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:________________________________________ Email:__________________________________________________________ Mailing Address:_____________________________________City______________________State_______Zip________ Phone:_______________________ Licensed Contractor: Name:___________________________________ Email:__________________________________________________________ Mailing Address:_____________________________________City______________________State_______Zip________ Phone:_______________________ State License # & Class:________________________________ City Business License #:_______________________ Ex. Date:______________________ Architect/Engineer: Name:_____________________________________ Email:__________________________________________________________ Mailing Address:_____________________________________City______________________State_______Zip________ Phone:_______________________ Project Contact: Name:________________________________________ Email:__________________________________________________________ Mailing Address:_____________________________________City______________________State_______Zip________ Phone:_______________________ Permit Holder: Property Owner* Contractor To-be-determined (plan review requests only) * Completed and signed owner/builder form required Plan Review Process: Standard Paper Submittal Electronic Plan Check (EPC) 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__________________ To be completed by City staff: DISCIPLINE ROUTING (check all those that apply) ISSUED BY: □ Building □ Fire □ Planning □ Public Works/Eng □ MUD □ Other_____________________ Project Type: Commercial Residential Master Plan Production Home — Template #____________________ New Construction Addition Tenant Improvement Alteration Demolition Other:___________________________________ Fire Sprinklers? _____Yes _____No OSHPD-III Certification Required? _____Yes _____No FLOOD ZONE(S): ___A ___AE___AH___AO___X Construction Type:______________ Occupancy Type(s):____________________________ # of Stories:________ # of Dwelling Units:______ Area Determination: 1st Floor:____________sf 2nd Floor:______________sf 3rd Floor:_________________sf 4th Floor:_____________sf Total:______________sf Garage:_____________sf Patio/Porch:____________ sf Deck/Balcony:_____________sf Other:______________________ ______________sf JOB DESCRIPTION: 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: $