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HomeMy WebLinkAbout005-386-010t -w , JOSIE JARVIS --41 -------------- - {//j A 984' Coloradow St , -Chico C JARVIS Permit #565-75P,E(ueUt��) '1� Fire Damage' -Report 4/21/81-; 1 ,ELEC.-t� GAS s- a' SUPPORT STRUCTURE REQ. ' COMPACTION TEST REQ. Q Permit•=#694-76MHI Issued a 5-386-10. 3688-89P.,. ! JARVIS, KC:C.. & Jesie 984 Colorado S t, -Chico - ' (instal 1.,.water - heater) - 005-386-010 _99-2320- JARVIS, 99-2320~JARVIS, CECIL 984 COLORADO, CIRCO CONT: CIRCO ELECTRIC��G /�$/94 . REPLACE ELE SER/MHqL / i 4 i L �Q Il! M GO iCfll R COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, C%lifornia 95965 • Telephone (530) 538-7&41 PERMIT . (Rev. 12/96) APPLICATION AND PERMIT — C..' ASSESSOR PA/rM — 1_01V ZONING ONING3 BUILdING PERMIT OWNER - C �c 3 o SO. FT. OCC. BUILDING VALUATION OWNER'S MAI Dr�r 1•.L� 1177 t CONTRACTOR' �, t TELEPHONE CONTRACTORS NG ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS 9� r Ci Energy Plan Checking Fee $ $ PERMIT FEE $ LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMITFilin g Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK F New ❑ Addition ❑ Remodel O Utilities ❑ Installation ❑ Other ❑ Describe Work: C.IJIJ i ly C.E. �g, Zy�' �L) - H �1 }Ll) Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 E00V OR LESS Main Service 200A OR LESS 23.00 3 bV LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professigns Code, and my license is in full force and effect. License Class �'"- r t,> Lic. No. '-'�S"f '3"IS OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. Business and Professions Code for this reason Main Service TO ,000A 46. NEW CONST. DWEWNOCC EL OR AOONS. ( a ACCO. BLDCSUP. SO so 3.52FT. NON REST-, , MULTI -OUTLET @7,50 PSOWEINLER APPARATUTLETUS 8 GOCIR. Ex. Occup. OUTLET OR FIXTURES SAL so FIXED APPLNS. OR Ex. Occup. ourLETs RESIo. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Am rzo gk;. � 1�;i1'c,,, vs_„l _ ucGt�t Policy Number wZis 4,0 (The above sections need not be completed jf the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wit those provisions. X t Date t — 6 rt q Signature of Applicant- ❑ Ow r ❑ Contractor ❑ Agent An OSHA permit is required for ex vations over 5'0” deep and demolition or construction of structures over 3 stories in hei t. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ y,j. D NA2. D. FE ,61� FLOOD CDF - PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicat above for which tees have By ; };� L t ;��� PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date Date Receipt No. WHITE-D.D.S.-B.O. CANARY -ASSESSOR . PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 965 Telephone 530 538-7541 ERMIT , O. 7 County Center Drive Oroville, California` p ( ) �������► (Rev. 12/96) APPLICATION AND PERMIT .�— LpWM 7, 3s/ wJ U � Q O ASSESSOR PAMM7, 'K ZONING BUILDINGPERMIT OWNER S_ - MR' �3 8a SO. FT. OCC. BUILDING VALUATION OWNERS MAIIJrDrqCn /r~ TELEPHONE 841-1 3 CONTRACTOR IUNG ADD SS_ P CONSTRUCTION LENDER LENDER'S MAIUNG ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEERLICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 9 Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF W` Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap7.00 Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallatiorL ❑ Other ❑ Describe Work: Sp__ (�Q Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 1 @20.00 PERMIT FEE $ ELECTRICAL PERMIT I Fling Feel 20.00 600V0"LESS Main Service zo.A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.PSING License Class G 1 O Lic. No. '-►SSI 3"1} � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 100DA 46.00 NEW CONST. DWELLING OCCUP. OR AGNS ( a ACC. BIAS. S° 3.5¢FT; N°µR°�I MULTI.OUTLEr @7.50 a OURkT OWELER APPARATUCIR.S Ex. Occup. ourLET OR FDCTUREs zo p 1.00 BAL o .so Ex. Occup. onuntDrs� IEso.°EA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 3, 00 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier A c.A.J it _ A<<,a_c_ Policy Number 9 43oo,1 43-70,5 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wit those provisions. X A- Date i b- G -tea Signature of Applicant - ❑ Ow r ❑ Contractor ❑ Agent An OSHA permit is required for ex vations over 5'0" deep and demolition or construction of structures over 3 stories in hei t. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPEv�,r� TOTAL FEE $ L{3. " HAZ. I D. FE P FLOOD COF I P"CEL T HD LSSUE This permit is hereby issued under of the Butte County Code and/or indicat above for which fees have By PERMIT EXPIRES ON a/� ��p the applicable provisions Resolutions to do work been paid. ..Daate�� 10-6 d— Date Receipt No. .� I WHITE-D.D.S.-B. . CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 1h COUNTY OF BUTTE-- DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Caliiornia 95965 - Telephone: 916/538-7541 APPLICATI ON ANNPE RMIT ERMIT_y0.� ASSESSOR NUMBER PARCEL NU s- :)ea �,pa . ZONIN BUILDING'PERMIT OWNERCG JoS1F JAR✓/S TELEPHONE 3N2-' V SO. FT, OCC. BUILDING VALUATION OWNER'S MAILING Ap DRESS 0 /H /'/�91 i- r /G y ry 2- CS CONTRACTOR'S NAME 0 VV'rA TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS / Permit Fee $ ARCHITECT OR ENGINEER` I LICENSE No.- . I I, ARCHITECT OR ENGINEER'SIMAILING•ADD_RESS .., \-_� ` ' Plan Checking Fee $ - Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS _ r ��( �L Permit fee $ PLUMBING PERMIT Filing Fee 10.00 S^ 2 0 Each Trap 2.00 l Sol ar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP I Water piping X 5.00 Each qas water heater or vent 5.00 S ` USE OF STRUCTURE SF ❑ Duplex[] Mobilehomea O� th F� A(�"�`- � � 'A��� Y SPECIFY .j Gas piping system 1 - 5_outlets )i( 5.00 Building sewer " 5.00 Mobile Homq• S I G I W 1 10-00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Qther [y Describe work: Zis Pg,- L W.,q"rot�/'� 4?�R '� _ , !fi S w^j .SA -Ar 'R 0 -de- QL /ry%o cc " Permit Fee $ �+ Contractor ELECTRICAL PERMIT Filing Fee 10.00 L /J� - L'CQ 1 /i/ C �O �,� .6,7 /' Main service 600V OR LESS 100 AMP OR LESS Main service,,�,A. ADD -L 100 AMP 10.00 2.50 CONTRACTORS LICENSE LAW { I declare under penalty of perjury (Check One): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification �, '❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended orjoffered for sale. (Sec. 7044) i i ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUPM OR ADONIS.( ACC, BLDGS. 2/,20sq ft NEW CONSTR.ULT'.OUTLET NON.RESID BRANCH CIRC ITS ,. 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20050t SAL®ao EX. Occup. OUTLETS FIXED PRESID ILNS REA.� 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 - Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): i ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. i, shall not employ any person in any manner so as to become subject • . to the W.G. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation I Permit Fee Contractor $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which -may in any way accrue against said'County in consequence of the granting of this permit. 11 X Date ``- ; Signature of Applicant — Owner 2 Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE C AL TOTAL FEE $ ZS HAz CLIA PARK FAD PAR PD HD ISSUE ,��' =+T,his permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By / PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date�`Z i0?' H , Receipt No. 4 q 11 � P ITE-D.P.W.. YELLOW -ASSESSOR, INK -INSPECTOR. GOLDENROD -APPLICANT •���... .L-.s.�+-7','i.7�.i F"'"`^r*%'t'.si�J-=�";+:�"xu�b'a45'"�ls L$baa+�...-='+.r'i�C"�.r^=•..i+�:•«se.rw...+.r.»:.=.;,.�� COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. CY 7 l�l� r o-✓� � °�) ��� /Z� PS Z aos -fest ce�u�,re�• n , N p1fSS w�G • ✓9e- ((�� r \n..r�� tx-sea[ Ong - A -i A At, S 4-. � e, o�AOe,e a ,rou-� -{b wu U �•C— Inspector 4 Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT JN ASSESSOR PARCEL NUMBER '5'-- Dar. _ o ZON IN BUILDING PERMIT OWNERTELEPHONE �slFi' 14avJ3 3y� SO. FT. OCC. BUILDING VALUATIO OWNER'S MAILING A� /DRESS olY //�Bt�L— /cam 9f 1 L�" CONTRACTOR'SNAME 0 GIrA/e TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 G/1G%L J Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 ,S�Q Each qas water heater or vent 5.00 USE OF STRUCTURE rn SF [I Duplex❑ MobilehomOther ATT— W/9rfi�_{1/A91�,Q SPECIFY Gas piping system 1 - 5 outlets 5.00 s Building sewer 5.00 Mobile Home I S I G W 10.0 . TYPE OF WORK New❑ Addition [I Remodel❑ Utilities❑ Installation❑ Other Describe work: %SPALL. W-190x/L%//'L�B4/1s2 - ;,4 _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 r+ 1 O� S/-���o Wr'/ l he- L10."'"/O -� BOOV OR LESS Main service 100 AMP OR LESS Main service EA. ADD -L 100 AMP 10.00 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.tr) OR ADONS. ACC. BLDGS. , /20sgft NEW CONSTR.MULTI-OUTLET NON.RESID BRANCH .CIRC ITS 2.50 ea POWER APPARATUS tr SINGLE -OUTLET CIR. ) OUTLETS OR FIXTURES Ex. Occup(zAL030 .200530 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I, shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation. Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against sai County in consequence of the granting of this permit. � t //,��`� X Date Signature if -Applicant —Owner ® Contractor ❑ Agent F1 An OSHA permit is required for excallv__ations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE c TOTAL FEE $ HAZ CUA PARK SCHL FLD PAR PD HD lis This permit is hereby issued under of the Butte County. Code and/or work indicated above for which fees LIC By IREC OFi UBDate PERMIT EXPIRES Date the applicable provi- resolutions to do sions have been paid. WORKS % 7 11--7,— /^ J -9V Receipt No.qIQ 1 WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - De alrt.ment'of Public Works 7 County Center Dr4i,�ve, Oroville, CA 95965 OWNER -BUILDER VERIFICATION Phone: 916-538-7541 Attention Property Owner: An 'owner -.builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit_ will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) 2. I have have not) signed an application for a building permit for the proposed wor . 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contract rs License No. 4. I plan to provide portions of this to coordinate, supervise, and prov Name / ork, but I have hired the following person e the major work: . Address City Phone Co tractors License No. 5. I will provide some of the wpirk but I have contracted (hired) the following persons to provide the work? indicated: Name Address Phone Type of Work Signed: Property Owner J Social Security um Date C NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and -Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. FIRE REPORT. FC -18 (3/86) /7N ORIGIN LOCATInN a ORDER NUMBER REG. R.U. INCIDENT NO. START Mp DA NUM b��RA BI YEAR :CPO U NJ FM I M 3 FIRE NAME I FREG. [R.U. NO tliruZ:— IVIFM 