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027-060-028
0 02/-060-028 06-1807 r UT e,• AgEA. NOTES- ; 2921 BOHEMIA, PALERMO i Cont: BURNETT CONST GARAGE RESIDENTIAL APN: Permit No. Owner. Site Address: ` Contractor. Type of Permit: CHECKED BY SRA YET" FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: .=OK D = Nnt OK MANUFACTURED HOMES MISCELLANEOUS - DATE I Li PERMANENT FOUNDATION Lj SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn Test; FaII/CIO-Concrete 4 Wtr; Loctn-Test-Easeinent Needed -Regulator 5 Elec Loctn-GImcs-Gmd "Amp -Concrete 6 Yard Gas; Loctn-Test Wrap Nat ❑ or LP❑ Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnncir 9 Elec MH Cntnty Test-Crossovers-Breakers-Cimcs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -CIO to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers '--•-DATE D E C K S•C O V E R S -CA R P O R T S •GA R A G E S 6gWg4etbacks-Easements ?Ergs; SOilsSz=DpthSpacing-CnnctrsSteei 3 Decks, Girders/Joists-0cking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs-CnnctrsShthg. Frmg-Brcng 5 Alum Awn; Columns-GnnctnsSplice-Decal-Encisrs 6 Carpo �• Wndws-Doors YEfectric -FnchmStuds-Rftrs Trusses nailing-VeneerStucco-Lath 4b'Roof. -Roofing epsDoors-Landings &f -Braced Wall pnls ( Z4 ."' -�(/n DATE POOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance -GR 5 Elec Pool Lting;15 volts-GFI 6 Elec. En* clsrs; Conduit Entries -Terminals -Listed . 7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr 8 Elec Gmdng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes-Encisrs-pnlboardsansultn to Main Conduit 9 Health Dept App' M 10 Plmb; Cir Test-Wtr Supply Test —I 1 Lt Niche 12 Enclsr, Fencing -Alarms 13 Bonding, Diving board or Slide v'A 00 .0 dd Pool Drawing RESIDENTIAL (Single & Duplex)° 1 DATE JUNDERFLOOR DATE IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent Acc-Cmbstn Air Baffle 2 Ftg Main; SoilsrElee Grnd Ft4 Dpth 54 Wtr Pipe; Test & Ahchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg jppth 55 DWV; Test Fittings & Anchr.Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 5.6 Shwr Pan; Test, First fir -Tub Acc 5 Stemwalls' Main; Steel-Blockouts Wrapped 57 Test Tuti & Shwr, 2nd fir - Tub Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas.Piping 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12_ Elec Undrgrnd DATE M E C H A N I C A L 13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn 61 AC Ducts Insults & Support " 14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn 15 Acc & Vntitn 63 Condensate Drain & Ovrflw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pitfrm if Furnace in attic 4..1 DATE F R N G _YrSil er Materials & Anchrs DATE IFINAL 1 IrWalls Studs -Nailing Spacing & Braces -Plates -Sound 66 Ext Steps -Door & SideLt Prtctn-Landings 19 Bearing Walls over Girders 4,fir Nailing 67 Smoke Detector 20 Draft Stop In Walls (rat proof) 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr 21 'Rretops, Furred CeilingsStairs-Chasers Tubs In Garage; abv-flr-Ducts-Meth Prtctn ejpders& Be.ams* &" Bearing' 69 Bedroom Exiting 2 " ' s-Posf'Caps-Anchrs-Cnnctns 70 GFI A Bath Fxtrs & Tub Acc-Spa eill.ng Joist-R6Ties-Purlin-Roof Brac-TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue=Frplc Throat Cimc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz &'Rmz Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Cimc-Hearth 28 Garage Fire Prtcth Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Une Firewall & Opngs' 76 Ktchn, Fxtr & Appinc; Gmd-Air-Gap-Cooking Clmc 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 ss; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door, Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rttr Outrgrs 79 AC Duct In Garage -Dampen 33 Siding -Nailing Veneer 80 Wtr Htr, Vnts-Clmc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazin Area -Glass P etnSkyLts-Plastic . 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 S ar Walls; N g -Bolts 82 Elec Rcptcls in Garage (GFl) Romex Prtctn 3 race Intl Wall psis 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Cimc Dmge Planters O Yes D No 4010 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Pimb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Cimc to Opngs DATE ELECTRICAL 90 Wtr Well, Dscnnct, Elec, Plmb 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 4 ec l 1 Spacing-Lts & Switches at Doors &' 92 Vntitn thru House 4Z -ST -Boxes No Of Cndctrs Stapled 93 Glass Prtctn 4a'ffor_IeX Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 46 2 Appinc Cires in Ktchn & Cndctr Sz GFl 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz 41� 93CU or DAL 98 Address Posted AC Wire Sz ga CU or DAL 99 Fire Sprinkler 48 Range Circ , D CU or D AL Oven Circ, Oa D CU or DAL Insulated Neutral ❑ Yes D No 49 Service -Riser Cndctrs &Grnd Main Dscnnct m` 50 Eqp Clrncs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr USpa Lt 52 Smoke Detector o'' BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING'PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP061807 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 08/10/2006 APN: 027-060-028-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 2921 BOHEMIA AVE PAL Date: Contractor: Map Index: Description: DETACHED GARAGE (768) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: GAU LTN EY, WILLIAM & CHARLOTTE to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 857 BELL AVE 7000) of Division 3 of the Business and Professions Code) or that he or SACRAMENTO, CA she is exempt therefrom and the basis for the alleged exemption. Any 95838 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): (916) 922-6771 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: GAULTNEY, WILLIAM & CHARLOTTE such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one 857 BELL AVE year of completion, the owner -builder will have the burden of SACRAMENTO, CA proving that he or she did not build or improve for the purpose of sale.). 95838 / O I, as owner of the property, am exclusively contracting with (916) 922-6771 licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: BURNETT CONSTRUCTION ❑ lam Exempt under Article 3 of the Business d Professions Code JERRY BURNETT Dater 16,01 owner:8710 EL MODENA EL VERTA, CA 95626916-992-6444 -� WORKERSOMPENSATION DECLARATI ' C I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the License #: 418106 Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation Engineer: insurance carrier and policy number are: Carrier: Policy #: f Idl I certify that in the performance of the work for which this permit is otal Square Ft: 768 S.F. issued, I shall not employ any person in any manner so as to Valuation: $18,432.00 become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those rprovisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is��� unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of Labor compensation, damages s provided for in Section 3706 of the code, interest, and attorney's fees. 1n11 L/J� CONSTRUCTION LENDING AGENCY This permit is h reby' sued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the 3097 Civ.) Resolutions t rk indicat above for which fees have been paid. performance of the work for which this permit is issued (Sec By. Date: Name: Q PERMIT EXPIRES "� Address: Date ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent pf the owner. I agree to comply with form docum t of Butte County. I hereby all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official or authorize representatives of Butte County to enter upon the above mentioned property for inspection purp s 'ltkis i -1C e l��6il,Wlfhe !% Signature: 2�4 44V75�__ Print Name: Date: 7_ d _ Cl Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg �AJT r BUTTE COUNTY o DEPARTMENT OF DEVELOPMENT SERVICES o i 0 BUILDING PERMIT APPLICATION o 0 AND. SUBMITTAL REQUIREMENTS o o. '• 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 o =_ -_E+� o OFFICE #: (530) 538-7541 - A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION rf A Website: www,.buttecounty.net/dds S% P �� "PLEASE PRINT CLEARLY'"' o OWNER INFORMATION tN I �. F' tNa e (o Q! I Addres �. ( A v c` City , 0 State l�Pt %c Ph - o(2 76-1w Fax E-mail CONTRACTOR Name Address t I o Qom, City-t—�j �vp �� r Stag # Zipg6 Pho � _G � � �'� y Faxl.. E-mail L'i Class K. APPLICANT INFORMATION ARCHITECT/ENGINEER Name city C' Address Zipg5C7 OO City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Nam �( Ad Proe— city C' Sta Zipg5C7 OO h e�7—`C�7r�2.'7 1 Fax E-mail For office use only: Zoning Prop rt Vre s l �h� wtcc� Flood Zone I SRA Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BP�VI �. BIN It PROJECT LOCATION AP# ,7 Prop rt Vre s l �h� wtcc� Cityp I Cro tSV t kTru-S WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: Sq FT- Living Garage 011en Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and othdfl/epartment costs are not A✓-" '-1G,gG� Received by: Amount: Bldg 12CY4 •(72 SRA OVER FOR SUBMITTAL REQUIREMENTS L K•\FOPhAC\RI III IIINr Fr1RMC\RlrinAnnlCnhRnmte rinr Pana 1 of 7• Receipt #: c 6 N ( j Date: 7- 17 az Sheriff SMIP "1 A�j Other 1 Total. RFV R -19-n5 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 A1C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form . ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). El 7. , Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. . If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS1BIdgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 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: Q ASSESSOR PARCEL NUMBER l &7- Propo Building Use: t` Permit Technician: Jerl Date: -% T T770 G It s required in orde to apply for a permit All box ' MUST be checked OR marked NA in.orkler to apply. 1. Site plans 33 r 4 sets, signed by the preparer of the'plans. �Vj 2. Complete plan r 4 sets, signed by the preparer of the plans. 113. Engineered plans, 3,or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. 118. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate• 1. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. 4 11. Hazardous Material Form 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other `R�am Vining items needed to issue the permit (May require additional plan review upon receipt of the following items.) 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico Oroville, as applicable 0 15. Fire Sprinklers ............................................................................................ ❑ 16. Agricultural Buffer dr and site plan apr from the Ag Commissioner Sent by� ❑ 17. Soils Report and/or Engineered Foundation required ........................................... Erosion Control Plan Required........................................................................ r- . 19. ees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 20. City of Chico Plumbing permit........................................................................ 21. Site plan and business license approval from the City of Biggs....... V.6 ❑ �� 22. California Department of Forest( pian approval ❑ paid. Sent by: ., r d 23. Planning approval for (A) Use. (B) Parking: (C) Parcel Chedc:...........:.�� Y ❑ 24. Contact Land Development about _ Improvements, _ Drainage ........................�rr'�% 25. Fire Marshall Review (commercial projects only). Sent by: ...................... 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 29. Worker's Compensation Carrier and Policy Number .......................................... ❑ 30. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. 6d'violations ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other. 4- 0 ❑ 37. Other. When issued Telephone -01 )q22 -CMI CAU11K) and hold for pickup. I have been informed oft a above i>tejns and requirements for obtaining a building permit. Applicant r Date: 7 /1�1 / L 1. Index pe ppllcation for the' i s n mbenV Plan Check 0Tetter- 2. Additional items required -11 Contractor, designer, owner, was a v' d 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: Gil 09 Date: -a& Plans approved by: l�" -Date:-04. o►C Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division TO: FROM: A .—. Building Division = Development Services Environmental Health Plot Plan Floor Man Altadted Sent to SUDS SUBJECT: Sanitation Clearance CI&I+ 1, Owner Location AP# Plan Approved for: Sewage Disposa� Water Supply: Public Private Well Clearance for dwelling. Other `Y kv G �- Hold final for: Final clearance O.K. for: NOTE: Environmental Hea Building Clearance 9/2005 pecialist -+ -, i7)r -4A, Date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner App Date: GAULTNEY 7l1)711)nna APN No: 027-060-028 Permit Type: Subtype: Permit No: BP 061807 Permit Desc: I New 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION Plan Check portion of Permit Fee 2 FEMA Yes Flood Elevation Review $109.98 3 SRA* Rx Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 NON-REFUNDABLE portion of fees due at application $549.90 $219.96 $329.94 Balance of Building Permit Fee 0 $95.00 $204.98 $109.98 $314.96 FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION _$424.94 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $331 78 4 Balance of Building Permit Fees (from No. 1 above) 5 SMIP* - Strong Motion Instrumentation Program (Enter amount from permit system) 6 Additional Plan Check Fees (NON-REFUNDABLE) 7 7a 8 9 Other*: Other*: IMPACT FEES - RESIDENTIAL* Per Dwelling 1 Per Dwelling MFD Applications After 04/15/06 SFD County 4249.11 3183.54 Chico Urban Area 6146.23 4538.82 EI Medio Fire District 3249.97 2385.76 North Chico Specific Plan A SR -1, SR -3, SR-1/PD 8801.091 7395.04 coo R-1 8897.09 7491.04 do R-2 8390.09 6984.04 R-3 7604.09 6198.04 Processing Fee is automatically added to impact fee total 0 TER TENDER FEE (Not collected when Impact Fees Applicable) Enter Bat.# DRAINAGE FEES* 10 CHICO STORM DRAINAGE MASTER PLAN New construction, vacant land, on 1 acre or less - Enter 1 or less acre value 770 Butte Creek 771 Comanche Creek 772 Little Chico Creek 773 Big Chico Creek 774 Lindo Channel 775 SUDAD Ditch 776 Mud -Sycamore Creek 777 PV Ditch MH 3238. 8486.40 8582.40 RECEIPT 1�:36385 $329.94 $1.84 DATE Tech/Asst 7/27/06 Kourtni 8075.40 7289.40 RECEIPT DATE Tech/Asst $100.00 $200.00 � $7,997 $9,088 $6,776 $7,211 RECEIPT DATE Tech�/Asstl� �J 10a More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW 11 THERMALITO DRAINAGE AREA 1 $684 Maximum • Per each new living unit on existing lots where full drainage fees have not been paid 11a Temporary Dwelling 1 $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO ISSUANCE OF PERMIT. Forms will be prepared after plan check is completed for applicant to take to respective district office. 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* At the time of permit application, I was advised the abov es 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 GoverNmf6nt code Section 66020r,you are hereby notified Prode Items followed by an "*" may have been imposed on your prdject. You Wve 90 days from the date of approval of the porject or from the impostion of thea a referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 041506 PgTMENT OSP. G Department of Public , c. Works :o'j County of Butte ;) J. Michael Crump, LAND DEVELOPMENT DIVISION p / Storm Water Management Program Director 7 County Center Drive Oroville, CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE1 Project Description: Project Location and/or Parcel Number: OL IQAIU�_� 0, AL -Q_ By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB I 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 provi ' ' ' ' Signed: Title: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program . Revised 5/24/04 Butte County Department of-Developrnent Sel-Wces °,e,UTrr° 7 County Center Drive ° Oroville, CA 95965 (530) 538-7601 Telephone ° (530) 538-7785 Facsimilec�(1 NIS BUILDING PERMIT APPLICA'T'ION 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 plana 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 entitits 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: 0 V� o Building site address: CQ9 APN: ( 0 Lo Dr'�, LJ Permit No.: 06 l D 0 7 I have read, understood and accept the. terns and conditions as expressed herein as indicated by my submission of the above- ferenced buildng permit application and my signature below: 27166 SIG ATURE OF PPLICANT U DAT E Copy to ApplicanVEHMI,- ICFormVBldgPermitwithoutClmrances 020705 P PR��YT 1011 �uTTFa& ue artment ®f Public Works 0 C u n t y o f B u t t e 0 7 County Center Drive Oroville, CA 95965 ,cyo J . Michael Crump, Director (530)538-7681 0UN'� (FAX) 538-7171 p�eCic WOR,�y Shawn H. O'Brien, Assistant Director Assessors Parcel Number: o27-a6Q OZ Sl Building permit Owners Name: qd l Owners Mailing Address: Property Address: 2 Z- ENCROACHMENT PERMIT ACCEPTED: PERMIT NUMBER: Ve ENCROACHMENT PE RMT EXEMPTION: Reason for exemption: F] Not a County maintained road Existing driveway conforms to County S-31 standard Other Approved by Printed Name Title Date 7-2? —D�v CONDITIONS FOR EXEMPTING A DRIVEWAY PERMIT 1. An existing home with a driveway 10 years or older and doesn't cause any problems with the county road or drainage. 2. An existing home with only minor remodeling or repairs. r California Department of Forestry and Fire Protection Butte County Fire Department Fire Safe Requirements Permit#O& - Under authority of Public Resources Code Section 4290 and 4291, Butte County Improvement standards , and the California Building Code, the following checked items are required by CDFButte County Fire Department and r made part of this permit. These requirements are minimums and may be superseded by Butte County local r .regulations, which exceed these standards. Butte County Building Inspectors will make the compliance inspections. 1272.00 Maintenance of Defensible Saace Measures [X] To ensure continued maintenance of properties in conformance with these standards and measures and to assure continued availability, access, and utilization of the defensible space provided for these standards during a wildfire, provisions for annual maintenance shall be included in the development plans and/or shall be provided as a condition of the permit, parcel or map approval. Public Resources Code 4291 T information will be provided. 1 1273.10 Driveways [X] (a) All new driveway construction or an extension of an existing driveway shall comply with Public Resources Code 4290 roadway requirements. [X] (b) All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 E feet along its entire length. [X] (c) Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where the driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. [X] (d) A turnaround shall be provided to all building sites on driveways over 300 feet in length, and shall be I within 50 feet of the building. 1273.02 Roadway Surface [X] The surface shall provide unobstructed access to conventional drive vehicles, including sedans and fire engines. Surfaces should be established in conformance with local ordinances, and be capable of supporting a 40,000 pound load. 4" of class 2 aggregate base shall be required for all driveways, turnouts, and T T turnarounds. U 1273.03 Roadway Grades T [X] The grade for all driveways shall not exceed 15 percent. Grades above 15% shall have 4" of class 2 1 aggregate base and 2" of asphalt concrete. No driveways allowed in excess of 20%. 1273.04 Roadway Radius R [X] (a) No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional surface width of 4 feet shall be added to curves of 50-100 feet radius; 2 feet to those from 100-200 feet. [X] (b) The length of vertical curves in roadways, exclusive of gutters, ditches, and drainage structures designed to hold or divert water, shall be not less than 100 feet. M 1273.05 Roadway Turnarounds [X] Turnarounds are required on driveways and dead-end roads as specified in this article. The minimum turning radius for a turnaround shall be 40 feet from the center line of the road. If a hammerhead -T is used, the top of the "T" shall be a minimum of 60 feet in length. N 1273.06 Roadway Turnouts [X] Turnouts shall be a minimum of 10 feet wide and 30 feet long with a minimum 25 foot taper on each end. T Revised 07/25/06 1 1 S 11, 1273.07 Roadway Structures [X] (a) All driveway, road, street, and private lane roadway structures (Bridges, culverts, and other appurtenant structures which supplement the roadway bed,or shoulders) shall be constructed to cant' at least the maximum load and provide the minimum vertical clearance as required by Vehicle Code Sections 35550, 35750 and 35250. [X] (b) Appropriate signing, including but not limited to weight or vertical clearance limitations, one-way road or single lane conditions, shall reflect the capability of each bridge. [X] (c) A bridge with only one traffic lane may be authorized by the local jurisdiction; however, it shall provide for unobstructed visibility from one end to the other and turnouts at both ends. All bridges must be certified by a registered Civil Engineer. 1273.11 Gate Entrance [X] (a) Gate entrances shall be at least two feet wider on both ends then the width of the traffic lane(s) serving that gate: [X] (b) All gates providing access from a road to a driveway shall be located at least 30 feet from the roadway and shall open to allow a vehicle to stop without obstructing traffic on that road. [X] (c) Where a one-way road with a single traffic lane provides access to a gated entrance; a 40 foot turning radius shall be used. 1274.08 Addresses for Buildings [X] All buildings shall be issued an address by the local jurisdiction which conforms to that jurisdiction's overall address system. Accessory buildings will not be required to have a separate address; however, each • dwelling unit within a building shall be separately identified. 1274.09 Size of Letters, Numbers and Symbols for Addresses [X] Size of letters, numbers and symbols for addresses shall be a minimum 3" letter height, 3/8" stroke, reflectorized, contrasting with the background color of the sign. 1274.10 Installation, Location and Visibility of Addresses [X] (a) All buildings shall have a permanently posted address, which shall be placed at each driveway entrance and visible from both directions of travel along the road. In all cases, the address shall be posted at the beginning of construction and shall be maintained thereafter, and the address shall be visible and legible from the road on which the address is located. [X] (b) Address signs along one-way roads shall be visible from both the intended direction of travel and the opposite direction. [X] (c) Where multiple addresses are required at a single driveway, they shall be mounted on a single post. [X] (d) Where a roadway provides access solely to a single commercial or industrial business, the address sign shall be placed at the nearest road intersection providing access to that site. 1276.01 Setback for Structure Defensible Space (a) All parcels 1 acre and larger shall provide a minimum 30 foot setback for buildings and accessory buildings from all property lines and/or the center of the road. [ ] Your parcel is larger then 1 acre but your required minimum setback for buildings and accessory buildings is less then 30 feet from all property lines and/or the center of the road. You are required to meet the same practical effects requirements listed on page three. [ J (b) For parcels less than 1 acre, the local jurisdiction shall provide for the same practical effect. See page three for same practical effect requirements. [ ] Your parcel is less then 1 acre and your buildings and accessory buildings meet the 30 foot setback requirements from all property lines and/or the center of the road. Revised 07/25/06 2 r Same Practical Effect for Buildings less then 30 feet from property line: [) If the Building Setback is less then 30 Feet from all property lines and/or the center of the road, the following shall be required; • Class A roof • Fully enclosed eaves on entire structure (December 5, 2005, per 2001 California Building Code 704A.2.3, fully enclosed eaves are required on all structures in any fire hazard severity zone within State Responsibility Areas, regardless of setback distance from the property line or center of roadway) • Fire rated metal doors on side toward property line with insufficient setback • Siding on entire structure from the following list: (a) Stucco -3 coat (b) Non combustible Hardi-Board, Plank or similar siding (c) Masonry (d) Metal (e) Other Butte County Fire Department approved materials 1276.02 Disposal of Flammable Vegetation and Fuels [X] Disposal, including chipping, burning or removal to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction, road and driveway construction, and fuel modification shall be completed prior to completion of road construction or final inspection of a building permit. Other Requirements Butte County Improvement Standards Installation of Residential Fire Sprinklers [X] If your property was part of a parcel split after January 1, 1991, you are required to install residential fire sprinklers. It is your responsibility to inspect the official parcel map to confirm if sprinklers are required. 