Hcd Permit Form PDF Details

Navigating the intricacies of securing permits for mobilehome and special occupancy park construction in California requires a thorough understanding of the Department of Housing and Community Development (HCD) procedures. The HCD Permit form, as detailed in the Mobilehome and Special Occupancy Park Construction Plan Review Booklet (HCD MP 514, revised May 2009), serves as a critical guide for anyone looking to develop these types of properties. This detailed resource outlines everything from initial application steps to the specific documentation standards needed for a successful permit submission. It places an emphasis on proper planning and adherence to regulations, highlighting the importance of obtaining approvals from local planning departments, health departments, and other relevant agencies. Additionally, the form underscores the necessity of thorough preparation before the submission, including securing necessary local agency approvals and ensuring all plans, calculations, and engineering documents are in order. Fees, procedures for arranging preliminary plan review meetings, and the importance of patience during the 4 to 6-week review process are also covered. This comprehensive approach is designed to streamline the application process, helping applicants avoid common pitfalls and delays while emphasizing the collaborative effort between developers and the HCD to ensure compliant and safe mobilehome and special occupancy park construction.

QuestionAnswer
Form NameHcd Permit Form
Form Length22 pages
Fillable?No
Fillable fields0
Avg. time to fill out5 min 30 sec
Other namesca occupancy booklet, hcd 50 application, hcd permit, hcd 50

Form Preview Example

STATE OF CALIFORNIA -BUSINESS, TRANSPORTATION AND HOUSING AGENCY

Arnold Schwarzenegger, Governor

 

 

DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

DIVISION OF CODES AND STANDARDS

NORTHERN AREA OFFICE

9342 TECH CENTER DR. Suite 550 SACRAMENTO, CA 95826

(916) 255-2501

From TDD Phones: 1-800-735-2929

From Voice Phones: 1-800-735-2922

SOUTHERN AREA OFFICE

3737 MAIN STREET, SUITE 400 RIEVERSIDE, CA 92801 (951) 782-4420

From TDD Phones: 1-800-735-2929

From Voice Phones: 1-800-735-2922

MOBILEHOME AND SPECIAL OCCUPANCY PARK

CONSTRUCTION PLAN REVIEW BOOKLET

HCD MP 514

Revised 5-2009

STATE OF CALIFORNIA -BUSINESS, TRANSPORTATION AND HOUSING AGENCY

Arnold Schwarzenegger, Governor

 

 

DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

DIVISION OF CODES AND STANDARDS

MOBILEHOME PARK AND SPECIAL OCCUPANCY PARK

CONSTRUCTION PERMIT PROCEDURES

This booklet is provided as a guideline for construction permit applicants to explain the Department of Housing and Community Development (HCD) procedures and application requirements. Please read through the booklet carefully to see what regulation requirements apply to your project. Procedures for park construction are found in Part A and for park building construction in Part B. Using this booklet helps you to avoid any omissions. Also, before proceeding you are encouraged to contact the appropriate Area Office to learn which local or other agency approvals are necessary for this Department to approve your project and to answer any questions relative to your project.

Once you have obtained any necessary local agency approvals and have completed all necessary plans, calculations, engineering, etc., required for processing your application, it is strongly recommended that you contact the appropriate Area Office or Area Supervisor for additional guidance. The purpose of this contact is to arrange a meeting, preferably at the appropriate area office, to review your construction application, plans and other pertinent documents (project package). At that time, the plan check staff or area supervisor will use this booklet as a worksheet to indicate if your project package is complete and ready to be submitted for plan check or explain what items are remaining to complete your permit package. Commonly deficiencies are noted by circling the box in front of a plan requirement. If the project package is missing information, a second meeting may be recommended prior to submittal of the package for plan checking.

Fees will be charged for these preliminary plan check meetings as a technical service fee ($196.00 per hour, $196.00 minimum).

In addition to reviewing the completeness of your project package, the Area Supervisor or plan check staff will calculate construction and plan check fees. Separate permits are required for grading, utility construction, swimming pools and buildings. A copy of your worker’s compensation insurance coverage must also be provided. Only after the project package is complete should your application and three (3) sets of plans with calculations and specifications with all required fees be submitted to the Department’s plan check section. An incomplete or incorrect submission will result in it being returned, additional fees being charged for re-submittal, and project delays.

Once the submittal is received in the plan check office, it will be logged in and reviewed in the order it was received. Typically, plan review requires 4 to 6 weeks, so please plan accordingly and remain patient.

If the package is approved as submitted, you will receive your permit and job copy of the plans and documents by mail unless otherwise specified and paid for in advance. If the plan checker has questions, identifies errors, or information is missing from the submittal, you will be notified by mail of who to contact and the approval process will be suspended until a satisfactory response is received.

HCD Authorized Representative:

 

Phone Number

 

HCD MP 514 5/09

1

DOCUMENTATION STANDARDS FOR PERMITS TO CONSTRUCT OR

RECONSTRUCT MOBILEHOME PARK OR SPECIAL OCCUPANCY PARK UTILITY

SYSTEMS, BUILDINGS, AND SWIMMING POOLS

The following checked items are required of a permittee prior to submittal of a permit to construct or reconstruct facilities or buildings in a mobilehome park, special occupancy park (RV Park) or campground (25 CCR 1032): (The Area Office will advise you on which approvals are required)

1.

Obtain approval and signature from the local planning department on the Mobilehome and

 

 

Recreational Vehicle Park Government Agency Approval form or equivalent document.

2.

Obtain approval and signature from the local Health Department on the Mobilehome and

 

 

Recreational Vehicle Park Government Agency Approval form, or an equivalent document,

 

 

for on-site water supply and on-site or private sewage disposal. Health Department

 

 

approval is also required if there is any public food preparation as part of your

 

 

development. Pool plans must have the Health Department stamp upon them as well as a

 

 

signature on the Mobilehome and Recreational Vehicle Government Agency Approval form

 

 

or equivalent document.

 

 

3.

Obtain approval and signature from the local public works department or engineering

 

 

department on the Mobilehome and Recreational Vehicle Park Government Agency

 

 

Approval form or equivalent document for the park surface or subsurface drainage system

 

 

and encroachments.

 

 

4.

Obtain approval and signature for fire protection from the local fire protection district on the

 

 

Mobilehome and Recreational Vehicle Park Government Agency Approval form or

 

 

equivalent document.

 

 

5.

Obtain required approval and signature from the California Coastal Commission on the

 

 

Mobilehome and Recreational Vehicle Park Government Agency Approval form or

 

equivalent document for developments within coastal zones.

6.

Obtain approval and signature on the Mobilehome and Recreational Vehicle Park

 

 

Government Agency Approval form or equivalent document from

 

 

 

for

.

 

7.

Obtain approval and signature on the Mobilehome and Recreational Vehicle Park

 

 

Government Agency Approval form or equivalent document from

 

 

 

for

.

 

8.

 

Provide “will-serve” letters from gas, electric, water and sewer providers.

9.

Submit a permit application (HCD Form 50) with three (3) sets of all plans and documents

 

 

with appropriate fees to the Department after a preliminary plan review meeting has been

held. A separate application form is required for each building, utilities (combined), grading/drainage, etc.

10.Provide written evidence of compliance with the California Environmental Quality Act, Public Resources Code, Division 13, commencing with Section 21000. (Typically on the use permit)

HCD MP 514 5/09

2

PART A

PARK CONSTRUCTION - PLAN REQUIREMENTS

I.Plot-Site Plan/Title Sheet:

1. Site location including vicinity map with north arrow.

2. Address of proposed site.

3. Name and address of owner.

4. Name, address, telephone number, and email of person preparing the plans.

5. Index sheets on the title sheet.

6. Property lines, mobilehome or RV lot lines and dimensions of all lots.

7. Easements and/or right-of-ways, public or private, if any.

8. Location and size of all permanent buildings, parking spaces and storage areas.

9. Roadway widths and any required parking signs.

10.Method of lot line permanent identification.

11.Engineer’s stamp and wet signature if required.

12.Scale.

II.Drainage and Grading Plan:

1. General vicinity of the proposed site.

2. Property limits and accurate contours of the existing ground and details of the terrain and area drainage.

3. Limiting dimensions, elevations or finish contours to be achieved by the grading, and proposed drainage channels and related construction.

4. Detailed plans (3 sets) of all surface and subsurface drainage devices, walls, cribbing, dams and other protective devices to be constructed with, or as part of the proposed work together with a map showing the drainage area and the estimated runoff of the area served by any drains.

5. The building pads (lots) shall indicate a surface or subsurface drainage gradient of at least 1% towards an approved drainage facility.

6. The location of any buildings or structures on the property where the work is to be performed and the location of any buildings or structures on land of adjacent owners which are within 15 feet of the property or which may be affected by proposed grading operations.

HCD MP 514 5/09

3

7. A geotechnical Investigation report (3 copies) must accompany grading plans. This report must include a description of the geology of the site and shall include data regarding the nature, distribution and strength of existing soils. The report shall include construction and grading requirements if any. Such recommendations and requirements must be noted on the grading plan.

8. Required grading plan notes:

a.A soils report has been prepared and shall be considered a part of these plans.

b.All grading practices shall comply with the applicable sections of the current California Building Code.

c.The design engineer shall provide a letter upon completion that the final grades are in compliance with approved plans and applicable codes.

d.Total volume of cut and of fill material.

e.Upon completion of the grading, the soils engineer shall submit a final report. The report shall include all test results certifying that the work is in compliance with the specifications and recommendations contained in the soils reports.

9. All drainage and grading plans and specifications must be signed by a California licensed civil engineer.

III.Electrical Distribution Systems:

A. Specifications:

1. Provide manufacturer specification sheets for park service equipment, transformers, substations, secondary distribution panelboards and lot service equipment.

2. Specify the voltage, ampere and interrupting capacity rating, type and class of overcurrent protective device in the park service equipment.

3. Specify the voltage, ampere and interrupting capacity rating, type and class of overcurrent protective device for the primary system feeders and/or transformers.

4. Specify primary and secondary voltages. Specify KVA rating and impedance of transformers

5. Specify the voltage, ampere and interrupting capacity rating, type and class, of the overcurrent protective devices for the secondary system feeders.

6. Specify the type of conductors (CU or AL), type of insulation, voltage rating and temperature rating.

7. If the system is to be installed or owned by a utility company, provide a will-serve letter confirming such service, including information regarding the point of termination. Complete electrical specifications, plans and calculations are required if the point of termination does not comply with 25CCR Section 1184 or 2184.

HCD MP 514 5/09

4

8. Alternate Approval Application if lot service equipment will not be terminated on the lot within four feet of the MH-unit (only within mobilehome parks).

B. Electrical Plans:

1. Provide a single line diagram of the park electrical system, including lighting.

2. Indicate the locations of all equipment devices and conductors in the system.

3. Indicate all circuit lengths, conductor sizes and distance to the center of the load.

4. Provide details of all conductor installations.

5. Provide details of equipment installation and mechanical protective barriers if required.

6. Provide details of the correct method of grounding the system and equipment.

7. Provide details of the park lighting installation.

8. Plans for systems exceeding 240 volts require the signature of a California registered electrical engineer.

C. Electrical Calculations:

1. Submit load calculations for all loads served - not to exceed a total combined voltage drop of 5% for any total run.

2. Include all buildings in the load calculations.

3. Submit calculations used to determine the interrupting capacity of overcurrent protective devices for each transformer.

4. Submit calculations used to determine the interrupting capacity of overcurrent protective devices for secondary system feeders.

5. Submit park lighting calculations to substantiate compliance with 25CCR Section 1108 or 2108.

6. Calculations for systems exceeding 240 volts require the signature of a California registered electrical engineer.

IV. Fire Protection Plan:

1. Show the locations of the fire hydrants, type and manufacturer of the hydrants, location and type of shutoff valve and the hydrants’ head size.

2. Show the location and design of thrust blocks and provide sizing schedule.

HCD MP 514 5/09

5

V. Utility Trenches:

1. Show details of trenches, including the depth, width, location and spacing of the utilities in the trenches.

2. Show the types of bedding and covering for utilities, and the protection and backfill of the trenches and frost line.

VI. Sewage Disposal System Plan:

1. If applicable, show the location and design of the private sewage disposal system, including the sizes of tanks, distribution boxes and drain fields.

2. Show the size, length and grade of the sewer lines.

3. Show the type of pipe, manufacturer and pipe identification numbers, fittings and location of the pipe.

4. Show the location of the vents and (if applicable) cleanouts.

5. Provide details of lot inlets, p-traps (if any), venting and protection of traps, and MH-unit or RV connection details.

6. Indicate the location of the sewer inlet on the mobilehome or RV lot.

7. Provide an engineered design and calculations for any on-site sewage lift or pump stations. Include the manufacturer’s pump specifications, gate and backflow valve locations and alarm details. The stamp and signature of the responsible California registered engineer shall be on all calculations.

8. Provide a design of any sanitary dump station if required or provided.

9. Indicate the location and connection to the public sewer system

10.A signature and stamp of a California professional engineer is required if the grades of the system are less than specified in CCR, Title 25, Table 1268-2 or 2268-2, or if the park drainage system exceeds the fixture unit loading in CCR, Title 25, Table 1268-1 or Table 2268-1 (600 fixture units) .

