HomeMy WebLinkAbout201 SEA BREEZE DR; ; 69-M7; PermitSTATE OF CALIFORNIA co _____ lD No _____ _
Department of Housing and Community Development
Division of Building and Housing Standards
APPLICATION FOR PERMIT TO CONSTRUCT
BUILDING-PLUMBING-ELECTRICAL
TO BE COMPLETED BY APPLICANT DIVISION USE ONLY
(COMPLETE IN TRIPLICATE-PLEASE PRINT)
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A~pllcant~-~~~~-"--'L-"-'--'....__,_ ___ __._ __ .State Lie. N0 . ...11!:.:..:,.£.=:.c......,~,,__.L._...:..(!_=-.:6,=-...:/-11
Address...c%_=-=~----=:.......---='--..<.J..-.....l'--..L.:....l...!e4><--'--+----'-=<....!:c:..J'...!...;~""-....L...JC..U-"-----II
Workmen's Comp. Certificate Verifie"--------------------------1I
Approved,, __________ -=-,--,-=-----,=-----,---------------1I Project Owner/Operator
(Required for accessory structure, mobilehome park)
MOBILEHOME PARK
Lots: lndep ___ Dep._____Acc. Structure'-----------------------11
Description:~~A...,__..!.l...:..le......::..0 __ c:i.i...:.r--__ ..:::e:::•~...L.:.:::....!~:...Ll.-..!..., _ ___!~:___!...!:.w~~.=:.....L.J.~=-~-----l
Pu i2...e -I
Sq. ft ______ No. of Stories _____________________ -l
Accessory Building: Type __________________________ ~
PLUMBING
Other
BUILDINll
BUILDING PERMIT FEE . . . . . . .
PLUMBING
No. Item
--Fix/Inlets
--Hydrants
--Main Sewer
--Pvt. Dlsp. Sys.
--Water Heaters
--Gas Outlets
--Gas Regs
--Water Piping
--Alt/Rep,
--Sprinkler
--Backflow Prev.
--
Fee
SHL 0
EPL 0
MP 0
Acc/S O
PLUMBING PERMIT FEE .......... __
Fixtures/Sewer lnlets. ___________ ,Flre Hydrants ____________ -ll
Main Sewer __________ __,..rlvate Sewage Disposal ____________ -tI
water Heaters _______ ,Gas Outlets _______ ,Gas Regs ________ --1I
Water Pipln,,._ _______ ___J"Olt/Rep'--________ Sprlnkler ________ -tl
Backflow Preventer.._ __________ Other _______________ --11
ELECTRICAL
Outlets, _________ Fixtures, _________ Motors (HP>----------tl
Generators (KVA) ____________ Merc Lamps _____________ -11
Ranges/Heaters, ________ .Sign . ._ _______ Fire Alarm System _______ ~I
MH Lots ______ ,Service: 200 AMP or less ______ Over 200 AMP _______ ;1
Over 600 v ______ Other ______________________ ---;1
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 permit.
Plan Check Fee due with application-Not Refundable.
Distribution: Orig. to Area Office, 1 DR, 1 Applicant
HCD FORM 501A (REV. S,68)
ELECTRICAL
No. Item
--Outlets .
--Fixtures
--Motors (HP)
--Generators (KVA)
--Mere Lamps
--Ranges/Heaters
--Signs
--Fire Alarm
--MH Lot Equip.
--Service (AMP)
--
ELECTRICAL PERMIT FEES
ISSUANCE FEES
Total Permit Fee .
Plan Check Fee
Total Fee
OR ____ ~::__------~'
Fee
-~
Approved:-...,J'..R~~ff-~µ~~.J,J~U,,C,&!!>.._ __ _
l::,,. O&P
DATE __________ _ CUSTOMER NAME
CUSTOMER ADDRESS
SPACE NUMBER
CITY
F•2·6B
ENFORCEMENT AGENCY ______ ~----
OF BUILDING AND SAFETY
MOBILE HOME
P/L
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Cl 27 \969 t> c.1t)
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OF CARLS AD
ing Departm nt L
J,
STREET ~ff )J. BREe:Z.E LOT NO. 201
NAME OF PARK~~..@:~~if:::l.:~==:==------...,,,:.:,......,~--r------..---="1-------
PARK MANAGER'S AUTHORIZATION TO INSTALL __ ----,,+-~-.,;}:,-..::=:----,1:--.:....i...L...1.:......31G.--,---..
NOTE :
PARK MGR'S SIGNATURE J~ ,Ci_),,wr
PAR K BUil T PRIOR TO 10-16~5