00009037 Grading�.--'—,:._ .�---s: .. ,.-----,.--.,—.T.___.._-.—�-.PFIDRfi°APPtICRTiGfi'''',����...,T•:-ter;.
._ .... _ .. ...
County of Riverside
Department
of Building and Safety �.
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm..203 880 N. State Street
227 North "D' Street 46209 Oasis St. Rm. 310 160 N. Broadway }
Riverside, CA 92501 Banning. CA 92220 Hemet, CA:92343
Perris, CA 92370 Indio. CA 92201 Blythe. CA 92225 r `
Ph: 787-6146 Ph: 849.1312 Ph: 658-4484
Ph: 857-3898 Ph: 342.8271 Ph: 922-2810
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. permit is for one hundred ($100) or less. 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.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
• OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file
a DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing EJ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
' with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis
for • made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
' the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2. Sec 341, Title 8.
• penalty of not more than five hundred dollars (S500).):
C.A.C.)
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
•,structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law a ety, as noted above, unless such person has a permit to do such work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through Division of Industrial Safety Permit No.
his own employees. provided that such improvements are not intended or offered for safe. IL however, the building or Date Applicant
i improvement is sold within one year of completion, the owner -builder will have the burden of Droving that he did
not
build or improve for the purpose of sale.).
'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Lender's Name
Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
t- improves thereon, and who contracts for such projects with a contractor(sl licensed pursuant to the Contractor's Lender's Address
q License Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
i'n' I am exempt under Sec. / . B. 8 P.C. (Attach Certificate), city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
1
this county to enter upon the above-mentioned property for inspection purposes.
;,Date' Owner
_
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certilicate of consent to sell -insure, or a Signature of Applicant or Agent Date
. certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
Policy No. Company
information given is correct. I agree to comply with all state laws and county ordinances relating to building con -
struction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
for
t:[ Certified copy is hereby furnished.
the property which.) have applied for this permit for the purpose of making inspections.
Certified copy is filed with* the County Building InspectionDepartment or County Department.
Signature of Applicant or Agent Date .
Date" Applicant -
Print Applicant/Agent Name
`
APPLICANT NAiSE°(L, F, Mq�w
APPL/PRMT a
PS DATE -�----
11323
CITY/COM MUN ITY/STATE21 P
ipe .
?" 'JOB SITE ADDRESS/SPACE
"CITV/C�NIT�Y�/STATE/ZIP
"'.,.Lid QUANTis
'1 BOK PAG PRC C
77 0911 002
TRACT LOT
Otl000 1 10
d TRACT NAME
" OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 4
LICNC #
MOD I S 1
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
;1
PHONE 4 - LICNC 4 r
USE OF PERMIT -
y sr t
SL ZON FSB SSB SSB RSB OFC "
Pa10
ZONE ORD a `,. LOT SZ END , L "SIDE ,r -
p.
Jg' PREP
'.
TOTAL PERMIT COST IS
t.
' f
s t/
r
FORM 284-208
1 -•;y. 1
TOTAL
C J . FEE +it4Z. FCi
SPECTOR'S COPY' _
0.1323
.
RAI .
nnay �.
1944 R 56
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums h 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 Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace
P. L.
43
Final
10A
Fireplace
T. 0. ❑
°o
ADDITIONAL INFORMATION
'
------ --------------------------
SEWAGE SYSTEM SIZE & LOCATION
it Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
129 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
------------------ 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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
r
P/L
'
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
I
MOBIiEHOME INSTALLATION ON A FOUNDATION SYSTEM
HCD FORM 413 (1/1/80)
This form is to be completed at the time a building permit is issued for the installation of a mobilehome on a
foundation system pursuant to Section 18551 of the Health and Safety Code. A copy is to be immediately
transmitted to the department with a copy of the building permit and fees in amount of $11 for each trans-
portable section of the mobilehome. See instructions.
TO: THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards, Mobilehome Section
P.O. Box 31, Sacramento, CA 95801 (916) 445-3338
FROM:
(Name of local agency Issuing building permit) (Building Permit No.)
(Address) (Date Permit Issued)
(City) (County) (zip) (Telephone)
IP INFORMATION — MOBILEHOME
✓J iisiA r
(Registered Owner's Name) /
4
(s wer's Mailing Addres
f
el
h) (County) (State) (zip)
LEAVE THIS SPACE BLANK
t
(Legal Owner's Name)
(Legal is Mailing Address)
P'.
(City) -(State) (zip)
(Mobilehome will be Owner's Principal Resid ce?) (Form of Consent AccedptPd7-'Letter, etc.
,OWNERSHIP INFORMATION EAL PROPERTY
rheld in the Nome(s) of ?T v (ACCESSOR'S PARCE MBER?)
I Pro arty Mail dress) (1st Mortgage Holder's Nome) (2nd Mortgage Holder)
(County) s� (zip)
% (A ress) 45"_— (Address)
�A/ l��ri� �,?f�.� �is•L V
1 Property Size? Length X Width or Acres) (City) State) (zip) (City)
�� � ® ty) (state) (zip)
!%gip /s+� e,*
hod ofXerificiiton7 Deed, et n (loan Rate %) !) (arms) (Dote %) (Terms)
(LegYDescrip'tion of the Real Property?)
IDENTIFICATION IN ORMATION — MOBILEHOME
(Manufacturer's Name) (Date of anufacture)
SERIAL NO. (VIN) { INSIGNIA/LABEL NO. �+ LENGTH X WIDTH
..A„ Unit
"B" Unit x
"C" Unit x
"D" Unit
44e�
(MbDEL Name/Number)
DMV LICENSE/DECAL NO.
(From the rear of the
mobilehome, facing
toward the front,
the "A" Unit is the
one at your left.
Next Is "B", "C", etc.)
Builtin Cooktop?y
Builtin Oven?
Builtin Microwave?�
Builtin Trash Compactor?�
Builtin Vacuum? _/J7 O
Builtin Dishwasher? ef-9f 91f
Disposal?
Other?
N — MOBIL99ME
(PurchasePrice?**) *List the items and cWlar values of any0personal property items included in the purchaseopr ce of the
mobilehome. EXAMPLE: Dryter, $239.65)
FERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
284.2 (4/80)
(Date)
(Authorized Signature, Local Agency)
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
Exterior Wall Covering?
I'l—fo a s Total No. Rooms?
Roof Covering?
Bedrooms?
Exterior Wall Thickness?
2&Irr or
Baths?
Heating Type?
Dining?
Refrigeration? (A/C)
-O46Ie� Family/Den
/ D
Ceiling Height?
Utility?
Tow Bar Removed?
�isOther?
Axles Removed?
Other?
(From the rear of the
mobilehome, facing
toward the front,
the "A" Unit is the
one at your left.
Next Is "B", "C", etc.)
Builtin Cooktop?y
Builtin Oven?
Builtin Microwave?�
Builtin Trash Compactor?�
Builtin Vacuum? _/J7 O
Builtin Dishwasher? ef-9f 91f
Disposal?
Other?
N — MOBIL99ME
(PurchasePrice?**) *List the items and cWlar values of any0personal property items included in the purchaseopr ce of the
mobilehome. EXAMPLE: Dryter, $239.65)
FERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
284.2 (4/80)
(Date)
(Authorized Signature, Local Agency)
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
{ MOBILEHOME INSTALLATION ON A FOUNDATION SYSTEM
HCD FORM 413 (1/1/80).
This form is to be completed at the time a building permit is issued for the installation of a mobilehome on a
foundation system pursuant to Section 18551 of the Health and Safety Code. A copy is to be immediately
transmitted to the department with a copy of the building permit and fees in amount of all for each trans-
portable section of the mobilehome. See instructions.
f
TO: THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards, Mobilehome Section t
P.O. Box 31, Sacramento, CA 95801 (916) 445-3338
{
FROM: f
(Name of local agency issuing building permit) (Building Permit No.)
I
r
(Address) (Date
Permit Issued)
I
(City) (County) (Zip) (Telephone)
OWNERSHIP INFORMATION—MOBILEHOME / /` i �/
0
.ra
LEAVE THIS SPACE BLANK
(Registered Owner's /
r (Legal Owner's Nome)
%Nome)��,y� /
` !
V�-
(Registered Owner's Mailing Address)-
i (Legal Owner's Mailing Address)
06 Pa,
i,6,;o/
(City) (County) (State)
(Zip) (City) !(State)
(Zip)
n
� �J✓/��w/7
.Z
c7.,sOLw'/'
ice... tet/
(Mobilehome will be Owner's Principal Residence?)
(Form of Consent Accedpte!d? Letter, etc.)
OWNERSHIP INFORMATIONREAL PROPERTY
Refrigeration? (A/C)
(Title hold inthe Name(s) of ?) L
(ACCESSOR'S PARCEL NUMBER?)
Alp,
(Real Property Mailing Address) S 05 /
r (Ist Mortgage Holder's Nomee) (2nd Mortgage Holder)
(City) `(County) (Zip)
(Address) - - (Address)
(/
��
Other?
(Real Property Size? Length X Width or Acres) `/ {,�/►J
(City) C(�State) (Zip) (City) (State)
vp
(Zip)
(Method of Verifi�caaiiton? Deed, et (Loan (Loan Rate %) (/ i (Terms) (Loan Rate %)
��,I"� / R1 � Is�QI
S �y(Terms)
TAS
(Legal Description at the Real Property?)
70
l
IDENTIFICATION INFORMATION — MOBILEHOME
�,;;0;1 y I .c
(Manufacturer's}Nome) ` (Dote
` ' SERIAL NO. (VIN)) ,1 INSIGNIA/LABEL NOO.ee Q
„A" Unit .♦G ��.�C��/Qi �30jp
,.B„ Unit Alr oye8 2
"C" Unit
"n" llnif
LENGTH X WIDTH
rD x,��
X
X
fr
(MODEL Name/Number)
DMV LICENSE/DECAL NO.
/ (From the rear of the
mobilehome, facing
toward the front,
the "A" Unit is the
one at your left.
Next is "B", "C", etc.)
Builtin Cooktop?
Builtin Oven?
?
Builtin Microwave?
Builtin Trash Compactor? ✓�'>
Builtin Vacuum? –1-r 4�
Builtin Dishwasher?
f
Disposal?��
f
Other?
SALES,INFORMATION - MOBILEEHOME
,Z%�Y / - / %py 1 ewe, �s �L.r�-.'�',r�BA %�_�� r♦i /tea �.,�9
(Date of Purchase?) (Purchase Price?•') (**List the items and dollar volues of any"personal property items included in the purchase price of the
mobilehome. EXAMPLE: Dryter, $239.65) s
CERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
r
284-2 (4/80)
(Date)
(Authorized Signature, Local Agency) 17lj
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
Exterior Wall Covering?
V�-
Total No. Rooms?
Roof Covering?
,ztja
L' /
Bedrooms?
Exterior Wall Thickness?
n
Baths?
.Z
Heating Type?
Dining?���
Refrigeration? (A/C)
���-�
Family/Den
Alp,
Ceiling Height?
Utility?
i
Tow Bar Removed?
��
Other?
�
Axles Removed?
Other?
mobilehome, facing
toward the front,
the "A" Unit is the
one at your left.
Next is "B", "C", etc.)
Builtin Cooktop?
Builtin Oven?
?
Builtin Microwave?
Builtin Trash Compactor? ✓�'>
Builtin Vacuum? –1-r 4�
Builtin Dishwasher?
f
Disposal?��
f
Other?
