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Home My WebLink About017-190-075'll c:> 0 j pas& /r." 011-240-075 PERPIT#�98-1283 PICKERING, Mike V4 1958 Honey Run Rd.. hi New Single Family ;t/oq'� 0(7-00-07� COUNTY OF BUTTE Oroville, California GENERAL CLAIM CLAIMANT: A%%r-iA£L /✓.c•<�!J ^�G— f ADDRESS:/ 22 2.1�41� ?N ��► /�� . CITY & STATE: r. -I, C* DATE OF CLAIM: /fie /9S AWdRTANT T SEE INSTRUCTIONS SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES ON REVERSE SIDE DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) ' AMOUNT OWNEF PEQIDD NOT TO BUILD. AP #011-240-075, BP#98-1283, RECEIPT # ` 237106, DAT8D 6/17/98, OWNER: MIKE PICKERING:) TOTAL AMOUNT PAID ---'$557.00 RETAIN REFUND PROCESSING FEE RETAIN PLUMBING PERMIT FILING FEE RETAIN MECHANICAL PERMIT FILING FEE RETAIN 1/2 HR PLAN CHECKING FEE . $ 25.00 $ 20.00 $ 20.00 TOTAL AMOUNT TO BE RETAINED $128.00 TOTAL AMOUNT TO BE REFUNDED $429.00 TOTAL $429. 00 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. ZZ/1 Dated this day of J��—� , 1992 at l� C !> Calif. signature -or Clairiunt• I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles spec d above have pe ormed or delivered and that there is a Budget Appropriation I I or Specific Board Approval ( ) (Check one) for the tam _- Dated this 28TH day of JULY . 19 9 at OROVILLE Calif. Departmak Head or Authorized Deputy if Dept. a 002 Exp. Cods 4210500 FOR $386.00 PAYABLE FROM FUN tit DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. FOR BUILDING DIVISION USE: Receipt Information: �.. .. Number: a 6 Date: Issued To: it Amount Fees Retaine ___.._._._.._.Pr cessing Fee . .. __. _.._.__. _... _.._.......__.... B1 g Pi 1 ing Fee $� • W ~~ Plbg Filing Fee $ C E1 ec Filing Fee $ " ��ech'-Fi-l'i'ng'Fee- V"Energy P/C Fee YZ Plan Check Fee Inspection Fee $ p Total Amount Retained . - TOTAL REFUND DUE I- baw--- 1 • _ <9Y,-/72-V__-�> REFUND CLAIM APPLICATION CLAIMANT'S NAME C/ -.Ai ,/ /Vcl�(C MAILING ADDRESS 95 ASSESSOR PARCEL PERMIT RECEIPT NUMBERS) 237/0 Request a refund of fees paid on the above receipt-number(s) for the following reasons. - A'15)TZ easons:A'15)TZS --0^/ /-'o<Q,: F,cI i i. . Please refund any applicable fees in the following categories: (Check those categories which you.wish to have refunded.) Building Permit Fees [ ] Sheriff Fees [ ] Disposition SRA Fee (CDP Fire Planning) [ ] Urban Area•Fees ` [ ] of plans: Plans returned to me at counter. [ ] Please mail plans to me at above address. [ ] Please dispose of plans. SIGNATURE DATE LAND DEVELOPMENT L" - BUILDING BUILDING / ENVIRONMENTAL HEALTH - PERMIT CLEARANCE w ;!�S-t-OM N Wes 1-� . CP f,"4:1. OWNERSA•P• � NAME: I C� �erl r I !- : NUMBER: li, l I C / PRINT LAST NAME FIRST COUNTY ZONING FES DESIGNATION: FLOOD ZONE:/ >( FLOOD MAP: APPROVED: CONDITIONALLY APPROVED: ✓ RESOLVE PROBL PRIOR TO APPROVAL: PARCEL CREATION BY DEEDS OR MAP (,-a4 Ac- DEED C Bu!/d/ng Permit No. ( " _ /C�-) F 3 A zt b F DEED INFORMATION: DATE OF CREATION: DEED REFERENCE: LEGAL ACCESS PROVIDED: YES NO COMPLIES WITH COUNTY STANDARDS FOR DEED CREATION: COMMENTS/CONDITIONS: MAP INFORMATION: LEGAL ACCESS REQUIRED: YES NO .:- YES NO DATE OF RECORDING 8 LOT I BOOK 8 PAGE 3 COMPLIANCE WITH OLD SUBDIV ION LOT ORDINANCE REQUIRED? (MAP RECORDED PRIOR TO BOOK 17 OF MAPS AT PAGE 23): YES NO . IF YES, MARK APPROPRIATE ITEM(S) BELOW: A. Construct road to B. Meet parcel size required by zone. C. Meet current E.H.D. requirements. CHECK SPECIAL CONDITIONS WHICH APPLY TO MAP: ALL FEES TO BE PAID TO THE BU/LD/NQ DMS/ON UNLESS OTMERWISENOTED. X- 1. Maintain a 50 ft. building setback from centerline of road. 2. Maintain a ft.building setback from right-of-way/centerline of _ 3. Comply with Zoning code for building setback from road. 4. Maintain a 100 ft. leachfield setback from all existing wells. 5. Maintain a ft. leachfield setback from 6. Pay water tender fees in the amount of $ to Battalion Number of the Butte County Fire Department. 7. Meet the Fire Safe Regulations of Butte County and P.R.C. 4290. _ 8. Connect to a public water supply. 9. Connect to a public sewer system. _ 10. Automatic fire suppression sprinkler systems shall be installed in all residential structures in accordance with the National Fire Protection Association Standard for the installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet Fire Department specifications, serves the parcel. _ 11. Pay T.D.D. (Thermalito Drainage District) fee in the amount of $ _ 12. Meet the requirements of the Department of Fish and Game for the preservation of oak trees. (See phone number below) 0 _ 13. Obtain approval from the Department of Fish and Game for vegetation removal. Contact Fish & Game at 916-35.5-7010. _ 14. A traffic mitigation fee for each new or additional living unit shall be paid. Pay the amount of $ as stated in the Oroville Area Traffic Mitigation Fee Agreement. Peynp&W to be akdo to the Pl4wmd ng DAftba. _ 15. All new residential buildings shall be constructed to comply with the requirements of the Uniform Cod Buildinge for seismic safety. Mobile homes shall be constructed on a permanent foundation system which complies with the Seismic Zorie.3 requirements of the Uniform Building Code. _ 16. Deer Mitigation fees are to be paid, if such fees have been adopted by the Butte County Board of Supervisors. X 17. Pay school impact mitigation fees. :. X 18. A development impact fee for sheriff facilities shall be paid pursuant to the provisions of Chapter 3, Article II of the Butte County Code. _ 19. Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988 as amended. 20. If any cultural resources are encountered during ground disturbing activities, all work shall cease in the area of the find pending examination of the site by a professional, archaeologist. This person would then be able to assess the site significance and suggest appropriate mitigation measures. 21. 22. 23. 24. 25. 26. Ala iMdonna aN�f I3XIS 30 AM= 96618 1 N n r C13AI303H LD 7,96 CAW P51 TORMS SIBLDGPERM. CLR COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO (Rev. 12/96) APPLICATION AND PERMIT 99 - /JX3 ASSESSOR PARCEL NUMBER n • O S ZONING �P—E BUILDING PERMIT OWNER /1%r1rL TELEPHONE ?91 "0?93 SO. FT. OCC. BUILDING VALUATION o c�„. A�b l DBD OWNERS TVO- 7 7 MAILING ADDRESS 5� ` JLC TVO-54. �o CONTRACTOR'S NAME TELEPHONE I 7 r CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace /,j00 00 LENDER'S MAILING ADDRESS C, -,el r = Total Valuatlon $I ton ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ —7 , l BUILDING ADDRESS Energy Plan Checking Fee $ PERMIT FEE $ , LOT NO. SUBDIVISIONS MIME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 `7 USEOFSTRUCTURE SF Ir( Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: /�(E� I� Oat? S-�L_ Gas piping stem 1 - 5 outlets 15.00 (._ Building sewer 15.00 , Mobile Home I S I G I W Q20.00 PERMIT FEE $ L0D ELECTRICAL PERMIT Fling Fee 20.00 EOOV OR LESS Main Service 2o.A OR LESS 23.00 223M LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license IS ' full force and effect/ p License Class Lic. No. `O�D �e i OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed H the permit is for work of a valuation of one hundred dollars ($100) or less.) 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 workers', compensation laws of California, and agree that if I should become subject to the workers' compensation ovisions of section 3700 of the Labor Code, I shall forthwith comply with provisions. I, g� X _ Date '� Sig ature of plica Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60” deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO I000A 46.00 NEW CONST. DWELLING OCCUR SO OR ADONS. ( a ADC. BLDS. Npµgalp MULTI.OUTLEi @7.50 OWER POWER APPARATUS E oLmEr CI R. ' OUTLET OR FO(TURes p O I•50 Ex. Occup.SAL .w Ex. Occu . o Tit°TSA AEEsID.GERA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ S •�J MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling�I Hood 6.50 (p. Ventilation PERMIT FEL= $ Mobile Home Installation Fee $ Energy Inspection Fee $.Do occ CONST. TYPE TOTAL FEE $1(Dtp'g .44 D� IMP I FLOOD I COF I PARCEL I PO I HD I ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date _ (DW to) Receipt No. wHIT.—U.S. -u. CANARY -ASSESSOR PINK -IN ECTOR GOLDENROD -APPLICANT OL •---------- W- �"�,.�7-- - - _ _� _ � -� F ��- l COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER: i tL(�'extnq ASSESSOR PARCEL NUMBER: 01 I — Z40 Proposed Building Use: P Building Inspector: 52± Date: :9 o(t?< At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: N Date Received By ❑ 1. items have been submitted-------------------------------------------------------------------------------------- PP of plans, 3/4 sets, signed by the preparer of plans. ------------------------------------------------------------ U� 3. Complete plans, 3/4 sets, signed by the preparer of plans. ----------------------------------------------------- En eered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. -------- eered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------ 0-T ergy Design Compliance and supporting documentation. ---------------------------------------------------- ❑ 7. Statement of Intent for Non -Heated and A/C Buildings.--------------------------------------------------------- ❑ 8. Hazardous Material Form. 09. Manufactured Home data and installation instructions including Tie Down Specifications.------------------ 04v. Fees of $-� I aQQ- 34------------------------------------------------------------------------ ��Impact fees as shown on the attached schedule. ----------------------------------------------------------------- E312. California Department of Forestry plan approval/fees.--------------------------------------------------------- ❑ 13 /Fly elevation certificate. -------------r ---= --------------------------- L�.Y4. Sanitation and plot plan approval CiYt (COHealth Department. ❑ 15. City of Chico plumbing permit. --------------------------------------- ❑ 16. Plot plan and business license approval from the City of Biggs. --- 017 Planning approval for (A) Use: (B) Parking: // - (5�1 . Contact Land Development about Improvements, 13 Drainage, U4xgal Parcel. t'11.9. Encroachment Permit for driveway (construction approval prior to occupancy). --- 020. Pre -inspection for required. Request to Building Inspector on ❑21. Contractor's license information. (Number, Name Style, Classification). ---------------------- =------------- ❑22. Workers' Compensation carrier and policy number. ----------------------------------------------------------- 023. Owner -Builder Verification (Given to owner ❑, Mailed to owner 11) - -------------------------------------- 1124,,1 etter of signature authorization. -------------------------------------------------------------------------------- 5. Recorded copy of Agricultural Acknowledgment Statement. -------------------------------------------------- ❑26. Letter of intent on building use. ----------------------------------------------------------------------------------- ❑27. Manufactured Home utility clearance. --------------------------------------------------------------------------- ❑28. Existing violations and/or expired permits. ---------------------------------------------------------------------- ❑29. 0433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $ .--------------- E130. -------------- ❑30. Other: ------- (Date) en you issue thneermit rocess as follows El Mail to owner, ❑MailTo contractor. elephone 8'1 ' X39 3 and hold for pickup at U L��— office. ❑ Deli with inspector. Applicant;��, — Date: �� //—e, Copy of Haz-Mat foam sent ❑Health Department, ❑ Fire Department, ❑ Air Pollution Date: By: Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ Other: Date: By: 1. Index permit application for the above items numbered: ❑ Plan Check List 2. Additional items required: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date: Yellow Copy - Department of Devplopmpnt Services, Building Division. /�� p ,60�51�,�G�" /G o COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541 SCHEDULE OF FEES DUE OWNER_lw �� lC-��(VL� A.P. # -7S- PROPOSED BUILDING USE 'SIP:- 3Rj-/4rnOUV\ DATE (p / I a -OO, 3t J REC # DATE REC V 1. BUILDING PERMIT FEES _I -- Balance Due ................ $ . -- Additional Fees Due ........... $ -- Additional Fees Due ........... $ -- Revised Plan Checking Fee ....... $ �2. SCHOOL DISTRICT FEES (paid at District Office) 3. SHERIFF FEES (paid at Building Division) Residential ........ �_ x $360.00 = $ 3rot) . (00 Units Commercial (sq.ft.)... x $0.03 = $ Sq.Ft. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit) . x = $ #Units Amt. Commercial (sq.ft.) .. x =$ / Sq.Ft. Amt. RECREATION DISTRICT FEES (paid at District Office) 6. THERMALITO DRAINAGE DISTRICT FEES $425.00 (paid at Building Division) V 7. SRA FIRE INSPECTION AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # ) $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) 10. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees may be changed during the plan checking process. 