HomeMy WebLinkAbout043-252-013k 043-252-013 PERMIT# -25
COOKE, George lNAlE
•630 Oaklawn Ave.,.Chico
Cont: Tim Cooke' ;.
Reroof/SF
043-252-013 PERMIAAAL
-0°59
f
;,COOKt'tGeotrge ,..
, 630 'Oak Lawn Ave ..,t Chico';
Cont; Tim Cooke
Con v 'B6droom to Bath -& Add -New _ im/SF
SPENCER, H.E. 5107B • _#
630 Oaklawn Ave., Chico -252-13
(addition) 7�
Al
'ay
t
j
,,i
4
r
t
0
RESIDENTIAL
043-252-013 PERMIT#96-0159
COOKE, George
630 Oak Lawn Ave., Chico
Cont; Tim Cooke
j Conv Bedroom to Bath & Add New Bedrm/SF
OFFICE COPY
Address &30 cw-C �.4w/ i
wv 873JPL
GAS
Meter By Date �ZZ�%'
ELECTRIC
Meter By Date
OFFICE COPY
Address—
GAS
ddress_
GAS
Meter By
ELECTRIC Date
Meter By
Date�7�_�-t
JOB FINALED (Date) 9-13 –6
Signature
4
V= OK
5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete
O = Not OK
6. Gas; Location -Test -Wrap; / /'Ll't.
/ /Nat. or/ /'L°ft./ /LPG g r
Not Ap
MOBILE HOMES
Not Readyble
8. Utility Clearance
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements - Setbacks - Easements
Date
2. Soils; Special MH Support Sketch
Date
3. Sewer; Location-Test Fall-C/0-Concrete `
Date
4. Water, Location-Test-Easement Needed (Sketch)
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg -Rfg: Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap; / /'Ll't.
/ /Nat. or/ /'L°ft./ /LPG g r
7. Well Clearance & Disconnect
8. Utility Clearance
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings r
Date
Card 8-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Date
1. Zoning Requirements- Setbacks Easements
Date
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert of Occupancy
10. Plumb.; Cir. Test -Water Supply Test
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg -Rfg: Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Fnng.; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings r
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance-GFI
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/6 -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 8-1
J=OK
O = Not OK
= Not Applicable
Not Ready RESIDENTIAL (;
' =
Date UND FLOOR (Plans) OK except ft's
. Z fling -Setbacks -Easements -Flood -Slope
tg., Main;'Soils-Elec. Grnd.-/ /" Ftg. Depth
Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
.110 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; nderground
13. Pi ms & Ducts; Clearance -Material -Support -Ins.
1 . 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 a's
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 Floor -Tub Access
- -------------- ----------------------
20. Test Tub -&-Shower.- Second Floor -Tub Access
21. Gas Pipe: Size & Anchors
-----------
------ --------------------------------------------------------------------------
Date Card B-1 Date Card B-1
-------------------
------------_--------------------
Dale
------- ---------------
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except ft's22. Fixture & Transformer Clearance -Ins. Protection
- -- - -------------------------------------------------------
23.
----------------------------------------------
23. Elec. Receptacles Spacing -Lights & Switches at Doors
---------------------------------------------------------------
24. Size Boxes & No. of Conductors -Stapled
-- 25. Romex In led lose to Edge Studs of & C J
26. Eq u 3 a p /Mech Fastners-Bond Gas &. Water
------- - ----------'ru - -
27. 2 pli ce lichen & Conductor Size,GF1
____ J. ---------------------------------- --
28. Sub eed r ze r a. Cu or AI-A.C. Wire Size ga.
C or
29. Ra Circ. ga. or AI -Oven Circ. r r ga. Cu or Al.
Insul ted N u at ❑ Yes ❑ No
- - --- -- ----------'------------------- -----. . ..
30. Service_Ri er uc't s & Ground -Main Disconnect
------- - - .._.. -------------- ........ ........ ..
31. Equip. Clea ices Panels-Motors-Mech. Equip.
--------------
-
------------------ ------ -------------- _.._. ....... ....... ..
32. Clothes Closet Light -Shower Light -Spa Light
------
---------------------------- -- - --
33. Smoke Detector
Date Card B-1 Date Card B-1
- -- - - - . ......... ....... - -----..... ... ....... ... ... ..
Eve Card B-1 Date Card B-1
to MECHANICAL.(Permit) OK except it'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
38 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 4 S
39. Sils. Proper Material & Anchors
....... ... ... ....... ... ............ ... ... ... ... ..
40. Walls Studs -Nailing. Spacing & Bracing -Plates -Sound
..... - . . ... .I..... -_... . ....... ...... ...
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
>ingle & Duplex)
I Date FRAMING (Continued)
45. Hangers -Post Caps -Anchors -Connectors
46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng.
----- --- 47. Fireplace/ries or Type A Flue -Fireplace Throat clearance
4d. A s; Size & Romex Protection -Draft Stop -Ins. Baffles
----- ----- 49. m. Uadam or Exiting Doors -Sill Hgt. & Dimensions
50. Garage Fire Protection Framing
-------------- --------- --
----- ----
r i all & Openings
------------- - --- -- -- G
-Check - -
5 . Ext. Doors-- a -Chearage-3rd Story, 2 Exits
----------------------------- --ck Ga----
53. S trs: idth- eadroom-Rise- Run -Landing -Fire Protection
54. y d on of Overhang -Attic Vents -Rafter Outriggers
---------------- -- ------------
--------------- 55. idi gVeneer
-----
56. - Stucco ----- -- Me h -Drip - Screed -Fd. Vents-Underflr. Access
------------- --
57. Glazing Area- lass Protection -Skylights -Plastic
58. Shear Walls: Nailing -Bolts _
---------- -
59. Insulation -Walls -Ceilings
-----------------------------
60. Infiltration -Walls -Windows
---------------
----- ------- --- ------------------------------
Date
--------------------------Date Card B-1 Date Card B-1
- - - -- ---- -----------------------
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except a'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 Exiting
65. G.F.I & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel: Breaker Sizes & Labels
- - -- -----------
67. Stairs & Rails
68. Fireplace or Stove: Clearances -Hearth
----------------------------------
69. Elec. Outlets at Wood Panel: Int. & Ext.
- ------------------------- -------------
70. Kit.Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance
.. _....------------------------------------- -- --
71. Elec. Outlets & Receptacles at Kit. Counter
_ -- --
72. Garage Fire Door Swing -Landing -Closer -----
---------------
73.
-- - -----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 Construction -Post Caps
-- --- ------------ ------------------------------ --
79. Fon. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
80. Following instld� Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No:
Planters ❑ Yes ❑ No
. .-. ................ -- --...-------------------------------------
81. Stucco: Brown -Finish
.. ...... .._ .......-..-----------------------
--
....---------------------------------
82 A C. Unit: Disconnect. Electrical. Plumbing
.. ... ... ... ... --- .---------------------------- ---------------
--
83. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to
Openings
. . ... . ... . ....----------------------- ---.----------------------- -----
84. Water Well: D Disconnect. Electrical. Plumbing
.. ... ..... . ..... -.--------- ----------------------------
85 Exterior Elec. Trim: G.F.I. Receptacle -Underground
. . .. . ..... .. - - - ----- - --------- -----
86 Ventilation Throughout House
. ... ... ....... ...------------ ----------------------
87 GlassProtection---.---------..--------
88. rect ons from Previous Inspections
Gas Test -Meters Tagged: Gas -Electric
------- ---------------------------------------
�� 90. Water & Sewer Connected-CrO to Grade -HD Approval
- - ------------------------------
91. Energy Compliance Certificate -Other Certificates
----- - - ----------------------
Date Card B-1 Date Card B-1
-----------------------------------
Date
------------------ ------------Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments. at Final:
G
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
CORRECTION NOTICE
54 -D r
OWNER PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
iscom eted. If you have any questions pertaining to this matter, or need additional explanation,
ple contact this office immediately.
07'1� 1 #e-� I" —1�
I
Date Inspector
REV 10/
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 .County, Center Drive - Oroville, California ' 95965 - Telephone (916) 538-7541 PERMIT O.
APPLICATION AND PERMIT _ �
ASSESSOR PARCEL NUMBER
043-252-013
ZONING
A1
BUILDING PERMIT
OWNER
1EORE COOKS
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
630 OXXXK OAK LAWN AVE CHICO
10,368
CONTRACTOR'S NAME
TIM COOKS
TELEPHONE
899-1676
CONTRACTOR'S MAIUNG ADDRESS
1 IMOUSIN DR CHICO
Fireplace
CONSTRUCTION LENDER
UNIOVOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $
20,00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $ S
Energy Plan Checking Fee $
23.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDINGADDRESS
PERMITFEE $
PLUMBINGPERMIT Filing Fee
20.00
Each Trap 7.00
21.00
LOT NO.
SUBDNIS ION'S NAME
PARCEL MAP
Solar or heat pump water heater 23.00
USEOFSTRUCTURE
SF Q Duplex ❑ Mobilehome ❑ Other
SPECIFY
Water piping 15.00
15.00
Each gas water heater or vent 15.00
15.00
Gas piping system 1 - 5 outlets 15.00
15.00
Building sewer 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: CONVERT BEDROOM TO BATH AND ADD NEW
BEDROOM
Mobile Home I S J G W 1 920.0. 0
PERMITFEE S
Contractor
ELECTRICAL PERMIT Filing Fee
20.'00
Main Service ( a00v200A OR LESS OR LESS ) 23.00
23.00
Main Service ( 200A TO 1000A ) 46.00
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 f orce and effect. /
License Class Lic. No. 3Zyl6
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUR so'
OR ADDNS. ( a ACC. BLDS. ) 3.52 FT.
6.72
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS ) 97.50
( POWER APPARATUS )
8 SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES) B20 @ I.00
Ex. Occup. OUTLETS PLNS..ORR.A
( ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMITFEE $
49.72
Contractor
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
MECHANICAL PERMIT Filing Fee
20.00
Heating 2TON
15.00
Cooling 2TON
15.00
Hood 6.50
Ventilation
PERMITFEE $
50 ��
Contractor
Policy Number
(rhe 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 . y manner so as to become subject to workers'
compen tion laws of if la, and agree that if I should become subject to the
worker compens 'on - r isions of section 3700 of the Labor Code, I shall
forth h comp o provisions.
X '� Date �6 _
Signature of App scant - ❑ Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 50" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee Is 46.00
occ
CONST. TYPE
TOTAL FEE $ 482.62
HAZ.
D. F S
IMP FLOOD
COF PARCEL PD HD
UE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to
indicated above for which fees have been paid.
By Date
PERMITEXPIRESON
(pffi
do work
ReceiptNo.190574-161.90// '� ��I
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENR -APPLICANT
p��,�`�i�"�if•,i'�'4+i"�',,4!�i�i"+�i!N�°�''t`1'"""�j;;d+4',r��,i�'�'��°�'�,�t;•�`�+�°�•�"-:���t1��'�i"-,. r�►'�1!i'�^�"`,,�g;C�'�.r.,,y�c'Y�'''.
t
t � �
• �tK
�1
e
did**'�,'Y:;r'`�'�i�eY":.�.'�:`��.dNf'",+�YR�°�rti�Sr"rr^��niR,r���+cFKi''+Y'r°°x:fi7`wriK3P'I•�y+Y��Q(f,.;�r�"W"-"a.r�fi:-:.1w:,.wr.r,.
COUNTYOF BUTTE - DEPARTMENTOF DEVE,.QPMENTSERVICES -BUILDING DIVISION
t
j 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541
/ '• L I
PERMIT APPLICATION DATA SHEET
OWNER A. . No. NJ
Proposed Building Used Building Inspector Date V2,
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1. All items have been submitted . .......................Ilk
.................
2. Plot plans, 3/4 sets, signed by preparer of plans . ..........................
3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... r
4. Engineered plans and calcs, 3/4'sets, with wet signature on plans . .............
5. Hazardous Material Form . ............................................
6. -Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C'Buildings. .......................
8. Engineered truss details and layout in duplicate (required prior to plan check). ....
9. Mobilehomq 9B and-mmanufacturer's OstaLUation instru i W
se
10. Fees of $ % f % � Z t. 9�... J• S
�S
d 11. Impact fees as shown on attached schedule Sc�FA`�
12. California Department of Forestry plan approval/fees. ...:.. .
13. Flood elevation letter (100 year floyCalifornia Engineer . ............::::. .
14. Sanitation and plot plan approval Health Health Department. ..
15. City of Chico plumbing permit . .........................................
16. Plot plan and business. license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking:
18. Contact Land Development'about (A) Improvements (B) Drainage. .......... .
19. Driveway permit (construction approval required prior to occupancy). . .
F;,�a"� 10" `eq0�
20. Pre -inspection for
required. .. to euiiai�9 inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23. Owner -Builder Verification (Given to owner , Mail to owner ............
24. Recorded copy of Agricultural Acknowledgement Statement.
25. Letter of signature authorization. '
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
27. Letter of intent on building use .......................................... Olt
28. Mobilehome utility clearance . .......................................... '
29. Documentation of legal access . ..................... :...................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits.
....................................
32. Plan check list . ....................... .............................. .
33.
34.
When you issue the mit, ss as follows: Mail to owner
t/ Telephone ^� �� and hold for pickup at
Other
Parcel Creation
Acreage Applicant!
Mail to
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date
a
Deliver with inspector.
Date ( -F
BY
The following data must be submitted prior top mi 'ssuance: (Circle new item not checked above).
