Article Structure
The HCD 415 form serves as a crucial application tool for individuals and entities seeking various services related to manufactured homes and commercial modulars in the state of California. This document covers a range of essential applications, including alterations, additions, conversions, alternate approvals, and requests for technical services or inspections necessary to obtain regulatory insignias. By detailing critical information about the project, such as unit specifications, work descriptions, and contractor or owner-builder declarations, the form ensures compliance with state laws and local ordinances. Applicants must affirm their awareness of responsibilities tied to their projects, including the procurement of proper licensing and workers’ compensation coverage. This form also encompasses sections dedicated to applicant and contractor information, highlighting necessary declarations and certifications required to validate the application. By navigating the components of the HCD 415 form, owners and contractors can streamline the process of ensuring their construction or modification efforts align with California's regulatory framework.
Hcd 415 Example
State of California
Business, Transportation and Housing Agency
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
Division of Codes and Standards
HCD 415 APPLICATION FOR
Alteration |
Addition or Conversion |
Alternate Approval |
Technical Services |
Inspection To Obtain Insignia |
CONTRACTOR /
Not required for Special Purpose Commercial Modular
1. LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code and my license is in full force and effect.
License Class _______________Lic. No. __________________ Exp. Date___________________
Contractor ______________________________________________Date __________________
2.
I hereby affirm under penalty of perjury that I am exempt from the Contractors’ License Law for the following reason:
(Sec. 7031.5, Business and Professions Code: Any city or county which 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 Contractors’ License Law Chapter 9 (commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt there from 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))
SECTION 1 - UNIT INFORMATION
I / We are requesting services for the following unit(s): (Check Appropriate Box)
Manufactured Home/Mobilehome
Multifamily Manufactured Home
Commercial Modular (Occupancy Group _____________)
Special Purpose Commercial Modular
Decal Number ____________________________________________
Serial Number(s) / VIN Number______________________________
___________________________________________________________
Manufacturer Name / Model Name
___________________________________________________________
Year of Manufacture_______________________________________
_____________________
DTN / Permit No.
Fee |
|
__ |
|||
Date ___ |
__ |
||||
AA No. |
|
|
__ |
||
RT TO |
|
__ |
|||
RT BY |
|
__ |
|||
[ ] 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 of offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors’ License Law does not apply to an owner of property, who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the
[ ] I, as owner of the property, am exclusively contracting with licensed contractors to construct the project
(Sec. 7044, Business and Professions Code: The Contractors’ License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors’ License Law.).
[ ] I am exempt under Sec. _____________, B. & P.C. for this reason:
________________________________________________________________________________
Owner_______________________________________________________Date__________________
3. WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
[ ] I have and will maintain a certificate of consent to
[ ] I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier ________________________________________________________________________
Policy Number _________________________________________________________________
[ ] 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 workers' compensation laws of California, and agree that if I should become subject to workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Applicant _________________________________________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 IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
4. CONSTRUCTION LENDING AGENCY
I 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 (Section 3097, Civil Code).
Lender's Name _____________________________________________________________________
Lender's Address________________________________________________________________
5. CERTIFICATION
I 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 and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the
Signature of Applicant or Agent |
Date |
HCD 415 (Rev. 07/2013)
Insignia / HUD Label Number(s)_________________________ _______________________________________
SECTION 2 – OWNER / APPLICANT INFORMATION
Owner________________________________________________________________________________________
Address_______________________________________________________________________________________
City___________________________County_____________________________________Zip_________________
Location Address______________________________________________________________________________
Park Name (If Applicable) _______________________________________ Park ID#_____________________
Applicant_____________________________________________________________________________________
Address_______________________________________________________________________________________
City___________________________County_____________________________________Zip_________________
Telephone – Applicant______________________________ Homeowner ______________________________
(If Different than Applicant)
SECTION 3 – CONTRACTOR, ARCHITECT OR ENGINEER INFORMATION
Contractor’s Name____________________________________________________________________________
Address_______________________________________________________________________________________
Architect / Engineer Name_____________________________________________________________________
Registration No._______________________________________________________________________________
Address ___________________________________________________________________________ ___________
SECTION 4 – DESCRIPTION OF WORK / ACTIVITY AND VALUATION
Describe the proposed work / activity in detail. Attach additional pages if necessary. Where structural alterations or additions are proposed, complete plans, specifications, details, and calculations are required to be attached to this form. Provide the make and model of any appliance to be installed and provide complete electrical calculations for any electrical alternations or additions.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Indicate the Total Cost of the Work to be Performed____________________________________________
SECTION 5 - SIGNATURE AND CERTIFICATION
I / We hereby make application for the services designated above.
