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BUILDING APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)460.3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468.3165 <br /> THE APPLICATION Mt15T HE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Mobile Home Installation(Temporary) (Replacement) <br /> Project Address: 14100 S. Castle Rd.Manteca, CA 95336 <br /> Project Valuation: Contact E-mail: hhumbleharvQhotmail.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Stacey Farrow Name: Shawn Harve <br /> Address: 14100 S. Castle Rd. Address: 419 W. 1St.St. <br /> City: Manteca State: CA I City: Ripon State: CA <br /> ZIP: 95336 Ph#(209) 918-0211 ZIP: 95366 Ph#(209)401-1282 <br /> CONTRACTOR INFORMATION Ph#(209)823-9490 <br /> Lic. No: C47-689850 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 Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes❑ 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 /> I am E]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 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 �_-� }��i�v�- Date <br /> For your convenience checklists detailing any a conal 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:1Application Forms&Handouts\HANDOUTSIBuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08.10) <br />