HomeMy WebLinkAbout204 EASY PL; ; 70-9M14; PermitSTATE OF CALIFORNIA
Department of Housing and Community Development
Division of Building and Housing Standards
APPLICATION FOR PERMIT TO CONSTRUC1
BUILDING-PLUMBING-ELECTRICAL
CO.. -ID No..
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SHL •
EPL •
MP •
Acc/S •
TD BE COMPLETED BY APPIICANT DIVISION USE ONLY
(CDMPIHE IN TRIPLICATE—PLEASE PRINT)
Project
Name
Location_
Owner
Address-
Applicant
Address-.
-Slate Lie. No.
Workmen's Comp. Certificate Verified-
Apprnueri! ^
Project Owner/Operator
(Required for accessory structure, mobilehome parl()
Lots: Indep.. -Dep..
MOBILEHOME PARK
_Acc. Structure
BUILDING
Description:.
Sq. Ft._
Accessory Building: Type_
-No. of Stories_
Fixtures/Sewer lnlets_
Main Sewer
PLUMBING
^Fire Hydrants-
_Private Sewage Disposal.
Water Heaters-
Water Piping
_Gas Outlets-
Alt/Rep_
_Gas Regs_
_Sprinl(ler_
Bacliflow Preventers^ -Other_
ELECTRICAL
Outlets-_Fixtures_ .Motors (HP).
Generators (KVA)-
Ranges/Heaters
MB Lots
-Merc Lamps-
-Signs--Fire Alarm System.
0«er 600 V_
-Service: 200 AMP or less.
Other
.Over 200 AMP_
I hereby acknowledge that the information I have provided is correct and agree that all construc-
tion shall be in accordance with applicable provisions of the health and safety code and related
rules and regulations of the State of California, and on behalf of the owner, I herewith consent to
all necessary inspections incident to the issuance of this permiL
Date. J^l z-7 t> ^^/^^ OM^^
Plan Check Fee due with application—Not Refundable.
Distribution: Orig. to Area Office, 1 DR, 1 Applicant
HCD FORM SOIA (REV. 3-6e>
Prior local Approval:
Fire Department MWIZ'TO !^2t15******25.00
Health Department-
Planning Comm
other
Type dr
Type.aJL_Gr_
.Val.
-Val.
BUILDING
BUILDING PERMIT FEE
PLUMBING
No. Item Fee
Fix/Inlets . .
Hydrants . .
Main Sewer .
Fix/Inlets . .
Hydrants . .
Main Sewer .
Fix/Inlets . .
Hydrants . .
Main Sewer .
Pvt. Oisp. Sys.
Water Heaters
Gas Outlets
Gas Regs . .
Water Piping .
Alt/Rep. . .
Sprinlder . .
Water Piping .
Alt/Rep. . .
Sprinlder . .
Water Piping .
Alt/Rep. . .
Sprinlder . .
Backflow Prev. Backflow Prev.
PLUMBING PERMIT FEE
ELECTRICAL
No. Item Fee
Outlets
Motors (HP)
Generators (KVA)
Ranges/Heaters
MH Lot Equip
ELECTRICAL PERMIT FEES
ISSUANCE FEES
Total Permit Fee
Plan Check Fee .
Total Fee
o o
Fees Received:
DR
Approved: L Are/Supervisor ^
DATE.
Distance
from awn. or
structure this
side to left
Prop. line.
CUSTOMER NAME
CUSTOMER Anr>RF<;<: «^^^
SPACE NUMBER ^g^y
CITY C^/^>^stfi/^ eX
ENFORCEMENT AGENCY
Distance from awn. or structure
to rear Prop. line.
Distance from awn. or structure to street.
STREET WITHIN PARK
Distance from
awn. or structure
to right Prop.
line.^
4/
NAME OF PARK
PARK MANAGER'S AUTHORIZATION TO INSTAL
PARK MGR'S SIGNATURE
NOTE:
PARK BUILT PRIOR TO 10-16-65 Yes No.