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Home My WebLink About047-200-065119 -0- 0(04 .2 -90 C .ian Rd',, -.Chico 01-1 e A6 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE — OROV4LLE,-4&ALIFORNIA 95965 — TELEPHONE: (916) 538-7541 AGRICULTURAL BUILDING EXEMPTION PERMIT PERMIT N0. Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticulutral products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. ASSESSOR PARCEL NO.ZONING 6 FLOOD , 0 0 V_ "5; "0 OWNER ISSUE PHONE NO. OW ER'S ADDRESS I LOCATION OF BUILDING ^/ USE OF BUILDIN SIZE OF STRUCTUR X = y�v SQ. FT. TYPE OF CONSTRUCTI WOOD FRAME STEEL CONCRETE OTHER (Specify) TYPE OF SIDING ROOF COVERING FLOOR TYPE W ✓/��Ile I 1z' ESTIMATED COST OF CONSTRUCTION o a $ QOot AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances as follows:. FRONT J& SIDES— REAR S AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located am in imum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated above and the proposed use conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Department of Public Works and will obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date - 7 /?0 Signature of Owner Permit Fee - $25.0 The above described AG Building is exempt fr m a building permit. Receipt No. S'8 2 -N -N White - DPW, Yellow - Assessor, Pink - B. I., Goldenrod - Applicant Director of Public Works By Date 2- -7- FLOOD PARCE P.D. ROOFING ISSUE I Director of Public Works By Date 2- -7- COUNTY OF BUTTE - DEPAR OWNER Proposed Building Use 7 COUNTY CENTER DRIVE T,OF ..0UBLIC WORKS - BUILDING DIVISION PERMIT APPLIC At time of permit application, I was advised the following 1. All itemshave been submitted 2. Plot plans'in duplicate/triplicate, signed by preparer of plans ........ 3. Complete plans in duplidate/triplicate, signed by preparer of plans 4. Complete engineered plans and calcs, with wet signature on plans . . 5. Hazardous Material Form .......................................... 6. Ener Com and supporting Energy Design g Compliance documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions ..................................... .................. 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department X15. City of Chico plumbing permit ..................................... '16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-inspec. request to Building Inspector 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner o) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... 26. 27. 95965 - TELEPHONE: 916/538-7541 ON DATA SHEET Permit No. A. P. No. - y%-- Z O —Gr r ilding Inspector 65.E Date 2 A g must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED r When you Issue the permit, process as tollows: _jeof Mail to owner. Mail to contractor. Telephone Other and hold for pickup at office. 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_-nail counter by ..date Contractor, designer, owner, was advised of above required data by—phone —mal l_counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW 90 File No. ►_ . BUTTE COUNTY (For Action 1, 2,3) Public Works Dept. (For Information ✓) Director Dep. Dir. Sec. Rd. & Br. Mtce. Shop & Yards Bldg. Insp. Admin. O&C / Traffic Const. Rd. Des. Br. Des. Sur. & Loc. Transp. R/W Mapping Land Dev. Ref. Disp. Drng. / S.I. Sub. & Pcl. Maps Permits •H�r�C tilh Clinton Baccala Rt 4, Box 521 Chico. CA 95926 Dear fir. Baccala: f DEPARTMENT OF PUBLIC WORKS L� CLAY CASTLEBERRY, Director 7 COUNTY CENTER DRIVE, OROVILLE, CALIFORNIA 95965 Telephone: (916) 534-4541 H. W. McDONALD • January ll, 1983 Deputy Director RE: Building Permit A.P. # 47.20-22 With reference to the above subject, we have been advised by one of our building inspectors that you have not obtained the required permits,.and.inspections from this office for the work you are doing as follows: Constructing a two-story building on your property located off Meridian Rd.', Chico. Since permits and inspections are require& by both State and County laws, please contact this office within ten (10) days of the date of this letter, submit two (2) complete sets of plans, apply for the required permits, and pay the appropriate fees., including penalties. All work must stop until you obtain these permits and are authorized by our field inspector to proceed. This field authorization cannot be made until the existing work is inspected and approved. Your cooperation in resolving this matter would certainly be appreciated. Should you have any questions concerning this matter, please contact this office. Yours very truly, JFG:dd cc: guildin Inspector Chico ABsessW Clay Castleberry Director of Public Works Oreginal signed by .l. F. Glander J.F. Glander Chief Building Inspector LAND OF NATURAL WEALTH AND BEAUTY •H�r�C tilh Clinton Baccala Rt 4, Box 521 Chico. CA 95926 Dear fir. Baccala: f DEPARTMENT OF PUBLIC WORKS L� CLAY CASTLEBERRY, Director 7 COUNTY CENTER DRIVE, OROVILLE, CALIFORNIA 95965 Telephone: (916) 534-4541 H. W. McDONALD • January ll, 1983 Deputy Director RE: Building Permit A.P. # 47.20-22 With reference to the above subject, we have been advised by one of our building inspectors that you have not obtained the required permits,.and.inspections from this office for the work you are doing as follows: Constructing a two-story building on your property located off Meridian Rd.', Chico. Since permits and inspections are require& by both State and County laws, please contact this office within ten (10) days of the date of this letter, submit two (2) complete sets of plans, apply for the required permits, and pay the appropriate fees., including penalties. All work must stop until you obtain these permits and are authorized by our field inspector to proceed. This field authorization cannot be made until the existing work is inspected and approved. Your cooperation in resolving this matter would certainly be appreciated. Should you have any questions concerning this matter, please contact this office. Yours very truly, JFG:dd cc: guildin Inspector Chico ABsessW Clay Castleberry Director of Public Works Oreginal signed by .l. F. Glander J.F. Glander Chief Building Inspector BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS jZ SPECIAL INSPECTION REPORT Owner:A.P.%7r�-i 'Address:%.'' Date of Inspection' Z ' Inspector �G Tenant: .�/ f Building Location: !tii d . Type'of Inspection requested: - 1 ' Housing . f� 2.�' Financing ,(� 3. Change of Occupancy to • • '4. Other ( specify) ✓� �o�G W'2)%> ..,....!.''Present use. of building: �� A. 'Sanitation (Housing) .1. Water closet:. 2: Lavatory: 3. - Bathtub or shower: 4.: Kitchen sink:' 5. .Hot and cold water to fixtures: .6. Heating, acilities: - I: Natural light and ventilation: ' 8. ` Room and space requirements:, 9. .Bedroom window or -door for second exit: . 10. Infestation of insects, vermin, or rodents: -Connection:to,sewage disposal: 12. Connection to water -.supply: 13. Rubbish and garbage facilities: 14. . Cmri ents: B. . Structural 1. Piers and footings: 2. Floor construction: 3: Wall construction: ' 4. Ceiling and:roof construction: 5. Fireplaces: .. 6. . Comments: C. Electrical. l.. Service and ground: 2. Receptac: es• ' ' 3. Fusing: : 4. Comments: -- D. Plumbing . 1. Fixtures connected and vented: • 2. Gas water heater: 3. Gas heating vents: 4... Comments. {r E. Other 1. Maintenance and`r.epair: 2. Fire hazards-. • s. Safety hazards: 4. Weatl?er protection: S. Underfloor and attic ventilation: 6. Cormnents: F. CoTmrercial Buildings 1. Roof covering: 2'. Disrarce to property lines: 3. Physically handicapped: 4. Rest:-oom floors and walls: 5. Exits: 6.- Improvements: 7. Zoning: 8. Comment G. Field Problems or Viclatior,.s_ 1. Problem o_ iol3tzor.! (give Comp Pte de"cr.iptior.►) %% A.Info-nuation only - til<�. / Hold for ten (10) days, then writ -e letter. / / C. Write letter. 77D. Other: Al y 408-82B PERMIT NO. PERMIT EXPIRES OWNER Clint Baccala CONTR. Owner ASSESSOR PARCEL 47-20-22 LOCATION E/SNbridian Rd.,app.2 mi.S.of Wookey Rd., Chico , f' Temp. Power Pole Called PG&E Temp. Elec. Service Called PG&E Temp. Gas Service Cal led PG&E JOB FINALED (Date)�5 Signature V = OK . 0 = Not OK - = Not Applicable MOBILEHOMES ,M ' MISCELLANEOUS = Not Ready - Date MOBILEHOME UTILITIES (Plans) OK except N's Date DECP, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements Z Requirements—Setbacks—Easements 2. Soils; Special MH Support—Sketch ootings; Size—Depth—Spacing—Connectors 3. Sewer; Location—Test—Fall-C/0—Concrete 3. De ks; Girders and/or Joists—Decking—Bracing—Stairs—Rails 4. Water; Location—Test—Easement Needed (Sketch) 4_ Wood Awn.; 5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete 5. A' rn. Awry, Columns—Connections—Splice—Decal—Enclosures 6. Gas; Location—Test—Wrap:/ /"L"ft./ /"Nal.or/ PV ft./ /"LPG . &--Geape0s, ndows—Doors 7. Utility Clearance ria -- Card-BI Card -BI Date Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements Card -BI Card -BI Date Date Z Card -BI Date Date3�/,5� Card -BI Date POOLS (Plans) OK except #'s 1. Setbacks—Easements 2. Footings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability 3. Gas; MH Test—Demand—Valve—Connector 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining 4. Electricity; MH Test—Crossovers—Breakers—Clearances 4. Elec.; Receptacles and Lighting; Distances-GF1 5. Drain; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6. Water; MH Test—Regulator—Connector 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed 7. Water and Sewer Connected—C/0 to Grade—HD Approval 7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip.w/5'—Circulating Equip.—Pool Lghtg. Boxes— Enclosures— Pane lboards—Ins. to Main in Conduit 9. Exits; Insp.—Sketch 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test—Water Supply Test Card B-1 Date Card -BI Date Card -BI Date Card -BI Date Card B-1 Date Card -BI Date Card -BI Date Card -BI Date V = OK 0 = Not OK = Not Applicable = Not Ready RESIDENTIAL (Single and Dvplex) � Date UNDE OOR Plans OK exce t#'s Date FRAMING (Continued) ."Zoning requirements -Set - t n s 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /'' Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg, Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection tg., Porches & Decks; Soils -Steel- KZ-/" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, ; Ste I-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Ste a s Gara I-Blockouts-Wrapped-Slab -eel 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Pie WeDta 2 M. -'St 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D. I ittings-Test-2 way C/0 -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pip ize-Anchors 10. Waterripe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Card -BI Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date FINAL (Plans) OK except H's 56. Ext. Steps -Door & Sidelight Protection -Landings 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection Card -BI Date Card -BI Date Date PLUMBING (Permit) OK except p's 14. Water Ht.; Vent -Access -Combustion Air 15, Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access _ 18. Test Tub & Shower, 2nd Floor -Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 19. Gas Pipe; Size & Anchors 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. 65. Elec. Outlets at Wood Panel; Int. & Ext. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except q's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors 22. Size Boxes & No. of Conductors -Stapled 70. Plb., Elec. & Mech. Equip. Listed for Location 23. Romex Installed Close to Edge of Studs & C.J. 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 72. Insulation -Foam -Looked in Attic E] Yes - 25. 26. 2 Appliance Circuits in Kitchen & Conductor Size Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 73. Guard Rails &Deck Construction -Post Caps 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Neutral EYes El No 75. Following instld.: Drive E) Yes ED No; Walks ❑Yes ❑ No; PlantersF-1 Yes 0 N 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 30. Clothes Closet Light -Shower Light 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground Card B -I Date Card -BI Date 81. 82. Ventilation throughout House Glass Protection Card B I Date Card -BI Date Date MECHANICAL (Permit) OK except N's 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 31. A.C. Ducts; Insulation & Support 85. 86, Water & Sewer Connected -C/O to Grade -HD Approval Energy Compliance Certificate -Other Certificates _ _ 32. 33. Vent Fan; Exhaust above Insulation Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI Card -BI Date Card -BI Date Date Card -BI Date Card -BI_ Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRAMING(Plans) OK except q's 36, Sills; Proper Material & Anchors Comments at Final: _ 37. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound 38._ 39. Bearing Walls over Girders & Floor Nailing Draft Stop in Walls (rat proof) _40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Root Brac.-Truss-Shthng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing (NOTE: An entry must be made each time you visit jobsite) COUNTY OF BUTTE - DEPAR'TMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 .Telephone 916/534 g; APPLICATION.AND PERMIT LEPHON 7 ILING ADDRESS - CONTRACTOR'S MAILING A CONSTRUCTION LENDER AfD,d_f LENDER'S MAILING ADDRE ARCHITECT OR ENGINEER ARCHITECT OR ENGINEER 1M�IF///_ All T NO. I SUBDIVISION NAME NE NKN PARCEL MAP USE OF STRUCTURE SF LJ Duplex ❑ Mobi lehome ❑ Other SPECIFY TYPE OF WORK New ❑ Addition lam" Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe work: e2 4�e�, �Ci ' Aap ,g6z CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ 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 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. j I shall not employ any person in any manner so as to become subject �i to the W. C. laws of California. Notice to A Ilcant- If after maki this tate t h Id b TN BUILDING PERMIT SQ. FT. I OCC. 1 BUILDING VALUATION Fireplace permit Fee ELECTRICAL PERMIT Total Valuation $ Main service 100 AMP OR00V OR LESS5.00 d O Filing Fee $ 10.00 Permit Fee $4L,Qi 2,50 ea Plan Checking Fee $ 44, Penalty $ 2.00 Permit fee $ 19, PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Repair drainage or vent piping $ 5.00 Water piping MECHANICAL PERMIT Filing Fee 10.00 Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets Cooling Building sewer 3.00 Ventilation Lawn sprinkler system 5.00 Permit Fee Contractor permit Fee ELECTRICAL PERMIT Fi'lingFee 10.00 Main service 100 AMP OR00V OR LESS5.00 Main service EA. ADO'L 100 AMP 2.50 NEW CONST. (DWELLING OCCUP.y\ OR ADDNS. `ACC. SLOGS. I 20 sq NEW CONSTR -OU LET NON.RESID BRANCH CIRC TS 2,50 ea NEW CONSTR IPOWER APPARATUS 6\ NON-RESID. SINGLE OUTLET CIR, / HD Ex. OCCUp OUTLETS OR FIXTURES BA 1 p.06 EX. QCCU FIXED APPLNS. OR �OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation FT FF ng s men , s ou you ecome subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. permit Fee Contractor I certify that I have read this application and state that the above information Mobile Home Installation Fee $ is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequenceofthe granting of this permit. Xcr+L �� --I mil Date / �L Signature of Applicant — Owner ❑ Contractor ❑ Agent TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST, PARCEL PD HD I9 This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. An OSHA permit is required for excavations over 5'0" deep and demolition or construct- on of structures over3 stories in height. DIREC R OF PUBLIC WORKS By Date•�"��Z PE T EXPIRES Date Receipt No. / WHITE-D.P.W.. YELLOW ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPAF>�r'4c,�tIIENT OF PUBLIC WORKS 7 County Center Drive - Orovillerv�lifo iia 95965 - Telephone 916/534-4541 • AGRICULTURAL BUILDING EXEMPTION PERMIT Agricultural building is defined as follows: Agricultural building is a structure designe house farm implements, hay, grain, poultry, livestock, or other horticulutral products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. I ASSESSOR PARCEL NO. ZONING OWNER PHONE N0. OWN 'S ADDRESS LOCATION OF UILDING l ' USE OF BUILDING a- c SIZE OF STRUCTURE ' x �GDQ SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME L' STEEL CONCRETE - OTHER (Specify) ' TYPE 9F SIDING W ROOF OV ING FLO TYPE el 'e_ ESTIMATED CONSTRUCTION, D�COST ^^OF $ �y AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances as follows: SV -r . - FRONT IP--fl. SIDES .2- REAR C;2 - AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome,- and 23 feet from a commercial building. . AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated above and the proposed use conforms with the AG Building definition. if any change in use or occupancy of the building is made, I will contact the Department of Public Works and'will obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date 1 — 1-7 — 9 �) Signature of Owner�^-�- Permit Fee - $25.00 The above described AG Building is exempt from a building permit. Receipt No. 7(n ��Sd Director of Public Works By l Date White - DPW, Yellow - Assessor, Pink - B. I., Goldenrod - Applicant 991-81BjP,E$M - PERMIT,NO.- PERMIT EXPIRES OWNER Clint Baccala ,IL CONTR. Jdak,-fi,-U_ Chico Called PG&E - 7 - ASSESSOR PARCEL 47-20-22 Temp. Temp. Elec. Service LOCATION E/S Meridian Rd.,app.k mi.S.of Called PG&E Wookey Rd.., Chico Temg, Service JOB FINALED (Date) Signature Temp. Power Pole Called PG&E 7 - Temp. Temp. Elec. Service Called PG&E Temg, Service JOB FINALED (Date) Signature COUNTY OF BUTTE DEPARTMENT OF PUBLIC WQRKS^ 196 Memorial Way, Chico - Phone: 891-2751 7 County Center Drive, Oroville — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 4. CORRECTION* NOTICE /" _ �� _e BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this ^ Her or need additional explana:ion, please contact this office immediately. 7 v� J--x:J 3- Inspector Date COUNTY OF BUTTE , rrti DEPARTMENT OF PUBLIC WORKS /. 196 Memorial Way, Chico'— Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE &Z Awa - qt7r BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this 6atterVor need additional explanation, please contact this office immediately. ,Y, `-I% , i .. -.A' Z- Z� �e, �� iso SGt £fi'f:ol Inspector `'—f� % //�'�/ Date A COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way. Chico — Phone:'891-2751 • 7 County Center Drive, OroviIle — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 55' CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. ��J C/�d,�• / /I /f, !li /,✓ J111"e, //,L/W" /% 6U6 T Lv .6/ &,/I c/S- 0't f�o7vs s I-119?/ I .5/i// AZFrt✓ ) V .� - 4r,4aC 1 �'�/ Date / Inspector � / C-7 — J = OK 0 = Not OK - = NoVApplicable = Ilot Ready f RE=SIDENTIAL (Single and Duplex) Date UNDE LOOK Plans OK except #'s Date FRAMKG (Continued) Ae'Zoning requirements-Se-EasaaeW p 4 Pr�rty Line Firewall & Openings Main; S -he- §Jwr-Elego9Tff // /" Ftg. Depth 4 xt. Doors -One 3' -Check Garage -3rd story, 2 exits g., Garage; SajJ,�- / /" Ftg. Depth dth-Headroom-Rise-Run-Landing-Fire Protection 4. Ft Porches & Decks; Soils -Steel- / /" Ftg. Depth 3.wood on Roof Overhang -Attic Vents -Rafter Outriggers be"Sternwalls, Main; SfPPS-Blo&j(p -Wrapper-'SWb,/ S Siding -Nailing -Veneer $,-9temwalls, Garage; Suw.-BlozMeut's-Wra - sh-Drip Screed-Fdn. Vents-Underflr. Access 7. P' -Fireplace Ftg.-Steel 5 lazing Area -Glass Protection -Skylights -Plastic I D.W.V.: Fd+Y-Fi>Vis4s-T t wae res 55. Shear Walls; Nailing -Bolts $L� ize-Anchors a gtrf8tbr rvi �i lectric; Underground 2. +e Bucts; Clearance -Material -Support -Ins. 13�Girdecs-Sills-Anchor Bolts -Joists -Vents -Cripples Card -BI _ Date Card -BI 00 Date Card -BI Date Card -BI Date/ -Card -BI _ G Date _ _ff7- Card -BI Date i I Card -BI Date Date FINAL tans) OK except N's xt. Steps -Door & Sidelight Protection -Landings Date PLUMBING (Permit) OK except q's moke Detector 1 alar Ht.; Vent -Access -Combustion Air VaRi1r. Clearance -Comb. Air -Connector - 1 a ipe; Test & Anchors -Nail Protection Im_Gerage�.4beve Floor -Ducts -Meth. Protection_ 1 .W.V.- Test-Fttngs & Anchors -Nail Protection edroom Exiting an; Test, First Floor -Tub Access . G. & Bath Fixtures & Tub Access 18. Teq_tT1b & Shower, 2nd Floor -Tub Access lec. Trim & Subpanel; Breaker Sizes -Labels 1 as Pipe; Size & Anchors Card -BI Date �i Card -BI Date Card -BI Date 1 as Pipe; Size & Anchors emplace or Stove; CleBramles-He 17 6r- Elec. Outlets at Wood Panel; Int. & Ext. Kit._Eix+. & Appliance; Grnd.-A4v-6ep-Cook' arance Card -BI Date Card -BI Date Card -BI Date Card -BI Date lec. Outlets & Receptacles at Kit. Counter Date ELECT AL Permit OK except q's arage Fire Door;-Lase}iftg-Clpsw> ara a -Dam er 2 e & Transformer Clearance -Ins. Protection r. Htr.; Vents -CI � 'ce-Ceff4 ,4�ne irenetor-P - In G ; Above= -Mention 2 ec. Receptacles Spacing -Lights &Switches at Doors 7 b. Elec. & Mech. Equip. Listed for Location &k6 Boxes & No. of Conductors -Stapled 7 le Receptacles in Garage; (G. - omex Protec. Ome' x installed Close to ge of Studs & C.J. %i` E .Ground mad w/Mech. Fasteners -Bon Wa�B nsulaRecet ion- Foam- Looked. in Attic [_ 73. Construction -Post Caps Appliance Circuits in Kitchen & Conductor Size Seed Wire Size / / ga. Cu or AI-A.C. Wire 9iPe-/--/-gacCu or AI n. Vents &Crawl Hole Door -Drainage &Wood Earth Clearance Lo oor ❑ Yes ange Circ+ -4__.1 8e_Gv or AI-Ovem6irerl--/ a. Cu r AI, Insulated eutral Yes El ❑ GGA— 7 ollowing instld.: Drive Yes o; Walks E] Yes Gk'r�r Planters ❑Yes Conductors & Ground -Main Disconne Ifiser rown-Finish i AlS quip. Clearances; Panels-Motors-Mech. Equip. _ met Light -Shower Light s Above Roof; g. -A nce Fi IearaxGa4o-6pngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exte ' r Elec. Trim; G.F.I. Receptacle -Underground Card B -I DateCard BI Date 2 / 8+ --Ventilation throughout House Card B -I Date Card -BI Date Protection Date MECH ICAL (Permit) OK except q's orrectio from Previou .Inspections )tgf84. Gas st- rs T ed; Gas -E c A.C. Ducts; Insulation & Support r & re C/O (a.Gfede-HD Approval Compliance Certificate -Other Certificates _ ent Fan; Exhaust above InsulationEnergy 33. on ensa a Drain & Overflow; Size & Grade 34_Fuu+aee--Vent; Access -Comb. Air -Return Air Vent -115V outlet 3777AMC Access & Platform if Furnace in Attic Card -BI Date Card -BI Date dw Card -BI ___Date / Card -BI Date Card -BI Date '- S` Card -BI Date Card -BI Date Card -BI Date Card -BI W Date Card -BI Date Comments at Final: Date FRAMI G Plans OK except q's 3 s; Proper Material &Anchors -*-."Walls: Studs -Nailing, Spacing & Bracing -Plates -Sound _ in Walls over Girders & Floor Nailing raft Stop in Walls (rat proof) Ire Stops; Furred Ceilings -Stairs -Chases H.Pader & Beam -Size & Bearing Ha ers-Post Caps -Anchors -Connectors Joist-Rftr. Ties-Purlin oof Brac.-Ty ss-Shthnq.-Rfnp. _ re Iace.Siee-or Type ue-Fireplachroai 4 is Access; z o e. tection-DxadfZwprins. es m. Windows-'5r—Exiting Doors -Sill Hgt. & Dimensions 4 Garage Fire Protection Framing (NOTE: Anentry must be made each time you visit job site) V=OK L O = Not OK - = NotA'pplicable MOBILEHOMES MISCELLANEOUS 1'• * = 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/0 -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.-Shthg.-Rig.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete _ 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ P'L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. 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 -Easements 2. Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Gas; MH Test -Demand -Valve -Connector 3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining 4. Electricity; MH Test -Crossovers -Breakers -Clearances 4. Elec.; Receptacles and Lighting; Distances-GFI 5. Drain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Water and Sewer Connected -C/0 to Grade -HD Approval 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Panel boards -Ins. to Main in Conduit 9. Exits; Insp.-Sketch 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card B-1 Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date &INSULATION 3851 MORROW LANE - CHICO, CA LI FOR NIA 95926- (916) 895-3900 RESIDENTIAL ENERGY CONSERVATION STANDARDS CONSTRUCTION COMPLIANCE CERTIFICATE THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN INSTALLED IN CONFORMANCE WITH CURRENT ENERGY CONSERVATION REGULATIONS AT Meridian Road, Chico, CA 95926 (location) BU ILD ING PERMIT NO, A. P. NO. 41-7 ao - a. 4_ THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS: (Check each item or write N/A if not applicable) INSULATION: GLAZING: Slab Edge. N/A Single Glazed N/A Fdn..Walls N/A Special ( Insulated) Floors N/A CERT. & LABELED WDS. Walls X & SLIDING DRS. ✓ N-17? Ceiling/Roof X WEATHERSTRIPPED DRS. •- NSA Ducts ✓ BACK DAMPERED FANS ✓�6¢A Circulating Pipes INTERMITTENT IGNITION DEVICE N A APPROVED HEATER NOA✓ CERT. APPLIANCES APPROVED WTR.HTR.✓ I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE BEEN INSTALLED IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIREMENTS AND AGREE TO THE COMPLETENESS OF THIS CERTIFICATE AS SUBMITTED. Insulation Applicator Name_ C & J Roofing and Insulation Signature of (please print) Insulation Applicator (Omn,_t,, D,901_%n�' j State Contractors License No. 309245 General Cir/Owner Name n nj.+(-. B= ci i a lease print) Signature of General r/Owner C�__ Date State Contractors License No. THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO REQUESTING FINAL INSPECTION AND SHALL BE POSTED IN A CONSPICUOUS LOCATION WITHIN THE DWELLING. , COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS P�RM11T- N 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER - ZON NG _ 4 BUILDING PERMI OWNER - - TELEPHONE SO. FT. OCC. BUILDING VALUATION c' 1 (/ OWNER'S MAILING AD�.g ESS ' R+ V. L'SmL ;iv R JA 0`7 _ R ' CONTRALTO 5 ME _ TELEPHONE e t� ci b - Permit Fee $ 3a 00 MECHANICAL PERMIT ' Heating kk is correct. 1 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 avid keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue ag s; s • County I onsequence of th granting of this per it. CONTRACTOR'S MAILING ADDRESS Rt '' fCZFireplace Cooling _, 0Z b^ o Hood CONSTRUCTION LENDER UNKNOW Tot aI ValUatlOn $�'6. This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. ^ X Date 3 Signature of Applicant — —Owner Cont for ❑ Agenr Filing Fee - $ 10.00 LENDER'S MAILING ADDRESS Permit,,Fee $ DID ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ' Penalty $ - ARCHITECT OR ENGINEER'S MAILING ADDRESS - ' Permit fee $ BUILDING ADD ESS- ,(i1 rl r - PLUMBING PERMIT Filing Fee 100 JEach 15 Trap J1 2.00 J ;00 Repair drainage or vent piping 5.00 Water piping "no LOT NO. SUBDIVISION NAME PARCEL MAP •• Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE r SF Duplex ❑ Mobi lehome ❑ Other ' SPECIFY. Building sewer . Lawn sprinkler system 5.00 TYPE OF WORK New [Addition ❑, Remodel ❑ Utilities ❑ Instal lation❑ Other ❑ ' Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service Doov OR LESS 5.00 100 AMP OR LESSpo Main service EA.ADD'L 100 AMP 2.50 NEW CONST. ! DWEL I UP.y) OR ADDNS. \ ACC. G 22 sq ft CONTRACTORS LICENSE LAW ' I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of. Chapt. 9, Div. 3 of the BusinessSO and Professions Code and my license is in full force and effect.' License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) Eff I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ` 'at NEw CON5TR MULTI -OUTLET 2.50 ea NON.RESID BRANCH CIRCUITS) NEW CONSTR. /POWER APPARATUS D\ NON-RESIO. \SINGLE OUTLET CIR. I @ 25¢ Ex. Occup OUTLETS OR FIXTURES BAL@1 Ex. Occup. OUTLETS P(RESID )REA. 2.00 Temporary service 10.00 -Mobile Home Facilities 15.00 Misc. Wiring 7.50 ❑ I am exempt under Sec. Business and Professions Code Permit Fee $ for this reason Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): F-1The 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. Noti� t A Ii t• If aft. aki th' t t t h Id ce o pp can . r m Ing Is s a emen , s ou 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. Permit Fee $ 3a 00 MECHANICAL PERMIT FiIingFee 10.00 Heating kk is correct. 1 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 avid keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue ag s; s • County I onsequence of th granting of this per it. 190 TOTAL PERMIT FEE - $ V 7 V Cooling _, 0Z b^ o Hood 3.00 Ventilation sso This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. ^ X Date 3 Signature of Applicant — —Owner Cont for ❑ Agenr ce o pp can . r m Ing Is s a emen , s ou 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. Permit Fee $ 3a 00 Contractor I certify that I have read this application and state that the above information Mobile Home Installation Fee $ is correct. 1 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 avid keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue ag s; s • County I onsequence of th granting of this per it. 190 TOTAL PERMIT FEE - $ V 7 V oCCUP. GROUP I/K,J_ 3 `TY/PE of CONST. V~ Ai PARC PD Ho Y sso This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. ^ X Date 3 Signature of Applicant — —Owner Cont for ❑ Agenr An OSHA permit is required for axc ations over 5'0" deep and demolition or construct- ion of structures over 3 stories in he' ht. DlREC OF PUBLIC WORKS ByDate 17-7 - Receipt No. 4 Z-2 lob WNITE-D.P.W., rE E NK-INSPE TOR, GOLDENROD -APPLICANT PE T XPIRES Date RESIDENTIAL PLAN CHECKING GUIDE (S.F., DUPLEX, & MISC. ONLY) U-%� L//� CG �i (�/Q- r Bldg. dU tP. A RAL 44 -f eqf IG� � G� %4V I"zoning requis sideyards and parking). ,c.2: Valuation. -3—. Signature by R.C.E. or Architect (if,required). B. PLOT PLAN -Complete parcel size and dimensions. � Setback.$, sideyards,•easements, etc. 9'• Other buildings or structures. Grading, fills, drainage. C.' FLOOR PLAN .•Y. Complete to scale plan with dimensions. ',21 Required windows for Eight and ventilation (Sec. 1405). �! Required windows for second exit (Sec. 1404). Peit # # �f7'20-2z Allowable_glaz ing_ for_ energy_Ke . rements (2.0% max. per . State law) . •- Human impact glass (Sec. 5406). f Required room sizes, ceiling heights (Sec. 1407). A. G.F.C.I.'s in baths and exterior outlets (Sec. 210-8). Light fixtures, switches, receptacles, and exterior receptacles for maintenance of Lechanical equipment. ocations of water heater, heating & cooling equipment, other electrical or gas equipment, and plumbing fixtures. Garage firewall, door size, and closer (Sec. 503(d)(4)). J.1! 1 - 3'0" exterior exit door (Sec. 3303d).- Fireplace location. ,1-3: Smoke detectors (Sec. 1413). D. STRUCTURAL DETAILS ,,X• Foundation plan complete enough to construct building. >11 Floor construction details complete enough to construct building dQ Elevations and wall construction details complete enough to construct building. f�! Roof construction details complete enough to construct building. 5. F -&replace construction details and calcs if over one-story in height. Sufficient data and details to satisfy energy insulation requirements (State law). E. MISCELLANEOUS ITEMS TO LOOK OUT FOR ,.1. CCX plywood on.exposed locations and overhangs. -2 -stairway details (Sec. 3305). -'-.--Guardrail details (Sec. 1716) . .4. Briek or stone veneer (Chapter 30). plaster - weep screeds (Sec. 4706 & 4708). Proper roof pitch for roof covering•(Chapter 32). X Rafter ties or bearing _ridge beam. X Garage door or porch header sizes. • Adequate bracing• 19. 13kjing area over garage - complete 1 -hour separation required including supporting walls and posts, etc. exits on three-story dwellings (Sec. 3302). AGRICULTURAL AFFIDAVIT EMPLOYEE Employee S [eye.n C: FnX Phone ��f3��1L10 Employee's Address (Present) i7_+. y 1_2m 510 - r ch�Co ,�`1� Q;5cl Name of Owner—n, j n+o n San n c -1 a Owner's Address 24 6)� i -j u - G C' h iw l P q51--o2-io Owner's Assessor's Parcel No. Building/Environmental Health Permit Description and Number' Date Issued By Planning Department Approval: Date G� � � Zone J [ Dwelling 'on AP# -17 2� I, s2.Ve n c S2-,4 , do declare, subject to the penalty of perjury, that I am the employee of C l i h4nn ,I ��_Ojn, `1c. address (present) , zJ any, J3 Ch;m on _. AP# y_% -C a -a. and that I -will be employed under Section 24-21.2 for at least a to 7ET thirty-two'(32,) hours per week for at least sixteen,(16) weeks per year on AP# y %-rz� - Q 01 i AGRICULTURAL AFFIDAVIT EMPLOYER c I'i r N+0y 1 ZCx acn-iCL Employer Phone `` 44,3-7 !4l () Employer's Address (Present) T-±. I 13OX 510—E C% Cn Q�A Name of Owner 021 n -E -nn Owner's Address 11- C.h iC .) (''lel- GhCI Z O Owner's Assessor's Parcel No. 44 7O a-oZ .Building/Environmental Health Permit'Description and Number Date Issued By. TI(- Planning Department Approval: v Date J1116 I pone `"7a Dwelling on AP# 1, 0,1 i c1-tlyl ' ,(' C� �j(', _ , do declare sub j e c t to the penalty of perjury, that I am the employer of address (present) on and that I will be employer under Section 24-21.2 for at least a to_77. thirty-two (32) hours per week for at least sixteen (16) weeks per year on. AP# ' X17 - aC5 - Gt_ oL \" Signed v Dated , k �X% O