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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: 208 468-3121 <br /> ?cfFoiis� 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: `� Name: ,r�" -' <br /> Address: ; a Address: <br /> City: ° '" State: N City: State: <br /> ZIP: Phqlly5f �- ` ( " ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( } <br /> Lie. No: Company Name , 8 ri <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> 1 <br /> Lie. 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 ElNo ElOFFICIAL USE ONLY j <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 /> I <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❑ authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Bullder Verification Form signed and submitted). <br /> 1 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 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 /> FAApplication Forms$Han douMHANDOUTMuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-90) <br />