HomeMy WebLinkAbout026-230-056Fu
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RESIDENTIAL
26-23-56 99-91B,P,E,M
CLARK, Jenny
2340 Louis Ave, Oroville
Contr: Doyle Carter
(new sf )
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OFFICE COPY
Address
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GAS
Meter By Date
a ELECTRI
Meter By Date
r;
{
JOB FINALE
Signature
v=OK
O = Not OK
=Not Applicable MOBILE HOMES
' =Not Ready � � r
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-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / P L" ft.
/ /"Nat. or/ PV'ft./ /"LPG .`
7. Utilitv 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. Exits; Insp.-Sketch
10. Cert. of Occupancy
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg.-Rfg.-Br$cing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -.Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.;Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
d=OK`
O=Not OK
- = Not Applicable
Not Ready RESIDENTIAL (Single & Duplex)
�
Date UND FLOOR (Plans) OK except #'s Date FRAMING (Continued)
Zo ing-Setbacks-Easements-Flood-Slope 455 Hangers -Post Caps -Anchors -Connectors
, 2el tg., Main; Soils-Elec. Grnd. /" Ftg. Depth 01'k-
3.fttt-Garage; Soils-Steel-Elec. Grnd.-/M" Ftg. Depth /
Date
5 Stemwalls, Main; Steel -Blockouts-Wrapped
6-Sfemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
.. .W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
T Tomas Pipe; Size-Anc ors
/,Yt: Water Ripe; -Anchor-Regulator-Service Test
12. Electric; Underground
4e"Pienums & Ducts; Clearance -Material -Support -Ins.
f✓ 14,,Girders-Sills-Anchor Bolts -Joists -Vents -Cripples
( /f5. Insulation
Card 13-16//�&_ Date Card B-1
Card B-1 _,40.�_ JDate Card B-1
Water Htr.; Vent -Access -Combustion Air -Baffle
Water Pipe; Test & Anchor -Nail Protection
D.W.V.; Test -Fittings & Anchor -Nail Protection
er Pan; Test, First Floor -Tub Access
20.,Test Tub & Shower, Second Floor -Tub Access
Pipe; Size & Anchors
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Elec. Receptacles Spacing -Lights & Switches at Doors
. Size Boxes & No. of Conductors -Stapled
5. omex Installed Close to Edge of Studs & C.J.
. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water
27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga.
Cu or AI
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral 13 Yes ❑ No
0. Service -Riser Conductors & Ground -Main Disconnect
1 quip. Clearances Panels-Motors-Mech. Equip.
si,Clothes Closet Light -Shower Light -Spa Light
433/Smoke Detector
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
.v -R C. ucts Insulation & Support
3 ant Fan; Exhaust above insulation
densate Drain & Overflow; Size & Grade
7. Furn nce-Vent; Access -Comb. Air -Return Air Vent -115 outlet
ttic Access & Platform if Furnance in Attic
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
�39!Sils, Proper Material & Anchors
alls Studs -Nailing, Spacing & Bracing -Plates -Sound
Bearing Walls over Girders & Floor Nailing
rat Stop in Walls (rat proof)
ire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Headers & Beam -Size & Bearing
Joist-Rftr. ties-Purlin—roof Brac-
dace Ties or Type A Flue -Fireplace Throat clearance
is Access; Size & Romex Protection -Draft Stop -Ins. Baffles
r drm. Windows or Exiting Doors -Sill Hgt. & Dimensions
arage Fire Protection Framing
51. Property Line Firewall & Openings
Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits
- 53. airs; Width -Headroom -Rise -Run -Landing -Fire Protection
54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
55. Siding -Nailing Veneer
tucco Mesh -Drip Screed -Fd. Vents-Underfir. Access
7. lazing Area -Glass Protection -Skylights -Plastic 19
58. fiear Walls; Nailing -Bolts
Insulation -Walls -Ceilings
60. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date -rj Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
xt. Steps -Door & Sidelight Protection -Landings
Smoke Detector
urnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
Bedr Exiting
G.F.I._�_Bath Fixtures & Tub Access -Spa
�c. Trim & Subpanel; Breaker Sizes & Labels
Stairs & Rails
replace or Stove; Clearances -Hearth
ec. Outlets at Wood Panel; Int. & Ext.
. . ixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
ec. Outlets & Receptacles at Kit. Counter
arage Fire Door; Swing -Landing -Closer
r<-72-PrC. Duct in Garage -Damper
r. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage; Above Floor-Mech. Protection
Elec. & Mech. Equip. Listed for Location
36--Ere—c. Recqp1grJes in Garage; (G.F.I.)-Romex Protection
sulation-Foam-Looked in Attic 0 Yes
uard R ' & Deck Construction -Post Caps
7 -n Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
ft-fo-Tro—wing instld.; Drive 0 Yes No; Walks ❑ Yes o;
Planters 0 Yes ❑ No
rown-Finish
Unit; Disconnect, Electrical, Plumbing
83. Vents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
QaAnings
Water Well; Disconnect, Electrical, Plumbing
WE or Elec. Trim; G.F.I. Receptacle -Underground
VeRKation Throughout House
K ctions from Previous Inspections
8 . T i -Meters Tagged; Gas -Electric
er & Sewer Connected -C/O to Grade -HD Approval
Energy Compliance Certificate -Other Certificates
V*W r (' _&S
Date Card B-1 Date Card 6-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
(NOTE: An entry must be made each time you visit job site)
COUNTY OF BUTTE _...a
DEPARTMENT OF PUBLIC WORKS -`
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you,have any question pertaining to this
or need additional explanation, please contact this office immediately.
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Date '; Z� Inspector
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7-Co6nty Center Drive, Oroville — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
OWNER i PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
w
Date '��� Inspector
..t1�1 AF
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
r -ql
0Wr4ER PERMIT N0.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of.work is completed. If you have any question pertaining to this
maker, or nee additional explanation, please contact this office immediately.
V
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Date , ` �1 spe • In ct r
_
.' ENERGY INSTALLATION CERTIFICATE
Building Owner
Building Location
Building Permit #
DESCRIPTION OF INSULATION
ROOF
Material
Thickness(inches)
XTERIOR WAL
terial
Thickness(inches)
ILING
/Batt or Blanket Type
Thickness(inches)
Loose -Fill Type '
Minimum Thickness(Inche ) e_—
Area covered(ft.2)
FLOOR, ELEVATED_
Material _
Thickness(inches)
Z 9 -
FLOOR, SLAB
Material
Thickness(inches)
Width(inches)
FOUNDATION WALL - - -
Material
Thickness(inches)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance(R Value)
Brand Name
. Thermal.Resistance(R Value)-.
Brand Name .
Number of Bags Wt. per bag lb.
Thermal Resistance(R Value)
Brand Name
Thermal, Resistance(R Value)
Brand Name
Thermal Resistance(R Value)
Brand Name
Thermal Resistance(R Value)
I hereby certify that the above insulation was installed in the above building,
is consistent --with approved -building -department plans -and -attachments- and--con-
forms
nd--con forms with requirements of Chapter 2-53 of State of California Energy Requirements.
FIRM NAME/OWNER
SIGNATURE OF INSTALLATION APPLICATOR
STATE CONTRACTOR'S LICENSE NO.
DATE
I hereby certify the required features, devices, and equipment, a6 shown on the approved
Building Department -plans -and attachments have been installed and conform to the appli-
ance standards and Chapter 2-53 of the State of California Energy Lequirements.
;.4 DoU fie, C' �' _ '� E r �P6ses d
VBUILDINCONTRACTOR/OWNER (Please Print) STATE CONTRACTOR'S LICENSE NO.
(FIRM NAME)
TU F B 'LD CO ACTOR/OWNER 'DATE
HVAC FIRM NAME/OWNER (Please Print)
SIGNATURE OF HVAC CONTRACTOR/OWNER
STATE CONTRACTOR'S LICENSE NO.
DATE
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL INSPECTION
APPROVAL AND A COPY SHALL BE POSTED WITHIN THE BUILDING.
SEPTEMBER 1988
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
99-91
ASSESSOR PARCEL NUMBER
26-23-56
ZO
TJ NI G
BUILDING PERMIT
OWNER
T Ev. W Pr F1 o E
532-0426
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
28 Mpna Ile 6
D
1324 R
52,96U
320 M 4,480
CONTRAC TOR•SN ME
TELEPHONE
533-3810
194 cov
1,940
CON A TOR'S MAILING ADDRESS
PO _R Ile 95965
Fireplace "A" 1,000
CONSTRUCTION LE DER
UNKNOWN
Total Valuation I $
60,380
LENDER'S MAILING ADDRESS
Filing Fee
$
10.00
Permit Fee $
316.00
ARCHITECT OR ENGINEER
LICENSE No.
Plan Checking Fee
$
158.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
15.00
Penalty $
BUILDING ADDRESS
2340 Louis Ave, Oroville
Permit fee
$
A2L.00
PLUMBING PERMIT
Filing Fee
10.00
Each Trap
2.00
18.00
Solar or heat pump water heater
20.00
.
LOT NO.SUBDIVISION
5
NAME - -
Palermo Citrus Tract
PARCEL MAP
A/4 l j'�
Water piping
5,00
5.00
Each qas water heater or vent 5.00
5.00
USE OF STRUCTURE
SF X❑X Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
5.00
Building sewer 5.00
5.00
Mobile Home I S I G JW 1 10.00e
TYPE OF WORK
New a Addition❑ Remodel❑ Utilities❑ Installation❑ Other
Describe work: 2 bdrm
Permit Fee $
48.00
Contractor
ELECTRICAL PERMIT Filing Fee
10.00
Main service 8001 OR LESS
100 AMP OR LESS
10.00
10.00
CONTRACTORS LICENSE LAW
1 de la under penalty of perjury (Check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER
and Professions Code and my license is in full force and effect.
License No. � Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract -
ors. (Sec. 7044)
❑ I am exempt under Sec. Business and Professions Code
for this reason
Main service EA. ADO'L 100 AMP
2.50
2.50
NEW CONST. ( DWELLING Oc1(6V4&) 2yz¢sgft 41.10
OR ADDNS. ACC. BLDGS.
NEW CONSTR. ULTI.OUTLET
NON.R ESID BRANCH CIRC ITS 2.50 ea
APPARATUS &I
1 SINGLE OUTLET CIR.
Ex. Occup(ouTLETs OR FIXTURES SALO20@30AL®30
FIXED APLNS.
Ex. Occup. OUTLETS PRESID )REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $ 63.60
,
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ . The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL P RMIT Filing Fee
10.00
Heating
6.00
CoolingL-Vql)10.00
Hood 3,00
3.00
Ventilation 3.00
3.00
perm $
it Fee
32.00
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.,
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X J(�S,C)Lnr� ti'- �C'in �Q n� Date -1 _�' I
Signature of Applicant} • Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $ 30.00
CONSTrv�E
�7
TOTAL FEE $ 672.60
HA
i
CUA
PARK
sc
AR
RD
D ISSUE
Th;s permit is nereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO OF ?)BLIC
BY
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Receipt No. 83929 - 21�.`00// 39
WHITE-D.P.W., YELLOW-ASSESSCM. P'iNK-INSPECTOR. GOLDENROD -APPLICANT
PER EXPIRES Date
7- 9 L
. t
COUNTY OF BUTTE - DEPARTMENT OFtPUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILL&E, CALIFORNIA 95965 - TELEPHONE: 916/536-754,1
PERMIT APPLJCATION DATA SHEET
Permit No.
OWNER. r h Yt' GCA P17�
Proposed Building Use Building Inspector Date az'
At time of permit application, I was advised the following data must be submitted prior -to permit processing and/or issuance:
} t DATE RECEIVED APPROVED
1. All items .have been submitted. .................................
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. CompleteEplans in duplicate/triplicate, signed by preparer. of plans . .
4. Complete engineered plans and calcs, with wet signature on plans ..
5. Hazardous Material Form ......................................... .
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings
8. Engineered truss details and layout in duplicate (required prior top lan check)
Mobileho'me installation data including manufacturer's installation
instructions.. � ►.GO.�....................................
10. Fees of $' Q ........................
11. Chico Urban Area fees paid ........... ..........................
12. Park fe rpaid.......................................
3. � M 1 0 M SS DOI DisM1ric es paid .............. 2 --2 i
14. San itation'16pproval from C�C-� �� / C�` Health Department 2 —21-
15
21 15City of Chico•plumbing permit .....................................
I� 16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) LU e: (B) Parking: ......
- 8. Improvements may be'require&Contact Land Development Section DPW
�A9. Driveway permit (construction approval required prior to occupancy)
If 20. Pre -Inspection for required ... Pre-inspec. request to
Building Inspector (Date)
21. Contractors license information (No., Name Style, Classifications ...
[ 22. Certificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .....
24. Recorded copy of Agricultural Acknowledgment Statement ......... Z- 2)
25. Letter of signature authorization ........... ..................... .
d 26.
C 27.
Wh n you issue the permit, rocess as follows: Mail to owner. Mail to contractor.
Telephone nd hold for pickup at office. Deliver w.
/inspector.
Other
ff
Applicant &A .Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. _Fire Dept. Other Date By
I.
I,The following data must be submitted rior tf� permit issuance: (Circle new item no checked ab ve).
1. Index permit for above items No. �le: L'au,0u er JewS this �arcle in �j100 21004
2. Additional items requi Pv�r ��ioa Ic�o�< of flood vnm� it ;,5 u -t
ig
designer, owner, was advised of above required data by v phone--nail_counter by
{Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by Date/il'�YPlans approved by Date
Copy 17
DPW
Sets of plans on hold in File cabinet AP folder
TO Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
Owner Location AP#
Plan Approved for:
Hold final for:
Sewage Disposal
Final clearance O.K. for:
Clearance for bedroomiggpM home. Other
NOTE * * *
Water Supply
Water Supply
Water Supple
Date
Sanitarian
0�
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
q Q �_w
ASSESSOR PARCEL NUMBER
05� -Q.SI-D
ZONING
BUILDING PERMIT.
OWNER
e 0-
TELEPHONE
3a-o�la�
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
U m.o- Q. nqS1
CONTRACTOR'SNAME
TELEPHONE
CONT ACT R'S MAILING ADDRESS , p
j > V �e
CONS R CTION LENDER UNKNOWN
Fireplace 1�
Total Valuation Is
QQQ
LENDER'SOMAILING ADDRESS
ARC CT OR ENGINEER LICENSE No.
Filing Fee
$ 10.00
Permit Fee
Plan Checking Fee
$ 1
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
v
Penalty
$
BUILDING ADDRESS
L4 o 0Ll (. C. O U t
Permit fee
$ D.
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2,00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
e cro -Ui
PARCEL MAP
Water piping
5,00 O
Each qas water heater or vent
5,00 O 0
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
- SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
[10.00 ea
TYPE OF WORK
New Addition ❑ Remodel ❑_s/�Uti tie El❑ Other
InstallationE]
work:y� ❑
r
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 1101 OR LESS
100 AMP OR LESS
10.00 f `D
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions Of Chapt. 9, Div. 3 of the Business
and Professio s Code ^and�. 1my license is in full force and effect.
License No. � r7 �r Classification
❑ 1, as the owner, or my employees with wages as their sole compen-
satiC'n, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract -
ors. (Sec. 7044)
❑ I am exempt under Sec. Business and Professions Code
for this reason
Main service EA. ADD'L 100AMP
2,50
NEW CONST. DWELLING OCCUP
OR ADONIS. ( ACC. SLOGS.
V1 tsgft
NEW CONSTR. r ULTI.OUTLET
NON.RESID BRANCH' CIRC ITS
2.50 ea
POWER APPARATUS e
(SINGLEOUTLETCIR. )
Ex. Occup( OUTLETS OR FIXTURES
9A 030
Ex. Occup. ouTLETS PRESID.)REA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
�y I shall not employ any person in any manner so as to become subject
�l to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling ella
Hood
3,00
VentilationD_2M
Permit Fee
Contractor
$
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinancss and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
XThis
Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ i
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
30 00
occ
CONST TYPE
/
TOTAL FEE $ (�
HA2
I CUA I
PARK
I SCHL
FLD
PAR Po
HD Issue
permit is nereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable pro vi -
resolutions to to
have been paid.
WORKS
Date
Receipt No. J
WHITE-D.P.W.. TE74Asoa T f.OLDEHRaD-APPLICANT
• 5/89
RESIDENTIAL PLAN CHECKING GUIDE
MISCELLANEOUS ITEMS TO LOOK OUT FOR (CONY D)
Exterior plaster - weep screeds (Sec. 4706).
Proper roof pitch for roof covering (Chapter 32).
Roof covering type - (fire hazard)..
Rafter ties or bearing ridge beam.
Garage door or porch header sizes.
Adequate bracing.
. Living area over garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
-: Two exits on three-story dwellings (Sec. 3303 & see Mezannines - 1716).
Attic access and ventilation (Sec. 3205).
Underfloor access and ventilation (Sec. 2516)... .
. Combustion air for fuel burning appliances..
. Noise requirements on duplexes.
. Adobe soils-- special foundation design.
. Retaining walls requiring design.
nusual shape, size, or split level house requiring lateral design.
ashing at all exterior openings.
6f
---OWNER
RESIDENTIAL PLAN CHECKING GUIDE
(S.F., DUPLEY & MISC. ONLY)
5/89
GENERAL --
.•-T"" Zoning requirements: (sideyards and number of permitted living units).
_ Valuation.
.,3-. Plans signed by designer.
,A-`� Energy Design and Compliance.
Existing violations on property.
Items on data sheet. .
PLOT PLAN
mplete parcel size and dimensions.
--Z-.—Setbacks, sideyards, easements, etc. '
_-1---Other buildings or structures. 7
_
Grading, fills, drainage. -
Flood hazard.
Special conditions on creation map or compliance document
--7— FAU & FAS road setback. ,
FLOOR PLAN i
/complete to scale plan with dimensions.
Required windows for light and ventilation (Sec -...1205)..
'Required windows for second exit (Sec. 1204).
Skylights (Chapter 34 & Sec. 5207).
Human impact glass (Sec. 5406). .�
7- Required room sizes, ceiling heights (Sec. 1207)._. -
r' GFCIs in baths, garage, and exterior outlets-..(Ar-ticle 210-8)
Light fixtures, switches,- receptacles, and exterior receptacles for maintenance
of mechanical -equipment.
' .Locations of water heater, heating and cooling equipment, other. electrical or
gas equipment, and plumbing fixtures.
9-. Garage firewall, door size, and closer (Sec. 503(d)(3)).
t-.-1 - 3'0" exterior exit door (Sec. 3304(e)).
Fireplace and wood stove location, alcoves, and clearance.
B--.--'5moke detectors (Sec. 1210).
STRUCTURAL DETAILS
Foundation plan complete enough to construct building.
'Floor construction details complete enough to construct building.
Elevations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
- Fireplace construction details and calcs if necessary.
MISCELLANEOUS ITEMS TO LOOK OUT FOR
F
tairway details: landings, rise and run, head clearance, handrails (Sec. 3306).
uardrail details (Sec. 1711 & 3306(j)).
Brick or stone veneer (Chapter 30).
,�,.� T .. ._.-, � _ .. � . _ .�- T-,•,,����,�'�"4.is"Sr+,y�;,.'t"t7+a'i.+'�y'�"Jtilyc+tir'A"i.`4 cs,�M.FT(sK4:ia^"`•``;'Y'�n,s�,.`rl`+h.-�w<n�,s ,
BUTTE COUNTY -SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
'7(One Form "per Building) �
A.P. Number � �(� Building Department No.
School District 0(0 UM Q V't City County Jurisdiction
Property Owner
Project Location/Address �( �� r® V
Subdivision Lot Number
Residential Development: a
Sq. Footage
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: a Sq. Footage
New Addition (Including Exterior
Roofed .Areas )
Buildi'"g** epartment epresentattve 'Da e' '
(Floor Plans reviewed by School District Personnel)
10 6A
Ji- rict Id No.
(Apel'cant Name)
X46
4 treet Address)
School District certifies that
one Number
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. D
by th payment of $ representing 30� square eet.
School Dist ct Re esentative D to
-
PAID BY CHECK NO.
BANK NO
REMARKS:
j PAID BY CAS
White -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
4. The land referred to in this policy is situated in the State-of 9 1 — 0 6 1 6 3
�,
Q' Bg]t.te, and described as follow!li form a County of.
Parcel It .
Lot 5, ire .Block 56, of Subdivision No. 1, of the PALEMid CITRUS
''PACT, as shown on 'that certain r.ap, filed in the office of the
Recorder of the County of Butte, State Of Ceti Porn .a., February 28,
1-880.
Parcel IIs
A .right Of Way for read and public 'uti..ities described as €csliGWS'.
CO=If-MICzINC at the Scut-h.west- cornea. of Trot 3 of Block 61 cif
STME T- t TSION No. 1 or THE PAT,B".1 ? CT"MUS '.''PACT, according to tale
Od A.e'-C'al tga:l, is"'rp-o£ Mec n f-,�_ , .
the Ve-co-rder o€ H)e
County of F�de't:tr�:, State of rti�1 r^^. cIi�ptatar_yr 28, 1.34, using
(Cont ir)W-2'?
y
L�d3irY;1091itTc�iii.f.:il P Vit:?_^; `'n, C:1:(r.r
��`rr�I?ia11,'k' (?� f'l.It:°S�^'�`.(",,;lti�.•`
'Countersig Ped:
I� CLTA Standard Coverage Policy Form
i Schedule A "
run nunzca vn icer or Agent
=1
Attached to
609--0€32787
DESCRIPTION
Number
V-10522 —BE
also the centerline of Louie Avenue; thence along said centerline of Louis
Avenue, South fag° 55' 16" Last, a distance of 2n feet to the true point of
beginning for the parcel herein de,,,crihed; thence front said point of
)-)ag1nning, Tiorth 0011 03' 17" Can. ' diSt I'lM of 206.00 feet; thence north
891' 55, 16' T,e:tat, a distance of 20 root to a point: in the west line of said
Trot 3, thence along the West line of said Lot 3, Vorth 00" 03' 17" East, to
the fiorthweek..cornerr of said Lot 3: thence South 69" 55•"50* least, along the
Borth lire of said Lot 3, a dis tvmcce of tin feet:; thence I -pa •ing said �-Torth
line South 000 03, 17" trent, a di -stat ee cf 1.30.61 fteat; tbenc:e South 890 55,
16" Last, a distance of 20 fecL; thence South 001 03' 17" West and parallel
to the gest line of said Lot 3 to) a point in the centerline of 7.,oui.s Avenue,
which lies South ago 55, 16" hast, 60 feet from the point of beginning;
thence along said centerline of Louis Avenue, North 890 55' lfi" 'lent, 60 feet
to the point of hoginning.
rarcel. TIT.
?k right of way foo coal c,,nd public ut il.iP;.y p�.rrpor3e,, over the routs 60 feet of
.P.Yt T'o t 611 tart. T,ot 7, in �?c)c h ±1� rr- 0-tT r)T, r'tOi! t7f?. 1 C SSC i' iaLR�iQ
CTTR.T -1 TRACT, accc,)rc;ing to the 03"fi.c:ia.1 ?tap thereof filed in the office of
:the recorder of t1he County of ut:tef State of California, on rabrrua ry 20,
J. i3 i3 if.
EN® OF DOCUMENT
9 1 -06 163
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEiENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8.1 of the Butte County' Code-
requies this acknowledgement be recorded
prior to issuance of a building permit. ,
The property described herein is adjacent
91-006163
. Rec Fee
7.00Cas
to land or included within an area zoned
I Recorded
Rec
h
7.00 '
for agricultural purposes, and residents
Official Records
of this property may be subject to incon-
County of
veniences or discomfort arising from the
Butte*
;
use of agricultural chemicals, including,
Candace J. Grubbs
but not limited to herbicides, pesticides,
Recorder
and fertilizers; and from the pursuit
8;01am 19 -Feb -91
CD 2
of agricultural operations including,
but not limited to cultivation, plowing,
\
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise, and odor. Butte County
has established
agricul-
tural zones which. have as a priority use for
productive agricultural
purposes, and residents
within said zones and on adjacent property
should be prepared to accept
such inconvenience
or discomfort from normal, necessary farm operations.
All 'fhat .real property..'* situate in the County of Butte, State of California, described as
follows:
r
t� Date:Q-1-
<<
State of CAP. )
SS.
County of 5UJ4G4r )
0 (V -I3d —o5L-a
Present A.P. No.
PROPERTY OWNERS:
On this the 134'e'day of Feb rua N , 19 q/ , before me, the
undersigned Notary Public, personal y appeared
g -co n U lark
El Personally known to me. V Proved to me on the basis
of satisfactory evidence.
to be the person(s) whose name(s) S e
subscribed to the within instrument and acknowledged that
executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal.
6
Lim
T
a)
mu
LL =j
O criC-2
00
Do
W
L
V..
G
+
n
BUILDING DIVISION Obb ,�
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICLTz'*!!v;,s,'-
7 COUNTY CENTER DRIVE — OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 5 1 fi?'
a . AGRICULTURAL Bt-ALDING EXEMPTION PERMIT P
P MIT NO.
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public.
ASSESSOR PARQEL NO
ZONIN
OWNER
PHONE NO.
-zS,-2- _0 " �.
OWNER'S ADDRESS
LOCATION OF BUILDING
C
_ :1 f
USE OF BUILDING ,
�k� 0 'VL
SIZE OF STRUCTURE
SO. FT.
TYPE OF CONSTRUCTION: may,
WOOD FRAME —)�— STEEL CONCRETE --'?<— OTHER (Specdy)
TYPE OF SIDING
I --1 "-1l
ROOF COVERING
�u
FLOOR TYFE
� 2C) �.
—
ESTIMATED COST OF CONSTRUCTION
$ L.{ RC1 <.�3 0
AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances
as follows:
FRONTa ,4--. 'L SIDES /'L� If
/17
REAR
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building.
AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a
mobilehome, and 40 feet from a commercial building.
AG Buildings must comply with Flood Zone requirements. Finish floor elevation must be at or above elevation
USGS Datum.
I declare under penalty of perjury that the building will be used as stated above and the purposed use conforms with the AG
Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and obtain
any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy.
Date �� `"�� Signature of Owner L ---
Permit Fee - $50.00 The above described AlBuilding is exempt from a building permit. f.
Receipt No. 1.295-15(0
Manager Building Division
BY9Date Il 3- F °�
White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant
'COUNTY OF BUTTE
7 COUNTY CENTE'D I'VE
OWNER
II
Proposed Building Use_
rMEIyT OF PUBLIC WOkA 'rBUILDING DIVISION '
ORCTAI,�E, ,ALIFORNIA 95965 - TELEPHONE (916) 538-7541
k
PERMIT APPLICATION DATA SHEET
P. No. 0. ?6 a 30 - o�
Building Inspector A Date / / " -? Z -
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1.
All items have been submitted . ....................................... .
2
Plot plans, 3/4 sets, signed by preparer of plans . ......:.................. .
3.
Complete plans, 3/4 sets, signed by preparer of plans.
4.
Engineered plans and calcs, 3/4 sets, with wet signature on plans. .............
5.
Hazardous Material Form . .............................................
6.
Energy Design Compliance and supporting documentation. ....... x-
7.
Statement of Intent for Non -Heated and A/C Buildings . ......................
- 8..
Engineered truss details and layout in duplicate (required prior to plan check). ... .
Ii 9.
Mobiletiome data and manufacturer's installation instructions, 2 sets. ....::..... -
I 10.
Fees of $ ...............................
i� 11.
Impact fees as shown on attached schedule . ..............................
12.
California Department of Forestry plan approval/fees. ........ ................ . .
13.
Flood elevation letter (100 year flood) by California Engineer .................... .
II 14.
Sanitation and plot plan approval Health Department. .............
15.
City of Chico plumbing permit . ........................................ .
16.
Plot plan and business license approval from City of Biggs/Gridley. .............
AI 17.
Planning approval for (A) Use: (B) Parking:
I' 18.
Contact Land Development about (A) Improvements (B) Drainage. ......... .
19.
Driveway permit (construction approval required prior to occupancy). .. ... ... .
20.
st
Pre -inspection for required. .. to BuildinggI�speaor (Date)
21.
Contractor's license information. (No., Name Style, Classification) . ............. .
22.
Certificate of Workmans Compensation Insurance . ..........................
23.
Owner -Builder Verification (Given to owner , Mail to owner ) ............
f 24.
Recorded copy of Agricultural Acknowledgement Statement . ..................
25.
Letter of signature authorization. .........................................
..................................
26.
far. I,
Copy of recorded deed of parcel creation and 60 right of way to a public road. . ....
• 27.
Letter of intent on building use . ..........................................
28
Mobilehome utility clearance. ..........................................
I 29.
Documentation of legal access . ........................................
30.
Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . .............. .
31.
Existing violations/expired permits . ......................................
l 32.
Plan check list. .........................................
33.
�� 34
WoWu issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector.
h
Other
Parcel Creation AA
Acreage" Applicant WAS MARCO Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of'plans sent Health Dept. Fire Dept. Other Date
r"The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index"permit for above items No.
1`1. Additional items required: '
LIM
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by_phone _ mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
-- - -Certificate of Compliance: Residential
Climate Zone Il
Project Tltle _
it
Building Permit 0
-77:
- -- -
PruJeR Addrm—
i/moi... ./ : '. �% .o. 7✓Yrl ~checked By/ Data
tattoo Author
BUILDING DATA
Conditi ea a
Slab 'sed Floor _
WSingle amily Detached (SFD)
[ ] Single Family Attached (SFA)
[ ] Multi -Family (MF) .
Telephoner
BUILDING SHELL INSULATION• .
Component Insulation - LAcadoryCgmme:us
Type R -Value (ander, to gmga, e ireL etc.)
Wail.............. ..............
...
;-Roof ..........
EnloroQnent Agency Use Otaly
Glass Area 9b Gloss
Mandatory Measures Checklist: Residential MF -IR
NOTF_ Lo -r= residcndal buildings subjeet to the Sandareu mus contain these measuet rcpxilless of the compliance.
_.._.�.,-�.•-- �.�.�_....�, approach usad..ltems marked with an sstcsk.(') may be superseded by more sasntest urnplianoe requrrmsests 6stnd
.. _ _. on the Ceufr"^ of Compliance. when =tis is ineorperaied into the permit documents, the features Dowd sma-
-- as binrangminanum compondm perfomw" spoof •'ions far the Drandatory meurires
-- - - - . _--.---.,nasty•thcrae•s1»wn-dvewtsaein4feooaumnsts arondsisctxdtisCastr ".— =_ :^...-.-.^••.•-"'�---__-
North
Number of Stories
East
Number of .Units
South
[ ] Addition -Alone
West
[ ] Existing Building
Skylight
[ l Existing -Plus -Addition
Total
BUILDING SHELL INSULATION• .
Component Insulation - LAcadoryCgmme:us
Type R -Value (ander, to gmga, e ireL etc.)
Wail.............. ..............
...
;-Roof ..........
EnloroQnent Agency Use Otaly
Glass Area 9b Gloss
Mandatory Measures Checklist: Residential MF -IR
NOTF_ Lo -r= residcndal buildings subjeet to the Sandareu mus contain these measuet rcpxilless of the compliance.
_.._.�.,-�.•-- �.�.�_....�, approach usad..ltems marked with an sstcsk.(') may be superseded by more sasntest urnplianoe requrrmsests 6stnd
.. _ _. on the Ceufr"^ of Compliance. when =tis is ineorperaied into the permit documents, the features Dowd sma-
-- as binrangminanum compondm perfomw" spoof •'ions far the Drandatory meurires
-- - - - . _--.---.,nasty•thcrae•s1»wn-dvewtsaein4feooaumnsts arondsisctxdtisCastr ".— =_ :^...-.-.^••.•-"'�---__-
THERMAL MASS
Type/Covering Area Thickness :
(slab/exooscd, tile, etc.) (Sf) (inches) Locadon >scripdon (kitchen. bath, etc.)
HVAC SYSTEMS hiirimum Duct
Type (furnace, air Efficiency Location Duct Output Manufacturer / Model #
connd`iciioonncr.. hes urn) (SE, SEER,HSPF) (attic, etc.) R -Value Luh or approved equal)
i
• I
Maximum Furnace Heating Output: Btuh
HOT WATER SYSTEMS Tank Manufacturer/Model #
System T (starage gas, etc.) Capacity (or approved equal) Special Feature(s)
S C7
i
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) j
t
DESCRIPTION DESIGNFJt ENFORMAENT ._... _ .
Buitdint EnvrlopeMeanurrs '
' 12.5352(3)r- Minimum ceiling inauluion R-19 weighted avenge•
12.5332(by. Lohse fail insulation manufanurct'a Labeled R -values
' 12.5352(c): Minimum wall intubtion in framed walls R-1 l weighted avrtate (does not apply q
cstcnor nuss walls).
12.5352(k): Slab edge insulation- water absorption rate no v=ucr than 0.3%. water vapor
tnnsmtsston rate no grater than 2.0 perm(mch.
12.5311: Insulation spectfied or installed meets California ErxM Commission (CECT quality
sundards. Indicate type and form
12-5352(t): Vapor barriers manmrory in Climate Iona 14 and 16 only.
12.5317: lnfiltnsioWEtfrlrntion Controls
a. Doors and windows between conditioned and unconditioned spaces desiped to limit air
Icakage.
b. Doors and windo•rs certified
e Doors and windows weatherscippcd: all joints: and pencauions caulked and sealed
12.5352(e): Special infiltration barrier irsultcd to comply with 12-5331 mous CEC quality
standards
12.5352(d): Instillation of Faeplams '
1. Masonry and factory -built fsrcpbccs have
a. Tight fitting. closeable metal or glass door
b. Outside air intake with damper and conal
c. Flue dampa and control
7- No continuous burning gas pilots albwed
HVAC and Plumbint System Measures-
12-333 atd2.5303: Spacecotdidonin equipment 2(g) g W pmrnt aiaimg: attach calctdaCOM1L
R-53520)"2-5315: Setback thamwux on all applicable heating systems.
• 12-5316(a): Ducts constructed, installed and insulated per Chapter 10. 1976 UMC --
12.5316ft Exhaust systems have damper controls. .: - .
12-5314(c): Gas-fired spats heating equipment has intermittent ignition desires.
12-5314: HVAC cqW prrw-m water heaters, showerh=& and faucets certified by the CFC _
12.53520: Water hea=r insulation blanket(R-12 a gear=) or combined interiokaecrior -- `-
insulation (R-16 or Srcucr). first 5 feu of pipes closest to tank insulated (R-3 or greater).
12.5312(Exccption 1): Pipe insulation on steam and steam condensate return tit recirculating
piping-
12-53111(d): Swimming Pool Heating -
1. system mss -
a OvVoff switch on heater.. - -
b. weatherproof instruction plate on hate.
c Plumbed to alb- for solar.. -
L 75 percent thcmul ctGciency..
3. Pool cove.
e. Time clock. _ = - -
5. Directional water inlet.
Ulghtint and Appliance Mcncuro
a 12.5352gx Lighting - 25 lumens/watt or greater for gcrcral lighting in kitchens and bathrooms.
12.5314(c): Gas Cued appliances equipped with intermittent ignition deices.
12.5314(a): Refrigerators, refrigerator -(recurs• freezers and fluorescent lamp ballasu certified
by the CE -C. Indicate make and model number. w....
COMPLIANCE STATEMENT
- Roof ............
_
t
Tide 24. Chapter 2-53 and Title 20. (Imptcr2. %bctupter 4. Article 1 of the California Administrative code This
certificate has been signed by the individual with overall design resperisibility and the building owner. who shall
retain a copy of it and transmit the
outificau to tiny subsequent purchaser of the building.
t Designer
.............
Nuec
!
rtttefF-trrrs:
Address-
-Slab Edge...:.:....
TekpSone
7. 71 ' Telephone
,. GLAZING'_
Shading Devices ;
""'Area
Glazing' "
- �'� Area
Glass Type - Interior Exterior . Overhang FramingType -
-_ Enforcement Agency
Orientation
(sf)
(single, double) (Eviler blind, etc.) (shadescreen, etc.) (yes/no) (metal/wood)
- _. ACcncy:- :.:
,,.NO rLh
East (
)
East
Soutyh, (
)
-
South
West
West
Ve li ht
THERMAL MASS
Type/Covering Area Thickness :
(slab/exooscd, tile, etc.) (Sf) (inches) Locadon >scripdon (kitchen. bath, etc.)
HVAC SYSTEMS hiirimum Duct
Type (furnace, air Efficiency Location Duct Output Manufacturer / Model #
connd`iciioonncr.. hes urn) (SE, SEER,HSPF) (attic, etc.) R -Value Luh or approved equal)
i
• I
Maximum Furnace Heating Output: Btuh
HOT WATER SYSTEMS Tank Manufacturer/Model #
System T (starage gas, etc.) Capacity (or approved equal) Special Feature(s)
S C7
i
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) j
t
DESCRIPTION DESIGNFJt ENFORMAENT ._... _ .
Buitdint EnvrlopeMeanurrs '
' 12.5352(3)r- Minimum ceiling inauluion R-19 weighted avenge•
12.5332(by. Lohse fail insulation manufanurct'a Labeled R -values
' 12.5352(c): Minimum wall intubtion in framed walls R-1 l weighted avrtate (does not apply q
cstcnor nuss walls).
12.5352(k): Slab edge insulation- water absorption rate no v=ucr than 0.3%. water vapor
tnnsmtsston rate no grater than 2.0 perm(mch.
12.5311: Insulation spectfied or installed meets California ErxM Commission (CECT quality
sundards. Indicate type and form
12-5352(t): Vapor barriers manmrory in Climate Iona 14 and 16 only.
12.5317: lnfiltnsioWEtfrlrntion Controls
a. Doors and windows between conditioned and unconditioned spaces desiped to limit air
Icakage.
b. Doors and windo•rs certified
e Doors and windows weatherscippcd: all joints: and pencauions caulked and sealed
12.5352(e): Special infiltration barrier irsultcd to comply with 12-5331 mous CEC quality
standards
12.5352(d): Instillation of Faeplams '
1. Masonry and factory -built fsrcpbccs have
a. Tight fitting. closeable metal or glass door
b. Outside air intake with damper and conal
c. Flue dampa and control
7- No continuous burning gas pilots albwed
HVAC and Plumbint System Measures-
12-333 atd2.5303: Spacecotdidonin equipment 2(g) g W pmrnt aiaimg: attach calctdaCOM1L
R-53520)"2-5315: Setback thamwux on all applicable heating systems.
• 12-5316(a): Ducts constructed, installed and insulated per Chapter 10. 1976 UMC --
12.5316ft Exhaust systems have damper controls. .: - .
12-5314(c): Gas-fired spats heating equipment has intermittent ignition desires.
12-5314: HVAC cqW prrw-m water heaters, showerh=& and faucets certified by the CFC _
12.53520: Water hea=r insulation blanket(R-12 a gear=) or combined interiokaecrior -- `-
insulation (R-16 or Srcucr). first 5 feu of pipes closest to tank insulated (R-3 or greater).
12.5312(Exccption 1): Pipe insulation on steam and steam condensate return tit recirculating
piping-
12-53111(d): Swimming Pool Heating -
1. system mss -
a OvVoff switch on heater.. - -
b. weatherproof instruction plate on hate.
c Plumbed to alb- for solar.. -
L 75 percent thcmul ctGciency..
3. Pool cove.
e. Time clock. _ = - -
5. Directional water inlet.
Ulghtint and Appliance Mcncuro
a 12.5352gx Lighting - 25 lumens/watt or greater for gcrcral lighting in kitchens and bathrooms.
12.5314(c): Gas Cued appliances equipped with intermittent ignition deices.
12.5314(a): Refrigerators, refrigerator -(recurs• freezers and fluorescent lamp ballasu certified
by the CE -C. Indicate make and model number. w....
COMPLIANCE STATEMENT
This oatLficue of compliance lin
the building features and performance specifications needed to comply with
Tide 24. Chapter 2-53 and Title 20. (Imptcr2. %bctupter 4. Article 1 of the California Administrative code This
certificate has been signed by the individual with overall design resperisibility and the building owner. who shall
retain a copy of it and transmit the
outificau to tiny subsequent purchaser of the building.
t Designer
Building Owner.
Nuec
Nosier=
rtttefF-trrrs:
Address-
TitterFirrra: ,
Addrt:sa:
TekpSone
7. 71 ' Telephone
Lk .l:
(signature)
(data) '..:-_-... (siiaae) - _ _- _ (date)
Documentation Author
-_ Enforcement Agency
Namc:
: ritkfFirm
- _. ACcncy:- :.:
a
2. Wall Insulation
Number of stories
Single -
R -value . One
TWO
Three
R-0 - 103
-AS
32
R-19 8
•S
-2
R30 -Z
.1
•1
R-38 =0
0
0
R-13 2
2
• ...__...--:...0.50-...._._.. _176•
•= --••-84• -:-=-:-.,5�....
6
0.30 -10219
U -value
32
0.10 -26
-13
-114
0.08 -18
-9
-6.
O.C6 --4
0.30 -47
-36
O.C4
-2
1
0.02 4
2
1
1 O.CO 11
5
3
5
0.04 14
a
2. Wall Insulation
Floor Insulation
Single -
Single-
Single-
R-valua
Famdy
Family
Muifi-
R-value Detached
Attached
Family
R-0 -68
-51
34
R-11 0
0
0
R-13 2
2
1
R-19 8
6
4
U -value
•4. Slab Edge Insulation
Percent
0.80 -153
-114
-76
0.50 -91"
-68
46
0.30 -47
-36
•24
0.10 0
0
0
0.08 4
3
2
Us 9
7
5
0.04 14
11
7
0.02 19
14
10
0.00 24
18
12
3. Raised
Floor Insulation
Single -
Number of stories
Insulation in Floor
R-valua
One
Number of stories
Three
R -value
One Two
Three
R-0
-17 a
-5
R-11
-3 -2
•1
R-19
0 0
0
R-30
3 1-.
i
U -value
•4. Slab Edge Insulation
Percent
0.60.
-144 -70
-46
0.50
-120 -58
38
7 0.40
-95 -46
30
0.30
-69 -34
.22
0.20
-13 -21
14
0.10
-17 a
-5
0.08
-11 -6
-4
0.06
-6 -3
.2
0.04
-1 0
0
0.02
.1 2
1
O.co
10 . 5
3
Controlled Ventilation Crawlspace
- -
Single -
Number of stories
(yerceat glass x SQ
R-valua
One
Two
Three
R-0
-11
-7
-5
R-5
-t
-t
3
R -it
-2
-2
-2
R-19
-1
-2
•2
•4. Slab Edge Insulation
Percent
4
.51 to
Number cf Stories
.31 a 0.30
R -value
One
Two
Three
R-0
0
0
0
R-5
8
5
2
R-7
8
6 .
3
F2 fac:or
3
8
35
0.90
-t
-3
1
O.eo
-1
•1
0
0.70
2
2
1
0.60
6
4
2
0.50
9
6
3
0.40
12
8
4
S. tntittrauoa (Air. Leakage).:_ - -•
- -
Single -
SPecfimtion
(yerceat glass x SQ
E7rectlye Pei tett Glass
Points
WN
Mass
Sttindard
(Percimt glass x SC)
Family
0
Norb
East
South
West
:..
--
East South :West
Skylight
18
5
1 4
1
na
Percent
4
.51 to
.41 to
.31 a 0.30
or
Glass
Single Double
.60
.50
.40
less
50
-121 •53
.39
.24
10
4
•t0
-90 37
-26
-14
3
8
35
•75 -29
•19
.9
1
10
30
-61 -21
-13
-4
4
12
29
-58 -20
•12
-3
5
12
28
-55 18
-10
.2
5
13
27
-52 -17
•9
.2
6
13
26
-49 -15
-8
-1
7
14
25
-46 -14
•7
0
7
14
24
-43 •12
.5
1
8
14
23 .
-40 -11
-1
2
8
15
22
37 -9
3
3
9
15
21
34 •7
.2
4
10
15
20
31 -6
0
5
10
16
19
•29 -t
1
6
11
16
18
•26 3
2
7
12
16
17
-23 -1
3
8
12
17
16
-20 0
4
9
13
17
15
-17 1
6
10
14
17
14
-14 3
7
10
14
18
13-
-12 4
8
11
15
18
12
-9 6
9
12
15
19
11
-6 7
10
13
16
19
10
3 9
11
14
17
19
9 -
•1 10
13
15
17
20
8
2 12
14
16•
18
20
7. Shading (Shade Open)
Efreetive Percent Glu=
Single -
12. Cooling Syst•1tn
(yerceat glass x SQ
E7rectlye Pei tett Glass
Effect"
WN
Mass
Detached
(Percimt glass x SC)
Family
Effective
Norb
East
South
West
<Gtass
North
East South :West
Skylight
18
5
1 4
1
na
16
4
2 5
1
na
14
4
2 5
1
na
12
3
3 5
2
na -
11
3
3 5
2
na
10
2
3 5
2
1
9
2
3 5
2
2
8 .:
2
3 5:
2
2
7
1
3 4
2
2
6
1
3 4'.
2
3
5
1
2 4
2
3
4
.0
2 3
1
3
3
0
1 2
1
3
2
0
0 i
0
3
1
•1
.1 .1
.1
2
0
•1
-2 -4
.2
0
na - not allowed
1
1
1
& Shading (Shade Closed)
9. Interior Thermal Mass
Efreetive Percent Glu=
Single -
12. Cooling Syst•1tn
(yerceat glass x SQ
Family
Effect"
WN
Mass
Detached
Attached
Family
%Glazes
Norb
East
South
West
Sky N
18
.14
-1.8
-69
$4
na
16
-12
-42
-59
-55
na
Ili
-10
35
-50
-46
na
12
a
-29
-to
-37
rra
it
-7
•26
-36
-33
rta
10
-6
-23
31
-29
-74
9
-5
.20
-27
-25
a5
8
-5
-17
-23
-21
'-56
7
-t
.14
-19
-18
-47
6
•3
-11
•15
14
-38
5
-2
-9
•11
-10
-30
d
1
-6
-8•7
+5
•23
3
0
4
•5
-1
•16
2
1
1
.2
.1
-9
1
1
1
1
1
3.67
0 2
3
4
3
20%
9. Interior Thermal Mass
Single-
Single -
12. Cooling Syst•1tn
Wall
Family
Family
WN
Mass
Detached
Attached
Family
0.00
0
0.
0
0.20
3
2
InteriorMassICFA
0.40
5
4
3
0.60
8
6
4
interior
10
Stab Floor
Raised Floor
1.00
13
10
7
1.20
13
12
8
1.40
12
13
9
1.60
10
13
11 .
1.80
10
12
12 :
2.00
10
11
13 i
13
11
9
7
0.95
8.71
20
Mass
?CFA
One
Slodes
Two
Three
One
sores
Two
Three
Etrective
SEER
(asatmetducts In attic)��'••'
5
3
tt.r«�t*c•..rt
•!"'
efficiency)
2
Interior F, CFA
Effective -25
or
-24 to -14 b
•4 to
+6 b 16 or
I sire t
KISS
(vutC
a 4.2,
1e9 a:ooSed Stab?
+5
+15 more
0.30
2.75
-73
-64
-56
-47
0A
-8
-5
.4
.2
-1
.1
•29
Sim of7-10014
•18
0.4
3.67
-34
5%
101t:
tsx
20%
2S%
30%
3S%
40%
4Sx.SM
S5x
W%
6Sx
IV%
75%
box
857.
Sox
95x
tem
toss tloXttsy._t24x.1z51.
ol - 6--0--0-
0,3
-_7 ._..--2__-.0�..__t--L_-
0.60
SEER-..f15c.1.�5--07:�0_.Q2-Q4.0.6...Qe
5
5
4
3
3
1.1._ti._.ts_...1.7
0.70
6.42
19-21---23-..zs_.27_29�u_14__Js__ztt:cl
15
_
_ -
9
7
0.80
7.33
25
22
19
16
-
1.2.'(1.4
0.90
_1.8:..1.9:.21:_.2J'.2S_..27.:.29..11..:Sl...yS_:17.
.32
28
24
20
17
13
1.00
9.17
37
32
4_.._4.2. 4.4:•
45-.
46....S
----S
Z -
S 't
699
.1
1200
1700
_:.___-__-_•_______._••0..8"
- 2 -2 -
80
1d 12 •10 $
$
d
to
b
of
Type
1'
1.2
1.4
1.6
1.6
2
Z2
t4
21
29
3.1
13
1S
17
19
4.1
4.3
4.S
4.8
5
52
5.4
56
0.9
-5
•i
0
2
2
3
3
8.5
3
2
3
3014
QS
Q1
0.9
1.1
1.4
1.6
1.6
2
22
24
25
28
3
3.2
3.5
17
39
4.1
4.3
4.5
4.7
4.9
S.1
5.3
56
S6
1.1
-1
i
1
3
4
4
-5
•9 .7 -6 -5.
.4
•23
407:
Q7
119
1.1
1.3
1.5
1.7
1.9
22
24
26
28
1
12
3.4
16
3.8
4
4.3
4.5
4.7
4.9
5.1
5.3
5.5
S 7
59
1.3
IS
0
2
3
4
S
8.9
•5 -4 -4 3
-2
•2
50%
49
1.1
1.3
15
1.7
1.9
2.1
23
IS
27
3
12
14
16
18
4
42
4.4
4.5
4.6
S.1
5.3
5.5
S.7
5.9'
6.1
-3
1.5
-3
1
2
4
5
5
9.5
0 0 0 0
0
0
SS%
0.9
1.1
1.4
1.6
1.8
2
22
7.4
26
28
3
32
15
3.7
19
4.1
4.3
4.5
4.7
4.9
5.1
S3
SS
58
6
S2
2.0
-1
2
4
5
6
7
100
4 3 3 2
2
1
60%
1
1.2
1.4
1.7
1.9
L1
23
ZS
2.1
29
11
13
IS
3.8
4
4.2
4.4
4.5
4.8 '
S
52
5.4
56
5.9
6.1
63
25
0
3
5
5
7
7
8
10.5
1 6 5 d
7
3
2
6Sx
1.1
1.3
1.5
1.7
1.9
22
24
26
Z8
3
12
14
36
18
4
4.3
4.5
4.7
4.9
5.1
53
SS
5.7
5.9
6.1
6 4
3.0
1
4
8
8
9
9
11,0
9 7 6
4
3
70%
1.2
1.4
1.6
1.8
2
22
25
27
29
11
13
15
17
3.9
4.1
4.3
4.6
4.8
5
52
5.4
56
So
6
62
6 4
3.5
2
5
5
7
9
9
9
12.0
15 11 9
7
5
75%
1.3
iS
1.7
1.9
L1
23
25
27
3
12
14
16
It
4
4.2
4.4
l6
L8
5.1
5.3
53
S.7
5.9
6.1
6.3
6.5
4.0
3
8
9
10
-'
13.0
13
20 17 14 12
9
6
807:
1.4
1.6
1.8
2
22
24
26
28
3
13
Is
17
19
4.1
4.3
4.5
4.7
4.9
5.1
54
56
5.8
6
62
64
66
4.5
3
7
8
10
11
11
- i
- -
85%
1.4
1.7
1.9
21
23
2S
27
29
It
3.3
3.5
14
4
42
4.4
4.6
4.4
5
52
54
5.6
S9
6.1
63
6 S
6 7
5.0
4
7
9
11
12
12
Erredlve SEER
WY. *
1.5
1.7
2
Z2
24
26
26
3
3.2
14
16
It
4.1
4.3
4.5
4.7
4.9
5.1
53
55
11
5.9
62
64
fie
6 6
5.5
5.0
5
8
9
9
11
iZ
12
(SEER xlud etSielen c7)
45%
1.6
1.8
2
22
25
Z7
29
11
33
15
17
19
4.1
4.3
4.6
4.8
5
5.2
5.4
5.6
5.8
5
6.2
6.4
6 7
69
5
8
12
13
13
100.7:
1.1
19
LI
23
25
Z6
3
12.
14
16
18
4
Al
4.4
4.6
4.9
S.1
5.3
53
5.7
5.9
41
R3
6.5
6.1
1
6.5
6
9
10
12
13
13
Sun of 7-10
105 Y.
1.8
2
Z2
2.4
26
28
3
3.3
3.5
3.7
19
4.1
4.3
4.5
4.7
4.9
S.1
5.4
SS
5.8
6
6.2
6.4
66
6 8
7
7.0
6
9
11
13
13
14
Effec�ve-25 or -24 to -14 b -4 b
+6 b
16 or
110%
1.9
21
13
Z5
27
29
11 •
13
16
3.8
4
4.2
4.4
4.5
4.8
5
51
5.4
5.7
5.9
6.1
6.3
65
6.7
69
7.1.
7.5
6
10
11
13
14
14
SEER
fess -15 -5 +5
+15
more
I15Y.
2
22
24
26Z6
3
3.2
14
3.6
3.8
4.1
4.3
4.5
4.7
4.9
5.1
5.3
5.5
5.7
5.9
6.2
6.4
6.6
6.8
7,
72
8.0
7
10
11
13
14
14
120%
2
L3
IS
17
29
1
3.3
IS
17
3.9
4.1
4.4
4.6
4.8
5
5.2
5.4
5.6
58
6
6.2
6.5
6.7
6.9
7.1
73
8.5
7
10
12
13
14
15
5.0
30 -25 •21 -17
•13
-9
125%
21
13
25
28
3
3.2
14
18
18
4
4.2
4.4
l8
4.9
5.1
5.3
53
5.7
5.9
6.i
QJ
63
6.7
7
7.2
.' 7.4
6.0
•12 -11 •9 -7
$
-4
Point System
Summary:
Climate
Zone
11
is o a 0 0 0 o
10. Exterior Wall Thermal Mass
Exterior
Single-
Single -
Sum of 1.6
Wall
Family
Family
WN
Mass
Detached
Attached
Family
0.00
0
0.
0
0.20
3
2
1
0.40
5
4
3
0.60
8
6
4
0.80
10
8
5
1.00
13
10
7
1.20
13
12
8
1.40
12
13
9
1.60
10
13
11 .
1.80
10
12
12 :
2.00
10
11
13 i
11. Heating System
SE or HSPF
(assumes ducts In attic)
Zonal Control Adjustment
System Type
Resistance 10 9 7 6 4 3
Other 6 5 4 3 2 2
8.0
9.0
9
i6
8
14
Sum of 1.6
5
9
d
7
3
5
SCORE CARD
_
•25 or -24 to
-14 b -4 to
+6 to
16 or
SE
HSPF
less
-15
-5
+5
+15
mote
0.72
6.60
0
0
0
0
0
0
0.75
• ISM
3
3
3
2
2
1
0.80
7.33
8,
7
6
5
4
3
0.85
7.79
13
11
10
8
7
5
0.90
8.25
17
15
13
11
9
7
0.95
8.71
20
18
15
13
11
8
3
3
Etrective
SE or HSPF
5
3
(SE or HSPF x duct
efficiency)
2
Interior F, CFA
Effective -25
or
-24 to -14 b
•4 to
+6 b 16 or
SE
HSPF
fess
-15
.5
+5
+15 more
0.30
2.75
-73
-64
-56
-47
a
-30
na
3.41
-45
-39
-34
•29
-24'
•18
0.4
3.67
-34
-30
-26
-22
-18
-14
0.50
4.58
-10
-9
.8
-7
-5
-t
0.56
5.13
0
0
0
0
0
0
0.60
5.50
5
5
4
3
3
2
0.70
6.42
17
15
13
11
9
7
0.80
7.33
25
22
19
16
13
10
0.90
8.25
.32
28
24
20
17
13
1.00
9.17
37
32
28
24
19
15
Zonal Control Adjustment
System Type
Resistance 10 9 7 6 4 3
Other 6 5 4 3 2 2
8.0
9.0
9
i6
8
14
6
12
5
9
d
7
3
5
SCORE CARD
10.0
11.0
. 22
26
19
23
16
19
13
15
10
12
7
8
Measures -' Point Scores
12.0
13.0
30
33
26
29
22
24
18
20
14
15
9
10
1. Ceiling Insulation or ""- r
Zonal Control Adjustment
10 8 7 6 4 3
No Cooling System Installed
• ,Stories
or
R•valuc (01
F2 factor 10.771
One
-5
-t
-4
3
-2
-2
Two +
3
3
2
2
2
1
Single-Famlly Detached and
Attached
:SSSS
a. No flit -
%� Glass X
1(
Unit Size (SQ
Eff. o G ass
7
Water
x
039
12CO
1700
2200
2700
Heater
Credit
-or -
b
to
to
or
Type.
Type
lass ',1699
2199
2699
more
SG
None
0
0
0
0
0
or
Solar
12 ' '
8
6
5
4
HP
HWR
8
5
4
3
3
WS8
5
3
3
2
2
Interior F, CFA
POU
8.
5_
4
3
3
SE
None
37
-24
•18
-15
•12
11. Heating System
Solar
•1
•1
-i
0
0
Effective SE or
HWR
-t8
.12
-9
-7
$
WS8
-25
-16
-12
•10
a
POU_
-I8 _
-12
-9
-7
-6
n
None
-5
-3
.2
•2
-2
Solar
7
5
4
3
2
POU
3
2
1
1
1
IE
None
-28
19
•t4
-11
-9
Solar
8
5
4
3
3
POU
•10
-6
-5
-1
•3
Muld-Famity (lndlyldual
units)
Unit Size (so
Water
699
700
1200
1700
2200
Heater
Credit
or
b
to
b
of
Type
Type
less
1199
1699
2199
more
SG
None
0
0
0
0
0
or
Solar
14
7
5
4
3
HP
HWR
9
5
3
2
2
WS8
9
4
3
2
2
POU
9
5
3
2
2
SE
None
-45
-23
-15
•11
•9
Solar
2
1
1
0
0
HWR
-23
-12
$
b
•5
WS8
•25
-13
-8
3
-5
EQU
•23
-112..
-8
3
-5
IG
None
a
•4
•3
.2
-2
Solar
6
3
2
1
1
POU
1
0
- 0
3
0
IE
None
30
IS
-t0
-8
-6
Solar
18
9
6
4
4
POU
$
. -4
-3
-2
.2
R -value (38) U -value (0.0301
2. Wall Insulation or
R -value 111 U -value [0.0981 ..
3. Raised Floor Insulation 4_? or
-v a
v eU-value (0.0371
4. ` Slab Edge Insulation
or
R•valuc (01
F2 factor 10.771
5. Infiltration
Standard
6. Glass Heat Loss
Type (double!
U -value 10.651
96, Total Glass (161
7. Shading (Shade Open)
:SSSS
a. No flit -
%� Glass X
1(
S -
Eff. o G ass
7
b. East
x
. 49
C. South
1/.7 X=
sj • (p
d. West
�_ x
=
a al3
e. Skylight
�_ x
=
r✓
8. Shading (Shade Closed)
3'o Glass
SC
Eff. oro Gla
a. North
. k( x
b. East
�, x
=
c. South
x
=
3 • /
d. West
x
e. Skylight
x
9. Interior Thermal Mass
TYPE 1 MASS AREA 9
Interior F, CFA
COND. FLOOR
AREA
10. Exterior Wall Mass
TYPE 2 KASS
'FLOOR
AREA q
r
awrior Will Mass
ND.
AREA
11. Heating System
_ %,P-- x
= . 7% -
Zonal Control? ( Y / N)
SE or HSPF
Duct Efficiency [0.781
Effective SE or
Y(0.72/6 6]
HSPF (0.56/5.151
12. Cooling System
x
Zonal Control? ( Y / N)
SEER 19.51
Duct Efficiency (0.74)
Effective SEER 17.031
13. Water Heating
TYPe [SGJ :. ;..
Credit (none):. _.
0 %
0 t
Sum 1-6
PointTnta!_
S
Sum 77.10
���-' -- A