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Home My WebLink About039-260-064039-260-064' 06-1872- " FORD Ax 4058 ORD FERRY RD, CHICO Cont: MCCLELLAND AIR f HVAC- •/L,, . � /U —f � --D�, • i 1 � r I F r NOTES r039-260-064 06-1872 °., FORD"nnE. a y 4658'ORD FERRY RD, CHICO Cont: MCCLELLAND.AIR �' i � . . �o�>. HVAC { t' RESIDENTIAL APN: Permit No. r Owner. ;r Site Address: }Contractor. Type of Permit DATE JOB SIGNATURE: CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE e =Nat RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR - 1 Zoning -Setbacks -Easements -Flood -Slope 2 Ftg Main; Soils-Elec Grnd Ftg Dpth 3 Ftg Garage; Soils-Steel-Elec Grnd . Ftg Dpth 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 5 Stemwalls Main; Steel-Biockouts Wrapped 6'Stemwalis Garage; Steel-Biockouts-Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Si Test 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12 Elec Undrgmd 13' Plenums & Ducts; Cirnc-MaterialSupportansultn 14 GirdersSills-SillsBoltsJoists Vnts-Cripples 15 Ace & VnUtn 16 Insulation DATE jFrRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs -Nailing SPacirig & Braces-PlatesSound 19 Bearing Walls over Girders:& fir Nailing 20 Draft Stop In Walls (rat proof) 21 Fire Stops; F-rirrA CeifingsStairs-DhasersTutu 22 Headers & Be"—iS ! &•Bearing• 23 Hangers••P•osf•Caps Anchrs.Cnnctru 24 Ceiling JoW. 411tr T-jes-PurfliRoof Brac 1 nusShfhg 25 Frplc Ties or Type A Flue=F • Ic Throat Cimc 26 Attic Act; Sz &'Riaz 'd*t b6ft Stop -Ins Baffles 27 Bdnn Wndws or Exiting Doors -SIR (it & Dimensions 28 Garage Fire Pricbi Framing -RC Clrarinel 29 Prprty Line Firewall & Opngs' . 30 Ext DoorsAne 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; W -H idthdrm-Rise-Run4:anding-Fire Prtctn 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 33 Siding-Naifing Veneer 34 Stucco Lath Weep Screed-Fndtn Vnts-Undrfir Ace 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Wall psis 38 Insultn-W ails -Ceilings 39 Infiltration Walls-Wndws o` �`P 4s DATE JELECTRICAL 40 Fxtr & Tmsfrmr Clrnc-Ins Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex installed Close to Edge of Studs & CJ 44 Eqp Gmd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires In Kichn & Cndcir Sz GFl 47 Subfeed Wire Sz tta 0 c or DAL AC Wire Sz ga Elm or DAL 48 Range Circ Qa DCUorQAL Oven Circ oa Q CU or F1 AL Insulated Neutral Dyes ❑No 49 Service -Riser Cndctrs & Gmd Main Dsennct 50 Eqp Clmcs pnis-Motors-Meth Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector Uwit (PLUMBING - 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr•Hafl Pttctrt 56 Shwr Pan; Test, First fir -Tub Ace 57 Test Tubi & Shwr, 2nd fir - Tub Ace. 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas Piping DATE MECHANICAL 61 AC Ducts Insults & Support 62 Vent Fan, Exhaust abv Insulin 63 Condensate Drain & Ovrilw, Sz & Grade 64 Furnace -Vent Acc-Comb Air RbWent 115 Outlet 65 Attic Ace & Pltfrin if Furnace In attic DATE FINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr In Garage; abv-fir-Duds-Meth Prtctn 69 Bedroom Exiting 70 GFl 8 Bath Fxtrs & Tub Ace -Spa 71 GFl Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Cimc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Grnd Air -Gap -Cooking Cimc 77 Elec Outlets & Rcptcls a4 Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct In Garage -Damper. 80 Wtr Htr Vnts-DImc-Com Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Plmb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcls in Garage (GFQ Romex Prtctn 83 Insults -Foam -looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 Cimc Drnge Planters Q Yes ❑ No 87 Stucco Brown -Finish 88 AC Unit Dscnnet, Elec-Pimb 89 Vnts abv Roof, PlmbAppinc-Frpic-Cimc to Opngs 90 Wtr Well, Dscnnct, Elea Pimb 91 Ext Elec Trim, GFl Rcptcl-Undrgmd 92 Vntltn thru House 93 Glass Prtctn 94 Corrections from previous Irispctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler a'`' O`er` o,`• sa d +=OK 0 = Not MANUFACTURED HOMES DATE U PERMANENT FOUNDATION U SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Lorin Test; FaIUC/0-Concrete 4 Wtr; Loctn Test-Easeinent Needed -Regulator 5 Elec Loctn-Clrncs-Gmd • Amp -Concrete 6 Yard Gas; Loctn Test -Wrap Nat ❑ or LPQ Inch Sz Ft Lngth 7 Blckng; SzSpadng-Marriage Line 8 Gas; MH Test -Demand Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clmcs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -CIO to Grade 12 Gas and Electricity Tagged 13 Tie Downs Q Foundation Q 14 Exits 15 Cert of Occupancy 16 HUD LabeUlnsignia Numbers Serial Numbers o.,a ds da MISCELLANEOUS• DECKS'C9VERS'CARP0RTS*GARAGES 1 ZoningSetbacrs-Easements 2 Ftgs; Soils-Sr-OpthSpacing-CnnctrsSteel 3 Delo, Girders/Jotsts-Dcldng-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs-CnnctmShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-AnchrsStuds-Rflrs Tnisses 9 Siding; Nailing-VeneerStuccoo-lath 10 Roof. Shthg-Roofing 11 Eut; Steps -Doors -Landings 12 Braced Wali pnis v$ a. oe 0 1 Setbacks -Easements 2 Soils; •Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men-l.Ining 4 Elec Rcptds/Lting; D-rstance-GR 5 Elec fool Ltipg;15 volts-GFI 6 Elec.Ericlsrs; Conduit Entries-TenNnals-l-isted 7 Elec Bonding; Metal w/5'-Crdtng Egp-Htr 8 Elec Grndng; Eqp *17 Crcltng Eqp-Pool Ightg gmces-Encisrs-pnlboardsansultn to Main Conduit 9 Health 960 ApP' M . 10 Plmb; Cir Test-Wtr Supply Test 11Lt Niche ; 12 Endsr. Fending -Alarms 13 Bonding, Diving board or Slide Pool Drawing r,, -ZZ> 4-1-( C L Date: 8/24/06 Job#: 06435 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R Project Address 4058 Ord Ferry Road, Dayton Builder Name McClelland Heating and Air Builder Contact Telephone McClelland Heating and Air Plan Number HERS Rater Telephone Mery Martin (530) 894-8466 Sample G oup Number Compliance Method (Prescriptive) Climate Zone 11 Certifying Signature Digitally signed by Mervyn Martin Date in -Date: 2006.08.25 13:24:25 -77'00' Sample House Number Firm Energy Calculation Services HERS Provider CHEERS It! ddress'574 Manzanita Avenue, Suite 9 City/State/Zip:Chico, Ca. 95926 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was: ✓ El Tested ✓ ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. 121 The installer has provided a copy of CF -6R (Instal latiori Certificate). ❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). ❑ New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ✓ 0 MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) MeasuredValues ' I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: v*' El Cooling 0'0 Heating) or ✓ ❑ Measured 2 Enter Total Fan Flow in CFM: 1600 �/ ✓ 3 Pass if Leakage Percentage <_ 6% [ 100 x [-(Line # 1) / 1600 (Line # 2)]] ❑ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to 4 Duct System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System 5 for Duct System Alteration and/or Equipment Chan e -Out. 73 Enter Reduction in Leakage for Altered Duct System [_(Line # 4) Minus 73 (Line # 5)] 6 (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ 8 Entire New Duct System - Pass if Leakage Percentage <_ 6% El Pass ❑Fail 100 x 73 Line # 5 / 1600 Line # 2 4.56 TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out ✓ ✓ Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage 5 15% [100 x [ 73 (Line # 5) / 1600 (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage:5 10% [100 x [_(Line # 7) / 1600 (Line #.2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x [_(Line # 6) / (Line # 4)]] 11 ❑ Pass ❑ Fail and Verification by Smoke Test and Visual Inspection ] 2 Pass if Seating of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines # 9 through # 12 pass El Pass ❑ Fail Residential Compliance Forms April 2005 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVI.LLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERNII-I"'NU. BP061872 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE OR IF WORK IS DONE IN VIOLATION OF -ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 08/04/2006 APN: 039-260-064-000 the Business and Professions Code, and my license is in full force and effect. License Cl ss : License Number: Site Address: 4058 ORD FERRY RD CHI t1 ff /� J Contractor: r4CJI-L"&LA� A, Date: Map Index: OWNER:BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Description: NEW HVAC UNIT Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: FORD MARY ELIZABETH FAMILY TRUST to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Slate License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the. basis for the alleged exemption. Any 4058 ORD FERRY RD violation of Section 7031.5 by any applicant for a permit subjects the CHICO, CA 95928 applicant to a civil penalty of not more than five hundred dollars (8500).): ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the 'structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who does Applicant: MCCLELLAND AIR CONDITIONING, INC such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If however, the building or Improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for the purpose of 801 MARAUDER ST. sale.). CHICO, CA 95973 ❑ 1, as owner of the property, am exclusively contracting with (530) 891-6202 licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such. projects with a 'contractor(s) licensed , pursuant to the Contractors' State License Law.). Contractor: MCCLELLAND AIR CONDITIONING, INC ❑ I am Exempt under Article 3 of the Business and Professions Code Date: Owner: 801 MARAUDER ST. CHICO, CA 95973 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for (530) 891-6202 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit License M 345121 is Issued. 1 have and will maintain, workers' compensation Insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Architect: Carrier: � �� a-tf Engineer: Policy #: ❑ 1 certify that in the performance of the work for which this permit Is 0 S. F. issued, I shall not employ any person In any manner so as to Total Square Ft: become subject to the workers' compensation laws of California, Valuation: $0.00 and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Census Code: forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit Is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there Is a construction lending agency for the Resolul n . to do work indicate abo a for which fees have been paid. performance of the work for which this permit Is Issued (Sec 3097 Civ.) BY;3 ��j` Date: Cl Name: PERMIT EXPIRES ON: a�� Address: Date ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑. Notification in accordance with Section 19827.5 of California Health & Safety Code Is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. 1 hereby certify that I have read this application, that the above information Is correct, and that I am the owner or the duly authorized agent the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of y official form docum n o utle County. I hereby " authorize representatives of Bulte County to enter upon the above mentioned property for Inspection purposes Signature Print Name:' Date:��?`� ❑ Owner ❑ Contractor ❑ Agent for Owner Agent for Contractor B. C. Building Permit 0 1-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF LICENSED CONTRACTORS 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. LicenseClss : "� License Number: l SIA /� Dale: c/ � Contractor: HCLL*.1.�i&4Q 41 i, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which 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 pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the. basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of 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 Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for the purpose of sale.). ❑ I, as owner. of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such. projects with a'contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code Date: Owner: WORKERS' COMPENSATION DECLARATION I 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. 3P1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: I A_0 Policy #: `71 —Z%C/ PERMIT'NO. BP061872 IF WORK IS DONE IN VIOLATION OF -ANY COUNTY OR STATE LAWS. Issued Date: 08/04/2006 APN: 039-260-064-000 Site Address: 4058 ORD FERRY RD CHI Map Index: Description: NEW HVAC UNIT Owner: FORD MARY ELIZABETH FAMILY TRUST 4058 ORD FERRY RD CHICO, CA 95928 Applicant: MCCLELLAND AIR CONDITIONING, INC 801 MARAUDER ST. CHICO, CA 95973 (530) 891-6202 Contractor: MCCLELLAND AIR CONDITIONING, INC 801 MARAUDER ST. CHICO, CA 95973 (530) 891-6202 License M 345121 Architect: Engineer: ❑ 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 Total Square Ft: become subject to the workers' compensation laws of California, Valuation: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Census Code: forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is 8- �- VVV unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued i I hereby affirm that there is a construction lending agency for the R.esoluflyng to do work indica performance of the work for which this permit Is Issued (Sec 3097 Clv.) By: Name: PERMIT EXPIRES ON: Address: 0 S. F. $0.00 the applicable provisions of the Butte County Code and/or )oye for which fees have been paid. Date: Cl I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owne�Y duly authori� gent the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it Is unlawful to alter the substance of official form docum n o utte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for Inspection purposes Print Name:TT '/ Signature Dale: 61-141c)(0 ❑ Owner ❑ Contractor ❑ Agent for Owner Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL -REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 4 OFFICE #: (530) 538-7541 A. FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** APPLICANT INFORMATION CONTRACTOR OWNER INFORMATION Last Name FoW _Tirst Name Addresst_ /1 l,J �� F E-mail City Cls � E-mail State Zip Phone � � ��.1. Fax E-mail APPLICANT INFORMATION CONTRACTOR Namek C.CL-1— LL_At Pi X !_3� Address GD I M L"A ;;A, city ch;uo State Zip Phone i � Fax E-mail Lic. #� Cls � APPLICANT INFORMATION ARCHITECT/ENGINEER Name City (' _ State v i Address Phone f _ / Fax ,Z �O City Occ. State Zip Phone Page Fax E-mail Date Approved: State License Number APPLICANT INFORMATION Name Address � City (' _ State v i Zip Phone f _ / Fax ,Z �O E-mail —&d For office use only: Zoning Flood Zone City j � � ch, 1 a 00 SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BP I BIN # PROJECT LOCATION AN Tt QW -M - - �(] Property Address n L4 6 C. �/'�62 Fs 1�^" City j � � ch, 1 a 00 Cross Street WORKER'S COMPENSATION Policy Number Carrier 5 TfuMiD If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: 1 Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be 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. Received by: vrj, Amount: J5� Bldg SRA Receipt MI �� Sheriff SMIP Date LIGD Other I I L j Total Page 1 of 2 REV 8-12-05 SUBMITTAL & PERMIT REQUIREMENTS. Y 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 /N INK ❑ 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 faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (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. - .0 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). 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. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit 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 KAFORMSSUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05