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grtENTCihOli STATE OF CALIFORNIA—BUSINESS, TRANSPORTATION AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS d ��
ACTIVITY REPORT /0 AREA OFFICES
Date V •�� ! 3 Report by
�' L_�i Jti �f N es ' /j �
��rthern Area
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LJ 1800 Third Street
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Sacramento, CA 95814
To: Name
P.O. Box 1407
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-
Sacramento, CA
Address C_��
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95e12-1407
�!�—�
Tel. (910) 445-0135
Activity Site (If other than above)
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❑ Southern Area
2038 Iowa Avenue
COUNT4=15
DEPT
Bldg. B. Suite 102
Riverside. CA
Owner (If other than above)
BUILDING
92507.2435
``%
Tel. (714) 782-4420
Address
AUG p
OSE OF REPORT: (Checked(
INSPECTION RECORD ONLY EAM
❑ INFORMATION ONLY❑ NOTICE OF VIOLATION AND RELATED INFORis re rovides rsoNIce of
violations of the Califorpia Health and Safety Code, Division Ion ,Title
25, Part 1, Chapter _, Sections indicated. Copies of the regulations may be obtained from the State of
California, Office of Procurement, Publications Section, P.O. Box 1015, North Highlands, CA 95660-1015.
Violations indicated shall be corrected and a written request for further inspection filed with the Area Office
indicated above on or before . The request for inspection shall be accompanied by
minimum fee of A
4 -•'
'A
A permit shall be obtained from the Area Office identified a4 a for;work to coriecYifetn(s)'$t
If you believe this report has been issued in error or is factualk6646, please contact the Area Supervisor at the
Area Office indicated above.
INSPECTED UNIT IDENTIFICA
Type of Unit Box Size Overall Size RT Decal No.
Manufacturer, Year and Model
HUD LABEL or HCD Insignia No. Serial No. or V. I. N.
INSPECTION RESULTS OR INFORMATION: r
�/z y/93
I f
FILE IDENTIFICATION
iArTION
` _
CPT # d®� FAC. ID #
ASSIGNMENT it
LABOR DATA:
0
DR ID J 3 �D'TTE
PCA/ACT COOEZ %- r AREA
CO -f LOC TR MILES
TIME: INSP/ACT t TR d y
INSPECTI DATA:
TIME REPORT ONLY
❑ INITIAL INSPECTION ❑ REINSPECTION
rt HOME/UWT # FLOORS
VIOLATION DATA:
TOTAL MP TENANT
S _ F _ E _ M _ P _ GIO _ NP
MH ALTERATION TYPE:
AC ❑ ACC ❑ ROOF ❑ FP ❑ O
THIRD -PARTY MONITORING:
OAA @ HO ❑ IP ❑ OL ❑ Is
DAA $t PLANS ;t COMPLY
MP INSPECTION DATA:
BLG/FIX _ MH LOT— RV LOT— AS—
EH
S—EH INSPECTION DATA:
❑ ACTIVE ❑ INACTIVE
MAX CAP P CAP OCC
SFD DORM MH/RV O
FEE ACCOUNTING:
COL#
USED I DUE I ATTACHE[
INSPE9TION
I
INSIGNIA
OTHER
ATTACHED FEE I.D.
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------------
RECEIVED BY GDA,y Lyr,l� lt,� QuJ,rJre_ TITLE
DEPARTMENTAL USE ONLY: Action: Close File ❑ Reinspection Required ❑ Progress Inspection Required
❑ Enforcement Action Needed ❑ Other
SEND COPIES TO: Recipient ❑ Owner�j� ❑ SAA ❑ OL ❑ Other
SUPERVISOR REVIEW K % DATE 7 COPIES SENT BY DATE i
HCO-61 (REV. 3-91) 91 91928 PAGE 1 of