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Home My WebLink About024-190-043- -1 0247190=043 94=0174&-. ECHO . BUJrL9/16/93 DING PATIO COVER W/O PERMIT -LEONETTI, q CONT:,REID CONSTRUCTION 200 TOWNSHIP RD.., GRIDLEY /� d /a O� PSD/ PATIO COVER/ 024-190-04 04-1672 COOK, BRIAN _-j 200 TOWNSHIP RD, GRIDLE Cont: OWNER WALE RE -ROOF 75 SQ (2 BLDGS)-200 d! ww— a ti �, t „= RESIDENTIAL 024-190-043-94-0174B LEONETTI, ECHO CONT: REID CONSTRUCTION 200 TOWNSHIP RD., GRIDLEY PATIO COVER/SF V=OK O = Not OK -=Not Applicable = No) R@ady MOBILE HOMES ' n Date/Initials MOBILE HOME UTILITIES (Plana) OK except #'a 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3: Sewer; Location -Test -Fall -C/0 Concrete 4. Water; Location -Teat -Easement Needed (Sketch) S. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Teat -Wrap: / /" L"ft. / /"Nat. or/ / L"ft./ /"LPG 7. Well Clearance & Disconnect 8. Utility Clearance i Date/Initials MOBILE HOME INSTALLATION (Plana) OK except #'a 1. Zoning Requirements -Setbacks Easements 2. Footings; Size -Spacing -Marriage Line 3.. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Teat-Crossovers-Breakere-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. Exits; Insp.-Sketch 10. Cert. of Occupancy MISCELLANEOUS Date/Initial DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'a 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rolls 4. Wood Awn.; Posts-Beams-Rftra: Connectore Shthg -Rfg: Bracing 5. Alum..Awn.; Columna -Connections -Splice -Decal -Enclosures 6. (ports; Windows -Doors 7. lectric Frmg; Sils=Anchors-Studs-Rftrs-Trusses 9 ng; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Step =Do -Landings Date/Initials POOLS (Plans) OK except #'a 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. f Boxes-Enclosures-Panelboards-Ins. to Mein in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test V=OK O = Not OK -=Not Applicable RESIDENTIAL (Single & Duplex) = Not Ready Date/Initials UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ P' 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 Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date/Initials PLUMBING (Permit) OK except #'s 16. Water Htr.; Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Neil Protection 18. D.W.V.; Test -Fittings & Anchor -Nail Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe; Size & Anchors Date/initials ELECTRICAL (Permit) OK except #'a 22. Fixture & Transformer Clearance -Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. 26. Equip. Ground made up w/Meth. Fastners-Bond Gas & Watei 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No 30. Service -Riser Conductors & Ground -Main Disconnect 31. Equip. Clearances Panels -Motors -Meth. Equip. 32. Clothes Closet Light -Shower Light -Spa Light 33. Smoke Detector Date/Initials MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support 35. Vent Fan; Exhaust above insulation 36. Condensate Drain & Overflow; Size & Grade 37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet 38. Attic Access & Platform if Furnance in Attic Date/Initials FRAMING (Plans) OK except #'s 39. Sils, Proper Material & Anchors 40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound 41. Bearing Walls over Girders & Floor Nailing 42. Draft Stop in Walls (rat proof) 43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing Date/Initials FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties -Puri In -roof Brec-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailing -Bolts 59. Insulation -Walls -Collings 60. Infiltration -Walls -Windows Date/Initials FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protectlon-Landings 62. Smoke Detector 63. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 64. Bedroom Exiting 65. G.F.I. & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel; Breaker Sizes & Labels 67. Stairs & Rails 68. Fireplace or Stove; Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit.Fixt. & Appliance; Grnd: Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door, Swing -Landing -Closer 73. A.C. Duct in Garage -Damper 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage; Above Floor -Mach. Protection 75. Plb., Elec. & Mach. Equip. Listed for Location 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection 77. Insulation -Foam -Looked in Attic ❑ Yes 78. Guard Rails & Deck Construction -Post Caps 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 80. Following instld.; Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No: Planters ❑ Yes ❑ No 81. Stucco; Brown -Finish 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg :Appliance -Fireplace: Clearance to Openings 84. Water Well; Disconnect, Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 86. Ventilation Throughout House 87. Glass Protection 88. Corrections from Previous Inspections 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates Comnwnts at Final: COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 99,65 - Telephone (916) 538-751� PERMIT NO. APPLICATIONAND PERMIT O �_l ASSESSOR PARCEL NUMBER 024-190-043 ZONING A40 BUILDING PERMIT OWNER ECHO LEONETTI TELEPHONE SQ. FT. OCC. BUILDING VALUATJPff OWNER'S MAILING ADDRESS 3901 GARDEN HWY SACRAMENTO 95834 CONTRACTOR'S NAME REID CONSTRUCTION (408)1462-6124 TELEPHONE Jr CONTRACTOR'S MAILING ADD b77 EDMUND LN CAPITOLA CA 95010 Fireplace CONSTRUCTION LENDER XX NONE t1 UNKNOWN Total Valuation S LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER NONE LICENSE NO. Plan Checking Fee $ 46 0 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ 144 GO BUILDING ADDRESS 200 TOWNSHIP RD PERMIT FEE $9R9 Rr GRIDLEY PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF 9 Duplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 20.00 TYPE OF WORK New ❑ Addition Remodel EIUtilities CIInstallation ElOther ❑ Describe Work: PATIO COVER 0 p e►^►'n 1 L.5 PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 2100V OR LESS ) 2ODA OR LESS 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCC P. OR AODNS. ( & ACC. BLDS. ) SO. 3.50 FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ I am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET •NON-RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BA20 @ 1.000 Ex. Occup. ( OUIT EDTS IRES D:OEA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, colts, and expenses which may in any way accrue against said Countyji3il Csequen of the graqting of this permit. X 6u � Date IC7UThis Signature o Applicant 0 Owner ❑ Contractor ❑ Agentof An OSHA permit is required for excavations over 5"0" de p and de lit or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ocC CONST. TYPE TOTAL FEE $ HAZ. I D. FEES I IMP I FLOOD I CDF PARCEL PD D ISSUE permit is hereby issued under the applicable provisions the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. '�,�, y�jDIRECTOR OF PUBLIC WORKS /� BY �y�(�0�/ Data ' i I PERMIT EXPIRES ON 21 lDerel Receipt No. 155847 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT rOF BUTTE - DEPARTMENTOFDEVf.LO.P,. ENT SERVICES -BUILDING DIVISION - vt; 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 / OWNER _ C Proposed Building Use_ I PERMITAPPLICATION DATASHEET �00 r7 e Fro evt/elf A. P. No. Building Inspector 4tA Date �O 9 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY —k1f items ha -9 been submitted. . Plot plans0A sets, signed by preparer of plans. Complete plans, 3/4 sets, signed by preparer of plans . ...................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ........................................... . 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non-Heated_and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. 10. Fees of $ ......................................... 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees......................... ood elevation letter (100 year flood) by CaIJ'�pp nia Engineer................... 9 Sanitation and plot plan approval ��y i Cal Department. . 5. City of Chico plumbing permit. ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. -,-,Planning approval for (A) Use: (B) Parking: 18. Contact Land Development.about (A) Improvements (B) Drainage. ......... . 19. Driveway permit (construction approval required prior to occupancy). ............ 20. Pre -inspection for required. .. oB�ild 9 �speao�— (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner ). .......... . 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. 'Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .................. 29. Documentation of legal access . ....................................... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ..................................... . 32. Plan check list . ................... 33.� . o. 3S3 ........ . 34. r �` . �. s ,�4 when youissue the permit, process as follows: X _ Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other i Parcel Creation /W .Acreage Applicantt Date Copy of Haz-Mat form sent Health Dept. I Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data,must be submitted prior to permit issuance'N(cle new item not checked above). 1. Index permit for above items No. ?7 . 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail CoAjnter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail eunter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Al Copy - Department of Public Works Phil Holt Atluched Fluor Him Alwchvd i Scol to BA), ' TO: Building Department FROM: Environnicntal Health SUBJECT: Sanitation Clearance Owner Location AP// Plan Approved for: Sc\va,e ]disposal Clearance for bedroom mobile home.I Othcr Hold final for: Final clearance O.K. for: NOTE Environmental Health Specialist 8/92 \\later Supply: Public Private Well ]date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds, ERMIT NO. BP041672 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 06/09/2004 APN: 024-190-043-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address' 200 TOWNSHIP RD GRI Date: Contractor: Map Index: Description: reroof W/comp 4 bldgs (75 sq) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: LEONETTI ECHO TRUST to its issuance, also requires the applicant for such permit to file a LEONETTI ECHO TRUSTEE signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section P O BOX 881 7000) of Division 3 of the Business and Professions Code) or that he or ZEPHYR COVE, NV 89448 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, *or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: LEONETTI ECHO TRUST owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owrrer-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec., 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: and who contracts for such projects with.a contractor(s) licensed pursuant to the Contractors' State License Law.). , ❑ I am Exempt under Article 3 of tho Business and Professions Code Date: License #: WORKERS' CO ENSATION DECLARATION I hereby affirm under penal of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. ❑ 1 have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy #: Valuation: $0.00 Census Code: d8� I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California . and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. U [ % Date: i rU911/ Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of a a compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. L�Z ), . CONSTRUCTION LENDING AGENCY This permit is he by is under the applicable provisions of the Butte County CodA anrVor I hereby affirm that there is a construction lending agency for the Resolutions to in ' ated above for which fees have been paid. <l j il performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By: Date. Address: PERMIT EXPIRES ON: / 1 Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or b duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substanc a official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection pu ses c 1 Print Name: 2Cf, fr 1! v rT` _ t( rte% Signal Date: d 1-( / 13 Owner ❑ Contractor ®—Agent for Owner 0 Agent for Contractor t BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP041672 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 06/09/2004 APN' 024-190-043-000 ' the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address' 200 TOWNSHIP RD GRI Date: Contractor. Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: reroof W/comp 4 bldgs (75 sq) Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner' L•TRUST CoV(1C&L to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section -F $$1 O �" l + 7000) of Division 3 of the Business and Professions Code) or that he or Cr she is exempt therefrom and the basis for the alleged exemption. Any { ) violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): Sp '11 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered' for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: LEONETTI ECHO TRUST owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: and who contracts for such projects with.a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of t,4 and Professions Code �BBuuusiinness Date: �Owne : "' License #: WORKERS' CO ENSATION DECLARATION I hereby affirm under penal of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. ❑ I have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy #: Valuation: $0.00 64--1 certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one l� hundred thousand dollars ($100,000), in addition to the cost of l a compensation, damages as provided for in Section 3706 of the Labor __ _.. -.. .. -• - code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is he rbiss under the applicable provisions of the Butte County Code anrUor I hereby affirm that there is a construction lending agency for the Resolutions to in ' ted above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) /��1 - 6 Name: By Date: PERMIT EXPIRES ON: ! t Address: Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substanc a official form or document of Butte County. I hereby authorize representatives of Butte County upon the above' mentioned property for inspection pu ses ntoj�enter Print Name: tZs2o 6 l+ v 11R-� v% — jo Q Signal e: Date: �� ^ `0 �( / ❑ Owner ❑ Contractor M—Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION OWNER Name Address 2oO -To L City _ Sta Zips o Phone _ 7S4fS I Fax E-mail APPLICANT SIGNATURE X For ffice use onI : CONTRACTOR Nameh, Address Amount: Bldg SRA City State Zip Phone _ Fax E-mail Map Book Lic. # Class APPLICANT SIGNATURE X For ffice use onI : ARCHITECT/ENGINEER Name Address Amount: Bldg SRA City State Zip Phone _ Fax E-mail Map Book State License Number APPLICANT SIGNATURE X For ffice use onI : APPLICANT NAME Name Address Amount: Bldg SRA City State Zip yg Phon _ Fax E-mail Map Book APPLICANT SIGNATURE X For ffice use onI : Zoning Flood Zone Amount: Bldg SRA SRA I Yes I No Occ. Date: Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT BIN # LOCATION AP# 1(1 qf2z Property Uuh ! i� Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address 1 Description or Scope ofWork: f VO Sqj Footage S4 0 �, J ❑ Structure Buift without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 Received by: 92 Amount: Bldg SRA Receipt #: Sheriff SMIP Date: Other Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 3 Complete sets of plans; signed by the preparer. NO GRAPH PAPER! ❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 9. Sanitation and site plan approval from the Environmental Health Department. ❑ 10. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2. Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and, signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04 de rl IL j JL Ali .1 06/gVO4 12:08 FAX 5308460584 BTEC GRIDLEY 0002 {; J -_ uW,j u �]�� IIII'�I19 g11(If M, • �C013DIIVG BliQUE3>'EQ BY �Q11P.Z�s�' ��.�`�--Z�-QZ �. Bidwell Tide & Escrow Compapy Recorded I REC FES 1E.6 Official "Records- A TAX- AND WHEN RscoRDFD MAIL TO ` Couurity OfJkUTTE BNao Cook CMAM J. iIIil1B19S f\. Recorder I Add R.O_Hott]05z ROSEpOARY IIICK�N l - ee.m assistant I Shauna 89a00pM 30 -Apr -+M4 1 Page 1 of 2 crry'sr.re Gridley, CA 95948 oaet+� 0,0203283-00-4 SPACE ABOVE THIS-tjKE-FOIFREC0[t1 WSrWX- GRAN' DID. Patcclrto_ oa4.�so.-aa3 THIS FORM FURNISHED BY BIDWELL TITLE & ESCROW COMPANY The Undersigned Grentor(s) Dod"'s) Documentary.TransfecTax iS $- 97 . Q0 O City/ own of 10 computed on full value of interest or property conveyed, or 0 lJnipcorporated Atea.. 3 (411 value bias voluF of liens or encumbrances re raining at the time of sale E3 Monument Pee of $10,00 FOR A VALUe►BLf. CONSIDERATIQN, receipt of which is hereby acknowlcdged, Echo Leonetti, 1999 Trust Agreement and Echo Leonetti, Trustee, u/i/cr April 5,-1999 ll -wow. QRANT(91 to , Brian Cook, An Uhmarried Man the_foHo_-wingreal.property_in the [3-Cityof.. /Unincwporii!cd Arca County of Butte, State ofcalifornia- SE&E HIRIT AA ATr'1t,CHML ERETO.AND MADE APART.HEREOF Soho Leaaet i•. Document Date: April 27, 2004 State. Of CAdifMia . . County of —i6 ,v'A-- SS. Otr;�F � ��'�.�� DO�- . befQte.ate�the uadett<igttod, a.Notarx publiein end. for std CQurtty_aLtd Baty. Qergoaa 1 appceted Echo t�enetti — — Personally known to me (or proved to me on the basis of satisfactory 4vidgnce) to be thq. p@rson(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/shelthey executed,. the same in histhedtheir authorized eapacity(ics), and that by his/herltheic.sigpamrgs}tui-the_iraku=nt tbe_person(s), or the entity, upon behalf of which the parson(s) acted, executed the instrument. WETNESS my hand an&offrciel-seal C Signature FOR NOTARY SEAL OR STAMP - LYNETTE- GAP -TON-- Comm. B 1351379 I YO NOTARY PUBtWXALIFORNIA County of Bulle- Comm. L*res April 17, 2006 MAIL-TAX-S-TA7EA1M8-TQ_ SameasAbo_p RTFRdAA.rYQFEQ. 08/"/04 12:08 FAX 5908480584 BTEC GRIDLEY EXBMHTA THE. LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: 0 009 order No. 0020328 004 ALL THAT CERTAIN REAL PROPERTY--SITUATE-Ii-THE-COUDMY-GF-BllTTEtSTATE_OF CALIFORNIA, -DESCRIBED AS. FOLLOWS,_ - A PORTION OF THE NORTHEAST QUARTER OF SECTION 24, TOWNSHIP 17 NORTH, RANGE 2 EAST, M. D. B. &.M., DESCRIBED AS FOLLOWS -- PARCEL 2 AS -SHOWN -ON TIIATCER-'FAwPARCEL-MAR,-FILED-M THE OFFICE_OETHE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JULY 27,1982, IN BOOK 89 OF PARCEL MAPS, AT PAGE(S)14. EXCEPTING THEREFRONLALL-TAT--PORTMDESCRiWMLD --DEED-TQ-TRKC—OUNMOF BUTTE, RECORDED JUNE 18, 1992 IN BOOK 2731 OF OFFICIAL RECORDS, AT PAGE 7, RECORDS OF BUTTE COUNTY, CALIFORNIA. AP NO: 024-1200431 oei0axA4 1 Bidwt*T- k &-Escrow-Company 560 Kentucky, PO Box 949, Gridley, CA 9594`8 (536}846.4005 - BUYERSBORROWERS CLOSING STATEMENT Final BuyerBon war Brian Cook F.scwwNo: 00203283-004 LXN Clow Date:-.04Mn,0 4 proration Date: 04/29/2004 Date Prgpted-.. 06/Q9/2004 Property: 200 Township Road Gndle CA 95948 ��N=70'..� +S A .-.+`wa�E. r 5�,.. 4 -:'S... �✓f'.. �S'b.. !,y '• i„ i i�.Y`.... v..Y(3C '}M..n.i 0 _ , TOTAL CONSIDERATION: Total Consideration $270;000.00- ' Deposit/Earnest Moncy 1,000.00 Closing Funds 60;I00.QO NEW AND EXISTING ENCUMBRANCES: Principal Amount of Loan from U.S. Bank N.A. 216,000.00 NEW LOAN CHARGES: Appraised Fee to tI:S-BadcN.A--... 35000 - Credit Report to CBC 16.00 Document Prep Fee to U.S. Bank N.A. 1-25.40. - Tar Service Fee to U.S. Bank NA 80.00 Processing Fee to U.S. Bank N.A. 373-00- - Flood Certification Fee to US Bancorp Service 20.00 Mail/Courier Fee to U.S. Bank N.A. 35-00— Prepaid Interest to U.S. Bank N.A. Prepaid 65.10 @ $32.55 per day From 04/29/04 To 05/01/04 Hazard Insurance to U.S. Bank N.A. 338.52 3 mos. @ S112.841nanlh Cc"Property Taxes to U.S- Bank N.A. 843.75 3 mos. @ 5281.25hnonth Application Funds to U.S. Bank N.A.(350.00 PROBATIONS AND ADJUSTMENTS: County Takes From 04/30/04 To 07/01/04 618-33 Based on the Semi - Annual amount of $1,824.57 TITLE CHARGES: Lenders Policy to Bidwell Title & Escrow -Company- 490-82- 9D82Owners OwnersPolicy to Bidwell Title & Escrow Company 1,269.40 Courier/Delivery Fees to Bidwell Title & Escrow Company 30-10. Endorsements to Bidwell Title & Escrow Company 25.00 Wire Fee to Bidwell Title & Escrow Company 1.5:00.. &mail Documents to Bidwell Tide & Escrow Company 50.00 ESCROW CHARGES Escrow Fee-tu,Eli�n Tirty & Fs = .Company_ _ 153-00 ServiciuWDocurnm Prep. to Bidwell Title & Escrow Company 200.00 Notary Fee to Bidwell Title -&.Escrow -Compal 6-0.OQ . REC-ORDffiQFEES:. eev.m (smsr) a— 0ft4W 09/09rd',4 12:09 FAX 5308460584 _ BTEC GRIDLEY 10005 Bidweff Title-& Eserew-Eompa�y 560 Kentucky, PO Box 949, Cnidley, CA 95948 (530)846-4005- BuyedBoaower: Brian Cook Property: 200 Township Road BUYERSBORROWERS CLOSING STATEMENT Final.. , Escrow No: 00201283-004 L'YN Close Date: 04/30/2004 Froration Date: 04/29/2004 Datc Prepared; 06/09!2004 '4+wtr'l�'SaT1 4' S. A.Y. ,a :e'✓u'h ..5�. NMi6` � n''i ;�•' u.H�vcw%`1 ). 'L�.YY �� •max 5 �4.;... Y.on,.s„iaKd fl .h„'•,..1i.,h: `in. R=rdmg Service_to.Bidwdl'Lidc &.Esq'ow Company , $100.00 County Transfer Tax to Bidwell Title & Escrow Company 297.00 ADDITIONAL CHARGES: Fuc/Ha klns. grqktrmto Allstate Insurance 1,367.00 3upTol+ds, 276,975.92 217,100.00 Refund Due Buyer/Borrower 124.08 Totals $277,100.00 $277,100.00 bM1F1(6W7)Rev, a&U4AA 06/69/04 12:08 FAX 5908460584 _ BTEC GRIDLEY 0 001 CMCO 500 Wall St. PO Box 5173 Clbico_CA 95927 (530) 894-2612 FAX (53.0 894-0713 Since X913 Date: June 9, 2004 To: KarewJones-- From: Brandy Kopp OROVELLE 1835 Robinson St. PO Box 811 Oroville, CA 95965 (530) 533-2414 .FAX (53Q) 5331-1589 PARADISE 145 Pearson Road PQBox 490 Paradise, CA 95967 (530) 877-6262' FAX (530) 872-5129 FAX,COV-ER-.SHEET 116: 200-To1 reship. FAa+r- FrCA_ 9.5948. Brian Cook Escrow* 0020.3283-OD4-LYN Number of pages including cover sheet: Message - Phoney •- Fax: 538-2140 f RIDLEY. 560 Kentucky' PO-Box-94� Gridley, CA 95948 (530}846-400 FAX (530) 846=0584 Phone (53 x.8.46-4QQk Fax: (530) 846-0584 Please.-fintia-copy-oCthe_recorded..Grant_Qee,d Oow�na.B(fen F094 as QwP®(_ SQECIALMEQRMATtON A130lJT THI.'.FAx:_ ' The Information contained in this facsimile message may be confidential, proprietary and/or legally privileged information Intended\ only for the use of the individual or entity named above. If the reader of this message Is not the intended recipient, you are hereby notified that any copying, dlsseminationr or.distributian of-confidentlalrproprieta y or. privileg_pd.information is strk. ly prah�bite - If you have received this communication in error, please immedlately notify the sander by telephone, and we will arrange for the return of the facsimile. Thank your 560 Kentucky P6 Box 949 Gridley, CA 95948 Tel (530) MANS a Fax (530) 946-0584 FAXCgVER. J VIOLATION CHECK LIST A.P. # 024-19-0-043 Address 200 Township Road, Gridley Owner Echo . eone i Owner's Address ar enwy, acramento Owner's Phone No. Supervisoral District Tenant's Name Phone No. Type of Violation in Detail with Code Section Priority No. patio cover without permits Specific Plot Plan with C/V Noted yes no" Penalties Required 1st. Notice Sent 10/16/93 2nd. Notice Sent (Date Date Comments and/or Determination W1111,15- M_,, r�1_1 Disposition For Citation Citation (Date) (Date) Department Recommendation to Court Court Action Notice of Violation Recorded Date) hEatte count, BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (916) 538-7541 FAX: (916) 538-2140 December 28, 1993 Echo C. Leonetti 3901 Garden Hwy. Sacramento, CA 95834 RE: Building Code Violation A.P.#024-19-0-043 200 Township Road, Gridley Dear Echo C. Leonetti: This is a formal warning notice. Pursuant to Butte County Code (BCC) Section 41-2, we sent you a courtesy notice dated October 15, 1993 notifying you that you are in violation of the BCC at the above -referenced location. As of this date, the following violations still exist: Failure to obtain the required permits, inspections and approvals from this office for construction of a patio cover for single family res- idence in violation of th 1991 Uniform Building Code as adopted by Section 26-1 of the Butte County Code as follows: (a) Section 301(a) Permits Required (b) Section 305(a) Inspections Required (c) Section 305(d) Inspection Approval Required before Use or Occupancy The above violation(s) shall be corrected or abated by you by submitting three (3) complete sets of plans, applying for the required permits, and paying the appropriate fees, including penalties. After permit issuance and field authorization to proceed, the work must be completed and approved by this office within the permit specified time. This is your final warning. Unless you contact this office and make the proper arrangements to correct or abate the violation(s) voluntarily, within ten 10 days from the date of this letter, enforcement shall be pursued through the issuance of a citation (ordering you. to appear in court) for said violation(s) and for failing to comply with this warning letter. Upon conviction of said violation(s) or of failing to comply with this letter, the court shall impose penalties (fines) and a Notice of Violation shall be recorded in accordance with Butte County Code Section 41-7. The Notice of Violation shall include a description of the premises the violation concerns, a description of the violation, the date of your conviction and the action necessary to correct or abate the violation(s). Should you have any questions concerning this matter, please contact Scott Rutherford or Michael C. Vieira in this office at the address or telephone number listed above. Sincerely, MCV: dmsMidhael C. Vieira, C.B.O. Manager, Building Inspection PRCOF OF SZR'irC BY NL4r-, I am over t;e ase of le and acc a partv ca chi 3 taus,*. T_ am a resident of and e=plo?ed in the court? *,►c are the mailiz- Building Division ac: -.=r-_ M7,buairess address is gp rtme � �zer op e t Services Calf CaLor�.a. OrovdlLe, G1 959E-5 I served the foragoia3 SECOND NOTICE VIOLATION LETTER . .(!.P. #024-19-0-043) br enc -1 os:Lag a true copy i= a sealed envelope and depositing said envelop, in the United 28TH. of DECEMBER States mail with postage fully prepaid. an ?? 93, and addressed as follows: Echo C. Leonetti 3901 Garden Hwy Sacramento, CA 95834 �i 1 declare under penalt7 of rerjur7 under the laws of r. the State of CaLOr^�a chat the fore_a-inQ is t= se a=d correct 23 I and that this de_laracioa was executed an 12/28/93 20 I ac Ornv;1 i o Caliorzia. 25 .. 29 WILliAlo'—, -'— MiLLel C. Vieira, C.B.O. I Manager; Building Inspection - Echo C. Leonetti 3901 Garden Rwy. Sacramento, CA 95834 October 15, 1993 RE: Building Code Violation A.P. #024-19-0-043 200 Town,-E'ii.p Road, Gridley Dear Echo C. Leonetti: This is a courtesy notice to notify you that you are in violation of the Butte County Code, as follows, at the above -referenced location. Failure to obtain the required permits, inspections and approvals from this office for construction of a patio cover. Since permits and inspections are required for the above work, please submit three (3) complete sets of plans, apply for the required permits, and pay the appropriate fees. All work must stop until these permits are issued and you are authorized by our field inspector to proceed. The field authorization cannot he made until the existing work is inspected and approved. It is the County's goal. to obtain voluntary compliance with the Butte County Code. However, you should be advised that Butte County has an active Code Enforcement Program which provides an effective means of enforcement if voluntary compliance is not obtained. Enforcement may be pursued through the issuance of citations, fines and the recording of a Notice of Violation including a description of the action necessary to abate the violation. You have thirty 30 days to voluntarily comply with the above directions or to present an acceptable plan for abatement or corrective actions to be taken by you. Should you have any questions concerning this matter, please contact Michael. Vieira or Scott Rutherford in this office at the address or telephone number listed above. Sincerely, -WCV : dms ✓�-�� Mic e1 C. Vieira, C.B.C. Manager, Building inspection cc: .Assessor ?_ -e, d 3�' COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE / r jo -7DwA-,,5* % o 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 notify 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. C o t/ azo- ii2 Fo�� telx < R Date Inspector REV 10/92 COMPLAINANT: ADDRESS: PHONE NUMBER: OTHER COMMENTS• I 9g y