BP-152643 - Laserfiche WebLink

Home Browse Search

ys BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT " 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: (209) 468-3121 cgt�FOR `" INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: Tn s/c // /Nb 6�e 460<c Project Address: Z Project Valuation: X00 e� d Contact E-mail:Valuation: :/-(J F199106 /'9 ()Z-, Co/M OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: G /� �jtfP��S Name: Address: Z/3 2�P /�A/{z/J6S z �. Address: City: sCc /U� State: 4 u . City: State: ZIP: Ph#(coq )470-0666 ZIP: Ph#( ) CONTRACTOR INFORMATION Ph#( Lia No: Company Name: Address: City: St: ZIP: DESIGNER INFORMATION Ph#( ) Lic. No: Company Name: /6/0ll//C: Address: City: St: ZIP: LENDING AGENCY Ph#( ) Company Name: c-7-, Address: City: St: ZIP: Permit will be issued to an "Owner-Builder" Yes RJ No ❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am ❑ a California licensed contractor or Oche property owner or ❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information I have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above-identified/id / property for inspection purposes. Applicant's Signature /��y� G'CG� Date For your convenience checklistsetailing any additional submittal requirements for various building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check- list. F.\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 (Revised(07-08-10)