HomeMy WebLinkAbout007-150-084STE GERTRUDE POWERS
n,/ s Mort Lane $ 56601 W. of L zrnap Ave.
Chico ..e`7-�
1 Perm' ' 34 a --75P; E(4 il- ) M��J
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i PERMIT DESIGNATION:
I DEPARTMENT OF
t BUILDING AND SAFETY
LOT BLOCK SUBDIV. uRb z_=--_/Wtv I
SUPPORT &..CRUCZ RE 3Z ° na
TYPE OF COMPACTION TEST lU4Q . _ _
PERMIT PERMIT NO. PLAN NO. DATE ISSU 1 , I �r�.�.
C'ONTR - yDakmont MH Center, Chico
Issued X02-
::APermit,#6209-75MH
007-150-084 ,94-0618B,PE•,
..REEVES, -SUSAN.
.. 956 MORT LN . , CHICO
COV PORCH, CABANA/MH
REMARKS
B -BUILDING E -ELECTRICAL U -USE PERMIT
P -PLUMBING TV -RADIO -TV ANTENNA V -VARIANCE
T -TRAILER S/W-SIDEWALK NOTICE S -SIGN PERMIT
' V4
HM -HOUSE MOVING
EP -ENCROACHMENT
D - DEMOLITION 600.1
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LOCATION,
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EXTERIOR
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INTERIOR
PLASTER
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OROVILLE, CALIFORNIA
GENERAL CLAIM
CLAIMANT: SUSAN REEVES
i
ADDRESS: 956 MORT LANE
CITY & STATE: CHICO. CA 95926 IMPORTANT:
4�7�94 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)
AMOUNT j
OWNERS DECIDED NOT TO BUILD
j
(B.P.#94-0618, RECEIPT #156330, A.P.#007-150-084, OWNER:
SUSAN REEVES) TOTAL
j
RETAIN REFUND PROCESSING FEE ..................$ 25.00
j
RETAIN BLDG.PRMT FILING FEE :...................$ 20.00
I
RETAIN BLDG.PRMT PLAN CHECK FEE................$172.25
j
RETAIN PLUMB.PRMT FILING FEE ...................$ 20.00
RETAIN ELEC. PRMT FILING FEE ...................$ 20.00
TOTAL AMOUNT TO BE RETAINED .......... $257.25
TOTAL AMOUNT TO BE REFUNDED.........................$306.70
-i
i
i
TOTAL
306.
70
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. C� o
Dated this > day of �/./............ 19�/ et.. ../.................... Calif. 4/w�wxM..l..../ ......
......... ........................ i
Signature of Claimant
1, the undersigned, hereby certify that, to the best of my knowledge, the services or artic es •fi a ove eve be performed or de- I
livered and that there is a Budget Appropriation E] or Specific Board Approval O (Checko ) f sa e I
7TH
�,tDDDDTTTT (�/. 11�� TTTT TT pp I
Dated this .................................... day of ....... tt.J,.l).J..ta....... 19.9.4 at ..QA1.Qy.J..INUf:�.... . Calif. i
apartment ead or Authorized Deputy
Dept. Exp. j
Code ...440-002 .................... Code .4.2.10500 .......................... PAYABLE FROM FUND
DO NOT WRITE BELOW THIS LINE — AUDITOR'S USE ONLY
DEPT. & SUB. PROJ. I SUB. OBJ. I CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT.
