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`0 = No OK
= Not Applicable
' ', I1AOLEYHOMES
MISCELLANEOUS • '
= Not Ready. ..
Date MOBILE HOME UTILITIES (Plans) OK except #'s
r`
Date DECKS,COVERS,CARPORTS;GARAGES; (Plans)OK except #'s
1,.Zoni.ng Requirerrients-Setbacks-Easements `
1: Zoning'Requi' i ts-Setbacks-Easements
2: Soils; .Special MH Support -Sketch' • ',
- _ 2. Footings, Soils`Size=Depth-Spacing-Connectors-Steely . ;-
3. Sewer; Location -Test -Fall -CLO -Concrete,.
3: -:Decks; :Girders and/or�Joists=Decking=Bracing-Stairs-Rails
`-:4:'Water; Location -Test -Easement Needed -(Sketch) : ''
4,: Wood . Awn ,\, Posts-Beams-Rftrs Connec
5.'El ectricity;'Location-Cl earan ces=Grnd / / Amp -Concrete
Shthg:-Rfg '.Bracing a --
6. Gas, Location:Test-Wrap:,/ / L"ft.'
5:.Alum. Awn.; Col umns-Connections-Splice- Decal=Enclosures
/'Nat. or/ :/"L' ftL' -/".LPG. =
6: Carports; Windows -Doors;_':
7: Utility -Clearance
7. Elec. +
e t
<S. Frm Sills=Anchors-Stdds-Mrs-Trusses
g`
9: Siding; Nailing -Veneer -Stucco -Mesh- '
. Card -B1. : Date..." : Card -31:.. . •Date. ._
10: Roof;''S hthg-Roofing ..'. _
-Card-B1Date. ',Card=131 ''.Date ' :" (
11. Ext.; Steps_Doors-Landings
Date :_ : MOBILEHOME`INSTALLATION (Plans):OK'except #'s' -
1: Zoriing Requirements-Setbacks'..Easements
Card -61 Date' Card -131 Date
. 2. Footings; Siie=Spacing-Marriage Line
Card=B1 > Date,' Card=B1" Date
3. Gas; MHTest-Demand-Valve-Connector
' 4. Electricity; MH Test -Crossovers -Breakers -Clearances'
Date POOLS (Plans)'OK except #'s
5. Drain; MH Test-F$11=Flex'Connector "','
1. Setbacks -Easements '
i T 6;.Water;,,MH.Test-Regulator=Connector
2. Soils; Compaction -Structure Stability
.7: Water and Sewer Connected=C/O,to Grade=HD Approval '.
3: Pool Structure; Steel -Connections -Thickness -
'8: Gas and. Electricity Tagged ,
Dead Men -Lining r
9: -Exits; Insp.-Sketch.
4fElec.; Receptacles and. Lighting; Distances-GFI
10 =Cert 'of Occupancy " :.'
S:.EIec.; Pool Lightmg,'15 volts-GFI,
y
6- Elec.; Enclosures, Conduit.Entries-Terminals-Listed
"
7. Elec.; Bonding; Metal.w/5'-Circulating Equip. -Heater'' ..
`
Equip..w/5'-circulating,Equip.-Pool Lghtg.
Bones-Enclosures-Pane'lboards- Ins. to' Main in Conduit
.8:".Elec.;Grounding;.
Card -B1• Date, Card -01. Date
c ~Card -131` Date` Card -131 ' Date
9. Healtti Department Approval
10:.Plumb.; Cir. -Test -Water Supply.Test
T
Card -131. Date Card -B1 Date
Card=B1 ' Date Card -B1 'Date
4.
• ,
=0% - ,. . _
° = Not
A plicable RESIDENTIAL (Single and Duplex)'
= Not Ready
Date
UND OR Plans OK except #'s,
DateFRAI" Continued
ong-Setbacks;-Easements-Flo ope ^fd t
rnC
4 .H gars -Post Caps -Anchors -Connectors
tg., ain; Soils -Steer .-/' fes(' Ftg. Depth
Ing. J ist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shth
arage; Soils -Steel-/ u" Ftg..Depth
47. ace Ties or Type A Flue -Fireplace Throat learanc
4 tg.; P es &Deck's; Soils -Steel-/ /"Ftg. Depth.
t' cess; Size & Romex Protection -Draft Stop n"s..Baffles
123-
walls; Main; Steel-Blockout's-Wrapped
d indows or;Exiting Doors -Sill Hot. 8 Dimen ns
temwalls, Garage; Steel-Blockouts-Wrapped
arage Fire Pr otectio"n Framing
7}(S41b; Steel -Wrapped
y Line Firewall & Openings
iers- '
xt. Doors -One 3'-Check,Garage-3rd story, 2 exits
i/
.; Fi4.Ft%ngs- y C/O-Seweclest-
idth-Headroom-Rise-Run-Landing-Fire Protection
i/
1 Pipe; Size -An rs
lywood on Roof Over ng -Attic Vents -Rafter Outriggers
iy
ater Pipe; T rs,Regwator- ce
ailing V
12 Ele ric; Undergrourid
a cco M Screed -Fd. Vents- UnderfIr. Access"
1 enums.& Ducts; f4erranc .- er-Su'pprt-Ins.
la ' A a -Glass Protection -Skylights -Plastic
(LVGirdAr4-,qOe-Anchpp4olts-Joistents-IIs;
Nailing -Bolts
15AInsulation
tPirlin tion-Walls-Clg.
filtration-Walls-Wndws
Card -B1
Date$a1*2q Car -B1
Card -B
- Datf:- Card -131 Date
Card -B ate j I-J.Q Card -131(/ Date /-
Card -B1 ate If - `Card=B1 Date
Date PLUMBING Per t OK except #'s
16. Wa r Ht. Vent-Access-Combusti - a
Date. L Pans OK except #'s
Pipe; Test & Anchor -
Steps -Door & Sidelight- Protection -Landings
W.V.; Test-Fttngs.& Anchors- ail Protection
a Detector
19 ower Pan; Test, First Floor -Tub Access
�i
rnace; Vents -Clearance -Comb. Ai.r-Connector-
n ge; Above Floor -Ducts -Meth. Protection;
. T t Tub ,& Shower, 2nd Floor -Tub Access
. Gas _Pipe"; Size &.Anchors
edloom Exiting
fi F.I. & Bath Fixtures & Tub Access -Spa
ec. Trim & Subpanel; Breaker Sizes -Labels
CardltW,
Date I[_ ,o Card -B1 Date
`Card
&'Rails
Card -B
Date -Bb Date I
C6VFireplace or Stove; Clearances -Hearth
Outlets at Wood Panel; Int. & Ext. dl
- y
Date ELECTRICAL: Permit OK except -#'s
22 Fix& Transformer Clearan ns. Protection
7 Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance_UiFoi<
e eceptacles Spacing -Lights & wi_c_ es at. Doors
7 c. Outlets &Receptacles at Kit. Counter
i oxes & No. of Conductors -Stapled'
arae g Fire Door; Swing-Landing-Closer.a
1
o installed Close to Edge of Studs & C.J.
uct in Garage -Damper
gyj?-Ground made up w/Mach. Fasteners -Bond Gas &Water
Wtr. Htr.; Vents -Clearance -Comb. Air -Connector-
Garage; Above Floor -Mach. Protection,
Appliance Circuts in Kitchen & Conductor Size/G.F.I.
76' PI Elec. & Mech. Equip. Listed for Location yi
28. a Size/, / ga. Cu or AI-A.C: Wire Size/ /ga.
u or,AI f
7 I ' Receptacles in Garage; (G.F.I.)-Romex Protec.
7 ulation-Foam-Looked in Attic ❑ Yes
29. Range Circ. //o/ g Cu r AI -Oven Circ.' / / ga. Cu or Al.
Insulated Neutral `es No
7 . 9!�rard Rails & Deck Construction -Post Caps
36 -Riser Conductors & Ground -Main Disconnect
n. Vents & Crawl Hole Door -Drainage &Wood -Earth
Clearance Looked under; Floor - 'D es
learances Panels-Motors-Mech. Equip.
3i
89. Fotowing instld.; Driv es ❑ No; Walks Yes ❑ No;
%e P nters ❑ Yes o
I es Closet Light -Shower Light-Spa:Light
moke Detector
8 , S ucco; Br - inish D.fC /,2../S -- S
Card-
Date i.- Card -B1 Date
8 A.C. Unit; Disconnect, Electrical, Plumbing
Card -131
Date Card -B1 Date
8jk,Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
'Openings.
Date
MECH NICAL Permit OK exce t #'s
Well; Disconnect, Electrical, Plumbing
C Ducts Insulation & Support
8 . terior Elec. Trim; G.F.I. Receptacle -Underground_
ant .an; Exhaust above insulation
8 ntilation throughout House
3q o ansate Drai'ii & Overflow; Size & Grade
8%,4046ss Protection
3 urnace-Vent; Access -Comb. Air -Return Air Vent -115 outlet
orrectio s from'Previous. Inpections
a8-A+b*c-AmrM& Platform if Furnace in Attic
8st-Meters Tagged; Gas -Electric F��p9�j7v
9 . er & Sewer Connected -C/O to Grade -HD Approval .:
nergy Compliance Certificate -Other Certificates
92 Roofing Certificate
Card- _ atej�-� Card -B1: .' Date
Card-131�
Date Card -B1 Date
Card -131y Datd2-41Q Card -131 Date
Card -81 Date Card -131 " Date
Date FRAM Plans OK except #'s
Proper Material &Anchors
Card -81 Date Card -B1 Date
Its S uds-Nailing, Spacing & Bracing—Plates-Sound
Comments at Final:
ng Walls over Girders & Floor Nailing
Stop in Walls (rat proof)
i Stops; Furred Ceilings -Stairs -Chases -Tub
44/Header & Beam -Size & Bearing
(NOTE: An entry must be made each time you visit iob site)
1 COUNTY OF BUTTE
t` DEPARTMENT OF PUBLIC WORKS
196 Memorial. Way, Chico — Phone: 891-2751
7 County Center,Drive;'OroviIle -- Phone: 538-7541.' ,
747 Elliott Road, Paradise— Phone:, 872:-0307
CORRECTION NOTICE
.'OWNER PERMIT NO.,
`.
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 n eed�additional explanation, please contact this office immediately..
a
r•, S c� KJ(/fK
s rs P i% 4CA r w°
z
f
L
ti
Y Inspector
Date
A routlne� Inspection Indicates that thefollowing violations of County Ordinance
exist at the above. address'. and stiobld be- corrected.. Please notify this office
when correction of work Is cornpleted-, If you have any,question pertaining to this
''mitter or need additional explanation plebse co - ntact this office Immedlatel Y.,
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 M6moria I Way. Chico Pli one: 891-275 1
C ouniY Center Drive. Orovi Ile � Phone' -7541
-538
747r-Elli6tt Road, Paradisd Phone: .872-6307
_,-CORRECTION'NOTICE
OWNER
-PERMIT NO.
A routlne� Inspection Indicates that thefollowing violations of County Ordinance
exist at the above. address'. and stiobld be- corrected.. Please notify this office
when correction of work Is cornpleted-, If you have any,question pertaining to this
Inspector. Date—.
''mitter or need additional explanation plebse co - ntact this office Immedlatel Y.,
4"),
Z,4
4�!
1�41_
14. 14,f
&>"
Inspector. Date—.
A"
i
COUNTY OF BUTTE
DEPARTMENT.OF PUBLIC WORKS
196 Memorial Way, Ghico — -Phone: 891-2751
., 7 County Center Drive, Orovi Ile -Phone: 538-7541
' ` I 747 EI!liott 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 correctir of work is completed. If you have any question pertaining to this
:. matter, or ed additional explanation, please contact this office Immediately.
�•_ � vs` .� 111 - _.
A
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yam. t \•,. '
K;. t��v�- c�'�` O'er t7C.•QJ1� yL Q.vt�iA�,P,rd_'t��../ '
�` Inspector ` Date
. Owner:—
Permit No.
ENERGY C•E R T I F I C A T ION
863 Westmonte Drive, Chico Ca
-
_
LOCATION
A. P., No.
DESCRIPTION
OF INSULATION
ROOF
Material
Brand, Name
Thicknees(inches)
TI►ermal Resistance (It Value)' .,
EXTERIOR WALL.
Material Fiberglass Batts
Brand Name Owens-CorniLlq
Thicknees(inchee)_ 3 5/8"
Thermal Reeistance(R Value) RIA
CEILING
Batt or Blanket Type, Fiberglass Batts
Brand Name QwPnR_ nrnj
Thicknese(incites) gam"
Thermal Resistance(R Value) R30
Loose Fill Type Fiberglass
Minimum Thicknes@(Inches) 12'3/4".
Brand Name nwenq_('nin)no
Number -,of Bags 26' Wt..per bag
Area covared(ft. ) 1711
Thermal Resistance (11 Value) RM
FLOOR, ELEVATED
Material Fiberglass Batts
Owens-Corning
Brand Name ,
Thickness (incites) 61"
Thermal Resistance(R.Value), R19,!
FLOOR, SLAB
Material
Brand Name
Thicknees(inches)
Thermal Reeistance(R Value)_________
Width(inclies)
FOUNDATION WALL
Material
Brand Name
ThlckpeAe(inches)
Thermal Resistonce(R Value) �_,�___�
I hereby certify that the above insulation.was"installed
in the above building
in conforaance With the State of California
Rnerty Requirement@,
.Loerke Insulation Co. 49915n
FIRM NAME/OWNER STATE CONTRACTORS LICENSE NO.
December 4, 1989
8IGNA URE OF INSTALLATION APPLICATOR DATE
I hereby certify the above insulation and all required items as shown on the
Building Department approved plane -and attachments have been installed as
required by the State of California Energy Requirements.
All equipment,' devices and materials are of.'the quality prescribed or are
specifically approved by the State of California.
F / P1 e print) STATE CONTRACTORS LICENSE NO.
s
IGNATURE OF GENERAL CON CTOR OWIIER DATE
THIS CERTIFICATE MUST BE ON FILE WITH_THE,BUILDING-DEPARTMENT PRIOR TO VINM.,
L BE POSTED WITHIN THE BUILDING
INSPECTION APPROVAL.
AND A COPY 311AL •
January 1984 .
COUNTY OE BUTTE Department of Public Works
7 County Center Drive, Orovill.e; CA 95965 Phone:. 916-538-7541
OWNER -BUILDER .VERIFICATION
Attention Property 'Owner:
An.'"owner=builder" building permit has been applied-for,in your name-and'bearing
Your signature
Please compiete,:and return, this; information' .at your, earliest, opportunity to avoid
unnecessary delay in processing .4r!4 issuing your.'buildng:;permit.,r. No building permit
will be. issued until this:verification is received.
1.. I .personally planto provide -the major labor and materials for construction of
the_ .propose d.property.improvemebt '(.yes or no)..- _
2. I (have/have not) signed an-•application'for.a building permit._
for the proposed work., -
3. I have contracted with—the following .person (fi-rm) to, provide the .proposed
construction:' �n
Name
Address City
Phone, ..Contractors .License. No_,.
4. I pian-tb: provide portions of this work., but I have,hired the .following person.'.
to coordinate, supervise, and provide the major work:
Name
Address.,.City
-Phone '-Contractors License -No,
5. I willprovide some of the work but I have contracted (hired) the following
persons to provide_ the work indicated:
Name,.Address Phone Type of Work
Signed:
Property Owner .
Social Security Number
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831. and.
19832 of the California Health and Safety Code.
This verification must -be completed and returned to our office before we are per-
mitted to issue the permit.
z,
r
& CJ rf 7 o,v7
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS PER No.
7 my Center,Drive - Orovill,0Cal ifoinla 95965 Telephone: 916/538-7541.
APPLICATION. AND PERMIT
-•ASSESS R P -ARC UM - ZON N
V
.. ,
�(�
•-BUILDING PERMIT.
-OWNE - - -
-; ,.ac 2 r
TELEPHONE
7 _1 _7
S0. FT. :` 'OCC. BUILDING VALUATION,
36
-
OWNSR'S MAILING ADDRES
�1�
-
,
CONT XCTOR'S E
r a z r
TELE PHONE
((J
CONT ACTOR'S MAILING "ADD ESS � 7 ,
dh P .» c G
95-1 m4lo
Fireplace.
CONSTRUCTION LENDER
UNKNOWN
Total Valuatio
-
••'Flllflg Fee- '�. -
-.$, �• 10.00
LENDER'S MAILING ACDR 39 - F
:Permit Feer
$ 2 J7 No
A-RCHITECT OR ENGINEER -
LICENSE NO.
�,
Plan Checking-Fee$
-Z__/3:.-yi�.�
.Energy Plan Checking F@@
ARCHITECT OR ENGINEER'S MAILING ADDRESS -
Penalty
,
BUILDING ADDRESS -
Permit fee`OK
15
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
/ 2.00' 1 -
Solar or heat pump water heater
Solar
20:00
LOT NO.
SUBDIVISION _ _PARCEL MAP (
/-3 4-�
Water piping
5.00
ch qas water heater or vent
5.00 .5
USE OF STRUCTURE
Sf� Duplex ❑ Mobi lehome ❑ Other
.SPECIFY
Gas piping system 1 -5 outlets
5.00
Building sewer
5.00 5 .O
MobileHome - -S GW
10-00ea
TYPE OF WORK
-New Addition
s❑�Remodel❑ 'Utilrties/❑ Installatio ❑ Other El;
Describe work: / r d s 1 '� �rj R�
Permit Fee
$
Contractor .
ELECTRICAL PERMIT..
Filing Fee 10.00:_
_
Main service 100V OR LESS
100 AMP OR LESS
10.00 Q Q '
Main service EA. ADD'L 100 AMP
2.50 •��J
CONTRACTORS. LICENSE LAW
I declare under penalty of perjury (check one):
Il,♦..I I am IIC@nsed under provisions of.'Chapt. 9, Div. 3 of. the Business
and Professions Code and my .license is in full force and effect.
License No. u P�'� I Classification _ .�
—r �- --_
❑_1,, as the owner, or my employees with wages -.'as their sole compen-
sation- will do the work, and .the structure is not intended or offered,
for sale. (Sec. 7044)Mobile
❑ I, as the owner, am exclusively .contracting -with licensed contract=
ors. (Sec. 7044)
❑ I _am exempt under Seo... Business,and Professions Code
for this reason
�
oR ADDNST' ACCL'P
B V) I�2¢SQft
NEW CONSTR.. MULTI -OUTLET
NON-RESID .BRACIRCUITS
2.50 ea
? POWER APPARATUS el
SINGLE OUTLET CIR. /
Ex. OCCup OU?LETS OR FIXTURES
Zoeaoe
BAL930
FIXED _APPLN . OR
Ex. OCCUp.- OUTLETS (RESID) EA.)
-
2.00 _
Temporary service.
10.00 �-----
Home Facilities _
15.00 "
Misc. Wiring
15.00
Permit Fee
$
Contractor .
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE.
I declare under penalty of perjury (check one):
The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a_'Certificate, of. Workmen's 'Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to,Appllcant: 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.
Heating
Cooling S Or
O
Hood
3.00 3' �—
Ventilation
3 O
'Permit Fee
$
Contractor
i'certify,that ,l have read this application and state that the above information
is correct.; I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above;mentioned property for inspection purposes.
I also ee to: save, indemnify and. keep harmless the County of Butte against
al!I I i ides, judgments, co s, and expenses which may in any way accrue
aga s sald'Co t i" o ua[ice of the grantmg.,of this permit.
'Date _('——
','SignatLre,of. Applicant..= O r? Contract Agent ❑` J
An OSHA permit is inquired for excavations over 5:0'.` deep and demolition orconst�uci
ion of structures over. -3 stories in hel,ghte "
Mobile Home Installation Feer
s
$ is
Energy Inspection Fee. $
Q�f
TOTAL PERMIT FEE/-, • $ '� C72 ' Sfl,
o cu P.
CONST.TYP6
-
1.c
FL000 :ARclI PD a
s3uc
This'permit is hereby issued under.the
signs' of the Butte County Code and/or
work ,indicatedo above< for 'which
if DIRECTOR, ! PUBLIC
By
PE EXPIRES Date
applicable prove -
resolutions to do
fees 'have been paid.
WORKS
..Date
,-!
Receipt No. `
WNITL-D:P.W..TSILOW-A7elO30R,PINR-INDPLCTOR. col.ocNRoo-APPLICANT
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f.,:-r+���''„-rirrs4rr yw;�' �4�f+:,";-'.:'.hei•M ...F,�.t•..�u-f.�.A�,i-�:;A.., �a'..r�`-'L-u'� ` �`..' .. ail.^»N;.1�:.;r,,'i�virt`"'relris'y.'.,-a'ri�.''�'+{�,'.`;;nL� .�,.. �. _ .� ..
COUNTY OF BUTTE - DEPARTMENTO_F�PUB LIC WORKS -BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA' 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
s. Permit No.
OWNER �(` f'� 2. 1 �2 k- Q co VN, A. P..No.-Z/S- /S
Proposed Building Use s. Building Inspector Date —2 `r
At time of permit application, I was advised the following data must be submitted priorto permit processing and/or issuance:
1 DATE RECEIVED APPROVED
1. All items have been submitted . .................... .............
2. Plot plans in duplicate/triplicate, signed by preparer of plans........ -
3. Complete plans in duplicate/triplicate, signed by preparer of plans ..
4. Complete engineered plans and calcs, with wet signature on plans ..
5. Energy Design Compliance and supporting documentation .........
6. Statement of Intent for Non -Heated and AC Buildings •..............
7. Engineered truss details and layout in duplicate (required prior to plan check)
8. Mobilehome installation data including manufacturer's installation
��instructions.......................................................
Fees of $ ...........
Chico Urban Area fees,paid .L. !.�""✓./7�................
1 Park .fees paid .7. 2 .Z. U_ ....: .................................... 6
12. School District fees paid ..
3: Sanitation approval from Health Depattment ...
4 City of Chico plumbing -.permit ................ .. .............. G 11 1
15. Plot plan and business license approval from City of
(see City for other requirements)
16. Planning approval for (A) Use: (B) Parking:
A!Improve ments may be required.
18. Driveway permit, (construction approval required prior to occupancy) ...
`-19. Pre -Inspection for required .... Pre-Insperi request to
l
p q � Building Inspector (Date)
20. Contractor's license information (No., Name Style, Classification) ........
21. Certificate of Workmans Compensation Insurance ..............:...
22 -Owner-Builder Verification (Given to owner ❑, Mail to owner ❑)
1.23 Recorded copy of Agricultural Acknowledgment Statemen�0. M :}'!
qLeer of signature authorizatio ........ .........../�..
26.
Wh n you issue the permit, process as"fofroW,s,,µ Mail to owner. Mail to contractor.
Telephone -2 1/16 and hold for pickup atC % c7 office. Deliver w/inspector.
Other
Applicant F-1 ---� . Date 7 4/
Copy of plans sent Health Dgpt., Fire Dept., Other Date
The following data must be submitted prior top mit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2.' Additional items required:
Contractor, eslgner, owner, was advised of above required data by _phone__nall_counter by `bate` l—EQ
Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by Date Plans approved by tic- Date `l, _J69
Sets of plans on hold in = ile cabinet AP folder
Copy—DPW is
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BUTTE COUNTY SCHOOLS DEVELdPME'NT FEE CERTIFICATION FORM
(One .Foam per, Building) '
A:P.Number ' .'BuiIdi'n.g Department No. .
.School 'District ty County Q, -Jurisdiction
I roper.ty, Owner L
Project "Location%Addres•s' "4) 0� U;
'Subdivision Y GF% : Ib�f' �.�i� . !�'" Logit. Number
YU
Re's idential:D.eve)opmegt /
Sq Footage 4; a3(n
of L. Bving� `.;MHI • ,Addition ,,,(.Group R,),,.
Units a"
F,a t=°Commercial/Industriatl: a' a� Sq Footage,"
aNdw7"1'Ardditi.on (In.c�lddirig "Exterior
ROOzf,ed,�Areas).
r
n Ta e ' r
.; Building, Department,,Representati,ye'<< . r Date
ly
�9
''(Floor "Plans :reviewed''by School District Personnel),
District
School Districtcertifies°Vt`liat .
uit?Pfil�ciant 4Name�) ��,,: "'�'" ' , ? �� t';.�'r�(�Phone Number)
�� .. � X59 1a I►,;�. , .b x. , _
' '(Street Address )' p,: 4
(City) (State) ( -Zip Code)
has complied' with the .requirements. of',Resoliition'.No.
=Y •by the .payment of $~. 1,; �gb,%� ` representing�%3,�„ . square feet.
School District Repres nt�ativerr ;' `Date
PAID -BY CHECK NO. / REMARKS;:
..BANKN.0
pPAID BY •C'ASH
f. white -applicant, ye'll,ow-bui.lding�'department, pink -school district
SCHOOL.FEE (8/88)
5/89
RESIDENTIAL PLAN'CHECKING GUIDE
MISCELLANEOUS ITEMS.TO LOOK OUT FOR (CONT'D)
Exterior plaster - weep screeds (Sec. 4706).-
Proper roof pitch for roof covering (Chapter -32).
-6:_� Roof covering type - (fire hazard).
-Gafter ties or bearing ridge beam.
arage-door or porch header.sizes.
quate bracing.
Living area over garage - complete l -hour separation ,required on garage side
including supporting walls and posts, etc.
,11 -. Two exits on three-story dwellings (Sec. 3303 &'see Mezannines - 1716).
�At'tic access and ventilation .(Sec. 3205).
'r3.. --Underfloor access and ventilation (Sec. 2516).
Combustion air for fuel burning appliances.
..;!'5/Noise requirements on duplexes.
Adobe soils - special foundation design.
147: Retaining walls requiring design.
j8': Unusual shape, size, or split level house requiring lateral design.
�$: Flashing at all ex rior openings.
RESIDENTIAL PLAN CHECKING GUIDE
(S.F..' DUPLEX & MISC. ONLY)
Bldg. Permit # 2394-89'
OWNER o nl �(�,4Z 1 E 2 A. P:' # 61-x- - -4G— 2t3
i
GENERAL
oning requi',rements:- (sideyards
Valuation.
Plans signed,by designer._;
Energy Design`:and Compliance.
I�5. xisting violations on property.
tems on data sheet.
PLOT PLAN
and number- of permitted living units).
Complete parcel size and dimensions.
?. Setbacks, sideyards easements, etc.
Other buildings or structures.
Grading, fills, drainage.
Flood hazard.
Special conditions on creation map or compliance document.
FAU & FAS road setback.
FLOOR PLAN
X Complete to scale plan with -.dimensions.
Required windows for lightland ventilation (Sec. 1205).
.3"'- Required windows for second exit (Sec. 1204).
.Skylights (Chapter 34 & See. 5207).
5 Human impact glass (.Sec. 5406).
5/89
1a:�Required room sizes, ceiling heights (Sec. 1207).
GFCIs in baths, garage, and exterior outlets (Article 210-8).
8� Light fixtures, switches, receptacles, and exterior receptacles for maintenance
of mechanical equipment.
Locations of water heater, heating and cooling equipment, other electrical or
gas equipment, and plumbing fixtures.
10'.- Garage firewall, door size, and closer (Sec. 503(d)(3)).
1 - 3'0" exterior exit door (Sec. 3304(e)).
1-2: Fireplace and wood stove location, alcoves, and clearance.
1,3'.' -Smoke detectors (Sec. 1210).
STRUCTURAL DETAILS
Foundation plan complete enough to construct building.
Floor construction details complete enough to construct building.
Elevations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
Fireplace construction details and talcs if necessary.
MISCELLANEOUS ITEMS TO LOOK OUT FOR
,1! Stairway details: landings, rise and run, head clearance, handrails (Sec. 3306).
Guardrail details (Sec. 1711 & 3306(j)).
Brick or stone veneer (Chapter 30).
'=r�:n.,:.�+a-.y..�i� ..r �1rrn� ; ~; - �;r'4-•'viaA"is-"RSTaIt,^t!. rY^"'.hf�i.✓.n:,r-.'...uvr.,. ,-F
BUTTE COUNY PARKS DEVELOPMENT FEE CERTIFICATION FORM
CHICO AREA RECREATION AND. PARK 'DISTRICT
Assessor Parcel Number(s)
Property Owner Q OL 7-
Project Location/Address] (,v p $ (' v►. d v�-� (`
�y � s
Subdivision � , c( \ ' v r Pt Lot Number(s)
Residential Development: (check one)
`'iaNew Development Alteration/Addition
Mobilehome(s) Non -Residential to Residential
Total Number of Dwelling Units 0/44-0
Comment:
Buildlrig Depa tmen`t Repfese tative Date
yryryryryryr��yr��k�lr�kyY�try�rYr�lr�k�Yr�k�k�k�k�lr�k�k�Yc�k�rMrYrYlr�k�k��k�nYMr�k�rYr��k�t�k�k�k�k�k�k�lc�k9r��k�yr���lr�lr�kyr�ykyr�k�ryr�k
Chico Area Recreation and Park District(CARD) certifies that
Applicant Name
(Street Address)
0- d
t- t.
�'f�l�'
(City) (State
ID ``i rat. " C�41
Phone Number)
Zip Code
has complied with the requirements of -Butte Co. Resolution No. 89-081 by
payment for dwelling units @ $722 for total payment of $
f
CARD Representative Date
PAID BY CHECK NO. q.12 REMARKS:
BANK NO.
PAID BY CASH
RECEIPT NO.
park.fee (7/89)
BUTTE COUNY PARKS DEVELOPKENT FEE CERTIFICATION
FORM..
i
CHICO AREA RECREATION AND PARK, DISTRICT.
Assessor Parcel.Number(s)
Property Owner O (� A, Z l 2 ✓�
Project Location/Addressg 3 — C� P s� ►�.: a �
Subdivision 1. , ct \ h:• c v v��C 1� Lot Number,(s)
FH
Residential Development:' (check.one)i�
•'
New Development _Alteration/Addition
TTLr�"_.OU
'Mobilehome (s) Non -Residential
to Residential
i_.HG;;}i•
; i�� -�
Total Number of Dwelling Units
I_41r'1'17r .
Comment: j1 Q Zr, H o
2 Y ---
Bu i t es tative Date
Chico Area Recreation and -Park District(CARD) certifies that. -
C-3cla -aLQ
(Applicant Name) (Phone Number)
(Street Address)
�D(Grl H IC_0 L�-hF-`C L n l_-) 1r4(c7
(City) (State) (Zip Code)
has complied with the requirements of Butte Co. Resolution No. 89-081 by
payment for I dwelling units @.$722 for total payment of $ 7,_�,q
epresentative
PAID BY CH/ECR NO. �� y :� REMARKS:
BANK NO.
PAID BY CASH
RECEIPT NO.
park.fee (7/89)
-Y2
Date
PRWECT ADDRESS
CITY OF CHICO APPLICATION PERMIT
441 MAIN STREET/P.O. BOX 3420 PHONE (916) 895-4891
LOT
i.�nn•i rl Rf HTV. Tr TAAI I i
E8: -
BLOCK SUBDPA
storm
DATE OF APPLICATION COUNTY AP NO.
6-89 042-460-028
ON ZONING OCCUPANCY RES.UNRS
Chunty
PEITMrr NO,
2659
PUN PLAN NO.
-
I ora r�nmr r �n� �.. �., .+.� . �..., ... . �n •..0 vr�r con vhI �
P 1
VALUATION
USEIVAR.
NO. STORIES
TYPE CONST.
BLDG. USE
PARKING SPACE
AREA SO. Fr.
OWNER:
Ron Frazier
OWNERS ADDRESS:.
859 Valentine Court
- PHONE:
342-2196
BLDG. USE/DESCRIPTION OF WORK'
Plumbing permit - Lateral connection to
-
existing
CONTRACTOR Ronald L. Frazier Construction Owner/bUl
I derIu6614
sewer man
CONTRACTORS
ADOSS-. 859 Va ent ne Court, co
° -
u ng nspec or inspects
AFO CTENGIWER . -
LICE.
- eS On
OR DESIGNER.
RO4:
'AN PERMR 4S REQUIRED FOR EVALUATX7NS OVER s'0'DEEP AND
ARCIfTECTS EW -OWER OR
DESIGNERS ADDRESS,
DEMMITiON OR CONSTRUCTION OF STRUCTURES OVER ) SNRIES W HEIC,rn.
- LICENSED CONTRACTORS DECLARATION
PLUMBING PERMIT
PROCESSING
OTY FEE
-
REMARKS
.1 hereby affirm that I am licensed under the provisio apter 9 (commencing with
Section 7000) of Di ' ion 3 01 the Busines essans e. and my license Is in
FIXTURE TRAP
BUILDING SEWER
full force and effect X36881
Lic. Num r_.,.,,
WATER HEATER AND/OR VENT
.License C)a s / ..
—
GAS SYSTEM
.
Dale.8.�_�. ._Contractor✓.-------_----------- _.... ._ —
INSTAL. ALTER REPAIR WATER PIPE
OWNER -BUILDER DECLARATION
Ihereby affirm that 1 am exempt from the Contractors License Law for the follovang
-
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires
a permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance.
also requires the applicant for such permit to file a signed statement that he is licensed
to the provisions of the Contractor's License Law (Chapter 9 (commencing with
pursuant
Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
TOTAL PLUMBING FEES
20.00
SUMMARY OF FEES
Acct- Not.
therefrom and the basis for the alleged exemption. Any violation of Seclion 7031.5 by any
PROCESSING BUILDING P/C
10476
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.
ELECTRICAL PERMIT
OTY, FEE _ SS APPLICATION #
31.487
will do the work. and the structure is not intendedor offered for sale (Sec. 7044, Business
.SERVICE
-
10.474
and Professions Code: The Contractor's License Law does not apply to an owner of prop-
-
CIRCUITS
OFFSITE IMPR. P/C
erty who builds or improves thereon, and who does such work himself or through his own
It, how-
10-476
employees, provided that such improvements are not intended or offered for sale.
RECEPT SWITCH, OTHER OUTLET
ENERGY P/C (EST)
- ever, the budding or improvement is sold within one year of completion, the owner -builder
will have the burden of proving.that he did not build of improve for the purpose of sale.)
POWER APPARATUS
_
1.7 I, as owner of the properly, am exclusively contracting with licensed contractus to
Code: The Contractor's
APPLIANCE
FEES PAYABLE AT,
construct the project (Sec. 7044, Business and Professions
SIGNS
TOTAL
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 pursuant to the Contractor's
NEW RESIDENTIAL .025X
TIME OF APPLICATION -
License Law.).
1 i I am exempt under Sec. — _.._: B. 8 P. O to this n
TEMP POWER,
8-16-89 pr1/
TOTAL ELECTRICAL FEES
BUILDING PERMIT
10425
Date Owner
PLUMBING PERMIT
10-425 20.00
WORKERS COMPENSATION DECLARATION
l hereby affirm that I have a certificate of consent to self -insure, or a cerlifirate of Work-
PROCESSING
ELECTRICAL PERMIT
10-425
ers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
MECHANICAL PERMIT
OTY- FEE
PERMIT
10 425
Policy No. _---__—_ CompanyMECHANICAL
-----------------�--
MECH EXHAUST -HOOD/DUCT
Certified copy is Hereby furnished.
VENT FAN SINGLE DUCT
STREET FACILITY IMPROVEMENT FEE
29-485
COOLING
SEWER TRUNK LINE -
30-486
l7 Certified copy is filed with the city building inspection division.
Date Applicant -
HEATING
SEWER WPCP
31-487
CERTIFICATE OF EXEMPTION FROM WORKERS'
WOODSTOVE
COMPENSATION INSURANCE
�j
o ed if it the permit is for one hundred donars{5100) or
s&wIlo�completed
-
SEWER MAIN
32'8 �
less.)
I certify that in the performance oAthelof which this per t Issu9O7I shall not em -ploy
STORM DRAIN
26-493 '
any person in any manner some subjec to rF„efS/' Compensation
Laws of Call ta.
TOTAL MECHANICAL FEES
IN LIEU (STREET)
25-497
Date _�'i&-89 Applicant_--- —__—_-- --.
ALLEY IMPR.
25:498
APPROVALS REQ.:
- -
ENG. INSP. FEES
10-474
NOTICE TO APPLICANT: II, after making this Certificate of Exemption, yo sh td be -DEPT.
come subject to the Workers' Compensation provisions of the Labor Code, yo st forth-
HEALTH j] PLANNING ❑ ARB (] ENG. ❑ SCHOOL [] FIRE-
PLAN MAINTENANCE FEE
-
10-481
with comply with such provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY
ElOTHER
-
SUPP. PLAN CHECK FEE
I hereby affirm that there is a construction lending agency for the performance of the
APPROV xg,THIS
APPLICATION
OTHER: Park
work for which this permit is, issued (Sec. 3097, Civ. C.).
Lender's Name _ — --
Lender's Address -- _- - `_
BECOMES A PERMIT
WHEN VALIDATED..
TOTAL FEES PAYABLE AT
ME OF PERMIT ISSUANC . '� CASH
(N CHECK 497.00
X r
I certify that I have read this application and state that the above information is correct
I agree to comply with all city and county. ordinances and state laws relating to building
hereby of the city to enter upon the above-
SIGNATOR OF APPLICANT OR AGE
L DATE 8/16/89
construction, and authorize representatives
mentioned property for inspection purposes.
OWNER CONTRACTOR 1] AGENT 1_I
BY:
VALIDATION0
O. yc�
�� CC���
7 . r
,f ,trt /x t' lljl tt yrs i. �..k t.4 c w ".0 (V}J4-T ni Yea 1i i:s N„4 S '+.-
ifx v h`S v
F . N h'*}i. •. ,., . (�, a a -n w +1 u -.;1.3,,. t�; L .�" L
y v * tk q xyt i NK t Ja a 5
Return to;,DPW �: it AGRICULTURAL' STATEMENT OF ACKNOWLEDGEMENT '
FOR RESIDENTIAL DEVELOPMENT
�ci t iron' 26-fi l of the13utte 'County Cpd,e
requires ;ttirs'".acknowledgement " `be recorded
prior to issuance of a, building permit..
The' -property, : ,described,' herein is ,addacent
to- land or included "within an area,,zoned
I
RECOR
or agricultural purposes, • and ,r'esidents R-- -r--
of . this property may'. be: `sub ject,.'to ''incon-
veniences or'- discomfort -arising `, from the ' .AT $':�1 A.M.
use of agricultural'chemicaIs,:- including',
but note l imlted to .herbicides, pesticides, AUG 1999
and fert.Ll.i.zers; and 'from the pursuit
of, agri-cultural' operations including,
but not, limited, .to. cultivation-,,"plowirig;
spraying,.. pruning;, ..and,,, harvesting `which'
:occasionally generate dust,• smoke, noise and .odor. Butte ,County has establ:ishcd,;igricnl
-lural-' zones' -which have as' a-prio"rity .use :for :productive, agricultural purposes,- and i -vs i (Iui
within "sai.d zoned'and.'on adjacent property should be prepared to accept .suc:h ,i.n.()i iveiiicn� o
or.-disconform fro.m.normal necessary farm.operations.
All that., real:' property situate in the' County .'of Butte, .State of .Califor•ni:a, -descrihr(l ati
fol-16ws
Lot 3 -..as sh-own on that certain Map. entitled, "STORM SUBDIVISION'.,,
which Map .was Recorded. in- the office of- the Recorder of -the County
'
of. Butte, State of California, on March 20, 1987;',in Book 104 of .
.Maps-,` at Pages 91 and 92. .
Date: Aug. 16 1989,` PRO RTY OWNERS:
Ronald Frazier
State of California � On 'this: the day, of 19 before mc,
).SS_. .the undersigned Notary Public, personally appeared
County
of Butte
Z
t r-
., OFFICIAL SEAL s'® Personally known to me. -Q Proved to, me on .the bas i.5.
MARY R. (ASEBEER of satisfacLory evidence.
NOTARY PUBLIC •CALIFORN1A .to be''the:persoh(s) whose name(s') 1 is
BUTfimsJNtY.' "subscribed to the within instrument and acknowl:ed ed that,
AAr Corton Eakins ka 29;1993 g . --
ezecuted 'the same . for the purposes therein contained. 1, N _W.I TNFtiti
WHEREOF', J _hereunto: set, my hand and off.ici.al. seal..
Present. A. P. No. J '`02'; Notary Public
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
Owner has decided not to do work. (B1dg.Permit Appin. 97-87B P,
Receipt #781641 date� A #42-15738. Lot '3) ner : temDrew)
,M,
.
Retain filing.fees-===---------=------- --$ 10.00
Retain
Retain` energy plan checking fees -'7 ----- J,15.00
Amount,retained ---=---=--- 241.50
. .
Refund:due------- --=-=-------.----- ..--=-----=------------$433.00,:
Plumbing permit fees paid---- -$51.00
Retain'filin fees-----------=------------------- $10.00
Refund due ---------------------------- ------------------ ---$41.00 .
—_
Electrical permit fees paid -----------=----------$81.95
Retain filing fees ------------------- =------- ----- 10.00
Refund due= ----------------------------=------------------ 71.
Mechanical:permit fees paid --------------- - ------ $28.00
Retain filing fees----------------- -- 10.00.
Refund .due`--- ---=-------=------------ ------------------
A
- Refund,, energy inspection fee's. paid , ------ ---------------- L-0--00
JOT FUND DUE ----------------- -----.---=---------------
TOTAL
$593
95
I, the undersigned, declare under penalty of perjury that the servicesor articles claimedhave en performed or livered, a d that this
claim is true snd corrrrect es stated /fI r� /
Dated this / ...... day.of ,v, 19,1/, at �2�4�<.C� Calif:
i / ......... j..... .............
Signature of Claimant
1,the undersigned; hereby -certify_ that, to the best of my 'knowledge,. the services or articles specified above been pedo"ned or de-
livered end,that there is a -Budget Appropriation O or Specific Board Approval (Check one) for the same.
Dated this 16th doY or ..::A�rll 1987 at Oroville Calif.
..... ..
.. ..... ........ ......... ...
pertment Head or Authorized uty
' Dept - E=p _
Code ................... ...: Code ......... �. PAYABLE FROM ..:... :..
........ ........ ...... ..... FUND
-DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
DEPT. & SUB, 'PROJ.' SUB. OBJ. ` CLAIM NO. INV:NO. INV. DATE ENCUMB. GROSS AMT.
I
COUNTY OF. BUTTE - DEPARTMENT OF PUBLIC WORKS 0.9PERMIT NO
7 County Center Drive - Oroville;_Califernia 95965.- Tel 916/534-4541
APPLId ATION AND PERMIT
ASS ESSO PARCEL NUMBER
ZONING
.- _BUILDING. PERMIT'
owNER
r .LE PHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S. MAILIt4G ADDRESS
y L�vTi �` Com:elr
177
CONTRA T R'5 NAME _p
1rT
TELEPHONE
a
CONTR ACTOR'.S.MAI LING ADDRESS
c
Fireplace x '
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee'
$ -10.00
LENDER'S AILING ADDRESS', , - -
Permit Fee
$
ARCHITECT OR•ENGINEER
721-5
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking
$
ARCHIT C OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS -
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00 l
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00 S
Each qas water heater or vent
5.00 -37 "
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S G W
0.00ea
TYPE OF WORK
New) Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work: cJ�� Q/5✓47J YY)
Permit Fee
$
Contractor
,
ELECTRICAL PERMIT..
Filing Fee 10.00
Main service J00V OR LESS
00 AMP OR LESS
10.00 !� ,
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penaltyof perjury
p I y (Check One):
�'
. I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professio s od � my license is in f force and effect.
License No. Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do tbe'work,and the structure is not intended or offered
for sale. (Seo 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 OC P.
OR ADDNS. ACC. BLDGS /zQsgft
NEW CON5TR U TI -OUTLET 2,50 ea
NO N.RESID BRANCH CIRCUITS
POWER APPARATUS 6\
SINGLE OUTLET CIR.
Ex. Occu 20050C
Occup(OUTLETS OR FIXTURES eAL030
FIXED APPLNS. \
Ex. Occup. OUTLETS (RESID,)REA.J 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
g
Permit Fee $ IiF/ 915 -
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ i have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person.in any manner so as to become subject
to the W. C. laws of California.
Notice to -Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
(f.
Hood
3.00 _
Ventilation
Penult Fee
$ ."
Contractor
I certify that I have read this application and state that the above information
is correct. I -agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also awe to save, indemnify and keep harmless the County of Butte against
-all li ies •judgments, costs, and expenses which may .in any way accrue
agai t id -County in coa uen the�granting of this permit.
X
Signature of A licant — Owner
g pp ❑ C ntr for ❑ Agent ❑
An OSHA permit is required for excavations er 5'0" deep and demolition or construct.
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $ _
eL)i]
TOTAL PERMIT FEE $
O UP,
CONSwPE
V IV
�S
FLOOD
PARCEL
P ND
ISSUE
This permit is hereby issued under
sions of the* Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been aid.
p
WORKS
Date
Receipt No.
WHITE-D.P.W., YELLOW-ASSFi SOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
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COUNTY OF BUTTE - DEPARTMENT OF-PUBLIC'WORKS -"BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE'`YaAC7'FORNIA 95965 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET
a , Permit Noy/�0
OWNER ��� - A. P. No./a %�r 31F/I:::2 2
Proposed Building Use Building Building Inspector-3:�� Date s
At time of permit application, I was advised the following data must be submitted prior to permit processing
andJor issuance: DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . . . .
2. 'Plot plans in du licate/triplicate, sLgLeded by preparer of plans. ,
3. Complete plans in duplicate. /triplicate, signed by preparer of plans.
4. Complete engineered plans and calcs, with wet signature on plans.
5. 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 $ . . . . . . . .
.,� 9. Letter of signature author�ton _ .. . . . . . . `� T
10. Sanitation approval from gp .
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 ,xw-y.: (Date)
17. Pre -Inspection for Required. Building Inspector
18. Recorded copy of Agricultural Acknowledgment Statement, y
19. Driveway Permit.
20. Plot plan approval from city of
Xe v
When you issue the permit, process as follows: Mail to owner, Maii to contractor.,
Telephone -3�a -v��l� and hold for pickup aitfice, Deliver w/inspector.
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 by—phone---Mall counter by date
Contractor, designer, owngr,)pas advised of above required data by—phone —mal l—counter by date
Plans checked by
_Sets of plans on ho
Copy—DPW
Date 11 C/R"2 Plans approved by
2=,�File cabinet a AP folder
Date
— Flours: 10:00 a.m. - 3:00 p.m.
�tL
t
I
RESIDENTIAL PLAN CHECKING GUIDE 7/85
(S.F., DUPLEX & MISC. ONLY)
Bldg. Permit #
OWNER (/(/� / //Gly r u�e�" 2 A.P. #
GENERAL
�l. 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
Complete parcel size and dimensions.
0 Setbacks, sideyards,.easements, etc.
Other buildings or structures.
Grading, fills, drainage.
Flood hazard.
6 Special conditions on creation map or compliance document.
FLOOR PLAN
,-K Complete to scale plan with dimensions.
,2!- Required windows for light and ventilation (Sec. 1205).
Required windows for second exit (Sec. 1204). ,
W Skylights (Chapter 34 & Sec;. 5207)..
.t5! Human impact glass (Sec. 5406).
,6..Required room sizes, ceiling heights (Sec. 1207)..
r7: 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..
Locations of water heater, heating and cooling equipment, other electrical or gas
equipment, and plumbing fixtures.
9' Garage firewall, door size, and closer (Sec. 503(d)(3)).
-14 1 - 3'0" exterior exit door (Sec. 3304(e)).
4-2:, Fireplace and wood stove location.
,Ja- Smoke detectors (Sec. 1210).
STRUCTURAL DETAILS
Foundation plan complete enough;.to construct building.
Floor construction details complete enoughto construct building.
,.--3''Elevaiions and will construction details complete enough to construct building.
4*20 Roof construction details complete enough to construct building.
-5< Fireplace construction details and calcs if necessary.
6)- Sufficient data and details to satisfy energy requirements.(State Law) (Form 1).
MISCELLANEOUS ITEMS TO LOOK OUT FOR
Exposure I plywood on exposed locations and overhangs.
Stairway details: landings, rise and run, head clearance, handrails (Sec. 3306).
Guardrail details (Sec. 1711 & 3306(j))..
ick.or stone veneer (Chapter 30).
erior plaster - weep screeds (Sec. 4706).
Proper roof pitch for roof covering (Chapter 32).
Rafter ties or'bearing ridge beam.
RESIDENTIAL P1,AN,CHECKING GUIDE (CONT'D)
MISCELLANEOUS ITEMS.TO LOOK OUT FOR (CONT'D)
rage door or porch header sizes.
Adequate bracing.
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).
,,14" --Wood stoves, clearances, alcoves & 1 -hour shafts.
1a'.' --Combustion air for fuel burning appliances.
Noise requirements on duplexes.
Adobe soils - special foundation design.
Retaining walls requiring design.
Unusual shape, size or split Bevel house requiring lateral design.
t
lt' i ------------
t4-
ge
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('-' k�/ �
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r �s
d
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a �
7/85
/V,, A n s cv,e r'
FOR
A.M"
DATE TIME --'PM.
M
OF
PHONE
AREA CODE NUMBER EXTENSION
LELIEP
. WPONE
tGAM EAROIS E EIY!@ �U
JW, I I] &C-Aff WGA I N=
IREIRlYRNE wQuuml
MH6=MENTI'E-)N=j
=I
MESSAGE
(144 g&,L4 7W� .
SIGNED
LITHO IN U.S.A.
3002- L P5S H. S. CROC'KER CO.. I N C..
- ti - 3#1(�,r U71"`t i •(. N1.'Uy:',�.^.. a ,_ f..- _ i i:° ,.. :�r.9ytu ,. ... ,
CITY OF CHICO '- OFFICIAL RECEIPT
i
NOTICE TO PAYOR: Check this Receipt carefully, Itis your proof.
g � uk {`� '� 1 �1?a:ot•payillenttoCity.ofamount shown_below for purpose,stated
,• .!' �'40,411'Receipt is Incorrect;'notify Finance Office immedIlMeiy
r � b
I 'FO POSTING REFERENCE
%'' it PAYMENT INFORMATION
L I Fund
Acct.
.Amount
1. Date �
2.. Amount Paid
7-1 arch 13, 1987
Ck
},l1'❑ GF,
`4 O PF
fry
!fir
30-A56
,,$4,250.0.0
3. Purpose �,;5#?8`9,
4 Received by
5 ❑ SF'
0Q.00
;! a� ci Rrrent�` Avr;nue
PRF
•3.1=437`'
��
Api�: q� 9- r, 9112
Z;
5. Payor -
lo'sr❑
7' p AF
9:0 TFC
'
.`
F'.onal d_ L, . f ra: i ear Con,1:t-uc ` lon
❑r
`3519 ;.'i coli i.7 ne Court 21
I`
r
e rt
DISTRIBUTION: White FO Serial File"
Yellow—FO Date File; Pink—Payor,
1'15 1y8 85 15M
iii} of i c
1a k�aii�i o i�
• ' t h� f. BVI . �..
a T �
� V
\ k Y'r •T.Y r(rr (�. y 1 c � . � „tea
i,�84��t �,fR_•7`�{x k' t "'�'{' 1 p k�� �r�� } ti �
kY
All
f n�3�t"w ;{
>5rkI
A rh }��i iY - ,ya.4n��• ',#'ifi r ,2 r„fir >r y 7'� ` 6 x i -, -
jj
.'^-r3� '”? ` •1 '�.'.�;'�' .., A,�_ _ .�..:��_ v. , a..ni �v- .... ..i a •r: i .
Sewer Fees whichever is longer. Any amendments to the C1ty:s Sewer
Connection' Fees. become effective on or�'about1JJuly Whenst 0thesehact ons:a�e
should take the action marked with an X be
completed, you .may then contract with fromctheeDepartmenliensd t.ofnPublic rWorks
may then secure the necessary permits
and proceed with the desired. -connection.
Annexation to the City of Chico or ex:ecu'lnon of n sewer"Aservice�n Contact the
Service Agreement is a cond�t,on of obta g
City Planning Office in the Municipal Building, 5th'and Main Streets, Phone
895-4851. Also, if your property is annexable, you will be required to
-or construction._ (Chico Municipal; Code
secur.e:City building permits
16.10-190)
permiom
Pay the computed connection fees prior to securing necessary,
5 tht:andrMain
the Department of Public .Works, 2nd';floor, P
sh b
Streets. In this regard, ourion
aherlsewe� connectiopay the �nfeesl.whichebecome
s now ln
order to avoid havin to a
effective. on or about Jul 1 f each year. If ata later date.you decide
not to r�ceed with this roj=ct, You ma r -e uest to receive a refund of
sewer connection fees paid.
This office has determined tr t.yt City
ousa,re eligible. for the deferred payment
en
of sewer connection fees quot_d herein, in couptoaconnecthyour rproperty to
Council' policy. The agreemen= would allow you
the'City sewer system now and-, the sewerare interested i'n
rnnection eopursuing-year
this
period.' Please contact this .ffice �f you
.. opti,on.
Construction of a sewer' extension as shown on the attached plat is
payingthe connection fees as noted:
your responsibility.in.addition to .
(.In -this regard, you may wisr, soo eXlease contactecute with ethetCommuny a ityrServices
Reimbursement Agreement I , P
Department about such .an agreement prior to commencement of work.)
fees
seer cnnetion.
'No,further action is.necessarr sin itswfromotheCDepartmentwofePpublic�Wor'Ks..
paid, except_to secure'requi•_d pe .
DIRECTOR OF PUBLIC WORKS
By
M. Dale Shaddox
Community Services Assistant
Phone: 895--4872
DS:kt
Attachmert:.Sewer APplicatio
l Chronc File Sy t
D_stribu ion SS App AP# 042=15-38 E
B il.Oing FO-lder: W. Sacramento Avenue, 042-46-25
( ) Planning
Subdiv.is •n File ."
Rolis, Andersc—, Rolls, 965 Fir Street, .Chico, CA 95928
j .
i°
.RESIDENTIAL
- r
SECTION 'IhI -.COMMUNITY SERVICES,DEPARTMENTy,USE
r
A ProperEy Information
,.. ; x_ ;.
In' "City
2..• In Cit, tas of June''18 1982 (Ihcludi'ng Annexation No 384 ):'. Q;Yes
3. Within City Sewer Service Area: .� :Yes .
0 No `
4. Anne xable:! Q Ye%s
too :..DNA
�4-
x:
5: Existing. Zoning, (.��T- or._General Plan Designation
6, Property Front, Footage y SCS `. l.f: (Shortest side)
7 : Property Area: -� acres
8. .; No.. of Residential Units•'Presently ,Connected to.Sewer:
of Non -Resident'i'al Acres'*Presently Connected: t'o .Sewer:' r
10. Property jn a:Sewe :Assessment District: No.a Yes. Name'.:
iw 11'.,y�Subject,to NECSAD reimbursement -Agreement:
O
12 .;. Main Extension-Requ_ired Q No . Yes:'`' Estimated Cost'$ .z '� en7.
13°. Sewer Connection.Fee Credits;.
a. Trunk Line Capacity, Fee.,
'No. of , Units '� _@ 5510/3850
Cu.renC Equiv. --�
-'
No. of .Acres -- @ 52.038/53,391 $ ��
Current 'Equiv.
,Payments
b'Waiter Pollution.ControA, Plant Feer
No of Uni s'- "" @ 5850 $`
Current Equiv.
:No ofti Acres @. 53,397• $. y
Current Equiv.
Payments
a
14 Subject to 'SeNer Cor.riection 'Fees' for.;
1
•;a Trunk' Line Ca aci.t Fe
p Y`
No of.•Uni
b whtcr Pollut-io Control' Plant FccS
:
fF
`No o'f .Units"
,.
;c `Sewer Main ins allatiori'Fec
Front Footage l f:; (Min. 60 ft.; Subdivisions
gr.catcr than
y 4. acre, - 150 ft.)
1' '�DNA(Main xtens`ion Requsred)
{
Q DNA_ ( Exe-F
)
t. •3+ µ 'il h r
-
CSD �w r
1/87
PagE,f 4
S. Computation of Applicable Sewer Connection Fees: FESIDENT IA,L
1: Trunk Line Capacity. Fee s X $/E850 = S LIZ S70
Units
Less Credit,, from A. 13. a. above)
Net .
2.. Water Poll.: Cont: Plant Cap: -Fee:
x$850 S (� ZSbov
Units'
Less Credit (from A,.13.b. above), = S(
Net: Uv
3.. Sewer Main Installation Fee
❑ $23 /front foot X • 1--) 1 . f . _
See REMARKS Section; Item No. 3
4.. Less Application Fee (IF CONNECTION FEES PAID WITHIN 60 DAYS
OF THE DATE OF CITY RESPONSE LETTER.).
S. ,TOTAL K£T ADDITIONAL SEWER.CONNECTION FEE:
C., Estimated Additional Monthly Sewer Service Fee:
✓� X S3'90,/month S SO
Number• Residential'Units /month
REMARKS:
1: SEWER SERVICE IS AVAILABLE
This property r
and iis.poposed use can be served by the ex
collection system:
isting.sanitary: rsewe
2. SEWER SERVICE IS NOT AVAILABLE
This Property -and/or its proposed use cannot•be served at this
the time because of
following:
The, proposed.use of this,property. is not in compliance with the''Chico'C.ene_a1
Plan: The Chico:Genefa,l Plan designation for this
property is
Q This property is located outside of the Chico Sphere of Influence and is r.ct
currently eligible -City sewer' service-. Sewer service to this` property woul,
rhe-ihire. changes l Plan'
Council policy,; the Chico Sphere of Influence, and
'the Chico General plan: •
property is located cut's ide,of .the City Sewer Service Area., There is
insufficient capacity in t -he existing Sewer Collection System to s
P operty. erve the
3. If an approved private sewage''disposal system is installed in lieu of connect :cr.
to City.sanitary.scwcr system, a'_1 connection fees quotcc herein,. lus a sewer -.a-n '
insta'_�lation fee of S!,
paid, as a'condition `of the issuance of a connection crm_t f. f. ,X S23) shall: c
p (CMC 16.36.190)
S:. Sewer rt'in instal kation fees Subjkti tc a Sewer Reimbursement Agree-ent (other than NECSAO):.
CS'0 .
RESIDE*'TIAL
FD. Reviewed by: 3L3 & 7•
E. Approved by: DIRECTOR OF PUBLIC WOPKS
gy �i �%✓,oy,��TX�
Dated:
FOR
OFFICE USE ONLY
[D Deterred Payment Agreement Executed
Date
Sewer Connection Fees Paid:
O.R.I
Amount S
INDIVIDUAL FEE PAYMENTS:
Date 0. R. NO.
:.-noun;
Sewer Main Installation Fee:
S
Lot I
Fee Descriptio*•
Trunk CapScit%
S
WPCP
S
Trunk Capacit.
S
WPCP
S
Trunk CapacitN
S
WPCP
S
Trunk Capacit%
S
WPCP
S
Trunk Capacity
5
WPCP
S
Trunk CapaCit;.
S _
WPCP
S
Trunk CapaciL�
S
WPCP
i
Trunk Capaci"t.
WPCP
S
Trunk Capaci•.
S
WPCP
S
Trunk Capacit•
WPCP
$
Trunk CapaCit,
5 _
WPCP
S
�
Y
8
A--.w�
!/3
0 039
C
I6
55 2IC
S 00° (l*54"£ 32500 033 AC.
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BZr6 BO.co BO.CD 00003B.
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roe INSTALL 420 LF l0"
116'
I
N n SANITARY SEWER AND
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ri C 4 8 " S -10 MANHOLE
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A 29 029
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62 Z7 BO.Q� 80W Bow 8953
WESTMONT DRIVE
$;
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IC6
A.P. 042-015-038
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vai
& 042-460-025
H
1.42.ACRE 450 FR FEET
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0 26 AC.
w
3
rW 73
N'000 04'1-C " £
266
IF_X,ISTING
I
24" TRUNK SEWER
}
m
CITY
OF
CHICO DEPARTMENT OF
PUBLIC WORKS
1�.
{
DRAWN BY
CHECKE: BY'
w
':•..;:.-.'.^DROVED
DATE �-3'07
SCALE
' ♦Y
BY
F.pr mrl OF P11R1 V —ORKS
R.C.E.
§!, BUTTE COUNY 'PARKS", DEVEI:OPMENT FEE ,CERTIFICATION FORM
CHICO AREA'RECRTATION
AND PARK' 'DISTRICT f,
Assessor Parcel 'Number (s;)_
Property Owner . Q +'� (` a 2 1
✓�
Project .Location/Address`:. (7
WQ�'w�
Subdivision a .' ' h ". c v1 1`'� rCt`� L'ot Number'(s)
Residential '.Development:,'(check one) .
New Development
Alteration/Addition
Moblehome(s)
_Non-ResdentialJto Residential
{
Total Number of Dwelling 'Units-
C9 h �
,
Comment
�r
,
T.
Buil i e es tative
Date
p
.;:, ., �r�r���r��*�r�r�r�r�r�c;r�r�c�r�ti�w�r�r��r�r�r�r�r�r�r�r�rw�r�r*�r�*�r�r�cw,rv��r�r�.��r�r�r��r�r�r�rw�r�r�r�r�r�c�r�rw�c�r��r�c�r•:, '
Chico. Area;Re'creation and Park District(CARD),,certifies.,that
r or 4Z�1�f'�
•it�l�
(Ap'plicant�Name)
(Phone 'Number)
'(Street, Address)
:.(City)-�—: (State)
(Zip,.Code)
has complied with..the requirements -of
Butte.Co..,•Resolut"ion No.. 89-08,1. by
payment for dweiling units' @'" $722
60
,for. total payment of.$,'
-
- Y
epresentative
�''
PAID BY CHECK NO REMARKS._
-
BANK ' N0..
PAID BY CASH -.
RECEIPT`NO1...
park.
i
rn1
AUG 18 1988
Nr
iPl
rl
-
{�•
..l
r:_� ?', ter-
'
.�-+'k
_
Certificate of Compliance: Res id; Climate Zone 11
R. DN f :RrA2t6
' Project Title 2 8
8� W EST' tM bN T Building Permit M o
Project Address b+-1� -4-69--
C Checked By / Date .
LA ..
Documentadod Author Twp. °ne Fltforcement Agency Use Only
•BUILDING
Area
% Glass
DATAGlass
t>�•
North-
G 2—
2 e,9
._
' Conditioned Floor Area 'LI UP Number of Stories- I
East
�,L02�•
•
S1abgOaFloor. Number. of _Units I :.
South
2.,(o
• 2 ' .
[ ] Single Family Detached (SFD) : [ ] Addition Alone
West
12�
5 •'�
[ ] Single Family, Attached (SFA) [ ] Existing Building
Skylight
[ ] Multi-Family,(NM f ] Existing -Plus -Addition
Total
31
WELDING SHELL INSULATION
Component ' Insulation Location/Comments .
R -Value (atria, io garage, typic:84 etc.)
Wall .............. -13 EXT e WALLS
Wall.... ....
Roof .. .. , - `
Roof ............
Floor............ N RAI
Floor .:...........
Slab Edge.....
GLAZING Shading•Devices
Glazing Area Glass Type Interior. Exterior f
Overhang
Framing Type
Orientation . (sf) (single, double) (Toiler blind, etc.) (shadeacreett. etc.)
(yeom)
(metal/wood)
Mandatory Measures Checklist: Residential' MF -1R
NOTE: 'Lowrise residential buildings subicci to the Standards must contain thea measures regardless of the compliance
1 approach used.,Items marked with an asterisk (•) may be superseded by mac stringent compliance mquuemenu listed
on the Certificate of Com'plunce: When this checklist is incorporated into the permit documents. the features noted shall
' be considered by all parties as binding minimum component performance speditcatrorts for the mandatory measurer
whether they are shown elsewhere in the documents or on this checklist only.
DESCRIPTION DESIGNER ENFORCEMENT
Building Envelope Measures ;
• §2.5352(a): Minimum ceiling insulation -R•19 weighted avenge..`
§2.5352(b): Loose fill insulation manufactwer% labeled R•Value. '
• §2.5352(c): Minimum wall insulation in framed walls R• 11 weighted average (does not apply to
exterior mass walls).
l
§2.5352(k): Slab edge iiuulauion - water absorption rate no greater than 0.3%. water vapor
transmission rate no greater than 2.0 permftnch.
I�
12.5311: insulation specified or installed meets California Energy Commission (CEC) quality
standards. Indicate type and form.
62.5352((): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§2-5317: Infilttation/Exfiltiauon Controls '
a. Doors and windows between conditioned and unconditioned spaces deigned to Emit air
leakage
b. Doors and windows certified.
c. Doors and windows weatherstripped: all joints and perpetrations caulked and sealed
§2-5352(e): Special infiltration barrier installed to comply with 12-5351 meets CEC quality
standards.
I+
12-5352(d): Installation of Fireplaces
1. Masonry and factory -built fireplaces have:
a. Tight fitting. closeable metal or glass door
b. Outside au intake with damper and coned .
e. Flue damper and coned
2. No continuous burning gas pilots allowed.
HVAC and Plumbing System Meattures
i' §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach ealcoh otts.
y
02-5352(h) and 2-5315: Setback thermostat on all applicable heating systems
' §2-5316(a): Ducts constructed. installed and insulated per Chapter 10.' 1976 UMC .
§2.5316(br Exhaust systems have damper controls.
r
12-5314(c): Gas -feed space heating equipment has intermiaent ignition devices
62-5314: ' HVAC equipment, water heaters. showerheads and faucets Certified by the CEC. .
§2.5352(i): Water heater insWation bLanka (R-12 or greats) or combined interiorkxterior
J insulation (R-16 or greater): fust 5 feet of pipes closest to tank insulated (R-3 or greater). --
No ith. ((PT (62-/1�MeA AL 12-5312(Exception 1): Pipe insulation on steam and steam condensate return A recirculating
Nortrl� DrDin&
§2-531R(d): Swimming Pool -Heating
East i✓Y 02 r 1 sya
a. oe ii
f
East ( ) _ - switch on heater.platconheater. _
X
souLh
. c. Plumbed to allow for solar. t ,
SOU tri ( ) 2. 75 percent thermal efficiency-
3- Pool cover.
West ' \ �/_ IZI Wl•!tT i. 4. Time clock.
( ) 5. Directional water inlet
West
° Lightinga nd Appliance Measurer
Skyl l ghtr...... a Ip §2-5352(1): Lighting - 25 lumens/watt or greater for general fighting in kiiehens`and bathrooms.
THERMAL MASS §2-5314(c):' Gas fired appliances equipped with intermittent ignition device.
'. -
Type/Covering Area Thickness -
§2 by the CEC.f Indicate make and model number.
-
ens and fluorescent lamp ballasts certified
(slab/exposed, tile, etc.) (Sf) (inches) Location/Description (kitchen, bath, etc.)
COMPLIANCE STATEMENT ..
This certificate of oomgliance lists the budding features and perfonnance specifications needed to comply with
Title 24. Chapter 2-53 and Title 20. Chapter 2.' Subchapter4..Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner. who shall '
HVACSYSTEMS. Minimum Duct retain a copy of it and transmit the c6rdficate.00 any subsequent purchaser of the building,
Type (furnace, air Efficiency Location " Duct - Output , . Manufacturer/ Model #,
conditioner, heat pump) (SE, SEER,HSPF) (attic; etc.) -- R -Value', (Btuh) (Or approved equal) Designer. Building O
Nana: Name:
mA xce :72 'CL 5, 7 g rtt tn;t " rtl t,n
a/e..ick ' iD Address: Address: Q1,1t '
Tekphone:. Telephone Z Z
Maximum Furnace Heating Output . �. Btuh t.ic. N:
HOT WATER SYSTEMS 5 `
Tank Manufacturer/Model #
System Type (storage gas •etc) Capacity (or approved equal) Special Feature(s) (signature) (date) (sig attrz) (date)
STO R>P►a E GAS . Documentation Author Enforcement Agency.
Name: Name
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) ;
TIWFum: Agenc):
I. Addreu: Tekphmw
1. Ceiling Insulation
U -value
Number of stones
SCORE CARD
R -value
One
Two
Three
R-0
-103
-49
-32
R-19
-8
-4
-2
R-30
-2
-1
-1
R-38
0
0
0
U -value
0.10
-17
-8
0.50
-176
-84
-54
0.30
-102
-49
32 _
0.10
-26
-13
-8
0.08
-18
-9
-6
0.06
-11
-5
-4
0.04
-4
-2
-1 •
0.02
4
2
1
0.00
11
5
3
-11
-7
-5
R-5
2. Wall Insulation
-4
3
R-11
Single-
Single -
2
R-19
Family
Family
Multi -
R -value
Detached
Attached
Family
R-0
-68
-51
-34
R-11
0
0
0
R-13
2
2
1
R-19
8
6
4
U -value
3
F2 factor
8
0.80
-153
-114
-76
0.50
-91
-68
-46
0.30
-47
-36
-24
0.10
0
0
0
0.08
4
3
2
0.06
9
7
5
0.04 -
14
11
7
0.02
19
14
10
0.00
24
18
12
3. Raised Floor Insulation
16
-20 0
Insulation
in Floor
13
17
15
Number of stories
6
R -value
One
Two
Three
R-0
-17
-8
-5
-R-11
3
-2
-1
R-19
0
0
0
R-30
3
.1
1
U -value
Specification .
SCORE CARD
Interior '•
0.60
-144
-70
-46
0.50
-120-
-58"- - -
-38 -
0.40
-95
-46
30
= 0,30
-69
-34
-22
0.20
-43
-21
-14
0.10
-17
-8
-5
0.08
-11
-0
-4
0.06
-6
-3
-2
0.04
-1
0
0
0.02
4
2
1
0.00
10
5
3
Controlled
Ventilation Crawispace
10
30
Number of stories
-13
R -value
One
_ Two
Three
R-0
-11
-7
-5
R-5
-4
-4
3
R-11
-2
-2
2
R-19
1
2-.
-2
4. Slab Edge Insulafiou
26
-49 -15
k
Number of Stones
7
R -value
One
Two'
Three
R-0
0
0
0 .,
R-5
8
5
2,
R-7
8
6
3
F2 factor
8
15
22
0.90
-4
3
-1
0.80
-1
-1
0
0.70
2
2
1
0.60
6
4
2
0.50
9
6
3
0.40
12
8
4
5. Infiltration.(Air Leakage)
7. Shading (Shade Open)
Effective Percent Class
(Percent Stan x SC)
Effective
Specification .
SCORE CARD
Interior '•
Points
Water
%Glass
Standard
East
South
0
18
6. Glass Heat Loss
1
4
1
Total
16
4
2
U -value
1
Percent
14
.51 to
.41 to
.31 to 0.30 or
Glass
Single Double
.60
.50
.40
less
50
-121 -53'
-39
-24
-10
4
40
-90 37
-26
-14
3
8
35
-75 -29
-19
-9
1
10
30
-61 -21
-13
-4
4
12
29
-58 -20
-12
-3
5
12
28
-55 -18
-10
-2
5
13
27
-52 -17
-9
-2
6
13
26
-49 -15
-8
-1
7
14
25
-46 -14
-7
0
7
14
24
-43 -12
-5
1
8
14
23
-40 -11
-4
2
8
15
22
37 -9
-3
3
9
15
21
-34 -7
-2
4
10
15
20
-31 -6
0
5
10
16
19
-29 -4
1
6
11
16
18
-26 3
2
7
12
16
17
-23 -1
3
8
12
17
16
-20 0
4
9
13
17
15
-17 1
6
10
14
17
14
-14 3
7
10
14
18
13
-12 4
8
11
15
18
12
-9 6
9
12
15
19
it
-6 7
10
13
16
19
10
3 9
11
14
'17
19
9
-1 10
13
15
' 17
20
8
2 12
14
16
18
20
7. Shading (Shade Open)
Effective Percent Class
(Percent Stan x SC)
Effective
Climate Zone 11
SCORE CARD
Interior '•
Slab Floor Raised Floor
Water
%Glass
North
East
South
West Skylight
18
5
1
4
1
na
16
4
2
5
1
na
14
4
2
5
1
na
12
3
3
5
2
na
11
3
3
5
2
na
10
- -2-
3
5
-2--
-1 -
9
2
3
5
2
2
8
2
3
5
2
2
7,
1
3
4
2
2
6
1
3
4
2
3
5
1
2
4
2
3
4
0
2
3
1
3-
3
0
1
2
1
3
2
0
0
1
0
3
1
1
-1
-1
-1
2
0
-1
-2
-4
-2
0
na = not allowed
7.0
6
9 11. 13
13
16. Shading (Shade
Closed)
6
10 11 13
Effective Perealt Clara
14
8.0
'. (Percent
glass x SC)
14
.Ettetdiva' '
8.5
7
10 12' 13
14
%Gle>u. NoAt
EMSautlt
3
West
My light
18
14
48
-69
-64
na
16
-12
-42
-59
-55
na
14
.-10.
-35
-50
-46
na
12•
-8
-29
-40
-37
na
11
-7
-26
-36
-33
na
10\
-6
-23.
-31
-29
-74"
i 9
-5•
=20
-27.
-25
•-65
8
-5
-17 '
: -23'
-21.
-56
7
-4
-14
-19
-18
-47
6
-3
-11
-15
-14
-38
5
-2
-9
-11
-10
-30
4'
-1
-6
-8
-7
43 ,.
3'.
0
-4
-5
-4
-16
2
1
1
-2
-1
-9
1
1
1
1
1
-4
0
2
3
4
3
0
not albwAd
0.75
6.88
3 3 3 2
, ,
9. Interior Thermal Mass
Climate Zone 11
SCORE CARD
Interior '•
Slab Floor Raised Floor
Water
Mass
109
Stones Stones"
1700
/CFA.
One_
' Two Three, One Two . Three,
0.0
-8
15 -4 -2
-1
-1
0.1.
-8
-5 3 -1
0
0
0.3
-7
-4 -2. 0
1
1
0.5
-6
3 -1 1
1
2
0.7
-5
-2 -1 1
2
2
0.9
-5
-1 0 2
3
3
1.1
-4
-1 1 3
4
4
1.3
-3
0 2 3
4
5
1.5
-3
1'" 2 4
5
5
2.0
-1
2 4 5
6,
7
2.5
0
3 5 7
7
8
3.0
1
4 6 8
8
9
3.5
2
5 7, 9
9
10
4.0
'3
6 8 9
10
10
4.5
3
7 8 10'
11
11
5.0
4
7 9 11
12
12
5.5
5
8 9 11 "
12
12
6.0
5
8 10 12
13
13
6.5
6
9 10 12
13
13
7.0
6
9 11. 13
13
14
7.5
6
10 11 13
14
14
8.0
7
10 11 13
14
14
8.5
7
10 12' 13
14
15
10. Exterior Wall Thermal Mass
3
Exterior
Single- Shvle-
POU
-10
Wall
-5
Famiy Family,
Multi
3.8 .
Mass
units)
Detached Attached
Fame
0.00
S -
0 0
0
Water
0.20
699
3 2
1
1700
0.40
Heater
5 4
3
to
0.60
to,
-8 6
.4
Type
0.80
1199
10 8
5
more
1.00
None
13 10
7
0
1.20
0
13 12
8
14
1.40
5
12 13
9 ,
HP
1.60
9
10 13
11
"
1.80
3.5
10 12
12
4
2,00
2
10 11
13
POU
11. Heating System,
5
3
2
2
SE or HSPF
None
-45
-23
(assumes ducts In attic)
-11
-9
24
Solar
Sum of 1-6
1
1
_
0
25 or -24 to -141D -4106-4
to
16 or
SE HSPF
less -15 -5 +5
+15
more
0.72
6.60
0 0. 0 0
0
6
0.75
6.88
3 3 3 2
2
1
0.80
'7.33
8 7 6 5
4
3
0.85
7.79
13 11 10 8
7
5
0.90
8.25
17:- 15 13 11
9
7
0.95
8.71
20' 18 15 13
11
8
1
_-0
Efrective SE or HSPF
0
0
(SE or HSPF x duct emciency)
None
Effective -25 or -24 to -14 b• -4 to +6 to 16 or
SE HSPF less -15 -5 ': +5
+15 more .
0.30.
2.75
-73 -64 -56 -47.
-38
-30
na,
3.41
-45 -39 -34 -29
-24
-18
0.40
3.67
- -34. -30 -26 . -22
-18
-14
0.50
4.58
-10 -9 -8 -7
-5
-4
0.56
5.13
0 0 0 0-,-
0
0
0.60
5.50
5' 5 4 3
3
2
0.70
6.42
17 15 13 11
9
7
.0.80
7.33
25 22 19 16`
x`:13
10
0.90
8.25
32 28 24 20
17
13
1.00
9.17
37 32 28 24
19
15
21
Zonal Control Adjustment.
25
System
Type
.
3.1
3.3
3.5
Resistance
10 9 7 6
4
3
Other
4.8
6 5 .4 3
2
2
12. Cooling Syst.!m
Climate Zone 11
SCORE CARD
Unit Size (SO
SEER
Water
1. Ceiling Insulation
109
(assume: ducts In attic)
1700
2200
Sim of 7-10
Heater
Credit
or
-25 of -24 to -14 to -4 b
+6 to
16 or
SEER
less -15 -5 +5
+15
more
8.0
-14 -12 -10 -8
-6
-4
8.5
-9 -7 -6 -5
-4
-3
8.9
-5 -4 -4 -3
-2
2
9.0
-4 -3 -3 -2
-2
1
9.5
0 0 0 0
0
0
10.0
4 3 3 2
2
1
10.5
7 6 5 4
3
2
11.0
10 9 7 6
4
3
120
15 13 11 9
7
5
13.0
20 17 14 12
9
6
None
Effective SEER
-24
-18
-15
(SEER x dud efficiency)
-I-
Solar
Sim of 7-10
-1
-1
Effective -25 or -24 to -1410 -410
+6 to
16 or.
SEER
lest -15 -6 +5
+15
more
5.0
-30 -25 -21 -17
-13
-9
6.0
-12 -11. -9 -7
-6
4
6.6
-5 4 4 3
-2
2
7.0
0 0 0 0
0
0
8.0
9 8 6 5
4
3
9.0
16 14 12 9
7.
5
10.0
22 19 16 13
10
7
11.0
26 23 19 15
12
8
12.0
30 26 22 18
14
9
13.0
33 29 24 20
15
10
-19
Zonal Control Adjustment
-11
-9
10 8 7 6
4
3
5
No Cooling System Installed
3
Stories
One -5 -4 -4 -3 -2 -2
Two + 3 3 2 2 2 1
Single -Family Detached and Attached
Point System Summary:
Climate Zone 11
SCORE CARD
Unit Size (SO
Water
1. Ceiling Insulation
109
1200
1700
2200
2700
Heater
Credit
or
to
to
to
or
Type_
Type
less
1699
2199_
_ 2_699_
more _
SG
None
0
0
0
0
0
or
Solar
12
8
6
5
4
HP
HWR
8
5
4
3
3
+
WSB
5
3
3
2
2
POU
8
5
4
3
3
SE
None
-37
-24
-18
-15
-12
-I-
Solar
-1
-1
-1
0
0
I
HWR
-18
-12
-9
-7
-6
WSB
-25
-16
-12
-10'
-8
POU
-18
-12
-9
-7
-6
IG
None
-5
-3.
-2
-2
-2
2W.
Solar
7
5
4
3
2
60%
POU
3-
2
1
1
1
IE
None
-28
-19
-14
-11
-9
0.8
Solar
8
5
4
3
3
23
POU
-10
-6
-5
-4
-3
3.8 .
Multi -Family (individual
units)
4.4
4.6
4.8
S -
Unit Size (SQ
10%
Water
0.4
699
700
1200
1700
2200
Heater
Credit
or
to
to
to,
or
Type
Type
less
1199
1699
2199
more
SG
None
0
0
0
0
0
or
Solar
14
7
5
4
3.
HP
HWR
9
5
3
2
2
3.5
WSB
9
4
3
2
2
5
POU
9
5
3
2
2
SE
None
-45
-23
-15
-11
-9
24
Solar
2
1
1
0
0
3.9
HWR
-23
-12
-8
-6
-5
5.3
WSB
-25
-13
-8
-6
-5
1.3
RQU
-23
-J-2-.
_._8
3
-5
IG
None
-8
-4
-3
-2
f -2
.4.3
Solar
6
3
2
1
1
5.7
POU
1
_-0
0
0
0
E
None
-30
-15
-10
-8
-6
3.2
Solar
18
9
6
4
'4
4.6
POU
-8
-4
-3
-2
-2
Point System Summary:
Climate Zone 11
SCORE CARD
Measures
1. Ceiling Insulation
R-30 or
L _
R -value [38) U_ -value 10.030]'
2. Wall Insulation
5,10
Interior Mass/CFA
3. Raised Floor Insulation
R _ I_ or
R -value [ 19] .. U value (0.037]
4. Slab Edge Insulation
or
Sum 1-6
R -value [0) F2 factor [(1771
I TTn I MASS
% Glass
Sc
Eff. % Glass
a. North
b.
- -Z t - -
X '
- -+ - -- - =
2
-
2
East
4 t
x-
+
(l.iaunca..t)
x
,� 2
d. West
$•-)
4 TYPE '1 M55
tUIMC
4.2.
Se: e:posed,slabl
e. Skylight
r 7
x
-I-
8. Shading (Shade Closed)
(Carpet .d slab)
I
a'.. North
% Glass
Z't9
X
SC
, 61 =
Eff. % Glass
l 4
y. -
b: East
X
c. South1
•2
X
% =
7 9
-}- Z
---d. WestQ�
"0%
.
5%'
10%
15%
2W.
25%
30%
35%
-40% 45%
50%
55%
60%
65x
70%
75%
8o%
851f.
90%
95%
100% 105% 1101: 115% 120% 125•
0%
0
0.2
0.4
0.6
0.8
1.1
1.3
1.5
1.7
1.9
21
23
;.25
".2.7
2.9
3.2
3.4
3.6
3.8 .
4
4.2
4.4
4.6
4.8
S -
5.3
10%
0.2.
0.4
0.6
'0.8
1
1.2
1.4
1.8
1.9
2
23
2S'
2.7
2.9
3.1
3.3
45
3.7
4
4.2
4.4
4.6
4.8
5
5.2
5.4'
20%
0.3
0.6
0.8
1
1.2
1.4
1.6
1.8
2
22
24
27.
29
3.1
3.3
3.5
3.7
3.9
.4.1
4.3
4.5
4.8
5
5.2
5.4
56
30% •
0.5
0.7
0.9
1.1
1.4,
1.6
1.8
2'
22-
24
.26
28
3
3.2
3.5
3.7
3.9
4.1
4.3
4.5
4.7
4.9
5.1
5.3
5.6
58
40%
0.7
0.9
1.1
1.3
1.5
1:7
1.9
22
24
26
2.8
3
3.2
3.4
3.6
3,8
4
.4.3
4.5
4.7
4.9
5,1
5.3
5.5
5.7
5.9
509.
0.9
1.1
1.3
15
1.7
1.9
21
23''
-25
27
3
3.2
3.4 -
3.6
3.8
4
42
4.4 .
4.6
4.8
5.1
5.3
5.5
5.7
5.9.
6.1
55%
0.9
1.1
1.4N
'1.6
1.8
2
2.2
24
2.6
28
3
3.2
3.5
3.7
3.9 ..4:1
4.3
4.5
4.7
4.9
5.1
5.3
5.6
5.8
6
6.2'
60%
1
1.2
1.4
1.1
1.9
21
2.3
25
2.7
29
.
3.1
3.3
3.5
3.8
4
4.2
4.4
4.6
4.8
S
5.2
5.4'
5.6
5.9
'
6.1
63
65%
1.1
1.3
1.5
1:7
1.9
2.2
2.4
2.6
' 28
3
3.2
3.4
3.6
3.8
4
4.3
4.5
4.7
4.9
5.1
53-
55
.5;7'
5.9
6.1
-6.4
70%
1.2
1.4
1.6
1.8
2
2.2
2.5
`27
2.9
31
3.3
3.5
3.7
3.9
4.1
4.3
4.6
4.8
5
52
5.4
5.6
5'8
6
6.2
64
75%
1.3
.1.5
1.7
1.9
21
23
25
27
3
32
3.4
3.6
3.8
4
4.2
4.4
4.8
4.8
5.1
5.3
5.5
5.7.
5.9
6.1
6.3
6.5
809.
1.4
. 1.6
1.8
2
22
2.4
26
2.8
3
3.3
3.5
3.1
3.9
4.1
4.3
4.5
4.7
4.0
5.1
54
56.
5.8
6
6.2
64
66
e5%
1.4
1.7
1.9
2.1
2.3
2.5
2.7
2.9
31
3.3
3.5
3.8
4
4.2
4.4
4.6
4.8
-5
52
54
.56
5.9
6.1
63
65
67
90%
1.5
1.7
2
2.2
24
26
2.8
3
3.2
3.4
3,6 •
3.8
4.1
4.3
4.5
4.7
4.9
5.1
53
5.5
5.7
5.9
6.2
6.4
66
60
95%
1.6';
1.8
2
2.2
.2.5
27
2.9
3.1
33
3.5
3.1
3.9
4.1
4.3
4.6
4.8
5'
5.2
5.4
5.6
5.8
`6 '
6.2
6.4
6.7
6.9
100%
1.7
1.9
'2V
22
25
28
3
..9.2
3.4
18
3.8
4
4.2
4.4
4.6
4.9
5.1
5.3
55
5.7
5.9=
6.1
6.3
6.5
6.1
7
105%
1.8
2'
' 2.2
2.4
2.6
28
3
3.3
3.5
3:7
3.9
4.1
4.3
" 4.5
4.7
4.9
5.1
5.4
S.6
5,8.
:6,'.'
6.2
6.4
66
68
7
110%
1.9
2.1
2.3
2.5
27
29
3.1
3.3
36
3.8
4 _
4.2
" 4.4
4.6
4.8
5
5.2
5.4-
5.7
5.9
6.1
6.3
6.5
6.7
69
7.1
115%
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6-
3.8.•
4.1
-4.3
4.5
4.7
4.9
5.1
5.3
5.5
5.7
5.9
6.2
6.4
6.6
6.8
7
7.2
120%
2
2.3
2.5
2.7
2.9
3.1
3.3
3.5
3.7
3.9
4.1
4.4
4.6
4.8
5
5.2
5.4
5.8'
58
6
6.2
6.5
6.7
6.9
7.1
7.3
125%
2.1
2.3
25
2.8
3
3.2
3.4
3.8
3.8
4
4.2
4.4
4.6
4.9
5.1
5.3
5.5
5.7
` 5.9
6.1
6.3
6.5
6.7
7
7.2
7.4'
Point System Summary:
Climate Zone 11
SCORE CARD
Measures
1. Ceiling Insulation
R-30 or
L _
R -value [38) U_ -value 10.030]'
2. Wall Insulation
5,10
R -value 1111 U -value 10.0981
3. Raised Floor Insulation
R _ I_ or
R -value [ 19] .. U value (0.037]
4. Slab Edge Insulation
or
Sum 1-6
R -value [0) F2 factor [(1771
S. Infiltration
Standard
p
6. Glass Heat Loss
L _
5,10
�.
Type [double]
U -value 10.651
% Total Glass [ 16)
Sum 1-6
7. Shading (Shade Open)
% Glass
Sc
Eff. % Glass
a. North
b.
- -Z t - -
X '
- -+ - -- - =
2
-
2
East
4 t
x-
+
1c. South
x
,� 2
d. West
$•-)
x
e. Skylight
r 7
x
-I-
8. Shading (Shade Closed)
I
a'.. North
% Glass
Z't9
X
SC
, 61 =
Eff. % Glass
l 4
y. -
b: East
X
c. South1
•2
X
% =
7 9
-}- Z
---d. WestQ�
5.7-
x,
`I =
Z-7 :
^ 3
e. Skylight,
t'7
x
9., Interior Thermal MaSS
O
TYPE 1> HIASS AREA a 0
-
In terior'M-iss/CFA
COND. FLOOR
TYPE 2 MASS
AREA
:.....
AREA'
C>-
t�
_ J
10. Exterior Wall Mass
d
= G 8
Exterior Wall Mass
ND. FLOOR
AREA
Sum 7-10
11. Heating System
• 7Z
x
116-5
_ IG'a
Zonal Control? ( Y / N)
SE or HSPF
[0.721 l
Duct Efficiency 10.781
Effective SE or
HSPF 10.5615. 151
12. Cooling System,
�.7
X
•8 Z
_ 7 25
Z
Zonal Control? ( Y / N)
SEER [9.51
Duct Efficiency 10.741
Effective SEER 17.031
13. Water Heating
TypeJSGJ
Credit [none]
Point Total
;