HomeMy WebLinkAbout022-350-02822=35-28 1408-89B,P,E,M
I•
CHIP(Richard Levofsky) _
2887 3nd.St.,lot 18, Mi"Biggs
(new single family)
X22-35-28 1408-891,P,E,M
CHIP(Richard Levofsky)
2887 3nd St.,'lot 18, City of Biggs
(new single family)
PERI
PERMIT EXPIRES
OWNER
CONTR.
ASSESSOR PARCEL
LOCATION
OFFICE COPY v
i Address-a2T q
GAS CTTemp. Poo Meter By
ELECTRIC —to
Meter By Date
Temp. Elec. Service .mss
Called PGA
Temp. Gas Sen
Called PGA
JOB FINALED
Signature
RECEIVED MAR 301990
.z
B6ilding Owner 0#J
Building Location
ROOF
Material
Thickness(inches)
ENERGY INSTALLATION CERTIFICATE
EXTERIOR WALL
Material .�
Thick.-iess(inches) 3.
CEILING
CA Building Permit #
DESCRIPTION OF INSULATION
Brand Name
Thermal Resistance (R Value)
Brand Name 0 6�c-
Thermal Resistance(R Value) P--//
Batt or Blanket Type Brand Name
Thickness(inches) Thermal Resistance(R Value).
Loose Fill Type 6��� Brand Name ,2o- A`
Minimum Thickness(Inches) 2.3 " Number of Bags 41, Wt. per bag .27 _lb.
Area covered(ft.2) R 4 q . Thermal Resistance(R Value) 12-30-
FLOOR,
2-3D
FLOOR, ELEVATED
Material
Thickness(inches)
FLOOR, SLAB
Material
Thickness(inches)
Width(inches)
Brand Name
Thermal Resistance(R Value)
Brand Name
Thermal Resistance(R Value)
FOUNDATION WALL
Material Brand Name
Thickness(inches) Thermal Resistance(R Value)_
I hereby certify that the above insula! -ion was installed in the above building,
is consistent with approved building department plans and attachments and con-
forms with requirements of Chapter 2-5:;i of State of California Energy Requirement
3351-71
FIRM NAME/OWNER STATE CONTRACTOR'S LICENSE NO.
gAo
SIGNATURE OF INSTALLATION APPLICATOR DATE
I hereby certify the required features, devices, and equipment, a5 shown on the approved
Building Department.plars and attachments have been installed and conform.to the appli=
ance'standards and Chapter 2-53 of the State of California Energy requirements.
BUILDING CONT A OR/OWNER (Please Print)
(FIRM NAME)
SIGNATURE F BUILDIN CONTRACTOR/OWNER
HVAC FIR:K NWE/OWNER (Please Print)
STATE CONTRACTOR'S ICENSE NO.
.3
DATE
STATE CONTRACTOR'S LICENSE NO.
SIGNATURE OF HVAC CONTRACTOR/OWNER DATE
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL INSPECTION
APPROVAL AND A COPY SHALL BE POSTED WITHIN THE BUILDING.
SEPTEMBER 1988
= OK
0=Not OK
= Not Readyable MOBILE HOMES
MISCELLANEOUS
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Date
DECKS,COVERS,CARPORTS,GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-
Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
6. Gas; Location -Test -Wrap: / /"L"ft.
/ /"Nat. or/ /"L"ft./ /"LPG
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec.
8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
Card -81
Date Card -B1 Date
10. Roof; Shthg-Roofing
Card -B1
Date Card -B1 Date
11. Ext.; Steps -Doors -Landings _
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements ,
Card -131
Date Card -B1 Date
2. Footings; Size -Spacing -Marriage Line
Card -B1
Date Card -131 Date
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
Date
POOLS (Plans) OK except #'s
5. Drain; MH Test -Fall -Flex. Connector
1. Setbacks -Easements
6. Water; MH Test -Regulator -Connector
2. Soils; Compaction -Structure Stability
7. Water and Sewer Connected -C/0 to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness -
Dead Men -Lining
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
4. Elec.; Receptacles and Lighting, Distances-GFI
10. Cert. of Occupancy
5. Elec.; Pool Lighting; 15 volts-GFI .
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
Card -B1
Date Card -B1 Date
8. Elec.;Ground ing; Equip. w/5' -circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
Card -B1
Date Card -B1 Date
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Card -B1
Date Card -B1 Date
Card -B1
Date Card -B1 Date
J
'v
i
= VK
0 Not OK
- =Not Applicable RESIDENTIAL (Single and Duplex)
` = Not Ready
Date
UNDERFLOOR (Plans) OK except #'s
Date
F AMING (Continued)
-7�
. Zoning -Setbacks; -Easements -Flood -Slope
45. ngers-Post Caps -Anchors -Connectors
/2�Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
Garage; Soils -Steel-/ /" Ftg. Depth
Type A Flue -Fireplace Throat Clearance
&Pfg, Porches & Decks; Soils -Steel-/ /"Ftg. Depth
14 -6. -Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Steel- Bloc kouts-Wrapped
. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
ge; Steel- Bloc kouts-Wrapped
. Garage Fire Protection Framing
7 b; Steel-Wrappedroperty
Line Firewall & Openings
IL -Steel
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
-]�
. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
irs; Width -Headroom -Rise -Run -Landing -Fire Protection
10. Gas Pipe; Size -Anchors
4. P ywood on Roof Overhang -Attic Vents -Rafter Outriggers
11. Water Pipe; Test -Anchors -Regulator -Service Test
5. Siding -Nailing Veneer
1 d15
s -np Screed -Fd. Vents-Underflr. Access
13. ums uc s; earance-Material-Supprt-Ins.
ITrGlazing Area -Glass Protection -Skylights -Plastic
1 chor Bolts -Joists -Vents -Cripples
olts
15-krsufatbTt-
2
Insulation-Walls-Clg.
60. Infiltration -Wal Is-Wndws
Card -B1
Date ,- Card -B1 Date
Card -131
Date and -B1 Date
Card -B1
Dat - Card -B1 Date
Card -B1
Datand-B1 Date
Date LUIO ING (Permit) OK except #'s
ater Ht. Vent -Access -Combustion Air- Baffle
Date
AL (Plans) OK except #'s
gr2later Pipe; Test & Anchors -Nail Protection
1. t. Steps -Door & Sidelight Protection -Landings
8. D.W.V.; Test-Fttngs & Anchors -Nail Protection
.,Srhoke Detector
-Test, First Floor -Tub Access
.Furnace; Vents -Clearance -Comb. Air -Connector -
Jn Garage; Above Floor -Ducts -Mach. Protection
2 . ower, 2nd Floor -Tub Access
1. Gas Pipe; Size & Anchors
A. Bedroom Exiting
,5•P'rl. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes -Labels
Card -B1
C4�2 Datqq Card -B1 Date
ails
Card -B1
Date Card -B1 Date
arances-Hearth
a
6 el; Int. & Ext.
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
0. Ki ixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
3.,Elec. Receptacles Spacing -Lights & Switches at Doors
c. Outlets & Receptacles at Kit. Counter
2. Garage Fire Door; Swing -Landing -Closer
4,Aize Boxes & No. of Conductors -Stapled
5. Rgmex Installed Close to Edge of Studs & C.J.
-11 age -Damper
E ' . Ground made up w/Meeh. Fasteners -Bond Gas & Water
LW4. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
or-Meeh. Protection
. 2 Appliance Circuts in Kitchen &Conductor Size/G.F.I.
5., Elec. &Mech. Equip. Listed for Location
ize / / ga. Cu or AI-A.C. Wire Size / /ga.
-Cu or Al
&_Ei Receptacles in Garage; (G.F.I.)-Romex Protec.
021 Range Circ. / ga. Cu or I- ven Circ. / / ga. Cu or AI.
Insulated Neutral Yes l0
7. Insulation -Foam -Looked in Attic ❑ Yes
7 ai s Deck Construction -Post Caps
Service -Riser Conductors & Ground -Main Disconnect
i9. s raw ole Door -Drainage & Wood -Earth
Clearance Looked under Floo ❑ Yes
t2?-l-q1p. Clearances Panels-Motors-Mech. Equip.
82. 91 set Light -Shower Light -Spa Light
80. Following instld.; Drive 019s ❑ No; Walks tYles ❑ No;
Planters ❑ Yes ❑
Smoke Detector
6i. n- in
Card -B1
Dat Card -B1 Date
L,9'2,.#, -C. Unit; Disconnect, Electrical, Plumbing
Card -B1
Date Card -131 Date
3. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
Date
MECHANICAL (Permit) OK except #'s
, Electrical, Plumbing
. A.C. Ducts Insulation & Support
W._,Exterior Elec. Trim; G.F.I. Receptacle -Underground
Vent Fan; Exhaust above insulation
entilation throughout House
Condensate Dr ' & Ov rflow; Siz &Grade
7.�tass Protection
37. Furnace- ; Ac -Comb. r- eturn IR' Vent -11 utlet
-
--c-errections from Previous Inpections
38.o „tlie- eeess:,..& Platform if Furnace in Attic
89.
Gas Test -Meters Tagged; Gas -Electric
ater & Sewer Connected -C/O to Grade -HD Approval
i. Energy Compliance Certificate -Other Certificates
Card -B1
Dat and -B1 Date
92.
Card -B1
Date Card -Bi Date
Card -B1
Card -B1
Dat and -B1 Date
Date Card -61 Date
Date FBMING (Plans) OK except #'s
Sills, Proper Material & Anchors
Card -B1
Date Card -B1 Date
Comments at Final:
V 0 Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
1Aearing Walls over Girders & Floor Nailing
2. aft Stop in Walls (rat proof)
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
4• Header & Beam -Size & Bearing
(NOTE: An entry must be made each time you visit job site)
1 ,
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMI NO
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-75
APPLICATION ASID' PERMIT
ASSESS PARCEL UMBER 0 q
2 C(JJ
ZONING*Valuation
LDING PERMI
o `EG ` 44-611 L �V d S
TELEPHONE
BUILDING VALUATION
MAILING ADDRESS /
OWNER'S MAILING
!� 5 01-0 V,
CONTRACTOR'SNAME
& 19r [i . -1,01e 0
TELEPHONE
CONTRAC OR' MAi NG ADDRESS
CONSTRUCTION LENDER
17 Ar
UNKNOWN
$
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
.$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS 2
Permit fee
PLUMBING PERMIT
Filing Fee 10.00
4L. -IT
Each Trap
2.00 .00
Solar or heat pump water heater
20.00
LOT NO.
SU1,9 tB�DIVISIO/NA
N
/1
Pi'Jo 7JcL_
PARCEL MAP
Water piping
5.00 (� D
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea
TYPE OF WORK
New Addition ❑ odel ❑ Utilities EI allatio her ❑
Describe work:
a
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 6101 OR LESS
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):
❑ 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.
No. Classification
X1,
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.N) ,
OR ADDNS. ACC. BLOGS. / /20sgIt
NEW CONST R. U NCH C,LET 2.50 ea
NON•R ESID BRANCH CIRC ITS
/POWER APPARATUS e
(SINGLE OUTLET CIR. /
p o UTLETS OR FIXTURES D1030
EX. OCCU 2AL@ense 30
FIXED APLNS
Ex. OCCUp. OUTLETS PRESID.)R EA.) 2.00
Temporary service 1,0.00
Mobile Home Facilities .00
Misc. Wiring 15.00
9
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Ce ficate of Workmen's Compensation Insurance or a Certificate
PkIConsent to Self -Insure.
EF/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 shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
g
Hood
3.00
Ventilation
permit Fee
=
Contractor
1 certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
alaiso I abillit es, j dgments, c emnifsts,nandeexpensels harmess which maythe nin any wayButte aacc ue ainstO
against said ounty in consequence of a granting of this permit.
X Date ��
Signor„ a of Applicant — Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep an demolition or construct-
ion of structures Over.3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL P RMIT FEE
CUP.