I
All
0
All
ISM*
PERMIT* #:
ASSESSORS PARCEL #:
ER'S NAME:
S. Amount: and'Purpose-
- SED -PLAN CHEM
B CE OF FEES: $
ADDITI AL.FEES:-$
REINSPE
KN' FEE:
SHERIFF FEE:
CHICO URBAN AR FEE-:
\AR
THERMALITO/NO. OR TRAFFIC:
OROVILLE AREA TRAFFI
COPIES: $
ik Z
IF BALANCE. OF FEES OR/ITIONAL VALUA ION:
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-75 P MIT NO,
APPLICATION AND PERMIT �-� F
'ff6V—'T j�u-1%
l U
NING
zoRTl
BUILDING PERMIT
N t
OX5R
6 MORT LANE, CHICO 95926
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
R 22,937
DO448
WNERLING ADDRESS
140 C 1,890
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee $
20.00
LENDER'S MAILING ADDRESS
Permit Fee $
265.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
172.25
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS 956 MORT LANE, CHICO
PERMIT FEE $
1457 - 9911
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7,00 21.00
Solar or heat pump water heater
23.00
Water piping
15,00 15.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobilehomeyd Other
SPECIFY
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G I W
@20.00
TYPE OF WORK
New ❑ Addition ff Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describework: COVERED PORCH, CABANA—FAMILY ROOM, SEWING
PERMIT FEE $
71.00
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
ROOM, BATH
Main Service ( 600V 0R LESS )
200A OR LESS
23.00
Main Service ( 200A TO 1000A )
46.00
NEW ELLINOR ADONS CONST. ( D a ACCGBLDS. )
3.5C ST. 15.70
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 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 compensation, will do
� khe work, and the structure is not intended or offered for sale. (Sec 7044)
l� I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ 1 am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI.OUTLET
NON-RESIO. ( BRANCH CIRCUITS )
@7.50
( POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
BA20 @ 1.000
Ex. Occup.FIXED APPLNS. OR
(OUTLETS IRESID.I EA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
vCertificate of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
35.70
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
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 Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
County in consequence of the granting of this permit.
X ,—� Date / p
Signature of Applicant Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
consT. TYPE
TOTAL FEE $ 563.95
HA EEsIMP
F O CDF
PARC
HD SS
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for hich fees have been paid.
By Date
7 h
PERMIT EXPIRES ON 3`�l `_q L5
tDate/
ReceiptNo. 156330Dr
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILL CeLwORNIA 95965 -TELEPHONE (916) 538-7541
PERMIT APPLICATION DATASHEET
OWNER A. P. No. D07-
-Proposed Building UseBuilding Inspector (2�6 Date 3 ( b
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECENED 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 $ . .............: .
11. Impact fees as shown on attached schedule. ��/. 1 ���............ .
California Department of Forestry plan approval/fees. ....................... .
Flood elevation letter (100 year flood) by California Engineer . ................. .
14. Sanitation and plot plan approval r (Q 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). .. .
oA
20. Pre -inspection for to Bussing Ins re°or
required. .. to Building io�edo� • (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: Mail to owner. Mail to contractor.
c Telephone fir!-5857and hold for pickup at C14%,( o office. Deliver with inspector.
Other '
Parcel Creation
Acreage Applicant /=�?w-a-�.ir , , Date 3 - / o
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollu`fionfDate'LK/I✓��f,-
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new it note hecked above).
1. Index permiffor above items No,
2. Additional items required:
Contractor, designer, owner, was advised of above required data by _ phone _ mail C inter by _ Date
Contractor, designer, owner, was advised of above required data by _phone _mail ounter by _Date
Plans checked by Date Plans approved by Date 3 d
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
Iris••.,a��..�rw�+e+�ia'�rzt-iaa+aw^-�"«,�. . � • �'rr„'�„T"r'�aa�'�s?�"'6Y'"�'�{°tit��'�if�F�ii'�+�''rd`F"K'QR�tn�3�
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District ic°'
A!P. Number Q� [ ' �.>�� 8 Jurisdiction 0 City
Property Owner _ 5 (JSAAI
Property Location/Address
Subdivison
Residential Development
AWN
Commercial/Industrial
0
No. of Living MHI•
Units
D
New
Building Department No.
P_. County
Lot No.
XSq. Footage yV/U
ditio (Group R)
Sq. Footage
Addition (Including Exterior
Roofed Areas)
Building Depart M* ent Repres tive Date
(Floor Plans reviewed by School District Personnel)
District Identification No:.
School District certifies that 'IQA_�
(Applicant)
(Street Address)
r ,
(CRY)
has complied with the requirements of Resolution No.
representing square feet.
School District Representative
Paid by Check Number
Bank Number
Paid by Cash
(State)
(Phone Num
(Zip
by payment of $ G x
'3 9 c
Date
AJ Remarks:
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) feeformmkl (4/92)
G,cOUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, Califo(nia 95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER �D j5.� _�n
C�
ZONING
S�?.�- BUILDING PERMIT
OWNER
^-,,
TEL E
�z-s s'!
SQ. FT. OCC. BUILDING VALUATION
2Z 3
OWNER'S MAILING ADDRESS C
.(/ C I t:,
CONTRACTOR'S NAME TELEPHONE
1
CONTRACTOR'S MAILING ADDRESS
Fireplace
Total V8IU8tlOn $
CONSTRU O
UNKNOWN
Filing Fee $
Permit Fee S
Plan Checking Fee $
20.00
c2 5 , E 0
/ 72 . Z r
LENDER'S MAILING ADDRESS
ARCHITECT EER
UCENSE NO.
Energy Plan Checking Fee $
+
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS o
C C
PERMIT FEE
PLUMBING PERMIT
Filing Fee 20.00 '
Each Trap 31
7.00 go
Solar or heat pump water heater
23.00
Water piping
15.00 Qc:.>
LOT NO. SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00 .)!!:f;1'p�
Duplex ❑ Mobile homeX Other
SPECIFY
Mobile Home S G I W
@20.00
TYPE OF WORK
PERMIT FEE $
� (D0
New O Additio4 Remodel El Utilities O Installation ❑ Other O
Contractor
�
Describe Work: A) O/L/A
ELECTRICAL PERMIT
Filing Fee 20.00
R LESS
Main Service ( BOOV O )
200A OR LESS
23.00
Main Service ( 200A TO 10ooA )
46.00
NEW CONS.OR ADONST ( O&ACCG B,— )
3.5C ST; S?0
CONTRACTORS LICENSE LAW(
I declare under penalty of perjury (check one)
❑ 1 am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. Classification
O I, as the owner, or my employees with wages as their sole compensation, will do
NEW CONST. MULTI -OUTLET
•NON RESID. ( BRANCH CIRCUITS )
@7.50
POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
SAL. 20 @ 1-00
Ex. Occup. (FIXED APPWS. OR )
OUTLETS IRESID.) EA.
5.00
Temporary Service
23,00
Mobile Home Facilities
20,00
the work, and the structure is not intended or offered for sale. (Sec 7044)
O 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ 1 am exempt under Sec. Business and Professions Code
Misc. Wiring
23,00
forthis reason
WORKER'S COMPENSATION INSURANCE
PERMIT FEE $
,j S o`7 o
Contractor
I declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
O 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Certificate of Consent to Self -insure.
❑ I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Hood
6.50
Ventilation
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
PERMIT FEE $
such provisions or this permit will be revoked.
Contractor
Mobile Home Installation Fee $
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
Energy Inspection Fee $
Occ corNsr. TYPE TOTAL FEE
HAZ. 1 D. FEES IMP I FLOOD I CDF
J� %✓J� o
PARCEL [ PU HO ISSUE
County in consequence of the granting of this permit.
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.
�}
X Date /
Signature of Applicant - ❑ Owner O Contractor O Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
By
PERMIT EXPIRES ON
Date
Receipt No. 33 D
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
/Dere!
COUNTY OF BUTTE - Deoartnient of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
OWNER-BUILDER.VERIFICATION:
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay is processing and issuing your building permit. No building permit
will be issued until this verification is received.
1. I personally plan to. provide the major labor and materials for construction of
the proposed property improvement (yes or no) S
2. I (have/have not) L%4,5 S signed an. application for a building permit.
for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4: I plan to provide' portions of this work; .but, I have hired' the following person
to coordinate, supervise, and provide the major work:
Name
AddressCity
Phone Contractors License No.'
5. I will provide some of the work�but I have contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner
Social Security Number
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
I
F.H. USE ONLY
Plot I'I:m Attachcd P'/
Floor I'I:m Auacl d
Sent to It. U.
TO: ! Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
2 ee rreJ
9SZ /hug -T li,- 7-ir- -
Owner Location, AP#
Plan Approve d~for: Sewage Disposal Water Supply: Public Private Well
Clearance for bedroom mobile home. Other
Hold final for:
Final clearance O.K. for:
NOTE:
Environmental Health Specialist
8/92
Date
9
p' r
•J{ /�{k/!J r�
PERMIT NO. 3/68-75P,E
P
E
M
UTIL.
PERMIT NO.
r
qPERMIT EXPIRES
5C -76
TOWNER Gertrude Powers
JCONTR.
f
LOCATION (A.P. 4.4.'33-84
)
n/s Mort Lane, 560' W. 6f
Burnap Ave., Chico
li
,4
f
,+ Temp. Power Pole
l° Called PG&E
Temp. Elea Serv.- 460
'
�1
Cabled PG&E
i • Tem Gas Serv.
Called PG&E
OB
JOB
INA
(Date)
(Signature)
Framing
�a
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD '
Water Htr.
BUILDING BUILDING (Cont'd)
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Sidina
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwall
Slab
Prov. for physically
handicapped
Heaters
Appliances
Carport
Footings
Conformance of ex.
structure
Gas Piping & Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
I FIRE SPRINKLERS
Motors
Framing
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
DATE ��0 — 7� REMARKS OR CORRECTIONS
® 0-1 rn P4 E ,ff d [. iE cT/V C.- Tv
16c Co A(Al,
a- 7C) -/7
G� e
9. Electrical •
A. Is service large enough to provide adequate amperage to mobilehome (must equal ratingtf
mobilehome .with a minimum of 100 amp) and,other facilities on lot, i.e., water pumps,
garage, cabana, etc.? Yes No
B. Is there proper clearances around panels? Yes_L-'**No
C. Is power supply cord or feeder assembly properly fused? Yes No_
D. Is continuity test satisfactory as per the following procedure? Yes_" o
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 fot r 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 f
Manufacturer and/or.Namestyle
Length b69 Width
Vehicle •Serial No.
C)
State Identification No. r ol!�E
Additional,Informati.on-or Comments:
7
P
MOBILEHOME INSTALLATION INSPECTION CHECK LIST
11, Is the mobilehome located with /required separation from lot lines and buildings and generally
conform to plot plan? Yesy No
' r"
2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes�N0
3. Are footings and supports properly sized, spaced, and braced as per approved plans?- (Note
possible variation at spring shackles.) (Sec. 5082 & 5083) YesG/No
4. Is the mobilehome level? (Sec. 5088) Yes L, -,No
5. I.f more than a single unit, are crossover connect* ns properly installed? (Sec. 5088)
Yes No
6. Water
A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Set. 5566)
Yes L,; -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
%. Wastes and Drains
A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes ��No
B. Does it have minimum k" per foot slope and is it properly supported? Yes L__90
C. Are any leaks detected in drainage system after running 3 -gallons of water through each
fixture including washing machine standpipe? Yes No
D. If coach is not State of California approved, does station have required trap and vent?
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 mobilehome gas line inlet without reductions other than the mobilehome
connector. Yes(/ No
B. Test OK as per following procedure? Yes�o
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 No
TO: Building Department
FROM: Environmental Health
RE: Sewage and/or water Clearance
/
:a
0611NER LOCATION A .P##
Has been approved for: /
SEWAGE DISPOSAL
rJATER SUPPLY J
anitarian
n�+o
S95-775
ti COUNTY OF BUTTE — MUEP*RTMENT OF PUBLIC WORKS ,
7 County Center Drive — Uroville, California 95965 / — 7 ---
• Telephone: 5a4-4541 JJ
APPLICATION AND PERMIT i
— -1 — —p—avnaauvca VI LI IC I�UUnIy UI OULIC LU VIILUF UPUI1 mu
above-mentioned property for ins/p'ection purposes.
X r e-G<1�.,_ Date /7-
Signature
7Signature of Permitee or Agent
Receipt No.
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permitis.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 U,U IC WORKS
BY Date — 0 -G-
d#prermit expires Date%
BUILDING
Owner e
SQ. FT. OCC. BUILDING VALUATION
Mai I Ing Address
Telephone No.
Fireplace
e
Contractor e
Total Valuation
Mailing Address ';�Znlo 10T
Permit Fee
anChecking Fee &/or Penalty
_
le ne N
Permit Fee
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE J$3.00 ,
'—
Each Trap 1.50
c
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. Q p
3"—
Zoning 8 Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet _ .30
Fe
9afr4etion
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
D laration
Parcel Ma P
60' R/W
Improvements
P
Lawn sprinkler system 2.00
Bldg. Plans c'd
Parcel App a
Plan Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 100 AMP OR00V OR LESS5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family ❑ Duplex ❑ Mobil Home Others ❑
Main service 1 0 AMP OR VER 600V LESS 25.00
Main service EA. ADD•L too AMP 1.00
®
NEW CONST. DWELING
OR ADONIS.( ACCLBLDGS.OCCUP. &) 20sgft
NEW CONSTR. (MULTI -OUTLET
NON•RESID, BRANCH CIRCUIT'S) 2.50ea
--�
NEW CONSTR. (POWER APPARATUS &
NON -R S'SID. (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 BAL@}
Ex. Occu FIXED APP LNS, OR
P•(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. >J4
_�� Classification � ' G %
Misc. Wiring '6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit 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.
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 1 2.00
Permit Fee 0:4 OC $
$
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
TOTAL PERMIT FEE
$
— -1 — —p—avnaauvca VI LI IC I�UUnIy UI OULIC LU VIILUF UPUI1 mu
above-mentioned property for ins/p'ection purposes.
X r e-G<1�.,_ Date /7-
Signature
7Signature of Permitee or Agent
Receipt No.
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permitis.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 U,U IC WORKS
BY Date — 0 -G-
d#prermit expires Date%
f COUNTY OF BUTTE - DEPARTMENT OF PUBLIC W � l '7
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541 /
APPLICATION AND PERMIT
Z 3 3 �f!.� U v oy - —
Receipt No. l Q
White-D.P.W. - ellow-Assessor — Pink -Inspector — Goldenrod -Applicant uilding permit expires Date
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address T ax J 1-�L� r
ne
R;6neo
-2�
Fireplace
Contractor LA.) Ay &7
Total Valuation
Mailing Address
Permit Fee
P I an Checki ng Fee &/or Penalty
Telephone No.
Permit Fee
Building Address �,�� D
PLUMBING No. @ FEE
FILING FEE $3.00 �, QQ
-IAIPERMIT
�Q Q
Each Trap 1.50
C/
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. N -- ��
/L'�"'ZanZ P
Gas piping system 1 - 5 outlets 1.50 Q
Each additional outlet .30
es
San ti Fire Dept.Fire
Zone
Use Permit
Building sewer 5.00•
EQA
Parking
Plans
I Parcel
Declaration
Parcel Ma P
60' R/W ImprovementsLawn
sprinkler system 2.00
g. Plans Rec'd
Par pprovaI
Plans Approval
Permit Fee $ a3r10
$ 3. d
NEW ADDITION UTILITIES a OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 0,00
Main service incl. 1 meter -, 19 d
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
-
Single Family Duplex Mobil Home 0 Others ❑
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
Light fixtures b 1
Receps., switches & fix outlets
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00 S•
Temp. Power Pole 5.00
Li ense No. Classification
Misc. wiring
K 2f I am exempt from the Contractors License Laws of the State of California.
Permit Fee &aA 00
$=-2,/, ®(
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.
ve placed on file with the County of Butte a certificate of
kmen's Compensation Insurance.
rtify that in the performance of the work for which this
V�1.0,�, ,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
Ventilationmit
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
CL
e& Date / g7S
Signature of Permitee or Agent
TOTAL PERMIT FEE
$ 0
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.
IREC�TOR OA PUBLIC WORKS
/` YC ^�/ i : e r, r
Z 3 3 �f!.� U v oy - —
Receipt No. l Q
White-D.P.W. - ellow-Assessor — Pink -Inspector — Goldenrod -Applicant uilding permit expires Date
1w
Z r'
Phis set of. pians and specifications
MUST be
ked on the job at all times and It is unlawM to
whe any changes. or. a -iterations. on. same wiiheut
L -n Pler Sisson from the `Departmc'., of PubFfc
VVOI'6, eour!t1/ of
Septic system
d_
=rem
Butte County Heat
o be as" per
Dept. Re
qul'rements.
Che
. Setback shall be
5 ft., from
The side
property line and
ft. from
the
@Werline of the road,
p rmittingp `
ma',
um of a 2 ft.' eave
o erharOi ,
t�tr
All utility
within 4 ft o�OP-
section
shall be
h
o -f, . th utsi
left (r°ad) mO
e theom
—
mee side of t
`e".h
e�obile
.
f
O� OG 5rN
-
Ob
b
- A /
t vJ
41
J
h f
V'
connections shall b�
ll utility \
located within 4 ft. outside the rear ��
A
orn
third sectiond) side of hof the mofe mobile �
on the left (r
horse. `
l
ta.
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS'
7 County Center Drive, Oroville,.CA.
PHONE: 534-4541
MOBILEHOME INSTALLATION SHEET
1. Owner's name: ('F�� l %TUOf= /3,
2. Installer's name: 013A h9c1✓ T /17 c,3l6i•' /�.,,i- �.;w r��
3., Is the site currently under permit? Yes 7_177 No T_7
.( If yes, furnish permit number 7(rJ ��%�' ) OR
Is the site an existing site? Yes / / No ////
(If yes, furnish two (2) plot plans.)
4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and
clear of all setbacks and easements? Yes —1-71- No / /
'( If no, clarify )
5. What is the mobilehome electrical rating? ----------------------- / d p Amps
6. What is the mobilehome site service rating? --------------------- /,Z. Amps
7. What is the mobilehome site circuit breaker rating? ------------- % O o Amps
8. Is there any other electric load to be served by the mobilehome
site service? ------------------------------ -------------------- Yes / / No
(If yes, identify the load and size: (Load) (Amps)
as P.. size.
g P ?--------------- ----
9. What is the mobilehome site pipe --- �n.
10. What is.the type of gas service? ----------------------------- Natural /✓/ LPG
11. What is the gas pipe length from meter or tank to. the mobilehome? (ft,)
12. :What is the mobilehome gas demand?- ------------------------------ Oa,2 (BTU)
(This information not required if pipe length less than 6 ft, on natural gas
or less than 50 ft. on LPG.)
�_'r',.n �,�`-tri yJ� 4,,�.• - -
i' ,
MOBILEHOME' :SU! POM: DATA
Mobilehome Mfr. /liZ?-�iool� Setup Model,No. Z Year 17>S
Width /.Z (ft.) Length _ (ft.) -Expando Size ft.x ft.
(Draw support details below)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets (if not on file with the County of Butte).
Center.:..' Center Support
Support Footing Sizes
f -�,�
Location`s (in.~
x
tt.lo �
zin:
SiFootings- (check.one)
i
1. Wood 'either
pressure treated or
fdn.`grade.
/ 2. .Concrete pad.
3. Other, `specify
Supports (check one)
1. Concrete block
2. Concrete piers
3. Steel piers
4. Other, specify +.I
E U
.. . ....
Typical Support
... ...
�-� /2 x 30 Footing Size
x ..�s(in.)(in.)
- Max. Pier.
Spacing
- .
ft. in.),,....
,wasr�nr►s�a(1-.)xi I !- Max.
f 1 `i -19 Overhang
'Im
*If center piers are other than drawn above,
draw in locations,` spacing, and dimensions.
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
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lot
,,;rev e
APPROVE -D
13LWe County Environmental Health
j