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Gu'k ii <br /> 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 /> o t FOR 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: gonq ( 0 <br /> Project Address: Jtq .fir �S C l <br /> c !T <br /> Project Valuation: Contact E-mail: Ell d- <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> -Name: Name: 4AAS <br /> Address: _ L/ �� ✓� dress: <br /> City: <br /> l <br /> Cit)': L SG State: City: State: <br /> ZIP: Ph#( 7 _ ZIP: Ph# <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lie. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> I <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an "Owner-Builder" Yes ❑ No❑ OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> Identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am❑ a California licensed contractor or❑ the property owner or❑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-relafing.to building construction; I authorize <br /> representatives of this city or county to enter the above-idenfified property for inspection purposes_ <br /> Applicant's Signature IT Date <br /> For your convenience checklists detailing any ad ' iona[submittal requirements for various building permit types <br /> are available at the Building Division counter. D ofition permit and mobile home on foundation require check- <br /> HSL <br /> F:Wppliration Forms&Handouts\HANDOUMBuilding Permit Appllcation.docPage 1 of 2 <br /> (Revised(07-08-10) <br />