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1319* Block Rd, Gridley-. dniv
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.021-120-004 PERMIT#984749�,j
Cont North, Va"lle� Eiect�icl�_
Ele S�r Ch House
B08-0670 021-120-004
MISCELLANEOUS HVAC Change Out
REPLACEMENT HVAC NAT GAS
1319 BLOCK RD
LITTLE, GARY
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOLJR rNSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
- WEBSITE: www.buttecounty.net\dds
INFORMATION
Site Address: 1319 BLOCK RD
Owner:
Pennit No: B08-0670
APN: 021-120-004
LITTLE, GARY
Issued Date: 04/14/2008 BY TMP
Permit type: MISCELLANEOUS
1215 BLOCK RD
Subtype: HVAC Change Out
GRIDLEY, CA 95948
Expiration Date: 04/14/2009
Description: REPLACEMENT HVAC NAT GAS
(530) 624-1844
Occupancy: Zoning: A40
Contractor
Applicant:
Square Footage:
BROWN JOHN HEATING AND AIR
BROWN JOHN HEATING AM
Building Garage Remdl/Addn
1024 REGENCY DRIVE
1024 REGENCY DRIVE
CHICO, CA 95926
CHICO, CA 95926
Other Porch/Patio Total
(530) 592-9277
(530) 592-9277
FEE INFORMATION.
DBM Heat Pump (Package Unit) $59.00
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
BROWN JOHN HEATING AND 1825622 / C20 / 10/31/2009
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
. . lif
is z�)ce and effect.
A 04/14/2008
Contractors Signature Date
WORKERS" COMPENSATION DECLARATIOW.-,
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
I 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.
I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers' Compensation insurance carrier and policy number are;
Carrier: State Fund Policy Number: 238,00 2 95 Ep. Dal,:02/01/2008
(This section need not be compl5ted it the permit is tor on.M.nriad dollars (s100)_o_rTe_ss_.T_
CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
SSUED, 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.
X
04/14/2008
Signature Date
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address
city state Zip
Balance Due: $0.00 Receipt No: B6996
OWNER / BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
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 Contractors 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 [$5001;
Please check one of the following:
E] 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 Code: The Contractors License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.).
F1, As OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
_1CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code:
The Contractors License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
I AM EXEMPT under Section B. & P.C. for this reason:
X 04/14/2008
Owner's Signature Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
prop_qqy owner oramauthorized to act "a property gymers. behalf.
r— 04/14/2008
1:1 Owner , 1:1 Contractor OR: 11 Agent for Owner ElAgent for Contractor I
FILE COPY
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION"
OFFICE#: (530)538-7541 FAX#:(530)538-2140
A FEE WILL BE REQUIRED A T TIME OF APPLICA TION
Website: www.buffecounty.net/dds
14J, �11 4� 0 PLEASE PRINT CLEARLY
"When filed, this application and all supporting material becomes subject to the California Public Records Act. All
related to this application is subject to public inspection and will be posted on the County's website for electronic access.
CONTRACTOR
OWNER INFORMATION
Last Name
1"T ko—
I First Name 1ph-i� e
Mailing Address
.
Phone_So
'tip ejp -7
.7
Fax
city CA
Lic. #
State CA
1 Zip
Phone ��o2L4—
E-mail
Fax
E-mail
CONTRACTOR
Nlame,`�_ A
1 2 e2 K_ "
Address I C-) 0'"
City (,% -
. k 0-0-1
'ttate
zip
1
Phone_So
'tip ejp -7
.7
Fax
E-mail
Lic. #
Class
r1kC_.,J
APPLICANT SIGNATURE
X
PERMIT
NO.
,0 ^ %�—O& 7
Pu
PROJECT LOCA TION
AP11
Property Addr6ss
city a A
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license cofitractors, a certificate of worker's
I c mpensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
I I
-PESCRIPTION OR SCOPE OF WORK.
J
Scl FT- Living Garage Open Cov
0 Structure Built without Permits
0 Proposed Change of Occupancy
(Note previous use):
For office use only:
ARCHITECTIENGINEER
Name
e/ 4
Address
city
State
Zip
Phone
Fax
E-mail
State License Number
APPLICANT SIGNATURE
X
PERMIT
NO.
,0 ^ %�—O& 7
Pu
PROJECT LOCA TION
AP11
Property Addr6ss
city a A
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license cofitractors, a certificate of worker's
I c mpensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
I I
-PESCRIPTION OR SCOPE OF WORK.
J
Scl FT- Living Garage Open Cov
0 Structure Built without Permits
0 Proposed Change of Occupancy
(Note previous use):
For office use only:
- APPLICANT INFORMATION
Name
e/ 4
Address
city
State
zip qyq 75
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
PERMIT
NO.
,0 ^ %�—O& 7
Pu
PROJECT LOCA TION
AP11
Property Addr6ss
city a A
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license cofitractors, a certificate of worker's
I c mpensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
I I
-PESCRIPTION OR SCOPE OF WORK.
J
Scl FT- Living Garage Open Cov
0 Structure Built without Permits
0 Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning Flood Zo SRA I Yes I No
L
Occ. TType
Const.
FIRE DAMAGE REPORT
OVINER: rl�4 Q,"MiW4 Z-1 DATE: rZ 1C)
12 -00
--0
LOCATION: A.P. # _-x_
CONTRACTOR: ZONING:
DATE TO INSPECTOR: PERMIT HISTORY NONE (WAS FOLLOWS:
BUILDING INSPECTOR'S REPORT
Building Description:
A-
Commercial/Usage:
Residential # of Units:
Currently Occupied (� �o
Abandone
Electric:
Electric Currently ( ) On ( eyllf 1,
Condition of Electric
Gas: Currently ( ), On ( 1 -0- -f f--,
Condition
Sanitation:
Plumbing Wofking No
Obvious Sewage Problems ( ) Yes ( ) No
Mobile Home Condition of Utilities: ( ) Damaged - Requires Permit ( ) Undamaged - No Permit Required
Description of Damaged Area:
Estimate Cost of Repairs'
Condition of Foundation: Good Poor Explain if repairs needed:
Inspector:
e
Sketch building Severs and indicate area of damage.
Date:
4
t-co'l
I
CDFIBUTTE COUNTY FIRE INCIDENT LOG
DAT . E 09/11/20031
REPORT TIME 9:411
INCIDENT NUMBER 10633 LOGGED BY ICJS
j
LOCAL FIRE NUMBER 108931 RO MATTOS
STATE FIRE NUMBER BI 86 BRUSH
CASE NUMBER MEDICS
LOCATION �1312 BLOCK RD
RP PHONE NUMBER
WILDLAND FIRES El ESTIMATED ACRES
STRUCTURE FIRE IRESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PRA jYl Ecc El
342-2875 REPORT METHOD 1911
FIRE INFORMATION
FIRE INFO SENT HOW BY
j TO
7 -DAY LOGGED INITIALS
INCIDENT NAME r =LOCH
PSA/OTHER START. DATE 09/11/20 START TIME
HAZ MAT DIAMOND # 1.0 ..... j
COMMENTS CAUSE UNDETERMINED
MOBILE LAND USE FARM/RANCH
HOME I
ACRES f-0 TYPE OF ACRES
j
DIAMOND 5 ONLY $ DAMAGE TYPE JALL OTHER
DOLLAR DAMAGE DO SAVE 60000.001
INJURIES/FATALITIES El
# CIVILIAN INJURIES # CIVILIAN FATALITIES 01
EMD El OEs El # FF INJURIES � ...... JO # FF FATALITIES
FC -40 INFORMATION
",New Incidbn't', FC -40 DATE OF FC -40 INC
AGENC�'INC# Jr- INC P#
FC -40 COMP DATE FC -40 COMP BY
County Notifications E:] EARS Hard Copy Recieved [:] EARS Checked Agenst EARS Computer
F_ - ___ - ___
SANPLE, MR & MRS.
1312 BLOCK RD. GRIDLEY
CAL PAC ROOFING6/1,#-/
REROOF WITH STEEL
G 1 0 LD i EN, 14erb 4031B
(3(4 -02. �200P
_3332E
071 -1
approx 11001 S of"rfrMe Ave., 1,;Ib on
Block Rd., Gridley
CONTR: joe C. Wright, Rt 2, Box 54A, Grii.,!]
(new, single-family)
0 2
21-1,20�004 PERMIT -#9'8-1 749
LITTLE, lGary W.
1319 Block Rd'., Gridl6y
Co t.
Cont: North Valley Elect
I- ric
'Ele SenCh
@ HoLfse
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive I Oroville, California 95965 1 Telephone (530) 538-7541 PERMIT NO.
4.0-- ---t q,� - I
(Rev. 12/96) APPLICATION AND PERMIT
ASSEU2yMJ
_ =Z04
ZONIN9
BUILDINGPERMIT
OWN UARY W LiTrix
T=195
SO. FT. OCC. BUILDING VALUATION
OWNT�ffl*
13M ROAD, GRIDLEY
0OWN"Amy
I TELEPHONE
CONTf"WS
_
W 9VIUNGtIQ PIJ4
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Fee $
ARCHITECT OR ENGINEEWS MAIUNQ ADDRESS
—Permit
Plan Checking Fee $
BUILDINGADDRESS
ON I ROAD. GRIDLEY
Energy Plan Checking Fee $
$
-AT -1=01-
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome A Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities 0 Installation 0 OtherjU.
Describe Work: REPUCE 100 A" SR CH 1 HOUSE
Gas piping sy2tem I - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W 920.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
R LES:
000 0 LES
Main Service .VA OR 2 3.0 0 7-3
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 for the following reason:
0 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.
1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A 46.00
NEW CONST. DWP"CIG OCCUP. so
OR ADDNS. Ac S. 3.50FT.'
=T,, 0 @7.50
OWER APNRATU
PSIN. E 0 _Er CSR.
200 1.00
Ex. Occup. OUTLET OR FDcrURES BAL @ .50
Ex. Occup. OZE%A(g.,6.)0ER, 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
FRt1_Tr1,F_ Jeou
PERMIT FEE $ W) IOU
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, forthe performanceof workforwhich this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
- of one hundred dollars ($100) or less.)
,0_ I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisio s -of section 3700 of the Labor Code, I shall
forthwith comply with those pr I ns.
X Date
Signa4tureo Ap/icant - 0 Owner 0 Contractor [3 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structurep"over 3 stories in height.
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEiE $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE 66.
TOTAL FEE $
FEES IMP
I FLOOD
I COF
PARCEL
I PD
HO
ISSUE
60-1
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
By Date
PERMIT EXPIRES ON
I (Date)
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
FM
COUNTY OF BUTTE - DEPARTMENT OF DEVEI�OPME�T SERVICES - BU-ILDING DIVISION
MIT
7 County Center Drive a Ciroville, California 95965 * Telephone (530) 538-7541 LPE R
(Rev. 12/96) APPLICATION AND PERMIT
AssEnY-I�T=04
ZONINR-40
BUILDINGPERMIT
OWN tARY W LITTLE
TAT9 24 19 5
SO. FT. OCC. BUILDING VALUATION
.OWN T�ff'�tn ROAD, GRIDLEY
c"M�fli"TALLEY ELEC
TELEPHONE
CON`MY'!WU'dTftEY
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER 717
NO..
Filing Fee
$ 20.00
Permit Fee
$ -
ARCHITECT OR ENGINEEIR�S MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
1319 R ROAD, GRIDLEY
Energy Plan Checking Fee
$
$
-LOCK
PERMIT FEE
$
LOT NO.
SUBDrVISIOWS NAME
I
PARCEL MAP
I
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 6 Other
SPECIFY
Each Trap
1 7.00
—
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Ulilities; 0 Installation El OtherXX
Describe Work: REPLACE 100 AMP SER CH @ HOUSE
-----------
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G
920.00
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20-00
R LESS
OOOV 0 LESS
Main Service .A OR
23.0023.00
�91
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
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, as owner of the property, or my employees with wages as their sale compensation,
will do the work, and the structure is not intended or offered for sale.
1< 1. as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
13 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
P>IZL-1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
P'ov's'o Or
workers' compensation provisi of section 3700 of the Labor Code, I shall
forthwith comply with those pr i 2ins. sect,
,�ase eprns.
X e!�& Date
Signature of Alsficant - 0 Owner 0 Contractor 0 Agent
An OSHA per is required for excavations over 60" deep and demolition or construction
of struct ;7over 3 stories in height.
Main Service 200A TO 1000A
46.00
NEW CONST. DV=113ffUp. 0.
C S. 3.5,s
R ADDNS. Fr..
NEW CONST. OUTLET
NON-RESID. M.ULTHI CIRCUITS
97.50
0 a AP=US
PSI:GIE 0 C..
20 @ 1.00
Ex. Occup. OUTLET OR FIXTURES BAL @ .50
Ex. Occup. IR= .) E 5.00
..FIXED APP . OR".
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PRE INSP 123.00
PERMIT FEE $ 66.00
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6..50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee Is
Energy Inspection Fee Is
Occ
CONST.TYPE
TOTAL FEE $ 66.00
FEESS IMP
I FLOOD
I CDF
PARCEL
I PO 'I
HD
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
A
9V
Dateg/7/�
Receipt No. 2—q4? 93 49
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD-APFPLICANT
(Rev. 12/96)
il
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPM9NT SERVICES - BUILDING DIVISION
7 County Center Drive - Ciroville, California 95965 o Telephone (530) 538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NU ZO
JrER
BUILDING PERMIT
OWNERC TELEPHONE
SO. Fr. OCC. BUILDING VALUATION
OWNER'S MAILING ADPRE
C9 C_
f
CONTRACTOR' E 4
TELEPHONE
CO=NG AlfORESb
CONSTRUCTIqN LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation
ARCHITECT OR ENGINEER
LICENSE NO.
Filina Fee
20.00
Permit Fee
ARCHITECT OR ENGINEERS IAWNG ADDRESS
Plan Checking Fee
ADDRESS
BUILDING /,:5 aLc_ =e__d
Energy Plan Checking Fee
014(d ±PA.CEL
PERMIT FEE $
LOT NO.
SUBDIVISIONSNAME MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECU:Y
Each Trap
7.00
—Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities A Installation El Other 0
Describe Work: V_e tz e_
I/, C_,C_
—Gas piping system I - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I WF_
(920.00
PERMIT FEE
ELECTRICAL PERMIT
Filing Fee 20.0
( 800V OR LESS
Main Service .0. LESS
23.00 'o, - cu
7
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
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 [,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.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project
0 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, forthe performance of work for which this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(rhe above sections need not be completed if the permit Is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person In any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X Date
Signature of Applicant - 0 Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over Vo"deep and demolition or construction
of structures over 3 stories in height
Main Service 200A TO 1000A
48.00
NEW CONST OWELLM OCCUR SQ.
OR ADONS. & ACC. BLDS. 3.50M
Iftw MULTI -OUTLET @7.50
NON-RE'SMID.1
P.0=AP=U9
0 C..)
Ex. Occu OUTLET OR FIXTURES) 20 @ 1.00
akL @ .50
Ex. Occup. TSM 5.00
.%DAPPZ..D.R
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc_Wiring 23.00
OERMIT FEE 6 6. 0.0
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee
Energy Inspection Fee
Occ
CONST. TYPE
TOTAL FEE$
;Thispternmft
HAZ.
1 0, FEES IMP
I IFLOOD
I CDF
PARCEL
PD
HD
ISSUE
is hereby Issued under the applicable
of the Butte County Code and/or Resolutions
Indicated above for which fees have been
By Date
PERMIT EXPIRES ON
I (Date)
provisions
to do work
paid.
Receipt No.
WHITE-D.O.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
PRE -INSPECTION
j
OWNER: 4A Ttb_ DATE 8h IF g -
f. f
LOCATION: /_7� 9 Zo c- fC A. P.
CONTRACTOR: ZONING
PRE -INSPECTION FOR: . Aff6 Se,,L..,f,e_p C21 Az 4 k z e
DATE TO INSPECTOR
PERMIT HISTORY: NONE
1�nAS FOLLOWS:'
TYPE OF OCCUPANCY
=--7
FIELD INFORMATION
I
BUILDING USAGE:
TENNANT:
OCCUPIED 'HAS ELECTRIC HAS GAS E:] HAS SANITATION FACILITIES
HEATED -COOLED ED PERSON CONTACTED
OTHER COMMENTS:
ACTION RECOMMENDED:
ISSUE HOLD FOR
OTHER:
BY DATE
PRE -INSPECTION,
OWNER: Tt&_
LOCATION:
CONTRACTOR:
------------ - ----
PRE-INSPECTION FOR:
DATE
A.P. # Z/� 12-4)-60y
ZONING
---------------------
DATE TO INSPECTOR -44
------------- - ---
PERMIT HISTORY: NONE [!I -AS FOLLOWS:.
TYPE OF OCCUPANCY
----------
BUILDING USAGE:
TENNANT:
OCCUPIED
HEATED -COOLED
OTHER COMMENTS:
FIELD - INFORMATION
HAS ELECTRIC HAS GAS
ED PERSON CONTACTED--'
HAS SANITATION FACILITIES
ACTION RECOMMENDED:,
0 ISSUE 0 HOLD FOR.
OTHER:
I
BY DATE
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 9 Telephone (530) 538-7541 PERMIT NO.
(Rev. 1 �/96) APPLICATION AND PERMIT
ASSESSOAPAACELNUIMER -77 e-10
BUILDING PERMIT
OWNER )NE
SO. FT. —OCC. 9UILDING VALUATION
OWNER'S MAILING ADPRESS
12— 15- F2 (OC -k t—cf-
t
Fireplace
75=' i tg /t ge,
TELEPHONE
9 MAILING AUDRESS
CONSTRUCTICIN LENDER
LENDER'S MAILM ADDRESS
Total Valuation is
ARCHITECT OR ENGINEER
LICENSE NO.
Rlina Fee $ 20.00
ARCHITECT OR ENGINUR'S MAUNG ADDRESS
Permit Fee $
Plan Checkina Fee $
BUILDING ADDRESS
/,3z!�F
- Energy Plan Checking Fee $
OT
$
PERMIT FEE $
LOT NO.
SLISDIVISIDN'SN&ME /I
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Moblishome 0 Other
SPECFY
—Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
—Each gas water heater or vent 15.00
TYPE OF WORK
Now 0 Addition 0 Remodel 0 UdIdes )4 Intaktion E3 Other C3
Describe Work: Ire .rep -
Gas piping system I - 5 outlets 15.00
Building sewer 15.00
Mobile Home ISI GJ W1 020.00
PERMIT FEE
1-7(0 L, --S
ELECTRICAL PERMIT Filing Fee 20.00
Ce OR =8 )
Main Servi 23.00 2 y
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
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
13 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.
0 1, as owner of the property. am exclusively contracting with licensed contractors
to construct the project
13 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance otwork for which this permit Is Issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit Is Issued. I shall
not employ any person In any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code. I shall
forthwith comply with those provisions.
X Date
Signature of Applicant - 0 Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60' deep and demolition or construction
of structures over 3 stories in height
Main Service 200A TO I CODA 46.00
NEW CONST. DWELLM DOW SOL
OR ADDNS. & ACC. SLDS.' 3.50FT.
MW MLILT�-Ounff
NO14- VESID. @7.50
BRANCH CIRCLIM
&IS-=—
OU;ff-
. )
EX. OCCUp. OUTLET OR FD(n1RES 20 0 1*00
SAL 41 .50
=APPLNS
Ex. Occup. I EA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc_Wiring 1 23.001
— r—k2liz -El., S� /0 1 :;k_o, ere
I
PERMIT FEE
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEPE $
Mobile Home Installation Fee $
Energy Inspection Fee
OCC
CONST. TYPE
TOTALFEE$
I
HAZ
I D. FEES IMP
J IPLOOD
I COF
PARCEL
M
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
Indicated above for which fees have been paid.
By Date
PERMIT EXPIRES ON
M410) I
ReceiptNo.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
14f,
77,
2 -12-04
LITTLE, Gary
i'ag wor er-1
M�'Ul
A-7
P
RESIDENTIAL
21-12-04 92-861 P,E
LITTLE, Gary
1319 Block Rd, Gridley
Unit A
ag worker mh utilities
?4 —919
72—
V=OK-
0 Not OK
Not Applicable
Not Ready MOBILE. HOMES
Date MODJL-E'HOME UTILITIES (Plans) OK except #'s
I
It
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements _.' I
2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusies
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof: Shthg-Roofing
11. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
ate POOLS (Plans) OK except #'s
1. Setbac ks- 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-Enclosu res -Panel boa rds- Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
zqpjacr-Requirements-setbac-ks-Easiments
MH Support Sketch
P�ocation-Test-Fall-C/0 Concrete
L--�4. %YW�.�ation-Test- Easement Neede. 0 LSJAtch)
5. Elec Location -Clea /Amp -Concrete
L_—�CGaA
ocation-Test-Wrae/1 �5"ft.
s 0
or/ /"L"ft./ P'LPG
'Z—�W-11161earance
& Disconnect
Utility'Clearance
Datz L2!n
70!1d* B- 1 R�� Card B-1
Date
Card B-1 Date Card B-1
Date
MWILE HOME INSTALLATION (Plans) OK except #'s
til. Zghing Req u ire ments-Setbacks Easements
b -'-Footings; Size -Spacing -Marriage Line
3. as; MH Test- Demand-Valve—Connector
qctricity; MH Test -Cross vers- Brea ke rs- Clearances
�Di ; MH Test -Fall -Flex Connector
tz'wSter; MH Test -Regulator -Connector -
L.,;�.ater and Sewer Connected -C/0 to Grade -HD Approval
�,Q,Iai�and Electricity Tagged
!-::�E
�Insp. let6w�;>
_42$� Cert. of Occupancy
Da ley —d�S_VCard
B-1 Card B-1
Date
—Card B-1 Date --card B-1
7
I
It
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements _.' I
2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusies
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof: Shthg-Roofing
11. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
ate POOLS (Plans) OK except #'s
1. Setbac ks- 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-Enclosu res -Panel boa rds- Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
V OK
0 Not OK
Not Applicable
Not Ready RESIDENTIAL
Date UNDERFLOOR (Plans) OK except If's
U- Zon i ng -Setbacks -Ease ments-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. Sternwalls, Main; Steel -Bloc kouts-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/0 -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. Pienums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Access & Ventilation
16. Insulation
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit).OK except #'s
Water Htr.: Vent -Access -Co mbust ion Air -Baffle
17. Water Pipe: Test & Anchor -Nail Protection
18. D.W.V.: Test -Fittings & Anchor -Nail Protection
9. Shower Pan: Test. First Floor -Tub Access
20. Test -Tub & Shower. -Second Floor -Tub Access - ---------
21. Gas Pipe: Size & Anchors
--- - - ----- - -- ----------- - --
Date Card B-1 Date Card B-1
- --- - - - ---------- --------------------
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except ft's
22. Fixture & Transformer Clearance -Ins. -Protection ------------------
- -- - - - - - -- 23.-E-Iec. Recept-acles Spacing -Lights & Switches at Doors -------------
24. Size Boxes & No. of Cond uctors-Sta pled
---------------------------
25. Romex Installed Close to Edge of Studs & C.J.
-- - ---------- - - ---------------- ---------------
-------------- 26. --Eq u i p..- Gro und- made-up-w/M ec h.-Fastne rs- 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
29. Range Circ. ga. Cu or Al -Oven Circ. ga. Cu or Al.
Insulated Neutral 0- Yes 0 No
------------- 30.- Service-Riser-Co-nductors-&-Gro-u-nd-Main- Disconnect -------------
-------------- 31-.-Equip.-Cleara-nces Panel s- Motors- Mech. Equip.
--- --- -32, Clothes -Clos-et-Light-Shower-Light-Spa.-.Light ------------------------
- - ---------- 33.--Smoke-Detector ------------ - -----------------------------------
-----------------------------------------------------------------------------------
Date Card B-1 Date Card B-1
-------------------------------------------------------------------------------
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
------------ 34.--A.-C.- Ducts Insu-1ation &-Sup-port ----------------------------------
35. Vent Fan: Exhaust above insulation
-----------------------------------------
-------------- 36,--Cond-ensate Dr,ai-n- & Overflo-w: Size -&-Grade --- ------- --
37. Furnance-Vent: Access -Comb. Air -Return Air Vent- 115 outlet
------- ------ 38,.- At.ti-c-Access-&- Pla tfo_rm_i f -Fu rna nce in_.Attic -----------------------
---------------- ---------
Date Card B-1 Date Card -B-1
------------------- --------- ------
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except k's
39. Sils. Proper Material & Anchors
------------------------------------------------------
------------- 40.- W-alls- Studs -Nailing. Spacing-&-Bracing-Plates-Sou-nd--..---
- -- - - -4 1.. -Bearing -Wal Is.ove-r- G -i rde rs-&- Floor N ai hing -------------------------
------------ 42.--Draft-Stop-i-n Walls- (rat- p -roof) - - -------- - --------- --------------
43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub
------------- - ------------ ---------
44. Headers & Beam -Size & Bearing
')Ingle & Duplex)
Da,%e *FRAMING (Continued)
45. Hangers-PoSt Caps -Anchors -Connectors
46. CIng. Joist-Rttr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat clearance
Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles
---49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
50. Garage Fire Protection Framing
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-Underfir. Access_
-------- - --- 57.- Glazing Area -Glass Protection -Skylights -Plastic
58. Shear Walls: Nailing -Bolts
59. Insulation -Walls -Ceilings
60. Infiltration-Walls-Winclows
------- - ----------- - - ----- -
D -a t e.
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
61. Ext.' Steps -Door & Sidelight Protection- Land i ngs
62. Smoke Detector
--------------- --
63. Furnace: Vents -Clearance -Comb. Air -Connector -
In Garage: Above Floor- Ducts-Mech. 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: Clbarances-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 Protection
7;. Insulation -Foam -Looked in Attic 0 Yes
--------------- -------------- - - --- - -----
--------- ---78.-Guard-Rails & Deck -Const ruct ion- Post Caps
79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor 1:1 Yes
80. Following instid.: Drive 11 Yes 0 No: Walks ID Yes
Planters 0 Yes 0 No
0 No;
81. Stucco: Brown -Finish
-------------------------------
82 A C. Unit: Disconnect. Electrical, Plumbing
--------------------------------
83. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to
Openings
-.84L.Water Well: Disconnect, Electrical, Plumbing
.85.-.Exl-eriorEIec.-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 Gracle-HID Approval
91. Energy Compliance Certificate -Other Certificates
------ -------------------------- - -----
-------------------- - ---------
Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
-------------------- -------------------
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
CORRECTION NOTICE
Wati- _S4 3
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 notify 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.
V
phzo-v //-
7Z) CzA/Vif-e-q- 14e,-, 1641le-0110CS —/D L1V1,c*--
AltA�q � -, L- - 0EW01v -S.
Lo.40 CX6C-% E-t?� �SL&C57-=4�,ck.
L �
M
AL"
Re-
Date -7 - -17 -2.2-�-spector
REV 11 /91
100
Inspector
Date
REV1 1/91
COUNTY OF BUTTE
DEPARTMENT OF,PUBLIC WORKS
1469 Humboldt Road, Chico, C -A - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541.
747 Elliott Road, Para se, CA - (916) 872-6307
CORRECTION NOTICE
Z
OWNER PERMIT N&.
A routine inspection indicates that the following violations of Butte County Ordinances. exist at
the above address and should be corrected. Please notify this office when correction of work
is completed. If you have any questions pertaining to this matter, or need additional explanatio
please contact this office immediately.
4f s la"11111 11" e-f-� Az�e
A
Inspector
Date
REV1 1/91
MOBILEHOME INSTALLATION ACCEPTANCE
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE.
OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 538-7541
PERMIT NO./
Address or location of mobilehome A Z U19 7- /4-
Owner's'name
Owner's address
Insignia or hud number
Manufacturer's name—+4n1/AA
Serial numb of V.I.N.,-M 777 9 Year of manufacture,
ci a I—A-0-pl%vi ng In stal I dti on
IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION
ACCEPTACE SHALL BECOME INVALID. THIS, FORM SHALL NOT BE USED WHEN THE
MOBILEHO-%";E IS INSTALLED ON A FOUNDATION SYSTEM.
V7
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At
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4
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CS (5 (Z-,
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V/ CGUNr� OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
V
ASSESSOR PARCEL NUMBER
()21-19n_nQ4
ZONING
A-40
BUILDING PERMIT ff
OWNER
Ga 1�itt
TELEPHONE
846-4195
SO. FT. OCC. BUILDING VALUAZI"
OWNER'S MAIL G Ss
..Rje
287 O'Brian, Gridley 95948
CONTRACTOR'S NAME
Unknown
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$20.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$35.00
PLUMBING PERMIT
FilingFee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
1 7717
L MAP
Water piping
7.00
Each qas water heater or vent
7.001
USE OF STRUCTURE
SF [:1 DuplexF� Mobilehome[] Other 00 A tj 0
J SPECIFY
Gas piping system I - 5 outlets
5.001
Building sewer
15.00
Mobile Home S I G I W
@ 15.001
TYPE OF WORK
NewF_J AdditionF] Remodpl�o Utilities[] Installatioriv )therE]
Describe work:
I I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
main service 600V OR LESS
200A OR LESS
18�.50
Main service 200A TO 1 OOOA)
37.501
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
0 1 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
Fl 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)
1, 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 OCCUPM
OR ADDNS. ' ACC. BLDGS.
3.64 sq.ft.1
NEW CONSTR. MULTI -OUTLET
NON-RESID. BRANCH CIRCUITS)
@ 5.00
(POWER APPARATUS.&)
SINGLE OUTLET CIR
Ex. OCCUP( OUTLETS OR FIXTURES
120 @ 7iT,
qAL C@ 46
OCCUP. FIXED APPLNS OR -_
— Ex. OUTLETS (RESI'D.) EA.)
1 3.00
Temporary service
15.00
Mobile Home Facilities
15'.001
Misc. Wiring
15.00
+
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� The permit is for $100.00 (valuation) or less.
