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HomeMy WebLinkAbout061-340-009B07-0082 061-340-009 MISCELLANEOUS Electric Panel REPLACE ELECTRICAL SERVICE BO . ORO QUINCY HWY DWYER, DON y o9 LRION MILLER 10 mi E Oro Quincy i rd 1 Y Hwy at end mi N Brush Creek Storermit#904-81E(ele ser for wellfutu e lot developme t 3 �/ �/ _ - a f r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds FEE INFORMATION Single Phase Service - Res $55.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 01/16/2007 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION 1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I 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. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Rl Carrier. Policy Number. Exp. Date: (This section nee ple not a comted if the permit is or one hundredollars ($100) or less. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to 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 01/16/2007 blgnature — Date WARNING: FAILURE TO SECURE WORKE OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State Zip Balance Due: $0.00 Receipt No: 'B1504 OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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 five hundred dollars [$500]; Please check one of the following: 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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: 01/16/2007 Date I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the prop owner oZorL7 to act on the pro arty owner's behalf. 01/16/2007 Name of Perffittee'S-11MV Print Date Ml Owner 1:1 Contractor OR. DAgent for Owner ElAgent for Contractor (In, FILE COPY PROJECT INFORMATION Site Address: ORO QUINCY HWY Owner: Permit NO: B07-0082 APN: 061-340-009 DWYER, DON Permit type: MISCELLANEOUS P O BOX 250 Issued Date: 01/16/2007 By KCG Subtype: Electric Panel FORBESTOWN, CA 95941 Expiration Date: 01/16/2008 Description: REPLACE ELECTRICAL SERVICE (530) 589-2117 Occupancy: Zoning: U Contractor Applicant: Square Footage: DWYER, DON Building Garage RemdI/Addn P O BOX 250 FORBESTOWN, CA 95941 Other Porch/Patio Total (530)589-2117 FEE INFORMATION Single Phase Service - Res $55.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 01/16/2007 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION 1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I 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. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Rl Carrier. Policy Number. Exp. Date: (This section nee ple not a comted if the permit is or one hundredollars ($100) or less. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to 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 01/16/2007 blgnature — Date WARNING: FAILURE TO SECURE WORKE OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State Zip Balance Due: $0.00 Receipt No: 'B1504 OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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 five hundred dollars [$500]; Please check one of the following: 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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: 01/16/2007 Date I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the prop owner oZorL7 to act on the pro arty owner's behalf. 01/16/2007 Name of Perffittee'S-11MV Print Date Ml Owner 1:1 Contractor OR. DAgent for Owner ElAgent for Contractor (In, FILE COPY BU'T'TE COUNTY DEPARTMENT OF DEVELOPMENT -SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY* OWNER INFORMATION Last Name irs Name L_ Mailing Address Address State(fW _ ZipGj�7�/� Phon �0 s-- Z !`� Fax E -mai --- ----- - --- APPLICANT INFORMATION CONTRACTOR Name City State t3Tvurr�/ C/9` Address Phone 3'957 S O I Fax 0 City Subdivision Name State Zip Phone Planner Fax E-mail Lic. # Class --- ----- - --- APPLICANT INFORMATION ARCHITECT/ENGINEER Name City State t3Tvurr�/ C/9` Address Phone 3'957 S O I Fax 0 City Subdivision Name State Zip Phone Planner Fax E-mail State License Number --- ----- - --- APPLICANT INFORMATION Name Address / City State t3Tvurr�/ C/9` Zi Phone 3'957 S O I Fax 0 E -mai APPLICANT SIGN4TURE X For office use only: Zoning Flood Zone Prop? Addres SRA Yes No Occ. Type Const. Subdivision Name Map Bo olc Faye Lot # Planner Date Approved: PERMIT NO. BIN # PROJECT LOCATION Al ©& Prop? Addres City C� Cros Street f~® t WORKER'S CCIMPENS,46TION 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" r Scope of Work:// Sq FT- Living Garage Open Cov ❑ 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 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:KG. Amount: 5� 00 _Bldg SRA Receipt #: r� l Sheriff Date: 07 co Amer I Total , �' >:o Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION 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 you plan to subcontract, you should be aware of the following information for your benefit and protection: ° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal 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. There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° 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 unders state law, contact the Department of Benerit 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 thier work personally or through thier own employees, without a license 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's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). 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 1 IMPROVEMENT. (YES OR NO) I(gPiAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 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 Description: REPLACE ELECTRICAL SERVICE BOX Reference Number: B07-0082 Applicant Name: DWYER, DON Signature of Property Owner: Date: �.,� '� � 1 �r � . .� �: 1 ,�-�a Wiz: ����� �� �. ,{' ����� r �t4,4- 6 �� PrC)/- 3/D OYU quIHcy �d V - - f CCIONTY-OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE7:7�,� 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-45 APPLICATION AND PELRMIT ASSE 50 PARCEL NU B R - —© �_ ZONING BUILDI IT OWNER �!/� l,_ IOAJ IUiL LC—A?— TELEPHONE 638 0936 SQ. FT. OCC. UILDING VALUATION DMAILING 2!89Q�`C ✓/��c�T/EL�EPH'O�NsE CONT CTOR*SSNAME V CONTRACTOR'S MAILING ADDRESS " 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 $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUIL ING A DRESS 3 0IS PLUMBING PERMIT Filing Fee 10.00 ®� AlaJ5 Each Trap 2.00 Repair drainage or vent piping 5.00 r Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00_7 . Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New❑ Addition ❑ Remode Utilities❑ Installation[] Other Describe work: ,G ,r Weil I � F.�� �� � 1 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service soov OR LESS 100 AMP OR LESS 5.00 Main service EA_ ADD'L 100 AMP 2;50 NEW CONST. (DWELLING OCCUP.y) OR ADDNS. ACC, BLDGS. 20 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole comperi- sation, will do the work,and the structure is not intended or offered /for sale. (Sec. 7044) Lv� 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 CONSTR I -OUTLET 2;50ea NON-RESID BRA CH CIRCUITS) NEW CONSTR / POWER APPARATUS 61 NON RES (SINGLE OUTLET CIR. / 50 @ 25C Ex. Occup(OUTLETS OR FIXTURES BALP1 LNSO) EX. QCCu p.�oUTLETS IXED APP(RESID )REA. 2.00 Temporary service 10.00 (j Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ , Contractor MECHANICAL PERMIT Filing Fee 10.00 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 Consent to Self -Insure. shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: I'f 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. Heating Cooling Hood 3.00 Ventilation Permit Fee S 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. 1 also agree to save, indemnify and keep harmless the County of Butte against (-all li bili ' s, judgments, cost and expenses which may in any way accrue ai iYounty en co ue f ranting of this perrytit� // X Date Signature f Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST. PARCEL PD I No I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIREC OF PU / � BY ` PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. IC WORKS ate '��� �� i Receipt No. WNIT!-D.P.W., YELLOW-ASSl930R, PINK -INSPECTOR, GOLDENROD -APPLICANT STATE OF CALIFORNIA- BUSINESS CONSUMER SERVICES AND HOUSING AGENCY EDMUND G. BROWN JR. Governor DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT p�ING Division of Codes and Standards •� a �� Z W 3G 0 Title Search ° D� Date Printed : 01/28/2014. Decal #: AAA5838 Manufacturer: Tradename: KIT Model: Manufactured Date: UNKNOWN Registration Exp: 04/30/2014 First Sold On:, 00/00/1960 Use Code: SFD Original Price Code: AAN Rating Year: 1960 Tax Type: ILT Last ILT Amount: $1.00 " Date ILT Fee Paid: 03/22/2013 ILT Exemption: NONE Serial Number HUD Label / Insigni, Length 1283 61696 55' Record Conditions: PPF Exempt i Registered Owner: DON DWYER ,PO BX 250 FORBESTOWN, CA 95941 Last Title Date: 03/15/1994 Last Reg Card: 03/26/2013 Sale/Transfer Info: Price $500.00 Transferred on 01/31/1994 Situs Address: QUINCY HWYBALD ROCK RD BERRY CREEK, CA 95919 Situs County: BUTTE Inactive Decal/DMV: y DMV DV3743 Renewal Fees:. $24.00 * * * END OF TITLE SEARCH Width 10' M ALIFORNIA - DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT EDMUND G. BROWN JR. Governor ARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT °\3SING aNISION OF CODES AND STANDARDS 7571526 MANUFACTURED HOME ° ° ';; z ' ISI REGISTRATIONRENEWAL BILLING NOTICE 3G a� 1111111 Ill�la I�IIIIII�0111011 D IF FEES ARE PAID ON OR BEFORE APR 30, 2013, THE REGISTRATION RENEWAL FEES DUE ARE: $ 24 IF FEES ARE PAID AFTER APR 30, 2013 BUT ON OR BEFORE AUG 27, 2013 THE FEES AND PENALTIES DUE ARE: $28 IF FEES ARE PAID AFTER AUG 27, 2013 THE TOTAL FEES AND PENALTIES DUE ARE: 1 $78 TO PAY THE REGISTRATION FEES EITHER: Access our online registration renewal service at www.hcd.ca.gov and charge the payment to a credit card, or, mail this notice with a check or money order to HCD, PO Box 1979, Sacramento CA 95812-1979. If you have any questions, please.contact the Registration and Titling Call Center at 800-952-8356. If the location address where the unit is actually located differs from the "Unit Location" shown above, please print the correct location address below: Street or Site: City: County: State: Zip: If you believe you are no longer responsible for the fees due, please complete the appropriate portion of the questionnaire below and return this notice to the address listed above. [ ] This unit was sold on Buyer(s) Name(s) Buyer(s) Address [ ] This unit was destroyed on by and is unfit for human habitation. I/We certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on at (date) Signature Address 7571526 111111111111111111011 Printed Name (city/state) 02262013 - 13,720 . Decal: AAA5838 Serial: 1283 Make: KIT Expires: APR 30, 2013 Addressee: Exempt: DON DWYER PO BX 250 Located at: FORBESTOWN, CA 95941 ' QUINCY HWY/BALD ROCK RD BERRY CREEK, CA 95919 • Registered to: DON DWYER IF FEES ARE PAID ON OR BEFORE APR 30, 2013, THE REGISTRATION RENEWAL FEES DUE ARE: $ 24 IF FEES ARE PAID AFTER APR 30, 2013 BUT ON OR BEFORE AUG 27, 2013 THE FEES AND PENALTIES DUE ARE: $28 IF FEES ARE PAID AFTER AUG 27, 2013 THE TOTAL FEES AND PENALTIES DUE ARE: 1 $78 TO PAY THE REGISTRATION FEES EITHER: Access our online registration renewal service at www.hcd.ca.gov and charge the payment to a credit card, or, mail this notice with a check or money order to HCD, PO Box 1979, Sacramento CA 95812-1979. If you have any questions, please.contact the Registration and Titling Call Center at 800-952-8356. If the location address where the unit is actually located differs from the "Unit Location" shown above, please print the correct location address below: Street or Site: City: County: State: Zip: If you believe you are no longer responsible for the fees due, please complete the appropriate portion of the questionnaire below and return this notice to the address listed above. [ ] This unit was sold on Buyer(s) Name(s) Buyer(s) Address [ ] This unit was destroyed on by and is unfit for human habitation. I/We certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on at (date) Signature Address 7571526 111111111111111111011 Printed Name (city/state) 02262013 - 13,720 , _. EET OF ZONING: UTILITIES—SITE IMPS. Water: Public E3 Well❑ Ditch BUTTE COUNTY- RESIDENTIAL PROPERTY RECORD NAME r NAME PROPERTY LOCATION ook PARCEL NUMBER Pcga BI ck •P' r'cel' Co Electricity: Yes ❑ Assessment Year 19 2 19 19 19 19 19 19 Gas: Pub] ic❑ LPG(–) None Date // D(Od0 Building Record Sanitary Swr.: Public Indiv.❑ Appraiser 6g Storm Swr.: Public ❑ Natural ❑ 160 Use Code R VX LX Total Improvements I Al Street: Conc.❑ 'Asph.❑ Dirt❑ Grovel 140 Base Year MARKET DATA Street Lights: Yes ❑ No ❑ Comparable 1 ComparobIa. 2' C & G: Yes ❑ No ❑ 124 Transfer Comparable 3 Sidewalks: Yes ❑ No ❑ 108 Acreage Sale Data 163 Imcomplate P.U. 19 P.U. 19 P.U. 19 P.U. 19 P.U. 19 P.U.14 P.U. 19 SITE TOPOGRAPHY 167 Building Class Land a Level ❑ Rolling ❑ Other ❑ 168 Bedrooms Slopes Up❑ Down ❑ S -S❑ 169 Baths At 0 Above ❑Below - ❑Grade 1.70 Effective Year View ❑ Of: 1711 Area of Residence REMARKS 1721 Land Type Lot[] Homesitte❑ LLot[:]Homesite❑ ❑ LotHomesite❑ LLot[]Homesite❑ .Lot❑ Homesite❑ Lot[]Homesite❑ Lot❑ Homesitel 173 Car. Shelter Yes ❑ No Cd msYes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ 174 Pool Yes ❑ . No Ye's ❑ .No ❑ Yea ❑ No ❑ Yes ❑ No ❑ Yaa ❑ • No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Transfer Base Year Ai c Appraisal. Date_ 2 U st _ . 9' IMPROVEMENT SUMMARY Building Record Building Record Misc. Record Total Improvements I Al MARKET DATA Comparable 1 ComparobIa. 2' Comparable 3 List Price Sale Data Sale Price TOTAL''PROPERTY APPRAISAL Land a Improvements Total Property31pewely