HomeMy WebLinkAbout062-760-006Mal -760-00(P A.P .
Mr. &.Mrs. Douglas A. Ward
s1s Bald Rock Rd. 2 mi. east of Sugar
Pine Store, Bald Rock ,
Permit 3413-72P,E11-�1e�13��3
t' s or mobile Lnmel
1230 '90B', P, E', M, '<
SCHLICTING, Mary�
23 6ingle Ln, 'Berry•. Creek
Cont:r: Clanton` Constuctiori
(new,, single family)
062-760-006 06-0246 .
SCHLICHTING, MARY V '
23 SINGLE LN, BERRY CREEK
Cont: RISSE & SONS
REPLACE WATER HEATER V f
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61
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BUTTE COUNTY INTERDEPARTMENTAL CORRESPONDENCE
DELIVER TO LAST PERSON NAMED
DATE I NAME I DEPT. I DATE I NAME I DEPT.
RESIDENTIAL
62-21-108 1230-90B,P,E,M
SCHL141NG, Mary
23 Single Ln, Berry `Creek
Contr: Clanton Constuction
:3 (new single family)
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JOB FINALED (Date) —
{ Signature
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x:
RESIDENTIAL
62-21-108 1230-90B,P,E,M
SCHL141NG, Mary
23 Single Ln, Berry `Creek
Contr: Clanton Constuction
:3 (new single family)
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F�
JOB FINALED (Date) —
{ Signature
J=OK
O = Not OK
N�pt= Applid
Not Readyable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch J
3. Sewer; Location -Test -Fall -C/O Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / /"L"ft.
/ /"Nat. or/ /" L' ft./ /"LPG
7. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks Casements
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector ,
6. Water; MH Test -Regulator -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
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (PlaA)OK except #'s
a
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Stent
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs: Coonectors
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. Fad.; 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-Enclosu res -Panel boards- 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
✓=OK
O=Not OK
- = Not Applicable
' Not Ready
RESIDENTIAL
=
Date UNDEF
AOOR (Plans) OK except #'s
oning-Setbacks-Easements-Flood-Slope
2. Ftg., Main; Soils-Elec. and Ftg. Depth
g., Garage; Soils-Steel-Elec. Grnd j TL( Ftg. Depth
Porches & Decks; Soils-Steel-/f'/Ftg. Depth
walls, Main; Steel-Blockouts-Wrapped
a-Sterrhwalls, Garage; Steel- Bloc kouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab; I -Wrapped
i e rs- F h epl aT F[g'9tee4
V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. Gas Pipe; Size -Anchors
mer 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. Insulation
Date Card B-1 Date Card B-1
Da +) Card B Date Card B-1
Dat PLUMBING Permit OK except #'s
Water Htr.; Vent -Access -Combustion Air -Baffle
Water Pipe; Test & Anchor -Nail Protection
U,8-_D.W.V.; Test -Fittings & Anchor -Nail Protection
.19 -Shower Pan; Test, First Floor -Tub Access
Wiest Tub & Shower, Second Floor -Tub Access
21. Gas Pipe; Size & Anchors
Date 010-' f7 Card B-1 &14 Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. ere & Transformer Clearance -Ins. Protection
—2' Elec. Receptacles Spacing -Lights & Switches at Doors
Size Boxes & No. of Conductors -Stapled
omex Installed Close to Edge of Studs & C.J.
Equip. Ground made up w/Mech. Fastners-Bond Gas & Water
Z_F2 Appliance Circuts in Kitchen & Conductor Size/GFI
S /-ga. Cu or AI-A.C. Wire Size /b/ ga.
_( 01!Z) _
9. Range Circ. / 1. ga. Cu or Poven Circ./ / Cu or Al.
I elated Neutral 0 Yes . ,! o
0. "vice -Riser Conductors & Ground -Main Disconnect
1. Equip. Clearances Panels-Motors-Mech. Equip.
32c-etotlfs Closet Light -Shower Light -Spa Light
Smoke Detector
Date Card Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
34. A.C. Ducts Insulation & Support
08 -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 b W / Card B-1 4�w Date Card B-1
Date Card B-1 o Date Card B-1
Date FRAMING (PI s) OK except #'s
39. Sils, oper Material &Anchors
0 alts Studs -Nailing, Spacing & gjaci - lates-Sound
Bearing Walls over Girders & Floor Nailing
.%k42 -Draft Stop in Walls (rat proof)
L L4T'Plre Stops; Furred Ceilings -Stairs -Chases -Tub
Headers & Beam -Size &
(Single & Duplex)
Date FR NG (Continued)
gers-Post Caps -Anchors -Connectors
Ing. Joist-Rftr. ties-Purlin-roof Bra -_ hthng.-Rfng.
;47. Fireplace Ties or Type A Flue -Fireplace Throat clearance
L45'Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
Garage Fire Protection Framing
59-4Rreperty Line Firewall & Openings
Ext. Doors -One T -Check Garage -3rd Story, 2 Exits
53-Stwr9,_`Width-Head room -Rise-Run -Land ing-Fire Protection
'L54"plyw od on Roof Overhang -Attic Vents -Rafter Outriggers
iding-Nailing Veneer
5C_Siueee,)Mesh-Drip Screed -Fd. Vents-Underflr. Access
C,5? -Glazing Area -Glass Protection -Skylights -Plastic,
58 Walls; Nailing -Bolts
9. In.awlation-Walls-Ceilings
Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date {x,17 JCard B-1 Date Card B-1
Date FIN Plans OK except #'s
Of Ext. Steps -Door & Sidelight Protection -Landings
Smoke Detector
un
Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
Bedroom Exiting
, F.l. & Bath Fixtures & Tub Access -Spa
_46&.-Ere—c. Trim & Subpanel; Breaker Sizes & Labels
airs & Rails
66. replace or Stove; Clearances -Hearth
/J;9.�ec. Outlets at Wood Panel; Int. & Ext.
it.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
. Outlets & Receptacles at Kit. Counter
/ Garage Fire Door; Swing -Landing -Closer
73.A_-er-9vct'In Garage -Damper
I.K. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
I Garage; Above Floor-Mech. Protection
Plb., Elec. & Mech. Equip. Listed for Location
l Receptacles in Garage; (G.F.I.)-Romex P otection
l nsylation-F.eam-Looked in Attic es
Guard Rails & Deck Construction -Post Caps
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor es
80. Following instld.; Drive es No; Walks es EI
Planters 0 Yes No
inish
A.C. Unit; Disconnect, Electrical, Plumbing
LOS-V-ent Above Roof; Pibg.-Appliance-Fireplace.-Clearance to
Openings
Water Well; Disconnect, Electrical, Plumbing
xter- rElec. Trim; G.F.I. Receptacle -Underground
entilation Throughout House
Glass Protection
88. Corrections_jmffi Previous Inspections
89. Gas TArMeters Tagge GA ctric
90. W e>'& Sewer Connected -C/O to Grade -HD Approval
nergy Compliance Certificate -Other Certificates
Date Card Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
(NOTE: An entry must be made each time you'visit'job site)
V ,+ -� - ..` - ... s °.t r •s ^Y yb, .,i .. wj'�°t{i�?»n' '.....w.Y. "�,t� q�4� :'h ,�y�,�, f a� itt
�r`E Six.
Owner Permit No., w
-T ENERGY CERTIFICATION
LOCATION
ROOF
MATERIAL_
THICKNESS
EXTERIOR -WALL
A. P. NO.
DESCRIPTION 00 INSULATION
BRAND NAME
THERMAL RES.
MATERIAL `
FIBERGLASS BRAND NAME
CERTAINTEED
THICKNESS
74 THERMAL RES.
CEILING
3114 �� C
BATT OR BLANKET
TYPE, BRAND NAME
CERTAINTEED
THICKNESS
THERMAL RET.
LOOSE FILLTYPE
INSUL-SAFE IIIBRAND NAMERTAINTEED
THICKNESSri
2 THERMAL RES.
O
FLOOR,ELEVATED
MATERIAL
FIBERGLASS. BRAND NAME_ I
^ CERTAINTEED
THICKNESS
THERMAL RES/
_tq
FLOOR, SLAB
MATERIAL
THICKNESS
WIDTH
FOUNDATION WALL
MATERIAL
THICKNESS
BRAND NAME
THERMARES .
BRAND NAME
%THERMAL RES.
I HEREBY CERTIFY THAT THE ABOVE/INSULATION WAS INSTALLED IN THE ABOVE
BUILDING IN CONFORMANCE WITH T,8 STATE OF CALIF. ENERGY REQUIREMENTS.
SHASTA INSULATION INC. ( #530235
FIRM NAME/O NE STATE CONTR. LICENSE NO.
iv- - t9— O.O
I hereby certify the above irt'sulation and all required items as shown
on the Building Depart. approved plans and attachments have been installed
as required by the State of 'California Energy Requirements.
All equipment, devices and materials are of the quality prescribed or
are specifically approved 1�y the State of Calif.
/ 1-----6------------
FIRM NAME/OWNER (PLEASE FiRINT) STATE CONTRACTOR'S LICENSE NO.
SATURZZ A-/ e,) -
OF NERAL COPITRACTOR/OWNERr D TE
T is certificate must b,e on file with the BUILDING DEPARTMENT prior to
final inspection approval and a copy shall be posted within the building.
J
JANUARY 1984
,r
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 538-7541
I 747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
r I I / /
JNER PER b IT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
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Date/2—��/ Inspector
COUNTY OF BUTTE <:
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
JD c -T a
OWNER i PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
.when correction of work is completed. If you have any question pertaining to this.
matter, or need additional explanation, please contact this office immediately.
l .i
zT.
Date /�1i Inspector
f, •Fi
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541'
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
S�_
OWNER m PERMIT N(
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this.office
when correction of work is completed. If you.have any question pertaining to this
matter, or,ed additional explanation, please contact this office immediately.
r
1
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`w be 4r-- r14-7 f�%U A?()
y
Date 9//Inspector �/
i
L COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751 .
7 County Center Drive, Oroville — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
OWIVER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
42
vr�
Date&6-) �S Inspector �&� _
1 .
4
COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMEli„ER
62-21-108
ZONING
U
BUILDING PERMIT
OWNER
MarSChlicti
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
1895 R 75 800
OWNER'S AILING ADDRES
246 W. F1 nn Ln Phoenix.
484 M 6 776
CONTRACTOR'SN ME.
Clanton—
TELEPHONE
100
Coa 1 000
CONTRACTOR'S MAILING ADDRESS -
252AveFireplace
A 1,000
CONSTRUCTIO LENDER
UNKNOWN
Total Valuation 1 $ 84,576
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$ 388.00
ARCHITECT OR ENGINEER
none
LICENSE NO.
Plan Checking Fee
,$' 194.00
Energy Plan Checking Fee
$ 15.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$ 607.00
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00 16
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
iZ
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF [W-,, Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00e
TYPE OF WORK
New 'n Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work: 3 BR _
Permit Fee
$ 61 nn
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00 10.00
Main service EA. ADD -L 100 AMP
2.50 2.50
CONTRACTORS LICENSE LAW
1 declar under penalty of.perjury (check one):
I am licensed under provisions Of Chapt. 9, Div. 3 of the Business
and Professions ode and my license is in full force and effect.
%� ` 3
License No. V J Classification .�
❑ I; 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)
❑ 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 oc grc�)
OR ADDNS. ACC. BLDGS
1 .
2yzOsgft 59.45
NEW CONSTR. ULTI.OUTLET
NON.RESID BRANCH CIRC ITS
2,50 ea
POWER APPARATUS.8.)
SINGLE OUTLET CIR.
Ex. Occup OUTLETS OR FIXTURES
20®g0¢
SAL®30
Ex: Occup. OU LETS ED PR
(RESID IEA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 '
Permit Fee
$ 81.95
Contractor
i
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
f Consent to Self -Insure.
LJ ' 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
Filing Fee 10.00
Heating
6.0
GAS PACK
Cooling
6,��
Hood
3.00 3.00
Ventilation
Permit Fee
$ 25.00
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
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 ounty in co eq nc f t granting of this permit.
X Date �� ®
indicated
Signatur of Applicant — Owner ❑ Contractor agent ❑
An 0 A permit is required for excavations over 5'0" d emolition or construct.
ion o structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $-,C�
c
CONST
V
TOTAL FEE $
804. 5 -
HAzcuA
�-
PARK
SCHL
-�
F D
PAR
PD
H
ISSUE
This permit is nereby issued under
sions of the Butte County Code and/or
work above for which fees
DIRECT OF PUBLIC
By
PER T EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
ate J ,�l — ^y
Receipt No. 64153 `-O �- P'
WNIr!-D.P.W., TEL LOW-A53[S90 R, PINK-INSPE R,, aLD a -A L NT
11r.
COUNTY OF BUTTE - DEPARTMENT.OF• PUBLIC, WORKS> BUILDING DIVISION
4f. It ^
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95865 -TELEPHONE: 918/538-7541 '
r �t,'� ° ... -
-�' PERMIT AP.PLItATION DATA SHEET
iPermit.'No.
OWNER /fog 24 llUs A. P. No.
Proposed Building Use nm lS�t' %` Building Inspector -OW Date
v _
At time of permit application, I was advised the following data rriust be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1. All items have been submitted. ........... " ........... ... ....
2. Plot plans in duplicate/triplicate, signed •by preparer of plans.. 4.....
3. Complete plans`in duplicate/triplicate, signed by preparer.of plans ..
4. Complete engineered plans and calcs, with wet signature on plans ..
5. Hazardous Material Form ................. :.........................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ............... _
8. Engineered truss details and layout in duplicate (required prior to plan check) •
9. Mobilehome installation data including manufacturer's installation
instructions.......................................................
10. Fees of $ ...............
11. Chico Urban Area fees paid•' ...................................... .
12. Park f s paid ....................................................
` i13. 1/1A School District fees paid ................
V/u/ 14. Sanitation approval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
7 7. Planning approval for (A) Use: —(B) Parking: ......
` 18. Improvements may be required. Contact Land Development Section DPW
_1 9. Driveway permit (construction approval required prior to occupancy)
20. Pre -Inspection for required Pre-Inspec. request to
Building Inspector (Date)
21. Contractor's license information (No., Name Style, Classifications ..
22. Certificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ...
24. Recorded copy of Agricultural Acknowledgment Statement .........
25. Letter of'signature a thori ti ...................................
26. Di✓,L,o.(/
27.
When you issue the permit, process as follows: Mail to owner. Mail to contractoNti l
Telephone and hold for pickup at 090 office. Deliver w/inspector.
Other
Applicant 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 to permit is e: (C le n�ewi t checked above).
1. Index permit for above items No. 11T /11
2. Additional items required: -
Contractor, designer, owner, was advised of above required data by—phone ___jnai.l—counter by ..date
Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by Date Plans approved by c1Z Date J L//
_�,–
Sets ofS1 Qin FEW. i 11 mut AP folder
Copy—DPW
I
TO
'FROM:
`,. SUBJECT:
Building Department
Environmental Health
Sanitation Clearance
_..�— Owner Location A?#
Plan Approved for: Sewage Disposal Water Supply
?old final for: Water Supply
Final clearance O.R. for: Water Supply
Clearance for -7�3 bedroom cme Other
NgTE
Sanitarian Dat®
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
6 7 County Center Drive - Oroville, California 95965 - Telephone: 916:1538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASES OR P RC L NU B�
0
ZO"' `
BUILDING PERMIT
w a ,� `
0;r
TELEPHONE
S0. FT. OCC. BUILDING VALUATION
'
O NER'S M ILING A RESS
I'� 0 h tol f� ii 1- )
C TRACTOR'S NAME �1 TEL PHONE
® cher � -
✓
C RACTOR'S AILING ADDRESS
Ls r• Z
Fireplace
/,000
CO RUCTION EN ER
n V1 C-
UNKNOWN
a
Total Valuation J
Filing Fee
$
10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ CW.
190
AR H ECTCOR ENGINEER
LICENSE No.
Plan Checking Fee
$
D
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS q ^ `
OR/va(
Permit fee
'
$ 6
91001
PLUMBING PERMIT
Filing Fee
10.00
Each Trap
2.!flo
t^ ��E
Solar or eat pump ater heater
20.
LOT NO. SUBDIVISION NAME
PARCEL MA
Water piping
5.00
's-_00
Each qas water heater or vent 5.00
USE OF STRUCTURE
SFIK Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Q Q
Building sewer 5.00
Mobile Home Is G W 10.00e
TYPE OF WORK
New Addition [:1Remodel El_ U-lities ❑ Installation❑ Other [J
De cribe work: ���`J
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee
10.00
Main service eoov OR LESS
100 AMP OR LESS
10.00
p
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, 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 contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
OR ACONSDDNST (DAWELLIN G0cc
S.
Z/vtsgft
NEW CONSTR ULTI.OUTLE%2.50 ea
NON.RESID BRANCH CIRC ITS
/POWER APPARATUS e
(SINGLEOUTLETCIR. )
Ex. Occup(OUTLETS OR FIXTURES 200300
eAL030C
FIXED APPLNS. R
Ex. Occup. OUTLETS RESID IEA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for 5100.00 (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.
❑ 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.
Contractor
MECHANICAL PERMIT Filing Fee
10.00
Heating
Gos
lin
Cooling
6,073
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.
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 consequence of the granting of this permit.
X Date
Signature of Applicant — Owner❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures oveY-3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $ D 4�
HAZ
I CUA
PARK
SCHL
FLo
I PAR
I PD
I HD I ISSUE
Th;s permit is hereby issued under
sions of the Butte County Code and/or
'work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable
resolutions
have
WORKS
Date
provi-
to do
been paid.
..
Receipt No. 4.54
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
Mrs. Thos. N. Schlichting
West est Flynn Lane
Phoenix, Arizona 85013
Return to DPW AGRICULTURAL STATEMENT OF.ACKNOWLEDGEMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8.1 of the Butte County Code.
requires this acknowledgement be recorded
prior to issuance of a building permit.
The property describedherein is adjacent
to land or included within an area zoned A(,',, iEPTED F-Ok RECORDING
for agricultural purposes,. and residents AT
&01 A.hfi�
of this property may be subject to incon-
veniences or discomfort arising. from theP1pY 9 g 1990
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 agricul-
tural zones which have as a priority use for productive agricultural purposes, and residents
within said zones and .on adjacent property should be prepared to accept such inconvenience
or disconform from normal, necessary farm operations.
All that real property situate in the County of Butte, State of California, described as
follows:
Parcel 3. Portion of the south 1/2 of the northeast.1/4 southwest 1/4 section
34, T21N, R55, MDB&M. Record of survey and parcel map filed in Office of
Recorder, Book•41, page 27.
23 Centurion Way
Berry Creek, CA 95916
Date: r -
U
State -of &2utLcl )
County of r )
PROPERTY OWNERS:
s
Gt
On this the r)-/ day of , 19770 before me,
SS. the undersigned Notary Public, per ovally -appeared
Pers dally known to me. MProved to me on the basis
�1 of satisfactory evidence.
to be the person(s) whose name (s)-R&iAs, (1. Seal, di.h1 ,5
subscribed to the within instrument and acknowledg d tha J
executed the same 'for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal.
lrfy C, l,T ui; i s Sepi 17,1993
u n ,
Present A.P. No. - o� - F Notary Public
5/89
RESIDENTIAL PLAN.CHECKING GUIDE
MISCELLANEOUS ITEMS TO LOOK OUT FOR (CONY D)
Exterior plaster - weep screeds (Sec. 4706).
,,Proper roof pitch for roof covering (Chapter 32).
Roof covering type - (fire hazard).
jG-.1"Ra,ter ties or bearing ridge beam.
arage door or porch header sizes.
Adequate bracing.
wing area over garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
two exits on three-story dwellings (Sec. 3303 & see Mezannines - 1716).
WL$'. Attic access and ventilation (Sec. 3205).
Underfloor access and ventilation (Sec. 2516).
,-k :_Combustion air for fuel burning appliances.
Noise requirements on duplexes.
�obe soils - special foundation design.
�etaining walls requiring design.
unusual shape, size, or split level house requiring lateral design...
a.9% Flashing at all ex erior openings.
&C
M
5/89
RESIDENTIAL PLAN CHECKING GUIDE
(S.F., DUPLEX & MISC. ONLY)
Bldg. Permit #
OWNER' l l Gr�i� / l2� A.P. # l -10r
.
GENERAL
4Y/ Zoning requirements: (sideyards and number of.permitted living units).
�Z. luation.
Plans signed by designer.
Energy Design and Compliance.
-5—. --Existing violations on property.
Items on data sheet.
PLOT PLAN
i• Complete parcel size and dimensions.
Setbacks, sideyards, easements, etc.
-3'- Other buildings or structures.
Ll" Grading, fills, drainage.
Flood hazard.
,�
Special conditions on -creation map or compliance document.
7'. FAU & FAS road setback.
FT.nnR PT.AN
Complete to scale plan with dimensions.
Required windows for light and ventilation (Sec. 1205).
Required windows for second exit (Sec. 1204).
,A' --Skylights (Chapter 34 & Sec. 5207).
LK Human impact glass (Sec. 5406).
1.6'--' Required room sizes, ceiling heights (Sec. 1207).
'T: GFCIs in baths, garage, and exterior outlets (Article 210-8).
c8. ight fixtures, switches, receptacles, and exterior receptacles
.,af mechanical equipment.
-19! Locations of water heater, eating and cooling equipment, other
gas equipment, and plumbing mss.
L1.0" -Garage firewall, door size, and closer (Sec. 503(d)(3)).
t
3'0" exterior exit door (Sec. 3304(e)).
��Fireplace. and wood stove location, alcoves, and clearance.
]`3 Smoke detectors (Sec. 1210).
STRUCTURAL DETAILS
for maintenance
electrical or
�! Foundation plan complete enough to construct building.
k2'- Floor construction details complete enough to construct building.
i, levations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
•60" Fireplace construction details and calcs if necessary.
MISCELLANEOUS ITEMS TO LOOK OUT'FOR
�-1 Stairway details: landings, rise and run, head clearance, handrails (Sec. 3306).
--2:-�Guardrail details (Sec. 1711 & 3306(j)).
Brick or stone veneer (Chapter 30).
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT 90-2 1 6 T 9
FOR RESIDENTIAL DEVELOPMENT
Section 26-8.1 of the Butte County.Code
requires this acknowledgement be recorded
prior to issuance of'a building permit.
The property described herein is adjacent
to land or included within an area zoned 90-021679 Rec Fee
.5.00
.for agricultural purposes, and residents Cash
5..00 ,
of this property may be subject to incon- Recorded
veniences or discomfort arising from the Official Records
,•,
use of agricultural chemicals, including, County of
but not limited to herbicides, pesticides, Butte
and fertilizers; and from the pursuit Candace J. Grubbs
of agricultural operations including, Recorder
,
but not - limited to cultivation, plowing, 8:01am 29 -May -90
CD 1
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise, and odor. Butte County has established
agricul-
tural zones which have as a priority use for,, productive agricultural purposes, and
residents
within said zones and on adjacent property ',should be prepared to accept such inconvenience
or disconform from normal, necessary farm operations.
All that real property situate in the County,. of Butte, State of California, described
as
follows:
Parcel 3. Portion of the south 1/2'bf>`the northeast 1/4 southwest 1/4
section
34, T21N, R55, MDB&M. Record of survey and parcel map filed in Office
of
Recorder, Book 41, page 27.
23 Centurion way
Berry Creek, CA 95916
Date: L,4
State of )
County of )
PROPERTY OWNERS:
N114 WE 5
Ell,
On this the ;�//_ day of19 Jbefore me,
SS. the undersigned Notary Public, per onally appeared
t_
® Pers(t(ally known to me. MProved to me on the basis
of satisfactory evidence.
to be the person(s) whose names) mA� (1• Se�I, �, iV�— Seh�le��q
subscribed to the within instrument and acknowledg d tha?
executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal.
' r
Present A.P. No.
My Commission EVires Sept 17,1993
Notary Public
END OF DOCUMENT
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1
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WOR S
' 7 County Center Drive - Oroville, California 95965 7,
Telephone: 533-1230, Ext. 259 , P
APPLICATION AND PERMIT
BUILDING
Owner AM Z14-01-4 SQ. FT. OCC. BUILDING VALUATION
H
Mailing Address
Fireplace
Contractor Total Valuation
Mailing Address Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee $ $
h PLUMBING No. @ FEE
Building Address �s G� /� PERMIT FILING FEE $2.00 G
,G Each Trap 1.50
Repair drainage or vent piping 1.50
L C8 d C Water piping 1.50
Each gas water heater or vent 1.50 6
A. P. No. � - a a b o ing Q�Z Gas piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone Fire Dept. S nitation P anning ing sewer 5.00
/Lawn sprinkler system 2.00
Plans f/ Fees, -"W. C.� R/W Encroachment
NEW ❑ ADDITION ❑ OTHER ❑ Permit Fee $ 6
ELECTRICAL No. @ FEE
P PERMIT FILING FEE $3.00 (�
Main service incl. 1 meter G�
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURB Single Family ❑ Duplex ❑ Others ❑ Range, dryer or water heater 1.00
Oven, Cook -top or space heater 1.00
Light fixtures
Receps., switches & fix outlets
CONTRACTORS LICENSE LAW Hood, Ex. Fan or F.A. Furn. Motor 1.00
I am licensed under the provisions of Chapter 9, Div. 3, of the Evap. cooler, gar. disp. or D.W. 1.00
State of California Business & Professions Code under the name Air conditioner or heat pump
style of: Water pump
Misc. wiring
C ! G
License No. Classification
�^ iam exempt from the Contractors License Laws of the State of California. Permit Fee $ Op $42
O�
WORKMEN'S COMPENSATION INSURANCE MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
I am aware of the provisions of Section3700 of the California Labor Heating
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of Cooling
W rkmen's Compensation Insurance.
Pcertify that in the performance of the work for which this Ventilation
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
Permit Fee $ $
jtate Fee For Str�7ng Motion $
1 certify that I have read this application and state that the above Instrumentation Yrogrom $0.07/$1000 Evaluation
information is correct. I agree to comply to all County Ordinances TOTAL PERMIT FEE .l.`2C�
and State Laws relating to building construction, and hereby $
authorize representatives of the County of Butte to enter upon the This permit is hereby issued under the applicable provisions of
abo entioned property for inspection purposes. the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
X Date Al ` .2 DIRECTOR OVDUBLIC WORKS
Signat r ofsPeerrmmitee or Agent
L_C� ®L�� By � Date �a 7 7
Receipt No. — Building Permit Expires Date 47- % 3
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
2 J2, cl
Sept;c sysiern
•a1.. IQCataOn'n
t t � .jrtt� rlC�ir, ct��h -,� +•�. fo' , ��: .
�' .Butteou»t y. Healthx I7et Fzer`
`jpo quirements t "
�r 3.411 �,�) �l�C.�-1SLSfi� r.'�'7��■ r t _
%
..t�i,•�'• �iry,�r.-3 • IRf'' �T. F { ' �•ft i'y lr ' , ,t
'+ f n L / , ?ti �t ' a.'r .wA' M r . S , ' � . �1.d ,tJ t � iy y�. 1 a .t' ` rt ' .• -
third section of the mobil:; home
on'the left (road) side of the•mob ile,
home. = a
r�
6U i TE COU NAY
}�e/� s �r►ts sot of pfY:u and sUeci`icationa MUST be y, •� L 7: ;
', 4 �1,. r ''y `moi► # a t t pt all tirrss 'I it is unl'awfu# t�s`;tt t`.r ��f�v�l�iri DEPA
Cv�, t 'S or z 3rui. 1S' on s me Wit r r _ {•
`' , • w ttEn ii .rmfswn from the Departi-nont of Public•` ` PIP 1"�;
W rks, 'County of B_ure. V'P_
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/S/�7`E :
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.
BP060246
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: 02/02/2006 APN: 062-760-006-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: 3� License Number:0`lOYfliS
Site Address: 23 SINGLE LN BCK
Date: 071 -AAI(, Contractor: %Lt 5; i-,44 e t
Map Index:
Description: REPLACE WATER HEATER
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: SCHLICHTING MARY V
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
23 SINGLE LN
signed statement that he or she is licensed pursuant to the provisions of
BERRY CREEK, 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
95916
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: RISSE &SONS INC.
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
PO BOX 67
such work himself or herself or through his or her own employees,
RIO LINDA, CA
provided that such improvements are not intended or offered for
95673
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
916-991-3030
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: RISSE & SONS INC.
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
PO BOX 67
pursuant to the Contractors' State License Law.).
RIO LINDA, CA
❑ 1 am Exempt under Article 3 of the Business and Professions Code
95673
916-991-3030
Date: Owner:
License #: 264815
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
Architect:
is issued.
I have and will maintain workers' compensation insurance, as
Engineer:
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:—Oe—PT— OF (NQv577L4f/t 9-eCit-rit1N5
Total Square Ft: 0 S. F.
3 y,% 5-Q P/L lcO
Policy #:
Valuation: $0.00
❑ 1 certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
�+
h�e
and agree that if I should become subject to the workers'
L1
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
This permit is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resol io s to do work indica ed a Ove for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)2-?
_ ocp
Date:
Name:
V
BY n �}
PERMIT XPIRES ON:
Address:
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 & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte Countytoenter upon the above mentioned property for inspection purpose
�`�---'—
Print Name: C�Y!/T/G� CiG %/�? Pte✓ % Signature: C//
Date: a2 /e?10 10
❑ Owner ❑ Contractor ❑ Agent for Owner Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
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
**PLEASE PRINT CLEARLY**
OWNER INFORMATION
Last Name
First Name
Address wv
city flee,t 2 f- e/l,e-P�
Ste
Zi
Phone � J S �� %
Fax
E-mail
APPLICANT INFORMATION
CONW CT R
Name
,
1 �_
Address
) ,
v
City _ d 1 -
Phone
stqt4
Zi
Fax
E-mail
Map Book
Li .
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
Cityf24 dGlc v✓f-
Address
�`S—G 73
City
Fax
State
Zip
Phone
Map Book
Fax '
E-mail
Planner
State License Number
APPLICANT INFORMATION
Name
f?l SS e �t e c_171 cs C
Address
Cityf24 dGlc v✓f-
State
�`S—G 73
Phone
Fax
E-mail
APPLICANT SIGNATURE
For office use only:
Zoning
Property Address
2N 3 .SAN
Flood Zone
Cross Street
SRA
I Yes
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K•\Fr1RMC\RI III nimr-, r:nPhAC\RlrinAnnlSiihRnmtc rinr.
PERMIT
,ANOOL'
BP:.
-�.
BIN #
PROJECT LOCATION
Property Address
2N 3 .SAN
Cily
Cross Street
WORKER'S COMPENSARON-
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
Paoe 1 of 2
Description or Scope of Work:
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: �,� Amount: If 155.130 Bldg
Receipt #:I 3725 Sheri f
SMIP
Dater "2.. `,; �• 55 ` 00Other
Total
RF\/ R_17_nr
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 faxesl
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and' A/C for Non -Residential Buildings. '
❑ 6. Manufactured homes: (A) Installation 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 by the engineer.
❑ 8. Flood Elevation Certificate,.wet-stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 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).
r_17. 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
KAFORMSOUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
1. Ceiling Insulation
U -value
(assumet duets In attic)
Number of stories
1 --
R -value
_
One
Two
Three
R-0
-103
-49
32
R-19
-8
-4
-2
R30
-2
U -1
-1
R38
0
0
0.
U -value
-13
-21
14
0.50
-176
-84
-54
0.30
-102
-49
32
0.10
-26
-13
-8
0.08
-18
-9
-6.
0.06
-11
-5
-4 '
0.04
-4
-2
-1
0.02
4
2
1
0.00
11
5
3
27
-52
-17
2. Wall Insulation
-2
6
R -value
Single
Single -
Three
-8
Family
Family
Multi -
R -value
Detached Attached
Family
R-0
-68
-51
-34
R-11
0
0
0
R-13
2
2
1
R-19
8
6
4
U -value
15
22
37
0.80
-153
-114
-76
0.50
-91
68
-46
0.30
-47
-36
•24
0.10
0
0
0
0.08
4
3
2
0.06
9
7
5
0.04
14
11
7
0.02
19
.14
10
0.00
24
18
12
3
0.80
-1
-1
3. Raised Floor Insulation
-20
0.70
-
Insulation
in"Floor
17
0.60
6
Number of stories
2
R -value
One
Two
Three
R-0
-17
-8
-5
R-11
-3
-2
-1
R-19
0
0
0
R-30
3
1
1
'
U -value
(assumet duets In attic)
Measures
1 --
--.0.60 ,
-144
-70
-46
J.
0.50
-120
-58
38
Double
0.40
-95
-46
30
50
0.30
-69
-34
-22
-10
0.20
-13
-21
14
-26
0.10
-17'
-8
-5
-75
`0.08
-11
3
-4
10
-0.06
-6
-3
-2
-4
0.04
-1
0
0
-20
0.02
4
2
_
1
28
0.00
10
5
3
5
Controlled Ventilation Crawispace
27
-52
-17
Number of stories
-2
6
R -value
One
Two
Three
-8
R-0
-11
-7
-5
-46
R-5
-4
-4
3
14
R-11
-2
-2
.-2
1
R-19
1
-2
2
-11
a. Slab Edge Insulation
2
8
15
22
37
-9
3
-'_--"
9
Number of Stories
21
-34
R -value
One
Two
Three
15
R-0
0
0
0
5
R-5
8
5
2
-4
R-7
8
6
3
i
F2 factor
3
2
7
12
•0.90
-4
3
-1
3
0.80
-1
-1
0
-20
0.70
2
2
1
17
0.60
6
4
2
10
0.50
9
6
3
3
0.40
12
8
4
-S. Infiltration (Air.Leakage)
Specification Points
Standard 0
6. Glass Heat Loss _
Total
Etrective Pei cei t Glass
(assumet duets In attic)
Measures
U -value
Interior
Percent
Mass
Sbries
.51 to
.41 to
.31 to 0.30 or
Glass
Single
Double
.60
.50
.40
less
50
-121
-53
-39
-24
-10
4
40
-90
37
-26
-14
3
8
35
-75
-29
-19
-9
1
10
30
-61
-21
-13
-4
4
12
29
-58
-20
-12
-3
5
12
28
-55
-18
-10
-2
5
13
27
-52
-17
-9
-2
6
13
26
-49
-15
-8
-1
7
14
25
-46
-14
-7
0
7
14
24
-43
-12
-5
1
8
14
23
-40
-11
-4
2
8
15
22
37
-9
3
3
9
15
21
-34
-7
-2
4
10
15
20
31
3
0
5
10
16
19
-29
-4
1
6
11
16
18
-26
3
2
7
12
16
17
-23
-1
3
8
12
17
16
-20
0
4
9
13
17
15
-17
1
6
10
14
17
14
-14
3
7
10
14
18
13
-12
4
8
11
15
18
12
-9
6
9
12
15
19
11
3
7
10
13
16
19
10
3
9
11
14
17
19
9
-1
10
13
15 '
17
20
8
2
12
14
16.
18
20
7. Shading (Shade Open)
9. Interior Thermal Mass =.
Etrective Pei cei t Glass
(assumet duets In attic)
Measures
(perreut glass x SC)
Interior
Effective
Mass
Sbries
Stories
-
---
%Glass North
East
South
'west
Skylight
18
5
1
4
1
na
16
4
2
5
1
na
14
4
2
5
1
na
12
3
3
5
2
na
11
3
3
5
2
na
10
2
3
5
2
1
9
2
3
5
2
2
8
2
3
5
2
2
7
1
3
4
2
2
6
1
3
4
2
3
5
1
2
4
2
3
4
0
2
3
1
3
3
0
1
2
1
3
2
0
0
1
0
3
1
-1
-1
-1
-1
2
0
-1
-2
-4
-2
0
na = not allowed
Family Family
Malo
Mass
Detached Attached
a3. Shading
(Shade Closed)
0 0
0
ElfeWve Petemt Glass
0.20
3 2
1
(Pts, ent
plass X SC)
-
Elective
5
0.60
8 6
4
16.
%GIa16
NoM Ead
South
West
Shyfi&
18i
-14
-48
-69
-04
na
16
-12
-42
-59
-55
na
14
-10
-35
-50
-46
na
12
-8
-29
-40
37
na
11
-7
-26
36
•33
na
10
-6
-23
31
-29
-74
9
-5
-20
-27
-25
-65
8
-5
-17
-23
-21..
-56
7
-4
-14
-19
-18
-47
6
3
-11
-15
-14
38
5
-2
-9
-11
-10
-30
4
-1
3
-8
-7
-23
3
0
-4
-5
-4
-16
2
1
-1
-2
-1
-9
1 '.
1
. 1
1 ..._
1
-4
0-'•-`
2"`
3"
4
3
0
na . not allowed
0 0 0 0
0
0
0.60 5.50
9. Interior Thermal Mass =.
SCORE CARD
(assumet duets In attic)
Measures
1. Ceiling Insulation
Interior
Slab F)oor •-'-: Raised Floor ,.
Mass
Sbries
Stories
-4 b
/CFA One
Two Three one
, Two
Three
0.0 -8
-5 -4 -2
-1
-1
0.1 -8
-5 3 -1
0
0
0.3 -7
-4 -2• 0
1
1
0.5 -6
3 -1 1 • '
1
2
0.7 -5
-2 -1 1
2
2
0.9 -5
-1 0 2
3
3
1.1 -4
-1 1 3
4
4
1.3 -3
0 2 3
4
5
1.5 -3
1 2 4
5
5
20 -1
2 4 5
6
7
25 0
3 5 7
.7
8
3.0 1
4 6 8
8
9
3.5 2
5 7 9
9
10
4.0 3
6 8 9
10
10
4.5 3
7 8 10
11
11
5.0 4
7 9 11
12
12
5.5 5
8 9 11
12
12
6.0 5
8 10 12
13
. 13
6.5 6
9 10 12
13
13 ;
7.0 6
9 11 13
13
14
7.5 6
10 11 13
14
14
8.0 7
10 11 13
14
14
8.5 7
10 12 13
14
15
10. Exterior Wall Thermal Mass
-9 .
Exterior
Single- Single -
-11 -9
-7
Wall
Family Family
Malo
Mass
Detached Attached
Family
0.00
0 0
0
0.
0.20
3 2
1
0 I
0.40
5 4
3
5
0.60
8 6
4
16.
0.80
10 8
5
5
1.00
13 10
7
13
1.20
13 12
8
26
1.40
12 13
9
8 '
1.60
10 13
: 11...
18
1.80
10 12
12
33
2.00
10 11
13
i
1
Zonal Control Adjustment
4.1
4.3'
11. Heating System
4.8
10
SE or 13SPF
6
4
_ (assumes ducts In attic)
i
No
Sum of 1.6
Installed
1.4
-25 or -24 to -14 to -4 to +6 to
16 or '
SE HSPF
less -15 -5 +5
+15
more
0.72 6.60
0 0 0 0
0
0
0.75 .6.88
3 3 3 2
2
1
0.80 7.33
8- 7 6 5
4
3
0.85 7.79
13 11 10 8
7
5
0.90 8.25
17 15 13 11
9
7
0.95 8.71
20 18 15 13
11
8
Single
Efrective SE or HSPF
2.8
(SE
or HSPF x duct efriciency)
3.4
Water
Effective -25 or -24 to -1410 1 to
+6 b 16 or
SE HSPF less -15 -5 +5
+15 more
0.30 2.75
-73 -64 -56 -47
-38
-30
na 3.41
-45 -39 -34 -29
-24
-18
0.40 3.67
-34 30 -26 -22
-18
-14
0.50 4.58
-10 -9 -8 -7
-5
-4
0.56 5.13
0 0 0 0
0
0
0.60 5.50
5 5 4 3
3
2 j
0.70 6.42
17 15 13 11
9
7
0.80 7.33
25 22 19 16
13
10
0.90 8.25
32 28 . 24 20
17
13
1.00 9.17
37 32 28 24
19
15
Zonal Control Adjustment
3
System Type
SE
None
-37 -24
Resistance
10 9 7 6
4
3'
Other
6 5 4 3
2
2
12. Cooling
SEER
Point System Summary: Climate Zone 11 ,
SCORE CARD
(assumet duets In attic)
Measures
1. Ceiling Insulation
Stm of 7-10
x
-
R -value [38] U -value [0.0301
2. Wall Insulation
-25 or -24 b 1 -td b
-4 b
+6 to
16 or
SEER
less
-15 i •6
+5
+15
more
8.0
-14-
-12 -10
'-8
3
-4
. 8.5
-9
-7 -6
-5
-4
3
8.9
-5
4 -4
-3
-2
-2.
9.0
-4
3 -3
-2
-2
•1
9.5
0
0 0
0
0
0
10.0
4
3 3
2
2
1
10.5
7
6 5
4
3
2
11.0
10•
9 7
6
4
3
`- 12.0
15
13 11
9
7
5
13.0
20,
T
17 ., 14
12
9
6 ;
35%
40%
ER4dve SEER
50%
SS%
607E 6516
(SEER xduct eMclency)
7S%
80%
85%
Sum of 7-10
` 957L
100%' 105% 110% 115% 120% 125•
Effective -25 of
-24 to -14 b
.4 to
+6 b
16 or
SEER
loss
-15 -5
+5
+15
more
5.0
-30
-25 -21
-17
-13
-9 .
6.0
-12
-11 -9
-7
-6
-4
6.6
-5 :
-4. -4
3
-2
-2 ;
7.0
0.
0 0
0
0
0 I
8.0
9
8 6
5
4
3 1
9.0
16.
14 12
9
7
5
10.0
22 :,
19 16
13
10
7
11.0
26
23 19
15
12
8 '
12.0
30
26 22
18
14
9
13.0
33
29 24
20
15
10
1
Zonal Control Adjustment
4.1
4.3'
4.5
4.8
10
8 7
6
4
3
i
No
Cooling System
Installed
1.4
= Stories
1.8
2
22
24
26
One
-5
d 4
3
-2
-2
Two +
3
3 2
2
2
1
5.3
5.6
So
40%
0.7
09
1.1
1.3
1.5
1.7
1.9
22
Single
-Family Detached and Attached
2.8
3
4 Unit Size (so
3.4
Water
3.8
1199 '1200""1700
4.3
2200
27W
Heater
(.(edit
or b
to
to
or
50%
Type
less 1699
2199
2699
more
_Type
SG
None
0 r.0
0
0
0
or
Solar
12 '' 8
6
5
4
- HP
'HWR
8 5
4
3
3
5.7
WSB
5 3
3
2
2-
1.4
POU
8 5
4
3
3
SE
None
-37 -24
-18
-15
-12
3.9
Solar
-1 -1
-1
0
0
5.1
HWR
-18 -12
-9
-7
-6
60%
WSB..
-25 •16
-12
-10
-8
-
POU
-18 _ -12.
•9
•7.
-6
IG
None
-5 -3
-2
-2
-2
4.6
Solar
7- 5
4
3
2
5.9
POU
3_ 2
1
1
1
IE
None
-28 -19
-14
-11
-9
2.8
Solar
8 5
4
3
3
4
POU
-10 3
-5
-4
_3
53
_
Multi -Family (individual units)
5.7
5.9
6.1
Lkit Size (s
n
1.2
Water
1.6
699 4 70
1200
1700
2a0
Heater
Credit
or '. 10
to
10
3.7
Type
TYPO
less ;1199__1699
4.6
218!7
mors
SG
None
0 0
0
0
0
or
Solar
14 7
5
4
3
HP
HWR
9 :, 5
3
2
2
3.4
WSB
9 4
3
2'
2
4.6
POU
9 5
3
2
2
SE
None
-45 .•-23
-15
-11
-9'
1.6
Solar
2 1
1
0
0
2.8
HWR
"-23- -12
-8
-6
5
4.1
WSB
-25 -13
-8
-6
5.1
-_PQU=23 -12
-8
3
-5 ..
IG
None
-8 -4
3
-2
--2
--
Shc&
.' 6= t. 3
2
1-
f 1
3.1
POU
1 0 .
'.. 0
0 ..
0 . .
.� E
None
. 30 -15
-10 -`'-8
".-.6
54
- z _--Solar
5.9
"18', 9 ....
6
. 4
4.
.._,L -.-POU
1.5
'8 -41.
' •3 ..
-2
. _2
Point System Summary: Climate Zone 11 ,
SCORE CARD
x_
Measures
1. Ceiling Insulation
�L or.
x
-
R -value [38] U -value [0.0301
2. Wall Insulation
k II or
t
R -value [I1] U -value [0.098]
Interior Mass/CFA
.
_
R -value [ 19] U -value [0.037]
x
_ V&_
e. Skylight
x
77
=
9. Interior Thermal Mass
TYPE 1 MASS -AREA B
L
InteriorA/aas/CFA
GOND. FLOOR AREA
•10.. Exterior Wall Mass
TYPE 2 MASS AREA = 9
Exterior Wall Mals'
ND FLOOR
AREA
fir..
11. Heating System
x
Ic.:paM .l_e1
_
"Zonal Control? ( Y / N)
SE or HSPF
Duct Efficiency 10.781
Effective SE 6r
r..v
[0.72/6.6]
It TYPE
1
X%SS
(UI11C a 4.2,
ie:
exposed
slab)
=
.;Zonal Control? ( Y / N)
SEER [9.5[9.51-
Duct Efficiency [0.741
Effective SEER [7.03]
13. Water Heating
- 'LIE
0%
5%
" 10%
is% 20%
2S%
30%
35%
40%
45Y.
50%
SS%
607E 6516
70%
7S%
80%
85%
90%
` 957L
100%' 105% 110% 115% 120% 125•
0%
0
0.2
0.4
0.6
0.8
1.1
1.3
1.5
1.7
1.9
21
23
25
2.7
2.9
3.2
3.4
3.6
3.8
4
4.2
4.4
4.6
4.8
5
5.3
IOP.
0.2
04
0.6
0.8
1
1.2
1.4
1.5
1.9
21.
23
25
2.7
2.9
3.1
3.3
3.5
17
4
.4.2
4.4
4.6
4.8
5
5.2
5.4
20%
0.3
0.6
0.8
1
1.2
1.4
1.6
1.6
2
2.2
24
27
29
3.1
3.3
3.5
17
3.9
4.1
4.3'
4.5
4.8
5
5.2
5.4
56
30%
0.5
0.T
0.9
1.1
1.4
1.6
1.8
2
22
24
26
28
3
3.2
3.5
3.7
3.9
4.1
43
4.5
4.7
4.9
5.1
5.3
5.6
So
40%
0.7
09
1.1
1.3
1.5
1.7
1.9
22
24
26
2.8
3
3.2
3.4
3.6
3.8
4
4.3
'4.5
4.7
4.9
5.1
5.3
5.5
5:7
5.9
50%
0.9
1.1
1.3
15
1.7
1.9
21
23
25
27
3
32
14
3.8
3.8
4
42
4.4
4.6
4.8
5.1
5.3
5.5
5.7
5.9
6.1
55%
0.9
1.1
1.4
1.6
1.8
2
2.2
24
2.6
28
3
3.2
3.5
3.7
3.9
4.1
4.3
4.5
'4.7
4.9
5.1
5.3
5.6
5.8
6.
62'
60%
1
12
1.4
1.7
1.9
21
2.3
2S
2.7
29
3.1
3.3
3.5
3.8
4
4.2
4.4
4.6
4.8
' 5
5.2
5.4
5.6
5.9
6.1
63
65%
1.1
11
1.5
1.7
1.9
2.2
24
2.6
2.8
3
3.2
3.4
36
3.8
4
4.3
4.5
4.7
4.9
5.1
53
55
5.7
5.9
6.1
64
70%
1.2
1.4
1.6
1.8
2
22
25
27
2.9
3.1
3.3
3.5
3.7
3.9
4.1
4.3
4.6
4.8
4
5.2
5.4
5.6
58
6
6.2
64
75%
1.3
15
1.7
1.9
21
23
25
27
3
3.2
3.4
16
3.8
4
4.2
4.4
4.6
4.8
'S.1
5.3
5.5
5.7
5.9
6.1
6.3
6.5
Wy-
1.4
1.6
1.8
2
22
2.4
26
2.8
3
3.3
3.5
27
3.9
4.1
4.3
4.S
4.7
4.9
5.1
5.4
5.6
5.8
6
6.2
64
66
BSP.
'
1.4
1.7
1.9
2.1
2.3
25
2.7
29
3.1
3.3
3.5
18
4
4.2
4.4
4.6
4.6
5
52
54
S6
5.9
6.1
63
65
67
90Y.
1.5
1.7
2
2.2
24
26
2.8
3
3.2
3.4
3.6
3.1
4.1
4.3
4.5
4.7
4.9
5.1
63
5,5
5.7
5.9
6.2
6.4
66
68
95%
1.6
1.8
2
22
2.5
27
2.9
3.1
33
3.5
17
3.9
4.1
4.3
4.6
4.8
5
5.2
5.4
5.6
5.8
6
5.2
6.4
6.7
69
100Y.
1.7
1.9
21
2.3
25
28
3
3.2
3.4
3.6
18
4
4.2
4.4
4.6
4.9
5.1
S.3
55
5.7
5.9
6.1
6.3
6.5
6.7
7
105%
1.8
2
22
2.4
2.6
28
3
3.3
3.5
3.7
3.9
4.1
4.3
4.5
4.7
4.9
5.1
5.4
56
5.8
6
6.2
6.4
66
68
7
110%
1.9
21
2.3
2.5
27
29
3.1
3.3
3.6
3 8
4
4.2
4.4
4.6
4.8
5
5.2
5.4
.5.7
5.9
6.1
6.3
6.5
6.7
69
7.1
115%
2
22
24
2.6
2.8
3
3.2
3.4
3.6
3.8
4.1
4.3
4.5
4.7
4.9
5.1
5.3
5.5
5.7
5.9
6.2
6.4
6.6
6.8
7
72
120%
2
2.3
2.5
2.7
2.9
3.1
3.3
3.5
3.7
3.9
4.1
4.4
4.6
4.8
5
5.2
5.4
5.6
58
6
6.2
6.5
'6.7
6.9
7.1
73
125%
21
23
25
2.8
3
3.2
3.4
3.6
3.8
4
4.2
4.4
4,6
4.9
5.1
5.3
5.5
5.7
5.9
6.1
6.3
6.5
6.7
7
7.2
7.4
Point System Summary: Climate Zone 11 ,
SCORE CARD
x_
Measures
1. Ceiling Insulation
�L or.
x
-
R -value [38] U -value [0.0301
2. Wall Insulation
k II or
t
R -value [I1] U -value [0.098]
3. Raised Floor Insulation
tf l I or
_
R -value [ 19] U -value [0.037]
4 Slab Edge Insulation
5.: Infiltration
6. Glass Heat Loss
i
Point Scores
-a
0
or
R -value [0] F2 factor [0.771
Standard p
13.-< 4-3 "
Type [double] U -value [0.651 % Total Glass [ 16] Sum 1.6
7. Shading (Shade Open)
% Glas SC ..Eff. % Glias(%
a. North % x ?7 = . --
b. East �_ x = /
c. South -�--� x = 3
d. West 1-3 - x = /. do
e. Skylight (Z_ x = Q
.8. Shading (Shade Closed)
% Glass SC Eff. % Glass
a. North
_�
x_
_
b. East
D •
x
c. South
t
x
=
d. West
x
_ V&_
e. Skylight
x
77
=
9. Interior Thermal Mass
TYPE 1 MASS -AREA B
L
InteriorA/aas/CFA
GOND. FLOOR AREA
•10.. Exterior Wall Mass
TYPE 2 MASS AREA = 9
Exterior Wall Mals'
ND FLOOR
AREA
fir..
11. Heating System
x
p-
_
"Zonal Control? ( Y / N)
SE or HSPF
Duct Efficiency 10.781
Effective SE 6r
r..v
[0.72/6.6]
HSPF (0.56/5.15]
12.'Cooling System
x
Y
=
.;Zonal Control? ( Y / N)
SEER [9.5[9.51-
Duct Efficiency [0.741
Effective SEER [7.03]
13. Water Heating
- 'LIE
_. _.... .. ... _
.... [SGI
Credit [none]
4-L
+3-
Sum
Sum 7-10
Point Total:
.�i
Certificate of Compliance: Residential . Climate Zone 11
Project Title 0 - / I r • o
Protect Address A 3 S i n q Ae C n
Documentation Author Telephone
r --
lama -Qo
BuildiniijPcn
Checked By/ Date �J
Enforcement Agency Use Only
HVAC SYSTEMS Minimum Duct
Type (furnace, air Efficiency Location Duct Output Manufacturer / Model #
conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh) (or approved equal)
law AA
Maximum Furnace Heating Output: �.2 Btuh''
HOT WATER SYSTEMS Tank Manufacturer/Model #-
Cvetrm Tvrw fit—.. ore. .r, 1 rnnar-ity (nr annmveii ennal) Snecial At dAh'�,1
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
N
Mandatory Measures Checklist: Residential MF -IR.... -
NOTE Lowrise residential buildings subject to the Standards must contain these Musu;rs rcgndlcss of the comQliartoo
approach used Items marked with an asterisk (•) may be superseded by more stringent compliance requucments listed
on the Certificate of Compliance. When this checklist is incorporated into the permit documents. the fnturis noted 0120
be considered by all parties as binding minimum component performance spwfxatioru for the mandatory measures
wheUKr they arc &lawn elsewhere in the documents or on this chocklist only.
DESCUP ION
Building Envelope Measures
• §2.5952(a): Minimum ceiling insulation R-19 weighted avenge.
§2.5352(b}. Loose full insulation manufacturer's labeled It -value.
• §2.5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to
exterior mass walls).
§2.5352(k}. Slab edge insulation • water absorption rate no greater than 03%. water vapor
transmission rate no greater than 2.0 permr=h.
§2.5311: Insulation specified or installed meets California Energy Commission (CF..C) quality
standards Indicate type and form.
§2.5352(f): vapor barriers mandatory in Climate Zones 14 and 16 only.
§2.5317: Infiltntion/Eafxltration Controls
a. Doors and windows between conditioned and unconditioned spaces designed to limit air
leakage.
b. Doors and windows certified.
e Doors and windows weathcrstrippcd: all joints and perxvations caulked and sealed
112-5352(e): Special infiltration barrio installed to comply with 12-5351 moots CEC quality
standards.
§2.5352(d): Installation of Fvcplaces
1. Masonry and factory -built fireplaces have;
a. Tight fitting, closeable metal or glass door
b. Outside au intake with damper and control
c Flux damper and control
2. No continuous burning gas pilots allowed.
HVAC and Plumbing System Measures
12-5352(8) and 2-5303: Space conditioning equipment siring: attach calculations.
12-5352(h) and 2-5315: Setback thernwsta: on all applicable heating systems.
• §2.5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC.
§2.5316(b): Exhaust systems have damper controls.
§2-5314(c): Gas -rued space heating equipment has intermittent ignition devices.
62-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC.
§2-5352(1): water heater insulation blanket (R-12 or greater) or combined interiorkxterior
insulation (R-16 or grcatcr); fust 5 feet of pipes closest to Lank insulated (R-3 or greater).
§2.5312(Exception q: Pipe insulation on steam and steam condensate return & recirculating
piping.
§2-5319(d): Swimming Pool Heating
1. System has:
a. On/off switch on heater.
b. Weatherproof instruction plate on heater.
c. Plumbed to allow for solar.
2. 75 percent thermal efficiency.
3. Pool cover.
4. Time clock.
5. Directional water inlet.
Lighting and Appliance Measures
§2.5352(1): Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms.
§2-5314(x): Gas fired appliances equipped with intermittent ignition devices.
12.5314(a): Refrigerators. refrigerator-freeurs. fmczers and fluorescent lamp ballasts certified
by the CEC. Indicate make and model number.
COMPLIANCE STATEMENT
DESIGNER I ENFORCEMENT
This certificate of compliance lists tlr. Wilding features and performance specifications needed to comply with
Mile 24, Chapter 2-53 and Title 20, C2lagtcr2, Subdupier4. Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner. who shall
retain a copy of it and transmit the certificate to any subsequent purchaser of the building.
Designer
Name:
Tweffirm:
Address:
Te rte
(sign ) (date)
Documentation Author
Name:
Tstk/Fum:
Address:
Building Owner
Name
MWFunt:
Address:
Telephone
(signature) (date)
Enforcement Agency
Nona:
Atatcy
Telephone
r
Glass Area
% Glass
BUII.DING DATA
North
/.So
%,
C
Number of Stories _�
Number Units
East
South
Ig_
-77
Sl sed Fl
of
Single Family Detached (SFD)
[ ] Addition Alone
West
A 15
— . 3
[ ] Single Family Attached (SFA)
[ ] Existing Building
Skylight
O
U
[ ] Multi-Family(MF)
[ ] Existing -Plus -Addition
Total
BUILDING SHELL INSULATION
Component Insulation Locafinn!C'omments
Type R -Value (anile, to
garage, e�icc, etc.)
Wall ..............
--�--�
Wall ..............
Roof .............
Roof .............
"
Floor .............
Floor .............
Slab Edge .....
GLAZING
Shading Devices
Glaring Area Glass Type
Interior Exterior
Overhang
Framing Type
Orientation s (sin double) koller blind, etc. (shadescreen, etc.)
esino)
(metaltwood)
North
North ( )
East
East ( )
South ( ) :
_
South ( )
West ( ) .2. :5'
West ( )
Skylight....... _0
THERMAL MASS
Type/Covering Area
Thickness
(stab/exposed tile, etc.) (sf)
(inches) Location/DCscription
(kitchen, bath, etc.)
IV
HVAC SYSTEMS Minimum Duct
Type (furnace, air Efficiency Location Duct Output Manufacturer / Model #
conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh) (or approved equal)
law AA
Maximum Furnace Heating Output: �.2 Btuh''
HOT WATER SYSTEMS Tank Manufacturer/Model #-
Cvetrm Tvrw fit—.. ore. .r, 1 rnnar-ity (nr annmveii ennal) Snecial At dAh'�,1
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
N
Mandatory Measures Checklist: Residential MF -IR.... -
NOTE Lowrise residential buildings subject to the Standards must contain these Musu;rs rcgndlcss of the comQliartoo
approach used Items marked with an asterisk (•) may be superseded by more stringent compliance requucments listed
on the Certificate of Compliance. When this checklist is incorporated into the permit documents. the fnturis noted 0120
be considered by all parties as binding minimum component performance spwfxatioru for the mandatory measures
wheUKr they arc &lawn elsewhere in the documents or on this chocklist only.
DESCUP ION
Building Envelope Measures
• §2.5952(a): Minimum ceiling insulation R-19 weighted avenge.
§2.5352(b}. Loose full insulation manufacturer's labeled It -value.
• §2.5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to
exterior mass walls).
§2.5352(k}. Slab edge insulation • water absorption rate no greater than 03%. water vapor
transmission rate no greater than 2.0 permr=h.
§2.5311: Insulation specified or installed meets California Energy Commission (CF..C) quality
standards Indicate type and form.
§2.5352(f): vapor barriers mandatory in Climate Zones 14 and 16 only.
§2.5317: Infiltntion/Eafxltration Controls
a. Doors and windows between conditioned and unconditioned spaces designed to limit air
leakage.
b. Doors and windows certified.
e Doors and windows weathcrstrippcd: all joints and perxvations caulked and sealed
112-5352(e): Special infiltration barrio installed to comply with 12-5351 moots CEC quality
standards.
§2.5352(d): Installation of Fvcplaces
1. Masonry and factory -built fireplaces have;
a. Tight fitting, closeable metal or glass door
b. Outside au intake with damper and control
c Flux damper and control
2. No continuous burning gas pilots allowed.
HVAC and Plumbing System Measures
12-5352(8) and 2-5303: Space conditioning equipment siring: attach calculations.
12-5352(h) and 2-5315: Setback thernwsta: on all applicable heating systems.
• §2.5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC.
§2.5316(b): Exhaust systems have damper controls.
§2-5314(c): Gas -rued space heating equipment has intermittent ignition devices.
62-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC.
§2-5352(1): water heater insulation blanket (R-12 or greater) or combined interiorkxterior
insulation (R-16 or grcatcr); fust 5 feet of pipes closest to Lank insulated (R-3 or greater).
§2.5312(Exception q: Pipe insulation on steam and steam condensate return & recirculating
piping.
§2-5319(d): Swimming Pool Heating
1. System has:
a. On/off switch on heater.
b. Weatherproof instruction plate on heater.
c. Plumbed to allow for solar.
2. 75 percent thermal efficiency.
3. Pool cover.
4. Time clock.
5. Directional water inlet.
Lighting and Appliance Measures
§2.5352(1): Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms.
§2-5314(x): Gas fired appliances equipped with intermittent ignition devices.
12.5314(a): Refrigerators. refrigerator-freeurs. fmczers and fluorescent lamp ballasts certified
by the CEC. Indicate make and model number.
COMPLIANCE STATEMENT
DESIGNER I ENFORCEMENT
This certificate of compliance lists tlr. Wilding features and performance specifications needed to comply with
Mile 24, Chapter 2-53 and Title 20, C2lagtcr2, Subdupier4. Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner. who shall
retain a copy of it and transmit the certificate to any subsequent purchaser of the building.
Designer
Name:
Tweffirm:
Address:
Te rte
(sign ) (date)
Documentation Author
Name:
Tstk/Fum:
Address:
Building Owner
Name
MWFunt:
Address:
Telephone
(signature) (date)
Enforcement Agency
Nona:
Atatcy
Telephone
r
. I fl ,q I . � - e
A
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