F1 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.
I shall not employ any person in any manner so as to become subject
,P1 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
Fi I ing Fee 15.00
Heating
I Cooling
Hood
00'
6.50
Ventilation
LH
P
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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnif and kewryarmless the County of Butte against
;, cos� 9
all liabili t -i es gmentE ts, a <penses which may in any way accrue
against said nty in c ting of this permit.
X X_ Date
_14
Signature f A Ii d/nt – Ownerb4t_ Contractor El Agent
0 pp "
An OSHA. p.ji required for e/C7.-tions over 5'0" deep and demolition or construct-
ion of structur er 3 stories in height.
Mobile Home Installation Fee $70.00
Energy Inspection Fee $
OCC
CONST TYPE
I TOTAL FEE $105.00
1 1
HAZ
—
1 0 FEES
F ZOO
I CDF
PARC!E�L, �D�D�
ISSUE
This permit is hereby issue'd under the applicable provi-
sions of the Butte ounty Q e and/or resolutions to do
work indicat 0 W i c
Vef h fees have been paid.
E 9F BLIC WORKS
- �wui
By 4:4— Date
PEOM_�rtxkkES "' Date
Receipt No.
WHITE-O.P.W., YELLOW-ASSFSSOR. PINK -INSPECTOR. GOLDENROD-APPLI CANT
COUNTY OF' BUTTE DEPARTMU4,h'.0ig PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
ERM.il APPLICATIION DATA SHEET
Permit No.—
OWNER 42 r -
A. P. No.
Bui'ldi.ng Inspector M*00— Date
Proposed Building Use
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 sub>tted . .....................................
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. Complete plans in duplichte/triplicate, signed by preparer. of plans
4. Complete engineered plains and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ... ...........
8 Engineered truss details and layout in duplicate (required prior to 'plan check)
C9)Mobilehome installation data including manufacturer's installation
instructions ..................................... 1�
10. Fees of $ ........................
11. Chico Urban Area fees paid .......................................
12. Par f ,e a i d ....................................................
e
riva School District fees paid ..............
14. Sanitation �pproval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) Use:—(B) Parking: . ......
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
Pre -Inspection for required ... Pre-Inspec. request to
Building Inspector (Date)
!;tp� ntractor's license information (No., Name Style, Classification) ...
""' Gertificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner 0, Mail to owner 0) .....
24. Recorded copy of Agricultural Acknowledgment Statement .........
25. Letter of nature authorizption
k -e;10 Pe -e _S Za2
dorp -71 17 1!9,Z
When you issue the permit, process as follows: Mai I to owner. Mail to contractor.
Telephone and hold for pickup at —office. — el.iver w/inspector.
Other—
Appli
Date
/11
Copy of H.az-Mat form sent _HE�alth Dept. —Fire Dept. -----Air Pollution Date
Copyofplanssent ____HeaIthDept. —FireDept. —Other— Date— By.
The following data must be submittedpriqr,�o per (Circle new item not checked above).
1. Index permit for above items No. _X, w , tA i
2. Additional items required:
Contractor, designer, owner, was advised of above required data by —phone ---mal I —counter by—date
Contractor, designer, owner, was advised of above required data by —phone —ma I I —counter by— date
Plans checked by OW Date_at311!9?_ Plans approved by- ICLX Date
—Sets of plans on hold in —File cabinet _AP folder
Copy—DPW
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - OrovWe, Califbrnia 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
_Z /_ /Z — a
ZONING
, r,�- — '-/' (-)
BUILDING PERMIT
OWNER
��el r- I/ L
TELEFHONE
g L16 — 411 f
SO. F T. OCC. BUILDING VALUATION
OWNER'S MAILff4,G ADDREKS
-L ? -7
CONTRACTOR'S NAME
L—V,, 14 ",VL,, V-- -
TELEPHONE
I
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
F i I i ng Fee 15.00
Each Trap
1 5.00i
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SFEJ DuplexF� MobilehomeF] Other Ljvr-V--e--
JSPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home I S I G JW I
@ 15.00
TYPE OF WORK
New F� Addition [:1 Remode I [] Uti lities Installationj% Other E]
Describe work:
(22
I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
main service 600V OR LESS
200A OR LESS
18.50
Main service 200A TO 1 OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Busines S
and Professions Code and my license is in full force and effect.
License No. Classification
D I, as the owner, or my employees with wages as their sole compen_
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El I, as the owner, am exclusively contracting with licensed .UIILIaL;L-
ors. (Sec. 7044)
F1 I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUPM
OR AODNS. ACC.BLDGS.
3.64 sq.ft.1
NEW CONSTR. 14rJLTI.OU TLET
NON, E-910* BRANCH CI.C..TS)
@ 5.00
(POWER APPARATUS.&
k SINGLE OUTLET CIR
:�76d
Ex. Occup( OUTLETS OR FIXTURES
20
AL (@ 4F;A
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) A.)
—
3.001
Temporary service
15.001
— Mobile Home Facilities
15.00
Misc. Wiring
'15.00
I
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� The permit is for $100.00 (valuation) or less.
E] 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.
I 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 shall be deemed revoked.
MECHANICAL PERMIT
Fi I ing Fee 15.00
Heating
Cool ing
Hood
6.50
Ventilation
P emit 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 ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner EJ Contractor [I Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee 7 C)
Energy Inspection Fee $
occ
CONST TYPE
;
1 TOTAL FEE $ /05
HAZ
I D FEES I
IMP
I FLOOD
I CDF
I PARCEL
11�0
T his permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No.
wmire-o.P.w.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
P
BUTTE COUNTY DE13ARTMENT OF PUBLIC WORKS
7 County -center Drive, Oroville, CA
.PHONE: 538-7541.
MOBILEHOME INSTALLATION SHEET
1. Ownerls Name: C-, 4vt,
2. Installer s Name: Ck "Pi
3. Is the site currently under permit? Yes No F
(If yes,
furnish permit number
OR
Is the site an
existing site?
Yes
No
FV
V_\j
(If yes, furnish two plot plans.) I
4. W -ill the,mobilehome be located at least 5 ft. -away from septic tank and leach
fields and cle I ar of all setbacks and easements? Yes 9-1 No F-1 -
(If no, clarify
5. What is the-mobilehome electrical rating? --------------- Amps
6. What is the mobilehome site service rating? ------------- Amps
7. What is the mobilehome site circuit breaker rating? Amps
8. Is there any other electric load to be served by the
mobilehome site service? -------------------------------- Yes El No
(If yes, identify the load and size: (Load) —(A.mps)
9. What is the.mobilehome site gas pipe size? -------------- - Z t1'e- (in.)
? ura-' LPG
10. What 'is- the --type- -of gai-s.--service. Ndt l..
11. What is the gas pipe length from meter or tank to the
mobilehome? --------------------------------------------- - -7 5
12. What is the mobilehome gas demand? ----------------------- - (BTU)
*(This information not required if pipe length less than 6 n,
natural gas or less than 50 ft. on LPG.)- 6
I U C Uj
3 4Eo Ty
NEXT PAGE MUST BE COMPLETED TO PROCESS PERMIT 9JgMf',9,k-W,,,G,% DEPAR11 I T1 11VAIENT
APPROVED
MOBILEHOME SUPPORT DATA
If other than single wide,
Mobilehome Mfr._A9tK1e4+e furnish Setup Model No. Year -
Width— t2 (ft.) Box Length__W/d_(ft.) Tagalong or.Expando Size ft. -x ft.
.on all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation.
manual and -structural setup sheets (if not on file with the County of Butte).
FOOTINGS (check one) I.' Wood' -pressure treated or'founda*tion grade. 2. Other (spec'ify)
El'
SUPPORTS (check one) F;�<l 1. Concrete.block. 2. Other-(spec-ify)
Pier Footing Sizes and Locations
SINGLE -WIDE
Beams >
Line 2 Line
Line I
Line 1. Piers:
Size -Min.
Spacing -Max. -------
I j
From Ends -Max
Line 2 Piers:
Size -Min -------------
Spacing-Max. -
�From Ends -Max --------
Main Beams
Tag or. Tri.ple
I.Inp 4
Line
.Line 1 Openings:.
Size -Min - ------------------ .x
EaCIT SiCe of CTeniigs
With Width Over ---------
Line 3 Piers: (Under Bearing Wall Only)
Size -Min -------------------
Spacing-Max ----------------
From Ends -Max --------------
Line 3 Roof Loads,
Size -Min. x 11x 11 "x 1. 1 Ix 1. -A
Location (I om -F
F ----
root
Line. 4 Piers-. -Line 5 Piers:- (Under Bearing.,Walls.-Only)
Size -Min -------------- Size -Min --------------------
Spacing-Max ---------- Spacing -Max ----------------
From Ends -Max -------- From Ends -Max --------------
N
Line 5 Roof Loads:
Size -Min. ------
x 11x 11x 11x 1. -x I. .1x I.
Location (From Front)
J
COUNTY OF BUTTE -,DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPL11GATION AND PERMIT
PERMIT NO.
q;�� :�a 6 1 /
ASSESSOR PARCEL NUMBER
021-120-004
ZONING
PC 40
91,
BUILDING PERMIT
OWNER
Gary Little
TELEPHONE
846-4195
SO. FT. OCC. BUILDING VALUATIOVZ]
OWNER'S MAILING ADDRESS
287 O'Brian, Gridley 95948
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$
ARCHITECT OR ENGINEER
E NO.
Plan Checking Fee
$20.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$20.00
PLUMBING PERMIT
FilingFee 15.00
I'll 9 'RI ack Rd - CrJ ril in3;
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME 7=L
MAP
Water piping
7.00
Each qas water heater or vent
7.001
USE OF STRUCTURE
SF [R DuplexF� Mobilehomef-1 Other 6A Uoi,14--,
J SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
Mobile Home S FGTW
15-00
3@ 15-00 45.0(
TYPE OF WORK
NewF� Additiono RemodelE] UtilitiesIX Installation[D Other
Describe work: MHU
H 1A
I
Permit Fee
$60.00
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
600V OR LESS
main service 200A OR LESS
18.50 18.50
Main service 200A TO 1 OOOAi
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F� 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)
0 1, 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.8d)
OR ADONS. ( ACC. BLOGS.
3.64 sq.ft.1
NEW CON5TP_ MULTI -OUTLET
NO N.R E S, 0, B . ANCH CIRCUITS)
@ 5.00
(POWER APPARATUS
SINGLE OUTLET CIR.&)
Ex. OCCUP(OUTLETS OR FIXTURES
�,20 @ .1,6
.0
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.)
3.00
Temporary service
15.00
Mobile Home Facilities
15.00 15.00
Misc. Wiring
'15.00
I
Permit Fee
$48.50
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.
IUI I shall not employ any person in any manner so as to become subject
41'�2'4 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 S Lich
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
LContractor
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 ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemni fy and �Aep harmless the County of Butte against
a M
ll liabili t ie dgments, costs, all-Vexpenses which may in any way accrue
It
against Sal n y in conse ranting of this permit.
X vfk_ Date
Signature -1 nt — Owner Contractor [] Agent
An OSHA renired for excavations over 5'0" deep and demolition or construct-
ion of stru r stories in height.
Mobile Home Installation Fee
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE
$128.50
HAZ
1 0 FEES
MP
I FLOOD _JC0F
PARCEL
PO
SSUE
This permit is hereby issued under the
sions of the Butte C ty Code and/or
or
I
vvor�kTindicated bog 'or fh' h fees
,e ncn
ID
E R�PU IC
U
By
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date 7
Receipt No_&60 1W
WHITE-O.P.W.. YELLOW-ASSCSS6.. PINK -INSPECTOR. GOLDEN ROD-APPL I CANT
COUNTY OF BUTTE DEPARTMENTOE PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PEDMITAPPLA At-1.04-'�RATAIHE ET
'Permit No.
OWNER (!,I a A. P. N o. 2-1-17--6'1
Proposed Building Use LAJ Buildin . g Inspector ma 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 submj.Ued-. ....................................
--!5=- 2. Plot plans in 4jjj �Wftri2licaldsigned by preparer of plans ........ 3S -1-7 —6i Z
3. Complete plans in duplicate/triplicate, signed by preplarer. of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form..' ........................................
6. Energy Design C6mpliance and supporting"documentation .........
7. Statem�nt of Intent for Non -Heated and AC Buildings ..............
6. Engineered truss details and lavout in dunlicate (renuired prior to n'lan check'
9. Mobilehome installation data including manufacturer's installation
instructions .....................................
10. Fees of $ ........................
11. Chico Urban Area fees paid .......................................
12. Park fees paid ...............................................
k— School District fees paid ..............
Sanitation approval fromf Health Department
15. City of Chico plumbing permit ......... I -****---*---*-
16. Plot plan and business license approval from City of
(see City for other requirements) WOW
CP Planning approval for (A) Use: -9 (B) Parking: -
8 Improvements may be required. Contact Land Development Section DPW
Driveway permit (construction approval required prior to occupancy) IT/Z-
20. Pre -Inspection for required ... Pre-inspec. request 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 0, Mail to owner 0) .....
copy of Agricultu ' r1al Acknowledgment Statement .........
25. Letter of signature auth rization ...... .............................
14==�I-- A!9 tj I'Le , 0 ex t,%,CL
Wfie-n you issue the permjt, process as A0'fl`oW'*' s: W Mai I to owner. —Mail to contractor.
Telephone ---and hold for pickup at _off ic Deliver w/inspector.
Other
p -I ica
1 3: ---
Date 5- -F,,—
Copy of H.az-Mat form sent —Health Dept. —Fire bept. ----Air Pollution 'Date
Copyofplanssent ---HealthDept. —FireDept. —Other— Date— By—
The fol lowing data must be submg, tE
1. Index permit for above items No.
2. Additional items required:
,rior to permit issuance: (Circle new item not checked above).
Contractor, designer, owner, was advised of above required data by—phone---jnail —counter by—date
Contractor, designer, owner, was advised of above required data by —phone —ma I I —counter by— date
Plans checked by 6W --Date. 313119'2- Plans approved by Rd Date A 22.
Sets of plans on -hold in
Copy—DPW
File cabinet —AP folder
TO: Building Department 0-c-
- j ;aL
FROM: Encroachment Permit Se ction
RE: Driveway Clearance
�F' //7/1 1:310,�k RI
owner location
12- - 0/-(
AP #
Driveway permit 14e -lit -e7"j has been issued for the above property.
w7
si date
/ature
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Orovialle, Calffornia 95965 - Telephone: 916/538-7541
APPLICATJON AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
4,410
BUILDING PERMIT
OWNER
TELEPHONE
0 CY16- way S�_
SQ.FT. OCC.1 BUILDING VALUATION
OWNER'S MAILINGJADDRESS
97— 0�"IaA S4
CONTRAC . TOR'S NAME _V�_ J ITELEPHONE
CONTRACTOOQFTS*We� ADDRESS
__T7`N�WN
Fireplace
CONSTRUCTION LENDER
Total Valuation Is
Filing Fee
$ --ts-.eo
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ a eq—
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Z 3 /9— 12/oc/s' 12a(
Permit fee
$
PLUMBING PERMIT
FilingFee 15.00
Each Trap
5.001
9s- 41,g;l
Solar or heat pump water heater
20.001
LOT NO.
