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BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 85205 <br /> BUSINESS PHONE: (209)468-3121 <br /> 7t,$ lxi INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUS-1.BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Mobile Home Installation Permanent Foundation <br /> Project Address: 26065 N.Dustin Rd.Acam o, CA 95220 <br /> Project Valuation: Contact E-mail: hhumblehary@hotmail.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: James Page Name: Shawn Harvey <br /> Address: 26193 N. Dustin Rd. Address: 419 W. 1St.St. <br /> City: Acam o State: CA City: Ripon State: CA <br /> ZIP: 95220Ph#(209) 712-5740 ZIP: 95366 Ph#(209)401-1282 <br /> CONTRACTOR INFORMATION Ph#(209)823-9490 <br /> Lic. No: C47-689850 1 Company Name: Chris' Mobile Home Service <br /> Address: 2303 W. Atherton Drive City: Manteca st:CA ZIP: 95337 <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY —4_Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder' Yes D 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 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 /> 1 am []a California licensed contractor or❑the property owner or®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 ail 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 { _�/ z ; . � Date' <br /> Z_-?p _� <br /> For your convenience checklists detailing any Itional 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 /> RkApplication Forms&HandoutslHANDOUTSIBuilding Permit Applicatlon.docPage 1 of 2 <br /> (Revised(07.00.10) <br />