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026-182-002
I 0 EZ ............... .92-407.3B 2237 worth, Paler"mo .e molish sjaT 026-18-2-002'/- LOPEZ, Raul. ,7/ 93-1249 P, E (MH,/ 2237 Kenilworth Avenue, (util,'MH,, 000 Oroville Al - q-f ,tJo 93 626 --I LOPEZ8-2-002 ,, ;.?/1 -Raul' / 93-1250 MHI: 2237'Kenijw� orth Avenue, (MHI/93-'l 249., Orov e 02(0- ISZ - o -1-182-002 -SUMMARY'SHEET FOR LAND DIVISIONS 6/2/93 RAUL LOPEZ. 026-182-062 ,CER TIFICATE OF MERGER Raul & Maria, -Lopez 7/6/93;' OFFICE COPY Address— I G AS /� / Meter BY �/ Date `'— ELECTR[ Me� ter By I f J JOB FIN/ALED (Da "natMro V=OK O=Not OK Not = Not Readyable MOBILE HOMES Date/Initials MOBI E'HOME UTILITIES Plans OK except #'s oni equirements-Setbacks-Easements IIs; Special MH Support Sketch Wer; Location -Test -Fell -C/O Concrete 4ocetion-Test-Easement Needed (Sketch) ricity; Location-Clearences-Grnd-/ /Amp -Concrete action -Teat -Wrap: / /"L"ft. / Nat. or/ P1L"ft./ /"LPG 47"Well glefrance & Disconnect .,/,8._Utt1Tty Clearance C./ Date/Initials MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks Easements '2. Footings; Size -Spacing -Marriage Line 3.. Gas; MH Teat-Demand-Valve—Connector 4. Ej ctricity;, MH Teat -Crossovers -Breakers -Clearances Drain; MH Test -Fall -Flex Connector Watec;MF1'Test-Regulator-Connector L,. -7: -Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Exits; Insp.-Sketch ? 10. Cert. of Occupancy h MISCELLANEOUS Date/Initial DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg: Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date/Initials 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, 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. Boxes-Enclosures-Panelboards-Ina. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test V=OK O = Not OK - = Not Applicable = Not Ready RESIDENTIAL (Single& Duplex) 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 -Bloc kouts-Wra pped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped S. 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 Teat 12. Electric; Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulatiory 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 & Water 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 -Mein Disconnect 31. Equip. Clearances Panels -Motors -Mach. 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 Wells (ret 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 -Pu rlin -roof Brac-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protectlon-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 -3b 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 -Ceilings 60. Infiltration -Walls -Windows Date/Initials FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protection -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 -Meth. 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-Drainagge & 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 Comments at Final: MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 558-7541 cl-% PERMIT NO. Address or location of mobilehome Owner's name Owner's address Insignia or hud number Manufacturer's s name I.N. manufacture Serial number V. —4— Year of mai 5 Tofficiall Appr`6-,-irreInstol lotion) (Date) IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN TH9!, MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. 5138 White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT 0. ASSESSOR PARCEL NUMBER 026-182-002 ZONING ARMH-1 BUILDING PERMIT OWNER Raul Lopez TELEPHONE S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 359 Palermo 95968 CONTRACTOR'S NAME Unknown TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 , Permit Fee $20,00 ARCHITECT OR ENGINEER LICENSE ND. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $35.00 PLUMBING PERMIT Filing Fee 15.00 Oville Each Trap 5.00 Solar or heat pump water heater 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❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 1 15.00 TYPE OF WORK rr-��" New j Addition _i Remodel C 17L Utilities Installation Other ❑ Describe work: MHI (500 Sq. Ft. Min.) _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 Main service 200A To 1000A) 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9Div. 3 of the Business , and Professions Code and my license Is In full force and effect. License No. Classification F-1 1, 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) 21"l, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUP.&) DR ACDNS. 1 ACC. BLDGS. I/ 3.64 sq.ft. NEW CONSTR ULTI-OUTLET _NO ESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS & (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 2075d EX. OCCUp. OUTLETS PIR E SI D.)RE 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. byirin 9 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. LrJJ 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 becomesubject 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 said County in consequence of the granting of this permit. X Dates/ 7,3 Signature of Applicant — Owner Contractor'❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct - ion of structures over 3 stories in height.D Mobile Home Installation Fee $ 70.00 Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $105.00 rlAz DFEE IMP — I RODD CDP PARCEy� rY PO L HD Issu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees E UB C By PERMIT EXPIRES Dat the applicable provi- resolutions to do have been paid. WORKS Dat ( Z2 Receipt No. 141205 WNITE-D.P.W., TELLOW-A99E990R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7COUNTY CENTER DRIVE -OROVVE,A'L RNIA95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATASHEET OWNER A. P. No. Owl- /4"Z - 00 -7 - Proposed Building Use Building Inspector tl9b Date S 3 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ....................................... . 2. Plot plans, 3/4 sets, signed by preparer of plans . ........... ............... . 3. 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. Statemerit 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. ...........1� $ 10. Fees of $ . ......................................... .................. 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health.Departr--MrIt. ............ 15. City of Chico plumbing permit . ............... ,..... f .............. . 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 11ne�'°n requestrequired. . to Building Inspector. (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 . ................ Ilk26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use. ` ....... k ...................... . �� 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. ........ r 31. Existing violations/expired permits: :....? ........................:...... . 32. Plan check list. ............ .................................. . 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone X37 - /9/0/ and hold for pickup at Dam office. Deliver with inspector. Other Parcel Creation / Acreage Applicant ^ Date % i3 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 1. Index permit for above items No. _ 2. Additional items required: nce::LCIL06 new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone - mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone - mail Counter by _ Date Plans checked by Date Plans approved by . Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works i COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916)5387541 OWNER zeaz A.P. N0eP PROPOSED BUILDING USE IPMI ✓i DATE REC. # DATE REC School' District Fees (paid at District Office) „ ,„ Sheriff Fees (paid at Building Department) Residential ......... x 0 unit amt. Commercial(per sq.ft.) X =$ sq.ft. amt. 3. Urban Area Fees (paid at Building Department Residential.(per unit) x =$ # units amt. Commerical(per sq.ft.)' X _$ sq.ft. amt. - .4w Recreation District Fees (paid at District Office) 5. Drainage District Fees (Contact Land Development) ................ 6. Other 7. Other At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT x/1/5 DATE 4 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKIZ 7 County Center Drive - OroviIIe, California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER /n� ((/{ ZONING ,q# / BUILDING PERMIT OWNER •,/ / / 0 TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'SAI LI NG7c K ESS Yo o'35c A-leot o e,4 -^gm'? CONTRACTOR'S NAME D�/V TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ '20. 420 Energy Plan Checking Fee $ - ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Z Z3 7 e/Ur f G Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 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❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home I S I G JW 615.001 TYPE OF WORK New _ Addition L --j RemodeI L; Uti lities L_ Installation4 Other ❑ Describe work: -5-0 C> 5 G2 V T Ad 1U Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 200A OR LESS j$.SO Main service 20GATO IOOOA1 37.50 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. Classification ' Lj 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 NEW CONST. / DWELLING OCCUPM OR ADDNS. l ACC. BLDGS. // 3.64sq.tt. NEW CONSTR. MULTI -OUTLET NON-RES10 BRANCH CIRC ITS 5.00 POWER APPARATUS tr (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76A FIXED Ex. Occup. OUTLETS PIRESID 1NS REA.� j 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor — 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. 71 1 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. MECHANICAL PERMIT Filing Fee 15.00 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 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 _54 Signature of Applicant - Ov.ner �- r 9 PP ❑ Contractor L. Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct• ,on of Structures over 3 stones in height. Mobile Home Installation Fee S Q Energy Inspection Fee $ DCC CONST TYPE TOTAL FEE $ /O 0o HAz I DFEES IMP I FLOOD COF I PARCEL I PD 1 HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC 8Y PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date / Receipt No. 7 COUNTY OF BUTTE - DEPARTMENT OV PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916)5387541 OWNER / A. P. NO . 60 G -XZ - 60 PROPOSED BUILDING USE /���� DATE REC. # DATE REC 1. School District Fees (paid at District Office) ...... 2. Sheriff Fees (paid at Building Department) Residential x =$ unit amt. Commercial(per sq.ft.) x =$ sq.ft. amt.'. 3. Urban Area Fees' (paid at Building Department Residential.(per unit) R # units amt. Commerical(per sq.ft.) x =$ sq.ft. amt. 4. 'Recreation District Fees (paid at District. Office) 5. Drainage District Fees (Contact Land Development) ......................... 6. Other .7. Other At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE 0 i�'S cr�r�r111 < BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District �,� /(f%� Building Department No. A.P. Number U��z Jurisdiction 0 City Property Owner Property Location/Address 27-5-7 A (�Q_ County G?S Subdivison Lot No. t Residential Development 0 0 No. of Living_ `r MHI— Addition Weflw e ° Units Commercial/Industrial New Addition r Building Department Repr sentative (Floor Plans reviewed by School District Personnel) District Identification No. Sq. Footage 7 2, 0 (Group R) Sq. Footage (Including Exterior Roofed Areas) -5-1y Date 0it&V-Ub Xr'� School District certifies that ��uQ (Applicant) �R 31. (Street Address) .A•. 18 (State) has complied with the requirements of Resolution No. -720-111 �� representing $ '7 (0 legkare fee -LA aj— School District Representative .'. Paid by Check Numberd Bank Number Paid by Cash Number) (Zip Code) by payment of $ Q.3-1.66 �N! 4 3 Date 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 jC White (applicant), Yellow (building department), Pink (school district) feeform.wkf (4/92) Wil Die /Farrel r of Development Services 9D4- 4 .1 , Dat e OWNERS' CONSENT TO MERGER leee Z X41A` owners of all that real propert agree to the merger of such lands on Exhibit "A" attached hereto: SIGNATURE SIGNATURE RICHARD FEUERSTEINQ COMM. #986104 ci 2 ° Br •. NOTARY PUBLIC -CALIFORNIA Q (} o BUTTE COUNTY ' A ti My Comm. Expires Feb. 28,1997 Ne to be merged, do hereby consent and into one single parcel as described 5-i3�y3 DATE DATE State of California County of On before me, personnally appeared XAu/ /"%Qia G. Awe---, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names(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 by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s), acted, executed the instrument. WITNESS my hand and official seal. Notary Public 93-28537 93-0285371 Rec Fee 8.00 AFTER RECORDING RETURN TO: I Cash 8.00 Recorded I / County of Butte Official Records I Department of.Public Works County of I No. 7 County Center Drive Butte I Oroville, CA 959.65 Candace J., Grubbs I Recorder 10:23am 7 -Jul -93 1 PUBL XX 2 CERTIFICATE OF MERGER COUNry OF Se LANDS BEING MERGED: BUILDING DEPT QQ' AP NUMBERS) O� �-1 U�^: �o �-- o0 o JUS 14 1993 SUBDIVISION/PARCEL'MAP: U BOOK S PAGE BLOCK 7 -----LOT(S) J q �! 7 / l f `day �V As of the h of 19 9 3 those lands noted above are merged to cr46ate one single parcel of land as described on E,*tlibit "A" attached hereto. Wil Die /Farrel r of Development Services 9D4- 4 .1 , Dat e OWNERS' CONSENT TO MERGER leee Z X41A` owners of all that real propert agree to the merger of such lands on Exhibit "A" attached hereto: SIGNATURE SIGNATURE RICHARD FEUERSTEINQ COMM. #986104 ci 2 ° Br •. NOTARY PUBLIC -CALIFORNIA Q (} o BUTTE COUNTY ' A ti My Comm. Expires Feb. 28,1997 Ne to be merged, do hereby consent and into one single parcel as described 5-i3�y3 DATE DATE State of California County of On before me, personnally appeared XAu/ /"%Qia G. Awe---, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names(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 by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s), acted, executed the instrument. WITNESS my hand and official seal. Notary Public A parcel -of land- in Butte County, California being in. Township 18-- -. North,. Range -4. East, Mount Diablo Mer-id-ian . and - .being . more _particularly described as follows: Beginning at the northwest corner of Lot 40; in Block 24,. as shown on that certain -map entitled, "Town of Palermo", ---which map was recorde.d. in.- the- ' Office of 'the Recorder o -f -theCounty .of .Butte, State of` :Ca-1ifornia, ori February, `17;' -1891,- in _Book. 5':o f. Maps, at ' Page 4;- thence'- East, =a l'ong' the north' l.ine - of ._1 ots 40, :39 and 38 of said Block 24,-a distance of 75 feet- to -the northeast corner of lot --38 of. said Block 24; thence South, along the east Fine of said 1ot.38; a distance of 150 feet to the southeast corner of said lot 38; thence West,.along the south lines of lots 38, 39, and 40, a distance of 75.feet to the southwest corner* of -lot 40; thence North, along the west line of. -lot 40, a distance of 175 feet to.. the Point 'of -Beginning. This -constitutional one legal merge -'parcel 'and lots 38 .through•40- - cannot be sold separately. 0 1l G. AOFF, �yc `moo w � No. 647 OF Ch qrs,y. w r a a x �:L ��o� IDOCUTAF SUMMARY SHEET FOR LAND DIVISIONS APPLI ADDRESS P.O. Box 359 Palermo CA 95968 CoUNWOMME BUILDINUUtrl OWNER Same U N. 1993 PROJECT DESCRIPTION APPLICATION.FOR CERTIFICATE OF MERGER LOCATION_Iyarcel located on the south side of Kenilworth Avenue, approx 230 east from its'intersection with Melvina Avenue. Palermo aree-'%'' ft - ASSESSOR'S PARC ELLNUMBER(S)-. �26-182-02 (Lots 38. 39 & 40) - ZONING -. GENERAL PLAN PROJECT CONSISTENT? .. , .GENERA '' � -• •f - .* ..r L PLANfCONFORMANCE:.REPORT . �,• .,. t� �`•'t � ," ", LAND CONSERVATION i.ACT. CONTRACTS ? - _.'DATErAPPLICATIONr(RECEIVED June 2 1993 ?r ` • L' •. ' - • y J •' Itis ,1yS. i •• J +`. { ? AGENT/SURVEYOR/CIVIL ENGINEER Robert G. Agee.. jr.' $ ADDRESS_ -._.'______-.,1201 Brereton Way, Oroville.-CA' 95965• DATE PLANNING'DIRECTORS, REPORT PREPARED ENVIRONMENTAL CATEGORICAL EXEMPTION - DATE FILED ' DETERMINATION AND DATE NEGATIVE DECLARATION - DATE ADOPTED MIT. NEG. DECLARATION = DATE ADOPTED ENV.IMPACT REPORT -'DATE CERTIFIED STATE CLEARINGHOUSE NO. DEVELOPMENT REVIEW COMMITTEE HEARING DATE APPEALED APPEAL HEARING DATE, BOARD ACTION COMMENTS. FOR'PLANNI'NG DIRECTOR'S REPORT P-1-c-Toplo To 'ASSIGNED TO z DISK ' "RECEIUPT. NUMBERt J, -„ • ..LD 1005 11 /92). BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS ' 7 County Center Drive, Oroville, CA PHONE: 538-7541. MOBILEHOME INSTALLATION SHEET 1. Owner's Name: AU � d Joe Z- 2. 2. Installer's Name: 01A/ Y) E' % 3. Is the site currently under permit? Yes © . No F (If yes, furnish permit number 173 OR Is the site an existing site? Yes F] No (If yes, furnish two plot plans.) 4. Will the mobilehome-be.located at -.least 5 ft. -away from -septic tank and leach fields and clear of all setbacks and easements? Yes ® No (If no, clarify 5. What is the mobilehome electrical rating? --------------- Amps 6. What is the mobilehome site service rating? ------------- 6 0 O Amps 7. What is the mobilehome site circuit breaker rating? ----- 1 ©� Amps 8. Is there any other electric load to be served by the mobilehome site service? -------------------------------- Yes R] No 4 (If yes, identify the load and size: rI! (Load) g o�� (Amps) ? 9. What is the mobilehome site as pipe i e size. ----- --------- 3/4� (in.) type g. ? ------ ------ 10. What is the t e of as service. -- ----- Natural FV] a . 11. What is the gas pipe length from meter or tank to the. / mobilehome? --------------------------------------------- (ft.) What is the mobilehome gas demand? ---------------------- (BTU) *(This information not required if pipe length less than 6 ft. on 93-4,50 4,50 natural gas or less than 50 ft. on LPG.) BUTTE coin . NEXT PAGE MUST BE COMPLETED TO PROCESS PERMIT "W%3Z pEPAMIWENT APPROVED, /� 06/93 MOBILEHOME SUPPORT DATA If other than single wide, Mobilehome Mfr. �yI,'" e__ furnishpc -Setup-Model No. Year ! j pr Width(ft.) Box Length (D O (ft.) Tagalong or Expando Size ft. x ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). FOOTINGS (check one)r7791. Wood -pressure treated or foundation grade. 2. Other (specify) SUPPORTS (check one)�1. Concrete block. a 2. Other (specify) TT Pier Footing Sizes and Locations SINGLE -WIDE Main Beams s — — _ — _ — — — — — — — — .♦ Line 2 Main Beams — — — — — —• — — �Llne 4 Tag or Triple — — — — — — — — -- — r— i=ce Line 1 Line 1 Piers: Line 1 Openings: Size -Min. ------------ Size -Min. ------------------ � Spacing -Max. -------- , „ Each Side of Openings From Ends -Max. ------- '_ " With Width Over --------- Line 2 Piers: Line 3 Piers: (Under Bearing Wall Only) Size -Min - ------------ „x„x jD Size -Min.------------------ u Spacing -Max.--------- �,_ „ Spacing -Max ---------------- ,- From Ends -Max.------- '_ ” From Ends -Max .------------- Line 3 Roof Loads: Size -Min.---------- „x „x I. Ix „ ,k „x „ „x „x „x Location (From Front) _ _ �_ �� �� �_ •�� �_ „ �_�_ Line 4 Piers: Line 5 Piers: (Under Bearing Walls Only Size -Min.------------ Size -Min. ------------------ ,'x n Spacing -Max.--------- ,_ „ Spacing -Max .--------------- From Ends -Max.------- „ From Ends -Max .------------- Line 5 Roof Loads: Size -Min ------------- "x N I. "A "x 11'k "x " "x " "x Location (From Front) L! i. IJO. r1*43k i x,913(1 VS 3 _ AP OWNER L D� Y ' PERMIT �k MH UTIL.CLEARANCE DATE INSPECTOR ELECTRIC., GAS Support Struc. Compaction Test eq. arvice Other Pipe YES NO YES NO ize Load Type Size Length s: 1, 1 g, 'c 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 f' Z OWNER 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. Date IInspector REV 110/92 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 OWNE R PERMIT NO. A routine inspection indicates that the E llloowing violations of Butte County Ordinances exist at the above addressnd should be corrected. Please notify this officeXait" rection of work is completed. If you have any questions pertaining to this matter, or nenal explanation, please contact th s office immediately. 1 Date4'-q�!23 Inspector REV 10192 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville,Califordia 95965 - Telephone: 916.`538-7541 APPLICATION LAND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER it 026-182-002 ZONING ARMH-1 BUILDING PERMIT OWNER Raul Lo ez TELEPHONE 532-1401 SO. FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 359 Palermo Ca 95968 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ TWM Permit Fee $ 20.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 20.00 PLUMBING PERMIT Filing Fee 1 15.00 9917 Vianilworth Ave-, Drairille Each Trap 5.00 1 Solar or heat pump water heater 20.00 LOT NO. 39"3 �% SUBDIVISION NAME aJ L �f /l� O PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ElDuplex❑ Mobilehome© Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer —TG 15.00 Mobile Home TSW @ 15.00 5.0 TYPE OF WORK'– New 17 Addition El Remodel❑ u�t� Utilities ' Installation❑ Other ❑ Describe work: MHLJ, (1 Bedroom) Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600AORLESS 1 18.501 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 .Jo. Classification LJ 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 ADDNS. 1 ACC. BLDGS. II 3.64 sq.ft. NEW CONSTR "ULT' -OUT LET NO N.RESID BRANCH CI"C" C ITS @ 5.00 POWER APPARATUS & (SINGLE OUTLET CIR. Ex. p OUTLETS OR FIXTURES zo 760 FIXED EX. Occup. OUT P(RESI 0.)RE..) ( .3.00 Temporary service 15.00 Mobile Home Facilities 1 15.00 15.00 Misc. Wiring 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 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 again said/County in consequence of the granting of this pe/rmit./ X. Date S/ L% / 1� " Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" 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 $128.50 HAZ DFEES IMP/ V/ FLOOD COF FARCE 'Z /1. PD HD Is This permit is hereby issued under sions of the to Count ode and/or work indi to ab which fees I OF PUBLIC By PE M XPIRES Date the applicable provi- resolutions to do have been paid. WORKS ate ? CSr C! Receipt No. 141205 WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLD ENROD-APPLICANT P%OUNTYOF BUTTE - DEPARTMENT OFD`VELOPMENT SERVICES - BUILDING DIVISION w 7 CICU ,' TY CENTER DRIVE - ORCVIL E CALIFORNIA 95965 -TELEPHONE (916) 538-7541 P RM IT APPLICATION DATA SHEET OWNER A. P. No. Z Z Proposed Building Use _ `/�(� Building Inspector � Date 5 - At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: 1. DATE RECEIVED BY All items have been submitted . ...........:.......... ................ . 2., -Plot plans, 3/4 sets, signed by preparer of plans . ......................... . 31' 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 .......... .....'t ............................ 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......................... . ' . 13. --' 14. ` Flood elevation lettdr (100 year flood) by California Engineer. .. ". Sanitation and plot plan approval DOU, %/e-- Health Department . ............ `^ 15. City of Chico plumbing permit . ........................................ . f 16. Plot plan and business license approval from City of Biggs/Gridley. Planning approval for (A) Use: (B) Parking: Contact Land Development.about (A) Improvements (B) DrainagetJ£._ j�yj19. Driveway permit (construction approval required prior to occupancy). . . Pre 20. -inspection for required. .. a ill 9 n�ao�-(Date) 21. Contractor's license information. (No., Name Style, Classification) . ............. . 22. Certificate of Workmans Compensation Insurance . .......................... 23. 24. Owner -Builder Verification (Given to owner , Mail to owner ............ .......... Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. 27. Copy of recorded deed of parcel creation and 60 right of way to a public road..... . Letter of intent on building use . ......................................... 28. v 29. Mobilehome utility clearance. ...:.......................................... 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. 34. When ou issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone 577r7- - /4/D/ and hold for pickup at office. office. Deliver with inspector. Other Parcel Creation Acreage ' Applicant 2gtA c/ / Date 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 it issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, o , was advised of above required data by _phone _ mail Counter b Date Contractor, designer, owner, was advised of above required data by _ phone -mail Counter by _ Date Plans checked by Date Plans approved by' ` Date% 5 � , 3 Sets of plans on hold in File cabinet AP folder s- Copy - Department of Public Works • Plot I'lun Aauchud ___ _ "_,'C�.,.-� Flour I'Ihn Atwched� _ lent to I1.U,----------_-/tea TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location Plan Approved for: Sewage Disposal Water Supply: Public Clearance for / bedroom mobile home. Other Hold final for: Final clearance O.K. for: NOTE: . Environmental 8/92 c. lth-*�Pecialist 'S AP# Private Well //,)- h5 Date A • Plot I'lun Aauchud ___ _ "_,'C�.,.-� Flour I'Ihn Atwched� _ lent to I1.U,----------_-/tea TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location Plan Approved for: Sewage Disposal Water Supply: Public Clearance for / bedroom mobile home. Other Hold final for: Final clearance O.K. for: NOTE: . Environmental 8/92 c. lth-*�Pecialist 'S AP# Private Well //,)- h5 Date I f1 00 eli ► Ap AW°F ' INTER -DEPARTMENTAL MEMORANDUM ? X993 TO: Butte County Building Dept. FROM-: Doug Fogel, R.E.H.S., Env. Health RE: Health Clearance for Lopez, Kenilworth Rd. (AP# 26-iB2-02) DATE: May 12, 1993 We have given final approval for the well repairs as noted on our clea-ance dated April 12, 1993. So you do not need to hold the final on our account. DF/sg ..- rI COUNTY OF BUTTE,- Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 91.6-538:-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been -applied for in your name and bearing your signature. Please .complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until.this verification is received. (1�1.. I.personally plan to provide the major labor and materials for construction of the proposed property improvement (yam or no) e 20 (have/have 'not) 7 4ia Ve signed an application for a building permit for.the proposed work: 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: o Name Address City Phone Contractors License No. 5. I will provide.some of the work but I have contrac.ted..(hired) the following persons to -provide the work indicated.: Name Address Phone Type of Work .S-gfdied Property Owner, ,(Rz f Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the Califo.rnia:Health and Safety -Code.- - This verification must be completed and returned to our office before we are per- mitted to issue the permit. State of California County On C) jqq3 before me, personal1y appeared �,`�,,�� A • Loo �-� personally kn wn 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 >Y )�'= COMM.