Permit To Operate - California Department Of Housing And Community (Page 2 of 2) in pdf

INSTRUCTIONS

Complete sections 1 through 5. Submit all copies of this application with the appropriate fees as specified in the Health and Safety

Code, Division 13, Parts 2.1 or 2.3 and the California Code of Regulations, Title 25, Chapter 2 or 2.2 to the appropriate area office:

Northern Area

Southern Area

Department of Housing and Community Development

Northern Area Office

Southern Area Office

9342 Tech Center Drive, Suite 550

3737 Main Street, Suite 400

Sacramento, CA 95826

Riverside, CA 92501-3337

(916) 255-2501

(951) 782-4420

Section 1. Type of Permit Requested

Enter the park identification number issued by this Department.

Original:

Check this box if this is the original request (newly constructed park) for a Permit to Operate this park.

Amended:

Check this box if this is a request for an amended Permit to Operate and indicate the type of change that is

being reported. When there is a change in the number of lots, enter the total number of lots in the space

provided. The addition of lots to an existing park requires local approvals in accordance with sections 1032

or 2032 of Title 25 of the California Code of Regulations.

Check the appropriate box to indicate the type of park for which the permit to operate is being requested. For combination

parks, more than one box may be checked.

Section 2. Lot Information

Number of Lots -

Provide the total number of lots within the park for each category listed. If a category does not apply, leave

it blank. Enter a total of all lots in the space provided. This is the number of lots that will be shown on the

Permit to Operate. DO NOT add lots or change existing categories without submitting approvals from the

local jurisdiction in accordance with Sections 1032 or 2032 of Title 25 of the California Code of Regulations.

Conditional Uses -

Check the appropriate box to indicate any conditional uses. For lots constructed with electrical systems

designed exclusively for units of 50, or 30 amperes (California Code of Regulations, Section 1142). These

lot numbers will appear on the Permit to Operate. Enter any other conditions on the use of the park as

defined in Health and Safety Code, Sections 18205, 18300.1, 18862.13 and 18865.1.

Section 3. Park Information (This section must be filled out completely)

Enter the name of the park as it should appear on the Permit to Operate.

Enter the park telephone number, including the area code.

Enter the location of the park. This is the physical address, do not use a P.O. Box or route number.

Check the appropriate box to indicate if the park is located in an incorporated city or unincorporated area.

Enter the name, telephone number, and mailing address of the park owner.

Section 4. Manager Information (This section is optional, but recommended.)

Enter the park manager’s name , phone number and mailing address.

Section 4. Owner Certification

The signature of the park owner is required along with the owner’s printed name. Also enter the date and place the form is

signed.

Distribution:

White - Park Yellow - Department

Pink - Inspector

Goldenrod - Area Office

HCD 500 Side 2 (Rev 7/04)

Permit To Operate - California Department Of Housing And Community Page 2

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