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058-220-012
058-22-0-Or2 96-1009 P,E MH) GRAHAM, Harold 13381 Concow �Rfo�adOrovil� ELEC GAS 2p3�—`'� COMP TEST SUPPORT STR REQ�0 058-2'1-0-012 96-1010 MHI GRAHAM, Harold 13381 Concow , 0 oville Road (MHI/96-1009) n_" ,�/� I O012 GRAHAMC, ` r'a , o'� " -96f 1010 MRI 13381 , d oncow Road,'Oroville iMHI/96-1009) iz-P/- , . t. L I O012 GRAHAMC, ` r'a , o'� " -96f 1010 MRI 13381 , d oncow Road,'Oroville iMHI/96-1009) iz-P/- , . t. 411*16. .. •'i.."_'Ai•1Af" ` Tr T �,►, r' f ..}"tt'^x..�a�+n,. ,.. .- y�.R�y. L. .,.�RY�.�n v. mr� � ,��.rQs .-,, y .SC, 7t, QOUNTYOF- Uft -DEPARTMENT OF. DEVELOPMENT SERVICES1BULLDINGDIVISION 7 County] Center Drive - Oroville, California 95965 - Telephone' (916) 538-7541 je/ APPLICATION AND PERMIT PERMIT NO / . ' I� ?) ASSESSOR PARCEL NUMBER 058-2k—d12 ZONING j R5 BUILDING PERMIT OWNER IM0 HAM GRA TEL PHONE ` 12-0566 SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 27 1 PMM RD OROVILLE, 9590 CONTRACTOR'S NAMEMM RICHARD VAN STAVM11 T 77NE6198 CONTRACTOR'S MAILING ADDRESS LICF.IVSE#3747$ Fireplace CONSTRUCTION ENDER UNYNOWN Total Valuation is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS }�PERMITFEE CONCOW RD S 43.00 PLUMBINGPERMIT Filing Fee 20.00 , OF.OVILLE, 95965 Each Trap 7.00 LOTNO. SUBDIVISIONS NAME PARCEL MAP Solar or heat pump water heater 23,00 Water piping 15.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome 0, Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel f❑ Utilities ❑ Installation Ij Other ❑ Describe Work: �"/ ��/ ,— / a / — Mobile Home S G W 920.00 PERMITFEE $ Contractor ELECTRICAL PERMITFilin Fee 20.00 Main Service E00V OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law -for the following reason: -4Q: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUR OR ADDNS. a ACC. BLDS. ) SO. 3.SQ FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 WER (a STING E OUTLETTUS C R. ) Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL 9 .50 Ex. Occup. FIXED 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE s Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, 1 Shall forthwith comply with those provisions. X �/�Date _��'� / N'Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ 100.00 Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 143.00 I HAZ. D. FEES IM FLOOD CDF _ PAROL. h�/ PD HO ISSU�F This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated Above for wrich fees have been paid. in I ` 2 % BY Date PERMITEXPIRESON (Date) ReceiptNo. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT RESIDENTIAL T' 96-1009 058-22-0-012 P,E(MR); 4 GRAHAM, Harold 13381 Concow Road, Oroville (util/MH) OFFICE COPY Address GAS Meter B Date it e ELECTRIC Meter By Date JOB FINALED (Date) �7112.5 h4 — Signature V=OK 0 = Not OK = Not Applicable = Not Ready Date MO MOBILE HOMES I MISCELLANEOUS HOME UTILITIES (Plans) OK except #'s Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s g'R uirements - Setbacks - Easements 1. Zoning Requirements -Setbacks -Easements ial MH Support Sketch 2. Footings; Soils-Size-DepthSpacing-Connectors-Steel Location -Test -Fall -C/O -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails :station Test -Easement Needed (Sketch) 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors icily; Location -Clearances -Gm - proncrete 6. Gas; Location -T st-Wrap; / / L'ft. / at. o 'L"ft.{ LPG Well learance& sconnect tility Clearance Dat :OW-4kCard B-� Date Card B-1 0 eat ' Card B-1 Date Card B-1 Date MOBI HOME INSTALLATION (Plans) OK except #'s Lje7orjkfg Requirements- Setbacks Easements tings; Size -Spacing -Marriage Line Gas;,MH Test -Demand Valve Connector lectricity; MH Test -Crossovers -Breakers -Clearances JA,Crra7h; MH Test -Fall -Flex Connector air; MH Test -Regulator -Connector r and Sewer Connected -C/O to Grade -HD Approval Gas and Electricity Tagged Tie ns -Type Installation Cert. n-_ xits; Insp.-Sketch Cert of Occupancy Date 712 11Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 '7 JP Shthg: Rfg: Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Fnng.; Sils-AnchorsStuds-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s I 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining { 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/6 -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5 Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test r Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK O = Not OK = Not Applicable Not Ready RESIDENTIAL (Single ' = Date UNDERFLOOR (Plans) OK except k's 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel -Bloc kouts-Wrapped 6. Stemwalls, Garage; Stee'- Bloc kouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Stee! 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 a'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 1,'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 Size ga. Cu or AI-A.C. Wire Size ga. Cu or At - -----------` - - ----- - - 29 --------------------------------- Range Circ r , ga. Cu or AI -Oven Circ. ga. Cu or Al. Insulated Neutral ❑ Yes _�,No -------------------------- -----.....-- ---..._. .. 30. Service -Riser Conductors & Ground -Main Disconnect ----------------------------------------- ---------------- ------ ------- -- 31. Equip Clearances Panels-Motors-Mech. Equip. ----- ---- ----------- -----......... .. ....... .. 32. Clothes Closet Light -Shower Light -Spa Light --------------------------------- 1-- 33. Smoke Detector --------------...------------- ..................... ........................ .. Date Card B-1 DateCard B-1 -- ----------•---- ..._................. ..-------....... .......... ... ... .. Date Card B-1 Date Card B-1 Date MECHANICAL,(Permit) OK except #'s 34. A.C. Ducts Insulation & Support -----------------...-- --- ----..... - - .. .......................... ... .. .... .. 35. Vent Fan: Exhaust above insulation --------- -------------- ....... ............. ... ... ... .. 36. CondenFate Drain & Overflow: Size & Grade ------------ --....._.....................__..._.. ..... . . 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet ............... -. ... ... .. 38 Attic Access & Platform if Fu.-nance in Attic ---- - .. .... ......... .. .. . .. . Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except 4's 39. S Is. Proper Material & Anchors ...... ... ... ... ... ... ............ ... ... ... .. 40. Walls Studs -Nailing. Spacing & Bracing -Plates -Sound ...... ....... ... ... ....... _ ............ ...... .. 41. Bearing Walls over Girders & Floor Nailing ........... ... ....... ........._.._........... I..... ... .. 42. Draft Stop in Walls (rat proof) _..... -- ................-_. _ .. .... ... .._ 43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub ..... .. ....... . .. ... ... .. 44. Headers & Beam -Size & Bearing & Duplex) 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 -Ceilings 60. Infiltration -Walls -Windows ` -------------------------------------------- Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except a's 61. Ext. Steps -Door & Sidelight Protection -Landings ----------------- -------------------- - -- 62. Smoke Detector ----- ------------------------------------- - - 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage: Above Floor -Ducts -Meeh. Protection --------------------------------------------- 64. Bedroom Exiting ...----------------------------------------- -- 65. G.F.I. & Bath Fixtures & Tub Access -Sp a .... -- . ---- -- - -------------- 66. Elec. Trim & Subpanel: Breaker Sizes & Labels -------------------------------------------- 67. Stairs & Rails .........__. ------------ -------- 68. Fireplace or Stove: Clearances -Hearth ..... --------------------------------- ----- 69 Elec. Outlets at Wood Panel: Int. & Ext. ------------ -------------pp - ------------ --- --- - 70. Kit.Fixt. & Appliance: Grnd.-Air Ga Cookin9 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 -Meeh. Protection ----------------------------------------- 75. -------------------------- ---- 75. Plb.. Elec. & Mech. Equip. Listed for Location ...........- ----------------------- - 76. Elec. Receptacles in Garage: (G.F.I.)-Romex Protection --- ------------------------------------------ 7;. - -------------------------------------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 ❑ No: Planters ❑ Yes ❑ No --------------------------------------------------- 81. Stucco: Brown -Finish . ------.._...----------------------------------------- 82. A C. Unit: Disconnect. Electrical. Plumbing .. ... ... ... ... ... .. --- - ------------------------------ -- ----- 83. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to Openings -- - ----------------------- ------ 84. Water Well: Disconnect. Electrical, Plumbing 85 Exterior Elec. Trim: G.F.I. Receptacle=Underground .. ....... ---- - ----- ------------------------------- 86 Ventilation Throughout House ------------ --------------------------------- 87 -------------------------------87 Glass Protection 88. Corrections from Previous Inspections - ---- -- ------------------------------- 89 Gas Test -Meters Tagged: Gas -Electric ... -- . .---------------------------------- 90. Water & Sewer Connected-CrO to Grade -HD Approval - ------------------------------ 91. Energy Compliance Certificate -Other Certificates . ... .. .... ... . . ..... ..... ..----------------------------------- Date Card B-1 Date Card B-1 -- ---- -------- --------------------------------------- Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments. at Final: COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIO Y' 7.County Center Drive - Oroville, California •95965 - Telephone (916) 538-7541PERMIT O. APPLICATION AND PERMIT ?�"�� ed ASSESSOR PARCEL NUMBER 058-220-012 ZONING FR5 BUILDING PERMIT OWNER HAROLD GRAHAM TELEPHONE 532-0566 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 2781 PENTZ RD OROVTT,T,F, Q5965 CONTRACTOR'S NAME WNER TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS t/ D COl)COr o� RD PERMITFEE $ O PLUMBING PERMIT Filing ing Feoe 20.00 OROVILLE Each Trap 7.00 LOT NO. SUBDIVISION'S NAME P C L MAP Solar or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome IR Other—Gas SPECIFYBuilding Each gas water heater or vent 15.00 piping system 1 - 5 outlets 15.00 sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities 6 Installation ❑ Other ❑ Describe Work: 2 BEDROOM MH Mobile Home @20.00 PERMITFEE S 80-00 Contractor ELECTRICAL PERMIT Filina Fee 20.'00 Main Service000V OR LESS ( 20 A OR LESS ) 23.00 QQ -93 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUR SO. OR ADONS. ( a ) 3.52 FT. NEW CONST. MULTI -TI- OUUTLETLE T NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) 8 SINGLE OUTLET CIA. Ex. Occup. ( OUTLET OR FIXTURES) 20 @ I.00 BAL 0 .50 Ex. Occup. (oFXEfs (AES16.) OR5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 120.00 Misc. Wiring 23.00 PERMITFEE $ 63.00 Contractor 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 is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 14 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X� Date � Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 166.00 HAZ. D. S IMP FLOOD C F ARC i PD i This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indic d above for which feeq have been paid. , A B /' , w �Oate y �o PERMI EXPIRESON 67/`3z/%7 (Date) Receipt No.%2_s-ss,!� WHITE-D.D.9.4.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT -.n�.:,y,+ilN,�,a.,.o. ... .w�.....rarr in....ir:..r....»cw.-^,-:..s��;;%�v1�:L...tr. .s:.��+A�;vy;�.'yq"u��r �wr'.��,.-.'w....rw•u....nar,:✓: +��.,:w..,cy .a.. �3.«... �. .. ' COUNTYOF BUTTE - DEPARTMENTOFDLQPMENTSERVICES -BUILDING DIVISION �- . . 7 COUNTYCENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNERX�AVOY `'cLk&-� A. P. No. S9'22- D Proposed Building Use 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 J I•itiffffi s have been submitted. . �L Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. .............. 10. Fees of $ .......................................... Impact fees as shown on attached sched C- alifornia Department of Forestry plan rov res, ..N. od elevation letter 100 year floo b CaliforniaEngineer .................. . anitation and plot plan approval O✓"o Health Department. a 15. City of Chico plumbing permit . ....................................... . 16. Plot plan and business license approval from City of Biggs/Gridley. - 7.Pnning approval for (A) Use: (B) Parking: ........ n act Land Development about (A) Improvements (B) Drainage. ....::..:: Driveway permit (construction approval required prior to occupancy). ............ I,Inspedion request 20. Pre -inspection for required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification). ........ ..... 22. Certificate of Workmans Compensation Insurance . ......................... . 23. ner-Builder Verification (Given to owner Mail to owner :::::::.. . W.Recorded copy of Agricultural Acknowledgement Statement. . 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access. .....................:................. . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ....................................... 32. Plan check list . ..................................................... 33. 34. Wheys you issue the permit, process as follows: MailAowner. Mail to contractor. Telephone 2 • 0666 and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicants Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit 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 _ mail Coun r by Date Plans checked by Date Plans approved by Date6- Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works 1 s TO: FROM: SUBJECT: Building Department Environmental Health Sanitation Clearance ' � <, 7 • Plan Approved for: Sewage Clearance for bedroom Location ' Disposal o ile ther Water Supply: Public B.H. USE ONLY Plat Plm AttmLed Fbw Plan AMkchod Sort to B.D. / APAP Private Well NOTE: Cjt�sr— / ' Environmental Health Specialist FIA r7 I NO -4 6011 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 I#or and materials for construction of the proposed property improvement: YES[• NO[ I. 2. I HAVE[ A 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: NAI E: 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: NA�TME• 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 PH0�NE TYPE OF WORK µ SIGNED: PROPERTY OWNER:_. SOCIAL- SECURITY 0 DATE: NOTE: This owner -Builder Verification is required by Section 19831 and =`r 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are ermitted to issue the permit. :. Fk OVER , y �. ,� * ..,-v - w--•-r-Tr"1�. �„r K, �. . reT �•.r.,,,,�•„�.H,n,i."�."r.'C.I,w^v.....,.ypy4rwti�e, kn..�- r' ,y„_'�..: •....�...�... ` BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM a = (On4 Form Per Building) School District 51aj�� ^-_ Building Department No A.P. NumberS.-2� d- of ?� Jurisdiction: City � County Property Owner Property Location/Address ) Subdivison Lot No. U Residential Development 0 Sq. Footage 2- 7 No. of Living MHI Addition (Group R) Units 0 Commercial/Industrial New Addition Sq. Footage (Including Exterior Roofed Areas) Building Department R90refeAtive Det (Floor Plans reviewed by School District Personnel) . 0 (Street .:96014? 11 60 A) 1111Ahool District certifies (Apel %"—!e n i 1 ISZ-1: , - -- - Number) (City) h. (State) (Zip Code) _ • has complied with the requirements of Resolution No. �- 9� by payment of $ representing g square feet. AB 2926 District Representative Paid by Check # Bank Number Paid by Cash Remarks: Date If, subsequent to the School District liepresentative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeformmkt (11/94)dmm n 0 LAND DEVELOPMENT BUILDING f�ENVIRON,MENTAL4,HEAL°TH PERMIT CLEARANCE Balding Permit No. 1 o %/I _R IC p/_rrL. /a-55WSOA- OWNERSL I A.P. NAME: %rojnru-n . ITCt_�)IQ NUMBER: __Sd PRINT LAST NAME FIRST COUNTY ZONING DESIGNATION: %2 S FLOOD ZONE: X FLOOD MAP: /So /3 / APPROVED: CONDITIONALLY APPROVED: ✓ RESOLVE PROBLEMS PRIOR TO APPROVAL: PARCEL CREATION BY DEEDS OR MAP DEED INFORMATION: DATE OF CREATION: DEED REFERENCE: LEGAL ACCESS PROVIDED: YES NO COMPLIES WITH COUNTY STANDARDS FOR DEED CREATION: COMMENTS/CONDITIONS: MAP INFORMATION: LEGAL ACCESS REQUIRED: YES NO YES NO I-Ated e~ G111/ ACG-t&r aA/l T- / DATE OF RECORDING LOT 4 BOOK .3 % PAGE I'i /B COMPLIANCE WITH OLD SUBDIVISION LOT ORDINANCE REQUIRED? (MAP RECORDED PRIOR TO BOOK 17 OF MAPS AT PAGE 23): YES NO . IF YES, MARK APPROPRIATE ITEM(S) BELOW: A. Construct road to B. Meet parcel size required by zone. C. Meet current E.H.D. requirements. CHECK SPECIAL CONDITIONS WHICH APPLY TO MAP: ALL FEES TO BE PAID TO THE BU/LD/NG DIVISION UNLESS OTHERWISE NOTED. I 1. Maintain a 50 ft. building setback from centerline of road. e 6-L _ 2. Maintain a ft:building setback from right-of-way/centerline of _ 3. Maintain a 100 ft. leachfield setback from all existing wells. X 4. Maintain a lou ft. leachfield setback from ST/Z�} rpt _ 5. Pay water tender fees in the amount of $ to Battalion Number of the Butte County Fire Department. 46. Meet the Fire Safe Regulations of Butte County and P.R.C. 4290. _ 7. Connect to a public water supply. 8. Connect to a public sewer system. _ 9. Automatic fire suppression sprinkler systems shall be installed in all residential structures in accordance with the National Fire Protection Association Standard for the 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 Fire Department specifications, serves the parcel. _ 10. Pay T.D.D. (Thermalito Drainage District) fee in the amount of $ _ 11. Meet the requirements of the Department of Fish and Game for the preservation of oak trees. (See phone number below) _ 12. Obtain approval from the Department of Fish and Game for vegetation removal. Contact Fish & Game at 916-355-7010. _ 13. A traffic mitigation fee for each new or additional living unit shall be paid. Pay the amount of $ _ as stated in the Oroville Area Traffic Mitigation Fee Agreement. PsynmW to be gads to the Pla mft Divis o". _ 14. All new residential buildings shall be constructed to comply with the requirements of the Uniform Building Code for seismic safety. Mobile homes shall be constructed on a permanent foundation system which complies with the Seismic Zone 3 requirements of the Uniform Building Code. _ 15. Deer Mitigation fees are to be paid, if such fees have been adopted by the Butte County Board of Supervisors. X 16. Pay school impact mitigation fees. X 17. A development impact fee for sheriff facilities shall be paid pursuant to the provisions of Chapter 3, Article II of the Butte County Code. _ 18. 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. 19. If any cultural resources are encountered during ground disturbing activities,.all work shall cease in the area of the find pending examination of the site by a professional archaeologist. This person would then be able to assess the site significance and suggest appropriate mitigation measures. 20. 21. 22. 23 24. 11 25. AIO iMdol3A30 (INVI RM8 10 A1Nf100 9661 I Z 833 C13AI333H LD 9195 - CAWP51\FORMS.K\8LDGPERM.CLR And when recorded mail to: Building Division #7 County Center Drive Oroville, Ca. 95965 MAY 0 8 1996 r40T COMPARED WITH ORIGINAL DOCUMENT 96-017212. . J AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code requires 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 foragricultural 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: 0 \"� . ��1c�� C_ - VCA, V-,C\Ct nt i 0U, 1 �Ck T VQ) � � Qnuary Date: �/ �' PROPERTY OWNERS: State of Calif rni• ) County ofu� ) On before me, personally appeared /`( 0A O L� ��1� vl {�L.CQ/�'��� norcnnolly known to me (or proved to me on the basis of' satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowled-4ed to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and ollicial seal. [Notary RAJ. GUDGEON mmission !1050724 MW CPS1 �'� Public mSi atUI C e ISI. ffo County, Calnomla , •° Commission Exp. MAR. 8, 1900 r . , P,,;. NOTE TO RECORDER: DO NOT RECORD THIS SIDE A.A. - 1 AGRICULTURAL STATEMENT OF ACKNO�YtE-DOEMEN'T: <::`: Instructions for recording Agricultural Statement of Acknowledgement: 1. Insert the legal description of the property in the space provided on the other side of this form. The legal description is the narrative description of the property - which will be on your deed. If you don't have access to the .deed, the Recorders Office can provide this information. ( The description may be handwritten or typed in the space provided or attached on a separate sheet if more space is required). 2. Property owners must sign in the presence of a Notary Public and have the form notarized. 3. Make a copy of the form and then take the original and copy to. the Recorder's Office at 25 County Center Drive, Oroville (the Administration Center building). The Recorder will record both the original and copy. They will keep the original and return the copy to you. Just bring the copy back to the Building Division at 7 County Center Drive. RECORDER'S FEES: $6.00 - 1st. Page $3.00 - Each Additional. Page RECORDER'S OFFICE HOURS: 9:00a.m. - 3:00p.m. (Monday - Thursday). OVER -1 cOyl 0_0 ; t' o�e- ;;NYc Y V j I %' C d fYGQ1"®ICC lie' ` ------ 1Q1'J�-Power �ine 'F le __-- — hi 1s °f plans and spectticat�ns be 16b`atinti' iris arrd itis-,mta to c� _- - --, F- chi a#+ans•-e�-se -A out ryrittert permission fr the D Works, I ks, Coon of s. , L i. l e Gjregf > 11 • � .t L h• -i '; ' � � . 3,, si���� .....-.,�I I � �7i' r � Tz- �=.. ams The attach Fire Safe 3b• r -�� N1ee,^ requirement `must be comple o : t©' 14 J; as'specified nd approved 1 by C.D.F. I \ F?Ary �5 I �_ 4�0 Legeh LiNcBEJif U 8Y 7"Sf F_ :jTTE CO. FiR� DEPT. C LIF. DEPT. of FORESTRY Ll submitted i s ► \ a prov;d as f a i s ,rroled with conditions =-fin edals, & Workmanghld SW I �ordance wit : Re45b n' � I ,x ,heet. • %,, �_ c,,�Of li res �� - 9 1Zed Good ACact ces'an� r ef,a e o U ty p �Ci� d fro the Specifiq" use in lh Buildin iumbing & Mech icai' Codes; \4 C'� 1 Nations ctrical� de. AP2RpI Butte C1ntYealt U o Ewm ironen L 05'6- o.- 0)9L %Uri - Ici ARD FQLIIP SNL�ASEMf-WS' $TFtUCTUR A L B . LAR O. it I SIDS p`ND r lV O 10 -~-� Li L E j SVI /` © �! FR �S A!yt3 �VeRNANa'S OF �pR PR�PEF+TI L1i�� ; ea . It)° F StrIA A 5��� AC Fp,Ot�R'�TRE' p GE�iERLIr! NY �(��p;� I----�- , FY ROA p�,� 1 BUTTE �Ro,a1► >~ o e�ul - I _ i� E COUNT1f ,� of sT�UGb eRr�A>ao• - c R�111:-BAR — f POR A Z 6 APPMOED � Loll 96 -/c/o M Nx PPD.- CDF FIRE SAFE REQUIREMENTS 52�, 22-f 22 '? --(OO? LD AP# PERMIT # NAM Under authority of PRC 4290, the following checked items are required by the Butte County Fire Department and are made a part of this permit. These requirements are minimums and will be superseded by Butte County local regulations which equal or exceed these standards. Field inspections will be made by the Butte County Building Department for compliance.. (] 1272.00 Maintenance of Defensible Space. To ensure continued maintenance of properties in conformance with these standards and measures and to assure continued avail- ability, access and utilization of the defensible space .provided for in these standards, annual maintenance must be provide for by the land owner. Driveway Standards 1273.02 Surface. All driveway surfaces and structures (bridges, 1273.07 culverts and other app,rte-iant structures which supple- ment the roadway bed or shoulders) shall provide unob- structed access to conventional drive vehicles, includ- ing sedans and fire apparatus weighing up to 40,000 pounds. 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius ] 1. No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional sur- face width of 4 feet shall be added to curves of 50- 100 feet radius; 2 feet to those from 100-200 feet. [�7 2. The length of ver`:i^tel curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet. [Y-] 1273.05 Turnarounds. If required, will have a minimum turning radius of 40 feet from the center of the road. l 1273.05 Turnouts. Shall be a minimum of 10 feet wide and 30 I feet long with a minimum 25 foot taper on each end. 1270...10 Width. All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. Page 1 of : :?. , /C 1160 22 —( 2 9k ? ( �-A�� � LJ9 AP # PERMIT # NAME �(] 1273.10 Turnouts. Driveways exceeding 150 feet in length, but 1 less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. 0 1273.10 Turnaround. A turnaround shall be provided at all building sites on driveways over 300 feet in length and shall be within 50 feet of the building. 1273.11 Gates [ 1. Gate entrances shall be at least two feet wider than the roadway it serves. mh L1-4- 2. The gates must be located at least 30 feet from the I roadway and shall open to allow a vehicle to stop without obstructing traffic on that roadway. [ ] 3. Where a one-way road with a single traffic lane provides entrance, a 50 foot turning radius shall be used. Fuel Modification 1276.01 Setback for Structure Defensible Space. `All parcels 1 acre and larger shall provide a mini- mum 30 foot setback for buildings and accessory buildings from � p;operty lines and/or the center of the road. !/y / a [ ] 2. For parcels less than 1 cre, local jurisdiction shall provide for the same practical effect. See Other Requirements below. [ 127.6.02 Disposal of Vegetation and Fuels. Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction, road and driveway construction and fuel modification shall be completed prior to completion of road construction Dr fi_ial inspection of a building permit. Page 2 of 3 AP # 9G —ro�q PERMIT # Other Requirements 0 If Building Setback is 15 to 30 Feet: - Class A or B roof - Enclosed eaves NAME [ ] If Building Setback is Less Than 15 Feet Choose any 3 of the following: - Metal or no doors on side toward property line with insuffi- cient setback - Class A or B roof with enclosed eaves - Interior automatic sprinkler system per NFPA 13D - Glass area not to exceed 'i0% of wall area toward property line with insufficient setback Siding from the following list: Stucco 3 coat Hardi-Board or Plank Masonry Masonry veneer Metal Other Butte County Fire Department approved materials Ki ell 6_3 —9� Date Signatur Page 3 of 3 MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION --7 COUNTY CENTER DRIVE OROVILLE, CA 95965 --PHONE (916) 538-7541 APN: PERMIT NO.: Owners: Name: i� Owners: _ Address: Mobilehome Year of Manufacturer + , L C' __ ar' Manufacture: Serial number _ C V Insignia or � ! 1 f � f ? '53 or V.I.N. -5 J HUD number: Official approving installation: Date: If the mobilehome is moved or relocated, the mobilehome installation acceptance shall become invalid. This form shall not be used when the mobilehome is installed on a foundation system. 513B White -Owner, Yellow -Installer, Pink -Bldg:, Gold -Assessor r COUNTY OF BUTTE -DEPARTMENT OF -DEVELOPMENT SERVICES-BUILDINGDIVISION 7 .County Center Drive - Oroville,'California 95965 - Telephone (916) 538-754 /_ PSR I 11- APPLICATION AND PERMIT (o �(J�(J ASSESSOR PARCEL NUMBER 058-220-012 FR5 ZONING BUILDING PERMIT OWNER HAROLD GRAHAM T TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 2781 PENTZ RD OROVILLE, 95965 CONTRACTOR'S NAME OWNHX RICHARD VAN STAVERN TELEPHONE 877-6198 CONTRACTOR'S MAILING ADDRESS LICENSE#37478 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS J JS CONCOW RD PERMITFEE $ 43.00 OROVILLE 95965 PLUMBINGPERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDNISION'S NAME PA Solar Solar or heat pump water heater 23.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobilehome EX Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel �❑ Utilities ❑ Installationnn EX Other ❑ Describe Work: 1/0 q. / /_� � `� 6 ✓ --'�— p3;�V� Mobile Home S G W @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filina Fee 20:00 Main Service8000V OR LESS ( 200 OR LESS ) 23.00 Main Service ( 200A TO ,000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCURS OR ADDNS. ( 8 ACC. BUDS. ) O. 3.5Q FT. NEW CONST. MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) & SINGLE OUTLET s Ex. Occup. ( OUTLET OR FIXTURES ) 20 Q 1.00 BAL .50 Ex. Occu FIXED APPLNS. OR p (OUTLETS (REBID.) EA) 5.00 t . Temporary Service 23.00 Mobile Home Facilities 2 0. 00 Misc. Wiring 23.00 PERMITFEE $ Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shallTOTAL \ not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith complywith those provisions. X / Date Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ 1000 Energy Inspection Fee $ OCC CONST. TYPE FEE $ 143.00 [This HAZ. I D. FEES IM FLOOD CDF PAR PD H ISSU permit is hereby issued under of the Butte County Code and/or in Indic o e fo which fees have / /^ B /'lam y PERMITEXPIRESON I the applicable provisions Resolutions to do work been aid. D to Z 1-7 (Date) Receipt No.� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR -GOLDEN ROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION;rr ' DEPARTMENT OF DEVEL613M SERVICES- t "? 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - ('916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 r is CORRECTION NOTICE OWNEF^ PERMIT NO. , A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. „ Date -712-11-lw Inspector REV 10/92 r i u DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDS P.O. BOX 1407 SACRAMENTO, CA 95812-1407 (916) 255-2501""' . TIEDOWN SYSTEM CERTIFICATION (To be completed by the mobilehome installation permittee or their representative) (PNM Name and Title) hereby certify under penalty of perjury and in accordance with the provisions of the California Code of Regulations, Title 25, Division 1, Chapter 2, Section 1326 that the tiedown system installed at 1-33 21 CQAJ1QiJ Rj, me (Address) (Lot No.) (CIM (ZIP Code) was not modified prior to or during the installation, and was installed in accordance with the tiedown manufacturer's installation instructions or in accordance with plans and specifications of an engineered tiedown system. (Signature) (Data) Note to Installers: Pursuant to, the CCR, T25, Section 1326(4) upon completion of the installation of the home, the home manufacturer's installation instruction, the approved plot plan, a copy of the plans and specifications for an engineered tie down system f used, and a copy of any maintenance requirements for the tiedown system shall be placed within the home for retention by the homeowner. Permit # Department Use Only • District Representative Hca-NAo.21 (Rev. 6/95) �'=I.:N:iti.4.ilrr•'�--i^*"^�%r`�sv'... �iMr"^*y'..'..n:.�y1Kh'-tN(�4+'ii4��'M`�.4TT'f�'d�".�S'�r' � �r`rv:+M n:.ti,::ir«#f't'•.., »..-.A` �' •�,�--+."'4%��'.+vFa'�.:�.`:Nii �:-::,Yr .: er�:••,• +;,COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION', 3 � ' 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATASHEET OWNER //4 /A�►2 A. P. No. Sp- 2 c) • C19- / Z, Proposed Building Use % Building Inspector %9- 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 . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans. ......... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. :.,.......... . 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... Engineered truss details and layout in duplicate (required prior to plan check). .... Mobilehome data and manufacturer's installation instructions, 2 sets. .......... . Feesf$ ......................................... 7. mpactfees as shown on attached schedule. ........................s:�� 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . ......................................... 16. Plot plan and business license -approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. . . 20. Pre -inspection for required. .. to Build 9 �Speda� (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 . ....................................... . e-- 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use ......................................... . Mobilehome utility clearance . .......................................... OL�ffl 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 . .................................. . • �an k list.��z 34. When you issue the permit ,pp�rocpicess as follows: Mail o owner. Mail to contractor. Telephone'.53.2- and hold for kup at 01-6 office. Deliver with inspector. Other Parcel Creation Acreage Applicant _ Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prio pm' an a 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 _ mail Counter by _ Date Plans checked by Date Plans approved by G 5,54S Date Sets of plans on hold in File cabinet Z. AP folder Copy - Department of Public Works COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541 OWNER PROPOSED BUILDING USE A.P. # .�y --Zed—OlZ DATE REC . # DATE REC _6�%) SCHOOL DISTRICT FEES �� (paid at District Office) SHERIFF FEES (paid at Building Division) Residential...... x unit amt. Commercial (sq.ft.). x =$ 3. URBAN AREA FEES (paid at Building Division) Residential (per unit). x =$ #units amt. Commercial (sq. ft.) .. x = $ sq. ft. amt. 4. RECREATION DISTRICT FEES (paid at District Office) 5. THERMALITO DRAINAGE DISTRICT FEES ....... $400.00_(paid._at BLilding.Division),_. Division)_ _,= , _ 6. SRA FIRE INSPECTION AND PLAN C CK $89.00 (paid at Building Division) 7. WATER TENDER FEES (BATTALION # ) $200.00 (paid at Building Division) 8. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) ' 9. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE O.B.- I Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will' be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES[ ] NON. 2. I HAVE HAVE NOT[ ] signed an application for a building permit for the proposed work 3. I have contracted with the following person (firm) to provide the proposed NAl�E: ADDRESS: CITY: PHONE: SI -T 19K CONTRACTOR'S LICENSE NO. -Il �A,` g 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NA1tiIE: 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: NA"ME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: SOCIAL SECURITY NUMBER:_ DATE: NOTE: This owner -Builder Verification is required by Section 19831 and �w 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER � - / \ _-�---�_-�� / -----..-----BUlLDjNG-DEPAR- ENT NJ NJ / 1. Owner's Name: n,r, t �m 2. Assessor's Parcel Number: nF:�'R - aa6 — n \'a J. : 3. Installer's Name: 4. Is the site currently under permit? Yes[ ] No[V-(Permit No. 5. 'Ig the site an existing site? Yes[ J No[,,f (If.yes, furnish two plot plans). 6. What is the electrical rating of the mobilehome? 1 p 0 Amperes. 7. What is the mobilehome site circuit breaker rating? Amperes. 8. What is the electrical rating of the mobilehome site? i0 0 Amperes. 9. Is the mainservice re ote from the mobilehome site? Yesir , No ] If it is, what is the rating? Amperes: 10. Is there any other electric load to be served by the mobilehome site electric service (i.e. well, garage etc.)? Yes [Kj No[. ] If yes, please identify the load and size: a) The mobile home site: Load- W eL. L• Amperes- -30 b) The main service: Load- Amperes - 11. Type of gas service at mobilehome site: Natural[ ] Propane[✓) None[ ) 12. Size of gas pipe at the mobilehome site from the meter or tank: 3/y inches. 13. What is the gas pipe length from the meter or tank to the mobilehome? 14. What is the mobilehome gas demand? B.T.U.* *(This information is not required if the pipe length is less than 6 feet on natural gas or less than 50 feet on propane). THE OTHER SIDE OF THIS FORM MUST BE COMPLETED IN ORDER TO PROCESS THIS PERMIT APPLICATION p-. r. . f { 1995 r 1 ��Pr\ 8.5 �, W 1 M.H.I.- Z Mobilehome Manufacturer: `, ��,b(a (� Manufacture Year: If other than single wide, furnish Setup Model Number: Width:_2,L�_(ft.) Length:(ft.) Tagalong or Expando Size --Eft.) x (ft.) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets. UV / FOOTINGS: Wood pressure treate or foundation grade[ WOther: SUPPORTS: Concrete block[ her: Provide Tie Down Specifications for all Mobilehomes: fT R 0 Ck /U () L O C Pier Footings Sizes and Location SINGLE WIDE MULTI -WIDE Line 1 Line 1 Line 2 Line 2 ................................................................................................ Main Beams Line2 ............................................................................................... ine 2 Line I Line 3 Line 2 ................................................................................................ Main Beams ...:...........................................................................................: Line 2 Line I �— or T ' e� ine 4 .................. ....................... ine I Line 1 Piers: Size minimum: r i x Spacing maximum: 1 4` From ends -maximum: ` Line 2 Piers: Size minimum: (t Z ] x [3 01. Spacing maximum: ` CpI From ends -maximum: -i-` ea Line 3 Roof Loads: U -4-C& Size minimum Location (from front): Line 5 Roof Loads: Size minimum: Location (from front): Line 1 Openings Size minimum: [ ] x [ ]. Each side of openings with width over: I` Line 4 Piers: Size minimum: [ ] x [ ]. Spacing maximum: ` From ends -maximum: ` OVER !TLE COPY i6 -/d to