CONST rPEJ
ISC:400FLO
o
PARCEL
j
ND se
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
PE T EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date �Si'Lr_�I �
�� Z" s / qO
Receipt No.BY
WHITE-D.P.W.. YELLOW-ASSCSSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
.-'--�..�.--7+vh-4.l'L;�,�ir,�=•�•f�+'�i'�+. � `•1•� a.. �},:���,�«'�is+.`�%."S',^'.�'M'�'�+.T'-^C�-�"""'1...'�"�':.f;..-.j,.w-++•Y-y�1C`-�5.�,�,�'��'�+`--• ..
COUNTY OF BUTTE - DEPARTMENT.OF''PUBLIC WORKS - BUILDING�DIVIS.ION
7 COUNTY CENTER DRIVE - OROVILLt,,CA6IF0'RNIA'95965 - TELEPHONE: 916/538-7541��/
-
PERMIT APPLICATION DATA SHEET
`t t Permit No.
OWNER i A. P. o.
Proposed Building Use — Building Inspector Date
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1
2
3
4
F3
9.
10.
1.
12.
13.
- ' 15.
�t
16.
17.
18.
19.
20.
21.
22.
23.
4.
25.
26.
All items have been submitted
Plot plans in duplicate/triplicate, signed by preparer of plans ........
Complete plans in duplicate/triplicate, signed by preparer of plans . .
Complete engineered plans and calcs, with wet signature on plans ..
Energy Design Compliance and supporting documentation .........
Statement of Intent for Non -Heated and AC Buildings ...............
Engineered truss details and layout in duplicate (required prior to plan check)
Mobilehome installation data including manufacturer's installation
instructions.......................................................
Fees of $ ..........................
Chico Urban Area fees paid ........................................
Parkfees id ..................................................
School District fees paid ............ ... .
Sanitation ap r al from Health Department ...
City of Chico plumbing. -permit ......................... ...........
Plot plan.and business license approval from City of
(see City for other requirements)
Planning approval for (A) Use: (B) Parking: .........
Improvements may be required.
Driveway permit (construction approval required prior to occupancy) ...
Pre -Inspection for required ...... Pre-Inspec. request to
Building Inspector
Contractor's license information (No., Name Style, Classification) .......
Certificate of Workmans Compensation Insurance ....................
Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ........
Recorded copy of Agricultural Acknowledgment Statement ............
Letter of signature authorization ...................../............... .
(Date)
When you issue the permi , Tpcess as follows: Ma' to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other
Applicant Date
Copy of plans sent Health Dept., Fire Dept., Other Date
The following data must be submitted prior
1. Index permit for above items No.
2. Additional items required:
(Circle new item not checked above).
Contractor, designer, owner, was advised of above required data by_phone_maiI—counter by i" --date { 4
Contractor, designer, owner, was advised of above required data by—phone —ma II—counter by date
Plans checked by Date_Plans approved by� Date ✓�
Sets of plans on hold in File cabinet AP. folder ,
Copy—DPW
M
' COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
L
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit
will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no) YES
Y
2. I (have/have not) signed an application for a building permit
for the proposed work.
3. I plan to provide portions of this i,,ork but
of encv
I have contracted with the following p to provide the-}e�eeed
construction technical assistance to coordinate and supervise the nejor work.
Name Coarmin i t -v Hntisi na Mmoroypakent- Proaram
Address 429 Normal Av City Chico, CP.
Phone 891-6931 Contractors License No. 390764
4. I plan to provide portions of this work, but I have hired the following person
to coordinate, supervise, and provide the major work:
Name
N/A Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
ButtacavQli Industr. lo15 Yuba Str., Yuba City CIS 741-2619 Insulation
Caldwell Ent., P.O. Box 787, Gridley, CA, 95948 846-4142 mets & Counter o_c
Coleman Concrete Constr., 91 Lone Tree Rd. Oroville, CA 534-3303
Clunberland P1Lmibina, 40 Cta)cvale Ct. , Oroville 534-0589 inq
Foothill Electric, 5887 Orrin Lane Paradise, CA 877-1357 E ec ica
Fox CO., 3995 Olive Hca . Oroville, CA, 533-27YO— Hea t J
Trojan Truss Co. P.O. Box 85, Orland, CA, 95963, 865-2 •o russes
Signed: 9 clLa4a(s -7
Property Owner / r
Social Security Numtitr
Date
NOTE: This Owner -Builder Verification is sent to YOU '**as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and rer.urned to our offico before we are per-
mitted to issue the permit.
When recorded mail to:.
Chico Housing Improvement
429 Normal Avenue
Chico, CA 95928
ATTORNEY-IN-FACT AGREEMENT
I/We hereby appoint the Community Housing Improvement Program and/or any of its
authorized agents as my/our attorney-in-fact for the purpose of executing any
notices of completion, waivers of liens and/or stop notices and/or release of
liens and/or stop notices and building permits relating to that certain real
property described as follows:
All that certain land situate, lying and being in the County of Butte ,.
State of California, described as follows:
Lot 18 of Pidmtta SlixUvisicn , as shown on that certain map filed
for record in the office of the county Recorder of the County of Butte ,
State of California, on ,7anuary 15 , 1988 ; in Book 108 of Maps
and Surveys, at page 59
Date /
Date
STATE OF CALIFORNIA
County of
OFFICIAL SERI.
LINDA F: WILSON
NOTARY PUBLIC • CAUFORNUI
i BUTTE COUNTY
My Comm. Expires Feb. 15, 1992
W, No W. � ffA rX a 01
dLq
Owner
On this 12thday of April in the year
1989 , before me
Linda F. Wilson , a Notary
Public, State of California, duly commissioned
and sworn, personally appeared Richard J.
Levof sk ,
personally known to me or proved to me on t e
basis of satisfactory evidence) to be the
person(s) whose name(s) is/are subscribed to
the within instrument, and acknowledged to me
that W he executed the same.
IN WITNESS WHEREOF I have hereunto set my
hand and affixed my official saute the
County of
on the date set forth above in this
certificate.
Notary Public State of Ca iforn a
Linda F. Wilson,.
My commission expires 2/111992
BUTTE COL
M
I
A.P. Number )G!'
1
SCHOOLS DEVELOPMENT,,,FEE CERTIFICATION FORM
(One Form'per Building,)
3 S " 2 P Building Department No.
"School Di'stri t ('Cla City ''Count Q Jurisdiction
Property Owner�Ac F- e V v 5
Project Location/Address-2-,98-7 -33Vo! SJr. gI
Subdivision •c%o a Lot Number /
Residential Development:
^ � Sq. Footage C9.1-
of
J �of Living MHI Addition (Group R)
Units
__,Commercial/Industrial: Sq. Footage
New Addition -,(Including Exterior
Roofed Areas)
Building Department Representative
Date
(Floor Plans reviewed by School District Personnel)
District Id N o X 66
School District certifies that
(Applicant Na e) (Phone Number)
(Street Address)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No.
b the payment of, $ /��•Sl/ representing square feet.
School ;istrict Representative /Date'
PAID
BY
CHECK
NO . ,,Q66 -f aPYEMARKS :
BANK
NO
PAID
BY
CASH
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
IOIp U,E,
W.IbG.
INS
ul
/
122'
/
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2 • Prat- To o�cu�NcY, P�oPaS� 2- Pm�M , 1 54TH
AU,uT1►11-t7� �' (�- R�I� X49 h• P
LoM I'LL( W ITN --�pjV6 lc;N �c�t it•�j�tTh
HAt2c L_p- MAY QLD
� � tv�as�ec 6ri rile Tor fiuVi lq
G1TY ENIIN �Jr ��
SITE J PLAN�s PLAN N°•
_ .,
LOCATION:
lizetrT
AP NO.
NOTES: COMMaDt3JJTY.. HOUSING'..
. �
PH 7&M � PROGRAM
AVE. CHICO
])�6,10WNER : t-�✓Y
DATE: 4 -JAN S9
SCALE: III = 20l