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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 />THEAp,puc~"itl~ta;~~S:~:tl~lf~M'P.oIilFf,:If~...-,"...::.. <br />",,.~••..,.'.~•~0.-"'•••••••_J ._:;",.,!.l:'o.,,~..•••~(,.....•.•...,..,""'~'.4..;..••.;.;; <br />Scope of Work:ew HtJuf,C <br />Project Address:7 9 3 (;vJ <br />ZIP: <br />Lic.No:Company Name: <br />Address: <br />Lic.No: <br />Address: <br />Company Name: <br />Address: <br />Permit will be issued to an "Owner-Builder"Yes ~No 0 <br />If yes,a completed Owner-Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />r.iContactE-mail: <br />Name:Te 1"'1,te <br />Address:5S;).. <br />City:'-(yt-iC <br />ZIP:q~3 <br />Ph#() <br />City:SI:ZIP: <br />Ph#( <br />City:SI:'ZIP: <br />Ph#( <br />Identification Number: <br />By my signature below,I certify to one of the following: <br />I am 00 a California licensed contractor or ~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 have 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 to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signatl1~Date /I /1/1 0I <br />For your convenience che klis Cfetailing any additional submittal requirements for various building permit types <br />are available at the Building ivision counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouls\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)