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Home My WebLink About025-240-033� \ } , � / . i � r . . � ^ / - MUR Y. osemal 'r'WESTERNt James 112 87B 1125 Paler:mo-Rd Oft Power House---Hill Rd-. -;il� mi.-no. of Palo Road,. Oroville Lni � . m -I@ / VI ~ r— • 29-3610F,E 025-24-0-033 MURFHY, Rosemary 1125 Palermo Rd,Oroville contr: Carver & Walbergmovegas line/mh e elec pole, sewer PI, P/p�a 916, 1-0 1 • A y A t,a .4 4 i is ,y B� OFFI E COPY A Address L GAS '%J �.r Meter By I pa . ELECTRIC Meter By 'Da _ r' r— • 29-3610F,E 025-24-0-033 MURFHY, Rosemary 1125 Palermo Rd,Oroville contr: Carver & Walbergmovegas line/mh e elec pole, sewer PI, P/p�a 916, 1-0 1 • A y A t,a .4 4 i is ,y B� OFFI E COPY A Address L GAS '%J �.r Meter By I pa . ELECTRIC Meter By 'Da _ �. n�+',91�i'L+_f,'y',.:•:.a.y.':tGt"''> s. •IT. Aso ..r '!i6c'Y�!�.,'�iA',=•� s9 COUNTY QF BUTTE - DEP'ARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-75 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 025-240--033 ZONING ARM 2.5 BUILDING PERMIT OWNER ROSEMARY MURPHY TELEPHONE 533-7070 So. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS 1125 PALERMO ROAD OROVILLE 95965 RM 55 CONTRACTOR'S NAME CARVER & WALBERG TELEPHONE 534-0123 CONTRACTOR'S MAILING ADDRESS 6655 LOWER' WYANDNM ROAD OROVILLE 95966 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 1125 PALERMO ROAD OROVILLE 95966 Permit fee $ PLUMBING PERMIT FilingFee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeF] Other SPECIFY Gas piping system 1 - 5 outlets 5.00 IMP" Building sewer 15.00 Mobile Home @ 15.00 • TYPE OF WORK s New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] �'��C6er ❑ Describe work: MOVE WUNDER GROUND & REPLACE POW* POLE & SEWER PIPE REPAIR Permit Fee $ 3y� Contractor ( ' ELECTRICAL PERMIT , " 1=i ling Fee Main service 200AVORLESS ` 18.50 Main service 20GATO1000A1 37,50 CONTRACTORS LICENSE LAW -,, I declare under penalty of perjury (check one): ' Q I am licensed under provisions of Chapt. 9, Div. 3 of thesiness and Professions Code and my license Is In full force an effect. License No. �/, `' 73 1' Classification ❑ I, as the owner, or my employees with wages as their sole' ompen- sation, will do the work,and the structure is not intended o offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed oontract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OR ADDNS. 1 ACC. BLDGS. / OCCUR.&\ 3:6d sq.ft. NEW CONSTRMULTI-OUTLET NON-RESID BRANCH CIRCUITS @.5.00 RDWER APPARATUS R1 1 SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 120 20 7Q Ex. Occup. OUTLETS PIRESID IREA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 15.00 Misc. IVirin g 15.00 Permit Fee $ 48.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a 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 W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FilingFee 15.00 Heating Cooling g Hood 6.50 Ventilation Permit Fee j Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against. said County in consequence of the granting of this permit. X =� Date TGA" -i- `% 'L Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations ave o" de p q p and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ 69.5 0 occ CONST-YPE TOTAL FEES 83 gyp'" HAZ OFEES I IMP I FLOOD I COF PARCEL PD I HD I ISSU This permit is hereby issued under the applicable provi- sions of the Buttepounty Code and/or resolutions to do work indicated �' ove for w ich fees have been paid. � I I�CTOJR OF PUBLIC WORKS By k� r .� .�.• Z � Date ' .; � PERMIT EXPI'• ESQ Date y 126223 — Receipt No. �� WHITE-D.P.W., YELLOW-ASS[3SOR, PINK-IN24CTOR. GOLDENROD -APPLICANT o- COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 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 / — 0i u WNER f 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, Date Z Inspector,�-� REV 11/91 + ., -v _,ri- _�_-- _ � -- ---'�.o-..s'y."""'^l+a'7F,��s.r"+f._.,=,a,-••--rR-pc.^-�.r.rr�.��,.., ,'!Gm^�-i+./6.q.h,..� COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 1469 Humboldt Road, Chico, CA - (916)-.891-2751 7 County Center Drive, Oroville, CA - ($16) 538-7541 747 Elliott Road, Paradise, CA - (916) 8.72-6307 CORRECTION NOTICE 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 contahis office immediately. y U 3 z VwiL 7�60,jE -'S-16C /a /p i A /L,lh D,ein o� �lS Cots•-��T -F-0 i2 /SELL Date �,; —`1� Inspector REV 11/91 ��-�'•'ir_Y-' �-il� .-.tbi � ti�y.r �..a� _ �!e-_. Y" .. -s .. .-i• � . •- •� ,;: COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 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 OWNER / PERMIT NO. , A routine inspection indicates that the following violations of Butte County Ordinances exist at 3 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. r .}:x111 r r . _1t4r ; t- � Datel63D�� Inspector REV 11/91 t COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 - APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 025-240-033 ZONING ARMH 2.5 BUILDING PERMIT OWNER ROSEMARY MURPHY TELEPHONE 533-7070 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1125 PALERMO ROAD OROVILLE 95965 RM 55 CONTRACTOR'S NAME CARVER & WALBERG TELEPHONE 534-0123 CONTRACTOR'S MAILING ADDRESS 6655 LOWER WYANDOTTE ROAD OROVILLE 95966 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING AODRES:i Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 1125 PALERMO ROAD OROVILLE 95966 Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME 77TPARCEL MAP Water1 in PP 9 7.00 Each qas water heater or vent 1 7.00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeK] Other SPECIFY Gas piping system 1 - 5 outlets 1 5.00® Building sewer 15.00 Mobile Home I S nG17V @ 15.001 t5 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe work: MOVE GAS UNDER GROUND & REPLACE POWER POLE & SEWER PIPE REPAIR .00 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service R LESS 200A OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No.Y/N`73 $ Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000AI 37.50 NEW CONST. ( DWELLING OCCUP.&) OR ACDNS. ACC. BLDGS. // 3.64 sq.ft. NEW CONSTR. ULTI-OUTLET NON.RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS b (SINGLE OUTLET CIR. ) Ex. OCCUp(OUTLETs OR FIXTURES 20 @ 76 FIXED APPLNS. Ex. Occup. OUTLETS ((RESID )REA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 Permit Fee $ 48.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a 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 W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling g 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 County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte'to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against d County i nsequence of the granting of this permit. Date >`r'1'— �1 Z Signature of Applicant — Ownersions ❑ Contractor �" Agent ❑ An OSHA permit is required for excavations ove '0" de p and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEES $— HA2 DFEES IMP I FLOOD I CDF PARCEL I PD HD ISsu This permit is hereby issued under the of the Butte County Code and/or ove for ich fees T OF P BLIC Work ind*11.1ET BY PER IT Date applicable provi- resolutions to do have been aid. p WORKS Date Receipt No. 126223" 93.6-0 �5 WHITE-D.P.W., YELLOW -ASSESSOR, PINK --IN CTOR. GOLDENROD -APPLICANT . �f� . .'.F Fr`•� �' �q' �# fir,. COUNTY OF`BUTTE�PARTMENT & PUBLIC WOF ,.' BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - 'TELEPHONE (916) 538-75410 PERMIVAPPLICATION DATA SHEET OWNER ivvT� 7 Ul� 7 f7` o ovZ� c)V6-6 33 Proposed Building Use gZLCBuilding Inspector Date VJe At 2. 3. 4. 5. 6. 7. 8. 9. 0. 12. 13. 14. 15. 16. 17. 18. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. t"application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY All items have been submitted......................................... Plot plans, 3/4 sets, signed by preparer of plans : .......:................. . Complete plans, 3/4 sets, signed by preparer of plans . ...................... Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. Hazardous Material Form ............................................. Energy Design Compliance and supporting documentation. Statement of Intent for Non -Heated and A/C Buildings. ..... `................ . Engineered truss details and layout in duplicate (required prior to plan check). .... Mobilehome data and manuf cturer's stal!latiorn� in$tructions, 2 setp.� .......... Fees of $ '25-.00 %�r..tc.l(...r�.4 i�jv..y�0�.lg44e ........ Io 9 Impact fees as shown on attached schedule . .............................. California Department of Forestry plan approval/fees. ........................ Flood elevation letter (100 year flood) by California Engineer . ................. . Sanitation and plot plan approval Health Department . ............. City of Chico plumbing permit . ........................................ . Plot plan and business license approval from City of Biggs/Gridley. ............. Planning approval for (A) Use: (B) Parking: . ........ Contact Land Development about (A) Impr vements (B) Drainage. .......... . Driveway permit (c ,S�rt}ctiojq{�prov�I req jre p�ol u-pancy). .. ... . Pre -inspection for I k t/ Ytil f7 l/ ( / G Pre -Inspection requesi- p r ulred. . . to Building Inspector (Date) Contractor's license information. (No., N me Style, Classification) . ............. . Certificate of Workmans Compensation Insurance . .......................... Owner -Builder Verification (Given to owner , Mail to owner _) ............ Recorded copy of Agricultural Acknowledgement Statement . .................. Letter of signature authorization . ........................................ Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use . ........................ .................. Mobilehome utility clearance . .......................................... Documentation of legal access . ........................................ Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ........... .... . Existing violations/expired permits . ...................................... Plan check list. _ _ . _ _ . A When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applican __Ooc Date d Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to per it' suance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: C designer, owner, was advised of above required data by Zphone one mail Counter b Date o /ntractor, esigner, owner, was advised of above required data by _ mail Counter byteDate A/2 Plans c ed by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy' - Department of Public Works COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR/ PA L NU `ERS t! -P�t- o -3 ZONI 21 BUILDING PERMIT V � IM U/ TELE o� S0. FT. OCC. BUILDING VALUATION '�) �(� OWN R - ASING ADDRESS O r��p/� M SIS— � CONTRACTOR'S Nr CO. /v�1 Y` ✓V TELEPHONE. 3 CONTRACT R'S MAILING AD RESS O/L 020vi1/r1 Fireplace CONSTR CTION LENDER C> UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee 15.00 Permit Fee $ ARCHITECT OR ENGINEER �A LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Ener Plan Checking F $ Energy g ee Penalty $ BUILDING ADD E L� �< Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 1 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Duplex[] MobilehomeXOther ��"``` ��\��\ SPECIFY Gas piping system 1 - 5 outlets 5.00 S;O Building sewer 15.00 Mobile Home I S J G I W @ 15.00 TYPE OF WORK New❑ Addition[] Remodel❑ UUtilities/❑ IInstallation❑/ Other Describe work:�%l/l0%�� !i (//" [SGC-� Pact)arz, P Permit Fee $ r Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service ZOOAOR ORLESS 18.50 i CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A) 37.50 DWELLING OCCUP. Y\ 3.60 sq.ft. NEW CONST. OR ADONS. ( ACC. BLDGS. lI NEW CONSTR. ULTI.OUTLET @ 5.00 NON.RESID BRANCH CIRC ITS (POWER APPARATUS e) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 75d A FIXED APLNS. EX. Occup. OUTLETS PRESIO )REA.) ( 3.00 Temporary service 15.00 Mobile Home Facilities 1 15.001/15, Misc. IVirin g 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a 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 W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Penult Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this perm7it/ C X Date b / Signature of Applicant — Owner❑ Contractor ❑ Agent ❑ An OSHAwork permit is required for excavations over 5'tl" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ , HAz 1 0FEES I IMP FLOOD I COF PAR EL PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By BY PERMIT EXPIRES Date Receipt No. IZ16z Z 2; WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT OWNER: PRE -INSPECTION LOCATION: / a LG��1(7 �OL'B,�Y • -' (� CONTRACTOR {�(�� UVf} L j L�/ �- {= ZONING k"ll c 2, S_ INSPECTION FOR: P C0' DATE TO INSPECTOR PERMIT HISTORY: NONE E] AS FOLLOWS: TYPE OF OCCUPANCY FIELD - INFORMATION BUILDING USAGE: n I,(d•e) Z i< Sy / TENNANT: in- K ,4 %-.,o OCCUPIED HAS ELECTRIC HAS GAS HAS SANITATION FACILITIES Q HEATED -COOLED -F--I—PER—SON CONTACTED cprnYrQc�drS r *-OTHER COMMENTS: -VY1 n 5 i 0 o S ael a -" 19 )7 Flo+ y a ACTION RECOMMENDED: ISSUE [ HOLD ,FOR . c ul( `�i c erw►c� - 4 s ' r .�1.�� sus �P ,,��1-'= _}r; � � • —�` OTHER: kc(s. h0 Q&rOrCtl QQ_ \ �- i S LA �. _ C �� Y (4 R c C. C. � :.o QV a BY _ -, 1 DATE Z, 7e) v.s VO - 033 wls rVr;wrw4—0 Oi.. CbRED HOMES (MOBILEHOMES):�-,";-, W. 1 -4 &-1+- -So -01 --0 OWNER X_ PMPO E? R MIJIM. E RECREATIONAL VEHICLE dQ 40 I MIT. Q-1 YL citv Z;n-0,10 U. FACTORY -BUILT HOUSING' o, mcroity-guu..uousiNG- 1 5OMPONE - :4*1. -'OV fwfO Irr, rwwlrni�:. Location Add if Different 6"Vmt, oxw .!f3"::APPLiCATIC)N.fOk.�ALTERNAlIE-.APPROVAL.'.-!.,vw,.. REQUESTED INSPECTIOA-;�*_ APPLICATION FOR ALTERATION, ADDMON;' ,_�Olt'-_ , VERSION,�, k 4,- , 961 to. nc4n 'CON -.1. 'Airm . 1. APP Add ress - �,Iojfi -b-r[,iyc L I* =Ut&.9 �b t'rin- Te*=: i..2 42 zzz zip 2 civA 1..� REQUEST.FOR'TECHNICAL_SERVICES REQUEST FOR"k0U6iEi;Fr MicAX/L.Ak _t"AT -XIA3111 Con. Clan -ZIJH�tao� -:4JNff.SERIAbinihoq.,YEAROF-t-i n*eAv I.;MANUFACTUREFeSt k -INSIGNIA 4AME;p ad c, iuPCAUFORNIA rn It _U CENSE-b*pw NOM Do, ViiaAfto, I= lot w Now. Allow a -minimum of ion (10) days for scheduling. Z 134"i AN INSPECTION IS REQUESTED FOR THE FOLLOWING DATE E PURPOSE OF THf 3.1u: ,.1NSPtCTION is To. OBTAIN INSIGNIX;Q-��:;E] ",CLEAR. NOTIdt OF -Vt6 LA -TIONS'? 