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062-440-025
�•!• ° aREa Butte County Department of Development Services. IN o TE S TCounty Center Drive, Oroville, CA 95965 ' (530) 538-7601 vAv v.buttecoiinty neyoos i • t w+l RESIDENTIAL APN: Permit No. ner: 062-440-025 06-0556 t WELSH, DENNIS =Site Address:-1 1 ?/PINE RIDGE LN, BERRY CREEK — Cont: OWNER *Contractor GARAGE MST 01-112 1 'Type of Permit: s � 1 1 f Y'Y�• 4 Y ` SPECIAL CONDITIONS CHECKED BY s A r g y ❑ FLOOD CERTIFICATE EQUIRED J� ! - ❑ FIRE SPRINKLERS REQUIRED s?Y I ❑Q SPECIAL INSPECTION ITEMS ❑ VERIFY ❑USE PERMIT CONDITIONS ❑ SUBSTANDARD HOUSING LETTER i ❑ ENCROACHMENT PERMIT i + ❑ REINSPECTION FEE PAID ' ❑ ENV. HLTH CLEARANCE 0 ;;'DATE JOB FINALED: .__i' ATUREt = OK o = Not un - WANUFACTURED -HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET DATE DEC RS`C A RPO RTS ARAGES oning-Setbacks-Easements 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch Ftgs; Soils -Sz-DpthSpacing-CnnctrsStee I 3 Sewer; Loctn-Test; FallIC/O-Concrete 3 Decks, GirderslJoists-Dcking-Brcing 4 Wtr; Loctn-Test-Easement Needed -Regulator Stairs-Guard/Handrails 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg 6 Yard Gas; Loctn-Test-Wrap . Nat ❑ or LP❑ Frmg-Brcng Inch Sz Ft Lngth 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 7 Blckng; Sz-Spacing-Marriage Line 6 Carports; Wndws-Doors 7 Elect 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs , it nchrs-Studs-Rftrs-Trusses 10 Drain; MH Test -Fall -Flex Cnnctr I ; Nailing -Veneer -Stucco -lath 11 Wtr & Sewer Connected -00 to Grade 1 oof SShth oofing 12 Gas and Electricity Tagged - 11 Ext ps-Doors -Lan din gs 13 Tie Downs ❑ Foundation ❑raced Wall pnls 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers rd DATE POOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GF1 5 Elec Pool Lting; 15 volts-GFI 6 Elec Encisrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w15'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Bones-Encis rs-pnlboardsdnsultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Encisr; Fencing -Alarms 13 Bonding, Diving board or Slide o' e` Pool Drawing r, LA,9 36:051OA/S fiRF !lAi I'Lf�M-eNEC S ko 1=02 Ole o /ti( S PC- C T ` rooTId6s Peie OcvaaPOW (140T em;l E� t. I� • moo) OK = Not OK RESIDENTIAL (Single & Duplex) , DATE UNDERFLOOR DATE PLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 2 Ftg Main; Soils-Elec Grnd Fig Dpth 3 Fig Garage; Soils-Steel-Elec Grnd Fig Dpth. 4 Ftg Porches/Decks; Soils -Steel Fig Dpth 5 Stemwalls Main; Steel-Blockouts-Wrapped 6 Stemwalls Garage; Steel-Blockouts-Wrapped 61 Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test i.t Wtr Pipe; Test-Anchrs-Rgltr-Service Test 12 Elec Undrgrnd 13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn 14 Girders-Sills-Anchr Bolts Joists-Vnts-Crippies 15 Acc & Vntltn 16 Insulation DATE IFRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs -Nailing Spacing & Braces-PlatesSound 19 Bearing Walls over Girders & fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 22 Headers & Beams-Sz & Bearing 23 Hangers -Post Caps-Anchrs-Cnnctns 24 Ceiling Joist-Rftr Ties -Purlin-Roof Brac-TrussShthg 25 Frplc Ties or Type A Flue-Frplc Throat Clmc 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctn Framing -RC Channel 29 Prprty Line Firewall & Opngs , 30 Ext Doors -One T -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 33 Siding -Nailing Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrfir Acc 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Wall pnls 38 Insultn-Walls-Ceilings 39 Infiltration -W alts-Wndws o'e m o'e m DATE JELECTRICAL 40 Fxtr & Tmsfrmr Clmd4ns Prtctn 41 Elec Rcptcls Spacing-LLs & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz 9a ❑ CU or ❑AL AC Wire Sz ga ❑ CU or ❑ AL 48 Range Circ 92 ❑ CU or ❑AL Oven Circ ga ❑ CU or ❑ AL Insulated Neutral ❑ Yes ❑ No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Cirrus pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector oae 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr Nail Prtctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub. Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas Piping I UHIt IMECHANICAL I O'e 61 AC Ducts Insulin & Support 62 Vent Fan, Exhaust abv Insultn 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air RtrnlVent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic mac. FINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Mech Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Sts & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Cirnc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Cirnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct in Garage -Damper 80 Wtr Htr; Vnts-ClmcCom Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Plmb; Elec & Mech Eqp Listed for Loctn .82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Dmge Planters ❑ Yes ❑ No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-Cirnc to Opngs -90 Wtr Well, Dscnnct, Elec, Plmb .91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntltn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns _ 95 Gas Test -Meters Tagged, Gas-Elec _ 96 Wtr & Sewer Cnnctd-D!O to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted - 99. Fire Sprinkler \C 0\ O\ 0\S COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive - Oroville, CA • (530) 538-7541 CORRECTION NOTICE (n k 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 call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector as indicated below. -5 /z A Date ' ` (� OT Inspector �� �� V✓"�" REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than 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 Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the ContractolfheBusiLneandPofessi nse Law.). ❑ I am Exempt under ArticlCode Date. ` Z, 0 6 Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy #: Tl I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: -- Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Address: PERMIT NO. BP060556 Issued Date: 04/27/2006 APN: 062-440-025-000 Site Address: 12 PINE RIDGE LN BCK Map Index: Description: garage (480), master 01-112 Owner: WELSH, SUSAN AND DENNIS 136 SUNNYBROOK LN OROVILLE, CA. 95965 530-534-8005 Applicant: WELSH, SUSAN AND DENNIS 136 SUNNYBROOK LN OROVILLE, CA. 95965 530-534-8005 Contractor: License #: Architect: Engineer: Total Square Ft: 480 S.F. Valuation: $11,520.00 Census Code: R C 4 A1,50 -2,52- 14aof�t q r2' 6?, q 7 Ss.�� it is hWbede applicable provisions ofthe Butte County Code and/or is to ve forwhi h fees have been paid. Date: PERMIT EXPIRES ON: -Y ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the 4jiy authorized agent o"thenekr. ree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of an o Icial form or documen. I hereby authorize repr0s R s of Butte County takanter upon the abov11 men 'oned property for inspection purposes. Print Name: e twl l5 els Signature: ' Date: I / " U_ v - Owner ❑ Contractor Agent for Owner ❑ Agent for Contractor R C Ruildinn Parmit 01-16-04 no 1 II BUTTE COUNTY PERMIT DEPARTMENT OF DEVELOPMENT SERVICES NO. BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS /_ 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 BPQ(o OFFICE #: (530) 538-7541 BIN # A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION "PLEASE PRINT CLEARLY" OWNER Last Nae sz- Firs Na S Addres U City011D,,,71,, Cl:;�_ ° tate Zip Phon%,..3�_ v"gC1�� Fax E-mail • • ` Yi7{!✓.3 PA_ N For office use only: CONTRACTOR Name 67_��L_yz Address SRA City No State Zip Phone Book Fax E-mail Planner Lic. # Class • • ` Yi7{!✓.3 PA_ N For office use only: ARCHITECT/ENGINEER Name '0�'VL/_F7z Address SRA City No State Zip Phone Book Fax E-mail Planner State License Number • • ` Yi7{!✓.3 PA_ N For office use only: APPLICANT NAME Name '0�'VL/_F7z Address SRA City No State Zip Phone Book Fax E-mail Planner • • ` Yi7{!✓.3 PA_ N For office use only: Zoning Pro erty Ad s %i_D6C- 6-6V . Flood Zone Cross Street . 4 0 3I wv C t SRA es No Occ. Typb Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS Description or Scope of Work: Sq. Footage t f8 ❑ 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. �, /LOCATION { �' API 062 f D��J Pro erty Ad s %i_D6C- 6-6V . City Cross Street . 4 0 3I wv C t S97 Bldg SRA Sheriff -WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: Sq. Footage t f8 ❑ 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. K TORMS\BUILDING FORMS\BIdgApplSubRgmts.doc Page 1 of 2 REV 6-16-04 Received by: Receipt #: I Amount: w �3�0 6b3 S97 Bldg SRA Sheriff �qq SMIP Date- �%===Z7 Other Total K TORMS\BUILDING FORMS\BIdgApplSubRgmts.doc Page 1 of 2 REV 6-16-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (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. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 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: l�VL2S/-� ,/G� �/I%�S ASSESSOR PARCEL NUMBER Proposed Building Use: 67AY (�� Permit Technician: Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. / N 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or find plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Hazardous Material Form N 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other \ Remainin ms needed to issue the permit. (May require additional plan review upon receipt of the following items.) .7 14. anitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable ❑ . Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... \❑ 18._Erosion Control Plan Required........................................................................ ees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 20. City of Chico Plumbing permit........................................................................ ❑ 21. Site plan and business license approval from the City of Biggs ---r . .............� .. a 22. California Department of Forestry plan approval a ii3"�Sent b- ............. 23. Planning approval for (A) Use: (B) Parking: (C) Parcel Check: ......... .. heck:............ \❑ 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ...................... 26. NPDES Form.......................................................................................:..... ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... O .29. Worker's Compensation Carrier and Policy Number .......................................... IN 30. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... / N 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction......................................................... :,:�.............................. ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other. �j 1 N 37. Other. G rrzn F2 u Co>-7y2ir-,r 2 /4 When issued T flephone z �_ W 1 S 7,70 -9407 and hold for pickup. I have been informed of the above items/'and requirements for obtaining a building permit. Applicant:U �1� I Date: 1. Index permit application for ttieiabov"items numbered: Plan Check' etter 2. Additional items required Contractor, designe , caner was advised of the above data by phone, ❑ mail, ❑ counter, by _ Date: ZE I H Contractor, designer, o ner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Dat Date: Plans approved by: Date: Structural reviewed by' . Structural approved by: Date: Note transfer by: Date: L71a 1, Yellow: Building Division K/Building/Plan Check/Data Sheets/data sheet page 2 9.27.05 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.but'tecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner welsh, Susan and dennis APN No: 062-440-025 Application Date 3/10/2006 Permit No: BP 06 0556 Permit Type:ag rade 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION $439.92 Plan Check portion of Permit Fee $175.97 $263.95 Balance of Building Permit Fee 2 FEMA BYes Flood Elevation Review $109.98 0 3 SRA* Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 _ $204.98 NON-REFUNDABLE portion of fees due at application $175.97 __ , RECEIPT DATE Tech/Asst FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION _ FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT 4 Balance of Building Permit Fees (from No. 1 above) 5 SMTP* - Strong Motion Instrumentation Program (Enter amount from permit system) 6 Additional Plan Check Fees (NON-REFUNDABLE) 7 Other*: 7a Other*: 8 IIMPACT FEES - RESIDENTIAL* I lPerDwellinq I lPerDwellinq I I Per Dwellii 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* At the time of perr checking process. $175.97 $265.101 DATE Tech/Asst are required to be paid prior to issuance of the permit. These fees may be changed during the plan Applicant.Date: 11 (/ UPursuant to Governme ode SkNeon 66y02r you are hereby notified those Items followed by an "*" may have been imposeU on your project. You have 90 d; from the date of approval of the porlect or from the impostion of the above referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 121205 Butte County DeparLmentofDeveloprjent&.1-wCes 7 Cbunty Center Drive o$03rI" G Oroville, CA 95965 �' (530) 538-7601 Telephone (530) 538-7785 Facsimile cpUN�-1 BUILDING PERMIT APPLICATION WITHOUT. REQUIRED CLEARANCES I request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: I need to submit applications for septic and/or- well to Butte County Environmental Health immediately. I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained. e I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building_plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not .limited to, verification the parcel was legally created, adherence.to all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). j Please print: Applicant Name: rcrt S APN: Building site address: Permit No.: I have cad, understood and accept the terms and conditions as expressed herein as indicated by my subm ion of the above -referenced building permit application and my signature below: SIGUA OF APPLICANT DATE Copy to Applicant/EH/File K Forms/BldgPermitwithou tClearances 020705 iMENT TT Department of Public Works I' O �� ij jA���l._°�j Cou my of B u t t e O i� = -- ° ° ° ;�� J. Michael Crump, LAND DEVELOPMENT DIVISION 0 0 / Storm Water Management Program \\ O ��� DireC for 7 County Center Drive Oroville, CA 95965 'OvgLIC t<<' )530) S38-7266 (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: Project Location and/or Parcel Number: CSG Z-YC1'0-- d � 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. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. „ Signed- igned: Title- Title: Date: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04 BUTTE BOUNTY SCHOOLS IMPACT -FEE CERTIFAON FORM (One form per Building) School District V V (vim L—� Building Departm No. i /' 0 6 © 5s6 A.P. Number �6�7 Jurisdiction: Q City County Property Owner Property Location/Address f �/ N ' ZO Subdivision Lot No. ,......__.................................................................. Residential Development Q 0 Q Sq. Footage No o Living Mobile Home Addition/ .Supplemental to (Group. R) Units Installation Conversion Permit # (No foundation inspection) ........................................................................................ Commercial/Industrial Building 0 New Addition Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage (Including Exterior Roofed Areas) Date 3-/0-496 trict Identification No. r 0601 Q 2 ! . �1 � � ` " L School District certifies that WghL /—� (Applicant) CUL. go — (Street Address) (Phone Number) —? (State) has complied with the requirements of Resolution No. ( D �; — 4?y I I ; � square feet. School istrict Representative Paid by Check # Remarks: (Zip Code) by payment of $ i L� .� zsss $ ULL MITIGATION $ Date Noflca: You may protest the Imposition of the fees tdentifled above by submitting a written protest to the District, In compliance with Gove nnwnt Code Section 66020(a), within 90 days from the date fees we paid Failure to submit a timely written protest will prohibit you from challenging the Imposition of the fees In any court action. N, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District Is notMed by the applicable Local Planning Agency that this project Is being rwrlewed under the CalNornis Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate Its Impact on the school distrlcft schools. BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM FEATHER .RIVER RECREATION AND PARK DISTRICT (FRRPD) ❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD) ❑ PARADISE RECREATION- AND PARK DISTRICT (P.RPD) 0 DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) 1�6 Z_ — Building Permit Number D Property Owner (s) Project Location /Address /' n //Li1�7-- 10-106L.5: Subdivision Name Assessable Sq. Ftge L 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 ) erified by Building Department Comments: - - K_ YRRPD ❑ CARD ❑ PRPD 0 DRPD certifies that: Applicant Name Phone Number 0 `fox CA Sq�� Mailing State . Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No by Pare of: r Dwelling Units @ $ per unit for a total of $ Square Feet @ $ per sq foot for a total of $ Remarks: Paid by Check No: Paid by Cash: Receipt No: l V 3 0 a, -lie SITE -PLAN REVIEW APPLICATION Date: Permit Number (if applicable) APPLICANT INFORMATION Owners Name: s Address: Telephone No.: Site Address: Proposed Use: Residential PkNew Single Family Residential ❑ Single Family Addition ❑ Single Family Remodel ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation/Issue: jqF� ;'� L Bin Number Size: ❑ Commercial Remodel ❑ Industrial Remodel Well Agricultural Buffer Form o`-- Zone: (A_ GP: T'�^ 20 ' at2 21" 1 ) DEVELOPMENT SERVICES INFORMATION (For Staff Use) fe Approved Conditionally Approved ❑ Resolve Problems Prior to Approval ❑ Resolved By • Date 1 2006 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Williamson Act Minimum Acreage: ❑ Residence can be built per contract' Watershed Protection Overlay Zone SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: • Flood Zone: • Flood Panel No.:, Index Date: ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan ❑ Chapman/Mulberry ❑ Cohasset Area Use Requires: ❑ Use Permit ❑ Variance ❑ Agricultural Worker Affidavit ❑ Administrative Permit ❑ Minor Use Permit ❑ Minor Variance Zoning: ( General Plan: 11A - Applicable Building Setbacks: ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 2 2006 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front Side ' %9 t Side Street Rear C t 7 36 Height Waterway N/A N/A N/A ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 2 2006 P . — Parcel Created By: ❑ Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Subdivision Map/Parcel Map: ��� Q e5V� Map Date of Recording: Lot: 2 '� SSG «G� Book: 3 Page: C45-- q6 2006 The undersigned, James M. Ladd , on unmarried man , as owner, and BUTTE COUNTY TITLE COMPANY , ocorporation, as Trustee under Deed of Trust recorded August 23, 1968, in Book 1531 , of Official Records, at page 627, Butte County, California, do hereby certify Ihot we are the only persons whose consent is necessary to pass o clear title to the land Included within PINE, CREST ESTATES as shown on this mop, and we consent to the preparation end recordation of said map as shown within the colored boundary lines. PINE RIDGE LANE , DEER RUN LANE B STAR CREST LANE as shown within the colored boundary linea me private roads but subject to easements over and along and within sold roads for public utility facilities, drainage facilities, and the traveling public% use. We also provide the following easements for the specific uses outlined below: (a) Rights of way cod easements for water,gos, end drainage pipes, and over- head and underground wires for electric and telephone service, together with any and oil appurtenances appertaining thereto, on, over, and under those strips of land lying between the rear and/or sidelines of lots and the lines designated "PUBLIC UTILITY EASEMENT LINE'. (b) Easements for light and air over those strips of land lying between the front and/or sidaknms of lots and the linea shown hereon and designated " SETBACK LINE °, said Strips to be kept open and free of buildings. Jame M. Ladd Butte County Title Company, a corporation By:1� t J;y r r I,_DgB_t._;g9h' hereby certify that 1 am a Registered Civil Engineer of;: State of California; that the annexed map of FJM_.B M[,s'jBTEJ7 — correctly represents a survey made under m v supervision in Fse�_— 19L9—; that the survey is complete as aha that the monuments shown therean exist and are of the character and oceiQrt the positions indicated and are sufficient to enabley/1/gh�e surv�7r to be replaced. n J. pqk R.C.E. 13062 I, Albgtf yy(,gly)t_--_—, Director of Planning, of the Planning Commission of the County of Butte, State at California, do hereby certify that the annexed final map of— PINE 2BES7 ESTATES ____ ___ _----_cordorms substantially with the subdivision design shown4,n',th9.T1tative MaD whigh was approved by this Commission on the_Jl_d�. Director of Planning I—C y—calut Y_ Director of Public Works of the County of Butte, Slate of California, do hereby certify that I have examined the final map of ------ EI&I5 --------_—and that it Is substantially the same as what appears on the Tentative Map on file and any approved alterations; that all the provisions of the Subdivision Map Act of the State of California and any total ordinances applicable of the time of approval of said Tentative Mop has been complied with and 1 am satisfied that the map is technically correct. / 6eT lR.Crecof Public Works of the County of Butte, State of California, do hereby certify that there are no tax Ilene against ---___ ------PIN£ CREST ESTATE - hereon set forth or unpaid State, County, Municipal, or local taxes, or special assessments not yet payable. Taxes or assessments which are a Igen but not yet payable, I estimate to be in the amount of_Z2&X_'00_ — . State of California ss County of Butte On th(aJQ,'Iay of1S�o__ 190 before me LAG L'rl�_Nydse y — a Notgty Public in and for the County f Butte / personally a Dpeored _.d4J�C12s--------------- kgoim to me to be the persons who executed the foregoing certificate and atlrotFwtedged to me that they amItuted the S ne. o Pub' — My'Cammission expires_QQ q— State of California sa County of Butte On otc 19IR 1 ire me,4 •Y1B ��•� a Notar Public , in n f _fes �L Cou y, State of ..personally����aappeoreQQ�� _ ut6'��x -----known t� to `be'•Ihe_IL r_X__! �2tt.S.— — --of the corporation that executed the within instrument, and also known to me to be the person who executed it'on.behalf of such corporation and acknowledged to me that au h 6brpo2ction executed the some. e My ,Commission expves 'CVr �!� F. H. e Jr. �QG V County Auditor � �4 State of California ss County Of Butte On-- me___-----___—__— a Notary Public, to and for _____--County. State of____..__ personally appeared _ _ — _ — — — _ _ — _ — — — — —known to me to be the-----__------- of the corporation that executed the within Instrument, and also known to me to be the person who executed it on behalf of such corporation and acknowledged to me that such corporation executed the some. _-------______ _— Notary Public My Commission expires _—__--_—. o5s_ 4 s. �.do hereby certify that on the.rl_day, or_�au e___,19LQ the Butte county Board of Supervisors officially approved the Subdivision Map of ---1/yrf _SBE.Yr_C£.4LEZ — — — _ _ — —,The receipt of satisfactory iieturiry in the Auditory estimated amount ofA A4k.AG—to insure payment of taxes' which are a lien but not yet payable was acknowledged. PJLJE 100-0 9NE PSUL9SIL+ shown on said map was not offered for dedication and -- �,a knot _-- accepted on behalf of the public for road. purposes. : b f>Li•. Recorded in the office of or sR-e-corder.. of utte County, State of California, at the request of -6—=—I—, •-----_—_----- this_.JR_day of—,4;o xde�._ v—_, 191, at-20—minutes Raatj—_—o•abck Q.M., in Map Boake —at page T£..L�.drC Recording NumbereZJ6C___ xdJ9tfdd! ---_ County Recorder SUBDIVISION N0. -Y --- = 69 PIM - CRfST ESTATES A Portion Of. The S. W. 1/4 Of Section 28, T2/N, R. 5E. M. D, B. 8 M, Butte County, California coo Owner & Subdivider James /Df Ladd Feather River Boulevard Oroville, California J N. E. Car. of S. E. I/4 of S.W. 1/4 of Se0.28 T. 21 N„ R.5 E. Fd. 12 LP.IORpn End) At base of 1 Codor 1050.40' (Record) 57" W 3 4 3 O0 ,B�°0. ,�ia 30 $ 9 ' 3 9 •'� a I0 •� $ I I �°I roryb I2 g 4. g" o tiA it �z Build' z S°Ib `t4 108.0 ' DEER RUN -m R boo o 9 13 d 15 N 05° S X57 E ro N 89° '40° E 104. I IOI.S7 ; _ It am Iss.00 II w 0 12 14 °'o N o e J N f5 o °$ 3 a - I 22 0 21 .3d id o,� 14 0 4 s 3 w J �• 2 - o - J2e02 •4r d°� /eJJJOJP 30 1p'NI)5°33 STEN N85°5337'E W, NB9°4040'E b q 122.93 122.93 a. n g 15500' S 2 W o . $' a �" a;A 15 23 0 20 w FN Hto J 4✓O 6J N IN B9°40a0'E R I `0.\O 6009 PO /JaBB J f o 9124.65 1 155.00 19 \Z 251 ,�Q2h� � /J?BOJ. h P�4`p E a '• `I 16 � 3? ,� ' b, 25 �. ? N68° 219? 2 d 1e av OJi •�`'p y �6 //� 2� 2(P.QT.) d' 26 17 DISTANCE `� 27 BOJ o' �m� 9 ) 10.00 , 10.00' 27.60' 20.00' 3 21.66 2e N 20.00 38.22' )2 29 m 40.53 9�J • 0o 40.96' 0 Req Q OCK ROAD s S LEGEND o c Set 3/4!' Iran Pipe w/ Tap Marked R.C.E. 13062 0° ° Set Con.. Mon. w/ Tog Marked R.C.E. 13062(Typc S-17) •• 20 Building Setback Line -, _- _•• 15' Drainage Easement ACREAGE Lj�2 LOTS -13.771 Ac.± T. 21 N. ROADS -2.195 Ac.3 TOTAL -15.966 Ac. * LO ° 1"ND, SUBDIVISION NO. --4--.-69 1.00' Deaded to the County of Butte, Bank __----O.R. ,R5 E. /�" I I CATION MAP SCALE - I"° 2000 rIlVEE CREST EJ)"PI ES A Portion Of The S. W. //4 Of $a Section 28, T2/N°, R. 5E. ,Y M. D. B. 8 M. Butte County, Co/ifornio Owner a Subdivider W(m ,,1 3 •• James M Ladd 3 N74� 2 R sv1FB Feather River Boulevard Fd R Orovi//e California as sholvn on Shell 1 of I Sheets of BALD ROCK ROAD R/W MAP, Pra)ect NM 2T r 6 4603-66-1 on file in the Department of Public Works, County of Butte, 44603 3 1 IPS as S 52.02 O5" E. All roads within the colored boundary lines of P/R£ CR£sr ESTATES P- or 0 Private Roods. p z Fd. I" I.P.^ - m �� 5 ^° open End z ° ryti 29 a S 88° 29' 23' W 10 .. OROVILLE CALJFORh11li T.21 N., R.S E. 32 33 a. _ Sheet 2 Df 2 z yogi , `AocP 1.00' Deeded to the County of Butte Book--_-- -O.R,poge _--_-_ 2h p4i CURVE DELTA RADIUS ARC C•f• I 09. 19' 50" 830.00' 135.1 2 OB° 19' 33' 830.00' 120.61 3 0.35' 08" 820.00' 94.25' 4 0:'28'46" 830.00 122.89 5 05.45' 49" 830.Od 83.49• 6 90.00'00" 20.Od 31.42 FQ P.R. Spike 7 25°16'35" 460.Od 203.24 Sta, 36+66.22(E.C.) 8 38.17.15'• Cd 86.87 9 36.17'15" :3 100.00 66.82 10 38.17' IS" 70.00• 46.78 Fd. R.R. Spill I I 86° 13 17" 20.00'30.10 Ste. 41+25.6 12 93.46'43" 20.00' 32.73' 13 44°24'551' 20.00' 15.50 14 86.28'53" 50.00' 75.47' COURSE BEARING IS 110°35'04' 50.00, 96.50 - I6 71.45 52" 50.00' 62.63' A N 38. 47' 38"E(R 17 44.24'55" 50.00 3876' B N 52.12' 30"E(R t0 72.06'03' 50.00' 62.92' C N 85° 53 57"E 11966. 05'35" 50.06 57.68' 0 N 85. 53' 37' E 20 SI°4245' 155.00' 139.90 E N 34°49 00'E 21 51.42 45 165.06 166.97' F S 52. 02'05" E 22 20°49'42' 215.00' 78.16' G N 00' 19' 20"W 23 18.09'54 215.00' 66.16' H S 85. 33 37'W • (, 24_ 12°43'09" 213.00' 47.73' J N DO. 19' 20"E 25 30°55'24" 87006 591.01 26 26°21'50" 50Q00 230.07 27 126-43'33!' 1 5O000 1 233.23' NOTE The Basle of Bearing lar this survey 11 the centerline of BALD R N. E. Car. of S. E. I/4 of S.W. 1/4 of Se0.28 T. 21 N„ R.5 E. Fd. 12 LP.IORpn End) At base of 1 Codor 1050.40' (Record) 57" W 3 4 3 O0 ,B�°0. ,�ia 30 $ 9 ' 3 9 •'� a I0 •� $ I I �°I roryb I2 g 4. g" o tiA it �z Build' z S°Ib `t4 108.0 ' DEER RUN -m R boo o 9 13 d 15 N 05° S X57 E ro N 89° '40° E 104. I IOI.S7 ; _ It am Iss.00 II w 0 12 14 °'o N o e J N f5 o °$ 3 a - I 22 0 21 .3d id o,� 14 0 4 s 3 w J �• 2 - o - J2e02 •4r d°� /eJJJOJP 30 1p'NI)5°33 STEN N85°5337'E W, NB9°4040'E b q 122.93 122.93 a. n g 15500' S 2 W o . $' a �" a;A 15 23 0 20 w FN Hto J 4✓O 6J N IN B9°40a0'E R I `0.\O 6009 PO /JaBB J f o 9124.65 1 155.00 19 \Z 251 ,�Q2h� � /J?BOJ. h P�4`p E a '• `I 16 � 3? ,� ' b, 25 �. ? N68° 219? 2 d 1e av OJi •�`'p y �6 //� 2� 2(P.QT.) d' 26 17 DISTANCE `� 27 BOJ o' �m� 9 ) 10.00 , 10.00' 27.60' 20.00' 3 21.66 2e N 20.00 38.22' )2 29 m 40.53 9�J • 0o 40.96' 0 Req Q OCK ROAD s S LEGEND o c Set 3/4!' Iran Pipe w/ Tap Marked R.C.E. 13062 0° ° Set Con.. Mon. w/ Tog Marked R.C.E. 13062(Typc S-17) •• 20 Building Setback Line -, _- _•• 15' Drainage Easement ACREAGE Lj�2 LOTS -13.771 Ac.± T. 21 N. ROADS -2.195 Ac.3 TOTAL -15.966 Ac. * LO ° 1"ND, SUBDIVISION NO. --4--.-69 1.00' Deaded to the County of Butte, Bank __----O.R. ,R5 E. /�" I I CATION MAP SCALE - I"° 2000 rIlVEE CREST EJ)"PI ES A Portion Of The S. W. //4 Of $a Section 28, T2/N°, R. 5E. ,Y M. D. B. 8 M. Butte County, Co/ifornio Owner a Subdivider W(m ,,1 3 •• James M Ladd 3 N74� 2 R sv1FB Feather River Boulevard Fd R Orovi//e California as sholvn on Shell 1 of I Sheets of BALD ROCK ROAD R/W MAP, Pra)ect NM 2T r 4603-66-1 on file in the Department of Public Works, County of Butte, 44603 3 as S 52.02 O5" E. All roads within the colored boundary lines of P/R£ CR£sr ESTATES P- or 0 Private Roods. p z Fd. I" I.P.^ - m �� C.0:b S.SOCIATE'S' open End z ...:.:,.'� ....; .M1 .. EN. G1fJEERPK3 CONSULTANTS' 29 a S 88° 29' 23' W Fd. Aale 2 93.50 Record .. OROVILLE CALJFORh11li T.21 N., R.S E. 32 33 53 _ Sheet 2 Df 2 LESS THAN 3 ACRE CONVERSION EXEMPTION FOR ADMIN. USE ONLY STATE OF CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION Ex. # NOTICE OF TIMBER OPERATIONS THAT ARE EXEMPT FROM CONVERSION AND TIMBER HARVESTING PLAN REQUIREMENTS Date of Receipt RM -73(1104.1 a) (9/99) Date Accepted VALID FOR ONE YEAR FROM DATE OF RECEIPT BY CDF TIMBER OPERATIONS CANNOT START UNTIL VALID COPY Date Expires OF A NOTICE OF ACCEPTANCE IS RECEIVED FROM CDF 1 The Director of the Department of Forestry and Fire Protection is hereby notified of timber operations under the requirements of 14 CCR 1104.1(a). Harvesting of trees which is a single conversion to a non -timber growing use of timberland of less than three acres. (See 14 CCR 1104.1(a) for a description of the conditions on the conduct of this type of timber operation, and additional information that is required to be submitted.) Complete Items 1. through 8. on both pages of this notice. 1. TIMBER OWNER(S) OF RECORD: Name Susan E. Welsh Address 136 Sunnybrook Lane City Oroville State CA zip 95965 Phone (530)990-8007 SIGNATU Date TIMBER TAX EXEMPTION: Timber owners owe timber yield tax when they harvest trees unless the harvest is exempt (Revenue and Taxation Code sec. 38116) _Some small or low value harvests may be exempt from timber yield tax: Timber removed from an operation whose value does not exceed $3,000 within a quarter, according to BOE Harvest Value Schedules, Rule 1024. If you believe your harvest may qualify for this exemption, please complete items A and B below. For timber yield tax information or for further assistance with these questions call the state Board of Equalization, 1-800400-7115, or write: Timber Tax Section, MIC: 60, State Board of Equalization, P.O. Box 942879, Sacramento, California 94279-0060; or contact the BOE Web Page on the Internet at littp:Hivww.boe.ca.gov. A. Circle the option that most closely estimates the total volume for this harvest, in thousands of board feet (mbf - Net Scribner short log):Under 8 mbf 8-15 mbf 16-25 mbf Over 25 mbf B. Estimate what percentage of timber to be removed during this harvest will be: Redwood _%; Ponderosa pine/Sugar %; Douglas -fir %; Fir %; Port -Orford Cedar—%; Cedar (IC, WRC) _ _ %; Other, conifer_ %; Other, hardwood %. 2. TIMBERLAND OWNER(S) OF RECORD: Name Susan E. Welsh Address 136 Sunnybrook Lane City Oroville State CA zip 95965 Phone (530)990-8007 I certify, under penalty of perjury, that this is a one-time conversion to a non -timberland use, that there is a "bona fide intent" [14 CCR 1100 (b)] to convert to Yard and home construction site, and that / have mailed a letter of notice of intent to harvest timber, prepared by the Registered Professional Forester, to all adjacent landowners within 300 feet of the boundaries of the exemption. SIGNATURE Date 3. LICENSED TIMBER OPERATOR(S): Name Roy Wheeler Lic. No. A1118 Address 2838 Orange Ave City Oroville State CA zip 95966 Phone (530)532-0788 SIGNATURE ,L �i,L Date�0 V 4. Designate the letal (5nfdedEriptiori of the location of timberland conversion. A map h wing a location of the timberland conversion MUST be attached. The map must show the ownership boundaries, the location of the timber operation, boundaries of the conversion, location and classification of all watercourses, and landing locations. Section Township Range Base & Meridian County Acreage to be Converted Assessors Parcel Number 28 21 N 5E MDB&M BUTTE Aac 062-440-025 Page 1. NOTE:This form has two pages. Continue on and complete Page 2. Read the instructions before attempting to complete. LESS THAN THREE ACRE CONVERSION EXEMPTION, Page 2. 5. The following are limitations or requirements for timber operations conducted under a Less Than Three Acre Conversion Exemption (Notice, Notice of Conversion Exemption, Conversion Exemption): A. Timber operations shall comply with all other applicable provisions of the Forest Practice Act and regulations, county general plans, zoning ordinances, and any implementing ordinances; copies of the state rules and regulations may be found on CDF's Web Page on the Internet at http://www.fire.ca.gov. B. All timber operations shall be complete within one year from the date of acceptance by the Director. C. All conversion activities shall be complete within two years from the date of acceptance by the Director unless under permit by local jurisdiction. Failure to complete the conversion requires compliance with stocking standards and stocking report requirements of the Act and board regulations. D. The timber operator shall remove or dispose of all slash or woody debris in accordance with 14 CCR 1104.1 (a) (2) (D). The timberland owner may assume responsibility for the slash treatment, provided the landowner acknowledges in writing to the Director such responsibility at the time of submission of this notice. The specific requirements shall be included with the acknowledgment. E. Timber operations shall not be conducted during the winter period unless a winter operation plan or in lieu practices required by Forest Practice regulations are specified within (attached to) this Notice. F. No timber operations are allowed within a Watercourse and Lake Protection Zone unless specifically approved by local permit(e.g. county, city). G. No timber operations shall be conducted until the Director's notice of acceptance is received and a valid copy of this Notice and the Director's acceptance shall be kept on site during timber operations. H. No sites of rare, threatened or endangered plants or animals or species of special concern shall be disturbed, threatened, or: damaged. I. No timber operations are allowed on significant historical or archeological sites. J. Within one month of the completion of timber operations, including slash disposal, the timberland owner shall submit a Work Completion Report to the Director. 6. I, , declare as the authorized designee of the County of Butte that this conversion exemption is in conformance with all town/county regulatory requirements, including public notice. (If the county has authorized a designee this item MUST be completed. If it has not, see item 7.) SIGNATURE Date 7. Registered Professional Forester preparing Notice: Name Randolph Vasquez _ Number 1884 Address 1600 Feather River Blvd Suite B City Oroyille State CA Zip 95965 Phone (5301534-5229 I certify that 1, or my supervised designee: prepared this Notice of Conversion Exemption Timber Operations; visited the site and flagged the boundaries of the conversion exemption, applicable WLPZ's and equipment limitation zones; prepared a notice i according to 14 CCR 1104.1(a)(3) to be mailed by the landowner and that a copy of the notice was posted and dated on the ownership, visible to the public, at least 5 days prior to the postmark date of submission of the Notice of Conversion Exemption; and that if the County Board of Supervisors has not designated a representative authorized to sign in Item 6., that 1, or my supervised designee, contacted the county and the Notice is in conformance with county regulations. SIGNATURE of RPF Date 8. NOTICE SUBMITTER(S): Susan E. Welsh Address 136 Sunnybrook Lane City Oroville State CA Zip 95965 Phone (530)990-8007 Submitter must be either 1, 2, or 3 above, and must sign. SIGNATURE Date FILE THIS NOTICE WITH THE NEAREST CDF OFFICE BELOW FOR THE COUNTY IN WHICH THE OPERATION WILL OCCUR: Humboldt, Del Norte, Mendocino, Sonoma, Marin, Lake, Napa, Colusa, Solano, Alameda, 135 Ridgway Avenue San Mateo, Santa Cruz, Santa Clara, Contra Costa, and western Trinity Counties. => Santa Rosa, CA 95401: Siskiyou, Modoc, Shasta, eastern Trinity, Lassen, Tehama, Glenn, Butte, Sutter, Plumas, => 6105 Airport Road Yuba, Sierra, Nevada, and Placer Counties. => Redding, CA 96002 EI Dorado, Amador, Alpine, Calaveras, Tuolumne, Mariposa, Merced, Madera, Fresno, Tulare, Kern, Stanislaus, San Benito, Monterey, King, San Joaquin and Sacramento Counties. => 1234 East Shaw Avenue => Fresno, CA 93710 Ventura, Los Angeles, San Bernadino, Orange, Riverside, Inyo, Mono, San Diego and => 2524 Mulberry Street Imperial Counties. => Riverside, CA 92501 ; WINTER OPERATIONS Assessors Parcel Number 062-440-025 less than 3 acre conversion For Timber operations occurring within the Winter Season the following plan shall be used; The in -lieu option as allowed in 14 CCR 914 (934, 954) .7 14 CCR 934.7(c) 1) Tractor yarding, or the use of tractors for constructing layouts, firebreaks or other tractor roads shall be done only during dry, rainless periods where soils are not saturated. ! 2) Installation of drainage facilities and structures, is required from October 15 to May 1 on all constructed skid trails and tractor roads prior to sunset if the National Weather Service forecast is a "chance" (30% or more) of rain within the next 24 hours The provisions of this subsection do not apply to mechanical site preparation. i 3) During winter operations after rains, road use shall be suspended until the running surface has stabilized by i freezing or drying. Hauling operations to cease when surface material must be shaped to develop a driveable medium. * No hauling, road construction, or maintenance shall occur when road surface is saturated as defined in CCR 895.1. Emergency road maintenance conducted to alleviate erosion problems does not fall under this limitation. I * Erosion control structures will be maintained in working condition during wet weather road use at any time of the year. ! NOTE: "Winter period" means the period between November 15 and April 1, except as noted under special County Rules at Title 14 CCR 925.1, 926.18, 927.1, and 965.5 (a) except as otherwise provided in the rules: (1) All waterbreaks shall be installed no later than the beginning of the winter period of the current year of timber operations. (2) Installation of drainage facilities and structures is required from October 15 to November 15 and April 1 to May 1 on all constructed skid trails and ' tractor roads prior to sunset if the National Weather Service forecast is a "chance" (30% or more) of rain within the next 24 hours. ! Saturated Soil Conditions means that site conditions are sufficiently wet that timber operations displace soils in yarding or mechanical site preparation areas or displace road and landing surface materials in amounts sufficient to cause a turbidity increase in drainage facilities that discharge into Class I, II, 111, or IV waters, or in downstream Class 1, I1, III, or IV waters that is visible or would violate applicable water quality requirements. In yarding and site preparation areas, this condition may be evidenced by: a) reduced traction by equipment as indicated by spinning or churning of wheels or tracks in excess of normal performance, b) inadequate traction without: blading wet soil, c) soil displacement in amounts that cause visible increase in turbidity of the downstream waters in at receiving Class 1, 11, III, or IV waters, or in amounts sufficient to cause a turbidity increase in drainage facilities that ! discharge into Class I, II, 111, or IV waters, or d) creation of ruts greater than would be normal following a light rainfall. On logging roads and landing surfaces, this condition may be evidenced by a) reduced traction by equipment as indicated by spinning or churning of wheels or tracks in excess of normal performance, b) inadequate traction without: blading wet soil, c) soil displacement in amounts that cause visible increase in turbidity of the downstream waters in receiving Class 1, II, III, or IV waters, or in amounts sufficient to cause a turbidity increase in drainage facilities that discharge into Class 1, 11, III, or IV waters, d) pumping of road surface materials by traffic, or e) creation of ruts greater than would be created by traffic following normal road watering, which transports surface material to a drainage facility that discharges directly into a watercourse. tr' ,+ " S ,� `.'E t `«.r''�� �n'•u'-+' t+ � t;• r +� *+'' + j ��Irt f' ' t y � ° .�. F .•, ,�w hrti Lpp� F �� .47a UW�it - 'rFF f i i r7 . 0 ..�. ....I` � � � .Jrr 1+ ,'k. �..�'f, � t s, r li �•' �' d.{ r' .s �, 1' I ' ' � , FT• r • � �}orf'- f � �� , I.�Tf dF; ��� � }N��� 4�_ �• trr '�<� `{, • _�� 4 V+ ... F + 4�. �' 31s� �.,-��'� • 1 Ew � ' 4J � v`•{ � f .X �.�f y iEf..�_ � �.._.- af-.j�- e�Iyr'_�w..v-': ,i�� d ' t'•'yrL a7_; 3 .%e. -,. ir+`{ '-�~...`.;t1 �'`'y"■ma,q ,px!� " fa TfY?'1J4� ;ftt }s�' %';.' , ` V;r' 1 ,rfS� 1'�. ��i�{S••' ,�i.� 11t1 o i'SsiC�f+�• �!Pii�f.�y,(.7.,L1,rp� Aa.`3 . 4t . 111 ,.1 . '1��y�rd.'�f�tj ��r��i�,/��, , ; r t� 3� 'y .t �1•���'_yy"`.jr.Y„°`'i"�.- x!`r7:�r1�`;` ` _t jf k.b,I���r_L!;'yi �. ___t.`fia'.1 .-4r�er�sF.ry.,'.:+.f,.�a.TJ' �,i)V, ! ,. J •���`' t',rk:�ti'•.`! i`a�5j.':5��yIf.`t �s i��■.4hI1T`'�:r,. - '`!aqa.rl.l�.F;,".,i o--r.r"�+j(Cir j i. •, -.t..�.'-- �.-�,jr6i�i �'�! �r-i �i`.:�,'� a,-tia'f,, -_�+.—�y:.�.i,�, •`.r�ff.i+s�r t` .� '_° - r4' er�'�?1"l�, ��-r Y,��i"v, .��e r e•;✓:V1 ''a,'� „;:'�`t'.�:',+sh. yy I .rf`;r * ? , rr-e`ti.,,�afr''1I1(f`'sP,••,a ��r '�f.I'l ' � .1'. 1..._ �'T✓r. t, dF`i+'*�.� � .' �.•'. f' .Jr• r ri 'Y =E joy. i E'025-4` 74 2227 ES 33 2,348 SCALE 1:12000 jo r Ii j er Q�Sh;9l 0 100 200 300 400 500 600 700 800 900 YARDS 0 1000 2000 FEET 0 �1i i phi ■ 0 100 200 300 400 500 600 700 800 METERS 16° E i 13r { rr' 1 e Name: BERRY CREEK Location: 039° 38'33.63" N 121. 25' 19.70" W Date: 4/3/2006 Caption: Welsh Conversion Scale: 1 inch equals 1000 feet Sec 28 T21 N R5E MDBM Copyright (C) 1997, Maptech. Inc � o s _01,8/ ,OO a.#&ON 40 °l. 10.61,�1- 'i+ A '0 O Le Oao 3MV7 15361.7 yV'S w 0 Q 12 Q ' o W rt/ 2 s OL OOF e fI'r'a. v Vie. Z `- v•Irr O, dr om ;o � Ill o t 3MV7 ` pc m Q ».fir O 00 m W 4 C4 bs ry �r 4 ti C A N O • eta • rz o "Iy ♦� O t0 V o O .�° oDo °° 0 Q pv ot,kq 'S. .i c 0 a J4 n w b \ b `-• V W w � n v � I Department of Forestry and Fire Protection 6105 Airport Road Redding Calif. 96002 Attn; William Schultz Deputy Chief Dear Mr. Schultz; This letter is to acknowledge that responsibility for treatment of logging slash and woody debris is assumed by the landowner. The landowner acknowledges in writing notice of such responsibility and specific slash and woody debris treatment requirements and timing as follows; (1) Unless otherwise required, slash greater than one inch in diameter and greater than two feet long, and woody debris, except pine, shall receive full treatment no later than April 1 of the year following its creation, or within one year from the date of acceptance of the conversion exemption by the Director, whichever comes first. (2) All pine slash three inches and greater in diameter and longer than four feet must receive initial treatment if it is still on the parcel, within 7 days of its creation. (3) All pine woody debris longer than four feet must receive an initial treatment prior to full treatment. (4) Initial treatment shall include limbing woody debris and cutting slash and woody debris into lengths of less than four feet, and leaving the pieces exposed to solar radiation to aid in rapid drying. (5) Full treatment of all pine slash and woody debris must be completed by March 1 of the year following its creation, or within one year from the date of acceptance of the conversion exemption by the Director, whichever comes first. (6) Full slash and woody debris treatment may include any of the following: a. burying; b. chipping and spreading; c. piling and burning; or d. removing slash and woody debris from the site for treatment in compliance with (a) -(b). Slash and woody debris may not be burned by open outdoor fires except under permit from the appropriate fire protection agency, if required, the local air pollution control district or air quality management district. The burning must occur on the property where the slash and woody debris originated. (7) Slash and woody debris, except for pine, which is cut up for firewood shall be cut to lengths 24 inches or less and set aside for drying by April 1 of the year following its creation. Pine slash and woody debris which is cut up for firewood shall be cut to lengths 24 inches or less and set aside for drying within seven days of its creation. All treatment work must be completed prior to the expiration date for the conversion exemption. U Any treatment which involves burning of slash or woody debris shall comply with all state and local fire and air quality rules. (9-) This section does not supersede more restrictive treatments or time frames within a Forest district or subdistrict. Signature below indicates agreement to the above stated responsibilities. Timberland Owner Name:Susan E Welsh Street Address/PO Box:l36 Sunnvbrook Lane City: Oroville_ Zip Code:95965 Telephone Number:_(530)990-8007 Signature: Feather River Recreation 1200 Myers Street Oroville, CA 95965- 0 (530) 533-2011 Registration Receipt Date: 04/27/2006 Receipt #: 19036 User ID: 002 Site: PAYEE INFORMATION I PAYMENT INFORMATION SUSAN GIFFORD P.O. BOX 5786 Oroville, CA 95966 Customer #: 022110 534-8005 (530) - (530) Amount Charged ....................... $ 1106.00 Total Amount Due ....................... $ 1106.00 Amount Paid ....................... $ 1106.00 Balance Due ....................... PAYEE A ance ...................... Used To Pay Fees ....................... Current Balance ....................... $ 0.00 $ 0.00 $ 0.00 Cash $ 0.00 ID : Check $ 1106.00 Check #: 1430 Bank #: Card $ 0.00 Card #: Card Type: Memo $ 0.00 Memo #: IMPACT FEES ENROLLEE(S): AN SUSAN GIFFORDActivity: 9124.104 MISC. REVENUEFees: $ 1106.00 Customer # 022110 Location: MUNICIPAL AUDITORIUM Amount Applied: $ 1106.00 From07/01/2005 To06/30/2006 F - Times 08:OOA 05:OOP Amount Owed: $ 0.00 FEATHER RIVER RECREATION AND PARK DISTRICT AGREEMENT WAIVER, AND RELEASE I have carefully read the description of the class(es) for which Uwe are registering and in consideration for being permitted by the Feather River Recreation and Park District to participate in the activity listed, I hereby waive, release and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance FRRPD (its officers, employees and agents) from any and all liability arising out of or connected in anyway with my participation in said activitiy, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is futher agreed that this waiver, release and assumption of risk is to be binding to my heirs and assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of my death or injury or property damage that I may sustain while participating in said activity. Parental Consent: (to be completed and signed by parent/guardian if applicant is under 18 years of age). I hereby consent that my son/daughter, , participate in the above activity. I hereby execute the above Agreement, Waiver and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I herby agree to indemnify and hold the persons and entities mentioned harmless from any loss, liability, damage, cost or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND FEATHER RIVER RECREATION AND PARK DISTRICT AND I SIGN OF MY OWN FREE WILL. Name(Print) Signature Date 662-440-025` - 06-1438 NOTES ; WELSH, SUSAN 12 PINE RIDGE, BERRY CREEK �,' Cont: OWNER •ADD-GAR&PATIO COVER APN: Permit No. Owner. Site Address: Contractor. Type of Permit'. !�(o-)55*3 vv CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE �I I s 4 \ O� DATE JOB FINALED: 1 � � SIGNATURE:' t r r=OK o = Not OK MANUFACTURED HOMES DATE I Li PERMANENT FOUNDATION Lj SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; Fall/C/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clmcs-GmdAmp-Concrete 6 Yard Gas; Loctn Test -Wrap Nat ❑ or LP❑ Inch Sz Ft Lngth 7 Bickng; SzSpacing-Marriage Une 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Cimcs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -CIO to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers MISCELLANEOUS - ,DATE DECKS'COVERS'CARPOR S'GARAGES 1 ZoningSetbacks-Easements 2 Ftgs; SoilsSz43pthSpacing-CnnctrsSteel 3 Decks, Girders/Jotsts-0cking-Brcing Stairs-Guard/Handrails j 4 Wood Awn; Posts-Beams-Rftrs-CnnctrsShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carpo s -Doors 7 E!qWc 8 rmg; Sills-AnchrsStuds-Rftrs Trusses 9 S g; Nailing VeneerStucco-Lath 1 oaf; Shthg-Roofing 11eps-0oors-Landings 1 rr/aced Wall pnls ` DATE POOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men-Uning 4 Elec RcptclstUng; Distance-GR 5 Elec Pool Lting;15 volts-GF1 6 Elec.Enclsrs; Conduit Entries-Terminals-Usted 7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eop-Pool Ightg Boxes-Enclsrs- iolboardsansultn to Main Conduit 9 Health Dept Apprvl 10 Pimb; Cir Test-Wtr Supply Test 11 Lt Niche , 12 Enclsr, Fencing -Alarms 13 Bonding, Diving board or Slide o'er 0`� o'er da} Pool Drawing 0 = Not OK - RESIDENTIAL (Single & Duplex) I DATE JUNDERFLOOR 1 ZoningSetbacks-Easements-FloodSlope 2 Ftg Main; Soils-Elec Grnd Fig Dpth 3 Ftg Garage; SoilsSteel-Elec Grnd Ftg Opth 4 Fig Parches/Decks; Soils -Steel Fig Dpth 5 Stemwalls Wain; Steel-Blockouts Wrapped 6 Stemwalls Garage; Steel-Blockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgitrService Test 12. Elec Undrgmd 13 Plenums & Ducts; Cimc-MaterialSupport4nsultn 14 GirdersSills-SillsBoltsJoists Vnts-Cripples 15 Acc & Vntltn 16 Insulation DATE JFRAMING 17 Sills Proper Materials & An 18 Wells Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders 8 flr Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops; Furred CeilingsStairs-Chasers-Tubs 22 Headers & BearhsSi & Bearirig 23 Hangers -Post Caps-Anchrs- Cnnctns 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac TrussShthg A Flue=Frplc Throat Clrnc 25 Frpic Ties or Type 26 Attic Acc; Sz & Rmx prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctri Framing -RC Channel 29 Prprty Line Firewall & Opngs 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run4:anding-Fire Prtctn 32 Plywd an Roof Ovrhng Attic Vnts-Rftr Outrgrs 33 Siding -Nailing Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass PrtetnSkyLts-Plastic . 36 Shear Wails; Nailing -Bolts 37 Brace Int/Ext Wall pnis 38 I nsultn-Walls-Ceilings 39 Infiltration -W alis -W ndws 0.s° �. m DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrncdns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Mech Fstnrs 45 Gmdng Electrode Bond Gas & Wtr 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz 0 C or ❑AL AC Wire Sz ya ❑ CU or ❑ AL 48 Range Circ ya ❑ CU or ❑ AL Oven Circ ya ❑ CU or 0 AL Insulated Neutral ❑Yes ❑No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pnis-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector UArE IPLUMBING 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn ' 55 DWV; Test Fittings & Anchr. Nail 'Prtctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas.Piping DATE MECHANICAL 61 AC Ducts Insuitn & Support 62 Vent Fan, Exhaust abv Insultn 63 Condensate Drain & Ovrfiw, Sz & Grade 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic Ole DATE FINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Meth Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Clmc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Gmd Air -Gap -Cooking Cimc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door; Swing -Landing -Closure 79 AC Duct in Garage -Damper. 80 Wtr Htr; Vnts-Cimc-Com Air Cnnctr-PRV; abv flr Mech Prtctn; LPG Appince Undr House 3' drain 81 Plmb; Elec & Mech Eqp Listed for Lactn 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insulin -Foam -Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 Cimc Dmge Planters ❑ Yes ❑ No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Pimb 89 Vnts abv Roof, Pimb-Appinc-Frpic-Cimc to Opngs 90 Wtr Well, Dscnnc% Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntitn thru House 93 Glass Prtctn 94 Corrections from previous Ihspctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP061438 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 08/01/2006 APN: 062-440-025-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 12 PINE RIDGE LN BCK Date: Contractor: Map Index: Description: ADD TO SF(210), CARPORT(371), ADD TO 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 GAR(198), COV(120) Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a Owner: WELSH, SUSAN signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 12 PINE RIDGE LN 7000) of Division 3 of the Business and Professions Code) or that he or BERRY CREEK, CA she is exempt therefrom and the basis for the alleged exemption. Any 95965 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).): (530) 990-8007 I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: WELSH, SUSAN such work himself or herself or through his or her own employees, 12 PINE RIDGE LN provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one BERRY CREEK, CA year of completion, the owner -builder will have the burden of 95965 proving that he or she did not build or improve for the purpose of sale.). (530) 990-8007 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor: pursuant to the Contractors' State License Law.). ❑ I aim Exempt under Article the , sinLs an ofessions Code Ofl Date: �= Owner: If I WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: ❑ 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. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Square Ft: 899 S.F. Policy#: ITotal I certify that in the performance of the work for which this permit is Valuation: $26,258.00 issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers'/� (�/�� compensation provisions of Section 3700 of the Labor Code, I shall 1 `r � _y forthwith comply with those provisions. fy, i � S S<6 Date: ~ l Applicant: / J�0 lSJ 15-� WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one `V 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. `B`I-DC CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm lh there is a construction lending agency for the Resolutions tp do work indicated ove for which fees have been paid. performance of theiNprk for which this permit is issued (Sec 3097 Civ.)�y� tl 0 Name: r /U�+t By: /ll Dater:? 2-1-06) l , Address: Q PERMIT / PIRES ON: O` I"n Date ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health 8 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 t e duly authorized agen f the owner. I agree to comply with all county and state s relating to building construction. I acknowledge it is unlawful to alter the substance of a y official form or doc e t of B County. I hereby authorize representati sof Butte County to enter upon the bove m ntioned property for inspection purposes Print Name: 1� S Signature: V V1 Date: �-' 1-i) ❑ Owner ❑ Contractor AAgent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 Plot Plan Attached E.H. E ONLY Floor Plan Attached� Sent to 8DIDS j TO: Building Division = Development Services FROM: Environmental Health SUBJECT: Sanitation Clearance ZV- 23-%vim t�a� f� `� o 2 r WO -a zs Owner Location AP# Plan Approved for Sewage Disposal: G/� Water Supply: Public Private Well Clearance for dwelling. Other % Hold final for: Finallclearance O K for C'_ NOTE: Environmental Health Specialist Dat Building Clearance 9/2005 s 1 r COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION, 7 Comity Centel Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET BPO A 1 y 3t OWNER: Wt S -b ASSESSOR PARCEL NUMBER - (YO' 9C_�J Vin � Proposed Building Use: & I r C \I Permit Technician: 1 . Date: Iteps required in ordeo apply for a permit All boxes MUST be checked OR marked NA in order to apply. `V 1. Site plans,25r(3hr r 4 ets, signed by the preparer of the plans. 2. Complete 4 sets, signed by the preparer of the plans. ❑ 3. En ineered mr, 3 or 4 sets with wet signature on plans AND 2 sets of stamped and signed calculations. 9 t� 9 P P� 9 ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. `I�N 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in dulalicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calks 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. Hazardous Material Form \11SN 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other Redairing items needed to issue the permit (May require additional plan review upon receipt of the following items.) NO�LN 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable 0 15. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer dr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... ❑, �'�' 0 18. Erosion Control Plan Required........................................................................ Fees as shown on the attached Schedule of Fees Due Sheet .............................. 0 20. City of Chico Plumbing permit........................................................................ ❑ 21. Site plan and business license approval from a CjJof Biggs ....... :...................... 22. California Department of Forestry Ian approvalMn paid. Sent by: 23. Planning approval for (A) Use: (B) Parking: (C) Parcel Checlk:. ❑ 24. Contact Land Development about _ Improvements, _ Drainage ........................ 25. Fire Marshall Review (commercial projects only). Sent by ...................... vlt4 .26. NPDES Form............................................................................................. Cl 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 Numbe '. 30. Owner -Builder Verification (_ Given to ownet+INafeowner) ..................... (V 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... 1'❑, 36. Other. O 37. Other. When issuedrjelephone(530) 9q& '�0n2 Dt�(nPr and hold for pickup. I have been ihfdrmed of the agove itfins and requirements for obtaining a building permit. a r. �.�WAS Date:- I1�_' 06 1. Index permit apoliMo_n foiliki4 abobeitems 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, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner was advised of the ab ve dta by ❑ phone, ❑ mail, ❑ counter b Date: Plans reviewed by- �-� Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner WELSH APN No: 062-440-025 Permit Type: Buildiffi Subtype: App Date: 6/15/2006 Permit No: SP 061438 Permit Desc: AW • Addition $852.35 $340.94° $511.41 Balance of Building Permit Fee 0 $95.00 $204.98 $109.98 $435.94 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION Plan Check portion of Permit Fee 2 FEMA RYes Flood Elevation Review $109.98 3 SRA* Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 NON-REFUNDABLE portion of fees due at application FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $545.92 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT IFS 514T04 RECEIPT DATE Tech/Asst j I 6/15/06 Kourtni specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 041506 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) 538-7785 Facsimile ADMINISTRATION '° BUILDING * PLANNING July 21, 2006 Susan Welch 12 Pine Ridge Lane Berry Creek, Ca. 95967 Assessor Parcel Number: 062-440-025 Building Permit Number: 06-1438 Thank you for submitting the plans for your building project. The plans have been.reviewed and comments are listed below. Please respond in writing to each item by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Your complete and clear response will expedite the re- checkand ap r/val of this project. COM S: . Specify roof material on building plans. Sho a partial floor plan of the existing area being affected. The addition shows a hallway for ac ss to the new bathroom, but the existing floor plans do not address how you are getting cc to the new areas. Submit two new corrected sets of plans. If you wish to discuss any of these requirements, please call (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. Please refer to your Data Sheet for remaining non -plan check items. (You received this form when you app ied for your rmit.) The counter staff will answer any questions concerning the Data Sheet. tPlanps eterson Examiner Cc: Bill Sumner; Designer Jul 31 06 03:11p BPOGMSS RP* O�Z-�9a025 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. P•2 \ 1. I personally plan to provide the major labor and-m"ta enal for corisiiudion of this proposed - property improvement: YES .[X] NO [ ]. 2. I HAVE [,\-Q HAVE NOT j ) signed ail application for a building permit for the proposed work 3. I have -contracted with the following person (firm) to provide the pt'oposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the worm but I have hired the following person to coordinate, supervise, and- provide the major work.- NAME: ork NAME: ADDRESS: PHONE` CONTRACTOR'S LICENSE N0: S. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE- TYPE OF WORK SIGNED: PROPERTY OWNER: DATE: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. �..:: y.r x .tiw � .rs.V.^.. .,..�• �, w� v+.�t�n + ,�,'� «- ... • � � Y � ti.. r. .. BUTTE COUNTY SCHOOLS IMPACTFEE CERTIFICATION FORM r (One form per Building) t IP 1V 1- v� School District orovilikun'RMhs(hnol Building Depa ent No. w A.P. Number ��� qLn-a1b Jurisdiction: 0 City County , Property Owner ('sh ty,,, .. , Property Location/Address ' Pt (�,� l� �Q r C 1 CA, 1 Subdivision Residential Development 0 Q No of Living Mobile Home nits' ' -t— -Installation O _ 1 Commercial/Industrial 0 0 New Addition Building Department Representative . Lot No. EO 0 Addition/ 'Supplemental to Conversion Permit # '(No foundation inspection) Sq. Footage 210'__ (Group. R) Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) N Sq. Footage (Including Exterior f Roofed Areas) . + ; fin- Date District Identification No: Q _� 8 r - ( , i i � � �1 h -t � r) �t School District certifies that W Q I s VN (Applicant) (Street Address) {� v Q (Phone Number) ►�J�1 y- (City) (City) �� (State) (Zip Code) has complied:with the requi ements°of.Resolution Nol ) by payment of $ representing / Z4 c,,square feet. JAB 2926 $ r rN n ° VULL MITIGATION $ School District K.. Paid by Check # EN -J m Remarks. Date fdotlee : You may protest the Imposition of the fees Idendited above by submitting a written protest to the District, In conhpliance with Government Code Section 66020(a), within 90 days from the date fees are paid. FaHure to submit a tlmeiy written protest will prohibit YOU from challenging the Imposition of the fees In any court action. M, subsequent to the School District Representative slgning this Butte County Schools Impact Fee Certification Form, the Schooi District is notified by the applicable Local Planning Agency that this project Is being reviewed under the C&Wwnla Emrkonmantat Qua ft Act (CEQA), this project may be subject to additional school fees to fully mitloate Its Imoaet on the school dlsbWs schools. White (school district), Yellow (building department), Pink (applicant). %slonn.xls (3105)dr= Butte CorntyDepartmentofDevelopnlentServiceS 7. County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile OUR 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'T'HOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. 1 hereby acknowledge: I need to submit applications for septic and/or well to Butte County Environmental Health immediately. I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plana 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 reauire submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not .limited to, verification the parcel was legally created, adherence.. t6. all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). , Please print: Applicant Name: ,u�� (til ' (�-��-(S�j APN_ Building site address: Permit No.: 06/ 7 31-6 I have rTd, understood and accept the terms and conditions as expressed herein as indicated by my submissi� of the above -referenced building permit application and my signature below: SIGNA APPLICANT DATE Copy to ApplicanVEHMI.- K:Forms/BldgPermirwithoutClearznces 020705 10 9QPtTMENr O Tr c = (I c G � o —� 1 c� U 14, A�etrc woR,�S Department of Public Works J. Michael Crump, Director LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive oroville, CA 95965 (530)538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement LLESS THAN 1 ACREI Project Description: O,�-v h u --r- J Project Location and/or Parcel Number: By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB I 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. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. 1 Signed: Title: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storrs Water Management Program vodmd BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND. SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www*.buttecounty.net/dds ��.Cp3 xxPLEASE PRINT CLEARLYrr APPLICANT INFORMATION OWNER INFORMATION Last Name Il\je, k Z/ Address Address 12— ?,�, I City C,�, � /� �C t„�y Zip Phone7 G2� Fax d —S — E mail L'ic. # Class APPLICANT INFORMATION CONTRACTOR Name Awe— City Address Zip City Fax State Zip Phone Subdivision Name Map Fax E-mail Lot # L'ic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Subdivision Name Map Fax " E-mail Lot # State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning AP# 10 �� S Flood Zone SRA Yes No' Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BPGGILI3S BIN # I Description or Sl~ cov Ski FT- Livingo Garag+ Open Ginn' i ❑ 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. I I Received by: V Amount: �-1� Bldg I I 0- 1 M 7 20q ."I p SRA Receipt #:TZ)ov (O Sheriff Com' I1�3� SMIP Date fJY �15 3� Other GJ1�5 ,q 2� Total RFS/ R-1 9-05 PROJECT LOCATION AP# 10 �� S Property Address City Cross Sr WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than 'cense ntractors, certificate of worker's compens ' n s n of e f erm issuance. ENDING AGEN Name Address - ' d b �ik �09 A6d � I Description or Sl~ cov Ski FT- Livingo Garag+ Open Ginn' i ❑ 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. I I Received by: V Amount: �-1� Bldg I I 0- 1 M 7 20q ."I p SRA Receipt #:TZ)ov (O Sheriff Com' I1�3� SMIP Date fJY �15 3� Other GJ1�5 ,q 2� Total RFS/ R-1 9-05 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. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed bV the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form _ ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. . If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the.person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 + t _ s r Butte County Department of Development Services. O�rrE �aEa N O T E S 7 County Center Drive, Oroville, CA 95965 ��G (53,p) 538-7601 vnwv.buttecoitnty neVdds coast{ I v CS '� _ � RESIDENTIAL APIJ- y Permit No. owner. 062-440-025 06= 0553 }?- — WELSH, DENNIS y , Site Address: PINE RIDGE LN, BERRY CREEK Cont: OWNER contractor. _ NSF MST 9-7--" Q — 3 K Type of Permit: oto., f its OFFICE COPY Address ` GAS Meter By Dat in ELECTRI + Meter By. Date tQ 7�i 35- E-=�- o W BM -0 Rod-- I ock I CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED » SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE I R + DATE JOB FINALED: 1 1 on �/ 1 r _ SIGNATURE: OK o = Not OK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FallIC!O-Concrete DATE D E C K S'C O V E R S`C A R P O R T S `G A R A'G E S 1 Zoning -Setbacks -Easements 2 Ftgs; Soils-Sz-DpthSpacing-CnnctrsSteel 3 Decks, Girders/Joists-Dcking-Brcing 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap . Nat O or LPO Inch Sz Ft Lngth Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs Cnnctrs-Shthg Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 7 Blckng; Sz-Spacing-Marriage Line 6 Carports; Wndws-Doors 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 7 Electric . 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 11 Wtr & Sewer Connected -C/O to Grade 10 Roof; Shthg-Roofing 12 Gas and Electricity Tagged 13 Tie Downs O Foundation O 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers _ DATE IPOOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI ops '3 ° 0c 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries-Terminals=Listed 7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr 8 Elec Grndng; Eqp w15' Crcltng Eqp-Pool Ightg Bones-Enclsrs-pnlboards4risultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide O� 0� Pool Drawing i q. = OK = Not OK RESIDENTIAL (Single. & Duplex) DATE JUNI E�RFLOOR I DATE TPLUJ4BING Z1 fLOing-Setbacks-Easements-Flood-Slope fg Main; Soils-Elec Grnd - Ftg Opth 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth. 4 Ft orches/Decks; Soils -Steel Ftg Dpth temwalls Main; Steel-Blockouts-Wrapped 6 �Sremwalls,Garage; Steel-Blockouts-Wrapped Hold Downs and Special Anchrs 7 SI ; Steel Wrapped iers-Frplc Ftg-Steel V; Fall -Fitting -Test -2 -way C/0 -Sewer Test Gas Pipe; Sz Anchrs-Sz Test r Pipe; Test-Anchrs-Rgltr-Service Test *X2ec Undrgrnd ums & Ducts; Clrnc-Materia"upport-Insultn ers-Sills-Anchr BoltsJoists-Vnts-Cripples & Vntltn .lation C d lie 0: TE IFRAUING }aWtr ; Vent-Acc-Cmbstn Air Baffle tr st & Anchr-Nail Prtctn ��'' JJ V' t Fittings & Anchr Nail Prtctn 4jy51�,,,!- 7—+c1— If-Shwr Pan; Test, First flr-Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub-Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas Piping MECHANICAL 61oodoS Ducts Insulin & Support nt Fan, Exhaust abv Insultn 3 C ensatee Drain & Ovrflw, Sz &Grade 64Furnace-Vent Acc-Comb Air RtrnNent 115 Outlet 65 Attic Acc & Pitfrm if Furnace in attic 0 JW'Sills Proper Materials & Anchrs DATE I F I NA L 1s Studs -Nailing Spacing & Braces-PlatesSound Ceps -Door & SideLt Prtctn 1 Eire ring Walls over Girders & fir Nailing moke Detector 2t Stop in Walls (rat proof) 68 Furnace Vnts-CImc-Comb, Air-Cnnctr Stops, Furred Ceilings -Stairs -Chasers -Tubs *Iec e; abv-fir-Ducts-Mech Prtctn 2 e rs & Beams-Sz & Bearing Exiting 2 angers -Post Caps-Anchrs-Cnnctns th Fxtrs & Tub Acc-Spa 24�ling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg ault 25 Fr res or Type A Flue Frplc Throat Clmc & Subpnl, BreakerSis &Labels 2 cc; Sz & Rmx Prtctn-Draft Stop4ns Baffles 73 Stairs, Guard/Handrails dr ndws or Exiting Doors -Sill Ht & Dimensions-111'pic or Stove, CImc-Hearth 2 arage Fire Prtctn Framing -RC Channel -Outlets at Wood Pnl, Int &Ext 29 Prprty Line Firewall & Opngs tchn, Fxtr &Appinc; Grnd-Air-Gap-Cooking Clrnc 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exitsc Outlets &Rcptcls at Ktchn Counter 31 Stai Wi dth-Hdrm-Ris e -Ru n-Landin g -Fire Prtctn 78 Garage Fire Door, Swing -landing -Closure 3 Z.= on Roof Ovrhng-Attic Vnts-Rftr Outrgrs, 79 P"uct in Garage -Damper -Nailing Veneer �- I I • � • a tb� �(� - 9 � oy� �y�•Q.fiQt,F tr Htr; Vnts-Clrnc-Dorn Air Cnnctr-PRV; abv fir 1t -OCQ �� Lath -Weep Screed=Fndtn Vnts-Undrflr Acc Me Prtctn; LPG Appince Undr House 3" drain 35 GI Area -Glass Prtctn-SkyLts-Plastic mb; Elec &Mech Eqp Listed for Loan Shear Wags; Nailin olts lec Rcptcls in Garage (GFI) Romex Prtctn (t -$ O(o Da 37 BrqejedExt VVfl pnls B3 Insultn-Foam-Looked in Attic 3B Insultn-Walls-Ceilings 84 GG and Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws : ndn Vnts & Crawl Hole Door Drnge & Wood -Earth O 86 Clpr c Drnge Planters 0 Yes [_]No RYStucco Brown -Finish o' t m o'er ° �B-{tGlUnit Dscnnct, Elec-Plmb abv Roof, Plmb-Appinc-Frplc-CImc to Opngs DATE JELECTRICAL - tl�VVWell, Dscnnct, Elec, Plmb 40 FxtLA Tmsfrmr Clmc4ns Prtctn 9yi�x lec Trim, GFI Rcptcl-Undrgrnd 4;•� Rcptcls Spacing-Lts & Switches at Doors 9 Vntltn thru House �oxes & No Of Cndctrs Stapled : Glass Prtctn Romex Installed Close to Edge of Studs & CJ 94 C rrections from previous lnspctns 44� Grnd made up w/Mech Fstnrs est -Meters Tagged, Gas-Elec 43Grndng Electrode Bond Gas & Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl 4 Ap arcs in Ktchn & Cndctr Sz GFI p@rgy Cmpinc Cert -Other Certs 4 feed Wire Sz ❑ CU or ❑AL ` ddress Posted AC z g. ❑ CU or ❑AL 99 Fire Sprinkler ange Circ 92 ❑ CU or ❑ AL Oven,Circ 9a ❑ CU or ❑ AL07 ��• Insulated Neutral .-� , ❑ Yes ❑Nor a` 0 c o� •� 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eg Clrncs pnls-Motors-Mech Eqp 51,,C'othes Closet Lt-Shwr Lt -Spa Lt ; 5�moke Detector ..w COUNTY OF BUTTE BUILDING DIVISION t DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 { rY CORRECTION NOTICE a OWNER PERMIT NO. ' 3 t A routine inspection indicates that the following violations of Butte County Ordinances exist at /ve F? x theab address and should be corrected. Please call for re -inspection when correction of work s completed. If you have any questions pertaining to this matter, or need additional exp nation, please contact the Building Inspector as indicated below. Vv0✓V\ 1, J"/ l LA 11rV\l� 1 a VN Ind i y ` J �k'3 r -. G l' r ,r ^r. -A(!I/ 1 �., .� / y \ ` � • r t11��a"1 Date.._ Inspector � A REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 =' ...000NTY OF BUTTE ... .. ... ............ x BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE 7- V77, PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, ,please contact the Building Inspector as indicated below. �! /"/ 7/ /'/G 1ZS f4 ' //J71 -/Gy 9 Date 1r9' v v Inspector REV 4/05 Phone # �� 7 l / FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 0 COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center'Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE G U I Oc 066P SC �y (ROO J p E N11V 9 Cel -/1e/ /UCc- `(—o (/ ,6y Ff &� �3, &-r r /Z O nI T ►v 1 %�C)U(6 67 PERU U�� �1711/S =4 siTE %o/z 19UL / SF�Zc -7-/6A Date Q t6* bo Inspector 1"')-C3GPA k+ L N 1z PES REV 4/05 Phone # ISI -3 9 - (0 6 Z 1 FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 OWNER PERMIT NO.Aj :* A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector as indicated below. G U I Oc 066P SC �y (ROO J p E N11V 9 Cel -/1e/ /UCc- `(—o (/ ,6y Ff &� �3, &-r r /Z O nI T ►v 1 %�C)U(6 67 PERU U�� �1711/S =4 siTE %o/z 19UL / SF�Zc -7-/6A Date Q t6* bo Inspector 1"')-C3GPA k+ L N 1z PES REV 4/05 Phone # ISI -3 9 - (0 6 Z 1 FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 -` COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive - Oroville, CA - (530) 538-7541 CORRECTION NOTICE O NER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector asp indicated below. LAW62f )2-00W 1P//ay-/,44 At/17?--1 ,9l c _ /rf-� �� % r/-/ ✓ori/c Date �v Inspector ��C r� `� Otis r C REV 4/05 Phone # > FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 If ... COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRtCTION NOTICE ER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector as indicated below. 1h T(_ t1 /n)4 l .. x/157 17 9 t/�C // i r Date 1! Inspector REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 01/18/2007 THU 11:35 FAX 1&002/003 INSULATION CERTIFICATE Job Number: 8139 Dennis Walsh Contractor/Owner Name 12 Piot Midge, Berry Creek CA Job Address (street, city, state) Butte County Subdhidon Name Lot Number DESCRIPTIN OF INSTALLATXON 1. ROOF Material Brand Names Thickness (inches): Thermal Resistance (R Valne): i L CEILING Batt or Blanket Type: Fibergkass Brand Name: Knaid : Thickness (mches): 131/2 Thermal Resistance (R -Value): 43 Loose kill Type: Fiberglass Brand Name: Knour Minimum Installed Weight/ft .649 lb Minimum Thickness: 141/2 inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (It -Value): 43 31 EXTERIOR WALL Frame Type.- Type:A. A.Catity Insulation Material: Fiber lass Brand Name: Knauf Thickness (inches): 31/2 Thermal Resistance (R-Valuc): 13 B. Exterior Roam Sheathing t Material: Brand Name: Thickness (mches): Thermal Resistance (R -Value): 4. RAISED F OOR Material: Fiberglass Brand Name: Knae Thickness (inches): 6 1/4 Thermal Resistance (R -Value): 19 5. SLAB FLOOR/FERIMETER Material; Brand Name: Thickness (inches): T4ermak Resistance (It -Value): Perimeter Insulation Depth Inches: 6. FOUNDATION WALL Material: Thickness (inches): Brand Name: Thermal Resistance (R Valuc): DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current EnerV Efficiency Standards for residential buildinge (Title 24, Part 6, California Code of Rcgolations) as indicated on the Certdicate of Comphanc err ap )icable. 2,3&4 ^ L Chico Insulation & Fireplaces RM Number's Signature and Date Installing Subcontractor (Co. Name) or General Contractor (Co. Name) or Owner Item Number's S"iture and Date >t, • butalling Subcontractor (Co, Name) or "General Contractor (Co. Name) or Owner C. 1'. BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060553 B. C. Building Permit 01-16-04 pg 1 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: 04/27/2006 APN: 062-440-025-000 the Business and Professions Code, and my license is in full force and effect. License Class_: License Number: Site Address: 12 PINE RIDGE LN BCK Map Index: Date: Contractor: Description: nsf (1224), master #97-40 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: WELSH, SUSAN permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 136 SUNNYBROOK LN. signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA. the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 95965 she is exempt therefrom and the basis for the alleged exemption. Any 530-534-8005 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: WELSH, SUSAN Code: The Contractors' Slate License Law does not apply to an 136 SUNNYBROOK LN. owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, OROVILLE, CA. provided that such improvements are not intended or offered for 95965 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 530-534-8005 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.). ❑ I am Exempt under Article 3 of a eusine s and a sio ode Date: -' ZdG Owner: License #: WORKERS' COMPE ATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: ❑ 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 and policy number are: Carrier: Total Square Ft: 1224 S.F. Policy #: Valuation: $79,560.00 Census Code: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: - LL4- Applicant: / WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one "'� / 7 CIS 19502 j�/ � "'' ( hundred thousand dollars ($100,000), in addition to the cost of -19502 -SG i cG�CJr compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. 175, `17 ( M2/07"l CONSTRUCTION LENDING AGENCY This permit is h reby issued under the -applicable provisions of the Butie County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions t9, o wort, indicateWi for which fees have been paid. ` performance of the work for which this permit is issued (Sec 3097 Civ.) Date:k- Name: BY - - - Address: PERMIT EXPIRES ON: ate O 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. O Attached are copies of the required E.P.A. notification forms. I hereby certify th I have read this application, that ttdabove information is correct, and that I am the owner or the du l ulhorized agent of the owner. I agree to comply with all county and st t laws relating to buildin c n ru n. 1 acknowledge it is unlawful to alter the substance of any offici I form or do ment of Butte u ty ereby authorize repres nt lives of Bu Cou ty n r on t e mentioned property for inspection purposes. Print Name: 1( tfir Date: 7 nO ❑ Owner ❑ Contractor Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 EH UgReNLY Plot Plan Attached e Floor Plan Attached Sent to BDlDS� Building Division — Development Services ROM: Environmental Health SUBJECT: Sanitation Clearance Owner Plan Approved for: Sewage Disposal Clearance for dwelling. Other '---�,\,kiold final for: rmava NOTE: N. X. for: Environmental Health Specialist Building Clearance 9/2005 %✓e- Location 5ell, —Water Supply: Public Private Well O� q 77' q0 Imj`n 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: ASSESSOR �� ASSESSOR PARCEL NUMBER !/O Z - �L!� ')?'YProposed Building Use: NSI 1/1r5 7Z--Y-Z97 ydP�it Technician: 61- Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. 1,A1 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bidgs: (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. ❑ 1 11. Hazardous Material Form /�/ 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other \ Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 4. Sanitation and site plan approval from the Environmental Health Department in 11 Chico ❑ Oroville, as applicable ❑ ire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... ❑ 18. Erosion Control Plan Required........................................................................ �j . !es as shown on the attached Schedule of Fees Due Sheet .............................. ❑ . City of Chico Plumbing permit........................................................................ 21. Site plan and business license approval from the City of Biggs - 3- 22. California Department of Forestry plan approval �paTd Sent by: 23. Planning approval for (A) Use: (B) Parking: (C) Parcel Check: ............ f ❑ i 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ...................... N26. NPDES Form............................................................................................ P 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)............��f` :<�/N 31. Letter of Signature authorization .......................................... . I "........... 32. Recorded copy of Agricultural Acknowledgment Statement......... .-n, 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... /V 36. Other: 6 o F- &,,, ^/ Si 37. Other: I e -iz r-;2aK-- Coyv7yu-c ro /L - a When issued Telephone Pe--e-vol S 9 q�% ' �� % and hold for pickup. I have been informed of the a ove item's a d r quirements for obtaining a building permit. 16 Applicant: / ! Date::/> "` >/ U� 1. Index permit application for the above items numbered: Plan e eck Letter 2. Additional items requiredb .. i Contractor, designer caner as advised of the above data by phone, 1-1 mail ❑ counter,, y Date: Contractor, designer, er, was advised of the above data by ❑phone, ❑mail, ❑ counte`rI by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed b : Dat . Structural approved by: Date: Note transfer by: Date: Yellow: Building Division i' K r K/Building/Plan Check/Data Sheets/data sheet page 2 9.27.05 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner WELSH APN No: 062-440-025 Application Date 3/10/2006 Permit No: BP 060553 Permit Type: NSF DWELLING 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION Plan Check portion of Permit Fee 2 FEMA RYes Flood Elevation Review $109.98 3 SRA* Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 NON-REFUNDABLE portion of fees due at application $1,633.29 $653.32 $979.97,4)alance of Building Permit Fee 0 $95.00 $204.98 $109.98 $748.32 RECEIPT DATE Tech/Asst FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $858.30 FFFS (RFI Owl MIF PRIOR TO ISSIIANCF OF PFRMIT i A5.1Rd_Rn oaiance or ouuamg rermu rees trrom mo. _i auovel SMIP* - Strong Motion Instrumentation Program (Enter amount from permit system) Additional Plan Check Fees (NON-REFUNDABLE) Other*: Other*: 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* At the time of permit ap checking process. uy952/ 3/7/06 Curtis Dy/y.yr $7.96,1 UA 1 t Tech/Asst are required to be paid prior to issuance of the permit. These fees may be changed during the plan UApplicant: I Date: TA- - pD- n-6 Pursuant to Government codection 66N0, y u ereby notified those Items followed by an ""may have been impose&onSAr project. You have 90 days - from from the date of approval of orject or from the impostion of the above referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 121205 Butte County .Department of .Development Services ADMINISTRATION ° BUILDING `GIS `PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your naive listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: 0. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and; if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confinn that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Scott Rutherford Chief Building Inspector NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. 062- tIL10r02Y 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. 1. I personally plan to provide the major labor and material for construction of this proposed property improvement: YES [X] NO [ ]. 2. I HAVE [ ] HAVE NOT [X] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: DATE: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte CoulltyDeparanent ofDevelop.7leilt ,5'er-wces 7 County Center Orive ° ° ° Oroville, CA 95965 (530) 538-7601 Telephone (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 WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: e I need to submit applications for septic and/or well to Butte County Environmental Health immediately. I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained e I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not .limited to, verification the parcel was legally created, adherence. to all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). 3 Please print: Applicant Name: J)gzqj'.1'- ,(/ _ 1,1' k4 APN: 0 6Z- I-IYO— Building site address: Permit No.: I have read, understood and accept the terms and conditions as expressed herein as indicated by my submi ion of the above -re enced building permit application and my signature below: SIGOA F APPLICANT DATE V Copy to Applicant/EH/File K,Forms/BldePermitwi thout0earances 020705 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 1 COUNTY CENTER DRIVE OROVILLE, CA 95965 �r �i . �r �i . ►r . Recorded I Official Records I County of I But I CANDACE J. GRi1BBS i County Clerk-Recorderl I 1 011:50AM 17 -Mar -2006 I REC FEE 7.00 CONFORMED COPY 2.00 LU 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: LOTS 6, 7, and 25, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PINE CREST ESTATES", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE 9, 1969, IN BOOK 35 OF MAPS, AT PAGE(S) 45 AND 46. Date G,1 cA /7 a&06- PROPERTY OWNERS: -sustw State of California County of &41e, On �ii�/'G� /i, Zva Gj before me, personally appeared c4iJ E. ' (A)e� �!, personally —knowa4e-me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(*) is/afe subscribed to the within instrument and acknowledged to me that-be/she/they executed the same in hWher/their authorized capacity(ies), and that by-his/her/their signature(s) on the instrument, the person(6*or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature Seal: ,090 JAMESLAMAR KINSER .-Qon COMM. #1377185 -� ~ �' NOTARY PUBLIC -CALIFORNIA A.P.# bipa-I-NO-ooh,©074- oat,_ BUTTE -COUNTY F ' My Comm. Expires Sept. 28, 2006 t11X)4)-,IOG --(3003 b9b'10�0� sib 233- Ma A 3MMO 119b^i0�9R->f^rslJ +t#nuoJ !J � 19¢Bq I K S-1EM-CI =:IIO ^�IIflilf��f �lC1ff��ffllilfl�flif P AftiMENT °o6V�Tr�o�`;, Department of Public Works County of Butte o o r� .. \1 0 J. Michael Crump, LAND DEVELOPMENT DIVISION 0 0 // Storm Water Management Program // Director 7 County Center Drive C V N y Oroville, CA 95965 A�AUC W0P)530) 538-7266 (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: S /— Project Location and/or Parcel Number: 6 Z- G/ ,/ o Z S 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. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. A Signed: Title: Date: Less than 1 Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04 RECORDING REQUESTED BY Mid Valley Title & Escrow Company AND WHEN RECORDED MAIL TO: Susan E. Welsh PO Box 5786 Oroville, CA 95966-0786 2006-0007323 Recorded I REC FEE 13.88 Official Records I Count of I CM J. esum I AI County CleA-Recorderi I I BY 8E:WN if¢feb-8886 I Page 1 of 3 Space Above This Line for Recorders Use Only A.P.N.: 062-440-006-000 a0'%4DoZS File No.: 0403-2059431(AM) INTERSPOUSAL TRANSFER GRANT DEED 3 (Excluded from Reappraisal under California Constitution Article 13A ❑ 1 et seq.) The Undersigned Grantor(s) dedare(s): DOCUMENTARY TRANSFER TAX $; CITY TRANSFER TAX $; SURVEY MONUMENT FEE; This conveyance is solely between spouses and establishes the sole and separate property of a spouse and is EXEMPT from the imposition of the Documentary Transfer Tax pursuant to Section 11930 and/or 11911 et seq. of the Revenue and Taxation Code. This is an Interspousal Transfer and not a change in ownership under Section 63 of the Revenue and Taxation Code, and transfer by Grantor(s) is excluded from reappraisal as a creation, transfer, solely between the spouses of any co-owners interest. FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, Dennis Welsh, spouse of the grantee herein hereby GRANTS to Susan E. Welsh, a married woman as her sole and separate property the following described property in the unincorporated area of Oroville, County of Butte, State of California: Attached hereto as Exhibit A. It Is the express Intent of the Grantor, being the spouse of the Grantee, to convey all right, title and Interest the Grantor, community or otherwise, In and to the herein described property to the Grant his/her sole and separate property. Dated: 01/27/06 ZI Z Dennis Mail Tax Statements To: SAME AS ABOVE A. P. N .: 062-440-006-000 STATE OF C'.Q�, �orN� )SS COUNTY OF Fie No.: 0403-2059431(AM) On /1-2.91D(o . before me. 144,4`l r. 6,4wel/ PJ67-jWV htwi�— Notary PUblic, personally appeared (7ef44 Tc Lj e./ s 1" . personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capadty(ies) and that by his/her/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 hand and official seal. Signature My Commission Expires: � Notary Name: Notary Registration Number: KARY'J: BIDMIELL commission #1381097 eJ Notary Pu611c-641461wa 03 Butte Cou�rd y* My Comm. Exp. NR* 08.2006 Th/s area for oA9dal notarial sea/ Notary Phone: County of Principal Place of Business: 'Page 2 A.P.N.: 062-440-006-000 Interspousal Transfer Grant Deed - continued File No.: 0403-2059431(AM) EXHIBIT A LOTS 6, 7, and 25, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PINE CREST ESTATES", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE 9,1969, IN BOOK 35 OF MAPS, AT PAGE(S) 45 AND 46. 0 AT 4 m i.J ./�� t � qp �� ! — � I Z Q �/✓ � t- -FQ=cam C@7,✓l �� �K�i �� Q1Q0 �� a ;� �. l �. i_.1 � `1 � r I�� �� 4 't fj+l 11! I�� �� I� I�� _ II� �� I I� !. I +� �I� iI BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION **PLEASE PRINT CLEARLY** OWNER Last NameLC L/ / Fit ameN Address N City State Zip Phone 3lr 0_ Q - Fax' E-mail For office use only: CONTRACTOR Name taw Address SRAYes City No State Zip Phone Book Fax E-mail Planner Lic. # Class For office use only: ARCHITECT/ENGINEER Name Flood Zone Address SRAYes City No State Zip Phone Book Fax E-mail Planner State License Number For office use only: APPLICANT NAME Name Flood Zone Address SRAYes City No State Zip Phone Book Fax E-mail Planner For office use only: Zoning Property Addres �i��� �26LEGov Flood Zone ross Street SRAYes WORKER'S COMPENSATION No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BPO 6 0 5rS_ BIN # LOCATION AP# G 2 - �/ VO _0 2 Property Addres �i��� �26LEGov City g L ross 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 or Scope of Work: NSI= l2 2 Sq. Footage I m 7 -z�� ❑Structure Built without Permits % ❑ Proposed Change of Occupancy v (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. OVER FOR SUBMITTAL REQUIREMENTS II KAFORMSWILDING F0RMS1BIdgApp1SubRgmts.doc Page 1 of 2 Received by: Amount: Bldg SRA Receipt#:� Zf Sheriff Ll �r SMIP Date: ,r,nb Total REV 6-16-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (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. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Station and site plan approval from the Environmental Health Department. ❑ " .."li ood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 <Z�zj r Wt wl ou .all '` Sm. 0 v• K 4.4 7J. I P, - 7AA PLANNING DIVISION - BUILDING PLAN APPROVAL Use: llr, Date: &_0 Parking: LandscapiN: Other. Signature: ire