PMT15-03913 City of Menifee Permit No.: PMT15-03913
29714 HAUN RD.
4"ACCELA—> MENIFEE,CA 92586 Type: Mobile Home
MENIFEE Date Issued: 1 211 812 01 5
PERMIT
Slte Address: 27190 DIX HILL RD, MENIFEE, CA 92585 Parcel Number: 331-340-026
Construction Cost: $3,350.00
Existing Use: Proposed Use:
Description of ADD PERMANENT FOUNDATION TO EXISTING MOBILE HOME
Work: SERIAL*CAFL3AA09082359 HUD* CAL1 83950
SERIAL*CAFL3BA09082359 HUD#: CAL183951
SERIAL#:CAFL3CA09082359 HUD* CAL183952
Owner Contractor
DJL EQUITIES PERMA-BRACE CONSTRUCTION
397 E 23RD ST 21690 VINE ST
NEWPORT BEACH, CA 92660 WILDOMAR, CA 92595
Applicant Phone: 9512459373
WENDY BROWN License Number:636757
PERMA-BRACE CONSTRUCTION
21690 VINE ST
WILDOMAR, CA 92595
Fee Description Qtv Amount(SI
Manufactured Permanent Foundation 1 240.72
Permit Fee 1 27.00
$267.72
The issuance of this permit shall not prevent the building official from thereafter requiring the wrrection of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'Ifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bing Pertnit_Templatespt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Stale License Law forth,
following reason:
1 hereby affirm under penalty or perjury that I l, en d under provisions of
Chapter 9(commencing with section 70A f of ivisi 3 of the Business and By my signature below I acknowledge that, except for my personal residence Ii
Professions Code and , ense is in full fo a ffect. �/ which I must have resided for at least one year prior to completion c
License Class —Llc ns / improvements covered by this permit, I cannot legally sell a structure that 1 haw
Expires_,: 3/�� Signatur built as an owner-building If It has not been constructed in its entirety by license
contractors. I understand that a copy of the applicable law,Section 7044 of th,
WORKERS'COMPENSATION RATION Business and Professions Code,is available upon request when this application i
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: http-//www.leginfo.m.gov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Dale
Section 3700 of the Labor Code, for the performance of work for which this
permit Is issued. Property Owner orAuthorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: 1 am the propert
��'[7� I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read IN
SECtion 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. 1 agree to compl
permit is Issued.My workers'cempensati insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildin
construction.I authorize representatives of this city or county to enter the above
Carder �J r 75 identified property for the inspection purposes.
Policy#���9'Ly Expires — Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is Issued,I
shall not m to a persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or e
workers'comp s on laws of California,and agree that If I should become mixture containing a hazardous material equal to or greater that the
subject to th rs' mpensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I sh m Iy with those provisions. ❑YES ❑NO
Applic Date; fZg � Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
W 1 G: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting cheemis,
C PENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($1 00,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the cute
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve,demolish, EPA RENOVATION REPAIR AND PAINTING(RRP1
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's Stale License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property O An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that It was not built or improved for the Firm Certification No.:
Purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractols License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
'Menifee
DATE PERMIT/PLAN CHECK NUMBER �j
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ®MOBILE HOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL []MECHANICAL
[-]NEW []PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK AJ2,0 ReVfnan Eoor)A2�t;yo /nl o
me,4d 40vn,��
T M
PROJECT ADDRESS -J o lJ�,A - LC_ C1 92
ASSESSOR'S PARCEL NUMBER 331- 3L/0-oa4-`SOT 2— TRACT Building & Safety Dc pt.
OWNER NAME DEC 18 '2015
ADDRESS D J L-- Cr ,` — r� 4M
PHONE � 9'1q� �7S— 0 /Sd EMAIL d
APPLICANT NAME
ADDRESS �/�� �7/L
PHONE EMAIL
CONTRACTOR'S NAME /OWNERBUILDER2 ❑YES NO
BUSINESS NAME G2G� �, Con,6/ru
-
ADDRESS 2l C0 :o m e_ S <, AC/IU`YYl
PHONE (,. ` �j f, p�-yLj— 3 EMAIL &v C,-e
7
CONTRACTOR'S STATE LIC NUMBER ,-� (O 7S/ LICENSE CLASSIFICATION C'V7
i
VALUATIONS �JJ S FT 17ZQ LSQFr/ p J
APPLICANT'S SIGNATURE % DATE
DEPARTMENT DISTRIBUTI CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 _ PAIDAMOUNT ^
AMOUNT �lY O��-Q�' O�' `vCASH ✓CHECK# ^.CREDIT CARD VISAJMC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# O CREDITUIRD VLWMC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citycf,nenifee.us Inspection Request Line 951-246-6213
PERMIT NO. Q..
SITE PLAN O
NAME PHONE —D/Sa UJ
SITE ADDRESS - 2 7/%27 Z?i V A,z--1-
ASSESSORS PARCEL NUMBER lL
Provide North Arrow REAR PROPERTY LINE O
� o 4� buildiinyg & Safety Dept
CITY OF MENIFEE
DEC 18 2015 `
BUILDING AND SAFETY DEPARTMENI Received
FLAN APPROVAL
D �� REVIEWED BY TE
E E
P *Approv3I of these plans shall not be construed to be a permit f r,or an P:
R approval of,any violation of any Provisions of the f plans mustbe kep on the i,state )T eity R
O regulations and ordinances. This set of approved p Q
P jobsite until completion. P
E E
R R
T �} p �/J T
y Y
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7G�
FRONT PROPERTY LINE
STATE OF CALIFORNIA-BUSINESS,CONSUMER SERVICES MID HOUSING AGENCY EDMUND G.BROWN JR.Governor
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT °USING 9
Division of Cod"and Standards s't'
O ® n Z
Title Search 3� �04�
Date Printed: 12/14/2015
Decal#: AAV1748 Use Code: SFD � y
Manufacturer: FLEETWOOD Original Price Code: AJQ `d
Tradename: HIGHLAND PARK Rating Year: 1980 City Of Menifee W
Model: Tax Type: ILT Building & Safety DeptUb
Manufactured Date: 00/00/1980 Last ILT Amount: $166.00
Registration Exp: 06/30/1988 Date ILT Fee Paid: 05/07/1987 DEC 18 2015 LL
First Sold On: 00/00/1980 ILT Exemption: NONE _
Serial Number HUD Label/Insigni; Length Width
CAFL3AA09082359 CAL183950 6U 12'
CAFL3BA09082359 CAL183951 60' 12'
CAFL3CA09082359 CAL183952 28' 10,
Record Conditions: HCD Lien Placed on Unit for 120 ILT Delinquency
PPF Exempt
Registered Owner:
WALTER ERWIN GLASS
CAROL J GLASS(Tenants in Common Or)
PO BX 220
SUN CITY,CA 92381-0220
Last Title Date: 05/19/1987
Last Reg Card: 05/19/1997
Sale/Transfer Info: Unknown
Situs Address:
RD
SUN
SUN HILL CITY,
,CA 9232381 'y\
Situs County:RIVERSIDE
Legal Owner:
HOUSEHOLD FIN CORP
3630 CENTRAL AVE
RIVERSIDE,CA 92516
Lien Perfected On: 05/06/1987 14:35:00
Inactive Decal/DMV:
DMV SV7910
Renewal Fees:
$4,050.00
*** END OF TITLE SEARCH ***
L
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([y+�� DEPARTMENT OF BUILDING d SAFETY O FIELD
1114 7 `./
RN vENNn iYY \ .! COUNTY OF RIVE]SIDF.
�- A 0 r
�•Addttional ln(ormotion.
I •FACTORY BUILT HOUSING - KAPnHPP
I
MOBILE HOME INSTALI.ATlO
wilding & Safety Dept. i
.Manufacturer
'Model Designation MH Man uf. ^r-,- ; ;Y. 18 New
Uriii Siliui No, Size ��y X �•�/ a sect—
I]
Pion A Totoi Fees 5 — —
'Insig.Seriol No.
Sewage System Moving a ys I
T t P Permission Is hereb a move the
al or Fees b v groused 1
: vrunure, described below,m
GRADING Width Length Height
el
Number
of :;p
. EII' Secnons
"Talol Fees 5 ,r�
communst at on
'RElOr.-ATION INSPECTION Communlrs County �
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Present location
Community County Tosnl Fees --t
total Fees $ i
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Use o(Permlt - S I.- T r .• H
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� Requirement
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g DEPARTMENT OF BUILDING 8 SAFETY FIELD �-•`
eaaain No •actin..,-c I COUNTY OF RIVE251DF. 1/�•�/r,
A011147
Additionol Inlormorion.
' riFACTORY BUILT HOUSING - MOBILE HOME INSTALLATION
.Manufacturer j
Model Designaiion -- Size
Monuf. �; , New
Un C.o.ilGaia ---- iolai Fees Sre e-4 x L!L Relomted- ❑ I
Pion Approval No.
Insig.Seriol No. Moving !
Sewage System
T I 1 a Permission is hereby gromed'a move the
orcl Fees $ slrunure.described below,in
Width Length I Height
'GRADING L I
Number i
: ut of
Eill' Sections
'''Totoi Fees b u3
Presen-Location I
- `RELOr.ATION INSPECTION Communny Coum i
Des-marton y
• FFesentlocation j
Communlr --
Y County Total Fees
Total Fees 5 g i
— — ---
Permit No. Job Address l SP:+ Z:P r O+vner j
:1471
R. I I Community Vnlvo'-on Dme Dist I nit I a r I
: t Use of PermitA`�i IS :'• i •'�4'f � '- „h e:[i t1 f-r �3LV
Reinspection Parcel No Lct Size
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Bond x•< Grp Type Unit u, I
eading ( eas
Engineer license Final Dose I I penoi Env Assmt I
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Escrow Company Branch i
,•Reiocatiors
Address
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•33a. I
FORM 2114•46eA 5.77 0•
Y r�
';sb.•-
NOTICE TO APPLICANT
l County
dl00 The SiaorMlIIIVr
1. Cohlorne
uard � lowwFMoe emll.I ,Dr v.whlChmvar is appable.
DepWlmenlul cod ome l dedp lbml or 116e
CER1W CAIE OF q(TIICAN!
plane mock.ce apjHHgH re Mack:
❑ I. C.ollnom of Coolant ra WIf.DH we blood by the Diredar of Induurial Re1R1iom.
❑Copy on film ❑Copy Nbmbled
❑ it. CRINDCab of Wo kon,Cempenallen loswanI W lied by on adminad hannan.
❑Copy an File ❑Copy suISIT ld
❑III. The all el the work IR be,pedanned I+EI00-leu.
AN. IanifY That in III"fformanceohhework lam whuhnhi+permlrt+mued.I+hall naremployartypeESaeinanymanne"""become
wbjecllo the Worimpe Compenwlion low[of Cattle,.. I Nah....Hily That.In The even I bmame subject Io The WorkeK CompemR-
D4n povi5lam of he Labor Code Thai I will amply lw inuilh with the poo.w.n al Labor Cade Seniun 0700,al+ep.,Rod under-cd
She,If I do at rampty,the lion.(hall be deemed revoked.
❑y, 1 Candy .. the owner (or the open, at the owner, tM, In the pcFe,.me of The walk far wh..h III., permit IF clued
I have ePw,.d
an.Rnw. IConaonor 1 oe b.av mil ante repuit tl ahovs.) J
Appbanr.Silicon.—
Do.. /r?It— �, v� pe,mN Na.�1SI�574
AddenS and I.cn—whine wok IS tR be pmlormed.f '�12a alie / —��--
ze..ul Re. ern /
outwima PERMIT HEADOUARTERS L�
INJ/ Na,l„p DEPARTMENT OF BUILDING d SAFETY o f
865 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES INOPLUMBING FEES
ITT FL EO.FT R S U.nISKl4 SYSIFMET.a FL. SO FT.R .Mh"Ev 1 sVC G7PO4. SO.fT.O POWfR Wrlfl WMS
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MECHANICAL FEES SWIM IUDL cants wutmsoNfMR
7.1 in, PAN NAP CM tICCO vcN Wr HSEQ(AwORDISHI
PPIIANC[ DRYER. GARBAGE DM I
IAUMBYIRAY
URNACE UHT WALL FlIX LAKNDEV
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:AWS•.mVI431D1 CININIY AND THE SIAM M CAUNTW NIA
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.// .. n-• r 'wl•ar6t inn,,gC11CfiSS[IG THE BUNrdSS AMIHIVESSONS CODE a lhf STATE Or C}l.\ANIA
•.luIEDIND PERMIT - _• ;I
f nrw DEPARTMENT OF BUILDING&SAFETY FIELD
vw
e c C ^ COUNTY OF RIVERSIDE n 1
{ O VCJONSTTRRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
$ UNITS '
1 ISTK SO fi.g Yp4D 9901 5Y51LM
I ]ND.EL SO,LI R f MOBBENOME Svc rf BAR SINK
i FOR SO 11.$ ` FOWER MIMI JEJ RGOEDRAWS
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FS"m CONSIPUC1101]VAIOAIION IS SWIM i NON.PN IIOGR DRAIN NOTE:NPI IR lk med rn pppPrry m.voNPlron WAIW SOFTENER
MECHANICAL FEES SWIM;Mt.CO.
SICK WASEIE4(AUTORDISHI
VIEWTr511u FAN NAP.COCA, rICOD GARBAGE DISIVSAI
"a OVER LAUNDRY TRAY
i FUieract UNIT WAIT FLOOR BUSPENDED KITCHEN SIM
E A@ NATIONS UNIT C1M at FtiIER WptfR OL sFl
A6504PIN)N SYSTEM B 1 U T[M➢USE PERMIT SVC
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i SCIITR B I U. SO FT p , WAIFR HEATER
1 SET 11 RESID11- I ( S,VVAGf DISPOSAL SV
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r l J f/Il THIS MIMI STALL BECOME VOID IF WORK IS NOT COMMENCED VA7"W 1"DAYS. CESSATION Of WORK •wA.MW
,•k'r R""•'�4 �'f /1•, f04 IM DAYS EHAtt ALSO CAUSE KbMIt TO BFCM'VO'D
1 HEREBY RIVE 7HAT ME ERSIDE COUNTY IND IC F StP E OF WITH .15 FERMI Wltt BE DONE IN ACCORDANCE WITH
IH TAWS Or ERSOE COUNTY
x IHEREBY CERTIFY DUIiHE IADWIDUAL WHO PREPARED THE PUNS AND SPEOFIGNONS HAS DONE SOW
!.� ACCORDANCE WIfN SECTION SSII OF THE BUSINESS AND PROFESSION CM
S CODE Or THE STATE OF IFO4NIA.
J
r
NO OFFPwtIOM J WE 1N 004 NO OPERATION DALE INSKC)OP��_
BUILDING APPROVALS_ MECHANICAL APPROVALS _ y
1 SrIBxL ]] Vanula,An Spleen
M 51eh Gr 35 iw„we C.mpol
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- ----^'--•`�'J=1 ^- - � SEWAGE SYSTEM SIZE i LOCATION
y_ _ __�••,_,__..._—_, REAR OF PROPERTY LINE
_ ELECTRICAL APPROVALS _ _ _
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t1 APPROVED BY:
q O — LAND USE DIVISION. a
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Required BcfoV Finalizing 17�
VL Paved parking, driveway,
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Landscaping —y no
Tree Req. yes no / \��`^
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NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Pcooll No
,DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWpl1�/10 /6M&A /W Is r A,Nlece___ CalNaaar.--_ —
Addreas Of,' (.:9 /T 1`7
CIIY :11. Ct1Y
Plwner�- + �>> Pbme___— _,.
I(•e)Ne u MIK"od.ho.ew[nbly nN a h—`,tWe.'Ma 1 I.11 Mv< oad ILe apol<a..and yrm Iplt d CUN am, GwN, aM
P."."Ito DNNaeen pl npbl el•W.1 repmyl be 111e CwM nl Ruen.de. lls Rwernde Cwm1Y Otparlmml el Du.Id.M Md Salely
"it MI mlho a LNI NUPetpen uNd YM Ityu.lemenit Mre been met 1 am Ww sure INl rm wv4 Is to W dnrw mahm the Cawdl A/W
0 •d11N1 M..worm tl pNm.l.
