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dam" <br /> BUILDING PERMIT APPLICATION <br /> �a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> %a INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> C <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: ,�� JSL/ ' le, 4 /ei �, 'Zo1it=� <br /> Project Address: <br /> Project Valuation: Contact E-mail: /)/A9.0a"o <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: LC� <br /> Address: �� Sf �/ Address: 050!5 <br /> City: State: City: ff�a�u� State: <br /> ZIP: Ph#( ) ZIP: <br /> CONTRACTOR INFORMATION Ph#( <br /> Lic. No: 33�Z1 + 5x Company Name: <br /> Address: ,=at : ry�Q�ejZ/t/ St: IP: <br /> DESIGNER INFORMAT N Ph#( ) <br /> Lic. No: Company Name: '��^ <br /> Address: ��� '' � �j City: �� St ZIP:.f gW <br /> LENDING AGENCY s C Ph#( <br /> Company Name: �l'4 C ✓ �C"a <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 owners <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 � California licensed contractor or❑the property owner or❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form 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 /> Applicant's Signature Date1,�5 <br /> For your convenience checkli s detaili y a t ton bmittal requirements for varioi4s build permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. <br /> F:Wpplicalion Farms&HandoutsIHANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />