HomeMy WebLinkAbout021-131-002FIRE DAM G REPORT
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-ETHEL DYLLARD ��//�0/��
S/S Little Ave, 500 E of Lewis ILLARD, Ethel D. 336B,
Oak, Gridley 4 — 2696P
Permit#6747-78B(reroof) SF I j
21-1i 31=02 - �•z 852=89B . 640„'._.east__of..Lewis..0a$ .on Little ve., ridl '
co R: Joe Wright, Rt. 2, '•Box �54A,'Gridley
POLK,V�James' ct (new, single mnly) -
645 Little Avenue, :,Gridley-
.(new
Gridley(new carport) , r'` /- • - �'
FINALED:
021-1317002 PERMIT#95'0683'”`
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SCHRIEKEN, -,Richard -
645 'Little Ave,, Gridley,,g/y�.
- Conv Carport to .Garage,.& Relockte
Gas Meter/SF
,
021-131-002
VILLANUEVA, AGUST
645 LITTLE AVE, GRID
Cont: WHEELER CONS'
FIRE DAMAGE
021-131-002 04-3169
V1LI_ANUEVA, AGUST)N • `
645 LITTLE AVE,'GRIDLEY40�1101.
CONT:,MIKE HURST
NEW ELECTRIC SERVICE.
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P 21-13 -2
-ETHEL DYLLARD ��//�0/��
S/S Little Ave, 500 E of Lewis ILLARD, Ethel D. 336B,
Oak, Gridley 4 — 2696P
Permit#6747-78B(reroof) SF I j
21-1i 31=02 - �•z 852=89B . 640„'._.east__of..Lewis..0a$ .on Little ve., ridl '
co R: Joe Wright, Rt. 2, '•Box �54A,'Gridley
POLK,V�James' ct (new, single mnly) -
645 Little Avenue, :,Gridley-
.(new
Gridley(new carport) , r'` /- • - �'
FINALED:
021-1317002 PERMIT#95'0683'”`
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SCHRIEKEN, -,Richard -
645 'Little Ave,, Gridley,,g/y�.
- Conv Carport to .Garage,.& Relockte
Gas Meter/SF
,
021-131-002
VILLANUEVA, AGUST
645 LITTLE AVE, GRID
Cont: WHEELER CONS'
FIRE DAMAGE
021-131-002 04-3169
V1LI_ANUEVA, AGUST)N • `
645 LITTLE AVE,'GRIDLEY40�1101.
CONT:,MIKE HURST
NEW ELECTRIC SERVICE.
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P 21-13 -2
-ETHEL DYLLARD ��//�0/��
S/S Little Ave, 500 E of Lewis ILLARD, Ethel D. 336B,
Oak, Gridley 4 — 2696P
Permit#6747-78B(reroof) SF I j
21-1i 31=02 - �•z 852=89B . 640„'._.east__of..Lewis..0a$ .on Little ve., ridl '
co R: Joe Wright, Rt. 2, '•Box �54A,'Gridley
POLK,V�James' ct (new, single mnly) -
645 Little Avenue, :,Gridley-
.(new
Gridley(new carport) , r'` /- • - �'
FINALED:
021-1317002 PERMIT#95'0683'”`
z
SCHRIEKEN, -,Richard -
645 'Little Ave,, Gridley,,g/y�.
- Conv Carport to .Garage,.& Relockte
Gas Meter/SF
,
021-131-002
VILLANUEVA, AGUST
645 LITTLE AVE, GRID
Cont: WHEELER CONS'
FIRE DAMAGE
021-131-002 04-3169
V1LI_ANUEVA, AGUST)N • `
645 LITTLE AVE,'GRIDLEY40�1101.
CONT:,MIKE HURST
NEW ELECTRIC SERVICE.
S. O
NOTES
v
RESIDENTIAL
PERMIT NO.(YkAr (A_r�(QDIS
V I to ruul'x�_i ASS
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Fye dGVncx.c. vqrlirsLUCAD U
1 SPECIAL CONDITIONS 11
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) Ili r
,Signature ��y
CHECKED
BY
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RESIDENTIAL
PERMIT NO.(YkAr (A_r�(QDIS
V I to ruul'x�_i ASS
Cid
Fye dGVncx.c. vqrlirsLUCAD U
1 SPECIAL CONDITIONS 11
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) Ili r
,Signature ��y
CHECKED
BY
J=OK
0 = Not OK
. = Not Ready NotApplicable MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Zoning Requirements -Setbacks -Easements
1.
Zoning Requirements -Setbacks -Easements
3.
2.
Soils; Special MH Support Sketch
Wood Awn.; Posts-Beams-Rftrs-Connectors
3.
Sewer; Location -Test -Fall -C/O -Concrete
5.
4.
Water; Location -Test -Easement Needed (Sketch)
Roof; Shthg-Roofing
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
Ext.; Steps -Doors -Landings
6.
Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or/ /" L "ft./ P LPG
Braced Wall Panels
7.
Well Clearance & Disconnect
8.
Utility Clearance
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
Date
1.
Card B-1 Date Card B-1
Date
2.
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
1.
Zoning Requirements -Setbacks -Easements
Elec.; Receptacles and Lighting, Distance-GFI
2.
Footings; Size -Spacing -Marriage Line
Elec.; Pool Lighting; 15 Volts-GFI
3.
Gas; MH Test -Demand -Valve -Connector
Elec.; Enclosures; Conduit Entries -Terminals -Listed
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
5.
Drain; MH Test -Fall -Flex Connector
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panelboards-Ins. to Main Conduit
6.
Water; MH Test -Regulator -Connector
Health Department Approval
7.
Water and Sewer Connected -C/O to Grade -HD Approval
Plumb.; Cir. Test -Water Supply Test
8.
Gas and Electricity Tagged
Light Niche
9.
Tie Downs -Type -Installation Cert.
Enclosure; Fencing -Alarms
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
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-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- 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
J=OK
0 = Not
- =NotAApplicable RESIDENTIAL (Single & Duplex)
p
. = Not Ready
Date UNDERFLOOR (Plans) OK except #'s
1.
Zoning -Setbacks -Easements -Flood -Slope
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
6a.
Hold Downs and Special Anchors
7.
Slab, Steel -Wrapped
8.
Piers -Fireplace Ftg.-Steel
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11.
Water Pipe; Test -Anchors -Regulator -Service Test
12.
Electric Underground
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15.
Access & Ventilation
16.
Insulation
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55.
Date
56.
Card B-1 Date Card B-1
Date
Siding -Nailing Veneer
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Glazing Area -Glass Protection -Skylights -Plastic
17.
Water Htr.; Vent -Access -Combustion Air Baffle
61.
18.
Water Pipe; Test & Anchor -Nail Protection
Insulation -Walls -Ceilings
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
Date
20.