°�J73Got _ the same in his/her/their authorized capacity(ies) ,. COMMill `' hJ:)fA.Fil' i Uf3t..IC CALIFORNIA g ature (s) on the O. and by his/her/their si n BUTTE COUNTY instrument the person(s), or the entity P on person(s), acted, execu behalf -of which the ted the instrument. WITNESS.my hand and official seal. j Notary Public 1\cI-u111 . t,u Lr w A"A.L%jul lumtLu J1Alyd'w- l Ur AL,"UW.1,bVbM"1 FOR RESIDENTIAL DEVELOPMENT Section 26-8.1 of the Butte County Code requires this acknowledgement be recorded prior bo issuance of a building permit. The property described herein is adjacent ACCEPTED F to land or . included within an area zoned ®R RECORDING for agricultural purposes, and residents AT 8;01 A.M. of this property may be subject to incon- veniences or .discomfort arising from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the . pursuit i of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricul- tural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All f4eft real :prop'erty'-situate in.the County of Butte, State of California,- described as follows: !.t]TS %R; 39 AND 40, IN B(,Oe';I( 24, AS SHOWN CSN THAT CERTAIN MAP ENTITLED. "TOWN OF PALERMO",' WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE; STATE.OF CALIFORNIA, ON FEBRUARY 17, 1891, IN BOOK 5 OF MAPS, AT PAGE 4. Date: ✓' // PROPERTY OWNERS: i 1 State of C&_\: On this the O �k day of 19_J:�L, 'before me, the 1 ) SS. undersigned Notary Public, personaXy appeared County of Personally known to me. R[ '" KU Proved to me on the basis IS BB) of satisfactory evidence. to be the person(s) whose name(s)I c:.ur•;rr -►subscribed to the within instrument and acknowledged that 1 0� +• C.- -nm. [ x{:ires sept. 23, 1996 executed the same for the purposes therein contained. IN WITNESS WHEREOF,.I hereunto set my hand and official seal. Y� iesent.A.P. No. S _ Notary Public I tpv xc — COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKSz, PERMIT NO. 7 County Center Drive - Oroville, CPalifornia 95965 - Telephone: 916.'538-75 I APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER p -OO Z ZONING W -Y-( BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC.1 BUILDING VALUATION OWNER-MAILING-ADDRESSX V`/��Wo ��W CONTRACTOR'SN ME TELEPHONE D V �__l CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 2 �z- 7e�v�lGUo2f�l v� Permit fee $ L.C�, PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE �OOFF'STRUCTURE SF ❑ Duplex[] Mobilehom'(I Other 4 SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home @ 15.00 TYPE OF WORK New!— Addition;_; Remodel( Utilitie; & Installation[ Other ❑ Describe work:_1WH_a Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 200A OR LESS 18.50 p Sp �O - Main service 20GATO IOOOAI 37.501 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 :Jo. Classification �j 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 NEW CONST. / DWELLING OCCUP.&) OR ADDNS. l ACC. BLDGS. 3.66sq.ft. NEW CONSTR. ULTI-OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS e SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 076d 120@ 76 FIXED APPLNSOR I Ex. Occup. OUTLETS P(RESID )REAJ __46L7(CD "00 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ -//9-56 . Contractor — 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. 71 1 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. MECHANICAL PERMIT FiIingFee 15.00 j Heating I Cooling Hood 6.50 i Ventilation permit Fee $ I Contractor I 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 Signature of Applicant — Owner ❑ Contractor C Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories In height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ I+Az 1 0FEES j IMP I FLOOD I CDF I PARCEL PO HD ISSUE , This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. L//°?0 J Ln C) bA Thts set of plans ations MUST be �t_ 750 — —4 -1=-= A III time 'and 7�_ ,,,kept on the job at all time 'a' -it is unlawful to hferof 'and ti ?n4ke any changes or alfe—iations on same without $9 wriien permission from Departnef# of Pub0c Works, County of Butte. NOTE:=All Materials & Wo * ., /1 1 1 1.1" Workmanship Shall Be in 0 Accordance with Recognize&Good Practices and of a quality prescribed for the Specified use in the Uniform Building, Plumbing & Mechanical Codes and the National Electrical Code. �Dz Ob 6- gy _CO2 - Ff i9 ALL STRUCTURES AND EQUIPMENT INI OVERHANGS SHALL BE CLEAR OF ALL EAST A SET BACK OF f^ FT. FROM THE S Fr. FROM THE REAR PROPERTY L11 1'0 FT. FROM THE ROAD CENTERLINE 6 CLEAR OF STRUCTURES AND EQUIPMENT F,9R A 2 FT. SAVE WERHANG. U11 -w-'. 11 BUTTE COUNTY BUILDING DEPARTMENT A P P R 0 V ED AND AND L BE QS I In [S � �,�\ mr w�2222 /y. .r � e G !■ 9� ^ d m _ d t s r I In [S � �,�\ AP —DO OWNER '�-� -PERMIT"�k ` 7 Ml UTIL.CLI ARANCE DATE 1 INSPECTOR ELECTRIC GAS Support Struc. Compaction Test Re . Service Size Other Load T e Pipe. Size Length YES NO YES NO c� j�r'4�1 �/, .V\s. .� - r+vr;�.r�..`•�s-v:accY�•�:Y,7�aYK%�`.'�'iL!;-��„C^.*...P..,t�?��,,':tfr�{t+;i,�+/'.:-'M^i".'`.r{"'. ^<:rr'[�'!V,F+�RY1+���Ah.tl &''���•�:,t'^h;� 71 026-18=2-002 . :`. LOPEZ,92- .RAUL 4073B 2237 � g Kenilworth, Palermo demolish sf i f COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION,AN4 PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER nA ZONING • > '� BUILDING PERMIT OWNER _ - A7 nr. TELEPHONE 532-1401 SO- FT. OCC. BUILDING VALUATION OWNER- A G DDRESS P-0. Palermo 95968 ,!i 500.00 CONTRACTOR'S NAME Nripr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation$ 500• 00 LENDER'S MAILING ADDRESS Filing Fee $ 155,00 Permit Fee $ 15.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 30.00 F' PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE w SF a Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ® Describe work:_ nptr►ci Permit Fee $ Contractor ELECTRICAL PERMIT FiIingFee 15.00 Main service 600V OR LESS 200AORLESS 18.50 CONTRACTORS LICENSE LAW I declare underenalt of p y perjury Iur y (Check One): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. Classification 5aI, 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 200ATO1000AI 37.50 NEW CONST. / DWELLING OCCUP.& 3.64 q.ft. OR ADONS. \ ACC. BLDGS. NEW CONST R ULT' -OUTLET NON-RESID BRANCH CIRC., TS @ 5.00 APPARATUS e� (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 2 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 $ 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 FiIingFee 15.00 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 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses whichmay in any way accrue against said County in consequence of the granting of this permit. XDate �{g''�w,� Signature of Applicant — Owner -RI Contractor ❑ Agent ❑ An OSHA permit is required For excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE I TOTAL FEE $ 30.00 I HAz DFEES IMP FLOOD CDF PARD CEL PD H Iss This permit is hereby issued under the applicable provi sions o�h%Butte County ode and/41` resolutions to do work�indted abo�e�fowhich fes hae been paid. b �. DIREG�dq' -0F P BLI `WORKS B . /( Date P&IMIT EXPIRES Date I I ` `� .12985 Receipt No. WNIT[-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT / COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS < 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT N0. �3 ASSESSOR PARCEL NUMBER — — OWNER ZONING . U BUILDING PERMIT TELEPHONE 532-1401 SO. FT. OCC. BUILDING VALUATION OWN AII G MADDRESS Box 35 Palermo 95968 r Est. 500.00 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 500,00 LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 15.00 Permit Fee Plan Checking Fee $ 15.00 $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 30.00 9917 Ypnilwnrth Ave.- Palermo PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Water piping 7.00 Each qas water heater or vent _700— 00USE USEOF STRUCTURE SF J Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile HomeS G W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ® Describe work: TIPmO Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service LESS 200A OR LESS 18.50 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO I000A) 37.50 NEW CONST.3.6Qsq.ft. DWELLING OCCUP.&\ OR ADDNS. ( ACC. BLDGS. II NEW CONSTR. U I,ouTLET _NON R ESID BRANCH CIRC ITS @ 5.00 (POWER APPARATUS e) I SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76 AL 0 46A FIXED APPLNS. OR Ex. OCCUp. OUTLETS (RESID.) EA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 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. `I71 I shall not employ any person in any manner so as to become subject 1� 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 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 again said C unty in consequence of the granting of this permit. X �v Date�1-/ of Applicant — Owner", Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct-OIR ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 30.00 HAz 1 0 F11 I IMP I FLOOD I COF PARCEL I PO HD Iss This permit is hereby issued under the sions Bions of Butte County ode and/ worZn7ted a f hich fe F P c I B PE MIT EXPIR Date applicable provi- re lutions to do h e been paid. KS ate Receipt No. 129825 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT I COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ' ASSESSOR PARCEL NUMBER G – ,Z – ! ZONING BUILDING PERMIT OWNER � ,^ OL L O PE- H T�j21�D1 JJ FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS o box -av pmeTlu d /S)0. 'GS - CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 15.00 Permit Fee Plan Checking Fee $ s $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS —� Permit fee $ 3OC110 J v C PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SFI Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition Remodel❑ Utilities InstallationOther Describe work: ��M O L ( 51 �ly� ❑ --r— Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 R LESS Main service 200A OR LESS 18.50 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 iI, 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) EJI, as the owner, am exclusively contracting with licensed contract -Mobile ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A) 37.501 NEW CONST. OR ADDNS. DACC. BLDGS. WELLING OCCUR 3.61t sq.ft. T LRC ET NEW NON.RCOSID NSTR ULTI.OUCH C EBRANIITS @ 5.00 POWER APPARATUS e SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 20 76d Ex. Occup. OUTLETS IPRESID IRE 3.00 Temporary service 15.00 Home Facilities 15.00 Misc. Wiring 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 j provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 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 County Ordinances and 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. 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 Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA ion of structures f)oveerrr 39storiesoineheighftions over S'0" deep and demolition or construct- Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $�O HA2 DFEES IMP FLOOD COF PARCEL PO HD SSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. / � / �; 25<r� WHITE-O.P.W.. YELLOW-ASS&SSOP, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - De.pdrbment of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: _916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner:. An 'owner -builder" building permit has been applied for in your name and bearing your..s.ignAture. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I pers.onally.plan to.provide the major labor and materials for construction of the proposed property improvement.(yes.or no) Je S 2. I (have/have not) �� 'L signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name . Address City Phone Contractors License No. 4. I plan to provide portions.of this work-, but L have hired the following person to coordinate, supervise, and provide the major work: Name..... Address City Phone_. Contractors License No. - 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work y Signed: Y_e�`"'� Property Owner � � V L O {' E L Social Security Number Date 11 4 6 GI 2 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. Demolition Permits Asbestos Notifita'tion Statement Date AP# 26 --182 - 6-Z_— Pursuant.to.section 19827.5 of the California Health and Safety Code, all demolition permit applicants are 'required to fill out this form. "19827.5. A demolition.permit shall not be issued by any city, county, city and county, or state and local agency which is authorized to issue demolition permits'as to any building or structure except upon the receipt from the permit applicant of a copy of each written asbestos notification regarding,�Ithe building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency-, or both,.pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit -may be issued without the applicant submitting— -copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project. The permitting agency may -require the applicant to make the declaration in writing, or it may incorporate the applicant's response on the demolition permit appli— cation." Attached is a copy of my written asbestos notification to the United States Environmental Protection Agency for the demolition project located at Signature of Applicant eR I hereby declare that a written asbestos notification to the United States Environmental Protection Agency is not applicable to this demolition project. Signature of Applicant 2/19/91. MAIL TO ASBESTOS NOTIFICATION EPA/NESHAPS Region IX 1235 Mission St. A-3-3 San Francisco, Ca. 94103 DATE: PROJECT JOB # (Please see reverse side) Aq�ncios ' � 23rstitiad: ❑ TM+ t ❑ C&" A's Rosocuoos Beard ❑C'i am& ❑ svi I dig D,,,xt ,nt ASBESTOS DEMOLITION/RENOVATION NOTIFICATION P1PagA ch nk one; Renovation Demolition requiring 10 day notice Demolition requiring 20 day notice Revision of Original (Form on reverse side) IDE—PLEASE READ BEFORE USING THTq EPA USE ONLY DateRec Pstmrk School Del/ND ADQUTE? Code## : Doc#: rnuM 1. OPERATOR: (Contractor) 3. FACILITY NAME - ADDRESS STREET ADDRESS CITY STATE CITY STATE ZIP PHONE( ) COUNTY ZIP 2. OWNER 4. FACILITY DESCRIPTION ADDRESS AGE __ SIZE CITY STATE ZIP PHONE( ) PRIOR USE 5. Project Start Date: Completion Date: 6. Estimate of Friable Asbestos: ON PIPE: Linear Feet SURFACE OF OTHER COMPONENTS: Square Feet Nature of Materials: 7. DESCRIBE METHODS OF REMOVAL: 8. PROCEDURES USED TO COMPLY WITH 40 CFR 61.147 152: 9. NAXE & LOCATION OF DISPOSAL SITE: ANY FURTHER PERTINENT INFO CAN BE INCLUDED BY ATTACHING ADDITIONAL SHEETS QUESTIONS??? FOR FURTHER INFORMATION CALL (415) 556-6415 Sam/4pm M -F TNSTlaCTTONS FOR IISF' OF ASn7RTOS nEMOL TTTON /RENO rnTTON NOTTFICA,. rO %0 RENOVATION: means altering in any way'bne or more facility components. NOTICE. MUST BE POSTMARKED AS EARLY AS POSSIBLEBEFORE PROJECT DEMOLITION: means the wrecking or taking out -of load -,supporting structural members of a facility toa?ther with any related handling'operatior< 10 Day notice for MORE than 160 sq.ft.or 260 linear ft. asbestos 20 Day notice for LESS than 160 sq.ft.or 260 linear ft. asbestos, includes facilities which contain no asbestos. FACILITY: means any institutional, commercial -or industrial structure, installation, or building. Renovations on single family residence and apartment buildings with 4 units or fewer are exempt from notification to EPA. - PROJECT JOB a: Your OWN TN -HOUSE D for a specific jobsite. Optional, but expedites communication -concerning notifications. LOCAL AGENCY: Most areas in Region 9 have local NEsHAP delegated agencies. In these areas notice must be provided to both EPA and the local agency. 1. OPERATOR/CONTRACTOR: Full information concerning person doing the work. 2. PROPERTY OWNER: Complete in full. 3. FACILITY NAPE: Must have complete address OR directions to the jobsite. 4. FACILITY DESCRIPTION: Current use of building. Project location in the facility. Other descriptive information as necessary. 5. START AND COMPLETION DATE: Provide month, day and year. Must be revised if dates change. (see revision form below) 6. Estimate of amount to be removed (must be in square or linear feet). Revisions(see form below) must be made for additional amounts uncovered. 7. Examples of methods: glovebag, scrape, remove in sections, etc. 8. Examples: Adequate wetting prior to and during work, double bag, etc. DRY REMOVAL MUST RECEIVE PRIOR WRITTEN APPROVAL FROM EPA OR THE LOCAL DELEGATED AGENCY IF MORE SPACE IS NEEDED THAN PROVIDED, ADDITIONAL SHEETS SHOULD BE ATTACHED TO REVISE A NOTIFICATION ALREADY ON FILE WITH EPA, USE FORM PROVIDED BELOW PROJECT NAME PROJECT JOB A ORIGINAL NOTIFICATION DATE Revision Notice al 2 3 4 5 please circle This is to advise that the above referenced notification presently on file has been revised. Please note the revised portion listed. C=HANGES FOR THIS REVISION: PROJECT ( ) CANCELLATION 1. NEW Location 2. NEW Scope of Work 3. ADDITIONAL Quantity of Asbestos 4 --NEW Start Date 5. NEW Completion Date 6. NEW Disposal Site