UBDIVISION NAME
is
ARCEL MAP
1P
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SFD� DuplexF� MobilehomeF-] Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home FR
615.00
TYPE OF WORK
L UtilitiesX
N Addition 0 R emode I [] Installation[] OtherE]
Describe work:
KA
Permit Fee
$ 6 0
Contractor
ELECTRICAL PERMIT
Fi (i ng Fee 15.00
main service 600V OR LESS
200A OR LESS
18.50 VOL
Main service 200A TO 1 OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F� 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
F-1 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)
1, 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.&)
OR ADONS. ' ( ACC. BLOGS.
3.64 sq.ft.1
NEW CONSTR. MULTI -OU _T
IT"
NON-RESID. BRANCH CIRCUITS)
@ 5.00
POWER APPARATCJS 1,)
SINGLE OUTLE T R.
Ex. Occup(OUTLETS OR FIXTURES
.2,0=,10
AL (a 4F;A
FIXED APPLNS. OR
Ex. Occup. OUTLETS_(_RESI c .) F A.)
3.001
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
'15.06
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� 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.
I 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 wit h such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I i rig Fee 15.00
Heating
Cooling
I Hood
6.501
I Venti lation
Permit Fee
$
Contractor e'
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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant Owner El Contractor El Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
TOTA L FEE $ /-Z
HAZ
1 0 FEES I
IMP
I FLOOD
I COF
I PARCEL
I PC)
HD
ISSUE
T his permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
I
applicable provi-
resolutions to do
have been paid.
WORKS
Date
I
Receipt No.
.HITE-O.P.W.. YELLOW-ASSE55OFt. PINK -INSPECTOR. GOLDENROD-APPL I CANT
Return to DPW
AGRICULTURAL STATEMFNT OF ACKNOWLEDGEMENT
FOR RESIDENTIAL DEVELMMNT
Section 26-8. 1 of the Butte County Code
requires this. acknowledgement -be recorded
prior to issuance of a building permit.
92-013329
The property described herein is adjacent
to
land or included within an area zoned
Recorded
for
agricultural purposes, and residents
i Official Records
of
this property may be subject to incon-
County of
veniences or discomfort arising from the
Butte
use
of agricultural chemicals, including,
Candace J. Grubbs
but
not limited to herbicides, pesticides,
. Recorder
and
fertilizers; and from the pursuit
11:33am 27 -Mar -92
of
agricultural operations including,
but
not limited to cultivation, plowing,
spraying, pruning, and harvesting. which
92- 13329
Rec Fee
Cash
PUBL
5.00
5.00
XX I
occasionally generate dust, smoke, noise, and odor. Butte County has established agricul-
tural zones which have as a priority use for productive agricultural purposes, and residents
within said zones and on adjacent property should be prepared to accept such inconvenience
or discomfort from normal, necessary farm operations.
All that re6l property, situate in the County of Butte, State of 'California, described as
f ollows:
That portion of the Southeast quarter of Section 3, Township 17
North, Range 2 East, M.D.B. & M. and being more particularly described
as follows:
Commencing at a point on the line of said Section 3, distant thereon
North 1233.0 feet from the section corner common -to Sections 2, 3, 10
and 11 of said Township and Range hereinabove referred to: thence
south 89' 34' West a distance of 2571.0 feet to the Easterly boundary
line of that certain piece or parcel'of land conveyed to the Sutter
Butte Canal Company by deed from Frank C. MItchell, et ux, dated
February, 28, 1921 and recorded in Book 188 of Deeds, at page 345;
thence North along -the Easterly boundary line of the tract of land so
conveyed and the Easterly boundary line of -the tractconveyed to the
Sutter Butte Canal Company by Dead from S.F.'Wilcox, et ux.dated
January 10, 1919 and recorded In Book 172 of -Deeds, at page 70, dis-
tance of 746.70 feet to a point which is 660 feet South of the East
and West centerline of said Section 3; thence North 89* 49" East
parallei with said East and West centerline, a distance of 2571.Q,
feet to the Section line common to Sections 2 and 3 of said above
mentioned Township and Range; thence South along said Section line#
a distance of 735.50 feet to the point ofbeginning.
Date: 7- PROPERTY OWNERS:
State of Cal i forni)a On this the 27thday of March , 1992 before me, the
).SS. undersigned Notary Public, personally appeared
County of Butt,e
Gary, W. Little
Personally known to me. '" Proved to me on the basis
lai
of satisfactory evidence.
to be the personZ�.whose namets�)_ is
subscribed to the within instrument and acknowled-ed thathe-
0
executed the same for the purposes therein contained. -PIN 14ITNESS
WHEREOF, I hereunto set my hand and official seal.
Present A.P. No.F�6/=/��_
OFF SEAL Notary C
SHAR N E. ZUNINO
NOTARY PUBLIC - C41FORPM END OF 00cumc
. BUTTE COUNTY NT
IF I MY COMM. EAxiv)ires Juna i A i aa -i
9 Cj
k:L cn
C'n
0-i
0 )
NOTE-�-AM
cyi a qualst,..,
UnIfonn, Bui Plumbi
and the
Location of structures &
Squipment shall be as shown
& clear -of all easements.
06 VA19 0
,z eel- W\rz 10
5-01 FW-1gyn q OF eO&O
4epoc 3!�-e ( - :>M
v?
E]
_�L66PIIJ&
DO(Z M
C9 ck
_AL__ (I
!�PIN&
,z Yo F
P
Good Prx-Mem
'pacified U** in 0�%.:
42X Mechamical Ca6m
This set of -plans and specifications MU S'T be
kept on the ;o6 cf. a I f imes and it is unlawful to
make any- cl"nges or alteratioihs on same withouf
written permis5ion fr m the Department of Pu6lie.
Works, f I ffe.
U�
MA
BU
(
E COUNTY
BUILOW
ki
DEPARTMEN1
Ar%
RO E
Q$
Z:
C�
-4.
eACIC r -e
OF eo^c)
AGRICULTURAL AFFIDAVIT
ENPLOYER/EMPLOYEE
Please read the following'carefully bef.ore signing:
Section 24-21.2 Agriculture Employer/Employee
(Applicable only in zones A75,.A-10, A-20, A-40 and A-160)
An individual who verified, by personal affidavit and by.affidavit
of his employer, that he is, or will be, employed at least thirty-
two (32) hours per week for at least sixteen (16) weeks per year,
or*that his primary sourceof annual income is, or is anticipated
to be, derived from, any of the following described occupations:
CD
(a) The prepara-tion, care and treatment of farm land, pipelines
or ditches., including leveling for agricultural purposes,.
d fertilizing the soil;
plowing, discing an C3
CD
(b) The sowin and planting of�'-� agricultural or horticultural
commodity;
(c) The care of any agricultural or horticultural.commodity.
As used in this subdivision, "care" includes, but is not
limited to, cultivation, irrigation, weed control, thinaing,
heating, pruning, or tieing, fumigating, spraying and -dusting;
(d) -The harvesting of any agricultural or horticultural commodity
including, but not limited to, picking, cutting, thrashing,
mowing, knocking off, -field chopping, bunching, baling, balling,
field packing, and placing in field containers or in the ve-
hicle in Aich the commodity will be hauled on the farm or to
the place of first processing;
(e) The assembly'and storage of any agricultural or horticultural
commodity including, but not limited to, loading, roadsiding,
banking,, stackingi binning and piling;
CD
(f) The raising, feeding a -ad management of livestock, fur -bearing
0
animals, fish, frogs and other aquatic animals, and bees in-
.cluding, but not limited to, herding,.housing, hatching, milking
.shearing, handling eggs and extracting honey;
The operation, conservation, improvement or maintenance of
such farm and its tools and equipment.
AGRICULTURAL AFFIDAVIT
EKPLOYEE
Employee
Employee's Address (Present)
Name of Owner
Owner's Address
Thone 0
Ou-ner s Assessor's Parcel No �2_1 - I �Z
Building/��nviro=e.ntal-Health----/
t�e_rmit Description and Number
-Issued
Date
EP�lja�nnin`gDepartm�ent �Appr�oval_-
Date �31 P#_2212- i --I Q-0 - 00 Li
Zone A - L4 0 Dwelling on.A
do..declare, subject to the
penalty of perjury, that -I am the employee of
address (present) 28-7 diweK 4&e Gd� e:;- on Ap#_z,_�-z �-�
and that I wi 11 be employed under Section 24-21.2 for atleast
(a) to (g)
thirty-two (32) hours per week for at least sixteen (16) weeks per year on
AIV
Dated. 3 — --Z� 2!;p
COU14TY Oir Ourfft
BUILDING DEPt
MAR 2 7 jgsZ
AGRICUIPLURIAL AFFIDAVIT
EIPLOYER
Employer.
Employer's AddreA (Pres'ent)
Name of Owner—
Owner'.s Address
Owner's Assessor's Parcel No. -a- 2- - giq
Building/Environmental Health
Permit Description and Number
Date Issued B
Planning Department Approval:
Date cA-1- Zone A- 4D Dwelling. on AP#,—!2-v-1r1-0
By_
-o the
do decla re, subject t
penalty o/per-jury, that I am the employer of We, z -,a,
address (present) on
and that I will be employer'under Section 24-21. . 2 -T-aT—t o . (g) for at least
thirty-two (32) hours per week for at least sixteen.(16) weeks per year on
�—O ��-
Signed
Dated
Np
j;;;Ac.
Af .0 1; le A
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District 6 L9 I OLCY Building Department No.
A.P. Number Jurisdiction city County Z661 9 z 9nV
W300N Ing
Property Owner 6AV-11 UuLe Ming zio ;TNn03
Property Location/Address 1519 GLCr--If , i?(3�10
Subdivison Lot No.
Residential Development
Commercial/Industrial
Sq. Footage -720
Addition (Group R)
= Sq. Footage_
Addition (including Exterior
Roofed Areas)
Z(, t,9 -z
Building DepartmentRepresentative Date
(Floor Plans reviewed. by School District Personnel)
District Identification No.
s
ic c.1ehifie"'ihat:,_
z4u�o� �.School Distr: t'
(Applicant)
(Street Address) (Phone Number),
(City) State)
has- complied with t he requirements of Resolution No.
representing square feet.
District ReD(esentative
Paid by Check Number Remarks: -JW W-4��C-t
Bank Number
Paid by Cash
(Zip Code)'
by payment of $
Date
_41- ./ '&:� -7 — —
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district)
feeform.wicl (4/92),
No. of Living
MHI
Units
A& %AjOetetZ
New
Sq. Footage -720
Addition (Group R)
= Sq. Footage_
Addition (including Exterior
Roofed Areas)
Z(, t,9 -z
Building DepartmentRepresentative Date
(Floor Plans reviewed. by School District Personnel)
District Identification No.
s
ic c.1ehifie"'ihat:,_
z4u�o� �.School Distr: t'
(Applicant)
(Street Address) (Phone Number),
(City) State)
has- complied with t he requirements of Resolution No.
representing square feet.
District ReD(esentative
Paid by Check Number Remarks: -JW W-4��C-t
Bank Number
Paid by Cash
(Zip Code)'
by payment of $
Date
_41- ./ '&:� -7 — —
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district)
feeform.wicl (4/92),
RESIDENTIAL
-04
. r�21' 12 92-863 P, E
LITTLE, Gary
.1319 Block Rd, Gridley
Unit B
'ag,worker mh utilities
JOB FINALED (Date) W c7i
Signature - �;� ( ��'
OFFICE COPY
Address
GAS
?e-- �-c
Meter By D a t
ELECTRIC
Meter Bv baiW��
JOB FINALED (Date) W c7i
Signature - �;� ( ��'
,1 OK
0 Not OK
Not Applicable,
Not Reaqy MOBILE HOMES
Date M,0810E HOME UTILITIES (Plans) OK except #'s
_Z,,,.ng Requirements -Setbacks -Easements
Z-8oli—sspecial MH Support Sketch
3. Se,;4ep,�bcation-Test-Fall-C/0 Concrete
ion -T est- Ease men t Needed (Sketch)
-Clearences-grnd-/ /Amp -Concrete
,5. Electricity; Location
6. Ga.5�-ifocatipn-Te!ft-Wrki�W"L"ft.
11_�1_7'Nat. or/ P'L L/ /LPG
k---'7' WegC-lbarance & Disconne�t
%----g—Utility Clearance
Card B-1
Date Card B-1 Date Card B-1
Date MOEIjkE HOME INSTALLATION (Plans) OK except #'s
. ZOQ�ng Requirements -Setbacks Easements
&��.�ootings; Size -Spacing -Marriage Line
MH Test-Demand-Valve—Connector
p4'El_�,Wricity; MH Test -Crossovers -Breakers -Clearances
L,�D�rn; MH Test -Fall -Flex Connector
A-131I.W.-ter; MH Test -Regulator -Connector
"eater and Sewer Conn,.ected-C/0 to Grade -HD Approval
Electricity Ta'gged
of Occu
7r-
.1 0 -
Date ard B-1 4 Date Card B-1
Dat� Card B-1 iDate Card B-1
-7-5.
MISCELLANEOUS.,
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans) 0KN;xcept #'s
1. Zoning Requir.ements-Setbacks-Easements
2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Decks; Griders and/or Joists-Deckin_g_-Bracing-Stairs-Rails
4. Wood Awn.; Posts- Bea ms- R ft rs.-Con necto rs
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg: Si I s -An c hors- Stu ds- Rftrs-Trusses
9. Siding; Nail i ng -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
ate, ard B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbac ks- Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boa rds-1 ns. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date' Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
V OK
0 Not OK
Not Applicable
Not Ready RESIDENTIAL.(!
Date UND112FIFLOOR (Plans) OK except #'s
1. Zonirfg-Setbacks-Easements-Flood-Slope
2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3�.01=tg_ Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks: Soils -Steel-/ /Ftg. Depth
5. Sternwalls, Main; Steel -Bloc kouts-Wrapped
6. Sternwalls, 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/0 -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. Pienums & Ducts: Clea rance-Materia I -Su pport- ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Access & Ventilation
16. Insulation
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit),OK except #'s
16. Water Htr.: Ven t -Access -Co mbust ion Air-.Batf;e - -----------------
-17. Water Pipe: Test & Anchor -Nail Protection
------ 18. D.W.V.: Test -Fittings & Anchor -Nail Protection -------
Shower Pan: Test. First Floor -Tub Access
20. Test Tub &-Shower,-Second Floor -Tub Access ---- - ----------
Gas Pipe: Size-& Anchors
- - - -- - - ------------------------- -
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B- I
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -ins. Protection
- ------------------- - --------------------
---- - - - - - -- 23.-E-Iec. Recept-a-cles Spacing -Light -s-& Switches at Doors -------------
24. Size Boxes & No. of Cond uctors-Sla pled
- ----------- - ---------------------- - ----- ----------- - ----------------------
25. Romex Installed Close to Edge of Studs & C.J.
- - --------------------------- -------------------
26. Equip. Ground made up w!Mech. Fastners-Bond Gas & Water
- --------------------- - -----------------------------
27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI
- ----------------------- ----- - -------- - -------------
28. Subfeed Wire Size ga. Cu or Al-A.C. Wire Size ga.
Cu
29. Range Circ. ga. Cu or Al -Oven Circ. ga. Cu or Al.
------ -1 ----------- I-nsulated Neutral --------- 0 Yes - ------ 0 No -------------------
-------------- 30.- Service-Riser-Conductors-&-Gro-u-nd-Main- Disconnect -------------
-------------- 31. -Equip. -Clearances -Panels- Motors- Mec h. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
-------------
-- - --------- 33.-. Smoke -Detector ------------------------- - -------------------------
------------------------------------------------------------------------------------
Date Card B -I Date Card B-1
-------------- ---------------------------------------------------------------
Date Card B-1 Date Card B-1
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. Furnance-Vent: Access -Comb. Air -Return Air Vent- 115 outlet
- ----------- - ---------------------
Attic -Access-&.. Pla Iform-i f -Fu rnance in -Attic ------------------------
--- - ------ - ------------------------ --- --- ---------------------------- ----- --------
Date Card B-1 Date Card B-1
- -- ---- - ----------------------------------- - -------------------- ----------------
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
39. Sils. Proper Material & Anchors
------------- - ----------------------------------- - ----------------- - --------
40. Walls Studs -Nailing. Spacing & Bracing-Piates-Sound
---------------------------------
41. Bearing Walls over Girders & Floor Nailing
--------------- - -------- ----------------
42. Draft Stop in Walls (rat proof)
--------------- - ---------------------------------
------------- 41 Fire -Stops: Furred Ceilings -Stairs -Chases -Tub - -----
44, Headers &. Beam -Size & Bearing
"Ingle & Duplex)
Date FRAMING (Continued)
45. Hangers -Post Caps -Anchors -Connectors
46. Cing. Joist-Rftr. ties- Pu rlin -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 T -Check Garage -3rd Story, 2 Exits
------ - ----- 53.- Stairs: Width -Head room -Rise-Run- Land i ng -Fire Protection
54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
55.� Siding -Nailing Veneer
56. Stucco Mesh -Drip Scr�ed-Fcl. V6nts-Underflr. Access
57. Glazing Area -Glass Protection-Skyl ights- Plastic
----------- - 58. Shear Walls: -Nailing -Bolts
59. Insulation -Walls -Ceilings
------ - -------
------- - ----- 60.- Infiltration -Walls -Windows
-------------------------
------------------
_D_ate_______.___ Card -B-1- Date Card B-1
Date Card B-1 Date Card B-1
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
-----------------
------------- 65.-G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel: Breaker Sizes & Labels
------------------------------
67. Stairs & Rails
---------------------------------
68. Fireplace or Stove: Cl�arances-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-Dafnper
--------------
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 Protection
----------------
-------------- 7-,'.- Insulation -Foam -Looked in -Attic 0 Yes
78. Guard Rails & Deck Construction -Post Caps
--------------- -------- - - __
79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
--------------- Clearance Looked -under Floor- 0 Yes
80. Following instld.: Drive 0 Yes 0 No: Walks 0 Yes 0 No;
Planters 13 Yes 0 No
-----------------------------------
81. Stucco: Brown -Finish
82 A'C. Unit, Disconnect. Electrical, Plumbing
------------- I ------ ------------- - ----------
83- Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to
Openings
84. Water Well: Disconnect, Electrical, Plumbing
- --------- --- - --- -------------
85. Exterior Elec. Trim: G.F.I. Receptacle- U nderg round
----------- ------------------- ___
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 -HO Approval
___ _91.- Energy-Comp-liance-Certificate.-Other Certificates -
---------------------------- - --------
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:
---------------------------------
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
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 notify 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.
n4ln 544A dC1 IGP�— -n
COUNTY OF BUTTE
i'DEPARTIVIENT OF PUBLIC WORKS
1469 Humboldt Road, Chico, CA - (916) 891�2751
7 CoLMty Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
.4
CORRECTION NOTICE,<3�(o5c
..4
OWNER PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinancesexist at
the above address ' and should be corrected. Please notify this office when -correction of work
is completed. If you have any questions pertaining to this matter, or need additional exp!anation,
please contact this office immediately.
MOBILEHOME INSTALLATION ACCEPTANCE
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE
OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 538-7541
C
PERMIT NO. �
Address or location of mobi lehome -,L3 / ? UAJ,!�L_! L3
Owner's'name
Owner's address
Insignia or hud number
Manufacturer's name LA L -
Serial number'ohV.I.N. 's, (p Year of manufacture
IF.TH,E 60BILEHOME'IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION
ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE
1,
MOBILEHOMr=-IS INSTALLED -ON A FOUNDATION SYSTEM.
OWNER f
PERMIT
MH*'lJT IL. CLEARANCEADATE
INSPECTOR
ELECTRIC
GAS
Suppo t
Struc. I
Compaction
Test.Req.
Service
Other
I
Pipe
Y*ESj NOL
YES NO
Size
Load
Type
-Size
Len th
�/VAT
COLIN -DEP
,;_Y,i� BUTTE 14RTIVIENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
/,PERMIT NO.
-7
ASSESSOR PARCEL NUMBER
021-120-004
ZONING
A-40
BUILDING PE
OWNER
&a r Little
TELEPHONE
846-4195
SQ.FT. OCC.1 BUILDING VALUA71TN
L&
OWNER'S G ADDRESS
287 O'Brian, Gridley 95948
CONTRACTOR'S NAME
Ow.ier
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
Total Valuation is
LENDER'S MAILING ADDRESS
Filing Fee $ 15.00
Permit Fee $
ARCHITECT OR ENGINEER
E NO.
Plan Checking Fee $20, 0
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
Permit fee $35.00 -
PLUMBING.PERMIT FilingFee 1 15.00
I'll 9 R1 nrk- Rd Cri r! I Py
Each Trap 1 5.001
Solar or heat pump water heater 1 20.001
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
1
Water piping 1 7.001
Each qas water heater or vent 1 7.00
USE OF STRUCTURE
SFEI DuplexF� MobilehomeE:] Other r4
SPECI FY
Gas piping system I - 5 outlets 1 5.00
Building sewer 15.00
Mobile Home S I G I W 6 15.00
TYPEOF WORK
NewD Addition [:1 �emode I t iti s ristallation Other
Describe work:
_14Q
Permit Fee $
Contractor
ELECTRICAL PERMIT Fi I i ng Fee 15.00
main service 600V OR LESS
200A OR LESS 18.50
Main service 200A TO 1 OOOA) 37.50
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)
1, 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 OCCUPM 3.64 sq.ft.
OR ADDNS.* ( ACC. BLDGS.
NEW CONSTFL MULTI -OUTLET
N N.RES,., BRANCH CRCU, TS) I @ 5.001
(POWER APPARATUS &) F_
SINGLE OUTLET CIR.
20 @ 75cl
Ex. Occup( OUTLETS OR FIXTURES dAL 0 ARA
FIXED APPLNS. OR I
Ex. Occup. OUTLETS (RESID.) EAJ 3.001
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring -15.00
I I
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F1 The permit is for $100.00 (valuation) or less.
E] 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.
I 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 shall be deemed revoked.
Contractor
MECHANICAL PERMIT Fi I ing Fee 15.00
Heating
Cooling
Hood 6.50
Ventilation
Pennit 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 keepft—rjPess the County of Butte against
all liabi I ities��nts costs an xp Ks which may in any way accrue
ri . of
against saidebVdy in I. In this permit.
-okseque' Z -
X Date
Signature of Appl�i,.?I— 0- p 51 Contra.,., E] Agent 1:1
.i,.d r;
An OSHA �,ermit fo v.ti ons over 5'0" deep and demolition or construct-
..f
ion of struc ures over stories in height.
Mobile Home Installation Fee $70.00
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $105.00
I ii;�
0 FEES
MP
FLOOD
I
I COF
PAIZCE
I P
Ss
I
This permit is hereby issued under the applicable provi-
sions of the e eCoy Code and/or resolutions to do
work in at d a for which fees have been paid.
'OR (OF PUBLIC WORKS
By Date F -2k -*:-
PERMIT EXPIRES Date -?,I
Receipt No. 6 -<-/
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT I
OWNER
COUNTY OF BUTTE DEPkAR_TMEN7-qr,'j'01UBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTE�fl DRIA,OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMi-TIAPPLICATION DATA SHEET
W
Permit;,No.—
A. P. No. -2-
Proposed Building Use Building Inspector 406) Date
At time of permit application, I was advised the following data must be submitt d prior to permit 'processing and/or issuance:
DATE RECEIVED APPROVED
1 . All items have been submitted.
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. Complete plans in duplicate/triplicate, signed by preparer. of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy'Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
/8, Engineered truss details and layout in duplicate (required prior to 'plan check)
(2.Wobilehome installation data including manufacturer's installation
instructions .......................................................
10. Fees of $
11. Chico Urban Area fees paid .......................................
Parkfeespaid ....................................................
School District fees paid .............. 1
4. Sanitation 4provai from Health Department
15. City of Chico plumbing permit ...............
16. Plot plan and business license approval from City of I
(see City for other requirements)
17. Planning approval for (A) Use:—(B) Parking: -
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
20. Pre -inspection for required ... Pre-Inspec. request to
Building Inspector (Date)
Contractor's license information (No., Name Style, Classification)
k722- Certificate of Workmans Compensation Insurance ..................
-23. Owner -Builder Verification (Given to owner 0, Mail to owner 0) .....
24. Recorded copy of Agric'ultural Acknowledgment Statement .........
5. Letter of signature autl�Wrization
Pe -e 3 f 3 4 0
She
20 MLLU djqaAaw ce
When you issue the permit, process as follows: Mai I to owner. —Mail to contractor.
Telephone
and hold for pickup at
Other
#I
Appli
off ice. �,=!:? Del.iver w/inspector.
Date
Copy of Haz-Mat form sent —Health Dept. "—Fire Dept. I ----Air Pollution Date
Copy.of plans sent -----Health Dept. —FireDept. —Other— Date— By.
The following data must be submitted priorWrZ
it issuance: (Circle new item not checked above)
1. Index permit for above items No. _�Jq
2. Additional items required:
Contractor, designer, 6wne , was'advised of above required data byAA/_phone__rnai I —counter by VAAJ ..clate 1j1 -1t0 -
Contractor, designer, 0�),r, was advised of above required data by —phone _rna I I —counter by— date
ni
Plans checked by NAJ —Date__M1 191- Plans approved by D ate
—Sets of plans on hold in
Copy -DPW
File cabinet _AP folder
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
ZON.ING -V
A ,� 6
BUILDING PERMIT
OWNER
TELEPHONE
?-16 //9�
SQ.FT. OCC. BUILDING VALUATION
OWNER'S MAILINGr DRESS
--,7 Y 2 - -
—FO—NTRACTOR'S NAME:
t4 11,A 1, 0 LA, I'- I
T-ELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Fi I i ng Fee 15.00
13117- 23 /c, If le
Each Trap
5.001
��Y, , d
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
1
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SFEI Duplexf_� Mobilehome[-] Other di�
1 1 �_� SF ECIFY
Gas piping system 1 - 5 outlets
5.00.;._
Building sewer
15.00
Mobile Home S I G I IN
15.00
TYPE OF WORK
NewD AdditionO Remode I [:] Utilities lnstallati4L Other
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
Main service 600V OR LESS
200A OR LESS
18.50
Main service 200A TO 1 OOOA)
37.50
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
0 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 L;UIILFCIL;I-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUPM
OR ACDNS. ( ACC. BLDGS.
3.64 sq.ft.
NEW CONSTR. MULTI -OUTLET
NON-RESIO. BRANCH CIRCUITS
@ 5.00
(POWER APPARATU &
SINGLE OUTLET C11 .
Ex. Occup( OUTLETS OR FIXTUR S
120 @ 75
OCCUP. FIXED APPLNI.,IR,,.
Ex. OUTLETS
3.001
Temporary service
15.00
— Mobile Home Facilities
15.00
Misc. Wiring
—
'15.00
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� The permit is for $100.00 (valuation) or less.
1 have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
Fi I ing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
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
ail liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant - Owner El Contractor [I Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
Energy Inspection Fee $
OCC
I CONST TYPE
I
I TOTAL FEE $
HAZ
1 0 IIES I
IMP
I FLOOD
I CDF
I PARCEL
PD
HD
ISSUE
T his permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No.
WHITF-D.P.W.. YELLOW-ASSE350R. PINK -INSPECTOR, GOLDENROD-APPL I CANT
1. owner's Name:
2. Installer's Name:
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville,-CA
PHONE: 538�7541.
MOBILEHOME INSTALLATION SHEET -
3. Is the site*currently under permit? Yes No r-1
(If yes, furnish permit number OR
Is the site an existing site? Yes No
(If yes, furnish two plot plans.)
H (i � 0, (e - -L>>
4. Will the mobilehome-be located at least 5 ft. away from septic tank and leach
fields and clear of all setbacks and easements? Yes No
(If no, clarify
F,
What is'the mobilehome electrical rating? -* ------------- Adb— Amps
(�6�- What is the mobilehome site service rating'? ------------- - 1690 Amps
Qj What is the mobilehome site circuit breaker rating? ----- Amps
8. Is there anv other electric load to be served by the
---------------------------------
Yes
No
mobilehome site
service?
(If yes, identify the load and size:
(Load)
—(Amps)
9.
What is the
mobilehome site gas pipe size? --------------
- ltz--
(in.)
-T
type
Natuta I.-
LPG�E
10.
e
What is th'
gas_
_,.of service
11.
What is.the
gas pipe length from meter or tank
to the
mobilehome?
------------------------- -------------------
(ft.)
What is the
mobilehome gas demand? ----------------------
-
(BTU)
*(This
information not required if pipe length less than �.-(g-6t4
natural gas or less,than 50 ft. on LPG.)
COUNTY
E
NEXT
PAGE MUST BE COMPLEM TO PROUSS
PEkMT Aluar"S
I)EPARTME&IMIT
Fft
APrKV
r% ^ V E D
F/A-0-
M
MOBILEROME SUPPORT DATA I I , 11
If other'61lan single wide,
Mobilehome Mfr.Wg�akes�ee furnish Setup Model No.. Year Z Z
Width (ft. ) Box Length_�.5�-(ft.) Tagalong or Expando Size ft. x ft.
on all mobilehomes-manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets (if not on.file. with the County. -of Butte).
FOOTINGS (check one) 1'. Wood-priessure'treated or foundat io . n grade. 2.. -Otfie-r (specify)
SUPPORTS (check one) 1 Concrete block* _Other (specifO
Pier Footing Sizes and Locations
----------
SINGLE-WIDE MULTI -WIDE
Line 1
2 Line 2
-`��N�Ma—in B—eams— >
LLae 2 —\ — — — — — — - Line
Line I L N
Lin. '2
Main Beams
Line
Line 1
�Lin:
Tag or Triple
1A np
17 Line
Line 1 Piers-: Line 1 Openi ngs:
Size -Min - ------------ Si ze-Min - -------------------
Spacing-Max. ------ Each Side of Openings
From Ends -Max - ------- With Width Over ---------
Line 2 Piers: Line 3 Piers: -(Under Bearing Wall Only)
Size -Min - ------------ Si.e-Mi ---------------------
Spacing-Max ------ Spacing -Max -----------------
From Ends -Max -------- From Ends -Max ---------------
Line 3 Roof Loads:
Ix
Size -Min ------------- �x.,. I.x IX -IIx I. 'Ix 1.
bocat ion (From Front)
F
Line -4 Piers: Line 5 Piers:- (Under- Bearing Walls On!
Size -Min ------------- Size -Min -------------------
Spacing-Max ---------- Spacing -Max -----------------
From Ends -Max -------- From Ends -Max --------------
Line 5 Roof Loads:
Size -Min ----------- I---- .1x 1Ix I.x IIx 1. ..x 1. 1Ix It
Location (From Front)
iriq" - r -rt-i -
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
,(Qne Form -Per Building)
t Building Department No.
School Distirg -6 OTLe q
A.P. Number oO County
J�� 6-004 Jurisdiction City
Property Owner CaAe-q Lvrn_n�'4','-
Property Location/Addre-is- I� 1c)
Subdivison Lot No.
Residential Dev6lopment
-No. of Living MHI Addition
Units
Commercial/Industrial Ar, - LuOetfE 9-
eel� I DE NiCOE
ew Addition
)resentaitive
(Floor Plans reviewed by School District Personnel)
Sq Footage 6 -7
(Group R)
Sq. Footage (including Ekterior
Roofed Areas)
Ef 126 7—
Date
District Identification No.
c
hool Districtcertifie,s",that,',
(Applicant)
(Street Address) (Phone Number)!.
(City)
(State)' (Zip Code)
has complied with the requirements of Resolution No. by payment'of $
representing square feet.
Schooldistrict Rejdresentative Date
Paid by Check Number
Bank Number
Paid by Cash
Remarks:
2
If, subsequent to the School District Representative signing this Butte Cobnty,4schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeformmkl (4/92)
AGRICULTURAL AFFIDANIT
EHPLOYER/EMFLOYEE
Please read the following carefully before signing:
Section 24-21.2 Agriculture Employer/Employee
(Applicable only in zones A -5,-A-10, A-20, A-40 and A-160)
An individual who verified, by personal affidavit and by affidavit
of his employer, that he is, or will be, employed at least thirty-
two (32) hours per week for at least sixteen (16) weeks per yearl
or'that his primary source of annual income is, or is anticipated
to be, derived from, any of the following described occupations:
The preparation,' care and treatment of farm land, pipelines
or ditches, including leveling for agricultural purposes,
plowing, discing and fertilizing the soil;
0
(b) The sowing and planting of any agricultural 'or horticultural
CD
commodity;
(c) The care of any agricultural or horticultural.commodity.
As used in this subdivision, "care" includes, but is not
limited to, cultivation, irrigation7 weed control, thinning
91
heating, pruning, or tieing, fumigating, spraying and-dus.ting;
ting of any agricultural or horticultural commodity
(d) -The harvesLl
including, but not limited to, picking, cutting, thrashing,
mowing, knocking off, field chopping, bunching, baling, balling,
field packing, and placing in field containers or in the ve-
hicle in Aich the commodity will be hauled on the farm or to
the place of first processing;
(e) The assembly'and storage of any -.agricultural or horticultural
commodity including, but not limited to, loading, roadsiding,
banking, stackingi binning and piling;
0 0
- f) The raising, feeding and management of livestock, fur--�bearing
animals, fish, frogs and other aquatic animals, and bees in-
cluding, but not limited to, herding, housing, hatching, milkin
shearing, handling eggs and extracting honey;
C)
.(g) The operation, conservation, improvement or maintenance of
such farm and its tools and equipment.
F,
L -
Dated 75
COUNTV OF 8 U'"Z
BUILDING DEPT
MAR - 2- 7 IN'
AGRICULTURAL AFFIDATIT
EHPLOYEE
Employe
Phond
Employee's Address (Present)
L
Name of Ovmer
Owner's,'Address krev�
Ou-ner's Assessot's Parcel No.. -6
Bui lding-/�Envi:rbt L �me n fa -f - -H i Fa! 7f 11,
���s-cr-i-p-t-:�on-and-Nu,lmb.Fer.-.
Y ---i
Date Issued -;;9 - PJ- 2- B
[P17ann7in7gD_ear_t�ment �App�rova�l_-'
p
I Ot-7- Zone—A - H 0 Dwelling on.A-Ppr
I Q-0.- 00 4
.Date—'3-'?,
By_L2�
17 C7 Ig WW 7- -VA
do declare, subject to the
penalty'of perjury, that -I am the employee
of C-�zt�
address (present)', _29 -7 �96fq%e_& A:f�
on AP#__.t?
and.that I will -be employed under Section
�4-21.2- for at,.least
(a) to (g)
�-thirty-two (32) hours per -week for at ledst'sixtee-P
(16) weeks.per.year on
Signe
za��e�
L -
Dated 75
COUNTV OF 8 U'"Z
BUILDING DEPT
MAR - 2- 7 IN'
AGRICUIPLUTILP�L AFFIDAVIT
E11PLOYER
Employer-.
Employer's Address (Present) 2-97 INPI-i'ft _Adjt<_.
Name of Owner
Owner's Address.
Owner's Assessor's Parcel'No. :Z 1 2-
Building/Environmental Health
Permit Description and Number,
Date Issued
By__��
Ph o ne
Planning Department Approval:
.Date —Zone A -,Ho_ Dw e 11 i ng. on AP #1 0 -?_1 - I -Z-C> __00
By.
I, (4.zt�e
W_
L,
. do declare, subject to the
penalty of
/ erjury,
p
that' -I
am the employer of
n
address (prese t)
on
and that I
will be
employer'under
Section 24-21.2 for at least
(a) to (g)
thirt-j-two
(32) hours per
week for at least sixteen (16) weeks per year on
A-V
Sig-ned
P. i-- �,q
Gk -:2 - _� _-J Ir e_
COUIV?v 0or — _'
BUILDING Do
MAR 2
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION ARD -PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
021-120-004
ZOi"',INt�____
A , -40
I F, i
BUILDING PERMIT W I
OWNER
Gal: t e
RAIM—MSS
TELEP ONE
846 4195
SQ.FT. OCC.1 BUILDING VALUATION
OWNER'S MAI
287 OBrian, Gridley 145946
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
__77�OWN
Fireplace
CONSTRUCTION LENDER
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ 20.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$20.00
PLUMBING PERMIT
FilingFee 15.00
1 '119 'Rlqrk Rd f1ri ('11 P:V
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
UBDIVISION NAME
is
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.001
USE OF STRUCTURE
SFEI DuplexF� Mobilehome[:] Other as s (A) 10 1- IL !f r—
PECIFY
Gas piping system 1 - 5 outlets
5.001
Building sewer
15.00
Mobile Home I S I G JW 1
@ 15-00 45.00
TYPE OF WORK
New R Addition [] Remodel[] Utilities InstallationEl Other F�
Describe work: I�M (B) �M-
H U
%
—3
Permit Fee
$60.00 -
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
Main service 600V OR LESS
200A OR LESS
I . 18.50 18.50
Main service 200A TO 1 OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El 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)
El 1, as the owner, am exclusively contracting with licensed MILI'lut-
ors. (Sec. 7044)
n I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.aj)
OR ACDNS. ACC.BLDGS.
3. 64 sq.ft.
NEW CONSTR. MU LT"OUT T
NON-RESID, BRANCH 1.4CUITS)
@ 5.00
I POWER APPARATUS.&)
%SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
42LO '6
1-46
OCCUP. FIXED APRLNS. OR
Ex. OUTLE TS (RESID.) EA.)
3.00
I
Temporary service
15.00
Mobile Home Facilities
1 15.00 15.00
Misc. Wiring
'15.00
I
Permit Fee
$48-90
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
n The permit is for $100.00 (valuation) or less.
E] 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.
I 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 th.e.W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all 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, indemni fy and k.9(tp harmless the County of Butte against
all liabili 3, judgments, c sts d xeenses which may in any way accrue
'0
ci� ,
against s unty in conseq e ranting of this permit.
Date ' 7
Signo ure of,/Ap.,//.'."nt Owner Contractor E] Agent F-1
An OSHA i it is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $128.50
HAZ
1 0 IEIS
IMP
I FLOOD
I CDF
I PARCEL
I PD
V
H
i�
ISSUE
L1.1
This permit is hereby issued under the
sions of the Butte County Code and/or
work inclicat d ab)��ve for which fees
OR P LIC
B Y ro 0 7, rall
PERWIT EXPIRE�S (Z Date Lf
applicable provi-
resolutions to do
have been paid.
WORKS
Dateq-3—f2_
Receipt No -&_&Z 4S !V
WHITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLD ENROO-APPL I CANT
I
L1.
OWNER
COUNTY OF BUTTE - DEPARTMENT OF'. UBLIC WORKS - BUILDING DIVISION
- - 1
7 COUNTY CENTER DRIVE - OROVIL6E. CALIfORN(&a.5965 - TELEPHONE: 916/538-7541
X
PERM11T-APPLIMMON DATA SHEET
11-i I I i -Permit No.
L t 77--e
A. P
_-4,
No. oe-1 'I
Proposed Building Use Building Inspector—M tQ Date
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1. All items have been subm
jIted . ....................................
2. Plot plans in duplicate/ 6ri Liicat- 812710Z j R
k signed by preparer of plans ........
3. Complete plans in duplicate/triplicate, signed by preparer. of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to 'plan check)
9. Mobilehome installation data including manufacturer's installation
instructions ........................................................
10. Fees of.$ . ........ I ..................
11. Chico Urban Area fees paid ........................................
12. -,Park fees paid .................................................... ...
A 1 --13 School District fees paid ..............
Sanita'tion approval from bldf pl&rt 0-,q wft&A Health Department
15. Cit)4�of Chico plumbing permit ............ .....................
--1,6. Plot plan and business license approval from City of
(see City for other requirements)
akm Planning approval for (A) Use:_aA 12191-917%) Parking: . ......
T8' improvements may be requireq. Contact Land Development Section DPW
Driveway permit (construction approval required prior to occupancy)
20. Pre -inspection for required ... Pre-inspec. request 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 0, Mail to owner 11) .....
-0(6724. Recorded copy of Agricultural Acknowledgment Statement ......... 2>11:7 t
—25. Letter of signature authorizgVon ............................
Aq Lvoowe� At -t; cA 61 U �'j
0
When you issue the permit, process as follows: Mai I to owner. —Mail to contractor rNyhJ
Telephone ea)
and hold for pickup at —office. _D iver w/inspec'tor�._
Other AZyi�tS 62r Aorm -ell A
t
WL11
Da
A P /16n t
V -0p e
Copy of Haz-Mat form sent —HealthDept. —FireDept - ----- Air Pollution Date
Copyofplanssent —HealthDept. —FireDept. . Other' Date— By—
The following data must be submitted lop4Q i)ev4:R4t issuance: (Circle new item not c
1. Index permit for above items No. 0�t) . hec'ked above).
2. Additional items required:
Contractor: clesigne <�, was advised of above required data by— one --mai I —counter by&1_.date 43 9Z
Contractor designer, owner, was advised of above required data by—phone —mal I —counter by— date
Plans checked by DW —Date -3/3t/97 Plans approved by GA-) Date 4
—Sets of plans on hold in —File cabinet _AP folder
Copy—DPW
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916i'53B-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONI%ql 'N
BUILDING PERMIT
OWNER
TELEPHONE
SO.FT. OCC. BUILDING VALUATION
OWNER'S MAILIf9G ADDRESS
z 9?_ ot [-e'(1 47 f4l Ip
CONTRACTOR*S NAME TELEPHONE
CONTRACTOR -Somist�NVG" ADDRESS
Fireplace
CONSTRUCTION LENDER
Total Valuation is
Filing Fee
$ ts_=
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
E NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
FilingFee 15.00
Zy & 1?d
Each Trap
5.00
(4 P, I W((9 L4
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00,
USE OF STRUCTURE
SF [I DuplexF� MobilehomeF_� Other
SPECIFY
Gas piping system 1 - 5 outlets
5.001
Building sewer
15.00
Mobile Home
@ 15.00
TYPE OF WORK
NewO Addition[:] Remodelo Utilities[] Installation[] OtherE]
Describe work:
I
Permit Fee
$ 15 0
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
600V OR LESS
main service 200A OR LESS
18.501 r,-10,
Main service 200A TO 1 OOOA)
37.501
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
El 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.&)
OR ADONS. ACC.BLDGS.
3.64 q Jt.
—NEW CONSTP_ MULTI-OuTLET
NON-RESID, BRANCH CIRCUITS)
@ 5-00
POWER APPARATUS &I
(SINGLE OUTLET CIR. I
Ex. Occup( OUTLETS OR FIXTURES
20 @ 76d
QAL_ (@ 450
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.)
3.001
Temporary service
15.001
Mobile Home Facilities
15.00
Misc. Wiring
'15.00
I
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
f'� The permit is for $100-00 (valuation) or less.
Ej 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.
r-1 I 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 shall be deemed revoked.
MECHANICAL PERMIT
Fi I ing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner 0 Contractor E] Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $
HAZ
I CI FEES I
IMP
I FLOOO
COF
I
I PARCEL
JP0
T . his permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No.
WHITE-O.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD-APPL I CANT
0 Buildinc Department
01 FROM: Environmental Health
SUBJECT: Sanitation Clearance
U
-Owner Locktion AP#
Plan Approved for: Sewaqe D-44..sposal Water Supply
Hold final for:
Final clearance O.K. for:
Clearance for bedroom mobile home.
. t I i I
Water Supply
Water Supply
Othert2 rm.
NOTE
Dats'
Sanitarian
I
LNV
NOTE-:-�-AM 'W cmarrship Shag U -te.
Acoxclan-ci- -�`th Good Pr--�cNc=
&f a quality 4 r th Specified uj:* jtj
UnIfonn. Builr,41t-r, Plurnbi g Mechamical Gaefe*
iud the
Location'of structures &
equipment shall be as shown This set of plans c ind specifications MUST be
& clear -of all easements. kept- on the ;06 af a I f imes and it is unlawful to
.(� / make any c6.,inges or alterations on some withouf
C S �106 VA1Z 10
C—T written permis:sion frc m the Deparfmont of Pu6i;r.
Bkscr-�. .(,Zs el --4 YA rz 0 . Works 'County of BlIffe.
b�)' FV -GM q or IZOAD
A
14
BU
BIU-ILDI?
AP
riz
Z:
Vogm
leff
S-0 I sel-
P-4 , OA CIC
17W
-E COUNTY
DEPARTMENT
�RO El
C�
Tzr-
q oF eo,,ko
It
92-013329 92-013329
IL
A� i
R e ed
cord
icial Records I
,�'I, -dounty 9:f
Butte
J. Grubbs I
Reco*r'd6r
xx
F
INSTRUCTIONS FOR RECORDING AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT
1. Insert the legal description of the property in the space provided
on the attached form. The legal description is the narrative
description of the property -7 which will be on your deed. If you don't
have access to the deed the Recorder's Office can provide this
information. (The description may be handwritten or typed in the space
provided or attached on a separate sheet if more space is required.)
2. Property owners must sign the form in the presence of a Notary Public
and have the -form notarized.
3. Make a copy of the form and then take the original and copy to the
Recorder's Office at 25 County Center Drive, Oroville (the
Administration Center building). The Recorder will record both the
original and copy. They will keep the original and return the copy
to you. Just bring the copy back to the Building Department at 7 County,
Center Drive. * (If you don't have access to a copier the Recorder's
Office can make the copy for an additional charge.)
RECORDER'S FEES: $5.00 - lst Page
$3.00 - Each Additional Page
$1.00 - To Make a Copy
It
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT
FOR RESIDENTIAL DEVELOPMENT
Settion 26-8. 1 of the. Bmtte County Code
requires this acknowledgement be recorded
prior to issuance of a building permit.'
The property described herein is adjacent
to land or included within an area zoned
for agricultural purposes,. and residents
of this property may be subject to incon-
veniences or discomfort arising from the
use of agricultural chemic ' als, including,
but not l'imited to herbicides, pesticides,
and fertilizers; and from the pursuit
of agricultural operations including,
but not limited to c ' ultivation, plowing,
sprayino,- pruning, and harvesting Which
occasionally generate dust, smoke, noise, and odor.
tural zones which have as a priority 'use for productive
within said zones and on adjacent property should be
or discomfort from normal, necessary farm operations.
'92-013329
Butte County has established agricul-
agricultural purposes, and residents
prepared to accept such inconvenience
All that real property situate in the County of. . Butte, State of
California, described as
follows -
That portion of the Southeast quarter of Section 3, Township 17
North, Range 2 East, M.D.B. & M. and being more particularly described
as follows:
Commencing at a point -on the li n6 of said Section 3, distant thereon
North 1233.0 feet from the section corner common to Sections 2, 3, 10
and 11 of said Township and Range hereinabove referred to: thence
south 89' 34' West a distance of 2571.0 feet to the Easterly boundary
line of that certain piece or parcel*of land conveyed to the Sutter
Butte Canal Company by deed from FrankC. MItchell , at ux, dated
February, 28, 1921 -and recorded in Book 188 of Deeds* at page 345;
COUNTY OF 13UTTE
thence North along the Easterly boundary line of the tract of land so
BUILDING DEPT
conveyed and the Easterly boundary line of the tractconveyed to the
Sutter Butte Canal Company by Deed from S.F. Wilcox, et ux.dated
January 10, 1919 and recorded in Book 172 of Deeds, at page 70, dis-
MAR 2 7 1992
tance of 746.70 feet to a point which is 660 feet South of the East
and West centerline of said Section 3; thence North 89* 49" East
parallel with said East and West centerlinet a distance of 2571.0
feet to the Section line common to Sections 2 and 3 of said above
mentioned Township and Range: thence South along said Section line,
a distance of 735.50 feet to the point ofbeginning.
Date: -7 - PROPERTY OVNERS:
State of Californi)a On this the 27thday of March , 1992 , before me, the
) SS. undersigned Notary Public, personally appeared
Countyj of Butte
Gary W. Little.
Present A.P. No. -21
Personally known to me. [3 Proved to me on the basis
of satisfactory evidence.
to be the person N� Whose name( ---4 is
subscribed to the Within instrument and acknowledoed that he
executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand -and official seal.
OFFICIAL SEAL Notar c
SHARON E. ZUNINO
NOTARY PUBUC - CALIFOR]KA
BUTTE COUNTY
f Comm. Ex0es June 13. 19,93
Te
-Vvyplr� -0 -
n�
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
021-120-M4
ZONING
A 40
BUILDING PERMIT
OWNER
GAff LXr=
TELEPHON'E
81
4(
SQe FT.' OCC.1 BUILDING VALUATION
W" MT 1,"
OWNER'S MAILING ADDRESS
287 O'BRIAN GRIMff 9—W4#
RACTOR
CONT 0WM 'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ is
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$ 22.50
ARCHITECT OR ENGINEER
L I C E N S ff-IN-0.
Plan Checking Fee
$ 2-0.00
ARCHITECT OR ENGINEER's MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS
1319 MACK ROAD GRIDLEY
Permit fee
$ 57.50
PLUMBING PERMIT
FilingFee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
UBDIVISION NAME
PARC�L MAP
Water piping
7.00
Each cias water heater or vent
7.00
USE OF STRUCTURE
1
SFEI DuplexF� MobilehomeFl Other AG WORM DOW
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home I S I G JW
15.00
TYPE OF WORK
New F� Addition [I Remode I E] Utilities [:1 Instal lationEl ther EJ
Describe work: INSTALL NEW WINDOWS TO ITPRO
AND UPGRADE ELEMIC,
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
600V OR LESS
Main service 200A OR LESS
18.50
Main service 200A TO I OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1 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. (See. 7044)
El 1, as the owner, am exclusively contracting with licensed (;UIILIdGt-
ors. (Sec. 7044)
I am exempt under Sec. Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.&)
OR AODNS. ACC. BLDGS.
3.5* sq.ft]
NE W C0N5TR_ "ULT'*OUTLET
N.N-RESI., BRANCH CIRCUITS)
@ 5.00
(POWER APPARATUS &)
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
1 20 @ 761
0) 451
5A (
FIXED APPLNS. OR
—Ex. Occup. OUTLETS I RESI EAT
3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 15*00
I
Permit Fee
$ 3USOU
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F-1 The permit is for $100.00 (valuation) or less.
E] 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.
I 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 shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
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 expi�psgls,.which may in any way accrue
against said 6o4ty in consequence ol_tp!�ganting of this permit.
X Date Z,
Signature of Applic Owner;K. Contractor�'O Agent
An OSHA perm�� �irq_uired for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
Energy Inspection Fee $
OCC
CONST TYPE
I TOTAL FEE $ 87.50
HAZ
I D FEES I
IMP
I FLOOD
I CDF
I PARCETI
7,DHD
ISSUE
This permit is hereby issued under the applicable provi-
sions of the Butte County Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OP,PUBILIC WORKS
y i Date
PERMIT EXPIRES 3
1
lIU370
Receipt No.
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD-APPLI CANT —1
YUNT,Y OF, BUTTE - DEPARTMENT OF PUBLIC WORKS PERMI-T-NO.
unt� Center Drive - Oroville, California 95965 - Telephore: 916/538-7541
APPLICATION AND PERViT-
ASSESSOR PARCEL NUMBER
021-120-004
ZONING
A 40
BUILDING PERMIT
OWNER
GARY LITTLE
TELEPHONE
846-4195
SQ.FT. OCC. BUII DING VALUATION
CONT EST 11000
OWNER ' S MAILING ADDRESS
287 O'BRIAN GRIDLEY 95946
CONTRACTOR'S NAME —1-7—ELEPHONE
OWNER
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is 11000
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$ 22.50
ARCHITECT OR ENGINEER
E NO.
Plan Checking Fee
$ 20.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
1319 BLACK ROAD GRIDLEY
Permit fee
$ 57.50
PLUMBING PERMIT
FilingFee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
1
UBOIVISION NAME
77T;,�
L MAP
Water piping
7.00
Each qas water heater or vent
7.00.
USE OF STRUCTURE
SFEI DuplexF_1 Mobilehome[] Other AG WORKER DORM
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
Mobile Home
@ 15.00
TYPE OF WORK
NewD Addition [:] Remodel[] Utilities[:] Installation[] Other
Describe work: TNqTAT.T. NRW wTNnnwq Tn IRF.PT.A('F. qffliTTERS
A ND I JPGR A DE ET ECIR I C.
Permit Fee
$
contractor
ELECTRICAL PERMIT
FilingFee 15.00
main service 600V OR LESS
200A OR LESS
18.50
Main service 200A TO 1 OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F� 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)
El I, as the owner, am exclusively contracting with licensed L;UIILrctt;t-
ors. (Sec. 7044)
F1 I am exempt under Sec.-, Business and Professions Code
for this reason
NEW CONST DWEL.LING OCCUP.&)
OR ADDNS.' ( ACC. BLCGS.
3.64 sq.ft.1
NEW CONSTR_ T'_OU L T
U�
NO N.RES,., _�;A 111: H CTI R -E:: U I T S
@ 5.00
(POWER APPARATUS.&)
SINGLE OUTLET CIR
Ex. Occup( OUTLETS OR FIXTURES
20 @ 754
dA1 8 drJ
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESIO.) EAJ
3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
-15.00 15.00
I
Permit Fee
$ 30.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F] The permit is for $100.00 (valuation) or less.
E] 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.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
6/05" 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 1 15.00
Heating
Cooling
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harm] th County of Butte against
all liabil I ties, ju ments, costs, and I h may in any way accrue
e,peE ?!Tice
against said ty in co ence ��_g'of this permit.
rise L�i �
X Date
Signature of Applic Owne�K Contractor Agent F
An OSHA perrn >9
,Ki5 required for excavations over 5'0" deep and demolition or construct-
Lion of struc tur,es over 3 stories in height.
Mobile Home Installation Fee
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $ R7 -,,n
HAZ
I D FEES I
IMP
I FLOOD
I CDF
I PARCEL
, PD
F -T
HD
ISSUE
This permit is hereby issued under the
sions of the Butte County Code and/or
work indicated abovg for which fees
DI � �Oy
By 1�!JC
PER T EXPIRES C6ate
applicable provi-
resolutions to do
have been paid.
WORKS
Dateq_3--q2_-
/ 110370
Receipt No.--
WHITE-O.P.W.. YELLOW-ASSrSSOR. PINK -INSPECTOR. GOLDEN ROD-APPL I CANT 11
_7W9_Ar 17 �w KIP14Z f M T_; i W q K,
0"" S
AW
COUNTY OF BUTTE_\-DIEPARTMENT OF PUBLIC WO KS - BUILDING DIVISION
ER
7'COUNTY.CENTER , RIVE - OROVILI!E, CALIFORNIA 959W-'T��PF�fONE: 916/538-7541
'7
PERKtT'A'Pt,,FLICATIONDAT_ASHEE,,T"I
Permit No.
OWNER A. P. No.
Proposed Building Ufse 6sz/�Awws ANt�T/ce_-,t- Building Inspector- /45- - Date *1
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 .11
2.
........................ * * * , * * * * *
Plot plans in duplicate/triplicate, signed by preparer of plans ........
3.
Complete plans in duplicate/triplicate, signed by preparer. of plans
4.
Complete engineered plans and calcs, with wet signature on plans
5.
Hazardous Material Form ..........................................
6.
Energy Design Compliance &nd supporting documentation .........
7.
State ment of Intent for Non -Heated and AC Buildings ..............
8.
'
Engineered truss details and layout in duplicate (required prior to 'plan check)
9.
Mobilehome installation data including manufacturer's installation
instructions .......................................................
10.
Fees of $ ........................
11.
Chico Urban Area fees paid .......................................
12.
Park fees paid .........................
13.
School District fees paid ..............
,4
Sanitation approval from Health Department
15.
City of Chico plumbing permit ......................................
—16.
Plot plan and business license approval from City of
(see City for other requirements)
Planning approval for (A) Use:_(B) Parking: . ......
18.
Improvements may be required. Contact Land Development Section DPW
19.
Driveway permit (construction approval required prior to occupancy)
20.
Pre -Inspection for required ... Pre-Inspec. request to
Building Inspector
21.
Contractor's license information (No., Name Style, Classification) ...
22.
Certificate of Workmans Compensation Insurance ..................
23.
Owner -Builder Verification (Given to owner 0, Mail to owner 11) .....
24.
Recorded copy of Agricultural Acknowledgment Statement .........
25.
C06
Letter of signature authorization ..... - * * * 'T
A-yiee50 ? A
27.
When you issue the permit, process as follows: — Mail to owner. -
__!=::f-_T�eIephone- and hold for pickup at 0 office.
Other
4 -
Applicant
Mail to contractor.
_9ei)iver w/inspector.
6
Copy of Haz-Mat form sent ' Health Dept. —Fire Dep;K --Air Pollution Date
Copyofplanssent _L___HeaIthDep t. —FireDept. —Other— Date— By—
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone—mal I —counter by—.date
Contractor, designer, owner, was advised of above required data by—phone —mal I —counter by— date
Plans checked by BW . Date -41,319 2- Plans approved by &4) Date !If-3f9Z
Sets of plans on hold in —File cabinet _AP folder
Copy—DPW
I --
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephor--: 916Z538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
6,2
ZON
BUILDING PERMIT
OWNER 6,41
ZC, 6h6lE
TELEPHONE
r06 _�
SQ.FT. OCC. BUILDING VALUATION
.
___ 419,�)
0 W N E R�';S PFA I �C. (N G A 2 aA)
,"Kss
_E_0_NTRACTU.,bN.
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
7,
Filing Fee
15.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 2 Z -
ARCHITECT OR ENGINEER
LICENS E NO.
Plan Checking Fee
$ 2-0
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$ 5 7, TC>
PLUMBING PERMIT
Fi ling Fee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
1
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTVRE
SF [I Duple.F� MobilehomeFj Other /� (Y Worl<'&? 0(3 (,M
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home S I G I IN
1-5.00
TYPE OF WORK
New F1 Addition 0 R emode I [] Utilities [I Installation[] Other
Describework: Mysz4a A116(A) U�),;Vntjws I (:>
6�7 0 De
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
600V OR LESS
Main service 200A OR LESS
18.50
Main service 200A TO 1 OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
1 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
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed L;UIItIdL;1-
ors. (Sec. 7044)
El I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUR.&)
OR ADONS. ( ACC.—BLDGS.
3.6* sq.tt.1
NEW CONSTR. MULTI -OUTLET
NON-RESID, EIR A C , �:, �, C U.TS)
@ 5.00
(POWER APPARATU &
F
SINGLE OUTL _ T CIR.
Ex. Occup( OUTLETS OR FIXTURES
1.2. @ 76d
(a 464
FIXED APPLNS_
Ex. Occup. OUTLETS (RE S.
3.001
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
'15.00 7 S—cu—
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� The permit is for $100.00 (valuation) or less.
Ej 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.
I 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 shall be deemed revoked.
MECHANICAL PERMIT
Fi ling Fee 15.00
Heating
Cooling
LH:ood
6.50
I Venti lation
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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X . Date
Signature of Applicant — Owner 0 Contractor [] Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct.
ion of structures over 3 stories in height.
Mobile Home Installation Fee 41
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $
HAZ]
0 FEES I
IMP
I FI.06�
COF
I PARCEL
PD
H
T his permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
y
PERMIT EXPIRES Date
I
applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No. 116370
WHIYE-O.P.W.. YELLOW- ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
Ll
�f
COUNTY OF BUTTE - Department of P ' ublic Works..
7 County Center Drive, Oroville, CA 959�5 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and earing
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. 1 personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
2. 1 (have/have not) kete_�� signed an application for a building permit
for the proposed work..
3. 1 have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. 1 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 Contractors License No.
5. 1 will provide some of the work,but I have contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner
Social Security Number
Date 7Z
NOTE: This -Owner -Builder Verification is sent to you as required by Sections -19831 and
19832 of the Ca'lifornia Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
a
m
-BUITE COUNTY
ILDING DEPARTMENT
PPROVED
Isp if .�rz - 9-o
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(o ck KJ
7-1 Ir V^
ne
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0�,
tAb
I
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10
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WC -C
0
STATE OF CALIFORNIA—BUSINESS, TRANsi%3RYAftN AND HOUSING AGENCY
-DEPARTMENT OF, HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
N ACTIVITY REPORT
AREA OFFICES'�.
i"ern Area ',;q
i�
Date R �;�4by f
11000 Tfilrd Streit
Sacramento, CA 91581
4
To
Name P.O. Box 1407
Sacramento. CA
Address' #2 ON12-14M
Tel. (916) 44"136
Activi i:te(If other than above) Southern Area
21XIS Iowa Avenue
131!) 6%4_,,
Bift B, Suite 102
Riverside. CA
OwCne er than above) .92507-2435
Tel. (714) 782-4420
Address
PURPOSE OF REPORT: (Checked as appropriate)
E1.,INSPE*CTION RECORD ONLY.
13k. INFORMATION ONLY-:,
NOTICi Ol� VIOLATION AND RELATEWINFORMATION:_ -This report, provides notice of
violations of the California Health' and. Safety Code, Division' 13 or the California Code oL Regulations;- Title'.'.'
25. Part, 1, Chapter _/—, Sections, indicated.-.1copies. of the regulations may be-obtairled from the State. -of
California, Off ice of Procurement_ . Publicatiofis-'Sectiorf,-P.O. Box 1015,.North Highlands, CA,95660-10 15.
Violations indicited shall be corrected and a written request for I urther inspection filed with the Area Off ice
indicated above on or before The request for inspection shall be accompanied by
minimum fee -of $ Oza j2e 7
A4
A permit shall be obtained from the.Area Office identified above forwork to correct item(s)
If you believe this report has been issued -in error or is factually incorrect, please coriftict the Area Supervisor at the
Area (Mice indicated above. -
INSPECTED UNIT -IDENTIFICATION:
Tv�e of 'Unit Box Size Overall Size
Manufacturer. Year and Model
— FIT Decal No.
HUD LABEL or HCD insignia No. Serial No. or V. 1. N.
FILE IDENTIFICATION
CPT a FAC. ID
ASSIMNI
IVT
E I WID.' 2�1_t IfIDA-if 9
.42
CE AREA,
INSPECTION DATA.`
71M REPORT ONLY
INITLAL INSPECTION REINSPECTION
HOME/uW FLOORS
VIOLATION DATA:_
TOT�1_ MP TENANT'_
i19—F— y M 4P _L Gio*.J-'NP
MH ALTERATION TYPE: -
AC [:] Acc 1:1 R;,OOF 0 _' Flo o E
THRO-PARTYMON11TORIN& ""'N
OAA
ii;� Ei OL is E
7
_1_kCOMPLY
DAA Mlt�l
MP INSPECTIM DATA:
N')
W.
BLGIFIX W Lar FW LOT AS
'EH INSPECTION, DATA�'
EL INACTIVE
,__ACT1VE
MAX CAP�
P CAP'
SIFD oortm
FEE ACCOUNTINM-
COL# -3
DM
INSPFCWN
INSIGNIA
OTHER
ATTACHED FEE ID.
INSPECTION. RESULTS OR INFORMATION: e,4w cf %4 -o -j
1-9 0/1JV11_ 4 lcue /-17 IL;X.
_1e Jf Ic
7) Ir 4' A
71
L_ r
-13 -47,-e-
ectlow. Required,, Proi
Relhep
EP'ARTMENTAL'tit E_ONL-YiZ�Aal 0�668e-i
'e
4-
E aforcem t�A I 'Other,
an
I _1W-4,
COPIES TO:.j, R El*,- or AA' '13i 6L EL oth '4?
SEN02 er.:
..SUPERVISOR REVIEW". DATEr COPIES. sEurBY.- DATE�
PAGE:.W. 00� _—
L .fi Ai�
0 �*6rihem Area' --'0,
Box -1407
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AGRICULTURAL AFFIDVIT
E?IPLOYER/EMPLOYEE
Please read the following'carefully before signing:
Section 24-21.2 Agriculture Employet/Employee
(Applicable only in zones A -r -5,.A-10, A-20, A-40 and A-160)
An individual who verified, by -personal affidavit and by affidavit
of his employer, that he is, or will be, employed at least thirty-
two (32) hours per week for at least sixteen (16) weeks per year,
or'that his primary source of annual incom6-.is,,or is anticipated
to be, derived from, any of the following described occupations:
(a) The prepara-tion, care and'treatment of -farm, land, pipelines
or ditches, including leveling for agricultural purposes,
plowing, discing and fertilizing the soil;
CD
(b) The'sowing and planting of any agricultural or horticultural
CD
commodity;
(c) Th'e care of any agricultural or horticultural.co=odity.
As used in this subdivision, "care" includes, but is not
limited to, cultivation, irrigation, weed control, thinning,
heating, pruning, or tieing, fumigating, spraying and -dusting;
(d) _The harvesting of any agricultural or horticultural -commodity
including, but not limited to, picking, cutting, thrashing,
0 C)
mowing, knocking off, -field chopping, bunching, baling, balling,
field packing, and placing in field containers or in the ve
hicle in w1iich the commodity will be hauled on the farm or to
the place of first processing;
(e) The assembly and storage of any agricultural or horticultural
commodity including, but not limited to, loading, roadsiding,
banking, stacking, binning and piling;
�- <Z 0 1
- f) The raising, feeding and management of livestock, fur -bearing
CD 0
animals, fish, frogs and other aquatic animals, and bees in -
g
cluding, but not limited to, herding, housing, hatching, milkin
- honey;
shearing, handling eggs and extractin.,
.(g) The operation, conservation, improvement or maintenance of
such farm and its tools and equipment.
11
AGRICULTURAL AFFIDAVIT
E1,1PLOYEE
Employee 4 le-kapLcLi-n V&_svcce��_
Phone
Employee's Address (Present) J -5 -5 --t-t- (61
Name of Oi-mer
OvTner's Address _'10 7 �-e4N k�'
Owner's Assessor's Parcel No..* 0 1-2-o
-O-o!t
Building/Environmental Health
Permit Description and Number
Date Issued -By
Planning Department Approval:
Date Zone A-L�)O -Dwelling on.
By 10, 1 01
I VA 5 7
do -declare, subject to the
penalty of perjury, that�'-I'am the employee
of (Qgtz� zo_,L,��
address (present) n4_z ell
on AP# -cw
and that I will be employed under Section
24-21.2 for at. --Least
(a) to (g)
thirty-two (32) hours per week for at least
sixteen (16) weeks per year on
S i gn e d "r,
Dated
AGRICULTURAL AFFIDAVIT
E11PLOYER
Employer.
zv-
Employer's Address (Present) �2
Name of"Owner—
Owner's Address
Phone
Ovrner's,Assessor's Parcel No. n a i - I --7-f3 - 0 00!�(
Building/Environmental Health
Permit Description and Number
Date'Issued By,
Planning Department Approval:
Date
By.
M
Zone Dwelling. on Ap#--9E�:)-rLo- 00 Ll
do declare, subject to the
penalty of perjury, that I am the employer of
addre ss (present) cle:�q La
on
and that I will be employer'under Sect.ion 24-21.2 for at least
(a) to (9)
thirty-two (32) hours per week for at least sixteen (16)weeks per year on
Signed.
Dated Y- [,!:� e7--
&
AGRICULTMkL AFFIDA-VIT
EHPLOYER/ENPLOYEE
Please read the following'carefully before signing:
A_(O
Section 24-21.2 Agriculture Employer/Employee
(Applicable only in zones A -5,-A-10, A-20, A-40 and A-160)
An individual who verified, by personal affidavit and by affidavit
of his employer, that he is, or will be, employed at least thirty-
two (32) hours per week for at least sixteen (16) weeks per year,,*
or'that his primary source of annual income is, or is anticipated
to be, derived from, any of the following described occupations:
The.preparation, care and treatment of farm land, pipelines
or ditches, including leveling for agricultural purposes,
p lowing, discing and fertilizing the soil;
(b) The sowin- and planting of any agricultural 'or horticultural
0
commodity*
ricultural or horticultural.commodity.
(c) The care of any ag4.
is not
As used in this subdivision, "care" includes, buU
limited to, cultivation, irrigation, weed control, thinning,
heating, pruning, or tieing, fumigating, spraying and-dus.ting;
(d) -The harvesting of any agricultural or horticultural�commodity
-not limited to, picking, cuttin-,. thrashing,
in ludin-, but
mowing, knocking off, -field chopping, bunching, baling, balling,
field packing, and placing in field containers or in the ve
hicle in Aich the commodity will be hauled onthe farm or to
the place of first processing;
(e) The assembly and storage of any agricultural or horticultural
commodity including, but not limited to, loading, roadsiding,
banking, stacking, binning and piling;
CD
- f) The raising, feeding and management of livestock, fur -bearing
animals, fish, frogs and other aquatic animals, and bees in-
cluding, but not limited to, herding, housing, hatching, milkin..,
shearing, handling eggs and extracting honey;
.(g) The operation, conservation, improvement or maintenance of
such farm and its tools and equipment.
A.GRICULTURAL AFFIDAVIT
E11,1PLOYEE -
Employee Phone.
Employee's Address (Present)
Name of Oi-mer 774?
Owner's Address 9-7 /0 12kLe-A 14,_e�
Owner! s Assessor's Parcel No. A :2-1 - t.2 -o -
Bu_i1xUxL&/Environmenta1 Health
-Permit Description and Number
Date Issued By
Planning Department Approval:
'ZZone
Date A L-10 Dwelling on AP# Izo _C) 0
By.
do.declare, subject to the
penalty of perjury, that—I am the employee of
addr e s s (p r e s e n t)
_;��.-o n
and that I will be employed under Section 24-21.2 for at.'least
(a) to'(g)
th . irty-two (32) hours per week for at least sixteen (16) weeks per year on
�-d co��-
9�4WOR"l-
Dated q _i_ (k9-
I(
AGRICUIPLURRAL AFFIDAVIT
EIPLOYER
Employer-.
Phone
f
Employer's Address (Present) f
Name of'Owner
Ownerls Address
Ovmer's.Assessor's Parcel No. 4 2-
-Building/Environmental Health
Permit Description and Number
Date Issued
Planning Department Approval:
Date Z on e A - L4D -Dwe 11 i ng. on A:P#,--Q <Z I -
Bv
17
penalty of perj
address (present)
J
do declare, subject t- o th e
zl&e
that' -I am the employer of -2-11--/4" Z
C
0 on'
and that'I will be employer"under Section 24-21.2 , , for at least
(a) to (9).
er year on
thirty-two (32) hours per week for at least sixteen (16).weeks p,
Signed
Dated
q01 Ar
A.
T FM STATE OF CALIFORNIA—BUSINESS, TRANSP TATION AND HOUSING AGENCY
"DEPARTMENT OF HOUSING AND crC;M1,MUN_ITY DEVELOPMENT-_`
DIVISION OF CODESAND STANDARDS
_. 1�11;� &I . r '
ACTIVITY REPORT AREA OFFICES
Northern Area
Date Report by S ISW Tlilrd Street
Sacramento. CA 95814
To: Name Z, P.O. BOX M7
Sacramento. CA
Address -.41* 6A9, th-
95812-1407
Tel. (916) 445-0136
Activity Site (if other than above) Southern Area
13 2038 Iowa Avenue
Bldg. 8. Suite 102
Owne�r (If . other than above) Riverside. CA
92507-2435
4-
;�jel. (714) 782
-4420
Address
PURPOSE OF REPORT: (Check�d t )as appropriate)
INSP ECTION RECORD ONLY
INFORMATION ONLY.
1 -fiCE OF VIOC4TION AND RELATED INFORMATION% This,report, provides I notice of
4 - 0
'California Health'and Safety. Code, Division 13 or the California Code of Regulations.- Title
violations of the.
25, Part 1. Chipter Se�6floiis, � iindicated. , Copies� of the. regulations may be obtained frorn'the State of -
'California, 6ffice-of Procurement ' Publicatioris - Section, P.O., Box "165,.North Highlands, CA 9566b-1015.
Violations indicated shall be corrected and a writte.n.re quest for fur I ther inspection filed with the Area Offic4:.,
Indicated above on or befor 3 -ft- - '9 't-, The request for iiispection shall b -a acc_ompa�ied by
minimum fee of $ 97 - nn
A permit shall be obtained from the.Area Office identified above for work to correct item(s) #
If you believe this report has been issued in error or is factually incorrect, please contact the Area Supervisor at the
Area Office indicated above.
INSPECTED UNIT IDENTIFICATION:
Type of Unit Box Size Overall Size FIT Decal No.
Mentifacturer, Year and Model
KUD LABEL HCO Inaignia No.'- No. or V. 1. . N.
- - --------- = - ___
INSPECTION kf-- 4rew z aj j - r;d �'l S4 - e,
-RESULTS OR INFORMATIOW, -j 'a -4
. �4'
AF
Ale'. ir-
�4
�ej Z -V -e
e
e(/,
0
"e 44 IV,,
RECEIVED BY JITLE
DEPARTMENTAL USE ONLY:- Action:_,,' [1 --close File. "t [J- ReInspection -Required!. Progreew.Inspectl6n Required,
her- -
E1._,Enforcement Action Needed_ 'Of'
SEND. -COPIES TO: Recipient- 12: .Owner -EI-SAA [:1., OL Other
SUPERVISOR REVIEW DATE� COPIES SENT BY. -.DATE
JHICID�G I (REV. 3-9 1) 91 919" PAGE I of
FILE IDENTIFICATION
..CPT # FAC. to
ASSIGNMENIT�L #
LABOR DATA.
DR 10 3.2 DATE
PCA/ACT CODE Al 000 AREA
Ca CDC TR MILES
JIME: INSP/ACT TR
INSPECTION DATA.
TIME REPORT ONLY
INITIAL INSPECTION REINSPECTION
HOME/ UNIT FLOORS
VIOLATION DATA.
TOTAL M, AW
S -1 FIE -:�/_ m __/P G/o Np'��
MH ALTERATION TYPE:
AC El - ACC'[] ROOiF, FP 0
THRD-PARTY MONITORING: -
4 17A
0 DL D
OAA_ 1.10 IP
DAA -*PLANS #COMPLY
MP INSPECTION DATA: f �4
BL6/FIX MH LOT
-'EH INSPECT10N DATA.:"L�
NACIJVE
MAX t
CAP P CAP
f
SF6 _�_DORM
FEE ACCOUNTING:
COL# 1,73 7 -
UE
USED 0 ATTACHED;
INSPECTION
INSIGNIA
OTHER
ATTAC14k) FEE I.D.
o�-
.0 Nodblim A'
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