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BUILDING PERMIT APPLICATION <br /> Q. y 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 /> 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: <br /> Project Valuation: ���G� ZOO Contact E-mail: G b oh r t Yrl � G(G!'1 , �U1 4) 1,�1 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name:. ( R 61 Name: ' ('lf��� JC��r^1�v, I ��� ►'. <br /> Address: } � � �� Address: 3a. p6r]< , 51e- L <br /> City: I r 1 State: (A City: State: rA <br /> ZIP: Z Ph#( ) ZIP: q r jj Ph#(110qllyllq6p <br /> CONTRACTOR INFORMATION.' h#( <br /> P ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#(gj� q qa G <br /> Lic. No: Company Name: ;11 CX <br /> Address: br� l City: 5 - ��- St: ZIP: C�J2) <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, I certify to one of the following: <br /> I 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 /> have read this construction permit application and the information I have provided is correct. <br /> I agree to comply Wth all applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of-this cjorcounty to ente, the above-identified property for inspection purposes. <br /> Applicant's Signature DateFor your convenien detailing any ditio I submittal requirements for various building permit types <br /> are available at the Building Division counter. moliti n permit and mobile home on foundation require check- <br /> list. <br /> F:1Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage i of 2 <br /> (Revised(07-08-10) <br />