HomeMy WebLinkAbout007-240-07777
7-24-P/7
JOHN PIERCE
3510 Bridle Lane, Chico �•`J�
ContR: Filer & son
Ermit#3590-88B,E(new gar e)
007-240-077 05-0245 1
PIERCE, JOHN 1 n`
3510 BRIDLE LN, CHICO
Cont: G&R ROOF Cs
REROOF 31 SQ
c -'c -n
�'ePlace l✓adcQStQve'
"tel' �� ����"��
NOTES
m
-q RESIDENTIAL
PERMIT NO. _,'o67 -_24d-077___ 05-0245
PIERCE, JOHN
{ 3510 BRIDLE LN, CHICO
i Cont: G&R ROOFING
REROOF 31 SQ
11 SPECIAL CONDITIONS 11
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
CA- V� �A�
JOB FINALED (Date) $ d5
Signature V pt%�
CHECKED
BY
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netldds
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license Is In full force and
effect. �v�
License
hhClass: License Number: �1 ,
Date: e�/ �� Contractor. �Z 6.91 O ( � u� i
OWNER -BUILDER DECLARATION
I hereby affirm under penally of perjury that I am exempt from. the
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city.or county which requires a
permit to construct, alter, Improve, demolish; or repair any structure, prlor
to its Issuance, also requires the applicant for such permit to file a
signed statement that he or she Is licensed pursuant to the proyisions.of,
the Contractor's Stale License Law (Chapter g.commencing with Sectlon
7000) of Division 3 of the Business and Professlon§ Code) or that he &
she is exempt therefrom and the basis for the alleged exemptloh..:Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees wilh.wages as their
sole compensation, will do the work, and the structure Is. not
Intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' Stale License Lew does not apply. to an
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such Improvements are not Intended or offered for
sale. If however, the building or Improvements' are sold within one
year of completion, the owner-bullder will have the burden of.
proving [hat he or she did not build or Improve for the purpose of
sale.).
❑ I, as owner of the properly, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' Slate License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Dale: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
La olr Code, for the performance of the work for which this permit
9/1
ssued.
I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit Is Issued. My workers' compensation
Insurance carder and policy number re:
Carrier. r �/r l/��� QA
Policy M OU [ OLX
❑ 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 workers' compensation laws of California,,
and agree that If I should become subject to the workers','
N compensation provisions of Section 3700 of the Labor Code. I shall;
forthwith. comply with those provisions.
Date:
Applicant:
E
WARNING Failure to secure workers' compensation''coverage;.ls
unlawful, and shall subject an employer to criminal penalties and onef
hundred thousand dollars ($100,000), In addition to the cost of;
compensation, damages as provided for In Section 37.06 of the Labor
code, interest, and attorney's fees. ,
CONSTRUCTION LENDING AGENCY
I hereby affirm that lhere'Is a construction lending agency I& the '
performance of the work for which this permit Is issued (Sec 3087 Civ.)
Name:
PERMIT NO.
BP05024t
Issued Date: 02/02/2005 APN: 007-240-077-000
Site Address: 3510 BRIDLE LN CHI
Map Index:
Description: RE ROOF 31 SQ. COMP
.;.Owner: PIERCE JOHN L
+: 3510 BRIDLE LN
CHICO, CA
' 95973-8748
f '
Applicant: G & R ROOFING
2587 NORD AVENUE
CHICO, CA 95973
(530) 894-6537
Contractor: G & R ROOFING
2587 NORD AVENUE
CHICO, CA 95973
(530) 894-6537
License #: 773913
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
0 S. F.
$0.00
This pernill.is hereby issued under the applicable provisions of the 811110 County CndO enrl/or
Resolutions to d work Indicated abq e r which fees have been paid.
'7
By:
�• �• Date:
PERMIT EXPIRES ON: r�� _ o? 2)L
Address:
Cl I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification In accordance with Section 19827.5 of California Health & Safety Code, Is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information Is correct, and thal'I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and slate laws relating to building construction. I acknowledge It Is unlawful to alter the substance f any official form or cument of Bulla County. I hereby
authorize representatives of Butttte� Count enter upon the
/above mentloned property for Inspection pur s
Print Name: 1' V iti— Slgnalur
Dale:
Agent for Contractor
0 Owner 0 Contractor a Agent for Owner
J=OK
0 = Not OK
. = NotReadyable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6. Gas; Location -Test-Wrap; -/ /" L'ft.
/ P Nat. or/ /" L "ft./ P LPG
MISCELLANEOUS
Date
7.
Well Clearance & Disconnect
1.
8.
Utility Clearance
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
Date
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
Card B-1 Date Card B-1
Date
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
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
Date
8.
Gas and Electricity Tagged
Date
9.
Tie Downs -Type -Installation Cert.
Date
10.
Exits; Insp.-Sketch
1.
11.
Cert. of Occupancy
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
Date
Elec.; Receptacles and Lighting, Distance-GFI
Card B-1 Date Card B-1
Date
Elec.; Pool Lighting; 15 Volts-GFI
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve
5.
Electricity; MH Test
6. Water; MH Test
Enclosure; Fencing -Alarms
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
9.
Exits
10. License Decals
11.
Verify #'s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
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, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes -Enclosures- Panel boards- Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
,s. •.1•:.w 1:1
J=OK
0 = Not OK
- = Not Applicable
. = Not Ready
RESIDENTIAL (Single & Duplex)
Date - UNDERFLOOR (Plans) OK except #'s
1.
Zoning -Setbacks -Easements -Flood -Slope
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
6.
_
Stemwalls, Garage; Steel- Bloc kouts-Wrapped
6a.
Hold Downs and Special Anchors
7.
Slab, Steel -Wrapped
8.
Piers -Fireplace Ftg.-Steel
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11.
Water Pipe; Test -Anchors -Regulator -Service Test
12.
Electric Underground
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15.
Access & Ventilation
16.
Insulation
Date
FRAMING (Continued)
Card B-1 Date Card B-1
Date
68.
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
70.
17.
Water Htr.; Vent -Access -Combustion Air Baffle
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
18.
Water Pipe; Test & Anchor -Nail Protection
73.
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
20.
Shower Pan; Test, First Floor -Tub Access
A.C. Duct in Garage -Damper
21.
Test Tub & Shower, Second Floor -Tub Access
.57. Siding -Nailing Veneer
22.
Gas Pipe; Sixe & Anchors
Elec. Receptacles in Garage (F.FI.)-Romex Protection
23.
Fire Sprinkler; Test
60. Shear Walls; Nailing -Bolts
Guard Rails & Deck Construction -Post Caps
61. Brace Interior/Exterior Wall Panels
Date
62. Insulation -Walls -Ceilings
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Date
24. Fixture & Transformer Clearance -Ins. Protection
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
25.
Elec. Receptacles Spacing -Lights & Switches at Doors
65. Smoke Detector
26.
Size Boxes & No. of Conductors Stapled
Ventilation Throughout House
27.
Romex Installed Close to Edge of Studs & C.J.
91.
28.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
Gas Test -Meters Tagged, Gas -Electric
29.
2 Appliance Circuits in Kitchen & Conductor Size GFI
94.
30.
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
Address Posted
31.
Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI
Insulated Neutral U Yes U No
Date
32.
Service -Riser Conductors & Ground Main Disconnect
Card B-1 Date Card B-1
33.
Equip. Clearances Panels-Motors-Mech. Equip.
Comments at Final:
34.
Clothes Closet Light -Shower Light -Spa Light
35.
Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36.
A.C. Ducts Insulation & Support
37.
Vent Fan, Exhaust above insulation
38.
Condensate Drain & Overflow, Size & Grade
39.
Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40.
Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41.
Sills Proper Materials & Anchors
42.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
43.
Bearing Walls over Girders & Floor Nailing
44.
Draft Stop in Walls (rat proof)
45.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46.
Headers & Beams -Size & Bearing
Date
FRAMING (Continued)
67.
47. Hangers -Post Caps -Anchors -Connectors
68.
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
69.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
70.
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
71.
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
72.
52. Garage Fire Protection Framing -RC Channel
73.
53. Property Line Firewall & Openings
74. Elec. Outlets & Receptacles at Kit. Counter
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
Garage Fire Door; Swing -Landing -Closure
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
A.C. Duct in Garage -Damper
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
.57. Siding -Nailing Veneer
Plb.; Elec. & Mech. Equip. Listed for Location
58...Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
Elec. Receptacles in Garage (F.FI.)-Romex Protection
59. Glazing Area -Glass Protection -Skylights -Plastic
Insulation -Foam -Looked in Attic
60. Shear Walls; Nailing -Bolts
Guard Rails & Deck Construction -Post Caps
61. Brace Interior/Exterior Wall Panels
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
62. Insulation -Walls -Ceilings
Clearance Looked under Floor O Yes
63. Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
64. Ext. Steps -Door & Sidelight Protection -Landings
Water Well, Disconnect, Electrical, Plumbing
65. Smoke Detector
66.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67.
Bedroom Exiting
68.
G.F.I. & Bath Fixtures & Tub Access -Spa
69.
-Elec. Trim & Subpanel, Breaker Sizes & Labels
70.
Stairs & Rails'
71.
Fireplace or Stove, Clearance -Hearth
72.
Elec. Outlets at Wood Panel, Int. & Ext.
73.
Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75.
Garage Fire Door; Swing -Landing -Closure
76.
A.C. Duct in Garage -Damper
77.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
Elec. Receptacles in Garage (F.FI.)-Romex Protection
80.
Insulation -Foam -Looked in Attic
81.
Guard Rails & Deck Construction -Post Caps
-82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
83.
Following Instld./Drive 0 Yes U NoMalks 0 Yes 0 No/Planters U Yes U No
84.
Stucco Brown -Finish
85.
A.C. Unit Disconnect, Electrical -Plumbing
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87.
Water Well, Disconnect, Electrical, Plumbing
88.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
89.
Ventilation Throughout House
90.
Glass Protection
91.
Corrections from Previous Inspections
92.
Gas Test -Meters Tagged, Gas -Electric
93.
Water & Sewer Connected -C/O to Grade -HD Approval
94.
Energy Compliance Certificate -Other Certificates
95.
Address Posted
96.
Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
e
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.netldds
PERMIT NO.
BP050246'
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 02/02/2005 APN: 007-240-077-000
provisions
the Business and Professions Code, and my license Is In full force and
effect. /l v� '� 13
LicensehClass : Lj License Number: •
Site Address: 3510 BRIDLE LN CHI
pp�^
ContractorO L�Lh S
Map Index:
—L
OWNER -BUILDER DECLARATION
Description: RE ROOF 31 SO. COMP
I hereby affirm under penally of perjury that I am exempt from the
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
to construct, alter, Improve, demolish; or repair any structure, prior .
.,Owner: PIERCE JOHN L
permit
to Its Issuance, also requires the applicant for such permit to file a
I 3510 BRIDLE LN
signed statement that he or she Is licensed pursuant to the provisions of,
1; CHICO, CA
the Contractor's Slate License Law (Chapter 9. commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
1!s 1.,
. ' di ,' �' 95973-8748
she is exempt therefrom and the basis for the alleged exemption. Any
the
"J
violation of Section 7031.5 by any applicant for a permit subjects
applicant to a civil penalty of not more than five hundred dollars ($500).):
Of
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is not
t
Intended or offered for sale (Sec. 7044, Business and Professions
Applicant: G & R ROOFING
Code: The Contractors' State License Lew does not apply to an
I
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
2587 NORD AVENUE
provided that such Improvements are not Intended or offered for
CHICO, CA 95973
sale. If however, the building or Improvements are sold within one
year of completion, the owner-bullder will have the burden of
(530) 894-6537
proving that he or she did not build or Improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Profdsslons Code. The Contractors' Slate License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ '1 am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
La or Code, for the performance of the work for which this permit
ssued.
