A012313 (BLDG)PERMIT NO.
A012313
,'Additional Information:
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S ; FIELD
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� 'DEPARTMENT OF BUILDING & SAFETY
TYPE COUNTY-iDF RIVERSIDES
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III III VIII IIII 03
IE
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,FACTORY BUILT HOUSING
MOBILE HOME INSTALLATION
Manufacturer
MH Manuf. •!6!)nQ,,
New
Model Designation
Size
Relocated ❑
Unit Serial No.
Total Fees $
CJ"r
r
,Plan Approval No.
;Insig. Serial No.
Moving
Sewage System
T 1 1
p
Permission is hereby granted to move the
structure, described below, in
Width Length
Height
Total Fees $
GRADING
#1
Number
of -#2
Sections
#3
Cut
Fill
'Total Fees $
Present Location
Community County
RELOCATION INSPECTION
r
Destinatiori
;Present location
;Community
County
Total Fees
$
Total Fees $
Permit No.
0123141Y
Job.9ddress
Cor
SP #
Zip
Plan Check
Co munity�,,
(Dt it�Q'%-+Q._
Valuation
$ (.° �lGf
- Date,
y�� s9C4— ot./
2st
ff
P.C.
r
Reinspection
Use of Permit
r, ta,
Ba; cel r
LOT Size
Factory-
Built
Set backs
Use Permit q
Le9 Description
11 9'0—, ��rt�.
,Grading
Bond z
$)lIVL
ne Grp
Type
Unit
c by
Mobile home
ngineer License
#-3o
Fin Date
gp
Inspector
nv. Assmt.
Requirement
Relocations
Escrow Company
B anch
.Total Fees
$
Address
City
Zip
Cash
Check
MO
NC
Owner/Agent
Tel.
!Receive Dote
C, 49-(a
Address
City
Zip
Rela a rmitlsl
Con octor/Mover
Tel.
workers• cpmp.
yes Ca/' no ❑
Address
,/L�Y! c / pclrY c. r c': t , -/ I Z,
City -7
Zip
-1 certify that in the performance of the work for which this permit is
issued I shall not employ any person in any manner so as to become sub-
ject to the workers' compensation laws of California.
OwnerSignature
Builder Signature
FORM 284-208A 5.77 (E)m
This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days
shall also cause permit to become void.
I hereby agree that all work in connection with this permit will be done in accordance with the laws of
Riverside County and the State of California. I hereby certify that the individual who prepared the plans and
specifications has done so in accordance with Section 5541 of the Business and Professions Code of the
State of California.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Firms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Comport.
3
Steel
36 Inlets
& Outlets
4
Grout Blocks
37 Combustion Air ,
5
Bond Beams
38 Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40 Fire Damper
8
Vents
41
Smoke Detention Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P.L.
43
Final
JOA
Fireplace T.O.
NON
.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
1 1 Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls IBattsl
12B Ceiling (Bat is)
12C Ceiling (Blown)
14 Final 6
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank
Pit L. Line
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE
OFFICE DATE TIME `3 PERMIT NUMBER
�p OC;71 / / z INSPECTION
REQUESTED
ADDRESSSS� /�� r i SPACE NO. FOR:
60ll(-%
0. u a -A I
OWNER COMMUNITY A.M.
P.M.hl A
Z!,
BUILDING PLUMBING ELECTRICAL MECHANICAL
KION
TUTS
a WED
REMARKS:
THUR
ok RI
w
OWNER/CONTRACTOR TEL.NO.
01
281-6A N/�5
DEPARTMENT OF,,BUILDING AND SAFETY
COUNTY -OF RIVERSIDE
NOTICE TO APPLICANT
In conformity with the provisions of State of California Labor Code Section
3800, the applicant shall have on file or file -with the Riverside County
Department of Building and Safety a certificate as designated in Items I or
II below, or shall indicate Item•III, IV or V, whichever is applicable.
CERTIFICATE OF APPLICANT
Please mark the appropriate block:
I. Certificate of Consent to self -insure issued by the
Director of Industrial Relations.
0 Copy on file Copy submitted
II. Certificate of Workers' Compensation Insurance issued by
an admitted insurer.
Copy on file F-1 Copy submitted
(� III. The cost of the work to be performed is $100 or less.
