Name: l Z_ <br /> Address: �4%'�L-C Address: 1 SLG <br /> City: t State: �f City: State: p <br /> ZIP: / J Ph#( j '�3"�j'C5Z- ZIP: Ph#(?i' rfy �i✓ j' , <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: u�✓✓e iZ -/j� fL d /� <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 xNo❑ 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 owner or E] authorized to act on the property owner's <br /> behalf(requires written approval and OwrferlBuilder 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 county to enter the above-identified property for inspection purposes. <br /> Applicant's Signature Date <br /> For your convenience checklists 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- <br /> list. <br /> FMpplicatton Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />