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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: Mobile Home Permanent Foundation (Replacement) <br />Project Address: 21093 Oleander Ave. Manteca, CA 95337 <br />Project Valuation: <br />Contact E-mail: hhumbleharv@hotmail.com <br />OWNER NAME AND ADDRESS <br />APPLICANT NAME AND ADDRESS <br />Name: Gary & Breanne Geist <br />Name: Chris' Mobile Home Service <br />Address: 21093 Oleander Ave. <br />Address: 2303 W. Atherton Dr. <br />City: Manteca <br />State: CA <br />city: Manteca <br />State: CA <br />ZIP: 95337 <br />Ph#(209) 221-9084 <br />ZIP: 95337 <br />Ph#(209) 823-9490 <br />CONTRACTOR INFORMATION - <br />Ph#(209) 823-9490 <br />Lic. No: C47-689850 <br />I Company Name: Chris's Mobile <br />Home Service <br />Address: 2303 W. Atherton Dr. city: Manteca <br />St: CA ZIP: 95337 <br />DESIGNER INFORMATION Ph#( ) <br />Lic. No: <br />Company Name: <br />Address: <br />City: <br />St: ZIP: <br />LENDING AGENCY <br />Ph#( ) <br />Company Name: <br />Address: <br />City: <br />St: ZIP: <br />Permit will be issued to an "Owner -Builder" Yes ❑ No <br />If yes, a completed Owner -Builder Verification Form must <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />OFFICIAL USE ONLY <br />Identification Number: <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below, I certify to one of the following: <br />I am R 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 Q,iLv� Date _-/ 20/ <br />For your convenience checklists detailing any additiona ictal 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\HANDOUTS\Building Permit Application.docPage 1 of 2 <br />(Revised (07-08-10) <br />