3 TOWNSHIP , N I RANGE LSEC. a z'- ci zsl -- El DUMP MILESDIRECION * '- "' - E] FOREST INDUSTRY NAT,"CITY- -&-STREETk-- IONACFOREST. DIST -,"IC NO.,FROM RECREATION El DUMP ... IN. ETC "El WILDLAND ❑ UTILITY, RAILROAD [3 NON-WILDLAND BLOCK 10 ❑ OTHER INCIDENT TYPE * '- "' - E] FOREST INDUSTRY RANCH -FARM RECREATION El DUMP FIRE❑ALARM—GO TO "El WILDLAND ❑ UTILITY, RAILROAD [3 NON-WILDLAND BLOCK 10 ❑ OTHER RESPONSIBILITY STATE ZONE Cl WILDLAND BURNED OR THREATENED— % 46 —STATUTORY RESPONSIBILITY 0 CDF LOCAL GOVT. CONTRA CT AT ORIGIN) 0 UNPROTECTED O Cl ASSIST OTHER C:l STATEj AGENCY (Not City) U.S.F. El i LOCAL ZONE CDF LOCAL GOVT. CONTRACT 00 B.L.M., 0 ASSIST OTHER.AGENCY (Not City) 0 El OTHERFEDiERAL FEDERAL ZONE 0 ASSIST FED. AGENCY (Not Mil.) ❑ OTHER 0 CDF LOCAL GOVT. CONTRACT MISC. AND OTHER 9 C3 ASSIST CITY, CONTRACT CO., MIL, OTHER C❑ AU ARTS IN OR 0IGSE ONLY) LIGHTNING ❑ DEBRIS ❑ PLAY,W/FIRE C] CAMPFIRE El ARSON OTHER/,M!SC. ❑ SMOKING EQUIPMENT LAND USE (STARTS IN 1 'OR^ ® : ONLY) Iii" DOMESTIC ..%:::,: * '- "' - E] FOREST INDUSTRY RANCH -FARM RECREATION El DUMP [3 OTHER INDUSTRY-COMRCL.: C] ROAD "El WILDLAND ❑ UTILITY, RAILROAD [3 NON-WILDLAND D UTILITY, ELECTRIC ❑ OTHER OTHER STRUCTURES 3/OR &gNTENTS VEHICLES & CONTENTS OTHER TOTAL ACRES OF VEGETATION BURNED 10 OVER PLEASE CDF 7340-130-0118 87 LU19 6- 7-8 N y Owner Address: �d Tenant • (p Building Location: %b BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS SPECIAL INSPECTION REPORT 91M110 A.P. Date of In6fttion /'7G 1 ! Inspector. Type of Inspection requested: 1. Housing. "'2. Financing 3. Change of Occupancy to 4. Other (specify) F/ -PC Present use of building: A. Sanitation (Housing) 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities: 7. Natural light and ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: 12. Connection to wate:r'.supply: 13. Rubbish and garbage facilities: 14. Comments: B. Structural 1. Piers and footings: 2. Floor construction: 3. Wall construction: 4. Ceiling and'roof construction: 5. Fireplaces: 6. Comments - C. Electrical 1. Service n td ground : _.__ 2. Recep« c'. 3. Fus i.Tig : 4. Coua,ents: D. Plumbing 1. Fixtures; connected and vented: 2. Gas water heater: 3. Gas heating vents: 4.. Comments /.•.,,,timiaA nn hackie E. Other 1. Maintenance and repair: 2. Fire hazards:. 3. Safety hazar.ds: -^+ 4. Weather protection: S. Underfloor and attic ventilation: 6. Conuxents: F. Commercial Buildings 1. Rcof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Rest:-oom floors and :gills: 5. Exits: _ 6. Improvements: 7. zor_ ng • 8. Commexit- G. Field Probl.rns or eicla;.ioris 1. Problem cr :Violation (give complete description)- 2. escription): 2. What action taken (give complete-.Jescripti.oxx) : 3. What an -Lion -recon ended: . 7-7 A . s.nforsaation only - f 1 -. / / B. Hold for tcn (10) days, then wri-e letter. / C Write letter. /7D; other: AD -� A,,r— s J) -O c .-q V or } F0, R E, - FIRE NUMBERREPORT, — REG. R.U. IND. thru FC -18 (1/80) - 15 2 RORIGIN LOCATION _ SEC. TOWNSHIP, N RANGE E MILES _ IRECTIOI 'FROM *i !NEJW 0'-Ny0 p^m,�l U5`� (STARTS IN 1 0 5 OR 8 OPILY) Ell Did not start InW5 2 5 or< i SMOKING EOUIPMENT �] LIGHTNING DEBRIS ❑PLAY W/FIRE ❑ CAMPFIRE ❑ARSON ❑OTHER/MISC. J: LAND USi(STAP.TS IN 1000 VOR B ONLY) Did not start In1002 (5.)oro ❑ FOREST INDUSTRY DOMESTIC `� RECREATION ❑. RANCH -FARM ❑OTHEP. INDUSTRY- COMRCL. ❑ DUMP r-1W.ILDLAN0 ❑ ROAD F]NON-WILDLAtJD • f UTILITY, RAILROAD ❑OTHER Cl UTILITY, ELECTRIC e--,DAIM AGE (10 2005 OROS ONLY) Number S DAMAGE INCIDENT TAPE TIMBER 3 IR ❑FALSE ALARM ''' TOP GO TO 1.0 1 2 8/or 85 BRUSH TIMBER C./OR ORESPOi�SIRILITY (AT ORIGIN) 4A 4B DIRECT PROT. RE�P.('D.P.R') STATUTORY Rot. 7—ST—ATE: ZONE RESPONSIBILITY 10 WILDLAND BURNED OR THREATENED ❑ O� SCHEDULE A D.P.R. STATE 03 UNPROTECTED 1p.DISTRICT 40O OTHER AGENCY D.P.R. (Other than T&YG) CRY ! LOCAL ZONE a ❑COUNTY hdSCHEDULE A D.P.R. U.S.F.S. •90❑ OTHER AGENCY D.P.R. (Unincorp) (Other than TBYG) B.L.M. FEDERAL ZONE FIB.I.A. 0 ❑ FEDERAL(except Military) D.P.R. N.P.S. 1 SCHEDULE A D.P.R.OTHER P ,•, FEDERAL - ❑ MISC./OTHER (-ZONE•) ❑ OTHER 0'-Ny0 p^m,�l U5`� (STARTS IN 1 0 5 OR 8 OPILY) Ell Did not start InW5 2 5 or< i SMOKING EOUIPMENT �] LIGHTNING DEBRIS ❑PLAY W/FIRE ❑ CAMPFIRE ❑ARSON ❑OTHER/MISC. J: LAND USi(STAP.TS IN 1000 VOR B ONLY) Did not start In1002 (5.)oro ❑ FOREST INDUSTRY DOMESTIC `� RECREATION ❑. RANCH -FARM ❑OTHEP. INDUSTRY- COMRCL. ❑ DUMP r-1W.ILDLAN0 ❑ ROAD F]NON-WILDLAtJD • f UTILITY, RAILROAD ❑OTHER Cl UTILITY, ELECTRIC e--,DAIM AGE (10 2005 OROS ONLY) YEAACOUNT1Y FIRE NAME: NATIONAL FOREST, FIRE DIST., CITY 8 STREE ETC. ACRES OF VEGETATION BURNED 9 ON ARR3fAI. t�,�[ 1 VEGETATION FIRE SIZE _lw . _'d NATIONAL � n, VEG. TYPE Number S DAMAGE NO DA`,1AGE IN(N TIMBER earest 100 00 5 OR 8 o1 Veh0, 1 2 8/or 85 BRUSH TIMBER C./OR B.I.A. GRASS W.P.R. S. Ex -BOR). YOUNG GROWTH FED. CDF TOTAL OTHER WILDLAND VEGETATION 1' (Other than T&YG) TOTAL i AGRICULTUPAL PROD (Other than TBYG) L .' DWELLINGS P ,•, 8/OR CONTENTS OTHER STRUCTURES 8/OR CONTEUTS VEHICLES 8 CONTENTS OTHER TOTAL $ YEAACOUNT1Y FIRE NAME: NATIONAL FOREST, FIRE DIST., CITY 8 STREE ETC. ACRES OF VEGETATION BURNED 9 ON ARR3fAI. t�,�[ 1 VEGETATION FIRE SIZE _lw . _'d NATIONAL � n, VEG. TYPE ACRES BURNED t 5 TIMBER STATE WOOD LAND U.S.F.S. BRUSH B.I.A. GRASS W.P.R. S. Ex -BOR). AGRIC. PROD. FED. CDF TOTAL OTHER STATUT. RESPON. t0 ACRES BURNED OF STATE ) U.S.F.S. B.L.M. B.I.A. W.P.R. S. Ex -BOR). OTHER FED. I OTHER 1' • TOTAL i OTHER, GO TO tO DISTANCE (Origin to'head) ACRESI FEET WEATHER (ESTIMATE AT SCENE) WINO' DIRECTION FROM TEMPERATURE, M.P.M. io' OVER PLEASE CDF 7540-130-011• 7",0,r.6 1 -AD '!. util. NO. 5.6-6-75P,E �y P. E M MH UTIL. PERMIT NO. PERMIT EXPIRES _ZZ/ OWNER Josie Jarvis ;CONTR. owner OCATION (A.P. 46-126-10 1 �r :984 Colorado St., Chico y7 yi s, p , Temp. Power Pole Called PG&E 3TwiLnw. Elec. Serv. Called PG&E 3—//�7- mGas Serv. }/FINALED Called PG&E —/ 'i a�B / � ���� 2 -b (Date) (Signature) ti• - i � ' , .. , s _ 1 P r ^, 1 I r ' � � . .. , + � i � _ y � • • . � ' � � .. _ ._ _ i . �,� .. � � , 1 ti ` - � 4y r r � � �- � ti �• COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING I BUILDING (Cont'd) I PLUMBING Setback - /— (o Forms Firewall Parapets Soil Piping 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer 1—.-02 t`— Garage Fdn. Vents Fixtures Footings Gara a Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structure Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLA E Final % Footings Footing ELECTRICAL Reinf. Steel FIRE SPRINKLERS Stucco Final I Subpanels Mesh MECHA CAL Grd. Fault Prot. Scratch Heating Service /— Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final --?,, — / / '7 DATE REMARKS OR CORRECTIONS COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the reqquirements of the alifor is dministrative Code, Title 25; Cha to 5, pnder permit numb r — � for the following location: � �{�c�.c o/?AAo C t c c, Owner LVA V / ,4 Owner's Address q�O o2,4 D C3 S C i c C, 12 C-IDMobilehome Mf /2%/C o �S ��� Mfg. Model wcST Year /q7/ Insignia No/ 1 55 2 5 3.3 Serial No. U S(o7 X It is hereby certified or occupancy at the above described 1 catio and may be occupied. Director of PubliF Works Date"/ �_ -7 ( By i THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED MOBILEHOME INSTALLATION INSPECTIGN •LICK LIST 1. Is the mobilehome located wit required separation from lot lines and buildings and generally conform-to.plot plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.50851 Yes'o 3. Are footings and supports properly sized, spaced, and braced as per ed plans? (Note possible variation at spring shackles.) (Sec.508 5083) Yes o 4. Is the mobilehome level? (Sec. 5088) Yes o 5. If more an a single unit, are crossover connections properly installed? (Sec. 5088) Yes. o 6. Water A. Ise e connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) fl Yes No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes C. Backflow -I /i;Oalve? s not State ofCalifornia approved, does station havebackflow device and pressura Yes_ No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes `_'No B. Does it have minimum 4" per foot slope and is it properly supported? Yes No C. any leaks,detected in drainage system after runnin�-gallons of water throu h each s fixture including ..washing machine standpipe? YeL--'go- 7 D. If ch'i State of California approved,- does station have required trap and vent? Yes - 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector nop more than 6 ft, long? Note: All piping is to be at least a's large as the mobile a gas line inlet without reductions other than the mobilehome connector. Yes No B. Test OK as per following procedure? Yes�No 1. Open all appliance connector valves._ 2. Shut off _appliance burner and pilot valves. 3. test with,manome'ter to 10"-14" water column, or test with slope gauge,,(min mum 6oz.-maximum 8.oz.) calibrated in tenth pound increments. Test for 10'min, without drop. 4. ect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? -Ye �✓ P P Y s No 9. Electrical A. Is service large enough to provide adequate, amperage- to mobilehome (must equal ratil-g of mobilehome with a minimum of 1 amp) land other facilitie o t i.e wa er u s, UO garage, cabana, etc,? Yes No /0 ��� � � B. Is there proper clearances around panels? Yes 1.1-111-0- C. Is power supply cord or feeder assembly properly fused? YesNo D. Is continuity test satisfactory as per -the following procedure? Yes 1. ;Deer e7ectrical wiring system of the mobilehome at the pedestal. 2,ce sure that the power supply cord or feeder assembly conductors, including neutral conductor', have been disconnected. 3.ch all breakers and switches in the mobilehome to the "on" position. 4. nnect one lead of a test.instrument to the mobilehome grounding conductor and apply tl- other lead to each mobilehome supply conductor, including neuLra7.• 5. non-current., carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such i.pment and the grounding conductor. 6, on completion of the above procedure, the power supply cord or feeder.assembly conductors.shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and 11. If everything okay, sign off card and tag services. I9VOeA,�> o MOBILEHOME DATA Manufacturer and/or Nameeiistyle Length Width S 7'� r C:- - i n- i. c �T' Vahic.l- _Serial Ne. 11 3 s�2s�Cv�. sit -&I inNo. 5&A7 0 Additional.Informati.on orSC ents: - m xz sanitation?jj%S%lO�l� F, COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT BUILDIN Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address e C Telephone No. Fireplace Contractor 4f--zo Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee $ Building Address98 46 . O PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 .g (� / A. P. No. mG Zoning &Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F W. Se�i�etrvn Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking -Plans Parcelparcel Declaration Ma P 60' R/W Imp Provements Lawn sprinkler system 2.00 BI .-R Parcel Approval Plans royal Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 S e OR LESS 5•00 DR LESSG��anservce0AMP �•� / _ %� �i ($� / Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home, Others ❑ OVER 600V Main service 100 AMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONST. DWELING OR ADDNS. ( ACCL BLDGS.CCUP. &) 2¢sq ft NEW CONSTR. MULTI -OUTLET NON-RESID. BRANCH CIRCUITS) 2.50ea NEW CONSTPOWER APPARATUS & NON- R. RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Ex. Occup(OUTLETS OR FIXTURES) BAL@1 Ex. OCCU FIXED APP LNS. OR P•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. Elhave placed on file with the County of Butte a certificate of 'Workmen's Compensation Insurance. j, I certify that in the performance of the work for which this "-' permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby /' TOTAL PERMIT FEE authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. A IL,� ", Dat 1�4 Signature oof;W5� gennttj c_ Receipt No. / / y White-D.P.W.— Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0,F, PUBLIC WORKS By+,`Date Z' 7-0 —7t i lding permit expires Date Z - -;r-o —•7 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive = `ni`oville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT - I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date s 61i9 nature of Perm' a or Agent Receipt No. �.,;?J�6 6 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 7 TOTAL PERMIT FEE IL� This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been pa DIRECTOR OF PLIC WORKS �^ By ate Z%71 B ' ding permit expires Date<<f 7 BUILDING r Owner© C•_ SQ. FT. OCC. BUILDING VALUATION Mai I ing. Address 7'- C Telephone No. - S Z Fireplace Contractor 69 CtJ A I (T-lej Total Valuation Mai I ing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address O 77 PLUMBING No. @ FEE PERMIT FILING FEE $3.00 c4eco Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 (� Each gas. water heater or vent 1.50 A. P. No. �_A &_ D �Zon? g 8 Panning Gas piping system 1 - 5 outlets 1.50 , Each additional outlet .30- Fa W. . S Fire Dept. FireZo Use Permit Building sewer. . 5.00/0- 0 EQA Parking Plans Parcel Declaration parcel Ma p 60' R/W Improve is p Lawn sprinkler system 2.00 �}��% 6i1dyL�ans Recd Parcel Approval Plans pproval Permit Fee $-35 C NEW ❑ ADDITION ❑ UTILITIES',R OTHER E] ELECTRICAL No. @ FEE PERMIT FILING FEE J$3.00 F. Q Main service incl. 1 meter 30 Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) _ Single Family ❑ Duplex ❑ Mobil Home. Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures b %2510 Receps., switches & fix outlets 12U (612510 CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. coo I er, gar. d i sp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. Classification Misc. wiring I am exempt from the Contractors License Laws of the State of California. Permit Fee1--240 MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ' ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. jam{ I certify that in the performance of the work for which this permit ,is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date s 61i9 nature of Perm' a or Agent Receipt No. �.,;?J�6 6 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 7 TOTAL PERMIT FEE IL� This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been pa DIRECTOR OF PLIC WORKS �^ By ate Z%71 B ' ding permit expires Date<<f 7 U T R NAM'. M'. SLIP c�L) Date To �W�,___I n, O„ A i.h �r r ,Li / " ......Approval REMARKS ......Necessary action ......Prepare reply ......Comment ......Note and return ......Note and file ......Investigate ......Signature ......Confer ......As requested ......For information ......Per telephone conversation BUTTE COUNTY 10 OF P'liTTE wopKs C)Eg.V. OF PUBLIC NOV 1'7 1975 FIRE REPORT. FC -18 (3/86) /'1 ORIGIN MrATInA! MILES , TOWNSHIP;oN RANGE Cskz,�_,, ❑S _ L•❑W MILES , DIRECTIONNATIONAL ❑ FROM.. IN. FOREST, FIRE DIST., CITY & STREET NO., .' y '� ' Number BLOCK' 10 I 1 ETC. r 5 b LAND USE (STARTS IN t 2 5 OR 4& ONLY) DOMESTIC ❑ FOREST INDUSTRY RANCH -FARM • ❑ RECREATION ` ❑ DUMPOTHER INDUSTRY{OMR ❑ Cl.; Cl ROAD ❑ WILDLAND ❑ UTILITY, RAILROAD ❑ NON-WILDLAND ❑ UTILITY, ELECTRIC El OTHER r� DAMAGE (n n n na n %77 �� 3 INCIDENT TYPE I -, - - FIRE ❑ FALSE ALARM—GO TO y '� ' Number BLOCK' 10 I 1 _ RESPONSIBILITY �! 5 4A 46 / STATE ZONE V= STATUTORY O ❑ WILDLAND LAND BURNED OR THREATENED RESPONSIBILITY ❑ CDF t. . LOCAL GOVT. CONTRACT O AT ORIGIN) 0 30 UNPROTECTED O❑ ❑ STATEI GRASS ❑ ASSIST OTHER AGENCY (Not City) Cl U.S.F.S. ❑ A .25 ACRE OR LESS LOCAL ZONE 0 ❑ B.L.M. , CDF LOCM GOVT. CONTRACT B.I.A. ❑ 0 ❑ ASSIST. PROD. OTHER, AGENCY (Not City) ElOTHER FEDERAL STAT T. RESPON. FEDERAL ZONE •❑ OTHER ® ❑ ASSIST FED. AGENCY (Not Mil.) Other than -T,B Y G)-,- O ❑ CDF LOCAL GOVT. CONTRACT i MISC. AND OTHER Q❑ ASSIST CITY, CONTRACT CO., MIL, OTHER AGRICULTURAL PRODfi?>`` (STARTS IN 0 0 0 OR O ONLY) r ECAUSE ❑ LIGHTNING ❑ DEBRIS ❑ PLAY i W/FIRE ❑ D 100-299:, ACRES " Other than T & Y G ❑ CAMPFIRE ❑ ARSON ❑ OTHER/MISC. ' - ❑ SMOKING EQUIPMENT I ". I Y " ' b LAND USE (STARTS IN t 2 5 OR 4& ONLY) DOMESTIC ❑ FOREST INDUSTRY RANCH -FARM • ❑ RECREATION ` ❑ DUMPOTHER INDUSTRY{OMR ❑ Cl.; Cl ROAD ❑ WILDLAND ❑ UTILITY, RAILROAD ❑ NON-WILDLAND ❑ UTILITY, ELECTRIC El OTHER r� DAMAGE (n n n na n %77 �� I ACRES BURNED ",' , - - ' ` ~ Y-' y '� ' Number . S DAMAGE off toNearssf SI 1 2 b/or 8 5 , TIMBER &/0 R'::: LAND t. . BRUSH YOUNG GROWTH GRASS E'' ❑ A .25 ACRE OR LESS AGRIC. , WILDLAND VEGETATION PROD. > <`> STAT T. RESPON. Ol ACRES BURNED Other than -T,B Y G)-,- >?fr} wf OF AGRICULTURAL PRODfi?>`` - + Y• r ❑ D 100-299:, ACRES " Other than T & Y G U.S.F.S. - I I Y " ' WELLING ❑ F 1000-4999 ACRES - B.I.A. ! &/OR(JULATENTS ` ? B.O.R.. OTHER FED. OTHER STRUCTURES ''.'•}}•�•';:: is {J'•'}i.ti:.r+3.$ f0:.'v: r �..}iu:.::•:. }::v'Qi'.4::;.•.::{i::':titi•. :}}}:::z•}::;:F:::..:.}•:.. r}ww,::.;•.;;}:w;}••:{ >:;:.}::} •::::.z::.:. OTHER &/OR S VEHICLES d CONTENTS 1 OTHER TOTAL :,<.}•�; /EGETATION BURNED \� I ACRES BURNED ",' , VEG. 1 TYPE TIMBER v SIZE CLASS WOOD LAND t. . BRUSH GRASS E'' ❑ A .25 ACRE OR LESS AGRIC. , PROD. > <`> STAT T. RESPON. " - v SIZE CLASS TOTAL 8D E'' ❑ A .25 ACRE OR LESS , ❑ B .26 -9 ACRES > <`> STAT T. RESPON. Ol ACRES BURNED OF E] C 10-99 ACRES «•`:' STATE ❑ D 100-299:, ACRES " :?'•! U.S.F.S. x s ❑ E 300-999 ACRES '«?^ B.L.M. ❑ F 1000-4999 ACRES €>. B.I.A. ❑ G 5000 ACRES OR MORE ` ? B.O.R.. OTHER FED. . ''.'•}}•�•';:: is {J'•'}i.ti:.r+3.$ f0:.'v: r �..}iu:.::•:. }::v'Qi'.4::;.•.::{i::':titi•. :}}}:::z•}::;:F:::..:.}•:.. r}ww,::.;•.;;}:w;}••:{ >:;:.}::} •::::.z::.:. OTHER 1 TOTAL ON ARRIVAL (Q VEGETATION FIRES ONLY) ► 9 " SIZE " + DISTANCE (Origin to head),, +" fJ. ACRES FEET ' WEATHER" ESTIMATE AT SCENE) WIND SPEED (M.P.H.) DIRECTION (FROM) TEMPERATURE (°F) s 10 OVER PLEASE CDF 7560-130-01 18 87 45419. A• I�s l 0(,- I // /o l e ou "(Ye ko4 /as-fic o'�.) rva bN a-�- 190 - A-1 u �r � � �,� C -e- a pol o tic P� Wo 3 oo rn m U O� C Z Q Q ow W