BP-16 - Laserfiche WebLink

Home Browse Search

BUILDING PERMIT APLI Tt SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ;• 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 BUSINESS PHONE: 209 468-3121 t�FOF' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING P TS. Scope of Work: G t 10 / Project Address: 9,(a el AI• X./a Project Valuation: Contact E-mail: OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Name: lot S Name: `gu, Address: Address: 21 4y �y® City State: ® City:J4j State: ZIP: Cj�, yl' Ph#(1,14 Y64- WH ZIP: `1 ,76' CONTRACTOR INFORMATION Ph#( ) Lic. No: . Company Name: Address: City: St: ZIP: DESIGNER INFORMATION Ph#( 1 Lie. No: 6 *3®K Company Name: 44rGA, 4'1 g Address: 1Z & -*Z7'-0 City: St: ZIP: 4709,5- LENDING AGENCY Ph#(%1h) 4 Company Name: Address: City: St: ZIP: Permit will be issued to an"Owner-Builder" Yes ❑ No❑ OFFICIAL USE ONLY If yes, a completed Owner-Builder Verification Form must Identification Number: be signed and submitted along with copy of the owner's identification prior to issuance of the building permit. DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to one of the following: I am ❑a California licensed contractor or❑the property owner or❑ authorized to act on the property owner's behalf(requires written approval and Owner/Builder Verification Form signed and submitted). I have read this construction permit application and certify the information I have provided is correct. I also agree to comply with all applicable county ordinances and state laws which govern this project. During the course of construction I will also takes steps to preserve all survey monuments. In addition, I authorize representatives of this county to enter the above- identified property for inspection purposes. Applicant's Signature Date _ Foryour convenience checklists detailing any additional submittal requirements forvarious building permit types are available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. FMpplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 - (Revised(01-28-15)