41t:[D �DETERMINE�616APNA?41d- OF'-ALTERATK)NS,:ETC. A REPRESENTATIVE PF THE DEPARTMElfT-WILL CONTACT )rCW..TO CONFIRM'THE DATE OF.INSPECTION. AW ALTERATION, ADDITION,. CONVERSION: -Describe the pr000sed work in detail in the spot;e. provided in Item Number -5. Use odditional pages if necessary. Where structural alterations or additions are proposed, complete plans, specifications, details, -and calculafioni;iIm required to- be attached .:-to this form. Provide the make and model of any appliance to be installed and proovide complete elect, cal �colculations for any electricalalterations or additions. INDICATE THE TOTAL COST OF THE WORK T"O' BE PERFORMED S DESCRIPTION 711 A 7"04) &JL, 7 /2ek,4 Vg im,04"/ CAeA.0C_J-/'d," Ae_~jC 61, A..'L 0 6 r OL C* a; A 1 n g: I e 2 -JW-LACEMEW--CAUFORL41A..JNSIGNJA-OR-HUD.-LABEL-J/3VE-BBtEBX-AiAKEAPPUCAT/ON..,FOR-REPLACEMENT-.OF-A LOST-JNSIGNIA OR LABEL FOR THE UNIT INDICATED IN ITEM NO 2 ABOVE VWE CERTIFY THAT THERE HAVE BEEN NO ALTERATIONS, ADDITIONS, --DR-"IFICo4DOt4-rO-JNE-Ubff--VMCH-WD=-AFMa-COAIPIJANCE-MaDL.CALLEORhUA-DR.-FEDEKAL-IAW-DE-n"UIM.-AND REGULATIONS OF THE DEPARTMENT. (Whom a"= or modificatimm have bow moole, ftm 3 and 4 nwit be compkfed.) SIGMA Tw .. dzo 'A J DATE OFA APPRC*E16 *0*0 44 -12 sww Dow. *(See mvww We for 11'" or reason for "JIM 4!�G! v, - V ;513' Elm t bOntO Anc4,f-A Y"M E 'FOR NOTM X; 31100w, % V., a6ft -rd 'OWNER R'MANUFACTLJRED HOMES (MOBIM"HomEmq- Ix rt -AAANUFACTUREDMOME j(MO8ILEWYA4!- d An&, t-�olq Wap, I lot QWY Jar MO`T! 09W, m� umi a*# -to qo:rozroF -SM 13RECREATIONAL VEHIM !S. .4tIn city Count&—iRico/7 Qpta�4.w ,!!.n FACTORY -h Z LJ -WILT HOUSING qtr y Location Adclre%,�,,�, 000 FACTORY-BUILT-kIOUSING 0 if Diff~ ;SYS "or", a; 6t.*n2-i r..r- vjw m5ii ;�ifo,• ow.C MTIr REQUESTED INSPECTION APPLICA APPLICATION FOR ALTERATION, ADDITION, Address 6AS!r 'M :}OR CONVERSIOWn„,- t&, to. ooL-,swrttz AbqC!;j *11! I—sit rz a. -0 .AP-F.0k.:ALTERNATE -.APPROVAL 4;. T n-,; j -b-rLivain e:� i44it'r"* -,Z cn-A -isb REQUEST. FOR TECHNICAL -SERVICES Telephone —Zi P REQUEST FOR`WhW6&ENr iNsiGNR;7rrL',ksir I lic Clan GtJH tao; Z,- -.4jmff.SRIA6-4t*joq.,.YFAR.,OF-!--rr.*Ku&ftm.DECALORzi.ft*Woit.wa n*Aw t:.-MANUFACTURERIS-NAMEgiLedNIA- *iupiCALIFORINSIGNIA -WMBE Alkfr Ni rvk _-MA-K k/*QDEL' ABE NO R.(F 6�*b9ZHUD-L. L Al IL Nose Allow a minimum often (10) days for scheduling. av i, AN INSPECTION IS REQUESTED FOR THE FOLLOWING DATE THE PURPOSE OF THE INSPECTION .1 X ZA 3- IS TO: C1 OBTAIN INSIGNIA:—- '.,CLEAR. NOTICE' OF V16LATIONS db_APtIA?4d -OF -ALTERATIONS” ETC. in A REPRESENTATIVE OF THE 017ART6111K., WILL CONTACT YOU _Y0 CONRRM -.THE DATE OF- INSPECTION. ALTERATION, ADDITION, CONVERSION: -Describe the proposed work in detail in the space. provided in Item Number -5. Use additional pages if necessary. Where structural alterations or additions are proposed, complete plans, specifications, details, and oolculafions!cwe required to be attached 4' '-'-to this form. Provide the make and model of any appliance to be installed and provide complete electrical calculations for any electrical alterations or additions. INDICATE THE TOTAL COST OF THE WORK TO BE PERFORMED $ DESCRIPTION fiKd- A-46 7* AD dArm p-'tvu 7 Aevt of AgiAm,Ve WaWZ e_1CJ9A&C_j"Je10A" ACA"JC 01 &1 XiAv MeA1W SL" A*A-1"L01_.1A1 zip &,7- An 2D,,v )'-Oege __REfLACEMENT_ LALIFORNIA. JNSIGNIA-OR-MUQ.-LASELJIYVE-BBZEBY-hLAKE-APPUCATION. FOR-REPTACEMENTI.Of-A 10STI-INSIGNIA OR LABEL FOR THE UNIT INDICATED IN ITEM NO. 2 ABOVE //WE CERTIFY THAT THERE HAVE BEEN NO ALTERATIONS, ADDITIONS, —jDR-AtQPIRC4DOt4-TO-ME-Uhff-l&MCH-WDMD-AFFECT -COAIEUANCE-M7f-CAUEORMA-CW-MDEM"W--Og THE RULES.- AND REGULATIONS OF THE DEPARTMENT, (Whereakwahons or modirkvdions have been made, hems 3 and must be compkiect) . ...... SIGNA Mite D&ARTM9NT tISE OMY " DATE OFA TION rim J2-�APPFIIR CONDIT116kii-"fl' -DISAPPROVED- J0_/ :.•J *(Sw rareae sids f1hr aattdillola or nmen for