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031-281-062
®31-281-0(0Z 031-281-062 02-0 fiNALED FORRESTER, SAM i' U �'S-7TI-IERMALI-I.0 A OR NEW MI -I PERM FND NEW E 031.281.062 02.2077 FORRETER, SAM 859 THERMALITO AVE., OROV I LLE DECK (6'X 127) op NOTES RESIDENTIAL 03 1 -281-062 T 02-0713 + FOESTER., SAM S"R.R T.HERMALITO AVE., ORO NEW MII PERM FND NEW SITE THE HCD FORM 433A FOR THIS MH CANNOT BE RECORDED UNTIL ONE OF THE FOLLOWING HAS BEEN TURNED IN TO THE BUILDING DIVISION: (1) LICENSE PLATE(S) OR DECAL (THE INSPECTOR MUST RETREIVE). (2) STATEMENT OF FACTS (ONLY ON NEW MH' S). INSPECTOR TO VERIFY SERIAL & LABEL #'S. SPECIAL CONDITIONS SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPY Address CHECKED BY GAS �Z Meter ELECTRI Meter By Dat�� I / J JOB FINALED (Date) V Signature 1 NOTES RESIDENTIAL 03 1 -281-062 T 02-0713 + FOESTER., SAM S"R.R T.HERMALITO AVE., ORO NEW MII PERM FND NEW SITE THE HCD FORM 433A FOR THIS MH CANNOT BE RECORDED UNTIL ONE OF THE FOLLOWING HAS BEEN TURNED IN TO THE BUILDING DIVISION: (1) LICENSE PLATE(S) OR DECAL (THE INSPECTOR MUST RETREIVE). (2) STATEMENT OF FACTS (ONLY ON NEW MH' S). INSPECTOR TO VERIFY SERIAL & LABEL #'S. SPECIAL CONDITIONS SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPY Address CHECKED BY GAS �Z Meter ELECTRI Meter By Dat�� I / J JOB FINALED (Date) V Signature •V=014 0 = Not OK - = Not Applicable ..MOBILE HOMES = Not Ready Date �UOB�OME UTILITIES (Plans) OK except #'s Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L'ft. / /'Nat. or/ /"L"ft./ /'LPG 7. Well Clearance 8 Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOWLE WME INSTALLATION (Plans) OK except #'s 1,/Electricity, ootings; Size -Spacing -Marriage Line - s; MH Test -Demand -Valve -Connector MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector rte; MH Test -Regulator -Connector 7yWarrand Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. owns -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Can. of Occupancy 5. Permanent Foundation Only; License Decal Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 s�7 I MISCELLANEOUS Date DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing ', 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels 9 i Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3.. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 ./ = OK 0 = Not OK - = Not Applicable = Not Ready RESIDENTIAL (S Date 46. Underfloor (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists- Vent s-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date 63. PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors 70. Fireplace or Stove, Clearance -Hearth Date 71. Card B-1 Date Card B-1 Date 72. Card B-1 Date Card B-1 Date 73. ELECTRICAL (Permit) OK except #'s 23. Fixture & Transformer Clearance -Ins. Protection 24. Elec. Receptacles Spacing -Lights & Switches at Doors 25. Size Boxes & No. of Conductors Stapled 26. Romex Installed Close to Edge of Studs & C.J. 27. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 28. 2 Appliance Circuits in Kitchen & Conductor Size GFI 29. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At 30. Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At Insulated Neutral O Yes O No 31. Service -Riser Conductors & Ground Main Disconnect 32. Equip. Clearances Panels-Motors-Mech. Equip. 33. Clothes Closet Light -Shower Light -Spa Light 34. Smoke Detector 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clea rance to Openings Date 86. Card B-1 Date Card B-1 Date 87. Card B-1 Date Card B-1 Date 88. WECHANICAL (Permit) OK except #'s 35. A.C. Ductsansulation & Support 36. Vent Fan, Exhaust above insulation 37. Condensate Drain & Overflow, Size & Grade 38. Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet 39. Attic Access & Platform if Furnace in Attic 94. Address Posted Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s Comments at Final: 40. Sills Proper Materials & Anchors 41. Walls Studs -Nailing Spacing & Braces -Plates -Sound 42. Bearing Walls over Girders & Floor Nailing 43. Draft Stop in Walls (rat proof) 44. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 45. Headers & Beams -Size & Bearing jingle & Duplex) Date FRAMING (Continued) 46. Hangers -Post Caps -Anchors -Connectors 47. Cling. Joist-Rftr. Ties- Purlin-Roll 6rac.-Truss -Shting.-Ring. 48. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 50. Bdrm. Windows or Exiting Doors -Sill HI. & Dimensions 51. Garage Fire Protection Framing 52. Property Line Firewall & Openings 53. Ext. Doors -One 3' -Check Garage 3rd S'ory, 2 Exits 54. Stairs; Width -Headroom -Rise -Run -Lancing -Fire Protection 55. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 56. Siding -Nailing Veneer 57. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 58. Glazing Area -Glass Protection -Skylights -Plastic 59. Shear Walls; Nailing -Bolts 60. Brace Interior/Exterior Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Walls- Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 63. Ext. Steps -Door & Sidelight Protection -Landings 64. Smoke Detector 65. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 66. Bedroom Exiting 67. G.F.I. & Bath Fixtures & Tub Access -Spa 68. Elec. Trim & Subpanel, Breaker Sizes & Labels 69. Stairs & Rails 70. Fireplace or Stove, Clearance -Hearth 71. Elec. Outlets at Wood Panel, Int. & Ext. 72. Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance 73. Elec. Outlets & Receptacles at Kit. Counter 74. Garage Fire Door; Swing -landing -Closure 75. A.C. Duct in Garage -Damper 76. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 77. Plb., Elec. & Mech. Equip. Listed for Location 78. Elec. Receptacles in Garage (F.F.I.)-Romex protection 79. Insulation -Foam -Looked in Attic 80. Guard Rails & Deck Construction -Post Caps 81. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 82. Following Instld./Drive J Yes J No/Walks J Yes J No/Planters J Yes J No 83. Stucco Brown -Finish 84. A.C. Unit Disconnect, Electrical -Plumbing 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clea rance to Openings 86. Water Well, Disconnect, Electrical, Plumbing 87. Exterior Elec. Trim, G.F.I. Receptacle -Underground 88. Ventilation Throughout House 89. Glass Protection 90. Corrections from Previous Inspections 91. Gas Test -Meters Tagged, Gas -Electric 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates 94. Address Posted Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: - :;OUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES F 411 Main Street • Chico, CA • (530) 891-2751 r 7 County Center Drive • Oroville, CA • (530) 538-7541 a` CORRECTION NOTICE Uiz 2 c S7� tit-- t) `z-- -C.. /3 OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. rl) l ,ety v o z li4 0 / 1 I V6 w � G Date �� " �-/ W� Inspector el - REV 10/92 COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES — 411 Main Street - Chico, CA - (530) 891-2751 7 County Center Drive - Oroville, CA - (530) 538-7541 CORRECTION NOTICE 05- V O `'- P< ,.- O Z --0 71,I' OWNER PERMIT NO. K� 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, please contact this office immediately. -% ice./ -/�Yy K �L / Date 7/��/�Z Inspector -deA REV 10192 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541(,,QPERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT��� ASSESSOR PARCEL NUMBER 031-281-062 ZONING AR BUILDING PERMIT OWNER SAM FORRF= TELEPHONE 218-7085 SO. FT. OCC. BUILDING VALUATION 7 ' OWNER'S MAILING ADDRESS P.O. BOX 614, PALERM, CA 95968 533-4564 CONTRACTORS NAME OWLYI:.L\ TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $55.728.00 ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee 441.50/2 $220.75 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 23.00 BUILDINGAD ESS S THEMLIM AVE. OR0�7T� T.F Energy Plan Checking Fee $ $ PERMIT FEE $263-75 LAT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome IK Other SPECIFY Each Trap 1 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 L5.00 Each gas water heater or vent 1 5.00 5.00 TYPE OF WORK ' New EX Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: NEW MH ON PERM M. NEW SITE Gas piping system 1 - 5 outlets 1 5.00 5 , 00 Building sewer 15.00 5,00 Mobile Home J� 920.00 PERMIT FEE $ 80.00 ELECTRICAL PERMIT Fling Fee 20.00 A LESS Main Service 2o0A OROR tESS 23.00 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 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 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 Main Service 200A TO 1000A 46.00NEW CONST. DWELLING OCCUP. s0 OR ADDNS. ( & ACC. BLDS. 3.5¢FT. NON-RESID T.MULTI.OUTLFiCET @7.50 FOWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ 1'00 BAL @ .50 Ex. OCcu . Ops RD,DEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 43,00 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.) ,Ecl 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 f I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall f hwith comply with those provisions. D_ / Date/ i. 7 Z 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. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $386. HAZ. D. FEES IMP FLOOD CDF PARC HD ,` SS l This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have 49441 By PERMIT EXPIRES ON the applicable provisions Resolutions to do been paid. D to Da work Receipt No. 3,x-6, % WHITE-D.D.S.-B.O. CANARY4ASSESSOR PINK -INS CTOR GOLDENR D -APPLICANT I I�;» .� .f....yf •, ,..".1'."'irn•�7"i.;�^ a•...-."7^"+•L',�.MS^•�V..'.H+AF+iS: �4f'S!rr�,�`, �;�L ...-_....�,.�..•..,. "-_�yrr i. chi` ,fit✓" ' 'it.:� i ' COUNT OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville; CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNEF_=O Yr es+ ASSESSOR PARCEL NUMBER Proposed Buil ding Use: S4e k�A) M4 1'(r -M, r(di7. Counter Technician: 1 r' Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply - 1. Plot pply.1..Plot plans, 3 or 4 sets, signed by the preparer of the plans. j 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. X ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Energy compliance design and supporting documentation in duplicate. )e6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. ❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. ;D) ReK plans in triplicate. All of these must be stamped and wet -signed by the engineer. 1' Items uired for initial plan review. If checked items have not been received, plan review cantt proceed. The per�w�ill be indexed and returned to the plan review line-up when r3,6cduplicate �eF��k t�rtrevic aeived B \JJ /PI od Elevation Certificate, wet -stamped and signed ................................ � of plan and business license approval from the City of Biggs .................................... 0�,Letter of intent for non-residential buildings......................................................... ❑ 11. Detached Accessory Building Form filled out by the owner ..................................... ❑ 12- Hazardous Material Form............................................................................... ❑ 13. Other .... Remai 'ng items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 4. Fees as shown on the attached Schedule of Fees`Due Sheet..S,ChP61 t-�",S... . 5...... ❑ 14, StaVement of Intent for Non -heated and A/C Buildings ........... M..... Cir—,#— i"citation and plot plan approval from the Environmental Health Department in ! 17. City of Chico Plumbing permit........................................................................ �j 13. California Department of Forestry plan approval ❑ paid. Sent by: ...................... ❑ 19. Planning approval for (A) Use: C K . (B)Parking: (C) Parcel Check: 01- 0 2). Contact Land Development about ❑ Improvements, ❑ Drainage ............................... d Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 22. Pre Inspection for required ................ ❑ 23. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. 5�,�025. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... Letter of Signature authorization.................................................................... . Recorded copy of Agricultural Acknowledgment Statement .................................... ❑ 28. Manufactured home utility clearance..................................................... ❑ 29. E 'sting violatio s and/or expired permits.........:. Nwr 3 rant Deed .H. Title/Statement of Facts-fxorn=-ega�0�vrier, eck to C.D. $ When issued Telephone � and hold for pickup. I have been infored of the ab a items and requirements for obtaining a building permit. r-- Aj 2 Applicant: L Date: / 2 -7/ 0 2 1. Index permit application for the above items numbered: 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ coin Plans reviewed by: Date: / ,P1kt4.approved by: St-uctural reviewed by: Date: % �J -^ f �tetural pa proved by: Note transfer by: Date: Yellow: Building Division Plan Check Letter Date: Date: Date: Date: COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965`- TELEPHONE (530) 538-7541 SCHEDULE OF FEES DUE OWNER. 1-0 Y� re- S � A.P. # 0 V — ��/�—D� D PROPOSED BUILDING USE t�_w �� n �/�' r 'ATE z f 11— �l / J 1. BUILDING PERMIT FEES RECEIPT # DATE: REC. --Balance Due ........................................................ $ / --Additional Fees Due ............................................ $ / --Additional Fees Due ............................................ $ / --Revised Plan Checking Fee ................................. $ 2. CHOOL DISTRICT FEES �3l - p� (paid at District Office) 3. SHERIFF FEES (paid at Building Division) Residential .................................... x $360.00 = $ Units 7s- -w'l'it Commercial (sq. ft.) ...................... x $0.03 = $ Sq. ft. 4. URBAN AREA FEES Residential ............................ x = $ # Units Amt. Commercial (Sq. ft.) ............. x = $ Sq. ft. Amt. 5. RECREATION DISTRICT FEES 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) J"- 7. SRA FIRE INSPECTION AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # ) $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) 10. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees may be changed during the plan checking process. FF r APPLICANT DATE J Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentionec items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original - Building Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 6/00) x t School District A.P. Number Property Owner BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) Vi OYl 1�SL. Building Department No. ��,+p��� • ��� Jurisdiction: city I County Property Location/Ac Subdivision b,k- air � Lot No. .............................................................................................................. Residential Development € Sq. Footage b ; No of Living M bile Home Addition/ 'Supplemental to (Group R) Units Installation Conversion Permit # '(No foundation inspection): Commercial/Industrial (Floor Plans reviewed by School District Personnel) Sq. Footage (Including Exterior Roofed Areas) " 1.0 Date District Identification No. 020140 Draf,11L441rin 6h School District certifies that r (Applicant) e2 llr-- (Street Address) (Phone Number) (City) has complied with the requirements of Resolution No. representing D-3?— square feet. i School District Paid by Check # � Remarks: (State) Cr (Zip Code) by payment of $ M • 61st./ AB 2926 $ FULL MITIGATION =rye Date O Y NAA l.G'kl5mor 01-1 Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is + notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. a White (applicant), Yellow (building department), Pink (school district) feeform.xls (10/98)dmm AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 caca285 Recorded Official Records 1 RE:C FEE 10.00 ! COPIES 1.50 Count Buff; Gf ! ! CANDPCE: J. MUMS ! Recorder ! ROSEi<IhRY DICKS014 ! Assistant !j=ay 01a4Ell. M 31 -pray -2002 d Page i of 2 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: Date S 1 '3 C>!p r_ State of California County of DkkA -& K"wn-te-me (or proved to me on the basis of satisfactory evidence) to be the person($) whose name() is/ane-subscribed to the within instrument and acknowledged to me that he/shelthey executed the same in his/her/their authorized capacity(", and that by his/her/their signature($) on the instrument, the person(,ti'j or the entity upon behalf of which the person(,$) acted, executed the instrument. WITNESS my hand and official seal. Signature 4;1 Ueal: KELLY J. REESON COMM. # 1336087 NOTARY P B U LIGCALIFORNIA BUTTE COUNTY A A.P. # COMM. EXP. DEC. 22, 2005'A Preliminary Report PARCEL III: CONTINUED Order No. BU -196428-3 AM :R L-Y..LII � QE:=SAID LOT 12, AS SHOWN ON THAT CERTAIN MAP ENTITLED, :4:'.�;-W�CH MAP WAS--RECO'RDED-I1V �iE. FICE OF THE RECORDER OF THE BUTTE, STATE OF CALIFORNIA, ON JUNE 8, 1887. - APN 031-281-029-000 PARCEL IV: LOTS 4, 5, 6, 7, 8 AND 9, IN BLOCK 60, AND A PORTION OF PLACER AVENUE, HERETOFORE, ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "THERMALITO", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE- 8, 1887, DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID BLOCK 60 AND RUNNING THENCE EAST ALONG THE SOUTH LINE OF THERMALITO AVENUE TO THE NORTHEAST CORNER OF LOT 4 OF SAID BLOCK 60; THENCE SOUTH ALONG THE EAST LINE OF SAID LOTS 4 AND 9, AND EXTENSION THEREOF, 355 FEET TO THE CENTERLINE OF PLACER AVENUE, HERETOFORE ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK; THENCE WEST ALONG THE CENTERLINE OF SAID AVENUE TO THE EAST LINE OF 9TH STREET; THENCE NORTH ALONG THE EAST LINE OF SAID STREET TO THE POINT OF BEGINNING. EXCEPTING THEREFROM THE FOLLOWING DESCRIBED PARCEL OF LAND: BEGINNING AT THE NORTHWEST CORNER OF SAID BLOCK 60; RUNNING THENCE EAST ALONG THE SOUTH LINE OF THERMALITO AVENUE, 122 FEET AND 8 INCHES; THENCE SOUTH A DISTANCE OF 355 FEET TO THE CENTER OF PLACER AVENUE, NOW ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK; THENCE WEST 122 FEET AND 8 INCHES TO THE EAST LINE OF NINTH STREET; THENCE NORTH ALONG THE EAST LINE OF NINTH STREET, 355 FEET TO THE POINT OF BEGINNING. ALSO EXCEPTING THEREFROM THE EASTERLY 75 FEET OF LOT 4, LYING BETWEEN PARALLEL LINES. APN 031-281-062-000 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 C®F:),Y of Document Recorded 06 -Aug -2002 2002-0040598 Has not been compared with original BUTTE COUNTY RECORDER SPACE ABOVE THIS LINE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, . INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. SAMUEL AND MARIE FORRESTER REAL PROPERTY OWNERILESSOR PO BOX 614 MAILING ADDRESS PALERMO BUTTE CA 95968 CITY COUNTY STATE ZIP 859 THERMALITO AVE. INSTALLATION MAILING ADDRESS, IF DIFFERENT OROVILLE BUTTE CA 95965 CITY COUNTY STATE ZIP SAMUEL FORRESTER UNIT OWNER (if also property owner, write "SAME") SAME MAILING ADDRESS CITY COUNTY STATE ZIP BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS . OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 02-0713 (530)538-7541 BU D G PFR.MITN TELEPHONE NUMBER 8-6-02 IG ATURE OF LOCAL AG OFFI IAL DATE a NONE DEALER NAME (if not a dealer sale, write "NONE") NONE DEALER LICENSE NO. UNIT DESCRIPTION CHAMPION 1992 INFINITY r MANUFACTURERS NAME DATE OF MANUFACTURE MODEL NAME/NUMBER 09936993602A/3 46/44 X 24 RAD650225/6 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. # 031-281-062 SEE ATTACHED HCD FORM 433(A) REV. 8/91 WHITE -County Recorder CANARY - HCD PINK - Applicant GOLDENROD -Building Dept. TOU DA11YSTIE I Ctlitt 'ICA E OP- OCCUP BUILDING PERMIT NUMBER: 02-0713 Address or location of unit: 859 THERMALITO AVE., OROVILLE, CA. 95965 Legal Description of Real Property: A.P.# 031-281-062 SEE ATTACHED (x) Mobilehome/Manufactured Home () Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health and Safety Code Section 18551. Owner's name: SAMUEL FORRESTER Owner's address: PO BOX 614, PALERMO, CA. 95968 INSIGNIA OR HUD NUMBER: RAD650225/6 SERIAL NUMBER OR V.I.N.: 09936993602A/B MANUFACTURER'S NAME: CHAMPION YEAR: 1992 OFFICIAL APPROVING INSTALLATION• ' DATE: 8-6-02 PHONE: (530) 538-7541 H.C.D. 513C Preliminary Report PARCEL III• CONTINUED Order No. BU -196428-3 AM THE NORTHERLY LINE OF SAID LOT 12, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "THERMALITO", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE 8, 1887. APN 031-281-029-000 PARCEL IV: LOTS 4, 5, 6, 7, 8 AND 9, IN BLOCK 60, AND A PORTION OF PLACER AVENUE, HERETOFORE ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK, AS SHOWN' ON THAT CERTAIN MAP ENTITLED, "THERMALITO", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE 8, 1887, DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID BLOCK 60 AND RUNNING THENCE EAST ALONG THE SOUTH LINE OF THERMALITO AVENUE TO THE NORTHEAST CORNER OF LOT 4 OF SAID BLOCK 60; THENCE SOUTH ALONG THE EAST LINE OF SAID LOTS 4 AND 9, AND EXTENSION THEREOF, 355 FEET TO THE CENTERLINE OF PLACER AVENUE, HERETOFORE ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK; THENCE WEST ALONG THE CENTERLINE OF SAID AVENUE TO THE EAST LINE OF 9TH STREET; THENCE NORTH ALONG THE EAST LINE OF SAID STREET TO THE POINT OF BEGINNING. EXCEPTING THEREFROM THE FOLLOWING DESCRIBED PARCEL OF LAND: BEGINNING AT THE NORTHWEST CORNER OF SAID BLOCK 60; RUNNING THENCE EAST ALONG THE SOUTH LINE OF THERMALITO AVENUE, 122 FEET AND 8 INCHES; THENCE SOUTH A DISTANCE OF 355 FEET TO THE CENTER OF PLACER AVENUE, NOW ABANDONED BY DEED RECORDED IN BOOK 1, PAGE 76, OF ROAD BOOK; THENCE WEST 122 FEET AND 8 INCHES TO THE EAST LINE OF NINTH STREET; THENCE NORTH ALONG THE EAST LINE OF NINTH STREET, 355 FEET TO THE POINT OF BEGINNING. ALSO EXCEPTING THEREFROM THE EASTERLY 75 FEET OF LOT 4, LYING BETWEEN PARALLEL LINES. APN 031-281-062-000 RECORDING REQUESTED BY MID VALLEY TITLE & ESCROW CO. AND WHEN RECORDED MAIL TO: SAMUEL B. FORRESTER P.O. BOX 614 PALERMO, CA 95968 ORO -C Illi "I III I III I'll I'I "II I II"I �I 2002-0023704 Recorded I REC FEE 16.80 Official Records I TAX 44.00 Cou_ nty_ Of CANDACJ. EE GRUBBSRecorder I ROSEMARY DICKSON I Assistant I Kathy 09:N8AM 89 -*ay -2002 I Page 1 of 4 Above This Line for Recorder's Use Only A.P.N.: 031-281-062,031-281-030 Order No.: 196428AM Escrow No.: 196428AM 031-281-031, 031-281-029 k GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $44.00 F/ X ] computed on full value of property conveyed, or [[ l computed on full value less value of liens or encumbrances remaining at time of sale, X ] unincorporated area; [ ] City of _, and FOR A VALUABLE CONSIDERATION, Receipt of which is hercby acknowlcdgcd, MARJORIE F. ROSE AND JAMES H. ROSE, JR., HER SON, AS JOINT TENANTS, AS TO PARCELS I,U,IH; JAMES H. ROSE, JR., A SINGLE MAN, AS TO PARCEL IV hereby GRANT(S) to SAMUEL B. FORRESTER AND MARIE FORRESTER, HUSBAND AND WIFE AS JOINT TENANTS the following described property in the UNINCORPORATED AREA, County of Butte State of California; SEE ATTACHED LEG, .L DESCRIPTION AESROSE, JR. ate: April 26, 2002 W-FINMI: ROSE STATE OFGA1W4RMA/Gw )SS JOAN F. WILLIAMS—NO RY PUBLIC COUNTY �O,F /LrC?✓Q! O►l ) 4-1 On l' / /Q U i aOd 2 before me, / ! / personally appeared/ JAMES H. ROSE, JR. personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESSmy* hand and official seal Signature 1 This area for official notarial seal. JOAN F. WILLIAMS > Commisslon Number 707951 ^mss:�•r. E 'res �. �a-o Mail Tax Statements to: SAME AS ABOVE or Address Noted Below �t 5 �41-1 STATE OF CALIFORNIA COUNTY OF BUTTE On MAY O8, 2002 before me, ANGELA D. MASTELOTTO-NOTARY PUBLIC personally appeared MARJORIE F. ROSE personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribL"d to the within instrument and acknowledged to me that livshe; they executed the same in his/her/their authorized capacity(ies). and that by his/her/their signatures) on the instrument the persons) or the entity upon behalf of which the per acted. executed the instrument. WITNESS my hand and official seal. Signatu Z.N. �+ ANGELA D. MASTELOTTO b Commission 01193929 0 V Notary Public - Calitomia Butte County co My Comm. Exp. SEPT. 16, 2002 ITh; a...a Ur oa.aw nrta„igt y..;.. Title of Document GRANT DEED Date of Document APRIL 26, 2002 No. of Pages 3 Other sign tures not acknowledged JAMES H. ROSE, JR. yCV y It '0 7, STATE OF CALIFORNIA—DEPARTMENT OF HOUSING AND COMMUNITY DFVFlnPMFNT CERTIFICATE OF TITLE MOBILEHOME DECAL NO LAU33 MA14UFACTURER NAME/ID CHAMPIGN HM BUILDERS CO/90086 TRADE NAME INFINITY MODEL INFINITY SI699C DOM 07/23/92 DOT 07/24/92 DFS 10/12/92 SPC EXPIRAT U SERIAL NUMBER I 09936993602A LABEL/INSIGNIA NUMBER RAD650225 WEIGHT 018400 LENGTH 000552 WIDTH 000142 ISSUED 01/26/93 SCC 58 x MPT USE SFD 2 09936993602B RAD650226 014780 000528 000142 TOTAL 3 FEES 5 PAID: 6 $60.00 A GREENTREE ACPT INC D 9310 TECH CENTER DR 200 D SACRAMENTO CA 95826 R E S S E R BELLFLOWER WILLIAM G/ " T E t"�f1t t lam, JTnJ rti..g,x O M $ a•. S I 4133 FEATHER RIVER BL N T L Y` E AV, 95901 E 1 ! "v w-, D EE EA*E O S 4133 FEATHER "RIVER BL W I Ya ' N T E U MARYSVILLE CA 95901,: R S G L GREENTREE ACPT' INC :::::. GqF-EN TREE;ACCEPT A TECH CENTER DR 200 L O SACRAMENTO '6' CA W ATE: 11/13/92 12:27:00 N E 2.A) R RELEASE OF LEGAL J U F N I I R O S R T L I E N S M E O C L O 0 N E D R RETENTION •OF XEGA ASSIGNMENT OF 3. RELEASE OF DEALER _ THE NEW REGISTERED OWNER., FILL IN ITEMS 4 - 9 THE , 4.A) AND OQ 9 )-g, AQ )m Cn d2 0 CS —, c NAME - PLEASE P,RrINT 54,X) -AL Ga L " C!JRRENT MAIL.T_Ng ADDRESS / CITY;'" CNTY ST ZIP CITY NEW 1ST JR. STERED OWNER;43WIATURE FILL IN ITfMS:.10 - 12 .<.... CNTY ST ZIP i FILL IN ITEMS 23 - 15 iEifiE - PLEASE PRINT ADDRESS 15. CITY CNTY STZIP >E NEW 2ND JR. LIENHOLDER, FILL IN ITEMS 16 - 18 16. li ^N PLEASE PRINT 17. U ADDRESS 18. CITY CNTY ST ZIP IMPORTANT 02-021-0 THIS CERTIFICATE OF TITLE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. 020007: 13. { q 14. STERED OWNER;43WIATURE FILL IN ITfMS:.10 - 12 .<.... CNTY ST ZIP i FILL IN ITEMS 23 - 15 iEifiE - PLEASE PRINT ADDRESS 15. CITY CNTY STZIP >E NEW 2ND JR. LIENHOLDER, FILL IN ITEMS 16 - 18 16. li ^N PLEASE PRINT 17. U ADDRESS 18. CITY CNTY ST ZIP IMPORTANT 02-021-0 THIS CERTIFICATE OF TITLE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. 020007: r k 36 707 STATE OF CALIFORNIA- DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMFNT REG15TRATION r CARD MOBILEHOME DECALNO. LAU33 MANUFACTURER NAME/10 TRADE NAME MODEL DOM DOT : DFS SPC EXPIRAT CHAMPIOP HM BUILDERS CO/90086 INFINITY INFINITY SI699C 07/23/92 07/24/92 10/12/92 U SERIAL NUMBER 09936993602A LABEL/INSIGNIA NUMBER RAD650225 WEIGHT 018400 LENGTH 000552 WIDTH 000142 ISSUEDSCC 01/26/93 58 EXEMPT SE SF� 2 099369936028 RAD650226 014780 000528 000142 TOTAL --- 3 C FEES 5 PAID. 6 $60.00 A GREENTREE ACPT INC D 9310 TECH CENTER DR 200 D SACRAMENTO CA 95826 R E S S E i " R BELLFLOWER WILLIAM G/ a E MARY C JTRS G M I A 4133 FEATHER RIVER BL T s I T L V E MARYSVILLE " CA 95901 R O s 4133 FEATHER RIVER:BL w I s N T&a S E U KVYSVILLE CA 95901 ,. == ........... R S ............. a < ' M .._.....:... L GREENTREE ACPT INC :.:.:...:` .:.::: 3 a E -.c:,..... ........ ...-' A 9310 TECH CENTER DR 200 L i f O SACRAMENTO CA 95826 f w DATE: 11/13/92 12:27:00< f R J U F N I I R.. O S R T ALEGAL OWNER COPY IN ORMAtI,ON ONLY �q �z 2}�a,. .es i� ',2 L I E N S M E O C L O O N E D R IMPORTANT 02-021-( THE OWNER INFORMATION SHOWN ABOVE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT .i TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. 020007° _ i OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES 18 NO 0 C2) I HAVE 1& HAVE NOT E3 signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: DRESS: CM: PHbYE: CONTRACTOR'S LICENSE NO. 4. I plan to pr vide portions of this work, but I have hired the following person to supervise, and -provide the major work: NAME: ADDRESS: PHONE: C 5. I will provide some of the work but I have the work indicated: NAME ADDRESS SIGNED: PROPERTYOWNER: CITY: -� y OR'S LICENSE NO. racted (hired) the following persons to provide PHO TYPE OF WORK SOCIAL SECURITY NUMBER: (/ -- DATE: 2-7/ o 2 NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit OVER OWNER BUILDER INFORMATION I ] Dear Property Owner' An application for a building permit has been submitted in your name listing yourself as the builder of properly improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible parry of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors. then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, X�, IM el C. Vi ira, C.B.O. ger, Building Inspection NO TF: This Owner -Builder Information is required by Section 19830 of die CaUfa rnla Health and Safety Code- OVER oda OVER SITE PLAN REVIEW APPLICATION Date: O3 - 'n - O 2 Permit Number (if applicable) D Z" O�) AP# 031- Z81 -0 6'Z APPLICANT INFORMATION Parcel Size: t A C Owners Name: Owners Address: PA1-GgAv,p CA '9S")C F Telephone No.: Situs Address: -7H G_-)Zm—n Lrrt> A V'&_ Proposed Use: Residential ❑ New Single Family Residential ❑ Single Family Addition it Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Ntulti-family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) a Approved ❑ Conditionally Approved ® Site Plan Stamped Approved By L.P ❑ Resolve Problems Prior to Appro,,W Date `3-= Z-$ - ©`Z Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: • Flood Panel No.: 0"7 9 0 C, Index Date: 9 ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mu I berry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance ------------------------------------------------------------------------------------------------- ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: A-2 Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front p Side Side Street Rear Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Applicable Development Fees: , Standard Fees Amount ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road IN Thermalito Impact ❑ Other Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) Formula * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By K Deeds: Date of Creation: 19 S� Legal Access Provided: ❑ No ® Yes Deed of Reference: Legal Access Required M No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ® Yes, Road Name: -T'H13Zrr PkL TcS AA Complies with County Standards for Deed Creation: ❑ No ❑ Yes Comments: Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger . ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 ❑ Subdivision iVlap/Parcel Map: Map Date of Recording: Lot: Book: Page: ❑ Use Permit/Miinor Use Permit Permit Number: Date of Approval: ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance on slopes steeper than 30%. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ A plan prepared by a certified arborist, botanist or landscape architect that shows the existing on-site mature trees, located in any area proposed for buildings and vehicular access, and provides for methods to protect the trees identified to be preserved, shall be provided to and approved by the Planning Division prior to the issuance of building permits and/or prior to grading or vegetation removal. The removal of mature trees shall be minimized, where possible. A mature tree shall be defined as a tree with a trunk measuring 4 inches in diameter, 4 feet from ground level. Mature trees removed shall be replaced on a 3 -to -1 ratio, utilizing existing oak tree stock. Each tree to be preserved shall be surrounded by a circular zone (minimum 40 -foot radius) identified by an orange fence during construction activities. No vegetation removal, soil disturbance, or other development activities shall occur within the fenced area. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. Page 4 of 5 a n a u Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CAMy Documentt\Building Permit Site Plan Reviewl.doc Page 5 of 5 :e�rgBuB� p, :BuOmPuBI -:Bind [I'VAOUddY NVId ONI°IUtB -NOISIAI° ONINNV Id 48 SL Qr V) ci o O- of cr Q- E #j Q uj Cf Qr V) COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541P,�RM1T NO. (Rev. 12/96) APPLICATION AND PERMIT � l��J ASSESSOR PARCEL NUMBER 031-281-062 ZONING AR BUILDING PERMIT OWNER FORRESTER SAM TELEPHONE 218-709972 SO. FT. OCC. BUILDING VALUATION 0 50'x.00 OWNERS MAILING ADDRESS P.O. BOX 614 PALERMO CA 95968 CONTRACTORS NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDERS MAIUNG ADDRESS Total Valuation Is 504.00 ARCHITECT OR ENGINEER LICENSE NO. Fee $ 20.00 —Filing Permit Fee $ 17.0 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 2 BUILDING ADDRESS 859 THERMALITO AVE. OROVILLE CA 95965 Energy Plan Checking Fee $ $ PERMIT FEE $ 60.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome )0 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 IR Describe Work: NEW OPEN DECK 6 X 12 Gas piping system 1- 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling FeE 20.00 Main Service pp.AORLESS 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.PSINGLE License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: .;Q, 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 To 46.00 WEE200A NEW CONST. DWELLING OCC P. CC OR ACC.- sr. ( 3.5¢� uBLDDS EW cor M NON-RESID. @7.5C 8 OUTLET COWER APPARATUs IR. Ex. Occup. OUTLET OR FIXTURES 20 @ 1'00. SAL @ .50 Ex. Occup. oF"X S AaDOE 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 permitis issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing 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.) 39 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 �� thwith comp) with those provisions. f.� Date 'LS C� Signature of App Icant - ❑ 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 Is Energy Inspection Fee $ occ LCONMST. TYPE TOTAL FEE $ 60.00 Po HD MSU IN 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. // �3 Gi By Date EXPIRES ON Z �3 Date ReceiptNo.PERMIT WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT . COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 'ERMIT N (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONNO o - �/ -- v 6 a Al� BUILDING PERMIT OWNER TELV44ONE d21 7�� SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS O CONTRACTOR'S NAME TELE7NONE NEW CONST: ( OR ADDNS. s 3 t< I 3.50 SO Ft. i CONTRACTORS MAIUNO ADDRESS MULTFO .L NSTRUCTION LENDER NDER'S MNUNG ADDRESS Fireplace — CHrTECT OR ENGINEER LICENSE NO. Total Valuation S Filing Fee I $ 20.00 C -'ECT OR ENGINEERS MAILING ADDRESSE Permit Fee $ 7r 0 BUILDING ADDRESS Plan Checking Fee $ 2 3 . o D Energy Plan Checking Fee $ $ LOT NO. SUBDWLSIOWS NAME PARCEL MAP _ PERMIT FEE S - s PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE 1 `� /�� Each Tre 7.001 SF ❑ Duplex O Mobilehome t F Other Solar or heat u ater heater 23.00: Water piping15.00 sPEcsv TYPE OF WORK Each as water heater or vent 15.001 New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Gas piping stem 1 - 5 outlets 5.00 ryry � Describe Work: / ChJC� Buildingsewer j 15. S G V� j Mobile Home W @20.001 SRA O 44Ktje- C ��li1�tC� 00 !Rocie. W&M Ab C4" "hy- Ex. Occup. OUTLET OR FDRURES PERMIT FEE 1 $ EX. Occu ZED APPLNS. OR OUTLETS ESID) EA ELECTRICAL PERMIT Fling Feel 20.00 Main Seryl OODV ORLESS 200A OR LESS23.001 H 20 00, Main Service To 1000A 46.00 NEW CONST: ( OR ADDNS. a AOC OCC UP. I 3.50 SO Ft. i ONS NON•RE41D. MULTFO .L 1 97.501 Ex. Occup. OUTLET OR FDRURES I 20 BAL SO ' EX. Occu ZED APPLNS. OR OUTLETS ESID) EA 1 5.001 Temporary Service1 23.00 Mobile Home Facilities 20 00, Misc. Wiring 23.001 PERMIT FEE S MECHANICAL PERMIT Fling Fee 1 20.00 Heatin Cooling Hood 1 6.501 PERMIT FEIE S Mobile Home Installation Fee $ Energy Inspection Fee $ OCD CONST. TYPE TO AL FEE $ NAZ. I D. FEES I !V7 I RJQA I COF I 64CEL 1 ° , HD I ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work Indicated above for which fees have been paid. By PERMIT EXPIRES ON Date COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: �?(C�/i_:2� ASSESSOR PARCEL NUMBER Proposed Building Use: D a-ke Counter Technician: Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. <--L-. Plot plans, 3 or 4 sets, signed),&y the preparer of the plans. -4Z:2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Energy compliance design and supporting documentation in duplicate. ❑ 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. ❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The.permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................ ❑ 9. Plot plan and business license approval from the City of Biggs .................................... ❑ 10. Letter of intent for non-residential buildings......................................................:.. ❑ 11. Detached Accessory Building Form filled out by the owner ..................................... ❑ 12. Hazardous Material Form............................................................................... ❑ 13. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 14. Fees as shown on the attached Schedule of Fees Due Sheet ....................................... ❑ 15. Statement of Intent for Non -heated and A/C Buildings .......................... `......... ....... 35 16. Sanitation and plot plan approval;from the Environmental Health Department in ❑ 17. City of Chico Plumbing permit......................................................................... ❑ 18. California Department of Forestry plan approval ❑ paid. Sent_ by: ...................... ❑ 19. Planning approval for (A) Use: a K (B)Parking: . (C) Parcel Check: arL ❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage .............................. ❑ 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 22. Pre -Inspection for required ................ ❑ 23. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. ❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... ❑ 26. Letter of Signature authorization.................................................................... ❑ 27. Recorded copy of Agricultural Acknowledgment Statement .................................... ❑ 28. Manufactured home utility clearance............................................................... ❑ 29. Existing violations and/or expired permits......................................................... ❑ 30. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 31. Other: When issued Telephone U and hold for pickup. I have been inf med of the above �����taininga building permit. Applicant: �.,Date: -71I07- 1. Index permit application for the above items numbered 2. Additional items required Contractor, designer, owner, was advised cf the above data by Contractor, designer, owner, was advised of the above data by Plans reviewed by: Date: Structural reviewed by: Date: Note transfer by: Date: Plan Check Letter ❑ phone, ❑ mail, ❑ counter, by Date: _ ❑ phone, ❑ .mail, ❑ counter by Date: _ Plans approved by: / Date: _Structural approved by: Date: Yellow: Buildine Division A, �•'`I• pat -'2 81 • O(. 9 D+7lLESS TNE4MAL.1 To Dkqj.- Y. Jam. fP' M. .218- 708.5 ING DIVISION- BUILDING. PLAN APPROVAL '' is E R rn A L f To /} �/ K Date: ��'/i" 0 -2-7 ' , :-----_ Landscaping: LOther- f - SIgre: Ib A 1 Ia N .1 I 1 ^ k o I A ALL ZTRUCTURE6 AND EQUIPMENT INCLUDING 3 I , OVFPHANGS SHALL BE CLEAR OF ALL EASEMENTS' ca I A SET BACK OF S FT. FROM THE SIDE AND .s FT. FROM THE REAR PROPEMY LINES AW. ca, SLEO FT. FROM THE ROAD CENTERLINE SHALL BE AD OF STRICTURES AND EOUIPMENT EXCEPT u 1 I FOR A S FT. EB� A E OVERHA. j r lil � w BUTTE COU N -TY DEPARTMEN o �� .3UILDING ppC� \% E D _ C ZZ• o �. r/ �y ,�— f, Ti G PLYWOOD CC EYT. .,J Z`.1 u 401fv DF*2 2.,%G. DECKING (ALT) GIRDERS .I Ya" TIG PLYWOOD CC EXT. / �r CrUARDRAIL i qr MAX. PRECA .PIER DECKIUG �o r MHS 14".14.' MIN. F"0o7' I NG 48". MAX. GIRDER X r d r� 4.09 V FRMIJG. CLIP = _ q")W MOBILE HOME OR DECK I zo -- 7' x 12" STAIR STRINGEIZ. 4B'o.c,. MAX. 70P VIEW H AIJDQAIL NOT SHOWN FOR CLAR(TY. r 3/g� BOLT LM MAXMTI. FRKCL1P (EA. • .. 4% G. 4'x4' POST 2'x 12" OWF. (2) 3/e. err. DOLTS Z 4'x9" POST ADL'QU4TE DIA60NAI. 13RACING. %o r - w a 20-7'7 BUTTE COUNTY y•MI INN, DEPARTME „ %Mpp0VFr x i0 Z 2",(4" PRESSURE" 7RfAT-rl' eR /I-'RFDWOOD PI.A7F. T YP►CAL R - SI nz AMM. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville. California 95965