11.A letter from the design engineer stating he/she will verify the grade of all sewer lines on the job site and provide the enforcement agency with a statement that he/she has inspected the grade of the lines.

VII. Water Distribution System:

1. Indicate the source and pressure of the water system.

2. Provide the location of the connection to the source, meter size, backflow prevention devices (if required) and assemblies and methods, pipe sizes, fittings, type and material of pipe and fittings.

HCD MP 514 5/09

6

3. Provide details of service riser to each lot, size, material, valves and backflow prevention devices, assemblies and methods, and mechanical barrier protection if required.

4. Additions to existing systems shall include PSI at point of interconnection to an existing system and existing size of water main at the point.

5. Provide water demand calculations consistent with the California Plumbing Code.

6. Provide the location and design of thrust blocks and a sizing schedule consistent with the California Plumbing Code.

7. Provide a complete single-line diagram of the new and existing system.

8. Provide the locations of service risers for each lot.

VIII. Gas Distribution System Plan:

1. Show the source of the gas supply and pressure and indicate the type of gas (LP - Natural).

2. Provide calculations for the demand and pipe sizes (CCR, Title 25, Section 1230 and 1232 and/or 2230 and 2232).

3. Show the length of runs, location of runs and shutoff valves in the run. Show size transition locations in the runs. Show the BTUH demands. If adding to an existing system, provide complete demand calculations along with a single line diagram of the existing and the proposed system.

4. Provide a schedule of pipe size, pipe manufacturer and identification numbers of pipe and protective covering when required.

5. Provide details of the lot service riser, gas shutoff valve, regulator and/or meter installation and supports, protective barrier location where necessary.

6. If the system is LPG, show the location, method of protection and size of the tank(s).

7. If the gas system is over eleven (11) inches, water column systems shall be designed by a California licensed professional engineer.

8. Provide details of cathodic protection for metallic gas piping systems.

Plan Review (circle one) COMPLETE - INCOMPLETE

HCD Authorized Representative: ____________________________________

Date:____________________________________

HCD MP 514 5/09

7

THIS PAGE INTENTIONALLY LEFT BLANK

HCD MP 514 5/09

8

PART B

PARK BUILDING - PLAN REQUIREMENTS

I.Plot-Site Plan/Title Sheet:

1. Site location including vicinity map with north arrow.

2. Address of proposed site.

3. Name, telephone number and address of owner.

4. Name, telephone number, email and address of person preparing the plans.

5. Index sheets on the title sheet.

6. Show all property lines and dimensions.

7. Indicate easements and/or right of ways, public or private, if any.

8. Show location and size of the proposed building in relation to the property lines, existing buildings, park lot lines, streets, parking areas, trees, signs, swimming pools, etc.

9. Provide engineer’s stamp and wet signature if required and all structural calculations. 10. Indicate scale used.

11. Provide provisions for grading and drainage.

12. Specify occupancy classification of building.

13. Specify the fire hazard severity zone.

II.Foundation Plan:

1. Show dimensions and depth below finish grade or original grade of all walls and post foundations and frost line depth.

2. Indicate locations and size of anchor bolts, tie-downs, hold-downs, seismic reinforcement and under-floor access.

3. Show typical sections through footing.

4. Indicate soil classification and bearing pressure.

III.Elevation Views:

1. Show exterior finishes and roof coverings.

2. Indicate roof slopes.

3. Show significant height dimensions.

4. Indicate dimensions of overhangs.

HCD MP 514 5/09

9

IV.

Floor Plan:

 

1.

Indicate the exact and complete dimensions of the structure.

 

2.

Provide identification of the proposed use for all rooms.

 

3.

Indicate location and sizes of all doors, windows and openings, include glass/glazing

 

 

requirements. Indicate rating of fire doors.

 

4.

Indicate location of all appliances and fixtures, such as range, oven, washer, dryer, furnace,

 

 

water heater, air conditioner, sinks, etc.

 

5.

Show type of interior ceiling, wall and floor finishes.

 

6.

Show change in floor level at all doorways.

 

7.

Designate on the plan the posting of the occupant load in accordance with the California

 

 

Building Code.

 

8.

Indicate the type of locks or latches installed in the required doors.

 

9.

The minimum scale shall be 1/8” = 1’ 0”.

V.Framing Plan:

1. Note design loads on drawings.

2. Indicate material type and grade.

3. Provide roof framing plan to include mansard or similar structure.

4. Provide floor framing plan.

5. Provide wall framing plan.

6. Provide ceiling joist-framing plan.

7. Provide framing details at wall openings.

8. Note braced wall lines, braced wall panels and shear wall locations.

9. Provide typical reinforcement details for masonry and/or concrete construction.

10. When prefabricated trusses are used, complete details and calculations of the specific truss used shall accompany the plans.

11. Show attic separation walls in accordance with the California Building Code requirements and details.

12. Indicate size and location of attic access.

13. Where roof drains are required, show size and location of overflow drains.

HCD MP 514 5/09

10

VI. Details and Sections:

1. Provide sufficient detailed and dimensioned sections through portions of the building to adequately clarify the framing details.

2. Provide connection details at bearings of individual members.

3. Provide connection details for top and bottom of partition walls.

4. Provide connection details to adequately show lateral load transfer.

5. Provide details of fireplace construction.

6. Provide details of roof covering.

VII. Electrical Plan:

1. Provide location of all panels indicating sizes.

2. Indicate type, size and material of all conductor conduits.

3. Indicate type and size of all conductors.

4. Indicate proposed wiring method.

5. Indicate location of all electrical outlets, including lights, plugs, receptacles and junction boxes.

6. Indicate method and location of grounding.

7. Show location and rating of all electrical appliances.

8. Provide a circuit schedule, indicating the size of overcurrent protection.

VIII. Plumbing Plan:

1. Provide a single-line and isometric drawing of the drain, waste and vent system showing sizes, dimensions, types and identification of all fittings and materials.

2. Indicate location of all cleanouts.

3. Indicate termination of vents.

4. Provide a single-line drawing of the water supply system showing sizes, lengths of runs, type of materials and valves.

5. Show available pressure at meter or regulator.

6. Indicate type and number of fixtures.

IX. Mechanical Plan:

1. Indicate type of fuel.

HCD MP 514 5/09

11

2. Provide a single-line drawing of the fuel lines, showing size and type of material, and change in pipe sizes.

3. Indicate location, type, size and rating (in BTUH or CFM) of all appliances.

4. Show type of flue, indicating location and termination.

5. Show combustion air and how it is provided.

6. Indicate fire dampers and assemblies.

7. Provide details when mechanical ventilation is used to ensure minimum required air changes.

X.Disabled Access:

1. All park public buildings and public areas shall comply with disabled access requirements per California Building Code, Title 24, Chapter 11B. Provide details showing compliance. Note: Park buildings and areas not for the general public are not required to be accessible.

2. ALL AREAS of RV parks are required to comply with the disabled access requirements contained in the California Building Code, Title 24, Chapter 11B. Provide details showing compliance.

3. All park offices shall comply with disabled access requirements. Provide details showing compliance with accessibility requirements.

4. All park swimming pools, recreational buildings, and recreational areas shall be required to comply with disabled accessibility requirements if they are offered for rent, lease, rented or leased to, or used by the general public at any time. Where required show compliance with accessibility requirements.

XI. Energy Requirements

1. Provide details showing compliance with California Code of Regulations and Title 24, if the building is heated or cooled.

XII. Wildland Urban Interface (Fire Hazard Zone)

1. Submit a completed Wildland Urban Interface Classification form (attached), or an equivalent document to indicate the fire hazard severity zone.

XIII. Fire Sprinklers

1. Where buildings are required to have sprinklers, provide a single-line drawing of the water supply system showing sizes, lengths of runs, type of materials, water source, type of sprinkler heads, and head locations.

Park Building - Part B

 

 

 

Plan Review (circle one)

COMPLETE

-

INCOMPLETE

HCD Authorized Representative:___________________________________

 

Date:___________________________________

HCD MP 514 5/09

12

 

 

STATE OF CALIFORNIA -BUSINESS, TRANSPORTATION AND HOUSING AGENCYArnold Schwarzenegger, Governor

DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

DIVISION OF CODES AND STANDARDS

MOBILEHOME OR RECREATIONAL VEHICLE PARK

GOVERNMENT AGENCY APPROVAL FORM

NORTHERN AREA OFFICE

SOUTHERN AREA OFFICE

9342 Tech Center Drive Suite 550

3737 Main Street, Ste 400

Sacramento, CA 95826

Riverside, CA 92501

(916) 255-2501

(951) 782-4420

This form is for use by applicants for a Department of Housing and Community Development Permit to Construct a mobilehome park, recreational vehicle park or additions/improvements as noted below.

The applicant listed below is applying to the Department of Housing & Community Development (HCD) to

construct a project which is located within(city or county). HCD is the enforcement and permit issuing agency for construction within mobilehome/recreational vehicle parks at this location. Prior to issuing any construction permits HCD must be assured that the project has received all required government approvals. Accordingly, HCD has instructed the applicant to obtain signatures from the agencies which are checked below. Comments and conditions of approval may be attached.

If your agency wishes to be contacted prior to final inspection approval please indicate by checking so under your printed name. For agencies requesting final review, this form will be re- circulated prior to final inspection for signature confirming that the project is in compliance.

Project name:

Project street address:

Assessor’s Parcel #:

Describe work to

be done:

Applicant/owner:

 

 

 

 

 

 

 

Phone number: (

)

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Architect/Engineer/Contractor (circle which):

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number:

(

)

 

 

 

 

 

 

 

 

 

 

Contact person:

(print)

 

 

 

 

 

Phone number: (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Government agencies - NOTE: A permit application cannot be processed without the approval signatures from any agency checked in the left margin boxes.

Planning:

x

 

 

 

 

A signature here confirms the proposed construction is consistent with local planning requirements Title

 

x

 

 

 

 

Print name

Phone #

Date

Upon completion, does your agency want to review the project/site prior to HCD finalizing the permit(s)?

Yes

 

No

If yes, this form will be re-circulated prior to the final for your signature below.

 

 

 

 

 

 

 

 

 

Final approval signature

 

Date

HCD MP 514 5/09

 

 

 

 

13

 

 

 

Health

x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A signature here confirms the proposed construction is consistent with local health requirements

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print name

 

 

 

 

 

 

Phone #

Date

 

 

 

 

 

 

 

 

Upon completion, does your agency want to review the project/site prior to HCD finalizing the permit(s)?

 

Yes____

No

 

 

 

If yes, this form will be re-circulated prior to the final for your signature below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Final approval signature

 

 

 

 

 

Date

 

 

 

 

 

 

 

Public

x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Works

A signature here confirms the proposed construction is consistent with local public works requirements Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print name

 

 

 

 

 

 

Phone #

Date

 

 

 

 

 

 

 

 

Upon completion, does your agency want to review the project/site prior to HCD finalizing the permit(s)?

 

Yes

 

 

No

 

 

If yes, this form will be re-circulated prior to the final for your signature below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Final approval signature

 

 

 

 

Date

 

 

 

 

 

 

 

Fire

x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Protection

A signature here confirms the proposed construction is consistent with local fire requirements

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print name

 

 

 

 

 

 

Phone #

Date

 

 

 

 

 

 

 

 

Upon completion, does your agency want to review the project/site prior to HCD finalizing the permit(s)?

 

Yes____

No

 

If yes, this form will be re-circulated prior to the final for your signature below.

 

Final approval signature

 

 

 

 

Date

 

 

 

 

 

 

 

________

x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________

A signature here confirms the proposed construction is consistent with local

 

 

 

 

 

requirements Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print name

 

 

 

 

 

 

Phone #

Date

 

 

 

 

 

 

 

Upon completion, does your agency want to review the project/site prior to HCD the permit(s)?

 

 

 

Yes ___

No

 

If yes, this form will be re-circulated prior to the final for your signature below.

 

 

Final approval signature

 

Date

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Applicant

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

Date ________________________

 

 

 

 

 

 

 

 

 

 

 

HCD MP 514 5/09

 

 

 

14

 

 

 

 

 

STATE OF CALIFORNIA -BUSINESS, TRANSPORTATION AND HOUSING AGENCYArnold Schwarzenegger, Governor

DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

DIVISION OF CODES AND STANDARDS

NORTHERN AREA OFFICE

SOUTHERN AREA OFFICE

9342 Tech Center Drive Suite 550

3737 Main Street, Ste 400

Sacramento, CA 95826

Riverside, CA 92501

(916) 255-2501

(951) 782-4420

SUPPLEMENT TO APPLICATION TO CONSTRUCT OR

RECONSTRUCT PARKS AND/OR PARK BUILDINGS OR FACILITIES

Park Name

 

 

 

 

 

 

 

 

 

Park I.D. No.

 

 

 

Mobilehome Park

 

 

 

Special Occupancy Park

Campground

 

Number of Mobilehome Lots

Number of RV Lots W/Drains

 

 

 

Number of RV Lots W/O Drains

Number of Campsites

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Park Construction Fees

 

 

 

 

Fee X

No. = Sub-Total

 

 

 

 

Fee

X No. = Sub-Total

 

Electrical - Building

 

____________________

 

Lots

$

5.75 _________________________

 

 

Outlets

 

 

$

.35

 

 

____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Park Elec. Ser.

$14.00 _________________________

 

 

Fixtures

$

.35 ____________________

 

Sub-Sta. / Trans

$10.50 _________________________

 

 

Misc.

 

$ 7.00 ____________________

 

Lot Elec. Ser.

$

7.00 _________________________

 

 

Disposal/Dishwasher

$ 1.50 ____________________

 

Street Light

$

3.00 _________________________

 

 

Range/ Heater/Dryer

$ 7.00 ____________________

 

Park Drain Sys.

$14.00 _________________________

 

 

Signs

 

$ 3.00 ____________________

 

Private Sewer

$14.00 _________________________

 

 

Ser. 200 AMP & Under $ 7.00 ____________________

 

Lot Drain Inlet

$

7.00 _________________________

 

 

Ser. Over 200 AMP

$10.00 ____________________

 

Park Water Sys.

$

7.00 _________________________

 

 

Other

 

 

____________________

 

Water Ser. Outlet

$

4.25 _________________________

 

 

Plumbing - Building

 

 

 

 

 

 

Fire Hydrant

$

4.25 _________________________

 

 

Fixtures

$

3.00 ____________________

 

Park Gas Sys.

$

7.00 _________________________

 

 

Building Sewer

$14.00 ____________________

 

Gas Tank 60#

$

7.00 _________________________

 

 

Pvt. Disp. System

$14.00 ____________________

 

Lot Gas Riser

$

4.25 _________________________

 

 

Water Heater/or Vent $

7.00 ____________________

 

Other

$

_________________________

 

 

Gas Outlets up to 5

$

7.00 ____________________

 

 

 

 

 

 

 

 

 

 

Water Piping Outlets

$

1.00 ____________________

 

 

 

 

 

 

 

 

 

 

Lawn Sprinkler

$

7.00 ____________________

 

Park Building Fees

 

 

 

 

 

 

 

 

 

 

 

Mechanical - Building

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heaters < 100,000

$14.00 ____________________

 

Occupancy

Type

 

Square Footage

 

Vents

 

$

7.00 ____________________

 

 

 

 

 

 

 

 

 

 

AC Appliances

$14.00 ____________________

 

Occupancy

Type

 

Square Footage

 

Heaters > 100,000

$21.00 ____________________

 

 

 

 

 

 

 

 

 

 

Air-Handling Units

$

7.00 ____________________

 

Fees : $2000 and less - $45

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$2,001 - $25,000 =

$45 1st. $2000 + $9.00 each addn. $1000

 

Ventilation Equip.

$

7.00 ____________________

 

$25,001 - $50,000 = $252, 1st $25k + $6.50 each addn. $1000

 

 

 

 

 

 

 

 

 

 

$50,001 - $100,000 = $414.50, 1st $50k + $4.50 each addn. $1000

 

 

 

 

 

 

 

 

 

$100,001 - $500,000 = $639.50, 1st $100k + $3.50 each addn. $1000

 

 

Permit Fee

 

 

 

 

 

 

$500,001 - $1,000,000 = $2039.50, 1st $500k + $3.50 addn. $1,000

 

 

 

 

 

 

 

 

 

Inspection Fees -

 

 

 

 

Permanent Buildings Only -

 

 

Plan Ck. Fee

 

 

 

 

 

 

Additional inspection fees

 

 

Strong Motion Fee Calculation:

 

(Minimum ½ Permit fee)

 

 

 

may be required for multiple

 

 

Building Value $0 - $7,000 =

$0.50

 

 

 

 

 

 

 

 

inspections and reinspections.

 

$7000 & up .00007 per thousand

 

Strong Motion Fee

 

 

 

 

 

 

 

 

 

 

ex: 31,000 x $ .00007 = $2.17

 

 

(Applicable only to buildings)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Permit Fee

 

 

 

 

 

HCD MP 514 5/09

 

 

15

 

 

 

 

 

 

 

 

 

 

THIS PAGE INTENTIONALLY LEFT BLANK

HCD MP 514 5/09

16

WILDLAND URBAN INTERFACE CLASSIFICATION

The following information is used by the Department of Housing and Community Development (HCD) in order to determine the correct installation of materials and construction methods for exterior wildfire exposure. Applicants should obtain information as indicated below from the local authority having jurisdiction, and are requested to submit the following information with the HCD 415 and/or HCD 50 form at the time of permit application to HCD.

Applicant Name _________________________________________________________________

Date _________________________Telephone No.______________________________________

Applicant to complete items 1 through 3

1.Site Location of Home or Structure: __________________________________________

2.Assessor Parcel No. (if known): ______________________________________________

3.Mobilehome Park Name (if applicable) ________________________________________

Obtain Assistance from Local Authority Having Jurisdiction in completion of the following:

1.Fire Department or District: _________________________________________________

2.Contact Person and Telephone ________________________________________________

The home or structure described above is or is intended to be located in an area as noted below:

State Responsibility Area (SRA)

Very High

High

Moderate

Unzoned

(LRA) Local Agency Very-High Severity Zone

(LRA) Wildland Urban Interface Area – Specify the ignition-resistant construction require by the local authority having jurisdiction for fire protection on this property

N/A

HCD MP 514 5/09

17

THIS PAGE INTENTIONALLY LEFT BLANK

Sta te o f C a lifo rnia

Busine ss, Tra nsp o rta tio n a nd Ho using Ag e nc y

De p a rtm e nt o f Ho using a nd C o m m unity De ve lo p m e nt

Divisio n o f C o d e s a nd Sta nd a rd s

Mo b ile ho m e a nd Sp e c ia l O c c up a nc y Pa rks Pro g ra m s

A PPLIC A TIO N FO R PERMIT TO C O NSTRUC T

(SEE REVERSE SIDE O F FO RM FO R INSTRUC TIO NS A ND A DDITIO NA L INFO RMA TIO N)

C O NTRA C TO R/ O WNER BUILDER DEC LA RA TIO NS

No t re q uire d fo r c o mme rc ia l mo d ula rs o r Re c re a tio na l Ve hic le s

1. LIC ENSED C O NTRAC TO RS DEC LARATIO N

Ihe re b y a ffirm und e r p e na lty o f p e rjury tha t I a m lic e nse d und e r p ro visio ns o f C ha p te r 9 (c o m m e nc ing w ith Se c tio n 7000) o f Divisio n 3 o f the Busine ss a nd Pro fe ssio ns C o d e , a nd m y

lic e nse is in full fo rc e a nd e ffe c t.

Lic e nse C la ss_______Lic . No . ______________ Exp . Da te _________

C o ntra c to r ________________________________Da te ____________

2. O WNER-BUILDER DEC LARATIO N

I he re b y a ffirm und e r p e na lty o f p e rjury tha t I a m e xe m p t fro m the C o ntra c to rs Lic e nse La w fo r the fo llo w ing re a so n (Se c . 7031.5), Busine ss a nd Pro fe ssio ns C o d e : Any c ity o r c o unty

w hic h re q uire s a p e rm it to c o nstruc t, a lte r, im p ro ve , d e m o lish, o r re p a ir a ny struc ture , p rio r to its issua nc e , a lso re q uire s the

a p p lic a nt fo r suc h p e rm it to file a sig ne d sta te m e nt tha t he o r she is lic e nse d p ursua nt to the p ro visio ns o f the C o ntra c to rs Lic e nse La w (C ha p te r 9 (c o m m e nc ing w ith Se c tio n 7000) o f Divisio n 3 o f the Busine ss a nd Pro fe ssio ns C o d e ) o r tha t he o r she is e xe m p t the re fro m a nd the b a sis fo r the a lle g e d e xe m p tio n. Any vio la tio n o f Se c tio n 7031.5 b y a ny a p p lic a nt fo r a p e rm it sub je c ts the a p p lic a nt to a c ivil p e na lty o f no t m o re tha n five hund re d d o lla rs($500).):

I, a s o w ne r o f the p ro p e rty, o r m y e m p lo ye e s w ith w a g e s a s the ir so le c o m p e nsa tio n, w ill d o the w o rk, a nd the struc ture is no t inte nd e d o f o ffe re d fo r sa le (Se c . 7044, Busine ss a nd

Pro fe ssio ns C o d e : The C o ntra c to rs Lic e nse La w d o e s no t a p p ly to a n o w ne r o f p ro p e rty w ho b uild s o r im p ro ve s the re o n, a nd w ho d o e s suc h w o rk him se lf o r he rse lf o r thro ug h his o r he r o w n e m p lo ye e s, p ro vid e d tha t suc h im p ro ve m e nts a re no t inte nd e d o r o ffe re d fo r sa le . If, ho w e ve r, the b uild ing o r im p ro ve m e nt is so ld w ithin o ne ye a r o f c o m p le tio n, the o w ne r-b uild e r w ill ha ve the b urd e n o f p ro ving tha t he o r she d id no t b uild o r im p ro ve fo r the p urp o se o f sa le .).

I, a s o w ne r o f the p ro p e rty, a m e xc lusive ly c o ntra c ting w ith lic e nse d c o ntra c to rs to c o nstruc t the p ro je c t (Se c . 7044, Busine ss a nd Pro fe ssio ns C o d e : The C o ntra c to rs Lic e nse La w

d o e s no t a p p ly to a n o w ne r o f p ro p e rty w ho b uild s o r im p ro ve s the re o n, a nd w ho c o ntra c ts fo r suc h p ro je c ts w ith a

c o ntra c to r(s) lic e nse d p ursua nt to the C o ntra c to rs Lic e nse La w .).

Ia m e xe m p t und e r Se c . _______, B. & P.C . fo r this re a so n:

_________________________________________________________

O w ne r_________________________________Da te ____________

3.WO RKERS' C O MPENSATIO N DEC LARATIO N

Ihe re b y a ffirm und e r p e na lty o f p e rjury o ne o f the fo llo w ing d e c la ra tio ns:

I ha ve a nd w ill m a inta in a c e rtific a te o f c o nse nt to se lf-insure fo r w o rke rs' c o m p e nsa tio n, a s p ro vid e d fo r b y Se c tio n 3700 o f

the La b o r C o d e , fo r the p e rfo rm a nc e o f the w o rk fo r w hic h this p e rm it is issue d .

Iha ve a nd w ill m a inta in w o rke rs' c o m p e nsa tio n insura nc e , a s re q uire d b y Se c tio n 3700 o f the La b o r C o d e , fo r the

p e rfo rm a nc e o f the w o rk fo r w hic h this p e rm it is issue d . My w o rke rs' c o m p e nsa tio n insura nc e c a rrie r a nd p o lic y num b e r a re :

C a rrie r _______________________________________________

Po lic y Num b e r___________________________________________

(This se c tio n ne e d no t b e c o m p le te d if the p e rm it is fo r o ne hund re d d o lla rs ($100) o r le ss).

I c e rtify tha t in the p e rfo rm a nc e o f the w o rk fo r w hic h this

p e rm it is issue d , I sha ll no t e m p lo y a ny p e rso n in a ny m a nne r so a s to b e c o m e sub je c t to w o rke rs' c o m p e nsa tio n la w s o f

C a lifo rnia , a nd a g re e tha t if I sho uld b e c o m e sub je c t to

w o rke rs' c o m p e nsa tio n p ro visio ns o f Se c tio n 3700 o f the La b o r C o d e , I sha ll fo rthw ith c o m p ly w ith tho se p ro visio ns.

Ap p lic a nt

__________________________________Da te ______________

WARNING : FAILURE TO SEC URE WO RKERS' C O MPENSATIO N

C O VERAG E IS UNLAWFUL, AND SHALL SUBJEC TAN EMPLO YER TO C RIMINAL PENALTIES AND C IVIL FINES UP TO O NE HUNDRED THO USAND DO LLARS ($100,000), IN ADDITIO N TO THE C O STO F C O MPENSATIO N, DAMAG ES AS PRO VIDED FO R IN SEC TIO N 3706 O F THE LABO R C O DE, INTEREST, AND ATTO RNEY'S FEES.

4. C O NSTRUC TIO N LENDING AG ENC Y

I he re b y a ffirm und e r p e na lty o f p e rjury tha t the re is a

c o nstruc tio n le nd ing a g e nc y fo r the p e rfo rm a nc e o f the w o rk fo r w hic h this p e rm it is issue d (Se c .3097, C iv. C .).

Le nd e r's Na m e _________________________________________

Le nd e r's Ad d re ss __________________________________________

5. C ERTIFIC ATIO N

I c e rtify tha t I ha ve re a d this a p p lic a tio n a nd sta te tha t the a b o ve info rm a tio n is c o rre c t. I a g re e to c o m p ly w ith a ll c ity a nd c o unty o rd ina nc e s a nd sta te la w s re la ting to b uild ing

c o nstruc tio n, a nd he re b y a utho rize re p re se nta tive s o f this c o unty to e nte r up o n the a b o ve -m e ntio ne d p ro p e rty fo r insp e c tio n p urp o se s.

____________________________________________ ____________

Sig na ture o f Ap p lic a nt o r Ag e nt

Da te

SEC TIO N 1 - O WNER/ A PPLIC A NT INFO RMA TIO N

Pa rk Na m e __________________________________________________________

Pa rk

Ad d re ss________________________________________________________

City_______________________________C o unty__________________________

Zip ____________________Uninc o rp o ra te d _______Inc o rp o ra te d _________

Pa rk O w ne r_________________________________________________________

APPLIC ANT_________________________________________________________

C O NTRAC TO R O WNER O the r ________________________

Ad d re ss ____________________________________________________________

___________________________________________Te l. No ________________________

Arc hite c t/ Eng ine e r__________________________Lic . No . ________________

Ad d re ss___________________________________Te l. No .

___________________

SEC TIO N 2 - DESC RIPTIO N O F WO RK A ND VA LUA TIO N

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Va lua tio n $_______________________________________________________

SEC TIO N 3 – A C C ESSO RY BUILDING S O R STRUC TURES

 

NEW

REINSTALL Sta nd a rd Pla n Ap p ro va l No . _______________

Aw ning

C a rp o rt

Po rc h

C a b a na

O the r (sp e c ify) _________________________________________________

O WNER________________________________Te l. No . ____________________

Ad d re ss __________________________________________________________

RESIDENT _______________________________Te l. No . ___________________

Lo t No . _____________________

SEC TIO N 4 - MA NUFA C TURED HO ME/ MO BILEHO ME INSTA LLA TIO N

O w ne r _________________________________ Te l. No . ___________________

Ad d re ss _________________________________________________________

Re sid e ntLo t No . ____________________

Se ria l Num b e r(s) __________________________________________________

 

 

Ma nufa c ture r Na m e /

Da te o f MFG .

 

Mo d e l Na m e ______________________________

Insig nia / HUD

 

 

La b e l No . _________________________________________________________

SEC TIO N 5 - PA RK O WNER, O PERA TO R O R MA NA G ER SIG NA TURE APPRO VED:

____________________________________________________ ____________

(Sig na ture Re q uire d )

Da te

DEPA RTMENT USE O NLY

ID. No .__________________________

MP AS MHI

C lo se d By ______________________

Da te C lo se d ___________________

C O LLEC TIO N INFO RMA TIO N

C o lle c tio n # ____________________

________________________________

Fe e Re c 'd ______________________

________________________________

C o lle c tio n Da te ________________

Assig ne d To ____________________

Ro ute d By _____________________

Up o n De p a rtm e nt a p p ro va l to

re le a se , a nd p a ym e nt o f fe e s, this p e rm it is issue d o nly fo r ite m s

va lid a te d b e lo w .

PERMIT#

____________________

MH AC C / S ____________________

MP

_____________________

BLDG

_____________________

MHI

_____________________

MISC .

_____________________

TEC H SER.

____________________

PLC 'K

_____________________

S.M.I.

_____________________

ISSUE

_____________________

TO TAL

_____________________

 

 

 

 

DIVISIO N PRO C ESS REC O RD

Ap p lic a tio n ____________________

Lo c a l Pla nning _________________

Lo c a l Fire ______________________

Lo c a l He a lth ___________________

Pub lic Wo rks ___________________

Enviro nm e nta l

Im p a c t ________________________

Ne g a tive

De c la ra tio n ____________________

Sc ho o l Im p a c t

Fe e s ___________________________

Da te __________________________

Issue d By ______________________

________________________________

Exp ire s _________________________

HC D 50, Sid e 1 (Re v. 7/ 04)

DISTRIBUTIO N: WHITE - DEPARTMENT,

BLUE - APPLIC ANT,

YELLO W - DISTRIC TREPRESENTATIVE, PINK - ASSESSO R

INSTRUC TIO NS

A C C ESSO RY STRUC TURES: C o m p le te Se c tio ns 1, 3, 5 a nd C o ntra c to r/ O w ne r Build e r De c la ra tio ns. Sub m it the c o m p le te d a p p lic a tio n a nd the re q uire d fe e s to the a p p ro p ria te Are a O ffic e liste d b e lo w .

MA NUFA C TURED HO ME/ MO BILEHO ME INSTA LLA TIO N: C o m p le te Se c tio ns 1, 4, 5, a nd C o ntra c to r/ O w ne r Build e r De c la ra tio ns. Sub m it the c o m p le te d a p p lic a tio n a nd re q uire d fe e s to the a p p ro p ria te Are a O ffic e liste d b e lo w .

18551 FO UNDA TIO N SYSTEM: C o m p le te Se c tio ns 1, 2, 5 a nd C o ntra c to r/ O w ne r Build e r De c la ra tio ns. Sub m it the c o m p le te d a p p lic a tio n a nd the re q uire d fe e s to the a p p ro p ria te Are a O ffic e liste d b e lo w .

PA RK UTILITIES: C o m p le te Se c tio ns 1, 2, 5 a nd C o ntra c to r/ O w ne r Build e r De c la ra tio ns. Sub m it the c o m p le te d a p p lic a tio n a nd re q uire d fe e s to the a p p ro p ria te Are a O ffic e liste d b e lo w .

NEW PA RKS A ND PERMA NENT BUILDING S: C o m p le te Se c tio ns 1, 2, 5 a nd C o ntra c to r/ O w ne r Build e r De c la ra tio ns. Sub m it the c o m p le te d a p p lic a tio n a nd re q uire d fe e s to the a p p ro p ria te Are a O ffic e liste d b e lo w .

No rthe rn Are a O ffic e

So uthe rn Are a O ffic e

9342 Te c h C e nte r Drive , Suite 550

3737 Ma in St., Suite 400

Sa c ra m e nto , C A 95826

Rive rsid e , C A 92501

(916) 255-2501

(951) 782-4420

SEC TIO N 1 -

O WNER/ APPLIC ANTINFO RMATIO N: Ente r the p a rk na m e a nd a d d re ss. Ind ic a te if the p a rk is lo c a te d in a n uninc o rp o ra te d

 

a re a o r a n inc o rp o ra te d a re a . Ente r the p a rk o w ne r's na m e (s). Ente r the a p p lic a nt's na m e , a d d re ss a nd te le p ho ne num b e r

 

(The De p a rtm e nt w ill c o nta c t o r c o rre sp o nd w ith the p a rty tha t is e nte re d a s the a p p lic a nt.) C he c k the a p p ro p ria te b o x to

 

d e sc rib e the a p p lic a nt. If the b o x "O the r" is m a rke d , p le a se ind ic a te the re la tio nship to the o w ne r. If the re q ue ste d se rvic e s

 

invo lve a n a rc hite c t o r e ng ine e r, e nte r the a rc hite c t o r e ng ine e r's na m e , a d d re ss, te le p ho ne num b e r, a nd lic e nse num b e r.

SEC TIO N 2 -

DESC RIPTIO N O F WO RK AND VALUATIO N: Pro vid e a d e sc rip tio n o f the w o rk to b e p e rfo rm e d (i.e ., insta lling a m a nufa c ture d

 

ho m e o n a fo und a tio n syste m , e tc .) Ente r the to ta l c o st o f the w o rk to b e p e rfo rm e d (to ta l c o ntra c t p ric e ).

SEC TIO N 3 -

AC C ESSO RY BUILDING S o r STRUC TURES: C he c k the a p p ro p ria te b o x to ind ic a te if the a c c e sso ry b uild ing / struc ture is a ne w

 

insta lla tio n o r a re insta lla tio n. A ne w insta lla tio n m e a ns a ne w a c c e sso ry b uild ing o r struc ture o r a n a c c e sso ry b uild ing o r

 

struc ture tha t ha s no t p re vio usly b e e n insta lle d w ith the unit. A re insta lla tio n m e a ns a n a c c e sso ry b uild ing o r struc ture tha t is

 

b e ing re insta lle d fo r the sa m e p urp o se a s the o rig ina l insta lla tio n. Ente r the Sta nd a rd Pla n Ap p ro va l Num b e r if this is a ne w

 

insta lla tio n. C he c k the a p p ro p ria te b o x to ind ic a te the typ e o f a c c e sso ry b uild ing / struc ture . If the b o x "O the r" is c he c ke d ,

 

e nte r the typ e o f b uild ing / struc ture o n the line p ro vid e d (i.e . sto ra g e b uild ing , g re e nho use , e tc .). Ente r the na m e ,

 

te le p ho ne num b e r a nd a d d re ss o f the o w ne r. If the o c c up a nt o f the m a nufa c ture d ho m e / m o b ile ho m e is o the r tha n the

 

o w ne r, e nte r the na m e o f the re sid e nt, te le p ho ne num b e r a nd the lo t num b e r w he re the unit is lo c a te d .

SEC TIO N 4 -

MANUFAC TURED HO ME/ MO BILEHO ME INSTALLATIO N: Ente r the na m e , te le p ho ne num b e r a nd a d d re ss o f the o w ne r. If the

 

o c c up a nt o f the m a nufa c ture d ho m e / m o b ile ho m e is o the r tha n the o w ne r, e nte r the na m e o f the re sid e nt a nd the lo t

 

num b e r w he re the unit is lo c a te d . Ente r the se ria l num b e r(s) o f the m a nufa c ture d ho m e / m o b ile ho m e . The se ria l num b e r(s)

 

c a n b e lo c a te d o n the Ma nufa c ture r's C e rtific a te o f O rig in, the C e rtific a te o f Title , re g istra tio n d o c um e nts o r o n the fro nt

 

c ro ss m e m b e r o f the unit. Ente r the ye a r the unit w a s m a nufa c ture d . Ente r the m a nufa c ture r's na m e a nd Mo d e l na m e .

 

This info rm a tio n c a n b e o b ta ine d fro m the Ma nufa c ture r's C e rtific a te o f O rig in, the C e rtific a te o f Title , re g istra tio n

 

d o c um e nts o r m a y b e d e sig na te d o n the o utsid e o f the unit itse lf. Ente r the C a lifo rnia Insig nia Num b e r(s) o r HUD La b e l

 

Num b e r(s) issue d fo r this unit, if kno w n.

SEC TIO N 5 -

PARK O WNER, O PERATO R O R MANAG ER SIG NATURE: The sig na ture o f the p a rk o w ne r, o p e ra to r o r m a na g e r is re q uire d

 

a lo ng w ith the d a te the fo rm is sig ne d . This sig na ture is a n a c kno w le d g m e nt tha t the p a rk is a w a re a nd a p p ro ve s o f the

 

se rvic e s b e ing re q ue ste d in this a p p lic a tio n.

C O NTRA C TO R/ O WNER BUILDER DEC LA RA TIO NS

C O NTRA C TO R:C o ntra c to rs p ro p o sing c o nstruc tio n a re re q uire d b y sta te la w to p ro vid e the fo llo w ing info rm a tio n:

Ite m 1 -

Lic e nse d C o ntra c to r De c la ra tio n: Ente r the c o ntra c to r's lic e nse c la ss, lic e nse num b e r, d a te the lic e nse e xp ire s, the c o ntra c to r's

 

sig na ture a nd d a te .

Ite m 3 -

Wo rke rs' C o m p e nsa tio n De c la ra tio n: Pla c e a c he c k m a rk ne xt to the d e c la ra tio n re g a rd ing the w o rke rs' c o m p e nsa tio n c o ve ra g e

 

tha t a p p lie s to the c o ntra c to r. If the se c o nd d e c la ra tio n is m a rke d , the c o ntra c to r m ust a lso p ro vid e the c a rrie r's na m e a nd p o lic y

 

num b e r. This ite m m ust b e sig ne d b y the c o ntra c to r a nd d a te d .

Ite m 4 -

C o nstruc tio n Le nd ing Ag e nc y: If the re is a c o nstruc tio n le nd ing a g e nc y fo r the p e rfo rm a nc e o f the w o rk fo r the se rvic e b e ing

 

re q ue ste d , e nte r the na m e a nd a d d re ss o f the le nd ing a g e nc y. If the re is no le nd ing a g e nc y invo lve d , e nte r the w o rd "no ne ."

Ite m 5 -

C e rtific a tio n: The c e rtific a tio n m ust b e sig ne d a nd d a te d b y the c o ntra c to r o r a g e nt o n b e ha lf o f the c o ntra c to r.

O WNE R BUILD E R: If the w o rk o r a c tivity a s d e sc rib e d o n the a p p lic a tio n, is b e ing c o m p le te d b y the o w ne r, the o w ne r m ust c o m p le te the

 

fo llo w ing ite m s:

Ite m 2 -

O w ne r-Build e r De c la ra tio n: Pla c e a c he c k m a rk ne xt to the d e c la ra tio n w hic h is a p p lic a b le . If the third d e c la ra tio n is m a rke d , e nte r

 

the se c tio n num b e r fro m the Busine ss a nd Pro fe ssio n C o d e w hic h p ro vid e s the e xe m p tio n a nd the re a so n fo r the e xe m p tio n. The

 

o w ne r m ust a lso sig n a nd d a te this se c tio n.

Ite m 5 -

C e rtific a tio n: The c e rtific a tio n m ust b e sig ne d a nd d a te d b y the o w ne r.

HC D 50, Sid e 2 (Re v. 7/ 04)