Laserfiche WebLink
BUILDING PERMIT APPLICATION <br />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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS. <br />Scope of Work: <br />Project Address: <br />Project Valuation:Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:A t:.rt:» <br />Address:C17 S C'>t!\S <QO 0 <br />City: <br />ZIP: <br />Lic.No: <br />Address:57-l- <br />DESIGNER INFORMATION Ph#( <br />Company Name: <br />ZIP:~ <br />LENDING AGENCY <br />Company Name: <br />Address: <br />Identification Number: <br />City:St:ZIP: <br />OFFICIAL USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes 0 No 0 <br />If yes,a completed Owner-Builder Verification Form must <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 t29..aCalifornia licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />beha1f(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 appli able county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or ounty to enter the above-identified property for inspection purposes. <br />Applicant's Signature_-'-"d-Jf't:::;P""-""--4='----1L--Date 0 6 -J 4=-I L <br />For your convenience ch cklists detailing any additional submittal requirements for various building permit types <br />are available at the Buil ng Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:lApplication Forms &Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)