IV. I certify that in the performance of the work for which
this permit is issued, I shall not employ any person in
any manner so as to become subject to the Workers'
Compensation laws of California. I further certify that,
in the event I become subject to the Workers' Compensation
provisions of the Labor Code that I will comply forthwith
with the provisions of Labor Code Section 3700, et seq.,
and understand that, if I do not comply, the permit shall
be deemed revoked.
F-1 V. I certify as the owner (or the agent of the owner) that in
the performance of the work for which this permit is issued
I have engaged ,
contractor. (Contractor must have on file, or submit
certificate required by I or II above.)
Applicant's Signature /T �/� ��'ru�,c� _
Date ���Oy Permit No.&2 :�2 I I
Address and location where work is to be performed
284-141 Rev. 6/77
aTRAILER PARK
INDIVIDUAL LOT
NAME OF PARK
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
MOBILEHOME INSTALLATION APPLICATION
,DISTRICT NO
�ljq
ADDRESS
TELEPHONE.NO.
OWNER/AGENT
ADDRESS '0�
,� .'i}
(.•C.c V
SPACE N0.
MOBILEHOME INSTALLER
ADDREWWA &/A.4)
TELEPHONE N0./u 1"3as_3
INSTALLERS 'CONTRACTOR'S LICENSE NO 4;2,2_2&19,
DATE OF MANUFACTURE OF MOBILE 1 17 !2 WIDTH. LENGTH(LESS HITCH)"_
NEW_J�RELOCATE
MANUFACTURER
STATE INSIGNIA
MODEL R HUD
LABEL: U -UNIT
0 X -UNIT AV z //o
SERIAL NUMBER.� c�
ROOF LIVE
LOAD WIND LOAD/J__
APPLICANT&I �(. �a rye tF;
APPLICANTS
(PRINT NAME)
."(SIGNATURE)
PARK OWNER/MANAGER
PARK OWNER/MANAGER w
(PRINT NAME)
(SIGNATURE)
COMMUNITY ZONE - CASE NO
LEGAL DESCRIPTIO
SETBACKS: FRONT 6 SIDE REAR ,!�_) 0
QA
DATE SIGNATURE OF LAND USE OFFICIAL`
appD ugs ®IVmolm
gXpT. OF BUILDING $
*MftSIDS OFFICE
284-77 Rev. 8/77 '_ `
Street or Driveway
'WIDTH =
14�_ ..... .......
-
T —
minimum
OOA
MOBILEHOME INSTALLATION INFORMATION SHEET
a-
n
ELEVATION
I
I
I
I
I
I
MOBILE HOME d ��
minimum
I
I
I
Gas
Drain inlet
Water
Electrical)
�ELEVATION
IV 0/
WIDTH = ,�
T
Site Utility Service.
Notes: (a) Utility connections shall be located
outside the rear 1/3 of the mobile -
home within 4 feet of the left wall.
(b) Show relative elevations of each cor-
ner of lot or site.
1. Gas: natural LPG
Riser size
2. Drain Inlet: size 3 "
3. Electrical Equipment:
(a) Receptacle Rating (amps}Cw
(b) Connection for power supply assembly
Circuit breaker rating (amps)
(c) Equipment rating (amps)
Mobilehome Data
1. Size: length width.
2. Electrical: Ply cord L
Ampere rating j,,.,C . OR
power supply assembly . Ampere
rating Flexible conduit size
3. Gas supply inlet: Size3Y41.
Gas connector, escribe:
4. Water connector, describe:_ U4
T
5. Drain connecto'describe:
6. Manufacturer:A
Model: lr4i,-ugg-L Serial No, .
State insignia numbers: X unit: j42 11
U unit:/V,, i2 0
Roof live load: Z'i° P.s.f.
Wind load: / r p.s.f.
284-79 6/74
RIVERSIDE COUNTY DEPARTMENT OF BUILDING AND SAFETY
MOBILEHOME INSTALLATION ACCEPTANCE
1. Installation Permit No. �{ 16 1� ! "Z-7/7
2. Address or Location: "' f' ' �0 Jl 4 i'!!:— 5`7
1,A t2 f1 l 47-x`;
3. Owner's Name:
4. Owner's Address:
i -1 j",
5. Mobilehome: f ��
�
=
(a) Insignia No. Serial No. r
Year Mfr. � 7 1
(b) Manufacturer `�l X.: Al A QA Model No.
s'1 pis
Installation approved by: �ysPecToa) Date:
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
284-130 (2/80)