Shower Pan; Test, First Floor -Tub Access
Card B-1 Date Card B-1
21.
Test Tub & Shower, Second Floor -Tub Access
Ext. Steps -Door & Sidelight Protection -Landings
22.
Gas Pipe; Sixe & Anchors
66.
23.
Fire Sprinkler; Test
Bedroom Exiting
68.
G.F.I. & Bath Fixtures & Tub Access -Spa
Date
Elec. Trim & Subpanel, Breaker Sizes & Labels
Card B-1 Date Card B-1
Date
Ventilation Throughout House
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Corrections from Previous Inspections
24.
Fixture & Transformer Clearance -Ins. Protection
93.
25.
Elec. Receptacles Spacing -Lights & Switches at Doors
Energy Compliance Certificate -Other Certificates
26.
Size Boxes & No. of Conductors Stapled
96.
27.
Romex Installed Close to Edge of Studs & C.J.
Card B-1 Date Card B-1
28.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
Date
29.
2 Appliance Circuits in Kitchen & Conductor Size GFI
30.
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
31.
Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insulated Neutral O Yes O No
32.
Service -Riser Conductors & Ground Main Disconnect
33.
Equip. Clearances Panels-Motors-Mech. Equip.
34.
Clothes Closet Light -Shower Light -Spa Light
35.
Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36.
A.C. Ducts Insulation & Support
37.
Vent Fan, Exhaust above insulation
38.
Condensate Drain & Overflow, Size & Grade
39.
Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40.
Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41.
Sills Proper Materials & Anchors
42.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
43.
Bearing Walls over Girders & Floor Nailing
44.
Draft Stop in Walls (rat proof)
45.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46.
Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57.
Siding -Nailing Veneer
58.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59.
Glazing Area -Glass Protection -Skylights -Plastic
60.
Shear Walls; Nailing -Bolts
61.
Brace Interior/Exterior Wall Panels
62.
Insulation -Walls -Ceilings
63.
Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
64.
Ext. Steps -Door & Sidelight Protection -Landings
65.
Smoke Detector
66.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67.
Bedroom Exiting
68.
G.F.I. & Bath Fixtures & Tub Access -Spa
69.
Elec. Trim & Subpanel, Breaker Sizes & Labels
70.
Stairs & Rails
71.
Fireplace or Stove, Clearance -Hearth
72.
Elec. Outlets at Wood Panel, Int. & Ext.
73.
Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74.
Elec. Outlets & Receptacles at Kit. Counter
75.
Garage Fire Door; Swing -Landing -Closure
76.
A.C. Duct in Garage -Damper
77.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80.
Insulation -Foam -Looked in Attic
81.
Guard Rails & Deck Construction -Post Caps
82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
_
83.
Following Instld./Drive O Yes O No/Walks O Yes O No/Planters O Yes O No
84.
Stucco Brown -Finish
85.
A.C. Unit Disconnect, Electrical -Plumbing
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87.
Water Well, Disconnect, Electrical, Plumbing
88.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
89.
Ventilation Throughout House
90.
Glass Protection
91.
Corrections from Previous Inspections
92.
Gas Test -Meters Tagged, Gas -Electric
93.
Water & Sewer Connected -C/O to Grade -HD Approval
94.
Energy Compliance Certificate -Other Certificates
95.
Address Posted
96.
Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7.541 FAM (530)538-2140
WEBSITE: www.buttecounty.net\dds
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
the Business and Professions Code, and my license is in full force and
effect.
License Class: rLicense Numberr•
Date: j/l/7 ContractokJ 11 Uero_r r
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
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
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
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
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,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
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
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
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
�/�s issued.
j2r 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:
Carrier:
Policy #: r] z
❑ 1 certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
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
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
PERMIT NO.
BP042623
Issued Date: 09/08/2004 APN: 021-131-002-000
i
Site Address: 645 LITTLE AVE GRI
Map Index:
Description: fire damage repairs (val $20K, sheet
rock/ele/etc)
Owner: VILLANUEVA AGUSTIN & ROBIN F
645 LITTLE AVE
,> GRIDLEY, CA
95948
t
rApplicant: VILLANUEVA AGUSTIN & ROBIN F
I
I
Contractor: WHEELER CONSTRUCTION, JOHN
3
P O BOX 5262
OROVILLE, CA 95965
(530) 534-5950
License #: 586797
(
I
i Architect:
`Engineer:
Total Square Ft:
Valuation:
Census Code:
0 S. F.
$0.00
This permit is hereby issued under the applicable provisions of the Bun
Resolutions to do work ittdicatpd above for which fees have been paid.
PERMIT EXPIRES ON:
O' 1
L:Ounry Cods aneVor ' _
9-�2.14-
Address: Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & 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. 1 acknowledge itis unlawful to alter the subs of any official form or current of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection rpos
Print Name: I— Signature:
Date:
0 Owner ❑ Contractor ❑ Agent for Owner �ent for Contractor
0
BUTTAUNTY
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.
9P042623
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: 09/08/2004 APN• 021-131-002-000
the Business and Professions Code, and my license is in full force and
effect. cl �
Licensees Class : Liiceense Num/ berr
Site Address: 645 LITTLE AVE GRI
-�
Date: / Contractor(Jhn l(/hr�(,FC_/
Map Index:
Description: fire damage repairs (val $20K, sheet
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
roc )
k/ele /etc
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
Owner: VILLANUEVA AGUSTIN & ROBIN F
signed statement that he or she is licensed pursuant to the provisions of
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
645 LITTLE AVE
she is exempt therefrom and the basis for the alleged exemption. Any
GRIDLEY, CA
violation of Section 7031.5 by any applicant for a permit subjects the
95948
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
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,
Applicant: VILLANUEVA AGUSTIN & ROBIN F
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
`
proving that he or she did not build or improve for the purpose of
sale.).
❑ 1, 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
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Contractor: WHEELER CONSTRUCTION, JOHN
Date: Owner:
P O BOX 5262
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
OROVILLE, CA 95965
O 1 have and will maintain a certificate of consent to self -insure for
(530) 534-5950
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
' issued.
License #: 586797
and will maintain workers' compensation insurance, as
,required
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 ar
Architect:
Carrier: w ?✓
Engineer:
Z,
Policy #: L
❑ 1 certify that in the performance of the work for which this permit is
issued. I shall not employ any person in any manner so as to
Total Square Ft: 0 S. F.
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
Valuation: $0.00
compensation provisions of Section 3700 of the Labor Code, I shall
Census Code'
forthwith compI with t hose provisions.
-
Date:
Applicant: .ZZhA
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 County Coda anfVor _
Resolutions to do work i 'ca! d above for which fees have been
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
paid.
LL/
Name:
By: Date: 7
Address:
PERMIT EXPIRES ON:
Date
O 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.
