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BUILDING PERMIT APPLICATION <br /> 2 r.+ <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> K 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 COMPLETELYFILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of work: Temporary Mobile Home Installation 2nd Single Family Dwelling) <br /> Project Address: 2146-Hansen Rd. Tracy, CA 95304 <br /> Project Valuation: 3,500.00 Contact E-mail: hhumbleharv@hotmail.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Ernesto Martinez Name: Chris' Mobile Home Service <br /> Address: 21400 Hansen Rd. Address: 2303 Atherton Dr. <br /> City: Tracy State: CA City: Manteca State: CA <br /> ZIP: 95304 Ph#(650)678-0262 ZIP: 95337 Ph#(209) 823-9490 <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: C-47 689850 Company Name: Chris' Mobile Home Service <br /> Address: 2303 Atherton Dr. 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 ®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 /> F:\Application Forms&Handouts\HANDOUTSOuilding Permit Application.dooPage 1 of 2 <br /> (Revised(07-08-10) <br />