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HomeMy WebLinkAbout027-230-09094-1337PE(MH) 027-230-0190., WARNER, CHARLOTTE' 60 EASTMAN LN -OROVILLE *. - MOB,ILEHOME'.UTILITIES, /'li/fj/. iELECT RIC 7 '-GASi.LINE 'I, .1 COMPACTION -,TEST., REQ SUPPORT.- STRUCT, REQ i_­Zl v 94-1338MHI 'WARNER, CHARLOTTE*,,. 60 EASTMAN,LN': ' 01-ZOVILLE 'iqOBILEHOME'INSTALLATION 7o1 0 4 ,j o RESIDENTIAL S. 94-1337PE(MH) 027-230-090 WARNER, CHARLOTTE 60 EASTMAN LN., OROVILLE MOBILEHOME UTILITIES OFFICE COPY Address GAS Meter By Date ELECT Meter By Date JOB FINALED (Date) Signature )1,l V=OK ' O = Not OK NotReaadyabe MOBILE HOMES MISCELLANEOUS Date/Initials MOB E. HOME UTILITIES Plans OK except #'a kjeZ_prrWg Requirements -Setbacks -Easements fJt'S_OW; Special MH Support Sketch `.3'Sr; Location -Teat -Fell -C/O Concrete Wim; Location -Teat -Easement Needed (Sketch) I iicity; Location-Clearences-Grnd-/ /Amp -Concrete es; Location -Teat- ap: / /"L"ft. / "Nat. or 'L"ft. /"LPO Wel Clearance & Cilebonnect IN�tllity Clearance Date/Initials MOBILE HOME INSTALLATION Plans OK except #'s Zoni Requirements -Setbacks Easements ootings; Size -Spacing -Marriage Line e-vaas; MH Test-Demand-Valve—Connector ectric ty; MH Test-Crossovers-Breakere-Clearances n• -MH Test -Fall -Flex Connector i ater; M.H -Test-Regulator-Connector { e nd Sewer Connected -C/O to Grade -HD Approval a d Electricity Tagged it ep.-Sketch rt. o_f0966pancy i I .t Date/Initial DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'a 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-Depth-Spacing-Connectore-Steel 3. Decks; Gridera and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftre.-Connectors Shthg: Rfg.-Bracing 5. Alum. Awn.; Columns-Connectione-Splice-Decal=Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftre-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date/Initials POOLS (Plana) OK except #'a I. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Else.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.;Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ina. to Main In Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test V=OK O = Not OK - = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date/Initials _UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope - 2.Ftg., Main; Soils-Elec. Grnd.-/ P' Ftg. Depth 3. 'Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance -Materiel -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date/Initials PLUMBING (Permit) OK except #'s 16. Water Htr.; Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Nail Protection 18. O.W.V.; Test -Fittings & Anchor-Naii Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe; Size & Anchors Date/initials ELECTRICAL (Permit) OK except #'s 22. Fixture & Transformer Clearance -Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. 26. 'Equip. Ground made up w/Meth. Fastners-Bond Gas & Water 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At. Insulated Neutral ❑ Yes ❑ No 30. Service -Riser Conductors & Ground -Main Disconnect 31. Equip. Clearances Panels -Motors -Mach. Equip. 32. Clothes Closet Light -Shower Light -Spa Light 33. Smoke Detector Date/Initials MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support 35. Vent Fan; Exhaust above insulation 36. Condensate Drain & Overflow; Size & Grade 37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet 38. Attic Access & Platform if Furnance in Attic Date/Initials FRAMING (Plans) OK except #'s 39. Sils, Proper Material & Anchors 40. Wells Studs -Nailing, Spacing & Bracing -Plates -Sound 41. Bearing Wells over Girders & Floor Nailing 42. Draft Stop in Walls (rat proof) 43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing Date/Initials FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties- Puri in -roof Brac-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing.Area-Glass Protection -Skylights -Plastic 58. Shear Wells; Nailing -Bolts 59. Insulation -Wells -Ceilings 60. Infiltration -Walls -Windows Date/Initials FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector 63. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection 64. Bedroom Exiting 65. G.F.I. & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel; Breaker Sizes & Labels 67. Stairs & Rails 68. Fireplace or Stove; Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door; Swing -Landing -Closer 73. A.C. Duct in Garage -Damper 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage; Above Floor -Mach. Protection 75, Plb., Elec. & Mach. Equip. Listed for Location 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection 77. Insulation -foam -Looked in Attic ❑ Yes 78. Guard Rails & Deck Construction -Post Caps 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 80. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 81. Stucco; Brown -Finish 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg: Appliance -Fireplace: Clearance to Openings 84. Water Well; Disconnect, Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 86. Ventilation Throughout House 87. Glass Protection 88. Corrections from Previous Inspections 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates Com"tents at Final: MOBILEHOME INSTALLATION-ACCEPTANCE COUNT 0-NaLITTE ht DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965Y— TELEPHONE: (916) 538-7541 PER' IT N0. �3 7 rt Address or locations off/mobilehome n,� �- Owner's name Owner's address y Insignia or hud number 14X r, Manufacturer's name's Serial numl z r of V. N. / Year of manufacture fficial Approving Installation) -1 /' Vat IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. 7' C -R -3o-- oqo 5138 White - Owner, Yellow - Installer, Pink - D.P.W. /Ot- / lQ k S &- � - COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT 9� 3 ASSESSOR PARCEL NUMBER 027-23-0-090 A5 ZONING BUILDING PERMIT OWNER K9 CHARLOTTE WA ER TELEPHONE 534-6855 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 147 WAYNE CHARLES RD OROVILLE 95966 CONTRACTOR'S NAME GARY L. WARNER OWNER TELEPHONE 534-6855 CONTRACTOR'S MAILING ADDRESS 74 EASTMAN LANE Fireplace CONSTRUCTION LENDER N A UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS N A Filing Fee $ Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS EASTMAN LN PERMIT FEE $60 *�M Z DROVIT.I.E., 95966 PLUMBING PERMIT Filing Fee 1 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT N . SUBDIVISION'S NAME PA E M 6 b Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex O Mobilehome ❑X Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home @20'0 Lp0 TYPE OF WjORK �9,/ New ❑ Addition ❑ Remodel O Utilities Installation ❑ Other ElContractor Describe Work: MHU 3 BEDROOM PERMIT FEE $ Q ELECTRICAL PERMIT Filing Fee 20.00 Sof� I`�{ o V Q ... r- � I Wq VV �! ) Main Service ( 2OOV OR LESS ) 20OA OR LESS 23.00 G .� 07� Main Service ( 200ATOI000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. BLOS. ) 3.5C FTSO.. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 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 CHR. Ex. Occup. ( OUTLET OR FIXTURES ) BAL. @ x.50 Ex. Occup.FIXED APPS. OR (OW UTLETS (RESID.) EA. ) 5.00 Temporary Service 23.00 C' Mobile Home Facilities 20.00 z� 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. d� 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 $ s ma 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 ngequence of the granting of this permit. C� X /, 9 / t'1 Date V _/6 _ l Signature of Applicant Owner O 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 $ OCC CONST. TYPE TOTAL FEE $ 166.00 HAZ. I D. FEES I IMP I Fr _, F PARCELPO D Iss This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicat above for hich fees have been paid. ey � Dace PERMIT EXPIRES ON 7- ZH? (Date! Receipt No. 162669 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT M COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 444 ~ 7COUNTY CENTER DRIVE -OROVIL4_E;CAL111,j6RNIA95965- TELEPHONE (91 38-7541 PERMIT APPLICATION.DATA SHEET OWNER tr/v �v�-/U � - \ A. P o. -7 Proposed Building Use Building Inspector Date 15-1 D C1 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items "have been submitted. . 12. Plot plans, 3/4 sets, signed by preparer of plans .......................... 3_ Complete plans, 3/4 sets, signed by preparer of plans . ..................... . .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5.. Hazardous Material Form . .............................................. 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $................................. . ...... Impact fees as shown on attached schedule. �+ I ,�,• California Department of Forestry pLa_n_ approval/ , 3. Flood elevation letter (100 year flood) bey C lifornia Engineer. .. .......... `.. 14. Sanitation and, lot2la_n approval D!2 Health Department. .......... 5. City of Chico plumbing permit............. . .......................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ......... '� 9Contact Land Devel'opment.about (A) Improvements (B) Drainage. . . Driveway permit (construction approval required prior to occupancy). ..P���eaio� req�- 20. Pre-iest nspection for required. .. to Building J.epedor (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... ecaner -Builder Verification (Given to owner Mail to owner_). .........:: 4Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance. 29. Documentation of legal access . ......................................... 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ........................................... 33. 34. When u issue the permit, process s follows: Mail to owner. Mail to contractor. IX Telephone and hold for pickup at n� office. Deliver with inspector. Other Parcel Creation _9 Acreage Applicant G2/,i!YL�it/ Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitti 1. Index permit for above items No. 2. Additional items required: new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, o5in(err,, was advised of above required data by _ phone _ mail Coune�� Date Plans checked by> DateS�� Plans approved by Date a7— Sets of plans on hold in File cabinet AP folder G>���� Copy - Department of Public Works F� TO: FROM: SUBJECT: Building Department Environmental Health Sanitation. Clearance E.H. USE ONLY., M Plan Amacbed Flo" Plan At Scotto B.D.— Owner Location AP# Plan Approved ' for: Sewage Disposal Water Supply: Public Private Well—If ,Clearance for 3'bedroom mobile home. Other Hold final for: Final clearance O.K. for: NOTE: LAI I A / Environ*1 Heal Q Specialist Date 8/92 COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 ..�. ..747 Elliott. Road, Paradise, CA' --('91.6).872-6307 . CORRECTION NOTICE NER f PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office-whan correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please gomact this office immediately. > 47r- P Date Inspector ` REV 10/92° COUNTY OF BUTTE Department of D .velopment 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 (yes or no) 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address 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 2 �� Social Security Number �- Date 1�-/0-7 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. AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT id"ring Division FOR RESIDENTIAL DEVELOPMENT.. Section 26-8.1 of the Butte County Code requires this acknowledgement be recorded. prior to issuance of a building permit. J U L 25 1994 The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences' or NOT ORIGINAL DOC UPAMM discomfort arising from the use of agricultural chemicals, ORI6IPIAL including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations 9 _031503 including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,smoke, noise, and odor. Butte County has established agricultural zones which have as a priority use for productive agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: o + c e l �a rc "' PO, � Z �,� � 3 . � J Show a� n ha.f r� �-`' �' r� � s 1'0 -e- c� -f-� e e Cor cl e r -I-��e CO«n+ OT n _ _ y o rn , 2 0� J�-� 1 qts— �r.e 99 _ � ) � i� Lc� a to r 00L r9 �J n n -/ �0,E' { a'yl 2 bt= 'F e ��S �fv�{ %t- fit` ?�f— , . � � , �M o►,� C1'C bA51ue- R h 1�c er��m�n- .fir l c�.1, and tC)o-y n e- C 0� 5 koa� , 2s ase .cc�� IarYe��m�t?Drc(t i nc,p�1c o� ¢hc �eordpr(0 1h� ��un �Yrciwr•or�thafC-eri��nJ� �� ot(5<<'t�e/SleoPCa 0rnI2,onJa( Date: PROPERTY OWNERS: 3 �4Ss1 a�o� � MO)OI a State of California ) County of ) On before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature Seal: A.P. # .;?-7_2�3_0 —Oq'D STATE OF COUNTY OF On '% L appeared CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT me, I SS. undersigned, a Notary Public in and for said State personally Names) of Signer(s) rsonally known to me OR ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within, instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity .^ upon behalf of which the person(s) acted, executed the instrument. or �__ instrument. T. AZkVECL DO LU MAR ~990044 . 'NOTARY PUBLIC -CALIFORNIA III � BUTTE COUNTY 'i) A1yComm.ENO" . f,4�r;h31,1997 j� �¢Lrmr�;cmum s� (This area for official notarial seal) Capacity Claimed by Signer ndividual(s) ❑ Corporate Officer(s) - Title(s) ❑ Partner(s) ' ❑ Attorney -In -Fact ❑ Trustee(s) ❑ Guardian/Conservator ❑ Other: Signer is Representing: Name of person(s) or Entity(ies) SAV -191A (3/94) Witne and offical seal. Name (Typed or Printed) Description of Attached Document This certificate must be attached to the document described below: Q r Title or type of d current [C.(n Y fi Num er �fgag`esL_'' Date of Document Signer(s) Other than Named Above ATTENTION NOTARY Although the information requested above is optional, it could prevent fraudulent attachment of this certificate to another document. MOBILEHOME INS TWFB.�CEPTANCE COUN DEPARTMENT OF�PUBLIC WORKS — 7 COUNTY CENTER DRIVE =� OROVILLE, CALIFORNIA 95965 TELEPHONE: (916) 538-7541. qtL O/ PER IT NO. 133 7 - Address or locations ooff/mobilehome Owner's name 'w Owner's address��7Zz�--� Insignia or hud number - �— Manufacturer's name Serial number -of 1. N. Year of manufacture (Official Approving Installation) ate) IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. 5138 White - Owner, Yellow - Installer,. Pink - D.P.W. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541ERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 027-23-0-090 � A5 ZONING BUILDING PERMIT OWNER CHARLOTTE WARNER TELEPHONE 534—=6855 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 147 WAYNE CHARLES RD OROVILLg.6 CONTRACTOR'S NAME TELEPHONE WARNERGARY 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 $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 60 EASTMAN PERMIT FEE $ 43.00 OROVILLE, 95966 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 pA M�p�do Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobilehome{ Other 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 ElUtilities ElInstallations Other ❑ Describe Work: MHI 3 BEDROOM PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 � ` �� ' C Main Service ( BOOV OR LESS ) 200A OR LESS 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BLDS. ) SO• 3.50 FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ 1 am a licensed under provisions of Chapter 9, Division 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 compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) ❑ 1, 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 ) BAL. @ 1.50 Ex. Occup.FIXED APPS. OR ( OW UTLETS (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. 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 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. 1 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 i co sequ nce of the granting of this permit. X Date 4J/0"� Signa re of Applicant - 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 $ .00 Energy Inspection Fee $ ocC CONST. TYPE TOTAL FEE $ 143.00 HAZ• 1 0. FEE IMP Flo CDF PARCEL PD I This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By;41�Date6W2z PERMIT EXPIRES ON Deter provisions to do work paid. 9S, Receipt No. 162669 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �r COUNTY OF BUTTE -DEPARTMENT OF D OPMENTSERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, C¢AL` IFORNIA95965 -TELEPHONE (916) 538-7541 k OWNER Proposed Building Use PERMIT APPLICATION DATA SHEET R/Ot"(/ 61-�� Building Inspector A.'.P. No. C Date -�-3-Q-6) . ,-moi At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: I DATE RECENED BY II items have been submitted... ................. . Plot plans, 3/4 sets, signed by preparer of -plans ............................. 3, Complete plans, 3/4 sets, signed by preparer of plans . ...................... ,4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. . 5. Hazardous Material Form . .....................:..................! 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings ................:s... . 8 Engineered truss details and layout in duplicate (required prior to plan check):` .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ' .�........ . Fees tf$schedule .................!�............. li�npact fees as shown on attached schedule. .. " 12. California Department of Forestry plan approval/fees. ....{..... I ............... . 13. Flood elevation letter (100 year flood) by California Engineer. ...:............. . 14. Sanitation and plot plan approval Health Department. . 15. City of Chico plumbing permit . ......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. ........`.. . 19. Driveway permit (construction approval required prior to occupancy). . . 20. Pre -ins action for Pre-Inspedion request-,,, required. . . to Building Inspector �` (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... Owner -Builder Verification (Given to owner , Mail to owner _ ). ........... AjF"k Recorded copy of Agricultural Acknowledgement Statement . ................. . . 25. Letter of signature authorization . ................... /`.................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . ---�7. Letter of intent on building use . .................. % ...................... 28. Mobilehome.utility clearance . ..................:....................... b 29. Documentation of legal access . ..................... 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: Mail too ner. Mail to contractor. Telephone and hold for pickup at' office. Deliver with inspector. Other Parcel Creation Acreage Applicant, 2 ��.� Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted o ce: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by Date.— Contractor, ate.Contractor, designer, owner, wasadvised of above required data by _ phone _ mail Counter Date Plans checked by Dated Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works At time -of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 - TELEPHONE (916) 538-7541 . OWNER //(// /��y l� l/�/ A.P. # o�7-o? 3d ' �clD PROPOSED. BUILDING USE DATE 51 10 h¢— REC. # '.,DATE REC V2SCHOOL DISTRICT FEES _ (paid at District Office) ......................... . SHERIFF FEES (paid at Building Department) Residential...... x =$ unit amt. Commercial (sqft) x _$ sq.ft. amt. 3. URBAN AREA FEES (paid at Building Department) Residential (per unit) x =$ # units amt. Commercial (per sq.ft) x =$ sq.ft. amt. ALT 4. RECREATION DISTRICT FEES ,(paid at District Office) ......................... Nm_ 5. DRAINAGE DISTRICT FEES (Contact Land Development Division) .............. }� T � 6. SRA FIRE INSPECTION AND PLAN CHECK = $89.00,.,,,, f (paid at Building Department) 7. OTHER 8. OTHER At time -of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE 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 (yes or no) . 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address 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 Social Security Number Date- NOTE: ate 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. -7`77-777,77i d000". P. • ®e? Ulu v p Rid j, Pfg ql� J LTJ n 2 j �A�u.37 Y' ° L J V ` Q Z gt" E 02, ' ifoof a a i.. }':. F a a f� art; :� S � � ''r6��1tt. �. � • r t - ..< , � i. � •� a I toe&. aw VtT.74V E TMA �c ' 5C?� SO. V. RNIM'P-R FOR NAWLES• 4'r'�' v C �•��t�rJ �� s • Y Phi . rr. `mom 4-A"-A&j 4FA4AA AF ►53-7 149 st 133 M H- �....-�.... 4b ... LO �-L CDF—FIRE_SAEE_REQUIREMENTS Z-?- i 3 _'7 o 5�-12 3 2 ��,�, �rn� AP# PERMIT # NAME Under authority of PRC 4290, the following checked items are required by the Butte County Fire Department and are made a part of this permit. These requirements are minimums and will be superseded by Butte County local regulations which equal or exceed these standards. Field inspections will be made by the Butte County Building Department for compliance. [}(] 1272.00 Maintenance of Defensible Space. To ensure continued '\ maintenance of properties in conformance with these standards and measures and to assure continued avail- ability, access and utilization of the defensible space provided for in these standards, annual maintenance must be provide for by the land owner. Driveway Standards [)] 1273.02 Surface. All driveway surfaces and structures (bridges, 1273.07 culverts and other appirtentant structures which supple- ment the roadway bed or shoulders) shall provide unob- structed access to conventional drive vehicles, includ- ing sedans and fire apparatus weighing up to 40,000 pounds. 4C] 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius ] 1. No roadway shall have a horizontal inside radius of / curvature of less than 50 feet and additional sur- face width of 4 feet shall be added to curves of 50- 100 feet radius; 2 feet to those from 100-200 feet. �C] 2. The length of verti^wl curves in roadways. exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet. [�] 1273.05 Turnarounds. If required, will have a minimum turning radius of 40 feet from the center of the road. [x] 1273.05 Turnouts. Shall be a minimum of 10 feet wide and 30 feet long with a minimum 25 foot taper on each end. T1270.10 Width. All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. Page 1 of :?.-, AP # PERMIT # NAME 1273.10 Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. [�1 1273.10 Turnaround. A turnaround shall be provided at all building sites on driveways over 300 -feet in length and shall be within 50 feet of the building. 1273.11 Gates [)] 1. Gate entrances shall be at least two feet wider than the roadway it serves. 2. The gates must be located at least 30 feet from the / roadway and shall open to allow a vehicle to stop without obstructing traffic on that roadway. [ ] 3. Where a one-way road with a single traffic lane provides entrance, a 50 foot turning radius shall be used. Fuel Modification 1276.01 Setback for Structure Defensible Space. [�} 1. All parcels 1 acre and larger shall provide a mini- mum 30 foot setback for buildings and accessory buildings from ul] property lines and/or the center of the road. [ ] 2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See Other Requirements below. [�] 1276.02 Disposal of Vegetation and Fuels. Disposal, including chipping, burying, 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 ,r fi_ial inspection of a building permit. Page 2 of 3 Y 7-7-2-3 D�10 AP # 7 PERMIT # Other Requirements [ ] If Building Setback is 15 to 30 Feet: - Class A or B roof - Enclosed eaves [ ] If Building Setback is Less Than 15 Feet Choose any 3 of the following: - Metal or no doors on side toward property line with insuffi- cient setback - Class A or B roof with enclosed eaves - Interior automatic sprinkler system per NFPA 13D - Glass area not to exceed _0t of wall area toward property line with insufficient setback - Siding from the following list: Stucco - 3 coat Hardi-Board or Plank Masonry Masonry veneer Metal Other Butte County Fire Department approved materials Date Signature Page 3 of 3 MOBILEHOME SUPPQRT DATA If other than single wide, Mobilehome Mfr.ln�TT�'(Z�— furnish Setup Model No. Year e Width- (ft.) Box Length ��(ft.) Tagalong or Expando Size 3 i! —ft. x_:�_ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). r FOOTINGS (check one) 1. Wood=pressure treated or foundation grade.a 2. Other (specify) SUPPORTS (check one) 1. Concrete block.El2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE , , MULTI -WIDE Line r � Line 1 Line 2Line 2 Main Beams Line 2 — — _ — — — — — — -\ — — — — tine 2 Main Beams --- ----- — tine 2 Line 1 .._Line Tag or Triple Line 4 .. 1 Line 1 F 'Line 1 Piers: Line 1 Openings: 'Sitie-Min---`--------- Size -Min. -------------- x - . Spacing -Max. --------- _ Each Side of Openings From Ends -Max. ------- '_ " With Width Over--=------ _ � u Line 2 Piers: Line 3 Piers: (Under Bearing Wall Only) Size -Min. ------------ Size-Min------------------- Spacing-Max ---------- ------------------Spacing-Max.--------- ,_ „ Spacing -Max .---------------. , From Ends -Max.------- '_D " From Ends -Max .------------- Line 3 Roof Loads: Size -Min ------------- Loc ------------ Location (From Front) Line 4 -Piers•. . Size -Min .------------ Spacing -Max.--------- „ From Ends -Max .------- e 5 -Piers: - (Under Bearing. Walls...Only).. Size -Min .------------------ "x Spacing -Max.--------------- From Ends -Max .------------- Line 5 Roof loads: Size -Min. ---- - ------- „x „x k "x Location (From Front) _ , r` �; j'� �" �js7v , vd � . BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 538-7541. kA MOBILEHOME INSTALLATION SHEET m 1. Owner's Name: 2. Installer's Name: 3. Is the site currently under permit? Yes ® . No 7i O , (If yes, furnish permit number 'W- (—S --S-7 ) OR f Is the site an existing site? . Yes F-1, No R! (If yes, furnish two plot plans.) 4. Will the.mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes M No (If no, clarify 5. What is the mobilehome electrical rating? --------------- _ IDD Amps 6. What is the mobilehome site service rating? ------------- aco Amps 7. What is the mobilehome site circuit breaker rating? ----- Afto 1d) Amps 8. Is there any other electric load to be served by the * 12. What is the mobilehome gas demand? ---------------------- *(This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) (BTU) COUNTY OF NEXT PAGE MUST BE COMPLETED TO PROCESS PERMIT APPLICATION. BUILDING DEPT AUG 161994 mobilehome site service? -------------------------------- Yes No (If yes, ' identify the load and size: we,0_ (Load) (Amps) 3 9. What is the mobilehome site gas pipe size? -------------- _ (in.) 10. What is the type of gas service? ------------------- Natural J LPG 11. What is the gas pipe length from meter or tank to the mobilehome? --------------------------------------------- o (ft.) * 12. What is the mobilehome gas demand? ---------------------- *(This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) (BTU) COUNTY OF NEXT PAGE MUST BE COMPLETED TO PROCESS PERMIT APPLICATION. BUILDING DEPT AUG 161994 Butte County Environmental Health Qis d 99 q Date 7- -- igna rr e < -41 7 ���ca*a�v.��' �"�'1�x •i.�K.,.r�j..�;�y3� e�' tiio°i�+�'i'��``�"'f�e'��`t}4��`'.;Z��r.a?+;'L"`��5;'���i"' ,a 1 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District Building Department No. A.P. Numberoi%�a3-O-f>9a Jurisdiction City 0 County Property Owner: ' GHAi2 LO 7TE 1A 1A 1e469 YZ, Property Location/AddressQ� Subdivison Lot No.. f� Residential Development 0 Sq. Footage 0 y No. of Living MHI Addition v Group Units Commercial/Industrial 0 . Sq. Footage New Addition (Including Exterior Roofed Areas) Building epartmeo Representative t Date (Floor Plans.reviewed by School District Personnel) , District ldentfication No.a Q fl I f"k School -District certifies that (Applicant) t f' (Street Address) (Phone Number) (CRY) a has complied .with the requirements of Resolution No. representigg� �� square feet. School bisfrict Rep (State) (Zip C by payment of $VA I� i J s to q ., ` • Date Paid by Check Number Remarks: w Bank Number Paid by Cash If, subsequent toithe School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CECQA), this.project may be subject to additionai school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department),.Fink`(school district) feeform.wkl (4/92) .x p?turririo AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT 7 4 - 3,115.0 3 P»+Iding Division FOR RESIDENTIAL DEVELOPMENT.. Section 26-8.1 of the Butte County Code requires this, acknowledgement be recorded, prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort arising from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,smoke, noise, and odor. Butte County has established 94-031503 1 Recorded I Official Records I County of 1 Butte I Candace J. Grubbs I Recorder I 12:03om 25 -Jul -94"1 agricultural zones which have as a prion ty use for productive agricultural purposes and residents within said zones and on adjacent'property should be prepared. to accept such inconvenience or discomfort from normal, necessary fano operations. All that real property situate in the County of Butte, State of California, described as follows: P0'-r0-eJS'2La,n'J S �hocv o rCIO, n - ems`n+i'c-e - � �e�°raer 6 COU -n o �u.7�e j s �7��07 Q 0-V1 Jbk 1. h.1- �o r Oa.c a�rld Q lo t-�� 1� PU r s 6 v elr- f�� Gcl�sfe r� rig , . J 1 0 Feerg► h Sou herr a Co �.� -e. b A -4 e I TOc, M5n � � � �o rfh) lP � �s �- �n �%�/� , " ¢} oh -�cg� Uc� ��.b l i� eCe�me�►-1�-�or-1 cess a�,� Y 1 I d U-) M C rf'es IeO0 , 25 re SS C� vlcl�1r�l09el Ouel� �� c MoLonoy ��YY1Q �L1orc�i n� f1��(c e D %% rCeha4-C,erfaIYJ �, o- ea(�Ct,- rnlQ,Onjut Date: - PROPERTY OWNERS: 3 i42?S, 1 n ok 99 a ma) 41 a State of California ) " County of ) _• On before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. , r Signature Seal: A.P. # 94-31503 a CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT STATE OF COUNTY OF 1 SS. On (�054__ before me, he undersigned, a Notary Public in and for said State personally appeared 6 � 8o__P— kLp� Names) of Signer(s) �rsonally known to me OR ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the Ila. �_ �""---=--� instrument. COMM.9soo44 Witness m and and offical seal. 'NOTARY FUBUC•CALIFORNIA aA BUTTE COUNTY My Comm. Ezpres March 31, 1997 „a0 Signature of Notary as (This area for official notarial seal) Name (Typed or Printed) Capacity Claimed by Signer nl ,l dividual(s) ❑ Corporate Officer(s) - Title(s) ❑ Partner(s) ❑ Attorney -In -Fact ❑ Trustee(s) ❑ Guardian/Conservator ❑ Other: Signer is Representing: Name.of person(s) or Entity(ies) SAV -191A (3/94) Description of Attached Document This certificate must be attached to the document described below: Q r J( +t, - Title or type of documeht /-,p �• C �Y Num •el/ o ��gesL / Date of Document -- I- [C�/ q Signer(s) Other than Named Above ATTENTION NOTARY Although the information requested above is optional, it could prevent fraudulent attachment of this certificate to another document. END OF DOCUMENT