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
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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
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, . � � ,
�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
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�-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
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rig , . J 1
0 Feerg► h Sou herr a Co �.� -e. b A -4 e
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�s �- �n �%�/� , " ¢} oh -�cg� Uc� ��.b l i� eCe�me�►-1�-�or-1 cess a�,�
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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