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BUILDING PERMIT APPLICATION <br /> 'COG <br /> Q ?{ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> ciaoR� P 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. aP <br /> Scope of Work: P y'f Un �Z �lU <br /> Project Address: <br /> Project Valuation: Contact E-mail: f () <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �- Name: � >ZLG <br /> Address: Address <br /> City: State:State: City: ��pG. p� State: <br /> ZIP: ���227 Ph#( Ph#(:�10;p <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: �✓) �y <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) ( 1 <br /> Lia No(f-,7,{) Company Name: yyU <br /> Address: 76771lif/nSfAve- I C14: St: ZIP: <br /> LENDING AGE CY Ph#( ) <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 ❑ a California licensed contractor or❑the property owneror uthorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Fogned and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> 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 a <br /> bove-identified property for inspection purposes. <br /> Applicant's Signature / `�zDate <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 /> FMpplication Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />