The URL can be used to link to this page

Home My WebLink About021-020-010-' - DR. -E; A,-STEADMAN A.P. 21-02=10 2 mi. off s/s Gridley-Colusa Hwy. along Cherokee Canal, Gridley Pemi it -JIM- 73'B;E' �(�) 021-020-010 04-1070 COOK, DEAN 823 CHEROKEE CANAL RD LE% CONT: OWNER RECONSTRUCT SF'� 021-020-010 ` - "--04-Z324 WILLIAMS 823 CHEROKEE CANAL RD, GRIDLEY Cont: OWNER t DEMO SF 1 r 06761" ce AJ T- e -1-V O -CE q- 7q. APP&; C4A_) E 7 - E-1) /-WD FA 40 s T"��f� r� . t r r ♦, lnt*c1 +fit. , y FEMA FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND 07I �0Or INSTRUCTIONS t "s s T"��f� r� . t r r ♦, lnt*c1 +fit. , y FEMA FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND 07I �0Or INSTRUCTIONS t NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 81-31 The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE: Please do not send your completed form to the above address. PURPOSE OF THE ELEVATION CERTIFICATE The Elevation Certificate is an .important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR-F). The Elevation Certificate is required in order to properly rate post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIR -IA), for flood insurance Zones AI -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, and AR/AO. The Elevation Certificate is .not required for pre -FIRM buildings unless the building is being rated under the optional post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a.community, the NFIP requires the community to adopt a floodplain management ordinance that specifies minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings and maint4in a record of such information. The Elevation Certificate provides a way for a community to comply with this requirement. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for lending -institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to supporta LOMA or LOMR-F request. This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofrng of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non- residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1 -7. " O.M.B. No. 3067-0077 Expires December 31, 200° SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUILDING STREkT ADDRESS (Including Apt_ Unit, Suite, and/or Bldg, No.) OR P.O. ROUTE AND BOX NO, Company NAIC Number CITY�-�p �� ,� STATE ZIP CODE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) IL BUILDING USE (e.g., Residential, Non-residenti;11,_Addition, /accessory, etc. Use a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: ( ##' - *W - ##.#IF or ft#.� l l NAD 1927i—I NAD 1983 SOURCE: L -I GPS (Type): 914 611 It 2s 22� ®u L—I USGS Quad Map L -I Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. FIP COMUNIT1Y NAME 8 COMMUNITY NUM". CoutffY NAME B3. S 84. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX T. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER _ l 5— t G DATE JVa� S �1�(g EFF€CTIVE/REVISED DATE JvN� Fs ►g� ZONE(S) (Zone AO, use depth of flooding) I to -7 o 810. indicate the source of Base Flood dation (BFE) data or base flood depth ent ered in � .� �� FIS Profile FIRM Community Determined � Other Describe : 1311. Indicate the elevation datum used for the BFE in B9: &4 NGVD 1929 J__J NAVD 1988 �_J Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Yes 011 No Designation Date: SECTION C. - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: bOConstruction Drawings' (_Building Under Construction' (_Finished Construction 'A new Elevation Certificate At be required when construction of the building is complete. C2. Building Diagram Number ID (Select the building diagram most similar to the building for which this certificate is being completed -see pages 6 and 7. If no diagram accurately represents the building, provide a sketch'or photograph.) C3.'Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion .calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum CvVD 29 Conversion/Comments Elevation reference mark used 0Td3 Does the elevation reference mark used appear on the FIRM? I_J Yes PY No ❑ a) Top of bottom floor (including basement or enclosure) m ❑ b) Top of next higher floor _ ft.( ) a ❑ c) Bottom of lowest horizontal structural member (V zones only) ' o o FES ❑ d) Attached garage (top of slab) A9}- ft ( ) 0 y S. ❑ e) Lowest elevation of machinery and/or equipment q W m Z servicing the building (Describe in a Comments area.) ft.( ) N RCE 003 ❑ f) Lowest adjacent (finished) grade (LAG) J�� , S ft.( ) m I °C —� Exp. 0-05 ❑ g) Highest adjacent (finished) grade (HAG) / 2 ft.( i) 0 ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade MIX C ❑ i) Total area of all permanent openings (flood vents) in C3.h UA sq. in. (sq. cm) qTf OF CA4\F SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME g , L-Ae Au A) LICENSE NUMBER (2 I I I Lt t F _ /� COMPANY NAME/ � ! f T/N11' ADDRESS(GU is ( C) CI�"(I) ir� 6L 1`` ,�'yC-9S C�Vi'�t(i ZIB.0&/4(`CLJC� --t5 �✓1 FEMA Form 81-31, JarA6ry 2003 DATE See reverse side for continuation. G') I_ l(ob Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A For Insurance Company Use: BUILDINGEET�UDRE�S tlSclud T Apt., Unit, Suite, arrL&or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY G VI( CI �-f STATE IP �i,5 a„Z CODE Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner. wmMtry i s V Utb(iCy AiIt �j ( L -L �ctC7kC{ > I ,, �� nAJOIS 7LIA� -z SeT >:t 0Iii 4 lfD €t 0012 n SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number S (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketgh or photogra h.) E2. The top of the bottom floor (including basement or enclosure) of the building is (•--L—) ft. in. (eabove or below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I—I—) ft. (m) (_(_din. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is �� ft.� in. ( above or �� below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1-1 Yes 1_1 No I_I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B,'C (Items C3.h and C3.1 only), and.E for Zone A (without a FEMA4ssued or community -issued BFE) or Zone AO must sign here. The statements in SectionsE A, B, Q and are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS L_I Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. �_J The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.-(_) A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. �_J The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED' G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for. 1_1 New Construction (_I Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: —ft. (m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ fL (m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE COMMENTS DATE 1 Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions COUNry JUL 2 DEVx,Lopr�,.-- I SrR.6�i 9,61V s FEMA FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND A -A r? I INSTRUCTIONS s NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 81-31 The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE: Please do not send your completed form to the above address. PURPOSE OF THE ELEVATION CERTIFICATE The Elevation Certificate is an .important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR-F). The Elevation Certificate is required in order to properly rate post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), for flood insurance Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, and AR/AO. The Elevation Certificate is .not required for pre -FIRM buildings unless the building is being rated under the optional post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a.community, the NFIP requires the community to adopt a floodplain management ordinance that specifies minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings and maintain a record of such information. The Elevation Certificate provides a way for a community to comply with this requirement. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for lending institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to supporta LOMA or LOMR-F request. This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofrng of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non- residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200° ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME T�0'3 r Policy Number BUILDING STREET ADDRESS (Includirlg Apt., Unit, Suite, andlor Bld . No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STA ZIP CODE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) F* 21 - - F', 'Z 0&& I ca BUILDING USE (e.g., Resifiential, Non residenfia�Addition, 4ocessory, etc Use a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: ( #;r - ##'- ##.#r or ##.#####*) III NAD 1927 (—I NAD 1983 SOURCE: I --J GPS (Type): 9 16 611 SoSo"32! i*wt 3®u (�I USGS Quad Map �I otner SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. FIP COMn�UNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. S Co'000 o ®®1 1 5 U r� r— CIkt-1 r' B4. MAP AND PANEL 65. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER _ �^ ( j DATE e� JVIJI; ��Ci EFF€CTIVE/REVISED DATE JvNE �j 1g� �A ZONE(S) t) Clone AO. e depth of flooding) I B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. (_) FIS Profile J_ -J FIRM (--.1 Community Determined A4 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: W NGVD 1929 �-J NAVD 1988 �J Other (Describe): B12. Is the building located Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? (—J Yes No Designation Date: SECTION C. - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings* 1--IBuilding Under Construction' (_Finished Construction 'A new Elevation Certificate) be required when construction of the building is complete. C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed -see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3.'Elevations-Zones Al -A30, AE, AH, A (with BFE), VE, V1 430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum 6X D zq Conversion/Comments Elevation reference marls used L)T-c' 651-b i4- Does the elevat n reference mark used appear on the FIRM? t_J Yes QS1 No O a) Top of bottom floor (including basement or enclosure) O b) Top of next higher floor _ fL(m) n FESSIp�yq O c) Bottom of lowest horizontal structural member (V zones only) _ () m y �F�I. O d) Attached garage (top of slab) . _ ft.( ) E �Q 2 �� O e) Lowest elevation of machinery and/or equipment q u, m servicing the building (Describe in a Comments area.) ft.( ) E Q uJ NE R .30--053 z} O f) Lowest adjacent (finished) grade (LAG) J�� , 5 ft.( ) N {x O g) Highest adjacent (finished) grade (HAG) % 2 ft.( i) c!'j CN,1C ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NIX OF C 0 - O i) Total area of all permanent openings (flood vents) in C3.h LM sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Secdons A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Seclion 1001. CERTIFIER'S NAME n ,!1 q�c ` t-lA� t� �.I ^ ' LICENSE NUMBER (/2-G' TITLE t J 1 l� �-� R„ `vim COMPANYk) TITLE e `� ► to ADDRESS L. M �/`�. t. UI��X CI 1�9S 1 , ZIP.0 DF�r�� ` SIGNATURE Ci �J DATE TELEPHONE �[ "( 1 �3© ��I• ICob FEMA Form 81-31, Jagyary 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING gREET�DORESS (I�cludm� Apt, Unit, Suite, ar0or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATES �` ZCODE Company NAIC Number GO -1 o �� SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. I:VMMtIVIJ 1laclheyc, �,;(lfijtj5r�j WlIL C LE"L17d2 �� 5A-t(�' i�. �64W A all �v� r` ► Eu 2C1*K- -t'F FIST SEi' Et tJ Ilii 4 11FD F10012-_ � S pc�t3� -tam �� 1 1t✓ ��,� . q '�r'�j'�2 't�Z 0 �3 11(°+, S1 "4 `� t7;:92 �o'� Vim) Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sket9,h or photograph.) E2: The top of the bottom floor (including basement or enclosure) of the building is in. (e* L)�J above or �-J below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1--u ft. (m) (_l--Iin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the buildingis 9 ft. oWfl_� � in. (0 L%�_4 above or L.-1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1_1 Yes I_1 No I-1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B,'C (Items C3.h and C3.i only), and.E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I-1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable Rem(s) and sign below. G1. �_J The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.-1__1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. �_J The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED' G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: —ft. (m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft. (m) Datum: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS TITLE TELEPHONE DATE 1-1 Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions B UNT CODNTY JUL 2 6 2004 DE VELOPMEM-T SERVICES FEMA FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE INSTRUCTIONS NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 81-31 The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the.upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE: Please do not send your completed form to the above address. PURPOSE OF THE ELEVATION CERTIFICATE The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management . ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR-F). The Elevation Certificate is required in order to properly rate post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), for flood insurance Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, and AR/AO. The Elevation Certificate is .not required for pre -FIRM buildings unless the building is being rated under the optional post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a. community, the NFIP requires the community to adopt a floodplain management ordinance that specifies minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings and maintain a record of such information. The Elevation Certificate provides a way for a community to comply with this requirement. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for lending- institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to supporta LOMA or LOMR-F request. This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non- residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1 - 7. " O.M.B. No. 3067-0077 Expires December 31, 200`. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME T�Q r�� Policy Number BUILDING STREET AD/D�R�ES-S (Ind di � t., Unit Suitor Bldg; No.)lORR P.O. ROUTE AND BOX NO. Company NAIC Number CIN t/Csli�� al'� ST L4� ZIP PROPERTY DESCRIPTION (Lound Block Numbers, Tax Parcel Number, Legal Description, etc.) r' -V- -2-I ---- bio 2 YDdia ICS BUILDING USE (e.g., Resyential, Non-residential Addition, /accessory, etc. Use a Comments area, if necessary.) 1927 or NAD i9-2-7') NAD 1983 SOURCE: �-I GPS (Type): 91 e Lill *4tt 3 2rQ 22-► 30 I—I USGS Quad Map I_I Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. FIP COMnn��U,NITY NAME 1, COMMUNITY NUMBER B2. COU�Y NAME B3. S . TE NU N0 69011 , • YOU TTr— C14641- I r- 84. MAP AND PANEL 85. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD 89. BASE FLOOD ELEVATION(S) NUMBER I 5-- t 1 G DATE I �vNEQv �l�g EFF€CTIVE/REVISED DATE .IvN+r I�q� ZONE(S) (Zone AO, use depth of flooding) (1 h 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth e(Describe): ered in � FIS Profile FIRM CommunityDetermined A Other Describe : B11. Indicate the elevation datum used for the BFE in B9: � NGVD 1929 1-1 NAVD 1988 [--1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? J--! Yes No Designation Date: SECTION C.- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: KIConstruction Drawings' 1--IBuilding Under Construction' 1---IFinished Construction 'A new Elevation Certificated be required when construction of the building is complete. C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3: Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Gl(D 7-9 Conversion/Comments Elevation reference mark used OV -0:5 65*3 H- Does the elevation reference mark used appear on the FIRM? (_! Yes JA! No O a) Top of bottom floor (including basement or enclosure) ❑ b) Top of next higher floor ❑ c) Bottom of lowest horizontal structural member (V zones only)M/ Q��f 1p�9 ❑ d) Attached garage (top of slab) ArA-00 ) e ❑ e) Lowest elevation of machinery and/or equipment 19 U,0 m , servicing the building (Describe in a Comments area.) s ft.( ) E u+ N CE 18003 O 0 Lowest adjacent (finished) grade (LAG) J . 5 ft.( I) m N xp. -30- 5 ❑ g) Highest adjacent (finished) grade (HAG) 2 ft•(n i) ❑ h No. of permanent openings (flood vents) within 1 ft. above adjacent grade A//A- � `flq�. civ� ❑ i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) OF C W. SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME A ,/1 ��4 ` L� k) LICENSE NUMBER (� r, t- 19 j TITLE t J I �� q„ COMPANY NAME 1 n ! 1 �n `` Il�� Gi ADDRESS l y�Ur`�X CIl`- U 47 �. !fit-1(-,� �C9S V ,t*.., ZI O 4� I SIGNATURE! l% DATE TELEPHONE 53® 61l-1 FEMA Form 81-31, JagAry 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING UREETQADDRESS (I luding ApL, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY A r ' STATE ^ IP CODE Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS fZ�l%tbCTcJl7 t �j 2 t61 It- �j (. L_TTZ-t/L �c1CkC ItX� i� A all �� m , =� QT IS -t 1 t hT SE'i' F -I O Ilii F4 1;� FLCOk'- py Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) - For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number S (Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photogra h.) E2: The top of the bottom floor (including basement or enclosure) of the building is ��J ft. � i in. (e* above or below (check one) the highest adjacent grade. (Use natural grade, if available.) E9. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1_" ft. (m) L -1 --lin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. E4.'The top of the platform of machinery and/or equipment servicing the building is 1-41 ft. 00)1---L7, 1 in. (0 W above or below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1_1 Yes L1 No 1_1 Unknown. The local official must certify this information in Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A. B,'C (Items C3.h and C3.i only), and.E for Zone A (without a FEMA4ssued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, Q and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I-1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. �–J The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.- A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED [G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY —F ISSUED G7. This permit has been issued for: [--I New Construction [--I Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: —ft. (m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ft. (m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions M- BUTTE' LJ COUNTY JUL 2 6 2004 DEVELOPMENT SERVICES 08/02/200.4 MON 8:27 FAX iii Butte Dev, /Planningll R002/002 .. LAUGHLIN and SPENCE PROJECT ' G� .. �pFESS10�j ,�� CIVIL ENGINEERS m)d SURVEYORS DATES h 1003 LIVE OAK ROULEVAIIO 1`30) 611.100! } � � YUbA CITY, CA W.1991 Pvt i3. tl)6T 1•Ik!_ � YYY JOB NO. 04-- I SHEET OF -- ODA - cao - 0 ) -D FEMA b �, ( D-7 t> .. BmTr COUNTY JUL 15 2004 DEVELOPMENT SERVICES FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE A" p�� INSTRUCTIONS TTLE COUjimt E D NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 81-31 The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE: Please do not send your completed form to the above address. PURPOSE OF THE ELEVATION CERTIFICATE The Elevation Certificate is an .important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR-F). The Elevation Certificate is required in order to properly rate post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), for flood insurance Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, and AR/AO. The Elevation Certificate is .not required for pre -FIRM buildings unless the building is being rated under the optional post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a.community, the NFIP requires the community to adopt a floodplain management ordinance that specifies minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings and maintain a record of such information. The Elevation Certificate provides a way for a community to comply with this requirement. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for lending- institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a LOMA or LOMR-F request. This certificate is used only to certify building elevations. A separate certificate is required for floodproofrng. Under the NFIP, non-residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non- residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1 - 7. '0 O.M.B. No. 3067-0077 Expires December 31, 200; SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME ��3 600y— Policy Number BUILDING STREP� ADDRESS (Includi Apl., Unit, Suite, andlor Bld . No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number %ice . �. �. v r-.. r.� _ � n P Y ( ##° • ##' - ##.##P or ##.# t u j NAD 1927 L—I NAD 1983 �vutc�t: I__I UFU (I ype): �7a of 1 'o ll 32 7.'L J® (_I USGS quad Map �I other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bt. FIP COM UNITY NAME 8 COMMUNITY NUMBER 62. COU NAME B3. S to 00 I'j YL) TTF � ' 84. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER _ ro-" c 1 DATE JVkw z �� EFF CTIVE/REVISEEDADATE 31 Ae- 11116 ZONE(S) (Zone AO, use depthoff flooding) (-7 �o B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. n_ J__J FIS Profile �_J FIRM J__J Community Determined Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: W NGVD 1929 NAVD 19W �_J Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? t—J Yes (No Designation Date: SECTION C. - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings' (_Building Under Construction' I-IFinished Construction 'A new Elevation Certificated be required when construction of the building is complete. C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G. as appropriate, to document the datum conversion. Datum �I(D 7-9 Conversion/Comments Elevation reference mark Used MCX2 IS5*3 F4- Does the ele a n reference mark used appear on the FIRM? J --J Yes QSJ No ❑ a) Top of bottom floor (including basement or enclosure) _ ft,(r{t) O b) Top of next higher floor_ ft.( ) a Q�pFESS ❑ c) Bottom of lowest horizontal structural member (V zones only) / , _ ft.(ri) ❑ d) Attached garage (top of slab) �tLf} _ ft.( ) a c, -❑ e) Lowest elevation of machinery and/or equipment u, m, servicing the building (Describe in a Comments area.) ft,( ) ? c . R 180 ❑ f) Lowest adjacent (finished) grade (LAG) 5S . $- ft.( ) Z 9 Ex ❑ g) Highest adjacent (finished) grade (HAG) b' 2 ft (;) m N ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade Allam 9TF OF CAL�F�r� ❑ i) Total area of all permanent openings (flood vents) in C3.h WA- sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, ORr4REHrm T4;-,E This certification is to be signed and sealed by a land surveyor, engineer, or architeyaorizekw, to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represen my besfeffdrts to in t' �rpr t the data available. K!/ ✓ 1 understand that any false statement maybe punishable by fine or im ris4 t er,JB {l S ,Code, S zoh`1001. CERTIFIER'S NAME c� .� NSE NUMBER k TITLE (J (� ^„ COMPANY NAM }" y S hK� �fl �� J �v�° ADDRESS I �/1 ( U /� I - CI (J 4� C..l IL SIGNATURE t% U G� DATE TELEPHONE X30 61 I • I cob FEMA Form 81-31, Ja ry 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING WEET,44DDRESS (I�cludinAq Apt, Unit, Suite, a iddlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATECODE Company NAIC Number Gt4-1 10 LIS-, tCAW-,C)�—ZIP SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. I:UMMtN 1 J i/n„„ .�.L t rD t I — _ � ��ti / d /,v 1..1✓�j ��[TL-1/L �cLikCd%� et (C,Y9 -ya #=bt.w� A all �� m u l�i1fi 4� o'TE -i� �k SE'i1►J Ilii I-� �`i� €tom 1� SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketgh or photograph.) E2. The top of the bottom floor (including basement or enclosure) ofthe building is �[.—1 ft. (_1 in. (e�*l above or 1-1 below (check one) the highest adjacent grade. (Use natural grade, N available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1--" ft. (m) �—(_Jin. (cm) above the highest adjacent grade. Complete Items C3.h and C31 on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is (_ � ft. ( —, I in. (g¢ij � above or 1--1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? I-1 Yes I_I No LI Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and.E for Zone A (without a FEMA4ssued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS LI Check here tf attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the communitys floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.- A community official completed Section E for a building located in Zone A (without a FEMA -Issued or community -issued BFE) or Zone AO. G3.1--1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. 1_1 New Construction 1-1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft. (m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft. (m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE COMMENTS DATE 1-1 Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions INSTRUCTIONS FOR COMPLETING THE ELEVATION CERTIFICATE The Elevation Certificate is to be completed by a land surveyor, engineer, or architect who is authorized by law to certify elevation information when elevation information is required for Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, or AR/AO. Community officials who are authorized by law or ordinance to provide floodplain management information may also complete this form. For Zones AO and A (without BFE), a community official, a property owner, or an owner's representative may provide information on this certificate, unless the elevations are intended for use in supporting a LOMA or LOMR-F. Certified elevations must be included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F. In Puerto Rico only, elevations for building information and flood hazard information may be entered in meters SECTION A - PROPERTY OWNER INFORMATION This section identifies the building, its location, and its owner. Enter the name(s) of the building owner(s), the building's complete street address, and the lot and block number. If the building's address is different from the owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location description based on distance and direction from a fixed point. of reference. For the purposes of this certificate, "building" means both a building and a manufactured (mobile) home. A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or detailed community map is appropriate. If no map is available, provide a sketch of the property location, and the location of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water. For building use, indicate whether the building is residential, non-residential, an addition to an existing residential or non-residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of Section F if needed. If latitude and longitude:data are available, enter them in degrees, minutes, and seconds, or in decimal degrees, taken at the center of the front of the building. Enter arc seconds to two decimal places. Indicate the horizontal datum and the source of the measurement data (for example, taken with GPS, scaled from a USGS Quad Map, etc.). SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Complete the Elevation Certificate on the basis of the FIRM in effect at the time of the certification. The information for Section B is obtained by reviewing the FIRM panel that includes the building's location. Information about the current FIRM and a pamphlet titled "Guide to Flood Maps" are available from the Federal Emergency Management Agency (FEMA) website at http://www.fema.gov or by calling 1-800-4274661. If a Letter of Map Amendment (LOMA) or Letter of Map Revision (LOMR-F) has been issued by FEMA, please provide the letter date and case number in the Comments area of Section D or Section G, as appropriate. Item Bl. NFIP Community Name & Community Number. Enter the complete name of the community in which the building is located and the associated 6 -digit community number. For a building that is in an area that has been annexed by one community but is shown on another community's FIRM, enter the community name and 6 -digit number of the annexing community. For a newly incorporated community, use the name and 6 -digit number of the new community. Under the NFIP, a "community" is any State or area or political subdivision thereof, or any Indian tribe or authorized native organization, that has authority to adopt and enforce floodplain management regulations for the areas within its jurisdiction. To determine the current community number, see the NFIP Community Status Book, available on FEMA's website at http://www.fema.gov or by calling 1-800-4274661. Item B2. County Name. Enter the name of the county or counties in which the community is located. For an unincorporated area of a county, enter "unincorporated area." For an independent city, enter "independent city" Item B3. State. Enter the 2 -letter state abbreviation (for example, VA, TX, CA). Instructions —Page 1 Item B4. Map and Panel Number. Enter the 10 -digit number shown on the FIRM panel where the building or manufactured (mobile) home is located. The first six digits will not match the NFIP community number: 1) when the sixth digit is a "C," in which case the FIRM panel is in a countywide format; or 2) when one community has annexed land from another community but the FIRM panel has not been updated to reflect this annexation. If the sixth digit is a "C," itis followed by a four -digit map number. For maps not in countywide format, enter the "community panel number" shown on the FIRM. Item B5. Suffix. Enter the suffix letter shown on the FIRM panel that includes the building's location. Item B6. FIRM Index Date. Enter the effective date or map revised date shown on the FIRM Index. Item B7. FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be determined by calling 1-8004274661. Item B8. Flood Zone(s). Enter the flood zone, or flood zones, in which the building is located. All flood zones containing the letter "A" or "V" are considered Special Flood Hazard Areas. The flood zones are A, AE, Al -A30, V, VE, V1 -V30, AH, AO, AR, AR/A, AR/AE, AR/A1-A30, AR/AH, and AR/AO. Each flood zone is defined in the legend of the FIRM panel on which it appears. Item B9. 'Base Flood Elevation(s). Using the appropriate Flood Insurance Study (FIS) Profile, Flood Elevation Table, or FIRM panel, locate the property and enter the BFE (or base flood- depth) of the building site. If the building is located in more than one flood zone in Item B8., list all appropriate BFEs in Item B9. BFEs are shown on a FIRM or FIS Profile for Zones Al -A30, AE, AH, V1 -V30, VE, AR, AR/A, ARAE, AR/A1-A30, AR/AH, and AR/AO; flood depth numbers are shown for Zone AO. Use the AR BFE if the building is located in any of Zones AR/A, ARAE, AR/Al-A30, AR/AH, or AR/AO. In A or V zones where BFEs are not provided on the FIRM, the community may have established BFEs or obtained BFE data from other sources. For subdivisions and other developments of more than SO lots or 5 acres, establishment of BFEs is required by the community's floodplain management ordinance. If the BFE is obtained from another source, enter the BFE in Item B9. Item B10. Indicate the source of the BFE that you entered in Item B9. Item B11. Indicate the elevation datum to which the elevations on the applicable FIRM are referenced Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA). Federal flood insurance is prohibited in designated CBRS areas for buildings or manufactured (mobile) homes built or substantially improved after the date of the CBRS designation. An information sheet explaining CBRS areas may be obtained on FEMA's website at http://www.fema.gov or by calling 1-800-427-4661. SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Complete Section C if the building is located in any of Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, or AR/AO, or if this certificate is being used to support a LOMA or LOMR-F..If th building is located in Zone AO or Zone A (without BFE), complete Section E instead To ensure that all required elevations are 0DIaMeG, It may to enter at g necessary uor instance, if the building has a basement or sunken living room, split-level construction, or machinery and equipment). Surveyors may not be able to gain access to some crawl spaces to shoot the elevation of the crawl space floor. If access to the crawl space cannot be gained, use the following guidance: • Use a yardstick or tape measure to measure the floor height to the "next higher floor," and then subtract the crawl space height from the elevation of the "next higher floor." • Contact the local floodplain administrator of the community that the building is located in. The community may have documentation of the elevation of the crawl space floor as part of the permit issued for the building. • If the property owner has documentation or knows the height of the crawl space floor to the next higher floor, try to verify this by looking inside the crawl space through any openings or vents. In all three cases, provide the elevation in the Comments area and a brief description of how the elevation was obtained. Item C1. Indicate whether the elevations to be entered in this section are based on construction drawings, a building under construction, or finished construction. For either of the fust two choices, a post -construction Elevation Certificate will be Instructions — Page2 required when construction is complete. If the building is under construction, include only those elevations that can be surveyed in Items C3.a-g. Use the Comments area to provide elevations obtained from the construction plans or drawings. Select "finished construction" only when all machinery and/or equipment—furnaces, hot water heaters, heat pumps, air conditioners, and elevators and their associated equipment—have been installed and the grading around the building is completed. Item C2. Select the diagram on pages 6 and 7 that best represents the building. Then enter the diagram number and use the diagram to identify and determine the appropriate elevations requested in Items C3.a-g. If you are unsure of the correct diagram, select the diagram that most closely resembles the building being certified, or provide a sketch or photograph of the m building and enter all elevations in Ites C3.a-g. Item C3. Indicate whether the elevation reference mark (benchmark) used during the field survey is an elevation mark on the FIRM. If it is not, indicate the source and datum for the elevation. Vertical control benchmarks other than those shown on the FIRM are acceptable for elevation determinations. Show the conversion from the field survey datum used to the datum used for the BFE(s) entered in Item B9. All elevations for the certificate must be referenced to the datum on which the BFE is based. Show the datum conversion, if applicable, in this section or in the Comments area of Section D. For property experiencing ground subsidence, the most recently adjusted reference mark elevations must be used for determining building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter elevations in Items C3.a-g to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico). Items C3.a-d. Enter the building elevations (excluding the attached garage) indicated by the selected building diagram (Item C2.) in Items C3.a-c. If there is an attached garage, enter the elevation for top of attached garage slab in Item C3.d. (Because elevation for top of attached garage slab .is self-explanatory, attached garages are not illustrated in the diagrams.) If the building is located in a V zone on the FIRM, complete Item C3.c. If the flood zone cannot be determined, enter elevations for all of Items C3.a-g. For buildings in A zones, elevations a, b, d, and a should be measured at the top of the floor. For buildings in V zones, elevation c must be measured at the bottom of the lowest horizontal structural member of the floor (see drawing below). For buildings elevated on a crawl space, Diagram 8. enter the elevation of the top of the crawl space floor in Item C3.a, whether or not the crawl space has openings (flood vents). If any item does not apply to the building enter `NIA " for not applicable. BUILDING ON NG WITH BUILDING ON PILES, SLAB PIERS, OR COLUMNS ;, 0 a BASE O FLOODELEVATION O ADJACENT ... GRADE y Item C3.e. Enter the lowest elevation of machinery and/or equipment—furnaces, hot water heaters, heat pumps, air conditioners, and elevators and their associated equipment—in an attached garage or enclosure or on an open utility platform that provides utility services for the building. If the machinery and/or equipment is mounted to a wall, pile, etc., enter the platform elevation of the machinery and/or equipment. Indicate machinery/equipment type in the Comments area of Section D or Section G, as appropriate. If this item does not apply to the building, enter `NIA "for not applicable. Items 01--g. Adjacent grade is defined as the elevation of the ground, sidewalk, patio slab, or deck support immediately next to the building. If the certificate is to be used for a LOMA or LOMR-F, provide in the Comments area the lowest adjacent grade elevation measured at the deck support or stairs if that elevation is lower than the building's lowest adjacent grade. For Instructions — Page 3 Zone AO, use the natural grade elevation, if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F. Items 014. Enter the number of permanent openings (flood vents) in the walls supporting the building, including the attached garage, that are no higher than 1.0 foot above the adjacent grade. Determine the total area of all such openings in square inches (square cm, in Puerto Rico), and enter the total in Item C3.i. If the building has no permanent openings (flood vents) within 1.0 foot above adjacent grade, enter "0" (zero) for each of Items C3.h and C3.i. Enter in the Comments area whether the openings are on the foundation walls of the building and/or on the walls of the garage. SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or architect who is authorized by law to certify elevation information. Place embossed seal and signature in the box next to elevations in Section C. A flat stamp is acceptable only in states that do not authorize use of an embossed seal over the signature of a professional. You are certifying that the information in Sections A, B, and C on this certificate represents your best efforts to interpret the data available and that you understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of Section D, on the back of the certificate, to provide datum, elevation, or other relevant information not specified on the front. SECTION E.- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO & ZONE A (WITHOUT BFE) Complete Section E if the building is located in Zone AO or Zone A (without BFE). Otherwise, complete Section C instead. Item El. Select the diagram on pages 6 and 7 that best represents the building, then enter the diagram number. If you are unsure of the correct diagram, select the diagram that most closely resembles the building, or provide a sketch or photograph. - Explain in the Comments area if the measurement provided under Item E.2, E.3, or EA is based on the "natural grade" Item E2. Enter the height 'in feet and inches (meters and centimeters, in Puerto Rico) of the top of the bottom floor (as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). For post -FIRM buildings in Zone AO, the community's floodplain management ordinance requires that this value equal or exceed the base flood depth on the FIRM. Buildings in Zone A (without BFE) may qualify for a lower insurance rate if an engineered BFE is developed at the site. Item E3. For Building Diagrams 6-8 with proper openings (see page 7), enter the height in feet and inches (meters and centimeters, in Puerto Rico) of the next higher floor or elevated floor (as indicated in the applicable diagram) above the highest adjacent grade (HAG). Be sure that you have completed Items C3.h and C31 on the front of the form to show the number of permanent openings (flood vents) within 1 foot above adjacent grade and the total area of the openings. Item E4. Enter the height in feet and inches, in relation to the highest adjacent grade next to the building, of the platform that supports the machinery and/or equipment servicing the building. Indicate machinery/equipment type in the Comments area of Section E. If this item does not apply to the building, enter "NIA "for not applicable. Item E5. For those communities where this base flood depth is not available, the community will need to determine whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION Complete as indicated. This section is provided for certification of measurements taken by a property owner or property owner's representative when responding to Sections A, B, C (Items C3.h and C3.i only), and E. The address entered in this section must be the actual mailing address of the property owner or property owner's representative who provided the information on the certificate. Instructions — Page 4 SECTION G - COMMUNITY INFORMATION (OPTIONAL) Complete as indicated. The community official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. If the authorized community official completes Sections C, E, or G, complete the appropriate item(s) and sign this section. Check Item G1, if Section C is completed with elevation data from other documentation, including elevations obtained from the Community Rating System Elevation Software, that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. Indicate the source of the elevation data and the date obtained in the Comments area of Section G. If you are both a community official and a licensed land surveyor, engineer, or architect authorized by law to certify elevation information, and you performed the actual survey for a building in Zones Al - A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/Al-A30, ARAE, AR/AH, or AR/AO, you must also complete Section D. Check Item G2. if information is entered in Section E by the community for a building in Zone A (without a FEMA4ssued or community -issued BFE) or Zone AO. Check Item G3. if the information in Items G4 -G9 has been completed for community floodplain management purposes to' document the as -built lowest floor elevation of the building. Section C of the Elevation Certificate records the elevation of various building components but does not determine the lowest floor of the building or whether the building, as constructed, complies with the community's floodplain management ordinance. This must be done by the community. .Items G4 -G9 provide a way to document these determinations. Item G4. Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued for the building. Item G5. Date Permit Issued. Enter the date the permit was issued for the building Item G6. Date Certificate of Compliance Issued. Enter the date that the Certificate of Compliance or Occupancy or similar written official documentation of as -built lowest floor elevation was issued by the community as evidence that all work authorized by the floodplain development permit has been completed in accordance with the community's floodplain management laws or ordinances. Item G7. New Construction or Substantial Improvement. Check the applicable box. "Substantial Improvement" means any reconstruction, rehabilitation, addition, or other improvement of a building, the cost of which equals or exceeds 50 percent of the market value of the building before the start of construction of the improvement. The term includes buildings that have incurred substantial damage, regardless of the actual repair work performed. Item G8. As -built lowest floor elevation. Enter the elevation of the lowest floor (including basement) when the construction of the building is completed and a final inspection has been made to confirm that the building is built in accordance with the permit, the approved plans, and the community's floodplain management laws or ordinances. Indicate the elevation datum used. Item G9. BFE. Using the appropriate FIRM panel, FIS, or other data source, locate the property and enter the BFE (or base flood depth) of the building site. Indicate the elevation datum used. Enter your name, title, and telephone number, and the name of the community. Sign and enter the date in the appropriate blanks. Instructions — Page 5 BUILDING DIAGRAMS The following eight diagrams illustrate various types of buildings. Compare the features of the building being certified with the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item C2. and the elevations in Items C3.a-C3.g. In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor elevation is taken at the bottom of the lowest horizontal structural member (see drawing in instructions for Section C). DIAGRAM 1 All slab -on -grade single- and multiple -floor buildings (other than split-level) and high-rise buildings, either detached or row type (e.g., townhouses); with or without attached garage. Distinguishing Feature — The bottom floor is at or above ground level (grade) on at least one side. GRADE n a _�i NEXT HIGHER r r FLOOR i GRADE N BOTTOM FLOOR !j Y9 (determined by existing grade) DIAGRAM 3 All split-level buildings that are slab -on -grade, either detached or row type (e.g., townhouses); with or without attached garage. Distinguishing Feature—The bottom floor (excluding garage) is at or above ground level (grade) on at least one side r n a r r n HIGHER i b BOORS r NEXT HIGHER GRADE FLOOR f A g ) (determined by e)asting grade) DIAGRAM 2 All single- and multiple -floor buildings with basement (other than split-level) and high-rise buildings with basement, either detached or row type (e.g., townhouses); with or without attached garage. Distinguishing Feature — The bottom floor (basement or underground garage) Is Maw ground level (grade) on all sides. Buildings oaatnrcted above crawl spaces that are below grade on all sides should also use Bus diagram.* GRADE NEXT HIGHER I ( b ! FLOOR 7 BOTTOM FLOOR (BASEMENT) f 9 (determined by existing grade) DIAGRAM 4 All split-level buildings (other than slab -on -grade), either detached or row type (e.g., townhouses); with or without attached garage. Distinguishing Feature — The bottom floor (basement or underground garage) Is below ground level (grade) on all sides. Buildings conducted above crawl spaces that are below grade on all sides should also use this diagram. r r r a HIGHER GRADE FLOORS NEXT HIGHER BOTTOM FLOOR FLOOR f 9 (determined by existing grade) b ' A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for living -purposes; or as*an officei garage, workshop, etc. Instructions — Page 6 DIAGRAM 5 All buildings elevated on piers, posts, piles, columns, or. parallel shear walls. No obstructions below the elevated floor. Distinguishing Feature — For all zones, the area below the elevated floor is open, with no obstruction to flow of flood waters (open lattice work andfor readily removable hued screening is permissible). NEXT HIGHER b FLOOR a ELEVATED FLOOR GRADE f Y 9 (determined by existing grade) /\� (For V zones only) cc DIAGRAM 7 All buildings elevated on full -story foundation walls with a partially or fully enclosed area below the elevated floor. This includes walkout levels, where at least one side is at or above grade. The principal use of this building is located in the elevated floors of the building. Distinguishing Feature — For all zones, the area below the elevated floor Is enclosed, either partially or fully. In A Zones, the partially or fully enclosed area below the elevated floor is with or without openings" present In the walls of the enclosure. Indicate information about openings In Section C. Budding Elevation information (Survey Required). r , r r r b NEXT HIGHER O a FLOOR GRADE O 9 f WALKOUT LEVEL h i DIAGRAM 6 All buildings elevated on piers, posts, piles, columns, or parallel shear walls with full or partial enclosure below the elevated floor. Distinguishing Feature — For all zones, the area below the elevated floor is enclosed, either partially or fully. In A Zones, the partially or. fully enclosed area below the elevated floor is with or without openings— present in the wails of the enclosure. Indicate Information about openings in Section C. Building Elevation Information (Survey Required). i NEXT HIGHER r FLOOR r W b ELEVATED • FLOOR GRADE ENCLOSURE A. ' ^7��i j:-i?ei=ti•��%`•"7t`=i=i::7y`<�7:,=i:'.r^ 'w° _. ...� �q,...;: ;...,.1�' _ .. ::7 �: ice:: �. .._r>•. �-,: f 9 (determined by f r. C existing grade) For V zones only) DIAGRAM 8 All buildings elevated on a crawl space with the floor of the crawl space at or above grade on at least one side, with or without an attached garage. Distinguishing Feature — For all zones, the area below the fust floor is enclosed by solid or partial perimeter walls. In all A zones, the awm space is with or without openings" present in the walls of the crawl space. Indicate information about the openings In Section C. Building Elevation Information (Survey Required). •' An "opening" (flood vent) is defined as a permanent opening in a wall that allows for the free passage of water automatically in both directions without human intervention. Under the NFIP, a minimum of two openings is required for enclosures or crawl spaces with a total net area of not less than one square inch for every square foot of area enclosed. Each opening must be on different sides of the enclosed area. If a building has more than one enclosed area, each area must have openings on exterior walls to allow floodwater to directly enter. The bottom of the openings must be no higher than one foot above the grade underneath the flood vents. Alternatively, you may submit a certification by a registered professional engineer or architect that the design will allow for the automatic equalization of hydrostatic flood forces on exterior walls. A window, a door, or a garage door is not considered an opening. Instructions — Page 7 June 22, 2004 Dean Cook P.O. Box 35 Truckee, CA 96160 Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 (530) 538-2140 FAX Assessor Parcel Number: 021-020-010 Building Permit Number: 04-1070 Thank you for submitting the plans for your building project. The plans have been reviewed and comments are listed below. Please respond in writing to each item by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Your complete and clear response will expedite the re -check and approval of this project. NON-STRUCTURAL COMMENTS: None g TURAL COMMENTS: mplete Section C items C3a through C3i of the flood elevation certificate. Note items , C3h and C3i do not apply and can be noted "N/A" on the certificate. Specify attachment of the deck to the primary structure in accordance with CBC 2320.13. This may be accomplished by attaching the deck ledger with.lag bolts. If you wish to discuss any of -these requirements, please call (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. To discuss non-structural items, ask for Russell. Philo will answer your structural questions. Please refer to your Data Sheet for remaining non -plan check items. (You received this form when you applied for your permit.) The counter staff will answer any questions concerning the Data Sheet. 1 Russell Bloomfield Philo Hunt, P.E. Plans Examiner Plan Check Engineer cc: Gary Laughlin, Architect F Tt> Stkvw rI N l S l'� dam' 1� t A4:Z0 V%E V�F6 !+61. w,Lu AAJ 1ofI LAUGHLIN and SPENCE (� ? CIVIL ENGINEERS and SURVEYORS 1008 LIVE OAK BOULEVARD (530)671-1008 ng x y5 YUBA CITY, CA 95991 fax (530) 671-0822 v �oQRO ESS/p,�,�! cc No. R . nn� . NO -5-14;m! PROJECT 0, BY/ " � DATE JOB NO. e SHEET OF L t L 'Z 41��FAQ_o)I�w F Z ¢ w - OL _ 20 PLP IF m E copoy BUTTE COUNTY JILDiNG DIVISIQN VES _ X390¢ p , YA IL COPY o -a A LAUGHLIN and SPENCE PROJECT CIVIL ENGINEERS and SURVEYORS �} 1008 LIVE OAK BOULEVARD (530)BY q 671-1008 DATE pe&Ls YUBA CITY. CA 95991 fax(530)671-0X22 _ I JOB O. J SHEET OF UT — «'(kms LSC- r,. I u. wt-ot_,� 2-xILA r� `�! ( �T �e,n Lk )/ ��,� ° A and SPENCEPROJECT TH--k— LAUGHLIN CIVIL ENGINEERS and SURVEYORS BY %.!/��!� z t� DATE t � "' 1003 LIVE OAK ROULL'\9\RO (530)671-1008 eea �s YU6A CITY. CA 95991 fax (530) 671-0322 E _ �y JO - O. SHEET OF uuco UJ ui 2 x v VIL %c 14- P�k, r: VW� �P y d� 4- iz . j DO LAUGHLIN and SPENCE CIVIL ENGINEERS and SURVEYORS 1008 LIVE OAK BOULEVARD (530)671-IOOR YUBA CITY. CA 95991 1.,.,(530)671-0822 PROJECT BY Bim DATE�r-I6� JOB NO. SHEET OF 5cq 4 -zx r -("A I(-) Z u 1 /'2w- 2� 1 /i• °° 4 LAUGHLIN and SPENCE a CIVIL ENGINEERS and SURVEYORS `O 1008 LIVE OAK BOULEVARD (530)!,71.1008 OR U5 YU13A CITY. CA 95991 fax (530) 671-0822 PROJECT ` \ --� (P+ i' BY / DATE'3-' � JO NO. a SHEET_ OF 0 0. A.a, O. 0 63&1 ® doh P6 l • LAUGHLIN and SPENCE PROJECT CIVIL ENGINEERS and SURVEYORS BY �� DATE��%(p • `9 1008 LIVE OAK BOULEVARD (930) 671-1008 °etr vs YUBA CITY. CA 95991 laz (530) 671-0822 SHEET_ OF ___--- T7 -�- +Ll 0 J . �t�x 2X1,33 xZ�S 4, 3� h �. A LAUGHLIN and SPENCE CIVIL ENGINEERS and SURVEYORS 1008 LIVE OAK BOULEVARD (530)671-I WR Pe �5 YUBA CITY, CA 95991 fa.,1-U8 (530) 6722 PROJECT � (.'rry V � BY [�-- DATE 3a(0-04-- JOB N SHEET % OF /t(ru)(Cox7, , E�7C1(33 --'� Cw\,a-�-- t c � 06, i LAUGHLIN and SPENCE ` CIVIL ENGINEERS and SURVEYORS 1008 LIVE OAK 13OULI:VAIID 1530) 671-10,1808 _ Pe y 4s YUBA CITY. CA 95991 fitx (530167122 PROJECT BY It DATE�►6 " JOB O. SHEET n OF Wuj VIA 40VL 1 ............................ �j 14. 141 �1 q ,. al h. t' Actual r Model Dimensions Fasteners Allowable Loads Joist Size No. Ga ��•� �' z ;DF/SP S ecies Heatley p ��; SPF Species Header Code W H B Face Joist YUphH� 5 UpII(i 4�Floorr Snow 'Root ° Floor Snow Roof Ref. HU1.81/5 (Min) 1'356 53/8 2'/z F (13�) .:(160) 100)3 (115); (]25) (100) (115) (125) VY4 x 5'/z 14 12-16d 4-10dxl'/z 480 575 1610 1850 2010 1390 1600 1740 26,83 HU1.81/5 (Max) 113/,6 53/a 2'/z 16-16d 6-1Odx1'/z 720 865 2145 2465 2680 1855 2135 2320 26 1�4x T/4 HU7 (Min) 14, 113hs 611/16 2'h 12-16d 4 tOdxlYz 480r 575' s161U 1850 2010" tT43555010 1740 26, 83 HU7 (Max) 113/is 61'/16 2'/z 16 16d 8 l Odx11/z as ,. 960 �s X1150421452465 r_ 2680, 2320 26 y 13/4 x 9'h HUS1.81/10 HU9 (Min) 16 117/16 113/,6 87/8 3 30-16d 10-16d 2845 3000 4900 5045 5145 5145 431 14 113/6 96/,6 2'/z 18-16d 6-1Odxi 1/z 720 865 2410 2775 3015 2610 26, 83 HU9 (Max) HUS1.81/10 95/16 2'/z 24 16d 10 10d x1'/z 1200 1440 3215 3700 4020 2785 3200 3480 26 1 '1`4 x HU11 (Min) 16 113/6 117/,6 87/8 3 30-16d 10 16d 2845 fi3000? 4900T t R ' ,5045 a 5145 4355 5010 5145 4,37 11Y4 x 117/8 14 11'/,c 2'h 22-16d ---i0-16d 6-1 OdxlYz +720 f865�� 2950fY °3390 u "3685 2550 2935.3190 HUI1 (Max) 113/6 11'/,6 2'h 10 10dxtlh 2pO 14401 40209315'44058 3480 4000 4350 26 HUS1.81/10 16 113/6 8'/e 3 30-16d 10-16d 2845 3000 4900 5045 5145 4355 5010 5145 4,37 1 4x14 U14 113/,6 10'/4 2 1416d 6lOdxl'h 720 865 1860 2140 2330 1610 1850 2010 26 HU14 (Min) 14 113/,6 13'+/,6 21/2 28-16d 8-10dx11/z 960 1150 3750 4110 4180 3250 3735 4060 26,83 HU14 (Max) 113/,6 13"/,6 21/z 36-16d 14-10dx11/z 1680 2015 4540 4730 4855 4175 4730 4855 120 21Ysx HU2.75/10(Min) 14 23/4 .9 21/2 .14-16d 6-1Odxl1/z � _ ' " xx720, -� 865 �� 0`18752155234 HU2.75/10 (Max) - 9Ya x 9'h 23Y4 g 21/2 18-16d 10-1 Od x11/z :1625.. 1200�� 1440 � x 41,0 3 $ 2 2090 1876: 2400 2030 2610 26 HGUS2.75/10 . 12 2314 815/is . 4 - 46-16d 16-16d X2753015¢ X94 3630 3630 0' n82208410 5980 :6195 6335 160 211'/i6 x HU2.75/12 (Min) 14 23/9 103/4 2'/2 16-16d 6-1 Odxl'/z 720 865 2145 2465 26801855 2135 2320 26, 83 11 ''/a x 11'/8 HU2.75/12 (Max 23/4 103/4 2'/z 22 16d 10-1 Od x1 1/2 1200 1440 2950 3390 3685 2550 2935 3190 26 HGUS2 75/12 HU2.75/14 (Min) 12 23/4 23/4 1015/,6 4 56-16d 20-16d 4055 4055 8410 8760 8995 6335 6600 6775 160 2"/,6 x 14 14 13 2'/2 . .18=16d 8 10dx1�h '- "� X960 gh 50 k �?410,� „2775 3015 2090. 2400. 2610 26,83 HU2.75/14 (Max) 2�4 13 21h 24 16d 14 10d x1'h si1680� X2015 3215 37004020 HGUS2.75/14' 12 .. 2:Y 1215/;6 4 66716d 22-16d ,2785 538 5380 864.5 8030ai X285 6510 3200 3480 26 21Y,6 x 16 HU2.75/16 (Min) 14 23/4 141/,s 2%z 20-16d 8-1Odx1'h 960 1150 2680 3080 3350 2320 6800 2670 6995 2900 160 26, 83 HU2.75/16 (Max) 23/4 141/,6 21h 26 16d , 14 10d x1 /2 1680 2015 3485 4005 4355 3015 3470 3770 26 HGUS2.75/14 HU48(Min) 12 N. 1215/,6 4 '2'h.` 66 l6d 22 l6d 5380 5380 8645 9030 9285 6510 6800 6995 160 14 39/,6 673/6 10.164 4104 605 Z c1340 10540 1675 ^ 1160 1335 1365 26,83 HU48 (Max) 3'h x 7Y. HGUS46 39/6. 6135s 2iiz 14=16d 6-1 Od 905 85 �t3Z5 X2155 2345 1625. 1870 2030 26 12 35/8 35/e 39/16 4�/s , .394Q. 716 83/8 4:: , 4 20-16d 36 16tl 8-16d 12;164 2325 25? �4535�; 4930 :3410. ;3220 , X3220 Y 8' `83b `7925 5890.. .: 3920 6655 4260 :6655 3, 39,140 HGUS48- U410 16 HUS410 39/,6 81V% 2 2 14-16d 6-10d 890 1065 1860 2140 2330. 1610 1850 2010 26,83 31/2 x 39/1s 85/8 21/2 8-16d 14-16d 8-164 2160 2590 2010 2310 2510 1650 1900 2065 1,84 HU410 (Min) 91/4 x 91h 14 39/,6 85/a 21/2 18-164 6-10d 10-10d 905 1085 1875 2155 2345 1625 1870 2030 26,83 HU410 (Max) HHUS410 35% 9 3 30 t6d 10 t6d 1505 1810 2410 2775 3015 2090 2400 2610 26 HGUS48 35/8 7'/16 4 36-16d 2855 3430 5190 5900 5900 4385 5040 5480 4,37,140 12 9'/16 12-16d 3220 3220 6805 7830 7925 5890 6655 6655 HGUS41035/8 39/s 83x5 4 2 46 164 16 164 3630 3630 8780 8940 8940 7365 WpoR j-510 7510 3, 39,140 U41016 HUS412 14 164 6 104 890` ai , 5 218603-1 1149 3330 1610 1850 2010 26, 83 39/6 101h 2 10 164 10 164 2700 -32404 ,25}0 ,2885 .3140 2065 2375 2580 1,84 HU412 (Min) 3 h.x 14 39/6 105/,6 21h .1616d 6l0d 905 "1085 21°45 X2465 6680: 1855 2135 2320 26, 83 HU412 (Max) 11'/4 x 117/8 39/6 105/16 2'/2 22-16d 10-10d 6:505 ,11810 295_Ort x33906 ; 3685 2550 2935 3190 26 HHUS410 35/8 9 31. '30-16d 10 16d e2855 X3430 x 5190 %590 ,5900 4385 5040 5480 4, 37,140 HGUS48 3% T/16 4 36-16d 12-16d 3220 ` 3220 s� 6805 ; 7830 925 5890 6655 6655 HGUS410 12 3% 9'/16 4 46-16d 164 ��220 3630 � 3630 8780' 28990 +X8940_) 7365 .� 7510 7510 3,39 f1GUS412° U414 16 3% 10'/s 4 56-16d 16d 4055,1b�4055� "9i55,�,y�155 r y9155 � 7690 7690 7690 160 HU416 Min 39/,6 39/,6 10 1355 2 2'/z 16-16d 6-1Od —8-1 890 1065 2130 2445 2660 1840 2115 2300 14 39/,6 135/9 21/2 20-16d O4 1205 1445 2680 3080 3350 2320 2670 2900 26' 83 HU416 (Max) 3'/z x 14 26-16d 12-10d 1810 2015 3485 4005 4355 3015 3470 3770 26 HHUS410 .HGUS410 35/8 35/a 9 3 30-16d 10-16d 2855 3430 5190 5900 5900 .4385 5040 5480 4,37,140 12 9'/,s 4 46-16d 16-16d 3630 3630 8780 8940 8940 7365 7510 7510 3, 39,140 HGUS414 35/a 12�/,s 4 66 16d 22-16d 5380 5380 10015 10015 10015 7890 8185 8380 160 1.1Od commons or 16d sinkers may he ,lead instend „f,�. _. --- -_ ---.....11..11.., — .. a ap—lied lou al 0.85 of the table load value. 2.16d sinkers may be used instead of the specified 10d commons with no load reduction. 3. Uplift loads based on Douglas Fir have been increased 33% and 60% for earthquake or wind loading with no further increase allowed. Divide by 1.33 and 1.60 for normal loading such as in cantilever construction. For SPF, use 0.86 x DF/SP Uplift Load. 4. MIN nailing quantity and load values—fill all round holes; MAX nailing quantity and load values—fill all round and triangle holes. 5.Avg Ult not shown due to limited space. CODES: See page 10 for Code Listing Key Chart. 75 V/2UM4.1014:.11 FAX_. July 28, 2004 Z00V006 C I. V. I l... F N L L..N L.FR S_ it. n d..S. LJ R.V. k:..Y Q_ R_.S 1009 I.IVF. OAK ROUI.r;VAItU (53,0) 671-100t: ' YIIRA QIT.Y. Q_A 251 11 Pru- (:&.10) r;7 L.Q8.2.2... Mr. Philo Hunt Butte County-Burldtrtgflrvtsiort-- 7 County Center Drive Oroville, CA 95965 RE: WolmanizcdHearn-Ealett}-atiew�- - Attached are the revised beam calculations and. accompanying tables from Triis.loist for the Woimiulized PaiAlani beams. All load values were taken. from my previously submitted calculations. Please mark "WO.LMAN1ZLD" on all Floor girders per our phone discussion. The wolmanized cndwall beams are specified at 11 1/4" depth. This is a special order through-Trus:loistand I wish.to_Chaneto.t.t.7/8"-depth.(standard-ordeT-).. Could -you -also- - mark 11 7/8" depth on endwall beams? According to a phone conversation this morning, the owner is planning to come; by your office Gn__Thursday,the 2Qih,to see if he_can_obtain_the_building_pe=it_ ALsora_cnpX of whaLw-asfaxe(Ltoday.vii.lLaLso_.be_sentta.yott_bXmaiLsigned-aud_sta Wedgy Plcasc contact me at (530) 671-1008 with any questions. ' Th G y E. ugTiJin� /IIb,, AS I Cjf'ov�,f LixPoc,e , ; v.,-� Z�Flo Mots+ Lp-• t . / 0-rA-L_ L3 V E Low. D- 5� o t±. /iP- L L-� PS L -E).-74 I -we Lo4� - 57 z g/.c4 < LL, 11 : /01I .':'-lr! Use 9)/4 u 14- PSL F- 1.74- S AiR N � 13 c) Cdye T oTR-L_. LOA- 4 S O �/ < T l (ti. = 5bo *l /-(� �5r �'/z x iI �/� la��.z�� PSS �/.71- V �-i BUTTE COUNTY JUL 3 0 2004 DEVELGPMENT SERVICES A iauGHLEv anaYsPENCE PROJECT Of DATE �I" Z - 04- CIVIL ENGINEERS and SURVEYORS ae y �5 1008 LIVE OAK BOULEVARD (530)671-1008 YUBA CITY. CA 95991 fax (531) 671-0322 C y G R •� nn SHEET I OF. ion /IIb,, AS I Cjf'ov�,f LixPoc,e , ; v.,-� Z�Flo Mots+ Lp-• t . / 0-rA-L_ L3 V E Low. D- 5� o t±. /iP- L L-� PS L -E).-74 I -we Lo4� - 57 z g/.c4 < LL, 11 : /01I .':'-lr! Use 9)/4 u 14- PSL F- 1.74- S AiR N � 13 c) Cdye T oTR-L_. LOA- 4 S O �/ < T l (ti. = 5bo *l /-(� �5r �'/z x iI �/� la��.z�� PSS �/.71- V �-i BUTTE COUNTY JUL 3 0 2004 DEVELGPMENT SERVICES P The exceptional strength and durability of WolmanizeO Parallam® PSL makes it ideal for use in balconies, porches, decks or any other outdoor application. WOLMANIZED� 1 Wolmanized® Parallam® PSL headers and beams are stocked in the following sizes: 13/4" x 117/8" 13/4" x 14" 3'/2" x 9'/4" 3'/2' x 117/8" 3'/2" x 14" 3'/2' x 16" 5'/4" x 117/6" 5'/4" x 14" Other sizes (see page 22) are also available by special order. Contact your Trus Joist MacMillan representative for assistance. Wolmanized® Parallam® PSL columns and posts are stocked in the following sizes: 3'/2" x 31/2" 3'/z" x 51/4" 5'/4" x 5'/4" 31/2" x 7", 5'/4" x 7" and 7" x 7" WolmanizedO Parallama PSL columns and posts are also available by special order. Contact your Trus Joist MacMillan representative for assistance. GUARANTEE Against manufacturing defects, In addition to being exceptionally strong and durable, WolmanizeO Parallame PSL can also be /'finished and left exposed. Its attractive, exotic grain will add a unique touch to any porch or deck. Parallam® PSL products enter an airtight treatment cylinder - a highly -controlled, pressurized environment where they are exposed to the Wolmanized® treatment process. WOLMANIZEDS "X� 21 WOLMANIZED° PARALLAM® PSL ALLOWABLE DESIGN STRESSES LOAD DURATION) SERVICE SERVICE' LEVEL 1 LEVEL 2 SERVICE LEVEL 3' Shear modulus of elasticity G = 111,250 psi 108,750 psi Modulus of elasticity E = 1.78 x'106 102,500 Psi, psi 1.74 x 106 psi Flexural stress Fb = 2175 psi(l) 2090 psi(t) Compression perpendicular to 1.64 x 106 psi ) 1915 psi(') 1 r grain parallel to wide face of strands F,.L = 465 psi(Z) 385 psi(Z) P 315psi(?)/ Compression parallel to grain, f = 2060 psi dl P 1680 psi Horizontal shear perpendicular 1275 psi , to wide face of strands FY = 190 psi 175si P 1psi Creep Factor C,= 1.2 1.6 1..88 5 (1) For 12 -inch depth. For others, multiply 0.111 by 171 (2) F�[ shall not be increased for duration of load. The following formula approximates creep deflection (AcD) in inches for Wolmanized® Parallam® PSL ACU = IADL + ALL (F - 1.0)) (CRc - 1.01 Total load deflection (ATL) = AU- ADL + ACD F = 1.2 for floors; 11for roofs ALLOWABLE DESIGN PROPERTIES (100% LOAD DURATIONAERVICE LEVEL 2) 13 - /4tt WOLMANIZED® PARALLAM® PSL 51/4tt WOLMANIZED° PARALLAM® PSL 7" WOLMANIZED® PARALLAW PSL GENERAL ASSUMPTIONS FOR WOLMANIZED® PARALLAW PSL • Lateral support is required at all bearing points and along compression edge at intervals of 24' on -center or closer. • Parallam® PSL beams are made without camber, therefore, in addition to complying with the deflection limits of the applicable building code, other considerations, such as long term deflection under sustained loads (including creep), ponding (positive drainage is essential) and aesthetics, must be evaluated. • Roof members shall either be sloped for drainage or designed to account for load and deflection as specified in the applicable building code. • 31/2' members may be two pieces of 13/4' or a single 3'/2' width beam. 51/4' members may be three pieces 13/4', one piece 13/4' with one piece 31/2', or a single 51/4' width beam. 7' members may be two pieces 13/4' around one piece 31/2% two pieces 31/z", or a single 7' width beam. Seepages 16 and 17 for multiple member beam connections. P-" .♦ MOW TO USE THIS TABLE 1. Determine the total load and live load on the beam or header in pounds per lineal foot (plf). . 2. Locate under SPAN a span that meets or exceeds the required beam or header span (center -to center of bearing). Ie 3. Scan from left to right within the SPAN row until you find a cell where both the maximum TOTAL LOAD and the maximum LIVE LOAD meet or exceed the required loads. In cells where LIVE LOAD is not listed, TOTAL LOAD will control. 4. The dimensions of the beam are shown at the top of the column of the selected cell. 5. If the selected beam is too deep or the MIN. END/INT BEARING length is too long, continue scanning to the right to find a wider beam that may require less depth and less bearing length. KI ULNERAL NOTES • Values shown are the maximum uniform loads in pounds per lineal foot (plf) that can be applied to the beam in addition to its own weight • Tables are based on uniform loads and the most restrictive of simple or continuous spans. • Total load values are limited to deflection of IJZ40. Live load values are based on deflection of U360. Check local code for other deflection criteria. • For deflection limits of L/240 and L/480, multiply live load values by 1.5 and 0.75 respectively. The resulting live load shall not exceed the total load shown. • Table applies to beams used in Service Level 2 conditions (above ground exposed, maximum 28% moisture content). Also see General Assumptions on page 22. 23 L '�." a �* ��:r •t�� r `F�a ..tir�.��1 �Fr`� ��""�"Q+'7 i�-:z:<.i�� `fi. �- '"� r �e''i a -•w'. � +•-.r -` �. v€ u� .i+ F ru, tx 6 B 1 2 1- n 1745 .ri., 1781 1207 Z235 -143 1 1 1 D ai9 _LyT[`k,� 1 • }tl 738 8951 1 IR s ,tD -•-?-ice c 1 �...-g. -.^�990 .1 ui' Ate 1 1 4.0/10.1 1 11 167 272 1 145 Z331 290 466 679 689'Veq 1ti lx r 1> ii` 83 138 276 248 413 76 1 IZ3 245 228 368 1 L �L d� G D -�F 1 tea• E _ 139 136 52 85 f z tutl�° Ds r ULNERAL NOTES • Values shown are the maximum uniform loads in pounds per lineal foot (plf) that can be applied to the beam in addition to its own weight • Tables are based on uniform loads and the most restrictive of simple or continuous spans. • Total load values are limited to deflection of IJZ40. Live load values are based on deflection of U360. Check local code for other deflection criteria. • For deflection limits of L/240 and L/480, multiply live load values by 1.5 and 0.75 respectively. The resulting live load shall not exceed the total load shown. • Table applies to beams used in Service Level 2 conditions (above ground exposed, maximum 28% moisture content). Also see General Assumptions on page 22. 23 08/02/2004 MON 8:32 FAX LAUGEL NandSPENCE (."IV.11, ENGINEERS and SURVEYORS I IxjH I JVI:OAK 140111.F.V.A III) LETTER "IMA CIT V. r.A TIMI DATE -t—so—(A- TO SUBJECT- .. ....... .... ... &K 10 3�Cr G Vk921 t --T Or SIGNED 08/02/2004 MON 8:32 FAX X002/002 I;AlC1E'rHL1V and SPl�}Er� ' ffi PROJECT. �pS$ CIVILENGINEERS and SURVEYORS16 -- 100s I.IVF'.r)AK K0411.F'.V.iQI) (RI90:.11111It � VVIIA CITY. CA 4,%041 S, 0).;7 AA71 ^ -S JOO NO. 18003-.�:--......_....._,.. _ _ -. ��•. _- P. g.3p.O5...z} SHt=ET.OF~. . F0CA,.�Fc,.` r �. - - 7x4: :. 4"Aw WY C.D BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.neAdds PERMIT NO. BP042324 LICENSED CONTRACTORS 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 Issued Date: 08/05/2004 APN: 021-020-010-000 the Business and Professions Code, and my license is in full force and effect. n l/ 1 v Site Address: License Class: License Number: Date: Contractor. Map Index: Description: DEMO SF OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: COOK DEAN permit to construct, alter, improve, demolish, or repair any structure,. prior Y to its issuance, also requires the applicant for such permit to file a PO BOX 35 signed statement that he or she is licensed pursuant to the provisions of TRUKEE, CA the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 96160 she is exempt therefrom and the basis for the alleged exemption. 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).): Y 1, 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 (Sec. 7044, Business and Professions Applicant: WILLIAMS, HUGH Code: The Contractors' State License Law does not apply to an 11031 TORREY PINE RD owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, TRUCKEE, CA provided that such improvements are not intended or offered for 96161 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-587-2275 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 Professions Code. The Contractors' State License Law does Contractor' 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 of the Business and Professions Code \3p /G K Owner:`�'�'^' Date: License #: WORKERS' COMPENSATION DECLARATION I 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 Architect: is issued. Engineer: ❑ 1 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 carrier and policy number are: artier: Total Square Ft: 0 S.F. Valuation: $0.00 Census Code: olicy #: 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' I^y! ` �� compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 17 / yA `1 Aco Applicant: Rf WARNING: Failure to secure workers' compensation coverage is 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 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte Cnunty Cods ?nruor I hereby arm that there is a construction lending agency for the affirm Res o to do work ' iceted ve f r which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) B Date: .8 /s rJ Name: � PERMIT EXPIRES ON: F X V� Address: (Oatal ❑ 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 8 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 that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: C1 Q < < ra r` Signature: Date: X Zc/—o LILI ❑ Owner ❑ Contractor > Agent for Owner 0 Agent for Contractor P-1 OWNER-EUII,DER VERIFICATION - ] Afation Property Owner. An `owner builder" building p=mit has been applied for in your name and bearing your signature. Please complete and retum this infomaah= at pour earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit' will be issued until this vcrfication is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES)3C, NO 13 2. I HAVE A_ HAVE NOT E3 signed an application for a building permit for the proposed work- 3. ork3. I have contracted with the following person (film) to provide the proposed construction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE, NO. 4. I plan to provide portions of this work, but I have bired the following person to coordinate, supervise, and provide the major wodc NAN1L• ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of tine work but I have contrasted (hired) the following persons to provide the work indicateck NAME ADDRESS PHONE TYPE OF WORK SIGNED: NOTE: Tkir Owner Builder Yerifka on is required by Section 19831 and 19832 of the Cahforma Health acid Safely Corte 17s veroTu on must be completed and refta7ted to our office before we are permified to issue the permit Demolition .Permits Asbestos -Notification Statement Date MMO `( AP#L'j l I —Oa 0 - C5 Pursuant to section 19827.5 of the California Health and Safety Code, all demolition permit applicants are required to fill out this form. "19827.5. A demolition permit shall not be issued by any city, county; _city and county; or state and local agency which is authorized to issue demolition permits as to any building or structure. except upon the receipt from the permit applicant of a copy of each written asbestos notification' regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification• if the applicant declares that the notification is not applicable to the scheduled demolition project. The permitting agency may require the applicant to make the declaration in writing, or it may incorporate the applicant's response on the demolition permit, appli- cation." Attached is a copy of my written asbestos notification to the United States Environmental Protection Agency.for the demolition project located at Signature of Applicant. 6R I hereby declare that a written -asbestos notification to the United States Environmental Protection Agency is not applicable to this demolition project. LL_ 1 - S6L Signature of Applicant 2/19/91 s National Pollutant Discharge Elimination -System Water Pollution Prevention Plan (SWPPP) S Stem (NPDES) Phase 11 Construction Storm WaAcknow Acknowledgement LLESS THAN 1 ACRE1 Project Title: By signing below, >y the project owner/owner's agent, certify that I am aware that a construction Water Permit from the project that disturbs 1 acre or more of land requires a Construction responsibility to submit a Notice of Intent State Water Resources Control Board and that it is my rep nd a check for $700.00 made (N.O.I.), a Storm Water Pollution Prevention Plan (SWPPP), rmit if y project P ayable to the State Water Resources Control Board to obtain esus t disturb 1 acre or disturbs 1 acre or more of land. I, further, f�s angor inthisproject ccurate information may result in more of land. I am aware that submitting provided by law. -Te-voEa 'on of grading and/or other permits or other sanctions p Signed: Title: Date: L ' o BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP041070 LICENSED CONTRACTORS 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 Issued Date: APN' 021-020-010-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 823 CHEROKEE CANAL RD GRI Date: Contractor: Map Index: Description: NSF (1040) DECKING (476) RE -BUILT OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: COOK, DEAN permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a PO BOX 35 signed statement that he or she is licensed pursuant to the provisions of TRUKEE, CA the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 96160 she is exempt therefrom and the basis for the alleged exemption. 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 with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant' HUGH WILLIAMS Code: The Contractors' State License Law 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, 11031 TORREY PINE RD. provided that such improvements are not intended or offered for TRUCKEE, CA 96161 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-587-2275 proving that he or she did not build or improve for the purpose of sale.). O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor' 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 aim Exempt under Article of the Business and Professions Code (3 Date: 1L�2_ 0 3— Owner: License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 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 Architect: is issued. Engineer: ❑ 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 carrier and policy number are: Carver: Total Square Ft: 1040 S.F. Valuation: $67,600.00 Census Code: Policy a: r;� 7� 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' f ` (� 1 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Q 6 Date: &h, -1&_n 1 Applicant: ( WARNING: Failure to secure workers' compensation coverage is 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 3706 -of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte Count Code snruor I hereby affirm that there is a construction lending agency for the Resolu ' n to do work indicated a e for hich fees have been paid. performance of the work for %tihich this permit is issued (Sec 3097 Civ.) Name: B U ~ Address: PERMIT EXPIRES ON: (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 & 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 that I am the owner or the duly authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. A— W -- L i bis `— — Print Name: Signature: Date: 0 /r/o `I ❑ Owner 0 Contractor .Agent for Owner ❑ Agent for Contractor School District A.P. Number Property Owner Property Location/Ai Subdivision BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) Building Department No. 10 J risdiction:City County 1610 LOX No. Residential Development F- ILIQ .. . ...................... ...................................... Q Sq Footage t 0 No of Pving Mobile Home Addition/ *Supplemental to (Group R) Units Installation Conversion Permit # *(No foundation Inspection) ............................ 7 ........................................... t .................... Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Commercial/Industrial Q Q Sq. Footage Now Addition (Including Exterior Roofed Areas) Building Department Rip n,41i've Date District-Adentification School District certifies that 41, Gz�nP (Street (City) has complied with the requirements of Resolution No. representing FD square feet. IV (Applicant) (Phone Number) C1sq (State) (Zip Code) by payment of $ 2926 $ FULL MMGATION $ Paid by Check # Remarks: Date Nofts: You may protest the Imposition of it* fen Identified above by submitting a written protest to the District. In compliance with Gova. . isid Code Section 66020(a). wWdn 90 days fin�m-,ths data fen are paid. Failure to submit a timely written pn*M will'prohlbit you from challenging the Imposition of the fees In a" court salon. M, subsequard to the School District Represeritative signing this - Butte County Schools Impact Fee Certification Fom% it* School. District Is clod by the spplieable Local planning Agency that this project Is being i w lew under the California Envirorwriental Quality Act (CEQA) this project mey be subject to additional school too to fully mitigate. Us Impact an the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.As (10/03)dmm Jul_ o6*4 11:33a P.1 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 in 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: YESPO n for a building permit for the NO[ ]. 2. I HAV1i'[x] HAVE NOT[ ' j signan applicatio proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: Com= PHONE: CONTRACTOR'S 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: ADDRESS: CITY: PHONE: CONTRACTOR'S 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 V/SIGNED:►; PROPERTY OWNER: � °�r,�.w► y Sl I1cOr0 ✓� � d L/ SOCIAL SECURITY NUMBER: v DA NOTE: This owner -Builder Verification is required by Section 19831 and 19832 of the -California Health and Safety Code.. This verification must be completed and returned to our office before . we are permitted to issue -the permit. - OVER Jul Cq' 4 11:33a p.2 Dear Property Owner: An application for a building permit has been submitted in your name listing Yourself as the builder of property improvements specified nsible of rerd For your protection, you should be aware that as "owner -builder" you are We rzspo party co on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, You may pmtect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. tion of various trades that you plan to subcontract. You if you plan to do your own work, with the exception should be aware of the following information for your benefit and protection: an persons other than your immediate family, and the work (including 0 If you employ or otherwise engage Y materials and other costs) is $300 or more for the entire project, and such. Persons are not licensedas contractors or subcontractors, then you may be an employer. 0 If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance mss, and unemployment compensation contributions. 0 There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. 0 For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Rosiness Administration). For more specific information about your obligations under State Law, contact the Depart�nenf of Benefit Payments and the Division of Industrial Accidents.are allowed m If the stmctum is intended for sale, property owners who are not licensed contractors perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. of unlicensed A 5�equent practice sed persons professing to be contractors is to secure an-"orvtterbuilde�' building permit, erraneouy implying that the property owner is providing his or her own labor and material to be signed by property owners unless they are performing their ownpersonally. Building permits are not required work personally.the Contractors State License be obtained b Information about licensed contractors may Y contracting Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until fire verification is returned. Ivtichail C. Vi662. C.B.O. Manager, Building Inspection NATE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code - OVER MMWO Ybrx4ri-,9 Ar .:1 JY. "d A 00-4s,AlONY. PIA h5 I--ZIN tub ujr uwf q ydbuuje ocl 04 r4 :, . '1z r."14 � IWA-I'N 1, DIT �,Moa Vil 71 Anw-v frao 55 ni "out tow., bziam,�rjki *td • n, -ne'l m', b.,Xtbuinji L zovpui 0; brm "Wth?,a f D' TWMIGI� 2 40', leii? 2?:Aw-W3 aucAuw 1q) r,' -j Z)Ma uo! *b "al nuil'amr.0-ai in. '--UNts all bg.jf,,�f? wx,� fattfs t,�iIamztj y—up, '1 0 ,Ulao :id; le. vicra Ofttf? -'adw bao On-hvim—, w-,Clqfw, !",j c-ni -tnal aufRt ".."Osrunwd'up 20 "a7"I'mm WADA hatu"wa, Oily 14,t:w bix. wfoz pitunl3al b -as lua yma "Ob. or; ortkq-1; Ivy I& U'U", --.xU?oq-, mom X.,. .(j)f In -:N litvfk",inimh�A. Wistaubat a0a ing to -tafvnrumrha;"5,1w,)V v 4rwo -Li-fl! 10 f:-Voftq odd Iwo -1A nvio xv), m'm b: -Yaa.ljf A;Ods milo.;4-griolid rm'-ww .1"Xia VA 05(Zol m 10 viiaulm,'Zim- ivow fri bUD9 tvb anov.-n wb r.p 'flaiiVAII-W z�Zr!qj$ ym zrw%w; n!� noy "u -t L" `gci)x)iir1`sv' W41- Ri • If wa -��Nzf V6163 bpct "'11WH Al .13%11 ek 1 ui. ti.1i ;RECORDING R1:OMT60 4BY: MMD VALLEY 11TLE RECORDING REQUESTED BY First American Title Company AND WHEN RECORDED MAIL TO: Dean F. Cook and Sharon ]. Cook p. 0. Box 35 Truckee, CA 96160 2003-0061 1 89 Recorded Official Records County Of BUTTE CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 09:00AM 18 -Nov -2003 I REC FEE 16.00 1 TAX 160.05 1 MONUMEN 10.00 I I I I I Alyce I Page 1 of 4 Space Above This Line for Recorder's Use Only File No,: 2901-1214530 (S]) A.P.N.: 021-020-010-000 The undersigned Grantor(s) Declare(s): CgCUMENTARY TItANSPEP. TAX $ 160 . 05 L SURVEY MONUMENT FEE $ computed on the consideration or Full value of property conveyed, OR , C x computed on the consideration or fvll value less value of liens and/or encumbrances remaining at time of sale,rJ x unincorporated area; [ ] City of, and CORPORATION GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, LSPI Exchange Corp., a Nevada Corporation organized under the laws of the State of Nevada hereby GRANTS to Dean F. Cook and Sharon J. Cook, husband ndd wife as community property (,I V1 LAVH V1C6 V Po KAieel the following described property in I+je-Eity'Qf, County of Butte, State of California: FOR DESCRIPTION OF THE PREMISES SEE EXHIBIT "A" ATTACHED HER Dated: 11 U2 2003 LSPI Exchange Corp., a Nevada Corporation BV Ro I Stone, President Mali Tax Statements To: SAME AS ABOVE ,v 021-020-010-000 STATE OF -)SS c��• )SS COUNTY OF ) On v Grant Deed - continued File No.:2901-1214530 (S]) Date: 11/12/2003 before personally appeared me, personally known to me (er to be the person') whose name(d) is/afe-subscribed to the within Instrument and acknowledged to me that-he/shelt4ey executed the same in 4fher/thelr- uthorized capacity(i s , and that by -h s/her/ter signature ks) on the instrument the persons), or the entity upon behalf of which. the personv acted, executed the instrument. WITNESS my hand and official seal. Signature My Commission Expires:., � �eA . (�F5 .y This area for official notarial seal ., Ai.,C;sA F COATS Commi_:sion.41371.032 Z Notr.ry P;,b!ic - C0'0Mla San'_a Clara County , Amy 24, 2005 �l Dean & Sharon Cook PO Box 35 Truckee, CA 96160 Phone (530) 587-7536 April 9, 2004 To Whom It May Concern: RE: 823 CHEROKEE CANAL RD, BUTTE COUNTY, GRIDLEY, CA AP# 021-020-010-00 Hugh Williams is authorized to act on our behalf regarding the above- mentioned property as our agent. Respectfully submitted, Dean Cook Sharon Coo M j Dean & Sharon Cook PO Bog 35 Truckee, CA 96160 Phone (530) 587-7536 April 9, 2004 To Whom It May Concern: RE: 823 CHEROKEE CANAL RD, BUTTE COUNTY, GRIDLEY, CA AP# 021-020-010-00 As owners of the above-mentioned property, we hereby request that the Plan Check be completed "in house." Respectfully submitted, Dean Cook Sharon Cook k l . BUTTE COUNTY DEPARTMENT OF DEVELOPMENT BUILDING PERMIT APPLICAI 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (53 OFFICE #: (530) 538-7541 PERMIT NO. BP1 lD 4 DATE 7-7 � -�!�L IAPN:02 /_6 D ZONING: AU 7 OWNER'S LAST NAM9-- CD© OWNER'S FIRST NAME: HO E PHONE S91r> STREET ADDRESS: I O d S FAX CITY, ZIP: 'fgAC'VeA- 06160 E-MAIL• SITE ADDRESS: Sa 3 CA, r0 /eeG CITY, ZIP-.&i(-1`a/i . /U.L C - �-i D AS - NEAREST CROSS STREET: TRACT/LOT P APPLICANT NAME: dXk-dI .4 JPPHONE 5�17 -z2 7s STREET ADDRESS: � � FAX: CITY, ZIP: / " /. E-MAIL' CONTRACTOR NAME: PHONE: STREET ADDRESS: FAX CITY, ZIP: E-MAIL LICENSE NUMBER LICENSE TYPE: ARCHITECT/ENGINEER NAME: ,:-y L��tw �,�,, `,voE�svN c1 PHONE: STREET ADDRESS: FAX CITY, ZIP: LICENSE NUMBER E-MAIL: DESCRIPTION OR SjGOPE OF WORK: i% , Co ev s4 it At O Ol AM IL ❑ Structure Built wi out permits it ILA ❑ Proposed Change of Occupancy (note previous use)vxv GGD74W - Al a 7 sC EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of ap In action on an application after expiration, a new application, plans and fees will be re uired. er t REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request mu the expiration of the permit and no construction work has been done. Filing fees, plan check fees f checked and other department costs are not refundable. pr' o pl For office use only: Notes:44t Application Received by: Date:Receipt number:Amount Received: Ira (� 5 (n— da 0 -j sli U—tcr �nnlir�tinn a..d_(Ih,` I ..-.... +... 4 ,t' .. w ... Y . 1 r r _ P' .,.4.. i 1. •rM1~ 7 y _ _ , . _ - i COUNTY OF BUTTE -DEPARTMENT O' LOPMENT SE VICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 r PERMIT APPLICATION DATA SHEET OWNER: A S SOR PARCEL NUMB �v Proposed Building Use: Counter Technician: JI& Date: �0required in order to apply for a permit. All boxes MUST be checked OR marked NA in prder to apply. 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. 1 ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. 4. Engineered truss details and layouts in duplicate. No faxes! 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. 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. 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑13. Detached Accessory Building Form filled out by the owner 14. Hazardous Material Form Sanitation and site plan approval from the Environmental Health Department in ❑ Chic dr&,lle, as applicable. 0 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ Lj�l! 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by .. Q' IC �j 19. Soils Report and/or Engineered Foundation required ........................................... ......... � 20. Erosion Control Plan Required........................................................................ ;1 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ , a 22. City of Chico Plumbing permit........................................................................ �r"T)ft 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. ❑ 24. Planning approval (A) Use: E� �B)Parking: (C) Parcel Check: -'3-- 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ` ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... f32. Letter of Signature authorization ...................................... :............................. 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ -35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... 37. PMrant Deed ❑ M.H. Tit tem of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: d�PE��/Y ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant:I U(.` C 1. Index permitplicatio f apor the above ite items required 4o=ntrac'tor.�ddesigner, igner, owner, was advised of the ow er, s advised of the Plans reviewed by: Date:_ Structural reviewed by: Date:. Note transfer by: Date:. Date: d: Plan Check Letter data by one, ❑ mail, ❑ counter, by Date: d tb phone, ❑ mail, ❑ count r, ate: tans approved by: Date O uctural approved by: Date: Yellow: Building Division TO: - Building Department FROM: Environmental Health 441, use ONLY Am Plan Anechad Raw Mn Annefted Sam to 8.0 - SUBJECT: Sanitation Clearance LocatIon AP# Owner Water Sugp� Public Private Will Plan Approved for: Sewage Disposal Y: f� Lj r"A Y-) Clearance for dwelling*. Other Hold final for: Final clearance O.K. for: NOTE: U hIN WR� Date Environmental Health Specialist ,a. OWNER COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 � S HEDULE OF RECEIPT OF FEES PR P OSED BUILDING USE f J_Jt— 1. BUILDING PERMIT FEES --- Balance Due ..................... --- Additional Fees Due........... $ --- Revised Plan Checking Fee.... $ 2. SCHOOL DISTRICT FEES (paid at School District Office) (form available after Nan Check) 3. SHERIFF FEES (paid at Building Division) A.P. # DATE rL' RECEIPT # DATE REC. Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... X $0.03 = $ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit)..... X = $ # Units Amt. Commercial (Sq. Ftg.).... X = $ Sq. Ftg. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $89.00 (paid at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid. at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone Zone X =$ # Units Amt. Commercial (sq. ftg.) ......... IX = $ Sq. Ftg. Amt. 10. OTHER A/® At time of permit application, I was advised the abo fees are required to be paid prior to issuance of the permit. These fees may be changed during the checking process. APPLICANT �d..t u W im" DATE y \\ /16 ho � Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) PERMIT NUMBER- B 2421-73B,E P E fi PERMIT EXPIRES 7-10-7 SOWNER Dr. E. A. Steadman owner CONTR: LOCATION (A.P. 21-02-10 2 mi. off s1s Gridley-Colusa Hwy. along Cherokee Canal, Gridley s COUNTY OF BUTTE Department of Public Works BUILDING .NSP.,EGTION RECORD Zoning Setback Forms Foundation Piers & Girders Fireplace Rgh. Plumbing Bond Beam Lath & Plaster i Rein. Steel Gas Piping & Test Found. Vents I Framing —/0 7 Plmg. Topout Rough Elec. Wtr. Htr. Furnace Kitchen Vent Firewall Garage Vents Sanitation & Water ELECTRIC S BUILDING Temporary _ �— L —��{ emporary Cert: of Occup. Final %P% — % 3 Final Final /,o DATE REMARKS OR CORRECTIONS 101, COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORK 7 County Center Drive — Oroville, California 9596511 Telephon.:: 534-441 M/r� APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. x Signature of P ermitee A nt Receipt No. /0 / 2 3 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OV)PUBLIC WORKS BVC Date %"'ice Building permif e_,p—M Dafe BUILDING Owner -SQ. FT. OCC. BUILDING VALUATION Mailing Address �� G cJ Tel hone No. .$ 12' Fireplace Contractor S 3 —1�;L�of Total Valuation Mailing Address �-�- - - Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ (j( Building Address PLUMBING No.1 @ I FEE PERMIT FILING FEE $2.00 C J d Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 E' Each gas water heater or vent 1.50 A. P. No. j--- l oning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W.C. I Sanitation Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Ma P 60' R/W Im provements Lawn sprinkler system 2.00 Bldg.Plans Recd Parcel A pproval Plans Approval Permit Fee $ $ NEW ADDITION ❑UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter 3 Additional meter h 1.00 Sub -panel (12 or less) (more than l2) Single Family ❑ Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 (/ Water Heater or Space Heater 1.00 LigLt fixtures bald l0 - Re s., sw i tcfhes & fix ob tIets S 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. FanorF.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 Temp. Power Pole 5.00 License No. Classification Misc. wiring I am exempt from the Contractors License Laws of the State of California. Permit Fee $ 06 $ ;2- 1 C, WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. x Signature of P ermitee A nt Receipt No. /0 / 2 3 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OV)PUBLIC WORKS BVC Date %"'ice Building permif e_,p—M Dafe | La i NI LL Nt- i NOTES -,e-1 EA,� V } i PERMIT NO. i i RESIDENTIAL U21-020=0`1 o s— COOK, DEAN 04=1070 823 C CONT: OWNER .CANAL RDGR RECONSTRUCT RECONSTRUCT SF jl DETACH FOR SERVING UTILITY AddressGG ` `°4 G 4fA�ovQe_ GAS Meter By Date ELECTRIC' Meter By Date �� t�.✓1P4 J -t. Qj �A.1 ; SPECIAL CONDITIONS CHECKED BY RA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPY A Address (!?2-2;. } GAS I Meter By Date I ELECTRIC �7 Meter By Date / s 7777 JOB FINALED (Date) o O Signature , • � yi i t� t i RESIDENTIAL U21-020=0`1 o s— COOK, DEAN 04=1070 823 C CONT: OWNER .CANAL RDGR RECONSTRUCT RECONSTRUCT SF jl DETACH FOR SERVING UTILITY AddressGG ` `°4 G 4fA�ovQe_ GAS Meter By Date ELECTRIC' Meter By Date �� t�.✓1P4 J -t. Qj �A.1 ; SPECIAL CONDITIONS CHECKED BY RA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPY A Address (!?2-2;. } GAS I Meter By Date I ELECTRIC �7 Meter By Date / s 7777 JOB FINALED (Date) o O Signature , 4=OK 0 = Not OK =Not. Applic = Not Ready able MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Sols; Special MH Support Sketch 3. Sewer, Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L'ft. / P Nat or/ /" L "ft1 P LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances S. Drain; MH Test -Fall -Flex Connector 6. Water, MH Test-Regulator-Connectoe 7. Water and Sewer Connected -C/O to Grade -HD Approval ,8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert of Occupancy Date Card B-1 - Date Card B-1 Date 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 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-Tnisses 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-Panelboards-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 = OK = Not OK = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date UNDEf�FLOOR (Plans) OK except #'s 1 ing-Setbacks-Easements-Flood- lope 2AooFtg., Main; Soils-Elec. Gmd.-/ UP Ftg. Depth 3. Ft ., Garage; Soils-Steel-Elec. Gmd.-/ /" Ftg. Depth Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab. Steel -Wrapped v . D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 0. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Elec is Underground 13. gums & Ducts; Clearance -Material -Support -Ins. 1,V Access & 16. Insulation Date 6 - QO-Card B-1 Date Card B-1 Date 4-4 Card B-1 Date Card B-1 Date PLU BING (Permit) OK except #'s AWMater Htr.; Vent -Access -Combustion Air Baffle 1 er Pipe; Test & Anchor -Nail Protection W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower. Second Floor -Tub Access Gas Pipe; Sixe & Anchors 23. Fire Sprinkler, Test Date Card B-14 Date Card B-1 Date % Card B- Date Card B-1 Date ELEC CAL (Permit) .OK except #'s 2t.-FiLftre & Transformer Clearance -Ins. Protection 2 Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Plomex Installed Close to Edge of Studs & C.J. 2V Equip. Ground made up w/Mech Fasteners -Bond Fas& VOer 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Siz23 /ga kw& AI -AC. Wire Size/ /ga Cu or AI 31. Range Circle/ Tga Cu or AI -Oven Circ. / /ga Cu or AI Insulated Neutral 0 Yes 0 No '32--Service-Riser Conductors & Ground Main Disconnect quip. Clearances Panels-Motors-Mech. Equip. ,clothes Closet Light -Shower Light -Spa Light Smoke Detector Date / 9C Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36 C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platt rm if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAM G (Permit) OK except #'s 41 Sills Proper Materials & Anchors 42 alis Studs-Naiiing Spacing & Braces -Plates -Sound 43 earing 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 FRWNG (Continued) 411. Hangers -Post Caps -Anchors -Connectors g: Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting: Rtng. 4 . Fireplace Ties or ype Fireplace Throat Clearance 50. Attic Access; Size x Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht & Dimensions ,---qe-4&aqe Fire Protection Framino-RC Channel 5}rExt. Doors -One 3' -Check Garage 3rd Storv. 2 Exits 4' Stairs; Width -Headroom -Rise- Run- Landing -Fire Protection 5 �ywood on Roof Overhang -Attic Vents -Rafter Outriggers Siding-Nailinq Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access 59. Glazing ea -Glass Prot tion -Skylights -Plastic 60. Sheat -Walls; Nailing olts 61. Brace Interior/Exterior Wall Panels 62. Date /.I Z J -ECard B-1 ! Date 6 Card B-1 Date : f JCard B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext, Steps -Door & Sidelight Protech -Landings rndRe Detector , ,@S/Furna Vents -clearance -Corn b, Air-Connecfor- Ir arage; Above Floor-Ducts-Mech. Protection .68' G. Bath Fixtures & Tub A6cess-Spa c. Trim & Subpanel, Breaker Sizes & labels Stairs & Rails 7, Fireplace or Stove, Clearance -Hearth Elec-Outlets at Wood Panel. Int. & Ext. Clearance 74' Elec. Outlets & Receptacles at Kit. Counter 75. Gar ge Fire Door, Swing -Landing -Closure 7 'Duct in Garage -Damper Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in C32rgge; Above Floor -Meth. Protection 74,-161b.; Elec. & Mech. Equip. Listed for Location 7 . Elec. Receptacles in Garage (F.El.)-Romex Protection u4etion-Foam-Looked in Attic uard Rails & Deck Construction -Post Caps 0 Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes 83. Following InstldJDdve 0 Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 No 84. St co Brown -Finish A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings Well, Disconnect, Electrical, Plumbing 88!Exte,9! 'EIec. Trim, G.F.I. Receptacle -Underground 8L,K' ation Throughout House rre s from Previous Inspections WAs9 est -Meters Taqqed, Gas -Electric Water & Sewer Connected -C/O to Grade -HD Approval Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date 9 Card B-1 Date Card B-1 Date ate Card B-1 -Date M 7 p Card B-1 Date Card B-1 Comments at Final: •. OK SOLID FUEL -BURNING APPLIANCES 211-39 Table 8.6(b) Reductiori-of Appliance Clearance with Specified Forms of Protection �.. �.� J Clearance reduction system applied Maximum allowable reduction,in,N When the required clearance with to and covering all combustible sur- clearance (percent) (�--! —'� no protection is 36 in., the clear - faces within the distance specified as " -` – ances below are the minimum required clearance with no protection allowable clearance. For other 4ee 8-6.1). required clearances with no pro- tection, calculate minimum -allow- able clearance from maximum allowable reduction 9'10 As Wall As Ceiling _ F 'AAs Wall As Ceiling Protector Protector • Protector - Protector (inJmm) (inJmm) (a) 31/2 in. (90 mm) thick masonry tw..'33rIo – 24/610 – )wall without ventilated air spacel "�i (b) 1/2 in. (13 mm) thick noncom- 50% 33% 18/457 24/610 bustible insulation board over 1 in. (25 mm) glass fiber or mineral wool batts without ventilated air space , (c) 0.024 in. (0.61 mm) (24 gage) 66% 5017c ' 12/305 18/457 sheet metal over 1 in. (25 mm) glass fiber or mineral wool bate rein- forced with wire, or equivalent, on rear face with ventilated air space (d) 31/2 in. (90 trim) thick masonry 66% – 12/305 – wall with ventilated air space (e) 0.024 in. (0.61 mm) (24 gage) 66% �— 50% 12/305 18/457 sheet metal with ventilated air space (f) 1/2 in. (13 mm) thick noncombus- 66% 50% 12/305 18/457 tible insulation board with venti- lated air space. (g) 0.024 in. (0.61 mm) (24 gage) 66% i 18/457 sheet metal with ventilated air space over 0.024 in. (0.61 mm) (24 gage) sheet metal with ventilated air space (h) I in. (25 mm) glass fiber or min- 66% 50% 12/305 18/457 eral wool batts sandwiched between two sheets 0.024 in. (0.61 mm) (24 gage) sheet metal with ventilated air space 'Spacers and ties shall be of noncombustible material. No spacers or ties shall be used directly behind appliance or conductor. 'With all clearance reduction systems using a ventilated air space jadequate air circulation shall be provided as described in 8-6.2.4. There shall be at least a I in. (25 mm) between the clearance reduction system and combustible, walls and ceilings for clearance reduction systems using a ventilated air space. 'Mineral wool batts (blanket or board) shall have a minmum density of 8 l per ft' (128.7 kg/m') and have a minimum melting.point of 15007 (816%). 'Insulation material used as pan of clearance reduction system shall have a thermal conductivity of 1.0 (Btu,-in.)/sq ft -hr -°F) or less. Insulation board shall be formed of noncombustible material. ' If a single wall connector passes through a masonry wall used as a wall shield, there shall be at least 1h, in. (13 mm) of open, ventilated air space between the connector and the masonry. 'There shall be at least I in. (25 mm) between the appliance and the protector. In no case shall the clearance between the appliance and the wall surface be reduced below that allowed in the table. 'Clearances in front of the loading door and/or ash removal door of the appliance shall not be reduced from those in Section 9 - 'All clearances and thicknesses are minimums; larger clearances and thicknesses are acceptable. '1'o calculate the minimum allowable clearance, the following formula may be used: C = C", x (I — R/100). C , is the minimum allowable clearance. is the required clearance with no protection, and R is the maximum allowance reduction in clearance. "'Refer to Figures 8.60q and 8.6(g) for other reduced clearances using materials (a) through (h): 1992•Edition 14*40? e,4 Cwt; 6 f -V 3. EMY Ex, C F, I 41. Ff-WR c"v � J�- nns n%sums al R-zazwm r".:^'`''...;.:.••- #,qA Un - 'a 1, �� -I-mv �,5 ama-., —ma s" o, Lot Four"-'a'ap nth A hm - go, �� x Z w , L :n- PC qw. -r-,T, -,--zc�l mt� 43 4 4 -L(I FIN - ;n, LAMIRO, kk tall 'If qad-, a g ql, cz, c I 'Man;ml DI�Q V% Go �'ilx.z c-aw-n-A FEMA FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND r?�,� �I Kb�04 INSTRUCTIONS j NATIONAL FLOOD INSURANCE PROGRAM . ELEVATION CERTIFICATE PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 81-31 The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE: Please do not send your completed form to the above address. PURPOSE OF THE ELEVATION CERTIFICATE The Elevation Certificate is an .important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR F). The Elevation Certificate is required in order to properly rate post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), for flood insurance.Zones AI -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, and AR/AO. The Elevation Certificate isnot required for pre -FIRM buildings unless the building is being rated under the optional post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a. community, the NFIP requires the community to adopt a floodplain management ordinance that specifies minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings and maintqtin a record of such information. The Elevation Certificate provides a way for a community to comply with this requirement. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for lending- institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to supporta LOMA or LOMR-F request. This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofmg of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non- residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1- 7. O.M.B. No. 3067-0077 Expires December 31, 200; SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME t.e?W i!!�� Policy Number BUILDING STREQT ADDRESS (Includ i Apt., Unit, Suite, and/or Bid 1. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY `/--��- P� STATE ZIP COO Cc PROPERTY DESCRIPTION (L and Block Numbers, Tax Parcel Number, Legal Description, etc.) - �t-- 2-1 P& 2 P Ica BUILDING USE (e.g.. Res pential, Non-residential Addltlon, ccessory, etc. Use a Comments area, if necessary.) HW-flrn kir-, 1 LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: or �.� 1 W (� NAD 1927 u NAD 1983 SOURCE: u GPS Rte): Lill l� 3� y� �� (_J USGS Quad Map Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION (1UNITY NAME COMMUNITYUMBER .COU . B3. S ��Bt PCOMJ B4. MAP AND PANEL NUMBER 85. SUFFIX B6. FIRM INDEX DATE�� B7. FIRM PANEL Be. FLOOD 69. BASE FLOOD ELEVATIONS) JANE � EFF lVE/REVISED DATE a� � 14a � � ZONE(S) flooding) (Zone AO. eSthOe- 4o �.. 810 Indicate the f the B . source o ase Flood Elevation (BFE) data or base flood depth entered in B9. J_J FIS Profile J._J FIRM u Community Determined Other (Describe): COIVNIVKy16 544 g' f A�e'ya 611. Indicate the elevation datum used for the BFE in 139: W NGVD 1929 ) NAVD 1988 [-1 Other (Describe); B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? "Yes tXJ No Designation Date: SECTION C.- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings* J. _Building Under Construction' ( Finished Construction •A new Elevation Certificate ndl be required when construction of the building is complete. C2. Building Diagram Number lj (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3: Elevations - Zones Al A30, AE, AH, A (with BFE), VE, VIIV30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in ftem C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum 0610 zq Conversionicomments Elevation reference mark UseC!22 % I -i- Does the elevaf n�erencmerk used appear on the FIRM?_J Yes JyCJ No ❑ a) Top of bottom floor (including basement or enclosure) ft ( )❑ b) Top of next higher floor l�j h OFES ❑ c) Bottom of lowest horizontal structural member (V zones only) �. — ft.( ) R L, A N !� ❑ d) Attached garage (top of slab)- . - ft.( ) E00 o -❑ e) Lowest elevation of machine and/or W Q 2 machinery equipment servicing the building (Describe in a Comments area.) fL () E a 18003 a ❑ f) Lowest adjacent (finished) grade (LAG) Jr� . 5 ft.( I) z' * p tri 07 ❑ g) Highest adjacent (finished) grade (HAG),- 2 ft,(m) I % ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NIX 0 _ � CAMEo ❑ i) Total area of all permanent openings (flood vents) in C3.h _uo__ sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFlER'S NAME A ,/1 LICENSE NUMBER .(2 COMPANY NAME ,�t ,. SOU � ADDRESS 0�� l U (a. Cl�iv � tt 1-'► S `11L. ZI*2i4ct ) FEMA Form 81-31, 144ry 2003 —�7 See reverse side for continuation. (011- IIob Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING U2EET-ADDRE5-S (Ictcluding Apt, Unit, Suite, a dfor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CIN LSTATE_.-, _ ZIP CODE I Cmmnanv NAI' Numher SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) - Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcbmpany, and (3) building owner. nr.a muTn 1 { �� e t` --U am t) o T s -1+Vs--r h Ei' E-1 019214 11FD FLC* t2..>, L ' --Cj,Oj'Z �'i to i .33 +• I ((,+ , 5�/ `Q � �'"iT 1&o'G / Vel Check here if attachments SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through. E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. Building Diagram Number 25 (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2: The top of the bottom floor (including basement or enclosure) of the building is i__m ft -o �_ai ln. (e MI above or t_) below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the ne)d higher floor or elevated floor (elevation b) of the building is L I ft. (m) t-4—lin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. E4. The top of the platform of machinery andfor equipment servicing the building is ft. Oft—t7.1 in. (, ) above or L_1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no flood depth number Is available, is the top of the bottom floor elevated In accordance with the community's floodplain management ordinance? 1_1 Yes I_1 No U Unknown The local official must certify this information in Section G SECTION.F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B.'C (Items C3.h and C3.i only), and.E for Zone A (without a FEMA4ssued or community4ssued BFE) or Zone AO must sign here. The statements In Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME r""'r%C" CITY STATE ZIP CODE Q/vrw 1 vrtc DATE TELEPHONE COMMENTS - 1-1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized bylaw or ordnance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable Rem(s) and sign below. G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who Is authorized by state or local law to certify elevation Information. (Indicate the source and date of the elevation data in the Comments area below.) G2.-1__1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. L_J The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1_1 New Construction L -I Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ft. (m) Datum: 409. BFE or (in Zone AO) depth of flooding at the building site is: _ fL (m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE blUNA I uKt DATE k:UMMtN I S I I Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES `r 7 County Center Drive • Oroville, CA • (530) 538-7541 _ CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional t explanation, please co tact the Building Inspector as indicated below. _ T �S 1 LD 's Date Inspector. L REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 COUNTY OF BUTTE ` = ' BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE oy-/a7o OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of ywork is completed. If you have any questions pertaining to this matter, or need additional .explanation, please contact the Building Inspector as indicated below. y' 4,. Z 'J �r ti k 7 r. cis :�- Date �l/ /J Inspector REV 4/05 Phone # S3 S�3 FOR RE -INSPECTION CALL: 538:7636.'OR 891-2834 wb- '•fir".;i.-.,.rr.., .}5�� ":j'' FISH 4 GAME MONUMENT AREA IN BUTTE SINK, FLAT NOT FOUND 241 ' :•j AND VEGETATED w/ TYPIGAL BUTTE 51 NK VEGETATION GOMPOUND .•t .. r. AREA IEX DRI VE C. AI ' I 2 Y •� ri '' " C1rn mu 1w - I t}ty y�ro 91: O EX, SEPTIG TANK . + N m I LEAGH FIELD m APN: 21-020-010 s' j 40`-* AGRES' ~ corn. L� nvironmentol ' \ - m I EX. WELL �1• EX; GAIN ®ate Istj �� Ji�n�slytC I ti oti • I 1 a00 + EXIST. PROPERTY LINE (TYP.) 1 1318.7' � 57jAPPROVED FOUND F15H 4 Butte County EXIST, FENCE GAME MONUMENT- 9, WITNE55 P05T cnv'ronmental Health ae FOUND FISH � GAME MONUMENT & WITNE55 P05T J Z V LU w 0 LU 2 X LU h� FOUND FISH 4 GAME MONUMENT $ WITNE55 POST 00 w v d W SITE PLAN e■■ 0 w w go X " 10-1s-03 sw. 1.-W RLH 03-1169 1 � xr a