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027-020-043
/ m \ 27-2-43 District Center Dr., Orov He GDMPACTION TEST REQ. 310 Summit Ave.:.Tl Perm - it #332�r76MH 0 -9 - Issued— 7V76__' jj/ 310 Summit Ave., Oro. Permit 1887-840WMHI�,P?�PzZ4 927-02'07043 05-1084 .105-,1663 C= �CAROLC'. .T AVE, OROVILLE CONT: OWNER ' U c� ~ -1 - County of Butte Oroville, Califomia GENERAL CLAIM CLAIMANT: Carole Chapman ADDRESS: 310 Summit Ave. CITY & STATE: -Oroville, CA 95966 DATE OF CLAIM- 09/n2/ns SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELA AMOUNT Refund Claim - See attached calculation sheet APN: 027-020-043 Permit No.: _05108.4._ PAID RETAINED REFUND Develo ment Services $ 997.09 $ 942.10 $ 54.99 THERM DRNG $ _ $ _ $ _ SMTP $ $ $ SHR $ - $ - $ - SRA $ 95.00 $ 95.00 TOTAL $ 997.09 $ 942.10 $ 54.99 ............ :.:.:..:.:. •'•'° . . .' :.:.' >}%> > 'a . . BREAKDOWN ::::::::: `::: RUD.GET:::AC.C.0 INNT :�lY 0U*'N'f: .. 101001 DVLPMNT SVC. 440-001 4210500 $ 54.99 ... 1011822- THERM DRNG 1800 280 $ - 1011430 SMIP 1001 .280 $ - 1011811 SHR 1800 280 $ - 101001 SRA 0100 4617240 $ - TOTAL $ 54.99 $ 54.99 unuc aiyncu. ucaiere unuer penairy or perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as slated. Dated this day of 2005, at 0 Calif. aSiglattl6ofClaim nt I, the undersigned, hereby certify that, to the best of my knowledge„ the services or articles specified above have been performed or delivered and that there is a Budget ApproprialiaQ or Specific Board Approval (Check onZTdrlh ame. a Dated this day of 2005, at Oroville Calif. Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE nNl Y DEPT & SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE " ENCUMB. GROSS AMT. r 6 � t o�OTrFo Bufie, County Department of Development Services 0 0 o _ o www.buttd6ounty.net/dds o `�= 0 7 County -,Center Drive c�U N'�y Oroville, CA '95965 (530) 538.7601 Telephone (530) 538-7785 Facsimile '. '-ADMINISTRATION * BUILDING * PLANNING 9/2/2005 Carole Chapman:: 31.0 Summit Ave, Oroville, CA 95966;:: RE: Permit No. 05-1084 APN#027-020-043 Owner: same On 4/26/2005, a deposit was made in the amount of $1.092.09, of which $1037.10 was retained. Please sign, date, and return the enclosed claim form to this office. Once we receive the claim form, we,will then process your refund in the amount of $54.99. Should you have any questions, please contact this office Monday through Friday, 8:00 a.m. to 4:00 p.m., at 538-7601. Sincerely, Diane Lewellen Account Clerk, Senior Administrative Division enclosure a 05-1084.1tr Ded7 (� F= t= 1% ELU M E til- c1 i S i u "1 BUTTE COUNTY G C J 2 JUN 16 2005 DEVELOPMENT SERVICES lz0�, ;4 z OL L G N Ap M ►ter ►'�, 3 �v su�►�,�- �cs"-�v. sus <z3� 0 s- I o -z; y v 2� - oz o o c/3 ;,--..Sun 14 05 12:58p Deal Svcs & Env Health 530 538-7785 p.1 - .BUTTE ' COUNTY �asTrF �Butte,Coun(y Department of Development Services J C N 2005 ° }. ,.. ° �, ° Building Division ° - " ,i LOPMENT ° ° . 7 County. Center I)rive DE E ACES 0 Oroville, C4 9S965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY . Butto County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose naive is on the receipt issued for the fees paid. Any refund chocks will bo made payable to.tho name on the recoipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of pormit issuance for permits issued - if no construction work has ,been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Foos paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to tho address below for signature (by the person whose name is on the receipt) and return to D@ve10 ment Services for payment processing. CLAIMANT'S NAME:� 12ULG t'/ MAILING ADDRESS: ! d Su III M I -rj 12e t c C 6 6 PHONE: ASSESSOR'S PARCEL NO.: A 2. Z - lZ X a_ - [Please use one claim form per permit,] BLDG PERMIT NO.: / S " .L d ✓ Recti t No. 1 Rccei i No. 2 Rocci t No. 3 l' Z i a - Ai A . z I �L d - -- RECEIPT NO.: '6 s RECEIPT DATE: l 09 o 7 4• D ��\ RECEIPT AMOUNT: REASON FOR REFUND REQUEST: p ,zC)&-CLr N L�- Tb T= i PI ,4 r/lCc-- S Check those fees which you wish to have considered for refund: ,FWIBuilding Permit Fees [Sheriff Fees [-I�SRA Fees (CDF Fire Planning) =Other (specify): Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If ypu want the plans, you may ick them up prior to that time. Applicationer Irt )// �► a L ��- ?� - �� � o� s �� a O� �. � � O• ' 1 ��� a ,apo sire y NSF �z�-�� ova ���i�- 6-zy-� s REFUND CALCULATION SHEET CLAIMANT: Carole Chapman ADDRESS: 310 Summit Ave. CITY & STATE: .0roville, CA 95966 DATE OF CLAIM: 07/27/05 APN: 027-020-043 RECEIPT INFORMATION NUMBER: 426324 DATE: 04/26/2005 Carole Chapman ISSUED TO: CHECK #: $1,092.09 AMOUNT: 05-1084 PERMIT #: Yes No Yes No Yes No PRIOR REFUNDS: ::::::j x FEES VERIFIED x I REFUND BREAKDOWN Fund.:::::::: 00, Dept .......... ... .... ... :::::440.�OG1:::::: ............. ................ . PR M Accnd::::::4'2fd�dd: .. . .......... .............. ........... ................... ............. Cashj;�Jqi ::::101:1822::;;::::::1.0;1;1;:4 DETAIL PAID RETAIN REFUND .......... 1. ......... .......... X,.......... 887.11 0.00 ITH 1,092.09 I $ 1,037.10 I $ 54.99 APPROVAL CHECK: $54.99 Date Reviewed 08/16/2005 DIFFERENCE: $0.00 Scott Rutherford (Should be blank) Chief Building inspector Z�&� E 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 1 1 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds **��� O PLEASE PRINT CLEARLY** 6� OWNER Last Name �� First ame OLG� Address I t4 _ City,.edol L L Sta Zi Phon— O, _ Fax 5 E-mail APPLICANT NAME CONTRACTOR Name t� State Address Phone City E-mail State Zip Phone Map Book Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name State Address Phone City E-mail Slate Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT NAME NameS Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE t+ X 4A a::�" -) For office use only: Zoning I R-51Flood Zone I X I SRA Yes No Occ. I Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. LOCATION AP# -UZD-0 Property Address 3165a fig 'c* City ieo 1/04 GL ross Street S 1 (Note previous use): 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 c Descripti n or Scope of Work: J �s a9 q Sq. Footag - C1) L ❑ Structure 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 required. 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 Amount: �7 v Receipt #: Sheriff 471b / SMIP Date ,_C/ ,-� Other Z Total REV 2-24-05 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 inst, (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 Applicant: Cha man, Carole Permit No: 05-1084 Project Type: NSF/Gar/Cov APN: 027-020-043 100% 70% Plan Check Fees $ 887.11 $ 620.98 $ 887.11 $ 620.98 WILLDAN Fee $ 620.98 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss, Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other Butte County Department of Development Services �UTTF YVONNE CHRISTOPHER, DIRECTOR o I 00 7 County Center Drive 0 0 o ° ° Oroville, CA 95965 c�U M co (530) 538.7601 Telephone N'�y (530) 538.7785 Facsimile O TO: WILLDAN ' FROM: Scott Rutherford (530) 538-7160 LOLOsrutherford@buttecounty.net SUBJECT: Plans Transmittal For Review Per Contract O DATE: 4/27/2005 Applicant: Cha man, Carole Permit No: 05-1084 Project Type: NSF/Gar/Cov APN: 027-020-043 100% 70% Plan Check Fees $ 887.11 $ 620.98 $ 887.11 $ 620.98 WILLDAN Fee $ 620.98 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss, Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: C/� / �C`. ASSESSOR PARCEL NUMBER 027- 020 --0`7 Proposed Building Use: NSF: Permit Technician: 6 Date: L-/-,06-O.T Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. I" 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. SOV 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. NI N 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. Aj 6. Energy compliance design and supporting documentation in duplicate. ❑ 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 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 buildings ❑ 12. Hazardous Material Form A j 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other All of these Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 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 ........................................... ❑ 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 Ci of Biggs .......................... _ `e �� 23. California Department of Forestry Ian approval .,e"yam C .. \ P y P PP Paid. Ste` t `7b .:.. �1 24. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: ............ \ ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ 7 (/`/ 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) ..................... ',."`v"T ❑ 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. When issued Telephone -L�' o and hold for pickup. I have been informed ,offtthe above items and requirements for obtaining a building permit. y ` Applicant: Date: 1� Date: 1. Index permit application for the above items timbered: 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: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division e p� s/ 08 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 A.P. # ® 27 `/ OWNER PROPROSED BUILDING USE /V y 1. BUILDING PERMIT FEE , S --- Balance Due ..................... ` $ / --- FEMA Flood elevation review ... $ Additional plan checking Fee.... $ 2. SCHOOL DISTRICT FEES (paid at School District Office) (form available after Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ Units �4RECREATI'ON mmercial (sq. ftg.)..... X $0.03 = $ Sq.Ftg. DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMPACT FEES COUNTY WIDE (per dwelling) $ /L CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ ORTH 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 # C �0.00 (paid at Building Division) 8SMIP 'Z 9. OTHER 10. OTHER 11. OTHER DATE 0— Zv —.0 5— RECEIPT # DATE REC. v -29 -o -T 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 during the plan checking process. APPLICANT 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. 3/05) 13 t� 7/ RI -116 L7�; 77) � - -tel IA;L06,1 �-r- 04 (--Z&-d� i i i Butte CountyDepartment of -Development Services °��TTF0 7 County Center Drive ° Oroville, CA 95965 ° `Y ° (530) 538-7601 Telephone ° (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 • 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: � � ( �-c APN: 07.7 0 7 Building site address: `> /0 �U� % ( i OAO - Permit No.: �6� %®�V 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: IGNATURE AP ICANT DATE Copy to Applicant/EH/File K:Forms/BldgPermitwithoutClearances 020705 5 A"9C1C woR* Department J. Michael Crump, Director Public Works LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville. CA 95965 (530) 538-7266 (FAX) 538-7171 N National. Pollutant Discharge Elimination System (NPDES) Phase If Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 9 ACRE] Project Description: Project Location and/or Parcel Number: 0 �/ v� i 0��`"Q_ DZ`7- ©2� Y� 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 than one acre of disturbed soil will require a Construction Storm Water Permit 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. , Signed: Title: 0 (,e,) o �G Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04 p{.t":d: . '. .c'• :' :i ., :l. ^•( - ° .� it ";.ti .:�� .'.A'_ _ . In 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. c `1. I personally plan to provide the major labor and material for construction of this proposed property improvement: YES [r,4 NO [ I. • 2. I HAVE [`� .] HAVE NOT f ] 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: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: - � PROPERTY OWNER: 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. Rev'd 11/4/2004 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 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 Califomia 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. Vieir4 C.B.O. Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. k . '2976 16P,E iOERMIT N0. ,I. PERMIT EXPIRES OWNER Ruth McMahon 1: owner CON TR. 27-2-43 LOCATION (A..P. ) W/S Summit Ave, app. 3+ mi.SW of District Center Dr., Orville r � . .a i ri i t' 2 Temp. Power Pole—/ Called PG&E A/1%foTemp. Elec. Ser —/R" 7% LL Called PG zp Temp. Gas erv._7- Calle PG&E JOB j (Date) 1 (Signa re)/ + �� ' w t ;M 1. t. � ' i • �. � ' � ' r .. � w L COUNTY'OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING I BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor StemwaII Siding, To out Slab Roof Sheathing Water PI in Piers Roofing Sewer r Garage Fdn. Vents Fixtures Footings StemwaI I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica ed Conformance of ex. structure A liances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Mesh MECHANICAL -Grd. Fault Prot. Scratch Heating Service— Bfbwn Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) °+' s;a. j COUNTY OF BUTTE DEP,,*RTMENT OF PUBLIC WORKS ' 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, under permit number 3'S Z� ' X for the following location: IJA't' e? 3IC '74 Owner__ =•r 'f�' lN' /11r//�.i�DD1 L Owner's Address Mobilehome Mfg. `�>>`' h�°= s > Model Year Insignia No. Serial No. 14 G I It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date ' �! / By Co lr�_�il THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED MOBIL EHOME INSTALLATION INSPECTION CHECK LIST l Is the mobilehome locatedwiaW'required separation from lot lines and buildings and -generally conform to.ploi plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yeses No 3. Are footings and supports properly sized, spaced, and braced as per pproved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes No 4. Is the mobilehome level? (Sec. 5088) Ye s.�+ .5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No, 6. Water , A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes t/ Nc B: Test - Does water piping withstand working pressure or.50 lbs. air test? Yes 4 ---No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -'relief valve? Yes_ No P/y/ ` 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes A---N—o B. Does it have minimum 4' per foot slope and is it properly supported? Yes /--No C. Are any leaks detected in drainage system after running/ 3.:.gallons of water through each fixture including washing machine standpipe? Yes No D. If coach is not Stat of California approved, does station have required trap and. vent? Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome gas line inlet without reductions other than the mobilehome connector. Yes�4—No B. Test OK as per following procedure? Yes_ 1. Open all appliance connector valves. 2..' Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes No 9. Electrical A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minianum of amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes No B. Is there proper clearances around panels? Yes � No C. Is power supply cord or feeder assembly properly fused? Yes_ No D. Is continuity test satisfactory as per the following procedure? Yes_✓No 1. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all 'breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test. instrument to the mobilehome grounding conductor and apply the other "Lead to each m.obilehorne supply conductor, including neuL•ral. 5. All non-current., carrying metal parts of the mobilehome (aluminum siding, gas line, water line),. including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon 'completion of the above procedure, the power supply cord or feeder.assembly conductors. shall be connected to the site service equipment. A further continuity tes shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle 13-/ d� Length �� Width Vehicle Serial No. Z41!:n/ State Identification No. 5`3-� Additional.Information or Comments: COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive Oroville, California 95965 Telephone: 534-4541 `%/ 76 APPLICATION AND PERMIT / (J> !C/�� BUILDING Owner 7_17r /;/ J-'� SQ. FT. OCC. BUILDING VALUATION Mailing Address 13 /� ,49S �L/�'S /�7C t"/i�tJr- Tel ephone No. 'y / Fireplace Contractor _ hyo Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address �.: s PLUMBING No. @ FEE PERMIT FILING FEE $3.00 1vo r7p -3 G .% I%iJj S' /= Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping ooa Each gas water heater or vent 1.50 A. P. N9. --2- 7--'_D_—,513 AZS a I Gas piping system 1 - 5 outlets D,o-0 Each additional outlet .30 Fee W.Q/ an n Fire Dept. Fire Zone Use Permit Building sewer g.®E) v EQA_ Parking Plans Parcel Dec!ration Parcel Map � R/W Improvements Lawn sprinkler system 2.00 �dg. anR c'd cel Approval PILel Permit Fee $ 33.0 $ 33, O NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 _3p C> Main service 600V OR LESS 5.00 100 AMP OR LESS 4,a" Main service EA. ADD'L 100 AMP 1 2.50 2, 5Z) Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service 10 0 AMP VER OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 L1T� `, rV NEW CONST. DWELLING OCCUP. & OR ADDNS. ACC. BLDGS. 20sgft NON.RESID NEW CONSTR (BRANCH CIRCUITS 2.50ea NEW CONSTR. (POWER APPARATUS & NON,RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: tv 00 Ex. Occup(OUTLETS OR FIXTURES) 50 BAL� Ex. Occu FIXED APP LNS. OR P'(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /gyp License No. Classification Misc. Wiring 6.25 FT 1 am exempt from the Contractors License Laws of the State of California. Permit Fee $ Zl« $ Z WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 Workmen's Compensation Laws of California. 1 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 MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 L$ Permit Fee $ TOTAL PERMIT FEE $� - ...r....,.,,, ••••, •••,, , .,c vvuniy vl uuuc tv anicl upull uIC above-mentioned property for inspection purposes. X "W, �, Signature of Permitee or Agent / Receipt No. �4 7 5?/ �% White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF-1PUBLIC WORKS 21�ding permit expires Date i BUILDING z Owner�i2 �' +� -COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS r 7 County Center Drive — Oroville, California 95965 Tel ephon"&: 534-4541 APPLICATION AND PERMIT •"1-•----"•••-•••.ri-!!- vv -y - uu— - GI 1 UPW11 1110 above mtentioned pr ns ection purposes. X Date Signature o Permi or Age(ntt Receipt No. �`�" White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have bee aid. DIRECTOR 0 UBLIC WORKS By Date -1 r —2 C Building permit expires Date BUILDING Owner�i2 �' +� SQ. FT. OCC. BUILDING VALUATION Mailing Address 1� �� Ave.- . Tele one o./ YY Fireplace Contractor ���� g �v Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee Building Address b �% ' D PLUMING No. @ FEE PERMIT FILING FEE $3.00 s� `` /� ( '9w t 1 CAGT_- .. Each Trap 1.50 'Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. —2 — Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 tr Fees ii W.C.8arrFtatrer) Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration parcel Ma P/ 60' R/W Improvements]Lawn sprinkler system 2.00 1 P s ed Parcel ApplFev1 Plans proval Permit Fee $ s NEW I ADDITION ❑ UTILITIES ❑ OTHER ® ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 .O / �S I I 101tJ Fo P r �` % 10'%�o Main service 1SLESS 5.00 00 AMP OR Main service EA. ADD -L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service 100EARMP oR LESS 25.00. Main service EA. ADD•L 100 AMP 1.00 - NEW CONST. ( DWELLING CCUP. & OR ADDNS. ACC. BLDGS. ) 2�sgft NEW CONSTR. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS) '2.50ea NEW CONSTR. POWER APPARATUS & NON-RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW ' I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code' under the name style of: Ex. Occup(OuTLETS OR FIXTURES)@ L@104 Ex. Occu FIXED APPLNS. OR P•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 X241 am exempt from the Contractors License Laws of the State of Califomia. Permit Fee WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 Workmen's Compensation Laws of California. MECHANICAL No.1 @ FEEPERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 .�.. / IU>/ —"/ 1 �d TOTAL PERMIT FEE •"1-•----"•••-•••.ri-!!- vv -y - uu— - GI 1 UPW11 1110 above mtentioned pr ns ection purposes. X Date Signature o Permi or Age(ntt Receipt No. �`�" White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have bee aid. DIRECTOR 0 UBLIC WORKS By Date -1 r —2 C Building permit expires Date f BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville,.CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 7. What is the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome `17 service? ----------------------------------++-----f------------ Yes //7 / No 1. Owner's name: �� I-) 1, Rw Ti t & 8L 2. Installer's name: 9. What is the mobilehome site gas pipe size? ---------------------- 3. Is the site currently under permit? Yes No —L is the type of gas -service? ----------- Natural / / LPG / / (If yes, furnish permit number ) OR is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. Is the site an existing.site? Yes No ? (BTU) (If yes, furnish two (2) plot plans.) -:4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and less than 6 ft. on natural gas clear of all setbacks and easements? Yes / / No or less j than 50,lft . ~on; LPG.) . (If no, clarify ) 5. What is the mobilehome electrical rating? ------------------- ' Amps 6. What is the mobilehome site service rating? --------------------- Amps 7. What is the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome site service? ----------------------------------++-----f------------ Yes //7 / No (If yes, identify the load and size: U'U �4- (Load) c) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- (in.) 10. What is the type of gas -service? ----------- Natural / / LPG / / 11. What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. What is the mobilehome gas demand? ------------------------------ ? (BTU) (This information'not required if pipe length less than 6 ft. on natural gas or less j than 50,lft . ~on; LPG.) . MOBILEHOME SUPPORT DATA _ Mobil ehome Mfr.. i ✓1 p e &s Setup Model No. Year(Q. Width (ft.) Length ..S.S_ (ft.) -Expando`Si t. (Draw support details below) . On all mobilehomes`_:manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets :(if. not .on file with the County of Butte). S.in le - Footings -(check.one; i W 1. Wood:either , m pressure treated or Center Center Suppo A :: fdn.`grade.:: Support; Footing Sizes Locations (in.) /,� 2—Concrete pad. A/ ....... jinin,� ` / / 3 . : Other, -` specify in.) — Supports (check one; Concrete block /`r/ 2. •Concrete piers ; - )(ino.. 3. Steel piers :T:.• ...... Other, specify .... ......... t Typical Support xin. in,)Footing size 2 �r.. .. . (in.) (in.) 11. 1 tit �... Max. Pier. r---.., .... Spacing ft.) (in.) - _ (in.) (in.) I _ (I Max. COUNTY 0,' BU7 iF Overhang DEPT. O PUBLIC WORKS IFF I~ilI *If center piers are other than drawn above, BUTTE COUN Y�! ;J'UL 12 1976 draw in locations, spacing, and dimensions. .BUILDING . DEPAR� 1112 12 1 1 i 1 1' APPROVED I'his set of plans kept on the ;obl tq � V ___. "s MUST be at ael tines a.id it is urjl,wcvl tc make any changes or altera,ioyps 0,1 sa,'", W; iJoui written permisson .from t')e Department o; P�.+l,l;, Works, County of Butte. r Pe, -pit a 9 6 .-7 All utility connections shall located within 4 ft. outside t rear third section of the mobi on the left (road) side of home home. a mobile Septic system and location - i�t to be as per Butte County Health Der)t. Re- tquirements. j, Si The- Setback, shell Be .n ft. from the sidle property line and, K! fir, c, om the centerline of the rold, permitting . a maximum of of 2 ft. eave overhanq. tec*I" a Ooee \.)e N e Mo ®bs dUTfE COUNTY . 3UILDING DEPARTMENT APP'RO'VED* -- NOTE.—All !e'9rtrri!^+Is Pc t^lorlcmnnship Shall Be in Accorrlr ce'. a wlih r:oin',,ed Good Prelctices hn`' nre4cr',- Pc! Tear Specifierl use in the . of qurli+.,, Uniform Quikiinq, .•the Pluenkinq & Machanical Codes and the National Electrical Code. I'his set of plans kept on the ;obl tq � V ___. "s MUST be at ael tines a.id it is urjl,wcvl tc make any changes or altera,ioyps 0,1 sa,'", W; iJoui written permisson .from t')e Department o; P�.+l,l;, Works, County of Butte. r Pe, -pit a 9 6 .-7 All utility connections shall located within 4 ft. outside t rear third section of the mobi on the left (road) side of home home. a mobile Septic system and location - i�t to be as per Butte County Health Der)t. Re- tquirements. j, Si The- Setback, shell Be .n ft. from the sidle property line and, K! fir, c, om the centerline of the rold, permitting . a maximum of of 2 ft. eave overhanq. tec*I" a Ooee \.)e N e Mo ®bs dUTfE COUNTY . 3UILDING DEPARTMENT APP'RO'VED* .jARECORDING REQUESTED BY AND WHEN RECORDED MAIL TO NAME Merritt McMahon ADDRESS 13.531 Burke Road CITY -4. Los Altos Hills, California STAfE. L Title Order No. Escrow No; _ MAIL TAX STATEMENTS TO NAME Aomiss "Same as Above" CITY 6 STATE I � L i I OF�ici.,4 r•;.rcOros GUT'i E ('GUri7Y-CALIF 971 !_ul'lSL KL.JEitlt:i; i �i7 ftllii;l'Y fIECJ; D -E. J 111594 rye SPACE ABOVE THIS LINE FOR RECORDER'S USE DOCUMF-NTAP.Y TRANSFER TAX $..S�3�/,.Q-,�•,,,,,;,,,;;,,,,, COMPUTED ON FULL VALUE OF PnOPLRTY COtIYetYL), Olt �] COMPUTED ON CULL VALUE LESS LIc:V: & Ei'iCUM n �iNE69 EMAINING Tit�RL-ON AT'rih•iE OF $AL ....,:.,..:..:::. - `�titgnotur� of declarant or ag��orLrn•ini»p 111A I1llii i1e71 lllb bibual 37foblt Tella urp eeb WESTERN TITLE FORM NO. 105 FOR VALUE RECEIVED, J. MAURICE GRAVIER, a married man, dealing with his separate property GRANT to MERRITT N. McMAHON and RUTH E. McMAHON, his wife as JOINT TENANTS all that real property situate in the unincorporated County of Butte , State of California, described as follows: A portion of Lot 9 as shoiin on the Official Amended flap of Ross Orchards Tract, yj filed in the office of the Recorder of the County of Butte, State of California, June 6, 1926 in Book: "8" of Maps, at pages 31A, 32A and 33A, described as follows: Commencing at a point in the Northwesterly boundary line of said Lot 9 frorn ' which point the most %ly corner of said Lot 9 hears Nori-.h 3.20 461 East, 384.29 feet distant. along said ?vort;nvestr rl.y .iiie and rin_,ii.ny thence across said Lot 9, South 450 521 Fast, 2;'•,-1 feet; thence Soi!til 4;)0 22' East 1437 * s Ieet; t11r,i1Ce rJOi!tll 1:40 Ly°:):-,:" II L 3ij,7j feet; thence, South i33 , !-s n West 286.51 feet, tlielice SOuth' 2`10 54' 311, l`iest 3-15,57 feet-, thence South 470OP 381, t West, 786,67 feet to the point of beginning for the herein described sc ibect parcel of ! land; thence Nortliivesterly in a straight line to a point on the Westerly boundary of• said Lot 9; said opoint nbeing the f�ortllerly terrlinus of a course having a bearing of North 51 39 East and a distance of 300, n O feet; thence alon., the 1tlesterly, ,boundary of said Lot 9 th,. follo!ving courses and distances: South 510 39' West, 300,0 feet; thence South 3.10 54, t9est, 140,0 feet; - thence South 80 55, East, a distance of 347,28 feet; thence leaving the ti'esterly boundary of said Lot 9 North 810 17' 28" East 323.10 feet 'to a point h.hich bears South 470 O1' • 38" West from„ said point of be, inning; thence North 470 011 3811 East, 300.0 feet rcore or less to the point - of be -ginning, TU'vETHER WITH and RESERV1L;'G T 1 11 Ei?E1PLR'0C,; a 1101 -1—excIusii%e easeG1i;:it 'Lor rCCd NiirposeS over a strip of land 60 feet' in' width lyin;f 30 feet on each side of the follolving described centerline: Beginning at an in the i,!ort;nvesterly boundary Eine of said Lot 9 from which point the roost Northerly cornet of sair-t Lot 9-Se,'irs-jloi`-tii 390-46'_ East; a distance of 414,39 feet; thence Soirtil X15° 52' East a distance of 20v'."r5 feet; thence South 400 22' East a distance of 43,72 feet; thence South 040 29' 52" Dlest, 310.41 feet; thence South 130 47' 46" t9est, 286,61 feet; thence South 290 541 37" !gest, 345,57 feet; thence South 470 01.' 38" -West; 1086,67 feet to the end of the herein desc- ribed centerline.. ALSO a right of !way for road purposes over a strip of land"60 feet in eaidth the centcrlire of which is described as follows' BEGIPli-lli•!G at the most Northerly I= 0 0 ae CAI corner of Lot 9 as shown on the official amended reap of Ross Orckards Tract, Cir filed in the office of the Recorder of the County of c Butte, State of California, n June 6, 1928 in Book "8" of ;,caps, at pages 31A, 32:1 and 33A; thence South 320 =16' , Brest along the iNfortliwesterly line of said Lot 9 a distance of 450 feet to a point F� 73 and the end of said cent.erli.ne, ,A 0 v � MAIL TAX STATEMENTS AS nlPwrr`Tr •.....� r 400 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR -PARCEL NUMBER A't ` % -- '� - ZONING BUILDING PERMIT OWNIN J�L ) ,,� r ,�/! 11 TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAMETELEPHONE CONTRACTOR'S MAILING ADDRESS ,S? I , C, 111. .. D '� Fireplace _ CONSTRUCTION LENDER'UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER )'Y1 r LICENSE NO. Plan Checking Fee $ /'y,0b Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ^� 110.00 BUILDING ADDRESS u A, y PLUMBING PERMIT FiII Fee ng Each Trap 2.00 Repair drainage or vent piping 5.00 { Water piping LOT NO.SUBDIVISION NAME PARCEL MAP Each gas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeFq-' Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ AdditionE], Remodel ❑ Utilities ❑ Instal lation [�� Other ❑ Describe work: �{5 Y 1C 1 i I ►� n '� ► ! .' Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR001 OR LESS5.00 •� Main service EA. ADD -L 100 AMP 2.50 NEW CONST. ( DWELLING OCCUP.81) OR ADDNS. \ ACC. BLDGS. 20 sq it CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full rjorce 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 NEW CONSTit I -OU L T 2,50 ea NO BRANCH CIRC ITS NEW CONSTR. ( POWER APPARATUS 6) NON-RESID. SINGLE OUTLET CIR. 50 e 25¢ Ex. Occup OUTLETS OR FIXTURES 100 Ex. QCCUp.(OUTLETS P(RESID.)REA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Mise. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 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. Heating Cooling Hood 3.00 Ventilation permit Fee S Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs,nd expenses which may in any way accrue against said County iirr(consequen a of the granting of his permit. X 1� s�1-±'"Dat)~ ��' �� �- �r •�q Signature of Applicant — Owner M Contractor E]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 $ 7-7W. r TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST. F PARCEL PD HD ISSUE �` .' This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC I -r By. li "'" `�_ -----Date PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS - ° � �i11 Receipt No. (� ( /� WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE P, DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, .,under permit number Z"ZI for the following location: Owner Via/-//- Owner's Address_ 'ter Mobilehome Mf !f "���' r- Model-�,rX/r Year %y g•� Insignia No. .� X '� 7 -7- er- Serial No. --L'_-,4 =/ 14-A It is hereby certified for occupancy at the above described location and may be occupied. Director'of Public Works Date c. By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. �.. ..�... ; _�' _..� �' .�.! ..�; � .._.... L7 ii � � n Vie. ck -ol �aaaa> CLI Cr, ns ej If Q ow tj �E 33 ai t7r ca uj 41 I to M. LLl —. 0 ti 0A m - is COUNTY OF BUTTE tr DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7. County Center Drive, Oroville — Phone: 534-45¢1 a Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 j CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS 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. -1 S7 I le '17 (/,/ / ,� 10�-/- Inspector �� ,, _ - — Date � ` % �� — i� Z� UZ. COUNTY OF BUTTE ' DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovilie, California 95965 - Telephone 916/534 541 APPLICATION AND PERMIT PERMIT NO. ^ O ASSES O RCEL NUMB Oa —^ E --6 ZONING BUILDING PERMIT OWN V TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILI G A DRESS 6—aII� � Fireplace CONSTRUCTION LENDERNKNOW, N _ Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER l LICENSE NO. Plan Checking Fee $ /S,00 Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS - Permit fee $ BUILDING AD RESS c v PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5,00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome[L��Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK �, New ❑ Addition Remodel ❑ Uti ities [:J� Installatio 9� Other ❑ Describe work: 1—C. -It— Permit Fee $ Contractor ELECTRICAL PERMIT Fi'IingFee 10.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 Main service EA. ADD'L 100 AMP 2050 NEW CONST. /DWELLING OCCUP.51) OR ADDNS, \ ACC. BLDGS. 2�Sgft CONTRACTORS LICENSE LAW I dere under penalty of perjury (check one): 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Profes 'ons dj� and my license is in full ce nd effect. License No3t S ^ Classification ❑ 7 I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR -OU LET 2,50 ea NON-RESID BRANCH CIRCUITS) NEW CONSTR. ( POWER APPARATUS e� NON-RESID, SINGLE OUTLET CIR. 50 @ 28¢ Ex. Occup OUTLETS OR FIXTURES BAL@1 Ex. Occup. (OUTLETS FIXED P(R ESID,)LINIS REA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 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. Heating Cooling Hood 3.00 Ventilation Permit Fee S Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 als agree to save, indemnify and keep harmless the County of Butte against all Iia ilities, judgme costs, land expenses which may in any way accrue against aid County i c nseq en a of the granting of this permit. X Dat V� O Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE OCCUP. GROUP TYPE OF CONST. PARCEL PD HD SSUk This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECT OF PUBLIC PE T XPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date_�� iE-D.P.W., S eipt No.�yl L2By rTReYELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE Department of Public Works. 7 County Center Drive Oroville ----- 534-4541 ELECTRICAL INcFORMATION FOR DE -RATING MOBILEHOMES Owner p.rr�� 1� I'C A, "1 AA I Aah -a Location U Ift *I Mobilehome Installation Permit No. FILL IN INFORMATION FOR ITEMS 1 THRU 10 Watts 1. Width x Box Length (7 x 3 = q 3p 2. 2 Kitchen Appliance Circuits = 3,000 3. 1 Laundry Circuit ............................ = 1,500 4. Ovens ........................................ = o ff 5. Cook Stove Top ............................... = / 6. Hot Water Heater ............................... = 7., Dishwasher & Disposal ......................... = 8. Clothes Dryer................................ .9. Other (specify, i.e., motors, exhaust fans, etc.) Sub -total - Watts ..... Ca First 10,000 watts @ 100% ................................. = 10,000 Remaining watts @ 40% ....................... = 10. Air Conditioner..VA " i"1_ watts @100%.. = (o l-� b ) Largest Demand = Central Heat System. gn W watts @ 65%.. = TOTAL DEMAND WATTS REQUIRED 'A ©;a 0 ll "Demand Watts Required" ; 230 ............_ 3 b AMPS De -rate Mobilehome to .................................... 13 1'1 (a AMPS SUTTF - _ - �►= - iN) YY). rm n-14 CV1 (3 PLW his set Of r1ans hs ------- MUST be kept on 111C m3j',� iny tc writ!cn Works C Y ro —7All 1 - utility connections shall located \,vithin 4 ft. t outside t rear third section of the n �i h MObil, home )f m i on the left (road) side of , home. e mobile Septic system and location c. Lq Ni o�n, a o i z j - �-' gi- r! �4 "., T � 6 T6, i- tt �-.;rt to , as per L) f't' e" County '-lc3lth Dent. RP- quirements.. 3Z-3 f 1-., YF. from. . N\ -\e �Or e ;0' r) 0 1. Owner's name: BUTTE COUNTY.DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 2. Installer's name: Q T- g&p DEKA "T1 " 3: Is the•site currently under permit? Yet /. / No (If yes, furnish permit number ) OR Is the site an existing site? Yes No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tankland leach fields and clear of. all setbacks.and easements? Yes No ( If no, clarify ) 5. ,What is the mobilehome electrical rating? ----------------------- Amps 6. What is the mobilehome site service rating? =--------- - _ Amps 7.. What is the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome siteservice? --------------------------------------------------- Yes[ No (If yes, identify the load and size: "-(Load) (Amps) 9. --------------- What is the mobilehome site gas pipe size? ----------------------- 10. What is the type of gas seryice?----------------------------- Natural / / LPG -IT—/ 11. What is the gas pipe length from meter or tank to the mobilehome? 12. What is the mobilehome gas demand?.------------------------------ (BTU) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) 4 . MOBILEHOME SUPPORT DATA If other than single wide, ��� Mobilehome Mfr. furnish 'Sttup Model No. Year Width—2 (ft.) Box Length 60 (ft.) Tagalong or Expando Size ft. x ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). All center supports measured from front of mobilehome unless otherwise specified: Footings (check one) ,, Single 1. Wood either pressure treated or foundation grade. �► Z x3° 2. Other: (specify) Center support Center support .. Supports (check one) locations* footing sizes (in.) 1: Concrete block. (� ❑ .2: Other. (specify) (ft.)(in.) VI _, (in.) (in.) (ft.)(in.) �6 (in.) (in.) V) 2 x3v (ft.)(in.) (in.) (in.) (ft.) (in.) Q (in.) (in.) Li OA *If center piers are other than drawn above, draw in -locations, spacing, and dimensions. Tagalong or Expando,' show support details. j� x �00 -- Typical Support in.) (in.) Footing Size -- Max. Pier Spacing (ft.)(in.) -- Max. Overhang (ft.)(in.) / 98%-82- 00 111 L COUN Il E3 AWING DEPARTMEN APPROWLD FERMIT NO;- 5200-77B PERMIT EXPIRES IOWNER Merrit & Ruth McMahon CONTR. Acro -Lure, Oroville LOCATION (A.P. 27-02-43 ) 310 SummitAve., Oroville Temp. Power Pole Called PG&E _ Temp. Elec. Serv., Called PG&E . Temp. Gas Serv. _ C� JOB FINA Reinf. Steel I Final I Fixtures Bond Beam rr _/I .I FIRIA SPRINKLERS I Motors Framing 7 / Test COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION REgORD Stucco BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Pi in Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwa I I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handicaped Conformance of ex. structure Appliances Gas Piping & T st Temp. Gas Slab Final Z Sanitation Patio FI EPLACE Final Footings % Footing n LECTRICAL Reinf. Steel I Final I Fixtures Bond Beam rr _/I .I FIRIA SPRINKLERS I Motors Framing 7 / Test Water Htr. Stucco Final Subpanels Mesh ME HANICAL Gird. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec_ Service V Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE /9 z r f77 REMARKS OR CORRECTIONS OaJ& -- (NOTE: An entry must be made on this form each time you visit the job site.) ' COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 Telephone: 5,; 4-4541 n� —7 7 APPLICATION AND PERMIT ' / authorize representatives of the county of Butte t upon the above-mentioned pro erty for inspection X Date) h- ignature of mitee or Agent Receipt No. 1`7 Q 3 () Jb White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR PUBLIC WORKS BY Date /- —i a — 7 B(fiIding permit expires Date / — ' r - 7 BUILDING e Owner ,y 7,/ /�/' Al b Al- SQ. FT. OCC. BUI ING VALUATION 'L U O Mailing Address Telephone No. Fireplace Contractor AZO o u ,C , Total Valuation Mailing Address ��, Permit Fee Plan Checking Fee &/or Penalty Telephone No. / Permit Fee $ • & v Building Address 20 A4 Ad 12: 4v C I PLUMBING No. @ FEE PERMIT FILING FEE $3.00 7iC9/C AID Each Trap 1.50 _ 61 S7- CS Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 o.Gas —('ji� '" "13 A. P. No. -7 — A(? Zoning & Planning Zoning& Planning Gaspiping system 1 - 5 outlets 1.50 Each additional outlet .30 F S on FireDept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans P rcel Declaration Parcel Ma P '' R/W Im pr ments Lawn sprinkler system 2.00 Bldg. PI ec'd Parcel Appr val Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER [ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP ORV OR LESS5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ OVER 600V Main service 100 AMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 / 3!0 A11 NEW OR ADDNST ( ACCLBLDGLING OCCUP. &) 20 sq ft NON .RESID R. ( BRANCH CIRCUITS) 2.50ea NEW CONSTPOWER APPARATUS &) -NON.RESI R. D. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name. le of: style 2W 44C Ex. Occup(OUTLETS OR FIXTURES) @La¢ BAL�1 Ex. Occu FIXED APPLNS. OR P• ( OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. 27 Classification �'��c Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood' 2.00 Permit Fee $ $ 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 I TOTAL PERMIT FEE Is J6 GC authorize representatives of the county of Butte t upon the above-mentioned pro erty for inspection X Date) h- ignature of mitee or Agent Receipt No. 1`7 Q 3 () Jb White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR PUBLIC WORKS BY Date /- —i a — 7 B(fiIding permit expires Date / — ' r - 7 4 0 BUILDING DIVISION COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: (530) 538-7541 AGRICULTURAL BUILDING EXEMPTION PERMIT 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 PARCEL NO. ZONING / ' OWNER OWNER'S ADDRESS ,31ps 41 e ojz- LOCATION OF BUILDING .S t/ — USE OF BUILDING S - 4F -M 5'0 SIZE OF STRUCTUR l 0�1 ='X SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL CONCRETE OTHER (Specify) TYP,_OF SIDING R9PF COVERING FLOOR TYPE ESTIMATED COST OF CONSTRUCTION g SDC,O. ejo + - AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as follows: FRONT SIDES 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. I declare under penalty of perjury that the building will be used as stated about, and the purposed use confirms 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 -0 - Z y /2 57- Signature of Owner Permit Fee /� Q.9b The above described AG Building is exempt from a building permit. Receipt No. �� I I `? �� FL D PARCEL PIDi ROOFING JISSUE r Manager Building Division By Date White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant