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,ur <br /> BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �l 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> L1FiiR� INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: i� Ft l ! J <br /> 1v. � �rd <br /> Project Address: <br /> Project Valuation: Contact E-maiL­RobLz jGSI tih68 66 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> CL � Name: �� ,� <br /> c Yo <br /> Address: ( g ; 4 Address: /� �,?o <br /> City Eoe KT oN State: cl City: 5 eclkACj[V State: <br /> ZIP: C I S Ph#( ,,c;) c% ? `? Z( ZIP: Ph#(?Ooo <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be tssUed 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 Bowing: <br /> l 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 addition, I authorize representatives of this county to enter the above- <br /> identified property for iris ction purposes: <br /> Applicant`s Signature.3 q Date <br /> For your convenrenoe checklists detailing any additional submittal requirements for various building permit types <br /> are available at the BuFltlmg Division counter. Demolition permit and mobile home on foundation require check-list. <br /> F:AApplication Forms&HandoUfs\k bioTS%Uilding Permit Application 1-2015.doc Page 1 of 2 <br /> (Revised(01-28-15) - <br />