HomeMy WebLinkAbout041-500-008„t-�e-moi'^•-F- ,.....R-.�,t. - _ -...<-
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041-500-008 02-0549 J
SHOOK, DON & DENISE
g$� CHEROKEE, OROVILLLS'
3� CONT: SKYCREST ENT �Ga'
,NEW MH NEW SITE PERM FND
E
RES_ inimmm
041-500-008 02-0549
SHOOK, DON & DENISE
PERT&CHEROKEE, OROVILLE
CONT: SKYCREST ENT
NEW MH NEW SITE PERM FND
THE HCD FORM 433A FOR THIS MH CANNOT BE
RECORDED UNTIL ONE OF THE FOLLOWING HAS
BEEN TURNED IN TO THE BUILDING DIVISION:
(1) LICENSE PLATE(S) OR DECAL (THE
INSPECTOR MUST RETREIVE).
(2) STATEMENT OF FACTS (ONLY ON
NEW MH'S).
INSPECTOR TO VERIFY SERIAL & LABEL #'S.
SPECIAL CONDITIONS
CHECKED
BY
_SRA
-.FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
_ SPECIAL INSPECTION ITEMS
_ VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
C
P
OFFICE COPY
Address
5
GAS
Meter By_&4�—_ _ Date
EL
Met...1
-sy Aa4r-
ELECTRIC
Meter By Dat4162—
JOB
FINALED (DateZ �--
Signature
I
d=OK
0 = Not OK
- = Not Applicable , , MOBILE HOMES
= Not Rwdy
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; ation-Test-Easeme eeded (Sketch)
5. tricity; Location -CI ances-Grn - /Amp -Concrete
1/ Gas; Locatioap;-/
d / /' Nat. V'rL-ft./ /'LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date M91311LEJONIE INSTALLATION (Plans) OK except #'s
Zon ingRequirements-Setbacks-Easements
rings; Size -Spacing -Marriage Line
p as; MH Test -Demand -Valve -Connector
a4 tricity; MH Test -Crossovers -Breakers -Clearances
tCe�brain: MH Test -Fall -Flex Connector
/.E7jWater and Sewer Connected -C/O to Grade.HD Approval
8. Gas 9nd Electricity Tagged
9. Downs -Type -Installation Cert.
Z) L' 4W Exits; Insp_Skefetr'
11. Cert. of Occupancy
12. Permanent Foundation Only; License Decal
Date Card B-1 Date Card B-1
Date < (�r li7i Card B-1 * Date Card B-1
� � 1
3 b
f
8,V 7
r
1
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 FINAL (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 in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
a
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- Bea ms- Rftrs.-Connectors
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 FINAL (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 in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
✓ = OK
0 = Not OK
- = Not Applicable
= Not Ready
RESIDENTIAL (;
Date
Underfloor (Plans) OK except #'s
Hangers -Post Caps -Anchors -Connectors
i.
Zoning-Setbacks-Easements-Flood-Slope
Cling. Joist-Rftr. Ties- Purlin-Rolf Brac.-Truss-Shting.-Rfng.
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
4.
Ftg., Porches & Decks; Soils-Steel-/ /" Ftg. Depth
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
Garage Fire Protection Framing
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
Property Line Firewall & Openings
6a.
Hold Downs and Sliecial Anchors
Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
7.
Slab, Steel-Wrapped
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
8.
Piers-Fireplace Ftg.-Steel
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
9.
D.W.V.; Fall-Fitting-Test-2 Way C/O-Sewer Test
Siding -Nailing Veneer
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
11.
Water Pipe; Test-Anchors-Regulator-Service Test
Glazing Area -Glass Protection -Skylights -Plastic
12.
Electric Underground
Shear Walls; Nailing -Bolts
13.
Plenums & Ducts; Clearance-Material-Support-Ins.
Brace Interior/Exterior Wall Panels
14.
Girders-Sills-Anchor Bolts-Joists-Vents-Crippies
Insulation -Walls -Ceilings
15.
Access & Ventilation
Infiltration -Walls -Windows
16.
Insulation
Date
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Ext. Steps -Door & Sidelight Protection -Landings
17.
Water Htr.; Vent-Access-Combustion Air Baffle
Smoke Detector
18.
Water Pipe; Test & Anchor-Nail Protection
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
19.
D.W.V.; Test Fittings & Anchor-Nail Protection
Bedroom Exiting
20.
Shower Pan; Test, First Floor-Tub Access
G.F.I. & Bath Fixtures & Tub Access -Spa
21.
Test Tub & Shower, Second Floor-Tub Access
Elec. Trim & Subpanel, Breaker Sizes & Labels
22.
Gas Pipe; Sixe & Anchors
Stairs & Rails
70.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
72.
ELECTRICAL (Permit) OK except #'s
23.
Fixture & Transformer Clearance-Ins. Protection
24.
Elec. Receptacles Spacing-Lights & Switches at Doors
25.
_
Size Boxes & No. of Conductors Stapled
26.
Romex Installed Close to Edge of Studs & C.J.
27.
Equip. Ground made up w/Mech Fasteners-Bond Gas & Water
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
29.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or Al
30.
Range Circle / / ga Cu or AI-Oven Circ. / / ga Cu or At
Insulated Neutral p Yes ❑ No
31.
Service-Riser Conductors & Ground Main Disconnect
32.
Equip. Clearances Panels-Motors-Mech. Equip.
33.
Clothes Closet Light-Shower Light-Spa Light
34.
Smoke Detector
84.
A.C. Unit Disconnect, Electrical -Plumbing
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Water Well, Disconnect, Electrical, Plumbing
MECHANICAL (Permit) OK except #'s
87.
35.
A.C. Ducts Insulation & Support
88.
36.
Vent Fan, Exhaust above insulation
89.
37.
Condensate Drain & Overflow, Size & Grade
90.
38.
Furnace-Vent Access-Comb. Air-Return Air Vent 115 outlet
91.
39.
Attic Access & Platform if Furnace in Attic
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Date
FRAMING (Permit) OK except #'s
Date
40.
Sits Proper Materials & Anchors
Card B-1 Date Card B-1
41.
Walls Studs-Nailing Spacing & Braces-Plates-Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings-Stairs-Chasers-Tubs
45.
Headers & Beams-Size & Bearing
>ingle & Duplex)
Date
FRAMING (Continued)
46.
Hangers -Post Caps -Anchors -Connectors
47.
Cling. Joist-Rftr. Ties- Purlin-Rolf Brac.-Truss-Shting.-Rfng.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skylights -Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
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
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
82.
Following Instld./Drive :1 Yes J NoMalks Z) Yes :1 No/Planters Yes 'J No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
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:
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
OWNER
PERMIT
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.
C.17 m( ISIL 1 i1 d . -
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERM,I��o.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR"U41UM.7UO-008
ZONING
BUILDINGPERMIT
OWNER
DON &DENISE SHOOK
TELE53PHONE
534-1819
SO. FT. OCC. BUILDING VALUATION
1527 R 82458.00
. OWNERS MAILING ADDRESS
2920 CLARK RD, PARADISE 95965
CONTRACTOR'S NAME
AKYCREST ENT
TELEPHONE
342-2694
CONTRACTORSa3468 ADDRESS
99 E, CHICO CA 95973
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 82458.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee 563 / 2
$ 281.50
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$ 23.00
BUILDINGADDRESS
CHEROKEE RD OROVILLE
Energy Plan Checking Fee
$
$
PERMIT FEE
$ 324.50
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome K Other
SPECIFY
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 ❑ Installations Other ❑
Describe Work: NEW MH NEW SITE PERM FNDN
Gas piping system 1 - 5 outlets
15.00 15.00
Building sewer
15.00 15.00
Mobile Home I s I G I W
@20.00
PERMIT FEE
$ 65.00.
ELECTRICAL PERMIT
I Fling Feel_ 20.00
Main Service oa mss
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in II force and effect. pp si��
License Class <:?V % Lic. No. e2(J �1 d-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I 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' c sation insurance carrier and policy number are:
Carrier
Policy Number/
(The above sections need not be competed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 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 f I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Xgi,�� eV,4�; Date �+
Si ure of Applicant - ❑❑ wContractor ❑ Agerft
An SHA permit is required for excavations over 5'0" deep and demolition or construction0
of structures over 3 stories in height.
Main Service 200A TO i000A 46.00NEW
CONST. DWELLING OCCUR sD
OR ADONS. ( d ACC. BIDS. 3.50FT.
NEW SIDONSTCIRCUITS OUTLET
@7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occu . OUTLET OR FIXTURES 2O @ ''00
eAL p .w
Ex. Occup., DuTLEEDrsA p °,° 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
t_
PERMIT FEE $ 43.00
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ 432.50
HA2.
_
D.
IMP
X
FLOOD
X
COF
-
PARCEL
-
Po
HD
ISS
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date 2
e
Receipt No. -3 Y3 Jr R Q4 Y3,?,S-Q
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
E.K USE ONLY
Plot Plan Attached
Floor Plan Attact ed
Sant to B.D. E/--Q2—
TO: Building Department
FROM: Environmental Health 0�
SUBJECT: Sanitation Clearance
Owner Location AP#
Plan Approved for: Sewage Disposal Water Supply
Clearance for dwelling. Other .�,v.
Hold final for:
Final clearance O.K. for:
NOTE:
Environmental Health Specialist
8/96
Private Well
S 3 " )t --&2----
Date
4 + t
1ANTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
+ 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ShDoie- ASSESSOR PARCEL NUMBER 0141 - OO
Proposed Building Use: I i t + I /rerl'✓� • FGIt�) • %�P� Silt Counter Technician: IT- Date: J � � � r
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
1�/�. Plot plans, 3 or 4 sets, signed by the preparer of the plans.
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.
Bl*'6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet-si ng ed 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.
Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
❑ 9. Plot plan and business license approval from the City of Biggs .....................................
❑ 10. Letter of intent for non-residential buildings..........................................................
❑ 11. Detached Accessory Building Form filled out by the owner ......................................
❑ 12. Hazardous Material Form...............................................................................
❑ 13. Other ....
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 14. ees as shown on the attached Schedule of Fees Due Sheet...... �..�.o. (............. '
. Statement of Intent for Non -heated and A/C Buildings................'.................C..f.0 _
Sanitation and plot plan approval from the Environmental Health Department in j a-
7. City of Chico Plumbing permit........................................................
California Department of Forestry plan approval Laid. Sent by:.�..�.:
19. Planning approval for (A) Use: ��(B)Parking: (C)�Pe he- ck:Ae - (�--D2
ontact Land Development about ❑Improvements, ❑Drainage ...............................
ncroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
22. Pre -Inspection for l required ................
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:..............................
❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) .....................
etter of Signature authorization....................................................................
F28.
ecorded copy of Agricultural Acknowledgment Statement ....................................
anufactured home utility clearance...............................................................
❑ - 9. Existing violations and/or expired permits.......................:.....................l.�... r.... r,•� C1
30. rant Deed, Title/Statement of Facts, ❑Letter from Lrregal Owner, L7Check to H.C.D $
er1
issued Telephone � and hold for pick p. � Y��, L�l �y�
I have been informed of the above 'terns and requirements for obtaining a building permit. n 6iO-{
Applicant Date: �T
1. Index permit application for the above items numbered: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised of the above data by 11 phone, ❑ mail, ff counter, by Date:
Contractor, designer, owne was advised of the abo e to by ❑ phone, ❑ mail, ❑ counter, by Date:
,
Plans reviewed by: Date: Plans approved by: 06. 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 (916) 538-7541
SCHEDULE OF FEES DUE
OWNER
PROPOSED BUILDING USE IyC� w ' V 1 pefv�.��✓� .
1. BUILDING T FEES
--Balance Due $ .... .
-- Additional Fees Due ...... $
-- Additional Fees Due ..........
-- vised Plan Checking Fee ....... $
�2.CHOOL DISTRICT FEES
(paid at District Office)
3. SHERIFF FEES (paid at Building Division)
Residential ........ x $360.00 = $ !�
Units
Commercial (sq.ft.)... x $0.03 = $
Sq. Ft.
4. URBAN AREA FEES (paid at Building Division)
Residential (per unit) . x _ = $,
#Units Amt.
Commercial (sq.ft.) .. x =$_
Sq. Ft. Amt.
5. RECREATION DISTRICT FEES (paid at District Office)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion # )
$200.00 (paid at Building Division)
9. CSA 87 'TRAFFIC FEE $2500.00 (paid at Building Division)
10. OTHER
A.P. # � "50o-oo '
DATE
RECEIPT # DATE REC
3N35Lo� 3-i�-�v
ki-1111- -IC-P,
34Z62o-(r � --iLf -o2
313 5-2DTF 3-iq - D2
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit.
These fees may be changed during the plan checking process.
APPLICANT DA D—
Pursuant to Gove t Code 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 Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 2/97)
rte,
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1
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
.t':(One•forni per Building)"
School District O IJ � 1 j 'Z Building Department No..��,+
A.P. Number Jurisdiction: City lCounty
'Property Owner �()� �- D.Q a.
.f`
Property Location/Address t 1y rk ,p ,G%,z ���j) v , �•?
Subdivision; _ Lot No.
'4 "
�....................................................................................................................:
Residential Development Sq. Footage (S 7
No of Living Mobile Home Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
*(No foundation inspection):
........................................ ....................................................................... .... .
Commercial/Industrial
New Addition
(Floor Plans reviewed by School District Personnel)
Sq. Footage
(Including Exterior
VRoofed Areas)
:51)49 -7
Date
r
District Identification No. 020-112
/IWL �Y } School District certifies that i1 4--
U(Applicant)
&19
(Street Address) (Phone Number)
C r
(City) /
has complied with the requirements of Resolution No.
representing /) 7.� square feet.
Representative
0
Paid by Check 1t Remarks:
/(State) C� (Zip Code)
by payment of $,g
AB 2926$ .
FULL MITIGATION $ '
Dy-! 2 -d2 -
Date
ZvCn b
rr �� l C,�i i C� - -•3 �(3 --:
i
,
N
i
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit +�
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing.this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA),-
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) ` feeform.xls (10/98)dmm
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Environmental Health Issues:
Septic Permit Review:
Well Permit Review:
Land Development Review:
Parcel Created by:
a Deeds
❑ Map
Agriaftre Affidavit Required
Designated Well Site
Drainage Plan (Com/Ind/Multi)
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
Date of Creation: Legal Access Provided: ❑ No ® yes
Deed Reference: 1 6 Li 9 Legal Access Required: ❑ No ❑ Yes
Parcel Frontage on Publicly Maintained Road: ❑ No ff Yes, Road Name: CHEILOKE& Z.O
Complies with County Standards for Deed Creation: ❑ No ® Yes
Comments:
Date of Recording:
Lot:
Block: Book: Page:
Conditions That Must be Met Prior to Issuance of Permit:
❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Creation Deed
❑ Comply with condition no. of conditions of approval for the r
❑ Obtain a Certificate of Compliance (See Planning Division for application).
❑ Construction across property lines is not permitted (See Land Development for a Merger Application/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 EHD requirements.
❑ Other
General Comments:
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<i 71 NASIR BA 1N VOI.• !
SEC. 4
ILL 51 P6. 6-82D
HUM0
20# CENTERLINE SUPPORT REQUIREMENTS' z
MANN BY : VAN
=r iN>S SHEET IS TO BE INSERTED WITH SUPPLEMENT TO FIELD INSTALLATION MANUAL FOR DATE: 07 09/2001
20# ROOF ZONE SNOW LOAD. SEE A80VE PRINT FOR LOAD REQUIREMENTS AND LOCATIONS. 2Dj ROOF P
uvE LOAD 6026-3CK-1 3/48 -CATH 4810 -CT
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
COPY of Document Recorded
12 -Apr.. -2002 2002-0018652
Has not been compared with
original.
BUTTE COUNTY RECORDER
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT ,
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the butte County Code require 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 residentsof 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 plowing,
spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and order. Butte County has established or
discomfort from normal, necessary farm operations.
All that real property situate in the County of Butte, State of California, described as follows:
SEE ATTACHED LEGAL DESCRIPTION
Date X/- I1^'0A PROPERTY OWNERS:
�7�Z-
X,7�-
Donald F. Shook
State of CaTaZ--
r
County of
On -V—,'V-4P V before me,
`7ti, S��S.d.✓ .4 -A-fZ
Eli
personall
y appeared A,0WJLL,6 F.- --wn. -Nicko patsenally
1689vA"o-be(or proved to me on the basis of satisfactory evidence) to be N32rson s hos are D—hsrqrsubscribed to
the within instrument and acknowled ed to me that he/she executed the same in is/her err authorized
ie , and that by his/her err signatures n the instrument, th rson or the entity upon behalf of which the
acted, executed the instrument.
WITNESS my hand and official seal.
LATZ
Signature I/;?. Seal: M. SUSAN
COMM.4 128066480664
NOTARY :PUBUC-CAUFORnu
A.P. # 041-500-008 Q COUNTY of BUTTE
d Comm. Expires Oct. 16, 2004
A. .
EXHIBIT "ONE"
Parcel I:
.All that portion of the North half of the South half of the South half of the ,Southeast
quarter of Section 28, Township 21 North, Range 4 East, M:D.B.&M.
Parcel ll:
A right of way for road purposes over a strip of land 30 feet in width lying Northerly of
and adjacent to the Northerly line of the above described Parcel I.
Assessor's Parcel No: 041=500-008
AROACHMENT PERMIT
COUNTY OF BUTTE u DEPARTMENT OF PUBLIC WORKS
7 County Center Drive u Oroville, CA 95965 u Phone: (530) 538-7681 u Fax: (530) 538-4356"
Download Forms: www.buttecounty.net/publicworks
NOTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE JPermitNumber District
Phone: (530) 538-7339 OL O 2 &T -E
APPLICATION
I I WE, the undersigned, hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads and
highways, all in accordance with Count ordinances and general laws. All information except signature must be ed or legibly printed.)
1. Applicants Name: Q la. Company Name: ,( 62
2. Address: - 010
�� TL�� �� • �� /�1 9�%
3. Phone: - �v1 4. Assess P�rcel I�mb5 �GO�
5. Location of Work to be Doneg
6. Applicant's Signature: [_ 7. Date
v tONTRACTOR'S INFORMATION
8. Contractor's Name:
9. Address:
10. Phone: �1 11. Fax:
of / 13. Certificate of Insurance!/Yews a No e
12. Contractor's Number.
14. Contractor's Signature:
15. Authorized Agent:
TYPE OF WORK TO BE DONE
16. Please Check: Curb: ❑ Gut Sidewalk: ❑
17. Driveway (List Type): 3� k 18. Other.
PERMIT GRANTED
In compliance with the above request, and subject to all terms, conditions (including those printed on the back of this form) and special conditions
written below, permission is hereby granted.
19. Conditions
I
I Underground Service Alert (U.S.A.) must be notified two working days prior to any excavation. 800-227-2600
20. ❑ All work shall conform to accompanying: Detail ❑ Plans ❑ Special Conditions ❑
21. Date Issued: 3/,19/04 22. Expiration Date: �8 /Os 23. Surety: Yes X No 13
Mike Crump, Director of Public Works By: neE Vnrez L'i-eA
"Note: If permits are faxed to any number besides (530)538-4356, they can be delayed up to one week.
Page I of 2
General Conditions — See Page 2
-a
• GENERAL CONDITIONS •
t. :t .s urcers;ccc arc agreed .hat the Ccunry nas prior right to the use of its rights of way. It is further understood and agreed by the Permittee that the
doing of any wcrx urcer r:s permit sr.all constitute an acceptance of all the provisions contained herein and failure on the Permittee's part to comply with any
provision will be cause fcr revocation of this permit. Except as otherwise provided for public agencies and franchise holders, this permit is revocable at any time.
This permit .s to be cn ;oc at all times while the work is being dore.
2. All wcrk shall to done subject to the supervision of and to the satisfaction of the Public Works Department of the County of Butte. The Permittee shall, at ,
all times, during the progress of he •Nerk. keep the County Highway in as neat and clean a condition as is possible and upon completion of the work granted herein,
shall leave the County Highway in a thoroughly neat, clean, and usable condition.
3. The Permittee agrees by the acceptance of this permit to property maintain any encroachment placed by the Permittee on any part of the County Highway
and to immediately repair any injury to any portion of the highway, which occurs as a result of the encroachment until such time as the Permittee may be relieved of
the responsibility of such encroachment by the County Department of Public Works.
4. It is further agreed by the Permittee that whenever construction, reconstruction, or maintenance work upon the highway may require the installation
provided herein shall, upon request of the County Department of Public Wor ks, be immediately moved by and at the sole expense of the Permittee.
5. No material use% `cr 511 or backfill in the censtructien of the encroachment shall be borrowed or taken from within the County right of way.
6. At least one tare of any public road, under the jurisdiction of the Board of Supervisors of Butte County, and other public roads junctioning or intersecting
therewith, shall be kept open for travel by the general public at all times. No public road under the jurisdiction of the Board shall be closed to travel by the general
public without special permission, in writing, from the Board of Supervisors.
7. The Permittee, by the acceptance of this permit, shall assume full responsibility for all liability for personal injury or damage to property which may arise
out of the work herein permitted or which may arise out of the failure on the part of the Permittee to do the work provided for under this permit. In the event any dawn
of such liability is made against the County of Butte or any department, official, or employee thereof, the Permittee shall defend, indemnify, and hold them and each of
them harmless for such claim.
8. All excavations shall be backfilled and compacted immediately after work therein has been completed. Trenches shall not be left open farther than 300
feet in advance of pipe laying operations or 200 feet to the rear thereof, unless otherwise permitted by the Engineer. Unless otherwise permitted under the Special
Conditions, backfill shall to place and mechanically compacted in such a manner that the relative compaction throughout the entire fill within the County road right of
way shall conform to the percentage of compaction as stated below. Permittee shall notify foreman 24 hours before backfilling and/or paving.
a. The relative compaction from the bottom of excavation to a plane five feet (5) below finish surface grades shall be no less than ninety percent (90%)
as determined by Test Method No. Calif. 216-0 of the Materials and Research department, State of Caldomia, Transportation Department, Division
of Hghways, or other approved test method.
b. The relative compaction from a plane five feet (5') below the finish surface grade to said finish surface grad shall be no less than ninetyfive percent
(95%) as determined by the above testing method. Permittee shall bear ail costs and responsibility for compaction tests.
C. Material for use as trench backfill in any existing or proposed roadway section shall be sand, shall be place in 8' lifts, and be compacted to a relative
compaction of not less than 95%. .
Material `cr use as backfill in roadside gutter excavations shall be the native material and be compacted to a
relative compaction of not less than 90%.
Any pavement cutting shall be scored, or saw cut before trenching.
Minimum depth of cover over all underground facilities shall be 30 inches, except drainage culverts.
All instailat ons, parallel with roadway, shall be placed as close to the rightof•way line as possible.
No portion of the backfill(s) shall be compacted by ponding or jetting.
All pavements, curbs, gutters, sidewalks. borrow ditches, pipes, headwalls, road signs, trees, shrubbery. and/or
other permanent road facilities impaired by or as a result of construction operations at the construction site(s), or at
other ground(s) occupied by materials and/or equipment, shall be restored immediatety upon backfilling or the
excavation to the original grades and cross sections, and to a condition as goos as, or better than, existed prior to "
the cors. ction.
All surfacing materials of roadways and driveway approaches cut or damaged by or as a result of construction
operations, shall be replaced within ONE WEEK following the backfilling of excavation, weather permittiry, with
compacted layers of surfacing materials at least as thick as the existing, and no less than two inches (2) of asphalt
concrete over eight inches (8') of aggregate base, according to current California State Specifications.
9. Whenever necessary to secure permission from abutting property owners, such authority must be seared by the Permittee prior to starting work.
10. The future safety and convenience of the traveling public shall be given every consideration in the location and type of construction. Permittee shall cause
to be placed, erected, and maintained all warning signals, lights, barricades, signs, and other devices or measures essential to safeguard travel by the general public
over and at the site of work authorized herein.
it. If the constrXion work covered by this permit is to be done by a private contractor hired by the applicant, applicant shall notify contractor as to the special
conditions and requirements contained herein.
LOCATION:
3F,Go C�er�keeTZd.
DATE: 3 // 4/2&
FOREMAN:.J Jc'rnven -MIN, DISTANCE:.
DISTRICT: 6 FL
PERMIT#: •�.� .. _. .... .- .. ,_. ,—
SPEED LIMIT OF ROADWAY
ID DRIVEWAY LOCATION:
DISTANCE TO NEAREST INTERSECTION:
SIGHT DISTANCE
GOOD
O POOR
IF POOR — RECOMMENDATION TO IMPROVE: None
O CUT BANK
O REMOVE VEGETATION (TEMPORARY)
O OTHER (EXPLAIN)
ADJACENT .TOP.O
O FLAT,
O CU.T SLOPE FT,
O FILL 'SLOPE. _..
O CURB AND GUTTER
O AC DIKE
O EXIST. DIST. � TO EP FT.
DRAINAGE RECOMMENDATIONS
❑ NONE
O SWALE
CULVERT
MIN. DIST. FT.
EDGE OF EXISTING PAVEMENT
(EP)
c�
z
J 12' MIN.
20' MAX,
AREA
TO BE
.PAVED
R/W
10' MIN.
.NOTE:
IF GREATER THAN
109 UP' OR DOWN
REFER TO ENGINEERING.
MAX. 1 FOOT VERT. RISE OR DROP
PER 10 FEET HORIZ. DISTANCE
MIN. DEPTH TO FT. EP
DIAMETER _ z IN
LENGTH ZC� F EXIST. 01ST, i MIN. I MAX 10%
O OTHER (EXPLAIN) 2%DIST.
I
NOTE: t MIN. .DEPTH MAX 109,
PAVEMENT TO' EXTEND = �
AT 29 CROSS SLOPE`
OR., .MATCH _-EXISTING � . •
ROADYV _ ..
AY CROSS SLOPE. N.T.B.
t
PRIVATE DRIVEWAY FIELD REVIEW sppl*ftry
STT
�xroo
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE CA 95965
COPY of Document Recorded
22 -Kay -2002 2002-0026431
Has not been compared with
original
BUTTE COUNTY RECORDER
SPACE ABOVE THIS LIVE FOR RECORDER USE ONLY
NOTICE OF MANUFACTURED HOME (MOBILEHONIE) OR COMMERCIAL COACH,
INSTALLATION ON A FOUNDATION SYSTEM .
Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section
18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described
hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be
indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its
contents to all persons thereafter dealing with the real property.
DON AND DENISE SHOOK
REAL PROPERTY OWNER/LESSOR
2920 CLARK RD.
MAILING ADDRESS
PARADISE BUTTE CA 95969
CITY COUNTY STATE ZIP
3888 CHEROKEE RD
INSTALLATION MAILING ADDRESS, IF DIFFERENT
OROVILLE BUTTE CA 95965
CITY COUNTY STATE ZIP
SAME
UNIT OWNER (if also property owner, write -SAME-)
MAILING ADDRESS
CITY COUNTY STATE ZIP
UNIT DESCRIPTION
SKYLINE HOMES INC
BUTTE COUNTY BUILDING DIVISION
LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY
7 COUNTY CENTER DRIVE
MAILING ADDRESS
OROVILLE, BUTTE, CA 95965
CITY COUNTY STATE ZIP
530)538-7541
BUIL%7p. TELEPHONE NUMBER
5/21/02
SIGNATURE OF LOCAL A CY FFICIAL DATE
COUSIN GAR 'S
DEALER NAME (if not a dealer sale, write "NONE-)
91265
DEALER LICENSE NO.
4810 -CT
MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAMENUMBER
8V-70-0175-P-B/A 60 X 26 ULI525950/1
SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIAILABEL NUMBER(S)
REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER
SEE ATTACHED
A.P. # 041-500-008
HCD FORM 433(A) REV. 8/91
WHITE -County Recorder CANARY - HCD PINK -Applicant GOLDENROD- Building Dept.
t
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iir S'i .1...^t°
xri 4:. ;. �,aERTIFI"E',k .' (1,(CTIO ,
;ct^ .-*':. 7q; f,y:M l ,.G-•Fe:i -..y w S .-x `C a... �,.:�" k ? S'„�.+ ' iw
K _ :Arse i�'.I�'3.�..h"s. •',i`;. t; .a=Y`:.kcr:.i`�`ii:'i�...Li:S.4i..,^t"'E�:hL�'s., t"�.Y.':'� �€+.f�.=�. CYT L:
BUILDING PERMIT NUMBER: 02-0549
Address or location of unit: 3888 CHEROKEE RD, OROVIELE, CA. 95965
Legal Description of Real Property: A.P. #041-500-008
SEE ATTACHED
1
c
(x) Mobilehome/Manufactured Home
O Commercial Coach
Has been affixed to the real property above by installation on a foundation system
pursuant to Health and Safety Code Section 18551.
k
Owner's name: DON AND DENISE SHOOK ,
Owner's address: 2920 CLARK RD., PARADISE, CA. 95969
INSIGNIA OR,HUD NUMBER: ULI 525950/1
SERIAL NUMBER OR V.I.N.: 8V-70-0175-P-B/A
i
MANUFACTURER'S NAME: SKYLINES YEAR: 2001
OFFICIAL APPROVING INSTALLATION:
DATE:
5/21/02 /
PHONE: (530) 538-7541
k_
H.C.D. 513C
Order No. 206902
EXHIBIT "ONE"
Parcel l:
All that portion of the North half, of the. South half of the South half of the Southeast
quarter of Section 28, Township 21 North, Range 4 East, M.D.B.&M.
Parcel II:
A right of way for road purposes over a strip of land 30 feet in width lying Northerly of
and adjacent to the Northerly line of the above described Parcel I.
Assessor's Parcel No: 041-500-008
2
APR. -09' 02(MON) 13:41 FIDELITY. NATIONAL
RECORDING REQUESTED SY:
Fidenty National Tltle'of California
Esorow No. 207264 -JW
Tale Order No. 00207264
When Recorded Mail Document
and Tax Statement To:
Denise M. Shook
2920 Clark Road #1D-15
Oroville, CA 95965
GRANT DEED
TEL:5308999531 P.002
1111111111111111111111111131
iryG'wma—m01&161
Recorded
Official Records
CoeuUn e f
CANDACE J. GRUBS
Recorder
RDSEMARY DIGIISON
Assistant
02:08131'9 29 -Mar -2082
The undersigned grantor(s) declare(s)
Documentary transfer tax Is $51.70
1 X I computed on full vskje of property conveyed, or
1 1 computed on full value less value of liens or encumbrances remaining at time of sale,
I x I Unincorporated Area City of
REC FEE I&@@
TAX 51.70 is m
Kathy
Page Iof2
FORA VALUABLE .CONSIDERATION, receipt of which is hereby acknowledged, Steven Carter Johnson and
Chistina M. Johnson, husband end wife
hereby GRANT(S) to Denise M. Shook, A Married Woman as her Sole and Separate Property
the following described read property In an unincorporated area
County of Butte, State of California:
DATE: March 25, 2002
STATE OF CALIFORNIA
COUNTY OF 8 tte
ON before me,
ersonally appeared
alemyrw Carter JohnsonndChrl in son
personally known to me (or proved to me on the basis
Of satisfactory evidence) to be the person(s) whose
name(s) istare subscribed to the with(n instrument and
acknowledged to me that he/she/they executed the
same in his/her/their authorized capicity(ieai, and that
by his/her/their signeture(sl on the instrument the
person($), or the entity upon behalf of which the
Person(s) acted, executed the instrument.
Witness m hend nd%offl4al seal.
Signature
Chistina M. Johnson
J. WHITSETT
ue COMM. 01229842
R COIa yUNTY0 BUTTE
comm—Explrot Aug. 20, 2003
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 7196) • GRANT DEEu
APR. -08= 02(MON1 13:42 FIDELITY.NATIONAL TEL:5308999531 P. 003
Order No. 206SUZ
EXHIBIT "ONE"
Parcel 1:
All that portion of the. North. half of the South halt of the Sbvth half .'of. the Southeast
quarter of Section 28, Towns hip1VNorth,-Range 4'East,,M.D.6.&IVI. .
Parcel I1:
A right of way for road
�erply line of thesabove described Parcel of land 30 feet iriI�dth lying Northerly of .
and adjacent to the Nor
Assessor's Parcel No: 041,500-008
e9iO4/21001 10:28 130-223-2751 SKYCREST ENTERPRISES FADE 01
'IT "f STATE d? CALIFORNIA NUAIBER:
BUSINESS. TRANSPORTATION AND HOUSING AGENCY A
DEPARTMENT OF HOUSING ANO COMMUNITY DEVELOPMENT CL
01VISION OP CODES AND STANDARDS
MANVFACTUREO HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
ORIGINAL (PMK) FDRYYARD TO THE INVENTORY CREOffM. UNLE6$ THERE tS NONE. THEN fORVJARO TO THE PURCHASER (DEALER OR TRANSFEREE)
COPY 1 (WHITE) FORWARD 717 THE DEPAR7IMENT AT P.0 1I011 1820. RACRA IEWO. CA OW12-1B2a MtHIN FNE (6) GAYS OF RELEASE.
CO" 2 "LLD" DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS 6ESTINA710N.
COPY'3 (OOLOEHROO) TO WE RETAINED 9Y THE MANUFACTURER.
MCO 093.0.31* 1 • (7117 _
a` D
r
❑
—'
CHECK IF THIS
18 A DUPLICATE MCO -ENTER ORIGINAL MCO NO.
111ANVE C TURED HOME OR MULTIUNIT MANUFAC7URED HOUSING
y
iJ SFD (SINGLE FAMILY DWELLING) ❑ MUMH (MULTI -UNIT MANUFACTURED HOUSING
NUAIBER OF
TRANSPORTABLE SECTIONS 2
t•ru�uco et + u•
OCCUPANCY GROUP
MANUFACTUR
MANUFACTURER LIC91431
N B
SKYLINE HOMES INC
: ' 90002,
MANUFACTURER ADDRESS.
SUGGESTED RETAIL PRICE:
1710 LAST BEAKER STREET WOODLANDClea
95776ZI
$ 72,299.75
Street
A
FL NAME
ANDIOR NUMBER.
DAY OF W0URMF1r__
WES?BROOK
4810 -CT" -
8/23/°2001
NOME OF OGALIIR OR TRANSFEREE (OWNERSHIP TRANSFERRED TO):
CALIF. DEALER NLIMSEft OR
GATE OF TRANSFER:
SKYCREST ENTERPRISES/COUSIN GARYS
TRANSFEREE DESIGNATION:
8/27/2001
91265
DEALER OR TRANSFEREE ADDRESS
_
13468 WdY 99 SOUTH
CH CO CA
95926
Sbwl
_ (Cty) (State) (ZIP)
INVENTORY CREDITOR NAME:
DEUTSCHE FINANCIAL,
INVENTORY CREDITOR ADDRESS:
655 MAR.YSVILLE CENTRE DRIVE
s(res
S OUTS MID
(Stolle)63141 Z
ITECTION
(1 41
MANUFACTURER SERIAL HUM7ER
NCO IN610NIA OR HUD LABEL NUMBER
LENGTH W.OTH
.�
Y4F4Hr
1
6V -70 -0175 -P -B
ULI 525950
720 156
21.585
Z
BV -70 -0175 -P -A
ULI 525951
720 156
20,415
TRANSPORTER NAW'
D 6 R TRANSPORT
TRANJPORTER ADORERS:
T.O. BOX 179
DURHAM CA
95938
SVW
OESTMATIMFOR UNIT (XiCRIIJOAYOVS:
.. ._. .. ....__...`:,__ __ ...�. ... ....... .....:... ...
SKYCREST ENTERPRISES " 468 HWY 99 E
CHQ CA
926
(WA*)
slut
I W" wx w P.RNIY d Pww undo 1M Mrs of N» SM• of C•9Pot1ft ww ow sb01N I" as %'W we eens9l ......
.....
8/27/2001 at WOODLAND POLO
CA
WRATURE Of AUTWPUEDAGENT:
ORIGINAL (PMK) FDRYYARD TO THE INVENTORY CREOffM. UNLE6$ THERE tS NONE. THEN fORVJARO TO THE PURCHASER (DEALER OR TRANSFEREE)
COPY 1 (WHITE) FORWARD 717 THE DEPAR7IMENT AT P.0 1I011 1820. RACRA IEWO. CA OW12-1B2a MtHIN FNE (6) GAYS OF RELEASE.
CO" 2 "LLD" DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS 6ESTINA710N.
COPY'3 (OOLOEHROO) TO WE RETAINED 9Y THE MANUFACTURER.
MCO 093.0.31* 1 • (7117 _
a` D
r
... ... .......
...... ......
.. ...... .......
...... ...... ....... .......