HomeMy WebLinkAbout064-040-030'6t-
64-04-'30 1214-90B�,P,E;�M
CARVER;'Mike
1464i'Bridgeport. ircle, Magali
'Mike Carver nst c
Contr:.,
m(new-single f afnily)
12 1'
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g e 1 rcl e �ali
po r
Carver on
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'64-�04-13U�`�"
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RESIDENVAL"
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7- �OB, P, E, M
64 04-30
CARVER, Mike
14641 Bridgeport Circle, Magalia
Contr: Mike Carver Construction
-�new single f.��_m�
ofe. j�,.p�JL
copl
OFFIC
p6dress
t �e('7
GP'S ate
mete(
JOB FINALED (Date)
SIgnature
f/ OK
0 Not OK
Not Applicable
Not Ready MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #a
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
Sewer; Location -Test -Fall -C/0 Co�crete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / P'L"ft.
P'Nat. or/ /"L"ft./ P'LPG
7. Utility Clearance
Date,� Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except fra.
Zoning Requirements -Setbacks Easements
2. Footings; Size Spacing -Marriage Line
3. Gas: MH Test -Demand -Valve --Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
S. Drain; MH Test -Fall -Flex Connector,
& Water; MH Test -Regulator -Connector,
7. Water and Sewer Connected -C/O to Grade -HD Approval
S. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
10. Cart. of Occupancy
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 Ws
1. Zoning Requirements -Setbacks -Easements
2. Footings; Solls-Size-Depth--Spacing-Connectors-SteeI
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Boams-Rftrs.-Coonectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
-6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-goofing
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 We
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances -GH
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.: Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
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-Afater Supply Test
-Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
*J = OK
0 Not OK
Not Appitcable
NotReady RESIDENTIAL'(Single & Duplex)
Date LINDERFLOOR (Plans) OK except #'s I
2e-'Ftg.,,Main; Soils-Elec. Offfid.-4W4" Ftg. Depth
34F16-6arage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
K. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
2,sfemwans, main; Steel-Blockouts-Wrapped
%'Stemwaills, Garage: Steel- Bloc kouts-Wra pped
15a,*Wfd -Downs and Special Anchors
4L -Stab; Steel -Wrapped
�Fireplace Ftg.-Steel
LV6.w.v.; Fall -Fitting -Test -2 Way C4O-Sewer Test
10. 92.Pipe; Size -Anchors
,;I4'.'water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground
13. ��ms & Ducts; Clea ra nce- Material -Su pport- Ins.
&K'Girders-Sills-Anchor Bolts -Joists -Vents -Cripples
15. Insulation
I
Dal*4��--/'/ Card BJIM Date 'dard B-1
Date &-4 ZCard B-16605�' Date Ckd B-1
Date PLUMBING (0'ermit) OK except #'s
W��ter Htr.; Vent -Access -Combustion Air-BafII6'
&W-Wat!ope; Test & Anchor -Nail Protection
2ffi,-0`w.V.; Test -Fittings & Anchor -Nail Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower. Second Floor -Tub Access
21-da's Pipe; Size & Anchors
Date
�:3VXard B-1;05�� Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except If's
ir-- 12�`Finture & Transformer Clearance -Ins. Protection
I 24--Eijs�eReceptacles Spacinq-Liqhts & Switches at Doors
2W.'Sizp
,,Boxes & No. of Conductors -Stapled
ompx Installed Close to Edge of Studs & C.J.
�quGround made up w/Mech. Fastners-Bond Gas & Water
jy.�ppiiance Circuts in Kitchen & Conductor Size/GFI
28. Subfeed Wire Size ga. Cu or Al-A.C. Wire Size ga.
Cu or Al
29. Range Circ. / / ga. Cu or Al -Oven Circ. / / ga. Cu or Al.
Insulated Neutral 0 Yes 0 No
kDrISeryice-Riser Conductors & Ground -Main Disconnect
Pane I s- Motors-Mec h.
32. Pk5thes Closet
od� Smoke Deted(c
Date --/.//Card B- 16 DatLr Card B-1
Date Card B-1 Date Card B-1
Date MEC mit excep #'s
.,,HA ICAL (Per 1 0
e!� VIA.C. Ducts insulation
35. Vent Fan; Exhaust above insulation
36. Condensate Drain & Overflow: Size & Grade
37. N -mance -Vent; Access -Comb. Air -Return Air Vent -1 15 outlet
tag.' -Attic Access & Platform if Furnance in Attic
Date 7- 3E�Eard B- 1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMIBIG"(Plans) OK except it's
d91*'9i1§,Pf6per Material & Anchors
A"al_!.5�-Studs-Nailing. Spacing & Bracing -Plates -Sound
V,,A�reing_Walls over Girders & Floor Nailing
P�_ op in Walls (rat proof)
�rs I
41-fir!,,Stops; Furred Ceilings -Stairs -Chases -Tub
6Xeaders & Beam -Size & Bearing
Date FRAMING (Continued)
Ing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng.
