PROJECT INFORMATION DECLARATION BY PERMIT APPLICANT COMMUNITY DEVELOPMENT DEPARTMENT PERMIT CENTER SERVICES 345 NORTH EL DORADO STREET STOCKTON, CA 95202-1997 PH: (209) 937-8561 FAX: (209) 937-8893 Permit # Date APPLICATION FOR PERMIT Project Location: Address:______________________________________________________________________________ Suite #:________________ Subdivision:_________________________________________ Lot #:_______________ Parcel # (APN):__________________________________________ Property Owner: Name:________________________________ Phone:_____________________ Email:______________________________________ Mailing Address:_______________________________________________ City:____________________________ State:_________ Zip:______________ Licensed Contractor: Name:_______________________________ Phone:__________________ Email:_____________________________________ Mailing Address:_______________________________________________ City:____________________________ State:_________ Zip:______________ Contractor State License #:_______________________________ City Business License #:______________________ Ex. Date:______________________ Architect/Engineer: Name:________________________________ Phone:___________________ Email:_____________________________________ Mailing Address:_______________________________________________ City:____________________________ State:_________ Zip:______________ Project Contact: Name:__________________________________ Phone:___________________ Email:______________________________________ Mailing Address:_______________________________________________ City:____________________________ State:_________ Zip:______________ Permit Holder: Property Owner* Contractor** To-be-determined (plan review requests only) * Completed and signed owner/builder form required **”Authorized to Sign” form required if other than contractor applies Plan Review Process: Standard Paper Submittal Electronic Plan Check Applicant is: Property Owner Contractor Architect/Engineer Other: ________________________ BY MY SIGNATURE BELOW I CERTIFY TO EACH OF THE FOLLOWING STATEMENTS: I have read this application and the information I have provided is correct. I agree to comply with all applicable City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of this permit. I authorize representatives of the City of Stockton to enter the above mentioned property for inspection purposes. Applicant’s Signature____________________________________ Print Name_________________________________________ Date__________________ This section to be completed by City staff: DISCIPLINE ROUTING (check all those that apply) □ Building □ Fire Prevention □ Planning □ Public Works/Engineering □ Municipal Utilities □ Other_____________________ Project Type: Commercial Residential Master Plan Production Home — Template #____________________ New Construction Addition Tenant Improvement Alteration Demolition Other:___________________________________ State Licensed Facility? _____Yes _____No If yes, OSHPD-III Certification Required? _____Yes _____No Flood Zone: ______________________ Construction Type:_________ Occupancy Type:_____________ Existing Use:____________________ Proposed Use:______________________ Is Building Sprinklered? _____Yes _____No Is Building Conditioned? _____Yes _____No # of Stories:________ # of Dwelling Units:_______ Area Determination: 1st Floor:_____________sf 2nd Floor:_____________sf 3rd Floor:_____________sf 4th Floor:_____________sf Total Bldg:_____________sf Garage:______________sf Patio/Porch:_____________sf Deck/Balcony:_____________sf Other:_____________________ _____________sf SCOPE OF WORK: The applicant shall provide an estimated permit value at time of application. Permit valuations shall include total value of work, including materials and labor. Valuations shall be based on FAIR MARKET VALUE for labor and materials, even if performing the work yourself. Final building permit valuation shall be set by the building official. New construction will be based on City established per square foot cost. VALUATION: $