I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit Is Issued. My workers' compensation
Insurance carder and policy number re:
Carrier. 2Sec6A2 EA
Policy#: ov�d,u `t'
Contractor: G & R ROOFING
2587 NORD AVENUE
CHICO, CA 95973
(530) 894-6537
License #: 773913
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
0 S. F.
$0.00
O 1 certify that in the performance of the work for which this permit Is,
issued, I shall not employ any person In any manner so as tot
become subject to the workers' compensation laws of California.,
and agree that if 1 should become subject to the workers"
N compensation provisions of Section 3700 of the Labor Code, I shall
forthwithcomply with those provisions. I ;
Date:
Applicant: I
WARNING: Failure to secure workers' compensation 'coverage Isf, l
unlawful, and shall subject an employer to criminal penalties and one,
hundred thousand dollars ($100,000), In addition to the cost of,
compensation, damages as provided for in Section 37.06 of the Labor
code, interest, and attorney's fees.
,�J f cr . S 7 A-ryyn1 61 202 , �4
CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte Cnunly Cods enrilor
I hereby affirm that there is a construction lending agency for the Resolutions to•d work Indicated ab lar which fees have been paid.
r
performance of the work for which this permit Is Issued (Sec 3097 Clv.) Dale: -�• U�
Name: By:
PERMIT EXPIRES ON: '2.7 �( /-'
Address: (Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification In accordance with Section 19827.5 of California Health & Safely Code Is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information Is correct, and that'l am the owner or the duly authorized agent of the owner. I agree to comply with
all county and slate laws relating to building construction. I acknowledge It Is unlawful to alter the substancef any official form or dgcument of Bulla County. I hereby
authorize representatives of Butte Count enter upon the above mentioned property for Inspection put s
Print Name: Slgnalur :
Dale:
� Cr-
0 Owner ❑ Contractor 4 Agent for Owner Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICA TION
Website: ,vww.buttecounty.net1dds
"PLEASE PRINT CLEARLY"
CONTRACTOR
OWNER
Last Name,
errj-)
irst Name
Address
City
City
Phone (�
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State
Zip
Phone
Cm
Fax
E-mail
State License Number
CONTRACTOR
Name K n
Address 8
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Address bj kulpll
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City
Star A
City
Phonep(�,/Z�
Phone (�
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Fax
E-mail
Lic. # qq
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Cm
APPLICANT NAME
ARCHITECT/ENGINEER
Name
Address bj kulpll
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Address
Sta
City
Phonep(�,/Z�
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name vi.or&a
Property Addre'DO I 00rtd
Address bj kulpll
t�
Cpb,n�C
ity
Sta
Zip
1
Phonep(�,/Z�
Fax
E-mail
APPLICANT SIGNATURE
X` �J&�
For office use only:
Zoning
Property Addre'DO I 00rtd
Flood Zone
Cross Str
SRA
Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doe
PERMIT
NO
QSC
BP
BINNN
LOCATION
Property Addre'DO I 00rtd
Cross Str
WORKER'S COMPENSATION
Policy Numbero Oo
Carrier LA Rd
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
I-Toa.c n-" reo-ppiq Corf P
Sq. Footage
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
Page 1 of 2
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by� Amount: ! �'S� Bldg
SRA
Receipt #4qS -5 `7 Sheriff
06# - SMTP
Other
Dat f (SO Total
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑ 5. Statement of Intent,for Non -heated and AIC for Non -Residential Buildings.
❑ 6. Manufactured homes; (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings.
❑ 11. Detached Accessory Building Form filled out by the owner (if required).
❑ 12. Hazardous Material Form (for Commercial Buildings only).
❑ 13. Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑ 2. Impact Fees.
❑ 3. California Department of Forestry plan approval (if required).
❑ 4. NPDES Form.
❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 6. Contractor's license information. (Number, Name Style, Classification).
❑ 7. Worker's Compensation Carrier and Policy Number.
❑ 8. Owner -Builder Verification (if required).
❑ 9. Letter of Signature authorization (if required).
❑ 10. Recorded copy of Agricultural Acknowledgment Statement.
❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538.7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one=year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS }
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable,
OVER FOR BUILDING PERMIT APPLICATION
K1FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
�r
(SPA0106) ASSESSORS SECURED MASTER PROPERTY DETAIL (PAGE 2 OF 2)
PARCEL 007-24-0-077-0 ST ACT TRA 062-51 USE RSXZX
NAME DEPT OF VETERANS AFFAIRS
C/O MARLER SYDNEY ANN SS 880526900
STRT 3510 BRIDLE LANE MISC CODE 25
CITY CHICO CA ZIP 95926 0000
SITUS 3510 BRIDLE LANE
RECORDER # 85-28346 TAX DELINQ _-
SOC SEC 1..*...-....... SOC SEC 2 ..... ........
11-10-88 09:09
ZONING CODE ASR'
GEN PLAN L_ ZONE CONF _
AC .62 ZONING YR 00
PROP MISC
NEW PARCELS
RETIRED SUB CODE
MAP REFERENCE SALES AREA CODE
USE CONF _ ATYP ADJ NEW COND ADJ CODE 0
PENAL FLAG 0_%
APRAISER NO ..... EVENT DATE 04-03-85 TRANSFER STATUS _ PICKUP YR ..
ORCH CODE 00 BLDG CODE 0 FIREPLACE CODE _ HEAT CODE_ COOL CODE _
BLDG CLS D65BM BDRMS 3 BATHS 2.5 EFF YR 1901 SQUARE FT 1,959
LAND TYPE L GARAGE Y POOL N YR BLT 1962
PERMIT NO. 3590=88B, E
ro.
PERMIT EXPIRES
OWNER JOHN PIERCE
CONTR. Filer & Son
ASSESSOR PARCE _7-24-77
LOCATION 3510 Bridle Lane, Chico
r
i
-
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f!
e 1•
a
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+ Temp. Power Pole _
f
Called PG&E—
Temp. Elec. Service
Called PGi
Temp. Gas Ser
Called PGJ
JOB FINALED
Signature
(—I
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751 •
7 County Center Drive, Orovifle — Phone: 538-7541 _
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
35 9 0 --tj
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.
Inspector �/4� Date j z// 7" Ap
= OK
0 = Not OK
' = Not Aeadyable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
3. Sewer; Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
6. Gas; Location -Test -Wrap: / P'U ft.
/ /"Nat. or/ /"L"ft./ /"LPG
7. Utility Clearance
Card -131 Date Card -131 Date
Card -131 Date Card -81 Date
Date MOBILEHOME 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
Card -B1 Date Card -B1 Date
Card -131 Date Card -B1 Date
MISCE+LLANE0US
Date D
Plans)OK except #'s
footings; Soils-SIzt--De4M1'Spacing-Connectors-Steel
Joists -Decking -Bracing -Stairs -Rails
earns-Rftrs.-Connec.-
Shthg.-R .-Bracing
mns-Con nections-Splice- Decal- Enclosu res
ws=Doors
. I c.
V—Fr5pg; Sills-Anchors-Studs-Rftrs-Trusses
. iding; Nailing -Veneer -Stucco -Mesh
0 f; Shthg-Roofing
Ext.; Steps -Doors -Landings
Card -B Date Z and -B1 Date %o-7 gym/ b
Card -BI Date Card -B1 Date
Date POOLS (Pla s) 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
Card -131 Date Card -131 Date
Card -131 Date Card -131 Date
= OK
0 = NotOK
- =Not Applicable RESIDENTIAL (Single and Duplex)
= Not Ready
Date
UN LOOR (Plans) OK except #'s
D&te
FRAMING (Continued)
oning-Setbacks;-Easements-Flood-Slope
45. Hangers -Post Caps -Anchors -Connectors
2. Ftg., Main; Soils-Steel-Elec: Grnd.-/ /" Ftg. Depth
46. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
3. Ftg., Garage; Soils -Steel-/ /" Ftg. Depth
47. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. Depth
48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
5. Stemwalls, Main; Steel-Blockouts-Wrapped
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
50. Garage Fire Protection Framing
7. Slab; Steel -Wrapped
51. Property Line Firewall & Openings
8. Piers -Fireplace Ftg.-Steel
52. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
10. Gas Pipe; Size -Anchors
54. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
11. Water Pipe; Test -Anchors -Regulator -Service Test
55. Siding -Nailing Veneer
12. Electric; Underground
56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
13. Plenums & Ducts; Clearance-Material-Supprt-Ins.
57. Glazing Area -Glass Protection -Skylights -Plastic
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
58. Shear Walls; Nailing -Bolts
15. Insulation
59. Insulation-Walls-Clg.
60. Infiltration -Wal Is-Wndws
Card -131
Date Card -81 Date
Card -131
Date Card -B1 Date
Card -131
Date Card -131 Date
Card -131
Date Card -131 Date
Date
PLUMBING (Permit) OK except #'s
16. Water Ht. Vent -Access -Combustion Air -Baffle
Date
FINAL (Plans) OK except #'s
17. Water Pipe; Test & Anchors -Nail Protection
61. Ext. Steps -Door & Sidelight Protection -Landings
18. D.W.V.; Test-Fttngs & Anchors -Nail Protection
62. Smoke Detector
19. Shower Pan; Test, First Floor -Tub Access
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
20. Test Tub & Shower, 2nd Floor -Tub Access
21. Gas Pipe; Size & Anchors
64. Bedroom Exiting
65. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes -Labels
Card -131
Date Card -61 Date
67. Stairs &Rails
Card -B1
Date Card -61 Date
68. Fireplace or Stove; Clearances -Hearth
69. Elec. Outlets at Wood Panel; Int. & Ext.
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
70. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
23. Elec. Receptacles Spacing -Lights & Switches at Doors
71. Elec. Outlets & Receptacles at Kit. Counter
24. Size Boxes & No. of Conductors -Stapled
72. Garage Fire Door; Swing -Landing -Closer
25. Romex Installed Close to Edge of Studs & C.J.
73. A.C. Duct in Garage -Damper
26. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
27. 2 Appliance Circuts in Kitchen &Conductor Size/G.F.I.
75. Plb., Elec. &Mech. Equip. Listed for Location
28. Su Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga.
or
Cu or AlAl
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral Yes No
77. Insulation -Foam -Looked in Attic ❑ Yes
78. Guard Rails & Deck Construction -Post Caps
30. Service -Riser Conductors & Ground -Main Disconnect
79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
31. Equip. Clearances Panels-Motors-Mech. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
80. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑ No
33. Smoke Detector
81. Stucco; Brown -Finish
Card -131
Date Card -131 Date
82. A.C. Unit; Disconnect, Electrical, Plumbing
Card -131
Date Card -81 Date
83. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
Date
MECHANICAL (Permit) OK except #'s
84. Water Well; Disconnect, Electrical, Plumbing
34. A.C. Ducts Insulation & Support
85. Exterior Elec. Trim; G.F.I. Receptacle -Underground
35. Vent Fan; Exhaust above insulation
86. Ventilation throughout House
36. Condensate Drain & Overflow; Size & Grade
87. Glass Protection
37. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet
88. Corrections from Previous Inpections
38. Attic Access & Platform if Furnace in Attic
89. Gas Test -Meters Tagged; Gas -Electric
96. Water & Sewer Connected -C/O to Grade -HD Approval
91, Energy Compliance Certificate -Other Certificates
Card -B1
Date Card -131 Date
92. Roofing Certificate
Card -B1
Date Card -B1 Date
Card -B1
Date Card -131 Date
Card -131
Date Card -131 Date
Date FRAMING (Plans) OK except #'s
39. Sills, Proper Material & Anchors
Card -131
Date Card -61 Date
40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
Comments at Final:
41. Bearing Walls over Girders & Floor Nailing
42. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Header & Beam -Size & Bearing
(NOTE: An entry must be made each time you visit job site)
" COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATID AND PERMIT
PERMIT NO.
3 J —
ASS SSOR CELS BER
—
ZONI
BUILDING PERMIT
0
TELEPHONE
SQ. FT. OCC. BUILDING VALUAf ION
OWN R'S MAILING DR ES
CON Tft AC OR'S N ME
-r 4
TE E HO
CO RACJ R' ADDRE
1^� . SSC—
Fireplace
CONSTRUCTION LEND R
UNKN WN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
,$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
n,
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
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/)Gas
SF ❑ Duplex❑ Mobilehome❑ Other tf /J
SPECIFY
piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S G W
0.00 ea
TYPE OF WORK
New Z Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
�- I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. %91.798 Classification 73—/
❑ 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-
EJ 1,
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCC O
OR ADONS. ACC. BLDGS. k% Osq ft ,
NEW CONSTR TI -OUTLET
NON-RESID .BRANCH CIRC ITS 2.50 ea
POWER APPARATUS &)
SINGLE OUTLET CIR. )
2011
EX. OCCUp(OUTLETS OR FIXTURES Bw 03FIXED
APLNS.0
Ex. Occup. OUTLETSP(RESID )REA.) 2.00
Temporary service 10.00
Home Facilities 15.00
Misc. Wiring
9 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.
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. I
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
Cooling
g
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. i agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, copts, and expenses which may in any way accrue
a ai st s 'd Count consecfuence'of e granting of this permit.
•� ��^ �'�+ -�
+'`—.Date//-/sions
Signature of Applicant — Owner ❑ Contractor En Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE
occu P.
co L
SCHOOL
F o
PA ceL
P
J__HD_";71_3S e
L_
This permit is hereby issued under
of the Butte County Code and/or
work indicate abov for which
R (�, R UBLIC
BY
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WOR2�_�
Date
Receipt No.
WRITL-O.P.W.. YELLOW -Ase S�OR, PINE-IN9PLCTOR, aOLDLNROD-APPLICANT
P
COUNTY OF BUTTE - DEPARTMENT OF, PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILIL'E, -CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET /
OWNER
Proposed Building Use
r
Permit No.
A. P. No.
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 APPROVED
1. All items.have been submitted. . . . . . . . . . . .
2. Plot plans in duplicate. /triplicate, signed by preparer of plans. .
3. Complete plans in duplicate/triplicate, signed by preparer of plans.
4. Complete engineered plans and calcs, with wet signature on plans.
5. Plans with Energy Design Compliance Statement. . . . . .
6. School District "Fees Paid" Stamp on Floor Plan.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ , . , , , . ,
zz9. Letter of signature author izat�n1,., . . . . . . . .
Sanitation approval from ` ►'1 + �-� Health Dept.
11. Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner0, Mail to owner ❑.)
_15. .Improvements may be required. . . . . , . . . , ,
16. Mobilehome Installation Data. . . . . . . . . .
17. Pre -Inspection for RequiredPre-Inspec. request to . Building Inspector (Date)
18. Recorded copy of Agricultural Acknowledgment Statement.
19. Driveway Permit. 4)
20. Plot plan approval from city of
1. Engineered trusses in duplicate (required prior to plan check).
22.
Whe you issue thennerrnmit pr ce s as follows: Mail t(Yowner, Mail to contractor.
Telephone and hold for pickup at/`�i�Cbffice, —Del iver w/inspector.
Other
Applicant r Date
Copy of plans sent Health Dept., Fire Dept., Other Date
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--nail—counter by date
Contractor, designer, owner, was advised of above required data by—phone —mal l—counter bye date
Plans checked
Coov—DPW
Date Plans approved by
Sets of plans on hold in File cabinet AP folder
Date I I — f U
TO Buildina Department :~e
FROM: Environmental Health
SUBJECT: Sanitation Clearance
-.Pittew- -7 2
Owner Location AP#
Plan Approved for: Sewaqe Disposal Water Supply
Hold final for:
Final clearance O.K. for:
Clearance for _ bedroom mobile home.
NOTE ***
Sanitarian
Water_Supply
,,rr�� Water,Supply
Other (�p .(
Date
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