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HomeMy WebLinkAbout056-310-008<i -77 056-310 -008 08 � 99-2507 DOERSCHLAG, DON 5M HEADWATERS, FOREST RANCH CON"CR: OWNER LOT DE r. 056-310-008 99-2533 DOERSCHLAG, DON 5472 HEADWATER, FOREST RANCH CONTR: OWNER p DEMO CABIN 7 i 056- 10-008 DOE CHLAG, Don ,5q' -1-1 ea aters, Forest Ranc MHU P. . 056-310-008 00,1226 DOERSCHIA DON® .0\ 5472 ATERS, FO i MR ON FND v August 23, 2000 Don Doerschlag PO Box 127 Forest Ranch, CA 95942-0127 Dear Mr. Doerschlag: -butte Co, LAND OF NATURAL WEALTH AND BEAUTY BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES - 7 COUNTY CENTER DRIVE • OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (530) 538-7541 FAX: (530) 538-2140 RE: Address on Headwaters Road, Forest Ranch A.P. #056-310-008 The official address for AP #056-310-008 is 5472 Headwaters Road. This address was issued November 2, 1981, please see attached document. The address typed on your building permits was incorrect. The use of the address of 5492 Headwaters Road is not valid for this parcel and should no longer be used by you. Use of incorrect addresses may hinder the ability of proper response of emergency vehicles. If you have any questions concerning this matter, please contact me at 538-7541. Sincerely, Scott Rutherford Chief Building Inspector sr: aam e NOTES RESIDENTIAL. -------------- 056-31-0-008 00-1226 ,#;4 J PERMIT NO. _'DOERSCHLAG, DON 15492 HEADWATERS, FOREST RANCH CONTR: OWNER MH ONON_PERM a� �q �,Cee��nss�fl THE HCD FORM 433A. -FOR THIS MH CANNOT- BE ANNOTBE RECORDE UNTIL ONE OF THE FOLLOWING HAVE B TURNED IN TO THE BLDG DIV: (t LICENSE PLATE(S) or DECAL(THE INSPECTOR MUST RETRIEVE) (2) STATEMENT OF FACTS(ONLY ON } !NEW MH S) _ INSPECTOR TO VERIFY SERIAL.& LABEL #_`S CAFL_�3 7 .c SPECIAL CONDITIONS CHECKED f BY • g SRA 3 FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPS y- Address S�e 9'�L GAS / / Meter ey (/ ELECTRIC Meter.By (fly Date 4 JOB FINALED (Date) Signature `� ✓ = OK 0 = Not OK - = Not Applicable MOBILE BIOMES = Not Ready Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L'ft. / P Nat. or / /"L"ft./ /'LPG 7. Well Clearance 8 Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card 8=1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy 12. Permanent Foundation Only; License Decal Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s r� 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors Shthg.-Frg-Bracing 5.;�'Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (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, Distance-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 11. Liaht Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 = OK 0 = Not OK - = Not Applicable = Not Ready RESIDENTIAL R (: Date :- Underfloor (Plans) OK except #'s Hangers -Post Caps -Anchors -Connectors 1. Zoning -Setbacks -Easements -Flood -Slope ' jr Cling. Joist-Rttr. Ties-Purlin-Roff Brac.-Truss-Shting.-Rfng. 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Fig. Depth Fireplace Ties or Type A Flue -Fireplace Throat Clearance 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Sfeel- Blockouts-W=pPed 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 -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s PLUMBING (Permit) OK except #'s 63. 17. Water Htr.; Vent -Access -Combustion Air Baffle 64. 18. Water Pipe; Test & Anchor -Nail Protection 65. 19. D.W.V.; Test Fittings & Anchor -Nail Protection 66. 20. Shower Pan; Test, First Floor -Tub Access 67. 21. Test Tub & Shower, Second Floor -Tub Access 68. 22. Gas Pipe; Sixe & Anchors 69. Stairs & Rails Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance 23. Fixture & Transformer Clearance -Ins. Protection Elec. Outlets & Receptacles at Kit. Counter 24. Elec. Receptacles Spacing -Lights & Switches at Doors Garage Fire Door; Swing -Landing -Closure 25. Size Boxes & No. of Conductors Stapled A.C. Duct in Garage -Damper 26. Romex Installed Close to Edge of Studs & C.J. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 27. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water Plb., Elec. & Mech. Equip. Listed for Location 28. 2 Appliance Circuits in Kitchen & Conductor Size GFI Elec. Receptacles in Garage (F.F.I.)-Romex Protection 29. Subteed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At Insulation -Foam -Looked in Attic 30. Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At Insulated Neutral Q Yes O No Guard Rails & Deck Construction -Post Caps 31. Service -Riser Conductors & Ground Main Disconnect Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth 32. Equip. Clearances Panels-Motors-Mech. Equip. Clearance Looked under Floor ❑ Yes 33. Clothes Closet Light -Shower Light -Spa Light Following Insild./Drive J Yes 0 No/Walks D Yes Q No/Planters Q Yes ] No 34. Smoke Detector Stucco Brown -Finish 84. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date 86. MECHANICAL (Permit) OK except #'s 35. A.C. Ducts Insulation & Support 36. Vent Fan, Exhaust above insulation 37. Condensate Drain & Overflow, Size & Grade 38. Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet 39. Attic Access & Platform if Furnace in Attic 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s Card B-1 Date Card B-1 40. Sits Proper Materials & Anchors Date 41. Walls Studs -Nailing Spacing & Braces -Plates -Sound 42. Bearing Walls over Girders & Floor Nailing 43. Draft Stop in Walls (rat proof) 44. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 45. Headers & Beams -Size & Bearing 'iingle & Duplex) Date FRAMING (Continued) :- 46. Hangers -Post Caps -Anchors -Connectors 47. Cling. Joist-Rttr. Ties-Purlin-Roff Brac.-Truss-Shting.-Rfng. 48. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 50. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions _51:.Garage Fire Protection Framing 52. Property Line Firewall & Openings 53. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 54. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 55. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 56. Siding -Nailing Veneer 57. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 58. Glazing Area -Glass Protection -Skylights -Plastic 59. Shear Walls; Nailing -Bolts 60. Brace Interior/Exterior Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 63. Ext. Steps -Door & Sidelight Protection -Landings 64. Smoke Detector 65. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 66. Bedroom Exiting 67. G.F.I. & Bath Fixtures & Tub Access -Spa 68. Elec. Trim & Subpanel, Breaker Sizes & Labels 69. Stairs & Rails 70. Fireplace or Stove, Clearance -Hearth 71. Elec. Outlets at Wood Panel, Int. & Ext. 72. Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance 73. Elec. Outlets & Receptacles at Kit. Counter 74. Garage Fire Door; Swing -Landing -Closure 75. A.C. Duct in Garage -Damper 76. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 77. Plb., Elec. & Mech. Equip. Listed for Location 78. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 79. Insulation -Foam -Looked in Attic 80. Guard Rails & Deck Construction -Post Caps 81. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 82. Following Insild./Drive J Yes 0 No/Walks D Yes Q No/Planters Q Yes ] No 83. Stucco Brown -Finish 84. A.C. Unit Disconnect, Electrical -Plumbing 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 86. Water Well, Disconnect, Electrical, Plumbing 87. Exterior Elec. Trim, G.F.I. Receptacle -Underground 88. Ventilation Throughout House 89. Glass Protection 90. Corrections from Previous Inspections 91. Gas Test -Meters Tagged, Gas -Electric 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates 94. Address Posted 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: COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PE MIT O. (Rev. 12/96) APPLIC�ITiON A14D PERMIT���� ASSESSOR PARCEL NUMBER 056-31-0-008 ZONING AR BUILDING PERMIT OWNER DON DOERSCHLAC TELEPHON — '3�f 2o1 SO. FT. OCC. BUILDING VALUATION 798 43,092 . OWNERS MAILING ADDRESS P.O. BOR 127, FOREST RANCH, CA 95942 CONTRACTORS NAME OWM TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDERS MAILING ADDRESS Total Valuation $ 43,092 ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee 375 2 $ 187.50 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 2-3-00 BUILDING ADDRESS —%&" HEADWATERS, FOREST RANCH Energy Plan Checking Fee $ 5V 9 $ PERMIT FEE $233.50 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome IN Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: MOBILE HOME. PERM FOUNDATION , PRESENTLY UNI Gas piping system 1- 5 outlets 15.00 Building sewer 15.00 obile HomeS G w @20.00 MHU 00-0592 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 oV LESS Main Service . , OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION.50 I hereby affirm under penalty of perjury that 1 am exempt from the Contractors License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUR OR ADDNS. ( a ACC. B1nS. SO 3.5¢FT: "No�FIESIDT' MULTI.00UTLET @7,50 8SIPONGLE OUTLET CIR.WER APPARATUS EX. Occu OUTLET OR FORURES s20 @ 1.00 Ex. Occup. OFIXED g p6Ip.) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall rthwith com y with those provisions. Date j) _ 4iWature of p scant - R -Owner ❑ntractor ❑ Agent An OSHA permit is required for excavatio over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 233.50 HA2 – D FEES IMP _, FLOOD a// cOf �/ PARCEL - HD ISSyE � This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By �C%2/�/ �/ PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. (p 2 [N Date q Dale Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 7^+'1✓-�-.7"'F�"a-� �„�: ,�•G'�•.:..+',�`"�• i;�., '„i��-�:rr�'►%�r1S'�``::.:w;�i.'.,`.J �l4vf ,.lam, •�r�`.q �R � ., :r-'' COUNTY OF BUTTE - DEPARTMENT+OF DEV PMENT SERVICES - BUILDING DIVISION I ��ti 7 COUNTY CENTER DRIVE - OROVIL ,^E, C�4�'iOI�JVIA 95965 - TELEPHONE (530) 538-7541 PERMIT". -, I DATA SHEET OWNER: �._ ASSESSOR PARCEL NUMBER: Q Proposed Burlding Use: "" wilding Inspector: s Date: At time of permit application, I Was advised the toHowing data must be submitted prior to permit pro essing and/or issuance: ------------------------------- Date Received By El 1. All item§ have been submitted.-------------------------------------------------- —- 02. Plot plans, 3/4 sets, signed by the preparer of plans. ------------------------------------------------------------ ❑3. Complete plans, 3/4 sets, signed by the preparer of plans. ------------------------=: -------------------------- 04. ------------------ ==-------------------------- ❑4. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. -------- ❑ 5. Engineered truss details and layout in duplicate (required prior�to plan review) No faxes! ------------------ 0 6. Energy Design Compliance and supporting documentation. ---=---------`-------------------------------------- 0T ------------------------------------- ❑7. Statement of Intent for Non -Heated and A/C Buildings. --------------------------------------=------------------ ❑ . H azdous Material Form. ---------------------------------------------------=------------------------------------- anufactured Home data and 'installation instructions including Tie Down Specifications .------------------ - ❑ 10. Fees of $ " /------------------------------------------------------------------------------------ pact fees as shown on the attached schedule. ------------------------------ ---------------------------------- - iW w��------------------ . California Department of Forestry plan approval/fees. '� ------ 0 P. J_1Qod elevation certificate. ------------------------ ----------------------- ---------------------------------------- Sanitation and plot plan approval Health Department. ------------------------------------------- ❑ 15. City of Chico plumbing permit.--------------------------=------------------------------------------------------ ❑ 16. Plot plan and business license approval from the City of Big 9'$ ---------------------- ❑ 17. Planning approval for (A) Use: (B) Parking:., _. ❑ 18. Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel ❑ 19. Encroachment Permit for driveway (construction approval prior to occupancy). --- ❑20. Pre -inspection for required Request to Building Inspector on 112 1,. Contractor's license information. (Number, Name Style, Classification). ❑22. Workers' Compensation carrier and policy number. ----------------------- E123. Owner -Builder Verification'(Given to owner ❑, Mailed to owner ❑). -- 024. tter of signature authorization. ------------------------------ -------------------------------------------------- kf5 ---------------------------=-------------------------------------------------- 5 . Recorded copy of Agricultural Acknowledgment Statement.-1�---------------------------------------- 026. Letter of intent on building use. ----------------------------------------------------------------------------------- ❑27. Manufactured Home utility clearance. --------------------------------------------------------------------------- ❑ xisting violatidins and/or expired permits. ---------------------------------- - ----------------------- ©433 A, 4J Grant Deed, ❑ M.H. Title, b -Check to H.C.D I --------------- 1130. Other: 1-_� When you issue the permit, process as follows WM' ail to owner, ❑Mail to contractor. ❑Telephone and hold for pickup at office. ❑ Deliver with inspector. Applicant: Copy of Haz-Mat form sent ❑ Health Department, o Fire Department, ❑ A Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑�} r: _ (Date) By; By: 1. Index permit application for the above items numbered: ❑ Plan Check List 2. Additional items r Contractor, designer own ,was advised of the above required data by phone, , 11 Building Division counter, b Date: Contractor, design , owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, bjj Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Div-'�' n counter, by Dat Plans reviewed by: Date: Plans approved by: Date: tltg Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date: Vallnfr (`nnv _ TlA„o.•t.,,o..t nfTlo..el•......,.-.a o....:_-- r�___ts_ ,.• x , COUNTY' OF BUTTE DEPARTMENT. OF DEVELOPMENT ,SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541 SCHEDULE OF FEES DUE OWNER. A.P. # PROPOSED BUILDING USEDATE RECEIPT # DATE REC 1. BUILDING PERMIT FEES -- Balance Due ............. $ -- Additional Fees Due ........... $ -- Additional Fees Due ........... $ *Revised Plan Checking Fee ........ $ ° �'/2. SCHOOL DISTRICT FEES C %J 1 C 0 (paid at District Office) .3. SHERIFF FEES (paid at Building Division) Residential ..:..... x $360.00 = $ Units Commercial (sq.ft.)... x $0.03 = $ Sq. Ft. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit) . _X__ $ #Units Amt.. Commercial (sq.ft.) x =$ Sq.Ft. Amt. 5. RECREATION DISTRICT FEES (paid at District Office) 6./ THERMALITO DRAINAGE DISTRICT FEES $ 10.00 (paid at Building Division) _ 01k7. SRA FRE INSPECTION' AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # ) $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid'at Building Division) 10. OTHER 615`13a2 e) At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees may be changed during the plan checking process. APPLICANT//J ..l. /� DATE G Pursuant to Government Code Section 66020, you are herebyified that items 2,3,4,5;6,8,9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). { Original -Building Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 2/97) BUTTE COUNTY SCHO&SS,,IPF'E MACT E CERTIFICATION FORM (One form p6r. i q) 4$-; r'" to -,('- School District D Building Department No. A.P. Number edeJu� fiction: �City County / / L /(/( DP� % Property Owner tse Property Location/Address , Subdivision Lot No. Residential Development � Sq. Footage No of Living Mobile Home Addition/ *Supplemental to (Group R) Units Installation Conversion Permit # i '(No foundation inspection); mercial/Industrial -0— tJ .+ Sq: Footage f New Ad Hion (Including Exterior R ofed Areas) Building Department Representative Date (Floor Plans reviewed'by School District Personnel) District Identification No. / V 14 0, m( v�. 0 School District certifies that �t (Applicant) P./a K" .?�--?2, (Street Address) (Phone Number) 47��� q,59�� (City) has complied with the requirements of Resolution No. representing e�70 square feet. School District Representative Paid by Check i/ 14 Remarks: (State) (Zip Code) 7 V� �(y by payment of $ AB 2926 S FULL MITIGATION $ Date Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. 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.xls 110/98)dmm COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephcne ;5.30).538-7541 PERMIT APPLICATION AND PERMIT A.SSESSOR P&AC4i'lum .", 3 1 Q —O /I A BUILDING PERMIT OWNCR a�'e-� raE�tr"°"E �O �- cJ SO. F7 _ I OCC_ _ BUILDING _ VALUATION OleS F 9�59 VZ— CONTRACTOR'S NAME l- TEUSNONE CONTRACTOWS MAUNo ADORM i i CONSTRUCTION LENDER Fireplace 0 % 1— LENOors MNUNo ADoNS11 Total Valuation b v� ARCNrTECT OR EWER uceme NO. Filincz Fee b 2 0. O C r Permit Fee _ Plan CheckingFee '7 -L b ARCH ECT OR ENOMIM S WULIM ADORM allLDWGAMAESS 7i � a '� r S Energy Plan Checking Fee b 7 p PERMIT FEE b _ ' I LOT 140. aueoneanNAMe ►" � PLUMBING PERMIT , g Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome Other WEzr Solar or heat pump water heater 23.00 Water piping,15.00 Each gas water heater or vent 15.00 TYPE OF WORK / er New C3 Addition ❑ Remodel C3Udlitim ❑ Inshdation 0" eth❑ Describe Work: /wo/16r /'G /Ty -.*e__ �J .i��/�%,/ i'D .�— Tl e 5 �N y �f Gas piping stem 1 - 5 outlets Buildingsewer 15.00 15.00 Mobile Home ' S ! GI W @20.00 PERMIT FEE _ �w t/ „< / f (-)o O s C� �� ELECTRICAL PERMIT Filing Fee 20.00 + Main Serviceo ooRR =s' 23.00 ' it/G(t (� N /� C 4-C 1 •ti- U- (f ( L q5 e1 % ^ .3 ^ 7 [ G (� Main Service noon TO I000A 46.00 NEW CONST. OWgyyp OCCUP. SO OR AooNS. a ACC. etos. 3.50x. . coNs . Mu�TwurtFr NDNREs�o. @7.50Fs�owEA APPARATUS i b OLm.Er CIa Ex. Occup. OUTLET OR FWURES 2O � ' s BAl , .SO Ex. Occup. a,lnE��.)EIL 5.00 Temporary Service 23.00 Mobile Home Facilities I 20.00 Misc. Wiring 23.00 PERMIT FEE b MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEP- S Mobile Home Installation Fee b 0 Energy Inspection Fee i Occ CONST rype TO AL FEE $ (rul. p. }'EEa I 1✓reby C_DI P l NO 4SU t i 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. By Date PERMIT EXPIRES ON Owl OWNER -BUILDER ,VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until ' this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. YES .. NO 2. I HAVEO HAVE NOT 13 signed an application for a building permit for the proposed work. 3. I have contracted with the following person. (firm) to.prov#:*,.proposed, construction: NAMEi >(4 a.c�i ,.,► ADDRESS: CITY:_ . PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired.the following person to coordinate, supervise, and provide the major work: NAME: �C a ADDRESS: CITY: - PHONE: CONTRACTOR'S LICENSE NO. F 5. I will provide some of the work'but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER: L /,-P / (9y L SOCIAL SECURITY NUMBER: DATE: C7 '- NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. ' For your protection, you should be aware that as "owner-buildee, you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you inay protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and. to have a business license from the city or county. They are also required by law to put their license number on all permits for which*th'ey apply. ; . If yon! pled to day o' with with the exceptlon of various trades that you plan to subcontract you should be aware of the following information for your benefit and protection: ' ♦ if you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire. project, and such persons are not licensed as contractors subcontractors, then you may be an employer. " ♦ If you are an employer, you must register with the State and Federal Governments as an employer and yoware subject to several obligations including state and federal income tax withholding, federal social security. taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions.-'- + There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in7your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, AA' Mic el C. Vi ira, C.B.O. Ma ger, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OVER Sent By: BUTTE CO ENVIRONMENTALHEALTH; 530 895 6512; Jun -19-00 9:34AM; Page 1/3 -c� T!- ter,•:. b ,.. l n r not Me" Acumhed Flow AirIMM Sam W T0: ; ,,--- wilding Department FROM: Envitonmentat Health SOBJEOT: Sanitation Clearance AS11�lLAl^ I kaw m P& A F-2 sr., - Am - Do? Owner Location AP# Plan Approved for: Sewage Disposal ✓ Water Supply: Public Private Well ✓ Clearance for dwelling. Other +fold final for; C2C.� fin c earanca O.K. for: NOTE: Environmental Health Specialist T� Date 8/96 Page 2/3 Sent By: BUTTE CO ENVIRONMENTALHEALTH; • 530 895 6512; AP#56-310-00'8 5492 HEADWATERS PARCEL 2 5,09 AC, k oaTfr r-1.) M y 2 0 `ro 6r Jun -19-00 9:34AM; 0 APPROVED Butte cou^ty Environmental Health 3 _ n- i re M Page 3/3 %4 f„oc�4T1�' a. Ob wr+srd2-i►�(:. a Exis: ��b^ 4 N Icon t- ° k S�rG', ra►+K 14 xSi Most LE QO 68�/ Zq. Sf Z 22- ............ S S3 �O,po H ERc� w A 7tiA S � gA � Environments! Health MAR Z 3 2000 Chico, CaUtOmia RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 COPY of Document Recorded 24 -Jul -2000 2000-0028343 Has not been compared with •` original BUTTE COUNTY RECORDER 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. DONALD A. DOERSCHLAG AND SANDRA K. DOERSCHLAG REAL PROPERTY OWNER/LESSOR PO BOX 127 MAILING ADDRESS FOREST RANCH, BUTTE, CA 95942-0127 CITY COUNTY . STATE ZIP 5472 HEADWATERS ROAD INSTALLATION MAILING ADDRESS. IF DIFFERENT FOREST RANCH, BUTTE, CA 95942 CITY COUNTY STATE ZIP SAME - UNIT OWNER (if also property owner, write MAILING ADDRESS r CITY COLMY STATE LP 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 00-1226 (530)538-7541 Bj4LfING LERMIT N TELEPHONE NUMBER 07/20/00 IG ATURE OF LOCAL AGtif OFF IAL DATE NONE DEALER NAME (if not a dealer We, write 'NONE') DEALER LICENSE NO. FLEETWOOD 1989 SANDPOINTE . MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER CAFLJ 17A 10312SP 57'X 14' RAD487018 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. # 056-310-008 SEE ATTACHED HCD FORM 433(A) REV. 8/91 WHITE County Recorder CANARY - HCD PINK - Applicant GOLDENROD - Building Dept. LEGAL DESCRIPTION A.P. #056-310-008 All that certain real property situate in the County of Butte, State of California, described as follows: PARCEL I: Parcel 2, as shown on that certain Parcel Map entitled, `BEING A.PORTION OF THE N.'/z OF SEC. 28, T. 24N, R. 3E., M.D.B. & M.", said Parcel Map was filed in the Office of the Recorder of the County of Butte, State of California, on May 18, 1972, in Book 41 of Parcel Maps, at Page 93. PARCEL II: A right of way for road and public utility purposes over the roads as shown on that certain Parcel Map entitled, "A PORTION OF SECTION 28, T. 24N., R. 3E., M.D.B. & M.", said Parcel Map was filed in the Office of the Recorder of the County of Butte, State of California, on April 21, 1971, in Book 37 of Parcel Maps, at Page 82, 83, and 84. AP No. 056-310-008 BUILDING PERMIT NUMBER: 00-1226 Address or location of unit: 5472 HEADWATERS ROAD, FOREST RANCH, CA 95942 Legal Description of Real Property: A.P..#056-310-008 SEE ATTACHED (x) Mobilehome/Manufactured Home O 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: - DONALD A. DOERSCHLAG _ Owner's address: PO BOX 127, FOREST. RANCH, CA 95942-0127 INSIGNIA OR HUD NUMBER:.RAD487018 SERIAL NUMBER OR V.I.N.: CAFLJ17AI0312SP MANUFACTURER'S NAME: FLEETWOOD YEAR: 1989 c OFFICIAL APPROVING INSTALLATIO 00 -7 DATE: 07/20/00 PHONE: (530) 538-7541 H.C.D. 513C CORDING REQUESTED BY well Ti e & Escrow AND WHEN RECORDED MAIL TO Name Donald A. Doerschlag & Sandra K. Doershlag Street P.O. Box 127 Address Forest Ranch, CA 95942- Order 5942 Order No. 00189260-002 . 1999-0046429 GRANT DEED Recorded Official Records Count tY_Of CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 11:30AM 02 -Nov -1999 REC AX 2 FEE 109.000 Maureen Page i of 2 SPACE ABOVE THIS LINE FOR RECORDER'S USE 6 THE UNDERSIGNED GRANTOR(s) DECLARE(s) Documentary Transfer Tax is $ 29 -70 County 0 unincorporated area 0 City of 0 computed on full value of interest or property conveyed, or O full value less value of liens or encumbrances remaining at Parcel No. 056-310-008 the time of sale FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Gary Uhl, an unmarried man hereby GRANT(s) to Donald A. Doerschlag and Sandra K. Doerschlag, husband and wife, as Joirit Tenants the following real property in the Unincorporated Area county of Butte, state of California: - SEE SCHEDULE C ATTACHED FOR LEGAL DESCRIPTION Dated: October 22, 1999 J Gary Uhl STATE OF CALIFORNIA } SS: COUNTY OF BUTTE . v On _ /O- L 9 �d d"L ltel' � ,before me, ) U[J 4.'e-1.�. a Notary Public in and for said County and State, personally appeared GARY UHL Personally (mown to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the. person(s) acted, executed the instrument. . . WITNESS my hjN and offjgal seal. Signature FOR NOTARY SEAL OR STAMP FMy JODIE FINATO COMM. f 1115313 NOTARY PUBLIC-CALIFORNIACOUNTY OF BUTTE Comm. E.xplres Nov. 3, 2000 MAIL TAX STATEMENTS TO PARTY SHOWN ON THE FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE Name Street Address Clty & State Crystal D. Jones Grantdee THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA; DESCRIBED AS FOLLOWS: PARCEL I: PARCEL 2, AS SHOWN ON THAT CERTAIN PARCEL MAP ENTITLED, "BEING A PORTION OF THE N. 1/2 OF SEC. 28, T. 24N., R. 3E., M.D.B.&M.", SAID PARCEL MAP WAS FILED IN.THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON,MAY 18, 1972, IN BOOK 41 OF PARCEL MAPS, AT PAGE 93. PARCEL II: A RIGHT OF WAY FOR ROAD AND PUBLIC UTILITY PURPOSES OVER THE ROADS AS SHOWN ON THAT -CERTAIN PARCEL MAP ENTITLED, "A PORTION OF SECTION 28, T.24N., R.3E., M.D.B.&M.", SAID PARCEL MAP WAS FILED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON APRIL 21, 1971, IN BOOK 37 OF PARCEL MAPS, AT PAGES 82, 83, AND 84. AP NO. 056-310-008 Exec Comp C STATE OF CALIFORNIA - DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT CERTIFICATE OF TITLE Issued Total Fees Paid Apr 28, 2000 $86.00 Addressee _ DONALD A DOERSCHLAG PO BX 127 , FOREST RANCH, CA 959'42,-, - Registered -DW nec(sK DONALD �fi i&4CH1A' G SANDR6K"DOERSCHLAOJTRS PO J - BX FORE T RANCH, CA 1942 Situs Address/ 5492 $EADWATERSI_.y FOREST RANCH, CA 959.t2: 44 e a i. ., ,��.. ;,moi a �'• , 41 •rk '^"' •"_..� ,'i�'.�1 `.i� �'-,>ss L.,c�:�fFi>r.. SSP-�tr:�t�" �. ., % jy✓ ya. ,`'�,, r Irl � • � � '�f} ♦ c •�.-xry "'a•-•�. �~4 � ",��,. . TAY IMPORTANT THE OWNER INFORMATION SHOWN ABOVE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING -AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. Manufactured Home Decal No: LAN5805 Manufacturer ID/Name Trade Name Model DOM DFS RY Exp. Date 09534 FLEETWOOD HM SANDPOINTE 2562K 04/28/1989 05/08/1989 Serial Number Labeinnsignla Number Weight Length Width 'SPC SCC Exempt Use Type CAFLJ17A10312SP RAD487018 18.200 57' 14' 04 SFD LPT Issued Total Fees Paid Apr 28, 2000 $86.00 Addressee _ DONALD A DOERSCHLAG PO BX 127 , FOREST RANCH, CA 959'42,-, - Registered -DW nec(sK DONALD �fi i&4CH1A' G SANDR6K"DOERSCHLAOJTRS PO J - BX FORE T RANCH, CA 1942 Situs Address/ 5492 $EADWATERSI_.y FOREST RANCH, CA 959.t2: 44 e a i. ., ,��.. ;,moi a �'• , 41 •rk '^"' •"_..� ,'i�'.�1 `.i� �'-,>ss L.,c�:�fFi>r.. SSP-�tr:�t�" �. ., % jy✓ ya. ,`'�,, r Irl � • � � '�f} ♦ c •�.-xry "'a•-•�. �~4 � ",��,. . TAY IMPORTANT THE OWNER INFORMATION SHOWN ABOVE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING -AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. ' -- / / NOTES i RESIDENTIAL 056-310-008 00-0592 PERMIT NO. _-DOERSCHLAG,-Don --.— - -- 5492 Headwaters, Forest Ranch Nmu C �r �,O/G - p- II SPECIAL CONDITIONS II SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS —VERIFY' USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER CHECKED BY Signature 1-4 vl INTER -DEPARTMENTAL MEMORANDUM c TO: BUILDING DIVISION, OROVILLE FROM: �,5.<,Liay, , ENVIR. HEALTH, CHICO. DATE: RELEASE ENV. HEALTH HOLD ON BUILDING SAL FOR: OWNER NAME: SEPTIC: WELL: AP#: �7'/J D l/[ _ ADDRESS/LOCATION: S WoD /!S� �'2S P , Comments: GUmemos/releasehold 3M Y COUNTY OF -BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SPERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE R . PERMIT NO. A routine inspection ind'cates that the following violations of butte county Ordinances exist at the .={c above address and shEd be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact th'ice immediately. 0 - Date Date :5 II Inspector REV 10/92 V = OK ' 0 = Not OK - = Not Applicable = Not Ready MOBILE HOMES I Date MOBILE TILITIES (Plans) OK except #'s 2. ng Require rnents- Setbacks- Ease is 3. Soils; Special MH Support Sk f 4. 3. Sewer; Location-Test-Fa -Concrete 5. 4. Water; Location- as ent Need (S ch) 6. 5. Electricity; Loca earan Gr /Amp-Concrete 7. 6. Gas; Location-Test-Wrap; 1,,--P Nat. 8. r . Wo,dlearance & Disconnect& Disconnect 9. 600'Utilitv Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy 12. Permanent Foundation Only; License Decal Date Card B-1 Date Card B-1 Date Card B-1 Date Card B1,11, DKA va s f. 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; Girders -and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms- Rftrs.-Con nectors Shlhg.-Frg-Bracing _ 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carpons; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rtirs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (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, Distance-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 11. Light Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 V = OK 0 = Not OK - = Not Applicable = Not Ready RESIDENTIAL (: Date Underfloor (Plans) OK except #'s Hangers -Post Caps -Anchors -Connectors 1. Zoning -Setbacks -Easements -Flood -Slope Cling. Joist-Rttr. Ties-Purlin-Roll Brac.-Truss-Shting.-Ring, 2. Ftg., Main; Soils-Elec. Grnd.-/ , /" Ftg. Depth Fireplace Ties or Type A Flue -Fireplace Throat Clearance 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 4. Ftg., Porches & Decks; Soils -Steel-/ /".Ftg. Depth Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 5. Stemwalls, Main; Steel-Blockouts-Wrapped Garage Fire Protection Framing 6. Stemwalls, Garage; Steel -Blackouts -Wrapped Property Line Firewall & Openings 6a. Hold Downs and Special Anchors Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 7. Slab, Steel -Wrapped Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection .8. Piers -Fireplace Fig. -Steel Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test Siding -Nailing Veneer 10. UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test Stucco Mesh -Drip Screed -Fd.' Vents-Underflr. Access 11. Water Pipe; Test -Anchors -Regulator -Service Test Glazing Area -Glass Protection -Skylights -Plastic 12. Electric Underground Shear Walls; Nailing -Bolts 13. Plenums & Ducts; Clearance -Material -Support -Ins. Brace Interior/Exterior Wall Panels 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies Insulation -Walls -Ceilings 15. Access & Ventilation Infiltration -Walls -Windows 16. Insulation Date Date Date Card B-1 Date Card B-1 Date Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Ext. Steps -Door & Sidelight Protection -Landings 17. Water Htr.; Vent -Access -Combustion Air Baffle Smoke Detector 18. Water Pipe; Test & Anchor -Nail Protection Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection Bedroom Exiting 20. Shower Pan; Test, First Floor -Tub Access G.F.I. & Bath Fixtures & Tub Access -Spa 21. Test Tub & Shower, Second Floor -Tub Access Elec. Trim & Subpanel, Breaker Sizes & Labels 22. Gas Pipe; Sixe & Anchors Stairs & Rails 70. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date 72. ELECTRICAL (Permit) OK except #'s 23. Fixture & Transformer Clearance -Ins. Protection 24. Elec. Receptacles Spacing -Lights & Switches at Doors 25. Size Boxes & No. of Conductors Stapled 26. Romex Installed Close to Edge of Studs & C.J. 27. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 28. 2 Appliance Circuits in Kitchen & Conductor Size GFI 29. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At 30. Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At Insulated Neutral ❑ Yes ❑ No 31. Service -Riser Conductors & Ground Main Disconnect 32. Equip. Clearances Panels -Motors -Mach. Equip. 33. Clothes Closet Light -Shower Light -Spa Light 34. Smoke Detector 84. A.C. Unit Disconnect, Electrical -Plumbing Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Water Well, Disconnect, Electrical, Plumbing MECHANICAL (Permit) OK except #'s 87. 35. A.C. Ducts Insulation & Support 88. 36. Vent Fan, Exhaust above insulation 89. 37. Condensate Drain & Overflow, Size & Grade 90. 38. Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet 91. 39. Attic Access & Platform if Furnace in Attic 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Date FRAMING (Permit) OK except #'s Date 40. Sits Proper Materials & Anchors Card B-1 Date Card B-1 41. Walls Studs -Nailing Spacing & Braces -Plates -Sound 42. Bearing Walls over Girders & Floor Nailing 43. Draft Stop in Walls (rat proof) 44. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 45. Headers & Beams -Size & Bearing 'ingle & Duplex) Date FRAMING (Continued)• 46. Hangers -Post Caps -Anchors -Connectors 47. Cling. Joist-Rttr. Ties-Purlin-Roll Brac.-Truss-Shting.-Ring, 48. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 50. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 51. Garage Fire Protection Framing 52. Property Line Firewall & Openings 53. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 54. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 55. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 56. Siding -Nailing Veneer 57. Stucco Mesh -Drip Screed -Fd.' Vents-Underflr. Access 58. Glazing Area -Glass Protection -Skylights -Plastic 59. Shear Walls; Nailing -Bolts 60. Brace Interior/Exterior Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 63. Ext. Steps -Door & Sidelight Protection -Landings 64. Smoke Detector 65. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 66. Bedroom Exiting 67. G.F.I. & Bath Fixtures & Tub Access -Spa 68. Elec. Trim & Subpanel, Breaker Sizes & Labels 69. Stairs & Rails 70. Fireplace or Stove, Clearance -Hearth 71. Elec: Outlets at Wood Panel! Int. & Ext: �. 72. Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance 73. Elec. Outlets & Receptacles at Kit. Counter 74. Garage Fire Door; Swing -Landing -Closure 75. A.C. Duct in Garage -Damper 76. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 77. Plb., Elec. & Mech. Equip. Listed for Location 78. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 79. Insulation -Foam -Looked in Attic 80. Guard Rails & Deck Construction -Post Caps 81. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 82. Following Instld./Drive 0 Yes 0 NoMalks ❑ Yes ❑ No/Planters p Yes 0 No 83. Stucco Brown -Finish 84. A.C. Unit Disconnect, Electrical -Plumbing 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 86. Water Well, Disconnect, Electrical, Plumbing 87. Exterior Elec. Trim, G.F.I. Receptacle -Underground 88. Ventilation Throughout House 89. Glass Protection 90. Corrections from Previous Inspections 91. Gas Test -Meters Tagged, Gas -Electric 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates 94. Address Posted 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: r u COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California ,95965 • Telephone (530) 538-7541 PERMIT N . (Rev.12/96) IAPPLICATION AND PERMIT 00-0592 ASSESSOR PARCEL NUMBER r_ _ ZONI BUILDING PERMIT OWNER DON DOERSISMAG TELEPHONE 342-02201 SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS BOX 127 FOREST RANCH 95942 CONTRACTOR'S NAME owmm TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 23.00 BUILDINGADDRESS Energy Plan Checking Fee $ PERMIT FEE S43.00 LAT NO. SUBDIVISIONS NAME PA MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: MHU Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home Mn 920.00 C0.00 PERMIT FEE $ 80.00 ELECTRICAL PERMIT Fling Fee 20.00 600VOR UE Main Service 2o0A OR LESS 23.00 00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 19- I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO IuooA _23 46.00NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. BLDS. SO 3.50FT. ►N,OONN-RESIO OUTLET 97.50 & PSINOWGERLE APPARATUS OUTLET CIR.oLmFT Ex. Occu OR FocruREs 20 @ 1.00 BAL @ .so FIXED PPLNS. Ex. Occup. OUTLETSRES D.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 20 00 Misc. Wiring 23.00 PERMIT FEE $ 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S 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.) jC 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall orthwith comply with those provisions. _ Date 21'i neo &ature of Applicant -- ❑�❑ Co ctor ❑ Agent An OSHA permit is required for excavations v r 5'0" deep and demolition or construction of structures over 3 stories in height 3 , I G Mobile Home Installation Fee $ Energy Inspection Fee $ occ TY CONST. TYPE TOT FE 1 .00 ".►Z' I FL P PD HD su 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. L By D to I- 06 PERMIT EXPIRES ON Y ( Fi / 1Der Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT I le 14 �FCO1' NMOF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541 s .� PERMIT APPLICATION DATA SHEET OWNER: (/ 0 Gid S G 41A,ASSESSOR PARCEL NUMBER: S �' - b Proposed Building Use: rJ C/ Building Inspector: �.�✓�' Date: 3– 7, – Z n, o — At time of permit application, I was advised the following data must be submitted prior to permit process' g and/or issuance: Date Received By ❑ 1. All items have been submitted ------------------------- 02. Plot plans, 3/4 sets, signed by the preparer of plans. 03. Complete plans, 3/4 sets, signed by the pieparer of plans. ----------------------------------------------------- 114. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans.-------- 115. ------- ❑5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------ 116. Energy besign Compliance and supporting documentation. -------------------- '----- ------------------------- ❑ 7. Statement of Intent for Non -Heated and A/C Buildings.----------------------------------------------------- ❑ 8. Hazardous Material Form. 09. Manufactured Home data and installation instructions including Tie Down Specifications.------------------ ❑ 10. ees of $ ------------------------------------------------------------------------------------- ❑ 1 Impact fees as shown on the attached schedule. - --- -- ------------ --1,-�-- ---- ---- California Department of Forestry plan app 1/f s -1�-'-�--`- -� - ----------------------- ^ ,❑l113 . Flood elevation certificate. ------------------ — ------------------------------------------------------------------- �4. Sanitation and lot plan approval C "``�����vvv P P PP t -Health-Department. ------------------------------=--=--------- ❑ 15.. City of Chico plumbing permit.---------------------------------------------------------------- ❑ 16. Plot plan and business license approval from the City of Biggs. ❑ 17. Planning approval for (A) Use: (B) Parking: ❑ 18. Contact Land Development about ❑ Improvements, ❑. Drainage, ❑ Legal Parcel. ❑ 19. Encroachment Permit for driveway (construction approval prior to occupancy). -- 0 20. Pre -inspection for required Request to Building Inspector on ❑21. Contractor's license information. (Number, Name Style, Classification). 022. Workers' Compensation carrier and policy number. ----------------------- 023. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑). ❑i 4. Letter of signature authorization. ------------------------------- 5. Recorded copy of Agricultural Acknowledgment Statement. ❑26. Letter of intent on building use. --------------------------------- ❑27. Manufactured Home utility clearance. -------------------------- 028. Existing violations and/or expired permits. ------------- -------- 029. 0433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $ 030. Other: 'r- – / When you issue the permit, process as followz'b Mail to owner, ❑Mail to contractor. ❑Telephone and hold for pickup at office. %❑ Deliver with inspector: APPhc � Cd! Date: Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department,A i Pollution`'– Date: By: Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ Other: Date: By: 1. Index permit application for the above items numbered: ❑ Plan Check List 2. Additional items required: ' Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ BuildingD i ' on counter, by Dae: Plans reviewed by: Date: Plans approved by: Date: Sets of plans on hold in 0 Plan Cabinet, 11 A.P. folder. Note transfer by: Date: (Date) -s �Z tl —lb TO: Building Department FR Environmental Health SUBJECT: Sanitation Clearance E.H. USE ONLY Riot Plan Attached Floor Plan c ed Sent to G. O Owner Location AP# Plan Approved for: Sewage Disposal +/ Water Supply: Public Private Well Clearance for dwelling. Other • .�-.� � �'� � ' ,tau C'� SE- Sr �- ��;, rtfinal -for t�'f , "1-cieaParice O.K. for: NOTE: Environmental Health Specialist Date 8/96 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT r, ,UeV 121961 APPLICATION AND PERMIT 60'© AS SFSSOR PARCEL NUMBER 5L C ` ZONING BUILDING PERMIT OWNER -�k-1 L TELEPHONE SO. F r. OCC. BUILDING VALUATION -- OWN ERQ lO ADDRESS zh, ' 1 CONTRACTOR'S NAME TELEPHONE j CONTRACTORS MAILING ADDRESS I i CONSTRUCTION LENDER i Fireplace LENDER'S MAILING ADDRESS Total Valuatlon $ _ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee I $ U • V V Permit Fee $ ARCHITECT OR ENGWEEWS MAILING ADDRESS Plan Checking Fee $ 2 BUILOING ADORESs�-� ` 1 /d7X L lee-G- Energy Plan Checking Fee $ $ I PERMIT FEE $ LOT NO. SUBONISIONSHAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 1 7.00 USEOFSTRUCTURE Solar or heat pump water heater 23.00 Water piping 15.00 SF ❑ Duplex ❑ MobilehomeOther Each gas water heater or vent 15.00 sPEclFv- TYPE OF W RK New ❑ Addition ❑ Remodel ❑ UtlGfies Installation ❑ Other ❑ Gas piping stem 1 - 5 outlets 15.00 i I i Building sewer 15.001 I Mobile Home S (020.001 6 Q t I Describe Work: , PERMIT FEE S coo ELECTRICAL PERMIT Fling Feel 20.00 Main Service Zo AOR LESS 23.00 23- _ Main .Service 200A TO IOOOA 46.001 NEW CONST. DWELLING OCCUR I OR ADONS. ( 6 ACC. BLDS. s0.1 3 5¢Sri,: /) ULTI- i NON-RESID. OUTLET NEWCONS =-,-=T, 97,50? ,I POWFA APPARATUS 6 SINGLE Ol!(LET CIR. I Ex. Occup. OUTLET OR FDCTURES 1 FIXED ALNS. OR I Ex. OCCU PP OUTLETS RES10. EA 204 1.00 1 RAL 9 .S0 j S.00 I Temporary Service I 23.001 Mobile Home Facilities 20.001 Misc. Wiring I I 23.00; PERMIT FEE S MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling i Hood i 6.50 __ - ---- -' Ventilation PERMIT FEE 1 $ Mobile Home Installation Fee I $ Energy Inspection Fee S D" CONST TYPE TOTA EE $ 1 J i HA: 0 FEES : IMP 1 FLOOD COF PAR L PO n0 rISSLE This permit 1s 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. By - -- Date _ --__--- PERMIT EXPIRES ON OWNER -BUILDER ;VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until . this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES Cr� NO 0 -2. I HAVE L -HAVE NOT 13 signed an applicatiion for a building permit for the proposed work 3. I have contracted with the following person.(firm) to.proyi4e:the.proposed const *on: NAME: ADDRESS: CITY:. PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired. the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY:. PHONE: CONTRACTOR'S LICENSE NO. # 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYO WNER: v- - SOCIAL SECURITY NUMBER: DATE: NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in youi name listing yourself as the builder of propeity improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and, to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply.c If you plait to &o -your own'wo&, with die exception of various trades that you plan to subcontract, you 'should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including`niaterials and other costs) is 5300 or more for the entire.proj=4 and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. 4ic ly, C. Vi ira, C.B.O.r, Building Inspection NOTE. This Owner -Builder Information is required by Section 19830 of the CaWornia Health and Safety Code OVER AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DMSION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 ,COPY of Document Recorded 28 -Mar -2000 2000-0011137 Has not been compared with original BUTTE COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences'or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural 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: PARCEL 2, AS SHC PORTION OF THE I` SAID PARCEL MAP COUNTY OF BUTTE, OF PARCEL MAPS, Date 3 ^ Z 0 eo State of California County of ��- On Z lG�fr/1-+ WN ON THAT CERTAIN PARCEL MAP ENTITLED, "BEING A . 1/2 OF SEC. 28, T. 24N., R. 3E., M.D.B. & M.", WAS FILED IN THE OFFICE OF THE RECORDER OF THE STATE OF CALIFORNIA, ON MAY 18, 1972, IN BOOK 41 AT PAGE 93 before me, TY OWNERS: personally appeared Dohri y /l . /in er St,( /4- r� personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my nd and official l seal. Si nature ✓�. i l�Z� —TON LYNN M. NE'.1nut Signature Seal: y Commission # 1093283 �. Notary Public — Callfom!a Butte County A.P. # o6 bV 8 My Comm. Expires Apr 27.2000 AP,,56-310-000 5492 HEADWATERS PARCEL 21 50109 AC, N o R'fi4 1-0 CA -rj ora v Pages ROAD. 6r 1% APPROVED 13utte county Environmental Wealth 3 3 591 e �'TrLls. C """' • %ILO 00 Wi} 6a Lj"C - _p AXIS%/M(r L, 4 1 c143)N � _J Dov 12 � 171, /4 C4 el to ) Do PAX s _ fr 120,,t 70 1y x�6 °r'1oB1lIE CO 6 gni iZq.S/. Z2S.S3 0 w,A ;R S �_ oA a Health . �,nvlronmenta MAR 2 3 2000 Ch1coCaltfomla 4 . f APPROVED - Butte County Environmental Health up 0",/- t q Permitclearance 1§ APPROVED ❑ CONDITIONALLY APPROVED ❑ RESOLVE PROBLEMS PRIOR TO APPROVAL Permit #• C)9 — 2� — 1 1 Date: Y-99 Genera/Information Owners Name:�41J L�.Ofc2 U- �. AP #: GG �o l Same as Computer Information: ❑ No ❑ Yes Address: F. Q ,1So x ) .2`� _7P0 2GS T- 2 Ra.N a g 59 y Z S'TG ; is --)�`Z N ���wxaTE2S Propertylnformation Zone District:_ ] rji — Date of Zoning Ordinance: 2-" �% ' `P A General Plan: (z Development Agreement:. , Use Permit: Variance: Parcel Is In: Land Conservation Agreement §j No ❑ Yes, check use Minimum Acreage: . Nitrate Action Plan ' E9 No ❑ Yes Violation Area I No ❑ Yes' Specific Plan is No ❑ Yes ❑ Chico ❑ D2N Enterprise Zone M No ❑ Yes, check use Floodplain Iff No ❑Yes Zone: Watershed Protection Zone Wo ❑ Yes ❑ Cohasset Panel Number: I Proposed Use: ❑ Agriculture Building ❑ Commercial ❑ Industrial ❑ Mobile Home ❑ SFD ❑ Residential Accessory ❑ 2nd Dwelling ❑ Multi -Family >2 units per parcel Other Proposed Use Complies With• General Plan 49 Zoning Proposed Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit Commercial/Industrial/Multi-Family Uses• Parking: ❑ Parking Requirements are OK as Shown Landscaping: ❑ Landscaping Requirements -are OK as Shown Road and Drainage Improvements Required: ❑ No ❑ Yes Aoplicable Setbacks: ❑ Accessory Building Use ❑ Other ❑ Other 4 Zoning Code: Street & Hi hwais Fire Prevention Subdivision Ma Front Side 0 Side street L Rear I , 7 Heiqht Environmental Health Issues• Septic Permit Review: Well Permit Review: Land Development Review: Parcel Created by: ❑ Deeds a Map Permit Clearance Agriculture Affidavit Required ❑ No ❑ Yes Designated Well Site ❑ No ❑ Yes Drainage Plan (Com/Ind/Multi) ❑ No ❑ Yes Date of Creation: Legal Access Provided: Deed Reference: Legal Access Required: Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation: ❑ No [-]yes Comments: ❑ No ❑ Yes ❑ No ❑ Yes Date of Recording: Lot: G— Block: Book: Page: 1 Conditions That Must be Met Prior to Issuance of Permit: ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Creation Deed ❑ Comply with condition no. of conditions of approval for the ❑ Obtain a Certificate of Compliance (See Planning Division for application). ❑ Construction across property lines is not permitted (See Land Development for a Merger Application/Lot Line Adjustment). ❑ Comply with Old Subdivision Lot Ordinance (Maps Recorded Prior to Book 17 of Maps Page 23). ❑ Construct road to ❑ Meet parcel size required by zone ❑ Meet current EHD requirements. ❑ Other General Comments: A,��*� 6-3 10 -0 00 5492 HEADWATERS PARCEL 21 51*09 AC, N o 2Tl4 SclA�-6' ; I'' = f oo' � ROAD ��DINa E��Ipi��ENT t SEMENS. -`LIpESo-�� CSE � �r A� �E SIDE AND ��Fry��c ND � _,; , ; ��i= a r'z ?�t�pER Lc1E SµAlt. 6 T -; o FigNaDSP fll. EP . VE c��tC zo F Go Dov e6 0 apP v�fi�h Y ' Vp4n ���Cpve6ne� �hce't �- b P Pay„- / 8 �t; G j2r�+s'4 DaA_1H g(rji� W IF I- L DEM o w S4E0 cKi31N PERr►�i '�5'�-Dof'I'Jv 171,AG(fh{ j 1000 &ALS �wK - iy xSb 1-1081Lj o O �- 0 6 A i r-lR S 225.53 �A o j� 19 D 8U17E COUN i i BUILDING DEPAM EN ' p p 0 V F 0!5�'o b 6'? 2 -- 14=S 14 -s -W CDF FIRE SAFE REQUIREMENTS AP# PERMIT # NAME f Under.authority of PRC.4290, the following checked items are required i by the Butte County Fire Department and are made a part of this permit. These requirements are minimums and will be superseded by Butte County ; local regulations which equal or exceed these standards. Field inspections will ' be made by .the Butte -County -Building- Department for compliance. 1272.00 Maintenance of Defensible Space. To ensure continued maintenance of properties in conformance with these standards and measures and to assure continued avail- ability, access and utilization of the defensible space provided for in these standards, annual maintenance must be provide for by the land owner. Driveway Standards [] 1273.02 Surface. All driveway surfaces and structures (bridges, 1273.07 culverts and other appurtenant structures which supple- ment the roadway bed cr shoulders) shall provide unob- structed access to conventional drive vehicles, includ- ing sedans and fire apparatus weighing up to 40,000 pounds. [�] 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius [�] 1. No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional sur- face width of 4 feet shall be added to curves of 50- 100 feet radius; 2 feet to those from 100-200 feet. [�] 2. The length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 �( feet. [(� 1273.05 Turnarounds., If required, will have a minimum turning radius of 40 feet from the center of the road. [�] 1273.05 Turnouts. Shall be a minimum of 10 feet wide and 30 I feet long with a minimum 25 foot taper on each end. 1270.10 Width. All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. Page 1 of .3-', f AP # PERMIT # NAME [� 1273.10 Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. 1273.10 Turnaround. A turnaround shall be provided at all // building sites 'on driveways over 300 feet -in length and shall be within 50 feet of the.building. 1273.11 Gates 1. Gate entrances shall be at least two feet wider than the roadway it serves. [�] 2. The gates must be located at least 30 feet from the roadway and shall open to allow a vehicle to stop without obstructing traffic on that roadway. [ ] 3. Where a one-way road with a single traffic lane provides entrance, a 50 foot turning -radius shall be used. Fuel Modification 1276.01 Setback for Structure Defensible Space. Y) 1. All parcels 1 acre aid larger shall provide a mini- mum 30 foot setback for buildings and accessory buildings from 411 property lines and/or the center of the road. [ ) 2., Fo,r parcels less than 1 acre, local jurisdiction shall provide for the same practical effect.' See Other Requirements -below. 1276.02 Disposal of -Vegetation and Fuels. Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction., road and driveway construction and fuel modificatior shall be completed prior to completion of road construction �r f.4 --.Lal inspection of a building permit. Page 2 of 3 '., AP # PERMIT # NAME Other Requirements [ ] If Building Setback is 15 to 30 Feet: Class A or B roof Enclosed eaves [ ] If Building Setback is Less Than 15 Feet Choose any 3 of the .following: - Metal or no doors on aide toward property line with insuffi- cient setback - Class A or B roof with enclosed eaves - Interior automatic sprinkler system per NFPA 13D - Glass area not to exceed 10% of wall area toward property line with insufficient setback - Siding from the following list: Stucco - 3 coat Hardi-Board or Plank Masonry Masonry veneer Metal Other Butte County Fire Department approved materials Date Signature Page 3 of 3 :r .,: ...,,,:...�,. _�._: =.rr �.j,+•*%:br.�„A�'Y.r-- ;....� _ .t .:Y• .. ,�, ..y: �. t a•fi+.... «:..w'. ---,.i_. . .x w� �-:. .c-.. ....�.. 4 .-.-�. 056-310-008 '' 99-2533 _ DOERSCHLAG,: DON 5472 HEADWATER, FOREST RANCH CONTR. OWNER D EM O CABIN , P i 7 • Address!,�:J� Date— G G P S Meter By x O Et EGTFt�G Meter BY 2,� ka c COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT �� : ASSESSOR PARCEL NUMBER / q - h j� �Jl ZONING BUILDING PERMIT OWNER J� C k I—A TELEPHONEI � SQ Fr. OCC. BUILDING VALUATION OWNEfiS MAILING ADDRESS �, � f i v' �a JL -/ � � / � r:7 'II CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ /C U O ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ c ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS L ` 17"rl/y/�� ���� Energy Plan Checking Fee $ $ PERMIT FEE $ S� LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: J00A;l O S F62,r C) 1 jA " - e 4 big Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G I WT_ 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service zoDA OR LESS 23.00 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.POWEPPARATUS License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service TO 46.00 WEE200A CCUODOA NEW CONST. DWELLING OCCUP. OR ADDNS. ( 6 ACC. BLDS. SO — '. N .ESIDT MULTI -OU CUI TS 97,50 b SINGLER AOUTLEr CIR. Ex. OCCu OUTLET OR FDITURES 2C@''0° SAL @ .SO Ex. Occup. OFlxurLEEGrs R=GER, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier 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 shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 37.00 of the Labor Code, I shall forthwith comply with those provisions. / — X f 6 / 1 ,/ .i � � _Date Si - gnature of Aoplicant - ❑ Owner ❑ 90 -tractor ❑ Agent An OSHA permit is required for excavations over 5'0" dee and demolition or construction of structurs over 3 stories in height. p MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ HAZ' p• FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the Butte County Code and/or indicated above for which fees have in / By , e ,C� f mZl1 PERMIT EXPIRES ON �� the applicable provisions Resolutions to do work been paid. Date /// / ✓ ' Z�✓ J Dela Receipt No. _1 6 3 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT r' i �, �� j�' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION c6 7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT - ASSESSOR PARCEL NUMBER 2 O J ZONING �j� BUILDING PERMIT OWNER On.1110 n (9e-� C (�- � LkI-ATELEPHONE W I SQ. FT. OCC. BUILDING VALUAiI'ON OWNER'S DUNG ADDRESS C` ,",rP-—X-tJc-A r CONTRACTOR'S NAME pw,J e-4- TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAIUNG ADDRESS Fireplace Total Valuation ARCHITECT OR ENGINEER LICENSE NO. Filen Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS AIA011 Ore' A r7 Energy Plan Checking Fee $ Energy $ PERMIT FEE $ S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF.Ef Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: /-JO's-y0 ks Pe, )C� JR 6 6,1 (oJ,1 Gas piping system 1- 5 outlets 15.00 Buildin sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service "Oo OR LESS 200A OR LESS 23.00 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.P License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. s0 OR ADDNS. ( a Acc. Bins. 3.5aFT: NoWRESID. MUL OcuRLET @7,50 OWER APPARATUS 8 SINGLE OUTLET CIR. EX. Occup. OUTLET OR FIXTURES BAS @ .50 Ex. Occup. irrtrs FIYRESIo.) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ 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.) certify thatin the performance of the work for which this permit is issued, I shall employ any person in any manner so as to become subject to workers'HAZIMP compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall rthwith comply with those provisions. X Date _ I ture of A ant - ❑ wner ❑ tractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CO�TYPEI TOTALFEE$ S�not FLOOD CDF PARCEL PD HD ISSUE 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. By Date l� 3 PERMIT EXPIRES ON (�" 3,200`0 Date Receipt No. 1 �`Z&3 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT rs ,L OWNER -BUILDER ,VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the WJor labor eels for W the proposed property.improvement : YESANO a 2. I HAVF !§- HAVE NOT ❑ signed an application for a building permit for the proposed work. 3. I have contracted with the following person. (firm) to.provice.the proposed construction: ADDRESS: CITY:_ . PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired.the following person to coordinate, supervise, and provide a major work:: NAME: , ADDRESS: -CITY:. PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work'but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK v& IZA SIGNED: SOCIAL SECURITY NUMBER: DATE: z - 2 — !f !-,: NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of propeity improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that p'`erson applies for the 'proper permit in his or her name. Contractors are required by law to be licensed and bonded, by the State of California and. to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. Ifyod plaiito doyour own'work, with the exception of various trades that you plan tdsubcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (includingmaterials and other costs) is $300 or more for the entire.project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you .are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations; and'these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perforin their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued'until the verification is returned. rely, Mic el C. Vi ira, C.B.O. Ma ger, Building Inspection NOTE. This Owner -Builder Information is required by Section 198.I0 of the California Health and Safety Code. OVER ... :, '•. r.. _ �.:Wr.`rb6-i.w'�+tia.. '.wL�d.M97.1Y ?:'4...is `1 F.;.r,itv'.^'Awti'A ,G, •..� .. - . ,^ "-_ T "056-310=008 DOERSCHLAG`, DON'' q.- .5472 HEADWATER', " FOREST RANCH CONT: OW1�ER :LOT DEVELOPMENT E COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT - `�- `�� T ASSESSOR PARCEL NUMBER 0A6 -310—W3 ZONING BUILDING PERMIT OWNER DOERSCILAG, DON TE342-N-2201 SO, FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. BOX 127, rOREST RANCH, CA 95942 CONTRACTOR'S NAME I -_`W— TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 5492 HEADWATERS, FOREST RANCBgy Ener Plan Checking Fee g $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: UT DEVELOPMENT Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 LEss Main Service zoeoovOA OoR R LESS 23.0023.00 I LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: f7� I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, em exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP, OR ADDNS. ( & ACC. BLDS. SO 3.5QFT; NON-RESID. RANCHT. O RCUT @7,50 PowER APPARATus a SINGLE oLmET cIR. EX. Occup. OUTLET OR FDMRES 20 g .00 BAL @ 1. 0 Ex. Occup.OFIX.ES RW�IpOEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PRF. INSPECTION 1 123.00 23.00 PERMIT FEE $ 66.00 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ 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.) �s1 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers'HAZ compensation laws of California, and agree that if should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall .� forthwith comply with those provisions. Date ' P `+ Signature of Applicant - ❑ Owner X Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 69' . IMP FLOOD COF,'PARC ` HD ,'ISSUE ' This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have !I 1 , By +> PERMIT EXPIRES ON I ` the appllcab el provisions Resolutions to do work been paid. Date , Data Receipt No. �+ � WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DE ARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 - Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT -?g z ASSESSOR PARCEL NUMBER OCry6-310-008 ZONING BUILDING PERMIT OWNER DOERSCHLAG, DON TELEPHONE 342-2201 SO. FT. OCC. BUILDING VALUATION . OWNERS MAIUNG ADDRESS P.O. BOX 127, FOREST RANCH, CA 95942 CONTRACTORS NAME OWNER U TELEPHONE CONTRACTORS MAIUNG ADDRESS r CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE N0. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 547-9 HEADWATERS, FOREST RANCH Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: LOT DEVELOPMENT Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 "OOVOR LE Main Service 2oOA OR LESS 23.00 23.00 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class LIC. NO. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License La forthe following reason: , as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. _ Date_ _ 6a1 ture 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 height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. SO OR ADONS. ( a Acc, 81ns. 3.50 FT. NON-REOSID. MULTJ.I.. IC TITS @7,50 POWER APPARATUS a SIN GLE OAP= CIR. Ex. Occup. OUTLET OR FDCTURES BAL p':S0 Ex. Occup. ounaTs PRM.oEw 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PRE INSPECTION 1 23.00 23.00 PERMIT FEE $ 66.00 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ HAZ. D. FEES P FLOOD CDF PARC HD 5 This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By , - PERMIT EXPIRES ON 2�lq-06 I the app icable provisions Resolutions to do work been paid. ate 6 �7 i Date Receipt No. Z CJ Z WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE • DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ' 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO (Rev. 12/96) ' APPLICATION AND PERMIT ASSESSOR PARCEL NUMMM —31(9 ` (1O � O v �/ ZOMNO BUILDING PERMIT OWNER 6 o /2 5 c� � � TELEPHONE 3 Y2_ - Z2_0 1 SO. FT. OCC. BUILDING VALUATION _ _,j ow , 12.E �oa�s� l�id�rc�i C� ��'�4rZ C) B CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTWN LENDER Fire lace LENDER'S TA ILM ADDREas Total Valuation S ARCHITECT OR ENKiINM LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCWMC'T OR EWMEEAB MAILIM ADDRESS Plan Checking Fee $ SUILO OADOAESS- S Energy Plan Checking Fee S S PERMIT FEE $ LOT NO. ausOmgN°NA"r PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Tr 7.00 USEOFSTRUCTURE ' Solar or heat pump water heater 23.00 SF ❑ Duplex ❑ Mobllehome ❑ Other Water piping 15.00 BPeoIFY Each gas water heater or vent 15.00 TYPE OF WORK Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: ✓r (Jc✓G���rti��l Mobile Home ISI GI W (920.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 OOOV OR LESS Main Service sooA oR LESS 23.00 Z Main Service 200A TO IOWA 46.00 NEW CONST. DWELLN a ocCUP. 3.5Qso. OR ADONS. a ACC. BLDS. NON!•RESID. MULTFOUTI.ET @7.50 POWFA APPARAT US 8 SNIOLE OUTLET CI0. Ex. OCCU OUTLET OR FOCTURES 200 1.00 SAL @ SO ' Ex. Occu ounETs� o.)EA. L 5.00 —Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating ,C O Cooling Hood 6.50 Ventilation PERMIT FEL= S �C� V Mobile Home Installation Fee $ U �g Energy Inspection Fee $ °c° CONST TYPE TOTAL FEE $ A/) ~_ MA 0. FEES I IMP I FLOOD COF pMCEL HO I ISSUE I I 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. By Date PERMIT EXPIRES ON jO�Ial OWNER -BUILDER ,VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YESA .. NO D 2. I HAVE,- HAVE NOT ❑ signed an application for a building permit for the proposed work. 3. I have contracted with the following person. (firm) to.proyi4e.the.. proposed const;uctkon: NAME: /, Z4 ADDRESS: CITY:_ PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired. the following person to coordinate, supervise, and provide the major work: NAME: x, ADDRESS: CITY:. PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work'but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER: SOCIAL SECURITY ER: — DATE: NOTE. This Owner -Builder Verification is required by Section 198.31 and 19832 of the California Health and Safety Code. This. verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and -to have'a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. ,r If yod plaid, to ddyour own work, with the exception of various trades that you plan to subcontract you should be aware of the following information for your benefit and protection: , ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including'niaterials and other costs) is 5300 or more for the entire.project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security. taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue. Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. ..'� rely, �.` /GUk, M21pel C. Vi ira, C.B.O. Ma ger, Building Inspection NOTE. This Owner -Builder Information is required by Section 19830 ojthe California Health and Safety Code. OVER COUNTY bF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541 PERMIT APPLICATION DATA SHEET OWNER: d o.- i 0V f R S C H LA G ASSESSOR PARCEL NUMBER: - 3 I- D g Proposed Building Use: Building Inspector: L. Date: At time of permit application, I was advised the following data must be submitted prior to permit pe cessing and/or issuance: Date Received By ❑ 1. All iiems have been submitted -------------------------------------------------------------------------------------- 112. Plot plans, 3/4 sets, signed by the preparer of plans. ------------------------------------------------------------ ❑3. Complete plans, 3/4 sets, signed by the preparer of plans. ------------------------ 7 ---------------------------- ❑4. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. -------- ❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------ 06. Energy Design Compliance and supporting documentation. ---------------------------------------------------- ❑ 7. Statement of Intent for Non -Heated and A/C Buildings. --------------------------------------------------------- ❑ 8. Hazardous Material Form. ------------------------------------------------------------------------------------------ ❑9. Manufactured Home data and installation instructions including Tie Down Specifications ------------------- El10. Fees of $ ------------------------------------------------------------------------------------- ❑ 11. Impact fees as shown on the attached schedule. ----------------------------------------------------------------- ❑ 12. California Department of Forestry plan approval/fees. --------------------------------------------------------- 1113. -------------------------------------------------------- ❑13. Flood elevation certificate.---------------------------------------------------------------------------------------- ❑ 14. Sanitation and plot plan approval Health Department. ------------------------------------------- ❑ 15. City of Chico plumbing permit. ----------------------------------------------------------------------------------- ❑ 16. Plot plan and business license approval from the Biggs. ---------------------------------------------- Planning approval for (A) Use: 19 K . �Bfar king: -------------------------- -T� Contact Land Development about It Improvements, ❑ Drainage, d Legal Parcel. ----------------------- `❑ 19. Encroachment Permit for driveway (construction approval prior to occupancy). ---------------------------- 20. Pre -inspection for el, 1* L rR 14 /✓ required Request to Building Inspector on - (Date) 021. Contractor's license information. (Number, Name Style, Classification). 022. Workers' Compensation carrier and policy number. ----------------------- ❑23. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑). -- ❑24. Letter of signature authorization. -------------------------------------------- ❑25. Recorded copy of Agricultural Acknowledgment Statement. -------------- ❑ 26. Letter of intent on building use. ----------------------------------------------. ❑27. Manufactured Home utility clearance. --------------------------------------- 028. Existing violations and/or expired permits. ----------------------------------- El 29. --------------------------------. ❑29. 1143 A, C3 Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $ 030. Other: When you issue the permit, process as followAMai1 to owner', ❑Mail to contractor ❑Telephone and hold for pickup at office. ❑ Deliver with inspector. / Applicann Date: Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ A. Pollution Date: By: Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑Other: Date: By: 1. Index permit application for the above items numbered: ❑ Plan Check List 2. Additional items required: Contractor, designer, owner, was advised of the above required data; by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required dati,by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Sets of plans on hold in 0 Plan Cabinet, 11 A.P. folder. Note transfer by: Date: PRE -INSPECTION REPORT OWNER: e r S 6 LOCATION: `�J o� 14io•17 ' ��r5 CONTRACTOR: DATE: A.P. #-'656 ZONING: - PRE-INSPETION FOR: e le DATE TO INSPECTOR: PERMIT HISTORY:( ) NONE () AS FOLLOWS: BUILDING INSPECT'OR'S REPORT Building Description: Electric: Commercial/Usage: Residential/# of Units: Currently Occupied , AbandonedNacant Yes No Electric currently On Off Condition of Electric ' Gas: , Natural Propane None Currently On Off Obvious Problems: . Sanitation: ' Plumbing Working Well Working Potable Water Obvious SewageProblems Comments:_ i�ilr+li0[�7 /o� ACTION RECOMMENDED: ISSUE: HOLD FOR Inspector. ,b �� Date Sketch buildings on reverse and indicate location on property. COUNTY OF BUTTE - DEARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION County Center Dri e • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ?q g5eT ASSESSOR PARCEL NUMBER 056-310-008 ZONING BUILDING PERMIT OWNER DOERSCHLAG, DON TELEPHONE LLEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MARINO ADDRESS P.O. BOX 127, FOREST RANCH, CA 95942 CONTRACTORS NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS . CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee S 20.00 ARCHITECT OR ENGINEERS MARINO ADDRESS Permit Fee $ Plan Checking Fee $ SULDINGADOREss 5492 HEADWATERS, FOREST RANCH Energy Plan Checking Fee $ a PERMIT FEE $ IDT NO. SUBDN510N'SNAAIE PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: LOT DEVELOPMENT Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W (920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200' OR LESS 23=23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I herebyaffirm under penalty of perjury that I am exempt from the Contractors License P hY P 1 rY P Lafor the following reason: V, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier 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.) certify that in the performance of the work for which this permit is issued, I shall employ any person In any manner so as to become subject to workers'D. compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date19 &ZtAugre of Applicant - �00wne�rEOntractor ❑ Ag nt An OSHA permit is required for excavations over 5'0° deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW CONST. OwEUING OCCUP. SO OR AnoNs. a ACC. BIDS. 3.5¢x; TNgN1,R9ID ' MULTI.OIrtLET @a 7.50 P,0 APPARATUS a swOLE ourtET CIII 2001000 Ex. Occup. OUTLET OR FIXTURES 8 . Ex. OCCU MD APPLNS. OR ovnE. EsiD. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PRE INSPECTION 1 123.00 23.00 PERMIT FEE s 66 0 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt S Mobile Home Installation Fee $ Energy Inspection Fee $ occ ]CWONT. TjPEI ETOTA4L FEE S rlnot LOOD CDF ARC HD This permit is hereby Issued under the app of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXPIRES ON Icable provisions to do work paid. ate Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT AP#56-310-0000 5492 HEADWATERS ROAD PARCEL 2� 9 Af q�16„�aav Nofzrp SaA�E : I" = foo' � Lr BUTTE CO: of FORESTRY CALIF. DEO �pproved as submitted � Q aoproved with conditions Wc;le $�i. ✓�O Data 7 2.0 �r0C>4 1'1 ON i o� i So g V)4 0 1000 (shL �wU S ��434cfr — TM H K 0 G �ZE�� t�2A-1� rr(rf cAt JV FIIsLa Itix�;c MOSILE o - 0 r 89� i 2-O'. St H EA�t� u��1 i QRS 2 - A A D O ww'' `NSO CDF FIRE SAFE REQUIREMENT -_ , s em Ap# PERMIT #[ NAME Under authority of PRC 4290, the following checked items are required by the Butte County Fire Department and are made a part of this permit. These requirements are minimums and will be superseded by Butte County local regulations which equal or exceed these standards. Field inspections -will be made by the Butte County.Building Department for' compliance. [+� 1272.00 Maintenance of Defensible Space. To ensure continued onformance with these maintenance of properties in c standards and measures and to assure continued avail- ability, access and utilization of the defensible space provided for in these standards, annual maintenance must be provide for by the land owner. Driveway Standards 1273.02 Surface. all driveway surfaces int structures ures (bridges, which 1273.07 culverts and other appy supple- ment the roadway bed or shoulders) shall provide unob- structed access to conventional drive vehicles, includ- ing sedans and fire apparatus weighing up to 40,000 pounds. 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional sur- face width of 4 feet shall be added to curves of 50- 100, feet radius; 2 feet to those from 100-200 feet. [U/ 2. The length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet. 1273.05 Turnarounds.of 40 feetefromethewill center ve a minimum turning radiusof the road. nd [ 1273.05 Turnouts. Shall minimum 25 foot taper on each s 30 feet long end V g wth 1270.10 Width. All driveways shall ryer d alclearanceminimum 10 ofoot traffic lane and unobstructed 15 feet along its entire length. Page 1 of -1, • X-1. t - 1 - Class A or B roof - Enclosed eaves [ ] If Building Setback is Less Than 15 Feet Choose any -3 of the following: - Metal or no doors on side toward property line with -insuffi- cient setback - Class A or B roof with enclosed eaves - Interior automatic sprinkler system per NFPA 13D - Glass area not to exceed 10V of wall area toward property line with insufficient setback - Siding from the following list: Stucco - 3 coat Hardi-Board or Plank Masonry Masonry veneer Metal Other Butte Countv Fire Department approved materials ate Page 3 of 3 AP PERMIT 4 NAME [� 1273.10 Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. 1273.10 Turnaround. A turnaround shall be provided at all building sites on driveways over 300 feet in length and shall be within 50 feet of the building. 1273.11 Gates 1. Gate entrances shall be at least two feet wider than the roadway it serves. 2. The gates must be located at least 30 feet from the roadway.and shall open to allow a vehicle to stop without obstructing traffic on that roadway. [� 3. Where a one-way road with turninge traffic ne provides entrance, a 50 foot g radius shall used. Fuel Modification 1276.01 Setback -for Structure Defensible Space. [� 1. All parcels 1 acre and larger shall provide a mini- mum 30 foot setback for buildings and accessory buildings from 413 property lines and/or the center of the road. [ ] 2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See Other Requirements below. [ 1276.02 Disposal of Vegetation and Fuels. Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction, road and driveway construction and fuel modification shall be completed prior to completion of road construction )r fi:tal inspection of a building permit. Page 2 of 3 AP#56-310-008 5492 HEADWATERS ROAD PARCEL 2, 5,09 AC, N o RTµ e 3S oe t �•t Y- \A CIS M t� D R A- I tiff Oo Z � l .o , Iu Ir T", 00 W FE i �- � 11 � � ` ^ • W � R L o �.t SkEO c148►►4 ('ERr•+�f Ian • . ' � DO ` � Elly-� So � g v,� rlIfI'D Q,�� 000 v o �- m 6g 9, I Zq. �l ZZS.S3 �Aao N A TZA s X PA a �a JV p'PR 4. Is the site currently under permit? YesV] No[ . ] Termtt.No Od b �T 5. Is the site an eaasting site? .:Yes No furnish two lot P lens �.,;�,.`>T. .a_.. 6. What is the eiectr cal rating of the ifi6W home? A peres:J . V 7. Whit is the mobiilehome site breaker rating? y _ , • What is the electrical rating of the mobilehome site? Amperes f. 9. -Is the main service remote from the mobilehome site? Yesw �NO[ ] If it is, what is the rating? Amperes. - 10. m eves"10. U there any other electric load to .be served by, the mobdehome site electric service (i.e. well, garage etc.)? Yes[ ] ]Stoo If yes, -please identify the load -and size: a) The mobile home -'site: Load- Amperes - b) The main service: _ ... . Load- Amperes- K At 11. Type of gas service at mobiilehome site: Natural[ ] Propanckj None[ ] 12. y Size o gas pipe gat the mobiilehome site from �, the teeter or .tank a inches. 13. What is the gas pipe length from the meter or tank to the mobiilehoiirtL ft.). X14. What is the mobilehome gas demand?; = .T.0 * v. *(This information is not required if the pipe length is 'less than 6 feet. on natural gas or less than 50 feet on propane). Manufacture Year: . `' 7 'Mobilehome Ma6ficturer. If other than sinsle wide, furnish Setup Model Number. � _(�•� >` ?._ !t. T ona or Expando lze )X- L Width:t)-� ) manufacturer's October, �, 1973, furnish On all mobiilehomes, marnac�e atter .. - `vets. v. - �- insgUation manual and itidit setup sh Wood porerfoundation gradeW other M Sxn?k• Concrete block. Oth ;' x, Mobilehoines: = ltovtdt lie own Spemfications for aD Y Pier FootinV Sim and Location—"Mm,•rVw►>nay . s[MGM WED` z .01 _.._, • 1 .. r. '.. ... U01 • L�AR ...._ ... a�..S M,. .ww«............w«. •w. ................... - r 1 i ' t w Lir3 t.� t Lirr}itiW.�Lim 1 ........................................ t........... 1 Line Openings:. Line i,pieirs'" - Sizeminimum: x � �• Size minimum �x Each side of openings spacing numdmtun: with width over'",, -—"—� From ends -maximum • }gine 2' piers: ` Line Piers: (Z x ?O . Size minimum: x . Size minimum:. maximum: spacingSpacing maxim : . - From 7ends-maximum From ends -maximum Line 3 Roof Loads: minimum Location (from front): Line 5 Roof Loads: Size'ininitnum: z.Location (from"front): � Y 14..E • � � ^�� fi �{� �. r `t. .. M. May 1995 8.4 I R l-I.J L1J L�-1 ;DTI;c .o ra. rxwla ( I '.n„" usou I ., I weefj I I I I V""" 1 O"ON D 0 I I I N � s w • I I I I I I I I a `rt� `1`-' a mm Raw I I I I sem>c PIM I u roU11DAT1 • rouwD4r�i►a w 4 Q a wius T T T I o woMo .. CW4 NLT DOUBLE TIIDE TYPICAL _ sINGLtt WIDE TYPICAL 20'. 24'. 24' OR 20- PLAN R'PLAN DOUBLE WIDE MOBILE COACH Scale: 1_ - 10' NOTE• FOR MORE THAN TRIPLE WIDE UNITS. SUBMIT N1YGIIT TO THARP k ASSOC. FOR AP,'ROVAL. STANDARD PIER & FOOTING SPACING PER MOBILE HOME MANUFACTURER'S INSPULITION MANUAL CONFIGURATION SHOVN 11 THE MINIMUM NU`WER OF PADS REQUIRED. 3' X 3' PLATE -%- MAX TUK HEIGHT 3' SHORT TUSE 14' LONG TUK 4 - 3/8' - KILTS TIGHTEN TO 180 1N -PUDE 3/4' THREADEDD - • spa • COACH 1 KAN CAL�lnRMA CMOF Rg,ATTO W TM 25 ANDt= W4 RDfI'ION. 1. OR810N LOADS: 4 - 3/8' DOLTS 2' DIA STD PIPE vii' PLo TE THS DNOON GOAD$ $HAIL U CMANIVIT WITH WW U1VS LOAD. WIND UMA ANO UMM ZS AN 3/160 PLATE LEGS S/iAK.u11 MRp=ANWgjUMWl'11iDiAlnWsCLWALAR" T YP OF 4 3. THS FOUNDATION • CmmogM TO COMM M A POUAMT 1iptNMT10N. 4. ALLTOMI1a10S ARSIDUKIt'FOMNYMKLNL47UAi UCWPJR <DCOHZM W1+FOmw ARS TO?M. LOAD SON. pii�S AND VwL U OWAIMS WfM LOCAL SOa. 5/16' PLATE DISIONID FOR 100$ >'SF CONDrrx) O. 5/8' X 1 1/4' SOL.' WITH HARDENED WRa11ER SEISMIC PIER Not to s c a_t e, S. STRUCTURALrnmL. a.SH[AILCOMORM TO AM AM V'-36 FA MOM= IR PIALL,UFASMAT,<DA�000lln TO AM MW MAIMM �„i C.P. SEISMIC PIER## - PATENT PENDING a WL" NNWE= AOCORDINTOAWSVOW ICAVIOW' L RLACTROPM[ 970 & MATIS: ASTM A36 NOrE� YI, ANCHOS,WZT/. ASTMA317 w.. BOLT$: 8AI ORS -ASTM Mr -ASTM AW 180 IN•POUNUS 1S EQUIVALENT TO 13 CT -POUNDS V. THRZADIDRO� COLD DRAWN LOW CARBONWZLDASLS A ALL. MSTALOOIQOMM V4CUMM NAIL$ • SCREWS STC. ARS TO U M10r1'NC M C"711A IL THE MSR AND MOR BLUA K ffORT ANOMM UXL SS COAT$a NRH =MUM WWAW 11414M CIR APPROVED BQLAVALENT AND OWL N UrfW AND LAM BY CSI�'I'1/ISD 7=TW AND COIMIILTIIK>► 2 - 3/8' x i' DOLTS gnVICSS(r,'nFORTHIPOLLOW1N0LOADL FIELD ORP -L DOLES OPTION OF a LATUAI. 1700 iM MAX 4 - 014 TEX STS COACH C 0. VORTICAL: 13810IM.MAX OR J SEAN 7. THIS FOUNDATION NI !ORM/1T•DIO MANII/ACTURSD JNIII.OQM CONM1C'SD Illflii LO$IQMDWA1' OR 1 /4'x 2'x 4' 3' x 3' ANGLE 3' WIDE PLATE ' $. CROSS JOIIi'fiL Tld IOLNDATM MAN !B DEOOIrID TO BS ooNrtnx'1sDaI A FAD1tI.Y LSVSL tti'i WRH NO Da$'11N0 /Ott. tFroB[iM� >ir RT1lJYlaT' oo�'ulu Dus'f O K1OR ti011. iER NO?S!. !. R! ARIAS WWZ DWFERSNR%I. RT LUCIIT (QL) CAN OOCU16 MMiLAAcnMSD UMM GULL U 4 - 1 /2' SEISMIC WU ADVUMLY ACT TTR UR OF IM RSADXXTSD WHIN DLL MOCUDS 1N', OR WM R FMI DOLTS12' PIER MANUFAOMiD UMM 10. TH1$ BMIIM M ADAFTAN S TO STANDARD NMUM MASONRY SMM MSRL it. FDR BOO! tm LOADS Cr uipl08o "WIT HIS lOLJNDM'101 SY$T m MAY IN! tm WRH m NUMBRR Cf C.1: $I w MIRE n1o" CH IM MAN. NoWriM BOOT LOADS XUM TRAM 30 M MAY RBQM THS U•.. TYPICAL BEAM aFADQ[11Q�1ALrtANDARDlADA1�p1�t1u7�l:A$IRRTitRMANiWAR.'IURSR'fQi/'1'AU.A'110NMAMIAL. CONNECTIONS PA MAN M A !RECAST CCNCRSTS FOUNM7I0N FAD. TO FLYWOM LDTO LAN Not to Scale 1' FFOU14OATION r�ADMAAY U UM TUML SINGLE WIDE MOBILE COACH 2. rout*IDA?l0NPAN 1111AILMR.wO1DaNU=t W$= scale: 1" - 100 it so Co n[RN11zc f oR mppm 3.AND STANDARD PIER Ar FOOTENG SPACING s. JIM ML AT b DAYS AS TURD AND MANWACTURSD BY STARLTR N►S W CONCRS'R. PER MOBILE HOME MANUIFACPURER': -4 8' INSTALLATION "MANUAL ;:-CONIfiURATIM SHGNN US THE MINIMUM NUMBER OF PADS REQU1 RED.wir 1114, _ w s M 8R# Qwvs w w •$MwR q ELEVATION NOT TO SCALE ►. ISMTTULOW D11 OMC/THRIADU - r!iliMOILUAR TO'1'1a CQAt'a[ DRAM (M SMO'R►N Oti T!laL�W1W . A WHERE: FIILD Cmmm1ON$ 2' W=S FADROTAIWW140 NOBS THM HAL/ OF TIR !ADS IN A TSAVMU Lm CAN BS : nATlD SD TTtAT in uvo Dwi mmm Of m. PADS ARS FABALIAL. TO 4. 3/4 mm Al.A 4$M ee!'II m imi m OC• Imams. wa -QA m. i' liL �--- 36. 112' yr I 1 3/9'SrLAW&C 1. MAXINUN LJMTH OF SDVOLI WIDE COACH - W MRI: ANOW owl 3.5' L MAXSM LOOM OF DOUKZ W109 COAQt - 78 FSR. 4%4_4%4 Wr-., 1, � 3. UN= AFMC1VED BY THAI► A AMC. R= TO == HS10M' N0T TO S70L W 4. t FRIT FOR ONOti W1DR OOACHM k10 FRT !OR ]8' DOLALR Ww= COAC= PRECAST CONCRETE ` I3lRTMtW.W. &WDOU=WIDNC0AC1M FOUNDATION PAD 4. POR MI%Z WR C0AC1I= MUM MA MAMTR CSM NT RN AS 0l0WN ON TIM D«ALi WIDR MOM COP". SCALE: 1' = 1.5' s. "1 ANY COACH SIZE OTHER THAN M SHOWN ON THIS MAN CC RItMER XJ1D ADM THS MER AND FAD L AYOLUf OWL U REVIZWED AND A"WVSD BY DONMD IL r ABF A MOCUTK BF"$m NOTgo 3/4' PLYWOOD SHEETS I. SPACNIO 211OWN ON THIS MAN ARS FOR COACH WIN l$ INCH AND 13 M UAW OR S INCH PACO SCREWED TOGETHER WITH CORRUOATSDBEAMR, 30102'0/4' 12 48 x 1 1/2' FHWS PLYWOOD 3. ANY OTTIER 8 V= BIAM IS NOT TO CANl1 M MORS THAN 6.0 FRT ON IAM END OF UMI' AND QACD10 OF UMM MIRE CAN NOT SIMM M$ MT - HOLES :HOLES FOR " N>ri�n�P 4TMM' 1/2' x 2 1/2' CA ' " ".✓ 4At10 QNB $A/$H GBPR MC7MN MM1 18'x32'x3/40 M . ■ ■ 1d• 30' APPROVID .�t5' �Lp1f. r/ Pi S PLYWOOD 11ANA ro COIwCT111" NK dw 1r[ OvAmd # 41r� 110. 06/12 1 tir. rw.14wM�1.l�wl�r4.d "Ploy I /3 �1 l FIF (to aft of ceow* �• ---- 32' --+� 7STANSAW �' CAI •. ALTERNATIVE PLYWOOD y F N A T I O N PAD VA Na DU D 'ak � A, vvwBi lb"ImO Z6 ld�o RWNL�WAL OF SCALE 1!"=1.5' STATZ SUfMMAUP 30.�r i2 -CA (9 9