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Home My WebLink About028-040-012COMPLAINT TO INSPECTOR 2—l0 -61f COMPLA TtTO D45PELTOR ' 3 -z -OS .. a ELKINS � I 2403B .� e 2396E V 028.040-012 4 FORD 02-2864 o —� — (a 2774E -Supp. yy��G6 ®_; 9865 AHART RD., ORO VI e s Apart Rd. a H p / pp. 1000' so. Central'rouse P.d.;' CONT: SEARS HOME I p Honcut , VINYL SIDING (repairs) J' 028-040-012 04-2119 FORD, ROBERT 9865 AHART RD. PALERMO ! _+ Cont-. GEORGE ROOFING RE -ROOF - ��..�� _ �_ ,.___.� .. - _ - t . -..,`�• `ELKINS, Roy M: 423�6B 344-67E 8-04-12 4 I e/s Ahart Rd• app• mi. so. of en r House ' Rd., Honcut I (new detached private garage) 7 -mss -67 i • � /I k-A-ew If !OMPLAINT TO INSPECTOR ELKINSLo' 240,38• �2— �-- 27794E -.:Supp.V. e/s; Awt Rd. app. 1000' so. Central Ouse Rd I Horicut T (repairs) ? .JJ -A ELaNS, Roy M.' 423-66B - 344-67E / ;e:n;ra'?House e/s Ahart Rd. app. -j mi. so. of Rd., Honcut (new detached private garage) -7 —6 7 • 028-040-012 02-2864 FORD 9865 AHART RD., OROVI CONT: SEARS HOME I p VINYL SIDING �� 028-040-012 04-2119 FORD,ROBERT 9865 AHART RD, PALERMO Cont: GEORGE ROOFING RE -ROOF ff I ,- ELKINSLo' 240,38• �2— �-- 27794E -.:Supp.V. e/s; Awt Rd. app. 1000' so. Central Ouse Rd I Horicut T (repairs) ? .JJ -A ELaNS, Roy M.' 423-66B - 344-67E / ;e:n;ra'?House e/s Ahart Rd. app. -j mi. so. of Rd., Honcut (new detached private garage) -7 —6 7 • PTN. SEC. 9 T. 17N. R. 4E M.D.B. &M. 02 N89'16'22'E — N89'20'E�-- --� --- —_ _ _.. ._ --- - - cnvn RO 628.69 a98.00 140 t � C� OI o 6.34 AC 14.3 568.99 O 2 1.00 AC = 9.16 AC 141 02 Z o _l 3.15 AC 526.00 498.20 188.20 142 O C-=� 1.00 AC 4.80 AC W4� 160.00 a —&UM — 11.04 AC± C_ 145 1 t� 02 NONCUT 7 M.O.R. 85 3-13-1899 16 3.57 AC± 146 14 11.49 AC±14 o N .c m 02 m 436.25 c m O r � o e (n 140 13 p „C 1.5 AC "t J 235.00 Qr 1� 12 5! 0 28-04 1'=200' 2�•� 197.75 72.26 / / Butte County Assessor's Map / Book 28, Page 04 / NOTE These panels aro for assessment purposes I / a* and may not constitute legal pan�e/s. / CREATED BY CREATED ON 2-25-2002 RENSED BY REVISED ON 2-25-2002 REVM: 09-99 ETFEOVE 2002-03 ROLL Previous Book , Portion O/ Page / Com led The Butte County Assessor's Office I / 028-040-012 02-2864 FORD 9865 AHART RD., OROVI CONT: SEARS HOME I •® VINYL SIDING 02-30 -O 028-040-012 04-2119 FORD,ROBERT 9865 AHART RD, PALERMO Cont: GEORGE ROOFING RE -ROOF ELKINS ,-Roy-..M��` 2403B 2396E L 'A - 0 C4 -12-- VF 2774E -Supp. Rd.. e/s Ahart Rd. app. 1000' so. Central House Honcut (repairs) ELKINS, Roy M: 423-66B 344-67E- 2g-04-12 e/s Ahart Rd. app. 4 mi. so. of .en ra House Rd.) Honcut (new detached private garage) -7 -6 '7 MIA LAI 0 Inspector must draw a plot plan with all building locations on the back of this sheet. Revised 10/2003 (1) BUTTE COUNTY DEVELOPMENT SERVICES COMPLAINT FORM This information is not available to the public! ! ! ! ! ! ! DO NOT COPY FOR THE PUBLIC OR THE FIELD INSPECTOR!! The following information is required for Housing Complaints and the Complainant MUST BE the person living at the complaint address! Complainant: Address: Phone Number: The above information is not available to the public! ! ! ! H r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP042119 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 Issued Date: 07/16/2004 APN• 028-040-012-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: 5 1 Site Address: 9865 AHART RD HON Date: iv -Y9 Contractor: . Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: RE -ROOF (14 SQ) Contractors' State 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 Owner: FORD ROBERT J II & DEBORAH M 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 State License Law (Chapter 9 commencing with Section 9865 AHART RD 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA 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 95966-9690 applicant to a civil penalty of not more than five hundred dollars ($500).): 0 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 offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: GEORGE ROOFING 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 improvements are sold within one 6810 LINCOLN BLVD year of completion, the owner -builder will have the burden of OROVILLE CA 95966 proving that he or she did not build or improve for the purpose of , sale.). .(530) 533-6393 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State 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 Contractor: GEORGE ROOFING pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code 6810 LINCOLN BLVD OROVILLE, CA 95966 Date: owner: (530) 533-6393 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 452266 O 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation insurances carder policy numberare: �and Carrier:'/1�SP TCGQC Total Square Ft: 0 S. F. Policy #:A?Q-6Ti�q-0 Valuation: $0.00 ❑ I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: L L lA Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor interest, fees. �83 I 10.— %• 14. O 4 code, and attorney's ( CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte. County Code andlor I hereby affirm that there is a construction lending agency for the Resolutions 1 do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: _ By: �'�- Date: PE IT XPIRES ON: -7' 1 Z. - O S Address: Date D 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. O Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. O Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon he above mentioned property for inspection purposes. Print Name: ��'f�/C�/ f✓ Signature: Date: ❑ Owner ❑ Contractor gent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICANT SIGNATURE X S u ey e- F�gent or Geor o f For office use only: OWNER Name Jim & Debbie Ford Address 975 N. George Washington Blvd. city Yuba City State CA Zip 95993 Phone 530-674-0299 Fax E-mail Lic.# APPLICANT SIGNATURE X S u ey e- F�gent or Geor o f For office use only: CONTRACTOR Name GEORGE ROOFING Address 6810 Lincoln Blvd City Oroville State CA Zip Phone (530) 533-6393 Fax (530) 533-0287 E-mail dan@abcgc.com Lic.# Class dan@abcgc.com 452266 1 C39 APPLICANT SIGNATURE X S u ey e- F�gent or Geor o f For office use only: ARCHITECT/ENGINEER Name N/A Address 6810 Linocln Blvd City Oroville State CA Zip Phone (530) 533-6393 Fax E-mail dan@abcgc.com State License Number APPLICANT SIGNATURE X S u ey e- F�gent or Geor o f For office use only: APPLICANT NAME Name GEORGE ROOFING Address 6810 Linocln Blvd city Oroville State CA Zip 95966 Phone (530) 533-6393 Fax (530) 533-0287 E-mail dan@abcgc.com APPLICANT SIGNATURE X S u ey e- F�gent or Geor o f For office use only: Zoning Flood one SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. NO. BP 042119 BIN # LOCATION AP# aZ8•m4-C�• c fz Property Address 9865 Ahart Rd. Oroville, Ca. ( Honcut ) Cross Street WORKER'S COMPENSATION Policy Number 272-596-02 Carrier STATE FUND If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work Reroof — F -Fm u -se Sq. Footage 14 Squares ❑ Structure Built Without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: "I Amount: Receipt #: 4 c& 8Iz Date: 7. 1 G - 04- 11-0 Bldg SRA Sheriff SMIP Other 1 10 Total REV: George Roofing --- __-`_FORD CONT: 5EARS Ho E I" PROVE. V114YL SIDING' — -'' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541-.,PERMI N1. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER,+"'% -,Ir r-" ZONING BUILDING PERMIT OWNER rr T HONE 3(7-11 46),1 SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS t �r�r_\,e* QLA 6v()�SAVP. CONTRACTOR'S NAME �Jec�cS ,, (_,z ( TELEPHONE CONTRACTORS MAILING ADDRESS N.. t. -,.ii. U CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ �! ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUIILDINGGADDRESS ,f C i Q N \ �,- % T r... Energy Plan Checking Fee $ $ () ( '-)J.\\C„ rl '.rttC& PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.0023.00 USEOFSTRUCTURE SF f�Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other I Describe Work: Q.,{\. , S�� d f'f ti'E�l L�t"Y� _ e SO Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20:00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license iss'in full force and effect. License Class ` J • *k \C Lic. No. "N �,`�j OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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 offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 0 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 11001, have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier L. % !Au yyll CI -0 Policy Number \,w Q_ G N t (N-) c.l ' 94 '-`! Q& 2— (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply h th provisio X Date . 1 �"1 • () ` Signature of Applic nt - ❑Owner ,C�RContractor ,gent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A To , 46.00so NEW CONST. DWELLMIO OCCUP. SO U OR ADDNS. ( a ACC. BLDS. 3.50FT. NEW o9 MULTI.OUTLET 97.50 NO,.R T. POWER APPARATUS a SINGLE ourLET cIR. 20 ®' 00 Ex. Occup. OUTLET ORFIXTURES SAL so EX. Occup. ouTLErsF'ED APPRESIDLNS. . OR EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ =.A IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the' Butte County Code and/or Resolutions to do work indicatedilbove for which fees have been paid. Bpi,, /.,�/ / �/. Date PERMIT EXPIRES ON Dale Receipt No. % WHITE-D.D.S.-B.D. CAN'ARG-ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Em COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PE§MI N (Rev. 12/96) APPLICATION AND PERMIT ��T ASSESSOR PARCEL NUMBER � o IT ca ZONING / BUILDING PERMIT OWNERT IF o V-�y � HONE . 4014 x• SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS e GSl u \ CONTRACTOR'S NAME acs TELEPHONE CONTRACTORS MAIUNG ADDRESS ZS3 E. CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS "'- Total Valuation $ �Ol • — ARCHITECT OR ENGINEER LICENSE No. Filing Fee $ 20.00 Permit Fee $ \ 7k ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS °1$ 5 N�� Energy Plan Checking Fee $ $ Q C'U,i-k\\Q. a scACoicp PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF,Pol"Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Unities ❑ Installation ❑ Other Describe Work:V �_(�� C(�1�YVli1 T7iJ� IOC - \LN�D\2- )`1 S0 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 2o0A OR LESS 23.00 LICENSED CONTRACTOR'S 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. > i� \C Lic. No. License Class � 2\3n8 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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 offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the ,performance of the work for which this permit is issued. CY I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and olicy number are: �`N"�-�� .� VT,4j Carrier � Policy Number a cu 4 Mo" Z q !FJ 3 2, (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall 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 the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply h th pro .0 X �`'�� Date_, \(� . O Z _ Signature of Appli nt - ❑ Owner contractor gent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A To 1000A 46.00 NEW CONST. DWEwNG OCCUP. SO OR ADDNS. ( a Acc. BLDS. 3.5¢Fr. NON•REESID. MULTI.OUTLET 97,50 POWER APPaR U a SINGLE OUTLET CIR. OUXEO OR FINIS REs Ex. Occup. BAL @': o FlXED AFPUS. OR Ex. Occup. OUTLETS RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TALFEE$not HAZ. ±TYPEP❑ D FLOOD CDF PARCEL PO HD ISSUE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated bove for which fees have been paid. B� /< Date PERMIT EXPIRES ON ate Receipt No. WHITE-D.D.S.-B.D. CA A -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT MARSH USA INC. CERTIFICATE OF..INSURANCE CNUMBER CHHI-0I-0IATE00399223-00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH LISA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 500 W. MONROE STREET POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE CHICAGO, IL 60661 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Attn: SANDRA GRANDISON 312 627 6162 COMPANIES AFFORDING COVERAGE COMPANY A LIBERTY MUTUAL FIRE INSURANCE COMPANY INSURED COMPANY SEARS, ROEBUCK AND CO. B SEARS HOME IMPROVEMENT PRODUCTS, INC. ATTN: RISK MANAGEMENT B5 - 1808 COMPANY 3333 BEVERLY ROAD C HOFFMAN ESTATES, IL 60179 COMPANY D COVERAGES :.. This certificate supersedes and replaces any previously Issued certificate for.the policy period noted: belbw..: : . THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DONY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY RG2-C41-004249-362 04/01/02 04/01/03 GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $ X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PERSONAL S ADV INJURY $ 5,000,000 EACH OCCURRENCE $ 5,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one tire) $ 5,000,000 MED EXP (Any oneperson) $ 500 A AUTOMOBILE LIABILITY AS2-C41-004249-442 04/01/02 04/01/03 COMBINED SINGLE LIMIT $ 5,000,000 X ANY AUTO — BODILY INJURY $ ALL OWNED AUTOS (Per person) SC.FIEDIILED AUTOS _ BODILY INJURY (Per accident) $ HIRED'AUTOS NON-OWNED AUTOS DAMAGE $ ' 'PROPERTY A GARAGELIABILITY AV2-C41-004249-062 04/01102 04/01/03 AUTO .ONLY -EA ACCIDENT $ 5,000,000 OTHER THAN AUTO ONLY: A X ANY AUTO AV2-C41-004249-222 04/01102 04/01/03 EACH ACCIDENT $ 5,000,000 X GARAGEKEEPERS AGGREGATE $ 5,000,000 LEGAL LIABILITY EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM A A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WA2-C4D-004249-022 WC2-C41-004249-032 04/01/02 04/01/02 04/01/03 04/01/03 STATU X I ORY LIMITS EL EACH ACCIDENT $ 5,000,000 EL DISEASE-POLICY LIMIT $ 5,000,000 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL ' EL DISEASE-EACH EMPLOYEE $ 5,000,000 0 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS (LIMITS MAY BE SUBJECT TO DEDUCTIBLES OR RETENTIONS) ANYONE WHO IS DESIGNATED BY WRITTEN CONTRACT/AGREEMENT WITH THE NAMED INSURED TO BE AN ADDITIONAL INSURED SHALL BE SO DEEMED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL —30 DAYS WRITTEN NOTICE TO THE CITY OF NOVATO BUILDING DIVISION CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR 901 SHERMEN AVE. NOVATO, CA 94945 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES. MARSH USA INC. BY: Mary Hollis MM1(9199) VALID AS OF: 02/28/02 +smo + Asmt # Status Tax I Fee #1028-040-012-000 ACTIVE , Status Date - 000 NORMAL OWNERSHIP TRA 092 013 Name FORD ROBERT J II & DEBORAH M Iii Addrl9865AHART RD � - - - --• —• Addr2 OROVILLE CA 95966-9690 _ - — �� Situs 9865 AHART_RD_ HONCUT Addr3j Base Dt 01!0111986 Addr4 y .__._ 11 FTimber Preserve AgPres r Etal Notes Bonds 0J Multi Situs ) Flag1 Flagg Land 6,739 Structure 43_,135',' Fixtures 0 - - Growing - 0' - Total L&I 49,87, .4 Fix. R 0,' MH PP 0; PP 01, Comments 2804001200 CONVERTED 09!08!88 Creating Doc# 198582418400 �� Date= �—J Current Doc# 200280028162 Date 05131!2002' - I�� Killing Doc# A Date Asmt Desc 19865 MART RD ,l SuplCnt� Zoning F -----J Dwell 0 J Acres/Sq Ft 0 j NIC 028 910 MH Asmt PP Pen Tax PP Pen Exempt - - 7,OOD, Net 42'874 RIC# C3 Appeal Pending T/R Dt=� r Split Pending R!C Stag PHY OWNEXP TAX IHON j ATT SIT APR, PCL r, • ►�: Find - 1 Ili Ready J 2002 I CPenman, 0811212002 12:49:50 PM