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BUILDING PERMIT APPLICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE:(209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING PERMITS. Scope of Work: Project Address: Ph#( OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name:Name: Address:Address: City:State:City: ZIP:Ph#(ZIP: CONTRACTOR INFORMATION Lic.No: Address: Lic.No: Address: Company Name: City:St:ZIP:Address: OFFICIAL USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes 0 No 0 If yes,a completed Owner-Builder Verification Form must be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. Identification Number: DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below,I certify to one of the following: I am VaCalifornia licensed contractor or the property owner or 0 authorized to act on the property owner's beha1fP.~quires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and the information I have provided is correct. I agree to comply with all applicable county ordinances and state laws relating to building construction.I authorize representatives of this city or county to nter th abov -i entified property for inspection purposes. Applicant's Signature_--I-~~:::::':~4,.-_.t:+..1...<::::::::loo...<,,"",*~Date~'-L..1:1 For your convenience checklists detailing any additional submittal requirements for various building permit types are available at the Building Division counter.Demolition permit and mobile home on foundation require check- list. F:\BUILOING\HANDOUTS\Buifding Pennit Application.doc (Revised 1-23-09) Page 1 of 2