,,-WFireDlace Ties or Type A Flum-EwaPia-ce Throa1_&6at:'9M9_--'
1� VAttic Access; Size & raft Stop -Ins. Baffles
Ae-16cirm. windows or Exiting Doors -Sill Hgt. & Dimensions
60.1164(age Fire Protection Framing
653 --Property Line Firewall & Openings
Ile /IPExt. Doors -One T -Check Garage -3rd Story, 2 Exits
53. Stairs; Width -Head room - Rise-Run-Landi ng -Fire Protection
A47 'p!ywood on Roof overhang -Attic Vents -Rafter Outriggers
58.00'§iding-Nailing Veneer
--va.-etagco Mesh -Drip Screed -Fd. Vents-Underflr. Access
!.9,zing ATa-Glass Protection -Skylights -Plastic.
-Stripe-Walls; Nailing -Bolts
PO�'I-nqtilatinn-Walls-Ceilingst I
60. Infiltration-Wa!!s-Windows
Date V-'�W Card 10",7
I ICE
Date
R-0_7,Card B-JgFeZ_-_ Date
Date nNALKansy'0K except #-s
A."ExtJpo-Door & Sidelight Proilection-Land-in-E
L -9'm -oke Detector
-B3-+4"4aae-UxaLs-Clearance-Comb. Air -Connector-
- lnGaraae: Above Floor-Ducts-Mech. Protection
J5^3_FJe"& Bath Fixtures & Tub Access -Spa
'1C. -n & Subpainel; Breaker Sizes & Labels
& Rails
brl- F!��f- or Stove: Clearances -Hearth
ti�!KOutleis at Wood Panel: Int. & Ext.
Ai. Kit-Kixt. & Appliance; Grnd.-Air Gap -Cooking Clearan�-e
A--EI,W. Outlets & Receptacles at Kit. Counter
7j§.-*-Garaae Fire Door: Swinci-Landinq-Closer
IA*'Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
,;R"Garage; Above Floor-Mech. Protection
-, Elec. & Mech. Equip. Listed for Location
K. Et�Li;-Receptacles in Garage; (G.F.I.)-Romex Protection
7 . In tion -Foam -Looked in Attic 0 Yes
7!?_Guacdfk6ils & Deck Construction -Post Caps
7* -'rd -n. Vents & Crawl Hole Door -Drainage &_Woed-Earth
Clearar.ce Looked under FIqPr 43"qe-s
80. Following instld.: Dave @S?�SWs 11 No: Walks El Yes 11L�c;
Planters 0 Yes Lllilo
Gi 0@4_�Osh
82�-rc. Unit; Disconnect, Electrical, Plumbing
831 V Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
'Y�os
Openings
84. Vtpe Wefl�,--(Xsconnect, Electrical, Plumbing
65-Extorior Elec. Trim; G.F.I. Receptacle- Un de rg round
W-Veptilation Throughout House
.. lasyProtect on
8 . orpe(ions fr m Previous -Inspections
8*-&a�,�est- Meters Tag'ged; Gas -Electric
_q2(<N'ater & Sewer Connected -C/O to Grade -HD Approval
1_91- Enerav Compliance Certificate -Other Certificates
Date K(41'fMard B -1F, OVf-- Date Card B-1
Date I Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
(NOTE: An entry must be made each time you visit job site)
- 4
. �
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w K z w �� � w��u � �� r z �� M 'V' o - p� o I
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'
ENERGY CERTIFICATION
4 N -- L-;6 ...... . .....
ROOF' ' -
'--'
, MATE
BRAND NAME
THICKNESS_ -.__THERMAL
RESISTANCE (R
EXTERIOR WALL
MATE RIAL_____1FI8EGLASS
. BRAND NAME____CERTAINTEED___
THICKNESS (INCHES � �~`(' lFHERMAL RESISTANCE (R VALUE n�___
CEILING
_
BATT OR BLANKET TYPE FIBERGLASS_-
RA �D�NAME CERTAINTE��D__
TH_
tCKNESS__ ��������-�BRAND
_____
THERMAL RESISTANCE (Q VALUE)
