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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 /> c'�i�oQ1�P 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: ,'� ?G 'I C' i <br /> Project Address: <br /> Project Valuation: > �''� , ` I Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Name: <br /> Address: 7f C✓, �i;- t��»�<' _ Address: 5/. <br /> CitState: City: u. State: <br /> ZIP: 'C' <br /> CONTRACTOR INFORM ATION Ph--" ) <br /> Lic. No: L(v SS Company Name: /� �c r/c ` : <br /> Address: " ! S f -r• City: I Stj/ ZIP: <br /> DESIGNER INFORMATION -Ph-"( ) <br /> Lic. No: Company Name: <br /> Address: City F-t 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, l certify to one of the following: <br /> I am ❑ a California licensed contractor-or El-the property owner or❑ authorized to act-on the property owner's <br /> behalf(requires wrfften approval and-Owner/Build.er 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 inspection purposes. <br /> Applicant's Signature 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-list. <br /> FAkpplication Forms&Hand outs\HANDOUTS\Buking Permit Aoolication 1-2015.doc PROP.1 of 9 <br />