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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 />Project Address: <br />Project Valuation: <br />OWN6:R NA~E AND ADDRESS <br />ZIP:Ph#( <br />CONTRACTOR IN'FORMATION <br />Contact E-mail: <br />Lie.No:Company Name: <br />Address: <br />Lie.No: <br />Address: <br />LENJ91NG AGEt'JCY <br />APPLlCAN"TIf'lAME iXt'JD ADDRESS•'/'f,'•' <br />ZIP: <br />Ph#( <br />City:st:ZIP: <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes D No D <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 />St:'ZIP: <br />Ph#( <br />City:St:ZIP: <br />Identification Number: <br />I am D a California licensed contractor or D the property owner or D 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 applicable county ordinances and state laws relating to building construction,I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature _ <br />For your convenience checklists detailing 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 />Oate _ <br />F:lApplication Forms &Handouls\HANDOUTS\Suilding Pennit Application.docPage 1 of 2 <br />(Revised (07-0B-10)