HomeMy WebLinkAbout021-160-063,�A 21-16- 73---]
'R Y CASEY
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Permit-#1384-88P-,E(MH util)
ELEC. _4
GAS
,SUPPORT STRUCTURE REQ
COMP I ACTION TEST REQ. 7/1(8
21-16:-63
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December 19, 1994
Tammy Woolfolk
1073 French Avenue
Gridley, CA 95948
ffutte county
I- A I -D C N A T L) R W E- A L T H A IN D B E A U T V
W-0
PLANNING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: 1916) 538-7601
FAX: (916) 538-7785
Re:. Administrative Permit, (A-P-azi--1-60--063--�
#95-67
Dear Ms. Woolfolk:
Enclosed is your vatidated Administrative Permit No. 95-67 to allow a large family day care
facility for up to 12 persons on property zoned A-5 located at 1073 French Avenue,
Gridley, CA.
Every Administrative Permit expires and is automatically null and void without further
action by the County if the Activity or use for which the Administrative Permit was granted
has not been actively and substantially commenced within one year of the date of its final
approval.
Should you have any questions regarding this matter, please contact Stephen Lucas of
this office Monday through Thursday, between the hours of 8:00 a.m. and 4:00 p.m. ,
Very truly yours,
9
Barry K. ogan
Planning Manager
BKH:bd
Enclosure
cc: Building Division
Land Development Division
Environmental Health Division
Department of Forestry
ADMINISTRATIVE PERMIT
BUTTE COUNTY PLANNING DIVISION. December'12.1994
DATE
95-67
PERMIT NO.
021-160-063
ASSESSOR'S PARCEL NO.
Pursuant to the provisions of the Zoning Ordinance of the County of Butte and the special
conditions set forth below: Tammy Woolfolk is hereby granted an Administrative Permit in
accordance with application filed: September 22, 1994 to allow a large family day care facility
for up to 12 persons on property zoned A-5 (Agricultural) located on the west side of French
Avenue at 1073 French Avenue, Gridley, CA.
Failure to comply with the conditions specified herein as the basis for approval of
application and issuance of Permit, constitutes cause for the revocation of said
permit in accordance with'the procedures set forth in the Butte County Zoning
Ordinance, including Butte County Code Section 24-62.
2. Unless otherwise provided for in a condition to an Administrative Permit, all
conditions must be completed by the permittee within 12 months of the delivery of
the countersigned permit to the permittee.
3. If any use for which an Administrative Permit has been granted is not established
.within one year of the date of receipt of the countersigned permit by the permittee,
the permit shall become null and void and reapplication shall be required to
establish the use.
4. The terms and conditions of this permit shall run with the land and shall be binding upon
and be to the benefit of the heirs, legal representatives, successors, and assigns of the
Permittee.
SPECIAL CONDITIONS:
The facility is a single family residence that is the principal residence of the provider and
the use is clearly incidental and secondary to the use of the property for residential
purposes.
2. Properties proposed for Large Family Day Care shall be located at least 500 feet driving
distance from any other Large Family Day Care property and the granting of the permit
shall not result in any residence being bounded on more than one side by a Large Family
Day Care.
3. Large Family Day Care homes shall meet the following traffic control measure:
a. In addition to providing the required number of parking spaces for the residential
use, one off-street parking space for each employee' of the facility and one off-
street parking space/loading area shall be provided. The driveway area may be
used to meet this requirement.
b. Large Family Day Care homes located on principal or minor arterial roads as
designated by the General Plan Circulation Element shall provide drop-off and pick-
up areas which prevent vehicles from backing onto such roads.,
C. Properties proposed for Large Family Day Care homes shall have frontage on and
access off of a paved road. Roads that are constructed for the purpose of meeting
this requirement shall meet the RS -4C standard as contained in the Butte County
Improvement Standards contained in Chapter 20 of the Butte County Code.
4. One sign, not to exceed 3 square feet, shall be allowed.
5. The applicant shall be licensed by the California Department of Social Services,
Community Care licensing for a Large Family Day Care facility.
6. The applicant shall meet all State Fire Marshall regulations pertaining to Large Family Day
Care facilities.
7. The applicant must meet all other applicable County and State ordinances, statutes, and
regulations.
Note: Minor changes may be approved administratively by the Director of Development Services
upon receipt of a substantiated written request by the applicant. Prior to such approval,
verification must be mad by each Department or Division that the modification is consistent with
the application, fees paid and environmental determination as conditionally approved. Changes
deemed to be major or significant in nature shall require a formal application for amendment.
NOTE: Issuance of this Administrative Permit does not waive requirement of obtaining Building
and Environmental Health Division permits before starting construction and their approvals prior
to use or occupancy, nor does it waive any other requirements.
Barry K. Hp n
,ban, Butte Co# ty Planning Manager
cc: Land Development Division
Building Division -
Environmental Health Division
Department of Forestry
orc-�Ar�
--Trl�lylll\ �,'OCCD��-Ow�
No -7 3 '�',rozncl VN �� �l "--
AP P ROVE D"
!i DEVELOPMENT PLAN
DATE
,�..&PERMIT VARMANCE
BY
A "111111Y - TV UILUIRL
Z. �� "'. , I
073. FrFiTW Road
-Ck95948
ridlij.'
Dear Mrs -Woolfolk,
-'�-With reference to the above subject and your request for inspection of the proposed"large-
amily day care at 1073 French Road, in GriGley, the inspection was made Dece
mber 20,
94...
i6�orlble'visual inspection was made without going on the roof, under the buil
dip'g, or in.
Od found the following items which must be done or resolved:
I kr Provide a fixed and substantially constructed metal guard around the wood
stove. This guard must be a minimum of 36" high, and the guard members
must be spaced not more than apart. ( Please see item 13 on the
Community Care facilities, Large Family Day Care Homes handout.
/_;1)�In'stall permanent smoke detecwrs in all bedrooms within 12" of the ceiling as
scribed in item #4 of handou"-.
�e
63 Pro
vide a device suitable for sounding a fire alarm no lower than 3 (three) feet
off the floor, and a maximum of 5 (five) feet off the floor. ( See item 6 on
the handout.
This inspection by the County of Butte does not act as a guarantee or warranty as to the
ini - ernal soundness of said building.
it is now in order for you to complete the above items and call for a re -inspection.
Should you have any questions concerning this matter, please contact this office.
Sincerely,
4/ 1 �Izp
r
Scott Rutherfo �
Supervisor, Building Inspection
.STATE OF CALIFORNIA
MINI -MEMO
.3TD 100-8 (REV. 9-70)
A
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RETURN TO
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. ldSUBJECT:
or F.