1 APPLICANT DATE i Original -Owner Copy -Building Div. (Rev. 12/96) COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATI®N'AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDERS MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ $ PERMIT FEE $ LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 1100V OR LESS Main Service 2o0A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.POSINGLE License Class J Lic. No. 0��e 7 3 OWN DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service TO 46.00So CCUOOOA NEW CONST. DWELLING OCCUP. DWE200ALLING OR ADDNS. ( 6 ACC. BUDS. SO 3.5¢FT, RESINEW D. BRANCH CIRCUITS MULTI -OUTLET 97.50 b OUTLET CIR.WER APPARATUS 20@ 1.00 Ex. Occup. OUTLET OR FIXTURES BAL p .50 Ex. Occup. OUTLETSA� oR� 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation pr visions of section 3700 of the Labor Code, I shall forthwith comply with tho provisions. _ XDate� Si 6Wre of Ap ant -Owner Contractor ❑ Ag nt An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ HAZ. I D. FEES IMP I FLOOD CDF PARCEL Po HD ISSUE 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. By Date PERMIT EXPIRES ON ale Receipt No. WHITE•D.D.S.•B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT _ 1 ew�++ CHICO UNIFIwaED SCHOOL•DISTRICT 1163 EAST SEVENTH STREET CHICO, CALIFORNIA 95928 (916)891-3006 C.U.S.D. SCHOOL DEVELOPMENT REFUND AGREEMENT Terms and Conditions for obtaining a SCHOOL/_DEVELOPMENT REFUND pursuant to C . U . S . D . Resolution No. �tq5 %_ y 0 I am requesting a SCHOOL DEVELOPMENT REFUND for fees paid on Assesso�i Parcel No. 11•,�9 (/0-019 represented by C.U.S.D. ID No. Ct� for one of the following reasons: —I-- will not be building a residential unit on this parcel and I have cancelled my building permit. - no Perm.t7- 155ued3 Credit for demolition of an existing residence...(copy of permit & County Appraisal Report attached) Other Development fee paid Less administrative fee $ Q > ($2.50 per residential unit) Total refund Q -Applicant Signature Date Pr ' nted Name Address Phone No. City/Zip ******************************************************************** School District Representative White -applicant, pink -building department, REFUND.APP. B.S. 43 (2/91) to ellow-school district L -7/9i 1 Robyn, Please reimburse Chico Unified School District October 27, 1998 Michael Pickering Const. for school fees on 1445 Citrus Avenue Chico, CA 95926 � � J CUSD # - 980498 AP # -11-240-075 Permit never issued, individual not building at this time. AMOUNT PAID $3,716.80 ADMIN FEE 2.50 REFUND DUE $3,714.30 11-61-51-2020-8683-00-0000 $3,714.30 THANKS, DIANE CC: SCOTT REFUND.SUB } BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) --School District (/4S L.J Building Department No. A.P. Number //. 7 n - Jurisdiction: Q City 14 County Property Owner / Property Location/Address / Subdivision Lot No. Residential Development Sq. Footage 0 No of Living Mobile Home Addition (Group R) Units Installation Commercial/Industrial Sq. Footage New Addition (Including Exterior Roofed Areas) Building Department Representative Date Plans reviewed Dv scnooi uistnct versonneii District Identification No. g C 0 Y9Z School District certifies that (Applicant) X93-63913 . (Street Address) (Phone Number) (City) (State) (Zip has complied with the requirements of Resolution No.(Q'S �7 by payment of $ 3 ! tG, representing Qt ,� square feet. 2926 $ PMU MITIGATION $ z92 L(ev School Distric 'Representative Date Paid by Check # A-gIV Remarks: Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County. Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.xls (2/97)dmm • ROUTING CITY OF CHICO INTER -OFFICE MEMORANDUM ACTION DESIRED TO DEPT. - OFF. - INDIV INT. a p ° rj Review (Comment If appropriate) and return City Manager City Attorney Call/See me re this City Clerk Investigate and report ACM- Act as indicated ACM- Please process RlGSM For your info./file Finance Off. Your signature required PIT/Ad. Tech- Return to sender CSD Per your request Dir. Pub. Wrks. ADPW Circulate Bldg. Off. I Please Post Planning Dir FILE Park Dir. Chief of Police TICKLER Fire Chief Signature � De rt ent Date 11-8 1/96 loom Chico Unified School District Administrative Office, 1163 East Seventh Street Chico, CA 95928-5999 Where STUDENTS are the FIRST Priority 4 r A . off 30 CCT2 1 CITY OF CHICO OMMUNITY DEVELOPMENT DEPT b �J COMMUNITY DEVELOPMENT DEPARTMENT PO BOX 3420 CHICO CA 95927