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Home My WebLink About040-290-083L w`LOPE'Z, Philip Its s'� 4 ''1920 Sycamor-e LN, Durham new.sf 040-29-0-083 93-1942 '� 13 i` OPEN DECK/SF u a :Y !ml E D NTIAL ' 92=4257 040-29-0-083 LUEZ, Philip Durham 1920 Sycamore LN,. 2� new sf 2 -3' 01 1 s. (o-a-q3 l.�eKat�r — W/v ,.. �� (n-II-OIz — I��QMC� C vn►�R�C�oR T►�A7 9 I qa y -7-H13 ! OFFICE COPY - Address )iO12 C0 S \f ok 9-C . i GAS y �t �o�► k:n Meter B /r,J�rl,v�—� Date ELECTRIC - Meter By Date OFFICE COPY Address e GAS Meter ELECTRIC Meter By Date i JOB FINALED (Date) Signature V=OK O= Not OK -=Not Applicable ' =Not Ready MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except If's 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 i-. 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 If'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 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 8-1 J i A MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except If's 1. Zoning Requirements -Setbacks -Easements 2. Footings;.Soils-Siid-Depth-Spacing-Connectors-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 B21 Date POOLS (Plans) OK except It's 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability i' ) i r 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 Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. _ Boxes -Enclosures -Panel boards -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 0 �OK t = Not OK = Not Applicable Not Ready RESIDENTIAL (Single = Date UNDERFLOOR (Plans) OK except If's Date y7ening-Setbacks-Easements-Flood-Slope �tg., Main; Soils-Elec. Ftg. Depth e§. Ftg., Garage; Soils-Steel-Elec. Gvrd'-112" Ftg. Depth joelFtg., Porches & Decks; Soils-Steel-12/Ftg. Depth Stemwalls, Main; Steel -Bloc kouts-Wrapped --- W.. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Soecial Anchors 7. Slab; Steel -Wrapped %8. -Fireplace Ftg.-Steel D.W.V.; Fall -Fitting est- Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test LU -Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground Plenums & Ducts; Clearance -Material -Support -Ins. 14' -Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 10 -"Access & Ventilation 16. Insulation Date 3,s,g3 Card B-1 CQ, Date 2, >Card B-1 Date Card B-1 Cyr Date Card B-1 Date PLUMBING (Permii/,OK except u's 1E. Water Htr.: nt-Access-Combustion Air -Baffle ------------------ ---------- ------------------------- 17. Wate ipe: Test & Anchor -Nail Protection --- ----- ---------------------- 1!ZVV.: Test -Fittings & Anchor -Nail Protection ( er Pan; Test. First Floor -Tub Access -- - - c& Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe: Size & Anchors --Dat----C-- -- --- - - -- - - — - - - - - e \� ( Card --1 Date Card B-1 —a--- -4' --------- -- ---------------------------------- ,.Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s xture & Transformer Clearance -Ins. Protection ;Receptacles Spacing -Lights & Switches at Doors Boxes & No. of Conductors -Stapled ----------------------------------------------------- ome Installed Close to Edge of Studs & C.J. i ----- -- - ------ -- -- E "I Ground made up w!Mech. Fastners-Bond Gas & Water -------------- -------------------------------------------------------------- 2 Appliance Circuts in Kitchen & Conductor Size/GFI ------ - ------------ ------------------ 28. Subfeed Wire Size / i ga. Cu or AI-A.C. Wire Size ! ga. Cu or Al ----------------------------------------- ------------------------ 29. Range Circ--------------------- ! ga. Cu or, Oven Circ. / i a. Cu or Al. ------- ----- Insulated Neral Yes In - -- --- -------- ------ - ------------------------------ 30. Ser vi e' -Riser Conductors & Ground -Main Disconnect 31. Clearances Panels-Motors-Mech. Equip. ------------------ ------ --------------------------- --- --up- -------------------------------------------------------- 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 MECHA ,ICAL (Permit) OK except a's 3 - . Ducts Insulation & Support --- -- -------------------------------------------------------- . Vent Fan: Exhaust above insulation - 36. Condensate Drain & Overflow: Size & Grade 37. Fur ce-Vent: Access -Comb. Air -Return -Air Vent -1 -- ------ -- -- --- ------ -- -------- --- - - -- --- - -------- ---------- -------- -----15 outlet- ---- - ----- Att cAccess & Platform if Furnance in Attic Date Card B Date Card -B- 1 Date Car -1 Date Card B-1 Date FRA"G (Plans) OK except N's .S. S' Proper material & Anchors IIs Studs -Nailing. Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing -- - ---- in ---- (rat------------------- ----------- ----- --- -- --------------------------------- aft Stop Walls proof) `4&I-Fire"Stops: Furred Ceilings -Stairs -Chases -Tub ------------- ---- --- -,�-B--------------- --------- 44..F1L�aders & Beam -Size & Bearing NO=V & Dy'plex) MING (Continued) ers-Post Caps -Anchors -Connectors Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng. lace Ties or Type A Flue -Fireplace Throat clearance c -- Access; Access; Size & Romex Protection -Draft Stop -Ins. Baffles rm. Windows or Exiting Doors -Sill Hgt. & Dimensions rhe Fire Protection Framing )oerty Line Firewall & Ooeninos ,t5K Ext/Doors-One 3' -Check Garage -3rd Story, 2 Exits (a�O.,t3tairs; Width -Headroom -Rise -Run -Landing -Fire Protection &M X5%. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer --------------- ------ -- _Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57_Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailing -Bolts 59. Insulation-Walls-Cei I i nos 60. Infiltration-Walls-Wi Date Card B-1 �_— Date Card B-1 Date Card B-1 Date Card B-1 Date If 6 FINAL -(Plans) OK except ff's %V E I. Steps -Door & Sidelight Protection -Landings Smoke Detector --------------- Furnace: Vents -Clearance -Comb. Air -Connector - Garage: Above Floor-Ducts-Mech. Protection ---------------- --- - --- 4. Bedroom Exiting - ----- t -G & Bath Fixtures & Tub Access -Spa - - Elec. Trim & S_u_bpanel: Breaker Sizes 67*1' 8 s & Rails 68 Fireplace Sto a learances-Hearth _ btT��Ffec. Outlets at Wood Panel: Int. & Ext. - --- 71� Ki Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance Elec. Outlets & 'Receptacles at Kit. Counter ------------ 7e' - Garage Fire Door: Swing -Landing -Closer 73 1CC.-Duct in Garage -Damper _ �a. Wlr. Htr.: Vents -Clearance -Comb. Air-Connector-P.R.V. - f1n Garage: Above Floor Mech Protection -T5/Plb. Ele_c. & Mech. Equip. Listed for Location 76. c. Receptacles in Garage: _.F.I.)-Romex Protection ------------ I ulation-Foa tic Yes Guard Rails & eck C ructi -Post Caps dn. Vents &Crawl Hole Door -Drainage &Wood -Earth Clearance Looked under Floor ----O Yes .P-Ifollowin mstld.: Drive 0 Yes ❑ No: Walks ❑ Yes 0 No: Planters ❑ Yes 0 No ------------------------------------ cco: Br n -Finish ------------- ------ -- ------------ --- A l: on I. trical, Plumbing Vents ove Ro A anc Fireplace. -Clearance to penings ---------- Water Well: Disconnec , e rica Plumbing ---- P'E'Exterior Elec_Trim: G.F.I. Receptacle-Underground— s1 Ventilation Throughout House --- -------- - lass Protection CerrecUons from Previous Inspections - dJ. Gas est -Meters Tagged: Gas -Electric — — ------ - - -------------- ------ ------------- --------- ter --& -- Sewer Connected -C/O to Grade -HD Approval ------------ - — — Energy compliance -Certificate -Other Certificates ------------------------------------------ ---- ---- Date Card B-1 (/3�► - Date Card B-1 Date Cand B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: C� COUNTY OF BUTTE DEPARTMENT OF PUBLIC 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 4Z- 'ERMIT N A routin inspection indicates that the following violations of County Ordinance exist the above address and should,be corrected. Please notify this office when orrection of work is completed. If you have any question pertaining to this mat er, or need additional explanation, please contact this office immediately. t r � 1 /1 - • fAi��7 1t- • .. •.r!�ii^-• �^!.:'"'ir"s...,zh-,.:�,<�-r �. ,.,.•ds�JF. ,. ,.i}''"...-n1�. 1 ti, COUNTY OF BUTTE •l BUILDING DIVISION .DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE L o d7- 92, qas 7 01NNE.R PERMIT NO.- Avoufinefinspectimn indicates that the following violations of Butte County Ordinances exist at . r the above:addr..ss and should be corrected. Please notify this office when correction of work' iscoapleted.11fyouhave any questions pertaining to this matter, or need additional explanation, please contact,this office immediately. 9y±y J Date Inspector ^''j ji t REV IGM. V .y `S, r� aa-/ j ...t+y��-•�ti-'*-�`li'Z��i� .' M"s�""7..-+"`i:PS� iV'1'�`'`i�'�,,w'. COUNTY OF BUTTE BUILDING DIVISION , DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - -(916).891-2759 County Center Drive, Oroville, CA - (9'16) 538-7541 p: 747 Elliott Road, Paradise, CA - (916) 872-6307 is CORRECTION NOTICE I• s. Loft -z: e OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation,, Please- contact this office immediately. 1 To 14 Nei. 1I✓SrALLe 3' PIr�M►T �� oP �/ 1 nCK �Arl, lks To A 12t is 4 -r �-A-RAes--t- vJ Ir,,�� - Date �/- ��_ Inspector REV 10/92 �'.'..�.-.e+.n..4;�r..<'--'�Lkcb-E'�"�.i...'#lin.y"L.r-.,+.a�4r'�+•,.`G�,i�+�..''��.•-�aE�,c„Rr..`�C"�'y.w'Y=+-•"'� * COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE OWNER PERMIT NO. ., A routine inspection indicates that the following violations of Butte County Ordinances exist at e the above address and should be corrected. Please notify this office when correction of work . J is completed. It you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. W0?; 510Qt 1N5TAc.1;Qi /ZG� Ty M L a2MIT ufZ OfSiAPN A l�SI— JNLLATIJ.J IaT IMS OF W00% S-,oV� 1N StAlI�C�o�J• Date �-� ?� Inspector f j ;W „r,,!�t REV 10192 COUNTY OF BUTTE - DEPAATMENT OF PUBLIC WORKS RMIT NO. 7 County Center Drive - Oroville, Califorhia 95965 - Telephone: 916/538-7541 92-4257 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 0402290-083 OWNER ZONING A-10 0 BUILDING PERMIT PHILIP LOPEZ TELEPHONE 891-8426 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1992 SYCAMORE LANE DURHAM CA 959386n6 1488 R80.352 M CONTT��TTTRACT��OTTR'S NAME TELEPHONE 234 coy O 3 042 CONTR1AOCTR'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN NONE Fireplace "All Total Valuation $ 1 500 802 LENDER'S MAILING ADDRESS - ARCHITECT OR ENGINEER LICENSE NO. NONE289.75 Filing Fee $ 15.00 Permit Fee Plan Checking Fee $ 579.50 $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ 20.00 Penalty $ BUILDING ADDRESS LANE,1920 SYCAMORE DURHAM Permit fee $ 904.25 PLUMBING PERMIT Filing Fee 15.00 Each Trap 9 5.00 45.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 7.00 Each Qas water heater or vent Gas piping system 1 - 5 outlets 7.00 7.00 5.00 5.00 USE OF STRUCTURE SF [:R Duplex] Mobilehome❑ Other SPECIFY Building sewer 15.00 15,00 Mobile Home S I G I W 615. TYPE OF WORK New® Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑ Describe work: 3BR Permit Fee a 94.00. Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS .501 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑FIXED 1, 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 200ATO1000A1 37.50 NEW CONST. / DWELLING OCCUP.�\ OR ACDNS. 1 ACC, BLDGS. II 3.6Qsq.ft. 73,50 NEW CONSTFL ULTI.OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS e� SINGLE OUTLET CIR. EX. OCCUp(OUTLETS OR FIXTURES 20 @ 76 APPLNS. OR EX. Occup. OUTLETS IRESID,I EA.) 3.00 Temporary service 15.00 15.00 Mobile Home Facilities 15.00 Misc. Wiring -15.00 Permit Fee $ 127.00 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 C6mpensation Insurance or a Certificate of Consent to Self -Insure. 1 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 .00 Cooling 116.50 Hood 6.501 6-90 Ventilation .50 Permit Fee $ 60.50 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 my in cons ence of the granting of this permit. X Date 2_, Signature of Ap Kant - 0- Zre❑ Contractor ❑ 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 $ Energy Inspection Fee $ 40.00 occ R3 CONST TYPE V -N I TOTAL FEE $ 1225.75 HA2 - 'D FEES X IMP - FLOOD X COF - PARCEL X PD X HD X ISS This This permit is hereby issued under the applicable provi- sionsns of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. TO OFPUBLIC WORKS By Date Z 3 PERMIT X I • S Date _ 2- "Z.-�� Receipt No. 300i)19 WNITC-D.P.W., YELLOW-A88(890R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENT ORDEVELOPMENT SERVICES - BUILDING DIVISION 1k 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER A%/1. Z- o A. P. No. -! 0 "2- 7 Proposed Building Use By A Building Inspector e.5 Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3_ Complete plans, S14 sets,'signed by preparer of plans . ...................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5.. Hazardous Material Form. . '.......................................... . 6. Energy Design Compliance and supporting documentation . .................. . K 7�Statement of Intent for Non -Heated and A/C Buildings. . ----8., Engineered truss details and layout in duplicate (required prior to plan check). .... /Z - z Z 9. Mobilehome data and manufacturers installation instructions, 2 sets. ........... 'Fees of $ . ......................................... Impact fees as shown on attached schedule. ......... 12. California Department of Forestry plan approval/fees......................... 13. Flood elevation letter (100 year flood) by California Engineer ................... 14. Sanitation and plot plan approval Gy/ �` Health Department .............. Wz 15. City of Chico plumbing permit . ............. 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ......... 18. Contact Land Development.about (A) Improvements (B) Drainage. .......... . 9. Driveway permit (construction approval required prior to occupancy). .. .. . 20. Pre -inspection for t. Bu Pre -Inspection request required. . . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . ......................... . 23. Owner -Builder Verification (Given to owner , Mail to owner _)........... . 24 -'Recorded copy of Agricultural Acknowledgement Statement . ..................; Z—z3 l 25. Letter of signature authorization . ......................................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. 'Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access. . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... )_ 31. Existing violations/expired permits . ...................................... 32. Plan check list......................................................� 33. -34. When you issue the permit, process as follows: VMail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other i Parcel Creation 23L,11. Acreage (;"k- ApplicanL Date 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 must be submitted prior 1. Index permit for above items No. 2. Additional items required: new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Dat Sets of plans on hold in File cabinet AP folder - Copy - Department of Public Works TO: Building Department FROM: Enyironmental Health SUBJECT: Sanitation Clearance venter Location Plan Approved for: Sewa,e Disposal Water Supply: Public Clearance for bedroom I Dome. Other Hold final for: Final clearance O.K. for. NOTE: Environntiental Health Specialist 8/92 --I:.n. I ISliesrE ONLY Il.d Iltw Attached I.7nur Ilan Ataiched— Sent to till). /s 7v -zP AP// Private Well 12,,,1 -7- Date TO: Building Department FROM: Encroachment Permit Section RE: Driveway Clearance r , owner locat on AP # Driveway permit g 2 h �0� has been issued for the above property. si ature date `Q-gUNT,Y OF BT= - DEPARTMEYT OF PUBLIC WORKS - BUMDING DMSION 7 cowry CZNTZR DRIVE - OROVILLE, CALIFORNIA 95963 - 7ELEP1,10NE (916)5387541 NER tii� G�:�G.-�? A. P. NO. S C OPOSrED BUMDING USE ��`� 2- DATE REC. DATE REC 1. School Distric Fees � ( paid at District Of fife ) __��, '��. She_-iff Fees V (paid at Building Department) Residential ......... ( 1 3 v 3mac% unit amt. Commercial(per sq.ft.) R' sq.ft. amt. 3. Urban Area Fees (paid at Building Department Residential (per unit) X =$ units amt. Commerical(per sq.ft.) R =$ sq.ft. amt. 4. Recreation Distr-ict Fees (paid at District Office) 3. Drainage District Fees (Contac. Land Development) 6. Other 7. Other time of permit application, I was advised the above fees are required to be paid pr issuance of the permit. TLICANT i �.�: ;� 7 �,,�' DATE-/ 2 " ��- uwn.er: !<_!/Joel.y-1y .r F.NF.RCY ICE"F7I4PVCATI0N LOCATION Permit A. P. A DESCRIPTION OF INSULATION k00F MATERIAL THICKNESS EXTERIOR*'WALL MATERIAL Fiberglass THICKNESS a CEILING BRAND NAME THERMAL RES. .BRA1&D NAME Certineed THERMAL RES.. BATT OR BLANKET TYPE—FIBERGLASS BRAND NAME Certineed, THICKNESS /D � THERMAL RES. 3(� LOOSE FILL INSULSAFE III BRAND NAME CERTAINTEED THICKNESS THERMAL RES. FLOOR—ELEVATED ' IK1lTERIAL Fiberglass THICKNESS FLOOR -SLAB INTERIOR WALL MATERIAL Fiberglass THICKNESS BRAND NAME Certineed THERMAL RES. BRAND NAME Certineed THERMAL RES. I HEREBY . CERTIFY THAT- THE ABOVE. INSULATION WAS INSTALLED IN THE ABOVE BUILDING IN CONFORMANCE WITH THE STATE OF CALIF. ENERGY REQUIREMENTS. HAWKINS IND..INCJdba SHASTA INSULATION LIC.#650722 Ihereby certify the above insulation and. all required items as shown on the building department approved plans and attachments have been installed .as. required by the State of California Energy Requirements. All egjipment,devices and materials are of the quality.. prescribed or are specifically approved by the St.a[e of Calif . FIRM-NNME/OWNER (PLEASE PRINT) . , STATE CONT. LICI, SIGNATURE OF GENERAL CON V OWNER DATE This c-ertificate must. be on file with the Buildin Dept. j and Dosted within the hui ldin6 _ g p. prior do Final a iAl..l. that. real pr.uperty situate in the CounLy of Butte, StaLe of California, c1c.-4cri.hed as "Follows: : 'COUNTY OF BUTTS BUILDING DEPT DE-: 2 9 4992 Da to PROPERT WNE S: State of 04t#',�rw:n On this the �day of Der- 19 SZ, before me, } SS. the undersigned Notary Public, personally appeared CounLy of 1 UAL ) / _ �1°PeZ E]Personall y known to Inc.- Proved to me on the basis of satisfactory ev.ideiic e. Eo be the person(.a) whose name(a) � J subscribed to the within instrument and acknowledged than tie_ executed the same for the purposes therein contained. r WITNESS WHEREOF, I hereunto set my hand and oCf:icial seal. Present. A.P. Nr). /_� " 2 70 3 Notary Public 92-56935 Inc Lurn AGR1(:ULTURAL STA`I'EMF.i4'C OF ACKNOWLL•DGEMLNT -, FOR RESIDENTIAL DEVELOPMENT `"ection, 16-8.1. of the Butte County Code re(11_11res Lhis acknmledgement be recorded I)rior to issuance of a building permit. The props rI. y described herein is ad jacerit 'land 92-0569 1 Rec Fee 8. 00 , to or included' within an area zoned I Check 8. 00 ['or' agricull ural. purposes, and residenLs Recorded of this pro porLy sty he suh jecL Lo incon- Official Records vc,n.i.rncrs or d i.scunfort air i sing from the County of I use of a gr.icul t..urall chemicals, including' Butte but. not, l.imiLcd to herbicides, pesticides, and fert.i I.i•rers; and from the pursuit Candace J. Grubbs I of agr.icuILural operations including, Recorder I but not. 1 im:i I.ed to cultivation, plowing, 11:04am 14 -Dec -92 I PUBL XX 2 spraying, prrrnin.gr and harvesting which -- - -- occasionally generate dust, smoke, noise, and odor. Butte County has established ag-r-ic..u.1- Lural zones which 'have as a priority use for productive agricultural purposes, and residowl ; within sa i.d zonesand on adjacent property should be prepared to accept such i nrunvMn i once Vr cliscomfor-L [roanaormal, necessary farm operations. iAl..l. that. real pr.uperty situate in the CounLy of Butte, StaLe of California, c1c.-4cri.hed as "Follows: : 'COUNTY OF BUTTS BUILDING DEPT DE-: 2 9 4992 Da to PROPERT WNE S: State of 04t#',�rw:n On this the �day of Der- 19 SZ, before me, } SS. the undersigned Notary Public, personally appeared CounLy of 1 UAL ) / _ �1°PeZ E]Personall y known to Inc.- Proved to me on the basis of satisfactory ev.ideiic e. Eo be the person(.a) whose name(a) � J subscribed to the within instrument and acknowledged than tie_ executed the same for the purposes therein contained. r WITNESS WHEREOF, I hereunto set my hand and oCf:icial seal. Present. A.P. Nr). /_� " 2 70 3 Notary Public CL E 0 U m r U a NJ LL co 0 Cl) } STATE OF CALIFORNIA !� }ss. COUNTY OF On /2— to Z before me, /taw 41 ,), 19, personally appeared C° r u -z. e: ka Pe -z-- personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that lae/sheAiwy executed the same in his/herAl*r authorized capacity(iee), and that by-Os/herAheir signature(s)-on the instrument the per's'ift1M-or•thsentity.upon ,behalf. of which the ..egos.. ea`�o• r� OFFICIAL SEAL i person(§) acted, executed the instrument. . ,D RDhI.=.LD D. CALLEN NOTARY PUBLIC _CALIFORNIA'; • WITNESS my hand an o ' al seal. �:�a BUTTE COUNTY' ^ 1 q My Comm. Exp. May 7, 1994 ^' Signature rJ " ......... (This area for official notarial seal) EN® OF DOCUMENT EXHIBIT "A" Ail that cer_ain real property situate in Butte County, California described -is ioliu.a. AN UNDIVIDED ONE-HALF INTEREST AND TO THE FOLLOWING: All that portion of Allotment 111, as shown on that certain Map entitled "Subdivisional Plan, Third Unit, Durham State Land Settlement", which Map was filed in the Office of the Recorder of the County of Butte, State of California, on March 26, 1923, in Boca 8 of Maps at Page 44, and more particularly described as follows: BEGINNING at a point in the Southerly line of said Allotment, from which point the Southwesterly corner of said Allotment bears South 75° 45' 00" West, 7.00 feet; Thence, through said Allotment, North 35° 28' 7.0" West, 344.33 feet; Thence North 71° 25' 18" East, 237.18 feet; Thence South 35° 48' 00" East, 364.35 feet to said Southerly line of Allotment 111; Thence South 75° 45' OU" West, 245.69 feet along s, -.id Southerly line to the Point of Beginning. Containing 1.85 acres, more or less. TOGETHER WITH an easement and right-of-way for road and public utility purposes 60 feet in width, lying Southwesterly and adjacent to the following described line; Commencing at a point in the Southerly line of said Allotment, from which point the Southwesterly corner of said Allotment bears South 75° 45' 00" West, 7.00 feet; Thence, through said Allotment, North 35° 28' 20" West, 709.14 feet to the Northerly line of sa4.d Allotment 111; Thence along said Northerly line North 66° 48' 00" East, 230.12 feet to the TRUE POINT OF BEGINNING of the following described line; Thence leaving said Point of Beginning and said Northerly line South 350 48' 00" East, 384.84 feet to the terminus of said line. .1 RESIDENTIAL PLAN CHECKING GUIDE (S.F., DUPLEX & MISC. ONLY) OWNERj� GENERAL �oning requirements: (sideyards and number Valuation. ans signed by designer. ProperPr description of work on application. ,',�xisting violations on property. 8/91 Bldg. Permit # 90 ,57 A.P. # Yo a - F3 Plan Checker 4-S of permitted living units). 6* Items on data sheet. (W.C., fees, Health, Developer Fees, License law, etc). .�ecorded notice of violation. PLOT PLAN f plete parcel size and dimensions. backs, sideyards, easements, etc. er buildings or structures.ding, fills, drainage. od hazard. cial conditions on creation map, tible, and foundations). FAU & FAS road setback. (noise, CDF, fire sprinklers, non -comb - Building or utilities across lot lines (Record form). FLOOR PLAN Complete to scale plan with dimensions. -Required windows for light and ventilation (Sec. 1205). Required windows for second exit (Sec. 1204). -Skylights (Chapter 34 & Sec. 5207). Human impact glass (Sec. 5406). Required room sizes, ceiling heights (Sec. 1207). GFCIs in baths, garage, kitchen, and exterior outlets (Article 210-8). Light fixtures, switches, receptacles, and exterior receptacles for main- tenance of mechanical equipment. Locations of water heater, heating and cooling equipment, other electrical or gas equipment. Garage firewall, door size, and closer (Sec. 503(d)(3)). 1 - 3'0" exterior exit door (sec. 3304 (f). Fireplace and wood stove location, alcoves, and clearance. Smoke detectors (Sec. 1210). Plumbing fixtures, water closet clearances and shower size. STRUCTURAL DETAILS Standard bracing or engineered design (Table 25V) Unusual shape, size, or split level house requiring lateral design. Clerestory requiring balloon framing and/or engineering. Three story building requiring engineered calculations and plans. Foundation plan complete enough to construct building. loor construction details complete enough to construct building. levations and wall construction details complete enough to construct Roof construction details complete enough to construct building. Fireplace construction details and calcs if necessary. Rafter ties or bearing ridge beam. Garage door or porch header sizes. S ud heights. Adobe soils - special foundation design. . Retaining walls requiring design. Special Inspection required. building 8/91 RESIDENTIAL PLAN CHECKING GUIDE MISCELLANEOUS ITEMS TO LOOK OUT FOR Stairway details: landings, rise and runs" head clearance, handrails :ec. 3306). Guardrail details (Sec. 1711 & 3306(j). ick or stone veneer (Chapter 30). E terior plaster - weep screeds (Sec. 4706). Proper roof pitch for roof convering (Chapter 32). -6. Roof covering type - (fire hazard). —7. Foam insulation - protection. 36" halls and stairways. A Living area over garage - complete 1 -hour separation required on garage side including supporting walls and posts, etc. X1(5' e exits on three-story dwellings (sec. 3303 & see Mezannines - 1716). Attic access and ventilation (Sec. 3205). 11-2 Underfloor access and ventilation (Sec. 2516). 44'. --Combustion air for fuel burning appliances - L.P.G. requirements. U. Noise requirements on duplexes. Energy design. Flashing at all exterior openings. . OF responsible area requirements. ;,�dt.-1��z?+,�;.�c,•� Cyt..._.-..;.,,..,-„.-.�-�yr'r-�-CYT-•s•-sr'��-.w.-.-�,o-.--..--,.r,�.,.,tiMav�rrR--yl,+•,c....�eys I,r`''r'+"'”�x�"S'�S',ec-bt)�.��Mr�..«?w+.6�'tf4 "Zr�'°f'yuiE' .c BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District uJu Hi641 Building Department No. 4C, A.P. Number 4L'710 ' VO, Dei Jurisdiction City E�I�County a Property Owner L f ,o a Property Location/Address u l',q .-4 0 4 C- C. :✓ �J /L ,A.�.-4 Subdivison Residential Development r` Commercial/Industrial r No..of Living Units Lot No. r 0 0 Sq. Footage MHI Addition (Group R)� i. et New, I 'Sq. Footage Addition\ (Including Exterior Roofed Areas) oe Building Dept a entative— a ' Date (Floor Plans reviewed by School District Personnel) District Identification No. .b4cr17AM 1/o1z,,L C School District certifies that (Applic nt) (Street Address) t (Ph'one Number) (CRY) (State) �. (Zip Pode) has complied with the requirements of Resolution No. 9� ' � fb Payment of $ 5. i representing /��'� square feet. $ ! School Dist */- Representative f�� Dates Paid by Check Number t r`'n Remarks: Bank Number54 / 1 Paid by Cash If, subsequent to'the School District Representative signing this Butte County Schools Impact Fee Certification Form, the ScFiool Districtiis notified by the applicable Local Planning Agency that this project is being reviewed under t6 Califorr is Environmental Quality Act (CEQA), this.project may be subject to ' additionai school fees to;fuliy mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pi k (school district) feeformmkf (4/92) S `9 -' ".:R.:, '� ut;f :....�`– .:.s�t� ,,.��s..l _'.•,,LT.h.��Ylit�il COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916,'538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 040-290-083 ZONING A-10 BUILDING PERMIT OWNER - Phillip Lopez168 TELEPHONE 891-8426 .SQ. FT. OCC. BUILDING VALUATION Open 1,176.00 OWNER'S MAILING A ADDRESS 1992 Sycamore Lane, Durham 95938 CONTRACTOR'S NAME Unknown TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER None_ UNKNOWN Total Valuation 1$1.176.00 Filing Fee. $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $25.50 ARCHITECT OR ENGINEER iTECT LICENSE NO. Plan Checking Fee $ Ener Plan Checking 9Y g Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 40.50 PLUMBING PERMIT FilingFee 15.00 9iQ C81DOr@ I ails Durha>i 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 a 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 a Addition LX,` Remodel L; Utilities ❑ InStallationC Other ❑ Describe work: Deck RE: .P. #92-4257 Permit Fee $ Contractor ELECTRICAL PERMIT FilingFee 15.00 Main service 600VORLESS 18.50 200A OR LESS Main service 200A TO I000A) CONTRACTORS LICENSE LAW I declareunder penalty of perjury (check one): r I am licensed under provisions of Chapt. 9, Div. 3 of the Business 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) Q' 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 _37.50 OCCUP.E,\ 3.6Qsq.ft. NEW CONST. ( DWELLING OR ADDNS. ACC. BLDGS. II 1 NEW CONSTR.TI UL.OUTLET NON-RESID BRANCH CIRC ITS @ 5.0° /POWER APPARATUS e 1 SINGLE OUTLET CI R. 20 7611 Ex. Occup(OUTLETS OR FIXTURESFIXED APLNS. Ex. Occup. OUTLETS P(RESIO )REA.1 I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 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. � l 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 becomesubject 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 FilingFee 15.00 Heating 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. 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 said County in consequence of the granting of this permit. X - ` "✓ —Date r i Contractor Agent signature of Applicant — y Owner1�3 e_F"" ❑ ❑ 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 $ 0cc CONST TYPE TOTAL FEE $ 40.I HAz 1 11 FEES IMP I FLOOD I CDF PARCEL I PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR -OF -PUBLIC WORKS //� r/^ 7. e i ,1'x/2 r' '';� /17 � By Date u PERMIT EXPIRES Date t' ••- Receipt No. I ! I �li WNITE-D.P.W., YELrLOW-ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P. 7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. .3 -- 9-z ASSESSOR PARCEL NUMBER 040-290-083 ZONING A-10 All; 0 BUILDING PERMIT OWNER Phillip TELEPHONE 891-8426 SQ. FT. OCC. BUILDING VALUATION 168 0 en 1,176.00 AO OWNER'S ILING ADDRESS ..\:992 Sycamore Lane Durham 95938 CONTRACTOR'S NAME Unknown TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER None UNKNOWN Total Valuation 1$1,176.00 Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ 25.50 ARCHITECT OR ENGINEER . None LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 40.50 PLUMBING PERMIT Filing Fee 15.00 192n Sycamorp Lane, Durham Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF [J Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home I S I G JW11 @ 15.00 TYPE OF WORK New r Addition Y Remodel ❑ Utilities ❑ Installation[] Other ❑ Describe work: Deck RE: B.P. #92-4257 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200A OR LESS 18.50 Main service 200ATO1000AI 37.50 CONTRACTORS LICENSE LAW I d�la �.w penalty of perjury (check one). e / V-7am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License ;Jo. 