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 /> LIFORN <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: `-7 2-ZZ 5,, VZ Ny A,_, 5— <br /> Project <br /> ` , 5— <br /> Project Valuation: ?j 00 1 0 00 ✓o,�O Contact E-mail: GA� Cr Xj rN < u <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: �/ �� ) ( ( Name: <br /> Address: ACy�fUIC 1,710 Address: jG C <br /> City: g /P() State: City: W6],fGN 0*14 State: Gr`( <br /> ZIP: 63Ph#(.3 J-0/— 17�5ZIP: '?5 __? __,3/ Ph#WJ CIL43-93 j'Z <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION <br /> Lic. No: Company Name: Y _ ��r UaG� <br /> Address: J5G City: I St: ' 'ZIP: 5 2 ( <br /> LENDING AGENCY Ph#(:,X' <le j ; <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 owners <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 /> 1 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 relating to building construction, I authorize <br /> representatives of this city or county to enter the above-identified property for inspection purposes. <br /> r <br /> Applicant's SignatureC�, 11�H "� Date ( � <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 /> FAApplication Fonns&Handouts\HANDOUTMBuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />