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58-17-75 - ERNEST & OLEVIA KINSEY 4001 Deadwood Rd, lot 88,, ORoville ContR: Franks MH Ser Permit#2628-88P,E(MH) 440 ELEC .� GAS pjy� SUPPORT- STRUCTURE _ REQ.. . v _ COMPACTION TEST REQ. '"• 58-17-75 Permit#2791-88B(new deck/MH) r 58-17,-75 Permit#1787-91MHI (mh install) 58-17-75 Permit#257 - 1P (gas line/mh) -70 w R': -0 i 58-17-75 - ERNEST & OLEVIA KINSEY 4001 Deadwood Rd, lot 88,, ORoville ContR: Franks MH Ser Permit#2628-88P,E(MH) 440 ELEC .� GAS pjy� SUPPORT- STRUCTURE _ REQ.. . v _ COMPACTION TEST REQ. '"• 58-17-75 Permit#2791-88B(new deck/MH) r 58-17,-75 Permit#1787-91MHI (mh install) 58-17-75 Permit#257 - 1P (gas line/mh) -70 w R': -0 7 'PERMIT NO. 2628-88P,E(MH) ' PERMIT EXPIRES x �r EARNEST & OLEVIA KINSEY OWNER Franks MH CONTR. ASSESSOR PARCEL 58-17-75 LOCATION 4001 Deadwood Rd, lot 8, Oroville f OFFICE COPY Address f 1 N� meq— Date ELECTRIC Meter By Date t Temp. Gas Sen Called PGA JOB FINALED Signature = OK , 0, Not OK = Not Readyable MOBILE HOMES Date MO E HOME UTILITIES (Plans) OK except #'s f Moping Requirements -Setbacks -Easements oil pecial MH Support -Sketch V49—r; Location -Test -fall -C/O -Concrete ater; Location- -Easement Needed (Sketch) lectricity; Location-Clearances-Grnd. dAmp-Concrete — rGe-Eeeation-Test-Wrap: / /"L"ft. / ,P'Nat. or/• /"L"ft./ /"LPG tility Clearance Card -131j7' Datf—j,�%A Card -131 Date Card -B1 Da — Card -B1 Date Date M0_010EHOME INSTALLATION (Plans) OK except #'s Zo ing Requirements -Setbacks -Easements r ootings; Size -Spacing -Marriage Line M est emand-Valve-Con ector oltlectricit!F—MI-I Test -Crossovers -Breakers -Clearances rai ; H Test -Fall -F onnector „ater; MH Test -Regulator -Connector Water and Sewer Connected -C/O to Grade -HD Approval 46-6as-aad Electricity Tagged xits; Insp.-Sketch 0.9<ert. of Occuoancv Card -131 J - Date 7&g&Card-61 Date Card -B1 Date �� Card -131 Date -2-7 2Z $ �l 0 MISCELLANEOUS . Date DECKS,COVERS,CARPORTS, GARAGES, (Plans)OK excepS-#'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Bea ms-Rftrs.-Connec.- Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Elec. 8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Card -131 Date Card -131 Date Card -131 Date Card -131 Date 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 Card -B1 Date Card -61 Date Card -B1 Date Card -131 Date = OK = Not OK RESIDENTIAL (Single and Duplex) - = Not A "cable = Not Ready UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks; -Easements -Flood -Slope 2. Fig., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils -Steel-/ /" Fig. Depth 4. Fig., Porches & Decks; Soils -Steel-/ /"Ftg. Depth 5. Stemwalls, Main; Steel- Blockouts-Wrapped 6. Stemwalls, Garage; Steel- Blockouts-Wrapped 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test 10. Gas Pipe; Size -Anchors 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance- Material -Su pprt-Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Insulation Card -B1 Date Card -B1 Date Card -81 Date Card -131 Date Date PLUMBING (Permit) OK except #'s 16. Water Ht. Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchors -Nail Protection 18. D.W.V.; Test-Fttngs & Anchors -Nail Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, 2nd Floor -Tub Access 21. Gas Pipe; Size & Anchors Card -B1 Date Card -B1 Date Card -131 Date Card -B1 Date Date ELECTRICAL (Permit) OK except #'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. Fasteners -Bond Gas & Water 27. 2 Appliance Circuts in Kitchen & Conductor Size/G.F.I. 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga. Cu or Al 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / 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. Smoke Detector Card -131 Date Card -B1 Date Card -B1 Date Card -131 Date Date MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support 35. Vent Fan; Exhaust above insulation 36. Condensate Drain & Overflow; Size & Grade 37. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet 38. Attic Access & Platform if Furnace in Attic Card -61 Date Card -B1 Date Card -131 Date Card -Bi Date Date FRAMING (Plans) OK except #'s 39. Sills, 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. Header & Beam -Size & Bearing Date FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. 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. 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-Clg. 60. Infiltration-Walls-Wndws Card -B1 Date Card -B1 Date Card -B1 Date Card -B1 Date Date FINAL (Plans) OK except #'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 67. Stairs & Rails 68. Fireplace or Stove: Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance 71: Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door; Swing -Landing -Closer 73. A.C. Duct in Garage -Damper 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 75. Plb., Elec. & Mech. Equip. Listed for Location 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 77. 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 ❑ No; Planters ❑ Yes ❑ No 81. Stucco; Brown -Finish 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg.-Appliance-Firepl.-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 Inpections 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates 92. Roofing Certificate Card -B1 Date Card -B1 Date Card -131 Date Card -61 Date Card -B1 Date Card -B1 Date Comments at Final: (NOTE: An entry must be made each time you visit job site) MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965 — TELEPHONE: (916) 538-7541 PERMIT NO./ 73�1�7- 1 Address or location of mobilehommee ��U.©% -,D n e.), ad t ,/ Owner's name Owner's address Insignia or hud number 27 2-2-8 7— 7 z 2 2 Manufacturer's name_ �7 / l Serial number of V.I.N. S6 52 6 `,X Year of manufacture �— pproving Installation IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOINILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. rY --^^i .ti �."7-"t.�-•�4 Y.,c*—�i.�-^'�—^ .phi Ly' f v COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 ' 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE OWNER NO. A routine ingpection 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. Inspector f�/y� Date ,.r - .c "M`i ++,i•�ti- '� :�;i�;, �,� pl; :;;n'�`,;'�: *�' s'44 a'�+ ssL "meq-"`wer"ry`� COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE A routine inspection exist at the above when correction of matter, or need addi U — ER IT NO. tej'- that the following violations of County Ordinance and should be corrected. Please notify this office mpleted. If you have any question pertaining to this ,planation, please contact this office immediately. F 1 l, 7 Date Inspector �. a3ll •v" _.i_"� -r, �vf�"P.'' iei U'Rn QO s_ aeax:'�+'AM`� . ;..7`.'.x.!,MMMOAK COUNTY OF BUTTE a DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE, OWNHR PERMIT N0. t 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 have an you If completed. p y y question pertaining to this matter, orr�need additional explanation, please contact this office immediately. 1 G1— PT �a i �S a, nom! . ej ^--- - xi �t r Date Inspector COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive • Orovllle, California 95P,65 • Telephone: 916/538.7541 _ .4 APPLICATION AND PERMIT ASSESSOR PARCEL NU B R 58-17-75 ZONING BUILDING PERMIT OWNER Ear est534 TELEPHONE 1-44 SO. FT. •.00C. BUILDING VAL ATI - OWNER'S MAILING ADD ESS - CONTRAC TOR'S,NAME Ownpr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is ' Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 15.00 ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee Energy Plan Checking Fee E$. $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $25.00 PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome® Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation® Other ❑ Describe work: MHT BCQeCQ Y► RE: B.P. #2628-88 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 10OV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 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, 1, 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 CONST. DWELLING OCCUP.6 OR ACDNS. ACC. BLDGS. ,/z¢sgft TLET NEW CONSTRESID, NCH CIRCUITS) NO N•R RES BRANCH CIRC ITS 2,50 ea (POWER APPARATUS e) SINGLE OUTLET CIR. / Ex. OCCup\OUTLETS OR FIXTURES 20050t IsALO 3o FIXED APPLNS. OR Ex. OCCUp. OUTLETS (RESID.) EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Iyirin 9 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 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. y7j 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation - F-77 Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyof 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, cos s, and expenses which may in any way accrue agai ai ounty iMcuence of the granting of this permit.This �� Date Signature of Applicant - Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee _$45,00 Energy Inspection Fee $ occ CONST TYPE TOTAL FEE .$ 70.00 HAL.CUA• PARK SC FLD _ CDF _ PAR PD I HD. J.. ISSUE permit permit is hereby issued unser the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS o By Date 6,1d PE T EXPIRES Date �` Receipt No. 93877/$70.00 WHITE-O.P.W... YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT �j-.,..:� .ter .. ... , ,...yYy7..•^yhr-tiT"T.� .:e"Y�.Y✓ hr.y.. ,... i"rr '4.v.�C�'i��'R'�-";vri'S4a":.5 _ ��'+yc + ,.. ,r COUNTY OF BUTTE -DEPARTMENT OF P'WORKS -BUILDING DIVISION COUNTY CfEYN,TER DRIVE-�OR( ,VJLL', CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMITAPPLICATION Q DATA SHEET Permit No. OWNER A. P. No. SS—l;7 Proposed Building Use s/�l 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 APPROVED 1. All items have been submitted. .......... 2. Plot plans in duplicate/triplicate, signed by preparer of plans ........ 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans . . 5. -Hazardous Material Form .................... " < , s is 6. Energy Design Compliance and'supporting documentation ...... '� 7. Statement of Intent for Non -Heated and AC Buildings 8. Engineered truss details and layout in duplicate (required prior to plan check) _ 9. Mobilehome installation data including manufacturer's installation instructions........... .......... ....................... (o 10. Fees of $ ' ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid — 13• O �V; ool District fees paid ............. . 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) 21. -Contractor's license information (No., Name Style, Classifications ... 22: Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... 26. 27. When you issue the permit, process as follows:Mail to owner. Mail to contractor. _Telephone S 3l/'����fand hold for pickup at 6 office. Deliver w/inspector. Other (rc✓� Applican Date_ L_-1 Copy of Haz-Mat form sent Health Dept. Fire Dept. ----Air Pollution Date Copy of plans sent Health Dept. Fire Dept. r- Other Date By The following data must be submitted 'riot ermit issuance: (Circle new item Inot checked above). 1. Index permit for above items No., 2. Additional items required: ' Contractor, designer, owner, was advised of above required data by_phone--inail—counter by Contractor, designer, owner, was advised of above required data by—phone—mall counter b 4 P ns checked by OW Date _Plans approved by Sets of plans on hold in File cabinet AP folder Copy—DPW ..date date Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBERZONING _ BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION re4 2rV.95 r` ./�n1 s e 6-/ 3i-//4/ M LEPHONE Butte to enter upon the above-mentioned property for inspection purposes. TOTAL FEE $ ICI I also agree to save, indemnify and keep harmless the County of Butte against HAL. I CUA PARK SCHLFLD CDF J PAR PO I HD. IssuE all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. This permit is hereby issued unser the applicable provi- X Date sions of the Butte County. Code and/or resolutions to do Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ work indicated above for which fees have been paid. An OSHApermit is required for excavations over 5'0" deep and demolition or construct- DIRECTOR OF PUBLIC WORKS ion of structures over 3 stories in h 'ght. Receipt No. 977 By WHITE-D.P.W.. YELLOW-ASeE750R. PINK -INSPECTOR. GOLDENROD -APPLICANT PERMIT EXPIRES Date. Date CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER,1 / ` ^ UNKNOWN Total Valuation Is Filing Fee - $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS�Q �O Q 'Di04W Permit fee $ PLUMBING PERMIT Filing Fee 10.00 501 ad Each Trap 1 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIvISION NAME PARCEL MAP Water piping 5.00 Each gas water heater or vent 5.00 USE OF STRUCTURE SF [I Duplex `MobilehomOther- - - SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home Is G W O.00ea . TYPE OF WORK New ❑ Addition RM,Utilitie-7..--4rrstallatiozother ❑ Describe -work: GKLl 1/y/Contractor �102C5?-80 Permit Fee $ ELECTRICAL PERMIT Filing Fee 10.00 OR Main service 6100OV AMP ORSLESS 10.00 Main service EA. ADD -L 100 AMP 2.50 - " - . • CONTRACTORS LICENSE LAW _ _ _ _ __ ... I declare under penalty of perjury (ch ❑ 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.FIXE ❑ 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) ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason oCCUP.N) OR Ih¢sgft ADDNS. ACC. BLDGS. I NEW CONST. ( DWELLINGone): NEW CONST CONSTR.UL LOUT LET N -s ESID BRANCH CIRC ITS 2.50 ea - POWER APPARATUS a SINGLE OUTLET CIR. ( FIXTURES At° Ex. OCCUp\OUTLETS OR FIBAL&30 0 EX. OCCUp. OUTLETS P(RESID IRE A.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor 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. ❑ t 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 withtsuch provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. 1 agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Mobile Home Installation Fee $ Energy Inspection Fee $ _ occ CONST TYPE Butte to enter upon the above-mentioned property for inspection purposes. TOTAL FEE $ ICI I also agree to save, indemnify and keep harmless the County of Butte against HAL. I CUA PARK SCHLFLD CDF J PAR PO I HD. IssuE all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. This permit is hereby issued unser the applicable provi- X Date sions of the Butte County. Code and/or resolutions to do Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ work indicated above for which fees have been paid. An OSHApermit is required for excavations over 5'0" deep and demolition or construct- DIRECTOR OF PUBLIC WORKS ion of structures over 3 stories in h 'ght. Receipt No. 977 By WHITE-D.P.W.. YELLOW-ASeE750R. PINK -INSPECTOR. GOLDENROD -APPLICANT PERMIT EXPIRES Date. Date COUNTY OF BUTTE.- Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) r' I (have/have not) signed an application for a building permit for the proposed work. 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 this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name 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 Signed: Property Owner 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 per- mitted to issue the permit. -�i �. y�:.'t'*w'r,. ,. ^f:+ 7'"'�'^� 9'j�. rpt f'-'"'."4: �+r`""'�`o� �'t.•Q' � t,�n„T-.�,,"�i"..,f �'✓''`1' '-;�. ::.mbn^'.'.,, '+Y`+"T 1�.'.:�:..5,,//,,.q. ,,.,,.:�!` BUTTE COUNTY SCHOOLS DEVELOPMENT FEE`CERTIFICATION FORM ^�, n, / 0-0�7�'ne Form ,aper Building) ,i//© — h� A.P. Number /-�7-75' ;Buildin.g De artment No. CJ .S� P School Districto Klp OA R Cj City F-1 County -jurisdiction Property f Owner A f -AV _6 - 1'0 L I V I A- ik /A) SE�-1 Project Location/Address0o Subdivision Lot Number Residential : Develo ment p a Sq. Footage 00 # of Living MHI Addition (Group R) Units Commercial/Industrial: Building D,dpart New t Representative Sq. Footage Addition (Including Exterior Roofed Areas) Dtate ******************************************************************* 1 t ;(Floor�Plans,reviewed by School District. Personnel) District Id No. 9102 4 } I�OYAu "L�t�1'XJ f�/`(JSchoo1 District certifies that (A licdnt Name) L ~" (Phone Number) F (Street Address) (City) W (State) (Zip Code) t has complied with the requirements of Resolution No. IA::5--fO /t by the payment of $ �(p d representing square feet. School Di{tridt Re�.e entative Date PAID BY CHECK NO:• " REMARKS: ] A BANK NO PAID -BY CASH { • ,white -applicant, ye,,11 w-bui.lding department, pink -school district SCHOOL . FEE 1(8/8&) _ ', tom., . - - -� ....__ � . ,�• _ BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 538-7541. MOBILEHOME INSTALLATION SHEET 1. Owner's Name: 2. Installer's Name C? 0 yl e, V- 3. Is the site currently under permit? Yes No a (If yes, furnish permit number ) OR Is.the site an existing site? . Yes No [—] (If yes, furnish two plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? -------------- (in.) 10. What is the type of gas service? ------------------- Natural LPG 11. What is the gas pipe length from meter or tank to the �l mobilehome?