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063-050-001
-- -- - - ;063"05'-0-001 `�,` 9,1=3776'. -rCONT.R : ;,,OWNER F I�TZGE'RALD "DR,. FO STr RANCH _ M H. NU T I L CAS 3 Fl I COMPACTION TEST REQ ,A10 SUPPORT STRUCT REQ_/� 063-05-0-001 •a ti BAY, ROB I N `x--48 7 CONTR : VALLEY ES la -13' I 15739 FITZGE D DR -,'FOREST RANC MHI ' 63-05-01 92-635B , BAY, Robin 15739 Fitzgerald Dr, Forest Ranc _ (open deck/mh) s" g Z 063-05-0-001 99-0256 BP 'MEAD, Margaret - 15739 Fitzgerald Dr, Forest Ranch (MH/perm f n) eix MH) Rons MH Ser ;2 31q c 0 t4 NMI i ►.1 S I D E 94 RE TIAL 063-05-0-001 C)LrrS91-3776 • BAY, ROBIN CONTR: OWNER 15.739FITZGERALD DR, FOREST RANCH MH UTIL 9/AppA-m-cd 6u4,r-Kw�PvG-6, A fls owe , an, p,&� a4 r�- z-- OFFICE COPY Address, -7 `3 y r� GAS Date:�",/J'� I Meter By ELECTRIC 1f1 i .Meter By v� Date �/3 J=OK �`• O = Not OK Not Applic NO y Readable MBILE HOMES ,10 Date MOBILE UgfNIE UTILITIES (Pians4 except #'s 1. Z016V<equirements-Setb s -Easements 2. SQA?-,' Special MH upport Sketch 3. Sewer; Loca ' -Test-Fall /O Concre c 4. Water; Location -Test -Ease men Needed (Sketch) 5. ElectriVy; Lo on-Cleare es -G d-4 mp-Concrete 6. Gas; Location -T t-Wragi 100 L"ft. / /-Nat. or/ /" L" ft./ LPG 7. Well Clearance & Disconnect Utility Clearance Datell-11% I Card B -1 y$ Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE ME INSTALLATION (P s) OK except #'s nin Requirements -Set ck Easements otings; Size -Spacing rriag Line 3 as; Test -Demand- al —Con vKctor ectri ty; MHT ro over Bre rs-Clearances ain; MH Test -F a nnector er: MH Test-Reau r -Connector 7..W3� d Sewer Connected-OieTo Grade -HD Approval as and Electricity Tagged 9! ExJ s; Insp.-Sketch i✓ert. of Occupancy DatgZ—/3—.?/ Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 6 z 04 f4 r ' 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 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 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 -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 L\ 'J -OK ,? O = Not OK =Not Applicable Not Ready RESIDENTIAL (Single & Duplex) =` - Date UNDERFLOOR (Plans) CK except #'s j I Date FRAMING (Continued) 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- Bloc kouts-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. Romex Installed Close to Edge of Studs & C.J. ----------------------------- ------ ----------------------------------------- 26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water -------------- 2 Appliance Circuts in Kitchen & Conductor Size/GFI -------------------------------------------------------- 28. Subfeed Wire Sizer ga. Cu or AI-A.C. Wire Size ga. Cu or At ------------------------------------------------ ---------------------------------- 29. ---------- --------------------------------------------------- 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-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 ----------- ------------------------------------------------------- 35. Vent Fan: Exhaust above insulation ----- ----------------------------------------- --- - -- ---------- -------------- 36. ------- 36. Condensate Drain & Overflow: Size-&. Grade 37. Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet ---------- -- ------- ---- -------------- - - - - - - -------- 38 ------ 38 Attic Access & Platform if Furnance in Attic ---------- ---------------------------- ------------ -------------------------------------- Date ------------------------------------ Date Card B-1 Date Card B-1 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: Fur -red -Ceilings -Stairs -Chases -Tub - ---- ------------------ ------------ ---- - ---------- 44. Headers & Beam -Size & Bearing 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties-Purlin-roof Bra c-Truss-Shthng.-Ring. 47. Fireplace Ties o'r Type A Flue -Fireplace -Throat clearance 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hqt. & 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 Walls; Nailing -Bolts --------------- 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows Date ------ ------Card B-1 T 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 -Meth. 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: Swing -Landing -Closer ---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 ---------------------------------- ---- 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. ----------------------------80. Following instld.: Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 81. Stucco: Brown -Finish ------------------------------- --- 82. A.C. Unit: Disconnect. Electrical, Plumbing ------ ----- - ---------------------r --- - 83. Vents Above Roof: Plbg.-Appliance,Fireplace.-Clearance to Openings - - - - - - ------- -----------------------= - 84. Water Well: Disconnect, Electrical, Plumbing - -- -- - - - - - - - - --------------- 85. -------------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 6-1 Comments at Final: NOTES RESIDENTIAL 063-05-0-001 99-0256 BP MEAD, Margaret P 15739 Fitzgerald Dr, Forest Ranch ' (MH/perm fdn) ex MH) Rons MH Ser IT 336 Cow �--CA - RD 561A -l' t t "—THE HCD FORM 433A TbR THIS MH CANNOT BE RECORDED UNTIL ONE OF THE FOLLOWhNG HAVE BEEN TURNED IN TO THE BLDG DIV: ' (1) LICENSE PLATE(S) or DECAL(THE. INSPECTOR MUST RETRIEVE) (2) STATEMENT OF FACTS(ONLY ON NEW MH'S) INSPECTOR TO VERIFY SERIAL & LABEL #'S SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER JOB FINALED (Date) Signature V = OK 0 = Not OK - = Not Applicable = Not Ready MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 6. 1. Zoning Requirements -Setbacks -Easements Water and Sewer Connected -C/O to Grade -HD Approval 2. Soils; Special MH Support Sketch 9. 3. Sewer; Location -Test -Fall -C/O -Concrete Exits; Insp.-Sketch 4. Water; Location -Test -Easement Needed (Sketch) 12. 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Carports; Windows -Doors 6. Gas; Location -Test -Wrap;-/ /" L'ft. / /'Nat. or/ /"L"ft./ /'LPG Electric 7. Well Clearance & Disconnect Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 8. Utility Clearance Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s t 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 -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. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy 12. Permanent Foundation Onlv: License Decal Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs.-Connectors Shthg.-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card 8-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosure s- Pan elboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 V= OK 0 = Not OK - = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date Underfloor (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Fig., 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 -Blackouts -Wrapped 6. Stemwalls, Garage; Steel- Blockouts-Wrapped 6a. Hold Downs and Special Anchors Date 7. Slab, Steel -Wrapped Hangers -Post Caps -Anchors -Connectors 8. Piers -Fireplace Ftg.-Steel 48. 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 10. UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test 51. 11. Water Pipe; Test -Anchors -Regulator -Service Test Property Line Firewall & Openings 12. Electric Underground 54. 13. Plenums & Ducts; Clearance -Material -Support -Ins. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 57. 15. Access & Ventilation Glazing Area -Glass Protection -Skylights -Plastic 16. Insulation 60. Brace Interior/Exterior Wall Panels 61. Date 62. Card B-1 Date Card B-1 Date 71. Card B-1 Date Card B-1 Date 72. PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors 79. Insulation -Foam -Looked in Attic Date 80. Card B-1 Date Card B-1 Date 81. Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 23. Fixture & Transformer Clearance -Ins. Protection 24. Elec. Receptacles Spacing -Lights & Switches at Doors 25. Size Boxes & No. of Conductors Stapled 26. Romex Installed Close to Edge of Studs & C.J. 27. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 28. 2 Appliance Circuits in Kitchen & Conductor Size GFI 29. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or AI 30. Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At Insulated Neutral ❑ Yes ❑ No 31. Service -Riser Conductors & Ground Main Disconnect 32. Equip. Clearances Panels-Motors-Mech. Equip. 33. Clothes Closet Light -Shower Light -Spa Light 34. Smoke Detector 94. Address Posted Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Date 35. A.C. Ducts Insulation & Support Comments at Final: 36. Vent Fan, Exhaust above insulation 37. Condensate Drain & Overflow, Size & Grade 38. Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet 39. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 40. Sits Proper Materials & Anchors 41. Walls Studs -Nailing Spacing & Braces -Plates -Sound 42. Bearing Walls over Girders & Floor Nailing 43. Draft Stop in Walls (rat proof) 44. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 45. Headers & Beams -Size & Bearing Date FRAMING (Continued) 46. Hangers -Post Caps -Anchors -Connectors 47. Cling. Joist-Rftr. Ties-Purlin-Roff Brac.-Truss-Shting.-Rfng. 48. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 50. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 51. Garage Fire Protection Framing 52. Property Line Firewall & Openings 53. Ext. Doors -One T -Check Garage 3rd Story, 2 Exits 54. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 55. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 56. Siding -Nailing Veneer 57. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 58. Glazing Area -Glass Protection -Skylights -Plastic 59. Shear Walls; Nailing -Bolts 60. Brace Interior/Exterior Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Wal Is -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 63. Ext. Steps -Door & Sidelight Protection -Landings 64. Smoke Detector 65. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 66. Bedroom Exiting 67. G.F.I. & Bath Fixtures & Tub Access -Spa 68. Elec. Trim & Subpanel, Breaker Sizes & Labels 69. Stairs & Rails 70. Fireplace or Stove, Clearance -Hearth 71. Elec. Outlets at Wood Panel, Int. & Ext. 72. Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance 73. Elec. Outlets & Receptacles at Kit. Counter 74. Garage Fire Door; Swing -Landing -Closure 75. A.C. Duct in Garage -Damper 76. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 77. Plb., Elec. & Mech. Equip. Listed for Location 78. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 79. Insulation -Foam -Looked in Attic 80. Guard Rails & Deck Construction -Post Caps 81. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor O Yes 82. Following Inslld./Drive J Yes D No/Walks D Yes J No/Planters D Yes D No 83. Stucco Brown -Finish 84. A.C. Unit Disconnect, Electrical -Plumbing 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 86. Water Well, Disconnect, Electrical, Plumbing 87. Exterior Elec. Trim, G.F.I. Receptacle -Underground 88. Ventilation Throughout House 89. Glass Protection 90. Corrections from Previous Inspections 91. Gas Test -Meters Tagged, Gas -Electric 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates 94. Address Posted Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 (Rev. 12/96) APPLICATION AND PERMIT qq`5�� ASSESSOR PARCEL NUMBER r•• D ZONING BUILDINGPERMIT OWNER MARGARET MEADE TELEPHONE SO. FT. OCC. BUILDING VALUATION R 72,576-00 OWNER'S MAILING ADDRESS TranGERALD DRI- FOREST RANCR CONTRACTOR'S NAMETELEPHONE TI ' _4t i- 8 -CONTRACTOR'S MAILING ADDRESS P " 2 96007 CONSTRUCTION LENDER [Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee z 5e0 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 23.00 BUILDINGADDRESS Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ MobilehomeYq Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other 67 Describe Work: RnFT p Ff1TTNnAT'IQN FirTSTING MQRTT,F Gas piping system 1 - 5 outlets 15.00 Buildin sewer 15.00 15.00 Mobile Home ISI GI W1 @20.00 PERMIT FEE $ 65.00 ELECTRICAL PERMIT Filing Fee 20.00 Main Service zoOA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class /y 7 LIC. No. G4 O ENW R BUILDER D CL TION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO I000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. BUDS. SO 3.50 FT. NON•RESIDT ANCI O R 'I @7.50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES SAL p I.50 PPLNS Ex. Occup. ouTEEDTs RES D.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 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. Z I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATF. FTTNT) Policy Number T LI R � 3 2 ? _ OS (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith mply ith those provisions. qq4 Z __ Date —� _{ ( _ X 6*bof Sig atApplicant - ❑ Ownertractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demoli ' n or con truction of structures over 3 stories in height. r U MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ -7 occ coNsr. TYPE TOTAL FEE $ HA D. F IM FLOo c PARD HD su This permit is hereby issued under the applicable of the Butte Count Code and/or Resolutions indiated above for which fees have been By Date PERMIT EXPIRES ON Z &.) provisions to do work paid. Receipt No. 258158/125.00/258159/125. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD•APPLICANT YCOUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538.7541 PERMIT NO (Rev. 1'2/96) APPLICATION AND PERMIT w.wolt.�+ledw�.e1 zoF.a BUILDING PERMIT Tm"O"a SO. FT. OCC. BUILDING VALUATION 0Vn='8 MAAM A0001134 Co►+rnucnar Upeat 1tMOM WAA+p ADORM Fireplace Total Valuation $ �� OR VOXNM ucerca NM–Total Fee S 20.00 AACHffgCr OR V400IM48 Irl LM ADDRESS Permit Fee t SURD oAooFENG Plan Checkln Fee $ _ Energy Plan Checking Fee i s PERMIT FEE $ IN Ex. Occup. 0MV 011 FWMAIN eusolvsaws a rMca KOP PLUMBING PERMIT Fllnp Feel 20.00 Mobile Home Facilities USEOFSTRUCTURE Each Trap 7.00 Solar or heat pump water heater 23.00 SF O Duplex O hiobilshome O Other Water piping 15.00 15 specvy_ TYPE OF WORK Each as water heater or vent 15.00 Gas piping system t - 5 outlet 15.00 1s, New O Addition O Remodel O L=m O iodation O Other O Building sewer 15.00 /S` Describe Work: Moble Homo ISI GI W1 @20.00 PERMIT FEE S ELECTRICAL PERMIT FillnifFee 20.00 Win Service =owner 23.00 Main Service ( —To 1— 1 46.00 Ex. Occup. 0MV 011 FWMAIN •• aw .se Ex. Occup. oun�0 om. a 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Wsc. Wiring 23.00 PERMIT FEE S i MECHANICAL PERMIT Fling Fee 20.00 Heating 1 Cooling Hood 6.50 PERMIT FEE S Mobile Home installation Fee $ Energy Inspection Fee b «c ca1ST. TYK TOTAL FEE $ LI MAZ 0. FE!'9 WP F1000 COf PMWCl1 f0 'IO 65�E This permit is hereby Issued under the appikable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. OBy Date ------ 5 aS.� 2 5g �S/1940 4 - __ _PERM17 EXPIRES ON RECORDING�iEQUESTED BY: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BU I DING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 1 999-0006482 Recorded Official Records County CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 09:46AN 16 -Feb -1999 SPACE ABOVE THIS LINE FOR RECORDER USE ONLY REC FEE .00 CONFORM .00 Nikki Page i of 2 NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, • INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. MARGARET MEAD REAL PROPERTY OWNER&ESSOR PO BOX 567 MAILING ADDRESS FOREST RANCH, BUTTE, CA 95942-0567 CITY COUNTY STATE ZIP 15739 FITZGERALD DRIVE INSTALLATION MAILING ADDRESS, IF DIFFERENT FOREST RANCH, BUTTE, CA 95942 CITY COUNTY STATE ZIP SAME UNIT OWNER (ifalso property owner, write "SAME") MAILING ADDRESS CRY coANrr STATS 78 UNIT DESCRIPTION BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 99-0256 (530)538-7541 BUILDING PE TELEPHONE NUMBER 2/12/99 SIGNATURE OF O FICIAL DATE DEALER NAME (if not a dealer sale, write "NONE") DEALER LICENSE NO. GOLDEN WEST HM 1991 BRADBURY MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAMENUMBER GW6CALBC9243A/B 56' X 24' RAD619329/30 SERIN. NUMBER(S) LENGTH X WIDTH INSIGNWLABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. #063-050-001 SEE ATTACHED HCD FORM 433(A) REV. 8/91 WHITE -County Recorder CANARY - HCD PINK - Applicant GOLDENROD -Building Dept LEGAL DESCRIPTION A.P. #063-050-001 All that certain real property situate in the County of Butte, State of California, described as follows: LOT 4, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 9, 1972, IN BOOK 41 OF MAPS, AT PAGE(S) 1. CERTIFICATES OF CORRECTION RECORDED JULY 2, 1985, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 85-19773 AND SPETEMBER 15, 1987, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 87-33112. Rgr ,-ORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 COPY of Document Recorded 16 -Feb -1999 1999-0M482 Has not been compared with original BUTTE COUNTY RECORDER SPACE ABOVE THIS LINE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBELEHOME) OR COMMERCIAL COACH, INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording.' When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. MARGARET MEAD REAL PROPERTY OWNER/LESSOR PO BOX 567 MAILING ADDRESS FOREST RANCH, BUTTE, CA 95942-0567 CITY COUNTY STATE ZIP 15739 FITZGERALD DRIVE INSTALLATION MAILING ADDRESS, IF DIFFERENT FOREST RANCH, BUTTE, CA 95942 CITY COUNTY STATE ZIP SAME UNIT OWNER (if also property owner, write 'SAME*) MAILING ADDRESS Crrr eoaHlr SATE IID UNIT DESCRIPTION BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 99-0256 (530)538-7541 BUILDING PEZ TELEPHONE NUMBER 2/12/99 SIGNATURE OFOFFICIAL DATE DEALER NAME (if not a dealer sale, write 'NONE*) DEALER LICENSE NO. GOLDEN WEST HM 1991 BRADBURY MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER GW6CALBC9243A/B 56'X 24' RAD619329/30 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBERS) REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER A.P. #063-050-001 SEE ATTACHED HCD FORM 433(A) REV, 8/91 WHITE -County Recorder CANARY - HCD PINK - Applicant GOLDENROD- Building Dept. �A3. �\ . 5 ...... � �/ .�/ Wit.\\ % .. .............. . . .... BUILDING PERMIT NUMBER: 99-0256 Address or location of unit: 15739 FITZGERALD DRIVE, FOREST RANCH, CA 95942 Legal Description of Real Property: A.P. #063-050-001 SEE ATTACHED (x) Mobilehome/Manufactured Home () Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health and Safety Code Section 18551. Owner's name: MARGARET MEAD Owner's address: PO BOX 567, FOREST RANCH, CA 95942-0567 INSIGNIA OR HUD NUMBER: RAD619329/30 SERIAL NUMBER OR V.I.N.: GW6CALBC9243AB MANUFACTURER'S NAME: GOLDEN WEST HM YEAR: 1991 OFFICIAL APPROVING INSTALLATION: DATE: 2/12/99 PHONE: (530) 538-7541 H.C.D. 513C LEGAL DESCRIPTION A.P. #063-050-001 All that certain real property situate in the County of Butte, State of California, described as follows: LOT 4, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF - THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 9, 1972, IN BOOK 41 OF MAPS, AT PAGE(S) 1. CERTIFICATES OF CORRECTION RECORDED JULY 2, 1985, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 85-19773 AND SPETEMBER 15, 1987, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 87-33112. COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 - Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE 2S PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. Date ar4 Inspector, REV 10/92 ...... � .•; ...-.13� .� ".raT=�'��`'�`3:i�:;3;,';.'sf"�.r'4..,}--:-�i"�"=�t"-�i4xa�1F�`+``'"�r,.. COUNTY OF BUTTE •' BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 . 7 County Center Drive • Oroville, CA • (530) 538-7541 -1 CORRECTION NOTICE 99 - ER 5% ,_ PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter; or need additional explanation, please contact this office immediately. ra -� s Dat^ _ -/ �= Inspector REV 10/92 02/05/99 11:21 FEB -05-95+ 1.1:05 AM NOTICE TO ASSESSOR ' HCD 433(8) 4/86 • THIS FORM MUST 8E COMPLETED By T -HE OWNER OF A MANUFACTURED HOME MOBILEHOME OR COMMERCIAL COACH AND FORWARDED TO THE COUNTY IOU?-40A- ASSESSOR EM UPON PURS O NT COMPLETION SECTION E18SSST HEALTHH At°0 SAFET'YF THE NIT ON CODE- A FOUNOA ORIGINAL PURCHASE PRICE FOR: 1. n.. Tiwc Vr`r S 2. Oti"al Eo+�o^y" d vv9rod++ f 7. Svtrrore� S 1. ♦U worM� ✓a •C(r..Or/ SnWvr� y. ,re.r (Sv.oM 'Q. Da+i...ry b VWQJ q,o^ 7 TOTAL SAIES P910E. DOES THE BASIC PRICE INCLUDE: O YES .�+ NO frs+ b WA..h ❑ Yfs x NO ❑ YES IS NO UST NUMBER OF ROOMS 4/.�_oo 0 D:.'" Roo- �— r iom4y Roo- bgrf.. V.;liry Roc- R oo- j ortw Room L P.03 The soles Prue os shown docs not inciud0 any amount for Orly i"IQ<e location. o 2- 3 Zv -3 2 The AS111101 s '>0rcel Nvrnb'cf of rho nsiclla6cm site is i S, o^a^�' •' /�S%3 tl7LG �/lf1 ., a d... • olt£.Sr ,r,��1 M ,'h.0 1A) TTP. of Extinor Wall Co- '-q IAh.•al. wood. rt I cdf�,o Type 01 Roof CcH,i-9 (AA�.aI. wo�old. GomPw^'^ WK.i y;,WC.E A, Type, Boor C., wall K.." C3T'E S *% NO Ton I Air I:OKf�+o^�`0� D 'EES 54,40 Ewpwativo Cooler Q YES No CyAkwp: -1YES NO y,rih�n Or^: . E S N O Eu 11�n Oi �l.�ofA.r bwpv�n WWI bar: YES % YES -0 U NO R.Ir:pwoY'Or: C2 YES 19 NO .d.( Roof 0".+--g i;,^VrVIr IKIVd� C3 YES NO voA.. S LNG X WIOT7,1 a Corp. -is Corp.-^_. YES A—"; YES Porth: Garage. ❑ YES NO x YES C No Swrvo• $019th ' YES NO /G O JNEA. 51imnQ: (EE• The soles Prue os shown docs not inciud0 any amount for Orly i"IQ<e location. o 2- 3 Zv -3 2 The AS111101 s '>0rcel Nvrnb'cf of rho nsiclla6cm site is i S, o^a^�' •' /�S%3 tl7LG �/lf1 ., a d... • olt£.Sr ,r,��1 M ,'h.0 v .D f�) Ol O !9 re) Ln T J U1 2 Y X E Y } Q a- y Y OD toy -8' K` 8� G�191 i 5 - 4� OI MASTER IEDROOM ulrnnu nwrn B! DROp1Yf 3 =I NAMTFO MUNQ I 4• Pktr4y L&A.Vrrdil o BD 561 A4 1344 SQ.' FT.. �v w 3 Bedroom with Great Room yU . r - �. Jw 3y �Q'1 V� tSUT ( E CUWN i I iUILDING DEPARTMCim? APPROvEP. Ploy PL4,) ySss� z a N C 4� 1/1- It 1.R • i/1. AD N111 wC '•V15 - IYR 1/2'! 1' 111 011 1/7' CAIS nr[N1n( w1 t IRJ1 • • 1/1' M ITP. RP2029 PAO WITH RP7p00 SERIES STAND w0 SCALE . - 1/2' le Irl. - 1/2• AOAfsIINC WIS - TI'I. 1/T! 1' ►I1 a 1/7' _f u.s i•AC�iit eaI (wl a - 1/6' R T5'P. R2028 PAO , 7,. ..!11'1PW900 SE IT 1 ES5 TANG_ w0 SC -L( 0 �L >. r, _ RP2029/2029F% PAnG NO SCALE / II =_ TOP VIEW ENO VIEW r 7 M• �T SIDE VIEW RP2028 PAO NO SCALE 1n-.tr rr b 8 Extenson n Extension roll RPloll/7071 STANDS FOR RP2007 STAND ot51p• IISi(o A 0 IESILO 61 65R 1 AS SOCIAlts vA Ywf I. mvADo. P( . 11511wC w0, r01l0lost QR�FE���h cl)Q4Dy�r< r O Or W � Eri.�_j1Lor1� 2^. a[lI CMI- a��P if �.` k.E: '4aM -0 $T«x04L S(CTa. •Wi A I I 1 0 v E D saw Ac, ro cwucro-.I -. "o :ro Z.`i( . Dort __ C . 0— aA...1 sp k NO. ---� b- - F — 'il.i. Vim Ap txv.a! EA 4- V1r 1 0 .-� 1A I O •y k I T 1...•.<. ^h. Beom Restroant - Clomp NI. Beom Restro;nl Clomp rl r o Y e 1 ✓ ,� 1 <c r ^ni It 1'(VU/ 1($,2 1;L _j 1Am() I Y. 12 - 19 ( NI 10' 1 r� c ►-1 rruR�.-se. ro b USE RP2o29E PAD 5 (SEE N07C ISI k Ur _111-2 U 2 l ANO PERMANENT FOUNDATION SYSTEM BOB POLYMER 2000 SYSTEMS RP1900 SERIES STANOS RP2000 SERIES STANOS RR2028, RF -2029 A-0 RP20290 POLvMER CONCr(Elt "AOS WILLIAM A. SOMMERMEYER, CME ENGINEER 1111-0 CC C-0 REAL - ARROYO CRAr'Ot. CA ,1.20-255• RCC 11616 <•p.12/11/00 605/•6,-,160 �a i APRIL 199E SHE[ I 1 OI' ] slicclS � SouthSE 1699 W 0 B x 305 0 l.1 C 1rW,I u: -,6007 .4rk Tql Beom Restrorll-Clomp ot51p• IISi(o A 0 IESILO 61 65R 1 AS SOCIAlts vA Ywf I. mvADo. P( . 11511wC w0, r01l0lost QR�FE���h cl)Q4Dy�r< r O Or W � Eri.�_j1Lor1� 2^. a[lI CMI- a��P if �.` k.E: '4aM -0 $T«x04L S(CTa. •Wi A I I 1 0 v E D saw Ac, ro cwucro-.I -. "o :ro Z.`i( . Dort __ C . 0— aA...1 sp k NO. ---� b- - F — 'il.i. Vim Ap txv.a! EA 4- V1r 1 0 .-� 1A I O •y k I T 1...•.<. ^h. Beom Restroant - Clomp NI. Beom Restro;nl Clomp rl r o Y e 1 ✓ ,� 1 <c r ^ni It 1'(VU/ 1($,2 1;L _j 1Am() I Y. 12 - 19 ( NI 10' 1 r� c ►-1 rruR�.-se. ro b USE RP2o29E PAD 5 (SEE N07C ISI k Ur _111-2 U 2 l ANO PERMANENT FOUNDATION SYSTEM BOB POLYMER 2000 SYSTEMS RP1900 SERIES STANOS RP2000 SERIES STANOS RR2028, RF -2029 A-0 RP20290 POLvMER CONCr(Elt "AOS WILLIAM A. SOMMERMEYER, CME ENGINEER 1111-0 CC C-0 REAL - ARROYO CRAr'Ot. CA ,1.20-255• RCC 11616 <•p.12/11/00 605/•6,-,160 �a i APRIL 199E SHE[ I 1 OI' ] slicclS � SouthSE 1699 W 0 B x 305 0 l.1 C 1rW,I u: -,6007 10 Y-' 1 ' �a ..`I• \'J' ATTACH SECURELY' I_V \ f: L• !'�\60 MOBILE HOME SVVPdII � 1� `�* 0` 5D\�P' r /[`• cIRDER IYP . I 110 rV .o I 0 . ..SJPP" // oe•,f' / 9/16 -DIA. IYP. \�c1/%- ROD X%-1 /2" WELDED \ •Siff` P111S c'v BEAM RESTRAINT 11T• * KEY ORMIIp M�/ CLAMP DETAIL- "L ETAIL"L • W SCALE -... c i— 6- j� M11161.1A. 1/2-�-T- P - BEAM RESTRAINT BASE PLATE DETA 1 L No SCALE TYPICAL INSTALLA710N DETAIL - NO SCALE 1/16. OIA- TYP. S — 10• �1E I 6 �A"- 'I *• -� J ' + SEE (LL�lt�tp 1 i P - 1 O � + I- TYP- 1/%- PLATE BASE PLATE DETAIL NO SCALE SlppoRy GIRDER - I-1 /STANDARD BEM RESTRAIKT ASSEMBLY DEAN RESTRAINT CLAM. 9/16'�Ijjj��I11I 6C�\(NI1610 0 SEE OETAII 1/2-1'• T 1- STD. MAX. 9/16' • NOTE X1/2-17. 1B IYf. FOR1/7- 10,2-1/2'11/.- 1/%' PLATE —DEM RESTRAINT BASE 1- S I- 5 1/B- L CuSSET PLATES FOR 1900 SERIES STANDS LENGTH VARIES. 16--62- NO SCALE PLATE - SEE OETAIL ARE ACCEPTABIEI 1-1/16• ROD WELDED TO 71- STALL I/2- NO COIMECI ION - TYP, CA IPPER SASE PLATE. 1/2. IS" THREADED ROD. 1/Y FILLET BELOVION 1/f- FILLET WELD BELOW KM WELD AWA OR PlLIC WELD MOVE TO A. SASE PLATE 1_5/6- 5 1-1/16. 5 1/6- PL 2- 0.0. SOI 60 PIPE WITH 1/2- HOLE FORMED .TO -U- I/1- (ILLlT; BOTH SIDES ' o 1/1- HOLE FOR LOCKINC PIN - TYP 2-1/6. 0.0. SCH'60 PIPE _ O 4— 1. - - - o ♦ - 3/6- CAOHIUI- HB PLATEDTYP., PLATED CJI.S INTO CAST H -LAC E 00 C• 1 \ _ FERROL INSERTS 1- 1/16. OIA- TYP. S — 10• �1E I 6 �A"- 'I *• -� J ' + SEE (LL�lt�tp 1 i P - 1 O � + I- TYP- 1/%- PLATE BASE PLATE DETAIL NO SCALE SlppoRy GIRDER - I-1 /STANDARD BEM RESTRAIKT ASSEMBLY f 9/16'�Ijjj��I11I 6C�\(NI1610 0 ON PIAN r1 1- STD. MAX. 9/16' • NOTE 1)• TALL MWS' FOR1/7- 10,2-1/2'11/.- 1/%' PLATE PLATE 1- S I- 5 1/B- L CuSSET PLATES FOR 1900 SERIES STANDS LENGTH VARIES. 16--62- NO SCALE 160TH ARE ACCEPTABIEI 1/16. OIA- TYP. S — 10• �1E I 6 �A"- 'I *• -� J ' + SEE (LL�lt�tp 1 i P - 1 O � + I- TYP- 1/%- PLATE BASE PLATE DETAIL NO SCALE SlppoRy GIRDER - I-1 /STANDARD BEM RESTRAIKT ASSEMBLY SIDE VIEW FRONT VIEW RP 2028 PAO WITH RP1900 SERIES STAND NO SCAIL OESICN LISTED AND IESILO 51 6i. . o--• vAYNE I, POLvADO. PT - l•STINC HO. !01601051 t. roi No.-cnV1_ In C ^ \rE6F CA'�C�c/ �.aiMt%a,%u fO1++IAANu. •.\ILA. • -SUM ^IO SAPM COOL SICYKU. 451: C A P P R O V E 0 SVRRC'1 q CORRMCTIO-51 •0270 - • CODE: v- SI.rW5nt71 • SPA NO. -FiM.;►sol. At P-10" E1m:(r O� •2L� ?AOc> PERMANENT FOUNDATION SYSTEM BOB POLYMER 2000 SYSTEMS RP1900 SERIES STANDS RP2000 SERIES STANDS RP2028 RP2029 AND RP2029B POLYMER CONCRETE PADS WILLIAM A. SOMMERMEYER• CIVIL ENGINEER 1171-0 ELCAHINO REAL - ARROYO GRANDE, CA 11%70-255• RCE 11656 eaP•12/11/00 605/%69-5160 APRIL 1998 SHEET 2 OF 3 SHEETS OUTTE COON 17 80ILDINIG DEPARTP 9MY / 16- B - CENTERED 0 1- COLLAPSED )• 5 2-1/2. 5 1/6- PLATE: 1- STD. MAX. 1p- WELD TO BEM 1)• TALL MWS' RESTRAINT PLATE, BOTH SIDES OPTIONAL DIACONAL BRACING 1- S I- 5 1/B- L LENGTH VARIES. 16--62- 6• STD. 12- TALL 71- STALL I/2- NO COIMECI ION - TYP, SIDE VIEW FRONT VIEW RP 2028 PAO WITH RP1900 SERIES STAND NO SCAIL OESICN LISTED AND IESILO 51 6i. . o--• vAYNE I, POLvADO. PT - l•STINC HO. !01601051 t. roi No.-cnV1_ In C ^ \rE6F CA'�C�c/ �.aiMt%a,%u fO1++IAANu. •.\ILA. • -SUM ^IO SAPM COOL SICYKU. 451: C A P P R O V E 0 SVRRC'1 q CORRMCTIO-51 •0270 - • CODE: v- SI.rW5nt71 • SPA NO. -FiM.;►sol. At P-10" E1m:(r O� •2L� ?AOc> PERMANENT FOUNDATION SYSTEM BOB POLYMER 2000 SYSTEMS RP1900 SERIES STANDS RP2000 SERIES STANDS RP2028 RP2029 AND RP2029B POLYMER CONCRETE PADS WILLIAM A. SOMMERMEYER• CIVIL ENGINEER 1171-0 ELCAHINO REAL - ARROYO GRANDE, CA 11%70-255• RCE 11656 eaP•12/11/00 605/%69-5160 APRIL 1998 SHEET 2 OF 3 SHEETS OUTTE COON 17 80ILDINIG DEPARTP 9MY P C:ENERAL_ "OTES I. DESIGN LOADS: MIND LOAD. FO UP. EXPOSURE 'C' SEISMIC HOME. W SNOLOAD AS REOUIREO By BUILDING OFFICIAL. 1. THIS FOUNOAT IOM SYSTEM IS DESICMEO TO BE CONSTRUCTED ON AN APPROXIMATELY LEVEL SITE. 1. CARRY ALL FOOTINGS DOWN TO FIRM. UNDISTURBED SOIL. FOOTINGS ARE DESIGNED FOR 1000 ni ALLOWABLE SOIL PRESSURE. •. CHASSIS BEAM SUPPORTS SMALL BE LOCATED AND SIZED FOR THE LOADS AS SHORN IM THE MOBILENOME MANUFACTURERS INSTALLATION INSTRUCTIONS. S. w AREAS WHERE E DIFFERENTIAL SETTLFJNT IO.S.1 CAN OCCUR. MAHU- FACTUREO HOME SMALL BE READJUSTED WHEN D.S. EXCEEDS IFR OR WHEN IT WILL ADVERSELY AFFECT MAMUFACTUREO HOME UNIT. S. STRUCTURAL STEEL: FABRICATE ACCORDING TO AMSC SFECIFICAT IOM. WELD ACCOROIMC TO AWS SPECIFICATIONS. ELECTRODES. ITS PLATEf. ASTM A36 BOLTS. SAE CR.S - ASTM AAItl - ASTM A17MS 1. ALL jjEPOfED STEEL SURFACES OF COMPONENT PARTS TO BE FINISHED IN VURASLA INOUSTRI AL-GItAOE PAINT. OR R COROSION-RESISTANT PLATING. BEFORE DELIVERY TO THE MDBILEHOE SITE. NO STEEL SURFACES TO BE IN ENRECT CONTACT WITH SOL SUBCRADES. I. THE STAND AMO PAD ASSEMBLIES SMALL BE LISTED AND LABELED BY / BSK E ASSOCIATES FOR THE FOLLOWING LOADS: HORIIONTAL N71S. VERTICAL SI M M. 9. THESE STAND AND PAD WITS ARE DESIGNED TO BE USED WITH MOBILE - NOME CHASSIS BEAMS OF STANDARD SECTION EQUAL TO Olt GREATER THAN WIXTM. ANY OTHER SECTIONS SHALL BE FIELD EMC4kEERED TO ADAPT TO SECTIONS ACTUALLY ENCOUNTERED. 16. EXISTING COACHES MAT BE RETROFITTED TO RESIST SEISMIC FORCES AT INSTALLING THESE WITS AS SHOWN ON THE TYPICAL FOUNDATION MN. it. MULTIPLE -UNIT INSTALLATION IS ACCEPTABLE PROVIDED THE NUfBER OF FOUNDATION WITS MEETS THE REQUIREMENTS SHORN ON THIS SHEET AMO THE PLACE3ENT AND INSTALLATION PROCEDURES ARE FOLLOWED PROPERLY. 11. FORLONG DURATION SNOW LOADS, USE APPROPRIATE NUMBER OF ADO, TNNNAL UNITS AS DETERMINED BY THE FOLLOWING FORMULA: IILONG TERM SNOW L6AD!S/FT11 X IROOF AREA SQ.FT.11 : $970. USE EVEN NUMBER. OF UNITS ARRAMCED SA EACH DIRECTION. (MOTE: DES ICM SHOW LOAD UM RE REDUCED UI TO 7S1 WHEN APPROVED BY BUILDING OFFICIAL.I . 11. FOR POLYMER CONCRETE PADS. USE CONCRETE MATERIAL CONSISTING OF SAND AGGREGATE ROUND TOGETHER WITH POLYESTER RESIN AND REINFORCED WITH COMTIMl10VS WOVEN GLASS STRANDS. THE CONCRETE THUS PRODUCED MUST "VE THE FOLLOWING MIHAUUU MECHANICAL PROPERTIES: COMPRESSIVE STRENGTH Mi. 300 PU TENSILE STRENGTH 1.000 " FLEXURAL MODULUS 3.1 X le' PNi ;ENSILE MODULUS S.1 X 1S' P•: 1%. THE MANUFACTURER MUST CERT IFT' THAT THE MATERIALS HAVE BEEN TESTED TO TINE REOUREMENTS OF THAT METHOO O -A3. SECTION 1, PROCEDURE a:a SAID CSRTIFICATIOk WILL GUARANTEE THAT THE CON- CRETE HAS CMIOMICAL RESISTANCE AGAINST THE FOLLOWINC CHEMICALS IN THE CONCENTRATIONS NOTED: SOD11M CM COLD( SI SULFURIC ACID N.1M SOOIIAN SULFATEN. tN HYNOCNLORIC ACID A.1N SODIUM HYDROXIDEN.1w ACETIC ACID 31 KEROSENE PER ASTM D-SA3 TRANSFORMER OIL PER ASTM O-SA3 11 IN LIEU OF RPIC71B IAO THE RP)N71 STAND CAN BE INSTALLED USING RP7071'AD AMO APPROPRIAIt OI AGO.AL BRACING PER SHEET 7 wdm B' No.. CD —'G�)-" �- O O O IIDCE KM SUPPORT AS ..._ REQUIRED By M0"ACTURER-TYP. O siA10A1tD IH FOPOAT IOM '.ERs - AS IECONB(1p(D Br M RNMXACTUREA OR M ENCIIEER - TYPICAL T1IR000WT. RELOCATE AS NECESSARY - TVP• n MY PAIR MAY BE ROTATED n n �.� SO- TON AVOID CLEARANCE PROBLEM RECOMMENDED PLAN FOR 12 SUPPORTS 'ARIES - SEE TABLE t • MOI. Alba BEM SUPPORT AS REQUI RED By O — O VAWXACTURER-Ti•►. O STANOAltO III FOUE)AT I OM P I ERS . AS IIECON E/IDED Rr THE MAHJFKTURER OR THE ENGINEER - TYPICµ TINRQlOIGlf. RELOCATE AS MECESSMY - TA. 1ADS IN AMY PAIR MY K TO• 90 ROTATED n n n AP�BLEM n RECOMMENDED PLAN FOR 16 SUPPORTS TYP I CAL PERMANENT FOUNDATION PLANS NO SCALE E - 7' MIN / 6' MAX 5 - 6' MIN / 76' MANS DESIGN LISTED ANO TESTED BY BSK L ASSOCIATES WAYNE T. POLVADO, PE - IISTIMC M0. F01601051 NORMAL LOADS SNOW LOAD - 0 NO. OF WIDTH LENCTH UNIT Qh�fE$j)O 10' TO 37' % Q I 3e -se' 6 10' 59-7e' e �W'EKAYKL-T`FE\l%/A. KA�G Z 17' TO 37' 4 1 rn 33 -SO' 6 2! N�. C (!A :IJ r, 12' 69-e5• 10 13' LpA �P %s -s4' a qrF (.F C��aO� 1,1 65-80 10 �MRRi1%Yr .O•R•OAtM>.. •Ty1.. 11' TO 26• ♦ RAIO• ROAD SA/ET1 CODE SECTION •431 29- 14, 6 N - RS -60' B A P P R O v E D lA' 61-76' 10 "a"CT t0 COMRICT10N0 NOTED 20' TO 32' 6 .S_68 12 %... NNP...... w +►rrr Ir M.. -...N ,W . _ . 20' 69-80' 16 S•N.. cam• -60'- 16" 12 1 0-6-0- IX CODES AAO SI—O.Itt S 2A' 61 ' 26' TO 3%• a by ,].,,�'- �' — D0- "-�7 26' SS -73' 16 SPA NO. 33-50' 12 '0. P{DM A f pwo 'Eff boirM - ` -Z '- Zob0 SI -66 ' 16 T 26• 69-77' 16 /�E pROfESSiCh . PERMANENT FOUNDATION SYSTEM BOB POLYMER 2000 SYSTEMS RR 1900 SERIES STANDS RP2000 SER I ES STANDS RP2028, R 2029 AND RF -2029B POLYMER CONCRETE PADS t$UTTG Co biN I 1 WILLIAM A. SOMMERMEYER. CIVIL ENGINEER 1173-0 EL CMINO REAL - AAROYO CAANIDE, CA 93470-755• RCE 11658 -P.12/31/00 805/%89-5380 3©ILDING DEPARTMENAPRIL 1998 SHEET 3 OF 3 SHEETS DDD()VP r MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA — 534-4541 Address or location of mobilehome + ' Owner's name Owner's address s Insignia or hud number_ Manufacturer's name Serial number of V.I.N. i PERMIT N0. r r t' Year of manufacture (Official Approving Installation) (Date) 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 - D.P.W. STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY �,pENTprr� DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDS ' REGISTRATION AND TITLING PROGRAM STATEMENT OF FACTS This unit is a: 0 Mobilehome 0 Commercial Coach 0 Floating Home 0 Truck Camper Decal (License) No.(s) Trade Name Serial No.(s) uES7 ��5 God C/ a '94406-w/1 Gcv6L'AGB� g2�i3 / I/We, the undersigned, hereby state: bg e,4 4-S — /-c5I I/We further agree to indemnify and save harmless the Director of Housing and Community Development, State of California, and subsequent purchasers of said unit, -for any loss they may suffer resulting from registration of the above-described unit in California, or from issuance of a California certificate of title covering the same. I/We certify under penalty of perjury that the foregoing is true and correct. Executed on (Date, Signature(s) 1_i,Tl.,., , (City) Printed name(s) City ` State HCD 476.6 (REV 9/91) (State) u -uy-s0 RW, 12:33 FAX 530x:0.10713 BIDIVELL TITLE �0��, STATE OF. CALIFORNIA, BUMMUS, TRAMSPORTATION AND K0u61N6 AGEVCY _ 6MY DAYIB, Oa.ernor DEPARTMENT OF H+� SING AND C...—. MUNITY DEVELOPMENT �— Dlvlabn of eodee end Standard*My1TOF Witte Search' Date Brin-cd : 02/04/99 n Decal #: LAS6094 Nlanufacturer. 09248 GOLDEN WEST }:Ad Tradename: BRADBUR'Y Madel: BD561 A 1 Manufactured Date: l +.129/91 Registration Exp: First Sold On: lzn6/91 Serial Number GW6CALDD9243A GW6CAL13D9243B Registered Owner: HUD babel / insiglija RAD619329 RAD619130 Use Code: SFD Original Price Cade: Ai03 Rating Year: Tax Type: Lyr Last MT Amount: Date ILT Fee Paid. ILT Exemption: NONE Length Width 56' 12' 56' 12, MARGARET MEAD PO BX S67 FOP -Z- T RANCH, CA 95942 L ut Title Date: 11/29;'94 Last Reg Card: 11/29/94 Sale/Transfer Info: Prico $45,000.00 Tmwferred on 09/15/94 Situs Address: 15139 PITZGM ALD DR FOREST I ANC1 CA 95942 Situs County: 13L'T47E. Legal Owner: ROBIN CETINA JA -MES CRTINA TM3 Ptd BX 120 BURN" RANCH; CA 95527 hien Perfected Ou: 10/31/94 12:00:00 Title Searches: BMWELL TITLE PO EX 5173 CFUCO, CA 95927 Title File ha: 2-186076 . *** En OF TITLE SEARCH *** TOTRL P.03 STATE OF CALIFORNIA -'DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT RFnTCTRATTFTN f ARTT MFTRTI Fwn*,ip ncrni i -n a . r I . . I :AtAWFACIURER IJAI:IE/ID GOLDEN NEST HM/09248 TRADE NAME BP.ADBUP.Y1B MODEL D561A1 DOM 11/29/91 DOT 11/29/91 OFS 12/16/91 SPC ` EXFIRAIION U SERIAL NUMBER I GI16CALBD9243A LABEL/INSIGNIA NUMBER RAD619329 WEIGHT 021400 LENGTH 000672 WIDTH 000144 ISSUEDSCC 11/29/94 04 EXEMPT USE SFD 1, _F 2 GW6CALBD92438 RAD619330 018200 000672 000144 Vla TOTAL 3 a FEES s PAID: B $51.00 A D D R E 5 S E R . E M I A S I T L E R E D O S W I N T E U R S L E G A L O W N E R J U F N I I R O S R T L I E N S H E O C L O D N E D R MEAD MARGARET PO BX 567 FOREST RANCH CA 95942 sV z HEAD HARGARET PO BX 567 FOREST RANCH A a"K.0"95942 15739 FITZGERALDtDR- FOREST RANCH CA 95942 Z - ROBIN CETIHA/ La JAMES CETINA JTRS PO BX 120 mom'. I BURNT RANCH ES CA 9s DATE: 1.0/31/94,,12:00:00 A- € r DUPLICATE COPY Ya TO BE FILED WITH THE MOBILEHOME `PARI( OPERATOR AS REQUIRED BY LAW F "int � t;3 V p-' R a {:f�a ea43�s R IHPORTAt1T 03-326-00188 THE 014NER INFORMATION SHOWN ABOVE MAY 140T REFLECT ALL LIENS RECORDED 14ITH THE DEPARTMENT OF HOUSING AND COl-1MUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT.. 2 THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. 0300018 {:f�a ea43�s as _ffi4 i" P3 7 Vla IHPORTAt1T 03-326-00188 THE 014NER INFORMATION SHOWN ABOVE MAY 140T REFLECT ALL LIENS RECORDED 14ITH THE DEPARTMENT OF HOUSING AND COl-1MUNITY DEVELOPMENT AGAINST THE DESCRIBED UNIT.. 2 THE CURRENT TITLE STATUS OF THE UNIT MAY BE CONFIRMED THROUGH THE DEPARTMENT. 0300018 02.,'08,* 99 31ON 12:34 FAX 5103944 i 13 BNAVELL TITLE RGWrd el the R"uest of MId Valley Tit,@ a Escrow .:ampany Ordor No. Escrow No. 143774CA 1 Loan NO, WHEN RECORCED MAIL TO: MARGARET MEAD Y.O. sox 557 FORST IL;,yCH, CA 95942 MAIL TAX STATEMENTS TO: &AME AS ABOVE 063-03o.00l 94-34136 134-0,341:36,' Rea Fee 9. r10 I DOC Recorded I Check OSficlel'Records I 44.00 53.00 Co:anty of I Sutte ) Candace .J. Grubbs I Recorder I 6100am 15 -Aug -94 I HVTC JR 2 DOCUMENTARY TRANSFER TAX 341pp f 7ry,b..� X friar UW"d m rM Wfabrsdm of bear to 1, A i I gorr4eret OR conmw at M omumroton or VMS YY flex or Itrela worim ltae*hg r am of IoM. Ths almdAmId ad iib -tom. pkmm SOn't" of oNUM w *Oft ritsMn6 4 but - FWM Narita GRANT DEED FOR A VALUABLE CONs:oERATION, receipt Of which± is hereby acknomouq tf, 1UIYMOND JAMES CETINA and ROBIN CETINA, husband and wife, who acquired title its RhBIN MARK BAY, a single wornan hereby GRAW(S) to MARGARET MEAD, a marr led woman as her separate property 1116 rem Prppelty In the City of unincorporated area County of BUTTE ,VA" cfcaft owoomor hod u SEE ATTACHED LEGAL DESCRIPTION Dated Atf0im in—J-994 STATE OF CAUFOPINIA ) OOUNTY OF &uTT: ) On 8/ 12/9+ dote Poraonalty appoared ROHIN CF;TL'f.1 )L1Y"10ND JAMES CF.TINA pOeApre)1y known to me !or proved to mo Ort the Mao of m"factory *A40 co) fo be the Penoeb) ldleee name(a) lalar4 wbxnoed to tho w4" +utta+rt+ent and acknmvWped to no that holahurlhey onocutad the 3AM9 in ;tWNM/ h6? authatzee capaaty(les). and :hat by hwltWheir stgnetule(s) on the klelrumG1A the Pofsan(a) Cr IN amity _non boha't of ATIM iffo Person(3) aced, eremAed the I.'alrumeni. MTNESS r y hand end offidel seal. Wit_ .\ /, ' K.�l AIO JA.` 'S CET INA wlmtlo�n�MURtaouetaept.rMluawr!aannlwi >� C ARAGON 12 IENYY�wuN1 Nlr.:u Iwwun:4 NIININIIuIYOiIIbNN�111II e I nnt�f Z 01) 4 02: 05:99 310i 12:34 F,T 3108940713 BIDWELL MILE 005 / 94-34 136 ORDER NO. 6U-143774 CA DPSCRSPTION ALL THAT CERTAIN REAL ?ROFE .TY SITUATE IN THE STATE O:' CALIFORNIA, COUNTY OF BU17E, DESCRIBED AS FOLLOWS: LOT 4, AS SHOWN ON THAT CERTAIN PARCEL MA?, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 9, 1972, IN BOCK 41 OF MAPS, AT PAGES) 1. CERTIFICATES OF CORRECTION RECORM JULY 6, 1983, UNDER BUTTE COUNTY RECORDERS SERIAL NO. 85=19773 P.NO SEFTEHBER 15, 1987, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 87-33112. "AG-" 4- 110N 12:34 FAX 530.5940713 BIDWELL TITLE (;o3 ' • � $] mein CrTice ❑ OroviHe ❑Paradise [3 Gridley 500 wall sheet 1835 R6birlson SK. 7126A Skyway 560 Kentucky St. Lal7asna Joyner President 4 P.O. Box 5173 Chic, CA 95927 P.O_ Box 811 Oroville, CA 95965 P.O. Box 490 Paradise, CA 95967 P_O. Box 949 Gridley, CA 95948 Chief ExecuSve Officer (530) S94-2-512 (530) 533-2553 (530) 533-2414 FAX (530) 533-1589 (530) 877-6262 FAX (530) 87:-5129 (530) 846-4005 FAX (530) 846-0-584 (530) 846-4583 :Serving Me uoah FAX (530) 894.07'3 mweshwe 1929 February 8, 1999 Escrow No: 2 -186076 -KM Butte County Building Department Attn: Alice RE: Mead to Young AF //063-050-001/15739 Fitzger3id Drive, Forest Ranch 1991 Golden West Mfg Horne, Decal #LAS6084 The above referenced NZanufactured Horne is being installed on a foundation by Ron's Mobile Home Service. Notice is hereby given that Bidwell Title & Escrrw Company has been instructed to surrender the original Certificate of Title and Registration (or executed Duplicates) to the Butte County Building Department at close of the above referenced escrow. Sincerely, YOUR BIDWELL TITLE AND ESCROW COMPANY TEAM By: �:-1 �✓7 �� Krisann Nforton, Escrow Officer O'ECAeeere I 1 rr OUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center grive - Oroville, California 95965 - Telephone (916) 538-7541/��_ ��� NO. (Rev.12/96) , APPLICATION AND PERMIT `� P ASSESSOR PARCEL NUMBER — 0 ZONINGB ,! U I LD I N G P ER M I T OWNER MARGARET MEADE TELEPHONE 510-899-82 SO, FT, OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 1.144 R 72.57 CONTRACTOR'S NAME TELEPHONE ' 1 —365-6118 CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS ' Fireplace ' Total Valuation—7—i ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee 519-"72., $Z,Sg ft*( ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee 1 $ BUILDING ADDRESS Energy Plan Checking Fee $ PERMIT FEE 03, LOT NO. SUBONIS IONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome)C4 Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Q Describe Work: RETROFIT FOUNDATION EXISTING MOBILE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 1 1@120.