1. Index permit for above items o. ``°•
2; Additional items required. (1 r OCTA 6 Yi7� a,
y�
Contractor, designer, owner, was advised of above required da by _ phone _ mail -Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Plans checked by Date Plans approved by �4 Date a�G
v
Sets of plans on hold in File cabinet 1 AP folder
Copy - Department of Public Works
E Nk k `
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
'IR
B.H. USE ONLY
Plot Pbm Anacba L
Poor Plan AthcbadS
Seas to B.D. — — It,
.Teor e C°ooKe 6,30 C �l�wr� Aver,, Ci1�ca _ L13- z - X13
O ner Location AP#
Plan Approved for: Sewage Disposal Water Supply: Public Private Well
Clearance for bedroom mobile/ home. Other &I "ry I dr00M fB ft -,Om . eJose�T
dd� /2
Hold final for:
Final clearance /O.K. for:
NOTE: Kern bee- Of _ ]�AP 66y", Ah"e ,
Envimnm tal Health 06cialist Date
E:IL'-N
`^'"`''ti-.''i-�•lrv.,,,.n.�rt�-•-satY 19''�r'�Yy�-,�:,^�c'°Y69r►i+r�`1f'M.-r�:.r. rrN*1Rrf.4�^q�'.%oyY��-aT...�-�.i"i't�',•,ry.�^°N�++1+�Li��f+'ti �.. s-ti.{�r�.{ ,,fes .. ,., ... �: .,
k
BUTTE COUNTY SCHOOLS IMPACTAE'CERTIFICATION FORM
(One Form Per Building)
te Y"
.r,
School District�,�(66 61iu )qe t Building Department No.
A.P. Number Jurisdiction: 0 City County
Property Owner C90 ke
Property Location/Address &3® P4"A, PA—"A,evAl �Q-rsf
Subdivison Lot No.
Residential Development
Commercial/Industrial
0
No. of Living MHI
Units
s1 '
?� New
[R ! Sq. Footage %,57Z
Addition (Group R)
0 Sq. Footage
Addition
(Including Exterior
Roofed Areas)
Building Department Mpresentative Dat
(Floor Plans reviewed by School District Personnel)
District Identification No. •,�:'. ,, !
(1 School District certifies that
E
Address) —
(City)
dl' 1CTK...L
(Applicant)
(Phone Number)
(Zip
has complied with the requirements of Resolution No. '529-9,
/7 —9, by payment of $
representing 19g square feet.
i
e
School District Representative
AB 2926 $
FULL MITIGATION $
a 96
Date
Paid by Check # /ue Remarks:
Bank Number
Paid by Cash
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the SchoolDistrict is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality. Act (CEOA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district)
j, 1 4 4
feeformmkl (11/94)dmm
I
CERTIFICATE OF COMPLIANCE: RESIDENTIAL Page 1 CF -1R
Project Title.......... Cooke Addition Date........ 02/07/96
Project Address........ 630 Oak Lawn Avenue *******
Chico, California *v4.50*
Documentation Author... Donna Wallace ******* Building Per i f
Wallace Energy Consulting �- -
399 East 9th Avenue P an Check'/ Date
Chico, CA 95926
916-893-4982 Field Check/ Date
Climate Zone.. ..... 11
Compliance Method...... MICROPAS4 v4.50 for 1995 Standards by Enercomp, Inc.
MICROPAS4 v4.50 File-COOKE Wth-CTZ11S92 Program -FORM CF -1R
User#-MP0995 User -Wallace Energy Consulting Run -Cooke Addition
GENERAL INFORMATION
Conditioned Floor Area.....
Building Type ..............
Construction Type .........
Building Front Orientation.
Number of Dwelling Units...
Number of Stories..........
Floor Construction Type....
Glazing Percentage.........
Average Glazing U -value....
192 sf
Single Family Detached
Addition Alone
Front Facing 270 deg (W)
.14
1
Raised Floor
16.7 % of floor area
0.6 Btu/hr-sf-F
BUILDING SHELL INSULATION
Component Frame Cavity Sheathing Assembly
Type Type R -value R -value U -Value Location/Comments
Wall
Wood
R-13
R-0
0.088
Typical
Roof
Wood
R-30.7
R-0
0.035
Typical
Floor
Wood
R-19
R-0
0.037
Typical
FENESTRATION
# of Interior
Area. U- Pan- Shading/
Orientation (sf) Value es Description
Window Back (E) 20.0 0.600 2
Window Right (S) 12.0 0.600 2
Minimum
Equipment Type Efficiency
Furnace
ACSplit
Blinds.Lt
Blinds. Lt
HVAC SYSTEMS
Duct
Location
0.780 AFUE Attic
10.00 SEER Attic
Over -
Exterior hang/ Framing
Shading Fins Type
None None Vinyl
None Yes Vinyl
Duct Thermostat
R -value Type
R-4.2 Setback
R-4.2 Setback
SPECIAL FEATURES/REMARKS
As part of this project, a new gas furnace, electric air
conditioner, and gas water heater will be installed. All
must meet current minimum CEC Standards.
1",
unBUT% its �
AP � oniS
CERTIFICATE OF
COMPLIANCE: RESIDENTIAL
Page 2
CF -1R
Project Title.......... Cooke Addition
Date........
02/07/96
MICROPAS4 v4.'50 File-COOKE Wth-CTZ11S92 Program -FORM CF -1R
User#-MP0995 User -Wallace Energy Consulting Run -Cooke Addition
SPECIAL FEATURES/REMARKS
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance
specifications needed to. comply with Title -24, Parts 1 and 6 of, the
California Code of Regulations, and the administrative regulations to
implement them. This certificate has been signed by the individual with
overall design responsibility. When this certificate of compliance is
submitted for a single building plan to be built in multiple orientations,
any shading feature that is varied is indicated in the Special Features/
Remarks section.
DESIGNER or OWNER
Name.... Tim Cooke
Company. Cooke Company
Address. 13999 Limousin Drive
Chico California 95973
Phone... (916, 899��
License. 337,��4
Signed.:
ENFORCEMENT AGENCY
Name....
Title...
Agency..
Phone...
Signed..
(date)
DOCUMENTATION AUTHOR
Name.... Donna Wallace
Company. Wallace Energy Consulting
Address. 399 East 9th Avenue
Chico, CA 95926
Phone... 916-893-4982
Signed.. U►iZ&_ - 2-1711(,
a e
Mandatory Measures Checklist: Residential+ MF -1R
Project Title Cooke Addition
Date 02/07/96
NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach
used. Items marked with an asterick (*) may be superseded by more stringent compliance requirements listed on the
Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be
considered by all parties as binding minimum component performance specifications for the mandatory measures whether they
are shown elsewhere in the documents or on this checklist only.
DESCRIPTION I DESIGNER I ENFORCEMENT I
Building
Envelope Measures
R-30
*150(a):
Minimum R-19 ceiling insulation.
150(i):
N/A
150(b): Loose fill insulation manufacturer's labeled R -value.
*150(c):
Minimum R-13 wall insulation in framed walls (does not apply to exterior mass walls).
R-13
150(d):
Minimum R-13 raised floor insulation in framed floors; minimum R-8 in concrete raised
R-19
have insulation blanket (R-12 or greater) or combined interior/exterior insulation
floors.
N/A
150(1): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor
2.
transmission rate no greater than 2.0 perm/inch.
By Contractor
Fiberglass
118: Insulation specified or installed meets California Energy Commission quality
standards. Indicate type and form.
Batts
116-17:
Fenestration Products, Exterior Doors and Infilitration/Exfiltration Controls
Cooling system piping below 55 degrees Fahrenheit insulated.
a. Doors and windows between conditioned and unconditioned spaces designed to limit air
Leakage.
b.
Manufactured fenestration products have label with certified U -value, and
By Contractor
*150(m): Ducts and Fans
infiltration certification.
Ducts constructed, installed and sealed to comply with UMC Sections 1002 and 1004;
c.
Exterior doors and windows weatherstripped; all joints and penetrations caulked and
ducts insulated to a minimum installed value of R-4.2 or ducts enclosed entirely
sealed.
within conditioned space.
N/A
150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
150(f): Special infiltration barrier installed to comply with Section 151 meets Commission
quality standards. N/A
150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs
1. Masonry and factory -built fireplaces have:
a. Closable metal or glass door
b. Outside air intake with damper and control N/A
c. Flue damper and control
2. No continuous burning gas pilots allowed.
Space Conditioning, Water Heating and Plumbing System Measures
110-13:
HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
By Contractor
150(i):
Setback thermostat on all applicable heating systems.
By Contractor
150(j):
Pipe and Tank Insulation
1. Indirect hot water tanks (e.g. unfired storage tanks or backup solar hot water tanks)
have insulation blanket (R-12 or greater) or combined interior/exterior insulation
(R-16 or greater).
2.
First 5 feet of pipes closest to water heater tank, non -recirculating systems,
By Contractor
insulated (R-4 or greater).
3.
All buried or exposed piping insulated in recirculating sections of hot water system.
4.
Cooling system piping below 55 degrees Fahrenheit insulated.
5.
Piping insulated between heating source and indirect hot water tank.
*150(m): Ducts and Fans
1.
Ducts constructed, installed and sealed to comply with UMC Sections 1002 and 1004;
ducts insulated to a minimum installed value of R-4.2 or ducts enclosed entirely
within conditioned space.
By Contractor
2.
Exhaust fan systems have backdraft or automatic dampers
3.
Gravity ventilating systems serving conditioned space have either automatic or
readily accessible, manually operated dampers.
114: Pool and Spa Heating Systems and Equipment
1.
System is certified with 78% thermal efficiency, on-off switch, weatherproof
N/A
operating instructions, no electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36" pipe between filter and heater for future solar heating.
N/A
b. Cover for outdoor pools or outdoor spa.
3.
Pool system has directional inlets and circulation pump time switch.
115: Gas-fired central furnace, pool heater, spa heater or household cooking appliance
have no continuously burning pilot light. (Exception: Non -electrical cooking
N/A
appliance with pilot < 150 Btu/hr.)
Lighting
Measures
150(k):
40 lumens/watt or greater for general lighting in kitchens and rooms with water
N/A
closets; and recessed ceiling fixtures IC (insulation cover) approved.
Residential
Compliance Form
January 1995
COMPUTER METHOD SUMMARY Page 1 C -2R
Project Title.......... Cooke Addition Date........ 02/07/96
Pro'ect Add 30 O k L A *******
res6
s........ a awn venue
Chico, California *v4.50*
Documentation Author... Donna Wallace ******* Building Permit
Wallace Energy Consulting
399 East 9th Avenue Plan Check Date
Chico, CA 95926
916-893-4982 Field Check/ Date
Climate Zone.. ..... 11
Compliance Method...... MICROPAS4 v4.50 for 1995 Standards by Enercomp, Inc.
MICROPAS4 v4.50 File-COOKE Wth-CTZ11S92 Program -FORM C -2R
User#-MP0995 User -Wallace Energy Consulting Run -Cooke Addition
Zone Type
Energy Use
(kBtu/sf-yr)
MICROPAS4 ENERGY USE SUMMARY
Standard Proposed Compliance
Design Design Margin
Space Heating.......... 20.29 18.18 2.11
Space Cooling.......... 19.19 21.22 -2.03
Total 39.48 39.40 0.08
*- ADlD1T ioN Com PLI E S
*** Water Heating not calculated ***
GENERAL INFORMATION
Conditioned Floor Area.....
Building Type ..............
Construction Type ...
Building Front Orientation.
Number of Dwelling Units...
Number of Building Stories.
Weather Data Type..........
Floor Construction Type....
Number of Building Zones...
Conditioned Volume.........
Footprint Area .............
Ground Floor Area..........
Slab -On -Grade Area.........
Glazing Percentage.........
Average Glazing U -value....
Average Ceiling Height.....
192 sf
Single Family Detached
Addition Alone
Front Facing 270 deg (W)
.14
1
ReducedYear
Raised Floor
1
1728 cf
192 sf
192 sf
0 sf
16.7 % of floor area
0.6 Btu/hr-sf-F
9 ft
BUILDING ZONE INFORMATION
Floor
Area Volume
(sf) (cf)
HOUSE
Residence 192 1728
# of Vent Special
Dwell Cond- Thermostat Height Vent Area
Units itioned Type (ft) � (sf)
1
0.14 Yes Setback .3°0S 2.O0 as
COMPUTER METHOD SUMMARY Page 2 C -2R
Project,Title.......... Cooke Addition Date........ 02/07/96
MICROPAS4 v4.50 File-COOKE Wth-CTZ11S92 Program -FORM C -2R
User#-MP0995 User -Wallace Energy Consulting Run -Cooke Addition
Surface
HOUSE - New
1
Wall
2
Wall
3
Wall
4
Roof
5
Floor
Surface
HOUSE - New
1 Window
2 Window
OPAQUE SURFACES
Area
U-
Insul
Act
Solar Form 3
Location/
(sf)
value
R-val
Azm Tilt Gains Reference
Comments
108
0.088
13
0
90 Yes W.13.2X4.16
Typical
124
0.088
13
90
90 Yes W.13.2X4.16
96
0.088
13
180
90 Yes W.13.2X4.16
192
0.035
30.77
n/a
0 Yes R.30.2X12.16
Typical
192
0.037
19
n/a
0 No FC.19.2X8.16
Typical
FENESTRATION
SURFACES
# of
Vent
SC SC
Interior
Area Pan-
Frame
Open
U- Act Glass Int Shading/
(sf) es
Type
Type
value Azm Tlt Only Shade Description
20.0 2
Vinyl
Slider
0.600 90 90 0.88 0.58 Blinds.Lt
12.0 2
Vinyl
Slider
0.600 180 90 0.88 0.58 Blinds.Lt
OVERHANGS AND SIDE FINS
Window— Overhang
Area Left Rght
Surface (sf) Hght Wdth Dpth Hght Ext Ext Ext
HOUSE - New
2 Window 12.0 3.0 n/a 1.5 1.5 n/a n/a n/a
HVAC SYSTEMS
System Type
HOUSE
Furnace
ACSplit
Minimum
Efficiency
Left Fin Right Fin—
Dpth Hght Ext Dpth Hght
n/a n/a n/a n/a n/a
Duct Duct Duct
Location R -value Efficiency
0.780 AFUE Attic R-4.2 0.830
10.00 SEER Attic R-4.2 0.810
SPECIAL FEATURES/REMARKS
As part of this project, a new gas furnace, electric air
conditioner, and gas water heater will be installed. All units
must meet current minimum CEC Standards.
HVAC SIZING
Project Title..........
Project Address.. ....
Documentation Author...
Climate Zone.. .....
Compliance Method......
.
Cooke Addition
630 Oak Lawn Avenue *******
Chico, California *v4.50*
Donna Wallace *******
Wallace Energy Consulting -
399 East 9th Avenue
Chico, CA 95926
916-893-4982
11
Page 1 HVAC
Date........ 02/07/96
Building Permi
Plan Check Da e
Fie Check/
Da e
MICROPAS4 v4.50 for 1995 Standards by Enercomp, Inc.
MICROPAS4 v4.50 File-COOKE Wth-CTZ11S92 Program -HVAC SIZING
User#-MP0995 User -Wallace Energy Consulting Run -Cooke Addition
GENERAL INFORMATION
FloorArea .................
Volume.. .. ............
Front Orientation..........
Sizing Location............
Latitude... .... ........
Winter Outside Design......
Winter Inside Design.......
Summer Outside Design......
Summer Inside Design.......
SummerRange ...............
Interior Shading Used......
Exterior Shading Used......
Overhang Shading Used......
Latent Load Fraction.......
192 sf
1728 cf
Front Facing 270
CHICO EXP STA
39.7 degrees
27 F
70 F
102 F
78 F
37 F
No
No
Yes
0.20
HEATING AND COOLING LOAD SUMMARY
deg (W)
Sensible Load .................... 4132 3516
Latent Load...................... n/a 703
Minimum Total Load 4132 4219
Note: The loads shown are only one of the criteria affecting the selection
of HVAC equipment. Other relevant design factors such as air flow
requirements, outdoor design temperatures, coil sizing, availability of
equipment, oversizing safety margin, etc., must also be considered. It is
the HVAC designer's responsibility to consider all factors when selecting
the HVAC equipment.
Heating
Cooling
Description
(Btuh)
(Btuh)
Opaque Conduction and Solar......
1838
941
Glazing Conduction ...............
826
461
Glazing Solar......... .........
n/a
1141
Infiltration .....................
1093
359
Internal Gain ....................
n/a
294
Ducts............................
376
320
Sensible Load .................... 4132 3516
Latent Load...................... n/a 703
Minimum Total Load 4132 4219
Note: The loads shown are only one of the criteria affecting the selection
of HVAC equipment. Other relevant design factors such as air flow
requirements, outdoor design temperatures, coil sizing, availability of
equipment, oversizing safety margin, etc., must also be considered. It is
the HVAC designer's responsibility to consider all factors when selecting
the HVAC equipment.
.....�ar`*.'s.+Ti.T" rC" � !i %yr••-,; .. .�.,, .� y�-..7tAt , , piFh,r �'�•str•+.+� -z
0 3-252-013 PE I I jr
coo
KE,.George`
630 Oaklawn - Ave . , Chico cf 2,5-oz.
Cont-: Tim Cooke
Reroof/SF
ce
1
.•1•{`wir..�;,R.,,,,. r ¢�Mv.�'r{ t.%•v r+i'h:,a*i:�'�-} �:«w /yL.11.�Yl;jw� n,. rr.4.•e _�,� iY .'y;�:..,,1 4 i i1..r� �;.+.. tom: : i•... :�,. �"• •i^p{+� a � ♦ ,
i 7 /
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES- BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone3'(916) 538-754j� PERMIT NO.
APPLICATION AND PERMIT ,
U
ASSESSOR
43 252-013
2111 r
BUILD G PERMIT
GEORGE COOKS OWNERTELEPHONE
Sq OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
1390 LIMOUSIN DR.
14 SQJ3
840
CONTRACTOR'S NAME
TIM COOKE
TELEPHONE
899-1676
CONTRACTORS MAILING ADDRESS j
13999 Q N DR
Fireplace
CONSTRUCTION LENDER „�-
UNMOf1WN
Total Valuation Is
LENDER'S MAILING ADDRESS ° - 1
Filing Fee
$ , 20,00
Permit Fee
$ 23.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty
$
BUILDINGADDRESSS
' 630 OAK LAWN
PERMITFEE
43.00
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
LOT NO.
SUBDIVISION'S NAME i
PARCEL MAP
Solar or heat pump water heater
23.00
USE OF STRUCTURE
SF [3� Duplex ❑ Mobilehome ❑ Other
- SPECIFY
Water piping
15.00
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
.Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe work: REROOF WITH COMP 14 SQ.
'
Mobile Home I S I GI W 1
920.00
PERMITFEE
$
Contractor
ELECTRICAL PERMIT
Filing Fee 20.'00
Main Service EOOV OR LESS
( 200A OR LESS )
23.00
Main Service ( 200A TO 1000A )
46.00
---
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 fullJorce and effect. ��/� 7
License Class Lic. No. ]� ...3
OWNER-BUILDER—DECLARATION
I hereby affirm under penalty of perjury/that l 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.
❑ I am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUP.
OR ( 8 ACC. BLDS. )
s0.
3.50 FT.
CNS.
NEWAD
CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS ),
_97.50
WER APPARATUS )
( PON
' a`SIWER OUTLET us
EX. Occup. (OUTLET OR FIXTURES
a4L Q 150
EX. Occup. (o(RES
OUTLETS IO.) )
5.00
Temporary -Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
$
Contractor
• • WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the 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
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
$
Contractor
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'
compensatioh laws of C�fornia,• and agree that if I should become subject to the
workers' ��ompensat9n piovisions of section 3700 of the Labor Code, I shall
forthv�ittfcomply .ith Uadse�provisions. i
.// . ••.� +.: `.- _
X\=�_- 1� Date _•'/��
Signature of Appll ant - ❑Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0” deep and demolition or construction
of structures over stories in Height. - ..
Mobile Home Installation Fee
$
Energy Inspection Fee $
OCC'
I CONST. TYPE
TOTAL FEE $ 43.
HA2.
I D. FEES
I IMP I FLOOD
I COF
PARCEL
PD HD
ISSUE
This permit is hereby issued under ttie
of the Butte County Code and/or
indicated above for which fees have
i - '
BY����CSGXIi ��.��
PERMITEXPIRESON
applicable provisions
Resolutions to do work
been paid.
I Date do -C/-f S
9 " ?6 r .-
(Date)
ReceiptNo. S 3•oU
WHITE-D.D.S.-B.D. , CANARY-ASSE OR PINK -INSPECTOR GOLDENROD -APPLICANT
U '_4:.
COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVIS N
7 .County Center Drive - Oroville, _California 95965 - Telephone (916) 538-75 r�?o NO.
APPLICATION AND PERMIT
I
A
ASSESSOR PARCEL NUMBER
043-252-013
ZONING
R1
BUILD14G PERMIT
OWNER
GEORGE COOKE
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
14 S R3
840
OWNERS "UNG ADDRESS
13999 LIMOUSIN DR.
CONTRACTOR'S NAME
TIM COOKE
TELEPHONE
899-1676
CONTRACTORS MAILING ADDRESS
13999 LIMOUSIN DR.
Fireplace
CONSTRUCTION LENDER
UNMOWN
Total Valuation Is
Filing Fee
$ 20.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 23.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
630 OAK LAWN
PERMITFEE
$ 43.00
PLUMBINGPERMIT
Filing Fee 20.00
Each Trap
7.00
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
Solar or heat pump water heater
23.00
USEOFSTRUCTURE
SF LA Duplex ❑ Mobilehome ❑ Other
SPECIFY
Water piping
15.00
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: PROOF WITH COMP 14 SQ.
Mobile Home S I G I W
@20.00
PERMITFEE
g
Contractor
ELECTRICAL PERMIT
Filina Fee 20.'00
Main Service a Ov OR LESS
( 200A OR LESS )
23.00
Main Service ( 200A TO L000A )
46.00
LICENSED CONTRACTOR'S DECLARATION
I( 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 fu Orce and effect.
License Class Lic. No. 3 3 7!z/::1
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUR
OR ADDNS. ( & ACC. BUDS. )
so.
3.50 FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
97.50
( POWER SINGLE APPARATOUTLET sUS )
8
Ex. Occup. ( OUTLET OR FIXTURES )
B20 @'.500
EX. OCCU I FIXED APPUNS. OR
p ( OUTLETS (RESID.) EA)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
g
Contractor
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
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
$
Contractor
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 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'
compensate laws of C 'Vrnillo,, and agree that if I should become subject to theworkers' mpensati ons of section 3700 of the Labor Code, I shall
forth omply sisions.
Date —/D�L� S _
Signature of App I nt - ❑Owner Contractor ❑ Agent
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 is
occ
co NST. TYPE
TOTAL FEE $ 43.0
HAZ.
D. FEES
IMP
FLOOD
CDF PARCEL PD HD
ISSUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated bove for which fees have
BY
PERM ITEXPIRESON %�
applicable provisions
Resolutions to do work
been paid.
Date /o -9-9S'
' 9 — C16
(Date)
ReceiptNo. / ` ,Q�
WHITE-D.D.S.-B.D. CANARY-ASSE SOR PINK -INSPECTOR GOLDENROD -APPLICANT •