HomeMy WebLinkAbout024-090-0360
024-090-036 tAVIS, Mrs. Playbelle Prue 113-68B
DAVIS; IRMA INALE 995-68B*f 104-68P',- 39-68B
369 O'BRIEN, GRIDLEY
14-69P 94-68E* -
(3) METERS -DUPLEX & SF 9-69E
24-097
- n/s O'Brien app. 8001 east of G'ils Ju ley
r-024-090-036 03-3037 (remodel) (*addition & conversion)
DAVIS, IRMA (**sheetrock & new windows on unit at'east e�.
365,369 O'BRIEN AVE, GRIDLEY
Cont: OWNER of duple
INSTALL RELOCATE METER
024-090-036
03-3708
OBRIEN, IRMA
9 3]
,361/1690BRIENGR-IDLEY
C K
COnt: UNKNOWW
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IN -STALL 3SERV METERS
M
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D
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RID Ey
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3-3.708
'-024-090-036 04-3-5817
IRMA DAVIS TRUST,
369 OBRIEN AVE, GRIDLEY INALE
Cont: ROMERO CONSTRUC ION
TO COMP 01-3037. 03-3708
NOTES RESIDENTIAL
-6
PERMIT NO, f' 0 4 090-03 04-3�87V
IRMA DAVIS TRUST, -
369 OBRIEN AVE, GRIDLEY
Cont: ROMERO CONSTRUCTION
0 COMP 03-3037,03-3708
SPECIAL CONDITIONS
C ECK
I H BY ED
SRA
— FLOOD CERTIFICATE REQ.
— FIRE SPRINKLERS REQ.
—SPECIAL INSPECTION ITEMS
—VERIFY
— USE PERMIT CONDITIONS
— SUB -STANDARD HOUSING LETTER
JOB FINALED (Date)
Signature
N
SPECIAL CONDITIONS
C ECK
I H BY ED
SRA
— FLOOD CERTIFICATE REQ.
— FIRE SPRINKLERS REQ.
—SPECIAL INSPECTION ITEMS
—VERIFY
— USE PERMIT CONDITIONS
— SUB -STANDARD HOUSING LETTER
JOB FINALED (Date)
Signature
4
4 = OK
0 = Not OK
- = Not Applicable
. = Not Ready MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except ft
1 . Zoning Req u irements-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;-/ P' L 'ft.
/ P Nat. or/ P' L "ft./ PLPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #Is
1.
Zoning Req uirements-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- Reg ulator-Con nector
7.
Water and Sewer Connected -C/0 to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -installation Cert.
10. Exits; Insp.-Sketch
11.
Cert. of Occupancy
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except ft
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
Decks, Girders and/or Joists- Decking- Bracing -Stai rs-Rails
1 .
Zoning Requirements -Setbacks -Easements
5.
2.
Footings; Size -Spacing -Marriage Line
6.
Carports; Windows -Doors
3.
Blocking
Electric
4.
Gas; MH Test- Demand -Valve
9.
5.
Electricity; MH Test
10.
Roof; Shthg-Roofing
6.
Water; MH Test
Ext.; Steps- Doors- Landings
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
Card B-1 Date Card B-1
9.
Exits
Card B-1 Date Cird B-1
Date
.10.
License Decals
1 .
Setbacks- Easements
11.
Verify #'s with Office
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
Date
Elec.; Receptacles and Lighting, Distance-GFI
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except ft
1 .
Zoning Requirements -Setbacks -Easements
2.
Footings; Soi Is -Size- Depth-Spaci ng -Con nectors-Steel
3.
Decks, Girders and/or Joists- Decking- Bracing -Stai rs-Rails
4.
Wood Awn.; Posts-Seams-Rftrs-Connectors
Shthg-Frg -Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
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 Cird B-1
Date
POOLS (Plans) OK except ft
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
Dat -3
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
4 = OK
0 = Not OK
- = NotApplicable
* = Not Ready
RESIDENTIAL (Single & Duplex)
Date UNDERFLOOR (Plans) OK except #s
1 .
Zon i ng -Setbacks- Easements- Flood -Slope
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5.
Stemwa'Is, Main; Steel- Blockouts-Wrapped
6.
Sternwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7.
Slab, Steel -Wrapped
8.
Piers -Fireplace Ftg.-Steel
9.
D.W.V; Fall-Fifting-Test-2 Way C/0 -Sewer Test
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11.
Water Pipe; Test -Anchors- Reg ulator-Service Test
12.
Electric Underground
13.
Plenums & Ducts; C learance- Material -Support- Ins.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15.
Access & Ventilation
16.
Insulation
Date
FRAMING (Continued)
Card B-1 Date Card B-1
Date
Hangers -Post Caps -Anchors -Connectors
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17.
Water Htr.; Vent -Access -Combustion Air Baffle
18.
Water Pipe; Test & Anchor -Nail Protection
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
20. Shower Pai; Test, First Floor -Tub Access
Garage Fire Protection Framing -RC Channel
21.
Test Tub & Shower, Second Floor -Tub Access
Property Line Firewall & Openings
22.
Gas Pipe; Sixe & Anchors
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
23.
Fire Sprinkler; Test
Stairs; Width -Headroom -Rise- Ru n- Landing- Fire Protection
56.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
59.
24.
Fixture & Transformer Clearance -Ins. Protection
60.
25.
Elec. Receptacles Spacing -Lights & Switches at Doors
61.
26.
Size Boxes & No. of Conductors Stapled
62.
27.
Romex Installed Close to Edge of Studs & C.J.
63.
28.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29.
2 Appliance Circuits in Kitchen & Conductor Size GFI
30.
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or A
FINAL (Plans) OK except #s
31.
Range Circlei /ga Cu or Al -Oven Circ. / /ga Cu or All
Insulated Neutral 0 Yes 0 No
Ext. Steps -Door & Sidelight Protection -Landings
32.
Service -Riser Conductors & Ground Main Disconnect
33.
Equip. Clearances Panels-Motors-Mech. Equip.
34.
Clothes Closet Light -Shower Light -Spa Light
35.
Smoke Detector
69.
Elec. Trim & Subpanel, Breaker Sizes & Labels
Date
70.
Card B-1 Date Card B-1
Date
71.
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36.
A.C. Ducts Insulation & Support
37.
Vent Fan, Exhaust above insulation
38.
Condensate Drain & Overflow, Size & Grade
39.
Furnace -Vent Access -Comb. Ait- Return Air Vent 115 Outlet
40.
Attic Access & Platform if Furnace in Attic
Date
78.
Card B-1 Date Card B-1
Date
79.
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
Insulation -Foam- Looked in Aftic
41.
Sills Proper Materials & Anchors
Guard Rails & Deck Construction- Post Caps
42.
Walls Studs -Nailing Spacing & Braces- Plates -Sound
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
43.
Bearing Walls over Girders & Floor Nailing
Clearance Looked under Floor Q Yes
44.
Draft Stop in Wa'Is (rat proof)
45.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46.
Headers & Beams -Size & Bearing
0
Date
FRAMING (Continued)
47.
Hangers -Post Caps -Anchors -Connectors
48.
Cling. Joist-Rftr. Ties- Pu rlin- Roff Brac.-Truss-Shting.-Rtng.
49.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50.
Aftic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51.
Bdrrn. Windows or Exiting Doors -Sill Ht. & Dimensions
52.
Garage Fire Protection Framing -RC Channel
53.
Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55.
Stairs; Width -Headroom -Rise- Ru n- Landing- Fire Protection
56.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57.
Siding -Nailing Veneer
58.
Stucco Mesh -Drip Screed -Fd. Vents-UnderfIr. Access
59.
Glazing Area -Glass Protection-Skyl ig hts- Plastic
60.
Shear Walls; Nailing -Bolts
61.
Brace Interior/Exterior Wall Panels
62.
Insulation -Walls -Ceilings
63.
Infiltration-Walls-Winclows
Date
Card B-1 Date Card B-1
Date
Card E-1 Date Card B-1
Date
FINAL (Plans) OK except #s
64.
Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66.
Furnac�e Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor- DLcts- 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 -PRIM.
in Garage; Above Floor-Mech. Protection
78.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
Elec. Receptacles in Garage (F.Fl.)-Romex Protection
80.
Insulation -Foam- Looked in Aftic
81.
Guard Rails & Deck Construction- Post Caps
82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor Q Yes
83. Following Instld./Drive 0 Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 No
84.
Stucco Brown -Finish
85.
A.C. Unit Disconnect, Electrical- Plumbing
86.
Vents Abcve Roof, Plbg-Applian.-e-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 Inspections
92.
Gas Test -Meters Tagged, Gas -Electric
93.
Water & Sewer Connected -C/O to Gracle-HD Approval
94.
Energy Compliance Certificate -Other Certificates
95.
Address Posted
96.
Fire Sprinlder
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:
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: �(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.netkidds
PERMIT NO.
BP043587
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: 12/20/2004 APN: 024-090-036-000
the Business and Professions Code, and my license is in full force and
effect. 19 ?(,2.5-33—
License Class: License Number:
Site Address: 369 OBRIEN AVE GRI
Date: Jn -W -.0 �ontractor 4,1-"
Map Index:
Description: PERMIT TO COM 03-3037 & 03-3708 (1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
MAIN& 8 SERVICE
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
to its issuance, also requires the applicant for such permit to file a
Owner: DAVIS IRMA B TRUST
signed statement that he or she is licensed pursuant to the provisions of
C/O DAVIS IRMA B TRUSTEE
the Contractor's State License Law (Chapter 9 commencing with Section
369 OBRIEN AVE
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
GRIDLEY, CA 95948-9714
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: ROMERO CONSTRUCTION, DION
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
110 CALIFORNIA STREET
proving that he or she did not build or improve for the purpose of
GRIDLEY, CA 95948
sale.).
(530) 263-2438
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,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: ROMERO CONSTRUCTION, DION
Q 'I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
110 CALIFORNIA STREET
GRIDLEY, CA 95948
WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(530) 263-2438
13 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
License 762535
L6bor Code, for the performance of the work for which this permit
'is issued.
13 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
insurance carder and policy number are:
Engineer:
Carrier:
Policy #:
9t 1 certify that in the performance of the work for which this permit is
Total Square Ft: 0 S. F.
issued. I shall not employ any person in any manner so as to
Valuation: $0.00
become subject to the workers' compensation laws of California.
and agree that if I should become subject to the workers'
Census Code:
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNING: Failure to secure workers' compensation 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
mp s r 'io'
code, interest, and attorney's fees.
de inte es
CONSTRUCTION LENDING AGENCY
This permit is hereby issuied der the applicable provisions of the Btitte County CodA 7701
f Iss
Resolutions to do -dic-Vned above for which fees have been paid.
her:b affirm that there is a construction lending agency for the
I r. ff
y - in
erforr9nance of the work for which this permit Is issued (Sec 3097 Civ.)
p perform c
By_ Date: 6
Name:
U
Address:
PERMIT EXPIRES ON:
(Date)
0 1 h reby 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.
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.
J 'Signature:
Print Name:
Date: -A-D
0 Owner 4f Contractor Q Agent for Owner U Agent for Contractor
.J
COUNTY OF BUTTE - DEPARTMENT OF DeV - EAMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 * Telephone (530) 538-7541
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
024-090-036
ONING
BUILDINGPERMIT
OWNER
DAVIS, IRMA
TELEPHONE
846-4606
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
369 O'BRIEN, GRIDLEY 95948
CONTRACTOR'S NAME
OWNM
TELEPHONE
CONTRACTORI MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
20.00
—Permit Fee
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
BUILDING ADDRESS
365,1, 369 & O'BRIEN AVE, GIRTM EY
Energy Plan Checking Fee
$
.371
$
PERMIT FEE
$
LOT NO.
SUBDrVISION'S NAME
I
IPARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
Each Trap
1 7.00
—
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Ulilifies 0 Installation 0 Other 0
Describe Work: INSTALL & REWCATE I 'MAIN
SEE BP#,03-2175 FPR RE;PCATOPM PF 3 =S
Gas piping system I - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I G 1
920.00
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20-00
600V OR LE::
Main Service .A OR .
23.00 23.010
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law I for the following reason:
Z�l I as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A
46.00
NEW CONST DIN
,"NO OCCUP.
OR ADONS. C S.
SE
3.50FT.
NEW CONST. OUTLET
_NON-RESID. =LT.' CIRCUITS
@7.50
PDWE.RAPUPARATUS
S T. CIR.
Ex. Occup. OUTLET OR FIXTUR ES
20 @ 1.00
SAL .50
DXED AP M OR.
Ex. Occup. rLETS (PL.16.) E
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00 9,�_on
PERMIT FEE
$ 66.00
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
[I I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, forthe performance of work forwhich this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEt
$
Policy Number
(The above sections need not be completed 0 the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
w ke S' compensation provisions of section 3700 of the Labor Code, I shall
cc m
f compl ith those provisions.
X Date 0
tv,21 )
SignatL 0 Owner 0 Contractor 0 Agent
An OSHA permit is required for excavatio&over 60" deep and demolition or construction
of structures S irv4qeWW.'
JP7)09y1i9 - lrlow%l�� JT/—
ReceiptNo.-1�1
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTALFEE$
00
HAZ.
I D. FEES IMP I FLOOD CDF PARCEL PD HD
L211
This permit is hereby issued under the
Bu:e v unty Co e and/or
f Ike t
indicas" f w ic fees have
T
ByP ��c
PERMIT EXPIRES ON
I
applicable provisions
Resolutions to do work
been aid.
ate /. 0/9 L�g
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINIC-INSPECTOR GOLDEN ROD -APPLICANT
(R6v. 12/96)
CO
J�
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 * Telephone (530) 538-7541
APPLICATION AND PERMIT -
-036:9 1 ZONING I BUILDINGPERMIT
1// 0 IZ-24 /) so. Fr. I OCC. I BUILDING VALUATION
CONSTRUCTION LEND ER
4�CTRICAL
PERMIT
Filing Fee
LENDER'S MAJUNG ADDRESS
Fireplace
23.00
Main Service
200A To 1000A
Total Valuation $
NEW CONST.
