HomeMy WebLinkAbout043-710-016a I
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Of =Not OK
,-=.NotApplicable ' RESIDENTIAL (Si.n Ie and Du 'lei
Not Ready 9 p ) .
Date. UNDERF OR Plans ' OK except #'s
Date FRA
ING' Continued
11 requirements-SetbaC sernents
.
Property Line Firewall Openings'- .' 'n '
_
ain; Soils -Steel -EI - /t / Ftg: Depth
la •'Ext.
Doors -One 3' -Check Garage=3rd story,, exits
A--Ftg., Garage; Soils=Steel- / /'.' Ftg. Depth.
l°,' 50.,
Stairs; Wldth-Headroom-Rise='Run-Landing=Fire Protection =
4. FSp Porches &Decks::Soils-Steel- /,. ::/" Ftg: Depth
1.
Plywood on . f Overhang -Attic Vents -Rafter Outriggers
�"Slgmwalls, Main, Steel-Blockouts-Wrapped-Slab .
52.
Si - ailing -Veneer,
Stem -ails, Garage"Steel -8locko ts-Wrapped-Slab•.;
.-StuccoMesh,-DripScreed-Fdn..Vents=Underflr.Access
te_r-i .St s l
.
Glazing Area -Glass Protection -Skylights -Plastic ,
Fall=Fittings s 2 way C%O-Sewer Test
Shear Walls; Nailing -Bolts
s.P_ipe; Size -Anchors:
--�q
-dpr"Water Pipe: Test -Anchors -Regulator Service Test
V U rlectric:•Un rground-
lenums Ducts; Clearance -Material -Support -Ins.-
1 tr Sills -Anchor Bolts 'Joists "Vents -Cripples
Card -BI
Date' 1),6-- Card -BI Date. -
i,d Sf. � ('� ' •
_ -z• %Card
-
Card -BI
Date Card -BI Date .
-BI
,Date Card -BI Date {
Card BI Date Card -B1 Date
Date FIN
(Plans)'AK ezce t q's
Card BI Date Card -BI, Date -
t
Date. P ING (Permit) OK except p's
t. Steps -Door & Sidelight Protection -Landings
Detector j
ter Ht.: Vent -Access -Combustion Air
Tes &.Anchors -Nail Protection'age;
Fttngs &Anchors=Nail Protecti
g�.t
Pan: Test, First Floor-, Tub Access
st-Tub & Shower, 2nd, Floor-T.ub Access
--
6 ./'Gas Pi e`. Size & Anchors
U� P
-lace
Card -BI Date `�' / 1� Card BI • Date ;
Card Bl Dete Card -61 Date.
Furnace; Vents -Clearance -Comb. Air-Connector-er
Above Floor-Ducts-Mech. Protection
B oom Exitingwer
I. & Bath Fixtures & Tub Access,
Elec>Trim & Subpanal; BreakerrSizes=Labels,
- -
& Rails
or Stove{; "Clearances -Hearth
Eutlets at Wood Panel; Int:,& Ext.:
K txt. & Appliance; Grnd.-'Air.Gap-Cooking Clearance
E_Igo, lets,& Receptacles at Ki[. Counter'
Date' EL 7RICAL Permit OK except N's
arage Fire Door; Swing- Land ing=Closer "
! -mS��buct
in Garage -Damper
Fixture &Transformer Clearance -Ins. Protection ,
tr Elec. acles Spacing Lights &Switches at Doors
2 Si xe & No. of Conductors -Stapled
Romex Installed Close to Edge of Studs 8 C.J..
3OEquip. Ground made up w_/Mech. Fasteners -Bond Gas '& Water
j 2 Appitance Circuits in.Kuchen &'Conductor Size.
ubfeed Wire Size / /-ga Cu or AI A.C..Wire Size / / ga. Cu or At
Range Circ. / / ga.'Cu or AI Oven Circ.) /-ga.'Cu or AI,
Insulated Neutral Yes 'No _
8/Service. Riser Conductors & Ground Main Disconnect_
Z� Equip.• Clearances Panels Motors Mech. Equip _
Clothes Closet Light -Shower Light _
- -- ----- --- -
= --
Card B -I Date �j II) Card BI Date
Card B'J V - bate Card -BI . .Date ,
_
-Clearance-Co - or -P. -
ir' Htr Vents Clearance Comb. Air Connect R V,.
�arage; Above Floor-Mech. Protection
4e --PI
lec..& Mech. Equip. Listed for Location '
Receptacles in Garage; (G'.F.I.)-Ro Protec.
nsulation- Foam- Looked in Attic es
ward Rails & Deck Construction -Post Caps
Fdn. Vents & Crawl Hole Door-Drainage•&Wood-Earth Clearance
Looked under Floor EJ Yes
-75.
Following•instld.: Drive es No; Walks s �.No;
Planters Y s o
6
_
n Finish
A C. Unit; Disconnect-Clrnces-Brkr.'&.Gond. Size -115V Outlet
7
Vents Above Roof; Plb .-Appliance-Firepl.-Clearance to Opngs.
ter Well; Disconnect, Electrical, Plumbing '
��cterior
Elec. Trim; G.F.I. Receptacle -Underground '
nti lation thr "ughout House
8 .
Glass Prote ion
Date MEC NICAL (Permit) OK except Y's
rrecti from Previous Inspections
s est -Meters Tagged; Gas -Electric � . �-3
. 'A.C. Ducts: Insulation & Support_
l Vent Fan: Exhaust above Insulation
:3. Condensate'Drain.& Overflow Size'& Grade
�4. Furnace -Vent: Access -Comb. Air=Return'Air Vent -115V Outlet
�s5. Attic Access & Platform if Furnace in Attic
'-
Card -BI Date 1 Card -BI Date
Gard -BI Date Card -BI : Date
_9
-
W r & Sewer Connected -C/O to Grade -HD Approval
nergy Compliance Certificate=Other Certificates .r
-- -
Card -BI•
Date ,i Card -BI Date
Card -BI.
Date Card -BI. Date
Card -BI
Date Card -81• Date .
Date FRAMING(Plans) OK except -p' f
'Cont:lents at Final -,
36• Sills: Proper Material &. nc
WWs: Swds-Nailing. Spacing & Bracing -Plates -Sound
�- 38! aring Walls.over Girders & Floor Nailing
Dr Stop.iii Walls.(rat proof):
ire Stops Furred Ceilin s Stairs—Chases—Tub
JA.tl Header & Beam -Size & ringring - -
Ha r - t Caps n�1C chors-Connectors
4 . n J ist- r, ie i PPre lace ro uriin-Ro f - ss- nq.
44. F replace Ties or T.ypCA Flue iC
!Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles'
a§(8 Windows or -,Exiting Doors Sill Hgt & Dimensions a
Garage Fire Protection Framing
-_
-
- — -- - -
-- _-- --
—
- - --
--_
_-
(NOTE` Anentrymust be made each time you Visit tobsite)'
■
V OK
6 Not OK
— Not Applicable
MOBILEHOMESMISCELLANEOUS
Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except #'s
1, Zoning Requirements—Setbacks—Easements
Date
DECKS; COVERS, CARPORTS, ETC. (Plans) OK -except #'s
1. Zoning Requirements—Setbacks—Easements
2. Soils; Special MH Support—Sketch
2. Footings; Size—Depth—Spacing-Connectors
3. Sewer; Location-Test-Fall-C/O—Concrete
3. Decks; Girders and/or Joists-Decking-Bracing—Stairs—Rails
4. Water; Location—Test—Easement Needed (Sketch)
4. Wood Awn.; Posts—Beams—Rftrs.-tonnec.—Shthg.—Rfg.—Bracing'.
5. Electricity; Location—Clearances—Grnd/ Amp—Concrete
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
6. Gas; Locatiort--Test—Wrap: /"L"ft./ Nat. or,/ /"L"ft./ LPG
6, Carports; Windows—Doors:,
7. UtilityClearance
7. E fec.,
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date ,
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements-Setbacks,—Easements
Card -BI
Date
Date ..Card -BI Date
POOLS (Plans).OK except #'s
1, Setbacks—Easelments
2. Footings; Size—Spacing—Marriage Line
2., Soils; Compaction—Structure Stabi I ity
3. Gas; MH Test—Demand—Valve—Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men—.Uning. ....,
4. Electricity; MH Test—Crossovers—Breakers—Clearances
4. Elec. Receptacles and Lighting; Distances—GFI
5. Drain; MH Test—Fall—Flex Connector
Elec.; Pool Lighting; 15v olts GFI V.,
6. Water; MH. Test—, Regu lator—C on nec t or
6. EleL'�Endiosuresl'Conduit Entries—Terminals—Listed
7. Water and Sewer Connected—C/0 to Grade—HD Approval
7- Elec.; Bonding; Metal w/5'—Circulating Equipment—He6ier,
8. Gas and Electricity Tagged'
8. E lec.; Grounding; Equip, w/5'—Circulating-Equio.—Pool Lghig.
Boxes tnc losures—Pane I boards-, Ins, to Main in Conduit
9. Health Department Approval
9. Exits; lriip.—Sketch
10. Cert. of Occupancy
.10. Plumb; Cir. Test—Water*Supply Test
Card B-1
Date Card -BI DateCard-BI
Date Card-,B,l Date
Card B-1
Date Card -131 Date
'Card -BI
Date Card -Bl'
COUNTY.OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 5387541'
747 Elliott Road, Paradi e— Phone: 872-6307
C®RR ECT I N NO I E
,a
"V
OWNER. PE MIT NO.
A'joutine Inspectiom indicates that the following violations of �ountyyOrdinance
exissfIat 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 thiZZ� ffiImediately.
' a
VV
v
C. .� R,
:.'l
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico - Phone: 891-2751
.7 County Center Drive, OroviIle— Phone: 5384541
747 Elliott Road, Paradise - Phone: 872-6307
CORRECTION NOTICE .
93 --
OWNER _ PERMIT NO.
A routine inspection Indicates that the following violations of County Ordinance
exist at the above address and should be corrected. PI ase _notify this office
when correction of work is completed. If you have any question pertaining to this
matW. or need additional explanation, please contact this office Immediately.
Inspector Date
4 COUNTY OF BUTTE
DEPARTMENT OF PUBLIC. WORKS
196 Memorial Way, Chico — Phone:.891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
OBER G PERMITNO.
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.
(•> d U' _( %.� { p r r l c� (�. mac: rte•
Inspector Date
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County. Center Drive, OroviIle— Phone: 538-7541
747.ElIiott 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.1s completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
inspector Date
Owner:
Monty Betty Construction
Permit No.
s
y�y
ENE'
It. GY. CER''IF.ICAT I0N
.
z
lot,- Lazy Trail' Dr —
Chico_'
r=
LOCATION
'P. No.
A
DESCRIPTION 01T' INSULATION`
ROOF
_
Material
<3rand Name
Thickness(inches)
Thermal Resistance (R Value)
EXTERIOR WALL
x
`
ttaterial. Fi hPrg,] AQQ
6"
_._. Brand Name C'PrtaintPP
Thermal Resistance(R Value)_g�
Thickness (inches)
r
Y
CEILINGbr
Batt or BlanketJ;jrpe '
Brand Name_
z y k .
Thickness(inches),Thellmal
Resistance(R Value)_
.-
Loose Fill Type Tnesil
czfo = =o._ Brand Name f Prtni ntPPri
Minimum Thicknes (Inches) 1_ 1 ,_ Number of Bags � Wt. per bag
R Value)
ll '
Area
Thermal Resistance( .R_�n
- covered(ft..)
_
FLOOR, ELEVATED
y
Material
Brand Name
Thermal Resistance(R Value)
Th ickness(inches.)
FLOOR, SLAB
Material
Brand Name
Thermal-Resistance(R Value),___
Thickness(inches)
5f:
Width(inclhes)
FOUNDATION WALL
'
Mater.ial
Brand Name
Thermal ltesistance(R Value)
Thickness(i.nchcs)
I hereby certify that the
above insul&ti:on was installed in the above building.
in conformance. with the S/r-a of California Energy Requirements.
�c=
/ INION
272941
'.
/I. ,SHASTA
'
FI �it:fUWhT
STATE CONTRACTOR'S LICENSE NO..
'
SI OF INSTALLATION
APPL� ATOR. DATE.
I hereby., certify the above.
insulation and all required items as shown on
the
Building Departmcat.approvc.d plaus and :attachments have been installed as
4
:.
required by the State 'of.
California Energy Requirements..
u
f•ry
4 •.
All equipment, devices and
materials are of the quality prescribed or are
.
�,��'
specifically .zpproved by
the State of C lifornia
gk54
..: {
FIRM /OSJNER
(Please
.print) STATE CONTRACTOR'S. N0.
SIGNATURE OF GFNERAL CONTRACTOR OWNCR DATE
THIS CERTIFICATE MUST BE.ON
FILE WITH THE BUILDING DEPARTMENT.PRIOR TQ FINAL��y.
�.
INSPECTION APPROVAL AND
A COPY SHALL LE POSTED WITHIN THE BUILDING.
y
,�
-
January 1984
' .COUNTY OF BUTTE, - DEPARTMENT OF. PUBLIC WORKS PERMIT N 0.
—tr` ---• 7 County. Center. Drive - Oroville, California 95965 - Telephone 916/534-4�3_
APPLICATION AND PERMIT
ASSESSOR PARCEL NUBE= :..
ZONING
- .,BUILDING PERMIT .
OWNER-
TELEPHONE
SO. FT. OCC. BUILDING VA ATION
OWNE 'S•MAI.LING ADDRESS
CONTRACTOR'S NAME—�y.�{t TEL PHONE
ljywy 7-Al'tL/C —
CONTRACTOR'S MAILINGAD
' S �SS�
Fireplace /� ��
CONSTRUCTION LENDI�.p -
U.NKNOWN
Total Valuation $
'
Filing Fee' '"
$'• "- 10 00
LENDER'S MAILING ADDRESS - -. _ -
Permit Fee
$
ARCH I T T OR ENGINEER ..
LICENSE NO.
"Plan Checking Fee
$.
Energy Plan Checking Fee
$ S
ARCHITECT OR ENGINEER'S MAILING A-DDRESS -
Penalty
$
BUILDING ADORES - .. ..
/40-7$
Permit fee
PLUMBING PERMIT
Filing Fee 10.00 -
Each Trap
2.00 • -
Solar.or heat pump water heater
20.00
'LOT NO.
SUBDI I ON NAME
13 / ql , (fkl
PARCEL MAP
s/
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF4 Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1' - 5 outlets
5.00 C73
Building sewer,
5.00
Mobile Home S G IN
10.00ea
TYPE OF WORK
NewX Addition[❑ mode 10 ,Utilities❑ Installation❑ Other❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 6001 OR LESS
100 AMP OR LESS
10.00 Q�
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
1 declare under penaltyof perjury
p 1 y (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.
fi�nn,,
License NO3pg q S 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)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING 0 I�
OR ACDNS. ACC. BLDGS,21/22sgft
NEW'CONSTR U I-OUTL T 2,50 ea
NON.R ESID BRANC CIRC ITS
- - POWER APPARATUS e '
SINGLE OUTLET CIR. )
Ex. Occu 20930t
Occup(OUTLETS OR FIXTURES eAL@30
Ex. Occup. .OUTLETS PIRESID•)LNS REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 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.
have placed on file with the County of Butte Building Department
Ln 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
Hood
3.00
Ventilation
3ct�
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.
er Contractor _ Agent ❑
Signature of pplicant - 0 E]P
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 $
TOTAL PERMIT FEE $
OCCUP:
CONST.TYPc
FLoo
PARC
PD
HO 390
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECT F. PUBLIC
BY
PER T EXPIRES -Date-/�/l
the, applicable provi-
resolutions to do
fees' have. been paid. "
WORKS
Date
Receipt No. 9'3
� � •
,�
WHITE-D.P.W., YELLOW-A38E3SON, PINK -INSPECTOR. GOLDENROD -APPLICANT
Q
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f: COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
• 7 COUNTY CENTER DRIVE - OROVILLE,.CAtt GRN1,4 95965 = TELEPHONE: 916/534-4541
PERMIT_APPLICATIONDATA SHEET• ^^ t�
Permit No. c ' \ ',�`
OWNER �aL C�tJ Sri rz/77' A. P. No. K7
At
Proposed Building Use �tJ.S�,T� Building inspector a0_1122 Date �- a3 �1
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.
Complete plans in duplicate./triplicate, signed by preparer of pla7s.—, "off �02�
4. Complete engineered plans and calcs, with wet signature on plans..
5.' Plans with Energy Design Compliance Statement.
6-. CUSD''Fees Paid'' Stamp on Floor Plan . . . . . . . . ?
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . , , , , ,
Letter of signature authoriz io
Sanitation approval from fa� Health Dept.•[
11. Planning approval for (A) Use: (B) Parking:, ,
12. Certificate of Workmen's Compensation Insurance. . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner❑, Mail to owner ❑ )
_15. Improvements may be required. . . . . . . . . . . .
16. Mobilehome Installation Data. .. . . . . . .• Pre-Inspec. request to (Date) .
17. Pre -Inspection for Required, Building Inspector
8. Recorded copy of Agricultural Acknowledgment Statement.
3 Driveway Permit.
0. Plot plan approval from city of 1!
21._
22.
When you issue the permit, process as follows: Mail to owner, Mail to contractor.
Telephone and hold for pickup at—off ice, Deliver w/inspector.
Other
ApplicantVAXDate
Copy of plans sent Health Dept., Fire Dept., Other Date
The following data must be submitted prior to 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 by1en`phone__rnail—counter by-d!P--'date
Contractor, designer, owner, was.advised of above required data by—phone —mal l—counter by date
Plans checked by_
Copy—DPW
Date Plans approved by
Sets'of plans on hold in JKFile cabinet AP folder
Date
— Flours: 10:00 a.m. - 3:00 p.m.
M
.1
G;
..,_.. .. .. a.-. , ... �
......:. W - ..-..
.....:...,,.y. - ..
.mss. ... ;_
i
iz-
;` t,t+
TO: Building Department
FROM: Encroachment Permit Section
RE: 'Diriveway Clearance
2 � /1, T;
Q�wner i location AP #
Driveway permit -,E has been issued for the above property.
number
signatur
'y date
Date
BUTTE
UFFIC;Hy
Return to DPW AGRICULTURAL. STATEMENT OF ACKNOWLEDGEI�NT: L RECORDS By
FOR .RESIDENTIAL DEVELOPMENT VALLEy.TITLE '
Co
Section 26-8.1- of the Butte County.Code requires - this acknowledgement6$l AR (�
be recorded prior to issuance of a building permit. AN
g�- 9286 CANDAGE J: GRU
The property described herein;is adjacent, to, land orincluded $$$,
within an ,area zoned for agricultural purposes,' and residents of tCORDER FEE
property may be,subject to inconveniences or discomfort arising from
the use of agricultural chemicals, including, but not limited.to herbicides,_. pesticides,
and fertilizers; and from the pursuit of agricultural operations including, but not limited
to•cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor.".Butte County has established agricultural'.zones which have as a
priority 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,
necessary farm operations.
All that real property situate in the.County,of Butte, State of California, described
as follows:
Lot 149, As shown on that certain Map entitled, "BIG CHICO CREEK
ESTATES UNIT 4", which Map was filed in the Office of.the Recorder
of the County of Butte, State of California, on May 13,' 1983, in
Book -91 of Maps,, at Pages,28 thru 33..
NOT COMPARED WITH
ORIGINAL DOCIjAA
EN T
Date: March 6, 1987 PROPERTY OWNERS • ---- ; r
Glen A. Storm
State of Ca l if ornia ) On this the �� day of March 19 87' before
).SS. me, the undersigned Notary Public, personally appeared
County of Butte
Glen A. Storm
Personally known to me. Proved to me on the basis
of satisfactory evidence.
y �m�c���a�easm��s�prne� to be the person (s) whose names) is subscribed to
�r fwd MARY R.CASEBEER the within instrument and,Acknowledged that he
NOTnavPueuacnuFoaNin ® executed the same for the purposes therein contained.
Buttec01"�' a IN _WITNESS WHEREOF, I hereunto set . my hand and .official seal.
a\ WCombsimExOresNoc30,1988 ■
�a�sari�e����i���s���s�o■
Notary.Public
Present A.P. No.
(2) INFILTRATION:
❑ (A) A vapor barrier is required in climate zones, 1, 14 & 16.
(B) All manufactured windows and sliding glass doors shall meet the
1972 ANSI Air Infiltration Standards and shall be certified and
labeled. 4
(C) All swinging doors and windows leading to unconditioned areas
shall be fully weatherstripped.
Tight - the above standard features plus:
❑ (D) Continuous infiltration barrier
❑ (E) Electrical outlet plate gasket
❑ .(F) Air-to-air heat exchanger
(3). GLAZING:
(A) Location
Area Glazing Vloor Area Single Double Triple
Total Bldg
North lob • Z.
East till 1
South 2Z
West L 1 b
❑ Skylights
(B) Shading
Shading
Coefficient Description
East
South
® West s.�2
❑ Skylights
V (C) South Overhang
Length of projection ft. Description
❑ (D) Moveable insulation: Area ftz Description
(E) Thermal
mass
FOR I
RESIDENTIAL ENERGY
PLAN CHECK/INSPECTION SUMMARY
Type
- Area
Ft.2
HC_
Owner
a
EIA
Cl#ate Zone , Permit No.,
Floor Area
_
-
Compliance
path:
Package ❑ A ❑ B ❑ C
Point System ❑ Budget ❑ Other
Ft. 'HC=
MIN
Rw
R -VALUE DESCRIPTION
MC=
REQ'D
INSTALLED
ITEMS
(1) INSULATION:
Type
W
Roof/Ceiling
_HC=
R=
Wall
Location
❑
Slab Floor Perimeter
❑
Type
Raised Floor
-.Area
(2) INFILTRATION:
❑ (A) A vapor barrier is required in climate zones, 1, 14 & 16.
(B) All manufactured windows and sliding glass doors shall meet the
1972 ANSI Air Infiltration Standards and shall be certified and
labeled. 4
(C) All swinging doors and windows leading to unconditioned areas
shall be fully weatherstripped.
Tight - the above standard features plus:
❑ (D) Continuous infiltration barrier
❑ (E) Electrical outlet plate gasket
❑ .(F) Air-to-air heat exchanger
(3). GLAZING:
(A) Location
Area Glazing Vloor Area Single Double Triple
Total Bldg
North lob • Z.
East till 1
South 2Z
West L 1 b
❑ Skylights
(B) Shading
Shading
Coefficient Description
East
South
® West s.�2
❑ Skylights
V (C) South Overhang
Length of projection ft. Description
❑ (D) Moveable insulation: Area ftz Description
(E) Thermal
mass
❑
Type
- Area
Ft.2
HC_
R.
MC=
Location
❑
Type
- Area
Ft. 'HC=
Rw
MC=
Location
❑
Type
- Area
Ft.
_HC=
R=
MC=
Location
❑
Type
-.Area
Ft.
HC=
R=
MC=
Location
❑
Type
- Area,
Ft.2
HC=
R=
MC=
Location
❑
Type
- Area
Ft.
HC=
R=
MC=
Location
7/83
FORM
(4) MASONRY AND FACTORY -BUILT FIREPLACES shall be equipped. with tight
fitting 'closeable metal or glass doors 'covering the entire opening
of the firebox; a combusion'air intake equipped with a..readily,
accessible, openable, and tight fitting damper to draw air from the
outside of the building; and a tight fitting flue damper with a
readily accessible control.
*1(5) HEATING, VENTILATING, AIR CONDITIONING SYSTEM
(A).1.Heat ing
Central Gas Furnace %
(brand and model number) SE
Btu/hr
(heating capacity)
❑
Heat Pump.
(brand and model'number) ACOP
Btu/hr
(heating capacity at 47°F)
❑
Active Solar
'type (liquid or air) Collector brand and
ft2
model number solar fraction collector area .collector
orientation collector tilt rated y -intercept
rated slope
Other
(describe)
J
*1 (B) Cooling
Electric Air Conditioner �. d
(brand and model number) (seasonal EER)
Btu/hr,
(cooling capacity at 95°F)'
Q
Electric Heat Pump
EER
Btu/hr
(cooling capacity at 95°F)
❑
Other
(describe)
❑
(C) A TWO-STAGE THERMOSTAT, which controls the supplementary heat on
its second stage, shall be required for heat pumps.
(D) AN AUTOMATIC SETBACK shall be'provided for all thermostats; except
those controlling heat pumps.
(E) AN INTERMITTENT IGNITION DEVICE shall be provided for all gas-fired
fan type central furnaces, gas-fired fan type wall furnaces and
gas cooking appliances.
®
(F) BACKDRAFT DAMPERS shall be provided for.all fan systems exhausting
air to the outside.
(G) DUCT CONSTRUCTION & INSULATION. All transverse duct, plenum, and
fitting joints shall be sealed with pressure sensitive tape or
mastic to prevent air loss and shall be insulated to conform to
the provisions of Section 1005 of the UMC, 1976 Edition.
7/83
2
(7) LIGHTING
(A) Lamps used in luminaries for general lighting in kitchens and
bathrooms shall have an efficacy of not less than 25'lume ns per
watt .(usually florescent).
*1 Submit documentation of sizing heating and cooling equipment by Manual J, sizing
charts (form #4') or other.approved methods, section 2-5352(8), and fill out the
following:
Heating: Winter design temperture 2�°, elevation Ste', heating load P[�TU
e evation factor _� x heating load m maximum outlet capacity gas furnace
BTU
Cooling: Summer design temperat ure°, cooling load 31 b BTU
(USE ONLY AS A SIZING GUIDE, COOLING MAY BE INADEQUATE)
*2 Submit T.I.P.S.E. chart or other approved system (form #5) to document sizing of
solar panels.-
DESIGN
anels.DESIGN COMPLIANCE STATEMENT:..The above building design meets the requirements of
Title 24, Part 2, Chapter 2-53 of the California Administration Code.
7/83
SfGNAtUj OF BUILDINIV DESIGNER OR APPLICANT
' 3 _
FORK 1
1,
(6)
DOMESTIC WATER SYSTEM' '
Po!
-(A)
Gas Only Gallops
(brand and model number) (tank size)-,
❑ .
Heat Pump w/Electric Backup
(brand and model number)
Gallons
(tank .size)
2
13*
Active Solar
(collector brand and model number)
(rated y -intercept) (rated slope) (solar fraction)
ft2 .
(backup heater type, brand and,model number) (collector area)
(collector orientation) (collector tilt)
❑
Location of Solar Panels
❑
Other
(Describe)
"(B)
TANK INSULATION. Storage type water heaters and storage and
backup tanks for solar systems shall be externally wrapped with
R-12 insulation or greater.
(C)
PIPE INSULATION. The five feet of pipe closest to the water
heater and outside conditioned.space shall be insulated with a
minimum of R-3.. Steam and steam conditioned space shall be
insulated with a minimum of R-3. Steam and steam condensation
return piping and recirculating hot water piping outside the
building envelope shall be insulated in accordance with
T20 -1408(d).
(D)
FLOW RESTRICTORS shall be provided for showerheads and faucets
as outlined in the new appliance efficiency standards and shall
be certified to,the Energy Commission.
(7) LIGHTING
(A) Lamps used in luminaries for general lighting in kitchens and
bathrooms shall have an efficacy of not less than 25'lume ns per
watt .(usually florescent).
*1 Submit documentation of sizing heating and cooling equipment by Manual J, sizing
charts (form #4') or other.approved methods, section 2-5352(8), and fill out the
following:
Heating: Winter design temperture 2�°, elevation Ste', heating load P[�TU
e evation factor _� x heating load m maximum outlet capacity gas furnace
BTU
Cooling: Summer design temperat ure°, cooling load 31 b BTU
(USE ONLY AS A SIZING GUIDE, COOLING MAY BE INADEQUATE)
*2 Submit T.I.P.S.E. chart or other approved system (form #5) to document sizing of
solar panels.-
DESIGN
anels.DESIGN COMPLIANCE STATEMENT:..The above building design meets the requirements of
Title 24, Part 2, Chapter 2-53 of the California Administration Code.
7/83
SfGNAtUj OF BUILDINIV DESIGNER OR APPLICANT
' 3 _
-ZONE -
;iabla73-3a ?Ceiling Inaulatioa ' 'Table ] 7. :South-Facin Glazin pta-•; Table 3-10:',•Stiadin Coef[lcieat'.Polnts
` OWNER• ,: .,a �. � �'•.,. ,.:. POINTS. _
!,'
J: Points
.-_ .
= ASSIGNED
PERMIT NO:, -
: 'ACTUAL `
'
A'Yalua of Insulation"t 40ints 'I
.
L 1 Glaiing Typo
_' I Total L .,'
1' SLAB INSULATION
r
;':I
`I P - (
I 2 of -. I ,3ng1, Dbl, ` .=Trill
2 T FLOOR R-19 • `
I 19_--.. 1^ -4' I
I Flaor. • I- (U - i.(u .6.(U •.1
I Araa.•...''1.1.1o)'.I• o.6s).,I'0.41)I'
'nt
-•PRISED
�'
I o
I -' 1
I`o'ints2 ts,.I o22' l
' +s +
3 CEILING:.�b•
30 R
$ •
_
1
42 . 1_
49 - I. ' +4 I
o
+33o
I,u'p .to 1.5 I +2 1 +2 : 1: +2
1 1.'6-'3.6 1 -1 I 0*
WALL R-19 ;
+
1 '..19 .42' 10 I'; .011 ' 0 I 0'I ;-0,
I L I
1'; 3.7- 5.2 I 4'' I -2 I
5.." :NORTH GLAZING 2.'4 3 6w , K
n
(�
1:5.1.3 1 1 6:J 1.7.9 1
_'' .-2
I ,5.3- 6.5 I, , -6 1: '-4: •: i -7 1
GLAZING , 2.-5-; 3 67 �• U ; `
4
.58-.82 1. -1 1 ,3 1 -6 1 12.1 -15
.83 up I -2.1.
Q
7 `SOUTH GLAZING ly 6-3 67 r. - e G� -
,.:
A
y
?able.3-4a. Will Insulation Points-
9:0 10.0
-
; '10.
J 10.1-11.5 1:'47'. 1 -13 •1 -11 ^I-
' 8 WEST, GLAZING 2:9.3 T
I R-Palue of ,Insulation 'I Points ,I.
I 11'.6-13.0 1; :-21 1 '=16 1 -14'^ 1
I% 13:1-14.5 .I:, =25 ` i -19
sngl; ` bbl:.., Trill
1 I I
1 14.6--28 ,1.-22 I -!9•
9 SKYLIGHT 7;
-
.I a :1 -7`'
'.
I:i:_.'Floor`_ 1 U :. I
•
3-8. Weet-Ficin Clatin
' +--
10 SHADING (Exclude Overhang)
1 19 -. ' I 0 I
.Table
' Pts.
0:65)
I 24 I +2 I.
:
I in jla_-I R Value o[:.Insvl'atfon 1
1 L -Value o;. I '
EAST -r : 6.6 •:�8�0
I 30 I r -•+3 I
I I I
- I. Total -
Glazing Type
SOUTH:, 19-.42
1 tion': I
I
I x of
I• Sngl,; Dbl, Tr 1,
v
��_
f'
WEST 13'= 36�� ��/ =r
, -
Table'3-3. North-Ficin�.Glatin� Pts.:
I : Area -I
'(U' tU'-
.1.10).1 0:65) 1 0.41)'1
.�epch,
ii
SKYLIGHT 37= 5T
7.points
1 .... I
.
1,
Clstin8`'lYpe? I
I
I ' ince' I oints I ointal
I .+4 I
O
nt
+6
1 I 0 2 1}3-4
O
11 HORIZONTAL SUTH OVERHANG
Total I -: I
I_. x '.
I_ ,up' -to 1.3
I . +5' I' +6. -1 +6 .
1 +2., I
* NONE "~
-3,-1 •`Tabl_e 3-12. lovable-Insulitlon
.lnchea .
of Sn_gl.
[rocr L.0 -
.,Dbl,
L;n:- : •I''
Trpl.
U - 1 .:-I
I:`•-1.4-:2.2
xra
I 43
L •:o F ` tz
O
%32 -MOVABLE INSULATION
1
i--:=2.9-:3.6 I 7' 1 6 _1
-y'I Points .
J `:'Ri
Table 3-13. Infiltzation Control
Features Potnts
,I Control Features I Points I
I Standard I 0 I
1 I I
10.9 air changes per hr 1 1
I I I
I Tight 1 +12 1
I I I
10.6 aIV changes per hr I' 1
1 I 1
Table 3-15. Gas Furn4ee Without
Refrigeration Cool -ng Points
I�Seasonal Efficiency I Points I
1 (SE), 2 I I
I 71 - 76 I 0
I 77 - 82 I +2 I
I 83 - 88 I +4 I
I 89 - 94 I +6 1
I 95 up I +8 I
I I I
Table 3-16. Feat Puma Points
Energy Effic!eacy 1 Points I
I Ratio (EER)
I 7.5 - 7.9 I +3 1
I 3.0 - 8.3 I +6 I.
I 8.4 - 8.7 I +9 I
I 8.6 - 9.1 I +12
I 9.2 - 9.6 I +15 I
1 9.7 - 10,2 1 +18 I
I 10.3 - 10.8 I +21 I
I 10.9 - 11.5 I +24
1 11.5 - 12.3 1 +27 I
I 12.4 - 13.2 1 +30 1
I I I
Table 3-17. Cas Furnace With
Refrigeration Cooling Points
T-
'Retriaeracioal Gas Furnace I
I
Cooling I SE ; 1
1171-177-i 8 - 9- 5
1 1 761 821 881 941 u I
I S-0, - 8.3 1 01 +21 +41 +61 +8 1
'1 e.4 - 8.7 1 +21 ;sl +61 +e1+10 1
1 8.8 - 9.2 1 +41 +61 4-81+101+12 1
1 9.3 - 9.7 1 +61 +81+101+121+14 1
I 9.8 - 10.3 1 +314-101+121+141+16 1
1 10.4 - 10.9 I+10i+L2i+151+16i+18 I
1 11.0 - 11.6 1+121+i:1+1614'181+20 1
7/7/83
TABLE 3-14 (ADAPTED)
!MSS
ZONE I1 `, x
INTERIOR THERMAL KASS POINTS
ARE FOOT
AREA
SQ: FT.
1,000
A 8 C
D
A.
1.500
8 C
0
A
2,000
B C
D
A
2,500
8 C
D
A
3.000
B C, D I
A
3,500
B y C;, 10
1,000 I,S00
A B C 0 I A 8 C 0
_
5,000 - 1
A I C
50
2
2 2
2
2
2
2
0 1
2
2
2
0
0
0
0
0
0-
0
0 .,1 0
0
00- +0
0
0
0
0
j 0
0
0
0I
00
+14
0
0 1i
'.00.
4
4 4
2
2
2
2
2
2
2
2
2
2
2
2
0
2
2
l., 0
Z
2, 0_ j0
2
2
0
0
2
2
0
0
f 0
0
0
0 i
ISO
6
6 6
4
-4
4
4
2
2
'2
2
2
2
2
2
2
2
2
2 Z
2
2 "'2 y2
!
2
!
0
2
2
2
0
2
2
2
0
200
8
8 6
4
6
6
4.
2
4
4
4
2
4
4
2
2
2
!
2 :- V
2.
2 • 1: '<2
2
!
2
2
2
2
2
I
2'
253
10
10 8
6
6
6
6
4
6
6
4
2
4
1
4
2
4
1
2
'2
i
2 2 2
2
2
2
2
2
2
2
2
2
2
2
309
12
12 10
6
8
6
6
4
6
6
6
4
6
6
4
2
4
4
4- 2'
4
4, :2. ,''=2
2
2
2
2
2
2
2
7
2.2
2
2
350 -
14
14 12
8
10
10
8
6
6
6
6
4
6
6
6
2
6
4
4 •.2•
4
4; „1 2
4
4
2
2
4
4
2
7
2
2
2
±
400
14
14 12
8
10
10
8
6
8
8
6
4
6
6
4
4
6•
6
4 2'
4
4 4' 2
4
4
4
2
I 4
4
2
2
3
4
2
2
500
18
18 16
10
12
12
10
6
10
10
8
6
N
8
6
4
6
6
6. 4•
6
6." `6• ;2
6
6
4
24
4
4
2
600
22
20 18
12
14
14
12
8
12
12
10
6
10
10
8
6
8
8
6-. 4
8
C 6 4
6
6
6
4
I 6
6,
4
2!
•6
/
1
793.
24
24 20
14
18.
16
lr
10
14
14
12
8
10
10
10
6
10
10
8 6
8
8 - 6 4
6.
6
2
230
26
24 22
16
70
16
16
10
14
14
12
8
1Z
10
10
6
10
10
8 6•
10
8 8 ••4
18
!
6
6
4
8
6
6
4
6
6
6
6
a
6
2
4
903
28
28 74
16
22
20
18
12
16
16
14
10
14
14
12
8
12
12
10
10
10 3 6-I
3
8
'8
4
B
B
6
- 4
B
1.010
30
30 25
18
'2
20
20
14
18
18
16
10
1/
14
12
8
12
11.
,6
10 .�6
12
10 :10;'..6
10
10
8
6
8
B
0
4
8
8
6
b
c
i i
1".00
.IZ
32 28
.0
24
2!
22
14
20
20
18
10
16
16
14
8
14
14
12 ,8
12
12 •.10"{ 6
10
10
10
6
13
10
g
E
!�
a
e
1
1,200
34
32 30
22
26
26
22
16
22
20
18
12
18
'18
14
10
14
14
12, ' 8.
14
12'it
IL
12
10
6
10
10
8
6
10
in
B
6 i
1,7C0
74
Jt 32
22
28
26
24
16
22
22
20
12
IS
19
16
10
13
14'
lA '"8
14
1
12 1'2'` 8
12
12
10
12
1,400
34
34 32
24
28
28
26
18
24
24
20
1F
20
20
18
12
18
16
14 10
14
14 12 -`8
14
11
12
6
8
12
IO
1±
10
*0
6
10
`C
F
b
FI
10
13
10
i 1
I,iOo
36
34 34
24
30
30
26
18
24
24
22
14
22
20
18
12
18
1B
16 .1016
16 Y4 8
14
14
12
8
17
12
10
f.
;7
12
1:
0 1
2.00,1
34
34
32
22
30
30
26.
18
26
26
22
16
22
22
20 11 120
20 18 12
18
18
16
10
16
16
'14
8�
14
14
12
S 1
2,509
34
34
30
22
30
30
26
18
26
26
24 16
24
24 22. 14
22
22'
18
12
20
2D
IS
!
)I
15
It
'u i
7,000
34
32
30
22
30
30
26 ',18,
28
26 24 .1b..2J
24
22
14
22
27
20
14 }
3,500
-
_
32
32
30-20'
30
30 26�°aa'
26
28
21
16
26
Z4
27
141
`4
14
.20
A4 '
4.000
-
,-
-
32
32 30--20
30
30
26
18 ' 78
28
24
It
26
26
'22
if
4,500.
32
32
28
20
30
30
2F
iE!
ii,
23
±=
it
5,003I---------
l2
17
2r
20 1
IJ
;v •
:6
ld
�! ,. i's - Loncrece iiao: nt'tl.93; R-.29; Fec to r•7.7
2. 3 3/4" Thick Common Brick: 11C!; .125; R•.t3; Factor -7.3
81 1. Spy• Concrete Slab: HC -14.106; i-.458; Factor -7.1
C 1. B" Solid Filled Block: HC -20.63; R-1.93; Factor -5.1
2. 8" Solid Filled Block With 80th Sides Exposed To Conditioned Air.
NOTE: Use all square footage direttl7 exposed to conditioned air
for Thermal'. Hass Area: HC -10.164; R-.963; Factor -6.1
D) 1' Thick Concrete/Tile: it
R•:083; Factorr3.7
Table 3-19. Zonally Controlled
Electric Reststence
space Heating Points
Points for thiseeasurc v!11 I Table 3-20. Solar Hater Heatin With Can 8ac1u Points
I be completed after the CZC I
I has approved an Alternative I
I Component Package for Resistance 'I
1 Beat.
Table 3-18. Active Solar Space
Heatinct'vitn (;as Points
I Net Solar Fraction I Points 1
1 (NSF), % I I
I 0-6
I 0 1
I 7 - 14
I +2 1
1 15 - 23
I +4 I
1 24 - 30
I +6 I
I 31 - 39
1 +8 1
I 40 - 47
I : +10 I
I 48 - 55
I +12 I
56 - 63
I .+14 I
I 64 - 71
I +18 1
I 72 up
I +20 I
wood "stove ¢33 points -(no back up)
casablanca fan + !.point
Fultifamil (er unit oints)
Floor Area
Net Solar Fraction (NSF). Z
per unit,
( Solar vith Electric I
I Re+!stance Backup 1
I
I Meering the Require- I
I
I ments to Part 2 I
0 1
I
I Electric Resistance I
I`
1.
0.9
t0 -L9
20-29
30-39
40-49
50-59
60-69-
70-79
600-799
0
+3
+7
+10
+14
+17
+21
+24
800-999
0
+3
+5
+8
+11
+14
+16
+19
1,000-1,499
0
+2
+4
+6
+8
+10
+12
+14
1,500-1,999
0
+1
+3
+4
+6
+7
+8
+10
2X00 and up
0'
+1
+2
+4
'+5
1 +6
+7
+9
All others (Pe buildin oints),
8u0-899
0
+5
+10
+14
+19 .
+24
+±g
+34
900-999
0
+4
+9
+13
+17
+21_
+26
+30
1,J00.1,199
0
+4
-1-7
+11
+15
4-19
+22
'+26
1,20fr1,499
0
+3-
+6.
+9
+12
+15
+18
+21
1,500-1,999
0
+2
+5
+7
+9•
+12
+14.
+le
2,000-:,999
0
+2.
+3
+5
t7
+8
+10
+11
3,060 nr.d uo
0
+1
+3
+S
+5
+7
+8
+10
Pca.
I System Type I Points
I Cas Only 1
I
0 I
I
Heat P,rmp . i
I
0
( Solar vith Electric I
I Re+!stance Backup 1
I
I Meering the Require- I
I
I ments to Part 2 I
0 1
I
I Electric Resistance I
I`
1.
only
'-40 1
RESIDENTIAL PLAN CHECKING GUIDE 7%85
(S.F.; DUPLEX MISC..ONLY)
Bldg -;,-'Permit #3
OWNER S TO LM A. P. # 4Z - 4(p- 1 lv
GENERAL
,K Zoning requirements: (sideyards and number of permitted living units').
2'. Valuation.
Plans. signed by designer.
,�. Energy Design and Compliance.
Existing violations 'on property.
PLOT PLAN
Jl Complete parcel size and dimensions.
2'. Setbacks,'sideyards, easements, etc.
Other buildings or structures.
4�, Grading, fills, drainage.
Y. Flood hazard.
,�. Special conditions on creation map or,compliance document.,
FLOOR PLAN
Complete to scale plan with dimensions.
;2. Required windows for light and ventilation (Sec. 1205).
3'. Required windows for second exit (Sec. 1204).
1101.. Skylights ' (Chapter 34 & Sec,.. 5207) . ,,,
,.5: Human impact glass (Sec. 5406).
6. Required room sizes, ceiling heights (Sec. 1207).
�Y. G.F.C.I.'s in baths, garage and exterior outlets (Article 210-8).
�! Light fixtures, switches, receptacles, and exterior.receptacles for maintenance of
mechanical equipment..
A' Locations of water heater, heating and cooling equipment, other electrical or gas
equipment,, and plumbing fixtures._
Garage firewall, door size, and closer (Sec. 503(d)(3)).
]A� 1 - 3'0" exterior exit door (Sec, 3304(e)).
,12. Fireplace and wood stove location..
13. Smoke -detectors (Sec. 1210).
STRUCTURAL DETAILS
)/. Foundation plan complete enough;Ao construct building..
Floor construction details complete enough:to construct building.
J Elevations and wall construction details complete enough to construct building.
�+. Roof.construction details complete. enough to construct building.
Z. Fireplace construction details and calcs if necessary.
,(:
RESIDENTIAL PLAN CHECKING GUIDE (CONT'D) 7/85
MISCELLANEOUS ITEMS TO LOOK OUT FOR (CONT49)'
Garage door or porch header sizes.
Adequate bracing.
LOQ. Living area over garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
Two exits on three-story dwellings (Sec. 3303 & see Mezannines 1716).
Attic access and ventilation (Sec. 3205).
Underfloor access and ventilation (Sec. 2516).
45. Wood stoves, clearances, alcoves & 1 -hour shafts.
1�. Combustion air for fuel burning appliances.
].(• Noise requirements on duplexes.
L?'. Adobe soils - special foundation design.
1-9. Retaining walls requiring design.
14. Unusual shape, size or split level house requiring lateral design.
9
r
BUTTE.000NTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M. (530);538-7636 (OROVILLE) (530) 891-2834.(CHICO)
OFFICE M (530) 538-7541 FAM (530)538-2140
WEBSITE: wvlrw.buttecounty.neAdds
PERMIT NO.-
BP041798
LICENSED CONTRACTORS DECLARATION
I hereby affirm under, penalty of perjury that I am licensed under
,provisions of Chapter 9 (commencing with Section 7000) of Division 3 of sued Date: 06/21/2004• APN: 043-710-016-000
the Business and Professions Code, and "my license is in.full force and '
effect.
License Class,: l�—� License Number: :5� Y Site Address: 1632 LAZY TRAIL DR CHI
Date: Contractor. -, c� �� //6Y "Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of -perjury that I'am exempt from the Description: TEAR OFF & RE -ROOF W/COMP (55 SQ)
Contractors' State License Law for thefollowing-reason (Sec. 7031.5;
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior Owner: MORROW DAVID D & STEWART-MORROW --
to its issuance, also.requires the applicant for such permit to file.a .IEANNE T
signed statement that he or she is licensed pursuant to the provisions,of
the Contractor's State License Law (Chapter.9 commencing with Section.- P O BOX 6517
7000) of Division 3 of the Business and Professions Code) or that he or c CHICO, CA v,
she is exempt therefrom and the basis for the alleged exemption. Any 95927-6517
violation of Section 7031.5 by any applicant for a permit subjects the ' j
applicant to a civil penalty of not more than five hundred dollars ($500).): k
t
❑ I, as owner of the properly, or my. employees with wages as their. t
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does Applicant: ALLADIN ROOFING ' -
such work himself -or herself or through his or her own employees,
provided- that such- improvements arenot intended or. offered for `
sale., tthowever, tlieibuilding or improvements are sold within one P;O BOX 4262
year of completion,; the owner -builder: will have the• burden of fi OROVILLE, CA 95965 '
proving that he or she did not build or improve for the purpose of
sale.). (530) 533-2934
❑ 1, as owner of .the' property; .,am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon; j
and who'contracts for such projects with a contractor(s) licensed )Contractor: ALLADIN ROOFING
pursuant to the Contractors' State License Law.)..
❑ - I am Exempt under Article 3 of the Business and Professions Code ! P O BOX 4262
i OROVILLE, CA 95,965
Date: Owner:(530) 533-2934
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:. I License M 532834
❑ 1 have and will maintain a certificate of consent to self -insure for
Workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
I have and will maintain, workers, compensation insurance, as Architect:required by Section 3700 the Labor. Code, for the performance'of . Engineer:
the work for which this permit is issued. My, workers' compensation'
insurance carrier and policy number are:
Carrier:
Policy#: Total Square Ft: 0 S.F.
LII certify that in the performance of the work,for,which this permit is Valuation: $0.00 r'
issued, I shall not employ any person, in any manner so as .to Census Code:
becomesubject to' the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation -provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: /�y��
Applicant f" /4
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
��F-7 I 3a� . 5�
code, interest, and attomey,s fees. —
CONSTRUCTION LENDING AGENCY: _. This permit is, hereby issued under the applicable provisions of the Bit to County Code anrVor
1 hereby affirm that there is a construction lending agency for the Resolution to do work indicated above for which fees have been paid:
performance of the work for which this permit is -issued (Sec 3097 Civ.)
BY Date:
Name:
PER EXPIRES ON: 1 I • OS
Address: Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with,Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.,
❑ Attached are copies of the required E.P.A. notification forms.
I hereby cartify that I have read this application, that the above information is correct,-,aridthat I am'the owner or the duly authorized agent.of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawfulto alter the'substance,of any official form or document of Butte County..;) hereby
authorize representatives of Butte County to enter upon the above mentioned property for Inspection purposes .
Print Name:/1 f �1(/ Signature:
Date:- O =UT
0 Owner �4� Contractor ❑ Agent for Owner' ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION#:'(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP041798
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury. that 'I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 06/21/20N APN: 043-710-016-000
the Business and Professions Code, and my license is in full force and
effect.
�_3 g ?c;Pk_3 y
License Class: License Number:
Site Address: 1632 LAZY TRAIL DR CHI
Date: 6- 2� Contractor. 'c,.%s�
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: TEAR OFF & RE -ROOF W/COMP (55 SQ)
Contractors' State License Law for the following. reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: MORROW DAVID D & STEWART-MORROW
to its issuance, also requires the applicant for such permit to file a
JEANNE T
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
P O BOX 6517-
7000) of Division 3 of the Business and Professions Code) or that he or
CHICO; CA
she is exempt therefrom and the basis for the alleged exemption. Any
95927-651?.
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred. dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
Applicant: ALLADIN ROOFING
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or. improvements are sold within one
P O BOX 4262
year of completion, the owner -builder will have the burden of.
OROVILLE, CA 95965
proving that he'or she did not build or improve for the purpose of
sale.).
(530) 533-2934
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: ALLADIN ROOFING
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
P O BOX 4262
OROVILLE, CA 95965
Date: Owner:
(530) 533-2934
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #• 532834
'
❑ 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.
Architect:
I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Engineer:
-the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier. J %l[' P &G _u
Total Square Ft: 0 S.F.
Policy #:_ %_)/
Valuation: $0.00
❑ I certify that in the performance of the work for which this permit is
issued, 1 shall not employ any person in any manner so as to
Census Code:
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith` comply with those.provisions.
Date: Cn/-Z-/�%y� •j/:�
Applicant: r°iyr
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages my' provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
4oc,4-7 1 3d1. 50
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable provisions of the BiMe"County Cada anrvor
I hereby affirm that there is a construction lending agency for the
Resolution to do work indicated above for which fees have.been paid:
performance of the work for which this permit is issued (Sec 3097 Civ.)
By: Date:
Name:
PER EXPIRES ON: �za (' 405
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ,
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is cored, and that I am the owner or the duly authodzed,agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize represennta�tives of Butte County upon the above mentioned property for inspection purposes.
ytt`o�enter
H �1�/_/CJ �/ Signature:
Print Name: ) f
'
Date: (D - ZZ -0 [�
❑ Owner )R�Contractor ❑ Agent for Owner 13 Agent for Contractor
' BUTTE''COUNTY
DEPARTMENT OF DEVELOPMENT. SERVICES
BUILDING. PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS .
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL, BE REQUIRED AT,TIME -OF APPLICATION
- .
CONTRACTOR
Name
'
Address _
-
City i 1�
Fax
State
7jD —
Phone
Map Book
Fax
7
Phone, _
23.3
Y
Fax
. E-mail . :
Lic. #C
ss
-32
APPLICANT NAME_
ARCHITECT/ENGINEER
Name
City
"Address
-
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail .
Planner Date Approved:
State License Number
APPLICANT NAME_
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
rX
For offic4 use only:
Zoning
Flood Zone
SRA
Yes
No
. J
Type Const
Subdivision Name
Map Book
Page
Lot #
Planner Date Approved:
LOCATION
Property Address
Cross Street
WORKER'S COMPENSATION
Policy Number
13- 0
Carrier
If hiring anyone other than cense contractors, a certificate of worker's.
compensation must he shown at the time of permit Issuance.
LENDING AGENCY
Name .
Address
Description or Scope of.Work:
t
Sq. Footage
a
❑ Structure Built without Permits
Proposed Change of -Occupancy, ,
(Note previous use):
EXPIRATION OF APPLICATION '
Applications for which a permit has not been issued will expire bne
year after the date of application.. In order to renew action on an
application after expiration, a new application, plans and fee will be
requii ed
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who.
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: ��'� Amount 3c>> • Bldg
SRA
Receipt #: 4eYz,4•-71 Sheriff
SMTP
Other
Date:. 64a-4 -
'3': .50 Total .
OVER FOR SUBMITTAL REQUIREMENTS
KAFORMS\BUILDING FORMS\BIdaADDISubRomts.doc Page 1 of 2 . REV 430-04
r
SUBMITTAL REQUIREMENTS
The following drawings and specifications. must be submitted to the Building Division in order to apply
fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INS.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPERI
❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to
mobile or modular homes.)
❑ 7. 2 Flood Elevation Certificate, wei-stamped and signed (if required).
❑ 8. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 9. Sanitation and site plan approval from the Environmental Health Department.
❑ 10. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs-in triplicate; (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI
❑ 2. 2 Data sheets and installation instruction manual
❑ 3. 2 Marriage line. information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑ 1. 4 Site Plans, signed by the preparer. NO GRAPHPAPERI
❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4. Letter from Engineer or Architect for truss design review.
❑ 5. 2 Energy compliance design and supporting documentation, (if required).
❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7. Statement of Intent for Non -heated and A/C (if required).
❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and -Wet -signed by the engineer.
❑ 9. Letter of intent.
❑ 10. Hazardous Material Form.
❑ 11. Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMSWILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2
REV 4-30-04
aF Cs��;a'�`•d��l��;"-��ai.-°�:s�:�'Fi{i�'t,�:Nr:£,y�.c'.:rT'.��dY'Cu�""SR.S'F9'Yrf;?�"�ir ,,...:. c'f5•^: .. •.?w.
043`710-016 PERMIT_
#95-1286 �.
STEWART, Jeanne
1632 Lazy Trail Dr., Chico
Cont; Doug Imhoff
3, French Doo s & li tng/SF
Ilk I
r
1 _
I
,i
Y
roA�f'
'-
COUNTY OFBUTTE- DEPARTMENT OF`DEVELOPMENTSERVICES-BUIL"D'ING ISION
7 County Center Drive - Oroville, Calgornia, 95965,- Telephone (916) '53 54 PERMIT
RMIT NO.
APPLICATION.AND PERMIT. "'
ASSESSOR PARCEL NUMBER - i
043-710-016
ZONING -
ASR
BU ING PERMIT•
OWNER
HANNE SMART
902-0384
SO.FT. OCC. BUILDING VALUATION
6,0W
OWNERS MAILING ADDRESS - I
1.932 LAZY TRAIL DR CHICO 95926
CONTRACTOR'S NAME
MUG IMHOFF
TELEPHONE ,1::
343-4970
CONTRACTORS MAJUNG ADDRESS
fj
Fireplace
CONSTRUCTION LENDER
UNIWOWN
Total Valuation $
Filing Fee $ 20.00
LENDER'S MAIUNG ADDRESS -
Permit Fee $
ARCHITECT OR ENGINEER .`: („ _ 1\
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty $
BUILDING ADDRESS
SAM
PERMITFEE $ 101.00
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
LOT NO.SUBDN510NS
NAME
PARCEL'.'MAP
1{
Solar or heat pump water heater 23.00
Water piping 15.00
USEOFSTRUCTURE
SF 4 Duplex ❑ Mobilehome ❑ Other
SPECIFY
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: 3 FRENCH DOORS RECESS LIGHTING
Mobile Home I S I GI W I920.00
PERMITFEE t
I
Contractor
ELECTRICAL PERMIT Filina Fee 20.00
Main Service000V 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 full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I herebyaffirm under penalty of perjury that I am exempt from the Contractors License
p ty p i ry p
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 licensed1contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason i
NEW CONST. DWELLING OCCUR SO.
OR ADDNS. ' ( & ACC. BLDS. ) 3.50 FT.
NEW CONST. MULTI -OUTLET
NON-RESID. (_BRANCH CIRCUITS ) @7,.50.
POWER APPARATUS
(a SINGLE OUTLET CI R. )
Ex. Occup. (OUTLET OR FIXTURES) 20 @ 1.00
BAL .SO
Ex. Occup. (ouXEtDrs iR o.OERs ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring .
23.0
PERMITFEE $ 43.00
Contractor
WORKERS' COMPENSATION DECLARATION I
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'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, .l shall
forthwith comply with those provisions.
4
X „!moi ! L Date
Signature of Applicant - Owner ❑ Contractor ❑ ,Ag ent—T r
Am;/OSHA permit is required for excavations over 60" dee�and demolition or construction
of structures over 3 stories in height. (f
Mobile Home Installation Fee $
Energy Inspection,•Fee " $
OCC
CONST. TYPE
TOTAL FEE $ 144.00
HA2.
D. FEES
I IMP I
FLOOD
CDF PARCEL PD
I HD
I ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for whiqh fees have been paid.
By Date
PERMITEXPIRESON /_
�— (Date)`
ReceiptNo.1 14S
WHITE-D.D.STT- CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING ISION
7 County Center Drive - Oroville, qalifoun a 95965 -'Telephone (916) 53 54 �PE IT NO.
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
043-710-016
ZONING
ASR'
B INGPERMIT
OWNER
ST EWART
TELEPHONE
892-0384
-
SO. Fr. OCC. BUILDING VALUATIONJEANNE
6,000
OWNERS MAILING ADDRESS
1632 LAZY,TRAIL DR CHICO 95926
CONTRACTOR'S NAME
DOUG IMHOFF
TELEPHONE
343-4870
CONTRACTORS MAILING ADDRESS
977 WOODLAND AYR, CHICO 95926
Fireplace
CONSTRUCTION LENDER
UNMOWN
Total Valuation $
Filing Fee
$ 20.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 81.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Plan Checking Fee
$
ECT OR ENGINEERS MAILING ADDRESS -
ARCHITECT
Penalty
$
BUILDING ADDRESS
SAME
PERMITFEE
$ 101.00
PLUMBING PERMIT
Fling Fee 20.00
'Each Trap
7.00
LOT NO.
S UBDNISIONS NAME
PARCEL MAP
.Solar or heat pump water heater
,23.00
USEOFSTRUCTURE
SF � 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 ❑ UGlites ❑ Installation ❑ Other ❑
Describe Work: 3 FRENCH DOORS RECESS LIGHTING
Mobile Home I S I G W 1
920.00
PERMITFEE
$
Contractor
ELECTRICAL PERMIT
Filina Fee 20.00
Main Service / 000V 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,POWER
and my license is in full force and effect.
License Class Lic. No.
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. ( a ACC. BLDS. )
SO.
3.52 FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
@7.50
APPARATUS )
8 SINGLE OUTLET CIR.
Ex. Occup. (OUTLET OR FIXTURES )
20 O I.50
BAL .00
OR
Ex. Occup. (oFIXED PLNS..OR A)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.002 . 00
PERMITFEE
$ 43.00
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
9
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'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X _ Date J,
Sirture of Applicant - Owner ❑ Contractor ❑ nt
OSHA permit is required for excavations over 5'0" de nd demolition or construction
f structures over 3 stories in height.
Mobile Home Installation Fee
TT7777
Energy Inspection Fee Is
ocC
CONST. TYPE
TOTAL FEE $ 144.00
HA2.
D. FEES
IMP
I FLOOD
I CDF I
PARCEL PD HD ISSUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated above for whi fees have
By
PERMITEXPIRESON �?
I i
applicable provisions
Resolutions to do work
been paid.
Date
ReceiptNo.'bfS
WHITE-D.D.SCCANARY-ASSESSORPINK -INSPECTOR GOLDENROD -APPLICANT
I
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Sefety Glazing A f
Safety Glazing
(p PTI D W) 14")
S Ls N- z I W
ing
_7 Safety Glazi
ProvI24 adequate clbra
3af6ty 01
p7ing
Drotedtlon anda, Typei-A 5luo 191 _7
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Provide adequate clearanca (3
nrotection and a Typ- A Flue.
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Provide one-hour pro,i
garage side of common wall 0,Fq
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together with self-closing 1-3/81'
thick solid door, npp� �m r �4
-core A/ W�
2 2 6
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PROVIDE APPROVED VENT
.�L_ Af
AND ADEQUATE COMBUSTION
26 kv
AIR FOR HEATER VOR W. H.
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BUILOHNIG DEPAR,1.ENT
APPROVED