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HomeMy WebLinkAbout058-053-010`1 Dale Osborne W/S Yana Trai , 1400'N.of Ishi Trail, t Concow Permit-77P,E((gtil. ,MH) k12 2 ELEC ' % GAS VA suPP61T STRUCTURE REQ. —LP.a COMPACTION TEST REQ. -7 G 58-36-80 contr: S.O. S Mobile Home Serv., Marys. Permit #1825-')'7MHI lo�l�j7 Issued 77 1308=1383 058-530-010 MISCELLANEOUS Electric Panel NEW POWER POLE AND ELECTRIC F 41217'JACK DALE WAY OSBORN ale t F73f i 1 7 Cit G. - _ y j 2' r•-,. ems' S "i �'�` � ��i i ,1 i M l ft I•b�'. — -'i Related Records and Activities for APN: 058-530-010 Address: 4121 JACK DALE WAY Cancel ? No Stib-GeoRecords FOLInd Permits + B08-2225 Type== MISCELLANEOUS StatLIS= t. HDER REVIEW + B08-22080 Type= MISC:E:LU\IUEOUS Status= ISSUED + 1308-2079 Type= RESIDENTIAL Status= IS;Z)UED + L03-1 708 Tyle= MIS CELL NEOtJ:3) Status= FII ALED -+: 1308-1383 Type= MISCELLANEOUS Status;= I"IlwALEE) No Project Records FOL11-1d vv Code Enforcement No Business Licenses FoLind No CRM Records Found Cancel ? PERMIT N0. 1212-77P� E ' ` PERMIT EXPIRES V-71 OWNER Dale Osborne CONTR. owner LOCATION (A.P. 58-36-80 ) ' W/S Yana Trail, 1400'N.of Ishi Trail, Concow s (77 - Wadtt P� 1 ` •1 �1 �y{e Temp. Power Pole Called PG&E _ Temp. Elec. Serv. a Called PG&E Temp. Gas Serv. Called PG&E FINALED • (Date) (Si nature) a ' Relnf. Steel Final Fixtures Bond Beam /FIRE SPRINKLE Motors Framing Test Water Htr. nal Grd. Fa It Prot. Servs T p. Pole F ish I DiAts Vnderground In rior Lathentllation Permanent oor Closer Final anal MOBILEHOME UTILITIES -----------------AElec_ Service �ec. Pedestal a Water Pipin1p ZS 77 �, Sewer Gas Piping MO=1 E OME INSTALLA� TION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE R ARKS 0 CORRE TIONS t9 a� ,,��� ,2- i/;7 moo 09 c-� z©� ��- 7S evz� 7 4�77(NOTE 2- �- An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Se ack [A(ewall S I PlpinFor ar ets 1 t Floor Mai Bldg. est om Finish 2n Floor Fo tins Wlndo�k rd Noor Stem ad I Sidin To out Slab Roof SheaNhIna Water Pi i Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwa I I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. forpeh sical handicapd Conformance of ex. V structure V Appliances Gas Piping & Test Temp. as Slab Final A Sanitation Patio REP ACE Final Footings A Footing E ECTRI L Relnf. Steel Final Fixtures Bond Beam /FIRE SPRINKLE Motors Framing Test Water Htr. nal Grd. Fa It Prot. Servs T p. Pole F ish I DiAts Vnderground In rior Lathentllation Permanent oor Closer Final anal MOBILEHOME UTILITIES -----------------AElec_ Service �ec. Pedestal a Water Pipin1p ZS 77 �, Sewer Gas Piping MO=1 E OME INSTALLA� TION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE R ARKS 0 CORRE TIONS t9 a� ,,��� ,2- i/;7 moo 09 c-� z©� ��- 7S evz� 7 4�77(NOTE 2- �- An entry must be made on this form each time you visit the job site.) TO: Building.Department FROM: Environmental Health RE: Sewage and/or t4ater Clearance t'f LOCATION; k .P;y Has been approved for: 1ATER SUP_'LY -i ;7 .Sanitaria n Date COUNTY OF BITE- — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. r ' X Date Signatureof Perrm)itee or Agent %�v Receipt No. J White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF/P)JBLIC WORKS By _ Date `( -2- 9--77-- Bit' --77B ��Hding`permit expires Date cf—�f — 7� BUILDING or I OwnerD Q SO. FT. OCC. BUILDING VALUATION l' Mailing Address �j t) 73— e • Q� ac (s o Telephone No. 7�g� d— Fireplace Contractor J, Q, ✓!G Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty ff/T �I pp Permit Fee I d Building Address PLUMBING No. @ FEE PERMIT FILING FEE $3.00 /Zoo Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 M / Da/G'O� Each gas water heater or vent _ 1.50 A. P. No Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F Saw4a4eR Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration parcel Ma p 60' R/W Improvements p Lawn sprinkler system 2.00 Bldg. Ions Recd Parcel A royal Pla ppro..I Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 ,rs 7 7 Main service incl. 1 meter Additional meters, each 1.00 Sub -panel 02 or less) (more than 12) Single Family ❑ Duplex ❑ Mobil Home,g Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures bo@2 Receps.., switches & fix outlets 20 CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of:'' // (� I ifS & � �J 1'70lw S,Cyil 1/I G.Q Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 30 �� G_16 / License No. Classification Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relatinq to buildinq construction, and hereby 7V1111 TOTAL PERMIT FEE $ Q authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. r ' X Date Signatureof Perrm)itee or Agent %�v Receipt No. J White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF/P)JBLIC WORKS By _ Date `( -2- 9--77-- Bit' --77B ��Hding`permit expires Date cf—�f — 7� BUTTE COUNTY DEPARnIMNT OF PUBLIC WORKS 7 County Center Drive, Oroville CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: '�Gt /-P iSS ,Do �►'+ 2. Installer's name: �'� ,S 3. Is the site currently under permit? Yes / / No (If yes, furnish permit number�OR Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 away from septic tank and leach fields and clear -of all setbacks and easements? Yes 7x1 No / / (If no, clarify 5. What is the mobilehome electrical rating?-'=�-_=�=pd="-D-_ 6. What is the mobilehome site service rating? --------------------- 7. What is the mobilehome site circuit breaker. rating? -------- 8. Is there any other electric load to be se:r.ved by the mobilehome Amps �Dd _Amps. d d Amps site service?--------------------------------•-•------------------- Yes / / No 7177 / (If yes, identify the load and size: (Load) (Amps) a 9. What is the mobilehome site gas pipe size? --------- ------------ (in.) 10. What is the type of gas service? ------------------------------ Natural/ / LPG,/ / 11. What is the gas pipe length fror,. mFf:er or, tank to the mobilehome? _ - (ft.) 12. What is the mobilehome gas demand? -r ------------------------------ (BTU) (This information not required: if Pipe length less than 6 ft. on natural gas or less than 50 ft, on LPG.) MOBILEHOME SUPPORT DATA Mobilehome Mfr. �C�/h G0� D s Setup Model No. �O_�_ Year � / 7�Z Width (ft.) Length .. V• / (ft..) - Expando Size ft.x ft. (Draw support details below) . On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structilral setup sheets :(if not .on file with the County of Butte) . f44 1A-0��d *-,,w G '' Sin le —�� Footings--(check.one; J644_ �4 - n I� A Center Support Locations Center Support Footing Sizes (in.) 1 T x3 D ... 17 1 zn. in. in. rr — — %■ alm 4. .... ....... .......... (in.) (in.) i 4 A. Wood :either , pressure treated;or fdn. %grade.: Z. Concrete pad. S.. -Other, ---specify Supports (check one; 1. Concrete block 2. Concrete piers 7_1 3. Steel piers Other, specify Typical Support PA X-3-01 Footing Size in. in.) .� ieja d ......... . .... Max. Pier Spacing ii 4.5Tk2n. in.) (in.) ' ' Iiax. Overhang If center piers are other than drawn above, Q C,CH% /A,rS D 0 draw in locations, spacing, and dimensions, BUTTE COUNTY BUILDING DEPABTMr-NT APPROVED �� �-- TWINEIT ILE HO Dale Osborne Mobile Home Lancer 1440 sq. ft. IL Telephone (916) 742-8575 5456 Chestnut Road Marysville, California 95901 We submit the following calculations for Deamp of the above Coach. 1440 sq. ft. @ 3 watts .................................. 4.32 2-20 watt appliance outlet 3.0 Laundry dircuit......................................... 1.5 Range ................................................... 12.0 Water heater.............. 2.5 Dishwasher .............................................. 1.2 Furnace ................................................• 20.0 Dryer ................................................... 5.0 T9.52 First 10 kw @ 100° ................. 10.0 Remainder 39.52 @ 40%o .............. 15.80 2— 5�0 25.80 x 1000 = 25800: 230 = .::.::.............. 1.12.17 BUTTE COUNTY BUILDING ®EP,4.RT�"4r'N7 APPROVED ✓- E COUNTY OF BUTTE - DEPARTMENT OF' PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 i Telephone: 534-4541 APPLICATION AND PERMIT -�7 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X� (1-47AA6me Date Signatt,re of Permitee or Agent Receipt No. J 6 3 White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF UBLIC WORKS By Date BZing/ permit expires Date BUILDING Owner Ge- OS 13optN e� SQ. FT. OCC. BUILDING VALUATION Mailing Address 5076- e/1/ /C eAo; Fireplace Contractor Total Valuation Mai I i ng Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address �) S. �. ! • PLUMBING No. @ FEE PERMIT FILING FEE $3.00 T [/ oo Al Q 1,$ ^ f ,c. ° Each Trap 1.50 O M C O tk' Repair drainage or vent piping 1.50 Water piping a Zoning Verification Only Each gas water heater or vent 1.50 Z'a Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W. Sa on Fire Dept. FireZone Use Permit Building sewer 4,.0& /'0 - Parking Parking Parcel Plans Declaration(i Parcel•Ma p 60' R/W Im roveme is p Lawn sprinkler system 2.00 BI gCF�n i�ec'd �-IPa a Approval PI pproval Permit Fee $ $ ELECTRICAL No. @ FEE NEW ❑ ADDITION ❑ UTILITIESIfte OTHER ❑ PERMIT FILING FEE $3.00 Main service 100V OR LESS1005.00 1AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 S� Main service OVER 600V 25.00 100 AMP OR LESS Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP j 1.00 NEW OR ADONST ( ACCLBLDGLING OCCUP. &) 20sgft NEW CONSTR. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS .&) NON-RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Ex. Occup(OUTLETS OR FIXTURES) BqL@T 009 Ex. Occup. ( OUTLETS P(RESID.)REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 License No. Classification I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ rD MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit' Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relatina to building construction, and hereby Z_ 14n fit TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X� (1-47AA6me Date Signatt,re of Permitee or Agent Receipt No. J 6 3 White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF UBLIC WORKS By Date BZing/ permit expires Date y Q.VR. � Y'at.i % Septic system aad-leeegenrof'bAd- iBa be as per Butte County Health Dept. Re- quirements. # Aziz - 77 AII' /ility connections shall be located within 4 ft. outside the rear third section of the mobile home on the left (road) side of the mobile home. ra c:. NOTE:—All Materials .& Workmanship Shall Be in Accordance with Recognized Good Practices and of a quality prescribed for the Specified use in the Uniform Buiiding, Plumbing & Mechanical Codes and the National Electrical Code. This set of plans and iperifiai-4teRs MUST be kept on the io4 at call times and it is unlawful to make any chareles or alters+io-, A,or1 some without written permission from iiie Dopartment.of Public W.ork�, Coutrty of Butte. V� 3 %.fib The fig. Setback shall be 5 it. from the side property line and- 50 ft. from the centerl;ne of the road, permitting a maxi- mum of a 2 ft. eave overhang but entirely out of all easements. BUTTE COUNTY BUILDING DEPARTH NT APPROVED to s,.::-�-•�is�.^-+ � �z',,.A'!'�.ar;�s�-4��yli`'d�� .,,;,a, 1� A .� i y..r ; •-+,, �'!"a � €' q: ^:�.ar-ti:'�i'"9'�"".°: r-� COUNTY OF BUTTE, . DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OVOCCUPANCY This mobilehome has been installed in accordance with the requirements of the C lifornia Administrative Code, Title 25, Cha ter• under permit number 22 -for the following location: w%S �.4�1/fiz Owner R a k Owner's Address S Mobilehome Mfg. Mode l/L 7 AYear 77 Insignia No. �Jr79L, d�i�lOr� S�_ Serial No% /7e8 It is hereby certified for occupancy at the above described location and may be occupied. Directu is orks Date �! %7 By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds PROJECT JNFORMATION Site Address: 4121 JACK DALE WAY APN: 058-530-010 Owner: OSBORN Permit NO: B0$-13$3 Issued Date: 7/21/2008 By GLB Permit type: MISCELLANEOUS 4121 JACK DALE LN Subtype: Electric Panel OROVILLE, CA 95965 Expiration Date: 7/21/2009 Description: NEW POWER POLE AND ELECTR Occupancy: Zoning: FR10 I Contractor Applicant: Square Footage: D T G ELECTRIC D T G ELECTRIC Building Garage Remdl/Addn P O BOX 8923 P O BOX 8923 CHICO, CA 95927 CHICO, CA 95927 Other Porch/Patio Total (530)321-6233 1 (530)321-6233 FEE,INFORMATION DBE Single Phase Service-Resid $59.00 Total Charged: $59.00 Fees Paid: $59.00 Balance Due: $0.00 Receipt No: B8027 LICENSED CONTRACTOR'S<DE(Z MTION _ OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires D T G ELECTRIC 825782 / C10 / 10/31/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencin with Section 7000) of 'v' 'on 3 of th Business and Professions Code, and my license is in full f ce nd elle X 7/21/2008 Contrac ors Signature Date ❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). HAVE ❑ 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compansation insurance carrier and policy number are; ❑ 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier: Policy Number: Exp. Date: (This section need not be completed if the permit is for one hundred dollars ($100) or less.) ❑ I AM EXEMPT under Section B. & P.C. for this reason: ZI CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any in any manner so as to become to the Workers' X 7/21/2008 person subject Compensation Laws of California, and agree that if I should become subject to the workers' comp lion provisions of Section 370 of the Labor Code, I shall forthwith comply with those Prov ions Owners Signature Date t X 7/21/2008 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and Stale laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or am authorized to act on the property owners behalf. °vl _ '~ 7/21/2008 Sig atu Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING'AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Name of Permittee [SIGN] Print Date Owner ontractor OR. ElAgent for Owner Agent for Contractor FILE COPY Lenders Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES PERMIT BUILDING PERMIT APPLICATION* * NO., OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 ' A FEE WILL'BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds grn # PLEASE PRINT CLEARLY "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. APPLICANT INFORMATION OWNER INFORMATION Last Name ac G I First Name Mailing Address .T C V l� City 460 State State Zi S Phone Fax Fax E-mail Lic. # �i'�2 51 APPLICANT INFORMATION CONTRACTOR Name M& � Gc�G �' f L . Address 6 ,2 3 CityG� C Fax State Zi ,, 7 Phon Fax E-mail .. Lic. # �i'�2 51 Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City © Address Zis 7 � City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name LIU � Address / City © State Zis 7 � Ph Fax E-mail PROJECT LOCATION AP# S'$ , U l O Prope Addr ss y /) IMIVG City L WORKER'S COMPENSATION Policy Number Carrier If hiring anyorie`other than licensed contractors, a certificate of worker's compensation must be shown at the dme of pennit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK., Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes No 0cc• Type Const. 'M0BTi:l H0,'•tG INSTALLATION INSPECTION CHECK LIST 1. Is the mobilehome locat0l wi.'I -- uired separation from lot lines and buildings and generall.y conform to plot plan? Yc:3 � the mobilehome have required clearances above ground? (Sec.5085) Yes Q No 3. Are footin„;s and supports properly sized, spaced, and braced as pe approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yeso_ 4. Is the mobilehome level.? (Sec. 5088) Yes_U/No+ S. If more•than a single unit, are crossover connections properly installed? (Sec. 5088) YesNo h: Water A. Is flexible connector of adequate size and properly installed (1/2” ID min.)? (Sec. 5566) Yes .B. Test - Does water piping withstand working pressure or lbs�air�.te ? Yes�< No C. Backflow - If coach is not State of Ca fa approved, does station have backflow device and pressure -relief valve? Yes No 7, Wastes and Drains A. Is connection made witl'i Schedule 40 DWV and have flex connectors at each end? Yes No B. Does it have minimum k;" per foot slope and is it properly supported? Yes_ No .C;. Are any leaks detected in drainage system after runnin�gallons of water through each fixture including crashing machine standpipe? Yes No_ D. If coach is not State of Californiaapp does station have required trap and vent? Yes No 8. Gas Piping and. Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft, long? Note: All piping is to be at least as. large as the mobilehome gas lin inlet without reductions other than the mobilehome connector. Yes No B. Test OK as per following proc ure? Yes_ No , 1. Open all appliance connecor v Ives. 2. Shut off appliance burner an pil v ves. :3. Air test with manometer to 0"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min, without drop. 4. Connect: gas meter to mobilehome with connector, turn, on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes No I 9. Electrical A. Is service large enough to provide ,Adequate amperage to mobileliome. (must equal rating of mobilehome (aith a. :s:inh-um of 100'amp) -and other facilities on lot, i.e., water pumps) garage, caMna, crc.? Yes �No_ B Is them proper clearances around panels? Yes 11�No C. Is power supply cord or feeder assembly properly fused? Yes 'o D. Is continuity test satisfactory as per the following procedure-.? Yes— No I. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, havE: been disconnected, 3. Switch all breakers, and switches in the mobilehome to the "on" position. 4. Connect one load of a test instrument to the mobilehome grounding conductor and app.L :Iie other I au %� e-UlL;-t1 riivurtCttuTttt supply CUnuuCtU'i, 111iliiUlllg r1E�1Lrd1. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall. be connected to the site service equipment. A further continuity te.�;t shall then be made between the grounding electrode and the chassis of the 1110bilehome. Upon satisfactory completion of the electrical tests, the lot or site servicP equipment- may be approved for energizing. ls, job card si-ned by Health Departmeat for water and sanitation? 11. If everything okay, sign off card and to services. MOBTLLi?0."L•' DATA Manufacturer and/or Namestyle Length � Width Vehicle Serial No. State Identification No. IU Y -L 4&,, Ltional Infoi-oration or Cormnents: