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062-350-003
m 06 350 003 °R t 03-0857 w KEITH, CARLA }tea -18 SAND CREEK, BERRY CREEK Cont: BARNEY BONE MMI a COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION - 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 (Rev. 12/96) APPLICATION AND PERMIT -J / ASSESSOR PARCEL NUMBER 069 lied) -M1 ZONING . 11 BUILDING PERMIT OWNER cAlziA Itrizx TELEPHONE SO. FT, OCC. BUILDING VALUATION OWNER'S MAILING VALLEY ^ 107 FELTON A WIS VIEW, ` CONTRACTOR'S NAME � BONE TELEPHONE 1-534-9694 CONTRACTORS V -7R _ MMM- E CA959664 j CONSTRUCTION LENDER N LENDER'S MAILING ADDRESS Fireplace �" _(, �.. �. _A f ! Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ Plan Checking Fee $ 23.00 BUILDING fg1ES� CI� ADR. , BBRY I� CA ii VV Energy Plan Checking Fee $ $ PERMIT FEE $ 43.00 LOT NO. SUBDIVISIONS NAME PARCEL'MAP 11 PLUMBING PERMIT Fling Fee 1 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15:00 r Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ f Describe Work:I Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home 1-§TGI 1—§GW I @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Feel 20.00 I Main Service noon oa LE S 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full tfo'r�cee and effect. -� ` License Class 4r-"' T / Lic. No. / 5 `f i OWNER -BUILDER DECLARATION i I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: j ❑ 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.` O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. I ❑ 1 am exempt under Sec. Business and Professions Code for this reason i TO Main Service TO 46.00 NEW CONST. DWELL EE OCCUCUP. SO ADDNS. ( 3.5¢Fr; NOR EW CONST. MLI Co Er �µREs,D_ BRANCH CIRCUITS @7.50 POWER APPARATUS S SINGLE OUTLET CIR- EX. OCCU OUTLET OR FIXTURES 20 Q 1.00 840 .50 Ex. Occup. GFlxuTe£°TSA R6DOEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE t WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and,policy number are: Carrier -57–A 7- 4- F, yv cjG Policy Number C_Dc_) : '! e Cj — 0,:J (The above sections need not be completed 0 the per MTN for work of a valuation of one hundred dollars ($100) or less.) I not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. " Id ,� X .-..J _ ) — 7S __ Date 7 ,, Signature of Applicant /❑ Owner� .❑' Co`n`tractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ 100. Energy Inspection Fee $ Occ CONST. TYPE 43.00 HAZ. D. FEES IMP FLOOD - _ COF PARCEL PD HD ISSUE v This permit is hereby issued under the applicable provisions of the BUtte County Code and/or Resolutions to do work - dt indiced above for which fees have been paid. ✓ r i 4-29-03 By ,` Date PERMIT EXPIRES ON V/4-29-04 Date ReceiptNo. =� f a 'xll i,w ,3 S% fr. f , `v WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT U A.P. # (� E- -Cd d `� OWNER _le',I PERMIT # 2 - .3;3 -7 MH UTIL. CLEARANCE DATE_ jam% 6 INSPECTOR Z3-. f ELECTRIC GAS SUPPORT. STRUCTURE COMPACTION TEST REQ. SERVICE OTHER PIPE SIZE LOAD TYPE- SIZE LENGTH YES NO YES NO t,G i�� * COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 _. 7 County Center Drive.* Oroville, CA • (530) 538-7541 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact thiyofhce immediately. Date- G Inspector REV 10/92 MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION - COUNTY CENTER DRIVE OROVILLE, CA 95965 - PHONE (530) 538-7541 APN: t9 6 1- � � � --, o -3 PERMIT NO.: � .; '7 Owner's�Name16;�_ / j _ j ur ( t � �Addre s: Owners r // Y tc'�_ C '4 Mobilehome Manufacturer:h 2 ,!5 Year of Manufacture: Li Serial Number or V.I.N.: Insignia or HUD Number: I O 61 2-�� t "� L— M� �+ Official approving installation: Date: A ' 41 If the mobilehot'{ie is moved or relocated, the mobilehome installation a1ccepiance shall become invalid. This form shall not be used when the mobilehome is installed on a foundation system. 513B White -Owner, Yellow -Installer, Pink -Bldg, Gold -Assessor MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION - COUNTY CENTER DRIVE OROVILLE, CA 95965 - PHONE (530) 538-7541 APN: PERMIT NO.: OwnerstName: r t' ! �'. r 1 Owner's Address: J M`olbilehome Manufacturer:' Year of Manufacture: _ (j Serial Number or V.I.N.: ?, Insignia or HUD Number: Official approving installation:` ' ♦ Date: r7A / t If the mobilehome is moved or relocated, the mobilehome installation acceptance shall become invalid. This form shall not be used when the mobilehome is installed on a foundation system. 5138 . White -Owner, Yellow -Installer, Pink -Bldg, Gold -Assessor COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street - Chico, CA - (530) 891-2751 7 County Center Drive - Oroville, CA - (530) 538-7541 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. � �� -� /' •C.� ice. � r � {..� 1w 1 v � � . � ('� � u- ?' < moi/ COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75410- ' (Rev. 12/96) APPLICATION AND PERMIT J ASSESSOR PARCEL NUMBER 062-350-003 ZONING 11 BUILDING PERMIT OWNER CARLA KEITH TELEPHONE SO. FT, OCC. BUILDING VALUATION - OWNER'S MAILING ADDRESS 107 VALLEY- CONTRACTOR'S NAME BARNEY BONE r TELEPHONE 15-34-9694 CONTRACTORS MAIUNG ADDRESS 24-33 V-7 'Rd-, DROVIII E Q95966 CONSTRUCTION LENDER Fireplace LENDER'S MNUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 2-3-00 BUILDING flAE! A. CREEK DR. , BE_KRY CREEK CA 11 LjS� ti1V Energy Plan Checking Fee $ $ PERMIT FEE $ 43,00 LOT NO. SUBDNSION'S NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: ILII Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service zooA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class T Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insuran carrier a , policy number are: Carrier .S %y4-1- .v Policy Number CDGG -- O (The above sections need not be comple ed if the perm 's for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 workers' compensation laws of California, and agree that f I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Ci Date �— Signature of Applicant ❑ Owner ❑ Co�ctor ❑ Agent An OSHA permit is requi d for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00NEW CONST. DWELLING UP. s0 OR ADDNS. a ADC. 81n& 3.5Q�' NEW CONST. MULTI.OUTLET r.RESID. C @7.50 POWER APPARATUS 8 SINGLE OUTLET CIR. EX. Occup. OUTL ET OR FIXTURES @'.50 BAL p .50 ED Ex. Occup. DFlx�T.R= OR EA, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ 100, 0 Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 143.00 HAz. D FEES IMP FLOOD _ CDP PARCEL PD HD ISSU This permiLie perm''hereby issued under of the utte County Code and/or indi ted above for which fees hav B PE IT EXPIRES ON 4-29-04 the applicable provisions Resolutions to do work been paid. Date 4-29-03 ale Receipt No. r S i�,� �•�� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINKANSPECTOR GOLDENROD -APPLICANT COUHTY OF B[!T TE - DEPARTMENT OF (DEVELOPMENT SERNACES - SUiL IMG DIV;SIOH 7 County Center Drnr_ m. Oroville, Cardornia 95965 ► Telephone (53 538-1541 NO. APFUCA- IONANDPERMIT P �1 D. /, , \ arar+o BUILDING PERMIT 1 f °° r� cwrasmo rotas � a. (,7.50 ®semme=AMR= Rreafa.-e mmm ou somm I ow Valuation i Er •a�s � Q S00 one FiTn Fee 5 20.00 SC i'eQnrft Fee S :e. Ifting 23.DD I== eb eomms mum Anus Pian Ch=Who Fee S -- � mnwv ?imn g Fes S Z ECHAMCAL PERMIT r- fmg Fee 20.DD �9 �,� S� 3 _, 3 PA6=3 PAP PIX11af»s •P:RMT Fffmg Fee 20.DD Trap $ J V� 7.0D UsEoFs ie7UCNRE gofer or heat pump wdar hester 23.0D 3F 0 Dvl= D 6bbifeb Offer Watw pghg Mabfle Hanna fastslliftn Fee S --- 15.06 sP�a -%:b P= wetw heir or vert 15.DD TYPE OFWORK �Q G=' ! - 5 aat6e� 0 FEE $ I S.Do fm f7 Aim 0 Rsucdel 0 WE= D Lzsfsit Olv r O__ 71 B� amwer � 15.DD ' MZbb t bMs 13 1 C �t o.00 t>a=&a VOo • pmw Fac s cd the Butte County Cade and/or Resohi6= b do work f3ECrRIC1tL PEFM T ind1=81ad above for wfirA fryer have been paid. FEmg Fs-- moo 5y . Dsia Fte tNa _ _ _ _ _ _ _._� ��R��.� PERMIT EXPIRES on � . S_ry own Z=-� rJ W R-vo 1 Z c7 Z -r-& r *) t _ mean sar its 00% To s mt MOD p LSD. = �/ ac, O -U r� cwrasmo rotas � a. (,7.50 mmm ou somm .— Er •a�s � Q S00 *P r «E Pun $ 1 Tem s�i�---i SC _ $�� �) DDD MMI lbbite Horne Fsaw-ms 212D :e. Ifting 23.DD T! ,�\ � PE?.�HfT F=arm.S . Z ECHAMCAL PERMIT r- fmg Fee 20.DD �9 Had s.5o �����Virl'f 1 �—i►�ri � Gd $ J V� . P: -AWT err S Mabfle Hanna fastslliftn Fee S --- i�ergy hrspeaiiion Fee : Tm 0 FEE $ * TO IS � Vim cow ' This perms is hereby issued under the appfcab1a prgvi ob s cd the Butte County Cade and/or Resohi6= b do work ind1=81ad above for wfirA fryer have been paid. 5y . Dsia Fte tNa _ _ _ _ _ _ _._� ��R��.� PERMIT EXPIRES on � . �........eC�rTC t_!1. .et..ti.•.RSO011�6 LT COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: tAyl-11ASSESSOR PARCEL NUMBER 2-55 X63 Proposed Building Use:M A� r-. ' G� 1 ) Counter Technician: Date: Items required in order to apply for a permit. All boxes MUST be checked OR ked NA in order to apply. . Plot plans, 3 or 4 sets, signedty the preparer of the plans. 0'2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Energy compliance�desig and supporting documentation in duplicat ❑ 6. Manufactured horn Data sheets and installation instructions�arriage line information, (C) Floor Plan17r iedown or foundation plans, alLin-�dalicate. r ❑ 7. Metal buildings: (A) Metal Building Plans; (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The.permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................ ❑ 9. Plot plan and business license approval from the City of Biggs .................................... ❑ 10. Letter of intent for non-residential buildings......................................................... ❑ 11. Detached Accessory Building Form filled out by the owner ..................................... ❑ 12. Hazardous Material Form............................................................................... _ ❑ 13. Other Re fining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 61'-�. 2 0 -IM as shown on the attached Schedule of Fees Due Sheet.....,J.................... ❑ 15. Statement of Intent for Non -heated and A/C Buildings ............................................. ❑ 16. Sanitation and plot plan approval from the Environmental Health Department in ❑ 17. City of Chico Plumbing permit........................................................................ ❑ 18. California Department of Forestry plan approval ❑ paid. Sent by: ...................... ❑ 19. Planning approval for (A) Use: C), kz,' (B)Parking: (C) Parcel Check: —2— ❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ............................... ❑ 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 22. Pre -Inspection for required ................ ❑ 23. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ...... ........:...................... ........ ❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... ❑ 26. Letter of Signature authorization.................................................................... ❑ 27. Recorded copy of AgriculturalAcknowledgment Statement .................................... �. Manufactured home utility clearance............................................................... 29' Existing violations and/or expired permits......................................................... ❑ 0. ❑ Grant Deed, ❑ M.H. Title $tateme�nt of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ U1. Other: els/ C �( A en issued Telephone I have been i Applicant: -) gand hal or p'c up. ents for obtaining a building permit. Date: 7— 1. Index permit application for the' e i s numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, kas adv" he above data by ❑ phone, ❑ mail, O counter, by Date: _ Contractor, designer, owner, was advised of the ab ve data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: 19- Date: - T% 03 Plans approved by: I/A0 03 Date: AL ?, Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541 I \ SCHEDULE OF FEES DUE OWNER PROPOSED ' DING USE —/ BU ILDING PERMIT FEES lance Due ....................... $ Additional Fees Due ................. $. Additional Fees Due ................. $ Revised Plan Checking Fee .............$ 2. HOOL DISTRICT FEES (paid at District Office) (Available after Plan Check 3. SHERIFF FEES (paid at Building Division) Residential ...................... nits x $360.00 S_ d3 A.P. # DATE n- CI-` RECEIPT # DATE REC. DATE 03 Commercial (sq. ft:) ............... x $0.03 = $ Sq. ft., 4. URBAN AREA FEES (paid at Building Division) Residential ................... -x-=$ #Units Amt. Commercial (sq. ft.) ............ -x-=$ ' Sq. ft. Amt. 5. RECREATIONAL DISTRICT FEES (paid at Distri ct Office) (Available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE IN SPECTION AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) 10. OTHER At time of permit may be chan ged I APPLICANT � �- n, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees plan checkipl process. Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original - Buiding Div. 2nd Copy -Applicant 3rd Copy -Owner ' (Rev. 6100) POWER OF ATTORNEY On this date of Jan 4, 2003 I, Carla Keith, appoint Dana Pike as my agent to act in my absence for the purpose of expediating and completing the purchase of one 1980 Coffman and Broad Manufactured home being held in escrow with Mid Valley Title and Escrow Company, 2295 Feather River Blvd., Oroville, Ca 95965. I authorize Dana Pike to sign any documents necessary to complete the purchase of this manufactured home and to expedite the moving of the manufactured home to a temporary location of his choosing by whatever means he finds necessary. I authorize him to again move the home to it's permanent location at the property address of #3 Sand Creek Drive, Berry Creek, California, Assessors Parcel Number 062-350-003 at such time that weather conditions will permit. I authorize Dana Pike to sign any documents required by the County of Butte or utility suppliers necessary to bring the property to a livable condition as required by Butte County Law. For the above purposes, I grant Power of Attorney to Dana L Pike for a period of Jan 4, 2003 through September 30, 2003. CARLA KEITH 1. Owner's Name: (!� A gL4 14 e,—V , 2. Assessor's Parcel Number: O 2 3 S® "- 3. Installer's Name: J 4. Is the site currently under permit? YesW] No[ ] Permit No.0 Z �- 3SIZ 5. Is the site an existing site? Yes[] No[ ] (If yes, furnish two plot plans). 6. What is the electrical rating of the mobilehome?_L0 P Amperes. 7. What is the mobilehome site circuit breaker rating? 2 00 Amperes. 8. What is the electrical rating of the mobilehome site? Amperes. 9. Is the main service remote from the mobilehome site? Yes[] No If it is, what is the rating? 00 Amperes. 10. Is there any other electric load to be served by the mobilehome site electric service (i.e. well, garage etc.)? Yes[ ] No* If yes, please identify the load and size: a) The mobile home site: Load- Amperes - b) The main service: . Load- Amperes - 11. Type of gas service at mobilehome site: Natural[ ] Propane[A None[ ] 12. Size of g s pipe at the mobilehome site from the meter or tank. inches. 13. What is the gas pipe length from the meter or tank to the mobilehome?�(ft.). 14. What is the mobilehome gas demand? q®UDO B.T. U. *(This information is not required if the pipe length iA less than 6 feet on natural gas or less than 50 feet on propane). t. THE OTHER SIDE OF THIS FORM MUST BE COMPLETED IN ORDER TO PROCESS THIS PERMIT APPLICATION May 1995 ivIobilehome Manufacturer: Manufacture Year: Go If other than single wide, furnish Setup Model Number: 0;�+..amore, 1308 Width: 12. (ft.) Length: 52- $ (ft.) Tagalong or Expando Size (ft.) On all mobilehomes manufactured after October 7, 1973, fumish manufacturer's installation manual and structural setup sheets. FOOTINGS: Wood pressure treated or foundation grade[] Other: SUPPORTS: Concrete block[] Other: Provide Tie Down Specifications for all Mobilehomes: E -Z- -r;,C- o k► 5u 5+,e,1 Pier Footings Sizes and Location SL`1GLE WIDE MIILTI-WIDE I Line 1 Line 2 fL,ne 2 Main Beams .............................................................................................e 3 Line 2Line 1e 2 .............................................................................................Main Beams e 2 e 1 0 .................................................ine 5 Tag or Triple ine 4 ?I ine 1 Line 1 Piers: Size minimum: r 1 x Spacing maximum: ` From ends -maximum: 1 ` Line 2 Piers: Size minimum: [ ��) x Spacing maximum: From ends -maximum] \ ` Line 3 Roof Loads: Size minimum Location (from front): Line 5 Roof Loads: Size minimum: Location (from front). May 1995 Line 1 Openings Size minimum: [ j Z ] x [�� ]• Each side of openings with width over: U ` Line 4 Piers: Size minimum: [ l ]• Spacing maximum: ` From ends -maximum: ` w J �I E E -Z_ ___DOWN SYSTEM "01 -0 -AGARS. *WIND LOAD.— 15 PSF I. THIS TIE DOWN SYSTEM IS DESIGNED TO BE CONSTRUCTED ON A FAIRLY LEVEL MINIMUM SOIL PARAMETERS: H NOTYPE 5NCOHESIVE G SOIL RSOIIL, WITH MINIMUM SOIL BEARING CAPACITY OF 1000 PSF. 2. CHASSIS BEAM SUPPORTS SHALL BE LOCATED AND SIZED FOR THE LOADS AS SHOWN IN THE "MANUFACTURED HOME INSTALLATION INSTRUCTIONS% 3. IN AREAS INHERE DIFFERENTIAL SETTLEMENT (DS) -CAN OCCUR, MANUFACTURED HOME 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 (.31 °SECTIONS IN WIDTH. CONTACT THE DESIGN ENGINEER FOR DESIc:NS OF MANUFACTURED HOMES OVER (3) SECTIONS WIDE. 5. STRUCTURAL STEEL: FABRICATED ACCORDING TO AISC SPECIFICATION. WVf..O ACCORDING TO AWS SPECIFICATIONS. ELECTRODES -370 PI ATED-ASTM A36. BOLTS=ASTM A307 6. THE E-4 TIE ASSEMBLIES ARE CAPABLE OF THE FOLLOWING LOADS: HEIGHT KORf-ONTAL 18" VE RTICAL -CHASSIS BEAbt SUPPORT PIERS --SIZE AND SPACING AS REOIARED BY THE HOMr•. MANUFACTURER, - 210. 2010 (Ib) 5004 (Ib 891 Ib 1825 (Ib 25" 1510 lb � 6000 Ib 6000 8b 801 1b 7.8" 1.419 Ib 36" � 6000 (Ib 664 Ib 629 Ib 867 lb 6000 (lb) .385 �lb) 7. ALL METAL COMPONENTS AND ATTACHMENT ITEMS S COATED. NAIL BE PROTECTIVE 8. WHERE STAND IS PLACED ON EXISTING CONCRETE SLAB, 1/2' SLEEVE ANCHOR BOLTS MAY BE USED TO SECURE PFER BASE PAD. 9. ATT.ACHMENf MEIHODS FOR "C" A "J" BEAMS SHOWN ON SHT. 12, W10 C m THE-LO.NC DIRECTION OF THE E - Mm I :-!.I r envv. • UF PAD (37") MUST BE INSTALLED J�k0>r".v- tW (fUARD WAeAM S951 FLOM . PTs'[tXNS ROAD SACRAME M. CA 95823 PH: (600) 382-8831 FAX: (916) 383-5207 SINGLE WIDE COACHES DOUBLE/MULTIPLE COACHES E= 2' MIN. / 8' MAX. E= 2' MIN. / 11' MAX. VARIES 1o' -7O' EVENLY SPACED BETWEEN 13 I RIDGE BEAM -SUPPORT AS REQUIRED BY MANUFACTURER E7 I] (TYPICAL) n n TATE • APPROVALS°. 1, APPROVED 0 SUBKCT TO CORRECTIONS KOTBDf Approval does not authorize ar approve say omisslon or •Aetiiatioa from re4witelttesea of eppheable Slate lays and reLWhtkms�- Seale of C2111mmia DetDa hent of Hou:irg end C -..ap, Dcvn!gment N 5'U!' 0.'• CODES PS•!il t gnattrd SQA NO EM5 1 /4 r This Plas AnpmW Expires 1 t THIS TIE DOWN SYSTEM MEETS -THE REQUIREMENTS OF SECTION 1336.3 SUBSECTION. (a). WAYNE T. POLVADO, PE -LISTING NO. 99001 SHEET 1 of RI k.. E -Z TIE SUPPORT PAD -•� 0 u -CHASSIS BEAbt SUPPORT PIERS --SIZE AND SPACING AS REOIARED BY THE HOMr•. MANUFACTURER, - LENGTH _ NUMBER OF E•-Z'T E_S _. - OF HOME 18 HT .. --4 4 4�- _ 500' - •-- - 4 _4=._6 - fi j- - :i 8 - --- —. 6 b a _.___.._._...—.... _....... 6 s.. _ _. f 1 TATE • APPROVALS°. 1, APPROVED 0 SUBKCT TO CORRECTIONS KOTBDf Approval does not authorize ar approve say omisslon or •Aetiiatioa from re4witelttesea of eppheable Slate lays and reLWhtkms�- Seale of C2111mmia DetDa hent of Hou:irg end C -..ap, Dcvn!gment N 5'U!' 0.'• CODES PS•!il t gnattrd SQA NO EM5 1 /4 r This Plas AnpmW Expires 1 t THIS TIE DOWN SYSTEM MEETS -THE REQUIREMENTS OF SECTION 1336.3 SUBSECTION. (a). WAYNE T. POLVADO, PE -LISTING NO. 99001 SHEET 1 of RI k.. iNSTQLlA_jlQ_ INS RUCTIONS E -Z TIE DOWN SYSTEM I - PIERS MUST BE PLACED ON BEAM WITHIN 24" OF AN OUTRIGGER OR CROSS MEMBER, OTHERWISE INSTALL WEB STIFFENER ON CHASSIS BEAM. 2- MAKE LEVEL THE PLACE WHERE THE PAD WILL SET, DOWN 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 WITH THE STUD BOLTS. REPLACE THE NUTS AND WASHERS AND TIGHTEN DOWN. I•_ BEAM - ..,. . S. 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 TFIEN TELESCOPE. RAISE THE TOP OF THE PIER UNTIL THE PLATE IS AS CLOSE TO THE BOTTOM OF THE CHASSIS BEAM AS PUSSIfILE. PLACE ADJUSTMENT PIN -THRU ADJUSTMENT HOLE AND SECURE WITH THE COTTER PIN. 6. RAISE THE TOP PLATE.. USING THE ADJUSTMENT NUTS UNTIL THE PIER TOP IS TIGHT AGAINST THE BOTTOM OF THE CHASSIS 11EAM. 7. PLACE THE GRIPPFR PLATES OVER THE FLANGE OF THE BEAM AND TIGHTEN DOWN FIRMLY WITH rH.E TOP NUTS. .J. -*9E MS 8. HEAD OF PIERS REQUIRES THAT TWO (2) TEIC SCREWS BE PLACED THRU THE SIDE OF THE BEAM IN ADDITION TO ONE' CRIPPER-PLATE. 9. FOUR (4) STEEL STAKEi (SUPPLIED) ARE TO BE DRIVEN THRU GUIDES INTO SOIL UNTIL STOPS ARE FLUSH WITH THE CUIDL. ALTERNATIVE: (2) #12 S,w.S. OR WELD _3/79 (2) d1.1 S.M.S. Vs ANGLE IRON NOTE: USE STIFFHER IF OUTRIGGER OR CROSS MEMBER DO NOT OCCUR WITHIN 24" OF STANCHION (TYP) YPEB STIFFENER DETAIL AM3C().0U5 GUARD cone 5851 F710NN • PERF ROAD SACRAMEWq CA 95823 PH: (30)'382-8831 . WAYNE T. POLVADO, PE -LISTING.: N0...99001 FAX: (916) 383-5207 SHEET 3 of ra �! z"X2"x3/16" STL. AIIGLE - Val' CAD PLATEO BOLT, NUT & WASHER 1/2" DIA. HOLE (8) PLACES COUNTER BORED FLUSH YATH BOTTOM 1 (8) REQUIRED 1/4" STAND BASE ¢ �- ABESCO ABS PAD ,503 CHASSIS FRAME f — 10.50 18.75 3/4" DIA. x is" LG. �ETAiL;A" (4) REQUIRED A y 30.00 GRIPPER PI_ArF (2) REQUIBEU 114" GRIPPLR BASE -. • 1/2•-13UNC-A1D7 a 4" BOLI WITH NU IS (4) Rl.•QUIRED 01 1/2" SCH 40 P1PI.. RISER WITH X1/2" ADJUSTER 1101E:S AND 3/8" THICK TOP PLATE 02" SON 40 PIPE NAND WITH TWO 0.112" ATIJUSTER IIOLFS ` ARESCO ABS PAD ,503 .. %r STEEL FRAME'•• •. ST-�-F-RAM_E — // TOP VIEW •/2"x1 11a" X3/15 (4} 3p#5. / 36' MAX / (4) REQUIRED fiLC3 ,- 1 9 10 BOTTOM Or PAD _......... ...... .. r! SIDE VIEW ��-•- -_� / J' 01/2'x 3" C.R. l LOCK PIN WITH Al/B° BRIDGE PIN I l� 10,00 o 49/16 HOLE (TYP) rOP VIEW . 1/4"xI-1/4 TEK STS (2) REQUIRES 1/4" GRIPPER SASE - 1/2` A307 BOLT (4) REQUIRED 5851 Flom - Pi3RKiN -iiiA6 SAS, CA 93823 PH: .(800) uz-8831 {918) 383-5207 L=film ATTACHMENT I-II "C- f RAME GRIPPE .ATE INNE,L - ,•J'• FRAME EEK STS ) REQUIRED " A307 1100 REQUIRED 1/4" GRIPPER BASE �- 1/2" A307 BOLI (2) REQUIRED .1 -SEAM .AIACHMENT E -Z. TIE_ OOWN_SYSTEM WAY14E T. POLVADO, PE—LISTING N0. ' 94fl()f SHEET 2 of 3 -ooe- YLviry liao --- I%IA �MAU 01- OA 1 101 . ...... . 600 7'/ 1' CIO �K osc T T 15, -t , LR. I \[ APPROVED Bufte Coun Envlmnme tat %alffi ate-, Sign turL- LU woo aAA LU A CL Te I< M NOTES 1 i RESIDENTIAL k; 062-350-003 02-3372 PERMIT N0. f__ KEUki, CARLA_ ' _ jff7sAR6 CREEK DR., BERRY CREEK i CONT: BARNEY BONE MHU SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE REQ. . FIRE SPRINKLERS REQ. SPECIAL' INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER OFFICE COPY Address I i GAS Meter By dV Date `® ELECTRIC Meter By - Dat ' I — ---- Z JOB FINALED (Date __3 6 Signature = OK = Not OK = NotReadyab1e MOBILE HOMES Date MOBV HOME UTILITIES (Plans) OK except #'s o g Requirements -Setbacks -Easements o ; Special MH Support Sketch Alovgewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete - as; Location -Test -Wrap;-/ /" L 'ft. , y� / P Nat. or /" L "ft./ /' LPG �G � el' aranc & Disconnect tility'Clearance Datotqt 12, Card 131-1,;MDate Card B-1 Date ' Card B-1 - Date Card B-1 Date MOBIL OME INSTALLATION (Plans) OK except #'s I,- Zoning Requirements -Setbacks -Easements gs; Size -Spacing -Marriage Line le"Gas; MH Test -Demand -Valve -Connector ectricity; MH Test -Crossovers -Breakers -Clearances 5 in; MH Test -Fall -Flex Connector er; MH Test -Regulator -Connector a er and Sewer Connected -C/O to Grade -HD Approval s and Electricity Tagged owns -Type -Installation Cert. ; Insp.-Sketch Wert. of Occupancy Date Card B-1 Date . Card B-1 Date d / Card B-1 R AA;, Date Card B-1 Date t G PERMANENT'END SYSTEM (ONLY) Line 4.%Ga5; 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 g-./ (32-7 8o z<l9 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 t 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI f 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 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-/ /" 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) 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 fo, Location 79. Elec. Receptacles in Garage (F.F.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 CI Yes 83. Following Instld./Drive O Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 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: Date Card B-1 Date Card B-1 Date 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 Date Card 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. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 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 0 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 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. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper 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 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 fo, Location 79. Elec. Receptacles in Garage (F.F.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 CI Yes 83. Following Instld./Drive O Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 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: CERTIFICATE OF ANCHOR INSTALLATION True 25 CCR MobTehome Puke Act Section 1326 (bX3) I certify those portions of the tiedown system installed below grade were not damaged prior to or as a , result of the installation, were not modified prior -to or during the installation, 'and. were installed in accordance with the manufacturer's installation instructions, plans and specifications of the engineered tiedown system referenced on this certificate. Tiedown System: Manufacturer.! Model: Instaged by: E /on if'- Date'.. UntrAwner.: r- yv c� i� �. License No.: COUNTY OF BUTTE — DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 County Center Drive • Oroville, C,aliforni; 95965 • Telephone (530) 538-7541 (R>rv..12/96) , APPLICATION AND PERMIT (/li ASSESSOR PARCEL NUMBER -)'02-350-003 i__ ZONING BUILDING PERMIT OWNER V ,7 r TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS A QqA4P CONTRACTOR'S NAME i ELEPHONE „, , F ' CONTRACTORS MAILING ADDR S CONSTRUCTION ND y L 5 ' Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $� Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 21.00 BUILDINGADDRE SAND CBEEI: D BERRY raT Energy Plan Checking Fee $ $ PERMIT FEE $ 91-00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome hI Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK I New ❑ Addition ❑ Remodel O Utilities K Installation ❑ Other ❑ Describe Work: MH(1 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home @20.00 60-00 PERMIT FEE $ Ro ELECTRICAL PERMIT Filing Fee 20.00 Main Service 20."ORLESS 23.00 23 00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.POWER License Class C— S' 7 Lic. No. 75/ Y OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: / ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service ODA TO tOooA 46.00 NEW CONST. DW EWNG OCCUP. OR ADDNS. ( 8 ACC. sLDS. So 3.50F7, NEW CONST, . OUTLET NOWRES DMULTICIRCUITS - @7,50 APPARATUS 8 SINGLE OUTLET CIS. EX. Occu . OUTLET OR FDCTUSES .00 BAL @ 200 '. 0 ED APPLNS. OR Ex. Occup. ouTLETs RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring , 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the ,Performance of the work for which this permit is issued. 13 I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier S'tKiT 'p– rt. IV • Policy Number / S 2 3 4- N I– G Z (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 workers' compensation laws of California, and agree that f I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Date /%— 6 Z _ nature of Appli nt Owner PR Contractor O Agent OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Iing ee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Hom6 Installation Fee $ Energy Ins ction Fee $ occ co T. TYPE TOTAL FEE $ D. FEES H 5SU This permit is hereby issued under the of th tte Coun Code and/or Resolutions indi ate for whbch fees have ByateReceiptNo. EXPIRES ON applicable provisions to do wor been paid. �An Oew NQ 645CS'l `' 1 `5. 00PERMIT WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT M M TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance E.H. USE ONLY Piot Pian AttecMd Phar pian At:achad San% to B.D. 4�& rIa I�'e th Sld Creed Dr, v -c QG� ,3S-doT Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Publicy Private Well Clearance for v dwelling. Other —'X AS R Hold final for: Final cli NOTE: / Environme l Health Spec' list � 8/96 j (Q, I a-- 6 -C),) - Date S-. Q M M TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance E.H. USE ONLY Piot Pian AttecMd Phar pian At:achad San% to B.D. 4�& rIa I�'e th Sld Creed Dr, v -c QG� ,3S-doT Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Publicy Private Well Clearance for v dwelling. Other —'X AS R Hold final for: Final cli NOTE: / Environme l Health Spec' list � 8/96 j (Q, I a-- 6 -C),) - Date n w t 1 COUNTY OF BUTTE -DEPARTMENT dF D LOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: l�l�(I(� J1 (�. ASSESSOR PARCEL NUMBER 0//' ��3 _Sn—c�(13 Proposed Building Use:' 177 H �) CounterTechnician: �Y' Date: 12- Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order -to apply. -Vii. _Plot plans, 3 or 4 sets, signedty the prepares of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. N ❑ 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. Energy compliance design and supporting documentation in duplicate. ❑ 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information Floor Plan, (D) Tie down or foundation plans, all in duplicate. 0 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.` Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate........... 11 .................. - ❑ 9. Plot plan and business license approval from the City of Biggs................I .................. ❑ 10. Letter of intent for non-residen 'al buildings........................................................ ❑ 11. Detached Accessory Building Arm filled ov y=the oRmer ❑ 12. Hazardous Material Form .................................................. ......................... _ ❑ 13. Other .... Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 1_ =...4` ees as shown on the attached Schedule of Fees Due Sheet ....................................... ❑ 15. Statement of Intent for Non -heated and A/C Buildings ................................./..':........ iSanitation and plot plan approval from the Environmental Health Department in( ) l2 cp 7. City of Chico Plumbing permit....................................................................... lifornia Department of Forestry plan approval ii�id. Sent. by: . Planning approval for (A) Use: (B)Parking: (C) Parcel Check: ❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ............................... W30 .Encroachment Permit for driveway from the Public Works Dept. (cons ruction approval prior to occupancy). ❑ 22. Pre -Inspection for r quired................ ❑ 23 ❑ 24 ❑ 2 2 ❑ 28 ❑ 29 ❑ 30 Contractor's license information. (Number, Name Style, Classification) ...................... Worker's Compensation Carrier and Policy Number ..............:.............................. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... Letter of Signature authorization.................................................................... Recorded copy of Agricultural Acknowledgment Statement .................................... Manufactured home utility clearance............................................................... Existing violations and/or expired permits......................................................... ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 31. Other: When issued Telephone �,%C / q and hold for pickup. I have been informed �of t above itelmsadd requirements for obtaining a building permit. Applicant: !y a„r�� /,av� Date: A2 — 1/51 — G 1. Index permit application for the above items numbered: I Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised cf t e above data by ❑ phone, Q mail, ❑ counter, by Date: _ Contractor, designer, owner, was advised of the above dap by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: QJg, Datej Ll Ni J v '>✓ Plans approved by: _� , Date: Structural reviewed by: Date: Structural approved by: �— Date: Note transfer by: Date: Yellow: Building Division COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541 SCHEDULE OF FEES DUE OWNER CSG-/�l.` 1�.�E i �L /i� PROPOSED BUILDING USE 11 ,da 41. BUILDING PERMIT FEES Q Balance Due ....................... $ O Additional Fees Due ................. $ Additional Fees Due ................. $ Revised Plan Checking Fee .............$ 2. SCHOOL DISTRICT FEES (paid at District Office) (Available after Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential ...................... x $360.00 = $ Units Commercial (sq. ft.) ............... x $0.03 = $ Sq. ft. 4. URBAN AREA FEES (paid at Building Division) Residential ................... -x-=$ # Units Amt. Commercial (sq. ft.) ............ -x-=$ Sq. ft. Amt. 5. RECREATIONAL DISTRICT FEES (paid at District Office) (Available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES / $510.00 (paid at Building Division) V 7. SRA FIRE INSPECTION AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # ) $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) 10. OTHER A.P. # DATE /•%� L B Z� RECEIPT # DAT REC. 8 ZA S i- 7- 3(o y -W,3 /Z-�e--o 2 -- At At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees may be changed during the plan checking process. APPLICANT DATE Pursuant to .Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original - Buiding Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 6/00) 1 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT .r1 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: Date //— $P— o -2- State State of California CountyofScl4}a C fLt PROPERTY OWNERS: CArZ L /.l E '/'T /-1 On,A)d 9�r(4 - 2 before me, personally appeared_' 6l,(/4, ee • t& 4)eFsoAaUy Imew4i.taane (or proved to me on the basis of satisfactory evidence) to be the persono whose name�Ois/,ar-e subscribed to the within instrument and acknowledged to me that he/she/try executed the same in 4iWher/tl authorized capacity,(j*, and that by-kWher/their signature(o on the instrument, the personW or the entity upon behalf of which the personvacted, exe 'ted the instrument. WITNESS my ha d a d o c' I` al. (r MATT ROMo Signature - !� Seal: Commission # 1339694 Notary Public - California Santa Cruz County — A.P. # Z — 50 —yC'-� My Comm. Expires Jan 14, 2006 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE 1'... ded 1 R -C E 121 OROVILLE, CA 95965 t'txciai Records. + 'COPIES. 5'! +1ouri, sv Of CkNiDACE J. r LIBBS ; Recorder i ROSrE-MARY DICKSON I Assista ! "Jr 0 2:4 -pini 07-Jan-2���+1 : I=a�e s 0 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT .r1 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: Date //— $P— o -2- State State of California CountyofScl4}a C fLt PROPERTY OWNERS: CArZ L /.l E '/'T /-1 On,A)d 9�r(4 - 2 before me, personally appeared_' 6l,(/4, ee • t& 4)eFsoAaUy Imew4i.taane (or proved to me on the basis of satisfactory evidence) to be the persono whose name�Ois/,ar-e subscribed to the within instrument and acknowledged to me that he/she/try executed the same in 4iWher/tl authorized capacity,(j*, and that by-kWher/their signature(o on the instrument, the personW or the entity upon behalf of which the personvacted, exe 'ted the instrument. WITNESS my ha d a d o c' I` al. (r MATT ROMo Signature - !� Seal: Commission # 1339694 Notary Public - California Santa Cruz County — A.P. # Z — 50 —yC'-� My Comm. Expires Jan 14, 2006 FROM MID VALLEY TITLE AND ESCROW COMPANY ,4!:�lv / -8+1 r DESCRIPTION (TUE) 1 7 2003 11:34/ST.11:33/NO.5011992654 P 3 ORDER NO. SU -188480-3 THE LAND REFERRED TO HEREIN IS SITUATED IN THE STATE OF CALIFORNIA, COUNTY OF BUTTE, AND IS DESCRIBED AS FOLLOWS; LOT 3, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PONDEROSA PINES SUBDIVISION", WHICH MAP WAS RBCORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON MARCH 4, 1963, IN BOOK 30 OF MAPS, AT PAGES) 1, 2 AND 3. APN 062-350-003-000 �L• ry Ila APPROVED Butte County Environm"l -Health D4, Ft e— _7 a'�_ _61 nature re P10 1- .3 SITE PLAN REVIEW APPLICATION Date: Permit Number (if applicable) 0 2 ^ �7 Z AP# O 62 - -!>'�; ©" 00 APPLICANT INFORMATION Parcel Sizer Owners Name: 1 1 ' CA r2- C_ 11 Owners Address Telephone No.: Situs Address: Proposed Use: 10 7 VA u-sy v i ew A V G -R" ,- 0j'0 Ce)l � 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 IM Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): IS3L4-9b9 ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well DO NOT WRITE BELOW THIS LINE DEVELOPMENT SER VICES INFORMATION (For Staff Use) ❑ Approved J5 Conditionally Approved ❑ Resolve Problems Prior to Approval Site Plan Stamped Approved By Date Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ® Snow Load Area: 'Zc4-aD i'e) 2,9 O -Z>4:7 — ❑ 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) I ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: Ix • Flood Panel No.: Ob00 Index Date: -& 8— 9 ❑ 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) 4 Use Requires: a ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance _ ----------------------------------------- --- ----------- -------------- —---------- -------- ❑ Detached Building Use Form ❑ Encroachment Permit , ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement f Zoning: U Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. a CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 r Zoning Code Streets & Highways Fire Prevention Subdivision Map Front ©� 1 k Side Side Street Rear Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. a CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 r Applicable Development Fees: Standard Fees ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) Amount Formula * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By ❑ Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Decd Creation:❑ No ❑ Yes Comments: ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ 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 Map/Parcel Map: PO��1✓�t� Pi iJ�s SU �j Map Date of Recording: Lot: ❑ Use Permit/Minor Use Permit Permit Number: Book: SO 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 C Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel ( ` I 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. i ❑ 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. j ❑ 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.! i i Page 4 of 5 Al u 0 C u 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. CAMy Documents\Building Permit Site Plan Reviewl.doc Page 5 of 5 School District A.P. Number Property Owner I ., --. n...- 1 s. .F'.-.c.wN`._�. .�X...ti .A .,y'^ � n4i.rt ^l.�V,,�,.. k •ti.. .,�.}N�``...N.d tiwTFS. �r.. •. �Y'Ir..i..r sy n+• - .., - BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) Building Department No. C) l.o a' , ' U UJ Jurisdiction: City (x County Property Location/Address Subdivision Lot No. .................................................................................................................: q 9 Residential Development S .Foots e No of Living Mo tie Home Addition/ *Supplemental to Grou R) 4 PP ( P Units Installation Conversion Permit # r` '(No foundation inspection): Commercial/Industrial / Sq. Footage New Addition (Including Exterior Roofed Areas Building Departm, nt R Pres tative Date v imoor clans reviewed by School uistrlct Personnel District Identification No! 030t 1, 7 y(('V1 School District certifies that Cfvim/r L (Applicant) .—'tom 1 l *%"7 I t �l 1 (Street Address) (Phone Number) (City) (State)) (Zip Code) has complied with the requirements of Resolution No. -1k.W by payment of $ representing \Q square feet. AB 2926 $ ✓ FULL MITIGATION $ DR) Sc ool District Representative Date Paid by,Check # '" { "LNIM 0emarks: L r � • A -N \ cC��.�1 Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeform.As 00/98)dmm STATE OF CALIFORNIA DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT CERTIFICATE OF TITLE —� Manufactured Home Decal No: LAE1781 Manufacturer ID/Name Trade Name Model DOM DFS :RY Exp. Date 1308 03/14/1980 05/06/1982 ! 20128 KAUFMAN/BROAD � BILTMORE _ 'Serial Number Labellinsignia Number Weight Length Width SPC SCC 1 ExemUse Type SN012327 180249 11,000 51' 8" 12' i 04 SFD Li I Issued j Total Fees Paid Feb 03, 2003 I $161.00 Addressee ` CARLA KEITH 107 VALLEY VIEW AVE FELTON, CA 95018 Registered Owner(s) CARLA KEITH 107 VALLEY VIEW AVE FELTON, CA 95018 Situs Address AP 062-350-003 SAND CREEK DR BERRY CREEK, CA 95916_ 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: 2820703 02032003- 246 lY f. AND WHEN-RECORVED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 ikPAJ O&L -35G-003 3'7Z o 2103—im0GD 1 1 96 Recorded Official Records County Of BUTTE CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 02:45PM 07 -Jan -2003 REC FEE 10.00 COPIES 2.50 MaryR Page 1 of 2 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: 817- A � lk I TA CIY Z � Date //— Jn— 6 Z PROPERTY OWNERS: &�Z -/c- -0 -d 0 C`AZLA E/7" State of California County. of -ck,-d & C f� On."b/ q r� 2 ocn before me, personally appeared ' C ef//rA lie; fk ..pexs"atly 4ammvn.ta.me (or proved to me on the basis of satisfactory evidence) to be the person whose namef'is/axe subscribed to the within instrument and acknowledged to me that JWshe/they executed the same in 4Wher/thak authorized capacity, and that by4Wher/their signature( on the instrument, the person(pf or the entity upon behalf of which the personVacted, exe0ted the instrument. WITNESS my ha d a c' al. MATT ROMO Signature Seal: Commission # 1339694 it i .- . Notary Public - Califomia Santa Cruz County A.P. MY Comm. Expires Jan 14, 2006 �1 • FROM MID VALLEY TITLE AND ESCROW COMPANY y DESCRIPTION (TUE) 1 7 2003 11:34/ST.11:33/NO.5011992654 P 3 ORDER NO. BU -188480-3 THE LAND REFERRED TO HEREIN IS SITUATED IN THS STATE OF CALIFORNIA, COUNTY OF BUTTE, AND IS DESCRIBED AS FOLLOWS: LOT 3, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PONDEROSA PINES SUBDIVISION", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF C&LIFORNIA, ON MARCH 4, 1963, IN BOOK 30 OF MAPS, AT PAGES) 1, 2 AND 3. APN 062-350-003-000 w 11 R fi- U WA 7'Cle 6_0,V1V,5C 710.1V A z- -It Vt )rc Z.7 ., 51 Coll. #j _S IDE YARD 5 E TBA C K ft). 66)k Al VIV VA po tt &0 I fL1 , I I . I e"0AJA)tC C ... . ..... . 4c R wt ' '.4 A' V\,/A 7-,e....2 K 4 A LkA 3c) Y C )Ivl 11VA 7 W L X4 Xat L A 1�'Z /07 v'A1_e16`Y FEtT0A1j CA 91-.5'0/8 be -Re y c e -6-61k" W'A v/s 1AA)IV, LCW# PLANNING DIVISION. BUILDING PLAN APPROVAL PLANNING BUILDING AL 'L G PL Use: Date: Landscapng- [Parking:- Lardscaong: Other, Signature: 3 AV A 2 NOTE: See, ttie attached ...... r ij .7 S '1)'r1D1:"YAY/) .5,67BACk 11W aftadled Rm %aqit TeqU9wn&_49 must be 00mot M pjpmvcj 'Aw bY CAF. a $CAL i /#"c/0 ZZoo' Ar It AM dr zA w 0 PAI 0 6 Zft /7 LOT -3 POAIIW� k"OSA P`A1F-,.`j_ I 0;0"� r1530) r? 70 - 5413 1504sr Z� f -VI -7Z, /10 1- MAU"OV!� RIA16 194k' RLIC6 a $CAL i /#"c/0 ZZoo' Ar It AM dr zA w 0 PAI 0 6 Zft /7 LOT -3 POAIIW� k"OSA P`A1F-,.`j_ I 0;0"� r1530) r? 70 - 5413 1504sr Z� f -VI -7Z, /10 1-