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HomeMy WebLinkAbout028-140-00377 28-14-3 1 1 Karen Young •28-14-03�* O 41-90r QR,, E/S Tennesse Ln.,app. 1300'S.6ff La z ;, Porte Rd.,Bangor, WINGO„ Stephen Per #-268-76P E(uti MH) G a �133'Tennes`see Un; ;Bangor r ELEC. .S' "so Exemption Permit « GAS 9/26 3 (hay storage, ag equipment storage,.', y �. SUPP T STRUCTURE REQ, CaMPACTI N T RE `Ina _ 28-14-3 ....__ t!Permit #6634 T6I ssued 3 7 28-14-3 {' STEVEN WINGO� ' 33 Tennessee Ln, Bangor ContrL Custom Steel t Permit#1456-87B(reside/SF) 028=14 0-003•,1 R �. #98 2256 .� WINGIO, STEVE & bONNA A' 133 TENNESEE LN t ARYSVILLEt °:, NELSON CONSTRUCTION ' , REPLACINGwWINDOW • ` 3 :u, Y. 00 f, qv�� C**4 --r.yww ,,;spt�r.wr-v..._ �. .a r-y�"g�..,�„ye,nrvn:;z.�,..sr•wcw,;r�pa.r�y �q;�S�'p^S�W�+s7�,�4'+�O•'7W�apj�,�¢"A'��''�/..y`•'•�',�1`e;�:1s'•kl�'^"-9v....a-•x.�.rr �•�� , 028=14-0-00T #98-2250 WINGIO, STEVE &;DONNA - 133 TENNESEE LN.,-MARYSVILLE NELSON CONSTRUCTION, *r. REPLACING -WINDOW,`' i 028=14-0-00T #98-2250 WINGIO, STEVE &;DONNA - 133 TENNESEE LN.,-MARYSVILLE NELSON CONSTRUCTION, *r. REPLACING -WINDOW,`' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 FERMI o. (Rev.12/96) APPLICATION AND PERMIT �f�'� 4 .�'l-� ASSESSOR PARCEL NUMBER O2p 140 M3 ZONING A5 BUILDING PERMIT OWNER WINGIO, SSE & DONNA U��-- 748.5 SO. FT. OCC. BUILDING VALUATION FST OWNER'S MAIf.JJ lY�i�NESEE LN, MARYSVILLE CONTRACTOR'S NAME NELSON CONSTRUCTION TEM L :b364 CONTRACTOR35M yY RD. CAMERON PARR CA 956802 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ Asa ARCHITECT OR ENG:NEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 90,00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 133 TENNESEE LN Ener Plan Checking Fee Energy 9 $ $ MARYSVILLE PERMIT FEE S LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF:O Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other 11 Describe Work: REPLACING WINDOWS OF SAME SIZE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service z*OA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I arr>�'tc`ensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 he Business and Professions Code, and my license is in ful force and effect. License Class Lica No.-�lr.i OWNER -BUILDER 'D CL•ARATION_ I am exam t from the Contractors License I hereby affirm under penalty of perjury p Law for the following reason: ❑ I, as owner of the property, or my em loyees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as requirl by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service TO 46.00 CCU000A NEW CONST. DWELLING OCCUP. V; OR ADDNS. ( 8 ACC. S. SO 3.5QFT. NOµR°�ID, - MULTI -OUTLET @7.50 POWER APPARATUS 8 SINGLE OUTLET CSI R. E7�, OCCU OUTLET OR FIXTURES �L @ ':So OEs FI%ED APPLNS.OR EX. Occup. ourLFTs RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEI= $ Policy Number (The above sections need not be completed if the permit is for work of a valuation /of one hundred dollars ($100) or less.) O 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall /forthwith comply with those provisions. ,4 f Date _ f zz// y Signature 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.By Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ I In nn HAZ. D. FEES IMP FLOOD CDF PARCEL PD Ho S; This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have - t - . rA PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. � r; Date Date Receipt No. �� `�( ', �)" WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT _ COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 89172751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE k. ZZr OWNER IPERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, pleasetce tact this office immediately. (Sf�l, — r�� bx J W7 ( G C &-Jf s REV 10/92 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION - 7 County Center Drive • Oroville, California -495965 • Telephone (530) 538-7541 g����d¢�v0. (Rev.12/96) APPLICATION AND PERMIT (g ASSESSOR PARCEL NUMBER 028-140-003 ZONING A5 BUILDING PERMIT OWNER WINGIO, STEVE & DONNA 9 /yO 1485 SO. FT. OCC. BUILDING VALUATION EST 6684-00 .OWNER'S MAIL�IQADDRBflQ.rNESEE LN, MARYSVILLE JNA.7ME 1.�1V CONTRACTOR'S NELSON CONSTRUCTION TEt7 / NE0364 co ..RACTOR� G SM13URY RD. CAMERON PARK CA 95682 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 90.00 ARCHITECT OR ENGINEERS MAULING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 133 TENNESEE LN Energy Plan Checking Fee $ $ MARYSVILLE PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF XI Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other] Describe Work: REPLACING WINDOWS OF SAME SIZE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 600V OR LES Main Service p.ORLESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in f}►1 force and effect. License Class Lic. No. „����'3� OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADONIS. ( a ACC. BLOB. SO 3.5¢FT; NOµR6ID. * MULTI. OUTLET 97.50 POWER APPARATUS a SINGLE OUTLET CIR. �(, OCCU OUTLET OR FIXTURES B20 O 1.00 w Ex. Occup. ounFis AUS IFIX'ISo.GeA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Po'cy Number e above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the w kers' compensation provisions of section 3700 of the Labor Code, I shall o with comply with those provisions. X __ Date �G1 ! Signature of pplicant - ❑Owner ❑Contractor ❑Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ' OCC CONST. TYPE TOTAL FEE $ HAz. D. FEES IMP I FLOOD I CD F PARCEL J'1TPD ISSU This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have s By PERMIT EXPIRES ON I the applicable provisions Resolutions to do work been paid. Date V — - 64 0— pate) Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBERVa L2 - _ /S/ v _ - ZONING_ .4 BUILDING PERMIT OWNER TELEPHONE-. 1,,79 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS "i 77 k S E E Z Q CONTR TOR'5 NAME J/7 V 7> TELE HONE (/ CONTRACTOR'S AILING A LING ADDRESS i7-,4�fl -r- ✓ Fireplace CONSTRUCTION LENDER- �il�i('� ✓C, 1 ._Fire %V< /� UNKNO'N Total Valuation $ " I Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER _ LI ENSE NO. Plan Checking Fee ,$ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ o Dd BUILDING ADDRESS Permit fee PLUMBING PERMIT 5, Filing Fee 10.00 ZA) Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF�] Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I I O.00ea TYPE OF WORK New ❑ Addition❑ Remodel, Utilities ❑ Installation❑ 'Other ❑ Describe work: /_;:�f S//,= Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 _ Main service 100V OR L 00 AMP ORSLESS i 10.00 `- Main service EA. ADD'L 100. AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check.one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business (' and Professions Code and my license is in full force and effect. (► ,,//JJ License No. �f�y%�. Classification L.l El 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST.DWELLING OCCOPI" r 'h¢sgft OR ADONS. ( ACC. BLDGS.��, NEW CONSTR. ULTI-OUTL• 2.50 ea NON-RESID BRANCH CIR •5 (POWER APPARATUS .& (POWER OUTLET CIR. Ex.Occu o aoeaoe Occup(OUTLETS OR FIXTURES eALO 30 FIXED APPLNS. Ex. Occup. OUTLETS ((RESID,)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. Q I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that i have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 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 in consequence of the granting of this permit. ---X- X % L``"r_. �= - -If— Date � � � / Signature of Applicant - Owner Q Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.TYPE JILOOO[PARCEL.1 PD ND 59UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By ( /;`1��%?>,d`�x PERMIT EXPIRES Date the applicable provi- resolutions to do feefs" have been paid. WORKS lDate-_--2 Receipt No. .l - x / WNITF-D.P.W.. YELLOW-A9eE35OR. PINK -INSPECTOR, GOLDENROD -APPLICANT i J� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. -ASSESSOR PARCEL NUMBER_DD3 ZONING BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 13-3 S -__� COySR CTOR'S NAME _Ir- i G TELEPHONE CONTRACTOR' MAILING ADDRESS 7 Fireplace COjy$TijUCTION LENDER UNKNOW Total Valuation $ Filing Fee $ 10.(]0 L EEJN/D!-/EER'SS/ AI LING AA-DDRESS l� Permit Fee $ ARCHITECT OR ENGINEER LI E 5E NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ D� BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 L� Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S=::d 110.00ea TYPE OF WORK New❑ Addition[] Remodel Utilities[]Installation❑ Other❑ Describe work:4/ 6 �/ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 10.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check.one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. �1 SDS�Gny Q License No. Classification ❑ 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUP.&) OR ADDNS. ( ACC. BLDGS. +/zQsgft NEW CONSTR. U TI.OUTLET 2,50 ea BRANCH CRC ITS NO N.R ESID I POWER APPARATUS e (SINGLE OUTLET CIR. ) Ex. Occup(ouTLETS OR FIXTURES 3 .ALO 0 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. nvI have placed on file with the County of Butte Building Department F`= a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure: ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the 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 sai County in consequence of the granting of this permit. _5_ 8 X Date Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ "�67) OCCUP. CONST.TYPEJ I FL000 PARCEL PD ND 1390E This permit is hereby issued under the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By� !Date PERMIT EXPIRES Date ✓ Receipt No. 0&,:5 e,--/ WHITE-D.P.W., TELLOW-A9e C330R, PINK -INSPECTOR. GOLDENROD -APPLICANT TRUCK INSURANCE EXCHANGE_, INTERIM CERTIFICATE AS TO EVIDENCE OF INSURANCE THIS IS NOT AN INSURANCE POLICY. THIS IS ONLY A VERIFICATION OF INSURANCE. IT DOES NOT IN ANY WAY AMEND, EXTEND OR ALTER THE COVERAGE PROVIDED BY THE POLICIES LISTED BELOW. Nomad Insured Lary Grayson ' R, Address DBA: Custom Steel & Vinyl -Products Po11cyN•Gen. la . 4221 Northgate Blvd, Suite 7 95 Ag 388 Sacramebtlo, CA 95834 Agent Policy 11 •Auto Llab. Policy N - CARGO This is to certify that policies for the above named insured are in force as -follows: N0508 23 74 Policy M - Work Comp. This Interim Certificate As To Evidence of Insurance shall expire sixty days from 12) 01 A M May 05 , 19—U, unless cancelled prior to such date by written'notice to the named insured. OWNED AUTO- MOBILES, IF COVERED *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Urdinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. DeunbedDewiption El below ❑ woired . 1 YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY, I IDENTIFICATION NUMBER r t , LAST 3 DIGITS SHOWN N/A Umbrella liability $ ,000 retained limit POLICY NUMBER $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior -to the expiration date, we shall provide 30 days advance notice in writing to whom this certificate is issued. Certificate issued to: CERTIFICATE HOLDER & ADD' L INS I D Name Butte County Building Department And Address • 7 County Center Drive •Oroville, CA _ Cou # # Not Applicable in Texas. Authorized Representative # # -In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. . 564514 Bas 11501 2oalsT PRINTED IN U.S.A. INSURED'S COPY COVERAGE COMBINED LIMITS OF LIABILITY COVERED AUTO COVERED UAISILITY ❑ ® Owned Bodily Injury $ 000 each person - ® ❑ Hired $ 000 each occurrence X❑ E) Non -Owned Employer's Non -Ownership Property Damage T $ ,000 each occurrence © E] Contingent Liability Single Limit Liability for Coverages checked ® above $ l , 000 000 each occurrence GENERAL LIABILITY M&C - OLT Bodily Injury $ 000 each person # Owners & Contractors $ 000 each occurrence ® ❑ Contractual # $ ,000 annual aggregate products o s • Elevators Property Damage $ 000 each occurrence ® ElProducts and/or $ annual aggregate Completed Operations ,000 products s • • Single Limit Liability for Coverages checked ® above 1,000 $ 000 each occurrence annual aggregate $ 1 (10.0 1000 products • • • ❑ - ® CALICO, $ 000 each vehicle $ 000 each occurrence ❑ COM�SAON statutory *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Urdinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. DeunbedDewiption El below ❑ woired . 1 YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY, I IDENTIFICATION NUMBER r t , LAST 3 DIGITS SHOWN N/A Umbrella liability $ ,000 retained limit POLICY NUMBER $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior -to the expiration date, we shall provide 30 days advance notice in writing to whom this certificate is issued. Certificate issued to: CERTIFICATE HOLDER & ADD' L INS I D Name Butte County Building Department And Address • 7 County Center Drive •Oroville, CA _ Cou # # Not Applicable in Texas. Authorized Representative # # -In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. . 564514 Bas 11501 2oalsT PRINTED IN U.S.A. INSURED'S COPY y� ''1PERMIT N0:`5268-76P,E PERMIT EXPIRES 'OWNER Karen Young CONTR. owner LOCATION (A.P. 28-14-3 E/S Tennessee Lane, app. 1300'S.off La Porte Rd . , . Bangor Temp. Power Pole Called PG&E Temp/glec. Serv.�J,r�L��� Called PG&E Temp. Gas Serv.- Called 1a3.r/ JOB FINALED (Date) (Signature) R COUNTY OF BUTTE — DEPARTMENT OF,PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd)t PLUMBING Setback Firewall Soil Piping Forms Para ets 1st Floor Main Bldg. Restroom Finis 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Pi in Piers Roofing Sewer M/,F Garage Fdn. Vents Fixtures Footings StemwaI l Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica ed f Conformance of ex. j structure Appliances Gas Piping & Test Temp. Gas q2 Slab Final.Sanit'�at -- Patio FIREPLACE Final Footings Footing \ ( ELECTRICAL Reinf. Steel M I Final Y I Fixtures / Bond Beam A I FIRE SPRINKLERS I Motors final Brown C001 11 Finish Ducts Interior Lath Venti Door Closer Final DATE REMARKS OR CORRECTIONS /CR •s a �� . f• �z�v2/7G �zc n e IAK Ole, Water Htr. Subpanels Grd. Fault Prot. Service -V-A Temp. Pole Underground Permanent Final _7 / M (NOTE: An entry must be made on this form each time you visit the job site.) 4 TO: Building Department pRON: environmental health RS : Sewage and/or :.dater Clearance '27Z 12 O11NER LOCA IOA A P## Has been approved for: S ,4GE DISPOSAL IATSR SUPPLY p 77 Sanitaria n zl- i% ate S95-775 J- 1.4 = 1L:L_ ii0}37i,1?IiULt.G INSTALLA -LON INSPECTION CHECK LINT 1. Is the.. mobilehonit 1oc;�!ted with required separation from lot lines and buildings and generally conform to plot plan? YcS No 2. Doe:., thE! m(-.bil.ehome have requireA clearances above ground? (Sec.5085) Yes No 3. Are footings and supports properly sized, spaced, and braced as per approved plans?' (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes No �4. Is the mobilehome level.? (Sec. 5088) YcsNo+ TT �- 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No h: Water A. Is flexible connector of adequate size and properly installed (1/2" IDSmin.)? (Sec. 5566) Yes No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes No C. Bar�fl-OMj—I e of alifo ap_p-r-ovQd d -does station have.backflow device and pressure -relief valve? Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes No t! B. Does it have minimum ," per foot slope and is it properly supported? Yes No C. -Are any leaks detected in drainage system after running` �-gallons of water through each fixture including washing machine standpipe? Yes_ No Al D. I.fno e a i ornia,Tpr-aGed, does station have required trap and vent? Yes No 8. Gas Piping and Gas .Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome gas line inlet without reductions other than the mobilehome connector. YesX,, No B. Test OK as per following procedure? Yesx- No 1. Open all appliance connector valves. 2. Shut off appliance burner and..pilot val've's. ,. 3. Air test .with manometer to 10"•-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. . C. Are all appliance vents properly installed?. Yes N-1 No e 9. Electrical A. Is service large enough to provide adequar_e anipc>rage to mobileliome (must equal rating; of mobilehome (aitii a:::inu::um of 100 amp) anal other facilitic!,; on lot, i.e., water pumps, C; �rat;e, cab.�nrl, ePc.? Yes No 11. Is then, proper clearances around panels? Yes No C. Is power supply cord or feeder assembly properly fused? Yes . , No_ D. Is continuity test satisfactory as per the following procedure? Yes No 1. De. -energize electrical wiring system of the mobilehome at the pe estal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one 1:._id of a test instrltmnnt to the mobilehome grounding conductor and apply t ie oi.i,.i r ie:.ad to each AiObilciiiiiiie Sup�jiy CUnuucto'i, ilicliluing; LieuLrat, 5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, carter line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completicn of the above procedure, the power supply cord or feeder assembly conductors shat) be connected to the site service equipment. A further continuity te�;t shall then be made between the ,grounding electrode and the chassis of the rioi)ilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. Is ;ob card signed by Health Departmeat for water and sanitation? ll. If everything oi:ay, sign off card and t.a; sarvices. ' iOBILEM.^L_DATA /n Manufacturer and/or Namest:yle Length --14-3Width a -' - /SX Vehicle Serial No. State Identification No. 4dei�tional Information or Comments: COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY' This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, hapter 5, under permit number I,& 3W %_ for the following location: i"l�S��-P-��•��C•�'-e Wr /3ao�S �f—r Owner Owner's Address Mobilehome Mfg. Model - Year Insignia No. _S 2. -jO �'-.Serial No. A/(ocP yf w It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date 772�7 z/7 % By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED COUNTY OF BUTTE - DePARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 fel ephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X"— t-;" Date Signaturt of Permitee or Agent Receipt No. �-�� r7 6 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIREC R OF PUBLIC WORKS By Date G Building permit expires Date BUILDING OwnerI!CA/2�� yd L/Al/ SQ. FT. OCC. BUILDING VALUATION Mailing Address I—A ,0„z <)sTi %�, P—Te--. Telephone No. 7S- ZSZ Fireplace Contractor s Total Valuation Mailing Address Off/ Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee $ Building Address � � d � �' ���'L-� PLUMBING No.1 @ FEE IL PERMIT FILING FEE $3.00 I-4i✓45' 190.0 /=T. 5 'a. Each Trap 1.50 0 r '=, /i /”' C3 /a612 fF <�O_( !J 54 W6 OA Repair drainage or vent piping 1.50 Water piping 1„gg /C , � �� \/ rl Each gas water heater or vent 1.50 A. P. No. �/ �� a Gas piping system 1 - 5 outlets 1-66 Each additional outlet .30 F S rV a on Fire Dept. Fire Zone Use Permit Building sewer 5.99 0, EQA I Parking Parcel Ma Plans p 60' R/W Improvements p Lawn sprinkler system 2.00 Bldg. Plans Rec'd 1p C e proval PI s Approval Permit Fee $ 7• 00 $ NEW ❑ ADDITION ❑ UTILITIESIS OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3.00 Main service 100 V OR LEAMP ORSL _SS 5.00 15, 0 0 Main service EA. ADD'L too AMP 2.50 'j, 5'-0 Single Family ❑ Duplex ❑ Mobil Home Others ElMain Main service 100 AMP OR LESS 25.00 service EA. ADD•L too AMP 1.00 �9Q0SQ. FT. MINIMUM NEW CONST. DWELING OR ADDNS. ( ACC`BLDGSCCUP. &) 20sgft NEW CONSTR. MULTI.OUTLET NON-RESID. (BRANCH CIRCUITS) 2.50ea FOX MOIJILL5 NEW CONSTR. (POWER APPARATUS & NON-RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name St Y le Of: -Z- L,," A Z hP. Z-00 2.0 a Ex. Occup(OUTLETS OR FIXTURES)@g¢ BAL@1 FIXED APPLNS. OR Ex . Occup.(OUTLETs ( RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ o $ l WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ 1 have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ n V 19C authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X"— t-;" Date Signaturt of Permitee or Agent Receipt No. �-�� r7 6 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIREC R OF PUBLIC WORKS By Date G Building permit expires Date t u A k 0 ne IM Setback shall be 5 ft. from" the side property line and 50 ft. from the centerline of the road permittit% a maximum of a 2 ft. eave overhang. Septic system and location dfAag& to be as per Butte County Health Dept. Re- quirements. 694 This sef of plans 00M MUST be kept on the job at all times and itis unlawful .to make any changes or alterations on same without written permisson from the Department of Public Works, County of Butte, "-NOM—All Materials & Workmanship Shan. I$e in r.,rnrdonce N,;}h Recognized Good Practices and of a quilt},., hrescri�,PrJ for }he Specified use in the Uniform 13u►1rling, Plumbing & Machanical Codes and the National Electrical Code.. r , k ermit ill be rgquired for the in allati of the mobilehome. All utility connections shall be located within 4 ft. outside the rear third section of the mobile home on the left (road) side of the mobile home. r BUTTE COUNTY BUILDING DEPARTMENI COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive. — Oroville, California 95965 U11-1-76 fel ephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. �i1oitr1lzGr a �✓- s£r �r7t�iP 10#4 C�c X Date 17(e- SignaturA of Permitee or Agent Receipt No. Z2 Z 7" White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0 P BLIC WORKS 2By Date' 7 - 7 L ding permit expires Date Z �t 7 -77- BUILDING Owner C G SQ. FT. OCC. BUILDING VALUATION Mailing Address Tel epho=e No. ✓✓ Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty -Te lephone No. Permit Fee Building Address p� S E PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 CA,7,),PQA 0,C A0,99£o� Ci/i/-Ooc Each gas water heater or vent 1.50 A. P. No. _ 3 Zoning &Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 -es Wim. Sar3+4atien Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma p 60' R/W Im provements Lawn sprinkler system 2.00 Bldg. Ions Rec'd Parcelvol Plans A a Permit Fee $ NEWJj ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 / ✓ /',�' CG /' N �/G Main service 8011 OR LESS 5.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600 25.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 1.00 NEW OR ADDNST ( ADWECCLBLDGSCCUP. &) 22sgft - NEW CONSTR. MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS) 12.50ea NEW CONSTR. (POWER APPARATUS & NON.RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name St le of: Y Ex. Occup(OUTLETS OR FIXTURES) @L��1 BA Ex. Occu FIXED APPLNS. OR p• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ErI am exempt from the Contractors License Laws of the State of California. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. Elhave placed on file with the County of Butte a certificate of 'workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ dt authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. �i1oitr1lzGr a �✓- s£r �r7t�iP 10#4 C�c X Date 17(e- SignaturA of Permitee or Agent Receipt No. Z2 Z 7" White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0 P BLIC WORKS 2By Date' 7 - 7 L ding permit expires Date Z �t 7 -77- ' BUTTE COUNTY DEPARTMENT OF 'PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 1. Owner's name 2. Installer's n, MOBILEHOME INSTALLATION SHEET 3. Is the site currently under permit? Yes / / No (If yes, furnish permit number ) OR ,Is the site an existing site? Yes / / No / 5 (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft: away from septic tank and leach fields and clear of all setbacks and easements? Yes / / No ( If no, clarify ) 5. What is the mobilehome electrical rating? ----------------------- Amps 6. What is the mobilehome site service rating? --------------------- Amps 7. What is the mobilehome site circuit breaker rating? ------------- s. 8. Is there any other electric load to be served by the mobilehome. site service. ----------/l�� /l S Oo 1, N/n f -- ------------------------ - Yes / / No (If yes, identify the load and size: (Load) 7d -s) 9. What is the mobilehome site gas pipe size? ---------------------- 3 (in.) 10. What is the type of, gas service? ----------- ------------------�N t ral / / LPG 4X 11. What is the' as pipe length from meter or tank to the mobileho"e? ft. g P P g � ( ) 12. What is the mobilehome gas demand? ------------------------- ---- �l O (BTU) (This` iiformation,not required if pipe length less than 6 ft. on natural gas or. less than 50 ft .,,on LPG, ) MOBILEHOME SUJPPORT,DATA leUJ ,moo Mobilehome Mfr. � � Al� Setup Model No. Year -Width .(ft.) Length (ft-.) Expando Size ft.x _-ft. (Draw support details below) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). Center Support Locations ("f t) (in)A I_ (fE.-) in. *If center p draw in l.e c, 're other than drawn above, spacing, and dimensions. Footings (check one) / 1. Wood either pressure treated or fdn. grade. 2. Concrete pad. 3. Other, specify Supports (check one) /9 1. Concrete block 2. Concrete piers 3. Steel piers 4. Other, specify Typical Support r�x .34Footing Size in.) -(lin. ) i Max. Pier ( �.).(_lq) Spacing Max. Overhang' �.ft:3) (inn BUTTE COUNTY BUILDING DEPARTMENT APPROVED STATE OF CALIFORNIA, SS. COUNTY OF Rutte D" ON nrtnhar before me, the undersigned, a Notary Public in and for said State, personally appeared * KAREN JOHANNA YOUNG. * * * * known to me, to be the person_ whose name— 1S subscribed to the within Instrument, and acknowledged to me that she— executed the same. F07DORRIS FICIAL SEAL M. GOFF WITNESS my hand and official seal. PUBLIC • CALIFORNIA{ 1,UTTE COUNTY GyGC� Cii/"wlql�� �- m. expires MAY 26, 1979 — Notary Public in and for said Stat i Il DECLARATION REGARDING LOTS OR PARCELS I certify that as owner of the property acquired by deed in Volume Page �3 Official Records of Butte County, (AP# I am requesting permission to build or install an additional living unit on this property. I will not divide the aforementioned property for sale, lease, rent, or financing unless all applicable land division laws and map requirements are com- plied with. I am conversant with the present zoning regulations affecting the aforementioned a property, and declare that I shall not violate same. I represent that the proposed use of the additional living unit is and that further I shall not change this proposed use of the additional living unit unless and until I receive written approval therefor from the County of Butte. k I fully understand that pursuant to Chapter 20 of the Butte County Code and @11535 et seq of the Business and Professions Code that if I, in the future, sell, lease or finance the area on or adjacent to said improvement without fully complying with the applicable laws and ordinances, that I shall be guilty of a misdemeanor and t therefore, subject to the aforesaid penalties and imprisonment pursuant to law. Further, this statement shall be properly acknowledged and recorded at the request of the County of Butte. 01Owner Address Date STATE OF CALIFORNIA ss c COUNTY OF RIITTE On this fif th day of October 1976 , before me, Dorris M. Goff * *it * * a Notary Public in and for the County of . i,, Butte State of California, residing therein, duly commis- , sioned and sworn, personally appeared Karen Johanna Young. known , to me to be the person_ whose name - subscribed to the within instrument -and. acknowledged to me that she executed the same. IN WITNESS WHEREOF I have hereunto set my hand and affixed my official seal in the County of Butte the day and year in this certificate first above_ written. CIAL SEAi-7- 0 M. GOFF ES BLIC • CALIFORNIA BUT COUNTY expires MAY 26, 1979 i • Notary Public . S96-1275 _ t% COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 „„TELEPHONE: (916) 538-7541 AGRICULTURAL -'BUILDING EXEMPTION PERMIT PERMIT NO. Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticulutral products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. ASSESSOR PARCEL NO. s 0 3 ZONINGk_ — OWNER / PHONE NO. OWNER'SADDR S ISSUE LOCATION OF BUILDING I r I USE OF BUILDING . A !!�E, 1�lf 60— 21111A �CC- SIZE OF STRUCTURE %6 X = SO. FT. TYPE' OF CONSTRUCTION: WOOD FRAME k STEEL CONCRETE OTHER (Specify) TYPE OF SIDING zz"o ROOF COVERING y .f FLOOR TYPE ESTIMATED COST OF C NSTRUCTION $ AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances as follows: FRONT -:a'4 '-- 4__ SIDES _ REAR AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated above and the proposed use conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Department of Public Works and will obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date / oZ Signature of Owner - CA) Permit Fee - $25.00 The above described AG Building is exempt from a building permit. Receipt No. White - DPW, Yellow - Assessor, Pink - B. L, Goldenrod - Applicant Director of Public rks By ✓ Date L y�� co �1 FLOOD PARCEL P.D. ROOFING ISSUE I I I I Director of Public rks By ✓ Date L y�� co �1 � ' ^ ` . � ' . . ' � ----------- -- -_- __.---_---.'__---_- .^ ` ' �14- 4,J -e � ��_�=��`� "«°rT&j 19�3-e," ^ [ l ` `� 3 .._ - C.�G��-�- G S. � - T .n .'y£i�'' ♦:s,1 '.�' # rM""'Y"1 1"''� r+ , *...,:'Y` ti t`•'r 4r + . ;ry" t r �`L�fH?�ri�"�'.ry.:�ra-+f r:"'i"y, `' •:� IVY COUNTY OF BUTTE - DEPARTMENT.OF PUBLIC WORKS - BUILDING DIVISION OWNER Proposed Building Use 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95985 - TELEPHONE; 918/538-7541 PERMIT APPLICATION DATA SHEET Permit No. A. P..No.!= 3 Building Inspector Date a At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted . ..................................... 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ — 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. — 5. Hazardous Material Form .......................................... — 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings ............... — 8. Engineered truss details and layout in duplicate (required prior to plan check) — 9. Mobilehome installation data including manufacturer's installation instructions....................................................... — 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... — 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... — 16. Plot plan and business license approval from City of (see City for other requirements) — 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW — 19. Driveway permit (construction approval required prior to occupancy) — 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classifications ... —22. Certificate of Workman's Compensation Insurance .................. —23. Owner -Builder Verification (Given to owner o, Mail to owner ❑) ..... —24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... —26. —27. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w./inspector. Other \Applicant 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 prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. %A 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone_-nail counter by ..date Contractor, designer, owner, was advised of above required data by_phone—mal l—counter by date Plans checked by Sets of plans on hold in Copy—DPW Date Plans approved by File cabinet AP folder Date