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B07-0752 038.190-002
MISCELLANEOUS HVAC Change Out
HVAC REDUCT
9007 STANFORD LN
LUCAS, RAY T & LINDA SUE
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address: 9007 STANFORD LN
Owner:
Permit No: B07-0752
APN: 038-190-002
LUCAS,
RAY T & LINDA SUE
Issued Date: 04/10/2007 By GLB
Permit type: MISCELLANEOUS
9007 STANFORD LN
Subtype: HVAC Change Out
DURHAM, CA 95938
Expiration Date: 04/09/2008
Description: HVAC REDUCT
Occupancy: Zoning: A5
Contractor
Applicant:
Square Footage:
GALLAGHER'S HEATING & AIR
GALLAGHER'S HEATING &,
Building Garage Remdl/Addn
PO BOX 35
PO BOX 35
LOS MOLINOS, CA 96055
LOS MOLINOS, CA 96055
(530)384-2444
(530)384-2444
Other Porch/Patio Total
FEE INFORMATION
DBM Heat Pump (Package Unit) $55.00
Total Charged: $55.00 Fees Paid: $55.00
Balance Due: $0.00 Receipt No: B2580
LICENSED CONTRACTOR'S DECLARATION
OWNER / BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
GALLAGHER'S HEATING & AIF 777334 / C20 C38 / 04/30/2008
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a 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
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
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
is in f force and ffect
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
X
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil of not more than five hundred dollars
04/10/2007
penalty ($500];
Please check one of the following:
C factors Ignature Date
❑ 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 (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
HAVE AND WILL
the work himself or herself or through his or her own employees, provided that such improvements
❑I MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not intended or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of completion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
improve for the purpose of sale.).
,I f HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Imo[
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractor's License Law dows not apply to an owner of the property who builds or improves
My Workers' Compensation insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
State Fund 713-0013855 ExpDate: 05/01/2007
Policy olicy Number: .
Contractor's License Law.).
(This section nee not be completed if the permit is or one un red dollars ($100) or less.
❑ I AM EXEMPT under Section B. & P.C. for this reason:
❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
X 04/10/2007
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owner's Signature Date
provisions.
X 04/10/2007
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
5 ure Date
WARNING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnity, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
o arty ort r r aul orized to a on the pr arty o rs bah If.
04/10/2007
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
ame off 6hmittee (SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
❑ Owner 0 Contractor OR DAgent for Owner ElAgent for Contractor
FILE COPY
Lender's Address City State Zip
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICATION
"PLEASE PRINT CLEARLY"
CONTRACTOR
OWNER
Last Name
U C_ qss
irst Name Q.
Address
00 Sfa1 Vl Fr La
City
r
State
Zip
Phone
Fax
Fax
E-mail
State License Number
CONTRACTOR
Name 670—[La4U /t
Address 1pO O�
City >i_S 616 ( t ViCS
r 1
State
C
d
-Phone
(fVP
-Fax
E-mail
Lic."77 733 4
Phone
For office use I :
ARCHITECT/ENGINEER
Name
4+V..><
Address
C
d
City
Lot #
State
Zip
Phone
—Name
Fax
E-mail
State License Number
For office use I :
APPLICANIlT}} NAME
Namvia
4+V..><
Address Po
r
C
d
City
Lot #
State0/ ►
/�
Zip
Phone
—Name
Fax
E-mail
For office use I :
Zoning Flood Zone SRA Yes No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BP •
BIN #
LOCATION
Property Address
60 ' rj Ljol
flity
31ky-bo
Cross Street
WORKER'S COMPENSATION
Policy Number . I ` 00 k5as 5
Carrier S�JF
'Lt^^
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
SMIP
LENDING AGENCY
—Name
Address
R_- �b Description or Scope of Work:
�2 c�UL c;t a l dl Q. rc'
Sq. Footage
❑ 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
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.
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
REV 7-27-04
Received by: Amount:
Bldg
SRA
Receipt #:
Sheriff
SMIP
Date:
Other
Total
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INiC
❑
1.
Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑
2.
Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑
3.
Engineered truss details and layouts in duplicate (if required). No faxesl
❑
4.
Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑
5.
Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑
6.
Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑
7.
Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑
8.
Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑
9.
Site 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 (if required).
❑
12.
Hazardous Material Form (for Commercial Buildings only).
0_1.3 Sanitation_and-site_plan_appr_ov.aiJrom the-Envir_onmentaLHealth-Department.
Remaining
items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May
require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538.7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
DROP BOX COVER SHEET
All of the following information must be completed. Writing must
be legible.
Date: Q
Assessor's Parcel Number:
Owner and/or Applicant:
Permit/Application Number:
E -Mail Address:
Contact Phone Number: VA &4e ba— -F -5
Directed to (Staff Person): _
_ J
off- 20 �(
BUTTE
COUNTY
OCT 14 21004
%FVFIrn,DMv.NT
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1.7.
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNER'S NAME
RAY LUCAS
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
9007 STANFORD
O.M.B. No. 3067-0077
Expires December 31, 200;
For Insurance Company Use:
Policy Number
Company
CITY STATE ZIP CODE
DURHAM CA 95938
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
APN: 038-190-002
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
New Residential Structure
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type):
( ##° - ##' - ##.#N' or ##.######°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
BUTTE COUNTY, & INCORP. AREAS 060017 BUTTE COUNTY CA
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX DATE
B7. FIRM PANEL
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
NUMBER
co
o c) Bottom of lowest horizontal structural member (V zones only)
EFFECTIVEIREVISED DATE
o 0
(Zone A0, use depth of flooding)
06007CO520
C
SEPT. 29,1989
JUNE 8,1998
AE
144.6
B1 u. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: Z NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date PN/A
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3. -a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used RM 58 Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No
o a) Top of bottom floor (including basement or enclosure)
See Comments. _ft(m)
co
o b) Top of next higher floor
146.1 ft.(m)
co
o c) Bottom of lowest horizontal structural member (V zones only)
N/A.
o 0
o d) Attached garage (top of slab)
_fL(m)
NIA,. _t(m)
E g
o e) Lowest elevation of machinery and/or equipment
W cc
servicing the building (Describe in a Comments area)
145.3 ft(m)
a
o t) Lowest adjacent (finished) grade (LAG)
144.0 fL(m)
Z.2)
o g) Highest adjacent (finished) grade (HAG)
144.0 fL(m)
o h) No. of permanent openings (flood vents) within 1 ft above adjacent grade 24
o i) Total area of all permanent openings (flood vents) In C3.h 1640 sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
ROBERT G. AGEE. JR. RCE 27647
TITLE COMPANY NAME
Civil Engineer `, SIERRA WEST SURVEYING.
ADDRESS CITY STATE ZIP CODE
5437 BLACK OLIVE DRIVE PARADISE CA 96969
SIGNATURE
DATE
SEPT 15, 2004
TELEPHONE
(530) 877-6253
FEMA Form 81-31, January 2003 A (lee reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
BI JILDING STREET ADDRESS (Including Apt, Unit, SuiL-, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. P0cy Number
,9007 Stanford Lane
yr CITY STATE ZIP CODE Company NAIC Number
DURHAM CA 95938
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent(company, and (3) building owner.
COMMENTS
C3a) The lowest elevation under the crawl space is 144.0 feet NGVD.
C3e) The lowest elevation of the machinery and/or equipment servicing the building is the air conditioning compressor unit at 145.3 feet NGVD.
The area of the enclosure is 1640 square
BENCH MARK on site, nail in PP north edge driveway. Elevation =144.23'
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately
represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E3. For Building Diagrams 6-8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4. The top of the platform of machinery'and/or equipment servicing the building is _ t(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E5. For Zone AO only: If no flood depth number is available, is the top of the boftom floor elevated in accordance with the community s floodplain management ordinance?
❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA4ssued or community -
issued BFE) or Zone AO must sign here. -The statements in Sections A, B, Q and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑ Check here 'If attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community s floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation
Certificate. Complete the applicable item(s) and sign below.
G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or communiity4ssued BFE) or Zone A0.
G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: — -ft(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: - _ . _ fL(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
FEMA Form 81-31, January 2003 Replaces all previous editions
DROP BOX COVER SHEET
All of the following information must be completed. Writing must
be legible.
Date: all
Assessor's Parcel Number: O —0 O
Owner and/or Applicant: &V L. U G
Permit/Application Number:
E -Mail Address:
Contact Phone Number: Sl &-R 9Je,-5_-r
Directed to (Staff Person): FpjLY3j/(/46erson)
B10. Indicate the source of the Base Flood Bevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Dcennined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: Z NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date PWA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ® Construction Drawings' . ❑ Building Under Construction' ❑ Finished Construction
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations—Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, ARIA1-A30, AR/AH, AR/AO
Complete Items C3. -a4 below according to the bullring diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurarnarnfs and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used RM 58 Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No
o a) Top of bottom floor (induding basement or enclosure)
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
O.M.B. No. 3067-0077
Expires December 31, 200'r-
00;ELEVATION
B6. FIRM INDEX DATE
ELEVATIONCERTIFICATE
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
Important: Read the instructions on pages 1- 7.
NUMBER
SECTION A - PROPERTY OWNER INFORMATION
EFFECTIVEIREMSED DATE
For Irsuranoe Company Use:
BUILDING OWNER'S NAME
o g) Highest adjacent (finished) grade (HAG)
06W7C0520
Policy Number
RAY LUCAS
JUNE 8,1998
AE
144.6
BUILDING STREET ADDRESS (including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
Company NAIC Number
9007 STANFORD
CITY
STATE
ZIP CODE
DURHAM
CA
95938
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
APN: 038-190-002
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
New Residential Structure
LATITUDE/LONGITUDE (OPTIONAL)
HORIZONTAL DATUM: SOURCE:
Cj GPS (Type):
( 011P - #N - ##.##" or
❑ NAD 1927 ❑ NAD 1983
❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
BZ COUNTY NAME
B3. STATE
BUTTE COUNTY, & INCORP. AREAS
060017
BUTTE COUNTY
CA
B10. Indicate the source of the Base Flood Bevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Dcennined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: Z NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date PWA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ® Construction Drawings' . ❑ Building Under Construction' ❑ Finished Construction
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations—Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, ARIA1-A30, AR/AH, AR/AO
Complete Items C3. -a4 below according to the bullring diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurarnarnfs and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used RM 58 Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No
o a) Top of bottom floor (induding basement or enclosure)
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX DATE
B7. FIRM PANEL
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
NIA. _ft.(m)
NUMBER
servicing the building (Describe in a Comments area)
EFFECTIVEIREMSED DATE
o f) Lowest adjacent (finished) grade (LAG)
(Zane A0, use depth offlo N)
o g) Highest adjacent (finished) grade (HAG)
06W7C0520
C
SEPT. 29,1989
JUNE 8,1998
AE
144.6
B10. Indicate the source of the Base Flood Bevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Dcennined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: Z NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date PWA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ® Construction Drawings' . ❑ Building Under Construction' ❑ Finished Construction
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations—Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, ARIA1-A30, AR/AH, AR/AO
Complete Items C3. -a4 below according to the bullring diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurarnarnfs and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used RM 58 Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No
o a) Top of bottom floor (induding basement or enclosure)
See Comments. _R(m)
o b) Top of next higher floor
146.1 ft.(m)
o c) Botom of lowest horizontal structural member (V zones only)
NIA. _fL(m)
o d) Attached garage (top of slab)
NIA. _ft.(m)
o e) Lowest elevation of machinery and/or equipment
servicing the building (Describe in a Comments area)
145.3 ft.(m)
o f) Lowest adjacent (finished) grade (LAG)
144.0 ft.(m)
o g) Highest adjacent (finished) grade (HAG)
144.0 ft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 24
o i) Total area of all permanent openings (flood vents) in C3.h 1640 sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
1 certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME LICENSE NUMBER
ROBERT G. AGES JR RCE 27647
TITLE COMPANY NAME
Civil Engineer SIERRA WEST SURVEYING.
ADDRESS CITY STATE ZJP CODE
5437 BLACK OLIVE DRIVE Al PARADISE CA 96969
SIGNATURE DATE TELEPHONE
/'I- SEPT 15, 2004 (530) 877-0253
FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions
SS1CO
0s=2764737EizNF
(No.
CA�-�F
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
1 certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME LICENSE NUMBER
ROBERT G. AGES JR RCE 27647
TITLE COMPANY NAME
Civil Engineer SIERRA WEST SURVEYING.
ADDRESS CITY STATE ZJP CODE
5437 BLACK OLIVE DRIVE Al PARADISE CA 96969
SIGNATURE DATE TELEPHONE
/'I- SEPT 15, 2004 (530) 877-0253
FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A For Innanoe Company Use:
BU ING STREET ADDRESS (Indudug Apt, Unit Suite, ardor Bldg. No.) OR P.O. ROUTE AND BOX NO. Pobj Number
9007 Stanford Lane
CITY STATE ZIP CODE Company NAIC Number
DURHAM CA 95938
SECTION D - SURVEYOR, ENGINEER, OR ARCHRECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
C3a) The lowest elevation under the cxawl space is 144.0 feet NGVD.
C3e) The lowest elevation of the machinery and/or equipment servicing the building is the air conditioning compressor unit at 145.3 feet NGVD.
The area of the enclosure is 1640 square feet
BENCH MARK on site, nail in PP north edge driveway. Elevation =144.23'
❑ Check here 'If attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (INtTHOUT BFE)
For Zone AO and Zone A (withocrt BFE), complete Item E1 through E4. If the Elevation Certificate is intended for use as supporflng information for a LOMA or LOMR-F,
Section C must be eorpleted.
E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. ff no diagram amurately
rests the Wi ing, provide a sketch or photograph.)
E2. The tap of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(c m) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E3. For Bunking Diagrams 68 with openings (seepage 7), the Wend higher floor or elevated floor (elevation b) of the building is _ ft(m) _in.(crn) above the highest adjacent
grade. Complete item C3.h and C3.D on front of form.
E4. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in.(crn) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E5. For Zone A0 only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the oommunitt/s floodplain management ordinance?
❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Seton G.
SECTION F - PROPERTY OWNER (OR OWNER'S REF RES HAMP CII3tiFICATIION
The property owner or ods aultmmd representative whom, Sections A. B, C (Items C3b and C3j oxiy), and E iorZoxne A (nxflhouta FEMAtsuW oroarrmu *,
iissauedBMorZcwAOmstsignhere 7heswane*inSeCUDWAAQandEarecarredtofhebed ofmykmowledge.
-•,T:-' ,STT rim (1• � ,r- (1-��i� -��--1 �� ��L
ADDRESS CITY STATE ZIPCODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑ Check here if attachments
=TION G - COMMUNITY INFORMATION (OPf10NAL)
The bat dkiai who is alhAW by k worad is b administer Ore oormrutl>✓s floodplain management ordnance can co rplete Sections A, B, C (or E), and G of this Elevation
Certificate. Complete the applicable item(s) and sign below.
G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA4ssued or oommunitymissued BFE) or Zone A0.
G3. ❑ The following information (Item G4 -G9) is provided for community floodplain management purposes.
PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: — ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ . _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
TURE DATE
COMMENTS
FEMA Form 81-31, January 2003 Replaces all previous editions
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
i` NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200E
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1- 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
RAY LUCAS
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
9007 STANFORD
CITY STATE ZIP CODE
DURHAM CA 95938
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
APN: 038-190-002
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, f necessary.)
New Residential Structure
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type):
( #M° - ##' - ##.#1R' or ##.#####) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
BUTTE COUNTY, & INCORP. AREAS 060017 1 BUTTE COUNTY I CA
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX DATE
B7. FIRM PANEL
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
NUMBER
EFFECTIVEIREMSED DATE
(Zone A0, use depth of floc ft
06007CO520
C
SEPT. 29,1989
JUNE 8,1998
AE
144.6
B10. Indicate the source of the Base Flood Elevation (BFE) data or base food depth entered in B9.
❑ FIS Profile N FIRM ❑ Community Determined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: N NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _
B12. Is the building looted in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date PWA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: N Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 430, V (with BRE), AR, ARIA, ARIAS, AR/A1-A30, ARIAH, AR/AO
Complete Item C3. -ami below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BRE in
Section B, convert the datum to that used for the BRE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used RM 58 Does the elevation reference mark used appear on the FIRM? ❑ Yes N No(No.
ESS/p
o a) Top of bottom floor (including basement o enclosure) See Comments.
o b) Top of next higher floor
_ft(m)
146.1 ft(m)
v.
'Ao
c) Bottom of lowest horizontal structural member (V zones only)
d) Attached garage (top of slab)
WA. ft.(m)oo
NIA. ft(m)
Eo
e) Lowest elevation of machinery andlor equipment
u,
servicing the building (Describe in a Comments area)
f)
145.3 ft.(m)
E
27647
o Lowest adjacent (finished) grade (LAG)
144.0ft.(m)
zIo
g) Highest adjacent (finished) grade (HAG)
144.0fL(m)
CIVko
h) No. of permanent openings (flood vents) within 1 it above adjacent grade 24
C
o i) Total area of all permanent openings (flood vents) in C3.h 1640 sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001.
CERTIFIERS NAME LICENSE NUMBER
ROBERT G. AGEE A RCE 27647
TITLE COMPANY NAME
Civil Engineer SIERRA WEST SURVEYING.
ADDRESS CITY STATE ZIP CODE
5437 BLACK OLIVE PARADISE CA 96969
SIGNATURE DATE TELEPHONE
SEPT 15, 2004 (530) 877-0253
FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insuranoe Company Use:
BUILDING STREET%DDRESS (Including Apt, Unit, Suite, ar>dlor d9. No.) OR P.O. ROUTE AND BOX NO. Policy Number
9007 Stanford Lane
CITY STATE ZIP CODE Company NAIC Number
DURHAM CA 95938
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certficate for (1) community official, (2) insurance agerNoompany, and (3) building owner.
COMMENTS
The lowest elevation under the crawl soace is 144.0 feet NGVD.
Cie) The lowest elevation of the machinery and/or equipment servicing the building is the air conditioning compressor unit at 145.3 feet NGVD.
The area of the enclosure is 1640 square feet
BENCH MARK on site, nail in PP north edge driven ay. Elevation =144.23'
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zane A (without BFE), complete items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be oornpleted.
E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram aocurately
represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, 'rf available).
E3. For Building Diagram 6-8 with openings (seepage 7), the next higherf oor a elevated floor (elevation b) of the building is _ it(m) _in.(an) above the highest adjacent
grade. Complete item C3.h and C3.i on fnxnt of form.
E4. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in.(an) ❑ above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?
❑ Yes ❑ No ❑ Unknown. The local. official must certfy this information in Seton G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The properly owner or owners authorized representative who completes Sections A, B, C (item C3.h and C3.i only), and E for Zone A (without a FEMAfssued or corr ty-
wied BFE) or Zane AO must sign here The statements in Sem A A C, and E are oared to the best ofmy larowledge.
PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authored by law oronfnance to administer the commu*s; floodplain management oninance can complete Sections A, B. C (a E), and G of this Elevation
Certificate. Complete the applicable Rem(s) and sign below.
G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMAassued or oommunity4ssued BFE) or Zone A0.
G3. ❑ The following information (Item GA -G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER I G5. DATE PERMrr ISSUED I G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: — ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ . _ ft(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
FEMA Form 81-31, January 2003 Replaces all previous editions