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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 />THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />BUILDING PERMITS..". <br />Scope of Work:Vt~-bJIAi-r.IlY\f)f 'PlAn+\ <br />ProjectAddress:3fo 17____D~RrYV)P£A.,\\?lC-Y .t <br />".,, <br />APPLICANT NAME AND ADDRESSOWNERNAMEANDADDRESS <br />Name:f24Y\iv 14Llu-Name: <br />vall~y rt:''"'v •••'w.___ <br />108 Birmingham Ct. <br />\D\)~~t2J.uiscovery OClY,vf'.<1'.oJVoJ <br />Address::?it0l)Address:209-923-2999 valleypermits@aol.com <br />City:~~State:M City:State: <br />ZIP:qtt)1J(~~Ph#(tJ.fl)~f)?:J)r+ZIP:Ph#() <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />DESIGNER INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:St:ZIP: <br />LENDING AGENCY Ph#() <br />Company Name: <br />Address:,City:St:ZIP: <br />Permit will be issued to an "Owner -Builder"Yes lO No 0 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 0 a California licensed contractor or 0 the property owner or ~uthorized 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 Signature~Date 4\~hl, <br />For your convenience checklists 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 />F:\8UllDING\HANDOUTS\8uilding Permit Application.doc <br />(Revised 1-23-09) <br />Page 1 of2