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HomeMy WebLinkAbout061-300-035BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060494 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/20/2006 APN: 061-300-035-000 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Site Address: 510 MILSAP BAR RD BCK License Class : License Number: Map Index: Date: Contractor: Description: nsf (2540), open (440), Cov (442) OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: STOWE TIMOTHY L & WILMA A permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 68 4TH ST the Contractor's State License Law. (Chapter 9 commencing with Section WOODLAND, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95695 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).): 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: STOWE TIMOTHY L & WILMA A 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 68 4TH ST sale. If however, the building or improvements are sold within one WOODLAND, CA 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 95695 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: pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Busin9p an I Prossions Code Date Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for License #: workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance carrier and policy number are: Carrier: Total Square Ft: 3422 S.F. Policy#: certify that in the performance of the work for which this permit is Valuation: $176,572.00 issued, I shall not employ any person in any manner so as to Census Code: 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 those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject a( employ)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 vi ° code, interest, and attorney's fees. rS CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code4016—r" I hereby affirm that there is a construction lending agency for the ReI tions do work indicated for fees have been paid. l performance of the work for which this permit is issued (Sec 3097 Civ.) /which / Date: n// CSE Name: By.s GF' ! f// JDate r/ PERMIT EXPIRES ON: —v 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 & 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 enteruponthe above mentioned property for inspection purposes. v� Signature: Print Name: v Date: ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 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 REO UIRED AT TIME OF APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" ARCHITECT/ENGINEER OWNER INFORMATION Last Name .. uSj T1e . Ized Address / CiW[C State Sta ZIP5;; Phonc3l� Fax E-mail E-mail Lic. # ARCHITECT/ENGINEER CONTRACTOR Name city . �iriV G�' S Address Pn°�c3���d� ax City Occ. State Zip Phone Page Fax E-mail Date Approved: Lic. # Class ARCHITECT/ENGINEER Name Address r7 i;ood� r city . �iriV G�' S ?�J—' Pn°�c3���d� ax E-mail State License Number 0 APPLICANT INFORMATION Name cs' Address 152–��/_� City)Z'yv/ S /ma � �pFJ-yc�7%. Phor- 7 Fax,,, --S l/�( E-mail APPLICANTSIGNATURE X For office use only: Zoning U. I Flood Zone SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BPC BIN # PROJECT LOCATION AP# �l /- 3.�'' �_q-3 Property Address f City Cross Street ZZ- c.S,21/_� 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 Description or -Scope of Work: 2 clyv L/NZ Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): 8;Z 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. Received by: Amount: / / —Bldg 2 `I SRA Receipt #: 1 Sheriff N L4 I SMIP Other Date f'7 / 3 O f li / I� Total 6 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA .95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: 457WY14/-`-,_ / l� ASSESSOR PARCEL NUMBER . 06 /_ 30&7-0 Proposed Building Use: %V Permit Technician: 62i� Date: '"wd 6 Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. \/ A) 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. �❑/Al 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including 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 plans in triplicate. All of these must be stamped and wet -signed by the engineer. 0 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑� 11. Hazardous Material Form /A/ 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other emaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable 15. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... �� ❑ 1P,, -Erosion Control Plan Required........................................................................ �p 9. F es as shown on the attached Schedule of Fees Due Sheet......... I.,! .................. ❑ City of Chico Plumbing permit....................................................................... 21. Site plan and business license approval from the City o4; .............................. 22. California Department of Forestry plan approval -�d. SegP6y:-t-/ C_ 6 23. Planning approval for (A) Use: (B) Parking: (C) Parcel Check: ... ........... 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ...................... 1.� 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept .28. Contractor's license information. (Number, Name Style, Classification) ................... ". ,:r ❑ �� '. "29. Worker's Compensation Carrier and Policy Number .......................................... l� 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ...................•. ❑ 31. Letter of Signature authorization................................................................... 32. Recorded copy of Agricultural Acknowledgment Statement ................................. 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction................................................................***....................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone //W W S%� �Pb --3y n hold for pickup. I have been informed of the above ite s andrequirements for obtaining a building permit. 70 Applicant:��_46 Date: 1. Index pd r6itTpp&cation for -the above ite s numbered: G 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 Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Z2 Z Plans approved by: Date: Structural reviewed by: Dat Structural approved by: Dates Note transfer by: Date: Yellow: Building Division ' E K/Buil • ing/Plan Check/Data Sheets/data. sheet page 2 9.27.05 TO: FROM: a , '01 Building Division — Development Services Environmental Health SUBJECT: Sanitation Clearance Plot Plan Attadted Floor Plan Attadied Sent to BD !off' I 3a?-�6 7r(� 0 L- i � /'�5�90 lr e2 6 / —3° —03 Owner Location AP# Plan Approved for: Sewage Disposal: DC Water Supply: Public Private Well Clearance for dwelling. Other 2, Hold final for: Final clearance O.K. for: NOTE: Enviroffinental Health Specialist Building Clearance 9/2005 Date BUTTE CbUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner Stowe, tim APN No: 061-300-035 JPer Dwelling Application Date 3/2/2006 Permit No: BP 06-0494 County 1 4096.87 3071.14 3117.43 Chico Urban Area 5372.09 3995.45 4889.56�i/�J" EI Medio Fire District 3128.31 2297.77 2326.36 �� 3a"I RECEIPT DATE Tech/Asst 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION $2-,7.8383 -x$71) 38 j150 6. Plan Check portion of Permit Fee 771 Comanche Creek $8,069 $1,113.57 772 Little Chico Creek $8,792 2 FEMA 774 Lindo Channel $8,139 Flood Elevation Review $109.98 0 More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW 3 SRA* Res Yes Fire Plan Check - Non -Refundable $95.00 $95.00 0 10 owrlu /7V 7 (State Responsibility Area) Building Inspection $109.98 $109.98 NON-REFUNDABLE portion of fees due at application $1,208.57 _ _ RECEIPT DATE Tech/Asst FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION [ $1,318.55 Ny1-16/3 3—z –o 6 4 SMIP* - Strong Motion Instrumentation Program (Enter amount from permit system) 5 Additional Plan Check Fees (NON-REFUNDABLE) 6 Other*: 6a Other*: 7 8 9 9a 10 10a IMPACT FEES - RESIDENTIAL* Applications After 2114/05 Per Dwelling SFD ,r JPer Dwelling Per Dwelling MH v' U( t'" ,, .,_ RECEIPT DATE Tech/Asst 4,196.87 )ISOH J_ 9 2DAD - RECEIPT DATE Tech/Asst F MFD ,> County 1 4096.87 3071.14 3117.43 Chico Urban Area 5372.09 3995.45 4889.56�i/�J" EI Medio Fire District 3128.31 2297.77 2326.36 North Chico Specific Plan SR -1, SR -3, SR-1/PD 7938.531 6757.081 7633.49 R-1 8031.53 6850.08 7726.49 do R-2 7541.53 6360.08 7236.49 R-3 6780.53 5599.08 6475.49 Processing Fee is automatically added to impact fee total 1 $100.00 WATER TENDER FEE INotcollected when Impact Fees Applicable) Enter Bat.# $200,00 DRAINAGE FEES* CHICO STORM DRAINAGE MASTER PLAN 770 Butte Creek $7,736 771 Comanche Creek $8,069 New construction, vacant land, on 1 acre or less - Enter 1 or less acre value 772 Little Chico Creek $8,792 773 Big Chico Creek $6,596 774 Lindo Channel $8,139 775 SUDAD Ditch $6,975 776 Mud -Sycamore Creek $6,070 777 PV Ditch $8,603 More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW THERMALITO DRAINAGE AREA 1 $652 Maximum Per each new living unit on existing lots where full drainage fees have not been paid Temporary Dwelling T $130 At time of building permit $130 annual renewal fee for first 4 renewals. Not to exceed $652. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO ISSUANCE OF PERMIT. Forms will be prepared after plan check is completed for applicant to take to respective district office. 11 SCHOOL DISTRICT FEES* , 11a RECREATION DISTRICT FEES* r Oroville High/pioneer_101_— 0 10 owrlu /7V 7 Oroville At the 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: Date: 3—C Pursuant to Gover ent code Section 6020, you are hereby notified those Items followed by an "*" may have been imposed on your project. You have 90 days from the date of approval of the porject or from the impostion of the above referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 1105 oEP���T 0A, 'Department �o�QT7- 'Department 6f Public �! ork's ° 0C o u n t y o f B u t t e O O C C 7 County Center Drive AC' UN -ly J. Michael Crump, Director orovi95965 (5530)30) 538-7681 5 (FAX) 538-7171 �Qcic wo�`Shawn H. O'Brien,'Assistant Director Assessors Parcel Number: -3CC---(.s'S— Building permit # Owners Name: i I i, S -f Owners Mailing Address: Property Address: r'l�1Ar' ia� roti ENCROACHMENT PERMIT ACCEPTED: PERMIT NUMBER: ENCROACHMENT PERMIT EXEMPTION: Reason for exemption: tv� Not a County maintained road �❑ Existing driveway conforms to County S-31 standard ❑ Other - Approved_bY— .....-..._....�...... Printed Name�� oZ� Title ,- 9 Date A/Z,�C , CONDITIONS FOR EXEMPTING A DRIVEWAY PERMIT 1. An existing home with a driveway 10 years or older and doesn't cause any problems with' the county road or drainage. 2. An existing home with only minor remodeling or repairs. 0 Butte CountyDepartznent ofDevelopl7lent'5,0-1vlces $0T r� 7 County Center Drive ,� '.�0 Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile CIO' I BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: I need to submit applications for septic and/or well to' Butte County Environmental Health immediately. I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained a I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building_ permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not .limited to, verification the parcel was legally created, adherence.to all mitigations and conditions imposed on the patcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs. and environmental issues (fire, agriculture buffer zones, and habitat/species). . Please print: Applicant Name: Z-, Building site address: APN: Permit No.: I have read, understood and accept the terms and conditions as expressed herein as indicated by my submission of the above-referenc d building permit application and my signature below: SIGNATURE OF APPLICANT DATE 0 Copy to Applicant/EH/File KFonns/BldePermitwithoutClearnces 020705 Department ..0 o u n ty J. Michael Crump, Director Public Works f B u t•. t e LAND DEVELOPMENT DrVMPN Storm Water Management Program 7 County Center Drive Oranlle, CA 95965 (3530) 538-7266 (FAX) 53&'7171 National Pollutant Discharge Elimination System (NPDES) Phase 11 Construction Storm Water Permit and Storm Wafer P61lution Prevention Plan (SWPPP) Acknowledgement tLESS THAN 1 ACRE] Project Description: Project Location andlor Parcel Number: By signing below, L the project.owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more. of land and that L 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. It .SI ped: Title: Date OWNJER-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 material for construction of this proposed property i provement: YES NO [ ]. 2. I HAVE [HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK PROPERTY OWNER: _A�M/ / IN DATE: 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. Rev'd 11/4/2004 Butte County Department of Development Services purr ADMINISTRATION * BUILDING * GIS * PLANNING _0 ZM11/1, o�7 County Center Drive 0 Oroville, CA 95965 0 (530) 538-7541 Telephone (530) 538-2140 Facsimile OWNER -BUILDER INFORMATION Dear Property Owner: 0 0 0 0 0 An application for a building permit has been submitted in your name listing yourself as the builder of the 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 your. plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government 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. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact 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 contractor 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 contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Scott Rutherford Chief Building Inspector NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. r AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 2006-0012193 Recorded I Official yyRecords I CoButte f I CANM J. GRIIBBS I County Clerk-Recorderl I I 012:51PM 10 -gar -2006 I REC FEE 10.00 JC Page 1 of 2 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: s Date v ` v v PROPERTY OWNE State of California County of VDI 6 — On "1 Ch 1D, (.DO(1109 before nke, personally Appeared ' personally known to me (or proved to me on the b sis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and ackno ledged to me that he/she/they executed the same in his/her/their authorized capacity(ies at by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the perso (s) AcmLexecuted the instrument. WITNESy han a d official Signatur Seal: STEPHANIE DEBO _ Commission # 1391979 �l -m Notary Public— California; A.P. # S Yolo County My Comm. Expires Jan 24, 2007 2 Iva EURAB L 32k-VA3 36 f -,.Ido 1 yintoo! Order No. 1-181379 SCHEDULE C THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL THAT CERTAIN REAL PROPERTY.SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: LOT 8, ACCORDING TO THAT CERTAIN MAP ENTITLED, "BALD ROCK TRACT UNIT NO. 1", WHICH MAP• WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF -BUTTE, STATE OF CALIFORNIA, JUNE 7, 1957 IN BOOK 22.OF MAPS, AT PAGE(S) 29 AND 30. AP NO. 061-300-035 District Identification No. 060228 i i + tm'L 4rAfthool District certifies that tq-"� S 6w-eL- (Applicant) (63a) loCrs- !S3 47 (Street Address) (Phone Number) (State) has complied with the requirements of Resolution No. O S —qV p�, 5 o square feet. School District Representative Paid by Check # �WRemarks: (Zip Code) by payment of $ MULL$IGATION 7 - Tarte, .. / Nodce: You may protest the Imposition of the fees Identified above by submitting a written protest to the District, In compliance with Govemment Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the Imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District Is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental duality Act (CEQA), this project may be subject to additional school fees to fully mitigate Its Impact on the school distrie ti schools. White (school district), Yellow (building department), Pink (applicant) feefonn.xIs (3l05ks w - BUTTE COUNTY SCHOOLS IMPACT -FEE CERTIFICATION FORM (One form per Building) School District n 110,f a r Building Department No.. A.P. Number (i�!'��(}��'� Jurisdiction: City ®County Property Owner �' f�'r�(Qi� , �j ►•yt Property Location/Address Subdivision Lot No. Residential Development,© Q ........................................................................................ Q Q € Sq. Footage �•��'! d No of Living Mobile Home Addition/'Supplemental to (Group. R) Units Installation Conversion Permit # '(Nq foundation inspection) :........................................................................................ ,.. Deed Restricted Sq. Footage , (Attach a signed copy of Deed Restriction and Notice of Limited Use'Facllity document) Commercial/Industrial 0 0 Sq. Footage New Addition (Including Exterior Roofed Areas) Building Department Representative Date District Identification No. 060228 i i + tm'L 4rAfthool District certifies that tq-"� S 6w-eL- (Applicant) (63a) loCrs- !S3 47 (Street Address) (Phone Number) (State) has complied with the requirements of Resolution No. O S —qV p�, 5 o square feet. School District Representative Paid by Check # �WRemarks: (Zip Code) by payment of $ MULL$IGATION 7 - Tarte, .. / Nodce: You may protest the Imposition of the fees Identified above by submitting a written protest to the District, In compliance with Govemment Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the Imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District Is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental duality Act (CEQA), this project may be subject to additional school fees to fully mitigate Its Impact on the school distrie ti schools. White (school district), Yellow (building department), Pink (applicant) feefonn.xIs (3l05ks w M BUTTE COUNTY DEVELOPMENT .FEE CERTIFICATION FORM EATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) ❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD) ❑ PARADISE RECREATION AND PARK DISTRICT (PRPD) ❑ DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) ��� ��n� ©, Building Permit Number Property Owner (s) X34,-3 p_ yy� Project Location /Address 'ZE4(,-g Subdivision Name AsseseahlP 4n Ftaa 4`�, �%//1 y New Development Alteration/Addition(s) Mobile home Demo Permit (date iss Comments: Type of Residential Development (check one) Single Family -Detached Single Family -Attached Non -Residential to Residential Multi -Family Dwelling Mobile home replacement verified by Assessor Department ed ) verified by Building Department / K� ol ❑ FRRPD ❑ CARD ❑ PRPD ❑ DRPD certifies that: Applicant Mailing Address Phone Number City State Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: Dwelling Units @ $ Square Feet @ $ Remarks: Paid by Check No: Paid by Cash: Recreation and Park District Representative per unit for a total of $ p (fy per sq foot for a total of $ 1 Receipt No: Cid Zip PJ - SITE PLAN REVIEW APPLICATION Date: v AP# Permit Number (if applicable) o.'"T! Bin Number APPLICANT INFORMATION Parcel Size: Owners Name: / G Owners Address: ��� Telephone No.: Site Address: Proposed Use: Zone: ssidential GP: New Single Family Residential ❑ Single Family Addition ❑ Single Family Remodel ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ Commercial Remodel ❑ New Industrial ❑ Industrial Addition ❑ Industrial Remodel Other ❑ Septic ❑ Well ❑ Agricultural Exempt Building ❑ Agricultural Buffer Form ❑ Other: Brief Explanation/Issue: DEVELOPMENT SERVICES INFORMATION (For Staff Use) ❑ Approved ❑ Conditionally Approved . ❑ Resolve Problems Prior to Approval ❑ Resolved By. Date 1 ., ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Williamson Act Minimum Acreage: ❑ Residence can be built per contract ❑Watershed Protection Overlay Zone SRA - (CDF to determine specific requirements) 100 -Year Flood Plain: • Flood Zone: • Flood Panel No.: Index Date: ❑ 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 ❑ Chapman/Mulberry ❑ Cohasset Area Use Requires: ❑ Use Permit ❑ Variance ❑ Agricultural Worker Affidavit ❑ Administrative Permit ❑ Minor Use Permit ❑ Minor Variance Zoning: U General Plan: Applicable Building Setbacks: Uc ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 4 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front / Side ` Side Street Rear V 0 Height Waterway N/A N/A N/A Uc ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 4 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: ❑ 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 ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Subdivision Map/Parcel Map: Map Date of Recording: S� Lot: Book: Page: �a 3. Sec. 7 sec.B 1 530-3. G3' Sec. is I SL -_C. 17 ._-zao ` - - . _.. __ _. _.... _. _...i . r... _ - e•- - 1 _ V O7 i' 7.70SA— ''/ 1 1 ' 7J/6A.. 2.30SAc. 3C' C�6 l 1 Sri O O eJAc.0 ?.40GA. ' '� •�°\ail, A 3~ � e - ® ti ry _ � ;'-py¢� �F�:e� yu . GO \ o 46 4p 4ND II Rei �$?• i i 0 13 Q, j @2.431 Ac. ` 1A� ° 10 C Ac' 1 1 Ips 1.531 A, 2.046 M1 4� q v AF I enar-' Cf].99 • • n 31 2.00 Ac. ul 1.572 Ac. © $ '_$ 17 ® 2.0/6 Ac. I.557Ac.Rv .679 Ac. 0 ® 1.920 Ac. / i r 1.67.9A - � rB9'99't -916 A1' n' Seg' '!-J39.9e• 1 �l , s4sr ® 1.0t6Ac. ZIEtl I.BG2 Ac. l4JT - J31.24 '_ nl LA— -J$9.ae�..... : ,y ° ® 1.045Ac.Wl• `tl,7as9 cI a% 1.816 Ac. � $ © 1.900Ac. -1\� 1.700 Ac. © ° o © 2A48A.. ' Ac. u Q��1911^L350 \^ 0 be �I 4 -N Tai,/ acres • 68-238Ac. bcarirys 5hq— an ihis subdivision are true solar beor.ny_s. All /Ot areas 0,0'd,'-vlvn•ces are 1'. M. or the 0djo'ning rood. Tha Millsoa 8or Rood R/W Wi II be deeded h7 the U.S. Fores{ service - Iron pipe vci of all /qF corners excfpf where c r7Creto monuments are shown Thus 0 Privofe roads are nai }o be main foincd by suite co -19. `D 2 @2.431 Ac. ` 1A� ° 10 Ac' 1 1 Ips 1.531 A, 2.046 M1 4� q AF I enar-' Cf].99 • • n 31 2.00 Ac. ul 1.572 Ac. © $ '_$ 17 ® 2.0/6 Ac. I.557Ac.Rv .679 Ac. 0 ® 1.920 Ac. / i r 1.67.9A - � rB9'99't -916 A1' n' Seg' '!-J39.9e• 1 t. La4a Ac. o°^o. t.096A.. 19 F.11,110 .� , s4sr ® 1.0t6Ac. ZIEtl I.BG2 Ac. l4JT - J31.24 '_ nl LA— -J$9.ae�..... : ,y ° ® 1.045Ac.Wl• `tl,7as9 cI a% 1.816 Ac. � $ © 1.900Ac. -1\� 1.700 Ac. © ° o © 2A48A.. ' Ac. Q��1911^L350 \^ L R T i LOCATION DIAGRAM p �J Q S Seca I SEC.9 996. tl' sec.l7 I SEC. IG sof BALD ROCK TRACT we9T T` UNIT- N9 1 I�I�o1G.99' ��•c. • BEING A SUBDIV 1 SION OF A PORTION OR THE NORTH {Y'l\4•e d HALF OF- SECTION 17 -T 21 N - R G E - M.D.B.0 M. `Ky, .\ QWVNER- SUBDIVIDER L FEATHER RIVER PROPERTIES INC. ev K. E.SOVLE L.S.2519 BEP' -1'. 1955 SCALE. 1°l200' Y RECORDED JUN- 0.7r" 19:•71N BOOK 120F MAPS AT PAGES 29 C.'•0 SHEET 2 OF 2 SH BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 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 the Business and Professions Code, and my license is in full force and effect. License Class :. License Number: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stale 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 to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 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 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 rive 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 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.). ❑ 1, 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 pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of Busin ss an ro sions Code Dale �-a-emd & Owner WORKERS' COMPENSATIO DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: PERMIT NO. BPO51101 Issued Date: 04/20/2006 APN: 061-300-035-000 Site Address: IVIIISCIP Bar RDad , BtP.Py CrttK Map Index: Description: ELECTRIC FOR WELL ONLY Owner:.STOWE TIMOTHY L & WILMA A 68 4TH ST WOODLAND, CA 95695 Applicant: STOWE TIMOTHY L & WILMA A Contractor: License #: Architect: Engineer: 68 4TH ST WOODLAND, CA 95695 Carrier: Policy #: ❑ 1 certify that in the performance of the work for which this permit Is Total Square Ft: issued, I shall not employ any person In any manner so as to Valuation: become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �� .00 Date: Applicant: - 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. 0 S. F. $0.00 CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to do work Indicated above f r which fees have been paid. performance of the work for which this permit Is issued (Sec 3097 Civ.)*. By:_ Al, '14A A 0" Date: -q -20 _ OGP Name: IJ4 PERMIT EXPIRES ON: '4D- , Address: (Date) ❑ I 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 & 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 docume0t of Butte County. I hereby authorize repr¢sentalives of Butte County to enter upon the above mentioned property for inspection urpose Print Name: ` Signature Dale: Owner 0 Contractor 0 Agent for Owner 0Agent for Contractor �1 OY\(YVA- 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 Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** APPLICANFSJGNA�_ ___777777 For office use only: CONTRACTOR OWNER Last Name UWe U irst Name �1 afih Address GV FouetlA e City M�rBLook Fax State Zip C2Sc7 9r Phones _ _53 Fax 5,,_(p(p _o3QS E-mail APPLICANFSJGNA�_ ___777777 For office use only: CONTRACTOR Name Zoning Address U City Policy Number State Zip Phone M�rBLook Fax E mail Plan ICI J11.6 Lic. # Class APPLICANFSJGNA�_ ___777777 For office use only: ARCHITECT/ENGINEER Name Zoning Address U City Policy Number State Zip Phone M�rBLook Fax E mail Plan ICI J11.6 State License Number APPLICANFSJGNA�_ ___777777 For office use only: APPLICANTT'NAME Name Zoning Address / g U City V00SUK l Policy Number State Zip ��ys— Phone53O M�rBLook Fax 530- �` 6 _D39.S (L E-mail Plan ICI J11.6 APPLICANFSJGNA�_ ___777777 For office use only: AP# Property A Zoning Flood Zone SRA Yes No Occ. Policy Number Type Const. Subdivision Name LENDING AGENCY M�rBLook Page 21-3049 Lot # Plan ICI J11.6 Date Approved: -U 17, PERMIT NO. or2- l(G P BIN # LOCATION AP# Property A dr ,ss Cross Stre t 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 el Addre s / zz OVER FORUBMITT#L REOUIREMENTS LL K:\FORMS\BUILDI G FORMS\BldgApplSubRgmts.doc Page 1 of 2 Description or Scope of Work: ztc_ Sq. Footage ❑ Structure Built without Permits ❑ 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 ar. application after expiration, a new application, plans and fee will be required. 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, plar. check fees for work plan checked and other department costs are no: refundable. Re.ceip #: 2_ t o q�o Date' g Amount: SRA IP Other 5 E_�,__,)___Total REV 2-24-05 14 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (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. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: <U �` ASSESSOR PARCEL NUMBER cu UU b Proposed Building Use: ' "`'�-C T ` , Permit Technician: Date: 1 Items required in order to apply for a permit. III boxes MUST be checked OR marked NA in ord 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. ❑ 4. 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. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including 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 plans in triplicate. All of theze must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Letter of intent for non-residential buildings ❑ 12. Hazardous Material Form ❑ 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other__ _ Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable ❑ 16. Fire Sprinklers............................................................................................ ❑ 17. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 18. Soils Report and/or Engineered Foundation required ........................................... ❑ 19. Erosion Control Plan Required........................................................................ ❑ 20. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 21. City of Chico Plumbing permit........................................................................ ❑ 22. Site plan and business license approval from the City of Biggs .............................. ❑ / 23. California Department of Forestry plan approval ❑ paid. Sent by: 24. Planning approval for (A) Use: �(B)Parking: (C) Parcel Check: ❑ - 25. Contact Land Development abou _ Improvements, _ Drainage ........................ ❑ 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 29. Worker's Compensation Carrier and Policy Number .......................................... ❑ 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 1 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or. MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone bb(o - 5_ `1 I and hold for pickup. I have been informed ofthe above i ms an , requirements for obtaining a building permit. Applicant: Date: 17 1. Index permit application for he above items numbered: Plan Check Lpttej 2. Additional items r t wired Contractor, desig r, own as advised of the above data by e phone, ❑ mail, ❑ counter, b Date: 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 Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division Kim c. STALEY CML ENGINEER WAD DATE . Ae al Anllxcllwct-llo9 zo Joe, CKIM )7 6 � Ii 11 ill EXT.3/31;'08 No. 26639 OF 2316 FAIRCHILD COURT, EL DORADO HILLS, CA. 9S762 PHONE (916) 933-3357' r MM C. STALEY OY ENGINEERING FOR JOE . S-Tow6 TO�X�: -- ADDRESS .0 o c DATE 2 SIE.ET_ZL OF liv .drrlc, r � ✓ V W�� �v�L ���,7__r_o '. �( �•.•�V{ I /���C.�.4.4I_ . _ .�/Y�C„(�/�%� /�y J�/��� 123 - - -- - - -. - -- - - - _ (�jJJ/��{ //}}''�� /vy%/�///J•� (��//����/��C _ • _ ._Yi._� / /�L .iIV�V%� -r. /V./4.ir-��.'�//_//•/J .✓L,/ -V' �L.f.`!-- ._- VV •yam / auM Au _ - A Rr. - PPR - 6-- Z) . _id �o f'a.X. 4- o .Mss L)/�1WIV TS57—:Z 4 - 2-- --5u- \Z 0/✓ �/,'C/� ��0`1�1�" �iD��u`1e. Td Tod �� s!7G :z o QR�F ESSloryq! 4�' 1(/L,L�, p /31/ ,� t V/Mi�'�_✓ 3 Exp - - - - - ��� � �� .�_ -• ---• - _ -- -. �... _ _ _.—_` .--- .-- � No. 2663 zltucw S/29 F_ OF r.a�1F�� 2316 FAIRCHILD COURT, EL DORADO HILLS, CA. 95762 PHONE (916) 933-3357 KEM C. STALEY CPIILENrahNEER ENGINEERING FOR - - - -: JOB i J� .ZjA16- tic-. _ _... - -- ADDRESS o, L.7 c _ DATE SHF T 7— OF _ t ' /Nd -- - - - -- _------------- dr B- MING, A n+?d.. 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