Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> �7✓ ' <br /> BUSINESS PHONE: (209) 468-3121 <br /> FORS INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THEAPPLICANT IN ORDER-TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: A� / <br /> Project Address: S�lOp GQ //zl Cj ��y <br /> Project Valuation: Cont at E-mail: r� ���✓e <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRE <br /> Name: / GAG Name: <br /> Address: _ 5��� !/GL � �/ Address: <br /> City: State: / City: _ _ - State: <br /> ZIP: f�i/? Ph#( Z, ZIP: Ph#( ) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: �EGT <br /> Address: City; ��� Sjd St: ZIPGj'.S <br /> LENDING AGENCY P <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 owners <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 /> 1 am ❑ a California licensed contractor or ak a property owner or 0 authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form slgned'andsubmitted). <br /> I hale 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 ta'bulldirig`construction. I authorize <br /> representatives of this city or county to ter the above-identified property for inspectjon'purposes_ <br /> Applicant's Signature Date �9 <br /> For your convenience checkii s 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- <br /> list, <br /> FMppllcalion Fonns&Handouls\HANDOUTMBuilding Permit Appllcation.docPage 1 of 2 <br /> (Revised(07-09-10) ,i its <br />