HomeMy WebLinkAbout047-580-007s�-a7
Donn tch
E/S Meridian Rd.,app.400'S.of Munjar
Rd., Chico
Permit #5216- 0O ;, uti1.BMH) G/
ELEC . 72-79 8o �pOA ZooA �'oA
GAS /2-I9-80 X49 �GPly
SUPPORT STRUCTURE REQ.
_COMPACTION TEST REQ.
-79
Permit #521 KOMHI /
Issued - A /
0H -7-58o q, I
r
I Mims!
5216 -80P -,E
PERMIT NO.
PERMIT EXPIRES-
OWNER Don Hatch
owner
CONTR.
r ASSESSOR PARCEL -22-79
LOCATION E/S Meridian Rd., app.400'S.of Mun7ar
t
R Rd., Chico
i
.l
d.
sl
}
t
Fi
K Temp. Power Pole
Called PG&E
Temp. Elec. Service / 2'
Called PG&E
Temp. Gas Service Z ��
i Called PG&E
t JOB FINA ED (Date)
Signature
J=OK
0 = Not OK '
= Not Applicable MOBILEHOMES
= Not Ready
9
0
MISCELLANEOUS
`P,
Date MOBIL ME UTILITIES (Plans) OK except a's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except q's
1r/S oning Requirements -Setbacks -Easements
1. Zoning Requirements -Setbacks -Easements
al MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors
ewer; L ion -T -F II- - o'qggo
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
er; Lo tion-T'-EesemeM.Dleeded (Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing
IL, Ele city; Lo ion-Cleara - .-/Ad/ Amp o ete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
'6 G s; Locatio Tes Wrap:/ /"L"ft./ /"Nat.or/ /"L"ft./ "LPG
:_
6. Carports; Windows -Doors
Utility Clearance
7. Elec.
Card -BI Date1Z1%V-_fjS Card -BI Date
Card -BI
Date Card -BI Date
Card -BI Dat ✓ RQ Card -BI Date
Card -BI
Date Card -BI Date
Date MOBILEHOME INSTALLATION (PI OK except N's
Date
POOLS (Plans) OK except #'s
;601foning Requirements -Setbacks -Easements
1. Setbacks -Easements
outings; Size -S acing -Marriage Line
2. Soils; Compaction -Structure Stability
(W. s; M Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
i . e tricity; M Crossovers -Breakers -Clearances
4, Elec.; Receptacles and Lighting; Distances-GFI
51. Drain; MHja�Fall-Flex Connector
6. Water; MHQyD-Regulator-Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
L-Wa-ter and Sewer Connected -C/0 to Grade -HD Approval
7, Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8: Gas and Electricity Tagged
1
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enc losures-PaneIboards- Ins. to Main in Conduit
WI -ex -its; Insp.-Sketch
1 ert. of Occupancy
F,
9. Health Department Approval
10, Plumb; Cir. Test -Water Supply Test
Card B -I Date and -BI Date
Card -BI
Date Card -BI Date
Card B -I Date Card -BI Date
Card -BI
Date Card -BI Date
4 d V T $I my
�I/"VAt cxu�wupd 4ox4ed
3
N, n 4,VEi` / (ffG$ #,g cy " NUJ �wxol)114,
,
112' jvs 4 T�.v 4 y
CcIF.II CC /-G7%
t.
6) i flo,/no1 USE > deft
fpp� fit,,' J4/S� "Id
I
.t I
�
X y3
J 014
0 = Not OK
= 'Not Applicable
= Not Ready
RESIDENTIAL (Single and Duplex)
Date
UNDERFLOOR Plans OK except #'s
Date
FRAMING (Continued)
1.
Zoning requirements -Setbacks -Easements
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.
Fig., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4.
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
55.
Glazing Area -Glass Protection -Skylights -Plastic
Shear Walls; Nailing -Bolts
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
9. Gas Pipe; Size -Anchors
10. Water Pipe; 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
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
FINAL (Plans) OK except q's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except q's
57.
Smoke Detector
14.
Water Ht.; Vent -Access -Combustion Air
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
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.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date
Date Card -BI Date
ELECTRICAL Permit OK except ft's
66.
Elec. Outlets & Receptacles at Kit. Counter
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
70.
Plb., Elec. & Mech. Equip. Listed for Location
22.
Size Boxes & No. of Conductors -Stapled
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23. Romex Installed Close to Edge of Studs & C.J.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Insulation -Foam -Looked in Attic ❑Yes73.
Guard Rails & Deck Construction -Post Caps
25. 2 Appliance Circuits in Kitchen &Conductor Size
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At
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 ❑Yes 0 N
75,
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
28.
Service -Riser Conductors & Ground -Main Disconnect
76.
77,
Stucco; Brown -Finish
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
29. Equip. Clearances; Panels-Motors-Mech. Equip.
30.
Clothes Closet Light -Shower Light
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
Water Well; Disconnect, Electrical, Plumbing
Card B -I
Date Card -BI Date
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
81.
Ventilation throughout House
Card B -I
Date Card -BI Date
82.
Glass Protection
Date
MECHANICAL (Permit) OK except q's
83.
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
31.
A.C. Ducts; Insulation & Support
85.
Water & Sewer Connected -C/0 to Grade -HD Approval
32.
Vent Fan; Exhaust above Insulation
86,
Energy Compliance Certificate -Other Certificates
_
33.
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
Date Card -BI Date
Card -BI
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
Comments at Final:
36.
37.
Sills; Proper Material & Anchors
Studs -Nailing, Spacing & Bracing -Plates -Sound
_
38.
_Walls;
Bearing Walls over Girders & Floor Nailing
39.
_
Draft Stop in Walls (rat proof)
40.
�41.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
_
42.
43.
44.
Header _& Beam -Size & Bearing
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Ring.
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)
MOBILEHOME INSTALLATION INSPECTION CHECK LIST
1.- Is the mobilehome located with required separation from lot lines and buildings and generally
conform to plot plan? Yes_ No
2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes— No
3. Are footings and supports properly sized, spaced, and braced as per approved plans? (Note
possible variation at spring shackles.) (Sec. 5082 & 5083) Yes— No
4. Is the mobilehome level? (Sec. 5088) Yes_ No
5. If more than a single unit, are crossover connections properly installed? (Sec. 5088)
Yes No
6. Water
A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566)'
Yes 'No
B. Test -,Does water piping withstand working pressure or 50 lbs, air test? Yes No
C. Backflow - If coach is not State of California approved, does station have backflow device
and pressure -relief valve? Yes_ No
7. Wastes and Drains
A. Is connection made with Schedule 40 DWV,and have flex connectors at each end? Yes— No
B. Does it have minimum 4" per foot slope and is it properly supported? Yes— No
C. Are any leaks detected in drainage system after running 3 -gallons of water through each
fixture including washing machine standpipe? Yes No—
D. If coach is not State of California approved, does station have required trap and vent?
Yes— No
8. Gas Piping and Gas Vents
A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum
mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as'
large as the mobilehome gas line inlet without reductions other than the mobilehome
connector. Yes— No
B. Test OK as per following procedure? Yes_ No
1. Open all appliance connector valves.
2. Shut off appliance burner and pilot valves
3. Air test with manometer to 10"-1411 water column, or test with slope gauge (minimum
6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min, without
drop.
4. Connect gas meter to mobilehome with connector, turn on gas, test connections with
soapy Nater.
C. Are all appliance vents properly installed? Yes— No
a
9. Electrical
A. Is service large enough to provide adequate amperage to mobilehome (must equal rating of
mobilehome with a minimum of 100 amp) and other facilities on lot,, i.e., water pumps,
garage, cabana, etc.,? Yes_ No
B. Is there proper clearances around panels? Yes_ No
C. Is power supply cord or feeder assembly properly fused? Yes_ No
D. Is continuity test satisfactory as per the following procedure? Yes_ No_
1. De -energize electrical wiring system of the mobilehome at the pedestal,
2. Make sure that the power supply cord or feeder assembly conductors, including neutral
conductor, have been disconnected,
3. Switch all breakers and switches in the mobilehome to the "on" position.
4. Connect one lead of a test instrument to the mobilehome grounding conductor and
apply the other lead to each mobilehome supply conductor, including neutral.
5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line,
water line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon completion of the above procedure, the power supply cord or feeder assembly
conductors shall be connected to the site service equipment. A further continuity
test shall then be made between the grounding electrode and the chassis of the
mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site
service equipment may be approved for energizing.
10. Is job card signed by Health Department for water and sanitation?
11. If everything okay, sign off card and tag services.
MOBILEHOME DATA
Manufacturer and/or Namestyle
Length Width
Vehicle Serial No.
State Identification No,
Additional Information or Comments:
0
^� COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
695 Oleander Avenue, Chico — Phone 343-4211, Fxt. 70 ,
7 County Center Drive, Oroville — Phone 534-4541
Skyway and Elliott Road, -Paradise — Phone 877-3435
CORRECTION NOTICE
i% 00
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.
x ' e r 0 %2 Nk ! /� G Ooh c ,,�l � n W_
Cz 4? .-)
County of Butte
DEPARTMENT OF OUBLIC.WORKS
695 Oleander Ave., Chico — 343-4211, Ext. 70
7 County Center Dr., Oroville — 534-4541
Skyway and Elliott Rd., Paradise — 877-3435
CORRECTION NOTICE
11 ...........................5"................. g............
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.
...-...........u!.:...�.-...-....:;............................................... l
...r ...................................................... ....................
t:.r�- .......... .......... ..A....................
................:-............... ............ ......................
Date.l =1. ,.� ?.�.. Inspector ....................
Do Not Remove This Tog
i aoo-ai
COUNTY OF BUTTE `
" DEPARTMENT OF PUBLIC WORKS
695 Oleander Avenue, Chico — Phane.343-4211 ,• Ext. 70. ,
7 County Center Drive, Oroville — Phone 534-4541
Skyway and Elliott Road, Paradise — Phone 877-3435
CORJECTIONOOTICE
/ 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 work is completed. If you have any question pertaining to this
maRer, d dditional explana ' please contact this ice immediately.
Al
t
Inspector J 1 -f — Da
1
Inspector J 1 -f — Da
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - S34-4541
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with therequirements
of the California Administrative Code, Title 25, Chapter 5, under permit
number 4'31'*> for the following location:
AV< 1 lel .Aim 'IS stnWIin r yam. _4� �,
Owner
Owner's Address
Mobilehome
�'-� Model Year,/q-'
Mfg..�'!�%/���°'
Insignia No. 47A, �! l�-.� Serial No. L7h /- -X �1G /J
i
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of -Public orks
Date 1-29- 5r/ gy._�/�'.� ,
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow -.Installer, Pink - D.P.W.
8. Is there any other electric load to be served by the mobilehome
site service? ---------------------------------------------------
Yes[ No
(If yes, identify the load and size: , Gain/^ / (Load) (Amps)
9. What is the mobilehoine site gas pipe size? ---------------------- (in.)
10. What is the type of gas service? ----------------------------- Natural/% LPG
11. What is the gas pipe length from meter or tank to the mobilehome? y� rT (ft.)
12. What is the mobilehome gas demand? ------------------------------
(This information not required if pipe length less than 6 ft. on natural gas
or less than 50 ft. on LPG.)
P
(BTU)
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
`
7 County Center Drive, Orovillej CA,.' f,i, '0,
PHONE: 534-4541
t' -
MOBILEHOME INSTALLATION
SHEET
l.-
Owner's name: A/A//1 C
2.
Installer's name:
3.
Is the site currently under permit? Ye9
No
-
(If yes, 'furnish permit number
) OR
Is the site an existing site? Yes / /
No
(If yes, furnish two (2) plot plans.)
4.
Will the mobilehome be located at least 5 ft. away
from septic tank
and leaeh'fields�and
clear.bf all setbacks and easements? Yes
No
(If no, clarify
)
5.
What is the mobilehome electrical rating? -----------------------
1��'.
Amps
6.
What is the mobilehome site service rating? ---------------------
'g
Amps
7..
What is the mobilehome site circuit breaker rating?
------------
Amps
8. Is there any other electric load to be served by the mobilehome
site service? ---------------------------------------------------
Yes[ No
(If yes, identify the load and size: , Gain/^ / (Load) (Amps)
9. What is the mobilehoine site gas pipe size? ---------------------- (in.)
10. What is the type of gas service? ----------------------------- Natural/% LPG
11. What is the gas pipe length from meter or tank to the mobilehome? y� rT (ft.)
12. What is the mobilehome gas demand? ------------------------------
(This information not required if pipe length less than 6 ft. on natural gas
or less than 50 ft. on LPG.)
P
(BTU)
MOBILEHOME SUPPORT DATA
If other than single wide, Z � q-3 Z BD
MobilehAme Mfr. : 14:A.V'7V UG furnish Setup Model No. hS- ���% Year
Width z j'' (ft.) Box Length (ft.) Tagalong or Expando Size - ft. x `�° ft.
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets (if not on file with the County of Butte).
All center
supports measured from
front of
mobilehome
unless
otherwise specified.
Footings (check one)
Single
1. Wood either
.A
A
pressure treated ox
(� 01
X %6 r"
r
foundation grade.
(ft 1(in.)
(in.) (in.)
2./Other (specify)
nter pport
lo
Q
Center support
footing sizes --.L
�, Supports (check one)
j�S/v"
(in.) M
Q/ 1. Concrete block.
2. Other (specify)
(f (in.)
(in.) (in.)
�
SL -",11
,V� 6 7 7
laevl
4----fragalong or Expando,'
show support details.
(ft in.)
y
(in.) (in.)
p �/�
g'X
�yyl(v8G
n
X/6
IL�
-- cal"S"u or 4
TypiPP
(in.)
Footing Size
s `
X
(ft:)(in.)
(in.) (in.)
t�
-- Max. Pier Spacing
•
(ft.)(in.)
3'
Max. Overhang Q.
(ft. (in.)
(in.) (in.)
G
in.)
=0 �
� ZY�/7
BUTT5.1COUN �
BUILDING M'll PARTtR
q.
♦
V
ARPR u 1/ED�
f center piers
are
other than drawn
above,
raw in -locations,
spacing, and dimensions.
� COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS PERMIT NO
r 7 County Cente; Drive - Oroville, California 95965 - Telephone 916/534-454
APPLICATION AND PERMIT AR
ASSESS ,�,Q=CE�I�yJM B�,$�
// Z
ZONING
/(IJ-
rlw AA BUILDING PE
MAT '019!U
1f�T
O WUERA/
O
EPHONE
O
SO. FT. OCC.1 BUILDING VALUATION
ER'SISAAD A
O,ok%1OL_I YHQSI 7
CONTRACTOR'S NAM
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LEND R
UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAI LIN ADDRESS
Permit Fee
$
ARCHITECT OR ENGIN ER
LICENSE NO.
Plan Checking Fee 1, 1,41
,$' "o
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUIL NG ADQRE55� #A1 P—b. Pp. ,/OO 's
`7
fGIVvA
PLUMBING PERMIT
Filing Fee 3.00
r P_
V
Each Trap
2.00
Repair drainage or vent piping
2.00
f
Water piping
LOT NO.
/Z'-��
SUBDIVISION NAME
P RCEL MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehome E!�'Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Instal lationCG-5ther ❑
Describe work: —
r:::g� t/ %�L- 0C,06A1f1oP
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service eoov OR LESS
100 AMP OR LESS
5.00
c
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELING
OR ACDNS. ( ACCLBLDGS.CCUP,&�
20sgft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check one):
-1I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
lz , as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEw CONsrR ULTI-OUTLET 2,50 ea
NON.RESID BRANCH CIRC ITS
NEW CON
NON -RES D. (POWER APPARATUSSINGLE OUTLET CIR.&
Ex. Occup(OUTLETS OR FIXTURES 50�
BAL�1os
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 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.
Ea,,f shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
Filing Fee 3.00
Heating
Cooling
Hood
2.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
agai st said County i consequence o the granting of this permit. Qui
X �/+= Date�� "� /J~//O
Signature of Applicant — Owner El Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Land Development Fee $
TOTAL PERMIT FEE 00
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
ND
I ISSUE
v
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIR TOR OF PUBLIC
-�
By -
P MIT EXPIRES Date _.
the applicable provi-
resolutions to do
fees have been paid.
WORKS
DaterL�-,;
_ /Z— i7 d� I
Receipt No. tL��
WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
✓ �; � COUNTY OF BUTTE - DEF'sARTNI�_N'T OF PUBLIC WORKS PERMIT NO
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4 41 6Z21.6
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APPLICATION AND PERMIT
ASS SOR PARCEL N BFR
7 Z� 7
ZONING
�"7i'
BUILDING PERMI
OWNER
V0A IJATC�
SO. FT. OCC. BUILDING VALUATION
1^ /n� /-/�-�} �/�3�
Oylgl0 .ER'Iv]j+,lOXLING ADDR �S �L D v �• ' �• 96a�
C(/!!O//�`NTRACi/TOOR'S�NAME � i--,g
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LEN
UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee f v
$ ,00
Penalty
$
ARCHITECT OR EN INEER'S MAILING ADDRESS
Permit fee
$
BUIL I ADDRESS ,
S Ems/ j�/,qAl AV,4Z . /9 -PP, S.
PLUMBING PERMIT
Filing Fee &00
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
,QO
LOT N%
/
SUBDIVISION NAME
P[/*�EL MAP
`f —��
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
la.d90
USE OF STRUCTURE
SF ❑ Duplex[] Mobilehome5�/Other
SPECIFY
Building sewer
, 00
Lawn sprinkler system
2.00
TYPE OF WORK
New❑ Addition❑ Remodel❑ Utilities Installation❑ Other E]
Describe work:
Permit Fee
$ 41v.o0
Contractor
ELECTRICAL PERMIT
Filing Fee Igloo
Main service 600V OR LESS
100 AMP OR LESS
5.00 -OD
Main service EA. ADD'L 100 AMP
2.50 G��V
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ACC, BLDGS.
20sgft
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
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 -a
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW NON.RESID CONSTR.BRANCH CIRCUITS 2.50 ea
NEW CONSTR. (POWER APPARATUS gl
NON.RESID. SINGLE OUTLET CIR. /
Ex. Occup(OUTLETOR FIXTURES 50@�
S BAL@10Q
FIXED APP LNS. OR
Ex. Occup.(OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00'/,5,00
Misc. Wiring 6.25
A[
Permit Fee $ ZA SQ
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 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.
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 3.00
Heating
Cooling
Hood
2.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
aga' t said County in consequence of the granting of this eerrmit.
ay �� C! S
T� Date
Signature of Applicant — Owner❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures overstories in height.
Mobile Home Installation Fee
$
Land Development Fee $
TOTAL PERMIT FEE $ .,Go
� Q
OCCUP. GROUP
TYPE of CONST.
PARCEx
y�
PD
HD
ssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIREC R OF PUBLIC
By
P EJWT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date _1i?– `4—�P9v
l3
Receipt No. �D/tJ
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
fJ COUNTY OF BUTTE — DEPARTM+�EN(T=OF'P6lJ06WORKS— BUILDING'DIVISIUN
County Center Drive — Oroville, California 95965 - Telephone 53/-4541
PERMIT APPLICATION DATA SHEET
r
' i _ Permit No. _
OWNER_ DP> j H A l G A.P. No. _7a,
Proposed Building Use 1A 4/, (J'77 /
Permit fee based upon:/ --"% Contract Price ..DPW Valuation
Oatherl,(iFXIjai n
Building Inspector / //�/L/ / Date /A / C,-- k`,-)
At time of permit applicatioil,l/wds advised the following data must be submitted prior to permit processing and/or
issuance:
DATE RECEIVED, APPROVED
1.
All items have been submitted...................................................................
2.
Plot plans in duplicate/triplicate...............................................................
3.
Complete plans in duplicate/triplicate...................................................
4.
Complete engineered plans and calcs.....................................................
5.
Plans with Energy Design Compliance Statement ............................
6.
State Energy Forms No. ....................
7.
Statement of Intent for Non -Heated & AC Buildings ...................
8.
Fees of $..................................................
9
Letter of signature authorization...>.........................................................
�/
0
Sanitation approval from Health Dept....
,/
1.
Planning approv I for .............
12.
13.
Certificate of Wbrr me9 Compensation Insurance ........................
Ctx i�cefrS�'r�ition (no., name style,
classification) ...............................
14.
Improvements may be required. Contact Land
Development Section of Dept. Public Works (see
addressbelow).................................................................................................
15.
Pre -inspection for required. Pre-inspec. request to
bldg.inspector (date)
16.
Other
When you issue
the permit, process as follows: Mail to owner
Mail to contractor.
Telephone
and hold for pickup at
office. Deliver w/inspection.
Other U011 711 <�-PALPI iC Te"T Ll l6,y 5/ sT 1,c �2,,
Appl icanap �'2- % ate
Copy of plans sent Health Dept., Fire Dept., Other Dater
During the plan checking process, the following data must be submitted prior to permit issuance:
(For required items not checked above at time of acation, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, wne was
clans checked by
Plans approved by
OTHER:
Copy/DPW
of above required data by
�=_/a
ephone ✓�
l
er
Date
Date
Date
xI-
.'3
To: Building Department
From: Environmental Health.
Subject: Sanitation Clearance
Owner
Plan approved fore Oewa�6e Disposal l/� dater Supply
Mold Final for: dater Supply
Final Clearance Q.K: for: mater Suppler
Clearance for bedroo mobile home. ther.
r
Clearance for addition'of
Note
Sanitarian Data
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NOTE:—ATI Materials - & Workmanship Shall Be in
Accordance with Recognized Good Practices and
of alquality prescribed for the Specified use in .the
'Uniform Building, Plumbing & Machanical Codes and
+.he National Electrical Code.
NJ
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motility connect ons shall be withi \) j
4 ft. of the mo ilehome, either`
directly behinc or within the rear
half of the roa side (left) of the
mobilehome. /
A setback of 5 ft. from the
property lines and a setbac
of 50ft. from the road
centerline shall be clear of
structures or equipment ex
fora 2 ft. eave overhang.
This set of plans and,-t.ecifications MUST. be
kept on the inh at all =s irises and it is unlawful;.to"
male any changes or alterations on same without -
written permission from the Department of Publi6
Works, County of Butte.
A permir will a required for the •,
installation of the mobilehom
,
5 7,/6.80
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
1