SALES,INFORMATION - MOBILEEHOME
,Z%�Y / - / %py 1 ewe, �s �L.r�-.'�',r�BA %�_�� r♦i /tea �.,�9
(Date of Purchase?) (Purchase Price?•') (**List the items and dollar volues of any"personal property items included in the purchase price of the
mobilehome. EXAMPLE: Dryter, $239.65) s
CERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
r
284-2 (4/80)
(Date)
(Authorized Signature, Local Agency) 17lj
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
(W61311.EHOME INSTALLATION ON A FOUNDATION SYSTEM
HCD FORM 413 (1/1/80)
This form is to be completed at the time a building permit is issued for the installation of a mobilehome on a
foundation system pursuant to Section 1855) of the Health and Safety Code. A copy is to be immediately
transmitted to the department with a copy of the building permit and fees in amount of $11 for each trans-
portable section of the mobilehome. See instructions.
TO: THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards, Mobilehome Section i
P.O. Box 31, Sacramento, CA 95801 (916) 445-3338 It
FROM:
(Nome of local agency issuing building permit) (Building Permit No.)
i
(Address)
(Date Permit Issued)
(City) (County) (zip) (Telephone) it
OWNERSHIP INFORMATION —MOBILEHOME
I
.W.
LEAVE THIS SPACE BLANK
(Registered Owner's Name)
r (Legal Owners Name)
.
-,
1/
x&22_ t
Baths?
Dining?
Family/Den
Utility?
Other?
(Registered Owner's Mailing Address)
(Legal Owner's Mailing Address)
/
i --•(city)' (County) (State)
(zip) j (City)
r
i(State)
(zip)
(Mobilehome will be Owner's Principal Residence?)
/
(Form of Consent Accedptpd? Letter, etc.) L
OWNERSHIP INFORMATION — REAL PROPERTY
{
e
1110
(Title held inthe Nome(s) of ?)' �/ /
(ACCEESSSOR'S PARCELNUUMB-ER'?)
,
(Real Property Mailing Address)
(Ist Mortgage Holder's Name) (2nd Mortgage Holder)
(City) - (County) (zip)
APOr
/ (Address) /`�
(Address)
X92 6D
100�r
(Real Property Size? Length X Width or Acres)
(City) (State) (zip)
(City) , (State)
(zip)
IG'
1'r oy±ry
(Method of Verificgiton? Deed, etc:) :,d�r , P -
_/ _ (Loan Rote %) �,.., i (Terms) (Loan Rate %)
(Terms)
(Legal Description of the Real Property?) • /' , r�
IDENTIFICATION INFORMATION — MOBILEHOME �f
(Manufacturer's Name) (Date of Manufacture) (MODEL Name/Number)
j SERIAL NO. (VIN))'} / �t vINSIGNIA/LABEL NO. �LENGTH X WIDTH DMV LICENSE/DECAL NO.
•,A„ Unit f tr �� t1(`j ji /�c i ^. ^ !/ X r}C� (From the rear of the
mobilehome, facing
„B„ Unit x r toward the front,
the "A" Unit is the
„C„ Unit x one of your left.
"D" Unit x
Next is "B" "C" etc.)
Exterior Wall Covering?
Roof Covering?
Exterior Wall Thickness?
Heating Type?
Refrigeration? (A/C)
Ceiling Height?
Tow Bar Removed?
Axles Removed?
-G.
Al
_''�IYA wwle►
Builtin Cooktop?
Total No. Rooms?
��j%%Jd�•
Bedrooms?
1/
x&22_ t
Baths?
Dining?
Family/Den
Utility?
Other?
"e
Other?
-G.
Al
_''�IYA wwle►
Builtin Cooktop?
Builtin Oven?�
Builtin Microwave?
Builtin Trash Compactor?>
Builtin Vacuum?
-" 0
Builtin Dishwasher?
Disposal?
Other?
SALESINORMATION— MOBILEHOME
E/ x OBa/ g�, 000 ��/%w
, ,—
(Date of Purchase?) (Purchase Price?*:) (**List the items and dollar values of any%personal property Items included in the purchase price of the
mobilehome. EXAMPLE: Dryter, $239.65)
t � .
CERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
284.2 (4/80)
(Date)
(Authorized Signature, Local Agency) tr
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
s f
QMOBKEHOME INSTALLATION ON A FOUNDATION SYSTEM
HCD FORM 413 (1/1/80)
This form is to be completed at the time a building permit is issued for the installation of a mobilehome on a
foundation system pursuant to Section 18551 of the Health and Safety Code. A copy is to be immediately
transmitted to the department with a copy of the building permit and fees in amount of all for each trans-
portable section of the mobilehome. See instructions.
TO: THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards, Mobilehome Section ,
P.O. Box 31, Sacramento, CA 95801 (916) 445-3338
FROM: I
(Name of local agency issuing building permit) (Building Permit No.)
(Address) (Date Permit Issued)
r
(City) (County) (Zip) (Telephone) f
N
11
LEAVE THIS SPACE BLANK
OWNERSHIP INFORMATION — MOBILEHOME
/l�i�i/;�•� ��6�' (�.�//�trs�� f/..r�����t+A��
.�•I�/u/ �_� ./'�-���' � R��f�✓ .
(Registered Owner's Name) /� /
t
(Legal Owner's Name)
Bedrooms? -��
45�57-
Exterior Wall Thickness?
1~ Baths?
(R�egistterred Owner's Mailing Address) '/
�� �r��,il
(Legal Owner's Moiling Address)
I / �rr+'" "'
/ ,'�- � 6+1
�P'►�...�if��i�i7/�"�:� r . It= .
�:..�
(City)' (County) (State) (Zip)
..�
(City) !(State)
(Zip)
!!/
Ceiling Height?�
Utility?_
Builtin Dishwasher?
(Mobilehome will be Owner's Principal Residence?) r
t
(Form of Consent AccedpteE?-Letter, etc.) -•-
/
Other?
OWNERSHIP INFORMATION/ —' REAL PROPERTY jf
•
,7J •R'`.R/1�,./ f.% l -'
_
(Title held inthe Name(s) of ?)' • //
(ACCC`ESSOR'S PARCEL NUMBER?) _
--�/+,�.Lr• !'s•r ... �. i /i1► .. �.Ix1
(ReaIP ty Mailing Address)
(1 st Mortgage Holder's Name) (2nd Mortgage Holder) z
(City) `(County) (Zip) ¢i�
s (
> r /Y.
(Address) �y (Address)
% i' f f
(Real Property Size? Length X Width or Acres) je�
(City) (State) / (Zip) (City) (State) (Zip)
(Method of Verificoiton? Deed, etc.) (Loan Rate %) ! -` r(Ternis)" (Loan Rate %)
It
(Terms)
(Legal Description of the Real Property?)
101't' J �-/w•1/1 IY ��rr
r y �
i
�IDENTIFICATION INFORMATION — MOBILEHOME o,
f/�7 GwT/A .L �.�iw� ate+► ,,e./
"vf/I�
(Manufacturer's Name) 11
(Date olUManufacture) " (MODEL Name/Number) r
SERIAL NO. (VIN) INSIGNIA/LABEL NO. LENGTH X WIDTH DMV LICENSE/DECAL NO.
�• �r
"A" Unit ,l ,C9 4'r, �l /�u.(s% _L� �14 4IJ (From the rear of themobilehome, facing
^ W
"B" Unit,/o V-�z A �2 5L.;f5 r +• X toward the front,
.,C„ UnitX , the "A" Unit is the
one at your left.
D„Unit X Next is"B",'Y",etc.) y
Exterior Wall Covering?
��4G��,.' . Total No. Rooms?
Builtin Cooktop?��
Roof Covering?
Bedrooms? -��
Builtin Oven? ,rte
Exterior Wall Thickness?
1~ Baths?
Builtin Microwave? /•�
Heating Type?
Dining? ��/�
Builtin Trash Compactor'? �^ r
Refrigeration? (A/C)
.e L
w
,. ems. Family/Den --
Builtin Vacuum?
Ceiling Height?�
Utility?_
Builtin Dishwasher?
Tow Bar Removed?
Other?
Disposal? - -_- -
Axles Removed?
�+��'' Other?
Other?
SALES /INFORMATION — MOBILEHOME
.( J Gam-/ � — � % ��� C/G/. f/�/ � �/A..i .As��• �
--�/+,�.Lr• !'s•r ... �. i /i1► .. �.Ix1
r(Dats of Purchase?)
(Purchase Price? --the items and dollar values of arty"personal property items included in the purchase price of the '
mobilehome. EXAMPLE: Dryter,
$239.65)
CERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
completed and a/this certificate of occupancy issued on
`
284-2 (4/80)
(Date)
(Authorized Signature, Local Agency)
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
CMOBKEHOME INSTALLATION ON A FOUNDATION SYSTEM
HCD FORM 413 (1/1/80)
This form is to be completed at the time a building permit is issued for the installation of a mobilehome on a
foundation system pursuant to Section 18551 of the Health and Safety Code. A copy is to be immediately
transmitted to the department with a copy of the building permit and fees in amount of $11 for each trans-
portable section of the mobilehome. See instructions.
TO: THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards, Mobilehome Section
P.O. Box 31, Sacramento, CA 95801 (916) 445-3338
FROM:
(Name of local agency Issuing building permit) (Building Permit No.)
(Address)
(Date Permit Issued)
(City) (County) (Zip) (Telephone)
In
LEAVE THIS SPACE BLANK
OWNERSHIP INFORMATION — MOBILEHOME
. %,�..>u� f t.• `e�'%%.Gly ��.�.aw.'.e.�l.�' `'e'�r�!.,<r.G* Le �'''�r'.�...,�.�� .,�?'.i�i' ci"�ICl,.rf. -' /�. fps r.- ,��G:-+.
(Registered Owner's Name) f (Legal Owner's Name)
f / a
r- -/4 `L!-�d! /%� rpt - C/ � "/
(Registered Owner's Mailing Address), _( - (Legal Owner's Mailing Address) _
ii7' y' 1 %
(City) (County) (State) (zip) (City)'' !(State) (zip)
(Mobilehome will be Owner's Principal Residence?) (Form of Consent Accedpted?;Letter, etc.)- �•
/ r f
OWNERSHIP INFORMATION — REAL PROPERTY
',�'.r �►.% /'1s cy� s',����.�r.ditr,. ''`'.� f✓ ,� i`l �" �'�,t''i / - < _
(Title held In the Name(s)of?) /' (ACCESSOR'SSPPARRCEL NUMBER?)
,
((Re`yal ,Property Mailing Address) 'Ir (1 tissttt Mortgage Holder's Name) (2nd Mortgage Holder) / -Plyf [GAG
J
(City) (County) (zip) (Address) (Address)
k ' a k /,� dt /9r. rr'0' l�.,rr 5�"t.c-r � . eel
(Roof Property Size? Length X Width or Acres) ' (City) a(State) ++ (zip) (City) (State) (zip)
le-,r'cy r - �t. yr.♦
(Method of Verificaiton? Deed, etc.) - (Loan Rate %) .4K o(Terms)' • (Loan Rate %) (Terms)
(Legal Description of the Real Property?) Y �'
r� lin
I"•
IDENTIFICATION INFORMATION — MOBILEHOME f
(Manufacturer's Name) (Date of Manufacture) (MODEL Name/Number)
SERIAL NO. (VIN) INSIGNIA/LABEL NO.
S+' {�
„A" Unit % 1 "00`
"B" unit/G/9_i
"+C" Unit
LENGTH X WIDTH
xV.,./
+'D" Unit
Exterior Wall Covering?
L`� JG�`
Total No. Rooms?
Roof Covering?
Bedrooms?
Exterior Wall Thickness?
",y",
Baths?
Heating Type?
Dining?
Refrigeration? (A/C)
I-,,— _;0"
Family/Den
Ceiling Height?
Utility?
Tow Bar Removed?
Other?
X
DMV LICENSE/DECAL NO.
Builtin Cooktop?
Builtin Oven?
(From the rear of the
mobilehome, facing
toward the front,
the "A" Unit is the
one at your left.
Next is "B" "C" etc.)
Builtin Microwave?
Builtin Trash Compactor?
-r -
Builtin Vacuum?
Builtin Dishwasher?
Disposal?
1.11 f
Axles Removed?Other? Other? _
SALES INFORMATION — MOBILEHOME
w .4 � / /Z - � 1 4 �',, C: 4'' � •sIMA sT+.r. K'.�A-se".[% /",�'r .r l.� n r i't
(Date of Purchase?) (Purchase Price?**) `("List the items and dollar values of any personal property items included in the purchase price of the
mobilehome. EXAMPLE: Dryter, $239.65) .I
CERTIFICATE OF OCCUPANCY Installation of the above described mobilehome on the real property particularly described hereon has been
71 completed and a/this certificate of occupancy issued on .11
284.2 (4/80)
(Date)
(Authorized Signature, Local Agency)
DISTRIBUTION: White -Recorders Office, Blue -Owner's Certificate, Green -DMV Final Notice, Canary -Bldg. 8 Safety File, Pink -Assessor's Information, Goldenrod -DMV Preliminary Notice.
APPLICANT NAME (L, F, MI)
ROBERTS &,, CORRAL
A D�JSSS py g ��gg t���» p�tt���g yrt���99
ve►ZaO ¢i�J.SE NNOWER OR
Chi 9225'30400
J5g jj V ESS/SPACE EISENHOWER DR
C`TVOM{4�21P CA 922%30000
B97
PA691
PRC 0
N
C
TWN
dot
SE
o
8
TF61 0 b it L V
6F
MY
SB
TOTAL
FEE
T��y�i��II1��wBMi�gMuA1��R.((ll�9y,�ht �_Q ALr, ,m S
01MOCwi�. i �A II& COR AL
CORA
CONTRACTOR -FIRM NAME
ADDRESS
CITY SCO MM UN ITV/STATE/ZI P
PHONE #
LICNC N
ARC/ENG FIRM, NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE p ,,
f�
LICNC #
UNri IMITPRF.' PERM rOUND
ab N
j� u
*11
qS�
�J
tB
(+
#So
11,
(j d
ZONE ORD H
LOT SZ
END
0a
SIDE
01u
E,
APPL/PRMT #PS DATE
000 A1�� 011284
f
rt
APPLICATION VOR MOBILE HOMe SITE -PREP
TOTAL
FEE
m r� lvna wrT
011284
APPLKATTO . M MOBIL9 HOMEaM-PREP
TMY9. 18 AN APPL110AT10N 0N'LY
YOU Aus'l See the fallowing Departments (if lisied) for toocuorence DEFORM
it Permit can be issueds'
}gip Doscr *ptiun Department
EB ARAT'iti
FORM 284208 12/81)-u—✓-
f
rt
FORM 284208 12/81)-u—✓-
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING. APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 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 Detection Device
9
Garage Fire Wall
42
Commercial Hood
. 10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
❑
°o
ADDITIONAL INFORMATION
~
Y -
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
,12A Drywall
13 yFinish Grade .
+ INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
�--_,_- --- -------- fl'cl ,rINC-A:r.rROVAL3-------------------------------------
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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
'
P/L
P/
26 Power Pole
27 Conduit
' 28 Service Entrance '
29 - Wiring
29A Grounding Wire
29B Bonding ,
30 Fixtures `
31 Service
32 Final_
1• i Y _ } STREET NAME r