Are you looking to acquire a Hazardous Chemical Declaration (HCD) permit for your business or organization? Knowing the process of HCD permit form filing can help simplify and speed up the application process. This blog post explains what an HCD is, which organizations are required to submit forms, and how to apply for an HCD permit. Learn more about what it takes to get approved and make sure your paperwork is in order with these helpful tips.
| Question | Answer |
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| Form Name | Hcd Permit Form |
| Form Length | 22 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 5 min 30 sec |
| Other names | ca occupancy booklet, hcd 50 application, hcd permit, hcd 50 |
STATE OF CALIFORNIA |
Arnold Schwarzenegger, Governor |
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DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
NORTHERN AREA OFFICE
9342 TECH CENTER DR. Suite 550 SACRAMENTO, CA 95826
(916)
From TDD Phones:
From Voice Phones:
SOUTHERN AREA OFFICE
3737 MAIN STREET, SUITE 400 RIEVERSIDE, CA 92801 (951)
From TDD Phones:
From Voice Phones:
MOBILEHOME AND SPECIAL OCCUPANCY PARK
CONSTRUCTION PLAN REVIEW BOOKLET
HCD MP 514
Revised
STATE OF CALIFORNIA |
Arnold Schwarzenegger, Governor |
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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
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.
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HCD MP 514 5/09 |
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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)
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Obtain approval and signature from the local planning department on the Mobilehome and |
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Recreational Vehicle Park Government Agency Approval form or equivalent document. |
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Obtain approval and signature from the local Health Department on the Mobilehome and |
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Recreational Vehicle Park Government Agency Approval form, or an equivalent document, |
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approval is also required if there is any public food preparation as part of your |
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development. Pool plans must have the Health Department stamp upon them as well as a |
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signature on the Mobilehome and Recreational Vehicle Government Agency Approval form |
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or equivalent document. |
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Obtain approval and signature from the local public works department or engineering |
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department on the Mobilehome and Recreational Vehicle Park Government Agency |
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Approval form or equivalent document for the park surface or subsurface drainage system |
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and encroachments. |
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Obtain approval and signature for fire protection from the local fire protection district on the |
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Mobilehome and Recreational Vehicle Park Government Agency Approval form or |
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equivalent document. |
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Obtain required approval and signature from the California Coastal Commission on the |
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Mobilehome and Recreational Vehicle Park Government Agency Approval form or |
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equivalent document for developments within coastal zones. |
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Obtain approval and signature on the Mobilehome and Recreational Vehicle Park |
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Government Agency Approval form or equivalent document from |
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Obtain approval and signature on the Mobilehome and Recreational Vehicle Park |
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Submit a permit application (HCD Form 50) with three (3) sets of all plans and documents |
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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 |
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PART A
PARK CONSTRUCTION - PLAN REQUIREMENTS
I.
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
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.
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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
HCD MP 514 5/09 |
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8. Alternate Approval Application if lot service equipment will not be terminated on the lot within four feet of the
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.
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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,
6. Indicate the location of the sewer inlet on the mobilehome or RV lot.
7. Provide an engineered design and calculations for any
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
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.
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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
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 |
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THIS PAGE INTENTIONALLY LEFT BLANK
HCD MP 514 5/09 |
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PART B
PARK BUILDING - PLAN REQUIREMENTS
I.
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,
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.
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Floor Plan: |
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Indicate the exact and complete dimensions of the structure. |
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Provide identification of the proposed use for all rooms. |
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Indicate location and sizes of all doors, windows and openings, include glass/glazing |
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requirements. Indicate rating of fire doors. |
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Indicate location of all appliances and fixtures, such as range, oven, washer, dryer, furnace, |
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water heater, air conditioner, sinks, etc. |
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Show type of interior ceiling, wall and floor finishes. |
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Show change in floor level at all doorways. |
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Designate on the plan the posting of the occupant load in accordance with the California |
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Building Code. |
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Indicate the type of locks or latches installed in the required doors. |
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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
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.
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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
2. Indicate location of all cleanouts.
3. Indicate termination of vents.
4. Provide a
5. Show available pressure at meter or regulator.
6. Indicate type and number of fixtures.
IX. Mechanical Plan:
1. Indicate type of fuel.
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2. Provide a
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
Park Building - Part B |
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Plan Review (circle one) |
COMPLETE |
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HCD Authorized Representative:___________________________________ |
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HCD MP 514 5/09 |
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STATE OF CALIFORNIA
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) |
(951) |
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
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Government agencies - NOTE: A permit application cannot be processed without the approval signatures from any agency checked in the left margin boxes.
Planning: |
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A signature here confirms the proposed construction is consistent with local planning requirements Title |
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HCD MP 514 5/09 |
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Health |
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A signature here confirms the proposed construction is consistent with local health requirements |
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A signature here confirms the proposed construction is consistent with local public works requirements Title |
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A signature here confirms the proposed construction is consistent with local fire requirements |
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Upon completion, does your agency want to review the project/site prior to HCD the permit(s)?
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Final approval signature |
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Signature of Applicant |
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Title |
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Date ________________________ |
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HCD MP 514 5/09 |
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14 |
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STATE OF CALIFORNIA
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) |
(951) |
SUPPLEMENT TO APPLICATION TO CONSTRUCT OR
RECONSTRUCT PARKS AND/OR PARK BUILDINGS OR FACILITIES
Park Name |
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Park I.D. No. |
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Mobilehome Park |
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Special Occupancy Park |
Campground |
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Number of Mobilehome Lots |
Number of RV Lots W/Drains |
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Number of RV Lots W/O Drains |
Number of Campsites |
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Park Construction Fees |
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Fee X |
No. = |
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Fee |
X No. = |
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Electrical - Building |
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____________________ |
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Lots |
$ |
5.75 _________________________ |
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Outlets |
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$ |
.35 |
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Park Elec. Ser. |
$14.00 _________________________ |
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Fixtures |
$ |
.35 ____________________ |
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$10.50 _________________________ |
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Misc. |
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$ 7.00 ____________________ |
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Lot Elec. Ser. |
$ |
7.00 _________________________ |
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Disposal/Dishwasher |
$ 1.50 ____________________ |
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Street Light |
$ |
3.00 _________________________ |
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Range/ Heater/Dryer |
$ 7.00 ____________________ |
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Park Drain Sys. |
$14.00 _________________________ |
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Signs |
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$ 3.00 ____________________ |
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Private Sewer |
$14.00 _________________________ |
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Ser. 200 AMP & Under $ 7.00 ____________________ |
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Lot Drain Inlet |
$ |
7.00 _________________________ |
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Ser. Over 200 AMP |
$10.00 ____________________ |
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Park Water Sys. |
$ |
7.00 _________________________ |
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Other |
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Water Ser. Outlet |
$ |
4.25 _________________________ |
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Plumbing - Building |
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Fire Hydrant |
$ |
4.25 _________________________ |
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Fixtures |
$ |
3.00 ____________________ |
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Park Gas Sys. |
$ |
7.00 _________________________ |
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Building Sewer |
$14.00 ____________________ |
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Gas Tank 60# |
$ |
7.00 _________________________ |
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Pvt. Disp. System |
$14.00 ____________________ |
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Lot Gas Riser |
$ |
4.25 _________________________ |
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Water Heater/or Vent $ |
7.00 ____________________ |
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Other |
$ |
_________________________ |
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Gas Outlets up to 5 |
$ |
7.00 ____________________ |
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Water Piping Outlets |
$ |
1.00 ____________________ |
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Lawn Sprinkler |
$ |
7.00 ____________________ |
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Park Building Fees |
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Mechanical - Building |
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Heaters < 100,000 |
$14.00 ____________________ |
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Occupancy |
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Square Footage |
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Vents |
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$ |
7.00 ____________________ |
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AC Appliances |
$14.00 ____________________ |
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Occupancy |
Type |
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Square Footage |
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Heaters > 100,000 |
$21.00 ____________________ |
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$ |
7.00 ____________________ |
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Fees : $2000 and less - $45 |
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$2,001 - $25,000 = |
$45 1st. $2000 + $9.00 each addn. $1000 |
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Ventilation Equip. |
$ |
7.00 ____________________ |
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$25,001 - $50,000 = $252, 1st $25k + $6.50 each addn. $1000 |
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$50,001 - $100,000 = $414.50, 1st $50k + $4.50 each addn. $1000 |
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$100,001 - $500,000 = $639.50, 1st $100k + $3.50 each addn. $1000 |
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Permit Fee |
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$500,001 - $1,000,000 = $2039.50, 1st $500k + $3.50 addn. $1,000 |
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Inspection Fees - |
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Permanent Buildings Only - |
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Plan Ck. Fee |
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Additional inspection fees |
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Strong Motion Fee Calculation: |
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(Minimum ½ Permit fee) |
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may be required for multiple |
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Building Value $0 - $7,000 = |
$0.50 |
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inspections and reinspections. |
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$7000 & up .00007 per thousand |
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Strong Motion Fee |
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ex: 31,000 x $ .00007 = $2.17 |
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(Applicable only to buildings) |
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Total Permit Fee |
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HCD MP 514 5/09 |
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15 |
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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
□(LRA) Wildland Urban Interface Area – Specify the
□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
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
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
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
____________________________________________ ____________
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
_____________________________________________________________________
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Va lua tio n $_______________________________________________________
SEC TIO N 3 – A C C ESSO RY BUILDING S O R STRUC TURES |
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NEW |
REINSTALL Sta nd a rd Pla n Ap p ro va l No . _______________ |
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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) __________________________________________________
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Ma nufa c ture r Na m e / |
Da te o f MFG . |
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Mo d e l Na m e ______________________________ |
Insig nia / HUD |
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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 ____________________ |
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MP |
_____________________ |
BLDG |
_____________________ |
MHI |
_____________________ |
MISC . |
_____________________ |
TEC H SER. |
____________________ |
PLC 'K |
_____________________ |
S.M.I. |
_____________________ |
ISSUE |
_____________________ |
TO TAL |
_____________________ |
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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) |
(951) |
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 |
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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 |
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(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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 , |
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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 , |
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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 |
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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 |
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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 |
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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) |
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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 |
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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 . |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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
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fo llo w ing ite m s: |
Ite m 2 - |
O w ne |
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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 |
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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)