Manufactured Home Building Permit Application - County Of Tehama - Department Of Building & Safety
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1COUNTY OF TEHAMA
DEPARTMENT OF BUILDING & SAFETY
John Stover, Building Official
Tehama County Courthouse Annex
nd
444 Oak St. 2
Floor Room H
(530)527-7002 (530)527-2655 Fax
Red Bluff, CA. 96080
e-mail:
building@co.tehama.ca.us
MANUFACTURED HOME
BUILDING PERMIT APPLICATION
CONSTRUCTION ADDRESS
PROPERTY OWNER
__________________________________
NAME
PARCEL #____________________________________
MAILING ADDR.______________________________
_______________________________
ADDRESS
CITY_________________ STATE____ ZIP_________
__________________________________
CITY
PHONE_______________________________________
CONTRACTOR
ARCHITECT/ENGINEER
NAME______________________________________________
NAME_______________________________________________
ADDRESS___________________________________________
STATE LIC #__________________ EXP___________________
CITY_____________________ STATE____ ZIP___________
PHONE________________________ FAX__________________
*CONTACT PERSON____________________________
EMAIL_________________________________________
*CONTACT PHONE_____________________________
STATE LIC #_______________________ CLASS____________
PROJECT VALUATION: _________________________
APPROVED PLOT PLAN
PRE OWNED MOBILE HOME INFORMATION
(2) TIE DOWN/FOUNDATION PLANS
MANUFACTURER:_____________________________
(3) ADDITIONAL FULL SIZE FLOOR PLAN
SIZE: _______X________ YEAR:_______________
INSTALLATION MANUAL
INSIGNIA:_________________________________
FLOOD ELEVATION CERTIFICATE
(IF APPLICABLE)
SERIAL: ___________________________________
MARRIAGE LINE CHART/BLOCKING PLAN
:____________________________________________
LIENHOLDER RELEASE/CONSENT (if applicable)
REGISTRATION/TITLE
I understand I am responsible for delivering all necessary
TAX CLEARANCE/DEED
items to the Building Department BEFORE the building
For Permanent Foundation:
permit will be issued. Omission of these items may cause a
DECAL/LICENSE PLATES (pre-owned)
delay in processing my permit.
MANUFACTURER CERTIFICATE OF ORIGIN (new)
All manufactured homes manufactured after 1/1/2012 require
APPLICANT SIGNATURE
fire sprinklers. Alterations made in/on/to a manufactured home
must be permitted through HCD. A permit can be obtained
through the Dept. of Housing and Community Development.
X:_____________________________________
PERMIT #
RCVD BY:
$ DEPOSIT AMT:
CHECK #
RCPT #
PROJECT DESCRIPTION:
DATE:
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