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026-230-018
BUTTE COUNTY DEPARTMEWT Off DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #. '(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Dale: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended -or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Articl o t e'Business rofessions Code Date: )� jo 05 Owne WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy #: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and ode hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. PERMIT NO. BP052325 Issued Date: 10/06/2005 APN: 026-230-018-000 Site Address: 7904 MELVINA AVE PAL Map Index: Description: NSF (1440) COV(720) Owner: ROBISON, ARTHUR M & JULIE A 9 MIONE WAY CHICO, CA 95926 (530) 693-1766 arobison@buttecounty.net Applicant: ROBISON, ARTHUR M & JULIE A 9 MIONE WAY CHICO, CA 95926 (530) 693-1766 arobison@buttecounty.net Contractor: License #: Architect: Engineer: HUBLEY, MICHAEL D. Total Square Ft: 2160 S.F. Valuation: $105,120.00 Census Code: � 5607.90 �Py001� CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolution to do work indicated above for which fees have been paid. performance of the workr PERMIT EXPIRES lo—)— 1which this permit is issued (Sec 3097 Civ.) 1 _ Co- f_ Name:INI� BYkftXn% r Date: \ 0 / L_ Address: ON: O G !Date) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage, . handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. 1 hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance any official form or ocument of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection pur s. Print Name:jzi3Fu�- P"B1S� Signatur Date: �d ;/Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor R r. Riiilrlinn Pprmit n1 -1R -n4 no 1 y YBU'fTE BOUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION \ `� Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER INFORMATION Last Name. s�/� First ame Address C/ /ql DAI c kv,4y City /& CC Stated Zip9�21 Phone 5 --?0 93-170(, Fax E-mail // a/-V(9ISah �(vu APPLICANT INFORMATION CONTRACTOR Name /�� 0 Address 4 AL 44 City Fax State Zip Phone Map Book Fax E-mail Planner Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name & /�� 0 Address �CG12� 4 AL 44 City— Fax Stat Phone Map Book Fax E-mail Planner State License Number 4-23 Z APPLICANT INFORMATION Name �r3 is ons Addre2 DIYC74 :�o Sta e, Z' Phone D-'/ /76 6 Fax E -mai r„D�iSo/) t�,�cc�.eG4r-G . ✓��. APPLICANT SIGNATURE For office use only: Zoning AR -5 Flood Zone I A SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BPO52SZ BIN ft A5 PROJECT LOCATION AN OZ& -- 230-0/9 Property Address Q�n "'e /'>-✓e ��grrko. Cr ss Street liD WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: I /Fii/ f%/ G��57Rr ccrr o til / 44v Sq FT- Livin' Garage Open Co 12D ❑ Structur Built without Permits ❑ Proposed Change of Occupancy (Note previous use): Page 1 of 2 EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: K.ej Amount I n 00, 34 Bldg SRA Receipt #:y 35383 Sheriff �+ SMIP ' O q . ��7t Tl R Ot er Date: �- 30 -O5 111002 Total REV 8-12-05 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 i Applicant: Robinson, Art Permit No: 05-2325 Project Type: Nsf 026-230-018 100% 70% Plan Check Fees . $ 1,000.34 $ 700.24 $ 1,000.34 $ 700.24 WILLDAN Fee $ 700.24 Copies Attached: Qty Chk 0 ' Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other oOUTrFo o 7 County Center Drive 0 o o .- o o Oroville, CA 95965 N (530) 538.7601 Telephone (530) 538.7785 Facsimile N TO: WILLDAN ' FROM: Scott Rutherford (530) 538-7160 srutherfordL buttecounty.nel SUBJECT: Plans Transmittal For Review Per Contract O DATE: 08/31/2005 Applicant: Robinson, Art Permit No: 05-2325 Project Type: Nsf 026-230-018 100% 70% Plan Check Fees . $ 1,000.34 $ 700.24 $ 1,000.34 $ 700.24 WILLDAN Fee $ 700.24 Copies Attached: Qty Chk 0 ' Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other bp0 a2,325 COUNTY,OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISI011P 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: Vn6r onASSESSOR PARCEL NUMBER U2('-2 ?Q '0'I Proposed Building Use: til S Dwei I �n o; Permit Technician: . C7 • Date: D- JO tm Items required in order to apply for a permit. All bdxes MUST be checked OR marked NA in order to apply. 'fil-TN 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. `1 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. � 'I /MN 3. Engineered plans, 3 or 4 sets, with wet signature -on plans AND 2 sets of stamped and signed calculations.. t=� 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. VIVI 6. Energy compliance design and supporting documentation in duplicate. (Includfol in Flnf1S) ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Letter of intent for non-residential` buildirigs ❑ 12. Hazardous Material Form N6/*].TJ 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) �p 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable�/�i/ate h ❑ 16. Fire Sprinklers............................................................................................ ❑ 17. Agricultural Buffer cir and site plan apr from the Ag Commissioner Sent by I ❑ 18. Soils Report and/or Engineered Foundation required ........................................... 0 Erosion Control Plan Required........................................................................ 20. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ .. City of Chico Plumbing permit........................................................................ ❑ 22. Site plan and business license approval from the City of Biggs .............................. ❑ 23. California Department of Forestr plan approval ❑ paid. Sent by: 24. lanning approval for (A) Use: (B)Parking: (C) Parcel Check: ..c ...... (Q _ ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ 26. NPDES Form.....................................................................:...... ` 'If �. Encroachment Permit for driveway from the Public Works Det porn.... , D 8 Contractor's license information. (Number, Name Style, Classification)....... Y,...... _�- _❑ 29. Worker's Compensation Carrier and Policy Number .......................................... 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... 31. Letter of Signature authorization.................................................................... 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits ....................:... ....... .......................... ❑ 34. Deed Restriction..........................................................::.............................. ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: �5'3o Xbg3-I%(pCp oR When issued Telephone F=01j I : art 6j-,() 4)i COU t jnd hold for pickup. I have been infor edl,of the abovei eeems and requirements for obtaining a building permit. Chi` --_0 I.r Applicant: Date. 1. Index permit application for the above items numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed y' Date: 4 4 Structural approved by: Date: Note transfer by: Date: Yellow: Building Division A \f. TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance QfAl-"� Owner Plan Approved for: Sewage Disposal _ Clearance for dwelling. Other Hold final for: Final clearance O.K. for: NOTE: Environmental Health 8/96 * -t E.H. USE ONLY Plot Pian Anachod Floor Pian Attached Sam to S.D. / Location AP#,r Water Sypply: APAjblic Private Well 1N � Date �Po52325 COUNTY OF BUTTE DEPARTMENT OF DEVELOOMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140 SCHEDULE OF RECEIPT OF FEES Website: www.buttecounty.net/dds OWNER eQ6j S()ri A.P. #026-230-01L PROPROSED BUILDING USE NU -DATES-0-n-05 J RECEIPT # DATE REC. vq�i BUILDING PERMIT FEES /' --- Balance Due ..................... $ 1500-51 X14 0=0` -OJ iv ,MA Flood elevation review ... $ �l )"t o �� --- Additional plan checking Fee.... $ i 2. SCHOOL DISTRICT FEES rOV I J't H 1 QhSC, Oo l (paid at School District Office) (form available after'Plan Check) 3. SHERIFF FEES (paid at Building Division) Commercial (sq. ftg.)..... X $0.03 = $ Sq.Ftg. AX1 r-" 4. RECREATION DISTRICT FEES ftfl(tC RIV-.i (paid at Recreation District Office) (form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMPACT FEES COUNTY WIDE (per dwelling) $ 4 o q CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ NORTH CHICO SPECIFIC PLAN (per dwelling) Zoning $ 6. SRA FIRE INSPECTION AND PLAN CHECK FEE $204.98 (paid at Building Division) 7. WATER TENDER FEES BATTALION # I $200.00 (paid at Building Division) 8. SMIP A I D .5 ll �qOQ 17 10 -C - 9. DRAINAGE FEE 10. OTHER 11. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed g the plan ch king process. APPLICAN DATE 8 AICS — Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 7/05) (.17��2: :.t_: . :I •� •ltd:°•4 �yt/c i.��._ _ �� �- _''J.'� .,S'i_ ..O` �}r -� ? y l^. ��'� - +t4rL+'. l _ '. �y-,�,'_ ,.�/ 1.f_,.• � rSyy 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. I personally plan to provide the ix1aJor labor and material for construction of this proposed property improvement: 'YES [ ] NO [ ]. 2. I HAVE [ ✓ ] HAVE NOT [ ] 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: PHONE: CONTRACTOR'S LICENSE NO: 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: S. 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 SIGNED: � /� PROPERTY OWNER DATE: 0 a 16 NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. . This verification must be completed and returned to our office before we are permitted to issue the permit. Butte County Department of bievelopment Services ADMINISTRATION E BUILDING t GIS `PLANNING 7 County Center Drlve Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile I-V i,W ver"."`!.• .! t,,..... 3:'�a e %�:=�� TtN � Y. ^ .��a e�Gi+..:?ma•�r_.r..•.�s k ; S_=Y � �Fy:i—' �"� Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as -contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Departrnent of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "ovmer-builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. C. Vieir+ C.B.O. Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California health and Safety Code. Butte CounCy Depart ne it ol-Develop.ment Services °�11, rF° 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone_ DUNl (530) 538-7785 Facsimile BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: I need to submit applications for septic andlor well to Butte County Environmental Health immediately. 0 I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained ® I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building�Oans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not limited to, verification the parcel was legally created, adherence to. all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name �" / �ISoN APN: Z30 -O/S7 Building site address: �eldi�a Permit No.: 05 23E I have read, understood and accept the tetnm.s and conditions as expressed herein as indicated by my submission of the above -referenced building permit application and my signature below: cir1.TAT1TRF.0F APPLICANT DATE 11 Department C o u n t y J. Michael Crump, Director of Public Works O f B u t t e LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville. CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES)Phase 11 Construction Storm Water Permit and Storm Water Pollution Prevention Plan (sWPPP) Acknowledgement (LESS THAN 1 ACRE) Project Description: ��s�"'�` "�'I'` c C 144-0 Ch Project Location and/or Parcel Number: a— CroSS g(ff g4 Vi !�C- D2-!2-230 Old By signing below, L the project ownerlowner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Perrnit from the State of California Regional Water Quality Control Board I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Title - Date: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 30 -Sep -2005 2005-0059716 Has not been compared with original BUTTE COUNTY COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit 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 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 that real property situate in the County of Butte, State of California, described as follows: S' av\d 4ro / 4►h OoGO" 53; a.5 64-Low✓1 ods +kaf- ce:- Fuio map en4- 4 I e d- j ." Map 'X SW d,+ V s ovi tJ 1 c �' t l�Le �cz.I r rv� v C.. ;-� s Trac c. -� 13i.�tte CuV)4, / CAL. Whtc.h map was re.cor-ded i-0 -the o�t-ic'.�. o F. +ke. Recorde-r o9 he- CoLt.4 y oP Bv-�e, S+a�e CP (A-1t'qrr1 LP -.1 bh Febru.c><rj ZE, 188S, Date State of California ) County of BU -h4 e- ) On / - �0 Q� before me,�- // J rM - Gon4c.r N SIC personally appeared &�JM, 0121.Soa, q.Al ci KohiSo personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)is/are subscribed to the within instrument and acknowledged to me that-hefahe/they executed the same in W&41 er/their authorized capacity(ies), and that by-hisfher/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS myhagd and.offi a] seal. i _ 41 Signature Seal: JAMES LAMAR KINSER COMM. #1377185 NOTARY PUBLC CALIFORNAr#Z D'0SP • BUTTE COUNTY w ' My Comm. Expires Sept. 28, 2006 Ci .1 dila bezagao3 need fon aaH lanigl7o 513QRO33H YTLu00 YTHUO3 3YTiUH �WILLies Serving Publ,DA�N September 29, 2005 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 (530) 538-7169 (530) 538-2140 FAX 2399 Gateway Oaks Drive, Suite 210 Sacramento, California 95833 916/924-7000 fax 916/924-3644 www.willdan.com BUTTE COUNTY PLAN REVIEW REPORT Status: Approved Jurisdiction Job No: 05-2325 Assessor's Parcel No: 026-230-018 Description: Robinson -NSF Willdan Project No: 14353-1887-M Dear Mr. Rutherford: Willdan has completed a plan review of submitted plans and documents for the above referenced project and recommends your approval with the conditions noted on the 2"d page of this letter. The plans and documents provided for this review that have been found in compliance with the applicable codes are: * Plans: Two (2) copies Site Plan sheets Al through A6 dated 8/24/05 by Art Robison and S1.0 through S3.2 dated 6/29/05 by Michael Hubley, S.E. # Structural Calculations: Two (2) copies dated 6/28/05 by Michael Hubley, S.E. # Truss Calculations: Two (2) copies dated 8/23/05 by Endeavor Homes �k Energy Calculations: Two (2) copies dated 8/30/05 by Computer Performance * Misc. Documents: Two (2) elevation certificates dated 4/11/05. Two (2) copies EOR's Truss Review letter dated 8/26/05 by Michael Hubley, S.E. The plans have been stamped with the Willdan approval stamp and dated. On the pages to follow is the identification of the codes and standards applicable to the project, a code analysis, conditions -of -approval and identification of any deferred submittals. N47WILLies Serving Publ,DA�N APPLICABLE CODES Our review was based on requirements of the 2001 California Building Standards Code found in the California Code of Regulations, Title 24: • Part 2, known as the California Building Code (CBC). • Part 6, known as the California Energy Code, and Energy Commission Standards (CECS). CODE ANALYSIS Specific Use of Type of Stories Total Sq Ft Oc up Co ton Dwelling R-3 V -N 1 1440 Covered Porches R-3 V -N 1 720 CONDITIONS OF APPROVAL 1. Approval is contingent upon the -review, requirements and approval of other departments and/or agencies that have jurisdiction over this project. 2. Revisions and/or notes as red -lined on the plans. 3. All plan sheets shall be signed by designer or person responsible for the plans as required by California Health & Safety Code Section 5536.1. 4. Upon completion of the structure, the elevation of the lowest floor shall be certified by a registered professional engineer or surveyor & verified by a Butte Co. building inspector to be properly elevated, & the cert. & verification provided to the Flood Plain Administrator. SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. DEFERRED SUBMITTALS Our plan review reveals no deferred submittals. Sincerely, Richard Essenwanger Plans Examiner II Ricardo Guzman, S.E. Structural Engineer Cc: Alice Mefford, amefford@buttecounty:net Art Robison, 9 Mione Way, Chico, CA 95926,.E -mail: arobison(a,buttecounty.net Michael Hubley, S.E., 383 Rio Lindo Ave, Ste 200, Chico, CA 95926, vertech@sbcglobal.net Page 2 of 2 Butte County 05-2325 Willdan 1.4353-1887-M.PC1F /ZOO P" fC BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) 0 CHICO AREA RECREATION AND PARK DISTRICT (CARD) ❑ PARADISE RECREATION AND PARK DISTRICT (PRPD) 0 DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) (9 26-2310 ^ 4:�>/ 6 Building Permit Number epo 5232 _11T Property Owner (s) 6>A J Project Location /Address 1// A/A /L�_ Subdivision Nam Assessable Sq. Ftge yyo Type �Resiential Development (check one) New Development amily-Detached Single Family -Attached Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling Mobile home Mobile home replacement verified Assessor Department Demo Permit (date issued ) erified by Building Department Comments: Building bt—partment Representative ❑ FRRPD ❑ CARD ❑ PRPD ❑ DRPD certifies that: % Date Applicant Name Phone Number g A60AJE WAY- -a a=4- 9,5TZ5;� Mailing Address City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of . Dwelling Units @ $ Square Feet @ $ _ Remarks: Paid by Check No: Paid by Cash: Recreation and Park District Representative . ,--......... 11, * n,n rnoN AC% V —, fnrm rev I.Am per unit for a total of $ �(p , per sq foot for a total of $ Receipt No: /8_0)02 BUTTE COUNTY SCHOOLS IMPACT.FEE CERTIFICATION FORM ac(One form per Building) School District H- �J/ "�y L ` / Building Department No.'D� A.P. Number Jurisdiction: City County Property Owner / _sb %� J Property Location/Address / vt/L Subdivision Lot No. ....................................................................................... Residential Development No o�fivQ Q Q Sq. Footage No of iving Mobile Home Addition/ 'Supplemental to (Group. R) Units Installation Conversion Permit # •(Nofoundation inspection) ......................................................................................... =r Building Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage Date (Including Exterior Roofed Areas) strict Identification No. V V O+ a ` p �,a�,-chool District certifies that (Applicant) (Street ddress) o (Phone Number)_ 4?S9 fob (City) (State) (Zip Code) (40 has complied with the requirements Of Resolution No.IS90 by payment of $ - ao�S representing I► 4� square feet. School District Paid by Check # � Remarks: B 2926 $ ULL MITIGATION $ Date Notice: You may protest the Imposition of the fees Identified above by submitting a written protest to the District, In compliance with Government Code Section 66020(a), within 90 days from the date fees aro paid. Failure to submit a timely written protest will prohibit you from challenging the Imposition of the fess In any cor rt action. ^. . If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Forin,'the School District Is notified by the applicable Local Planning Agency that this project Is being reviewed under the California Environmental QuaNty Act (CEQA), this project may be subject to additional school fees to fully midgate Its Impel on the school district's schools. ; White (school district), Yellow (building department), Pink (applicant) feeform.xis (3l05)drhm BUTTE COUNTY AGRICULTURAL BUFFER NOTIFICATION ANDIOR UNUSUAL CIRCUMSTANCES REQUEST Butte County requires a 300 foot buffer between neighboring agricultural operations and a residence. This dimension is based on environmental assessments and studies. The Agricultural Commissioner may identify unusual circumstances where the 300 foot buffer cannot be met on existing parcels. This exception is not available for lots being created, divided or subdivided. Owner or Authorized Agent must complete the following and return with the required site plan to: Development Services Department 7 County Center Drive, Oroville, CA (530) 538.7601 Name: A c � Re. 6 t S.- ^ 1LMailing Address: Clue , C� Phone: S 3 $ — 4DL4 L(p Aar. k � �y leWS q9`7? 26 1 ' E -Mail address CL r-061 S oVuvv,l (z , ✓l . —I Assessor's Parcel Number. 024 - 23 o Of Q Reason you believe you qualify for the unusual circumstances exception: watt uw - rx.Llbut.4 3 0 V;7 bj Owner or Authorized Agent's signature Date UNUSUAL CIRCUMSTANCES DEFINITION: An exceptional or extraordinary condition where the existing lot size or shape or an existing improvement (well, septic systems, structures etc.) does not allow for the standard condition of a 300 -foot buffer zone. SITE PLAN REQUIREMENT: submit 4 copies with this form. Refer to the Site Plan Submittal handout for specific requirements .......................................................... Internal Dept. Contact Info: ❑ Env. Health ❑ Planning ❑ Building gOther Contact Person: q;Ra6 -O-oak Phone: S 3 $- Z g1l . ......................................................................................................................................................................................... For Agricultural Commissioner office use only. (to be completed after submittal) DISCRETIONARY PERMITS (Planning) ❑ Exception.Recommended ❑ Exception NOT Recommended setbacks from adjacent MINISTERIAL PERMITS(Building) Exception Granted with the following conditions: operations: NrGt_[ St36 W Agricultural Department Signature: I Date: -LAS-1 dell YMC 7/1/03 Date: SITE PLAN REVIEW APPLICATION APSE Permit Number (if applicable) /� i� Z ' �J a APPLICANT 17VFOBMATION Parcel Size: Owners Name: ' Owners Address: Telephone No.: ��-3 `y %6 Situs Address:f .L%L Proposed Use: Residential I New Single Family Residential S' ❑ Single Family Addition ❑ Single Family Remodel Mobile Home Residential Accessory , 6*h� o ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt bfinnie) ❑ Temporary Travel Trailer ❑ Multi -family Ikon -residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial - ❑ Industrial Addition . Other Septic ❑ Agricultural Exempt Building ❑ Other. ❑ Commercial Remodel ❑ Industrial Remodel bS= Z3Z S� 471 Brief Explanation ('if necessary): 10-5 DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved ��solve Problems Prior to Approval ALL TTEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Afinimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year FIood Plain: (See attached) , • Flood Zone: :::/�C • Flood Panel No.: `/ Index Date: ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/MulbmV (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Minor variance El Variance El Administrative Permit ❑ Detached Building Use Form ❑ Encroachment -Permit ❑ Agricultural Worker Affidavit Agricultural Acknowledgement Statement Zoning: - Applicable Building Setbacks: Zoning Code Streets & I-fighways Fire Prevention Front Side Side Street Rear t Height Waterway NIA N/A i N/A Subdivision Map ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Applicable Development Fees: Standard Fees ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other Amount Formula ---------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) # Check with school district to verify actual fee if pre -application review. A find determination wiU be made at the time of the building permit. Parcel Created By Deeds: Date of Creation. Legal Access Provided: ❑ No Syes Deed of Reference: 7 Legal AEess Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No 0 Yes, Road Name:. Complies with County Standards for Deed Creation -E] N E]Yes Comments: If -727 - % �r 73 %o e >-/7 -� P�K21 ' Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance y ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements ❑ Subdivision MaD/Parcel Map: Map Date of Recording: Lot: Book: page:, ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: Parcel Map/Subdivision Map[Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway anal other civil construction associated with residential development.. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required, ❑ Class A roofs are required, ❑ Property owners responsible for roa LSI Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. C-UxryS\BUUCrMg Permit Sits Plan Revicwl.dDC BUTTE COUNTY AGRICULTURAL BUFFER NOTIFICATION AND/OR UNUSUAL CIRCUMSTANCES REQUEST Butte County requires a 300 foot buffer between neighboring agricultural operations and a residence. This dimension is based on environmental assessments and studies. The Agricultural Commissioner may identify unusual circumstances where the 300 foot buffer cannot be met on existing parcels. This exception is not available for lots being created, divided or subdivided. Owner or Authorized Agent must complete the following and return with the required site plan to: Development Services Department, 7 County Center Drive, Oroville, CA (530) 538.7601 Name: A4 ec 5.