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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 />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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPRt~CANT IN ORB.ERTO APPLY FOR <br />--f;3UIl,.DlNGPERMITS..,I <br />Scope of Worle <br />Project Address: <br />Project Valuation: <br />Name: <br />Address: <br />City:~~"F7I:~r- <br />CONTRACTOR INFORMATION <br />Address:I t?.3 23 <br />DESIGNER INFORMATION <br />Lic.No: <br />Address: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes 0 No <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 />QEGLARATION BY CONSTRUCTION PERMIT APPLICANT <br />•"••"< <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Fonn signed and submitted). <br />Applicant's Signature Oate _ <br />For your convenience checklists detailing any additional submittal requirements for various building pennit types <br />are available at the Building Division counter.Demolition pennit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouts\HANDOUTSIBuilding Permit Application.docPage 1 of 2 <br />(Revised (07'{)8-10)