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Home My WebLink About058-690-0080 - DON NICKELS Lot 7, Hwy --7' , Deer Peak Estate, Orovi 1 O �.. PErmit#21O3-87B(new Bazebo) 0 58-69-9; Contr. ranks D!lzer.er PErmit#3 _ 7PE(util GAS wGGC� SUPPORT STRUCTURE COMPACTION TEST RE _ n Contr : JimFi -08 �I,TlO 7 -PErmit#378 I Issue 0 r � � �� -� i ��a, �, �. 'I I, 1 370 PERMIT NO. 3651-87P.E(MH) .; PERMIT EXPIRES o ,_ OWNER nQN NTCKET, CONTR. Frankg Dozer ' ASSESSOR PARCEL 5R—hA� LOCATION Jtiay.7Q, T)aar Peak FGtatP, 1 of 7 Oro .1 r OFFICE COPY r Address Temp. Power Zr By Date Collect P( ELECTRIC r Meter By. ff Dated Temp. Elec. L_ - Called PG&E d Temp. Gas Service Called PG&E JOB FINALED (Date) v "� Signature C = OK 0 = NotOK - =Not Applicable RESIDENTIAL (Single and Duplex) ' = Not Read) Date UNDERFLOOR (Plans) OK except #'s Date FRAMING (Continued) 1. Zoning requirements-Setbacks-Easements 44. Hangers-Post Caps-Anchors-Connectors 2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 45. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. 3. Ftg., Garage; Soils-Steel-/ /" Ftg. Depth 46. Fireplace Ties or Type A Flue-Fireplace Throat 4. Ftg., Porches & Decks; Soils-Steel-/ /"Ftg. Depth 47. Attic Access; Size & Romex Protection-Draft Stop-Ins. Baffles 5. Stemwalls, Main; Steel-Blockouts-Wrapped 48. Bdrm. Windows or Exiting Doors-Sill Hgt. & Dimensions 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 49. Garage Fire Protection Framing 7. Slab; Steel-Wrapped 50. Property Line Firewall & Openings 8. Piers-Fireplace Ftg.-Steel 51. Ext. Doors-One 3'-Check Garage-3rd story, 2 exits 9. D.W.V.; Fall-Fittings-Test-2 way C/O-Sewer Test 52. Stairs; Width-Headroom-Rise-Run-Landing-Fire Protection 10. Gas Pipe; Size-Anchors 53. Plywood on Roof Overhang-Attic Vents-Rafter Outriggers 11. Water Pipe; Test-Anchors-Regulator-Service Test 54. Siding-Nailing Veneer 12. Electric; Underground 55. Stucco Mesh-Drip Screed-Fd. Vents-Underflr. Access 13. Plenums & Ducts; Clearance-Material-Supprt-Ins. 56. Glazing Area-Glass Protection-Skylights-Plastic 14. Girders-Sills-Anchor Bolts-Joists-Vents-Cripples 57. Shear Walls; Nailing-Bolts 15. Insulation 58. Insulation-Walls-Clg. 59. Infiltration-Walls-Wndws Card-B1 Date Card-81 Date Card-Bt Date Card-81 Date Card-B1 Date Card-131 Date Card-B1 Date Card-B1 Date Date PLUMBING Permit OK except #'s 16. Water Ht. Vent-Access-Combustion Air Date FINAL (Plans) OK except #'s 17. Water Pipe; Test & Anchors-Nail Protection 60. Ext. Steps-Door & Sidelight Protection-Landings 18. D.W.V.; Test-Fttngs & Anchors-Nail Protection 61. Smoke Detector 19. Shower Pan; Test, First Floor-Tub Access 62. Furnace; Vents-Clearance-Comb. Air-Connector- In Garage; Above Floor-Ducts-Meth. Protection 20. Test Tub & Shower, 2nd Floor-Tub Access 21. Gas Pipe; Size & Anchors 63. Bedroom Exiting 64. G.F.I. & Bath Fixtures & Tub Access-Spa 65. Elec. Trim & Subpanel; Breaker Sizes-Labels Card-61 Date Card-81 Date 66: Stairs &Rails Card-131 Date Card-B1 Date 67. Fireplace or Stove; Clearances-Hearth Date ELECTRICAL (Permit) OK except #'s 68. Elec. Outlets at Wood Panel; Int. & Ext. 22. Fixture & Transformer Clearance-Ins. Protection 69. Kit. Fixt. & Appliance; Grnd. -Air Gap-Cooking Clearance 23. Elec. Receptacles Spacing-Lights & Switches at Doors 70. Elec. Outlets & Receptacles at Kit. Counter 24. Size Boxes & No. of Conductors-Stapled 71. Garage Fire Door; Swing-Landing-Closer 25. Romex Installed Close to Edge of Studs & C.J. 72. A.C. Duct in Garage-Damper 26. Equip. Ground made up w/Mech. Fasteners-Bond Gas & Water 73. Wtr. Htr.; Vents-Clearance-Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 27. 2 Appliance Circuits in Kitchen &Conductor Size 74. Plb., Elec. & Mech. Equip. Listed for Location 28. Su Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga. or Cu or AlA 75. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 29. Range Circ. / / ga. Cu or AI-Oven Circ. / / ga. Cu or Al. Insulated Neutral Yes No 76. Insulation-Foam-Looked in Attic 0 Yes 77. Guard Rails & Deck Construction-Post Caps 30. Service-Riser Conductors & Ground-Main Disconnect 78. Fdn. Vents & Crawl Hole Door-Drainage & Wood-Earth Clearance Looked under Floor 0 Yes 31. Equip. Clearances Panels-Motors-Mech. Equip. 32. Clothes Closet Light-Shower Light-Spa Light 79. Following instld.; Drive 0 Yes 0 No; Walks 0 Yes 0 No; Planters 0 Yes 0 No 80. Stucco; Brown-Finish Card-131 Date Card-131 Date 81. A.C. Unit; Disconnect, Electrical, Plumbing Card-131 Date Card-131 Date 82. Vents Above Roof; Plbg.-Appliance-Firepl: Clearance to Openings. Date MECHANICAL (Permit) OK except #'s 83. Water Well; Disconnect, Electrical, Plumbing 33. A.C. Ducts Insulation & Support 84. Exterior Elec. Trim; G.F.I. Receptacle-Underground 34. Vent Fan; Exhaust above insulation 85. Ventilation throughout House 35. Condensate Drain & Overflow; Size & Grade 86. Glass Protection 36. Furnace-Vent; Access-Comb. Air-Return Air Vent-115 outlet 87. Corrections from Previous Inpections 37. Attic Access & Platform if Furnace in Attic 88. Gas Test-Meters Tagged; Gas-Electric 89. Water & Sewer Connected-C/O to Grade-HD Approval 90. Energy Compliance Certificate-Other Certificates Card-B1 Date Card-B1 Date Card-131 Date Card-61 Date Card-81 Date Card-B1 Date Date FRAMING (Plans) OK except #'s Card-B1 Date Card-131 Date 38. Sills, Proper Material & Anchors Card-81 Date Card-B1 Date 39. Walls Studs-Nailing, Spacing & Bracing-Plates-Sound Comments at Final: 40. Bearing Walls over Girders & Floor Nailing 41. Draft Stop in Walls (rht proof) 42. Fire Stops; Furred Ceilings-Stairs-Chases-Tub 43. Header & Beam-Size & Bearina (NOTE: An entry must be made each time you visit job site) =OK.- 0 Not OK Not ' = Not Ready MOBILE MOBILE HOMES ` MISCELLANEOUS Date MQJKE HOME UTILITIES Plans OK except #'s Date DECKS,COVERS,CARPORTS,GARAGES, (Plans)OK except #'s te;oning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -Easements s; Special MH Support -Sketch 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel Se er; Location -Test -Fall -C/O -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails er; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts- Beam s-Rftrs.-Con nec.- Shthg.-Rfg.-Bracing Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete Location -Test -Wrap: / /"L"ft. ///"Nat. or/ /"L"ft./ /"LPG 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors Utility Clearance 7. Elec. 8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh Card -13 % Date -- rd -131 Date 10. Roof; Shthg-Roofing Card -13 Dat - /,9xard-B1 Date 11. Ext.; Steps -Doors -Landings Date - -MOJKEHOME INSTALLATION (Plans) OK except #'s . Z "ing Requirements -Setbacks -Easements Card -B1 Date Card -B1 Date Footings; Size -Spacing -Marriage Line Card -131 Date Card -131 Date MH Test -Demand -Valve -Connector ctricity; MH Test -Crossovers -Breakers -Clearances Date POOLS (Plans) OK except #'s in; MH Test -Fall -Flex Connector 1. Setbacks -Easements A, . W fer; MH Test -Regulator -Connector 2. Soils; Compaction -Structure Stability ater and Sewer Connected -C/O to Grade -HD Approval 3. Pool Structure; Steel-Connections-Thickness- Dead Men -Lining ,�[ 8. 9afand Electricity Tagged ts; Insp.-Sketch 4. Elec.; Receptacles and Lighting, Distances-GFI W.'Cert. of Occupancy 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' -circulating Equip. -Pool Lghtg. Boxes-Enclosu res -Panel boards- Ins. to Main in Conduit Card -B1 Date — --� rd -B1 Date Card -81 Date and -131 Date 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Card -61 Date Card -131 Date Card -B1 Date Card -B1 Date t%I t�D t�/ -7 / 9 C/ MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA — 534-4541 PERMIT N0. Address or location of mobilehome Owner's name Owner's address Insignia or hud number Manufacturer's name Serial number of V.I.N. Year of manufacture (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. i 513B White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE IT NO! A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work Is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector ! ' y Date ER COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE T NO. A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work Is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector 40/ —Date—//— / " 1?t — ') 7 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE 31s/�7 PERMIT NO. A routine inspection Indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office Immediately. P G�--� Ins ecto� Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS ,..7 County Center Drive - Oroville, California 95x65 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. �1 ASSESSOR PARC UMBEZONJNG, ,/ CI/may) BUILDING PERMIT OWNER ITEL_E/PCH Xont SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDR SS Y CONTR T 'S NAME / T EP NE CONTRAC OR',5_1S f�L G A D ES ,. �^/, o� c� v r v Fireplace 4$ CONSTRUCTION LENDER UNKNOWN Total Valuation Filing Fee $' LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$ .00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDR SS n r / Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARC L MAP .S lf, Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeX Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer .5.00 Mobile Home bO.00ea TYPE OF WORK New ❑ Addition [:1Remodel ❑ Utilities rR Installation❑ Other ❑ Describe work:0—V Awel�_ Permit Fee $ Contractor 0119 ELECTRICAL PERMIT Filing Fee 10.00 i Main service TOO AMP ORV OR LESLESS 10.00 /.),00, Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): 1=/I 11`XJI I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. 335% o2s �I Classification ❑FIXED 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP"' , ACC. ) h¢sgft New CONSTR. TBI.OUTLET NON.RESID .BRA CN CIRC Ts 2.50 ea APPARATUS &) (SINGLE OUTLET CIR. Ex. OCCU OUTLETS OR FIXTURES 20A50t P eAL93o PR Ex. Occup. OUTLETS (RESID )EA.Y 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 9 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. JZ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in c of the granting of this permit X Date 1f hin Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct -1 ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.TYP! SCHOOL Rio o� q/ PARC! r NO 39U This permit is hereby issued under sions f the Butte County Code and/or wa I icated bove for which CTQR OF PUBLIC ey PERMIT EXPIRES Date _ the applicable provi- resolutions to do fees have been paid. WORKS f Date `// /ice Al// fi Receipt No. a0 rg✓ WHITE-D.P.W.. YELLOW-A389330M. PINK-INSPC R, GOLDENROD-APPLI CANT AP # 5 lD OWNER PERMIT�k_��5�"� MH UTIL.CLEARANCE DATE INSPECTOR ELECTRIC GAS Support Struc. Compaction Test Reg. Service Size Other Load Type Pipe Size Length YES NO YES NO COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION i i 7 COUNTY CENTER DRIVE - OROVILLE, CALL. RNTA-$5965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET t Permit No.— OWNER o. OWNER AaC A. P. No. to + Proposed Building Use �� 6,(— Building Inspector// Date At time of permit application, I was advised the following data must be submitted prior to permit processing �t , and/or Issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate/triplicate, signed by preparer of plans. . 3. Complete plans in duplicate/triplicate,, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. School District "Fees Paid'' Stamp on Floor Plan. 7 Statement of Intent for Non -Heated and AC Buildings.. . . . . 8. Fees of $ . . , . . . . 9. Letter of signature authoriz �G� on. . . . M1 Sanitation approval from VHeaIth Dept, . Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) Owner -Builder Verification (Given to owner❑, Mail to owner ❑) _..._15. Improvements may be required. . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . . . 1 . Pre -Inspection for________ ...__.__ _ Required. 8 Recorded copy of Agricultural Acknowledgment Statement. 9. Driveway Permit. 20. Plot plan approval from city of_ 21. 22. Pre-Inspec. request to (Date) Building Inspector When you issue the permit, process as follows: Mail to owner, « T e I e p h o n e 3J o;�, (11info and hold for pickup a office, Other Applican a Mail to contractor_ ' _Deliver w/inspector. tt Date 4 i - :5--:Z Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted 1. Index permit for above items No. - 2. o._2. Additional items required: or to permit issuance: (Circle new item not checked above). C ra r, designer, owner, was advised of above required data by_phone__c �nailounter by date Factor, designer, owner, was advised c? 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—DPW TO Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance LO—C-L . Owner Location AP# Plan Approved for: Sewage Disposal - Hold final for: Final clearance O.K. for: Clearance for X?-- bedroom obile home. Other NOTE * * * Water Supply Water Supply Water Supply Sanitarian ate Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEI FOR RESIDENTIAL DEVELOPMENT R�CURDBD BU%TB COUNTY' FFtCIAL RECO ,RDS BY Section 26-8.1 of the Butte County Code requires this acknowledgement��_ be .recorded prior to issuance of a building permit. 8wf �55� COv�Gk� � The property described herein is adjacent to land or included 1987 NOV IS AN l!: 25 within an area zoned for agricultural purposes, and residents of this: CANDACE J.GRUBBS property may be subject to inconveniences or discomfort arising from pit the use of agricultural chemicals, including, but not limited to herbi�L'S-,R�� :. and fertilizers; and from the pursuit of agricultural operations including,'-, but not.'lim.ited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or disconform from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF Date: . November 12, 1987 State of California ) On this ) SS. me, the County of Sutter ) ®� c E gyp �� Fmy N� PROPERTY OWNERS: the 12th day of. November 19 87 undersigned Notary.Public, personally appeared before Personally known to me. IX/ Proved to me on the basis OFFICIAL SEAL of satisfactory evidence. VOLAh®A G. KERMA to be the person(s) whose names) is subscribed to •�.-'.� NOTARY ?UDLIC-CAUI, N1A y .ir' ,SU the within instrument and acknowledged that he My Cor.imission Expires Mar. t, t99t executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public Present A.P. No. 058-'69-0-008-0 IE EXHIBIT "A" DESCR-IP'T'ION All that certain real property situate in the. County' of Butte, State of California, described as follows: PARCEL ONE: Lot 71 as shown on that certain .nap entitled, "PEER PEAK LAKE ESTATES UNIT NO. 1", which map. was filed, in the office of the Recorder of the county of Butte, State of California, October 28, 1982 in Book 85 of Maps, at pages 80, 81, 82., 831 84, 85 and 86. PARCEL TWO: Being a. portion_ of Section 15, Township 21 North, Range 4 East, M.D:B. & M., and more particularly described as follows: BEGINNING at the Soiuthw%t corner of said Section 15; thence along the West line of said Section 15, North 1 40' .20" West, 1216.30 feet to the Southeasterly line of that certain parcel of land described as Parcel 2 in the Grant Deed from Winston F. Stoody and Virginia J. Stoody, husband and wife, to the State of California, and recorded in Book 910 of Official Record, at page 257, records of Butte County, California; thence along said line, North 39 34' 00"' East, 836.94 feet; thence South 50 26' 00" East, 175,01 feet to the Easterly line of that certain parcel of land described in the exception, therefrom in the Grant need; from Winston F. Stoody and Virginia .T. Stoody to the State of California and recorded in Book 910 of Official Record, at paste 262, records of Butte County, California; thence along said line, South 5 30' 00" Fast, 1749.77 feet to the South line of said Section 15; thence along said South line, South 890 261 3.5" West, 800.28 feet to ;.he point of beginning. Personally known to me./ Proved to me on the basis OFFICIAL SEAL of satisfactory evidence. Y®LANDA G•REYE� to be the erson//s whose name(s) is subscribed to NUt'ARY AUBLIC-CALlfOf1N1A p l ) SUTTER COUNTY the within instrument and acknowledged that he sny Cor:Inission Expires Mar. 1, 1991 executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. G R&A 0 /_2__ Notary Public Present A.P. No. 05.8-69-0-008-0 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Ca4ifornia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PXRMIT, NO. 1/ ASSESSORP- EL NUMBER ZONING BUILDING PERMI'� OWN R TELEPHONE SQ. FT. OCC, BUILDING VA'1::�LIATION O NER' ,] ILING ADDRESS / 3 C rCCO ACTOR'S E e n j ONTF" OR'S MAIL NG ADDRESS 5025 /'G C Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADD ss _ Permit fee $ -vp PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NQ. SUBDI ION NAME PARCEL MAP Water piping 5.00 Each pas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex[] MobilehomepR' Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW 1 10.