- n Phone: $ 3 8 — (OL4 L(o Aas k S4 ski o n + C C q 2� &'15 -I-7to4, � 1LMailing Address: "I Nl,tovi e- Ct t' Cel E -Mail address Cl- r-06 l S 0n ( Assessor's Parcel Number. 024 _ 23o OL$ Reason you believe you qualify for the unusual circumstances exception: . L w;.tt "�- rA.164.j 3 oa �- 104 Owner or Authorized Agent's signature Date UNUSUAL CIRCUMSTANCES DEFINITION: An exceptional or extraordinary condition where the existing lot size or shape or an existing improvement (well, septic systems, structures etc.) does not allow for the standard condition of a 300 -foot buffer zone. SITE PLAN REQUIREMENT: submit 4 copies with this form. Refer to the Site Plan Submittal handout for specific requirements ............................................................................................................ Internal Dept Contact info: ❑ Env. Health ❑Planning Contact Person: 8.6 'G-� ❑ Building gOther Phone: _ _ S 3 S— Z 911-8 ......................................................................................................................................................................................... For Agricultural Commissioner office use only: (to be completed after submittal) DISCRETIONARY PERMITS (Planning) ❑ Exception Recommended ❑ Exception NOT Recommended setbacks from adjacent MINISTERIAL PERMITS(Building) CK Exception Granted with the following conditions: operations: PArC-aA S %;I- w L � 41 -t-E.L Agricultural Department Signature: I Date: I- A T- �?J1w� , YMC 7/1/03 ' ----- ----- 6N rq RS � +� | ! | '| GI' LD | LA _ � � | l |} ' | ' 026-230-0(9 � APH: 026-230-.018 SIZE AC. 9'MIONE WAY LOCATION: MELVINA AVENUE' PALG;Z'RMO CA '-ROSS STREET: SOUTW VILLA AVOKIL)g: ^ ^ � i - |^ | --�r- �r P. | � �ZONIN14: AR -5 ~~r -^/r -ml ^/ MlA.k I , A r---1 - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 j ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number Art & Julie Robison BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. CompNumber 7904 Melvina Ave. C -, C& CITY Palermo A.P.N. 026-230-018 STATE CA Number, Legal Description, etc.) ZIP CODE 95968 "4t, BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) r. " Non -Residential (864 SF Bam/Garage) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( ##- ##' - ##.#W' or ##.❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NAP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Butte County 060017 Butte CA B4. MAP AND PANEL 0 a) Top of bottom floor (including basement or enclosure) B7. FIRM PANEL 99. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE B8. FLOOD ZONE(S) (Zone AO, use depth of flooding) 0600700995 C 61858 6N8 AE 152.1 B10. Indicate the source of the Base Flood Elevation (BRE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ' ❑ Other (Describe): 611. Indicate the elevation datum used for the BRE in 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): 1_12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date_ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1(Select the building diagram most similar to the building forwhich this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations—Zones Al -A30, AE, AH, A (with BRIE), VE, V1 -V30, V (with BRE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3. -a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BRE in Section B, convert the datum to that used for the BRIE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum N/A Conversion/Comments Elevation reference mark used RM 7 Does the elevation reference mark used appear on the FIRM? ® Yes ❑ No 0 a) Top of bottom floor (including basement or enclosure) 152. 7 h4m) O b) Top of next higher floor WA. _ft.(m) 0 c) Bottom of lowest horizontal structural member (V zones only) ,`, N/A . _ft.(m) o 0 d) Attached garage (top of slab) —' : WA _ft.(m) E 0 e) Lowest elevation of machinery and/or equipment W servicing the building (Describe in a Comments area) WA. _ft.(m) 0 f) Lowest adjacent (finished) grade (LAG) 151. Olt(m) z' 0 g) Highest adjacent (finished) grade (HAG) 152. 3 ft.(m) 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 J 0 i) Total area of all permanent openings (flood vents) in C3.h 0 sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Michael S. Byrd RCE 289% Reg. Expires 03/31/07 TITLE COMPANY NAME Civil Engineer Rolls, Anderson & Rolls ADDRESS CITY STATE ZIP CODE 115 Yellowston Chico CA 95973 SIGNA RE DATE TELEPHONE (530) 895-1422 FEMA For -31' January 2003 See reverse side for continuation. Replaces all previous editions ( 'IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company use: BUILDING STREET ADDRESS (Including Apt, Unk Su'1e, andtor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 7904 McMna Ave. CITY STATE ZIP CODE Company NAIC Number Palermo CA 95968 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenl/company, and (3) building owner. COMMENTS ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this cerlificate is being completed —see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servidng the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMAissued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and Ease correct tote best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here 0 attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMAissued or communityissued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _. _ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _. _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE Aii]8I&I0i•19 ❑ Check here 9 attachments FEMA Form 81-31, January 2003 Replaces all previous editions FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME Art & Julie Robison BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. O.M.B. No. 3067-0077 Expires December 31, 2005 For Insurance Company Use: Company NAIC Number CITY STATE ZIP CODE Palermo CA 95968 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A.P.N. 026-230-018 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Non -Residential (864 SF Barn/Garage) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type): ( ##° - 4W - ##.W' or ##.#####� ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bt. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Butte County 06001T Butte CA B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX ' B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 06007CO995 C 6/858 &W8 AE 152.1 B10. Indicate the source of the Base Flood Elevafion (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): _ 611. Indicate the elevation datum used for the BFE in 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _ B12. Is the building located in a Coastal Barrer Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date_ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Ci. Building elevations are based on: ® Construction Drawings' ❑ Building Under Construction' ❑ Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations—Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3. -a -i below according to the building diagram specified in Item C2. State the datum used. If the da t ffPE-tn &BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation.' I N i eib4he C g tM of Section D or Section G, as appropriate, to document the datum conversion. tD V �J Datum N/A Conversion/Comments _ Elevation reference mark used RM 7 Does the elevation reference mark used appear on the FIRM? ®Yes [:]No 0 a) Top of bottom floor (including basement or enclosure) 152. 2 ft.(m) 0 b) Top of next higher floor NIA. _ft.(m) 0 c) Bottom of lowest horizontal structural member (V zones only) NIA. _ft.(m) 0 0 Attached garage (top of slab) N/A _ft.(m) 0 e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) NIA. _ft.(m) 0 f) Lowest adjacent (finished) grade (LAG) 151. 0 ft.(m) 0 g) Highest adjacent (finished) grade (HAG) 152. 3 ft.(m) 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 �Cc 00 E� w(a n� E c zcn J 0 i) Total area of all permanent openings (flood vents) in C3.h 0 sq. in. (sq. cm) -SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Michael S. Byrd . LICENSE NUMBER RCE 28998 Reg. Expires 03/31/07 TITLE Civil Engineer COMPANY NAME Rolls, Anderson & Rolls ADDRESS CITY STATE ZIP CODE 115 Yellowstone >e--7 Chico CA 95973 SIGNATURE—DATE 4 TELEPHONE (530) 895.1422 FEMA For 81-31, January 2003 See reverse side for continuation. Replaces all previous editions 4 fi PORTANT: In Mese spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt, Unit, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATE ZIP CODE Company NAIC Number Palermo CA 95968 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑ Check here 9 attachments SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) _.. For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMB -F, Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ fL(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ fL(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ fL(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA4ssued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and Eare oonud tote best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ADDRESS P CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here 9 attachments { SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E fora building located in Zone A (without a FEMAAssued or oommun'ityAssued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: — —ft -(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: — _ ft(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here 'rf attachments FEMA Form 81-31, January 2003 Replaces all previous editions Department C o u n t y J. Michael Crump, Director of Public \.XJorks o f B u t�t e LAND DEVELOPMENT DN1S10N Storm Water Management Prograrn 7 C6uny Center Drive Oroville, CA 95965 (530) 538-7766 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase 11 Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP)'Acknowledgement jLESS THAN 9 ACRE Project Description, Project Location andlor Parcel Number: ,�iZ/�. •Avei By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more on Storm Water Permit from the State of than one acre of disturbed soil will require a Constructi California. Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project. that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: p� Title: Date: EA DOTES / RESIDENTIAL PERMIT NO. 1 026-230-018 - 65-2325 - ROBISON, ART 7gQLf MELVINA AVE, PALERMO Cont: OWNER NSF - z .7r �<�; r F r� SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS' VERIFY a �. USE PERMIT CONDITIONS f SUB -STANDARD HOUSING LETTER r .1 i 11 OFFICE COPY Address Rn d y GAS Meter By D ELECTRIC Meter By Gi"�i�l » Date;4-75, r JOB FINALED (Date) 3- / rl _ Signature 2e- 4 -OK o -Not OK .. NutAppricallot Rmay °'e MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils'; Special MH Support Sketch 3. • Sewer; Location -Test -Fall -C/O -Concrete 4. Water, Location -Test -Easement Needed (Sketch) 5. Electricity, Location-Clearances-Gmd-/ . /Amp -Concrete 6. Gas; Location -Test -Wrap: / . P L'fL / PNat or/ /"LW • PLPG 7. Well Clearance & Disconnect 8. Utility Clearance - Date Card B-1 Date , Card B-1 Date Card B-1 : Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1.' Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water, MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert 10. Exits' Insp.-Sketch 11. Cert of Occupancy Date Card B-1 • Date Card B-1 Date ,Card B-1 Date • Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; S¢e-Spacing-Marriage Line 3. Blocking t , 4. Gas; MH Test -Demand -Valve 5. •Electricity; MH Test 6. Water, MH Test . •7. Water and Sewer Connected 8. Gas and Electricity Tagged _ 9. Exits " 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Cart B-1 WIPTR"Wil KWO Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-S!7e-Depth-Spacing-Connectors-Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs-Connectors Shthg-Frg-Bracing S. Ahura. Awn.; Columns -Connections -Splice -Decal -Enclosures & Carports; Windows -Doors . 7. Electric 8. Frmg.; SiUs-Anchors-Studs-Rftrs-Trusses 9. Sidng; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext ; Steps-Doors-Landngs 12. Braced Wall Panels Date Cana B-1 Date Card B-1 Date . Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s - 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pod Lighting;15 Volts-GFl . 6. Oec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elea; Bonding; Metal w/T-Circulating Equip. -Heater 8. El&-; Grounding; Equip. w/5' Circulating Equip.' -Pool L.ghtg. Boxes=Enclosures-Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. - Plumb.; Cir. Test -Water Supply Test 11. -Light Niche 12.. Enclosure; Fencing -Alarms Date Card B-1 _ _ _ Date Card B-1 Date _ Card B-1 Date _ Card B-1 = OK ftAp�We RESIDENTIAL (Single & Duplex) tact Ready Date UNUAFLOOR (Plans) OK exceot #'s Ftg., Main; Soils-Elec. Gmd. / /" Ftg. Depth 3. F ., Garage; Soils-Steel-Elec. Gmd.-/ /" Ftg. Depth g., Porches & Decks; Soils -Steel-/ /' Ftg. Depth Stemwalls; Main; Steel-Blockouts-Wrapped Uadlfiold Dowps and Special Anchors 9r6 W.V.; WI -Fitting -Test -2 Way C/O-Sevyef Test Z;1 ,&( 1ZI,10. U s Pipe; Size Anchors -Yard iping; Size Test 44, -Water Pipe; Test -Anchors -Regulator -Service Test 12. ElectijwUhderground 13. P & Ducts; Clearance -Material -Support -Ins. ers-Stills-Anchor Bolts-Joists-Vents-Crippies Access & Ventilation 16. Insulation Date Z- Ay Card B-1 Date Card B-1 Date L21- Card B-1 Date Card B-1 Date PLU 13ING (06rinilf OK except Vs ter Htn; Vent -Access -Combustion Air Baffle A.f �aterPi ; Test & Anchor -Nail Protection 9 .W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Xest Tub & Shower Second Floor -Tub Access Gas Pipe; Sixe & Anchors 23. Fire Sprinkler, Test Date r5, 7_3 ,/((a Card B-1 i Date Card B-1 Date Card B-1 Date Card B-1 Date ELECYRICAL (Permit) .OK except #'s 24! Erfdure & Transformer Clearance -Ins: Protection at Doors 26/$ize Boxes & No. of Conductors Stapled 2?.' Romex Installed Close to Edge of Studs & C.J. uip. Ground made up w/Mech Fasteners -Bond Gas & Water 29' ?/Appliance Circuits in Kitchen & Conductor Size GFI 88' Sutifeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or AI 31. Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or Al Insulated Neutral 0 Yes 0 No 32. S ce-Riser Conductors & Ground Main Disconnect 22!a6uip. Clearances Panels -Motors -Meth. Equip. . Cl thes.Closet Light -Shower Light -Spa Light 3 . Smoke Detector Date/,,, V i Card B- I'/ Date Card B-1 Date Card B-1 Date Card B-1 Date MEC ICAL (Permit) OK except Vs Ducts Insulation & Support 3 . Vqnt Fan, Exhaust above insulation Condensate Drain & Overflow, Size & Grade Fy ace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet Attic Access & Platform ff Furnace in Attic Date ,Z 1 a,C-d B-1 , Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMy4G (Permit) OK except k's 44--'s'ps Proper Materials & Anchors IIs Studs -Nailing Spacing & Braces -Plates -Sound 4. aring Walls over Girders & Floor Nailing . Draft Stop in Walls (rat proof) Fie Stops, Furred Ceilings -Stairs -Chasers -Tubs 4&.41eaders & Beams -Size & Bearing DateFRAljf1ING (Continued) Hangers -Post Caps -Anchors -Connectors 48!CJing. Joist-Rftr. Ties-Purfin-Roff Brac: Truss-Shting: Rtng. 4 . Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50_ !!tic Access; Size & Romex Protection -Draft Stop -Ins. Baffles SLe'lldrm. Windows or Exiting Doors -Sill Ht & Dimensions 52. Ciadrage Fire Protection Framing -RC Channel Pryperty Line Firewall & Openings SWTxt Doors -One T -Check Garage 3rd Story, 2 Exits 55. Sjairs; Width -Headroom -Rise -Run -Landing -Fire Protection . ��ruvood on Roof Overhang -Attic Vents -Rafter Outriggers 57o.Siding-Nalfing Veneer 58. *qca Mesh -Drip Screed -Fd. Vents-Undert1r. Access 'ng Area -Glass Protection -Skylights -Plastic §OPSpear Walls; Nailing -Botts 61. race Interior/Exterior Wall Panels Q !%A -6f Insulation -Walls- Ceilings 63. Infittration-Walls-Windows Date (0, Z_ J,Q Card B-1 , I Date Card B-1 Date Card 8-1 Date Card B-1 Date Fl(Plans) OK except Vs �5ct. Steps -Door & Sidelight Protection -Landings W Smoke Detector 66. Fu ce Vents -clearance -Comb, Air -Connector - I IGa rage; Above Floor-Ducts-Mech. Protection Sg/ ..I. & Bath Fixtures & Tub Access -Spa Elec. Trim & Subpanel, Breaker Sizes & Labels (192 Stairs & Rails Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int & Ext 7,31-1% Fiat. & Appliance; Ground -Ai -Gap -Cooking Clearance ZA/Llec. Outlets & Receptacles at IGt. Counter 75. Garage Fire Door, Swing -Landing -Closure 76. A.C. Dud in Garage -Damper . V. HV.; Vents -Clearance -Comb. Air Connector-P.R.V. i Garage; Above Floor -Meth. Protection 74KPlb.; Elec. & Mech. Equip. Listed for Location 79. Elec. eceptacles in Garage (FFI.)-Romex Protection 8 . lation-Foam-Looked in Attic Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes 83. Following InstldJDiive 0 Yes 0 NoAValks 0 Yes 0 No/Planters 0 Yes O No 84. Stucco Brown -Finish A C. Unit Disconnect, Electrical -Plumbing WVents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87.Aater Well, Disconnect, Electrical, Plumbing tW) Exterior Sec. Trim, G.F.I. Receptacle -Underground 'Tr SG!l/ ntilation Throughout House 901'96_ss Protection Correcti ns from Previous Insp ions , 92. G t -Meters Tagged, -Electric U^1 ater & Sewer Connected -C/O to Grade -HD Approval ` e Fffiergy Compliance Certificate -Other Certificates Address Posted 96. Fire Sprinkler Date i . 7-6, Q Card B -f, Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: Ar - COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive - Oroville, CA • (530) 538-7541 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 call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional e\\ ation, please contact the Building Inspector as indicated below. Pclt U�N o ��d r Date`[ V v Inspector lJ/ REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 -'!�j .Y 'Yj .:4r COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE _V�) In ► 5n l-� 0�� e5 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 call for re -inspection when correction of work i completed. If you have any questions•pertaining to this matter, or need additional expl a. ion, please contact the Buildirfft` spectoryas indicated below. - Date t Inspector REV 4/05 Phone # o FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 a, w Date t Inspector REV 4/05 Phone # o FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 COUNTY OF BUTTE h BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES" 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE - Ro 0-7- T.:2 T-� OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at r the above address and should be corrected. Please call for re -inspection when correction of. work is completed. If you have any questions pertaining to this matter, or need additional ' A /6 �z fII ri ;t y34 cy Date !1 Inspector REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 ER . . , .. COUNTY OF BUTTE. ..............: BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE PERMIT NO A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, ply contact the Building Inspector as indicated below. T �t N' Date _ — Inspector �� % �'� �a�i� l ,SIG•C REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 'Ypp VerticalTechnology er Engineering M Rio LrcbA,— #20q C[V4 CA, 9S% *AATIecch P. (-IW) 899-M6 Pic PD) 899-110 9 January 24, 2006 RE: Robison Residence, Melvina Avenue, Palermo, CA To Whom it May Concern: I observed the placement of threaded rod �in Simpson Epoxy at missed anchor bolts along wall line A on the plans. The bolts appeared to be installed in accordance with the manufacturer's recommendations. VerticalTechnology er Engineering M Rio L rcbAye #MO, Chun, CA, 999x6 I I AAA, ec h P' (-IM)89,18A6 F&(930)89}l1M January 20, 2006 RE: Robison Residence, Melvina Avenue, Palermo, CA To Whom it May Concern: A 2x sole plate is permissible at the #2 shear wall locations (wall line A) provided the following criteria are met: 1. Y2 diameter anchor bolts with 7" embed into Simpson ET epoxy are provided at 8" o.c. at shear wall locations. 2. Simpson ET epoxy is used per manufacturers recommendations. 3. Existing reinforcing is located and avoided prior to drilling. Sincerely, gROFESS/oy9� D �G< Mike Huble a No. S 4732 y Exp. 6/30/06 S.E. cP v 7� , Ue-ro P �FOF CAl1E���`P and Block Numbers, Tax Parcel Number, Legal Description, etc.) A.P.N. 026-230-018 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential (1,440 SF House) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 0 GPS (Type):_ ( W - ##' - ##.##' or f##. ) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Butte County 06001T I Butte j CA B4. MAP AND PANEL B7. FIRM PANEL FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NUMBER NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 EFFECTNEIREVISED DATE ELEVATION CERTIFICATE (Zone A0, use depth of flooding) 06007CO995 Important: Read the instructions on pages 1- 7. 6W 69% SECTION A - PROPERTY OWNER INFORMATION 1522 For Insurance Company Use: BUILDING OWNER'S. NAME Policy Number Art & Julie Robison BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company KgI`eVber 7904 Melvina Ave. comny CITY STATE ZIP CODE Palermo CA 95968 DEC 1 a 2nr; and Block Numbers, Tax Parcel Number, Legal Description, etc.) A.P.N. 026-230-018 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential (1,440 SF House) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 0 GPS (Type):_ ( W - ##' - ##.##' or f##. ) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Butte County 06001T I Butte j CA B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTNEIREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 06007CO995 C 6W 69% AE 1522 610. Indicate the source of the Base Flood Elevation (BRE) data or base flood depth entered in B9. ❑ AS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BRE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12. Is the building located in a Coastal Barrer Resources System (CBRS) area or Otherwise Protected Area LOPA)? ❑ Yes ❑ No Designation Date_ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' Q Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations–Zones Al -A30, AE, AH, A (with BRE), VE, V1 -V30, V (with BRE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3. -a4 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BRE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NIA Conversion/Comments_ Elevation reference mark used RM 7 Does the elevation reference mark used appear on the FIRM? ® Yes ❑ No O a) Top of bottom floor (including basement or enclosure) 155. 8 ft.(m) ❑ b) Top of next higher floor N/A. _ft(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N/A. —ft(m) ❑ d) Attached garage (top of slab) NIA _ft.(m) ❑ e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) 152. 3 fit(m) E ❑ f) Lowest adjacent (finished) grade (LAG) 151. 8 ft(m) Z O g) Highest adjacent (finished) grade (HAG) 152. 0 ft.(m) C 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 15 VROFESS/A K oL 3, 6 l�y� a `° ¢ c4 m v No.28998 M Exp.03-31- 7 ux- IT 10 FOF CA �0 ❑ i) Total area of all permanent openings (flood vents) in C3.h 1,496 sq. in. (sq. cm) /_ zo — O,:;5. SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Michael S. Byrd RCE 28998 Reg. Expires 03/31/07 TITLE COMPANY NAME Civil Engineer Rolls, Anderson & Rolls ADDRESS CITY STATE ZIP CODE 115 Yellowsto a Chico CA 95973 SI RE DATE TELEPHONE (530)895-1422 FEMA �m 81-31, January 200X� See reverse side for continuation. Replaces all previous editions 15 a�aS 'IMPORTANT: In these spaces, copy the corresponding information from Section A. ( For Insurance Company Use: BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.I Policy Number 7904 7904 Medina Ave. CITY STATE ZIP CODE95I Company NAIC Number Palermo Palermo CA 968 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑ Check here 9 attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cn) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, 4 available). E3. For Building Diagrams 6-8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery andlor equipment servicing the building is _ fL(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the communilys floodplain management ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMAissued or oommunity- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are condi tote best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here 9 attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the communitys floodplain management ordnance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMAissued or communiityissued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _. _ft.(m) Datum: _ G9. BFE or (in Zone AO) depth of flooding at the building site is: _. _ ft -(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here 9 attachments FEMA Form`81-31, January 2003 Replaces all previous editions INSULATION CERTIFICATE Job Number: 7204 Art Robison 7904 Melvin Ave., Palermo CA Contractor/Owner Name Job Address (street, city, state) Butte County Subdivision Name Lot Number DESCRIPTION OF INSTALLATION 1. ROOF Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): 2. CEILING Batt or Blanket Type: Fiberglass Brand Name: Knauf Thickness (inches): 12 Thermal _Resistance %:Value): 38 Loose Fill Type: Brand Name: Minimum Installed Weight/ft lb Minimum Thickness: inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value): 3. EXTERIOR WALL Frame Type: A. Cavih, Insulation Material: Fiberglass Thickness (inches): 61/4 Brand Name: Knauf Thermal Resistance (R -Value): 19 B. Exterior Foam Sheathing Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): 4. RAISED FLOOR Material: Fiberglass Brand Name: Knauf Thickness (inches): 61/4 Thermal Resistance (R -Value): 19 5. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): Perimeter Insulation Depth Inches: 6. FOUNDATION WALL Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of Regulations) as indicated on the Certificate of Compliance, where applicable. 2,3 & 4 r-- 1 /l/17/ 1,��dLL!1=vc� Chico Insulation & Fireplaces Item Number's Signature and Date Installing Subcontractor (Co. Name) or General Contractor (Co. Name) or Owner Item Number's Signature and Date Installing Subcontractor (Co. Name) or General Contractor (Co. Name) or Owner BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #. '(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class: License Number: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm' under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended -or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). t� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Articl of-tf 'e Business rofessions Code Date: i'0110105 Owne WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy #: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensationcoverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. PERMIT NO. BP052325 Issued Date: 10/06/2005 APN: 026-230-018-000 Site Address: 7904 MELVINA AVE PAL Map Index: Description: NSF (1440) COV(720) Owner: ROBISON, ARTHUR M & JULIE A 9 MIONE WAY CHICO, CA 95926 (530) 693-1766 arobison@buttecounty.net Applicant: ROBISON, ARTHUR M & JULIE A 9 MIONE WAY CHICO, CA 95926 (530) 693-1766 arobison@buttecounty.net Contractor: License #: Architect: Engineer: HUBLEY, MICHAEL D. Total Square Ft: 2160 S.F. Valuation: $105,120.00 Census Code: � CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code andlor I hereby affirm that there Is a construction lending agency for the Resolution to do work indiCated above for which fees have been paid. 1 /� performance of the work r which this.permit is issued (Sec 3097 Civ.) By. t Date: Name: r PERMIT EXPIRES ON: 10 li— 0 6) Address: 1 - (Date) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance any official formo�rlocument of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection pur Print Name: 42T�41(o- /,�- Rq&lSoA Signatur Date: �d4 w Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor �+ 'annmm� YPlTIf 111 -ID -u4 nu i PLAN REVISION/RETURN Owner's Name: Y,k)- AP#: O,—�U ' �� 6. 6) C BP#: Com` Date: Contact Person & Phone Number: Received By: Time: I I ,n q-�)- nU(0 PURPOSE OF RE -SUBMITTAL OR REVISION ❑ Permit Application Data Sheet Item ❑_..-*C_-Engrneertng_--� *Plan Revision ❑ *Requested by Building Inspector's Correction Notice — Inspector's Name: ❑ Requested by Plan's Examiner — Plan Examiner's Name: ❑ Other: *If revising a plan which has already been issued, submit two (2) drawings reflecting the revision for plan review along with your approved plans. If engineering is involved in this revision, the engineer must put his requirements on these drawings and wet stamp and sign two sets of engineered drawings. Revised drawings must clearly show changes proposed and locations involved.. WHEN APPROVED, PROCESS AS FOLLOWS: ❑ Mail to Owner/Contractor at this address: ❑ Call ❑ Deliver with next inspection. and hold for pick-up. Minimum revised plan check fee to be collected at time of submission of revision, plans examiner will determine if additional plan checking fees are needed: Minimum $54.99 Receipt #: O 'Fee not required for revisions requested by plans examiner prior to issuance of permit. ❑ ' Additional Fee Amount: Receipt #: Revised 2/04 January 25, 2006 VerticalTechnology Engineering 363 Rb LixbAe. #20q Chive, CA, 99926 Ph. (530) 899$716 Fac (530) 899-1102 RE: Robison Residence, Melvina Avenue, Palermo, CA To Whom it May Concern: I have reviewed the truss calculations by Endeavor Homes dated 1-18-06 and have found that the trusses appear to be designed in accordance with the general design concept of the structural documents. The specific design shall remain the responsibility of the engineer who has sealed the calculations. Cinrcrcly XAAAAVerticalTechnology . r Engineering mRiourdoAye#mooa,mcq,99926 PK(SM)899-M6 xPQ)89941M January 20, 2006 RE: Robison Residence, Melvina Avenue, Palermo, CA To Whom it May Concern: A 2x sole plate is permissible at the #2 shear wall locations (wall line A) provided the following criteria are met: 1. '/2" diameter anchor bolts with T' embed into Simpson ET epoxy are provided at 8" o.c. at shear wall locations. 2. Simpson ET epoxy is used per manufacturers recommendations. 3. Existing .reinforcing is located and avoided prior to drilling. A AND WHEN RECORDED MAIL TO. BUTTE COUNTY BUILDING DIVISION. 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 2005-0059716 Recorded I REC FEE Official Records I County of I CONFORMED COPY Butte I CANDACE J. 6Rl1BBS I County Clerk -Recorder[ I I LV 02AWN XHep-2005 I Page 1 of 1 7.00 1.00 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit 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 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 that real property situate in the County of Butte, State of California, described as follows: LZI[S- r �, av\A�r / 1'611 Mock 33, as SadoWoi owa $kaf- c2:~4-afV1 Map e✓1- 41e6t f tf leap ol- &b66V'1S10V1 tJO J OP $'kgCderrK.v Tr a.c -> Z":tte Co L.t n-4-.8 / CAL w k ic-1'1 nnc�� (( was r�e.c or-ded Itv' 4 h e �o1 "i ce, ©.l_..-+ ke �Recov-de-r- ot- +41e- Ccut-4y OS- 1j-, . e., S-1-�,�-i-e ot- C.1t'J orrl.LA- Olel ;:� Ibru.ar l 28, 188S, Date State of California ) Countf y of &A- 4 e- ? -30--05' ) On / - 30 -0j� before me, / ✓ JG M G�in�«r- �t 0 S,er personally appeared Ar� ,.r- M, 0)2�Soa..) gAi cls Kob15o lJ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)-is/are subscribed to the within instrument and acknowledged to me that-trefshe/they executed the same in bisA 4w/their authorized capacity(ies), and that by-hisAter/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 had and. official seal. -Signature _ �,.� Seal: @,My JAMES LAMAR KINSER COMM. #1377185 A.P.#O2 —Z,30-Q)e NOTARY PUBLIC - CALIFORNIA BUTTE COUNTY Comm. Expires Sept. 28, 2006 BUTTE COUNTY PERMIT NO. DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT BPO52744 24 HOUR INSPECTION #. (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 10/19/2005 APN: 026-230-018-000 the Business and Professions Code, and my license is in full force and effect. se Class: License Number: License Site Address: 7904 MELVINA AVE PAL Map Index: Date: Contractor: Description: gar (896) OWNER -BUILDER DECLARATION. 1 hereby affirm under penalty of perjury. that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: ROBISON ARTHUR AND JULIE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 9 MIONE WAY signed statement that he or she is licensed pursuant to the provisions of CHICO, CA. the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 95926 she is exempt therefrom and the basis for the alleged exemption. Any 530-693-1766 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: ROBISON, ARTHUR AND JULIE Code: The Contractors' State License Law does not apply to an 9 MIONE WAY owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, CHICO, CA. provided that such improvements are not intended or offered for 95926 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-693-1766 proving that he or she did not build or improve for the purpose of sale.). ` I73/ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and,Professions Code. The Contractors' State License Law does Contractor: not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exem t under Article 33 off the Business and Professions Code rn�b Owner: A2Z _Z(3 jsct� , Date: I'6 License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: rotal Square Ft: 896 S.F. Policy#: Valuation: $21,5Q4.00 Census Code: ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: i1 WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one /1 7� ,�J�o�n hundred thousand dollars ($100,000), in addition to the cost of l` compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issuedu nd a appllcable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the solutions o do worktindicat abo a for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Date: —/q Name: t 11n, �— PERMIT EXPIRES ON: !�1`� Address: v� (Cate) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, '10 handling and use of hazardous materials. CEI Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. N iD Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the labove mentioned property for inspection pur -. e A.I.' ��it3%�C7/V Signatur t" Print Name: A0 � Date: 0/owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 I Butte County Department of Development Services• �urrfe aREn NOTES 7 County Center Drive, Oroville, CA 95965 e _ (530) 538-7601 www.buq COLInty neVdds •°Ouwt�• I { It RESIDENTIAL APN: _ Permit No. 026-230-018 OS -2744 Owner: G ROBISON, AUTHUR _ � �t�MELVINA, PALERLMO Site Address: I . Cont: OWNER Contractor: + GARAGE Type of Permit: _ J PERMIT RENEWAL DATE: �i ZZ -Ob BP# O S- _Z7 yy L EXPIRES• CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE C_Z SMT(f off= DATE JOB FINALED: t ( VJ SIGNATURE: a,� +=OK 0 = Not OK MANUFACTURED HOMES t MISCELLANEOUS DATE PERMANENT FOUNDATIONSOFT-SET DATE DEC S'C O V E R S'C A R P O R T S'G A R A G E S 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch l Z/- oS Z I or ing-Setbacks-Easements Z tgs; Soils-Sz-Dpth-Spacing-CnnctrsSteel 3 Sewer; Loctn-Test; Fall/C/0-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator I -3 Decks, Girders/Joists-Dcking-Brcing Stairs-Guard/Handrails 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap Nat ❑ or LPO 4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg Frmg-Brcng _ Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage Line ' 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Cyorts; Wndws-Doors y 8 Gas; MH Test-Demand-Valve-Cnnctr ,7,1EIRttric 9 Elec MH Cntnty Test-Crossovers-Breakers-Cirncs $.Kmg; Sills-AnchrsStuds-Rftrs-Trusses 10 Drain; MH Test -Fall -Flex Cnnctr 9 Sidig; Nailing -Veneer -Stucco -Lath 11 Wtr & Sewer Connected -C/O to Grade 10-10•t,(o An' oof; Shthg-Roofing 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation ❑ 11 Ext; Steps -Doors -Landings Z9 -0(o 02%C. d Wall pnis 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers Z/, OC- \� C4A.4y DATE IPOOLS 1 Setbacks -Easements 1 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI \\c ° I 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries -Terminals -Listed 1 7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr I 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes -Enclsrs-pnIboards Insultn to Main Conduit ' 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide '4 I Pool Drawing .t i • f 1 F is - t� y , , = OK 0 = Not OK RESIDENTIAL (Single. & Duplex) DATE JUNDERFLOOR DATE PLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg Dpth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth. 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First fir -Tub Acc 5 Stemwalls Main; Steel -BIockouts-Wrapped 57 Test Tub & Shwr, 2nd fir - Tub Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 1A .� s 10 UF, Gas Pipe; Sz Anchrs-Sz Test O' 0 11 Wtr Pipe; Test-Anchrs-RgltrService Test DATE IMECHANICAL 12 Elec Undrgrnd 61 AC Ducts Insultn & Support 13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn 14 Girders-Sills-Anchr Bolts Joists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn _ 15 Acc & Vntltn 63 Condensate Drain & Ovrflw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic Q7 I Oq 0� 0`40 DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE IFINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders & flr Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof) 68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-flr-Ducts-Mech Prtctn 22 Headers & Beams-Sz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps -Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frplc Throat Clrnc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Clrnc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc 30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 79 AC Duct in Garage -Damper 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-Clrnc-Com Air Cnnctr-PRV; abv flr 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnls 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctr-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters ❑Yes ❑No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Plmb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc-Ins Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/0 to grade -HD Apprvi 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga EJ CU or ❑AL 98 Address Posted AC Wire Sz ga ❑ CU or ❑ AL 99 Fire Sprinkler 48 Range Circ ea ❑ CU or ❑ AL Oven Circ ga ❑ CU or ❑ AL Insulated Neutral ❑Yes [::]No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector m41 O'er 0 0a 0 Fla BU r TE COUNTY DEPARTMENT OF'DE;/ELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP052744 B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 10/19/2005 APN: 026-230-018-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 7904 MELVINA AVE PAL Map Index: Date: Contractor: Description: gar (896) OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: ROBISON ARTHUR AND JULIE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 9 MIONE WAY signed statement that he or she is licensed pursuant to the provisions of CHICO, CA. the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 95926 she is exempt therefrom and the basis for the alleged exemption. Any 530-693-1766 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: ROBISON, ARTHUR AND JULIE Code: The Contractors' Stale License Law does not apply to an g MIONE WAY owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, CHICO, CA. provided that such improvements are not intended or offered for 95926 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-693-1766 proving that he or she did not build or improve for the purpose of sale.). / fH I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exem t under Article 3 of the Business and Professions Code Date: (a 0 Owner: ;42.r �131S� License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier rotal Square Ft: 896 S. F. Policy#: il, a Valuation: $21,5Q4.00 Census Code: ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. f'r wetqqApw :z / a tt CONSTRUCTION LENDING AGENCY This permit is hereby issued and a applicable provisions of the/ Butte County Code and/or I hereby affirm that there is a construction lending agency for the solutions o do work�indi. cat abo a for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) fAaRb Date: r! ! Name: 1e a 1"g-49,6 PERMIT EXPIRES ON: Z (1_a Address: uv ( ate ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, 0 handling and use of hazardous materials. Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ! Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the mentioned property for inspection pur e (above �/,(O'em" Print Name:' / K Signatur Date: Q Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 e r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION **PLEASE PRINT CLEARLY** OWNER La L�.Jam irst Name AddresS IGO l�lJ� Address Stat zip GR2/o P one Fax 5 E-mail a►r-olo►Soo C� 6 ARCHITECT/ENGINEER CONTRACTOR Name � Address /!0, &K /54L Address Slate City Ph o J 53 b� State Zip Phone Book Fax E-mail Planner Lic. # Class ARCHITECT/ENGINEER Name E ndeavor wie Address /!0, &K /54L City Vi Slate PhoF3o-�3-r7(o(o Ph o J 53 b� FaCx� E-mail State License Number APPLICANT NAME Name Addie Y city stal€ , zp9s 5, PhoF3o-�3-r7(o(o Fa�53o-s3�-64t'q E-mail CLdbIf Ajej— Ol`o 0 t1 C2) cLLA& APPLICANTSIGNATURE x For office use only: Zoning Property Address Flood Zone 1+ SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP0S Z BIN # LOCATION AP# Property Address Cr treet WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: G' 4 f15 -)9G Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Receipt#: Date: in 1 l(%16 Amount: Bldg SRA Sheriff SMIP Fe m Other C. 11A SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS PIUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. o 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Cl 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 COUNTY OF BUTTE -DEPARTMENT OFDEVELOPMENTSERVICES-BUILDING DIVISIOIV, a 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140. PERMIT APPLICATION DATA SHEET OWNER: 120f, -315101\J ASSESSOR PARCEL NUMBER 07-6 _2?" -0/ 15 Proposed Building Use: ['�1�7Permit Technician: C�-u�7 Date: tems required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. Iry 1. Site plans, 3 or\4 sets, signed by the preparer of the plans. Al 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. Cl 7. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. yv 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Letter of intent fog non-residential' buildings ❑ 12. Hazardous Material Form 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) /,A) 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable ❑ 16. Fire Sprinklers............................................................................................ ❑ 17. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 18. Soils Report and/or Engineered Foundation required ........................................... \ O 19. Erosion Control Plan Required........................................................................ 20 Fees as shown on the attached Schedule of Fees Due Sheet .............................. - ❑ 21. City of Chico Plumbing permit ........................................... ❑ 22. Site plan and business license approval from the City of Biggs .............................. ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: 24. Planning approval for (A) Use:(B)Parking:(C) Parcel Check:..6.�`..... 0 0 ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ fnj 26. NPDES Form..............:......................................................:....................... ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 29. Worker's Compensation'Carrier and Policy Number .......................................... 30. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization..................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits.. '***"** ........... ......... ........ ..... ermits....................:.....,...........:.... ❑ 34. Deed Restriction..........................................................::.............................. El 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone A41- U 7 -/ 76% and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applican . Date: /0 5 D 1. Index permit application for the above items numbered: Plan Check Letter 2. Additional items required -- Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date: 44r, Structural approved by: Date: Note transfer by: Date: Yellow: Building Division COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140 SCHEDULE OF RECEIPT OF FEES Website: www.buttecounty.net/dds OWNER/S PROPROSED BUILDING USE C� �- ef 1. BUILDING PERMIT FEES `� 17 --- Balance Due ..................... $ qu --- FEMA Flood elevation review ... $ V --- Additional plan checking Fee.... $ SCHOOL DISTRICT FEES (paid at School District Office) (form available after Plan Check) SHERIFF FEES (paid at Building Division) Commercial (sq. ftg.)..... X $0.03 =$ Sq.Ftg. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMPACT FEES COUNTY WIDE (per dwelling) $ CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ NORTH CHICO SPECIFIC PLAN (per dwelling) Zoning 6. SRA FIRE INSPECTION AND PLAN CHECK FEE $204.98 (paid at Building Division) 7. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) f% 8. SMIP \\ / 9. DRAINAGE FEE �u 10. OTHER 11. OTHER A.P. # 02-6 -Z3LO—a18 DATE 5— RECEIPT # DATE REC. 1-q-0s-rP At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed d the plan ch ing process. / APPLICAN DATE Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 7/05) i..•.Y!:E 4.'p. i•1 �:)`i ' :1'�' 'li �' •'r,/c:l �i'�.i.s `i •. '•—i. �:.�1, _ .'xh zf �!_ u• %•,;.�y. ".,, -SAF .,1, ...�' ' a .,'ti _t� •rr�.''} .` ''�t •,' - Attention Property Owner - Aa a "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. �•.l. I personally plan to provide the major labor and material for construction of this proposed ` • property 71�7=OT YES [ NO [ ]. 2. 1 HAVE [ ] •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: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: S. 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 SIGNED: 4 PROPERTY OWNER-' )E:: -r Rnr3lSeN DATE: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Butte County Department of Development Services ADMINISTRATION ° BUILDING' GIS `PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile -M—11T 112--`1 �1Y61 .M +fs fT d. Dear Property Owner_ An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. C. Viei.4 C.B.O. Building Inspection NOTR_: This Owner -Builder Tnfnrmafinrn is rPnnirF-d by CPrfinn 1 oR2n off—hp rcoifn—a TyPeifh %nA C->fPfv rt%ap Butte County Department ofDevelop-mentser-vlces °�"Tr, 0 o X' `• o 7 County Center Drive Oroville, CA 95965 °o -' o (530) 538-7601 Telephone c0UN��t (530) 538-7785 Facsimile BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: I need to submit applications for septic and/or well to Butte County Environmental Health immediately. I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained e I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not .limited to, verification the parcel was legally created, adherence.to.all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name:APN: 1)2_4-730-019 Building site address:1 Permit No.: I have read, understood and accept the terms and conditions as expressed herein as indicated by my submission of the above -referenced building permit application and my signature below: SIGNATURE OF APPLICANT Copy to ApplicandEH/File 110-157-06— DATE 10-5-06— DATE v KFontu/BidePermitwithoutCleaances 020705 TRUSS SCHEDULE Tails Project: Art =�•���•i1 MIu�ljECI WKM Art Robinson County: Butte Contractor: Endeavor Homes I Date: September 27, 2005 Roof: comp Plan: Garage Snow: 0 Drawn By: MT Tail Cut: Plumb r Adl QD MiTek° MiTek Industries, Inc. 7777 Greenback Lane Suite 109 Citrus Heights, CA, 95610 Telephone 916/676-1900 Re: art robinson Fax 916/676-1909 ARobinson The truss drawing(s) referenced below have been prepared by MiTek Industries, Inc. under my direct supervision based on the parameters provided by Endeavor Homes. Pages or sheets covered by this seal: RI 8489045 thru RI 8489046 My license renewal date for the state of California is September 30, 2006. FESS/pN� ONG YG 2 Uj C 19' * EXP oras BUTTE o�a`�' BUILDING OUNTY OFC BUILDING APPROVED :.:. October 3,2005 VED Yu, Ray The seal on these drawings indicate acceptance of professional engineering responsibility solely for the truss components shown. The suitability and use of this component for any particular building is the responsibility of the building designer, per ANSI/TPI-2002 Chapter 2. Job I Truss.. fuss Type Qty Ply ARobinson I/def! L/d PLATES GRIP TCLL 16.0 Plates Increase 1.25 818489048 ART ROBINSON At HOWE 2 1 art robinson TCDL 10.0 Lumber Increase 1.25 BC 0.06 Vert(TL) -0.03 Job Reference (optional) Homes, Oroville, CA 95965 6.200 s Jul 13 2005 MiTek Industries, Inc. Fri Sep 30 11:41:42 2005 Page t -2-0-0 14-0-0 28.0-0 30.0.0 2-0.0 14-0-0 14-0-0 2-0-0 Scale = 1:51.9 3x4 = 04 i 4x4 12 3x4 = 28-0-0 3I$ LOADING (psf) SPACING 2-0-0 CSI DEFL in (loc) I/def! L/d PLATES GRIP TCLL 16.0 Plates Increase 1.25 TC 0.16 Vert(LL) -0.02 23 n/r 120 MT20 220/195 TCDL 10.0 Lumber Increase 1.25 BC 0.06 Vert(TL) -0.03 23 n/r 90 BCLL 0.0 Rep Stress Incr YES WB 0.03 Horz(TL) 0.00 22 n/a n/a BCDL 10.0 Code UBC97/ANSI95 (Matrix) Weight: 165 lb LUMBER TOP CHORD 2 X 4 DF No.18Btr G BOT CHORD'2 X 4 DF No.1&Btr G WEBS 2 X 4 DFStclG OTHERS 2 X 4 DF Std G BRACING TOP CHORD Sheathed or 6-0-0 oc purlins. BOT CHORD Rigid ceiling directly applied or 10-0-0 oc bracing. JOINTS 1 Brace at Jt(s): 43 REACTIONS (Ib/size) 2=237/28-0-0, 34=93/28-0-0, 32=28/28-0-0, 42=110/28-0-0, 41=96/28-0-0, 40=96/28-0-0, 39=96/28-0-0, 38=96/28.0-0, 37=96/28-0-0, 36=97/28-0-0, 35=94/28-0-0, 31=87/28-0-0, 30=98/28-0-0, 29=96/28-0-0, 28=96/28-0-0 , 27=96/28-0-0, 26=96/28-0-0, 25=96/28-0-0, 24=110/28-0-0, 22=237/28-0-0, 44=76/28-0-0 Max Horz 2=- 1 5(load case 3) Max UpIW=-65(load case 5), 41=-23(load case 4), 39=-1 (load case 5), 36=1 (load case 5), 27=-1 (load case 5), 25=-23(load case 3), 22=-65(load case 5) Max Grav2=237(load case 1), 34=93(load case 1), 32=56(load case 2), 42=130(load case 2), 41=96(load case 6), SU6 Td COUNTY 1), 39=96(load case 6), 38=96(load case 6), 37=96(load case 1), 36=97(load case 6), 35=94(lo c�s ,Cil, �' NG 31=89(load case 7), 30=98(load case 1), 29=96(load case 1), 28=96(load case 7), 27=96(load case to d DIVISION case 1), 25=96(load case 7), 24=130(load case 2), 22=237(load case 1), 44=76(load case 1) V FORCES (lb) - Maximum Compression/Maximum Tension APPROVED TOP CHORD 1-2=0/39, 2-3=-39/16, 3-4=20/16, 4-5=-18130.5-6=18140, 6-7=-18/51, 7-8=-18/62, 8-9=-18f72, 9-10=-18/83, 10-11=-18/94, 11-12=28/22, 12-13=30/21, 13-14=16/94, 14-15=19/83, 15-16=-18!70, 16-17=-18/58, 17-18=-18/46, 18-19=-18/34, 19-20=18/23, 20-21=20/10, 21-22=39/17, 22-23=0/39 BOT CHORD 2-42=0/52, 41-42=0/52, 40-41=0/52, 39-40=0/52, 38-39=0/52, 37-38=0/52, 36-37=0/52, 35-36=0/52, 34-35=0/52, 33-34=0/52 , 32-33=0/52, 31-32=0/52, 30-31=0/52, 29-30=0/52, 28-29=0/52, 27-28=0/52, 26-27=0/52, 25-26=0/52, 24-25=0/52, 22-24=0/52 WEBS 34-43=-65/0, 11-43=-65/0, 32-44=0/0, 13-44=-76/0, 3-42=-90/3, 4-41=-64/22, 5-40=-70/14, 6-39=-69/16, 7-38=-69/15, 8-37=-69/15, 9-36=-70/17, 10-35=-69/13, 14-31=-64/15, 15-30=-71/16, 16-29=-69/15, 17-28=-69/15, 18-27=-69/16, 19-26=-70/14, 20-25=-64/22, 21-24=-90/3, 11-13=0/72, 43-44=0/0 NOTES 1) Unbalanced roof live loads have been considered for this design. 2) This truss has been designed for the wind loads generated by 80 mph winds at 25 ft above ground level, using 6.0 psf top chord dead I and 6.0 psf bottom chord dead load, 100 mi from hurricane oceanline, on an occupancy category I, condition I enclosed building, of dimensions 45 ft by 28 ft with exposure B ASCE 7-93 per UBC97/ANSI95 If end verticals or cantilevers exist, they are exposed to wind. porches exist, they are not exposed to wind. The lumber DOL increase is 1.33, and the plate grip increase is 1.33 3) Truss designed for wind loads in the plane of the truss only. For studs exposed to wind (normal to the face), see MiTek "Standard Gable End Detail" 4) All plates are 1.5x4 MT20 unless otherwise indicated. 1 Continued on page 2 October 3,2005 A WARNING - Ver(My design parameters and READ NOTES ON THIS AND INCLUDED WTEE REFERENCE PAGE MD -7473 BEFORE USE. 7777 Greenback Lane Design valid for use only with MTek connectors. This design 4 based only upon parameters shown, and is for an individual building component. Suite 109 Applicability of design paramenters and proper incorporation of component is responsibility of building designer - not truss designer. Bracing shown Citrus Heights, CA, 95610 is for lateral support of individual web members only. Additional temporary bracing to insure stability during construction is the responsibillity of theerector. Additional permanent bracing of the overall structure is the responsibility of the building designer. For general guidance regardingM117 � fabrication, quality control, storage, delivery, erection and bracing, consult ANSI/11`I1 Quality Criteria, DSO -89 and BCS11 Building Component „eLm Safety Information available from Truss Plate Institute, 583 D'Onofrio Drive, Madison, on, WI 53719. " Symbols Numbering System General Safety Notes PLATE LOCATION AND ORIENTATION Failure to Follow Could Cause Property Damage or Personal Injury �� 3/a *Center plate on joint unless dimensions indicate otherwise. .Dimensions are in inches. Apply 1. Provide copies of this truss design to the plates to both sides of truss and building designer, erection supervisor, property securely seat. owner and all other interested parties. J2 J3 J4 2. Cut members to bear tightly against each ,/8 TOP CHORDS other. 3. Place face truss o c, JS 0 �, ; plates on each of at each joint and embed fully. Avoid knots and wane at joint locations. O U �e U U 4. Unless otherwise noted, locate chord splices O , at 14 panel length (± 6' from adjacent joint.) •For 4 x 2 orientation, locate ~ ce V ce BOTTOM CHORDS 5. Unless otherwise noted, moisture content of lumber shall not exceed 19% at time of fabrication. plates 1 /8" from_ outside edge J 1 J8 J7 J6 of truss and vertical web. 6. Unless expressly noted, this design is not applicable for use with fire retardant or preservative treated lumber. *This symbol indicates the required direction of slots in JOINTS AND CHORDS ARE NUMBERED CLOCKWISE 7. Camber is a non-structural consideration and connector plates. AROUND THE TRUSS STARTING AT THE LOWEST JOINT is the responsibility of truss fabricator. General FARTHEST TO THE LEFT. practice is to camber for dead load deflection. WEBS ARE NUMBERED FROM LEFT TO RIGHT 8. Plate type, size and location dimensions PLATE SIZE shown indicate minimum plating requirements. The first dimension is the width 4 4 9. Lumber shall be of the species and size, and x perpendicular to slots. Second in all respects, equal to or better than the dimension is the length parallel CONNECTOR PLATE CODE APPROVALS grade specified. to slots. SOCA 96-31, 96-67 10. Top chords must be sheathed or purlins ICBO 3907, 4922 provided at spacing shown on design. LATERAL BRACING SBCCI 9667,9432A 11. Bottom chords require lateral bracing at 10 ft. spacing, or less, if no ceiling is installed, Indicates location of required WISC/DILHR 960022-W, 970036-N unless otherwise noted. continuous lateral bracing. NER 561 12. Anchorage and / or load transferring connections to trusses are the responsibility of others unless shown. 13. Do not overload roof or floor trusses with stacks of construction materials. BEARING Indicates location of joints at ® 14. Do not cut or alter truss member or plate Without without prior approval of a professional which bearings (supports) occur. I engineer. MiTek® 7775 vwq15. Care should be exercised in handling, erection and installation of trusses. MiTek Engineering Reference Sheet: MIX -7473 © 1993 MiTek® Holdings, Inc. Job russ, Truss Type Qty PlyARobinson ' - R18489046 ART ROBINSON Al HOWE 2 i an robinson ' Job Reference (optional) NOTES 5) Gable requires continuous bottom chord bearing. 6) Gable studs spaced at 1-40 oc. 7) This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent With any other live loads. 8) A plate rating reduction of 20% has been applied for the green lumber members. 9) Bearing at joint(s) 44 considers parallel to grain value using ANSI/TPI 1 angle to grain formula. Building designer should verify capacity of bearing surface. LOAD CASE(S) Standard 4 I BUTTE COUNTY BUILDING DIVISION APPROVED A WARNING - Vert fy design parametero and READ NOTES ON TMB AND INCLUDED MTEE REPERENCE PAGE PM -7473 BEFORE USE. 7777 Greenback Lane � Design valid for use only with MTek connectors. This design is based only upon parameters shown, and is for an individual building component. Suite 109 Applicability of design ramenters and incorporation p ponsibifity of building designer- not trussdesigner. Bracing shown Citrus Heights, CA, 95610 - pp tY g pa proper incor ation of com onent is res is for lateral support of individual web members only. Additional temporary bracing to insure stability during construction is the responsibillity, of the erector. Additional permanent bracing of the overall structure is the responsibility of the building designer. For general guidance regarding fabrication, quality control, storage, delivery, erection and bracing, consult ANSI/TPII Qualify Criteria, DSB-89 and BCSII Building Component e m Safety Information available from Truss Plate Institute, 583 D'Onof io Drive. Madison, WI 53719. M iTek Symbols Numbering System General Safety Notes PLATE LOCATION AND ORIENTATION Failure to Follow Could Cause Property Damage or Personal Injury 3/4' *center plate on joint unless dimensions indicate otherwise. Dimensions are in inches. Apply 1. Provide copies of this truss design to the plates to both sides of truss and building designer, erection supervisor, property owner and all other interested parties. securely seat. J2 J3 J4 2. Cut members to bear tightly against each TOP CHORDS other. 3. Place plates on each face of truss at each o joint and embed fully. Avoid knots and wane _ �� 3 at joint locations. _ X:U �' O U U A 4. Unless otherwise noted, locate chord splices n- O at 1A panel length (± 6'from adjacent joint.) • For 4 x 7orientation, locate Oce c7 BOTTOM CHORDS 5. Unless otherwise noted, moisture content of lumber shall not exceed 19% at time of fabrication. plates 1 /8" from, outside edge J 1 J8 J7 J6 of truss and vertical web. 6. Unless expressly noted, this design is not applicable for use with fire retardant or preservative treated lumber. *This symbol indicates the required direction of slots in JOINTS AND CHORDS ARE NUMBERED CLOCKWISE 7. Camber is a non-structural consideration and connector plates. AROUND THE TRUSS STARTING AT THE LOWEST JOINT is the responsibility of truss fabricator. General FARTHEST TO THE LEFT. practice is to camber for dead load deflection. WEBS ARE NUMBERED FROM LEFT TO RIGHT 8. Plate type, size and location dimensions PLATE SIZE shown indicate minimum plating requirements. The first dimension is the width 4 4 9. Lumber shall be of the species and size, and x perpendicular to slots. Second in all respects, equal to or better than the dimension is the length parallel CONNECTOR PLATE CODE APPROVALS grade specified. to slots. BOCA 96-31, 96-67 10. Top chords must be sheathed or purlins ICBO 3907, 4922 provided at spacing shown on design. LATERAL BRACING SBCCI 9667, 9432A 11. Bottom chords require lateral bracing at 10 ft. spacing, or less, if no ceiling is installed, Indicates location of required WISC/DILHR 960022-W, 970036-N unless otherwise noted. continuous lateral bracing. NER 561 12. Anchorage and / or load transferring connections to trusses are the responsibility of others unless shown. 13. Do not overload roof or floor trusses with stacks of construction materials. BEARING Indicates location of joints at ® 14. Do not cut or alter truss member or plate without prior approval of a professional which bearings (supports) occur. engineer. MiTek® M 15. Care should be exercised in handling, erection and installation of trusses. MiTek Engineering Reference Sheet: MII-7473 © 1993 M11TekO Holdings, Inc. O SPACING 2-0-0 Qty Ply ARobinson ' TAr"S']Tiu-�ssype TC 0.48 TCDL 10.0 R1B489045 ART ROBINSON SCISSORS 15 1 art robinson WB 0.74 BCDL 10.0 Code UBC97/ANS195 (Matrix) Job Reference (optional) Endeavor Homes, Oroville, CA 95965 6.200 s Jul 13 2005 MiTek Industries, Inc. Fri Sep 30 11:41:412005 Page 1 -2.0.0 i 7-5.4 14-0-0 20.6.12 I 28-0-0 30.0-0 1 2-0-0 7-5-4 6.6.12 6.6-12 7-5.4 2-0.0 Scale = 1:52.7 4x5 = 1 7-5-0 14-0-0 201'-12 1 28-0-0 1 7-5.4 6-6.12 6-6-12 7-5.4 LOADING (psf) SPACING 2-0-0 CSI TCLL 16.0 Plates Increase 1.25 TC 0.48 TCDL 10.0 Lumber Increase 1.25 BC 0.61 BCLL 0.0 Rep Stress Incr YES WB 0.74 BCDL 10.0 Code UBC97/ANS195 (Matrix) LUMBER TOP CHORD 2 X 4 DF No.18Btr G BOT CHORD 2 X 4 DF No.18Btr G WEBS ; 2 X 4 DF Std G REACTIONS (Ib/size) 2=110910-3-8,6=1109/0-3-8 Max Horz2=-15(load case 3) FORCES (lb) - Maximum Compression/Maximum Tension TOP CHORD 1-2=0/36, 2-3=-3614/0, 3-4=2577!0, 4-5=-2577/0, 5-6=-3614/0, 6-7=0/36 BOT CHORD 2-10=0/3327, 9-10=0/3326, 8-9=0!3326, 6-8=0/3327 WEBS 4-9=0/1583, 3-10=0/283, 5-8=0/283, 3-9=-984/0, 5-9=984/0 DEFL in (loc) I/def! L/d PLATES GRIP Vert(LL) -0.25 8-9 >999 360 MT20 220/195 Vert(TL) -0.58 8-9 >576 180 Horz(TL) 0.35 6 n/a n/a Weight: 111 Ib BRACING TCP CHORD Sheathed or 3-2-0 oc purlins. BOT CHORD Rigid ceiling directly applied or 10-0-0 oc bracing. NOTES 1) Unbalanced roof live loads have been considered for this design. 2) This truss has been designed for the wind loads generated by 80 mph winds at 25 It above ground level, using 6.0 psf top chord dead load and 6.0 psf bottom chord dead load, 100 mi from hurricane oceanline, on an occupancy category 1, condition I enclosed building, of dimensions 45 ft by 28 It with exposure B ASCE 7-93 per UBC97/ANS195 If end verticals or cantilevers exist, they are exposed to wind. If porches exist, they are not exposed to wind. The lumber DOL increase is 1.33, and the plate grip increase is 1.33 3) This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other live loads. 4) A plate rating reduction of 20% has been applied for the green lumber members. 5) Bearing at joint(s) 2, 6 considers parallel to grain value using ANSI/TPI 1 angle to grain formula. Building designer should verify capacity of bearing surface. LOAD CASE(S) Standard BUTTE COUNTY BUILDING DIVISION APPROVED October 3,2005 A WARNING - ver(/y design parameters and READ N07FS ON THIS AND INCLUDED MI7ER REFERENCE PAGE MU 7473 BEFORE USE. 7777 Greenback Lane Design valid for use only with MTek connectors. This design is based only upon parameters shown, and is far an individual building component. Suite 109 Applicability of design poromenters and proper incorporation of component is responsibility of building designer- not truss designer. Bracing shown Citrus Heights, CA, 95610Mil is for lateral support of individual web members only. Additional temporary bracing to insure stability during construction is the responsibillity of the erector. Additional permanent bracing of the overall structure is the responsibility of the building designer. For general guidance regarding fabrication, quality control, storage, delivery, erection and bracing, consult ANSI/TPII Quality Criteria, DS3.89 and BCSII Building Component \ a �eLm Safety Information available from Truss Plate Institute, 583 D'Onofd'r o Drive, Madison. WI 53719. „' R Symbols Numbering System A General Safety Notes PLATE LOCATION AND ORIENTATION Failure to Follow Could Cause Property Damage or Personal Injury 4#_1 3/4 *Center plate on joint unless dimensions indicate otherwise. Dimensions are in inches. Apply 1. Provide copies of this truss design to the plates to both sides of truss and building designer, erection supervisor, property securely seat. owner and all other interested parties. J2 J3 J4 2. Cut members to bear tightly against each 1/8 TOP CHORDS other. �/g -► �- o �+ JS _�� 3 3. Place plates on each face of truss at each joint and embed fully. Avoid knots and wane at joint locations. s " �' O U 4. Unless otherwise noted, locate chord splices �,5 U U CL 0 CL at V. panel length (± 6" from adjacent joint.) For 4 x 2 orientation, locate ~ C8 Q C6 BOTTOM CHORDS 5. Unless otherwise noted, moisture content of lumber shall not exceed 19% at time of fabrication. plates 1 /9'from. outside edge J 1 J8 J7 J6 of truss and vertical web. 6. Unless expressly noted, this design is not applicable for use with fire retardant or preservative treated lumber. *This symbol indicates the required direction of slots in JOINTS AND CHORDS ARE NUMBERED CLOCKWISE 7. Camber is a non-structural consideration and connector plates. AROUND THE TRUSS STARTING AT THE LOWEST JOINT is the responsibility of truss fabricator. General FARTHEST TO THE LEFT. practice is to camber for dead load deflection. WEBS ARE NUMBERED FROM LEFT TO RIGHT 8. Plate type, size and location dimensions PLATE SIZE shown indicate minlmum plating requirements. The first dimension is the width 4 4 9. Lumber shall be of the species and size, and x perpendicular to slots. Second in all respects, equal to or better than the dimension is the length parallel CONNECTOR PLATE CODE APPROVALS grade specified. to slots. BOCA 96-31, 96-67 10. Top chords must be sheathed or purlins ICBO 3907, 4922 provided at spacing shown on design. LATERAL BRACING SBCCI 9667,9432A 11. Bottom chords require lateral bracing at 10 ft. spacing, or less, if no ceiling is installed, "lndicateslocation of required WISC/DILHR 960022-W, 970036-N unless otherwise noted. continuous lateral bracing. NER 561 12. Anchorage and / or load transferring _ connections to trusses are the responsibility of others unless shown. 13. Do not overload roof or floor trusses with ` stacks of construction materials. BEARING Indicates location of joints at ® 14. Do not cut or alter truss member or plate without prior approval of a professional which bearings (supports) occur. engineer. M iTeko ® 15. Care should be exercised in handling, erection and installation of trusses. MiTek Engineering Reference Sheet: MII-7473 © 1993 MiTek® Holdings, Inc. FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number Art & Julie Robison BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 7904 Melvina Ave. CITY STATE ZIP CODE, Palermo CA 95968 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LLv� A.P.N. 026-230-018 DEC 13 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) DEVs LOPIM INk Residential (1,440 SF House) gEgVICES• LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( ##- ##9 - ##.##' or ##.#####) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Butte County 060017 Butte CA B4. MAP AND PANEL NIA. _ft.(m) O c) Bottom of lowest horizontal structural member (V zones only) B7. FIRM PANEL 0 d) Attached garage (top of slab) B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 06007CO995 C 6/&58 6/ 98 AE 1522 B10. Indicate the source of the Base Flood Elevation (BRE) data or base flood depth entered in B9. ❑ AS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BRE in 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area LOPA)? ❑ Yes ❑ No Designation Date_ Q SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ®Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations—Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.-aA below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum WA Conversion/Comments Elevation reference mark used RM 7 Does the elevation reference mark used appear on the FIRM? ®Yes ❑ No O a) Top of bottom floor (including basement or enclosure) - 155. 8 ft(m) O b) Top of next higher floor NIA. _ft.(m) O c) Bottom of lowest horizontal structural member (V zones only) WA . _ft.(m) o 0 d) Attached garage (top of slab) WA _ft.(m) E O e) Lowest elevation of machinery andlor equipment w iu servicing the building (Describe in a Comments area) 152, 3 ft.(m) E 0 f) Lowest adjacent (finished) grade (LAG) 151. 8 ft.(m) Z 0 g) Highest adjacent (finished) grade (HAG) 152. 0 ft.(m) 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 15 0 i) Total area of all permanent openings (flood vents) in C3.h 11496 sq. in. (sq. cm) /— SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION , a This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Michael S. Byrd RCE 28998 Reg. Expires 03/31/07 TITLE COMPANY NAME Civil Engineer Rolls, Anderson & Rolls ADDRESS CITY STATE ZIP CODE 115 YellowstoW4)nve'11___1 Chico CA 95973 — 2B (530) 895-1422 FEMA Feirm 81-31, January 200 See reverse side for continuation. Replaces all previous editions ,f PORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 7904 Melvina Ave. CITY STATE ZIP CODErmI Company NAIC Number I Palermo CA 95968 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑ Check here 'If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (VATHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement orencosure) of the building is _ ft.(m) _in.(cm) ❑ above or E] Wow (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6.8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.t on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA -issued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, Q and E are conect to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME COMMENTS CITY STATE ZIP CODE DATE TELEPHONE ❑ Check here 9 attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable ftem(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. ❑ New ConstrLction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: — _ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here 6 attachments FEMA Form 81-31, January 2003 Replaces all previous editions FEDERAL EMERGENCY MANAGEMENT AGENCY O. M.B. No. 3067-0077 °~ NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insuranotfigg" use: BUILDING OWNER'S NAME Policy NLOOCTNW Art & Julie Robison BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Co 0,I I u4mtibr) 7904 Melvina Ave. CITY STATE ZIP CODE JUbVXJ"Jriv=iv. Palermo CA 95968 SERVICES PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A.P.N. 026-230-018 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Non -Residential (864 SF Bam/Garage) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( #i - ## - ##.##' or ##.) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Butte County 060017 Butte I CA B4. MAP AND PANEL 152. 7 ft.(m) ❑ b) Top of next higher floor B7. FIRM PANEL ❑ c) Bottom of lowest horizontal structural member (V zones only) 89. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTNEIREVISED DATE B6. FLOOD ZONE(S) (Lone A0, use depth of flooding) 06007CO995 C 6/8✓rJ8 6/8>'38 AE 152.1 B10. Indicate the source of the Base Flood Elevation (BRE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BRE in B9: ®, NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ®No Designation Date_ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations—Zones Al -A30, AE, AH, A (with BRE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, ARIAH, AR/AO Complete Items C3. -a i below according to the building diagram specified in Item CZ State the datum used. If the datum is different from the datum used for the BRE in Section B, convert the datum to that used for the BRE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NIA Conversion/Comments Elevation reference mark used RM 7 Does the elevation reference mark used appear on the FIRM? ® Yes ❑ No ❑ a) Top of bottom floor (including basement or enclosure) 152. 7 ft.(m) ❑ b) Top of next higher floor N/A. _ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N/A.. _ft.(m) • d) Attached garage (top of slab) NIA _ft.(m) ❑ e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) N/A. _ft(m) O f) Lowest adjacent (finished) grade (LAG) 151. 0 ft.(m) O g) Highest adjacent (finished) grade (HAG) 152. 3 ft.(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 a) U) a N O E W iv E Z' N J O i) Total area of all permanent openings (flood vents) in C3.h 0 sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Michael S. Byrd RCE 28998 Reg. Expires 03/31107 TITLE COMPANY NAME Civil Engineer Rolls, Anderson & Rolls ADDRESS CITY STATE ZIP CODE 115 Chico CA 95973 (530) 895-1422 FEMA For -3 , January 2003 See reverse side for continuation. Replaces all previous editions L IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 7904 Melvina Ave. CITY STATE ZIP CODE Company NAIC Number Palermo CA 95968 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑ Check here 9 attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6.8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and CW on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone A0 only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA -issued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and Eare conectto the best of my knowledge. OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS SECTION G - COMMUNITY INFORMATION (OPTIONAL) Check here 9 attachments The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _. —ft(nn) Datum: G9. 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