2001 California Building Code, December 5, 2000 704A.1 Roofing. 704A.1.1 General [X] Roofs shall comply with the requirements of Chapter 7A and Chapter 15. Roofs shall have a roofing assembly installed in accordance with its listing and the manufacturer's installation instructions. 704A.1.2 Roof coverings [X) Where the roof profile allows a space between the roof and roof decking, the spaces shall be constructed to prevent the intrusion of flames and embers, be fire stopped with approved materials or have one layer of No. 72 ASTM cap sheet installed over the combustible decking. 704A.1.3 Roof valleys [X] When provided, valley flashings shall be not less than 0.016 -inch (0.41mm) (No. 28 galvanized sheet gage) corrosion -resistant metal installed over a minimum 36 inches (914 mm) wide underlayment consisting of one layer of No. 72 ASTM cap sheet running the full length of the valley. 704A.1.4 Roof gutters [X] Noncombustible screens on gutters. Roof gutter shall be provided with the means to prevent the accumulation of leaves and debris in the gutter. 704A.2 Attic Ventilation. 704A.2.1 General [X) When required by Chapter 15, roof and attic vents shall resist the intrusion of flame and embers into the attic area of the structure, or shall be protected by corrosion resistant, noncombustible wire mesh with '/4 inch (6mm) openings or its equivalent. Revised 0725/06 3 0. 704A.2.2 Eave or cornice vents. [X] Vents shall not be installed in eaves and cornices. EXCEPTION: Eave and cornice vents may be used provided they resist the intrusion of flame and burning embers into the attic area of the structure. 704A.2.3 Eave Protection. [X] Fully enclosed noncombustible eaves on entire structure. Eaves and soffits shall meet the requirements of SFM 12-7A-3 or shall be protected by ignition -resistant materials or non combustible construction on the exposed underside. All of the Butte County Fire Department requirements are posted on our website at http://buttefire.orp/Fireprevention/protpian/protpian.htmI AUG 0 2 2006 Date Revised 0725/06 4 Darren Read Fire Protection Planning �- NOTES RESIDENTIAL PERMIT NO. 027-060-028 GAULTNEY, B1 [j. U4-2183 2921 BOHEMIA AVE, OROVILLE �/J � " Cp�,1.r.C.�1 �••�S - vlL CONT: BURNETT CONST ADD/REMO.DEL SF ysww\� k. yX3001 SPECIAL CONDITIONS SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER CHECKED BY OFFICE COPY I` Address �t GAS Meter By Date_— ELECTRIC Dat l l Meter By JOB FINALED (Date) LZ c —7— J Signature � COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 i CORRECTION NOTICE Cy -1 _ Z g OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is complete . If you have any questions pertaining to this matter, or need additional explanation, ase contact the Building Inspector as indicated below. 0-C, Q,.)t? r r cc f TIC c !o r O cr r' 1 Q .a 1A t 1- L. -- Ar T Date Ci — Inspector „1�tz.-I-e S REV 4/05 Phone # CAI , FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 • ..COUNTY OF BUTTE...... ' BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE i rl ( / 1, OWNER PERMIT NO A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of. work is completed. If you have any questions pertaining to this matter, or need additional •, e Date r Inspector � / f/� �✓ REV 4/05 Phone # ' FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 INSTALLATION CERTIFICATE (Page 12 of 12) CF -6R Site Address),U I^' 11 Permit ©tuber County Subdivision Lot Number Su` � Description of Insulation (Formerly IC -1 Form) Signature Date,4/10/ I. RAISED FLOOR �( � d f �' Cely-+CL,Material Brand Signature Date NameI A, . Thickness (inches)-� t/2 ' Thermal Resistance (R -Value) 2. SLAB FLOORJPERIMETER Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Perimeter Insulation Depth (inches) .(if applicable) 3. EXTERIOR WALL General Contractor (Co. Name) OR Owner Frame Type 2 Y- (o A. Cavity Insulation MaterialY,; ,�''}- c j(�{ �S Brand Name Ce- (fiac n e Thickness (inches) Thermal Resistance (R -Value) B . Exterior Foam Sheathing Material Brand Name Thickness (inches) Thermal Resistance (R -Value) 4. FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R -Value) 5. CEILING rr�� Batt or Blanket Type KV -000 - CkCeJ. � Brand Name �, G Thickness (inches) Thermal Resistance (R -Value) — Loose Fill Type Brand Contractor's min installed weight/ft2 lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) 6. ROOF Material CO m 5'�i v� % Brand Name 3b YR_ GA r- Thickness (inches) EG Thermal Resistance (R -Value) Declaration - ✓ E l hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Ejficiency Standards for residential buildings (Title 24, Part 6, California Code of Regulations) as indicated on the Certificate of Compliance, where applicable. Item #s (if applicable) Signature Date,4/10/ Installing Subcontractor (Co. Name OR General Contractor (Co. NameR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner r OR Window Distributor ! Ite,xi.#s Signature Date Installing Subcontractor (Co. Name) OR .(if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Residential Compliance Forms April 2005 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES .BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netldds PERMIT NO. BP042183 LICENSED CONTRACTORS DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 12/06/2004 APN: 027-060-028.000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 2921 BOHEMIA AVE PAL Date: Contractor. Map Index: Description: ADD(1000)REMODEL(800) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury, that I am exempt from the Contractors' State License Law for the following reason .(Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: WILLIAM AND CHARLOTTE GAULTNEY permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 857 BELL AVE the Contractor's State License Law (Chapter 9 commencing with Section SACRAMENTO, CA 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom.and the basis for the alleged exemption. Any 95938 violation of Section 7031.5 by any applicant for a permit subjects the 916-284-0416 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: WILLIAM AND CHARLOTTE GAULTNEY PP owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: BURNETT CONSTRUCTION . .TERRY BURNETT ❑ I am Exempt under Article of the Business an rofessions Code 8710 EL MODENA Date: I'2' -64 owner: EL VERTAi CA 95626 916-992-6444 WORKERS' COMPENSATION DECLARATION e7l 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for License #: 418106 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as Architect' ' required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance causer and policy number are: Carrier: Total Square Ft: 1653 S.F. Pdlacy#: I certify that in the performance of the work for which this permit is Valuation: $107,445.00 issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: LL WARNING: Failure to secure workers' compensation erage is unlawful, and shall subject an employer to criminal penalties and one / hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This pe i ' ereb issued under the applicable provisions of the Butte County Coda ?nrvor � I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Reso ork indi ted above for which fees have been paid. a 7 `Y' By: `' Date: Name: PERMIT EXPIR Address: Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or documen f Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: a{(�'�4-yi io U Signature: a\ -Lf Date: .d c T I�Owner 0 Contractor 0 Agent for Owner ❑ Agent for Contractor �cnewal Ot BAI ANCE OF FEES l SB= DATE: - Q� PERMIT: ASSESSOR PARCEL, #: 027_ 060-02 OWNER'S NAME: � r _ FEES: (Amount and Purpose): ,. BALANCE OF FEES: $ ADDITIONAL FEES: $ I REVISED PLAN CHECK: $ SHERIFF FEE:- SRA EE:SRA $ COPIES $ URBAN AREA FEES $ CSA 87 (North Chico Spec) $ WATER TENDER FEE $ BATTALION # THERM DRAINAGE FEE $ OTHER PP-i1f-'W Q OTHER $ VALUATION - IF BALANCE OF FEES OR ADDITIONAL FEES: .TOTAL VALUATION: $ ADDITIONAL VAL: $ (Check one) COUNTY CITY OF BIGGS (Check one) RESIDENTIAL, COMMERCLAL X20* q 4 30® 1 (2 - 2 O5 J=OK 0 = Not OK . = NotReadyable 1. MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 3. 1. Zoning Requirements -Setbacks -Easements Electricity; MH Test -Crossovers -Breakers -Clearances 2. Soils; Special MH Support Sketch 6. 3. Sewer; Location -Test -Fall -C/O -Concrete Water and Sewer Connected -C/O to Grade -HD Approval 4. Water; Location -Test -Easement Needed (Sketch) 9. 5. Electricity; Location -Clearances-Grnd-/ /Amp -Concrete Exits; Insp.-Sketch 6. Gas; Location -Test-Wrap;-/ /" L'ft. / P Nat. or/ /" L "ft./ P LPG 7. Well Clearance & Disconnect 8. Utility Clearance POOLS (Plans) OK except #'s 8. Gas and Electricity Tagged Setbacks -Easements 9. Exits Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of OccuDancv Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 9. 1. Zoning Requirements -Setbacks -Easements 10. Roof; Shthg-Roofing 2. Footings; Size -Spacing -Marriage Line 11. Ext.; Steps -Doors -Landings 3. Blocking 12. Braced Wall Panels 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test Card B-1 Date Card B-1 6. Water; MH Test Card B-1 Date Card B-1 7. Water and Sewer Connected POOLS (Plans) OK except #'s 8. Gas and Electricity Tagged Setbacks -Easements 9. Exits Soils; Compaction -Structure Stability 10. License Decals Pool Structure; Steel -Connections -Thickness Dead Men -Lining 11. Verify #'s with Office Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 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, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels 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, Distance-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- Panel boards- Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK RESIDENTIAL - =Not Applicable w = Not Ready Date UNDE OR (Plans) OK except #'s 1., o ' g -Setbacks -Easements -Flood -Slope g., Main; Soils-Elec. Grnd.-/1i2/" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Poyches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Ste alts, Main; Steel-Blockouts-Wrapped 6. qfemwalls, Garage; Steel-Blockouts-Wrapped Hold Downs and Special Anchors /7. Slab, Steel -Wrapped j�I 8-!P' s -Fire lace Ft .-Steel 0_1W �*� W.V.; Fall -Fitting -Test -2 VVay C/0 -Sewer Test 10. , Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 1 - Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. plenums & Ducts; Clearance -Material -Support -Ins. 1 Gi ers-Sills-Anchor Bolts-Joists-Vents-Crippies 1 ccess & Ventilation 16. Insulation (Single & Duplex) Dat¢g-%%-e ,� Card B-1 Date �� L " i6 Card ET- -/,- Date MD hard B -a/ / Date Card B-1 Date :/ " " PLUMBING (1136rmit) OK except #'s 'VA lgw,'Oater Htr.; Vent -Access -Combustion Air Baffle /r!(ff 8 Water Pipe; Te <& Anc ail Protection 9J D.W.V.; Test Fittings & Anchor -Nail Protection 20` Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access as Pipe; Sixe 23. Fire Sprinkler; Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTBJCAL (Permit) OK except #'s ns. Protection & Switches at & No. of Conductors 2-4. 6mex Installed Close to Edge of Studs & C.J. 28: Equip. Ground made up w/Mech Fasteners -Bond Gas & V4 -*Kr 29. 2 Appli nce Circuits in Kitchen & Conductor Size GFI 30. S ed Wire Size/ /ga. Cu r AI-A.C. Wire Size/ /ga Cu or Al ange Circle//' /ga Cu ven Circ. / /ga Cu or Al Ins lafed Neutral ❑ Yes ❑ No Service -Riser Conductors & Ground Main Disconnect 33. d,". Clearances Panels-Motors-Mech. Equip. Xr C hes Closet Light -Shower Light -Spa Light Smoke Detector Date Card B-1 Date Card B-1 Date Card B Date Card B-1 Date MEC NICAL (Permit) OK except #'s A.C. Ducts Insulation & Exhaust above insulation to Drain & Overflow, Size & Grade 39!Furnace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet UR-OAttic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMIWalPermit) OK except #'s 4< . ills Ppper Materials & Anchors 4 S ds -Nailing Spacing & Braces -Plates -Sound 4 B ing Walls over Girders & Floor Nailing Draft IIs (rat proof) %!>tdi'pS, Furred Ceilings -Stairs -Chasers -Tubs 4 eaders 8 Beams -Size & Bearing Date FRA G Continued) -A -C. Unit Disconnect, Electrical -Plumbing n ers-Post Caps -Anchors -Connectors 4e Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Firepl s or Type A Flue-Firepla a Throat Clearance Access; Size & Romex Pro -Draft Stop -Ins. Baffles Z-60-j!drm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. S!4<s; Width -Headroom -Rise -Run -Landing -Fire Protection 5 lywood on Roof Overhang -Attic Vents -Rafter Outriggers ddress Posted Siding -Nailing Veneer 58. S u co Mesh -Drip Screed -Fd. Vents-Underflr. Access Card B-1 e(,-'07- Date Card B-1 Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts Card B 1 Date Card B-1 Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -W Is- endows Dated(- /0 r �(j Card B Date Card B-1 Dates' Card B -1r Date Card B-1 Date FINAL ns) OK except #'s xt. Steps -Door & Sidelight Protection -Landings 6,5..8moke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 5<5-edroom Exiting 6 ..I. & Bath Fixtures & Tub Access -Spa 69. rim & Subpanel, Breaker Sizes & Labels Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Putlets at Wood Panel, Int. & Ext. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77��Attr Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection >-PtM; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. I ation-Foam-Looked in Attic Guard Rails & Deck Construction -Post Caps a2-- ' rn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 83. Following Instld./Drive 0 Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 No 84. Stucco Brown -Finish 85 -A -C. Unit Disconnect, Electrical -Plumbing §§,415nts Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. er Well, Disconnect, Electrical, Plumbing jor E rior Elec. Trim, G.F.I. Receptacle -Underground Ve elation Throughout House Glass Protection ?11_�rections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. ter & Sewer Connected -C/O to Grade -HD Approval Ene y Compliance Certificate -Other Certificates ddress Posted 96. Fire Sprinkler Date'Zrj -"? Card B-1 e(,-'07- Date Card B-1 Date E'Is-, ct7Card B-1 t✓� Date Card B-1 Date Card B 1 Date Card B-1 Comments at Final: CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM County of Butte Oroville, California GENERAL CLAIM Charlotte Gaultney 857 Bell Avenue Sacramento, CA 95838 05/20/05 6- / v0,5--, SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY) AMOUNT Refund Claim - See attached calculation sheet APN: 027-060-028 Permit No.: X04=2183 '! PAID RETAINED REFUND Development Services $ 2,752.37 $ 2,270.10 $ 482.27 THERM DRNG $ - $ - $ - SMIP $ 10.74 $ 10.74 $ SHR $ - $ - $ - SRA $ 43.00 $ 43.00 TOTAL $ 2,763.11 $ 2,280.84 $ 482.27 .... . ACCOUNT:: IVM AOUNT 10]001 DVLPMNT SVC 440-001 4210500 S 482.27 1011822 THERM DRNG 18001 280 $ - 1011430 SM1P 1001 280 S 1011811 SHR 1800 280 S 101001 SRA 0100 4617240 $ - L::::� TOTAL I $ 482.27 $ 482.27 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and tha I claim is true and correct as stated. Dated this r7 day of, 2005, aty� Com, Calif. Signature of Claimant 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 Appropriation or Specific Board Approval (Check one or the same. Dated this �' day of, 2005, at Oroville Car . ��Ult�lJLJ Department Heatl ur Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY r & SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT. M 0 %3TrF0 Butte County Department of Development Services o Building Division ,_..•- < C 7 County Center Drive O �O Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY -Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on t he receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 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 permit 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. Fees 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 the address below for signature (by the person whose name is on the receipt) and return to Development Services for paVment processing. CLAIMANTS NAME: Check those fees which you wish to have considered for refund: =Building Permit Fees =Sheriff Fees =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 you want the plans, you may pick them up prior to that time. 1 �6 0._ Signature K:/Forms/Refund Application 082203 CLAIMANT: CITY & STATE: DATE OF CLAIM: NUMBER: DATE: ISSUED TO: CHECK #: AMOUNT: PERMIT #: tREFUNDS: VERIFIED DETAIL BLDG Time Filing from Plan Check Plan Check/Filing 0.2 Inspection BLDG FEES OTHER BLDG SRA REFUND PROCESS FEE BUILDING TOTAL APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector REFUND CALCULATION SHEET Charlotte Gaultney 857 Bell Avenue Sacramento, CA 95838 12/22/04 APN: 027-060-028 RECEIPT INFORMATION Charlotte GaL 3488 $2,806.11 04-2183 Yes I No X X REFUND BREAKDOWN Title Fund Dept Accnt Cash BLDG 0010 440-001 4210500 101001 THRM DRNG 1800 rHRM DRN 280 1011822 AUD SUSP 1001 (SMIP) 280 1011430 SHER DEV FEE 1800 (SHR) 280 1011811 FIRE 0100 (SRA) 4617240 101001 PAID RETAIN REFUND 2642.39 2160.12 482.27 ............................... ... ..:.:.:.:.:.:.:.:.:.:.:.:.:.... .......... .......... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............................... ::*:,:.,:., :.:.:.:.:.::::::::::,.:,.:::::,:,:,:,:,:,: .......... ::::::::::::::::::.. . ............................... .......... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ..:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. .................... .......... .......... .................... .......... .......... ..................... .......... ::::::::::::::::::::: .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... :::::::::: ......... .......... ......... ...::::.::::. ......... .......... ......... ::::::::::::::::: .......... ......... :::::::::: ......... .......... ......... ......... 0.001 0.00::::::::::::::::::.* 1056.96 864.05 192.91 192.91 1585.43 1296.071 289.361 289.36:.::::::::::::: 109.98 109.98 0.00 0.00 0.00 0.00 0.00 0.00 2752.37 2270.10 482.27 482.27 0.00 0.00 10.74 10.74 0.00 0.00:::::::::: 0.00 0.00: 43.00 43.00 0.00 0.0( $ 2,806.11 $ 2,323.84 $ 482.27 $ 482.27 $ - $ - $ - $ - CHECK: $482.27 05/18/2005 DIFFERENCE: $0.00 n, ,✓��q (Should be blank) DEPARTMENT OF DEVELOPMENT SERVICES DEPOSIT SHEET BUILDING DIVISION DEPOSIT # BAG # 255 3en PERMIT# RECEIPT# ACCOUNT # F-10 ACCOUNT# ACCOUNT# AVA COURT (SRA) 0100 (SHR) 1800 F-10 ACCOUNT# ACCOUNT# (CUA) 1800 (SMTP) 1001 ACCOUNT# (COPIES) 0010 040644 406936 $ 662.55 $ 171.99 042182 406942 $ 659.88 ''k ...... ...... ..... ...... ... . ..... .. ....... .. .... . .......... . . ... ...... ......... . ... ...................... BP04209-3 406944 $ 274.95 BP042184 406944 $ 426.18 042185 406945 $ 2,199.97 43.00 $ 305.01 $ 16.02 042186 406946 $ 4,786.13 $ 43.00 $ 305.01 $ 32.31 042187 406947 $ 164.97 042188 406948 $ 659.88 $ 43.00 042198 406948 $ 852.35 042190 406949 $ 426.17 042191 406950 $ 467.42 BP041366 406951 $ 507.77 $ 4.36 042192 406952 $ 110.00 BP032759 406953 $ 54.99 042193 406954 $ 109.80 BP042194 406956 $ 1,466.56 $ 43.00 042195 406957 $ 549.90 042196 406958 $ 549.90 $ 17,681.74 $ 215.00 $ 782.01 $ $ $ 63.43 $ MONEY COLLECTED: audkoryellow COMPILED BY: GRAND TOTAL TO BE DEPOSITED DIANE LEWELLEN extn 6869 DATE BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.neAdds PERMIT NO. BP042183 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 12/06/2004 APN: 027-060-028-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 2921 BOHEMIA AVE PAL Date: Contractor. Map Index: Description: ADD(1000)REMODEL(800) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the. Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a' Owner: WILLIAM AND CHARLOTTE GAULTNEY permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 857 BELL AVE the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or SACRAMENTO, CA she is exempt therefrom and the basis for the alleged exemption. Any 95938 violation of Section 7031.5 by any applicant for a permit subjects the 916-284-0416 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, .and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to ar-- Applicant: WILLIAM AND CHARLOTTE GAULTNEY owner of property who builds or improves thereon, and who doeiv such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for; sale. If however, the building or improvements are sold within one, year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 21 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business'. and Professions Code. The Contractors' State License Law,does not apply to an owner of property who builds or improves thereon, . and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). . Contractor: BURNETT CONSTRUCTION JERRY BURNETT ❑ I am Exempt under Article of the Business an rofessions Code 8710 EL MODENA Date: la' - Owner: EL VERTAi CA, 95626 916-992-6444 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a certificate of consent to self -insure for License #: 418106 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance carrier and policy number are: Carrier: Total Square Ft: 1653 S.F. PPl1cy#: I certify that in the performance of the work for which this permit is Valuation: $107,445.00 issued. I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers compensation provisions of Section 37CO of the Labor Code, I shall forthwith comply with those provisions. I Date: a� Applicant: WARNING: Failure to secure workers' compensation erage is unlawful, and shall subject an employer to criminal penalties and one j �Il, I6T hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor interest, and attorney's fees. /� )- -� 1( `�, ��� �vCU ._(1 ,lUOt -code, _ _ -— CONSTRUCTION LENDING AGENCY This pe i 's ereb issued under the applicable provisions of the Butte County Code anrvor n I hereby affirm that there is a construction lending agency for the Reso ork indi ted above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) 1 Zjjj Name: BY Date: � Address: PERMIT EXPIR Date ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. • - I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or documen f Butte County. I hereby authorize representatives of Butte County to enter upon the above property for inspection purposes. Jmentioned Print Name: r L l "� l.(.1T� i% (.( Signature: /�"'� /� Date: `7 Owner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor 0 0 p 1� 060-028 – �' GAULI FY, BILL OROVILLE BUTTE COUNTY 2921 BOHEMIA A CONST 1T OF DEVELOPMENT SERVICES CUNT: BURNF-TT !NG PERMIT APPLICATION wIREMODEL SF JBMITTAL REQUIREMENTS INSPECTION#: OROVILLE: (530) 538-7636 - CFECO: (530) 891-2834 OFFICE #:.(530) 538-7541 Uy A FEE WILL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" APPLICANT NAME OWNER Last ame MNa e C l� oL Addres rn 0 , d`l City Fax StateC.A rp, S 9 - Ph Page Fax E-mail Date Approved: APPLICANT NAME CONTRACTOR Name , o Addres L )n _. City . e Fax State Cf�Zi Subdivision Name Map Phon1�- Page Fax E-mail Date Approved: WillD CI APPLICANT NAME ARCHITECT/ENGINEER Name C� f� 7—R, D Address Zap City Fax State 71— Subdivision Name Map Phone Page Fax E-mail Date Approved: State License Number APPLICANT NAME Name Oup V1 r Address City State Zap Phone Fax E-mail iW RRY's Iii For office use only: Zoning I Flood Zone 'ic I SRA I Xj No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR RURMIT'TAI RF01IIRFMFNTS LOCATION AP# r 1 D CO 13 Property ldr McV{ Cross Str t Lk S WORKER'S COMPENSATION Policy Number Carrier j 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 �\ P0 �v U Address �cdplionopeo Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. �EFI.►NrQ �1g2.2? ReGeived by:t>9M Amount / Bldg Veceipt #' Sheriff •� U� Q SMIP L4 ,2 Other Dat '�Zllld Tota SUBMITTAL 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 INS. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER1 OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. -2 Engineered truss details and layouts (if required) (NO FAXESI). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the en ' eer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPHPAPERI ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous• Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 53.8-7541. OVER FOR BUILDING PERMIT APPLICATION AFORMSMILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 RE/ 6.16-p4 COUNTY OF BUTTE-DEPARTMNT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET 6 OWNER: ��.-` ASSESSOR PARCEL NUMBER Proposed Building Use: 1 `� ✓`•-� �.1 / 1 l✓1 Counter Technician: Date: )tems required in order to apply for a permit. All boxes MUST be checked OR marked NA in orde to apply. ' ,:�4']' 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. -� 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie -down or find plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. . ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner jpL14. Hazardous Material Form 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) b17. Fire Sprinklers............................................................................................ b 18. Agricultural Buffer c!r and site plan apr from the Ag Commissioner Sent by 19. Soils Report and/or Engineered Foundation required ........................................... ........ 20. Erosion Control Plan Required........................................................................ A,,•�e 21. Fees as shown on the attached Schedule of Fees Due Sheet ................ I.............. (_ ❑ 22. City of Chico Plumbing permit.........................................,,,ryn ' 23. California Department of Fore plan approval- paid. Sent Tt�24. Planning approval (A) Use: �I`-{B)Parking: (C) Parcel Check: *?o 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form.........................................................................................`.:.. �� 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... Jk30. Worker's Compensation Carrier and Policy Number .......................................... l 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... El 32. Letter of Signature authorization.................................................................... 01' 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ -35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone 6 ` and hold for pickup. �1 p?O�D� eO,� I have been informed of the above items,"and requirements for obtaining a building permit. Applicant: 0 11y,41y t Date: Z 1. Index permit application for the above items numbered: Plan Checl Letter 2. Additional items required ontr o signer as advised of the above data by ,Phone, ❑ mail, ❑ co ter, by Date: 0 CPsrev7iewed esigner, o r was advised of the ab a da by 6"phone, ❑ mail, 5 r, Date: O /�'1'�`r L ry,,s��• by: Date: /f D Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division E.d V 3w .SE ONLY Plot Vlea Anec Poor Plan Anachad Sens to S.D. ! TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance J�(3L�40JN� C3411 &hrnIA Owner Location AP# N,_ Plan Approved for: Sewage Disposal Water S ply: ublic Private Well Clearance for dwelling. Other Hold final for: Final clearance O.K. for: NOTE: Environmental Health Specialist 8/96 LIS- Date COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 S HEDULE OF RECEIPT OF FEES OWNER A.P. # PROPROSED BUILDING USE n5 DATE —7--7" RECEIPT # DATE REC. 1. BUILDING PERMIT FEES --- Balance Due ..................... $ --- Additional Fees Due........... $ --- Revised Plan Checking Fee.... 2. SCHOOL DISTRICT FEES / (paid at School District Office) (form available after Plan Check) 6 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ _ Units Commercial (sq. ftg.)..... X $0.03 = $ _ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit)..... X = $ _ # Units Amt. Commercial (Sq. Ftg.).... X = $ Sq. Ftg. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE !!+ -1 0aid at Building Division) i52 8. WATER TENDER FEES BATTALION # _ $200.00 (paid. at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ......... X = $ / Sq. Fig Amt. y 10. OTHER VJ" �2 CQ)SA0 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 proc4. APPLICANT y ' ,t ,�,C Q -C, DATE 2 Z OX 11 U If Pursuant to Government Code Section 66020, you are hereby notified that items, , 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. 2/2003) I O.B.- I OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES ❑ NO M"- I HAVE_❑ HAVE NOT GO"signed an application for a building permit for the proposed work. 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 this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: 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 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. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. 0 If you are an employer, you must register with the State and Federal Governments 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. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract 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 contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely,y � w. Mic el C. Vi ira, C.B:O. M ger, Building Inspection NOTE. This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OVER Department C o u n t 1 J. Michael Crump, Director Public f B u t Works LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville. CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE1 Project Description: G Project Location and/or Parcel Number: D �� 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. 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: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/12/04 PLAN REVISION Owner's Name: AP#: oal • n66, 60_ gp#: <0 1 Received By: Date: Time: O', -3e) Contact Person &Phone Number: PURPOSE OF RE -SUBMITTAL OR REVISION ❑ Permit Application Data Sheet Item ❑ *Engineering ❑ *Plan Revision ❑ *Requested by Building Inspector's Correction Notice — Inspector's Name: ❑ , Requested by Plan's Examiner — Plan Examiner's Name: ❑ Other: *If revising a plan which has already been issued, submit two (2) drawings reflecting the revision for plan review along with your approved plans. If engineering is involved in this revision, the engineer must put his requirements -on these drawings and wet. stamp and sign two sets of engineered drawings. Revised drawings must clearly show changes proposed and locations involved. WHEN APPROVED, PROCESS AS FOLLOWS: ❑ Mail to Owner/Contractor at this address: ❑ Call and hold for pick-up. ❑' Deliver with next inspection. Minimum revised plan check fee to be collected at time of submission of revision, plans examiner will determine if additional plan checking fees are needed: ❑ Minimum $54.99 Receipt #: ❑ Fee not required for revisions requested by plans examiner prior to issuance of permit. ❑ Additional Fee Amount: Receipt #: Revised 2/04 --:i�'��=� .rs-.z »+. ti-;o.,i;="nom _ ;_:s".a... :..�v,,:.. ..� a:.' �_ ..... -. '* _�:�-�a'�»• �.. _ , -T--..c.:. ;.:.'�'� a .,s:; wi- �,-�.-:.::,,..� -r.:.F =� - Yt EsHw. USE ONLY Plot Plan AnocMd Floor PlaPlanAntseertad Sant to B.D. ! TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public r,Private Well Clearance for dwelling. Other f��� R n �- '� ► �) R } '°J A . -=,'ti; T - Hold final for: Final clearance O.K. for: NOTE: Environmental Health Specialist Date i. ' -s-,... .�-. n..,: _.".1�.':....... J�c..•a-. _: Tl ..eK.'_. J`..` `.� .. -.w ]'�a .w.. . i .... ...........'Q'.�.. +.'.f,.� 1 ttec a sign copy o e es nc ion an o ice o mi i tty "-merciai/Industrial; New -( Addition Building Department Representative District Identification.No. 050123 110)111 -lb.(( J n I }'� School District certifies that rJ (Including Exterior Roofed Areas) j7l5 0l Date (Applicant (,�`7_L1 (Street Address) (Phone Number) (City - / (State) q (Zip Code) has complied with the requirements of Resolution No. �S ' i 0 by payment of $ �2 • b l' representing _q9 ( square feet. JAB 2926 $ y I. � UFULL MRIGATION $ School District Representative Paid by Check # Remarks: �r,i.; ;•.ai'�; +#• :"� t_yt- �.=,-.r t''ay�.^...:=.�x''*+�.:.i��tT��;�.._ ...`+q ' ��'m � � .c�.., - Date ' Notice: You may protest the Imposition of the fees ktentified above by submitting a written protest to the District, in compliance with Govwnnwg cods section 66020(a), within 90 days from the date fess ars paid. Fallum to submit a timely written protest wlll'prohibit P you from chal"ing tine Imposition of the fees in any court action. ( if, subsagwnt to the School District Representative sipning this Butte County Schools Impact Fee Certification Form, the School District Is notified by the applicable Local Planning Apsncy that this poled is being rsvtewsd under the CaiHomla Envlm menti Quality Act (CEQAh this pro)eat may be subset to additional school fees to fully midgets. its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.xis It0/031dmm PLAN REVISION Owner's Name: BP#: 0�-l�3 Date:_1 0 "ALL Contact Person & Phone Number: AP#: o;,E < 0"'c)D- Received By: cklt� Time: 11 PURPOSE OF RE -SUBMITTAL OR REVISION ❑ Permit Application Data Sheet Item ❑ *Engineering ❑ *Plan Revision ❑ *Requested by Building Inspector's Correction Notice — Inspector's Name: Q' Requested by Plan's Examiner — Plan Examiner's Name:eus�ai� ( I ❑ Other: *If revising a plan which has already been issued, submit two (2) drawings reflecting the revision for plan review along with your approved plans. If engineering is involved in this revision, the engineer must put his requirements on these drawings and wet stamp and sign two sets of engineered drawings. Revised drawings must clearly show changes proposed and locations involved. WHEN APPROVED, PROCESS AS FOLLOWS: ❑ Mail to Owner/Contractor at this address: Call ql !91 �,P_�(v7 7 and hold for pick-up. ❑ Deliver with next inspection. Minimum revised plan check fee to be collected at time of submission of revision, plans examiner will determine if additional plan checking fees are needed: ❑ Minimum $54.99 Receipt #: I? r ee not required for revisions requested by plans examiner prior to issuance of pennit. ❑ Additional Fee Amount: Receipt #: Revised 2/04 VISION PLAN RE Owner's Name: �,�U�P�` / AP#: 0 2 7 — t,5260 0 2_�3 BP#: Date: Contact Person & Phone Number: Received By: 23a - Time: PURPOSE OF RE -SUBMITTAL OR REVISION ❑ Permit Application Data Sheet Item ❑ *Engineering ❑ *Plan Revision ❑ *Re uested by Building Inspector's Correction Notice — Inspector's Name: Requested by Plan's Examiner — Plan Examiner's Name: SS �2L ❑ Other: *If revising a plan which has already been issued, submit two (2) drawings reflecting the revision for plan review along with your approved plans. If engineering is involved in this revision, the engineer must put his requirements on these drawings and wet stamp and sign two sets of engineered drawings. Revised drawings must clearly show changes proposed and locations involved. WHEN APPROVED, PROCESS AS FOLLOWS: ❑ Mail to Owner/Contractor at this address: Y/6— 95 and hold f r pick-up. Lr Call �L72j't�.�� P P o Deliver with next inspection. Minimum revised plan check fee to be collected at time of submission of revision, plans examiner will determine if additional plan checking fees are needed: ❑ Minimum $54.99 Receipt #: IE( Fee not required for revisions requested by plans examiner prior to issuance of permit. ❑ Additional Fee Amount: Receipt #: Revised 2/04 SITE PLAN REVIEW APPLICATION Date- / ,23 D AP# a� — Permit Number (if applicable) /� �3 APPLICANT EVFORMA ELONY Parcel Size: 0 27 Owners Name: Owners Address: FS-7 9!F3d" Telephone No.: 9rle - 9 - 6 7 7 `l Situs Address: Proposed Use: Residential ❑ New Single Family Residential ❑ Single Family Addition ❑ Single Family Remodel ❑ Mobile Home .n J Residential Accessory (, 6ea/ �aa"" Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ CommerciZRemodel ❑ Industrial Remodel DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) a Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval V Site Plan Stamped Approved* By Date ��3 0 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) Watershed Protection Overlay Zone (See attached standards and requirements) Expansive Soils (Test for expansive soils and if verified proper foundation design required) SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: . X • Flood Panel No.: D & 40 7e 6 MKI) Index Date: ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance ❑ Detached Building Use Form ❑ Encroachment -Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: I� — s Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. .D--„ n -.C-' Zoning Code Streets & Highways Fire Prevention Subdivision Map Front 20, Side /01 Side Street Rear /0 r Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. .D--„ n -.C-' Applicable Development Fees: Standard Fees Amount ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other Formula ------------------------------7--------------------------------------------------------------------------------------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By ❑ Deeds: Date of Creation: Deed of Reference: Parcel Frontage on Publicly Maintained Road: Complies with Co ty Standar s for Deed( Comments: & &,( ?Z7 i -A I A . Legal Access Provided: ❑ No Legal Access Required ❑ No ❑ No ❑ Yes, Road Name: ❑ No ❑ Yes �✓ A ❑ Yes ❑ Yes N Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Subdivision Map/Parcel Map: Map Date of Recording: Lot: ❑ Use Permit/Minor Use Permit Permit Number: Book: Page:, Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development.. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for roa 07 7 f/. 0 0 0 Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc *,?PERMIT N0. — !.� PERMIT EXPIRES {OWNER Alfred Martin 1 3 CONTR. owner " LOCATION (A.P. 27-06-2$ a r j W/S pri.rd.,app.500'S.of Bohemia Ave., 4 mi.E.of Citrus Ave., Oroville Y ' 1 Temp. Power Pole Called PG&E Temp. Elec. Serv. t Called PG&E Temp. Gas Serv. Called PG&E t ' JOB FINALED (Da i l / '7 0 `. ,' C COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD 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 v- To out Slab Roof Sheathing ��- Water Piping Piers Roofing v--' Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Insulation ^f Heaters Slab Carport Footings Prov. for physically handica a Conformance of ex. structure Appliances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footino ELECTRICAL Masonry Walls Throat I Rough Reinf. Steel Final I Fixtures rraming Test Water Mr. Stucco Final Subpanels Mesh MECHANICAL Grid. Fault Prot. Sgratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Int6i'Ior Lath Ventilation ; / Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec_ Service Elec. Pedestal Water Piping Sewer Gas Piping M0016EEHHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF�BUTTE - DEPARTMENT OF PUBLIC WORKSPER IT NO^ 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541z4 �/ APPLICATION AWD PERMIT ) .ASSESSOR IAIC6 NUMBE ZO ING _ BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWN R'S MAILIN DID SS Ut Il rZ CONTRACTOR'S WIAME O �1 W TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER e' UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee / $ 60,21 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$' Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ZLga BUILDIN ADD S UJ. � � PLUMBING PERMIT Filing Fee 10.00 d 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 STRUCTUFtE SFKI Duplex❑ Mobilehome❑ Others 7A . Na SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ Addition ❑ jl ❑ Utilities ❑ Installation❑, /Other Describe work: % `�� ��`z9 � :;��%6`�"��� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service DOOV OR LESS 100 AMP OR LESS 5.00 Main service EA. ADO'L 100 AMP 2.50 NEW CONST. (DWELLING OCCUP.d) OR ADDNS. ACC. BLDGS. 2�sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F]I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and m license is in full force and effect. y License No. Classification Id 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 I -OUTLET 2,50 ea NON-RES,BRANCH CIRC ITS NEW CONSTR. / POWER APPARATUS D1 NON-RESID. %SINGLE OUTLET CIR. / 50 @ as Ex. Occup OUTLETS OR FIXTURES gpLei FIXED APPLNS, OR Ex. OCCup.(OUTLETS (RESID,) EA. 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. IVI 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 $ 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, indemnifyAnd keep harmless the County of Butte against all Iiabiliti s, judgments, costs expenses which may in any way accrue ag4J st sa' ty in onse uen g_QLthis permit. x Date Signature o Ap licanr — Owner Contractor 1:1 Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures oovver3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ Q OCCUP, GROUP I TYPE OF CONST. I PARCEL PD I HD I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which ECTOR OF PUBLIC By PERMIT EXPIRES ate .SAEj2 the applicable provi- resolutions to do fees have been paid. WORKS Date S 7 7- 2� Receipt No. 4'7 -Tq �/ WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY -OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT FWA 54 "Meg' �'a1" ASS=550R PAIQCEL NJMBER (! & ZON'LL� /V BUILDING PE T /Vt 10A'0 OW ERI n e-77, / //\V TELEPHONE 3�-//� 7z -- �� S0. FT. OCC. BUILDING VALUATION MAILING 1, V V /� 649616015 t_J?1 t30h1C 4444=Q0 CONTRACTOR'S NAME TEI-EPHONC LLVV 200 IrlL...C! L 000 O o CONTRACTOR S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN Fireplace '� OUQ• 0a Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ 121,67D ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ fDO SD Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ �• J BUI D NG ADDRESS OO /J d ✓O'/�! ��7 PLUMBING PERMIT Filing Fee 3.00 'n rAl Al/. C-' V . e17RV 05' Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeQ�Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Install tion Q Other Describe work: e,46,4AJA . )040"14-Z)Ade D— Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 100 AMP OR00V OR LESS5.00 Main service EA. ADO'L 100 AMP 2.50 NEW CONST. DWELLING GGYY§§CCyy11 pp,, & OR ADDNS. ACC. BLDGS/(/V 20 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one):', ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. �License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ 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. ULTI-OUTLET 2.50 ea NON-RESID BRANCH CIRCUITS) NEW CONSTIRL / POWER APPARATUS 6� NON-RESID, %SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 50@� BAL�10¢ FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ U Contractor MECHANICAL PERMIT Filing Fee 3.00 WORKMEN'S COMPENSATION INSURANCE 1 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 2.00 Ventilation permit Fee $ 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, i5demnify and keep harmless the County of Butte against all liabilities, judg t ,costs, and expenses which may in any way accrue agains aiCou t e of the granting of this permit. - Date / CO Signatur7rre of Applicant — Owner Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE $ . 9v OCCDP GROUP TYPE of CONST. V PARCEL PD HD 95UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIR OF PUBLIC By P MIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date •S� �'7 �� I 7 -{�(/ Receipt No. O �Q� WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF RUTTE•— DEPARTMENT OF PUBLIC WORKS — BUILDING DIVISION 7 County Center Drive — 0roville, California 95965 — Telephone 534-4541 PERMIT APPLICATION DATA SHEET / Permit No. _ OWNER 41 jr D ,�T/ A A.P. No. Proposed Building Use RA.4jg /2/a" - / Permit fee based upoJ; Complete Contract Price DPW Valuation G/ er (explain) Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted................................................................... *41 ". Plot plans in duplicate/triplicate............................................................... 3. Complete plans in . irate triplicate ................................................... 6 Z7 4. Complete engineered plans and calcs..................................................... 5. Plans with Energy Design Compliance Statement ............................ 6. State Energy Forms No. .................... 7. Statement of Intent for Non -Heated & AC Buildings ................... -- f Fees of $ /!'9 • SIJ 9. Letter of signature authorization............................................................. 0. Sanitation approval from ,dQ Health Dept.... 11. Planning approval for 12. Certificate of rk a 's Compensation Insurance ........................ 13. cc �`rmation (no., name style, M classification) ............................... 14. Improvements may be required. Contact Land } t Development Section of Dept. Public Works (see addressbelow)................................................................................................. 15. Pre -inspection for required. Pre-inspec. request to (date) bldg.inspector 16. Other When you issue the permit, process as follows: ail to owner Mail to contractor. Telephone and hold for pick-up at office. Deliver, w/inspection. Other Applicant i� , /i lfi���l //�. , /=� Date 1 i �� Irl) Copy of plans sent Health Dept., Fire Dept., Other Date During the plan checking process, the following data must be submitted prior to permit issuance: (For required items not checked above at time of apprcle i 1. Index permit for above Items No. 'c n, I ` - 2. Additional items required: (Contractor, Designer, Owner) was advised of above required data by Telephone Mail Other By Date Plans checked by Date Plans approved by Date 66-- Z Cd OTHER: Copv/DPW +. rtj c'r t � � I` e � I ! ♦ i i i f i I f % n �� D �r S Cu lit a. � � e n t � s � rc�lo e ►� � �d ✓� �® yt WC- ,. -14,4 �e� t �o� mo�O�e /iPW, L/ OL o �, tCX e n A Y C �or 0. lee f r; use COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 ERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING[` i!1 , BUILDING PERMIT BUILDING OWNEIdEBB HOMES TELEPHONE SQ. FT. OCC. BUILDING VALUATION 1688 R 91,152 OWNER'S MAILING ADDRESS 38g CQnnars; Col-irt, Chico 95926 484 M 8,712 AE CONTRACTOR'S NM TELEPHONE /. 'i 96 CONTRACTOR'S MAILING ADDRESS .., Fireplace A 1,500 CONSTRUCTION LENDER UNKNOWN Total Valuation $ 103,860 Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 653.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 1 PERMIT FEE $ 696.50 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 15.00 LOT N0. SUBDIVISION'S NAME 8 Amber rove Sub PARCEL MAP (�' Each gas water heater or vent 15.00 19,00 USE OF STRUCTURE SF L Duplex O Mobilehome O Other SPECIFY20.00 Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W TYPE OF WORK New )p Addition ❑ Remodel CIUtilities ❑ Installation ❑ Other 1:1Contractor Describe Work: Plan #326 From Master #21-91 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( BDDv OR LESS ) 23.00 2WA OR LESS Main Service ( 200A TO 1000A I 46.00 NEW CONST. DWELLING OCC UOP. S OR ADDNS. ( 6 ACC. BLDS. I 3.50 ST; NEW CONST. MULTI.OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 CONTRACTORS LICENSE LAW I decjtke under penalty of perjury (check one) I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Qdo an .m license is in full force and effect. License No. _< J/ � 7 J Classification El 1, as the owner, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) ❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason POWER APPARATUS ) 6 SINGLE OUTLET CIR. EX. OCCU OUTLET OR FIXTURES 20 @ 1.00 P• ( I BAL. @ .50 Ex. Occup.UTETS(RESD OR OUTLETS (RESID.1 EA. I 5.00 T Temporary Service 23.00 Mobile Home Facilities 20,00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. 1 have placed on file with the County of Butte Dept. of Development Services, Building Division 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 Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating split attic 15.00 Cooling 3 ton 15.00 Hood 6.50 Ventilation 7.. 459 -21-7 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 Butte County Ordinances and California 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, ud me s, costs, and ex ense which may In an way accrue against said 1 9 P Y Y Y 9 County in copse ce oft grand g' f this permit. q X \1 Date /G / Signature of Applicaht - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. a lla rk� Mobile Home Installation Fee S Energy Inspection Fee S 46.00 °°"S TOTAL FEE5 1,056.00 HAZ. D. F F� IMP ✓ F100D CDF AflCEL PD i_ i. HD ISS This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indic abo a for which fees have been paid. ORS OF PUBLIC WORKS By Dates tla g / PERMIT EXPIRES ON `� �l•l� t/ ({j IOetel _ Receipt No. 14i�A5fi�l�i.00 n.C.�� IS ��15C �53-- WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT LAND DEVELOPMENT BUILDING/ ENVIRONMENTAL .HEALTH" PERMIT CLEARANCE Building Permit No. OWNER �c.h� //, / % f' � A.P. NAME:_/ V V(? �. l l b L i'O �d NUMBER:PRINT LAST NAME FIRST` r ADDRESS / LOCATION: U COUNTY ZONING I� �� DESIGNATION: �� ISI /-� S FLOOD ZONE: X FLOOD MAP: APPROVED: CONDITIONALLY APPROVED: RESOLVE PROBLEMS PRIOR TO APPROVAL: V Co. 5 %q c PARCEL CREATION BY DEEDS OR MAP Sc hra on crt Pm_ oJ-E C.C. DEED INFORMATION: DATE OF CREATION: Z� / / 7fl DEED REFERENCE: /&0Z 0%2 ,I1Aem 10 Cf26_ 4'rc 0 Z7-060-29 /Nt': LEGAL ACCESS PROVIDED: YES NO LEGAL ACCESS REQUIRED: YES NO COMPLIES WITH COUNTY STANDARDS FOR DEED CREATION: YES NO COMMENTS/CONDITIONS: I v R-5 Z 7'0�> F_rLO V1 06:5- CP1 f770n% MAP INFORMATION: DATE OF RECORDING LOT BOOK PAGE COMPLIANCE WITH OLD SUBDIVISION LOT ORDINANCE REQUIRED? (MAP RECORDED PRIOR TO BOOK 17 OF MAPS AT PAGE 23): YES NO . IF YES, MARK APPROPRIATE ITEM(S) BELOW: A. Construct road to B. Meet parcel size required by zone. C. Meet current E.H.D. requirements. CHECK SPECIAL CONDITIONS WHICH APPLY TO MAP: ALL FEES TO BE PAID TO THE BU/LD/NG DIVISION UNLESS OTHERMSE NOTED. _ 1. Maintain a 50 ft. building setback from centerline of road. _ 2. Maintain a ft.building setback from right-of-way/centerline of _ 3. Comply with Zoning code for building setback from road. _ 4. Maintain a 100 ft. leachfield setback from all existing wells. 5. Maintain a ft. leachfield setback from _ 6. Pay water tender fees in the amount of $ to Battalion Number of the Butte County Fire Department. _X 7. Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 i 8. Connect to a public water supply. 9. Connect to a public sewer system. _ 10. Automatic fire suppression sprinkler systems shall be installed in all residential structures in accordance with the National Fire Protection Association Standard for the installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet Fire Department specifications, serves the parcel. _ 11. Pay T.D.D. (Thermalito Drainage District) fee in the amount of $ _ 12. Meet the requirements of the Department of Fish and Game for the preservation of oak trees. (See phone number below) _ 13. Obtain approval from the Department of Fish and Game for vegetation removal. Contact Fish & Game at 916-355-7010. _ 14. A traffic mitigation fee for each new or additional living unit shall be paid. Pay the amount of $ as stated in the Oroville Area Traffic Mitigation Fee Agreement. PaynnW to be madly to the Plrarn%y Dhdslan _ 15. All new residential buildings shall be constructed to comply with the requirements of the Uniform Building Code for seismic safety. Mobile homes shall be constructed on a permanent foundation system which complies with the Seismic Zone 3 requirements of the Uniform Building Code. _ 16. Deer Mitigation fees are to be paid, if such fees have been adopted by the Butte County Board of Supervisors. X 17. Pay school impact mitigation fees. X 18. A development impact fee for sheriff facilities shall be paid pursuant to the provisions of Chapter 3, Article II of the Butte County Code. _ 19. Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988 as amended. _ 20. If any cultural resources are encountered during ground disturbing activities, all work shall cease in the area of the find pending examination of the site by a professional archaeologist. This person would -then be able to assess "the site significance and suggest appropriate mitigation measures. 21. 22. 23. 24. .25. 26. 'AIC) 1N3UVd013A3C) ONbI RM810 kiNt100 1661 1 0 100 a3ni333a LD 5/97 c,wvs 1 %F ow.e. KWL0GPEM. as OFFICE COPY Address) --uLz4�- GAS Date Meter By, ELECTRI- DaA�aL Meter By COUNTY OF BUTTE - DEPARTMENT OF DFVELQPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916)5-7541PERMIT NO. APPEICATI�ON.AND PERMIT t) 3 ASSESSOR PARCEL NUMBER �- 027--06M98 ZONING ARMH5 BUILDING PERMIT OWNER JUNE MARTIN TELEPHONE i SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS �^ _ CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITE6TOR ENGINEER'S MAILING ADDRESS N Penalty $ BUILDING ADDRESS PERMIT FEE $ PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobilehome C1 Other POLE SPECIFY Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 20.00 TYPE OF WORK New ❑ Addition ❑ Remodel C)Utilities ❑ Installation C)Other ❑ Describe Work: REHANG MAIN PANEL PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 (REPLACE REM POLE) Main Service ("v OR LESS 200AORLESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. S0, OR ADDNS. ( & ACC. BLDS. ) 3.50 FT, NEW CONST. MULTI -OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 CONTRACTORS LICENSE LAW( I declare under penalty of perjury (check one) ❑ 1 am a licensed underrovisions of Chapter 9, Division 3 of the Business and P P 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 compensation, 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 contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL. so Ex. Occup.FIXED APPWS. OR ( OUTLETS (RESID.) EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. `O I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 43,00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California 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 } )- t _ .,r Date J,.: ' % % Signature of Applicant - ID Owner ❑ Contractor .❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile,.Home Installation Fee $ Energy Inspection Fee $ CONST. TYPE' TOTAL FEE $ LOCC HAZ. D. FEES I (MP I FLOOD I CDF PARCEL PD HD ISSUE 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. � ^01 � l,.C�vf).7 �t�7� Y Date JI, ` ' , ' PERMIT EXPIRES ON/..Z f ��• __/ ID Receipt No. 170786 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT Of DEVELOPMENT SERVICES - BUILDING DIVI N 7 County Center Drive - Oroville, California 95965 - Telephone (916) -7 PERMIT No. APPLICATION.AND PERMIT ASSESSOR PARCEL NUMBER 1719 —060-628 ZONING BUILDING PERMIT OWNER MARTIN TELEPHONE 533-117 SO- FT- OCC. BUILDING VALUATION -11-INR OWNER'S MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDEWS MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 2912-1 Livil"l-Lri AVE PERMIT FEE $ PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other POWER POLE SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W @20.00 F - TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities 1:1Installation ❑ Other 1:1Contractor Describework: REHANG MAIN PANEL PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 ( REPLACE NXXXX POLE) Main Service ( 200V OR LESS OR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. BLDS. ) 3.50 SPT,O, CONTRACTORS LICENSE LAW 1 declare under penalty of perjury (check one) ❑ I am a licensed underrovisions of Chapter 9, Division 3 of the Business and P P Professions Code and my license is in full force and effect. License No. Classification 1$(I, as the owner, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) ❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET NON•RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL. .50 Ex. Occup.FIX ED APPWS. OR (OUTLETS IRESID.1 EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division 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 to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 43.00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California 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 r.4 42 1 Date �a'% 9� Signature f Applicant - Owner Contractor ❑Agent An OSV permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ocC 1111T. TYPE TOTAL FEE $ HAZ• I D. FEES I IMP I FLOOD COP PARCEL I Pb HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated abo a for whic es have been paid. / «Z Date / PERMIT EXPIRES ON (Date) Eeipt 1 7n7$( TE•D.D..D.S.-6.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ,� _, , 4 COUNTY OF BUTTE Department..of Development Services Building Division Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541 Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement `ryesIor no) I tave/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractor's License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City 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 is - - 9� NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. F S PERMIT NO. ' E i ✓ � PERMIT EXPIRES OWNER Alfred Martin f CONTR. owner �4t LOCATION (A.P. 27-06-28 W/S pri.rd.,500'S.Bohemia Ave., 4 mi.E.Citrus Ave., Palermo r rAI Temp. Power Pole" Called PG&E / /-0/ n Temp. Elec. Serv. (� a" Z Called PG&E Temp. Gas Serv. Called PG&E JOB FINALE ci v COUNTY OF BUTTE 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 '�C� 7�7Tfor the following location: 11t�S testi . �n4j SDC:! <,R til_ , _ &I w.. N7-0- 01 C A . - _ Rn I�, r ,. Owner Owner's Address 1 Q 1 Ym jjz'-4'y'% I er- ►h0 l.' , Mobilehome Mfg. n M Model'CePl u o,q7a Year744 Insignia No. �/ Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of Public WvvojrkKs Date A` %— By _ ,�1 THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White- Owner, Yellow- Installer, Pink - D.P.W. COUNTY OF BUTTE 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 7. %4for the following location: 112/S er l . pr) SIC n a i�4\L wrva.. 1 - 11-f )T1s . C n .i % U U o t r� �l� 3 bit I'Owner Owner's Address 1 7R In,:, --AA 1-4 Par "n© Mobilehome Mfg. M A -Am 0I n i1 Model (22'41(405Is __ Year# Insignia No. �/ iC ii Serial No. -3 j It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date 7 By '"Q ' �. THIS CERTIFICATE IS VOID WHEN MOBILEHOME I&ELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. MOBILEHOME INSTALLATIONINSPECTION CHECK LIST 1, Is the mobilehome located with required separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes No 3. Are footings and supports properly sized, spaced, and braced as per pproved plans? (Note possible variation at spring shackles.) (S�ec�No 5082 & 5083) Yes_ No leh me level? Sec. 5088) Yes_V 4. Is.the mobs (— 5. If more t ' gle unit, are crossover connections properly installed? (Sec. 5088) Yes N 6. Water A. Is fle ble connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes_ No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes 4/No C. Backflow - If coach is not Stat fAa .ifornia approved, does.station have backflow device and pressure -relief valve? Yes N 7, Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Ye _ No B. Does it have minimum 4" per foot slope and �s it properly supported? Ye4�1/No_ C. Are any leaks detected in drainage system after running 3-ga ons of water through each fixture including washing machine standpipe? Yes No D. If coa i n State of California approved, does station have required trap and vent? Yes 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: piping is to be at least as large as the mobilehome ga ne inlet without reduct'ons other than the mobilehome connector. Yes No B. :Test OK as per following procedur i Yes_ N 1. Open all appliance connector v Ives. .2. Shut off appliance burner and pi o valves. 3. Air test with manometer to 10" 4" ater column, or test with slope gauge (minimum ® 6oz.-maximum 8 oz.) calibrat in to th pound increments. Test for 10 min, without drop. 4. Connect gas meter'to mo ilehoute.with con ctor, 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 minimum of 10 amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes_ No_ c panels? Yes �/No B. Is there proper clearances around p _ C. Is power supply cord or feeder assembly properly fused. Yest,_ No_ D. Is continuity Iest satisfactory as per the following procedure? Yes_ No 1. De-energe eleltrical wir ng syste of tPfmobil home at the�ped stal. 2. Make sure that the power supply cord or feeder ass m ly co uctors, lud ng n traf 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 mobilehome supply conductor, including neutral. 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 test 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 (OA Length_ Width Vehicle Serial No. 5 �� State Identification No. e9 Additional Information or Comments- r- 7 Ll - coa� 6 I 1 R Mallk Bldg. Slab Piers Stemwa I I Slab Carport Footings Slab Patio Footings isainry Walla Reinf. Stee amani ucco Mesh COUNTY OF BUTTE — DEPARTMENT -OF PUBLIC WORKS + BUILDING INSPECTION RECORD BUILDING A BUILDING (Coht'd) A PLUMBING Rest om Finish Windo Siding Roof Shea in Roofing Fdn. Vents Garage Vents Insulation Prov. for physical , handica ed Conformance of ex. Footing Throat Final FIRE SPRINKLEF Test Final MECHANICAL Heatl SdX1 Piping 114 Floor 2n Floor 3rd koor To out Water Pi I Sewer Fixtures Water Htr. Heaters Appliances Gas Piping & Test Temp. Gas Sanitation Final Fixtures orpwn X ICooVhg Tjfmp. Pole nish D is nder round erior Lath ntllation Permanent oor Closer ''al Ffinal MOBILEHOME UTILITIES •.... • Elec- Service Elec. Pedestal .� Water Piping Sewer Gas Piping OBILEHOME INST LLATI N . - ... . • • • • • Support Elec. Continuity Water Piping - - Drainage Gas Piping DATE REMARKS OR CORRECTIONS 0-101Ta oo S s0 X, '7, (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — %DEPARTMENT OF PUBLIC WORKS : v _ -k7 County Center Drive — Oroville, California 95965 77 APPLICATION Telephone: 534-4541 7 APPLICATION AND PERMIT authorize representatives of theXol�nty of Butte to enter upon the above-mentioged property for i p c ion purposes. ate �- Sig at r of Permitee or A ent Receipt N. �� 0 9 Z 7% 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 aid. DIRECTOR P BLIC WORKS By Date -:7:7 % 0 p Bui ing permit expires Date BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address 7 ,49 /V6 L 0 2 ((�� 0 On 7 JO S Telep one No. Fireplace Contractor a uir-,f fs—fes• Total Valuation Mai I i ng Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Jt -0 f -S^ 9010/@M Each Trap 1.50 44S v¢. A ll� • •� F 5-- 7-44,S Repair drainage or vent piping 1.50 Water piping J-4,4* % 0 &OirQ YQritication Vu1y. A L F9h'�-a . - Each gas water heater or vent 1.50 A. P. No.c2 7" �t / r, 8 p ^� O g - Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F VC. I S Ian I Fire Dept. Fire Zone Use Permit Building sewer 5.99 0 ^ EQA Parking Plans Parcel Parcel Ma Im rovements Declaration p Lawn sprinkler system 2.00 BI "' .(pJQI ec'd Par I oval PI pproval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIESZ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP LESS 100 5.00 Main service EA. ADO'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 1.00 NEW CONST. ( DWELLING OCCUP. &) 22syft OR AODNS. ACC. BLDGS, MULTI -OUTLET NON•RESID CONSTR. ( BRANCH CIRCUITS) 2.50ea eNEW LP .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)50 @25¢ 104 FIXED Ex. Occup.(OUTLETSPLNS (RESID)REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 / License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ 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. rV I certify that in the performance of the work for which this LIN 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. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 1 2.00 Fee $ $ 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 relatinq to buildinq construction, and hereby Permit 1h U' 2 6_ O�S�•- TOTAL PERMIT FEE $7 lEn authorize representatives of theXol�nty of Butte to enter upon the above-mentioged property for i p c ion purposes. ate �- Sig at r of Permitee or A ent Receipt N. �� 0 9 Z 7% 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 aid. DIRECTOR P BLIC WORKS By Date -:7:7 % 0 p Bui ing permit expires Date •This set of plans'and rlaee;ge"4"'hs M1.1ST he kept ori the jo6 at all times and it is unlawful to mop any changes or altercations on same without written permission from the Department of Public Works, County of ' Butte. NOTE:—All Materials & Workmanship Shall Be in Accordance with Recognized Good Practices and a quality prescribed U Specified Uniform buildingg,, Plumbing & Mecan col Codes and the National Electrical Code., S �� f�jEp �11�Rfi1 N f7f.4 Nit The 49dg. Setback shall be 5 ft. from the side property lire and, 50 ft. from the cented',ne of the road, permitting a maxi- mum of a 2 ft. eave overhang but entirely out of all easements. R� 6� P 4. . P rmrt will allatip�17 of h, eguirea 4 �C \2-z WS Septic system in eat to be as per Butte County Health Dept. Re. quirements. Ott /y63- 717 AII /ility connections shat located within 4 ft. outside the rear third section of the mobile home on the left (road) side of the mobile home; ti BUTTE COUNTY BUILDING DEPARTMENT s 'V COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center drive —' Oroville, California 9596.5 Telephone: 5�4-4541 APPLICATION AND PERMIT V2-79 Owner 1 Mailing Address % L7yw-JPP Avix, �elephone Na. Contractor _ BUILDING `J SQ. FTS I OCC. BUILDING VALUATION Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address Plan Checking Fee&/or Penalty Permit Fee j 4z PLUMBING No.1 @ FEE PERMIT FILING FEE J$3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 ,� A. P. No. 7 ,--CO) � Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 FIS Vke -Ga.� I Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Ma p 60' R/W Improvements p Each additional outlet .30 Building sewer 5.00 Bldg. �Rec'd Parcel Approval ans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ ^— 77 ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 0ov DR LESS 1SS 100 AMP OR LE 5.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADO'L 100 AMP 2.50 Main service OVER e O 100 AMP OR LESS 25.00 Main service EA. AOD'L 100 AMP 1.00 NEW CONST. / DWELLING OC cup- &') OR ADDNS. ACC. BLDGS. 2�Sgft 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: NEW CONSTR. MULTI.OUTL T NON.RESID BRANCH CIRCUITS 2.50ea NEW CONSTR. POWERAPPARATUS e NON.RESID. SINGLE OUTLET CIR. EX. Occup(OUTLETS OR FIXTIIRES BAL@1 FIXED LNS Ex. Occup. ( OUTLETS P(RESID )REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 License No. Classification ® I am exempt from the Contractors License Laws of the State of California. Permit Fee $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor PERMIT FILING FEE J$3.00 Heating 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. 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 uilding construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property folipection purposes. Date^%6 ✓ Si to a of Per tee or Agent Receipt No. a T Ll 1 / �% White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Coo I i Ventilation Hood 1 1 2.00 Permit Fee $ $ L $O. ba TOTAL PERMIT FEE $ D 6� 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. DIR OF P IC WORKS By Dat P� Building permit expires Date v"��% MOBILEHOME SUPPORT DATA If other than'single wide, Mobilehome Mfr.le%.. furnish Setup Model No. ��� Years=_ Width Lz (ft.) Box Length (ft.) Tagalong,�or Expando Size� ft. x ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973, furnish manufacturers 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 A, A pressure treated or foundation grade. x ( t.)( in:) (in.) (in.) 2. Other (specify) Center upport Center sup ort locat ns* footing s zes Supports (check one) (in.) 1: Concrete block. 11 F1 L Other (specify)- (ft.)(in. (in.) (in.) 4 ---Tagalong or Expando,' show support details. f (ft.)(in.) in.) (in.) -- Typical Support 7in. ,(i�.) Footing Size: AV x (ft.)( n.) (in.) ( .) .� S -- Max. Pier Spacing Max. Overhang (in.) (ia.) BUTTE COUNT`S BUILDING DEPARTMEN APPROVED a' *If center piers are other than drawn above, draw in -locations, suacine. and dimensions. 1. Owner's name: l/� BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County„Cennt_er Drive, Oroville, CA. PHONE: 534-4541, MOBILEHOME INSTALLATION SHEET C 2. Installer's name: 3. Is the site currently under permit? Yes /17/ 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 tank and leach fields and clear of all setbacks and easements? Yes No (If no, clarify ) 5. What is the mobilehome electrical rating? ----------------------- y d Amps 6. What is the mobilehome site service rating? --------------------- Amps 7.. What is the mobilehome site circuit breaker rating? ------------- Amps 8: Is there any oth- electric load to be served by the mobilehome site service? - - - - ..____-_---C __ ____ _ P ------- (If yes, identify the load and size: (Load) 9. What is the mobilehome site gas pipe size?* ---------------------- 10. What is the type of gas service? ----------------------------- Natu 11. What is the gas pipe length from meter or tank to the mobilehome? 12. :What is the mobilehome gas demand? ------------------------------ Yes f (, No / / (Amps) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.)