DWELLING OCCUP.
ARCHITECT OR ENGINEER LICENSE NO.
Filing Fee
$
20.00
ARCHITECT OR ENGINEM'S MAILING ADDRESS
Permit Fee
$
I ISSUE
Plan Checking Fee
$
BUILDING ADDRESS
71 0"OW)_
Energy Plan Checking Fee
$
/11) .
$
-
('4W,
1
PERMIT FEE
$
LOT NO. SUBDIVISION'S PARCEL MAP
1 z
PLUMBING PERMIT
Filing Fee 20.00
V
Each Trap
1
7.00
USEOFSTRUCTURE
Solar or heat pump water heater
23.00
SF 0 Duplex 13 Mobilehome 13 Other -
Water piping
15.00
SPECIFY
Each gas water heater or vent
15.00
TYPE OF W0FkK
EGas piping system I - 5 outlets
15.00
New 0 Addition 0 Instal lat�i=WOth
Building sewer
15.001
79�rq�
Mobile Home IS .1 G I 1
1
@20.00.1
Describe Work:
� i �/,'& N APFAWffff�AA111105AM
3 19m_�
ERMIT FEE PAID
SRA
SHERIFF
OTHER
AMOUNT RECEIVED $
DATE RECEIVED.
RECEIPT #
PERMIT FEE $
4�CTRICAL
PERMIT
Filing Fee
_,Service
Vki In (
600.V O.R UE.SS
. S
23.00
Main Service
200A To 1000A
46.00
NEW CONST.
DWELLING OCCUP.
so
3.50
OR ADDNS.
& ACC. S.
Fr.
Nt:w uuNui.
NON-RESID.
MULTI -OUTLET
RRANnH MAMM'Q
@?7.50
EX. OCCUp. OUTLET OR FDCTUAES
I EZ ";0
OMD4 NS OR,
Ex. Occup. PP L. 16.) E
5.00
Temporary Service
23.00
Mobile Home Facilifies
20.00
Misc. Wiring
23.00
PERMIT FEE 1 $ 1 (Z (O(Z --- 0
MECHANICAL PERMIT I Filing Fee 1 20.00 1
Hood . 1 1 6.50
Ventilation I I
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid,
By Date
PERMIT EXPIRES ON
PERMIT FEt
$
Mobile Home Installation Fee
$
Energy Inspection Fee
$
CCC
CONST. _P� TOTAL FEE $
KA7-
1D.FEES1 IMP .
I FLOOD
I CDF
I PARCEL
I PD
HD
I ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid,
By Date
PERMIT EXPIRES ON
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 * Telephone (530) 538-7541
(Rev. 12/96) APPLICATION ANDPERMIT -0-3-
ASSESSOR PARCEL NUMBER
024-090-036 DAVIS, IRMA
ZONING
I
I BUILDINGPERMIT
OWN'n69 O'BRIEN AVE. GRIDLEY 846-46dg
ELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOWS MAILING ADDRESS
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
UCENSE NO,
—Filing Fee
$ 20.00
ARCHITECT OR ENGINEWS MAILING ADDRESS
Permit Fee
$
Plan Checking Fee
$
81"LDIM999 o,BRiEN GRIDLEY
Energy Plan Checking Fee
$
PERMIT FEE
$
LOT NO.
SUBDIVISIOWS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
—Each Trap
7.00
- Solar or heat pump water heater
23.00
—Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Ulilities 0 Installation 0 Other 0
Describe Work: INSTALL ADDITIONAL SERVICE METERS (3)
Gas piping system I - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I GI W[
(920.00
PERMIT FEE
$
ELECTRICAL PERMIT
I Filing Feel 20.00
R 's
Main Service v -R
( =-A Lis's
31 23.0009.00
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 is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
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.
I , 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
1 46.001
NEW CONST. DWELLING OCCUP.
OR ADDNS. & ACC. BILDS.
so.
I 3.50Fr.
NLW UUM 1.
NON-RESID. =11 0
@7.50
OWER AP=TU
&PSIN.LE . CIR.
Ex. Occup. OUTLET OR FIXTURES
SAL @ .50
..11XED A OR
Ex. Occup. PPM.) EA.
5.001
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
930023.00
.00
PERMIT FEE
112.00
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
19 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
(a
X 1 Date
Signature of Applicant - IS Owner 0 Contractor El Agent
of structurn� sto . iqheiAt. _�2 . __
An OSHA permit is required for excavati over SO" deep and demolition or construction
4 1:!2
Receipt No.,7� 211( ,/u-77 / P)
I
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
—
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TW4YPE
TOTALFEE$ 112.00
—
I
HAZ.
I In AAQ I El=" Car WD]
I I I i
ISSUE
This permit is hereby issued under the
of the Butte Co nty Code and/or
indi abo r hich es have
By CP §iUmd,
PERMIT EXPIRES ON
applicable provisions
Resolutions to do work
been paid.
Date /;Lkn
i
Afb-,24
(D.W ,
WHITE-D.D.S.-B.D. CANIARY-ASSESSOR PINK -INSPECTOR GOLDEN R6D-_APPLICANT
.oe
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 9 Telephone (530) 538-754 h3 -:3;7M'
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
Day
N
SO. Fr. 010C. BUILDING VALUATION
OWN IUI ADDRESS
t 6 &,�,
-00977Za V
TELEPHONE
CONTRACTOPM MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER LICENSE No.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER'S MAJUNG ADDRESS
Plan Checking Fee $
m1 FQA /42� *t
,
Energy Plan Checking Fee $
$
— . V
l
PERMIT FEE $
LOT NO.
SUBDIVISION'S NAME
1
PARCEI
1
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY___
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 01 /Flemodel 0 /Jfilifies 0 Installa er
Desc e )Vork:
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
920.00
PERMIT FEE $
ELECTRICAL PERMIT
Filing Fee 20.00
OOOV OR o�
Main Service .."0.
23.00 (,p!?
C,
IIIIIIIIIIIIIIS
Sik irk
Tzft; ed mom
%
AW -PE -4
at&
Vyt
X Date
Signature of Applicant - [3 Owner 0 Contractor 13 Agent
An OSHA permit is required for excavations over 60" deep and demolition or constructon
of structures over 3 stories in height.
Main Service 200A TO j900A 46.00
NEW CONST. DWELLING OCCUP, so.
OR ADDNS. & AM. BLDS. 3.50FT.
Ng:.O.ONST
N ID M UQ 0 @�7.50
&PO*E.RAP=TUS
IN. 0 C'.
20 @ 1.00
Ex. Occup. OUTLET OR FDITURES BAL @ .50
_L
0 OR,
Ex. Occup. OM OPIM.1 E 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
I
Energy Inspection Fee $
OCC
CONST. TYPE
ITOTAL FEE $
ES I IMP
I FLOOD
I CDF
PARCEL
pD
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
indicated above for which fees have been
By Date
PERMIT EXPIRES ON
2=!
provisions
to do work
paid.
II
ReceiptNo.___
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD-APPLICAWT
03-2175
024�-090,0366
M
DAVIS, IRMA
9 p
r369 O'BRIEN, GRIDLEY
(3) METIfRS-DUPLEX & SF
OFFICE COPY
Address
GAS'.
Meter -By Date
ELECTRIC Dat*,�-*`
Meter By
3
A
COUNTY OF BUTTE - DEPARTMENT OF 1016VELOPMENT SERVICES - BUILDING DIVISION
IZ. A 1
7 County Center Drive *, Oroville, California 95965 * Telephone (530) 538 PJ&IT NO.
(Re I v. 12/96) APPLICATION AND PERMIT 12 -1J I e. ( f —
ASSESSOR PARCEL NUMBER
ZONING
BUILDINGPERMIT
OWN
DAVES
TELEPHONE
P46-4606
SO. FT. OCC. BUILDING"VALLIATION
OWNERS MAIJNG RM
360 O'BRIM AVE,, GRIDM. CA 95948 -�NE
CONTRACTORS NAME
MER
[FE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
LENDERS MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Permit Fee
$
Plan Checking Fee
$
BUILDING ADDRESS
365, IG9 & 171 WERIEN AVE, GRITHEY
Energy Plan Checking Fee
$
A
*ERMIT tO
LOT NO.
SUBDIVISIONS NAME
MAP'
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECFf
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Lifilifies 0 Installation 0 Other 0
Describe Work: INSTALL (3) SEPARATE ELEC. SERVICE
MEIMS FW DUPLEX & HOUSE
Gas piping system I - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I GI WF--
@D20.00
PERMIT FEE
$
ELECTRICAL PERMIT
I Filing Feel 20.00
Main Service ( '.".v. Oo2
31 23.001 6 9 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 is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemp
.1 from the Contractors License
Law for the following reason:
�, [,as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 -1 -aim exam pt- u n -d elr- St. '.usinqs nd �Pr
reason 016i'Gions CocLe for this:,.;
WORK - ERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury'bne of the followinig dae -.1arations:
c
"L"Op
0 1 have and will maintain a certificate of consent self -insure for workers'
compensation, as provided for by section 3TOPI(Nt Labor Code, for the
performance of the work for which this permit is issued. '\
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, forthe performance of workforwhich this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply witK, those provisions.
u w .....
X 7 If J I A66 A Date 9- 21-007
re of Appli, 'MPUWhZr Contra
s r v rV
n OSHA permit is requir.44or excavations over 60" deep a �dd demolition or construction
of structures over 3 stories in heigh t,
-
Main Service ( 200A TO 1000A 1 46.001
NEW CONST. DWELLING OCCUP. so.
OR ADDNS. & ACC. BWS . I 3.50Ft.
Ntw uum I
NON-RESID. =' 0 97.50
OWER AP=US
( PSIN.. 0 C..
Ex. Occu . ( OUTLET OR FIXrURES
20 @ 1.00
BAL @ .50
Ex. Occup. (R= EA 5.00
..FIXED APP .OR
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring
23.00 23,()()
23.00
I I
'4�'PEF�WTFd ST,
"Poe
MECHANICAL PERMIT 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee
$
Energy Inspection Fee $
OCC
CONST. TYPE —
TOTALFEE$ 115.00
!�I.P�.113
HAZ.
I D. FEES
I CDF
PARCE��
ISSUE
This permit is hereby issued under
Of the Butte County Code and/or
indicated abov for which fees have
PERMIT 15XPIRES ON��,
the applicable provisions
Resolutions to do work
been paid.
—V
Date
-,PC,
G)
Receipt No._ ika 566 It T:1!11 r��) ivm�
WHITE-O.D.S.-B.D. CANAAY-WEPSIM - —PINtMNISPECTOR GOLDEN ROD -APPLICANT I
REQUEST FOR IN
Locatipn: Le
Permit No.
Contractor:
Call L] Phone: g -L,( 3 -
BLDG.
PLUMB/IVIECH
ELECTRIC
M.H.I./M.H.U.
PRE -
INSPECTION
Form
Rough
Rough
Fnd/Ftg
Frame/Underfloor
Top Out
Temp. Service
Job Status
Stucco Lath
Gas PipingfTest
Main Service
Corrections
Per al
m
Stucco Brown
Temp. Gas
Underground
Final
Woodstove
Sewer Piping
Well Circuit
Ex MoMe—Site
Brace Panel
Water Piping
POOL
Insulation
ShowerPan
Nailing
Gunite
Demo
Bonding
Light Niche
Corrections
Corrections
Corrections
Final
Final
Final
Corrections
Ready for
Final
Inspec.on:
Date: 'A \ �) Comment:
I '. I t I
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 9 Telephone (530) 5386�f,42(3!SIT No.
(Rev. 12/96) APPLICATION ANDPERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDINGPERMIT
OWNffR
DAVIS, IRM
TELEPHONE
_2A.Ci-__Zra06_
SO. Fr. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
- O'BRIEN I -WE., GRIDLEY, CA 95948
169
CONTRACTORS NAME
01WER
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENG INEER
LICENSE NO.
Filing Fee
$ 20.00'
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS
36 5 M9 8, 73 WDIRIEN WE-, CRIMEY
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
1
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Other 0
Describe Work: INSTALL (3) SEPARATE EUC. SEEVTCE
=1 ERS FOR -DUPLEX & HOUSE
Gas piping system 1 - 5 outlets
15.00
Buildina sewer
15.00
Mobile Home I S I G I wi—,
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20-00
Main Service , o.R ". b'
_I 23.00 e9,00
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
71, 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1. as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700of the Labor Code, for the performance of work for which this permitis issued.
MY workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwilb) comply w those provisions.
X �Rao�(9 9 — 2-) ' 0 -3
-5W—ner 0 Contrlo_ft�m�nt
�ure offAp�plicanV rdfc r excavations over 60" deep and demolition or constyruct-on <
of structures over 3 stories in heig)t.
Main Service 200A TO 1000A 46.00
NEW CONST DWELLING OCCUR 3.50SQ.
OR ADONS. & ACC. BLDS . Fr.
NEW CONST. LTI-OUTLET
NOWRESID . =. CIRCUITS @7.50
OWELR AP.PARATU
PSING E . C SIR.
Ex. Occup. OUTLET OR FIXTURES @
BAL @ .50
..MED A LNS OR"
Ex. Occup. W(R.,6j E 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 1 23.001 )1
T -N-n p C, 3� J-011 I I
—
PERMIT FEE $ 135.()()
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
—
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee
Energy Inspection Fee $
occ
CONST. TYPE
TOTALFEE$ 1.., (Y)
_�AT_
FEES IMP
I FLOOD
I CDF
HD
ISSUE
This permit is hereby issued under
11e_Q unty Code and/or
ab_.f
hle! f
irfdtic du or which fees have
y
I ES
PERMIT RES 0
(0�
the applicable provisions
Resolutions to do work
been paid.
Date C;&.)-
(Date)
I g / -:9 - -7,__
ReceiptNo. --?Yoe !qtp;�?
WHITE-D.D.S.-B.D. CANARY-ASIESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
7
77
41
COUNTY OF BUTTE -DEPARTMENT OF DEVELO PMENT SERVICES-BUILDINGPIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: AS SS4OP, PLARCEL NUMBER
,a _62,4-6q6
Proposed )UhA) I u r Technician: Date:
u'71 e:� � A A (I
Items re: iqrisn order to apply for a permit. MUST be checked OR marked NA in order to apply.
0 L. Plot plans, 3 or 4 sets, signeAy the preparer of the plans.
0 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
0 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
0 4. Engineered truss details and layouts in duplicate. No faxes!
0 5. Ener � compliance design and supporting documentation in duplicate.
gy
0 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
0 7. Metal buildings: (A) Metal Building Plans, B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Flqpr plans in �iplicate. All of these mdst be staMped and wetsigned by the engince
Items required for 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 line-up when required items are received.
Date Received By
0 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
0 9. Plot plan and business license approval from the City of Biggs ....................................
0 10. Letter of intent for non-residential buildings .........................................................
0 11. Detached Accessoiry Building Form filled out by the owner .....................................
0 12. Hazardous Material Form ..............................................................................
0 13. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the followinj items.)
0 14. Fees as shown on the attached Schedule of Fees Due Sheet ............ : ..........................
0 15. Statement of Intent for Non -heated and A/C Buildings .............................................
0 16. Sanitation and plot plan approval from the Environmental Health Department in
0 17. City of Chico Plumbing permit .........................................................................
0 18. California Department of Forestry plan approval 0 paid. Sent. by: .......................
0 19. Planning approval for (A) Use: _(B)Parking: (C) Parcel Check: .
0 20. Contact Land Developmer t about 0 Improvements 0 Drainage ...............................
21. Encroachment Per -Al t fo 've ay the i k ept. (construction approval prior to occupancy).
22. Pre -Inspection fo 1A required ................
0 23. Contractor's license information. (Number, Name Style, Classification), ...............
-40 L, 2 p a e y
4. Worker's. Coni'ansation C"rri'r and Polic '�Number,',, ............ . ...................
. 2 5. Owner -Builder Verification (0 Given to owner, 0 Mailed to owner) .....................
ff26.,Letter of Signature authorization ....................................................................
.0 27. Recorded copy of Agricultural Acknowledgment Statement ....................................
0 28. Manufactured home utility clearance ................................................................
0 29. Existing violations and/or expired permits ......................
0 0. 0 Grant(Pr itle/nemn=, tter e al� 6- ... k to' H.C.D. $
31. Other -
en issued Telepho e V 1 4,.j and hold pickup.
0�, fol
I have been informed ol�the above itpjs anArequirements (or obtajEjEV building permit.
Contractor, designer, owner, was advised cf the a6*16v-e data by El phone, 0 mail, 0 counter, by
Contractor, designer, owner, was advised of the above data by 0 phone, 0 mail, 0 counter, by
Plans reviewed by: Date: Plans approved by:
Structural reviewed by: Date: Structural approved by:
Note transfer by: Date:
Yellow: Building Division
Plan Check Letter
I
Date:
Date:
Date:
Date:
OWNER -
LOCATION: L'040
CONTRACTOR.
PRE -INSPECTION REPORT
JATE:
0 A -P- If- QZ�d�
44, 1P.
pRE.,KsPE.noN Fopti L- 5-j 4QJ aU dx.J'JL, - �.UA V, LLLU,.,e�,J/
DATE TO INSFECTOPL PZRJMH5TORY:( )NONE )AS F0LLOWS.---------__
BUILDENG ViSP&MOR'S REPORT
BuDding Desetiptionz.
Residend" OfUnits.'
CM=,dy O=zpicd
Al,
Electric:
Yes "�.wo
C�ndition of Meet&
Gu:
Ficcticcwr=tIYOnA---Off��c
Natural Propane— Nme— Currmitly
Obvious Probl 011t�06
J
Staltidlon:
Plumbing Worldng Potable Water 9
WeU Woridniz /9
Obvious Scwar-Problems—r-..
Comments: Al Mf=
0-1 —.,Z=Q
ACTIQN RECOMMENDED: LSSUE: JiOLD FOR
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Inspector.
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Cleaning 13 1121
FLOOR FINISH I TRIM INTERIOR FINISH
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ARCHITECTURE
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FOUNDATION
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CONSTRUCTION RECOR
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BATH DETAIL
Permit . Amount Date
No For
YEAR YEAR Age Rama ing Arch. Func. Con. Storage Space Work-
Life Table % Cond. Att,. Plan form _C_�`p,_V7dCloset 'n.hp
FINISH
Fl. No. Floors I Walls
FIXTURES
Wc LojTbj Type I Grade
SHOWER
St.IQTIGD Finish
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SP !AL FEATURES
Book Cases
Built-in Beds
Venetian Blinds
Shutters
COMPUTATION
APPRAISER & DATE
076 4M 7IZ5-177
Unit Unit Uni Uni Uni Unit
I co Unit Unit
Unit Area Cost Cost Cost Cost Cost, Cost Cos1t Cost Costt Cost Cos st Cost Cost Cost Cost
4 --
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TOTAL
IN,'ORMAL % GOOD
R. C. L. N. D. -419
AH 530-A
MISCIELLANEOUSSTRUCTURES
fi�, n- COMPUTATIONS
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ITile
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M-B.T.U.
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CONSTRUCTION RECORD
Permit I . I -
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BATH DETAIL
1141SH I FIXTURES
SHOWER
COMPUTATION
APPRAISER & DATE 50V7 7 1 1 T__
Unit
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unit
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R. C. L. N. D.
AH 530-A
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MISCELLANEOUSSTRUCTURES
COMPPTATIONS
Remarks: 1—.�,Q-77 1.1,
MISCELLANEOUS BUILDING RECORD PA RCEL 4- Z,
ADDRESS I AM/ SHEET4- * OF SHEE
DESCRIPTION. OF BUILDINGS
i3ldg.
Structure
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O.B.- I
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.
Gpersonally plan to provide th ajor labor and materials for construction of the proposed
piroperty im
,provement: YES NO 11
HAVE)� HAVE NOT El signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. 1 plan to provide portions of this work, but I have hired the following person to coordinate,
supervise, and provide the major work:
NAME:—,
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
5. 1 will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNE
IPROPERTYOV;V*INER: /C
ell
NOTE. This Owner -Builder Verification is required by Section 19831 and 19832 of the
California Health and Safety Code. This verification must be completed and
returned to our office before we are permitted to issue thepermit.
OVER
Q.B.- I
I OWNER BUILDER INFORMATION -1
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such
a permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business'
license from the city or county. They are also required by law to put their license number on all permits -for which they
apply -
If you -plan to do your own work, with the exception of various trades that you plan to subcontract, you should
be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License Board in your
community or at 1020 N, Street, Sacramento, CA. 95 814. 1�
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
rely,
4NEc e1C.Vi iraC.B.O.
I
M a
, J"�
M ger., Building Inspection
NOTE. Th is Owner -Builder Information is required by Section 19830 of the California Health and Safety Code
OVER
Certification of Trust
Irma B. Davis Trust
Dated June 27, 2003
Irma &Davis, pursuant to California Probate Code Section 18100.5, hereby certifies:
I Establishment of Trust. Irma B. Davis, as Senior, has executed a Declaration ofTrust on June 27, 2003,
establishing the Irma & Davis Trust (the "Trust"), which Trust is not of record in any court. The Trust is
in full force and effect and has not been revoked or amended in any manner which would cause the
representations contained herein to be incorrect.
2. Benefidary. Settlor is the present beneficiary uriderthe terms of the Trust.
3. Trustees and Successors. The current Trustee is Irma B, Davis. Upon the death, resignation or
incapacity of Irma B. Davis, the Trustee shall be Louis U Speaker. If Louis L. Speaker shall fail or
cease to act for any reason, the Trustee shall be Ava Y. Speaker.
4. Powers of Trustee. The Trustee is vested with and has all the rights, duties, powers and privileges which
an absolute owner of property would have. The powers and authority of the Trustee with respect to the
Trust property include, but are not limited to, the following:
A. To appoint, empower and remove special, ancillary and/or assistant trustees or agents; and grant
powers of attorney, including durable powers, for any purpose and to any person.
B. To singularly orjointly, open, close, or transfer any type of account with any bank, savings and
loan, credit union, brokerage firm or other financial institution; to sign checks, drafts, withdrawal
slips or other documents, give instructions for the payment� receipt or delivery of money, securities
or other property; and have access to any safe deposit box or other place containing Trust property.
C. To buy, sell, invest� reinvest, and trade in securities of any kind or nature on margin or otherwise,
including, without limitation, any stocks, bonds, investment trusts and companies of every kind and
description, mutual funds, trust deeds, annuities, limited partnerships, mortgage participations,
options, warrants, commodities, puts and calls, and short sales; and for such purpose to maintain
and operate brokerage accounts; to have all the rights, powers and privileges of any owner,
including, without limitation, the power to vote, give proxies, and pay assessments or other charges
levied.
D. To purchase, receive, hold title, manage. control, grant options on, sell for cash or on deferred
payments, convey, exchange, partition, divide, improve, and repair trust property, and to
subdivide, adjust lot lines, mortgage, option, lease, dedicate for public purposes, create, impose or
release anv covenants, conditions, restrictions, easements, servitudes, or rights of way on any Trust
property, all with or without consideration and under such terms as the Trustee may deem to be in
the best interest of the Trust; and to sign, execute, affirm, sea], acknowledge, and deliver any deed,
application, map, receipt, release, contract, agreemenL covenant, indenture, evidence of
indebtedness, notice, or other instrument of every kind and nature which the Trustee may believe
necessary and proper for the execution of any of the powers described herein.
Certification of Trust Page 2
5. Federal Tax Identification Number. This Trust is classified as a "grantor trust" under applicable
Treasury Regulations, and the Settloes Social Security number may be used as the federal taxpayer
identification number for the Trust.
6.- Title to Trust Assets. Title to assets held in Trust should be taken as follows:
Irma B. Davis, Trustee of the Irma B. Davis Trust Dated June 27,2003.
This Certification of Trust has been signed by the currently acting Trustee on June 27, 2003.
/1=31B. Davis
Acknowledgment
State of California
ss.
County of Butte
On June 27,2003, before me, V A C �_;—b (L— / r ( - / I' ( It V 11� It CC 8Z
a Notary Public in and for said County and State, personally appeared Irma B. Davis, personally known to me (or
proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within
instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature
on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.
WITNESS my hand and official seal.
ary Public
MANSLLA
No" RM - C0106
am courkly
412,2006
J
I AV
I Durable Power of Attorney
Notice to Person Executing Durable Power of Attorney
(California Probate Code Section 4128)
,2-n
A durable power of attorney is an important legal document. By signing the durable power of attorney you are
authorizing another person to act for you, the principal. Before you sign this durable power of attorney, you should
know these important facts: ' -
Your agent.(attomey-in-fact) has no duty ;o act unless you and your agent agree otherwise in writing.
This document gives y6ur agent the powers to manage, dispose of, sell, and convey your real and personal property,
and to use your property as security if Your agent borrows money on your behalf
Your agent will have the right to receive reasonable paymentfor services provided under this durable power of
attorney unless you provide otherwise in this power of attorney.
The powers you give your agent will continue to exist for your entire lifetime, unless you state that the durable power
of attorney will last for a shorter period of time or unless you otherwise terminate the durable power of attorney. The
powers you give your agent in this durable power of attorney will continue to exist even if you can no longer make
your own decisions respecting the management of your property.
You can amend or change this dut�ble power of attorney only by executing a new durable power of attorney or by
executing an amendment through the same formalities as an original. You have the right to revoke or terminate this
durable power of attorney at any time, io long as you are competent.
This durable power of attorney must be dated and must be acknowledged before a notary public or signed by two
witnesses. If it is signed by two witnesses, they mustwitness either (1) the signing of the power of attorney or (2) the
principal's signing or acknowledgment of his or her signature. A durable power of attorney that may affect real
property should be acknowledged before a notary public so that it may easily be recorded.
You should read this durable power of attorney carefully. When effective, this durable power of attomiy will give
your agent the right to deal with property that you now have or might acquire in the future. The durable power of
attorney is important to you. If you do not understand the durable power of attorney, or any provision of it, then you
should obtain the assistance of an att6mey or other qualified person.
Article I ,
Declarations
1. 1. Appointment of Aftorney-in-Fact. 1, Irma B. Davis, appoint Louis L. Speaker as my
attorney-in-fact. IfLouis L. Speaker is unable or unwilling to act, then I appoint Ava Y.
-Speaker.
1.2. Intent of PringiWAl. I intend to create a Durable Power of Attorney (herein referred to as
this "Power") pursuant to Division 4.5 of the California Probate Code. Unless this Power
shall sooner be revoked and such revocation communicated to you, you shall have and
may exercise the power§ hereby granted until my death, upon which date this Power
terminates. This durable power of attorney shall not be affected by the subsequent
incapacity of the principal.
Durable Power ofAttorney - Irma B. Davis Page 2*
1.3' Assets Included. This Power is granted over all assets of every kind and nature, real and
personal, tangible and intangible, in which I now or may hereafter have any interest.
Article 2
Delegated Powers
2.1. Deleaationof Powers. I delegate to you the powers set forth in this Article 2, plus all
powers granted to an attorney-in-fact by law, implication, or necessity. You shall have
full power and authority, to the extent that a principal can art through an agent, to do and
perform every act as I might or could do for myself. Your exercise of the delegated '
powers must be in a fiduciary capacity for my benefit and on my behalf You shall have
the power:
A. Delegation of Powers. To appoint subagents with respect to any powers granted
hereunder, but any empowerment under this paragraph shall create a fiduciary
relationship between me and any such subagent.
B. Financial Accoun . To open, close, continue, or transfer any account with any
bank, credit union, brokerage firm or other institution; to sign checks, drafts,
withdrawal slips or other documents.
, give instructions for the payment, receipt or
delivery of money, securities or other property; and have access to any safe
deposit box or other place containing my property.
C. Securities. To buy, sell, invest, reinvest, and trade in securities of any kind or
nature, including, without limitation, any stocks, bonds, mutual funds, investment
trusts, trust deeds, annuities, I imited partnerships, mortgage partici p*ations,
options, warrants, and short sales; and for such purpose to maintain and operate
brokerage accounts; to have all the rights, powers and privileges of any owner,
including,without limitation, the power to vote, give proxies, and pay
assessments or other charges levied.
D. Real Propegy. To purchase, receive, hold title, manage, control, grant options on,
sell for cash or on deferred payments, convey, exchange, partition, divide,
improve, and repair my property; and.to subdivide, adjust lot lines, mortgage,
option, lease, dedicate for public purposes, create, impose or release any
covenants, conditions, restrictions, easements, servitudes, or rights of way on my
property, all with or without consideration and under such terms as you may deem
to be in my best interest; and to sign, execute, affirm, seal, acknowledge, and
deliver any deed, application, map, receipt, release, contract, agreement, covenant,
indenture, evidence of indebtedness, notice, or other instrument of every kind and
nature which you may believe necessary and proper for the execution of any of the
powers described herein.
Durable Power ofAtiorney - Irma B. Davis Page 3
E. Insurance and Annin
& Transactions. I give you all of the powers listed below in
this paragraph. All powers described in this paragraph are exercisable with
respect to any contract of insurance or annuity in which I am in any way
interestecL whether made in this state or elsewhere.
(1) Existing Personal Coverage. Continue, pay the premium or assessment
on, modify, rescind, release, or terminate any contract procured by me or
on my behalf that insures or provides an annuity to either me or another
person, whether or not I am a beneficiary under the contract.
(2) Procuring New Coverage. Procure new, different, and additional contracts
of insurance and annuities for me and my dependents, and select the
amount, type of insurance or annuity, and mode of payment.
(3) Paying Premiums for New Coverage. Pay the premium or assessment on,
modify, rescind, release, or terininate a contract of insurance or annuity
procured by my attorney in fact.
(4) Beneficiary Designatio . Designate*or change the primary and contingent
beneficiaries of any existing or new contract, including the power to
designate any trust of which I am the Settlor as the beneficiary of the
contract, or an extension, renewal, or substitute for the contract, regardless
of whether the contract was procured by me or by you.
(5) Borrowing. Apply for and receive a loan on the security of the contract of
insurance or annuity.
(6) Surrendering. Surrender and receive the cash surrender value.
(7) Elections. Exercise any elections or options available to me.
(8) Manner of Paving Premiums. Change the manner of paying premiums.
(9) Conversion. Change or convert the type of insurance contract or annuity
as to any insurance contract or annuity to which I have or claim to have a
power described in this paragraph.
(10) Goven imental Aid. Apply for and procure government aid to guarantee or
pay premiums of a contract of insurance on my life.
(11) Transfe . Collect, sell, assign, hypothecate, borrow upon, or pledge my
interest in a contract of insurance or annuity.
Durable Power ofAiturney - Irma B. Davis Page 4
'(12) Release. No insurance company or other person shall be required to
inquire into * or take notice of any of the provisions of this Power of
Attorney, or see to the application or disposition of any proceeds. Your
receipt to any insurance company or other person shall be effective'to fully
release and discharge it for any payment so made and shall be binding
upon me, my estate, heirs, successors and assigns.
F. Retirement Plan Transactions. To deal with and make any and all available and
appropriate elections then permitted with respect to any retirement accounts, and
to have and exercise all of the powers listed below in this paragraph. All powers
described in this paragraph are exercisable with respect to any retirement plan
received by Or payable to this Trust, whether the plan is in California or
elsewhere. My attorney-in-fact shall have power to:
(1) Select PaMent Qptions. Select any payment options under any retirement
plan of which I am a participant or beneficiary.
(2) VolLm
Contributions. Make voluntary contributions to retirement
plans.
(3) . Rol -lovers.* Make roHovers of plan benefits received into other retirement
plans when permitted by law.
(4) Subaccounts. Create subaccounts within such accounts and to distribute
accounts or subaccounts as inherited accounts when appropriate following
procedures such as those set forth in PLR 964103 1. In the event that the
law is not well settled in this area at the time that my attomey-in-fact may
choose to make any such elections or distributions, my attorney-in-fact is
encouraged to seek competent tax advice and to obtain a Private Letter
Ruling if that step is recommended by my attomey-in-fact's advisors.
(5) Withdrawals of IRA Proceeds. To withdraw all or any portion of the
remaining retirement accounts balance, or to direct that the plan benefit or
individual retirement account be paid directly to a beneficiary, including a
beneficiary of a trust which is the beneficiary.
(6) Change Custodians. To change custodians, issuers and investment
advisors of retirement accounts and to provide directives for the
investment and management of such accounts or plans by direct Trustee to
Trm,tee, Custodian to Custodian, and Issuer to Issuer transfer.
(7) Penafty on Early Withdrawal. Pay any penalty tax imposed because of the
early withdrawal of funds from a retirement accounts, including the
withdrawal of funds from a Roth IRA within five years of its creation, but
Durable Power ofAltorney - Irma B. Davis Page 5
only in the event that in my attomey-in-fact's sole discretion such
withdrawal is necessary or is in the best interest of me or my beneficiaries.
(8) Cooperation with Spouse. My attorney-in-fact is instructed to cooperate
with my surviving spouse, if any, in accomplishing the transfer or rollover
of the portion of the retirement accounts or benefit in which my spouse has
a legal interest.
(9) Conversion of IRAs. My attorney-in-fact may convert my IRAs to Roth
IRAs as those accounts are defined in Internal Revenue Code § 408A, to
the extent permitted by law. My attomey-in-fact may convert qualified
plans to IRAs and generally deal with IRAs and retirement accounts to the
extent permitted by the applicable law.
(10) PMent Alternatives. My attomey-in-fact shall have the right to direct
that any retirement accounts benefit be paid directly to a Trust, or be paid
directly to a beneficiary of a Trust who is entitled to income and/or corpus
of such Trust.
(11) Release. No plan trustee or other person shall be required to inquire into
or take notice of any of the provisions of this power of attorney, or see to
the application or disposition of any proceeds. My attorney -in -fact's
receipt to any plan trustee or administrator, or other person shall be
effective to fully release and discharge it for any payment so made and
shall be binding upon me and my estate, heirs, successors and assigns.
G. Leases. To lease my property for any term, whether within or beyond my life, for
any lawful purpose, including, without linitation exploration for and removal of
gas, oil, and other minerals, and to enter into community oil, gas and mineral
leases, pooling and unitization agreements.
H. Indebtedness. To incur indebtedness, finance or refinance my property, and
borrow money by any means including, without limitation, by credit card,
overdraft, promissory note, line of credit or otherwise, and to encumber or
hypothecate my property by mortgage, deed of trust� pledge or otherwise; and to
pay all such debts or obligations with my assets.
I. Claims and Actions. To commence, prosecute, defend, submit to arbitration,
release, settle, compromise, or intervene, at my expense, any action, proceeding,
arbitration, claim, receivable, debt, obligation, or demand with respect to me or
my assets, as you may deem advisable, and give an appropriate release therefor.
Creation of Trusts. To create any revocable or irrevocable trust and transfer my
assets thereto. Any living trust you create must have as remainder beneficiaries
Durable Pow -r qj'Alforney - Irma B: Davis Page 6
those who I have named in a then valid will or living trust, if any, otherwise those
who would take by intestate succession.
K. Existing Trust. To transfer my assets, including any unproductive assets, to the
Irma B. Davis Trust Dated June 27,2003 and, subject to limitations contained
in the trust instrument, amend the Trust.
1'. Entities. To create any corporation, partnership, or other entity, to make any
elections and decisions in connection therewith, and to transfer my assets thereto
in exchange for an interest therein.
M. Estate Transactions. To represent and act for me in all ways and in all matters
affecting any estate of any decedent, absentee, minor, or incompetent, or the
administration of any trust or other fund, out of which I am entitled, or claim to be
entitled, to some share, interest or payment, including the power to make any
disclaimer on my behalf; and to enter into any agreement with any estate
including, without limitation, agreements to sell or purchase assets, and to lend or
borrow money or other assets, with or without security.
Residences. To hold, maintain, sell, exchange, replace, or. acquire any residence I
own, or interest therein, and pay all expenses thereon.
0. EmploMent of Advisors. To employ accountants, investment advisors, brokers,
attorneys, agents, specialists, or other persons, even if they are associated with
you, to advise or assist you in the performance of administrative duties; to act
without independent investigation upon their recommendations; and instead of
acting personally, employ one or more agents to perform any act of
administration, whether or not discretionary.
P. Payment and Settlement Authori . To pay, contest, compromise or waive any
and all taxes. interest, penalties, assessments, debts, claims
demands, and
expenses of every kind and nature, upon such tenns as you shall deem expedient.
You may pay any sum or sums which may be the subject of any contest,
compromisc, or proceeding, and may file any claim, demand, or swit for payment,
refund, or abatement thereof.
RcpL)rts and Rcturris. To prepare, sign, file, and deliver all reports, returns,
applications, proofs, declarations, vouchers, or other papers that may be required
by any governmental agency or that you believe desirable or necessary for any
purpose, and make any payments with respect to them, and to make any tax or
other elections which may be available.
R. Gifts. To gift or otherwise transfer my assets to the residue beneficiaries in the
Irma B. Davis Trust Dated June 27,2003, and to any other persons with the
Durable Power ofAttorney - Irma B. Davis Page 7
consent of said residue beneficiaries, for the purpose of protecting my assets from
depletion due to catastrophic illness; and for estate and other tax reasons; and to
make charitable gifts according to my pattern of giving during the immediately
preceding two years.
S. Unproductive Prope - To retain, purchase or otherwise acquire and hold
unproductive property, including unimproved land and. wasting assets; to operate
at my risk, and to abandon my assets.
T. Attomevs fees and Costs- To incur attorneys fees, expenseg and other fees in
connection with any action or duty authorized herein and to pay them from my
assets. You shaR not be obligated to incur or pay any costs or expenses unless my
funds are sufficient to pay the same.
U. Public Benefits. To apply for, maximize and maintain any and all public benefits
to which I may be entitled or may become entitled to because of the agent's
actions, including Veteran's benefits, Social Security, Medicare, and Medi -Cal,
particularly in the event that major expenses relating to my incapacity are
foreseeable. This authori7ation includes: (1) Modifying or revoking in whole or
in part any trust established by me in order to effect a transfer of my residence to
my spouse, if any, or to other transferees then permissible under applicable state
or federal law; (2) Making gifts of my property to my beneficiaries, so long as
such gifts do not result in my ineligibility for public benefits and the gifts do not
change the ultimate provisions of the distribution of my estate; (3) Creating a
revocable trust or, an irrevocable trust to contain my assets, so long as my plan for
the distribution of my estate remains unchanged; (4) Creating an irrevocable trust
that does not violate Medi -Cal law; (5) Dividing my property into separate
property of myself and my spouse in a manner permissible under applicable state
and federal law; (6) Changing the characterization of my property from
community property to separate property; (7) Making transfers of community
property from myself to my spouse, as that person's separate property; (8) Seeking
court or other enforceable orders for spousal support to prevent impoverishment
of my spouse; and/or (9) Taking any other action necessary to maximize my
eligibility for public benefits. My attorney-in-fact is further directed to take all
legal steps necessary to defend my actions, or my attorney-in-fact' s actions, under
this section, including retaining attorneys and other professionals and paying for
the services of such attorneys and other professionals out of my property.
2.2. Pdvate Home Nursing Care. It is my desire to continue to live in my own residence as
long as I am physically able and my then acting health care agent deems it is practical. Ii
is my further desire that you provide nursing care to me in my residence, so long as my
estate, including any assets held in trust for my benefit, contains adequate funds for such
upkeep. I authorize and direct you to take such steps as are necessary to carry out my
desires as expressed above, including, but not limited to, modifying my residence, hiring
Durable Power ofAltorney - Irma B- Davis Page 8
home care providers (including around-the-clock nursing care), obtaining such equipment
as might assist in home care, or taking such other measures as you consider advisable
under the circumstances. In exercising your discretion, you shall take into consideration
the community and/or separate property character of my estate and any other income or
financial resources available to me so far as known to you.
Article 3
General Provisions
3
1. Severabfffty. If any of the provisions of this Power are found to be invalid for any
reason, such invalidity shall not affect any of the other provisions of this Power.
it I It
3-2. Pronouns. The pronouns "I", me" my", "mine", and "myself' refer to the Principal.
' The pronouns "you", "Your", and "Yourself' refer to the attomey-in-fact
3.3. Compensation and Reimbursement of Attorng3L-in-Fact. My at * tomey-dri-fact shall be
entitled to reasonable compensation and to reimbursement of reasonable expenses
incurred on my behalf in the performance of duties hereunder.
3.4. Example of SigLmture. When signing on my behalf under this Durable Power of
Attorney, use the following form:
Irma B. Davis by Louis L. Speaker, her allorney-in-
fiact
3.5. Exculpation. You are not liable to me or my successors when, in good f
aith, you act or
do not act under this document, but this freedom from liability does not apply in the event
of your willful misconduct or gross negligence.
3.6. Capacily.. For all purposes under this Power, I shall be deemed "incapacitated" if so
declared by a court of competent jurisdiction or upon the written statement of two (2)
physicians licensed to practice under the laws of the state where I am domicilcd, that I am
unable to properly care for myself or my property.
3.7. Effective Date.. This Powcr shall become cffective immediately upon execution.
[The rest of I&Y page was intentionally left blank]
Durable Power of Altorngy - Irma B. Davis Page 9
This Durable Power of Attorney is executed in Butte County, California on
June 27, 2003.
Inha B. Davis
Acknowledgment
State of California
ss.
County of Butte
On June 27, 2003, before me, A 14-S f C, C
a Notary Public in and for said County and State, personally appeared Irma B. Davis, personally known to me (or
proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within
instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature
on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.
WITNESS my hand and official seal.
Kotary Public
All —0
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