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005-401-003
Richard Kisling 1358 Davis' St. , Chico (CONVERTED GARAGE TO LIVING UNIT & INSTALLED W/H WITHOUT PERMITS) 5-401-03 128 'f8'9E HALL, Patricia A. eitinger 1358 Davis St ico �� 0' Contr: Au ey Electr' 4 (upgra elec ser)SFr o 005=401-003 92-2630 BPEM .VLH CONSTRUCTION 1358 Davis St, Chico /-/ y- 9.3 new"sf 92-3416B 005-40-1-003 VLH CONST 1358 Davis, Chico Z demolish sf 005-40-1-003 92-3967B,E VLH CONST ^-- 1358 Davis St, Chico / _/l, 93 repairs for detached garage • r gem . " Zoning violation letter, dated 3/28/83 C)0Ct) — ll•j 0 r I I I Richard Kisling 1358 Davis' St. , Chico (CONVERTED GARAGE TO LIVING UNIT & INSTALLED W/H WITHOUT PERMITS) 5-401-03 128 'f8'9E HALL, Patricia A. eitinger 1358 Davis St ico �� 0' Contr: Au ey Electr' 4 (upgra elec ser)SFr o 005=401-003 92-2630 BPEM .VLH CONSTRUCTION 1358 Davis St, Chico /-/ y- 9.3 new"sf 92-3416B 005-40-1-003 VLH CONST 1358 Davis, Chico Z demolish sf 005-40-1-003 92-3967B,E VLH CONST ^-- 1358 Davis St, Chico / _/l, 93 repairs for detached garage • r gem . " Zoning violation letter, dated 3/28/83 C)0Ct) — ll•j 0 r f AI®, ems- - •lam y 122:7^- U t t R IDENTIAL 005-_401-003 63 W-20 HP -1 VLH CONSTRUCTION 1358 Davis St, Chico new sf /J .1 • �F I�PY Address ZA y GAS ' Meter By Date ELECTRIC I , Meter By V�� Date Z R .• � 1OFFICE COPY Address__ 130) --AVIS 1/- I GAS 1 � iL Meter By Date ELECTRIC Meter By Date JOB FINALED (Date) Signature .i OWNER: PRE -INSPECTION LMGX ,i LOCATION: ch l CC) DATE • 1' / 1 co) qz A. P. # OCiS - 5 3 -0000 CONTRACTOR: r ZONING A PRE -INSPECTION FOR: F1 y e DATE TO INSPECTOR PERMIT HISTORY: NONE AS FOLLOWS: lei Shoo 4-o replace t TYPE OF OCCUPANCY FIELD - INFORMATION BUILDING USAGE: TENNANT: [::] OCCUPIED D HAS ELECTRIC �= HAS GAS Q HAS SANITATION FACILITIES Q HEATED -COOLED PERSON CONTACTED OTHER COMMENTS: ACTION RECOMMENDED: ISSUE Q HOLD FOR OTHER: BY DATE DEC -:3 1 -92 THU 1 E _ Q 1 �.LH �COtA .~T`RUCT I 01J P 1 (04�SJ ; permit No. VTI...'. -2- /,,* �fia ;) I;Nt�RGI CkRTI CAT10N 005 = 'yam i _ 003 1358 Davis Street, Chico Ca. �---- LOCATION A.P, NA, DESegrrrION of -INSVLATION ROOF Brand Meme Material Thermal Reaistancp (R Value), ThickneeaC�.nchse) EXTRRIOR WALL FIBERGLASS BAITS Araad Name OWENS-CORNING Material Thermal Reviatance(A Value) R Thlckneas (i.nches) CEILING 4ttar Blanlcat Typo aFIBERGLASS BATTS Brand Nam Batt 12„ Thermal Resiatance(R Value) ..'Thickneae(inclres) � grand Nuwe Loaae fill Type 16" Number aP bags, 6Ht, per bag 35 lb. Minimum Thicknee (Inckses) Arca covered(ft o ) a Ther"I Resiatance(R FLOOR, ELEVATED Material Thicknees(inches) F).00R,, 81 Ag, , Material Thickneas(inches) width(inches) Brand Name ' Thermal ROsistance(A Value),--� Brand Nana ' Tltsraaal _Rsaiae'ance(R V41uo),,,_� FOUNDATION WAIL RVOW Nave I Material Thera+al R�isigt�nos(R Value ,,,,.,,,,... Ti►icknea8(incltiea) `'.r ,... , I hereby certify that the above tnrulatS.on was inpkiiXod in tho *boira building in conformance with the State of C41iforn14 Bnrr57 Requ"Wout"t LOERKE INSU:.ATION CO. INC.. 499150 • FIRM /OWRER STATE CONTRACTOR $ I+ICE N0. 2 h DATE URE December 30 1992 40TZIfi—Eor ATION APPLICATOR = - I hereby certify the above inaulatiOn and all T09" ed item " shown on the Building Department approved plane and 4tt4abim0t8'h4v0 been inatalled as required by the State of California Energy Requirements. All equipment, devices and materiAl• ax• of the qua lity'preocribed or are apocifically approved by the State of California,• 6 v c 10 �-77 6 2. - FIRM H"/OWNER please print) STATE CONTRACTOR 8 LTCKNBR KO, 2-3 Sir TURi OF lar.-NERALC0 CTOR OWliRR DATE t. . �• TUTS CRRTTVXCATE MUST HR ON FILE WITH T09 BU14PINO 0804TMRNT p6tion TO FINAL INAI'EGTION ApPROV&L AND A COPY BNA:LI. P9 pASM WITHIN TO PUTPINO • J=OK, O=Not OK -=Not Applica0e = Not Ready -MOBILE HOMES MISCELLANEOUS Date MOBILE HOME UTILITIES (Plans) OK except #'s Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements ' 1. Zoning Requirements -Setbacks -Easements 2 �Soils;'Special MH Support Sketch ---J 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Sewer; Location -Test -fall -C/O Concrete ` ' 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch)._] 4. Wood Awn.; Posts- Beam s-Rftrs.-Connectors 5. -Electricity; Location-Clearences-Grnd-/ /Amp -Concrete Shthg.-Rfg.-Bracing 6. Gas; Location -Test -Wrap: 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures / /"Nat. or/ /" L"ft./ /"LPG 6. Carports; Windows -Doors 7. Well Clearance & Disconnect 7. Electric 8. Utility Clearance 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing Date Card B-1 Date Card B-1 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks Easements Date Card B-1 Date Card B-1 2. Footings; Size -Spacing -Marriage Line Date Card B-1 Date Card B-1 3. Gas; MH Test -Demand -Valve -Connector Date POOLS (Plans) OK except #'s 4. Electricity; MH Test -Crossovers -Breakers -Clearances 1. Setbacks -Easements 5. Drain; MH Test -Fall -Flex Connector% �,y-tib 2. Soils; Compaction -Structure Stability 6. Water; MH Test -Regulator -Connector _ 3. Pool Structure; Steel -Connections -Thickness 7. Water and Sewer Connected -C/O to Grade -HD Approval Dead Men -Lining 8. Gas and Electricity Tagged 4. Elec.; Receptacles and Lighting, Distances-GFI 9. Exits; Insp.-Sketch 5. Elec.; Pool Lighting; 15 volts-GFI -10. Cert. of Occupancy 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. Date - - Card B-1 Date Card B-1 Boxes-Enclosures-Panelboa rds-Ins. to Main in Conduit Date Card B-1 Date Card'B-1 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test -�-. Date Card B-1 Date Card B-1 Date Card B-1- Date Card B-1 �t - h V t 1 J=OK O = Not OK = Not Applicable Not Ready RESIDENTIAL (Single & Duplex) = Date UNDERFLOOR (Plans) OK except q's 1. Z ning-Setbacks-Easements-Flood-Slope a ZF, Ftg., Main; Soils-Elec. Grnd. g tg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth qe'4. Ftg., Porches & Decks; Soils -Steel-(/ g. 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 -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date/0- and B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date-PWMBING (Permit) OK exceot a's Gas Pipe _Date -q Card-B_lkio - --Date Card B-1---------- - ----------------------- Date Card B-1 (,� Date Card B-1 Date ELECTRI L (Permit) OK except #'s xture & Transformer Clearance -Ins. Protections eceptacles SpaGjy�ights & Swig Doors ---- -------------- 24-'5,ze-Boxes -& -- No. -- of Conductors -Stapled --------------------------------/ -------------- 25`8e <x Installed Close to Edge ofd& C.J. -------------- ------------------------------------- ----- -- 26._ Equi-G nd made upw astners-Bond G ---- Wa ---------------- --------------------------- ppliance Circuts in Kitchen & Conductor Size/GFI ---------------------------------------------------------------------------------- u ee ire iz Wire Size 1 / ga. Gu or At -------------------------- - --------- ---------------- ------------------------- --- 29. c.. Circ. / / ga. Cu or Al. =area rveufral res � O No --------------------------------------------------- -------------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect -------------------------------------------------------------------------------- 31. V.44tCrip. Clearances Panels-Motors-Mech. Equip. --- - -- 32. CI s Closet Light -Shower Light -Spa Light ----- ----- ----------------------------------------------- 3 Smoke Detector ---- --- - --------------- - - - -- - --- Datel-1-7.-q-` Card B-1 - Date Card B-1 -- ----- ---- ---- --- -- -- --- .--- --------------------------------------- -- - - Date Card B-1 Date Card B-1 Date MEC NICAL (Permit) OK except ft's A. ucts Insulation & Support 35. en n: Exhaust above insulation 3 densate Drain & Overflow: Size & Grade - - - Fu nce-Vent: Access -Comb. Air -Return Air Vent -115 outlet -- -- --------------------------------------------- F- -- - -- - -------------------- t ----- ttic Access & Platform if Furnance in Attic ---- ---- --- - - ------------------------------ - Dat - Card B-1 DateCard B-1 --- - --- -------------- ---------------- Date Card Bj,3 Date Card B-1 Date tans) OK except a's 3 roper Material nch -------- --- -- ------------------ ------------------------ 40. Walls Studs _Nailing Spaci raci g- ates-Sound 41. Bear ng Walls over Gir ers & Floor Nailing ---- --- - ------------------------------------------------------------- 4 raft Stop in Walls (rat proof) ---------- --- ---------------------------------------------------------- re Stops; Furred Ceilings -Stairs -Chases -Tub gk!aders & Beam -Size & Bearing Date FRAMIN. ontinuedL=� 45. Han4esPost Caps -Anchors -Connectors 46. Cln .,joist- s-Purlin-root Brac-Tru .-Ring. W-lire�place Ties or Type A Flue��-Fir�eplace T t clearance 4j, Size & Rorrre2' rotection-Draft Ste - ns. Baffles rm. Wi itin Do , 1 Hgt. & Di ions arage Fire Protection Framing 51. Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection ------------ j- plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55- iding-Nailing Veneer . 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailinq-Bolts 14742 59. Insulation -Walls -Ceilings - 60. Infiltration -Walls -Windows Date Card B-1 Card B 1 ,i Date Card 13-1&j3 Date Card B-1 Date FINAL (Plans) OK -except ft's 6 xt. teps: Doer & Sidelight Protection -Landings Smoke Detector �63._Eo6flaee; Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor -Ducts -Meeh. Protection -------------------- 6 - edieom Exiting & Bath Fixtures & Tub Access Trim & Subpanel: Breaker Sizes -- ------------- & Rails e or Stove: Clearances -Hearth lec. O ZOutlets at Wood Panel: Int. & Ext. -- ig. i. ixt & Appliance; Grnd.-Air Gap -Cooking Clearance 7>�ec_ Outlets & Receptacles at Kit. Counter ---- - - z 2-'haiage Fire Door_Swing-Landing-Closer ------------- dt3!A'177-Duct in Garage -Damper 7a�ltr. Htr.: Vents -Clearance -Comb. Air-Connector-P.R.V. , In Garage: Above Floor-Mech. Protection 7` �b_b_. Elec. & Mech. Equip. c Listed for Location 74. -Ere -c. Receptacles in Garage: (G.F.I.)-Ro Protection 7&,1rnsulation -Foam-Looked in Attic Yes --------------- ---------- --=--------------------------- 3-_Gtrard-Rails & Deck -Co nst ruction -Post Caps nn s &Crawl Hole Door -Drainage & Wood -Earth arance Looked under Floor Yes -�-� ollowing inslld.: Drive ❑ Yes No; Walks ❑ Yes ®'No; Planters 0 Yes E�,�o ----------------------------------------- --- .81. Stucco: Brown -Finish -- �2!l�Unit: Disconnect. Electrical, Plumbing - -------------------------------- - .aq-*ents Above Roof: Plb9 ' APP liance-Fire p lace. -Clearance to Openings as W24er Well: Disconnect, Electrical, Plumbing 8 erior Elec. Trim; G.F.I. Receptacle -Underground - - - ------------- ___ ------ ----- 8 tilation Throughout House d ass Protection ctions fr Previous Inspections y�y 89. Gas T - eters Tagged Gas -Electric ater & Sewer Connected -C/O to Grade -HD Approval - 1. ergy Compliance Certificate -Other Certificates- - - Date Card B-1 Date Card B-1 Date �t Card B-1 G$.✓ Date Card B-1 Date /%L4 A Card B-1 �i� -Date Card B-1 Comments at Final .. ...,. �`y _=�^",r.:^fir --'�21--^li:ti^'-nvQ`•"�''�• r" z�+•: r << COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-275.1 =, 7 County Center Drive, Croville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE >3 VLA may': OWNM PERMIT NO. A roudne -.--r an indicates that the following violations of Butte County Ordinances exist at the ah— and should be corrected. Please notify this office whien'correctiori .of work, is lfyoghave any questions pertaining to this matter, or need additional explanation;. please flitimmediately. AAe,17, f-eno julf"i-1 `M w t s `i f � `M w s `i y _ ._ v-., „--v`.. ,.-, �-tir rl., •• 's Y.. �,�'^iIY--'1.-�.^, kip+! wrn."� . M.,..9�L-1-yr,T...,�`Y=� i i ' COUNTY OF BUTTE i I DEPARTMENT -OF PUBLIC WORKS 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE YL4 3d-I� OWNER PERNQT NO. A rout a inspection indicates that the following violations of Butte County Ordinances exist at the a ov address should be corrected. Please notify this office when correction of work is c to . If you have any questions pertaining to this matter, or need additional explanation, act this office immediately. 1UW_1NA 10A 411Gki YiS' 0 0n /rn... i- L N n n /? rn rn., 0dn &1W W FW 1 >.".MA ---=. BM_ _ f V; WWI Date Inspect r� REV 11/91 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when cortection of wart is completed. If you have any questions pertaining to this matter, or need additionalexplanatiay please contact ' office immediately. AA Date/1 Inspector �� . JV/ I /yn REV 11191 9 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Orovllle, California 9596ii - Telephone: 916.'538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMB R • ZONINO 005-401-003 AR BUILDING PERMIT OWNER V. L. H. Construction TELEPHONE 8917--5015 SQ. FT. OCC. BUILDING VALUATION 760 R 51 840.00 OWNER'S MAILING ADDRESS 882 Bruce Lane, Chico 95926 /T U Cov. . i -z' 8-66 1.5& D CONTRACTOR'S NAME TELEPHONE V. L. H. Construction 891-5015 CONTRACTOR'S MAILING ADDRESS Fireplace A 1,500.00 882 BRUCE LANE CHICO CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15,00 LENDER'S MAILING ADDRESS Permit Fee $ 395.00 ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ 197.50 Bruno & Hawkins Ener Plan Checking Fee Energy g $ 20.00 ARCHITECT OR ENGINEER'S MAILING ADDRESS 10 Constitution Dr.. Chico 95926 Penalty $ BUILDING ADDRESS Permit fee 627.50 $ 1358 -.Davis St.. Chico PLUMBING PERMIT FiiingFee 15.00 ,r-- - -• - Each Trap 71 5.00 39.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 7.00 Each qas water heater or vent 7.00 7.00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 5.00 5.00 Building sewer 15.00 SF ® Duplex❑ Mobilehome❑ Other Mobile Home S G I W @ 15.00 SPECIFY TYPE OF WORK New* Addition❑ Remodei❑ Utilities Installation❑ Other ❑ Permit Fee $ 84,00 Describe work: -57 f _ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 18.50 200A OR LESS Main service 20GATO 1000A) 37.50 CONTRACTORS LICENSE LAW NEW CONST. ( DWELLING occuP.&\ 3.6a sq.ft. OR ADDNS. \ ACC. BLDGS. I I dec are under penalty of perjury (check One): NEW CONSTR. MULTI -OUTLET @ 5.00 1 am licensed under provisions of Chapt. 9, Div. 3 of the Buslnes$ NON -REST BRANCH CIRC ITS POWER APPARATUS 6 and Professions Code and my license is in f II force and effect. License No. :07i6� Classification 1 (SINGLE OUTLET CIR. ) Ex. Occup(OUTLETS OR FIXTURES 20 76 ❑ I, as the owner,•or my employees with wages as their sole compen- FIXED APLNS. EX. Occup. OUTLETS P(RESID )REA.) I 3.00 sation, will do the work,and the structure is not intended or offered Temporary service 15.00 for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- Mobile Home Facilities 15.00 ors. (Sec. 7044) Misc. byirin g 15.00 ❑ I am exempt under Sec. , Business and Professions Code for this reason Permit Fee $ - Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): MECHANICAL PERMIT FiIingFee 15.00 ❑ The permit is for $100.00 (valuation) or less. Heating 9.00 1 have placed on file with the County of Butte Building Department SPLIT SYSTEM a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling 9.00 ❑ I shall not employ any person in any manner so as to become subject LHood 6.50 6.50 to the W. C. laws of California. Ventilation 3 13.50_ Notice to Applicant: If after making this statement, should you become subject .50 to the W. C. provisions of the Labor Code, you must forthwith comply with such Penult Fee $ 5J5�, provisions or this permit shall be deemed revoked. Contractor I certify that I have read this application and state that the above information Mobile Home Installation Fee $ is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Energy Inspection Fee $ 4 Butte to enter upon the above-mentioned property for inspection purposes. 2 c4N�Tf PE 1 also agree to save, indemnify and keep harmless the County of Butte against 7 , I" TOTAL EE $ 87 all liabilities, judgments, costs, and expenses which may in any way accrue HAz 0FEES IMP F CDF PARC PD against said County in consequence of the granting of this permit. X 7 Z 0 Date This permit is hereby issued under the applicable provi- Signature of Applicant - 0 er Contractor Agent sions of the Butte County Code and/or resolutions to d0 An OSHApermitover '0" deep and demolition or construct- work indicated above for which fees have been aid. p urestover 3Qstoriesoinehe ght'ons Ji RE TOR PUBLIC WORKS e S S By Date/o -f'i LR,ceipt No PER XPIRES Date ITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENRO�- PPL I CANT r+;�"��s^r.��K3^'J"�c►"�t�r`tiIQb't�7�31t COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER V L n 0 O "-4 A. P. No. 00-�,- ZYO 1-003 Proposed Building Use Q± Building Inspector Date�- At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ..................... . 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............ . 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 1 Fees -of $ 5 9y . ............................... ...... 11. Impact fees as shown on attached schedule. 12. California Department of,Forestry plan approval/fees. ....................... . 1 Flood elevation letter (100 year floo ),by California Engineer . ............. . 14. Sanitation and Ipo lian approvalC�%cc., Health Department. ........... 15. City of Chico plumbing permit. ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. ... . uest 20. Pre -inspection for to Building nn re t required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. ? 22. Certificate of Workmans Compensation Insurance. . 23. Owner -Builder Verification (Given to owner , Mail to owner ) ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. - Z -3-592- ce ' 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ........................................ 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When ou issue the,�ppermit, process as follows: Mail to owner. Mail to contractor. Telephone X35/ " I S- and hold for pickup at It o office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted pfor e ' i s nce. ( ' cle new item not checked above). 1. Index permit for above items No. 2. Additional itergs required: �I�JCa Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was 1 .sed of above require data by _ phone _ mail Counter b Date Plans check�y _g ��lL lAe g (1 Plans 9&foved by _ � Date ns on hold in %File ca Copy - Department of Public t t' F.H. USE ONLY I'lut Plan Attachad �I Floor flan Auad d l� Sent to Ii. D. TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance VA C�-��4�, I �� y, ie--, �- 5-(0) � Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public _�— Private Well Clearance for bedroom +i+eb44e home. Other Hold final for: Final clearance O.K. for: NOTE: / Environ dental Health Specialist 8/92 p Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DMSION 7'COUNTY CENTP.R DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916)5387541 OWNER PROPOSED BUILDING USE S. A.P. NO. ,QQS L/D 0 03 DATE 2 - `2-`7 - `! Z 1. School Distric Fees (paid at District Office) 2. Sheriff Fees ` (paid at Building Department) Residential ..... X =$ unit amt. Commercial(per sq.ft.) X =$ sq.ft. amt. _ 3. Urban Area,Fees (paid at Building Department Residential (per unit) - X =$ # units amt. Commerical(per sq.ft.) X =$ sq.ft. amt. 4. Recreation District Fees (paid at District Office) 5. Drainage District Fees (Contact Land Development) 6: Other 7. Other REC. # DATE REC 2 - At time of permit application; I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE �� A.0 I:;.- I W E.D 1 5 2 13 Pe-: I I :L C t-, i F A X T R A N S M I T T A L Date'. Attn: A.VTO CQmpany; -JLA_"[TTe- __ Fax From,. Number of Pages; (Cover Sheet 1,-icuded) RE. - Remarks: i� &gng j,6,2Ji,ZL , ln-aLs P5 U C- G Ce 20 conmitulion Drive Suite A Chico, CA 95926 916/895-1125 P . 0 1 ieL,G— 1 —D2 W ED 1 — - = 0 P-� 1 1,C�h i =`�= F _ 02 'fir R Point System Summary: Climate Zone,. 11 JP -2n = n , i •5711. ,, �� jg .�i�. Project Title Dato � BUILDING DATA Conditloned Floor ArcaGj lv � Number orStories Slab/Raised FloorLf Check all applicable unit T'ypc condition(s): Pi' Single Family Dmacchcd (SPD) (J Addition Alone () Single Family Atu ichcd (SFA) j J Existing Building (J Multi•Family (MF)- ( J Existing-Plus-Addidon SCORECARD Glass Area � % Glass North __.Cry. 4. 33. East ;S •C.33 South 10. Exterior Wall Mass NVest 1. Ceiling Insulation Skylight 44 Total Sum 7.10 SCORECARD i S 7 Interior Mass/CFA Measures 10. Exterior Wall Mass Point Scores 1. Ceiling Insulation or Sum 7.10 11. Heating System' ,�2 R-valua (38) U -value 10.0301" Zgnal Control? ( Y / N) SE or INK` 2. Wall Insulation ?-- 14 or (0.72/6.6) �7 12. Cooling System R -value 111) X Lz_ LI -Value 10.0981- � Zonal Control? ( Y / N } 3. Raised Floor Insulation Wcetive Srr;R 17.031 or 13. Water Keating �� --- � R-valuc 1191 Ty;ha ISG) U -value 10.037) 4. Slab Edge Insulaiion (2? or Form Revised March 1989 � • R-vuluc 1101 M factor 10.77) S. Infiltration Standard p 6. Class Heat Loss _ 7.� ]� L- .w s 2. Type Idoublel U -value 10.65) baa ` oLai Glass 116) o� Sum 1.6 7. Shilling (Shade ®pen) To Glass SC E17 % Glass tt. North I tr3 x b. East <. t3 x ---L(—. —'z- _ �! C. South ; x d. West �� x �S�► s ?��9.1. c, Skylight L~ 12. X x .� S. Shading (Shade Closed) % C1ass SC Err. % Glass a. North 4.03 X ISO = 4 2 b, East - ss 33 x Go -- _._ 2. b 2° c. South X AQ .=S d. Wcst X so c. Skylight ----1 Z - X 4 t Ai 9. Interior Thermal Tvtass i S 7 Interior Mass/CFA ' 10. Exterior Wall Mass Exterior Wall Mass Sum 7.10 11. Heating System' ,�2 x Zgnal Control? ( Y / N) SE or INK` Duct Rffieieney 10.78) l;ffcctivc STs or (0.72/6.6) 111SPF 10,56/5,151 12. Cooling System I I. �?_ X Lz_ 7. b � Zonal Control? ( Y / N } sCER 19,51 Duct Efficiency 10,741 Wcetive Srr;R 17.031 13. Water Keating �� -.4& � Ty;ha ISG) Credit InoneJ Point Total: Form Revised March 1989 F-4UG— 1 92 W ED 1 S _ 2 1 F' e. 1�4! n_ _ =h i' F' 4�3 Shading Coefficient (SQ Worksheet Form S Items l - 9a and 10a rrus( be completed for glazing/shading combinations not found in Table, G-9 of the CCM by using documented manufficturcrs' data for the specific conditions indicated (42,98 and #11). For instructions on filling out the worksheet, sec Shading in the 1=CN1 Glossary. For overhang SC values (#14 and #151), see Section 4.2 in the GCM, General Information 1. GlazingType: 2. SCglazing aloha: - — —•� _ 3. Framing Type (metal/wood); 4. M'uUions (yes/no): Ina 5. FramingiMullion Factor: 16 b (from Table -10)� Glazing, Interior Shade & Framing 9a. (( =0o x 0.25) + 0.78; x .., 2 - x . _5.8 SCmax SQ?1ln FM>~ (#5) or 9b. (from Table 0•9) SC Shade Open 10a. [( 11 x 0.25) + 0.751 x ,W x _._:5b SCmrxx SCmin FMF (#S) or 101). (from Table 0-9) SC Shade Closed Exterior Shade G. Interior Shade Type: K4;W -4nr L 7. SCshade open' 1.00 8. SCshade closed: + (0 co (SC of shade w/ clear single glass) 1 �VD SC Shade Opcn SC Shade Closed Where: SCmax = largo of #2 and #7 SCmin = smaller of #2 and 07 Where. SCmax = larger of #2 and #8 SCmin = smaller of #2 and #8 Exterior Shade Type: 13+-A- 11. SceXterior shade: 1(01 (from Table G-11 or manufacturer's data w/ clear single glass) :1 - - Where: 12. H 1(0t� x 0.25) + 0.751 x ,(07 = ��, SCmax _ lar-er of ##9,a or #)b and #11 SCmax SC"'in SC Shade Open SCmin = smaller of #9a or #9b and #11 13 [( — Where: �(� x 0.25) + 0.751 x ►�� , CPO SCrrcax = larger of #10a or #lOb and #1 1 SCmrix SCmin SC :Shade Closed SC?n1n = smaller of #10a or #10b and #1 l Overhang (Point System Orly) Projection Ratio: 14. _ x Overhang Factor (Shade Open) is. _ Overhang Factor , (Shade Closed) rorm Roviscd March 1988 .1'o s Jl ,5naae UpcM (# 12) X , 4 C) SC Shade Closed (#13) SC Shade Open (with Overhang) SC Shade Closed (wllh Overhang) n 5M. ,_ - _1 Certificate of Compliance: Residential (Page 1 of 2) C+' -1R .ONS i- Z z -cid .��. Project Title Date 1?so Project Address Building Pennit N •e Documentation Author 'telephone �r OI j -j 55T� / / Checked By / Date Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Arca:. ci too ft2 Building Type:_ Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stories) Addition Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation: North / East South / West / All Orientations (circle one or more) Number of Dwelling Units: Floor Construction Type: Slab _/ Raised Floor (circle one or both) • 4 Infiltration Control: Standard right (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value (attic, to garage. typical, eta) Wall ........:..... R -II E4 r-fJL, Ia(L wnLLC, Wall .............. Front.... (f,) Sy Roof ............. G L ILI Roof ............. Front.... ( ) Floor ............. Floor ............. Left......�►�- Slab Edge.*.... YF� GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang FramingTypc Orientation (SO (single, doable) (roller blind, etc.) (shadcscrcen, etc.) (yes/no) (metal/woo(l) Front.... (f,) Sy Dr''�(. Y� ry1f riat- Front.... ( ) Left......�►�- YF� mh�rAL. Left...... ( ) Rear..... (,3) 2% Vat- Yat m ET n L Rear..... ( ) Right.... (N) to IP12; . Y Fq vn 4;:n4L Right.... ( ) Skylight....... z— ys?;tr Yv+k rrkL Skylight....... THERMALMASS Typc/Covering Arca Thickness (slab/exposed, tile, etc.) (go (inches) Loci tion/Description (kitchen, bath, etc.) i� G►�Q'F'P T /SC.aP� 23�•E (,�vi��c. ern, \)t0Yt. 1SI. wb I l o l r iTc H f rJ t�7 P�A-M .Mx_ rll a...: - - r Certificate of Compliance: Residential (Page 2 of 2) CF -111 orJ,P_ ?�EZ?r-om i.7 r-- Ne- "G 4A Project Title Date 7- 22-cZ HVAC SYSTEMS. �Y t.ow91z6a�.rr�� Minimum Duct Type (furnace, air Efficiency Location Duct Output titanufacNrer ode)-# conditioner. heat pump) (SE. SEERMSPFI (attic. etc.) R -Value (Btuh) (or approved equal) rueoAc,e- Gam,• ,-?2, A1716 S'7 Cn�.-YJ tr r� f± q � � K►�n rG S � 7 Maximum Furnace Heating Output: Btuh f -Si t: avTV. Ac3 0V_ HOT WATER SYSTEMS--- Tank 1 Manufacturer/Model # System Type (storage gas. etc.) Capacity for approved equal) Special Features) STo9 A J R-12 External Blanket On Storage Tank (Yes or No) SPECIAL FEATURES/REMARKS (Add extra sheets if neccssary) COMPLIANCE STATENIENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24. Chapter 2=53 and Title 20. Chapter 2. Subchapter 4. Article 1 of the California Administrative code. This certificate has been siencd by the individual with overall design responsibility and the building owner, who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, all building conservation features which vary are.indicatcd in the Special Features/Remarks section. Designer Name: '/'Aay 0AWIGIrJS Title/Firm: 'f-5R-utJO 4/i tauJ>✓�N� NYr.E7/ rF� r Address: 20 erif,077 ru1•1a.1 VZ 7F q IN1Gv ♦P 99924, Telephone: MIG9� - 12S' Lic. H: (P (signature) (date) Documentation Author Name: 14-Al2(- Title/Finn: In Address: Telephone: f1 ✓>7 (signature) (date) Revised July 1990 Building 0%%mer' Name: Title/Firm: Address: Telephone: (signature) (date) Enforcement agency Name: Agency. Telephone: (signature or stamp) (dater Mandatory Measures Checklist: Residential N'IF-1 R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (•) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION DESIGNER I ENFORCE\tE\T Building Envelope Measures §2-5352(x): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation manufacturer's labeled R -Value. • §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). Y §2-5352(k): Slab edge insulation - water absorption rate no greater than 0.3%. water vapor transmission rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352(0: Vapor barriers mandatory in Climate Zones 14 and 16 only. §2-5317: Infilmdon/Exfiltration Controls - 4 a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped: all joints and penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. §2-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal, or glass door b: Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. HVAC and Plumbing System Measures _k §2-5352(g) and 2-5303: Space conditioning equipment sizing: attach calculations. „1 §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. ,( ' §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. I X §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. ,( §2-5314: HVAC equipment, water heaters, showcrheads and faucets certified by the CEC. X . I§2-S352(i): Water heater insulation blanket (R-12 or greater) for storage and backup tanks for solar water heating systems (first 5 feet of pipes closest to tank insulated (R-3 or greater §2-5312(Excepdon I): Pipe insulation on steam and steam condensate return & recirculating piping. 12-5318(d): Swimming Pool Heating 1. System has: a. On/off switch on heater. b. Weatherproof instruction plate on heater. c. Plumbed to allow for solar. 2. 75 percent thermal efficiency. 3. Pool cover. 4. Time clock. 5. Directional water inlet. Lighting and Appliance Measures 12-5352(j): Lighting - 251umensAk-att or greater for general lighting in kitchens and bathrooms. X §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. ;2-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. s{ Revised July 1990 Point System Summary:. Climate Zone 11 MR Ot.1t. 'PaFARGi-gym ��iif�G.rJC_ -�cf' \/L N �cn.1STiLl?G71C1tiJ 7 �'.'.•�e�. YrojectTitle Date BUILDING DATA Conditioned Floor Arca , Q(oo Number of Stories 2 Slab/Raised Floor 4-P f> Check all applicable Unit Type condition(s): Lia- Single Family Detached (SFD) [) Addition Alone [ ] Single Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (MF) [ ] Exist'ing-Plus-Addition SCORECARD Glass Area, % Class North t., , (,3 Last Sy Measures South :,U, �• �c West.. 71,7 . ,Q, r Skylight 4— 42 - .42 - Total Total (Z7 1 , 22 SCORECARD Measures Point Scores L' Ceiling Insulation e -3o or -I It-value(381 U -value 10.0301 2. Wall Insulation Iz- II or O It -value I l 1) U -value 10.0981 3. Raised Door Insulation or It -value 1191 U -value 10.0371 4. Slab Edge Insulation 0 or O It -value (01 1.2 factor 10.77) S.. IntiItration Standard 0 G. Glass I-Icat Loss pal, t � ,Z� -> y Type (double] U -value 10.651 '90 Total Glass 1161 Sum 1-6 7. Shading (Shade Open) % Glass SC Err. % Glass a.. North , tn3 X I _n _ , 41c, -I b. East. S, tai X -7- = U, . 2 c. South 1,215 X = 2, �q 4 2 d. West ?_, F-11 X 1 7, = 2. Ito p c. Skylight , yZ X M _ d 8. Shading (Shade Closed) % Glass SC Eft. % Glass a. North ' , ln� X I r, o = t N2 2 b.' East 9., [off X c. South �, , �$ X (, = 2 yb d. West 2,P! X l hIn = I•a --'t e. Skylight , 442 X , to(o = , 2b O 9. Interior Thermal Mass , Interior Mass/CTA 10. Exterior Wall Mass —3 - Exterior Wall Mass Sum 7-10 11. IIeating System X Zonal Control? ( Y / N) SE or HSI T Duet Efficiency 10.781 Effective SE or [0.72/6.61 I ISPF 10.5615. 151 12. Cooling System 9,5 X t82. Zonal Control? ( Y / N) SEH [9.51 Duct Efficiency 10.741 Effective SEER (7.031 13. Water IIeating 6 0 6 Type ISGI Credit [none] Point Total: Form Revised March 1989 Thermal Mass Worksheet WS -1R Project Title Date INTERIOR THERMAL MASS Use one of the two following options for calculating interior mass as explained in Section 4.2 of the Energy Conservation Manual (ECM). Method B must be used for mass elements that have an interior unit mass capacity less than 1.7. Method A: Look upthe Interior Mass/CFA value from ECM Table 4-7 reprinted on the reverse side of this page. Type 1 mass has a Unit Interior Mass Capacity (UIMC) greater than or equal to 4.2 (see E•CM Tables 4-8a and 4-8b reprinted on Attachment). Type 2 mass has an UIMC greater than or equal to 1.7 and less than 4.2. Mass % is the mass surface area divided by conditioned floor area (CFA). For mass elements exposed on both (two) sides to conditioned space, enter the area of only one side to calculate the percentage. Mass % Type 1 Mass Area: Type 2 Mass Area: Interior Mass/CFA from Table 4-7: Method B: Calculate the Interior Mass/CFA value using the worksheet space below. Look up the Unit Interior Mass Capacity (UIMC) for each interior mass surface in ECM Tables 4 -8a;•4 -8b and 4-9 reprinted on the Attachment. Include the interior surfaces of exterior mass walls. For interior mass walls exposed on both (two) sides to conditioned space, enter the surface area of only one side. Include the inside surfaces of exterior mass walls as explained in Section 4.2 of the ECM. Description e a P -r / 56.g t3 Unit Interior Mass Area Mass Capacity X X = X = X EXTERIOR WALL THERMAL MASS Interior Mass Capacity 4Z1 .2. l 2h. C7 S:'So . 960. = ,57 Total CFA Interior Mass/CFA Calculate the Exterior Wall Mass of all exterior walls. Look up the Exterior Mass Factor for each opaque wall element from ECM Table 4-9 reprinted on the Attachment. Only exterior mass wall surfaces may be included in this calculation. Opaque Exterior Description Wall Area Mass Factor X = Conventional Walls roan Revised March 1988 »....,::....- X X = X 0 = Total Total Opaque Exterior Wall Area Wall Mass L�UINC f2 yr)IC-11 E�AS7- 1. Pse IA F, ----------------- 1'-0" S,OoT14 4/ 3b� L4 — �2 3030 — cl Z S IL7 UCyN t' RvLurn Lo DPW AGRICULTURAL STATEM-.AT OF ACKNOWLEDGEMENT 9 2— 4 3 0 6 3 FOR RESIDENTIAL DUFLOPMENT Section 26-8.1 of Llre Butte County Code requires Lh i s cac:knnwl.edgenion I: he recorded prior to issuance of a building permit The property described herein is adjacent i 5. 00 to land or hic'luded within an area zoned G� 7�'r04r���� I Rec Fee 7 5.00 fo.r a gri.c•ul.t.ur.nl. purposes, and res:idenLs I Cash of this pro>perLy may lie snbJecL to inc:on-Recorded I venlencos or discomfort arising from the: 1 Official Records Use of agr. ic•u1 L.ur,al chemicals, including, County of 1 but not limited to herbicides, pesticides, Butte and fert..i l.izers; and from the pursui L- 11 Candace J. Grubbs I of agr.icu.ltUral .opera Lions including, I Recorder I but not. l i.mi Led to' cultivation, plowing, i 12:54pm 24 -Sep -92 I PUBL. XX 1 spraying, pruning, and harvesting which ` - - occasionatl.y generate dust, smoke, noise, and odor. Butte County has established agric •.- Lural zones wlli.ch have as a priority use for productive agricultural. purposes, niid residcui <s, within sai.d zones and on adjacent property should be prepared to accept such incunveniencs or discomfctrL from normal, necessary farm operations. All Lhat. real property situate in the CounLy of Butte, State of California, dc':,cribed cis follows: Date: Z Z State of USE SS. CounLy of ,U- e ) rUR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ..- JEFFREY ROBERT HALL, a single man, and pATRICIA ANN DEITIixER HALL, an unmarried wnron, as joint tenants hereby GRANT(S) to VAUOOIS E. HANDLEY aril LAUREN E. HANDLEY, husband and wife as the follnwinl; described re:ll propeny in the County of Dutt'e , State of California: The Southerly half of Lot 8 in Block 5, according to that certain Map entitled; "Boucher's Second Addition to the Tam of Chi_", which Map was filed in the Office of the Recorder of the County of Butte, State of California, an September 7, 1901 in Volume "5" of Maps, at Page 15. PROPERTY. _ .. - i On this the day of , 1 , b(,for.c• me, .the undersigned Notr.iry Public, personally appeared Personally known to me. F1 Proved to me on the hasis of satisfactory evidence. a� OFFICIAL SEAL Lo be the person(s) whose name(s) y� FJ"E �'•y� LAURIE HILTON subscribed to the within instrument and acknowledged that NOTARYPUBLIC-CALIFORNIA executed the same for the purposes therein contained. IN W."I'N[:SS r ® ° BUTTE COUNTY WHEREOF, I y A IFOAN My Comm. Expires May 23, 1995 hereunto set m hand and o f ficial seat. Present A. P. No. Notary Puhl ic: EN® OF DOCUMENT �►�Td�l'�����7�•a �t� y��y�J°Z+�'vf1"r .sr�+�►r+F.i�"Mr,'menti.��^'ti'zf'3""",�"r;'iT"`a"'"'�►^'ww..^^�,...--„^'m^w�.*�,'4r'*""�-'K''a+'''gg=t�?a��t��.-�„ � t.•c y : , t' BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District,� Ur, LV-e-L�___ - Building Department No. _ A.P. Number -x Q� Jurisdiction (_ City County Property Owner Property Location/Address Subdivison Lot No. Residential Development] ( Sq. Footage No. of Living MHI Addition / (Group R) t Q �p C n�J Units _ CR& C6 �$7d Commercial/In ustrial d- • I = Sq. Footage New Addition (Including Exterior Roofed Areas) Building Department Representative (Floor Plans reviewed by School District Personnel) District Identification No. District certifies that Date I� Ti m2e-/- (Applicant) (Street Address) (Phone Number) Is (City) (State) (Zip Code) has complied with the requirements of Resolution No. -J- by payment of $ 9y�, $� representing �' rJ� _ _square feet. School District Representative Paid by Check Number �� Remarks: Bank Number Paid by Cash 91,4V 119. Date 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 (CEQA), 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.wkf (4/92) ........................Y�......+vu....•..�...:::n:.::H::...w.n....w iJ..........:4i..�........c ...tva..r'::.Lidut:W:..s.s.vv'tr.rn.riu.rvv.i.r....r...:.tiuuu................v...a.......u..a..,.....................v.......u..v.....r......v.�....�........., ..... keLurn to DPW AGRICULTURAL STATEMI-A 01" ACKNOWLEDGEMENT COR RESIDENTIAL DEVI?LOPMENT `iect.ioil 26-8.1. af. Lhe BUtLe Counry Code r'equi 1'e:: Lillis a:lckn(iwl.edgement. hr recorded prior to issuance of a building perut t'. SEP 2 4 1992 The pr, oper•.t v de'scri.hed herein i.s adjacent to 'land or hicluded within an area zoned fox a gri.c•ultur.al. purposes, and res.idenLs of this I)ropc•rLy may he suh.jecL to incon_. NOT COMPARED WITH ven.ioncrs or d i.scomfort arising from Lhe ORIGINAL DOCUMENT use of agr:ic•ultural chemicals, including, huL noL limited Lo herbicides, pesticides, and fert..il.i•rers; and from the pursuit 92-043063 of agr.icu.lLural operaLions including, but not. l iii t.ed to' cultivation, plowing, spraying, pruning, and harvesting which occasional.l.y generate dust, smoke, noise, and odor. Butte County has established ag,ric•u.l- Lural zones which have as a priority use for productive agricultural. purposes, and resident a' within sa i.d zones and on adjacent property should he prepared to accept such i nc-unvrn'i encs. or discomfort from normal, necessary farm operations. AIJ that real property situate in the CounLy of Butte, State of California," dcsc•ribed Lis ron.ows : Date: 2 State of SS. County .of gUTrS ) FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, JEFFREY ECBERT NAIL, a single roan, arca PAmUCIA ANN DETTJ%-ER HALL., an tumm'uried wmun, as joint tenants hcrchy GRANT(S)to VALWIS E. HANDLEY and LAUREN E. HANDLEY, husband and wife as the rollnwing described real property in the t:ounty or Dut't'e , Statc of Califurnia: The Southerly half of Lot 8 in Block 5, according to that oertain Map entitled; "BoUCher's Seoarl Addition to the T06m of Chico% which Map was filed in the Office- Of fficeof the Recorder of the Oounty of Butte, State of California, on September 7, 1901 in volume "5" of Maps, at Page 15. PROPEP OWN���G� audois E. Han ley ^, a y On this the day of ___XDXM W , 1(-o' , hc•for.r me, the undersigned Not-ary Public, personally appeared "�O Personally known to me. E] Proved to me on the b�isis of satisfactory evidence. POFFICIAL SEAL Lo be the person(s) whose name(s) ()Lim LAURIE HILTON subscribed to the within instrument and acknowledged Llr;it p v" NOTPYPuBLIC-CALIFORNIA executed the same for the purposes therein contained. • IN W.'fNI?SS BUTTE COUNTY WHEREOF I hereunto set Its hand and official sea[. (IFOVk' M Comm. Expires May 23, 1995 Y CAY -401— — _ Present A.P. No. (_QGj.Zt.QCS Notary Public: Certificate of Compliance: Residential Climate Zone 11 Project Title 13•�g o� rs s -r . - Project Addren BUILDING DATA Conditioned Floor Area F/O00 Slab/Raised Floor 4::,, LI; -- (X Single Family Detached (SFD) (] Single Family Attached (SFA) [ ] Multi -Family (MF) BUILDING SHELL INSULATION Number of Stories "'- Number of Units [ ] Addition Alone [ ] Existing Building [ ] Existing -Plus -Addition Component Insulation Locatiiorrleommews Type R -Value- (Attic. to garage t2i=d. etc.) Wall...... ... x-11_ Wall.. .......... Roof ............. l - Roof............. _ Floor ............. Floor ............. _ Slab 92 - Z6 -3o Buildint Permit M 9 K.. S- ZO -QZ melted By / Date Enfotoeseit Agency Use only GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang Framing Type Orientation (sf) (single. double) (roller blind etc.) (Shadescreen. etc.) (ya ) (ntetailwood) North Ncxl it.)µ tTE llli-6'L North ( ) DQf ec, East East ( ) South ( ) Sou ch ( ) West ( ) West ( ) Skylight....... 41 - THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath. etc.) VINYL l Loi - - 1.6 T L "a tJ llz Spt7-rN, HVAC SYSTEMS Minimum Type (furnace. air Efficiency conditioner. hest putt) (SE. SEER.HSPF) Duct Location Duct (attic, etc.) R -Value UN 7 .T IT G 61 Manufacturer / Model # Maximum Fumace Heating Output: A//4 Btuh A P HOT WATER SYSTEMS Tank / Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURESIREMARKS (Add extra sheets if necessary) Glass Area % Glass North O iv East S. South 36.1 Skylight Total 1 lOS GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang Framing Type Orientation (sf) (single. double) (roller blind etc.) (Shadescreen. etc.) (ya ) (ntetailwood) North Ncxl it.)µ tTE llli-6'L North ( ) DQf ec, East East ( ) South ( ) Sou ch ( ) West ( ) West ( ) Skylight....... 41 - THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath. etc.) VINYL l Loi - - 1.6 T L "a tJ llz Spt7-rN, HVAC SYSTEMS Minimum Type (furnace. air Efficiency conditioner. hest putt) (SE. SEER.HSPF) Duct Location Duct (attic, etc.) R -Value UN 7 .T IT G 61 Manufacturer / Model # Maximum Fumace Heating Output: A//4 Btuh A P HOT WATER SYSTEMS Tank / Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURESIREMARKS (Add extra sheets if necessary) ° ` - 5---'-----� �" ^—vv� g2-8087 — ' —B—,E— VLH CONST ' 1358 Davis St, Chico repairs for detached garage ^ . . . JOB FINALE � manamw J=OK s O =.;toot OK = Not Readyable 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-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / /"L" ft. / /"Nat. or/ /"L"ft./ /"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. Exits; Insp.-Sketch 10. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-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 -Panel boards -Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 V CK O = Not OK = Not Applicable Not Ready RESIDENTIAL (; ' = Date UNDERFLOOR (Plans) OK except it'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 -Bloc kouts-Wrapped 6. Stemwalls, Garage; Steel- Bloc kouts-Wra pped 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; Siie-Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permil),OK except ft's tE. Water Htr.: Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Nail Protection 18. D.W.V.; Test -Fittings & Anchor -Nail Protection ------------- ---- -- ------------------ -- ----19. Shower Pan; Test. First Floor -Tub Access --- - - - 20.--Test-Tub &---Shower,-Second Floor -Tub Access --------------------------- -------- -------- 21. Gas Pipe: Size & Anchors ------------------ ------------------------------------------------- Date Card B-1 Date Card B-1 --------------------- ----------------------------------------- Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except N's 22. Fixture & Transformer Clearance - Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors- ---------- --- - 24. Size Boxes & No. of Conductors -Stapled --------- -------------------------------------------------------------- 25. Romex Installed Close to Edge of Studs & C.J. ---------- ------------------------------------------------------------ 26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water ----------- ------------------------------------------------------------------ 27. 2 Appliance Circuts in Kitchen & Conductor SizerGFl 28. Subfeed Wire Sizer ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al ------------------------ 29. --- -----------29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No - ------------------------------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect ---------------------------------------------------------------------------------- 31. Equip_Clearances Panels-Motors-Mech.Equip_- ------------- ------- ---- --------- 32. - -Closet- Closet - Light -Shower - Light -Spa - -- Light -------------------------- ---------------- ----------------------- 33. Smoke Detector ------------------------------------------------------------------------------ Date Card -B-1 Date Card -B- 1 ------- ---- ---- -------------------- ------- -------------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except a's 34. A.C. Ducts Insulation & Support -- ---------------------------------------------------------------------- 35. Vent Fan: Exhaust above insulation 36. Condensate Drain & Overflow: Size & Grade 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet ---------------------------------------------------------------------------- 38. -Attic -Access-&- Platform if Furnance in Attic ----------------------- ---------------- ---------------------- ------ -------------------------------------- Date Card B-1 Date Card B-1 -------------- -- - ---------- - ------ --------------- ------------------- -------- Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s 39. Sils, Proper Material & Anchors - - - - - ----------------------------------- ----- --- -- - -- - 40. Walls Studs- Nailing. Spacing & Bracing -Plates -Sound ------------------------------------- 41. Bearing Walls over Girders & Floor Nailing -- - --- - ---- --------------------------------------------------------- 42. Draft Stop in Walls (rat proof) ------------------------------ ----------------------- --------------------- -------------- 43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub -- - --- -------------------------------------------------- 44. Headers & Beam -Size & Bearing 'ingle & Duplex) Date FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Ring. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings _ 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs: Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection -Skylights -Plastic SS. Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows -------------------------- _Date _______Card B-1__ _ _ Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except ft's _ 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector ------------------------ 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor-Ducts-Mech. Protection ---------- --------------------- 64. Bedroom Exiting 65. G F.I & Bath Fixtures & Tub Access -Spa - ---------------------------- 66. Elec. Trim & Subp anel: Breaker Sizes & Labels --------------- 67. Stairs & Rails ----------- ---------- ------------ -- 68. Fireplace or Stove: Clearances -Hearth ------------ - -------------------- 69. Elec. Outlets at Wood Panel: Int. & Ext. 70. Kit.Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance ------ --- . -- - ---------------------------- - 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door: Swing -Landing -Closer .-.-------,- -------------------- -- --- 73. A.C. Duct in Garage -Damper -•--------------------------------------- ----- 74. Wtr. Htr.: Vents -Clearance -Comb. Air-Connector-P.R.V. . In Garage: Above Floor-Mech. Protection ----------------------------------------- 75. Plb.. Elec. -&-Mech. Equip. Listed for Location 76. Elec. Receptacles in Garage: (G.F.I.)-Romex Protection ---------------- ---------------------------------------- 7i. Insulation -Foam -Looked in -Attic ❑ Yes ----------------------- -- 78. -Guard -Rails & Deck -Const ruct ion -Post Caps 79. Fdn Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 80. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No: Planters- ❑ Yes ❑ No -------------- ---- 81. Stucco: Brown -Finish 82. A.C. Unit: Disconnect. Electrical, Plumbing 83. Vents Above Roof: Plbg -Appliance-Fireplace.-Clearance to Openings ------------------------- -------- 84. Water Well: Disconnect, Electrical, Plumbing ----------I— ----------------------- -- 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 86. Ventilation Throughout House ---------- -------------------------------------------------- 87. Glass Protection -•-----... --------------------------- -------- 88. Corrections from Previous Inspections ------------------------------- 89. ----- -----------------------89. Gas Test -Meters Tagged: Gas -Electric ----------------------------------- ------------- ---------------------------------------- 90. Water & -Sewer Connected -C/O to Grade -HD Approval - -- ------------------------ 91. Energy Compliance Certificate -Other Certificates ------ ----------------------------------------- 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: ✓ COUNTY Oti_; BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County CenterSive - Oroville, California 95965 - Telephone: 916/538-754.1n a:- -= *67 APPLICATION AND PERMIT VVJr ASSESSOR PARCEL NUMBER 005-401-003 ZONING AR BUILDING PERMIT OWNER VLH Construction � TELEPHONE 891-5015 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 446 Bruce Lane, Chico 95928 4,000-0 CONTRACTOR'S NAME VLH Construction TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 15.00 Permit Fee Plan Checking Fee $ 52.50 $ 26.25 ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 93.75 1358 Davis St., Chico PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 5.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION Prtn/8 NAME Bouchers 2nd PARCEL MAP Water piping - 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SFV Duplex❑ Mobilehome❑ Other dIC SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel [R Utilities ❑ Installation❑ Other[?g Describe work:. Replace Dryrot Permit Fee $ 0 Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 CONTRACTORS LICENSE LAW dec911under penalty of perjury (check one): am licensed under provisions of Chapt. 9, Div. 3 of the BuslneSS and Professions Code and my license is in full force and effect. License No. �0% 7 �Z Classification ElFIXED I, 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) FJ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A, •37.50 NEW CONST. ( DWELLING ocC P. ) OR ADDNS. \ ACC. BLDGS. 3.64 sq.ft. lo�oo NEW CONSTR U TI -OUTLET NON.RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS .&) SINGLE OUTLET CIR. Ex. Occu p�OUTLETS OR FIXTURES 20 7e 9AL_ La 4r APPLNS. OR Ex. Occup. OUTLETS (RESIO.) EA.) 1 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee _$25.00 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. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 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 Countyot 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, a expenses which may in any way accrue against said County in conseque f the granting of this permit. X Date ll /O � Signoture of Applicant — O er Contractor Agent ❑ An OSHA a 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 S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ 138.75 HAz DFEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the sions of the Bu to Co Code and/or work Indic a ' e or which fees I T R OF PUBLIC By PE MI EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. 11-6 cif q WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT ;�- - 4COUNTY OF BUTTE -'DEPARTMENT OF*PUBLIC 1 bRi� - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE;. CALIFORNIA 95965-dTE6EPHOOA916) 538-7541 / rt' PERMIT APPUCATION DATA SHEET j/. I . A/. (o�jP/t✓cV7� OWNER A. P. No. Proposed Building Use er,P,,A. tMT a Building Inspector Date �� �� Z At time o71. application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY ll items have been submitted . ........................................ 2. Plot plans, 3/4 sets; signed:-by'preparei'of"plans. ......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of$ .......................................... 11. Impact fees as shown on attached schedule . ............................. . 12. California Department of Forestry plan approval/fees. ........................ 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............. 15. City of Chico plumbing permit ..... . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .... `...... . 19. Driveway permit (construction approval required prior to occupancy). .. . . Pre -Inspection requeis 20. Pre -inspection for required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner _)............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . .................... :..................... 28. Mobilehome utility clearance . .......................................... . 29. Documentation of legal access . ........................................ 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: V Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air P916ion Date Copy of plans sent Health Dept. Fire'Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail C nter by _ Date Plans checked by Date Plans approved by Date /870 Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works it el E 0 75 IL u p e r?j\v K, ST. tmawn of shuctums & ewomct "I be 99 ~ ,& chw of an owwwo- .15/2 'HOUSE... Pbms 's -T. APS h-Aol-,nol> .A-9 zok` ull i! el.3 U) F_X KTl 0& N�.GaQ.AGE I L JM COL41 EFART ff. , MPMkftgftt .13UTTE COUN A A F. - R BUILDING DEPARTMENT HA APPROVED VALipory OAPPLZY No. 18693 CA REN. YT el E 0 75 IL u p e r?j\v K, ST. tmawn of shuctums & ewomct "I be 99 ~ ,& chw of an owwwo- .15/2 'HOUSE... Pbms 's -T. APS h-Aol-,nol> .A-9 zok` ull i! el.3 U) F_X KTl 0& N�.GaQ.AGE I L JM COL41 EFART ff. , MPMkftgftt .13UTTE COUN A A F. - R BUILDING DEPARTMENT HA APPROVED VALipory OAPPLZY No. 18693 CA REN. YT UL.4 /W CC) gAIrWocs p 44 Ac 1vt,(o4,36# Fe* Gw- -Ajo- APAIles 1Q/(= I Lo U-tJPA-&M-- M--ARTMENT---,----------- A ftf!bft^t 9 , I. "I'All COUNTYOF BUTTE BUILDING DEPT N Wil 10 wi eount* of Dutte OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: Aubrey Electric ADDR ESS: P.O. Box 3162 CITY & STATE: Chico, CA 95927-3162 IMPORTANT: June 30, 1989 SEE INSTRUCTIONS DATE OF CLAIM: ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) I AMOUNT Owner has decided not to do work. (Bldg Permit Appin. #1283-89E, Receipt #41486, dated 6/27/89, A.P. #5-401-03). Owner: Patricia Deitinger Hall. Electrical permit fees paid -------------------- $50.00 Retain pre -inspection fee ----------- $15.00 Amount retained --------------------------------- TOTAL REFUND DUE ----------------------------------------- $25.00 .$25,00 TOTAL $25 00 I. the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. c ' Dated this ......... ...:..................... day of ............................ 19...... at....... ....................... Calif. .. ......../. ......................... ........ Signature of Claimant - I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above"havrSeen performed or de- livered and that theres a Budget Appropriation 0 or Specific Board Approval (Check one) for th»,amer-. 4 P1 Dated this ........... . .............. day of ......ii.. [ ...... 19y...l.'at 1.r 1 L !1\ Calif. .. / .... !!!! ' DeItment Head or Authon�eputy Dept' 440-002 EzQ' 4210500 COSn . , Permits Code............................................ Code ................................................PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT: �1 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERM T N0. ^/ 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 Y APPLICATION AND PERMIT ��JJ ASSESSOR PARCEL NUMBER /1. © -� 63 ZONI G BUILDING PERMIT OWNER q_ i -L% e +I er TELE HONE S 7923 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P-b boY, 361Qe-R5S2`T CONN�T RACCTO 'S NAME ) &6,—t ' a G TELEPHONE Tp CORACTOR'S M ILIN ADDRESS Po 5.0,K .4- Z C%t%G d [ %�-� Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ Energ Plan Checking y g Fee $ Penalty $ BUILDING ADDRESS Permit tee $ PLUMBING PERMIT Filing Fee 10.00 ACA Each Trap 2.00 CL Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation Other ❑ Describe work: Lw Q r0-d •t_ /21 : t.✓ mer I] I` C /�dw,.. .� i 2 ��4% j Permit Fee $ Contractor ELECTRICAL PERMIT FiIin Fee 10.00 e r- C_ � S r�, Main service 100v OR LESS 10.00 d 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I dec lar 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 fu I force and effect. License No. 184A-34 Classification e d 1, as ❑ 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) ❑, a (Sete owner, am exclusively contracting with licensed contract- 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.m` , OR ADDNS. ( ACC. BLDGS. I 20sq It NEW CONSTR. U TI-OUTLET NON.RESID .BRA C CIRC ITS 2.50 ea POWER APPARATUS.&) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20050, DAL@ 30 FIXED PLNS ID 1R Ex. Occup. OUTLETS(RES 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 7 `j `fir- 2i tj 6 etc-4 i5" $,cry Permit Fee $ , 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 °f Consent to Self-Insure. Lh ' 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Coolin g Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information 1s correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyoi Butte to enter upon the above-mentioned property for inspection purposes. also agre to save, indemnify and keep harmless the County of Butte against all liabi,' • s, judgment , costs, and expenses which may in any way accrue again t' id Cou ty ' n uenc of the granting of this permit. %� ate j Signa re of ApplicD r — Owner ❑ Co trot,., Agent ❑ An HA permit is required f r e c votions over 5' a nd lition or construct- ion of structures ave s I in a ght. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $C5,D • 00 OCCUP, CONST.TYPC SCHOOL FLOODIPARCELJ PD ND 15SUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY Date PERMIT EXPIRES Date Recelpt No. d z- S WHITE-D.P.W., rEL se ow, Mog;/tK. 0 N P.g &1 � n ae, _+- tiNgoess; n 9 -cn a r BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health 7 County Center Drive Oroville, CA 95965 (916) 538-7281 June 22, 1989 CERTIFIED MAIL - RETURN RECEIPT REQUESTED Jeffrey Robert -Hall, etal JT Patricia Ann Dettinger Hall 1182'Yocum Street Pasadena, CA 91103 RE: Housing Complaint - 1358 Davis Street, Chico, CA AP# 005-401-003 Dear Mr. Hall or -Ms. Hall, et al: On May 5, 1989, a special inspection was made of the above listed dwelling unit for electric service repair. The tenant permitted Mr. James Glandes and me to inspect her rental unit. The following conditions were observed which are in violation of the California Administration Code, Title 25, Chapter 1, Section 34 (a)(b) and (c) - Heating; and the California Health and Safety Code, Section 17920.3 (a)(2)(6)(10), (b)(7), (d), (e), (f) and (g)(2)(3); and which pose health or safety hazards to the tenants or occupants of the building. 1. There are no approved heating facilities in the dwelling. 2. The shower facility is an insanitary installation. 3. There was no electrical service to the house and electrical wiring had been illegally installed to serve rear garage conversion (no permits). 4. Electrical wiring has open splices in shower facility and unprotected wiring exposed in the dwelling. 5. Water heater is installed outside and requires proper weathertight enclosure and installation. 6. The house lacks weatherproofing. 7. Rear garage or storage building has been converted to a living unit without permit. In order to comply, complete the following repairs or corrections within THIRTY (3.0) DAYS from receipt of this notice. Obtain all Jeffrey Robert Hall et al JT Patricia Ann Dettinger Hall June 22, 1989 Page 2 required permits from the Butte County Department of Public Works, 7 County Center Drive, Oroville, CA 95965. 1. Provide approved heating facilities for the dwelling; capable of providing a minimum temperature of 70 degrees Fahrenheit in all habitable rooms as measured at a point 3 feet above the floor. 2. Provide a proper shower facility, lavatory and waterproof floor in the bathroom. 3. Provide electrical service to the house. Eliminate illegal wiring to rear garage or storage building conversion. 4. Cleanup electrical wiring, eliminate all open splices, protect all unprotected exposed wiring, eliminate and replace all inoperative or defective equipment and fixtures. 5. Provide weather protection and proper installation for water, heater. 6. Provide weatherproofing for house including doors, windows, walls and roof. 7. Cease occupancy of rear storage building or garage,. and remove illegal wiring, plumbing, etc. Failure to comply with this notice will lead to legal action through Butte County's Code Enforcement Program. This can result in citations and/or fines. In addition, the Franchise Tax Board will be advised of your noncompliance. You will then be prevented from claiming state tax deductions for taxes, depreciation, amortization, or interest expense connected with the property as long as it remains substandard. This notice is given to you pursuant to Section 17299 and 24436.5 of the California Revenue and Taxation Code. Contact me at the above listed .address or telephone number if you have any questions. Sincerely, Howar�dJ . Sny er, Director Division of Environmental Health HJS/kf cc: Public Works - Jim Glander I ,<--- /0�� 7w �✓ FOR A.M. DATE TIME P.M._ M OF PHONE / J AREA CODE NUMBER EXTENSION �i�51?�r/�z'3'�Yu.'b/X�/,".�'E lis s,/ IELEPHDNED �:�� � �y� <:' �.s'�9.axaak�i �'ti3'� ..��cc/.�q PLEASE'CALL ��� F VIVO,, VIV � �' eters �,,.. ,� ..✓ ,.,�3hi any&<�'��c.�`Sw�.hS Yi✓ $Y.,�./.E,� �/� r/�,.�?�� �.45/.X�4fr�"`Q�.z<l�'i i5 Inh%�d^s�hx/K..�i,°.H X� �NTi�i�< WANTS TO SEE Y0U s 'RUSH a , V CAIL�F� ����, tON�•n,/��� �RETURNED�YDUR �SPECIAL'A�T,TENT, ��j�� SIGNED UTHO IN U.S.A. TOPS FORM 3002S z _ NOTES 000000 COMPLAINANT ADDRESS: PHONE NUMBER: OTHER COMMENTS: N June 5, 1989 Aubrey Electric PiO. Box 3162 Chico, CA 95927 RE: Returned check AP# 5-401-3 Atention Randall Aubrey On April 27, 1989 you applied for anelectrical permit for Patricia Hall at 1358 Davis Street in Chico# The $50.00 permit fee check was returned for insufficient funds. Repeated calls to your office have been ignored.. Since we now owe the $50.00, please submit to us.$50X0 + $10.00'to cover cost of the bad check and processing -change. It we do not receive the $60.00 60.00 by Mondaj,June 17, 1989, we will turn the check over to the Butte County Collection Agency and will issue your firm no further electrical permits. Yours., very truly, ytiliam"Cheff D.irectbit of Public Works A J, F, !.q2�der Chief-%ilding Inspectbf u t File No. Z 3i VSec- V jDept. (For Action f. (For In ✓ d. & Br. Mtce. Shop & Yards Bldg.Insp. Admin. Design Engl. Bridge Engr• Constr. Engr• Surveys Mapping Transp. Land Dev. Drng• S.I. Sub. & Pcl. Maps Permits Add,. leia4vdi�d 144 14, llfoleie;� 8 County of Butte'* DEPARTMENT OF PUBLIC WORKS 695 Oleander Ave., Chico — 343-4211, Ext. 70 7 County Center Dr., Oroville — 534-4541 Skyway and Elliott Rd., Paradise — 877-3435 CORRECTION NOTICE ....................................................................................................................... Building or Property Address 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. Date.............................. Inspector.......................................................... Do Not Remove This Tag (400-4) ^� BTArE COIRTIT DEPARTMON'r OF,. Ir BLIC WOR SPECIAL_INSPECTI:ON REPORT Address..' Building Locaticn:��.�%�..o.�✓_�c ,Eype of inspect lon requested:. , p Housing.*. / _d 2.' Finnncin; 3. Change of Occupancy to Other (specify) tf1.<L l') ' . prase It y.�.J�,'.JS Li ll .6 �tiTi}=° � ..V w.F.:.._Lf•...% �(.�GUf"i...Vb45Jf / �.�1Xi� Li.- ....�.�.._ A. SaA�tatiion Fdr�us�, S 0 Water close~._.. p L a b tub nr shower: 4. K-Ltchen sink: 0 Hat and cold tia_ter 7p Natural i'xght and venftlat°'on; 8. Room and space regnir m'a.lto �__..._._.� _____��,�- �.._....�.• X30.' B_-d:oanwinow or door r for s :, .a....n.,.d.....awe..ox_..i..t kZ,feSttb window insects, Veii,is i14iU..+C._�.Z,....t...S__.' .aa4if .11p con.ection' Qo s`vagedisDoGalM.._..+_.v..m•.�..._.w.w�....�.wa....._.. :...._..-...�.-.e....._.�.+.._..�...s.�.........�...........�.+ r+ra.,.+.•... ��.ern...v.m.e..m.........+.+...«.�ra.......•�..x-.an 1.2. CO ,n:net:k.on to . 1.3. rmblb:ish and garbage facilities: 14. Couments:_ St r?%ctu al. t d 1. Piers 20 ?''10: ~ construction:_ 30 Wall coaistvictiexk: 4. Oe 7 a4 ; and'S;obf consri. ction:....�...._.. � r.. _.., _. r .., � �.� ° «..•.�„� >.�e �.... C. Elee-trlral d Service and gro�111 ::.... 2. 3. A. P. Date of Insjpecti-2- .G�.. Inspector 1. pi 1 'tS G01.i:?C�:C'Cl and ver -ted _. �_ . • �._ ._. ._ ..e .r _� a.... .� . A r...�2. Gas wlclter heater:Cv Other 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazarris: WeaO!er protection: 5.. Underfloor and att)--- vent5lation: 6. Com-ents: A------ Commlercial Buildings AO 1. ' Rcof covering: 2'.' Distance to property lines: 3. PIVs.i.,--ally h ' andicapped: 4 Fte-st—om., fl nn?. C nn,l -.T-z11 C! - 5• E x JZ t 6. improv 7. Zoning 8 C 1WI.qeII e- (Y 4 lase- rield Prnblcmis or Viclatio-rAsi 1. Problem oz- -.Y.I.olation (give cmqplete. description): 7. wl-,-:kt ac: tioli cmj)I,-tL, --Jescrif)tion .3. what ar;�.Jln recomlenkled: T7 A.Infonmation -oltly - f il -I!. B. Bold fer tc:) (10.) days, then uri'u letter. T. t e r . . 7-7-�. L f -J7 cl c4, A//, �ur.Gy ir 7-- C ' 1 •�ti 7h''� Inter-Do artme t`Momorandum GlM"A,C.W_ jou 61.c w'o'g ks . FROM: S-1detc —F-vLV.4ealfLx SUBJECT: 1358 �av� ..3TtV�cT,C�na[ o ..A P* 46-131-00 6 (- otLbw,wlo DATE: S-9-13 l(e�at 4t.a� 1e►Z a-l— 4t,*-_ a 4oye vacak-- ami kas eevt sa/� ?ea- NAo, Vtsk,W ' 4�e ftlaPexowwex,f CSee ?Alat4 d /V t) vu�. a,,.9aS i w-I�,..¢_ Co'rLy/�°x�d SMRdQe Our�ac� ol.u/l.�q yZsy lolsa'�. . �earu - �or�-�e2 nea lir hasar,�t. l��u.se {n Sale jw+4ke�c�n s ® P�tmPe c Qre 6l e�a� c�, fe auc/ Cew-y /ele. e 9-3 �v �✓a � oC ova w� �v �o � . Ate- � t I "L cok ver4e-dttos4dao ai-e-a- is e(ern :� s A�'•- �-6 ' t 3 t _o� ,; cc �� j • ,, � � 3'_ � ��vLs cam'- �-�i � Lc�. . �i � � � - -- ��- -� -. - - I <�ra_.�_ - Ct-,� "'M DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH ❑ 747 Elliott Rood Paradise, California 95969 Telephone: 916/872-2961, Ext. 58 Address O 196 Memorial Way 0:7 County Center Drive Reply to Chico, California 95926 Oroville, California 95965 Telephone: 916/891-2727 Telephone: 916/534-4281 March 14, 1983 Richard Kisling, et al 1358 Davis Street Chico, CA 95926 BEAUTY RE: Illegal Occupancy - Mobilehome', converted storage building, 1358 Davis Street, Chico, CA/AP# 46-131-003. Dear Mr. Kisling: On March 4, 1983, I contacted you on the above listed property and advised.you we had received complaints concerning occupancy of a mobilehome and converted storage building. At that time - you indicated the mobilehome was not yours, and you were vacating the converted storage building. This letter is an official notice to take the following actions within THIRTY (30) DAYS of its receipt: 1. Vacate the mobilehome. Disconnect all utilities, i.e., water, electrical, telephone, and sewer. Do not permit anyone to occupy the mobilehome. 2. Vacate the converted storage building, remove all plumbing, plumbing fixtures, wiring, etc., installed without permits from the Butte County Department of Public Works. Do not rent, occupy, or otherwise use this structure as a dwelling unit. Obtain all required permits from the Butte County Department of Public Works.to construct, reconstruct, or convert the building into a safe, legal storage building. A reinspection will -be made., Failure to comply with this notice will result in the Franchise Tax Board being notified of your non-compliance. You will then be prevented from claiming state tax deductions for taxes, depreciation, amortization, or interest expenses connected with the property as long as it remains sub- standard. This notice is given to you pursuant to section 17299 and ,24436.5 of the California Revenue and Taxation Code. Page 2 J �1. If'you have any questions concerning this matter, contact me at the above. listed address or telephone number. Very truly yo rs , GCi • and J. Snyder, Jr., R.S. Division of Environmental Health HJS/lda cc: LPublic -Works-Jim Gland.er Zoning fn.for`ceen't Officer -Vince Anzalone T PLANNING COMMISSION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 PHONE: 534-4601 CERTIFIED MAIL - RETURN RECEIPT.REQUESTED March 28, 1983 Richard Kisling, etal 1358 Davis Street Chico, CA 95926 Re: AP 46-131-03 Dear Mr. Kisling: It has come to my attention that since my letter of May 11, 1982, you have converted a storage building into a dwelling, and have, also, placed a mobile home on your parcel (both without approval or permit from any Butte County agencies), in violation of the Butte County Zoning Ordinance Section 24-33 site requirements, which states: (4) Lot area or building site which requires 8,125 square feet per dwelling. The above, together with the previous mentioned violations (letter May 11, 1992) of accumulation; storing dismantled and/or inoperative junk autos on and in front of your 66' x 66' (41.356 square feet) parcel, are your responsibility. Therefore, you are instructed: (1) Remove -the appearance of a junkyard (or apply for a use permit). (2) Either remove the mobile or disconnect the utilities and park it in dead storage. .(3) Re -convert the extra -dwelling back into a storage building (with inspection, approval and permits of the Butte County Building Department). Additional options for extra dwellin (1) Re -convert the extra dwelling unit into a guest house pursuant to Butte County Zoning Ordinance (with inspection, approval and permits of the Butte County Building Department. (2) 'Re -convert the extra dwelling into an age 60 and 640 square foot maximum living area. If -applicable Richard hisling, etal March 28, 1983 Pg. 2 (with inspection, approval and permits of the Butte County Environmental Health and Building Departments). Failure to follow the above instructions within 30 days of the receipt of,this letter will result in the matter being forwarded for -appropriate legal action. Please Note: The violation of the Butte County Zoning Ordinance is in addition to any violations by Butte County Health Depart- mentt and fih butte County Building Department. If,you have any questions, please contact thin office. Singerely, Vince Anzalone Zoning Infestigator VA:sb cc: County Counsel Planning Director Building Dept. - Jim Glander Environmental Health - Howard Snyder w -75"- _16_g3 L y_ _16_g3 a' BUTTE COUNTY DEPARTMENT OF_._PUBLIC WORKS `2�,SPECIAL INSPECTION REPORT owner: ..'L I' A.P. V Address: U%cf' S% Date of Inspecti n'.2-��-r Tenant:' A✓x-1EsC Inspector Building Location: /;571L. ' . Type of Inspection requested :z -�% 1: Housing : f�. 2.,'Financing 1 Z 3. Change of Occupancy to 4: Other (specify) T� Present use, of building: :t/ 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. Connectior.�.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.. I.. Service and ground:' 2. Receptac: es: 3.. Fusing: 4. Comments: D. Plumbing , 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4... Comments p E. Other 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazards: 4. Weather protection: 5. Underfloor and attic ventilation: 6. Comments F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Rest -room floors and walls: 5. Exits: 6:- Improvements: .� 7. Zoning:_ 8. Cun, ent G. Field Probler.is or Violations 1. Prohlem or vlolatiou (give complete description) Yf,l Ill it /.. A,' '.` 12 /&/�,ot�.� 2. What action taken (gig; complete descri )t:ozi f_ .. f / 3. What acti.in recommended: 77A. Infonuation only - / / B. Hold for ten (10) days, mien wri;`e letter. / / C. Write letter. [I�G� �/0 7 ,jam £ ��►/y �/(�11'[ (7 /N � ��i�i2f � CIGf/� � � G% �� /�� OcrJ.✓FG� jJ //vi�y i.v Goc/ �/F�t s;�c.J . Awes Si f j PRE -INSPECTION WNER: �Jj� DATE LOCATION:- S v 1/ l=A'. P . # S ex- 0,/ - �Q CONTRACTOR: � (COZONING J -T / v PRE -INSPECTION FOR: DATE TO INSPECTOR -7/7 lq7- ----- PERMIT HISTORY: NONE C'j AS FOLLOWS: V-"(A.c lis-oAd Q Ln� �. FIELD - INFOPOIATION BUILDING USAGE: TENNANT: [� OCCUPIED [] HAS ELECTRIC HAS GAS HAS SANITATION FACILITIES Q HEATED -COOLED PERSON CONTACTED OTHER COMMENTS: ACTION RECOMMENDED: C] ISSUE OTHER: Y - HOLD FOR, . #'�.`..,j"a9, e._ 9 •—'.....ti ;..,,f :{ .. a,w 'm� rf�'„ , ,:�. F'r 1s.t,,, ter} � ;;.,,,:v � iw/.tii .�sf�.w-. �rYy`"Ta �. ,'`.� [%e::..,,,- �",vTi.;�.t t'i�:.�.�'tiry�i'B t-1��Z"'ry. ` - °. 005=40-1-003 92-3416B VLH CONST u 1358 Davis, Chico demolish sf { v T _ S y F • 1 t 1 M''�t�';h - t .. d' :�'t -t' �' ;�b-: -:j ,"�; + `��, .t t'jl.i�if:. "�'"�t�;�i..��`..'�T�`�t�, .Y�� •'"4�'{ M;,�;r,'� �>"'='y,� / I COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PER N0. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 q APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 005-401--3 ZONING AR » BUILDING PERMIT OWNER VLH Construction TELEPHONE 891'-5015 SQA FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1358 Davis St., Chico 95928 ' t• • • CONTRACTOR'S NAME TELEPHONE Vadois Handley, CONTRACTOR'S MAILING ADDRESS 882 Bruce Lane Chico 95928 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $1 .0m.00 LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 15.00 Permit Fee Plan Checking Fee $ 22.50 $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 37.50 1358 DavisCh PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF I Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 1 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New❑ Addition El Remodel❑ Utilities ❑ Installation❑ Other® Describe work: Demo Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200V OR LESS 00AOR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check One): f'tT' f I am licensed under provisions Of Chapt. 9, Div. 3 of the Business(POWER and Professions Code and my license is in full force and effect. License No. t[ 07%(r2 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 or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A, 37.50 NEW CONST.OR ACDNS. / ( ACC. SLOGS. DWELLING OCCUP.�) 3.6p sq.f[. NEW CONSTR ULT'.OUTLET NON-RESID BRANCH CIRC., TS @ 5.00 APPARATUS y SINGLE OUTLET CIR. ) Ex. Occup(OUTLETS OR FIXTURES 20 @ 754 FIXED APLNS. EX. Occup. OUTLETS P(RESID )REA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Et I Permit Fee $ 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. Contractor MECHANICAL PERMIT Filing Fee 1 15.00 Heating Cooling g Hood 6.50 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 Countyot 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 Coup y in copse nce of the granting of this permit. X ���� Date / ZS Z Signature of Applicant — ner ❑ Contractor Agent ❑ An OSHA permit is requ��, d for excavations over 5'0" deep and demolition or construct- on of structures over 3�itora f in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC c"'s'"PE TOTAL FEES 37•SO HAz DFEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or i� work indicated ab ve #br�which tees ' to Tve,fi PUBLIC By lc-' PEF(M- tT EXPIRES Date applicable provi resolutions to do have been paid. WORKS Date E J7;y.- 123150 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS i PER NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 4:Z / APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 005-401-003 ZONING AR BUILDING PERMIT OWNER VLH Construction TELEPHONE 891-5015 S0. FT. OCC, BUILDING V LUATI N OWNER'S MAILING ADDRESS 1358.Davis-St. Chico 95928 Est. 1,000.00 CONTRACTOR'S NAME Vadois Handle TELEPHONE CONTRACTOR'S MAILING ADDRESS 882 Bruce Lane Chico 95928 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $1 000.00 LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ 22.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 37-50 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF© Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mob le Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other IbJ Describe work: Demo Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 1 15.00 Main service R LESS 200A OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I 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 Main service 20GATO1000A1 37.50 NEW CONST. (DWELLING OCCUP.&\ OR ADDNS. ACC. BLDGS. I/ 3.60 sq.ft. NEW CONSTR7ULTI-OUTLET NON.RESID BRANCH CIRC ITS @ 5•�0 POWER APPARATUS &1 (SINGLE OUTLET CIR. I Ex.Occu / p\OUTLETS OR FIXTURES zo 76 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 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 Countyot 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 Cou in conse nce of the granting of this permit. X Date ❑ Contractor Agent An OSHA permit is requ' d tar excavations over 5 0" deep and demolition or construct- ion of structures over 3 Dries in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE ITOTAL FEE $ 37.50 HAz I DFEES I IMP I FLOOD I CDF PARCEL I PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated ab ve o which fees I OF PUBLIC By 4s—' P EXPIRES Date applicable provi- resolutions to do j have been paid. WORKS Date'= Receipt No. 123150 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT 'A Tr /�'•+ g�,"' f +.. *T'.t ,ti �'�',.a p`,'1Y.�� e�rl'• � f'Dr7F�"*✓;; �',`t�fj1��'� � F'+ !�+' G'G COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS -BUILDING DIVISION .,, 7 COUNTY CENTER DRIVE - OROVI LE, CALIFORNIA 95965 - TELEPHONE (916) 538-751 PERMIT APPLICATION DATA (f OWNER V + _ Proposed Building Use v 41 SHEET 74 Building Inspector Date At time of perm pplication, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ....................................... . 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................. 6. Energy Design Compliance,and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of$ i ......................................... 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............. 15. City of Chico plumbing permit . ......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. ... ... . 20. Pre -inspection for to Building actors required. . to Building lnspedor (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner _) ............ 24. Recorded copy of Agricultural Acknowledgement Statement . ................. . 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ........................................ 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . .............. . 31. Existing violations/expired permits . ...................................... 32. Plan check list . ................................................ 33 - - M Whe ou issue the ermit, rocess as follows: M t�pwper. Mail to contractor. Telephone S5 /.� and hold for pickup ate ! office. Deliver with inspector. Other j Parcel Creation ` �� ��-� Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollupair Date Copy of plans sent Health Dept. Fire Dept. Other Date I By The following data must be submitted prior to permit issuance: (Circle new item not checked above). t 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916.538-7541 APPLICATION AND PERMIT ASSESSOR PAR L y,UMBE — -- 0 ZONING ,4 1 BUILDING PERMIT OWNERJ R 6-6) )) � � EIS.D SNE SO. FT. OCC. BUILDING VALUATION OWNS 'S� nIUNG ADDRESS I V I G ' ��[q�� J CON�R A AME TELEPHONE CONT A TOR'S Mgl¢IN/fa ] /!V/ � Fireplace CON RUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ I ARCHITECT OR ENGINEER - LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ . ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADORE _ 1 6 ' CZ Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Z Each Trap 5.00 I Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer j 15.00 Mobile Home I S I G JW I @ 15.00 TYPE OF WORK New❑ Addition F1 Remodel Utilities❑ Installation❑ Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 1 18.50 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 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 Main service 200ATO1000AI 37.50 NEW CONST. DWELLING OcCuP.y\ 3.60sq.h. OR ADONS. ACC. BLDGS. // NEW CONSTR TI.OUTLET NON•RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS &) SINGLE OUTLET CIR. 0 76d Ex. OCCUp\/ OUTLETS OR FIXTURES4113.001 FIXED APLNS.❑ EX. OCCUp. OUTLETS (RESIO 1R Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g '15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling g Hood 6.50 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 Countyot 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 perm' . G XZ Date ( Z Signature of Applicant — OwnerElContractor EJAgent An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in . igitt. Mobile Home Installation Fee S Energy Inspection Fee $ occ CDNSTTYPE TOTAL FEES 3 .� I HAz DFEES IMP FLOOD COF PARCELPD MD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. l �j 1 �� WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT 'Demolition Permits Asbestos Notification Statement • Date AP# 005 y0/-003 Pursuant to section 19827.5 of the California Health and Safety Code, all demolition permit applicants are required to fill out this form. "19827.5. A demolition permit shall not be issued by any city, county, city and county,- or state and local agency which is authorized to issue demolition permits as to any building or structure except upon the receipt from the permit applicant of a copy -of each written asbestos notification regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project. The permitting agency may require the applicant to make the declaration in writing, or it may incorporate the applicant's response on the demolition permit appli— cation." Attached is a copy of my written asbestos notification to the United States Environmental Protection Agency for the demolition project located at Signature of Applicant OR I hereby declare that a. written asbestos notification to the United States Environmental Protection Agency is not applicable to this demolition project. .117 Signature of _Wplicant 2/19/91 1. Ceiling insulation 2. Wall Insulation Single- Number of stories Number of stories R -value One Two Three R-0 -103 -49 32 R-19 -8 -4 -2 R-30 .2 .1 -1 R-38 0 0 0 U -value 8 6 4 0.50 -176 -84 -54 0.30 -102 -49 32 0.10 -26 -13 -8 0.08 -18 -9 -6 . 0.06 -11 -5 -4 j 0.04 -4 -2 .1 0.02 4 2 1 0.00 11 5 3 2. Wall Insulation 3. Raised Floor Insulation Insulation in Floor Single- Single - Number of stories R -value Family Family Multi - R -value Detached Attached Family R-0 -68 -51 -34 R-11 0 0 0 R-13 2 2 1 R-19 8 6 4 U -value -144 -70 -46 0.80 -153 -114 -76 0.50 -91 -68 -46 0.30 -47 -36 -24 0.10 0 0 0 0.08 4 3 2 0.06 9 7 5 0.04 14 11 7 0.02 19 14 10 0.00 24 18 12 3. Raised Floor Insulation Insulation in Floor Controlled Ventilation Crawlspace -4 Number of stories Number of stories R -value One Two Three R-0 -17 -8 -5 R-11 -3 .2 -1 R-19 0 0 0 R-30 3 1 1 U -value . Slab Edge Insulation 4 40 0.60 -144 -70 -46 0.50 -120 -58 38 0.40 -95 -46 30 0.30 -69 -34 -22 0.20 -43 -21 .-14 0.10 -17 -8 -5 0.08 -11 -6 -4 •0.06 -6 -3 -2 0.04 -1 0 0 0.02 4 2 1 0.00 10 5 3 Controlled Ventilation Crawlspace -4 -3 -1 Number of stories -1 R -value One Two Three R-0 -11 -7 -5 R-5 -4 -4 3 R-11 -2 .2 -2 R-19 -1' -2 .2 . Slab Edge Insulation 4 40 -90 Number of Stones -26 R -value One Two Three R-0 0 0 0 R-5 8 5 2 R-7 8 6 3 F2 factor 0.90 -4 -3 -1 0.80 -1 -1 0 0.70 2 2 1 0.60 6 4 2 0.50 9 6 3 040 12 8 4 5. Inriltration (Air Leakage) I. Specification Points Standard 0 6. Glass Heat Loss Total -14 48 -69 -64 U -value East Percent West Skylight .51 to .41 to .31 to 0.30 or Glass Single Double .60 .50 .40 less 50 -121 -53 -39 -24 -10 4 40 -90 37 -26 -14 -3 8 35 -75 -29 -19 -9 1 10 30 -61 -21 -13 -4 4 12 29 -58 -20 -12 -3 5 12 28 -55 -18 -10 -2 5 13 27 -52 -17 -9 -2 6 13 26 -49 -15 -8 -1 7 14 25 -46 -14 -7 0 7 14 24 -43 -12 -5 1 8 14 23 -40 -11 -4 2 8 15 22 -37 -9 -3 3 9 15 21 -34 -7 .2 4 10 15 20 -31 -6 0 5 10 16 19 -29 -4 1 6 11 16 18 -26 -3 2 7 12 16 17 -23 11 3 8 12 17 16 -20 12 4 9 - 13 17 15 -17 1 6 10 14 17 14 -14 3 7 10 14 18 13 -12 4 8 11 15 18 12 -9 6 9 12 15 19 11 3 7 10 13 16 19 10 -3 9 11 14 17 19 9 -1 10 13 15 17 20 8 2 12 14 16 18 20 7..Shading (Shade Open) Effective Pereatt Glass (percent Slane x SC) Effective -14 48 -69 -64 %Glass North East South West Skylight 18 5 1 4 1 na 16 4 2 5 1 na 14 4 2 5 1 na 12 3 3 5 2 na 11 3 3 5 2 na 10 2 3 5 2 1 9 2 3 5 2 2_ 8 2 3 5 2 2 7 1 3 4 2 2 6 1 3 4 2 -3 5 1 2 4 �2 3 4 0 /2 3 .1 3 3 0 1 2 1 3 2 0 0 1 -t7 3 1 , -1 -1 .1 2 0 -1 -2 -4 .2 0 na = not allowed 5 7 7 _ �. Shading (Shade Closed) Effective Peremt Glass (penmt:iasis x SC) Effectin GWu Norh Etat South Wat SkYW 18 -14 48 -69 -64 na 16 -12 42 -59 -55 na 14 -10 -35 -50 -46 na 12 -8 -29 -40 -37 na 11 -7 -26 -36 -33 na 10 -6 -23 -31 -29 -74 9 • -5 -20 -27 -25 -65 8 -5 -17 -23 -21.. -56 7 -4 -14 -19 -18 -47 6 .3 -11 -15 -14 38 5 -2 -9 -11 -10 .30 ' 4 -1 -• -8 - 1==;�. .23 3 0 -4-4 -3 1 -16 2 1 .1 2 -t -9 0 2 3 4 3 41 3 5 7 7 8 3.0 tea . not allowad 4 6 8 8 9. Interior Thermal Mass Interior single- Slab Floor Sum of 146 Raised Floor Mass Family Stories Mass Detached Stories Family JCFA One Two Three one Two Three 0.0 -8 -5 -4 .2 -1 -1 0.1 -8 -5 3 -1 0 0 0.3 -7 -4 -2 0 1 1 0.5 -6 -3 -1 1 1 2 0.7 -5 -2 -1 1 2 2 0.9 -5 -1 0 2 3 3 1.1 -4 -1 1 3 4 4 1.3 -3 0 2 3 4 5' 1.5 -3 1 2 4 5 5 2.0 -1 +15 more 4 5 6 7 25 0 3 5 7 7 8 3.0 1 4 6 8 8 9 3.5 2 5 7 9 9 10 4.0 3 6 8 9 10 10 4.5 3 7 8 10 11 11 5.0 4 7 9 11 12 12 5.5 5 8 9 11 12 12 6.0 5 8 10 12 '13 13 6.5 6 9 10 12 13 13 7.0 6 9 11 13 13 14 7.5 6 10 11 13 14 14 8.0 7 10 11 13 14 14 8.5 7 10 12 13 14 15 10. Exterior Wall Thermal Mass Exterior single- Single- Sum of 146 wall Family Family Multi Mass Detached Attached Family 0.00 0 0 0 0.20 3 2 more 0.40 5 4 3 0.60 8 6 4 0.80 10 8 5 1.00 13 10 7 1.20 13 12 8 1.40 12 13 9 1.60 10 13 11 1.80 10 12 12 2.00 10 it 13 11. Heating System SE or KSPF (assumes duets In attic) Zonal Control Adjustment System Type Resistance 10 9 7 6 4 3 Other 6 5 4 3 2 2 12. Cooling Syst• m SEER (assume; ducts In attic) Son of 7-10 -25 or -24 to 44 to -4 b +6 to 16 or SEER less -15 .6 +5 +15 more 8.0 -14 -12 -10 -8 -6 -4 8.5 -9 -7 -6 -5 -4 -3 8.9 -5 -4 -4 -3 -2 -2 9.0 -4 -3 -3 -2 -2 -1 9.5 0 0 0 0 0 0 10.0 4 3 3 2 2 1 10.5 7 6 5 4 3 2 11.0 10 9 . 7 61 4 3 12.0 15 13 11 9 7 5 13.0 20 17 14 12 9 6 Etradve SEER (SEER xduct etficlency) Som of 7-10 Effective -25 or -24 to -1410 -410 4610 1601' SEER less -15 -s +5 +15 more 5.0 -30 -25 -21 -17 -13 -9 6.0 -12 -11. .9 -7 -6 -4 6.6 -5 -4 -4 -3 -2 -2 7.0 0 0 0 0 0 0 8.0 9 8 5 4 3 9.0 16 14 12 9 7 5 10.0 22 19 16 13 10 7 11.0 26 23 19 15 12 8 12.0 30 26 22 18 14 9 13.0 33 29 24 20 15 10 Zonal Control Adjustment 10 8 7 6 4 3 No Coolin:; System Installed Stories One -5 -4 -4 -3 -2 -2 Two + 3 3 2 2 2 1 Single -Family Detached and Attached Sum of 146 Water :199 25 or -24 to -14 to -4 to +6 to 16 or SE HSPF less -15 -5 +5 +15 more 0.72 6.60 0 0 0 0 0 0 0.75 6.88 3 3 3 2 2 1 0.80 .7.33 8 7 6 5 4 3 0.85 7.79 13 it 10 8 7 5 0.90 8.25 17 15 13 11 9 7 0.95 8.71 . 20 18.. 15 13 11 8 slab) Solar Effective SE or HSPF -1 -1 (SE or HSPF x duct efficiency) 0 Effective -25 or -24 to -14 b .4 to +610 16 or SE HSPF less . -15 3 +5 +15 more .25 2.75 -73 -64 -56 -47 -38 -30 _0.30 na 3.41 -45 -39 -34 -29 -24 -18 0.40 3.67 -34 -30 -26 .22 .18 -14 0.50 4.58 -10 -9 -8 -7 -5 -4 0.56 5.13 0 0 0 0 0 0 0.60 5.50 5 5 4 3 3 2 0.70 6.42 17 15 13 i1 9 7 0.80 7.33 25 22 19 16 13 10 0.90 8.25 32 28 24 20 17 13 1.00 9.17 37 32 28 24 19 15 Zonal Control Adjustment System Type Resistance 10 9 7 6 4 3 Other 6 5 4 3 2 2 12. Cooling Syst• m SEER (assume; ducts In attic) Son of 7-10 -25 or -24 to 44 to -4 b +6 to 16 or SEER less -15 .6 +5 +15 more 8.0 -14 -12 -10 -8 -6 -4 8.5 -9 -7 -6 -5 -4 -3 8.9 -5 -4 -4 -3 -2 -2 9.0 -4 -3 -3 -2 -2 -1 9.5 0 0 0 0 0 0 10.0 4 3 3 2 2 1 10.5 7 6 5 4 3 2 11.0 10 9 . 7 61 4 3 12.0 15 13 11 9 7 5 13.0 20 17 14 12 9 6 Etradve SEER (SEER xduct etficlency) Som of 7-10 Effective -25 or -24 to -1410 -410 4610 1601' SEER less -15 -s +5 +15 more 5.0 -30 -25 -21 -17 -13 -9 6.0 -12 -11. .9 -7 -6 -4 6.6 -5 -4 -4 -3 -2 -2 7.0 0 0 0 0 0 0 8.0 9 8 5 4 3 9.0 16 14 12 9 7 5 10.0 22 19 16 13 10 7 11.0 26 23 19 15 12 8 12.0 30 26 22 18 14 9 13.0 33 29 24 20 15 10 Zonal Control Adjustment 10 8 7 6 4 3 No Coolin:; System Installed Stories One -5 -4 -4 -3 -2 -2 Two + 3 3 2 2 2 1 Single -Family Detached and Attached Interior Moss/CFA Unit Size (sQ Water :199 120e. '1700 22W 2700 Heater Credit or b to to • or Type Type less 1699 2199 2699 more SG None . 0 0 0. 0 0 or Solar 12 8 6 5 4 HP HWR 8 5 4 3 3 WS8 5 3 3 2 2 11•7 -°IK -4•I1 POU 8 5 4- 3 3 SE None 37 -24 -18 -15 -12 slab) Solar -1 . -1 -1 0 0 HWR -18 .12 -9 -7 -6 WSB .25 -16 12 -10- -8 POLI -1-8 -12 -9 -7 -6 IG None. =5 -3 --2 ..-2 -2 Solar 7_ - 5 .4 3 2 20% POU -3 2 1 1 1 IE None -28. -19 -14 -11 -9 00% Solar 8 5 4- 3 3 0.8 POU -10 ' -6 -5 -4 .3 2.1 Multi-Famll? (individual units) 2.9. 32 3.4 3.6 Unit Size (6 4 4.2 Water 4.6 699 700 1200 1700 2200 Heater Credit or In to 10 or Type Type less 1199 1699 2199 mom,, SG None 0 0 0 0 0 or Solar 14 7 5 4 3 HP HWR 9 5 3 2 2 2.2 WS8 9 4 3 2 2 3.7 POU 9 5 3 2- 2 SE None 45 -23 -15 -11 •9 1.1 Solar 2 1 1 0 0. 2.6 HWR •-23 -12 -8 3 -5 4.1 WS8 -25 -13 -8 -6 .5 5.6 PQU -P -12 -8 -6 _5' IG None. .-8 -4 .3 -2 -2 3 Solar 6 3 2 1 1 4.5 POU 1. 0 0 0 0 IE None 30 -15 -10 -8. 4 1.9 Solar 18 9 6 4 4 3.4 POU -8 -4 .3 -2 '-2 Interior Moss/CFA Point System Summary: Climate Zone 11 SCORE CARD Measures / Point Scores 1. Ceiling Insulation or R -value [381 U -value (0.030] 2. Wall Insulation or --K-value [111 U -value (0.098] 3. Raised Floor Insulation or R -value (191 U -value [0.037] 4. Slab Edge Insulation or R -value (0) F2 factor (0.77] S. Infiltration Standard- 0 6. Glass Heat Loss li • "' T [double] U -value [0.65] % Total Glass 16] Sum 13 7. Shading (Shade Open) a. North b. East c. South d. West e. Skylight 8. Shading (Shade Closed) a. North b. East c. South d.. West .,e. .. Skylight Interior Thermal Mass 10. Exterior" Wall Masi-'iZ "11 Heating,7 yS tem: 4 Zonal Control? (Y / N ) 12. Cooling System Zonal Control? ( Y / N ) 13. Water Heating Glass SC Eff. % Glass O'(o x '77 X = r g X = I X 47 v X % Glass . Sc _ Eff. % Glass X $. (, X X = Zt = X At X t%7 TYPE 1 MASS AREA InteriorlVN�A COND. FLOOR AREA / b TYPE 2 MASS AREA $ -�I ND. L OR AREA v ' Exterior Wall Mass Sum 7-1C -71 SE or HSPF Duct Efficiency [0.78] Effective SE or [0.6. y HSPF 10.5615. 151 " 1!> X 12; ?� = 719 SEER (9.5] Duct Efficiency (0.74] Effective SEER 17.031 ^ Type ISG] Credit [none] �-- Point Total: 1. S TYPS 1 MASS 11•7 -°IK -4•I1 t TYPE I MASS WIMC & 4.2. Set exposed slab) Ic.rp.t.O slab) - '� -. 0% S% 10% 15% 20% 25% 30% 35% 40% 4S% 50% 55% 60% 659. 70% 75% 80% .85Y. 00% 95% 100% 105% 110%. 115% 120% 125' 0% 0 0.2 0.4 0.8 0.8 1.1 1.3 1.5 1.7 1.9 2.1 23 25 2.7. 2.9. 32 3.4 3.6 3.8 . 4 4.2 4.4 4.6 4.8 5 S3 t0%- 0.2 0.4 0.6 0.8 1 1.2 1.1 1.6 1.9 21 23 2.S 2.7 2.9 3.1 3.3 3.5 3.7 •4 4.2 4.4 4.6 4.8 5 5.2 54 20% 0.3 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 24 27 29 3.1 3.3 3.S 3.7 3.9 4.1 4.3 4.5 4.8 5 5.2 54 56 30% 0.5 0.7 0.9 1.1 1.4 1.6 1.8 2 2.2 24 2.6 28 3 32 3.5 3.7 39 4.1 4.3 4.S 4.7 4.9 5.1 5.3 5.6 58 401/. 0.7 0.9 IA 1.3 i.5 1.7 1.9 2.2 2.4 26 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9 50% 0.9 1.1 1.3 1.5 1.7 1.9 21 23 ZS 27 3 32 3.4 3.6 ae 4 42 4.4 4.6 4.8 5.1 5.3 5.5 5.7 5.9 6.1 55% 0.9 1.1 1.4 1.8 1.8 2 2.2 24 2.6 28 3 3.2 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 5.8 6 6.2 60% 1 1.2 1.4 1.7 1.9 21 2.3 2.5 2.7 2A 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6 4.8 5 5.2 5.4 5.6 5.9 6.1 63 65% 1.1 1.3 1.5 1.7 1.9 22 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9 6.1 64 70% 1.2 1.4 i.6 1.8 2 22 25 27 2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.3 4.6 4.8 5 5.2 5.4 5.6 58 6 6.2 64 75% 1.3 1.5 1.7 1.0 21 23 2S 2.7 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.8 5.1, 5.3 5.5 5.7 5.9 6.1 6.3 6.5 MY. 1.4 1.6 1.82.2 2.4 26 2.8 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 5.6 5.8 6 6.2 64 66 857: 1.4 1.7 1.9 2. 2.3 25 2.7 2.9 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6 4.8 S 52 54 5.6 5.9 6.1 6.3 6 S 6 7 90Y.' 1.5 1.7 2.2 24 28 2.8 3 3.2 3.4 3.6 3.8 4.1 4.3 4.5 4.7 4.9 5.1 53 5.5 5.7 5.9 6.2 6.4 66 66 95Y. 1.6 1.8 '2 2 . 22 25 27 2.9 3.1 33 3.5 3.7 3.9 4.1 4.3 4.6 4.8 5 5.2 5.4 5.6 5.8 6 6.2 6.4 6.7 6.9 100Y. 1.7 1.9 21 2.3 25 28 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.9 S.1 5.3 53 5.7 5.9 6.1 8.3 6.5 6.7 7 105% 1.6 2 2.2 2.4 2.6 28 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 5.6 5.8 6 6.2 6.4 6.6 68 7 110% 1.9 2.1 2.3 2.5 27 29 9.1 3.3 3.6 3.8 4 4.2 4.4 4.6 4.8 5 5.2 S.4 5.7 5.9 6.1 6.3 6.5 6.7 69 7.1 115% 2 2.2 2.4 2.6 28 3 3.2 3.4 3.6 3.8 4.1 4.3 4.S 4.7 4.9 5.1 5.3 5.S 5.7 5.9 6.2 6.4 6.6 6.8 7 7.2 120% 2 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.4 4.6 4.8 5 5.2 S.4 5.6 58 6 6.2 6.5 6.7 6.9 7.1 7.3 M% 21 2.3 25 2.8 3• 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.9 5.1 5.3 5.5 5.7 5.9 6.1 6.3 6.5 6.1 7 7.2 74 Point System Summary: Climate Zone 11 SCORE CARD Measures / Point Scores 1. Ceiling Insulation or R -value [381 U -value (0.030] 2. Wall Insulation or --K-value [111 U -value (0.098] 3. Raised Floor Insulation or R -value (191 U -value [0.037] 4. Slab Edge Insulation or R -value (0) F2 factor (0.77] S. Infiltration Standard- 0 6. Glass Heat Loss li • "' T [double] U -value [0.65] % Total Glass 16] Sum 13 7. Shading (Shade Open) a. North b. East c. South d. West e. Skylight 8. Shading (Shade Closed) a. North b. East c. South d.. West .,e. .. Skylight Interior Thermal Mass 10. Exterior" Wall Masi-'iZ "11 Heating,7 yS tem: 4 Zonal Control? (Y / N ) 12. Cooling System Zonal Control? ( Y / N ) 13. Water Heating Glass SC Eff. % Glass O'(o x '77 X = r g X = I X 47 v X % Glass . Sc _ Eff. % Glass X $. (, X X = Zt = X At X t%7 TYPE 1 MASS AREA InteriorlVN�A COND. FLOOR AREA / b TYPE 2 MASS AREA $ -�I ND. L OR AREA v ' Exterior Wall Mass Sum 7-1C -71 SE or HSPF Duct Efficiency [0.78] Effective SE or [0.6. y HSPF 10.5615. 151 " 1!> X 12; ?� = 719 SEER (9.5] Duct Efficiency (0.74] Effective SEER 17.031 ^ Type ISG] Credit [none] �-- Point Total: Certificate of Compliance: Residential Climate Zone 11 Title 358 Documentation Author Telephone BUILDING DATA Conditioned Floor Area 5?IP0 Number of Stories Slab/Raised Floor Number of Units ['X Single Family Detached (SFD) [ ] Addition Alone (] Single Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (MF) [ ] Existing -Plus -Addition 9'Z - Z&3o Building Permit 0 9 le— R- Zo 'QZ Checked By / Date Pldottoanent ARency Use Only Glass Area % Glass North O iv East 5 South West Skylight . Total BUELDING SHELL INSULATION Component Insulation Locatiion/Comments Type R -Value (attic. to garage. typi- al, etc.) Wall .............. 12-11_ (toller blind. etc.) (shdesereen. etc.) (yeshto) (metal(wood) North ( ) Roof ............ flB L Roof ............. _ Fioor............. Floor ............. East ( ) Slab Edge ..... GLAZING Shading Devices f�inrr ?an+t Glaring Area Glass Type interior Exterior Overhang Framing Type Orientation (ED (single. double) (toller blind. etc.) (shdesereen. etc.) (yeshto) (metal(wood) North ( ) !o flB L A/ow "PIE AA-rL North East ( ) East South ( ) , Sou th ( ) _ West ( ) West ( ) Skylight....... ...... THERMAL MASS Type/Covering Area Thickness (slab/exposed, Life, etc.) _40 (inches) Location/Description (kitchen, bath. etc.) VNYL / G.I - 11�nr�sN ilz HVAC SYSTEMS Minimum Duct Type (furnace. air Efficiency Location Duct tl conditioner heat m) (SE. SEER.HSPF) (attic, etc.) R -Value Manufacturer / Model # , • a7 7� _AmG 14 C,_ -7._S"' 1 Le- S, Maximum Furnace Heating Output: Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas. etc) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) Mandatory Measures Checklist: Residential r MF -1R NOTE: Lownse residemial buildings subject to the Standards must contain these Measures regardless of the compliance approach used. Items marked with an asterisk (') may be superseded by mare stringent compliance requirements listed on the Certificate of Complianrc. when this checklist is incorporated into the permit doeummM the (attunes noted shall be considered by all parties as binding minimum component perforrmance specifications for the mandatory measures whether they are shown elsewhere in the documents or an this rhocklist only. DESCRIPTION DESIGNER ENFORCEMENT Building Envelope Measures ' §2.5352(1): Minimum ceiling insulation R-19 weighted avenge. §2.5352(b): Loose fill insulation manufacturer's labeled R -Value. ' §2-5352(c): Minimum wall insulation in framed walls R.I I weighted average (toes not apply to exterior muss walls). §2.5352(k). Slab edge insulation - water absorption rate no greater than 03%. water vapor transmission rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352((): Vapor barriers mandatory in Climate Zones 14 and 16 only. §2.5317: InfiltratioNExfiltration Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped: all ,'pints and penetrations caulked and sealed 12-5352(e): Special infiltration barrier installed to comply with 62-5351 mew CEC quality standards 12-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. HVAC and Plumbing System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. 12-5352(h) and 2-5315: Setback thtr ostas on all applicable heating systems. • §2-5316(x): Ducts constructed. installed and insulated per Chapter 10, 1976 UMC. §2.5316(b): Exhaust systems have damper controls. 112-5314(c): Gas-fired space heating equipment has intermittent ignition devices - §2 -5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. §2.5352(1): water heater insulation blanket (R-12 or greater) or combined interiorkxterior insulation (R-16 or greater): fust 5 feet of pi fes closest to tank insulated (R-3 or greater). §2.5312(Exception 1): Pipe insulation on steam and steam condensate return do recirculating piping. §2-5318(d): Swimming Pool Heating 1. System has: a. On/off switch on heater. b. weatherproof instruction plate on heater. e. Plumbed to aliow for solar. 2. 75 percent thermal cfriciency. 3. Pool cover. 4. Time clock. 5. Directional water inlet. - Lighting and Appliance Measures 12.5352(j): Lighting - 25 lumens/watt or greater for general Lighting in kitchens and bathrooms. §2-5314(c): Gas rued appliances equipped with intermittent ignition devices. 12.5314(a): Refrigerators. rtfrigerator•freezets, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. COMPLIANCE STATEIVIFNT Ibis certificate of r n piiance lists the binding feathnler and poformanoe specifications needed to comply with Title 24. Chapter 2-53 and Title 20. (3upw2. Subdmq ter4. Article 1 of the California Administrative code, This certif care has been signed by the individual with overall design responsibility and the building owner. who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. Designer Building - Name: Nam= T kffimm Addma: Tidc/FuTn: Addicts: Tekphone: Tekphonc Lic. 4: (sitnamm) (date) Documentation Author Name: rtwF,t„t; Addn=: l Znatare (date) orcement Agency Name: Agency: Telephone: