Laserfiche WebLink
° cps BRUILM G PERM TAPPUCAT` ,WmT <br /> a SAN JO.AQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � 5 K 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> \•1k INSPECTION REQUEST-24 HOUR RECORDER: (209) 468-3165 <br /> FOS ` <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: S� C� <br /> Project Address: Z-51 7 (> <br /> - <br /> ProjectValuation ContactE-maii: <br /> f <br /> OWNER NAME AND ADDRESS APPLICANT-NAME AND ADDRESS <br /> Name: cti F2� � � Name: r n/ <br /> Address: Z yrs j.C-4 Address: 'i-b cra-� G t <br /> City: tate: fy City: S 1 State: ,74 <br /> ZIP, Ph#(Zc'.6 Z'Z 7• � To 7 ZIP: q Za`� Ph#( or. <br /> CONTRACTOR INFORMATION Pn#.( ) <br /> Lic. No: 7AC7/ Company Name: <br /> Address: City: St: ZIP: <br /> DESIvfvER INFORMATION Ph#( ) <br /> Lic. Nn. Company Name: <br /> Address: City St: ZIP: <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 certify the information I have provided is correct. I also agree to comply <br /> with all applicable county ordinances and state laws which govern this project. During the course of construction I will also <br /> takes steps to preserve all survey monuments. In additioA, I authorize.representatives of this county to enter the above- <br /> identified property for inspection purposes. <br /> Applicant's Signature L Date " <br /> For your convenience checklists deta 'n /A/any dditional submittal requirements for various building permittypes <br /> are available at the Building Division counfet. Demolition permit and mobile home on foundation require check-list. <br /> F:Wpplication Forms&Handouts\HANDOUTS\Building Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) <br />