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SIGNED ADDRESS
SEND PARTS 1 AND 3 INTACT PART 3 WILL BE RETURNED WITH REPLY
85 93594
State of California
Oepartment of social Services------�
Community Care Licensing
520 Cohasset Road Suite 6
Chico, CA 95926'
Sharon Whitted
Licensing Program Analyst (916) 895-5914
CALNET 8-459-.5914
To
AM
Oate Jla /q�-Time El PM
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WHILE Y U WER!E�)DUT
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of—
Phone
Area Code Number Extension
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILLCALLAGAIN
WANTS TO SEE YOU URGENT
I RETURNED YOUR CALL
Message
9W &4
OperatW'
-- EASTMAN 4C200
STATE FIRE MARSHAL
FIRE.SAFETY INSPECTION RF011FST
COPY DISTRIBUTION:
1 -3 -STATE FIRE MARSHAI
SEE REVERSE OF COPIES 2 AND 5 FOR
INSTRUCTIONS FOR COMPLETION
2---fIRE AUTHORITY
1. REQUEST DATE
PROGRAM
STD 850 (REV. 8 / 86) 4 -5 -LICENSING AGENCY
2�
3. AGENCY CONTACT
4. TELEPHONE NO.
&EVALUATOR
DSS/COMKUNITY CARE LICENSIGN
895-5033
10104/M. BROMLEY
6. SFM REGION
-1.(916)
7. SFM I.D. NO.
S. REQUESTING AGENCY FACILITY NO,
9. REQUEST CODE
7041376218
3/A
CODES
RESPONSE REQUIRED
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
F
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
�tVAFTMEWT 01r SOCIAL SERVICES
IO.AGENCY
COMMUNITY CAIRE LICENSING
S. ADDRESS CHANGE
NAME
520 Cob.asset Road, Suite 6
S. NAME CHANGE
AND
PREVIOUS NAME
ADDRESS
7.OTHER
DATE OF ORIGINAL REQ.
1 1. AMBULATORY NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CAPACITY
AGE RANGE (YEARS)
PREVIOUS CAPACITY
AGE RANGE 4YEARS)
PREVIOUS
TO 18 18 To 65 AND
CAPACITY
TO IS IS TO 165 AND
CAPACITY
19. FACILITY
65 OVER
1
65
I
CODE
12
x
6 0
12
13/810/FDC
12. FACILITY NAME
13. NO.BLDGS
CODES
WOOLFOLK, TAMMY FAMILY DAY CARE
1. GACH 7. ICF/OT-
2. GACH/R 8. ICF/DD
14. STREET ADDRESS (ACTUAL LOCATION)
15. RESTRAINT
1073 FRENCH ROAD
NO
3. SH 9. ADHC
4. APH 10. CLINIC
CITY
ZIP CODE
16. HOURS
GRIDLEY, CA 195948
DAYS
5. PHF 11. JAIL
6. SNF 12. ICF/DDN
17. FACILITY CONTACT. PERSON
TELEPHONE NO.
116A. SPECIAL
TAMMY AND DOUGLAS WOOLFOLK
(916) 671-0263
13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
18. FIRE F
26. CLEARANCE
CODE
BUTTE COUNTY BUILDING DEPARTMENT
AUTHOR
CODES
7 COUNTY CENTER DRIVE
NAME
FIRE CLEAR, GRANTED
OROVILLE, CA 95965
AND
2. FIRE CLEAR, DENIED
ADDRESS
3. FIRE CLEAR, WITHHELD
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY
CODES
21. INSPECTOR'S NAME
TELEPHONE NO.
22. CFIRS
23. T-19 OCC.
ID NO.
CLASS
SCOTT RUTHERFORD
1. EXITS
BILL BARRON
346-�38'-7541
2. CONSTRUCTION
3. FIRE ALARM
24. INSP. DATE
25. INSPECTO SS URE For Scott &
MICHAEL C VIEIRA Bill
4. SPRINKLERS
5. HOUSEKEEPING
26. EXPLAIN DENIAL OR LIST SPECIAL C ITIONS
T
6. SPECIAL HAZARD
7. OTHER
STATE FIRE MARSHAL USE ONLY
DEI-I.A.RTMENT OF W.-ClAl -5 LEV.' Olaf*
20. REGIO N
C (,, M M'.j tl� T C A r,
OFFICE
COI)P-sse-� RZ�".�
AND 520
ADDRESS ChicO, CA 95926
L
Vol
County
L A N D '0 F NATUR.AL W E 'A L T H A N D B
C A U T Y
BUILDING DIVISION
-DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: 1916) 538- 7541 .
December 21,F;1)9936) 538-2140
RE: Special Inspection #94-25
Tammy Wolfolk A.P. #021-160-063
1073 French Road
Gridley, CA 95948
Dear Mrs. Woolfolk,
With refere nce to the above subject and your request for inspection of the proposed large
family day care at 1073 French Road, in Gridley,'the inspection was made December 20,
1994.
A reasonable visual inspection was made without going on the roof, under the building, or in
the attic and fodnd the following items which must be done or resolved:
1) Provide a fixed and substantialli constructed metal guard around the wood
stove. This guard must be a minimum of 36" high, and the guard members
must be spaced not -more than 2 " apart. ( Please see item 13 on the
Community Care facilities, Large Family Day Cate Homes handout.
2) Install permanent smoke detectors in all bedrooms within 12" of the ceiling as
described in item #4 of handout.
3) Provide a device suitable for sounding a fire alarm no lower than 3 (three) feet
o , ff the floor, and a maximum of 5 (five), feet off the floor. See item 6 on
the handout.
This inspection by the County of Butte does not act as a guarantee or warranty as to the
internal soundness of said building.
It is now in order for you,to complete the above items and call for a re -inspection.
Should you have any questions concerning'this matter, please contact this office.
Sincerely,'
try
Scott Rutherfbr��
Supervisor'l Building Inspection
y' that. I will obtain the"* nec( �L'lrmits and make Any necessary correc-
I hereby certif �ssarj per
V
tions, alterations, or repairs required by the County of Butte, -as a result of this inspec-
tion, to, comply with building and housing code requirements. I also certify that prior
to the use or occupancy of this building, I will complete the above required corrections,
alterations, or repairs, or, if the building is presently occupied, I will complete the
above required corrections, alterations, or repairs within 30 days.
cercti,.."_ llave� r aa,,, is-
thi 'alp.plica p -and �-stqte--tp�-*,above,,,,Info,;rmation is correct
�jl�.that. I, A
uthori*ze rE i
and hereby a Pftnta',' ves of Ue Co'un�y' 0' f 4Le t enter upon the above-
mentioned property for inspec ion purposes.
Date
Ugnature oflOwner
Fee Paid 0 Receipt No.
ist�DPW/2nd- Inspector/3rd-Applicant
7
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS
7"County Center Drive, Orovi ;�rnia 95965
9
'Telephone: 5 8--75,41
APPLICATION FOR S.PECIIA. INSPECTION
L rJO
Owner
A.P. No.
Mailing Addre�s ALP 1reAc 9 Telephone
No.
A p p 1 i'c a'�t
ph Telephone
No.
Mailing Address
Building Location &me
I hereby request a special inspection' of the folloV'ng uilding:
L701-4 1 .
'Dwo,lftiing (1 f only a portion, specif
2.
Apartment House (if only a portion, �specify)
3.
6ommercial (specify present occupancy)_,�,
4..
Other (specify)
I� am requestiAva special inspection,for,the purpose -of -:-
1.
Moving the building.
2.
Financing (speci�fy agency) Case No.
3.
Change of occupancy to
.4
F '-"-1 4.
Other (specify) e 0 q'Pe C, -on
y' that. I will obtain the"* nec( �L'lrmits and make Any necessary correc-
I hereby certif �ssarj per
V
tions, alterations, or repairs required by the County of Butte, -as a result of this inspec-
tion, to, comply with building and housing code requirements. I also certify that prior
to the use or occupancy of this building, I will complete the above required corrections,
alterations, or repairs, or, if the building is presently occupied, I will complete the
above required corrections, alterations, or repairs within 30 days.
cercti,.."_ llave� r aa,,, is-
thi 'alp.plica p -and �-stqte--tp�-*,above,,,,Info,;rmation is correct
�jl�.that. I, A
uthori*ze rE i
and hereby a Pftnta',' ves of Ue Co'un�y' 0' f 4Le t enter upon the above-
mentioned property for inspec ion purposes.
Date
Ugnature oflOwner
Fee Paid 0 Receipt No.
ist�DPW/2nd- Inspector/3rd-Applicant
COUNTY OF BUTTE DEPARTMENT OF -PUBLIC WORKS
�i,County,Center Drive,.Orovif' tCal'rf_-';rnia'_. 959615
'�Tele
phone: 53&-7541
lPftICATION FOR SPECIM, INSPECTION
Owner A.P. No. OC)/ M
Mailing AddF4� f -re A -C phone No.
Tele
4
I 1A
�=4
7k_ -Applican A me 11" Telephone No.
Mailing Addr6si's'
on"' S_
Building Locati
V1,
hereby request a special insuctidn of.the-follo uilding:
D iing
i if only"a portion, specif
2. Apartment House (if only a portion, '�pecif y)
s I
3. Commercial (specify p"resent occupancy)
4. Other (specify)
�6sti:r�g.-a_sp 'i',i--ins�ecti'n-�forl,t-hi�r-p- p-'.'
I-; am req ec a 0 os
1. Moving the building.
2. F inancing (specify agenc Case,,No.
Y)
3. Cha nge of occupancy to
rr N-7 7 1
re
4 bdPe� (specif y)., k0ee 6,i
4
I hereby certify that, I"will 0'btain',.'thd -,,necessary p mits and make any necessary 6orrec-:-
tions,'alterations,.or repairs required by the Cou'n' of Butte, as a result of this inspec-
tiori, to. comply with building and housing code requirements. I also certify that prior
to the use o occupancy of this building, 1 11.
will complete the above required corrections,
alterations, Pr repairs, or, if the building is presently occupied, I will complete the
above required -corrections'.- alterations, or repairs within 30 days.
rea -a, n --and_i state--th above information is correct
z * e r e 'k� n t aiX- V__ -6s` 0' f i-Y"Re" C -0 u n ty f B q_$ t e e n e r u p
-I.' Wavei d' th s4_
plicat
and"'hereby auth6lii t e
Av mentioned property for ins'pection!purposes'.
Date
aignature ofiOw�ner
Fee Paid $ Red t eipt No.
lst�DPW/2nd-Insp t�or/3rd-Appli ant
LC
VV\
Gah
lct+K
love.
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(OR
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OTE—Aff VaterIals '85 Wor,ii-m-m-NIp Shoff Ue In
Zcoi- I ��r--jc-Fces cmcl
UMIXO wlz'�I
a 0 U�e injt4a
St Meciounicci Codes 4U
�Q Nuiianad, Eledrical Code.
D
nd spc.c,.,�ilic-n-Hons MUST U��,
I hl g got ot plans c.
j@f3t )n f!-, * I +I . d. *'L . " Z)
r!n
:,P)Ota dtiv
UtIllty connections shall be within
4 ft. of the mobO-z:'i-orn, a, either
directly behind or vAthin the rear
half 4 F8&dF4d@ (;@ of the
!>
. I C,.-- -21,e ment of Pubic
,,*ft++ n pormmJOn,,--.,I —
WoZl, County of .5utfe.
ME
FOR A40BILES
Az
of 5 It. TrCm the
proportY llin�s and :' �etbDcl<
of 5n-n;'l. "C"J
centerline shall be clear of
structures or equipment exc@O
for a '2 !�. T,2vo overinaria.. 411
"t, . 4
Woolfolk, Tammy Family Day Care
1073 French Road
Gridley, CA 95948
Attn: Tammy and -Douglas Woolfolk
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (916) 538-7541
FAX: (916) 538-2140
February 10, 1994
RE: Day Care Fire Inspection
A.P. #021-16-0-063
The Department of Social. Services Community Care 'Licensing in Chico has made
a request to this office- for a fire safety inspection of your proposed day care
facility (maximum capacity, 12) at 1073 French -Road in Gridley.
Your property is located within ' an A-5 zone which requires a use permit from
-the Butte County Planning Department prior to business operation. Please contact
them' at (916)538-7601 betwden 8:00a.m. and 4:00p.m. for information on how to
proceed.
When you have made the application for 'the use permit, and - paid the
appropriate fees, you may apply to this office for a Special Inspection for the
fire inspection.
For the Special Inspection we will require a plot plan -showing the building
location on the property, a floor plan showing room uses, windows, doors,
mechanical equipment etc. , . and the appropriate fee and the application signed
by the property owner.
After we make the Special Inspection, we will write a letter advising you of
any improvements and building permits that may be required..
We will not notify the Department of Social Services of any clearances until
you have been issued a use permit and complied with both the Planning and Building
Department requirements.
Should you have any questions concerning this matter, please contact this office.
Yours very truly,
MCV: dms
Michael C. IVieir C.B.O.
Manager, Building Inspection.
cc: Department of Social Services
Planning Department
COUNTY OF BUTTE
FFICIAL
�ECEIPT
171010
OFFICE OR D ATIVIE T ISSUING RECEIPT
Z) X
9*
Received from,:��
The Sum of
For
Received: Recqive� By,
CASH Q Title
CHECK By
DAVCO BUSINESS FORMS - (916) 743-8511
k I
Address
4+ff4-88P,E(MH)
PERMIT NO.
6
D -at,
PERMIT EXPIRES
OWNER LARRY CASEY
Da
CONTR. UNKNOWN
ASSESSOR PARCEL 21-16-63
LOCATION 1073 French Ave.,
Gridley
L/-3
OFFICE COPY
Address
GAS
Meter B
D -at,
ELE&
Meter
Da
Temp. Power Pole
Callec
Temp. Ele
Callec
Temp. Ga
Callec
JOB FINA
Signa,
TO Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
rjL n
Location.
AP#
Plan Approved for: Sewage Disposal
Water Supply
Hold final for: Water Supply
Final clearance O.K. for: Water Supply
Clearance for bedroom mobile m:e2 Other
NOTE
Sanitarian -11132r2
Date
= OK
0 = Not OK
- = Not Applicable
* = Not Ready, MOBILE HOMES
MISCELLANEOUS
Date , MOBILE HOME UTILITIES (Plans) OK 'except #'s Date DECKS,COVERS,CAR PORTS, GARAGES, (Plans)OK exceot #'s
W. Zoning Req u i rements-Setbacks- Easements 1. Zoning Requirements -Setbacks -Easements
Soils; Special MH Support -Sketch 2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
-r; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts- Bea ms-Rf trs.-Co n nec.-
5. Electricity; Location-Clearances-Grnd,-YjaoAmp-Concrete Shthg.-Rfg.-Bracing
6. Gas; Location -Test-Wrap: / P'L"ft. 5. Alum. Awn.; Col u m ns -Con nections-Spl ice- Deca I- Encl osu res
/ ,J,�'Nat. or/ /"U'ft./ /"LPG 6. Carports; Windows -Doors
L;-Stility Clearance 7. Elec. .
8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses
9. Siding; Nai I i ng -Veneer -Stucco- Mesh
Card -B1 (-t,-D Date4-�_&ZCard-Bl Date 10. Roo ; hthg- oo ing
Card-BlAS� Date4-_'2Y-14Card-B1 Date . xt.; teps- oors- an ings
Date - M0Bjk6K0ME INSTALLATION (Plans) OK except #'s
ieelg*Kg Qequirements-Setbacks-Easements
Card -B1 Date Card -B1 Date
9
�o2�hgs; Size-Spacin -Marriage Line
Card -131 Date Card -131 Date
"aw'MH Test- Demand-yal ve-Con nector
lecWeity; MH C]��rossovers-Breakers-Clearances
Date POOLS (Plans) OK except #'s
_4el5rr_W,,,.MH Test-Fall-Fle)c Connector
1. Setbacks -Easements
(��.r; MH Test- Reg u lator-Con nector
2. Soils; Compaction -Structure Stability
j^a1pi'and Sewer Connected -C/0 to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness-
Dead Men -Lining
as a_!Id Electricity Tagged
-
-Z� ift��nsp.-Sketch
�(2JK
J�.�ert. of Occupancy
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-Panelboards-Ins. to Main in Conduit
Card-B1(v?,fg/N1!)ate Card -B1 Date
Card -B1 Dat��, Card -B1 Date
9. Health Department Approval
06 , vr-
c7 -71
47/
cla ;;,r"w
Ck
10. Plumb.; Cir. Test -Water Supply Test
Card-B1 Date Card -B1 Date
Card -B1 Date Card -B1 Date
= OK
0 = Not OK
- = Not Applicable REMDENTIAL (Single and Duplex)
* =.Not Ready '
-Dat-e ''
ONDERFLOOR (Plans) OK except #'s
Date
FRAMING (Continued)
1. Zo n i ng -Setback s; -Easements- Fl ood-Sl o pe
-
45. Hangers -Post Caps -Anchors -Connectors
2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
46. CIng. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
3. Ftg., Garage; Soils -Steel-/ /" Ftg. Depth
47. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. - Depth
48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
5. Sternwalls, Main; Steel-Blockouts-Wrapped
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
6. Sternwalls, Garage; Steel - BI ockouts-Wrapped
50. Garage Fire Protection Framing
7. Slab; Steel -Wrapped
51. Property Line Firewall & Openings
8. Piers -Fireplace Ftg.-Steel
52. Ext. Doors -One T -Check Garage -3rd story, 2 exits
9. D.W.V.; Fall -Fittings -Test -2 way C/0 -Sewer Test
53.Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
10. Gas Pipe; Size -Anchors
54. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
11. Water Pipe; Test -Anchors -Regulator -Service Test
55. Siding -Nailing Veneer
12. Electric; Underground
56. Stucco Mesh -Drip Screed -Fd. Vents-UnderfIr. Access
13. Plenums & Ducts; Clearance-Material-Supprt-Ins.
57. Glazing Area -Glass Protection -Skylights -Plastic
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
58. Shear Walls; Nailing -Bolts
15. Insulation
59. Insulation-Walls-Cig.
60. Infiltration-Walls-Wndws
Card -Bi
Date Card -B1 Date
Card -131
Date Card -B1 Date
Card -B1
Date Card -131 Date
Card -131
Date Card -B1 Date
Date
PLUMBING (Permit) OK except #'s
16. Water Ht. Vent -Access -Combustion AirBaffle
Date
FINAL (Plans) OK except #'s
17. Water Pipe; Test & Anchors -Nail Protection
61. Ext. Steps -Door & Sidelight Protection -Land i ngs
18. D.W.V.; Test-Fttngs & Anchors -Nail Protection
62. Smoke Detector
19. Shower Pan; Test, First Floor -Tub Access
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor- Ducts-Mech. Protection
20. Test Tub & Shower, 2nd Floor -Tub Access
21. Gas Pipe; Size & Anchors
64. Bedroom Exiting
65. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes -Labels
Card -B1
Date Card -131 Date
67. Stairs & Rails
Card -B1
Date Card -Bl Date
68. Fireplace or Stove; Clearances -Hearth
69. Elec. Outlets at Wood Panel; Int. & Ext.
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
70. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
23. Elec. Receptacles Spacing -Lights & Switches at Doors
71. Elec. Outlets & Receptacles at Kit. Counter
24. Size Boxes & No. of Conductors -Stapled
72. Garage Fire Door; Swing -Landing -Closer
25. Romex Installed Close to Edge of Studs & C.J.
73. A.C. Duct in Garage -Damper
26. Equip. Ground madeupw/Mech. Fasteners -Bond Gas &Water
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
27. 2 Appliance Circuts in Kitchen & Conductor Size/G.F.I.
75. Plb., Elec. & Mech. Equip. Listed for Location
28. Subfeed Wire Size ga. Cu or AI-A.C. Wire Size / /ga.
Cu or Al
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
29. Range Circ. ga. Cu or Al -Oven Circ. ga. Cu or Al.
Insulated Neutral Yes No
77. Insulation -Foam -Looked in Attic 0 Yes
78. Guard Rails & Deck Constructi on- Post Caps
30. Service -Riser Conductors & Ground -Main Disconnect
79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor 13 Yes
31. Equip. Clearances Pane Is- Motors- Mech. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
80. Following instId.; Drive -0 Yes 0 No; Walks 0 Yes 0 No;
Planters 0 Yes 0 No
33. Smoke Detector
81. Stucco; Brown -Finish
Card -B1
Date Card -131 Date
82. A.C. Unit; Disconnect, Electrical, Plumbing
Card -131
Date Card -131 Date
83. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
Date
MECHANICAL (Permit) OK except #'s
84. Water Well; Disconnect, Electrical, Plumbing
34. A.C. Ducts Insulation & Support
85. Exterior Elec. Trim; G.F.I. Receptacle -Underground
35. Vent Fan; Exhaust above insulation
86. Ventilation throughout House
36. Condensate Drain & Overflow; Size & Grade
87. Glass Protection
37. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet
88, Corrections from Previous Inpections
38. Attic Access & Platform if Furnace in Attic
89. Gas Test -Meters Tagged; Gas -Electric
90. Water & Sewer Connected -C/O to Grade -HD Approval
91, Energy Compliance Certificate -Other Certificates
Card -131
Date Card -B1 Date
92. Roofing Certificate
Card -B1
Date Card -B1 Date
Card -131
Date Card -131 Date
Card -131
Date Card -131 Date
Date FRAMING (Plans) OK except #'s
39. Sills, Proper Material & Anchors
Card -131
Date Card -B1 Date
40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
Comments
at Final:
41. Bearing Walls over Girders & Floor Nailing
42. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Header & Beam -Size & Bearing
(NOTE: An entry must be made each time you visit job site)
OWNER
COUNTY 6F BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way. Chico — Phone: 891-2751
7 County Center Drive. Oroville — Phone:'538-7541
747 Elliott Road', Paradise— Phone: 872-6307
CORRECTION NOTICE
PERMIT IN
V
A routine inspection indicatesithat the following violations of County Ordinance
exist at 4thea ve address a d should be corrected.' Please notify this office
wl�in
w c
hen corre oil of work is comRieted. If you have any question pertaining to this
matter, o nee�d��ad�ditlonal explanation, Please conj office immediately.
this
�!�C) Pre— 1-7 1.)
Inspector.( 1\, Date
t It
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive. Oroville — Phone:,538-7541
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
V
Aw /X
OWNER - PERMIT No.
A routine inspection indicates that the following vio.1,ations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this,
matter, or need additional explanation, please contact this office immediately.
L
LJ
-/" VIC) --T
I - nspector Date -7- /--:,-F;/
MOBILEHOME INSTALLATION ACCEPTANCE
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE
OROVILLE, CALIFORNIA — 534-4541
Address or location of mobilehome
Owner's name
Owner's address
Insignia or hud number
Manufacturer's name -
Serial number of V.I.N I
(Official�Approying Installation
PERMIT NO.
Year of manufacture
(Date)
IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION
ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE
MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM.
513B White - Owner, Yellow - Installer, Pink - D.P.W.
tV7
COUNTY OF BUTTE - DEPARTMENT'OF PUBLIC WORKS PERMIT NO
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 1314
APPLICATION* AND PERMIT
ASSESSOR PARCEL NU R
ZO111I G
BUILDING PERMff
SQ. FT. OCC. BUILDING VALUAT
OWNER -,C,a j '
/:� rr&
�0.
T E L E -PH
0 111 E F X I L I N E55
TOR'S_NAM!,�,
TELEPHO14-E
CONTRACTOR'S MAILING ADDRESS
r
Fireplace
CONSTRUCTION LENDER
4A)4k
UNKNOWN
Total Valuation Is
Filing Fee
$ 11)_�
LENDER'S MAILING ADDRESS'
Permit Fee
$
ARCHITECT OR ENGINEER
APUL
LICENSE NO.
I
Plan Checking Fee
$ 4:!z
Energy Plan Checking Fee
$
—
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit f I ee
$ 1 -5 -00 -
PLUMBING PERMIT
FilingFee 1 10.00
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO. SUBDIVISION NAME PARCEL MAP
Water piping
5.00
'Each qas water heater or vent
5.00
USE OF STRUCTURE
-SF [:1 DuplexM Mobilehome�bther
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
1 5.00
.
Mobile Home
0.00 ea. -
TYPE OF WORK
NewF� Addit i2 Rpmodel[I Utilities P— 'Installation[I Other
Describe work:.
I L-
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Fi I ing Fee 10.00.
Main service GOOV OR LESS
100 AMP OR LESS
10.00 164,
Main service EA. ADO'L 'An AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and � Professions Code and my license is in full force and effect.
License No. Classification
1, as the owner, or my employees with wages as their sole pompen-
sation, will do the work,and the structure is not intended,or offered
r sale. (Sec. 7044)
02/"10, as the owner, am exclusively. contracting with licensed L.U111,10ut-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUP.al) M
OR ADDNS. ACC.BLOGS. 21/2 0sq ft
NEW CONSTR. MULTI-OUYLET I
NON,RESID. BRANCH CIRCUITS) 2.50 ea
(POWER APPARATUS.&)
SINGLE OUTLET CIR
20@50t
Ex. OCCIJP(OUTLETS OR FIXTURES BAL030t
FIXED APPLNS OR
Ex. Occup. OUTLETS (RESI'O.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 tq(3
Misc. Wirin 15.00
AF ffee
' 4&—e4l
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F -I 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
f 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 10.00
Heating
Cooling
Hood
3.00
Venti lation
Permit Fee
Contractor
I certify that I have read this application and state that the above informa;;On-
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 sai ,County in conseguence of the granting of this permit.
X — — ��le
Date
Signature of A ;cant'- Owner [IT Contractor El AgentE?' /
An OSHA Zili is required for excavations �Ver 5'0" deep and demolition or construct-
ion of stru�tures over 3 storiel in height.., I
Mobile Home Installation ee
Energy Inspection Fee $
TOTAL PERMIT FEE $ _1�7171
occ up.
I CONST.TYPCJ
JSCJLJF��
P;f;�
IS
This. permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOFt OF PUBLIC
I —
By
PEOWIT'EXPIRES Date—.—'-*',
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date%>
.
R p
ecei 't No.
WHITE-D.P.W.. YELLOW-ASSE390R. PINK -INSPECTOR. GOLDENROD-APPLI CANT
COUNTY OF BUTTE- DEPARTMENT� OF PUBLIC WORKS - BUILDING DIVISION
4FA " -,�'l '
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
4",
PERM IT APPLICATION DATA SHEET
Permit No.
OWNER A. P. No.
Proposed Building Use Building Inspector—Z Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
andJor issuance: k� DATE RECEIVED APPROVED
1. All items have been submilted
Plot plans in duplicate//tripli-cate, s�igned by preparer of plans.
3. Complete plans in duplit7at67triplicate, signed by preparer 6f plans.
4. Complete engineered pI ans and calc�s, with wet signature on -plans.
5. Plans with Energy Design -Compliance Statement . . . . . .
6. School District "Fees Paid" Stamp on Floor Plan.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ .. . . . . . . . .
9. Letter of signature authorization . . . . . . . . . . .
��l 0. Sanitation approval from Health Dept.
11. Planning approval for (A) Use: (B) Parking: -
12. Certificate of Workmen's Compensation Insurance . . . . . .
13. -Contractor's License Information (no., name ' style, classif.)
14. Owner -Builder Verification (Given to owner[], Mail to owner
—15. Improvements may be required . . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . . . . .
Pre-Inspec. request to (Dat.
1 -�. Pre -inspection for Required- Building Inspector,
��'8. Recorded copy of Agricultural Acknowledgment Statement.
9. Driveway Permit. 9N
20. Plot plan approval from city of
21. Engineered trusses 'in duplicate (required prior to plan check). -
22.
When you issue the permit, process as follows: Mai I to owner, —Mai I to contractor.
L�Telephone__/_13 �d,4� and hold for pickup at office, —Deliver w/inspector.
Other
Applicant
Copy of plans sent — Health Dept., —Fire Dept., _' Other— Date f
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---jnal I —counter, by— date
Contractor, designer, owner, was advised of above required data by —phone —ma I I —countbr by— daf*e
Date -57
Plans checked by Plans approved by— Date
Sets of plans on hold in —File cabinet _AP folder
Copy—DPW
TO: Building Department
FROM: Encroichme""nt,,Permit
RE: Driveway'. C164r,,ance
owner
Section
A,
location
Driveway permit /IN has
si ature
AP #
been issued for the above property.
date
TO Buildina Department
FROM: Environmental Health
SUBJECT:, Sanitation Clearance
owner Location AP#
Plan Approved' for: Sewage Disposal Water Supply
Hold final for: Water Supply.
Final clear"ce O.K..fo r: Water Supply
LAj)
Clearanceffor bedroom obile home.
0 er
NOTE-
I-
Sanitar an
.1
010
rn Lo DPW AGRICULTURAI, ST ATEMI,'NT OF ACKNOWLEDC I'M I'NT
FOR RESIDENTIAL DCVLf,oi-m,-,NT � *
Section 26-8.1. of the Butte County Code
requi.res' Lhis acknowledgelliC-InL be recorded
prior to iSSLIZInce of a building permit.
I'lie. properLy described herein is adJacent
Lo land or inc-luded vithin an area zoned 88-013809
1 Rec Fee S.00
f'or agricultUri.11 purposes, and residents
Cash 5.00
of' Lh-i.S proper -Ly may be Subject to incon- Recorded
veniences or discomfort aris-ing from Lhe Official Records
use of agricultural. chemicals, including, County of
b u L noL limi-Led to herbicides, pesticides, Butte
i
,ind f e r Liti Ze r s and f rorn the pursuit Candace J. Grubbs
1
of a g ri c u 1. t u ral operations including, Recorder
1) Ll t not lirid ted to cultivaLion', plowing, I I : 25am 3 -May -88
BG I
sprayiiig, pruning, and harvesting which
occas.iona.Ily generaLe dusL, smoke, noise, and odor. Butte CounLy
has esLablished ;,igricti I—
Lural. zones which have as a *priority use for productive agriCLLI.Lural. purposes,' and residow
wi 1.hin said zones and on/ adjacent pfoperLy should be prepared to
accepL such
or d-isconform from normat, necessary farm operations.
A1.1 Lhat real property situate in the County of Butte, StaLe of
Calliforni.a,
[o[lows:
All. that certain real property situate in the Couhty
of Butte,
State of California, described as follows:
Lot 12, according to thatIcertain Ma ' p entitled, "Gridley
Colonv
No. 7, near Gridley, Butte Co., Cal.",w hich Map was
filed in the
office of the Recorder of the County of Butte, State
of California,
February 5, 1907 in Book.6 of Maps, at page 7.
EXCEPTING THEREFROM the Northerly 225 feet of said Lot 12.
Date: April --,28, 1988
PROPERTY OWNERS:
1-�� 4��-
Larry,^. Casey
SL;-iLe of Californ�a On this the 28th (Jay . of April —, 1.9 88 bef-ore 111u,
County of Butte �SS. the undersigned Notary.Public, personally 'appeared
Larry K. Casey
Personally known to me. 1A Proved Lo me on the I)asi.-;
of satislacLory ev.idencv.-
Lo be the perso.n(s) whose name(s) is
subscribed to the wiLhin instrument and acknowledged that he
executed the same for the purposes Lherein contaLned.
OFFICIAL SEAL IN WITNI;NS
LINDA F. WILSON WHEREOF, I hereunto set my h:an:dandu :of f ial seal
NOTARY PUBLIC - CALFORNIA
BUTTE COUNTY
My Comm. Expkes Feb. 15, 1992
"o, %, P,
Present- A.P. No. 21-16-0-063-0 No ' Lary Pubp C
Linda F. Wilson
COUNTY OF BUTTE Department of Public Works
7 County Center Driv . e, Or6ville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has-been applied for in your name And bearing
your signature.
Please complete and return this in * formation 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) Z 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. Ivill 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 S umber/ -
Date n��
NOTE: This Owner -Builder Verification is sent to you as required by.Sections 19831 and
19832 of the talifornia*Health and Safety Code.
This verification must be completed and returned to,our office before we are per-
mitted to issue �he permit.
AP #
OWNER
PERM -IT
.14H UTIL.CLEARANCE DATE
INSPECTOR
ELECTRIC GAS Support Compaction
-vice Other Pipe, Struc. Test.Req.
Load Tvi)e Size Lenath YES! NO YES NO
T -c,
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE7T *0
7 County Center Drive - Oroville, Cialifornia 95965 - Telephone: 916/538-75
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
1-1:7 / — & 1
'0
Z5
BUILDING PERMIT
OWNER —
4:2,
JT:� �r
SQ. FT. OCC. BUILDING VALU)IIAION
OWNER'S MAIL
J V
0 '71 �2�"
CONTRAC�OR-S N
�A
I
TELEPHONE
. _ ___
CONTRACTOR'S M`AILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation i$
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.—
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS Z07__-�
Permit fee
$
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
AASolar
or heat pump water heater
20-00
LOT NO. 'I
SUBDIVISION NAME ARCEL MAP
I
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF DupIexF1 Mobilehomeg--l"Ot her
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10-00ea
TYPE OF WORK
NewE� Addition [I Remodelo Utilities[] Installation 9?'Other n
Describe work:'
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
Main service 600V OR LESS
1100 AMP OR LESS
10.00
Main service EA. AOD-L 100 AMP
2.50
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.
cerise 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)
El 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 A ... S. ACC.. BLOGS. 21/20sq ft
NEW CONSTR. MULTI -OUTLET
NON-RESID. BRANCH CIRCUITS) 2.50 ea I
(POWER APPARATUS &I
SINGLE OUTLET CIR. I
0@50tJ
Ex. OCCUP(OUTLETS OR FIXTURES 52AL030C
FIXED APPLNS OR
Ex. Occup. OUTLETS (RESI*D. EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00'
Misc. Wiring 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
C-] The permit �is for $100.00'(valuation) or less.
E] I have placed on file with the County of Butte Building Department
a,C-ertificate of Workmen's Compensation Insurance or a Certificate
f Consent to Self -Insure.
I shal I 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 beconit; �Uujt;%A
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
FilingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
p ermit Fee
Contractor
I certify that I have read this application and state that the above in
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 sai , ounty in consequence of the granting of this permit.
a .
X Date
Signature of pplicant — OwnerZf ContractorE] Agen
" e�
An OSHA armit is required for excavations over 5'0" deep and demolition or construct-
ion of stru ctures over 3 stories in height.
Mobile Home Installation Fee $ 46 ov
Energy Inspection Fee
TOTAL PER IT FEE $
occup.1
CONST.TYPII
15C 011'1,0.21*Aj��Fib
ffd
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO OF PUBLIC
BY.
PE!NffEX"P1RES Date--------
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date v/- 7_7
16
Receipt No. 1(05� Ll
W"ITE-D.P.W.. YELLOW -A389330111, PINK-INsprcrOR. GOLDENROD-APPL I CANT
COUNTY OF BUTTE - DEPAR I IVIEN I -OF -IRM, BILIC WORKS - BUILDINGiDIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-75411—
PERMIT APPLICATION bATA SHEET
Permit No.
OWNER A. P. N o. (a3
Proposed Building Use U 7LX� Building Inspector Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
andlorissuance: DATE RECEIVED APPROVED
1.
All items.have been submitted . . . . . . . . . . . .
Contractor, designer, owner, was advised of above required data by—phone —mal I —counter by—
2.
Plot plans in duplicate./triplicate,. signed by preparer of plans.
Date -(a
3.
Complete plans in duplicate./triplicate, signed by preparer of plans.
4.
Complete engineered plans and calcs, with wet signature on plans.
5.
Plans with Energy Design -Compliance Statement . . . . . . .
6 (16 "Fees
6.
-1D School District Paid�,,$tamp on Floor Plan.
7
Statement of Intent for Non -Heated and AC Buildings.
8.
Fees of $
9.
Letter of signature authorization. . . . . . . .
10.
Sanitation approval from— Health Dept.
11.
Plann,ing approval for (A) Use: 7--arking:
-12.
Certificate of Workmen's Compensation Insurance.
13.
Contractor's...License Informatibn (no., name 'style, classif.)
14.
Owner -Builder Verification (Given to owner[], Mail.to ownerE])
-15.
Improvements may be required . . . . . . . . . . . .
-16.
Mobilehome Installation Data. . . . . . . . . .
I
17.
',� Pre-Inspec.
Pre -Inspection for Required- Building Inspector
request to (Date)
—18.
Recorded copy of Agricultural ACknowledgment Statement.
19.
Driveway Permit.
20.
Plot plan approval from city of
21.
Engineered trusses'in duplicate (required prior to plan check).—
r1i
When you issue the per t, process as follows: —Mail to owner,
(0-7
—Mail to contractor.
_L�_felephone
and hold for pickup a0if(I—office,
—'Deliver w/inspector.
Other
Copy of plans sent — Health Dept., —Fire Dept., — Other— Date
The following data must be submitted prior to perr it ,
III issu,��nce: (Circle new item not Ghecked al�o ve).
1. Index permit for above items No. 6A6 -,r� A21 A
2. Additional items required: Ua;> Abkk-
Contractor, designer, owner, was advised of above required data by—phone---mai I —counter by—
date
Contractor, designer, owner, was advised of above required data by—phone —mal I —counter by—
date
Plans check -d by Date —15-- �_WPlans approved by— C
Date -(a
Sets of plans on hold in —File cabinet _AP folder
Copy—DPW
COUNTY OF BUTTE - Department of Public Works
7 County Center Driv�, OroVille, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit
will be issued until this verification is received.
1. 1 personally plan to provide the -major labor and materials for construction of
the proposed property improvement (yes or no)
1
2. - I (have/have not) signed an app4cation for a bui I Iding permit
for the proposed work.
3.
I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
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 x
Social Security Numben" '
Date A�r
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to�our office before we are per-
mitted to issue �he permit.
)TE -,AU FA-aferfafs 'Ef' WoAman-Pp Sha'ff Be Tm
cordance willh Reco�.-nized Good Practices and
a qual. , I prescri,&J for Ae, Speci-Ned use in Ae
iform Bui'ding, Plumbing & Mechanical Codes and
Helional Electrical Code.
C:
UtIllty connections shall be within
4 ft. of the mobilehome, either
directly behind or within the rear
half 'of ",,F9&drid@ 4@4) of the
FTr
-P
U,-
N 1hij sot ot plans and specifications MUST I
(@y)+ )n a+ all firnes and it is unlawful -
dw nons on some wi$o
amv chf,-,nes or aiferc"
Wriff. n Permission from the Department of Pub
Wort County of autte.
--- - -- V111%JI/V
FOR MOBILES
A setback of 5 ft. from the
property lines and a setback
of 50ft. from the road
centerline shall be clear of
structures or equipment eXC@P4
for a 2 ft. eave overhang,
06r �Ps
0�a.11 ea4e1x-'
0-
3
,iu_ . N
BUTTE COUNTY DEPARTMENTAQVIPUBLIC WORKS
7 County Center Drive, Oroville, CA
PHONE: 538-7541
MOBILEHOME INSTALLATION SHEET
1. Owner's Name:
2. Installer's Name:
3. Is the site currently unde� permit?
(If yes, furnish permit r),umber
is the site an existing site? .
(if yes, furnish two plot plans.)
a -5 -lea
Yes Fj No
) OR
Ye s No 9
4. Will the mobilehome be located at least 5 ft. away from septi tank and leach
fields and clear of all setbacks and easements? Yes ff No F]
(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? ----
7 2_00_
A mps
8. Is there any other electric load to be served by the
mobilehome site service? ---------------------------------- Y�; No F1
(If yes, identify the load and size: (Load) 3,0 —(Amps)
9. What is the mobilehome site'ga's pipe size.? --------------- (in.)
10. What is the type of gas service? ------------------- Natural LPG
11. What is the gas pipe length from meter or tank to the
mobilehome? --------------------------------------------- (f t.)
12. What is the mobilehome gas demand? ---------------------- (BTU)
*(This information not required if pipe length less than 6 ft. on
natural gas or less than 50 ft. on LPG.)
MOBILEROME SUPPORT DATA
KtS if o-ther.than single wide,
Mobilehome Mfr. 6 C� furnish Setup Model NO.—
Year
Width � q __(ft.) Box Length� �6_3� (ft.) Tagalong or Expando Size ft. x
C . – 1�..
f t .
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) 91. Wood -pressure treated or foundation grade. 1:1 2. other (specify)
SUPPORTS (check one) 1. Concrete biock. 2 Other (s�ecify)
Pier Footing Sizes and Locations
SINGLE -WIDE
—Ma—in B—eams—
Line 2
Main Beams
Tag or Triple
LIne I Piers:
Size -Mill - ------------
Spacing-Max. - ---------
Fritin 1-,'nds-Max --------
LI il e 2 _LJ — :
Size -Mill -------------
Spac I. og -Max - ---------
From Ends -Max --------
Lj!�tj N�c,.L IA)ads:
Line 1 Openings:
Size -Min - ------------------
Each Side of Openings
With Width Over --------- E=
Line 3 Piers* (Under Bearing Wall Only)
Size -Min -------------------
Spqcing-Max ----------------
From Ends -Max --------------
ew A' -f-5
Size -Min ---------- "X IX "X
LAivation (From Front)
L 'x
.Lj ne .4 ±Ke r a : Line 5 Piers (Under Bearing Walla Only)
S J z, - M i n ------------- Size -Min -------------------
S pa" i ,g -Max ---------- Spacing -Max ----------------
From Eilds-Max -------- From Ends -Max --------------
Lj.q��_A_!kof loads:
locaLion (Frum Front)
A.PPROVED
.lx
F
lIx
x
lIx tx
X
Mr eA�
Gridley Union High School District
#2 East Gridley Road, Suite B
Gridley, California 95948
CERTIFICATION OF COMPLIANCE
SCHOOL DISTRICT DEVELOPMENT IMPACT FEES
PART I TO BE -COMPLETED BY APPLICANT
Property Owner's Name K" K - (—/9,5 U
Owner's Address
Project Address
Parcel Lot. No. City (,ej a County
TYPE OF CONSTRUCTION Please Check Please Check
Residential Construction Single Family
Residential Reconstruction Multiple Family
Commercial/Indust. Constrn. No. of Units
Commercial/Indust. Reconst. Mobile/Mfg. Home
"Aunt Minnie"
/�� 00
TOTAL NUMBER.OF SQUARE FEET , 00
THIS CERTIFICATION COVERS ONLY THE AMOUNT,,OF SQUARE FOOTAGE INDICATED ABOVE.
ANY'ADDITIONS AND/OR CORRECTIONS�TO'THE SQUARE FOOTAGE FOR THE PROJECT WILL
REQUIRE AN' AMENDMENT TO THE CERTIFICATION OF COMPLIANCE. FALSIFICATION OF THE
SQUARE FOOTAGE IS CAUSE FOR REVOCATION OF THE CERTIFICATION OF COMPLIANCE.
Applicant's Name
Applicant's Signa
PART II TO BE COMPLETED BY SCHOOL'DISTR-ICT'
Certifica.tion 6f,Compliance No. (Receipt No.)
Fees Collected
Residential # �2 sq. ft. x $1.50 = $
Commercial/Indust. # sq. ft. x-$0.25 = $
Exempt from Fees Reason
AS THE AUTHORIZED SCHOOL DISTRICT OFFICIAL, I HEREBY CERTIFY THAT THE REQUIRE-
MENTS OF GOVERNMENT CODE SECTION 65995 HAVE BEEN COMPLIED WITH BY -THE ABOVE
SIGNED APPLICANT.
Signature
Title Date
Origina7- School District
Copy - Applicant
Copy - Building Department
tj
.2
114v. -2FIZ5-
Gridle Ion High School Olstrict certifie
:Fshat
(name of p rmj't appil tj
7e� 9 (phone noj
(street gress)
Lze
(city) 1(sWe)
has com tied - (zip)
regarding P" mnth th;e =:�-i.,,rnents of ROsolution No. 17-868'7
or cOmmercial/industrial Unit(s) on
Assessor Parcel No.
the pa a of fees of $ by
square feet. reprbsenting
(date)
J..%3UHSD reprftwtatjv&)
13
I