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040-150-059
GARAGE CONVERSION WITHOUT PERMITS 1/3/92 L 6 41 Y. x,'92' 00 040--1570-059 RABO, RON & SHTRLEY' : It. CONT -OWNER - ,9616 OWNER:... ,9616 DURHAM .9616 LOTT RD;'DURHAM I CO((V GARAGE TO LIV 040-150=059 01- 49 RABO,RON INALED 9616 LOTT RD., DURHA 0 Z. CONTR: D& T ELECT NEW 200 AMP & TRANS S 040-150-059 06-0534• RABO,RONALD-' - 9616 LOTT RD; DURHAM CONT: DAVID J E.4TU�R'RI SRI C/o " ItoHVAC Butte County Department of Development Services. eu to `RE NOTES 7 County Center Drive, Oroville, CA 95965 (530) 538-7601 vrv\N.buttec0Linty nevdds RESIDENTIAL APN: Permit No. Owner. 040-150-059 06-0534 RABO-RONALD Site Address: 9616 LOTT RD, DURHAM CONT: DAVID J E. TURRI SR—' Contractor: HVAC C/O—,. � : ) Type of Permit: SPECIAL'CONDITIONS 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 DATE JOB FINAL ED h—� " (t� " SIGNATURE: OK Not OK RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR I DATE- IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 2 Ftg Main; Soils-Elec Grnd Ftg Dpth a 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth_ 4 Fig Porches/Decks; Soils -Steel Ftg Dpth ` 5 Stemwalls Main; Steel-Blockouts-Wrapped 6 Stemwalls Garage; Steel-Blockouts-Wrapped 69 Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test tl Wtr Pipe; Test-Anchrs-Rgltr-Service Test 12 Elec Undrgrnd 13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn 14 Girders-Sills-Anchr BoltsJoists-Vnts-Cripples 15 Acc & Vntltn 16 Insulation c` DATE IFRAMING 17 Sills Proper Materials & Anchrs 1B Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders & fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 22 Headers & Beams-Sz & Bearing' 23 Hangers -Post Caps-Anchrs-Cnnctns 24 Ceiling Joist-Rftr Ties-Purli6-Roof Brac-TrussShthg 25 Frplc Ties or Type A Flue-Frplc Throat Clmc 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctn Framing -RC Channel 29 Prprty Line Firewall & Opngs 30 Ext Doors -One T -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 33 Siding -Nailing Veneer f- 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Wall pnls 3B Insultn-Walls-Ceilings 39 Infiltration-Walls-Wndws o'er o` o'er o` DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns 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 Grnd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz go ❑ CU or ❑AL AC Wire Sz ga ❑ CU or ❑ AL 48 Range Circ ga ❑CU or DAL Oven Circ ga ❑ CU or ❑ AL Insulated Neutral ❑ Yes ❑ No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pnls-Motors-Mech Eqp 51 Clothes Closet Lf-Shwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr Nail Prtctn 56 Shwr Pan; Test, First flr-Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub. Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler-, Test 60 Yard Gas Piping DATE IMECHANICAL 61 AC Ducts Insultn & Support 62 Vent Fan, Exhaust abv Insultn 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pitfrm if Furnace in attic oqo 0 0 DATE FINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Clrnc-Comb, Air-Cnnclr In Garage; abv-flr-Ducts-Mech Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 Gn Arc Fault 72 Elec Trim & Subpnl, Breaker Sts & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Clrnc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct in Garage -Damper 80 Wtr Htr; Vnts-Clrnc-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 (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters ❑ Yes ❑ No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-CImc, to Opngs 90 Wtr Well, Dscnnct, Elec, Plmb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntltn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns 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 OK = Not UK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; Fall/C/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap . Nat ❑ or LP❑ Inch Sz Ft Lngth 7 Blckng; Sz-Spacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr it Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation ❑ 14 Exits IS Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers`c DATE ID EC K S -C O V E R S'C A R P O R T S `G A R A G ES 1 Zoning -Setbacks -Easements 2 Ftgs; Soils-Sz-DpthSpacing-CnnctrsSteel 3 Decks, Girders/Joists-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts -Beams -Rftrs-Cnnctrs-Shthg Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls ° 0; DATE POOLS 1 Setbacks -Easements 2 Soils; CompactionStructure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries -Terminals -listed 7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Bokes-Encisrs-pnlboards-Insultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide - Pool Drawing CaICERTS - Certificate. 4 4 - Page Page 1 of 1 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -411 9616 Lott Rd Project Address Air Control / 679438 Contractor Name / License No. bp06O534 Contractor Contact Telephone Permit Number Michael Hughes (530)828-4031 HERS Rater Telephone March 10, 2006 Certifying Signature Date Firm: Mike's HERS Rating Street Address: 14485 Holmwood Dr. 18497 Sample Group Number CC14-1798359079 Certificate Number Copies to: Homeowner, HERS Provider and Buildinq Delvartment HERS Provider:Ca10ERTS City/State/Zip:Magalia / CA / 95954 This CF -4R has been registered with the CaICERTSO registry in accordance with the Title 24 & Title 20 of the CCR. CaICERTS® is an approved HERS provider by the California Energy Commission. HERS RATER COMPLIANCE STATEMENT The house was 2 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 di a nostic tested compliance requirements as checked on this form. The installer has provided a copy of the CF -6R (Installation Certificate). : Main Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. - Main System HVAC System TXVJ LM Pass U Fall http://wywv.calcerrs.com/cf4r_print_certificate.cf n?lots=18497&RequestTimeout=100000 3/9/2006 � s• CERTIFICATE OF COMPLIANCE: RESIDENTIAL s"?L\ k SS�S+e►t,. (L[VA C-) ect Title C -f6 Lf rr - iOJect Address IJAVe 7TT�r t" i Documentation Author Telephone �l�i r 1/r 0-- 1 Compliance method (Package or Computer) Climate Zone GENERAL INFORMATION re 1 of 3) CF -IR ?-io-off le r::,' V6C)S`3`f Building Permit # Plan Check / Date Field Check / Date Total Conditioned Floor Area fe Average Ceiling Height: Conditioned Slab Floor Area W Building Type: Single Family Addition (check one or more) Multi -Family Existing -Plus -Addition Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one) Number of Stories Number of Dwelling Units: Floor Construction Type: Slab/Raised Floor (circle one or both) ft RADIANT BARRIER (required in climate zones 14, 8-15) Required for this submittal_ yes no BUILDING ENVELOPE INSULATION Component Frame Type Cavity Sheathing Total R- Assembly Location/Comments Type wd = wood Insulation Insulation Value' . U -Factor (attic, garage, typical, etc.) stl = steel R -Value R -Value Wall Wall Roof. Roof Floor Floor Slab Edge 'For prescriptive compliance. Total R Value and Assembly U -Factor are not required for a wood -framed wall that meets cavity R -value insulation requirements for the Prescriptive Package. FENESTRATION Shading Devices Fenestration Orien- Area Fenestration Fenestration Exterior Overhangs/ !ape/Pos. tation ftZ U -Factor SHGC Shading Att. Fins Front Front Left Left Rear Rear Right Right Skylight Skylight Compliance Forms August 2001 A-2 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -1R Pmiect Title Date HVAC SYSTEMS Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Heat Pump Type (furnace, heat Efficiency Location Piping Thermostat Configuration pump, etc.) _(AFUE or HSPF) (ducts, attic, etc.) R -Value Type (split or package) SEALED DUCTS and TXVs (or Alternative Measures ❑ Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) TXVs, readily accessible (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) 0 Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) .M ❑ Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U -Factor SEER Heating j WATER HEATING SYSTEMS Energy' External Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation Type Tyne in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value 1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btuftj list Rated input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list rated input and recovery efficiencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001 Residential Manual). Package C: thermal mass (thermal mass type, covering, thickness, and description). A 7 Minimum Duct Heat Pump Cooling Equipment -Type (air conditioner, Efficiency Location Duct Thermostat Configuration heat pump evap. cooling) (SE'E'R) (attic, etc.) R�-Value Typee2 (split or package) C wvi a lar t 14 l ' rum L- - 1 �- 6 �Q SEALED DUCTS and TXVs (or Alternative Measures ❑ Sealed Ducts (all climate zones) (Installer testing and certification and HERS rater field verification required) TXVs, readily accessible (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) 0 Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) .M ❑ Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U -Factor SEER Heating j WATER HEATING SYSTEMS Energy' External Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation Type Tyne in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value 1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btuftj list Rated input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list rated input and recovery efficiencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001 Residential Manual). Package C: thermal mass (thermal mass type, covering, thickness, and description). A 7 ,ti CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R Proiect Title Date COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business and Professions Code) Documentation Author Name: ) t- .0\A K0 \ Name: Title/Firm: DU3 tJe,•'r �' �iA f(� +� — Jl i� l— ( e/R= Address: 3 15� V `2 �fJ �� G Address: Telephone: /S 3 0 - $ 95— cyj O 3 Lic. #: �� V (signature) (date) Enforcement Agency Name: Title: Agency: Telephone: (signature / stamp) (date) A CDK�ra 1 _ Telephone: 3 U — S 2-1 'G %U i (signature) (date) INSTALLATION CERTIFICATE CF -6R Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required, however, use of this form to provide the information is optional.) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(b). ' HVAC SYSTEMS: Heating Equipment Equip. # of Efficiency Duct Duct or Heating Heating Type (pkg. CEC Certified Mfr Name Identical (AFUE, etc.)' Location Piping Load Capacity ZL�l ME s -M �it/�I��l�i � • ' r o Cooling Equipment Equip. CEC Certified Compressor # of Efficiency Duct Cooling Cooling Type (pkg. Unit Mfr Name and Identical (SEER, etc.)' Location Duct Load Capacity Numbe r Systems el fattig.c - -� -g-o- 1. > heads greater than or equal to. I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devt is (from the Appliance Efficiency Regulations or Part 6), where applicable. Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner WATER HEATING SYSTEMS: Distribution If Recv- # of Rated= Tank Effi- External Heater CEC Certified Mfr Type (Std, culation, Identical Input (kW Volume ciency2 Standby: Insulation Type Name & Model Number Point -of -Use) Control Type Systems or Btuthr) (gallons) (EF, RE) Loss (%) R -value' 2 For small gas storage (rated input of less than or equal to 75,000 Btift), electric resistance and beat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btulhr), list Recovery Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Recovery Efficiency and Rated Input. 3. R -I 2 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111. I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy I iciency. Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. Signature, Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner .r 11 U %_ I LL' E111HlTL' Pkil AR LL' 011T1\ L11i1T1 \ kPO X X O ❑ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfinhon x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction = Test Leakaget(Measured or Calculated Fan Flow) = Pass if leakage fraction <_ 0.06 ❑ ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE es ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN '1• ' ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2• ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -IR. Measured Fan Flow = Yes for both I and 2 is a Pass L:7 U Pass Fail ❑ ❑ Pass Fail ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] Tests Signature, ate Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 A-25 s^� I 1W BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060534 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 [provisions hereby affirm under penalty of perjury, that I am licensed under of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 03/08/2006 APN: 040-150-059-000 the Business and Professions Code, and my license is in full force and effect. / License Class: 1.- O License Number:, q 3 1 Site Address: 9616 LOTT RD DUR Date: �' 'deo Contractor: Vt C Vk'�-t Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: replace hvac 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: RASO RONALD P & SHIRLEY E 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 9616 LOTT RD the Contractor's State License Law (Chapter 9 commencing with Section DURHAM, CA 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 95938 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 Applicant: DAVID J E TURRI SR DBA AIR CONTROL 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 3115 VERNYCE CT. sale. If however, the building or improvements are sold within one CHICO, CA. 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 95973 sale.). 530-895-0503 ❑ 1, 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.). Contractor: DAVID J E TURRI SR DBA AIR CONTROL ❑ 1 am Exempt under Article 3 of the Business and Professions Code 3115 VERNYCE CT. Date: Owner: CHICO, CA. 95973 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 530-895-0503 ❑ I have and will maintain a certificate of consent to self -insure for " workers'' compensation, as provided for by Section 3700 of the License #: 679438 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 the Labor Code, for the performance of ` Architect: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Engineer: Carrier: Total Square Ft: 0 S. F. Policy #:. I certify that in the performance of the work for which this permit.is V issued, I shall not employ any person in any manner so 'as to become subject to the workers' compensation laws of California, Valuation: $0.00 and agree that if I should become subject to the workers' Census Code: f compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: - 1 Applica WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the This pe itis hereby,•is d and 'r the ap able provisions of the Butte County Code and/or Resol ions to do wor ndi ated bove f which fees have been paid. — performance of the work for which this permit is issued (Sec 3097 Civ.) B y Date: r Name: • PERMIT EXPIRES ON: Address: (Date) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms: I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the subst ce o official form or docume of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection rposes. Signatu e: Print Name:�,r \�Vr - V v Date: J I Q 8wner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 591-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY-4- OWNER LEARLYrr OWNER INFORMATION Last Name• �O Firs NarrLe QCoN Address 9G/6 Lo .t-/2 C City Ov r �A A uH Stat . Zi 5 9 Phone :&— Ll$vq �P Fax E-mail CONTRACTOR Name r4 2 / ,��ro l - DAV r v 2u2� Address 3 l qe C 4— City G O Statec v4 Zip 9S 3 Phone SZ I, 610 Fax E-mail " Lic. # J.D?9 Y3 $ FEt!s2-o APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail , APPLIPANT SIGNATURE v �] For office use only: Zoning Flood Zone ily vr���4 SRA Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP.06 053 BIN N PROJECT LOCATION AP# n- 150-0 PropertAddress 4/ L to ily vr���4 Cross Street � A -i 'U CI C3JVu WORKER'S COMPENSATION Policy Number Ovjj 'e� A- 1'e. 4e Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: 14 \Jv4 c c� Sq FT- LivingI DUS ara e (6)0Open Cov ❑ Structure Built without Pe its - El 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: Amount: Receipt #: (/ ' 6 4 8,ob Bldg SRA Sheriff SMIP Other 4 Total 1C.- SUBMITTAL C: 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 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 AIC 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. ❑ 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. O 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 RE I { EN IAL 040-15-0-059 92-00091, RABO, RON & SHIRLEY CONTR: OWNER i 9616 LOTT RD, DURHAM CONY GARAGE TO LIV I 44 I JOB FINALE Signature r �i -r RE I { EN IAL 040-15-0-059 92-00091, RABO, RON & SHIRLEY CONTR: OWNER i 9616 LOTT RD, DURHAM CONY GARAGE TO LIV I 44 I JOB FINALE Signature J=OK , O = Not OK N t Rehdyot able MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s t 1. 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-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / P L" ft. / /"Nat. or/ /"L"ft./ /"LPG 7. Well Clearance & Disconnect % 8. Utility Clearance Date Card B-1 Date Card'B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector} '41 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged _ 9. Exits; Insp.-Sketch 10. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 r-^ Pt =�Q�C{a 1+'tiL1ii���d1'iG.) �l Q 1.tT.►:`+`{C::^.i /_ -�J�iL,I �� n �f�.b��rP-i .i1 ��W �;_"!=�.�� rr; 1 .S '+�•:�� MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-Depth-Spacing-Cgnnectors-Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s j r 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and.Lighting, Distances-GFI' 5. Elec.; Pool Lighting; 15 volts-GFI.. ' 6. Elec.; Enclosures; Conduit Ent ries-TeiininaIs- 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 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 t �\ t Pt =�Q�C{a 1+'tiL1ii���d1'iG.) �l Q 1.tT.►:`+`{C::^.i /_ -�J�iL,I �� n �f�.b��rP-i .i1 ��W �;_"!=�.�� rr; 1 .S '+�•:�� MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-Depth-Spacing-Cgnnectors-Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s j r 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and.Lighting, Distances-GFI' 5. Elec.; Pool Lighting; 15 volts-GFI.. ' 6. Elec.; Enclosures; Conduit Ent ries-TeiininaIs- 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 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 t �\ ✓=OK O !Not OK = Not Applicable Not Ready RESIDENTIAL (Single = Date UNDERFLOOR (Plans) OK except fi's 1. Zoning-Setbacks-EaserAerlts-Flood-Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth I 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 -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. • 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation v 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit),OK except ti's 16. Water Htr.: Vent -Access -Combustion Air -Baffle ------------ ----- - ---------------------------- 17. ipe: Test & A rotection ------------ ------------------- --- ---- 18. D.W.V.: -Fi ' s & Anchor -Nail Protection -------- - --- -- ------------------- -- 19. Shower n: First Floor -Tub Access _- - 20. Tub & Shower,Sec_- Floor -Tub Access ------------ Gas Pipe: Size & Anchors -------------------------------- --- ---------------------- ------- - Date - - -Card B_1 --- - Date - - Card B_1 Date Card B-1 Date Card B-1 _ Date ELECTRICAL (Permit) OK except ft's 22. Fixture & Transformer Clearance -Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors -- -------------------------------------------------------------------- 24. Size Boxes & No. of Conductors -Stapled ----------------------------------------------------------------------------- 25. Romex Installed Close to Edge of Studs & C.J. 26. Equip. Ground made up w!Mech. Fastners-Bond Gas & Water ----------- ----------------------------------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI ------------- -------------------------------'------ ----------------- 28. Subfeed Wire Size ! ! ga. Cu or AI-A.C. Wire Sizer ! ga. Cu -orAt ------------------------ ----------------------------- 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At. Insulated Neutral ❑ Yes ❑ No - ----------- -------------- ------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect --------- - ----------------------------------------- 31. Equip. Clearances Panels-Motors-Mech. Equip. 32 Clothes Closet Light -Shower Light -Spa Light ------------ -- --- - - - ----- ----- -- -------------------- -- - 33. Smoke Detector --------------------------------------------------------------------------------- Date Card B-1 Date Card B-1 -------------- ------------------------------------------------------------------ Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except h's 34. A.C. cts Insulation & Su port 35. ------------------------------------- e nt Fan: a ov insulation -r------------ ------------- ------------------ --- ----------------- 36. Conden. Dr & Overflow: Size & Grade -------------------------------------------------------- --- 37. - 37. Fur ce-Vent; Acces omb. Air -Return Air Vent -115 outlet ------------------- _-------------------- -------------------------------------- 38. is Access & Platform if Furnance in Attic ----------------------------------- ------ ------------------------------------- Date Card B-1 Date Card B-1 ------------- -_ -- -------------------------------------------------------- Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except h's 316.'Sils. Proper Material & Anchors - 450 Walls Studs -Nailing. Spacing & Bracing -Plates - Sound - - - 41. Bearing Walls over Girders & Floor Nailing ------------- - --- --- - - 0�-Draft-Stop i -n Walls- - (rat - proof)- --- ------------ -- ------------------------------------------------ 4! Fire Stops_ Furred Ceilings -Stairs -Chases -Tub -------------------------------------- -------- 0. Headers & Beam -Size & Bearing r &.Duplex) Date FRAMING (Continued) 45-+4angers-Post Caps-Ahchors-Connectors *IB -Ing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng. IT -Fireplace Ties or Type A Flue -Fireplace Throat clearance Q6. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49-8drm. Windows or Exiting Doors -Sill Hgt. & Dimensions 58-.6arage Fire Protection Framing 5<_ Property Line Firewall & Openings SExt. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53-3tairs: Width -Headroom -Rise -Run -Landing -Fire Protection 5T.-"ywood on Roof Overhang -Attic Vents -Rafter Outriggers _ _ _ Sliding -Nailing Veneer X.' Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access ------------------- - _ _S?�Glazing Area -Glass Protection -Skylights -Plastic 58. -Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows ------------------ Date , (0 . Card B-1 Cr, Date Card B-1 Dale Card B-1 Date Card B-1 Date FINAL (Plans) OK except k's Fre E Steps -Door & Sidelight Protection -Landings ------------- Smoke Detector. 69�-�mnace: Vents -Clearance -Comb. Air -Connector - In Garage_ Above Floor-Ducts-Mech. Protection 64715e-droom Exiting ------------------------- 65. - __GF.I. & Bath Fixtures & Tub Access -Spa ---------- ,8� Tnm & Subpanel; Breaker Sizes & Labels & Rails --- ---------------------------- - 68--Fireplace_or Stove: Clearances -Hearth 6'zJ. c. Outlets at Wood Panel: Int. & Ext. 70-44itfixt. & Appliance, Grnd.-Air Gap -Cooking Clearance 71-` 4ec-Outlets & Receptacles at Kit. Counter 72. 0d. ge Fire Door; Swing -Landing -Closer ------------------------------------ - 73- _. . uuct in Garage -Damper *1. Wtr'Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor-Mech. Protection ------------ -------------------- jiJ' Plb.. Elec. & Mech. Equip. Listed for Location 76r-CHec. Receptacles in Garage: (G.F.I.)-Romex Protection 7.�- Insulation -Foam -Looked in Attic ❑ Yes -- --------------------------------- 7&-6r>a-d Rails & Deck Construction -Post Caps ----------------------------------------- 710-rff-n Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes -6f Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 61. Stucco: Brown-F�h Unit: Disconnect'. Electrical, Plumbing 23. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to Openings 84-Waler Well: Disconnect, Electrical, Plumbing 3� Exterior Elec. Trim; G.F.I. Receptacle -Underground A ventilation Throughout House ------------- 8J!Glass Protection ------------ --------------------- ----- 8d.�rrections from Previous Inspections - ---- - --- ---- -------------------------------- 89. as Test -Meters Tagged; Gas -Electric ------------------------------------------- 90r,VVMr & Sewer Connected -C/O to Grade -HD Approval -- - - - - -- ----- --------- 91--Epeftdy Compliance Certificate -Other Certificates Date- 2--IQ-*Card B_1-G.�---- Date _ _Card B-1 - Date Card B-1 CTG Date Card B-1 Date 2_?2 G1ZCard B-1 Gor& Date Card B-1 Comments at Final_ tNS.P_T_IJ.nI _-O F eo_fNy_fe,x��w_v�nA_DG_ �Fr __CotAAA LE---t41q.__R.E szvA1,-o_�_-1,�At,�= a_ Ak& . bla APPAegdr HAZAAl - _:. COUNTY OF BUTTE DEPARTMENT OAPUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE OWNER 1011 A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. C t 0e-(, Lac uT 9 -(t -Q1, A M", O �' ��i Irl F2nNT ANI, r << ,45�/ m (9'' STr,P RAS F /nl LA litnlil'P-4 km_ 11\/ L V I rJG S nn,, Y, 'N , r- E r . %, 3 1& " Jmo jcc4. Date ? - (o - C�l Z Inspector /-� hl.-l.T-,,J> COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 40-15-059 ZONING 1 BUILDING PERMI OWNER Ron & Shirley Rabo TELEPHONE 343-4516 SQ, FT. OCC. BUILDING VALUATION 473 R 9 460.00 OWNER'S MAILING ADDRESS 9616 Lott Rd., Durham 95938 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 9,460.00 LENDER'S MAILING ADDRESS , Filing Fee $ 15,00 Permit Fee $ 97.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 48.75 Energy Plan Checking Fee $ 20.00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee r $ 181.259616 PLUMBING PERMIT Filing Fee 15.00 Lott Rd Durham Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP .s O Water piping 1 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF X❑ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ® Describe work: GAra e Converted toContractor w/o Permits L A VjiinitlFA � Permit Fee $ ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business Fad' Professions Code and my license is in full force and effect. cense No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the workiand the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000AI 37.50 NEW CONST./ DWELLING OCCUP.g+) OR ACDNS. l ACC, BLDGS. 3.6p sq.ft. NEW CONSTR MULTI -OUT LET NON•RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS b SINGLE OUTLET CIR. ) EX, Occup�OUTLETS OR FIXTURES 1 20 76 12.00 EX. DCCUp. OUTLETS FIXED APPIRESID IREA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. byirin g 15.00 Permit Fee $ 27.00 - WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ve placed on file with the County of Butte Building Department ❑ I haDUCt a,/Certificate of Workmen's Compensation Insurance or a Certificate I Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating 1 ti.50 6.50 Cooling g Hood 6.50 Ventilation permit Fee $ 21.50 Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against s 'ad Co ty in cons en a of the granting of this permit. X I-� Date 2 ' Signature of Ap - c nt - Owner � Contractor ❑ Agent An OSHA per ' is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ /�occ /��✓� c�o%'STTYP.C� E Y l75 TOTA EE$2 J HAz I DFEES IMP4WOD CDF ---� PARCE PD HD Iss This permit is hereby issued under the sions of the Butte County Code and/or work indi ated abo or which fees D OF PUBLIC By k� PERMIT EXPIRES Date 2 - applicable provi- resolutions to do have been paid. WORKS Dater y-f� Y -93 Receipt No. I U.31 7C� WNIT!-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT i-� �jw T..+ .T.w....t'!i Ci , •"71"Nty`¢•t'+p""�"`' i•+^r '.iR' . �"ti:,{n*•. r t .rT � s+ 't ,,?�T u••- •'°�-: i. J.;F. ,;,:� . .. � ,f'iw . n;,: ., ,d!..- w . 5'' y-v�` +'+,}L..� ,^ v ••.l .... .a�i..� . -.iw -\ COUNTY OF BUTTE - DEP'A'RTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE�A'OROVtLL,9, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET ✓/ li j+� I, Permit No. OWNER ROA) r Imo. cc....:lU 0, A. P. No. q D -1.S- G 5 Proposed Building Uset/• Building Inspector Date 3 t L i At time of permit application, I was advised,the following data must be submitted prior to permit processing and/or issuance: I DATE RECEIVED APPROVED 1. All items have been submitted . ...............:i....... ........... 2. Plot plans in duplicate/triplicate, signed by preparer gf�irp-ians ........ 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form .......................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation /n /✓/ instructions ... �j 10. F-ees-e�$`/0���Ek....J5,O..l .... -2- 11. -11. Chico Urban Area fees paid ,;,Y Park fees paid ............................................. 13. C2 kaA& School District fees paidi�kAj! _ �-55'Z 4. Sanitation approval from Gk, 4- ® Health Department VV', 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: -(B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for 4 required Pre-Inspec. request to Building Inspector 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner o, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Lettpr of signature authoriza n ........................ ��26. 2 ,F E' J 27. Aa o?- Whenn U issue the perm itc,�% �o process as fol ows: Mail to owner. -Mail to contractor. hone Tele 3�3 /` p and hold for pickup at Cle•( office. Deliver w/inspector. Other Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data .mu.s.t Igq_sLbmi.tted prior opermit ' suance,:. (Circle new. i-tem•-not...c.he_cRed above). 1. Index permit for above items N .14P aa 2. Additional items requirdd: C /GAO"T Contractor, designer, o -41t` was advised of above required data by phone"rnai9 £ counter by Contractor, designer, owner was advised of above required data by -phone -ma il-counter by Plans checked by 21�&;_Date z Plans approved b -r,4 Sets of plans on hold in File cabinet AP folder Copy -DPW lvf 4-, Ji�7 0167 VL�����0/4.✓ ..date 7 A - date Date 02 G% Z_ rn r Ij TO 'Building Department FROM: Environmental Health •SUBJECT: Sanitation Clearance q6)L, LtLj 6A R ovne Location AP# Plan Approved for: Sewage Disposal 'dater Supply Hold final for: Water Supply Final clearance O.K.. for: Water Supply Clearance for bedroom mobile home. Other 04 rim %11 . _ . , n r k \ NOTE *** Date S. a —ni-t-gTAan COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville; California 95965 - Telephone: 916:'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESS R PARCEL NUMBER OS ZONING BUILDING PERMIT o ER Q TELEPHONE 5 f ro SO. FT. OCC. BUILDING VALUATION .7 OWNER'SILINp 7E�/� /o ee—3 9W33,8 CONTRACTOR'SNAME - l 0 ti TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ Z, ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $1197 Energy Plan Checking Fee $ a-�b ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS i` 4 0 4 / Permit fee $ , PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL' MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5-96 Building sewer .00 Mobile Home I S I G JW 1 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installatio ❑ Other Describe work: 416?,V U e/ -V 71-d Permit Fee $ Contractor ELECTRICAL PERMIT FiIingFee 15.00 Main service 200AOORLESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business f and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 20GATO 1000A, 37.50 NEW CONST./ 3.60sq.ft. DWELLING OCCUP.&\ OR ADONS. ( ACC. SLOGS. lI NEW CONSTR.MULTI-OUTLET NON.RESID BRANCH CIRCUITS) @ 5.00 POWER APPARATUS 14 (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURESFIXED APPLNS. Ex. Occup. OUTL TS ((RESID )REA.) I 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00 Misc. Wiring g '15.00 Permit Fee $, — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor , MECHANICAL PERMIT FiIingFee 15.00 Heating QLxa Cooling g Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against a' Cou ty in conseque of the granting of this per it. Date Signature of App ant — Ow er Contractor E]Agent An OSHA permit Is required for excavations over 5'0" deep and demolition or construct• ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ 0, occ CONSTTY' TOTAL FEE $ �9 %,S HAz 0FEES IMP FLOOD COF PARCEL Po HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte Count Code and/or resolutions to do y work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. vat c s-.� �-ew+�--^�n7^nri.:n� �,•r...s..,r �..,,IY't'T',4'^+� ""s%aif'• s,;.r°*jtW~SY�Ywrt,i;»wW""+'.�vv�f-.'"�re'F�YC.4we r•.,• �.�rr•.`.'h'i.'r{��%iJ'a'`T U7n•,�L rm.'s-°.;Y5M77•?�:�•:�e.v rY�- n -c BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM (One Form per Building) A. P. Number �Q'"���" 0:5 Building Department No.��-f-.�E School District �����,�,� _ City County ©r. Jurisdiction Property Owner I?e)n. • v Project Location/Address , -4 p ?4T XJ Subdivision I_p ft %gecz Lot Number Residential, Development:-" a a a- Sq. Footage. # of Living MHI Addition (Group R) Units. Commercial/Industrial: Sq. Footage New Addition (Including Exterior Roofed Areas) -e Building Depar ent Representative Date (Floor Plans reviewed•by School District'Personnel) District Id No. /," /w�u ,/ ,,,/ ,,.School District certifies that -(Applic (Street Y amen f ess) 4 (State Phone Number)' 9s -s e,?- (Zip Code has complied with the requirements of Resolution No. by the payment of $ representing 4,/;73 square feet. ool uistrict Representative R, PAID BY CHECK NO. BANK NO PAID BY CASH REMARKS: white -applicant, yellow -building department, pink -school district - sem- . Date SCHOOL.FEE (8/88) COUNTY OF BUTTE'-,Deoattment of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 910'-538-7541 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. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement es or no) 2. I ( av /have not) /r? Q UC_ 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 Address City Phone Contractors License No. 4. I plan 4zo provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name /� Address Phone Type of Work Signed: � r Property Owner Social Security Number _ Date alw/ NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. RESIDENTIAL PLAN CHECKING GUIDE .12/90 (S.F., DUPLEX & MISC. ONLY) O4,1Bldg. Permit # WNERA.P. A . P . # 5e� GENERAL Plan Checker ening requirements:. (sideyards and number of permitted living units). �l-uation. 3! P ns signed by designer. Proper description of work on application. Existing violations on -property. ® Items on data sheet. (W.C., fees, Health, Developer Fees, License law, etc). PLOT PLAN i /�'omplete parcel size and dimensions. :��Other etbacks, sideyards, easements, etc. buildings or structures. ; -EDF--fare—sT-r-i n k e r s , non-comrb- ustible, and foundations). 8—Btr±±-Mcg-er-tem-acr-os�-1-®•t �i-nes-�dox�n�y. FLOOR PLAN 1✓ omplete to scale plan with dimensions. �9v�e-n-rtS:eitl-ratii�on@�►().6S.ffel'�c.c�s.i 3 n-s1/2�0) Ngiggtgg� % �o ws c�s�T or E3ic�ko,� CDs-,-) Required room sizes, ceilin&-�eights (Sec. 1207). � ' Light fixtures, switches, receptacles, and exterior receptacles for main- tenance of mechanical equipment. P -_-Locations of watgr heater, heating and co ling equipment, other electrical or gas equipment C �,Ke�, fv , 4"//-/ r- ��£,v"C 7S 1 /3'0" exterior exit door (sec. 3304 M. 163.. Smoke detectors (Sec. 1210). � .�•--n� ''; " Q f ; � �e=�se t_c-1-ea-r-a� _�- r-A.d-s.hower-��-z e� STRUCTURAL DETAILS 1. Standard acing or engineered design (Table 25V) 2. Unusual shape, size, or sp it level house requiring lateral design. 3. Foundation plan complete :nough to construct building. 4. Floor construction det is complete enough to construct building. 5. Elevations and wall nstruction details complete enough to construct building. 6. Roof construction tails complete enough to construct building. 7. Fireplace constr ction details and talcs if necessary. 8. Rafter ties or earing ridge beam. 9.. Garage door r porch header sizes. 10. Stud heigh s. 11. Adobe so* s - special foundation design. 12. Retaini g walls requiring design. 13. Specia nspection required. 12/90 RESIDENTIAL PLAN CHECKING GUIDE MISCELLANEOUS ITEMS TO LOOK OUT FOR k---ct -ea l-% rings, rise and run, head clearance, handrails (Sec. 3306). L 3306(j) . 4..�x�e�i-e-r--p�-a�t�e-r•---�e•�p-�cr-ee�i-�-�-S�9'6�) . � ('h/-ap-t-e • 32) . �XlJ<!�✓y ���+�+ 36" halls and stairways. h-oa-r_s.ep. ra atio_n_r_e.q-ui-r-.d-on garage -suede i.nc�-udi-ra-g-sap� o.�t�g-zea �-1-s-an-d-p o•st s-,-et-c .- 13.303 & see Mezannines - 1716) . 1 Combustion air for fuel burning appliances - L.P.G. requirements. Xe•s . ©lp- OrEnergy design. .1jy,v �� r., �x-�ee��o� o�en3xg 1��.�t11'!_I ^ __ -_- = s . .1 -7 -.-GDF- ea, n- ; -',' _ =rea-r-eq-uir-emen-ts-.- .12,,;- % sWrr > i 7 ►rs /Vf soy xrE f z<r, t > fi 040-150-059 t 01-1049 f RABO, RON 9616 LOTT RD.,' -,DURHAM CONTR: D& T LECT NEW 200 AMP &,TRANS SWITCH r r Im I COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 1 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96)0 APPLICATIONAND PERMIT �� J' /1��/ ' ASSESSOR PARCEL NUMBER �••-y� 0y( "a), c/ 1 A ZONING 4.,j BUILDINGPERMIT OWNER Oil o,- / � - TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS f CONTRACTOR'S NAME / TELEPHONE CONTRACTORS MAILING ADDRESS • , ` _ CONSTRUCTION LENDER Fireplace LENDER'S AWUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MARINO ADDRESS Plan Checking Fee $ BUILDINGADDRESS fj r�fy , Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIMIONSNAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE % SF f�Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat um water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑l Other /❑ Describe Work: � %(- Zt� 00 ✓ /�!r%i/ � Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 OOOV OR LESS Main Service 200A OR LESS �7 �f 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. / j� . License Class Cw. — � © Lic. NO. � (Q � (./ �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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. ❑ I am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUR OR ADDNS. ( SO . =R.,..ONS' MULTI -OUTLET @7,50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 ®''00 BAL w Ex. Occup.. pUTIFTS Ap.0Ek 5.00 Temporary Service 23.00 AAobile Home Facilities 20.00 Misc. Wiring 23.00 21 f o PERMIT FEE = WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ 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.) a I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X r Date ���'~�� Signature of pelican - er OwnContractor ❑ 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 $ (,�. ICU HAZ. p. PEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated abov for which fees,, have been paid. By Date PERMIT EXPIRES ON ^� ate ReceiptNo.7i il..�. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINIC-INSP15CTOR GOLDENROD -APPLICANT 1' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERIT-NO. (Rev. 12/96) G APPLICATION AND PERMIT y ASSESSOR PARCEL NUMBER O U H ` ZONIN� BUILDING PER OWNER' �N o' i f TELEPHONE - SQ. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS �i U✓1 CONTRACTOR'S NAME,r� �_r CL/G TE H NE' CONTRACTORS MAILING ADDRESS � CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 6i Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF 8 -/Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ �Utilities ❑�Insttallllation ❑ Other ❑ / Describe Work:/J� w<�cy Gas piping system 1 - 5 outlets 15.00. Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 000v OR LESS Main Service 200AORLESS 23.00 03,60 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,pEoglp and my license is in full force and effect. // T License Class C — I O Lic. No. �,2 r0 (J �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( a Acc. sips. SO 3.5¢Fr: MULTI.OUTLUTITS @7.50 POWER APPARATUS 8 SINGLE Oun ET CIR. EX. OCCU OUTLET OR FIXTURES 20 t'00 BALLNS Ex. Occup.OFlxur�is AEs oR� 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 , Misc. Wiring 23.00 Cu PERMIT FEE _ ! 000 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEI: S 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.) Or I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. L4permit / o X/�iiDate �– C� "U _ Signature o Applicant - ❑ Owner WContractor ❑ 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 $ GU HAz. D FEES IMP FLooD CDF PARCEL I PD I HD IS UE This is ereby issued under of the B e unty Code and/or indicat d abov for which f have By PERMIT EXPIRES ON Iefe the applicable provisions Resolutions to do work been paid. Date(i t% Receipt No. �7 �� WHITE-D.D.S.- .D. CANARY -ASSESSOR MNK—rNSPECTOR GOLDENROD -APPLICANT