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BUTTE COUNTY DEVELOPMENT SERVICES
COMPLAINT FORM
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Complainant:
Address:
Phone Number:
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NOTES
RESIDENTIAL
_024-
080 169 d -076'l-,
PERMIT NO. C V OS, JOEY
WINTERS CT, GRIDLEY''
Cont: CAVAZOS CONST
NEW SINGLE FAMILY
I
SPECIAL CONDITIONS .
CHECKED
.BY
_SRA,
— FLOOD CERTIFICATE REQ.
— FIRE SPRINKLERS REQ.
— SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
Li - OFFICE COPY
Address
GAS Date -
meter By
ELECTRI DatqgP4
11
meter Byl�
JOB FINALED (Date) _L /()
Signature
OK
0 = No, OK
= No'Applicable
= Not Ready MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #s
1 . Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/0 -Concrete
4. Water; Location -Test- Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L 'ft.
/ P Nat. or / /" L "ft./ P LPG
7. Well Clearance & Disconnect
8. Utilitv Clearance
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1
. Zoning Requ i rements-Setbacks- Easements
2.
Footings; Size -Spacing- 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
9.
Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert. of Occupancy
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except Vs
1 . Zoning Req uirements-Setbacks- Easements
2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Decks, Girders and/or Joists- Decki ng- Bracing -Stai rs-Rails
4. Wood Awn.; Posts- Beams-Rftrs-Connectors
Shthg-Frg-Bracing
5. Alum. Awn.; Col um ns-Connections-Spl ice- Decal-Enclosu res
6. CarDorts: Windows -Doors
7.
Electric
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
11.
1 . Zoning Req u irements-Setbacks- Easements
12.
2. Footings; Size -Spacing- Marriage Line
3. Blocking
Date
4. Gas; MH Test -Demand -Valve
Date
5. Electricity; MH Test
Date
POOLS (Plans) OK except #s
6. Water; MH Test
1 .
Setbacks- Easements
7. Water and Sewer Connected
2.
Soils; Compaction -Structure Stability
8. Gas and Electricity Tagged
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
9. Exits
4. Elec.; Receptacles and Lighting, Distance-GFI
10. License Decals
Elec.; Pool Lighting; 15 Volts-GFI
11. Verify #'s with Office
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except Vs
1 . Zoning Req uirements-Setbacks- Easements
2. Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3. Decks, Girders and/or Joists- Decki ng- Bracing -Stai rs-Rails
4. Wood Awn.; Posts- Beams-Rftrs-Connectors
Shthg-Frg-Bracing
5. Alum. Awn.; Col um ns-Connections-Spl ice- Decal-Enclosu res
6. CarDorts: Windows -Doors
'11
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nai I i ng -Veneer-Stucco- Mesh
10. Roof; Shthg-Roofing
11.
Ext.; Steps- Doors- Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #s
1 .
Setbacks- Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5'Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
'11
r�
4 = OK
0 = Not OK
- = Not Applicable
. = Not Ready
RESIDENTIAL (Single & Duplex)
Date UNDEDFLOOR (Plans) OK excet)t #s
;e"Ptg., Main Soils-Elec. Grnd.-/ /" Ftg. Depth
J.ft�,, Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
-*.'Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
___ i;?
ternwalls, Main: Steel- Blockouts-WraDDed
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
t -. 7' &tM. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except #s
17. Wa)gr Htr.; Vent -Access -Combustion Air Baffle
ter Pip ; Test & Anchor -Nail Protection
.2 WDW.V.; Test Fittings & Anchor -Nail Protection
7-7k ey,07Whower Pan; Test, First Floor -Tub Access
'2r Test Tub & Shower, Second Floor -Tub Access
$2'."'Gas Pipe; Sixe & Anchors
23. Fire Sprinkler; Test
lob I
Date Card [314_� Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #s
eg-,Fixture & Transformer Clearance -Ins. Protection
2efirec. Receptacles Spacing -Lights & Switches at Doors
Aze Boxes & No. of Conductors Stapled
Romex In tailed Close to Edge of Studs & C.J.
firOuip. Ground made up w/Mech Fasteners -Bond Gas & Water
&',?eAppliance Circuitsgin Kitchen & Conductor Size GFI
Or Subfeed Wi 5�§ize/�_Iaga. Cu oy0g;h.C. Wire Size/ /ga Cu or Al
31. RangeqjFde/ /ba Cu or Al --Oven Circ. / /ga Cu or Al
,,, ln�Vlared Neutral Q Yes Q No
&000"Service-Riser Conductors & Ground Main Disconnect
33. gquip. Clearances Panels-Motors-Mech. Equip.
� �.lothes Closet Light -Shower Light -Spa Light
W"' Smoke Detector
Date Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ME91,11ANICAL (Permit) OK except #'s
,Vr,A.C. Ducts insulation & Support
OK,Vent Fan, Exhaust above insulation
V. Condensate Drain & Overflow, Size & Grade
�@�F mace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
4Q/Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date FRA
,MING (Permit) OK except #s
Oills Proper Materials & Anchors
,V. Walls Studs -Nailing Spacing & Braces- Plates -Sou nd
4i*,Bearing Walls over Girders & Floor Nailing
.Zraft Stop in Walls (rat pr000
V. Yire Stops, Furred Ceilings -Stairs -Chasers -Tubs
4#.r Headers & Beams -Size & Bearing
Date FRAPPNG (Continued)
44P.0'blangers-Post Caps-Ancho,s-Connectors
410.0'�ling. Joist-Rftr. Ties- Pu rlin- Roff Brac.-Truss-Shting.-Rtng.
40',Fireplace Ties or Type A Flue -Fireplace Throat Clearance
.,Attic Access; Size & Romex Protection- Draft Stop -Ins. Baffles
Bdrm. Wind ws or Exiting Doors -Sill Ht. & Dimensions
Garage Fire Protection Frarning-RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
6&.- Stairs; Width -Headroom- Rise- Run -Land i ng -Fire Protection
A6. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
%,giding-Nailing Veneer
jStucco Mesh -Drip Screed -Fd. Vents-Underfir. Access
Se gMFing Area -Glass Protection-Skylig hts- Plastic
V.'_Shear Walls; Nailing -Bolts
B��erior/Exterior Wall Panels
���2SEitrn6lation-Walls-Ceilings
Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor- Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door; Swing -Landing -Closure
76. A.C. Duct in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction- Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
83. Following Inst1d./Drive 0 Yes D No/Walks U Yes 0 No/Planters 0 Yes 0 No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical- Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle- Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Irspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/0 to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
COUNTY OF BUTTE - DEPARTM NT OF DEVE LOPMENT SERVICES - BUILDING
ISION 8
7 County Center Drive Or ! ville, California M965 * Telephone (530) 538-75 PERMIT NO.
(Rev. 12/96) APP ICATIONANDPERMIT
ASSESSOR PARCEL NUMBER 024-08G7109
ZONING A-5
BUILDINGPERMIT
OWNER
CAVAZO JOEY
TELEPHONE
-.9988
SO. FT. OCC. BUILDING VALUATION
__67
OWNERS MAILING AD�tss,
1623 STAIRR DR. (ST.D) YUBA CITY "95933
.2-342' R 126,468.00
770 U 15'.860.00
CONTRACTOR'S NAME
CAVAZOS CONSTRUCHON
TELEPHONE
674-5988
698 C
9,074.00
CONTRAZTORS MAILING ADDRESS
(SAME AS ABOVE)
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation 149.402.00
ARCHITECT OR ENGINEER
LICENSE NO.
-Filing Fee
$ 20.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Permit Fee
s 814.50
Plan Checking Fee
$ 529.45
BUILDING ADDRESS qt[OWINMS C -.P. GRIDLEY
Energy Plan Checking Fee
$ 23.00
PERMIT FEE
$1.386.95
LOT NO.
A
SUBDIVISIONSINAME
P14 82-60 4-28-01 1
IPARCEL MAP
PLUMBING PERMIT
riling Fee 20.00
USEOFSTRUCTURE
SF M Duplex 0 Mobilehome 0 Other SPECIFY
Each Trap
7.00 91.00
Solar or heat pump water heater
23.00
Water piping
15.00 15.001
-Each gas water heater or vent
15.00 15.00
TYPE OF WORK
New:& Addition 11 Remodel 1:1 Utilities 0 Installation 0 Other 0
Describe Work: NSF
Gas piping system I - 5 outlets
-
15.00 15.00
Building sewer
15.00 15.00
Mobile Home ISI GI W1
920.00
-
PERMIT FEE
171-00
EWOD:X. 1110C
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service '.*.A OR
23-00 23/00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license I full force and effect
License Class A Lic. 'No. z
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, asownerof theproperty, ormy employees with wages as their sole compensation,
will do the. work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A
46.00 108. 201
NEW CONST. DW:�IJNG OCCUP.
OR ADONS. C S.
so.
3.50FT.
Nt:W rUMT.
NON-RESID. =Tl 0.U.TLE.T
1@7.50
OWER AP= U
PSIN.. . C SIR.
Ex. Occup. OUTLET OR FIXTURES
20 @ 1.00
BAL @ .50
OR
Ex. Occup. 0=96.) EA
5.00
Temporary Service
23.00
-Mobile Home Facilities
20.00
- Misc. Wiring
23.00
I
PERMIT FEE
$ 151.20 -
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
&'I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
[I I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, forthe performanceof workforwhich this permitis issued.
My workers' c�74ens ti * s r and policy number are:
92on in e
Carrier - (�L K -
_ pnce c;y
Policy Number 7 6' C-5 V 7_3 V- M;�
(The above sections need not be completed if the permit i work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit is issued, I shall
not emplo)y any person in any manner so as to become subject to workers'
compenwon laws of California, and agree that if I should become subject to the
worker§rAo4ensabon provisions of section 3700 of the Labor Cod
f h co�ply with those provisions.
� -/ ?--o
X Date .
Sign.a�g of Applicant - 0 Owner ontractor 0 Agent
AnP6HA permit is required for excavations over 60" deep and demolition or comoLuction
of structures over 3 stories in height.
1 Z 6 a^
ReceiptNo. 632,4v5jzjw�yu
I WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK-INSPECT)Dq GOLDEN ROD -APPLICANT
MECHANICAL PERMIT
Filing Fee 1 20.00
Heating 1 1 20.00 120.00
Cooling SPLIT 1 25.00125.00
Hood 6.50 6.50
Ventilation
4.50 9.00
:1:1�
GAS FMA -CE
PERMIT FEiE $ 95.50
Mobile Home Installation Fee $
Energy Inspection Fee 46.00
Occ
R-3
CONST TYPE
VN* TALFEE$ 12850.65
KA2.
___
I D. FE IMP
I FLOOD
X
I CDF
PARCEL�
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
/Date 0
PERMIT EXPIRES ON lol 'i;IL
(DAt,) '
FFA
7o
COUNTY OF BUTTE-DEPAOTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ASSESSOR PARCEL NUMBER,
Proposed Building Use: Counter Technici:� Date:
Items required in order to apply for a permit. All boxes WST be checked OR marked NA in order to apply.
;j ora -r
%--i..Plot plans, 3 or 4 sets, signed'by. the preparer of the plans. W -t
- .1 1 � 'e- t . & ik /11
.3 or.4 sets, sig'fied1by the preparer of the plans. ;,4- 'X
JV 2. Complete pl I ans "L
IF3. Engineer6d pl - a - ns, 3 � or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
4. Engineer�d truss details and layouts i
n daplicaee.- No faxes!
i I u
docfi
Energy compli�nce "desigriand supporting in p cate.
1�6. Manufactured homes: (A),'Data sheers and installition instructiong, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in db�licate.
0 7. Metal buildings: (A) Metal Building Plans, (B) Foundation! plans land calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be starni')AN . A ;�et-signed by the enginee .
Items requir.ed-fdr initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be
indexed and returned to the plan review liiie-u�'�`h_en required items are received.
Date Received By
0 8. Flood Elevation Certificate, wet:stamped and sikned, in duplicate ................................
0 9. Plot ' D -" ie�'ssil'i6e'n*'Iet�pr"o,'v'al'6o'm thb�71eiqlc'f B`iggs ....................................
plan,and�busit
0 10. Lett�f of intent for no ' n4esidentiA,�uildings .........................................................
0 11. Detached Ac�essor�"B 'I
y Bui ding Form filled out by the owner .....................................
0 12. Hazardo'us�Maierial Form ...................... 4'��
.............................
0 13. Otheri !7
A
Remaining items nee ed\to issue the permit. (Ma�r`e`quire additional plan review upon receipt of the following items.)
3
14. Yees'as shown, on the attache� Schedule e Sheet .........................................
C1% 15. Statement of Intent for Non -heated and A/C Buildings .................................. 444
1AIL 1 16. Sanitation and plot pl�ti 'approval from the Environmental Health Department in F
/W __*4ta
0 17. City of Chico Plumbing permit .................................................. ................
FT,
0 18. California Departnnent of Forestry plan approval 0 paid. Sent by: . ......................
0 19. Planning approval for -(A) Use: c:0,'_ B)Parking: Q Parcel Check:
0 20. Contact Land Development about 0 Improvements, El Drainage ...........
1. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0 22 Pre-Inspecti6n for required ................
0 23., Contractor's license information. (Number, Name Style, Classification) ......................
0 24. Worker's Compensation Carrier and Policy Number ..............................................
0 25. Owner -Builder Verification (11 Given to owner, 0 Mailed to owner) .....................
6. Letter of Signature auftrizatjon ....... ........... i .............................. P ...................
7. Recorded copy of Agriccultuta*l Acknq�wledgment Statement..
...........
0�8. Manufactured iiom� &ilit��Cleiiridince ...............................................................
0 29. Existing violati�ns an(yo4e`xp ired permits ......................... e ................................
0 30. 0 Grant De6d E].M,�Fl. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 31. Other:
-7 f -7 7 6- X -
4p issued Tele-ph-o"ne and hold for pickup.
"J
(��e b8tiorm-e o 4 e�Aove items and eq 're-ments for obtaining a building permit.
j
Applicant: Date*
Plan Check Lette
1. Index permit application for the above items numbered:(V
2. , Additional items required , M
Contractor, designer, owner, was advised of the above data,� llho-flir,O 'Mail, 0 counter, by Date:
Contractor, designer, owner, was advised of the above data by 0 phone, 0 mail, 0 counter, by Date:
Plans reviewed by: Date- Plans approved by: -Date:
Structural reviewed by Date- 95yo
.3 Structural approved by: I�X Date:
Note transfer by: Date: 'T., I
Yellow Building Drvision
EAN56 ONLY
Plot Plan Attach.d��
Floor Plan Amchod
Sam to 6.0
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
0 wlnc�,Ls Iz)q
"wrier Location AP""
3
Plan Approved for: Sewage Dispo Water Sup I c.: P blic Private We�ll
)y
dwelling. Other��, 2
Clearance for
Hold final for:
Final clearance O.K. for:
NOTE:
I
eWta'l He—aitWgipecialist
8/96
...... .. ............. ................
Date
In
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALEFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER CaU070:5
1�1
P TRO P 1E BUILDING USE F
1. BUILDING PERMIT FEES
Balance Due ....................... s
-62
Additional Fees Due ................. $
Additional Fees Due ................. $
Revised Plan Checking Fee ............. $
2. SC 0 DISTRI T F1?ES
C'
:(pai Avaf& a0w,
HE FEES (paid at Building Division) 360.00
Residential ...................... —x $360.00 $
Units
Commercial (sq. ft'.) ............... —x $0.03 = $
Sq. ft.
4. URBAN AREA FEES (paid at Building Division)
Residential ................... —x—=$
# Units Amt.
Commercial (sq. ft.) ............ —x—=$
Sq. ft. Amt.
5. RECREATIONAL DISTRICT FEES
V
(paid at District Office) (Available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)'
WKS -RA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion #
$200.00 (paid at Building Division)
9. CSA 87 TRAFFIC FEE
$2500.00 (paid at Building Division)
10. OTHER
At time of permit application, I
may be changed during the pw
I
APPLICANT
A.P. # e;' �J — ()kV'— /
DATE 3 —/,c;�L
RECEIPT # DATE REC.
WAY
advised the above fees are required to be paid prior to issuance of the building permit. These fees
F,king process.
DATE 2
Pursuant to Governoe
,/t Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been
imposed on your p ect. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during whiclOyou may protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original - Buiding Div. 2nd Copy - Applicant 3rd Copy - Owner ' (Rev. 6/00)
School District
A.P. Number
Property Owner
.Property LocafionlAddj
Subdivision
Residential Development
, -4, —V—'J�ej 4r ,
BUTTE.COURTY , SCHOOLS IMPACT FEE, CERTIOICATION FORM
(One form per Building)
V Building Department No.
city s . County
.4 0-
Vot No. U
........... ..................
Sq. Footage
EZi
Nobf Living Mobile Home Addition/ *Supplemental to
(Group R)
Units Installation Conversion Permit #
*(No foundation inspection)i
....................................................................................................................
Sq. Footage
(Including Exterior
Roofed Areas)
Date
1noor rians revieweu oy z)cn-ooi uisinci rerson-neu
.Dist-rict ldentification�
171% School District certifies that V P,?Y)
C'i I kt AA I a
k3 0 JApplicant)
IStreet
N
(City)
has complied with the requirements.of Resolution No.
representing square feet.
School District
(State)
lPhone Number)
(Zip Codi)
by payment of $
�B 2926 $
IFULL MITIGATION $
Date
Paid by Check .# Remarks:
Nodbe: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 660201a), within 90 days from the date fees are paid. Faillur-eto submit a timely written,protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEGA),
this project may be subject to additional school fees to*fully mitigate Its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeformAs (16/98)dmm
*?St= FEE P.AXtb>
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SY Data
PnMrT EXPIRES ON
C6UNY OF BUiTE - DEPARTMEHT OF DEVELOPMENT
SERVICES - P ILDING DIVISIOH
7 County Center Drive, , or6vills, California 95965
& Telephone 0) 538-75,4-1 -.r-p:-:Pj 0.
is
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APPLICATIONAND PERMIT -r) -::3 - C)
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PnMrT EXPIRES ON
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street * Chico, CA - (530) 891-2751
.7 County Center Drive - Oroville, CA - (530) 538-7541
CORRECTION NOTICE
CQ D-2�- 0-7
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
c . ompleted. It you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
REV 10192
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street - Chico, CA - (530) 891-2751
7 County Center Drive - Oroville, CA * (530) 5381-7541
CORRECTION NOTICE
C"Iq FOS 03-07ol
OWNER PERMIT NO
A routine inspecti6n indicates that the following violations of butte county Ordinances exist at the
a * bove addr ' pss' and/should be corrected. Please notice this office when correction of work is
it
completed I y have any questions pertaining to this matter, or need additional explanation,
please con s office immediately.
7e&5S IP&44J5
(te-cwlsc-D nr&-55cs)
- PUMP
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REV 10/92 'xf1o1XC—(— V1C--1AZ4—
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street - Chico, CA - (530) 891 2751
7 County Center Drive * Oroville, CA - (530) 538-7541
CORRECTION NOTICE'
OWNER PERMIT NO.)
A
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work Is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please-c,ontact this office -immediately.
<:—,�� 1:71&- 7 -E-
V
CCj,,,-c,Ja-0�j %
J,AND VVAEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
Recorded
I REC FEE
Official Records
I COPIES
County Of
BUTTE
CANDACE J. GRUBBS
Recorder
ROSEMARY DICKSON
I
Assistant
I kathyh
10:37AM 24 -act -20007
I Paae I of 2
10.00
5.00
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes,
and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations'
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm
operations.
All that real property situate in the County of Butte, State of California, described as follows:
Date
State of California
C o u n ty o f Q_
On r-l�) , _J1Qb1Z;S before me,
- 7EZ M_Ar\-Q__ , \,o zs-\-t,�VA
personally appeared :,% personally
known to me (or proved to me oTrIthe basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me ' that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the.instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Si
gnature Seal: LYNETrE GARTO�N.
COMM1 1351379
b f@1
NOTARY PUBLIC -CALIFORNIA
COUNTY OF BUTTE
A.P. 4 OC� COMM Expires April 17, 2006
Order No. 00202892-004
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, DESCRIBED AS FOLLOWS:
PARCEL 4 AS SHOWN ON THAT CERTAIN PARCEL MAP FILED IN THE OFFICE OF THE
RECORDER OF THE COUNTY- OF BUTTE, STATE OF CALIFORNIA, ON APRIL 28,1981 IN
BOOK 82 OF MAPS, AT PAGES 60 AND 61.
TOGETHER WITH AND RESERVING THEREFROM AN EASEMENT FOR INGRESS AND
EGRESS AND PUBLIC UTILITIES AS SHOWN ON THAT CERTAIN PARCEL MAP FILED IN
THE OFTICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA,
ON APRIL 28,1981 IN BOOK 82 OF MAPS, AT PAGES 60 AND 61.
SAID EASEMENT TO BE FOR THE BENEFIT OF AND APPURTENANT TO THE REMAINING
LAND OF THE GRANTOR HEREIN AND SHALL INURE TO THE BENEFIT OF AND MAY BE
USED BY ALL PERSONS WHO MAY HEREAFTER BECOME THE OWNERS OF ANY PARTS
OR PORTIONS OF SAID APPURTENANT LAND.
AP NO. 024-080-109
TLAN REVIEW RESPONSE FORM
In order to expedite the rmicw of your plea" COWWO the ,
plans. Information ad ratum
tlil form is not completai as to AU coneWas Itj form
im we WW ait be able to "t you wcubmlW tv goU:�h Yft
'-W"" to aely 'Wm NuesW in Our Plan cortudon low. -By odar h not conddcred a vaud Thic,
'"WL" to wh ltem &W the l0cadOn wWO the Intomadon can be found on the pWWcalcs. ftw�.-
ATYAClf THN FOM'70 A COPY op y0M pL4X R&EW LZTTER An
VYMF.R3 NAME wwr" PAMM
i - A_ft
DATE:
A -ES -30 ---
RS ;NUMBER PERM T NUWMSE�R`.
Le.
.-F
ot k 0= A - --rr. k . .
rLAN REVIEW USPONSE FORM
[it order to expedite the review of y
this form is not MW our PU04 plan awleta ft to Information and fatum WS fon4
let'"* as to all 00ffwdOd WMA we WiU 06t be able to &=vt you m-ohmIQ &, MVIM You
respon-50 to evay hem "U"ted 'a our PIAA 0000WOU, IcUW- "By odor b not coaddered a vad U�
MVOM to ach ltem &W the locadOn Whm tbO Infonafillon ca be found on dw pbuidcalcs. Pift
I &TUT—AC"T"ll MMJTVOAACS02PYYOFyOM_pIANRMMWLMMAto
OWNF-93 NAME VMr" REMED
�A_Tft?�
DATE:
J00 -Y C-OVa-Los (0
ASSESSORS PARCEL NUMB
024 - -0-ro I
F -%Or% FLAR 6MtQF, LhTTF-R DATED:
Y I.cE, , 2- c) o 3 11
AN CHECK rMW#—
)MMENTS:
IL
G
RESPO-N—SE BY.
r,% c, r d
ct 4.(;
"104 us s.4,j"a ske
OL r.,
IMENTS:
C-rAlc-C�IL�+(O"s
M CHECK
S +- r uL.-4 ur c,
WENTS
SPONSE GY. --
'r IL V I V 0-d
L 0 C A 7 10 N-0 WNP—L AWN 8—M A—L C-3 --
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PcA..5 e- .4k 0 f 0-5 r Cc, I c- S
MINA" ENGINEEMNG CO.
10705 Gledhill Road; Yuba City, Califomia (530) 755-4442
June 17, 20032
Butte County Building Department
7 County Center Drive
Oroville, CA 95965
Subject: Building Permit for APN 24-080-109
1 Building Permit 09-0701 (Cavazos) -
In accordance with your letter dated May 15, 2003, we have reviewed the truss calculations
performed by MiTek Industries Inco ' rporated for Trojan Truss Company and found them in
confon.nance with our structural calculations revised and dated June 17, 2003.
If you have any questions or require additional information, please call.
Sincerely,
Sean Minard, P.E.
Civil Engineer
Cc: Joey Cavazos
0
0
RESIDENTIAL PLAN
0 REVIEW GUEDE
SINGLE FA?vffL Y, D UPLEXAND
MSCELLUEO US OhE Y
0�,vner. Building Permit Number: 6 6�2 &1//
Plans Examiner-:,L1/z9cj 54.rnfsorl A. P. Number: 6 acz - Imp ---Aj 2
G E LNE R.A, L:
LZoning requirements— (numberof permitted living units).
Plans signed by the designer.
Proper description of work on the application.
...,istinviolations on the property.
ecorded notic: of violation.
Building permit valuation.
PLOT PLA.N: VN
Complete parc.-I size and dimensions.
SetbaCkS. side yard, easements. etc.
Other buildings or structures.
Gradin& fills andior drainage.
Flood hazard.
Special conditions on Parcel Map:
Noise 0 SRA 0 Fire Sprinklers C1 Water Tender C3 Traffic and Drainage few 0
Federal Aid RouEt and/or Federal Aid Secondary Route setback requirement.
Building or udli6es across lot lines (Lot merger approval by Butte County Land Development)
FLOOR PLA -N: as and of sufficient clarity (UBC section 106.3.3).
Plans and specifications drawn to scale with dimeasio section 1203).
10% of natural light and 5% of ventilation (Uniform Building Code mWmun net
Escape or rescue windows shall have a minimurn act clear opetiable area of 5.7 square feet. The
clear openable height dimension shall be 24*. The minimum net clear openable width dimension "toiW.
When %,.indo%% s are provided as a means of escape or rescue, they shall have a finished sW height na more than
44" above the f1cor (Uniform Building Code section 310-4).
Skylights (Uniform Building Code section 2409 & 2603-7).
Glazin- in Hazardous locations (Uniform Building Code section 2406).
Habitable space shall have a ceiling height of not less than 7 feet 6 inches except as otherwise permitted in dds
section. Kitchens. halls, bathrooms and toilet compartments may have a ceiling height of not len dm 7 fed
measured to the lowest proiection from the ceiling (Uniform Building Code section 3 10-6. 11
All habitable rooms except kitchens shall have an area of not less than 70 square feet and not less than 7 fed in
anv dimension (Uniform Building Code section 310.6.2 & 310.6.3).
Al dC I in baths. ganige. kitchen. wet bar. and exterior r=ptacles (NEC 2 10). to be
Water heaters %% hich depend on the combustion of fuel shall not be installed in a room used.or designed
used for sleeping purposes, bathroom. clothes Closets or in a closet or other confined space opening ho a bath
or bedroom (Uniform Plumbing Code section 509.0).
Fuel burning equipment dull not be installed in a closet, bathroom or a room readily usable as a bedmom or in
a roorn. compartment or alcove opening directly into any of these (Uniform Mechanical Code SOWN 3044
Garage f
., Lre%vall separation -required on garage side including supporting walls and posts (UnW=Ibl""
Code section 302.4 exception #3).
U, nder no circurnstances shall a private garage have any opening into a room used for sleeping purposes
(Uniforn Building Code section 312.4).
Wood stove loc:i6on - Alcove — UNIC section 205 confined space & 223 unconfined space & 304-2).
tSmok.- detectors (Uniform Building Code section 310.9.1).
Page 1 of 2
.+r Water close, clearances (Uniform Plumbing Code 409.5).
"j4!� Sbov6VT compartment rniriimum 1024 sq. irL &- 30- circle (Uniform Plumbing Cbde 412.7).
that shall be of sufficient size to Support
Bearing m2l)s shall be supported on ffasoru), or concrete foundatiOns
aU joads (uniform Building Code secUon 1806.3).
STRUCTURAL DETAILS:
1. Braced V211 panels "I Start at not more thari 8 feet from each end of a braced A2H line. Braced %%-a paneh
must be in line or offset ftom each other by not more dw 4 feet (UBC Section 2320.11.3). Spacing sba1l noL
-xceod 34 feet on center in both the longitudinal and ummerse directions (UBC section 2320.4. 1.) Braced,% -a
lines must be continuous throughout the mcmm.
2. A Califorrija licensed architect or registered engineer must prepare a lateral analysis for the areas of the building
that do not compiv uith the Uniform Building Code. TWs must include the designees "weC SUMP, SiPawm,
es ed elements and cover sheets
registration number and expiradon date on all sheets of plans d . epicting the d ip
of calculations.
**-1V1 Oerestory requiring balloon framing and/or engineering. Building Code Table 1
Af' Foundation plans complete enough to construct building (Uriform
Floor construction details complete enough to coristruct building.
Memons and %%-aU construction details complete enough to construct building.
IRoof construction details complete enough to construct building.
Fireplace consauction details and calculations if ne=ssary.
Garage door header size(s).
Porcb header size(s).
71),pical header size(s).
Stud beights. ial foundation design required.
1-1igh expansive soil - Sp=
RqMining v4-alls requiring design.
Q)T�=waboard nailing inspection required. th tal
if the area below the lowest floor is full)- enclosed. Ow a minimum of two openings are required ui 2tO
act area of at least one square inch for every square foot of area enclosed uith the bottom of the openings no
more than one foot above grade. Alterriatively. certification may be provided by a mgistered professional
engineer or architect that the design mill allow equalization of hydrostatic flood forces on exterior walls.
Building must be designed and anchored to prevent floatation, collapse or lateral movement Construcdon
I design requirements must be shoum on the building plans.
--XfElectric, heating, ventilation, plumbing and air conditioning equipment and other smioe facilities shall be
designed and/or located so as to preventwater from entering or accumulating -Aith the components during
conditions of flooding.
MISCELLANTOUS rTEMS:
Staim"ay details — landings, rise and run. head cleawce, handrails (Uniform Building Code section 1003).
Guardrails (Uniform Building Code Section 509).
B Brick or stone veneer (Uniform Building Code section 1403).
Exterior plaster — weep xreeds (Uniform Bug ding Code section 2506.5).
S
G
Fu
r
tRoof pitcb for roof covering (Uniform Building Code Table 15 -B -I& 2, 15 -D -I & 2).
Foam hsulation — protection.
36" halls and staim-ays (Uniform Building Code section 100�3.3.2).
Tvkv exits on three — story dwellings (Uniform Building Code section 1004.2.3.2).
'Underfloor access and ventilation (Uniform Building Code section 2306.3 & 2306.7).
n
c
Attic access and ventilation (LWform Building Code sr tion 1505)
tl
Sound requirements.
so erg), design compliance and supponing documentation.
CaDF responsible area requirements.
LTJOL
UELDING PERMrT REQUIREMENTS:
1. 0 SRA.
2. 0 Flood elevadon certificaie.
3. 0 Fire SpdW- ers requirrA
4. 0 Special Inspection requiremems.
5- 0 Use Permit condi�ons.
6- 0 Sub -Standard Housing lener.
Pace -- -)f—'
SITE PLAN REVIEW APPLICATION
Date: 03 D12) AP#
Permit Number (if applicable) 0 3 (37 D I
APPLICANT INFORMATION Parcel Size:
Owners Name: C_ V A
' I G'2_ 7-S ST �) rz rT F
Owners Address: 95 9 9
Telephone No.: S9 8 cl�
Situs Address: )-f\)
Proposed Use:
Residential
New Single Family Residential
El Single Family Addition E] Single Family Remodel
F-1 Mobile Home
Fj Residential Accessory
F-1 Permanent Second Dwelling
F-1 Temporary Mobile Home (Aunt Minnie)
Fj Temporary Travel Trailer
F_� Multi -family
Non-residential
F-1 New Commercial
F-1 Commercial Addition
F-1 New Industrial
El Industrial Addition
Other
IS Septic
F-1 Agricultural Exempt Building
F-1 Other:
-Brief Explanation (if necessary):
F� Commercial Remodel
F1 Industrial Remodel
11 Well
DO NOT WRITE BELOW THIS LINE
DEVEL OPMENT SER P7CES INFORAL4 TION (For Staff Use)
N Approved 0 Conditionally Approved El Resolve Problems Prior to Approval
Site Plan Stamped Approved
By Date
v
Page I of 5
ALL ITEMS CHECKED APPLY TO THE PROPERTY
Parcel Is In:
F1 Snow Load Area: - -
El Land Conservation' Act Minimum Acreage: E] Verify residence can be built per contract
M Nitrate Action Plan (See Environmental Health for standards)
F� Watershed Protection Overlay Zone (See attached standards and requirements)
F-1 Expansive Soils (Test for expansive soils and if verified proper foundation design required)
r-1 SRA - (CDF to determine specific requirements)
F-] I 00 -Year Flood Plain: (See a ed)
Flood Zone:
Flood Panel No.: IndexDate: -6-0-9b
Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board)
Feather River Reclamation District (Approval must be obtained from the California Reclamation Board)
North Chico Specific Plan (See Development Fees Section and attached standards and requirements)
Chapman/Mulberry (See attached standards and requirements)
Cohasset Area (See attached standards and requirements)
Ej Grading Zone (See attached handout)
Use Requires:
F-1 Use Permit Minor Use Permit El Administrative Permit
FI Minor Variance Variance
------------------------------------------------------------------------------------------------------------------
F-1 Detached Building Use Form F� Encroachment Permit
F� Agricultural Worker Affidavit [:] Agricultural Acknowledgement Statement
Zoning: A —
Applicable Building Setbacks:
F� Setbacks drawn on site Plan. 0 CDF approval needed for encroachments into SRA setbacks.
Page 2 of 5
Zoning Code
Streets & Highways
Fire Prevention
Subdivision Map
Front
Side
Side Street
Rear
Height
Waterway
N/A
N/A
N/A
F� Setbacks drawn on site Plan. 0 CDF approval needed for encroachments into SRA setbacks.
Page 2 of 5
Applicable Development Fees:
Standard Fees Amount Formula
7 Fire
F� School*
F-1 Parks/Recreation'
El Roads
Sheriff
Drainage
7 NCSP/CSA 87
Fj Chico Urban Area - Road
7 Thermalito Drainage Area
Fj Thermalito Urban Area
7 Other
--------------------------------------
Subdivision Map Special Fees
F� Water Tender
R Road Improvement
R North Oroville Area
E] Other (per map)
Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of
the building permit.
Parcel Created By
Deeds:
Date of Creation: Legal Access Provided: No
Deed of Reference: Legal Access Required E] No
Parcel Frontage on Publicly Maintained Road: El No R Yes, Road Name:
Complies with County Standards for Deed Creation:E] No E] Yes
Comments:
r_1 Parcel Deemed to be legal
0 Yes
F1 Yes
E] Verify Legal Parcel EJ Verify Legal Access E]Provide Deed of Creation
r-1 Obtain a Certificate of Compliance
r-1 Obtain a Merger El Obtain a Lot Line Adjustment
E] Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23).
Construct road to: E] Meet Parcel size required by zone
Meet current Environmental Health Department requirements
�Page 3 of 5
S Subdivision Map/Parcel Map:
Map Date of Recording: L) -r�-S- o I
Lot: 9
F] Use Permit/Minor Use Permit
Permit Number:
Book- a
Date of Approval:
F -"--
Page:
Parcel Map/Subdivision Map[Use Permit Conditions
E] Comply with the following Conditions of Approval:
F1 Meet the Fire Safe Regulations of Butte County and P.R.C. 4290
Fj Automatic fire suppression sprinkler systems shall be installed in accordance with the
National Fire Protection Association Standard for installation of sprinkler systems in one
and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized
community water system, with hydrants that meet the Fire Department specifications, serves
the parcel.
El Wood stoves and fireplace inserts shall be EPA approved. and designed to meet the emission
requirements of the California Clean Air Act of 1988, as amended.
Provide an erosion control plan for building and land disturbance. The Erosion Control Plan
must be prepared by a registered civil engineer or other qualified professional and be
submitted to and approved by the Department of Public Works.
F] In lieu of a pressurized water system or water storage tank, payment into the appropriate
Battalion Water Tender Fund may be required.
E] Measures shall be taken to control fugitive dust emissions from all driveway and other civil
construction associated with residential development. Approved dust control measures are
found in the fugitive dust control plan for the site approved by the Butte County Air Quality
Management District, a copy of which can be obtained from the Butte County Department
of Development Services, Building Division."
Engineered foundations are required.
Class A roofs are required.
E] Property owners responsible for road maintenance, and stop sign maintenance.
F1
101
Page 4 of 5
II
NIF
�P.O. B.QX'80�-, SAN FRANCISCO,CA 941,ol-66 -
COMPEN-tAV614 07'
114 S U R A K�
J
FUND CERTIFICATE OF 'NORKERS' 'COMPENSATION INSURANCE
POLICY NUMBER: 1604234 -
ISSUE DATE: 11-11-02 02
CERTIFICATE EXPIRES., 1.11-r1l-03
J0Y-,CAVAS 0
JOB;' COUNTERT6PS
4�5-dRA T
YUBA CITY CA '9501
This is to certify that we have issued a valid workers' Compensation insurance policy in a form approved by: the
California Insurance Commissioner to the employer named below for the, policy period indicated.
This policy is not subject to cancell . ation by the Fund except upon 30 days' advance written notice to the ern . Oloyer.
We will also give you..:'O
diys?" advance notice should this policy be cancelled prior to its normal expiration
-le is no':
This certificate .6fJnsdran t an insur�nce olicy and does not am' xt Iter the coverage afforded
p en. e on.. or a
by the Policies.lisied he'eein."' 'Notwithstanding- anyrequirempot, term, or conditiory'
of any contract or other, dbcument.—
with respi3cf, to v;vhich this C'ertif icate of 'insurance may ..be" Issued or may P'ertqin, 1he insurance af f orded, by ihe
policies described herein is subject to al�l the termi, exci6sio'
Vs and conditions of such policies.
PRESIDENT
EMPLoyEri,'9��, LIABIL-XTY LIMIT INCLUDING DEFENSE COSTS.: $1 '0
DO" 090. 00 PER.OWMIRENCE.
ENDORSEMENT��. 42065, E-NTIT'
LED CERTIFICATE HOLDERS' NOTICE EFFECt,1VE —11 f/11 /02.
FORMS A PART OF THIS PdLi'cy. . It ATTAC"AP # AND
National Pollutant Discharge Elimination System (NPDES) Phase 11 &
SWPPP Non -Certification for Project # for Butte
County Storm Water Permit Compliance
By signing below, I, the project architect/engineer of record, indicate that I am aware that a
construction project that disturbs more than I acre of land requires. a Construction Storm Water
Permit from the State Water Resources Control Board. L additionally, understand that it is the
project owner's/owner's agent's responsibility to submit a Notice of Intent (N.O.I.), a Storm
Water Pollution Prevention Plan (SVVTPP) and a fee of $700.00 to the State Water Resources
Control Board to obtain such a permit. 1, further, certify that this project will not disturb more
than I acre of land. I have also reviewed the Best Management Practices Handhooks, California
Storm Water Quality Task Force, Sacramento, CA. I certify that appropriate BNTs will be
implemented to effectively minimize the negative impacts of this project's construction activities
on storm water quality. I acknowledge that it is my obligation to make the project owner and
contractor aware that the selected BNTs must be installed, monitored, and maintained to ensure
their effectiveness. If, at any time, site conditions and/or observations by a County official
warrant reevaluation and revisions of the choien BNIPs, the appropriate changes will be made
without unnecessary delay. I am aware that failure to properly implement and maintain the
BNTs necessary to prevent the discharge of pollutants from this project during construction
could result in significant penalties and/or delays.
Signed:
Title:
Date:
By signing below, 1, the project owner/owner's agent, certify that I am aware that a construction
project that disturbs more than I acre of land requires a Construction Storm Water Permit from
the State Water Resources Control Board and that it is my responsibility to submit a Notice of
Intent (N.O.I.), a Storm Water Pollution Prevention Plan (SWPPP) and a check for $700.00
made payable to the State Water Resources Control Board to obtain such a permit, if my project
disturbs more than I acre of -land. 1, further, certify that this project will not disturb more than 1
acre of land. This document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified individuals properly
gathered and evaluated the information submitted. Based on my inquiry of the person or persons
directly responsible for gathering the information, I certify, to the best of my knowledge and
belief, that the informatiop)sub;nitted is true, accurate, and complete.
Signed:
Title:
Date:
C) L -U P7 t. P—
NPDES & SWPPP Non -Compliance Certification Draft
Butte County Stormwater Plan
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