--------------------------------------------- T� (ft.) * 12: What is the mobilehome gas demand? ---------------------- (BTU) *(This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) ING DEPARTME (If no, clarify a 5. What is the mobilehome electrical rating? --------------- /00 Amps 6. What is the mobilehome site service rating? ------------- o� 690 Amps 7. What is the mobilehome site circuit breaker rating? ----- /00 Amps 8. Is there any other electric load to be served by the mobilehome site service? -------------------------------- Yes No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? -------------- (in.) 10. What is the type of gas service? ------------------- Natural LPG 11. What is the gas pipe length from meter or tank to the �l mobilehome?--------------------------------------------- T� (ft.) * 12: What is the mobilehome gas demand? ---------------------- (BTU) *(This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) ING DEPARTME MOBILEROME SUPPORT DATA If other than single wide, Mobilehome Mfr. 01'VIP furnish Setup Model No. % �� Year j Width dD (ft.) Box Length `-/O (ft.) Tagalong or Expando Size ft. x ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). FOOTINGS (check one)x 1. Wood -pressure treated or foundation grade.0 2. Other (specify) SUPPORTS (check one) 1. Concrete block.a 2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE Line 1 Piers: Size -Min. ------------ Spacing -Max. --------- , From Ends -Max- ------- Line 2 Piers: Size -Min ------------- Spacing-Max - ------------Spacing-Max---------- From Ends -Max .------- Line 1 Openings Size -Min- ------------------ Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wall Only) Size -Min .------------------ Spacing -Max.--------------- From Ends -Max -------------- Line 3 Roof Loads: ` x 30 ` Q 1 � toC. r• o r a r f n ®` Size-Min.------------ "x1.1�, "x "x .1Location (From Front) Line 4 Piers: Size -Min .------------ Spacing -Max.--------- From Ends -Max .------- Line 5 Roof Loads: Size -Min .------------ Location (From Front) e 5 Piers: (Under Bearing Walls Unly) Size -Min .------------------ Spacing -Max.--------------- From Ends -Max -------------- 'D COUNTY OF BUTTE -'DEPARTMENT OF PUBLIC WORKS P RMIT N 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-754�� APPLICATIOWAND PERMIT ASSESSOR PARCEL NUMBER S -k- 17- 57 ZONING 1 F e IU BUILDING PERMIT OWNER e -u � 4,, K' 76 ITELEPHONE y Q SQA FT. OCC. BUILDING VALUATION OWEMAILI G ADDRESS O ! S a u' C.-NTR:A CTOR'S NAME Yei v'cge 3)o7u TELEPHONE NTRACTOR S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee - E 00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS '= QO Permit fee `' = 00 PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Odv� Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME ora I PARCEL MAP I Water piping 5.00 Each qas water heater or vent 5,00 USE OF STRUCTURE SF ❑ Duplex[] MobilehomOther SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer, 5.00 Mobile Home S G W 0.00 aj AO TYPE OF WORK New❑ Addition[:] Remodel[:] .Utilitiesx Installation❑ Other [:1 Describe work: r `RA P - Amu -. —� Permit Fee SLVJ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service GOOV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADO'L 100 AMP 2.50 ` O CONTRACTORS LICENSE LAW 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 ❑ 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 CONST. DWELLING OCCUP.N , OR ADDNS. ( ACC. BLDGS. 20sgit NEW CONSTR. I.OUTLET '2,50 ea NON.RESIO .BRA C CIRCUIT S POWER APPARATUS 6 " SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES .20@030 Ex. OCCUp. OUT ETS FIXED APP(RESID IRE A.) 2.00 Temporary service 10.00 orf 17 Mobile Home Facilities 15.00 Misc. Wiring 15.00 g IFQU Permit Fee $ 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. IM I shall not employ any person in any manner so as to become subject A 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee ; Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnif and keep harmless the County of Butte against all liab' ities, judgments, co is. and expenses which may in any way accrueJPJ agai a' Co my in c n quence of the granting of this permit. X s Date 7l�- 1�-- �� Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excaUtions., over 5'0" deep and demolition or construct- ion of structures over 3 stories in heigghht. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE OcCUP. CON ST.TI PC school PAR PD NO 1 9UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which ECT R OF ELIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. c �U 6 WHITE-O.P.W.. TELLOW-ASOCSSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF,PUBLIC WORKS - BUILDING DIVISION 4 „ , . ., 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNI095965"TELEPHONE: 916/538-7541 ' a. .: ,AD PERMIT�APPLICATIOTwN ' `DATA SHEET Permit No. OWNERE6-rNeS_�--t blev,c- K,-Ns;t!q A. P. No. Proposed Building Use tl'ti u ' Building Inspector L Date At time of permit application, I was advised fhe following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED All items_h a be n s ®rl- '". —X 2. Plot plans i�c licat ne b� a rer o ans.' 3. Complete plans in duplicate/triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . , . . 6. School District ''Fees Paid" Stamp on Floor Plan. 7 Statement of Intent for Non -Heated and AC Buildings, 8. Fees of $ . . . , . . . . 9. Letter of signature authorization. . . . M1"0. Sanitation approval froo— _ Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. 13. Contractor's License Information (no., name style, classif.) _14, Owner -Builder Verification (Given to owner❑, Mail to owner ❑ ) 15. Improvements may be required. . . . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . . . 17. Pre -Inspection for—,----.. -.. .._ _- _ Re uired, Pre-Inspec. request to (Date) . p q 8 i ing Inspector Recorded copy of Agricultural Acknowledgment Statement. 9 �Ja��� 9. Driveway Permit. 20. Plot plan approval from city of _- 21. — — 22.When you issue the permit, process as follows: Mail to owner; Mail to contractor_ Telephone and hold for pickup at -off ice, Deliver w/inspector. Other _ AppIica� Date ✓ Copy of plans sent Health Dept.; Fire Dept., Other Date The following data must be submitted prio�jo permit issuance: (Circle new item not checked above). 1. Index permit for above items No. v _ 2. Additional items required: Contractor, designer, owner, was advised of above required data by—phone---naiI—counter by date Contractor, designer, owner, was advised c? above required data by—phone—mail—counter by date Plans checked by Sets of plans on hold„ in t" Copy—DPW 1� Date Plans approved by SS— DatefF-oZ-�� File cabinet AP folder TO Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner, Location AP# Plan Approved for: Sewage Disposal _� Water Supply/ Hold final for: Water Supply Final clearance O.R. for: Water Supply Clearance for -_ bedroo mobile ome. Other NOTE *** Sanitarian F Da TO: Building Department FROM: Encroachment Permit Section RE: Driveway Clearance 41,aZ to;--ey owner locution AP Driveway permit ��� ��l has been issued for the above property. 6 9 Ci / si ature �' "': ,.► date16'-9 J COUNTY OF BUTTE -.DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA 95965 PHONE: 916-538-7541. Olevia Kinsey P.O. Box -1532 VacavilleV CA 95696 With reference to the above subject: " Attached is: DATE A11Q,1.Qt 93, 1988 RE: Building Permit Application #1987-88 A.P. # 58-17-75 lot 8 Application for permit Mobilehome Utilities Installation Sheet Building Plans Mbbilehome Installation Information Sheet Engr. Calcs Typical Plan Sheet Owner -Builder Verification Form List of Codes Enforced OTHER X We need the following information: Permit application signed and completed where indicated with all copies returned. Fees of $ payable to Butte County Treasurer. Certificate of Workmen's Compensation Insurance or check exemption statement. Contractor's License Law information or check exemption statement. Complete plans in , including plot plans. X Plot plans in __ctriglica Structural details in .Complete plans and calcs in by registered engineer or architect. .Energy design including Street and drainage improvement plan approval from Land Development Section (DPW). sets of plans in accordance with the changes marked in red. Sanitation approval from Butte County Health Department at: 196 Memorial Way, Chico 7 County Center Dr., Oroville Skyway & Elliott Rd., Paradise Planning approval from Butte County Planning Department, 7 County Center Drive, Oroville, for Completed Owner -Builder Verification form. Recorded copy of deed showing Recorded copy of agricultural acknowledgement statement. X OTHER We need plot plans which show the entire parcel - in a subdivision which requires buildings to be within 3 The plot plans which you submitted show your trallPr %nn rectity that on your new plot plans. We need three copies of this new plot elan. 1-nanx you. Should you have any questions concerning the above, please contact this office. JFG/aj Yours very truly, William Cheff Director of Public Works .F. Glander Chief Building Inspector Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR R1S.T.DBNTTAL DEVELOPMENT_ Sc.cLion• 26-8.1 of. the BuLte County Code, ` requires Lhi.s acknowledgement be recorded prior to issuance of a building permit. ' The 88-027765 ; R e c Fee 5.00 property described herein is adjacent ; Cash 5.00 to land or :included within an area zoned ` Recorded ; for agr:i.cu.I.Lural purposes, and residents Official Records ; of Lhis property may be subject to :incon- County of ; PARTY veni.ences or discomfort arising from the Butte SHOWN ; usC.' of agricultural chemicals, including, Candace J. Grubbs ; but not IirniLed to herbicides, pesticides, Recorder ; and fcrL.i.l.-izer.s; and from the pursuit 1:47pm 22 -Aug -88 ; BG 1 ofagr.iculLural operations including,' but noL limited to cultivation, plowing, spraying, pruning, and harvesting which occasional.ly'-generate dust, Ismoke, noise, and odor. Butte County has established ogrirul Lural zones which have as a priority use for w i.Lh.i.n i.d productive agricultural purposes, ,End r-vsidc:-111.; , sa zones and on' adjacent %property or di.sconform should be prepared to, accept such i nrcnive n i c n� c .from normal, necessary .farm operations. A.11 that. real property situate in -the. County of Butte, StaLle' of Ca.l.ifor.nin, dcscribi,cl' follows: , as 0 WUU Date: o iv �-,�,-r- c�. ; ��t-i ,�,/v �i�.i ►BJP IAJ I 4-- i -niLyl'i 3 PROPERTY OWNERS: S L a L e of: On this the day of _, 19-2 9, he fore me, SS. the undersigned Notary Public, per ona.11.y appeared County o AJS 9 Per.sonally known to me. Proved to sati.sf� ® DANIEL F. HUNT tom be the person(s) whose namess)) NOTARY PUBUC-CALIFORNIA s scribed to the within instrument and a1: Rune cojmty ® mycoramissioni!xpiresoct.l,lggoe cuted the same for the purposes th rc ®a»;floe®®REOFf.ic tai®�esr®, me on the hasis Ftory evidence. know].e o Lh .n con a�r ncd a.]. s� ek ].. � Present A. P. No. ( �v 1 Notary Public W l AV -NS AP #�• . l7 'S 014NER r PERMIT MH UTIL.CLEARANCE DATE INSPECTOR ELECTRIC GAS Support Struc. Compaction Test Re . Service Size Other Load"�� Type Pipe Size Length YES NO YESI NO v 'r;EiS �A 5'1' O dl 9. 4 Par c L "a t se, • cell 'i,�-;,� ., �,- M ; : s:.�Y.: � r . . the.,-tom cat e i.. 5 ' puois 4;t_rr: f4" On N �wr.,or z e Clt�tC1'�E' fiiEe ye ' siar. dram +trit�en Per�� o �'e• • . �3�Q�iiCSe � . anshi Sholi Be in [Olt,...�AN Ma}eriais WoA P ,.tcw, and of • P+In a ccordance c .;,c+°�fe: r rF e: .i for ••irc: �C=- gid©$ and oT quyl :}+rPies �;u'i9 [ry j $pec as�cEicta3 , Uni�arr�E Bui..�Enc�, .Code. .1a� ®- ION ci nS Ok • n. o jj VEres ,�e r°3d o� Mgc groper r.Covco c\eat P� . � �\� .`e`ooR` � � ,,� 5Q •� `tee 5��1\ v`Pme�t �� c.,er"C\ 75 Feed' all w t 300 X. COUNTY OF BUTTE - DEPAF?'MENT OF PUBLIC WORKS 7 County Center Drive - Oroville. Calfhnia 95965 - Telephone: 916/538-7541 ,. 7 - -7 C-- APPLICATION NOPERMIT ASSES OR PARCEL NUMB ^ ZONJN / BUILDING PERMIT OWNE TELEPIONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRA{ TOR•5 NA`tvt,E TELEPDNE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOW Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSINO. Plan Checking Fee $ Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDR SS �) D G Permit fee $ PLUMBING PERMIT Filing Fee 10.00 le �� S�iC� s— Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomerO Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities� Installation Oher ❑ Describe work: 6AS P It P1 ki WI j Permit Fee $ 10 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 00V DR LESS 1AMP OR LESS 10.00 Main service EA. ADO'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the sines$ and Professions Code and my license Is In full force and effect. j License No. Classification.a I, as the owner, or my employees With wages gas their sole oompen- 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 licensedontract- ors. (Sec. 7044) ❑ i am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.S'\ OR ACDNS. ACC. BLDGS. +/zQsgft NEW CONSTRESID, BRANULT CH NON.R ESLD BRANCH CIRC ITS 2,50 ea POWER APPARATUS &) SINGLE OUTLET CIR. EX. OCCUp(OUTLETS OR FIXTURES L0 ALO30 FIXED APPLN5. OR Ex. Occup. OUTLETS IRESID.I EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte,against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. + K. Date – S' "/ Signature of Applicant — Owner ® C retractor ❑ 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 $ Energy Inspection Fee $ _ occ CONST TYPE TOTAL FEE $!!rl 0� HAz. J CUA I PARK I SCHL FLD I CDF I PAR I PD i HD, ISSUE This permit is hereby issued unser the applicable provi- sions of the Butte County.Code and/or resolutions to do work indicated above for which fees have been paid. 'IREOI-0—A OF PUBLIC WORKS By Dated PE MIT EXPIRES Date �' Z I ~'L'-� / t' �j Receipt No. E r[y]'�7'Q WHITE-D.P.W.. 7E�OW-ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville. Califso\nia 95965 - Telephone: 916/538-7541 APPLICAT„IDN AND PERMIT PERMIT NO. r ASSES OR PARCEL NUMB ZOyjN o BUILDING PERMIT OWNE TE/jL—EPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAIL ADDRESS IV CA TONA E TELEPHONE CONTRACTOR'S MA ING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDR S Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping - 5.00 Each qas water heater or vent 5.00 Q USE OF STRUCTURE SF❑ Duplex❑ MobilehomeFV Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 ea. TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Installation Other ❑ Describe work: - _ rA 10 fi:,—Kfj 1 110 O Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 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. , as the owner, or my employees with wages as their sole compen- FlI, 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 CONST. DWELLING OCCUP.S ) New AMULTI-OUTLET , h¢sgft CONSTR. NON.RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS e SINGLE OUTLET CIR. ) Ex. OccU OUTLETS OR FIXTURES P N0C eALO L030 Ex. Occup. (RESID our ETS P)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 9 15.00 Permit Fee $ 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 o 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. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling 9 Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the 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 aga' sal County in consqu ce of the granting of this permit. X/��� �!! �� �_�—_�� '� Date _� Signature of Applicant — Owner ontractor EJAgent Elwork An OSHA permit is required for exco otions over 5'0” deep and demolition or construct- ion of structures over 3 stories in heig t. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 71<1 �(� E HAz. cuw PARK SCHL fLD PAR PD I HD. ISSUE This permit is hereby issued unoer the applicable provi- sions of the Butte County. Code and/or resolutions to do indicated above for which fees have been paid. IRE O OF PUBLIC WORKS BY Date? _ PE MIT EXPIRES Date -2—ZI iQ-_� �" ,,// Receipt No. F— � �`7�''� WHITE-D.P.W.. YELLOW-ASSC3SOR. PINK -INSPECTOR. GOLDENROD -APPLICANT it PERMIT NO. 2791-88B PERMIT EXPIRES OWNER OLEIVA & EARNEST KINSEY CONTR. Owner ASSESSOR PARCEL 98-17-75 LOCATION . 4001 Deadwand Rd, ORoyi 1 1 e Temp. Power Pole Called PG&E Temp. Elec. Service Called PG&E Temp. Gas Service Called PG&E JOB FINALED (Date) Signature 11.��� V a 14 - sd �cq0 le— = OK 0=Not OK = Not Readyable MOBILE HOMES MISCELLANEOUS Date MOBILE HOME UTILITIES (Plans) OK except #'s Date DECKS,COVERS,CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Sewer; Location -Test -Fall -C/O -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.-Rfg.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 6. Gas; Location -Test -Wrap: / P'L"ft. / /"Nat. or/ P'L"ft./ /"LPG 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. 8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh Card -61 Date Card -131 Date 10. Roof; Shthg-Roofing Card -61 Date Card -131 Date 11. Ext.; Steps -Doors -Landings Date MOSILEHOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements Card -131 Date Card -131 Date 2. Footings; Size -Spacing -Marriage Line Card -131 Date Card -131 Date 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances Date POOLS (Plans) OK except #'s 5. Drain; MH Test -Fall -Flex Connector 1. Setbacks -Easements 6. Water; MH Test -Regulator -Connector 2. Soils; Compaction -Structure Stability 7. Water and Sewer Connected -C/O to Grade -HD Approval 3. Pool Structure; Steel -Connections -Thickness - Dead Men -Lining 8. Gas and Electricity Tagged 9. Exits; Insp.-Sketch 4. Elec.; Receptacles and Lighting, Distances-GFI 10. Cert. of Occupancy 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 Card -B1 Date Card -81 Date Card -131 Date Card -B1 Date 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Card -131 Date Card -81 Date Card -131 Date Card -61 Date = OK 0 = NotOK RESIDENTIAL (Single and Duplex) - =Not Applicable = Not Ready Date UNDERFLOOR (Plans) OK except #'s Date, FRAMING (Continued) 1. Zoning -Setbacks; -Easements -Flood -Slope 45."Hangers-Post Caps -Anchors -Connectors 2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 46. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. 3. Ftg., Garage; Soils -Steel-/ /" Ftg. Depth 47. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. Depth 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 5. Stemwalls, Main; Steel-Blockouts-Wrapped 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 50. Garage Fire Protection Framing 7. Slab; Steel -Wrapped 51. Property Line Firewall & Openings 8. Piers -Fireplace Ftg.-Steel 52. Ext. Doors -One T -Check Garage -3rd story, 2 exits 9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 10. Gas Pipe; Size -Anchors 54. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 11. Water Pipe; Test -Anchors -Regulator -Service Test 55. Siding -Nailing Veneer 12. Electric; Underground 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 13. Plenums & Ducts; Clearance-Material-Supprt-Ins. 57. Glazing Area -Glass Protection -Skylights -Plastic 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 58. Shear Walls; Nailing -Bolts 15. Insulation 59. Insulation-Walls-Clg. 60. Infiltration -Wal Is-Wndws Card -B1 Date Card -Bi Date Card -B1 Date Card -B1 Date Card -131 Date Card -B1 Date Card -131 Date Card -81 Date Date PLUMBING (Permit) OK except #'s 16. Water Ht. Vent -Access -Combustion Air -Baffle Date FINAL (Plans) OK except #'s 17. Water Pipe; Test & Anchors -Nail Protection 61. Ext. Steps -Door & Sidelight Protection -Landings 18. D.W.V.; Test-Fttngs & Anchors -Nail Protection 62. Smoke Detector 19. Shower Pan; Test, First Floor -Tub Access 63. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 20. Test Tub & Shower, 2nd Floor -Tub Access 21. Gas Pipe; Size & Anchors 64. Bedroom Exiting 65. G.F.I. & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel; Breaker Sizes -Labels Card -131 Date Card -131 Date 67. Stairs &Rails Card -131 Date Card -131 Date 68. Fireplace or Stove; Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. Date ELECTRICAL (Permit) OK except #'s 22. Fixture & Transformer Clearance -Ins. Protection 70. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance 23. Elec. Receptacles Spacing -Lights & Switches at Doors 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door; Swing-Landing-Closer73. 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. A.C. Duct in Garage -Damper 2 6. Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 27. 2 Appliance Circuts in Kitchen & Conductor Size/G.F.I. 75. Plb., Elec. & Mech. Equip. Listed for Location 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga. Cu or Al 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral Yes No 77. Insulation -Foam -Looked in Attic ❑ Yes 78. Guard Rails & Deck Construction -Post Caps 30. Service -Riser Conductors & Ground -Main Disconnect 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 31. Equip. Clearances Panels-Motors-Mech. Equip. 32. Clothes Closet Light -Shower Light -Spa Light 80. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑Yes ❑ No 33. Smoke Detector 81. Stucco; Brown -Finish Card -81 Date Card -B1 Date 82. A.C. Unit; Disconnect, Electrical, Plumbing Card -Bt Date Card -61 Date 83. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Openings. Date MECHANICAL (Permit) OK except #'s 84. Water Well; Disconnect, Electrical, Plumbing 34. A.C. Ducts Insulation & Support 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 35. Vent Fan; Exhaust above insulation 86. Ventilation throughout House 36. Condensate Drain & Overflow; Size & Grade 87. Glass Protection 37. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet 88. Corrections from Previous Inpections 38. Attic Access & Platform if Furnace in Attic 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy. Compliance Certificate -Other Certificates Card -131 Date Card -131 Date 92. Roofing Certificate Card -B1 Date Card -61 Date Card -61 Date Card -131 Date Card -61 Date Card -61 Date Date FRAMING (Plans) OK except #'s 39. Sills, Proper Material & Anchors Card -131 Date Card -131 Date 40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound Comments at Final: 41. Bearing Walls over Girders & Floor Nailing 42. Draft Stop in Walls (rat proof) 43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 44. Header & Beam -Size & Bearing (NOTE: An entry must be made each time you visit job site) COUNTY OF BUTTE - DEPARtMENT OF PUBLIC WORKS MITJNO. Yj_� 7 County Center Drive - Oroville, CaliFornia 95965 -Telephone: 916/538-7541 APPLICATIMAND HERMIT ASSESSOR PARCEL NUMBER 7 ,J' ZONING BUILDING PERMI OWNER .CJ .r / woks TE HONE SO. FT. OCC. BUILDING LUATION OWER A ING ADDRESS �_JJ CONTRACTOR'S NA ONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER VNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ AA Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS oD Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap J 2.00 Solar or heat pump water heater 20.00 LOT O SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 ea TYPE OF WORK New❑ Addition❑ Remodel❑ Utilities Installation❑ Other[] Describe work: Z Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 60OV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check One): ElI am licensed under provisions of Chapt. 9, Div. 3 of the BUslnesS and Professions Code and my license is in full force and effect. License No. Classification [� 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 CONST. DWELLING OCCUP.SI) OR AODNS. ACC. BLDGS. , �20sgft NEW CONSTR TI -OUTLET NON.RESID .BRA C CIRC S 2.50 ea / POWER APPARATUS e (SINGLE OUTLET CIR. ) EX. Occup OUTLETS OR FIXTURES eA 030 FIXED APNS Ex. Occup. OUTLETS P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �yirin g 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): f'-, The permit is for $100.00 (valuation) or less. 91 1 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation Penult Fee = Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, cos , and expenses which may in any way accrue againai County in co se encs of the granting of this permit. X Date D 3d eR' Signature of Applicant — Ow 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 $ Energy Inspection Fee $ TOTAL PERMIT FEE $ _ a OCCUP. CONST.TYPE SCHOOL FL P CEL D I su PD ;t This permit is hereby Issued under sions of the Butte County Code and/or work indicated above for wilich DI T 0 UBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS ate jV�UX �� Receipt No. /1--P7 WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT rP'arFW' VC 'i`f.+v:lr"ci ��Wih_ rY�za;, COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - QR6ALE CAS iFOR495965„- TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. _ OWNER A. P. No. Proposed Building Used" Building Inspector J� Date At time of permit application, I was advised the following data must be submitted prior to permit processing andJor issuance: DATE RECEIVED APPROVED 1. All items.have been submitted. . . . . . . . . . . . ' 2. Plot plans in duplicate./triplicate, signed by preparer of plans. . 3. Complete plans in duplicate./triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . r 6. School District "Fees Paid" Stamp on Floor Plan. 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ .. . . . . . . , , , 9. Z10. Letter of signature authorization. • Sanitation from ��� 36 approval !o/ Health Dept. . . 11. Planning approval for (A) Use: (B) Parking: . 12. Certificate of Workmen's Compensation Insurance. . . . . . M 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner, Mail to owner ❑.) _15. Improvements may be required. . . . . . . , . , , , 16. Mobilehome Installation Data. . . . . . . . . . 17. Pre-Inspec. request to (Date) Pre -Inspection for Required. Building Inspector 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. - 20. Plot plan approval from city of 21. Engineered trusses 'in duplicate (required prior to plan check). 22. When you issue the permit, process as follows: `Mall to owner, Mail to contractor. Telephone and hold for pickup at office, Deliver w/inspector. Other �,� 2�.--IeDate 9 Applicant —.36 — �I Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted prior to permit issuance: (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 date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by D� c.� Date a 'S° Sets of plans on hold in File cabinet AP folder Copy—DPW TO Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP# Plan Approved for:, Sewage Disposal _ Water Supply Hold final for: Final clearance O.R. for: Clearance for _ bedroom mobile home. NOTE *** Sanitaria Water Supply Water Suoply Other V (� Date COUNTY OF BUTTE -'Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 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 maLes labor and materials for construction of the proposed property improvement or no) 2. lir (have/have not) for t e roposed work. signed an application for a building permit 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 this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name 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 Signed: - Property Owner Social Security Number Date _�D_ Fs�_, 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 per- mitted to issue the permit. 4/3700'---...�_.. Par c s atea ypeci1i:~cxi'lons MUST tempt can s nnA it to the i .�,. _.�.�'-•.s On s fpp&�tE* tlr1 611CiR ormissio $ram ihaepar#r�r+# art##� P Ion. rizcnclnshipShall Be 4o�©�•.�AN Matert�ls & \Mo � ► a3'!'ract:rogn th Bance w;th and pSl , Ka pre$ F+; 1,�Icc'r►u:3ica1 Codes unI4e,� ► �ul�din�geicat Code. 4�ne �yeatios►ul► v U., � ok, ��d nab i off �Cle t a0� 1- pyo �zkv o GeiNJ�6S a�.egoJ � qY\, 31Q J41 �►� ��� ., peg® D �i,q 1- .