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028-390-075
BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP051077 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 06121/2005 APN: 028-390-075-000 the Business and Professions Code, and my license is in full force and effect. 3 License Class: License Site Address: 5409 LA PORTE RD BAN �_ Number: Date —Z�- s' Contractor: L=7—�l"S / �G �P_.�iv�� Map Index: OWNER -BUILDER DECLARATION Description: GAR(816) NO PLUMBING 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: MORIN SYLVAIN & POLLY-, permit to construct, alter, improve, demolish, or repair any structure, prior 4801 TYLER ST 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.' SACRAMENTO, CA the C6ntractor's State License Law (Chapter 9 commencing with Section 95841-3434 7000): of Division:3 of llie'Business and Professions Code) or that he or,: she is exempt therefrom•and the basis for, the -,alleged exemption. Any violation of Section'703.1.5 by any applicant for a perritil,subjects the. applicant to.a.civii penajty+of not more than five hundred dollars ($600)');. O I, "as owner• of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intendgd.orofferegfor;sale,(Sec. �oaa Business.,and.Protessions._ Appllcant:,,ERNEST, N. DEAVOR.. Code: The. Contractors.'�State License -Law -does not apply to an JIM BLANTON -,owner,-of property who. builds or improves thereon, and.who does 203 SHADY OAK DR such work himself or herself or through his or her own employees, piovided that... such..improvements are not intended or offered for OROVILLE, CA 95966 sale. If however,'the building or improvements are sold within one 530-589-5348 year of completion, the owner -builder will have the burden of 'proving that he or she did -not buifd or improve for the purpose of sale.). 0.,;.,.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 Contractor: ERNEST N. DEAVOR 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' State License Law.). 203 SHADY OAK DR OROVILLE, CA 95966 ❑ - 1 am Exempt under Article 3 of the Business and.Professions Code 530-589' 5348 Dater Owner: WORKERS' COMPENSATION DECLARATION License #: 4057.82 I hereby.affirm,underpenalty of perjury one of the following declarations: - - ❑ . I. have and will. maintain a certificate of consent to self -insure for workers'.pompensation, as provided.for by Section 3700 of:the Architect: Labor Code, for the performance of the work for which this permit is: issued... Engineer: ❑ ” I .have and will maintain ,workers` •compensation insurance, as required.by Section. -3700 the Labor Code, for the performance .of the work for.which this. permit is issued. My workers' compensation insurance earner and policy number are:-' 816 S.F. Carrier: Total Square Ft: ~7 Valuation: $19 584.00 —�i Policy #: / ` 3 — . � / x S^% ... _, . Census Code: ❑ I certify that fin the'.performance ofahe:work: for which this permit is issued, '1 shalLnot employ any person in any mannerso as to 1✓'v! become subject to -the workers!, compensation laws of California, and agree- that if. I should: become subject to the workers' Iron' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �C•� I : ✓- . �1 / Date 3. -Applicant: WARNING: Failu�e'to secure workers' 'Compensation coverage is unlawful; -and ;;shall'subject an employer lo=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 pe; ;t is hareb issu3d undsr' ,a sppfi: !�- p� isioas of the l3uffe County Code ?ntl/o, 1 hereby affirm.that there is: a construction lending agency for the Resolutions to do ork indi ad 'a ove for : icft�fe s have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) / � `r 6 Name: By: e� Date: (7 f PERMIT EXPIRES ON: C� 2 6 6 Address: Date ❑ 1 hereby.certifylhat,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 f have read this application, that the above information is correct, and that I am the owner or the duly authoriz d'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 for r document of Butte County. I hereby authorize representatives of Butte Co my to;�ter upon the above mentioned property for inspection purposes., Print Name: `' a V• ' V Signature: Date, . ::.:O'Owner. -' Contractor 0 Agent for Owner 0 Agent for Contractor a� NOTES RESIDENTIAL 05-1077 PERMIT NC 0 8-390-075 ISANDERS, DAN - 10 LA PORTE RD, BANGOR Cont: ERNEST N. DEAVOR NEW PRI DET GARAGE • i OFFICE COPY y� Address S yc L4 d002Y'e {� GAS t. i I Meter By Date ELECTRIC Meter By Date L SPECIAL CONDITIONS SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER .JOBB FINALED (Date) �lV OO^ Signature z:(rk CHECKED BY J=OK 0 = Not OK =Not Applicable < = Not Ready J MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer, Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L 'ft. - / P Nat. or/ P' L "ftJ P LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water, MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water, MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECW, COVERS, CARPORTS, GARACf_Wlans) OK except #'s o ' g Requirements -Setbacks -Easements ootings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Ca,;ports; Windows -Doors ectric ring.; Sills-Anchors-Studs-Rftrs-Trusses ding; Nailing -Veneer -Stucco -Mesh 4. Roof; Shthg-Roofing 11. .; Steps -Doors -Landings 11o0traced Wall Panels 21,(Tens% i 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.-, Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main Conduit _ 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK - = Not Applicable > = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /' Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access Date 22. Gas Pipe; Sixe & Anchors Date 23. Fire Sprinkler; Test Date FRAMING (Permit) OK except #'s Date Card B-1 Date Card B-1 Date Cana B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. Date 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water Date 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI Date '30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or AI 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI Insulated Neutral ❑ Yes ❑ No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps-Anchors-Ccnnectors 48. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infittration-Walls-Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Prctection-Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 83. Following InstldJDrive D Yes ❑ No/Walks ❑ Yes ❑ WPlanters ❑ Yes ❑ No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: t j d 2005-:00 09616 AND WHEN RECORDED MAIL TO: Recorded I REC FEE 13.80 BUTTE COUNTY BUILDING DIVISION Official Records I 7 COUNTY CENTER DRIVE County of I COPIES 2.50 OROVILLE, CA 95965 Butte I SHOKAGE -3.08 CANDACE J. GRiIBBS I County Clerk-Recorderl 1 I LV 812:57PM 14 -Jul -2085 1 Page 1 of 3 1111111111111111111111111111111111 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: o`er Com' Vl; ti? �j v Date PRO E�`R",TY OWNERS: W. State of Californias ) County of `[� 011 ) On (� ) � . ?00 S before mi 2 per§bnally appeared4)M Z (-& ' � U�� -)1J • personally known tome ( to be the persons) whose name i /a*&subscribed to the within instrument and ac no ledged to me that he/sh*A4*ey executed t e same in -14s authorized capacity , and that by �ignature(a -on the instrument, the person(s)or the entity upon behalf of which the persoonl� acted, executed the instrument. WITNESS my hand and.offic' I sea1. Signature Seal: CYNTHIA M. QUtGLEY A.P. # l / a -G Commission # 1327118 Z J.� Noffi�,s Public : Californiaf ' Z Butts County _ uy Can rv1 Expims Oct 27.2005 Order No. 00220823-001 ^' , EXHIBIT A THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: A PORTION OF SECTION 33, TOWNSHIP 18 NORTH, RANGE 5 EAST, M.D.B. & M., MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTHWEST CORNER OF SAID SECTION 33; THENCE NORTH 870 08'47" EAST, ALONG THE NORTH LINE OF SAID SECTION 33, A DISTANCE OF 1333.11 FEET; THENCE SOUTH 20 13'58" EAST, A DISTANCE OF 1330.38 FEET; THENCE NORTH 87° 5913211 EAST, A DISTANCE OF 1312.32 FEET TO THE TRUE POINT OF BEGINNING FOR THE PARCEL OF LAND HEREIN DESCRIBED; THENCE FROM SAID TRUE POINT OF BEGINNING, SOUTH 2- 12'06" °12'06" EAST, A DISTANCE OF 1349.76 FEET; THENCE NORTH 88'50'2811 EAST, A DISTANCE OF 995.05 FEET, MORE OR LESS, TO A POINT ON THE WESTERLY BOUNDARY OF THE LA PORTE COUNTY ROAD; THENCE NORTHEASTERLY ALONG THE WESTERLY BOUNDARY OF SAID LA PORTE COUNTY ROAD TO A POINT THAT BEARS NORTH 870 59' 32" EAST, FROM THE TRUE POINT OF BEGINNING; THENCE SOUTH 87'59'32" WEST, A DISTANCE OF 1179.43 FEET, MORE OR LESS, TO THE TRUE POINT OF BEGINNING. EXCEPTING THEREFROM THE NORTH 1012.32 FEET, MEASURED ALONG THE WEST BOUNDARY AND PARALLEL WITH THE NORTH BOUNDARY OF THE ABOVE DESCRIBED PARCEL. ALSO EXCEPTING THEREFROM THAT PORTION OF LA PORTE ROAD DEEDED TO THE COUNTY OF BUTTE BY DEED RECORDED SEPTEMBER 1, 1994, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 94-36950 AND BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: A PORTION OF SECTION 33, TOWNSHIP 18 NORTH, RANGE 5 EAST, M. D. M., AND A PORTION OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED MAY 28,1986, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-16627, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE INTERSECTION OF THE SOUTHERLY LINE OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED MAY 28,1986, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-16627, WITH THE EXISTING WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD AND THE TRUE POINT OF BEGINNING FOR THE PARCEL OF LAND HEREIN DESCRIBED; SAID TRUE POINT OF BEGINNING IS ALSO ON THE NORTHERLY LINE OF PARCEL EIGHTEEN (18) AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-05541; THENCE FROM SAID TRUE POINT OF BEGINNING, NORTH 04° 00'17" EAST, A DISTANCE OF 356.30 FEET ALONG SAID WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD TO THE INTERSECTION OF THE SOUTHERLY LINE OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-30212, AND THE WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD; THENCE SOUTH 86° 32125" Order No. 00220823-001 WEST, A DISTANCE.OF 18.5�F T TO A POINT ON THE SOUTHERLY LINE OF SAID PARCEL, SAID POINT BEING 45.00 FEET LEFT OF ENGINEER'S STATION "C4" 215+84.32; THENCE SOUTH 030 39'20" WEST, A DISTANCE OF 355.78 FEET TO A POINT ON THE NORTHERLY LINE OF PARCEL EIGHTEEN (18) AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-05541; SAID POINT BEING 45.00 FEET LEFT OF ENGINEER'S STATION "C411212+28.54; THENCE ALONG SAID NORTHERLY LINE NORTH 87° 23'21" EAST, A DISTANCE OF 16.31 FEET TO THE TRUE POINT OF BEGINNING. AP NO. 028-390-075 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES 1- BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP051076 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: 07/28/2005 APN: 028-390-075-000 the Business and Professions Code, and my license is in full (force and R Site Address: 5409 LA PORTE RD BAN License Class : LicenseNumber- t�lJ Dat ..e�?�— Contractor. ��-nQ_s Map Index: Description: NSF(2005)COV(522) OWNER43UILDER DECLARATION 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: MORIN SYLVAIN & POLLY'°"""�-�' ^�"-^---'-•'•-}: permit to construct, alter, improve, demolish, or repair any structure, prior, - - ,.. �, •- ' 4801 TYLER ST to its issuance - also requires the applicant for such permit to file`s• - signed'statement.thaf he or she is licensed pursuant to the provisions of, ,SACRAMENTQ;';CA £ !Nr �,. .- T.tj�•'�'i the Contractor's StatiiLicense Law (Chapter 9 commencing wdh•Secbon 95841-3434 t ' 7000) of Division 3 of the Business and Professions Code) or that he or ; r she is exempt therefrom and the basis for, the.alleged exemption. Any - - y r • , ' violation -ofidori 7031.5 by any applicant for a permit.subjects I I* 1 applicant to�a.civil.penal►y of not more than five hundred tlollars•($500):)' applicant -of 1, as owner the property, or my employees with wages as their,` sole compensation, will do the work, and the structure is not intended.ot,offered for,sale.,(Sec.,,704a,,Business,and,Professions, MCode T}ieICo . ractors`•State License, Law.. does. not apply to an JIM BLANTON r,,,, owner.of.property who builds or.improves thereon, and who does 203 SHADY OAK DR -such work.himself or herself or thiough-his or her own employees, pr zided that, such. improvements are not intended,or offered for OROVILLE, CA 95966 sale:" If However; the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-589-5348 proving that -he or she did -not bijiWor' improve for the -purpose of sale.). :0.. ,J.as. owner, :of -the., property- am. exclusively.,. contracting :with., licensed contractdrs:to construct the. project (Sec: 7044, Business -.-and Professions Code. The Contractors' State License Law does Contractor: ERNEST N. DEAVOR % . 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' State License Law.).. • ,. 203 SHADY OAK DR ,. , , 0ROVILLE, CA 95966 ❑ ; 1 em Exempt;under Article 3 of the Business and Professions Code L ' •' 530-589=5348- Dater 2,2t7.,., &'er: #: 405782-, : { r ' • • ' WaRKERS' COMPENSATION DECLARATION',;L, .�' :License I hereby affirm under: penalty of pedury one of the following declarations: ❑ ,. I' have'and will maintain a certificate of consent to self -insure for .-••----•-•- .- • . •--.•-.� worker.. compensation. -as provided for by Section.3700 of,the Architect: Labor Code,.for the performance of the work for which this permit is. issued - .,•.. , - w '.._� -1., :L . ,.,. Y-, :....:>... _, .,... _.Engineer: PURSELL,,FRANK JAMES ,...,..., _. [:.have and! - n. will :maintaiworkers . compensation • insurance, as �. ,......,�. „required by:Section 3700 the Labor Code, for.the performance of .,the work for which this permit is issued'_ My,workers'.-compensation insurancea rrierand policy number,are' s .• . . ; •' ° : " Carrier:',' Y �� \yrt` , o Total Square Ft: 2527 S.F. Policy #: 7 '--OCA-0— -291S % . Valuation: $138,677.00 Census Code: ❑ I certify that in:the performance ofthe-work for which this permit is .. issued,• 1• 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, 1 shall forthwith comply with those provisions. _ - .4 i Date: Applicant: WARNING F ure to secure workers compensation coverage' is unlawful; -and shall subject an employer to'criminal penalties and one �j•'�J l hundred'thousand dollars,•($100,000)}•ineaddition to the cost of 1 ' compensation; damages as'provided for in Section 3706 of•the Labor ,code, interest and attorney's fees. ter:• .. .. .�„� ,_,,�•� . I I LQ f `-�'C_P � f.:-=: •= .; :CONSTRUCTION LENDING AGENCY as :. I hereby affirm that there is a construction lending agency for the ` This permit is here4y issued under the applicable provisions of the Bufte County Cod anrt/or Resolutions t do ork indied above for which fees have been paid. performance of the•work for which this permit is issued (Sec 3097 Civ.) G S Name:' r •.. By: Date: PERMIT EXPIRES _ . • _-- _ . - _ _ _ _. Address: OV - Date O I hereby certify,that the. 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. ❑ Notificatidn in_accordancewith Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ ' Attachetl are copies of {he'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 authori d agent of the owner. 1 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 or document of Butte County. I hereby authorize representatives of Butte Co my to en er upon the above mentionedproperty for inspection purposes Print Name:.' �' "Iv - Signature: — - ` Date: ,. •/ !/� -`❑ Owner Contractor 0Agent for Owner L3 Agent for Contractor - ` �[ dt�aBS�{' 70 BU TE COUNTY 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 'vJ� A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds VA • �I "PLEASE PRINT CLEARLY" n� For office us only: OWNER Last Name Flood Zone First Name n v1 Address �t �� Z_�, Per CitySt toc�i' Zip Phone 3 2J Fax L E-mail E-mail For office us only: CONTRACTOR Name Flood Zone Address 6 OQI` U( V , City o zk No Stat Zip Phone 5- Fax E-mail Planner Lic. # yoS ?�Z Class For office us only: Zoning s Flood Zone Cross Street or, 13avti SRA es No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT (s -/D 7 6!5) BIN # —/2_ LOCATION AP# ;Ci 3q) o Property Address �/ 1„q / ^A�r � C't , Cross Street or, 13avti WORKER' OMPENS TION Policy Number - (� '713 20 - P r-7 Carrier 2�E& QL 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 Page 1 of 2 Description or Scope of Work: Sq. Foota O Struc ure uilt without Pbrmits O 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. D)40Vrevs=. 4 Received by. Amount: I. �II� v Bldg .SRA Receipt #:)Y2 Alto Sheriff SMIP Other Date- i j%Z_" Total REV 2-24-05 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 BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN 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 faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd 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). ❑ 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), 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. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit 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 Refunds 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 check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 Butte County Department of Development Services �vTTF 0 0 YVONNE CHRISTOPHER, DIRECTOR o 0 0 0 o _.. _y2o co 7 County Center Drive 0 0 Oroville, CA 95965 4 (530) 538.7601 Telephone c0U R (530) 538.7785 Facsimile O TO: WILLDAN ' N FROM: Scott Rutherford (530) 538-7160 snitherford@buttecounty.neLO t SUBJECT: Plans Transmittal For Review Per Contract O DATE: 4127/2005 Applicant: Sanders, Dan & Kathy Permit No: 05-1076 Project Type: NSF/Cov d APN: 028-390-075 100% 70% Plan Check Fees $ 1,141.88 $ 799.32 $ 1,141.88 $ 799.32 WILLDAN Fee $ 799.32 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 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICESI r UILDING /DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: %� _ t'G� _ i / ASSESSOR PARCEL NUMBER / �/ Proposed Building Use: /V Permit Technician: / V 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. �- 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) Installation manual, including 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. Letter of intent for non-residential buildings 0 12. Hazardous Material Form %:� 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable47 16. Fire Sprinklers............................................................................................ ❑ 17. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 18. Soils Report and/or Engineered Foundation required ........................................... ❑rosion Control Plan Required........................................................................ "ees as shown on the attached Schedule of Fees Due Sheet .............................. City of Chico Plumbing permit........................................................................ ❑ 22. Site plan and business license approval from the City of Biggs .............................. 0-01 23. California Department of Forestry plan approval 41,p1aid. Sent by: .......... =�r W44-1 24. Planning approval for (A) Use:B)Parking: (C) Parcel Check:...(/..... ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ r NPDESForm............................................................................................. croachment Permit for driveway from the Public Works Dept ..................... Contractor's license information. (Number, Name Style, Classification)...........,. .� ° ❑ 29. Worker's Compensation Carrier and Policy Number .......................................... S ❑ 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... etter of Signature authorization.................................................................... ecorded copy of Agricultural Acknowledgment Statement ................................. "`�j�jjj .Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, 'tle search registration or MCO ......................... 36. Other: ���lL� / C� ❑ 37. Other:ff When issued Telephone !,.5a 9' S_5,4120_16nI and hold for pickup. I have been informed of tVabove items and requirements for obtaining a building permit. z. Applicant: f Date: / 1. Index permits pplication for the above items numbered: 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: 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: I Structural approved by: ► Date: Note transfer by: QP11119n Date: '1 13 IDE Yellow: Building Division E.H. USE ONLY Plat Plan Anached Fleas Plan Attached Sena m B.D. TO: Building Departrne.nt FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public Private. Well Clearance for dwelling. Other ���d= 00���u �� 4-0 Hold final for: Final clearance O.K. for: NOTE: t Environmental Health 8/96 COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140 SCHEDULE OF RECEIPT OF FEES Website: www.buttecounty.net/dds OWNER A.P. # PROPROSED BUILDING USE DATE .� C6 S 1 Y-77 RECEIPT # DATE REC. 1. BUILDING PERMIT FEES r .� --- Balance Due..................... $ "1 --- FEMA Flood elevation review ... $ --- Additional plan checking Fee.... $ 2. SCHOOL DISTRICT FEES l (UI ', (paid at School District Office) (form avails a after Pla heck) (j'`Veh ����� �b 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... X $0.03 = $ /e_5r Sq.Ftg. V RECREATION DISTRICT FEES %iv�i1 �%141O�j %C• (psi t Recreation District�ffiee)-(form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMSA T FEE4g q-� COUNTY WIDE (per dwelling) $ CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ NORTH CHICO SPECIFIC PLAN (per. dwelling) Zoning $ PA6. SRA FIRE INSPECTION AND PLAN CHECK FEE �b c $204.98 (paid at Building Division) 7. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 8. SMIP `Q r 9. OTHER 10. OTHER 11. OTHER 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. l DATE APPLICANT Pursuant to Govemmtrnt Code Section 66020, you 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. 3/05) Butte County Department of Development Services o�UTrF0 7 County Center Drive 0 0 o Gy:-' 0 Oroville, CA 95965 0 0 o (530) 538-7601 Telephone c�UNty (530) 538-7785 Facsimile BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: • I need to submit applications for septic and/or well to Butte County Environmental Health immediately. • I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained • I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not limited to, verification the parcel was legally created, adherence to all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name: Z f`OLoJ74-A/. Ilea✓or APN: A? ,3156 47.� Building site address: SOV0 9 �D t�—G r • Permit No.: B�24 65-16.7 1'I4wys-v� -e 9r.. a,5-`�7 I have read, understood and accept the terms and conditions as expressed herein as indicate by my submission of the above -referenced building permit application and my signature below: SIGNATU OF APPLICANT DATE Copy to Applicant/EH/File K:Forms/BldgPennitwithoutClearances 020705 �U T 7r- 1 m m C C _ c AcO LJ 141 CLIC Department J. Michael Crump, Director of Public, ® f B U t o r k s LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville, CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (l.PDES) Phase 11 Construction Storm Water Permit and Storm Water Pollution Prevention Plan (S PPP) Acknowledgement //) S-&)7 1-2 Project Description: `K QST ��►�G'e -�" Project Location and/or Parcel Number: 9-S, 39v 07r By signing below, L the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre -or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of 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: 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) ❑ DURHAM RECREATION AND PARK DISTRICT (DRPD) 1 Assessor Parcel Number (s) now— o 6� _ Building Permit Number 0,3- / 6 Property Owner (s)_ Project Location /Address Subdivision Name Assessable Sq. Ftge 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 (date issued ) verified by Building Department Comments: Department ❑ FRRPDD ❑ CHAD" 10 PRPD 0 DRPD certifies that: cis-K,ts31-) e Applicant Name Phone Num er' Mailing Address f City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: Dwelling Units @ $ per unit for a total of Square Feet @ $ per sq foot for a total of $ Remarks: Paid by Check No: q�(.5Q Paid by Cash: ��r IC,Za � Irl � ��1�.n�-✓� 2�_f Recreation and Park District Representative KAFORMSWILDING FORMS\park-rec standard form rev Ldoc Receipt No: /-75-61g- r°x ' BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building)` .\ , School District 0 M (; i l A4i J^,- _ A. P. Number�ag� I O—��� Jurisdiction: City Property Owner Property Locationh Subdivision Building Department No. l 077 b ,y 1 .County 4 Lot No. ,r�. ................................................................................................................... Residential Development 0 Sq. Footage V O No oT Living Mobile Home Addition/ *Supplemental to (Group R) ' Units Installation Conversion Permit # ' *(No foundation inspection): .................................................................................................................... Commercial/Industrial New A A Addition Department wioor runs reviewed oy scnooi uistnct rersonni ')kp trict Identification No. 60U2 W Y I �,$ f School District certifies that (Street Address) fll- )6 (City) has complied with the requirements of Resolution No. representing V%S square feet. I A. School District Representative .o- Pai&by Check # Remarks: Sq. Footage (Including Exterior Roofed Areas) y Date/\' ` a.,n cul (Applicant) J X21 (Phone Number) (State) (Zip Code) /s ---n, / 0 - / 0 by payment of $ 1#191, t 1�13 2926 $ FULL MITIGATION $ D? Date Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 660201a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQAI, this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.xls (10/98)dmm AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 2005®0040966 Recorded I REC FEE 10.0@ Official kecords 1 County of 1 COPIES 2.50 Butte I CAN NCE J. GRUBBS I County Clerk-Recorderl I I LV 012:57PM 14 -Jul -n@5 I Page 1 of 2 IIIIIII III IIIIIIIN11II11II11II11 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: Date7/ 0y PRg-'ERTY OWNERS: 2f--� State of California p -- County of,� DS before perWnally appeared ,( %-� (A9' ' a,,,' '& '� C r-74- �. -,' p -1'1 �t�cy personally known to me ( ffe-e) to be the person(s) whose name(s) i /arr-e subscribed to the within instrument and acknowledged to me that he/sheA,4ey executed the same in-hieir authorized capacity' ,and that by ignature4on the instrument, the person4or the entity upon behalf of which the persoon ' acted, executed the instrument. WITNESS my hand and offic' 1 seal. Signature �l Seal: CYNT3 IAM. QURGLEY —;2LJ 4— r � + Ci Comm. Sion 01327116 Z A. P. # l ,� �7 �`� % 5 ~ — Notnry Pel2lic - Califomia �y Z putte County. My Can;h C-xpi?ns 0d 27, 2M5 Order No. 00220823-001 EXHIBIT A THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: A PORTION OF SECTION 33, TOWNSHIP 18 NORTH, RANGE 5 EAST, M.D.B. & M., MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTHWEST CORNER OF SAID SECTION 33; THENCE NORTH 870 08'47" EAST, ALONG THE NORTH LINE OF SAID SECTION 33, A DISTANCE OF 1333.11 FEET; THENCE SOUTH 2° 13'58" EAST, A DISTANCE OF 1330.38 FEET; THENCE NORTH 87° 59132" EAST, A DISTANCE OF 1312.32 FEET TO THE TRUE POINT OF BEGINNING FOR THE PARCEL OF LAND HEREIN DESCRIBED; THENCE FROM SAID TRUE POINT OF BEGINNING, SOUTH 2° 12'06" EAST, A DISTANCE OF 1349.76 FEET; THENCE NORTH 88'5012811 EAST, A DISTANCE OF 995.05 FEET, MORE OR LESS, TO A POINT ON THE WESTERLY BOUNDARY OF THE LA PORTE COUNTY ROAD; THENCE NORTHEASTERLY ALONG THE WESTERLY BOUNDARY OF SAID LA PORTE COUNTY ROAD TO A POINT THAT BEARS NORTH 870 59'32" EAST, FROM THE TRUE POINT OF BEGINNING; THENCE SOUTH 87'59'32" WEST, A DISTANCE OF 1179.43 FEET, MORE OR LESS, TO THE TRUE POINT OF BEGINNING. EXCEPTING THEREFROM THE NORTH 1012.32 FEET, MEASURED ALONG THE WEST BOUNDARY AND PARALLEL WITH THE NORTH BOUNDARY OF THE ABOVE DESCRIBED PARCEL. ALSO EXCEPTING THEREFROM THAT PORTION OF LA PORTE ROAD DEEDED TO THE COUNTY OF BUTTE BY DEED RECORDED SEPTEMBER 1, 1994, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 94-36950 AND BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: A PORTION OF SECTION 33, TOWNSHIP 18 NORTH, RANGE 5 EAST, M. D. M., AND A PORTION OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED MAY 28,1986, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-16627, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE INTERSECTION OF THE SOUTHERLY LINE OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED MAY 28, 1986, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-16627, WITH THE EXISTING WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD AND THE TRUE POINT OF BEGINNING FOR THE PARCEL OF LAND HEREIN DESCRIBED; SAID TRUE POINT OF BEGINNING IS ALSO ON THE NORTHERLY LINE OF PARCEL EIGHTEEN (18) AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-05541; THENCE FROM SAID TRUE POINT OF BEGINNING, NORTH 04° 00' 17" EAST, A DISTANCE OF 356.30 FEET ALONG SAID WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD TO THE INTERSECTION OF THE SOUTHERLY LINE OF THAT CERTAIN PARCEL OF LAND AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-30212, AND THE WESTERLY BOUNDARY OF THE LAPORTE COUNTY ROAD; THENCE SOUTH 860 32'25'9 Order No. 00220823-001 WEST, A DISTANCE. OF 18.53 FEET TO A POINT ON THE SOUTHERLY LINE OF SAID PARCEL, SAID POINT BEING 45.00 FEET LEFT OF ENGINEER'S STATION "C4" 215+84.32; THENCE SOUTH 030 39'20" WEST, A DISTANCE OF 355.78 FEET TO A POINT ON THE NORTHERLY LINE OF PARCEL EIGHTEEN (18) AS DESCRIBED IN DEED RECORDED UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 86-05541; SAID POINT BEING 45.00 FEET LEFT OF ENGINEER'S STATION "C4" 212+28.54; THENCE ALONG SAID NORTHERLY LINE NORTH 870 23'21" EAST, A DISTANCE OF 16.31 FEET TO THE TRUE POINT OF BEGINNING. AP NO. 028-390-075 1+. - a WI LLDAN Serving Public Agencies June 30, 2005 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 (530) 538-7169 (530) 538-2140 FAX 14 d*1' C Street Marysville, California 95901 530/749.2373 fax 530/749.2199 www.willdan.com BUTTE COUNTY PLAN REVIEW REPORT Status: Approved Jurisdiction Job No: 05-1076 Assessor's Parcel No: 028-390-075 Description: - Sanders-NSF/Cov Willdan Project No: 14353-1592 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 2nd 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 1 through 4 not dated. �k Structural Calculations: Two (2) copies revision dated 6/2/05, by Jim Pursell, P.E. # Truss.Calculations: Two (2) copies dated 3/14/05, by Longfellow Lumber Co., Inc. * Energy Calculations: Two (2) copies revision dated 6/5/05, by Don Freemyers. * Miscellaneous: Two (2) copies EOR's truss review letter dated 4/25/05, by Jim Pursell, P.E. The plans have been stamped with; the Willdan .approval stamp and dated. According to our previous letters relating to this project, the superseded plans and documents will be discarded 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. I 1 4 W I LLDAN Serving Public Agencies APPLICABLE CODES Our review was 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 (CBC) • Part 6, known as the California Energy Code, and Energy Commission Standards (CELS) r CODE ANALYSIS Our plan review revealed the following information regarding the occupancy designation, type of construction, and other pertinent features. This information is not consistent with that shown on the permit application form*. Butte County may recalculate the building permit fee based on this information. Specific Type of I Type of 0 Floor Sq 2 nd Floor Sq. Total Sq Ft Use Occupancy ;Construction Stories Ft Ft JJ}^�y-„i.,..�s ak:�ti�S f 7a' '`.. �!•}.4 �5 ��{ � �.( C� .Ff. �. < Kt�.t'.��� i Y.-"�'Sr "(• ,}f _ _� •.TY ��Ii _.i' i4... Dwelling R-3 s V -N 2 1,015 990 *2,005 Covered Porch & R-3 V -N 2 482 40 *522 Deck h ` 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. 3. *Permit application building areas specified in the scope -of -work shall be reconciled with plans to Butte County's satisfaction. 1 SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. DEFERRED SUBMITTALS' i Our plan review reveals no deferred submittals. Sincerely, , `f.• .. I C� Michael LeBeau ► Ricardo Guzman;S.E. Plans Examiner Structural Engineer Cc: Alice Mefford amefford@buttecounty.net Jim Pursell P.E., 2360 Baldwin Ave, Oroville, CA 95966, e-mail: jpursell@sbcglobal.net Dan & Kathy Sanders, 5409 LaPorte Rd., Marysville, CA 95901 Page 2 of 2 County of Butte 05-1076 Willdan 14353- 1592 PC2.F BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES ° BUILDING PERMIT ° 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) ' ° 4a OFFICE #: (530) 538-7541 FAX#: (530)538-2140 ° WEBSITE: www.buttecounty.netldds PERMIT NO. BP051077 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: 06/21/2005 APN: 028-390-075-000 the Business and Professions Code, and my license is in full force and effect. � Site Address: 5409 LA PORTS RD.BAN License Class: � License Number:� / (� Date 5S Contractor: G—!`�'I jtN- �,�e�ivb� Map Index: Description: GAR(816) NO PLUMBING OWNER -BUILDER DECLARATION 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: MORIN SYLVAIN & POLLY,„•'••• permit to construct, alter, improve, demolish, or repair any structure, prior., - '' ' 4801 TYLER ST to its ,issuance: -also requires the applicant for such permit to file a 1 signed statement thaChe or she is licensed, pursUant to the,provisions of.' a ; :; < rr. f �� ;'. , SACRAMENTO, CA s the Contractor's State License Law (Chapte(9-corrime-ncing with'Section ._•, W._..t,• .,_• _. , 95841-3434 7000)of Division`3 of ttie'Business and Professions Code) or that he op; , .._• ,1.,ti' . �, t,, ; ; i she is'exempt therefroW Wind the basis for, the; alleged. exemption. Any r. ?1 - ...-t '_ jai' ?I,;:•. violation of Secti6rf'703.1.5 by any applicant fora permit, subjects the.• violation applicant to a civil pena)ty;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 „ intendgd,or.o(fered;for sale (S@c.,To44„Business,and f?rotessions_ xCode: „o �, ,,.,.,Applicant •,ERNEST. N.,DEAVO_ R, .,, , The.. Contractors' -State License: Law does not apply town JIM BLANTON ,,;.,owner„of.propeRy who,builds or.improves.there,on, and.who does work 203 SHADY OAK DR such him self,or,herself orthrough his or her own employees, ;.,provided that -such improvements are not inteh6ed or.offered for OROVILLE, CA 95966 sale. If however; the building or improvements are sold within one 530-589-5348 year of completion, .the owner -builder will have the burden of proving that he or she -did -not b0d'or improve for the purpose of sale.). ,as.-owner,,,of-the„property,, amexclusively,•contracting, with, licensed contractors to construct, the' project (Sec. 7044, Business and Professions Code. -The Contractors' State License Law does Contractor: ERNEST N. DEAVOR 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' State License.Law.)., _ _ 203 SHADY OAK DR 'am k, • \ i OROVILLE CA 95966 y ❑ -iExempt under Article 3 of the Business and.Professions Code c ., 630'58915848 •' 1 ai, , Y t. Date;` `' ' Owner. a• : , '' . ' r • . k ' „License #:.405782 •: ; , _ _ ., , a :;.' ',WORKERS,COMPENSATION DECLARATION I hereby'affirm under'penalty of perjury one of the following declarations:'- i ❑I,haye and will. maintain a certificate of consent to self -insure for ”' ' ... ,,. ,..,... .., ..._,.„.... _ workers'; compensation as provided for by _Section• 3700, of the Architect: Labor.Code', for„the performance of,the work for which this permit is.issued • . ; _ En 'neer; ❑ I."have and will maintain .workers r compensation insurance, as „required by Section;3700. the Labor. Code,- for the performance of the work for.which this;permit is issued. My workers' compensation msurance;carrier an#d—policy number are Carver Total Square Ft: 816 S. F. Valuation: $19 584.00 / Policy'#: Census Code: _ ❑ I certify that in'the.performance of,the:work'forwhich this permit is .issued, 'I shall a not •employ,any person in any'manner.so as to become,subject to•the•workers'.compensation laws of California. and agree-, that:. if; l should ;,become subject 10 the workers' .compensation provisions of Section 3700 of the Labor Code, I shall „ c% b .forthwith comply with those -provisions. (/ � Date: • :' G-1( J ` • Applicant: WARNING Failure to' secure workers•compensation coverage is unlawful= and'shalI,subject an employer -to -criminal penalties and one •^ hundred'thousand'dollars'($100,000), in addition, to - the cost of compensation' -damages as`proQed'for in Section 3706 of'the Labor ' code, interest, and attorney's fees.^ . .. r ,:„ .. . ; ',.. s M. :. .... , f. ,• .,........ n, �,.. „ ... , ..., �., : •:a CONSTRUCTION LENDINGAGENCY,': This permit is hereb issued under a applic le isions of the Butte County CodR mnrUor I hereby affirrn.that there is a construction lending agency for the ' performance of.the work for which this permit is issued (Sec 3097 Civ.) Resolutions to do ork indi Qd'a ove for _jc shave been paid. Name:+” BY / Date: PERMIT EXPIRES (� , 2 6 6 f - Address:. 011-/ Date O I hereby certify thatthe 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, useof.hazardousmaterials..• ❑ •Notificatioh'in'accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ ' Attached ere'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 authoriz agent of the owner. I agree to comply with all county and state laws'ielating to building'construction,- I acknowledge it is unlawful to alter the substance of any official for r document of Butte County. I hereby authorize representatives of Butte Co my torr upon the above mentioned property for inspection purposes. f Prat Name:_r 1' ! J ' t� �! - Signature: )� Date * a Owner „ U.1t O Agent for Owner ❑ Agent .❑ (Contractor for Contractor ?A k�t 09/9.4F0 COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 �p OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION �`q •p�� Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY* * �y g OWNER Last Name Address irst Name Address �U `� > State(? City ��� L S t/ /' Phone S �g S—� 11p, State Zip q.5---9 (J/Phone 3z1 _ 593 Class Fax E-mail State License Number CONTRACTOR Name rhes D C'0' \/C) Address Address City cro V/ f fe State(? I No Phone S �g S—� 11p, Fax S e9 j/,Z j E-mail Lic. # yo 5—w- Class I� h For offic se only: ARCHITECT/ENGINEER Name Flood Zone Address SRA City I No State Zip Phone Map Book Fax E-mail Planner State License Number I� h For offic se only: APPLICANT NAME Name Flood Zone Address SRA City I No State Zip Phone Map Book Fax E-mail Planner I� h For offic se only: Zoning Property Address �.(f�Q / ( i (mat I u'S Flood Zone Cross Street j� ry �� ti vY U� wL SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. `Q� 13 P BIN LOCATION AP# r, 310 -07 Property Address �.(f�Q / ( i (mat I u'S C' 4 Cross Street j� ry �� ti vY U� wL �V WORKER9 COMPENSATION Policy Number 7/ O -� Carrier -le &I 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 -! G l �n /j� V Address Description or /Scope of Work: r%0`_ p16�. �V Sq. Footage k1 Qn, ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): Page 1 of 2 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 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 Mgn7t: • � `Y Bldg - SRA Receipt 4' /;?& &, Sheriff IP Date-�Other O • q� Total REV 2-24-05 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 BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN 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 faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd 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). ❑ 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). 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. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit 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 Refunds 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 check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 utte County Department of Development Services )NNE CHRISTOPHER, DIRECTOR WILLDAN Scott Rutherford (530) 538-7160 srutherford cDbuttecounty.net Plans Transmittal For Review Per Contract 4/27/2005 Applicant: Sanders, Dan & Kathy Permit No: 05-1077 Project Type: Det Gar/Temp Power APN: 028-390-075 100% 70% Plan Check Fees $ 1,141.88 $ 799.32 $ 1,141.88 $ 799.32 WILLDAN Fee $ 799.32 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 7 County Center Drive Oroville, CA 95965 (530) 538.7601 Telephone (530) 538.7785 Facsimile O TO: ' N FROM: LO t I SUBJECT: O 00 DATE: WILLDAN Scott Rutherford (530) 538-7160 srutherford cDbuttecounty.net Plans Transmittal For Review Per Contract 4/27/2005 Applicant: Sanders, Dan & Kathy Permit No: 05-1077 Project Type: Det Gar/Temp Power APN: 028-390-075 100% 70% Plan Check Fees $ 1,141.88 $ 799.32 $ 1,141.88 $ 799.32 WILLDAN Fee $ 799.32 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 sm�p 1. �l6 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, 0roville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET �nOWNER: ASSESSOR PARCEL NUMBERt./� Proposed Building Use: la Permit Technician:* Date: Items required in order to apply for a permit.(#1 boxes MUST be checked OR marked NA in order to apply. 1r- 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. ji 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) Installation manual, including 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. Letter of intent for non-residential buildings ❑ 12. Hazardous Material Form 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico Alloville, as applicable 16. Fire Sprinklers ................. *............................... ............................................ ❑ 17. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 18. Soils Report and/or Engineered Foundation required ........................................... ❑ \ 19. Erosion Control Plan Required........................................................................ I 20. ees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ City of Chico Plumbing permit........................................................................ 22. Site plan and business license approval from the City of Biggs .............................. alifornia Department of Forestry plan approval pkp�id. Sent by: Planning approval for (A) Use: (B)Parking: (C) Parcel Check:....j,%.. ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ I� 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 29. Worker's Compensation Carrier and Policy Number .......................................... ❑ 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone , d�� C15311U _(_ rj/ITr . ' and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant: Date: 9r11 1. Index permit q0plication for the above items numbered: 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: Contractor, designer, owner„was advised of the above data by ❑ phone, ❑ mail, ❑ counter, y Date: Plans reviewed by: Date: Plans approved by: Date: _ Q, Structural reviewed by: Date: Structural approved by:W# Date: Note transfer by: � , Date: Yellow: Building Division COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION - 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140 SCHEDULE OF RECEIPT OF FEES Website: www.buttecounty.net/dds OWNER �J( PROPROSED BUILDING USE Ce4Zi 1. BUILDING PERMIT FEES q. e --- Balance Due ..................... $ --- FEMA Flood elevation review ... $ --- Additional plan checking Fee.... $ SCHOOL DISTRICT FEES (paid at School District Office) (form available after Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... X $0.03 = $_ sq.rtg. 4. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMPACT FEES COUNTY WIDE (per dwelling) $ CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ A.P. # 4 __V DATE RECEIPT # DATE REC. NORTH CH CO PECIFIC PLAN (per dwelling) Zoning $ � SR FIRE INSPECTION AND PLAN CHECK FEE $204.98 (paid at Building Division) 4 !20 7. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 8. SMIP a 9. OTHER 10. OTHER 11. OTHER 7P. V 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 cking process. APPLICANT DATE Pursuant to Government Code Section 66020, you 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. 3/05) Butte County Department ofDevelopment Services ° v0 0 TCounty Center Drive 1 ° ° Oroville, CA 95965 °'�. ° ° �.. _ ° (530) 538-7601 Telephone ° . -`°� ° (530) 538-7785 Facsimile BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: • I need to submit applications for septic and/or well to Butte County Environmental Health immediately. • I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained. • I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. _ The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building_ permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not limited to, verification the parcel was legally created, adherence to all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name: Z" `O e J f A/. T)Q4 vo r APN: W -756 07.5`r Building site address: S C/o 9 �D r /-C r Permit No.: 03 P465- I. t/) V (p ;-'nt* wyr &.�-e 9r'%oi ?'�SSS. // r) F7 I have read, understood and accept the terms and conditions as expressed herein as indicatecFby my submission of the above-refTriced building permit application and my signature below: C/--aC-. SIGNATUOF APPLICANT DATE Copy to Applicant/EH/File K:Fonns/B1dgPennitwithoutClearances 020705 P PRll�,F—�IqT 0 �° �JTr 0 ` �,� O O o p Aco u t4l �LlC WOF� . .Department of Pubic Works J. Michael Crump, LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville, CA 95965 (5.30) 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 rLESS THAN 1 ACRE_ !�PAOS //101) CLS-l(J7 r� Project Description: Project ]Location ancuor Parcel Plumber: as, 3 /0 07.5— By iS By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre -or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of 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: Less than I Acre NPDES & SWPPP Compliance Certification W I LLDAN 117 C Street ,�WMarysville, California 95901 Serving Public Agencies 530/749.2373 fax 530/749.2199 www.willdan.com June 1, 2005 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 (530) 538-7169 (530) 538-2140 FAX BUTTE COUNTY PLAN REVIEW REPORT Status:. Approved Jurisdiction Job No: 05-1077 Assessor's Parcel No: 028-390-075 Description: Sanders -Det Gar/Temp Power Willdan Project No: 14353-1593-M 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, sheet 1 dated 11/3/04 by Jim Blanton * Truss Calculations: Two (2) copies dated 3/9/05 by Longfellow Lumber Co., Inc. The plans have been stamped with the Willdan approval stamp and dated. 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. A W1 LLDAN Serving Public Agencies 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 Cod and abbreviated herein as CBC. • Part 3, known as the California 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 astk& CODE ANALYSIS Specific Use Type of Type of Stories Total Sq Ft Occu ancy Construction "N MWW' A i .1 Detached Garage ! U=1 R-3 1 816 i 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. 3. The Detached Accessory,Building is a U-1 Garage/Storage Shed that has insulation but is not heated. If it is later: proposed to condition any part of the building or use it for any living or sleeping purposes, a new building permit and plan -review shall be required prior to commencement of "such use and/or construction and approval shall also be contingent upon the submissionl and approval of Title -24 Energy Calculations (where heating is proposed) and on a deed restriction being recorded. County of Butte Residential Accessory Building & Space-Use'Matrix 4. Butte County shall determine if a deed restriction is required for the current configuration. 5. Gable -End Truss calculation submittal is deferred to Butte County's review at Butte County Building Depa'rtment's discretion. I Page 2 of 3 Butte County 05-1077 Wil.ldan .14353-1.593.PC1.F A W I LLDAN Serving Public Agencies SPECIAL: INSPECTION NEEDS Our plan review reveals no special` inspection needs pursuant to CBC 1701 DEFERRED SUBMITTALS. Our plan review reveals Gable -End Truss calculation submittal is deferred to Butte. County's review at Butte County Building Department's discretion. Sincerely, Richard Essenwanger Plans Examiner II Cc: Alice Mefford ameff6rd@buttecounty.net Jim Pursell P. E., 2360 Baldwin Ave, Oroville, CA 95966, fax (530) 534-0902 Dan & Kathy Sanders, 5409 LaPorte Rd., Marysville, CA 95901 Jim Blanton, 203 Shady Oak Drive, Oroville, CA 95966, fax (530) 589-1125 Page 3 of 3 Butte County 05-1077 Willdan 14353-1.593.PC1F A/ SITE PLAN REVIEW .°.PPLICATION Date: p A.P# l /�d — Dt2.3— Permit Number (if applicable) 0 5_`/6 G 7 APPLICANT INFORMATION Parcel Size: 7 75- ac tz.S Owners Name: Owners Address: Telephone No.: Situs Address: Proposed Use: 91 /�s 0/L 611.1le— 7 ,533 -2r(o0 OZ svo Re idential �d 7(eNew Single Family Residential Single Family Addition ❑ Single Family Remodel ❑ Mobile Home Residential Accessory �� J -e. /077 Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other c'< Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Commercial Remodel ❑ Industrial Remodel DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) BUTTE COUNTY DEC 0 12004 DEVELOPMENT SERVICES a Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval Site Plan Stamped Approved By "�aivtA-. �li(/1 Date /-7 3 �% 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) SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See ajtached) • Flood Zone: I� • Flood Panel No.: /c/1 Index Date: ❑ Sacramento River Reclamation District (Approval must be obtained from the Chlifornia 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 El Minor Variance El Administrative Permit ❑ Variance ❑ Detached Building Use Form ❑ Encroachment -permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: A -5_ 6 P-Af-- Applicable Building Setbacks: Zoning Code Streets & Highways Fire Prevention Front Side Side Street Rear S Height Waterway N/A N/AI N/A Subdivision Map ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. 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 K Deeds: Date of Creation: Z. /3/gLegal Access Provided: ❑ No Yes Deed of Reference: ?Z Legal Access Required ❑ N ® s Parcel Frontage on Publicly Maintained Road: El No ® Yes, Road Name:alt Complies with County Standards for DeV Creation: E] No E]Yes Comments: C. a G. f in clZe - 390 -037 -030397 Fr Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑Provide Deed of Creation ❑ 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 ❑ 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 ma 0 n u t❑ 0 Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. C -M, rysSuilding Permit Site Plan Reviewl.doc RETURN TO: Public Works Land Development Section Do . UJOIU `r CORDED IN OFFICIAL RECORDS :?F BUTTE COUNTY. CALIFORNIA AT THE REQUEST OF L •.I.i Vr 086 FEB -3 PH Z. 30 CERTIFICATE OF COMPLIANCE ELEANOR K BECKER Issued to: Robert C. Lenhard CLERK—RECORDER FE: 6366 Bald Mountain Road Browns Valley, CA 95918 86— 3878 This Certificate of Compliance is hereby issued by the County Pages 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: at the northwest corner of Grimy Gulch Rd. and La Porte Rd. Bangor area. 2. Assessor's Parcel Number: 28-39-37 Description: All that certain property located in the County of Butte, State of California, more particularly described as follows: A portion of Section 33, Township 18 North, Range 5 East, M.D.B. & M., more particulary described as follows: Commencing at the Northwest corner of said Section 33; thence North 87° 08' 47" East along the North line of said Section 33, a distance of 1333-11 feet; thence South 20 13'58" East a distance of 1330.38 feet; thence North 870 59' 32" East a distance of 1312.32 feet to the true point of beginning for the parcel of land herein described; thence from said true point of beginning, South 20 12' 06" East, a distance of 1349.76 feet; thence North 880 50' 28" East, a distance of 995.05 feet, more or less, to a point on the Westerly boundary of the La Porte County Road; thence Northeasterly along the Westerly boundary of said La Porte County Road to a point that bears North 870 59' 32" East from the true point of beginning; thence South 870 59' 32" West, a distance of 1179.43 feet, more or less, to the true point of beginning EXCEPTING THEREFROM the North 1012.32 feet, measured along the West boundary and parallel with the North boundary of the above described parcel. 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: LD 1400 NONE County of Butte Subdivision Violation Committee BUTTE COUNTY AGRICULTURAL BUFFER NOTIFICATION AND/OR UNUSUAL CIRCUMSTANCES REQUEST E171*011montal N 0 V 2 4 20( 7 County Center r Oroolplq, Ca Butte County requires a 300 foot buffer between neighboring agricultural operations and a residence. This dimension is based on environmental assessments and studies. The Agricultural Commissioner may identify unusual circumstances where the 300 foot buffer cannot be met on existing parcels. This exception is not available for lots being created, divided or subdivided. Owner or Authorized Agent must complete the following and return with the required site plan to: Development Services Department, 7 County Center Drive, Oroville, CA (530) 538-7601 Mailing Address: E -Mail address Assessor's Parcel NumberC�) ---2) - Reason you believe you qualify for the unusual circumstances exception: or nature Phone: i q 0163 [I -a4 C�f Date UNUSUAL CIRCUMSTANCES DEFINITION: An exceptional or extraordinary condition where the existing lot size or shape or an existing improvement (well, septic systems, structures etc.) does not allow for the standard condition of a 300 -foot buffer zon . SITE PLAN REQUIREMENT: submit 4 copies with this form 0 Q� Refer to the Site Plan Submittal handout fors..ecific re..uirements �� �.........................................................................................................................., .....� VEnnrvnal Dept. Contact Info:. Health ❑ Planning [I Building El Other C tact Person: Phone: fi ......................................................................................................................................................................................... For Agricultural Commissioner office use only: (to be completed after submittal) DISCRETIONARY PERMITS (Planning) MINISTERIAL PERMITS (Building) ❑ Exception Recommended ❑ Exception Granted with the ❑ Exception NOT Recommended following conditions: Reason/Conditions/Specific setbacks from adjacent agricultural operations: Agricultural Department Signature: Date: YMC 7/1/03 86=3818 rCORDED IN OFFICIAL RECORDS RETURN TO: ')f BUTTE COUNTY. CALIFORNIA Prubl i c Works AT THE REQUEST OF Land Development SectionP1 MIJ^ 1986 FEB -3 PM 2 30 CERTIFICATE OF COMPLIANCE Issued to: ELEANOR M.BECKER Robert C. Lenhard C.LEAK4ECORDER F 9.�. r 6366 Bald Mountain Road Browns Valley, CA 959i8 86- 3878 This Certificate of Compliance is hereby issued by the County . rages 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: at the northwest corner of Grimy Gulch Rd. and La Porte Rd. Bangor area. 2. Assessor's Parcel Number: 28-39-37 Description: All that certain property located in the County of Butte, State of California, more particularly described as follows: A portion of Section 33, Township 18 -North, Range 5 East, M.D.B. & M., more particulary described as follows: Commencing at the Northwest corner of said Section 33; thence North 870 08' 47" - East along the North line of said Section 33, a distance of 1333.11 feet; thence South 20 13'58" East a distance of 1330.38 feet; thence North 870 59' 32" East a distance of 1312.32 feet to the true point of beginning for the parcel of land herein described; thence from said true point of beginning, South 20 12'. 06" East, a distance of 1349.76 feet; thence North 880 50' 28" East, a distance of 995.05 feet, more or less, to a point on the Westerly boundary of the La Porte County. Road; thence Northeasterly along the Westerly boundary of_said La_Porte County z a .............. ... ... ..... ....... ....... ......... .. ........ �. . .. _ .. ..... �.... _...- :............._:_...... __,<_._......1.��..'i.6; S.Z.. o_.. f7,� �g Assessor's Parcel Number Owner Name Address / Phor Site Location QL8 - 3`1O -b Ej Contact Name Dan - Cad 5aICQA-5 Phone -D 520-83x7 0 r',f332 98b0 0dWwa= ElMM ©®0 — ®Q© Scale: 1" _ FOR OFFICE USE ONLY PROVIDE FOR ALL ADJACENT PARCELS Zoning: SIZE (AC): General Plan Desig: ZONING: Size, Acres GEN PLAN: 4.00° USES: g Y r