O 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. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the subs of any official form I hereby
=ounty.
authorize representatives of Bute County to enter upon the above mentioned property for inspection rpos
Print Name: I Signature:
Date:
❑ Owner ❑ Contractor ❑ Agent for Owner P-Xgent for Contractor
�
BWfTE1OUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE M (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
ChGntf-= Loyn
OWNER
Last
(
i Nae
Address
City
City
LoG
State
Zi
Phone
•L ?
Fax
E-mail
Lic. #,,e oo •7
ChGntf-= Loyn
CONTRACTOR
Name
City
AddressE2
9W 5
City
Yes
State
Zip
Phone
L`
Fax
E-mail
))t:d e,e(-6n5 T J
Lic. #,,e oo •7
I Class g
ChGntf-= Loyn
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Yes
State
Zip
Phone
Type Const.
Fax
E-mail
Map Book
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Ea
Yes
I No
APPLICANT SIGNATURE
X
For office use o
LOCATION
Zoning
' ' -?�
Flood Zone
Property Addre
SRA
Yes
I No
Occ.
Type Const.
Subdivision Name
WORKER'S COMPENSATION
Map Book
Page
Lot #
Planner
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
PERMIT
BIN #
Description or Scope of Work:
LO 5
Z-�- -�(� Lk -.g--4 ;�v) - ,
Sq. Footage �_
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by:
Amount: a I L�_ Bldg
SRA
Receipt #: Sheriff
SMTP
Other
Dater � 6
Total
REV 6-16-04
LOCATION
AN V� l
' ' -?�
I ,
Property Addre
L4a 5l , I , _
j��
Ci
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
LO 5
Z-�- -�(� Lk -.g--4 ;�v) - ,
Sq. Footage �_
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by:
Amount: a I L�_ Bldg
SRA
Receipt #: Sheriff
SMTP
Other
Dater � 6
Total
REV 6-16-04
SUBMITTAL RE4IREMEN TS
The following drawings and specifications must be submitted to the Building Division in order to apply
for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4. Letter from Engineer or Architect for truss design review.
❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to
mobile or modular homes.)
❑ 6. 2 Flood Elevation. Certificate, wet -stamped and signed (if required).
❑ 7. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 8. Sanitation and site plan approval from the Environmental Health Department.
❑ 9. Metal Buildings: (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.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑
1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑
2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑
3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑
4.
Letter from Engineer or Architect for truss design review.
❑
5.
2 Energy compliance design and supporting documentation (if required).
❑
6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑
7.
Statement of Intent for Non -heated and A/C (if required).
❑
8.
Metal Buildings: (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.
❑
9.
Letter of intent.
❑
10.
Hazardous Material Form.
❑
11.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
BUTTE CCiIUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING HERMIT
24 HOUR INSPECTION k (530) 538-7636 '(OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541; FAM (530)538-2140
WEBSITE: www.buttecounty.net\dds
• ss
1y
I
PERMIT NO.
BP043169 ✓
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: 10/29/2004 APN' 021-131-002-000
the Business and Professions Code, and my license is in full force andeffect. '
License Class: G r� License Number: 33x-%6 7 Site Address: 645 LITTLE AVE GRI
� � / �/ , Map Index:
Date: �' —� Contractor: T//1466Z ,ST G C� '
`P
OWNER -BUILDER DECLARATION 1r'
I hereby affirm under penalty of perjury that I am exempt from the Desttcription: NEW ELECTRIC SERVICE
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a " ' I VILLANUEVA AGUSTIN & ROBIN F
permit to construct, alter, improve, demolish, or repair any structure, prior �Wner:
to itS46uance, also requires the applicant for such permit to file a i +
signed statement that he or she is licensed pursuant to the provisions of 645 LITTLE AVE
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 4 GRIDLEY, CA
she is exempt therefrom and the basis for the alleged exemption. Any I 95948
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 th8 wo&,and the, structure is not
intended or offered for sale (Sec,7044, Business and Professions
Code: The Contractors' State License Law does not apply to an VILLANUEVA AGUSTIN &ROBIN F
owner'of property who builds or improves thereon, and who does Applicant: _
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
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
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.). Contractor: HURST, MIKE
❑ I am Exempt under Article 3 of the Business and Professions Code
jjj 15 OAKCREST DRIVE
Date: Owner: OROVILLE, CA 95966
WORKERS' COMPENSATION DECLARATION 530-589-5330
I hereby affirm under penalty of perjury one of the following declarations: t . MIKE-TERRI@SBCGLOBAL.NET,-
❑ 1 have and will maintain.a certificate of consent to self -insure for License #: 33i -,i -
workers' compensation, as provided for by Section 3700 of the pp i OFFICE COPY
Labor'Code, for the performance of the work for which this permit
is issued. t
r
I have and will maintain workers' compensation insurance, as �.,rehiteet: Address
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation Engineer:
insurance carrier and policy number are: r Y' GAS
5. • Meter B `Date
By
Carrier: � L' V �1 ; • / r r'
V ELECT.RI P Da(e�^�•,/
Policy #: 1 M? r°By i,
Total Square Ft: ' i_
❑ I certify that in the performance of the work for which this permit is Valuation:
------------------
-
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California, Census Code:
and agree that if I should become subject to, the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. a'
t
Date:
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. 4
GU
CONSTRUCTION LENDING AGENCY This permit. is hereby issued under ih pp cable provisio of the Butte County Cods snWor
1 hereby affirm that there is a construction leridin'g agency for the
Resolutions°6 work-indicat d ab a fo whi n fees have been paid
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name: BY Date:
PERMIT EXPIRES ON:
Address: Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & 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 pu es.
Print Name: / ! / 11 !� i Signature:
Date: 11,0 — Ztl - 6 �f
0 Owner X Contractor ❑ Agent for Owner 13 Agent for Contractor
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street. - Chico, CA - (530) 891-2751
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 notice this office When correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
Hry lu/Vle
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netWds
PERMIT NO.
BPO43169
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: 10/29/2004 APN: 021-131-002-000
the Business and Professions Code, and my license is in full force and
effect. / 7
License Class : v/0 License Number: 33x96 /-
Site Address: 645 LITTLE AVE GRI
/ -
Date: ��� —6 Contractor: PI�G e�T1 I
VrJT
C.__ Map Index:
Description: NEW ELECTRIC SERVICE
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: VILLANUEVA AGUSTIN 8r ROBIN F
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
645 LITTLE AVE
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
GRIDLEY, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95948
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
Code: The Contractors' State License Law does not apply to an
Applicant: VILLANUEVA AGUSTIN &ROBIN F
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
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
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.).
Contractor: HURST, MIKE
❑ 1 am Exempt under Article 3 of the Business and Professions Code
15 OAKCREST DRIVE
Date: Owner:
OROVILLE, CA 95966
530-589-5330
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
MIKE-TERRI@SBCGLOBAL.NET
❑ 1 have and will maintain a certificate of consent to self -insure for
License #: 335967
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
I have and will maintain workers' compensation insurance, as
Architect':
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
Tota( Square Ft: 0 S. F.
Policy #:
❑ 1 certify that in the performance of the work for which this permit is
Valuation: $0.00
issued. I shall not employ any person in any manner so as to
Census Code:
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
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.
C� LU
CONSTRUCTION LENDING AGENCY
This permit is hereby issued undeFthe provisio ofthe,Butte County Cody♦ anrUor
I hereby affirm that there is a construction lending agency for the
Resolutions to work indicatgd whfees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)/
Name:
BY f Date:
PERMIT EXPIRES ON:
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & 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. thereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection pu as
Print Name: / / f II !� Q ��� Signature:
Date: me) 6
0 Owner X Contractor ❑ Agent for Owner ❑ Agent for Contractor
FIRE DAMAGE REPORT
t! A
OWNER: V `C n ��.1N1 V J, s U y_ DATE:
LOCATION: m 5 kj4j Q lty Q A.P. # a 2-1 -6 U 2
CONTRACTOR: ZONING: -�
DATE TO INSPECTOR �'' PERMIT HISTORY ( )NONE KAS FOLLOWS: G QYl �( l.(M I�6 f D
UDDING INSPECTOR'S REPORT �`Lara�
]Be
Building Description:
s
Commercial/Usage: 1
Residential # of Units:
Currently Occupied ( ) Yes (
AbandonedNacant:
Electric:
Electric Currently (n ( ) Off •
Condition of Electric
Gas:
Currently(�On ( )Off
Condition
Sanitation:
Plumbing Working ( es ( ) No
Obvious Sewage Problems ( ) Yes ( No
Mobile Home Condition of Utilities: ( ) Damaged - Requires Permit ( ) Undamaged - No Permit Required
Description of Damaged Area:
Estimate Cost Cost of Repairs: I n4-Ul fJVV
Condition of Foundation: (, Good ( ) Poor
Inspector: q
Sketch building on reverse and 'indicate area of d,
r:.
f.
Explain if repairs needed:
• Date:
i
COUNTY OF'BUTTE
BUILDING DIVISION _
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street - Chico, CA - (530) 891-2751
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 notice this office when correction of work is
completed. It you have any questions pertaining to this matter, or need additional explanation,
please contact.this office immediately.
AX
' -
O
r r_v ,vroc
1
"A.,
rNs ;;��. Permit#674c7-78B(reroof) SF 3
rp
21-131-02 852-89B ' _ ;640' east of-Lewis Oak on Little ve. rid'
`'� ► ti �.CONM Joe Wright, Rt. 2 Box 54A Gridley
POLK, James (new, single artily)
645 Little Avenue, Gridley
w, t�� +�``r �t�dy,. •-(new carport) : r
1
' � h
ra jff•S4" r ;�; FINALED:
l� � S•F������F��w�.l�.ws 1Yc'tq`fiy� .n �a �
021-131-0028 PERMIT#95-0683
SCHRIEKEN Richard
645 Little Ave., Gridley/y
^ Conv Carport to Garage & Relociatq
e � /
Gas Meter/SF
+ F
DATE 6/9/20041;
REPORT TIME 11.28
LOCATION 1645 LITTLE AV
RP IWANDA
INCIDENT NUMBER 6648
EVENT NUMBE 6660' LOGGED B
LOCAL FIRE NUMBS
RO
STATE FIRE NUMBER
BI
CASE NUMBER MEDICS
PRA
PHONE NUMBER 1846-4683 REPORT METHO 911
WILDLAND FIRES El ESTIMATED ACRES
STRUCTURE FIRE RESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PSA/OTHER
HAZ MAT
COMMENTS
HEAVY SMOKE SHOWING ... ALL CLEAR ON
PRIMARY
MB
ECC El
FIRE INFORMATION
FIRE INFO SENT HO JEMAIL I BY IMPTO Iii—A 74
7 -DAY LOGGED INITIALS MAA
INCIDENT NAM VILLANUEVA
START DATE 6/^9/2004' START TIME :001
DIAMOND # 5.0
CAUSE I
,ELECTRICAL POWER
LAND USE IDOMESTIC
ACRES TYPE OF ACRE
DIAMOND 5 ONLY $ DAMAGE TYPE ALL OTHER
DOLLAR DAMAGE 700000.00) SAVE 130000.0014
INJURIES/FATALITIES ❑
# CIVILIAN INJURIES 01 # CIVILIAN FATALITIES
# FF INJURIE F 01 # FF FATALITIES I 0!.
FC -40 INFORMATION
!Iiii FC -40 El DATE OF FC -40 INC
AGENCY. INC # INC P#
FC -40 COMP DATE FC -40 COMP BY r
County Notifications EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer El
be FQ
DATE 6/9/2004
REPORT TIME 11:2
LOCATION 1645 LITTLE AV
RP
INCIDENT NUMBER
EVENT NUMBE
LOCAL FIRE NUMBE
STATE FIRE NUMBER
CASE NUMBER
PHONE NUMBER 1846-4683
WILDLAND FIRES ❑ ESTIMATED ACRES
STRUCTURE FIRE RESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PSA/OTHER
HAZ MAT j_
COMMENTS
HEAVY SMOKE SHOWING... ALL CLEAR ON
PRIMARY
EMD ❑ OES ❑
AQ-* 021 -13► -002
6660 LOGGED B MB
10465aaf �� nra� FirF�ra RO NORMAN
1 RRf RfafA FilR Affirnrc BI
�aaroaaaN MEDICS j
_j PRAY1 ECC El
REPORT METHO 911
FIRE INFORMATION
FIRE INFO SENT HO EMAIL BY MBj TO j STA 74I
7 -DAY LOGGED INITIALS MAA j•
INCIDENT NAM VILLANUEVA ��
START DATE I 6/ 9/2004I START TIME
DIAMOND # 5A
CAUSE ELECTRICAL POWER
LAND USE IDOMESTIC
ACRES 0 TYPE OF ACRE
DIAMOND 5 ONLY $ DAMAGE TYPE ALL OTHER I
w...
...........
DOLLAR DAMAGE 700000.00 SAVE 130000.00
INJURIES/FATALITIES ❑
# CIVILIAN INJURIES # CIVILIAN FATALITIES 01
# FF INJURIE 1 01 # FF FATALITIES 1 0
-- ,m.,_ _ FC -40 INFORMATION
�- Ij ♦ New Incident {J���` FC -40 ❑ DATE OF FC -40 INC
_...-..�-....ate.,. 1. ' f ......._._.._.9
AGENCY INC # INC P#
FC -40 COMP DATE FC -40 COMP BY
County Notifications 0 EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑
RESIDENTIAL
j 021-131-002 PERMIT#95-0683
j SCHRIEKEN, Richard
{ 645 Little Ave., Gridley
Conv Carport to Garage & Relocate
Gas Meter/SF
OFFICE COPY
Address
GAS
Meter By
ELECTRIC — ��-
Date
JOB FINALED (Dat
Signature
V=OK
O=Not OK
-=Not Applicable.
Not Ready MOBILE HOMES
' =
Date/Initials MOBILE HOME UTILITIES (Plans) OK except #'a
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Teat -Fall -C/O Concrete
4. Water; Location -Teat -Easement Needed (Sketch)
S. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Teat -Wrap: / /"L"ft.
/ /"Net. or/ /"L"ft./ /"LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date/Initials MOBILE HOME INSTALLATION (Plans) OK except #'a
1. Zoning Requirements -Setbacks Easements
2 Footings; Size -Spacing -Marriage Line
3.. Gas; MH Test-Demand-Valve—Connector
4. Electricity; MH Teat-Crossovers-Breakere-Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
MISCELLANEOUS
Date/Initial DE COVERS CARPORTS GARAGES Plans OK except #'a
ng Requirements -Setbacks -Easements
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs: Connectore
Shthg: Rfg.-Bracing
S. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Elect is
rmgiSils-Anchors-Studs-Rftrs-Trusses
aeliging; N Iing-Veneer-Stucco-Mesh
2.fRShthg-Roofing
.-Ext.; Steps -Doors -Landings
Date/Initials POOLS (Plans) OK except #'a
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.;Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Pane lboards- Ins. to Main In Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
V=OK
O = Not OK
- = Not Applicable
= Not Ready
RESIDENTIAL (Single & Duplex)
Date/Initials UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Grnd.-/ P' Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchone
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground
13. Plenums & Ducts; Clearance -Materiel -Support -Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Access & Ventilation
16. Insulation
Date/Initials PLUMBING (Permit) OK except #'s
16. Water Htr.; Vent -Access -Combustion Air -Baffle
17. Water Pipe; Test & Anchor -Nail Protection
18. D.W.V.; Test -Fittings & Anchor-Naii Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower, Second Floor -Tub Access
21. Gas Pipe; Size & Anchors
Date/initials ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Elec. Receptacles Spacing -Lights & Switches at Doors
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Meth. Fastners-Bond Gas & Water
27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga.
Cu or Al
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral ❑ Yes ❑ No
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panels -Motors -Mach. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
33. Smoke Detector
Date/Initials MECHANICAL (Permit) OK except #'s
34. A.C. Ducts Insulation & Support
35. Vent Fan; Exhaust above insulation
36. Condensate Drain & Overflow; Size & Grade
37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet
38. Attic Access & Platform if Furnance in Attic
Date/Initials FRAMING (Plans) OK except #'s
39. Sils, Proper Material & Anchors
40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
41. Bearing Walls over Girders & Floor Nailing
42. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Headers & Beam -Size & Bearing
Date/Initials FRAMING (Continued)
45. Hangers -Post Caps -Anchors -Connectors
46. Cing. Joist-Rftr. ties -Purl in -roof Brac-Truss-Shthng.-Ring.
47. Fireplace Ties or Type A Flue -Fireplace Throat clearance
48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
50. Garage Fire Protection Framing
51. Property Line Firewall & Openings
52. Ext. Doors -One T -Check Garage -3rd Story, 2 Exits
53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
55. Siding -Nailing Veneer
56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
57. Glazing Area -Glass Protection -Skylights -Plastic
58. Shear Walls; Nailing -Bolts
59. Insulation -Walls -Ceilings
60. Infiltration -Walls -Windows
Date/Initials FINAL (Plans) OK except #'s
61. Ext. Steps -Door & Sidelight Protection -Landings
62. Smoke Detector
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
64. Bedroom Exiting
65. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes & Labels
67. Stairs & Rails
68. Fireplace or Stove; Clearances -Hearth
69. Elec. Outlets at Wood Panel; Int. & Ext.
70. Kit.Fixt. & Appliance; Grnd -Air Gap -Cooking Clearance
71. Elec. Outlets & Receptacles at Kit. Counter
72. Garage Fire Door, Swing -Landing -Closer
73. A.C. Duct in Garage -Damper
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage; Above Floor -Meth. Protection
75. Plb., Elec. & Mach. Equip. Listed for Location
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection
77. Insulation -Foam -Looked in Attic ❑ Yes
78. Guard Rails & Deck Construction -Post Caps
79. Fdn. Vents & Crawl Hole Door-Drainagge & Wood -Earth
Clearance Looked under Floor ❑ Yes
80. Following instid.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑ Yes ❑ No
81. Stucco; Brown -Finish
82. A.C. Unit; Disconnect, Electrical, Plumbing
83. Vents Above Roof; Plbg.-Appliance-Fireplace: Clearance to
Openings
84. Water Well; Disconnect, Electrical, Plumbing
85. Exterior Elec. Trim; G.F.I. Receptacle -Underground
86. Ventilation Throughout House
87. Glass Protection
88. Corrections from Previous Inspections
89. Gas Test -Meters Tagged; Gas -Electric
90. Water & Sewer Connected -C/O to Grade -HD Approval
91. Energy Compliance Certificate -Other Certificates
Comments at Final:
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES- BUILDING DIVISION
7 County Center Drive - Oroville, Califorzti& 95985 - Telephone (91�) : -_ 538-7541 PERMIT NO.
APPLICATION AND PERMIT 1111AI ` o4 0 3
ASSESSOR PARCEL NUMBER 021-131-002
ZONING
BUILDING PERMIT
OWNER RICHARD SCHRIEKEN
TELEPHONE
SO. Fr, OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
645 LITTLE AVE GRIDLEY
560 5 2,800.00
CONTRACTOR'S NAME
OWNER.
TELEPHONE
CONTRACTORS MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNMOWN
Total Valuation Is
LENDER'S MAIUNG ADDRESS
Filing Fee
$ 20.00
Permit Fee
$ 54.00
ARCHITECT OR ENGINEER
LICENSE NO.
Pian Checking Fee
$ 35.10
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
64S LITTLE AVE
PERMITFEE
$ 109.10
RIDLEY
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Solar Or heat pump water heater
23.00
USEOFSTRUCTURE
SF EX Duplex ❑ Mobilehome ❑ Other
SPECIFY
Water piping
15.00
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00 15,00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other b
Describe Work: CONVERT ATT VARPORT TO GARAGE
AND RELOCATE GAS METER
Mobile Home S G W
@20.00
PERMITFEE
$ 35.00
Contractor
ELECTRICAL PERMIT
Filinq Fee 20:00
Main Service60ov OR LESS
( 200A OR LESS )
23.00
Main Service ( 200A TO 1000A )
46.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law the following reason:
@/ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ I am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUP.
OR ( a ACC. )
SO.
3.52 Fr.
CNS.
NEW CONST. MULTI-OUUTLETLE T
NON-RESID. ( BRANCH CIRCUITS )
97.50
( 8 PSINWGOER APPARATUS )
LE OUTLET CIR.
Ex. Occup. (OUTLET OR FIXTURES )
20 Q 1.00
BAL .00
Ex. Occup. (OUFIXED APPUNS. TLETS (RES D.OR
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
_
Contractor
WORKERS' COMPENSATION DECLARATION
1 ereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT
Filing
9 Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
$
Contractor
Policy Number
(rhe above sections need not be completed if the permit is for work of a valuation
/6f one hundred dollars ($100) or less.)
I I certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
.--- �r
X �E' !✓`— Date Z I ��_
Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent&49� An OSHA permit is required for excavations over 5'0" deep and demolition or constructionB
of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
cD E
TOTAL FEE $ 144.10
HAZ. 0. F IMP I FLOG CDF PARCEL PD HD
—► . _..
SS E
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.
y 9 Dat
PERMITEXPIRESON /0 7
I (DJ.)
Receipt No. 175688
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
r � . , T ..�....-.dp'F.+ ...ws-. - v.�47'1wN'r•�li "• TMv^tii����'.'y.`1,�, A�'�,d.�Fi....�j�tX+`'e'PH`Pi�yrwi�-:.narP'iry y�,-�.PY�"Y'N�1;�ry, "'"''i"�,-,�...,,.I�,�....� . -,-..
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIOk
7 COUNTY CENTER DRIVE - OROVILLE, CALIFOROX95965 - TELEPHOgJ�,916) 538-7541
PERMIT APPLICATION DATA SHEET
OWNER 5� I� I� �l. P, .,No. oa �� -DO `2 -
Proposed Building Use
Building Inspector
Date
At time of per it appIic fio ;was advised the following data must be submitted prior to permit processing and/or issuance:
*'t...% / C11 DATE RECEIVED BY
e s ave �iee submitt�
:..� .......
lot plans, 3/4 set ,(signed by pry a roof plans. .
C plete plans, 3/4 sets, signed by preparer of plans . ......................
ngineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5. Hazardous Material Form.
6. Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check). ....
9. Mobilehome data and manufacturer's installation instructions, 2 sets. ...........
10. Fees of $ ..........................................
11. Impact fees as shown on attached schedule . ..............................
12. California Department of Forestry plan approval/fees. ....................... .
13. Flood elevation letter (100 year flood) by California Engineer . ................. .
14. Sanitation and plot plan approval .Health Department . ............
15. City of Chico plumbing permit. ........................................ .
16. Plot plan and business license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking: . .........
18. Contact Land Development about (A) Improvements (B) Drainage. .......... .
19. Driveway permit (construction approval required prior to occupancy).. .
�Freanspection reque�
20. Pre -inspection for required. . to Building Inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ...............
22. Certificate of Workmans Compensation Insurance . .................. ".:.... .
23. Owner -Builder Verification (Given to owner , Mail to owner _). .......... .
24. Recorded copy of Agricultural Acknowledgement Statement. .........� ........
25. Letter of signature authorization . ........................................
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .....
27. Letter of intent on building use . ................................ j.........
28. Mobilehome utility clearance . ......................................... .
29. Documentation of legal access . ..................... ; ..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
34.
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector.
Other
Parcel Creation I'0,i
Acreage Applicant 'Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other w Date By
r
The following data must be submitted prior to.oermit fiance: Circle new item not checked above).
1. Index permit for above items No. /�
2. Additional items required:
Contractor, designer, ow r, was advised of above required data by _phone _44a,l Counter b ate
Contractor, designer, owner, was advised of above required data by _ phone _ mail Cou ter by _ Date
Plans checked by Date Plans approved by Date:
Sets of plans on hold in File cabinet AP folder c�tia 1 �'7j) -4 J�
Copy - Department of Public Works
r-
O.B.-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 or labor and materials for construction of the
proposed property improvement : S ] NO[ ].
2. I HAVE[A HAVE NOT[ ] signed an application for a building permit for the
proposed.work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
NAME:
ADDRESS: CITY:
PHONE: 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:
NAME: `
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
SIGNED: c
PROPERTY OWNER:
SOCIAL SECURITY NUMBER:
DATE:
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
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
property improvements specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party of record
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 protect
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.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including
materials and other costs) is $300 or more for the entire project, and such persons are not licensed as
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 costs, 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 Business Administration). For more specific information about your
obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or subcontractor, only
under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbudder"
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing their own
work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License
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 the verification is returned.
S,n,&re1
Michail C. Vieira, C.B.O.
Manager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
,0W/ "_
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BUTTS COONTV
WILDING ®EPARTMEN )
APPROVE®
9�o6g�.
A7// C A✓ �
AT
N= -.All Materials & Workmanship Shall Be In
AMOW"noe with Recognized Good Praoticies and
Of Q1alitY Prescribed for the Specified use
En. the Uniform Building, dumbing & IIechanioeJ
Codes and the National Electrical Code.
0
21=131-02 852-89B
POLK, James
u - 645 Little Avenue, Gridley
(new carport) `
FINALED:
PERS
PERMIT EXPIRES
OWNER
CONTR.
ASSESSOR PARCEL
LOCATION
Temp. Power Pole
Called PG&E
. ' Temp. Elec. Service
Called PG&E
Temp. Gas Service
Called PGB�
JOB FINALED
Signature
=OK • '
0 = Not OK
- = Not Applicable
= Not Ready
MOBILE HOMES
MISCELLANEOUS
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Date
DE ,COVERS,CARPORTS,GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements
ning Requirements- s -Easements
2. Soils; Special MH Support -Sketch
_
. ootings; Soils-Siz -D pacing -Connectors t
3. Sewer; Location-Test-Fall-C/O-Concretend/or
oists-Decking-Bracing-Stairs-Rails
4. Water; Location -Test -Easement Needed (Sketch)
4
f• d� /
ood,, Awn.; Posts-Beams-Mrs.-Connec.-
Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
6. Gas; Location -Test -Wrap: / /"L"ft.
/ /"Nat. or/ /"L"ft./ /"LPG
lumns-Conn ions -Splice -Decal -Enclosures
arports; WiQ9Pv6s-D s
7. Utility Clearance
rmg; Sills-Anchors-Studs-Rftrs-Trusses
Q_Sid' ; Nailing -Veneer -Stucco -Mesh
Card -Bt
Date Card -B1 Date
1 . oof; Shthg-Roofing
Card -B1
Date Card -B1 Date
11_E�; &teps=Boof§-Landings
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Card -B1
Date i8 Card -B1 Date 6 —
2. Footings; Size -Spacing -Marriage Line
Card-B
Date - Card -61 Date
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
Date
DOLS (Plans) OK except #'s
5. Drain; MH Test -Fall -Flex Connector
1. Setbacks -Easements
6. Water; MH Test -Regulator -Connector
2. Soils; Compaction -Structure Stability
7. Water and Sewer Connected -C/O to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness -
Dead Men -Lining
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
4. Elec.; Receptacles and Lighting, Distances-GFI
10. Cert. of Occupancy
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-Panelboard s -Ins. to Main in Conduit
Card -81 Date Card -B1 Date
Card -B1
Date Card -131 Date
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Card -B1
Date . Card -B1 Date
Card -B1
Date Card -B1 Date
I
0=Not OK
- = Not Applicable RESIDENTIAL (Single and Duplex)N
= Not Ready
Date UNDERFLOOR (Plans) OK except #'s
2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
3. Ftg., Garage; Soils -Steel-/ ' /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped -
6. Stemwalls, Garage; Steel- Blockouts-Wrapped
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric; Underground,
13. Plenums & Ducts; Clearance-Material-Supprt-Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15 `Insulation .
Card -131 - Date Card -B1 Date
Card -B1 Date _ Card -B1 Date
Date PLUMBING' Permit OK except #'s
16. Water Ht. Vent -Access -Combustion Air-
Baffle
17. Water Pipe; Test & Anchors -Nail Protection
18. D.W.V.; Test-Fttngs & Anchors -Nail Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower, 2nd Floor -Tub Access
21. Gas Pipe; Size & Anchors
Card -B1 Date Card -B1 Date
Card -B1 Date Card -B1 Date
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Elec. Receptacles Spacing -Lights & Switches at Doors
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
27. 2 Appliance Circuts in Kitchen & Conductor Size/G.F.I.
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga.
Cu or Al
29. Range Circ. / / ga. Cu or Al -Oven Circ. / / ga. Cu or Al.
Insulated Neutral Yes No
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panels-Motors-Mech. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
33. Smoke Detector
Card -B1 Date Card -B1 Date
Card -B1 Date Card -B1 Date
Date MECHANICAL (Permit) OK except #'s
34. A.C. Ducts Insulation & Support
35. Vent Fan; Exhaust above insulation
36. Condensate Drain & Overflow; Size & Grade
37. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet
38. Attic Access & Platform if Furnace in Attic
Card -B1 Date Card -81 Date
Card -B1 Date Card -B1 Date
Date FRAMING (Plans) OK except #'s
39. Sills, Proper Material & Anchors
40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
41• Bearing Walls over Girders & Floor Nailing
42. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Header & Beam -Size & Bearing
Date FRAMING (Continued) -
45. Hangers -Post Caps -Anchors -Connectors
46. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
47. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
48. Attic Access; Size & Romex Protection -Draft Stop -Ins'. Baffles
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
50. Garage Fire Protection Framing
51. Property Line Firewall & Openings .
52. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
54. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
55. Siding -Nailing Veneer
56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
57. Glazing Area -Glass Protection -Skylights -Plastic
58. Shear Walls; Nailing -Bolts
59. Insulation-Walls-Clg.
60. Infiltration-Walls-Wndws
Card -B1 Date Card -B1 Date
Card -B1 Date Card -81 Date
Date FINAL (Plans) OK except #'s
61. Ext. Steps -Door & Sidelight Protection -Landings
62. Smoke Detector
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
64. Bedroom Exiting
66. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes -Labels
67. Stairs & Rails . e . • •-
68. Fireplace or Stove; Clearances -Hearth
69. Elec. Outlets at Wood Panel; Int. & Ext.
70. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
71. Elec. Outlets & Receptacles at Kit. Counter
72. Garage Fire Door; Swing -Landing -Closer
73. A.C. Duct in Garage -Damper
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
75. Plb., Elec. & Mech. Equip. Listed for Location
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
77. Insulation -Foam -Looked in Attic ❑ Yes
78. Guard Rails & Deck Construction -Post Caps
79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
80. Following instld.; Drive •❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑ Yes ❑ No
8i. Stucco; Brown -Finish
82. A.C. Unit; Disconnect, Electrical, Plumbing
83. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
84. Water Well; Disconnect, Electrical, Plumbing
85. Exterior Elec. Trim; G.F.I. Receptacle -Underground
86. Ventilation throughout House
87. Glass Protection
88. Corrections from Previous Inpections
89. Gas Test -Meters Tagged; Gas -Electric
90. Water & Sewer Connected -C/O to Grade -HD Approval
91. Energy .,Compliance Certificate -Other Certificates
92. Roofing Certificate
Card -B1 Date Card -B1 Date
Card -B1 Date Card -B1 Date
Card -B1 Date Card -B1 Date
Comments at Final:
(NOTE: An entry must be made each time You visit iob site)
f
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE'' +. Sk
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. if you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
�,_ A 4- . A /If7 A - -
Inspector Date—
'k
ate
J COUNTY OF BUTTE - DEf ARTC4 ENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
P?4RMIT NO.
.AA
ASSESSOR PA CEL NUMBER �, ZONING
A:;2- - ooh
BUILDING PERMIT
OWNER /ya� LEPH2ON/E�
Ar-lir]/ ✓�
SQ. FT. OCC. BUILDING VALUATION
OWNER'SMAILING VE) ESS
L i 1
CONTRACTEE
i
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
'
Fireplace
CONSTRUCTION LEN ER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 1 10.00
Each Trap
2,00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME - PARCEL MAP
Water piping
5,00
Each gas water heater or vent
5.00
USE OF STRUCTUR 0
SFDuplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00ea
TYPE OF WORK
New Addition❑ Rem�o/deell❑ Utilities❑ Installation❑ Other[]
Describe work: __ /V X
Permit Fee
$
Contractor
-
ELECTRICAL PERMIT
Filing Fee 10.00_
Main service e00V OR LESS
100 AMP OR LESS
10.00 �?
Main service EA. ADO'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
®' 1, as the owner, or my employees with wages as their sole compen-
\ sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑. I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.y
OR ADDNS. ACC. BLDGS. hICSQft
NEW CONSTR. -OUTLET 2.50 ea
NON-RESID BRANCH CIRCUITS)
POWER APPARATUS &)
SINGLE OUTLET CIR.
200500
Ex. OCCUp(OUTLETS OR FIXTURES eALO So
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID•) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. tiYirin 15.00
9
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
�j 1 shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement,should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
g
Hood
3.00
Ventilation
Permit Fee
:
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and exp, uses which may in any way accrue
agains said County in consequ c of granting of this permit.
X Date oZ
Sig fire of Applicant — Owne ElContractor❑ Agen
An 0 HA permit is required for excavations over 5'0" deep and demolition or construct-
ion structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE $ 15 >
OCCUP.
CONST.TT [
SCHOOL
T
I FLo
PARCCL
�-
PD
�,
ND
/
v
I su
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIREC R OF PUBLIC
BY
91��
PER EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date —3rM
-
Receipt No.
WNITL-O. P. W., 7CLL0 W-ASDlSSO R, PINK-INBP lCTOR. GOLDENROD -APPLICANT
COUNTY OF B&fE - DEPARTMENT.OF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVI LE�,PAL(SORNIA 95965 - TELEPHONE: 916/538-7541 /
' PtkMI,T APPLICATION DATA'SHEET J
Permit No.
OWNER �%) ._ A. P. No. 41- -
i
Proposed Building Use %poi ��Cr��-- Building Inspector_ Date
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1.
All items have been submitted...........................�..........
2
Plot plans in duplicate/triplicate, signed by preparer of plans........
Complete plans in duplicate/triplicate, signed by preparer of plans
.
4.
..
Complete engineere plans and calcs, w`itF"wet signature on plans
5.
Energy Design Compliance and supporting documentation .........
.6.
Statement of Intent for Non -Heated and AC Buildings ..............
7.
Engineered truss details and layout in duplicate (required prior to plan check)
8.
Mobilehome installation data including manufacturer's installation
instructions.......................................................
9.
Fees of $ ..........................
10.
Chico Urban Area fees paid ........................................
11.
Park fees paid .....................................................
12.
School District fees paid .................
3.
Sanitation approval from 6",t=4 4&,4 Health Department .. .
14.
City of Chico plumbing permit ...:................................. .
15..
Plot plan and business license approval from City of
_
(see City for other requirements)
16.
Planning approval for (A) Use: (B) Parking:
17.
Improvements may be required.
18.
Driveway permit (construction approval required prior to occupancy) ...
19.
Pre -Inspection for required .... Pre-inspec. request to
Building Inspector (Date)
20.
Contractor's license information (No., Name Style, Classification) ........
21.
Certificate of Workmans Compensation Insurance ....................
22.
Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ........
23.
Recorded copy of Agricultural Acknowledgment Statement ............
24.
Letter of signature authorization .....................................
25.
26.
When
\
you issue the permit, process as follows: V Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other
7 / 4
Applicant /<! QADate oZ
Copy of plans sent Health Dept., Fire Ddpt%., Other Date
The following data must be submitted prior to permit issuance
1. Index permit for above items No.
2. Additional items required:
(Circle new item not checked above).
Contractor, designer, owner, was advised of above required data by_phone—nail counter by date
Contractor, designer, owner, was advised of above required data by—phone —mal l—counter bydate
J
Plans checked by Date Plans approved by�Date
Sets of plans on hold in File cabinet AP folder
Copy—DPW
r
TO Buildinv Department
FROM:, Environmental Health
SUBJECT: Sanitation Clearance
Owner. Location AP#
Plan Approved for.: Sewage Disposal Water Supply
Hold final for:
Water Supply
Final clearance O.R. for: Wa er Supply
:0
Clearance for bedroom mobile home. Other
NOTE«*
.-... Vt4_ i
Sanitarian
Date
COUNTY bFr BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA' 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An 'owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay 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 yes or no)
2. I (have/have not) signed an application for a building permit
for the proposed work. "
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name \
Address City
Phone Contractors License No.
r
4. I plan to provide portions of this work, but I have hired the following person
to coor'd'inate, supervise, and provide the major work:
Name ,
Address \ City
Phone Contractors License No.
5. I will provide some o the work but I have contracted (hired) the following
persons. to provide , work indicated:
Name Tress Phone Type of Work
Signed:
Property Owner ,
Social Security Ndmber
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
Y r y
v
,—PERMIT NO. 6747-78B
PERMIT EXPIRES 11/16/79
P
DOWNER ETHEL DILLARD
CONTR. owner
LOCATION (A.P. 21-131-2
.SIS Little AVe, 500' E of Lewis Oak, Gridl
f
k
F
f
7
i
V
Temp. Power Pole
Called PG&E
Temp. Elec. Ser�"',
Called PG&E
Temp. Gas Serv.
�Cal1ed PG&E
VjOB y a
FINALED �J a
(D e)
(Signature)
Stemwall
COUNTY OF BUTTE —'DEPARTMENT OF PUBLIC WORKS
-BUILDING INSPECTION'RECHD
Heaters
BUILDING BUILDING (Cont'd)
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets i
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stem wall
-Siding
To out
Slab
Roof Sheathing
Water Piping
Piers
' Roofing Tr5
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwall
. Insulation
Heaters
Slab
Carport
p
Footings
Prov. for physical)
handicapped
Conformanceof X.
structure
Appliances
Gas PI in & T st
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat'
Rou h
Relnf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framing -
Test
Water Htr.
Stucco
Final.
Subpanels
Mesh
` MECHANICAL
Grd. Fault Pr94.
Scratch
Heating
Service
Brown'
Cooling
Temp. !A, e
Finish
Ducts
Under ound
Interior Lath
Ventilation
Pennarent
Door Closer
Final
Final.
MOBILEHOME UTILITIES ------------------
Elec- Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
OBILEHOME INSTALLATION - - - - - - - - - - - - - - Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE l ���� REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Tele -phone'. 934-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date
$ignatur Permitee or Agent
Receipt No. 1 aeya3t-0
White-D.P.W. — ellow-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.
By Date I I I I W to_
Building permit expires ate
BUILDING
Owner
SQ. FT. OCC. BUILDING VAL TI N
Mai I i ng Address M _
P.lephone No.
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee
Building AddressPlan
Checking Fee&/or Penalty
Permit Fee - Oa
'— L
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trao 1.50
Repair drainage or vent piping 1.50
A. P. No. �-
L�
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
Fe
ire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
I Declaration
I Parcel Map 1
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Parcel Approyal
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
Permit Fee $
$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600v OR LESS
100 AMP OR LESS 5•��
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
Main service OVER600v 25.00
100 AMP OR LESS
EA. ADD'L 100 AMP 1.00
Main serviceNEW
CONS./
OR ADDNST ( ACCLBL GS.CCUP. 4') 2¢sgft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
NEW CONSTR MU LT I.OUTL T
NI- ONST ( BRANCH CIRCUITS) 2.50ea
NEW CONST P_(POWER APPARATUS 8
NON-RESID. (SINGLOUTLET CIR.
Ex. Occuo(OUTLETS OR FIXTIIPES 5 L25
FIXED ALNS
Ex. Occup. (OUTLETSP(RESID)REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
P -t am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
2_f—certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relatinq to buildinq construction, and hereby
Land Development Fee
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date
$ignatur Permitee or Agent
Receipt No. 1 aeya3t-0
White-D.P.W. — ellow-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.
By Date I I I I W to_
Building permit expires ate
u
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