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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:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />Scope of Work: <br />Project Address:7. <br />Project Valuation:-t!".,"''''' <br />OWN6R NAME A~D A:~DRES~ <br />ZIP:ZIP: <br />.,.•"Ph#( <br />Lic.No:Company Name: <br />Address: <br />Lic.No: <br />Company Name: <br />SI:ZIP: <br />Address:City: <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 I.!i~:""'.';,-"..-'<l'---,"'c:.:.:~''''':'''~'-'-'-'''''--''''!''':''''!..JA..'=::~~~~~''':';'';';~==-'''''''''''-,-,-",-'-'----''----..j <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />I am 0 a California licensed contractor or 0 the property owner or Zl 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 the information I have provided is correct. <br />I agree to comply with all a plicable county ordinances and state laws relating to building construction.I authorize <br />representatives of this ci or county to enter t above-identified property for inspection purposes. <br />~~~~W~~$:i..r-------Date±-l~-10·ZDll <br />iling a y ditional submittal requirements for various building permit types <br />count r.Demolition permit and mobile home on foundation require check- <br />F:\Application Forms <br />(Revised (07-08-10) <br />ndouls\HANDOUTSlBuilding Permit Application.docPage 1 of 2