LOOSE FlLLTYPE IBE RB.ASS
NAME RTAINTEED --------
__F.
.MINIMUM THICKNESG(INC UMBER OF 8AGS T PER BAG P5 LB
AREA COVERED (SQ FT)_
THERMAL RESISTANCE (R VALUE)
FLOOR, ELEVATED
-
MATERIALFIBERGLASS_BRAND
NAMECERTAINTEED
THICKNESS (INCHES)
THERMAL RESISTANCE (R VALUE�
FLOOR, SLAB
---�'-
MATERIAL'
BRAND NAME
THICKNESS (INCHES)
THERMAL RESISTANCE (R VALUE)____`____
FOUNDATION WALL
'
MATERIAL___ �
BRAND
THICKNESS (INCHES)
THERMAL RESISTANCE (R VALUE�
% HEREBY CERTIFY THAT THE ABOVE
INSULATION WAS INSTALLED IN THE
ABOVE BUILDING IN CONFORMANCE WITH'
THE STATE OF CALIFORNIA ENERGY
REQUIREMENTS.
.
/
.
HAWKINS INSULATION
379407
-
-
ONTRACTORIS LICENSE NO.
SIGNATURE
-
DATE
I HEREBY CERTIFY THE ABOVE INSULATION AND ALL REQUIRED ITEMS AS SHOWN
ON THE BUR -DING DEPARTMENT APPROVED PLANS AND ATTACHMENTS HAVE BEEN
INSTALLED AS REQUIRED BY THE STATE OF CALIFORNIA ENERGY REQUIREMENTS.
�
ALL EQUIPMENTv DEVICES AND MERTiALS ARE OF THE QUALITY PRESCRIBED OR
ARE SPECIFICALLY TATE OF CALIFORNIA.
`
IRM NAME/OWNER f A—T `
SIGNATURE GEN.'CONT RACT8R/OWNER'�
` .r.
"P,
im
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WqRKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 5W-7541'
747 E I I i ott Road, Paraid i se — Phone: 872-6307
CORRECTION NOTICE
OWNER PEI
A routine inspection indicates that the following violations of County Ordinance
exist at " the above address and should be corrected. Please noti - fy 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— Inspector
T.-
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-27,51
7 County Center Drive, Orovi Ile — Phone: 538-7541'
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
OWNER
PERMIT N5-.
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 )TTediately.
Date— Inspector
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive. 0 roville — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
M
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.
" -AV I //
/;1
Date—� lnspector-"��//
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Orovillp, Califofni&95965 - Telephone: 916/538-7541
U.- � 1W I / q - q 0 //
APPLICATION AND PERMIT J,
ASSESSOR PARCEL NUMBER
64-04-30
ZONING
RTI
BUILDING PERMIT
J
OWNER
Mike Carver
TELEPHONE
891-883�L
SQ.FT. OCC. BUILDING VALUATION
-
1550 R 62,000
OWNER*S MAILING ADDRESS
PO Box 6226, Chico 95927
4Q8 M 07��
CONTRACTOR'S NAME
Same
TELEPHONE
17
040
CONTRACTOR'S MAILING ADDRESS
Firwl�iace i nnn
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ -7 1,192
Filing Fee
$
10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
349.00
ARCHITECT OR ENGINEER 777
E NO.
Plan Checking Fee
$
15.00
Energy Plan Checking Fee
$
15.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
14641 Bridgeport Cir, Magalia
Permit fee
$
389.00
PLUMBING PERMIT
FillngFee
10.00
Each Trap
402-00
20.00
Solar or heat pump water heater
20-00
LOT NO.
gn
SUBDIVISION NAME
P Pin.�s 11nit 12
PARCEL M
,,*P
-7-S
Water piping
5.00
5.00
Each qas water heater or vent 5.00
5.00
USE OF STRUCTURE
SFEE DuplexF_J MobilehomeF_1 Other
SPECI FY
Gas piping system 1 - 5 outlets
5.00
4.00
Building sewer 5.00
5.00
Mobile Home JSFG W 10 .00 ed.
TYPE OF WORK -1
New FX] Addition [:1 Remode 1 [:1 Uti lities [_ Installation[] Other
Describe work: Master #12-88
1
Permit Fee $
0*00
50.00
Contractor
ELECTRICAL PERMIT FilingFee
10.00
main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA, ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
1 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 f u 11 1 e and effect.
License No. _3 Y�' I -Z- Z Classification X
0 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)
El I am exempt under Sec.-, Business and Professions Code
for this reason
NEW CONST. ( DWELLING OC�bF4.8)
OR AODNS. ACC.BLCGS.
2'/2Csqft 51.20
NEW CONSTR MULTI -OUTLET
NON-RESID. BRANCH CIRCUITS) 2.50 ea,
(POWER APPARATUS
SINGLE OUTLET CIR.&)
Ex. Occup(OUTLETS OR FIXTURES 20 @ 50C
BAL@30C
OCCUP. FIXED APPLNS. OR %
Ex. OUTLETS (RESIO.) EA.) 2.QO
Temporary service 10.00 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
I
Permit Fee $
91-7n
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F -I The permit is for $100.00 (valuation) or less.
1 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.
1 shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, yoU must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
Fi I ing Fee
-
10.00
Heating
6.00
heat pump
Cooling
6.00
Hood 3.00
3.00
Ventilation 2 3.OT
-p
6.00
I ermit Fee $
Contractor
31.00
1 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,,ji d t , costs, and expenses which may in any way accrue
_ _) gmen s
against said��n n consequence of th�4ranting of this permit.
�,eooeo,
X Date
Signature of Applicant - Owner Q-1 Contractor F� AgentE]
f -
An OSHA permit is re ired for excavations over 5' deep and de lition or construct-
.ve yiu
ion of structures r stories in height. 7
Mobile Home Installation Fee $
Energy Inspection Fee 30.00
0
0 ST PE
�,w
I TOTAL FEE $
583�, 70
H �Z_J
CLA I
PARK
I SCHL
P
tt/l
PqH
Iss
Th's permit is hereby issued under
sions oi the Butte County Code and/or
work indicated above for which tees
I T OF PUBLIC
)�Ir, Ar
B _9A 11 -
PERMIT EXPIRES Date -
the applicable provi-_
resolutions to do
have been paid.
WORKS
-qo
Date
01
Receipt No. 64�&tQ 9A
WHITE-O.P.W.. YELLOW -ASSESSOR --E�TOF( /GOLDENROO-APPLIZANT
COUNTY OF BUTTE DEPARk ,OF PUBLIC WORKS - BUILDING DIVISION
�IMENTj�
7 COUNTY CENTER DRIVE -GR . OVILLE, CALIFORNIA 95965 --TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
;Permit No.
OWNER A. P. N o.
Proposed, Building Use �-Buildinq,,Jlnspector Date
At time,of permit application, I was advised the following data rri�s't,be submitted prior'to permit processing and/or issuance:
DATE RECEIVED APPROVED
1.*'All items have 666n submitted . .............................. * .......
2. Plot plans in duplicate/triplicate, signed 15y'preparer of plans. . .
3. Complete plans in 8�plicate/triplicate, signed by preparer. of plans
4. CompletebIngineered plans and calcs, with wet signature on plans
5. Hazardous Miierial Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings .........
8. Ehg'ineered truss details and layout in duplicate (required prior to plan check)
--'9.--Mobilehome installation data including manufacturer's installation
instructions .10 ................................................
10. Feevf $ 51 lot qQ Owl
11. Chico Urban Area fees paid ............. .........................
4� 2. Park fe% paid ....................................................
1, School District fees paid ..............
4\-Sanitatior approval from AeAOZK�_ Health Department 2 -7,
X,
City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
1 7 * Planning approval for (A) Use:—(B) Parking: . ......
1 8. Improvements may be required. Contact Land Development Section DPW
Driveway permit (construction approval required prior to occupancy)
_W
920 . Pre -inspection for required ... Pre-inspec. request to
Building Inspector (Date)
21. Contractor's license information (No., Name Style, Classification)
22 -Certificate of Workmans Compensation Insurance ..................
-.—V23. Owner -Builder Verification (Given to owner 0, Mail to owner 0) .....
_(�"4. R,ecorded copy'of Agricultural Acknowledgment Statement ......... V Jot 16
9151. Lett6r-of signature authorization ................. ..................
26.
27.
When you issue the permit, process as follows: Mai I to owner. —Mail to contractor.
Telephone Aqj—n-.>6
and hold for pickup at office. —Del.iver w./inspector.
Other
Applicant
Date
Copy of Haz-Mat form sent —Health Dept. —Fire Dept. ---Air Pollution Date
Copyofplanssent ---HealthDept. —FireDept. —Other— D6te—
The followina,data must be sub I mitted prior to permit
1. Index permit for above items No.
2. Additional items required:
By
ssuance: (Circle,.Q�w itRkuet checked above).
Contractor, designer, owner, was advised of above required data by —phone --mai I —counter by—date
Contractor, designer, owner, was advised of above required data by —phone _rna I I —counter by date
Plans checked by Date Plans approved by asa Date
Sets of plans on hold in
Copy—DPW .
File cabinet _,_AP folder
.1?
T6 : "'Building, Department
FROM: Encroachm!ant Permit Section
RE: 'Driveway Clearance
zv I
4,u
owner location A P
Driveway permit
has been issued for the above property.
nu b
s i
ign re date
TO Bu �'Iina Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
Location AP#
owner
Plan Approved for: Sewaqe Disposal water supply
Water Supply
Hold final for:
Final clearance O.K. for: .
Clearance for -�3 bedroom mobirle home. Other
NOTE * * *
Water supply
Date
4 n i �ta r kjM I Z'—
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS
7 County Center Drive- 0.rov#11e, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
"I
70
ZO NG
BUILDING PERMIT
OWN
TELEP
A K Wo
SO. FT. OCC. BUILDING VALUATION
e�.50 P_ 6�S �1_u
MAILING ADDRESS
OWN;P
401T AA
CONTRACTOR'S NAME
&A" &
-7 e?A1,
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
-Total Valuation
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
S E N 0.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
11611 /3�96C�-Z- a7Z-
Permit fee
$_,5Z4— " I
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
1V0.
SUBO 7N NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFJ�J DuplexF� MobilehomeF] Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer — —
_LS
5.00
Mobile Home LG FWT
10.00 ea
TYPE OF WORK
New% Addition 1:1 Rerriodel[--] Util' ies I stallationEl OtherE]
Describe work:
I
I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
main service 6001 OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Busines S
and Professions Code and my license is in full force and effect.
License No. Classification
0 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)
0 1,- 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. ( OWELBLILN.G-C
OR ADDNS. AC C. . S. W
NEW CON5TR. MULTI -OUTLET
NON* R ESI 0 E R,,A.N c . c., a c . T S
2-10 ea
P3 R P� R;�TUS.&
(SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
20050C
ISAL@ 30C,
FIXED APPL S OR
Ex. Occup. OUTLETS (RENSI'D .) E A.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� The permit is for $100.00 (valuation) or less.
E] 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
FilingFee 10.00
Heating
67 —
/)454r AIA41P
Cooling
6
Hood
3.00 *3—
Ventilation 17Fi-7�6
Permit Fee
$
Contractor
I certify that I have read Ahis application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
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 CD ' Ag.en!
An OSHA permit is required for excavations Over 5'0" deep and demolition or construct-
ion of structures over 3 stories iz height.
Mobile Home Installation Fee $
Energy Inspection Fee
occ
CONST PE
TOTAL FEE $ sz�c)
HAZ
I CUA
PARK
I SCHL
I FLD
I PAR
I PD
I HD
ISSUE
This permit is nereby issued under
sions oi the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
B y
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have bee n pa�i d.
WORKS
Date
Receipt No.
WHITE-D.P.W.. YELLOW-ASSE350R. PINK -INSPECTOR. GOLD ENROO-APPL I CANT
-'DEP ARTMENT OF PUBLIC WORKS PERMIT NO.
_9UNTY OF BOTE
-f -TCounty Center Drive - Orovilie, Cal ifbrnia 95965 - Telephone: 916/538-7541
AND PERMIT
ASSESSOR PARCEL NUMBER
64-04-30
ZO MON G
RT1
BUILDING PERMIT
OWNER
Mike Carver
TELEPHONE
891-8830
SQ. FT. OCC. BUILDING VALUATION
140 5 700
OWNER'S MAILING ADDRESS
P.O. Box 6226 Chico 95927
CONTRACTOR'S NAME
same
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
none
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 13.00
ARCHITECT OR ENGINEER
none
LICENSE NO.
Plan Checking Fee
$ 15.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
14641 Bridgeport Circle
Permit fee
$ 38.00
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Ma2alia
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFM DuplexF� Mobilehomen Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10-00ea
TYPE OF WORK
New n Addition[Y( Remodel El Utilities[] Installationn Other[:]
Describe work: open deck
Permit Fee
$
Contractor
—ELECTRICAL PERMIT
FilingFee 10.00
Main service 1IOOV OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I de la e under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Busines S
and Professl'Ans Code and my license is in full force and effect.
License No. ��" I'?- Z- 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)
0 1, 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 ADDNS. ACC.BLDGS.
21/20sqft
NEW CON5TR. MULTI -OUTLET
NON,RESI D, 2RANCHrIR1,:L1ITS)
2.50 ea
P7
W.R PF;�R� TCUI R.&
SINGLE OUTLET
Ex. Occup( OUTLETS OR FIXTURES
20 9 50c
SAL@ 30C
FIXED APPLNS. OR I
Ex. Occup. OUTLETS (RESID.) EA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
The permit is for $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 th.e.W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL, PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
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 Copty in consequence of the granting of this permit.
X �Date
_70 4_��
Signature of Applicant — Owner 71 Contractor E] Agent
An OSHA permit is ryuired for excavations over 5'0" deep and demolition or construct-
ion of structures over stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee
occ
CONST PE
TOTAL FEE $
38,.00
J_HAZ
—
I CUA
PA RK
_
CHL
_!_
FLD
I—
I
ISSUE
I i�
T.his permit is nereby issued under
sions oi the Butte County Code and/or
work indicated abov for which tees
R UBLIC
By XF
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
D a t e,:!�—/ 7- 9V
Receipt No. 66946
WMITE-D. W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPLI CANT
COUNTY OF BUTTE DEPARTMtNT 0 UB*CIC WORKS BUILDING DIVISION
P
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT -,VT
. � , UtATION DATA SHEET
Permit No. K,
OWNER J9 A. P. No.
Proposed Building Use V, D,9, B:Ui Iding Inspector Date
At tyimeoff ermit application, I was advised the following data must be submitted priorto.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 cal,cs, 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)
-v9. Mobilehome installation data including manufacturer's installation
instructions ....... ..................................................
10. Fees of $ ........................
11. Chico Urban Area fees paid ......................................... .
1,2,.' Park fees, Id .............................................................
A 4
14. Sanitation approval from Health. Depai'rtmerlt
15 City of Chico plumbing permit ............ ..........................
16. Plot plan and business license approval froTn City of
(see City for other requirements)
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, Classificati 0 n)
22. Certificate of Workmans Compensation Insurance .................. -7
23. Owner -Builder Verification (Given to owner 11, Mail to owner 0) .....
24. Recorded copy*of Agricultural Acknowledgment Statement .........
25. Letter . of siginaiture authorization ................. A ..................
26.
27.
ou issue th it ceas as follows: — Mail to owner. —Mail to contractor.
Telephonenrl _6po and hold for pickup at Of(D office. —Del.iver w*./ihspector.
6ther
Applicant 'Da t e
eel
Copy of Haz-Mat form sent —HealthDept. —FireDept. ----Air Pollution Date
Copyofplanssent ___HealthDept. —FireDept. —Other— Date By
The following data must be submitted 6tto permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of abo�e required data by—phone---mai I —counter by_date
4& Contractor, designer, owner, was advised of above required data by —phone —ma I I —counter by— date
9V Plans check . ed by 11 Date—Plans approved by ZIA� Date
—Sets of plans on holdJn File cabinet AP folder
Copy—DPW
R
FROM:
SUBJECT:
I
Buildina Department
;�,zL -�-,
Environmental Health
Sanitation Clearance`
Owner 'Location A?#
plan Approved for: Sewaqe Disposal Water Supply
Hold final for: Water Supply
Final clearance O.K. for: Water Supply
Clearance for bedroom mobile home. other JIQ r7le
NOTE
Date
a itarian
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Ordville, California 95965 - Telephone: 916.1'538-7541
APP�!qATIQN AND PERMIT
ASSESSOR PARC- E
PERMIT NO.
i4a 4 — 0 ZONING I I
BUILDING PERMIT
FPH
Zy; 6 Q ri f 4-L, - a B (-)
SO. FT. OCC. BUILDING VALUATION
0 ER'S MAIL G A E
, 0 : ge)AOO LJj (
"P O—A , (-(,D 9,; 1 �
/
7,77-
C TR^CTOR-S Nl-,
,3 ITEI-EP.ONE
c(m C_
CONTRA�TOR-S AILING ADDRESS
_]UNKNOWN
Fireplace
TRUCT ION LENDER
Total Valuation S
LENDER'S MAILING ADDRESS
Filing Fee 10.00
Permit Fee
ARC1iTEC7 OR ENGINEER ILICE.SE NO.
le) 4 0-
Plan Checking Fee S "S_ 19 r,
--A
ARCiiITEC_ OR ENGINEER'S MAILING ADDRE55
Energy Plan Checking Fee S
Penalty
S
BUILDING ACORE (!,
PL,mIt fee $ L
PLUMBING PERMIT FilingFee 10.00
Each Trao
2.00
Xa 0 L7 0
Solar or heat pumo.water heater
20-00
LOT NO.
SU eDIVISION NAME PARCEL MAP
Water pioing
_�_a_c_h_
5.00
—1
Pas water heater or vent
5.00
USE OF STRUCTURE
SF D,p I e. r_ Mobilehomei:] Other
SPECI FY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I W
hO.00 eal
TYPE OF WORK
New[] Addition,4 RemodelD. Ut'I't'e installation[:' Other
Describe
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Fili,gFeeT 10.00
Main service 610000'AMORP -0-RSISSESS
10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
1 am licensed under provisions of Chaot. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
1. as the owner, or my employees with wages as -their sole compen-
sation, w ill do tne work, and the structure is not intended or offered
for sale' (Sec. 7044)
1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—. Business and Professions Code
for this reason
Main service EA. ACO'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.8j)
OR ADONS. ( ACC. SLOGS.
Nh1iZQN 5 TR. -Ul-TI-OUTLE-6,
N ON R ESIO. BRANCH CI q C TS)
12.50 ea I
WEt AP�AR
e!TUS.6)
SINGL�_OU L i CIR
I
Ex. OCCUP( OUTLETS OR FIXTURES
*5
1.2 AOL'@ 30�
t XFO AP-LNS. 0
Ex. Occuo. OF67LETS (RESIC.)REA.)
2.00
Temoorary service
10.00
Mobile Home Facilities
1 S.Oo
Misc. Wiring
15.00
Permit Fee
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
,—I The Permit is for SiO0.00 ivaluation) or less.
El 1, have placed on file with the County of Butte Building Deoariment
Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
snail not employ any person in any manner so as to become subject
o 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 forinwi.th comoiy with such
provisions or this permit snail be deemed revoked.
Contractor
MECHANICAL PERMIT Fi I ing Fee 10-00
Heating
Cooling
Hood 3.00
Ventilation
Permit Fee
Contractor
I certify trial I have read this application and State that the aoove information
is correct. I aaree to comply to all County Ordinances and State Laws relating
to building construction, and rieretiy autrion ze feCresentatives of the County ot
Butte to enter upon the aoove-mentionea property for inspection purPoses.
I also agree to save. indemnity and keep harmless the County of Butte against
all liabilities, judgments, costs. and expenses which may in any way iccrue
against said County in consequence of the granting of- this permit.
X Date
Signature of Appl . icant Owner Contractor Agent I I
An OSHA ite—t- far e..co_�at,o.s ;�e, 5*0— deep and demolition or construct.
,cin of strvctufes over 3 stories in ne,ght.
Mobile Home Installation Fee S
Energy Inspection Fee S
'oCC CON . S7
L TOTAL FEE S -50-
CUA PARK 1 SCHL 1 FLO
I PAP Po
SSUE
T.-.;.- permit is nereoy issued unoer
sions or the Butte Ccunty Code and/or
work indicated a0ove for which tees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the appiicaole provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No.
TNs . set of plans and specifications MUST be
kept on the job at all times and it is unlawful to
make any changes or alterations on same without
written permission from the Department of Public
Works, County of Butte.
NOT -E --All Materials &)06rkmanship Shall Be in
Accorda ' nce with Recq&ized Good Practices and
of a quality presc�iXd for the Specified use in the
Uniform Buildi , Plumbing & Mechanical Codes and
the Natic Zlecirical Code.
A setback of 5 ft. from the
lines and a setback
of 50ft. from the road
centerline shall be 'clear of
structures or equipment excepi
for a 2 ft. eave overhang.
A
e-
asL-
BUTT: COUNTY
BUILDING DEPARTMENT
0 V E D
MIMI
I 44WMMM
--a
HUMMUM
ON
I I 1 -1 T i
f -,D
Alf
t
Rmpeasur oe, toe
-%�max-tolemnce-be4*an
brow wnWkr�tiis6/ftffv;+-- F11-
111-DING-DEPAR T. -ME.
A -p
Shan
amd
out;
NO A.- du md
C"6.
C8,60,MS MUSI; b.0
gem of PIAOS & t.j. and it -15 unlaw+ul '0
a 'job at 1311 oh,,,Sarne w!"VI
,pt, on jjura.�Ilons
of Pubb
,naV e any ChP&gcs ir fn the
,r-liten permisson
Works, CO"n" at
S C- fIrt C-
Z, "TAgSL
0% lot
Vm- 0 0 N Ov%
NX -ego
P. Soo Ff
Se
X\
Ok w\e -
Nel
7—
Ar
0
4
Eel. 1^
�*Il I () I)I'W AUMULTURAI, STATI"MENT OF_ ACKNOWLEDC!"MI."N't'
% . I 17MV VVQTnVM1'1 At 1117111M 1`11.1UPW11111
e County Code
26�3 ��f the Butt—
.this ackiiowledg�meiit be tecotded
Issuance or Fi building petmit, f
i oil
r eq u i r es
prior to
lf;�At"'t
Thv properLy deqcrI.bed her-eiii Is nd jacetit
90-019198 I Rec Fee
7.00
1() 10i'd or Iticluded withifi.an area'zotied
Total
7.00
for agelcull-deat purpose6i and t-esidents
Recorded
I-Iihs prboe'fty may be subje-c't to ificon-
Official Records
"1116"Ct'.-4 or di-SCOmf0ft tir'18ing from the
County of
iiise or' agri.�Uftural. cfi6mjtajj§j inciudl.hgj
Butte
bill. iiot. Jimi.Led to herbicild6.4i pesOxides,
Candace J. Grubbs
-irid 0
ferL.I.I.i0ers- and f iofii the pursuit
Recorder
Agrj cul toed]. ope-fdLi6ha ific.1 tiding j
8:01am 11 -May -90
B G
htit iioL 11mi tod Lo tutH.VaLlohi plowing,
2
spray -I hg, peunthg, and - hafvesting which
or(-asionafty git niei�aLci dUsLj' 8rfiok6i noise, and bdor. Butte CotitiLy has eSL.,1b.I.I.shcd
t.itirril zbnei§ whirth h6ve 66 6 ptiority use foi7
producti.ve agrictilLitral purposes, iiid
wil.hin sa.1d tobhts and on Adjacent pfopetty
should be prepared to accepl_ sijch hicoiivf-ii
i
or discon1brIll' from tiormali; n0cetisary farm operations.
