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HomeMy WebLinkAbout005-433-007Sep� ®6 Dale Brantley 1514 B St., ChicQ Permit # .9 78B,(demolish exis.fire damaged home/SF) f -6G0 1" a !G Permit 9—,F,(relocate ele & sewer line) MH S -j"-0"no') ELECS= COMPACTION TEST REQ? /1/ 0 SUPPORT STRUCTURE REQ? Al Permit #2547-79P(gas line/1513-79) I LCQ =I& contr: Carrell Bros., Chico Permit #2099-79MHi Issued `"— 7 I I I I I ( I i I I I o � �; �� �� ��I: ��� � PERfvfT NO. '.513-79P,E PERMIT EXPIRES OWNER DALE BRANTLEY CONTR. owner LOCATION (A.P. 46-153-7 ) 1514 B St., Chico Temp. Power Pole Called PG&E T—sp. Elec. Serv. Called PG&E 'Tamp. Gas Serv. Called PG&E ✓� JOB FIINALED r (Date) (Signa' ) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings StemwaI l Garage Vents Insulation Water Htr. Heaters Slab Carport p Footings Prov. for physically handica ed Conformance of ex. structure Appliances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL isonry Walls Reinf. Steel F r-raming Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation _ Permanent Door Closer Final Final MOBILEHOME UTILITIES ---------- Elec- Service a; Elec. Pedestal Water Piping_ Sewer P 9, BI EH ME INSTALLATION - - - - - - - - - - - - - - Support 5`! a L Elec. Continuity Water Piping Drainage �' -l0 ; .'7 s Gas Piping DATE sem,. (NOTE: An entry must be made on this form each time you visit the job site.) la, 9. Electrical A. Is service large enough to provide adequate amperage to mobilehome (must equal rating of mobilehome with a minimum of 10 amp) aigd other facilities on lot, i.e., water pu6ps,,,_ garage, cabana, etc.? Yeses No B. Is there proper clearances around panels? Yes VINO_ C. Is power supply cord or feeder assembly properly fused? Yes No_ D. Is continuity test satisfactory as per the following procedure? Yes_ No 1. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the ".on" position. 4: Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 5.- All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall.be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the. mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle 2� mllc e,� Length0199! Width 27 AM AD--/ %.T5 -F, Vehicle Serial No. IIAJ D 52 / `73 5-9 State Identification No. (�✓9C.:/l 2-ZI % Additional Information or Comments: MOBILEHOME INSTALLATION INSPECTION CHECK LIST 1. -Is"the mobilehome located with quired separation from lot lines and buildings and generally conform to plot plan'? Yes o 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes./.,/No 3. Are footings and supports properly sized, spaced, and braced as per approved plans? (Note possible variation at spring shackles.) (Sec. �� c.. 5082 & 5083) Yes_ No 4. Is the mobilehome level? (Sec. 5088) Yes r'" No_ 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes ' No 6. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes_j,--No_ B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes No_ C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes_ No �/ 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes -0 B. Does it have minimum V per foot slope and is it properly supported? Yes(/ No C. Are any leaks detected in drainage system after runn g 3 -gallons of water through each fixture including washing machine standpipe? Yes No -� If coach is not State of California approved, does station have required trap and vent? b Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobil home gas line inlet without reductions other than the mobilehome connector. YesNo B. Test OK as per following procedure? Yes_ZNo 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes_."1/No COUNTY OF BUTTE " DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CEORNFICATEOF OCCUPAN This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter S, under permit number - '>" ' for the following location: Owner Owner's Address Mobilehome Mfg. - Model a"' '� Year Insignia No. t L J i..FA Serial No. -' � ! yj V,` It is hereby certified for occupancy at the above described location and maybe occupied. � Date Director of Public Works 13Y THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED COUNTY OF BUTTE — DEPARTMENT OF PUBLIC -WORKS ;y 7 County Center Drive — Orovi lie, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT L -1Z X0 9 91- 2 9� authorize represe es of the County of Butte enter upon the above-mentione property fo section pure s A�� X Date Signature of Permittee or Agent Receipt No.1�� — WkitP-n-P.W- - Yellow -Assessor - Pink-InsDector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. IRE' R OF UBLIC WORKS B;—t Date ` Building permit expires Date `��� BUILDING /I i�AL� Owner Q�%jy %L �,/_ £ OR eAe40A_ Mailing Address 7C/Cj CIE,, 1,Q wd SQ. FT. OCC. BUILDING VALUATION nI- n Telephone No. i(o Contractor Oq,CRcu_ 62US. Mailing Address 3040 C—:5PL'U /7/ Fireplace Total Valuation n Telephone No. 895- 7lo Permit Fee Building Address Plan Checking Fee &/or Penalty Permit Fee 15/ $ S1-,eECf PLUMBING No.1 FEE 3U TTC Co , &9191-/,C PERMIT FILING FEE J$3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 /- A. P. �Cv /✓r3 % - Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 F s Sea+xasi.on. Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA _Plans Parcel I Declaration I Parcel Map 'Parking 1 60R/W Improve T2 Each additional outlet .30 Building sewer 5.00 dg. Plans Recd Parce pproval Plo pproval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER XJ Permit Fee $ M ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 600V OR LESSLE55 Main service 5.00 100 AMP OR Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service O100VEAMPOR soovR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 ' NEWCONST. DWELLING OCCUP. S OR ACDNS, ( ACC, BLDGS. 20sq ft CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the tinder the name State of California Business & Professions Code u style of: NEWCONSTR. MULTI -OUTLET NON-RESID. (BRANCH CIRCUITS) 2.50ea NEW CONST R. (POWER APPARATUS & NON -RESID. SINGLE OUTLET CIR. Ex. QCcuo(OUTLETS OR FIXTURES BAL@BAL@102 L OUTLETS ) 2.00 Ex. Occup. ( FIXED TS (1E S, OR S10,) EA Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 --SS� `/� /t License No. O/'tw Classification ( -i4 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ElI have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ 070 1 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 Land Development Fee Is TOTAL PERMIT FEE $Q Oct authorize represe es of the County of Butte enter upon the above-mentione property fo section pure s A�� X Date Signature of Permittee or Agent Receipt No.1�� — WkitP-n-P.W- - Yellow -Assessor - Pink-InsDector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. IRE' R OF UBLIC WORKS B;—t Date ` Building permit expires Date `��� COUNTY OFBUTTE DE T E P'P;R M NT OF PUBLIC WORKS 7 County Canter Drive — Oroville, California 95965 �~ Telephone:, 534-4541 APPLICATION AND PERMIT autnonze representatives of the uouniy or tsutte to enter upon the above-mentioned property for inspection purposes. X Aaetl Date _37.. Signature of Peermitee or gent Receipt No. ` 9K�17 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTIORa06-,PUBLIC WORKS By Date9 ilding permit expires Date BUILDING Owner A -Le L� y SQ. FT. OCC. BUILDING VALUATION /�%� Mailing Address Contractor ©W &J E V-- Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address 5 ( Plan Checking Fee&/or Penalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 o(jjj Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No, (� Zoning & Plan ter piping 4.68 Each gas water heater or vent 1.50 Fli4s W. 1 S i 'on .FireDept. Fire Zone Use Pe6//it Gas piping system 1 - 5 outlets 1.50 EQA Parking P -sans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 0(? Bldg. Pla Recd Par Approval Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES Un OTHER ❑ Permit Fee $ /0,00 $ ©C ZE:(,CSC aT-C- EL Cc , -f- 5P-WA-crE D15 P,> ELECTRICAL No. @ FEE �i0L. LJ- ATf--iL AUD e -14S "aLf—�—At, Lz-C PERMIT FILING FEE $3.00 ;tJO Main service 100 AMP OROR LE SLESS 5.00 CIO Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 2,.50 PARCELW AS 'iGU 10 05v OGGLPteD QpY OVER Main service 100 AMePooOvR LESS 25,00 Main service EA. ADD'L 100 AMP 1.00 vnjeI� F :i NEW CONST. ( DWELLING OCCUP. 7i\ 20s ft OR ADDNS. ACC. BLDGS. 1 q CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: NEW RESID. lBR LTI-OUTLET NON-RESID, ` BRANCH CIRCUITS) 2.50ea NEW CONST R. POWER APPARATUS & NON.RESID. (SINGLE OUTLET CIR, Ex. Occup(OUTLETS OR FIXTURES) 8 L@10Q Ex. Occup. (OUTLETS (RESID•)REAY 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /x.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ MECHANICAL No. @ FE_ E WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with. the County of Butte a certificate of Workmen's Compensation Insurance. 'pCi1 I certify that in the performance of the work for which this Vu -permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 1 1 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $a S r TOTAL PERMIT FEE 2 $3 autnonze representatives of the uouniy or tsutte to enter upon the above-mentioned property for inspection purposes. X Aaetl Date _37.. Signature of Peermitee or gent Receipt No. ` 9K�17 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTIORa06-,PUBLIC WORKS By Date9 ilding permit expires Date COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS ,. 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT � �! authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X / �! ��6.��/�"7 Date Signature of Permiteeee or Ag nt Receipt No.� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. RECTOR 0 BLIC WORKS By Date silding perm texpires Date BUILDING Owner Gip fit, SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address C L , Telephone No. Contractor Mai I i ng Address Fireplace Total Valuation Telephone No. Permit Fee Building AddressS �j� Plan Checking Fee&/or Penalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 % Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. v �; — Zoning & Planning Water piping1.50 Each gas water heater or vent 1.50 F64's W. Sa4kaAierr Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 ,• EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 ans ec Parcel Approval Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ® Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 2.50 . Main service O1V00ERAMeoov POR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONST. ( DWELLING OCCUP. 4) 24tsgft OR ADONS. ACC. BLDGS. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business &Professions Code under the name style of: NEW CONSTR. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS)l 2.50ea NEW CONSTF2. (POWER APPARATUS 9 NON -RESID. SINGLE OUTLET CIR. ( ) �@1 EX. OccupOUTLETS OR FIXTIiRES@ 0Q BALCs 1¢FIXED ALNS Ex. Occup. ( OUTLETS P(RESID.)REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ® I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICALN0.1 @ 1 FEE WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ®I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $ TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X / �! ��6.��/�"7 Date Signature of Permiteeee or Ag nt Receipt No.� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. RECTOR 0 BLIC WORKS By Date silding perm texpires Date PERMIT NO. 479-78B PERMIT EXPIRES 1�f19 OWNER Dale Brantley CONTR. owner LOCATION (A.P. 46-153-7 1514 B St., Chico Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOBS FINALED (Da e) (Signature) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS Y BUILDING INSPECTION RECORD BUILDING' , J �., BUILDING (Cont'd) / I \ PLUMBING / Setback Fire II Soil Piping Forms =Para a 1st Floor Main Bldg. Restroom inish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for phs ally handica ed Conforman of ex. structure Appliances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio y FIREPLACE Final Footinqs / \ I Footing / I i/ELECTRICAL \ .1 Bond Beam FIRE4PRIW6&RS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh M HANICAL Grd. Fault Prot. Scratch Heating Service Brown kooling Temp. Pole Finish D is Underground Interior Lath Ven lation Permanent Door Closer Final Final MOBILEHOS UTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - - - -- Support Elec. Continuity Water Piping Drainage Gas Piping DATE oenk 4 REMARKS OR CORRECTIONS i 7�2 (NOTE: An entry must be made on this form each time you visit the job site.) J COUNTY OF D-UTTE. — DEPARTMENT OF PUBLIC WORKS ,�. 7 County Center Driv--—-Urovi.11e, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT �'7,9_ZP- 10 M 11 BUILDING Owner /i �G% � �� ;�� �e'../ SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee S PlanCheckingFee &/orPenalty Telephone No. Permit Fee $ $ Building Address ' sl Z7J�� PLUMBING. No. @ FEE ' PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. o.� 1,5_3 — Z Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 / F®�S *< I Sa+�� FireDept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Ma p 60' R/W provementIs Improvement Lawn sprinkler system 2.00 Bldg-Plarrs—R2i"'d Parcel Approval Plans Approval Permit Fee $ ' $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 / 600V OR LESS Main service 600V AMP OR LESS S.00 Main service EA. AOD'L 100 AMP 2.50 OV R Main service 100EAMP600ORV LESS 25.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD -L 100 AMP 1.00 NEW CONST. OR ADDNS. ( DACCLBLDGLING SO,CCUP. &) 2¢syft, NEW CONST R. MULTI -OUTLET NON-RESID, BRANCH CIRCUITS) 2.50ea _ NEW CONSTR. (POWER APPARATUS & NON-RESID, SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW . I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under. the name style of: Ex. Occup(OUTLETS OR FIXTURES)50 @ 25¢ 101 Ex. Occu FIXED APP LNS. O P.(OUTLETS (REST D.)FE A) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become_ subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT. FEE $ , dulnunce representdtives of ule L,wnty of tsutte to enter upon ine above-mentioned property for inspection purposes. x X Q Date 79 Signature of Perermitee or Agent Receipt No.— White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR/_I PUBLIC WORKS BY Date ._-.7 i wilding permit expires Date �� -7f 1�'7 r , .r .•., RI r•i,fi••i„ 2-_ ~ J_.:I'L>' na '7.AG �--.a°k .:. r...Y.., u'4. 9•...,tl `46:'l 5. I•u. :I r FIRE NUMBER: :a;' RANGER UNIT (OR AGENCY):— .l%� A FIRE NAME: �- DATE FIRE STARTED: 5 If Fire Started in Another Jurisdiction, or Zone I or II, Name It: C. LOCATION. Spot fire origin. Always give section location where possible. D. CLASS OF FIRE Otherwisegivesub-division lot; R.F.D. box; etc. Sketch boundary of large fires, Vegetation roads, railroad, zone line, etc. Structural %S^ J `/ Vehicle v ` Improvement Refuse" False Alarm E' Permit Escape Includes weed burning O . SEC . TWN E. SCALE: t:" _ ',IeMit.ecnl Fireoccurrc .Direction from Town of F. WHAT BURNED? G. DAMAGE (Do no, make duplicate (a) If structure gsvepum sn es con%tructson, s Sts, size. (b) If entries below) vehicle give make, model, year, license, driver's name and dress. If ve aiion giv t a d area. (d) If Range other, describe fully.- / Standing Grain Harvested Crop /� / f` r Industrial Bldg (s) . Non -Indust. Bldg (s) . Building Contents Vehicle (s) Vehicle Cargo (j Oil or Oil Products Vegetation Area IIur a TOTAL $ H. CAUSE FIs: �_ Known C]; Log. E]l sta on: Known ❑; Log. 0 'ter irk Qn' Known ❑; Log. ❑ Vas "fid" ui er used before crew arrived? A14Dii jury o De th cur?Explain:Q K. NA ND ADDRESS OF OWNERS OF DAMAGED PROPERTY: Tenants Name and Address: L.. INSURANCE CARRIER(S) /�! �` `� r— J'G✓��%r��,;� Address: s 1 M. DESCRIBE PROPERTY SAVED AND ESTIMATE VALUE: P J. WEATHER WHEN FIRE STARTED Wind Velocity M.P.H. Wind Direction Temperature Humidity Fuel Moist. REMARKS N. HOW MUCH INSURANCE WILL PROBABLY BE PAID? _ n /f �, ��.� Signature of 0;& .,k.,1k.D.E BY; �1Cril�1 }lt�:cl�G�/� Oycer in charge l` Ltt t<.,. .� (. �t l , • k - •- a � � t , �. -•s �': ��-�� �- � ,�, .d-,�1 �'�,� �, Y4i � moo.. -u � c��� 4 k - •- a ,�, .d-,�1 �'�,� �, Y4i � moo.. -u � c��� 4 } � t