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058-590-039
- ^ �79 ri.zzlbert Middleton'E.of xem tion. Permit-' ' . ~ � GAS�COMPACTION TEST REQ. ` � , . . ^POLESCHOOK, MIKE 3790 GRIZZLY CREEK RD, OROVILLE`Cont: OWNER NEW SINGLE FAMILY REPLACE E,/ ~'-' ' Insulation Certificate . BUILDING OWNER: a e Le Ie BUILDING IACATION :.� / D C Description of Installation ?4�11 o 5-g rd —©3 i BUILDING PERMIT ROOF & h. Material^. Brand Name Thickness (inc Thermal Resistance (R -Value) CEILING 7 Brand Name ,1, Baa or Blanket Type Value Thickness ('inches) .D Thermal Resistance. (R- ) Brand Name Loose Fill Type Contractor's minimum installed weightlfft lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance (R -Value) EXTERIOR-WALLM�51,e1// -e Material Mat� Brand Name �. . Thickness (inches) a ( Thermal Resistance (R -Value) RAISED FLOOR o - /�ce�s v e- �% 2 Material ga f s Brand Name Thiclkmn (inches) Thermal Resistance (R -Value) SLAB FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) '^zrmal Resistance (R -Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of -the California Administrative Code. < </ License Number ral Contractor (Builder). Si a andTicle � Date Sub Contractor (Insulation Installer) Signature and Tide License Number Date THIS CERTIFICATE MUSSHBE PROVIDED HE BUWITHIN SING DEPARTMENT PRIOR TO FINAL INSPECTION APPROVAL AND A COP JANUARY 1993 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP041590 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 09/01/2004 APN• 058-590-039-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 3790 GRIZZLY CREEK RD CON Date: Contractor. Map Index: Description: NSF 1548 GAR 462 COV 11011 p OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the 1 Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: POLESCHOOK MIKE to its issuance, also requires the applicant for such permit to file a PO BOX 794 signed statement that he or she is licensed pursuant to the provisions of PARADISE CA the Contractor's State License Law (Chapter 9 commencing with Section , 7000) of Division 3 of the Business and Professions Code) or that he or 95967-0794 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant•' POLESCHOOK MIKE Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor. II I t pursuant to the Contractors' State License Law.). l n 111 � 15 v O 1 am Exempt under Article 3 of the Business and Professions Code Date: -� Owner. ��, `'�v-'Y License #: 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 Architect: is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carver: Total Square Ft: 2120 S.F. Policy #: Valuation: $113,468.00 Census Code: 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 the 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 tnose provisions. 0 d ✓ Date: — Applicant: �1 WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. �Q CONSTRUCTION LENDING AGENCY This permit is hereb'sued under the applicable provisions of the Butte County Code amt/ r 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.)O Resolutions coo indi ed above for which fees have been paid. 1 Name: By: / Date: PERMIT EXPIRES Date Address: ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purpo ses. /upon t M T �d P� Print Name:�r 6 L�S �/ r Signature: pIC6 ✓—.ol^ O� i Date: Owner EI Contractor ❑ Agent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICA NAME CONTRACTOR Name City Ad ss Zip City Fax State Zip Phone Type Const. Fax E-mail W Lic. # Class Planner LENDING AGENCY Date Approved: APPLICA NAME CONTRACTOR Name City Ad ss Zip City Fax State Zip Phone Type Const. Fax E-mail Map Book Lic. # Class APPLICA NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Type Const. Fax E-mail Map Book State License Number APPLICA NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: LOCATION Zoning Flood Zone SRA 1Yes No Occ. Policy Number Type Const. Subdivision Name Map Book Page Lot # Planner LENDING AGENCY Date Approved: OVER FOR SUBMITTAL REQUIREMENTS J�NOPERMIT �, r �1j _ BIN # /f Descriptio or Sco in o ork- Sq. Footage ❑Structure Built without Permit ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and -other department costs are not refundable. fjkce' by: Amount: Bldg SRA Receipt #: Sheriff SMIP Other - 3J V Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 101 Y� LOCATION Property e Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Descriptio or Sco in o ork- Sq. Footage ❑Structure Built without Permit ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and -other department costs are not refundable. fjkce' by: Amount: Bldg SRA Receipt #: Sheriff SMIP Other - 3J V Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 101 Y� SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans,..signed by the preparer. NO GRAPH PAPER!, ;. ❑ 2. 3 Complete sets of plans; signed by the preparer. NO GRAPH PAPER! ❑ , 3.1 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed. calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached AccessoryBuilding Form, filled out by the property owner (if required). ❑ 9. Sanitation and site plan approval from the Environmental Health Department. ❑ 10. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3.' 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑• 7..*32,Flood'Elevation Certificate, wet -stamped and signed (if required). �•�_-yam . Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ' ❑ 11. Sanitation and site plan approval from the Environmental Health Department. _ If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOWBUILDING PERMIT APPLICATION KAFORMSSUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04 A- T&VLOPMENT COUNTY OF BUTTE -DEPARTMENT OF SE VICES -BUILDING DIVISION ,7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 Pl n PERMIT APPLICATION DATA SHEET �j�( OWNER: (�L Se hOQ I � AS SSORPARCEL NUMBE O.J u ✓- f &0� Proposed Building Use: S iid Counter Technician: � Date 10' Items required in order to apply for a per it. All boxes MUST be checked OR marked NA in rder to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and.signed calculations. or4. Engineered truss details and layouts in duplicate. No faxes! 5. Letter from Engineer or Architect for truss design review. , 6. Energy compliance design and supporting documentation in duplicate. i 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, �,C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor glans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ `11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner 14. Hazardous Material Form \SO\- 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico Oroville, as applicable. 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ❑ 20. Erosion Control Plan Required........................................................................ ....... g/ 21. Fees as shown on the attached Schedule of Fees Due She .. ........................ ❑ , 22. City of Chico Plumbing permit ............................ ....... p/ 23. California Department of Forestry plan approval ent by: ............. 'y 24. Planning approval (A) Use: ci�-. (B)Parking: (C) Parcel Check: 7- Ce ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... d11T3�26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 32. -Letter of Signature authorization.................................................................... `❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction.................................................**................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement.of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ` ❑ 39. Other: When issued Telephone J 1 - and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant! 1NfC.Q- Date: - -zoo 1. Index permit application for the above items numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the'above data by ❑ phone, ❑ mail, ❑ counter, by "te: Plans reviewed by: Dale: Plans approved by: Structural reviewed by: Date:, tructural approved by: Note transfer byr=� Date: I J, I/ V 0 t Yellow: Building Division _ COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY'CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 CHEPULE OF RECEIPT OF FEES �j OWNER a S D A.P. # 0�� PROPROSED BUILDING USE V DATE RECEIPT # DATE REC. 1. BUILDING PERMIT FEES --- Balance Due ..................... $ --- AdditiouaLFees Due........... $ o ReviJPlanecking Fee....S RICT FEESaid at rict Office) (form available after Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... X $0.03 = $ Sq.Ftg. 4. URBAN AREA FEES Residential (per unit)..... - X # Units Amt (paid at Building Division) =0. Commercial (Sq. Ftg.).... X = $ Sq. Ftg. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 aid t Building Division) INSPECTION AND PLAN CHECK FEE $89. 0 (paid at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ......... X = $ Sq. Fig. Amt. 10. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking process. APPLICANT 991,L q2IAAI-�DATE Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) '`7 O.B.- I OWNER -BUILDER VERIFICATION Attention Property Owner: ` An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed a2 i property improvement,: YESN NO 11 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 construction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: CITY: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNE - ROPERTYOWNE '-yr� . - n3 Zd6 NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: • If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, s & c el C. Vi ira, C.B.O. M ger, Building Inspection NOTE. This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OVER Il/ BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM M1 I V3 yr (One form per Building) School District r A..P.'Number,, t, ✓ t V �v ✓ % Jurisdiction: City `C n �� 5� 0� I�, . Mi .�Le "'Progeny Owner Property Location/Address �3-7 90 -tel rI ZZ- I Crt e Building Department No. County nW•l4590 Subdivision Lot No. Residential Development Q . ......................:............... .� ..................:..... ...................... Q Q s Sq. Footage " `-' No o Living Mobile Home Addibonl Supplemental to (Group R) Units Installation Convention Permit # . e *(No foundation inspection) ................................................................................................ _ ... ; Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Commercial/Industrial Q Q Sq. Footage New Addition (Including Exterior Roofed Areas) Building Departmen epresentative Date District Identification No. 050072 j zoy t' l,(L U -1)i rA Pi 5t—school District certifies that (Applicant) -� � � �--� ,,✓ � Z-�-c�.t._ GSL ��.. �" i y �o I (Street (City) has complied with the requirements of Resolution No. representing square feet. . S 0 Lk --2,A School District Representative Paid by Check 8A))ARemarks: (Phone Number) LJ (State) (� (Zip Code) 1 0 by payment of $" JAB 2926 $ FULL MMGATI0 o 0 �- Date No9ce: You may protest the Imposition of the Nes Identified above by submitting a written protest to the District, In compliance with Government Code Section 66020(a), within 90 days from the dab Nes am paid. Failure to submit a timely written protest wlli'prehibk you from challenging the Imposition of the Nes In any east action. K, subsequent to the School District Representative signing this Butte County Schools Impact Fee Cerdf cation Foran, the School District is notified by the applicable Local Planning Agency that this project Is being rwlewed under the CalNornla Environmental Quality Act (CEQA) this project may be sutrject to addNioml school Nes to fully mkipate. he Impact on the school districtlt schools. White (applicant), Yellow (building department), Pink (school district) feeforn.xis (10/03)dmm BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION JUN 0 a 2006 AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION APPLICA NAME CONTRACTOR Name 11 City Ad ss Zip City Fax State Zip Phone Map Book Fax E-mail . / � � . Class - LENDING AGENCY APPLICA NAME CONTRACTOR Name 11 City Ad ss Zip City Fax State Zip Phone Map Book Fax E-mail Planner Uc. # Class APPLICA NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLICA NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Flood Zone I SRA JYejs No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NOBk BIN # C Descriptio or Scop oPork- Sq. Footage s) r �.`,21, ? ��z ❑ Structure Built without PermitT ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. ce by: Amount: Receipt #: SRA Sheriff SMIP 161 >4— Dth I � Dater � � (� � ✓Total I I K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 LOCATION Property a /� Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address C Descriptio or Scop oPork- Sq. Footage s) r �.`,21, ? ��z ❑ Structure Built without PermitT ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. ce by: Amount: Receipt #: SRA Sheriff SMIP 161 >4— Dth I � Dater � � (� � ✓Total I I K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 o�vTr�o BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES 0 0 0 0 BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS o -`=� =� 0 24 HOUR INSPECTION#: OROVELLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICA NAME • u CONTRACTOR Name City Ad ss Zip City Fax State Zip Phone Page Fax E-mail Date Approved: Uc. # Class LENDING AGENCY APPLICA NAME CONTRACTOR Name City Ad ss Zip City Fax State Zip Phone Page Fax E-mail Date Approved: Uc. # Class APPLICA NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Page Fax E-mail Date Approved: State License Number APPLICA NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning R -51 Flood Zone Property e = SRAM(Yes- No Occ• Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: c)VtK FUR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING F0RMS\B1doAoo1SubRnmtc.dor_ PERMIT NO B �k BIN Pana 1 of 9 Descriptio or sco o ork- Sq. Footage ❑ Structure Built without Permi ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. ce by Amount 1 Bldg /l SRA Receipt #: Sheriff �® SMIP thpr •at. Qui e_zn_ne 01 Of— 15 LOCATION AP# Q Property e Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, it certificate of worker's compensation must be shown at the time of pennit issuance. LENDING AGENCY Name Address Pana 1 of 9 Descriptio or sco o ork- Sq. Footage ❑ Structure Built without Permi ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. ce by Amount 1 Bldg /l SRA Receipt #: Sheriff �® SMIP thpr •at. Qui e_zn_ne 01 Of— 15 Applicant: Poleschook, Mike Permit 04-1590 Project Type: NSF APN: 058-590-039 100% 70% Plan Check Fees $ 1,028.65 $ 720.06 $ 1,028.65 $ 720.06 WILLDAN Fee $ 720.06 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other Butte County Department ofDevelopment Serviceso �� T r YVONNE CHRISTOPHER, DIRECTOR o Ms_rutherfordebuttecounty. ® o O 0 0 7 County Center Drive O W Oroville, CA 95965 - (530) 538-7601 Telephone cOU N �y (530) 538-7785 Facsimile Applicant: Poleschook, Mike Permit 04-1590 Project Type: NSF APN: 058-590-039 100% 70% Plan Check Fees $ 1,028.65 $ 720.06 $ 1,028.65 $ 720.06 WILLDAN Fee $ 720.06 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other TO: WILLDAN FROM: Scott Rutherford (530) 538-7160 Ms_rutherfordebuttecounty. net SUBJECT: Plans Transmittal For Review Per Contract O W DATE: 07/07/2004 Applicant: Poleschook, Mike Permit 04-1590 Project Type: NSF APN: 058-590-039 100% 70% Plan Check Fees $ 1,028.65 $ 720.06 $ 1,028.65 $ 720.06 WILLDAN Fee $ 720.06 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other OSPPRTMeNT o� �vTTF O ��-•,. O o o c O O, rr 9 �Jklc WO0` Department J. Michael Crump, Director Public Works LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville. CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Act nowledgement [LESS THAN 1 ACREI Project Description: SGl�00 �- Project Location and/or Parcel Number: By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: � Title: Date: O 3 _ 2.0 C'4: Less than 1 Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04 LF LSU EHOHEEROHa 5790 CLARK ROAD, PARADISE, CALIFORNIA 95969 Mr. Mike Poleschook 3790 Grizzly Creek Yankee Hill, CA 95965 (530) 872-0254 FAX (530) 872-9331 May 14, 2004 Subject: Statement Job No: 4051 Project: Poleschook Residence - 3790 Grizzly Creek, Yankee Hill, CA Structural review of single family dwelling plans for lateral stability in compliance with 2001 California Building Code and consultations with the building designer for required revision. Based on 1 hr @ $85.00 Total due to date $85.00 SECS �D 5 / ®lk'TE-----' r -LT F-NGINEERING y,. Date:" j Z:,; SITE PLAN REVIEW APPLICATION AP# Permit Number (if applicable) Bin Number APPLICANT INFORMATION Parcel Size: "`�• Owners Name: Owners Address: /,365." Telephone No.: r%�3y ' 5( q Ze�fJ Situs Address: .3 7 U 6v-�'22 Proposed Use: Residential New Single Family Residential ala -mew -e f ❑ Single Family Addition ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well ❑ Agricultural Buffer Form ❑ Applicable ❑ 'N/A DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval (� Site n Stamped pproved By Date Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ® Snow Load Area: ©� '2 -5 -OZ) ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract F-1NitrateAction Plan m (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) Expansive Soils (Test for expansive soils and if verified proper foundation design required) SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: j< • Flood Panel No.: 0 S 71& Index Date: Com' - 0 -1 129 ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance -------- ------------------------------------------------------------------------------------------- ------------ ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: E-� - &-P: t-4-2 Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. 1§ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 t Zoning Code Streets & Highways Fire Prevention Subdivision Map Front Side '' 2 d Side Street .Rear 10 Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. 1§ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 t Applicable Development Fees: Standard Fees Amount ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other. Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) Formula * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By []Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: e4f-C-6L ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot. Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 09 Subdivision Map/Parcel Map: Map Date of Recording: Lot: % ❑ Use Permit/Minor Use Permit Permit Number: 6--l- -Z3 1�,- 03 Book: 1, -7 Page: Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions. ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and'P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with -hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for road maintenance, and stop sign maintenance. ❑_ 0 Page 4 of 5 0 x Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the tirre of review. CALarrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 N;�VW I LLies Serving PubliDA�N August 30, 2004 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 (530) 538-7169 (530) 538-2140 FAX 117 C Street Marysville, California 95901 530/749.2373 fax 530/749.2199 www.willdan.com SUBJECT: COUNTY OF BUTTE PLAN REVIEW, APPROVED Willdan Project No: 14359-1026 Jurisdiction Job No: 04-1590 Assessor's Parcel No: 058-590-039 Description: POLESCHOOLK RESIDENCE Dear Mr. Rutherford: Willdan has completed a plan review of submitted plans and documents for the above referenced project and recommends your approval. The plans and documents provided for this review that have been found in compliance with the applicable codes are: Plans: Two (2) copies 1 —E1 (6 sheets) dated 4/30/04 by Kyle King Associates Energy Calculations: Two (2) copies dated 5/14/04 by Don Freemyers Truss Calculations: Two (2) copies dated 5/11/04 by Ray Yu The plans have been stamped with the Willdan approval stamp and dated the date of this letter. According to our previous letters relating to this project, the superseded plans and documents will be discarded within 10 days unless we receive other instructions. On the pages to follow is the identification of the codes and standards applicable to the project, a code analysis, and identification of any deferred submittals. APPLICABLE CODES Unless noted otherwise, all comments are based on requirements of the 2001 California Building Standards Code found in the California Code of Regulations, Title 24: • Part 2, known as the California Building Code and abbreviated herein as "CBC" • Part 3, known as the California Electrical Code and abbreviated herein as "CEC" • Part 4, known as the California Mechanical Code and abbreviated herein as "CMC" • Part 5, known as the California Plumbing Code and abbreviated herein as "CPC" • Part 6, known as the California Energy Code, and Energy Commission Standards, and abbreviated herein as "CECS" WILL®AN Serving Public Agencies CODE ANALYSIS Type of Occupancy Type of Construction Sprinklers 1" Floor 2° Floor Stories S Ft S Ft Total Sq Ft V -N No 1 1548 1548 R-3 U-1 V -N No 1 462 462 Covered Porch V -N No 1 110 110 SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. DEFERRED SUBMITTALS Our plan review reveals no deferred submittals noted at this time. Sincerely, Sam, Kuster Plans Examiner Ricardo Guzman, S.E. Plan Check Engineer CC: Alice Mefford at Butte County Email: amefford(aa)buttecountv.net Mike Pol.eschook, PO Box 794, Paradise, CA 95967 E.H-�Vsg ONLY Plot Plan Anach4�1 Roos Plan Attached Sant to S.D. / TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance ?.o lis G g Owner, a on AP# Plan Approved for: Sewage Disposal Water Sup Public Private Wel Clearance for dwelling. Other` A 1J+(�/'-� � —P 4 Hold final for: Final clearance O.K. for: NOTE: Environmental Health Specialist Date 8/96 r ' APPROVED FRONT E L SVA TION m A `1N3�o� 0 R y17►r,, . y ��01 The SANDSTONE' PLAN No. 2110 1,548 SQUARE FEET Jf;6o3 I� F"WM PA(XAGW H0bM �a vm.&d.. ,a cmc *Sawa 2=00. a-0. ear H.w.nom. w.o. aox neo (aaa Sao-- oti dao nor-owc PERMIT NO: `3195-80P,E PERMIT EXPIRES d O • 10 Rbbert Middleton OWNER CONTR. owner LOCATION (A.P. 4l�l_lT9 ) S/S Grizzly Creek Rd., app.1800'E.of Velvet Lane, Yankee Hill Called PG&E mpElec. Serv. Z .. /FINALED— alled PG&Ep. Gas Sery alled PG&E • (Date) ( ignatu ) f k 1 " ` r. r r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING S31back F wall So Ikp ipIng Fo s Paragets lstvloor M n Bldg. Rest r m Finish 2nd Noor otin s Window 3rd FI r St wall Siding To out Slak Roof SheatNng Water Pi in Pierk Roofing Sewer Garage Fdn. Vents Fixtures Footin Stemwa 1 I Garage Vents Insulation Water Htr. Heaters Slab / Carport Footings t Prov. for phy handicasicall ed Conformance of ex. structure A Iiances Gas PI In &Test Temp. Gas Slab Final Sanitation Patio FIREPL CE Final Footings Footing ECTRICAL Masonry Walls Throat Rough Reinf. Steel:' Final Fixtures Bond Beadf FIRE SPRINKLE Motors Framing / Test Water Htr. stucco Final Sub ane Mesht MECHANICAL Grd. F It Prot. Scrch HeatAq Servi B " n Co Ing T mp. Pole nish D cts nder round erior Lath entllation Permanent oor Closer 41 Inal IFinal MOBILEHOME UTILITIES ------------------ EIBc. Service Z@8 %-2.P—$6 leij[, Elec. Pedestal7 _ -2- Water Water Piping- _ 2)-o Sewer Gas Piping E OME INSTALL ---- Support 7—ZS —ru C n Elec. Continuity Water Piping r-zs---kQ Drainage-f--Z<&r0 Gas Piping DATE REMARKS 0 ORRECTIONS /-Z 14e 10 e s, ,2d eOS Zd (NOTE: An entry must be made on this form each time you visit the job site.) 9. .Electrical A. Is service large enough to provide adequate amperage -to mob ilehomd'(mus t, equal rating of mobilehome with a minimum of 100 amp) and other facilities on lot,'i.e., water pumps, garage, cabana, etc.? Yes (- No_ B. Is there proper clearances around panels? Yes No_ ' C. Is power supply cord or feeder assembly properly fused? Yes 1.1/110 D. Is continuity test satisfactory as per the following procedure? Yes_ No 1. De -energize electrical wiring system of the.mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply.conductor, including neutral. 5.� All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6: Upon completion of the above procedure,. the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode.and the chassis of the mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing, 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or NamestyleCi��� Length foo Width Vehicle Serial No. State Identification No, Additional Information or Comments: N MOBILEHOME INSTALLATION INSPECTION CHECK LIST ' 1. Is the'mobilehome located with required separation from lot lines and buildings and generally conform to plot plan? Yes o- 2. Does the mobilehome have. required clearances above ground? (Sec.5085) Yes° No 3� Are footings and supports properly sized, spaced, and braced as p approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes No 4. Is the mobilehome level? (Sec. 5088) Yes /No 5. If mo�e than a single unit, are -crossover connections properly installed? (Sec. 5088) Yes�r// No 6. Water A. Is fle ble connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No. B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes v C. Backflow - If coach S ate of California approved, does station have backflow device and pressure-relief&ae Yes— No - 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes— No B. Does it have minimum 4" per foot slope and is it properly supported? Yes— No C. Are any leaks detected in drainage system after running3- llons of water through each fixture including washing machine standpipe? Yes_ No— D. D. If coach is notOSS #�Californiaapproved, does station have required trap and vent? Yes— No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobil ome gas line inlet without reductions other than the mobilehome connector. Yes_ No B. Test OK as per following procedure? Yes_ No . 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes V No— COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 695 Oleander Avenue, Chico — Phone 343-4211, Ext. 70 7 County Center Drive, Oroville — Phone 534-4541 Skyway and Elliott Road, Paradise — Phone 877-343: a CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office . when correction of work is completed. If you have any question periaining to this matter, or need additional explanation, please contact this office Immediately. J, �c 1`j`1I cle"I Inspector G�/ Date �' 14 r� cle"I Inspector G�/ Date �' 14 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE, OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, . Chapter 51 under permit number .for the following location: Owner Owner's Address Mobilehz)me Mfg. Model Year. Insignia No. Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Date Director of Public Works By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ASS�S.SQ//R �R,7CEL {VyiM ¢€R ZON.G BUILDING PER OWNER e066;E7' M/DDLCTOAl TELEPHONE SO. FT. OCC. BUILDIN ALUATION OWNER'S MAILING ADDRESS CQyJ T�R AC� R•5 NAM;., /�Jj M• ,s SHONE 33-108 1 ADDR {.($� A %/V607 7652 TQ{i MA�I�%o %/V60 76S 2—P,4 CONSTRUCTION LENDER UNKNOW& Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$' Penalty $ .ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BU L ING ADDREZS� s =1�zZL G,eE-� PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO. SUBDIVISION NAME J.PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Maobilehome Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK r , New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationOther ❑ Describe work: _ — 69R— &I7`�(, 19C-1Z/t,J 3/ 9��00 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 1000 AMP ORLESS5.00 Main service EA. ACD'L 100 AMP 2.50 NEW CONST. (DWELLING OCCUP.& OR ACDNS. ` ACC. BLDGS. 22 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): �l am licensed under provisions Of Chapt. 9, Div. 3 of the BUStneSS and Professions Code and my license is in full force and effect. �^ /� � /' License No. Z145 [GtG>—:? Classification �[1] ❑ 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 CONSTRMULTI-OUTLET 2.50 ea NON-RESID BRANCH CIRC ITS NEW CONSTR / POWER APPARATUS 81 NON -RES D. SINGLE OUTLET C1R. / EX. OCCUp(OUTLETS OR FIXTURES BALI BALe1°s EX. Occup./FIXED APP LNS. OR \OUTLETS (RESID.' EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. N-4—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 3.00 Heating Cooling Hood 2.00 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 s C .nty in consequer�c�e granting of this permit. X 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 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE $ �Oa OCcUP. GROUP I TYPE OF CONST. PARCEL PD 1) I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECT F PUBLIC BY PER EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date -7 ZZ D�� ?-ZZ -O Receipt No. 31 WHITE-D.P.W., YELLOW-ASSF-SSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: �D C�c�22 r�rl I� rl 2. Installer's name: 300n1 M A J I,C an A,9- 6ti—U C G- 3. Is the site currently under permit? Yes Lam' No L-1 ( If yes, furnish permit number. OR Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans:) F. 4. Will the mobilehome be located at least 5 ft. away from septic tank and leaoh fields and clear of all setbacks and easements? Yes No 12. What is the mobilehome gas.demand?------------------------------ (BTU) (This information not required 'if pipe length less than 61t. on natural gas . or less than 50 ft. on LPG.) 3 %6.3-90 BUTTE COUNTY BUILDING DEPARTMENT APPROVED %a- (If no, clarify ) ( ) 5. What is the mobilehome electrical rating? -------------------- Amps, 6. What is the mobilehome site service rating? --------------------- ,2,9 C7 Amps 7.. What is the mobilehome site circuit breaker rating? ------------- An e7 Amps 8. Is there any other electric load to be served by the mobilehome site service? -- Yes No T- (I£ yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- -3 (in.) 10. What is the type of gas service? ----------------------------- Natural' 77 LPG 11. What is the gas pipe length from meter or tank to the mobilehome? 12. What is the mobilehome gas.demand?------------------------------ (BTU) (This information not required 'if pipe length less than 61t. on natural gas . or less than 50 ft. on LPG.) 3 %6.3-90 BUTTE COUNTY BUILDING DEPARTMENT APPROVED %a- MOBILEHOME SUPPORT DATA I If other than single wide, l Mobilehome Mfr. C�-Taonl furnish Setup Model No.-OpP Year Width—(ft.) Box Length_(ft.) Tagalong or Expando Size '-Z x--L-q—ft. (SHOW SUPPORT DETAILS BELOW) 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). All center supports measured from front of mobilehome unless otherwise specified. Footings (check one) Single 1 Wood ather I — I (ft.)(in;) Center support locations* (ft.)(in.) (ft.)(in.) (ft.) (in.) (in.) (in.) Center support footing sizes (in:) x (in.) (in.). �� (in.) (in.) (in.) (in.) L_X J I. (in.)I (in.) *If center piers are other than drawn above, _--draw. in -locations,- spacing, and dimensions. Mme- pressure treated or foundation grade. 2. Other (specify) Supaorts (check one) Concrete block: 2: Other (specify) -Tagalong or Expando,' show support details. Typical Support (in.) (in.) Footing Size S^ " -- Max.. Pier Spacing (ft.) (in.) (ft.)(in.) -- Max. Overhang COUNTY OF BUTTE - DEPARTMENT OF. PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSES PARCEL NUM E ZO IN= BUILDING PERMIT OWNER l ^^ T LEPHO E SQ. FT. OCC. BUILDING A DATION NER' Al LIN DURESS e� 3 CONTRACTOR'S ITAME r ITELEPHONE CONTRACTOR'S MAILING -ADETRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUIL ING A ESS S S r PLUMBING PERMIT Filing Fee 3.00 _4ppt Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping Q LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2,00 Gas piping system 1 - 5 outlets ,Da USEOFSRUCTURE [ISF Duplex❑ Mobilehome Other SPECIFY Building sewer 49 0 Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ UtilitiesInstallationC Other ❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 1000V OR 0 AMP ORSLESS 5.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELING OR ADDNS. ( ACCLBLDGS.CCUPM —NNON-CO 22 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El 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 NE RESID R. BRANMULTICH CTIRCLET ITS 2.50 ea NEWCONSTR POWER APPARATUS .&) NON.RESI D. (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES g L01� FIXED APPLNS, . R Ex. Occup. OUTLETS (RESID) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 9 - Misc. Wiring 6.25 , YJ I,.1 O Permit Fee $ , Contractor WORKMEN'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): I have placed on file with the County of Butte Building Department #�_The permit is for $100.00 (valuation) or less. a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. PK1 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 3.00 Heating Cooling Hood 2.00 Ventilation pennit Fee $ Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the 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 agai s Co y in copse e c o the granting of this permit. X ° Date 4fl�� Signature of Applicant J OwnerF Contractor ❑ AgentEV 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 $ Land Development Fee $ r TOTAL PERMIT FEE $G occUP. GROUP TYPE OF CONST. PARC P ND SSUE Y This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OFAUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. 9Q_or� WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT BUILDING DIVISION COUNTY OF BUTTE - DEPARTMA.W;OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIF NIA 95985 - TELEPHONE: (918) 538.7541 AGRICULTURAL BUILDING EXEMPTION PERMIT ERMIT NCj 1 Agricultural building is defined as follows: Agricultural building Is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. 15&SS�O0PAo EL NO. ZONING F OWNER �1 PHONE NO. J OWNER'S ADDRESS o L e o ;L G e LOCATION OF BUILDING f.O O M _ I� Z 'e q00 USE OF BUILDING SIZE OF STRUCTURE .�2D X�SO.FT. TYPE OF CONSTRUCTION: WOOD FRAME �� STEEL CONCRETE OTHER (Specify) TYPE OF SIDING ©off ROOF COVER G M DM FLOOR TYPE ESTIMATED CO T OF CONSTRU&J@N AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances as follows: FRONT SIDES %O REAR /�o f AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. AG Buildings must comply with Flood Zone requirements. Finish floor elevation must be at or above elevation USGS Datum. I declare under penalty of perjury that the building will be used as stated above and the purposed use conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and obtain any necessary permits, inspections, and approvals to comply with the uirements in effect at that time and before occupancy. Date 2-- Signature of Owner / Permit Fee - $50.00 The above described AG Building is exempt from a building permit. Receipt No. 12-301 � FLOOD PARCE P.D. ROOFI ISSUE Manager Building Division BY DateZ— White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant ,4,...,.j'r*"�;."Si'4rr•.tf:ti,71�?"f,t.-�,.rJtlrr'i��r?t..•� ji'j,7r�)`rN7�c/{/.... r�,,�r�:.`�+'.v:.. _n .. CO_l7N_Tlf OF BUTTE - DEPARTMEN ,PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION D SHEET OWNER woj6erv- 1,91,1 -mi . P. No. 0-'5__c9- `; Fes- 03� Proposed Building Use G E',rgA4D Building Inspector AD Date � g � Z - At timeof ermit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ....................................... . 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ..................... . 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................. 6. Energy Design Compliance and supporting documentation . ................. . 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. .......... . 10. Fees of$ .......................................... 11. Impact fees as shown on attached schedule . .............................. 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 Pre Inspection requeis- required. . to Building Inspector (Dale) 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 . ........................................ 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 checklist...................................................... 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date !� Copy of Haz-Mat form sent Health Dept. Fire Dept. r 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 Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works N TES z � i t PERMIT NO. RESIDENTIAL U58-590_-03_9------ 04=IS90` POLESCHOOK, MIKE 3790 GRIZZLY CREEK RD, OROVIILE Cont: OWNER NEW SINGLE FAMILY REPLACE s i 1 I s • Z SPECIAL CONDITIONS , CHECKED BY . SRAFLOOD CERTIFICATE REQ. - s FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS + VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER LA N lam' (1/6- rs p��� OFFICE COPY { Address J � /d ; Cj t7j) I GAS sza/!-1 Meter By f Date ELECTRIC P� Meter By �� Date �� I JOB FINALED (Date) ► G' z Signature-•-�� / at �,���� FAP.WEST HOMES 360 746 6443 06/02/05 11:24am P. 001 'ca:tw nn.gas .s mPai.-qel Wall Syst+ mll 887 NW State Avenue PQ Box 480 Chehahjg, Washington 98532-000 (360) 749-3351 (900) 752-0500 Facsimile Q3ii0) 748-6443 W%vw. Farwrs4l4omcs.coan Certification of Con&r ance June 2, 2005 To. Butte County Ref.: ]Mike Poleschook. The Mike Polescbook Residence at 3790 Grizzly Creek .ltd, Yankee .)Hill, CA was pre, -constructed in our plaint in Chehalis, WA. During construction the .nail off and shear wall nailing was inspected and f'ou* nd to meet both 1997 U.UC and 2001 Califomia Building Code, Fable No. 23-,1. t -B -t, as noted per floor plan. notes Sheet 1. 6.�, � I Tracy Moore Quality Control Shawn Jones Director. of Sales Bill QIder, Plant Manager J=OK 0 = Not OK : Not + = NotReadyablE- 1. MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 3. 1. Zoning Requirements -Setbacks -Easements Wood Awn.; Posts- Beams -Rftrs-Connectors Shthg-Frg-Bracing 2. Soils; Special MH Support Sketch 6. 3. Sewer; Location -Test -Fall -C/O -Concrete Electric 4. Water; Location -Test -Easement Needed (Sketch) 9. 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Plumb.; Cir. Test -Water Supply Test 6. Gas; Location -Test -Wrap;-/ /" L'ft. / P Nat. or / /" L "ft./ P LPG 12. 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoniig Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with C Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 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- Beams -Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date 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, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes -Enclosures- Panel boards- Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 = OK = Not OK = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date �_ UNDJERFLOOR (Plans) OK except #'s \" \Q. W9., Main; Soils-Elec. Grnd.-/ / /" Vg. Depth 3.14g., Garage; Soils-Steel-Elec. Gr .-/%Z /" Ftg. Depth 4 tg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 51 Oternwalls, Main; Steel-Blockouts-Wrapped V 1,6a/Hold Downs and SDecial Anchors 7. lab, Steel -Wrapped 8. iers-Fire lace Ftg.-Steel W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test Ur UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. *I Girders -Sills -Anchor Bolts-Joists-Vents-Crippies V5 -Access & Ventilation 16. Insulation Date IL oto Card B-1 Date Card B-1 Date Card B-1 %mr-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Water Htr.; Vent -Access -Combustion Air Baffle 118!fater Pipe; Test & Anchor -Nail Protection 1 . D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access Gas Pipe; Sixe & Anchors 23. Fire Sprinkler; Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s Fixture & Transformer Clearance -Ins. Protection 26.�Elec. Receptacles Spacing -Lights & Switches at Doors 2%j ize Boxes & No. of Conductors Stapled Romex Installed Close to Edge of Studs & C.J. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 2 Appliance Circuits in Kitchen & Conductor Size GFI ?2�. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31- Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral ❑ Yes ❑ No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. Clothes Closet Light -Shower Light -Spa Light 35!Smoke Detector Date Z Card B-1 moi( Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 4• .,Sills Proper Materials & Anchors Walls Studs -Nailing Spacing & Braces -Plates -Sound Baring Walls over Girders & Floor Nailing Draft Stop in Walls (rat proof) 5. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46 eaders & Beams -Size & Bearing Date FRAMING (Continued) 7. Hangers -Post Caps -Anchors -Connectors 418. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. .. ireplace Ties or Type AFlue-Fireplace Throat Clearance . A is Access; Size & Romex Protection -Draft Stop -Ins. Baffles . Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 8. Garage Fire Protection Framing -RC Channel . P.operty Line Firewall & Openings . 51f.' Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection ._ Plywood on Roof Overhang -Attic Vents -Rafter Outriggers ,57!$iding-Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access p-tiazing Area -Glass Protection -Skylights -Plastic 60. Shear Is; Nailing -Bolts 61 QTFracWte6o Exter' all Panels 62. nsulatior Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1( Date Card B-1 Date Ca B-1 F Date Card B-1 Date FI 64. 6,V/Smoke tans) OK except #'s jKvt. Steps -Door & Sidelight Protection -Landings Detector Furnace Vents -clearance -Comb, Air -Connector - 1 Garage; Above Floor-Ducts-Mech. Protection Bedroom Exiting 8. I. & Bath Fixtures & Tub Access -Spa F} c. Trim & Subpanel, Breaker Sizes & Labels 7 .airs & Rails 7 5wplace or Stove, Clearance -Hearth 72. ec. Outlets at Wood Panel, Int. & Ext. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 56it. lec. Outlets & Receptacles at Kit. Counter 5. Garage Fire Door; Swing -Landing -Closure 76. .C. Duct in Garage -Damper 7 . Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. Garage; Above Floor-Mech. Protection 7 . Ib.; Elec. & Mech. Equip. Listed for Location n. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80.,Insulation- Foam -Looked in Attic 8prfuard Rails & Deck Construction -Post Caps Fdn. VBents & Crawl Hole Door Drainaae & Wood -Earth s Clearance Looked under Floor ❑ Yes _ 83. Following Instld./Drive ❑ Yes ❑ No/Walks O Yes ❑ No/Planters ❑ Yes D No 84. ucco Brown -Finish S±_ C. Unit Disconnect, Electrical -Plumbing 6. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Xater Well, Disconnect, Electrical, Plumbing 8. xterior Elec. Trim, G.F.I. Receptacle- Undergr and 9. Ventilation Throughout House 0. Glass Protection 91. Porrections from Previous Inspections . Gas Test -Meters Tagged, Gas -Electric ..Water & Sewer Connected -C/O to Grade -HD Approval 4. ergy Compliance Certificate�ther Certificates Address Posted 96. Fire Sprinkler Date f` 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: s A P 0 55 - 590 -- cN39 IKL tic) LCScHOoK- I' C 130X -7 9 4- PAKAOiSI CA 75y67 SO 514-;! 6Cl x`79(' C'ZIZ7.1_) cPL, R0 YANKS Nr�c,cq E:X1Stl� ,ELL 1 pL Z \ \ \ 72 \ \ tri O Ac i i Z �+URK 0 E:X1Stl� ,ELL 1 pL Z \ \ \ 72 \ \ AO TACENr r'A►2cEir i 9 9� AC 1- r , / s< S 50 �Yll 0 O 36 OAIk ADJ-ACErJ i PARCEL. S .69 AC . 1=K-5 S C A L.E '. I . _ *"� � I M m z Ac i 1 1 Z �+URK AO TACENr r'A►2cEir i 9 9� AC 1- r , / s< S 50 �Yll 0 O 36 OAIk ADJ-ACErJ i PARCEL. S .69 AC . 1=K-5 S C A L.E '. I . _ *"� � I M m z