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030-410-015
•1. Ili•. t` r.. rh. yy: , .'Y•� R W' A f. �Y tr . 'ti• M r :t V.3=• ,•jY. e v n , : , , - , i' Yf+r .Y . yy��� 4�• 1- 1 h, Y `I r� �3 ,,� . ... +::. •• ....,'. �k. • , : ..r« . H,:;; .,;.r , ,fit :4..: _ ..,�+y". ..:{';F'I�. .1. it .:: F..♦y. 'meq. "..: .". ;i'. :F ^-'{:���•.'':: ..t. 1N,'. �y �w• .. 1,-¢. __...r..s..:..�,. .'.'aW._ ..__'•: .: s,G'?:� _>r Z'. r.nL .._,. ..... .. ...-. �... .._ ..::�' �_... _. _Sr.._aC;..��,{�'„:,. •.. .._ �. �_ b Yi92lh'in::i ... Of • kk A i t: w :I i i ;1 ii i :1 J' fV =, X.1” '>7e. 4 e t. '9 h` :, 1�. ,yri•:• s v. gyp. gid. 3: nF J 5 r *•fi. f ."A ry: =i t: .t. + ,w ' =`'� T":� �, ?� i • , `. 3.` I -� �+ r = OK o = Not OK MANUFACTURED HOMES MISCELL"ANE.OU.S- DATE PERMANENT FOUNDATION SOFT -SET --DATE ID E C K S -C. V E R S'C A R PO RT S `G A RAG E S ZoningSetbaclts-Easements 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 2 Ftgs; SoilsSz-DpthSpacingCnncfrsSteel 3 Sewer, Loctn-Test; FaIlIC/0-Concrete 3 Decks. Girders/Joists-0cking-Brcing . 4 Wtr, Loctn-Test-Easement Needed -Regulator Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftr;-GnnctrsShthg. 5 Elec Loctn-Clrncs-Gmd Amp�oncrete 6 Yard Gas; Locin-Test-Wrap ' ' Nat Q or LP Q Inch Sz Ft Lngth Frmg Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs 7. Blckng; SzSpacing-Marriage Line Carports; Wndws-Doors 8 Gas; MH Test-Demand-Valve-Cnnctr 7 Electric 9 Elec MH Cntnty Test-Crossovers-Breakers,Cimes : _ 8 Frmg; Siils MchrsStuds-Rftrs Trusses 10 Drain;,MH Test-Fall-Fiex Cnnctr 9 Siding; Nailing-VeneerStucco-Lath' 11 Wtr &Sewer Connected -CIO to Grade 10 Roof Shthg-Rooting i2 Gas and Electricity Tagged 11 Ext; Steps -Doors -Landings 13 Tie Downs" .0 °; Foundation] 12 Braced Wall pnis 14 Exits' 15 Cert of Occupancy 16 HUML-atielAnsignia Numbers Serial Numbers DATE POOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnncfns Thickness Dead Men4 fining . . 4 Elec Rcptcls/Ung; Distance-GFI 5 Elec Pool l pg,, 15 volts-GFi 6 Elec.Enclsrs; Conduit Entries-T0rmina1s4Jsted . . 7 Elec Bonding; Metal w/5'-Creftng Ecp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool ightg Soxgs-Encfsrs-p!Moards-lnsultn to Main Conduit 9 Health Dept Apprvl 10 Pimb; Cir Test Wtr Supply Test 11 Lt Niche 12' Endsr, Fencing -Alarms 13 Bonding, Diving board or Slide #F Pool Drawing a Not OK RESIDENTIAL DATE JUNDERFLOOR 1 Zoning -Setbacks -Easements -Flood -Slope 2 Ftg Main; Soils-Elec Grad Ftg Dpt!i 3 Ftg Garage; SoilsSteel-Elec Gmd Ftg Dpth 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 5 SWmwalls Main; Steel-Blockouts Wrapped 6 Stemwalls Garage; Steel-Blockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIOSewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12Elec Undrgmd 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 14 GirdersSlits-Anchr Bolts-Joists-Vnts-Cripples 15 Acc & VnUtn 16 Insulation 0*.cr DATE FRAMING 17 Silts Proper Materials & Anchrs 18 Walls Studs- Nailing Spacing & Braces-PtatesSound 19 Bearing Walls over Girders flr Nalling . 20 Draft Stop In Wa11s (rat proof) 21 Fire Stops,'F'urred CeilingsStairs-Chasers-Tubs 22 Headers & BeamsSi &'Bearing' 23 Hangers-P.ost'Caps-Anchrs-Cnnc ns 24 Ceiling Joist-Rftr Ties-Ptui"oof Brac-TrussShthg 25 Frpic Ties or Type A Flue=Pipit Throat CImc 26 Attic Acc; Sz &pilot Pitetpd)raft Stop4ns Baffles 27 Bdnfn Wndws or Exiting DoorsSf(1 Flt & Dimensions 28 Garage Fire Prtc Framing -RC Channel 29 PrprtyLine Firewall & Opngs' 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Pdctn 32 Plywd on Roof Ovrhng-Mc Vnts-Rfir Outrgm 33 Siding -Nailing Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrf r Acc 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace InVExt Wall pnls 38 Insultn-W al ls-Ceilings 39 Infiltration -W alis -W ndws 40 o �� DATE JELECTRICAL 40 Fxtr & Tmsfrrnr Chmc-Ins Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cnddrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Gmd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires In Ktchn & Cndctr Sz GFl 47 Subfeed Wire Sz Q. CU or OAL AC Wire Sz y, CU or ❑ AL 48 Range Circ Q. CU orHAL Oven Circ e, CUorAL Insulated Neutral YesNo 49 Service -Riser Cndctrs & Gmd Main Dscnnct 50 Eqp Cimcs pnls-Motors-Meeh Eqp 51 Clothes Closet LtShwr Lt -Spa Lt 52 Smoke Detector Single & Duplex)_ DATE PLUMBING 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr_Nail Prfctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tutt & Shwr, 2nd fir - Tub Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler, Test 60 Yard Gas Piping DATE MECHANICAL 61 AC Ducts Insultn & Support 62 Vent Fan, Exhaust abv Insulin 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace Vent Acc-Comb Air RhTdVent 115 Outlet 65 Attic Acc & Pitfrm If Furnace In attic DATE JFINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-CImc-Comb, Air-Cnnctr In Garage; abv-fir-Ducts-Mech Prtctn 69 Bedroom Exiting 70 GFl & Bath Fxtrs & Tub Acc-Spa 71 GFl Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrafls 74 Frplc or Stove, CImc-Hearth 75 Elec Outlets at Wood Pni, Int & Ext 76 Ktchn, Fxtr & Appinc; Grnd Air-Gap-Gooking CImc 77 Elec Outlets & Rcptcls at Kfchn Counter 78 Garage Fire Door; Swing -Landing -Closure 79 AC Duct In Garage -Damper. 80 Wtr Htr, Vnts-Clmc-Com Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3' drain 81 PImb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcls in Garage (GFl) Romex P. 83 Insuttn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dm e & Wood -Earth 86 CImc Dmge Planters F Yes Q No 87 Stucco Brown-Flntsh 88 AC Unit Dscnnct, Elec-PImb 89 Vnts abv Roof, PImb-Appinc-Frpic-Clmc to Opngs 90 Wtr Well, Dscnnct, Elec, PImb 91 Ext Elec Trim, GFl Reptcl-Undrgmd 92 Vntitn thru House 93 Glass Prtctn 94 Corrections from previous Itispcbts 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-C/O to grade -HD ApprA 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler �* a C LRT[ RIC ATL O R RI ELD VER I RICATION & .DI AGNOSTIC TF STING (P age 1, 6f &) C F4R ProjemAddress Measured Builder Name 1275Zaile CA95965 Values"z�<q Builder Contact InstallingContractor agki Telephone Plan Number HBR3 Rater Telephone , Sam Ie Grou Number fk Enur Total Pan Flow in CPM: HomerEnalas s� 760 7fi8-32281 ComplianceMeihad Prera ipLive 3 Paw ifLea1mgePercentage:96% j 100x ( - (Line* 1)/ -(Line *2)D ClimateZone: Certi fyi ng Signature � Wbfld iDate Sample House Number EIeiVonicall°?i31marl . allfte low inofBxietingDw:tS e.m Prior b Enur � nrCFM from CI 180E1 Firm 4 HEM Provider 4, • Erialasye Corp �.., � ' CBP`CA' Street Address: Cityr@tate+Zip for Duca SystemA Iteration a nd/or l3gaipment Chen erOut. Copies to: EURDER, HEM rRUV IV LK An u rduILVING VErAKIM Ln t HERS RATER COMPLIANCESTATEMENr The house was:.V ❑ Tested ✓ O Appmved as part oFsample testing, but was not tested As thgHERS raw providing diagnmici testi ngand field verification I mrtify that the house identified on this form complies with ft diagnmticU Aaoomplrance mquiremeawatebecbed *1on this form. The IMS rater must che&and verify Oatthe new distribution system is fulry ducted and correct urpe is used befoma CF -4R maybe released on every qgg 1gbuilding. T1reRMU rater must not reltheCF-4R until a proper ljoompletedandsigned CP -6R has been received for the sample and tested buildings. ❑ The insmliar bseprovided a copy ofCPfiR (Installation Certificate). 0 New Distribution system is fully ducted (i.&, does not use building cavities as plenums or platform returns in lieu ofduots). ❑ New sysiems where cloth backed, rubber ad huiYe duct tapo is ins_ tailed, mastic and draw bands an used in combination with cloth backed, rubber adhesive dual tape to seal leaks at duct connections. V iX�MTMMUM AEQUMEMENTS FOR DUCT LEAKAGE REDUCTION 00MPLIANCE CREDTr P,aee&oer fa, field v&,,Gcahoe &Add agAav,c resr;,tgofai,d,vin b,d;o csy&&*r&-e aurwtable is RACM Appe,AxRCA.3. Duct Diaenoslic.LeakaeeTealine Results ) NEW 00NSTRUCrION- TPBtResulta(CFM ®25Pa) Measured 4fgDaotPressuriasltion t��� Values"z�<q I Snte•r Tested LeskagePlow in CPM: b����,���°' ,�� ' 2 Pan Flow: Calculated (Nominal: sf O Cooling•►' O Heating)or V O Measured 1200 Enur Total Pan Flow in CPM: 3 Paw ifLea1mgePercentage:96% j 100x ( - (Line* 1)/ -(Line *2)D O PM Pail ALTERATIONS: Duct System andJor HVAC Equiprnent C6aup-Out allfte low inofBxietingDw:tS e.m Prior b Enur � nrCFM from CI 4 Dur=iS A an r*Tast y Uq P g 1142 �.., � ' 5 Enim Tested Leakage Pbw in CPM: Flnal Teat of New Duct System or Altered Duct3ystem for Duca SystemA Iteration a nd/or l3gaipment Chen erOut. Enter Reduction in Leakage for Altered Duct System j _(Ll nen 4) Minus _(Line* S)]�' b (Only if Applicabie) 7 EnzrTestedLealRgePlow inCPM to Outride (Only ifApplicable) ✓ ✓ En9reNew Duct System - Fev ifLealragePercentages 6% O Paas 0 Pail g. 100x Li'���ine*5 1 �,.; LineW2 7M OR VERTFICATION STANDARDS: For Altered Duct Spstern and/or HVAC Equlpment Cb2UZ#-01jt Untie one of the W116wipl four Teat or Verlflcatton St and ardsforco ttanoe: 9 Paas if Leabage Percen Cage s 1596 1100 x ( (Li ne if.5) / (Line * 2)]] O Pass O pail 10 PassifLeakagetoOutsidePercestges 10%(100x ( (Line#7)I (Line if2)]j 0 Pas 0 Fail k 1 ' "r-• Pan if Lealmge Reduction Percentage 2 60% 1100x ( 1�1'42_(Li ne *6) / 455_ (Line * 4)]] 060=2 jk(""Pass 0 Pei l II and Verifcatlonb SmolceTerl and Visual Inepection 12. Pala if Sealin o[aII Amessible Leaks and Vej ificationby Smoke Test and Visual in ion 1 O Pass 0 pail Pass tf Otic of Ltoes 9 tbrouyb d 12 pass u� ` � ,#x"; `°�k WRass 0 Pei I Rt6de&Al CarrpGa,rce Former Ap,i! 2005 l INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Permit Number 1275�Zack�Cir,,.Oroville CA95965 ` 061,734 ✓ CXR .THERMOSTATIC EXPANSION VALVE (TRV) Procedures jor field verijication of thermostatic expansion valves are available in R,404,Appendix Rl. . v ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided, for inspection. The procedure shall Location 1F Outdoor Unit Make consist of visual verification that the TX is installed on Outdoor Unit Model OF ✓ (X,�Yes ❑ No the system and installation of the specific equipment IR"i 13shall Date of Refrigerant Gauge Calibration be verified. Date of Thermocouple Calibration (must be checked monthly) Yes is a ass Pass Fail v ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial # ' Location 1F Outdoor Unit Make 1F Outdoor Unit Model OF Cooling Capacity Btu/hr Date of Verification 1F Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) j. Standard Charge Measurement Procedure (outdoor air dry-bulb 551E and above): Procedures jor Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temoeratures I Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Treturn, db) 1F Return (evaporator entering) air wet -bulb temperature (Tretorn, wb) 1F Evaporator saturation temperature (Tevaporator, sat), OF SucEion'line temperature (Tsuction, db) °F Condenser (entering) air dry-bulb temperature (Tcondenser, db) 1F unerheat Charge Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db — Tevaporator, sat °F Target Superheat (from Table RD -2) °F Actual Superheat —Target Superheat (System passes if between -5 and +5/F) 1F Temperature Split Method Calculations for Adequate Airflow .flit AUolhnd rnlrulntinn is not noroeenry W Adonunlo 4647nw erodil is m1rom Actual Temperature Split = T return, db Tsupply, db 1F Target Temperature Split (from Table RD3) 1F Actual Temperature Split Target Temperature Split (System passes if betweeri - 3/F and +3/F or, upon remeasurement if between -31F and. -1001 OF Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address Permit Number, '1'275Zack SCt��Orovlle'CA"+95965= 061734` INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE. INSTALLER COMPLIANCE STATEMENT The building was: ✓ GC'ested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:; R4 Remove at feast one.supply and.one return register, and verify that the spaces between the register boot and the interioi finishing wall are properly sealed.' R4 If the house rough -in duct leakage test was conducted without an air handler installed; inspect the connection points between the air handlei'and the Supply and return plenums to. verify that the connection points are properly sealed. R�,,,Inspect all joints to ensure that no cloth -backed rubber adhesive duct tape is used R,, New Distribution system, is fully ducted (i'.e., does not building cavities as plenums or platforms returns in lieu of ducts). ✓ 13 DUCT LEAKAGE REDUCTION Procedures or reld veri ieation and diagnostic tesling of air distribution systems are available in RACM Appendix RC4.3 [VIEW CONSTRUCTION: -Duct Pressurization Test Results (C"FM-@ 25 V.01) Measured µ'•ms.1 �� `»q � . � Values Values I Enter Tested Leakage Flow in CFM:' Fan Flow: Calculated (Nominal: ✓ [X.,;Cooling -/ ❑ Heating) or,/ ❑ Measured. 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 efnV(kBtu/hr) x Heating Wf 260 Capacity in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM hen: ✓ 3 Pass if Leakage Percentages 6% for Final ors 4% at Rough -in: ❑ Pass ❑ Fail 100 xjLine#l)/_____kfJne#2')jj ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct�`� . System Alteration and/or Equipment Change -Out. - X1142 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered DuctC' System for Duct System Alteration and/or Equipment Chan a -Out.,, Enter Reduction in Leakage for Altered Duct Systeme 'x'455 6 Ll4'142 Line # 4 Minus Cine # 5 — Onl if A livable X687• t ai l 7 Enter.Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ Vol, Entire New Duct System - Pass if Leakage Percentage < 6% for Final 13 Pass ❑Fail 8,. 100x ine#5 / Line #2 - TEST•OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ Out Use one of thefollowing four Test or Verification Standards for com fiance: 9 Pass if Leakage Percentage s 15% [ 100 x [ (Line # 5) / (Line # 2)]] ❑Pass ❑Fail 10 Pass if Leakage to Outside Percentage s 10% [ 100 x [.(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage , 60%, [ 100 x [ 11'42' (Line # 6) / _ 455 (Line # 4)]] � X60:2 IX -Pass ❑Fail 11 and Verification b Smoke Test and Visual Ins cnon 12 Pass if Sealing of all Accessible Leaks and Verification bySmoke Test and Visual Inspection � u� ❑ Pass ❑ Fail Pass if One of Lines # 9 through # 12 pass "iii .t �Vass ❑ Fail ✓ ❑I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply. with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: 08%021061 (ElectronicaIlyy""�ed))� ('opies to: BUILDING DEPARTMENT; INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address Permit Number :. 2 SPZacWb r OGville'{CA<95§6�V 0617 W. Ari installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completion of final inspection, a copy must be provided to the building. ' department (upon request) and the building owner At occupancy, per Section 10-103(a). HVAC SYSTEMS: Heating Equipment Equip Type (pkg. heat um CEC Certified Mf'r. Name and Model Number aY of Idefitical Systems'(;>CF-lR Efficiencyt (AFUE, etc.) value Duct Location allic etc. Duct or Piping R-value(Btu/hr) Heating Load Healing Capacity (Btu/hr) Split AC +.Gasti r`NJh1 YRW" Goodman"? _1; 13 0 Cooling Equipment Equip Type (pkg. heat um CEC Certified Mfr, Nameand Model Number #of Identical systems Efficiencyt (SEER or EER) 2CF-1R value Duct Location attic etc. Duct R -value Cooling Load Btu/hr Cooling Capacity Btutltt Split AC +.Gasti r`NJh1 YRW" Goodman"? _1; 13 0 1. > symbol reads greater than or equal to what is indicated on the CF -IR value. Include both SEER and EER ircompliance credit for high EER air conditioner is claimed. 011, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1 R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and.3) equipment that meets or. exceeds the appropriate requirements for manufactured devices (from the:Appliance Efficiency Regulations or Part 6), where applicable. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Gallaghers"Air Signature: Date: 08102106 ttiectrorncany(,stgneo);3 Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY �asvib#�nr<h'txUCo►n�r���c�;� April =2, k 34 .. ; BUTTE COUNTY �VTrF' DEPARTMENT OF DEVELO °o. PMENT SERVICES .: • BUILDING PERMIT c 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) . q--�-.`o OFFICE.#: (530)538-7541 PERMITS BECOME•NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm .under penalty of 'perjury that' I' am licensed under Issued Date: 07/20/2006 APN. 030-410-015-000 provisions of Chapter'9 (commencing with'Section 7600) of Division 3 of - p the Business and Professions Code, and my license is in full force and!, `. 7 —t effect.ORO License lass ''✓'�i License Number. I T / Site Address: 1275 ZACK CIR Y ` y . ; `Date: �1 Map Index: Contractor. Description: INSTALL NEW HVAC UNIT OWNER=BUILDER DECLARATION' 'r I hereby affirm under• penalty ofperjury that I 'am exempt from. the q Contractors:' State, License Law for the -following reason (Sec. 7031.5. Business and Professions Code:, Any city -or county which requires a OWn@�: NELSON ANDREW & KARISSA permit to construct; alter; improve; demolish, or repair any structure, prior to its issuance; also requires -the applicant for such permit to file'.a signed statement that he or she is licensed pursuant to the provisions of 1275 ZACK CIR the Contractor's State -License Law (Chapter 9 commencing ,with Section 700 0) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA _ she is exempt therefrom and.the basis for the alleged exemption. Any 959654340 ' violation of. Section •7031.5 by any applicant -for:a permit subjects the applicant to a'civil'penalty. of not more than five hundred dollars ($500):): ❑ I, as owner of i, e`property, or my employees with wages as their sole compensation, -will do .the work, and the .structure .is not 'intended or offered for'sale'(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant' GALLAGHER'S HEATING & AIR such work himselfor.herself or through his.or her own employees,' Pb BOX 35 provided that such improvements 'are not intended or offered for sale. If however, the building or improvements are sold, within one year of completion, the owner -builder will have the burden of -improve LOS MOLINAS, CA 96055 proving that he or she did not build or for the purpose of (530) 384-2444 sale.).: O I,.as owner of the property,:am exclusively ,contracting 'with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law.does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) licensed Contractor: GALLAGHER'S HEATING & AIR' pursuant to the Contractors' State License Law.). PO BOX 35 ❑ I am Exempt under Article 3 of the Business and Professions Code LOS MOLINAS, CA 96055 Date: Owner: (530) 384-2444 . . WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty'of perjury one,of the following declarations: License #:.777334 ❑ 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: >.. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued.", My workers' compensation insurance+ carder and policy number are: e arrier Carrier -.- Total Square Ft: 0 S.F. Policy#: '-1 1 .� ' d� 13 gJ S Policy #: C31"certify Valuation: $0.00 - 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 Census Code: become subject to the workers'-compensation'laws of California, and' agree that . if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: S' r` Applicant: WARNING: Failure to secure workers' compensationcoverage is unlawful; and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to 'the cost of compensation, damages as,provided for in Section 3706 of the Labor code, interest, and attomey's fees. -CONSTRUCTION LENDING AGENCY This permit is hereby issued under the'applicable provisions'of'th`e BGtte County Code and/or`-- -- 1 hereby affirm that there is a construction lending agency for the Resolution to do work indica d ab ve for which fees have been paid. performanceof the work for which this permit is issued (Sec 3097 Civ.)i ill f��-7 Name: .. n. Date: By:' r j�. PERMIT EXPIRES ON: I -L0 Address: .� Date ' ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ . Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled -construction of this project. ❑ Attached are copies of.the required E -PA. notification forms. I hereby certify that,l,have read this -application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating,to building, construction. I'acknowjedge it is unlawful to alter. the substance of'ariy official fo " or document of Butte County. I hereby, authorize represe tatives of Butte County to enter upon the above mentioned, property for inspec n oses. ' �. p ahnrll Print Name: Signature. Date: d 'Contra ❑ Owner ❑ Contractor . ❑ Agent for Owner E Agent for ctor a \'• B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY o DEPARTMENT .OF DEVELOPMENT SERVICES` � ' p BUILDING PERMIT A-PPLICA-TION AND' SUBMITTAL REQUIREMENTS p 24HOUR INSPECTIONC OROVILLE: (530) 538-7636 • CHICO:'(530)'89P-2834`: p OFFICE #: (530) 538-7541- A FEE -WILL BE REQUIRED AT TIME OFAPPLICATIIO Website: www,buttecounty.net/dds PLEASE PRINT CLEARLY** Last Name �J f1e 1 Address ' I C City Prov l Phone E-mail APPLICANT SIGNATURE • ' Tl For office use only:-, ` ARCHITECT/ENGINEER Name Flood Zone" Address' -SRA' • City No .. State Zip Phone Subdivision Name Fax E-mail Page State License Number . APPLICANT SIGNATURE • ' Tl For office use only:-, ` Zoning Flood Zone" -SRA' Yes No .. Occ. Type Const. Subdivision Name Map Book Page Lot # - Date Approved: PROJECT LOCATION Property Address_ • Ci j - .ZaGI� Cl r:.t r-owi i Cross Street WORKER'S COMPENSATION , Policy Number 1 3 oa 1 SSS" Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. ; LENDING AGENCY .1 Names. Address Description or Scope of Work: Cu- 1,i) ne, U-) 4V A C, Ltnt Sq FT,Living Garage, Open Cov•, ❑ Structure Built without•Permits ❑ 'Proposed Change of Occupancy (Note previous use). EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the ,date of application. In order to renew action on -an application after expiration, a new application, plans and fee will.be required REQUEST FOR REFUNDS. Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. n� Other Date:cP- . LTJ OVER FOR SUBMITTAL REQUIREMENTS T°tial fi K:\FORMS\BUILDINdFORMSMBIdgApplSubRgmts:doc.a Page 1 �of2 } REV 8-12-05 :.... 'COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive Oroville, California 95965 • Telephone (530) 538-7541 7 t7 PERM I (Rev. 12/96) APPLICATION AND�PERMIT ASSESSOR PARCEL NUMBER 030-410-015 ZONING AR '. BUILDING PERMIT - OWNERPIFFARETTI , LYNDA TELEPHONE 533-1875 SO, FT, OCC. BUILDING VALUATIO 24 1 1 44n nn OWNERS MMUNG ADDRESS 1275 ZACK CIRCLE, OROVILLE, CA 95965 CONTRACTOR'S "AME MIKE COOK TELEPHONE3-02 CONTRACTORS MARLING ADDaE$S7 LOMA VI. TA DRIVE, OROVILLE 95966 �(} CONSTRUCTIONLENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGWEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS 1275 ZACK CIRCLE, OROVILLE Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF 6 Duplex ❑ Mobilehome ❑ Other SPECIFY Each Tra 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 X] Describe Work: REROOF WITH COMP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service ".v °oRR mss 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 full rce and effect. `// License Class Lic. No.O/(�J / t.(� M'/ OWNER -BUILDER DECLARATION I 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 l000A 46.00 NEW CONST. OUNG OCCUP. OR ADDNS. ( a ACC. eI DS. S° 3.50FT. T. ,NON•pESID MULTI -OUTLET 97,50 SOI= o=U R Ex. Occu . O(n,�7 pit FIXTUREs eA1 Ex. Occu . O iSPP RESI6.°E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 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 $ 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.) 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 Califaynia, and agree that if I should become subject to the workers' comp nsation visions of section 3700 of the Labor Code, I shall forthwith Cp y w' th provisions. / �� _ ! X Date i — 7 Si t o Applicant - O ner Contractor ❑ Agent An OSHA permitis 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 $ 55.00 HA2. D. FEES IMP I FLOOD COF PARCEL PD HO ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES the applicable provisions Resolutions to do work been paid. // � Date CT M �LY to rReceiptNo. WHITE•D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .i . 'ASSESSORPARCELNUMaER...•i 41 / 20NING BUILDING PERMIT OWN" C r T !.'�r't 1r'f % '•.; ;.: HONE re� 8 7 SQ. FT.' OCC. BUILDING VALUATION owNERs MUS40 ADDRESS /j - z Q C_k C CNvIle'. 576 $L 5 Q $. CONTRACTOR'S NAME .. - ^ tSv�G1533 TELEPHONE 63OZ - - - - CONTRACTORS MAILING ADDRESS p CONSTRUCTION LENDER :. ; -�' -_ , •-'.:.. - - ,. - - LENDER'S MAILING ADDRESS., .. .. •, _ �, : _ - ..Fire lace Total Valuation S. - ARCHITECT_ OR ENGINEER .. .. ,. - -LICENSE NO. Filn g Fee $ .20.00 Permit Fee S 3 ARCHITECT OR ENGINEERS MAILING ADDRESS . Plan Checking Fee $ BUILDING ADDRESS6Z 7-S, n �� Energy Plan Checking Fee S. PERMIT FEE i5 57. c o Loma. SYRDIVISION's NAJM, PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE : `SF uplex ❑ Mobilehome ❑. Other: SPECIFY Each Tr 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 Describe -Work: �r0 Df &J Gas piping system 1 - 5 outlets 15.00 . "Building sewer 15.00 Mobile Home S G W-1@20.00 PERMIT FEE. _ ELECTRICAL PERMIT I'lling Fee 20.00 Main Service s�oo�A on mss 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 full force and effect License Class Lic. No. OWNER-BuILDER, DECLARATION I hereby affirm under penalty of perjury that'l am exempt.from the:Contractors License Law for the following reason: ❑ 1, as owner of the property, or my.employees with wages as their sole compensation,. will do the work, and the structure is not intended or offered for sale. ❑ 'I, as owner of the property, am exclusively.contracting with licensed contractors to construct the project ❑ 1 a exempt.under Sec. ;Business and Professions Code for'this reason WORKERS' COMPENSATION DECLARATION I hereby affirm 'under penalty of perjury one of the following declarations: ❑ I 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 forwhich this permit is issued. ❑ •I 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 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.) ❑ 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. X Date Signature of Applicant -•❑ Owner'.❑ Contractor -❑;;Agent, An OSHA permit is required for excavations over 60 deep and demolition or construction of structures over 3 stories in height Main Service sow TO IOWA 46.00NEW CONST, Dypgyyp OCCUR so OR ADS• :ACC. erns. 3.5¢FT: ►Na,-RE41D.MULTFTLET OU@7.50 BRANCH IR PowER APPAMTUS a sraLE oLrtLEraR Ex. Occu OUTLET OR FocnmEs 200 ,';� FIxED APPUlS. oR Ex: Occup.' oLrrLETs �,D• 5.00 'Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00. Heatin " Cooling Hood 6.50 Ventilation PERMIT FEE $ c Mobile Home Installation Fee $ Energy Inspection Fee L Occ CONST TYPE TOTAL FEE $ 0 � IMP Fu000 CDF PARCEL PD HD ISSUE This permit is hereby issued under of the '.Butte County Code and/or indicated above for which fees have -By PERMIT EXPIRES ON - the applicable provisions Resolutions to do work been paid._ Date ...._._, ReceiptNo. wu1Tc-n n Q .R n /:ANARV.ASQFSgf1R PINIC.INQPPCTCIR . rY11 r1FNRC1n.APPI ICANT . i 4 l iw w•y�'�M�k�.�r�wP -.., r'.y..•�,tP'„pM'b"�'h'r..�.M4P�{'f'CP'+Y,.'�".. 030-41-0-015 98-1260 B IRIFFARETTI, Lynda 1275_Zack Circle,_Oroville (reroof/SF) Mike Cook. 1 1P'"�1r" • COUNTY OP BUTTE -DEPARTMENT OF•DEVELOPMENT SERVICES - BU1LnING DIVISION 7 County Center Drive • Oroville, California 95965 • 'Telephone (530) 538-7541 PERMIT NO. (Rev.12/96) APPLICATION AND, PERMIT ASSESSOR PARCEL NUMBER 030--410-015 , ZONING AR BUILDING PERMIT 1 OWNER' PMAREM LYNDA, TELEPHONE 533--1575 SO. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS 1275- ZACK CIRCLE, OROVILL , CA 95965 (��/1 . CONTRACTOR'S NAME _ _ MIKE CWK TELEPHONE 533-4302 CONTRACTORS MAILING ADDTZ7 MIA VISTA DRIVE, OROVILLE 9`3966 j- CONSTRUCTION LENDER - Fireplace ' LENDER'S MAIUNG ADDRESS - Total Valuation $ i ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 35.00, ARCHITECT OR ENGINEERS MAILING ADDRESS Plan CheckingFee $: r�A n BUILDING ADDRESS 1275 ZACK CIRCLR,'.OROVILLE Energy Plan Checking Fee $ PERMIT FEE $• LOT NO. SUBDIVISIONS NAME' "PARCEL.MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap t 7.00 " USEOFSTRUCTURE SF 1; Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater- 23.00 Water piping in 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other -0 Describe Work: REROOF WITH GWMobile Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Home S G W Q20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service oo•ve ow mss 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 full f rce and effect ,�/ r" ,4, /� 7 / License Class Lic. No. =Y !e3%,� CA OWNER -BUILDER DECLARATION I 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 astheir 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 EA TO 46.00 NEW CONST. DW NEOCC LLING OCC - OR ADDNS. ( & ACC. BLDS.UP. SO 3.5Q NON-RESID. MULTI•ourLEr 97,50 PSO APPARATUS h SWGLE OUTLET CIR. Ex, Occup. ouTLETORFocruREs BAS ®I:w FUND APPLNS. OR Ex. Occup. ourLETs Es10. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 .� Misc. Wiring 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 sction 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 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.) �r 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 workers' comp nsation ovisions of section 3700 of the Labor Code, I shall forthwith �o , N w,tho§d provisions., - X _, ` ' _Date /, --4 " ��` Signatu a of Applicant - ❑ wner Contractor ❑.Agent An OSHA permit is required for excavations over 5'0° deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL. FEE $ 55,00 n: IMP I FLOOD CDF I. PARCEL PD I HD I ISSUE This permit is hereby issued under•the of the Butte County Code and/or indicated above for, which• fees, have By u ON_ "" " , ' - applicable provisions Resolutions to do work been paid. / ._ 4 _1;ty Date Com" DD TT 7 to Receipt No.PERMIT.EXPIRES WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets bst Floor ,Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing, Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Garage Vents Water Htr. Stemwa l l Insulation Heaters Slab Prov. for ph• sically Appliances Carport handica e. Gas Piping & Test Conformance of ex. Footings structure Temp. Gas Slab Final Sanitation Patio FIREPLACE Final. Footings Footin ELECTRICAL Masonry Walls Throat Rou h Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot.. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts -Underground Interior Lath Ventilation Permanent. Door Closer Final Final MOBILEHOME UTILITIES - - - - - - - - • - - - - • - - - - Elec. Service Elec" Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS DL,1/7 YVZ OAY� (NOTE: An entry must be made on'this form each'time you visit the job site.) aumonze represpntatives.ot ine .county of butte -to. enter upon me 'Thi.s'permi't is-:hereby•i'ssued''under.the applicable provisions of .' above-mentio property for inspection purposes. the Butte. nty; Code and/or' resolutions to do work indicated d above fo hi h fiees'have'been paid. F X Date I' CT0��P/jo OflKS ig tureofPermitee or A ent ,%•'' �� -� O . By ate Receipt No. ©. White-D.P.W. I44E3475oi - P nk=Inspector ='Golden rod-Applican't Building permit 'eXplre§ Date .BUILDING Owner t Ake SQ.`FT. OCC:' BUILDING' ALUATION Ma Iiing'Address r /Z'�.l✓, 3 1 Tel'ephone',' k, i Fireplace Contractor; ,�� GES--�`. Total Valuation ` Mailing Address - Permit Fee PI'an:Checking Fee /or.Pena a elephone No = Permit' Fee , : , ding Address PLUMING No. @ FEE PERMIT,FILING`FEE' $3:00 Each Trap 1:50 �� , LL Repair drainage or vent piping..:': 1.50. Water piping Each gas :water heater or. vent ".1 :50 A. P. W. _,?O Zoning`& Planning Gas piping system 1 -5 outlets 1.50, N' Each additional outlet .30 es -6 . tetierr Fire Dept, Fire Zone . Use Permit _ Building sewer 5.00 Parking EQA Plans. Parcel Declaration Parcel Map - 60'.R/W . 'Improvements Lawn sprinkler system .2.00 Q4dg-'PiOns�ise+d Parcel Approval' P-1 an S' Approval 'Permit Fee $ $ ' NEW Q ADDITION 'Q, UTILITIES 0 OTHER ELECTRICAL No; @ FEE.: PERMIT:FILING'FEE'. r. $3.00 d12 L, ' S' ,.A;;( ; Main service „100 AMP ORSLESS ". 5.00 - - 'Main seryice ,.E A,'ADD',L 100'AMP. - -2.50. Main, serviceOVER 800V* 100 ., AMP OR LESS 25.00 Single Family Duplex Mobil Home- °Others . �.•. ..' Maln ServlCe EA,' ADD'Ic 100 AMP 1.00 ' - OCCUP. &) .,.. 20Sgft OR ADDNST' ( ADWECCLSL G,LING S. _ 5' NE W;C ONST R, MU LT I.OU T,L ET .' - - NON-RESID: '('BRANCH CIRCUITS)':. �2.50ea-, - - .. •, - - - - - - NEW.CONSTR. ',- POWER APPARATUS &) NON-RESID, - (-SINGLE OUTLET CIR. t . - CONTRACTORS LICENSE -LAW' `+ am licensed' under the provisions 'of Chapter=9,. Div 3..of the ofession s' Code under the+name , ,. style Of: - State of California ,Bu siness2400!f_4_ Y ' .: �Y Ex.:Occup(ourLETS OR'.FIXTU RES).' � 09 BAL�1 EX:; OCCU .FIXED APPLNS, OR P,(OUTLE.TS (RESID ) EA)' 2:00 Ternporary'service " 10.00 Mobile Home Facilities. 15.00 License No.Classification Mi-sc.,Wiring' 16.25, EI am exempt -from the Contractors License Laws of the State -of CaWifomia. Permit Feb $ $ WORKMEN'S COMPENSATION .INSURANCE :.. , 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, have placed on file.wi.th thelCounty of Butte a certificate of Workmen's Compensation Insurance. "-l •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 1=IUNG'1=EE ' :. $3:00 ,.. , Heating ; n Cooling s.:. Ventilation" " - Hood 2.00 'Permit Fee. $ $ certify that I have read this application" and `state that the above information is correct. I agree to comply to all -County Ordinances and :State .Laws relating to :building construction, and ,hereby; ,' i TQTAL PERMIT,°FEE' $ aumonze represpntatives.ot ine .county of butte -to. enter upon me 'Thi.s'permi't is-:hereby•i'ssued''under.the applicable provisions of .' above-mentio property for inspection purposes. the Butte. nty; Code and/or' resolutions to do work indicated d above fo hi h fiees'have'been paid. F X Date I' CT0��P/jo OflKS ig tureofPermitee or A ent ,%•'' �� -� O . By ate Receipt No. ©. White-D.P.W. I44E3475oi - P nk=Inspector ='Golden rod-Applican't Building permit 'eXplre§ Date . , QW,a ' t - - " "; - , - !��.. �'� 1, V' - �-' , f, ,�'A - 1�11.�_;- "' ' "4i'j�'� �':�o�.';�4' 't.� -�i' � � '' , * "� � I "� �' ; "�- " 4, k� - - - , 'J�' J, C " ; .. ',; �. 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Meyers Roofing Service RF: Permit Application #6039-77 860 Onstott (AP•30-41-15) Yuba City, CA. 95991 . t GentTeffien: With 'reference to•the above subject, on November 14, 19779 you applied for a permit to reroof the Corbaley residence at 1275 Zack Circle in Oroville. At that time, we were unable to issue the required permit as your Certificate -of Workmen's Compensa- tion Insurance had expired on October 1' 19779 (We so notified you by mail dated November 18,.1977..) As of this date, we -still do not have the proper Certificate of Workmen's Compensation Insurance Arid you have done the work without the required permit and inspection from this office. , would•you please contact this office iwith.in ten (10) days of.the date of this letter. and 'submit 'a.,val'id Certificate of Workmen 1^s, Compensation Insurance together with a' $36.00 penalty fee and request inspection.6t,,this job. Your failure to comply with this request could cause us to refer the natter to other agencies for appropriate action. Should you have any questions concerning this, please contact us,- Yours s:Yours very truly, Clay Castleberry e Director of Public Works J.F. Glander JFG:dd Assistant Director `: . -, ,�'.' 4 r _ -; •.i: File No. (For Action 1, 2,3) BUTTE COUNTY r Public Works Dept. (For Information ✓) - Director - Dep. Dir. ;�•` s F�.. "r . +� Sec. 'Y i. Rd. & Br. Mtce. Shop & Yards Bldg. Insp. Admin. D&C / Traffic - !)"�tt. �.l, ... 'r�S ._�+.... -Const. Rd. Des. Br. Des. Sur. & Loc. Transp. F .i :� .+•:1 :rS"�:. Land Dev. ' Ref. Disp. Drng. / S.I. Sub. & Pcl. Maps '- Permits 5. vfj)jx 71- vfj)jx � �, T . •,1 ; h1 ,� ,� i' pry �" . r• ��\ C ,z kms' -�• e �'� _ r . s 3 �� � 7. y�,� !' r� r. _ v r •� �''� .. ,�y lir .� J. _ �yv • it �.-� f � � fv� �` - , . fix• /I� Al n r.f J;1.. �• t ,. � „ ' .lam" l • - - •; ;�.5"I`� - � �,�' )1 fir` •. � 'M�-' � �y /,�r � `' , � �, �. y '• .moi - �. 4` ��� a,' a+''tnr�•J - - - ' - r of i !+y r � M � •1 t � '' COUNTY OF BUTTE -'DEPARTMENT OF PUBLIC WORKS ✓� 7 County Center Drive, Oroville, California 95.965 PHONE: 916-534-4541 200 DATE V.)baCa : RE: ?Qrw,.'C Corba) With reference to the above subject: Attached is: Application for permit Building Plans Engr. Calcs. Typical Plan Sheet Mobile Home Sheet List of Codes Enforced OTHER / !// We need the following information: Permit application signed and completed where indicated with all copies returned. E�j es of $ Certificate of Workmen's Compensation Insurance, or check exemption statement. Contractors License Law information, or check exemption statement. Letter authorizing signature of Complete plans, in duplicate, including plot & floor plans and complete structural details. Plot plans in duplicate. Structural details in duplicate. Complete plans, in duplicate, prepared by.registered civil engineer or architect.. Engr: calcs. Two (2) sets of.plans in accordance with changes marked.in red. Sanitation approval from Butte County Health Dept. 695 Oleander Ave., Chicn 7 County Center Dr., Oroville. Skyway & Elliott Rd.,Paradise Planning approval, i.e., use permit, variance, rezoning, etc., from Butte County Planning Dept., 7 County Center Dr., Oroville. Improvement Plans. Parcel declaration recording data. Verification of access or right of way by deed. Verification of legally created parcel by deed. Deed for right of way.. Parcel map .recorded. (Recorded copy) (Recorded copy) I;k NNW011 MIT =100M As soon as we receive the above data, we will process your application, or, any.questions concerning the above,'please contact this office. Yours very truly, JFG:dd should you have Clay Castleberry Director of Public Works J.F. Glander -Assistant Director