Laserfiche WebLink
02/05/2014 09:55 7607712113. BARBARA DONDERO PAGE 02 <br /> „ BUILDING PERMIT APPLICATION <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT�1810 E.HAZELTON AVENUE, STOCKON CA 95205INSPECTION REQUEST- BUSINESS PHONE: ( 09)466-3121z4 HOUR RECORDER: ( 09)488.3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPUCANT'IN MIORDER TO APPLY FOR <br /> BUILDING PERT{$. <br /> Scope of Work: n.` E UU <br /> Project Address: <br /> Project Valuation: <br /> Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDkE55 <br /> Name: F„ <br /> � Name: <br /> Address; 0 Address: <br /> ;VC <br /> h!h <br /> — — I y' State: <br /> ZIP: . Ph# ZIP: U* +!v Ph# <br /> CONTRALtTOR INFORMATION <br /> Ph#{ ) <br /> Lie. No: Company Name: <br /> Address; City: <br /> Sk ZIP: <br /> DESIGNER INFORMATION Ph#( <br /> Lic. No: 003 Company Name: <br /> G l fI 7 <br /> Address: N�PY <br /> L <br /> LENDING AGE t3Y Ph#( ) <br /> Company Name: Ld <br /> Address: City: <br /> St; ZIP; <br /> Permit will be issued to an"Owner-Builder" Yes❑No❑ wt-NUAL 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 /> ey my signature helow, I Certify to one of the following: <br /> nia licensed <br /> ractor or <br /> he alff(requ!resrwritten approval tand Owner/Builder tVerification Formowner or❑signed and submitted).authorized to act On the <br /> Property owner's <br /> I have read this construction permit appiioation and the information I have provided is correct, <br /> I agreo 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-Identi <br /> fied Property four inspection purposes. <br /> Applicant's Signaturejo� GCQ t/Ct Date_ ^�— <br /> For your convenience checklists detailing any additional submittal requirementsfor various building permit types <br /> are available at the Building Division counter. Demolition Permit and mobile home an foundation require Check- <br /> list. <br /> F:1Hpplimtion Forms&HandoutAHANDOUMBullding permit Appllcatlon.docpage 1 of 2 <br />