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061-630-014
r . � :��. _ t ..r x" 'k .,� s. •'t. 3 ,_z. - r+f t3 . y � . +. *6z . , ',��. " . j" 32 _ � ',4 L# - , i �. r ' V3 X 'a6'!,� �yy�S } � 1Ti^� . ♦ LY��i� f F �3,j 1 �'*f-�Sr�fX•� {» ` ✓ �� � « ' r � }� .,r: *�? i .! ��S � , r `',�` , ` •A� r ! i -+J � 1 r� W _ '1�{�± ' .tjl . • � •�a �•' 1� mac„ R +y, ��! i � V..� t n ��jjjT,,,,,L���,t 1».� j �. -�'. , �� t � � ,. t. 'a�, s r•� .. � a�6�, + `� a , ,. '!n ''' . `.t + tf+n� j ! N � � ��: � f t -��� .. r • t , t1 4 . �. ,. . r- RECORDING REQUESTED -BV: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 2005-0063565 Recorded - ,I Official Records I County of I Butte I Cffim J. GRUBBS I County Clerk -Recorders 1 012:ffn 19 -act -2m I REC FEE 10.00 WORMED COPY 1.00 BN Page 1 of 2 SPACE ABOVE THIS LINE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, p( INSTALLATION ON A FOUNDATION SYSTEM. Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as'of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. BOBBY JO RILEY SR AND BETTY LOU HOOG ETAL REAL PROPERTY OWNER/LESSOR P.O. BOX 477 MAILING ADDRESS BERRY CREEK BUTTE CA 95916 CITY COUNTY STATE ZIP 294 DEER MEADOW RD INSTALLATION MAILING ADDRESS, IF DIFFERENT BERRY CREEK BUTTE CA 95916 CITY COUNTY STATE ZIP SAME UNIT OWNER (if also property owner, write "SAME") SAME MAILING ADDRESS SAME CITY COUNTY STATE ZIP UNIT DESCRIPTION BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE BUTTE CA 95965 CITY COUNTY STATE ZIP 05-22JO 530 538-7541. ILDI PERMIT m' TELEPHONE NUMBER ) Vai -3 S URE F LOCAL AGENCY OFFICIAL DATE SKYCREST ENTERPRISES DEALER NAME (if not a dealer sale, write "NONE") 91265 DEALER LICENSE NO. SKYLINE HOMES INC 2003 3701 -CT MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER 8V-70-0255-S-A/B 44 x 12,46 x 12 ULI550612/3 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUBER 06;1�630;QI4 SEE ATTACHED HCD FORM 433(A) REV. 8/91 WHITE -County Recorder CANARY - HCD PINK - Applicant GOLDENROD -Building Dept. $6, ti Vj 0/2005 14:06 FAX 530 859 55s� f'IUtllIY NAIJUNAI_ iiILL l.uUoLN_uAni.o ti:1•'• =''� G Order No. BU -211139-3 MAM Da=iPtioo The land rc&n+ to hmin is 66=1ed in the State of Calikmix, -CountY of Butte, and is dssaibed as follows. PARCEL 1, AS SHOWN ON THAT CERTAIN PARCELMAP, RIBCORDED IN THE OFFICE OF TER RECORDER OF THE COLWY OF BUITE, STATE OF CALIFORNIA, ON FEBRUARY 10, 1984, IN BOOR 94 OF MAPS, AT PAGE(S) 36, APN 061 -630 -014 -WO A. NON-EXCLUSIVE EASEMENT FOR ROAD PURPOBBS AMID PUBLIC UTILny PURPOng OVER A STRIP OF LAND 60 FEET W WIDTH LYING 30 DEBT ON EACH SIDE OF A LINE DESCRiBBD AS FOLLOWS: BEGINNING AT A POW-" IN TIM NORTH LINE OF TIM SOMHWBST QUARTER OF SECnON 6, TOWNSHIP 20 NORTH, RANGE 5 BAST, M D.B. & K. WHICH POW BEARS SOUTH 87° 04' 49' WEST. 882.96 FEET FROM THE NORTHEAST CORNER OF SAID SOUTHWEST QUARTER; Ta1BNCE FROM SAID POINT OF BEGRO IVO ALONG THE FOLLOWING COURSES AND DISTANCES. NORTH 03° 43- 13" WEST, 73.09 FBEP, NORTR 28° 59'25- WEST, 231A4 FST; NORTH 49' 43' 07" PAST, 147:56 FEST; NORTH 060 Sr IV LAST, 179.27 FEET; NORTH 34' 17' 02" WEST, 98.05 FEET; NORTH 016 09' 52" WRST,104.69 F881; NORTH 33° 50' 08" EAST, 284.86 FEET; NORTH 26" 46' 18" MST, 133.81 FMn%, NOklif 15-12- 01' EAST, 135AO FEET; NIDRTR 55° 49' 44" BAST, 158.$7 FEBI; NORTH 350 30' 52" EAST. 60.75 FB.13T; NORTH 700 53' 17" BAST, 71.74 FM; SOUTH 78° 55'29" BAST, 172.55 FEET; .80M 51° 58' $ V EAST, ,181 A6 FHM; SO nH 78 _37-"_58_RAS_'T, 2x3.53 I?L'ET;, NORTA_86' 36' 35" BA3T,171.37 FEET; SOUTH 75" 24" 58• HAST, 171.06 FEST; NORTH 54° 24 37' EAST, IS2,13 FEET; NORTH 23.34' 55" WT, 122.17 FEET; NORTH 360 56' 15" BAST, 235.72 FEST; SOUTH S6° 01' SO" EAST, 230.07 FEET; NORTH 34" 05' 0o' us T, 89.32 FSH r, AND SOUTH 86° 45' 48" BAST, 14OA 0 FMT TO A P01N T IN PONDEROSA WAY, AN =1V`30 PU'BI IC ROAD. PARCEL III: A NON-EXCLUSIVE ROAD AND PUBLIC VIIIITY.'EAMMWr OVER PARCELS 2. 3, AND 4, AS SHOWN ON THAT CERTAIN PARCEL MAP, : RF.00RDHD IN nMOFFICE OF lim RECORDER OF nm COUNTY OF BUTTE, STATE 0$ CALIFORNIA, ON RJNfi 5,198 1, IN BOOK 83 OF MAPS, AT PAWS) 9. A CERTIMcATE OF CORREenONRBCORDFD NOVEMBER 30.1983, IN BOOR 2888, PAGE 86, OFFICIAL RECORDS. CONTDkW Description: Butt®,CA Document-Y*ar.DocID 2003.37398 Page: 2 of 3 Order: lalala coaotrnt: i, CLAIMANT: ADDRESS: CITY & STATE: nATF OF: CI GIM County of Butte Oroville, California GENERAL CLAIM Rosemary Sierras 8113 Hague Way Elverta, CA 95626 ()5/05/06 t9/sem S/ail /or. SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELA ' AMOUNT Refund Claim - See attached calculation sheet APN: 061-630-014 Permit No.: 9104!25t4W PAID RETAINED REFUND Development Services $ 662.87 $ 329.94 $ 332.93 THERM DRNG $ - $ - $ - SMIP $ - $ - $ - SHR $ 305.01 $ - $ 305.01 SRA $ 95.00 $ - $ 95.00 TOTAL $ 1,062.88 $ 329.94 $ 732.94 a""` :.. ..... ::SREAKDOW1V ::::::::: SUDGET'::ACC.0U-NT:::AMOUN:T.- 101001 DVLPMNT SVC 440-001 4210500 $ 332.93 1011822 THERM DRNG 1800 280 $ - 1011430 SMIP 1001 280 $ - 1011811 SHR 1800 280 $ 305.01 101001 SRA 0100 4617240 $ . 95.00 TOTAL 1 $ 732.94 $ 732.94 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. / 1 Dated this 9 day of2006, at Signature of mant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specked abovehave perfo ed or delivered and that there is a Budget Appropriation or Speck Board Approval (Check one) for the sam Dated this lr day of —� , 2006, at Oroville Calif �v Department Head w Authored Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE -AUDITOR'S USE ONLY DEPT 8 SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT. I k County of Butte Oroville, California GENERAL CLAIM CLAIMANT: Rosemary Sierras ADDRESS: 8113 Hague Way CITY & STATE: Elverta, CA 95626 DATE OF CLAIM- 05/04/()8 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT Refund Claim - See attached calculation sheet APN: 061-630-014 iPermit No.: 04-2574 PAID RETAINED REFUND iDevelopment Services $ 662.87 $ 234.94 $ 427.93 ITHERM DRNG $ - I SHR $ 305.01 SRA $ 95.00 $ 95.00 TOTAL $ 1,062.88 $ 329.94 $ 427.93 ..... ............ .................. ............. .. ... ..... ............. ............... ............. ............ ............. ............ ............. .... ........ Hk EX"OWK' ....... G. ... -ACCO.(IN T.: ACCO.( ... A MOUN. r.:: 101001 DVLPMNT SVC 440-001 4210500 $ 427.93 1011822 THERM DRNG 1800 280 $ 1011811 SHR 1800 280 $ 305.01 TOTAL $ 732.941 $ 732.94 1, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Dated this 12th day of May 2006, at Calif. Signature of Claimant 1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same. Dated this day of _. 2006, at Oroville Calif. Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT & SUB PROJ SUB. OBJ CLAIM NO. NO. INV. DATE ENCUMB. GROSS AMT. -INV P mrrmwvm� Date Reviewed Bill Barron Supervising Building Inspector CHECK: $732.94 05/12/2006 DIFFERENCE: $ (Should be blank) Claim will reflect retention of only $329.94, the Building portion REFUND CALCULATION SHEET CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM: Rosemary Sierras 8113 Hague Way Elverta, CA 95626 05/04/06 APN: 061-630-014 RECEIPT NUMBER: RECEIPT DATE: ISSUED TO: CHECK #: AMOUNT: PERMIT #: PRIOR REFUNDS: FEES VERIFIED RECEIPT INFORMATION 412342 09/02/2004 Rosemary Sierras 9642 $1,062.88 04-2574 Yes No Yes No Yes No x x REFUND BREAKDOWN DDebrunner: Title Pian Check fee Fund Dept Accnt Cash BLDG 0010 440-001 4210500 101001 THRM DRNG 1800 rHRM DRN 280 1011822 HER DEV FE 1800 (SHR) -280 1011811 FIRE ' -0100 . ; -(SRA)Is' 4617240 101001 ° DETAIL PAID R AIN REFUND BLDG Time 109.98 497.90 ............ DDebrunner: Retention reduced by $95 for SRA Fee omitted in error from original refund calculation per Tim 5nellin s. »»>: .......... .......... .......... :::...... i ,. ..... : : : .. : . >:::::: : Filing from Plan Check 0.00-0.001_,--0.00 Plan Check/Filing 0.25 27.50 219.96 21 .961 95.00 95.00 Ins ecbon 0.00 277.94 277.941 277.94 BLDGFEES OTHER BLDG : : ::::::::::::::::::::::::::::::::::::::::::::::::::::: .... ................................ .......... ............................... .......... ................................ .................... >:::::: .......... .......... .......... . ii»> :::: >: SRA -Building Inspection 109.98 109.98 109.98 Sheriff Processing fee 54.99 54.99 0.00»>:::::::::: REFUND PROCESS FEE 54.99 54.99 54.99 54.99:::::::::. BUILDING TOTAL 662.87 329.94 :6427.93 ,;427.93 THERM DRNG 0.00.... SHR 305.01305.01 °. 305.01 SRA 95.00 p 95.,00 �0,� $ 1,062.88 $ 424.94 $ 427.93 1 $ - '$,305.91 mrrmwvm� Date Reviewed Bill Barron Supervising Building Inspector CHECK: $732.94 05/12/2006 DIFFERENCE: $ (Should be blank) Claim will reflect retention of only $329.94, the Building portion Forest Floor DeBrunner, Deborah From: DeBrunner, Deborah Sent: Friday, May 12, 2006 10:40 AM To: 'mrhenryt@sbcglobal.net' Subject: Refund Review Attachments: 04-2574 Sierras 061-630-014 5-11-06.x1s Good morning Mr. Riley. Page 1 of 2 As promised, I am providing you the results of the findings in reviewing your re(und claim. The $219.96 retained for the plan check was correct as L;,I�o chuck had heeI2 corn lefec1. Unfortunately, there was a mistake on our part originally in calculating the refund amount. The review showed that the Fire Department reviewed the plans as the property is in a State Responsibility Area (SRA) and considered at a greater risk for fire. Therefore, we sfiou/d have indicated that we were retaining $95 ofthe $204.98 collected for that Fire plan check (we were already refunding out- Building portion ofthat fee $109.98 that was for the actual inspection). Because this was an error on the part of the Department in initially calculating ,your refund, I have been asked "in good faith"to deduct the $95 SRA fee we neglected to retain, (rorn the $219.96 of plan check fees, with our Department bearing the loss, so we will not be retaining an additional $95.00. There were other errors on the original calculation too - showing $497.90 as the Plan Check/Filing Fee portion of the $662.87 paid For the Building Permit, and $109.98 as the inspection portion or the Building permit. When these were put on their proper line on the new calculation, they correctly indicated $219.96 as the Plan Check/Filing Fee portion and $277.94 as the Building permit inspection por-Eion. We naturally are refunding inspection fees ($277.94 and the SRA inspection fee of $109.98). Attached for your convenience are the new calculation sheet, errors corrected, and the new claim sheet. There should be tabs at the bottom of the program so you can toggle between both forms. This hopefully, will help clarify what can be a confusing process. Let me know if you aren't able to view the spreadsheets. I hope this explanation has satisfied you, if you have further questions, please do not hesitate to contact me. I(you wish.us to process the refund for $762.90, please print out, have Rosemary sign the claim (above "Signature of Claimant"), and return the claim form. To expedite the process, if you fax it in, we'll authorize it as an "original" so the Auditor will process it. 05/12/2006 Forest Floor Deboiwh. Z)eBru.n•►ier. Manager, Program Development Butte County Department of Development Services 7 County Center Drive Oroville, CA 95965 F (530) 538-7464 FAX 538-7785 05/12/2006 W -S Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR, 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Facsimile www.buttecounty.net/dds ADMINISTRATION * BUILDING * PLANNING 5/5/2006 Rosemary Sierras 8113 Hague Way Elverta, CA 95626 RE: Permit No. 04-2574 APN#061-630-014 Owner: Riley On 9/2/2004, a deposit was made in the amount of $1,062.88, of which $329.94 was retained. Please sign, date, and return the enclosed claim form to this office. Once we receive the claim form, we will then process your refund in the amount of $732.94. Should you have any questions, please contact this office Monday through Friday, 8:00 a.m. to 4:00 pm., at 538-7601. Sincerely, Diane Lewellen Account Clerk, Senior Administrative Division enclosure 04-2574.1tr N CLAIMANT: ADDRESS: CITY & STATE: nATF nF CI AIM - County of Butte Oroville, California GENERAL CLAIM Rosemary Sierras 8113 Hague Way Elverta, CA 95626 05/05/OF - SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELA AMOUNT Refund Claim - See attached calculation sheet APN: 061-630-014 Permit No.: 04-2574 PAID RETAINED REFUND Development Services $ 662.87 $ 329.94 $ 332.93 THERM DRNG $ - $ - $ - SMIP $ - $ - $ - SHR $ 305.01 $ - $ 305.01 SRA $ 95.00 $ - $ 95.00 TOTAL $ 1,062.88 $ 329.94 $ 732.94 ..�.......... ::: i:: >:« ...W: :J ::YDE:: :GOI :AUUNI:::::: ; 101001 DVLPMNT SVC 440-001 4210500 $ 332.93 1011822 THERM DRNG 1800 280 $ - 1011430 SMIP 1001 280 $ - 1011811 SHR 1800 280 $ 305.01 101001 SRA 0100 4617240$ 95.00 TOTAL I $ 732.94 $ 732.94 i, me undersignea, aeaare under penalty or perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Dated this day of 2006, at Calif. Signature of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same. Dated this day of 2006, at Oroville Calif. Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY EPT &SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT. FIRE 0100 (SRA) . 4617240 101001 95.00 $ 1,062.88 $ 329.94 $ 732.94 $ 332.93 $ - $ - $ 305.01 1 95.00 APPROVAL CHECK: $732.94 Date Reviewed 5/4/2006 DIFFERENCE: $0.00 Bill Barron (Should be blank) Chief Building Inspector REFUND CALCULATION SHEET CLAIMANT: Rosemary Sierras ADDRESS: 8113 Hague Way CITY & STATE: Elverta, CA 95626 , DATE OF CLAIM: 05/04/06 APN: 061-630-014 RECEIPT INFORMATION RECEIPT NUMBER: 412342 RECEIPT DATE: 9/2/2004 ISSUED TO: Rosemary Sierras CHECK #: 9642 AMOUNT: $1,062.88 PERMIT #: 04-2574 Yes No Yes No Yes No PRIOR REFUNDS: X FEES VERIFIED X REFUND BREAKDOWN BLDG THRM DRNG AUD SUSP SHERDEVFEE Title Fund 0010 1800 1001 1800 Dept 440-001 rHRM DRN (SMIP) (SHR) Accnt 4210500 280 280 280 Cash 101001 .1011822 1011430 1011811 DETAIL PAID RETAIN REFUND BLDG Time 109.98 497.90 : : : : : : : ::: :::::::::: :::::: :.: :::::.: :::':::':'::':::: ::: : : : : : :::::::::: :.: : : : : : : :::::::::::: ::::::::::::::::::: :.:.:.:::::::::::::: :':::'::::':::::: Filin from Plan Check 0.00 0.00 0.00 Plan Check/Filing0.25 27.50 497.90 219.96 . 277.94 277.94 Inspection 0.00 109.98 109.98 109.98 BLDG FEES ' OTHER BLDG �gr Pgcessing fee: 54.99 54.99 0.00 0.00 1'A ..LL/%4 1� 0.00 0.00 ::•:!<:: »:::::::::<•::::::::::: REFUND PROCESS FEE 54.99 54.99 -54.99 - -54.99 :::::::::: »::::::::< ..................... »>: >:::::::::::: .............................. ....... iii ::: : ::::::::::: »: > BUILDING TOTAL 662:87 329.94 332.93 332.93::::::: THERM DRNG 0.00 0.00 SMIP 0.00 0.00 ::: »»>:< SHR . 305.01: 305.01 305.01 SRA ' 95.00 95.00 FIRE 0100 (SRA) . 4617240 101001 95.00 $ 1,062.88 $ 329.94 $ 732.94 $ 332.93 $ - $ - $ 305.01 1 95.00 APPROVAL CHECK: $732.94 Date Reviewed 5/4/2006 DIFFERENCE: $0.00 Bill Barron (Should be blank) Chief Building Inspector 4= °�uTrF° Butte County Department of Development Services o o -I-Building Division - ° 7 County Center Drive }Oroville, CA 95965 - ; _ . _ .. ..(530)_538-7541 C . _. , REFUND REQUEST APPLLCAT_IONT.: - -_.: _:. - REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any, fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develoomen . ervices for payment processing. CLAIMANT'S NAME: Rosemary Sierras ----------------- MAILING ADDRESS: F113 IVV64(e IiM, 9/v0t#f 4 (�� C! -P-H-- � ASSESSOR'S PARCEL NO.: 061-630-014 [Please use one claim form per permit.] BLDG PERMIT NO.: 062. Q Q Receipt No. 1 Recei t.No. 2 Receipt No. 3 ✓412342 - ,0.62- V V RECEIPT NO.: 09/02/04 RECEIPT DATE: $1,062.88 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: ,p, Purchased new home and contractor bought all new permits. Check those fees which you wish to have considered for refund: OBuilding Permit Fees OSheriff Fees OSRA Fees (CDF Fire Planning) OOther (specify): Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick'them up prior to that time. Signature_�� Date K:/Forms/Refund Ap i ation 082203 BUTTE e COUNTY AN 0 5 2006 iEVELOPMENT SERVICES Wednesday, November 30, zoos Development Services - BUILDING DIVISION Ver. 1.0 ` Counter Alice I Person Fund 10 (Bldg Permits) $662.87 ( - , SRA Fees (Fire) $95.00 Payment Date 9/2/2004 SHR Fees (Sheriff) $305.01 I - Permit Number 04-2574 ' SMIP r-$0.00 Receipt Number - 412342 ( Copies/Document Sales $0.00 Check Number or Cash 9042 I ,CUA (Chico Urban Area) $0.00 Parcel Number 061-630-014 I TUA (Therm. Urban Area) $0.00 Applicant BOBBY RILEY SR Water Tender Btln #= $0.00 West Chico Fire Station $0.00 Received From ROSEMARY SIERRAS Witness Fees $0.00 Total Received $ 1,06 88 Recorders Fees (N.O.C) $0.00 Thermalito Drainage $0.00 t Total Fees To Collect $1,062.88 Oroville Area Traffic $0.00 NSF (Non Sufficient Funds) $0.00 ' Notice of Violation $0.00 + NCSP Trails System . $0.00 , NCSP Roads/Bridges $0.00 ` NCSP Storm Drainage -_ $0.00 NCSP Fire Station $0.00 NCSP Parks Type $0.00 Value $0.00 j COUN Y OF BUTTE 412341 OFFICIAL RECEIPT i r t y'y *, OFFICE OR DEPARTMENT ISSUING RECEIPT 20_..,.� Received from The Sum Of For Received: Received By CASH ❑ Title CHECK ❑ By DAVOD BUSINESS FORMS • t53�1743-8511 Farm 75702 COUNTY OF BUTTE 412342 Received from ' Die Sum of— For f_For Received: CASH ❑ CHECK ❑' DAVrO BUSSNESS FORMS • (530) 743.8511 OFFICIAL RECEIPT I 20 OFFICE OR DEPARTMENT ISSUING RECEIPT 75702 Received By Title By NTY OF BUTTE OFFICIAL RECEIPT 412343 OFFICE OR DEPARTMENT ISSUING RECEIPT 20 Received from The Sum of For Received: R ived e CASH ❑ CHECK ❑ UVOO BUSINESS FORMS • (Sq 743651 I x ece Y Title By UNTY OF B1 OFFICIAL RECEIPT 412344 OFFICE OR DEPARTMENT ISSUING RECEIPT 20 1 '? Zn+eed from Sum of --- $ .,.1 -." I I 1 4. Z�,06 APPROVAL Date Reviewed Bill Barron Chief Building Inspector 04/24/2006 DIFFERENCE: $0.00 (Should be blank) REFUND CALCULATION SHEET CLAIMANT: Rosemary Sierras ADDRESS: 8113 Hague Way CITY & STATE: Elverta, CA 95626 DATE OF CLAIM: 04/21/06 APN: 061-630-014 RECEIPT INFORMATION RECEIPT NUMBER: 412342 RECEIPT DATE: 09/02/2004 ISSUED TO: Rosemary Sierras CHECK #: 9642 AMOUNT: $1,062.88 PERMIT #: 04-2574 Yes No Yes No Yes No PRIOR REFUNDS: X FEES VERIFIED X REFUND BREAKDOWN Title Fund Dept Accnt Cash BLDG 0010 440-o01 4210500 101001 THRM DRNG * 1800 I-HRM DRN 280 1011822 AUD SUSP 1001 (SMTP) 280 1011430 SHER DEV FE 1800 (SHR) 280 1011811 DETAIL PAID RETAIN REFUND BLDG I Time 109.98 497.90 ............................... .......... ::::::::::::: »> ............................... .......... .......... »»»>::: .......... .......... »»>: .......... Filing from Plan Check 0.00 0.00 0.00 Plan Check/Filing 0.251 27.50 497.90 219.961 277.941 277.94 Inspection 1 0.00 109.98 1 109.981 109.98 BLDG FEES OTHER BLDG Sheriff Processing fee: 54.99 54.99 0.00 0.00 0.00 0.00 REFUND PROCESS FEE 54.99 54.99 -54.99 -54.99 :::::::::::::::::::::::::::::::. .......... .......... : ............................... .......... ............................... .......... ...................... ' :::::::::: .......... .......... .......... .................... .......... :::::::::::::::::::: .......... .......... .......... .......... BUILDING TOTAL 662.87 329.94 332.93 332.93 THERM DRNG 0.00 0.00 SMIP 0.00 0.00::::: >: »> SHR 305.01 305.01 305.01 SRA 95.00 95.00 APPROVAL Date Reviewed Bill Barron Chief Building Inspector 04/24/2006 DIFFERENCE: $0.00 (Should be blank) o�%U3TrFo Butte County Department of Development Services o � a Building Division o _T��;_'��: <0 7 County Center Drive c�UNty Oroville, CA 95965 (530).538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued -if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Development Services for payment processing. CLAIMANT'S NAME: �-........D... ! OBJ 67 a MAILING ADDRESS: ::.��:.,:.?':. PHONE: ASSESSOR'S PARCEL NO.: [Please use one claim form per permit.] BLDG PERMIT NO.: RECEIPT NO.: RECEIPT DATE: I: v a. '00 RECEIPT AMOUNT: REASON FOR REFUND REQUEST:ne- S'9 / � 92 k S -e- d neto_ 44PI-e and a Check those fees which you wish to have conside ed for refund: =Building Permit Fees =Other (specify): _ =Sheriff Fee4 =SRA Fees (CDF Fire Planning) (Plans for cancelled permits will be disposed of Within 10 working days upon submission of a Reauest for Refund. If you want the plans, you Zv pick them up prior to that time. Signature Date K:/Forms/Refund Application 08220 I DEPARTMENT OF DEVELOPMENT SERVICES DEPOSIT SHEET BUILDING DIVISION DEPOSIT # 285 BAG # 316 PERMIT# RECEIPT# ACCOUNT # F-10 ACCOUNT # (SRA) 0100 ACCOUNT # AVA COURT (SHR) 1800 F-10 ACCOUNT # (TUA) 1800-280 ACCOUNT# NCSP (SMIP) 1001 1800-280 03-1688 412163 $ 54.99 BP041045 412165 $ 1,254.25 $ 305.01 $ 540.01 $ 7.46 BP042576 412166 $ 219.98 042577 412167 $ 137.50' 031010 412168 $ 54.99 042579 412169 $ 220.00 BP042582 412171 $ 54.99 042569 412337 $ 109.98 042571 412338 $ 55.00 042570 412339 $ 109.98 BP042573 412340 $ 426.18 BP031972. 412341- $ 109.98 _-- _ _ _ A,•-__ BP042574 412342 $ 662.87 $ 95.00 $ 305.01__ BP042574 412343 $-_- 52.00 • n_.a_ „ 1'1 �_„_ _.�- _ -BP042575 412344 $ '384.98- -$` `-95-60 $ 2.34 BP042578 412345 $ 150.00 $ 0.37 BP042580 412346 $ 659.88 $ 95.00 $ 1.61 042581 412347 $ 110.00 042250 412348 $ 357.43 $ 2.88 T $ 5,184.98 $ 285.00 $ 610.02 1 $ - $ 540.01 $ 14.66 $ - GRAND TOTAL TO BE DEPOSITED $ 6,634.67 MONEY COLLECTED: 1 9/3/2004 auditor:yellow COMPILED BY: CHERYL SPOOR, Ext. 6571 DATE 12/21/20051 ` Project Log/Activity Sheet Project # CA APN #lL> r W4,\_� _ • • ff—X l �S 1 I W_J. '1 m vn i 2(zc to T-- y Project No: APN: Applicant: Issued: Renewal Date: Date Description _ Amount Receipt Check # ----------------------- �� LSAh9 diJ, t �� 440-001 APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector GHEGK: -$2.99 05/11/2006 DIFFERENCE: $0.00 (Should be blank) REFUND CALCULATION SHEET CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM: Bob Riley PO BOX 477 Berry Creek, CA 95916 04/21/06 APN: 061-630-014 RECEIPT NUMBER: RECEIPT DATE: ISSUED TO: CHECK #: AMOUNT: PERMIT #: PRIOR REFUNDS: FEES VERIFIED RECEIPT INFORMATION 412343 09/02/2004 Bob Rile cash $52.00 04-2574 Yes No Yes No Yes No X X REFUND BREAKDOWN Title Fund Dept Accnt Cash BLDG 0010 440-001 4210500 101001 THRM DRNG 1800 rHRM DRN 280 1011822 AUD SUSP 1001 (SMIP) 280 1011430 SHER DEV FE 1800 (SHR) 280 1011811 DETAIL PAID RETAIN REFUND BLDG Time 109.98 52.00 ............................... ::::::::::::::::::::::::::::::.: .......... ............................... .......... ::::::: »::::::::::::::::::::: .......... ............................... .......... ....................... .......... ::::::::::::::::....:::.. .......... .......... .......... :::::::::::::::::::::: >::::: >::: .......... . .......... .......... .......... »:::::: : Filin from Plan Check 0.00 0.00 0.00:::::::::: Plan Check/Filing 0.25 27.50 0.00 0.001 0.00. 0.00 Inspection 0.00 52.00 52.00 52.00 BLDG FEES OTHER BLDG REFUND PROCESS FEE 54.99 0.00 0.00 0.00 0.00 0.00 0.00 54.99 -54.99 -54.99 BUILDING TOTAL 52.00 54.99 -2.99:::::: THERM DRNG 0.00 o:oo SMIP 0.001 0.00 SHR 0.00 ° 6.0010.00 SRA 0.00 0.00 0:001- - APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector GHEGK: -$2.99 05/11/2006 DIFFERENCE: $0.00 (Should be blank) sus106 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Facsimile www. b u tteco u n tv. n et%d d s ADMINISTRATION * BUILDING * PLANNING 5/5/2006 Bob Riley P.O. Box 477 Berry Creek, CA 95916 Re: Permit Number: 04-2574 APN: 061-630-014 Owner: Same Upon review of the above -referenced permit file by the County Building Official, it has been determined that a refund cannot be processed for the following reason(s): ❑ Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. ❑ The request is over two years from the date of the fee payments on this non -issued permit. ❑ The request is over two years from the date of permit issuance and construction work has been done. ❑ Filing fees and plan check fees for work plans checked are not refundable. The above determinations have been made in accordance with Butte County Code 3-41(t). You may view Butte County Code online at http://municipalcodes.lexisnexis.com/codes/butteco/ - ® Other reason: Due to the processing regarding your permit application; there are no remaining fees to be reimbursed to you. Should you have further questions about this matter, please contact this office between 8:00 am and 4:00 pm, Monday through Friday. Sincerely, Diane Lewellen Account Clerk, Senior Administrative Division enclosure 04-2574.1tr 0 CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM County of Butte Oroville, California GENERAL CLAIM Bob Riley PO Box 477 Berry Creek, CA 95916 05/05/06 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELRO AMOUNT Refund Claim - See attached calculation sheet APN: 061-630-014 Permit No.: 04-2574 PAID RETAINED REFUND Development Services $ 52.00 $ 54.99 $ 2.99 THERM DRNG $ - $ - $ - SMIP $ - $ - $ - SHR $ - $ - $ - SRA $ - $ $ - TOTAL $ 52.00 $ 54.99 $ (2.99) O ..... .............. > %w BiiEAI�DOVVN 12GEJIVT ::A-Y�OU�t'I?:: 101001 DVLPMNT SVC 440-001 4210500 $ 2.99 1011822 THERM DRNG 1800 280 $ - 1011430 SMIP 1001 280 $ - 1011811 SHR 1800 280 $ - 101001 SRA 0100 4617240 $ - TOTAL 1 1 $ (2.99),$ (2.99 i, me unaersignea, oeciare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Dated this day of , 2006, at Calif. Signature of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same. Dated this day of 2006, at Oroville Calif. Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND UV IYV 1 WVr%1I C DCLVYY I r1lQ LIIYC - AUUI I UKJ UJC UNLT DEPT & SUB PROJ SUB. OBJ I CLAIM N0. I INV NO. I INV. DATE I ENCUMB. GROSS AMT. APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector 5/5/2006 DIFFERENCE: $0.00 (Should be blank) REFUND CALCULATION SHEET CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM: Bob Riley PO BOX 477 Berry Creek, CA 95916 05/05/06 APN: 061-630-014 RECEIPT NUMBER: RECEIPT DATE: ISSUED TO: CHECK #: AMOUNT: PERMIT #: PRIOR REFUNDS: FEES VERIFIED RECEIPT INFORMATION 412343 9/2/2004 Bob Rile CBSh $52.00 04-2574 Yes No Yes No Yes No X X REFUND BREAKDOWN Title Fund Dept Accnt Cash BLDG 0010 440-oo1 4210500 101001 THRM DRNG 1800 rHRM DRN 280 1011822 AUD SUSP 1001 (SMIP) • 280 1011430 SHER DEV FE 1800 (SHR) 280 1011811 DETAIL PAID RETAIN REFUND BLDGTime 1os.sa 52.00 :-:::: »»> ............................... :::::::::::::.....::::::::::::;:;:;:; ............................... ::::::::::.................... :::::::< :::::: .......... ............................... .......... ............................... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::: : : : �»»:*:.:.:.:.: .::::::::::::::::::::::::::::::::: i»::::::< .......... .......... ..................... >::: >:: .......... ::::::::: :::::: »>: ;:;:;:;:;::::::::::: :«< .......... .......... »»>: >:: .......... Tilingfrom Plan Check)'0.00 0.00 0.00:::::: Plan Check/Filing0.25 27.50 0.00 0.00 0.00 Inspection 0.00 52.00 52.00 52.00 BLDG FEES OTHER BLDG REFUND PROCESS FEE 54.99 0.00 0.00 0.00 0.00 54.99 -54.99 -54.99 BUILDING TOTAL 52.00 54.99 -2.99 -2.99 THERM DRNG 0.00 0.00:::: SMIP 0.00 SHR 0.00 0.00 SRA 0.00 APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector 5/5/2006 DIFFERENCE: $0.00 (Should be blank) YI z4(a 6- APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector e.A�AP"-- CHECK: $0.00 04/24/2006 DIFFERENCE: $0.00 (Should be blank) REFUNDCALCULATION SHEET CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM: Bob Riley PO Box 477 Berry Creek, CA 95916 04/21/06 APN: 061-630-014 RECEIPT NUMBER: RECEIPT DATE: ISSUED TO: CHECK #: AMOUNT: PERMIT #: PRIOR REFUNDS: FEES VERIFIED RECEIPT INFORMATION 412343 09/02/2004 Bob Rile cash $52.00 04-2574 Yes No Yes No. Yes No X X REFUND BREAKDOWN Title Fund Dept Accnt Cash BLDG 0010 440-001 4210500: 101001 THRM DRNG 1800• rHRM DRN 280 1011822 AUD SUSP 1001 (SMIP) 280 1011430 SHER DEV FE 1800 (SHR), 280 1011811 DETAIL PAID RETAIN REFUND BLDG Time 109.98 52.00 :::::::::: ............................... :::::::::::::::::: .......... :::::::::::::::::::::::::::::::::::::::::::::::::::: ............................... .......... ::::::::::::::::::::::::::::::•: .......... ::......:::::::::::::::::::::! .......... ............................... .......... ............................... ::::: :: :::::::::: .......... .......... .......... .......... .......... >:: ..................... .............................. ::::::::: : :::: .......... .......... .......... .......... .......... >: Filing from Plan Check 0.00 0.001 0.00 Plan Check/Filing0.251 27.50 0.00 1 0.001 0.00 Inspection 1 0.00 52.00 1 52.001 52.00 BLDG FEES OTHER BLDG REFUND PROCESS FEE 54.99 0.00 0.00 0.00 0.00 52.00 -52.00 -52.00 BUILDING TOTAL 52.00 52.00 0.00 0.00: THERM DRNG 0.00, SMIP 0.00 0.00:::::::::: SHR o.00 . 0.00 SRA.' 0.00 APPROVAL Date Reviewed Scott Rutherford Chief Building Inspector e.A�AP"-- CHECK: $0.00 04/24/2006 DIFFERENCE: $0.00 (Should be blank) o�UTrFo' Butte County Department of Development Services Building Division TO ; �7 County Center Drive ` covN�y Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid -the fees, whose -name is on P the_receip.t issued for_the_fees-paid:—Any-refund checks.will_be-made payable_fo the_name=on_the.rece►pt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Development Services for payment processing. CLAIMANT'S NAME: Bob Riley P.O. Box 477, Berry Creek, CA 95916 MAILING ADDRESS: (530) 589-3755 PHONE: ASSESSOR'S PARCEL NO.: 061-630-014 [Please use one claim form per permit.] BLDG PERMIT NO.: , I r C3 � -`'f. 52.00Receipt RECEIPT -NO.: No. 1 Receipt No. 2 Receipt No. 3 ''-'f'412343 - - 09/02/04 RECEIPT DATE: ✓ $52.00 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: Purchased new home and contractor bought all new permi s which you wish to have considered for refund: Ch=Building Permit Fees OSheriff Fees OSRA Fees (CDF Fire Planning) OOther (specify): Plans for cancelled permits will be disposed of within 10 working days upon.submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. 0001, Signature K:/Forms/RefOrid Application -08220 Date f4 Al 4 2006 'UX vt sib lt�pit 0 Wednesday, November 30, 2005 Development Services BUILDING DIVISION Ver. 1.0 Counter Alice ' Person Fund 10 (Bldg Permits) SRA Fees (Fire) Payment Date 9/2/2004 I SHR Fees (Sheriff) Permit Number 04-2574 I SMIP Receipt Number 412343 I Copies/Document Sales Check Number or Cash CASH I CUA (Chico Urban Area) Parcel Number 061-630-014 ' TUA (Therm. Urban Area) Applicant BOBBY RILEY SR. I Water Tender Btln # West Chico Fire Station Received From SAME ( Witness Fees Total Received ' $ 52.00 Recorders Fees (N.O.C) Thermalito Drainage Total Fees To Collect _ $52.00 Oroville Area Traffic NSF (Non Sufficient Funds) - Notice of Violation ' NCSP Trails System NCSP Roads/Bridges NCSP Storm Drainage NCSP Fire Station NCSP Parks Type Value $52.00 r $0.201 $0-02J $0.00 ` $0.00 $0.00 $0.00 $0.00 -$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $Q -22J. $0.00 $0.00 COUNTY OF BUTTE OFFICIAL RECEIPT' 4i"2341 OFFICE OR DEPARTMENT iSSUING,RIEZ�E-IPT 20 - Received from The Sum of For Received: Received By CASH❑ Title CHECK E) By Form 75742 - WW BUSINESS FORMS - (530) 743.8511 Form 75702 COUNTY OF BUTTE -412342 OFFICIAL RECEIPT OFFICE ORDEP,,F�f[TMENT ISSUING RECEIPT Received from The Sum of ]J2 20L— Fo Received: Received By 4f CASH ❑ Title CHECK LJ COUNTY OF BUTTE 412343 OFFICIAL RECEIPT OFFICE OR DEPARTMENT ISSUING RECEIPT 20 Received from The Sam of For Received: Received By By - WW BUSINESS FORMS - (530) 743.8511 Form 75702 COUNTY OF BUTTE -412342 OFFICIAL RECEIPT OFFICE ORDEP,,F�f[TMENT ISSUING RECEIPT Received from The Sum of ]J2 20L— Fo Received: Received By 4f CASH ❑ Title CHECK LJ 0 COUNTY OF BUTTE 412343 OFFICIAL RECEIPT OFFICE OR DEPARTMENT ISSUING RECEIPT 20 Received from The Sam of For Received: Received By CASH Q/ E:= Title CHECK 0 By nkV0O BLTAHM FORMS•OW) 743-857 I Form 75702 COUNTY OF BUTTE 412344 OFFICIAL RECEIPT OFFICE OR DEPARTMENT ISSUING RECEIPT 20 Received from The Sum of 0 i' Butte County Department. of Development Services 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone , (530) 538-7785 Facsimile ADMINISTRATION * BUILDING * PLANNING December 21, 2005 Bob Riley P.O. Box 477 Berry Creek, CA 95916 Re: Permit Number: 04-2574 APN: 061-630-014 Upon review of the above -referenced permit file by the County Building Official, it has been determined that a refund cannot be processed for the following reason(s): Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. ❑ The request is over two years from the date of the fee payments on this non -issued permit. ❑ The request is over two years from the date of permit issuance. ❑ Filing fees and plan check fees for work plans checked are not refundable. The above determinations have been made in accordance with Butte County Code 3-41(t). You may view Butte County Code online at http://municipalcodes.lexisnexis.com/codes/butteco/. Q/ Other reason: We can process the Refund Request Applicatiori after it has been si ied by Bob Riley; the second Refund Request Application needs to be signed by Rosemary Sierras whose name is on receipt #412342. Upon receiving the signed copies of the Refund Request Applications we will process your refund. Should you have further questions about this matter, please contact this office between 8:00 am and 4:00 pm, Monday through Friday. Sincerely, Gwyn Benedict Office Specialist, Senior 04-2574.1tr �UTr Butte County Department of Development Services 0 0 0 o Building Division - 0 0 � -' 0 7 County Center Drive 0Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid. the fees, whose name is on t he receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees. for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develo ment Services for payment processing. CLAIMANT'S NAME: Bob Rile ' MAILING ADDRESS: P.O. Box 477, Berry Creek, CA 95916 PHONE: (530) 589-3755 ASSESSOR'S PARCEL NO.: 061-630-014 [Please use one claim form per permit.] BLDG PERMIT NO.: ' I `f $52.00 RECEIPT NO.: Receipt No. 1 Receipt No. 2 Receipt No. 3 412343 0902/04 I I . RECEIPT DATE: $52.00 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: Purchased new home and contractor bought all new permits. Check those s which you wish to have considered for refund: Building Permit Fees OSheriff Fees OSRA Fees (CDF Fire Planning) OOther (specify): Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. Signature K:/Forms/Refund Application 082203 Date owrrFo3 Butte County Department of Development Services �� - o Building Division C--- 7 County Center Drive FOUR Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees; whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develo ment Services for payment processing. CLAIMANT'S NAME: Rosemary Sierras MAILING ADDRESS: PHONE: ASSESSOR'S PARCEL NO.: 061-630-014 [Please use one claim form per permit.] BLDG PERMIT NO.: - -)'— L QQ ' O .88 RECEIPT NO.: Receipt No. 1 Receipt No. 2 Receipt No. 3 412342 09/02/04 RECEIPT DATE: $17062.88 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: Purchased new home and contractor bought all new permits. Check those fees which you wish to have considered for refund: , OBuilding Permit Fees OSheriff Fees O'SRA Fees (CDF Fire Planning) DOther (specify): Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. 4 Signature K:/Forms/Refund Application 082203 Date 0 NOTES RESIDENTIAL PERMIT NO. 061-630-014 ' 04 RILEY SR, BOBBY aq4 DEER MEADOW RD, B CR Cont: GREENE ROOFING MHI- SOFT SET SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE. SPRINKLERS REQ. SPECIAL INSPECTION ITEMS , r VERIFY ` USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER JOB FINALED (Date) Signature J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date FRAMING (Continued) Card B-1 Date Card B-1 Date Hangers -Post Caps -Anchors -Connectors Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors 23. Fire Sprinkler; Test 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Date 57. Card B-1 Date Card B-1 Date 58. Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s Glazing Area -Glass Protection -Skylights -Plastic 24. Fixture & Transformer Clearance -Ins. Protection Shear Walls; Nailing -Bolts 25. Elec. Receptacles Spacing -Lights & Switches at Doors Brace Interior/Exterior Wall Panels 26. Size Boxes & No. of Conductors Stapled Insulation -Walls -Ceilings 27. Romex Installed Close to Edge of Studs & C.J. Infiltration -Walls -Windows 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water Card B-1 Date Card B-1 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI Card B-1 Date Card B-1 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes O No • 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector 69. Elec. Trim & Subpanel, Breaker Sizes & Labels Date 70. Card B-1 Date Card B-1 Date 71. Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Elec. Outlets at Wood Panel, Int. & Ext. 36. A.C. Ducts Insulation & Support Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 37. Vent Fan, Exhaust above insulation Elec. Outlets & Receptacles at Kit. Counter 38. Condensate Drain & Overflow, Size & Grade Garage Fire Door; Swing -Landing -Closure 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet A.C. Duct in Garage -Damper 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 80. 41. Sills Proper Materials & Anchors 81. 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 82. 43. Bearing Walls over Girders & Floor Nailing . 44. Draft Stop in Walls (rat proof) 83. 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 84. 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except#'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails - 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (FF.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth . Clearance Looked under Floor O Yes _ 83. Following Instld./Drive 0 Yes 0 No/Walks 0 Yes O No/Planters 0 Yes U No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: J=OK 0 = NoIOK = NotAppRea:lyable . = Not Rea DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s ' MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ P' L'ft. / P Nat. or/ P' L "ft./ P LPG Electric 7. Well Clearance & Disconnect Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 8. Utility Clearance Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line POOLS (Plans) OK except #'s 3. Gas; MH Test -Demand -Valve -Connector Setbacks -Easements 4. Electricity; MH Test -Crossovers -Breakers -Clearances Soils; Compaction -Structure Stability 5. Drain; MH Test -Fall -Flex Connector Pool Structure; Steel -Connections -Thickness Dead Men -Lining 6. Water; MH Test -Regulator -Connector Elec.; Receptacles and Lighting, Distance-GFI 7. Water and Sewer Connected -C/O to Grade -HD Approval Elec.; Pool Lighting; 15 Volts-GFI 8. Gas and Electricity Tagged Elec.; Enclosures; Conduit Entries -Terminals -Listed 9. Tie Downs -Type -Installation Cert. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 10. Exits; Insp.-Sketch Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panelboards-Ins. to Main Conduit 11. Cert. of Occupancy Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel - 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 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.neAdds PERMIT NO. BP042674 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 09/22/2004 APN: 061-630-014-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 294 DEER MEADOW RD BCK Date: Contractor. Map Index: Description: MHI NEW SITE(720) OWNER -BUILDER DECLARATION I 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: RILEY BOBBY JO SR ETAL permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a HOOG BETTY LOU signed statement that he or she is licensed pursuant to the provisions of P O BOX 477 the Contractor's State License Law (Chapter 9 commencing with Section BERRY CREEK; CA 95916-0477 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).): I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: RILEY BOBBY JO SR ETAL Code: The Contractors' State License Law does not apply to an HOOG BETTY LOU owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, P O BOX 477 provided that such improvements are not intended or offered for BERRY CREEK, CA 95916-0477 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: 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.). ❑ la E empI under Article 3 o9tpBusiness and Professions Code 9 as Date: Owner: ' License #: WORKERS' COMPENSATION DECLANATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: ❑ 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: Carrier: Total Square Ft: 0 S.F. Valuation: $0.00 Census Code: Policy #: I certify that in the performance of the work for which this permit is issued, 1 shall not employ any persons any manner become subject to the workers' compensation laws of California, nia,a, l{L�. 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. /1 ��%• 7 �• / Date: g)- 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the dR anrt/or This permit is hereby issued under the applicable provisions of the Butte Cou7�c Resoluti s do\work ind'c ed ab for ch fees have been paid. // performance of the work for which this permit is issued (Sec 3097 Civ.) cql Name: By Date: < Address: PERMIT EXPIRES ON: lyto ❑ 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 enter upon the above mentioned property for inspection purpose Print Name: a Signature: Date: a Owner Ll Contractor ❑ Agent for Owner (3 Agent for Contractor A+. BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" 0 4 OWNER Last Namo' a t� irst e� AddresP D 96 X Y 7 City C StaC��, -F/4 Phon� ^37� Fax E-mail APPLICANT NAME CONTRACTOR Name Cit Cbz 1� '�' Address SRA City Fax • State Zip Phone Fax E-mail Lot # Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name Cit Cbz 1� '�' Address SRA City Fax • State 717p_ Phone Fax E-mail Lot # State License Number APPLICANT NAME NamV U` J • Addr PO 7 Cit Cbz 1� '�' St&.j/i� SRA Phone , Fax • E-mail APPLICANT SIGNATURE X For office Me only: Zoning Flood Zone SRA r Yes j No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: E UVtK FUK SUBMITTAL REQUIREMENTS L, K:\F0RMS\BL1F1NG FORMS\BldgApplSubRgmts.doc Page 1 of 2 PERMIT NO. BP BIN # LOCATION Pr pert 5FA ;&YC42� 'Crbss Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description r cope of Wor 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 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 oth epartment co not refundable. NEWARM— , i Receipt #: qI yff S, Date: (1 a If yea 3`4-3 IP P Other 0 7-27-04 T._. , - .. .. � Tit• SUBMITTAL & PERMIT REQUIREMENTS A ' The-following drawings and specifications rmust'be submitted to the Building Division in order to apply for a perrriif.-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.Y , ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! * , ❑ 4. Energy compliance design and supporting documentation in duplicate.,(Note: Not required for additions to • mobile or modular•homes:)•^ ❑ 5. Statement of Intent_for Nonheated and A/C for Non-Residential Buildings. .,+, , • . ❑ 6. Manufactured homes:(A) Data sheets"and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie.dov rh tt ` 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 ,t - plans in triplicate. All of these must be stamped and wet-signed by the engineer. El 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. t , ❑ 11. Detached Accessory Building; Form filled,out by the owner (if required). ��` .'�_'•' ❑ .12. Hazardous Material Form (for Commercial Buildings only). 0.4 ' , ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning t4 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). a : ❑ 2.• Impact Fees. -, ❑ 3. California Department-of Forestry plan;,approval (if required). ❑ 4. NPDES Fofm: ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ - 6. Contractor's license information. (Number, Name Style, Classification). '• , .y, ❑ T. Worker's Compensation Carrier and Policy Number. ❑ •, 8. Owner-Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). z ' ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ' ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). • - ''' If you-have questions or would like additional information regarding this process, contact a•Permit.•. Application 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 ori an-applicatonaafter.•expiration, a new application,'plans and fees will be required. ' •b �« REQUEST FOR FEE REFUNDS ';Refunds=can;only be-made upon written request by the person who•pyaid the. fee. The request,must-be,,,made within`4vo# years from.the date`6f-fee, payment on permits not issued, and two �yea`rs, from the date.;of'permit issuance for•,permits. s ' 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. a OVER FOR BUILDING PERMIT APPLICATION -='• i V, •. K:\FORMS\BUILDING FORMS\BldgApplSubRrts.doc Page 2 of 2 REV 7-27-04 ,�F ' • �r A Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by 19. Soils Report and/or Engineered Foundation required ........................................... 20. Erosion Control Plan Required.........................y,..................... ,.../'t.... 21. Fees as shown on the attached Schedule of Fees Due Shevif 22. City of Chico Plumbing permit ....... :................. .............................. . 23. California Department of Forest plan approval f7paid. Sent by: 24. Planning approval (A) Use: '(B)Parking: (C) Parcel Chec : 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... 28. Pre -Inspection for required....... A 29. Contractor's license information. (Number,;.Name Style, Classification) ................... `%` 30. Worker's Compensation Carrier and Policy Number ....................................... 31. Owner -Builder Ver ifcation;(_ Given to owner, _Mailed to owner) ..................... tj > 32. Letter of Signature authorization;`-'.... -" ........................... ............................ el 33. Recorded copy of Agricultural Acknowledgment Statement ................................. 34. Manufactured home utilityclearance........:;,................................................... 35. Existing violations and/or expired permits..:::4 r` ................................................ ❑ 36. Deed Restriction........... y......... to............................................................. ❑ 37. ❑ Grant Deed, ❑ M.H. Title'/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other:, ❑ 39. Other: When issued Telephone - 0 - D and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. n Applicant: -/-7 Date: 1. Index permit applica i n f r the abov&,i4nns numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owne , a advised of the ove data b'y % phone,` ❑ mail, ❑count y `' Date: Plans reviewed by: Date., Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division J QJ T 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 / F , OWNER: let ASSESSOR � `CEL NUMB^ER�, �' x NE fN M N �1� �✓ 5 i TF -, u Proposed Building Use: Counter Technician: V r- - Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. 1. Site plans,0or 4 sets, signed by the preparer of the plans. ` ` <..h` ; f 0,1 2. Complete plans, 3 or 4 sets, signed by the preparer of the",plans �;, r 5 { ❑ 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. Zara f ❑ ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ! r 8. Manufactured homes: j� Data sheets an installation inst (9�#Aarriage line info, (Ca Floor Plan, ( ie down or nd plans, all in , duplicate. ❑ 9. Metal bldgs: (A) Metal Bldgplans,r(B) Fnd plans and,calcs in;triplicate, (.C) Elevat ons I t iplicate. (D) Floor plans in triplicate. All of these must be be stamped and wet -signed by the engineerand wet -signed by the engineer.=•''"''`� 7 ` �J' ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ . 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ._ ` ❑ 14. Hazardous Material Form 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16 Other - • �r A Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by 19. Soils Report and/or Engineered Foundation required ........................................... 20. Erosion Control Plan Required.........................y,..................... ,.../'t.... 21. Fees as shown on the attached Schedule of Fees Due Shevif 22. City of Chico Plumbing permit ....... :................. .............................. . 23. California Department of Forest plan approval f7paid. Sent by: 24. Planning approval (A) Use: '(B)Parking: (C) Parcel Chec : 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... 28. Pre -Inspection for required....... A 29. Contractor's license information. (Number,;.Name Style, Classification) ................... `%` 30. Worker's Compensation Carrier and Policy Number ....................................... 31. Owner -Builder Ver ifcation;(_ Given to owner, _Mailed to owner) ..................... tj > 32. Letter of Signature authorization;`-'.... -" ........................... ............................ el 33. Recorded copy of Agricultural Acknowledgment Statement ................................. 34. Manufactured home utilityclearance........:;,................................................... 35. Existing violations and/or expired permits..:::4 r` ................................................ ❑ 36. Deed Restriction........... y......... to............................................................. ❑ 37. ❑ Grant Deed, ❑ M.H. Title'/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other:, ❑ 39. Other: When issued Telephone - 0 - D and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. n Applicant: -/-7 Date: 1. Index permit applica i n f r the abov&,i4nns numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owne , a advised of the ove data b'y % phone,` ❑ mail, ❑count y `' Date: Plans reviewed by: Date., Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division J TO: FROM: SUBJECT: Building Department Environmental Health Sanitation Clearance EA. use ONLY FIoII Plan Attached V r Floor Elan Atnachad sont to S.D. ! Owner Location AP#" Plan Approved for: Sewage Dispos� 11,00 Water Su�ply: blit Private Well Carance for dwelling. Other f UP 1 1,001/ti / )�-4 1 A �J- IL Hold final for: Final clearance O.K. for: NOTE: Environmental Health Specialist 8/96 1' o�vT�Fo Department of Public Works C o u n t y o f B u t t e O O O J. Michael Crump, Director LAND DEVELOPMENT DIVISION O O r Storm Water Management Program C' y 7 County Center Drive Oroville, CA 95965 A�LIc WOP,�S (530) 538-7266 t (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE1 Project Description: --W�%¢LL /2,2 A 6 C) ZW 61,491— 2Z0� Project Location and/or Parcel Number: �;l�E�� /���9xh✓ /��1 By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/12/04 i OWNER -BUILDER VERIFICATION Attention Property Owner. An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing -and issuing your building permit No building permit will be issued until this verification is received. . I. I personally plan to provide the major labor and materials for constru.cfiion of the proposed property improvement: YES tib- NO ❑ 2. I HAVE 0 HAVE NOT bl�gned an application for a building permit for the proposed work. I have contracted with the following person (far) to provide the proposed consttvcdon: . NA M:E-.. ' ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major worla NAME' ADDRESS: C'I'y: - PHONE: CONTRACTOR'S LICENSE N.O. MINEMA •. Dimp! •.' •I r M" eee. Me Ie e e e•. e• e� ee e e e NAME ADDRESS 'PHONE I TYPE OF WO GNED' PROPERTYOWNMU ZAL S — DATE: NOTE: This Owner -Builder Veryzmdon is required by Section 19831 and 19831 of the California Health and Safety Code. This verification must be completed and returned to our of "ice before we are permitted to irrue the nernzit± OWNER BUILDER INFORMATION Dear Property Owner All e hcatioa far a bml&g p� bas been mbmiited in yon name listing yourself as ge bM1der of proPr sP [Y For yourpratecton, You shoWd be aware that as aowner4m7der" a ppm Big per. am not you are the responsible party ofrecord on sunt T to by pro own owners unless they are own c�orlc If your_wark is being performed by sameone other thaw Pa y Performing their liability if that person applies for the Yase1c You may Pmt yourself from. possible ProP�P� m his or her name. iicensem are wens from the ciW ed by law to be licensed and bonded by the State of Caiimmia and to have a business apply. O1 comfy Thi are also requrred by law in putt tip license number on all permits for vii trey Ifyou play to do your own`w0d; vel& the exception ofvadous trades that be aware of th.a following nnfa�on fir your benefit and protean; to plan to subcontract; you sbould � a Ifyou employ or OY p sows other Sun YOM immediate fimity, and the work (mciuding matrials and other costs) is $300 or more fnr $e entire pray then you may be an eamployer.. and snch puns are not licensed as cow or sub rs, ♦ If you are an employer, you mast register WA tin; State and Fetal Govt as anIo subject to seveial obligations includmg.� and federal income tux withholding, �P and Yo12 are ♦ There ceasation iasuraace disability ;,,�,, CDs, and unemployment may be financial rhh fDr pC)U ifytd do nat auui with. respect to worhes these obligaiions, and these rW= are a R>ecia Ry sadom ♦ For more specific mon aboutyonr obiigatim under Fedmal Law if You wish, ibe U.S. Small Business . c�ract the �1 Revue Service (and, State Law contact the D ). Far more c mon about your obligations ander epartment ofBenefit payer and the Division ofindasirial Amidenss. If the structure is intended for sale property owners who are not licensed are allowed to perfonn, theIr work personally or.dn=Vh their own emPlOYee; without a licensed co�artaror mb , only ander limited conditions. A frequent practice of uaiiceased p== Pmftsing to be yrs is to secure as P� �=Y mmP the -owner bmZdea" building permits are nit required to be owner is g his or her o�vea labor and matmial pMona123 . Building ia£caadm abouit licensed ° ' are p anfing weir own wor]c p= OOMmmnity or at 1020 N Strep Sam met, GA. 95814. State License Board m your Pie= co®plete the `Owner BMIder vetificai oe on Ste reverse side of taus fozoa so that we can confirm that yon are aware of Siwe mati�as, The buuilding P� w81 not be issued uatU the ver1ficat our is retumed, OTS T Frxs Ovtier-BrrBdPrlt orrrsatwn is regrured F,y Sec on IB830 of Bse C&VOrrria Hed& rad Safely Code ,. ,Y c . - � .. � ,.,,. -v ,.„ S ... w -r - • ♦ --, I •- ..r .-g, a� t..,; �.M t:--: r , w .. .. �.-.. � o =., .... • •-- . �r^. .. BUTTE CHOOLS'IM PACT FEE CERTIFICATION FORM. (One form per Building) School District �. t Building Department No. Das'7 A.P. Number 0 I ' ?V wV' J risd'�ction:. J City FCounty Property Owner VJ Property Location/Address (CIVI V ✓' (.i Subdivision -=Lot No. r ..........................._..................................:.................................. Residential Development Q Q Q S4• Footage No of Living Mobile Home r Addition/ 'Supplemental to Group R) Units Installation Conversion Permit # '(No foundation inspection) . Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Commercial/Industrial Sq. Footage New Addition (Including Exterior Roofed Areas) -_lo i 0 Building Department RepresentatiM Date District Identification No. School District c'e'rtifies that (Street Address) 9e rru Crete (City) has complied with the requirements of Resolution No. representing O square feet. � n School District Sr. (Applicant) •eau-� � � �9-�3 SSS (Phone Number) (Zip Code) by payment of $ 67 2926 S ' FULL MMGATION $ �► 2 --� ` Date Paid by Check # Remarks: r Notic You may protest the Imposition of the fess Identified above by submitting a writtan protest to the Dtsblct, in compliance with Govsmmsnt Code Section 66020(x), within 90 days from the data Nes are paid. Failure to submit a timely written protest wlll'prohibR you from c alMrgirg the imposition of the Nes In any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the school Disbict is r. notllMd by an applicable Local Plannbng Agency that this project Is being mvkwed under the Califomla Environmental Quality Ad (CEMA tits projad may be subject to additional school fan to fully rdtigeteAs Impact on the school distrid'a schools. White (applicant), Yellow (building department), Pink (school district) feeformads 00/03)dmm 'AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 03 -Sep -2004 2004-0054091 Has not been compared with original BUTTE COUNTY RECORDER 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: 1',,eRCC L 1 Pi4/1 C(:�-L L / 19S S'* kW v N Z -Y f/ WCCOR-0t_,D i^/ THS' OFF/"c 4 d> F 7W _5 OF . hoc Coy�✓TypF ��� i�r S/�« �r C'/���i=o.eNi�t� dti l=�Q2u�j /D/ Ae 4 y o �=AnAP- f 19 ! �00,0 a�<= ls) &6. /01®6/- 6 30 -0 /-y Date O PROPERTY OWNERS: ,P ,/e S'� el -Al L ooG State of California ) County of On /- .3 -Zo0 ew _ before me, is personally appeared tiabhvj, R % 1 e, Q ocp known4e-me (or proved to me A the basis of 4atisfactory evidence) to be th6 person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me thaLlWske/they executed the same in h6& r/their authorized capacity(ies), and that bpfitsfher/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my 49fd and offSial seal. Si naturi�,� g 1 Sea[:JAMES OMMMAR XNS R -+ _ S �� NOTARY PUBUC C40 � ALffORMA V��l/1�_ BUTTE COIDYTY A.P. # M Comm Expires Sept 28, 2006 � a T� ' ,J APPROVED 11 1 o ---------------- Environmental Healtl AUG 2 3 7004 7 County Center urive j� SITE PLAN REVIEW APPLICATION Date: �Ul " 2�71� AP# �3(% -0/V Permit Number (if applicable) d!?- 2 5747 Bin Number APPLICANT INFORMATION Owners Name: Owners Address: Telephone No.: Situs Address: Proposed Use: Parcel Size: A401l Residential ❑ New Single Family Residential ❑ Single Family Addition Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑. Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel•Trailer- ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well ❑ Agricultural Buffer Form ❑ Applicable ❑ '-N/A DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval l Si a Ian S'ta' ed Approved By `-' '1 Date y Page 1 of 5 .A ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: X • Flood Panel No.: ©122 5-G Index Date: 0�— ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance -------=--------------=---------------------------------------------------------------------------------------- ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: U Q � 1L-0 Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. 0 CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front Side Side Street Rear `S Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. 0 CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 ,t Appiicable Development Fees: Standard Fees Amount Formula ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other -----------------------------------------------------------------------------------------------=------------------------- Subdivision Map Special.Fees t ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit: Parcel Created By [1 Deeds: Date of Creation: Legal Access Provided: ❑ No Deed of Reference: Legal Access Required ❑ No Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: ❑ Yes ❑ Yes • ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 Subdivision ME/Parcel ME: Map Date of Recording: Feb. /0, Lot: / ❑ Use Permit/Minor Use Permit Permit Number: Book: Page: Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in Ione and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel ❑ Wood stoves. and. fireplace. inserts. shall be EPA -approved and -designed to. meet_the_emission— _ requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, -Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for road maintenance, and stop sign maintenance. 0 0 Page 4of5 Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 [h r Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 Building Permit Number: Q LI - Z �- 7y Owner Name: 12�ltj' Residential Construction Requirements BIPORTANT This set of plans and specifications MUST be kept on the job site at all times and it is unlawful to make any changes or alterations on same without written permission from the Building Division, County of Butte. All materials and workmanship shall be in accordance with recognized good practices and of a quality prescribed for the specific use in the 2001 California Building Code (2001 U.B.C), 2000 California Plumbing Code ( 2000 U.P.C.), 2000 California Mechanical Code (2000 U.M.C.) and the 1999 California Electrical Code (1999 N.E.C.) COMPLY WITH ITEMS CHECKED BELOW Your parcel lies within a designated 100 -year flood plain. Finish floor, electrical, H.V.A.C. equipment and services shall be a minimum of one foot above the elevation shown on the attached Flood Elevation Certificate. A Post Flood Elevation Certificate will also be required Note: We will normally accept the following as compliance with the flood elevation requirements: 1. Building is anchored to concrete stemwall system with conventional anchor bolts. 2. Building plate on top of stemwall to be one foot or more above the 100 -year flood elevation. (Plate height less than 24" above grade, or engineered design required). 3. Electrical, heating, ventilation, plumbing and air conditioning equipment and facilities located above the plate. 4. At least 2 openings in exterior walls, located on opposite or adjacent walls with a total net area of not less than 1 square inch for every square foot of enclosed area. 5. The bottom of the openings shall be no higher than 1 foot above grade. 6. The openings may be screened or covered with other devices that will permit automatic entry and exit of floodwater. Page 2of 2 Building Permit Number: o �. z S7� Owner Name: =. Parcel lies within the State Responsibility Area (SRA). Comply with attached requirements. Fire sprinklers are required in this structure. 0 The following parcel map requirements shall be met: _} All structures and equipment including overhangs shall be clear of all easements.' A setback of 30 feet from the side and A) feet from the rear property lines and 20 feet (25 feet if Federal Aid Route) from the edge of the right of way shall be clear of structures and equipment except for a 2 foot overhang. Expansive soil may be encountered on this site. This condition may require the foundation to be designed by a California registered engineer or licensed architect. s 1. Owner's N 2. Assessor's Parcel Number: 3. Installer's Name: y 77 / le 4. Is the site currently under permit? Yes[ ] NoO Permit No. 5. Is the site an existing site? Yes[] No[ ] (If yes, furnish two plot plans). , 6. What is the electrical rating of the mobilehome? %lel%. Amperes. 7. What is the mobilehome site circuit breaker rating? eres: 8. What is the electrical rating of the mobilehome site? 6 go Amperes. 9. Is the main service remote from the mobilehome site? Yes[ ] No[\Aflit is, what is <_ the rating? Amperes. 10. Is*there any other electric loa to be -served by the mobilehome site electric service ('i:peuTheamrageetc.)?Yes NoWff please identify the load and size: obile home site: Load- Amperes- /d d �% P b) The main service: _ Load- Amperes- S 0 t4J6L L 11. Type of gas service at mobilehome site: Natural[ ] Propane I Non _ 12. Size of as-.. -pipe at the mobilehome site from \the meter or tank: 3 inches. 13. What is the gas pipe length from the meter or tank to the mobilehome?�S- 14. What is the mobilehome gas demand? :1 B T.U.* *(This information is not required if the pipe length is less than 6 feet on natural gas or less than 50 feet on propane). THE OTHER SIDE OF THIS FORM MUST BE COMPLETED IN ORDER TO PROCESS THIS PERMIT APPLICATION ' ELECTRICAL, MECHANICAL, AND PLUMBING ELECTRICAL, MECHANICAL, AND PLU S o NOT PLAN CHECKED j CONSTRUCTION (NOT PLAN HEC "'�i`�H^,URRIENT EI�ITtON SHALLCOMPLY WITH CURRENT EDi N NSC' p� D UPC' OF NW, UMC AND UPC. i Mobilehome Manufacturer: ,� SManufacture Year:. 4 If other than single wide, furnish Setup Model Number: Width:_L(ft.) Length:_ 0 (ft.) Tagalong or Expando Mize(ft.) x ft.) On all mobilehomes manufactured after October 7, 1973, furnish man cturer's installation manual and structural setup sheets. FOOTINGS: Wood pressure treated or foundation grade[ Other: SUPPORTS: Concrete block[vr0ther: ' ,62S'YS7--EAA7 Provide Tie Down Specifications for all Mobilehomes: Pier -Footings Sizes and Location SINGLE WIDE MULTI -WIDE Line 1 Line 1 Piers:' I0011,' TaTa Size minimum: Spacing maximum: ` Fr6m,ends-maximunif / Line 2 Piers: Size minimum: -p--)',[1 ]w3a Spacing maximum: T 17 From ends -maximum ` Line 3 Roof Loads: ' Size minimum Location (from front): Line 5 Roof Loads: Size minimum. Location (from front): Line'l Openings Size minimum: Each side of opening with width over: ` Line 4 Piers: Size minimum: [ ] x [ ]. Spacing maximum: ` From ends -maximum ` OVER 11 131UTTE-COUNf-� :q,U.I,qDING DEPARTME.,A, I U-Im re E—Z TIE DOWN SYSTEM DESIGN LOADS: *WINO LOAD-- 15 PSF 1. THIS TIE DOWN SYSTEM IS DESIGNED TO BE CONSTRUCTED ON A FAIRLY LEVEL SITE WITH NO EXISTING SOIL PROBLEMS. MINIMUM SOIL PARAMETERS: TYPE 5 COHESIVE SOIL. WITH MINIMUM SOIL BEARING CAPACITY OF 1000 PSF. 2. CHASSIS BEAM SUPPORTS SHALL BE LOCATED AND SIZED FOR THE LOADS AS 54OWN IN THE "MANUFACTURED HOME INSTALLATION INSTRUCTIONS". 3. IN AREAS WHERE DIFFERENTIAL SETTLEMENT (OS) CAN OCCUR, MANUFACTURED HONE SHALL BE READJUSTED WHEN DS EXCEEDS 1/4', OR WHEN IT WILL ADVERSELY AFFECT MOBILE HOME UNIT. 4. THIS PLAN IS INTENDED TO BE USED FOR MANUFACTURED HOMES UP TO (3) SECTIONS IN WIDTH, CONTACT THE DESIGN ENGINEER FOR DESIGNS OF MANUFACTURED HOMES OVER (3) SECTIONS WIDE. 5. STRUCTURAL STEEL: FABRICATED ACCORDING TO AISC SPECIFICATION. WELD ACCORDING TO AWS SPECIFICATIONS. ELECIRDDES-370 PLATED -ASTM A36. BOL7S=ASTV A307. 6. THE E -Z TIE ASSE1iBLIES ARE CAPABLE OF THE FOU.OWIN£---4QAOS: HEIGHr HORIZONTAL VERTICAL UPLIFT =- 18" 2010 lb 600D Ib 891 Ib 21'. 1825 �fb 6000 �lb 801 Ib 25" 1510 (Ib 6000 (fb 664 Ib 28" 1419 I b 6000 lb 629 Ib 36" 867 �Ib 6000 (Ib 385 Iffil �7. ALL TIETAL COMPONENTS AND ATTACHMENT ITEMS SHALL BE PRO COATED Q oiESSro,_7qqq Na 179118 cAP.� Cb STAND IS PLACED ON A CONCRETE SLAB, USE 112' CON{ 41rq tERE PAIIS10N ANCHORS TO SECURE THE STEEL FRAME TO THE SLAB. � OF C 1) SNE PLASTIC BASE PADS ARE NOT REOUIREO. ® m M.Oi TTAC14MENT METHODS FOR "C" & "d" BEAMS SHOWK ON S!IT. #2. 0E LONG DIRECTION OF THE E -Z TIE PAD (37') MUST BE INSTALLED ERPENDICULAR TO THE CHASSIS BEAM. p A005C.-GUS GUARD COME 3851 FLORIN - PERKINS ROi SACRAM MM, CA 95823 SINGLE WIDE COACHES DOUBLE/MULTIPLE COACHES E= 2' MIN. / S' MAX. E= Z' MIN. / 11' MAX. VARIES 10'-70' EVENLY SPACED BETWEEN E -- -- —I- ---- I.*- E ITL �T' Q C1 l_J L_J -RIDGE BEAM SUPPORT AS REQUIRED BY MANUFACTURER (TYPICAL) D 0 8 n Q 13 O E -Z TIE SUPPORT PAD CHASSIS BEAM SUPPORT PIERS --SIZE AND SPACING AS REQURED BY THE HOME MANUFACTURER. LENGTH OF HOME 18"IIT NUMBER 21"HT OF E -Z 25"HT I TIES 28 -HT 3U -'HT 40' 4 4 4 4 6 50' 4 4- -4 -4 -6-.. _ 60' 4 4 4 6 8 .' 4 4 4 6 8 W 4 6 6 6 10 APPROVED SMJECT 7D COARECTIMS MTEO Apprallal does TO aft ize or approve any cm1sdm or deviation trom requirements d applicable State fans and regulations. Stabs pf$alliornie DepartmZZWWommu* Devea`opment S D STMARDS 13y Date SPA NO This PlanAapro+ral Expires /! o- 33Pp"z 3 T141S TIE DOWN 9YSTEM MEETS THE REQUIREMENTS OF SECTION 1336.3 SUBSECCION (a). WAYNE T. POLVADO, PE—LISTING NO. 99001 SHEET 1 of 3 2"x2"x3/16" STL ANGLE — 3/8" CAD PLATED EOLT. HUT do WASHER COUNTER BORED FLUSH WITH BOTTOM (8) REQUIRED 1/4" STAND BASE ABESCO ABS PAD J503 3/4" DIA. x 18" LG. NE�l (4; REQUIRED DETAIL "A" UHASSIS FRAME t/4" GRIPPER PLATE (2) REQUIRED 1/4` GRIPPER BASE -fir 1/2-13UNC-A307 x BOLI WITH NUTS (4) REQUIRED 41 1/2` SCH 40 PIPE RISER WITH 0112" ADJUSTER HOLES AND 3/8" TH" TOP PLATE 02" SCH 40 PIPE STAND WITH TWO $11/2` ADJUSTER HOLES ABESCO ABS PAD #503 Q STEEL FRAME - �-o®\\ 18 1/2 All, 35" MAX TO BOTTOM OF PAD 10.00 09/16 —� 0 0 10.00 09/ 16 HOLE (TYP) STAND BASE TOP VIEW 1 /4'x1-1 /4 TEK STS (2) REQUIRE 1/4" GRIPPER EASE 1/2" A307 BC (4) REQUIRE[, 5851 FLORIN - PERKINS ROAD SACRAMENTO. CA 95823 PH: (800) 382-8831 FAX: (916) 383-5207 ,— ii /-j" roA unl r !sl of Arrc TOP VIEW 1 1/2"x1 1/2"x3/16 x2" T.S. (4) REQUIRED COACH "C" FRAME r COACH "J" FRAME / 1/4"xl-1/4" 1/4" GRIPPER TEK STS PLATE (4) REQUIRED 2" CHANNEL 1/2" A507 BOLT (2) REQUIRED O 1/4- GRIPPER BASE LT 1/2- A307 BOLT (2) REQUIRED C—BEAM J—REAM ATTACHMENT ATTACHMENT E—Z TIE DOWN SYSTEM WAYNE T. POLVA.DO, PE -LISTING NO. s9Q0-v SHEET 2 of 3 t INSTALLATION INSTRUCTIONS E -Z TIE DOWN SYSTEM 1. PIERS MUST BE PLACED ON BEAM WITHIN 24" OF AN OUTRIGGER OR CROSS MEMBER, OTHERWISE INSTALL WES STI; FENER ON CHASSIS BEAM. 2. MAKE LEVEL THE PLACE WHERE THE PAD WILL SET, DOW:Y TO UNDISTURBED SOIL. 3. THE PAD MUST BE CENTERED BELOW THE CHASSIS BEAM. 4. REMOVE THE FOUR (4) NUTS AND WASHERS FROM THE STUD BOLTS IN THE PAO AND PLACE THE PIER. THE HOLES IN THE BASE PLATE WILL LINE UP WITI{ THE STUD BOLTS. REPLACE THE NUTS AND WASHERS AND TIGHTEN DOWN. I -BEAM . 5. REMOVE THE TWO (2) GRIPPER PLATES ON THE TOP OF THE PIER. START THE HEIGHT ADJUSTMENT BY REMOVING THE COTTER AND ADJUSTMENT PINS, PIERS CAN THEN TELESCCPE. RAISE THE TOP OF THE PIER UNTIL THE PLATE IS AS CLOSE TO THE BOTTOM OF THE CHASSIS BEAM AS POSSIBLE. PLACE ADJUStMENT PIN THRU ADJUSTMENT HOLE AND SECURE WITH THE COTTER PIH. 6. RAISE THE TOP PLATE USING THE ADJUSTMENT NUTS UNTIL THE PIER TOP IS TIGHT AGAINST THE BOTTOM OF THE CHASSIS BEAD. 7. PLACE THE GRIPPER PLATES OVER THE FLANGE OF THE BEAM AND TIGHTEN DOWN FIRMLY WITH THE TOP NUTS. C -BEAMS AND J -BEAMS 8. HEAD OF PIERS REQUIRES THAT TWO (2) TEK SCREWS BE PLACED THRU THE SIDE OF THE BEAM IN ADDITION TO CNE GRIPPER PLATE_ 9. FOUR (4) STEEL STAKES (SUPPLIED) ARE TO BE DRIVEN "HRU GUIDES INTO SOIL UNTIL STOPS ARE FLUSH WITH THE GUICE. ALTERNATIVE: (2) 112 S.M_S_ OR WELD -------------- (2) #1 2 S.M.S. ANGLE IR014 18$2'z1VVi vts" NOTE: USE STIFFNEF IF OUTRIGGER OR CROSS MEMBER DO NOT OCCUR WITHIN 24" OF STANCHION (TYP) WEB • STIFFENER DETAIL ABESCO-GAS GUAW COMPAAIY 5851 FWM - PEREWS ROAD SAICRANIlrT0) 38 —a831 WAYNE T. POLVA00, PE—LISTING N0. 99001 PH. {800) 382-3831 FAX: (916) 383-5207 SHEET 3 of 3 I CDF FIRE SAFE REQUIREMENTS. 061-630-014 BP -04-2574 Riley AP# PERMIT # NAME Under authority of PRC 4290, the following checked items are required by the Butte County Fire Department and made a part of this permit. These requirements are minimums and will be superseded by Butte County local regulations which equal or exceed these standards. Field inspections will be made by the Butte County Building Department for compliance. [X] 1272.00 Maintenance of Defensible Space. To ensure continued maintenance of properties in conformance with these standards and measures and to assure continued avail -ability, access and utilization of the defensible space provided for in these standards, annual maintenance must be provided for by the land owner. Drivewav Standards [X] 1273.02 Surface. All driveway surfaces and structures 1273.07 (bridges, culverts and other appurtenant structures which supplement the roadway bed or shoulders) shall provided unobstructed access to conventional drive vehicles, including sedans and fire apparatus weighing up to 40,000 pounds. [X] 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius [X] 1. No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional surface width of 4 feet shall be added to curves of 50-100 feet radius; 2 feet to those from 100-200 feet. [X] 2. the length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet. [X] 1273.05 Turnarounds. If required, will have a minimum turning radius of 40 feet from the center of the road. [X] 1273.05 Turnouts. Shall be a minimum of 1.0 feet wide and 30 feet long with a minimum 25 foot taper on each end. [X] 1270.10 Width. All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. [X] 1273.10 Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. 1273.11 Gates [X] 1. Gate entrances shall be at least two feet wider than the roadway it serves. 2. The gates must be located at least 30 feet from the roadway and shall open to allow a vehicle to stop without obstructing traffic on the roadway. 3. Where a one-way road with a single traffic lane provides entrance, a 50 foot turning radius shall be used. 1 wt 4 CDF FIRE SAFE REQUIREMENTS - 061-630-014 BP -04-2574 Riley AP# PERMIT # NAME Fuel Modification 1276.01 Setback for Structure Defensible Space [X] 1. All parcels 1 acre and larger shall provide a minimum 30 foot setback for buildings and accessory buildings from all property lines and/or the center of the road. [ ] 2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See other requirements below. [X] 1276.02 .Disposal of Vegetation and Fuels. Disposal, including chipping, burying, burning or removal,to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction, road and driveway construction and fuel modification shall be completed prior to completion of road construction or final inspection of a building permit. { . Other Requirements - [ ] If Building Setback is 15 to 30 Feet: - Class A or B roof Enclosed Eaves [ ] If Building Setback is Less Than 15 Feet — Class A or B roof with enclosed Eaves and: Choose any 2 of the following: Metal or no doors on side toward property line with insufficient setback Interior automatic sprinkler system per NFPA 13D Glass area not to exceed 10% of wall area toward property line with insufficient setback Siding from the following list: Stucco — 3 coat Hardi-Board or Plank Masonry Masonry Veneer Metal Other Butte county Fire Department approved materials 09/09/2004 Darren Read Date Signature 2 z STATE OF CALIFORNIA - DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT • CERTIFICATE OF TITLE Manufactured Home Decal No: LAL8405 Manufacturer ID/Name WESTBROOK Trade Name WESTBROOK Model WESTBROOK DOM 00/00/1976, DFS 12/09/1975 RY Exp. Date Serial Number Label/Insignia Number Weight Length Width SPC• SCC Exempt Use Type S4283 195438 60' 12' 04 FD LPT ' Issued Total Fees Paid Aug 20, 2003 $51.00 -Addressee ROSE PETTIGREW 6674 PENTZ RD #107 PARADISE', CA 95969 - Regi! tWred Z ROSE PE ill-,REVJ 6674 PEN.. RD 1'©.- PARADISJE A 95969 Situs Ad ess 6674 P - F� Z RD 107 IN PARA EISE, CA5969 CA 9 { 9 - — - ye h o -4 .. IMPORTANT THE OWNER INFORMATION SHOWN ABOVE MAY NOT REFLECT ALL LIENS RECORDED WITH THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT. THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. DTN: 3104229 08202003- 318 The California Health and Safety Code requires that all used manufactured home/used mobilehome be equipped with a smoke detector which is in proper working order on the date of sale. "We certify that the manufactured home, mobilehome, or multi -unit manufactured housing is equipped with an operable smoke detector on the date of transfer." I(We further agree'to indemnify and save harmless the Director of the State of California, Department of Housing and Community Development, and subsequent purchasers of said unit, for any loss they may suffer resulting from registration of the unit in California, or from, issuance of a California Certificate of Title covering the same. 1/We certify upder penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 711119 Releasing Signature of Registered C 11b. ),6 ,ladie XDate of Release Date of Release Releasing Signature of Registered Owner I — / 2. Ud' Release ❑ Retain * El Assign Interest Legal Owner of Record (if an t and check a r0 riate box (• if Assign Interest is checked - Complete New Legal Owner Below) ISECTION C - NEW OWNER INFORMATION; r I I I I I I I NFW RF.GICTFRFD OWNER = Pleace' Print. nr Tyne Clearly I 1 3a., 6 L% - L< 'L SC, 3c. New R istered Owners Name New Registered Owners Name 3b. �%��_�i� 3d. New Registered Owners Name New Registered Owners Name j If more than one New Joint Tenants with Right of Survivorship ❑ Owner going onto title, please check the appropriate Co-owner term box. Tenants In Common OR *❑ Trust/Trustee(s) If this box is checked -Complete HCD 476.6B) ❑ Tenants In Common AND ❑ Community Property ❑ Community Property with Right of Survivorship 4. 0, aQ K y7 7 ` 4MY QP&a5V ��. 9�°�914 Mailing Address of New Registered Owner City/State Zip Code ee�,� s. ,L-&- �i��Ja� ��o �. �-�,�y Q,5- 914 �jActual Location Address of Unit C--' City/State Zip Code 6.c S c5_OC/ Purchase Price orcheck box if Gift -0 Purchase Date or Transfer Date 7a. orr .-�✓L a /l �1 - 7c. i Sig6KrelFNew Registe 9� Owners Signature of New Registered Owners 7b.7d. LeVvReCJred igna re Owners Signature of New Registered Owners �' NEW LEGAL OWNER - Please Print or Type Clearly I ea 8a. 8b. New Legal Owners Name New Legal Owners Name If more than one New Lender going onto title, please check the appropriate Co-owner term box below. ❑ Joint Tenants with Right of Survivorship ❑ Tenants In Common OR * ❑ Trust/Trustee(s) (• If this box is checked -Complete HCD 476.6B) ❑ Tenants In Common AND ❑ Comm ty Property ❑ Community Property with Right of Survivorship P��. 9. L6A,3 Mailing Address of New Legal Owner Cit State ZiR Code 7 NEW .JMOR LEE DER - Please Print or Clearlv 10a. 10b. New Junior Lienholder Name New Junior Lienholder Name 11. Mailing Address of New Junior Lienholder City/State Zip Code ISECTION Dom- LEASE OF DEALERS-`- - - - 12. Signature of Selling Dealer Print Dealers Name and Dealer Number M x C NOTES f PERMIT NO. RESIDENTIAL 061-630-014 05-2210 RILEY, BOBBY 294 DEER MEADOW RD', BERRY V CREEK Cont: SKYCREST ENTERPRISES `N PERM-FND (NEW) OFFICE COPY. Address GAS Meter By Date ELECTRIC,' �q-� Meter By Date /�'7 " .t SPECIAL CONDITIONS - CHECKED BY SRA '4 FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY - } USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER 40 0 V t �?r 0 Q IA— JOB o/S Sb Av �•1.3 . i` tJOB FINALED (Date) f Signature J=oK I I 0 = Not OK = NotAppGrable , = Nut Ready IIESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Gmd. / r Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Fig. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemvvalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test-Anchars-Regulator-Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Cana B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors 23. Fire Sprinkler, Test Date Cana B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. S& Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Meth Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wre Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes O No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels -Motors -Meth. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Prooer Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill HL & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infittration-Walls-Windows "Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection t 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door, Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor -Meeh. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (FF.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps r 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor O Yes 83. Following InstldJDrive 0 Yes 0 No/Walks O Yes O No/Planters O Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Pfbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle_ Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: J=OK o = Not OK' = Not Applicable ` . ='Not Ready MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s'* `+ 1. Zoning Requirements-Setbacks=Easements 2. Sols; Special MH Support Sketch �+ 3. Sewer, Location -Test -Fall -C/O -Concrete f 4. Water, Location -Test -Easement Needed (Sketch) G 5.,Electricity;Location'Clearances-Gmd-/ /Amp -Concrete 6. -Gas; Location -Test -Wrap; -/ P;L'ft. ' / P Nat or/ /" LW P LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date - Card B-1 Date Card B-1 Date Card B-1 • Date MOBILE HOME INSTALLATION (Plans) OK except 9's 6. Water, MWTest 1. Zoning'Requirements-Setbacks-Easements ' 7. erpnd Sewernnected' 2. Footings; Size -Spacing -Marriage Line 8 G d El rty Tagged 3- Gas; MH Test -Demand -Valve -Connector' 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector - 6. Water, MH Test-Regulator-Connectoe • 7. Water and Sewer Connected -C/O to Grade -HD Approval 'Date Card B-1 8. Gas and Electricity Tagged _ Date Card B-1 c 9. -Tie Downs -Type -Installation Cert. I 10. Exits; insp.-Sketch 11. Cert of Occupancy r Date Card B-1 Date Card B-1 ' .Date Card B-1 Date t -Card B-1 f Date�� . t, F Card B-1 Date Card B-1 Date" PE ENT END SYSTEM (ONLY) le Line Gas; MH t -De d -Valve i 5. ' Electric' ; lH.Igst, 1. Zoning Requirements -Setbacks -Easements 6. Water, MWTest 2. Footings; Soils-Size-Depth-Spacing-Connectors=Steel 7. erpnd Sewernnected' 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 8 G d El rty Tagged is 10: License Decals 11. Verify it's with Office 7. Electric 1 Date- IWla::: Gard B-1. 'Date Card B-1 Date Card B-1 Date Card B-1 c 10. Roof; Shthg-Roofing I MISCELLANEOUS. Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except Ws ^ 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-Depth-Spacing-Connectors=Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs-Connectors _ - Shthg-Frg-Bracing 5.. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures. 6. Carports; Windows -Doors . 7. Electric 1 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses'° 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels r Date Card B-1 Date Card B-1 Date Card B-1 'Date Card B-1 Date POOLS (Plans) OK except Vs - 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI .Y 5. Elec.; Pool Lighting; 15 Volts-GFI w _ 6.• Elec.; Enclosures; Conduit Entries -Terminals -Listed - 7. Elec.; Bonding; Metal w/5%Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip: Pool Lghtg. " Boxes=Enclosures-Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test - 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1. - tt P BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: '(5301138'7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICt #: (530) 538-7541 PERMIT NO. BP052210 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 09/12/2005 APN: 061-630-014-000 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P ofessions Code, and my license is in full force and effect. 1. 'q�j� Site Address: 294 DEER MEADOW RD BCK License Class . License umber: � 1 �� Map Index: Date: Contractor: Description: MH PERM FND NEW SITE (1064) 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: RILEY BOBBY JO SR ETAL . permit to construct, alter, improve, demolish, or repair any structure, prior HOOG BETTY LOU to its issuance, also requires the applicant for such permit to file a P 0 BOX 477 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section BERRY CREEK, CA 95916-0477 . 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).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Applicant: SKYCREST ENTERPRISES pp intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an COUSIN GARY'S HOMES owner of property who builds or improves thereon, and who does 13468 HWY 99 such work himself or herself or through his or her own employees, for CHICO, CA 95973 provided that such improvements are not intended or offered sale. If however, the building or improvements are sold within one 530-342-2694 year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: SKYCREST ENTERPRISES not apply to an owner of property who builds or improves thereon, COUSIN GARY'S HOMES and who contracts for such projects with a contractor(s) licensed 13468 HWY 99 pursuant to the Contractors' State License Law.). CHICO, CA 95973 ❑ I am Exempt under Article 3 of the Business and Professions Code 530-342-2694 Date: Owner: License #: 812930 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Architect: Labor Code, for the performance of the work for which this permit Engineer: is issued. ❑ I have and will maintain workers' compensation insurance; as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier anj.,poli y number are: Carrier: Zed i'/7, Total Square Ft: 1064 S.F. Valuation: $69,160.00 Policy#: Zey&(IeDDFFe�l Census Code: ff ❑ 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' ry_ I compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1"�1 Date: A9 6 Applicant: AR Failure to secure worke 'compensation coverage is wful, 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. CONSTRUCTION LENDING AGENCY This permit is eby issued un" a plicableprovisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the of the work for which this permit is issued (Sec 3097 Civ.) Resolution o do work Iryd• ed abov for whi fees have been paid. performance By: Date: Name: _ PERMIT EXPIRES ON: —� Address: Date ❑, 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. ; O 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 the owne r the duly authoriz agent of the owner. I agree to comply with all county and state laws relating to building co struction. I acknowledge it is unlawful to alter a substance o any official form document of Butte County. I hereby ter upon the above mentioned property for ins ction purposes authorize representative—sof Butte Coun7/�,S4i_aatu Print Name: Liv h h Date: ❑ Owner Contractor ❑ 'Agent for Owner 13 Agent for Contractor ,eN BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTIONC OROVILLE`. (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** CONTRACTOR SAW Cit 41 df .' .�- /�O/��/ Zi Phone pZ, II Fax,0�_ E-mail Lic -9 Cl s CONTRACTOR Name ?�,. ,�e-s . Addres Cit 41 df State Zi Phone pZ, II Fax,0�_ E-mail Lic -9 Cl s APPLICANT NAME ARCHITECT/ENGINEER Name State Address Phone City E-mail State Zip Phone Subdivision Name Fax E-mail Lot # State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail fhPPLiqANTSiGNATURE V�gv&fice use only: Zoning I U I Flood Zone I X I SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BP D OA BIN # LOCATION AP 6&,/, D l/ WPro ertV ess Ci C s Street &Oc! WORKER'S COMPENSATION Policy Number P 6Dg�D1. Carrier , zee 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 OVER FOR SUBMITTAL REQUIREMENTS U K.\r:nRMC\RI 111 niN(; Pr)RhAC\R 1r1nAnn1CiihRnmte rinr. Pmna 1 of 9 Descriptio Scope of Work: C ct� J�. JLf �'�1. ur1 +vee Sq. Footage O Structure Built without Permits 0 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 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, plan check fees for work plan checked and other department costs are not refundable. Received.by: K 6 . Amount: �9Bldg� 20' .CM SRA Receipt #y: S S jf Sheriff C.i1QC1� #( 31 SMIP Date: Other f� (� �j i L— 1 - —1 (7 '2 Total REV 2-24-05 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. ❑ �'z 13.;, 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 du licate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor R 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. ❑ .1�--,40-,(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. OQwrier-Btailder Verificatiori: ir... ,..r,.. ��. .,,'.. n-�.- �,..i. . ...«_... �.:.,...r�+..isi...`i^i..J�.,�r.-r^�.:�:v.�rSk.,��.ir-�.�.:TMy.>'...-.^�.A`r-.',:+.�.k=... ���r+•'���:-'.ice..: .. .� �i^Y�::..�," • � . 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 SP05rn "i OWNER: ISI I �y ASSESSOR PARCEL NUMBER Proposed Building Use: ��� { 111 OIC Pl.�"1 FNJJ Permit Technician: . ) Date: It ms required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. \En --W 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 plaE ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans ANIs 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 NgA- eated and AIC for on, Residential Buildings. �N) Ng I 8. Manufactured homes: ( stalation.manual, Inc u ing marriaae_tine info, Q.Eloor (D) Tie down or fndHans 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Letter of intent for non-residential buildings ❑ 12. Hazardous Material Form \IN 13. Acknowledgement of building permit application without required clearances. ❑ 14. Other R maining items needed to issue the permit. (May require additional plan review upon receipt of the following items.41er 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applica 16. Fire Sprinklers............................................................................................ D 17. , Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 18. Soils Report and/or Engineered Foundation required ........................................... ❑ Erosion Control Plan Required............................................................... i........ r4110 20 ees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 1. 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: r a o� ,ni 24. Planning approval for (A) Use: (QL�=-(B)Parking: (C) Parcel Check: ... o15� ` ❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................ roYt�i 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) :..................... t ❑ 31. Letter of Signature authorization......................:..........................:.................. ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. \ ❑ 33. Existing violations and/or expired permits....................!................................. \ ❑ 34. De,e estriction......... I. ......................................�..,.%��.',.�................... ❑// 35.`I✓f Legal description,t�`M. . Title, title search, registration or tItLCO..'....................... �Q 36. Other: C-►fQ Q O 37. Other: j -1 ,e . ,f� . When issued Telephone 2- 2L69 t ` and hold for pickup. I haverbee brmed of the abov4 items and requirements for obtaining a building permit. Applicarft: - J Date: , 1.,Index permit application for the above ds numbered: Plan Check,Lzetter 2' Additional items required (61:cr 1 at r:,- --•.n Contractor', designer, owner, was advised of the above data by ❑ phone, ❑ mail, 'O •counter, by-' I 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, b Date: Plans reviewed by: Date: Plans approved by: Date: (' Structural reviewed b Date: -Structural approyed by: Date: J Note transfer by: Date: Yellow: Building Division a COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140' SCHEDULE OF RECEIPT OF FEES Website: www.buttecounty.net/dds OWNER Pile PROPROSED BUILDING USE bn �? 1. BUILDING PERMIT FEES � --- Balance Due ..................... $299 --- FEMA Flood elevation review ... $ A.P. # Oa P&��Jy DATE '� -17Z - RECEIPT q --- Additional plan checking Fee.... $ c�% 2. SCHOOL DISTRICT FEES i i `" an 1 105 (paid at School District Office) (form available after Pan Check) 3. SHERIFF FEES (paid at Building Division) Commercial (sq. ftg.)..... X $0.03 = $ Sq.Ftg.ECREATION DISTRICT FEES , 4. R{�CSfI l CC IUPI��tv�n SIC7105 1 / 105 (paid at Recreation District Office) (form available after Plan Check) 5. RESIDENTIAL DEVELOPMENT IMPACT � FEES (per dwelling) COUNTY WIDE ) $ 1 ,`i -�� CHICO URBAN AREA (per dwelling) $ EL MEDIO FIRE DISTRICT (per dwelling) $ NORTH CHICO SPECIFIC PLAN (per dwelling) Zoning $ 6. SRA FIRE INSPECTION AND PLAN CHECK FEE $204.98 (paid at Building Division) DATE REC. Z�_d J J. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) I �� 8. SMIP Co .9 IL 9. DRAINAGE FEE 10. OTHER 11. OTHER At time perffft—a—Mication,n, I was ad 'sed the above fees are required to be paid prior to issuance of the permit. These fees may be ch ged d ' the plan check' g process. APPLICA DATE % C� Pursuant o Govern t Code Section 66020, yo a hernotified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on yo r project. You have 90 ys the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 7/05) ,. ._6..,: .,_..; ..y.�. ,... _. _ _.. .... �__. ..-. .,, ,, .,- -... ,,,r .� .-..r... .... a ,r..Kn s....rr .c .- . ,� a :.•,.. ry+;r h � ... "r.:...'-... .y,•.y r _ 1 .t r BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) ' ❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD) 0 PARADISE RECREATION AND PARK DISTRICT (PRPD) 0 DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) -DCC-� �p ji� -- �t Building Permit Number Property Owner (s) Project Location /Address 2q �i �Q.�r Min dt),A( , erg �y Cre+ Subdivision Name Assessable Sq. Ftge Type of Residential Development (check one) New Development Single Family -Detached Single Family -Attached Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling Mobile home Mobile home replacement verified by Assessor Department Demo Permit (date issued ) verified by Building Department Comments: Building Department FRRPD. ❑ CARD ❑ PRPD 0 DRPD certifies that: Date � WAR /� rr••��•••®•�• •� v ru iic Mailing Address State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: Dwelling Units @ $ Square Feet @ $ _ Remarks: per unit for a total of $ per sq foot for a total of $ Paid by Check No: Paid by Cash: Receipt No: ��OjLk SYl C i+ �/ / Recreation and Park District UFORMSWILDING FOR�IMSlpark-rec standard form rev Ldoc - F 1 11� � r .fr G • Y l BUTTE COUNTY SCHOOLS IMPACT_FEE CERTIFICATION FORM �. (One form per Building) . 1- t • i� c ,. ti School District o 11� �^ �iV�1� �C Itl ri I Building Department No. gP� A.P. Number t - �J`t�y Jurisdiction: r City L�6ounty Property Owner A Property Location/Address r I t I*Vln If )t )W "%U . If ti'1 'l/ 1-'l r- 1'� , Subdivision i Lot No. Residential`bevelopment ASq. Footage Q j No of Living Mobile Home Addition/ Supplemental to (Group. R) Units Installation Conversion Permit # a i Commercial/Industrial 0 ... - New Ire „ d-' Department *(No foundation inspection) ��Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage Addition (Including Exterior Roofed Areas) f Date t District Identification No. QQ d 0 V i 1 llc V'�. �r ,\S'chool District certifies that (Appli` nt) N�" ` (Street Address) e Number) s (City) _ (State) } has complied with the requirements of Resolution No. representing (, square feet. IAB 2926 'w, ✓! PULL MITIGATION School District Represerit6tive - 1vd1� • r " �' " _ Paid by Check # "—t/Z�- Remarks: J 0I' (Zip Code) lent of. $ r Fees rs'c� AM, �Os ', 3\ �koy ns�c>�1S . 11 fe_r�\ . C.1 w,d. --Rete: You may protest the Imposition of the fees Identified above by submitting a written protest.to the District. In compliance with Government Code Section G 020(a), within 90 days from the date fees aro paid. Failure to submit i timely written protest will prohibit t you from challenping the Imposition of the fees In any court action. K, 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 Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate Its Impact on the school distrlct's'schools. White (school district), Yellow (building department), Pink (applicant) feeform xis (3ft)dMm . i E.6t. USE C7d1d .,. Fiat Plan Anechad Fleas Plan Attachad Sent to G.D. / TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance ------------- + Owner Location AP# Plan 'Approved for: Sewage Disposal Water Supply: Public Private Well ' Clearance for'39 dwelling. Other nuw nttat tut. Final clearance O.K. for: NOTE: Environmental Health Specialist Date 8/96 61 LIN a ENVIRONMENTAL. HEALTH AUG 7 7 COUNTY CENTER DRIVE W-4 IF- OP.i � � ® L W N p '"� ;UTI aP KITCHEI F DINING A i BEDROOM F 10 ROOM. ; No. 2 < I I I I I • _ LINEN OO ' t.f ' N CATHEDRAL TNRU•OUT MASTER I BEDROOM Y BEDROOM LIVING ROOM No.1 1T-4" i 13'4" 13'.4" I I OPii � ♦ I / ♦ I 3701CT146.4424 3BEDROOM - 2BATHS -CATHEDRAL THRU-OUT (1,064 SD.FT.) OPTION DEN CATHEDRAL THRU•OUT opt, OPTION LIVING ROOM COVERED 24' PORCH l ' r DR ♦ a OPTION BEDROOM CONFIGURATION ALT. DOOR 10 algaswo n AUG 2 4 20" BUTTE COUNTY DEPARTMENT OF DEVELOPMENT. SERVICES BUILDING.PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTIONC OROVILLE`. (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" CONTRACTOR Name e5 Addres Cit I Af Address Zi Phone CCS ! Fax.6� _ /74 E-mail LicoaY'% 7 ' I ARCHITECT/ENGINEER Name State Address Phone City E-mail State Zip Phone , Map Book Fax E-mail Planner State License Number APPLICANT NAME Name&01/r, Address City State Zip Phone Fax E-mail APPLIqANT ffice use only: Zoning Flood Zone SRA Yes 3 No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT. NO. ` BP 0527-1 BIN # LOCATION Pro Add ess Ci Cr s Street ' q. L7Da! 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 OVER FOR SUBMITTAL REQUIREMENTS K \Ff1RMC\RI 111 rllNr; Fr1R1\AC\RIrinAnn1.CnhRnmtc rinn.. Pang 1 of 7 Descriptio Scope of Work: � Sq. Footage O ❑ 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: �? n Receipt #: S ��1 1 4 eNtic j� Date: .J Amount: $ �l Q A G Bldg 201-1 . R'l SRA Sheriff _SMIP Other � �j ff `-I' 2 1 - `I(� 2 Total REV 2-24-05 �f VI CDF FIRE SAFE REQUIREMENTS AP# 061-630-014 PERMIT # 05-2210 NAME: Riley Under authority of Public Resources Code Sec. 4290, the following checked items are required by the Butte County Fire Department and made a part of this permit. These requirements are minimums and may be superseded by Butte County local regulations, which equal or exceed these standards. Butte County Building Inspectors will make compliance inspections. Driveway Standards [X] Surface. All driveway surfaces and structures (bridges, culverts and other appurtenant structures which supplement the roadway bed or shoulders) shall provided unobstructed access to conventional drive vehicles, including sedans and fire apparatus weighing up to 40,000 pounds. [X] Grade. Not to exceed 16 percent unless paved. Drivewav Radius [X] No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional surface width of 4 feet shall be added to curves of 50-100 feet radius; 2 feet to those from 100-200 feet. [X] The length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet radius. [X] Turnarounds. If required, will have a minimum turning radius of 40 feet from the center of the road. [X] Turnouts. Shall be a minimum of 10 feet wide and 30 feet long with a minimum 25 -foot taper on each end. [X] Width. All driveways shall provide a minimum 10 -foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. [X] Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. Gates [X] 1. Gate entrances shall be at least two feet wider than the roadway they serve. 2. The gates must be located at least 30 feet from the roadway and shall open to allow a vehicle to stop without obstructing traffic on the roadway. 3.. Where a one-way road with a single traffic lane provides entrance, a 50 -foot turning radius shall be used. C D F F I R E R E M E N T S Setback for Structure Defensible Space C [X] Maintenance of Defensible Space. To ensure continued maintenance of D properties in conformance with these standards and measures and to assure continued availability, access and utilization of. the defensible space provided for in these standards, annual maintenance must be provided for by the landowner. [X] 1. All parcels 1 acre and larger shall provide a minimum 30 -foot setback for buildings and accessory buildings from all property lines and/or the center of the road. T r [ ] 2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See "Other Requirements below. T 1 [X] Disposal of Vegetation and Fuels: Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction of flammable vegetation and - fuels caused by site development and construction, road and driveway construction. Disposal shall be completed prior to completion of road construction or final building permit inspection. E Other Requirements [ ] If Building Setback is 15 to 30 Feet: ✓ Class A roof R ✓ Enclosed eaves If Building Setback is Less Than 15 Feet E [ ] — ✓ Class A roof with enclosed eaves and choose any 2 of the following: ❑ Metal or no'doors on side toward property line with insufficient setback ❑ Interior automatic sprinkler system per NFPA 13D T T ❑ Glass area not to exceed 10% of wall area toward property line with insufficient v setback ❑ Siding from the following list: T o Stucco — 3 coat - 1 o Hardi-Board or Plank o Masonry D o Masonry Veneer j1 o Metal o Other Butte County Fire Department approved materials E M " E N ' 08/24/2005 Darren Read Date Signature C i CDF FIRE SAFE REQUIREMENTS AP# 061-630-014 PERMIT # 05-2210 NAME: Riley Under authority of Public Resources Code Sec. 4290, the following checked items are required by the Butte County Fire Department and made a part of this permit. These requirements are minimums and may be superseded by Butte County local regulations, which equal or exceed these standards. Butte County Building Inspectors will make compliance inspections. Driveway Standards [X] Surface. All driveway surfaces and structures (bridges, culverts and other appurtenant structures which supplement the roadway bed or shoulders) shall provided unobstructed access to conventional drive vehicles, including sedans and fire apparatus weighing up to 40,000 pounds. [X] Grade. Not to exceed 16 percent unless paved. Driveway Radius [X] No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional surface width of 4 feet shall be added to curves of 50-100 feet radius; 2 feet to those from .100-200 feet. pq The length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet radius. pq Turnarounds. If required, will have a minimum turning radius of 40 feet from the center of the road. [X] Turnouts. Shall be a minimum of 10 feet wide and 30 feet long with a minimum 25 -foot taper on each end. [X] Width. All driveways shall provide a minimum 10 -foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. [X] Turnouts. Driveways exceeding 150 feet in length, but less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. Gates [X] 1. Gate entrances shall be at least two feet wider than the roadway they serve. 2. The gates must be located at least 30 feet from the roadway and shall open to allow a vehicle to stop without obstructing traffic on the roadway. 3. Where a one-way road with a single traffic lane provides entrance, a 50 -foot turning radius shall be used. C D F F I R E R E Q U I R E M E N T S Setback for Structure Defensible Space C [X] Maintenance of Defensible Space. To ensure continued maintenance of D properties in conformance with these standards and measures and to assure continued availability, access and utilization of the defensible space provided for r in these standards, annual maintenance must be provided for by the landowner. r [X] 1. All parcels 1 acre and larger shall provide a minimum 30 -foot setback for buildings and accessory buildings from all property lines and/or the center of the road. T r [ ] 2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See "Other Requirements below. T 1 [X] Disposal of Vegetation and Fuels: Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction of flammable vegetation and fuels caused by site development and construction, road and driveway construction. Disposal shall be completed prior to completion of road construction or final building permit inspection. E Other Requirements [ J If Building Setback is 15 to 30 Feet: ✓ Class A roof R ✓ Enclosed eaves [ ] If Building Setback is Less Than 15 Feet E — ✓ Class A roof with enclosed eaves and choose any 2 of the following: l`C/ ❑ Metal or no doors on side toward property line with insufficient setback ❑ Interior automatic sprinkler system per NFPA 13D T j ❑ Glass area not to exceed 10% of wall area toward property line with insufficient u setback ❑ Siding from the following list: T o Stucco — 3 coat 1 o Hardt-Board or Plank o Masonry o Masonry Veneer o 'Metal o Other Butte County Fire Department approved materials E [] E . N 08/24/2005 Darren Read Date Signature T Department. r r, ii n t v j'. Michael Crump, Director Of. Public c� f- B U t t �©rks LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Orovilie, CA 95965 (530) 538-7266 (FAn 538-7171 National Pollutant . Discharge Elimination System (NPDES) Phase 11 Construction Storm Water Permit and. Storm Water Pollution Prevention Plan (SWP.PP) Acknowledgement jLESS THA11d ACRE Project Description: Project Location and/or Parcel Number. _ r 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 bora 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 - 1 am aware that submitting false and/or inaccurate information or failure to apply fora 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. Sided: Title: Date: Butte County Depc2rtmellt ofDevelop172ent setVICes o�`'T r "o° 7 County Center Drive Oroville, CA 95965 '(530) 538-7601 Telephone c0U41�y (530) 538-7785 Facsimile BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building'Division to, process this building permit application through the plans examination process WI'PHO:UT 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 Agriciulture. I hereby acknowledge: I need to submit applications for septic and/or well to Butte Courity 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 I am responsible for notifying Development Services, in writing, to stop processing of die 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 refiind 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 parcel at time of creation, as well as toping requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print:. Q �i�S� 1er:3�5 ' APN: Applicant Name: �` Aildin site address. 'I ���1 � D� �v ' Permit No.: �J�. 10 .g I have read, understood and accept the term's 'arid, conditions as expressed herein as indicated by my submission of the above -referenced building permit application and my signature below: D TE S NATURE . OF AP ICANT �-- IQ,+�IPi-I b�► - ��o�� STAGE 6ftALIFORNIA 1 TOFyoG� y, .,'BUSINESS, TRANSPORTATION AND HOUSING AGENCY NUMBER: - DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT :8'7052.18 DIVISION OF CODES AND STANDARDS MANUFACTURED HOUSING PROGRAM ttDE���� MANUFACTURER CERTIFICATE OF ORIGIN ❑ CHECK IF THIS IS A DUPLICATE MCO -ENTER ORIGINAL MCO NO. MANUFACTURED HOME OR MULTI -UNIT MANUFACTURED HOUSING NUMBER OF SFD (SINGLE FAMILY. DWELLING) . ❑ MUMH.(MULTI-UNIT MANUFACTURED HOUSING TRANSPORTABLE SECTIONS COMMERCIAL COACH: OCCUPANCY GROUP MANUFACTURER NAME: MANUFACTURER LICENSE NUMBER: SKYLINE HOMES INC 90002 MANUFACTURER ADDRESS: SUGGESTED RETAIL PRICE: 1720 EAST BEAMER• STREET WOODLAND CA 95776 $ 45,097.25 (Street) (City) (State) (zip) MANUFACTURER TRADE NAME: MODEL NAME AND/OR NUMBER: DATE OF MANUFACTURE: WESTBROOK 3701 -CT 9/18/2003 NAME OF DEALER OR TRANSFEREE (OWNERSHIP TRANSFERRED TO): CALIF. DEALER NUMBER OR DATE'OF TRANSFER: SKYCREST"ENTERPRISES/COUSIN GARY'S HOMES,.9/10/2003 TRANSFEREE DESIGNATION: 9165 DEALER OR TRANSFEREE ADDRESS: 13468 HWS.' 99 CHICO CA 95973 (Street) (City) (State) (Zip) INVENTORY CREDITOR NAME: TRANSAMERICA COi1lNERCIAL FINANCE INVENTORY CREDITOR ADDRESS: P.O. BOX 94900. PpT�TI)dE Ii. {094 (Street)(CI (sCafe) (zip) SECTION MANUFACTURER SERIAL NUMBER HCD INSIGNIA OR HUD LABEL NUMBER LENGTH WIDTH WEIGHT (1-6) (INCHES INCHES (POUNDS) 1. 8V -70-025.575-B. ULI 550612 528 144. 15,410 2 8V -70 -0255 -S-A ULI 550613 552 144 -17,341 Le TRANSPORTER NAME: D &•R TRANSPORT TRANSPORTER ADDRESS: P.O,..: BOX 179 DURHATM CP 95938 (Street) (City) (State} (Zip) DESTINATION FOR UNIT DESCRIBED ABOVE: COUSIN GARY'S HOMES 13468 HWY 99 CHICO CA 95973 (NAME) (Street) (Cit) (State) (zip) jx4ify under penalty of perjury under the laws of�the State of California that the above fads are true and correct. , 9/19/2003 WOODLAND POLO CA don' at (Date) (City) (County) (State) __•� 1_ IGNATURE OF AUTHORIZED AGENT: DISTRIBUTION: ORIGINAL (PINK) FORWARD TO THE INVENTORY CREDITOR, UNLESS THERE IS NONE, THEN FORWARD TO THE PURCHASER (DEALER OR TRANSFEREE). COPY 1 (WHITE) FORWARD TO THE DEPARTMENT AT P.O. BOX 1828, SACRAMENTO, CA 95812-1828, WITHIN FIVE (5) DAYS OF RELEASE. COPY 2 (YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. -0V 11rni n 10nn. Tn ac RFTeINFn av THF MANI IFCr.TI IRFR RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 COPY of Document Recorded 19 -Qat -2005 2005-0063565 Has not been compared with original BUTTE COUNTY COUNTY RECORDER SPACE ABOVE THIS LIVE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is ev=idence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded., this document shall be indexed by the county recorder to the named owner of the real property and Shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. BOBBY JO RILEY SR AND BETTY LOU HOOG ETAL REAL PROPERTY OWNE•RILESSOR P.O. BOX 477 MA1LBdG.ADDRESS BERRY CREEK BUTTE CA 95916 CITY COUNTY STATE 7JP 294 DEER MEADOW RD OROVILLE BUTTE CA INSTALLATION MAILING ADDRESS, IF DIFFERENT QTY COUNTY STATE ZIP BERRY CREEK BUTTE CA 9591.6 CITY COUNTY STATE ZIP SAME SKYCREST ENTERPRISES UNIT OWNER (if also propcny ownm write'SAME") 91265 SAME DEALER LICENSE NO. MAILING ADDRESS SAME - CITY COUNTY STATE ZIP UNIT DESCRIPTION BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE BUTTE CA 95.965 QTY COUNTY STATE ZIP 05-22JO 530 538-7541 LD : PERA4IT la TELEPHONENUMBER iovl Z25 S URE F LOCAL AGENCY' OFFICIAL DATE SKYCREST ENTERPRISES DEALER NAME Knot a dealer sale, writ: "NONE") 91265 DEALER LICENSE NO. SKYLINE HOMES INC 2003 3701 -CT MANUFACTURERS NAME DATE OF MANUFACTURE MODEL NAMENUMBER 8V -70 -0255 -S -AIB 44 X 12, 46 X 12 ULI550612/3 SERIAL NUMBER(S) LENGTH X WIDTH I INSIGNIAILADEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION SEE ATTACHED .ASSESSORSPARCEL NUMBER 061-630-014 HCD FORM 433(A) REV. 8/91 - 0/200; 14:06 FAX 530 859 85:11 hiUtLlir t;XIiUItiiL t1ILG - LUU4 (I_Unr;1 r --U Order Pio. BU-211139-3.MAM The lead =fh-m6 to hmaein is siwed in the State of Cs1iA"* •County of Butte, and is des=*M a@ follows: PARCEL 1, AS SHOWN ON THAT CERTAIN PARCELMAP, RBt.'ORDED IN THE OFFICE OF TBE RECORDER OF THE COUNTY OF BUTTF,. STATE OF CALIFORNIA, ON FEBRUARY 14, 1984, IN BOOK 94 OF MAPS, AT PAOE(S) 36. APN 061-630-014-000 A. NON-EXCLUSIVB BASEMSHT FOR ROAD PURPOM AND PUBLIC UTILITY PURPOng OVER A STRIP OF LAND 60 FEET IN WOW LYING 30 FEET ON EACH SMB OF A LIMB DESCRIBED AS FOLLOWS: BEGMUNG AT A POM IN TSS NORM EINE 'OF THE SOUT IMT QUARTER OF SECTION 6, TOWNSHIP 20 NORTH, RMol 5 BAST, M.D.B. & M., WHICH POINT BEARS SOUTH 87' 04' 49' WEST, 882.96 FEET FROM THE NORTHEAST CORNER OF SAID SOUTHWEST QUARTER; THENCE FROM SAID POINT. OF' BEOVNING, ALONG~ THE FOLLOWING COMSES AND DISTANCES: NORTH 03' 43- 13- WWT, 73.09 FMM, NORTR 28° 59' 25" WEST, 231.14 FEET; NOM 49' 43' 07^ EAST, 14736 FEET; NORTH 06' Sr 10". BAST, -17927 FEET; NOM 390 17' 02" wwr, 98.05 FnT; NORTH O 1' 09' 52- WEST, 104.64 FRET; NORTH 33° 50'08- EAST, 254.86 FBBT; NORTH 26" 46' 18" $AST, 133.81 FBFiI NOR'iii IS- 12' 01- HAST, 135AO FM; NORTR 55° 49440 BAST, 159.57 PELT , NORTH 35' 30' 52" EAST, 6,0.5 FM; NORTH 70' 53 17" BAS'% 11.74 FEET; • SOU M 78' 55'29" EAST, 12255 Mt,', , SO'H 51' 58' SV E AST, . M A6 FSSI , SOTnH.78°, 3.7'.'58'.EA3T, 223.83 ._.FEET; NORTH W 36' 35" BAST, 171.37 FEET; SOUTH 75' 24' 58- RAS7I 171.06 F>3HT; NORTH 54' 2a' 37- EAST.1Z73 FEET; NORTH 23° 34' 55" WT, 122-17 FEET, NORTH 36' 56' L5" EAST, 235.72 FEM-, SOUTS 56' 01' 30- EAST,. 230.07 FEET; NORTE[ 346 05' 0fl- EAST, 89.32 FEET; AND SOUTH 86' 45' 48" BAST, 140.10 FEET TO A POIidI' IN PONDEROSA WAY, AN EXISTM P'UBM ROAD. - PARCEL M: A NON-EXCLI)SWE ROAD AND PUBLIC t MrIY.'FASMMWr OVER PARCELS 2. 3, AND 4, AS SROWN ON THAT C MTAIN PARC:SL MAP;.'RF.EORDED IN THE OFFICE OF •'1HB REcoRDER OF THE COUNTY OF BUTTE, STATE 0P CALUMNIA, ON JM 5.198 1. IN BOOK 83 OF MAPS, AT PAGM) 9. A CERMCATE OF CORRECTION MORDED NOVEKOM 30,1983, IN BOOK 2888, PAGE 568 OFFICIAL. RECORDS. CONiTIUEA Description: Butta,CA Documant-Year.DOCID 2003.37392 Page: 2,cf 3 0 --der: 2a2a2a Cosaent: t . 4 BUILDING PERMITS NUMBER: 05-2210 Address or location of unit: 294 DEER MEADOW RD. BERRY CREEK Legal Description of Real Property: 061-630-014 SEE ATTACHED (x) Mobilehome/Manufactured Home () Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health and Safety Code Section 18551. Owner's name: BOBBY JO RILEY SR AND BETTY LOU HOOG ETAL Owner's address: P.O. BOX 477, BERRY CREEK INSIGNIA OR HUD NUMBER: 8V-70-0255-S-A/B SERIAL NUMBER OR V.I.N.: ULI 550612/3 MANUFACTURER'S NAME: SKYLINE HOMES INC YE R: 2003 OFFICIAL APPROVING INSTALLATION:' ". DATE: 10 -IS -0,5 PHONE: (530) 538-7541 H.C.D. 513C 'y)r l UL L L I T I t I LL .0/2005 14:05 FAX 530 zy� y aI bcmma »QULqm NY MM VALLEY TITLE & ESCROW CO ,arra WFAN PiMi= bWL TO: BODUY 70 R11.9Y, SR. Bt3TTY LOU HOOD P.O. BOIL 487 BROWNSVI IB, CA 95919 j II�1�11lIIl�rIiHIUN6ll�! Recorded 1 REC FEF I&" Official Rttcords ( TAX 12.10 CoBgTE N UNFa J.- mbs Recorder RO1MRY DIUM4 I Assistant I Andrew 69 -,CM 1b -Jun -2W I Pqe 1 of 3 Above No Lana Por Reamdcr'.s Un 0* A.P.N.: t36��34.014 Orden' No.: 211139M" Escrow No.: 211139MA M GRANT DEE® THE UNDE 'MONBD ORANfOF'o DHCLATtH(e) THAT DOCUMMt 1TARy TRANSFER TAX IS: OpUNTY 12 . competed on mill value of pmperq+ cnod, nveyor XIcomputed ou full valga less vvaallue of liens or euvAbrancos r+MaiDW at dM of sale. ummorporeted arca; [ J City Of ^, and FOR A VALUABLE CONSIDERATION, Receipt of which i$ hM*Y WJMOW10W, PAUL M. �AMNI and DOLORES L. AAPl'I M, gwb=A aad Wife wa Joint Teetants hereby GRANT(S) to BOBB'll JO RILZy, SR., gg Unrzftafed Ma m and BETTY LOU E000, an Unmarried Woman ss Joint Taaaaft the following described pmpeTty in ft etnincwporated an of 9ba, OKMLY Of Dutte State Of California; STATE OP CALVOMA SSS COUNTY OP _ BUTTE_ ) On JUNE 9, 2003 bmnueme, KARY A. THOMPSON,NOTARY paeoaalw app—vd PAUL M SANTOKI AND DOLORES L SiHTQ8T' -- ggetooaaalty known to nle (or proved to n1a on Itsa beak of Bleat awy CVMW s)) to br ibe.p*Q W(11) wtwaa name($) Wom surfeermed to ft wteemn keeennoeatt and aemo'wlodyod to nw that hzA*A1dW moaw6led rbe mama In htalherhAAh•,etwjWbed eepae q(1) gad that by hWhcr tWf atpnetura(A) as the aaeWeaea4 the peraotK or do trnky upon b"f of wb"� 6o paam M ectad. ea[ewlmd the metr nxm. wRTN8s4 m0: hatd and o9rlclel scei. KARY A OMPSON • : 7HOWS �- OOfllmiosla» t793814Tb ept10110 • Calltbinla my. . E PA. . xy,, A .16, 2M 1 W Tax St$t,e, =ts to: SAME AS A110VE or Address Noted Be lova Daacript.ion: Dutte,CA Daav=9 t;–Ymar.DocZD 2003.37398 Paga: 1 of 9 Order: Zalala Coament: v ;. 0/?005 U 1 14 : u6 FAX 530 858 85J) FlUtLi I'Y n�+1 lnL i 1 i L L LUUJIN_Ur IN I J ti, Order No. BU -211139-3 MAM , D*=iption Tire lend heti ntd to herein is simted in the State of Cahi meis, County of Butte, and is keeled no follows. PARCEL 1, AS SHOWN ON THAT CERTAIN PARCEL -MAP, RECORDED IN IM OFFICE OF TIM RECORDER OF THE COUNTY OF AUTTE, STATE OF CALIFORNIA, ON FEBRUARY 10, 1984, IN BOOK 94 OF MAPS, AT PAOE(S) 36, APN 061-630-014-000 PARCBT. Il: A. NON-EXCLUSIVE EASEMENT FOR ROAD PURPOSBB AND PUBLIC UTILTI'X Pi ong OVER A STRIP OF LAND 60 FEET IN WIDTH LYING 30 FEET ON EACH SIDE OF A LINE DESCRJE13D AS FOLLOWS: BE GINNING AT A PODJT IN "1'iiB NORTH LINE OF M SOtTY'di MT QUARTER OF SECnON 6, TOWNSW 20 NORTH, RANGE 5 EAST, M-D.B. & K, WHICH POINT BEAR$ SOUTH 8?° 04' 49" WEST. 882.96 FEET FROM THE NORTHEAST CORNER OF SAID SOU nMEST QUARTER; THENCE FROM SAID P0Wr OF BWINMG ALONG THE FOLLOWING COURSES AND DISTANCES: NORTH 03° 43'.13" WWT. 73.09 FEET, NORTIR 280 59'25" WEST, 231.14 FEFI; NORTH 49° 43' 07" EAST. MtM FEET NORTH 060 ST 10" BAST, 179.27 FEET; NORTH 390 17' 02" WWW, 98.05 FEET; NORTH 01° 09' 32" WP,ST, 104.69 PBBT; NORTH 33" 50'08w EAST, 284.86 FRET; NORTH 26° 46' 18" EAST, 133.81 FWP, NORTH 150 12'01* EAST, 135AO ".ZT; NORTH 556'49, 44" 9AST,159.57 FEET, NORTH 350 30' 52" EAST, 60.75 FPBT; NORTH 70° 53' 17" BAST, 71.74 FEET; SOUTH 78° 55' 28" BAST, 1223S FEEL- 80M 51° 58' 51" EAST, 181.46 FEM, SOVfii 780 37"58" EAST, 223.53 FM; NORTH 860 36' 33" BAST, 171.37 FEST; SOUI 750 24' 58" BAST, 171.06 FEET; NORTH 54. 24' 37' EAST. 1$2,13 PUT, NORTH 230 34' 55" EMT, 122.17 FEET; NORTH 360 56' i5" EAST, 235.72 FEED, SOUTH 56" 01' 30" EAST, 230.07 FBBT; NORTH 34'5'05' 00" EAST, 89.32 FEST; AND SOUTH 860 43' 49" BAST, 140.10 FMT TO A POINT IN PONDEROSA WAY, AN EX1STM I'UHLIC ROAD. PARCEL In., A NON-EXCLUSIVE ROAD AND PUBLIC UTIIIT MASE ENT OVER PARCELS 2. 3, AND 4, AS 'SHOWN ON THAT CRKTAIN PARCEL MAP . RECMDHD IN THE OFFICE OF RECORDER OF THE COUNTY OF BUTTE, STATE 0P CALIFORNIA, ON Rm 5,198 1, IN BOOTS. 83 OP MAPS, AT PAMS) 9. A CEltTMCATE OF CORRECTION RBCORDFD NOVEMBER 30, 1983, IN BOOR 2888, PAGE 86, OFFICIAL RECORDS. CONTDWED De®oription : Hutt®, CA Doan wnt-Y*ar. DOCZD 2003 , 37398 Page: 2 of 3 Order: lalala Gent: - • .. a •• '•' .,' � + � � .. . .1 -TS -4 il'-" �Rq U�4Rk'R�r Uj �• tt: �RS r -5-6'I OPT if SHW A NTY ki p SUI NG 171 IPPR® !SS !L29. 6-7u 20# CENTERLINE SUPPORT REQUIREMENTS DRAN 6Y : VIM THIS SHEE i IS TO BE INSERTED WITH SUPPLENEN ( TO FIELD INSTALLATION MANUAL FOR� a to -'So- UAU 0.i 4/2000 vix YAM ZCY ROOF ZONE SNOW LOAD. SEE ABOVE PRINT FOR LOAD REOUIREVENTS AND LOCAT;ONS.- :,201 ROOF ORAWXG KMOM UWL Lam 4624-3CK-26—CATH 1 3701—CT e m N -4424 30EDROOM 2BATHS . CATHEDRAL THRU-OUT (1064 SQ FT -1 a 3701 to146 + , CATNEDPAl THAU•DUr apl / OPTnIIpO�N COVERED LMNG ROOM PORCH 14' 6'4" OPTION 26EDROOM CONFIGURATION ALT. DOOR OPTION DEN BUTTE COUNTY BUILDING DIVISION APPROVE® Vector Dynamics . Foundation System INSTALLATION INSTRUCTIONS for the State of California Version 9/212003 INDEX PAGE RELEASE SECTION NUMBER DATE INTRODUCTION 2 9/2/03 GENERAL INSTALLATION 3 9/2/03 PARTS LIST 4 & 5 9/2/03 LONGITUDINAL DEVICES 6 9/2/03 . PIER HEIGHTS 7 9/2/03 SET-UP INSTRUCTIONS 8 9/2/03 FOOTER SIZES WIND ZONE I - SINGLE 9 9/2/03 - DOUBLE 10 9/2/03 - TRIPLE 11 9/2/03 - HIGH PIER 12 9/2/03 WIND ZONE II - SINGLE 13 9/2/03 - DOUBLE 14 9/2/03 - TRIPLE 15 9/2/03 V -DRIVE & PIER SYSTEMS 16 9/2/03 SOIL CLASSIFICATION 17 9/2/03 CONCRETE INSTALLATION 18 & 19 9/2/03 Spj Thl Approval >MANUPAcrtrnED z�oME►�Aa>3It.E>r FOUNDATION SYSTEM MMT R AND SAFETY CODE. SECTION l0n APPROVED MJWWT TO CORRECTIONS NOTED A"2MAL DOES NO'T AUTHORIZE OR A"%OYB AN OMISSIONS OR DEVIATION PROM REQUIMAENTS WPUCMLE STATE LAWS AND REGIM AUCKS Srat of Caufmnia H hV and CamudW DndWMW 7z5; CODES AND STANDAR P1anApprovd Espirat�.�.,_ O -SIE M. o � NO. 6 245 ^n 9 CIVIL �P SOF CALIFS COMPONENT PARTS AVAILABLE UPON REQUEST BUTTE COUNTY F3UI'O DIVISION Ai -PROVED 103 .mmme. co L Cn 0 N O O O Tie Down Engineering, Inc. VECTOR DYNAMICS INSTALLATION DESIGN INSTRUCTIONS Introduction These instructions describe the proper use of the lateral and longitudinal foundation system. You may also refer to the home manufacturer's installation manuals that include the Vector Dynamics system as an alternate foun- dation system. General The Vector Dynamics Foundation System provides the support to resist lateral, longitudinal and over -turning movement of the home as required by the Federal Manufactured Home Construction and Safety Standards in a specified wind zone when the system is used as described in these instructions. Please verify state or local wind load requirements prior to installation of the home. The Vector Dynamics Foundation System resists lateral & longitudinal wind & seismc loads by anchoring the two longitudinal main rails. The system is approved to be used on single or multi section homes: Nominally 12 feet to 16' feet wide- (single section) with main rail spacing of 95 inches or greater on center; multi section main rail spacing of 75 inches or greater on center. Nominal 8 foot or less top plate height at sidewalls with main rail depth of 12" or less. Maximum roof slope of 20 degrees (4.4" in 12" slope). Maximum eave width (roof overhang of sidewall) of 12" for Zone I, 8" fo Zone II Maximum pier height under main rails -see page 7. The Vector Dynamics Foundation Systems may be used as a part of the vertical or gravity support system con- sidering that each Vector Dynamics pad has two (2) or (3) square feets bearing area. To inquire about the use of the Vector Dynamics Foundation Systems with homes of four or more sections, other widths, or on homes requiring pier heights which are not included in these instructions, contact Tie Down Engineering, Inc. at 1-800-241-1806. The Vector Dynamics Foundation System has not been designed for use on exposure "D" homes within 1500 feet of the coastline. Additional vertical anchor ties that are unique to a home's design may be required by the home manufacturer. These locations may include shear walls, marriage line ridge beam support posts, end frame ties and rim plates. \ _�a Page 2 California 9/2/03 GENERAL INSTALLATION INSTRUCTIONS SITE PREPARATION It is necessary that the home site be properly graded and sloped to prevent water and moisture from standing or flowing beneath the home. FOOTINGS AND FROST LINES The Vector Dynamics Foundation System was designed to be placed directly on top of the ground (or poured concrete) after clearing all loose vegetation. In areas with frost heave, use Vector for Poured Concrete (see pages 20 & 21) to comply with local requirements for footer depth. FOUNDATION/FOOTING SPECIFICATIONS FOR VECTOR PADS Vector Pads are used in place of conventional foundation pads. One Vector pad provides two or three square feet of bearing support. Vector Systems should be spaced as symmetrically as possible along the length of the home. For pier locations in between the Vector Systems, use the normal foundation pads. LUMBER/MOISTURE - TERMITE SHIELD To cut PVC or lumber (2 - 2x4's,1 - 44 or 1 adjustable steel commpression member per Vector system) for the center compression section,when using concrete blocks for piers, measure „center to center frame (I-beam) dis- tance and subtract 16". When using METAL PIER STANDS, measure center to center frame distance and add 16" ALL WOOD MUST BE PRESSURE TREATED, GROUND CONTACT RATED. Tip: Pre-cut your lumber and mark as to brand or model of homes you will be installing. If frame widths are the same, the pre-cut boards will also be the same length in each Vector set-up. STRAP INSTALLATION All frame ties and diagonal straps must go from the anchor to the top of the I -Beam. See illustration below. 1. Attach frame hook to top inboard location of "I" beam. (Frame hook must be attached to frame at points closest to floor support.) 2. Keeping in line with the hook, wrap galvanized strap completely around "I" beam. 3. Pull strap past anchor head approximately ten inches before cutting to allow enough strap to give a minimum of five turns around the slotted anchor bolt. 4. Thread loose end through slotted bolt so that the strap is flush with the other side of the bolt. 5. Tighten slotted tensioning bolt a minimum of five full turns. Page 3 California 9/2/03 Vector Dynamics Foundation Systems Lateral Component Parts List Vector System Lateral Stabilization Block Pads #59018 - 2 sq. ff. single/double block pads with hardware, swivel straps and slotted bolts Vector System Lateral Stabilization for Concrete # 59036 - Single (only) block pads with hardware, swivel straps and slotted bolts. # 59049 - Double block pads with hardware, swivel straps and slotted bolts. Vector System Lateral Stabilization For Difficult/Rocky Soils # 59287 - V Drive System Must be used with: # 59018 - Vector for single/double block pads 3 Sq. Ft. Pad Vector System # 59271 - Vector 3 sq. ff. pad (2 required) # 59024 -Vector Lateral Hardware Kit, includes PVC adapter. Strap/Swivel Strap Connectors & slotted bolts not included. C Page 4 California 9/2/03 Vector Dynamics Foundation Systems Longitudinal Component Parts List • Longitudinal Stabilization Hardware Kit # 10733 - (for use with 59018 Vector System, single stack block sets only. Longitudinal struts not included) Longitudinal Stabilization Hardware Kit for Concrete # 59023 - Includes 2 beam clamps, tension brackets, nuts and bolts. (for use with #59036 & 59049, longitudinal struts not included) 3 Sq. Ft. Pad Vector Longitudinal System # 59026 - Includes 2 beam clamps, 2 tension brackets, nuts & bolts. (for use with #59271, longitudinal struts not included) Struts for Longitudinal Systems Part No. Length Pier Height # 59016 30" up to 2 Blocks # 59012 39" up to 3 Blocks # 59013 44" up to 4 Blocks # 59014 53" up to 5 Blocks # 59015 65" up to 6 Blocks PVC Adapter Bracket # 59281 - For use with Schd 40 PVC Center Compression Strut # 48612 - Single Section, 62"- 108" # 48613 - Double Section, 34"- 60" (includes short u -bolts, nuts, washers and 6 self taping screws) Page 5 California 9/2/03 C Longitudinal Stabilizer Devices The use of LSD systems on a single or multi section home replaces longitudinal anchors, stabilizer plates and straps. The Longitudinal Stabilization Device (LSD) is used with the Vector Dynamics System to resist loads in the longitudinal direction (short dimension) of home. The number of LSD required is shown on pages 10-13. LSD 1. Longitudinal Foundation Pad 2. Beam Clamp (2 per system) 3. Longitudinal Strut (2 per system) 4. Tie Bracket (2 per system) Combine Vector Dynamics & LSD Note: Two struts =1 L.S.D. system. Can be used on one pad or slipt on opposite ends of the home. Examples of Possible Placement: (Contact TIE DOWN for placment in other Wind Zones) Wind Zone I Single Section I I I I I I I I I I I I I I I I I I I I I Wind Zone I Double Section 18 Ft. Max. 32 Ft. Max. Forgreater widths use triple section design. Page 6 Wind Zone I Triple Section Wind Zone I Tag Section 48 Ft. Max. California 9/2/03 50 in max. Maximum Pier Height Vector Dynamics Foundation Systems may be used on single section homes in Wind Zone I which require pier heights (from surface of Vector pads to top of concrete or metal pier) not to exceed 50 inches under one or both main rail(s). Note that a ground anchor must be used at each Vector system location where the pier height exceeds 24 inches for single section homes. On multi -section homes in Wind Zone I, an anchor must. be used at each Vector System location with pier heights above 46" with the following exception: double section homes that are 24' wide, in Wind Zone I, have a maximum pier height without anchors of 38". See page 12 for double section home high pier set instructions. 50 it max. Unequal Pier Heights Maximum Homes with unequal pier heights are limited to 50" maximum pier height. The difference between the taller pier and the shorter pier cannot exceed 26". 1 �04EUh Page 7 California 9/2/03 Set -Up Instructions for Vector System #59018 Long U -Bolts 1. Set Vector Pads Clear all vegatation where pads will rest. Place a long U -bolt in pad as shown. Press or hammer pad into the ground. 2. Set Block or piers on pads. Center foundation blocks or piers on pads. Place pre- cut center compression member between blocks, rest- ing on pads, centers between U -bolts as shown. 3. Outside Tension Bracket Attach outside tension bracket as shown to outside of pads. 4. Inside brackets & Straps Attach the inside tie brackets to the U -bolts over the compresion member. Attach a strap w/hook or swivel strap w/nut & bolt. Place other end of the strap over opposite I-beam & down to outside tension bracket. Cut strap 12 - 15 inches past bracket. Attach strap & slotted bolt in bracket. Tighten strap until tight with 4-5 wraps around bolt. Repeat with opposite strap. �XOECM Page 8 California 9/2/03 WIND ZONE I, SEISMIC ZONE 4 Vector Dynamics Systems Required for Single Section Homes (Materials Required) Section ho me - S% . 1 MOP - `v = , `v _ - ' ,_ _ �z�z � �`' axe � • - .1 "r1 t � ' ` ALK cc CD,..- • 1 u. .?• gyb 7S yk 's� W 34 �. mom• o.c•�1p' Note: L S D.= longitudinal amu„ Stabilization Device NOTE: Vector Systems should be spaced as symmetricaSee Page;6..1 .1. of he homell PPier pac y as ng amustt be length consistent with home manufactu rers'. Soil: Classifications: ' 2, 3, 4A, & 4B o' and/or state requirements. ::. 'Instructions Soil Bearing Capacity." 1;000 PSF minimum . Anchors Required: 30" with 2=4 helix anchor (59095); 12" stabilizer plates (59292),1-1/4" frame ties WIND ZONE] Home Length Vector Systems' Required Anchors Required Per Side or 24" Pier 24+" Piers L.S.D. 0 to 72' 3 2, 3 2 . 73' to 90' 4 3 4 2 . e` tor arnics Each Vector,System requires one of the followings w = F ` 1-4x4 or 2-2x4's pressure treated wood compression member, f Schedule 40 PVC Pipe or 1 adjustable steel compression (see parts list) - �2 sq. ft. pad w co CD O WIND ZONE I, SEISMIC ZONE 4 Vector Dynamics Systems Required for Double Section Homes -,me h0 ` (Materials Required) __--'" __-"' eCt�pC1 ?2, doubles 1 a -- - - _ NOTE: Vector Systems should be spaced as symmetrically as possible along the length of the home. Pier spacing must be consistent with home manufacturers' instructions and/or state requirements. No anchors required. For pier heights up to 46" for 28'-36' wide, 38" for 24' wide. See Pg 12 for high pier instructions. WIND ZONE I 2 sq. ft. pad Soil Classifications: 2, 3, 4A, & 4B ------- Soil Bearing Capacity: 1,000 PSF minimum Anchors Required*: None (*Marriage wall anchors may be required by home manufacturer) Home Length Vector Systems Required Anchors Required Per Side L.S.D. 0 to 40' 2 0 2 41' to 66' 3 0 3 67' to 84' 4 0 4 85' to 90' 5 0 4 Each Vector System requires one of the following: 1-4x4 or 2-2x4's pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steel compression (see parts list) Note: L.S.D.= Longitudinal Stabilization Device See Page 6. WIND ZONE 1, SEISMIC ZONE 4 "" Se�t�o�tooy`sems:,, Vector Dynamics Systems Required for _ - - ' - , - 16 ft ma�tn9 for qe r Triple Section Homes " - , _ - EXarnphows genera\ sp (Materials Required) - ' ' -s`' r t\ons 1 -12 Home Length NOTE: :k , - LSD Main TAG C When a pier height at Vector locations exceeds 46", an TaGj ' 1 anchor must be used on the outside wall/beam at that . or__-,,, 0 - . approximate location. 1 full triple - t TM 0 NOTE: Vector Systems should be spaced as 2 85' to.90' 5 +2 on Tags " _ 0 Symmetrically as possible along the length of the 2 .home. Piers spacing use consistent,whome p g - mt bith Soil Classification_ s 2; 3, 4A, `& 4B ' c� manufacturers' instructions and/or state requirements. Soil Bearin Ca aci g . p...ty: 1;000 PSF minimum Anchors Required*: None (*Marriage wall anchors may' be required by home, manufacturer.) Home Length Vector Systems Required Anchors Required Per Side - LSD Main TAG 0to48'_ 2+2 on Tag 0 2 1 49' to 71'', 3 +.2 on Tag 0 2 1 72'to84'.; 4+2onTag., 0 2 2 85' to.90' 5 +2 on Tags " _ 0 2 2 DO '""' - �o u Each Vector System requires one of the following: 2 sq. ft. pad 2 sq: ft. pad 1-4x4 or 2-2x4s pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steel compression -(see parts list) w cQ CD N WIND ZONE I, SEISMIC ZONE 4 (High Pier Sets) Vector Dynamics Systems Required for Double Section Homes - - ' - - - - ' ' (High Pier Sets with Diagonal Ties) _ " - ' ' - " e hom _ ' CIA - _ -72' dou a NOTE: Vector Systems should be spaced as symmetrically as possible along the length of the home. Pier spacing must be consistent with home manufacturers' instructions and/or state requirements. l WIND ZONE I 7Max.eight Unit Width See Page 7 co A N O aeeam (A) Spacing R2 sq. ft. pad Home Length Vector Systems Required Anchors Required Per Side L.S.D 0 to 48' 2 2 2 49' to 71' 3 3 3 72' to 84' 4 4 4 85' to 90' 1 S 5 1 4 Soil Classifications: 2, 3, 4A, & 4B Soil Bearing Capacity: 1,000 PSF minimum Anchors Required*: 30" with 2-4" helix anchor (59095), 12" stabilizer plates (59292) 1-1/4" frame tie with connector Each Vector System requires one of the following: 1-4x4 or 2-2x4's pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steel compression (see parts list) 24" N C.0 WIND ZONE II (not to scale) Soil Classifications: Soil Bearing Capacity: Anchors Required": 2,3, 4A & 4B 1,000 PSF minimum 30" with 4" helix anchor (59095),; 1-1/4" vertical ties w/4725 lbs. min: breaking strength. Home Length Vector Systems Required Anchors Equired per side LSD WIND ZONE II, SEISMIC ZONE 4 (Hurricane) 3 5 2 Vector Dynamics Systems Required for 5 6 2 Single Section Homes 6 7 2 (High Pier Sets with Diagonal Ties) 7 8 2 `e se6o or cyst" MS. \ guide\fines 8 9 2 of aen �a�sP,Ing'me°tsa��a<�On to ustoe \\\ustta<l d sPa°ln9 m an ads o\pd0lonP --'' ;_- 24" N C.0 WIND ZONE II (not to scale) Soil Classifications: Soil Bearing Capacity: Anchors Required": 2,3, 4A & 4B 1,000 PSF minimum 30" with 4" helix anchor (59095),; 1-1/4" vertical ties w/4725 lbs. min: breaking strength. Home Length Vector Systems Required Anchors Equired per side LSD 0to48' 3 5 2 49' to 60' 5 6 2 61" to 72' 6 7 2 73' to 84' 7 8 2 85' to 90' 8 9 2 NOTE: Vector Systems should be spaced as . symmetrically as possible along the length of the home. Pier spacing must be consistent with home manufacturers' instructions and/or state requirements. Maximum allowable working drag load for the Vector System with steel compression strut is 4,000 lbs. per the K2 Engineering test report. R Each Vector System requires one of the following: \2 sq. ft. pad" 1-4x4 or 2-2x4's pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steel compression (see parts list) C-) w WIND ZONE II, SEISMIC ZONE 4 Vector Dynamics Systems Required for - ' ' - " �e se�t;ec oman - 9�de\%nes.l Double Section Homes - - - vb r v m - , NOTE: Vector Systems should be spaced as symmetrically as possible along the length i home. Pier spacing must be consistent witt manufacturers' instructions and/or state req Maximum allowable working drag load for tl System with steel compression strut is 4,001 the K2 Engineering test report. son bearing Uapacity: Anchors Required": l,uuu rbF minimum 30" with 4" helix anchor (59095), 1-1/4" vertical ties w/4725 lbs. min. breaking strength. Home Length Anchors Equired per side Vector Systems Required LSD 0 to 48' 4 4 3 49' to 60' 5 5 3 61" to 72' 1 6 1 6 1 3 73' to 84' 7 7 4 85' to 90' 8 8 4 Each Vector System requires one of the following: 1-4x4 or 2-2x4's pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steel compression (see parts list) WIND ZONE II, SEISMIC ZONE 4 Vector Dynamics Systems Required for - - - - ' " - - " - ' me ; Triple Section Homes - " - ' " - - - - - ', sectio {o ysiems- (Materials Required) - - - " - - , - - e of a Ie a� sPartn9 fOr ve" " r=- - -- mP� "` - n� _ EXa h°Ws 9e - F ; - -i- S ' NW trat�O� - v " „r r h � Home Length NOTE: - - - C- Oto48, .: When a pier height at Vector locations exceeds 46", ann anchor must be used on the outside wall/beam at that 4. 2. 1 49'to71' 4+2onTag . 6 3 2 72'to84' 4+3onTag 7 . approximate location. 2 85' to 90' 5 + 3 on Tag 8 13 2 CD NOTE: Vector Systems should be spaced as v, symmetrically as possible along the length of the gym. home. Pier spacing must be consistent with home _ manufacturers' instructions and/or state requirements: Tag Or"_ p - Soil. Classificlo ations`. 2, 3, 4A; & 4B Soil Bearing Capacity: 1,000 PSF minimum ! y ` ,. Anchors Required*: 3/4" x 30" with 4" helix anchor (59Q95) 1-1/4" vertical ties q w -w//4725 lbs. min. breaking strength. Ey Home Length Vector Systems Required Anchors Required Per Side •LSD Main TAG Oto48, .: 3+2onTag 4. 2. 1 49'to71' 4+2onTag . 6 3 2 72'to84' 4+3onTag 7 . 3 2 85' to 90' 5 + 3 on Tag 8 13 2 o Each Vector System requires one of the following: w 1-4x4 or 2-2x4's pressure treated wood compression member, Schedule 40 PVC Pipe or 1 adjustable steei compression (see parts list) 2 sq. ft. pad 2 sq. ft. pad . Vector Dynamics Metal Pier & V -Di METAL PIER FOUNDATIONS For metal piers, place the piers in the center of the Vector pads. Set the single 44 or two 2x4's through the piers, centered in the U - bolts. Outside Tension brackets attach the same, Inside tie brackets mount "upside down" as shown in drawing. Metal piers using the Vector System can only be used on level ground sets. Conventional pier adjusters must be placed under beam with upturned edge directed towards the outside of the home. Pier spacing must be consistent with home manufacturers' installation instructions and/or state requirements. To cut lumber (2 - 2x4's or 1 - 44 per, or 1 adjustable steel commpression member, part #59043 Vector system) for the center com- pression section, when using METAL PIER STANDS, measure center to center frame distance and add 16". Optional Moisture Termite Shield may be required in certain regions. ALL WOOD MUST BE PRESSURE TREATED, GROUND CONTACT RATED. Tip: Pre-cut your lumber and mark as to brand or model of homes you will be installing. If frame widths are the same, the pre-cut boards will also be the same length in each Vector set-up. V -Drive for rocky soil V -Drive anchors are used only in Zone 1, single section homes. V -Drive anchors are used only in'Zone I, single section homes in areas where rocky soil conditions do not allow helix style anchors to be installed. Vector Systems are set following the general set up instructions provided. With the V -Drive anchor, the short 2x4 boards used with the outside tension brackets are discarded. In place of the short 2x4's, a longer 2x4 is used as per the diagram above. This 2x4 board should extend from the base of the Vector pier set to 5 inches from the side wall of the home. Place the V -Drive head over the end of the longer board. Using a heavy hammer or electric hammer gun, drive the three V -Drive anchor rods through the V -Drive heads at an angle of approximately 45 degrees under the home. The rods must come to a complete stop on the V -Drive head. Attach a strap with hook or buckle to the frame and attach to the V -Drive head with a slotted bolt. Cut the strap end about 12 to 15 inches past the anchor head to allow at least four or five wraps around the slotted bolt. Continue tightening strap until all slack is out and strap is tight. Page 16 Californi�al 2/03 VECTOR DYNAMICS INSTALLATION DESIGN INSTRUCTIONS Vector Dynamic Foundation Systems may be used only on homes set on soils classified as Class 2, 3, 4A and 4B as described in the table below: SOIL CLASSIFICATIONS Soil Class Types of Soils Blow Count (ASTM Soil Test Probe (1) D2586) Torque Value (2) 1 Sound hard rock...... NA NA Very dense and/or 40 -up More than 550 lbs - in. cemented sands, coarse 2 gravel and cobbles, preloaded silts, clays, and corals Medium -dense coarse 24-39 350-549 lbs - in. 3 sands, sandy gravels, very stiff silts and clays 4A Loose to medium dense 14-23 275-349 lbs - in. sands, firm to stiff clays 4B and silts, alluvian fill 175-275 lbs - in Peat, organic silts, 0-44 175 lbs - in. 5 inundated silts, loose fine and lower sand, alluvium, loess, varied clays, fill, fly ash. (1) The purpose of the soil test probe is to gauge the strength of the soil below the surface and near the anchor's helical plate. The strength of the soil is estimated in terms of its resistance to penetration (flow) under load by means of the torque probe and is measured in Ib -in. The test probe has a helix on it. The overall length of the helical Section is 10.75 in.; the major diameter is 1.25 in.; the minor diameter is 0.81 in.; the pitch is 1.75 in. The shaft must be of suitable length for anchor depth. (2) A measure synonymous with moment of a force when distributed around the shaft of the test probe. Vector Foundation Pads Equivalent to Footer Pads* Footer Size: Footer Size: 16x16 = 256 sq. in. - '- ' - 20x20 = 400 sq. in. or 16x18 = 288 sq. in. or 17x25=425 sq. in. EQUALS -= - = EQUALS _ - 2 -Vector Pads # 59275 - = 1 -Vector Pad # 59271 288 sq. in. or 432 sq. in. 1 Vector Pad # 59130 Vector Pad(s) exceed the surface area required when used as the equivalent listed above. 'Foundations in soil with a bearing capacity of less than 1,000 PSF must be designed by a Registered Professional En ineer Jamiliar with site conditons � �W * C Page 17 California 9/2/03 Vector Dynamics System for Concrete Applications _ Instructions i'. These instructions are an addendum to the standard Vector Dynamics instructions. Read and follow all applicable instructions and guidelines in the Vector instructions and home installation manual. The Vector system for concrete pads applies to concrete footers, runners and slabs. Minimum size of concrete per Vector pier is 24"x24" x 4" or 18" round (min) x 10" deep. The bottom of footers must be below the frost line or a minimum of 4" below finished grade whichever is greater. Concrete must be sufficiently cured and set to accommodate an anchor bolt to its' full load resistance. 1. Determine location of pier sets where the Vector systems will be located. 2. Place one Vector concrete pad (galv. metal) on the concrete where the pier will be located, centered under the I-beam of the home. Place the upturned edge towards the center of the home and directed to the opposite Vector pier. Do the same for the opposite Vector pier. 3. Measure the distance between the two Vector system pads at the base where the Vector pad meets the concrete. Cut two ground treated 2x4's or Schedule 40 PVC pipe, or 1 adjustable steel commpression member, part #59043 this length and place between the piers as shown. 4. Place a long u -bolt under the 2x4's and through the holes of the Vector pad as shown. 5. Place the concrete pier blocks on the Vector pad. Center the blocks under the frame. The upturned edge end of the Vector pads should be up against the inside of the pier blocks. 6. Build vector piers but do not wedge at this time. 7. Using a concrete drill bit, drill two holes on each side into the concrete using the holes in the Vector pad as a guide. Drill the 3/8" diameter holes 3 inches deep. 8. Place an outside tension bracket on the Vector pad as shown in Illustration one. Line up the holes in the bracket, Vector pad and concrete pad. 9. Put a washer and nut on one of the 3/8" x 3-3/4" wedge anchors. The nut should be screwed on enough to have 1 or 2 threads showing on the top of the bolt. Place the wedge end of the bolt into one of the holes, going through the outside tension bracket, metal Vector pad and into the concrete. Illustration One of a Single Section Set -Up Vector pad for concrete Concrete footer Page 18 California Wood Cap and wedge Outside Tension Bracket Wedge Bolt *:cw 9/2/03 Vector Dynamics System for Concrete Applicativns Instructions ' 10. Using a hammer, tap the wedge bolt into the hole. Maximum,height for expansion bolt above concrete is 2". 11. Repeat for the other hole in the outside tension bracket and the"two holes on the other Vector system pier set. 12. Place an inside tie bracket over the u -bolt so that the lip of the bracket is between the Vector. plate and concrete blocks. Place washers and nuts on each U -bolt. Do not tighten yet. 13. Attach a strap with hook or crimp seal to the inside tie bracket,�with sufficient length to'go over the opposite pier and down to the outside tension bracket, plus 12 inches -for wrapping the slotted bolt. Repeat for the opposite side. 14. Tighten inside u -bolts at this time. 15. Use the outside tension brackets to remove any space between the outside tension brackets, concrete blocks and the inside edge of the Vector pad, by tapping the brackets with a hammer. Wedge the pier set at this time. 16. Using a 9/16" socket wrench, tighten all of the wedge/anchor bolts, se.curing .the outside tension bracket and Vector pad to the concrete. 17. Using a slotted bolt in the outside tension brackets, insert strap through slotted .bolt with end of strap aligned with outside edge of bolt. Turn slotted bolt until straps are light using at least five turns,on the slotted bolts. Illustration Twc Inside Tie Bracket Compressio boards or PVC Pipe U -bolt Page 19 Vector pad for concrete Concrete footer - California 9/2/03 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 2004-005409 1 Recorded OfficialRecords Count BUTTf E CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 01:0013M 03 -Sep -2004 REC. FEE 7.00 CONFORM 1.00 Kathyh Page 1 of 1 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:- P,4R C e L L /� S �Sh� cJ.✓ o it/ T Y f—/ CEi4 T/� ��/ 1g9'PC& L /W/9 �L CdR9 D /r✓ 7rfc OFf/re 8 h T/-�.= �� CDR1� ��2 Oh Coy/LJ7-/V(%c r S Z 6/= e� LI /�o��✓/%f � �iv /;ec &IFLovy /DJ %?ky /;J ,�©ems �1'Y o 1=- 17719pr 19 ���� IS��G. /9A1061 -630-0/y Date O PROPERTY OWNERS: ax �'� aS`2 P_71`y oo G State of California ) County of On y- 3 - 7-oo L/ _ before me, 4/'"C -S IA SC.- ZA I personally appeared le.5 RHoo!s Ilmsmally knewn-t&nte (or proved to me A the basis of 4atisfactory evidence) to be th6 person(s) whose name(s) is/are subscribed to the within instrument and acknowledged -to me thaLbe/she/they executed the same in kWh r/their authorized capacity(ies), and that by'tlis+er/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my d and official seal. Signatur Seal: ., JAMES LAMAR KINSER COMM. #1377185 rj NOTARY PUBLIC - CALIFORNIA J ( BUTTE COUNTY "- i J �r / Comm. Ex A.P�#_, _�, �r �_� _ � MY Aires Sept. '28, 2006 3B 339 1 bs1yiao9A MGVM I 2b'10390 lai:010 �03y3 i a f 2HHUA8 It 33MA3 I MUM YRAM3200 ft�Nt�N t frta�eiazA I jo 19gsq I OSSS-qs2-E9 1 UMS • •i ; q � L "{, rte. - Butte County Department ADMINISTRATION * BUILDING * GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538.7541 Telephone (530) 538.2140 Facsimile August 2, 2004 Bobby Jo Riley, Sr. ETAL Betty Lou Hoog P.O. Box 477 Berry Creek, CA 95916-0477 RE: Formal Warning Notice Butte County Code Violation Deer Meadow Road, Berry Creek AP# 061-630-014 Dear Mr. Riley and Ms. Hoog: jpr.-7� 722) ys' of DevelopmenQc Through our courtesy notice on June 7, 2004, you were notified pursuant to Section 41-2 of the Butte County Code of the presence of code violations on your above -referenced property. According to our records, the courtesy notice has not resulted in abatement orcorrection of the following specific violations: 1. Unauthorized camping or otherwise occupying a recreational vehicle. 2. The accumulation of garbage for more than seven (7) days in public view. Your failure to eliminate the stated violations are cause for the issuance of this formal warning notice. As of this date, our records indicate that the following violations to the Butte County Code still exist: • Butte County Code, Chapter 24, Section 24-65 - Applicability of zoning regulations. All uses of land within a zoned district not specifically authorized or permitted by regulations are prohibited. Butte County Code, Chapter 31, Section 31-50 The owner or tenant of any premises, business establishment or industry shall be responsible for the satisfactory removal of solid waste accumulated on said premises. To prevent propagation, harborage or attraction of flies, rodents or other vectors and the creation of a nuisance, solid waste, excepting non-flammable inert material, shall not be allowed to remain on the premises for more than seven (7) days. , Non-flammable inert materials stored on a premises shall not be allowed to become either a harborage for rodents, insects or other vectors, rior a public nuisance. Such inert non- flammable materials which are not properly stored shall not be allowed to remain on a premises for more than thirt7y.(30) days. • Butte County Code, Chapter 24, Section 24-260 (a) - Camping Limitations and Prohibitions. No person shall ,place or park or allow the placing or parking of any trailer Bobby Jo Riley, Sr. and Betty Lou Hoog AN 061-630-014 August 2, 2004 Page 2 coach, recreational vehicles, tent trailer, or tent, or otherwise occupy or allow the occupancy of any parcel (as defined in Section 24-305.310) f6r the purpose of camping (as defined in Section 24-305.095) on public or private property within the County for a period in excess of 9 days in any one calendar year, except in an outdoor recreational facility, campground, recreational vehicle park, or hunting/fishing camp, lawfully established and maintained pursuant to this Chapter. The determination that this violation exists on the property is based on the following definitions in the Butte County Code: 4i Butte County Code, Chapter 24, Section 24-305.170 - Garbage. ""Garbage" means every accumulation of animal or vegetable waste, matter that attends or results from the preparation, consumption, decay, dealing in, or storage of meat, fish, fowl, fruits, vegetables or other food products and shall include any food container in which there is putrescible material either solid or liquid. . • Butte County Code, Chapter 24, Section 24-305.370 - Rubbish. "Rubbish" shall mean all nonputrescible solid wastes, combustible, or noncombustible, including, but not limited to, paper, cardboard, yard clippings, grass, ashes, wood, bedding, crockery, glass, metal and other similar materials, excepting compost boxes. • Butte County Code, Chapter 24, Section 24-305.360 - Refuse. "Refuse" shall mean and include any solids or semi-solid waste other than domestic sewage, including, but not limited to, garbage, rubbish and trash. • Butte County Code, Chapter 24, Section 24-305.095 - Camping. Occupying or maintaining for occupancy any place for temporary living, sleeping or other human occupancy purposes. "Camping" does not include: The parking or storage of an unoccupied and otherwise unused trailer coach, recreation vehicle, or tent trailer on a privately owned parcel, as defined in Section 24-305.31; occupying a trailer coach, or recreation vehicle, connected pursuant to county permit to permanent *sewage disposal and water supply systems; or occupying a trailer coach or a recreation vehicle for any accessory use allowed in the applicable zoning district. In order to bring the property into compliance with the Butte County Code. and avoid further enforcement actions, you are hereby requested to take the following abatement or correction actions: Remove `all garbage, rubbish and refuse from your property and maintain a regular removal schedule in accordance with Butte County Code, Chapter 31, Section 31-50.' 2. Cease and desist camping activities on the property in accordance with the Butte County Code, Chapter 24, Section 24-260(a). This is your final warnin . Unless you contact this office and make the proper arrangements to correct or abate the violation(s) voluntarily, within ten (10) days from the date of this letter, enforcement shall be pursued through the issuance of a citation (ordering you to appear in court) for said violation(s) and for failing to comply with this warning letter. Upon conviction of said violation(s) or of failing to comply with this letter, the court shall impose penalties (fines) and a Notice of Violation shall be recorded in accordance with Butte County Code Section 41-7. The Notice of Violation will include a description of the premises the violation concerns, a Bobby Jo Riley, Sr. and Betty Lou Hoog AN 061-630-014 August 2, 2004 Page 3 description of the violation, the date of your convictions and the action necessary to correct or abate the a violation(s). i Should you have any questions concerning this matter, please contact me at the address or telephone number listed above. Sincerely, Scot Johnson Code Enforcement Officer SJ: Ir cc: Department of Development Services, Code Enforcement 1 s r 1 r f PROOF OF SERVICE BY MAIL 1 I am a citizen of the United States and employed in the County of Butte; I am, and was at the 2 time of the service hereinafter mentioned, over the age of eighteen years and not a party to the within 3 action. My business address is Department of Development Services, Building Division, 7 County 4 Center Drive, Oroville, California 95965. I am readily familiar with the County's practice for 5 collection and processing of correspondence/documents for mailing with the United States Postal 6 Service and that said correspondence/documents are deposited with the United States Postal Service 7 in the ordinary course of business on the same day. 8 On August 2, 2004,1 served the foregoing 10 -day Notice on the person(s) named below by 9 placing a true copy thereof in a sealed envelope, with first class postage thereon fully paid, addressed 10 as indicated below, and by placing said envelope. 11 12 In the appropriate place within the Department of Development Services where 13 mail is collected for mailing with the United States Postal Services on the same 14 day. 15' X In the United States Postal Service Mail in Oroville, California. 16 Bobby Jo Riley, Sr. ETAL 17 Betty Lou Loog P.O. Box 477 18 Berry Creek, CA 95916-0477 19 I declare under penalty of perjury under the laws of the State of California that the foregoing 20 is true and correct and that this declaration was executed on August 2, 2004, at Oroville, California. 21 22 Gwyn Be e ict Office Assistant H 23 24 25 26 27 28 BUTTEIPOUNTY DEVELOPMENAERVICES COMPLAINT FORM Date: 0(T Owner: 1.t_. 81 Address: 0 —,�)OX ,gevyu N -,P -1P -L GA Complaint/Violation Location: TYPE: (wilding COMPLAINT: AP#: o(o' ^IO�V— o Zoning: U General Plan: 7A ! S? /& -04 ,supervisorial District #: Wj { { } Health { } Planning r i Permit History on File {vj None { } See Attached Tenant: Description of Violation: Approx. Size of Bldg/MH: )Housing Complaint Taken By: INSPECTOR'S REPORT Address: { } Occupied Has Electricity { } Yes { } Vacant Has Sanitation { } Yes Under Construction { } Yes { } No Hazards: { } No { } Yes (explain) _ Person Contacted: Caution: { )Yes Why: Approx. Age of Bldg/MH: { )No Has Gas/Propane { } Yes { } No { } No Obvious Sewage Problems { } Yes { } No Built by/for { } Present Owner { } Previous Owner Describe Action Taken: INSPECTOR MUST ATTACH A COPY OF THE CORRECTION NOTICE!! Inspector: Date: ACTION RECOMMENDED { } Information Only, File { } Hold for Days { } Complaint Unfounded { } Other { } Resolved per Inspector's Report { } Send Letter of Compliance Inspector must draw a plot plan with all building locations on the back of this sheet. 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