HomeMy WebLinkAbout024-180-024NOTES
'A u_
i
RESIDENTIAL
PERMIT NO. 024-180-024 b! -3b5'§
PEEKAMA RANCH-,.'
544 LEVEE RD., GRIDLEY
NEW SINGLE FAMILY -REPLACES EX
HOUSE
11 SPECIAL CONDITIONS ' 11
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
11 -old -Ap r ;:;.- H,
(c be — W&,IF ej- +- e S
JOB FINALED (Patel—cr - 2=
Signatur 'r -
CHECKED
By
q = OK
0 S Not OK
NolApplicable
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. 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 Requ irements-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.
12. Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
10. Exits; Insp.-Sketch
MISCELLANEOUS
Date
11. Cert. of Occupancy
1.
Zoning Requirements -Setbacks -Easements'
2.
Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
6.
1 . Zoning Requ irements-Setbacks- Easements
7.
2. Footings; Size -Spacing -Marriage Line
8.
3. Blocking
9.
4. Gas; MH Test- Demand -Valve
10. Roof; Shthg-Roofing
5. Electricity; MH Test
11.
Ext.; Steps -Doors -Landings
6: Water; MH Test
12. Braced Wall Panels
7. Water and Sewer Connected
Date
8. Gas and Electricity Tagged
Card B-1 Date Card 8-1
Date
9. Exits
Card B-1 Date Card B-1
Date
10. License Decals
1 .
11. Verify #'s with Office
2.
Soils; Compaction -Structure Stability
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
12. Enclosure; Fencing -Alarms
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 #'s
1.
Zoning Requirements -Setbacks -Easements'
2.
Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg- Frg- Bracing
5.
Alum. Awn.; Cplu mns-Connections-Spl ice- Decal- Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12. Braced Wall Panels
Date
Card B-1 Date Card 8-1
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 -Term inals- 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.
Liqht Niche
12. Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
4 = OK
0 = Not OK
- = NotApplicable
= Not Ready
-RESIDENTIAL
Date UNORFLOOR
(Plans) OK except #s
'f
A6ning-Setbacks-Easements-Flood-Slope
2."Ftg.,
Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
4.
Ftgr, Porches & Decks; Soils -Steel-/ /" Ftg. Depth
500'Stemwalls,
Main; Steel-Blockouts-Wrapped
6e'STemwalls, Garage; Steel- Blockouts-Wrapped
6a.
Hold Downs and Special Anchors
7.
gab, Steel -Wrapped
�K
Pigrs- Fireplace Ftg.-Steel
-@-*5.W.V.;
Fall-Fifting-Test-2 Way C/0 -Sewer Test
4 _1 0.
UF,(;As Pipe; Size Anchors -Yard Gas Piping; Size Test
u-wa-ter
12.
13.
14.
Pipe; Test -Anchors -Regulator -Service Test
Electric Underground
Plenums & Ducts; Clearance -Material -Support -Ins.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15.
Access & Ventilation -
16.
Insulation
-
Insulation -Foam -Looked in Attic
Date Lt) - U (-Card
B- 1 6=1 Date Card B-1
Date
Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except Ws
le
-Water Htr.; Vent -Access -Combustion Air Baffle
lBool7vater
Pipe; Test & Anchor -Nail Protection
19,o0f5.W.V;
Test Fittings & Anchor -Nail Protection
jA_ 20; Shower Pan; Test, First Floor -Tub Access
��at
Tub & Shower, Second Floor -Tub Access
'�goodas
Pipe; Sixe & Anchors�
L �119V 23.
Fire Sprinkler: Test
(Si
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1 N
Date
Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except Ws
24.
Fixture & Transformer Clearance -Ins. Protection
2.5,�&ec. Receptacles Spacing -Lights & Switches at Doors
3@0tize
Boxes & No. of Conductors Stapled
27.
F
_�omex Installed Close to Edge of Studs & C.J.
-297
�2uip. Ground made up w/Mech Fasteners -Bond Gas & Water
2010'2
30.
31.
3r
Appliance Circuits in Kitchen & Conductor Size GFI
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or At
jpsulated Neutral Q Yes 0 No
Service -Riser Conductors & Ground Main Disconnect
33.
Equip. Clearances Panels-Motors-Mech. Equip.
3.4.
Clothes Closet Light -Shower Light -Spa Light
?I
Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Date
MJCHANICAL (Permit) OK except Ws
A.C. Ducts Insulation & Support
Vent Fan, Exhaust above insulation
Condensate Drain & Overflow, Size & Grade
Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
Attic Access & Platform if Furnace in Attic
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FR�eNG (Permit) OK except Ws
Bath Fixtures & Tub Access -Spa
4'r Sills Proper Materials & Anchors
Trim & Subpanel, Breaker Sizes & Labels
4r.-'VValls Studs -Nailing Spacing & Braces- Plates -Sound
& Rails
4_3,.o
%aring wans over Girders & Floor Nailing
or Stove, Clearance -Hearth
joe"'braft Stop in Walls (rat proof)
Elec. Outlets at Wood Panel, Int. & Ext.
4&.-,rire Stops, Furred Ceilings -Stairs -Chasers -Tubs
FixL4 Appliance; Ground -Air -Gap -Cooking Clearance
Outlets & Receptacles at Kit. Counter
4V' Headers & Beams -Size & Bearing
055r, Swing- Landing -Closure
76e<_C.
ngle & Duplex)
Date FRAY!M (Continued)
411. 1jarge-rs-Post Caps -Anchors -Connectors
4e- Cling. Joist-Rftr. Ties- Purl in-Roff Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
�c �Acces% Size & Romex Protection- Draft Stop -Ins. Baffles
,4fT7.Bdrm. Windowaor Exiting Doors -Sill Ht. & Dimensions
1-e �.age Fire Protection Framing -RC Channel
5&.40Fbperty Line Firewall & Openings
U.oSxt. Doors -One X -Check Garage 3rd Story, 2 Exits
!jjL6;Width H eadroom- Rise- Run -Landing- Fire Protection
%W'bod on Roof Overhang -Attic Vents -Rafter Outriggers
5.VSid i ng -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazina Area -Glass Protection-Skvliohts-Plastic
& 60 _54eTr Walls; Nailing -Bolts
094
V _-ZIP" A,6r Bface interior/Exterior Wall Panels
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FIN!L(Plans) OK except Ws
6!�.�.
Steps -Door & Sidelight Protection- Land i ngs
OT.
Smoke Detector
6_eWr.;nace
Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor- Ducts- Mech. Protection
V-19'e-droom
Exiting
Or-G.E.1,&
Bath Fixtures & Tub Access -Spa
6,*.OSlec.
Trim & Subpanel, Breaker Sizes & Labels
ZPy-STairs
& Rails
7,U-5replace
or Stove, Clearance -Hearth
72.
Elec. Outlets at Wood Panel, Int. & Ext.
7301�it.
74,,CTe-c_.
FixL4 Appliance; Ground -Air -Gap -Cooking Clearance
Outlets & Receptacles at Kit. Counter
74--ttar�e
055r, Swing- Landing -Closure
76e<_C.
Duct in Garage -Damper
7�7�r.
Htr.; Vents -Clearance -Comb. Air Connector -RR: V.
in Garage; Above Floor-Mech. Protection
7a-'Plb.;
Elec. & Mech. Equip. Listed for Location
79.
�iw. Receptacles in Garage (EF.I.)-Romex Protection
80-
Insulation -Foam -Looked in Attic
81
.Qrffa-rd Rails & Deck Construction -Post Caps
8'2_.F(Tn.
VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
83.'Following
Inst1d./Drive 0 Yes 0 No/Walks 0 Yes 0 No/PlLnters 0 Yes Q No
84.
Stucco Brown -Finish
8, -w,<
-C. unit Disconnect, Electrical- PI umbi ng
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87�:�aj��Well,
Disconnect, Electrical, Plumbing
8.5�xterior
Elec. Trim, G.Fl. Receptacle- Underground
89--Ve-ntilation
Throughout House
9,[)�-<ass
Protection
91.
C
q.r:rections from Previous Inspections
9
. ggs Test -Meters Tagged, Gas -Electric
9-r
�2y� & Sewer Connected -C/O to Grade -H D Approval
9�_�rgy Compliance Certificate -Other Certificates'
9!f Adrireq, Posted
V (<A 96. Fire Sprinkler
Date V 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 - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Ciroville, California 95965 9 Telephone (530) 538-7541 NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
024-180-024 1
ZONING
A
—LE/PQ
BUILDINGPERMIT
OWNER
PEEKAMA RANCH
If e N E
SQ. Fr. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
905 ALEXANDER AVE., GRIDLEY, CA 95942
936 R 509544.00
CONTRACTORS NAME
OWNER
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace A 1 5no - Inn
LENDERS MAILING ADDRESS
Total Valuation $ 52,,Q,/.
nn
ARCHITECT OR ENGINEER
LICENSE NO.
Fee 40
20.00
—Filing
Permit Fee $
2
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
978-20
BUILDINGADDRESS
544 TEVFF IRD_ GIRIDIEY
Energy Plan Checking Fee $
2
$
.
PERMIT FEE $
749. 0
QFee20.00
LOT NO.
SUBDIVISIONS NAME
1
PARCEL MAP
1
PLUMBING PERMIT
Filing
Each Trap
7.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00 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: NEW SINGIR FAMILY
REPIA-CE'S EX HOME
Gas piping system 1 - 5 outlets
15.0 0 1 c; -no
Building sewer
15.00 15-00
_@D2-0.00-
Mobile Home I S I G I WF_-_
PERMIT FEE$
65.00
ELECTRICAL PERMIT
Filing Fee 20-00
R LES:
800V 0 LES
Main Service .A OR
23.0023_Qo_
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 Profess ions 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:
)4- 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
Main Service 200A TO IOWA
46.00
NEW CONST. DW
.��Nll OCCUP.
OR ADONS C . )
So.
3.50FT.
NEw caNsT. MULT.10CL11.TTU.
NON-RESID.
97.50
PON1.E.RAPPARATUS
0 r. C..
Ex. Occu OUTLET OR FDcrURES
BAL @ .50
.�LEDA OR
Ex. Occup. PP=.) EA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Wiring
23.00
—Misc.
I
PERMIT FEE$
75.76
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 afthe Labor Code, forthe performance of work for which this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT Filing Fee 20.00
Heating
15, 00
Cooling 15-00..
Hood 6.50 �;.50
Ventilation 4.50 14-90
PERMIT FEt $
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.)
IK 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
hwith comply W��itj� those provisions.
X Date
g7
Sign-ature of4pplicant - )S�Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee s
Energy Inspection Fee $ Ar, no
Occ
CONST.TYPE
TOTALFEE$ 996.95
HAZ.
X
1 0. FEES IMP
X
FLOOD
A
CDF
PARCEL
I PD
I HD
I ISSUE
_X
This permit is hereby issued under the applicable provisions
of the Butte COV and/or Resolutions to do work
in fo Aocdhefees have been paid.
BV 7Dte,
PERMIT EXPIRES ON
I r (D -tel
ReceiptNo.364252
WHITE-D.D.S.-B.D. CANN&NOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
0
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER
PROPOS ED BUILDING USE
1. BUILDING PERMIT FEES
Balance Due ....................... $
dditional Fees Due ................. $
Additional Fees Due ................. $
R
evised Plan Checking Fee ............. $
2 S(
SCHOOL DISTRICT FEES
(paid at District Office) (Available after P ran 6heck)
3. SHERIFF FEES (paid at Building Division)
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
(paid at District Office) (Available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)'
7. SRA 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
A. P. #
DATE W
RECEIPT # DATE REC.
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees
may be changed during the plan checking process.
APPLICANT ZVOW r�
DATE // ) —.1771 -
Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5s 6, 7s 8, 9, and 10 above may have been
imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during which you 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)
COQNTY-(3F BUTTE -DEPARTMENT 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 6 Dc�
Proposed Building Use: Counter Technician: *,�. Date: C)
Items required in order to apply for a permit. All boxes MUST be checked OR ma4d NA in order to apply.
-G� L.Plot plans, 3 or 4 sets, signedty the preparer of the plans.
12. Complete plans, 3 or 4 sets, signed by the 1preparer of the plans.
3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
04. Engineered truss details and layouts in duplicate. No faxes!
5-0--5. Energ� compliance design and supporting documentation in duplicate.
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.
07. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
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.
�I Date Received By
'.' Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
09. Plot plan and business license approval from the City of Biggs ........ .............................
0 10. Letter of intent for non-residential buildings .......................................................
0 11. Detached Accessory Building Form filled out by the owner .....................................
0 12. Hazardous Material Form ...............................................................................
0 13. Other
R��inmp it d d t issue the permit. (May require additional plan review upon receipt of the followinj item
ems nee e o s
'Fee as shown on the attached Schedule of Fees Due Sheet .......................................
s
I S
tatement of Intent for Non -heated and A/C Buildings .......................
(JILL4�.� Sanitation and plot plan approval from the Environmental Health Department in
0 17. City of Chico Plumbing permit .........................................................................
0 18.,,Qalifomia Department of Forestry plan approval 0 paid. Sent. by: . ......................
Planning approval for (A) Use: OK (B)Parking: (C) Parcel Check:
KContact Land Development about 0 Improvements, 0 Drainage)(M.gv��-11��9..,4
-Ate.
A992 -1 -.-,Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to �cclipancy).
0 22. Pre -Inspection for required ................
0 23. Contractor's license information. (Number, Name Style, Classification) ......................
[a J4. V�orker's Compensation Carrier and Policy Number
-N�wner-Builder Verification (MGiven to owner, 0 Mailed to owner) .....................
—F
0 26. Letter of Signature authorization ....................................................................
0 27. Recorded copy of Agricultural Acknowledgment Statement ...... .............
0 29. Manufactured home utility clearance ................................. ..........................
0 29. Existing violations and/or expired permits ..................................................... ***'
0 30. 0 Grant Deed, 0 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 31. Other: 4 , �.)
When issued Telephone (505)- dkt* and hold—for pickup.
I have been infor -ed of the above items and requirements for obtaining a building permit.
Applicant: Date ale?,
1. Index permit application for the above it bered: 61 & 5 iP<; Plan Check Letter
2. Additional items required ;W
Contractor, designer, owner, was advised cf tee aDove data by 0 phone, 0 mail, 0 counter, by _Date:
Contractor, designer, owner, was advised of the abo e d t b 0 phone, 0 mail, 0 counter by Date:
g,.j a ,
Plans reviewed by: Date: 0— Plans approved by: Date: 1111-5-7t6 2 ---
Structural reviewed by: Date: Structural approved by: Date: I
Note transfer by: Date:
Yellow: Buildinp Division
E.H. USE ONLY
Plot Plan AnacMd
Final Plan Attachad
Sent to G.D.
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
b,
Ow-ner Location AP#.
Plan Approved for: Sewage DisposW-�--, Water Supply--,, Public
Clearance for — dwelling. Other uLn--2:� 11j,/w I Ib
Hold final for:
Final clearance O.K. for:
NOTE:
.Environmental Health Specialist
8/96
Private Well'***,�
Date
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building).
School District 041- footi Building Department No.
A.P. Number c2Y— Z2 Jurisdiction: city County
Property Owner f-^ _4A
Property Location/Address
Subdivision
Residential Development
No of Living
Units
Commercial/industrial
'New
Building
Distri6t ldentificatiorfNo.
(Street
Lot No.
..................................................................................................................
Sq. Footage
2367
Mobile Home Addition/ *Supplemental to
(Group R)
Installation Conversion
i
Permit # V> jS�,[ J#-/2
*(No foundation inspection)i
..................................................................................................................
Addition
oor
Sq. Footage
(including Exterior
Roofed.Ahaas)_
Date
Plansireviewed by School District Personnel)
V;
, g!4
School District certifies that -
(Applicant)
(City)
has complied with the requirements of Resolution No.
representing to square fe et.
. -'- - - , -+, 6 Ir
14 V,*. U V
School'blistrict k4pres`enthtiv_e Xr
Paid by Check # Remarks:
(Phone Number)
("'I
(Zip Code)
by payment of $
IAB 2926 $
FULL MITIGATION $
Date
Notice: You may protest the imposition of the fees identified above by submitting a wri"en protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to 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 (CEQA),
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) feeform.xis (10/98)dmm
24L
� I ri 11
91-A)'.J ,
I DP-: T.A I L S
544 L&VEe RD
(7 K) 0 L 15"� C.A
r
13
it
S, K a F
6 44 Q P,5 st
2
� Mf
p4R CE L - I go - Z)
2 IA 2. 9 -3//
5Ge-T A- A
8
SECT 15�11`111
2, FL9 MOIST�
co-ic.
GR. "Z'
coc.
/2 -1/0 -LJ 1q, I
to A). s E -G7 c- c
02--3c -2-6'FLR TOISTS
cw 0 T, Y
ME C
4,
iml a
111JR-D""M DEPAF
APPRC
.41
C%) ?��ISION TO IN ri)AL. 'PLAN BUTTE COUNTY I
Q)0rHv- I)FrAILS-NO r-PAM99' an MINN KEPAMO.-118-00
A P Ph A .01ft v F n
"
D
-T
U-jl'
A,
J-
FT
Su5-Roce f-PL�(-rov cox
cm TOP or FL6-P- ablST-1
le
I::,;, T
x ix Jeer
-4-
WiCbqLl
r
13
it
S, K a F
6 44 Q P,5 st
2
� Mf
p4R CE L - I go - Z)
2 IA 2. 9 -3//
5Ge-T A- A
8
SECT 15�11`111
2, FL9 MOIST�
co-ic.
GR. "Z'
coc.
/2 -1/0 -LJ 1q, I
to A). s E -G7 c- c
02--3c -2-6'FLR TOISTS
cw 0 T, Y
ME C
4,
iml a
111JR-D""M DEPAF
APPRC
.41
C%) ?��ISION TO IN ri)AL. 'PLAN BUTTE COUNTY I
Q)0rHv- I)FrAILS-NO r-PAM99' an MINN KEPAMO.-118-00
A P Ph A .01ft v F n
"
D
-T
if
544 LEFVE6 RP 6P 101-F AP Jbo-o:Z*-jgo
0 P ri m 1-0 vvA LL 44 �--T I PL—:AM AR E-A
aeam 'rid
V, 8
61tiC LAM /-A-"
3 j'A, A " �-
I _)� (MAx 159AK) 12�)
CAPACITY 580 PIAN
LOAD 17"/fC!'
4LUE LAk 6APy: 5gO'� 12':: (,,'76'0"
A It 4- F0 ST CAP Y = 3 10,9 "- v pi pj-- s I -p.4 i NCV
+ 1002 &-5Tk4/,\lcD
A v 4 Po6T- 5'
3 P05r ' 5, ALL R95TRAWC-D
(5F� PI -AN)
C-?�A+ (5EP PG6 4MA699D)
/ -concrdfrs Pfer- 1?- 12
I- 4RA176
12'MAX UTIOTY
Fy po 15 c- n y
0 EA f -I A
AKEA
(-V
36
56-1) L'067M rz T) cc.,,
:5 e
A—
Y
-7 ol t
IWTTE COUNTY
MAIM DEPAmnlumEwle
APP R 0 � E D
J.
PLC- k6t,14 CA 15-637
tl-20,02-
Fooploo
I W
c:
m
C-)
310
m g 2e
0$ : , :�
>
NZO
73 tv)
V -J
XD 70
Tj
11
z
Q)
TT"
SM
A
=7 -77
04
IMF -
XD 70
Tj
11
z
Q)
TT"
SM
7 NOTES
RESIDENTIAL
PERMIT NO. 024-180-024 03-0209
_PEEKEAA�RANCH
544 LEVEE RD., GRIDLEY,
OPEN DECK
'_1
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date)
Signature
CHECKED
BY.
4 = OK'
0 = Not OK
NotApplicable
Not Re9dy
COVERS, CARPORTS, GARAGES (Plans) OK except #'s
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except ft
Soils -Size- Depth -Spacing-Connectors-Steel
1.
Zoning Req u irements-Setbacks- Easements
Decks, Girders and/or Joists- Decking - Bracing -Stairs- Rai Is
2.
Soils; Special MH Support Sketch
Wood Awn.; Posts-Beams-Rftrs-Connectors
3.
Sewer; Location -Test- Fall -C/0 -Concrete
5.
4. Water; Location -Test- Easement Needed (Sketch)
wC6.
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
10.
6.
Gas; Location -Test -Wrap;-/ P' L 'ft.
P Nat. or/ P' L "ft./ PLPG
1 9.
7.
Well Clearance & Disconnect
Roof; Shthg-Roofing
8.
Utility Clearance
.12.
Braced Wall Panels
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 Requirements -Setbacks -Easements
2.
Footings; Size-Spaci ng- Marriage Line
3.
Gas; MH Test- Demand -Valve-Connector
4.
Electricity; MH -Test-Crossovers-Breakers-Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector
7.
Water and Sewer Connected -C/0 to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type- Instal lation-Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PERMANENT END*SYSTEM (ONLY)
1 .
Zoning Req uirements-Setbacks- Easements
2.
Footings; Size -Spacing- Marriage Line
3.
Blocking
4.
Gas; MH Test- Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11.
Verify #'s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date DEQVit,
COVERS, CARPORTS, GARAGES (Plans) OK except #'s
c T.
Xhing Req uirements-Setbacks- Easements
atO"Footings;
Soils -Size- Depth -Spacing-Connectors-Steel
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
-4.
Decks, Girders and/or Joists- Decking - Bracing -Stairs- Rai Is
5.
Mir 4.
Wood Awn.; Posts-Beams-Rftrs-Connectors
Elec.; Enclosures; Conduit Entries -Terminals -Listed
Shthg -Frg -Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
wC6.
Carports; Windows -Doors
Health Department Approval
10.
V'Frmg.;
Sills-Anchors-Studs-Rftrs-Trusses
1 9.
Siding; Nail i ng -Veneer -Stucco -Mesh
%A_jj�,
Roof; Shthg-Roofing
'AU 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, 5istance-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
4 = OK
0 = Not OK
- = NotApplicable
. = Not Ready
RESIDENTIAL
Date
UNDERFLOOR (Plans) OK except #Is
Date
1. Zon i ng -Setbacks- Easements- Flood -Slope
Date
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. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel- Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftq.-Steel
9. D.W.V.; Fall-Fifting-Test-2 Way C/0 -Sewer Test
Date
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
Date
11. Water Pipe; Test -Anchors -Regulator -Service Test
Date
12. Electric Underground
Date
13. Plenums & Ducts; Clearance- Material-Suppbrt- Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
(Single & Duplex)
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties- Purlin-Roff Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection- Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (P rmit) 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 Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler; Test
62. Insulation -Walls -Ceilings
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #s
Date
24. Fixture & Transformer Clearance -Ins. Protection
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
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 Al
31. Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or Al
Insulated Neutral Q Yes C3 No
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
75. Garage Fire Door; Swing -Landing -Closure
Date
Card B-1 Date Card B-1
Date
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
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #s
41. Sills Proper Materials & Anchors
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Walls (rat proof)l
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties- Purlin-Roff Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection- Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
Property Line Firewall & Openings
-53.
54. Ext. Doors -One X -Check Garage 3rd Story, 2 Exits
55. Stairs; Width- H eadroom- Rise- Run -Landing- Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. 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.Fl. & 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 -PRY
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.Fl.)-Romex Protection
80. 1 nsulation-Foam- Looked in Attic
81. Guard Rails & Deck Construction- Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor LI Yes
83. Following InstId./Drive EI Yes 0 NoMalks Q 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 Inspections
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
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
Z�
:R
?o S
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
completed. It you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
F ---E
WO—W-ww"Ab
i
COUNTY 0 BUTTE
BUILDING DIVISION
DEPA TMENT OF DEVELOPMENT SERVICES
411 Main Street *Chico, CA - (530) 891-2751
7 County Center DrIVEE�-P'roville, CA - (530) 538-7541
CORRECTION NOTICE
6WNER 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
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
t
Date sp
REV 10192
REQUEST FOR INSPECTION zftrmit No.
Location
0 Owner:
Call (j Phone:
e__
Contractor:
BLDG.
PLUIVIB/IVIECFQ!��
M.H.I./M.H.U.
PRE -
INSPECTION
F
Rough
Rough
Fnd/Ftg
�FF5rame derfloor
Top Out
Temp. Service
Job Status
, Lath
Gas Pipingrfest
Main Service
Corrections
Permit Renewal
Stucco Brown
Temp. Gas
Underground
Final
Verify Utilities
Woodstove
Sewer Piping
Well Circuit
Ex Mobile Site
Brace Panel
Water Piping
POOL
Insulation
ShowerPan
Nailing
Gunite
Demo
Bonding
Light Niche
Corrections
Corrections
Corrections
Final
Final
Final
Corrections
Ready for
,
. I
I
Final
.1
Inspec.on:
Date: Comment:
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 -
C
to I? - ?e
)WNER PERMIT
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 con >a t this office immediately.
L4 i rL c' -
REV 10/92
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 * Telephone (530) 538-75410-3 - PERM
(Rev 2/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
024_180_024
ZONING
1 1;�
BUILDINGPERMIT
OWNER
PEEKEMA 'RANCH
TELEPHONE
946-34�4-T
SO. Fr. OCC. BUILDING VALUATION
240 Q 6- 8- Q Q
Q
OWNER'S MAILING ADDRESS
905 ALDcANDER Ay -y-, c.7�TmEy- cA 9
.
-59 -42 -
CONTRACTOR'S NAME
OTvINER
TELEPHONE
CONTRACTOWS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAJUNG ADDRESS
Total Valuation_ jr-oo rn
ARCHITECT OR ENGINEER
LICENSE No.
Filing Fee .
—$ 20.00
—Permit Fee
$ -39.00
ARCHITECT OR ENGINEEWS MAILING ADDRESS
Plan Checking Fee
$ 95.,19
BUILDINGADDRESS
944 I= RD GRPIDIEV
Energy Plan Checking Fee
$
$
J
PERMIT FEE
$84.35
LOT NO.
SUBDIVISIONS NAME
1
PARCEL MAP
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 0 Remodel 0 Utilities 0 Installation 0 Other 0
Describe Work: OPEN DECK
piping system 1 - 5 outlets
15.00
—Gas
Building sewer
15.00
Mobile Home I S I G I W
ER!!
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20-00
( 60.0v OR LESSS
Main Service . 'OR LE
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 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
rLq&f.or 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.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
I am exempt under, Sec. Business and Professions Code for this
00 reason
Main Service 200A TO 1000A
46.00
NEW CONST. DW:LUNG OCCUR
OR ADDNS. ACC. S.
S5,
3.50FT.
CONS LT' -O T
=RESIDT r,, C�,,f,,
@7.50,
OWE.RAP.PARATU
P.IN. CSI R.
Ex. Occup. OUTLET OR FIXTLIRES
20 @ 1.00
aAL @ .50
O.FIXED APP . 0"
Ex. Occup. (Ra .) El
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
1 23.001
I I
PERMIT FEE
WORKERS' COMPENSATION DECLARATION
r1he by 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.
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
Arthygth,2omply with those provisions.
/V I
f ate
ignatur:e of Applicant Owner 0 Contractor 0 Agent
7
At �ermit is required for excavqktions over 60" deep and demolition or construction
it
of structures over 3 stories in heighl
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEiE $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 84. 35
HAZ. D. FEES IMP FLOOD COF PARCEL I FV I HD I IS UE
I
T-7- !a�-1 T-
This permit is hereby issued under the
of the Butte County Code a d/or
indicated above for ich fe s have
By
RMIT EXPIRES ON
PE 29Q
applicable provisions
Resolutions to do work
been paid.
Date
- 4/
(oate)
ReceiptNo.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR - PINK -INSPECTOR GOLDEN ROD -APPLICANT
.� - X..'a, �
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 Coun Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
ty,
PERMIPAPPLICATION, DATA SHEET
d q - I r�_ /,,I
OWNER: ASSESSPR PARCEL NUMBER Vat
f
Proposed Building Use: Counter Technician: 3W10V Date: 114 Z/
o apm
Items required in order to apply for a permit. All boxes NWST be checked OR marked NA in order t� p �y
Z-1. Plot plans, 3 or 4 sets, signedty the preparer of the plans.
,dA:T- Complete plans, 3 or 4 sets, signed by the p'reparer 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. Energ' compliance design and supporting documentation in duplicate.
y
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. I
0 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed by the enjZineer.
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 Accessory 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 ....................................
X1'6. Sanitation and plot plan approval from the Environmental Health Department in
0 17. City of Chico Plumbing permit ...........................................................
0 18. Calif6ii7iabZ_0artmdnt of Forestry plan approval 0 paid. Sent by: . ......................
0 19. Plann'ing approval for (A) Use: _(B)Parking: . (C) Parcel Check:
0 20. Contact Land Development about 0 Improvements, 0 Drainage ...............................
0 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).1
0 22. Pre -Inspection 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 (0 Given to owner, 0 Mailed to owner) .....................
0 26. 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 30. 0 Grant Deed, E3 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D.
0 3 1. 'Other: a! / gn
When issued Telephone b 61 L / and hold for pickup.
I have been iqbrmed of the above items and requirements for obtaining a building permit.
cant:
1. Index permit application for the above items numbered: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised cf the above data by 0 phone, 0 mail., counter, by Date:
Contractor, designer, owner, was advised of tl� above data by 0 phone, 0 mail,�- "CX'�,c'b'�u'nter, b Date:
Pldhs reviewed by: Date: Plansapproved Date:
Structural reviewed by: Date-'; 7. Structural appro�,M'6�" e�I%V Date:
y:
Note transfer by:
-1 ellnw- Ruildinf, Diviqinn
TO: - - Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
E.H. USE ONLY
Plot Plan Anach.d
Rout Rap"Amchad I .
Sent to G.D. -1 -7 LI /?D'�
2-q - /'�b - 2-'--)
Owner Location AP
Plan Approved for: Sewage Disposa.1, Water Supply: Public Private Well �-
r-7-�
Clearance for dwelling. Other 1,2
Hold final for:
Final clearance O.K. for:
NOTE:
4-S
Environmental Health Specialist Date
8/96
......... .. ........
N
KREAGP
,Appk(y, [�,-75A6�OS
;--"+ LE-VG'C- P-OAD G- k I P L- E r
YLO —1 P L-A t -j
attached
On
,Llil Con
MaLru—cti
EC m e n t s
page.,
9 t 1, TF, MY
rZ; CJ
- Te�
0,'� L;
A -P P 5P
Tr
-M
Q ;',,I
0 1-] F_ LL
BUTTE COUNTY'
0 0 4) e- e o
BUILDING DEPARTME
`KP-P-R-0-V-E:D--
--y
E COUN
ING DIVISION- BUILDING PLAN APPROVAL
C�� i< .) 14--�--VL - M I G IWPARTM Eff
Date. L0,,)'LD!K
P
Lar)dscaor)q: R 0 E D
BUTTE COUNTY. L� F-- 14 A
:Ie
PU1,1UNING DEPARTME...-N.11, PR OF NA —P'u t -JI - C�4 L-.: r-
v.1,A SH -74
"`RO� EP
A P
-0 achleye load an C85 Is 3,
i x3 1 3 11,� Ili, F i 2 i �', 26�50 4. Minimum -,!--ibP, c: nly-,
r.Q7 k t rc�t �, ;
I
C -N
I pi�
C44
2
L -
Z5
I
Qj
2
x <
LL.
LLUI
tl
�.V
BUILDING DEPARTMENT
A9% Im 9ft
F V t - u
� �c
'rP-rATtD 2v.6 P
,
TO CONC. POWQ�'rIOJ
-4 RC�',A), P057-
601jac-f-p 2 ftowD OC69
FDAT
A-r�p joicF
��I; 701ST Ph-,JGEt5
COUNTY OF BUTTE
Oroville, California
GENERAL CLAIM
CLAIMANT: PEEKEMA RANCH
ADDRESS: 4817 WELLINGTON PARK DR.
CITY & STATE: SAN JOSE, CA 95136
DATE OF CLAIM: 12/24/02
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
lka;
IMPORTANT.
SEE INSTRUCTIONS
ON REVERSE SIDE
,ATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT
OW�ERS_RENEWED
PERMIT; AP# 024-180-024, BP# 02-2703, RECEIPT# 3E3828 & 363989
9-27 OWNERS* J2RJZKED4A RA
TOTAL AMOUNT PAID:(RFCFTPT# 3r,3()Aq-$ 11q_7n/ug8,)8_28 cm� 198.20
RETAIN RFFIJND PRQCFSSTNa FPR- -251.00
RETAIN BUILDING PFRMTT FTI.TNG FF.F-- 2
RETAIN PLAN CHECKING FEE- 70.201
TOTAL AMOUNT TO BE.RETAINED: i15.20
0
1
ITOTAL AMOUNT TO BE REFUNDEF.- TOTALI 83.
00.
he undersigned, declare under penalty of perjury that the services or articles claimed hav erformed or delivered, and that this claim is true
I correct as stated.
ited this day of A&V
at e�� Calif. Signature of Claimant:
the undersigned, hereby certify that, to the best of my knowledge, the services or %dcified above h Jen,rformad 6r deRmed
11
3t there is a Budget Appropriation I I or Specific Board Approval I I (Check one) the
a d
ited this 30 day of DEC .' AN
__g,9 -at OROVILLE Ca*
--- 1---Deoarkment Head or Authorize *Duty
tpt. Code 440-001 Exp. Code 45210500 PAYABLE FRdM BUILDING PERMITS FUND
apt. Code Exp. Code PAYABLE FROM FUN
eptCode Exp. Code -PAYABLE FROM FUN
00 NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
DEPT. & SUB. I PROJ. I SUB. OBJ. I CLAIM NO. I INV. NO. I INV. DATE I ENCUMB. I GROSS AMT.
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive Oroville, California 95965 9 Telephone (530) 538-75 0.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
024-180-024
ZONING
A – An
BUILDINGPERMIT
OWNER
PE KAMA RANCH
ftuJPRdNE
SO. Fr. OCC. BUILDING VALUATION
Cont st 1000.00
OWNERS MAILING ADDRESS
7519 NE 69f: ST.) VANGOVER, WA
cot,rrRA&T6R--s -NAME 98662 TELEPHONE
0L7NT7P
-7
7680.00
coNTRA,c7T&;�'WiLma ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $ q,,,.Rn on
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Fee $108.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
—Permit
Plan Checking Fee $
70-20
BUILDINGADDRESS
544 LEVEE _RD_ GRITTEY
Energy Plan Checking Fee $
PERMIT FEE $1
C)P, _ go
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
Each Trap 1
7.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
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: REPLACE FOUMATION
piping system I - 5 outlets
—
15.00
—Gas
Building sewer
15.00
Mobile Home IS I GI W1
@20.00
PERMIT FEE
ELECTRICAL PERMIT
Filing Fee 20.00
000 R LES:
Main Service .VA 2R LES
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 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:
,K 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
Main Service 200A TO 1000A
46.00
NEW CONST DW:WIG OCCUR
OR ADDNS. ' C.
So.
3.50FT.
NEW CONS:1.7_ '_O
NON-RESID. =. CYRTCIT.
@7.50
POWE.RAP= US
CIR.
Ex. Occup. OUTLET OR FIXTUR ES
20 @ 1.00
SAL @ .50
Ex. Occup. ..-ED APP
(.M...R.)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.001
I
PERMIT FEE
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 ofthe Labor Code, for the performance of work for which 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 if the permit is for 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 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.
W
X VLA e4""d Date
Signature of Applicant - R'Owner 0 Contractor 0 Ageni
An OSHA permit is require4 for excavations over 60" deep and demolition or construction
of structures over 3 storiel in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ -.98. 20
HAZ. D. FEES IMP I FLOOD I CDF PARCEL I PO HD
-71 1
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
indicated above for which fees have been
By D
PERMIT EXPIRES ON �7
I ( Pt.)
provisions
to do work
paid.
e / 0
d -7
I I
ReceiptNo. _�� "28 78-50 (al Y
WHITE-D.D.S.-B.D. CYNARY-ASSESP/ PINK -INSPECTOR GOLDEN ROF-_APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - bUILUIMU -IJIVISION
it No
7 County Center Drive * Oroville, California 95965 - Telephone
Rev. 12/96) 1-7 OL -J. APPLICATION AND PERMIT
';VAL�U�
L BUILDING Plikiii
024- i�o
TNJPHDW S101. FF4Tr.00C. BUILDI 3 IATIO �N�jj
I jig I'll-= 12.0
kol's 7--
1,aM V
CONTPACW)PI*2 0 Y,/ YA
COWPACTCA'S M#AJNQ ADDIFIEN
cc =a=t�) j
LIP40ER'S W"40 ADDRIE112
AFtcmffL-CT Oft ENGINEER
AacmMECT OR &JOINEMI Lt*AJNO ADDRIESS
allCDWGADCFtESS --,i I I I
LOT NO. I susoNso"IWAC
USEOFSTRUCTURE
SF Duplex 13 Wbilehome 13 Otheor
TYPE OF WORK
New 0 Addition 0 Remodel 0 Lhiftes 0 Ins-tAlliltiOn 0 Other Of
Describe Work:
At-)
STS Ali
mwebe
o44he.tr 4
7 1-
4% bcO?L,+ ibly4d
Fireplace I
Total Valuatlo
S
:- 20.00
I Permit Fee 1OW11 9V on= I
Plan Checking Fee I $
PERMIT FEE
PLUMBING PERMIT
Each Trap _
Solar or heatNmp water heater
Water piping \
'�* or vent
Each gas wa r hea
Gas Ploina system 1 5 outlets
Building sewer
Wbile Home
7.00
23.00
15.00
15.00
15.00
15.00
(9?20.00
20.00
Ex. Occu2.,.. I OLITLAT OR FTWO
PERMIT FEE
Ex. Occup. (
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service (
=9 = )
23.00
Win Service
20" 'to IOWA
46.00
few COMT.
OA ADOM.
OWBAJW P.
&A=.M . )
Sal
3.5o".
Ex. Occu2.,.. I OLITLAT OR FTWO
i -:90
Ex. Occup. (
5.00
Temporary Service
23.00
Wbile Home Facil.:.::
20.00
Msc. Wirina
23.00
I PERMIT FEE S
I MECHANICAL PERMIT Filing Fee 1 20.00
6.50
Mobile Home Installation Fee I $'\# I � I
Energy In3pection Fee IS
occ I --T. "PI! ITOTAL FEE $
L I M FW I INIP I -A=0 I
This permit is hereby Issued under the aPPk*bI6 provisions
of the Butte County Code and/or RoWkfJCn3 to do work
indicated above for which fees have been Paid.
By Date
PERMIT EXPIRES ON
j - COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
yt_ (_04-6s, I -
OWNER: ASSESSOR PARCEL NUMBER
Proposed Building Use: YR 0c, Counter Technician: Date: C?
Items required in order to a�ply for a pirmit. All boxes MUST be checked OR markeld NA in order to apply.
0 L. Plot plans, 3 or 4 sets, signedty the preparer of the plans.
0 2. Complete plans, 3 or 4 sets, signed by the p*reparer 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. Energ � compliance design and supporting documentation in duplicate.
y
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) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
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.
I 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 Accessory Building Form filled out by the owner .....................................
0 12. Hazardous Material Form .............................................................................
0 13. Other
Remaping items needed to issue the permit. (May require additional p n review upon receipt of the followinj items.)*
Q/1 4. 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 Development about El Improvements, El Drainage ...............................
0 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0 22. Pre -Inspection 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 (0 GiVen to owner, 0 Mailed to owner) .....................
0 26. 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 30. 0 Grant Deed, 0 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 31. Other:
When issued Telephone and hold for pickup.
I have been informed of the above items and requirements for obtaining *a building permit.
9
Applicant: Date:
1. Index permit application for the above it s 1
2. Additional items required fn
Contractor, designer, owner, was advised cfl�
Contractor, designer, owilerwas advised of the
Plans reviewed by: _ . 0-451 Date: -
Structural reviewed by: Date:
Note transfer by: Date:
Plan Check Letter
�y' 0 phone, 0 mail, 0 counter, by _Date:
by 0 phone, 0 mail, 0 counter, b Date -
22, Plans approved by: Date: f
Structural approved by: Date:- 1 .1
Yeflnw- Aidlrfina N�ici_
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER
P BUILDING USE
A. P.
DATE -9.0 -7
RECEIPT #
BUILDING PERMIT FEES
Balance Due ...................
Additional Fees Due ................. $
Additional Fees Due ................. $
Revised Plan Checking Fee ............. $
2. SCHOOL DISTRICT FEES
(paid at District Office) (Available after Plan Check)
3. SHERIFF FEES (paid at Building Division)
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
(paid at District Office) (Available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA 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
DATE REC.
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees
may be changed during the plan checking process.
APPLICANT DATE
Pursuant to Government 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 project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during which you 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)
k
09/21/2002 07:,14 360-256-1729
024 - 180, 0 2 4 -
LOT V L -A? -J
G T PEEKENIA PAGE 02
LSVEF kOAD G -R I PLE'r
N
.. . . . ........
lt�Tlr, TAN K
AMAGiC
,Are IL -75 MAC�'S
0 VJ E LL
Hov5e,
644 uvcc. Fpj
So PPL,(
P4V POLE
t- E v r�-. ra rzvA D 2-710
BIJTTE couiyqftp
BUILDING DEPAR
9% TMEN,
App
�3 V T T C W ArE- R 15 TiZ k CT C, 4, N V . L 0
E D
6'T l7t-DK&MA
PROFF.Y5 IONA KGO C4!WT- ZF65
0910 -??,/2@02 07:14 360-256-1729 G T PEEKEMA
FA* aL
544 LE -VEE
-or 6
ews)tv 7"
-5,ie-.,w v-)
PAG E 01
VZ4-40-024,rp
,A",je 2" Y,,;)�
5Ccr A- A
A/r,
FkAl C
PA Alp,
A 1.1' -
.44
t
00
SIA
r3
BUTTE.COUNTY
DEPARrn-,;-q
APm P R 0" V E-,
- f"S'
4('
q
b.o++t*4
�CA Le
SL- CT
24�1 STS
C-0 - C.
3
5 m"T C - c
.777'-
2 6 FIR 3701STS'
7 ee
T,
04
r*)F
ONVNER-BUILDER VERIFICATION
A-ztencion Property Owner:
An -owner-builder" building permit has been applied for in your name and bearing YOW
please complete and return this information at your earliest opportunity to avoid ann_
in processing and ismling your building permit. No building permit will be
verification is received.
I personally plan to provide the major labor and materials for construction of
property improvement: YES PC No C3
I HAVE 9 HAVE NOT C3 signed an application for a building permit for th
j. _,�have contracted with the following person (f=) to provide the prop
ADDRE-5S..... CITY: Z
CO"
'CTO�
P H 0 NE R'S LICENSE N
,X:��'oNo�ing
A e Ilowing person to coordinawi
I plan to provide portio of this work, but I have hired th
�s w.
supervise, and provide the m * r work:
N.JCNEE:
ADDRESS: C=:
C
P H 0 NNE: CONiTR.4, 'S LICENSE NO,
5. 1 will provide some of the work but I hav contmracted ed) the following persons to provide
)r
the work indicated:
PHO
LN AIN I E ADD S PHOrN47F TYPE OF WORK
S4GKfD:
PROPERTYOWN7ERA- �eo/44-"'z &e
SOCIA1 SECURM NUMBER:
DATE.)..
NO TE: Th is 0 wn er-B uilder Verijklation is req uired by Section 19831 and 198J2 4VAW
California Health and Safety Code. This verification must be compl&W md
returned to our office before we are permitted to issue the permit.
OVER
OWNER BUILDER INFORINIATI01N
C
Aa application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
der ible party afrecord such
For your protection, you should be aware tba as -owner-buil you are the responsi
a permit. Building permits are n ; ot required to be signed by property owners unless they are pasonally
own work. If your work is being performed by someone other than yourself . you may protect If from
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 subcona-act. you should
be aware of the following information for your benefit and protection:
if you employ or otherwise'engage any pawns other am your hmediate ftmily. and the work (including mcmial
and other costs) is S300 or more for the entire project, and such persons are not licensed as contractors or
subcora-actors. then you m ' ay be an employer. M employer and you are
I;. you are an emplover, you must register with the State and Federal Govern ents as an
subject to several obligations includ . in- *state and federal income = withholding, federal social security taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
+ Therc mav �e Friancial risks for you if you do not carry out these obligations, and these risks are especlaHy serious
with r:sc)cGc,,o worker's compensation insurance. Service (and,
+ For rnere specii-ii: information about your obligations under Federal Law, contract the Internal Revenue - .
i Lf'vo u wish. d,.c U - S - S mal I B us iness Admin istration). For more spec if ic information about your obligations under
Scate Law. ccrtac- the Department of Benefit Payments and the Division of Industrial Accidents.
1-7 the mcru: is intended for sale. property owners who are not licensed contractors are allowed to p etform, their
work personally or E�xou&h their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice oC unlicensed persons professing to be contractors is to secure an "owner builder" building
is providing his or her own labor and material personally. Building
permit� erroncous!v implying that the property owner
permits are not required to be signed by property owners unless they are performing their own work personally.
InforTna(ion about licensed �ontractors may be obtained by contracting the Contractors State License Board in your
coru-nuniry or at 1010 Nk Screet� Sacramento, CA. 958 14. Lrm that you
Please comple'e the -Owner Builder Verification- on the' reverse side of this form so that we can conr
are aware of these matters. The building permit will not be issued until the verification is returned.
0
MLA &L-1
N111 C. Vidim C.B.O.
S
NI ger, Building Inspection
NO TE: TJs �s 0 w rr er- B u ilder Info rM a IiO /I is req u ir ed by Secdo n 19,810 of M e Califo rnia HCO1111 Ain d S40fty Codg
OVER
1/ 2 Cl Cl 2 0 7: 59 360-256-1729 G T PEEKEI-49 PAGE 01
W01,
loc rrlt"ed 17�t
77v,
�d dlh'� ��W41 b141
tf ho /.rw n n
C, lie P1411 -C Ae ��V aj5 61 'av- Vltg IAW
�69
la�t
tit", 17, Ale- o 14t, flo t'v �m�me- o* v ewtve-
Plewe cfll t?4 at 6�we a, 4ota;ho7,
-61-Itt
NOTES RESIDENT. IAL
024'-180'-0'* �/02-2703
PERMIT NO. -PEEKAMA!" Nuff
[,'7'r r
'44 LEVEE Rp, GRIDLEY
REPLACE FOUNDATIOI�
SPECIAL CONDITIONS
CHECKED
I BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date)
!gignature -
4 = OK
0 = Not -OK
- = NotApplicable
. = Not Ready
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #Is
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-/ /Aimp-Concrete
6.
Gas; Location -Test -Wrap;-/ /" L 'ft.
P Nat. or/ /" L "ft./ P LPG
7.
Well Clearance & Disconnect
8.
Utility Clearance
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Card B-1 Date Card B-1
1 .
Zoning Requirements -Setbacks -Easements
Card B-1 Date Card 5-1
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test- Demand -Valve -Con nector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
6.
Water; MH Test -Regulator -Connector
Elec.; Receptacles and Lighting, Distance-GIFI
7.
Water and Sewer Connected -C/O to Grade7HD Approval
Elec.; Pool Lighting; 15 Volts-GIFI
8.
Gas and Electricity Tagged
Elec.; Enclosures; Conduit Entries -Terminals -Listed
9.
Tie Downs -Type -installation Cert.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
10.
Exits; Insp.-Sketch
Elec.; Grounding; Equip. w/5'Cirdulating Equip. -Pool Lghtg.
Boxes- Enclosures -Panel boards- Ins. to Main Conduit
11.
Cert. of Occupancy
Health Department. Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
1 .
Zoning Requirements -Setbacks -Easements
2.
Footings;, Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve'
5.
Electricity; MH Test
.6.
Water; MH Test
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11.
Verify #'s with Office
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 #Is
1
. Zoning Req u i rements-Setbacks- Easements
2.
Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Con nectors
Shthg-Frg-Bracing
5.
Alum. Awn.; Colu mns-Connections-Splice- Decal- Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -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 5-1
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-GIFI
5.
Elec.; Pool Lighting; 15 Volts-GIFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5'Cirdulating Equip. -Pool Lghtg.
Boxes- Enclosures -Panel boards- 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
4 = OK
0 = Not OK
- = Not Applicable
. = Not Ready
RESIDENTIAL (Single & Duplex)
Date UNDERFLOOR (Plans) OK except #Is
1 . Zoning -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. Sternwalls, 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 -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 C�rcl B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #s
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
17. Water Htr.; Vent -Access -Combustion Air Baffle
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
18. Water Pipe; Test & Anchor -Nail Protection
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
19. D.W.V.; Test Fittings & Anchor -Nail Protection
Garage Fire Protection Framing -RC Channel
20. Shower Pan; Test, First Floor -Tub Access
Property Line Firewall & Openings
21. Test Tub & Shower, Second Floor -Tub Access
Ext. Doors -One X -Check Garage 3rd Story, 2 Exits
22. Gas Pipe; Sixe & Anchors
56.
23. Fire Sprinkler; Test
57.
Siding -Nailing Veneer
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Brace Interior/Exterior Wall Panels
24. Fixture & Transformer Clearance -Ins. Protection
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
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
31. Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or All
Insulated Neutral Q Yes El No
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
84. Stucco Brown -Finish
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
3,6. 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
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #s
41. Sills Proper Materials & Anchors
Date
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
Date
43. Bearing Walls over Girders & Floor Nailing
Date
44. Draft Stop in Walls (rat proof)
Comments at Final:
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47.
Hangers -Post Caps -Anchors -Connectors
48.
Cling. Joist-Rftr. Ties- Purlin-Roff Brac.-Truss-Shting.-Rtng.
49.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
FINAL (Plans) OK except #s
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
-51.
Garage Fire Protection Framing -RC Channel
-52.
53.
Property Line Firewall & Openings
54.
Ext. Doors -One X -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Head room -Rise -Run- Land ing-Fi re Protection
56.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57.
Siding -Nailing Veneer
58.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. 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 -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- Land i ngs
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.Fl. & 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.
Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
-73.
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-RR.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (FFI.)-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 E) Yes
83. Following Insfid./Drive, 0 Yes 13 NoMalks 0 Yes 0 No/Planters 0 Yes Q 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.Fl. 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 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 - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
ar J* r, -PERM50.
tt 4. . _7 County Center Drive 9 Ciroville, California 95965 * Telephone (530) 538-75V
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
09.-I-80=094
ZONING
AQ
BUILDINGPERMIT
OWNER
EMAMA, RANCH
TAM . E
SO. Fr. OCC. BUILDING VALUATION
Cont st 1000.00
OWNEWS "UNG ADDRESS
7519 NE 69th. ST VAN
00
CONTRACTOR'S NAME I _00M
(IJM
TELEPHONE
CONTRACTOWS MAILING ADDRESS
CONSTRUCTION LENDER
rFireplace
LENDER'S MAILING ADDRESS
Total Valuation
T
ARCHITECT OR ENGINEER
r 40.
Fee $ 20.00
-Filing
Permit Fee $108.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $ 70.20
BUILDING ADDRESS
54 MTDI"
Energy Plan Checking Fee $
$
PERMIT FEE $,I<)8,20
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome [3 Other
SPECIFY
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 13 Utilities 0 Installation 0 Other 0
Describe Work: RERACE FOMATION
Gas piping system I - 5 outlets 15.00
Building sewer 15.00
Mobile Home I §]-dT W -F 920.00
PERMIT FEE
ELECTRICAL PERMIT Filing Fee 20-00
( 6000.V D.R UE.SS
Main Service LE 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 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:
1, as owner of the property, or my employeeswith 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. DW
.!�LING OCCUP. SO.
OR ADDNS. C S. 3.50FT.
NEW CONST. OUTLET
MULT", CIRCUITS 97.50
_NON-RESID.
PONI.E.RAF�FARATUS
0". CIR.
20 @ 1.00
Ex. Occu OUTLET OR MTURES BAL @ .50
OFIXED APP M OR
Ex. Occup. . (RES16.) EA 5.00
-
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
-
I
PERMIT FEE
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
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
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.)
0 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to 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.
7
X / �, r I Atli I/ Date iAlk 2-
Signature of Applicant Owner 0 Contractor [3 Ageni
An OSHA permit is requireq for excavations over 60" deep and demolition or construction
of structures over 3 storiest in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTALFEE$ 198.20
HAZ.
I D. FEES HD I
WUF4
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.
Bv Date
PERMIT EXPIRES ON
(Date)
I -
rReceiptNo. J10.,J82,8 78.50 1131,43FIXq3 //(1.1/3
w 7
WHITE-D.D.S.-B.D. C ARY-ASSESPA PINK -INSPECTOR GOLDEN ROD -APPLICANT
T E
COUNVY OF BUTTE
BUILbING DIVISION
DEPARTMENT 09 EVSLOPMENT SERVICES
411 Main Street * hico, CA 9 (530).891-2751
7 County Center Dr; et -538-7541
Ne Oroville, CA - (530)
CORRECTION NOTICE
[-fC t L-' A n4 Z - 2 7'J3
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
completed. It you have any questions pertaining to this matter, or need additional explanation,
please contact this office immaiately.
/4 6,L
- /Y le'zf -� 1-14 /,( -r� <�--� -
Date
REV 10/92
I
4spector
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPaENT SERVICES
411 Main Street e Chico, CA - (530) 891-2751
7 County Center Drive Oroville, CA (530) 538-7541
CORRECTION NOTICE
A-
0
ER PERMIT NO.
A routine Inspection Indicates that the following violations of butte county Ordinances exist at the
a.bove address and should be corrected. Please notice this office when correction of work is
com eted. If you have any questions pertaining to this matter, or need additional explanation,
RL
pI6ase-cbntac1 this office immediately.
Ht:V IU/VZ
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES T
411 Main Street - Chico, CA * (530) 891-2751
7 County Center Drive - Oroville, CA - (530) 538-7541
CORRECT16N NOTICE
ER 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. If you have any questions pertaining to this matter, or need additional explanation,
ple, t this office immediately.
7�c -z— .
0t) t (? t-- /) CWT ro R,
Date Z 4-6 2 --In
I
REV 101 92
NOTES
RESIDENTIAL
OF24-180-024
1:, r E
13EEKE-MA RANCH
I r
r
544 LEVEE R
r13,,'�Gk EY
r EMODEL/REPAIR R0*017. WINDbWS,
LEC. SERV., SVIEETk6ck & PLUMBING
SPECIAL CONDITIONS
CHECKED
BY
— SRA
— FLOOD CERTIFICATE REQ.
— FIRE SPRINKLERS REQ.
—SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY
Address
GAS
Meter By Date -
ELECTRIC
Meter By Da
Z_
wtv-
,io $,I
JOB FINALED (Date)
Signature
OK
Not OK
Ndt Applicable
Not Ready
MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1 .
Zoning Require ments-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./ 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 #'s
1 .
Zoning Require ments-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 Gracle-HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cent. of Occupancy
12.
Permanent Foundation Only; License Decal
Date Card B- I Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Require ments-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-Seams-Rhrs.-Connectors
Shlhg.-Frg-Bracing
5.
Alum. Awn.; Columns -Co nnecl ions -Splice- Decal- Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rhrs-Trusses
9.
Siding; Nailing -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
FINAL (Plans) OK except #'s
1 .
Setbacks- Easements
2.
Soils; Compaction-Struclure 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- Enclosu res- Panelboards- Ins. to Main in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
V= OK
0 = Not OK
- = Not Applicable
* = Not Ready
Date
RESIDENTIAL (%c
Date
Underfloor (Plans) OK except #'s
Hangers -Post Capt -Anchors -Connectors
1 .
Zoning -Setbacks -Easements -Flood -Slope
Cling. Joist-Rftr. Ties- Purlin-Roff Brac. -Truss- S hti ng. - Rfng.
2.
Fig., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
Attic Access; Size & Romex Protection- Draft Stop -Ins. Baffles
4.
Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
5.
Sternwalls, Main; Stee I- Blockouts- Wrapped
Garage Fire Protection Framing
6.
Sternwalls, Garage; Steel-Blockouts-Wrapped
Property Line Firewall & Openings
6a.
Hold Downs and Special Anchors
Ext. Doors -One X -Check Garage 3rd Story, 2 Exits
7.
Slab, Steel -Wrapped
Stairs; Width - Headroom- Rise- Ru n- Landing -Fire Protection
8-
Piers -Fireplace Ftg.-Steel
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
9.
D.W.V.; Fal I- Filling- Test -2 Way C/0 -Sewer Test
Siding -Nailing Veneer
10.
LIF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
Stucco Mesh -Drip Screed -I'd. Vents-Underflr. Access
11.
Water Pipe; Test- Ancho rs- Reg ulator-Service Test
Glazing Area -Glass Protection -Skyl ights- Plastic
12.
Electric Underground
Shear Walls; Nailing -Bolts
13.
Plenums & Ducts; Clearance-Material-Supporl- Ins.
Brace Interior/Exterior Wall Panels
14.
Girders -Sills -Anchor Bolts -Joists- Vent s- Cripp ies
Insulation -Walls -Ceilings
15.
Access & Ventilation
1 nti Itrati6n-Walls -Windows
16.
Insulation
Date
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Ext. Steps -Door & Sidelight Protection- Landings
17.
Water Htr.; Vent -Access -Combustion Air Baffle
Smoke Detector
18.
Water Pipe; Test & Anchor -Nail Protection
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
19
D.W.V.; Test Fittings & Anchor -Nail Protection
Bedroom Exiting
20.
Shower Pan; Test, First Floor -Tub Access
G.F.I. & Bath Fixtures & Tub Access -Spa
21.
Test Tub & Shower, Second Floor -Tub Access
Elec. Trim & Subpanel, Breaker Sizes & Labels
22.
Gas Pipe; Sixe & Anchors
Stairs & Rails
70.
Date
Card B-1 Dale Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Elec. Outlets & Receptacles at Kit. Counter
23.
Fixture & Transformer Clearance -Ins. Protection
Garage Fire Door; Swing- Landing -C losu re
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
A.C. Duct in Garage -Damper
25.
Size Boxes & No. of Conductors Stapled
Wtr. Htr.; Vents -Clearance -Comb. Air Connector- P.R.V.
in Garage; Above Floor-Mech. Protection
26.
Romex Installed Close to Edge of Studs & C.J.
Plb., Elec. & Mach. Equip. Listed for Location
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
Ins ulation- Foam- Looked in Attic
29.
Subieed Wire Size / ga. Cu or AI-A.C. Wire Size / / ga Cu or At
Guard Rails & Deck Construction- Post Caps
30.
Range Circle / ga Cu or Al -Oven Circ. / / ga Cu or At
Insulated Neutral U Yes ID No
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
31.
Service -Riser Conductors & Ground Main Disconnect
Clearance Looked under Floor Q Yes
32.
Equip. Clearances Panels- M otors- M ech. Equip.
Following InsIld./Dfive j Yes :) NoMalks :) Yes :) No/Planters Yes :j No
33.
Clothes Closet Light -Shower Lighl-Spa Light
Stucco Brown -Finish
34.
Smoke Detector
A.C. Unit Disconnect, Electrical- Plumbing
85.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date C ard B-1
Date
MECHANICAL (Permit) OK except #'s
Ventilation Throughout House
35.
A.C. Ducts Insulation & Support
Glass Protection
36.
Vent Fan, Exhaust above insulation
Corrections from Previous Inspections
37.
Condensate Drain & Overflow, Size & Grade
Gas Test -Meters Tagged, Gas -Electric
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
Water & Sewer Connected -C/O to Grade -HD Approval
39.
Attic Access & Platform if Furnace in Attic
Energy Compliance Cerlificate-Other Certificates
94.
Address Posted
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
Date
FRAMING (Permit) OK except #'s
Card B-1 Date Card B-1
40.
Sills Proper Materials & Anchors
41.
Walls Studs -Nailing Spacing & Braces- Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs_
45.
Headers & Beams -Size & Bearinq
oingle Duplex)
Date
FRAMING (Continued)
46.
Hangers -Post Capt -Anchors -Connectors
47.
Cling. Joist-Rftr. Ties- Purlin-Roff Brac. -Truss- S hti ng. - Rfng.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection- Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One X -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width - Headroom- Rise- Ru n- Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -I'd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skyl ights- Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
1 nti Itrati6n-Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection- Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing- Landing -C losu re
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector- P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mach. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Ins ulation- Foam- Looked in Attic
80.
Guard Rails & Deck Construction- Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor Q Yes
82.
Following InsIld./Dfive j Yes :) NoMalks :) Yes :) No/Planters Yes :j No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical- Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle- U nderg round
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Cerlificate-Other Certificates
94.
Address Posted
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
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street * Chico, CA *.(530) 891-2751
7 6o—u;t'y Center Drive - Oroville, CA - (530) 538-7541
CORRECTION NOTICE
0�
OWNER PERMIT
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. If you have any questions pertaining to this matter, or need additional explanation,
pie se c9nPlathis office immadiately.
4-�
J /) 6 r Z 2
-67
J -K 7
'3
loo�
Htv Wftlz
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive 9 Oroville, California 95965 * Telephone (530) 538-7541 E MIO
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
az4 -1510 -og*
ZONING n
Jqr A-40
BUILDINGPERMIT
OWNER
Peekema Ranch
TELEPHONE
846-3217
SO. Fr. OCC. BUILDING VALUATION
10 sq 600.00
OWNERS MAILING ADDRESS
905 Alexander Ave Gridley 95948
--7,000 00
Coht��R�S NAME
e
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $ 17,rnc
no
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
—Permit Fee
$ 189-00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$ 12285
'"=Mee Road Gridley CA 95948
Energy Plan Checking Fee
$
PERMIT FEE
$ 1,41
LOT NO.
SLIBI)NMIONS NAME
I
PARCEL MAP
I
PLUMBING PERMIT
Filing Pe -e 20.00
USEOFSTRUCTURE
SF CR Duplex 0 Mobilehome 0 Other SPECIFY
Each Trap -
7.00 9R - 00
Solar or heat pump water heater
23.00
Water piping
15.00 i5. QQ
gas water heater or vent
15.00 15
TYPE OF WORK
New 0 Addition 0 Remodel R Utiltbas 0 Installation 0 Other 13
Describe Work: Remodel & repnir rnnf rimpnir rp-roo,
replace windows, rewire & =grade elec spry, q'hppt-r ck
—Each
piping system I - 5 outlets
15.00 1 171
—Gas
Building sewer
15.00
Mobile Home I S I G I W
@?20.
PERMIT FEE
93. 00
rep ir, plumbing -tub, toilet and 2 sinks
ELECTRICAL PERMIT
Filing Fee 20-00
600V OR LE:S )
Main Service .A .. S
23.00 9 -1 _ 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.
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.
I have and will maintain workers' compensation Insurance, as required by Section
3700ofthe Labor Code, for the performance of work for which this permit is issued.
My workers'sompensation insurance carrier and policy number are:
Carrier 7.0"11h r* 4
Policy Number WFZ_19q1QiTJq937
(The above sections need not be completed if the permit is for 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 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
,,�thwith comply �Afflh those provisions.
1�pz� q -f
X z Date
Signatu e 311 Applicant XiDv�ner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in he ) ight.
Main Service 200A TO 1000A 46.00
NEW CONST DW
.%r .0OCUP. so.
OR ADDNS. S. 3.50R. 98 -on
CONS T'_O TLET 97.501
=.RESIDT =11 NIRCUITS
PO"WE.RAP%UATuS
0 CIR.
20 @ 1.00
Ex. Occup. OUTLET OR FD(TURES EIAL @ .50
..1E1 A ORA. 5.00
Ex. Occup. '(R = 6.) E
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00,
Pre-hipsection b. 00
PERMIT FEE $ c)/,
MECHANICAL PERMIT Filing Pee 20.00
Heating 1115.00 L5.00
Cooling 15 00 15 Q0
_J_
Hood 6.50
Ventilation
PERMIT FEt s 50.00
Mobile Home Installation Fee I $
Energy Inspection Fee s
Occ
CONST. TYPE
TOT* FEE$ 568. R9
HAZ.
D.. FEES
rr
-
I r11L
I PVK
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
I
the applicable provisions
Resolutions to do work
been paid.
Date
tr
rReceiptNo. _3q37-2�19(,6,00
HITE-D.D.S. -APPL
W w"T i7 -B.D. CANARY/ASSESSOR PINK -INSPECTOR 4SOLDENROD ICANT
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, OrQyille, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
Me�kepn&, Fzancli aw - 1,Fa 0244
i ASSESSOR PARCEL NUMBER
f
Pr6posed Building Use: Counter Technician: Date:
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
0,51:�_Plot plansC3)(or 4 sets, signed by the preparer of the plans.
W. Complete planoor 4 sets, signed by the p*reparer 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. Energy compliance design and supporting documentation in duplicate.
0 6. Manufactured �omes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in dui)licate.
0 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet-sigi�ed by the engineer.
Items required for initial plan review. If checked items have not,,been received, plan review cannot proceed. The permit will e�
indexed and*returned to the plan review line-up when requiKed items are received.
Date Received By
O�, �'Flood Elevation Certificate, wet-stamp'ed and sigrigd, in duplicate ................................
0 9. Plot plan and business license approval frorif the City of Biggs ....................................
0 10. Letter of intent for non-residential buildings .........................................................
0 11. Detached Accessory Building Form filled out by the ..............................
0 12. Hazardou s Material Form ............. ......
0 13. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
OVr4_.� Fees as shbw" n on the attached Schedule of Fees Due Sheet .......................................
V. tatement of Intent for Non -heated and A/C Buildings .............................................
6 anitation and plot plan approval from the Environmental Health Department in —
7. C ity of Chico Plumbing permit ........................................................................
0 18. California Department of Forestry plan approval 0 paid. Sent -by: ......................
0 1�. Planning approval for (A) Use: B)Parking: (C) Parcel Check:
0 20. Contact Land Development about 0 Improvements, 0 Drainage ...............................
0 2 L. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0 22. Pre -Inspection for required ................
0 23. Contractor's license information. (Number, Name Style, Classification) ......................
Ejj�* Worker's Compensation Carrier and Policy Number .............
WA24e,Owner-Builder Verification (0 Given to owner, 0 Mailed to owner) .....................
0 26. 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 '30. 0 Grant Deed, 0 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 31. Other: I
When issued Telephone .3 tX1 ;Z 5 and hold for pickup.
I have been infor
,led of the abovi items and requirements for obtaining a building permit.
Applicant: Date: L( — q— 0Z,
1. Index pen -nit application for the i b v it s numbered: Plan Check Letter
2. Additional items required
Contractor, designer owner -was ad6ed of the above data by 0 Oone, El mail, 0 counter, by Date:
6 -
Contractor, designer:it&s advised of the abo e data by &"phone, 0 mail, 0 counter, by Date: L11 4-2—
Plans reviewed by: Date: 911) t
Z_ Plans approved by: Aol Da e: Z_
Stru�tural reviewed by: —Date: Structural approved by: Date:
Note transfer by: Date: Yellow: Building Division f/ 2-2-10 2,
OWNER -BUILDER VERIFICATION
Aaention 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 unne.cessary delay
in processing and issuing your building permit. No building permit will be issued until this
verification is received.
I personally plan to provide the major labor and materials for construction of the proposed
property improvement : YES)�i NO 0
2. 1 HAVE �� HAVE NOT 0 signed an application for a building permit for the proposed work.
3. 1 have contracted with the following person (f=) 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 fo llowing persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED: xek e
(' 2 4,
le nc_
PROPERTYOWNER:-
SOCIAL SECURITY NUM13ERA
DATE -
NOTE: This Owner -Builder Veriji-cation 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 the permit.
OVER
I OWNER BUILDER INFOR1NIATION I I
Dear Property Owner:
An applicarion 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-buildee, 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 perforniing 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 S300 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 emplover, you must register with the State and Federal Governments as an employer and you are
subject to several o�ligations 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
0 CP
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 Stree4 Sacramento, CA. 95814.
Please cor�nplete 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.
0
I rely,
Mic el C. Vidira, C.B.O.
so
+Mge'rC,iBVuiA1di2g CInspeCcition
NO TE. Th is 0 w n er- Bu ilder Info rm a tio n is requ ired by Sectio n 19 83 0 of th e Cal#lorn !a Health an d Safety Code.
OVER
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965'Phone (530)538-7541 Fax (530)538-2140
PEMT APPLICATION DATA SHEET
OWNER: pu� 4A ASSESSOR MRCEL NUMBER 6
0 F
Proposed Building Use: ALPA�� 5 LAQPIO"�'EoCouner Technician: N*4 Date:
I
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
lot plans, 3 or 4 sets, signed by the preparer of the plans. W 1'r4cmj
-complete plans, 3 or 4 sets, signed by the Ireparer of the plans.
0 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
04. Engineered truss details and layouts in duplicate. No faxes!
0 5. Energy compliance design and supporting documentation in duplicate.
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) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be
d returned to the plan review line-up when required items are received.
Date Received By
8. ood Elevation Certificate, wet -stamped and signed, in duplicate ................................
P9. Plot plan and business license approval from the City of Biggs ................................
0 10. Letter of intent for non-residential buildings .....................................................
0 11. Detached Accessory 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 following 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 .............................................
<[2�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: C> J./, (B)Parking: (C) Parcel Check:
0 20. Contact Land Development about 0 Improvements, 0 Drainage ...............................
21. Encroachment Pe it fo dr* fr the P41ic Works Dept. (ronstruction approval prior to occupancy).
fo � iveway op
22. Pre -Inspection r -QkIAO- -AA.-- � 4�90-4-A+equired ................
0 23. Contractor's license information. (Number, Name Style, Clas;ification) ......................
0 24. Worker's Compensation Carrier and Policy Number .............................................
25. Owner -Builder Verification (0 Given to owner, 0 Mailed to owner) .....................
0 26. 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 pen -nits .........................................................
0 30. 0 Grant Deed, 0 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 31. Other:
� -'2' 1?!�7 9 � &9/6—,799V and hold for pickup.
When issued Telephone, � ?.
1 -have been itl4ned of the ab items and requiriments for obtaining a building permit.
(A p p �Ii In t: bate: 1?- 07-
1. Index permit application for the above items number d: Plan Check Letter
2. Addifional items required 9 PZ
Contractor, designer, owner, was advised of the above data by Co"phone, 0 mail, 0 counter, by 40- Date: 6 Z�_
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: Structural approved by: —Date:
Note transfer by: Date:
Yellow: Building Division
COUNTY OF BUTTE
Oroville, California
GENERAL CLAIM
CLAIMANT: PEEKEMA RANCH
ADDRESS: 4817 WELLINGTON PARK DRIVE
CITY & STATE: SAN JOSE, CA 95136
DATE OF CLAIM: 12/31/02
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
IMPORTANT.
SEE INSTRUCTIONS
ON REVERSE SIDE
,ATE I
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
REPLACED
$6,.00 &
BUILING PERMITS: AP# 024-180-024, BP# 02-0834, RECEIPTf'S
343760 FOR $502.85. DATED* 4/9/02
343/59
FU
OWNER:
PEEKEMA RANCH
INV. DATE
ENCUMB.
TOTAL
AMOUNT PAID:
568.
5
RETAIN
REFUND PROCESSING FEE:
25.)0
BUILDING PERMIT FTT.TNG FEE*
20.110
,RETAIN
RETAIN
PLUMBING PERMIT FILING FEE:
20,
00
ELECTRICAL PERMIT FILING FEE:
20.,00
-RETAIN
RETAIN
MECHANICAL PERMIT FILING FEE:
20.00
RETAIN
PLAN CHECKING FEE:
122.85
RETAIN
PRE INSPECTION FEE:
23
00
TOTAL
ITOTAT.
AMOUNT TO BE RETAINED: TOTAL
AMOUNT TO RF REFUNDED* 1
0
250
3
85
00 -
he undersigned, declare under penalty of perjury that the services or articles claimed have or delivered, and that this claim is true
J correct as stated. : K ; 71_J'�;
aed this day of NPI 49�L at Calif. —
/ Signature of Claimant
the undersigned, hereby certify that to the best of my knowledge, the s: nceneor s c*fied above v an rformed 6r delivered and
ck 0
-3t there is a Budget Appropriation [ I or Specific Board Approval I I (C 2
ited this 13 day of DEC
---------- _226t OROVILLE Calif.
I Depa�ment Head or Authorized Do"
P
FUNJD
!Pt. Code — 4401 —E,p. Code 4210500 —PAYABLEFkm BUILDING PERMITS . FUND
!Pt. Coda Exp. Coda PAYABLE FROM FU
---------- U
ipt Code Exp. Coda PAYABLE FROM FU
DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
GROSS AMT
DEPT. & SUB. PROJ. SUB. OBJ.
CLAIM NO.
INV. NO.
INV. DATE
ENCUMB.
FOR BUILDING DIVISION USE.
Receipt Information:
Number
Date:
Issued To:
Amount:
Fees Retained:
ZProcessing Fee:
VIBIdg Filing Fee: $
P1bg Filing Fee: $
Elec Filing Fee: $
Mech Filing Fee: $
Energy P/C Fee: $
v/11plan Check Fee:
Inspection Fee- $
SRA Fee: $
Total Amount Retained $ ao
TOTAL REFUND DUE $
Al \ �'t
[FAXI-CING —ADDRES��,;
r --
A S 'S$ S 0 R P�ARQ E �L#-
NVU-M—BER(S)l
REFUND CLAIM APPLICATION
l,'ee
,,k.e,PnA
ozz/.- leo — 0 2,4/
(� So
36-2-) cl�� I / P--7
Request a refund of fees paid on the above receipt number(s) for the following reasons:
Please refund any applicable fees in the following categories: (Check those. categories
which you wish to have refunded.)
( ) Building Permit Fees ( ) Sheriff Fees
( ) SRA Fees (CDF Fire Planning) ( ) Urban Area Fees
[Di'spos
1�fion of Plin--9'��
Plans returned to me at counter
( ) Please mail plans to me at above address.
(-?( Q Please dispose of plans.
rS—1 G—N AT- U- R E
C:D:IA-T�?
7-
0 -Z,
PLEA SE DA TE AND SIGN THE A TTACHED COUNTY OF BUTTE GENERAL CLAIM
FORM. DO NOT COMPLETE ANY OTHER INFORMATION ON THAT FORM.
FOR BUILDING DIVISION USE.
Receipt Information:
Number
Date:
Issued To:
Amount:
Fees Retained:
V/Processing Fee:
/BIdg Filing Fee:
k"P'Ibg Filing Fee:
I
V-1r1ec Filing Fee:
ZMech Filing Fee:
Energy P/C Fee:
V/ Plan Check Fee:
Inspection Fee
SRA Fee:
Total Amount Retained
TOTAL REFUND DUE
760
!11111111
11ME11111
I
�51E7QE I P�-.T-N U �MB E R �(S),
a refund of fe(
at-r,A - 'k
REFUND CLAIM APPLICATION
12
0P -
,of,
02��4- . /,,(-a - 0 Z4
4d onffie above receipt number(s) for the following reasons:
--1 0 ---M r-, --� . -2� <)
Please refund any applicable fees in the following categories: (Check those. categories
which you wish to have refunded.)
( ) Building Permit Fees
( ) SRA Fees (CDF Fire Planning)
Plans returned to me at counter
( ) Sheriff Fees
( ) Urban Area Fees
Please mail plans to me at above address.
Please dispos'e plans.
IRE 7-
0 Z -
PLEASE DA TE AND SIGN THE ATTACHED COUNTY OF BUTTE GENERAL CLAIM
FORM. DO NOT COMPLETE ANY OTHER INFORMATION ON THAT FORM.
POAD aRIDLEY
_71
-M-rC-� APPROK 12
NOTE:
See the aftadhed
llM!W9UtI9l LeSILOW&U ! .
Reguirements
AP
-Pages
WE:LL
I
HO Q.5 E7
544 RD
- -.e- --
j 4. OL
P6V FOLE;
( a C4
J77E
L COUN Ty
DING
F LOW
�3VTTE W41 -E -K PISTIZtCT C-4NAL- D
PLANNING DIVISION- BUILDING PLAN AP7PROVAL
Use:
Parking: Landscaping: . ......
rmhor. 1-1 PQACcSCjPAlA VC eA f- 19
&-1 7(07
s
Ttl r, 4t
4k
444
ACP
0 -180-024
24
M4
r
4,
It
A, Y.
NI,
el;
C— ?A I
L9-VFF RD - 6P, I DCt-Y---
1) 5 TO \j E
C- L0 SF T-
3').1
\N,
�e- C, V e +
IfMe- ^?7
-31
�7:)
pek)II,ja 53-
APPROVED
Butte County
Environmental Health
- Mt
ng, re
tu
SINK
01
5,AT
0
HEATML(
U�-1 LITY
p
Man
T.ZATH T U E5
N -tow E: R
5cfe4
T 6 /cis ;�Avv
-ELECTF ICA L .. ....
WALL kt-ATr.V.
sePTIC -rANv-
01
I T -C I- 1EIN
w
p
Man
M
A LC -
M&, CAW
S44 LEVEE ROAD G-91I)LEY,
ANC5T -YA1-1(9&)
fi-r-
SCALE
ROOF CO3APACr6WlriTlC'5
"PLYWOOD, ",6' PLI)4 PAPER
co/-IP057-10N POOF/ro(,--7
lol�rp— LIFE
'SLOPE
--EY,(5TtNc, viALL-5,51DIM6t "-. I
BUTTE COUM
BUILDINO DEpA
. . RTMEIV
APPROVED
Iz
RAFrEp,-3 0,\j 2'0'�EAjc-qs-
ho
CEI(.fN('j 7i9lS'r rILL �/IKJISULATIOKI K19
KA15ED t6'�-(SEC
w I K% DOW
WiNpew
...... .. . .. ......
-------------
k
61--"Peff KEM,,% 4110 /0 ?-
-fRor,L-S51oNAL RE4 - CAwFir-25(05'
%oll We W45H 44 7+42
I'% WIND01, 0
virto
-1
.5q+ LEvE-F Rf? 6riw,�,voc',A
NORT�j IPLGA/�ATION
5611 L t j- "-, (-'0"
4
7j
VVJKJ D Ott/ (6 S L I E) I fJ
ri
'2')"S"RAF-TFK; ON ?-�CMTFFRS
j!
PA. E I. -S
lvjrE-P-ior?- WALL.
4"W BEAMS
ADDE[) 0 N) W/5 VIDE5
4ee �5T PE
p BUTTE COUNTY - . T-K04A 4-10-0?-
Fo. \j-MoLfi0AJ jA.A-lJA- fle.- "'ILDING DFOAPTMR-IN
OiJAt- RECI CALIF# Z%5'
M sma WA41V -102-
A R 0
ij
d
'I
T
7j
VVJKJ D Ott/ (6 S L I E) I fJ
ri
'2')"S"RAF-TFK; ON ?-�CMTFFRS
j!
PA. E I. -S
lvjrE-P-ior?- WALL.
4"W BEAMS
ADDE[) 0 N) W/5 VIDE5
4ee �5T PE
p BUTTE COUNTY - . T-K04A 4-10-0?-
Fo. \j-MoLfi0AJ jA.A-lJA- fle.- "'ILDING DFOAPTMR-IN
OiJAt- RECI CALIF# Z%5'
M sma WA41V -102-
A R 0
5/44 Lr-vi;r-- Kv GiZIPL-pj�, I c'el,
�50UTH 6A -EVA -1-10N
SCA LC- "Y� 0
4
")"-(e Wl wDoW
TTV I tn �k \AYA U.
4"- 4' OFAms
F —I
n-
--------------
Hum swuum Ir
lq,, %46644 Af)QF-D VIEIZ5 ON) NORTH/Sourfl 'S I D E ONLY BUILDING DERARTMEW
:% ef
FO -1 &1
e LA-,) t;ers P P
SEE ROOF DEMM2 ON �JCKIH qW�ST FCCVA'f-10tJe,
(5 T' PFC-9EI14A 4 - to - 0 z
P9,orb5510NAL P\R61lS"rPA'rI0N CALIF :02%5-
v ule \fvA5fi st 74+2
---------------
54 q- L U- V L �- P-1) - r, P, I L) Lj-� Y
EA5T FLUVATION3
�CA
�er- wcri Fok P66F Dt�M(L,
41
ME
R 0 V E D
PPVF0510tuAL, W66- CALIT 4t 205
%le, V w5t�zo 7442
rq
rip
1R.
>,..;u -----------
4(N
Tri
71
>
Q)
rip
>,..;u -----------
4(N
rip
Tri
71
>
Q)
RD
MISCFPLAM�005 DE�TAIL5 4jo NOT'Es
eo L -T 0 12 C- VjtE tS
V WASREK FAC41'FNE:
A D DEED TO
CAP PLA -M
-f-To—p,CF Exl,5.1-(tJQ '-,/ALL,
Nor T.") 5c,4L-5
0 v -T H
PIER. CLEVAT7CW
TAQD CONCIR-5T76 Pft-:P,'5
.-
-AEF DETAiL.S oN K012TH *4' 50, Ul 14 E Ll�- V.Ar 10 tj!; PlEft Pf-AN
NOT To �rA�E
.50r -IG FAIST'fl,,16 WALL 5T -V95 ARC AT ;Z+l',CF-fjrC-p
'T. A pr 5UC8 5,f;
1, 141AJ4 (ON PER-IMIFTFk OF
—DUlLDlW(-)'-'VlUHAV5 NE. STVD AP967D
—67ATc-.jzIoK
WALL- COVIFIZWO (8FVl5T'tlJ4) IS T-111 51DINer. nPL.Ac6: Atoy
MiMNCr OR.
-.UAMA6CrD
S5CTIONS ANA) KC-PAp4T C--&jTikt alll/.DJh/CT.5HUF'T Ro�m
INSUL-ATIOW@ RI -5 INSULAT10f,) To r3C- '"T'4"ED UU)Ek F&PORL p ErwG:E-N 2� 4" 'FLAOR J-01 5rS
F -Ill NSUI-AT10410 INSTALLED I" AT'nC 13z-rwFr-&j 2:"6" eaa.)V6 'roisrs
O..P.,13. wsvLA-r.io.N..,lI`JS.r.4LLrD PIJ.
WIUDOWS 'TO 05 THfiZf4A,L-. PAAJF
I- -14E.�?A q -
p5C
Mzor-CKSOA�- P,9:0 F 4 26-65'
&vA$H tr 74C?
N
E OF WASHINGTO(
PR0FESSI0N,'%[]::
PEEKEMA,GEbRG T-JFV
�'�519 NE 69TH ST
VA
�,NCOUVER WA 98662-4303
RE
7442 06-19,.02
'. ;'B
-da'd' fit
egisirati'oh,jor P*ida'jsj6:'
Ile `E ineers.:. :-:Labd-.Surveyo'r-s3i-
Ilk .,*i::.. ng'::
;63V CAP;M6L
SACRAMENT9.
CA SM3,212j&
CERTIF-CATE Mll-
2s6t EXPRA A
12/31/0;
t;EORGE T',WOMAS PEEKEMA
N'E. 69TH ST
::.v 14COUVER'. WA 9 8-6*6 2
-RECErPT wo
pm.
. . . . .........
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
+f~* -13-1 -k c- 2. NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
81'q102_ ek. ELEVATION CERTIFICATE
per eAS;,PPe4e 61 pt—of-
0-0 ions on pages 1 - 7.
.4 Important: Read the instructi
SECTION A - PROPERTY OWNER INFORMATION For.Insuranoe Company Use:
BUILDING OWNER'S NAME PEEKEMA MNCH ..Policy Nu _ r
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
544 Levee Road
Gridley CA 95948
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
024-1807024
BUILDING USE (e.g.. Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
Residential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ GPS (Type):
( ##* - ##'- ##.##" or W 0) IX I NAD 1927 LJ NAD 1983 )LJ USGS Quad Map " Other'.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2. COUNTY NAME B3.STATE
Gy441" SIA�4e_ eV g6qj+�6 _a&. 0,& 1 -1 Butte - Unincorr)orated- I CA I
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooc[4)
06007C 11101 C 1 6-8-1998 1 Same I A 1 90.8
13 10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. DWR Feather
1_1 FIS Profile 1_1 FIRM 1_1 Community Determined Other (Describe): River Profile
311. Indicate the elevation datum used for the BFE in 139:1 3Q NGVD 1929 NAVID 1988 1_1 Other (Describe):
312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_lYes IX-INo
Designation Date: N/A
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
�1. Building elevations are based on: 1_1Construction Drawings* I_lBuilding Under Construction* I_XlFinished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
�2. Building Diagram Number :15 (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
.,3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFIE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion,
Datum -USGS Conversion/Comments
Elevation reference mark used DWR RC Fg47 Does the elevation reference mark used appear on 0
a A.
0 a) Top of bottom floor (including basement or enclosure) 94 Q ft.ko
54 GeOrge
0 b) Top of next higher floor ft.(m)
0 c) Bottom of lowest horizontal structural member (V zones only)
0 d) Attached garage (top of slab) 0 a co
E c ct, rn
0 e) Lowest elevation of machinery and/or equipment W to o 245 8 rn
. LU
21 CC
servicing the building ft.(m) .0 M Exp. 12-31-05
E Zi
0 0 Lowest adjacent grade (LAG) go 'q ft.W 3 r
Z '9
a V)
0 g) Highest adjacent grade (HAG) 91 ft.W .
C
0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent gradeContinuous CIVIL
0 i) Total area of all permanent openings (flood vents) in C3h totalperimetenq. in. (sq. cm) F CA
SECTION D - SURVEYOR, ENGINEER, OR AR6HITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine orimprisonment under 18 U. S. Code, Section 1001.
neer
Ile
P a n e 1 T6 !Z&
ta 530-534-1911
FFMA Fnrm 811-11 1 )(11 A9 SFF RPVFR(;F.qinF FOITCONTINHATION RFPI A(FS Al I PRFVI01 IS FnITIONS
IMPORTANT: In these spaces, copy the corresponding information from Section A. ::]—For Insurance Company.Use:
BUILDING STREET ADDRESS (including Apt, Unit Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Polic
944 T -i -w -pi- Pnnrl y NP61 �r�
Gridley CA 01mir., ZIP CODE - Company�NAIC-ffurpber
95948
SECTION D - SURVEYOR, ENGINEER, OR ARQHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
REE established from DWR Feather River profile attached.
• Cox spillway river elev = 91.3' MSL Pror ridlev.
. 544 Levee Road House 90.8 MSL California USGS quad
• Mouth North Honcut Creek R.E. = 88.2' MSL
- - J_XJ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended foruse as supporting
information for a LOMA or LOMR-F, Section C must be completed.
El. Building Diagram Nurnber_ (Select the building diagram most similar to the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is 1-1-1 ft -(m) 1_1_lin.(cm) 1_1 above or 1_1 below
(check one) the highest adjacent grade.
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or -elevated floor (elevation b) of the building is
1 1-1 ft -(m) 1_1_lin.(cm) above the highest adjacent grade.
E4. For Zone AO only- If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? 1_1 Yes 1_1 No 1_1 Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or
community -issued BFE) or Zone AID must sign here.
PROPERTY OWNER's OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY SIAIt ZIP CODE
SIGNATURE DATE TELEPHONE
Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
;ections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
�2. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or
Zone AO.
3. 1-1 The following information (Items G4 -G9) is provided for community floodplain management purposes.
ISSUED
;7. This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement
38. Elevation of as -built lowest floor (including basement) of the building is: ft. (m) Datum:
;9. BFE or (in Zone AO) depth of flooding at the building site is: ft. (m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
I D5 . P 0 6T tO',�b P
P0 0 t\
X. D RY CR,
.. ... .. . . . . ........ ........
'Ob
..... . .........
r6
N
toll
'Ob
.......... ... ..
7(9
�b Cb
. .. .........
50 . ......
-7-
0 ..........
CNJ
-4
0'. 11
. .. ... ..... ..... ........ ..... ...
... ... . .......
fs....... .
00
All
CAI
oz),
—tSj
f3.. . ...... SL—
NL
... ........
. ..... ';TATF-. OF CALIFORNIA
"IF Ill"SounCES AGENCY
r) I= D A D -r
CHANNEL I
UF WATER RESOURCES
P.O. BOX 40,6908 COLUSA MY
SUl-TER,CA95982
TO:
fvi I L E15 SE
Mr. George Peekema
7519 69th Street
VanCouver, WA 98662
DWR 54 (New ims)
'Pur.
CENTER
10
90
Manzanita
c
88 .96
86
Sch ox Soiilw
RDA D
- 4-C,
15
--'cps-
"A'
r
ile
z
Lu
h-
�ell 90
PBELL RDA p
L
M",
8
08
LATERAL
j((
4,4
CHA DON
C; ..AVENUE .
22
pq
r
...... .. . ........
. ................... 61,
IF..............
p
C)
L��A
821 RDA D 27
7
4,
ific
80
A,
&I
0
Wells
"A
0
Ll- -00
ce Lu
Ld
I-
Ou
0
mi
79
WMile 44k\.15—)
.0
70 /1
ow5u-
I
PARCEL- 024-18(�-OZ4-
5744 L� C7 V G ZPAD aRIPL,='r
;2L -AN
A6P-9ACrC- APPROK 12,15ACIZE5
A�
Ho
LC-VgC-
WAD - 6izir)L-a,,(
�3VTTe W47C-P, Pj5Tj:etCT r4N,4L_ FLOW
0 P60 POLE
IONA R11;Cs- C4- t- I r-- 9 5,(o
7414,7
NOV-18,2002 9: 36AM PG&E NO. 402 P. I
460 Rio Lindo Ave., Chico C4., 95926
November 18, 2002
County of Butte, BdIg Dept
Attn-, Scott Ruthiford
7 County Center Dr
Oroville, CA., 95966
Re: 544 Levee Rd., Gridley
Peekama Ranch Electric Service
Notification #100657715
Dear Mr Ruthiford:
Here is the information you requested regarding clearance requirements for the above referenced
application.
In accordance with our discussion, the Peekama Ranch is rebuilding the single story home at 644 Levee
Rd. The new home has a slightly larger square footage however it will continue to be a single story
building. The applicant states they have not moved the new foundation closer to the existing pole line.
Based upon General Order 95. State Clearance requirements for high voltage electric lines, the proposed
building permit will not conflict with the PG&E high voltage line,
Thank you for ensuring that the safety clearances are being adhered to. If you should have any questions
regarding this information, please call me at (530) 894-4706.
kib:klb
Encs.
Sincerely,
Ken Bedsaul
New Business Representative
e- 'e
PARCE 1- 07-4 - I go - 0 z 4- 5-44 LC -:VCE POAD GRIDI-Fl�
.--.PL 0 -r PL-Atj
0 15TE i,�;. BOX
r
�CR&AGF-
mekoc 12,75AC,�C-S
APPROVED
Butte County
Envlronmental Heab.
z"o
fv
G
See the attached,
esid n
'Re uirements
3
Pages
0 "1 Fr LL
R.
PLANNING DIVISION- BUILDING PLAN T8)t
Use: Date:
Paddng:- Laridscaong:-
Other,
41 1
APpm"r, e�
HOU5E�
544 Lt--V�;(, RI)
FA
r70%vE-R SOPPL(
IC;0Am(1 -SERVI-IE
PRO�C-R-ff LIN(F -M
P(5jC- )70LE
0 U-1 �0 .5 0( elle cja-�-id
C ev-4--
L- E V C- F; IZOA r) - 6- P I r) L F, '<'
IWTTE. COUNTY
F�LOWMMLEMNG DEPARI "I
(�:,4 rjA L_
2- - 0 57 APPRO� ED'
MTTECOWN aT ?EIii'KeMA 4-tO-OZ
BU&DM [*PARTWM
PP\OP�- �S IONA R66 - CA L-1 i-- 121565-
APPROVED- WASH 714 -142-
P -A
!.:'k z Z;
ks-SX,
1", WAwyn...
.,q
c4p";
-'i'l ta\.'
"mm— 1
, Q1
K 1"A
N A
Nom-VolI
"Zo 0
le
14-1
Vu* 4:
Q-A
WWI Nom .......
021180024
..................... will, -
.4
Qy 0"Afall 60myse,
16
0: Now =cqw now.
-A.
-ITS withm favg.
MTV -by %XW
Neu SAMAR.,
.4
ik'
...... . . . . .
C 2. FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATION CERTIFICATE
P e -
Important: Read the instructions on pages I - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
PEEKEMA RANCH I
WILDING STREET ADDRESS (Induding Apt.. Unit, Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
544 Levee Road I
ATY STATE ZIP CODE
Gridley CA 95948
IROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
024-1807024
;UILDING USE (e.g.. Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
Residential
ATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: [_J GPS (Type):
##* - #:#'- ##.##' or ##. 0) LXJ NAD 1927 L_J NAD 1983 )�_] USGS Quad Map " Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3.STATE
(',r -i A I-oav B �A �� e- "f) 0AA-1-4-7- n f- o = i -, Rtiffp - Hninc-ornorated I CA I
B.4. MAP ANU PAINILL � b,). Z:)U�-HA � bb. HKM EINULA bf. 1-Imm 1`1kVNCL_ DO. � Ou. � I �__
NUMBER DAT EFFECTIVE/REVISED DATE ZONE(S) (Zone AO. use depth of flooding)
06007C I C 6-8-19S Same A 90.8
1). Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. DWR Feather
1_1 FIS Profile 1_1 FIRM Community Determined Other (Describe): River Profile
Indicate the elevation datum used for the BFE in Bg: I Y
� NGVD 1929 1_1 NAVD 1988 1_1 Other (Describe):
2. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_IYes IX -1 No
Designation Date: N/A
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Building elevations are based on: I_lConstruction Drawings* 1_1Building Under Construction* I XIFinished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
Building Diagram Number 15 (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
Elevations — Zones Al -A30. AE, AH, A (with BFE), VE, Vi -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum USGS Conversion/Comments
Elevation reference mark used DWR RC FR47 Does the elevation reference mark used appear on I
,�JKJ No
_J a) Top of bottom floor (including basement or enclosure) 94 0— ft krd
rge
0 b) Top of next higher floor (m) !� e%,
V
0 c) Bottom of lowest horizontal structural member (V zones only) (m)
0
0 d) Attached garage (top of slab) (m) 0
E c.5 No.24578
0 e) Lowest elevation of machinery and/or equipment W. W rn
Exp. 12-31-05
servicing the building (m)
E
:, C "Y --j
q 0 8 0) z 1-
0 0 Lowest adjacent grade (LAG) 0 V)
91 2
0 g) Highest adjacent grade (HAG) r
C10.
0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent gradecontinuous .02
0 i) Total area of all permanent openings (flood vents) in C3h totalp OF C AV-
e—lateir,q. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATI
nis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized Aaffi certiNeTeVat
1
r IDIM
r
4
certify that the information in Sections A, B, and C on this certiricate represents my best effof s t 4 OVable
PO �1 PA
understand that any false statementmay be punishable by rine orimprisonment under 18 U.S. Code,
ALAN C&. BROWN
Prin al "
Aven
11e
neerl
R
.1 A'"w f i 42 s UP —
-MA Fnrm 0-11 V K', qq 4111111101 SPIF RFVF:PqF sinir FnFT ('.ONTINI IATinN RF:PI ACPS At I PRFvint Is F:n]TlnN
.... I I I I UlUbe spaces, copy the coIrrespc
BUILDING STREET 7D—D—FFESS '(IncludingAlpt, Unit Suite,
11 1 - -
Gridley
g Information from Section A.
,r Bldg. No.) OR P.O. ROUTE AND BOX NO.
CA STA
N'&I!
'urarice Compan—
y Use:
SECTION D - SURVEYOR, ENGINEER OR ARCHITECT CERTIFICATION (CONLTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building own
COMMENT er.
lighed from DWR Feather River profile attached.
COX Spillway river elev = 91.3' MSL
* . 544 Levee Road House 90-8 MSL
. Mouth North Honcut Creek R.E. �=88.2' MSL
Prorated trom Gridley
California USGS quad
' v' Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT 13FE)
:or Zone AO and Zone A ithout 3FE), complete Items Ell through E4. If the Elevatio Certificate is intended foruse as supporting
.)formation for a LOMA orLOMR-F, Section C must be completed.
1. Building Diagram Number - — (Select the building diagram most similar to the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
:2. The top of the bottom floor (including basement or enclosure) of the building is ft.(m) 1_1_lin.(cm) 1_1 above or
(check one) the highest adjacent grade. _I below
:3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
I -J-1 ft -I J_J_Jin.(cm) above the highest adjacent grade.
'4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? 1 1 Yes 1_1 No 1-1 Unknown. The local official must certify this information in Section G.
S -TION F - � )PERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
Fhe property owner or owner's authorized representative who completes Sections A, 8, and E for Zone A (without a FEMA -issued or
:ommunity-issued BFE) or Zone AO must sign here.
:"ROPERTY 0
'kDDRES
AGNATUR
D
:OMMENT
I I r,
SECTION G - COMMUNITY INFORMATION (OPTIONAL) I eck here if attachments-
-e local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
�ctions A, B, C (or EI), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or
Zone AO.
3. 1_1 The following information (Items G4 -G9) is provided for community floodplain management purposes.
:;J I I I Z I
ub. UA I t CERTIFICATE OF UUMI'LIANCEICCCUPANCY
ISSUED
This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement
Elevation of as -built lowest floor (including basement) of the building is: (m) Datum:
9. BFE or (in Zone AO) depth of flooding at the building site is: —ft.(m) Datum:
OCAL OFFICI kL'S NAME
:OMMUNITY NAME TELEPHONE
AGNAT
DATE
,1 0 chments
_.,I�Che!'�'k h I btta'*'
L77. -q q
t RPPI A(-F=.';'Al I PRFvintis Fnffi_0N1;
De T*A L L. S
344 LEVEG RD L E�f' (�A
DnF
T
�Tc
coo TS
�n%ALTV,- Zrb I $ T5 F
L
L
(3
6
T
(:�) RJ/1SION -rG IN r,-IAG 'PLAN .
(�)OrHEZ VETAiL.,S-No r-PAmgg'
P,4 -R aL D 04 -190 - 02.4
2 -A 2. g 3111,
�R--T A- A
T
8
S11ARMU
UH'r%A r%rPAF(M
APPROVED
y
Zr
t4'
-Z3-DO
2'(o FLIZ MOISTS)
2'
bEAM
C Cojc.
O -C
rx
it
S Fr -T C- C
2 6 RR TOISTS
I,-
cor4c
PICFt-
FXISTIN
, 7'n
1�1
1�m
4�2-
0
)1�00c' ; Tov E
e– 0
. J'�OLID
HOT TO %41
0 fZ.-- kJIN 6
P L
6' DIWDLP,
';Top.in CE
CAP Wb -T
- - ----------- 2140.
I'j
TF -
5-1
POUSE
26,
APPROVED
Butte County
Envlmnmentai gamh
6'S Ll Dl,\j C,
—5�0 0 —1Z
I= A-:
w; J -c brace w& tit
e- I w/ 5/8" 1-1 - I I
0 el ;j
W18A
; AJ
;L
I S-FOVE L IG
0 15 t' e e
0 ry
'j S' W -.j
KiTCHEN mf e -i
- 71 \riASHFR -0 tj 0'ri c: A -e)
A
<L. DRYEP 94
DeAW
j lbo+t-% S'Je5l--
ee Td 61-ld
JJA
11 "o
V ei
E LEfco�'-IrL�T'6 MME COUNTY
�i 5 A T E� K (w"'-) C�b 4
VJLDNG DEPARTMEX�- .
N/
-ro SepTr� 't -A
Arp P R 0 � E WE-,< a mA A-LeYANOC-e t-tvase I
Lu.
LL
�ao J
ri
% I )
L�u
"I
n
z
L.0
Lr -1
IR
u
N
m
SO LEVEE ROAD Gk(PLEY'
.ANF5T fi-E-YATIO&)
SCA LC 1 0
ROOF
P L Y W C. r 0, P, L )---'�A ME k
col-iPOSTION POOF/N4
SLOPE
to
BUTTE Cuo"UN TY 90?
6—T
MmULDING MPARTMENI
APPROVED
VA5fl W 744 2
I
LV
VD
rV-
i
... . .......
Lu
10
LN
TZ -XI
ILI
�2.
01—
oc
A
CIZ
>
LU
CL/
<
LV
VD
rV-
i
... . .......
Lu
10
LN
TZ -XI
ILI
�2.
01—
oc
AP lfo )Z�
t-'�J,�6r-,LLMQE005 TX -::T -AL -S AN D
5Tj)pc2 To &e -jl'
5Ce Df�-Ur)LON 13P-1f)C;r1lQ& OVt�Z.VM� MOT)OW5
k/1N. 9OW5 3 A -NO 5 5-0 �i
Tv Pe 7-o m ee r 13AKPZ J�V FMM E- IR E�OH J -r
P,06X IN TUR 10& kWL4,3
P, 15, L)NPER- FLMR-
V,�-g Itj A TTIC- ?,F)FK-CFtJ 604- l(ja -)Z) 1�7 T5
@ Pjj PW V\/4Q,5-
WINDOW.5
P, g?,S IN 1�-:Xt705�17 brAM
2YF NO'- PF a 1, cg��5
BUTTECCUUMV J
SUILEMING" DEPAK tmmr.
APP"'ROVED'
CERTIFICATE OF COMPLIANCE: Residential
Page 1 CF-lR
--------------------------------------------------------------------------------
Project Title:
Peekema Ranch
Run: 603 01 -Nov -02
Project Address:
544 Levee Rd
Peekema
In'sul
Gridley, CA 95948
Assembly
Building Title:
Peekema Ranch
Building Permit #
Document Author:
Don Freemyers
U -value
--------
Telephone:
530*533-9365
Plan Check Date
Compliance Method:
CALRES2 1.4-04
Field Check Date
Climate Zone:
11
9
GENERAL INFORMATION
conditioned Floor Area: 936 ft2
Average Ceiling Height: 810" ft -in -
Building Type: SFD Single Family Detached
Building Front orientation: 0 deg (North)
Glazing Area, % of Floor Area: 19.6%
Average Fenestration U-Value:0.50
Average Fenestration SHGC: 0.53
Number of Stories: 1
Number of Dwelling Units: 1.00
Floor Construction Type: Raised floor
BUILDING SHELL INSULATION
FLOOR TYPES AND AREAS
Construction Type
Cavity
Sheathing
Exterior Conditions/Descripti
-------------------------
-------------------
Non-Slab
------------
936
Component
Insul
In'sul
Total
Assembly
0.55
Type
R -value
R -value
--------
R -value
--------
U -value
--------
Location/Comments
-----------------------
---------------
Door
--------
F0
3.03
0.330
Outside
Wall
9
0
15.38
0.065
Outside
Wall
119
0
15.38
0.065
outside
Wall
-19
0
15.38
0.065
outside
Wall
19�
0
15.38
0.065
Outside
Ceiling
39
0
41.67
0.024
Attic
Ceiling
28
0
30.30
0.033
outside
Floor
19
L��
0
27.03
0.037
Crawlspace
FLOOR TYPES AND AREAS
Construction Type
Area (ft2)
Conditioned?
--------------
Exterior Conditions/Descripti
-------------------------
-------------------
Non-Slab
------------
936
Yes
Crawlspace
FENESTRATION
Area Fenestration Fenestration
Type/Orientation
(ft2)
----- ---
U -factor
--------- ------------
SHGC
-----------------
Window North
83.2
0.50
0.55
Window East
22.0
0.50
0.55
Window South
48.0
0.50
0.55
Window West
30.0
0.50
0.55
Exterior overhang
Shading and Fins
BugScrn
None
BugScrn
None
BugScrn
None
BugScrn
None
SME COUNTY
o "UM'PARTYW,
u WC
APPROVED
I
Residential Page 2 CF-lR
CERTIFICATE OF COMPLIANCE:
Project Title: Peekema Ranch Run: 603 01 -Nov -02
THERMAL MASS Area Thick
Type Cover (ft2) (in) Location/Comments
--------- -------------- ----- ----- ---------------------------------------
None
HVAC SYSTEMS Refrigerant Distribution System
Charge and Location
Type Efficiency Airflow TXV and R -value
-------------------------- ---------- ----------- -------------------
Wall heater w/o fan 0.67 AFUE N/A
Air cond. - central split 0.67 SEER No Attic R-4.2
HVAC DISTRIBUTION EFFICIENCY DETAILS
Duct Leakage
Supply Target -
Duct Surface ACCA Manual D (leakage cfm/
System Name Area Design % of fan cfm) Fan CFM
------------- ------------- -------------- -------------- --------
None
WATER HEATING SYSTEMS
Distrib
Water
Water
# of
Energy
Volume
System Name Type
Heater Name
------------
Heater Type
-----------------
Htrs
----
Factor
------
(gal)
------
------------ --------
Gas.62EF Standard
GAS.62EF
Storage gas
1
0.62
40
SPECIAL WATER HEATING SYSTEM CREDITS
Solar savings Wood stove Wood stove
System Name fraction boiler? boiler pump?
------------ ------------- ---------- -------------
Gas.62EF No No
SPECIAL WATER HKATER/BOILER DETAILS
Rated Pilot
Water Recovery Input Standby Tank Light
Heater Name Efficiency AFUE (kBtuh) Loss R -value (Btuh)
------------ ---------- ---- ------- ------- ------- ------
GAs.62EF 76% -- 36.00
HYDRONIC DISTRIBUTION AND TERMINALS
Pipe Pipe Insul Insul
System/Name Type Number run (ft) diam (in) thck (in) R -value
-------------- ------------- ------ -------- --------- --------- -------
None
. CERTIFICATE OF COMPLIANCE: Residential Page 3 CF-lR
Project Title: Peekema Ranch Run: 603 01 -Nov -02
SPECIAL FEATURES, REMARKS, AND NOTES
1. Cooling duct register location: Ceiling.
2. No air conditioning equipment is specified for zone 'HOUSE'. minimum SEER
and attic ducts assumed.
11
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance
specifications needed to comply with the Energy Standards in Title 24, Parts 1
and 6, of the California Code of Regulations, and the Administrative regulations
to implement them. This certificate has been signed by the individual with
overall design responsibility. When this certificate of compliance is submitted
for a single building plan to be built in multiple orientations, any shading
feature that is varied is indicated in the Special Features, Remarks, and Notes
section.
DESIGNER OR OWNER
Certification #:
Signed Date
ENFORCEMENT AGENCY
Name:
Title:
Agency:
Telephone:
Signed Date
DOCUMENTATION AUTHOR
Don Freemyers
Freemyers Design
575 Nelson Ave., Oroville, CA
530*533-9365
0
Signed Date
COMPUTER METHOD
SUMMARY
------------------------------------------------
Project Title:
Peekema. Ranch
Project Address:
544 Levee Rd
Water
Gridley, CA 95948
Building Title:
Peekema Ranch
Document Author:
Don Freemyers
Telephone:
530-533-9365
Page 1 C -2R
----------------------------
Run: 603 01 -Nov -02
Peekema
Building Permit #
Plan Check / Date
Compliance Method: CA.LRES2 1.4.04 Field Check / Date
Climate Zone: 11
ENERGY USE SUMMARY (kBtu/ft2-yr)
Energy Use Standard Design
Space
Heating
15.82
Space
Cooling
15.46
Water
Heating
22.34
Total
Type
----------
53.62
GENERAL INFORMATION
Conditioned Floor Area:
Average Ceiling Height:
Building Type:
Building Front Orientation:
Glazing Area, % of Floor Area:
Average Fenestration U -Value:
Average Fenestration SHGC:
Number of Dwelling Units:
Number of Stories:
Floor Construction Type: ,
Number of Conditioned Zones:
Total Conditioned Volume:
BUILDING ZONE INFORMATION
Proposed Design
---------------
13.25
21.56
18.35
-------- Complies
53.16 Yes
936 ft2
8'0" ft -in
SFD Single Family Detached
0 deg (North)
19.6%
0.50
0.53
1.00
1
Raised floor
1
7488 ft3
Floor Vent
Zone Area Volume Thermostat Height
Name (ft2) (ft3) Type Type (ft)
------------ ------- -------- ------------- ------------ ------
HOUSE 936 7488 Conditioned CEC—Standard 210"
OPAQUE SURFACES
Surface
Area
U-
Insl
Total
Tru
Slr
Construction
Type
----------
(ft2)
------
factor
------
Rval
----
Rval
-----
Azm
---
Tlt
---
Gns
---
Type
------------
Location/Coniments
-------------------
Zone =
HOUSE
Door
20.0
0.330
0
3
90
90
Yes
CEC 30 -Wood
outside
Wall
204.8
0.065
19
15
0
90
Yes
W19.2x6.16
Outside
Wall
244.0
0.065
19
15
90
90
Yes
W19.2x6.16
Outside
Wall
240.0
0.065
19
15
180
90
Yes
W19.2x6.16
Outside
Wall
178.0
0.065
19
15
270
90
Yes
W19.2x6.16
Outside
COMPUTER METHOD
SUMMARY
Page
2
C -2R
Project Title:
Peekema. Ranch
Run:
603
01 -Nov -02
OPAQUE SURFACES continued
Surface
Area
U-
Insl
Total
Tru
Slr
Construction
Over -
Type
(ft2)
factor
Rval
----
Rval
-----
Azm. Tlt
--- ---
Gns
---
Type
------------
Location/Comments
-------------------
----------
Ceiling
------
364.0
------
0.024
38
42
0
Yes
R38.2x4.24
Attic
Ceiling
572.0
0.033
28
30
0
Yes
RP28.2x8.48
Outside
Floor
936.0
0.037
19-
27
180
No
FC19.2x8.16
Crawlspace
PERIMETER LOSSES
Insul
Perimeter Length F2 Insul Depth
Type (ft) Factor R-val (in) Location/Comments
None
FENESTRATION SURFACES
OVERHANGS
Fenestration
-------------------------- Length Height Left Right
Name Width Height 'H' IVI Extension Extension
------------ ------ ------ ------ --------- --------- ---------
None
FINS Left Fin Right Fin
Fenestration Dist Dist
-------------------------- Fin Fin Ht from Fin Fin Ht from
Name Height Width Depth Height 'V' fenes Depth Height 'V' fenes
------------ ------ ------ ------ ------ ----- ------ ------ ------ ----- ------
None
Fenestration
Exterior
Shade
Over -
Fenestration
Area
---------------
Tru
-----------------
hang
Name
Type
------
(ft2)
-----
U -factor
---------
SHGC
------
Azm.
---
Tilt
----
Type
----------
SHGC
------
/Fins
------
--------------
Zone = HOUSE
NORTH -1
Window
9.0
0.50
0.53
0
90
BugScrn
0.76
None
N-2
Window
16.2
0.50
0.53
0
90
BugScrn
0.76
None
N-3
Window
40.0
0.50
0.53
0
90
BugScrn
0.76
None
N-4
Window
18.0
0.50
0.53
0
90
BugScrn
0.76
None
EAST -1
Window
6.0
0.50
0.53
90
90
BugScrn
0.76
None
E-2
Window
16.0
0.50
0.53
90
90
BugScrn
0.76
None
SOUTH -1
Window
18.0
0.50
0.53
180
90
BugScrn
0.76
None
s-2
Window
24.0
0.50
0.53
180
90
BugScrn
0.76
None
S-3
Window
6.0
0.50
0.53
180
90
BugScrn
0.76
None
WEST -1
Window
15.0
0.50
0.53
270
90
BugSQrn
0.76
None
W-2
Window
15.0
0.50
0.53
270
90
BugScrn
0.76
None
OVERHANGS
Fenestration
-------------------------- Length Height Left Right
Name Width Height 'H' IVI Extension Extension
------------ ------ ------ ------ --------- --------- ---------
None
FINS Left Fin Right Fin
Fenestration Dist Dist
-------------------------- Fin Fin Ht from Fin Fin Ht from
Name Height Width Depth Height 'V' fenes Depth Height 'V' fenes
------------ ------ ------ ------ ------ ----- ------ ------ ------ ----- ------
None
COMPUTER METHOD SUMMARY Page 3 C -2R
Project Title: Peekema Ranch Run: 603 01 -Nov -02
THERMAL MASS
Vol Cond-
Area Thck Heat duct- Construction Insd
Mass Name (ft2) (in) Cap ivity Type Rval Location/Comments
None
SOLAR GAIN DISTRIBUTION
Fenestration Winter Summer Targetted
Name Fraction Fraction Thermal Mass Comments
------------ -------- -------- ------------ --------------------------------
None
HVAC SYSTEMS Refrigerant Minimum
Charge and Equipment Duct Location
System Name System Type Airflow TXV Efficiency and R -value
------------ -------------------------- ----------- ---------- -------------
Zone = HOUSE
FurnWall Wall heater w/o fan N/A 0.67 AFUE
See Note 2 Air cond. - central split No 0.67 SEER Attic R-4.2
HVAC DISTRIBUTION EFFICIENCY DETAILS
Duct Leakage
supply Target
Duct Surface ACCA Manual D (leakage cfm/
System Name Area Design % of fan cfm.) Fan CFM
------------- ------------- -------------- ---- 7 --------- -------
None
WATER HEATING SYSTEMS
Distrib Water Water # of Energy.Volume
System Name Type Heater Name Heater Type Htrs Factor (gal)
------------ -------- ------- ---- ----------------- ---- ------ ------
Gas.62EF Standard GAS.62EF Storage gas 1 0.62 40
SPECIAL WATER HEATING SYSTEM CREDITS
Solar savings Wood stove Wood stove
System Name fraction boiler? boiler pump?
------------ ------------- ---------- -------------
Gas.62EF No . No
COMPUTER METHOD SUMMARY Page 4 C -2R
Project Title: Peekema Ranch Run: 603 01 -Nov -02
SPECIAL WATER HEATER/BOILER DETAILS
Rated Pilot
Water Recovery Input Standby Tank Light
Heater Name Efficiency AFUE (kBtuh) Loss R -value (Btuh)
GAS.62EF 76% -- 36.00
HYDRONIC DISTRIBUTION AND TERMINALS
Pipe Pipe Insul Insul
System/Name Type Number run (ft) diam (in) thck (in) R -value
-------------- ------------- ------ -------- --------- --------- -------
None
SPECIAL FEATURES, REMARKS, AND NOTES
1. Cooling duct register location: Ceiling.
2. No air conditioning equipment is specified for zone 'HOUSE'. minimum SEER
and attic ducts assumed.
MANDATORY MEASURES CHECKLIST: RIESIDENTIAL(Page I of 2) MF-lR
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specification� for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Building Envelope Measures:
§150(a): Minimum R-19 ceiling insulation.
X,
§ I 50(b): Loose fill insulation manufacturer's labeled R -Value.
§ 150(c): Minimum R- 13 wall insulation in wood framed walls or equivalent U -Factor in metal frame walls
(does not apply to exterior mass walls),
§150(d): Minimum R-13 raised floor insulation in framed floors.
§ 150(l) : Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate
no greater than 2.0 perm/inch.
§ 118: Insulation specified or installed meets insulation quality standards. Indicate type and form.
§ 116-17:* Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field -fabricated) have label with certified U -Factor, certified Solar Heat
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed.
§ I 50(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§ 1 50(f): Special infiltration barrier installed to comply with § 15 1 meets Commission quality standards.
§ I 50(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilot lights allowed.
-Space Conditioning, Water Heating and Plumbing System Measures:
§ I 10-§ 113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
§ I 50(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
§ 150(i): Setback thermostat on all applicable heating and/or cooling systems.
§ 1500): Pipe and tank insulation
I . Storage gas water heaters rated with an Energy Factor less than 0.58 must be ex temally wrapped with
insulation having an installed thermal resistance of R-1 2 or greater.
2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R- 12
external insulation or R-16 combined intemal/external insulation.
4. All buried or exposed piping insulated in recirculating sections of hot water systems.
5. Cooling system piping below 55* F insulated.
6. Piping insulated between heating source and indirect hot water tank.
January 4, 2001
MANDATORY MEASURES CHECKLIST: RESIDENTIAL(Page 2 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
-DESCRIPTION
DESIGNER
ENFORCEMENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
§150(m): Ducts and Fans
1. All ducts and plenums installed, sealed and insulated to meet the requirement ofthe 1998 CIVIC Sections
601, 603, 604, and Standard 6-3; ducts insulated to a minimum installed level of R4.2 or enclosed entirely
in conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, Or other duct -closure
system that meets the applicable requirements ofUL 181, UL 181A, or UL 181B. lfmastic or tape is used
to sea] openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used.
Building cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and
their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used
in combination with mastic and drawbands.
2. Exhaust fan systems have back draft or automatic dampers.
3. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
IK
manually operated dampers.
§ 114: Pool and Spa Heating Systems and Equipment.
1. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no
electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36" ofpipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§ 115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btuhr)
Y_
Lighting Measures:
§150(k)l.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of40 lumens/watt
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a
readily accessible lighting control panel at an entrance to the kitchen.
§ 150(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
efficacy of40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § 150(k)2.; and recessed ceiling fixtures are IC (insulation cover) approved.
January 4, 2001
Department
C o u n t i,
J. Michael Crump, Director
Warner C. Phillips, Assistant Director
November 6, 2002
Peekema Ranch
4817 Willington Park Drive
San lose, CA 95136
Public
f .8 U t
Re: CA —p'
pjii,cation for Certificate f Si�ngje_- Merger
AP4-2-4-180-024 & on of 045 (Lotb�---,
To Whom It May Concern:
NOV 8
Works
2002
LAND DEVELOPMENT DIVISION
7 County Center Drive
Oroville, CA 95965
(530) 538-7266
(FAX) 538-7171
On November 4, 2002, the Department of Public Works made the finding that the
Certificate of Merger on the above referenced property is exempt from environmental
review, and approved the project.
Enclosed please find a conformed copy of the Certificate of Merger that was issued by the
Butte County Department of Public Works and recorded on November 4, 2002, under
Serial Number 2002-0059290, in. the office of the Butte County Recorder.
If you have any questions concerning this mat -ter, please contact this.office at (530)
538-7266, Monday through Friday, 8:00 a.m.'to 4:00 p.m.
Sincerely,
Stuart Edell
Manager, Land Development Division
SE/kp
cc: Anvironmental Health Department
Building Division
Ron Graves (02-037)
RECORDING, REQUESTED BY and
AFTER RECORDING RETURN TO:
Butte County Public Works
LAND DEVELOPMENT DIVISION
7 County Center Drive
Oroville, CA 95965
LANDS BEING MERGED:
C:09:31Y of Document Recorded
04-Kov-'2002 2002-0059290
Has not been compared with
original
BUTTE COUNTY RECORDER
CERTIFICATE OF MERGER
'0
AP NUMBER(S tZ�Ll
SUBDIVISION / PARCEL MAP:
BOOK PAGE BLOCK LOT(
As of the date of recordation, those lands noted above are merged to'create parcel(s) of land as
described in Exhibit(s) 1.411 — attached hereto.
ff, � ��� -a A14z��Zxe�- /,
MIKE CRUMP DATE
Director of Public Works
OWNERS'CONSENT TO MERGER
TH E U N DERSIGN ED as owners of all that real property to be merged, do helreby consent and agree to the
merger of such lands into that / those parcel(s) as described in Exhibit(s) /-? ' attached hereto.
A L L SIGNA TURES MUST BE NO TA RIZED Print name and title (if applicable) below signature line
ov,
Sign and print name & title
-C &-. 1)
,'�2C/- �51, ZOO -2
Date
-3 1
Sign, and print name 6L title A/
BUrW
1
E-�4 zl�
lvatl
sign and �rint nam�4 title Date
7- r&k-oiA
Sign and print name & title Date
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
Stateof
County of
On LO—L: 42 beforNneL
Date Name And Iritid of Officer (e.g., 'JanVQpe, Notary Public")
personally appeared
0 personally known to me — OR — roved to me on the basis of
whose qgffl��
and ac—khowlCd(
DARLA MORNHINWEG-1
COMM. #1358872 CO)
N :0
NOTARY PUBLIC - CALIFORNIA Cj)
SAN FRANCISCO COUNTY —
or the britity upon behalf of which
executed the instrument.
WITNESS my hand
I OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document.
Description of Attached IDDurnent,
Title or Type of Document:
Document Date: a Z_
Signer(s) Other Than Named Above:
Capacity(les) laimed by Signer(s)
Signer's Name: 9/ leeefe m , q
i .
9
Individual
Corporate Officer
Title(s):
0 Partner — 0 Limited 0 General
0 Attomey-in-Fact
0 Other:
El Trustee
0 Guardian or Conservator
0 Other:
Top
Top Of thumb here
717;
.0
__
Signer IsIRepresenting:
Numbero(Pages: 9
Signer's Name:L&4�j 4L ��,Ce a �4
CY\Individual
0 Corporate Officer
Title(s):
0 Partner — 0 Limited
0 Aftomey-in-Fact
Trustee
0 General
El Guardian or Conservator
0 Other:
Top of thumb here
Signer Ispepresenting:
'P,
0 1994 National Notary Association - 8236 Remmet Ave., P.O. Box 7184 - Canoga Park, CA 91309-7184 Prod. No. 5907 Reorder. Call Tofl-Free 1 -80D -876-6a27
T A M E )t
AL
V
Mid Valley Title andEscrow Company
STATE OF CALIFORNIA Iss.
COUNTY OF 6 L) .1
,Zf b
On before me, 1,4Ae,2;Le T, JJ 0
personally appeared
personally known to me
(or proved to me on the 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 instrumentihe
person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
Title of Document
Date of Document
Other signatures not acknowledged
(This area for official notarial seaQ
No. of Pages
Oroville Chico Paradise
EXIMIT 44A99
LEGAL DESCRIPTION
PEEKEMA MERGER
All that real property situate in Section 15, Township 17 North, Range 3 East,
M.D.M., unincorporated area of Butte County, California described as follows;
Lot N and Lot 0 as shown on the map entitled "Subdivision Of Lands Formerly
Owned By Andrew w. Campbell", which map was recorded in the Butte County
Recorders Office on July 6, 1920, in Book 8 of Maps at Page 32, merged into one (1)
parcel.
- No,
0:
a:: 0
I'In
*L
Job #02-037
APN 024-180-024, 045 (portion)
11-01-02
w
zt�,
ca
6L
4-1
GUARANTEE
11�- $ -� A M E R 'r C
M
First American Title Insurance Company
185471 1347(11/68)
10
FORM 1349 '
CLTA GUARANTEE FACE PAGE
(REVISED 12/15/95)
ORDER NO. BU -203614 RB
FIRST AMERICAN TITLE INSURANCE COMPANY
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE LIMITS OF LIABILITY
AND THE CONDITIONS AND STIPULATIONS OF THIS GUARANTEE,
FIRST AMERICAN TITLE INSURANCE COMPANY
A CORPORATION, HEREIN CALLED THE COMPANY
GUARANTEES
THE ASSURED NAMED IN SCHEDULE A AGAINST ACTUAL MONETARY LOSS OR
DAMAGE NOT EXCEEDING THE LIABILITY AMOUNT STATED IN SCHEDULE A,
WHICH THE ASSURED SHALL SUSTAIN BY REASON OF ANY INCORRECTNESS IN
THE ASSURANCES SET FORTH IN SCHEDULE A.
I
FIRST AMERICAN TITLE INSURANCE COMPANY
BY PARKER S. KENNEDY, PRESIDENT
BY ASSISTANT SECRETARY
PAGE 1
FORM 1355
CLTA GUARANTEE (REV. 6/6/92)
FORM NO. 12
SCHEDULE A
SHORT FORM LOT BOOK GUARANTEE
LIA.BILITY:$100.00
NAME OF ASSURED: PEEKEMA RANCH
ORDER NO. BU -203614 RB
DATE OF GUARANTEE: SEPTEMBER 25, 2002, AT 7:30 A.M.
THE ASSURANCES REFERRED TO ON THE FACE PAGE ARE:
FEE:$50.00
THAT, ACCORDING TO THE COMPANY'S PROPERTY RECORDS RELATIVE TO THE
FOLLOWING DESCRIBED REAL PROPERTY (BUT WITHOUT EXAMINATION OF THOSE
COMPANY RECORDS MAINTAINED AND INDEXED BY NAME):
THE LAND REFERRED TO IN THIS GUARANTEE IS SITUATED IN THE STATE OF
CALIFORNIA, COUNTY OF BUTTE, AND IS DESCRIBED AS FOLLOWS:
LOT N, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "SUBDIVISION OF LANDS
FORMERLY OWNED BY ANDREW W. CAMPBELL", WHICH MAP WAS RECORDED IN
THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, ON JULY 6, 1920, IN BOOK 8 OF MAPS, AT PAGE(S) 32.
APN 024-180-024-000
A. THE LAST RECORDED INSTRUMENT PURPORTING TO TRANSFER TITLE
TO SAID REAL PROPERTY IS:
PEEKEMA RANCH, LP, A CALIFORNIA LIMITED PARTNERSHIP, BY
GRANT DEED RECORDED JANUARY 31, 2002, UNDER BUTTE COUNTY
RECORDER'S SERIAL NO. 2002-05186.
DA:LJH OCTOBER 31, 2002
PAGE 2
F3
17
T . .1.7 N.
%NS
694,62
12.4 AC.
23507
68LZZ
PM 87- 43
X36AO,+
cpi
51.74 A�C
54.22AC
v
11
-, . cy
ly
..
Ro.
0 6. A C'
pm 69-'68
pm 06-5/9
40 AC .
10:026A
Zz .. , �k - , — ;;; I IV
4A�',
2 41
25.48AC p.
17 14
A--
Si8.92.AC.,,
IM,
9
157. TAC.
34* \,f
A
be'a-SUrvQY'Of -the tancr Crejjicted
ANDREW' W� CAMPBELL SUB.. M.- 0. R.. BK. 8 PG. 32--TAIS nM May &.rnay.not rporsL.,othet ASSESSOR'S M AP"NO*.* 2 4 --*1 B'-
rely'upon it for any'PJJ
should not (yf tfte parcer-or-Palt- COUNTY Or BUT'TE'. CALIF.
hereo You
rerjentation to the general location. REV . ISM , 11-95
ttfarr -cMprcted. 'Mid Vall ey Title 'and Escro* COMany Py
cele. I
preSty -,cfficjyms any liabltity for arreged- loss 0'r crarna�"`
whiclf-mgTresuit fjon-b rej*Fian'�e- L1 pon thi-S
'S
0
GUARANTEE
$ � A -MER, C
First American Title Insuranc . e Company
185470
0
-4
0
FORM 1349
CLTA GUARANTEE FACE PAGE
(REVISED 12/15/95)
ORDER NO. BU -203615 RB
FIRST AMERICAN TITLE INSURANCE COMPANY
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE LIMITS OF LIABILITY
AND THE CONDITIONS AND STIPULATIONS OF THIS GUARANTEE,
FIRST AMERICAN TITLE INSURANCE COMPANY
A CORPORATION, HEREIN CALLED THE COMPANY
GUARANTEES
THE ASSURED NAMED IN SCHEDULE A AGAINST ACTUAL MONETARY LOSS OR
DAMAGE NOT EXCEEDING THE LIABILITY AMOUNT STATED IN SCHEDULE A,
WHICH THE ASSURED SHALL SUSTAIN BY REASON OF ANY INCORRECTNESS IN
THE ASSURANCES SET FORTH IN SCHEDULE A.
FIRST AMERICAN TITLE INSURANCE COMPANY
BY PARKER S. KENNEDY, PRESIDENT
BY ASSISTANT SECRETARY
PAGE 1
FORM 1355 ORDER NO- BU -203615 RB
CLTA GUARANTEE (REV. 6/6/92)
FORM NO. 12
SCHEDULE A
SHORT FORM LOT BOOK GUARANTEE
LIABILITY:$100-00
NAME OF ASSURED: PEEKEMA RANCH
DATE OF GUARANTEE: SEPTEM13ER 25, 2002, AT 7:30 A.M.
THE ASSURANCES REFERRED TO ON THE FACE PAGE ARE:
FEE:$50.00
THAT, ACCORDING TO THE COMPANY'S PROPERTY RECORDS RELATIVE TO THE
FOLLOWING DESCRIBED REAL PROPERTY (BUT WITHOUT EXAMINATION OF THOSE
COMPANY RECORDS MAINTAINED AND INDEXED BY NAME):
THE LAND REFERRED TO IN THIS GUARANTEE IS SITUATED IN THE STATE OF
CALIFORNIA'r COUNTY OF BUTTE, AND IS DESCRIBED AS FOLLOWS:
LOT 0, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "SUBDIVISION
OF LANDS FORMERLY OWNED BY ANDREW W. CAMPBELL IN SECTIONS 15, 16,
17, 21 AND 22, TOWNSHIP 17 NORTH ' RANGE 3 EAST, M.D.B. & M.11, WHICH
MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF
BUTTE, STATE OF CALIFORNIA, ON JULY 6, 1920, IN BOOK 8 OF MAPS, AT
PAGE(S) 32.
APN 024-180-045-000 (PTN)..�_.,r
A. THE LAST RECORDED INSTRUMENT PURPORTING TO- TRANSFER TITLE
TO SAID REAL PROPERTY IS:
PEEKEMAAND PEEKEMA, A GENERAL PARTNERSHIP, BY. GRANT DEED
RECORDED DECEMBER 17, 1996, UNDER BUTTE COUNTY RECORDER'S
SERIAL NO. 96-47262.
DA:LJH OCTOBER 31, 2002
PAGE 2
I
(D
W
04
1�
Cl)
C�
C14
0
F)
04
L)
AF
%-As
R E M
.:E
�E
61
2 4 AC
ZZ07.
PM 87-43
2
7.36Aap
51.74 A C
54.22AC v
to
PO.06.Ac
!Ll
-410-
PM 66-5/9
4VAC
1120.62
ai
FT71'
a m.
.6 EQ
..t
goo"
04, Ot-
sbo
L
be
so/
C?/
Z
L
lc�6 6
�c ..0)t
6 c L
..24 /Oss
01-
L
Af
Jv
--2 41
-A.
ONVNER-BUILDER VERIFICATION
Aztencion Property Owner:
An -owner-builder" building permit has been applied for in your name and beming
Yaw
Please cbmplew and return this information at your earliest opportunity to avoid
in processing and ;=,,;ng your building permit. No building permit win be 96
verification is received.
0 1., 1 personally plan to provide the major labor and materials for construction of the proya
—property improvement: YES j�f, NO C3
I HAVEO- HAVE NOT 13 signed an application fbr a building perrolt for tbe;rmg an WO&
)1 have contracted with the following person (ffim) to provide the proposed SM=d=.
AINIE:
AD SS: CITY:
L "
A
IE
I SS
9L�
PH
0 NE. CON-MACTOR'S UCENSE NO.
I plan 0 pro e I e following person to caordjnate�
I plan to pro a portions of this work, but I have hired th
pel� 4
supervise, and pr ide the major work:
NIANIE:
ADDRESS: CITY:
P H ON -E: CONMkCTOR'S LICENSE NO.
5. 1 will provide some of the wor but I have contracted (hired) the following pemns to provide
the work indicated:
N AIN I E ADDRE PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER,/</,,,�� 7 -
SOCIAL SECURITY NUMBER:
DATE:
XOTE: Th is Owner -Builder Verification is required by Section 19831 and 198J2 oV&k
California Health and Safety Code. This verification must be conVI&W Md
returned to our office before we arepermilled to issue the permit.
OVER
OWNER BUILDER INFORINIATION
CCa.-
Ao application for a building perrruit has beea submitted in your name lis�g yourselfas the builder of property
improvements specific&
For your protection. you should be aware tba as -owncr-buildff" you are the responsible party oftem aftsuch
a permit. Building permits are not required to be Signed by property owners unless they are perxmWly
own work. If your work is being performed by someone other than yourself you may protect yourself fivM jos'Ale
liabil icy if that person applies for the proper permit in his or her aame.
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 subconuact, You ibOWd
be aware of the following information for your benefit and protection:
+ (f you employ or otherwise engage any persons other than your immediate fknily. and the work (including maurials
and other costs) is S300 or more for the entire project, and such persons are not licensed as contractors or
subcortraictors. then you may be an employer.
fi7 you are an eniplover, you must register with the State and Federal Governments as an employer and you are
s ubjeci to several obligations including *stare and federal income = withholding, federal smial security taxes,
0
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
+ There may �e Friancial risks for you if you do not car -,v out these obligations, and these risks are especially serious
with respe;,to worker's compensation insurance.
+ For more sreci,-,c informacion about your obligations under Federal Law, contract the Internal Revenue Service (and,
IC You wish', the U.S. Small Business Administration). For more specific information about your obligations under
Suize Law, co -mac, the Department of Benefit Payments and the Division of Industrial Accidents.
1 -7d -.e struc-ra: is intended for sale. property owners who are not licensed contractors are allowed to pedorm their
work'persorally or ch�roug;h their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequenc practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit. erroncous!v 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.
[nfor-nation about licensed contractors may be obtained by contracting the Contractors State License Board in your
corununity or at 1020 N Street, Sacramento, CA. 958 14.
please complete the -C)%vncr Builder Verification- on the reverse side of this form so that we can conru-m that you
are aware of these matters. The building permit will not be issued until the verification is returned.
CV
Nf�ichcl C. Vidira, C.B.O.
N1 ger, Building Inspection
NO TE: Tit Zr 0 w rr er- 8 u ilder Info rm a tio a is requ Ired by Section 1 98_1 0 of 1h e Cglyornia Health an d SqfcoF CO&
OVER
NOV,18,2002 9:36AM
November 18, 2002
County of Butte, BdIg 0ept
Aftn-, Scott Ruthiford
7 County Center Dr
Oroville, CA., 95966
Dear Mr Ruthiford:
PG&E NO -402 P. I
460 Rio Linda Ave., Chico C4., 95926
Re: 544 Levee Rd., Gridley
Peekama Ranch Electric Service
Notification #100657715
Here is the information you requested regarding clearance requirements for the above referenced
application.
In accordance with our discussion, the Peekama Ranch is rebuilding the single story home at 544 Levee
Rd. The new home has a slightly larger square footage however it will continue to be a single story
building. The applicant states they have not moved the new foundation closer to the existing pole line.
Based upon General Order 95, State Clearance requirements for high voltage electric lines, the proposed
building permit will not conflict with the PG&E high voltage line.
Thank you for ensuring that the safety clearances are being adhered to. If you should have any questions
regarding this information, please call me at (530) 894-4706.
klb:klb
Encs.
Sincerely,
Ken Bedsaul
New Business Representative
V
FEDERAL EMERGENCY MANAGEMEN I AULNG Y
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on _pagesl - 7.
. SECTION A - PROPERTY OWNER INFORMATION
3UILDING OWNER'S NAME
FIFEl4P-'Ii,At% PLANCH
BUILDING STREET ADDRESS (Including Apt.. Unit, Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
544 LEVES PI) STATE
4401DL&Y
(J.10,13. 1\10. )UuUU' ,
Expires July 31, 2002
For Insurance Company Use:
Company NAIC Number
Iq
024 -180 - 02'k etc. Use Comme,its section i necessary.)
-BUILDING USE (e.g., Residential, Non-resdential. S,i dition, Accessory
P'F;S1bL-NT1A1- SOURCE: 1_1 GPS jype)�
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: USGS Ouad Map 1_1 Other:
( or ##.#*Htfl 0) NAD 1927 1_1 NAD 1983
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B2. COUNTY NAME B3.STATE
B1. NRP COMMUNITY NAME & COMMUNITY NUMBER OUTTIE - (An1nCVrP9?rAW AircA 1 CA
6RIM-61( 0601117 --
B4. MAP AND PANEL t3b. but- 1A 1 00. HKNI 1111A ' 1, 1.1- 1 (Zone AO, use depth of flooding)
NUMBER C, DA EFFECTIVE/REVISED DATE A S) 10'0
TUN 9 'Ne S
04001c, 1110 1 -a-Fa'—'e
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Bg.
1-1 FIS Profile 1_1 FIRM 1_1 Community Determined IV I Other (Describe): CA DWK- COE Dthly"
B1 11ndicate the elevation datum used for the BFE in 139: 1_tj NGVD 1929 1_1NAVD1988 1_1 Other (Describe):_
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1Yes I P1 No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
-ire based on: I _lBuilding Under Construction* IZIFinished ConstrUction
Cl.'Building elevations z _lConstruction Drawings* I
*A new Elevation Certificate will be required when construction of the building is complete. see
C2. Buildinq Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being rompleted
pages 6 and 7. If no diagram accurately repr6sents the building, provide a sk'etch or photograph.)
C3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30 V (with BFE), AR,,AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and dAtUm conversion .
atUrn conversion.
calculation. Use the space provided or the Comments area of Section D or Section G, a . s appropriate, to document the
Datum _- Conversion/Comments appearont M? Yes No
Elevation reference mark used Does the elevation reference mark used
• a) Top of bottom floor (including basement or enclosure) ft - (m)
ft (m)
• b) Top of next higher floor
0 c) Bottom of lowest horizontal structural member (V zones only) ft. (m)
• d) Attached garage (top of slab) ft. (m)
• e) Lowest elevation of machinery and/or equipment
servicing the building ft. (m)
0 � Lowest adjacent grade (LAG) ft. (m) Z� CT
0 g) Highest adjacent grade (HAG) C
0 h) No. of permanent openings (flood vents) within 1 ft. abov adjace
vents) in C3 = sq. in. (s?. cm)
0 i) Total area of all permanent openings (flood C� —
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment tinder 18 U. S. Code, Section 1001.
. .1 - - k1i 1hAQr P
AW
FFMAFnrm81-'11 AIlGPC1
CA
PEEKIFKA RA
CITY
61ZWLE�Y
,;FP RF:VFP.I;F sinp FOR (.nNTINIIATinN
0 Z56 1-1
RPPI ACPS Al I PRF:\/Int IR FnITInN'
i
nding information from Section A.
FU. .� i- I— __
qr_1V&1F1 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
11 / P -- ._�
164,5e :rloetd JJeVAT1#n OP -M CO 717w -
I xt M . SL (*X ell. 3'0W "Vn- �-5" ��ev-a R�016 a �601
8,2 AwrMSL
F)AV, f fp,,J e I, vAms at Rmoi (rak is - — , �__ 4 _J_ dA A' A4 4L r?v- OFF
I hAIJiqA4 WTIV"97 InUffA111-7 m -1� El Check here if attachments
q 1.1
A 1 -1 :1,
ir) Ao are
V Olt .5qq Lel&
SECTION E 7 BUILDING ELEVATION INF RMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting
information for a LOMA or L OMR-F, Section C must be completed. e building for which this ce . rtificate is being completed -
E I. Building Diagram Number _ (Select the building diagram most similar to th
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
1_1_1 ft.(m) 1_1_lin.(cm) 1_1 above or 1_1 below
E2. The top of the bottom floor (including basement or enclosure) of the building is
(check one) the highest adjacent grade. ge 7), the next higher floor or elevated floor (elevation b) of the building is
E3. For Building Diagrams 6-8 with openings (see pa
1_1_1 ft.(m) 1_1_lin.(cm) above the highest adjacent grade. floor elevated in accordance with the community's
E4. For Zone AO only� If no flood depth number is available, is the top of the bottom
floodplain management ordinance? 11 Yes 1_1 No 1_1 Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION -issued or
s authorized representative who completes Sections A, B, and E for Zone A (without a FEMA
The property owner or owner'
COMMUnity-issued BFE) or Zone AO must sign here.
E RTy OWN E R 1::�, 57�!F� r �t, 8� Ji 111113 iR I ZE
FrR-op i9: E!15 P� E 9 E N TAT I E
CITY STATE ZIP ODE
ADDRESS
SIGNATURE DATE TELEPHONE
CO ENTS
Check here if attachmen
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official,who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A. B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. 1_1 The information in Section C was taken from other documentation that has been signed and em ' bossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.) (without a FEMA -issued or community -issued 8FE) or
G2. 1_1 A Community official completed Section E for a building located in Zone A
Zone AO.
G3. 1_1 The following information (Items G4-Gg) is Provided for community floodplain management purposes.
ISSUED
G7. This permit has been issued for: 1_1 New Construction 1_1 Substantial improvement ft.(m)Dqtum:
G8. Elevation of as -built lowest floor (including basement) of the building is: A tr
G9. BFE or (in Zone AO) depth of flooding at the building site is: )Datum:
TITLE
L L OFFICIAL'S NAME
TELEPHONE
COMMUNITY NAME
SIGNATURE DATE
7
NTS
-79 1 Check here if attachmE
CPS At I pRpvlot Is FnITIO
RPPI A
FFMA Fnrm R! �31. At IG PP
-IS L . 77x5e-, Aovw- elcvah-,n5 ire, (�I-trmoed
"
N�vv it ig
bno,,e, �eme /I i, wV
m Chetm d. --A Vve,,,(k)oFR,4T),,4mdTlV-6hooc�m
Ave,
(auYe Kdet-
Ptf -hict- Weir). Thts
elewxim I s 611.4 1 pvey ms I- , FrAm -t415 benc� modc) �he Ae,(Attm 4 Ae f -op o�
-ur, lwie 0 544 L,,ft PJ 13� Jeo�rrlwd -tv be 93,4'1 arid is i4re--6re- (at leo;e)
eve., Vv- DFP,.
-rhc ati-peke J,'-. 40E. Arho
al5,o
3;hrws th,&
P,�Fic-
W vi"6-xt Creek onJ
Coy
5plllw&vl. l7v-.�
qh^v-m a�,z e-4eh
4v be,
qdw6ed b,
�?o'
tv 6�fre;yrnj -& 056�
od
N6�Vf) d&-fA
. X0,
:�63V, C,AP;lT6t OAI:t 0ANT; fullt�:,Soo
tatRAWW-O. CA ttl3l-r§218
Al%irs gig 2453"-2221
CERT(FICATE NO. ...... ..... EXUMA 0
1 2565 12 / 3 1 / 0;
tEORGE THOMAS PEEXEMA
7519 NE 69TH ST ':
VANCOUVER WA 98662
s,,7.m4 -RECErPT VO.
pr*! 0 1 � A 5, 5,
STATE OF WASHINGTON
PROFESSIONAL ENGIKtEN"
" PEEKEMA,GiIt6Rbt -(J:H" -
7519 NE 69TH ST
Y�NCOLIVER WA 98662-4303
REFERENCE NUMBER EXPIRATI'
ON ATE
7442 06-19702
�lob137 X450 1V_T
_�--- _ S74TsnpCxuFonwm
THE RESOURCES AGENCY N�''-------i�--��-
P.O. BOX 40,6908 COLUSA HWY
CHANNEL P
TO.
Mr. George Peekema
7519 69th Street
VanCmmver, WA 98663
DWR 54 (New ims)
MfL-Ej$_ SEE
R
P&I/ RN
T ltnve d
-0�11�_Ovla eal
Elevation measurements at Campbell Orchard 5/17/02
Level Rod
mitinn rpnrli— Rod position
afV 41 t14-�5
1.09 -AF ... We.x hse floor - est)
4.365 CT (honev locust tree at
2 8-29 CT (honey locust tree at
latw Wj IM 58
8.36 CH (cpbl hse SW sidewa
6.056 V� �(CDbj �welr)
ELEV
AlW1
m.s-L
H. ' ILLV ' fit
:window sill rod rdq 2.07 inside 3.52 ou q) --V
-Pbf hse) 'qW. A, 9-
1 between rows 2 & 3 In Fuyu prunes south end
2 on levee top at entrance to cpbl hse
3 In new orchard E of alex hse
4 on alex S prop line going E
5 on alex S prop line going E
6 on alex S prop line going E
7 in cpbl orch half way to river pump
8 on levee top 600 ft S of weir
9 on levee top 1300 ft S of weir
IN.
&i R-14-&&kem qnd Gr.PakelAe,
kditjx nbe gnu norin)
-0-23
hse floor - est) (floor reaas iiiwith r o . d . o .. n
5.05
Ti (a x &rch tree
12.76
T6 (alex orch tree 6)
4 —4-33
T6 (al
4.28
T12
3.95
T16
2.96
T21
1 between rows 2 & 3 In Fuyu prunes south end
2 on levee top at entrance to cpbl hse
3 In new orchard E of alex hse
4 on alex S prop line going E
5 on alex S prop line going E
6 on alex S prop line going E
7 in cpbl orch half way to river pump
8 on levee top 600 ft S of weir
9 on levee top 1300 ft S of weir
IN.
&i R-14-&&kem qnd Gr.PakelAe,
2.83
T26
5 4.655 T26
4.42
T31
4.31
T36
4.06
T41
4.32
T46
4.32
T51
t
6 4.65
4.14
T56
4.23
T64
3.91
T66
4.18
HW (half way to BM)
7 4.Zo5 "VV (nalf way to E3M)
2-00
TBM (von Geldern E3M on power pole) 85.44 feet
8 6-38 W (cpbl
EL -r -t, q8.70
4.67
-------
IP (intermediate point on levee - 1200 South of weir)
--
!A03
A
IFLEV HT ej�"63 - . '�-' -LU�t:efq—jt-d=i—ate p2�i�fon levee 1200-south_of weir
-F-R-'
7.23
CW (chandon weir on IYW�'i�'a-s's-'-b"e'*n''c"h-*m"'ar'k' #- 47)
rROM
1 between rows 2 & 3 In Fuyu prunes south end
2 on levee top at entrance to cpbl hse
3 In new orchard E of alex hse
4 on alex S prop line going E
5 on alex S prop line going E
6 on alex S prop line going E
7 in cpbl orch half way to river pump
8 on levee top 600 ft S of weir
9 on levee top 1300 ft S of weir
IN.
&i R-14-&&kem qnd Gr.PakelAe,
FEDERAL EMERGENCY MANAUEIVIEN I
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important:' Read the instructions on pages 1 7.
SECTION A - PROPERTY OWNER INFORMATION
PEWFR�At% PLAN64 ' I 1 1. —
BUILDING STREET ADDRESS (Including�Apt., Unit. Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX. NO..
$44 LGVEE PD
STATE
CITIY
CA
-(IRIDLS�Y
is, i ax
U.IV1.1-3. 1,4u. -,�)J 0 U, I -
Expires July 31. 2002
For Insurance Company Use:
-Policy Number
11
commy NAIC.Number.,.
IP CODE
15 44 9
04 -160 - 0 2 4,
BUILDING USE (e.g., Residential, Non-res'Oe''10,16,ci, I Tor,.N."Ecesici�1, etc. UseCommiensseclioni Bssary.)
RF;S1D&-NT1A1I
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type):
or 1_1 NAD 1927 1_1 NAD 1983 1_1 USGS Ouad Map 1_1 Other:_
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIp COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3.STATE
VltrrTre -(An1nC0r0dYAW ArCA CA
- — Of. 1 --1
B4. WAp AND PANEL B5. SUFFIX I bb. HKM NUt Z N�(�) (Zone AO use depth of flooding)
NUMBER DATE EFFECTIVEIRE�1'�'E DATE 0
040C)IC 1110 Tuns 9, 101,110 same_ A C2, 0,
I — ah—e
B10. Indicate Ihp ,niircp of the Base Flood Elevation (BFE) data or base flood depth entered in cole
1_1 FIS Profile 1_1 FIRM 1_1 Community Determined I yl I Other (Opscribe):
B11. Indicate the elevation datum used for the BFE in 89: 1_1� NGVD 1929 1_1 NAVD 1988 1_1 Other (Describe):
812. Is the building located in a Coastal Barrier Resources System (CBRS) a.rea or Otherw . ise Protected Area (OPA)? 1_1 Yes W1 No
Designation Datei
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_1Construction Drawings' 1_18uilding Under Construction* 1_1Fi nished Construc . tion
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most similar to,the building for which this 6ertificate is being completed - see
pages 6 and 7. If no diagram accurately repr6sents t . he building, provide a sketch or photograph.)
C3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A,.AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the d@tUrn is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE: Show field measurements and cIntLIM conversion
C. u
calculation. Use the space provided or the Comments area of Section D or Section G, a I s appropriate, to document th . clat rn conversion.
Datum _- Conversion/Comments d appear on the FIRM? 1_1 Yes 1_1 No
Elevation reference mark used Does the elevation reference mark use
• a) Top of bottom floor (including basement or enclosure) ft.(m)
• b) Top of next higher floor ft. (m)
0 c) Bottom of lowest horizontal strUCtUral meniber (V zones oniy) ft.(mN
1 9 0
0 d) Attached garage (top of slab) ft -(M) E
t1i
0 e) Lowest elevation of machinery and/or equipment
servicing the building ft.(m)
ft. (m) Z� Ce
0 0 Lowest adjacent grade (LAG)
ft. (m)
0 g) Highest adjacent grade (HAG)
0 h) No. of permanent openings (flood vents) within I ft..above adjacent grade
0 i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I cerlify that the information in Sections A, B, and C on this cerlificate represents my best efforfs to inteipret the dite available.
I understand that any false statement may be punishable by fine orimprisonment tinder 18 U.S. Code, Section.1001.
I Ir-CKICE: K11 IKAAPP
.VA
w o tv- A vc;
FEMAFnrmA1-.11 All(-,Clq
CA
A
,�Pr- RF-VPR.-,F- sinl:- FnR EnNTINHATinN
or 30 756 1*1
RFPI ACPS At I PRF\/int Is FnITION!
A* i
ding information from Section A.
.;�TANT: In these spaces, copy the cortespon .0. ROUTE*AND BOX NO. Policy Number
MIA kL5ING STREET ADDRESS (Inclu ing Apt., Unit, Suite, and/or Bldg. No.) OR
any NAIC Number
4W 1 .,)� n
fl. �90,_ LC -VP -P- ZIP CODE Comp
rh STATE
CITY
45,146
0* CA
elp. IV Lro y SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company. and (3) build A i , ng owner.
__ CO N �&n (,&r� 444?4vh (sez 44wheh 4rJ Yerl�jj±l� S4M Dr44AMA of 61 DIJK Atz 011 1
t1l. Als L . 544 fv4,*, Rd 16
F So. M SL At *X �1�
elevA+tM, at RMttj (rak ji, ql,2' 4bw "a
,1 14 e, I -r
&A ie f M
if attachments
iq LOV& ovff M5L. A15 4eA I NE A (WITHOUT BFE)
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZO
For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended foruse as supporting
information for a LOMA or LOMR-F, Section C must be completed. ost similar to the building for which this certificate is being completed –
E I. Building Diagram Number _ (Select the building diagram m sketch or photograph.)
see pages 6 and 7. If no diagram accurately represents the building, provide a above or _I below
E2. The top of the bottom floor (including basement or enclosure) of the building is ft.(m
(check one) the highest adjacent grade. higher floor or elevated floor (elevation b) of the building is
E3. For Building Diagrams 6-8 with openings (see page 7), the next
1_1_1 fl.(m) 1_1_lin.(cm) above the highest adjacent grade.
E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? 11 Yes 1_1 No J_ Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or
community -issued BFE) or Zone AO must sign here.
PROPERTY OWNER'3 OR 0 NNER'S AUTHORIZED REPRE 3ENTATIVE'S NAME
_7DDRESS Cl STATE ZIP C
SIG AT RE 0 FE TELEPHONE
COMMENTS
I I Check here if attachmen
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local orricialwho is at ithorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B. C (or E), and G of this Elevation Certificate, Complete the applicable item(s) and sign below.
G1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
G2. I elevation data in the Comments area below.) (without a FEMA -issued or community -issued BFE) or
_I A Community official completed Section E for a building located in Zone A
Zone AO.
G3. 1_1 The following information (items G4 -G9) is provided for community
floodplain management purposes
11 1
G5. DATE PEI J111 l�3SUED
11 1 : :: !:, p i p: i
DA I E
i E CCUPANCY
7��
ISSUED
G7. This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is:
—ft.(M)Dattim:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
_ft.(m)DatUM:
L CAL OFFICIAL'S NAME
TITL
COMMUNITY NAME
TELEPHON
SIGNATURE
DATE
COMMENTS
I I Check here if attachME
RFPI A(',F-,c; Al I PRPVI01 1.1; FnITIO
FFIVIA Fnrm FO -11. AUG, qq
ard,'b '-..R egi site t 1,6W. -for
E el 'dits A -Llhd-:9'd'rv'iy6ts,.:
n n
S&CRAtEWTO, tA t6t3t.?928 . . . . .
316
CERT(FIC TE no.
1 2W; 12 3 1 /0;
tEORGE THOMAS PEEKEMA
T519 NE 69TH ST
VANCOUVER WA 98662
S��m. -RECEmr WO.
pr*: OT -l", 202,0000R
STATE OF WASHINGTON
PROFESSIONAL ENGWEEW*
PEEKEIVIA,b�6Rblt -(J:R"'' -
-'7519 NE 69TH ST
Y�NCOUVER WA 98662-4303
DIRECT RI
0 (e
EjfR RENCE NUMBER EXPIRATION ATE
7442 06-19�02
Iv vw- e-lewhor) 5 elre, (4e ferm oed ", 1\)GV V it -Zg b%;e behelittl4rL
m 6hein d,, -A VVero- (Mo FR 47)).O�d.-%e md ,�
6haoclm Avy-, (6kt�e Wafele Ptf met Weir). Thl's
4
e�evxkm is
111.4 pwy ms I- Fro'm -AP4 b4.n,-h
Ynoyk,� �he AeYalltm
fvp
514-q 1,,,va ald is -ffvre--tr?y-e-
(atleo;e)
oVer vv_
DF p*,
-T�c a0tocke J,'. 40 E. da+,o a15,o 3;hrwi ill&
P? 4ocmt Creek qnJ
60Y 5pillway. 17Y,9,
alevx*vo
5hAv-4 a,,,& eAeh 4v- bc, v-cdwc,-,d bq
�o 1 tv afre��) -6 us�*$
qnj tv6wvo dw�
ard,'b '-..R egi site t 1,6W. -for
E el 'dits A -Llhd-:9'd'rv'iy6ts,.:
n n
S&CRAtEWTO, tA t6t3t.?928 . . . . .
316
CERT(FIC TE no.
1 2W; 12 3 1 /0;
tEORGE THOMAS PEEKEMA
T519 NE 69TH ST
VANCOUVER WA 98662
S��m. -RECEmr WO.
pr*: OT -l", 202,0000R
STATE OF WASHINGTON
PROFESSIONAL ENGWEEW*
PEEKEIVIA,b�6Rblt -(J:R"'' -
-'7519 NE 69TH ST
Y�NCOUVER WA 98662-4303
DIRECT RI
0 (e
EjfR RENCE NUMBER EXPIRATION ATE
7442 06-19�02
77-71-
to -6pAU-CT'TV M�,
.. . .. ....... .
E14V -
�0
J
N. 3L.
............ :r . . .. .. . ................. . ..
.... .......... .. . ..
A
. .. ....... ..
4-
.........
. .. ... ........... ........ ..... ...
.............
V:
..... ..... .
CHANNEL F
... .... ... ........ .......
cz
00�'
CAI (3� %
.5
STATE OF CALIFORNIA
THE RESOURCES AGENCY
DEPARTMENT OF WATER RESOURCES
P.O. 13OX 40,6908 COLUSA HWY
SUTTER, CA 95982 ((<A9ZsKJ H
TO:
M.I.L.ElS. SEE
Mr. George Peekema
7519 6,9th Street
Vancouver, WA 98662
DWR 54 (New 10/95)
CHANNEL F
... .... ... ........ .......
cz
00�'
CAI (3� %
.5
STATE OF CALIFORNIA
THE RESOURCES AGENCY
DEPARTMENT OF WATER RESOURCES
P.O. 13OX 40,6908 COLUSA HWY
SUTTER, CA 95982 ((<A9ZsKJ H
TO:
M.I.L.ElS. SEE
Mr. George Peekema
7519 6,9th Street
Vancouver, WA 98662
DWR 54 (New 10/95)
Elevation measurements at Campbell Orchard 5/17/02
Level
position
Rod
reading
Rod position
L
61.9v HI q4.
2.54
AGS (afex hse,gnT�—q�5.. �LVSS
�9 4..
qI
1-09
AF (alex hse floor — est) (window sill rod rdq 2.07 inside 3.52 out)
4�
4.365
CT (honey locust tree at cpbl hse)
2
8,29
CT (honey locust tree at cpbl hse)
6LLV W1 q8. 58
i'36
6q (cpbl hse
6.056
W (cpbl weir)
4 C
3
1.885
AG (a ex se gnd
-0-23
AT—(a-iex- fi_sj_fi6_oj_— est) (floor reads 2 .1 2 with rod o n . .........
-(aiex
5.o5
Ti orch tree 1)
12.76
T6 (alex &ch trdd'6)'
4 4.33 T6 (alex orCh tree.6)
4.28
T12
3.95
T16
2.96
.121
2.83
T26
4-655 T26
4.42
T31
4.31
T36
4.06
T41
4.32
T46
4.32
T51
6 4.65 T-51
q. 14 1 Db
4.23 T64
3.91 T66
4.18 HW (half way to BM)
-15 HVV (halt way to BM)
7 4A
2.Lxi _TBM (Von Geldern BM on power Dole) 85.44 feet
ELPV HT — k
4.67 IP
9 4.60 1 P
FLEV 11T q8,63 - -
7.23 6-W
,veir)
nediate point on"ievee – south of weir) , 4,0�
ned—W-e point on levee – 1200 south of weir)
ndon weir on DWR brass benchmark # F"R*- *4-7')"'-'
PROM WGVD ze)
I between rows 2 & 3 in Fuyu prunes south end
2 on levee top at entrance to cpbl hse
3 in new orchard E of alex hse
4 on alex S prop line going E
5 on alex S prop line going E
6 on alex S prop line going E
7 in cpbl orch half way to river pump
8 on levee top 600 ft S of weir
9 on levee top 1300 ft S of weir
..�j R,M.Poke#A 4fid GTflakemc,
License Holders :
Search Results for Professional Engineers
The information on this page is updated five days a week (Monday - Friday).
To see all the information for a licensee, click on the highlighted name.
Name Type Number Status Address
PEEKEMA 1 2565 CLEAR 7519 NE
GEORGE 69TH ST
THOMAS
Record I
First Previous
Page I of I
city Zip County Actions?
VANCOUVER 98662 OUT OF No
STATE
Disclaimer
All information provided by the Department of Consumer Affairs on this web page, and on its other web
pages and internet sites, is made available to provide immediate accessfor the convenience of interested
persons. While the Department believes the information to be reliable, human or mechanical error
remains a possibility, as does delay in the posting or updating of information. Therefore, the
Department makes no guarantee as to the accuracy, completeness, timeliness, currency, or correct
sequencing of the information. Neither the Department, nor any of the sources of the information, shall
be responsiblefor any errors or omi . ssions, orfor the use or results obtainedftom the use of this
information. Other specific cautionary notices may be included on other web pages maintained by the
Department. All access to and use of this web page and any other web page or internet site of the
Department is governed by the Disclaimers and Conditionsfor Access and Use as setforth at (.*.'q1ifi)rni
Department of Consumer Affairs'Disclaimer Information and Use Information.
FB—a—ck I —Retur-h to: Mzfln-Lice—nse �Listi
http://www2.dca.ca.gov/pls/wllpub/WLLQRYNA$LCEV2.ActionQuery 6/18/2002
License Holders :
Page I of I
BOA-]`I%D FOR PROFESSIONAL ENGINEERS
AND LAND SURVEYORS
Name: PEEKEMA GEORGE THOMAS
Type: INDUSTRIAL ENGINEER
Number: 2565
Status:
CLEAR Definition
Expiration Date:
December 31, 2002
Address:
7519 NE 69TH ST
City:
VANCOUVER
State:
WA
Zip:
98662
County:
OUT OF STATE
Disciplinary Actions
No Records returned
Disclaimer
All information provided by the Department of Consumer Affairs on this web page, and on its other web
pages and internet sites, is made available to provide immediate accessfor the convenience of interested
persons. While the Department believes the information to be reliable, human or mechanical error
remains a possibility, as does delay in the posting or updating of information. Therefore, the
Department makes no guarantee as to the accuracy, completeness, timeliness, currency, or correct
sequencing of the information. Neither the Department, nor any of the sources of the information, shall
be responsiblefor any errors or omissions, orfor the use or results obtainedfrom the use of this
information. Other specific cautionary notices may be included on other web pages maintained by the
Department. All access to and use of this web page and any other web page or internet site of the
Department is governed by the Disclaimers and Conditionsfor Access and Use as setforth at Californi
Department ofConsumer Affairs'Disclaimer Information and Use.1riformation.
FB a —ck I
http://www2.dca.ca.gov/pls/wllpub/VvTLQRYNA$LCEV2.QueryView?P—LICENSE—NU... 6/18/2002
PRE -INSPECTION REPORT
PRE-INSPETION
DATE TO INSPECTOR:—q Pzmrr
Building Dacription:
Electric:
Gas:
C4mmercial/Usage:
Residential/# of Units:- (D
Currently Occupied
AbandonedNacant VE�
r
�;?-DATE-��
' i
0rF -
'7A.P. #-, 0 0
19
ZONING:
AS FOLLOWS:_
BUELDING INSPECTOR'S REPORT
Yes No Electric curmtly On Off
Condition of Electric
Natural. Propane None.,� ' Currently On Off
Obvious Problerns:
Sanitation:
Plumbing Working
Well Workinj Potable Water
Obvious Scwage�roblc'11'13, I
Comments: PO 4609-0 Q%9,0!pn 7—. F/40 A—
r
ACTION RECOMMENDED: ISSUE: HOLD FOR I CIL th t -T-
Inspecto
Date �4— /V — -2—
Sketch buildings on reverseand indicate location on piroperty
I
C-I�
(000z
0
7 County Center Drive - Croville, California 95965 - Telephone (530) 538-7,541 PER.mi7 t.-
12, 6 APPLICATION AND PERMIT
k,.SES-,OQPAACEL MISER
0 -,,Eq
P,- e vy" e,
PERMIT FEE I S
MAlUN0 ADDRIE
-JaC15
Total Valuation S
CON'T;kACTORS NAME
Filing Fee'
s AAiuNo Zoni-s
S
C:),,S TAUCTION LENDER
Permit Fee
Plan Checking Fee
Energy Plan Checking Fee
UNDEA S wNUNG ADDRESS
200A TO 100 -OA
-PC-r?ECT OR ENGINEER
AAC.ITECT OR ENGINEERS MAIUNG ADCAESS
PERMIT FEE
ADOPESS
,_ - u 0
L3T NO SUSONCSION'SKAME
UCENSE NO
USEOFSTRUCTURE
SF�$ DupIex0 Mobilehome(ZI Other SPECIFY
TYPE OF WORK
h
New 0 Add, 0 -'-st-"-t_ " ot�n
, WO
Describ k
*PERAUT FEE PA10
S PA
SHERIFF
OTM
. . I
AMOVNT RECGXVgb $.,5 es —
3 37 5 -7
3 q 2
TO U RM X"T0 C"An"
BUILL)INGPERMIT
SO. Fr. OCC.
t3UILUIN(j vALUATION
:Z, 67&1 C�)__
Fireplace I I
PERMIT FEE I S
U .3
Total Valuation S
?
Filing Fee'
Filin Fee
S
2.3, C
Permit Fee
Plan Checking Fee
Energy Plan Checking Fee
S
$
$
200A TO 100 -OA
46.00':
NEW CONST.
OR ADONS.
PERMIT FEE
S
S_
PLUMBING PERMIT
OUTLET
=11; CIRCUITS
Filing Fee; 20 C2
Each Trap
Solar or heat pump water heater
171
7. 0 O'Z�� I
23.00,
Water piping
1 5. 0 0
Each gas water heater or vent
I
15.001),f-, C,
Gas piping system I - 5 outlets
_, 'R.,.)
E
OUFITXEDSAPPLNS OER�A
5.001
Building sewer
Temporary Service
15.00.
Mobile Home ! S I G: W I
1
La20.00'
9.1 PERMIT FEE S
MECHANICAL PERMIT
Heating
Cooling
Hood
Ventilation
Filing Fee i
7-1,
6.50
1,73- o c
0e)
2 0 G__
1�-- 0C
C
PERMIT FEt S _Zi2_1 _0(,
Mobile Home Installation Fee $
Energy Inspection Fee $
T TYPE JTOTAL FEE $
,0 8—. K57_
Z. 1 0. FEES I IMP I FLOOD I COF I PARCEL I PO
This permd 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
ReceiptNo. PERMIT EXPIRES ON
WMTF-O.O.S.-8.0. CANARY -ASSESSOR PINK -INSPECTOR GOLOENROO-APPLICANf i Xkffife)
PERMIT FEE I S
U .3
--� 0
ELECTRICAL PERMIT
Filing Fee'
20.00
Main Service
" ' 'S
.A 0.11 LEN ��23.00'.?-
-M
Main Service
200A TO 100 -OA
46.00':
NEW CONST.
OR ADONS.
OWCUING OCCUP.
ACC. OLDS
G
3.5,s,,
NEW CONST
NON-RESIO
OUTLET
=11; CIRCUITS
@7.50:
POWER APPARAT Is
I SINGLE OUTLEr LAI,
Ex. Occup.
oururT OR FMTVAES
zo
Ex. Occup.
_, 'R.,.)
E
OUFITXEDSAPPLNS OER�A
5.001
Temporary Service
1 23.001.
Mobile Home Facilities
20.00-
Misc. Wirinq
23.00
9.1 PERMIT FEE S
MECHANICAL PERMIT
Heating
Cooling
Hood
Ventilation
Filing Fee i
7-1,
6.50
1,73- o c
0e)
2 0 G__
1�-- 0C
C
PERMIT FEt S _Zi2_1 _0(,
Mobile Home Installation Fee $
Energy Inspection Fee $
T TYPE JTOTAL FEE $
,0 8—. K57_
Z. 1 0. FEES I IMP I FLOOD I COF I PARCEL I PO
This permd 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
ReceiptNo. PERMIT EXPIRES ON
WMTF-O.O.S.-8.0. CANARY -ASSESSOR PINK -INSPECTOR GOLOENROO-APPLICANf i Xkffife)
B E A U T Y
DEPARTMENT OF PUBLIC HEALTH
June 5, 2002 DIVISION OF ENVIRONMENTAL HEALTH
18-B County Center Drive F1 411 Main Street �-<- 7 County Center Drive
Oroville, CA 95965 PO. Box 5364 0(oville, CA 95965
Peekema Ranch TEL: (530) 538-7282 Chico, CA 95927 TEL: (530) 538-7281
FAX: (530) 538-2165 TEL: (530) 891-2727 FAX: (530) 538-7785
905 Alexander Ave. FAX: (530) 895-6512
Gridley, Ca 95948
RE: Septic Repair Permit, 544 Levee Rd., APN 24-180-024
Dear Mr. Peekema;
We have received your application for a sewage disposal permit to repair the leach lines
at the above location. During the site inspection, it was noted that the septic tank is
situated too close to the structure, the building department requires that it be at least five
feet from any weight bearing portion of the structure.
Additionally, the building department is waiting for flood elevations from an engineer, to
deten-nine if the structure is within a flood zone. They will then determine if the dwelling
can be remodeled and repaired. Therefore, we will not issue a sewage disposal repair
permit until such time as the building department is satisfied with the flood elevation
data.
When the building department allows the remodel, it will be necessary for you to submit
an additional septic system repair application for the septic tank replacement. The
existing tank will have to be abandoned by breaking out the bottom and filling with
engineered fill or cement slurry. The fee for the additional permit is $232.
If you have any questions please contact me Monday through Friday, 8:00 am to 5:00
pm.
Sincerely,
41 ak 0A4
Charlotte Walters
Environmental Health Specialist
Cc: Butte County Building Department
Ob
130 A(I
117 �4 e-
411.
els
9-v
ed. !q^v
Ale
S.,
. .. I - - - - I . - - I . - . - - I - - - - - - - - I- - - - - -- - -- - . .1 1. � - - I . � . - � - -- � - -
S-ttc
L A N D 0 F N A T U R A L W E A L T H A N D B E A U T Y
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (530) 538-7541
FAX: (530) 538-2140
June 19, 2002
Peekema Brothers
7519 North East 691h Street
Vancouver, Washington 98662
Re: Fema Emergency Management Agency
Flood Elevation Certificate for
Assessor's Parcel # 024-180-024
Dear Mr. Peekema,
Although I am not the plan checker for your project, I was present during the discussion
with you and Russell Bloomfield at the Building Division counter in our Oroville office,
during the first week of June, 2002. We repeatedly informed you that although you are a
licensed industrial engineer in the State of California, and appeared to have accurate and
substantial data, and a flood elevation certificate completed by a civil engineer licensed to
practice in the State of California was required prior to permit issuance. The elevation
certificate must be stamped, and must contain an original signature. I
I apologize for any inconvenience this may have caused you. Should you have further
questions please call or contact Scott Rutherford or Russell Bloomfield at the address or
phone number above.
Sincerely,
Av-�— -
� wxl"T�
Scott Rutherford
Chief Building Inspector
1
License Holders :
Page I of I
BOARD FOR PROFESSIONAL ENGINEERS
AND LAND SURVEYORS
Name: PEEKEMA GEORGE THOMAS
Type: INDUSTRIAL ENGINEER
Number: 2565
Status: CLEAR Definition
Expiration Date: December 31, 2002
Address:
7519 NE 69TH ST
City:
VANCOUVER
State:
WA
Zip:
98662
County:
OUT OF STATE
Disciplinary Actions
No Records returned
Disclaimer
All information provided by the Department of Consumer Affairs on this web page, and on its other web
pages and internet sites, is made available to provide immediate accessfor the convenience of interested
persons. While the Department believes the information to be reliable, human or mechanical error
remains a possibility, as does delay in the posting or updating of information. Therefore, the
Department makes no guarantee as to the accuracy, completeness, timeliness, currency, or correct
sequencing of the information. Neither the Department, nor any of the sources of the information, shall
be responsiblefor any errors or omissions, orfor the use or results obtainedftom the use of this
information. Other specific cautionary notices may be included on other web pages maintained by the
Department. All access to and use of this web page and any other web page or internet site of the
Department is governed by the Disclaimers and Conditionsfor Access and Use as setforth at Californi
Department of'Consumer AEa.irs'Disclaimet- Idbrination and Use.Information.
http://www2.dca.ca.gov/pls/wllpub/WLLQRYNA$LCEV2.QueryView?P_LICENSE—NU... 5/31/2002
Attention Property Owner:
An "owner-buildee' 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
k- issued until this verification is received.
1, personally plan to provide the major labor and materials for construction of the
2) proposed property improvement: YESM. NO[ I
1 HAVEVJ HA.VE NOT['. I signed an application for a building permit for the
proposed work.
3. 1 ,have contracted with the following person (fmn) to provide the proposed
ADDRESS -t-,, CITY: - :
PHONE: CONTRACTOR'S LICENSE NO.,,"
4. Iplanto provide po of this work, but I have hired
0
coordinate, supervise!, �anovide the major work:
NAMIE:
ADDRESS:
PHONE: Co
5. 1 will provide some of the work but I
provide the work indicated:
NAMEE ADDRE�,.
SIGNED:
PROPERTY OWNER:
SOCIAL SECURITY NUMMER:
DATE:X�
zcrry:
'S LICENSE NO.
ed (hired) the following persons to
TYPE OF WORK
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 the permit.
OVER
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-buildee, 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 smbcontract, you
should be aware of the following- information for your benefit and protection -
0 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.
0 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.
0 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.
0 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 subconh=or, only
under fin-dted conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "'ownerbuilder"
building permiL 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. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm
that you are aware of these matt ers. The building permit will not be issued until the verification is returned.
S'n'clrel
Nfichagl C. Viciia, C.B.O.
Manajer, Build�ng Ins"ri
NOTE: This Owner -Builder Information. is required by Section 19830 of the California Health and Safety Code.
OVER
'11-N
I
'61,
(Rev. 12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive 9 Oroville, California 95965 * Telephone (530) 538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
024-180-024
ZONING
_40
BUILDINGPERMIT
OWNER
( PF_er,9VA 6P,0'
TWNE
s 0. Fr. OCC. BUILDING VALUATION
OWNEWS MAILING ADDRESS I
90-- R AVE_, GRIM.FY C.A 99qZLR
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation 1$
ARCHITECT OR ENGINEER
Sill
LICENSS NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
kan Checking Fee
$
BUILDING ADDRESS ED
I EVE.E.
Energy Plan Checking Fee
$
$
PERMIT VEE
$
LOT NO.
SUBDIVISIONS UWE
PARCEL
PLUMBING PERMIT/
Filing Fee 20.00
USEOFSTRUCTURE
SF Y Duplex 0 Mobilehome 0 Other
SPECIFY
"S&ch Trap
7.091
Sobwr heat pump watq( heater
23,40
Water'�Ikng
.00
Each gas ;�kr hea�_dr or vent
15.00
TYP OF WO41K
New 0 Addition 0 Remodel [3 Utiliti s 0 Installa' 103 Other P
I \-Mobile
I S V�
Describe Work: TEMP ELECIRI SERVICE
WI* PRE-INAcrION
IS\
s piping sy�v/f - s outlets
15.00
Building sewer /N
15.0
Home /1SJ GI W1
@20.00
PERMITAE
$
EqCTRICAL PERMIT /
Filing Fee 20-00
\ MaiN Service ( — '2"O'O'A OORA�s's
23.00
LICENSED C TRACTO 'S DECLARATION
I hereby affirm under penalty of perj ry that I a licensed under provision of Chapter
9 (commencing with Section 7000) of ivision 3 o the Business and Profes ions Code,
and my license is in full force and effec
License Class Lic.
OWNER-BUILDE DECLA TION
I hereby affirm und enalty of perjury that I m exemp, orn the Contrac; rs License
Law for the following Ire n:
tA 1, as owner of the prope ormyernployees ithwagesa eir so ompensation,
will do the work, n t e ucture is not int ded or offere or sale.
1\ 0 1, as owner of th r e , a exclusively co racting with licensed contractors
to construct the o ct
0 1 am exempt under ec. Business d Professions Code for this
reason
WORKERS' COMPENSATION--IkECLA TIO
T"
I hereby affirm under penalty of perjury one of the foI1bV4ngJIa.NrI%tions:
0 1 have and will maintain a certificate of consent If -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 have and will maintain workers' compensation Insurance, as required by Section
by
i.Section
3700 of the Labor Code, forthe performance of work forwhich this permit is issue
n Lie
My workers' compensation insurance carrier and policy number are:
Carrier Z&110% `r41<,M1A4C&
Policy Number VVF7- 4VJ+10* J 70 5
v I
(The above sections need not be completed if the permit is for work of a val ton
of one hundred dollars ($100) or less.)
u e
0 1 certify that in the performance of the work for which this permit is issue I shall
f hwith comply with th�� provisions. , jaa
not employ any person in any manner so as to become subject to orkers'
to ork
compensation laws of California, and agree that if I should become su 1. ct to the
ct to
e, I
w rkers' compensation provisions of section 3700 of the Labor C e, I shall
X Date
Lgriature of aplicant - J&Owner 0 Contractor 0. Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories iq height.
in ervice 200A tOOOA 46.00
NEVQ'�T. DW NG OCCUR
OR ADDNS. ( & C. BLDS 3.50'FT.
=ICONST. OUTLET
CIRCUITS @7.50
OWER APPARATUS
SINGLE OUTLET CIR
(9 1.0-D
Ex. Occup. OUTLET OR FOCTURES
11AL @ .50
Ex. Occup. (PIES,6.) E 5.00
OUFITX.ED APPLNS OR.,
Tern porarl/ Service
23-00 23.00
Mobile 4me Facilities 20.00
—
Misc. Aring 23.00
PWINSPECTION 23.0
PERMIT FEE $
I
MECHANICAL PERMIT Filing Fee 20.00
fieating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee
Energy Inspection Fee Is
Occ
CONST. TYPE
TOTALFEE$ 66.00
D. FEES IMP
D
1 '40
I CDF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
BV_
PERMIT EXPIRES ON
[
the applicable provisions
Resolutions to do work
been paid.
Date
(Da te)
ReceiptNo. '3 q3 61�, 60
WHITE-D.D.S.-B.D. CA9,ARY-ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
0
61,
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive 9 Oroville, California 95965 * Telephone (530) 538-7541 PERMIT NO.
(Rev. 1 2�96) APPLICATION AND PERMIT
77 .ty
ASSESSOR PARCEL NUMBER
024-180-024
ZONING
A -4Q,
BUILDING PERMIT
OWNER
( FF_w<e6iA iw
TiELZEPONE
- 7-
SO. Fr. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 1
905 AI.FXANDFR AVE-, GRIT)TEY CA 95948
CONTRACTORS NAME
TELEPH&NE
CONTRACTORS MAILING ADDRESS
'CONSTRUCTION LENDER
.................
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $
ARCHrrECT OR ENGINEER
LICENSE No.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan. Checking Fee
$
BUILDINGADDRESS
I JEVFF 'RD,
Energy Plan Checkin� Fe'e
$
$
PEWIT'VEE,
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT/
Filing Fee 20.00
USEOFSTRUCTURE
SF Y Duplex 0 Mobilehome 13 Other
SPECIFY
NE�qch Trap
7.09
Solar,spir heat pump watq(heater
23/0
Water p *ng
14.00
Each gas Nter heat r or vent
/15.00
TYPICIDIF WOhK
a
New 13 ACidition 0 Remodel 0 Utiliti s [03 Installa' 0 Other
TEMP EL=J
[L SZ \
Describe Work: SERVICE
WI PRE—INAIJION
Gas piping By 5 outlets
15.00
Building sewe.
_T§
15.00
Mobile Home G W1
920.00
PERMIT/EE
$
ELNECTRICAL PERMIT
Filing Fee 20.00
Sow OR
IMai� Service 2ooA :S
0 S
23.00
1 ICENSED C TRACTO 'S DECLARATION
T R AC T 'S DE C LA ATION
ice u
the nsR
V nd.r provisi on
I hereby affirm under penalty of per ry that I a licensed under provision of Chapter
P' r y
Eiss �e
n 3 h B sin and as
9 (commencing with Section 7000) of ivision 3 o the Business and Profes ions Code,
0) of v si' ' t Prof
d effec
and my license is in full force and effec
License Class Lic.
Lic.
Lic
_B ILDE DECLA TION
OWNER-BUI�LDE DECLA TION
E
J P\
I hereby affirm und�K %enalty of perjury tiva m exemp om the Contrac rs License
Jhont
t C C
'rJu ry that m exemp 'm a
Law for the following rib n
n.
A 1, as owner of the prsQ- rmymp Iyee, ith wage' a eiro 'm
Pie; ormyemploye s ithwagesa eirso ompensation,
the 'tructu r is Ot t, or offer, or le
�nd�
will do.th'e'.work, and the, t e s not intended or offere or sale.
11�ul c Le My— CoNracting with lic nsed contra
0 1, as oWner of the propert r:c'lu.i, e ctors
to -construct the Oroje�ct.
1 am exempt under Se "44'�Business\d Professions Code for this
reason c.
Nin 200A 10.A
46.00
_�,ervice
NE
RWT. OW
0 C S. P
S. %NG ffU
so.
Fr..
NEW OONST 1-0
NO.R.'. &g.
_3.50
@7.50
WER APPARATUS
(AOINGLE OUTLET CIR.
Ex. Occup. OVrLET OR FDCrU1RES
.1 20 @ 1.5000
BAL @
FIXED A UNS 0"
Ex. Occup. ( ..P(PRES.6.1 E.
5.00
Temporary( service
23.00
23.0023,00
Mobile Trip Facilities
000
20.00
M 'T
iic. , iriKcl-�
23.00
.00
FEVINSMUON
3.00
PERMIT FEE
66. 00
WORKERS' COMPENSATIO ECL� N
0
n gJT c"
1 hereby affirm under penalty., of perjury one of the lo . 9 clarations:
0 1 have and will maintain a certificate of consent f -insure for workers'
compensation, as pro�mded for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation Insurance, as required by 4Section
3700 of the Labor Code, forthe performance of work forwhich this permit is issued
sued
My workers' co;Rensation insurance carrier and policy number are:
Carrier 7M 7#1 fAM t) Cid
MECHANICAL PERMIT
Filing Fee 20.00
4eating
—
/Cooling
Hood
6.50
Ventilation
PERMIT FEt
$
Policy Number WEM V410!k lwv-
(The above sections need not be completed if the permit is for work of a valu tion
or a val
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit is issued I shall
ssu ed I
not employ any person in any manner so as to become subject to orkers'
!ut, or
compensation laws of California, and agree that if I should b ' ecome su j CA to the',
, j t t
workers' compensation provisions of section 3700 of the Labor e, I shall
f Ihwith comply with th?
,;spprovisions.
X Date
�_S(6natu_re&f_6fip_1icant -V%Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in, height.
Mobile Home Installation Fee Is
Energy Inspection Fee Is
Occ
CONST TYPE
TOTALFEE$ 66.00
HAZ- ID. ffFEES IMP I FLOOD I
A
This permit is hereby issued under the
of the Butte County Code and/or
indicated abov"e for which fees have
PERMIT EXPIRES ON
COF I PARCEL I PD I HD ISSUE
applicable provisions
Resolutions to do work
been paid.
Date
(Date)
ReceiptNo. 259& 6 wl 00
WHITE-D.D.S.-B.D. CA14,ARY-ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
163
COUhfY OFBUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVIS16N
7 County Center Drive 9 Oroville, Cb)ifornia 95965 * Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATIORAND PERMIT
ASSESSOR PARCEL NUMBER
024-180-024
ZONING
A-40
BUILDING PPERMIT'
PF-F-KEMA SAv
W:3ai?-
SO. FT. OCC. BUILDING VALUATION
OWX 7=AIUNG ADDRESS
905 ALEXAMER AVE., OTMEV CA 955148
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOWS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGI�EER'S MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS
'51& Irm: ]RD.
Energy Pla . n - Checking 4e
$
$
PERMIT VEE
$
LOT NO.
SUBONISIOWS NAME
PARCEL MAP
PLUMBING PERMIT/
Filing Fee 20.00
USEOFSTRUCTURE
SF X Duplex 0 Mobilehome 0 Other
SPECIFY It
��Ch Trap
7.091
So'latvr heat pump watq(heater
23/0
Water 'plkng
Y6.00
w vent
Each gas _111111ker heate'r or
/15,00
TYPrOF WO
New 0 A(Idition 0 Remodel 0 Utilit s C3 lnst:�Ilatilc 11 61ii-e $L
r L
Describe Work: TUMP UE= SERVICE\
W1* P&-INbt'TA;K10N
Gas piping sys)V I - 5 outlets
15.00
Building sewer N
15.00
Mobile Home I S I G I W
(—W20.00
PERMITf EE
ELECTRICAL PERMIT /
Filing Fee 20.00
'-,Mai6 Service ( 2000,OvA DWssss
23.00
T R AC T 'S DE C LA AJTION
LICENSED C TRACTO 'S DECLARATION
n
I hereby affirm under penalty of per ry that I a licensed under provision of Chapter
per tha u
y C'n 'edR d P n
i 0 t Bus " 'r irovisio
n 3 h in and
9 (commencing with Section 7000) of !vision 3 o the Business and Profes Code,
0
0 of iv si S Prof 's
l'
and my license is in full force and effec
License Class Li c.
Li
L
OWNER-BUILDE DECLA TION
t
I hereby affirm und nal� of perjury that I rn exemp om the Contra rs License
J
Law for the followi g rel n
0 0
Or my mp Joy s g IS 0
IA 1, as owner of the F opi or my employees ith wages a eirso ompensation,
P it I
u c u r . 0 0 0
will do the work, and t1he t(ucture is not inqnt�nde or off ere or sale
1'tr t i t t 0 r ff
a excl
0 1, as owner of the Property, usiviiIlq c ac if, with licensed contract6i
'to construct the project. ti
0 1 am exempt under Sec. Business d Professions Code for this
reason
WORKERS' COMPENSATIOaVECL TION
I hereby affirm under penalty of perjury one of the fol%t %clarations:
,�ng c
0 1 have and will maintain a certificate of consent f -insure for workers'
compensation, as provided for by section 3700 of the Labor Code
performance of the work for which this permit is issued.
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./I
My workers' compensation insurance carrier and policy number are:
Carrier XfortA T#1f&,eAnIC4
inService ( 2ooA 1000A
46.00
NEVWT. DW NG OC
OR S. ( & C. BUDCUP_
S.
so.
3.50 FT.
NE CONS LT'_OUTLET
.0 NESIDT ( CIRCUITS
@7.50
WER APPARATUS
(AINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES
1 20 @ 1 00
BAL@ �50
FIXED APPUNS. OR
Ex. Occup. ( OUTLETS (RESID.) EA
5.00
Temporar /Service
23.0023,00
Mnhiie H6me Facilities
20.00
Misc: iringi
-23.00
23. 061U. 00
PERMIT FEE
$ /66.00
MECHANICAL PERMIT
Filing Fee 20.00
)Aeating ?
0 -
Cooling 40 -
Hood
6.50
entilation
PERMIfFEt
$
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.)
10 1 certify that in the performance of the work for which this permit is issued/, shall
not employ any person in any manner so as to become subject to Y�orkers'
compensation laws of California, and agree that if I should become su4jiict to the
w rkers' compensation provisions of section 3700 of the Labor C_ de, I shall,
f hwith comply with thoew, provisions.
X
X Date 3"W_02.
-Signature of 6fIplicant - T%Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories,iii height.
Mobile Home Installation Fe6/
Is
Energy Inspection Fee <.e $
OCC
CONST. TYPE
TOTALFEE$ :66.()o
HAZ.
I D. FEES IMP
CDF
PARCEL
I PD
HD
ISSUE
This permit is hereby issued under'th6
of the Butte County Code and/or
indicated above for which fees have
�Q y_
PERMIT EXPIRES ON
applicable provisions
Resolutions to do work
been paid.
-;_Date�/
(Date)
ReceiptNo 393z59&K,*1,7F
WHITE-D.D.;.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
I it
. N
COUNTY OF:BUT4E - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVIS14N
7 County Center Drive * Oroville, California 95965 9 Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
'ASSE�SO PARCELNUMBER
'T 024-18"24
ZONING
40
BUILDINGPERMIT-
OW E
11�90 — ( F�.EKO,1-4
WE"41"Q
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
W5 MMMER AVE,* GRIMU CA 9590
CONTRACTORS NAME
TELEPHONE
CONTRACTORS MAIUNG ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDERS "UNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEi�
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR EAGINEERS MAILING ADDRESS
Plan Checking Fee. $
BUILDING AD `SS
— 7 LEM RD, 4\1
Energy Plan Checkinj 4e $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
LISEOFSTRUCTURE
SF Duplex 0 Mobilehome 0 Other
SPECIFY
Each I rap
7.0�a'
SolarNpr heat pump water'heater
23/0
Water pipjng
.00
Each gas !Ater heater or vent
TYPE OF WORK 'N"
Newl 0 Addition 0 Remodel 0 Utilities 0 Installati6n 0 Other KE\K
Describe Work: UW 1121=�AL SERVIM
WIU\ ME-INSF=0N
__;Z�15.00
Gas piping systqm 1 - 5 outlets
el 5.00
Building sewer
15.00
Mobile Home I S I G I W
-(—W20.00
PERMIT/FEE $N
ELECTRICAL PERMIT /
Filing Fee 20-00
Main Service 600v O;dSS
( 200A 0 SS
23.00
R T'
LICENSED C'bcACTOR'S DEC A ON
I hereby affirm under penalty of perp ry that I ar ed unde rovisio,\nof Chapter
r. licens LA r P,
9 (commencing with Section 7000) of qivision 3 oithe Bus! ons rode,
and my license is in full force and effect
License Class Lic.
OWNER -BUILDER DECLARATION
rom
1 hereby affirm und'aplenally of perjury thatli� m exemol rom the Contra ors License
Law for the following reason:
IA 1, as owner of the prope? employees with wages �as
will do the work, and the ftucture is not inianded or offered for sale.
0 1, as owner of the Property, a ffi,qxclusively �oMracti�'g with lic6nsed contrait8irs
to construct the project.
0 1 am exempt under Sec. siness a d Professions Code for this
reason K
WORKERS' COMPENSATION-Q,&CLARATION
I hereby affirm under penalty of perjury one of the fol aw'lng d, C larations:
0 1 have and will maintain a certificate of con ;.nt ��If-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 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, forthe performance of workforwhich this permitis issued.
My workers' compensatio , rrier and policy number are:
;ref I tA ;I,insuranc, ca
Carrier 4C.
� 1 9. r�
Policy Number V#1r
(The above sections need not be completed if the permit is for 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 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 Cbde, I shall
fo��with comply with thos* provisions.
I W
X Date
Signature of Applicant - Vwner 0 Contractor 0 Age6t
An OSHA permit is required f6eexcavations over 60" deep'and demolition or construction
of structures over 3 stories in height.
in Service 20OA/0 1000A 46.00
NEW�qPNST. OWrNG P. so.
SU 3.50
OR ADDNS. OCC FT.
C.- @7.50
=..ID.T 0
H =MITS
WER APPARATUS %
NGLE OUTLET CIR. I
Ex. Occu p.- OUTLET OR FDffUR ES
20 @ 1.00
SAL @ .50
O.FIXED A OR" 5.00
Ex. Occup P(PRM.) E
Temeora Service 23.00 23.00
Mobile Facilities k 20.00 -
'Home
Mis'c-Wrin' --23.00
PRIVII INSF=ON 23^23.00
PERMIT FEE $ bb. 00
MECHANICAL PERMIT Filing Fee 20.00
/Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $ 14
Energy Inspection Fee
OCC
C 0 PNMSS T. E
P TOTALFEEs 66.00
HAZ.
I D. FEES IMP
ES
I ATD
I CDF
PARCEL
71
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
(Date)
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR - PINKINSPECTOR GOLDEN ROD -APPLICANT