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028-230-039
BALANCE OF FEES SHEET DATE: PERMIT #: U va LI ASSESSOR PARCEL #: �� ' a7J� - 67 j OWNER'S NAME: FEES (Amount and Purpose): BALANCE OF FEES: $ ADDITIONAL FEES: $ REVISED PLAN CHECK: $ SHERIFF FEE (commercial only): $ SRA: $ COPY FEES ($1 or more) $ DRAINAGE $ BASIN BC RESIDENTIAL IMPACT County Wide Chico Urban El Medio North Chico Specific_ $ WATER TENDER FEES $ BATTALION # FEMA $ SMIP $ OTHER aVy\$ l U 9 -q-`b RECEIPT NUMBER(S) COPY BUTTE COUNTY ADMINISTRATIVE PERMIT FOR TEMPORARY TRAVEL TRAILER Assessor's Parcel Number for Site: Qr�� Street Address of Site:a, 1 _(_rN,C, da KS LNl . uQ R �_ QSR 14 Applicant's Name: :(T(AJk P---, ,• Applicant's Mailing Address: -o .5Dx59 UCS tzanc iD �tA S� 5 Applicant's Telephone Number: - 0,z�& � Building Permit Receipt Number: ('1� (Show copy of Permit signed and issued) Date Sewage Disposal Permit issued: qZRV-MQ5L.�-( TSSV E-6-�:, (Show copy of Permit signed and issued) 2 ct I certify that the above information is correct and that I have read Butte County Code Section 24-300-C (on the reverse side of this application.) Applicant's Signatur . ate:` 5 -O5 TO BE FILLED IN BY PLANNING DIVISION Date Application. Received: Zoning Verified by '1`'I S Permits Reviewed by L d- A Associated Building Permit # C�J�'' O Z( .7 Administrative Permit Planning Approval by Date Approved: 1 7" 0 .0 0-6 File: "Administrative Permits" Date revised: July 20, 2004 K:\Plamiing\FORMS\HPPLICATIONS\ADMINISTRATIVE PERMITS\Temp. Travel Trailer.doc Received from t" The Sum offer—t�� For`. Received: CASH a CHECK * L DAVCO BUSINESS FORMS • (530) 743-8511 Form 84702 NT1� O� BUTTE 431314 p ICIAL RECEIPT DEPARTMENT 1 SUING RECEIPT Received BY Title ey — , BUILDING DIVISION COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE — OROVILLE, CALIFORNIA 95965 — TELEPHONE: (530) 538-7541 AGRICULTURAL BUILDING EXEMPTION PERMIT PERMIT NO. 05 1 "S7 Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. A ., ASSESSOR PARCEL NO. ZONING �� c ns H��0 VN R'SESS "Fby, 5 -or ?D"c'-M WC-Wz1q10-f' CA� 'o a5q:Zc:5 OCATI�OF BU ING o& 4AmE T Lcs CNd259 1 USE OF BUILDIN `— _C' SIZE OF STRUCTURE ���j� ' �' X _ .J-i�! SO. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL CONCRETE OTHER (Specify) TYPE,OF SIDI G RO F COVERING FLWR TYPE l ,. ESTIMATED COST OF CONDUCTION $ l AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as follows: FRONT SIDES 30 3 0 REAR AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated about, and the purposed use confirms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date _7' (0 ® Signature of Permit Fee -$109.98 j Receipt No. " " L13 1 The above described AG Bui Manager Bu White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod —Applicant is exempt from a building permit. BUILDING DIVISION COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE: (530) 538-7541 AGRICULTURAL BUILDING EXEMPTION PERMIT PERMIT NO. p®so 2Y9 Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. A X7/1 ASSESSOR PARCEL NO. — © ®� ZQINS fi&kicu ' 1► R s - ` Q �J MATT ERJ'q HONE O. � ZAEL NER'S�RESS Scl Roo" O F... c OCATg OF BUI G USE OF BUILDING sm l C SIZE OF STRUCTURE ' X,� - SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL__X' CONCRETE OTHER (Specify) TYPE OF SIDING ROOOVERING FLOOR TYPE y ESTIMATED COST OFF CONSTRUCTION AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as follows: FRONT y SIDESREAR AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated about, and the purposed use confirms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date-' �� 0Signature of Own Permit Fee 469-9 tai .98 The above described AG Building is exempt from a building permit. L, � FLOOD PARCFk P.D. ROOFIy6' ISSUE_ Receipt No. Manager Building ivision �, •� A -ii_ By Date White — DPW, Yellow —Assessor, Pink — B. 1., Goldenrod —Applicant { ;r.r v.n s77,2 ; r L A N D O F N A. i U R A L ktd E Al.T H. A N D B•E A U T Y DEPT,?TMGJT OF PUBLIC LIVORS WILLIAM (Lill)CHEFF Director 7 W,-LJNTY CEN TEFi DRIVE, OFOVILLE. CaL1F01-:y7.4 95-:65- T h6ne: (9 5n5TEi?j:h6ne:;(9l fi) 5a44861 September .21,. 1984 William Rominger RE AP 28-23-33 and 28...... P. 0. Box 214 combined as one Bangor;. CA' 95914 Certificate of Compliance*. Dear Mr. Aominger: ` Enclosed please fired a copy of tCertificate of Compliance issued. by the Butte County Department of Public. Works which was recorded on September. 5., 19 in Book 2983 Page.. 3 , in the Office of the Butte County r Recorder. .Should .you have any questions "regarding. this matter, please ccontact. this office., Very truly yours, William.Cheff Director. of. Public Works i - 1 °ndonsa �fGt�YYI Assistant Director enclosure j Q Q q 0-00 Ll I � cc Health Department Wding Department .1pment Section �� -'DS RF"t; cp�r CERTIFICATE OF COMPLIANCE 1f it Issued " to: William Rominger A;-;{cj„:,,�4. { • �;._., P.. 0. Box 214 FEF $angor, CA 959i4 S74'7.7.1> This Certificate of Compliance is hereby issued by the County of Butte to certify that the land division which created the parcel of property identified below complies with the applicable provisions of the Subdivision Map Act and of Chapter 20 of the Butte County Code. 1. Property location: approx. two miles southeast of.the intersection of Los Verjeles Rd: and La Por to Rd., south side of Los Verjeles.Rd. Bangor area. 2. Assessor's Parcel Number:. 28-23-33 and 28-09-4 (combined as one') Description: All that certain property located in the County of Butte, State of California, more particularly -described as follows: SEt "EXHIBIT A" ATTACBED Issuance of this Certificate is conditional upon the following conditions which have been imposed pursuant to the Butte County Code Chapter 20-166 and Government Code, Section 66499.35 (b), to protect the public.health and public safety; NONE County'of Butte o Subdivision Violation Commitee . 41 a rn C -D LD 1400 -,.;ATE OF COtTLIANCE PAGE 2 28-23-33 and 28-09-4 (combined as. -,,one) William Rominger F.=BIT "Alt A11 that.re.al property described as a portion of Section 2, Township 17 North, Range 5 East; M.D.M. and a portion of Section 35, Township 18 North, Range 5 East,. M.D..M., Butte County, California, being more particularly described as follows: The southwest quarter and the east half of the. northwest quarter. of said Section 35, and the northwest quarter of said Section 2, together with a portion of said Section. 35 being more particularly described, as follows: Commencing at the northeast corner -of the west ha-lf of said sectionn ; said.corer be.ing the TRUE POINT OF BEGINNING; thence -South;. 160 rods; thence Fest 3.0 feet; thence North by hest, on the line of a certain. fence, about 80 rods to a point about 6 rods West of the e.ast I ine of the west half of the northwest quarter of Section 35; thence along the line of said fence', North by East about 80 rods'to a. point 32 feet west of the point o.f beginning; thence East, 32 feet,.t.o..the point of bEginning. EXCEPTING THEREFROM all that real property described in deed. to the County of Butte as described in that.,cer.tain-d:e.ed as 'filed for record in Book 1645.; Official Records, at Page 412. ALSO EXCEPTING THEREFROM all that real property in the east half of the northwest quarter of Section 35 lying northerly of that certain parcel of land is. described in deed to the County of Butte, as filed for record in Book 1645, Official Records, at Page 412.. ALSO EXCEPTING THEREFROM.all those lands in the northwest quarter of said Section 2; lyi.ng southerly,of Honcut Creek,. said lands being a portion of'Yuba County. COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: A I / 10y\) , �' �-S ASSESSOR PARCEL NUMBER 02- 6' - 030 - O3ia% Proposed Building Use: /t'1�'1 &X/ -- �(.. Counter Technician: -� -Date:-2-2-05- ate: 2^ 2--oS Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. Cl 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) b17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer cir and site plan apr from the Ag Commissioner Sent by ❑• 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required.....................................................................`.. ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization ...................................... :........ ..................... ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applican Q Date: "2 --2- 1. Z1. Indexermit application for the -fa items umbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division AND WHEN RECORDED MAIL TO - BUTTE COUNTS BU;�,DING DIVISION 7 COUNTY C�NTER DRIVE OROVILLE, CA 95965 2005-0006649 Recorded Official Records CoBBUUTT Of TE CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 01:26PM 02 -Feb -2005 REC FEE 10.00 CONFORM 1.00 CONFORM 1.00 Myles Page 1 of 2 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in.the County of Butte, State of California, described as follows: S -r -F- Pa-CRUAEZ) , Date 4 02 - DS PROPERTY OWNERS: State of California County of &i4e— On o(,- n(' 1--0`5 . before me, personally appeared T<X-Hr," Wlc.01ouw mulTer-N C,4cj `1 hov-e-5 3, i' CCC-(LrN per" aHy -me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that heAbe/they executed the same in his&er/their authorized capacity(ies), and that by his+er/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my nd and offcial seal. Signature �� Seal: JAMES LAW KINSER COMM. #1377185 -� NOTARY PUBUC - CALIFORNIA ' BUTTE COUNTY A.P. # 0:2c6- - 230 — 0 3 cj " My'Comm._Dpires Sept. 28,.2006 131 oya bab'YO.39P y.. VI. 7(tb?2l22A _ _ 93W!AL cB�CCE:� 3�4FA4� 6r�; W- ".i s Parcel is Parcel 3, as shown on that certain parcel map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988, in Book 111 of Maps, at page(s) 74 thru 79. Reserving therefrom a non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on the above Parcel Map. Parcel 11: A non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on that certain Parcel Map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988 in Book ill of Maps at page9s) 74 thru 79. I BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERMIT NO. BP050247 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR "STATE LAWS. . LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/29/2005 APN: 028-230-039-000 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. Site Address: 211 ROLLING OAKS LN BAN License Class : License Number: Map Index: Date: Contractor: I OWNER -BUILDER DECLARATION I Description: nsf (1968) cov (2280) I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: MATTERN, THOMAS AND DARLENE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file.a P.O. BOX 59 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section ROUGH AND READY, CA. 7000) of Division 3 of the Business and Professions Code) or that he or 95975 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 530-477-0991 applicant to a civil penalty of not more than five hundred dollars ($500).): 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 Applicant: MATTERN, THOMAS AND DARLENE 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 P.O. BOX 59 sale. If however, the building or improvements are sold within one ROUGH AND READY, CA. year of completion, the owner -builder will have the burden of 95975 proving that he or she did not build or improve for the purpose of sale.). 530-477-0991 O 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: pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Datei�:n`OSO er: WORKERS' COMPENSATION DEC ARATION I hereby affirm under penalty of perjuryone of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for License-#: 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 insurance carrier and policy number are: Carrier: Total Square Ft: 4148 S.F. Policy #: l� I certify that in the performance of the work for which this permit is ` Valuation: $157,900.00 issued, I shall not employ any person in any manner so as to 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. Census Code: / Date: " —Z9 ' 0,5 t WARNING: Failure to secure(oworkers' 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 code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is h y issu under the ap c ble provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions do work i " a e bove f r whi h fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) q Name: By: ' PERMIT EXPIRES ON: Address: Date ❑ 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. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ 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 the above mentioned property for inspection purposes. re Print Name: I :►'tw-L64's T - `- `v -t Signat re: Date: Owner 0 Contractor ❑ Agent for Owner 13 Agent for Contractor BUTTE COUNTY 4566960 DEPARTMENT OF DEVELOPMENT SERVICES `✓ � BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS . 1 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last me Address .o ' bo i C _ state / rpk I City P 2C -OSS ( Fax E-mail APPLICANT NAME CONTRACTOR - Name Address Zip City Fax State Zip Phone Page Fax E-mail Date Approved: Uc. # Class APPLICANT NAME ARCHITECT/ENGINEER Name SR tIAL Address Zip City Fax State Zip Phone Page Fax E-mail Date Approved: State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE rl For office use only: Zoning [&-2q Flood Zone Cid NCS SRA Yes No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP��f�2 BIN O LOCATION AP#�� ate_ Owl P�r-o�pe�rty AddressG 5 � Cid NCS Cros Street _ S O Structure Built vith6ut Permits --- WORKER'S COMPENSATION Policy Number Carrier 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: 1 IV S <,-V lC-E fX —sr-- _� Civ Sq. Footag (Bulb 22130 O Structure Built vith6ut Permits --- 0 Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for wbich a permit has not been issued will expire one year after the date of application. In order to renew action or, an application after expiration, a new application, plans and fee will be 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 pemut and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. J S� Received by: Amount: / / Bldg SRA Receipt #: � Sheriff I SMIP Date: Other `'� ~ / s - G Total Y7 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. ALL PLANS MUST BE LEGIBLE AND /N INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fid plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). El 9. Site .plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ * 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). — ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Per.�nif Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Mefunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan -heck fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION (AFORMSSUILDINd F0RMS\131dgApp1SubRgmts.d0c Page 2 of 2 REV 7-27-04 Applicant: Mattern, Thomas Butte County Department of Development Services �uT TF Permit No: 05-0247 YVONNE CHRISTOPHER, DIRECTOR ° ; � ( ° NSF/Cov 0 0 7 County Center Drive °;��, ° o _ "'.' ° APN: 028-230-039 Oroville, CA 95965 COUN'�-t 100% 70% (530) 538.7601 Telephone Plan Check Fees $ 1,113.57 (530) 538.7785 Facsimile N $ 1,113.57 C) 779.50 TO: WILLDAN ' ® FROM: Scott Rutherford (530) 538-7160 ■ ^ srutherford cDbuttecountv.net /l o SUBJECT: Plans Transmittal For Review Per Contract o DATE: 2/4/2005 Applicant: Mattern, Thomas Permit No: 05-0247 Project Type: NSF/Cov APN: 028-230-039 100% 70% Plan Check Fees $ 1,113.57 $ 779.50 $ 1,113.57 $ 779.50 WILLDAN Fee $ 779.50 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other r,,.=. +sT--,r+-,,•--'+�-.-..-+rh =..;-^-••----T^--.-... T-•...-.,....wti.-�.A�.c�'�17,.it`.r'�... ,t 't".. _--w COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVI ES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 l PERMIT APPLICATION DATA SHEET OWNER: MArtE �aJ ASSESSOR PARCEL NUMBER Z8 2 3D • o ��1 Proposed Building Use: 1..15 F ( 1 OWE)) Counter Technician: Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . �❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. e/ 6. Energy compliance design and supporting documentation in duplicate. ❑y 7. Statement of Intent.for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs • , ❑ 12. Letter of intent for non-residential buildings -, ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form { 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. • 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ ,. 0 Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 2 `°city. of Chico Plumbing permit........................................................................ t' / 23. California -Department of Forestry plan approval f�paid.2Sqnt Qyl ..... Planning approval (A) Use: Qft�(B)Parking: (C) Parcel Check: ✓ u oS O 25. Contact Land Development about _ Improvements, _ Drainage ......................... VAi 26. NPDES Form............................................................................................. : �c,r'f 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for ,% required....... ❑ 29. Contractor's license°information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy.Number.......................................... Q/1 d 31. Owner -Builder Verification (�iven to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization ...................................... :.................. ........... ��-- 33 Recorded copy of Agricultural Acknowledgment Statement ................................. 34. Manufactured home utility clearance............................................................... ❑ '35. Existing violations and/or expired permits......................................................... O36. Deed Restriction.......................................................................................... (� 37.Grant Deed, ❑ M.H. TitlelStatement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: c g C When issued Telephone 7. e d hold for pickup. I have been informed of the above items and requirements for obtaining a building permit.; Applicanl. \ ate: 1. Index permit application for thea a items numbered: Plan Check Letter 2/Additional items required ;Contractor, designe owner was advised of the above data by 11 phone, ❑ mail, ❑ counter, by Date. k-5 Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date. Plans reviewed by: Date: Plans approved by:I I Date: Structural reviewed b : Date: Structural approved by: Date: Note transfer by: Date: 11110 Yellow: Building Division TO: FROM: SUBJECT: Building Department Environmental Health Sanitation Clearance '197&- TT�.e /✓ Owner E.14. use ONLY Piot Plan Atteehod Flow Plan AttoeAad Sant to S.D. / Location " AP# Plan Approved for: Sewage Disposal Water Supply: Public Private Well ✓ Clearance for ✓ dwelling. Other iv cyi4 E Gv�9 /� ,4 ee t�,v,d d00,Ae- g< -)l n , n . Hold final for: Final clearance O.K. for: NOTE: n Z� Environmental Health 8/96 ialist Pic -"I" Date -61 COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES OWNER A.P. # PROPROSED BUILDING USE DATE r^®� RECEIPT # DATE REC. 1. BUILDING PERMITFEES --- Balance Due ..................... --- Additional Fees Due........... $ --- Re ised Plan Checking Fee.... $ 2. SCHOOL DISTRICT FEES (A (pai t School District Office) (form available after Plan Ch&k) 3. SHERIFF FEES (paid at Building Division) 2�/"� Residential........... X $360.00 =$ V C, Uni Commercial (sq. ftg.)..... X $0.03 = $ \ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit)..... X = $ # Units Amt. Commercial (Sq. Ftg.).... X = $ Sq. Fig. Amt. ".5. CREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) _ 6. THE ALITO DRAINAGE DISTRICT FEES $5 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $59+ftVaid at Building Division) 2�0 1/ 212-/G 8. WATER TENDER FEES BATTALION# $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ........ X _$ / ��/� Sq. Ftg.% Amt. 7ly Qj per// 10. OTHER f " t I P / 5 �� �( rli� `0 At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking process. DATE Z -Z —O 5 Pursuant to Government Code Section 66020,1you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) -ATM. M - w I D 4 VRIv C r IO a L•S!,m.""E3:.'::.tI:r.Y:.wSs':,YS;r�<o46.+.W.:..._.,.z"G�t��:R S�a4a:_ �.:.s};.s`� irm;�v �Nc+• : �:8:+'!F'ry Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and material for construction of this proposed property movement: YES [] NO__2. I HAVE HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY DATE: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/412004 Butte County Department of Development Services ADMINISTRATION * BUILDING * GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538.7541 Telephone (530) 538.2140 Facsimile ^v'z:�'�'.`Ak'�'�"3�a''ac1`�`.++�'�h. a� ,a h�..ww^'T i,.d'u'. >uiL.ra^�a' Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other thanyourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. U� C. Vieirl C.B.O. , Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. " rcQPgT�'t�T �vTTF ° ° ° J \� c�Uml- o� Department of Public Works _o County of B u t t e o J. Michael Crump, Director LAND DEVELOPMENT DIVISION / Storm Water Management Program 7 County Center Drive A .WO��S Oroville, CA 95965 LIC(530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE T - Project Description: Project Location and/or -Parcel Number: 0?'25 —2--5;o o� 2 1 - ,-Jg o"Z-s L4%j , �;> AYJ 66A, "`By°sfgnlrig below; I; the=pro�--ect--owner/owner's agent, certify that this project WILL NOT-�DTffURB- -' -1`.acre.ar=more>of tan'd�a1'tdthaI,ritherefore, do nofneed`to'apply`for'a:Construction StormWater;errrut=t » - = f orri.thewState of C llforriia Regional -Water Quality Control B6zird -.- Phased -.projects- tthat ..eontalri,� , - " --- -- -- = multlphesituf_iess tthan one acre but when. combined. -with.` subsequent, phases =totaLmore - R than --one =acre, of-.distur-bed- soil will require a Construction Storm- Water. -Permit from. the- State of--,-- California f --California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: Date: 7z- 2-05 Less than 1 Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5124/04 RECORDING REQUESTED BY First American Title Company AND WHEN RECORDED MAIL TO: Thomas Mattern and Darlene Mattern P.O. Box 59 Rough and Ready, CA 95975 N IIIIIIIIIi�III�IIII"II'IIIIt�IIII Recorded Official Records I REC FEE 10,00 I TAX County Of BUTTE 181.50 I CANDACE J. GRUBBS I Recorder I ROSEMARY DICKSON I Assistant I Jason - 09100AM 219 -Oct -21004 I Page 1 of 2 Above This Line for Recorder's Use Only A.P.N.: 028-230-039 File No.: 5102-1549616 (KF) GRANT DEED'�i The Undersigned Grantor(s) Declare(s): DOCUMENTARY TRANSFER TAX $181.50; CITY TRANSFER TAX ,$0.00; SURVEY MONUMENT FEE $ x computed on the consideration or full value of property conveyed, OR computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, x unincorporated area; [ ] City of , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Erhard W Teichmann, an unmarried man and Maria A. Chiaverini, an unmarried woman /J. /McCulloch hereby GRANTS to Thomas Mattern and Darlene Mattern , husband and. wife', as Joint Tenants the following described property in the Unincorporated area of , County of Butte, State of California: Parcel I: Parcel 3, as shown on that certain parcel map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988, in Book 111 of Maps, at page(s) 74 thru 79. Reserving therefrom a non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on the above Parcel Map. Parcel II: A non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on. that certain Parcel Map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988 in Book 111 of Maps at page9s) 74 thru 79. Dated: 10/12/2004 Mail Tax Statements To: SAME AS ABOVE A.P.N.:-028-230-039 Grant Deed - continued File No.:5102-1549616 (KF) Date: 10/12/2004 Erhard W Teichmann Varia A. Ch' enni STATE OF �� } }ss. COUNTY OF On OCT 162004 before me, Mn-QLee M. , 'Ckj .�cQ�S..A/ �h�� personally appeared Eraya- �� 1 i ic�ln ry g Kyl ojAd 0 IV « A eltiibLuort n L personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. r t,. WITNESS my hand and official seal. F .':,Slgnatur This area for o>f1dai . notarial seal '1y C�orr'pAssion Expires:�r��Nal?P1S NOTARY PUBLIC, STATE OF HAWAII COMMISSION EXPIRES: 11/4/2006 ` Notary Name: Notary Phone: Notary Registration Number: County of Principal Place of Business: WILLDAN Serving Public Agencies April 6, 2005. SUBJECT: COUNTY OF BUTTE PLAN REVIEW APPROVAL 117 C Street Marysville, California 95901 530/749.2373 fax 530/749.2199 www.willdan.com Willdan Project No: z Jurisdiction Job No: ti Scott Rutherford 028-230-039 Butte County Building Department 7 County Center Drive '. Oroville, CA 95965 (530) 538-7169 (53 0) 538-2140 FAX SUBJECT: COUNTY OF BUTTE PLAN REVIEW APPROVAL 117 C Street Marysville, California 95901 530/749.2373 fax 530/749.2199 www.willdan.com Willdan Project No: 14353-1371 Jurisdiction Job No: 05-0247 Assessor's Parcel No: 028-230-039 Applicant: Thomas Mattern Description: New SFD Dear Mr. Rutherford: Willdan has completed a plan review of submitted plans and documents for the above referenced project and recommends your approval with the conditions noted on the 2"d page of this letter. The plans and documents provided for this review that have been found in compliance with the applicable codes are: ➢ Plans: Two (2) copies sheets lthruogh 3 dated 09/09/04 sheet 4 dated 11/17/04, sheets 5, 6 and lldated 11/14/04, sheet 7 dated 10/25/04, sheet 8 dated 11/27/04, sheet 9 dated 11/29/04 and sheet 10 dated 10/07/04. by Thomas Mattern ➢ Energy Calculations: Two (2) copies dated 12/27/04 by Beutler Heating & Air Conditioning ➢ Structural Calculations: Two (2) copies dated 01/25/05 by Dale Huber Engineering The plans have been stamped with the Willdan approval stamp and dated the date of this letter. According to our previous letters relating to this project, the superseded plans and documents will be discarded within 10 days unless we receive other instructions: On the pages to follow is the identification of the codes and standards applicable to the project, a code analysis, conditions -of -approval and identification of any deferred submittals. W I LLDAN w Serving Public Agencies t APPLICABLE CODES Unless noted otherwise, all comments are based on requirements of the 2001 California Building Standards Code found in the California Code of Regulations, Title 24: • Part 2, known as the California Building Code and abbreviated herein as "CBC" • Part 3, known as theCalifornia Electrical Code and abbreviated herein as "CEC" • Part 4, known as the California Mechanical Code' and abbreviated herein as "CMC" • Part 5, known as the California Plumbing Code and abbreviated herein as "CPC" • Part 6, known as the California Energy Code, and Energy Commission Standards, and abbreviated herein as "CECS" CODE ANALYSIS Our plan review revealed the following information regarding the occupancy designation, type of construction, and other pertinent features. This information is consistent with that shown on the plans and permit documentation. Specific Use Type of Occu anc Type of Construction Stories I" Floor Sq Ft 2" Floor Sg Ft Total Sq Ft Dwellm* R-3 VN 11 1868 N/A 1868 Cov. Porch 'R-3 VN :1 2280 N/A 2280 CONDITIONS OF APPROVAL 1. Approval is contingent upon the review, requirements and approval of other departments. and/or agencies that have jurisdiction over this project. 2. Revisions and/or notes as red -lined on the plans:, DEFERRED SUBMITTALS Our plan review reveals no deferred submittals noted at this time. SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. I Sincerely, Michael Carlin Plans Examiner 4 Cc: Alice Mefford, E-mail: amefford@buttecounty.net Thomas Mattern, P.O. Box 59, Rough and Ready, CA 195975 .Page 2 of 2 i County of Butte Permit Number 05-0247 Wi.l.ldan P.roiect Number 14353-1371. i BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) ❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD) ❑ PARADISE RECREATION AND PARK DISTRICT (PRPD), 0 DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) Property Owner (s)_�(, Project Location /Address Subdivision Name Permit Number4 7 Type of Residential Development (check one) New Development Single Family -Detached Single Family -Attached Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling Mobile home Mobile home replacement verified by Assessor Department Demo Permit (dateissutd verified by Building Department Comments: C/�D/D% /!�1/ , D r ��i� RRPD 0 CARD ❑ PRPD D DRPD certifies that: l�M l" VOA T EL"p-r-5b ) 977 -Qa9 t Applicant Name Phone Number Mailing Address City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: Dwelling Units @ $ / J d. D per unit for a total of $ Square Feet @ $ per sq foot for a total of $ Remarks: Paid by Check No: Paid by Cash: and Park District KAFORMSWILDING FORMS\park-rec standard form rev Ldoc /DC, 00 Receipt No: ) J y/ C) /,0 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) School District �(t%V / BnL(�i(C9T If Building Department No. &�C� A.P. Number n sdiction v City County Property Owner Property Location/A Subdivision L)5-� �-);�//7 Residential Development Q Q Q Sq. Footage No of Living Mobile Home Addition/ 'Supplemental to (Group R) Units Installation Conversion Permit # *(No foundation inspection) ................................................................................................ _... i Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Commercial/Industrial 0 0 District Identification' No.Dfov")iu- dy\,��rv,%6)L School District certifies that (Street Address) V1r, (City) has complied with the requirements of Resolution No. representing / O square feet. Paid by Check # Remarks: C P Sq. Footage (Including Exterior Roofed Areas) Date ' `� - �'J a (Phone Number) ' (State) Rip Code) . / D� v by payment of $ 2926 t ` FULL MRIGATION = Date Notice: You may protest the Imposition of the fess Identl8ad above by submitting a written protest to the District, In compliance with Govertmbnt Code section 66020(a), within 90 days from the date foss are paid. Failure to submit a timely written protest wtll'prohibh you from challenging the Imposition of the fees In any court action. N. subsequsrd to the school District Representative signing this Butte County schools Impact Fes Certification Fom, the School Dbtrict is notlMd by the applicable Local Planning Agency that this project Is being reviewed under the California Environmental Quality /let (CEQA). this project may be subject to additional school foes to fidy mltlgate.its Impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeformads (10/03)dmm S SI'Z'E PLAN REVIEW APPLICATION Date: QS AN Qo0 L13 9 Permit Number (if applicable) 5 -0�`f 7 APPLICANT INFORMATION Parcel Size: Owners Name: ayy S -.r / - �. 470/C 579 4'al,9�,dad',tw a4 95_975 Owners Address: /2- Telephone No.:,,,\ 'Y'77-092/ Situs Address: Proposed Use: Residential New Single Family Residential ❑ Single Family Addition ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Septic ❑ Well ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) ,$I Approved, ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval IN Site Plan Stamped Approved' By Date Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required IN SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: X • Flood Panel No.: (�(00 7C, // 75� Index Date: 6 r ❑ Sacramento River Reclamation District (Approval must be obtained from th-e'Cafifornia Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit E] Minor Variance ❑ Administrative Permit ❑ Variance ------------------- —---- —------ ----------- ------ —------ --------- -------------------------- ❑ Detached Building Use Form ❑ Encroachment -Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: .20 P -Aio- Applicable Building Setbacks: Front Zoning Code � , Streets & Highways Fire Prevention Subdivision Map Side �S 30 Side Street Rear Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Page 2of5 El 64 Applicable Development Fees: Standard Fees Amount Formula ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage -❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other --------------------------------------------------------------------------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. . Parcel Created By ❑ Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:[:] Po ❑ Y Comments:°OC' q� j a� Parcel Deemed to be legal Verify Legal Parcel '❑ Verify Legal Access ❑Provide Deed of Creation El Obtain a Certificate of Compliance ❑. Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 ❑ Subdivision Map/Parcel Map: Map Date of Recording: Lot: Book: Page: ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. , Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for roa U Page 4 of 5 i Summary of Specific Requirements: This information provided in this summary is based on the application information and on the bes of review. t available data at the time C:llarryS\Building Permit Site Plan Reviewl.doc Page 5 of 5 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 02 -Feb -2005 2005-0006649 Has not been compared with original BUTTE COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT t FOR RESIDENTIAL DEVELOPMENT ' Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an.area zoned for agricultural purposes, and residents of this property may be subject to inconveniences br discomfort from the use of agricultural chemicals, including, but not limited.to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: SEE P�TTt-i CNLC. . Date — oZ - OJ PROPERTY OWNERS: State of California ) County of 6,i14t- ) On a- d- 2Q061' before me, personally appeared /h411e-°sJa,JJ "rhoW4s 3, r►'mc'44c.r�l Fer9mmHy _kaow*4a-me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that heAhe/they executed the same in hisAw/their authorized capacity(ies), and that by hisfher/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my nd and ofi ial seal. Signature I/C.(.1/l.� Seal: .. JAMES LAW KINSER COMM. #1377185 -� NOTARY PUBLIC - CAUFORMA BUTTE COUNTY A.P. # 0245 "Z30 - O 3 My Comm..Ezpires Sept. 28,.2006 Parcel is K'? Parcel 3, as shown on that certain parcel map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988, in Book 111 of Maps, at page(s) 74 thru 79. Reserving therefrom a non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on the above Parcel Map. Parcel II: A non-exclusive right of way and public utility easement known as Rolling Oaks Lane, as shown on that certain Parcel Map recorded in the office of the recorder of the County of Butte, State of California, on July 27, 1988 in Book 111 of Maps at page9s) 74 thru 79. i j I 1_ I