HomeMy WebLinkAbout056-400-008056-400-008 PERMIT#94-1610
BROOKS, WALTER
46 NORTH POINT RD., COHASSET j
NEW DET GARAGE
0
0
TE • DENTIAL
056-400-008 PERMIT#94=1610
BROOKS, WALTER
46 NORTH POINT RD., COHASSET
NEW DET GARAGE
� Z3
JOB FINALED (Date) A:::7/T/Fj_
Signature
J=OK
O = Not OK
= Not Applicable
Not Ready RESIDENTIAL (Single & Duplex)
=
Date UNDERFLOOR (Plans) OK except If
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils -Elea Grnd.-/ /" Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
D. oremwans, main; D[eel-nwcKours-vvrappea
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground
13. Pienums & Ducts; Clearance -Material -Support -Ins.
14. Girders-Sills-Anchor.Bolts-Joists-Vents-Cripples
15. Access & Ventilation
16. Insulation
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit),OK except #'s
16. Water Htr.: Vent -Access -Combustion Air -Baffle
-------------- - ---------------------
----
17. Water Pipe: Test & Anchor -Nail Protection
18. D.W.V.; Test -Fittings & Anchor -Nail Protection
-------- --------- --- ------------------
19. Shower Pan; Test. First Floor -Tub Access
20. Test Tub & Shower, Second Floor -Tub Access
--------------------------- ---------------
-- -----21. Gas Pipe: Size & Anchors
Date - Card B_1 -- Date Card -B- 1
----- ----------------------------------
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except ft's
22. Fixture & Transformer Clearance -Ins. Protection
---------------------- -------- ----------------------------------
-- - - 23. Elec. Receptacles Spacing -Lights & Switches at Doors
- ------- ---- ------------------------------------------
24. Size Boxes & No. of Conductors -Stapled
----------------------------------------------
25. Romex Installed Close to Edge of Studs & C_J.-
26. Equip. Ground made'up w/Mech. Fastners-Bond Gas & Water
--- ---- --------------------------------------------------------------
27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI
-------------------------`-------------------------
28. Subfeed Wire Sizer ga. Cu or AI-A.C. Wire Size ga.
Cu or At
------------ - ------------------- ----- -- ----- ----- - ------------
29. Range Circ. / ga. Cu or AI -Oven Circ. r / ga. Cu or Al.
Insulated Neutral ❑ Yes ❑ No
------------------ ------- ----- --------------
30. Service -Riser Conductors & Ground -Main Disconnect
--------------- - -----------------------------------------
31. Equip Clearances Panels-Motors-Mech. Equip.
- - - ----------- --------------- ---- - ----------
32. Clothes Closet Light -Shower Light -Spa Light
---------------------------------------
33.
---------------------------- 33. Smoke Detector
-- -- ----- ---------------- ---------------------------------------------
Date Card B-1 Date Card B-1
-
------------..---- --- ---------------------------------------------
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except 4's
34. A.C. Ducts Insulation & Support
------- ----- - ---- - ------------------------------------
35. Vent Fan Exhaust above insulation
36. Condensate Drain & Overflow: Size & Grade
37. Furnance-Vent: Access -Comb Air -Return Air Vent -115 outlet
- -- -------------------------------------------- --- -
38. Attic Access & Platform if Furnance in Attic
------------------------------------------------------------ ----------
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except N's
39. Sils. Proper Material & Anchors
------- ------------------------------------------------------------------------
40. Walls Studs -Nailing. Spacing & Bracing -Plates -Sound
--- - - ------------------ ------------------------------------
41. Bearing Walls over Girders & Floor Nailing
--- - - --------------------- - - ------------------
42. Draft Stop in Walls (rat proof)
-- -- - - - - -------- - ---------------- ------------------------
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
------- ---------------------------------------------------
44. Headers & Beam -Size & Bearing
Date FRAMING (Continued)
45. Hangers -Post Caps -Anchors -Connectors
46. Cing. Joist-Rftr. ties -Pu rlin-roof Brac-Truss-Shlhng.-Ring.
47. Fireplace Ties or Type A Flue -Fireplace Throat clearance
48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
---- _--- _ 50. Garage Fire Protection Framing
_ 51. Property Line Firewall & Openings
52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits
------------
53.-
-----------53. _Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
_ _54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
_ --55.-Siding-Nailing Veneer
------------56.-.Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
----- -
57. Glazing Area -Glass Protection -Skylights -Plastic
58. Shear Walls: Nailing -Bolts
---------- ----------------
59. Insulation -Walls -Ceilings
60. Infiltration -Walls -Windows
--------------
Date
Date
Card B-1 Date _ Card B-1
Card B-1 Date Card B-1
Date FINAL (Plans) OK except ti's
61. Ext. Steps -Door & Sidelight Protection -Landings
--- -------------------
62. Smoke Detector
-------------
63. Furnace: Vents -Clearance -Comb. Air -Connector -
In Garage: Above Floor -Ducts -Meth. Protection
---------------
64. Bedroom Exiting
- ------------
-- ---------------------
65. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel: Breaker Sizes & Labels
----------------
- _________ 5T Stairs -& Rails
68. Fireplace or Stove: Clearances -Hearth
- ----------- ---------------------
6J. Elec. Outlets ai Wood Panel: Int. & Ext.
- 70. Kit Fixt_& Appliance: Grnd._Air Gap -Cooking Clearance
71. Elec. Outlets & Receptacles at Kit. Counter
72. Garage Fire Door_
------- ------Swing-Landing-Closer
73 -.A. -C. -Duct
- Duct in -Garage-Damper
-------------------- ----
74. Wir. Htr.: Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage: Above Floor-Mech. Protection
75. Plb. Elec. & Mech.Equip. Listed for Location
------------------------------- ---- _ )
76. Elec. Receptacles in Garage: ((G.F.I.)-Romex Protection
7;. Insulation -Foam -Looked in Attic ❑ Yes
-----------------------------------
-------------
---------------------------------
78. Guard Rails & Deck Construction -Post Caps
79. Fdn Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
80. Following instld.'Drive ❑ Yes ❑ No; Walks ❑ Yes 11 No:
Planters ❑ Yes ❑ No ----
81. Stucco: Brown -Finish
------------------------------------------
82.
---------- ------------------------82. A.C. Unit: Disconnect. Electrical, Plumbing
- --------------- ' -- p --
83. Vents Above Roof: Plb9 APP liance-Fire lace. -Clearance to
Openings
.... ------------------------------- -
84. Water Well: Disconnect, Electrical, Plumbing
85. Exterior Elec. Trim: G.F.I. Receptacle -Underground
---------------- --------- ----
86. Ventilation Throughout House
.. ... - --- -------------------------------
87. Glass Protection
--- ------------------------------------------
88. Corrections from Previous Inspections
.. --- -------------------------------- ---------------------
89. Gas Test -Meters Tagged: Gas -Electric
. ....... - ... - - -----------------
90.
----------------90. Water & Sewer Connected -C/O to Grade -HD Approval
- ---- - ------------------------- ----- -
91. Energy Compliance Certificate -Other Certificates
Date Card B-1
Date - Card -B-1 -
------ ----------------------
Date Card B-1
Comments at Final:
Date Card B-1
Date Card B-1
Date Card B-1
J=OK
O = Not OK
�= Not Applicable
' = Not Ready MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
8. Utility Clearance
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O Concrete
_ Card B-1 Date Card B-1
4. Water; Location -Test -Easement Needed (Sketch)
Card B-1 Date Card B-1
5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
MOBILE HOME INSTALLATION (Plans) OK except #'s
6. Gas; Location -Test -Wrap: / P'U ft.
/ /"Nat. or/ /"L"ft./ /"LPG
0
I*
MISCELLANEOUS
Date DEC S, COVERS, CARPORTS, GARAGES, (Plans)OK except 's
ing Requirements -Setbacks -Easements is
Q. Footings; Soils -Size -Depth -Spacing -Connectors el
3. Decks; Griders and/or Joists -Decking -Bracing -St -..-
4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; indows-Doors
7. Elect -roll,'
Sils-Anchors-Studs-Rftrs-Trusses
n ; Nailing -Veneer -Stucco -Mesh
-,Shthg-Roofing
. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
_ Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card 13-1 Date Card B-1
7. Well Clearance & Disconnect
8. Utility Clearance
Date
_ Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks Easements
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
0
I*
MISCELLANEOUS
Date DEC S, COVERS, CARPORTS, GARAGES, (Plans)OK except 's
ing Requirements -Setbacks -Easements is
Q. Footings; Soils -Size -Depth -Spacing -Connectors el
3. Decks; Griders and/or Joists -Decking -Bracing -St -..-
4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; indows-Doors
7. Elect -roll,'
Sils-Anchors-Studs-Rftrs-Trusses
n ; Nailing -Veneer -Stucco -Mesh
-,Shthg-Roofing
. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
_ Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card 13-1 Date Card B-1
�J COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
• - 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 n`; /PERMIT NO.
APPLICATIOJII AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
46 NORTH PT RD, CH1120 915926
CONTRACTOR'S NAME
nLUER
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $ 20,00
Permit Fee $ 265.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $ 172.25
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
46 NORTH PT RD COHASSET
PERMIT FEE $ 457.25
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent 15.00
USE OF STRUCTURE
SF ❑ Duplex C)Mobilehome LlOther DETACHED GARAGE
SPECIFY
Gas piping system 1 5 outlets 15.00
Building sewer 15.00
Mobile Home S G I W @20.00
TYPE OF WORK
NewXO Addition ❑ Remodel ❑ Utilities LlInstallation ElOther O
Describe Work: 30 X 50
PERMIT FEE $
Contractor
ELECTRICAL PERMIT Filing Fee 20.00
Main Service ( 600V OR LESS ) 23.00
200A OR LESS
Main Service ( 200A TO 1000A ) 46.00
NEW CONS:. DWELLING OCCUP. SQ.
ORADDNS. ( & ACC. BLDS. ) 3.50 FT._
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
(cense No. Classification
&1 as the owner, 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)
❑ 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ I am exempt under Sec. Business and Professions Code
forthis reason
NEWCONST. MULTI.OUTLET
•NON-RESID. ( BRANCH CIRCUITS ) @7.50
( POWER APPARATUS )
8 SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES) 20 @ 1.00
BAL. .50
Ex. Occup.FIXED ATS (RESIDPPWS. .) R OR
() 5.00
OUTLE
Temporary Service I 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
certificate of Consent to Self -insure.
shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
Contractor
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood ' 6.50
Ventilation
PERMIT FEE $
Contractor
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California 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.
1 also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
County in consequence of the granting of this permit.
X 4',1J7� Date
Signature of Applicant Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5"0" a and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $
HAz „ra€s
IMP
I FL00D
' CDF PARCEL PO
/
I HD LISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
ByDate
PERMIT EXPIRES ON
IDetel
ReceiptNo. 162933-192.25//
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENRO -APPLICANT
COUNTY OF BUTTE
BUILDING DIVISION ..`�
DEPARTMENT OF DEVELOPMENT SERVICES
1469 Humboldt Road, Chico, CA - (916) 891=2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-63.47,.
CORRECTION NOTICE .y '*
OWNER PERMIT NO.
A routine inspectiopindicates that the following violations of Butte County Ordinances exist at M-'<
the ab a address and should be corrected. Please notify this office when correction of work
is co leted. If you have any questions pertaining to this matter, or need additional explanation, s
plea a contact this office immediately.
JOQ
uta l6etl - k rAL .
-
_4
N..
1
t :tom
3 . rr
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
F. H. USE, ONLY
I'lot Plan Attached
fluor flan AUaehed
Sent to B.D.
f`
tW &k -F,049 f < s its po% -m R,� V06 - 008
Owner Location AP#
Approved for: Sewage Disposal Water Supply: Public Private Well
Cl ranee for bedroom mobile home. Other rTi� .SI k Pee 6y 2�r GT�9 P.
Hol�'a final for:
Fi:x'tl clearance O.K. for:
NTE: I&V
vironm tal Health S ecialist Date
8/92
iiV�gy��+� 4V �• W 'FI"" �br -m.r.rxY%+� r q Irin*I'7�.'�"q'.TiWYzaWrp,+ai K irAFt7ii"S�+`y` ��^4J "'+ 'y
1 // t�.ti �y'i{jsn pf :%✓T�''DY4''%'sl�ItNV'rt'.r,4
�Y 1
COU NTYOF BUTTE - DEPARTMENT OF DEVELOPMENTSERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE,.CALIFORNIA95965 -TELEPHONE (916) 538-7541
t.
PERMIT APPLICATION DATA SHEET ci
OWNER dt/ 04�AI`nn& A. P. No.
Proposed Building Use _ aor -9 Building Inspector Date -
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1 •
All items have been submitted....x.I.....................................
2.
Plot plans, 3/4 sets, signed by preparer of plans. ......................... .
3.
Complete plans, 3/4 sets, signed by preparei of plans. .... ................ .
4.
Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5.
Hazardous Material Form. ..........1 ...........4 .................... .
6.
Energy Design Compliance and supporting documentation . ................. .
` 7.
Statement of Intent for Non -Heated and A/C Buildings.
8.
Engineered truss details and layout in duplicate (required prior to plan check). ... .
Mo A ehomjda a d manyfacturer's installation instructions, 2 sets. ...........
Feesof $ G ..........................................
Impact fees as shown on attached schedule. . .
Y 1
California Department of Forestry plan approval ees <'??-,/�%.
Flood elevation letter (100 year flood) y California ngineer. ............... .
Sanitation and plot plan approval l C Q Health Department . ............
City of Chico plumbing permit . ........................................ .
" 16.
• Plot plan and business license approval from City of Biggs/Gridley. .............
�_- 17.
Planning approval for (A) Use: (B) Parking: ........ '
18.
Contact Land Development about (A) Improvements (B) Drainage. ...........
19.
Driveway permit (construction approval required prior to occupancy). ..• -6 .
20.
Pre -Inspect r
ion requ�
Pre -inspection for required. . to Building inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ......................... .
23. Owner -Builder Verification (Given to owner , Mail to owner ........... .
24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . ........................................
opy of recorded deed of parcel creation and 60 right of way to a public road. .... .
:AALetter of intent on building use . .........................................
28. Mobilehome utility clearance . ......................................... .
29. Documentation of legal access . ..................... :..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
34.
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone3� c�"j4*744( and hold for pickup ate- ffirO office. Deliver with inspector.
Other
Parcel Creation '� G
Acreage Applicant "ZDate
Copy of Haz-Mat form sent Health Dept. Fire Dept. ,Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted p iermi .is ua ce: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by ./phone _ mail Counter by k6ate
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counfer by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
COUNTY OF BUTTE
Department of Development Services
Building_Division
Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541
Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signature.
Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and
issuing your building permit. No building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement
(yess1or no)
2. I (have/have not) 1 ff a (/,E 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 work:
Name
Address' City
Phone Contractor's License No.
5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated:
Name Address . Phone Type of Work
Signed: '
Property Owner 1414
Social Security Number _
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California
Health and Safety Code. '
This'verification must be completed and returned to our office before we are permitted to issue the
permit.
0
r
C/ 5F �A f"5 ' file, z i /�/"v 4
APPROVED
�anenta� Health
c4uo ?.Y If 4 Ma
sed garage
existing mobile home
exi,3ting septic 5y5tern -
MIN.. 50'
1
FLOOR PIAN
270'
existing well
existing storage shed
j
69'
.......
27 0'
I
ENVIRONMENTAL HEALTH
JUN 0 8 1994
nu1H