HomeMy WebLinkAbout021-250-013� 41�
-25713
�A
21-25-131. 0
..21
�-`,BOCK,,Robert Bock, Robert
'1322 Richins Ave, Gridley-* -E/S Richin�-Ave, approx. 950' S
-Cont:.Ray,B6rges- %of Little Ave, Gridley
lo
AP, Exemption Permit
'(fruits & nuts,'tractors)
21-25-13 93-170
-25-0-013
-Permit#2478-91B 021
��BOCK.,,, ROBERT
Oemo.sf)` qU�J�
4 1322",RICHINS-"AVE GRIDLEY",
V,
MRAL EXEM-F,1-1— -IT
-O.N,.PERM ij,
FARM.EQUI
04-1067- PMENT/ADDN,T0'EXISTING",-.
021-250-013
BOCK,ROBERT 404-1067-
E
1322 RICHINS AVE, GRIDLE
Cont: GALLAGHERS HEAT
C/O HVAC SPLIT SYS
021-250-013 04-1118
BOCK, ROBERT & LAURA
1322 RICHINS AVE, GRIIDLE
Cont: GALLAGHERS'AIR
REPLACE EX HEATrNG &AIR
04-3296
BO�K, ROBERT
4!�
1322 RICHINS AVE, GRIDLE
WE
Cont: HAGBERY, 0
LO EL
�REPLACE SH6WERJPLUM'B
A
. I
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buftecounty.netlidds
PERMIT NO
BP043296 7
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
I
Issued Date: 11/16/2004 APN: 021-250-013-000
the Business and Professions Code, and my license is in full force and
effect.
LicenseClass: -4R-�kft�45enseN ber:
Site Address: 1322 RICHINS AVE GRI
Date: Contractor: y'"'offi
Map Index:
Description: REPLACE SHOWER/PLUMBIMG
OWNER-BUILD�k DECLARATION
I hereby affirm under penalty of perjury that I am exempt from Ihe
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: BOCK FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
BOCK ROBERT 0 & LAURA L TRUSTEES
signed statement that he or she is licensed pursuant to the provisions of
1322 RICHINS AVE
the Contractor's State License Law (Chapter 9 commencing with Section
GRIDLEY, CA 95948
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
Ll 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: HAGBERY, J. LOWELL
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees.
1151 FRENCH AVENUE
provided that such improvements are not intended or offered for
GRIDLEY, CA 95948
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
530-682-1533 cell
proving that he or she did not build or improve for the purpose of
sale.);
El 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor: HAGBERY, J. LOWELL
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1151 FRENCH AVENUE
GRIDLEY, CA 95948
13 1 am Exempt under Article 3 of the Business and Professions Code
530-682-1533 cell
Date: Owner:
License #: 381195
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
Q 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.
Architect:
El I have and will workers' compensation insurance, as
Engineer:
maintain
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier: S-- C441XI454, i;'
Total Square Ft: 0 S. F.
Valuation: $0.00
Policy
Census Code:
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 the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:—
ADDlicant: Q,
_WnARNING:Failure to secure workers' compeatio erage is
awful. s
unlawful, a d shall subject an employer to criminal p I one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under tpe applicable provisions of the B!i�a County gods ;?nri/or
I hereby affirm that there is a construction lending agency for the
f h* h fees have been paid.
Resolutio to do work indi w ic
performance of the work for which this permit is issued (Sec 3097 Civ.)
9ted'07e
By: / -, ,6 17r
I 7 Date: 11116 A
A
Name:
— , / I/
F
PE XPIRES ON: &�
Address:
/ (Dole)
0 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
C3 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
Q Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name-.. 3 -ey�, Signature:
Date:
0 Owner W Contractor Ll Agent for Owner Ll Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buftecounty.net%dids
PERMIT NO.
BP043296
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 11/16/2004 APN: 021-250-013-000
the Business and Professions Code, and my license is in full force and
effect.
saka:�4,ense 39 9:5
Site Address:
r4
License Class: N ber:
1322 RICHINS AVE GRI
0 Contra �XA
Date: ctor. Zn
Map Index:
Description: REPLACE SHOWER/PLUMBIMG
OWNER-BUILDgA DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: BOCK FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
BOCK ROBERT 0 & LAURA L TRUSTEES
signed statement that he or she is licensed pursuant to the provisions of
1322 RICHINS AVE
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
GRIDLEY, CA 95948
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
Q 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: HAGBERY, J. LOWELL
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
1151 FRENCH AVENUE
provided that such improvements are not intended or offered for
GRIDLEY, CA 95948
sale. If however. the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
530-682-1533 cell
proving that he or she did not build or improve for the purpose of
sale.).
E3 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor: HAGBERY, J. LOWELL
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1151 FRENCH AVENUE
LI I am Exempt under Article 3 of the Business and Professions Code
GRIDLEY, CA 95948
530-682-1533 cell
Date: Owner:
License #: 381195
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
13 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Architect:
is issued.
Engineer:
El I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carder and policy number are:
Carrier: SICAk (I)ICAL110-1 a)14aW"-
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
I
Policy 16,
Ell I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: —11— /IL, — n <-/ .
Applicant:
?
F
WARNING: Failure to secure workers' compe at,.n ve rage is
_-9
unlawful, a7d shall subject an employer to criminal pen;es and one
s
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
IIIIX16
CONSTRUCTION LENDING AGENCY
This permit is hereby issue6 under tpe applicabl provisions of the Bi 1�e County 9odFt ?nrVor
I hereby affirm that there is a construction lending agency for the
Resolution t d rk indi ted; ve r which fees have been paid.
clo'wo
performance of the work for which this permit is issued (Sec 3097 Civ.)
A v
Name:
By: Date:
4EXPIRES /OT—
Address:
PE; MIT ON'
(D
fite)
E3 I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
0 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
L3 Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: U—h-- k \ Ot QJ2 -e-;(�, Signature:
Date: C) H 6 1
0 Owner W Contractor El Agent for Owner LI Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7635 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.bultecounty.netWds
C) I �-- (11 19
PERMIT NO.
BP041118 V
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 04/21/2004 APN: 021-250-013-000
the Business and Professions Code, and my license is in full force and
effect. --�'77331/ C7 & ic -v
License Class : License Number: . -
SiteAddress: 1322 RICHINS AVE GRI
Date: �1911611 Contractor. _c a 5 �Alnc
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Dec:cription: REPLACE HVAC SPLIT SYSTEM
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a.
permit to construct, alter, improve, demolish, or repair any structure. prior
Owner: BOCK FAMILY TRUST
to its issuance, also requires the applicant for such permit to file a
BOCK ROBERTO & LAURA L TRUSTEES
signed statement that he or she is licensed pursuant to the,provisions of
the Contractor's glateLicense Law (Chapter 9-commencind with S`ecti6h
1322'kI_C'HINS AVE
7000). of -Division 3 of the'Business and Professions Code) or that he Q'r.
-'exempt
GRIDLEY, CA 95948
she i s therefrom and the basis for the alleged exemption. Any
violation of. Section' 7031.5 by any apl5lidaint for a' 'perfnit . subjkts the
applicant,.,to.a.civ,il. penalty of not more than five hundred dof6rs*($500)'.)-
1, a i 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
to an
Applicant:- GALLAGHER'S,HEATING- &-AIR-
..,QWner of. property who.builds or improves thereon,. and who does
s�uch*rk him9elf or herself or thrbug� hi's or her own employees,
E. HWY 99
provided that such improvements are not intended or offered for
'
sale. If however, the'buildind or lmorovementg'i�e'sold within one,
LOS MOLINAS, CA
year of completion, the owner -builder will have the burden of
800-892-3556
proving that he or she did not build or improve forthe purpose of
sale.).
as... owne!� ..of, thP1_prqpeqy_, gm. q?�cI.u*yqIy,,qontrac rilig _!6tith..
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code, . The Contractors' State License Law does
- not apply to an owner of property who builds or.improves thereon,
Contractor: GALLAGHER'S HEATING & AIR
and who contracts for puch projects with a contractor�s) licensed
pursuant to the Contractors' State, Licenso Law.).
E. HVVY 99
1 am Exempt under Article 3 of the Business and Professions Code .
LOS MOLINAS-; CA
800-892-3556
Date: Owner:
License #' 777334
'WORKERS'.COMPENSATICiN'DEcLARA-fl(?N
1 hereby, affirm under penalty of perjury one of the following d6cia,rations:
0 l.'have an d- will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
Labor. Code, for the performance of the work for which this permit
Architect:
s issued.
and Will 'maihtaih'work,efs' como&s6tion 'irisurath-ce, as
Engineer:
required by Seotion 3700 the Labor.Code,.for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number aife:
Carrier: YX d
-
-7 d, 6,3
Total Square Ft: 0 S. F.
Policy#:.
V aluation: $0.00
'o'f'
I
ertify that i�theperf�rmanic'e the wo'r'kfor`w-h.i c` h.".-this'.'p. er'mit'is
Census Code:
issued. I shall not employ. any. person in �any manner so as to
become subject to the workers' compensation laws of -California,
and agree . that - if 1. should i become subject to - the, workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:-
,Applicant- A
WARNING:V�ailure to iecure Workers' compensation, �overage is
unlawful, and shall subject an employer to criminal penalties and one
hundred 'thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees. .
(cc eip-�-
CONST, RUCTION LIENPING AG I E I N CY
This pa; ... ;! ilsb�reby issued arider the applicatUa provisions of the Butte County Code andtor
I hereby affirm that there is a construction lending agency for the
Resolutio=icate2 a ve for which fees have been paid.
performance of the work for'which this permit is issued (Seic W97 Civ.)
Name:
By... Date:
PERMIT EXPIRES CW L_� — -7,
Address:
(Date)
1i I hereby 6eitify ttiat thb iiib of thig fidilitq shallc�mpl�'�vith Sedibris 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
0 -Notification in accordance with' Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
0 Attached are copies of the required E.P.A. notificationforms.
I hereby certify that, I have read this application, that t he above information is correct, and that I am the owner the d ly auth riz agent of the owner: I agree to comply with
,
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance f ny icial fo r oc ment f Butte County. I hereby
authorize represen�ta�as of Butte County to enter upon It) a above mentioned property for inspection purpo s.
. . I t, '
LJO S
Prin I Nat Signature:
Date:.
El Owner 0 Contractor MKAgent for Owner El Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: wwwbuttecounty.netkdds
PERMIT NO.
1 BP041118
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 04/21/2004 APN: 021-250-013-000
the Business and Professions Code, and my license is in full force and
effect. __� -7 7 3 31/
License Class License Number:
Site Address: 1322 RICHINS AVE GRI
Date: 91 . 16q Contractor:
Map Index:
Description: REPLACE HVAC SPLIT SYSTEM
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a.
permit to construct, alter, improve, demolish, or repair any structure, prior.
issuance,
.-Owner: BOCK FAMILY TRUST
w.
to its also requires the applicant for such permit to fit&.,
signedMatement that he or she is licensed pursuant to the�provisions of,
BOCK ROBERTO & LAURA, L TRUSTEES'
the Cbntr6�tor's*giateLicense Law (Chapt6r�-0"comm-enci'.n6"�,ith �ectiiih
1'K 2 --*F�I_C!'k I N S -AV E
7000). of -Division 3of thL- Business and Professions Code) or that he �r,
GRIDLEY, CA 95948
she ii'exempt therefrom and the basis,for the alleged. exemption... Any.
violati.6n by any Qpicant orlaipeqnit,-�O�jl
of.'Sec bon' 7034 5 �Ii`k 'f ects the
applicant-to.a.dy'i'l. penalty of not more than five hundred dii_16ri. q0
Q 1. i�-bwner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intend,ed or offered for sale ��ec. 7044, Busin - ess and Professions
w.' -10r p
icense*La-"' i;rqoii�
does
Applicant: -G -LLAGHER�'S,HEA-T-ING-&-AIR-,-,,,-,,,-----,,----,",---
A
qyvner of. propeqy who builds or improves thereon,. and who does
"s��c��w6rk�im�61f�r-.h6rselforihr'666h '
his or her own employees,
il�at's66h '4nis ' *or
E. HWY 99
�iro�ided improve a4 not'int ded offered for
4?p..
'T i.
sale. If ho'WeVer; th6 building 6F'A�pro�emen*ts'are sola within one"
LOS MOLINAS, CA
year of completion, the owner -builder will have the burden of
800-892-3556
�'proving that.he or.she.did not build,or improve for.the purpose of
sale.).
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code The Contractors' State Licensp. Law does
pot apply to an. owner of property who builds orJ!,nproves thereon,
Contractor: GALLAGHER'S HEATING & AIR
and who cont ' racts for such projects with a;contractor(s) licensed
pyrsua!lt to the Contractors' State.License. Law.).
E. HWY 99 7
I am E��emptu rider Article 3 -of the Business. and, Professions Code .
LOS MQLINAS-,-CA
�,Owner:
800-892-3556
Date:
License M'777334
DECLARATION -
I hereby affirm under penalty of perjury one of the following d4cla-rations:
Q'*' I.Pave an'd, will maintain a certificate of consent to self'insure for
wo*ers, compensation, as provided. for by Section. 3700 of -the
Labor. Code, for,the performance of the work for which this permit
Architect:
is issued.
J"�aiid' 'and �kill-'riiaintaih"�v'orkei�"comFen'�gtion ins6raiice,' 'as`
Engineer:
required. by Se.ction 37QO the Labor,-�Code,Jor.the performance of
the work for which this perm ' it is issued... My workers' compensation
insurance carrier and policy number aie:
f�4'1 d
Carrier
Total Square Ft: 0 S. F.
-79
Valuation: $0.00
-d' 1'4��riify that' in' the performance of the work for which this �permit is
Census Code:
.issued, I shall -not employ. any, pe�rson in 'any manner so as to
..become subject to I - he workers' compensation laws of California,
and agree . that - if 1. . should. become subject to -the, workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:�
�Applicant:
WAR NING:V�ai!ure to iecure* workeiis' compens ation c I over . age is
unlawful, and shall subject an employer'to criminal penalties and one
hundred ' th - ousand dollars ($100,000), in- addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
G5 -o3
code, interest, and attorney's fees. .
P4_
CONSTRUCTION LENDING AGENCY
This permit i"reby issued under the applicable provisions of the Butte County Code and/or
a construbtibn
I hereby, affirm that there is -leriding , a . genc y for the
6erformance of the work for which this permit is issued (Sec' �097 Civ.)
Resolution,1 77;�� for which fees have been paid.
Name:
By: Date:
Address:
PERMIT EXPIRES
(Date)
.0 i� hbeeby 66ftifjfti�t thb ihall 66rr;�I`y`�vitliSe6b6hs 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
hamildling and use.of.ha,zardous materials.
0 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
u Aitached are copi'es of the required E.P.A. notificationforms.
1 hereby certify that I have read this application, that the above information is correct, and that I 6m the owner the d ly auth rriz agent of the owner: I agree to comply with
-
all county and state laws relating t6 building construction. I acknowle'd6e it.1s unlawful to alter the substance f ny icial. fo r oc mentpf,Butte County. I hereby"
aluthohie represent es of Butte County'to en'tair upoin''the"a- 6ove mentioned property 'urpo
for inspedoin purpo s.
