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062-610-005
FAILURE TO FINAL ELECTRIC AND 9/1/93 T� e 62-61-05 DON BRINSFIELD'�'� —OZ�/Seminole Dr rry Cree ContR: Gle nson Permit 0-88P,E(elec & plbg/lo ev) F -61-0-005 93-3782 B FIELD, DON SEMINOLE DRIVE, BERRY CREEK HED GARAGE/9/y� 0-005• PERMIT#95-1368 IELD, Don & Jean 1"inole Ln., Berry Creek i 7 Cont; Jerry_ Perkins 0�� Mobilehome Utilities ELECTRIC GAS LINE COMPACTION TEST REQ��- SUPPORT�STRUCT REQ N 062-610-005 t PERMIT#95-13 9 �BRINSFIELD; Don & Jean 1W Seminole Ln.-, Berry � Creek q� MobilehomeV`Installation n �I 0 MOM Ml I I I c 1� to �.F�'::,;",-"asay '�':�! ksrjy� -.Pry 4'.t;" :'s•.�: '"�w �. .^.r ^c-.:;.,., .n.: •;ter; aai�` i1.Y'yt '�;n MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE ' DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION --7 COUNTY CENTER DRIVE OROVILLE, CA 95965 --PHONE (916) 538-7541 APN: / PERMIT NO.: Owner's: Name: Owner's: Address: E fO 46 Mobilehome �-5 Year of Manufacturer " �" Manufacture: ! / G✓ J Serial number Insignia or or V.I.N. HUD number: Official approving installation: Date: Y� e 44 `'U `/S (r -�_ If the mobilehome is moved or relocated, the mobilehome installation acceptance shall become invalid. This form shall not be used when the mobilehome is installed on a foundation system. 5138 White -Owner, Yellow -Installer, Pink -Bldg., Gold -Assessor 1 (AP35-072-08) RESIDENTIAL 062-610-005 PERMIT#95-1368 BRINSFIELD, Don & Jean Ir 9 Seminole Ln., Berry Creek Cont; Jerry Perkins Mobilehome Utilities OFFICE COPY Address GAS Meter By EL _ Date Mete: JOB FINALED (Date) Signature J=OK O = Not OK Not Readyable MOBILE HOMES Date MOBI OME UTILITIES Plans OK except #'s • J;elon�p Requirements -Setbacks -Easements oils; Special MH Support Sketch Sewer; Location -Test -Fall -C/O Concrete 4. Wat ; Location -Test -Easement Needed (4etch) lectricity; Location-Clearences-Grn p -Concrete 6. Gas; Location -.Test—# ap: / /"L "ft. / P Nat. or "ft "LPG # Well CI ance 8 isc nnect 8. t Clearance; Date L7 and B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOB HOM INSTALLATION (Plans) OK except #'s Zoni equirements-Setbacks Easements ootin e- Spacing -Marriage Line as; MH Test-Demand-Valve—Connector Elecfrtcity; MH Test -Crossovers -Breakers -Clearances rain; MH Test -Fall -Flex Connector ater; MH Test -Regulator -Connector 7 ater and Sewer Connected -C/O to Grade -HD Approval . G and EI tricity Tagged Exi , nsp.-Sketch 1 Cert. of Occuoancv Dateq)� & Card B-1 Date Card B-1 Dater T Card B-1 Date Card B-1 Cts` _?__4 q9o,5)1 01 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthq.-Rfq.-Bracinq 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. _ Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK O=Not OK -=Not Applicable Not Ready RESIDENTIAL (S ' = Date UNDERFLOOR (Plans) OK except #'s f 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15, Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit),OK except #'s 16. Water Htr.: Vent -Access -Combustion Air -Baffle ------------------ ----------------------------- 17. Water Pipe: Test & Anchor -Nail Protection --------- ----- -------------------------- 18. D.W.V.: Test -Fittings & Anchor -Nail Protection ------- ------------- ----------------- 19. Shower Pan: Test, First Floor -Tub Access ---- -- 20. Test -Tub & Shower, -Second Floor -Tub Access ------------------- ----- ----------- 21. Gas Pipe: Size & Anchors Date Card B-1 Date Card B-1 -------------------- ---------------------------------------------- Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 22. Fixture & Transformer Clearance -Ins. Protection -------------- ---- ---------------------------------------------------- 23. Elec. Receptacles Spacing -Lights & Switches at Doors -------- ----------------------------------------------------------- 24. Size Boxes & No. of Conductors-Stapled ----------------------------------------------------------- 25. -------------------------------- 25. Romex Installed Close to Edge of Studs & C.J. ------------------------------------------- --------------- 26. Equip. Ground made up w/Mech. Fasiners-Bond Gas & Water ----------- ----------------------------------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI --------------------- ---------------------------------------- 28. Subfeed Wire Size i r ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI ------------ --------------- ------------------------------- 29. Range Circ / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No ----------- ----------------------------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect ---------------------------------------------- 31. Equip_ Clearances Panels-Motors-Mech. Equip. 32 Clothes Closet Light -Shower Light -Spa Light 33. Smoke Detector ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- Date Card B -t Date Card B-1 ------------------- -------------------------------------------------------------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support ----------------------------------------------------------------- 35. Vent Fan: Exhaust above insulation ------------ ---------------------------------------------------------------- 36. Condensate Drain & Overflow: Size & Grade ---------------------------------------------------- ---- 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet -------- --------------------------------------------------------------- 38 Attic Access & Platform if Furnance in Attic ----------------------------------------- ------------------------ ----------- Date Card B-1 Date Card B-1 - ------ ------------------------------- ------------------------------------------ Date ----------------------------------------- Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s 39. Sils. Proper Material & Anchors ------- ---------- -------------------------------------------------------------- 40. Walls Studs -Nailing. Spacing & Bracing -Plates -Sound ------ ----------------------------------------------------------- 41. Bearing Walls over Girders & Floor Nailing ----------------------- -------------------------------------------- 42. Draft Stop in Walls (rat proof) ----------------------------------------------------------------- 43. Fire Stops: Furred Ceilings -Stairs -Chases -Tub ----------------------------- __ ----------------------------------------- 44. Headers & Beam -Size & Bearing ingle & Duplex) Depte FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors } 46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Ring. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions _ 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings _-_ 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits - 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection -------------------- 54. plywood on Roof Overhang -Attic 'Dents -Ratter Outriggers 55. Siding -Nailing Veneer ----------------------- -- 56. Stucco Mesh -Drip Screed-FdNen's-Underflr. Access , 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls: Nailing -Bolts 59. Insulation -Walls -Ceilings ----------- - 60: Infiltration -Walls -Windows ---------------- -Date -------- ___________Card_B-1_______ Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector -------------------------- - 63. Furnace: Vents -Clearance -Comb. Air -Connector -- In Garage: Above Floor-Ducts-Mecl-. Protection ------------------ ------------ 64. Bedroom Exiting _ ------------------------ -65.--G.-F.I & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel: Breaker Sizes & Labels ----------------- ------------ 67. Stairs & Rails _ 68. Fireplace or Stove: Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit.Fixt & Appliance: Grnd.-Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door: Swin Landin Clcser --------------------------------------- 73. A.C. Duct in Garage -Damper 74. Wtr. Htr Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor-Mech. Protection ---------------------------------------- 75. Plb.. Elec. & Mech. Equip. Listed for Location 76. Elec. Receptacles in Garage: (G.F.I.)-Romex Protection -------------- 7-,. Insulation -Foam -Looked in Attic ❑ Yes ----------------------------------------- - • 78. Guard Rails & Deck Construction -Post Caps 79. Fdn. Vents.& Crawl Hole Door -Drainage & Wood -Earth -------Clearance Looked -under Floor ❑ Yes+. ---------------------------------------- ` 80. Following instld.: Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No ---------------- - 81-.- Stucco: Brown -Finish ------------------------------------ --- -- 82. A.C. Unit: Disconnect. Electrical, Plumbing ---------------------------------------- --- 83. Vents Above Roof: Plbg.-Appliance-Fireplace.-Clearance to Openings - ------------------------- -- 84. Water Well: Disconnect, Electrical, Plumbing --------------------------------------- - ---- 85. Exterior Elec. Trim: G.F.I. Receptacle -Underground ------------ -------------------------- - 86. Ventilation Throughout House ------- ---------------------------------- 87. Glass Protection 88. Corrections from Previous Inspections ------------------------------------- 89. Gas Test -Meters Tagged: Gas -Electric ---------------------------------- - ------------- 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates------------------------- - --------------------------------------- ---- ---- Date Card B-1 Date Card B-1 -------------------------------------------- --- Date Card -B-1 Date Card B-1 Date Card B-1 Date Card 3-1 Comments at Final: COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES- BUILDING DIVISION w. 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PER T NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 62-61-05 ZONINGU BUILDING PERMIT OWNER DON & JEAN BRINSFIELD 7991.6770 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 1055 E ST RIO LINDO, 95673 CONTRACTOR'S NAME JERRY PERKINS TELEPHONE 533-1749 CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS #4 SEIvIINOLE LANE PERMITFEE $ PLUMBING PERMIT Filing Fee 20.00 BERRY CREEK 95916 Each Trap 7.00 LOT NO. 4 SUBDIVISIONS NAME PARCEL MAP 8q-40Water Solar or heat pump water heater 23.00 piping 15.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome 0 Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities EK Installation ❑ Other ❑ Describe Work: 3 BE ROOM Mobile Home 1§jG W @20.00 60. 00 PERMITFEE $ 80.00 Contractor ELECTRICAL PERMIT Filing Fee 20:00 Main Service ( E00V200A OR LESS OR LESS ) 23.00 23-00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ISL I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NEW CONST. DWELLING OCCUP. ` OR ( a ACC. BUDS. / SO. 3.52 FT. CNS. NEW CONST. MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) a SINGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES) 20 Q 1.00 BAL .50 Ex. Occup. FIXED IR ISE ISE . OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (rhe above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I� 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 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. I/ X &v _ r Date _( � � _ nature of Applicant ❑ Own ❑Contractor ❑ Agent An OSHA permit is required for ex avations over 50" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee Is occ CONST. TYPE TOTAL FEE $ 166.00 HAZ. I D. FEES IMP FLOOD ,--- COF PARCEL PD HD G� ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By ate `1 PERMITEXPIRESON (Dye Receipt No. 18032 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMEWT SERVICES 1469 Humboldt Road, Chico, CA s; .19,16) 891-2751 7 County Center Drive, Orov Ile; CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE / — 'PERMIT NO A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please conrtact this office immediately. n s7 S 7— P Date Inspector Id - R, 10/ COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, PA - (916) 891-2751 7 County Center Drive; Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION 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 notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. Approved steps and or porches shall be installed within 60 days where indicated by X. Permits are required. Date Inspector REV 10/92 DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DMSION OF CODES AND STANDARDS 60-0�,P.O BOX 1407SACRAMENTO, CA 95812-1407 • 916) 255-2501 TIEDOWN SYSTEM CERTIFICATION (To be completed by the mobilehome installation permittee or their representative) V-) i2 CIL r, A -2 L - (Print Name and Title) hereby certify under penalty of perjury and in accordance with the provisions of the California Code of Regulations, Title 25, Division 1, _ Chapter 2, Section 1326 that the portions of the tiedown system installed at r/vl 7 v C� N �J S~ (Addr s) (Lot No.) (City) (Zip ode) below grade were not damaged prior to or as a result of the ' stallation, were not modified prior to or during the installation, and were installed in accordance with the terms of the listing/or in accordance with plans and s�ecifi - ations of an engineered tiedown system. ' 4 , 24E I ZL (Signature) /(Date) Note to Installers: /+ Pursuant to the CCR, T25, Section 1326(d) upon completion of the installation of the home, the home manufacturer's installation instruction, the approved' plot plan, a copy of the plans and specifications ` for an engineered tie down system if used, and a copy of any maintenance requirements for the tiedown system, shag' be placed within the home for retention by the homeowner. Department Use Only Permit # District Representative HCD-NAO.21 (9/94) WARNING BEFORE BEGINNING GROUND ANCHOR INSTALLATION, MAKE SURE THE ANCHOR LOCATIONS WILL NOT BE CLOSE TO ANY UNDERGROUND ELECTRICAL CABLES, WATER LINES, SEWER LINES OR GAS LINES. FAE LURE TO DETERMINE THE LOCATION OF ELECTRICAL CABLES OR GAS LINES MAY RESULT IN SERIOUS INJURY OR DEATH. 1. PARTIALLY INSTALL APPROPRLATE GROUND ANCHOR ALLOWING TENSION HEAD TO MAINTAIN APPROXIMATELY 14" TO 16" MINIMUM GROUND CLEARANCE. 2. USING OVERSIZED HAMMER, VERTIC:LLY INSTALL STABILIZER PLATE BETWEEN FRAME AND ANCHOR. THE TOP SECTION O THE STABILIZER PLATE MUST BE DRIVEN FLUSH WITH THE GROUND TO INSURE SURFACE SOIL COMPACTION. 3. FULLY INSTALL GROUND ANCHOR UNTIL TENSION HEAD BOTTOMS OUT AGAINST STABILIZER PLATE. 1.2) J,,,, : I r r ,rJ INSTALLER/CO\TTRACTOR CERTIFICATION -I CERTIFY THAT I HAVE INSTALLED THE TIE DOWN ENGINEERING ANCHORING SYSTEM AS PER TIE DOWN'S II'�STAI.LATION INSTRUCTIONS AND THAT NO MODIFICATIONS HAVE BEEN MADE TO THE ANCHORING SYSTEM OR BUILDING STRUCTURE. COMPANY NAME: 1ql g �� / CONTRACTORS LICENSE r 4Vfe DATE: -�� e�(� �5 SIGNATURE PAGE 9 UAU IE TEST6NG SERVICES, INC. September 28, 1994 Mr. Locke M. Jones Tie Down Engineering 5901 Wheaton Drive Atlanta, GA 30336 Dear Mr. Jones: LISTING NUMBER: TIE Having completed the in-house audit of quality control, quality assurance, procurement, welding procedures, etc., Tri-State Testing Services in compliance with the rules and regulations of the Department of Housing of California lists the following products: MODEL NUMBER PART NUMBER DESCRIPTION M121-15/8 59080 5/8" X 58" DOUBLE HEAD ANCHOR W/6" AUGER M121-13/4 59085 3/4" X 48" DOUBLE HEAD ANCHOR W/6" AUGER M1225/8 59090 5/8" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS M1223/4 59095 3/4" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS MIT2 59115 3/4" X 8" DOUBLE HEAD THREADED ROD PATIO ANCHOR MIJ2 59120 5/8" X 12" DOUBLE HEAD J -ROD SLAB ANCHOR MICS2 59125 PATIO ANCHOR W/EXPANSION BOLT 59250 59250 31Ll-" X 36" DOUBLE HEAD ANCHOR W/6" & 4" AUGER MRA.") 59110 CROSS DRIVE ROCK ANCHOR 3/4" X 30" ROD \ MIC2 59096 5/8" X 30" CORAL ANCHOR 59292 59292 LATERAL STABILIZER PLATE MGRB 59145 GALVANIZED ROOF BRACKET MIDH 59100 DOUBLE HEAD ONLY MIS2 59105 SWIVEL ADAPTER HEAD 6756 GUCKLES 07)VE MEmpi-iis, TN 38133 90 1 -385-1 199 F.�x 901-386-6614 PAGE 10 B.H. USBQNL Plot Pian Attached i Floor Plan A ftiwd e� Sent to S.D.d�9J ' TO:, Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location L,,A-�<<' AP# N` Plan Approved for: ewage Dis Water Supply: Public Private Well Clearance for bedroo mobile . Other for: clearance O.K. for: Environmental Health 8/92 ;,n�7.`.. a -.'i: iv�r-%v:i'}+"iF�`.;;.��''t'!`. `+�,• ..-':k+'�'`�N>. �;�Lrl'rt`''..:7'°`:.1��,-.w�°1..,��'- '�,'.�r•- ry 'c.F: .0 tr� �- ..�� 000NTYOF BUTTE - DEPARTMENTOF DEVELOPMENTSERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIEORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET �-BOWNER �i -'i�- A. No. D(o,--1 -&/0,- 0 O Proposed Building Use Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: iDATE RECEIVED BY 1. All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of„plans. .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ..................... . 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ .............. ............... 11 mpact fees as shown on attached schedule. . 12. California Department of Forestry plan approval ees. ....jP ...� 3 Flood elevation letter (100 year flood) by California ngineer. ................... . I� 14. Sanitation and plot plan approval DY�vt Health Department . ........... . 15. City of Chico plumbing permit. ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............ . 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 9. Driveway permit (construction approval required prior to occupancy). .. . Pre -Inspection request 20. Pre -inspection for required. .. to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 71 Owner -Builder Verification (Given to owner , Mail to owner _). .......... . OfdZ-& Recorded copy of Agricultural Acknowledgement Statement . .................. . Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use .......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: !/ Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date t - )-/- Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted p 1. Index permit for above items No. 2. Additional items required: it issuance: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by G t 43 oe•l 5 Date 6 -a -a3 Plans approved by C I 8 aJS Date _ - Sets of plans on hold in File cabinet _�� AP folder Copy - Department of Public Works 9.5-0242351' Rec Fee 6.00 And when recorded mail to: I COP 1.00 Building Division Recorded I Cash 7.00 #7 County Center Drive Official Records I Oroville, Ca. 9'5965 County of I Butte I Candace J. Grubbs I Recorder I 9:43am 24 -Jul -95 I PUBL XX 1 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code requires 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: as s� O w'A o YN 'A Oct CC e\rka- V. '?CLMe ` � � � V\tya rT c� f 1 $, !3cl 1'Q 'PcurGe,\ MGtCIL V\ co 4 ac� . �•�G�.S �eCo �c-c��� r� 1�1 E Cl.� G^ F 2eLow 4 Date: 2'J � PROP TY OWNERS: -w4 State of California ) County of'. 04C'Q'41n&V'1� ) Ci- State i On c) 2 before me, jEAd,6 S-7-1?!r A941V personally appeared Pn/ 0 Gtr ? /�/r iSJ , E/L �/1 #/V 1-4 1/01MI.4 personaI known to me (or proved to me on the basis of satisfactory evidence) to be the ernes) whose names is/arc subscribed to the,..,- within he,.- within n instrument and acknowledged to me that he/she/they executed the same in his/her/t Lir—authorized capacity(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 mv hand and official seal. E ElT18bi E. Morgan U Comm. X982207 SACa�ro COUNTY � Signature al: Comm, E�YMIfa�Ct�24.1997-' RESIDENTIAL 062-61-0-005 93-3782 B BRINSFIELD, DON SEMINOLE DRIVE, BERRY CREEK DETACHED GARAGE 86190 r f JOB FINALED (Date) Signature V=OK O = Not OK =N tReadyal;le MOBILE HOMES Date/Initials MOBILE HOME UTILITIES (Plans) OK except #'a 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Teat -Fall -C/O Concrete 4. Water; Location -Teat -Easement Needed (Sketch) 5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Teat -Wrap: / /"L"ft. / /"Net. or/ /"L"ft./ /"LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date/Initials MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks Easements 2. Footings; Size -Spacing -Marriage Line 3.. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fell -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Exits; Insp.-Sketch 10. Cert. of Occupancy MISCELLANEOUS Date/Initial DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'a 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joista-Decking-Bracing-Stairs-Rails 4. Wood Awn.; Posts-Beams-Rftm. Connectors Shthg: Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date/Initials POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosu res -Panel boards- Ins. to Mein in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test V=OK O = Not OK - = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date/Initials UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ P' Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped .8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance -Materiel -Support -Ina. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date/initials PLUMBING (Permit) OK except #'s 16. Water Htr.; Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Nail Protection 18. D.W.V.; Test -Fittings & Anchor -Nail Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe; Size & Anchors Date/initials ELECTRICAL (Permit) OK except #'a 22. Fixture & Transformer Clearance -Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. 26. Equip. Ground made up w/Mach. Fastners-Bond Gas & Water 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No 30. Service -Riser Conductors & Ground -Main Disconnect 31. Equip. Clearances Panels -Motors -Meth. Equip. 32. Clothes Closet Light -Shower Light -Spa Light 33. Smoke Detector D_ ate/Initials MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support 35. Vent Fan; Exhaust above insulation 36. Condensate Drain & Overflow; Size & Grade 37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet 38. Attic Access & Platform if Furnance in Attic Date/Initials FRAMING (Plans) OK except #'s 39. Sils, Proper Material & Anchors 40. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound 41. Bearing Wells over Girders & Floor Nailing 42. Draft Stop in Walls (rat proof) 43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing Date/Initials FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Ong. Joist-Rftr. ties- Puri in=roof Brac-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Wells; Nailing -Bolts 59. Insulation -Wells -Ceilings 60. Infiltration -Walls -Windows Date/Initials FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector - 63. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection 64. Bedroom Exiting I 65. G.F.I. & Bath Fixtures & Tub Access -Spa 66.. Elec. Trim & Subpanel; Breaker Sizes & Labels 67. Stairs & Rails i 68. Fireplace or Stove; Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door, Swing -Landing -Closer 73. A.C. Duct in Garage -Damper I 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage; Above Floor -Mach. Protection 75. Plb., Elec. & Mach. Equip. Listed for Location 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection 77. Insulation -Foam -Looked in Attic ❑ Yes 78. Guard Rails & Deck Construction -Post Caps 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 80. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 81. Stucco; Brown -Finish 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg: Appliance -Fireplace :Clearance to Openings 84. Water Well; Disconnect, Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 86. Ventilation Throughout House 87. Glass Protection 88. Corrections from Previous Inspections 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates Comments at Final: COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County-&.,nter Drive - Oroville, California 95965 - Telephone (916) 538-7541 -� r PERMIT APPLICATION AND PERMIT � r ASSESSOR PARCEL NUMBER 062-610-005 ZONING U BUILDING PERMIT OWNER DON BRINSEIELD (991)"P76 SQ. FT. OCC. BUILDING VALUATION .� 480 M 8,640.00 OWNER'S MAILING ADDRESS O6.INER CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 70 2-C-11 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS SXNIXNKXNK SEMINOLE DR p�7� PERMIT FEE $ IQ 90 BERRY CREEK PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex ClMobilehome ❑ Other • I Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 TYPE OF WORK New (X Addition 1:1Remodel ❑ Utilities ❑ Installation 1:1Other O Describe Work: BUILT W/O PERMITS PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( BOOV OR LESS ) 200A OR LESS 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. SLOS. ) 3.50 FTSO,, CONTRACTORS LICENSE LAW( I declare under penalty of perjury (check one) ❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. - License No. Classification I, as the owner, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) ❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ I am exempt under Sec. , Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET .NON-RESID. ( BRANCH CIRCUITS @7.50 POWER APPARATUS 1 & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES 1 BA20 @ 1.000 Ex. Occu FIXED .)OR ( RESIEA. ) p' OUTLETS (RESTD.E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. XI shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certifythat I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in cons e uence of the grant' g of th' permit. X r / Date_ �l/—� Signature of Applicant - Own r ❑Contractor O Agent An OSHA permit is required excavations over 5"0" deep and demolition or construction of structures ovfr 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ cc coN r TOTAL FEE $ 198.20 HAZ. I D. FEES I IMP I RLOOP111 CDV PARCEL PD J D I This permit is hereby issued under the of the Butte Count Code and/or Resolutions y indicated above for which fees have been DIRECTOR OF PUBLIC BY ALC PERMIT EXPIRES ON `Z /Dare/ applicable provisions to do work paid. WORKS Cg Date ( /3 9`f' Receipt No. 1.53742 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT sp . u COUNTYOF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER 1060,� _ A. P. No. Proposed Building Use�C>: - � h I Building Inspector (��� Date 23 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: �� DATE RECENED BY 1. All items have�been� ubmitted:`. �� .C! ! .�. lot plans, /4 sets, signed b preparer of plans.. �� ........ 3. Complete plans, 3/4 sets, signed by preparer of plans... ................... . .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ ' I 6. Energy Design Compliance and supporting documentation . .................. /I i 7. Statement of Intent for Non -Heated and A/C Buildings . ..................... I 8. Engineered truss details and layout in duplicate (required prior to plan check). 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... fib 10. Fees of $.................................... W2. pact fees as shown on attached schedule. California Department of Forestry plan rov fees.oKPAibC/537Y.2 3. ood elevation letter (100 year flood) by California Engineer. ..... �� Sanitation and plot plan approval 006,/Me-Health Department. .. J 15. City of Chico plumbing permit . .................................... (� 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... fP, 19. Driveway permit (construction approval required prior to occupancy). .. .. ... Inspection reque / ra I 20. Pre -inspection for required. ..wPres�;�d;n9ln�pe���! Pate) 21. Contractor's license information. No., Name Style, Classification). 22. Certificate of Workmans Compensation Insurance . .........................: 23. Owner -Builder Verification (Given to owner , Mail to owner ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. ( / 25. Letter of signature authorization . ........................................ i• / 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . .......................................: .- 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ....::............... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list. ....... 33. .34. Whenry'ou issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone j9/-G77,Q and hold for pickup at Cp&(/,e__ office. Deliver with inspector. Other o lLG Parcel Creation //_7 Acreage Applicant Git_ Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). M Q t Q (4-- - Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner w s advised of above require data by _ phone _ mail Counter by _ Date Plans checked by �`� Date '% Plans approved by Ry% Date Sets of plans on hold in �e cabinet AP folder Copy - Department of Public Works --__ _ 0 E.H. USE ONLY 1'I,,t Ilam Aluchcd Hour Plan nunchrd w-, - 3i TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location `� AP// Plan Approved for: Sewaoe Disposal Fater Supply: !/ I'ubl�ic Private Well Clearance for e. Otherc�-zu Hold fin r: Final cl cc O. K. for: NOT lei Environmental Health Speciali Date 8/92 i COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7341 OWNER -BUILDER VERIFICATION Attention Property Owner:. An "owner -builder''' building permit has-been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to.avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) 2. I (have/have not) "/ signed an application for a building permit' for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors 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 Social Securit Date / NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we ar.e per- mitted to issue -the permit. VIOLATION CHECK LIST A. P. # e&2 -(v/ -Od,-5' Address G07'OY sxi;d�4 � 1� eUe-k, Owner / Owner's Address /OSS E. g&jX1 t e4- 756,7-:; Owner's Phone No. Supervisoral District' Tenant's Name Phone No. Type of Violation in Detail with Code Section Priority No. Specific Plot Plan with C/V Noted _yes no Penalties Required 1st. Notice Sent 9 3 2nd. Notice Sent ate Date Comments and/or Determination Disposition For Citation Citation Date (Date) Department Recommendation to Court Court Action Notice of Violation Recorded (.Date COMPLAINANT: ADDRESS: PHONE NUMBER: OTHER -COMMENTS: � q ' �b A 1� � q ' �b A 1� Donald W. Lavonna J. Brinsfiel'd 105- F. !�t reet Rio Lindo, CA 95673 RF: nuildi.nv Code Violations . Lot 4, Seminole :Drive, Berry Creek Dear Mr. and 'yrs. B.ri.nsfield: Niovember F, 1993 A.P. A: 0162-61--0-005 Thi.s is n courtesy notice to notify you that you are in violation of the Butte County Code, as fo.liows, at tl-:^ nbove referenced lc cation: Failure to obtain approval of previous corrections and failure to obtain fina' inspection prior to use and permit expiration for electr isfor well and future lot_ development. Since permits and inspoctions are required for the above work, apply for the required permits to slake corrections and complete- project and pay t?r� aporOT)ri.ate fees. Failure to obtain the required permits, inspections and approval,, fro. -.Ti this office for construction of a garage. Since pa.rmits and inspections are required for t1he abov` ,sorb, submit three :3i COMPlete sets of plans, apply for. the required e C e P Pp _�a ir�.d per:n�i t.�, .��nci pay th_ appropriate fees. All :'lOY1C must stop until these per -mics are issued and you are author' led by our field inspector to proceed. This field ..-uthori.zati.on cannot be lentil the existing wori: is inspected and approved. It is the Countvls goal to obtain voluntary co: -Oiance with the sZ11tL't: County C«d lIoivrever, you silou.ld be advised that utte County has an Fictive Code nforcement Program which provides an effective means of en Force;.tent if vol,nntary compliance is not. obtained. rnforcergent.: may be pursued throug'.1 the i.ssuanca of citations, fine:, and, the recording of a Notice of Viol. tion :i.ncludinc a description of the action necessary to abate the vio] t ion. Letter to Donald W. &. Lavonna J. Brinsfiel.d RE: Code Violations A.P. ##062-61-0-005 Page 2 November 8, 1993 You have thirty (30) days t:) voluntarily comply with the above directions or to present an acceptable plan for abatement or corrective actions to be taken by you. Should you have questions concerning this matter, please contact Michael �-ieira or Scott Rutherford in this office at the address or telephone number listed above. I`1CV: dms cc: Assessor Yours very truly, rti .0 7:ieira, C.- 1). Managers Fui dingy Inspection v S 4f germi� 1,9.1O-88 t Don Brinsfield Seminole -Dr;BC t - �yr! t: r t 4 Ott a � tom` � �- ,• � � � •,.. ��+ Vl,4 :OFFICEE COPY" Address ► f a M�ief By ' 9� Date I '� ELECTRIC Meter By Dat��� a t i o 7/301°1l . 1 COUNTY OF BUTTE4T= DEPARTMENT OF PUBLIG40RKS 7,County Center Drive - Oroville, Cai fornia 95965 - Telephone: 916/538-7541 APPLICATIOCI AND PERMIT PERMIT NO., . ASSESSOR PARCEL NUMBER ZONIt•�G BUILDING PERMIT . OWNERf j• l� its• ,. TELE -HONE Y r r r / SQ. FT. OCC. BUILDING VALUATION OWNER'S /MAILING �ADDRESS _.j CONTRACTOR'S NAME - TELE 'HONE CONTRACTOR'S MAILING ADDRESS /1 ! F r'( rj (/ r F t" K I Fireplace CONSTRUCTION LENDER UNKN')WN Total Valuation $ Filing Fee $ ,� 10,00 . LENDER'S MAILING ADDRESS I Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS _ Penalty $ BUILDING ADDRESS ( ;. Permit fee $ PLUMBING PERMIT Filing Fee 10.00 I - Each Trap 2.00 tf 1 r I jiNF k Solar or heat pump water heater 20,00 LOT NO. l SUBDIVISION NAME PAnceo MAP c L/0 Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE!! = SF [-I Duplex❑ Mobilehome❑ Other 4'41 SPECIFY Gas piping system 1 -.5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I IN 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Q Describe work: r ✓� r �� M f !t i r ' -i- �P VF 14'aine l Permit Fee $ (/ , Contractor ELECTRICAL PERMIT Filing Fee 10.00 a r SLESS V OR LES '10.00 Main service, 1000 AMP ORS 1/; 41/', Main -service tea. ADD'L too AMP 2.50 CONTRACT ORS'LICENSE LAW �-. I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the,Business/POWER and Professions Code and my license is in full force and effect. F License No. Classification' F] I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended offered for sale. (Sec. 7044) � Q I, as the owner, am exclusively contracting with Iicensed�.contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason — NEW CONST DWELLING OCCUPM '/20sgft OR ADONS, ACC. BLDGS. NEW CONSTR. UTI -OUTLET 2.50 ea NON-RESID BRANCH CIRCUITS) APPARATUS 61 (SINGLE OUTLET CIR. I zoesoe Ex. Occup OUTLETS OR FIXTURES eAL030 FIXED AP \\ h `7 EX. OCCUp. OUTLETS P( LESID R A ) 2.00 ✓ _D( / Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 AI1 r 14^ 19r% Permit Fee f $ L''%, U(. Contractor WORKMEN'S COMPENSATION INSURANCE f I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. O I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. \ MECHANICAL PERMIT FilirgFee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Lamrelating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue said County inconsequence of the granting of this permit. , X ��'�'�-��^' �''�''�4� Date �— �t I� Signature of Applicant — OWner ❑ Contractor ❑ Agent ❑ ,An OSHA permit is required for excavations over 5'0" deep and demolition of construr-t- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ r ,� 7 TOTAL PERMIT FEE $ 1�/ o Occup. CONST.TYP[J SCHOOL FLOOD PARCEL r% PD ND SSUE* Vagainst This permit is hereby issued under sions of the Butte County Code and/or work Indicated above for which DIRECTOR OF PUBLIC B / i V — _ Y _ PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date 'd•- %• �/j'' 4 - I(- 17 Receipt1 / ° WO. YELLOW-ASele SO R, PINK -INSPECTOR. GOLD LN ROD -APPLICANT r. ` � �a laf � °t- i � ti � � � a"'.�J '' �, { COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P MIT NO.! 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 / 4 ' Q/ APPLICATION AND PERMIT ASS S R PAR ELN MBE ZON N BUILDING PERMIT Yf oN R f^ t b �P O fd S0. FT. OCC. BUILDING VALUA ION OWNER'S MAILIN DR ` fi.9,5w CoyerACTOR'S 7r TELEPHONE CONTRACTOR'S MAILING ADDRESS - e rr. Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS N •l Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 r reteSolar or heat pump water heater 20.00 LOT4. . SUBDIVISION NAME PL MAP L/0 Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE t^ � SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer .5.00 Mobile Home S I G I W 0.00 ea TYPE OF WORK New ❑ AdditioryU Remodel ❑ Utilities ❑ I stall tion❑ Other Describe work: ©� -Ve61- i?(Pi? Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 I Main service 6101 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification F] 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) 5J I, as .the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec.—, -Business and Professions Code for this reason NEW CONST. ( DWELLING OR ADDNS. ACC. BLOCS. / OCCUP.y\ , h2sgft NEW CONSTR U TI.OUTLET 2,50 ea NON-RESID BRANCH CIRCUITS) POWER APPARATUS &) SINGLE OUTLET CIR. EX. Occup(OUTLETS OR F XTURES e20A 030 IXED AP Ex. Occup. OUTLETS P(RL,&e[7t40 1 2.00 .0 Temporary service 10.00 Mobile Home Facilities 15.00 Mis Wirin 15.00 g 196--I /K d Permit Fee If $ 19. Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. My I shall not employ any person in any manner so as to become subject `�k' to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue agajast said County iyoconsequerpe of the granting of this permit. Date h '��^7f y Signature of Applicant —/-nor ❑ Contractor ❑ Agent ❑ An OSHA permit is requir excavations over 5'0" deep and demolition or construct- ion of structures ove^r 3 srt�o/i�es in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ ©O OCCUP. CONST.TYPC SCHOOL FLOOD PA71 PD 1 ND ssu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DI ECT OF PUBLIC BY PE T EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS V/_1/���� Date Receipt No. ;/yiu WHITE-D.P.W., YELLOW-A!139361t, PINx-INSPECTOR. GOLDENROD -APPLICANT 1, COUNTY OF BUTTE - DEPARTMENT OF UBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville. California 9596 - Te phone: 916/536-7541 APPLICATION AND PE MIT ASS S R PAR EL N M- ER ZON N - — BUILDING PERMIT Ntln ` r 1 \ g�P 0 ! —7 F OCC. BUILDING VALUATION OWNER'S MAILIN Dq t G CO,MYCTOR'S N TELEPINONE / CONTRACTOR'S MAILING ADD ESS e r,^ FireplaceT. CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee Penalty $ BUILDING ADDRESS Permit fee $ h e— (L PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 eel1^ f Solar or heat pump water heater 20.00 LOT NO. ]SUBDIVISION NAME PAIRCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE [1I SF ❑ Duplex ❑ Mobilehome❑ Other_ ��C1C f r Ivi'_ Gas piping system 1 - 5 outlets Building sewer 5.00 5.00 SPECT FY Mobile Home S I G I W 10.00 ea TYPE OF WORK Other New F-1 AdditioRemodel❑ Utilities❑ Instal/711 l Permit Fee $ ) Describe work: fortion❑ Contractor P U& Olen ELECTRICAL PERMIT Filing Fee 10.00 Main service 6111 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW NEW CONST. DWELLING OCCUP.a OR AODNS. ACC. , /22sgft I declare under penalty of perjury (check one): BLOCS. ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business NEW CONSTR. 1 -OU LET NO...ESID RANCH IR TS //POWER APPARATUS e 2.50 ea and Professions Code and my license Is in full force and effect. (SINGLE OUTLET CIR. License No. Classification Ex. Occup OUTLETS OR F XTURES .20050 L9 30t ❑ I, as the owner, or my employees with wages as their sole compen- Ex. Occup. OUTLETS TPR I OiQ 2.00 ) O . sation, will do the work,and the structure is not intended or offered Temporary service 10.00 for sale. (Sec. 7044) ® I, as the owner, am exclusively contracting with licensed contract- Mobile Home Facilities 15.00 ors. (Sec. 7044) Mis Wiring g 15.00 ❑ I am exempt under Sec. , Business and Professions Coder, — / 00 for this reason Permit Fee 1 $ , Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): MECHANICAL PERMIT Filing Fee 10.00 ❑ The permit is for $100.00 (valuation) or less. Heating ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling g I shall not employ any person in any manner so as to become subject Hood 3,00 to the W. C. laws of California. Ventilation Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such permit Fee $ provisions or this permit shall be deemed revoked. Contractor 1 certify that I have read this application and state that the above information Mobile Home Installation Fee $ Is correct. I agree to comply to all County Ordinances and State Laws relating Energy Inspection Fee $ to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. TOTAL PERMIT FEE $ 1 also agree to save, indemnify and keep harmless the County of Butte againstOCCU P, CONST.TYP[ BLOOD PARCEL all liabilities, judgments, costs, and expenses which may in any way accrue SCNOOL PD ND ,39U[ ag said County i consequeiye of the granting of this permit. X / /�.--��-/ Date f^ r This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do Signature of Applicant – wner ElContractor E)Agent F] work indicated above for which fees have been paid. An OSHA permit is requir for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. DIRECTOR OF PUBLIC WORKS Receipt No. I ' %c�`7ri By Date WHITE-e.P.—TKLLew-a.wr. n. __. __..___ ___. __._ PFRUIT VV010ce ne TO Building Department FROM: , Environmental Health SUBJECT: Sanitation Clearance le! r» > pl e.(� a — 6 %� Owner. Location AP# Plan Approved for: Sewage Disposal Water Supply Oe.11 Hold final for: Final clearance O.R. for: Clearance for bedroom ile home. NOTE *** Other Water Supply Water Supply 113A Sanitarian Date COUNTY OF BUTTE - DE?ARTMENT OF (PUBLIC WORKS - BUILDING DIVISION .,, (. 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET / Permit No. / OWNER © t^ /t 43 hCA (C AP. No. 4OCh Proposed Building Use l C -C ►'�i Building Inspector . Date !J�/ At time of permit application, I was advised the following data must be submitted prior to permit processing and/orissuance: DATE RECEIVED APPROVED 1. All items.have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate./triplicate, signed by preparer of plans. . 3. Complete plans in duplicate./triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. School District "Fees Paid" Stamp on Floor Plan. 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . , , , , , 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. . . 11. Planning approval for (A) Use: (B) Parking: . 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Informatioi (no., name style, classif.) 14. Owner -Builder Verification (Given to owner[], Mail to owner El ) _15. Improvements may be required. r Mobilehome Installation —�Da a. Pre-Inspec. request to(� (Date Al.Pre-Ins Pre -Inspection for .4Re ure. Building Inspector 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. Engineered trusses in duplicate (required prior to plan check). 22. When.you issue the permit, process as follows: 4Mail to owner, Mail to contractor. Telephone and hold for pickup at—off ice, Deliver w/inspector. Other Applicant�� // to 1 �� `o 9 Copy of plans sent Health Dept., Fire Dept., Other ' Date The following data must be submitted) prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone---nail—counter by date Contractor, designer, owner, was advised of above required data by—phone —ma ll—counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW p �� gq - �-o pp)v dotIWA� REVlBVED.BYP..-' BUTTE GO. FIRE' DE. Rv L as sub, iired with col Iditiol is Her attach d she - t5 .I I iate F� 1-* I 'f- v . C)>, o LL STR . 00TURES AND EQUIPMENT INCLUDING WERHANGS SHALL BE CLEAR OF ALL EASEMENTS. I A SET BACK OF 3D FT. FROM THE SIDE AND/IN ?DFT T . FROM THE REAR PR0PEi:,x, LINES AND Fr. FROM THE ROAD CENTERLINE SHALL BE CLEAR & STRUCTURES AND EQUIPMENT EX.CEPTO a FOR A 2 FST'. EAVE OVERHANG. BUTTE COUNTY BUILOM DEPARTMEN1 APPROVED i5\14-1 '13 A,�OVED Butt# County Environmental iHealth . . . ............. . .... . ... . ... /0 COPy COUNTY OF BUTTE- DEPARTMENT OF DEVELOPM ENT SERVICES - BUILDING DIVISION 7 .County Center Drive - Oroville, California 95965 - Telephone (916) 538 -7541n, --PER MI o. APPLI-GATION AND PERMIT /23 ASSE062-610SSOR PARCEL MBER ZONING BUILDING PERMIT OWNER Don & Jean Brinsfield TELEPHONE 991 -6770 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 1055 E St., Rio Linda CA 95673 CONTRACTORS NAME Jerry Perkins TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNIOJOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 23.0 Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS HARING ADDRESS Penalty $ BUILDING ADDRESS Seminole Dr. Berry Creek PERMITFEE $ 43.00 PLUMBINGPERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDNISIONSNAME PARCEL MAP Solar Or heat pump water heater 23.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome kk Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation A Other ❑ Describe Work: far Util PPrmi r#A5-1 168 Mobile Home I S I GI W @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filing Fee 20:00 Main Service 800V OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter • 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, ano my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. l' I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUR OR ADDNS. ( & ACC. BUDS. ) SO. 3.50 FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 POWER APPARATUS (a SINGLE OUTLET CIR. ) Ex. Occup. (OUTLET OR FIXTURES) 20 Q 1.00 BAL .00 • Ex. Occup. (oFIXED (RESID .OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 1 I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to 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. • X_ Date Signature of Applicant CCC��0 Owner ❑ Contractor ❑ Agent An OSHA permit is required for exc ations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee Is 100.00 Energy Inspection Fee $ occ CONST. TYPE I TOTAL FEE $ HAZ. D. E MP FLOOD CDF PARCEL PD HD UE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have BY oo V �;��KfD PERMITEXPIRESON applicable provisions Resolutions to do work bee aid. ee/ I /b (Date) Receipt No. 180325 WHITE-D.D.S.-E.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �r ,A *'4,7-s- i 'hilrCl.6'M "I V'9y'YN-��l:giw�� •^YI'-• Pl _ ,'M',, `k(FN } COUNTY OF BUTTE - DEPARTMENT OF.DEVEL-DAENT SERVICES - BUILDING DIVIS 7 COUNTY CENTER DRIVE - CiRq � CAUFORj;NI'A 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER �ir' 1 V1�Tl P { �.,1 . No.f ��O, - (P I O% OOJ Proposed Building Use �Ak 1. 1 Building Inspector �I Date /4t� At time of permit, application, I was advised the following data mustrbe submitted prior to permit processing and/or issuance: DATE RECENED BY 1. All items have been submitted . ....................................... . 2. Plot plans, 3/4 sets, signed by prepa'rer of plans .......................... . 3. Complete plans, 3/4 sets, signed by preparer of,'plans. ...................... 4. Engineered plans and caics, 3/4 sets, with wet�signature on plans . ............ . 5. Hazardous Material Form . ............ ...... . ............ ` 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ....................... 8 Engineered truss details and layout in duplicate re Dior - ed to plan check). .... Eg�9 Mobilehome data andanu acturer sins a a on instructions 2 sets. ........... 10. Fees of $ .......................................... . a. Impact fees as shown on attached schedule. .`.... . 12. California Department of Forestry plan approval/fee`s........................... 13. Flood elevation letter (100 year flood) by California Engineer. :................. 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . ............................... :.......... 16. Plot plan and business license approval,from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: '` ;(B) Parking: . ......... 118. Contact Land Development about (A) Improvements (B).Drainage............ 19. Driveway permit (construction approval required prior to occupancy). . . Pre!SWCOA req6-67- 20. Pre -inspection for required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification).* .............. 22. Certificate of Workmans Compensation Insurance . ........................... 23. Owner -Builder Verification (Given to owner , Mail to owner _)............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization ......................................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. Letter of intent on building use . ........................................ Mobilehome utility clearance . .......................................... �3i^ 9. ocumentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements. s . 31. Existing violations/expired permits . ........................ter .............. 32. Plan check Ii ..... .......................................... 33. fi �u� �C�c• When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation ` Acreage Applicant Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submittE jdrilr to I e� itrrZ issua ) ce: Circle new item not checked above). 1. Index permit for above items No � 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by_ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY'OF BUTTE - DEPAF X- I ---OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 - TELEPHONE (916) 538-7541 OWNER (n5`IreA 0i PROPOSED BUILDING USE % SCHOOL DISTRICT. FEES' CIrC� (paid at District Office)....... .... 2. SHERIFF FEES .. (paid at Building Department) Residential...... _1 x o =$ unit amt. Commercial (sqft) x _$ sq.ft. amt. 3. URBAN AREA FEES_ (paid at Building Department) Residential (per unit) x =$ # units amt. Commercial (per sq.ft) x =$ sq.ft. amt. 4. RECREATION DISTRICT FEES (paid at District Office) ......................... 5. DRAINAGE DISTRICT FEES (Contact Land Development Division) .............. 6. SRA FIRE INSPECTION AND PLAN CHECK = $89.00...... (paid at Building Department) 7. OTHER 8. OTHER A.P. DATE REC. # DATE REC a! 9 At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. r APPLICANT lY DATE 0 48JOb Of plans and specifteaU flqlyt . at all times and it jisnl7a-qto p)IV al- h alterations'on same without Q�a I or nW1p'TnWis nfr6M the ]Depaxtu%nt of Public Wq&, -CounW of Butte. 0 A M ot - All Materials & Workmanship 81110 Be in tv- K e practic6s and Ac ordanoe Alco d Goo t of quality the =Izi Specified use 8c A�-ambing & MechajaiW inEe Uniform B W 0 F 1 '161 Code. Codes and the Electrioai . REVIEWED By E UTTE CO. FIRE DEPT. r CA IF. DEPT. of F r o -ST F Y ap Droved as submi- -`ed� pi vro°vsd vi:t�h ccridii pe afltaciiads-,-e 1c, 4 r 1 7 ALL STRbCTURES AND EQUIPMENT INCLUDING OVERHANGS SHALL BE CLE-AFRGAF ALL EASEMENTS./iN A SET RACK Or�-- �0 -F-. 'FROM THE SiME AND Sp F -T. Fr -10i -vi T'-iE UNES AND SHALL BE T. r-�7 CLEAR 10-� 0STPU'-=E--S ANID ;EQUIPMENT EXCEPTO V� FOR A 2 FT- EAVE ERHANG. C-140- BUTTE COUNTY BUILUM MPARTMEN1 APPROVED I ,a '� SefN t -�e i 1. Owner's Name: .v d "V 2. Assessor's Parcel Number: 0 d; Z- — �/o D 0 �- -. - 3. Installer's Name: 4. Is the site currently under permit? Yes[:<] No[ ] Permit No. /l;,W / 5. Is the site an existing site? Yes[ ] No[, ,] (If yes, furnish two plot plans). 6. What is the electrical rating of the mobilehome? / O 0 Amperes. 7. What is the mobilehome site circuit breaker rating? /,010 Amperes. 8. What is the electrical rating of the mobilehome site?, 1 a Amperes. 9. Is the main service remote from the mobilehome site? YesW No[ ] If it is, what is the rating? 2 o O Amperes. 10. Is there any other electric load to be served by the mobilehome site electric service (i.e. well, garage etc.)? Yes[K] No[ ] If yes, please identify the load and size: a) The mobile home site: Load- /�e Amperes- 170 b) The main service: Load- Amperes - 11. Type of gas service at mobilehome site: Natural[ ] Propane[(] None[ ] 12. Size of gas pipe at the mobilehome site from the meter or tank: inches. 13. What is the gas pipe length from the meter or tank to the mobilehome?At(ft.). 14. What is the mobilehome gas demand? _ B.T.U.* *(This information is not required if the pipe length is less than 6 feet on natural gas or. less than 50 feet on propane). THE OTHER SIDE OF THIS FORM .MUST BE COMPLETED IN ORDER TO PROCESS THIS PERMIT APPLICATION May 1995 BUTTE COUNTY 8.5 P9 M.H.L- 2 Mobilehome Manufacturer: e bcdl ' Manufacture Year: k-3 If other than single wide, furnish Setup Model Number: Z:�,6 Width:,2 V (ft.) Length: � (ft.) Tagalong or Expando Size --- (ft.) x --- (ft.) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets. FOOTINGS: Wood pressure treated or foundation grade] Other: SUPPORTS: Concrete block[] Other: Provide Tie Down Specifications for all Mobilehomes: Pier Footings Sizes and Location SINGLE WIDE MULTI -WIDE Line 1 f ine 1 Line 2 Line 2 Main Beams Line2...........................................................................................ine 2 Line 1 Line 3 Line 2 ........................................................................................... Main Beams Line 2 Line 1 ................................................ine S Tag or Triple ine 4 Finel Line 1 Piers: - Size minimum: r 1 x Spacing maximum: I j ` From ends-maximumf ` Line 2 Piers: Size minimum: [/Z ] x [301 - Spacing (j].Spacing maximum: ` From ends -maximum: ® ` Line 3 Roof Loads: Alkloo 0,�- Size minimum ywz Location (from front): Line 5 Roof Loads: Size minimum: Location (from front): Line 1 Openings Size minimum: [ ] x [ ]. Each side of openings with width over: ` Line 4 Piers: Size minimum: [ ] x [ ]. Spacing maximum: 4` From ends -maximum: 6` OVER TFI STATETF;'TING - ME]MPHIS, TENNESSEE A CAf TT&,INIfyAPPROVED LISTING AGENCY TIE DOWN ENGINEERING CALIFORNIA APPROVED ANCHORING PRODUCTS •,,-:: ata; _ MANUFACTURED HOUSING AND COMMERCIAL COA, INCLUDES SCHEDULES, DIAGRAMS FOR SINGLE/DOUBLE/TRIPLE/QUADRUPLE WIDE UNITS r 1 ,PRODUCTS DESIGNED FOR A. SOIL ---1,000-4,000 AND UP PSF SOILS (CLASSES 1-4, 200-550 INCH POUNDS AND UP TORQUE VALVE (CLASSES 1-5, UBC -CALIFORNIA) SOIL CLASSIFICATION =1P, 3/31/? J. 1. vliI/0 GENERAL DESCRIPTION OF SOILS ALLOWABLE PRESSURE (Pounds Per Square Foot) SOIL TYPE No allowance made for overburden based on the unified pressure, embedment depth, water classification system table height or settlement problems rock or hard pan 4,000 and u Sandy Gravel or Gravel 2.000 Sand, Silty Sand, Clayey Sand, 1,500 Silty Gravel, or Clayey Gravel Clay, Sandy Clay, Silty Clay, or 1.000 Clayey Silt Uncommined Fill Special analysis is required. Peat or Oroanic Clays I Soecial analysis is required. B. WIND—ZONE 1, 85 MPH EXPOSURE "C" i _/EDOwN 5yg7,�/n APPROVED S�JC!f:-, TO C C F 2 E C T S NOTED °PProvnl ,in..'. not rprrcve any omission or oev;C:tior. ironn reyv:�vr::,-�.•; of runplicnl�le Stole lows and �rµtloii. r.s. 51WC: v! californics Ca.rCr+etpnt cf Hot,sirc wad cemmvnity Develepment my-c:O;J O,q C, -E5 ,.;1D STANDARDS �sig.xuty: e) SQA '�1G...-_.�. Ap!:,rovc:,1 Expires.. � C. SEISMIC—ZONE 4 Types of Soil 1 Hard —1, Blow Count Test Probe 1 (ASTM D1586) Torque Value 2 NA NA 21.1 Very-d—a and'or cemented s..d,. coa.•u ravel and cobbles, more than prei-eird silts, and cl.ys 40"up 550 lb,. Inch more hen Ibl Corals 40vp 550 ib,. inch 3 Dtedi—dense c..,. san—y.ds. sandy gravels, y. 350 to stiff stn & clays 2:39 549 ths. Inti 4 Loose to medium dense sands. f .. to still clays & 200 to sdu. aeuvi.. fill 1: 23 339 lbs. huh 5 Conaae slab Tmsionm9 devien for is hconaeta ped. —. ate, hall be tested (same as anchors) and specifications as to PEI and we W- al conaeu, ronlor<em m s1... and thick—s of cnncau, site and depth of bait NA.. type and kid of shield d p—sb4. M'vtimom distance at which. tensiorting device can be Installed hom edge w end of slab. pad. tunes, ac., she➢ be specilsl. Inszuc:s.ns shipped with each tmaionin9 device shad include the abwe. (a) The test probe Is a drrice for -%=N the torque value of sods to assist in -dusting the haidbsg capability of the sods h uiAkh the anchor Is pbced. The last probe has a hall. on h. The ",an 4ngth of the heacal sects.. 6 10.75 hrhes: the major di—.. b 1.2+ inches: the mhb or diameter 0.81 fiches: the pitch 1.75 lnchn. The shah rmut M of suitable let9th lot anchor depth. @I A nxasure synonymous with menet of a face when cO ubuted around the shah of the test ptobs. Id 5.1— these wean. • proleus.nei emgi should be comlitc! or aidlnonal anchors added. Desion Wind -load Zones:. Standard Wind Zone 1 15 psf Horizontal 9 psf uplift' Hurricane Zone II _39 psf Horizontal 27 pst uplift Hurricane Zone III t47 psf Horizontal 32 psf uplift ' net uplift Note psf: pounds per square foot Reference -- Manufactured Home Construction and Safety Standards (MHCSS) 24 CFR 3280.305(c)(2), latest edition �pp e+Y 2. CAPACITY OFANCHORS - EACH GROUND ANCHOR, WHEN INSTALLED, SHALL B Ca OF RESISTING AN ALLOWABLE WORKING LOAD AT LEASE EQUAL TO 3,115A,P046PlUSN,G A 50 PERCENT OVERLOAD (4,725 POUNDS TOTAL) WITHOUT FAIL 3. CAPACITY OF STRAPPING - TIE DOWN ENGINEERING GALVANIZED STELS MEETS OR EXCEEDS THE NCSBCS/ANSI 225.1-1994 AND THE ASTM -D 3Qa597iSPI1TFICNS FOR 1-1/4"X.035 (MIN.) TYPE 1, FINNISH B, GRADE HOT DIPPED GAI:VANI+Z D STRAPPING. CONFORMS TO SB -750 REQUIREMENTS SECTION 1336.3 OF TH CALIFORNIA CODE OF REGULATION TITLE 25, 18613.4 OF THE HEALTH AND SAFETY CODE. PAGE 1 D M w Side Frame Ties Must Be No More Than 2' From Each End Of Unit Other Ties Spaced Evenly Thoughout The Length ❑f Unit. Wind - Zone I (85 MPH - Exposure "C") Side rtes Seismic - Zone 4 —) I— 2' Max. —I I— 2' Max. Double Wide Unit End Ties Required Number Of Tiedowns For Each Side And Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tiedown Locations Side End Side End Side EEd[Side End Side End Side End Side End Side End Side End Single Wide 4 4 4 4 S 6 4`' (4 Totnl Nunber OF 7 4 g 4 g 4 8 4 Tiedowns 16 16 1B ?n C aa --4 nn it aJ Engineering Calculations 85 MPH Wind EXP °C" 85 MPH Wind EXP "C" Vs. Seismic Zone 4 P LAT=(1.06)(1.3)(17)(1)=25.6 PSF 333 PLF=0.186 1(32.5)( � "")+160) W LAT=(25.6 PSF)(13')=333 PLF =50.8'=D 51' Vktth Seismic Zone 4 V=0.186(DL) V=0.186 C(10 PSF)C �; )+( +10 Psf)(;,,lh )+(2 WALLS)(8')(10 PSD] Wind - Zone 1 (85 MPH - Exposure "C') Seismic - Zone 4 Width Length Load /Load Trans Trans Total Load (Trans) Total Load (Long) 11 Trans T.D. Side 'ries B Long T.D. End Ties 40 FT. 333/333 13,320 LBS. 4,662 LBS. 5 2 Single Wide TO 14' 50 FT. 333/333- 16,650 LBS, 4,662 LBS. 6 2 60 FT. 333/392 19,980 Lbs, 5,488 LBS. 7 2 70 FT. 333/453 23,310 LBS, 6,342 LBS. 8 2 40 FT. 333/333 13,320 LBS, 9,324 LBS. 5 4 Double 50 FT. 333/333 16,650 LBS. 9,324 LBS. 6 4 Wide Wi28' 60 FT, 333/392 19,980 Lbs. 10,976 LBS. �� 70 FT. 333/453 23,310 LBS. 12,684 LBS. 8 4 40 FT. 333/333 13,320 LBS. 13,986 LBS. 5 6 Triple Wide To 42 50 FT. 333/333 16,650 LBS. 13,986 LBS. 6 6 60 FT, 333/392 19,980 Lbs. 16,464 LBS, 7 6 70 FT, 333/453 23,310 LBS. 19,026 LBS. 8 6 Quad 40 FT. 333/333 13,320 LBS. 16,650 LBS. 5 8 50 FT. 333/333 16,650 LBS. 16,650 LBS. 6 8 Wide Wi50' To 60 FT. 333/392 19,980 Lbs. 19,600 LBS. 7 8 70 FT. 333/453 23,310 LBS. 22,650 LBS. 8 8 TIE DOWN ENGINEERING INDEPENDENT TESTING RESULTS ML 45 DEGREE PULL ON -STABILIZER PLATE IN SILTY 6,067# 8/5/92. (59292) CLAY. TEST PROBE TORQUE VALUE BETWEEN (AVG.) 200-349 INCH POUNDS - NOTE: ALL ABOVE TESTS WERE CONDUCTED BY ATEC ASSOCIATES, PRODUCT TESTING, INC. AND GALLET & ASSOCIATES. THE INDIVIDUAL TEST RESULTS WILL BE MADE AVAILABLE UPON REQUEST. PLEASE FORWARD YOUR REQUEST FOR THIS INFORMATION TO: TIE DOWN ENGINEERING 5901 WHEATON DRIVE ATLANTA, GEORGIA 30336 PAGE 7 ULTIMATE MODEL NO. DESCRIPTION OF TEST STRENGTH TEST DATE M12H VERTICAL PULL-OUT IN MOIST SILTY CLAY. 6,133# 9/15/92 (5/8"&3/4") TEST PROBE TORQUE VALUE BETWEEN (AVG.) 200-349 INCH POUNDS - M122 VERTICAL PULL-OUT IN SILTY SAND AND GRAVEL . 5,733# 9/15/92 (5/8"&3/4-) TEST PROBE TORQUE VALUE 550 INCH POUNDS (AVG.) AND MORE-, - MRA VERTICAL PULL-OUT IN LABORATORY FIXTURES 5,567 3/2/93 FOR SIMULATION. UNCONFIRMED ROCK WAS NOT AVAILABLE. MICS2 VERTICAL PULL-OUT IN 2500 PSI CURED 5,200» 3/24/94 CONCRETE. TEST STOPPED AT 5,200 POUNDS. MIJ2 VERTICAL PULL-OUT IN 2500 PSI CURED 5,200# 3/30/94 CONCRETE. TEST STOPPED AT 5,200 POUNDS. MIT2 VERTICAL PULL-OUT IN 2,500 PSI CURED 5,2001-r 3/30/94 CONCRETE. TEST STOPPED AT 5,200 POUNDS. M122H64 VERTICAL PULL-OUT IN SILTY CLAY. TEST PROBE 5,200# 10/6/93 (59250) TORQUE VALUE BETWEEN 200-340 INCH POUNDS ML 45 DEGREE PULL ON -STABILIZER PLATE IN SILTY 6,067# 8/5/92. (59292) CLAY. TEST PROBE TORQUE VALUE BETWEEN (AVG.) 200-349 INCH POUNDS - NOTE: ALL ABOVE TESTS WERE CONDUCTED BY ATEC ASSOCIATES, PRODUCT TESTING, INC. AND GALLET & ASSOCIATES. THE INDIVIDUAL TEST RESULTS WILL BE MADE AVAILABLE UPON REQUEST. PLEASE FORWARD YOUR REQUEST FOR THIS INFORMATION TO: TIE DOWN ENGINEERING 5901 WHEATON DRIVE ATLANTA, GEORGIA 30336 PAGE 7 r TIE DOWN ENGINEERING ANCHORING SYSTEM MI2H (5/8"-3/4") 48" LONG ANCHOR PAGE 8 kTERAL STABILIZER PLATE MI22 (5/8"-3/4") 30" LONG ANCHOR 40' to so° V SIDE FRAME TIE (MBU) a J MRA (ROCK �o M BUCKLE/W STRAP (SIDE FRAME TIE) MLFT (ENI) FRAME TIE) TES�TIVG SERVICES, INC. September 28, 1994 Mr. Locke M. Jones Tie Down Engineering 5901 Wheaton Drive Atlanta, GA 30336 Dear Mr. Jones: LISTING NUMBER: TIE -942609 Having completed the in-house audit of quality control, quality assurance, procurement, welding procedures, etc., Tri-State Testing Services in compliance with the rules and regulations of the Department of Housing of California lists the following products: MODEL NUMBER PART NUMBER DESCRIPTION M121-15/8 59080 5/8" X 58" DOUBLE HEAD ANCHOR W/6" AUGER M12H3/4 59085 3/4" X 48" DOUBLE HEAD ANCHOR W/6" AUGER M1225/8 59090 5/8" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS M1223/4 59095 3/4" X 30 DOUBLE HEAD ANCHOR W/2=4" AUGERS MIT2 59115 3/4" X 8" DOUBLE HEAD THREADED ROD PATIO ANCHOR MIJ2 59120 5/8" X 12" DOUBLE HEAD J -ROD SLAB ANCHOR MICS2 59125 PATIO ANCHOR W/EXPANSION BOLT 59250 59250 3/4" X 36" DOUBLE HEAD ANCHOR W/6" & 4" AUGER MRA%% 59110 CROSS DRIVE ROCK ANCHOR 3/4" X 30" ROD MIC2 59096 5/8" X 30" CORAL ANCHOR 59292 59292 LATERAL STABILIZER PLATE MGRB 59145 GALVANIZED ROOF BRACKET MIDH 59100 DOUBLE HEAD ONLY MIS2 59105 SWIVEL ADAPTER HEAD 6756 DUCKLES CCDVE PAGE 10 . f M=impHis. TN 38 1 33 90 1-385-1 1 99 FAx 901-386-66 1 4 t 5, BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (Onfs Form Per Building) School District Crny Building Department No. A.P. Number QW—COW-007 Jurisdiction: 1,___i City Property OwnerLDl Property Location/Address zCounty Subdivison Lot No. Residential Development E� [] Sq. Footage 1.3(44 No. of Living MHI Addition (Group R) - Units " Commercial/Industrial 0 0 Sq. Footage ' New Addition (Including Exterior Roofed Areas) _ _ Building Departme t epresentative Date (Floor Plans reviewed by School District Personnel) Dict Identification No. "9 1;f' V '1*t4,iJJSchooI District certifies that I GCJ Applicant) (Street Add ss) �,,, (Phone Number) 1 (City) N (State) (Zip Code) p� has complied with the requirements of Resolution No, �Q S- ! &7 b payment of $ ' P q Y P Y representing square feet. School District Represent ive Paid by Check # Bank Number Paid by Cash All 2926 $ FULL MITIGATION $ Date 1 , If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School'District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. . White (applicant), Yellow (building department), Pink (school district) feeform.wkt (11/94)dmm