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class C 47 Lic. No. 702127 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 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 xg performance of the work for which this permit is issued. IS I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' com�Qpsation it a carrier and policy number are: Carrier WTATE E Policy Number O (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100)-6r less.) I ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith mpiy Ith those provisions. �„+,�.�------�— c.I --- X = Date 2 f r Sigrfature of Applicant - ❑ Ownerontractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. so OR ADDNS. ( & ACC. BLDS. 3.5c,. NON.REO,SID. MULTI -OUTLET @7,50 POWER APPARATUS & SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES BAL � .SO Ex. Occup. DLFEOTS gESIp.DEp 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEEo ' HAZ. / D. FEES I P FLOG9 PAR HD S This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above fo whi h fees have been paid. it ByD to �- PERMIT EXPIRES ON 2,/ J//ey) I are Receipt No.)tiJq/bU/ UU WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Y 1 71 Eatte, County L A N D O F NATURAL W E A L T H A N D B E A U T Y DEPARTMENT OF PUBLIC WORKS WILLIAM (Bill) CHEFF, Director 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 Telephone: (916) 534-4681 RONALD D. McELROY Deputy Director July 15, 1985 Hazel Erdman RE: AP 63-05-01 & 06 77479 Sawgrass-Circle Certificate of Palm Desert, CA 92260 Compliance Dear Ms. Erdman: Enclosed please find the Certificate of Compliance which was recorded by the Butte County Department of Public Works in the office of the Butte County Recorder on June 26, 1985, under document number 85-19091. If you should have any questions regarding this matter, please contact this office. Very truly yours, William Cheff Director of Public Works Original signed by JOHN MENDONSA John Mendonsa Assistant Director JM/ns Attachment cc: Environmental Health wilding Department Lippincott -Guth Associates, P.O. Box 671, Paradise, CA 95969 �. RETURN TO: Public Works Land Development Section CERTIFICATE OF COMPLIANCE Issued to: 9091 �:iC''iii:_li i• !"=� iz;.�'. PdEi;Orit,".. OF BUTTE COUr1T'f.CAL1FOFir;1�;a AT THE RE0U'_ST OF PUBLIC WOOW 1985 JON 26 Pt; Lq: 24 tLtA'll 1, 1. "'(.;i'iP Hazel Erd mjVRK% -RECORDER FEE_. FEE 77479 Sawgrass Circle Palm Desert , CA 92260 �`�m°19091 This Certificate of Compliance is hereby issued by the County of Butte'to certify that the land division which created the parcel of property identified below complies with the.applicable provisions of the Subdivision Map Act and of Chapter 20 of the Butte County Code. 1. Property location: on the south and west sides of the intersection of Fitzgerald Drive and Tippi-toe Lane. Forest Ranch area. 2. Assessor's Parcel Number: 63-05-01 and o6 Description: All that certain property located in the County of Butte, State of California, more particularly described as follows: J That portion of -Lot 1, as shown on that certain parcel map of a portion' of the .Southwest quarter of Section 5, Township 23 North, Range 3 East, M.D.B. & M., which map was filed in the office of the Recorder, of the County of Butte, State of California, on February 9, 1972 in Book 41 of Parcel Maps., at page 1, lying northwesterly of Fitzgerald Road as shown on said map. Issuance of this Certificate is conditional upon the following conditions which have been imposed pursuant to the Butte County Code Chapter 20-167 and Government Code, Section 66499.35p•(b)'. to . protect the public health and -public safety: 1. Provide" satisfactory evidence"''zna"t a 'suitable site ` for the in's*tallation and replacement of a sewage disposal system for a single.family residence exists on the property. 2.; Provide satisfactory evidence that adequate quantities of potable domestic water are available for a single family residence on the. property. 3. Once condition #1 and #2 have been complied with to the satisfaction of the Environmental Health Dept.; the applicant's engineer''or surveyor is to file a Certificate of Correction to.amend the map recorded in Book 41 at Page 1, to show this parcel as parcel 4 or lot 4. County of Butte Subdivision Violation Committee LD 1400 END OF DOCUMENT E Page BEAUTY 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 Telephone.: (916) 534.4681. RONALD D. McELROY Deputy Director August 1, 1985 Hazel Erdman RE: AP 63-05-01 and 06 77479 Sawgrass Circle Notice of Compliance Palm Desert, CA 92260 Dear Ms. Erdman: Enclosed please find the Notice of Compliance which was recorded by. the Butte County Department of Public Works in the office of the Butte County Recorder on July 8, 1985, under document number 85-20165. If you have any questions regarding this matter, please contact this office. Very truly yours, William Cheff D- irector of Public Works ,John Mendonsa / 401 - Assistant Director JM/ds {// cc Building Dept. Health Dept. Lippincott/Guth Associates g5-_2016.5 Ut'I'I'.•iAL AECORUS u= BUTTE COUNTY, CALIFORNIA ? ATTHE REQUEST OF RMUC N'ORKS REiJRN T0: 1985 JUL -8 PM 2: 02 ELEANOR M. EECKER Public Works Department GLEN -RECORDER' FEEt - Land Development Section . 85-2015 NOTICE OF COMPLIANCE Issued to:. Hazel Erdman 77479 Sawgrass Circle Palm Desert, CA 92260 This Notice of Compliance is hereby issued by the.County of Butte to certify that the conditions imposed on the Certificate of Compliance; recorded under Recorder's Document [Number 85-19091 , have been fulfilled.to the satisfaction of the Subdivision Violation Committee on the property identified as: a. Assessor's Parcel number: 63-05-01 and 06 b. Description: All that certain property located in the County of Butte, State of California, more particularly described as follows: That portion of Lot 1, as shown on that certain parcel map of a portion of the Southwest quarter of Section 5, Township 23 North, Range 3 East, M.D.B. & M., which map was filed in the office of the Recorder of the County of Butte, State of California, on February 9, 1972, in Book 41 of Parcel Maps, at page 1, lying northwesterly of Fitzgerald Road as shown on said map. NOTE: A Certificate of Correction was recorded July 2, 1985, under Recorder's Document Number 85-19773• Issuance of this Notice of Compliance is pursuant to Butte County Code, Chapter 20 -167 - County of Butte SAdivi,tion Violation Committee END OF DOCUMENT END OF DOCUMENT REIDE TIAL 63-05-01 92-635B 61 BAY, Robin 15739 Fitzgerald Dr, Forest Ranch (open deck/mh) i I JOB FINALE Signature J=OK O = Not OK Not = Not Readyable: MOBILE'HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s c4 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearences'-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / /"L"ft. / /•'Nat. or/ /" L"ft./ /"LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'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 -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 C D CKS_kOVTwITS. CARP S, GA ' S, Plans OK except #'s 1. Zoni R uir nts-Setb -Ea nts 2. Fo ' s; Soils -Size -De -Sp g -Connectors Q,45e-cks; Griders and/or jj-Decking-Bra -Sta' -Ra' 4. Wood Awn.; Pos eams-Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7.. 1erf 'r - 8. r - u 9. Sid' ucco- esh 10. Roof; Shthg;prng 11. Ext.; St -Doors-Lartdi s Date 044-44r4L Card B-1 Via Date Card B-1 Date (p-5•q/L Card B-t/,O 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 V OK O=Not OK = Not Applicable Not Ready RESIDENTIAL (; = Date UNDERFLOOR (Plans) OK except N's 1. Zoning -Setbacks -Easements -Flood -Slope - 2. Fig., Main; Soils-Elec. Grnd.-/ /" Fig. Depth 3. Fig., Garage; Soils-Steel-Elec. Grnd.-/ /" Fig. Depth 4. Fig., Porches & Decks; Soils -Steel-/ /Fig. 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 ft'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 --------------------- ------------------ -- Gas Pipe: Size &-Anchors Date ----- -----Card B-1 Date ----- -----Card -B-11-_----- 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. Romex Installed Close to Edge of Studs & C.J. ---- -,---------- --- -�------------------------------- 26. Equip_Ground made up_w!Mech. Fastners-Bond 'Gas & Water - ------- - ------------------------------------- _ 27. 2 Appliance*Circutsin Kitchen -&Conductor Size!GFI ---------------------------------------------- 28..Subfeed Wire Size ! ga. Cu or AI-A.C. Wire Size ! ! ga. Cu or At ------------------------ 29. Range Circ / r 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-1 Date Card B-1 ---------------------------------------------------------------------------------- Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except ft'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 Card B-1 Date Card B-1 Date FRAMING (Plans) OK except ft'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 tingle & Duplex) Date FRAMING (Continued)' -- - 45. Hangers -,Post Caps -Anchors -Connectors y 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 Vents -Rafter Outriggers Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access ------------------ - 57. Glazing Area -Glass Protection -Skylights- Plastic -------------------- _ Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows ------ ----------------------------- Card ----------------------------Card B-1 Date Card B-1 Date -Card B-1 Date Card B-1 Date FINAL (Plans) OK except N's _ 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector ------------------------- - 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. 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: Swing -Landing -Closer --------------------------------- ---- - 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 O No; Walks ❑ Yes ❑ No; Planters _❑ Yes ❑ No 81, Slucco.::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 -------------- I --- ------------------ 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 Comments at Final: Date Card B-1 Date Card B-1 Date Card B-1 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATIOWAND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 063-050-001BUILDING ZONING PERMIT OWNER Robin Bay TELEPHONE 342-1632 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 2#1 - Forest Ranch 95942 02 b CONTRACTOR'S NAME A/ Owner 6__:� TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation S LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee �_ 3 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 15.00 19719 Fitzgerald Dr., Forest Ranch Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome® Other Derk SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home s G W @ 15.00 TYPE OF WORK New ❑ Addition EX Remodel ❑ Utilities ❑ Installation[] Other ❑ Describe work: Deck Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 18.50 Main service 200A To 1000AI CONTRACTORS LICENSE LAW I declare under penalty of p y perjury Iur y (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 NEW CONST.( DWELLING OCCUP.&) OR ADONS. ACG. BLDGS. _37.50 3.6p sq.f[. NEWCONSTR ULTI.OUTLET NON•R ESID BRANCH CIRC ITS @ 5 00 POWER APPARATUS & (SINGLE OUTLET CIR. ) Ex. Occup(OUTLETS OR FIXTURES 20 @ 76 FIXED Ex. Occup. OUTLETS (RESID )REA.) 3.00 Temporary service 15.00 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 $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. �i I shall not employ any person in any manner so as to become subject mac' 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 15.00 Heating Cooling g Hood 6.50 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 again aid- o nt i nseq nce�of the granting of this permit. s y�I AvfP Date " ! 7— Signature of App ' ant OwnerX Contractor ' Agent � An OSHA permit is required for excavations over 5'0" deep ari�lition or construct- ion of structures over 3 stories i height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL F-� EE HAz DFEES I IMP FLO C PARC HD SUE j This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do I work indi sled 8bov for which fees have been paid. B D k-, R O UBLIC WORKS �� 1 y 1 Date PERMIT EXPI ES Date i Receipt No. 109938 %/.� %�,s�j(j`L WHITE-D.P.W., YELLOWS -AS.ES0 . PINK -INSPECTOR. GOLDENROD -APPLICANT w COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CAVIFI�RNlk,!5965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. OWNER `•s e` _ A. P U U Proposed Building Use Building Ins 6Dt At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED All items have been submate.d:................................... _ _ Plot plans in duplicate/i lica signed by preparer of plans . �J-/S 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.......................................... 33. z 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 ....................................... Parkfees paid.................................................... School District fees paid .............. ZPLoTS Sanitation approval from Health Department 19' 9 G City of Cliico plumbing permit..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: 18. Improvements may be required. Contact Land Development Section DPW 19. 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 ❑) ..... corded copy of Agricultural Acknowledgment Statement ......... Letter of signature authorization................................... 6. 27. When you issue the permit, process as follows: troTrer. Mail to contractor. ,Telephone and hold for pickup at j office. Deliver w/insp ctor. Qther ✓ — erSe r Applicant Date Copy of'. lez-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 for o e it suance: (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 count by_ date Contractor, designer, owner, was advised of above required data by_phone_mail_cou er by date Plans checked by Date flan approved by Date Sei/ ,b� F nh/a88 ,idZn File cabinet AP folder Copy—DPW 4, t TO: Building Department FROM: Environmental Health, Chico SUBJECT: Sanitation Clearance Owner motion AP# Plann approved for: sewage disposal water supply Hold final for: water supple Final clearance OA. for: water supply Clearance for bedroom mobile home. Other Note*** Sanitarian 41 Z -y L Date TO �-� Buildina Department FROM: , Environmental Health SUBJECT: Sanitation Clearance b • l r7 3 - e,.a-1 ' 4 3 -. r` - -1 Omer t Locati n AP# - Plan Approved for: Sewage Disposal Water Supply Hold final for: Water Supply Final clearance O.R. for: Water Supply) Clearance for bedroom mobile home. Other NOTE * * * _� • Date Sanitarian COUNTY OF BUTTE - Department I Public Works 7 County Center Drive, Oroville, CA .95965 OWNER -BUILDER VERIFICATION Attention Property Owner: Phone: 916-538-7541 An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and aMals for construction of the proposed property improvement (yes or no) 2. I (have/have not) a �— 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 poxtions: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 Security Number Date J -F S Z 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 beforz we are per- mitted to issue the permit. v to C Flo O>c �C rn �v x � Aj 1 (i atkd, r N I D 6 -3 ,_ � o ' Q� S Q I r 6 10 ?� N � O� r -43 I � 0 Q Y ' n 36 zo' BUTTE COUNTY-.. BUILDING DEPARTMENT. 'APPROVED u Qi ,nddkss lS739 Fit2qe rale 6,3-050-001 NJ COUNTY OF BUTTE - DEPARTMENT.OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916.538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER % 3 — O SO — 00 ZONING BUILDING PERMIT OWNEREL,Ep OtJ 't'(�O)C f/Q_ SO. FT. OCC. BUILDING VALUATION 6171 OWR'S MAILIAGOft/ E ��� CON'TRACTOR'S NAME OwNCr - TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Js LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 7 3 q /'i f Z �� Permit fee $ v PLUMBING PERMIT Filing Fee 15.00 1� Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO.SUBDI VISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex[] MobilehomeiR Other ZL-cA SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 615.00 TYPE OF WORK New Additions Remodel[] Utilities[] Installation❑ Other❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT FilingFee 15.00 Main service 200A OR LESS 1800V OR LESS .50 Main service 200A TO 1000A1 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑NO 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 _37.50 NEW CONST. ( DWELLING OCCUP. f\ 3.6Q sq.tt. OR ADONS. ACC. BLDGS. // NEW CONSTR ULTI.OUTLET @ S.00 N•R ESID BRANCH CIRC ITS POWER APARA TUS e (SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 20 76d EX. OCCUp. OU LETS FIXED PIRESID.)REA.� 3.00I Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 9 15.00 Permit Fee $ — 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. K1 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 15.00 Heating Cooling g Hood 6.50 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 9 PP ❑ Contractor ❑ Agent An OSHA permit ;s required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE CD HAz DFEES IMP FLOOD COF PARCEL O HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY DatePERMIT EXPIRES Date Receipt No. I WHITE•O.P.W.. 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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 NOTI,M , OWNER T 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 rrection of work is completed. If you have any question pertaining to this matte, or need additional explanation, please contact this office immediately. wlln•. 'Zig Date /_2 - 3—D Inspector f/ -lam (AtAA_ .... .. COUNTY OF BUTTE , 1�21y— DEPARTMENT OF PUBLIC WORKS t 196 Memorial Way, Chico — Phone: 891-2751, 7 County Center Drive, OroviIle — Phone: 538-7541 747 Elliott Road, Paradise — Phone: 872=6307 } CORRECTION NOTICE. ER � � PERMIT N0. 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. Date// 9' 9— Inspector (/��— / COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS V7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 • APPLICATION AND -PERMIT 7 ERM T NO. ASSESSOR PARCEL NUMBER 63-050-001 ZONING BUILDING PERMIT OWNER Robin Ba TELEPHONE 345-2054 SO. FT. OCC• BUILDING VWCUATlOf4 OWNER'S MAILING ADDRESS P.O. Box 763 Forest Ranch 95942 CONTRACTOR'S NAME V TELEPHONE 891-4981 MAILING CONTRACTOR' ADDRESS 2050n i 1 Dr, 301 Chico Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 20.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 35.00 PLUMBING PERMIT Filing Fee 15.00 15719 Eitzgprnlrl Dr, Forest Ranch Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF [:1 Duplex❑ Mobilehome[I Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S G W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation El Other ❑ Describe work: MHI 3 Bedroom _ j,( Permit Fee $ Contractor ELECTRICAL PERMIT [— Filing Fee 15.00 Main service S00vORLESS 200A OR LESS 18.50 Main service 200A TO 1000A) 37.50 CONTRACTORS LICENSE LAW I declare u er penalty Of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions� / C de Y � Classification and my license is in full force and effect. License No. Q� (� ( F1 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) 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 OCCUP.d\ OR AODNS. \ ACC. BLDGS. // 3.SQ sq.ft. NEW CONSTR. ULT' -OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS e SINGLE OUTLET CIR. EO X. CCUp�OUTLETS OR FIXTURES 20 �e Ex. Occup. OUTLETS IRESID .)OR EA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. �yirin 9 15.00 Permit Fee $ — 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 Consent to Self -Insure. II 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 15.00 Heating Cooling g Hood 6.50 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 Iia ties, judgments, costs, and expenses which may in any way accrue agai t s id u in copse uence of the granting of this permit. X Date 0, Z— 11 Signature of Applicant — Owner 0 Contractor ❑ Agent P` An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height.R Mobile Home Installation Fee $ 70.00 Energy Inspection Fee $ OCC CONST TYPE TAL FEE $ 105.00 HAz 1 DFEE IMP FLo CDF PA RC► ?/ P H ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees T OF PUBLIC BY PE T XPIRES Date applicable provi- resolutions to do have been p aid. WORKS DateiZ"J 'l/ 52:..�� �� Receipt No. 103104 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT • • f � T r V COUNTY OF BUTTE - DEPARTMENT OF PUBOICVORKS - BUILDING DIVISION 7 COUNTY'CENTER DRIVE-'ORgyV E, CALIFORN]k-9 6 '-TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET 11 Permit No. OWNER -O t Proposed Building Use Irl ]T � Building Inspector 1 Date �( At time of permit application, I was advised the following data must 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........ 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 ....................................... 1 Park fees pa LJ School District fees paid .............. 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) 17. Planning approval for (A) Use: (B) Parking: 18. Improvements may be required. Contact Land Development Section DPW 19. 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 i .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) , . . . ecorded copy of Agricultural Acknowledgment Statement........... 2 'etter o signature t ori ation . v.- ............................... Z you .ssue the ermit, rocs as follows: a Mail' to ow er. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other Applicant Date la / 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 priorto-permit issuanc : (Circle new item not checked above). , 1. Index permit for above items No. -7 � YS7 2. Additional items reg,4lired: CorArd'c'tor, designer, owner, was advised of above required data by,f�one---mail—counter by4622—.date ZZ'tZ_f Contractor, designer, owner, was advised of above required data by_phone_mall�counter by date Plans checked by Date Plans approved by--- Date Id j 1 Sets of plans on hold in File cabinet AP folder Copy—DPW COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND -PERMIT ASSESSOR PARCEL NUMBER S '—QQ ZONING BUILDING PERMIT O WNERk,0 TELEPHONE SO. FT. OCC.1 BUILDING VALUATION OW 'S MAI ING ADO (//J ,5 f0 I�� YC/• CO R!1CTOR'S NXA (.AE T EPHON 02 TRLCLORGS M`AILTJ qp ES l LGLv L,/) Fireplace CONSTRUCTION LENDER//f`/ UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ eu LDING�,Dp�t Permit fee $ 3 (7 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 US OF STRUCTURE SF EJ Mobilehom Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile HomeI S I G JW I @ 15.00 TYPE OF WORK Installation,�Other ❑ New❑ Addition ❑ � /ft emodel❑ oft Describe work:_ � Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200A OR LESS 18.50 Main service 200ATO1o00A1 1 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUP.ad OR ACDNS. 1 ACC. BLDGS. / 3.64 sq.ft. NEW CONSTRULTI.OUTLET BRANCH CIRC ITS @ 5-00NON.RESID APPARATUS &) \SINGLE OUTLET CIR. EX. OCcup(OUTLETS OR FIXTURES 20 76d E%. Occup. OUTLETS FIXED PIRESID 1REA.� I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Permit Fee $ — 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. ❑ 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 1 15.00 Heating Cooling g Hood 6.50 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. 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 Si nature of Applicant - Owner g PP ❑ Contractor ❑ Agent ❑ An OSHA permit is required For excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ d, Energy Inspection Fee $ occ CONST TYPE TOTAL FEES , HAz 1 DFEES I IMP FLOOD I COF I PARCEL PD I HD I ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. WHITE-O.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916)5387541 OWNER fol l" f>4 `-r A. P. NO. —O C --Q- Oo 1 PROPOSED BUILDING USE FYI 1 C DATE REC. # DATE REC I/ 1. School Distric Feesy S (paid at District Office) .......................... Sheriff Fees (paid at Building Department) Residential .......... X �U =$3 6D unit amt. Commercial(per sq.ft.) X =$ sq.ft. amt. 3. Urban Area Fees (paid at Building Department Residential (per unit) X =$ # units amt. Comm_erical(per sq.ft.) X =$ sq.ft.. amt. 4. Recreation District Fees (paid at District Office) 5. Drainage District Fees (Contact Land Development) ......................... 6. Other 7. Other At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE / BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 538-7541 MOBILEHOME INSTALLATION SHEET . 1. Owner's Name: 2. Installer's Name: 3. Is the site currently under permit? 4. Yes C� No F (If yes, furnish permit number 3 / 7 P ) OR Is the site an existing site? Yes t! No (If yes, furnish two plot plans.) Will the mobilehome be located at least 5 ft. away from septic tank and leach L... .I F11 fields and clear of all setbacks and easements? Yes I� No (If no, clarify 5. What is the mobilehome electrical rating? -------------7- Amps 6. What is the mobilehome site service rating? ------------- Amps 7. What is the mobilehome site circuit breaker rating? ----- l c�'Z7 Amps 8. Is there any other electric service? ------------------------------,--.Yes load to be served by the 2 -'No mobilehome site (If yes, identify the load and size: (Load) 2.&p (Amps) 9. What is the mobilehome site gas pipe'size?-------------- �y " (in.) 10. What is the type of gas service. Natural LPG' 11. What is the gas pipe length from meter or tank to the 6 mobilehome?---------------------------------- ----------- (ft.) 12. What is the mobilehome gas demand? ---------------------- (BTU) *(This information not required if pipe length less than 6 ft. ori natural gas or less than 50 ft. on LPG.) MOBILEHOME SUPPORT DATA iv / ?f other than single wide 'tobilehome Mfr.6;;� /a�t_ W furnish Setup Model No. Year 9 Width (ft.) Box 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,(if not on file with the County of Butte). FOOTINGS (check one)Elod-pressure treated or foundation grade. 2. Other (specify) o SUPPORTS (check one)9--r--Concrete block.❑ 2. Other (specify) Pier Footing Sizes and Locations S1NCLE-WIDE MULTI -NIDE Line 1 Line 1 2 Main Beams n2 2 Line 2 —Liuv 3 — — — 7 Line 2 Main Beams -- ---- —�--- — Line 2 Line 1 Piers: Size -Min. -------- -' nx , Spacing -Max. --------- From Ends -Max. ------- Size-Min- ------------ "x3 49 - Spacing -Max - „Spacing -Max. --------- - ,, From Ends -Max.------- / ._0 1. Size -Min------------- Location (From..Front) — — — — — — — . Line 4 Tag or Triple Line 1 Line 1 Openings: Size -Min. ------------------ ,,x Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wall Only) Size -Min ------------------- Spacing-Max - ------------------ Spacing-Max_ _______________ From Ends-Maax-------------- Line 4 Piers: Size -Min ------------- "x Spacing -Max.--------- , From Ends -Max. ------- Line 5 Roof Loads: Size -Min. ------------ Location (From Front) e 5 Piers: (Under Bearing Walls Only) Size -Min .------------------ "x Spacing -Max---------------- From Ends -Max -------------- _ "x "% "x "x "% ' ,x „x „x „x x Line 4 Piers: Size -Min ------------- "x Spacing -Max.--------- , From Ends -Max. ------- Line 5 Roof Loads: Size -Min. ------------ Location (From Front) e 5 Piers: (Under Bearing Walls Only) Size -Min .------------------ "x Spacing -Max---------------- From Ends -Max -------------- _ "x "% "x "x "% ' 6 770' 10ho A 11 7C)T 6j4REX i - - �av�a� �� '�':1JIl•Y,�E:.L� ?r�'Z's��:rt--- �--�" x �- %• .._�___� iz 4 i:l Sr dz so l_ 9 $� G�r7E �rJ4L1 ' GC+I.tA��L �•+�'�r • I I.oGRro�S ` l 03 (Dr, I e:11- •1-- - 1 t M�� � - , - e 5+1Pt'r - f SUPPORT PI ERS Fis O CAPACITY FOOTING SIZE !J CAPACITY FOOTING SIZSQ' FT. UKLU" hOW& E- � 12"x24" ® t;fla04 4E"X 24"' CARPET LAYOt1T AND RIDrEi�r;�� - I 24"X240 C5� m, Ono 600X24"BEAM FIELD StJPP0RT PIERS �-�'vIA e 60902 j ' 36x 24" .i.32 11-104- si 00..G. FW. � .. ELECTRIC GAS Support Struc. Compaction Test Req. Service Other Pipe YES NO YES NO Size' Load Type Size Length Zoo ZO W eA COUNTY OF ,BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N0. 7 County Center Drive - Orovllle, California 95965 - Telephone. 916.'538-7541 APPLICATION AND PERMIT ASSESSOR PARCML NUMBER 63-050-001/-5' 2 BUILDING PERMIT 7 OWNER Robin M. Bay TELEPHONE 345-2054 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. BW 763, Forest Ranch 95942 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total. Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 20.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty . $ BUILDING ADDRESS Permit fee $35.00 PLUMBING PERMIT Filing Fee 15.00 1-5%,� Fitz erald Dr. Forest Ranch Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome[R Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 3 @ 15.00 45.00 TYPE OF WORK New V Addition❑ Remodel❑ Utilities IM Installation❑ Other ❑ Describe work: New 3 Bedroom Permit Fee $ 60,00 Contractor ELECTRICAL PERMIT 11 Filing Fee 15.00 Main service 200A OR LESS 1. 18-501 18.50 Main service 20GATO IOOOAI 37.50 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 �-1FIXED 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) ❑ 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 DWELLING OCCUP.&\ NEW CONST.OR ADONS. ( ACC. BLDGS. I 3.6Q sq.ft. NEW CONSTR. MULTI -CUTLET NON.RESIEN BRANCH CIRCUITS) I @ 5.00 POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 20 76d APPLNS. OR EX. OCCUp. OUTLETS IRESID.I EA.� I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Iyirin g 15.00 15.00 Permit Fee $ 48,50 — 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. 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 15.00 Heating Cooling g Hood 6.50 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 again said Co in c sequence of the granting of this permit. X ' Date l! Signature of Applicant — O ner contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST TYPE TOTAL F E $ .12- .50. HAz OFEES IMP O CDF PARCE PD ISS This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees TO OF PUBLIC BY PER EXPIRES Dater applicable provi- resolutions to do j have been paid. WORKS Date Receipt No. 100968 WMITE•D. P. W., YELLOW PINK•INSPECTOR, GOLDENROD -APPLICANT ,i..: ^`r,r^'i. rrr � ,. v'- K �. nv �..- v,-•I-v,vl+^'..�,:. .�,...•j-,.v...C, _ ,�1'`: ,.r^ ..`•1. C-�„,. •"«�r�Yrf"y�-'�'�'�'':�„;,. a COUNTY OF BUTTE bERTMENT OF PUBLIC -WORKS - BUILDING DIVISION T 7 COUNTY CENTER DRIVE - OROVI&E, CALIFORNIA'f5965 - TELEPHONE: 916/538-7541 PERMIT APPLICAt-ION DATA SHEET Permit No. OWNER A P Proposed Building UseBuilding Inspector—_-4Date 10142 At time of permit application, I was advised the following data must 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 ........ 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 fees paid .................................................... School District fees paid .............. _ 14. Sanitation approval from/ e Health Department " 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec. requesi to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 2i,. -Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 4. Recorded, copy of Agricultural Acknowledgment Statement ......... 10- ;26- 11 1 25. Letter of signature authorization ................................... !< 26. 1, 27. When you issue the permit, process as follows: Mail to owner. —Mail -to contractor. «Telephone3`%S����.�`� and hold for pickup atK /Lo office. Deliver w/inspector. Other Applicant to e9 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 issuance: (Circle new item not checked above). 1. Index permit for above items No. t 2,' Additional items required: "'. r'' Contractor, designer, owner, was advised of above required data by_phone---nail—counter by .date I Contractor, designer, owner, was advised of above required data by_phone_mal I -,,counter by date Plans checked by Sets of plans on hold in Copy—DPW Date Plans approved bye 7File cabinet AP folder Date TO:- Building Department FROM: Encroachment Permit Section RE: Driveway Clearance t owner location Driveway permit si ature 1 OS o -®y/ AP 4F has been issued for the above property. 10 - -2- date TO Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP#• Plan Approved for: Sewage Disposal Water Supply Hold final for: Water Supply Final clearance O.R. for: Water Supply Clearance for .3 bedroom mobile home. Other NOTE *** Sanitarian ate COUNTY OF -BUTTE -DEPARTMENT OF PUBLIC WORKS r ' 7 County Center Drive - Oroville. California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCELN R ZON NG BUILDING PERMIT OWNER � obt'r� 1�1. i�j�� TELEPHONE LEPHONE S-zos SO. FT. OCC. BUILDING VALUATION OWNER' MAILING DDRESS r oX & CO NO A17'1NA VELEPHONE CON'IRAC!`I?OR*JS FAAILIING ACJDR5SS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 155,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ _,Z7 C7 ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS = Permit fee PLUMBING PERMIT Filing Fee 15.00 mill Each Trap 1 5.00 & ( Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PAR EL MAP Water piping 1 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeOther ���'�'������ SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home W @ 15.00 f TYPE OF WORK � New ❑ Addition u Rem5i [f,�{, �Iities�jyj Installation❑ Other [:]Permit Describe work: _ (K(J /�7//1 Fee g Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200AORLESS 18.50 l CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): (_ I am licensed under provisions of Chapt. 9, Div. 3 of the BuslnesS and Professions Code and my license Is In full force and effect. License .Jo. Classification -- 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) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main service 200A TO t000A1 37.50 NEW CONST.( DWELLING OCCUP.EI\ OR AOONS. ACC. BLDGS. // 3.6d sp.ft. NEWCONSTR. ULTI.OUTLET NON ESI D•. BRANCH CIRCUITS) @ 5,00 ( POWER APPARATUS 6 1 SINGLE OUTLET CIR. / Ex. OCCup(OUTLETS OR FIXTURES L 76d A FIXED APPLNS. OR EX. Occup. OUTLETS IRESID.) EA.� 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Iyirin g 15.00 jr, 02 Permit Fee $ — 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. ❑ shall not employ any person in any manner so as to become subject to the W. C. laws of California. No ' 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 15.00 Heating Cooling g Hood 6.50 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 over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ pZ , HA2 1 0FEES I IMP I FLOOD I COF I PAKCEL7 HO ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By EXPIRES Date applicable provi- resolutions to do have been paid. WORKS DatePERMIT Receipt No. WNITE-O.P.W.. TELLOW-ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: _ An 'owner -builder" building permit has been applied for in your.name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and m als 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 Number 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 are per- mitted to issue the permit. 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. 9'I-452.31 � `I.'he property described herein is adjacent 91-045231 1 Ree Fee 7.00 to land or included within an area zoned I STF 1.00 for agr.i.cu I.t..ur.-. 1. purposes, and residents Recorded I Cash 8.00 of th i.s pr(.)per. Ly moy he subject to incon- Official Records ve•n.i.encos or discomfort arisi-ng from Lhe, County of use of agr:i cul.t..ura.l chemicals, :including, Butte huL not l.imiLed to herbicides, pesticides, Candace J. Grubbe and fer-L.:il.irers; and from the pursuit Recorder of agi: i.cu.1 t.ural ope:raLions including, 10:38am 28 -Oct -91 K 2 but not lim:il:cd to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has establ..ishcd eagric.u.l- Lur.al zones which have as a priority use for productive agricultural. purposes, sand residents within said zones and on adjacent property should be prepared to accept sucfa i ncorrven'i.erlce or discomfort from normal, necessary farm operations. All that r.ea] property situate in the CounLy of Butte, State of California, dc:,cri.bed as follows: LEGAL DESCRIPTION ATTACHED HERETO AS EXHIBIT "A" AND BY REFERENCE MADE A PART HEREOF Date: October 28, 1991 PROPERTY OWNERS: State of CALIFORNIA) On this the 28th day of October , 19 91 , hoforo me, ) SS. the undersigned Notary Public, personally appeared County of BUTTE ) ROBIN MARIE BAY ■ Personal]y known to me. ® Proved to me on the basis ® JULIANNE PETERS a ® ® of satisfactory ev:ideu(:c. ® �® NOTARY PUBLIC -CALIFORNIA Lapp be the person(s) whose name(s) is Butte County My commission Expires Feb. 16,1995 4bscribed to the within instrument and acknowledged that. she ®Ossa®®}A��ecuted the same .for the purposes therein contained. fN W]"FNESS 9�t1EREOF, I hereunto set my hand and official seal. li Present A.P. No. 063_050=001` 91`45231 EXHIBIT "A" DESCRIPTION All that certain real property situate in the County of Butte, State of California, described as follows: Lot 4, as shown on that certain parcel map of a portion of the Southwest quarter of Section 5, Township 23 North, Range 3 East, M.D.B. & M., which map was filed in the office of the Recorder of the County of Butte, State of California, on February 9, 1972 in Book 41 of Parcel Maps, at page Certificate of Correction of said Map was filed July 2, 1985, under Recorder's Serial No. 85-19773, records, -of. -Butte County, California, which recites as follows: .. Lot 1, shown on said Map lying Northwesterly of Fitzgerald Road is to read Lot 4: Certificate of Corrections%of said map recorded September 15, 1987, under Butte County Recorder's Serial No. 87-33112, which recites as follows: Title Block should.read Northwest quarter of Southwest quarter of Section 5. 0 5-8� 9�-0° I. !0,-a.. RANGE O TUB/SHOWER j c CPT. GRON. TUB --------- �I W UTILITY o Eli( •J OPT. coINCLE � NALL -- - F / :)NEN . :PT. PAN. )MAST _ BATA _ _ --- WALK-IN - ,T NAADROBE t MASTER BEDROOM ;VAULTED CEIL'NG) U 2 W m II I I KITCHEN =- LILTED CEILING) i I i ice. y3PR J DINING ROOM (VAULTED CEILING) �i L 9 5'ct: 0Y rf.) o,+o b / 3 y .33y'/s ,sem 4 3 j s. G.D GREAT ROOM 7A2--5D';il,.::,3, .w CL 9 C^ a cal" c C(XAPA� Sid 561 A4 • 13A4 F" T 3 Bedroom with Great •Room E�l NAACACBE -- BATH tY)I7L CD BEDAG&JI3 0I AMU I � : 2 f 0, .. ....nAy,..- r �x .�Rv.rc;��,�+ti.oarr4r�!�w� . � �� �. .,,,�.+�- JW���''T��F -4�""' �afil����i^•RNI'� Rt��`1�""''(1 ,++-'t'^ �.�'J BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM (Oneiform per Building) A.P. Number UO -,00 Building Department No. School District IV City D County Jurisdiction Property Owner Project Location/Address 5 -7 Tz- 0 Z) & Subdivision ,�' Lot Number Residential Development: 1za Sq.' Footage # of Living MHI Addition (Group R) Units Commercial/Industrial: D New Addition Bu i epartment Representative Sq. Footage (Including Exterior Roofed Areas)' `' 9� of Da ******************************************************************* (Floor Plans reviewed by School District Personnel) District Id No: 9ODX to School District certifies that (Applicant Name (Phone Number) OAf /(Street Address) CL_ (City) (State) (//Zip Code) has complied with' the requirements of Resolution No.(!/�p"9/ by the p yment of.. $�/p��J, �j a representing 13 square feet. School District Representative Date' PAID BY CHECK NO. BANK NO 113 PAID BY CASH white -applicant, yellow -building department,'pink-school district SCHOOL.FEE (8/88) 7