Signature _____________________________________________ |
Date_________________________________ |
|
|
**DEPARTMENT USE ONLY** |
|
|
Permit Expiration Date_______________________________ |
|
APPROVED |
CONDITIONS (see reverse side) |
DISAPPROVED (see reverse side) |
Issued By: |
|
Date: |
_______________________________________________________________________________________________
Closed / Signature of District Representative |
|
Date |
|
DISTRIBUTION: |
YELLOW – DEPARTMENT |
WHITE – AREA OFFICE |
PINK – OWNER/APPLICANT |
INSTRUCTIONS:
Inspection to Obtain Insignia: Complete Sections 1, 2, 3, 4, 5 and
Alteration, Addition or Conversion: Complete Sections 1, 2, 3, 4, 5, and
Technical Services: Complete Sections 1, 2, 3, and 5. Submit the completed application and required fees to the appropriate Area Office listed below. Upon return receipt of your processed application (White Copy), contact the designated Area Office to schedule an appointment for services.
Southern Area Office |
Northern Area Office |
3737 Main Street, Suite 400 |
9342 Tech Center Drive #550 |
Riverside, CA 92501 |
Sacramento, CA 95826 |
(951) |
(916) |
Alternate Approval: Complete Sections 1, 2, 3, 4, and 5. Submit the completed application and required fees to: Department of Housing and Community Development, Manufactured Housing Section, P.O. Box 31, Sacramento, CA
SECTION 1 - UNIT INFORMATION: Check one box to indicate the type of unit for which you are requesting services. If Commercial Coach, also indicate the Occupancy Group Code (i.e. B2, E2, A1, etc.) in the space provided. Enter the unit serial number(s). The serial number(s) can be located on the Manufacturer's Certificate of Origin, the Certificate of Title, registration documents or on the front cross member of the unit. Enter the year the unit was manufactured. Enter the manufacturer's name and/or trade name. This information can be obtained from the Manufacturer's Certificate of Origin, the Certificate of Title, registration documents or may be designated on the outside of the unit itself. Enter the decal or license number. This number is located on the license plate issued by DMV or the decal issued by the Department of Housing. Enter the California Insignia Number(s) or HUD Label Number(s) that were issued for this unit, if known.
SECTION 2 - OWNER/APPLICANT INFORMATION: Enter the owner's name(s) and address of the unit. If the address for the owner is different than the location of the unit, provide that information is the "Location Address" area. If the applicant is other than the owner, enter the name, address and telephone number of the applicant. The Department will contact or correspond with the party that is entered as the applicant. If the applicant is the same as the owner, the applicant information is not required to be completed.
SECTION 3 - CONTRACTOR, ARCHITECT OR ENGINEER INFORMATION: If the services are being performed by a contractor, enter the contractor's name and address. Also enter the contractor's license expiration date. If requested services involve an Architect or Engineer, enter the architect or engineer's name, address and license number.
SECTION 4 - DESCRIPTION OF WORK/ACTIVITY AND VALUATION: Provide a description of the work to be performed (i.e., installing a new roof, installing new windows, etc.) Enter the total cost of the work to be performed (total contact price).
SECTION 5 - SIGNATURE AND CERTIFICATION: The signature of the applicant is required along with the date the form is signed. If the
application is for a replacement insignia or HUD label, the signature must be of the owner of the unit.
Contractor: Contractors proposing construction are required by state law to provide the following information:
Item 1 - Licensed Contractor Declaration: Enter the contractor's license class, license number, license expiration date and the contractor's signature and date.
Item 3 - Workers' Compensation Declaration: Place a check mark next to the declaration regarding the workers' compensation coverage that applies to the contractor. If the second declaration is marked, the contractor must also provide the carrier's name and policy number. This item must be signed by the contractor and dated.
Item 4 - Construction Lending Agency: If there is a construction lending agency for the performance of the work for the service being requested, enter the name and address of the lending agency. If there is no lending agency involved, enter the word "none".
Item 5 - Certification: The certification must be signed and dated by the contractor or and agent on behalf of the contractor.
Item 2 -
Item 5 - Certification: The certification must be signed and dated by the owner.
DEPARTMENT USE ONLY
APPROVAL OF THIS APPLICATION IS CONDITIONED TO COMPLIANCE WITH REGULATIONS OF THE DEPARTMENT: Any approval issued by the
Department pursuant to this application is conditioned upon the applicant's compliance with the applicable provisions of the California Administrative Code, Title 25, Chapter 3, and the Business and Professions Code as it relates to contracting.
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
HCD 415, Side 2 (Rev. 07/2013)
Form Characteristics
| Fact | Description |
|---|---|
| Purpose | The HCD 415 form is used in California to apply for alteration, addition, conversion, alternate approval, technical services, or inspection for manufactured homes and commercial modulars. |
| Legal Requirement | This form complies with California state laws, specifically the Business and Professions Code, Sections 7000-7031.5, and Labor Code, Section 3700. |
| Contractor Information | Licensed contractors must provide details about their license class, number, and expiration date when completing this form. |
| Owner-Builder Declaration | Homeowners declaring as owner-builders must affirm their exemption status under the Contractors' License Law and provide relevant section references. |
| Workers' Compensation | Applicants must declare their workers' compensation insurance coverage or affirm their exemption from such laws. |
| Submission Process | The completed HCD 415 form must be submitted to an appropriate Area Office along with applicable fees before inspection can be scheduled. |
Guidelines on Utilizing Hcd 415
Filling out the HCD 415 form is an important step for individuals seeking specific services related to manufactured homes, such as alterations, additions, or inspections. A completed form is necessary to obtain the relevant permits and ensure compliance with regulations. Below are detailed steps to help you fill out this form accurately.
- Gather Your Information: Collect all necessary details regarding the property, including the unit type, serial number, year of manufacture, and manufacturer name.
- Complete Unit Information (Section 1): Check the appropriate box for the type of unit. Fill in the decal number, serial number(s), manufacturer details, and any relevant permit information.
- Fill Out Owner/Applicant Information (Section 2): Enter the owner's name and address. If the applicant is different, provide their information as well.
- Provide Contractor, Architect, or Engineer Information (Section 3): If applicable, fill in the contractor's or architect's details, including their license number.
- Describe the Work (Section 4): Offer a detailed description of the work planned. Indicate the total cost of the project.
- Complete Contractor/Owner-Builder Declarations: If using a contractor, fill out the necessary declarations about their license. If you are an owner-builder, choose the appropriate declaration that describes your situation.
- Workers’ Compensation Declaration: Mark the box that reflects the workers’ compensation coverage applicable to your situation.
- Fill Out Construction Lending Agency Information: If applicable, provide the name and address of your construction lending agency.
- Signature and Certification (Section 5): The applicant or their agent must sign and date the form, certifying that all information provided is accurate.
- Submission: Submit the completed form along with any required fees to the appropriate Area Office, as indicated in the instructions.
What You Should Know About This Form
What is the HCD 415 Form and why is it necessary?
The HCD 415 form is a critical application made available by the California Department of Housing and Community Development. It is used to request various services including alterations, additions, conversions, technical services, or inspections to obtain insignia for manufactured homes and commercial modulars. This form ensures that the necessary approvals are obtained before conducting construction-related activities, thereby adhering to state regulations aimed at maintaining safe housing standards and compliance with local building codes.
Who needs to complete the HCD 415 Form?
Both licensed contractors and owner-builders are responsible for completing the HCD 415 form. Licensed contractors must affirm their licensure status and provide necessary details about their licenses, while owner-builders must declare their exemption from contractors' licensing laws and provide supporting reasoning for this exemption. Each party must sign and date the form to affirm that the information provided is accurate and that they will comply with all applicable laws and regulations concerning building construction.
What are the key sections within the HCD 415 Form?
The HCD 415 form consists of several important sections. First, Unit Information captures essential details about the specific unit requiring services, such as its type, serial number, and manufacturer. Second, Owner/Application Information gathers the applicant's contact details. Next, Contractor, Architect, or Engineer Information is included where relevant to document the professionals involved in the project. The Description of Work/Activity and Valuation section requires a clear explanation of the tasks to be performed along with the associated costs. Finally, the Signature and Certification section confirms that the applicant agrees to comply with all relevant laws and has reviewed the application.
What are the consequences of not securing workers' compensation coverage as outlined in the HCD 415 Form?
Failure to obtain necessary workers' compensation coverage when required can lead to serious legal repercussions. The law specifies that employers who do not comply may face criminal penalties and civil fines that can reach up to $100,000. This includes the cost of compensation as well as additional damages, interest, and legal fees. Ensuring that the appropriate coverage is in place is crucial not only for legal compliance but also for safeguarding both workers and employers from potential liabilities arising from workplace incidents.
Common mistakes
Completing the Hcd 415 form is a crucial step for anyone seeking to make alterations, additions, conversions, or inspections relating to manufactured homes in California. Unfortunately, many individuals make common mistakes that can lead to delays or rejections. Understanding these pitfalls can smooth the application process and increase the likelihood of approval.
One significant error individuals often make is not providing complete unit information. This section requires precise details about the manufactured home or modular unit, including the decal number, serial number, manufacturer name, and model. Omitting any of this information can render the application incomplete, causing unnecessary setbacks. Always double-check to ensure that every field is filled out accurately.
An additional mistake arises when applicants fail to sign or date the application. The signature is not merely a formality; it serves as a declaration that the applicant has read the information provided and affirms its accuracy. Without a signature and date, the application is left invalid. Ensuring that these crucial elements are included is essential for a smooth submission process.
Omitting the workers' compensation information is also a prevalent error. The Hcd 415 form necessitates a declaration regarding workers' compensation coverage. Some applicants mistakenly skip this section, which can lead to immediate disapproval. It's vital to confirm that you have completed the declaration relevant to your situation, whether self-insuring or having active workers' compensation insurance.
Additionally, applicants sometimes neglect to detail the work being performed. The form requires a comprehensive description of the proposed activity or changes. Incomplete or vague descriptions can lead to misunderstandings about the scope of the work, prompting further inquiries and potentially delaying the process. Clear, detailed information helps the reviewer assess your application more effectively.
An often-overlooked area is the construction lending agency declaration. If financing is involved, the form must include the lender's information. Skipping this section can be detrimental, particularly since the lack of this information gives the impression that the project may not have the necessary funding. Always ensure that this important detail is clearly indicated.
Finally, failing to adhere to submission instructions is a mistake that applicants frequently make. The Hcd 415 form comes with specific procedural guidelines on where to submit the application and how to schedule inspections afterward. Ignoring these steps can lead to further complications. It is critical to follow the instructions to avoid unnecessary delays, ensuring that your application reaches the right department on time.
Understanding these common mistakes can significantly ease the application process. By paying attention to details, ensuring proper signatures, and providing thorough information, applicants can improve their chances of successfully obtaining the necessary approvals.
Documents used along the form
When applying for building services like those outlined in the HCD 415 form, you might encounter several other documents that are essential to the process. Each of these forms plays a crucial role, ensuring compliance with various regulations and guiding you through the application stages with clarity.
- Building Permit Application: This form is crucial for obtaining permission from local authorities before starting construction. It includes details about the project, confirming that it adheres to local zoning laws and building codes.
- Site Plan: A site plan illustrates how the new construction or alteration will fit within the lot. It typically includes dimensions, setbacks, and the location of utilities, helping ensure it complies with local regulations.
- Notice of Commencement: This document is filed with the local county clerk before work begins. It officially begins the construction period and provides public notice of the project's start.
- Change Order: If modifications to the initial contract arise during the construction process, a change order documents those changes. This ensures that all parties are aware and agree to the revised terms.
- Certificate of Occupancy: After completion, this document is necessary to confirm that a building is safe and complies with all regulations. It’s required before the space can be occupied.
- Inspection Reports: Regular inspections are documented with reports that provide feedback on compliance with safety and building codes throughout the construction process.
- Construction Contracts: This agreement outlines the obligations and responsibilities between property owners and contractors, ensuring clarity on costs, timelines, and responsibilities.
- Environmental Impact Report (EIR): Depending on the project, an EIR may be necessary to assess the potential environmental effects of the construction. This document helps ensure compliance with environmental laws.
- Warranty Deed: A warranty deed is used to transfer ownership of the property. It contains guarantees pertaining to the title's validity, which can be crucial during the transaction process.
- Affidavit of Ownership: This document verifies the property owner’s identity, confirming that they have the authority to proceed with the application or construction work.
Understanding these complementary documents can streamline your application process and help ensure compliance with all necessary regulations. Being prepared with the right forms will help you navigate the journey of construction or alteration more smoothly.
Similar forms
HCD 414: This form also serves as an application for a manufactured home, mobilehome, or commercial modular approval. Similar to HCD 415, it requires detailed information about the unit and the work to be performed, ensuring that proper regulations are adhered to.
HCD 489: Another pivotal document, the HCD 489 is the application for installation permits. Like the HCD 415, it requires the owner's information and details regarding the nature of the work, thereby facilitating systematic tracking and compliance.
HCD 600: This application is centered around the change of ownership for mobilehomes. While HCD 415 addresses alterations and improvements, HCD 600 ensures the ownership history is maintained, both documents emphasizing accurate record-keeping.
HCD 923: This form pertains to the application for multi-family manufactured homes. While both forms maintain an application structure, the HCD 923 focuses on units intended for multiple occupants, highlighting distinct compliance needs.
Local Building Permit Application: This document is essential for any construction project. Similar to HCD 415, it outlines required declarations and project specifics, ensuring that local regulations are met before work commences.
Workers’ Compensation Insurance Declaration: This is mandated by California law for all projects. Like in HCD 415, it contains crucial information about workers' compensation, enabling tracking of compliance and protecting both workers and owners.
Construction Lending Agreement: This agreement outlines the financial backing for construction projects. It parallels the construction lending agency section in HCD 415, as both documents require confirmation of funding sources for projects.
Alteration Permit Form: Used for modifying existing structures, this form shares similarities with HCD 415 in that both require detailed descriptions of the proposed work and confirmations of regulatory adherence, maintaining consistent standards across applications.
Change Order Document: Similar as well, this document is used post-approval to alter the scope or cost of a project, much like how HCD 415 allows for adjustments before implementation.
Dos and Don'ts
Filling out the HCD 415 form can feel daunting, but clear guidelines can help streamline the process. Here are some things to consider, dividing them into what you should and shouldn’t do.
- Ensure accuracy. Double-check all information entered on the form. Errors can delay processing or result in improper approvals.
- Provide complete descriptions. When detailing the proposed work, be thorough. Attach additional pages if necessary, to ensure clarity and understanding.
- Obtain necessary signatures. Make sure that the application is signed by either the applicant or the owner, and that the date is noted.
- Submit on time. Make sure to submit the completed form and any required fees promptly to the appropriate Area Office for processing.
- Don’t rush through the form. Taking your time to fill out the application correctly can save you from making mistakes that lead to unnecessary complications.
- Don’t forget required attachments. Properly attach any necessary documents, such as plans or specifications, as these are crucial for your approval.
- Don’t leave out the workers' compensation section. This declaration is mandatory and must be completed as per state regulations.
- Don’t ignore the warnings. Pay close attention to the legal notices included in the form regarding penalties for failure to comply with regulations.
Completing this form carefully and thoughtfully will facilitate a smoother approval process, allowing you to move forward with your project without unnecessary delays.
Misconceptions
Misconception 1: The HCD 415 form is only for licensed contractors.
This form can also be used by owner-builders. Individuals who meet certain criteria may fill it out without being licensed.
Misconception 2: Submitting the HCD 415 form guarantees approval.
Approval depends on compliance with local building codes and regulations, not just the completion of the form.
Misconception 3: Completing the form is optional.
For specific projects like alterations or additions, submitting the form is necessary to obtain the required permits.
Misconception 4: All construction projects require a licensed contractor.
If an owner-builder is managing the project personally or through their employees, they may not need a licensed contractor.
Misconception 5: The HCD 415 form is only applicable for residential structures.
This form is also relevant for commercial modular buildings and multifamily units, among others.
Misconception 6: You cannot check multiple boxes for services requested.
You can select different services on the form, as long as they pertain to the same project.
Misconception 7: Workers' compensation coverage is not necessary for renovations.
California law requires that workers' compensation coverage is secured for most construction activities.
Misconception 8: The form doesn’t require detailed descriptions of the work.
The applicant must provide clear details about the project to avoid confusion and ensure the right approvals.
Misconception 9: Once the form is submitted, no further actions are needed.
After submitting the HCD 415 form, applicants must follow up to schedule inspections and ensure compliance with any additional requirements.
Key takeaways
Here are key takeaways regarding the use of the HCD 415 form:
- Correct Completion: All sections of the form must be filled out accurately to avoid delays.
- Declaration Requirements: Contractors and owner-builders need to provide specific declarations to affirm their status and compliance.
- Unit Information: Clearly indicate the type of unit and provide necessary details, including serial numbers and manufacturer information.
- Workers' Compensation: Ensure that the appropriate workers' compensation declaration is selected and the necessary details are provided.
- Signature and Certification: An authorized signature is essential in the certification section to validate the application.
- Submission Process: After completing the form, submit it along with required fees to the appropriate Area Office for processing.
Browse Other Templates
How Do I Get an Apostille in Ohio - The cover letter must confirm that all required information and fees are included before submission.
How to Get Power of Attorney Over a Parent in Michigan - The agent's actions will be recorded, and you will receive copies of all transactions for your records.