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056-080-090
A.P. 56-08-90 CECIL PENNOCK s/s Gates Rd.2 mi. east of Cohasset Rd., Cohasset Pei,mit 2009-73P 2 E F, no,\ 1- to - 9 S (utilities for_ mobile home) 056-080-090 PERMIT#95-1695 GOODWIN, Gerald / 206 Mud Creek Rd., Cohasset Cont; Executive Homes a �J' MH on Perm Fnd l 1 r. A.P. 56-08-90 CECIL PENNOCK s/s Gates Rd.2 mi. east of Cohasset Rd., Cohasset Pei,mit 2009-73P 2 E F, no,\ 1- to - 9 S (utilities for_ mobile home) 056-080-090 PERMIT#95-1695 GOODWIN, Gerald / 206 Mud Creek Rd., Cohasset Cont; Executive Homes a �J' MH on Perm Fnd l 1 I a O ADD Y,- z 3 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS -7 County Center Drive — OroviIle, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Signature of Permitee or Agent Receipt No. Date White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date BUILDING% Owner SO. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $2.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No.Gas Zoning 8 Planning piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W. C. Sanitation Fire Dep t. FireZone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Im P Improvements Lawn sprinkler system 2.00 Bldg. Plans Rec'd Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ 1:1OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (morethan 12) Single Family ❑ Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixturesbai O Receps., switches & fix outlets 7 11, 25 CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. Classification Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued l shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 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 TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Signature of Permitee or Agent Receipt No. Date White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — OroviIIe, California 95965 Telephone: 534-4541 APPLICATiON AND PERMIT u Lit Iorze represeiitatl ves ul thu t uurlty Ur bu[[e to enter upon the above-mentioned property for inspection purposes. is ,dly Date Signature of ermitee or Age % ] Receipt No. /Q__ / / _ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BYDate 6— l Building permit expires Date �_` { L.:�.7_/ BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address -.. PLUMBING No. @ FEE PERMIT FILING FEE J$2.00 , — Each Trap 1.50 �`r' �� 2 Repair drainage or vent piping 1.50 Water piping 1.50 , Each gas water heater or vent 1.50 A. P. No �+ /, °n'n P Gas piping system 1 - 5 outlets 1.50 Each additional outlet of 30 Fees W.C. Sanita ion Fire Dept. Fire Zone Use Permit Building sewer 5.00 s' EQA IParking ParcelParcel Plans eclaration Ma P 60' R/W Im Provements Lawn sprinkler system 2.00 Bldg. Plans Recd Parcel Approval `� Plans Approval Permit Fee e U $ Lei NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Sub -panel (12 or less) (more than 12) Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures bal aio Receps., switches & fix outlets CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pu Water pump NO Mobil Home Facilities 5.00 '~ Temp. Power Pole 5.00 License No. Classification Misc. wiring I am exempt from the Contractors License Laws of the State of California. Permit Fee $ O( WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. IMI certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. 1 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 MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ LTOTAL PERMIT FEE $ u Lit Iorze represeiitatl ves ul thu t uurlty Ur bu[[e to enter upon the above-mentioned property for inspection purposes. is ,dly Date Signature of ermitee or Age % ] Receipt No. /Q__ / / _ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BYDate 6— l Building permit expires Date �_` { L.:�.7_/ RESIDENTIAL e S 9A 056-080-09Q PERMIT#95-1695 GOODWIN,'Gerald 206 Mud Creek Rd., Cohasset Cont; Executive Homes j MH on Perm Fnd�iol9 O JOB FINALED (Date) f8 Signature J=OK , O=Not OK = Not Applicable ° MOBILE HOMES ' =Not Ready , Date MOBILE HOME UTILITIES Plans OK except #'s . Zoning Requirements -Setbacks -Easements 1 2. Soils; Special MH Support Sketch + 3. Sewer; Location -Test -Fall -C/O Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / P L" ft. / /"Nat. or/ /" L" ft./ /"LPG 1 7. Well Clearance & Disconnect Utility Clearance MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Rfg.-Bracing t 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures ii 6. Carports; Windows -Doors ( 7. Electric t 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Root; Shthg-Roofing Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBIL ME INSTALLATION (Plans) OK except #'s on' g Requirements -Setbacks Easements ke0ro-otings; Size -Spacing -Marriage Line as; MH Test-Demand-Valve—Connector lectr' ity; MH Test -Crossovers -Breakers -Clearances 5416'ra-in; MH Test -Fall -Flex Connector aC ; MH Test -Regulator -Connector 0'14ter and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Taqqed 10. Cert. of Date Card B-1 Date Card B-1 Date Card B-1 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater — 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test } Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK „ O = Not OK NotReadyable RESIDENTIAL (Single Date UNDERFLOOR (Plans) OK except it's Date 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth & Duplex) FRAMING (Conti 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfnq. 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth -- 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth -----' 5. Stemwalls, Main; Steel -Bloc kouts-Wra pped 6. Stemwalls. Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Criooles 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit),OK except 4's 1E. Water Htr.: Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Nail Protection 18. D.W.V.; Test -Fittings & Anchor -Nail Protection 19. Shower Pan; Test. First Floor -Tub Access 20. Test Tub & Shower. Second Floor -Tub Access -------- ---- ------------------------- - 21. Gas Pipe: Size & Anchors Date Card B-1- Date - Card B-1 --------------------------------- -------------- Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except a's 22. Fixture & Transformer Clearance -Ins. Protection --------------- ----- -------------------------------------------------- ---- 23. Elec. Receptacles Spacing -Lights & Switches at Doors ----------- ----------------------------------------------------------- 24. Size Boxes & No. of Conductors -Stapled -- -------------------------------- ----------------------------- 25 Romex Installed Close to Edge of Studs & C.J. --------------------------------------------------- - - 26. Equip. Ground made'up w/Mech. Fastners-Bond Gas & Water -------------------------------------------------- --- - --------------------------- 27. ----- - ----------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor SizerGFI ------------------------------'------------------------- 22. Subfeed Wire Size ga. Cu or AI-A.C. Wire Size ga. Cu or At ------------------------- --- -- -- ---- ----------------------------- 29. Range Circ. / r ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes Cl -No 30. Service -Riser Conductors & Ground -Main Disconnect -- --------------------------------------------------- - 31. Equip_ Clearances Panels -Motors -Meth. Equip. ---- ------------- - ---- -- - 32. Clothes Closet Light -Shower Light -Spa Light - ------------------------------------------------------- 33 Smoke Detector -------------------------------- -------------------------------------------------- Date Card B-1 Date Card B-1 ---------------------------------------------------------------------- ---------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except P's 34. A.C. Ducts Insulation & Support ------------- ------------------------------------------------------------------ 35. Vent Fan: Exhaust above insulation ----------------------------------------------------------- 36. --------------------------------------- - ----------- 36. Condensate Drain & Overflow: Size & Grade ------------------------- -- --- -- 37 Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet ------------------------------ -------------------------------------------------- 38. Attic Access & Platform if Furnance in Attic -------------------------------------------- ------------------------------------- Date Card B-1 Date Card B-1 --------------------------------------------------------------------- ---------- Date -------- Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except k's 39. Sils. Proper Material & Anchors - - ------ -- --------------------------------------------------------- 40. Walls Studs -Nailing. Spacing & Bracing -Plates -Sound ------ ------------------------------------------------------------- 41. Bearing Walls over Girders & Floor Nailing - - ------------------------------------- --------------------------------- 42. Draft Stop in Walls (rat proof) - ------------------------------------------------ 43. Fire Stops Furred Ceilings -Stairs -Chases -Tub ----------------------------- ----- ------------------------------------------- 44. Headers & Beam -Size & Bearing 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hqt. & Dimensions -50. Garage Fire Protection Framing 51.- Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53.- Stairs;-- Width -Headroom -Rise -Run -Landing -Fire Protection ------------------ - 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers ----------------- --- 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection-Skvlights-Plastic 58. Shear Walls: Nailina-Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows ------------------------------- - Date _ Card B-1 Date _ Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except ti's 61. Ext. Steps -Door & Sidelight Protection -Landings --- ------------------- 62. Smoke_D_etector 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor -Ducts -Meth. Protection -------------- ------------ ---- _____ 64. Bedroom Exiting 65.-.G.-F.I. & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel: Breaker Sizes & Labels - ---------------- 67. Stairs & Rails ---- ............... 68. Fireplace or Stove: Clearances -Hearth -- --- -- - ----------------- 69. Elec. Outlets at Wood Panel: Int. & Ext. --- .........------------------------ 70. Kit.Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter - - ----- --- - - - ------------------------ --- 72. Garage Fire Door: Swing -Landing -Closer 73. A.C. Duct in Garage -Damper 74. Wtr. Htr: Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor -Meth. Protection 75. Plb. Elec. & Mech_Equip. Listed for Location 76. Elec. Receptacles in Garage: (G.F.I.)-Romex Protection ----------------------------------------- 7--i.-Insulation-Foam-Looked in Attic ❑ Yes - ------------------------------- .---78.-Guard-Rails & Deck Construction=Post Caps 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes --------------------------------------- -------------- 80. Followinginstld.: Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No -------------------- - -------- - --- --- 81. Stucco: Brown -Finish ----------------------------- --- - 82. A_C_Unit_Disconnect. Electrical, Plumbing - - 83. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to Openings 84. Water Well: Disconnect, Electrical, Plumbing -------------- ---------------------- - - 85. Exterior Elec. Trim: G.F.I. Receptacle -Underground 86. Ventilation Throughout House --- ----------------------------------------- 87. Glass Protection -------------------- ----------------------- 88. Corrections from Previous Inspections ... - --- ----------------------- --------------------------- 89. Gas Test -Meters Tagged: Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval -- -- ._ -- . - ---- -- - --------------->--------------- 91. Energy Compliance Certificate -Other Certificates ------ ----------------------------------------------------- Date Card _B- 1 Date Card B-1 Date Card B-1 Date Card B-1 - -------------------------------------------- - Date Card B-1 Date Card B-1 Comments at Final: • V/ COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION _ 7 County Center Drive - Oroville„alifornia' 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT Q. a--- /14 ASSESSOR PARCEL NUMBER - ZONING TM5 BUILDING PERMI OWNER GERALD GOODWIN TELEPHONE SQ. FT. OCC. BUILDING VALUATION ,�-� OWNERS MAILING ADDRESS 7 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAIUNG ADDRESS 3042 ADE, CHICO 95973 Fireplace CONSTRUCTION LENDER UNMOWN Total Valuation $ G 7 31 LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.0 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 206 MUD CREEK RD, COHASSET PERMITFEE $ o�7,f,' PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome 00 Other SPECIFY Water piping 15-00 15 , 0 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 15.0 Building sewer 15.00 15.0 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ]� Describe Work: MH ONPERM FNDN Mobile Home S G W 920.00 PERMITFEE $ 05.0 Contractor ELECTRICAL PERMIT Filinq Fee 20:00 Main Service / 600v OR LESS 200A OR LESS ) 23.00 Main Service ( 200A To I000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. `�� License Class 7 Lic. No. o OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: /❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUP. SO. OR ADDNS. ( & ACC. BLDS. ) 3.5¢ FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) d SINGLE OUTLET C R. EX. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL SO Ex. Occup. ( OUTLETS RES. ETS EI)Ea) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this perrfi"tr is issued. My workers' compenspyon Insurance carrier and policy number are: Carrier 57/%0,0 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shallTOTAL not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the w rkers' compensation provisions of section 3700 of the Labor Code, I shall f rthw'th co ply those provisions. ,� _____`� ___ Date _ / �(J .5 Signa ure of Applicant - ❑ Owner Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in hei 'ht. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE FEE $ o HAZ I D. FE IMP FLOOD CDF PARCEL PD S „�. This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. t))9.5 By ,p at/e� PERMITEXPIRESON V V (Date) Receipt No. a 5 �, �— WHITE-D.D.S.-B.D. CANARY -A ESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 HumboldtoRoad;*Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-607 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contac this office immediately Date V/ / 7 /� ) Inspector REV 10/92 COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, CWco, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, ple'se contact this office immediately. (Lt 1P 1 U (L W Q6ie.) kv-t %Z xt_ F611 o iL C , Coy►, L6�72 LA-/��. ,aT Date ( -(5—C4 '�o Inspector REV 10192 x '. COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT S&VICES 1469 Humboldt Road, Chico, CA - (916) 8k1-2751 r 7 County Center Drive, Oroville, CA - (916) 538-7541 u�= 747 Elliott Road, Paradise, CA - (916) 872-h307 CORRECTION NOTICE WNER PERMI-r O. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please con s office immediately. DI�GI . tE�-Es7— L/,- *S Z, fL ew7— Date414(A73""Inspector, REV 10/92 �..,..; . j -.•�.-,. f .�..a,trr�-�..�r .r- 1jN4r ^• ..,+-.tr • ,q.Y,..-..'-.,� -..t-. ....M.It°•'srr7'* '�r.:.I�"rrr'.'!'Yt `(1rt'V.+1(M'+n-..rwn`,-. -r, rr. , . ~t r w 1 j} 4 JCOUNTYOF BUTTE - DEPARTMENTOF DEVELQPMENTSERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541 ^ PERMIT APPLICATION DATA SHEET �) OWNER � �f1,4 �O� It 0'1G' W 1 ,%n/ A. P. No. Proposed Building Use Kegllweyewl' o.r Oosr.,,y Building Inspector 45-, Date % L� At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and'calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . .................................. 6. Energy Design Compliance and supporting documentation. ......! . �....... . 7. Statement of Intent for Non -Heated and A/C Buildings. .......... `.. X....... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... Fees of $ 3-27 3 39.-75 ......V'ees .. Impact fees as shown on attached schedule. .... ... ...... alifornia Department of Forestry plan appro� "q3. Flood elevation letter (100 year flood) by Calineer. . . Sanitation and plot plan approval Cklc --1 Health Department . ............ 15. City of Chico plumbing permit. ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. ........... j�� Y 19. Driveway permit (construction approval required prior to occupancy). ...Pn�4Asect.o;r;4dest 20. Pre -inspection for required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23 Owner -Builder Verification (Given to owner , Mail to owner:. .......... j}s15. Recorded copy of Agricultural Acknowledgement Statement . ::::::::::::: : : :: io/95' Letter of signature authorization. -26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... . 28. Mobilehome utility clearance . ......................................... . 29. Documentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When y6u issue the permit, process as follows: Mail to owner. Mail to contractor. 14 Telephone C3 5 J - C 917 nd hold for pickup at j eI c office. Deliver with inspector. Other Parcel Creation �� 9 Acreage Applicant lam' Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit is uanc (Circle pew 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 _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by (r i A a od_S Date Plans approved by t3 a,Js Date Sets of plans on hold in File cabinet �C AP folder Copy - Department of Public Works B.H. USE ONLY Plot Plan Athchad r Floor Plan AMwhod Scotto S.D. / TO: Building Department, FROM: Environmental Health SUBJECT: Sanitation Clearance led. �o3aT���d ani Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public Private Well Clearance for. 7- bedroom mobile home. Other Hold final for: Final clearance O.K. for: NOTE: 'jri J Environmental�Flealth Specialist 8/92 f T -7.s- Date BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM f (One Form Per-, Building) School District ��� =�U Building Department No. C>e. o`�J i A.P. Number Jurisdiction: L__ J City County. Property Owner G LA � c?a! L✓,.J Property Location/Address Z O el J Ad C..� 10 10 Subdivison Lot No. Residential Development Commercial/Industrial 0 Sq. Footage Z oc No. of Living MHI e p" Addition (Group R) Units y r I CGC Ic- GM eivl s ! re - New Addition (Floor Plans reviewed by School District Personnel) District Identification No. ` e x School District certifies that ity) (State) C Sq. Footage (Including Exterior Roofed Areas) Z� Date W IML (Phone (Zip Code) has complied with the requirements of Resolution No.� by payment of $ representing square feet. AB 2926 $ PULL MITIGATION $ r \Wkl) (Y4 D A, v Sc istrict Re re erAativ Date Paid by Check # /� Remarks Bank Number Paid by Cash mob./.6 1w6b)Xe I e -z L V If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.wk, (11re4)dmm Return to:,. AGRICIMMIRAL STATEMENT OFACKNOWLEDGEMENT Building Division RESEDENTIAL DEVELOPMENT Se-aion �y16-8.1 of the Butte County Code requires this acknowledgement be recorded prior to issuance of a building permit. _ 0202@ G 95. The property described herein is adjacent to land or included AUG 1 O Jn9J within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort arising from the use of agricultural chemicals, including, but not limited , to herbicides, pesticides, and NpT CCOPAR fertilizers; and from the pursuit of agricultural operations ,M, including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,smoke, noise, and odor. Butte County has established agricultural zones which have as a priority use for productive agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: 7/ � /VM77,, eL�/ /l�O,e�fi`I�EST �u/�,�T�.e d,& �cP,o ��FE,�, }-S 77/E So9�iE Date: %io - 95- to of California ) ty of ) before me, ly app ,ared PROPERTY OWNERS: kw- m to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is%are to ' within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized s), d that by his/her/their signature(s) on the instrument, the person(s), or the entity upon behalf of which the ic executed the instrument. end and official seal. Seal: Geo -d90 i11 {1 1 (Wltness�Aknowledgment) J TICOR TITLE INSURANCE eaz- -+-yam STATE"Of CqLIFOR IA COUNTY On ) SS. personally appeared `befr� me, the undersigned, a Notary Public in and for said State, Personally known tome to be the person whose name is subscribed to the within instrument, or proved to be such by the oath Of a credible witness who is personally known to me, as being the subscribing Witness thereto, said subscribing Witness being by me duly sworn, deposes and says: That this witness resides in _ (� +gyp t and that said witness was present and saw elVN personally known to said witness to be the same Person(s) described in and whose name(s) is/are subscribed to the within and annexed instrument as a party thereto, and acknowledged to said affiant that he/she/they executed the same in his/her/their affiant ized rertsnfuturr,t'uausfrlrrl'uuufumuoumulsutytareurrrr� capacity(ies), and that by his/her/their signature(s) on the instrument ��_�a OFFICIAL SEAL ar the used tpersonhe or the entity upon behalf of which the persons) acted, 70'8978 executed the Instrument, and that affiant subscribed his/her name d, WENDY M. AUER � the within Instrument as a Witness. NOTARY PUBLIC.'r'• g COUNTY OF BUTTE RNIA� - c - =MY Commission Expires February 13, 139as WITNESS my hand and official seal. uurfum+ea.utrurnrutuuaumntuuuunuluuls^utr. ''e:' Signature (This area for official notarial seal) -;r July 26, 1995 Executive Homes Cathy Leveroni 3042 Esplanade Chico, CA 95926 Dear Ms. Leveroni: .~ utte Count, DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH ❑ 18-B County Center Drive 1469 Humboldt Road, Suite 100 1:1 7 County Center Drive Oroville, CA 95965 Chico, CA 95928 Oroville, CA 95965 TEL: (916) 538-7282 TEL: (916) 891-2727 TEL: (916) 538-7281 FAX: (916) 538-2165 FAX: (916) 895-6512 FAX: (916) 538-2140 RE: Building Clearance 2-0-6—Mud;C:r_eek=Rd.-, Cohasset APN 56=08-090 This Department has completed its review of your appliction for a Building Clearance on the above referenced property. A Clearance cannot be issued at this time for the following reasons: 1. Provide an approved septic system. Health Department records show the existing septic system was never given final construction approval. Our records also indicate that insufficient leach line was installed even for a one bedroom residence. It will be necessary to evaluate the present septic system and more than likely add additional leach line. Please apply for a septic permit. 2. Provide proof of bacteriologically potable water. The Health Department has no record of your well. The Department will inspect the well for proper seal and take a water sample. The fee for this service is $33.00 paid in advance. Please contact me as soon as.possible at the Chico office, Monday through Thursday between 8am and 9am, so the items indicated above can be resolved. AsLinc rel;, Loral I. Eng lenner, R.E.H.S O� Environmental Health Division, Chico LIE/dd/bldclear/goodwin.195 cc: Butte County Building Department Gerald & Teddy Goodwin, owners A CLEAN INDOOR AIR ENVIRONMENT FOR A HEALTHIER TOMORROW i'� RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: NAME BUILDING DIVISION STREET 7 COUNTY CENTER_DRIVE ADDRESS OROVILLE CA 95965 CITY, STATE and ZIP 95-0307571 Rec Fee .00 k 1 Total .00 Recorded I Official Recor s I County of I Butte 1 Candace J. Gr bs I Recorder I 10:09am 11 -Sep -95 1 COMS XX 1 SPACE ABOVE THIS LINE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for . installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. GERALD R AND TEDDY JO GOODWIN REAL PROPERTY OWNER/LESSOR P 0 BOX 1784 MAILING ADDRESS CHICO, BUTTE, CA 95927 CITY COUNTY STATE ZIP 206 MUD CREEK.ROAD INSTALLATION MAILING ADDRESS. IF DIFFERENT CHICO, BUTTE, CA 95926 CITY COUNTY STATE ZIP SAME UNIT OWNER (If also Property a. er, -rite "SAME'l MAILING ADDRESS CITY COUNTY STATE ZIP UNIT DESCRIPTION BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 95-1695 (916) 538-7541 BUILDING PERMI�O LEPHONE NUMBER ��' , 111.62�L 9/6/95 SIGNATURE OF LOCM AGENCY OFFICIAL DATE EXECUTIVE HOMES DEALER NAME (If not o dealer sale, -rife "NONE') 92081 DEALER LICENSE NO. FLEETWOOD HOMES 8/95 352-2L SPRINGHILL MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER _CAFLS17A17862SH12/CAFLS17B17862SH12 52'X23'6" RAD840228/RAD840229 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. #056-08-0-090 THE NORTHERLY 450 FEET OF THE WEST HALF OF THE NORTHWEST QUARTER OF SECTION 13. TOWNSHIP 24 NORTH, RANGE 2 EAST, M.D.B. & M., LYING WESTERLY OF THE CENTERLINE OF MUD REEK, AS THE SAME EXISTED ON AUGUST 1, 1967. `SENT OF 8q, HCD FORM 433(A) Rev. 8/91 P BUILDING PERMIT NUMBER: 95-1695 Address or location of unit: 206 MUD CREEK ROAD, CHICO Legal Description of Real Property: A.P. #056-08-0-090 THE NORTHERLY 450 FEET OF THE WEST HALF OF THE NORTHWEST QITARTER OF SF.C11QN-_-__ 13, TOWNSHIP 24 NORTH, RANGE.2 EAST, M.D.B. & M., LYING WESTERLY OF THE CENTERLINE OF MUD CREEK, AS THE SAME EXSITED ON AUGUST 1, 1967. [X]Mobilehome/Manufactured Home ► [ ]Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health and Safety Code Section 18551. Owner's name: GERALD R AND TEDDY JO GOODWIN Owner's address: P 0 BOX 1784 INSIGNIA OF HUD NUMBER: RAD840228 RAD840229 CAFLS17A17862SH12 SERIAL NUMBER OR V.I.N. CAFLS17B17862SH12 MANUFACTURER'S NAME: FLEETWOOD HOMES YEAR . 1995 - OFFICIAL APPROVING INSTALLATION: DATE: 9/6/95 PHONE: (916) 538-7541 H.C.D. 513C RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: NAME BUILDING DIVISION STREET 7 COUNTY CENTER_DRIVE ADDRESS OROVILLE CA 95965 CITY, STATE and ZIP 95-030 571 1 Rec Fee .00' r \ I Total .00 Recorded Official Recor s 1 County of , .1 Butte I Candace J. Gr be I Recorder I 10:09am 11 -Sep -95 I COMS. XX 1 SPACE ABOVE THIS UNE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. GERALD R AND TEDDY JO GOODWIN REAL PROPERTY OWNER/LESSOR P 0 BOX 1784 MAILING ADDRESS CHICO, BUTTE, CA 95927 CITY COUNTY STATE ZIP 206 MUD CREEK ROAD INSTALLATION MAILING ADDRESS, IF DIFFERENT CHICO, BUTTE, CA 95926 CITY COUNTY STATE ZIP SAME UNIT OWNER (If also property owner, write "SAME'l MAILING ADDRESS BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 95-1695 _ (916) 538-7541 BUILDING PERMIT NO JELEPHONE NUMBER ,�a✓!�y' ; , 1„�c2 �i 9/6/95 SIGNATURE OF LOCAL AGENCY OFFICIAL DATE EXECUTIVE HOMES DEALER NAME (If not a dealer sale, write "NONE'l 92081 DEALER LICENSE NO CITY COUNTY STATE ZIP UNIT DESCRIPTION FLEETWOOD HOMES 8/95 352-2L SPRINGHILL MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER CAFLS17A17862SH12/CAFLS17B17862SH12 52'X23'6” RAD840228/RAD840229 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. #056-08-0-090 THE NORTHERLY 450 FEET OF THE WEST HALF OF THE NORTHWEST QUARTER OF SECTION 13, TOWNSHIP 24 NORTH, RANGE 2 EAST, M.D.B. & M., LYING WESTERLY OF THE CENTERLINE OF MUD CREEK, AS THE SAME EXISTED ON AUGUST 1, 1967. Q`MEN..OF .. HCD FORM 433(A) Rev. 8/91 WHITE—County Recoraer CANARY—HCD PINK—Applicant GOLDENROD—Bwldtng Dept. BUILDING PERMIT NUMBER: 95-1695 Address or location of unit: 206 MUD CREEK ROAD, CHICO Legal Description of Real Property: A.P. #056-08-0-090 ` THE NORTHERLY 450 FEET OF THE WEST .HALF 0 THE NORTHWF�SgT QUARTER:--0'E SFr.TZQN..:;_ 13; TOWNSHIP 24 NORTH, RANGE 2 EAST, M.D.B. & M., LYING WESTERLY OF THE lERLINE OF MUD CREEK, AS THE SAME EXSITED ON AUGUST 1, 1967. [X]Mobilehome/Manufactured Home _ [ ]Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health and Safety Code Section 18551.' . Owner's name: GERALD R AND TEDDY JO GOODWIN Owner's address: P 0 BOX 1784 RAD840228 INSIGNIA OF HUD NUMBER: RAD840229 CAFLS17A17862SH12 SERIAL NUMBER OR V.I.N. CAFLS17B17862SH12 MANUFACTURER'S NAME: FLEETWOOD HOMES YEAR. 1995 OFFICIAL APPROVING INSTALLATION: DATE: 9/6/95 PHONE: (916) 538-7541 H.C.D. 513C 9i 11 /'35 00:57 B l DWELL 'TITLE / CH I CQ 4 8919753 NO, 191 P002 'i -1:86T j ' Irtcottoeaa ttaaeo,pt6tt Qr I ' - - . 0 MW 9 *ARA, 2•153O1 -IBJ AM WkB $ MCOND alga TO "^ Otarald R. 0=401n M?w«. ° o. &m 1984 6 90, CA 95937 cM I ray Tar 0109m ft TO r `1 J ®l-9aa®b7 11 ova Peg I Doc Recorded t CAssk OffleAal Reeorda I 66unty of I Butte I Ciandsd 1 6 S.0o 6.00 11.60 w O . rUUUg I FAME AS AD" Itoearder I ,rat :. 010088 10 -Apr -R1 I CD 1 �w L J SSASB ABOVE rale ust PAR R10O11191419 utt •. Asa-aao.o OndivOdual Gran: peed rrpa tn�, w ar t�iw� TTTt,e ai aat� O9tsFArrf The up4erligned grantor(s) declara(,)i I7Wument4ty warder tax to 9 ( x) computed Oft foil value a prep.ny conveye , or ( > Coinpilted on (1311 value lea, value of tions and ea#=bmncn remaining at time of sat+. ( x) Unintetpotamd ova-,( ) City of , and FUR A VALUABL9 WNSIDCRATION, ►eedpt of whkb is herby acknowledged, JUGS M. LANA', a ffwr d mm deal" with alto OtfO=tb PMP@rty I hereby GRANT(S) !a onit= [I. OCr'kfUl acv TM'W9v J", COMM, ra SNUVII *M wifn, ae :01at Tawto the fellewinb doaeT+'bed teal property in the +n�iral ASMa County of SUM tate Or CA ifernia: Tho i#.W93W1yy d� fast al ve mat Milt c c *a r tl'!'tt aut�rL tr Of tmt.sr 13, ! 'ttiwrs dip 26 Its, RWQ@ Z East. M.D.S. i M., 1 iffy iwsvtOsly o4 tho tw•:tftr1LM otY i turd Create, as tha flim w4vW an hoot 11 1967, Via 7t '1 t r DateJ� Msrr�t al. 1991_ _NNE lrflii M. ' STATE OP CAMPORNIA t'.OUN7V ON On „+, before ---^— me, the un44t,i/Me at a1 a nit far to fitltq peno>•11tv arrest �nonel y 11ilGwn 10 tnr W frewd 1 e+a on, , afgt t►f,etory ewifs" to At the pomp, �Wl,ws nurse "' `°•;, 4►• tuhtro the wiBhln Inttpymont end etanaw JeCali trNoj atl►T M"��•VM ie�iy.MO ,sit e4efuted the URIs• Lpp.'t1 A Uji A CQYN wet m( , 7v AenJ end of►idal M61 t,�q hl . 111 \lila l um FORM form at" rwMoo MAIL TAXB4ATJZMgMTi t1A4 at& to, off" PIVIW41 w•n A®dvR BEND Qd 6 r.. SU6-1 PEl ,U11 E2-1 @1e9 4- 9j1ND 3JT1T JJ3140IG 7p -:6U Zk�Ni t \�j iaeji - !e tv 1 00.e voq 000 I Q?"CA!9—so OVA 000 1 00.11 i an eblaooAl10101110 1 i to .cl�vo� t addut0 A 000ba00 • 1 �otr�aooil 1D WTO1l Oamw 7jj .0o spm a unrr immil tw- 103Stb •S t r+we-ft OT Am 0== lem Ctt1 fti;4�YjpS) .ii ble�tCi? ...r Mee A* 901M L Ot orlsi�ffotA t•T rrn t 00 1 i8-1qA-Ot vi00tG >1NCid/t EA ZW, � ----.-->?cu o'ajoaoOa ago >,Nu sun avotw Baa-- beo(J RMiD foubivibni o�aol�-daa �► htaC>y04 KC.'17QII 6 O.tJ'tT 7 Ott aLYDrx�A ts�v lJr� �(,)sul;sh (t)ToiwQ bsrtpT%bnu wir a ti zte 1s+11npc1 1(1+t)htmuav(t q t A na ege tq a sulav UU) no bltugqmna ( ar ) .Ake lb Amit a rileltmi mmdmwvm Ons mill to >tulIV ee~,l lulty 11111 no bsllf4mm ( ) bn. , to XII ( ) :Arta bvAtagva3mmU ( x ) ,bsgSelWonitu �dztsll d #W4w10 tgl"M MO1TAA9CIZRW 8JOAVJA,, A AU' -1 Y-*Wzu:n cMcato -VA rots► VuC=b Wert+ balrcm 0 t .M 9"t ,nitw bv+ trtetnrl AM= Ce VCWT trio 'trA= -n d1VM n! (t)TOAD tld-m l OMEMT !!toot Ob j e�sA �47ttrnr ++G ni {t•sgoiq bst bsdirnsD Srtlwotle; tn! jj :Aiaiel,t�lo'nef;, tv�7nuo� . � t �tst.f�3 10 'YcJsa+,rp � CtSs . �► Y�rl 7a�Al rst7 ii0 �! bt:lw yt�:l . ' to cru lukp YJ at to Yl prttY3 ..N a #0 -CA .sem t 09ftM .fb%&A aS Q11trFA:0' Ott MU Iduce no h3fairi- a= Ott C3 *710 )tl;1a HNT1 yt r,1101 IV�yt J' ,qv- 114-W 14 M W'w w tr..11o so e,w Ud n t@vt .t� �r� �btto0 .14 C I ik)E104 S 40 MTAT* AZ MO VtMUCe l t1blvd ,� n0 611041 ltd 161 6A ri t l')!101�y. fA "ObAY fdl .im Rw�.l -' 4attq'It 4'�c�een9 na stillt ewetI tY 1R1 01 tltlai►A (1ltaonnel tewdr +neRrq tdt t4 a »Atbi1>, pvnelu ahe tf1mNsm otlojhvvd)bi tM O ed++s .tTL1 td! 111fU1N1 ett11 .lose khi)10 ant [Aga -' tNN t1w s►t t,f%4e. c i C 1�u^dfJwir,l 9U ONM AVOCA O5 MICI as d!Y'MUNTATa XAT JIAM arr erene,o.t+ao, -�'i.�.-,.�.,..,,,{,�i_,r,�;w,�.rr.�,�7�-�.,,r,1,.,��.,�;�•.,,�,r, r' _ .�1y; a...*ti..�alf�-rM��i-.�-..3:'�-..-r-.,.��.:-.��tir-...l�-..., BUSINESS, TRANSPORTATION AND HOUSING AGENCY' EMS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT ` DIVISION GF CODES Ali D STANDARDS ' REGISTRATION AND TI'T'LING PROGRAM STATFA ENT OF FACTS t This unit is a: F-1 Mobilehome 0 Commercial Coach 0 Floating Home Truck Camper Decal (License) No.(s) Trade Name Serial No.(s) (Z 17 C,&4oaa�d CIS V'L_s t -7 A r-7 o aS44 I -a- 15 4 84 ©CAFL_S 1`'r B i`7%(Qa8+41a I/We, the undersigned, hereby state: THIS UNIT IS BEING PLACED ON A FOUNDATION SYSTEM IN ACCORDANCE WITH SECTION 18551'OF THE HEALTH AND SAFETY CODE. 1 We further agree to indemnify and save harmless the Director of Housing and Community Development, State of California, and subsequent purchasers of said unit, for any loss they may suffer resulting from registration of the above-described unit in California, or from issuance of a California certificate of title covering the same. I/We certify under penalty of perjury that the fegoing is true and correct. Executed on Sat (Date) (City) (State) Printed name(s) . I%�Tf�GC /—/• 16�-%ieDltJ/ City HCD 476.6 (REV 9/91)