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Home My WebLink About042-030-004} � � ^ � ( ' , / � �- ' ` -_� v AP 42-03-4 F. BYERLY s/s Bell Rd. approx. 400' W., of Cussick � Q Chico (FIRE DAMAGE REPORT/private workshop) 3 04 3043 Bell Rd, Chico of Alamo ;e-., Chico Chico. n/s Henshaw 2501 E. ContR: Butte Roofing CONGR:f) 0 'b42-03-0-004 92-0204 LEE, DENNIS 3043 BE LL RD, CHICO GAS LINE/SF OOF 042-030.QO4 490 40 BELL COURT, CO CONTR:OWNER SERVICE CHANGE � HIRST, WI 40 r ES SPLIT�L ��1 '��E�I�� ][(� 2�H n 042-030-004 k,01-2150 HIRST, WILLIAM' 40 BELL CT "A", CHICO SPLIT ELE TO MH OFFICE COPY �Opy 4,111 bdress pates GAS Meter [)ale*� Meter BY COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 • Telephone (530) 538-75410) �''�RMIT NO. (Rev. 12/96) APPLICATION AND PERMIT (2,,, S6 ASSESSOR PARCEL NUM8 ZONIQIC - I_ BUILDING PERMIT OWNER , TELEPHONE �1-3b '�' SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRE� w w� /� (�J (1 �16CONTRACTOR'S . NAME-,E/••(J TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESq Total Valuation $ ARCHITECT OR ENGINEER LICENSE N0. FIIin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checkin Fee $ BUILDINGADDRESS / � f /L } - �' i - Energy Plan Checking Fee $ $ W 1 , PERMIT FEE S LOT NO. SUBDNIS It�r1 ' PARCEL 1MAP 7®Y PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTR�JCTURE �j Jq-,DLiplex 0 MobilelloMeSF t Other sPECFv Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 } .)TYPE OF WORK aF -A n ?, New ❑ Addition ❑ Remodel Q Utilities O Installation 13 Other t� Describe Work: 0.yL�i Vim 1019 61 _-rW„T 04 ' ' �# Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ! ELECTRICAL PERMIT Fling Fee 20.00 OR LE Main Service 20.AORLEN ( 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I licensed under provisions f Chapter 9 (commencing with Section 7000) of Division of th`16`Busirjess and Professions Code, and my license is in full force and effect. 1 License Class Lic. No. 1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the ContraA s License Law for the following reason: fl, I, as owner of the property, army employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale*- O 1, 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: O 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. 04,04j *% ❑ 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 s valuation of one hundred dollars ($100) or less.) (� 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 rthwith comply with se provisions. • X �� Date 9) _ Signature of Applicant - ID ner ❑ Contractor O Agent An OSHA permit is required for excavations over 60” deep and demolition or construction• of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW CONST. DWEwNG OCCUP. s0 OR ADDNS. ( a4 ACC. S.3.5¢M. MULT NONgEOSIp. .' CRR UT ITS @7.50 POWER APPARATUS a sINGLE ourLEr aR. Ex. Occup. OUTLET OR FIXTURES 20 ®''00 BAL @ .SO Ex. Occup. OUTLEEOTSA REESID.OEA, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 443. ()0 MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST, TYPE 11 TOTAL FEE $ HAz. D. FEES IMP I FLOOD I CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicatec(,above for which fees have been paid. A r By Date ^,29 61 PERMIT EXPIRES ON 0,gra ReceiptNo. A-13- Ov WHITE-D.D.S.-B.D.CANARY-ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 1 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ,�, 7 County Center Drive • Orovill@;�Cali rnia 95965 • Telephone (530) 538-75410 a J�MIT NO. (Rev.12/96) APPLICATION AND PERMIT (� ASSESSOR PARCELNUMB 9 _I_ BUILDING PERMIT OWNER TELEPHO=E30 O SQ. FT. OCC. BUILDING VALUATION . OWNERS IUNG ADO CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuatlon $ ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS A4() UAll Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SFX Duplex ❑ MobilehomeA Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Otherx Describes Work: mAm ./ AU&L- /YI • Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 LE Main Main Service z�oal oA 23.00 a3. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.P License Class Lic. No. OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: it 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: ❑ 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. ❑ I 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 Main Service 200A TO tOOOA 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 6 ACC. BLDS. SO 3.50FT. NPN pESID MULTI.OUTLET @7,50 OWERAPPARATUs 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20@''00 BAL Q .SO FIXI Ex. Occup..OUTLETS (REESPPLNID.DRA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ r Q6 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEL: $ 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.) 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 ff I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall rthwith comply Swithse provisions. " X11 Date U ?�! Signature of Applicanter ❑ Contractor . ❑ Age.. An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ c 3 CpGL4 = TAL FEE $ O� .7 P I FLOOD I CDF PARCEL I ;TD ISSUE Nk, This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicate ova for which fees have been By Date PERMIT EXPIRES ON provisions to do work paid. Q efe Receipt No. :93. 00 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .7„ OWNER -BUILDER :VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature Please complete and return this information at your earliest opportunity to avoid unnecessary dela; in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the Jor labor and materials for construction of the proposed property ement : YES NO 2. I HAVE' HAVE NOT O sigaod an application fora building permit for the proposed work. 3. I have contracted with the following person.(frm) to-Mvioc.the.proposed construction: NAME. ADDRESS: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired -the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. S. I will provide some of the work"but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: - - " ,,� PROPERTYOWNER:� flL- SOCIAL SECURITY NUMBER: DATE: NOTE. This Owner -Builder Verification is required by Section 198.31 and 198.32 of the California Health and Safety Code. This verification must be completed and returned to our ofj4ce before we are permitted to Issue the permit. OVER r'• OWNER BUILDER INFORMATION ► Dear Property Owner: An applicadon for a building permit has been submitted in your name listing yourself as the builder of propeity improveamn specified For your protection, you should be aware that as "owner -builder" you are the responsible party ofrecord on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license ft+om the city or county. They are also required by law to put their license number on all permits for which they apply. , . If your plan to ayota own work, with the excepdon of various trades that you plan to suticontracf, you should be aware of the following information for your benefit and protecdon: ♦ If you employ or otherwise engage any person other than your immediate family, and the work (including-nidterials and other costs) is 5300 or more for the wWre.project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security. taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specif c information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, �CA—, Mic el C. Vi ira, C.B.O. Ma ger, Building Inspection NOTE. This Owner -Builder Information Is required by Section 19830 of the California Health and Safety Coda OVER -fa, k AXA 042-030-004 99-2490 HIRST, WILLIAM' - 40 BELL COURT, CHICO CONTR: OWNER SERVICE CHANGE llb'P'wo' I OFFICE COPY Address cn GAS Meter By ELECTRI C Meter By Date COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 99 - ASSESSOR PARCEL NUMBER 042-030-004 Z°�""° SR 1 BUILDING PERMIT - OWNER HIRST, WILLIAM TELEPHONE - n,:,'--9713 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 199 BAST IST AVENUE, CHICO 95().'6 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checkin Fee $ BUILDINGADDRESS 40 BELL COURT, CHICO' Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00, TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: SERVICE CHANGE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISIGI @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service 2D*.A OR LESS 23.00 23 • OU LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: .0 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: ❑ 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 Main Service 200A TO IDDDA 46.00NEW CONST. DWELLIG OCCUP. OR ADDNS. a ACC. S. sG 3.5QFr: NOµHESIU MULTI.OUTLET CIRCUITS @7,50 POWER APPARATUS a SINGLE OUTLET CIR. OUTLET OR FDCTURES Ex. Occup. BAL @ I:w Ex. Occup. FIXED �LE�A R� °E. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE INSPEICTION 1 23.00 23.00 PERMIT FEE $ 66 00 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 1?(1 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 if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wit ZS i ions. X Y_.. ate , �� Signature of Applicant - a Owner ❑ Contractor ❑ Agent , l An OSHA permit is required for excavations over 60" deep and demolition or constructionfI of structures over 3 stories in height. n t Mobile Home Installation Fee $ Energy Inspection Fee $ DCC CONST. TYPE TOTAL FEE $ 66.00 HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUF1' V This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. 4- ByP V tt/Gs Date / PERMIT EXPIRES ON Date 01-116. Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT n 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 - aiso 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. 171 Date lT_ ./—t/ I Inspector REV 10/92 1 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUIG DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (5 ) 538 -7r -Al 9 _ PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT // (n ASSESSOR PARCEL NUMBER 042-030-004 ZONING SR 1 BUILDINGPERMIT OWNER HIRST, WILLIAM TciKYON7513 SO. FT. OCC. BUILDING VALUATION .OWNERS MAILING ADDRESS 199 EAST 1ST AVENUE, CHICO 95926 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS 40 BELL COURT, CHICO' Ener Plan Checking Energy g Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: SERVICE CHANGE Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 '*OV OR LESS Main Service 20.AORLESS 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 full force and effect. License Class Lic. No. 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: ❑ 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 Main Service 200A TO +000A 46.00NEW CONST. DWELLING OCCUP, SO OR ADDNS. ( & ACC. BLDS. 3.5¢FT; N014-RCSID. MULTI.OUTLET @7,50 POWER APPARATUS a sINOLE 0 T. CIR. EX. OCCU OUTLET OR FDCTUREs 00 BAS @ I 0 Ex. Occup. DFUTIEEDTS g.,,D,°EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE. INSPECTION 1 23.00 23.00 PERMIT FEE $ 66-001 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wi s o i ions. Q X e -1 _ Signature of Applicant -K Owner ontractor ❑ Agent An OSHA permit is required for excavations over 60" deep and' demolition or constructionp'9 of structures over 3 stories in height. Mobile Home Installation Fee I $ Energy Inspection Fee $ occ CONST. TYPE TOTALFEE $ 66.00 HAz. D FEES IMP FLOOD CDF PARCEL PD HD I0 This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By . �'r. 4 ate i PERMIT EXPIRES ON 1 6 Receipt No. 280736/$6600 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ;"',its;?^��,;.,�.T;Xw�:1�`.,�iWG:cS;4yi�lR4+Z`-r:'�"+'�`�k'�'�"�M+w�� •,��'�f'�Sw�S�+� �` 7i�'..�Riti�i��' ' �"`�y-�;:�,�+r>t.'-(- -' .._,COUIVTY1O. BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - r ILDING DIVISION 7 GA TY CENTER DRIVE - OROVILLE,tCALIFORNIA 95965 - TELEP (5301/) ` -7541 PERMIT APPLICATION DATA S# ET OWNER` ASSESSOR PARCEL NUMBER: 4 Qt Proposed Building Use: Building Inspector: Date: b� At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issu nce- F Date Received By _--Q4? All iiems have been submitted .------------------------------------------------------------------------------------- ❑2. Plot plans, 3/4 sets, signed by the preparer of plans. ----------------------------------------------------- ------ E13. Complete plans, 3/4 sets, signed by the preparer of plans. ----------------------------------------------------- ❑4. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. -------- ❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------ 06. Energy Design Compliance and supporting documentation. ---------------------------------------------------- ❑ 7. Statement of Intent for Non -Heated and A/C Buildings. --------------------------------------------------------- 118. Hazardous Material Form. --------------------------------------- 1:j ------------------------------------------------- El 9. Manufactured Home data and installation instructions including Tie Down Specifications .----------------- ❑ 10. Fees of $ ------------------------------------------------------------------------------------- ❑ 11. Impact fees as shown on the attached schedule. ---------------------=----------------------------------------- ❑ 12. California Department of Forestry plan approval/fees. --------------------------------------------------------- ❑ 13. Flood elevation certificate. ---------------------------------------------------------------------------------------- ❑ 14. Sanitation and plot plan approval Health Department. ------------------------------------------- ❑ 15. City of Chico plumbing-permit.----------------------------------------------------------------------------------- ,� r ❑ 16. Plot plan and business license approval from the City of Biggs. ---------------------------------------------- ❑ 17. Planning approval for (A) Use: (B) Parking: -------------------------- ❑ 18. Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel. ----------------------- ❑ 19. Encroachment Permit for driveway (construction approval prior to occupancy). ---------------------------- ❑20. Pre -inspection for required. Request to Building Inspector on 112 1. Contractor's license information. (Number, Name Style, Classification). 022. Workers' Compensation carrier and policy. number.----------------------- ❑23.Owner-Budder Verification (Given to owner ❑, Mailed to owner ❑). - E124. Letter of signature authorization. -------------------------------------------- ❑25. Recorded copy of Agricultural Acknowledgment Statement. 026. Letter of intent on building use. -------------------------------- 027. Manufactured Home utility clearance. ------------------------- 028. Existing violations and/or expired permits. ------------------- ❑2 211433❑ 433 A, Grant Deed, ❑ M.H. Title, ❑ Check to H.C.I� X011433 lO�LPi �/I►�✓.�1�� %'��Y Il/9 as follows ❑ Mail to I '5bnd hold for nic (Date) office. ❑ 1)e11'= with inspector. CO A plican: i V' ate: h OL t 1 l Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ Air Pollution Date: By: Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ Other: Date: By: Index permit application for the above items numbered: 2. Additional items required ❑ Plan Check List Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by.❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by o phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date: Yellow Copy - Department of Development Services, Building Division. `;:; Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 2. 3. 4. 5 I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES] NO[ ]. I HAVE�J HAVE NOT[ ] signed an application for a bu�7ding permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. I will provide some of the work but I have contracted (hired) the following..pecsons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: r �� PROPERTY OWNER: SOCIAL SECURITY UMBER: DATE: NOTE: This owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. May 1995 2.26 .......................................... O.B.-1 .......... .:.;;.....:.... Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following informatio r your benefit and protection: 0 If you employ or otherwi" gage any perso other than your immediate family, and the work (including materials and other costs) is $300 or more or the entire project, and such persons are not licensed as contractors or subcontra , then you ma an employer. 0 If you are an employer, you must register with the State and Federal Governments as an employer and you. are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. 0 There may be financial risks'for"you if you do not carry out these obligations,'and these risks are especially serious with respect to worker's compensation insurance. 0 For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbuilder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Michael C. Vieira, C.B.O. Manager, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. May 1995 2.27 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NC (Rev. 12/96) APPLICATION AND PERMIT cl9'Z{9Q 2 — 6, j0 — DDNNO� BUILDING PERMIT OWN"(NlGi-Ily-ow j T N`3 SO. FT. OCC. BUILDING VALUATION OWNIM1 MALMO ADI I _ // bf v� e�fW 6 Misc. Wiring , 23.00 COMRAC}01111 TVAIP►gN! COMNACT0111 MALMO ADORES/ OOMTRUCnON umat LEN0ER1 MAAJW ADOREss Fire lace Total Valuation i AReN"Cr OR eNOMM ucENSE NO. Flin Fee $ 20.00 ARCWECT OR 09MEM'S WILJNO ADORESI Permit Fee t+ Plan Checkin Fee S 81.0� ' Gly Gf'IP—/ 10 Energy Plan Checking Fee i i PERMIT FEE S 1oTNo /1ADONebNSNAMe PAacEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other '� Each Tr 7.00 Solar or heat pump water heater 1 23.00 Water piping 15.00 TYPE OF WORK New O Add'dm ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: c71�R-�9 LA,,,`Q Q Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 - _ ..... Main Service 200V0A OA LESS 23.00 —•----'—'—_ Main Service —TO I—A 46.00 NEW CONST. / OWEill10 OCCVP. !Q OA AOONS. \ a ACC. eLns. 3.5eFT. NO"ESID.' ( YULTFOVnFT ) Q7.50 BRANCH Cil['llf�l Ex. Occup. OVnET OR FWTMa 20 o I'0° 5,4L.SO Ex. Occup. OUnM CRESSIio.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring , 23.00 VERMIT FEE S .e MECHANICAL PERMIT Fling Fee 20.00 Heating Coolin Hood 6.50 Ventilation PERMIT FEt S Mobile Home installation Fee S Energy Inspection Fee $ «c CONST. TYPE TOTAL FEE $ NAZ. o. FEES I IMP I FL000 I COI I PARCEC1 PO I NO I ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By Date PERMIT EXPIRES ON Oct -33-99 .+ 09:01P r _ 0 PRE-INSPE("'TION REPORT P.02 LOCATION: 4,1.) Coif1& CONTRACTOR: aj.J 4F DATE: //-/- ?-7 A.P. ZONING: Z52 / PRE-INSPETION FOR: DATE TO INSPECTOR: PERMrr HLSTOPY:( ) NONE ( ) AS FOLLOWS: Building Description: Commercial/Usage: Residentialf# of Units:—,;)--� Currently Occupied 11---_ AbandonedNacant Electric: Yes v No BUILDING INSPECTOR'S REPORT !! 4 Electric currently 1 D Off I Condition of Electric Gas: Natural Propane_ None Currently On f Off, Obvious Problems: /L?S Sanitation: Plumbing WorkingyL, 5 S Well Working � �7 sPotable Water J `p • Obvious SewageProblems Comments: ACTION RECOMMENDED: ISSUE: Inspector. "e& e2 HOLD FOR t tf ",*0 �i t . Date S zf 4i Sketch buildings on reverse and indicate location on property. d # Nov -01-99 08:44P P.02 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 �q— PERMIT NO.S IRev 12196) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 042-030-004 SR 1 ZONING BUILDING PERMIT OWNER HIRST, WILLIAM TW1513 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 199 EAST 1ST AVENUE, CHICO 959:6 �r CONTRACTOR'S NAME OWNER TlLEPti/ONE COMRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fire lace LENDER'S MWUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER UCtwi No. Felin Fee $ 2000 Permit Fee $ ARCNRECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 40 BELL COURT, CHICO' Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDNLS X)NB NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEGFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 1 23.00 Water piping I15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ _ Describe Work: SERVICE CHANGE Gas piping system t • 5 outlets 1 S.00 Buildingsewer 15.00 Mobile Home S G w p20.00 PERMIT FEE _ ELECTRICAL PERMIT FilingFee 20.00 eoov oR tEss Main Service aooA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors License Law for the following reason: X I, as owner of the property, or my employees with wages as their sole compensation, do the work, end the structure is not intended or offered for snle. ❑ I, as owner of the property, am exclusively contractingwith licensed contractors1 to construct the project.PRF, 13 l am exempt under Sec. Business and Professions Code for this reason Main Service 20M TO IOWA 48.00 NEW CONST. DWELLING OCCUP. R ADONS. ( a Acc. Bins. ONEW 3.5¢R. CONST. MULTI.OVTLET1. NON•RESIO. (g],SO OWER APPARATUS o cIR. Occup. utLET OR fDRURE6 ao I'00 DAL .so FIXE& APPINS. oR vTurm REBID. EA 5.00 ice23.00 WE ilities 20.00will 23.00 TMqP'Fr.TTON 2 00 23.00 PERMIT FEE _66-00 MECHANICAL PERMIT Filing Fee 20.00 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 requi:ed by Section 3700 of the Labor Code, for the performance of work for which this plarmit is issued. My workers' compensation Insurance carrier and policy number are: Carrier$ Heating Coolin Hood 8.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee Policy Number (The above sections need not be completed if the permit is for wort: of a valuation ,[ of one hundred dollars ($100) or less.) Lx I certify that 1n the performance of the work for which this permit Is issued, I shell 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 t rthwith com I w i ions. PY x 'A Signature of Applicnnt Owner ntractor ❑Agent An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. Energy Inspection Fee $ Dec co"' TYPE TOTAL FEES 66.00 NAz D FUM I IMP I nAOo I COP I PARCEL Po ND ISSUE This permit Is hereby Issued under the applicable provisions of the Butte County Coda and/or Resolutions to do work indicated above for which fees have been paid. B Date y Nov -0.1-99 08:44P PRE -INSPECTION REPORT I�II��IR LOCATION:_-J�9 CONTRACTOR: a.,U 4F P.O1 DATE: A.P. #_0lfZ-- ZONING:_ :P / PRE•INSPETION FOR: 1 DATE TO INSPECTOR: PERMIT HISTORY:( ) NONE { ) AS FOLLOWS: Building Description: Electric: Commercial/Usage: Residential/! of Units: Currently Occupied Abandoned/Vacant Yes No Condition of Electric Gas: BUILDING U4SPECTOR'S REPORT Electric currently On Off Natural Propane None Currently On Off Obvious Problems: Sanitation: Plumbing Working Well Working Potable Water Obvious SewageProblems Comments: ACTION RECOMMENDED: ISSUE: MOLD FOR Inspector. 7 Date Sketch buildings on reverse and indicate location on property. AP 42-03-4 - t.� •e3+ 1 • s/s Bell Rd. a ro. 1>;•;*a--:r� ' > �. OEM - 400' PP x. W. of Cussick� x. . }. �' �,.•:-..:., Chico REPORT/private 1 _ (FIRE DAMAGE T/private workshop) .. ±- C.A. 555-7 . ' LINDSEY, 42-03-04 , � s.� p .. FOREST B i 42-03- 4 ` YERLY -" ChCo 3043 Bell Rd, Chico �" of Alamo Ave., is r ' Henshaw 250' E. co ` n�s 1 73 E.Lindo Ave.,Chi :_:;.•,:' L- ContR: B '`' Grif "n Roofing, 3 Butte Roofing t it j :� / CONGR: - Permit#2177- ` T 88B(reroof /SF) (reroof)� =3 042-03-0-004 42-0204 LEE, DENNIS ' CONTR: LATHAN, JOHN 3043 BELL RD, CHICO GAS LINE/SF 042-030-004 99-2490 HFRST, WILLIAM 40 BELL COURT, CHIC0 ,,•'€"-2:CONTR: OWNER SERVICE CHANGE 00 1 i. d' i �� 4y�.t•��-K�� Lzf ;. Tj Y�,'' � j�' Y1 �N 'S �•YT.ls-..- .: - � '° .s+'��+ -.�'r -1 ; J •{z� . � � L °� ?' ; i " ii ' f � �1 ��.�,r� r x�t .•!.:<.•�`�-'.}cg's+" .','"1 ¢,� -r - Y�`�h� : i. � ti _` .. � tra ,y'%,`"fL .?4 s� Iii ! � �` '��-: � GN"�x�� v,' r"' �K � � •�' � '}s'�°� s � O .t. T �i_•t {tom •' P1�t"YY /. C. rt +' f .^�'' •� r'! a �� -:� -.��'. �.. :•f" . �„fi.4trSsyr ' �-� d .:.j,••. 'y -� �4Ya '%�� _ . •.. �I v > -'fes n k. - ::.;.-.�. .. _ - :s-- �-?•:psi, Oct -31-99 09:01P P.O1 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 - Telephone (530) 538-7541 PERMrr N( (Rev. 12n6) APPLICATION AND PERMIT --- cl9-Z�9 �•�• ,� .�, __� �D"MO J' BUILDING PERMIT d TRAPHON6 SO. FT. OCC, BUILDING VALUATION C~„ VALM ADO CICWMAC'TOII'e t , TEUP"O"! 04NTWI0a1 MOANa.0o11ete comia)cncm umet Fare lace vNoC" NAAJQAwlea Total Valuation = AAcmffvm O" etlamm X041 NO. Firing Fee S 2 0.0: Permit Fee i AP4WTW oe orosre I UAA" worM Plan Checkina Fee t GULD"OAOD"� ' Ener Plan Checking Fee ti PERMIT FEE _ LOT "M vAuca MAP PLUMBING PERMIT Filtng Fee 20.00 Each Tr 7.00 USBOR8TAUCTURE SF O Duplex O Mobilehome O Other Solar or heat puma water heater 29.00 Water piping 15.00 Each gas water heater or vent 15.00 New O Addition O Remodel O Describe Work: ��1� TYPE OF WORK Utilities O Instalattiiion0 �-G ��--��1 Other 0 �� Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S t G 1 @20.00 PERMIT FEE _ ELECTRICAL PERMIT Filing Fee 20.00 Main Service oR tl.i 23.00 Main Service C 206N TO 1000A 49.00 OWg11q OOCU►. 110. OR AD "s. •. 9.5Cn, tvQovtt.sT fQK�p]10. @7.50 Pj0 Avrwnntu MV Ex. Occup. ovnar on rturuma yLL '.,000 Ex. Occup. ovTnN olo. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 3� RMIT FEE MECHANICAL PERMIT Filing Fee 20.00 Heating Coolie Hood 9.50 VenGla�on PERMIT FEt f Mobile Home Installation Fee : Energy Inspection Fee = «` co"sr r" TOTAL FEES� of f3 1 lu. I M=0 co/ VUKrl s 0o -if This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do wor'^ indica:ed above for which fees have been paid. By Date / ".V.� r r, or~ PERMIT EXPIRES ON .nr - TU-INSPECTION'REPORT OWNER: ,///& !HeW 7- DATE:_ LOCATION: CONTRACTOR: 4kzVzF-/(Z PRE-INSPETION FOR:�� DATE TO INSPECTOR: /! PERMIT HISTORY:( ) NONE Building Description: CommerciaWsage:_ Residential/# of Units: Currently Occupied Abandoned/Vacant Electric: Yes No Condition of Electric Gas: A.P. ZONING:_ S�C / ( ) AS FOLLOWS: BUILDING INSPECTOR'S REPORT Electric currently On Off Natural Propane None Currently On Off Obvious Problems: Sanitation: Plumbing Working Well Working Obvious SewageProblems Comments: Potable Water ACTION RECOMMENDED: ISSUE: HOLD FOR Inspector: Date Sketch buildings on reverse and indicate location on property. `r".n+.-i,F�`"'`e�-1 �1f, te:tm'...,.�:----'aryp`.. '6-•+t •�'y`epi,'F`'iS•iK;�c7c;•ti"".w»i*`ti.!'''�:Ci:-ik,�rHr'".�ylaf`+a"�' % y Zo,4 ...• •.I fes+ - ^ - 3043 I5el l Rd • , Ch ico . Ccir OFFICE COPY Address ` G AS \ Meter B Date ELECTRI Meter By COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville• California 95965 - Telephone: 916/538.7541 APPLICATION AND PERMIT PERMIT NO. 92-204 SESSOR PARCEL NUMBER 042-030-004 ZONING S R 1 BUILDING PERMIT OWNER Ue to n t S M Lee - TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS '1 X035 CONTRACTOR'S NAME I owm TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS CECD Permit fee $ PLUMBING PERMIT Filing Fee 15.00 i Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ® Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 1 5.00 5.00 Building sewer 15.00 - Mobile Home S G W @ 15.00 TYPE OF WORKr�1 New ❑ Addition ❑ Remodel ❑ Uti lities [N Installation ❑ Other ❑ Describe work: GAS PIPING f _ Permit Fee $ 20.00 Contractor ELECTRICAL PERMIT Filing Fee 15.00 i Main service 600V OR LESS 18.50 200A OR LESS Main service 200ATO1000A1 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification � I, as the owner, or my employees with wages as their solei compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) 1 ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. ( DWELLING OCCUP.SI\ 3.64 sq.ft. OR ADDNS. l ACC. BLDGS. / NEW CONSTR. MULTI -OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS 6 SINGLE OUTLET CIR. / EX. OCCup\OUTLETS OR FIXTURES 20 76 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.1 EA.� I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 g Permit Fee $ Contractor — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. XI shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. •« . - %+�+-•A--� �2... . B _ X ' Date Siinature of Applicant - Owners, Contractor 11Agent❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Ener Inspection Fee $ 9Y P OCC CONST TYPE TOTAL FEES 20.00 HAz I DFEES I IMP I FLOOD I CDF PARCEL PD I HD ISS E � This permit is hereby issued under the applicable Prov% sions of the Butte County Code and/or resolutions to do 'I work indicated abIove for which fees have been paid. DIRI;CTOWbF AUBLIC WORKS BY J 4 -11_ I1, In Aa Date/-?_", !� PEF(MIT EXPIRES/ Date /— Receipt No. 103469 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT f ' COUNTY OF BU':,. 1 , a DEPARTMENT OF PUBL 7RKS 196 Memorial Way, Chico — Ph 891-2751 7 Cwnty Center Drive, Orovfl le — , , one: 538-75 747 Elliott Road, Paradise — Phone: 872-6307 , I CORRECTION NOTICE NO. A now6we inspection indicates that the following violations of County Ordinance east at the above address and should be corrected. Please notify this office adds of work is completed. If you have any question pertaining to this 01r need additional explanation, please contact this office immediately. Ins COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. 92-204 ASSESSOR PARCEL NUMBER 042-030-004 ZONING S R 1 BUILDING PERMIT " o ER "der h I s I4 - Lee TEL PHONE og eyt '=3y SO. FT. OCC. BUILDING VALUATION OWNER'S ,ff9q MAILI DDR✓SS K cf •JL f /r- 5 C - (I 039 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS e get , CHICO Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 5.001 5,00 Building sewer 15.00 SFNI Duplex❑ Mobilehome❑ Other Mobile Home S I G I W SPECIFY TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ® Installation[] Other ❑ Permit Fee $ 20,00 Describe work: GAS PIPING Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service SS 200AORV OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BusineS$ and Professions Code and my license is in full force and effect. License No. Classification Main service 200ATO1000AI OCCUP.9 NEW CONST. / DWELLING OR ADDNS, ACC. SLOGS. / l NEw CON5TR ULT' -OUTLET NON-RESID BRANCH CIRC', T, (POWER APPARATUS 6) / I SINGLE OUTLET CIR. Ex. OCCUp\OUTLETS OR FIXTURES 37.50 3.54sq.ft. @ 5.00 76 IAL- L-8 466 I, as the owner, or my employees with wages as their sole compen- FIXED APLNS Ex. Occup. OUTLETS P(RESID,IRE A./ 3.00 sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Temporary service Mobile Home Facilities Misc. Wiring 15.00 15.00 15.00 ❑ I am exempt under Sec. , Business and Professions Code for this reason Permit Fee $ — WORKMEN'S COMPENSATION INSURANCE Contractor I declare under penalty of perjury (check one): MECHANICAL PERMIT FiIingFee 15.00 ❑ The permit is for $100.00 (valuation) or less. Heating ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Hood Ventilation ' Permit Fee Contractor 6.50 t -... I , - d $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Mobile Home Installation Fee Energy Inspection Fee S $ Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue Pinsaid County in consequence of a granting of this permit. Date ,� OCC CONST TYPE TOTAL FEE $ 20,00 HAz DFEES IMP FLOOD CDF PARCEL PD HD Iss This permit is hereby issued under the applicable provi- provi- of Applicant — Owner Contractor ❑ Agent An OSHA excavations over 5'0" deep and demolition or construct- ion of structures tover 3gstoriesoin height. Receipt No. 103469 1 WHITE -D. P, W,. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT sions of the Butte County Code and/or resolutions to do work indicate a ve for which fees have been paid. TO OF UBLIC WORKS BY Date!—"� PE MIT EXPIRE Date k F� +r r rTfi• .. e�-r -�.� .a' -r -•%r .�,...�,-••--�.*^.-...-...:e+•�r,�...-rrw+.-�r•-K�. 4 .. ,r,.... y.y�..,.,;.�.��_ � v� .�� COUNTY OF BUTTE - DEPARTMENT OFPUBLIC WORKS -BUILDING DIVISION - _ a, . - - W 7 COUNTY CENTER DRIVE 'OROyIILLE-CA IFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. OWNER w �'� A. P. Proposed Building Use �jBuilding Inspector Date_ At time • permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1., All items have been submitted . .................................... - 2. Plot plans in duplicate/triplicate, signed by preparer of plans ........ - 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form ......................................... . 6. Energy Design Compliance and supporting documentation ......... - 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) - 9. Mobilehome installation data including manufacturer's installation instructions...........,.......................................... 10. Fees of $ 11. Chico Urban Area fees paid ......... ' .......................... 12. Park fees paid ..................... ........ I.................. 13. School District fees paid .............. 14. Sanitation approval from Health Department _ 15. City of Chico plumbing permit............. .................... 16. Plot plan and business license approval from C- ity of (see City for other requirements) _ 17.- Planning approval for (A) Use: (B) Parking: ....... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required ... Pre-inspec. request to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classifications ... -22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... -26. -27. When ygx� issue the permit, process as follows: Mail to ower. Mail to contractor. Telephone541CV`%r� �d hold for pickup at �H office. Deliver w/inspector. Other .-IA A / ® Q //--• j i Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. - Fire Dept. Other Date By The following data d prior to permit issuance: (Circle ne d above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by—phone---Mail Contractor, designer, owner, was advised of above required data by—phone—mall Plans checked by Date Plans approved by_ inter by ..date nter by date Sets of plans on hold in °' File cabinet AP folder Copy—DPW y 1 Date COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 OWNER -BUILDER VERIFICATION Attention Property Owner: Phone: 916-538-7541 An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. rl. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) G `2. I (have/have not) h(" signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I'plan vzo provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work ��Signed: Property Owner-, Social Security, Number - , Date 0 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. r This verification must be completed and returned to our office before we are per- mitted to issue the permit. ea� A o 0v✓ Ci �914i1� se'f/1�y'lEJ • �� f�� ,� r ;:s, IT �/fid . V COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Ccirifornia,-95965 - Telephone: 916/538-7541 i` APPLICATION AND PERMIT PERMIT N0. i ASSESSOR PAI CEL NUM ER Z�'A � BUILDING'PE`AMIT OWNER- �_ TELEPHONE SQ, FT. OCG`, BUILDING VALUATION OWNER'S MAILING ADDRESS --5 _.o �.t? n ci �c --i CJ7� CONTRACTOR'S NAME i ' ( R ,". ¢_ �a TELEPHONE -(n-rf w CONTRACTOR'S MAILING'ADDRESS e Q e,. V�' L4 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ _ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ i Tj ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ " Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS _ Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT FilihgFee 10.00 0 4/-3. �.C.0 .... .: ..'. ,. ..._. ... ..; ... -... .-.. _. -. .. ............ « _ hvA.l CML - Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME, ,..1 - PARCEL MAP Water piping 5.00 Each pas water heater or vent 5.00 USE OF STRUCTURE' SF Duplex❑ Mobilehome❑ Other sPECI Fv Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti Ijties ❑ Installation[] Other] j Describe work: �'I /� �r-�--{�!� - ii �r7 I� iJ Permit Fee $ Contractor ELECTRICAL PERMIT Fil.ingFee 10.00 Main service 600V OR LESS 10.00 100 AMP OR LESS Main service EA. ADO'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ® I am licensed under provisions of Chapt. 9, Div. 3 of the Business r and Professions Code and my license is in full rce and effect. License No. /_7 L Classification ElI, as the owner, or my employees with wages as their so a compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) , ❑ I am exempt under Sec. ,`Business and Professions Code for this reason I , NEW CONST. DWELLING OCCUP.SI) 'hQSpft OR ADDNS. ACC. BLDGS. NEW CONSTR.'.OUTLET 2,50 ea NON-RESID .BRA CH CIRC ITS POWER APPARATUS eI SINGLE OUTLET CIR. Ex, OCCup OUTLETS OR FIXTURES 200030 5AL@30 FIXED P Ex. Occup. OUTLETS IESID iINIS REA.) 2.00 R Temporary service*.; 10.00 Mobile Home,Facilities 15.00 Misc. 1Yiring I 15.00 - M Permit Fee $ , • •, ' - -' Contractor Y WORKMEN'S COMPENSATION INSURANCE j1 I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I I have placed on file with the County,of Butte Building Department a Certificate of Workmen,'s Compensation Insurance or a Certificate i of Consent to Self -Insure. ; EJI shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,. should you become subject to the W. C. provisions of the Labor Code, you mu.stjorthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. CC�� X ! +--•-"`-'s- Date-2�� "rQ Signature of Applicant - Owner ❑ Contractor ❑ Agent Qr An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. ---- Mobile Home Installation Fee $ Energy Inspection Fee $ 01 TOTAL PERMIT FEE $ x-7-4 Jz Occup. I CONST.TTPC SCHOOL FLOOD PARClL PD ND 1390E This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above /) which fees have been paid. ,/`� DIR�C�TO OF PUBLICIWORKS ey / 1 [ate �ERMIT EXPIRES Date f '! Receipt No. WNITL-D.P.W., 7lLLOW-032033011, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovill24 Califi;,rnia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT . . ASSESSOR PAR EL NUM R zvx BUILDING PERMIT OW ER i6 ONE GS !6 SQ. FT. OCC, BUILDING VALUATION O WMD _; ESS CONT ACTOR'S J4 AM E ` TELEPHONE -L CON RACT R'S MAILING-ADDFLYSS ® A 1- Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ Zj ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF rV Duplex❑ Mobilehome❑ Other SPECIFY . Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti (hies ❑ Installation ❑ Other ] Describe work: Zd4a J Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 1 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one p Y p j Y hk ( )• I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions /Codec and my license is in full force an effect. License No. 1:7 ( ^ .� Classification C El 1, as the owner, or my employees with wages as their so a compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec.-------:.—, Business and Professions Code for this reason NEW CONST. DWELLING OCCUP" OR AODNS. ACC. BLDGS. , /z�sgft NEW RES O, NCH CIRCUITS)2,50 ea NON-RESID .BRA CH CIRC S POWER APPARATUS e\ SINGLE OUTLET CIR. / / EX. OCCUp\OUTLETS OR FIXTURES GALO 30 OALO 30 Ex. Occup. OUTLETS P(V FIXED RESID IREA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said qounty in conseq ce of the granting of this permit. X _V Z_Lt=� Date Signature of Applicant — Owner El Contractor ❑ Agent s An OSHA permit is required for excavations over 5'0" deep and 4molition or construct- ion of structures ov r 3 stories in height./ Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.T;PZJ ISCHOOLIFLOODIPARCELI PD I HD ISSUE This permit is hereby issued under sions of the Butte County Code and/or work in dabove f which DIR F PU Z.. /7 JZd MIT EXPIRES Data the applicable provi- resolutions to do f s have been paid. I WORKS et Receipt No. WNITL-O. P.W.. YELLOW-ASSLDS R, PINK -IN 9P CCTOR, GOLDEN ROD -APPLICANT L -A�� 3o s1+3un3'an't °O� Owner: Address: BUTTE COUNTY.DEPAFTMENT OF PUBLIC WORKi SPECIAL INSPECTION REPORT ` /l A. P. # Date of Inspec�ionY-X. % Tenant: Inspec Building Location: Type of -Inspection requested: 1. Housing 2. FInanc.ing 3. Change of Occupancy to 4. Other (specify)__ ' Present use of build A. Sanitation (Housing) 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities: 7. Natural light and ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: '12. Connection to water supply: 13. Rubbish and garbage facilities: 14. Comments: /. B. Structural 1. Piers and footings: 2. Floor construction: 3. Wall construction: 4. Ceiling and roof construction: 5. Fireplaces: 6. Comments: C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments: - D. Plumb in 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4. Comments: L"I (continued on back) E. Other 1. Maintenance a 2.. Fire hazards: 3. Safety hazard 4. Weather prof-- _.,... 5. Underfloor and attic v 6. Comments: n ti]ation: F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Restroom floors and walls: 5. Exits: 6. Improvements: 7. Zoning: 8. Comments: G. Field Problems or Violations 1. Problem or violation (give complete description): 2. What action taken (give complete description) : 3. What act' ecammended: A. Tnfo ,ation only - file. / / B. Hold for ten (10) days, then write: letter. / / C. Write letter. 77D. Other: j. . -N ECdNTV- OF BUTTE DEPARTMENT OF PUBLIC WORKS v 695 Oleander Avenue, Chico — Phone 343-4211, Ext. 70 7 County Center Drive, Oroville — Phone 534-4541 Skyway and Elliott Road, Paradise — Phone 877-3435 CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. bs . e z10 ow 7- -- /.t% o o/ /6' U "C:7, !nspecto _ Date — P� 1>epDk-kioaof(Fort-ry1i, , L - 3033 RURAL., FIRE REPORT • ��.� `/ffm FIRE NUMBER: R - 73S RANGER UNIT (OR AGENCY): FIRE NAME: v r ��i _ DATE FIRE STARTED: I ► I ' 17 8 If Fire Started in Another Jurisdiction, or Zone I or II, Name It: ,,Ale ISCALE: t- = 21_ MiLetai I C. LOCATION. Spot fire origin. Always give section location where possible. Otherwise give sub -division lot; R.F.D. box; etc. Sketch boundary of large fire, roads, railroad, zone line, etc. G !'icy ( G C) ( Rd. n -;,c-J- 1 ✓C) D. CLASS OF FIRE Vegetation Structural Vehicle Improvement Refuse* False Alarm E. Permit Escape ' Includes weed burning SEC. / TWN. —"/-'RGE. �a� v Fire occurred Al —Mile (a) in l/✓rS � —Direction from Town of F. WHAT BURNED? (a) If structure give number, kind, type of construction, stories, size. (b) If vehicle give make, model, year, license, driver's name and address. (c) If vegetation give type and area. (d) If other, describe fully. Vegetation Area Burned acres H. CAUSE OF FIRE: i 5 « n C' y u - Known ❑; Log. ❑ Fire started in/on: Known[]; Log. (] ;aterial First Ignited: Known ❑; Log. ❑ Was "first aid" extinguisher used before crew arrived? 1110 Did Injury or Death occur? explain: Al.�) G. DAMAGE (Do not make duplicate entries bdu.) Standing Grain Industrial Blde(s). 1 1 Ivon-tndust.Isldg(s). ,000 Building Contents Vehicle(s) u or Oil P TOTAL S P 00 J. WEATHER WHEN FIRE STARTED Wind Velocity M.P.H. Wind Direction Temperature Humidity Fuel Moist. K. NAME AND ADDRESS OF OWNERS OF DAMAGED PROPERTY: 1-C_-1 ^ r- s �- 13x r- A Tenants Name and Address: (f 17 L. INSURANCE CARRIERS) F'��/"f �' } - t iv -s a :^• /div C E Address: REMARKS M. DESCRIBE PROPERTY SAVED AND ESTIMATE VALUE: N. HOW MUCH INSURANCE WILL PROBABLY BE PAID? � w Signature o/ REPORT MADE BY:L�C_`�� ' / �/�L` Officer in charge