Laserfiche WebLink
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 />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: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />City: <br />ZIP: <br />Lic.No: <br />Address: <br />Address: <br />Company Name: <br />City:St:ZIP:Address:__ <br />OFFICIAL USE ONLYPermitwillbeissuedtoan"Owner-Builder"Yes D NO)g( <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 />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I am D a California licensed contractor or ~the property owner or D authorized to act on the property owner's <br />behalf (requires written approval and OwnerlBuilder 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 applicable county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified erty for inspection purposes. <br />Applicant's Signature_----,~~~:::;~~~::;;:::2~==------DateB -CO -lO <br />For your convenience checklist etailing 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 />F:\Application Forms &Handouts\HANDOUTS\8uilding Permit Appiication.docPage 1 of 2 <br />''''_.'';__~'''~n,....••n\