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042-170-067
� ^ ` / ' ' At — . 77, 1 �l Pacific Gas and Electric Compal(y North Valley Division Customer Center 350 Salem Street P.O. Box 49 Chico, CA 95927 916/343-5515 800/273-4743 September 7; 1993 ` Butte County Building Department 7 County Center Drive Oroville, CA 95965 Gentlemen: COUNTY OF BUTTE BUILDING DEPT S EP p 9 1993 Occasionally our field personnel become aware of what may appear to be newly established residences•or living quarters that are receiving electricity from a non -inspected source such as an agricultural pump, stock water pump, etc. or perhaps from an existing residence. ` No doubt many of these are substandard according to local codes and may warrant your attention. For your information, the fol- lowing appears to be such a situation: Customer - Joseph Pavcik Supply - Mobile Home from prior ag ell Electric Meter #14B47 1� � H � �7 ��v �/�/ Location - 1730 Muir Ave, Chico P Account 46- JFB 64 04801�r If you have any further questions regarding this matter, please contact me at (916)896-4209. Sincerely, JOHN L. BROUILLARD Customer Services Representative 4htr'X1172.60 / 290 369.69 560 660 660 7 8 5 j 9. 7 5 d C. $QSg 1 2 22 54 Ac 2/. 73.4c 0 I lorh •� ot /0.16 Ac 12.73Ac f i 2 1� 660. _ 400' a 84 ' ! ' - O Q,�1�:8�•4� SLI �!'� n:,r� IV e10. O till.15 + v �ye - o -45 67'� .St �E X760 01 �, 4.5 I ,7 a - I BOAC. M 9.98AC.� I 2525"' H #1 m PIM 46-05 a N 36I. 9 CO 1 O 6 5' M 3000 ~ 4.0 N G` pM /2/-7 71 6N. 43 6.6 /B9 73 80 ° : 6: I•� 419. 42 1 =t 1 j 5D0 � F61.98 A I - /B•� 661.9 6 - �6� 1 4i 10.34Ac' / O 61.98 �,.1• I I 1 -�3 6 i �°�, 0111 IO /4 _ 1 �/ 40.00.40. I =,c. sc 2(.61 1 8/ h .4-1 I 1 X2711 T. N. , I t 1 / j 5 4 2$ 11 6. i 9Ac 43 I. I V(6 s // j I Qs a 5S46 N.4S 44 N ' n/1 , 1 ev =. Q SL N 375.:. t p ;360 53 /O.00Ac. rR� 24.94 Ac O Q I I » 15. 74 c. /5:664c. 2 S 2 1 1 I i O N 79 i-� /63/0.40 0�� I 66010 /� ! a ► I > f _ "' Q - 5 1 7 3.47oc. f p ` 1 Q• I c Ac. r / 1 //.B SI 58-29 0� ,'�,�� 5.00AC 4.a9Ac. t? 567.34 N (. S O. N M , � 6 2 ,� ; / � N /8 30' // 540.58 ^�� P �• /0.00 4C. ft �• � - a moo° 7 Assessor's Mop No. 42-/7 f 19 5 'N County of Butte, Calif. 33 ; S B; d we/1 7 r,l f S lc. �•f.O .R, 9/r a: r 0 - --. - -C Ve t fry DS a ; COMPLAINANT: ADDRESS: PHONE NUMBER: OTHER COMMENTS• COMPLAINANT: _ ADDRESS: PHONE NUMBER:. OTHER COMMENTS• Pacific Gas and Electric Company North Valley Division Customer Center 350 Salem Street ' P.O. Box 49 Chico, CA 95927 916/343-5515 800/273-4743 September 7,-1993 COUM OF BUTTE BUILDING DEPT SEP a b 1993 Butte County Building Department 7 County Center Drive Oroville, CA 95965 Gentlemen: Occasionally our field personnel become aware of what may appear to be newly established residences or living quarters that are receiving electricity from a non -inspected source such as an agricultural pump, stock water pump, etc. or perhaps from an existing residence. No doubt many of these are substandard according to local codes and may warrant your attention. For your information, the fol- lowing appears to be such a situation: Customer - Joseph Pavcik Supply - Mobile Home served from prior ag well Electric Meter //14B471 Location - 1730 Muir Ave, Chico Account JFB 64 04801 If you have any further questions regarding this matter,.please contact me at (916)896-4209. Sincerely, JOHN L. BROUILLARD Customer Services Representative Icl RE I TIAL 42-17-67 00-r'S0Q PAVCIK, Joe 1730 Muir Ave, Chico cont: Mobile Home Center (mh util) 7- L0 cc) Lo V OFFICE COPY Address 030 GAS Meter C�yDate ELECTRIC Meter By Da Address/ 2:3 1�21 U, r, 6-1 _j Meter Sy Bvte— ELECTR —.2 1 Meter By'C7 M_,Q/4e--? Date JOB FINALED (Date) Signature V=OK ` _. O = Nol OKNot = Not Readyable MOBILE HOMES Date MQfr1LE YdME UTILITIES Plans OK except #'s of Z,piring Requirements -Setbacks -Easements S ' s; Special MH Support Sketch Sewer; L ation-Test-Fall-C/O Concrete Wat , Location -Test -Easement Needed (Sketch) !&!Electricity; Location -Clea rences-GrnAmp-Concrete 6. Gas4tion-Test-Wrap: / /"L"ft. 1a . oZ0'L"ft. /"LPG 7.II Clearance & Disconnect Utility Clearance Date? Card B-1 Date Card B-1 Date Card B- Date Card B-1 Date MOBIL ME INSTALLATION (Plan K except #'s JL.Zo'ning Req uire ments-Setb asements 2. Footings; Size-S2pcing-Marriage Line f 3. Gas; M - emand-Valve—Connector tr'city; MH Test-Crossqwrs- Brea kers-Clealrelf5ces 5. Dr n; MHT t -Fall -Flex Connector t'dPVwater;Test-Rggulasor-Connector rade-HD Approval of OCC Datef-41/ Card B-1Zgbg Date Card B-1 Date Card B-1 Date Card B-1 t� 6 oC` 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; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Con nectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.;Enclosures; Conduit 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 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 a A J=OK O=Not OK = Not Applicable Net Ready RESIDENTIAL (Singl'e & Duplex) = Date UNDERFLOOR (Plans) OK except k's i 1. Zoning -Setbacks -Easements -Flood -Slope I 45. Hangers -Post Caps -Anchors -Connectors `*� X- 46. Cing. Joist-Rftr. ties-Purlin-root Brac-Truss-Shthng.-Ring. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access: Size & Romex Protection -Draft Stop- Ins!Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hat. & Dimensions Date FRAMING (Continued) Dale ELECTRICAL (Permit) OK except M's 22. Fixture & Transformer Clearance -Ins. Protection ------- -------------- --------- --------------------- --------------------- _ _____ 23. Elec. Receptacles Spacing -Lights & Switches at Doors --------------------------------------------------------------- 24. Size Boxes & No. of Conductors -Stapled =-------------------------------------------------------------------------- 25. Romex Installed Close to Edge of Studs & C.J. ------ ----- --------------------------------- --------------- 26. Equip. Ground made up w!Mech. Fastners-Bond Gas & Water ---------- ---------------------------------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor Size!GFI --------------------------------------------------------- =------------------------- 28. Subfeed Wire Size ga. Cu or AI-A.C. Wire Size ! / ga. Cu or At --------------- -- - ---------------------------- 29. Range Circ ! I ga. Cu or AI -Oven Circ. / ! ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No --------------------------------------------------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect -------- ---------------------------------------------------------------- 31. Equip. Clearances PaneIs- Motors-Mech. Equip. ----------------------------- ------------------------------------------------- 32. Clothes Closet Light Shower Light -Spa Light -------- - - - --- ------------------------ 33. Smoke Detector ---------------------------------------------------------------------------- --- Date Card B-1 Date Card B-1 --------------------------------------------------- ------------------------------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except tr's 34. A.C. Ducts Insulation & Support ------------------------------------------------------------------- -------------- 35. Vent Fan: Exhaust above insulation ------------------------------------------------------------ 36. Condensate Drain & Overflow: Size & Grade ----------------------------------------------•----- ---- 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet -------------- Attic Access & Platform if Furnance in Attic --------------------------------------------------------------------------------- - Date ..---Card-B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s 39. Sils. Proper Material & Anchors ----------------------------------------- 40. Walls Studs -Nailing Spacing & Bracing -Plates -Sound ------------ -------------------------------------------------------- 41. Bearing Walls over Girders & Floor Nailing -- --- -------------------------------------- --------- 42. Draft Stop in Walls (rat proof) ---------- --------------------------------------------------------------- 43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing 50. Garage Fire Protection Framing 51. Property Line Firewall & Openingsl.V 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits Iiy, ---------- 53. -.Stairs: Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer (1) 56. Stucco Mesh -Drip Screed-Fd�Vents-Underflr. AccessN-1"\- 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows •------------------------------- - Date _______ --Card B-1 Date Card B-1 Date Card B-1 Date Cara B-1. Date FINAL (Plans) OK except N's _ 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor -Ducts -Meth. Protection --------- ------------ 64. Bedroom Exiti ------------------------------ --- - 65. G.F.I. & Bath Fixtures & Tub Access -Spa ---------------------------- 66. Elec. Trim & Subpanel: Breaker Sizes & Labels,f_- --------- --------------------------- 67. Stairs & Rails------------- _ 68 Fireplace or Stove: Clearances -Hearth --------------- ---------------------- - 69Elec. Outlets at Wood Panel: Int. & Ext. - - . --------------------- & --------------------& Appliance; Grnd.-Air Gap -Cooking Clearance 71. Elec'-Outlets & Receptacles at Kit. Counter ----- 72. Garage Fire Door: Swing -Landing -Closer --------------------------------- -- - 73. A.C.�Duct in Garage -Damper --- -------------- -------- -------------- 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor -Meth. Protection 75 Plb.! Elec. & Mech. Equip. Listed for Location ---------------- 76. Elec. Receptacles in Garage:'(G.F.I.)-Romex Protection 7 . Insulation =Foam -Looked in Attic ❑ Yes -------------------------------- - - -- 78 Guard Rails & Deck -Const ruct ion -Post Caps \ 79. Fdn, Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor -- ❑ Yes j 80. Following instld.: Drive ❑ Yes ❑ No; Walks' 11 Yes ❑ No; Planters ❑ Yes ❑ No j 81. Stucco Brown -Finish 82. A.C. Unit: Disconnect. Electrical, Plumbing j --------------------------------------- -- - 83. Vents Above Roof; Plbg.-Appliance-Fireplace.`Clearance to Openings_° 84. Water Well: Disconnect. Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground - -- - ----------------------- 86. --------------86. Ventilation Throughout House I ---------------------------------- 87. ---- ------...---- --------------87. Glass Protection --------------------------------- ---------- 88. Corrections from Previous Inspections } ----------- 89. ----------89. Gas Test -Meters Tagged; Gas -Electric j 90. Water & Sewer Connected -C/O to Grade --HD Approval -------------------------------------- 91. Energy Compliance Certificate -Other Certificates ----------------------------------- ---------------------------------------- Date Card B-1 Date Card B-1 •-- ----- -- - -- - --- ---- ---------------------------------------- Date I •_ Card B-1 Date Card B-1 -------- ------------------- -----' Date T Card B-1 Date Card B-1 Comments at Final: ♦ ` 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit),OK except It's ---------------------- --- -- ---- ---------------------------------------------- ------------ ---------- Date --------- Date 16. - Water Htr.: Vent -Access -Combustion Air -Baffle --------------------------- 17. Water Pipe; Test & Anchor -Nail Protection ---------------- 18. D.W.V.; Test -Fittings & Anchor -Nail Protection -------------- - -------------------- 19. Shower Pan; Test. First Floo-r-Tub Access 20. Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe: Size & Anchors ----------------------------------------------------------- Card B-1 Date Card B-1 ---------------------------------------- ----------------------- Card B-1 Date Card B-1 Dale ELECTRICAL (Permit) OK except M's 22. Fixture & Transformer Clearance -Ins. Protection ------- -------------- --------- --------------------- --------------------- _ _____ 23. Elec. Receptacles Spacing -Lights & Switches at Doors --------------------------------------------------------------- 24. Size Boxes & No. of Conductors -Stapled =-------------------------------------------------------------------------- 25. Romex Installed Close to Edge of Studs & C.J. ------ ----- --------------------------------- --------------- 26. Equip. Ground made up w!Mech. Fastners-Bond Gas & Water ---------- ---------------------------------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor Size!GFI --------------------------------------------------------- =------------------------- 28. Subfeed Wire Size ga. Cu or AI-A.C. Wire Size ! / ga. Cu or At --------------- -- - ---------------------------- 29. Range Circ ! I ga. Cu or AI -Oven Circ. / ! ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No --------------------------------------------------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect -------- ---------------------------------------------------------------- 31. Equip. Clearances PaneIs- Motors-Mech. Equip. ----------------------------- ------------------------------------------------- 32. Clothes Closet Light Shower Light -Spa Light -------- - - - --- ------------------------ 33. Smoke Detector ---------------------------------------------------------------------------- --- Date Card B-1 Date Card B-1 --------------------------------------------------- ------------------------------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except tr's 34. A.C. Ducts Insulation & Support ------------------------------------------------------------------- -------------- 35. Vent Fan: Exhaust above insulation ------------------------------------------------------------ 36. Condensate Drain & Overflow: Size & Grade ----------------------------------------------•----- ---- 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet -------------- Attic Access & Platform if Furnance in Attic --------------------------------------------------------------------------------- - Date ..---Card-B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s 39. Sils. Proper Material & Anchors ----------------------------------------- 40. Walls Studs -Nailing Spacing & Bracing -Plates -Sound ------------ -------------------------------------------------------- 41. Bearing Walls over Girders & Floor Nailing -- --- -------------------------------------- --------- 42. Draft Stop in Walls (rat proof) ---------- --------------------------------------------------------------- 43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing 50. Garage Fire Protection Framing 51. Property Line Firewall & Openingsl.V 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits Iiy, ---------- 53. -.Stairs: Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer (1) 56. Stucco Mesh -Drip Screed-Fd�Vents-Underflr. AccessN-1"\- 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows •------------------------------- - Date _______ --Card B-1 Date Card B-1 Date Card B-1 Date Cara B-1. Date FINAL (Plans) OK except N's _ 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor -Ducts -Meth. Protection --------- ------------ 64. Bedroom Exiti ------------------------------ --- - 65. G.F.I. & Bath Fixtures & Tub Access -Spa ---------------------------- 66. Elec. Trim & Subpanel: Breaker Sizes & Labels,f_- --------- --------------------------- 67. Stairs & Rails------------- _ 68 Fireplace or Stove: Clearances -Hearth --------------- ---------------------- - 69Elec. Outlets at Wood Panel: Int. & Ext. - - . --------------------- & --------------------& Appliance; Grnd.-Air Gap -Cooking Clearance 71. Elec'-Outlets & Receptacles at Kit. Counter ----- 72. Garage Fire Door: Swing -Landing -Closer --------------------------------- -- - 73. A.C.�Duct in Garage -Damper --- -------------- -------- -------------- 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor -Meth. Protection 75 Plb.! Elec. & Mech. Equip. Listed for Location ---------------- 76. Elec. Receptacles in Garage:'(G.F.I.)-Romex Protection 7 . Insulation =Foam -Looked in Attic ❑ Yes -------------------------------- - - -- 78 Guard Rails & Deck -Const ruct ion -Post Caps \ 79. Fdn, Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor -- ❑ Yes j 80. Following instld.: Drive ❑ Yes ❑ No; Walks' 11 Yes ❑ No; Planters ❑ Yes ❑ No j 81. Stucco Brown -Finish 82. A.C. Unit: Disconnect. Electrical, Plumbing j --------------------------------------- -- - 83. Vents Above Roof; Plbg.-Appliance-Fireplace.`Clearance to Openings_° 84. Water Well: Disconnect. Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground - -- - ----------------------- 86. --------------86. Ventilation Throughout House I ---------------------------------- 87. ---- ------...---- --------------87. Glass Protection --------------------------------- ---------- 88. Corrections from Previous Inspections } ----------- 89. ----------89. Gas Test -Meters Tagged; Gas -Electric j 90. Water & Sewer Connected -C/O to Grade --HD Approval -------------------------------------- 91. Energy Compliance Certificate -Other Certificates ----------------------------------- ---------------------------------------- Date Card B-1 Date Card B-1 •-- ----- -- - -- - --- ---- ---------------------------------------- Date I •_ Card B-1 Date Card B-1 -------- ------------------- -----' Date T Card B-1 Date Card B-1 Comments at Final: ♦ ` 5 1 211111101111 11 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE `1< OWNER , � � � _ 6 /� RE-AdM 0. 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 come ion o�f'work is completed. If you have any question pertaining to this matter, r need additional explanation, please contact this office immediately. CL zCv' m n e of Q `t 4i a , ►� ' ' ►- el of e a m laex a agig O Ci47 o\u2 d A- 1 Z e (e. Y tZ 1 a s r ,a. Date 7 ' / Inspector" COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS aQI 196 Membrial Way, Chico — Phone: 891-2751 j1 r 4 7 County Center Drive, Oroville — Phone: 538-7541 l ' 747 Elliott Road, Paradise — Phone: 872-630 CORRECTION NOTICE OWNER PERMIT NO. A routine inspec •on indicates that the following violations of County Ordinance exist at tove address and should be corrected. Please notify this office when co4he of work is completed. If you have any question pertaining to this matter, additional explanation, please contact this office immediately. le ?6-0 (-)tI �'O- W e,kl c i r- C- CA- ; -�- Date ���� '9 Inspector ro 5�c ( ( ��' 'I COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS l 196 Memorial Way, Chico —•Phone: 891-2751 - 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise — Phone: 872-6307 CORRECTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at 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. 5. \l W -on Date / �� �j Inspector_ A COUNTY OF BUTTE r 6 DEPARTMENT OF PUBLIC WORKS ' 196 Memorial Way, Chico --;n Phone: 4391-2751 7 County Center Drive, Orovi Ile — Phone: 538-7541' 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE .a OWNER z US A routine inspection indicates that the following violations of County Ordinance exist at the above-faddress 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. �I GP r u I t� � r. u c9 .-i s e1 -t r o -• I M f Date 7— /9— — .1 Inspector M , R/ i_ COUNTY OF BUTTE- { DEPARTMENT OF PUBLIC WORKS .196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phoge: 538-7541. 747 Elliott Road, Paradise — Phone: 872-6307 CORRECTION NOTICE OWNER PERMIT NO. 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. ^� dQ e�` t s o c� rc.P e) -F-- Date _ �� L / Inspector MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER -DRIVE OROVILLE, CALIFORNIA — 5344541 PERMIT NO. f2 2 V 0—�// Address or location of mobilehome Owner's name C 1 • ►' Owner's address 3 / 3 Insignia or hud number P S•�-3 � 3 Manufacturer's name �la n-1 o S%15 7/1 v^ s ~ A� Serial number of V.I.N.;�L19GA 5N Ll t 432 rz44,o Year of manufacture (Official Approving Installation) (Date) 1 IF THE MOBILEHOME IS MOVED OR RELOCATED, ,THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE r MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. s ,.. 5138 White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPUCATION AND PERMIT, PERMIT NO. ASSESSOR PARCEL NUMBER 42-17-67 ZONING ,1 1 A-10 / BUILDING PERMIT OWNER Joe Pavcik TELEPHONE 343-5611 SQ. FT. OCC, BUILDING VALUATION OWNER'S MAILING ADDRESS 1187 Stanely Ave., Chico 95926 CONTRACTOR'S NAME Mobile Home Center TELEPHONE 521-2721 CONTRACTOR'S MAILING ADDRESS ' 3130 Esplanade, Chico 95926 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ 15.00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 15.00 PERMIT Filing Fee 10.00 7-30Mnir Ave-, ChicoPLUMBING Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME i.1 PARCEL MAP Water piping 5.00 Each pas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehomea Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00ea 30.00 TYPE OF WORK New Addition❑ Remodel❑ Utilities© Installation[] Other ❑ Describe work: MHU _ Permit Fee $ 40.00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 80Dv OR LESS 100 AMP OR LESS 1 10.00 10.00 Main service EA. ADD'L 100 AMP 1 2.50 2.50 CONTRACTORS LICENSE LAW I declare under penaltyof : perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Buslnes$ and Prof essi s Code and fpj� license Is In full force and effect. License No. l% Classification. L El 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.61\ OR ADDNS. ACC. BLDGS. / '/z2sgft NEW CONSTFL MULTI -OUTLET NO N•RESID BRANCH CIRC ITS 2.50 ea (POWER APPARATUS e) SINGLE OUTLET CIR. EX. OCcup(OUTLETS OR FIXTURES .2ALO 30 FIXED Ex. Occup. OUTLETS P(RESID )REAJ 2.00 Temporary service 10.00 Mobile Home Facilities 1 15.00 15.00Misc. Wiring g 15.00 Permit Fee $ 37.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed.revoked. Contractor MECHANICAL PERMIT 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 County ofocc I Butte to enter upon the above-mentioned property for inspection purposes. I 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 agains said County,' consequence of the granting of thi permit./ X Date - t/ �rG 1 nature of Applicant - Owner ❑ Contractor ElAgent�� An SHA ion permit is required for excavations over 5'0" deep and demolition or construct- of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ CONST TYPE TOTAL F $ 92.5 HAL CUA- PARK SCHL FL cDF PAR PD ISS This permit is hereby issued under the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated abov for which fees have been paid. D R OF LIC WORKS BY D.attee,� J PE MIT EXPIRES ate CO -1 T L/ eceipt No. 93930/$92.50 NITE-D.P.W., YELLOW-ASeEOSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT kF I ...�—..6►yr.�; ...1— _i_l. •.I _N-`; 1� I�� Mil.y7itir'`l't� L COUNTY OF BUTTE - DEPARTMEN - 7 COUNTY CENTER QRI:VE - dNOVILLI PERMIT APPL' OWNER Cl Proposed Building Use ° 14n 1z-/ _:p3Y•rt'i'�+.''+r►lief'7F4yi^yg7yA�. "0 PUBLIC,, �,,,�WORKS - BUILQING,D�VISION N7 CALIFORNIA 95965 ; TE`EPHONE: 916/538-7541 .. - ;ATION,DATA SHEET -'� Permit No. A.P. No. Z -/7 - Building Inspector IO Date 41 -97 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: ` DATE RECEIVED APPROVED All items have been submitted. .. 2. Plot plans in duplicategned 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 ......... �,r 7. Statement of Intent for Non -Heated and AC Buildings;............... r 8. Engineered truss details and layo.utin-=duplicate (required prior to plan check) ; 9. Mobilehome installation'data including manufacturer's installation 3 '` instructions .......................... 10. Fees of $ * ....... . 11. Chico Urban Area fees paid ....................................... 12. Park fees paid 13. School District fees paid . 14. Sanitation approval from Health Department "v -f/ �/ *, x,15. City of Chico plumbing permit ..................................... X16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: , • ... . 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) --" 20. Pre -Inspection for 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 ......... f 25. Letter of signature authorization F/ 26' ., When you issue the permit, process as follows: "Mail to owner. Mail to contractor. Telephone 5Z/, 7Zl and hold for pickup at (90�10 office. Deliver w/inspector. Other C�t6Go� j ,�izL.e.p Applicant.: Date , Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date-- - '4 - Copy of plans sent Health Dept. Fire Dept. Other DateBy The following data must be submitted Qriorto permit issuance: (Circle new item not checked above), 1. Index permit for above items No. 2. Additio_Ral items required: Con or, designer, o er, was advised of above required data by` phone_mall_counter by 6 date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by M'Io S (o / I Sets of plans on hold in File cabinet AP folder Copy—DPW Date ,9/ V TO Suildinv Department FROM:. Environmental Health SUBJECT: Sanitation Clearance Owner Lo ation AP# Plan Approved for: Sewage Disposal / Final clearance O.R. for: Clearance for bedroom mobile home. Other NOTE * * * Sanitaria Water Supp - s Water Su y Water Supply TO: Building Department FROM: Encroachment Permit Section i RE: 'Driveway Clearance location AP ;k owner Driveway permit y� has been issued for the above property. n b Sig re date (;4/?/) C h lGo COUNTY OF BUTTE -*DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT' ASSESSOR PARCEL NUMBER .ZONING Z , ? 410 BUILDING PERMIT OWNER P TELEPHONE SO. FT.OCC. BUILDING VALUATION OWNER'S MAILING ADDR i55 �7 N�/ / QXV CONTRACTOR'S NAME MLNb(e 0" P (Z TELEPHONE 52P' Z CONTRACTOR'S MAILING ADDRESS Fireplace e CONSTRUCTION LENDER I VNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee E$ $ Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 1 ' PLUMBING PERMIT Filing Fee 10.00 le U/ �Ue /, .(1 g 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 - •- - --.- _ Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 - SF ❑ Duplex ❑--Mobilehome;- "Other -- -- SPECIFY Mobile Home O.00ea TYPE OF WORK New❑ Addition Remodel❑ Utilitie�--Installation❑ Other ❑ Permit Fee $ Describe work: �1—y Contractor ELECTRICAL PERMIT Filing Fee 1 10.00 Main service8001 OR LESS 100 AMP OR LESS 10.00 r Main Service EA. ADO'L 100 AMP 2.50 Z,�j 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. ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work, and the structure is not intended or offered NEW CONST. ( DWELLING OCCUP.31 OR ADDNS. ACC. BLDGS. NEW CONSTR. MULTI -OUTLET ESID BRANCH CIRC ITS — POWER APPARATUS 6 ( SINGLE OUTLET CIR. ) Ex. Occup(OUTLETS OR FIXTURES FIXED APPLN5. OR Ex. Occup. OUTLETS (RESID.)EA.) Temporary service 1/2csgft 2,50 ea BAL9330 2.00 10.00 for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Mobile Home Facilities Misc. Wiring 15.00 15•0 15.00 ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Permit Fee $ 15 71 Contractor WORKMEN'S COMPENSATION INSURANCE - I declare under penalty of perjury (check one): MECHANICAL PERMIT Fi ling Fee 10.00 ❑ 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 Seif-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 wittrsuch provisions or this permit shall be deemed revoked. Hood Ventilation Permit Fee Contractor 3.00 $ 1 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 Mobile Home Installation Fee Energy Inspection Fee $ $ to building construction, and hereby authorize representatives of the County of 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 occ CONST TYPE TOTAL FEE $ _ G HAL CUAPARK scHL FLo coF PAR Po ) HD. ISSUE against said County in consequence of the granting of this permit. _ X Date This permit is hereby issued unser the applicable provl- sions of the Butte County Code and/or resolutions to do Signature of Applicant — Owner ❑ Contractor ❑ , Agent ❑ work indicated above for which fees have been paid. An OSHA permit is required fo excavations over 5'0" deep and demolition or construct- ion of structures over 3 stariesfin height. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. 97 WNITC-D.P.W.. TCLLOW.A38C 70R, PINK -INSPECTOR, GOLDENROD -APPLICANT WTEr--ASI I rinks & WO*menship "s in Acoordanm %vlth Recognized Good Practices and of a quality prescribed for the Specifled use in the Uniform Building, Plumbing & Mechanical Cod@6 and the National ElectriceA C,odc. i L (` Tft s of plans and specdiioations WST be list on the job at all times and it is unlawful to rm*e any changes or alterations on same -,,,Mhout ( written permission from the Department of F'uc (� c_Works, County of Butte. ®s®tbaok of ft . fom the property lines aald a setback �� J Of 50 ft. from the road i centerline shall be clear of structures or equipment excep fora 2 ft. ✓ have overhang. -� /`�/ k or S f i EUT'TT'ESOUNTY j { BUILDING PEPARTMENT , E R1®i/ 9.1-22538 91-022338' I Rec Fee 5.00 Check 5.00 Reporded 1 i. Official Records I County of I Butte I Candace J* -Grubbs I Recorder 1:03pm 6 -Jun -91 I XX 1 Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR RESIDENTIAL DEVELOPMENT - Section 26-8.1 of the Butte County Code requires this acknowledgement be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this )roperty may be subject to inconveniences or discomfort arising from :he use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, imoke, noise, and odor. Butte County has established agricultural zones which have as a ?riority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or disconform--from normal, iecessary farm operations. All that real property situate in the County of Butte, State of California, described is follows: Lot 39, according to that certain map entitled "Map of the Seventh t,. Subdivision of the John Bidwell Rancho near Chico, Butte County, California" which map was filed in the office of the Recorder of the County of Butte, State of California, November 11, 1902 in Volumn 5 of Maps at page 29. Excepting therefrom the northerly 360 feet thereof. f. ate.:67� PROPERTY OW14ERS State of ) On this the rot da of �%,t.n P . _� Y 19(311 before County of SS. me, the undersigned Notary Public, personally appeared ) OFFICIAL SEAL JAN WINT'E'RS NOTARY PUBLIC - CALIFORNIA {,a BUTTE COMM My comm. expires MAY 19, 1993 01 Personally known to me. / / Proved to me on the basis of satisfactory evidence. to be the person(s) whose name(s) 75 subscribed to the within instrument and acknowledged that executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. :esent A.P. No. 7 Z. —/$1 Notary Public EN® OF DOCUMENT rq _-O S3 rn MU IL J �Oa Z LL U� W JCOUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE MI N0. 7 Cognty'CAter Drive - Oroville, California 0.5965 - Tolephone: 916/538-7541 .APPLICATION AND PEAMIT A r ASSESSOR PARCEL NUMBER 042-170-067-000 ZONING A-10 - BUILDING PERMIT OWNER .,JOSEPH & BONNIE PAVCIK TELEPHONE 342-2318 SO. FT. DCCT, BUILDING VALUATI OWNER'S MAILING ADDRESS 1730 MUIR ACE I `� CONTRACTOR'S NAME MOBILE HOME CENTER PQ?Hl TELEPHONE 521-2721 CONTRACTOR'S MAILING ADDRESS QQ 3130 ESPLANADE CHICO Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ 15.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 25.00 PLUMBING PERMIT Filing Fee 10.00 1730 MUIR AVE. CHIC0 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. 39 SUBDIVISION NAME BIDWELL PARCEL MAP 8-29 Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehomeg Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Q Installation[] Other ❑ Describe work: MOBILEHOME1%9 INS_TAL1,A-T14 r RE• $rP �I�QS_�1 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 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 and Professions Code and my license is in full force and effect. License No. Classification. ❑ 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ® I, as the owner, am exclusively contracting with licensed contract- ontract- ors.(Sec. 7044) ors. ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.N) OR ADDNS. ( ACC. BLDGS. I , /20sq ft NEW CONSTR. ULTI.OUTLET NO N.RESID BRANCH CIRCUITS) 2.50 ea POWER APPARATUS tr (SINGLE OUTLET CIR. Ex. Occup( OUTLETS OR FIXTURES 20050t .ALC30 FIXED APPLNS Ex. Occup. OUTLETS IIRESID )REA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �Virin 9 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT 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 County of 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 I' bilities, ju ments, costs, and expenses which may in any way accrue ag n said Co t in con quence of the granting of this permit. X Date —7 - 1; l Si ture of Applicant — Owner ® Contractor ❑ Agent ❑ A OSHA permit is required for excavations over 5'0" deep and demolition or construct- I, of structures onver3 stories in height. Mobile Home Installation Fee $ 45.00 Energy Inspection Fee $ OCc CONST TYPE TOTAL FEE $ 70.00 HAz. _ can PARK scH FL c�F PAR Pow I Ho,� (/ Issu This permit is hereby issued unser the applicable provi- sions of the Butte County -Code and/or resolutions to do work indicated above for which fees have been paid. D RE OR OF PUBLIC WORKS /c? By Date 'Gu PER IT EXPIRE Date r U Receipt No. �-!T. ��`r T WHITE-D.P.W.. YELLOW-ASe[3SOR. PINK -INSPECTOR. GOLDENROD -APPLICANT �r�.W it, r: ,1 'V.C"'v"."f .MFRS. _iWVZr. " 1`RKe' aa+v►w.v+.�y�-u.. �{�r' ruifprp. r7pGIT�'t� ,i " COUNTY OF BUTTE - DEO`�kRTMEN-T. OF_ PL9.13 VORKS -BUILDING DIyISION'' / 7. 7 COUNTY CENTER PRW E}'V� L -'ORE, FORNIA &LI95965 - JELEPHONE: 916/538-7541 /` { PERMIT APPCI"CATION DATA SHEET r Permit No. �/ OWNER �S T �/ / (� �` A. T Z % Proposed Building Use /�'/ # Building Inspector Date At time of 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 ....:z ... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. JERgineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions....................................................... 10. Fees of $:y4a 11. Chico Urban Area fees paid ....................................... 12. Parkes A --1-3.(� School District fees paid .............. 7110M 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ............................... 16. Plot plan and business license approval from City of h t (see City for other requirements) f 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 ... N1 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... L; VLette of si n ture authorization 6 ,� 2_��l sG .......................... ,s When y�ssue the permit -process s follows: Mail��er. Mail to contractor. l/ Telephoh0a,,2 d hold for pickup at office. Deliver w/inspector. Other i m srAuje 2 DUTY" 6P- pp .Date i Al, KG 824-552 Applicant / r 3¢3- r f! Copy of Hdz-Mat form sent Heaith Dept. Fire Dept. Air Pollution Date Copy of plans sent ir- elt, ,Dept. FireDept. Other Date By The following data must be submitted Z' t permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone-__mail—counter by ..date Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date Plans checked by FAAJ Date_.�11012 I Plans approved by 04`�) Date 7allw Sets of plans on hold in Copy—DPW File cabinet AP folder COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 .APPLICATION AND PERMIT ASSESSOR PARCEL NUMBERZONA b G�2 �O — b &-7 - D o O _ G _to BUILDING PERMIT OWNER, `-50-55-16" --L(�ON/1!!e �.41/CC l� TELEPHONE 3y1 S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS -736 CONTRACTOR'S NAME NAME D E X!Tf,SZ-Z7ZI TELEPHONE CONTRACTOR'S MAILING ADDRESS •( Z Fireplace CONSTRUCTION LENDERUNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEERENSE LIC 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 13� Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME aa t PARCEL MAP Water piping 5.00 Each gas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duple !`' Mobilehome� Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Instal lation� Other ,❑ Describe work: ��! �C ' e ��l37'AL-64X/ st 1'1Qrj --cj� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'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 and Professions Code and my license is in full force and effect. License No. Classification. F-1 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. ( DWELLING OCCUP.&) OR ACDNS. ACC. BLDGS. YzQsgft NEW CONSTR. ULTI.OUTLET NON•R ESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS e (SINGLE OUTLET CIR. ) Ex.000up(OUTLETSOR FIXTURES 5AL930@50C ALoo FIXED Ex. Occup. OUTLETS ( R RESID IEA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 9 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation perrnit Fee $ I 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 County of 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 t said Zaon equence of the granting of this permit. 7 .� ^� t Date re of Applicant — Owner & Contractor ❑ Agent 1-1 HA permit is required for excavations over 5'0" deep and demolition or construct- Jonoftructures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ C -- E HAZ. CUA PARK SCHL FLo PA PD j HD. ISSUE This permit is hereby issued unser sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable'provi- resolutions to do have been paid. WORKS Date Receipt No. WHITE-D.P.W.. YELLOW-ASeE»OR. PINK -INSPECTOR. GOLDENROD -APPLICANT AP# OWNER PO -V' / C PERMIT l 7 5�4�9 MH UTIL.CLEARANCE DATE INSPECTOR - y�- ELECTRIC GAS Support Struc. Compaction Test Rea. 3ervi.ce 3iz. Other Load Tvpe Pipe Size 11 Len to YES —N -OE YES NO -ZOO A too +"� LSP �1i �,D Y dS *.' �� 0J r BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM (One,Form per Building) A.P. Number Building Department No. School District 41,11__l/ S 6 City County,k Jurisdiction Property Owner Project Location/Address112!i- Subdivision Residential Development: # of Living ;MHI Units Commercial/Industrial: a New _ Lot Number P-1 C -,{'LA c 6 Sq. Footage' Addition .(Group R) OSq. Footage, Addition (Including Exterior Roofed Areas) Date ..(Floor Plans reviewed by School -District Personnel) District Id No. 7.00/2 00 . A nA JAPrL School District certifies ,that Applicant Name) Street. Address) ty ate 3Li�L- (09/v Phone Numbers �a(::� Zip Cod has complied with the requirements of Resolution No. by the payment of $ 1039J. I ( representing 10a square feet. School District Representative Date-' PAID BY CHECK NO. REMARKS: G e.c, i,, bo_ nn r,.l r r Mn n 1n�,O. e,S F-c.=CAU 2 11� -P,-r_-Fr BANK NO This Certification is valid only upon tho i«rransa PAID BY CASH Of a Butte County/City of Chico Rodding PrrMit ` prior to 8/5/91. Building e 0 , or 8/tv/91. are subject to re -certification .ar,d additional r white -applicant, yellow -build rfg` �c1 F19akft it t,.r pqu •fd�ffl13pgjesq&ib pIcce SCHOOL.FEE (8/88) ' ' | | aN Be �GOCA Practices and 4n-�xp-----------� Vn"C.nm P|ornbinO8-- AAechmnica/Codp. � ______ '/+�-----�----�--^---��-/�---------- ------------' ----- ` Ai � /,t-�/ / '~^-�~�'7� lines and a C70-tbac.-k of 50 Ff. from the road , �tll I centerlii=r be clear of rb Zzgo- 91 ED � /,t-�/ / '~^-�~�'7� BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 538-7541 MOBILEHOME INSTALLATION SHEET 1. Owner's Name: 2. Installer's Name: 3. Is the site current y under permit? Yes No (If yes, furnish permit number ) OR Is -the site an existing site? Yes No (If yes, furnish two plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes No U (If no, clarify V 5. What is the mobilehome electrical rating?,--------------- O O Amps 6. What 'is the mobilehome site service rating? ------------- 2p Q Amps 7. What is the mobilehome site circuit breaker rating? ----- t/%'1 a - Amps 8. Is there any other electric load to be served by the --------------------------------.Yes El ER mobilehome site service? No (If yes, identify,the load,and size: (Load) (Amps) 9. What is the mobleiibme s'ite-gas pipe size? y -10. What is the type of gas service? ------------------- Natural 711 LPG X 11. What is the gas pipe length from meter or tank to the mobilehome?--------------------------------------------- (ft ) * 12. What is the mobilehome gas demand? ---------------------- (BTU) *(This information not required if pipe length less than 6 ft. on - natural gas or less than 50 ft. on LPG.) MOBILEHOME SUPPORT DATA �If other than.,single wide, P Mobilehome Mfr.,lKv� ;. furnish Setup Model No. / %l�-/-� Year / �7510' Width (Lt.) Box Length 7 g� (ft.) Tagalong or Expando Size ft. x-- ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). FOOTINGS (check one)© 1. Wood -pressure treated or foundation grade. 2. Other (specify) SUPPORTS (check one) FX Concrete block.F-I 2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE Line 1 Piers: Size-:in.------------ Spacing-Max - ----------- Spacing-Max- --------- From Ends -Max. ------- Line 2 Piers: Size -Min. ------------ Spacing-Max ---------- From Ends -tax -------- N ADZi fV66 ------- NA2ZIA"66 Line J Knot iaaas: lrl N S.ize-Miq.------------ Location (From Front) Tipp 4 Line 1 Ltne 1 Openings: Size -Min- ------------------ "x' Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wall Only) Size-Min------------------- Spacing-Max - -----------------Spacing-Max. --------------- From Ends -Max -------------- 15-78* (�9Z�v 2164- (OOZ9 3156 12"x2,+- IZ"x2¢" 30"- 3G "I V2-1, 30 "1 30"x36„ "x24„ N �A 2'-8 -114,_g 24,-4 „ 30,_8 42,_8 Line C Piers: Size -Min .------------ �k Spacing -Max.--------- ,- From Ends -Max .------- _ Line 5 Roof Loads- Size -Min.------------ . (Under Bear Size -Min .------------------ 'k Spacing -Max.--------------- r_ From Ends -Max -------------- I,x I.x Ix „x IIx Location (From Front) _ 11_ 1 _ _ „ 1- �_ Rnoco =T C n rter�}} L) APPROVED y] „y: 14 a ylt s4- 3 Z,3 }.,-13`_:x'' 1 «► rl 6� ao • _� r S l V � VJ r Of t MI -'e Mr �. •j�P• f r N / N 1 r. erg !3 11151 w'a It $ 91E 34.3 3332 PGE?L HOME CTR F.bz lk v i `C' b W o C. M n4 vJ f� tj P lk v V 0 m �. -0 C: Oz co 0 nw C �c C0 :n r.��_�i..-nr:-tT•,;T�r.�t;.� •Y .-+,,,r-•r.- ,Iis.t-�srrN�: ^Tn'-=,+!��.'.�. ��'*fs..'+-,' „w.r{�:+ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965, - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ,�_ 5► ASSESSOR PARCEL NUMBER 42-17-67 ZONING BUILDING PERMIT OWNER JOSEPH PAVICK TELEPHONE SO. FT. OCC, BUILDING VALUATION OWNER'S MAILING ADDRESSAVE • 1730 MUIR E 'CONTRACTOR'S NAME UNKNOWN TELEPHONE 342—H 8 CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10.00 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 1730MiJIR AVP Z(;O Permit tee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Water piping , 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF❑ Duplex❑ Mobilehome❑ Other WETL FJ.EI7MT(,, SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities [� Installation[] Other ❑ Describe work: WE -11, ErrF MIC CIRCUIT RF -42200-01 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑NON.RESID 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. a 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ontract- ors.(Sec. 7044) ors. ❑ I am. exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.& OR DCONS. A � , /20sgft ULTBI ODGS.UTL BRANCH CIRCUITS) 2.50 ea POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20®50t SAL930 FIXED APPLNS. OR \ EX. Occup. OUTLETS (RESID.) EA./ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 15.00 Permit Fee $ 25.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a•Certificate of Consent to Self -Insure. �I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 1 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 County of 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 accrueI aga'nst said Count,9 in coprpequence of the granting of this permit. 7 -2 rY .Signature of Applicant - Owner ❑ Contractor Agent ❑ An OSHA permit is required for excavations over 5 0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE . ' TOTAL FEE $ 25 5 ,00 HAZ. CUA PARK SCHL FLD CDP PAR PD I HD. Issu This permit is hereby issued under the appiicable provi- sions of the Butte County. Code an or resolutions to do work i d' ated above for which s have been paid. R OF Il �C WORKS 7/23/91 Y 9 yqte PERMIT EXPIRES Date Receipt No. ® WHITE-D.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovllle, California 95965 -Telephone: 916/538-7541 �v.�- APPLICAT1010AND PERMIT PERMIT NO. ASSESSOR PARCEL NUM9 R 42-17-67 ZONIyjG/0 'u/ BUILDING PERMIT OWNER JOSEPH PAVICK TELEPHONE,' —� SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS - 1730 MUIR AVE CONTRACTOR'S NAME UNKNOWN TELEPHONE 342-2318 CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 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 1730 MJTR AVE CHICO 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 ❑ Duplex❑ Mobilehome❑ Other TnIFT.T. FT.$j"j'Rj('. 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 ❑ Utilities q Installation❑ Other ❑ Describe work: W01 RIRCTRjC (2jg(UjT Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 101 OR L Main service 100 AMP ORSLESS 10.00 Main service EA. ADD'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 Buslnes$ and Professions -Code and my license is in full force and effect. License No. Classification. Q, I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors.(Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.&. OR ACDNS. ACC. BLDGS. ,/z¢sgft T LET NEW CONSTRESID, RANCH CIRCUITS) NON•RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. OCCup(OUTLETS OR FIXTURES 20®50¢ eAL®ao FIXED APPLNS. Ex. DCCUp. OUTLETS ((RESID.)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 115.00 Permit Fee $ 25.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. �- I shall not employ any person in any manner so as to become subject L= oto the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 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, Jud ments, costs, and expenses which may in any way accrue ag 'nst said Co in co equence of the granting of this permit. 7 _ �y-ct ( Date 2 i nature of Applicant — Owner ❑ Contractor4 Agent ❑ n OSHA permit is required for excavations over 5'0" deep and demolition or construct- an of structures over 3 stories in height. Mobile Home. Installation Fee $ Energy Inspection Fee $ ' Occ CONST TYPE E TOTAL FEE $ 25.00 5 HAz. cuA PARK SCHL FLD PAR I Ho. Issu This permit is hereby issued under the applicable provi- sions or the Butte County. Code and/or resolutions to do work i 'cated above for which s have been paid. D R OF C WORKS y to �� 7/23/91 PER IT EXPIRES Date Receipt No. 96640 WHITE-O.P.W.. YELLOW-ASSC3SOR. PINK -INSPECTOR. GOLDENROD -APPLICANT OWNER �}4.�i��H;IY'�i;.1:'y •.:c7_",7='RYr'�lu�°''t'':sr ./.'+e^'''sr^+K.�,.�,.,�,,,.,.._,.�. • x y ' M ��.., .151 COUNTY OF BUTTE - DEPARTMENT 'OF. PUBLIC W RKS BUILDING DIVISION 7 COUNTY CENTER DRIVE OROL); ,,�LIF�ORNIA 95965 - TELEPHONE: 916/538-7541,. ` PERMIT APPLIG^ TION DATUHEET. 9 r _ •�,;� ;. �,��`� Permit No. J'k Proposed Build L�,��,: _ Building.lnspector Date , � At time of 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 .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..........................:.......... 16. Plot plan and business licenseg�roval from City of (see City for other requirements)'-w"IltM 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) l 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classification, ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgmgnt Statement ......... 25. Letter of signature authorization ............`..` ...................... 26. 27. When you issue the perrpit roc ess a follows: Mail t caner. Mai ontractor. Telephon and hold for pickup at office. Deliver w/inspector. Other r A p p I icant JDate Copy of Haz-Mat form sent Health Dept. Fire Dept.\ Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Otf er Date By The following data must -be -submitted -prior to permit issuance: (Circle new item -not-cheoked above). r 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above'required data by_phone---nail—counter by ..date Contractor, designer, owner, was advised of above required data by_phone —mal l—counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW I COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICAT-!OWAND PERMIT AssEseo PARCEL L NUMB_ / ZONING BUILDING PERMIT ow e S e 4 1-4Pkv cC �/< TELEPNOME yr` S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 17 3o PZ -7 V i%, 4 U CONTF}A,tC,JQR;S NAMEel - (V/ !//��alg- TELEPHONE � Z T — 2 CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 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 - V 119- 1/ C_ c 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 ❑ DupleJ Mobilehome❑ Other ���� G SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00ea TYPE OF WORK New Addition [J Remodel[] Utilities Installation[] Other ❑ Describe work: C sago Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service DOOV OR LESS 100 AMP OR LESS 10.00 Main service EA. AOD'L t00 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect.SINGLE License No. Classification. ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. Business and Professions Code for this reason LIN OCCUP.&) oR ADDNST C DWEACCLG/ y2¢sgft NEW CONSTR.TI-OUTLET IRC ITS NON.RESID BRANCH CIRCUITS) 2.50 ea POWER APPARATUS e OUTLET CIR. Ex. OCcup�OUTLETS OR FIXTURES 200700 SAL03o Ex. Occup. OUTLETS PIRESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 0� Permit Fee S 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 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 County of 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 It lities, judgm ts, costs, and expenses which may in any way accrue ag i st aid Count ) conseq nce of the granting of this permit. X Date 7 - Z Z�r � Sig = ure of Applicant — Owner g- Contractor ❑ Agent ❑ $HA permit is required for excavations over 5'0" deep and demolition or construct- i of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE - TOTAL FEE $ 6;2 TOTAL HAz. CUA- PARK I SCHL I FLo I CDF I PAR Po 1 Ho. ISSUE This permit is hereby issued unser the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY Date PERMIT EXPIRES Date Receipt No. �f�t?�$ }`, WHITE-D.P.W.. YELLOW-ASeC330R, PINK -INSPECTOR, 00LOENROO-APPLICANT �,}-.a., s+�w,.- . � �" V'.-�%�t:�ii�Rtiri�..`���C.,; k"-., i..r��,..S�+r•, r..�-+'hn.;,,'��jr;�4'd,�R "f'�'�'1�'"�3M1�Y�.i.�'e. "�.r� ,r _yY.•�r �r ,�, rr^. „i . '+7rw��.^s ;'�.';'.r:d-`. y.�.:� ��3. .�"'f..y;;,�'-l.i+.r-+.t _J i �w'. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. 9 -4s:-n— V ASSESSOR PARCEL NUMBER ZONING49-117-067 A-10BUILDING PERMIT OWNER Joseph S. Pavcik , 1' ' TELEPHONE 3(4►22-66pO8 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1187 Stanley Ave., Chico CONTRACTOR'SNAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS _ Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ ;0,00 LENDER'S MAILING ADDRESS Permi; Fee s17.50 ARCHITECT OF2 L-� 1NEER LICENSE No. Plan Che_.Ning Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 27.50 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 SFIX] Duplex❑ Mobilehome❑ Other Demo SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other Describe work: Demo _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service BOOV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'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 and Professions Code and my license is in full force and effect. License No. Classification, yf I as the owner, or my employees with wages as their sole compen- ❑ sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCC U P. OR ADDNS. ACC, BLDGS. �\ l I +/Z�sgft NEW CONSTR. ULTI.OUTLET2.SOea "NON.RESID BRANCH CIRCUIT S IRC ITS POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES20030Q e ALO 30 FIXED Ex. Occup. OUTLETS P(RESID )LNS KEA.) 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 cr 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 FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 1 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 County of to enter upon the above-mentio6ed property for inspection purposes.TOTAL also agree to save, indemnify and keep harmless the County of Butte againstHAz all liabilities, judgm , costs, and expenses which may in any way accrue against said County onse aence of the granting of this permit. X Date � � c, , � � S�npture of Applicant — Owner ❑— Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- Cion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ E CONST TYPEButte FEE s27 -50I cua PARK SCHL + FLD EDF PAR PD ) HD. ISSU This permit is hereby issued unoer the applicable provi- sions of the Butte County.Code and/or resolutions to do work i dieted above for which ).ees have been aid. ���r A n r P Di tkil%A OF PUS WORKS J B Date r ' PERMIT EXPIRES Date .� r Receipt No. 93738 WHITE-D.P.W.. YELLOW-ASSE330R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE -'DEPARTMENT OF PUBLIC WORKS / 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 49-1 7—n67 ZONING A-10 BUILDING PERMIT OWNER Joseph B. Pavcik. TELEPHONE 342-6810 ,SQA FT. OCC. BUILDING VALUV70N 1,000-00 OWNER'S MAILING ADDRESS 1187 Stanley Ave. Chico CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN C Total Valuation $I 9000.0c- Filing Fee $ LENDER'S MAILING ADDRESS Permit Fee $ 17.50 ARCHITFCT OR LN ,1NEtP, _ LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 27.50 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 SFT Duplex❑ Mobilehome❑ Other nP_mr) SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ® Describe work: Demo Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6111 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'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 and Professions Code and my license is in full force and effect. License No. Classification. I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ 1, 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. C / DWELLING OCCUP.S) OR ADDNS. ACC. BLDGS. , �20sgft NEW CONSTR. MULTI -OUTLET NON-RESID BRANCH CIRCUITS 2.50 ea POWER APPARATUS 6 SINGLE OUTLET CIR , ) EOOUTLETS OR FIXTURES x, CCUp\( 200500 eALO 30t. Ex. Occup. OUTLETS P(RESID )RE A.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. bvirin 9 15.00 ' Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Coolin 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 County of 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, judgm s, costs, and expenses which may in any way accrue agai t said County onse ence of the granting of this permit. N Si tore of Applicant — Owner [�—Contractor ❑ Agent ❑ OSHA permit is required for excavations over 5'0" deep and demolition or construct- i n of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $27.50 HAL CUA I PARK SCHL I FLD I CDF I PAR I PD I HD. ISSU This permit is hereby issued unser the applicable provi- sions of the Butte County. Code and/or resolutions to do work i c ted above for which Yes have been paid. DI OF P C WORKS B Date PER EXPIRES Date Receipt No. 93738 WNITE-O.P.W., YELLOW-ASSE390R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUN40' F BUWRTE -'DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Orovllle, Callfornla 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR P CEL NUMB R i ZONING BUILDING PERMIT OWNER •� TELEPHONE 3 ell G o SO. FT. OCC, BUILDING VALUATION OWN E 5 MAILING ADDRESS 7 57-��e� n vc( CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS., (iU V,-- < Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee - $ ;0.00 LENDER'S MAILING ADDRESS Pe. -mit F a e $ ARCHITECT OR cv ;WEEP, LICE> SE NO. Plan Che king Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 42 Is 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 Duplex❑ Mobilehome❑ Other / / SPECT F Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel❑ Utilities ❑ Installation[] 0th,ef Describe work: ' Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): F -1I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is In full force and effect.( License No. Classification. ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.al OR ADDNS. ACC. SLOGS. +/x¢sgft NEW CONSTR ULTI.OUTLET NO N.RESID BRANCH CIRC ITS 2,50 ea POWER APPARATUS S SINGLE OUTLET CIR. Ex. Occup\OUTLETS OR FIXTURES eALO 30 FIXED APPLN5. OR Ex. Occup. OUTLETS (RESID.) EAJ 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 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. 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 against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ _ occ CONST TYPE TOTAL FEE $ HAL. I CUA PARK SCHL D 1. CDF I PAR PD I H ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date j Receipt No. e ..r... -+.n s •v +rn•v_.-a---n- .wt -i .InPef'Tn R, rfll_neN wn A-♦PPIICAMT DemolitQon Permits Asbestos Notification Statement Date AP# Pursuant to section 19827.5 of the California Health and Safety Code, all demolition permit applicants are required to fill out this form. "19827.5. A demolition permit shall not be issued by any city, county, city and county, or state and local agency which is authorized to issue demolition permits as to any building or structure except upon the receipt from the permit applicant of a copy of each written asbestos notification regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The.permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project. The permitting agency may require the applicant to make the declaration in writing, or it may incorporate the applicant's response on the demolition permit appli— cation." Attached is a copy of my written asbestos notification to the United States Environmental Protection Agency for the demolition project located at Signature of Applicant I hereby declare that a'written asbestos notification to the United States Environmental Protection Agency is not applicable to this demolition project. J Signature of Applicant 2/19/91 MAIL TO ASBESTOS NOTIFICATION EPA/NESHAPS Region IX 1235 Mission St. A-3-3 San Francisco, Ca. 94103 DATE: PROJECT JOB # (Please see reverse side) ❑ tMf i �s �� Notiti.od: ❑ California Air iiosouraas Board ❑ cal OSSA ❑ Paii I di�=tet S i ASBESTOS DEMOLITION/RENOVATION NOTIFICATION 'IDE—PLEASE READ BEFORE USING THIS Fnurt I. OPERATOR. -- (Contractor) 'ADDRESS -CITY-STATE ZIP PHONE( 3. FACILITY NAME :- STREET ADDRESS "- - CITY STATE ' COUNTY ZIP " 2.' OWNER _ Q FACILITY DESCRIPTION---____.:I- ADDRESS ESCRIPTION.ADDRESS CITY STAT �'--_:_-:�.._- _... _--- `. ~ AGE SIZE ZIP . , PHONE PRIORf USE R i 5..Project Start Date: .Completion Date: 6. Estimate of Friable Asbestos: ON PIPE: Linear Feet SURFACE OF OTHER COMPONENTS: Square Feet Nature of Materials: 7. DESCRIBE METHODS OF REMOVAL: 8. PROCEDURES USED TO COMPLY WITH 40 CFR 61.147 6 152: 9. NAME i LOCATION OF DISPOSAL SITE: ANY FURTHER PERTINENT INFO CAN BE INCLUDED BY ATTACHING ADDITIONAL SHEETS QUESTIONS??? FOR FURTHER INFORMATION. CALL (415) 556-6415 8am/4pm M -F EPA USE ONLY Please check one; - DateRec Pstmrk Renovation School Demolition requiring 10 day notice Del/ND Demolition requiring ADQIITE? 20 day notice Code#: _ Revision of Original (Form on reverse side) Doc#: 'IDE—PLEASE READ BEFORE USING THIS Fnurt I. OPERATOR. -- (Contractor) 'ADDRESS -CITY-STATE ZIP PHONE( 3. FACILITY NAME :- STREET ADDRESS "- - CITY STATE ' COUNTY ZIP " 2.' OWNER _ Q FACILITY DESCRIPTION---____.:I- ADDRESS ESCRIPTION.ADDRESS CITY STAT �'--_:_-:�.._- _... _--- `. ~ AGE SIZE ZIP . , PHONE PRIORf USE R i 5..Project Start Date: .Completion Date: 6. Estimate of Friable Asbestos: ON PIPE: Linear Feet SURFACE OF OTHER COMPONENTS: Square Feet Nature of Materials: 7. DESCRIBE METHODS OF REMOVAL: 8. PROCEDURES USED TO COMPLY WITH 40 CFR 61.147 6 152: 9. NAME i LOCATION OF DISPOSAL SITE: ANY FURTHER PERTINENT INFO CAN BE INCLUDED BY ATTACHING ADDITIONAL SHEETS QUESTIONS??? FOR FURTHER INFORMATION. CALL (415) 556-6415 8am/4pm M -F ' INS_T_AUCTIONS FOR USE CSF ASRFRTO1q DEMO-ITTOIK/RENOVA i IUN NOTTFIC T T ON FOR* RENOVATION: means altering in any way one or more facility components. NOTICE MUST BE POSTMARKED AS EARLY AS POSSIBLEBEFORE PROJECT DEMOLITION: means the wrecking or taking out -of load -supporting structural members of a facility together with any related handling-operatio= 10 Day notice for MORE than 160 sq.ft.or 260 linear ft. asbestos 20 Day notice for LESS than 160 sq.ft.or 260 linear ft. asbestos, includes facilities which contain no asbestos. FACILITY: means any institutional, commercial•or industrial structure, - installation; or building. Renovations on single family residencE and apartment buildings with 4 units or fewer are exempt from notification to EPA. - PROJECT JOB #: Your OWN IN-HOUSR T.D.-for a specific jobsite. Optional, but expedites communication -concerning notifications. LOCAL AGENCY: Most areas in Region 9 -have local NESHAP delegated agencies. In these areas notice must be provided to both EPA and the local agency. 1. OPERATOR/CONTRACTOR: Full.information concerning person doing the work. 2. PROPERTY OWNER: Complete in full. - ----- -- - - -- - 3. FACILITY NAME: Must have complete address OR directions to the jobsite. 4. FACILITY DESCRIPTION: Current use of building. Project location in the facility. Other descriptive information as necessary. 5. START AND COMPLETION DATE: Provide month, day and year. Must be -revised if dates change. -(see revision form below) 6. Estimate of amount to be removed (must be in square -or linear'feet).- -Revisions(see form below) must be made for additional amounts uncovered. 7. Examples of methods: glovebag, scrape, -remove in sections, etc. . 8. Examples: Adequate wetting prior to and during work, double bag, etc. DRY REMOVAL MUST RECF&IVE PRIOR WRITTEN APPROVAL FROM EPA OR THE LOCAL DELEGATED AGENCY IF MORE SPACE IS NEEDED THAN PROVIDED, ADDITIONAL, SHEETS SHOULD BE -ATTACHED TO REVISE A NOTIFICATION ALREADY ON FILE WITH EPA, USE FORM PROVIDED -BELOW PROJECT NAME PROJECT JOB ORIGINAL -NOTIFICATION DATE Revision Notice #1 2 3 4 please circle This is to advise that the above referenced notification presently on file has been revised. Please note the revised portion listed. • - ( ) - CHANGES FOR THIS REVISION: __ PROJECTCANCELLATION ' 1. NEW Location 2. NEW Scope of Work 3. ADDITIONAL Quantity of Asbestos 4. -NEW Start Date 5. NEW Completion Date 6. NEW Disposal Site J 'F . COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit wX-1. a issued until this verification is received. will personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) k 2. I (have/have not) 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 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 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 Securi Number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit.