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APPLICATION FOR PERMIT TO OPERATE MOBILE HOME PARK OR SPECIAL OCCUPANCY PARK Park ID #___
Section 1. TYPE OF PERMIT REQUESTED
| ☐ Original | ☐ Amended (Choose type below) |
|---|---|
| Type of Amendment: | ☐ Transfer of Owner / Operator / Manager (Transfer of owner requires recorded property deed with new owner's name) |
| ☐ Change of Name or Address | |
| ☐ Change in Number of Lots (Additional lots requires local approvals and inspection) | |
| Type of Park: | ☐ Mobilehome Park ☐ Special Occupancy Park (if applicable, select appropriate designation below) |
| Special Occupancy Park Designation (if applicable): | |
| ☐ Temporary Special Occupancy Park ☐ Incidental Camping Area ☐ Tent Camp | |
Section 2. LOT INFORMATION Number of Lots Conditional Uses
Section 3. PART 3 FORM ORMATION
Number of Lots Conditional Uses
Mobilehome Lots Number of lots with an electrical system designed exclusively for:
Special Occupancy Lots without Drains ☐ 30 amperes ☐ Other
Total Lots ☐ Other ☐ Other
Section 3. PARK INFORMATION — This section MUST be completed.
Park Name Telephone
Street Address—Do NOT use P.O. Box
City State County
☐ Incorporated City ☐ Unincorporated Area
Section 4. OWNER, OPERATOR, AND MANAGER INFORMATION
Owner Name ___
Mailing Address ___
City State Zip
Email Address Telephone ___
I am a
(If different than Owner)
ferent than Owner
Mailing Address ___
Number and Street or P.O. Box
Number and Street or P.O. Box
Email Address Telephone
root(ame) Hire Date
(If different than Operator)
Address ___
City State Zip
Number and Street or P.O. Box
_____ Telephone___
Section 5. OWNER CERTIFICATION
As owner of the park described above, I agree to all necessary inspections required to obtain a Permit to Operate. I also agree that this park shall be operated and maintained in accordance with Health and Safety Code, division 13, part 2.1 and/or part 2.3 and the applicable provisions of California Code of Regulations, title 25, chapters 2 and/or 2.2. I certify under penalty of perjury under the laws of the State of California, that the information provided in this application is true and correct.
Executed on___ at___
Date
City
Signature (required)___ Printed Name___
HCD MP 500A (Rev. 03/24) DEPT USE ONLY: Inspector Signature_____ Date_____
INSTRUCTIONS
Complete sections 1 through 5. Submit the appropriate fees and information required as specified in Health and Safety Code, division 13, parts 2.1 or 2.3 and California Code of Regulations, title 25, chapter 2 or 2.2 to the LOCAL ENFORCEMENT AGENCY for your park.
Park ID No.
Enter the park identification number issued by the California Department of Housing and Community Development. If this is an original application or you have not been assigned a park identification number, leave this blank.
Section 1. TYPE OF PERMIT REQUESTED
Original—Check this box if this is the original request (newly constructed park) for a Permit to Operate. Amended—Check this box if this is a request for an amended Permit to Operate.
Type of Amendment—Indicate the type of change being reported. If transferring ownership of the park, a recorded property deed with the new owner's name is required to be submitted with the application per California Code of Regulations (CCR), title 25, sections 1006.5 and 2006.5. When there is a change in the number of lots, enter the total number of lots in the space provided in Section 2. The addition of lots to an existing park requires local approvals in accordance with CCR, title 25, sections 1032 and 2032.
Type of Park—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.
Special Occupancy Park Designation—If applicable, check the appropriate box to indicate the type of special occupancy park. See CCR, title 25, section 2118 for special occupancy park designation information.
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 the total number of 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 CCR, title 25, sections 1032 and 2032.
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, title 25, 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 in completely.
Enter the name of the park as it should appear on the Permit to Operate. Enter the park telephone number and location of the park. This is the physical address, do NOT enter 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.
Section 4. OWNER, OPERATOR, AND MANAGER INFORMATION
Enter the name, mailing address, email address, and telephone number of the park owner, park operator if different than owner, and on-site property manager if different than operator. Enter the manager's hire date.
Section 5. OWNER CERTIFICATION
The signature of the park owner is required, along with the owner's printed name. Enter the date and location the document is signed.