NOW.N ood e,d i%aprM INI 1 Inl1.A MI etnq wmt proper'.a .611 em uuw wtl pepnly to b onuryM v d I'mol l ee
I-0ml W.Ib MI ltt a of Ipe Cdumy nl R..aryle arW NW Stwt of Call.p—et--p I'd prepplY-
DATE /Su_—. SIGNATURE OF OWNER AND'OR AGENT
/ App..l by Sippalpro 4ptd lAe FRllprid, DepallydaWD Lillad BeIpW
M.0 Bp Oblaitt d Prier Re tba lipid,of a Cppstro.11.Pam'it.
I SPACE N0.
I USE OF STRUCTURE
JOB ADDRESS _i�i 9C._ - _ ,/• L I .t�_
SINGLE FAMILY �DUPI_.
_ LEGA`-0ESCRIPTION OF PR`�P�E/'RT�Y �3,.(•I- r ��� _ APARTMENTS ❑ AGRIL
N /CjJ= .`1/✓ _ _-- COMMERCIAL ❑ INDUSTRIAL J
COMMUNITY
ALTERATIONS [J
O Z NO.OF SUBMITTED PLANS___,2—f USE OF PERMIT
`t
� < CASE N0. �o��
u
O ? NO.OF PARKING SPACES REQUIRED _---I------NO.OR BUILDINGS NOW EXISTING .J_ .----_.
3 i ZONFGt- T- Y.aeTBACKS: FRONT h=SIDE 7 REAR T
t3 GRADING PERMIT REQUIRED? YES = NO f! LOT SIZE /
SETBACK ORDINANCE R I_.._— OF FEET REQUIRED ON ._ —_ _ __ STRF�'(.'
DATE 1�,�a"L SIGNATURE OF LAND USE Of FICIAI
F DEDICATION REQUIRED: YES C1 NO C'.. 140. OF FEET- '�'J.✓�—
CURB AND GUTTER REQUIRED. YES O NO B� ____—STREET
M
Y
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES C. NO 0
O HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES 0 NO 0
r DATE____ SIGNATURE OF ROAD DEPT. OFFICIAL—
S SWIMMING POOLS PUBLIC
3 G SEVADE DISPOSAL SX-OTiF 7/J AI/! 7 /,AL Zen _SX/7 pin
m FOOD ESTABLISHMENT
WATER POLLUTION REMARKS --_—_
•d FLOOD CONTROL _ -
Y == AIR POLLUTION r
= DIV OF HWY
p — YOUR PROPERTY MAY BE SUBJECT TO
u FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 1" pod
CANM V—IILF. PINK—APPLICANT
,J J
DEPARTMENT OF BUILDING AND SAFETY
:. . COUNTY OF RIVERSIDE 1
MOBILEHOME INSTALLATION APPLICATION
TRAILER PARK DISTRICT NO
El
S
INDIVIDUAL LOT
NAME OF PARK
- - ADDRESS_ _ TELEPHONE NO.
OWNER/AGFNT V -A SS
ADDRESS SPACE NO.
;.a MOBILEHOML• INSTALLER 14 J Ur�i %nIS�•
ADDRESS 3'ri ?z .�'f• �,'A 3 r.'.-(• lP, , TELEPHONE N0. Ls
INSTALLERS CONTE°.CTOR'S LICENSE NO_• J� -' �J
PATE OF TDAN)IFACTURE OF MOBILE WIDTH �L�LF.NGTH(LESS HITCH ' E='
- -
NEW i� RELOCATE "+1�NUFACTURER ��.:.Lc
--�, - STATE INS.GNTAa?G'
MODEL I r/`HENL) OR HUD LABEL: U-UNIT `2l�lJ X-UNIT/10.39—
SERIAL ?DUMBER � �sy ROOF LIVE LOAD, WIND LOAD �S
APPLICANT ��CJ%' S APPLICANT
y (PRINT NAME) L (SIGNATURE)
PARK OWNER/MANAGER PARK OWNER/MANAGER.
(PRINT Ni0!E) (SIGNATURE)
s ,ti t;a rn Y 35
-'It
- COMMUNITY __3UnI 'i:.) ZONEii,-• i 'l. i CASE NO/'IP-l/1� �
LEGAL DESCRIPTION?/-1.-f.'r-'%-%G �•� �;'' %%• %==
;• ._ ,:;� - '-SETBACKS: FRONT /��- SIDE �':. / REAR �l
BATE d ��' ��) SIGNATURE OF LAND USE OFFICIAL.
rl ..
;284-77 Rev. 'S/77