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti I'ties ❑ I stallation�R 0th ❑ Describe work: m H r Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check -one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions C e and my license is in f II orce and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING , OCCUP.d OR ADDNS. ( ACC. BLOGS. h¢sgft NEW CONSTR. MULTI -OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS POWER APPARATUS e) SINGLE OUTLET CIR. Ex. OCCup(OUTLETS OR FIXTURES 2AL030 eAL030 FIXED APPLNS. Ex. OCCUp. OUTLETS ((RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 9 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ® I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, a d expenses which may in any way accrue against sai County in consequenc of the granting of this permi . �i X Date Signot0 F Applicant — Owner ❑ Contractor Agent ❑ An OS( �f permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ () Energy Inspection Fee $ TOTAL PERMIT FEE $ 4 Oc CUP. CONST.TYP! 7 FLOOD PARCEL FVD ND ISSUE This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which DIRECT R OF PUBLIC By PEPMT.EXPIRES Date1— the applicable provi- resolutions to do fees have been paid. WORKS Date — �— 7/� Receipt No. i) lo"k WNIT!-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT ....,may ..•.�;.: s, Y .'Z.'fiT+"r,�%.itiy"^t; 4 _`. irsi'Y :V� r s�r�,{;�Tf r,`4....: L,�' :r . .. t• r COUNTY OF BUTTE - DEPARTMENT OFRUBLLC WORKS - BUILDING DIVISION - 7 COUNTY CENTER DRIVE - OROVILLE, CALIF6WNIA 95965 - TELEPHONE: 916/534-4541 PERMIT,, APPLICATION DATA SHEET Permit No. r OWNER �'� A. P. No. \/ Proposed Building Use y>7IV,—F— .-4 Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and:/or i,s'suance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate. /triplicate, signed by preparer of plans. 3. Complete plans in duplicate./triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD ''Fee's Paid" Stamp on Floor Plan . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . . 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner, Mail to ownerF]), —15. Improvements may be required. . . . . . , . . . 16. Mobi lehome Installation Data. . . . . . . . . . 17. Pre -Inspection for Pre-Inspec. request to (Date) Required. Building Inspector 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. When you issue the permit, process as follows: Mail to owner, Mail to contractor. _L`TeIephone D72'0� /493 q and hold for pickup atffice, Deliver w/ i ns.pector. Other Applicant Copy of plans sent Health Dept., Fire Dept,, Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: �1.P ltfi 46i�,�i�� Contractor, designer, owner, was advised of above required data by_phone---nail—counter by date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by �0 Date / Sets of plans on hold in File cabinet AP folder Copy—DPW — Flours: 10:00 a.m. - 3:00 p.m. 7 r 1 )i 1c ke 1 This set of plans and specifications MUSTbt--- 6S0 pj,,Vqg S'rkFiT kept on the job at all times and it is unlawful tc- make any changes or alterations on same with v6� l �� 9599/ out written permission from.the Department of 9/6 — 673 , V g.2 y Public Works, County of Butte. } F' Osr Q'-- 6 q -0 - GD I I � T N� I �' i• weir A P,,rr+i+ will be required for the , i�tallation of the mobilehoms.2o0 I c®nnections shall b:' .� l06/ i U ility � obilehome, e1 er , , � 4 t. of the m within t �r d/ 8' ehind or di ectly roadside (left) o cem' ha f of tlitr SoS� e. M0 ilefio Cl a Fes' Qaf eQA + ; G` yet eta totea�\'oe o h ea NOTE:—All ateri Is & Workmanship Shall Be in p0� 'tetSot <� S t/8 Accordance with Recognized Good Practices and cQ� Jc'c�� Gx e��" 3� _�s . G of-a.qua lity F'r�escri ed for the Specified use in the�M� Uniform Builkling, Plumbing & Mechanical Codes and the Nati nal EI ctrical Code. OA -Vo k X t<. ►% ~ BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7.County Center Drive, Oroville, CA PHONE: 534-4541 10 MOBILEHOME INSTALLATION SHEET 1. Owner's Name: Wo, 2. Installer's Name: J I kyl `I'e l d S 3. Is the site currently under permit? Yes FE] No F] _ (If yes, furnish permit number ) OR Is the site an existing site? Yes No (If yes, furnish two plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic. tank and leach fields and clear of all setbacks and easements? Yes 2 No F] (If no, clarify 5. What is the mobilehome electrical rating? --------------- Amps 6. What is the mobilehome site service rating? --------------- c;� 0 O Amps 7. What is the mobilehome site circuit breaker rating? -----'p Amps 8. Is there any other electric load to be served by the --------------- ------ T mobilehome site service? - ------- Yes No � (If yes, identify the load and size: (Load)- (Amps) 9. What is the mobilehome site gas pipe size? -------------- (in.) 10. What is the type of gas service? ------'------------- Natural LP' 11. What is the gas pipe length from meter or tank to the mobilehome?-------------------------------------- / (ft.) * 12. What is the mobilehome gas demand? ---------------------- *(This information not required if pipe length less than 6 ft, on. ,natural gas or less than.50 ft. on LPG.) v.rt� (BTU) MOBILEHOME SUPPORT DATA 11 If other than single wide, Mobilehome Mfr. /L'Q7� furnish Setup Model No. 34/Le-2-( Year ® s Width of V (ft.) Box LengthYV (ft.) Tagalong or Expando Size ft. x ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). FOOTINGS (check one)51. Wood -pressure treated or foundation grade. 1:1 2. Other (specify) - SUPPORTS (check one). Concrete block. 1-1 2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE • � � Line 2 - Main Beams Line Main Beams Tag or Triple Line 1 Piers: Size-Min.------------ Spacing-Max - ----------- Spacing-Max. --------- From Ends -Max .------- Line 2 Piers: Size -Min ------------- Spacing-Max ---------- From ------------Spacing-Max.--------- From Ends -Max. ------- Line 3 Roof Load -2: Size -Min.---------- ��30 ,x Location (From Front) „ „ ,n Line 4 Piers: /4 U Size -Min --------------- Spacing-Max ---------- Fro ------------Spacing-Max.--------- From Ends -Max .------- , Line 5 Roof loads: MULTI -WIDE Line 1 Line 1 Openings: - Size -Min. ------------------ ox „ Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wall Only) Size -Min .------------------ 'k Spacing -Max.--------------- From Ends -Max -------------- c o riers: kunaer nearing waale uniy/ Size -Min ------------------- Spacing-Max ----------------- From ------------------ Spacing-Max,--------------- From Ends-Max.------------- Size-Min.------------ EE ,k „ „x Ei ,k „x „ „x „ ,y, „ Location (From Front) ,_ , ,- „ ,„ ,- „ ,_ „ F DOUBLE WIDE PIERING lgdt &tT __=-PSF ROOF LOAD PLANT # ..._i-.�--- s•.; :'•Yt %' I Im MAX. 11-011 .i.' SFE,PIERING PLAN DRAWING FOR MAIN RAIL SUPPORT FOOTING SIZES. MATING LINE PIERING TABLE $ tiw 76MgEAINITIAL ST OR 2ND FfTERI 4TH INTERIOR 5TH- INTERIOR 310 INrEtINPOST POS REAR SATI POT , IpATIONS AT FRO[U ppSr TJ POST POST POST -PIER LMD zN LBS (Ddfl 54do ?.ab 5�0 3oao x x X 26 �4x 34r 1. Focyrnrs slzE ,MCS' 1• ' 11 �C4 r g 34-9 L� r/ ' .. 1. FftoN'T' �A NOTES: fl. -Footing sizes based on 1000PSF soil bearing value. If soil conditions differ, see the Technical Installation Manual for method of calculation piering plan drawing or the Home t71l, I F COUNTY OF BUTTE - DEPARTMENT OF.PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSORO5�'PA� L=u M�ER__0 6�' r ZO''P— BUILDING PERMIT OWNER / T LE PHONE ,SOS FT. OCC. BUILDING VALUATION OWNER'S MAILrNG ADDRESS L !� CONTRACTO MM7 TELEPHONE CONTRACTO S NG'ADDR Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ .990 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee .$ Energy Plan Checking Fee $ , ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS _ G Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 1 2.00 Solar or heat pump water heater 20.00 LOT NO. i SUBDIVISION NAME PARCE MAP - Water piping 5.00 Each qas water heater or verit 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other (� C! ZC1 CJ SPECIFY Gas piping system 1 - 5 o t et 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00ea TYPE OF WORK New ❑ Addition ❑ Remodel Utilities [:1iristallation❑ Other Describe work:3 _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP MT' CONTRACTORS LICENSE LAW I declare under penalty of perjury (check -one): EJI am licensed under provisions of Chapt. 9, Div. 3 of the Busines$ and Professions Code and my license is in full force and effect. License No. Classification C-hFIXED 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ontract- ors.(Sec. 7044) ors. ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.(ti , h2sgit OR ADDNS. ( ACC. BLDGS. NEW CONSTR. U TI.OUTLET 2.50 ea NO N."E". BRANCH CIRC ITS POWER APPARATUS e (SINGLE OUTLET CIR. I Ex. Occup(OUTLETS OR FIXTURES 200600 eAL030 APPLNS. OR EX. OCCUp. OUTLETS (RESID.) EA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I decl re under penalty of perjury (check one): The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize(rep�esentatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless,the County of Butte against all liabil' ies, judgments, costs, and expenses which may in any way accrue against i Count in cons�qu e o e granting of this permit. Signature of Applicant — OWner Ontractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or cons ruct- ion of structures over 3 storiesinheight. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ u OCCUP. CONST.TYPEJ I IFLO.DIP.RCFL.1 PD 1$7 ISSUE This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt NO. a7 WNITE-D.P.W., TELLOW-ASSE35OR, PINK -INSPECTOR, GOLDENROD -APPLICANT ( r COUNTY OrGUTTr DEPT. OF PUBLIC WORKS 2 51987 I F; �_,4 COUNTY OF BUTTE - DEPARTMENT OF 'PUBLIC WORKS - BUILDING DIVISION , 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95165, - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET t ' / Permit No. OWNER 1 O� . /C�e f A. r6 6 P. No.. o`� Proposed Building Use �-a2�� Building Inspector Date S At time of permit application, I was advised the followifig data must be submitted prior to permit processing and:/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . 2. Plot plans in u�te_,tri-plicate, signed by preparer of plans. Complete plans irQuplicate/triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. ' 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid'' Stamp on Floor Plan . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ 9. Letter of signature authorization. 0r0 v i Sanitation approval from Health Dept. 11. Pl.anning,approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . Contractor's License Information (no., name style, classif.) Owner -Builder Verification (Given to owner❑, Mail to ownerE]). t _15. Improvements may be required. . . , . . , , , , , , 16. Mobilehome Installation, Data. . . . . . . . . ... 17. Pre -Inspection for Pre-Inspec. request to Required. Building Inspector (Ddte) 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. When you issue the permit, process as follows: Mail to owner, Mail to contractor. Telephone and hold for pickup at—off ice, Deliver w/inspector. Other Applicant Date Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted prior/t9 er At is nce: We new item not checked above). 1. Index permit for above items No.--:---. 2. Additional items required: T Contractor, design Kr�was advised of above required data b`)`J_phone___rnail—counter by ate Contractor, designer, owner, was advised'of above required data by—phone —mal l—counter by date' Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW — Hours: 10:00 a.m. - 3:00 p.m. TO. Buildina Department`` FROM: ' Environmental Health SUBJECT: Sanitation Clearance - �"1 Owner Location.AP# ti Plan Approved for: Sewage Disposal _� Water Supply Hold final for: Water Supply Final clearance O.K. for: Water Supply Clearance for _ _ — bedroom mobile home. Other Uiu- NOTE *** Sanitarian Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA 95965 PHONE: 538-7541 Don Nickel . 3374 S. Walton Ave. Yuba City, CA 95991 With reference to the above subject: Attached is: DATE 6/26/87 RE: Building Permit Application for Gazebo A.P. # 58-69-08 Application for permit Mobilehome Utilities Installation Sheet —� Building Plans Mobilehome Installation Information Sheet Engr. Calcs �— Typical Plan Sheet �- Owner -Builder Verification Form List of Codes Enforced OTHER Rereint 1_XL We need the.following information: Permit application signed and completed where indicated with all copies returned. Fees of $ payable to Butte County Treasurer. Certificate of Workmen's Compensation Insurance or check exemption statement. Contractor's License Law information or check exemption statement. X Complete plans in includin pplot pplans. Plot plans in . ��E BY Mr, FTSMAN) Structural details in Complete plans and calcs in by registered engineer or architect. Energy design including Street and drainage improvement plan approval from Land Development Section (DPW). sets of plans in accordance with the changes marked in red. X Sanitation approval from Butte County Health Department at: 196 Memorial Way, Chico X 7 County Center Dr., Oroville Skyway & Elliott Rd., Paradise Planning approval from Butte County Planning Department, 7 County Center Drive, Oroville, for X Completed Owner -Builder Verification form. Recorded copy of deed showing Recorded copy of agricultural acknowledgement statement. FAW OTHER Your plot plans and structural plang mnst he q little marp qpprifir - pl rnnr-- clearance, Return the plans ... nwnpr-hiviltipr fnrm tn - aq qnnn possible, h.n, you, Should you have any questions concerning the above, please contact this office. JFG/aj Yours very truly, William Cheff Director of Public Works .F. Glander Chief Building Inspector COUNTY''OF BUTTE DEPARTMENT OF'PUBLIC WORKS / 7 County Center Dries, Oroville, CA 95965 PHONE: 538-7541 ` DATE 6/26/87 Don Nickel RE: Building Permit Application. 3374 S. Walton Ave. for Gazebo Yuba City, CA 95991 A.P. # 58-69-08 With reference to the above subject: Attached is- Application s:Application for permit �- Building Plans Engr. Calcs -�— Owner -Builder Verification Form OTHER Rereint We need the following information: Mobilehome Utilities Installation Sheet Mobilehome Installation Information Sheet —?� Typical Plan Sheet List of Codes Enforced Permit application signed and completed where indicated with all copies returned. Fens of $� payable t`o,-ButteErCoubtir Treasurer.*'- _ Certificate of'Workmen's Compensation Insurance or check exemption, statement. Contractor's License Law information or check exemption statement. _X Complete plans in TIUPT,ICATF.__ includin lot, plans.Plot plans in �U�E BY THE URIMSMAN) Structural details in Complete plans and calcs in _ by registered engineer or architect. Energy design including _ Street and drainage improvement plan approval from Land Development Section (DPW). sets of plans in accordance with the changes marked in red. X Sanitation approval from Butte County Health Department at: 196 Memorial Way, Chico _ X 7 County Center Dr., Oroville Skyway & Elliott Rd., Paradise Planning approval from Butte County Planning Department, 7 County Center Drive, Oroville, for _ X Completed Owner -Builder Verification form. Recorded copy of deed showing Recorded copy of agricultural acknowledgement statement. OTHER Your No see the attached plan sheet. Comnl a.te the attached nwncr-hi,i 1 Jer verification --form,. -contact-thez.HPaJ t 1-k•,-nt- nt -518-7981 rnnrarni ng --nni tnti nn clearance Return the nl an,9 and .CtXa r hiji- 1 der fnrm to thi c nffi rp ac enr,O x uoss�bie. Thank you. _ ,Should you have any questions concerning the above, please,contact this office. Yours very truly, William Cheff Director of Public Works A.F. Glander JFG/aj Chief Building Inspector UNTY OF BUTTE 8'7249 „ OFFICIAIPT — 4?W / R ' -ELi Received from ^ � LID The Sum of -'{�� r. 14 a i For Received.Received BY r% 7f — CASH ❑ Title — CHECK ] : By PER . ST � I A V COUNTY OF BUTTE Department of'Public Works 7 County Center Drive,.Oroville, CA 95965 Phone: 916-534-4541 OWNER -BUILDER VPE'RIFICATION Attention Property Owner: An "owner -builder" building permit has t11eeu 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 -yi...,'cr 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-im rovement (yes or no) [/ 2. I (have/have not) ,i tined an appl cation for a building permit for the proposed'work. 3. I have contracted with the-following.person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address _; _ City Phone Contracts rs License No. 5. I will provide some of the work but ;i have contracted (hired) the following persons to provide the wort, indicated: Name Address Phone Type of tvlork Signed: Property Owner Social Security Number � / Date 7 NOTE: This Owner -Builder Verification is sent -to you as required by Sections 19831 and 19832 of the California Health and Sa`ety Code. This verification must be completed a.rd returned to our office before we are per- mitted to issue the permit, J ..1 Im ., . ;� � a, � �-�e� Cly ��_^ :- �- ' . -; -�r ' - 1 �; z A+ r�f 1'. f Iz zbi7 i t I 0 ,Pb AN a I LAI / �I" /i✓ / "- O', Im i MO 4/ 1 -4z _ A3 d m rt a � 6 A E