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°p4U`" BUILDING PERMIT APPLICATION <br /> \ t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �. 1810 E.HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> ca<iFSR��P 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: Mobile Home Installation (Permanent Foundation) <br /> Project Address: 258 S. Reid Rd. Linden, CA 95236 <br /> Project Valuation: Contact E-mail: hhumblehary@hotmail.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: David E. Bolio Name: David E. Bolio <br /> Address: 258 S. Reid Rd. Address: 258 S. Reid Rd. <br /> city: Linden state: CA City:Linden State: CA <br /> zip: 95236 Ph#(413) 537-0283 ZIP: 95236 Ph#(413) 537-0283 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <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 /> 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 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 <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 /> FAApplication Forms&Handouts\HANDOUTS1Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />