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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 />City: <br />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT I <br />BUILDING PERMITS. <br />ZIP: <br />CONTRACTOR INFORMATION Ph#( <br />Lic.No:Company Name: <br />Address: <br />DESIGNER INFORMATION <br />Lic.No:Company Name: <br />Address: <br />LENDING AGENCY Ph#( <br />Company Name: <br />OFFICIAL USE ONLY <br />Address:City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes No 0 <br />If yes,a completed Owner-Builder Verification or 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 />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <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 Form signed and submitted). <br />I authorize <br />Applicant's Signaturr-tL-----=;;~{LLJ.~;,L_}~:.:::::::.:..~~__:J_~-_#_.J::ac:!~:...-J~Date d2 2 -(5 -).tJ I 2> <br />For your convenie e checklists de <br />are available at the Building Divisio <br />list. <br />~,-,,",.ul nal submittal requirements for various building permit types <br />Demolition permit and mobile home on foundation require check- <br />F:\BUILOING\HANOOUTS\8uifding Permit Application.doc <br />(Revised 1-23"{)9) <br />Page 1 of 2 ~i"»~\0 0 0 \7""8