AIA Llint- real. property sitdi�te in the County of BuLte, StaLe of Ui.liforiihi, dv�,crilwd :v:
I'o I I ows:
SEE -ATTACHED DESCRIPTION
MILC: PROM- OWNERS:
Oil this the 10-th day of 1.99 -1'()f c liw.
.)UiLp of CALIF. MAY _Q_' 1) c
SS. the undersighed Notaty PUblIC, persoital.ly appeared
CoioiLy of BUTIF,
MICHAFM L. CARVER
Ver6onailk known. to me. [:] Proved to me oil
DAVID HALKOLA of satI81-actory
NOTARY PUBLIC-CAUFORMA to be the per§on(s) whose name(s) is
utte Upuny pires fnstrum6nt
My Commission 8x quh§ekibed to the wi.thin
I March22,1991 executed tile same for the purposes
WHEREOF, I hereunto set my
Pr (,:7 ir, t i I - A - 1. N 16-42
L h e ba s I
ev I delice
and acknowledged thil he
thereiri coiital.ned. IN WITNVS!-�
90 t
11711�2
AUE
OF
SITUATE IN TJJE STA!rE
PROPVATi
THAT:.: a TTE, I)tSdAlBED AS FOLLOWS i
U
E71�o CERT A $'PARADISE P111FS
114 MAP ENTITLEI)i
0 0 D IN THE -OFFICE. OF THE
LOT---�-9 AS Sfi `WN THAT
4AV.- %4Ag: RECORDE
OF CAL-YrORNIAj ON MAY 13,
24, 25, 26 AND 27,
9CORb9A-.: Or:: dc)UNTY
..49*"p -MAPSO AT PAGE(g)
N - BOOIW.. P.
VVUH AND OTHER
L MjtNERAjS' olbt GAS # AS P11A
I . AND ALL MINING
t WITIJ PROVISION. THAT ANY .
IIANCE FACE AREA
C
C
OR
96
1
EXC
p
IIYDR06AABOH![�� U onlr,"S OUTSIDE, THE SUR
. t) )C FROM
0 OP siiAU HE DONE TO
PSRAT "WTHAT NO I)MA"'
Or
U Ir C LAN 1)
URFACIt
ir" j OF
. ... .. . .' .. . . .... .. I A A14D B (1,11E.: COMMON AREA
6VER:�-Wlg
At! D � T1119 �'LOTS'-:.. DESj(;NA1.rEb FOR
140i . 4 1
UNIT 1jECLhRN1!IOH OF
AREAS.;
coRM614 ".'AND:'! PaM-TION AND" XIV.
#01i VNITS. VIV, VI xil kill
tv:
9 c3-
tao om
30:
0 S C-2
t-ob. �41i
01j. a
4) V3
If*- -,
ij 0 e2
BUTTE COUNTY S�H'601LS 6E VELOPMENT FEE CERTIFICATION FORM
(one, Form per Building)
A.P.'Number. Building D I epartment No.
School District City iCounty Jurisdiction
Property, Owner /�C_
Project Location/�ddr"ess &Zp"- C-A0TZ-_r_ I A614r-7A
Subdivision Lot Number
Residential Development:'
Sq.'Footage
#,of Living 1MHI Addition (Group R)
Units
Commercial/Industrial:
uildir�j Departme
New
epresentative
Sq. Footage
Addition (Including Exterior
Roofed Areas)
'DaTe-
'(Floor.Plans reviewed -by School District Personnel)
District, Id No.'
'School District certifies that
(Applicant Naffie
a
St-reet Addres
I
Ii.
Phone,Number
(City) (State) (Zip Code)
has complied �iith_the requirements of Resolution No.
.by the payment o $ representing square feet.
a A
�V. L4 Iv
'*�'S-cWodl Di-skrict Representative Date
PAID BY CHECK NO.
BANK NO.
PAID BY CASH
REMARKS:
white-applidant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)