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 NEW CONST. ( DWELLING OCCUP.&\ OR ADONS. ACC. BLOGS. // 3.64 sq.ft. NEW CONSTFL ULTI-OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS BI (SINGLE OUTLET cIR. Ex. Occup(OUTLETS OR FIXTURES 764 20 464 FIXED APLNS. Ex. Occup. OUTLETS P(RESID )KEA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. bVirin g 15.00 Permit Fee $ — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): e permit is for $100.00 (valuation) or less. `I. Vhaveplaced on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. 1 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 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, a expenses which may in any way accrue agaM;Znty in c segue of the granting of this permit.X ate Z 4 3 Signature of Apply ant — Owner Lff Contr -cOr ❑ 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 Ener Inspection Fee Energy P $ OCC CONST TYPE TOTAL FEE $ 40.50 HAz OFEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees By DI C PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date 4&!A Receipt No. 7� WHITE•D.P.W.. •E LO�W-ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT C V COUNTYOF BUTTE - 8EPARTMENTOf DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTYCENTER DRIVE - OROVILLE, CALIF OR95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER �� _ A. P. No. 7 Z�7 a� Proposed Building Useq" �� ^> .Y ZS7- ?"Lluilding Inspector Date 4,- Z Z S n At time of permi pplication, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted. .... .................................... 2. Plot plans, 3/4 sets, signed by preparer of plans. ... .. ........ ` ..... . 3_ Complete plans, 3/4 sets, signed by preparer of plans. ......t ................. r .4. Engineered plans and calcs, 3/4 sets,:with wet signature on plans . ............. 5.. Hazardous Material Form . .............................................. .6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $........................................... 11. Impact fees as shown on attached schedule. ............................. . 12. California Department of Forestry plan approval/fees. ............ . ........... 13. Flood elevation letter (100 year flood) by California Engineer ................... 14. Sanitation and plot plan approval Health Department . 15. City of Chico plumbing permit . ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development.about (A) Improvements (B) Drainage. ... ...... . 19. Driveway permit (construction approval required prior to occupancy). .. . . 20. Pre -inspection for required. .. oe�°�d gclon lnveduesto (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance. .......*............... 23. Owner -Builder Verification (Given to owner , Mail to owner _)............. 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization. ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . .......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . .................,.. ............. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits.. ..................................... . 32. Plan check list . ..................................................... 33. .34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. eliver with inspector. Other Parcel Creation Acreage Applicant ~ Date �5' 2 Z 3 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 must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works Ceiling insulation F2%cmr 0.90 Number of stones -3 .1 R -value One Two Three R-0 -103 -49 -32 R-19 -8 -4 .2 R-30 •2 -1 0 .1 0 1V38 0 12 3 U -value na Percent 3 0.50 -176 -84 -54 0.30 -102 -49 32 0.10 -26 .13 -8 0.08 18 -9 - 0.06 --4 2 -6 37 -26 0.0 2 .1 1 0.022 0.00 4 11 5 3 -19 -9 1 10 Wall Insulation -61 -21 -13 Single- Single- 12 29 Famiiy Family Muiti- R-value - Detached Attached Family R-0 -68 -51 -34 R-11 0 0 0 R-13 2 2 1 R-19 8 6 4 U -value .1 7 14 0.80 -153 -114 -76 0.50 -91 -68 -46 0.30 -47 -36 .24 0.10 0 0 0 0.08 4 3 - 2 0.06 9 7 5 0.04 14 11 7 0.02 19 14 10 0.00 24 18 12 31 -6 0 5 Raised Floor Insulation 16 19 Insulation In Floor -4 1 6 Number of stones 16 R -value One Two Three R-0 -17 3 .5 R-1 t -3 .2 .1 R-19 0 0 0 R•30 3 1 1 U -value . .17 1 . 0.60 -144 .70 -46 0.50 -120 -58 -38 0.40 -95 -46 30 0.30 39 34 -22 0.20 -43 -21 :14 0.10 -17 -8 .5 0.08 -11 -6 -4 0.06 -6 -3 .2 0.04 .1 0 .0 0.02 4 2 1 0.00 10 5 3 Controlled Ventilation Crawlspace 20 8 Number of stones 12 R -value One Two Three R-0 -11 -7 .5 R.5 -4 -4 3 R-11 .2 -2 -2 R-19 .1 .2 .2 Slab Edge Insulation Type Type • Number of Stoties 2699 R -value One Two Three R-0 0 0 0 R-5 8 5 2 R-7 8 6 3 F2%cmr 0.90 -4 -3 .1 0.80 .1 •1 0 0.70 2 22 0.60 6 0 0.50 9 - S. Infiltration (Air Leakage) 7. Shading (Shade Open) Effective Pa t Glass (percent glass x SC) Effective Specification -48 -69 Points North East South West Standard 18 5 1 4 1 0 16 6. Glass Heat Loss 2 5 1 na 14 Total 2 5 1 na . 12 3 1.1 -value na Percent 3 3 5 2 .51 to .41 to .31 to 0.30 or Glass Single Double .60 .50 .40 less 50 -121 -53 -39 -24 -10 4 40 -90 37 -26 -14 .9 8 35 -75 -29 -19 -9 1 10 30 -61 -21 -13 .4 4 12 29 -58 -20 -12 3 5 12 28 -55 -18 .10 .2 5 13 27 -52 -17 -9 -2 6 13 26 -49 -15 -8 .1 7 14 25 -46 -14 -7 0 7 14 24 -43 -12 -5 1 8 14 23 -40 -11 -4 2 8 15 22 -37 -9 .3 3 9 15 21 34 .7 .2 4 10 15 20 31 -6 0 5 10 16 19 -29 -4 1 6 11 16 18 .26 3 2 7 12 16 17 -23 -1 3 8 12 17 16 .20 0 4 9 13 17 15 .17 1 6 10 14 17 14 -14 3 7 10 14 18 13 -12 4 8 11 15 18 12 •9 6 9 12 15 19 11 -0 7 10 13 16 19 10 3 9 11 14 17 19 9 .1 10 13 15 17 20 8 2 12 14 16 18 20 7. Shading (Shade Open) Effective Pa t Glass (percent glass x SC) Effective -14 -48 -69 %Glass North East South West Skylight 18 5 1 4 1 na 16 4 2 5 1 na 14 4 2 5 1 na . 12 3 3 5 2 na 11 3 3 5 2 na 10 2 3 5 2 1 9 2 3 5 2 2 8 2 3 5 2 2 7• 1 3 4 2 2 6 1 3. 4 2 3 5 1 2 4 2 3 4 0 2 3 1 3 3 0 1 2 1 3 2 '0 0 1 0 3 1 -i -1 .1 .1 2 0 .1 •2 .4 -2 0 na 3 not allowed 4 6 8 8 S. Shading (Shade Closed) 3.5 2 5 7 9 Effective Pei c It Glass 10 4.0 3 (lP�t ttim x SC) - Effacbm Ghn Norio Est South West Skftl 18 -14 -48 -69 •64 na 16 .12 -42 -59 -55 na 14 -10 .35 -50 -46 na 12 -8 •29 -40 37 na 11 -7 .26 -36 .33 na 10 -6 .23 -31 -29 -74 9 -5 •20 -27 -25 35 8 .5 -17 -23 -21.. -56 7 -4 -14 -19 -18 .47 6 •3 -11 -15 -14 -3 5 .2 -9 •11 -10 -30 4 .1 3 -8 -7 •23 9. Interior Thermal Mass SC Intenor 1.3 Stab Floor Raised Floor SEER Mass 6.0 Stories Stories = (astatine, ducts /CFA One Two Three One Two Three 0.0 -8 -5 -4 .2 -1 .1 0.1 -8 -5 3 -1 0 0 0.3 -7 -4 .2 0 1 1 0.5 -6 -3 -1 1 1 2 0.7 -5 -2 -1 1 2 2 0.9 -5 -1 0 2 3 3 1.1 -4 .1 1 3 4 4 1.3 -3 0 2 3 4 5 1.5 -3 1 2 4 5 5 2.0 .1 2 4 5 6 7 2.5 0 3 5 7 7 8 3.0 1 4 6 8 8 9 3.5 2 5 7 9 9 10 4.0 3 6 8 9 10 10 4.5 3 7 8 10 - 11 11 5.0 4 7 9 11 12 12 5.5 5 8 9 11 12 12 6.0 5 8 10 12 '13 13 6.5 6 9 10 12 13 13 7.0 6 9 11 13 13 14 7.5 6 10 11 13 14 14 8.0 7 10 11 13 14 14 8.5 7 10 12 13 14 15 10. Exterior Wall Thermal Mass -0 Exterior Sirtpls- Satgle- blind .4 -4 Wall .2 Famly Farr@ 7.0 0 Masa 0 Detached Attached Family 0.00 9 0 0 0 4 0'203 9.0 2 5 3 9 0.40 0.60 5 8 6 4 19 16 0.80 1.00 10 10 8 13 10 5 7 26 1.20 15 13 12 8 12.0 1.40 26 12 13 9 9 1.60 33 10 13 12 15 1.80 1.9 10 . I zoo 8 7 10 11 13 3 11. Heating System rlo Coolln; System Installed 4.3 4.S _Stories SE or 15SPF 5.1 5.3 5.5 5.7 (manner duets In &UW •5 •4 •4 .3 -2 Sum of 14 Two + 3 3 2 2 .25 or .24 to .14 to -4 to +6 to 16 or SE HSPF less -15 -5 +5 _+15 more 0.72 6.60 0 0 0 0 0 0 0.75 0.80 6.88 7.33 3 3 . 3 2 8 7 6 5 2 4 1 3 0.85 0.90 7.79 8.25 13 11 10 8 17 15 _ 13 i t 7 _ 9 .. 5 ' 7 0.95 8.71 20 18 .. _ 15 : 13 " Type Type Effective SE or HSPF 2199 2699 (SE or HSPF x duct efndency) Effective -25 or .24 to -14 to -4 to +610 16 or SE HSPF less 45 -5 w5' +15 more 0.30 2.75 .73 34 46 -47 -38 30 na 3.41 .45 -39 -34 -29 -24 -18- 0.40 3.67 34 30 •26 -22 .18 .14 0.50 4.58 -10 -9 -8 '-7 •5 -4 0.56 5.13 0 0 0 0 0 0 0.60 5.50 5 5 4 3 3- 2 0.70 6.42 17 15 13 11 9 7 0.80 7.33 25 22 19, 16 13 10 0.90 8.25 32 28 24 20 17 13 1.00 9.17 37 32 28 24 19 15 4.2 Zonal Control Adjustment -25 -16 System Type -8 _ Resistance 10 9 7 6 4 3 Other IG 6 5 4 3 2 2 12. Cooling Syst• m SC Eff. % Qlass 1.3 X SEER 'b 6.0 TYPE I MA9s (UIMC + 4.2, fee exposed •1_b) = (astatine, ducts In attic) X Sim of 7-10 X tC.fAt.O .�.bl a.Sl .25 or .+2410 x1410 -4 to +6 to 16 or SEER less -15 4 +5 +15 moa 8.0 -14 .12 .10 -8 •6 -4 8.5 -9 .7 -6 -5 -4 -3 _ 8.9 -5 .4 -4 .3 •2 .2 9.0 -4 3 .3 -2 -2 -t 9.5 0 0 0 0 0 0 10.0 4 3 3 2 2 1 10.5 7 6_ 5 4 3 2 11.0 10 9 7 6 4 3 =. 120 15 13 11 9 7 5 3.8� 20 17 14 12 9 6 _13.0 57 107E 0.2 0.4 0.6 0.6 1 Effedve SEER 1.4 1.6 1.9 (SEER xduct of Ideney) Z3 ZS 2.7 Scan of 7-10 S1 3.3 Effective -25 or -24 b -14 b -410 +6 b 16 or SEER leu 45' -5 +5 +15 more 5.0 -30 -25 21 -17 -13 9 6.0 -12 -11. -9 -7 -0 -4 6.6 -5 .4 -4 -3 .2 .2 7.0 0 0 0 0 0 0 8.0 9 8 6 5 4 3 9.0 16 14 12 9 7 5 10.0 22 19 16 13 10 7 11.0 26 23 19 15 12 8 12.0 30 26 18 14 9 13.0 33 29 24 20 15 10 1.9 Zonal Control Adjustment 2.4 I 10 8 7 6 4 3 3.B rlo Coolln; System Installed 4.3 4.S _Stories 4.9 5.1 5.3 5.5 5.7 One •5 •4 •4 .3 -2 -2 Two + 3 3 2 2 2 1 32 3.4 3.6 3.B 4 Single -Family Detached and Attached 4.5 4.0 Unit Size (sQ 5.3 Water 5.7 .199 1204' 1700 22W 2700 Heater U;edit or -1 to to to - or Type Type less. 11699 2199 2699 more SG None 0 " 0 0. 0 0 or Solar12 ' ` 8 6 5 4 0.9 HP HWR _ � 8 5 4 3 3 Z4 2.5 WSB 5• 3 3 2 2 19 4.1 POU 8 5 _ 4 3 3 5.3 SE None 37 -24 •18 -15 -12 _ 1.4 S014 -1 •1 .1 .0 0 2.7 Z9 HWR -18 -12 -9 -7 -6 4.2 WSB. -25 -16 -12 -10, -8 _ POy -111. _-12 -9 .7. -6 IG None =5 .3 .2 .2 -2 Z4 Solar 7'. 5 •a 3 2 3.6 POU 3__....? 1 1 1 i fE None -28 -19 -14 -11 .9 6.1 Solar - 8 5 4 3 3 1.8 POU -10 3 •5 -4 -3 3.1 Multi-FamilI (individual units) 3.5 3.7 3.9 Unit Size (6f► 4.3 Water 4.8 699 700 1200 1700 2200 Heeler Credt or bb 6 A .10 or Type Type leas 1199 1699 2199 more SG None 0 0 0 0 0 or Solar 14 7 5 4 3 HP HWR 9 5 3 2 2 6.5 WSB 9 4 3 2 2 POU 9 5 3 2 2 SE Note -A5 •23 -15 -11 .9 Solar. 2 1 1 0 0 HWR -23 -12 .8 -6 -5 1.6 WSB .25 -13 -8 •6 •5 2.6 _PQU -12 -8 -6 -5 IG None -8 -4 •3 -2 ; •2 5.4 _ lar 6 3 2 1 1 Interior Mass/CFA '. TTI[ 2 PASS U. T.VtK•t. 21 SC Eff. % Qlass 1.3 X = 'b 6.0 TYPE I MA9s (UIMC + 4.2, fee exposed •1_b) = 3 3 X X tC.fAt.O .�.bl a.Sl X TYPE 1 MASS AREA s 8 COND. FLOOR AREA InteriorMiss/CFA TYPE 2 MASS 0% 5% 10%. 15% 20% 25% 30% 35% 40%.45% 50% 55% 60% 69% 70% 75% Box W. 00% 95% IW% 105% 110% 1151: 120% 12`. 0 0.2 o.4 o.6 0.6 1.1 1.3 1.5 1.7 1.9 21" Z3 2.5 2.7 Z9 3.2 3.4 3.6 3.8� 4 4.2 4.4 4.6 4.8 5 57 107E 0.2 0.4 0.6 0.6 1 1.2 1.4 1.6 1.9 Z1 Z3 ZS 2.7 2.9 S1 3.3 3.5 17 4 4.2 4.4 4.6 4.8 S 5.2 54 20% 0.3 0.6 0.6 1 1.2 1.4 1.6 1.e 2 Z2 Z4 27 Z9 3.1 13 3.5 3.7 3.9 4.1 4.3 4.5 4.8 5 5.2 5.4 5E 30% 0.5 0.7 0.9 1.1 1.4 1.6 1.6 2 22 Z4 Z6 28 • 3 3.2 3.5 3.7 39 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 Se 40Y. 0.7 0.9 1.1 1.3 1.5 1.7 1.9 Z2 2.4 26 2.3 3 3.2 3.4 3.6 3.B 4 4.3 4.S 4.7 4.9 5.1 5.3 5.5 5.7 5.9 1.1 1.3 1.5 1.7 1.9 Zt Z3 US- Z7 3 32 3.4 3.6 3.B 4 42 4.4 4.5 4.0 5.1 5.3 5.5 5.7 5.9 6.1 50% 0.9 55% 0.9 1.1 1.4 1.6 1.8 2 Z2 Z4 2.5 Z6 3 3.2 3.5 3.7 19 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 5.6 6 62 60% 1 1.2 1.4 1.7 1.9 21 13 Z5 2.7 Z9 3.1 33 3.5 3.8 4 4.2 4A 4.6 4.6 5 S.2 S.4 5.6 5.9 6.1 62 1.1 1.3 1.5 1.7 1.9 22 Z4 2.6 ZB 3 3.2 3.4 3.6 3.6 4 4.3 43 4.7 4.9 5.1 5.3 S.S 5.7 5.9 6.1 6A • 65% 1.2 1.4 1.6 1.8 2 Z2 Z5 Z7 2.9 3.1 13 3.5 3.7 3.9 4.1 4.3 4.6 4.8 -5 5.2 5.4 5.6 58 6 6.2 6 A 70% 1.9 Zt Z3 Z5 27 3 3.2 14 3.6 3.8 4 42 4.4 4.6 4.B 5.1 5.3 SS 5.7 5.9 6.1 6.3 6.5 75% 1.3 1.5 1.7 B0'r. 1.4 1.6 1.8 2 Z2 2.4 ZB 2.6 3 3.3 3.5 17 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 5.6 5.8 6 6.2 64 66 65%1.4 1.7 1.9 2.1 Z3 25 2.7 2.9 3.1 3.3 3.5 10 4 4.2 4.4 4.6 4.6 S 5.2 54 5.6 5.9 6.1 6.3 65 6 7 9o%, 1.5 1.7 2 2.2 14 Z6 2.8 3 3.2 3.4 3.6 10 4.1 4.3 4.S 4.7 4.9 5.1 S3 5.5 5.7 5.9 &2 $A 66 68 95Y. 1.6 1.6 2 22 15 2.7 Z9 3.1 33 3.5 3.1 99 4.1 4.3 4.6 4.8 S S.2 S.4 5.6 &1 6 6.2 6.4 6.7 69 1007E 1.7 1.9 11 .2.3 ZS Z6 3 3.2 3.4 3.6 3.0 4 4.2 4.4 4.6 4.9 S.1 S.3 SS S.7 S.9 6.1 U 63 6.7 7 105% 1.0 2 Z2 2.4 Z6 Z6 3 3.3 3.5 11 3.9 4.1 4.3 4.5 4.7 4.9 S.1 5.4 5.6 5.8 6 &2 6.4 6.6 68 7 11070 1.9 11 2.3 2.5 Z7 Z9 3.1: 13 3.6 3.8 4 4.2 4.4 4.6 4.6 5 52 5.4 5.7 SA &1 6.3 &S 6.7 69 7.1 115% 2 2.2 2.4 2.6 ZB 3 3.2 3.4 3.6 3.6 4.1 4.3 4.S 4.7 4.9 5.1 5.3 5.5 5.7 5.9 6.2 $A 46 6.8 7 7.2 120% 2 2.3 Z5 2.7 19 3.1 3.3 3.5 3.7 3.9 4.1 4.4 4.6 4.6 S 5.2 5.4 5.6 50 6 &2 6.S 6.7 6.9 7.1 71 125% Zi Z3 Z5 ZB 3 3.2 3A 3.6 3.8 4 42 4.4 4.6 4.9 5.1 S.3 S.5 5.7 5.9 V 6.3 6.5 6.7 7 7.2 7.4 Point System Summary: Climate Zone 11 SCORE CARD Measures 1. Ceiling Insulation 1� or R -value [381 U -value [0.030] 2. Wall Insulation or R-% ue [11] U -value [0.098] 3. Raised Floor Insulation pig or R -value [ 191 U -value [0.037] 4. 'Slab Edge Insulation S. Infiltration 6. Glass Heat Loss 7. Shading (Shade Open) . a. North b. East c. South d. West e. Skylight S. Shading (Shade Closed) a. North b. East c. South d. West e. Skylight 9. Interior Thermal Mass 10. Exterior Wall Mass 11. Heating System Zonal Control? ( Y / N ) 12. Cooling System Zonal Control? ( Y/ N ) or R -value [01 F2 facia [0.77] Standard Type [double] U -value [0.65] % Total Glass (16] % Glass SC Eff. % Glass 1.3 X 72= /, o a 5•0 X = 3.8 3- X 2,--, 3 X = X. = % Glass SC Eff. % Qlass 1.3 X = 'b 6.0 X = 3 3 X X _ a.Sl X TYPE 1 MASS AREA s 8 COND. FLOOR AREA InteriorMiss/CFA TYPE 2 MASS AREA t. 6 Exterior Wall Mass ND. R AREA X SE or HSPF Duct Efficiency [0.78] Effective SE or (0.72/6.6 HSPF [0.56/5.15] r X _ SE ..5] Duct Efficiency [0.741 Effective SEER (7.03] I P6int Scores '00 Sum 1.6 ;ertificate of Compliance: Residential Climate Zone 11 roject Title roject Addren /17, ocumentation Author BUILDING DATA :ondition o ea Pr .lab iced Floor Single Family Detached (SFD) ] Single Family Attached (SFA) ] Multi -Family (MF) . Number of Stories Number of Units I ] Addition Alone [ j Existing Building [ ] Existing -Plus -Addition I UILDING SHELL INSULATION ;omponent Insulation LocatioQ/Comme= `voe R -Value (aaia. to garage. tvpizaL VaU . Vail ............. 000f ............. t7 goof ............. Zoor............ ;lab Edge..... 'aLAZING ",laving Area Glass Type ,torch L forth ( ) ✓asst ( ) past ( ) ;ouch ( ) ;ou th ( ) 'Jest ( ) vest skylight....... THERMAL MASS 'ype/Covering Area Thickness slab/exposed, tile. etc.) (SO (inches) Location/Description (kitchen. bath. -eta.) - Shading Devices Interior . Exterior 9,12,-ela.57 Building Permit # 4,s i-- Z14.;5— Cbecked By/ Date Enforcement Altency Use Only Glass Area % Glass North o2 East South West SkylightO Total J�� /1? Overhang Framing Type iVAC SYSTEMS Minimum Duct "ype (furnace. air Efficiency Location Duct Output Manufacturer / Model # onditioner, heat site) (SB. SEER.HSPF) (attic, etc.) R -Value tut or approved al . _ 9G daximum Furnace Heating Output: Btuh 30T WATER SYSTEMS Tank Manufacturer/Model # ;vstern Tvpe (storage gas, etc.) Capacity_ (_or approved equal)_ _ Special Feature(s) �ea,#e e5k5 � M9, Mandatory Measures Checklist: Residential MF -1R NOTE: Lowrise residential buildings subject to the Standards must conuin these atrasttres regardlea of Ute Compliance approach used Ivens marked with an asterisk (') may be =Pawded by mac stnegett compllana requueatetts listed on the Certificate of Compliance. when this checklist is intarperated into the permit documents. the features [toted &MU be considered by all parties as binding minimum component performance spoafie:46 its ror the mie dawry measures whether they are shown elsewhere in the documents or on this chocklia ash. DESCRIPTION DPSIGNIM eoaaCFJdwr Building Envelope Measures 12.5352(a): Minimum ceiling insulation R-19 weighted avenge. 12.5352(b): Loose rill insulation manufacturer's labeled R -Value. 12-5352(c): Minimum wall insulation in framed walls R-11 weighted average ([toes not apply to exterior mass walls). 12.5352(k)r Slab edge insulation- water absorption ram no greeter than 0.3%. water vapor transmission tate no greater than 2.0 pe mfinch. 62-5311: insulation specified Of installed meets California Energy Commission (CEC) Quality standards. Indicate type and forth. 12.5352(rk Vapor barriers mandatory in Climate Zones 14 and 16 only. 12.5317: lnfiltration/ExfJtntion Controls L Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c Doors and windows wotherstripped: aU joints and pertetations caulked and wake 12.5352(cy Special infiltration barrier installed to comply with 12-5351 mom CEC quality standards. 12-S352(d): installation of Fireplaces 1. Masonry and factory -built ruopla= have L Tight rotting. closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous butrning gat pilots allowed. HVAC and Plumbing System Measures 12-5352(g) and 2-5303: Space conditioning equipment sizing: attach nlalatiotts. 12-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. 12-5316(a): Duets constructed. installed and insulated per Chapter 10. 1976 UMC. 12.5316(b). Exhaust systems have damper controls. 12-531a(c): Gas. rued space heating equipment has intermittent ignition devices. 12-5314: HVAC equipment. water heater. showerheads and (assess certified by the CEC. 12-53520' water heater insulation blanket (R-12 or greats) a combined interior/ex insulation (R-16 or greater): fust 5 feet of pipes closest to tank insulated (R-3 or greats). 12.5312(Exccption 1): Pipe insulation on steam and steam condensate return h reciraolatirtg piping §2-53 19(d): Swimming Pool Heating 1. System has. a. ONO(( switch on heater. b. weatherproof instruction plate on heats. c. Plumbed to allow for solar. 2. 75 percent thermal efriciency. 3. Pool cover. 4. Time clock. , 5. Directional water inlc. - Lithting and Appliance Measures 12-5352(j): Lighting - 25 hum cwwatt or greater for general lighting in kichem and bathrooms. 12-5314(c): Gas fired appliances equipped with intermittent ignition devices. 12.5314(a): Refrigerators, refrigcater.freezers, finerers and fluorescent lamp ballastsce oftad by the CEC. Indicate make and model numbs. COWLIANCE STATEMENT This certificate of r M piiance list's the building features and paformance specifications needed to comply with 'Title 24. Chapter -2-53 Mad Title 20. Chapter2. Subchapier4. Article l of the California Administrative Code. This Mnifi=e has been signed by the individual with overall design Msponsibility and the building owner. who shall Main a COPY of it and transmit the Certificate to any subsequent ptmc ta=r of the building. Designer - Building Owner Name Nttntc- Title/>+irrr>: TitW!`um: Addles:: Addm= Telephone Tekphsonc gfl- X"-t- Lic. g: (signamm) (date) (flgnatute) (date) Documentation Author Enforcement Agency N■..... Name-