Li I
r,
Print Name: -s-Sign atu re:
Date-:.
0 Owner 0 Contractor @/Agent for Owner 13 Agent for Contractor
County of Butte
Oroville, Califomia
GENERAL CLAIM
CLAIMANT: Robert Watters
ADDRESS: 478 E. 8th Street
CITY & STATE: Chico, CA 95928
nATF C)F r.1 Allul- 08/16/04
�r/ c-:)- ��/ 0 y
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
Refund Claim - See attached calculation sheet APN: 021-250-013
Permit No.104-1118
=PAID
RETAINEDREFUND
IDevelopment
Services
$ 55.00
$
$ 55.00
THERM DRNG
$ -
$
$ -
SMIP
$ -
$
$
SHR
$ -
$
$
ITUA
$ -
$
TOTAL
$ 55.00
$
$ 55.00
.
............................................
.............
............................................
.............
..............
.............
.............
Z"'
.............
............
...............................
...............................
.......................... .. : .
..............
............................
..............
............................
:::BUD GET:::::XCC0.UNT:
..............
..............
..............
..............
.............
..............
.............
..............
::AMO NT:::
iolow DVLPMNT SVC
440-001
4210500
55.00
1011822 THERM DRNG
1800
280
$ -
1011430 SMIP
1001
280
$
1011811 SHR
1800
280
$
1011816 TUA
18001
280
$ -
TOTALI
1
1 $ 55.00
$ 55.00
1, the undersigned, declare under penalty of pedury that the services or articles claimed have been perforified or delivejed, aP that this
claim is true and correct as tated. If
Dated this day of 20134, at v'�c fls�.-'Clalif' Sigature'of Claimant
1, the undersigned, hereby certify that, to the best of my knawledge. the services or articles specified above have been performed or
delivered and that there is a I Budget Approprial:ion or Specific Board Approval (Check dqTla �.same.
Dated this day of 2004, at Oroville an
Department Head or Authorized Deputy
Dept. SEE Exp.
Code BREAKDOWN Code PAYABLE FROM FUND
DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
,EPT & SUB PROJ SUB. 091 CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT.
I I I I I I
<R// 710Y
Butte County Department ofDevelopment Services
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-7785 Facsimile
ADMINISTRATION * BUILDING * GIS * PLANNING
August 16, 2004
Robert Watters
478 8'hStreet
Chico, CA 95928
RE: Permit No. 04-1118 APN#021-250-013 Owner: Robert Bock
On 4/21/2004, a deposit was made in the amount of $55.00, of which $0.00 was retained.
The remaining fees will be reimbursed to you. Please sip, date, and return the enclosed
claim form to this office. Once we receive the claim form, we will then process your
reftmd in the amount of $55.00.
Should you have any questions, please contact this office Monday through Friday, 8:00
a.m. to 4:00 p.m., at 538-6869.
Sincerely,
Diane Lewellen, OA III
Administrative Division
enclosure
04-1118.1tr
County of Butte
Oroville, California
GENERAL CLAIM
CLAIMANT: Robert Watters
ADDRESS: 478 E. 8th Street
CITY & STATE: Chico, CA 95928
r'IAT= 1-11= r4 AIKA- ORMA10A
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
Refund Claim - See attached c alculation sheet APN: 021-250-013
Permit No.
04-1118
PAID
RETAINED
REFUND
IDevelopment
Services
$ 55.00
$
$ 55.00
THERM DRNG
$ -
$
$ -
SMIP
$ -
$
$
SHR
$ -
$
$
ITUA
$ -
$
TOTAL
$ 55.00
$
$ 55.00
............
.............
............
........
............
.............
............
.............
............
.............
X
.... ........
............
...............................
...............................
...............................
...............................
................
..............
............................
..............
.........
.......
........ ...
..............
... ......
.............
..............
.............
.:AMOUN
.....
.
.66��
10100i DVLPMNT SVC
440-001
4210500
$ 55.00
1011822 THERM DRNG
1800
280
$
1011430 SMIP
1001
280
$
1011811 SHR
1800
280
$
1011816 TUA
18001
280
$ -
TOTAL,
. $ 55.00
55.00
1, the undersigned, declare under penalty of perjury that the services or articles claimed nave neen penormea or delivered, and trial this
claim is true and correct as stated.
Dated this day of 2004, at Calif.
Signature of Claimant
1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or
delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same.
Dated this day of_ 2004, at Oroville Calif.
Department Head or Authorized Deputy
Dept. SEE Exp.
Code BREAKDOWN Code PAYABLE FROM FUND
DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
)EPT & SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCLIMB. GROSS AMT.
REFUND CALCULATION SHEET
CLAJMANT:
-Robert Wafters
ADDRESS:
478 E. 8th Street
CITY & STATE:
Chico, CA 95928
JDATE OF CLAJM:
08/16/04
APN: 021-250-013,
RECEIPT INFORMATION
NUMBER:
394849
DATE:
4/21/2004
ISSUED TO:
Robert Watters
CHECK #:
2164
AMOUNT:'
$55.00
PERMIT
04-1118
Yes No Yes
No
Yes
No
PRIOR REFUNDS:
x
FEES VERIFIED
x
REFUND BREAKDOWN
A
Title
BLDG
THRM DRNG
AUD SUSP SHER DEV FEE THRM URBN
Fund
0010
1800
1001. 180 0 1800
Dept
440-001-
rHRM DRNC
(SMIP) (SHR) (TUA)
Accnt
4210500
280
280, 280 280
Cash
101001
1011822
1011430 '1011811 1011816'
DETAIL
PAID RETAIN REFUND
BLDG Time
109.98
55.00
..........
....................
....................
..........
....................
....................
..........
..........
.........
..........
...................
.........
....................
.......
..........
..........
..........
.........
........
.........
F 7ifing (from Plan Check) 0.00 0.001
Plan Check/Filing .0.25
27,50
22.00 1 22.001
22.00
....................
..........
Inspection
0.00
33.00 33.001
73-00
..........
....................
..........
B S
DG FEE
L -
.
....................
..........
....................
..........
................
.........
....................
..........
....................
....................
..........
..........
.........
..........
i OTHER B_LDG
ITUA 0.00 -0.00
SHR
0.00
0.00
............
......
......
....................
.......
REFUND PROCESS FEE
54.99
0.00
0.00
..........
....................
....................
....................
..........
..........
BUILDING TOTAL
55.00 0.00 5�.00
55.00
..........
....................
..........
..................
..........
....................
....................
....................
....................
....................
..........
..........
..........
..........
....................
........
..........
THERM DRNG 0.00
,§M1P
0.00
................
0.00
..........
..........
SHR 0.00
TUA
0.00
0.0
55.00 $ $ 55.00 $
55.00
$ $
APPROVAL
CHECK: $55.00
Date Reviewed
8/16/2004 DIFFERENCE: $0.00
Michael Vieira
- (Should be blank)
Building Manager
REFUND CALCULATION SHEET
CLAIMANT: Robert Wafters
ADDRESS: 478 E. 8th Street
CITY & STATE: Chico, CA 95928
IDATE OF CLAIM: 07/14/04 AFN: 021-250-013
RECEIPT INFORMATION.
NUMBER: 394849
DATE: 04/21/2004
ISSbED TO: Robert Walters
CHECK#: 2164
AMOUNT: 1$55.00- 1 1
PERMIT #: BP041336 o t4 -111 Is
Yes No Yes No Yes No
PRIOR REFUNDS: --- +-- x
FEES VERIFIED x I I I
REFUND BREAKDOWN
Title BLDG THR� ORNG AUD SUSP SHER DEV FEI i4M URSN
Fund 0010 1800 11001 1800 - 18001
o -poi rHRM
Dept 44 ORN( (SMIP) (SHR) (TUA)
Accnt 4210500 280 �80 280
Cash 101001 1011822 1011430, -�,1011811. 1011816:
DETAIL PAID RETAIN REFUND
�'BLDG Time 109.98
55.00
.. ........
Filing (from Plan Check) 0.00 0.001 0.00
........ ........ ................
. ................ ........ ........
Pla Check/Filing 0.25 27.50 22.00 22.001 22.00
........ ................
........ ........ .......
Inspection 0.00 33.00 1 33.001 33.0-0
BLDG FEES
................ ........ ........
I OTHER BLDG -
................ ........ ........
..... ........
ITUA
0.00 0.00
'.SHR
0.00 0.00
......................... . ....
REFUND PROCESS FEE 54.99 0.00 0.00
........ ...............................
BUILDING TOTAL ss.00 0.00 ..................
55.00 55.00 ::'
.........................
THERM DRNG - 0.00
"§-Mlp
0.00
0.00
............ ..
SHR 0.00 0-00
TUA, -
�0.0011 -.0.00
55.00
jP1 .. 1 $ 55.00 $ 55.00 r,
APPROVAL CHECK: $55.00
Date Reviewed /1 004 DIFFERENCE: $0.00
Michael Vielra (Should be blank)
Building Manager
Butte County Department ofDevelopment Services
Building Division
7 oun Center Drive
Oroville, CA 95965
(530) 538-7541
REFUND REQUEST APPLICATION
REFUND POLICY - Butte County Code 3-41(t)
1. Refunds can only be made upon written request by the person who paid the fees, whose name is on
t he receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt.
2. The request must be made within two years from the date of fee payments on permits not issued, and two
years from the date of permit issuance for permits issued - if no construction work has been done.
3. Filing fees and plan check fees for work plans checked are not refundable.
4. Fees paid to other County Departments are not covered by this claim.
INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be
generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the
receipt) and return to Developme Services for payment processing.
CLAIMANT'S NAME:
�6 (0-0- f � Ct
MAILING ADDRESS:
L � 7 K 15 Cvl-w�o 61� q5-52-,?
PHONE:
ASSESSOR'S PARCEL NO.:
[Please use one claim form per permit.)
BLDG PERMIT NO.:
L/ -
Receipt No. 1
Receipt No. 2
Receipt No. 3
2 11/ 1
RECEIPT NO.: V/
RECEIPT DATE:
6
RECEIPTAMOUNT:-
REASON FOR REFUND REQUEST:
--A'Zl k014 MAc
Check those fees which you wish to have considered for refund:
EEfBuilding Permit Fees Sheriff Fees SRA Fees (CDF Fire Planning)
Other (specify):
Plans for cancelled permits will be disposed of within 10 working days upon submission of a
Request for Refund. If you want the plans, you may pick them up prior to that time.
11%
Date
<)
�/' / 4) L
04-1118 1 �-11 I F-1
LAST NAME
CONTRACTOR
STREET NO
USE
VALUATION
S PAID
S2
=3
S4
Comments:
STREET NAME
TYPE
ra
RECEIPT
RECEIPT 2
RECEIPT 3
RECEIPT 4
FIRST NAME, RaTO
CITYICTY
����CITY
REMARKS
M
Ml
E
FLOOD
APPLIED
ISSUED
FINALED
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECT10N #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP041118-
PERMITS BECOME NULL AND VOID I YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 04/21/2004 APN: 021-250-013-000
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.
Site Address: 1322 RICHINS AVE GRI
License Class: License Number:
Map Index:
Date: Contractor:
E
Description: kEk�Alf Wk M
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which ;requires a
Owner: BOCK FAMILY TRUST'
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requ.ires the applicant for such permit to file a
BOCK ROBERT 0 & LAURA L TRUSTEES,
signed statement that he or she is licensed pursuant to the provisions of
1322 RICHINS AVE
the Contractor's State License Law (Chapter 9 commencing with Section
GRIDLEY, CA 95948
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 701.5 by any applicant for a permit s�ubjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
1, as owner of the property, or my employees with wages as their
sole compensation, will do. the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and ' Professions
Applicant: GALLAGHER'S. HEATING & AIR
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
E. - HWY, 99
provided that such improvements are not intended or offered for
LOS MOLINAS, CA
sale. If however, the building or improvements are sold Wthin one
year of completion, the owner -builder will have the burden of
800-892-3556
proving that he or she did not build or improve for the purpose of
-
sale.).
1, as owner of the property, am. exclusively contracting with.
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor: GALLAGHER'S HEATING & AIR
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
E. HVVY 99
0
LOS MOLINAS, CA
1 am Exempt under Article 3 of the Business and Professions Code
800-892-3556
Date: — Owner:
License #: 777334
. . 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 s�lf-insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Architect:
is issued.
Engineer:
CI I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carder and p6licy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy #:
Valuation: $0.00
Census Code:
0, 1 �e-rtify that in the. performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that it I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNING: Failure to secure workers' c ompensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
15c,-? oo
compensation, damages as provided for in Section 3706 of the Labor
Pd
code, interest, and attorney's fee s.
K -e of I'vo L
CONSTRUCTION LENDING AGENCY
This permit is bgrebyiss ed Per the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Resolutionsgd ork irtdi t! a ve for which fees have been paid.
i L( - Z/ - W
MW
Name:
By: Date:
1�7 - —
PERMIT EXPIRES ON: (Date) . q - Z-0 - D'�
Address:
Q I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health'and Safety Code, which regulate thestorage;
handling and use of hazardous materials.
0 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
0 Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: Signature:
Date:
IZI Owner 'IZI Contractor L3 Agent for Owner 0 Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
UT Butte County Department of Development Services Inspection Card
0 0 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
0 OFFICE #: (530) 538-7541
0
0
0 0 Visit our website at: www.buftecounty.net/dds
UN ALL PLAN REVISIONS MUST BE APPROVED BY THE COUNTY BEFORE PROCEEDING
Inspection Type Insp. Date
Ground work
Setbacks
Foundation/Footings
Piers
I Grade Beams
Eufer Ground
Hold downs
Sternwalls
Do Not Pour Concrete Until Above Signed
Slab -
Slab -Garage
Gas Test Yard Pipe
Blocks CMU/Logs
1 s' Lift
2no Lift
3'd Lift
Final Lift
Under Floor/Slab
Framing
Shear Transfer
Plumbing
Mechanical
Gas Piping
Do Not Install Floor Sheathing or Slab
Until Above Sianed
Inspection Type Insp. Date
Framing
Rough Framing
Rough Plumbing
Rough Mechanical
I Rough Electrical
Rough Gas
Roof Sheathing
Straps
Shear Transfer
ShowerPan
Rough Sprinkler
Do Not Insulate Until Above Signed
Insulation
Wall Insulation
I Ceiling Insulation
Do Not Cover Until Above Signed
Shear
Interior Shear
Exterior Shear
Braced Wall
Wall Covering
T -Bar Ceiling/RC
Sheet Rock-11st layer
Sheet Rock -2 nd layer
Separation/Location
Framing/Openings
Gas Test House Pipe
Stucco
* Lath
Scratch + Brown
Finish
Inspection Type Insp. Date
Final
Plumbing Final
Mechanical Final
Electrical Final
I Insulation Certificate
Final Sprinkler
Swimming Pool
Setbacks'
Pool Steel/Pie-Gunite
Electrical Bonding
Enclosures & Alarms
Plumbing
Electrical
'Gas Test
Light Nitch
Other Agencies Insp. Date
Public Works
Sewer
Special Inspection
Fire Department
I Underground
Final Sprinkler
Fire Final
Temp Elect Auth.
Elect Authorization
Gas Authorization
Permit Finaled
Date
I
B. C. I Insp. Card 01 -16-04 pg 2
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BUTTE COUNTY
DEPARTMENT OF DEV ELOPMENT SERVICES
BUILDIN(.,P' PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEIBSITE: www.by�ttecounty.netkdds
PERMIT NO.
BP041067
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of pedury 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
Issued Date: 04/15/2004 APN: 021-250-013-000
effect. 2
,�2 7_7717
LicenseClass:c— &LC3f LicenseNumber:
Date: 'Contractor:
J116W Address: 1322 RICHINS AVE GRI
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: CHANGE OUT HVAC SPLIT SYSTEM
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: BOCK FAMILY TRUST
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
BOCK ROBERT 0 & LAURA L TRUSTEES
the Contractor's State License Law (Chapter 9 commencing with Section
1322 RICHINS AVE
7000) of Division 3 of the Business and Professions Code) or that he or
is therefrom the basis for the Any
GRIDLEY, CA 95948
she exempt and alleged exemption.
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
1, as owner of the properly, or my employees with wages as their
OFF
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
Applicant: BOCK FAMILY TRUST
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
I
not apply to an owner of property who builds or improves thereon,
Contractor: GALLAGHER'S HEATING & AIR
and who contracts for such projects with, a contractor(s) licensed
pursuant to the Contractors' State License Law.).
E. HWY 99
ZI I am Exempt under Article 3 of the Business and Professions Code
LOS MOLINAS, CA
Date: - . Owner:
800-892-3556
License #: 777334
WORIKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
EI 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
. s issued.
W,-.,: have and will maintain workers' compensation insurance,
Architect:
as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:— 15!" /_ , ,
Total Square Ft: 0 S. F.
Policy M.
Valuation: $0.00
I certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
L) 16,11
Date:
no-oci
Applicant:
WARNING: Fl�i ure to se --pensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, �nterest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
de
This pe7it is qereby issued un 9 licable provisions of the Butte County Code and/or
ir tppve
I hereby affirm that there is a construction lending agency for the
Resolu ons� )rk indiTted a JfPcp which fees have been paid.
t do w(
performance of the work for which this permit is issued (Sec 3097 Civ.)
'k)aName: B MM& Date:
V
PERMIT EXPIRES
Address:
ON:
(Date)
L3 I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
• Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
• Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application. that the above information is correct, and that I a the o ner r the duly ut ized agent of he owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the s ' ubst e any offi I f um n I Butte County. I hereby
authorize represent7at's of Butte County to enter upon the abo entioned properly for inspectio 0
�Le
Print Name: 6
Signature
Date:
CI Owner IZI Contractor Ur"Agent for Owner 13 Agent for Contractor
1k
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: wwwbuttecciunty.neAdds
PERMIT NO.
BP041067
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
Issued Date: 04/15/2004 APN: 021-250-013-000
effect. - Class:c C 3 f License Number: -7-773-3'/
License.
_2�VL -
Date: 'contractor: C2ceIZ61A�,,57
Site Address: 1322 RICHINS AVE GRI
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: CHANGE OUT HVAC SPLIT SYSTEM
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: BOCK FAMILY TRUST
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
BOCK ROBERT 0 & LAURA L TRUSTEES
the Contractor's State License Law (Chapter 9 commencing with Section
1322 RICHINS AVE
7000) of Division 3 of the Business and Professions Code) or that he or
GRIDLEY,
she is exempt therefrom and the basis for the alleged exemption. Any
CA 95948
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five- hundred dollars ($500).):
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' State License Law does not apply to an
Applicant: BOCK FAMILY TRUST
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
Contractor: GALLAGHER'S HEATING & AIR
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
E. HWY 99
I am Exempt under Article 3 of the Business and Professions Code
LOS MOLINAS, CA
Date: Owner:
800-892-3556
License #: 777334
WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
13 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
W""I. issued.
have and will maintain workers' compensation insurance,
Architect:
as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carder: %,Al2 C�t� �L: , :; -F L.(
Total Square Ft: 0 S. F.
Policy #.
Valuation: $0.00
El I certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
'ie
16 -�
(Dt
Date:
Applicant:
/V
WARNING�: - re in s
ilure to s, - coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This pe7it is reby issued under t,"pplicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolu ns t, work indicated ees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
BY: Date: 6� - LIS -0-//
EXPIRES 1,57 `q -
Address:
PERMIT ON: L111-0
(Date)
0 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
(3 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
0 Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the o r the duly ut zed agent of the owner. I agree to comply with
Qner
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the subst e any offi 11 f um n f Butte County. I hereby
v
authorize representat' s of Butte County to enter upon the ab mentioned property for inspectio e
76
Print Name: SignaturJe
Date: i-1 Z
Q Owner 13 Contractor U/Agent for Owner 0 Agent for Contractor
�f
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING'PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP
q 16 & 9
DATE:
I
APN:Q2
I
ZONING:
/�
OWNER'S LAST NAME:
(� 0 (f K
OWNER'S FIRST NAME:
0
PHONE.
STREET ADDRESS, [z k
FAX
CITY, ZIP: d -
E-MAIL*
SITE ADDRESS: J
Cay, Z11 -
NEAREST CROSS STREET:
TFtACT/LOT P
APPLICANT NAME:
PHONE,
STREET ADDRESS:
FAK
CITY, ZIP:
E-MAIL:
CONTRACTOR NAME:
PHONE:
STREET ADDRESS: P,
FAX
CITY, ZIP: Alto
E-MAIL:
LICENSE NUMBER:-
7 53L/
LICZ!YP)E:
ARCH ITECT/ENGINEER NAME:
PHONE-*
STREET ADDRESS:
FAK
CITY. ZIP:
LICENSE NUMBER.
E-MAIL
DESCRIPTION OR SCOPE OF WORK:
C- Lj 44 r n & C -0 -c-0 f r,,Qr
Ll Structure Built without permits
El Proposed Change of Occupancy (note previous use)
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after the date of application. In order to renew
action on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to
the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan
checked and other department costs are not refundable.
For office use only:
Notes:
Application Received by: Date:
Receipt nunriber: Amount Received: J
'Z q
hA.0- —1;-fi- t-&-nA
TO: Building Department
FROM: Encroachment Permit Section
RE: Dfiveway Clearance
13,,
owner location AP
Driveway permit 41'z z o 7
T
n b
signa
..4re
has been issued for the above property.
date
BUILDING DIVISION
COUNTY OF BUTTE - DEPAJUMkNT OF DEVELOPMENT SrERVI)CES
7 COUNTY CENTER DRIVE — OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 53877541
AGRICULTURAL BUILDING EXEMPTION PERMIT
PERMIT NO.
q3_1 -7p
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public.
ASSESSOR PARCEL NO. Oo?. t -,�S 0 - Q �S
ZONING 04—
OWNER &
PHONE NO. ct- '3 -2 7 '9
e-rit "&Qk
OWNER'SADDRESS /Szz- /�iehl�v_s 14u e- 67r,'dlet
LOCATION OF BUILDING
,.SAM IE
USE OF BUILDING
IZE OF STRUCTURfj d&t-o Oois-rmW
61)
X Q. FT. fCrM i+ && t 3
TYPE OF CONSTR06TION:
WOOD FRAME — STEEL X CONCRETE OTHER (Specify)
TYPE OF SIDING
5 -r. n _-�' e/
ROOF COVERING
FLOOR TYPE
I oevc
ESTIMATED COST OF CONSTRUCTION
$ — k3icon
AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances
as follows:
FRONT SIDES REAR
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building!
AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a
mobilehome, and 40 feet from a commercial building.
AG Buildings must comply with Flood Zone requirements. Finish floor elevation must be at or above elevation
USGS Datum.
I declare,under penalty of perjury that the building will be used as stated above and the purposed use confirms with the
AG Buildi ng definition. If any change in use or occupancy of the building is made, I will contact the Building Division and
obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before
occupancy.
114d9
02 'le __
Date— Signature Of Owner
Permit Fee - $60.00
1
Receipt No. AM 7�9
The above described AG Building is exempt from a building permit.
FL00[y I PA P.Q I ROOF�RGISSUY�
I 'y I
Manager Building Division
I _�o 1014C
By Date
White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant
COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES - G DIVISION
17- . OUI QP
'T
7 COUNTY CENTER DRIVE - OROVII�9,-tA -fFORNIA95965 -TELEPHONE (916) 538-7541
OWNER
I
Proposed Building Use
PERMIT
1961/l/I
APPLIC.4TION'DATA SHEET
A. P. No. 0 12 '- ;,� �50 - 0 "3
Building Inspector_ R-0 Date A) - 41 -
At time of permit application, I was a&ised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
IZ 1 . All items have been submitted . ........................................
2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... .
3, Complete plans, 3/4 sets, signed by preparer of plans . ......................
4. Engineered- plans and caics, 3/4 sets, with wet signature on plans . .............
5. Hazardous Material Form . ..............................................
6. Energy Design Compliance and s:upporting documentation . ....................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check).
9. Mobilehome data and manufacturer's installation instructions, 2 sets . ...........
10. Fees of $ . .........................................
- 11. Impact fees as shown on attached schedule . ... ..........................
12. California Department of Forestry plan approval/fees .........................
13. Flood elevation letter (100 year flood) by California Engineer ...................
14. Sanitation and plot plan approval , Health Department . ............
15. City of Chico plumbing permit . .........................................
16. Plot plan and business license approval from City of Biggs/Gridley . .............
17. Planning approval for (A) Use: (B) Parking: .. ........
18. Contact Land Developmenta bout (A) Improvements (B) Drainage ............
19. Driveway permit (construction approval required prior to occupancy)- . . ........
,Inspection requ`FsF--
20. Pre -inspection for required. to Building Inspector Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23, Owner -Builder Verification (Given to owner Mail to owner ............
24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . .............
- 26. Copy of recorded deed of parcel creation and 60 right of way to a public road ......
27. Letter of intent on building use . ........................................ ; .-
28. Mobilehome utility clearance . ..........................................
29. Documentation of legal access . ..................... ; ..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
-34.
When you issue the permit, process as follows: X Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector.
Other
Parcel Creation
Acreage Applicant Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. _ Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other 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 mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
- Copy - Department of Public Works
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541'
.. I I
APPLICATION 'AND PERMIT
PERMIT NO.
NUMBER
ASSESSif Y
ZONING
A5
BUILDING PERMIT
OWNER
ROBERT EWK
TELEPHONE
846-3778
SQ. FT. OCC. BUILDING VALUATION
—7
-
COM IST 2900
OWNER'S MAILING ADORE ss
1322 RICMS AVE GRIDUY 95948
CONTRACTOR'S NAME
AV �IPIIWS
ITELEPHONE
CONTR�ACTOR'S M�JLING ADDRESS
UM014N
_PNKNOWN
Fireplace
CONSTRUCTION LENDER
Total Valuation $
---
Filing Fee
$ 10.00
LENDER'S MAILIN: ADDRESS
Permit Fee
$ 38.50
ARCHITECT OR EHGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR EMGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
1322 RICHINS AVE GRIDLEY
Permit fee
$ 48.50
PLUMBING PERMIT FilingFee 10.00
t
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO.
SUBC-IVISION NAME
ARCEL'MAP
1P
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF [F DuplexF� MobilehomeF] Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer.
5.00
Mobile Home S I G I W
0-00e�
TYPE OF WORK
New [-I Addition [_1 Remodel[] Utilities Ej InstaliationEl OtherU
Describe work: DEMO
(EXISTIN-3 HOUSE AS PER BP#841-91, ZONE A5-
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
NO 2?M nW.1,Y
600V OR L.ESS
Main service 100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El I am licansed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
LicenseNo. Classification.
1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or,offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed connaut-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.86)
OR ADONS. ACC.BLDGS.
2'/20sqft
NEW CON5TR. MUL T'*OUTLET
NON-RESID, BRANCH CIRCUITS)
2.50 ea
POWER APPARATUS.1%)
(SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
1.20050C
ALO 30C
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
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under peialty of perjury (check one):
F-1 The perrrit 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. provi3ions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed.revoked.
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I ha./e read this application and state that the above inforf
mation
is correct. I agreE to comply to all County Ordinances and State Laws relating
to building constriction, and hereby authorize representatives of the Countyot
Butte to enter upoi the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butt e against
all liabilities, judgments, costs, and expenses which may in any way accrue
y in consequen
against -rrcPQount ce of the granting of this per it.
X 7 le Date 7/m A
Signature of Appliccnt Owner 2� Contractor El Agent Ej
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
TOTAL FEE $ 48.50
HAL
I CUA I PARK
I SCHL
I FLD
I CDF
I PAR
PD
1) HD,
I;JE
This permit is hereby issued unaer the
si�i;s oi the Butte County. Code and/or
work indi' ated above for which J,�,es
� /1
DI . C bR OF P , L I
Byai I ,kBLIC
PERMIT EXPIRES Dat
applicable provi-
resolutions to do
have been paid.
WORKS
Datp VR� /
Receipt No. 96783
WHITE-O.P.W.. YELLOW-ASS9330R. PINK -INSPECTOR. GOLDEN ROD-APPL I CANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 Courity Ceriter Drive - OrovIlle, Califorple 0,5906 - Tolophono: 918/538-7541
APPLICATION AND PERMIT
Al ' AF11C9L NUM59R
21-25-13
ZONING
A5
BUILDING PERMIT
OWNER
ROBERT BOCK
TErE_PHONF
846-3778
SQ.FT. OCC. BUILDING VALUATION
CONTR EST 2900
OWNER'�MAILING ADORES
1 22 RICHINS �VE GRIDLEY 95948
CONTRACTOR'S NAME
AD RICHINS
EPHONE
CONTRACTOR'S MAILING ADDRESS
UNKNOWN __Ti�N
Fireplace
CONSTRUCTION LENDER
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 38.50
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
1322 RICHINS AVE GRIDLEY
Permit fee
$ 48.50
PLUMBING PERMIT FilingFee 10.00
Each Trap
2.GO
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
SFO Duple,F� Mobilehomer-1 Other
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
New El Addition [] Remodel[:] UtilitiesEl InstallationEl OtherXX
Describe work: DEMO
(EXISTING HOUSE AS PER BP#841-91, ZONE A5-
I
I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
Nn 9ND FAMTTY DWRLUNG
600V OR LESS
Main service 100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
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.
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)
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 ADDNS. ? ACC. BLDGS
21/20sqft
NEW CONSTR. MULTI -OUT LET
NON-RESID. BRANCH CIRCUITS)
2.50 ea,
POWER APPARATUS .&)
(SINGLE OUTLET CIR.6)
Ex. Occup(OUTLETS OR FIXTURES
.20050t
AL@300
OCCUP. FIXED APPLISIS OR
Ex. --- --- - 0 UTLETS (RESI*D.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
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.
1 shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed.revoked.
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above in formation
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
n c rise
again f the granting of thi pe it
X ��,oxenle Date
Signature of Applicant — Owner ContractorEl Agent Ei
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 $ 48-50
HAZ.
CUA
I PARK
SCHL
I FLD
I COF
I PAR
JPD
JJHD.JIVE
This permit is hereby issued under tne appiicable provi-
sions oi the Butte County. Code and/or resolutions to do
work ipdtlpated above for which s have been paid.
DI ROFP B WORKS
ri
By D e
PERMIT EXPIRES Date
Receipt NO. 96783
WHITE-O.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
Demolition Per�its
0 11
Asbestos Notification Statement
Date
AP#
Pursuant to section 19827.5 of the California Health and Safety Code, all
demolition permit applicants are required to fill out this form.
"19827.5. A demolition permit shall not be issued by any city, county,
city and county, or state and local agency which is authorized to issue
demolition permits as to any building or structure except upon the receipt
from the permit applicant of a copy of each written asbestos notification
regarding the building that has been required to be submitted to the United
States Environmental Protection Agency or to a designated state agency, or
both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations,
or the -successor to that part. The.permit may be issued without the applicant
submitting a copy of the written notification if the applicant declares that
the notification is not applicable to the scheduled demolition project. The
,.permitting agency may require the applicant to make the declaration in writing,
or it may incorporate the applicant's response on the demolition permit appli-
cation."
'�ttached is a copy of my written asbestos notification to the United States
Environmental Protection Agency for the -demolition project located at
Signature of Applicant
OR
I hereby declare that a written -asbestos notification to the United States
Environmental Protection Agency is not applicab;1e to Sis demolition project.
Signature of Applicant
2/19/91
VI
4
MAIL TO
ASBESTOS NOTIFICATION
EPA/NESHAPS Region IX
1235 Mission St. A-3-3
San Francisco, Ca. 94103
DATE:
PROJECT JOB #
(Please see reverse side)
A= Notif iod:
E3
Qt'a I i orn i m AIX P'"Curc�ss BCAXd
El C�a OSWL
EIB"qlAi naca=tmant
ASBESTOS DEMOLITtON/RENOVATION
. . 'NOTIFICATION
Please check one:
Renovation
Demo lition requiring
10 day notice
Demolition requiring
20 day notice
Revision 'of Original
(Form on reverse side)
IDE—PLF-zLSE READ BEFORE USING THIS
EPA USE ONLY
DateRec
Pstmrk
School
Del/ND
ADQUTE?
Code#:
Doc#:
OF
1.
OPERATOR:
(Contractor)
3. FACILIT)� NAME:
ADDRESS
STREET ADDRESS
CITY STATE
CITY STATE
ZIP PHONE(
CO UNTY ZIP
2.
OWNER
4. FACILITY DESCRIPTION
ADDRESS
AGE SIZE
CITY STATE
ZIP PHONE(
PRIOR USE
5.
Project Start Date: Completion Date:
6.
Estimate of Friable Asbestos: ON PIPE: Linear Feet
SURFACE OF OTHER COMPONENTS: Square Feet
Nature of Materials:
7.
DESCRIBE METHODS OF REMOvAL:
8.
PROCEDURES USED TO COMPLY WITH 40 CFR 61.147 152:
9.
NAME & LOCATION OF DISPOSAL SITE:
ANY FURTHER PERTINENT INFO CAN BE INCLUDED BY ATTACHING ADDITIONAL SHEETS
QUESTIONS??? FOR FURTHER INFOR MATION CALL (415) 556-'6415 8am/4pm M -F
'INSTAUCTIONS
Fog -USE OZ ASBEgTog bENoTTTTON/RENO :1014 NOTTFICATTON
RENOVATION:
FQ
mean * s altering in any way one or more facility components.
NOTICE MUST BE
DEMOLITION:
POSTMARKED AS EARLY AS POSSIBLEBEZQJZ PROJECT
means the wrecking or 'taking Out -of load -supporting structural
members of a facility tocethtzr with any related handling* operations
10
Day notice for MORE than 160 sq.ft.or 260 linear ft. asbestos
20 Day notice for LESS than 160 -linear
sq.ft.or 260 ft. asbestos,
includes facilities which contain no asbestos.
FACILITY:
means any institutional, commercial -or industrial structure
installation; or building. Renovations on single family residences
and apartment buildings with 4 units or fewer 'are exempt from
notification to EPA.
PROJECT JOB
#: Your OWN IN-HOUSE I.D. for a specific jobsite. Optional,
but expedites communication -concerning notifications.
LOCAL AGENCY: Most areas in Region 9.have local NESH'AP del . egated agencies.
In these areas notice must be provided to both EPA and the
local agency.
1. OPERATOR/CONTRACTOA: Full.information concerning-per'son doing the work.
2. PROPERTY OWNER: Complete in full.
3. FACILITY NAME: Mus"t' have complete address OR directions 1to the.j.obsite.
4. FACILITY DESCRIPTION: Current use of building. Project location in the
facility. Other descriptive information,as necessary.
5. START AND COMPLETION DATE: Provide m*onth, day and year. Must be revised
if dates e--hange..(See revision form below)
6. Estimate of amount to beremoved (must be in square or linear feet).
Revisions(se-e form below),-M'ust be made for additional amounts uncovered.
7. Exampl-es -0-f.-methods: glovebag, scrape, remove in sections,etc. -
8. Exampl-es: Adequate-wettin',`prior to and during work, double bag, etc.
9
DRY-RE1,10VAL MUST RECEIVE PRIOR WRITTEN APPROVAL FROM EPA
OR THE LOCAL DELEGATED AGENCY
IF MORE SPACE IS`-NEE0ED'THAN'P`ROVIDEDJ1 ADDITIONA . L"SHEETS'SHOULD BE ATTACHED
TO REVISEA NOTIFICATION ALREADY ON FILE WITH EPA, I USE FORM PROVIDED BELOW
PROJECT NAME. PROJECT JOB 44
ORIGINA:L-�NOTIFICATION DATE Revision Notice #1 2 3 4 5
please circle
This is,to advise that,the above referenced notification presently'on-file has
been,revised. Plea7se note the revised portion listed.
CHANGES FOR THIS REVISION: PROJECT
CANCELLATION
1. NEW Location
2. NEW Scope of Work
3. ADDITIONAL Q uantity of Asbestos
4. -NEW Start Date
5. NEW Completi.on Date
6. -NEW Disposal Site
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPUCAtIO'N AND.PERMIT
A33ESSOR PARCEL. NUMBER .
ZONING
OWNER 0 a ;X 50— k> / 3 1 L A _ 51 BUILDING PERMIT
JTELEPHONE
T2, — SO. FT. OCC. BUILDING VALUATION
i6\�A.S AV, &rJ1e_V �S�LW I cicot/ -f I &-5<1 :�E
r_7 , — I . f ITEL.EPHONE I I I
11A1 IZ�V6f W,41-
_rKNOWN
Fireplace i -
CONSTRUCTION LENDER
FilingFee 10.00
Total Valuation
LENDER'S MAILI.NG ADDRESS
Filing Fee
P 1; ! F -- e
ARCH17ECT OR _T
TC EN S E PI 0.
Plan Che-_-;--.ing Fee
Energy Plan Checking Fee
ARCHI�ECT OR ENGiNEERIS MAILING ADDRESS
Penalty
BUILDING ADDRESS 1322- Fkckms AV errialev q"461
Permit fee
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.)
PLUMBING PERMIT
Each Trao
10.00
Solar or heat pump water heater
LOT NO.
—
UBDIVISION NAME
I
PARCEL MAP
I
Water piping
Each aas w ater heater or vent
USE OF STRUCTURE
SF2r DuplexF� Mobilehome[:] Other
SPECI FY
Gas piping system 1 - 5 outlets
Building sewer
Mobile Home S
TYPE OF WORK
New F� AdditionFl Remodel[] Utilitieso InstallationEl 06-er 09
Describe work: - Demo — rx;�5ri'mov o 0,5 -e-
-W —98
A dni-I I 'e.
FifingFee 10.00
Permit Fee
Contractor
1
aNe A-5 -:-/v6 2`9 64%*141 owelli'v
CONTRACTORS LICENSE LAW
I declare under penalty of peejury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. — Classification.
1, as the owner, or my employees with wages as their sole compen-
sation, will do the work, and the structure is not intended or offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
1 am exempt under Sec.—, Business and Professions Code
for this reason
WORKM.EN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
R 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.
F-� I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: It 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.
'.0.00
$
FilingFee 10.00
2.00
20-00
5.00
5.00
5.00
5.00
ho.00 Pa,
I certify that I have read this application and state that the above information Mobile Home Installation Fee $
I s correct. I agree to comply to all County Ordinances and State Laws relating Energy Inspection Fee $
to building construction, and hereby authorize representatives of the Countyof
Butte to enter upon the above-mentioned property for inspection purposes. occ CONST TYPE TOTAL
I also agree to save, indemnify and keep harmless the County of Butte against I FEES
all liabilities, judgments, costs, and expenses which may in any way accrue HAZ. I CUA I PARK I SCHL I FLO COF I PAR I PO 0 - SSUE
against said County in consequence of the granting of this permit. TM ii
X Date This permit is hereby issued uncer ine applicaole provi-
sions oi the Butte County Code and/or resolutions to do
Signature of Applicant — Owner 0 Contractor D Agent work indicated above for which fees have been paid.
An OSHA permit is required for excavations over 5*0" deep and demolition or construct- DIRECTOR OF PUBLIC WORKS
ion of structures over 3 stories in height.
Receipt No. -)(, ?&'-3 - By
�HITZ-O.P.W.. YELLOW- �SZC330ft. PINK-I.SPECTOR. G0L0EWR00-.LICXMT PERMIT EXPIRES Date
Date
E ECTRICAL PERMIT
FilingFee 10.00
Main service 6,0000vAMOR L -Ess
OR LESS
10.00
main service EA. AOD-L 100 AMP
2.50
NEW CONST. OYIFLLING OCCUP.8i)
OR AOO.S. ACC.BLDGS.
2/20sqft
.NF-YY,CONSTP- "'AULT"OUTLT
_r
ON F
_N 0, .11-11C. CI.C..TS)
2.50 ea
(POWER APPARATUS &I
SINGLE OUTLET CIR. I
Ex. Occup( OUTLETS OR FIXTURES
e2L@05300et
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
Contractor
MECHANICAL PERMIT
FifingFee 10.00
Heating
Cooling
Hood
3.00
ventilation
Fe �-[ I F�-
$
Contractor
I certify that I have read this application and state that the above information Mobile Home Installation Fee $
I s correct. I agree to comply to all County Ordinances and State Laws relating Energy Inspection Fee $
to building construction, and hereby authorize representatives of the Countyof
Butte to enter upon the above-mentioned property for inspection purposes. occ CONST TYPE TOTAL
I also agree to save, indemnify and keep harmless the County of Butte against I FEES
all liabilities, judgments, costs, and expenses which may in any way accrue HAZ. I CUA I PARK I SCHL I FLO COF I PAR I PO 0 - SSUE
against said County in consequence of the granting of this permit. TM ii
X Date This permit is hereby issued uncer ine applicaole provi-
sions oi the Butte County Code and/or resolutions to do
Signature of Applicant — Owner 0 Contractor D Agent work indicated above for which fees have been paid.
An OSHA permit is required for excavations over 5*0" deep and demolition or construct- DIRECTOR OF PUBLIC WORKS
ion of structures over 3 stories in height.
Receipt No. -)(, ?&'-3 - By
�HITZ-O.P.W.. YELLOW- �SZC330ft. PINK-I.SPECTOR. G0L0EWR00-.LICXMT PERMIT EXPIRES Date
Date
RESIDENTIAL
841-91B,P,E,M
BOCK, Robert
1322 Richins AVe, Gridley
Cont: Ray Borge�s
(new sf)
17- 9Q
7 -�'— 4
OFFICE COPY
Address
GAS
Meter By—��� Dalh?-17Y
LELECTRIC
Meter By Date
OFFICE COPY
Address
GAS Da te
Meter By
ELECTRI
Meter By Dat
fk,.
JOB FINALEr-1
A
Signatur— -- :�4X'l
rf-. 77-
v Ok'
6 Not OK
Not Applicable
Not Ready MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plansy OK exceet #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O Concrete
4. Wate r;'Location-Test- Ease me nt Needed (Sketch)
5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / P'U'ft.
/ P'Nat. or/ /"L"ft./ P'LPG
7. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 . Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK exceEt #'s
1. Zoning Requirements -Setbacks Easements
2. Footings; Size-Spaci ng- Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged I I . I
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (Plar,&)OK exceet #'s
1. Zoning Requirements -Setbacks -Easements , I -
_2. Footings; Soils-Size-Depth-Spacing-Connectors-Ste4,I
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nail ing-Veneer-Stucco-Mesh
10. Roof; Shthg-R-oofing -
11. Ext.; Steps- Doors -Land i ng s
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks- Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, 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- Encl osu res -Pane I 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 RESIDENTIAL (§ingle
Not Ready
Date UN24RF'LOOR (Plans) OK except #'s
Date
, Zo n i ng -Setbacks- Easeme n ts-FI ood -Slope
Ftg., Main; Soils-Elec. Grnd.-//,!�Lflg. Depth F,:2�)7-ft
Ftg., Garage; Soi Is-Steel-Elec. Grnd.:/� �Z/" Ftg. Depth ' I IJ L,\7,
4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
5. Sternwalls, Main: Steel -BI ockouts-Wra p ped
6. Sternwalls, Garage; Steel-Blockouts-Wrapped
,�optns and Special Anchors
CA�.b; Steel -wrapped
8. Pie rs-Fi replace Ftg.-Steel
L-'9. D.W.V.; Fall-Fitting-TestC2 Way C-7b"3ewer Test
10. Gas Pipe; Sizq-Anchors
11. Water Pipe; Test -Anchor- Reg u lator-Service Test
12. Electric; Underground
13. Pienums & Ducts; Cleara n ce- Material -Su pport- Ins.
14. Girders -Sills -Anchor Bolts-ioists-Vents-Cripples
15. Insulation
DatK-:V; &ard B-1 V>� Date Card B-1
Date 'Card B-1 Date_ Card B-1
Date PLUMBING (Permit) OK except #'s
(f -
§,/Water Htr.; vent -Access -Combustion Air -Baffle
1=�ater Pipe; Test & Anchor -Nail Protection
(11,6.��est-Fittings & Anchor -Nail Protection
IWI
%ewer Pan; Test, First Floor -Tub Access
,20.-re—st Tub & Shower, Second Floor -Tub Access
24-Ges Pipe; Size & Anchors
.4 0
Da Card B-1 Date Card B-1
-JV' Date Card B-1
Dat§:�- Card B-1'
Date ELE&RICAL (P�rmlit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
-1&-EIec Receptacles Spacing -Lights & Switches at Doors
JA -9&e Boxes & No. of Conductors -Stapled
-2. �.omex Installed Close to Edge of Studs & C.J.
26.�Equip. Ground made up w/Mech. Fastners-Bbnd Gas �Wate
-Y��Ppiiance Circuts in Kitchen & Conductor Size/GFI
28--SW9eed-XWre Size ga. Cu or AI-A.C. Wire Size ga.
Cu or At
20-+harrg�i � / ga. Cu or Al -Oven Circ. / / ga. Cu or Al.
lnsu!%gd Neutral 0 Yes 0 No
3e-!Te-rvice-Riser Conductors & Ground -Main Disconnect
,yip,ciearances Pane Is- Motors- Mech. Equip.
3-r-091hes'Closet Light -Shower Light -Spa Light
3T'Smoke Detector
, dj
/Card B-14
Date 7 F �4 Date Card B-1
Date Card B -f Date Card B-1
Date MEC"NICAL (Permit) OK except #'s
2!!:.:2�.C.Ducts insulation & Support
3-5-*V-ent Fan; Exhaust above insulation
,�,ondensate Drain & Overflow; Size & Grade
34--<*rnance-vent; Access -Comb. Air -Return Air Vent -1 15 outlet
3B--Kt'tic Access & Platform if Furnance in Attic
r-.) J2
Date!- [card B-1j2r- Date Card B-1
Date' Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
3VSils, Proper Material & Anchors
40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
4,r -Bearing Walls over Girders & Floor Nailing
42- �raft Sto�pm Walls (rat proof)
4T' -Fire Stops: Furred Ceilings -Stairs -Chases -Tub
4*.-g-eaders & Beam -Size & Bearing
& Duplex)
ued
Post Caps -Anchors -Connectors
5t-Rftr. ties-Purlin -roof Brac-Truss-Shthng.-Rfn
Ties or Type A Flue -Fireplace Throat clearance
ccess; Size & Romex Protection - DralfyStop-Ins. Baffles
Windows or Exiting Doors -Sill Hgt. & Dimensions
? Fire Protection Framing
_53,,P�operty Line Firewall & Openings , I
,K'E5J�,Ooors-One T -Check Garage -3rd Story, 2 Exits
,ST -Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
SAe-at-vwood on Roof Overhanq-Attic Vents-Flafter Outriqqers
_55--giding-Nailing veneer
(59A.tucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
Area -Glass Protection-Skyl ights- Plastic
56.�-Shear Walls; Nailing -Bolts
59. Insulation -Walls -Ceilings
60. Infiltration -Walls -Windows
,� a
Dat�p)r-z� (Card 13-1/ft�r� Date Card B-1
Date I Card B-1 - Date Card B-1
Date ��L (plans) OK except #-s
I /,�;=�E teps-Door & Sidelight Protectio n -Landings
t.--"9-2 Sm2kA-Detector
1,�Furnace; Vents -Clearance -Comb. Air -Connector-
_ -4m -Garage; Above Floor-Ducts-Mech. Protection
droorn Exiting
6&;!&F.I. & Bath Fixtures & Tub Access -Spa
C65,glec. Trim & Subpanel; Breaker Sizes & Labels
L-'6!,E!!!nce or stove; Clea ra nces- Hearth
t-,--6-9. ElecQutlets at Wood Panel; Int. & Ext.
tS�it.!Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
�Elec. Outlets & Receptacles at Kit. Counter
72CX%rage Fire Door; Swing -Landing -Closer
/)C_74--Atr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
el In Garage; Above Floor-Mech. Protection
sec & Mach. Equip. Listed for Location
Receptacles in Garage; (G.F.I.)-Romeikotect on
Lel'77. Insulation -Foam -Looked in Attic LO -Yes
4c-_---7T-U-ua-ra-Nails & Deck Construction -Post Caps
.4 79. -FdTr.-Ve-nts & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor []_Yes - .
1 eg.Following instId.; Drivg�R-Yes 4Er'N-o; Walks Er -Yes *0 No;
_Planters 0 Yes"-ff No
cco; Brown -Finish
Unit; Disconnect, Electrical, Plumbing
L,--83. Vents Above Roof; PI bg. -Appl iance- Fi replace. -Cl eara nce to
Optnings
Ltf�-�r Well; Disconnect, Electrical, Plumbing
8?.ef
!�Lerior Elec. Trim; G.F.I. Receptacle- Unde rg round
1�,�6. ��on Throughout House
%,`�Glass Protection
88. Correct!,qps from Previ�� lnsR2�tio�L
.89. Gawrest:Meters T%poe ; qA�Elodric
4��ter & Sewer Conh-ected-C/O to Grade -HD Approval
ergy Compliance Certificate -Other Certificates
V
I
Date ard B-1 Date Card
'-Da!e aN - B-1 _,_eat�) Card B-1
Da rd B-1 n���e Card B-1
Con&e-nts 1iii Final: /
(NOTE: An entry must be made each time you visit job site)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Groville — Phone: 538-7541
747 Elliott Road, aradise — Phone: 872-6307
CORRECTION NOTICE
A routine inspection indicates that the following violations of County Ordinance
exist at the—above address and should be corrected. Please notify this office
of work is completed. If you have any question pertaining to this
additional explanation, please contact this office immediately.
Datel'o -1 � -C7 Ins
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
1WNER
9 -
PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
��rheed additional explanation, please contact this office immediately.
P�
Date lnspectork�k
/C
Permit No.
nwnpr:
ENERGY CERT I'F ICAT ION
1322 Richins, Gridley, Ca. A. P. No.
LOCATION
ROOF
Material
Thickness(inches)
DESCRIPTION OF INSULATION
Brand Name_
Thermal Resistance (R. Value)
EXTERIOR WALL
Material FIBERGLASS BATTS Brand Ham
Thermal Resistance(R Value) R19
Thickness (incites) 6w"'
CEILING
Batt or Blanket TypeFIBERGLASS BATTS Brand Nam" nWFN';-Q0RN1NG
n -r I —I Thermal Resistance(R Value)_ R30
Thickness(inches) 9-f " — Brand Name__QWL&IzL-��G-
Loose Fill Type FIRFRGL —Number of Bags 18 Wt. ppr.bag 35 lb.
Minimum'Thickneal(inches) 123/4,' Therma . I Resistance(R Value) R30
Area covered(ft. )- Z I � �QT -
FLOOR, ELEVATED
Material
Thickness(inches)
FLOOR, SLAB
Material
Thickness(inches)
Width(inches)
FOUNDATION WALL
Material
Thick.ness(inches)
Brand Name
Thermal Resistance(R. Value)
Brand Ham"
Thermal Reeistance(R. Value)
Brand Name
Thermal Resistance(R. Value)
I . hereby certify that the above insulation W88 installed in the above building
'in 19nergy RequLrements.
in conformance with the State of californ
LOERKE INSLLAFION CO., 14C. 499150
lnf�mvn STATE coffrmcToR'S LICENSE NO.
r ON NANE
h
SiGjjA-T,UhE OF IN fALIAJION APPLICATOR
obt. 16, 1991
DATE
I hereby certify the above insulation and all required items as shown on the
Building Department approved plans and attachments have been Installed as
required by the State of California Energy Requirements.
All equipment, devices and materials are of the quality prescribed or are
specifically approved by.the State of.California.
F RM HAME/OWNER (Please print) STATE CONTRACTOR'S LICENSE NO.
SIGNATURE OF (IFNERAL COW OWNER DATE
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL
INSPECTION APPROVA1. AND A COPY SiLkLL BE POSTED WITHIN THE BUILDING .
January 1984
COUNTY Or BUTTE - DEPARTMENT Or PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATi6N AND PERMIT
ASSESSOR PARCEL NUMBER
021-250-013
ZONING
A-5
q N, 4
BUILDING PERMIT
OWNER
Robert Bock
TELEPHONE
846-3778
SQ.FT. OCC. BUILDING VALUATION
2398 R 95,920
OWNER'S MAILING ADDRESS
1322 Richins Ave., Gridley 95948
528 M 7,392
CONTRACTOR'S NAME
1846-2328
TELEPHONE
123 C 1,730
Cgff4JCDTJ��S MAILING ADDRESS
422 Turner Ave., Gridley 95948
Fireplace i "All 11000
CONSTRUCTION LENDER
Nnnp
UNKNOWN
Total Valuation 1 $ -tot=
,_
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
3. E)& -
ARCHITECT OR ENGINEER
Danp Andps
LICENSE NO.
IC -9593
Plan Checking Fee
$
Energy Plan Checking Fee
$ 15.00
-
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
1322 Richins Ave,, Gridley
Permit fee
s706. 6eq--5-o
PLUMBING PERMIT FilingFee 10.00
Each Trap
2.00 28_00
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
1
Water piping ,
5.00 5.00
Each qas wate� heater or vent
5.00 5.00
-
USE OF STRUCTURE
SFE& Duplexf-1 Mobilehomen Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00 1 5,00
Building sewer
5.00 -00
Mobile Home S I G I W
�0-00 ea�
TYPE OF WORK
New)(�] Addition[:] RemodelE] Utilities[] InstallationD OtherEl
Describe work: 3BR
I I
Permit Fee
$ 58.00
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
main service 600V OR LESS
100 AMP OR LESS
10-00 in -nn
Main service EA. ADD -L 100 AMP
2.50 9 -,;n
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)
1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
El I am exempt under Sec.-, Business and Professions Code
for this reason
NEW CONST DWELLING OcSU-n
OR ADDNS. ACC. BLDGS. 9 9
21/20sq ft ,Q.()9
NE W CO`45T'�L MULT"OUTLET
BRANCH CIRCUITS)
2.50 ea
_NON-RESID.
(POWER APPARATUS.&)
-SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
1.20 (9 50t
AL030C
OCCUP. FIXED APPLNS. OR I
Ex. OUTLETS (RESIC.) EA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$ 89 -
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 10.00
Heating split system
6.00
Cooling
11.00
Hood
3.00 3.00
Ventilation
1 T.-OTF9.00
Permit Fee
$ 39.00
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 liabili", judgments, costs, and e enq wilhiochtmay in any way accrue
again he nti c f hi
t f txp s ng
X :;,���quenc ra-nt i ng of tels permit.
a h t
Signature of Applicant - Owner ControctorEl Agent
An OSHA permit is re
3quired for egcovattPrIs over 5'0" deep and demolition or construct-
ion of struc eigh
tures over stories in fir
Mobile Home Installation Fee $
Energy Inspection Fee $ 30.00
0 c
TOTAL FEE $910" �5_
I
"AZ.
I CUA- I PARK
---r -
Syl
Fri
CDF
I
Th's permit is hereby issued unaer tne applicable provi-
si�ns oi the Butte County.Code and/or resolutions to do
work indicated above for which fees have been paid.
? R,C TO 0 UBL IC WORKS
By C&IO Date
PERMIT EXPIRES Date_q__1
88243/898.9# 6167127jlph I
Receipt No.
F TE-D.P.W.. YELLOW-ASSC3SOR. PINKIIISPECTOR. GOLDeNROD-APPL I CANT
When you issue the permit, process as follows: — Mail to owner. —Mail to contractor.
Telephone— tZ and hold for pic'kup at —office. —Del.iver �w/inspector.
Other 4
Applicant
.Date
Copy of Haz-Mat form sent —Health Dept. —Fire Dept. ---Air Pollution Date
Copyofplanssent ---HealthDept. ____FireDept. —Other— Date— By
The following data must be submitted prior to permit issuance: (Circle new item not chec-ked above)t
1. Index permit for above items No.
1 A
2. Additional items required:
Contractor, designer, owner, was advised of above required data by —phone _--ma i I —counter by—date
Contractor, designer, owner, was advised of above required data by—phone—mall—cou date
Plans checked by Date Plans approved by— 2E7Date
—Sets of plans on hold in —File cabin AP folder
Copy—DPW 12 9-,") ol w*—
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
' -4
PERMIT
APPLICATION DATA SHEET
Permit No.
�e
OWNER
C, A. P. N o.
Proposed Building Use 5F 6JT/,A i Building Inspector Date- 312elcit
At time.of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED
APPROVED
1 .
All items have been submitted . .. ...................... ...........
2.
Plot plans in duplicate/triplicate, signed by preparer of plans ........
3.
Complete plans in duplicate/triplicaie, signed by preparer.of plans
4.
Compldtb'enginee'red plah�s and calcs, with wet signature on plans
5.
Hazardous Material Form ..........................................
6.
Energy Design Complia�ce and supporting documentation .........
7.
8.
Statement of Intent for Non -Heated and AC Buildings ................
Engineered truss details and layout in duplicate (required prior to plan check)
9.
Mobilehome installation data including manufacturer's installation
instructions ......... ............................................. 3 ki(Nt - t
Fees of $ 11. . .........................
11.
Chico Urban Area fees paid ....................................
12.
&K., 13.
14.
Park fee paid .. * ... : ...............................
G K M I e- C/ �chooi'District fees paid ..............
Sanitation ap6roval from CP41eLAf&'V-QQQ 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)
20.
Pre-Ins006ion for required ... Pre-inspec. request to
Building Inspector
(Date)
21'
Contractor's license information (No;, Name Style, Classification) ...
22.
Certificate of Workmpins Compensation Insurance ........... ........
23
:i*24*
Owner -Builder Verifi'ation (Given to owner 0, Mail to owner 11) .....
C 3_2 q
Recorded copy of Agricultural Acknowledgment Statement ......... 0% k
--7RC>
0725.
26.
Letter of signature authorization .
Ze- STA-7-4-r/9W
27.
When you issue the permit, process as follows: — Mail to owner. —Mail to contractor.
Telephone— tZ and hold for pic'kup at —office. —Del.iver �w/inspector.
Other 4
Applicant
.Date
Copy of Haz-Mat form sent —Health Dept. —Fire Dept. ---Air Pollution Date
Copyofplanssent ---HealthDept. ____FireDept. —Other— Date— By
The following data must be submitted prior to permit issuance: (Circle new item not chec-ked above)t
1. Index permit for above items No.
1 A
2. Additional items required:
Contractor, designer, owner, was advised of above required data by —phone _--ma i I —counter by—date
Contractor, designer, owner, was advised of above required data by—phone—mall—cou date
Plans checked by Date Plans approved by— 2E7Date
—Sets of plans on hold in —File cabin AP folder
Copy—DPW 12 9-,") ol w*—
TO Buildina Department
FROM: Environmental -Health
SUBJECT: Sanitation Clearance
46d ./,3(;)Lz P, C.�A , �-V �2 / - C;�S-- 13
Owner Location AP#
Plan Approved for: Sevaqe Disposal Water Supply
Hold final for: Water Supply
7inal clearance O.K. for: Water Supply
Clearance for bedroom mobile (h:o:m:�e-) Other'
NOTE
Date
Sanitarian
RESIDENTIAL PLAN CHECKING GUIDE -12/90
(S.F., DUPLEX & MISC. ONLY)
Bldg. Permit # Sq1-
OWNER rp on /Z- A.P. # 2 t - 7-- / -3
Plan Checker /ZY--
GENERAL
11(1�'
�oning requirements: (sideyards and number of permitted living units).
2�' Yal
Luation.
3?1*'-Plans'signed by designer.
4jP'Proper description of work on application.
5----E—xisting violations on property.
4n Items on data sheet. (W.C., fees, Health, Developer Fees, License law, etc).
-7. Re-co-r-ded-notice of violation.
PLOT PLAN
IV-;,
�eomplete parcel size and dimensions.
�etbacks, sideyards, easements, etc.
Other buildings or structures.
�rading, fills, drainage.
5' Flood hazard.
on creation map,
ustible, and foundations).
road setback.
(noise, CDF, fire sprinklers, non-comb-
Wi44±ffg or utilities across lot lines (Record form).
FLOOR PLAN
Co' 1 t- to scale plan with dimensions.
'pp e e
equired windows for light and ventilation (Sec. 1205).
ReqUired windows for second exit (Sec. 1204).
4A',Sk-ylights (Chapter 34 & Sec. 5207).
5�)�VnH man impact glass (Sec. 5406).
Re
,2� �Rired room sizes, ceiling heights (Sec. 1207).
7�7CIUC
s in baths, garage, kitchen, and exterior outlets (Article 210-8).
8 Light fixtures, switches, receptacles, and exterior receptacles f o*r main-
9��ance of mechanical equipment.
Locations of water heater, heating and cooling equipment, other electrical
o gas equipment.
0
l0t--G-S�ar-lge firewall, door size, and closer (Sec. 503(d)(3)).
114-T 3'0" exterior exit door (sec. 3304 (f).
12,1;.j!�r�eace and wood stove location, alcoves, and clearance.
0
13. o e detectors (Sec. 1210).
11KPlumbing fixtures, water closet clearances and shower size.
STRUCTURAL DETAILS
1 ��
Standard bracing or engineered design (Table 25V)
,,,Iffu—sual shape, size, or split level house requiring lateral design.
3,9' Foundation plan complete enough to construct building.
�c struction details complete enough to construct building.
vatcions and wall construction details complete enough to construct building,
:�.- toof construction details complete enough to construct building.
-7-.—Farrep-lace construction details and calcs if necessary.
-Ir--R-aft-er ties or bearing ridge beam.
izge door or porch header sizes.
ghts.
ils - special foundation design.
g walls requiring design.
1-3-.-SpecTat-I-nspection required.
12/90
RESIDENTIAL PLAN CHECKING GUIDE
I
MISCELLANEOUS ITEMS TO LOOK -OUT FOR
_1-.r---3t-drrwaT-4et-ai-I-s: landings, rise and run, head clearance, handrails
(Sec. 3306).
.2. Guar4rail._Aetails (Sec. 1711 & 3306(j).
3p,,'Brick or stone veneer (Chapter 30).
4-.--Exrer� plaster - weep screeds (Sec. 4706).
5 Proper roof pitch for roof convering (Chapter 32).
oof covering type - (fire hazard).
-7-.--Fo'am1nsulation - protection.
8. 36" halls and stairways.
97:��Ivi�n�ver garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
o exits on three-story dwellings (sec. 3303 & see Mezannines 1716).
1 Attic access and ventilation (Sec. 3205).
--r oor access and ventilation (Sec. 2516).
us
st
t
II . �Combu ion air for fuel burning appliances - L.P.G. requirements.
';,-�J:s-e�requirements on duplexes.
IV. _5pye-r-g-y design.
16' Flashing at all exterior openings.
k77.-CDF-T-esponsible area requirements.
- , -, - - V , -, ". I � -.1, , .-T, V�v .1 �, I f-?, �' t- I - 1"* -V- 'T,- "- �,r- - , , -q- �� ,
e,
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One Form per -Building)
I
A. P. Number 672 5'r>_ 0 1-3 Building Department No.
School District: VrIl e(eq city = county Jurisdiction
I
Property Owner '0 at
Project Location/Address 1/4?
Subdivision Lot Number
Residential Development: r-
Commercial/Industrial:
# of Living MHI
Units'
Sq. Fdotag,�, C.%
Addition ncluding Exterior
Roofed Areas)
S- Ck k - . , -,C.-
New
Building Department Representative
ElSq. Footage 3
Addition (Group R)
Date
(Floor Plans reviewed by School District Personnel)
District Id No.
School District certifie's that
-S.-Vt - C A0
(Applicant Name) -(Phone Number)
A -:2 �2_ -.,,a
Street Address
City`) // (State) -(Zip Code
has complied with the requirements of Resolution No.
by the payment of $J� Cr-�' 9V reptezenting square feet.
,�-School,,p,isfrict-ReiDfesentative Datd
PAID BY CHECK NO. REMARTS:
BANK NO 0,
PAID BY CASH
0
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
0
V
Residential Development: r-
Commercial/Industrial:
# of Living MHI
Units'
Sq. Fdotag,�, C.%
Addition ncluding Exterior
Roofed Areas)
S- Ck k - . , -,C.-
New
Building Department Representative
ElSq. Footage 3
Addition (Group R)
Date
(Floor Plans reviewed by School District Personnel)
District Id No.
School District certifie's that
-S.-Vt - C A0
(Applicant Name) -(Phone Number)
A -:2 �2_ -.,,a
Street Address
City`) // (State) -(Zip Code
has complied with the requirements of Resolution No.
by the payment of $J� Cr-�' 9V reptezenting square feet.
,�-School,,p,isfrict-ReiDfesentative Datd
PAID BY CHECK NO. REMARTS:
BANK NO 0,
PAID BY CASH
0
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
0
'IVIBIT "A"
1%
All that certain rea 1 pr operty situate -- in the.Cou'nt y -- o - f But t . e
State of California, described as follows:
The South half'of'Lot 14 of Gridley Colony No. 4, according to
the Official. Map of said Colony, filed in the Office of the County
Recorder of Butte County, on the 5th day of Febr.uary 1907, in Map
Book 6, at Page 8, Butte County Records.
PXCEPTTNG T11PREFROM all. that part and portion of the South half
of Lot No. 1.4 of Gridley Colony No. 4, according to the Official
Map of said Colony, filed*in the Office of the County Recorder
of Butte County, on'the 5th day of February 1907 in Map Book 6,
at Page R, Butte County Records, described as foll.ows,to wit:
COMMENCING at the Southeast corner of said Lot; thence Wes� 10
feet to a point; thence North 1* 30' West, 330 feet to a point,
thence East 10 feet to a point; thence South 10 30' East, 330
feet to the point of beginning.
12 0 9
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT -
FOR RESIDENTIAL DEVELOPIMFM
Section 26-8. 1 of the Butte County Code
requires this acknowledgement be recorded
prior to issuance of a building permit.
The property described herein is adjacent
91-012049 : Rec Fee 7.00
to land or included within an area zoned
1 Check 7.00
for agricultural purposes, and residents
Recorded
of this property may be subject to incon-
official Records
veniences or discomfort arising from the
County of
use of agricultural chemicals, including,
Butte
but not limited to herbicides, pesticides,
Candace J. Grubbs
and fertilizers; and from the pursuit
Recorder
of agricultural operations including,
1:33pm 29 -Mar -91 XX 2
but not limited to cultivation, plowing,
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise, and odor. Butte County has established aaricul-
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 'f h --At redl ..-pr-operty.- situate in . the County of Butte, State of California, described as
follows:
State of Califomia
SS.
County of Butte
W OFFICIAL SEAL .'
'OKATME�N M MC CLUNG
r� 7 r
NOTARY PUBLIC - CALIFORNIA
BUTrUCOLUM
14 comm. expResJUL 20, 1992
2:0 4.9
OWNERS:
On this the 29th day of March 19 91 , before me, the
undersigned Notary Public, personally appeared
Robert 0. Bock and Laura L. Bock
Personally known to me. E] Proved to me on the basis
of satisfactory evidence.
to be the person(s) whose name(s) arp
subscribed to the with ' in instrument and acknowledged that they
executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal.
Present A. P. No. L3
Nota7ry 'Pu'blic
END OF DOCUMENT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, Callfornla 95965 - Telephone: 916/538-7541
APPLICATION, AND PERMIT
ASSESSOR PARCEL NUMBE—R ZONING
PERMIT NO.
Q.2I - o-� 5; 0 - C> 1-3 //_5 BUILDING PERMIT
OWNER ONE SO. FT. OCC. BUILDING VALUATION
Robee-r-, Socz NZHa2 7TyC-1F— MCI
OWNER'S MAIL.ING ADDRESS 62
13 2 � e_ A V "a te y 15'? 1/ A 6g) r73 11 Z_
CWRACTOR' NAME TELEPHONE I_ ,
A, �4 D — P_� e I R41r_ -&07.0
-T_ur"e_e_ Fireplace i 08 0"
CONSTRUCTION LENDER _TUNKNOWN Total Valuation $
A)&AJe_ Filing Fee
LENDER'S MAILING ADDRESS
FZe
ARCP.ITF:CT OR L E ILICENSE NO. Plan Che.--:.*Iing Fee
DA�3e �`�Yda�5 5-(73
ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee
Penalty
BUILDING ADDRESS (32-7- Rk6\o-�-5 W 66A(eVIq S94 Permit fee
PLUMBING PERMIT
Each Trap
Solar or heat pump water heater
LOT NO. SUBDIVISION NAME PARCEL MAP —Water piping
I I Each qas water heater or vent
USE OF STRUCTURE as piping system 1 - 5 outlets
Building sewer
J
4'. 4 1 1 SFff DuplexF� MobilehomeF� Other SPECIFY Mobile Home S
TYPE OF WORK
New2� Addition[] Remode I E] Utilities [:] InstallationD Other F�
Describe work: 41L;�'(Aj 6F 36-1cm
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification.
1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed LoU111.1dut-
ors. (Sec. 7044)
E] I am exempt under Sec.—, Business and Professions Code
for this reason
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.
F1 I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
KI .1 . A 11 a If ff 1.1; 'k; . I k ]A
Permit Fee
$
W, M-1 W4 III, N
$ C'A7
Contractor
ELECTRICAL PERMIT
FilingFee
10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
/0,00
Main service EA. ADO'L 100 AMP
2.50
NEW CONST. 0 ELLING OCCUR
OR ADDNS. AWCC. BLDGS.�o
21/20sqft
.511,1151
NEW CONSTR. MU1 T�I�OUTLET
NON-RESID. 13RAN H CIRCUITS)
2.50 e a
POWER APPARATUS & I
SINGLE OUTLET CIR. I
$ C'A7
Contractor
ELECTRICAL PERMIT
FilingFee
10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
/0,00
Main service EA. ADO'L 100 AMP
2.50
NEW CONST. 0 ELLING OCCUR
OR ADDNS. AWCC. BLDGS.�o
21/20sqft
.511,1151
NEW CONSTR. MU1 T�I�OUTLET
NON-RESID. 13RAN H CIRCUITS)
2.50 e a
POWER APPARATUS & I
SINGLE OUTLET CIR. I
Ex. Occup(OUTLETS OR FIXTURES
20050t
.15AL0 30
FIXED APPLN5. OR
Ex. OCCUP. OUTLETS (RESID.) EA.)
2.00
service
10.00
-Temporary
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
Contractor
MECHANICAL PERMIT
FilingFee
10.00
Heating _-SPL:(r 4i457_
W.
&
Jk
Cooling
//,60
Il.&()
Hood
3.00
_7, Co
Ventilation
3.6o I
41,00
o ce a pp can . . — — .,J . . d . , 5 Ou you ecome subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such Permit Fee $
provisions or this permit shall be deemed revoked. Contractor
I certify that I have read this application and state that the above information Mobile Home Installation Fee $
is correct. I agree to comply to all County Ordinances and State Laws relating Energy Inspection Fee .30.00 $
to building construction, and hereby authorize representatives of the County ot occ CONST TYPE
Butte to enter upon the above-mentioned property for inspection purposes. TOTAL FEE $
I also agree to save, indemnify and keep harmless the County of Butte against
PARK SCHL I FLO I CDF PAR P
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
This permit is hereby issued unaer tne applicable provi-
X Date sions oi the Butte County Code and/or resolutions to do
Signature of Applicant — Owner E] Contractor 0 Agent work indicated above for which fees have been paid.
An OSHA permit is required for excavations over 5'0" deep and demolition or construct- DIRECTOR OF PUBLIC WORKS
ion of structures over 3 stories in helight.
Receipt No.— Mo By Date
WHITE-O.P.W., YELLOW-ASSF3301R. (INK -INSPECTOR. GOLD ENROO-APPL I CANT PERMIT EXPIRES Date
COUNTY OF BUTTE - DEPAR.TvMENT OF PUBLIC WORKS
7 COUNTY CENTER DRIVE - CROVILLE, CALIFORNIA 95965 - TELEPHONE: (916) 538-7541
AGRICULTURAL BUILDING EXEMPTION PERMIT
PERMIT NO.
q —1940
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to
house farm implements, hay, grain, poultry, livestock, orother horticulutral products. This structure shal'I not
be a place of human habitation or a place of employment where agriculturai products are processed, treated,
or packaged, nor shall it be a place. used by the public.
ASSESS(y 7ARCJ�Y8 0/5
FLOOD
ZONING
4
OWNEA
BOCK
ROOFING
PHONE NO.
OWNER'S ADDRESS
r/-/ If L -/-)0'E 'S -y0'5'5'E F of
A111 11-711
LOCATION OF BUJLDING
d
P-
jlle(C�4144-5 Ave) !��Orvx, 9-5-01-5 ef-l-ittie-h&_
USEOFBUILDING
-J
SIZE OF STRUCTURE
'X 1536 SQ. FT.
TYPE OF CONSTRUCTION
_C=9;I5r
WOOD FRAM E STEEL CONCRETE
__aF_
—OTHER (Specify)
TYPE OF SIDING
9rhA 1--
ROOFCOVERING
FLOOR TYPE
4,057, r7'/L
'5
ESTIMATED COST OF CONSTRUCTION
$ —L- ) 5— 0 L(
AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County
Ordinances as folLaws-
'4-- IL
r—el
N FRONT,30
SIDES 3
REAR—
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floorareashall be located a minimum of 6 feet from a residence, 10 feet
from a mobilehome, and 23 feet from a commercial building.
AG Buildings greaterthan 1000 sq. ft. in floorareashall be located a minimum of 23 feet from a residence and
a mobilehome, and 40 feet from a commercial building.
I declare under penalty of perjury that the building will be used as stated above and the proposed use
conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will
contact the Department of Public Works and will obtain any necessary permits, inspections, and approvals to
comply with the requirements in effect at that time and before occupancy.
Date- �'Zkjqo
Permit Fee - $25.00
Receipt No.
Signature of Owner
The above described AG Building is exempt from a building permit.
White - DPW, Yellow - Assessor, Pink - B. I., Goldenrod - Applicant
Director of Public Works
By. Date
FLOOD
PARCEL
P.D.,
ROOFING
ISSUE
I
I
Director of Public Works
By. Date
COUNTY OF BUTTE - DEPARTMENT.Cf. PUBLIC WORKS - BUILDING DIVISION
. 14
7 COUNTY CENTER DRIVE - OROVILLE. CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION'DATA SHEET
OWNER R0 kle.- f,\t. A&L
Proposed Building Use 62-M Building Inspector
Permit No.
P No. c2 Z —J,67 --Ij
-6 _Datar;Z44 9—n
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
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).
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.
14. 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).
17. Planning approval for (A) Use:—(B) Parking:
18. Improvements may be required. Contact Land Development Section of DPW.
19. Driveway permit (construction approval required prior to occupancy).
20. Pre -Inspection for ' required.
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).
24. Recorded copy of Agricultural Acknowledgment Statement.
25. Letter of signature authorization.
26.
27.
When you issue the permit, process as follows: —Mail to owner.
Telephone and hold for pickup at off ice
Other 4 4____4___
V I
Applicant
GENERAL INFORMATION
Mail to contractor.
—Del.iver w/inspector.
Date
BUILDING DEPARTMENT OFFICES HEALTH DEPARTMENT OFFICES
Chico . . . . 196 Memorial Way Chico. 196 Memorial Way
Phone: 891-2751 Phone: 891-2727
Hours: 8:00 a.m. - 10:00 a.m. Hours: 8:00 a.m. - 9:00 a.m.
Oroville 7 County Center Drive Oroville . . . 7 County Center Drive
-7281
.Phone: 538-7541 Phone: 538
Hours: 8:00 a.m. - 5:00 p.m. Hours: 8:00 a.m. - 10:00 a.m.
Parad i se . . . 747 Elliott Road Paradise . . . 747 Elliott Road
Phone: 872-6307 Phone: 872-6308
Hours: 8:00 a.m. - 9:00 a.m. Hours: 8:00 a.m. - 9:00 a.m.
PLANNING DEPARTMENT — 7 County Center Drive, Oroville — Phone: 538-7601
— Hours: 10:00 a.m. - 3:00 p.m.
Original — Applicant
Copy of plans sent — Health Dept., —Fire Dept., — Other—Date
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---maii—coun—ter by date"
Contractor, designer, owner, was advised of above required data by—phone —mal [—counter by— date
Plans checked by Date Plans approved by -x- J Date
Sets of plans on hold in File cabinet _AP folder
Copy—DPW
,'Ile
4�
A*
-COUNTY OF BUTTE DEPARTMENT O`FIPUBLI C I WORKS BUILDING DIVISION
7 COUNTY CENTER DRIVE - 6ROVILLeCA6&PRNI;k 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No. I e7 - CV.1
OWNER
fink�, P
A
Proposed Building Use 0 Bui Iding I ns pec tor Datec2ht�A
At time of permit application, I wa ed the following data must be submitted prior to permit processing and/or issuance:
1.
DATE RECEIVED APPROVED
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 signatur6 on plans . .
5�,
Hazardous Material Form .............................. k
6.
Energy Desig'H'-Co mpliance 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
instructi'6ns .......................................................
10.
Fees of $ ......... ............
11.
Chico Urban Area fees paid ........................ P ............
12.
Park fees paid .....................................................
13.
School District fees paid ..............
14.
Sanitatidn approval from Health Department
15.
City of Chico plumbing permit .......... I ...........................
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)
y
20.
Pre-Inspeciion for required ... P,e-Inspec. request to
Bu ilding Inspector (Date)
21.
Contractor's license information (No., Name Style, Classification) . . . - - -T--
22.
e�
Certificate 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 signature authorization ...................................
-26.
27.
When
you issue the permit, process as follows: Mai I to owner. —Mail to contractor.
Telephone and hold for pickup at —office. —Deliver w/inspector.
Copy of plans sent — Health Dept., —Fire Dept., — Other—Date
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---maii—coun—ter by date"
Contractor, designer, owner, was advised of above required data by—phone —mal [—counter by— date
Plans checked by Date Plans approved by -x- J Date
Sets of plans on hold in File cabinet _AP folder
Copy—DPW
,'Ile
Certificate of Compliance: Residential. Climate Zone 11
Project Title
Buildin amit#
ProjectAddress Y. 44, 170
Che&ed By/ Date
Documentation Author Telephone Enforicernent Agency Use Only
BUILDING DATA Gim Area % Glass
North / to 71 &
Conditioned Floor Area Z393 Number of Stories East -,g, 6P
Slab/Raised Floor SL5 Number of Units South
[4?'Single Family Detached (SFD) West
AdditionAlone
Single Family Attached (SFA) Existing Building Skylight
Multi-Family(MF) Existing -Plus -Addition Total -2.
BU11,DING SHELL INSULATION.' -
Component Insulation LocaffoniComments;
Type R -Value ____(atdc..to gange, SMicai, etc.':'
WaU ..............
WaU ..............
Roof .............
Roof .............
Floor .............
Floor .............
Slab Edge .....
GLAZING Shading Devices
Glazing Area GlassType Interior Exterior Overhang Framing Type
Orientation (SO (single, double) (roller blind. etc.) (sha&=Tem etc.) (yes/no) (metaltwood)
North L(2 21' OR1, _W441'rA i9R. Ag n.
NorT-h (0141TE,
East
East I
SOULh
South
West
West J1
Skylight .......
THERMAL MASS
Type/Coverirg Area Thickness
(slab/exposed, tile, etc) 40 (inches) Location/Dcscription (kitcherU bath. etc.)
7 P1 as PL. A Ce-
VJIJV L� 0-r , Aloo (4) &AMIt3 V7 1LJ
eW717* _R MS -1 _.J
HVAC SYSTEMS Minimum Duct
Type (fumace, air Efficiency Location Duct output
Manufacturer / Model #
conditioner, hesit pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh)
(or aperoved equal),
FU&N 7 7 - A
I I k; t -"U"41
A4 - a �7 &.11
1L ED
4y DIMCD
Maximum Fumace Heating Output: "99 it-uh
A 92� 924 9ft
HOT WATER SYSTEMS
Tank Manufacturer/Model #
System Type (storage gas, etc.) Capacity (or approved equal)
Special Featum(s)
SIO
SPEdAL FEATURESIREMARKS (Add extra sheets if necessary)
15
Mandatory Measures Checklist: Residential MF -111
NOTE. Lownse residential buildings subject to the Standards must contain these meastar" regardless of the compliar=
approac:hused. Items marked with an asterisk (,)may besupowdod �ymorcstringenticompliancerequirtments listed
on the Ccitificate of Compliance. Wben this checklist is incorporated into the permit doicurnerim the features noted shall
be considered by all parties as binding minimum component performance specifications for the marAwcary measures
whether they are shown elsewhera: in the documents or on this checklist only.
DESCRIPTION I DESIGNER I ENFORCEMEWT I
Building Envelope Measures
• §2-5352(a): Minimum ceiling insulation R-19 " we ighted average.
§2-5352(b): Loose rill insulation manufacturer's labeled R.Value.
• §2-5352(c): Minimum - wall insulation in frAmed walls R- I I weighted average (does not apply to
exterior mass walls).
52-5352(k): Slab edge insulation - water absorption rate no greater than 0.3%. water vapor
transmission rate no greater than 2.0 pcW=h.
§2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality
standards. Indicate type and form.
§2-5352(r): Vapor barriers mandatory in Climate; Zones 14 and 16 only.
§2-5317: Infiltration/Exraltration Controls
a. Doors and windows between conditioned and unconditioned spac designed to limit air
leakage.
b. Doors and windows certified.
c. Doors and windows weatlacirstripped; all joints and peractarnions cauLked and scaled
§2-5352(c): Special infi.1tration barrier installed to comply with 12-5351 meets CEC quality
standards.
§2-5352(d): Installation of Fireplaces
1. Masonry and factory -built fireplaces have:
a. Tight ratting. closeable metal or glass door
b. Outside air intake with damper and control
c. Fluc damper and control
2. No continuous burning gas pilots allowed.
HVAC and Plumbing System Measures
12-5352(g) and 2-5303: Space conditioning equipment sizing: atthch calculations.
12-5352(h)and2-5315: Setback thermostaion all applicable heating systems.
12-5316(a): Ducts consuruacd. installed and insulated pez Chapter 10, 1976 UMC.
§2-5316(b): Exhaust systems have damper controls.
§2-5314(c): Gas-fired spac heating equipment has intermittent ignition devices.
§2.5314: HVAC equipment. water heaten. showerheads and faucets certified by the CEC.
§2-5352(i): Water heater insulation blanket (R-12 or greater) or combined interior/extericar
insulation (R- 16 or greater)*. rust 5 fw of pipes closest to tank insulated (R-3 or greater).
§2-5312(Excep6on 1): Pipe insulation on steam and steam condensate return & recirculating
piping.
§2-5319(d): Swimming Pool Heating
1. System has:
a. On/off switch on heater.
b. Weatherproof instruction plate on heater;
c. Plum bed to allow for solar.
2. 75 percent thermal cfficiency.
3. Pool cover.
4. Tme clock.
5. Directional water inlet.
Lighting and Appliance Measures
§2-53520): Lighting - 25 lumcns/wait or greater for general lighting in kitchens and bathrooms.
§2-5314(c): Gas fised appliances equipped with intermittent ignition devices.
42-5314(a): Refrigerators, mfrigcrawr-frtczcrs. freezers and fluorescent tamp ballasts certified
by the CEC. Indicate make and model number.
COMTUANCESTATEN[ENT
This citrdficate of compliancic Usts tbe building features and pelifonnance specifications needed to comply with
Title 24. Cliapter 2-53 arid Title 20.Chakr 2. Subachapter 4. Article I of the California Administrative code. This
clertfficate has been signed by die irldividual with ovemll. design responsibility and the building owner, who shall
retain a copy of it and transnift the Certificate to sny subsequent purcliamr of the building.
Designer
Narnez
Tideffivala:
Addraita: -
Telephorac
Lic.
(signaturic) (date)
Documentation Author
TitIC/Furn:
Addrew
Building Owner
Name:
Titic/Fum
Address:
Teleephorte:
(signature) (date)
Enforcement Agency
Name:
Agency.
Tckounw-
1. Ceiling Insulation
-14
Number of stories
Number of stories
Number of stories
One
R -value
One
Two
Three
R-0
-103
-49
42
P-19
-8
-4
.2
R-30
-2
-1
.1
R-38
0
0
0
U-valuq
.60
0.60 .
-144
0.50
-176
-84
-54
0.30
-102
-49
-32
0.10
-26
-13
-8
0.08
-18
-9
-6 .
0.06
-11
-5
-4
0.04
-4
-2
-1
0.02
4
2
1
0.00
11
5
3
2. Wall Insulation
0
0.02
4
S le
Single -
0.00
10
F2 iiy
Family
Multi -
R -value
Detached
Attached
Family
R-0
-68
-51
-34
R-1 1
0
0
0
R-1 3
2
2
1
R-1 9
8
6
4
U -value
24
43
-12
0.80
-153
-114
-76
0.50
-91
-68
-46
0.30
-47
-36
-24
0.10
0
0
0
0.08
4
3
2
0.06
9
7
5
0.04
14
11
7
0.02
19
14
10
0.00
24
18
12
3. Raised Floor Insulation
Insulation In Floor
Controlled Ventilation Crawlspace
-14
Number of stories
Number of stories
R -value
One
Two
Three
R-0
-17
-8
-5
R -i 1
-3
-2
-1
R-19
0
0
0
R-30
3
1
1
U -value
4. Slab Edge Insulation
Double
.60
0.60 .
-144
-70
-46
0.50
-120
-58
-38
0.40
-95
-46
-30
0.30
-69
-34
-22
0.20
-Q
-21
.-14
0.10
-17
-8
-5
0.08
-11
-6
-4
0.06
-6
-3
-2
0.04
.1
0
0
0.02
4
2
1
0.00
10
5
3
Controlled Ventilation Crawlspace
-14
48
Number of stories
-64
R -value
One
Two
Three
R-0
-11
-7
-5
,R-5
-4
-4
3
R-1 1
-2
.2
-2
R-19
.1
.2
.2
4. Slab Edge Insulation
Double
.60
.50
N�Umb&OfStories
less
R-vaJue
One
Two
Three
R-0
0
0
0
R-5
8
5
2
R-7
8
6
3
F2 factor
-19
-9
1
0.90
-4
-3
-1
0.80
-1
-1
0
0.70
2
2
1
0.60
6
4
2
0.50
9
6
3
0.40
12
8
4
5. Infiltration (Air Leakage)
specification Points
Swodard 0
7..Shading (Shade Open)
Efrectlye Percent Glass
(percent Stan x SC)
Effective
-14
48
-69
-64
% Glass North
East
',.'6'Glm Heat Loss
West
Skylight
18 5
Total
4
1
na
16 4
U -value
5
Percent
na
14 4
.51 to
.41 to
.31 to 0.30 or
Glass
Single
Double
.60
.50
.40
less
50
-121
-53
-39
.24
.10
4
40
-90
-37
-26
-14
-3
8
35-
-75
-29
-19
-9
1
10
30
-61
-21
-13
-4
4
12
29
-58
-20
-12
-3
5
12
28
-55
-18
.10
.2
5
13
27
-52
-17
-9
.2
6
13
26
-49
-15
_8
-1
7
14
25
-46
-14
-7
0
7
14
24
43
-12
-5
1
8
14
23
40
-11
-4
2
8
15
22
-37
-9
-3
3
9
15
21
-34
7
-2
4
10
15
20
-31
0*11*"
0
5
10
16
19
-29
-4
1
6
11
16
18
-26
-3
2
7
12
16
17
-23
-1
3
8
12
17
16
-20
0
4
9
13
17
15
-17
1
6
10
14
17
14
-14
3
7
10
14
1 8
13
-12
4
8
11
15
18
12
-9
6
9
12
15
19
11
-6
7
10
13
16
19
10
-3
9
11
14
17
19
9
-1
10
13
15
17
20
8
2
12
14
16
18
20
7..Shading (Shade Open)
Efrectlye Percent Glass
(percent Stan x SC)
Effective
-14
48
-69
-64
% Glass North
East
South
West
Skylight
18 5
1
4
1
na
16 4
2
5
1
na
14 4
2
5
1
na
12 3
3
5
2
na
11 3
3
5
2
na
10 2
3
5
2
1
9 2
3
5
2
2
8 2
3
5
2
2
7 1
3
4
2
2
6 1
3
4
2
3
5 - 1
-.e
4
2
3
4 0
2
3
1
3
3 0
1
2
--1
3
2 0
0
0`1
0
3
1 -1
-1
-1
-1
2
0 -1
-2
-4
-2
0
na = not allowed
5
7
7
8
Shading (Shade Closed)
EffecdvePeic tGlan
(perewt Stan X SC)
Effecti"
%Glau Norih End South West -Sitylight
18
-14
48
-69
-64
na
16
-12
-42
-59
-55
na
14
-10
-35
-50
-46
na
12
-8
-29
-40
-37
na
11
-7
-26
-36
_M
na
10
-6
-23
-31
:-29
-74
9
-5
-20'
-27
-25
-65
8
-5
-17
-23
-21.
-56
7
-4
-14
-19
-18
-47
61
-3
-11
-15
-14
-38
5-
-4
-9
-11
-10
-30
4
1.3
-6
-8
-7
-23
.4
3
2
--e�
1
-4
J
-5 -4 -16
.2 -A----9
1
1
4
5
1
-4
0
2
3
4
3
0
na - not af�vqd
0
3'
5
7
9. Interior Thermal Mass
Interior
Single-
Slab Floor
Raised Floor
Mass
Family
Stories
Multi
mass
Stories
Attadwd
/CFA
One
Two
Three
One
Two
Three
0.0
-8
-5
-4
.2
-1
.1
0.1
-8
-5
-3
-1
0
0
0.3
-7
-4
-2
0
1
1
0.5
-6
-3
-1
1
1
2
0.7
-5
-2
-1
1
2
2
0.9
-5
-1
0
2
3
3
1.1
-4
-1
1
3
4
4
1.3
-3
0
2
3
4
5
1.5
-3
1
2
4
5
5
2.0
-1
2
4
5
6
7
2.5
0
3'
5
7
7
8
3.0
-ir-'_ 4
6
8
8
9
3.5
2
5
7
9
9
10
4.0
3
6
8
9
10
10
4.5
3
7
8
10
11
11
5.0
4
7
9
11
1 2
1 2
5.5
5
8
9
11
12
12
6.0
5
8
10
12
13
13
6.5
6
9
10
12
13
13
7.0
6
9
11
13
13
14
7.5
6
10
11
13
14
14
8.0
- 7
10
11
13
14
14
8.5
7
10
12
13
14
15
10. Exterior Wall Thermal Mass
Exterior
Single-
Single -
Wall
Family
Family
Multi
mass
Detached
Attadwd
Famil�
0.00
0
0
0
0.20
3
2
1
0.40
5
4
3
0.60
8
6
4
0.80
10
8
5
1.00
13
10
7
1.20
13
12
8
1.40
12
13
9
1.60
10
13
11.
1.80
10
12
12
zoo
10
11
1 3
11. Heating System
0
0 0
0
SE or KSPF
0
10.0
(assumes ducts In attle)
3 3
2
Sum of 1-6
1
10.5
-25or-24to
-14to -4to
+6 to 16 or
SE HSPF less -15
-5 +5
- +15 more
0.72 6.60
0 0
0 0
0 0
0.75 6.88
3 . 3
3 2
2 1
0.80 7.33
8 7
6 5
4 3
0.85 7.79
13 11
10 8
7 5
0.90 8.25
17 15
13 11
9 7
0.95 8.71
20 18
15 13
11 8
0
Effective SE or HSPF
(SE or HSPF x duct efficiency)
Effective -25 or -24 to -14 to -4 to +6 b 16 or
SE HSPF
less -15
-5 +5
+15 more
0.30 2,75
-73 -64
-56 -47
-38 -30
na 3.41
-45 -39
-34 -29
-24 -18
0.40 3.67
-34 -30
-26 -22
-18 -14
0.50 4.58
-10 -9
-8 -7
-5 -4
0.56 5.13
0 0
0 0
0 0
0.60 5.50
5 5
4 3
3 2
0.70 - 6.42
17 15
13 11
9 7
0.80 7.33
25 22
19 16
13 10
0.90 8.25
32 28
24 20
1 7 13
1.00 9.17
37 32
28 24
19 1 5
Zonal Control Adjustment
System Type
Resistance 10 9 7 6 4 3
Other 6 5 4 3 2 2
12. Cooling Syst,!m
SC /coo'
X 'I q.
Eff. % Glass
X
SEER
One
-5
.4
-4
-3
(assumet ducts
in aide)
Two +
3
3
Stm of 7-10
2
2
1
Single -Family
-25 or -24 to t1410
-4 ID
+6 to
16 or
SEER
leu
-15 1 -6
+5.
+15
mom
8.0
-14
-12 -10
-8
-o
-4
8.5
-9
-7 -6
-5
-4
-3
8.9
-5
-4 -4
-3
-2
-2
9.0
-4
-3 .3
.2
.2
-1
9.5
0
0 0
0
0
0
10.0
4
3 3
2
2
1
10.5
7
6 5
4
3
2
11.0
10
9 7
6
4
3
120
15
13 11
9
7
5
_1 3.0
20
17 14
12
9
6
-12
0.2
Effadve SEER
-1
-1
-1
(SEER xduct efflclency)
0
1.7
HWR
Sim of 7-10
-12
-9
-7
Effective-5or -24to -14to
-410
+6 to
16 or
SEER
less
-15 -5
+5
+15
more
5.0
-30
-25 -21
-17
-13
-9
6.0
-12
-11 -9
-7
-6
4
6.6
-5
-4 -4
-3
4
-2
7.0
0
0 0
0
0
0
8.0
9
8 "r
5
4
3
9.0
16
14 12
9
7
5
10.0
22
ig 16
13
10
7
11.0
26
23 19
15
12
8
12.0
30
26 22
18
14
9
13.0
33
29 24
20
15
10
Zonal Control Adjustment
10 8 7 6 4 3
No Cooling System Installed
-St6d.es
SC /coo'
X 'I q.
Eff. % Glass
X
One
-5
.4
-4
-3
-2
-2
Two +
3
3
2
2
2
1
Single -Family
ll�etached
and
Attached
____F L;aa
UMD. OR AREA
Unit Size (SO
X A . 3 =
Water
'099
12MY
1700
2200
2700
Heater
Credit
or
10
to
to
- or
.Type
Type
.,loss.
1699
2199
2699
more
SG
None
0
0
0
0
0
or
Solar
12
8
6
5
4
HP
HWR
8
5
4
3
3
6%
WSB
5
3
3
2
2
45%
POU
8
5
4
3
3
SE
None
-37
-24
-18
-15
-12
0.2
Solar
-1
-1
-1
0
0
1.7
HWR
-18
-12
-9
-7
-6
3.2
WSB
-25
-16
-12
-10,
-8
-4.6
POU
-18
_-12
-9
-7
-6
IG
None
-5
-3
-2
.2
-2
21
Solar
7
5
4
3
2
3.5
POU
3-
4.2
1
1
1
IE
None
-28
-19
-14
-11
-9
1
Solar
8
5
4
3
3
Z4
POU
-10
-6
-5
-4
-3
3.2
Muld-FamllY
4.3
(individual
units)
5
52
5.4
56
I Unit Size (so
0.5
Water
0.9
699
700
1200
1700
2200
Heater
Credit
or
10
to
10
or
TYP6
TYPO
less
- 1199
IM9
2199
mom
SG
None
0
0
0
0
0
or
Solar
14
7
5
4
3
HP
HWR
9
5
3
2
2
4
WSB
9
4
3
2
2
5.5
POU
9
5
3
2
2
SE
None
-45
-23
-15
-11
_9
3
Solar
2
1
1
0
0
4.4
HWR
-23
-12
-8
-6
'-5
5.9
WSB
-25
-13
-8
-6
-5
1.8
EQU
-23
-12
-8
Z8
-5
IG
None
-8
-4
-3
..6
-2
-2
4.7
Solar
6
3
2
1
1
6.2
POU
I-
'1_0
- 0
0
0
IE
None
-30
-15
-10
-8
-6
3.S
Solar
18
9
6
4
4
5
POU
-8
. -4
-3
-2
-2
Point System Summary: Climate Zone 11
SCORE CARD Measures
1. Ceiling Insulation 2.30 or
R -value 1381 U -value [0.0301
2. -Wall Insulation ;E_ Lq or
R -value fl. 11 U -value [0.098]
3. Raised Floor Insulation
4. Slab Edge Insulation
S. Infiltration
6. Glass Heat Loss
7. Shading (Shade Open)
a. North
b. East
c. South
d. West
e. Skylight
8. Shading (Shade Closed)
a. North
b. East
c. South
d. West
e. -Skylight
9.� Interior Thermal Mass
10. Exterior Wall Nfass
11. Heating System
Zonal Control? ( Y N
12. Cooling System
Zonal Control? ( Y / N
13. Water Heating
or
R -value [ 191 U -value [0.0371
Point Scores
MIS
oi
R -value (01 F2 factor [0.771
Standard 0
PRA.01 -(0 (9 -
Type (doublel U -value [U.-65) % Toutl Glass [ 16) Sum 1-6
% Glass SC Eff. % Glass
&,% - x 117 5113,
(a's X I 51V
2,"s X I
g.0 X
0.20, X
% Glass
SC /coo'
X 'I q.
Eff. % Glass
X
X
X
O -V
X
0.7.000'
Interior MayslCFA
TYPE 1 MASS AREA
Yte-rior M.iss/CFA
COND. FLOOR AREA
TYPZ I PASS
Exterior Wall Mass
____F L;aa
UMD. OR AREA
X A . 3 =
10-1600
Duct Efficien 81
Effective SE or
[0.7�216.61
�51 07--
X 21 -le
HSPF 10.5615. 151
-;,, I
-
SEER 1931
Duct Efficiency 10.74]
Effective SEER (7.03)
Credit [none]
-:5(2-
Type JSGJ
41.7.0 3 Pic 4. It
(c,rj?et*d 1b)
TYPE
I
KASS
WINC h 4.2. ie: exposed slab)
0%
6%
10%
IS%
20%
2S%
30% �36.4
40%
45%
50%
55%
6D%
69t
70%
?S%
110%
85%
00%
95%
100% 105% lJoy. 115% 120% 125 -
of.
0
0.2
0.4
0.6
0.8
1.1
1.3
1.5
1.7
1.9
2.1
Z3
ZS
'2.7
2.7
2.9
3.2
3.4
3.6
3.8
4
4.2
4.4
-4.6
4.8
5
53
10%
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.9
21
Z3
Z5
2.9
11
3.3
3.5
17
4
4.2
4.4
4.6
4.8
5
5.2
5.4
20%
0.3
0.6
0.8
1
1.2
1.4
1.6
1.0
2
2.2
Z4
U
2.9
3.1
3.3
15
U
3.2
4.1
4.3
4.5
4.8
5
52
5.4
56
,30%
0.5
0.7
0.9
1.1
1.4
1.6
1.8
2
2.2
Z4
26
2.8
3
3.2
3.5
17
19
4.1
4.3
4.5
4.7
4.9
5.1
5.3
5.6
58
40%.
0.7
0.9
1.1
1.3
1.5
1.7
1.9
2.2
2.4
16
2.8
3
3.2
3.4
3.6
3.8
4
4.3
4.5
4.7
4.2
5.1
5.3
5.5
5.7
5.9
50%
0.9
1.1
1.3
1.5
1.7
1.9
ZI
Z3
2.5
Z 7
3
3.2
3.4
3.6
18
4
42
4.4
4.6
4.8
5A
5.3
5.5
5.7
5.9
6.1
55%
0.9
1.1
1.4
1.6
1.8
2
2.2
14
2.6
Z8
3
12
3.5
3.7
3.9
4.1
4.3
4.5
4.7
4.9
5.1
5.3
5.6
5.8
6
6.2
60%
1
1.2
1.4
1.7
1.9
2.1
2.3
2.11
2.7
Z9
3.1
3.3
3.S
3.8
4
4.2
4.4
4.6
4.8
5
5.2
5.4
5.6
5.9
6.1
6 3
65%
1.1
U
1.5
1.7
1.9
2.2
Z4J
26
2.0
3
3.2
3.4
3 ' 6
3.8
4
4.3
4.5
4.7
4.9
5.1
5.3
5.5
5.7
5.9
6.1
6.4
M.
1.2
1.4
1.6
1.6
2
12
27
2.9
3.1
3.3
3.5
3 7
3.9
4.1
4.3
4.6
4.8
5
5.2
5.4
5.6
58
6
6.2
64
75%
1.3
IS
1.7
1.9
Z
Z3
75
2.7
3
3.2
3.4
3.6
3'8
4
4.2
4.4
4.6
4.8
5.1
5.3
5-S
5.7
5,9
6.1
6.3
6.5
M
1.4
1.6
1.8
2
12
2.4
2.6
2.8
3
3.3
3.5
3.7
3.9
4.1
4.3
4.S
4.7
4.0
5.1
5.4
5.6
5.8
6
6.2
64
6 6
85%
1.4
1.7
1.9
2.1
2.3
15
2.7
2.9
3.1
3.3
3.5
3.0
4
4.2
4.4
4.6
4.8
5
52
54
5.6
5.9
6.1
63
65
67
NY. '
1.5
1.7
2
2.2
2.4
Z6
2.3
3
3.2
3.4
3.6
3.8
4.1
4.3
4.5
4.7
4.9
5.1
53
5.5
5.7
5.9
6.2
6.4
66
68
9S%
1.6
1.0
21
2.2
2.5
Z?
2.9
3' 1
33
3.5
3.7
3.9
4.1
4.3
4.6
4.8
5
5.2
5.4
5.6
5.8
6
6.2
6.4
6.7
6.9
100%
1 .7
1 . 9
Z
2.3
2.5
Z8
3
3*2
3A
3.8
18
4
4.2
4.4
4.8
4.9
5.1
5.3
5.5
5.7
5.9
6.1
6.3
6.5
6.1
7
105%
1.8
2
Z2
2.4
2.6
Z8
3
3.3
35
3. 7
3.9
4.1
4.3
4.5
4.7
4.9
5.1
5.4
5.6
5.8
6
6.2
6.4
6.6
6 8
7
110*16
1.9
2.1
2.3
2.5
2.7
Z9
&1
13
3.6
3.8
4
4.2
4.4
4.6
4.6
5
5.2
5.4
5.7
6.9
6.1
6.3
6.5
6.7
69
7.1
IIS%
2
.2.2
2.4
2.6
2.8
3
12
3.4
3.6
3.8
4.1
4.3
4.5
4.7
4.0
5.1
5.3
S.S
5.7
5.9
6.2
6.4
-6.6
6.8
7
7.2
1 20%
2
2.3
2.5
2.7
Z9
3.1
3.3
3.S
3.7
3.9
4.1
4.4
4.6
4.8
5
5.2
5.4
5.6
56
6
62
6.S
6.7
6.9
7.1
J.3
125%
71
Z3
2S
2.8
3
3.2
14
3.6
3.0
4
4.2
4.4
4.6
4.9
5.1
5.3
$.S
5.7
5.9
6.1
6.3
6.5
6.7
7
7.2
7.4
Point System Summary: Climate Zone 11
SCORE CARD Measures
1. Ceiling Insulation 2.30 or
R -value 1381 U -value [0.0301
2. -Wall Insulation ;E_ Lq or
R -value fl. 11 U -value [0.098]
3. Raised Floor Insulation
4. Slab Edge Insulation
S. Infiltration
6. Glass Heat Loss
7. Shading (Shade Open)
a. North
b. East
c. South
d. West
e. Skylight
8. Shading (Shade Closed)
a. North
b. East
c. South
d. West
e. -Skylight
9.� Interior Thermal Mass
10. Exterior Wall Nfass
11. Heating System
Zonal Control? ( Y N
12. Cooling System
Zonal Control? ( Y / N
13. Water Heating
or
R -value [ 191 U -value [0.0371
Point Scores
MIS
oi
R -value (01 F2 factor [0.771
Standard 0
PRA.01 -(0 (9 -
Type (doublel U -value [U.-65) % Toutl Glass [ 16) Sum 1-6
% Glass SC Eff. % Glass
&,% - x 117 5113,
(a's X I 51V
2,"s X I
g.0 X
0.20, X
% Glass
SC /coo'
X 'I q.
Eff. % Glass
X
X
X
O -V
X
0.7.000'
TYPE 1 MASS AREA
Yte-rior M.iss/CFA
COND. FLOOR AREA
TYPE 2 t AEE8
Exterior Wall Mass
____F L;aa
UMD. OR AREA
X A . 3 =
10-1600
Duct Efficien 81
Effective SE or
[0.7�216.61
�51 07--
X 21 -le
HSPF 10.5615. 151
-;,, I
-
SEER 1931
Duct Efficiency 10.74]
Effective SEER (7.03)
Credit [none]
-:5(2-
Type JSGJ
00
�P� 0
Point Totak
41
OF
Sum 7-10
:5