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HomeMy WebLinkAbout056-360-0087777 ITT T Julius Jess 56-36-8 a, End of pri.rd.,apP•200'N.of Pere- grine Rd., aIp.500'W,ot Forest Ranch Rd . , Forest Rar[h Permit #1396-81B,P,E(new single family) t 056-360-008 � - 04-189- HINTZ, TOM,- PERMITWAL ' PEREGRINE RD, FOREST RANCH DATE: yCont:-OWNER'• ; 9P# NEW SINGLE FAMILY. e � - EXPIRES:. �7 056-360-003 04-2698 HINTZ, TOM- 4715 PEREGRINE RD, FOREST RANCH Cont: OWNER. CONVT SF TO GUEST HOUSE, B07-1926 056-360-008 ! MISCELLANEOUS <none> CONV EX SF TO GUEST HOUSE (REP 4715 PEREGRINE RD HINTZ, THOMAS ETAL 3-Wdr.�l --Ica BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 4715 PEREGRINE RD Owner: Permit NO: B07-1926 APN: 056-360-008 HINTZ, THOMAS ETAL Issued Date: 09/11/2007 By KCG Permit type: MISCELLANEOUS 4715 PEREGRINE Subtype: <none> FOREST RANCH, CA 95942 Expiration Date: 09/10/2008 Description: CONV EX SF TO GUEST HOUSE (R (530) 899-9180 Occupancy: Zoning: TM5 I Contractor Applicant: Square Footage: OWNER TOM HINTZ Building Garage Remdl/Addn 4715 PEREGRINE RD FOREST RANCH, CA Other Porch/Patio Total FEE INFORMATION DBOMSCF Supplemental Inspectio $57.99 Total Charged: $57.99 Fees Paid: $57.99 Balance Due: $0.00 Receipt No: B4583 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License OWNER / / Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 09/11/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractor's Signature Date [tel 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE VU COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: HAVE AND WILL the work himself or herself or through his or her own employees, provided that such improvements ❑I MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ❑ I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ I, As OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier. Policy Number: Exp. Date: (This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ IAM EXEMPT under Section B. & P.C. for this reason: FSI') CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1,4=0 ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' X 09/11/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions. X 09/11/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, injury, including death, and property damage caused by, arising out of, or in any way connected with DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or am authorized to act on the property owner's behalf. t 09/11/2007 CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Permittee [SIGN] nt Date the performance of the work for which this permit is issued. (3097 civ. code) WOwner Contractor OR; DAgent for Owner Agent for Contractor FILE COPY Lender's Address City State Zip Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the 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. If you plan to do your 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 materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. G If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal n income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact 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 thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor 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 contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. 1 PERSONALLY PL TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. b. E OR NO) 2. (HAV /HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: ADDRESS CITY PHONE CONTRACTORS 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 Description: CONV EX SF TO GUEST HOUSE (REPLACES 04-2698) Reference Number: B07-1926 Applicant Name: TOM HINTZ Owner's Name: HINTZ, THOMAS ETAL AP # : 056-360-008 Signature of Property Owner: U,0 & oag Date: Q ' -. 11-0t? BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** CONTRACTOR OWNER INFORMATION Last ante City Fi t Name Zip Z Fax Mailing Address Lic. # Class b O CiN E mail State Zi ores Phon _ ' Fax E-mail CONTRACTOR Name Address City State Zip Phone Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Fax E mail Slate License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X PERMIT NO. 307 1�12C� BIN # PROJECT LOCATION ' AQP# Property Address_4 P,e. Y e-9 V -e City F0 WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must -be -shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK: � 4 Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. Type Const. G� 9 011 ♦ �y ^s- _.�"�.a Tyr rr � i -N-,% W-1 iI ■ A� ��� 1'� 1 Owner's Name: A #: U �� (zq 0- V Uy BP#: `�' og 4)0 l ceived By: Ot X 14 Date: \ d Y ime: If I 11 Contact Person & Phone Number „ ❑ Permit�Application Data Sheet Item ❑ *Engineering ❑ *Plan Revis• n �quesd by Building Inspects ❑ Re sted by Plan's a iu — ❑ O er: mer's Name: Name: It *If revising a plan which has already been issued, submit two (2) drawings reflecting the revision for plan review along with your approved plans: If engineering is involved in this revision, the engineer must put his requirements on these drawings and wet stamp and sign two sets of engineered* drawings. Revised drawings must clearly show changes proposed and locations involved. - n ❑ o D mn revised qm check fee to lie -r ill dete a if additional plan Miuumum $54.9 Receipt M Fee not required for visions re Additional Fee Amount: WHEN APPROVE , OCESS AS FO LOWS: it to Owner/Contractor at this dress: ith next i hold for niWup. atto of submission of 'revision, plans fees ar needed: / by plans examiner prior to issuance of permit. Receipt #: Revised 2/04 BALANCE OF FEES SHEET DATE: — J� PERM �%— ESSOR PARCEL #: .ASS _ _ �� `�' II OWNER'S S NAME: 6 FEES (Amount and Purpose): BALANCE OF FEES: $ ADDITIONAL FEES: $ REVISED PLAN CHECK: $ SHERIFF FEE (commercial only): $ SRA: $ COPY FEES ($1 or more) $ DRAINAGE $ BASIN BC RESIDENTIAL IMPACT , County Wide Chico Urban — El Medio North Chico Specific'— pecific_WATER WATERTENDER FEES $ BATTALION # FEMA $ SMIP $ 1 OTHER �� RECEIPT NUMBER(S) i7 VA ! 2eiiO4-10c54738 Recorded Official Records I REC FEE I CONFORM 22.00 1.00 When recorded return to: County Of BUTTE I CONFORM 1.00 County of Butte CANDACE J. GRUBBS I Department of ROSERecorMARY dder ICK50N Assistant I I Kathyh Development Services 03:21PM 08 -Sep -2004 I Page i of 6 Building Division 7 County Center Drive Oroville, CA 95965-3397 Space above for Recorder's Use Owners Name: George Thomas Hintz and Sharon Jess Stephenson IV— VBuilding BuildingPermit No: 04-1899 (basement) V DEED RESTRICTION AND NOTICE OF LIMITED USE FACILITY I. WHEREAS, on this 2nd day of September, 2004, George Thomas Hintz and Sharon Jess Stephenson, hereinafter referred to as owner(s), are the record owner of the following real property: Peregrine Road, Forest Ranch, CA 95942, AP# 056-360-008, and as further set forth in Exhibit "A" attached hereto and . hereby incorporated by reference, hereinafter referred to as "the subject property"; and II. WHEREAS, the Building Division of the Butte County Department of Development Services is acting on behalf of the People of Butte County; and III. WHEREAS, the owner applied to the Building Division for a building permit in order to develop the subject property described above; and IV. WHEREAS, Building Permit No. 04-1899 was applied for on 6/28/2004 by the owner in accordance with the provisions of the Butte County Code and the California Building Code; and V. WHEREAS, the use allowed by Building Permit No. 04-1899 has been reviewed and approved for only the limited purposes set forth below; and VI. WHEREAS, it, is intended that this Deed Restriction and Notice of Limited Use Facility shall constitute an enforceable restriction and remain in effect until a new application for a different use has been approved; and Yvonne C ' o Director DS 11101111111 113111111111111iii aFwC`�000--�6J►(s)S al 33q ! NRR V M I { { ,lydtsii ! j y6 I IRA I. b9b^iangA e't-lo-no lel:) .J 10!V903 3i1ng HUT A 32AGM3 isbiooO K,2.iJIQ YARM32-OR Instejup Mos -ala -88 mgls:Efl .f Vll. WHEREAS, Owner acknowledges that Owner will comply with the limited use restrictions that were incorporated in reviewing and approving Building Permit No. 04-1899 which enabled Owner to undertake the limited use authorized by this permit. NOW, THEREFORE, with the issuance of Building Permit No. 04-1899 to Owners by Butte County, Owner hereby affirms Owner's desire to develop a limited use facility, as set forth below, which establishes restrictions on the use and enjoyment of this limited use facility. The undersigned Owner, for himself/herself and for his/her heirs, assigns, and successors in interest, acknowledges and agrees to those restrictions. This limited use facility shall be utilized in compliance with those limitations prescribed by the California Building Code occupancy classification assigned by the building official, except the following uses are not allowed in the basement area: no sleeping, cooking, or habitation. Basement area may not be heated or cooled and must be unfinished. Basement area may have smoke detectors as required and a switch controlled electric light. If any provision of. these restrictions is held to be invalid or for any reason becomes unenforceable, no other provision shall be thereby affected or impaired. This deed restriction and notice of limited use facility shall remain in full force and effect during the period that this permit, or any modification or amendment thereof, remains effective, and during the period that the development authorized by this permit, or any modification of this development, remains in existence in or upon any part of, and thereby confers benefit upon, the subject property described herein, and to that extent, this deed restriction and notice of limited use facility is hereby acknowledged and agreed to by Owner to restrict the use and enjoyment of this limited use facility and shall be binding on Owner and all his/her assigns or successors in interest. Owner agrees to record this Deed Restriction and Notice of Limited Use Facility in the Recorder's Office for the County of Butte as soon as possible after the date of execution. This document shall be recorded and returned to the Butte County Yvonne ristop Directo , DDS f" Department of Development Services, Building Division prior to the issuance of Building Permit No. 04-1899. DATE: �' .3 , 20 O Owner Signature: 7-1711W 7- z Print or Type Name of Above Owner Signature: 21a&C621 In j2 r'o n 7a� ►o h P_.u�.S�o rj Print or Type Name of Above Yvonne Christopher Director, DDS NOTE TO NOTARY PUBLIC: If you are notarizing the signatures of persons, signing on behalf of a corporation, partnership, trust, etc., please use the correct notary jurat (acknowledgment) as explained in your Notary Public Law Book. STATE OF CALIFORNIA SS. COUNTY OF BUTTE On 3 before meV,,) I Public, personally appeared -i to %i~ i , Notary e r proved to me on the basis of satisfactory evidence) to be the person(% whose name(IP) is/am subscribed to the within instrument and acknowledged to me that he/sh@A4@-�f-executed the same in his/fir authorized capacity(), and that by his/h@Oftir signature.W on the instrument the person), or the entity upon behalf of which the persono) acted, executed the instrument. WITNE m hand and official seal. W. CUR BALDWIN II COMM. 11377983 0 NOTARY PUBUC-CALIFORNIA COUNTY OF BUTTE Comm. Expires Oct. 3, 2006 Signature (Seal) STATE OF CALIFORNIA SS. COUNTY OF BUTTE On O o before Public, personally appeared Notary -EeF proved to me on the basis of satisfactory evidence) to be the person(*) whose name(o) is/atesubscribed to the within instrument and acknowledged to me that Wshe/t4@p-executed the same in*#Wher/NwW authorized capacity(ios), and that by As/her/ signature(&�on the instrument the person; or the entity upon behalf of which the person} acted, executed the instrument. Yvonne Christopher Director, DDS W. CURTIS BALDWT IN II ;.; COMM. 1377983 0 _NOTARY PUBLIC -CALIFORNIA j, COUNTY OF BUTTE Comm: Expires Oct: 3, 2006 (Seal) This is to certify that the Deed Restriction set forth above is hereby acknowledged by the Director of the Department of Development Services and that Butte County consents to its recordation thereof. / vonne'qhristooh6r, Director epartm nt De elopment Services STATE OF CALIFORNIA ) SS. COUNTY OF BUTTE ) �On 2�':�b%fore v me NotaryPubic,pally ared t/olNI'l p 61" , personally known to me (or proved to me on the basis of satisfactory evidence) to be the personWwhose nameW is/,ae subscribed to the within instrument and acknowledged to me that f:tWshe/grey executed the same in-bis/her/#teir authorized capacity0es), and that by NT/her/t tI& signature( on the instrument the person,(), or the entity upon behalf of which the person(tj acted, executed the instrument. WITNESS my hand and official seal. R . Signature Yvonne ISO r Directo , DDS T;��;AIC'EANN MEFFORD Gom.-mission IF 1365836 Notary Public - Califomia z Butte County My Comsri. Ezpims Jul 22,2006' (Seal) RECORDING REQUESTED BY AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: NAME �Qi®�eC ,r •7t%rnQv ••�r%� STRA'T�9haro h 3'e.Ss a�fe�hens: ADDRESS ap 6, jS OX 41- A e)CITY /+ /� S P TE Fro r e$ -t Ra n c/h I C A qS-,q 4 2 - Title Order No. Escrow No. C_�go12114—P�036Are. 1a4 Recorded Official Records 13 County Of BUTTE CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 12:58PM 16 -Jun -2004 SPACE ABOVE REC FEE 7.00 TAX 110.00 Lisa Page 1 of 1 MENTARY TRANSFER TAX $ a GRANT DEED computed on full value of property conveyed, or D� computed on full value less liens and JOINT TENANCY encumbrances remaining at time of sale. SIGNATURE OF DECLARANT OR ANTioeTautmimNYA FIRM NAME FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), _C+� l t�� n CGL/, �t c� l 1 (NAME OFIWANraR(tin grant to t� f�,�j-�`Q tP �� Ei �`a� TIIii and -q-ha rn.i ►NAME a aRANteea) _S -���h �D,(� g� , AS JOINT TENANTS, all that real property situated in the City of E.6x—g Ra r) ,� (or in an unincorporated area of) �Lr T ' >✓ County, State of C A —,described as follows (insert legal description): ��ra t'� r��on ©f �h,� Wesf t�41>� of t1�� A/ar�-ha~as� sau-�hec� armor' anld all -Ae f porf�oo o,P i4bTs socL�h hVf o,' fh� 3,l 0Hurnbol Abad at Y' n s� h v 3l 'T6wneh;'a /dot4h Qan je. 3 � Assessor's pa I No. 60 O 0 0 Executed on at //�� 0 IL1n AND 1 STATE OF ca0.I1T[[ df/NiO,_ COUNTY OF 'B 9 Ori Ino Ib40l►ybefore me, 0.`=�4BiAs , e r.e.7AsoTRr T u�ie RIGHT THUMBPRINT (optional) RIGHT THUMBPRINT 10 tions! personally appeared l ,Vw-ia u: Z T_,e<s (or proved to me on the basis of satisfactory evidence) to be the person(% whose name(M is/f m subscribed to thewithin instrument and acknowledged to me that fr/she/Ahwexecuted the same inNother/tho* authorized capacity(), and that by461herifla n signature(M on the instrument the person((r, or the entity upon behalf of which the personal acted, executed the instrument. WITNESS my hand and official seal. ISrONAtvRel MAIL TAX STATEMENT TO: O'n SARAH SI WMU MULUH COMM, #1487780 NOTARY"UGCAt"II►M COUNTY OF BUTTE Coma, F.*_ M" 4, Zoos 0 0 0 CAPACITY CLAIMED BY SIGNERIS) D INDIVIDUAL(S) O CORPORATE OFFICERS (TITLES) O PARTNERIS) O LIMITED O GENERAL O ATTORNEY IN FACT O TRUSTEE(S) O OTHERIAN/CONSERVATOR (SEAL) SIGNER IS REPRESENTING: L/ r (NAME of PERStNJ(s) oR ENTITr(IEs)): WOLCOTTS FORM 768 (price class 3A1 Before you use this form, fill in all blanks, and make whatever changes are appropriate GRANT DEED --JOINT TENANCY -Rev. 3.94b and necessary to your particular transaction. Consult a lawyer it you doubt the form's ��II�IIIIIII��I III III II�GI fitness for your purpose and use. Welcome makes y representation this or warranty. express or implied, with respect to the merchantability or fitness of this form for an Intended use or purpose. 7 67775 39768 o 01994 WOLCOTTS FORMS, INC. AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 IIII"I�I"III'I'�I'IIII"IIII"'I 2004-0050275 Recorded Official Records I REC FEE 7,00 1 CONFORM 1.00 County Of I BUTTE I CANDACE J. GRUBBS I Recorder I ROSEMARY DICKSON I Assistant I Mark 12:41PM 17 -Aug -2004 I Page 1 of 1 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: ,(BEIM& 4 20,4'7/11/1, oG rtil�' rHG 1V0R77VC,fsr g0Ae rZ,_e v./Hz- 50r�TN- r Arilo 1-%/,;17 �v,PT/ori 2rmr 5007-# i 57- C1Uai�Q L Y«'� cd6Y1251 �y o% Tf/� CZ-W,7Z'R G/ws off. CV.o 1116 uWt n►oa 32 (� v�/���T�,d��) IAS. s'�c7xely 3 TowAtsHvla-2y /)/o,QT// lP�NGE3r%�� Date % PROPERTY OWNERS: 600r- T��r'151111Y72- State of California County of $V4A.0— On Sf/r9/?o� cess before me, O''1ull�� NAXLry P, personally appeared G e -owe. f a M of t H ; n ALL 7- OLAJ Shmro,n -'r s ,$i-' o A%O ve �sef J hewn-te-me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that 411NO/they executed the same in l/their authorized capacity(ies), and that by //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 hand and official seal. Signature J� t&V�/ �� 1n, Seal: — _C SARAH SATCHELL MULUN COMM. #1487780 WE. jA.P. # 0 WTARY►USMCALIFORP" CoCmOm. Exp May 4,.l00i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP042698 LICENSED CONTRACTORS 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 Issued Date: 09/13/2004 APN: 056-360-008-000 the Business and Professions Code, and my license is in full force and effect. .i License Class: License Number: . [(�l� Date: Contractor: Map Index: 4�, ,,Si Description: CONV SF TO GUEST HOUSE OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: HINTZ TOM permit to construct, alter, improve, demolish, or repair any structure, prior , to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of PO BOX 813 the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or LOCKEFORD, CA 95237 she is exempt therefrom and the basis for the alleged exemption. Any 209-759-3701 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant•' HINTZ, TOM Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, PO BOX 813 provided that such improvements are not intended or offered for LOCKEFORD, CA 95237 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 209-759-3701 proving that he or she did not build or improve for the purpose of sale.). �r7 I, as owner of the property, am exclusively contracting with (� licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Busines and Professions Code "- C_-0 Date: Owner. License #: WORKERS' COMPENSATION DECLARATION I 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 Architect: is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy #: Valuation: $0.00 Census Code: I certify that in the performance of the work for which this permit is issued, I shall not employ any persons any manner so a become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' 9,e compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: O 1. g Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Coda andlor I hereby affirm that there is a construction lending agency for the dQ.work indi t abov f hi fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: VResoluo Date: ON: Address:IRES Dat ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print NameG�C�o,��� / VOV?71TS Signature: r- 3 '-0--t1 Date: / Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING. PERMIT 24 HOUR INSPECTION #: (530) 538-76364OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP041899 LICENSED CONTRACTORS 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 Issued Date: 09/13/2004 APN• 056-360-008-000 - the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 4715 PEREGRINE RD FRN Date: Contractor. Map Index: Description: NSF(2139)COV(456) OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: TOM HINTZ permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of P.O. BOX 813 the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or LOCKEFORD, CA 95237 she is exempt therefrom and the basis for the alleged exemption. Any 209-759-3701 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: TOM HINTZ Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: —13-rj Owner: CJ 7 License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of pe6ury 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 Architect: is issued" Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 2595 S.F. Policy #: Valuation: $146,331.00 Census Code: certify that in the performance of the work for which this permit is issued, 1 shall not employ any persons any manner so a //)6S /LVA become subject to the workers' compensation laws of California,a, S (P lTU � 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: Applicant: C3—�iT WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the B+dte County-.odp-an er-�— I hereby affirm that there is a construction lending agency for the Resoluti ns do work indi a d ab for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) O Name: B Date: PERMIT EXPIRES ON: Address: to ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: G�014 (6z �� 777V� VY /'1,1i« TZ Signatu �7 / �7— d Date: Owner 13 Contractor 13 Agent for Owner ❑ Agent for Contractor �VjpF BUTTE COUNTY o 0 DEPARTMENT OF DEVELOPMENT SERVICES 0 0 BUILDING PERMIT APPLICATION 0 0 AND SUBMITTAL REQUIREMENTS o = 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 o 0 OFFICE #: (530) 538-7541 CDV N'�y A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last Name irst Name 6 Address ®970Y ZI City 0 State c,,y Zip 9 7 Phone 7-370 Fax E-mail PLICANT NAME CONTRACTOR Name City Address Zip City Fax State Zip Phone Page Fax E-mail Date Approved: Lic. # Class PLICANT NAME ARCHITECTIENGINELtR Name City Address Zip City Fax St e Zip Phone Page Aax E-mail Date Approved: State License Number PLICANT NAME Name Address City State Zip LPhone Fax E mail APPLICANT SIGNATURE X dam) For office use only: Zoning -T?It , Flood Zone Cros Street SRAd. Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT No ---1 0o�� b 3 LOCATION AP# a S S 60 .— 00 3 Property Address PL-EG,� NC City,,�4 57- ia5/C�/ Cros Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name � 0 � ,— [�.. Address rsqrijg i Scope of Work: zj Sq. Footage ❑ Structure Built�without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. rx by: Amoun - '66K Bldg l 5 I g SRA Receipt #: %Sheriff / ' SMIP Other D to Total KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 Kr_V 0- 10-U4 SUBMITTAL REQUIREMENTS �3�( The following drawings and specifications must be submitted to the Building_ Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL'PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -shined by the engineer. Mobile, Manufactured, or Modular homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ` ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from:the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GA,4PHPAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 1L Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 53'8=7541::..., OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\61dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 r Y Butte County Department of Development Services. �0)TtF 0 0 YVONNE CHRISTOPHER, DIRECTOR _ 0 0 0 0 7 County Center Drive o Oroville, CA 959650 _ 0 (530) 538.7601 Telephone cOU N'�y (530) 538-7785 Facsimile 100 TO: ' FROM: M SUBJECT: 1 O DATE: LP2A Scott Rutherford (530) 538-7160 s rutherford 6Dbuttecountv.net Plans Tran_smittal.For Review Per Contract 6/28/20041 Applicant: Hintz, Tom Permit 04-1899 Project Type: NSF APN: 056-360-008 100% 70% Plan Check Fees 1,193.83 - $ 835:68 $ 1,193.83 $ 835.68 LP2A Fee $ "835.68 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction .Requirements Other Other COUNTY OF BUTTE -DEPARTMENT OF DEPELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phohe (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET i OWNER: ASSESSOR PARCEL NUMBER 'Ar f D� Proposed Building Use: Counter Technician: ( Date: ((/ ate' 4equired in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. je-1 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ,❑ 14. Hazardous Material Form 15. Sanitation and site plan approval from the Environmental Health Department in Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 17. Fire Sprinklers............................................................................................ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 2 Erosion Control Plan Required........................................................................ ........ l !es as shown on the attached Schedule of Fees Due Sheet ............................. ❑ 2. City of Chico Plumbing permit ............................. ................. . California Department of Forestry plan approval paid. Sent by. .......... l (Q P§ lanning approval (A) Use: �(B)Parking: (C) Parcel C eck: S.:=NoV 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... 30. Worker's Compensation Carrier and Policy Number .......................................... Y 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... 32. Letter of Signature authorization.................................................................... 33. Recorded copy of Agricultural Acknowledgment Statement.................................0�-- 0 34. Manufactured home utility clearance............................................................... ❑ -35. Existing violations and/or expired permits......................................................... 36. Deed Restriction.7-................................................................................... 37. �ra�n, D ed M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ 3 ett/ E' 1 I� ther.C. Q v D When iss}Ie Telephone - - ^% and hold for pickup. ---� Y� is v�� ccs- /e G�,�-s~t tfovTvr cQ.�v vv� r.o.�� campy-�,Gd�, I have been informed of the above items and requirements for obtaining a building permit. Applicant e /o p d" 1. Index permit application f r the above items numb d: ! Plan Check Letter 2. Additional itemsre ' Contractor, designeowner was advised of the above data by phone, ❑ mail, ❑.counter, by Date: Contractor, designer, er, was advised of the above data by ❑ phone, ❑ mail, ❑ `counter, by Date: . Plans reviewed by: Date: Plans approved by: 1 Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance E.N. USE >yir Piot Ran Attached Floor Ran Anschad ; Smart to 8� - _ Owner Location AP# Plan Approved for: Sewage Disposal '� Water Supply: Public Private Well Clearance for dwelling. Other Hold final for:. I1- 1YX1--y.-('Qy n yr Finaf clearance O.K. for: NOTE: (om) CAI& All Z6'7''MMG 46i - Z'4mv Environmental Health Specialist 6 _ ' G® E �T—/� 'Date COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES OWNER A.P. # PROPROSED BUILDING USE n5p DATE & - 1. BUILDING PERMIT FEES --- Balance Due ..................... $ --- Additional Fees Due........... $ -- Revised Plan Checking Fee.... el -2. SCHOOL DISTRICT FEES % (paid at School District Office) ( available after Plan C k) pp1!/ 3. SHERIFF FEES'I (Paid at Building Division) Residential............ X $360.00 =$ U6 Units Commercial (sq. ftg.). 4. URBAN AREA FEES X $0.03 = $ Sq.Ftg. Residential (per unit)..... X # Units Commercial (Sq. Ftg.).... X Sq. Ftg. Amt. Amt. RECEIPT # DATE REC. (paid at Building Division) 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES A'� � $510.00 (paid at Building Division) V " 6� SRA FIRE INSPECTION AND PLAN CHECK FEE $;A0 4p at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ......... X = $ Sq. Ftg. Amt. 10. OTHER 67//,3 d� At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking propess. APPLICANT DATElOr�.�'-G T Pursuant to Government Code Section 66020, you are hereby notified 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 Division Yellow -Applicant Pink -Owner (rev. 2/2003) _W SITE PLAN REVIEW APPLICATION Date: d S=YIDS/ ; AP# t9S�-j6,0-Oo8 Permit Number (if applicable) Del' IS'N' Bin Number !h -3 - APPLICANT INFORMATION Parcel Size: Owners Name: 7D n4 % �7 Owners Address: S'a;3 7 Telephone No.: \ Situs Address: P t� �✓!�' '1�D2�'�J �2�h � kM!) AIW Proposed Use: Residential (�_lew Single Family Residential VV __ ❑ Single Family Addition, ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑ Agricultural,Exempt Building ❑ Other: Brief Explanation (if necessary): -7p- 96 ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well (Agricultural Buffer Form 9 Applicable ❑ N/A DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) IXApproved ❑ Conditionally Approved Resolve Problems Prior to Approval Site Plan Stamped Approved ' By Date Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: Snow Load Area:99O0 -- Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: • Flood Panel No.: Index Date: ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance -------=------------------------------------------------------------------------------------------------------- ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: T114 -s Applicable Building Setbacks: Setbacks drawn on site Plan.,S ed for encroachments into SRA setbacks. dt r- ear w,�T Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front vV e, 0 �r Side Side Street aDi moo' �jc-�r Rear Height Waterway N/A N/A N/A Setbacks drawn on site Plan.,S ed for encroachments into SRA setbacks. dt r- ear w,�T Page 2 of 5 Applicable Development Fees: Standard Fees Amount Formula ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other ------------------------------------------------------------------------------------------------------------------------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By [1 Deeds: Date of Creation: A"'1- 2? Legal Access Provided: E]No ❑Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: aParcel Deemed to be legal Verify .Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a 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 Environmental Health Department requirements Page 3 of 5 ❑ Subdivision ME/Parcel Map: Map Date of Recording: i Lot: Book: Page: ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act'of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for road maintenance, and stop sign maintenance. Page 4of5 Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 LA Butte County Department ofDevelopment Services YVONNE CHRISTOPHER, DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538.7601 Telephone (530) 538.7785 Facsimile ADMINISTRATION * BUILDING * GIS * PLANNING September 3, 2004 Mr. Tom Hintz PO Box 813 Lockeford, CA 95237 Subject: Building Permit 04-1899 Dear Mr. Hintz: The Butte County Department of Development Services, Planning Division, has reviewed the submitted Building Permit 04-1899. Your permit has been approved for a new home. There are a few issues with the existing dwelling (cabin) located on your property. Your parcel is located in the Timber Mountain (TM -5) zone, and has a minimum parcel size of 5 acres. You are allowed one residence by right. However the proposed cabin must meet the qualifications of a Guest House. The building can be no larger than 500 square feet in size, and may not have a kitchen. This planning clearance is given with the understanding that prior to occupancy of the new dwelling, you will convert the cabin to the standards of a guest house. We recommend that you apply for the building permits necessary for this conversion now rather than wait until you are ready to occupy the new dwelling. Should you have any questions please feel free to call Carl Durling, Associate Planner, between the hours of 8:00 a.m. and 4:00 p.m. Monday through Friday at (530) 538-7150. Sincerely, eph W. Baker Planning Manager When recorded return to: County of Butte Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965-3397 COPY of Document Recorded 08 -Sep -2004 2004-0054738 Has not been compared with original BUTTE COUNTY RECORDER Space above for Recorder's Use Owners Name: George Thomas Hintz and Sharon Jess Stephenson Building Permit No: 04-1899 (basement) DEED RESTRICTION AND NOTICE OF LIMITED USE FACILITY 1• WHEREAS, on this 2nd day of September, 2004, George Thomas Hintz and Sharon Jess Stephenson, hereinafter referred to as .owner(s), are the record owner of the following real property: Peregrine Road, Forest Ranch, CA 95942, AP## 056-360-008, and as further set forth in Exhibit "A" attached hereto and . hereb incorporated by reference, hereinafter referred to as "the subject property"; and Y 11. WHEREAS, the Building Division of the Butte County Department Development Services is acting on behalf of the People of Butte County; and nt of 111• WHEREAS, the owner applied to the Building Division for a buildin permit in order to develop the subject property described above; and g IV- WHEREAS, Building Permit No. 04-1899 was applied for on 6/28/2004 by the owner in accordance with the provisions of the Butte County Code and the California Building Code; and V. WHEREAS; the use allowed by Building Permit No. 04-1899 has been reviewed and approved for only the limited purposes set forth below; and VI. WHEREAS, it is intended that this Deed Restriction and Notice of Limited Use Facility shall constitute an enforceable restriction and remain in effect until a new application for a different use has been approved; and Yvonne C o Director DS VII. WHEREAS, Owner acknowledges that Owner will comply with the limited use restrictions that were incorporated in reviewing and approving Building Permit No. 04-1899 which enabled Owner to undertake the limited use authorized by this permit. NOW, THEREFORE, with the issuance of Building Permit No. 04-1899 to Owners by Butte County, Owner hereby affirms Owner's desire to develop a limited use facility, as set forth below, which establishes restrictions on the use and enjoyment of this limited use facility. The undersigned Owner, for himself/herself and for his/her heirs, assigns, and successors in interest, acknowledges and agrees .to those restrictions. This limited use facility shall be utilized in compliance with those limitations prescribed by the California Building Code occupancy classification assigned by the building official, except the following uses are not allowed in the basement area: no sleeping, cooking, or habitation. Basement area may not be heated or cooled and must be unfinished. Basement area may have smoke detectors as required and a switch controlled electric light, If any provision of these restrictions is held to be invalid or for any reason becomes unenforceable, no other provision shall be thereby affected or impaired. This deed restriction and notice of limited use facility shall remain in full force and effect during the period that this permit, or any modification or amendment thereof, remains effective, and during the period that the development authorized by this permit, or any modification of this development, remains in existence in or upon any part of, and thereby confers benefit upon, the subject property described herein, and to that extent, this deed restriction and notice of limited use facility is hereby acknowledged and agreed to by Owner to restrict the use and enjoyment of this limited use facility and shall be binding on Owner and all his/her assigns or successors in interest. Owner agrees to record this Deed Restriction and Notice of Limited Ose Facility in the Recorder's Office for the County of Butte as soon as possible after the date of execution. This 'document shall be recorded and returned to the Butte County Yvonne ristop Directo , DDS Department of Development Services, Building Division prior to the issuance of Building Permit No. 04-1899. DATE: Owner Signature: Print or Type Name of Above Owner Signature:h,,a-,., Print or Type Name of Above Yvonne ristop Direct , DD ,� NOTE TO NOTARY PUBLIC: If you are notarizing the signatures of persons, signing on behalf of a corporation, partnership, trust, etc., please use the correct notary jurat (acknowledgment) as explained in your -Notary Public Law Book. STATE OF CALIFORNIA COUNTY OF BUTTE SS. On before mA� Notary Public, personally appeared e :;,-} e proved to me on the basis of satisfactory evidence) to be the person() whose name(g) is/atm subscribed to the within instrument and acknowledged to me that he/sts�-executed the same in his* authorized capacity{), and that by his/4@007&his/4@007&signatu'rej on the instrument the person°), or the entity upon behalf of which the personoj acted, executed the instrument. WITNE m hand and official seal.ym� W. CURTIS BALDWIN II COMM. 91377983 r NOTARY PUBLIC -CALIFORNIA COUNTY OF BUTTE Signature Comm. Expires Oct. 3, 2006 (Seal) STATE OF CALIFORNIA COUNTY OF BUTTE On O o before Public, personally appeared �� 44�-D0, SS. Notary -{ef proved to me on the basis of satisfactory evidence) to be the person(f) whose name(a,) is/axe-subscribed to the within instrument and acknowledged to me that he/she/t4@y-executed the same in-4/her/fir authorized capacity(ie&), and that by AiWher/ signaturek&- on the instrument the person*, or the entity upon behalf of which the persorv�* acted, executed the instrument. Yvonne Zt o r Direct , D W. CURTIS BALDWIN II COMM. 91377983 ; NOTARY PUBLIC -CALIFORNIA COUNTY OF -BUTTE Comm: "Explre$•Oc;1; 3., 2006 (Seal) This is to certify that the Deed Restriction set forth above is hereby acknowledged by the Director of the Department of Development Services and that Butte County consents to its recordation thereof. vonne-Uristo hbr, Director epartm nt De elopment Services STATE OF CALIFORNIA ) COUNTY OF BUTTE ) SS. On e� (:�ared v before me Public, p yNotaryersonall ✓cr)iu i��i-*f�v personally known to me (or proved to me on the basis of satisfactory evidence) to be the person( ywhose name ,W is/,ar-e subscribed to the within instrument and acknowledged to me that ttshe/they executed the same in-Ms/her/##sir authorized capacity(, and that by #if/her/tbm- signature(-sJ on the instrument the person(s-), or the entity upon behalf of which the person(i* acted, executed the instrument. WITNESS my hand and official seal. RL IC'c.� N €fAEFFORD ti Commission a 1365836 Notary Public - Califomia y Butte County W.COMM. = orea Jul 22, 2008 Signature (Seal) Yvonne ISO r Directo , DDS RECORDING REQUESTED BY x H ' ✓ a AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: NAMSTR.JE,. Ch PitGii;�� E 'F' )brnQS H;n-�e- ADDRESS h Fe ss �S �e{� bier z ADD�p CITY /+ n Z PATE F'o r eS `t IQa n��hI }�1.I+yA L ' "ClI "i ;2— J Title Order No. Escrow No. ilii tti iit t iiit i ti l ttlitt ii ill li 11 2QjtQJ4—Q3QJ13C�4rb4 Recorded I REC FEE 7.00 )� Official Records I TAX 110.00 County Of BUTTE I CANDACE J. GRUBBS I Recoder ROSEMARY i Assistant 12:58PN 16 -Jun -2004 I Lisa 1 Page 1 of 1 FOR RECORDER'S USE -------------- GRANT DEED DO�tJMENTARY TRANSFER TAX $ OCL G computed on full value of property conveye , or JOINT TENANCY 13 cornon full value less liens and encumbrances remaining at time of sale. SIGNATURE OF DECLARANT OR EAR DEER TMIMAIG TA)( FIRM NAME FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), (NAMt Or CAANTOR(sll grant to all that real property situated in the City of JOINT TENANTS, of �I��E _1^ t'�4 ¢� �Q � _ j Sri _ for in an unincorporated area of) County, State of described as follows (insert legal description): A-F+h eSoulhea� ehcl/ �apo^fao�id Qfop Sou the444 "d?yter ' ying t v'esfe-d% 6P o -P old 3.2 F urnbol A'cad� a tt in- Sec fi an 3l Ti,wnBh ) g �9hw4y ,y4 M, p 8.4 hl - p a J�l'Ex-,�h Assessor's pa I No.0 Executed on 24 at STATE OF 10. COUNTY OF 041meJt* before me,'`��� D!I wr ITL[.I E S we G.AA'1 auc r personally appeared cl� .s;�-��Q (or pfroved to me on the basis osatis actory evidence) to be the person(0) whose name(* isle► subscribed to thewithin instrument and acknowledged to me that!*/she/*W executed the same intie/her/till authorized capacity ft, and that by 6*her/ty�llL signature(✓* on the instrument the Person(d, or the entity upon behalf of which the personN acted, executed the instrument. WITNESS my hand and official seal. 0 0 SARAH SATCHFl1MULUH rl �l, ,tn n Wt OQ.li1n 80 HOTCAAiYPLIMm. i AIFM (SIG`MTVRl) courm0f suTTE CoLnrn.ltlq+tm►dap�, 2001 MAIL TAX STATEMENT TO: CAPACITY CLAIMED BY SIGNERIS) O INDIVIDUAL(S) ❑ CORPORATE OFFICERS ❑ PARTNER(S) ❑ LIMITED ❑ ATTORNEY IN FA❑CTENERAL ❑ TRUSTEEIS) 8GUAROIAN/CONSERVATOR OTHER (BEAU wOLC077S FORM 788 SIGIJER IS REPRESENTING: • (price class 3AI Before y°u use 'hs form, (III in all blanks, and make whatever than es are appropriate (NAME OF PERSONS) OR ENTnY(IES)): GRANT DEED --JOINT TENANCY -Ray. 3.94b and necessary to your particular transaction. Consult a lawyer if you doubt the formts I,'II��I�I'll t�l ��I� III I I /III f11° for your pwp°sa a^d use WOlcotts *hakes no representation or warranty, 111111111 1 1{ I f` I`111U11 expre9s or Implied, with rpspgct to the merchantability or fitness of this form for an Intended use or purpose. 67775 39768 O 01994 WOLCOTTS FORMS, INC. August 24, 2004 Mr. Michael Vieira County of Butte 7 County Center Drive Oroville, CA 95965-3397 Phone: (530) 538-7541 Fax: (530) 538-2140 Re: Plan Review: Address: Dear Mr. Vieira: Hintz SFD Peregrine Road County of Butte- FINAL REVIEW Jurisdiction Application No.: 04-1899 LP2A Job No. 2040015-090 Linhart Petersen Powers Associates (LP2A) has completed a initial review of the following documents: '1. Plans: Five (5) revised copies Plan Sheets Cover through 5 (5 total sheets) Title/Cover. Sheet dated April 21, 2004 by Quail Creek Log Homes. 2. Structural Calculations: Two (2) copies not dated by McMlllion Engineering. 3. Title 24 Energy Compliance Documentation: Two (2) copies dated June 28, 2004 by Energy Calculation Services. The 2001 California Building, Mechanical, Electrical, Plumbing and Energy Codes (i.e., 1997 UBC, 2000 UMC, 2000 UPC, and 1999 NEC as amended by the State of California) were used as the basis of our review. We do not have any further comments regarding this submittal package. This plan review is recommended for approval as submitted with redlines and the following condition: 1. The engineer ,must provide a geotechnical report for the assumed 2300 -psi soil bearing pressure for the retaining wall design. Sincerely, LINHART PETERSEN POWERS ASSOCIATES Roger Peterson, S.E. s Structural Engineer Plans Exa PK`ag Enclosures: Bin 61 fAbutte county 015\butte county 2004\2040015-090-pcf.doc IsLINHART PETERSEN POWERS ASSOCIATES 7610 Auburn Boulevard - Citrus Heights, CA 95610 (916) 725-4200 - FAX (916) 725-8242 - Toll Free (877) 235-0653 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 CONY of Document Recorded 17 -Aug -2004 2004-0050275 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: %'r/e/v 0,,c:'7 r114 si 1vo,e'iNr-Ws'r CF0vV17Z-,e :::)/C rHc 500;rr— C,�Si L Yin�G- id�srE2Ly p/= rh'� c4 � l—Z-w c�ivE a� aco /-11G#�ur�r Ivo, �2 0) #ALL. 11Y S'EC7141Y 3�J i`eWAI rH11-7 --2,51 /7ioRT/fJP iWAE3 ZWSI Date PROPERTY OWNERS: State of California County of $ V-tR On -A0q ust 1 b1�- _'2-06'A before me, 5�...r�. Suk-r hill �ull;n N'n�arll personally appeared Q -19 -ora -g- i1, o A oLt K; ntz aAJ Sharon Se -ss .5 ,P of P m --o n 4wown-to-me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that 4110ft/they executed the same in tom►/their authorized capacity(ies), and that by 11l1ftNtheir signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature gM Seal: � �opp /�LYY� mSARAH $ATCHELL MULLW COMM. # 1467780 a RHARYMALICXALIFORW COUNTY of BUTTE r- 6 A.P. # Vel Comm. Explrei May 1,1001 . OWNER-BTJII.,DER 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. 0I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES X NO 0 6)2I HAVE)t HAVE NOT 0 signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: 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 worla NAME: ADDRESS: CI1-y; 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 _22 ,V_�1- O This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Coda This verVx- anon must be completed and returned to our oj)ke before we are permitted to issue the permit OVER OWNER BUILDER INFORMATION Dear Property Owner: 0.B. - An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your proton, you should be aware that as "owner builder" you are the responsible party of record on such a permit Building pemvfs are not required to he 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 reph ed 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. If you plan to do your own work, with the exception of various hordes 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, mediate family, and the work (including materials and other costs) is $300 or more for the entire pmjert, 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 seveaal obligations inchmdn state and federal income tax withholding, federal social security taxes, wodcers 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 warp's compensation insu aum ♦ Fos more specific ini'ormation aboutyour obligations under Federal Law, contract the Intetal Revenne Service (and, if you wish, the U.S. Small Business Administration). For more specific inf oration about your obligations under State Law, contact the Department of Benefit Payments and the Division of Inddus rid Accidents. If tine structz is intended for sale, property owners who are not licensed contrarctom are allowed to perform their work personally or through their own employees, without a licensed contractor or subconhactor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building per.mit, erroneously implying that the property owner is providing his or her own labor and material personally. Binding permits are not re raked to be signed by property owners unless they are performing their own work personally. hiftemation about licensed cm actors may be obtained by contracting the Contractors State License Board m your community or at 1020 N Street; Sacramen D, CA. 95814. Please complete the "Owner Builder Verification" on time 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 rehvrned. $S . AS I C. V- ira, C.B.O. Bmlding Inspection NOTE: TIib Owner-BuilderWorr mfion is required by Section 19830 ofdie CaWarnia Health mrd Safety Code OVER EPWTMENT 6v T TF °�. ° ° ° o c o e ° ° c�UNI A�QLIC WOP�y Department Public Works J. e.ilt-iiccr %..rurnp, utrecror LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville. CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement f'LESS THAN 1 ACRE! Project Description: Project Location and/or Parcel Number: O� By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: (� Date: 2 ? O Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 524/04 t eta Vsj ckzwl, I'LT7 dlu I rr BUTTE COUNTY SCHOOLS'IMPACT FEE CERTIFICATION FORM. t4 - (One form per Building) School -District �iv Building Department No. A.P. Numbef6'9p —514 V' bGci Jurisdiction: 0, Clty , County Property Owner Property Location/A Subdivision Residential Development 0 Q N No of Living Mobile Home Units Installation Addition/ 'Supplemental to Conversion Permit # (Attach a Commercial/Industrial Q Q New Addition Building Department District Identification No. b 4-1! _. School District certifies that. (Street Address) I t l /\ U 11 A U ILL (City) U has complied with the requirements of Resolution No. representing square feet. School District Representative Paid by Check # �✓ Remarks: Noun: You may protest the Imposition of the teas Idenil ied above by submktirM Govrmmsrmt Coda Section 66020(a), within 90 days from the date fess are paid. F you hom challenging the Imposition of the has In any court actin ] K, subsequent to the School District Representative signing this Butte Courtly Sel mhotllled by the spoicable Local Planning Agency that this project Is being review this project m y bo.subjsc to additlonal school toss to fully ndtkisft.its Impact o White (applicant), Yellow (building department), Pink (school disti Sq. Footage 0139 1 3 1a (Group R) Deed Restricted Sq. Footage ~ copy of Deed Restriction and Notice of LimitedyUse Facility document) ( / Sq. Footage (Including Exterior Roofed Areas) Date t r f R 5 1 (Applicant) Y - q1 SQ (Phone Number) ') (State) (Zip Code) 41 by payment of $� i 2926 i {p FULL MmGAT10N f } 1 . Date F Yt• a written protest to the District, in compliance with Iiure to submit a timely written protest will'protdbk vols Impact Fes certification Form, the School District Is id under the California Environmental Quality Act (CEQA), �f i the school dbtrletls schools. .+� r feeform.xb 110/03)dmm M 'PERMIT NO. 1396-81B,P,E' PERMIT EXPIRES OWNER Julius Jess CONTR. owner ASSESSOR PARCEL 56-36-8 LOCATION Ed of pri.rd'.,app.200'N.of Peregrine Rd.,app.500'W.of Forest Ranch Rd., Forest Ranch 4, JOB PINAL� (Date) Signature tqf Temp. Power Pole_ CalledPG&E Temp. Elec. Service Called PG&E Temp. Gas Service Called PG&E,/— JOB PINAL� (Date) Signature J OK M 0 Not OK -'= Not Applicable MOBILEHOMES - Not Ready . J MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements - Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except a's 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rig.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date - Card -BI Date Date Card -BI Date - MOBILEHOME INSTALLATION (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements Card -BI Date Date Card -BI Date POOLS (Plans) OK except N's 1, Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Gas; MH Test -Demand -Valve -Connector 3. Pool`Structure; Steel -Connections -Thickness -Dead Men Lining 4. Electricity; MH Test -Crossovers -Breakers -Clearances 4, Elec.; Receptacles and Lighting; Distances-GFI 5. Drain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7, Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Panel boards -Ins. to Main in Conduit 9. Exits; Insp.-Sketch 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card B-1 Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date 7- V V = OK O = Not OK • - = Not.Applicable = Not Ready RESIDENTIAL (Single and Duplex) T Date UND LOOK Plans OK except #'s Date FRAMING Continued .� Zoning requirements -Setbacks -Easements Firewal Openings Ftg., Main; Soils -Steel -E nd.- /71 /" Ftg. Depth xt. Doors Chee*-earege ^r"3" Pttlsr Garage; Soils -Steel- / /" Ftg. Depth eadroom-Rise-Run-Landing-Fire Protection 4. F19., Porches & Decks; Soils -Steel- / /" Ftg. Depth Plywood on Roof Overhang -Attic Vents -Rafter Outriggers temwalls, Main;.44ael-Bloq�s-Wrappe8-S1eb. S'-N§4-t-*esrasr ^e-StamamHsTGarage; Steel-Blockouts-Wrapped-Slab rip Screed-Fdn. Vents-Underflr. Access Piers- I Glazing Area -Glass Protection -Skylights -Plastic 8. D i -T C/ w est -e55.-9heer1falls; Nailing -Bolts e; Size -Anchors ater Pipe; Test -Anchors -Regulator -Service Test nd 1 ums Ducts; Clearance -Material -Support -Ins. ire nth s-iei�ts-V s-CFi{:es Card -BI Date Card -BI Date O U G T CU Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date, l&f Card -BI Date 7 %8� Date FINAL �s) OK except #'s Card -BI 6@2 Date . / Card -BI 40 Date--d"i Date G PLU G (Permit) OK except #'s xt,,Steps-Door & Sidelight Protection -Landings 5t/Tmoke Detector ater HL; Vent -Access- it Vents -Clearance -Comb. Air- I ge; Above Floor -Ducts -Meth. Protection Connector-1a—ter Pipe; Test & Anchors -Nail Protection 1A_4"W.V.; Test-Fttngs & Anchors -Nail ProtectionB oom Exiting Win; Test, First Floor -Tub Access G. .. & Bath Fixtures 8rtub-Aesms r, 2nd Floor -Tub Access lec. Trim & Subpanel; Breaker Sizes-it,ab€�s •--49r-hes-f4'pe-Size & Anchors Is JIJTireplace or Stove; Clearance HeaN eeCntFels at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date Kit. ')t. -&A fiance; GF r,.p e Card -BI ® Date7,,G3,,Jro1/ Card -BI Date ec. Outlets &Receptacles at Kit. Counter Date ELECTRICAL Permit OK except #'s-�ct"'in moire Door; Swing -Landing -Closer 9� Garage -Damper -@9r-Fiiknre & Transformer Clearance -Ins. Protection tr. Htr.;P-10Venla-Clete-Ces�.Ai�Copyaaof- - bove Floor-Mech. Protection ec. Receptacles Spacing -Lights &Switches at Doors Ib., Elec. & Mech. Equip. Listed for Location ze Boxes & No. of Conductors -Stapled les in Garage; (G.F.I.)-Romex Protec. 2 o x Installed Close to Edge of Studs & C.J. i quip. Ground made up w/Mech. Fasteners on Wa . Insulation -Foam -Looked in Attic ❑Yes Is & Deck Construction -Post Caps Ob -Tai Appliance Circuits in Kitchen &Conductor Size Fdn. VerRSr& Cra ole Door- ina od-Eartfb,LJear�ce Looked under Floor ELYesr� 26. Subfeed Wire Size / / ga. Cu or AI-A:C�-Wire•-Si-ze-A--Lga-CFo7 AT 27' -VAI, I aced Neutral ❑Yes ❑No o lowing instld.: Drive es ,Walks E] Yes VNo__ ���1v Planters ❑Yes 'f�t�o Service -Riser Conductors i co t Finish 9. Equip. Clearances; Panels-Motors-Mech. Equip. 66a J fir et Light -Shower Light 7 nnect-Clrnces-Br & Cond. Size -115V Outlet -Above Roof; .-Ap nce-F' .-Cleara a ngs. ter Well; Disconnect, Electrical, Plumbing Ex r Elec. Trim; G.F.I. Receptacle -Un to Card B -I ` Date/� Card -BI Date A, . entilation throughout House -et--'Gla TVrotection Card B -I Date! Card -BI Date / Date MECHANICAL (Permit) OK except #'s c,&3­6erree taffs from Previous Inspections est -Meters Tagged; Gas -Electric 31._.G.C•4D4;=; Insulation & Support 8 ter & er C cted-C/O ade-HD Approval 32V2jL Fan; Exhaust above Insulation *JC6) Energy Compliance Certificate -Other Certificates _ 33. Condensate Drain & Overflow; Size & Grade 3+.-F.uUace-Vent; Access -Comb. Air -Return Air Vent -115V outlet 26_-A"ie.Access & Platform if Furnace in Attic Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date i ` Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRAM G(Plans) OK except #'s Comments at Final: S' Is; Proper Material & Anchors s; Studs -Nailing, Spacing & Bracing-Plates-8e"ed- ring Walls over Girders & Floor Nailing _Be r t Stop in Walls (rat proof) altire Stops; F SfsixcrOheses 4 Bader & Beam -Size & Bearing _ 42. Hangers -Post Caps -Anchors -Connectors Aff / V 3 43FLwJi . R&nf Rrar-Tcuce--Shop, .-R , - L3 ireplace T.iec.ore� FiF Jaee-ihroeet is Access; SiT-AlAomet) P1.etgction-Ilraff Stop Baff_ % drm. Windows or Exiting Doors -Sill Hgl. & Dimensions _ ,41-Gerege-Fire Protection Framing (NOTE: An entry must be made each time you visit jobsite) County of Butte bEPARTMENT OF PUBLIC WORKS 695 Oleander Ave., Chico — 343-4211, Ext. 70 7 County Center Dr., Oroville — 534-4541 5yway and Elliott Rd., Paradise — 877-3435 CORRECTION NOTICE �3� .-T' ...... Building or Property Address A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office �ely. �Q /...................................ll............................... G' ...... ............N...�..j........... .................... ,,.... .................. `' ...............v.". .....�..........`..... ..... ................................................ ry ..y -......p........_....................................... .................................... "11............................:................................... Date ................. I............ Inspector . ................... r ' `�" Do Not Remove This Tag (400-4) COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-,4,541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. J ` 1111L• c V i IJ Inspector Date �j COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 JG. CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter,;," need additioral explanation, please contact this office immediately. /r Inspector1, Date ) / 914 7- 7r 7 COUNTY OF BUTTE yr DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 f• 7 County Center Drive, Orovi Ile — Phone: 534=4541 Skyway and Elliott Road, Paradise— Phone: 872-2961, Ext. 57 CORRECTION NOTICE BUY -DING OR PROPERTY ADDRESS A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matte, need additional explanation, 'please contact this office immediately. G T Inspector ,/.� !"' (lG� Date 7— 3 / RESIDENTIAL ENERGY CONSERVATION STANDARDS CONSTRUCTION COMPLIANCE CERTIFICATE THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN INST LED IN CONFORMANCE WITH CURRENT ENERGY CONSERVATION REGULATION ATNdl�.c'£ i.J... n1i �ei_'rT �I (location) BUILDING PERMIT NO A. -P. NO. a THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS: (Check each item or write N/A if not applicable) INSULATION: Slab Edge H Fdn. Walls Floors .Walls Ceiling/Roof Ducts Circulating Pipes � APPROVED HEATER APPROVED WTR.HTR. GLAZING: Single Glazed Special (Insulated) CERT. & LABELED WDS.: v/ . & SLIDING DRS. WEATHERSTRIPPED DRS. BACK DAMPERED.FANS INTERMITTENT IGNITION DEVICE AJI�- CERT. APPLIANCES. I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE. BEEN INSTALLED IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIRE ENTS_AND AGREE TO THE CaIPLETENESS OF THIS CERTIFICATE AS SUBMITTED. Insulation Applicator Name� �___% Signature of (please print).. Insulation Applicator_ C� y State Contractors License No. General Contractor/0«er Name Signature of f"• (,please print) General Contractor/Owner ..ems-� Date. a, State Contractors L is ens e 'No . 0 THIS CERTIFICATE MUST BL ON F ILL' .WITH .THE BUILDING DEPARTMENT PRIOR TO REQUESTING FINAL. INSPECTION AND SHALL BE POSTED, INA CONSPICUOUS LOCATION WITHIN THE DWELL INC . COUNTY OF BUTTE - DEPA'RTMENT OF PUBLIC WORKSP RMIT N 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 1 APPLICAT)ON-AND PERMIT 1 ASSES OR PARC L UMBERZONI G .� BUILDING PERMIT OWN'ER— TELEPHONE `J ✓4075110 SQ. FT. OCC. BUILDING VALUATION OWNER I ING ADDR 5 U / p CONTRACTOR'SNAME TELEPHONE CONTRACTOR'S MAILING ADDRESS ' Fireplace d CONSTRUCTION LENDER UNKNOWN Total Valu On $ (' Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ 5140 p ARCHITECT OR ENGINEER 41119 LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS � Permit fee $ BUILDIN A RESS 15iQ% _ f,, PLUMBING PERMIT Filing Fee 10.00 ' / Each Trap 2.00 Qp Repair drainage or vent piping 5.00 Water piping SGS LOT NO. SUBDIVISION NAME PARCEL MAP// J'� -.`9W Each qas water heater Or vent 5.00 Gas piping system 1 - 5 outlets ,--,/ USE OF STRUCTURE SF Ltd' Duplex❑ Mobilehome❑ Other SPECIFY Building sewer `00 Lawn sprinkler system 5.00 TYPE OF WORK New Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe work: Permit Fee $ Contractor QcglVEoe, ELECTRICAL PERMIT Filing Fee 10.00 Main service 8001 OR LESS 100 AMP OR LESS 5.00 OlI Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING O •N� 20 sq ft O OR ADDNS. ACC. BLDG CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification R1 I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR TI-Ou T 2.50 ea NON-RESID BRANCH CIRCUIT S IRC ITS NEW. CONST R. ( POWER APPARATUS .& NON-RESID. SINGLE OUTLET CIR. 5D@250 Ex: Occup(OUTLETS OR FIXTURES BAL Lmt IXED APP LNS, OR Ex. QCCUp.�OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 r G Permit Fee $ Contractor MECHANICAL PERMIT FiIIng Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation Permit Fee 3 Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue again t sat County 'n consequence of the granting of this permit. S^ ���/ %� Date? S n ure of Applica Owner] Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ occu GROUP 3 TYPE OF CONST. PARC L 1'7 1.HD ssuE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRE OR D UBLIC �. By. �L J PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt NO. � WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT OWNER 't"' � lec A. GE- oning requirements _-2! Valuation. Signature by R.C.E. RESIDENTIAL PLAN CHECKING GUIDE (S.F., DUPLEX, & MISC. ONLY) • Bldg. Permit # A.P. # (sideyards and parking). or Architect (if required). B. PLOT PLAN Complete parcel size and dimensions. Setba'ckq; sideyards, easements, etc. Other buildings or structures. _Ac� Grading, fills; drainage. C.. FLOOR PLAN Complete to scale plan with dimensions. Required windows for light and ventilation (Sec. 1405). Required windows for second exit (Sec. 1404). , 9 Allowable glazing for energy requirements (20% max. per.State law). Human impact glass (Sec. 5406). Required room sizes, ceiling heights (Sec. 1407). �Y. G.F.C.I.'s in baths and exterior outlets (Sec. 210-8). Light fixtures, switches, receptacles, and exterior receptacles for maintenance of mechanical equipment. 9. Locations of water heater, heating & cooling equipment, other electrical or gas equipment, and plumbing fixtures. Garage firewall, door size, and -closer (Sec. 503(d)(4))., 1 - 3'0'.' exterior exit door (Sec. 3303d). Fireplace location. 3� Smoke detectors (Sec. 1413). D. STRUCTURAL DETAILS Foundation plan complete enough to construct building. 2-1"Floor construction details complete enough to -construct building. ,1! Elevations and wall construction details complete enough to construct building. ,4 --"Roof construction details complete enough to construct building. Fireplace construction details and calcs if over one-story in height.. Sufficient data and details to satisfy energy insulation requirements (State law). E. MISCELLANEOUS ITEMS TO LOOK OUT FOR .� CCX plywood on exposed locations and overhangs. Stairway details (Sec. 3305). .3:r Guardrail details (Sec. 1716). 1 Brick or stone veneer (Chapter 30). �Exterior plaster - weep screeds (Sec. 4706 & 4708). Proper roof pitch for roof covering (Chapter 32). Rafter ties or bearing ridge beam. Garage door or porch header sizes. Adequate bracing. Living area over garage - complete 1 -hour separation required including supporting walls and posts, etc. V. ,2�1� Two (2) exits on three-story,dwellings (Sec. 3302). BUTTE COUNTY f S 1' AGRICULTURAL BUFFER NOTIFICATION AND/OR. UNUSUAL CIRCUMSTANCES REQUEST Butte County requires a 300 foot buffer between neighboring agricultural operations and a residence. This dimension is based on,environmental assessments and studies. The Agricultural Commissioner may identify unusual circumstances where the 300 foot buffer cannot be met on existing parcels. This exception is not available for lots being created, divided or subdivided. Owner or Authorized Agent must complete the following and return with the required site plan to: Development Services Department, 7 County Center Drive; Oroville, CA (530) 538-7601 Name: DAy-� 1-1//V `%Z, Mailing Address: /_'� 6) 1 %f 0 E -Mail address Assessor's Parcel Number: Reason you believe you qualify for the unusual circumstances exception: 10 A -I— e Owner or Authorized Agent's Phone: 15—,3 O — �� 9/? D Wel-4 <�::� 95-1 yz Permit No. Date UNUSUAL CIRCUMSTANCES DEFINITION: An exceptional or extraordinary condition where the existing lot size or shape or an existing_impr-ovem.ent " (well, septic systems, structures a c+d0eTi0T0,0 )r the standard co. dition of a 3 oot buffer zone. 1^ A N SITE PLAN REQUIREM T: su it 4 co i s this form V�JIV Refer to the Site Plan Submi a an o or specific requirements V\3S� ......................................................................................................... u ......._._...... Internal Dept. Contact Info: ❑ Env. Health ❑ Planning ❑ Building ❑ Other Contact Person: Phone: FORWARD THIS FORM TO LARRY IN DEVELOPMENT SERVICES FOR PROCESSING ......................................................................................................................................................................................... For Agricultural Commissioner office use only: (to be completed after submittal ) DISCRETIONARY PERMITS (Planning) MINISTERIAL PERMITS (Building) ❑ Exception Recommended ❑ Exception Granted with the ❑ Exception NOT Recommended following conditions: Reason/Conditions/Specific setbacks from adjacent agricultural operations: Agricultural Department Signature: Date: YMC 7/1/03 q a Assessor's Parcel Number: E ® IN — F31 F(ofl 0 — E � ® Scale: 1" Owner Name %'O. Address / Phone No( Site Location i Contact Name Phone 5"30 - ��- FOR OFFICE USE ONLY Zoning: General Plan Desig: Size, Acres -- 4.0(r PROVIDE FOR ALL ADJACENT PARCELS SIZE (AC): ZONING: GEN PLAN: USES: SITE PLAN Owner Name Address / Phone NoI O Site Location 7 Contact: Name Phone odwW4 M Zoning: SIZE (AC): General Plan Desig: ZONING: Size, Acres GEN PLAN: 4.0(r - USES: R SITE PLAN .. ........ . . ... . ..... . .... ........ . .... . ..... .. ... . ...... ..... ... .. .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... .. .................. .......... ... ..... ... ' ...... . Assessors Parcel Number. Owner Name Address / Phor Site Location ®. EN— v ®®® Scale: 1 °' = o g T Contac: Name Phone 0cwbW MM FOR OFFICE USE ONLY PROVIDE FOR ALL:. Zoning: ADJACENT PARCELS SIZE (AC): General Plan Desig: ZONING: Size, Acres GEN PLAN: 4XV — USES: 4s f SITE PLAN Assessor's Parcel Number: 0 ®� — �} Q Q — ®®® Scale: 1 °' _ —SLO e OFa Owner Name Address / Phor Site Location Contact Name Phone OdW- ,2= Zoning: General Plan Desig: Size, Acres 4.00" PROVIDE FOR ALL ADJACENT PARCELS SIZE (AC): ZONING: GEN PLAN: USES: I a RPR -Z0-2004 09:50R FROM: TO:12097451115 p:2/e 1' 0 1/2" 1 1'-O 112 ..........._._ s ;iT BEAM p0chrr r f V ':rl•FI' WhYNF1111NRA-1ON M•n• 3' BEAR,,* I �� 0 A5 RLID'C). TL_) MAINTAIN ; 1 Q In I rP.O LK i K.U�jI ULI*III I I tY7 U N' Y B'•Ll' i0(JI. QR N0r.K 9TFMWAI;• ' O rt9 RCDAF, Art 16• 0-1: VCFT• (Y7 Q ALTE?.NAnNC HOOKS— ' t B4 RCF]AF- 0 Z•Y' O.C. I I0F:2. 6Y •I ((3) 13/-r X I •1" M.L f IN tLUUN. AbuwNO I* INGLULidu V—, I STORAGE I , / 64' ILl •: J d4z• v IV CVN(,. rnu w/ (J) P4 PLOAF t.w 24•.v In M1,17 f1mc: r(RTIINl: ,I W) 1X 05 CONT. Rft%AR Tom. 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FT. _ APPROVED - — Butte County Emviropm 0qtall alt D e m Signature - n 7 3 o 3 ' 0 •. 3 o SITE PLAN a Assessors Parcel Number R51 X® ® 0 ® — K 0 ® Scale: 1;- ® 5zeo Owner Name7®/W #11Y rd, Address / Phone Nolo 7 -,®/ ©•0 �/ �4�f Site Location Contact Name v<4AI-4F Phone 90�?0 October AM Zoning: General Plan Desig: Size, Acres ' 400" PROVIDE FOR ALL ADJACENT PARCELS SIZE (AC): ZONING: GEN PLAN: USES: t • i e� i 1. Hwy.•+.+ r.r,r....w .wn.+..�.+u; w�.1.WMww+�..rr�r�.riv...,r:..,iw ..w ..._.. ,..r...... w.�....»..�..... r•...... a��.�a��ars+MG-.�I. f 11`j 1 ! P C • i I � I 1 , E } � 1 .� .f1f of Ar.r... w ....� �«.Y MI .A. •`K .A n .....NA *1 V•.s• -a . rM.rtHf r V.o. � �. f ♦� `f rY1