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040-310-085
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A - r0. �t �!. iili Lti 'ft 1 h ��- it t+i � l i•i• £ �, s 3 1 � t+ j 1 L C' �3 NOTES RESIDENTIAL - -- 03_72 PERMIT N(- C�L�, 040-310-085 /0 C SANpHILL CT, CH CO Cont: UNKNOWN SATELLITE ANTENNA SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE. REQ. FIRE SPRINKLERS~ REQ... SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER .r' 1. . OFFICE COPY t Address t � S tGAS Meter By Date ELECTRIC a Meter By Date L JOB FINALED (Date)�� Signature •. � �� � .. ... -• •� • M1 t � � � ir._� • . _ _ .. ... . . ` C �• I , - - .. � � . t ' � � i � � '4 •-✓ I .. 1 , � � 4 1 1: ' qN ' � _ t, - • Y _4i> 1 1 < • � a ��. • 1 \ 1 - �� , , '�'� iU h:. � .. :., 4 � 1 4r ... l ♦ � ' , � .r 1 1 ' 1 r- I J=OK o = NotOK Applicable = Not Applicable RESIDENTIAL (Single & Duplex) . = Not Ready 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Dat - Card B- Date Card B-1 Date PLUMBING (KeEA OK except #'s 17. W r Htr.; Vent -Access -Combustion Air Baffle 1 r Pipe; Test & Anchor -Nail Protection 9 .W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors ' • 23. Fire Sprinkler; Test , Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECT L (Permit) OK except #'s _ i _& Transformer Clearance -Ins. Protection ' 2 . lec. qpci ptacles Spacing -Lights & Switches at Doors 26. oxes & No. of Conductors Stapled Ro Installed Close to Edge of Studs & C.J. 2 quip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. -Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al InsqjaV Neutral 0 Yes O No 3 ice -Riser Conductors & Ground Main Disconnect Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date UND FL,06h (Plans) OK except #'s d ing-Setbacks-Easements-Flood-Slope L. Ftg., Main; Soils-Elec. Grnd.-/ " Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Ste walls, Main; Steel-Blockouts-Wrapped 6. VWwails, Garage; Steel- Blockouts-Wra ed IqQ6wns and Special Anchors Date ab Steel -Wrapped 8. Vs -Fireplace lace Ft .-Steel Card B-1 Date Card B-1 W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Dat - Card B- Date Card B-1 Date PLUMBING (KeEA OK except #'s 17. W r Htr.; Vent -Access -Combustion Air Baffle 1 r Pipe; Test & Anchor -Nail Protection 9 .W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors ' • 23. Fire Sprinkler; Test , Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECT L (Permit) OK except #'s _ i _& Transformer Clearance -Ins. Protection ' 2 . lec. qpci ptacles Spacing -Lights & Switches at Doors 26. oxes & No. of Conductors Stapled Ro Installed Close to Edge of Studs & C.J. 2 quip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. -Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al InsqjaV Neutral 0 Yes O No 3 ice -Riser Conductors & Ground Main Disconnect Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.0 cts Insulation & Support 4T. -Tent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 _ Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound - 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purl in -Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector- In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting ' 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance=Hearth` 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (FF.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes 83. Following Instld./Drive O Yes O No/Walks O Yes O No/Planters O Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing Z 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventil4tion Throughout House 90. G1,49s Protection 1"Corrections from Previous Inspections - 92. Gas Test -Meters Tagged, Gas -Electric 93. Wate;4 Sewer Connected -C/O to Grade -HD Approval 94. EWrgy Compliance Certificate -Other Certificates 09"Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: �-7, J=OK 0 = Not OK . = Not Readyable MOBILE HOMES Date, MOBILE HOME UTILITIES (Plans) OK except #'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-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ P' L 'ft. / P Nat. or/ P' L "ft./ P 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 6. Water; M H. Test- Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-C on nectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 COUNTY OF BUTTE �1 BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE CA - 7- r3- 33711;2 OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact tq office immediately. Date 7 ' 6'-L11 Inspector REV 10/92 :t COUNTY OF BUTTE BUILDING DIVISION r DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE r6lpm 3.7 2 OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. COUNTY OF BUTTE ' BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE C-0 A/7 f- A -S ��- 33i1-, OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. pit � Jic�C.. ��/R�✓c��-- i0� ...� � • 1 Y ' S Date Inspector s REV 10/92 COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 ` 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE 612� eh1<77 OWNER PERMIT NO. ' A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is , completed. If you have any questions pertaining to this matter, or need additional explanation, ' please contact this office immediately. t T'", Aq COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OFsDEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is 'r completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. LTJ Gf /7.7 l/Y/I/AYIAr kJ r / fly "00F.* � e~ COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE 4 - OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, Date "/ , ` ' J Inspector REV 10192 +- D� i I COUNTY OF BUTT - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDI � NG DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75 P RMIT No. (Rev.12/96) APPLICATION AND PERMIT ' ASSESSOR PARCEL NUMBER i 040-310-085 ZONING M1 BUILDING PERMIT OWNER COMCAST CABLE 559 455-4204 TELEPHONE SO. FT. OCC. BUILDING VALUATION 1 . OWNER'S MAILING KESS 2441 N ROVE INDUSTRIAL DR FRESNO CA 93727 290 @88/ 25 520.00 CONTRACTOR'S NAME TELEPHONE UNKNOWN CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total valuation $117 200.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $702.50 ARCHITECT OR ENGINEERS MAILING ADDRESS IN Plan CheckingFee x'+56.63 BUILDIN D ss SANDHILL COURT CHICO Energy Plan Checking Fee $ 23.00 PERMIT FEE $ 1182'.13 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 31 7.00 21.00 Solar or heat pump water heater 23.00 Water piping 15.00 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: CONSTRUCTION OF A 2200SQ FT SINGLE STORY H&\D END FACILITY INCLUDING SATELLITE A=SMAS AND SIS i$ c Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W .19.00 @20.00 PERMIT FEE S71-00 ELECTRICAL PERMIT Filing Fee 20.00 Main Service .OA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingwith Section 7000 of Division 3 of the Business and Professions Code, ) and my license is in full force and effect.P License Class Lic. No. OWNER -BUILDER DECLARATION 1 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 iOOOA 46.00NEW CONST. DWELLING OCCUP. OR ADDNS. 8 ACC. BLDS. MULTI so 3.5¢FT; NEW CONST -OUTLET NON-RESID. C @7.50 99c; nr OWER APPARATUS 8 SINGLE OUTLET CIR. EX. OCCU OUTLET OR FDCTUREs BAS p x.50 Ex. Occup.OUTLETSAa OR... 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 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 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.) E� 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 omply wi thos provisions. X() ^ Date / Z 9 3 Si Applicant - ner ❑ Contractor ARZAgent An OSHA p mit is required r excavations over 60" deep and demolition or construction of structures over 3 stories in heig IL MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling 2 25,00 50.00 Hood 6.50 Ventilation PERMIT FEE $ 70 00 Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TO AL EE $ HAzD. IM o cOF P EL H Issy� 7r This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have B PERMIT EXPIRES O F applicable provisions Resolutions to do work been paid. ate V_V a (Da te Receipt No. F2,115 WHITE-D.D.S.-B.D. ANARY• SS SSOR PINK-INSPEC GOLDENROD -APPLICANT D, r.1, Dl VO4 09:04a Sacramento Office 916.564.2222 p..2 an& ASSOCIATES, INC. GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION July 30, 2004 Cliff Grable Comcast 2441 North Grove Industrial Drive Fresno, California 93727 RE: Final Letter Comcast 46 Sand Hill Court Chico, California Dear Mr. Grable: Krazan Project #036-04029 Permit #03-3372 In accordance with your request and authorization, we have performed periodic special testing and inspection services for the above referenced project. The special inspections for this project were: • Compaction Testing. Reinforced Masonry • Reinforced Concrete °f=leld Welding To the ,Nbest of our knowledge, the above referenced items have been found to be in general accordance with the approved plans and specifications. We trust that this report will satisfy your needs. Should you have any questions or if we can be. of further assistance, please contact our office at 916.564.2200. Respectfully, Krazan & Assoc canes, Inc. Fred Michels Project Manager Testing & Inspection Division FM/DA/kg cc: . herewith Dean Alexander Registered Civil Engineer RCE No. 34274 With Offices Serving The Western United States 5808 Price Avenue • McClellan, CA 95652 • (916) 564-2200 • Fax: (916) 5642222 P.109aW4%028 - Cams. - Cntm%tnal Leger - 08-N.dm % COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 i / a PERMIT APPLICATION DATA SHEET � OWNER: `✓n� Cl `�� �Y � ASSESSOR PARCEL NUMBER"f Proposed Building Use: 'T l l { Counter Technician: Date: Items required in order to apply for a permi� All boxes MU / e checked OR marked NA in ord to apply. 1 1. Site plans, 3 or 4 sets, signed by the-pfeparer of the plan ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! 5. Energy compliance design and supporting documentation in duplicate. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or frld 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. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. o Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................ ❑ 9. Site plan and business license approval from the City of Biggs .................................... ❑ 10. Letter of intent for non-residential buildings......................................................... C3 11. -Detached Accessory Building Form filled,out by the 2. owner r.......................C...E.......1.0. £C, —PC pazardous Material Form.-`�..?PVA.A V.120M .... e / ❑ 13. Fire Sprinklers............................................................................................ 4A 14. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by .. ❑ 15. Other g items needed to issue the permit. (May require additional plan review upon receipt of the a foljowing items.) es as shown on the attached Schedule of Fees Due Sheet ....................................... /' /-0 - Statement of Intent for Non -heated and A/C Buildings .................................. Sanitation and site plan approval from the Environmental Health Department i. �P(/V 19. City of Chico Plumbing permit........................................................................ 1 ifornia Department of Forestry, plan approval ❑ paid. Sent by: ...................... lanning approval for (A) Use: (>� B)Parking: (C) Parcel Check:( 5 � ontact Land Development about-&Im rovements!C' Draina e 27—c b � P P 9 ............................... L— NPDESForm ............................................ :.........................:....... ............... OCIf 24. Encroachment Permit for driveway from the Public Works Dept ................................. ❑ 25. Pre -Inspection for required ................ ❑ 26. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 27. Worker's Compensation Carrier and Policy Number ............................................. ❑ 28. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... 9. Letter of Signature authorization.................................................................... 30. Recorded copy of Agricultural Acknowledgment Statement .................................... ❑ 31. Manufactured home utility clearance............................................................... ❑ 32. Existing violations and/or expired permits......................................................... ❑`3n Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C. $ —eliher: cmc limen G When issued TelAphone 55q . q. _2 7 . L,Q 6�k and hold for pickup. I have been informed of.the ab ve items and requirements for obtaining a building permit. Applicant Dae �'' G3 • 1. Index permit applir, tion for the abov ems numb r Pla &ecketter 2. Additional items rq, uired 4, i G Contractor, designer, owner, was advised of the above data by- ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was dvised.of the above data by ❑ phone, ❑ mail, ❑ counter b Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date:Structural approved by: Date: Note transfer by: Date: Yellow: Building Division COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES OWNER C°urnC� s -c-' 01-0 OPR SED BUILDING USE tD)Lt)0 . , �1DEa] SWM4.Y2 1. BUILDING PERMIT FEES --- Balance Due ..................... $ 2 . --- Additional Fees Due........... $ 4 --- Revised Plan Checking Fee.... $ 2. SCHOOL DISTRICT FEES '(paid at School District Office) (form available after Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... ,�2Q0 X $0.03 — $ Sq. . 4. URBAN AREA FEES d (paid at Building Division) A.P. # © 40- -31 O - 09J5_ DATE RECEIPT # DATE REC. SgI-111,2 _-� I- -I 1- 4 le. #. 1504 Residential (per unit)..... X = $ # Units A//mt. _ Commercial (Sq. Ftg.).... AMC) , X `/' d � _ Sq.Ftg., /�_..._. .A 5. RECREATION TSIST&MIN ES o (paid at Recreation District Office) (form available after an eck) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $89.00 (paid at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Amt. Commercial (sq. ftg.) . .. X = $ Amt. 10. OTHER a14 1-64IP- At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be change�,durirjg th,# plan c�etking process. DATE) Q - Pursuant to Government Codi; Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) , I . , , TO LARRY PAINTER ETURN TO MICO EH SITE PLAN REVIEW APPLICATION Date: _I& AP# f)A S Permit Number (if aaDlicable) 00?> -� - Bin Number APPLICANT INFORMATION Parcel Size: Owners Name:'e- Owners Address: ay N / AJ . Grou e Telephone No.: 9_ y_ { t 4/,;L p y Situs Address: (QST 3 Proposed Use: Residential ❑ New Single Family Residential ❑ Single Family Addition ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family No -residential New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition OtS Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well ❑ Agricultural Buffer Form ❑ Applicable ❑ N/A DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) ll Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval 10 Site Plan Stamped Approved BY Date Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: \1 ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: X • Flood Panel No.: 05100,, Index Date: �— 9 ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) i ❑ Cohasset Area (See attached standards and requirements) , ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: V " 1 —�T Applicable Building Setbacks: Res) ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks Page 2 of 5 Zoning Code Fire Prevention Subdivision Map Front d I Side Side Street Rear Height ' Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks Page 2 of 5 Applicable Development Fees: Standard Fees Amount Formula ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: . ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 • d Subdivision Map/Parcel Map: Map Date of Recording: j 2— Z`? — CrD Lot: 3 ❑ Use Permit/Minor Use Permit Permit Number: Book: l S 0 Date of Approval: Page:_9 I Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with. the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to .control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for road maintenance, and stop sign maintenance. 0 Page 4 of 5 N07ES 1. These notes and the drawing on this sheet shows additional Information, is for informational purposes only, describing conditions at the time of filing and is not intended to affect record title interest. 2. Development of Parcels 1,2,3 & 4 will require connection to a public water supply. 3. The maximum al woble sewage flow per parcel is 334 gallons per day per acre. 4. A Development Impact Fee for Sheriffs facilities sl-iatl be paid pursuant to the provisions of Chapter 3, Article H of the Butte County Code, prior to issuance of Wilding permits. Said .fee amount will be determined and calculated as of the date of ap-ptication for the bu-il-din.9 permit. 5. Schiool im:buildi act fees shall be paid prior to the issuance of ng permits, if such P I unpaid fees are required by the Chico Unified School District resolution. 6. Should subsequent construction or development activities expose buried artifacts or other evidence cf prehistoric or early historic occupation, a qualified archaeologist should be contacted im-mediately in order to assess the potential impacts of the project to the cultural resources encountered. DER R j�EMOVED AND I / w FOR RAIL LOWER USED ROAD PURPOSES 60 1 INORESS, EGRE-5-5 OFFERED FOR AND P.U-E- DEDICATION ro BurrE COUNTY E AND ro BE RE-5ERVED IN DE ELSD-S 1-4 FOR rHE gENEFIr OF PARC E j7OUR PARCEL N OD 8.7 5 AC. eb PARCEL 3 0) 0 0 0 N S9 1.04 AC. GROSS ip 6.87 AC. (D- 0 .0 PARGEL 2 - Q- Z� .0 0.90 AC. NET 01 rn 1.04 AC. GROSS 0.89 AC. NET 198.04' 00� (S. 67006'33" W. 1159.71`) MIRI D. 3/4" I. P. BENT a LOOSE %T THIS POSITION ESET 5/4"I.P. LS56616 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM ' (One form per Building) School District 0 h1('0r, h Building Department No. S3 A.P. Number Jurisdiction: City County Property Owner ( % (���( �'j () A b l e Property Location/Address �,Lj /vI Subdivision Lot No. ,.............................._........ ...................... :...................................... Residential Development 0 Q Q Q € Sq. Footage No of Living Mobile Home Addition/ 'Supplemental to (Group R) Units Installation Conversion Permit # *(No foundation inspection) :............................................................................................... _ ...: Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction end Notice of Limited Use Facility document) Commercial/Industrial E-71 Q Sq. Footage��r Newer Addition (Including Exterior Roofed Areas) Building Department Representative Date District Identification No. School District certifies that t'� C!� � � • (Applicant) (Street Address) (Phone Number) J. 13 :2 (City) (State) (Zip Code) has complied with the requirements of Resolution No. &q'yOZ by payment of $ representing v square feet. School District Representative Paid by Check of &OW Remarks: 2926 $ FULL MM GATION = 111.5 Date ,r Noun: You may protest the Imposition of the fees Identified above by subs ttleg a written protest to the District, In compliance with Goverrunwd Code section 66020(a), within 90 days from the data less are paid. Failure to submit a timely written protest will'prohiblt you from challenging the Imposition of the fees In any cowl action. N, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District Is rrotllled by the applicable Local Planning Agancy that thisproject is being rwlewed under the Calffomis Environmental Quality Act (CEQA� this project may be subject to additional school fees to fully nrltlgate.Its Impact on the school df bkft schools. White (applicant), Yellow (building department), Pink (school district) feeform.* (10/03)dmm February 2, 2004 Mr. Sean Farrell Butte County Administrative Center 25 County Center Drive Oroville, CA 95965 CLEAR CONNECTION CORPORATION 814-B Striker Ave. Sacramento, CA 95834 OFF. (916) 567-0144 FAX. (916) 567-0147 RE: COMCAST UPGRADE - ENCROACHMENT PERMIT MIDWAY RD BETWEEN HEGAN LN AND SANDHILL CT Dear Mr. Farrell, VINHO917VO 31IIA080 tDO? � U 933 SUOGIAUadnsdo QUV0Q Please find enclosed 8 copies of an encroachment permit for a Comcast proposed bore route along Midway Rd. between Hegan Ln. and Sandhill Ct. Our proposal is to bore at a minimum 36" depth placing 2-2" HDPE ducts and to replace all existing CAN vaults with Armorcast 3'W x 5'L x 3'D vaults. The new vaults have a fiberglass base with a polymer concrete ring and non-skid torsion lids and are rated at 10K or 20K load bearing (as shown on attached permit). All restoration will be per County specifications and all traffic control will be per Caltrans specifications. If you should have any questions or require additional information please do not hesitate to contact me at (916) 869-6649. Thank You, Jeff Hall Contractor for Comcast cc: Kevin Bermingham l � WA l1W V ARMOREAST PRODUCTS �Armorcost ProductsCompany. Weave-ot,vou covered. Hgm-e- G lndustliP.S ProdUR$ i'ech�o9agy C4rMU j; Wars Calf Armorcast Today at (818) 982.3600 BOXES Armorcast offers a variety of shapes and sizes in either Fiberglass, Polymer Concrete or Rotocast bases to fit all your needs in 10 K or 20K load bearing splice, meter or valve boxes. Uses include: Junction Boxes, Pull Boxes, Handholes, Traffic Controller Bases, Traffic Signal Boxes and Splice Boxes FIBERGLASS BASE POLYMER CONCRETE 'FIBERGLASS BASE % i I / z , o v� 1 Armorcast Products Company. We've got you covered. Home p loldus ries ;I MOROI j TeafFn-o gy ;� GaritaCt 'f; News T ARMDRCAST RRODRDS - ;,-- Call Armorcast Today at (818) 982-3600 FIBERGLASS BOXES & VAULTS When ordering, specify 10K or 20K; Logo; Hex or Penta Head Bolts; Pluse desired options which may include: Mouseholes, Knockouts, Terminators, EMS Markers, etc. MORE BOXES I MORE VAULTS I MORE PRODUCTS 13 X 24 BOX ASSEMBLIES Pallet A6001868AX15 10K 13 X 24 X 14 Straight Wall 15 A6001868AX18 10K 13 X 24 X 18 Straight Wall 10 A6001946AX18 10K 13 X 24 X 18 Flared Base 16 17 X 30 BOX ASSEMBLIES Pallet A6001785AX18 10K 17 X 30 X 18 Straight Wall IF 9 A6001640AX18 10K IF 17 X 30 X 18 Flared Base 16 A6001534AX22 10K 17 X 30 X 22 Straight Wall 9 A6001989AX30 10K 17 X 30 X 30 Straight Wall 6 24 X 36 BOX ASSEMBLIES IF Pallet A6001974AX18 10K 24 X 36 7X7167-] Flared Base 8 30 X 48 BOX ASSEMBLIES Pallet �A6001550AX18 10K 30 X 48 X 18 Flared Base 5 -� VAULT ASSEMBLIES - Depths 24" - 48" A6001509AX- 10K 24 X 36 X Specify 1 Piece Cover A6001430AX- 10K 30 X 48 X Specify 1 Piece Cover A6001460AX- 10K 30 X 60 X Specify 2 Piece Cover A6001441AX- lOK 36 X 36 X Specify 2 Piece Cover ( A6001436AX- 10K 36 X 60 X'Specify so-2 Piece Covers A6001491AX- 10K 36 X 72 X Specify 2 Piece Cover A6001440AX- 10K 48 X 48 X Specify 2 Piece Cover r-A6001447AX- 10K 48 X 60 X Specie 2 Piece Cover A6001506AX- II 10K II 48 X 72 X Specify II 2 Piece Cover A6001448AX- 10K 48 X 78 X Specify 3 Piece Cover A6001449AX- 10K 48 X 96 X Specify IF 3 Piece Cover AVAILABLE OPTIONS FOR SPLICE BOXES INCLUDE Custom logos, EMS markers, terminators, BMT brakcets, knockouts, inserts, mouseholds, captive bolts STANDARD LOGOS INCLUDE Electric, telephone, CATV, Danger High Voltage, Communications, FTM, Fiber Optics, GAs , Water, Railroad, Traffic Signal, Illuminatons, Lighting, Psdestrian Lighting, Cali Box SPLICE BOXES Are available in either 10K or 20K load ratings and are open bottom. AVAILABLE OPTIONS FOR ALL VAULTS INCLUDE Custom Logos, EMS Markers, Terminators, BMT Brackets, Cable Racks, Knockouts, Pulling Eyes, Inserts, Mouseholes, Captive Bolts EXTENSIONS Are available for all vaults. STANDARD LOGOS INCLUDE Electric, telephone, CATV, Gas, Water, Railroad, Traffic Signal, Illumination, Lighting, Pedestrian Lighting, Call Box, FTM VAULTS Are available in either 10K or 20K load ratings and are either Open, Solid or Split Bottom Styles ADDITIONAL INFO For 20K products add a "T" prior to first sequential letter. Example: A6001449AX48 = 1OK; A6001449TAX48 = 20K o Splice Box and Vault Assemblies are complete with covers. Larger vaults are equipped with lifting bolts. 6 Solid Bottom styles include drains and sump. Splice Box Extensions are Bottom Mounting ► Torsion Assist Frames and covers as well as Top Mountin Vault Extensions are available on assemblies 30 X 48 through 48 X 96. Copyright © Armorcast Products Company 2003 1 info@armorcastprod.com 1 (818) 982-3600 4 r I • - t f r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.netWils PERMIT NO. BP040095 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date' 04/01/2004 APN' 040-310-085-000 the Business and Professions Code, and my license is in full force a ' effect. LicenseClass: iiccens Nu ber: Site Address: 4 & SAN[) I,+ -I LL GT GF+I Cd 'f —'� o ( Date: Contractor: 1'l 1VV---, Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: 1 15 AMP CIRCUIT 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: COMCAST OF SOUTHERN CALIFORNIA INC. to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or P O BOX 173838 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the DENVER, CO 80217-3838 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: COMCAST OF SOUTHERN CALIFORNIA INC such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of P O BOX 173838 proving that he or she did not build or improve for the purpose of sale.). DENVER, CO 80217-3838 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: ❑ I am Exempt under Article 3 of the Business and Professions Code Date: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the License #: Labor Code, for the performance of the work for which this permit is issued. ❑ I 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 Engineer: insura e&crder and policy numb&r are: Carrier: (��`(^'�/ I L (� Policy #: q� l�-1 Total Square Ft: 0 S. F. O I certify that in the performance of the work for which this permit is Valuation: $0.00 issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthw"th comply will those provisions. Date: Applicant: WARNING: Failure ecure workers' compensation coverage is unlawful, and all s t 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. 8 4-/1/,04 .3q!5 '�0 Z7! ¢5 CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions -)o do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) lt� .. 4 , O Name: By: ` Date: PER EXPIRES ON: 4' 1 - o5 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 1 have read this application, that the above information is correct, and that I am the owner or th 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 substance of a y a form or document of Butte County. I hereby authorize represen tives of Butte unty to en er pon the above mentioned property for inspection purpo Print Name: 2 Signature: Date: r ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor is BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP 640 Sq,5- DATE: ,.d APN: o40.3 to - o85 ZONING: OWNER'S LAST NAME: OWNER'S FIRST NAME: PHONE CO" C-Wr CebLJ&- STREET ADDRESS: 2-C-poveLVA EAk 1-7,4s CITY, ZIP: c 1 E- I _ SITE ADDRESS: SP9 tL Cin .0 CITY. ZIP-.CA&Z, NEAREST CROSS STREET: y , 1 O`A r TRACTILOT M: APPLICANT NAME: %'� �� PHONE: q�� �� �Z2 STREET ADDRESS: I .) p CITY, ZIP V � E-MAIL CONTRACTOR NAME: PH NE" STREET ADDRESS:p' 7 F 6 C(J� Ll l CITY, ZIP: I/v:' l E Z- itCi4l� LICENSE NUMBER: NE ARCHITECT/ENGINEER NAME: PHONE: O STREET ADDRESS: -- 2� ✓ Fil`b CITY. ZIP: �i W LICENSE NUMBER. a. Q �2 IL e (� DESCRIP11ON OR SCOPE OF WORK: a Toe C111i3l& ❑ Structure Built without permits ❑ Proposed Change of Occupancy (note previous use) EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. 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. For office use only: Notes: ♦ -� 4 - Application Received by: Date: Receipt number: 3q54,4,$ Amount Received: 7--f5 ENVIRONMENTAL HEALTH DE -C 2 3 2003 BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENfHICO, CALIFORNIA HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE (A Building Permit cannot be approved without this completed form.) Za BUILDING PERMIT NUMBER APN (240-210-034 Firm Name������ rnrta�`� 0Ab(te_- Address 9tt,!t' N G %2-0111- D R. /G� CA IF 3 7.2 7 Nature of Business C—�,13lr T_ !`: 9 S'a. �,`L/ G74, CPUC -6 ,/ Contact Person � GI FF. 4RA,3 Z_ /=-y Phone # 6451) `TSs-• 420 1. Does your business or that of your tennants handle, store, or transport hazardous materials? ❑ NO ;9 YES NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and.safety or to the evironment if released into the the workplace or the environment. "Hazardous Materials" include, but are not limited to, hazardous chemicals, hazardous waste, paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material which a handler or the administering agency has a reasonable basis for believing to be injurious to the health and safety of persons or harmful to the environment if released. 1 2. Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at standard temperature 4 pressure), or formulation containing hazardous material? ❑ NO �Z YES If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-538-7281) for a review of the project. 3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or sc pool site? NO ❑ YES IF YES, name of school. 4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors, fumes, vapors, or other volatile compounds? ❑ NO 5k YES IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements. Owner or Authorized Company Representati BCAPCD The applicant has met or is meeting the applicable requirements of Section 25505, 25533, and 25534 of the Health and Safety Code and the requirements for a permit from the Butte County Air Pollution Control District. T,45 Above Reg tions Do Not Apply To This Facility. BCEHD Signature Date "N,.& 11164 BCAPCD Signature Date - 0 WHITE- Building Dept O YELLOW- Env. Health ❑ • PINK - APCD ' ❑ GOLDENROD, Lke1 op1.0 3 P 01 :10 R C V D 0 BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE (A Building Permit cannot be approved without this completed form.) BUILDING PERMIT NUMBER! J �3 _ (:5 S92- APN 0 1210 - 3/0 - OBJ Firm Name U/YJ Cies 1 ZE Address ?tom % C20 C "C o C1 Nature of Business (r 0~1 UNi C14T7 oNS i.�Tl��' l �/ ,f� �19cL��iN 6– Contact Person G� 1°��'f3�/= Phone #Sl 1. Does your business or that of your tennants handle, store, or transport hazardous materials? ❑ NO OYES NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the evironment if released into the the workplace or the environment. "Hazardous Materials" include, but are not limited to, hazardous chemicals, hazardous waste, paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material which a handler or the administering agency has a reasonable basis for believing to be injurious to the health and safety of persons or harmful to the environment if released. 2. Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at standard temperature 4 pressure), or formulation containing hazardous material? ❑ NO -YES If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-538-7281) for a review of the project. 3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or school site? 'PLNO ❑ YES IF YES, name of school 4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors, fumes, vapors, or other volatile compounds? ❑ NO 'PL YES IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements. Owner or Authorized Company Representative/.j _/y -U �gn u e) (Date) BCEHD BCAPCD The applicant has met or is meeting the applicable requirements of Section 25505, L25533, and 25534 of the Health and Safety Code and the requirements for a permit from the Butte County Air Pollution Control District. The Abov gulations D of Apply To This Facility. BCEHD Signature Date ` — / 1 — L9/ BCAPCD Signature �� Dateor WHITE - Building Dept 0 YELLOW - Env. Health 0 PINK - APCD 0 GOLDENROD - Fire Dept. i a �1 Jr i yl � M r BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE (A Building Permit cannot be approved without this completed form.) BUILDING PERMIT NUMBER( ' _� SM� APN 0 YO - 3i0- QkY Firm Name C U/Y) C/-3Sl— CA611 Address /00 5A�AJ0A),41d GT C_ 0 C/9 Nature of Business r 01nfn UNt G/3T/ 062-5 UT/�)' 7- `/ (J;40 jjy 6 - Contact Person GJI^Fr' 6:2A.5Ao_,-, Phone # 1. Does your business or that of your tennants handle, store, or transport hazardous materials? ❑ NO �R-YES NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the evironment if released into the the workplace or the environment. "Hazardous Materials" include, but are not limited to, hazardous chemicals, hazardous waste, paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material which a handler or the administering agency has a reasonable basis for believing to be injurious to the health and safety of persons or harmful to the environment if released. 2. Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at standard temperature 4 pressure), or formulation containing hazardous material? ❑ NO %YES If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-538-7281) for a review of the project. 3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or school site? �LNO ❑ YES IF YES, name of school. 1 4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors, fumes, vapors, or other volatile compounds? ❑ NO '§,YES IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements. Owner or Authorized Company Representative / -/y_ U ign u el (Date) BCEHD BCAPCD The applicant has met or is meeting the applicable requirements of Section 25505, 25533, and 25534 of the Health and Safety Code and the requirements for a permit from the Butte County Air Pollution Control District. ElThe Above-R>_11egulations Do -Not Apply To This Facility. � BCEHD Signature �_ r C Date (— y BCAPCD Signature �% Date _/ WHITE- Building Dept 0 YELLOW- Env. Health 0 PINK - APCD 0 GOLDENROD -Fire Dept. u { BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE (A Building Permit cannot be approved without this completed form.) BUILDING PERMIT NUMBER Of `� � ��APN 0 `�3/0- Uk5 Firm Name C Um e%9S J CAr`'>��)) Address / (20 '5/iAJn14i"ZG 67-- CA. Nature of Business �" C�,+i�/n UNt G/aT/ 062-5 vr/ 7' `/ 6? (Ji LO,'A)'6- Contact G --Contact Person 676M6 Phone # Does your business or that of your tennants handle, store, or transport hazardous materials? ❑ NO YES NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present.or potential hazard to human health and safety or to the evironment if released into the the workplace or the environment. "Hazardous Materials" include, but are not limited to, hazardous chemicals, hazardous waste, paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material which a handler or the administering agency has a reasonable basis for believing to be injurious to the health and safety of persons or harmful to the environment if released. 2. . Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at standard temperature 4 pressure), or formulation containing hazardous material? ❑ NO $.YES If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-538-7281) for a review of the project. 3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or school site? LNO ❑ YES IF YES, name of school. 4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors, fumes, vapors, or other volatile compounds? ❑ NO ' LYES IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements. Owner or Authorized Company Representative / /1�1 U ign �u e) (Date) BCEHD BCAPCD The applicant has met or is.meeting the applicable requirements of Section.25505, 25533, and 25534 of the Health and Safety Code and the requirements for a permit from the Butte County Air Pollution Control District. The Above Regulations Do. -Not Apply To This Facility. BCEHD Signature -� �� r _<` f Date BCAPCD SignatureDate WHITE- Building Dept 0 YELLOW- Env. Health 0 PINK - APCD 0 GOLDENROD- Fire Dept. • `mss-'�'��i �^��^'wA�"#F BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ~" HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE r (A Building Permit cannot-be approved without this completed form.) i APN 0 "_� V 7 3 / 0 BUILDING PERMIT NUMBER X17 '" ��"J Firm Name c cmi cF)s C,/4 1 - Address **:#:?- / 00'14�°L1 Nature of Business l 61111 UA/t4./=372 oALS u7-1,4, i ; rC,?rn+ Contact Person 6.1 6.414 r514 Phone # 5:y - -ys- - �� o Does your business or that of your tennants handle, store, or transport hazardous materials? ❑ NO YES NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the evironment if released into the the workplace or the environment. "Hazardous Materials" include, but are not limited to, hazardous chemicals, hazardous waste, paints, oils, lubricants, fuels; flammables, combustibles, corrosives, gases, and any material which a handler or the administering agency has a reasonable basis for believing to be injurious to the health and safety of persons or harmful to the environment if released. 2. Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at standard temperature 4 pressure), or formulation containing hazardous material? ❑ NO KYES If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-538-7281) for a review of the project. 3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or school site? - ,' kNO ❑ YES IF YES, name of school. 4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors, fumes, vapors, or other volatile compounds? ❑ NO ®.YES IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements. Owner or Authorized Company Representative j� - `' - (Srgn M el 3 T (Date) BCEHD -BCAPCD The applicant,has met or is meeting the applicable requirements of Section 25505, aEir 25533, and 25534 oVthe Health and Safety Code and the requirements for a permit from the Butte County Air Pollution Control District. El1:1 The Above Regulations Do Not Apply To This Facility. BCEHD Signature " w �- <� < r' Date BCAPCD Signature ` n-;�j�' Date`" WHITE- Building Dept 0 YELLOW- Env. Health 0 PINK - APCD 0 GOLDENROD- Fire Dept. E.H. USE ONLY Piot Plea Aneched Roos Ron Attached Sent to B.D. Cat&ce TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance S4212W "ii �? -. yo 31�-Ups" Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public ✓ Private Well Clearance for Amwffing. Other 43 P c �' �L h ��1% ii��� �-Y vie P_ V final _for:al clearance O.K. for: NOTE: C%��zr szc� ,�dsy�Bri ae�cQ,z�9on>�- , oo e, �i-�-'%r� Gf Environmental a Ith Specialist Date 8/96 I n 01/14/2604 11:29 9169851877 PAGE 05 IV 1p V 2 &2�L , 7- I 20 2 4 if 2 Z - Tic STO G TAK ......... Z3.10 AAC 2 ........... ... ..... "1 7. . . . . . . . . . . . , . . . ....... .......... ..... . : . I * ' '' ". .. .... .. ...... ............. ........... - M. .. . . .....5...::: ......... .. .............. .3.211 6' . ....... . .. .. ... ....... .......... . ....... 20-3 50A C 204 OTC X ......... \ ` '� /- 405 ....... . 00"M 6 6 50A6 A�\ 10 75 M -PROVED Tc "e County 2 55.6.EnWropmental 1jeafth 20 367 paw 20 -35TW Pignature 204.507-W � � r�` � � � ,,� fy \\ A. ;`j,-' j nvironment �.j JAN 15 Z 70� Chico, California THI ow \ IN National Pollutant Discharge Elimination System (NPDES) Phase II & SWPPP Non -Certification for Project # for Butte County Storm Water Permit Complia 05' 31a By signing below, I, the project architect/engineer of record, indicate that I am aware that a construction project that disturbs more than 1 acre of land requires a Construction Storm Water Permit from the State Water Resources Control Board. I, additionally, understand that it is the project owner's/owner's agent's responsibility to submit a Notice of Intent (N.O.I.), a Storm Water Pollution Prevention Plan (SWPPP) and a fee of $700.00 to the State Water Resources Control Board to obtain such a permit. I, further, certify that this project will not disturb more than 1 acre of land. I have also reviewed the Best Management Practices Handbooks, California Storm Water Quality Task Force, Sacramento, CA. I certify that appropriate BMPs will be implemented to effectively minimize the negative impacts of this project's construction activities on storm water quality. I acknowledge that it is my obligation to make the project owner and contractor aware that the selected BNIPs must be installed, monitored, and maintained to ensure their effectiveness. If, at any time, site conditions and/or observations by a County official warrant reevaluation and revisions of the chosen BMPs, the appropriate changes will -be made without unnecessary delay. I am aware that failure to properly implement and maintain the BMPs necessary to prevent the discharge of pollutants from this project during construction could result in significant penalties and/or delays. Signed: OAJ -,�k Title: %Z EGA h'NGk2 c �tnc ST G 3 Date: By signing below, I, the project owner/owner's agent, certify that I am aware that a construction roject that disturbs more than 1 acre of land requires a Construction Storm Water Permit from the to Water Resources Control Board and that it is my responsibility to submit a Notice of Intent . . , a Storm Water Pollution Prevention Plan (SWPPP) and a check for $700.00 made payable to State Water Resources Control Board to obtain such a permit, if my project disturbs more than 1 ac f land. I, further, certify that this project will not disturb more than 1 acre of land. This document all attachments were prepared under my direction or supervision in accordance with a sy designed to assure that qualified individuals properly gathered and evaluated the information su tted. Based on my inquiry of the person or persons directly responsible for gathering the informatio certify, to the best of my knowledge and belief, that the information submitted is true, accurate, d complete. Signed: Title: Date: NPDES & SWPPP Non -Compliance Certification Draft Butte County Stormwater Plan 0 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Pae 1 of I. FACILITY IDENTIFICATION FACILITY ID # I EPA ID # (Hazardous Waste Only) 2 t BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3 L -- N CA:> II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases EYES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold —CHEMICAL DESCRIPTION (OES 273 1) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency lan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? []YES N NO 5 UST TANK (one page per tank) (Formerly form B) 2. Intend to upgrade existing or install new USTs? ❑ YES ONO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ONO 7, UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or [--]YES N NO 8 NO FORM REQUIRED TO CUPAS ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ❑ YES N NO 9 EPA ID NUMBER — provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? ❑ YES ® NO 10 per recycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ❑ YES ® NO 11 TREATMENT — FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) ' 4. Treatment subject to financial assurance requirements (for ❑YES ®NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Fonnedy DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION ❑ YES ® NO 13 SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑ YES ■ NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS_ Is (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) Business Activities Please submit the Business Activities page, the Business Owner/Operator Identification page (DES Form 2730), and Hazardous Materials Inventory - Chemical Description pages (DES Form 2731) for all submissions. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - Leave this blank. This number is assigned by the Certified Unified Program_ Agency (CUPA) or Administering Agency (AA). This is the unique number which identifies your facility. 2. EPA ID NUMBER - If you generate, recycle, or treat hazardous waste, enter your facility's 12 -character U.S. Environmental Protection Agency (U.S. EPA) or California Identification number. For facilities in California, the number usually starts with the letters "CA". If you do not have a number, contact the Department of Toxic Substances Control (DTSC) Telephone Information Center at (916) 324-1781, (800) - 61 -TOXIC or (800) 61-86942, to obtain one. 3. BUSINESS NAME - Enter the full legal name of the business. This is the same as the terms "Facility Name" or •DBA - Doing Business As" that might have been used in the past. f 4. HAZARDOUS MATERIALS ONSITE - Check the box to indicate whether you have a hazardous material onsite.• You have a hazardous material onsite if:; It is handled in quantities equal to or greater than 500 pounds, 55 gallons, or 200 cubic feet of compressed gas (calculated at standard temperature and pressure), It is handled in quantities equal to or greater than the applicable federal threshold planning quantity for an extremely hazardous substance listed in 40 CFR Part 355, Appendix A, Radioactive materials are handled in quantities for which an emergency plan is required to be adopted pursuant to Part 30, Part 40, or Part 70 of Chapter 10 of 10 CFR, or pursuant to any regulations adopted by the state in accordance with these regulations. 1 If you have a hazardous material onsite, then you must complete the Business Owner/Operator Identification page (DES Form 2730) and the Hazardous Materials Inventory - Chemical Description page (DES Form 2731), as well as an Emergency Response Plan and Training Plan. Do not answer "YES" to this question if you exceed only a local threshold, but do not exceed the state threshold. 5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST) - Check the appropriate box to indicate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code (HSC) §25316. If "YES", then you must complete one UST Facility page and UST Tank pages for each tank. You must also submit a plot plan and a monitoring program plan. t I 6. UPGRADE/INSTALL UST - Check the appropriate box to indicate whether you intend to install or upgrade USTs containing hazardous substances as defined in HSC §25316. If -YES', then you must complete the UST Installation - Certificate of Compliance page in addition to UST Facility and Tank pages, plot plan and monitoring program plan. 1 7. UST CLOSURE - Check the appropriate box if you are closing an UST and complete the closure portion of the UST Tank pages for each tank. (CUPAs may require additional information.) i 8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK (AST) - Check the appropriate box to indicate whether there are ASTs onsite which exceed the regulatory thresholds. (There is no UPCF page for ASTs.) This program applies to all facilities storing petroleum in aboveground tanks. Petroleum means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure (HSC §25270.2 (g)). The facility must have a single tank greater than 660 gallons, or cumulative storage capacity greater than 1,320 gallons for all ASTs. NOT Subject to the Act (exemptions): An aboveground petroleum storage tank (AST) facility with one or more of the following (see HSC §25270.2 (k)) is not subject to this act and is exempt: A pressure vessel or boiler which is subject to Division 5 of the Labor Code, A storage tank containing hazardous waste if a hazardous waste facility permit has been issued for the storage tank by DTSC, An aboveground oil production tank which is regulated by the Division of Oil and Gas, Certain oil -filled electrical equipment including but not limited to transformers, circuit breakers, or capacitors. 9. HAZARDOUS WASTE GENERATOR - Check the appropriate box to indicate whether your facility generates hazardous waste. A generator is the person or business whose acts or processes produce a hazardous waste or who causes a hazardous substance or waste to become subject to State hazardous waste law. If your facility generates hazardous waste, you must obtain and use an EPA Identification number (ID) in order to properly transport and dispose of it. Report your EPA ID number in #2. Hazardous waste means a waste that meets any of the criteria for the identification of a hazardous waste adopted by DTSC pursuant to HSC §25141. "Hazardous waste" includes, but is not limited to, federally regulated hazardous waste. Federal hazardous waste law is known as the Resource Conservation and Recovery Act (RCRA). 'Unless explicitly stated otherwise, the term "hazardous waste" also includes extremely hazardous waste and acutely hazardous waste. ' 10. RECYCLE - Check the appropriate box to indicate whether you recycle more than 100 kilograms per month of recyclable material under a claim that the material is excluded or exempt per HSC §25143.2. Check "YES" andcomplete the Recyclable Materials Report pages, if you either recycled onsite or recycled excluded recyclable materials which were generated offsite. Check "NO" if you only send recyclable materials to an offsite recycler. You do not need to report. 11. ONSITE HAZARDOUS WASTE TREATMENT. - Check the appropriate box to indicate whether your facility engages in onsite treatment of hazardous waste. "Treatment" means any method, technique, or process which is designed to change the physical, chemical, or biological character or composition of any hazardous waste or any material contained therein, or removes or reduces its harmful properties or characteristics for any purpose. 'Treatment" does not include the removal of residues from manufacturing process equipment for the purposes of cleaning that equipment. Amendments (effective 1/1/99) add exemptions from the definition of "treatment" for certain processes under specific, limited conditions. Refer to HSC §25123.5 (b) for these specific exemptions. Treatment of certain laboratory hazardous wastes do not require authorization. Refer to HSC §25200.3.1 for specific information. Please contact your CUPA to determine if any exemptions apply to your facility. If your facility engages in onsite treatment of hazardous waste then complete the Onsite Hazardous Waste Treatment Notification -Facility page and one set of Onsite Hazardous Waste Treatment Notification - Unit pages with waste and treatment process information for each unit. 12. FINANCIAL ASSURANCE - Check the appropriate box to indicate whether your facility is subject to financial assurance requirements for closure of an onsite treatment unit. Unless they are exempt, Permit by Rule (PBR) - and Conditionally Authorized (CA) operations are required to provide financial assurance for closure costs (per 22 CCR §67450.13 (b) and HSC §25245.4). If your facility is subject to financial assurance requirements or claiming an exemption, then complete the Certification of Financial Assurance page. 13. REMOTE WASTE CONSOLIDATION SITE - Check the appropriate box to indicate whether your facility consolidates hazardous waste generated at a remote site. Answer 'YES" if you are a hazardous waste generator that collects hazardous waste initially at remote sites and subsequently transports the hazardous waste to a consolidation site you also operate. You must be eligible pursuant to the conditions in HSC §25110.10. If your facility consolidates hazardous waste generated at a remote site, then complete the Remote Waste Consolidation Site Annual Notification page. 14. HAZARDOUS WASTE TANK CLOSURE - Check the appropriate box to indicate whether the tank being closed would be classified as hazardous waste after its contents are removed. Classification could be based on: Your knowledge of the tank and its contents The mixture rule Testing of the tank The listed wastes in 40 CFR 261.31 or 40 CFR 261.32. Inability to remove hazardous materials stored in the tank. If the tank being closed would be classified as hazardous waste after its contents are removed, then you must complete the Hazardous Waste Tank Closure Certification page. 15. LOCAL REQUIREMENTS - Some CUPAs or AAs may require additional information. Check with your CUPA before submitting the UPCF to determine if any supplemental information is required. , UPCF (1/99) UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of IDENTIFICATION1. FACILITY ID# 1 I BEGINNING DATE 100 1 ENDING DATE 101 BUSINESS AME(sameasFACILITYNor DBA —Doing Business ) 3 BUSINESS PHONE 102 O BUSINESS SITE ADDRESS 103 CITY 104 CA ZIP CODE 105 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 gall COUNTY 108 BUST SS OPERATOR NA E i 109 BUSINESS OPERATOR PHONE 110 ml�rpora'- i o 0'116' -- $ OWNER11. BUSINESS OWNER NAME111 OWNER PHONE 112 COM eoc cCkk 10^ 8 - 7581 OWNER MAILING ADDRESS'113 IS"-6 D Mojr6i (SVr CITY 114 STATE 115 ZIP CODE 116 1-�PA Ila— o ENVIRONMENTAL111. CONTACT NAME /� r , 117 CONTACT PHONgiS 118 Il ` a � qt(oCONTACT MAILING ADDRESS 119 AM- prospect ci V e. CITY 1 120 �STAT� 121 ZIP CODE 122 r o Qovct -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- .•NAME NAME � C123 NAME 128 "err Ma TITLE Q o \3 \k 124 E v�,eeP TITLE r 129 k rt uirovk ��e e r i22 to BUSINES HONE 1j 125 910.85 BUSINESS PHONE 130 167130 - -S - 0 (1. 24-HOUR P HON E� q 6S,0 126 S • 24-HOUR PHONE � �� 131 , PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUM NT PgEPARER 135 0 NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 UPCF ( 1199 revised) HMP 2 OES FORM 2730 (1199) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (onep a er material er building or areal []ADD ❑DELETE ❑REVISE 200 Page,;?—of I. FACILITY INFORMATION BUSINESS tVE (Same FAC IT AME or DBA — oing Business As) 3 G'. CHE IC OCATI N ` 20l CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 cui\oa\ ko �J Q'(�I�OC ❑ YES 9 NO FACILITY ID #111'1 I MAP# (optional) 203 GRID# (opt (optional) 201 II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET Yes No 206 Pf�205 0 'e ` If Subject to EPCRA, refer to instructions COMMON NAME za7 zas EHS' ❑ Yes ®No CAS# _ 209 If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES ( T etr f required b CUPA) 210 CO HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE 0 b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑ Yes I$ No 212 213 CURIES PHYSICAL STATE (Check one item only) ❑ a. SOLID 1B b. LIQUID ❑ c. GAS 214 215 LARGEST CONTAINER / QO �p FED HAZARD CATEGORIES 216 (Check all that apply) E a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ■ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 1 1 UNITS' 0 a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 Check one item only) ' If EHS, amount must be in pounds. 1pJ STORAGE CONTAINER 4B a. ABOVE GROUND TANK ❑ e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ cl. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE jr a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE , a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 s'1 227 ❑ Yes E No 228 ('� ` � 229 2 230 231 CL ❑Yes ®NO 232 . /\ n r 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑Yes ❑ NO 244 245 If more hazardous components are present at greater than I% by weight if non -carcinogenic, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here UPCF (1/99) OES Form 2731 Hazardous Materials Inventory - Chemical Description You must complete a separate Hazardous Materials Inventory - Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3. BUSINESS NAME - Enter the full legal name of the business. 200. ADD/DELETE/ REVISE - Indicate if the material is being added to the inventory, deleted from the inventory, or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201. CHEMICAL LOCATION - Enter the building or outside/ adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disclosure pursuant to HSC §25506. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check "Yes" to keep chemical location information confidential. If the business does not wish to keep chemical location information confidential check "No". 203. MAP NUMBER - If a map is included, enter the number of the map on which the location of the hazardous material is shown. 204. GRID NUMBER -If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed. 205. CHEMICAL NAME - Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not complete this field; complete the "COMMON NAME" field instead. 206. TRADE SECRET - Check "Yes" if the information in this section is declared a trade secret, or "No" if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by HSC §25511. Federal requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS - Check "Yes" if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209. CAS # - Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class, include all. Contact CUPA or AA for guidance. 211. HAZARDOUS MATERIAL TYPE -Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. 212. RADIOACTIVE - Check "Yes" if the hazardous material is radioactive or 'No" if it is not. 213. CURIES -If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214. PHYSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total capacity of the largest container in which the material is stored. 91A FFnFRAI HA7ARD CATEGORIES - Check all catennripg that rtpgnrihp the nhvsical and health ha7nrrls aggncintpri with the ha7arrirnrg material. PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Acute Health (immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short term exposure Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous, chemicals with an adverse effect with long term exposure 217. AVERAGE DAILY AMOUNT - Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/ outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218. MAXIMUM DAILY AMOUNT - Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at anyone time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT - If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3 -digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221. UNITS - Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). 222. DAYS ON SITE - List the total number of days during the year that the material is on site. 223. STORAGE CONTAINER -Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. 224. STORAGE PRESSURE - Check the one box that best describes the pressure at which the hazardous material is stored. 225. STORAGE TEMPERATURE - Check the one box that best describes the temperature at which the hazardous material is stored. 226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227. HAZARDOUS COMPONENTS 1-5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - Check "Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "No" if it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS - List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246. LOCALLY COLLECTED INFORMATION - This space may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs. Contact the COPA or AA for guidance. UPCF (1/99) OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one aee rmaterial erbuildin or area) ❑ADD ❑DELETE ❑REVISE 2W Page 4of I. FACILITY INFORMATION , BUSINESS NAMHSame as FA LITY NAME or DBA — Do' Business As) 3 o b CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES N NO 1 FACILITY [D # MAP# (optional) 203 GRID# (optional) 204 II. CHEMICAL INFORMATION C 205 TRADE SECRET 0 Yes E No 206 &1 1 If Subject to EPCRA, refer to instructions C MONO E 207 208 Il R69 AB&'rx2097 EHS* ❑ Yes 0 No CAS# 6,q 3 ^ . 'If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 G� HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE 2 b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑Yes No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID E b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 1 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 221 DAYS ON SITE: 222 UNITS*❑ a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS (Check one item onl • If EHS, amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE E r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 1 �e� zz7 ❑ Yes No zzH 229 2 f _ 230 •C A l• C 231 ❑Yes ® No 232 _ 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than I% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sin Here UPCF (1/99) OES Form 2731 Hazardous Materials Inventory - Chemical Description You must complete a separate Hazardous Materials Inventory - Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3. BUSINESS NAME - Enter the full legal name of the business. 200. ADD/DELETE/ REVISE - Indicate if the material is being added to the inventory, deleted from the inventory, or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201. CHEMICAL LOCATION - Enter the building or outside/ adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disclosure pursuant to HSC §25506. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check "Yes" to keep chemical location information confidential. If the business does not wish to keep chemical location information confidential check "No". 203. MAP NUMBER - If a map is included, enter the number of the map on which the location of the hazardous material is shown. 204. GRID NUMBER -If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed. 205. CHEMICAL NAME - Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not complete this field; complete the "COMMON NAME" field instead. 206. TRADE SECRET - Check "Yes" if the information in this section is declared a trade secret, or "No" if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by HSC §25511. Federal requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS - Check "Yes" if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209. CAS # - Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class, include all. Contact CUPA or AA for guidance. 211. HAZARDOUS MATERIAL TYPE -Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. 212. RADIOACTIVE - Check "Yes" if the hazardous material is radioactive or "No" if it is not. 213. CURIES - If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214. PHYSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total capacity of the largest container in which the material is stored. 216. FEDERAL HAZARD CATEGORIES - Check all categories that describe the physical and health hazards associated with the hazardous material. PHYSICAL HAZARDS I HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive other hazardous chemicals with an adverse effect with short term exposure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with Iona term exposure 217. AVERAGE DAILY AMOUNT - Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/ outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218. MAXIMUM DAILY AMOUNT - Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at anyone time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT - If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3 -digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221. UNITS -Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). 222. DAYS ON SITE - List the total number of days during the year that the material is on site. 223. STORAGE CONTAINER -Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. 224. STORAGE PRESSURE - Check the one box that best describes the pressure at which the hazardous material is stored. 225. STORAGE TEMPERATURE - Check the one box that best describes the temperature at which the hazardous material is stored. 226. HAZARDOUS COMPONENTS 1:5(% BY WEIGHT) -Enter the percentage weight of.the hazardous component in a mixture. If a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227. HAZARDOUS COMPONENTS 1-5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - Check "Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "No" if it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS - List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246. LOCALLY COLLECTED INFORMATION - This space may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs. Contact the CUPA or AA for guidance. UPCF (1/99) OES Form 2731 CALIFORNIA ANNOTATED MAP Business Name: Site Address: Map N: I I 1 I I 1 I I 1 I I I I I I I I I 1 I I I 1 I I ( 1 I I I I I 1 I 1 1 1 1 t I t I I I 1 ------r------r------r------r------r------r------t------- t I I I I I I 1 1 1 I I I I 1 I I 1 1 1 I I I 1 I I 1 1 1 I I 1 1 I I 1 I I 1 I 1 1 1 1 1 1 I 1 1 I I 1 I 1 ------r------r------r------r------r------r------r------ I I 1 I 1 I I I I 1 1 1 I I 1 1 I I I 1 1 1 1 I I 1 1 1 I 1 1 t 1 I 1 I I I 1 1 1 I I 1 I 1 1 II I I 1 I I ------r------r------r------r------r------r------r------r------r------ I I I I 1 1 1 ( I I I 1 I I I ► I I I I 1 I I I I I I I I 1 1 I I I I 1 1 I I 1 1 1 1 1 1 t I I I I I 1 I I ------r------r------r------r------r------r------r------r------r------ 1 1 1 I 1 I 1 1 1 I I t I I 1 1 1 I I I I I I I I I 1 I 1 I I 1 I I I 1 I I I I I I 1 1 I I I I I I I 1 1 1 ------r------r------r------r------r------r------r------r------r------ 1 I I I 1 1 I t 1 I I I I I I 1 1 I I I I I I 1 I 1 I I I 1 I I 1 1 I I I 1 I I I I I 1 I I I 1 I I 1 1 I 1 ------r------r------r------r------r------r------r------r------r------ 1 I 1 I I I 1 1 1 I I 1 I I I I 1 1 I I 1 I I I I I 1 I I 1 I 1 I I 1 1 I I I I I 1 I I I 1 I I 1 1 1 I 1 I C CLIX. Y X —1• For Site Map • Scale of Map ' • Loading Areas Parking Lots Internal Roads • Storm and Sewer Drains • Adjacent Property Use • Locations and Names of Adjacent Streets and Alleys • Access and Egress Points and Roads For Sub -Site Map • Scale of Map • Locations of Each Storage Area • Location of Each Hazardous Material Handling Area • Location of Emergency Response Equipmcnt T North Scale: 1"= IV. California Annotated Site Map - Instructions Attach a map of the facility using the standard grid. As a minimum, the map should show the following: 1. Site Layout • Scale of map • Site Orientation (north, south, etc.) Loading areas • Parking lots • Internal roads • Storm and sewer drains _ Adiacent property use • Locations and names of adiacent streets and allevs _ Access and egress points and roads 2. Facility • Location of each storage area • Location of each hazardous material handling area • Location of emergency response equipment For example, equipment for fire suppression approach and mitigation protective clothing, medical response. etc. .. APPENDIX VI -A 1994 UNIFORM FIRE CODE Division VI INFORMATIONAL APPENDIX VI -A HAZARDOUS MATERIALS CLASSIFICATIONS (See U.F.C. Sections 8001.1.2 and 8002.3) SECTION 1 — SCOPE Appendix VI -A provides information, explanations and examples to illustrate and clarify the haz- ard categories contained in Article 80. The hazard categories are based upon the Code of Federal Regulations, Title 29. Where numerical classifications are included, they are in accordance with nationally recognized standards. Appendix VI -A should not be used as the sole means of hazardous materials classification. SECTION 2 — HAZARD CATEGORIES 2.1 Physical Hazards. 2. 1.1 Explosives and blasting agents. 2.1.1.1 High explosives. Can be detonated by means of blasting cap when unconfined. Examples: dynamite, TNT, nitroglycerine, C-3, C-4. 2.1.1.2 Low explosives. Can be deflagrated when confined. Examples: black powder, smokeless powder, propellant explosives, display fireworks. 2.1.1.3 Blasting agents. Oxidizer and liquid fuel slurry mixtures. Examples: ammonium nitrate combined with fuel oil. 2.1.2 Compressed gases. 2.1.2.1 Flammable. Examples: acetylene, carbon monoxide, ethane, ethylene, hydrogen, meth- ane. 2.1.2.2 Oxidizing. Examples: oxygen, ozone, oxides of nitrogen, chlorine and fluorine. Chlorine and fluorine do not contain oxygen but reaction with tlammables is similar to that of oxygen. 2.1.2.3 Corrosive. Examples: ammonia, hydrogen chloride and fluorine. 2.1.2.4 Highly toxic.' Examples: arsine, cyanogen, fluorine, germane, hydrogen cyanide, hydro- gen selenide, nitric oxide, phosphine and stibene. 2.1.2.5 Toxic. Examples: chlorine, hydrogen fluoride, hydrogen sulfide, silicon tetrafluoride. phosgene. 2.1.2.6 Inert (chemically unreactive). Examples: argon, helium, krypton, neon, nitrogen and xe- non. 2.1.2.7 Pyrophoric. Examples: diborane, dichloroborane, phosphine and silane. 2.1.2.8 Unstable (reactive). Examples: butadiene (unstabilized), ethylene oxide and vinyl chlo- ride. 2.1.3 Flammable and combustible liquids. 2.1.3.1 Flammable liquids. CLASS l -A liquids include those having flash points below 73°F. (22.8°C.) and having a boiling point below 100°F. (37.8°C.). 1.452 1994 UNIFORM FIRE COOE APPENDIX VI -A CLASS I -B liquids include those having flash points below 73'F. (22.8'C.) and having a boiling point at or above 100°F. (37.80C.). CLASS I -C liquids include those having flash points at or above 73°F. (22.8'C.) and below 100T (37.8'C.). 2.1.3.2 Combustible liquids. CLASS II liquids include those having flash points at or above 100T (37.8°C.) and below 140°F. (60°C.). CLASS III -A liquids include those having flash points at or above 140T. (60°C.) and below 200°F. (93.30C.). CLASS III -13 liquids include those liquids having flash points at or above 200T (93.3°C.). 2.1.4 Flammable solids. 2.1.4.1 Organic solids. Examples: camphor, cellulose nitrate and napthalene. 2.1.4.2 Inorganic solids. Examples: decaborane, lithium amide, phosphorous heptasulfide, phosphorous sesquisulfide, potassium sulfide, anhydrous sodium sulfide and sulfur. 2.1.4.3 Combustible metals (except dusts and powders). Examples: cesium, magnesium and zirconium. 2.1.4.4 Combustible dusts and powders (including metals). Finely divided flammable solids which may be dispersed in air as a dust cloud. Examples: wood sawdust, plastics, coal. flour and powdered metals (few exceptions). 2.1.5 Oxidizers. 2.1.5.1 Gases. Examples: oxygen, ozone, oxides of nitrogen fluorine and chlorine (reaction with flammables is similar to that of oxygen). 2.1.5.2 Liquids. Examples: bromine, hydrogen peroxide, nitric acid, perchloric acid and sulfuric acid. 2.1.5.3 Solids. Examples: chlorates, chromates, chromic acid, iodine, nitrates, perchlorates and peroxides. Classification of liquid and solid oxidizers according to hazard: Class 4—An oxidizer that can undergo an explosive reaction due to contamination or exposure to thermal or physical shock. In addition, the oxidizer will enhance the burning rate and may cause spontaneous ignition of combustibles. Examples: ammonium perchlorate (particle size greater than 15 microns), ammonium permanganate, guanidine nitrate, hydrogen peroxide solutions (greater than 91 percent) and tetranitromethane. Class 3—An oxidizer that will cause a severe increase in the burning rate of combustible materials with which it comes in contact or that will undergo vigorous self -sustained decomposition due to contamination or exposure to heat. Examples: ammonium dichromate, calcium hypochlorite (over 50 percent by weight), chloric-acid (10 percent -maximum concentration), hydrogen peroxide solu- tions (greater than 52 percent up to 91 percent), mono-(trichloro)-tetra-(monopotassium dichlo- ro)-penta-s-triazinetrione. nitric acid, fuming (more than 86 percent concentration), perchloric acid solutions (60 percent to 72 percent by weight), potassium bromate, potassium chlorate, potassium dichloro-s-triazinetrione (potassium dichloroisocyanurate), sodium bromate, sodium chlorate, so- dium chlorite (over 40 percent by weight) and sodium dichloro-s-uiazinetrione (sodium dichloroi- socyanurate). Class 2—An oxidizer that will cause a moderate increase in the burning rate or that may cause spon- taneous ignition of combustible materials with which it comes in contact. Examples: barium bro- 1-453 1994 UNIFORM FIRE COOE APPENOIX VI -A paste 55 percent, benzoyl peroxide paste 50 percent peroxide/50 percent butylbenzylphthalate dilu- ent. cumene hydroperoxide 86 percent. di-(4-butylcyclohexyl) peroxydicarbonate 98 percent, t-bu-' tyl peroxy-2-ethytehexanoate 97 percent, t -butyl peroxyneodecanoate 75 percent, decanoyl peroxide 98.5 percent, di -t -butyl peroxide 99 percent, l,1 -di- (t-butylperoxy)3,5,5-tri methy lcyclo- hexane 75 percent, 2,4-dichlorobenzoyl peroxide 50 percent, diisopropyl peroxyd i -carbonate 30 percent, 2, -5 -dimethyl -2,5 -di- (2-ethylhexanolyperoxy)-hexane 90 percent, 2.5 -dimethyl - 2.5 -di- (t-butylperoxy) hexane 90 percent and methyl ethyl ketone peroxide 9 percent active oxy- gen diluted in dimethyl phthalate. ' CLASS IV: Class IV peroxides burn in the same manner as ordinary combustibles and present a minimum reactivity hazard. Examples: benzoyl peroxide 70 percent, benzoyl peroxide paste 50 percent peroxide/15 percent water/35 percent butylphthalate diluent, benzoyl peroxide slurry 40 percent, benzoyl peroxide powder 35 percent, t -butyl hydroperoxide 70 percent, t -butyl ' peroxy-2-ethylhexanoate 50 percent, decumyl peroxide 98 percent, di-(2-ethylhexal) peroxydicar- bonate 40 percent, laurel peroxide 98 percent, p -methane hydroperoxide 52.5 percent, methyl ethyl ketone peroxide 5.5 percent active oxygen and methyl ethyl ketone peroxide 9 percent active oxy- gen diluted in water and glycols. ' CLASS V. Class V peroxides do not bum or present a decomposition hazard. Examples: benzoyl peroxide 35 percent, 1, 1 -di-t-butyl peroxy 3,5,5-trimethylcyclohexane 40 percent, 2,5 -di -(t -butyl peroxy) hexane 47 percent and 24-pentanedione peroxide 4 percent active oxygen. 2.1.7 Pyrophoric materials. 2.1.7.1 Gases. Examples: diborane, phosphine and silane. 2.1.7.2 Liquids. Examples: diethyl aluminum chloride, diethyl beryllium, diethyl phosphine, diethyl zinc, dimethyl arsine, triethyl aluminum etherate, thriethyl bismuthine, thriethyl boron, tri - methyl aluminum and trimethyl gallium. 2.1.7.3 Solids. Examples: cesium. hafnium, lithium, white or yellow phosphorus, plutonium, po- tassium, rubidium, sodium and thorium. 2.1.8 Unstable (reactive) materials. CLASS 4: Materials which in themselves are readily capable of detonation or of explosive de- composition or explosive reaction at normal temperatures and pressures. This class should include materials which are sensitive to mechanical or localized thermal shock at normal temperatures and pressures. Examples: acetyl peroxide, dibutyl peroxide, dinitrobenzene, ethyl nitrate, peroxyacedc acid and picric acid (dry) trinitrobenzene. CLASS 3: Materials which in themselves are capable of detonation or of explosive decomposi- tion or explosive reaction but which require a strong initiating source or which must be heated under confinement before initiation. This degree should include materials which are sensitive to thermal or mechanical shock at elevated temperatures and pressures. Examples: hydrogen peroxide (greater than 52 percent), hydroxylamine, nitromethane, paranitroaniline, perchloric acid and tetrafluoroe- thylene monomer. CLASS 2: Materials which in themselves are normally unstable and readily undergo violent chemical change but do not detonate. This degree should include materials which can undergo chemical change with rapid release of energy at normal temperatures and pressures and which can undergo violent chemical change at elevated temperatures and pressures. Examples: acrolein, acrylic acid, hydrazine, methacrylic acid, sodium perchlorate, styrene and vinyl acetate. CLASS 1: Materials which in themselves are normally stable but which can become unstable at elevated temperatures and pressures. Examples: acetic acid, hydrogen peroxide 35 percent to 52 percent, paraldehyde and tetrahydrofuman. Classification by degree of hazard shall be in accordance with U.F.C. Standard 79-3. 1-4SS APPENDIX VI -A 1994 UNIFORM FIRE CODE mate, barium chlorate, barium hypochlorite, barium perchlorate, barium permanganate, I -bromo-3-chloro-5, 5-dimethylhydantoin, calcium chlorate, calcium chlorite, calcium hypochlo- rite (50 percent or less by weight), calcium perchlorate, calcium permanganate, chromium trioxide (chromic acid), copper chlorate, halane (1, 3-dichloro-5, 5-dimethylhydantoin), hydrogen peroxide (greater than 27.5 percent up to 52 percent), lead perchlorate, lithium chlorate, lithium hypochlorite (more than 39 percent available chlorine), lithium perchlorate, magnesium bromate, magnesium chlorate, magnesium perchlorate, mercurous chlorate, nitric acid (more than 40 percent but less than 86 percent), perchloric acid solutions (more than 50 percent but less than 60 percent), potas- sium perchlorate, potassium permanganate. potassium peroxide, potassium superoxide, silver per- oxide. sodium chlorite (40 percent or less by weight), sodium perchlorate, sodium perchlorate monohydrate, sodium permanganate, sodium peroxide, strontium chlorate, strontium perchlorate, thallium chlorate, trichloro-s-triazinetrione (trichloroisocyanuric acid), urea hydrogen peroxide, zinc bromate, zinc chlorate and zinc permanganate. Class 1—An oxidizer whose primary hazard is that it slightly increases the burning rate but does not cause spontaneous ignition when it comes in contact with combustible materials. Examples: all in- organic nitrates (unless otherwise classified), all inorganic nitrites (unless otherwise classified), ammonium persulfate, barium peroxide, calcium peroxide, hydrogen peroxide solutions (greater than 8 percent up to 27.5 percent), lead dioxide, lithium hypochlorite (39 percent or less available chlorine), lithium peroxide, magnesium peroxide, manganese dioxide, nitric acid (40 percent con- centration or less), perchloric acid solutions (less than 50 percent by weight), potassium dichro- mate, potassium percarbonate, potassium persulfate, sodium carbonate peroxide, sodium dichloro-s-triazinetrione dihydrate, sodium dichromate, sodium perborate (anhydrous), sodium perborate monohydrate, sodium perborate tetrahydrate, sodium percarbonate, sodium persulfate, strontium peroxide and zinc peroxide. 2.1.6 Organic peroxides. Organic peroxides are flammable compounds which contain the double oxygen or peroxy (-O-O-) group and are subject to explosive decomposition. They are available as: 1. Liquids. 2. Pastes. 3. Solids (usually finely divided powders). Classification of organic peroxides according to hazard: UNCLASSIFIED: Peroxides which are capable of detonation. These peroxides present an ex- tremely high explosion hazard through rapid explosive decomposition and are regulated in accor- dance with Article 77. CLASS I: Class I peroxides are capable of deflagration, but not detonation. These peroxides pres- ent a high explosion hazard through rapid decomposition. Examples: acetyl cyclohexane sulfonyl 60-65 percent concentration by weight, fulfonyl peroxide, benzoyl peroxide over 98 percent con- centration, t -butyl hydroperoxide 90 percent, t -butyl peroxyacetate 75 percent, t -butyl peroxyiso- propylcarbonate 92 percent, diisopropyl peroxydicarbonate 100 percent, di -n -propyl peroxydicarbonate 98 percent and di -n -propyl peroxydi -carbonate 85 percent. CLASS II: Class II peroxides bum -very rapidly and presenia severe reactivity hazard. Examples: acetyl peroxide, 25 percent, t -butyl hydroperoxide 70 percent, t -butyl peroxybenzoate 98 percent, t -butyl peroxy-2-ethylhex-anoate 97 percent, t -butyl peroxyisobutyrate 75 percent, t -butyl peroxy- isopropyl-carbonate 75 percent, t -butyl peroxypivalate 75 percent, dybenz-oyl peroxydicarbonate 85 percent, di -sec -butyl peroxydicarbonate 98 percent, di -sec -butyl peroxydicarbonate 75 percent, 1,1-di-0-butylperoxy)-3,5.5-tri methyecyclohexane 95 percent, di-(2-ethythexyl) peroxydicarbo- nate 97 percent, 2,5-dymethyl-2-5 di (benzoylperoxy) hexane 92 percent and peroxyacetic acid 43 percent. CLASS III: Class III peroxides burn rapidly and present a moderate reactivity hazard. Examples: acetyl cyclohexane sulfonal peroxide 29 percent, benzoyl peroxide 78 percent, benzoyl peroxide 1-454 P-Ppppp, APPENDIX VI -A 2.1.9 Water -reactive materials. 1994 UNIFORM FIRE CODE CLASS 3: Materials which react explosively with water without requiring heat or confinement. Examples: aluminum alkyls such as triethylaluminum, isobutylaluminum and trimethylaluminum. bromine pentafluoride, bromine trifluoride, chlorodiethylaluminium and diethylzinc. CLASS 2: Materials which may form potentially explosive mixtures with water. Examples: calcium carbide, calcium metal, cyanogen bromide, lithium hydride, methyldichlorosilane, potas- sium metal, potassium peroxide, sodium metal, sodium peroxide, sulfuric acid and trichlorosi lane. CLASS 1: Materials which may react with water with some release of energy but not violently. Examples: acetic anhydride, sodium hydroxide, sulfur monochloride and titanium tetrachloride. Classification by degree of hazard shall be in accordance with U.F.C. Standard 79-3. 2.1.10 Cryogenic fluids. 2.1.10.1 Flammable. Examples: carbon monoxide, deuterium (heavy hydrogen), ethylene, hy- drogen and methane. 2.1.10.2 Oxidizing. Examples: fluorine, nitric oxide and oxygen. 2.1.10.3 Corrosive. Examples: fluorine and nitric oxide. 2.1.10.4 Inert (chemically unreactive). Examples: argon, helium, krypton, neon, nitrogen and xenon. 2.1.10.5 Highly toxic. Examples: fluorine and nitric oxide. All of the cryogenics listed will exist as compressed gases when they are stored at ambient temper- atures. 2.2 Health Hazards. 2.2.1 Highly toxic and toxic materials. 2.2.1.1 Highly toxic materials. Examples: Gases—arsine, chlorine trifluoride, cyanogen, diborane, fluorine, germane, hydrogen cyanide, nitric oxide, nitrogen dioxide, ozone, phosphine, hydrogen selenide and stibene. Liquids—acrolein, acrylic acid, 2-chloroethanol (ethylene chlorohydrin), hydazine, hydrocyan- ic acid, 2-methylaziridine (propylenimine), 2-methyllactonitrile (acetone cyanohydrin), methyl es- ter isocyanic acid (methyl isocyanate), nicotine, tetranitromethane, and tetraethylstannane (tetraethyltin). Solids—(acetato) phenylmercury (phenyl mercuric acetate), 4-aminopyridine, arsenic pentox- ide, arsenic trioxide, calcium cyanide, 2-choloroacetophenone, aflatoxin B, decaborane (14), mer- cury (II) bromide (mercuric bromide), mercury (II) chloride (corrosive mercury chloride), pentachlorophenol, methyl parathion, phosphorus (white), and sodium azide. 2.2.1.2 Toxic materials. Examples: Gases—boron trichloride, boron trifluoride, chlorine, hydrogen fluoride, hydrogen sulfide, phosgene, silicon tetrafluoride. Liquids—acrylonitrile, allyl alcohol, alpha-chlorotoluene, aniline, 1 -chloro -2, 3-epoxypropane, chloroformic acid (allyl ester), 3-chloropropene (allyl chloride), o -cresol. crotonaldehyde, dibro- momethane, diisopropylamine, diethyl ester sulfuric acid, dimethyl ester sulfuric acid, 2-furalde- hyde (furfural), furfuryl alcohol, phorphorus chloride, phosphoryl chloride (phosphorus oxychloride), and thionyl chloride. Solids—acrylamide, barium chloride, barium (II) nitrate, benzidine, p-benzoquinone, beryllium chloride, cadmium chloride, cadmium oxide, chloroacetic acid, chlorophenylmercury (phenyl 1-456 APPENOIX VI-` mercuric chloride), chromium (Vi) oxide (chromic acid, solid), 2.4-dinitrotoluene, hydroquinone. mercury chloride (calomel), mercury (I1) sulfate (mercuric sulfate), osmium tetroxide, oxalic acid. phenol, P-phenylenediamine, phenylhydrazine, 4-phenylmorpholine, phosphorus sulfide, potas- sium fluoride, potassium hydroxide, selenium (IV) disulfide, and sodium fluoride. 2.2.2 Radioactive materials. 2.2.2.1 Common radiation source materials. More than 100 radioisotopes are in common usage in various medical, academic and industrial test and measuring situations. Most emit beta and gam- ma radiation. Some emit alpha radiation also. Some emit beta or gamma radiation exclusively. 2.2.2.2 Fissile materials. Fissile materials are materials which may undergo a fission reaction, and are usually found only at reactor sites, or as part of a nuclear weapon. Fissile materials may emit alpha, beta. gamma and neutron radiation. Examples: plutonium -238, plutonium -239, pluto- nium -241. uranium -233 and uranium -235. Note: Uranium (and certain other radioactive metals) are combustible in solid and finely divided form. as well as chemically toxic. When radioactive materials bum, the products of combustion (other than heat) will be radioactive as well. 2.2.3 Corrosives. 2.2.3.1 Acids. Examples: chromic, formic, hydrochloric (muriatic greater than 15 percent), hy- drofluoric, nitric (greater than 6 percent), perchloric and sulfilr_4c (4 percent or more). 2.2.3.2 Bases (alkalis). Examples: hydroxides—ammonium (greater than 10 percent), calcium, potassium (greater than 1 percent), sodium (greater than I percent) and certain carbonates—potas- sium. 2.2.3.3 Other corrosives. Examples: bromine, chlorine, fluorine, iodine and ammonia. Note: Corrosives which are oxidizers, e.g.. nitric acid, chlorine. fluorine: or are compressed gases, e.g., ammonia, chlorine, fluorine; or are water -reactive, e.g., concentrated sulfuric acid, so- dium hydroxide, are physical hazards in addition to being health hazards. 2.2.4 Carcinogens, irritants, sensitizers and other health hazard materials. 2.2.4.1 Carcinogens or suspect -carcinogens. Substances which produce or are suspected of pro- ducing or inciting cancer (see definitions, Article 2). Examples: asbestos, benzene, beryllium, car- bon tetrachloride, chloroform, diazomethane, P -dioxane, ethylene dichloride, polychlorinated biphenyls (PCBs) and vinyl chloride. 2.2.4.2 Other health hazard materials. Substances which cause damage to particular organs or systems (see definition, Article 2). Examples: Hepatoxins (chemicals which produce liver damage): carbon tetrachloride and nitrosamines. Nephrotoxins (chemicals which produce kidney damage): halogenated hydrocarbons and uranium. Neurotoxins (chemicals which produce their primary toxic effects on the nervous system): mercury and carbon disulfide. Blood or hematopoistic system toxins (chemicals which decrease hemoglobin function, de- prive the body tissues of oxygen): carbon monoxide and cyanides. Pulmonary damage agents (chemicals which irritate or damage the lungs): silica and asbes- tos. Reproductive toxins (chemicals which affect the reproductive capabilities, including chro- mosomal damage (mutations] and effects on fetuses (tersiogenesis]): lead and DBCP. 2.2.4.3 Irritants. Substances other than corrosives which cause a reversible inflammatory effect on living tissue by chemical action at the site of contact. Examples: diphenylaminechloroarsine, xylyl bromide and chloracetophene. 2.2.4.4 Sensitizers. Substances which cause an allergic reaction in normal tissue after repeated exposure. AND WHEN.RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 15 -Jan -2004 2004-0002449 Has not been compared with original BUTTE COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: Date r` �C �� PROPERTY OWNERS: State of Calif rnia County of YD known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal Signature, A.P. # O� Seal: JASON VANDENBERG Commission #t 1402657 -i` Notary Public •.Callfoinlp Butte County MyComm.ExQ wFeb27, 7 .G. �tI11iQa 1'�`. �.i EXHIBIT "A" Description The land referred to herein is situated in the State of California, County of Butte, and is described as follows: PARCEL I: PARCEL 3, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON DECEMBER 27, 2000, IN BOOK 1 SOOF MAPS, AT PAGE(S) 99 AND 100. RESERVING THEREFROM A 60 FOOT EASEMENT FOR INGRESS, EGRESS AND PUBLIC UTILITY PURPOSES AS SHOWN ON MAP RECORDED DECEMBER 27, 2000, IN BOOK 150 OF MAPS, PAGE 99 AND 100, BUTTE COUNTY RECORDS. ALSO RESERVING THEREFROM AN EASEMENT FOR ROADWAY INGRESS AND EGRESS AND PUBLIC UTILITY PURPOSES DESCRIBED AS FOLLOWS: A PORTION OF PARCEL 3, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, IN BOOK 150 OF MAPS, AT PAGE(S) 99 AND 100, MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE MOST NORTHERLY CORNER OF SAID PARCEL 3 AS SHOWN ON SAID PARCEL MAP; THENCE ALONG THE NORTHEASTERLY LINE OF SAID PARCEL 3 SOUTH 289 29' 10" EAST, A DISTANCE OF 40.00 FEET; THENCE SOUTH 61° 30' 50" WEST PARALLEL WITH THE NORTHWESTERLY LINE OF SAID PARCEL 3, A DISTANCE OF 150.00 FEET TO A POINT ON SANDHILL COURT AS' SHOWN ON SAID PARCEL MAP; SAID POINT BEING A POINT ON A CURVE HAVING A TANGENT BEARING AT THIS POINT OF NORTH 240 38' 38" EAST; THENCE ALONG SAID CURVE TO THE LEFT, BEING CONCAVE TO THE NORTHWEST, HAVING A RADIUS OF 50.00 FEET THROUGH A CENTRAL ANGLE OF 53° 07'48". AN ARC LENGTH OF 46.36 FEET TO A POINT ON THE NORTHWESTERLY LINE OF SAID PARCEL 3; THENCE ALONG SAID NORTHWESTERLY LINE OF SAID PARCEL 3 NORTH 610 30150- EAST, A DISTANCE OF 130.00 FEET TO THE POINT OF BEGINNING. APN 040-310-085-000 PARCEL II: AN EASEMENT. FOR INGRESS, EGRESS AND ACCESS OVER THE FOLLOWING DESCRIBED PARCEL OF LAND: BEING A PORTION OF THAT CERTAIN PARCEL AS SHOWN ON THAT CERTAIN MAP RILED FOR RECORD M MAP BOOK 124 AT PAGE 88 IN THE OFFICE OF THE BUTTE COUNTY RECORDER AND- BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: CONTINUED 16. 1 EXHIBIT "A" (Continued) PARCEL, 11: - CONTINUED .0400, COMMENCING AT THE INTERSECTION OF THE EASTERLY LINE OF THE SACRAMENTO NORTHERN RAILWAY RIGHT OF WAY WITH THE SOUTHERLY LINE OF THE SOUTHERN PACIFIC RAILROAD (STIRLING CITY BRANCH) RIGHT OF WAY AS SHOWN ON SAID MAP; THENCE SOUTH 280 29' 10" EAST, 909.74 FEET ALONG SAID EASTERLY LINE TO THE TRUE POINT OF BEGINNING, SAID POINT OF BEGINNING BEING MARKED BY A 3/4" OPEN IRON PIPE AS SHOWN ON SAW MAP; THENCE CONTINUING ALONG SAID EASTERLY LINE SOUTH 280 29' 10" EAST, 60.00 FEET; THENCE LEAVING SAID EASTERLY LINE SOUTH 610 30' 50" WEST, 33.00 FEET TO THE EASTERLY LINE OF THE "MIDWAY"; THENCE NORTH 280 29' 10" WEST, 60.00 FEET ALONG SAID EASTERLY LINE; THENCE LEAVING SAID EASTERLY LINE NORTH 61. 30' 50" EAST, 33.00 FEET TO THE POINT OF BEGINNING. PARCEL NII: A 60 FOOT EASEMENT FOR INGRESS, EGRESS AND PUBLIC UTILITY PURPOSES AS SHOWN ON MAP RECORDED DECEMBER 27, 2000, IN BOOK )50 OF MAPS, PAGE 99 AND 100, BU2 TE COUNTY RECORDS. EXCEPTING THEREFROM ALL THAT PORTION LYING WITHIN THE BOUNDS OF PARCEL 1, DESCRIBED HEREIN. ' r 2 - III{IIIIIIIIIINIIIIIf 101111111111 g�Y: tV1il� V6� Ret'orded I REC SEE 16.00 aIGIC.%4- OffCount Rpf rds 1 TAX 247.59 CANDACEUJ. SRUOSS I RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: Recorder R178EI►giRY DICKSON I Kristen Thalt Peters, Esq. Assti?laog—Q�3 I POP of 4 tI Cooper, White & Cooper LLP 1333 N. California Blvd,, Suite 430 Walnut Creek, CA 94396 APN 040-310-085.000 Space Above This Line For Recorder's Use GRANT DEED The undersigned Grantor(i) declare(s) under penalty of perjury that the following is true and correct: Documentary transfer tax is $247.50. Signature of Declarant or Agent Determining Tax William C. Chance and Kathryn L. Chance, husband.and wife, as community property hereby grant to. Comcast of Southern California, Inc., an Oregon corporation the following described real property in the County of Butte, State of California: See Exhibit "A" attached hereto and made a part hereof. Dated: October 2003 William C. Chance Kathryn L. Canoe 84833NI Z'd d�-1 d3d000'831IHM'63d00J WU80:01: 70, 7Z Ndf STATE OF CALIFORNIA ) COUNTY OF t.) ) On / , 2003, before me, I Z1 J r u a Notary Public in and for said State of California, personally appeared Llii 1 I iOpli 1417 , personally known to me (or proved to me on the basis of satisfactory evidence) to be the porson(s) whose name is subscribed to the within instrument and acknowledged that helshe/they executed the same in his/her/thoir authorized capaciry(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. TAMI BARLOW COMM. d 1289725 lip NOTARY PUSUC-CAUMN!1A COUNTY OF BUM Comm. Expires Jan. 7. 2006 STATE OF CALIFORNIA ) COUNTY OF .3 ) 88. Notary Public in and for said State On /b / 5 2003, before�Jnne, Qs'n 7-:34r-1Dui , a Notary Public in and for said State of slifornia, personally appeared K& h L . rAApr4e,personally known tome (or proved to me on the basis of satisfactory evidence) to tv the person(s) whose name is subscribed to the within in®trument and acknowledged that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. =PUBLIC-CALIFOANIA OW 89725 LIfOANIA UTTE. 7, x006 a9s3�o.I E'd Notary Public in and fbr said State d1_1 83dOODS31IHM'a3d00J WU80:01 V0, VT Mbf EXHIBIT "A" Description The land referred to herein is situated in the State of California, County of Butte, and is described as follows; PARCEL L PARCEL 3, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON DECEMBER 27, 2000, IN BOOK I50OF MAPS, AT PAGE(S) 99 AND 100. RESERVING THEREFROM A 60 FOOT EASEMENT FOR INGRESS, EGRESS AND PUBLIC UTILITY PURPOSES AS SHOWN ON MAP RECORDED DECEMBER 27, 2000, IN BOOK 150 OF MAPS, PAGE 99 AND 100, BUTTE COUNTY RECORDS. ALSO RESERVING THEREFROM AN EASEMENT FOR ROADWAY INGRESS AND EGRESS AND PUBLIC UTILITY PURPOSES DESCRIBED AS FOLLOWS: A PORTION OF PARCEL 3, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, IN BOOK 150 OF MAPS, AT PAGE(S) 99 AND 100, MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE MOST NORTHERLY CORNER OF SAID PARCEL 3 AS SHOWN ON SAID PARCEL MAP; THENCE ALONG THE NORTHEASTERLY LINE OF SAID PARCEL 3 SOUTH 2801 29' 10" EAST, A DISTANCE OF 40.00 FEET; THENCE SOUTH 61- 30' 50" WEST PARALLEL WITH THE NORTHWESTERLY LINE OF SAID PARCEL 3, A DISTANCE OF 150.00 FEET TO A POINT ON SANDHILL COURT AS' SHOWN ON SAID PARCEL MAP; SAID POINT BEING A POINT ON A CURVE HAVING A TANGENT BEARING AT THIS POINT OF NORTH 240 38' 38" EAST; THENCE ALONG SAID CURVE TO THE LEFT, BEING CONCAVE TO THE NORTHWEST, HAVING A RADIUS OF 50,00 FEET THROUGH A CENTRAL ANGLE OF 530 07'48". AN ARC LENGTH OF 46.36 FRET TO A POINT ON THE NORTHWESTERLY LINE OF SAID PARCEL 3; THENCE ALONG SAID NORTHWESTERLY LINE OF SAID PARCEL 3 NORTH 610 30'50" EAST, A DISTANCE OF 130.00 FEET TO THE POINT OF BEGINNING. APN 040-310-085-000 PARCEL II: AN 9ASEMENT.FOR INGRESS, EGRESS AND ACCESS OVER THE FOLLOWING DESCRIBED PARCEL OF LAND: BEING A PORTION OF THAT CERTAIN PARCEL AS SHOWN ON THAT CERTAIN MAP FILED FOR RECORD M MAP BOOK 124 AT PAGE 88 IN THE OFFICE OF THE BUTTE COUNTY RECORDER AND BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: CONTINUED t7 ' d d-1-1 83d00J831 I HM ' 63d000 WU60 : 0 L VO, V1 Nor EXHIBIT "A" (Continued) PARCEL 11, - CONTINUED COMMENCING AT THE INTERSECTION OF THE EASTERLY LINE OF THE SACRAMENTO NORTHERN RAILWAY RIGHT OF WAY WITH THE SOUTHERLY LINE OF THE SOUTHERN PACIFIC RAILROAD (STIRLING CITY BRANCH) RIGHT OF WAY AS SHOWN ON SAID MAP; THENCE SOUTH 280 29' 10" EAST, 909.74 FEET ALONG SAID EASTERLY LINE TO THE TRUE POINT OF BEGINNING, SAID POINT OF BEGINNING BEING MARKED BY A 3/4" OPEN IRON PIPE AS SHOWN ON SAO) MAP; THENCE CONITNUING ALONG SAID EASTERLY LINE SOUTH 28° 29' 10" EAST, 60.00 FEET; THENCE LEAVING SAID EASTERLY LINE SOUTH 610 30' 50-- WEST, 0"WEST, 33.00 FEET TO THE EASTERLY LINE OF THE "MIDWAY'; THENCE NORTH 28° 29' 10" WEST, 60.00 FEET ALONG SAID EASTERLY LINE; THENCE LEAVING SAID EASTERLY LINE NORTH 61. 30' 50" EAST, 33.00 FEET TO THE POINT'OF BEGINNING. PARCEL Ill: A 60 FOOT EASEMENT FOR INGRESS, EGRESS AND PUBLIC UTILITY PURPOSES AS SHOWN ON MAP RECORDED DECEMBER 27, 2000, IN BOOK 150 OF MAPS, PAGE 99 AND 100, BUTTE COUNTY RECORDS. EXCEPTING THEREFROM ALL THAT PORTION LYING WITHIN THE BOUNDS OF PARCEL 1, DESCRIBED HEREIN. v 0 S'd del d3d00J'831IHM`b3d00J WC60:0i V0, Vi Wbf 'ti '7:� '� •.l F�•"10 i r 2a -3i 1 I I � 1 20, PROPt�SE� WA TETE L F. ?Jr 3` I'- �?-"' � X2.7 �`• j � \. `{)3.f E 180.00 ylt �,P - — — — . ,---- - :3 Jti ,<r" Xaa tis ry J I i 75 LF LEACH t5OX '--�ODQ &ALL O .: 5EPT/C TAA ®� A I \\,,I rn m �Jm '—PRO" „ry 5EW? r �\ .:. •-/. dill � /. ,� 203.1 L J r'7--, rn•� - a�f-' 2a -3i 1 I I � 1 20, PROPt�SE� WA TETE L F. ?Jr 3` I'- �?-"' � X2.7 �`• j � \. `{)3.f E 180.00 ylt �,P - — — — . ,---- - :3 Jti ,<r" Xaa tis ry J I i 75 LF LEACH t5OX '--�ODQ &ALL O .: 5EPT/C TAA ®� A I \\,,I rn m �Jm '—PRO" „ry 5EW? / 203.1 L J 0 NI ZI 1 2a -3i 1 I I � 1 20, PROPt�SE� WA TETE L F. ?Jr 3` I'- �?-"' � X2.7 �`• j � \. `{)3.f E 180.00 ylt �,P - — — — . ,---- - :3 Jti ,<r" Xaa tis ry J I i 75 LF LEACH t5OX '--�ODQ &ALL O .: 5EPT/C TAA ®� A I \\,,I rn m �Jm ro� � �fj32 2p3-1 }2 0-5.67*06:33"W 0 $6 3 4. /8 ,tI .b pA :o `3 W 761.45' OF BEA�YVG/ X312 003 -D 4” L INET 1 � I IGRAPHIC SCALE 30 0 15 30 50 1 1 1 inch = 30 ft. THIS DRAWING MAY HAVE BEEN ENLARGED OR REDUCED. OI • I CJ r "4-7 I I \ I yJ39 X1.0 1 I of; I I 2r�k"3 2015 '—PRO" „ry 5EW? / 203.1 L J ro� � �fj32 2p3-1 }2 0-5.67*06:33"W 0 $6 3 4. /8 ,tI .b pA :o `3 W 761.45' OF BEA�YVG/ X312 003 -D 4” L INET 1 � I IGRAPHIC SCALE 30 0 15 30 50 1 1 1 inch = 30 ft. THIS DRAWING MAY HAVE BEEN ENLARGED OR REDUCED. OI • I CJ r "4-7 I I \ I yJ39 X1.0 1 I of; I I 2r�k"3 2015 '' ^'•' •��' ''- '� F 23Nir� �1�' <=12'� `�/ ! X3.1 i- 0.7 NV ;Call1,tT; , �.�`�.�-"- �A(. �_, • �.•¢ _ T � /,h `•.. `1.117 '1'J�' \_� � 75 LF LEA C, f, F ;�„fir 7�a I,�t-C--. ..-_ _ r.:�_ _..+ _ - P•'J, _ ... 1• 1 -- A - 'qMill' j •p1j.” rp 33 lz p3 ' to :>D/ T IBUTION BOX 3 20 GALL. ' pa 3 SEPTCW T/G TANK I�. B -p �-� GRAPHIC SCALE ® # I 30 0 15 30 60 col ie s Q 1 i1 -i yy. . .,�isY �-iY 4.,w etiM f',:.li• t IJ � .� -, r�- t - �:t��'sr "�'°•." ^;tip ;�° - _ - ;a- L FEET ) 1 inch = 30 ft THIS DRAWING MAY HAVE BEEN ENLARGED OR REDUCED. Q, _oI �� �-�i� - !„� �, �'?�-- � -`•, O FF,.�204.50PRD ED 4' 5EW,�R LINE' O Opn,� 17 4 C 0 /y I O nt Q :x'111 Fy3.: •'`.i � ��' <� � � � �3 �.. &0 �, 204 o SIJ / F-� CL ZI f / L J<Vv 1-1 "1 Z Q I LJ I yJ•1•`I 20A.0 p 1 I 5 a3ti y t 1 ;.,1 �i33 M3.2 1 d r� � I .• �.J3 � 3.1 I '� Z a# .- 20 b. R ,_._ .-, �-,:� -/,• • X3.2 � ,x;,34 � I % -T Ib `.%J "�•�' J =�?_"T — 5-6T` ak.3 p/Q6�3.W I8Q86. P� S� r p34 -fie 06 33„w OF 761.45' f ,n3:k ?70' A3 ®■ 23� H r3 -Ron 02 . ..... .... 6 5ANOHILL COURT 0,le�-5bo z N61*,05;F 2L 202,3 ahJ2.4 2 lb- �F, C.16./d 16 75 LF LEACH 'XI PgOrO.5"&V, 1-2 WATER: L -/6` 203 6c, -ION 5 -03k�tiZ:,.., �)2 q V6U7 7 "--TODO 67ALLOW.13 1 I 5 r C, TANK. o 3? V d GRAPHIC SCALE 30 0 15 30 60 .02 .6 4* iW-'FEET 1 inch = 30 ft llo� THIS DRAWING MAY HAVE BEEN ENLARGED OR REDUCED. PRO Eo 4 QJ if 4.50 SEWj L I NE U2� 0 �:. /- .1 /— >"o on ?,- OR 3 203.1 col L -J 4 0 z Ll 31 oi X3.2 I 00p 532 05 f'rF{" jam` I ,\q jVia./ I j;& 2040 LJs X33 567-06J3W < /8_0_86' -5e7'0 6 33 W 76-5' OF 5EA - 14 203.3 9 5ANOHILL COURT !y"'a\�ti ;�� 300 0 4Y�A N61" N ZI 2cj3LI zzi� § Z, C p WA 1q 0 A)3 0 -204.50 p26 �2.k� C5,- LF -LEA; z-0-6P�OUTION 50X &ALLO 50' T /C, TA W IpI Ips Ips � \A n 1 203.. 0 103.2 203.1 56706 PAO �j GRAPHIC SCALE 30 0 15 3 0 60 WFEET 1 inch = 30 ft. THIS DRAWING MAY HAVE BEEN ENLARGED. OR REDUCED. OI 0 4 cil LINE, of ir�� DO`` Z3 �i \ '0p X03.b 2049 3 /8 l 0 -36' �04 Ea4ronmental He, 7 -56 7*06 J3 W76145' NOV 0 4 7003 45J�Y-5 0/= o5EA ZIA-' Chico, CA 00 0 0 0 0 IMAGEWORKS ARCHITECTURE, INC. CON5ULTM : V wFWC1E zNGEREM&Dw- -ro6c—Iff70 GL I ENT Comcast 2441 N. Grove Industrial Dr. Fresno, California 93727-1535 PROJECT Comcast HEAD END FACILITY Chico, CA -UV C)KAWIN& KEY PLAN !0 ENGINEER I ARCHITECT PLOT PLAN SHEET 11, —PROP, 5E W� LJ 07' /00 1 203.. 0 103.2 203.1 56706 PAO �j GRAPHIC SCALE 30 0 15 3 0 60 WFEET 1 inch = 30 ft. THIS DRAWING MAY HAVE BEEN ENLARGED. OR REDUCED. OI 0 4 cil LINE, of ir�� DO`` Z3 �i \ '0p X03.b 2049 3 /8 l 0 -36' �04 Ea4ronmental He, 7 -56 7*06 J3 W76145' NOV 0 4 7003 45J�Y-5 0/= o5EA ZIA-' Chico, CA 00 0 0 0 0 IMAGEWORKS ARCHITECTURE, INC. CON5ULTM : V wFWC1E zNGEREM&Dw- -ro6c—Iff70 GL I ENT Comcast 2441 N. Grove Industrial Dr. Fresno, California 93727-1535 PROJECT Comcast HEAD END FACILITY Chico, CA -UV C)KAWIN& KEY PLAN !0 ENGINEER I ARCHITECT PLOT PLAN SHEET 11, KEYNOTES • „ 101 rim GMo WALL W Samw 5623125-39 (OR APPROVED EWAU STUDS • 16. O.G. - FILL ALL STUD CAVITIES n/ RHI BATT IWALATON - FINISH W %' TYPE -W GYP. BD. - TAPE as.e we ALLJONTS IYIALL � Ivv 2 i 6' ChV (TYP) e a 5 C0MWT SLEEVE 'v'� rr-o• Aha 4 HVA. WIT - SM MEEK DWSS. 9 ROOF UNE aP A10MN0 ew ►M6 Af✓l II b HEADEND 15WPIIENT RUL) ` 4 4 N y h 1 W ` 7 PROVIDE RRC ExnMWMIER AND MOLNT PER MANUFAGTRSBt3 SPECIRGA710NH5 6 40' NISH TO CAROL OF ACTUATOR - use EXTINGUISHER RATING 2A20BC i 1 0 9 WC AClAEIBIBLZ LAVATORY AND MIRROR (ABOVE) YVLL MOIMTED LRINN. (WG ACCESSIBLE) u w .o q1 -w T. 0A loe x+c WOW IM I� M } i 10 WATER CLOSET RVG ACCE95MLE) ® 11 SRAO BAR 12 TOILET PAPHR DISPBLe.6R ? �' g i� L{� {i E1 14 PAPER TOYS WSPEHSOV MMSTE REC!PTAGLE SEAT COVER. DI5PRl9Ol gI IS 80'[46' P25MARM CLEAR SPACE ..o• an we J p, 16 605 MRL CLEAR SPACE tw w x w s w w w w w w r w h 4060 1 HR RATED WIIDOrH NrIRQ - ® POOR 10 19 FLOOR DRAIN 54' H16H BASE CA43IEr . ® 20 WALL CABINET M DG m »e w M • k 4 ! ! N] 21 1105E BID - S@ PWMBIN6 DW7S HEAD" eGw. POOH N MJ 22 1 HR FIRE RATED MALL ' w ®' A6i GENERAL NOTES M KID" OP THE LEVEL AREA ON THE SNIDE TO MMGH THE DOOR 5109465 SHALL MKTEW 24' MINIM!•/ PACT THE STRUM w 0 w e e r 16 >A s x w : : a* 31. a T M e . i oP M DOOR 2 THE MOOR OR LAND00 SHALL NOT EC MORE TWH)Y LOVER THAN THE THRElMOLO OF T! DOORMAY. 5. PINE eXTNIGUSHER SHALL BE MOIMIED M CAGILY AGC 55M" APPROVEDI LOCATION, FEE OF OBSTRUCTON5. PROVIDE LOCATOR SIGN W EMNGUISH7! 15 NOT READILY VISIBLE. Butte County Environmental Health Y ® I� a '"" 4 . /ILL STORAGE RACKS RE DL' UNDER6'•0' TO A U TALL 5 5M !V".2!V".2.2 PGR RESTROOM PxT� AND A"a�39OIIE5 Dat — En nt~''ntal Health MOLIN INC HE 1175. 6. E9•acr REWIRED TO DEEM DooR(6) SHALL NOT aTc4>s 0 LDS. AT INT, 4 TEM. DDDICi AND 10 L.M. AT FIRE DOORS. G� xne DOOR 4 rKMe5 TO DE 'CURRW GONTANY' OR A l-WVED Signature U 4 7 A03 EMAL- - PROVIDE r✓ 2Qr� FgNt-C+ tH8 VMM 5T -EHED cET ONSIR ON W MIT951A1 WOOL d:Tram EAG" STFFCNE! Q l! LOCK EDGE TO Ix NDN -DCVO.® AND ROH'ORGED FULL Md*ff II STEMS_ 14TL'dRAL HINGE CHA1.C. r✓ cp41LCTE N614RDYIAR Z AID FROVDE FLUSH TOP 4 BarTIOM C 4 DOTTIOM GIWlB Q 1 WBDED AT MA7flMM 2 ' ON L OF 169M YCL W AT Chic( nr CEROt PAGE SHEETS TO 0 16tTcl COLD ROLL® PR0.GTON � T� ON 5EA.10 ON DOM� NO SIV LL Ib►VE FLLL PR VM DUNN-EvwAImS PAIN* (OR APPROVED EOUAu. PROVIDE M=K RLLOtS, PRIMUM ASD FR65H COAT 4 MAT9RIAL9 THAT ARE CONTAMBLE WITH ONE ANOTHER 4 59TH M StM MARS APPLIED TO. PROVIDE MANUFACTUNOI'S MST FLOOR PLAN SCALE: 3• - I-V 1 ROOM FINISH SCHEDULE DOOR HARDWARE SCHEDULE 004.1-9 ROOM ROOM FLOOR DACE NORTH HAN'R' MATL RK MAYL FII. MATL RI. EAST SOWN 10!97 !ALINE MAn PIK MATL FIN. I MATL FIN. MATT. RN. Q�]j V NOTEa 2 ♦ . 3 . ' F` a k G < [ x L yx ] GIIML TY FAINT MATOVAL Q THE VIRIONS GOATNS TYR 5 RESUMED THAT AfM BY MAHI PAGTU✓ EIR POR TMPLIGAORY �AITDIGA7R. TM AND ®D® FRP RAMLS TO d: MARLIT: RDOCGUl96 ROMGRCEO ROLYWTR PNGS MW). TEXTURE 4 COLOR 7O BE AS SHRFLTED BY Or4cR/ARCR97EGT. PROVIDE MARL ITE BRAND HAIWO MING MOL7IN0W–" OR 6-091 AVHMVE5, SiLloom SEALANT 4 DORIPM AGCEOORY FRODLKCTS AS IUMIRED, ALL. POR. MO M P MUST PROVIDE POR A MNIN9lM W GTNHSION JDRR 7V ENSURE IROFOR INSTA4 EATIOK ACRYLIC co4CIReTe TOPPNS MAT9VAL TO DE Wr CONCRETE 75CHHOI OSY, INC,. Wn) - COMPRISED OF A WLOR INTEGRATED, MODIFIED A0%YUG C 5.,ENT PRODUCT MADE OF PORRTLAlD C&MfT, 5LUCA SAND AND A MODIFIED ACRYLIC, RIWN POR rTS DONDI4G AGEfr. RESTROOM ACCED90RIE5 AM TO BL' BY DOM" OR APPROVED eQ A54G35ORY STYLE! To OE APPROVED BY 101 HEADED 5WIP. RM. P2 A2 d A2 109 N PC Al 109 Al W N ce. N OFEN - IOIA x - x x - X - x x - - x X x x x - 102 OFRCe411OW RK R A.2 d A2 109 N K Al WI Al W N C.2 N 10`-0' - 102A - - x - X - - - - X - - - - - - 109 MJ5 J`3TO iA I! RM F2 A2 d A2 WI Al WI Al W N W N C8 N OPEN - IOSA .• - x - x - - - - x - - _ - _ - _ - 104 RESTROOM P2 A2 D2 A2 VQ N I MQ N W2 N I MQ N GI N la -0' - Io4A - - X _ x _ _ x _ x _ _ x _ _ - DOOR AND FRAME SCHEDULE DOM ar SLIMFIE1 POM LTM Trrt NAn x LAm TYFe 14An rol YmM — 6 W11 HUD AVO 39J. NOTES ROOM FINISH CODES DOOR HARDWARE FLOOR DEscRTPnoN MODEL A 12xIStV6• VINYL GOFTOSITION TLE EXTERIOR DOOR 141we S STAILLEY FMIq 43x4s~ r7 ACRYLIC CONORETE TOFRN6 _ rt 102 A A! 4 T-0' I'�4' IM OO A NN R 4�AOJ NbJ INTORTOR DOOR NIHM9 STAH.BY FEE, 43.43 OWHOVARCOTEOT. A40J5TICAL CEILINS SYSTEM PANELS TO 00 A RMSTRONS WORLD INDUSTRIG3, INC. (OR APPROVED PIAL), C."U 9 TILE 4 LAYI1. IOa A A 4%0 T-0' 15/4' 144 60 A Fl1 R dADJ dADJ - EASES _ _ l04 A G'4 -0' a • t? at 1 4' TOP SET RUelCt DAVE CLOSER. DG2210xAaC4TbC•g4 SCHEDULE ABBREVIATIONS m W COVE BASE (AGRYLIG GOWAMTE TOPPNS) LoCK5Er 601mIN UT0200 SEOES METH 7 -PINS INTERCHfMIGCADLE CORE 49E0, 24.40.V WHITE. EDGE PROFILE TO d: TEGLLAR/ WMAL POR IN1— ACE W PRELLVe XL %* DPIOSED TIE. SU51FI9tlION SYSTEM. FROVIDE FRaITDe AL %' MW05W TEE AS MANUI'AGTURED DY ARMSTRONS N40MM INDUSTRIES, MC. COLOR LATCH.SEr CORRIN UT5200 5Me5 - LINER TYPE REWIRED PALLS DIGITAL LOCKSET SIMPLEX 1000 SERIES UVR TYPE REGVIRM) d.D6I BI WIN& FIK I RHS! I PM PRIJSGED McTAL Pr PAINT TO Be NATURAL ALLIKKIM ND MATCH T! ACTUAL COLOR OF THE SELECTED COLINS TILE. STRUCTURAL CLASSIFICATION TO BE AM CROSS TEESN SHALL COM9A AL QUA J1`Y �-O� TYPe •x• 6YPSLM BOARD N: PRP WNNSGOr TO «{D w%• WATOI KEYING DY COMGACT CAGLe BLA7JH0 (6L.A-N IFI HOLLOW METALDOOR LTt LETTER MAIL MATERIAL - I _ - I - I _ _ Rb19TANT 617. d7. ABOVE 6ALVA)Om7 (GALVANIZED STEE , AL LIKK M OR 5TANL 55 STMJ AS PR ASTM A 650 AND HAVE ROTARY 5TITC TINS (EXC9"OH, EXTRUDED ALUIM MINOR STAINLESS STMJ. MAIN BEAM AND CROSS T95 ARE POMAW STEL GONSTIOKTON WITS TYPE E)VOOED FLANGe DMOK EVIOSED SURFACES CHEMICALLY CLENYW, 0APPNS Pm -FINISHED GALVN9ZW STM (ALa4HM OR STAINLESS STEEL) IN DAH® POLYESTER, STOP GVLI ATY 904 CEILING EXTHVOR DOOR SEAL IF&fKO 53=4t x L 04M AS REGIUIRED G %- TYPE 'X' 6YPSIM BOARD INr19VOR DOOR SeAL. PE4K0 552GR x LE1aT" AS PSWIRED i GO 5LTSPEDED AGCOUSITc TLE rA EXrO` fS 5T RTU M 4 INYLATON /moo DOLOR morrom PE KO 411APKL PNNr. LEGEND noORTYFe •A• FRAheTSR[FINISHES 'A. KIGKPLATE IGVALITY 6" 1&,Q' U -V n/ I%%* N PAIW - 5 GOATS THRESHOLD 190A �5T1D5 a wo TYPE NX 6YP.•ED ON INTMOR OF FUOLNS MALL Aa FACTORY FINIS" I =_ IM. WALL - 5%, 1•CTAL STUDS • I6' OL. - %• TYPE 'x' SIT. W. BOTH SIDE! \ ri df. i der LOCATION SKETCH VIA1. -J� .......... ......... ..... .... ... ....... - ------ .. .......... .......... ........ . ... T I I i I 6 'P ------ L2 .kVE . ........... ...... J . 0. J do, P. �E. 40" P-1 -V -1) FA s-GYCrIl ........ fn v . .......... 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Mwky SYSTEM P&AWWm"A OkRrtiTt ...... .... ORAINREV No F FFIELDEDFIELDED By- I DATE DWG 41 V+ rA 7 6 uu3 o . 'yv'4-r4 Es nr u= s + t i I v t , • r , i v , i 1 } { 4 .i • 5 5.. i r-- F 1 1 e i f / f �^ 1 ! t Q 1 „F i i • f : , : 1 ' 1 , 1 r i , , : C9 41F t L, E A• A 1 ' - , t , 2 . I J LOCATION SKETCH NOTES: CC.Tcast communications OFFICE: 4350 PELL DR., SACRAMENTO, CA 95838 COMCAST UPGRADE sowm sxor. of l I /Z8 Mw WA b SYSMt 09*90rmf. = aFi ofulo I 2so' 9 RUM 6Y: DATE: SCALE DRAWING w 1-4- 1-�*7,n4- I�.I-I�: SZ OF4 ''oori L DG9 ' OACK ;tom®Gl �s, %kgN ��..� - �` v LOCATION SKETCH t i- , , i 1 ! k ., t : 1 i ...1 ... ..{ S � r 1 r _....._.` r ... .... .._ ... _. ._ _... .._ _. _ .... .. _ t i i , i r t ! r S I L S� I 40 : -� '7 , 4 3 ........... _....__---..j-_--, - - - - -- - - k t i • , i , 1 tlzill • 5 S i : i IL ' i C , : s !?ED�S'r •R�IFN �6 i t 3 S } j i s x � 3 1 t R.f 1p NEW I ' t .b Wy i S ; � � ^ Ili qll t f , PRar,os o �vREytrN 2 2 bIA TS'36 D6Pri1+ MIN. _ , i , t � I ; : �t6 �. 3. , + 4. "r % 1 j { , : NOTES: • EN'r' 1 ' i 3 , F PlWEM r iry i ,. 4 nr �e i : NZ. b • i t 1 • t . i , . _i.....,.., f , t • e v I i I ....... ; i _ v.r . i f : 1 ' r r -1ZGE cF � P�FyE�•cE�l t 1 3 � EDGE, e� _ ���: - , i _ r , i I , k i t f i 1 i f t , : . t , , 1 .. i , _ is tions come S commun a , DR.. SACRAMENTO, CA 95838 > 1 FFT 4 _ REGIONAL O CE. 350 ELL i > L r , , ...... ............ . i : -: - - - - COMCAS RADE 1112-0 _ , T UPGRADE I i _ : t f : 1 , : - t SYSiEAk L. DIs<61'i 3 D Rwr01Pi/1A �. i O Z S+ FIELDED BY: oA7E S�CnLE. NO REVOFAn it - b -- LOCATION SKETCH . ......... cp it iIr irS Zi t4s ii ... ... . ... .. . ......... ... . ...... . ......... .......... .. ........ 1 4 ...... . ... . ...... . .... ......... . ........ I--- .... ..... ...... .... ....... ... ... ......... . .......... .10. p i ... .... .... . . ....... . ..... . 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CpTcast communications OMCF_ 4350 PELL DR., SACRAMENTO, CA 95838 ... .. .. . ... ....... . . ...... . .. . ......... ...... . . ..... PROJECT: ....... ... ........ ..... . COMCAST UPGRADE 1+ -7 LOCATION: I ku AJOAT IWOWAY C, SYSTEM: camiT! vv ------ -.47 . ....... FlELM ErY.• OATE- DRAW SCALE. 4G MO. Fi in 4-1