HomeMy WebLinkAbout064-050-034�, 64-05-34
FREINK1AIKINS
4583 Asheville Drive Ma alis r064-050-034ISI
Contr: McD n ,ld Const g f PHYLLIS AIKINS TRUST
Permit#1653-85�pE(util, MH) r 14582 ASHEVILLE DRIVE, MAGAL
ELEC 5 ?Do Fh DAMAGE REPORj
GAS_,tlO 3
SUPPORT STRUCTURE REQ
COMPACTION TEST REO_
05':34 ?�1-��
Contr; Bay Area MH. Magalia ,
Contr: Bay Ar-e�
Permit.��l=-965 85MHI
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Ruedd _ / /j -X,�
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Contr: McMillan MH Ser, Magalia
Permit#2232-85B,P,E ew gars e, deck &
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�, 64-05-34
FREINK1AIKINS
4583 Asheville Drive Ma alis r064-050-034ISI
Contr: McD n ,ld Const g f PHYLLIS AIKINS TRUST
Permit#1653-85�pE(util, MH) r 14582 ASHEVILLE DRIVE, MAGAL
ELEC 5 ?Do Fh DAMAGE REPORj
GAS_,tlO 3
SUPPORT STRUCTURE REQ
COMPACTION TEST REO_
05':34 ?�1-��
Contr; Bay Area MH. Magalia ,
Contr: Bay Ar-e�
Permit.��l=-965 85MHI
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Ruedd _ / /j -X,�
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Contr: McMillan MH Ser, Magalia
Permit#2232-85B,P,E ew gars e, deck &
breezeway)
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FIRE. DAMAGE REPORT
OWNER: `C�Gin� ��1Lt5 .� Ka '(YlA`+
LOCATION:
l
CONTRACTOR:
DATE: l a• 1-3. n i
A.P. #
ZONING:
DATE TO INSPECTOR: V 1 PERMIT HISTORY:( ) NONE ( ) AS FOLLOWS:
BUILDING INSPECTOR'S REPORT
Building Description:
CommercialMsage:
Residential/# of Units:
Currently Occupied fS
Abandoned/Vacant
Electric: /
Yes No Electric currently On ✓ Off
Condition of Electric �
Gas:
2
Natural Propane None Currently On Off
Obvious Problems: &-6
6
Sanitation:
Plumbing Working
Well Working Potable Water
Obvious SewageProblems,
Description of Damaged Area;
rbvy s,
Estimate Valuation of Damaged Area:
Condition of Foundation:
Mobile Home: Condition of Utilities:
Inspector. Date i
Sketch building on reverse and indicate area of damage.
��G CpGry
CDF/BUTTE COUNTY FIRE INCIDENT LOG
DATE 07/21/2001 INCIDENT NUMBER
REPORT TIME 18:46 LOCAL FIRE NUMBE
STATE FIRE NUMBER
CASE NUMBER
LOCATION 14582 ASHVILLE DRIVE
RP MR. STROUPE PHONE NUMBER 873-8193
WILDLAND FIRES ❑ ESTIMATED ACRES
STRUCTURE FIRE RESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PSA/OTHER
HAZ MAT
COMMENTS
EMD ❑ OES ❑
LOGGED B IMAA
RO ROMINE
BI
MEDICS PARADISE
PRA V21 ECC ❑
REPORT METHO 911®�I
FIRE INFORMATION
FIRE INFO SENT HO EMAIL 1 BY MAA TO
7 -DAY LOGGED INITIALS JS
INCIDENT NAME JASHVILLE
START DATE '07/21/20011 START TIME 18:20
DIAMOND # 1.1-1.8
CAUSE ELECTRICAL POWER
LAND USE DOMESTIC
ACRES r=O TYPE OF ACRES
DIAMOND 5 ONLY $ DAMAGE TYPE I
DOLLAR DAMAGE 1000.00 SAVE50000.00
INJURIES/FATALITIES ❑
# CIVILIAN INJURIES 0 # CIVILIAN FATALITIES _ 0
# FF INJURIE 01 # FF FATALITIES 0
FC -40 INFORMATION
New Incident FC40 ❑ DATE OF FC -40 INC
AGENCY INC # INC P#
FC40 COMP DATE FC 40 COMP BY
County Notifications EARS Hard Copy Recieved 0 EARS Checked Agenst EARS Computer ❑
rmo
6'.
� F AIKINS 4-05-34
4583 Ville Drive, Magalia
Contr: Mc Do d Const
r Permit��1653
ELEC util, MH)
!� �Dp/
GAS to 3 6 -
SUPPORT STRUCTURE RE
COMPACTION TEST RE
RoY6l4�i
Contr: Bay Area , agalia Iffog
Contr: Bay a MH
r Permit 5=85MHI
Is ed %-//—
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64-05-34
Contr: McMillan MH Ser, Magalia
i Permit#2232-85B,P,E Wew gara e, deck &
breezeway)�Q/
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PERMIT NO. 2232-85B>P >E
PERMIT EXPIRESO (Q
OWNER FRANK AIKINS
?
CONTR.. McMillan MH Ser, Magalia
ASSESSOR PARCEL 64-05-34
LOCATION 14583 Asheville, Magalia
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gas Service
Called PG&E
a
:JOB FINALED (Date) orf d
:z
nature
0
J = OK z.
0 = Not OK �d
= Not Applicable MOBILEHOMES MISCELLANEOUS
= Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except #.s
1. Zoning Requirements -Setbacks -.Easements
2. Footings; Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4, Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat.or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date
POOLS (Plans) OK except N's
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4, Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed.
7. Water and Sewer Connected -C/O to Grade -HD Approval
7, Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
Card -BI
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Date Card -BI Date
Card B -I Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
V = OK
01 Not OK "
Not Applicable
Not Ready RESIDENTIAL )Single and Duplex)
�
i t
Date
UNDE LOOK Plans OK except #'s
Date . FRAM htinued
1,
oning requirements -Setbacks -Easements
48 erty Line Firewall & Openings
Ft Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49 . x oors-One_3'-Ch ck Garage -3rd story, 2 exits
tg., Garage; Soils -Steel- / " Ftg. Depth
tai ; tNi -H om-R' - -L g-Fire-ProteCtt[fTf
4.
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51; od on Roof Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
5 iding-Nailing-Veneer
emwalls, Garage; Steel-Blockouts-Wrapped-Sla
cco esh-Drip Screed-Fdn. Vents-Underflr. Access
7.
Pi Fireplace Ft .-Steel
54._l�zirtcf/ r
.Gea-Glass Protection -Skylights -Plastic
W.V.: Fall -Fittings -Test -2 way C/O -Sewer 49r
55. wiling -Bolts
9. Gas Pipe; Size -Anchors
10.
VAtTr Pipe; Test-Anchors-Regulator-Servic st
/
1 .
Electric; Underground
12.
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI Da Card -BI Date
Card -BI Date / Card -BI Date
Card -BI --Date Card -BI Date
Card -BI•
Dat Card -BI Date
Date FINA ans) OK except q's
Card -BI Date Zand-BI Date
Date
PLUMBING (Permit) OK except q's
14. ter Ht • Vent -Access -Combustion Air
5 Ext. Steps -Door & Sidelight Protection -Landings
etector
; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
Test & Anchors -Nail Protection
1
W.V.; Test-Fttngs & Anchors -Nail Protectionxiting
17.
Shower Pan; Test, First Floor -Tub Access
6 & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
reg/Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
airs & Rails
r Stove; Clearances -Hearth
64-'Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Dat Card -BI Date
ixt. & ppliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
&fi TrMs & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except q's
ge ire oor; Swing -Landing -Closer
.C. Duct in Gara Garage -Damper
2
'�kture & Transformer Clearance -Ins. Protection
6 en - - ir-Connector-P.R.V.-
I ove oor- ion
2• .
2 .
Elec. Receptacles Spacing -Lights &Switches at Doors
No. of Conductors -Stapled
7 I , E & Mee§rE-gvt�Listed for L ion
lec. Receptacles in Garage; Rome�cetec�
-
.oam-Looked in Attic ❑Yes
ldmex Instxes l
23. mex Installed Close to Edge of Studs & C.J.
24 p. G. Equiade up w/Mech. Fasteners -Bond Gas & Water
2 Appliance Circuits in Kitc " Conductor Size
7 Guard Rails & g_qck (j4netfuction-Posi6Geps�-'
26.
Sub eed Wire Size / ga. or AI-A.C. Wire Size / / ga. Cu or Al
r-Drainag od-Earth Clearance
Lpeked under Floor n YAw --'
27.
Ranke Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insu ted Neutral Dyes ❑No
7 lowing instld.: Drive E] Yes o; Walks ❑ Yes gE] No
Planters ❑Yes ❑
28.
Servi a -Riser Conductors & Ground -Main Disconnect
7 h
29.
Equipj Clearances; Panels-Motors-Mech. Equip.
onnect-Clr s-Brkr. & Cond. Size -115V Outlet
30.
Clothe Closet Light -Shower Light
Vents Above Roof; P .-A rance to Opngs.
Electrical, Plumbing
/xterior
. Trim, .F.I. acle-Undergwua4--
Card B -I
Date Card -BI Date
�Blation throughout House
s rotection
Card 8-I
Date
Date and -BI Date
MECHANICAL (Permit) OK except H's
8 orrec 1 from Previous Inspections
897_-GJ�eters Tagged; Gas -Electric
31.
A.C. Ducts; Insulation & Support
85 -WTMT-&hewer Connected -C/O to Grade -HD Approval
32.
33.
Vent Fan; Exhaust above Insulation
Condensate Drain & Overflow; Size & Grade
88' -'energy -Compliance Certificate -Other Certificates
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI Dat Card -BI Date
Card -81
Date Card -BI Date
Card -BI Date �_-FCard-BI Date
Card -BI
Date Card -BI Date
Card -BI Date Card -BI Date
Date
FRA
Plans OK except p's
Comments at Final:
36
S' ; Proper Material & Anchors
37
Walls; Stud NaY n , Spacing & Bracing -Plates -Sound
3
ing Wal aver Girders & Floor Nailing
`
39.
to in Walls (rat proof)
40.
o s; Furred Ceilings -Stairs -Chases -Tub
414! & Beam -Size & Bearing
42
gers-Post Caps -Anchors -Connectors ,Z
4 .
Cing. Joist-Rftr. Ties-Purlin -Roof Brac.-Truss-Sh ng.-Rfn_g_.
4
r pe A Flue -Fireplace Throat
ccess; Size & Romex Protection -Draft Stop -Ins. Baffles
46.
in ows or Exiting Doors -Sill Hgt. & Dimensions
rage i n-Eraming
(NOTE: Anentry must be made each time you visit jobsite)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751,
7 County Center Drive, Orov Ile — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of County 0=dinance
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 r need additional explanation, please contact this office immediately.
Inspector_ �L/� �`� Date
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND' -PERMIT rN
ASSESSZ; RCE^B3
Zo. G I
PERMIT
OWN;BUILDING
O WNE
TEL HONE
SO. FT. OCC. BUILDING VAILUATION
..]
OWN R'S M/A'ILING 48 E56wp
CON AGT 'S AME �9,�,..., I EL EP HONE
C^ t kA I�el V I ��
Y7
r V2 LF
e7-3
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
U v NOWN '
Total Valuation $
3
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
om
LICENSE NO.
Plan Checking Fee
$ ^Id�
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING DDRESS
Permit fee
$ 1
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00 a,
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PAR AP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUC URE /! �(
SF El Duplex ❑ Mobilehome❑ Other hr 1 6 a�1Q� rg
SPECIFY
Gas piping system 1 - 5 outlets
5.00
ilding sewer
5.00 ^
obi le Home S I G I W
10.00 ea
TYPE OF WORK
New RKAddition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work:
Permit Fee
$ U.0
Contractor
ELECTRICAL PERMIT
Filing Fee 110.00
Main service 500V 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):
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.544-74 / Classi f i cation ��/�
❑ 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 ,
OR ACDNS. ACC. BLD hOsgft /; p
NEW .
CONST". ULTIOU ET
ON -RE SID BRANCH CIRC ITS 2.50 ea
POWER APPARATUS &)
(SINGLE OUTLET CIR. )
EX. Occup(OUTLETS OR FIXTURES 30 DAL0
ewLO 30
FIXED APLISIS
Ex. Occup. OUTLETS P(RESID IREA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. lyirin 15.00
9
Permit Fee $ S
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
o shall not to Self -Insure.
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
FiIingFee 10.00
Heating
Cooling
g
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 Countyof
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 sa' County in consequence of the granting of this permit.
��� Date
ignature of �Applic.n�t— Owner EIC a n t r actor ®--A—genr
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 $
TOTAL PERMIT FEE $ 01 10>1 5'
OCCuP.
CONST.T7
I
F
PARCEL
PD
ND
Iseu
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO F PUBLIC
By
PER EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
—.Date
Receipt No. ���
WNITC-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: 916/534-4541 J
PERMIT APPLICATION DATA SHEET
�Permit No.—/� �
OWNER _ A. P. No. - 4 –ok 3
Proposed Building UseRn
Permit Fee Based Upon: Complete Contract Price DPW Valuation
Other (Explain)
Building Inspector.
Date
l
At time of permit application, I s advised the following data must be submitted prior to permit processing
and1or iss.eance: v DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . .
2.. Plot plans in duplicate./triplicate. . . . . . . . . . .
3. Complete plans in duplicate. /triplicate. . . . . . . . .
4. Complete engineered plans and calcs. . . . . . . .
5. Plans with Energy Design Compliance Statement. . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorization. . . . . . . . . . .
10. Sanitation approval from Health Dept. . .
11. Planning approval .for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner, Mail to owner ❑.) r
15. Improvements may be required. . . . .. . . . . . .
16. Mobilehome Installation Data. . . . . . . . .
•Pre-Inspec. request to
17. Pre -Inspection for Required. Building Inspector (Date)
18. Recorded copy of Agricultural Acknowledgment Statement.
19. Other r
When /you/issue the permit, process as follows: M&M—Tb owner. Mail to contracts
Telephoneand hold for pickup at`��1� office. Deliver w./inspector.
Other
Applican ._� _ lcc ��, Date
Copy of plans sent Health Dept., Fire Dept., Other Date
During the plan checking process,—the following data must be submitted prior to permit issuance:
(For required items not checked above at time of application, circle .item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by Telephone Mail Other
By Date
Plans checked by
Plans approved bi
Other
Copy—DPW
Date
Date
TQ; Building Department
FROM: Environmental Health
SUBJECT: SANITATION CLEARANCE
f,2 z wd, A z
OWNER
�w
LOCATION AP #
Plans
approved for: Sewage"Disposal
Water
Supply
Hold
final for:
Water
Supply
Final
Clearance O.K. for:
Water
Supply
Clearance for - bedroom mobile home. Other
/t
Clearance for addition o / cfi i�//�✓� (O
y (P4- 6�7) /
DATE
T0; Building Department
FROM: Environmental Health
SUBJECT: SANITATION CLEARANCE
sv�
0 ER ;
Plans approved for:
LOCATION Ap {p
Sewage Disposal Water Supply
Hold final for: Water Supply
Final Clearance O.K. for:
Clearance for -2,— bedroom mobile home." Other
Clearance for addi n o�
AN
Water Supply
:% 1
,,,
t1
i
NOTE:—All Materials & Workmanship Shall Be, in
�ed--Geed- �fClGtl6a6 ned.�---�+s se* e�f-{�dana-cad .speci#�r.#i,o��-pA4 1ST
WWI of a quality prescribed for the Specified use.ia-fine kept on the job at all times and it is unlaIU-T,-
Ito —i
Uniform Buiiding, Plumbing &� haul Codes and make any changes or alterationso i some without
the National Elecft c�S.gd written permission fro -+e Departrfa.ent:of f u
lakc
Works, Co of - Butte. ' I ,
,v}
A setback of 5 ft. f i ✓ �j \ �
rom the �, x
i grope +nes and a setback _ +
of 5106. from the road 7 1
enterline shall be clear of
structures or equipme xcepf
for a 2 ft. eae overhang.
+ i
J .1
V11
Z2.54 95' -
BU, TE
5'-BUTTE COUNTY
BUI G DEPARTMENT
AV)PROVED
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4
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a
Z2.54 95' -
BU, TE
5'-BUTTE COUNTY
BUI G DEPARTMENT
AV)PROVED
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evolok'
7,q c,� Arvktw�— Pas i
i
BUTTE COUNTY
BUILDING DEPARTMEN'T
c®us APPROVED
C� ye�
e
/-z 1 t, y/
A
Provide adequate bracing.:
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
T
e,
Y3
PERMIT NO. 1653-85P.E(MH)
PERMIT EXPIRES - '/'A2zV'
OWNER FRANK ATKT_NS
CONTR. McDonald Const- Magalia
ASSESSOR PARCEL 64-05-34
LOCATION 14583 Asheville Drive, Magalia
OFFICE COPY
Temp. Power;
Address
Called P i r
Tem Elec.Temp. S � Meter,By-_Date�Z?
ELECTRIC.
Called PC'Meter.,By_ .._. -- Date -ZZ
Temp. Gas
Called PG&E
JOB FINALED (Date)
\9n
' \
J = OK
0 = Not OK
— = Not Applicable M O B I L'EH OM ES
SIE = Not Ready
MISCELLANEOUS
s'
Date
MO IL ME UTILITIES (Plans) OK except k's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except #s
1ing Requirements—Setbacks—Easements
1. Zoning Requirements—Setbacks—Easements
24�spifs; Special MH Support—Sketch
2. Footings; Size—Depth—Spacing—Connectors
Sew ocation—Test—Fall-C;O—Concrete
3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails
4. at . Location—Test—Easement Needed (Sketch)
4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing
ectricity; Location—Clearances—Grnd.—/ / Amp—Concrete
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
ocation— Test—Wrap:/ /"L"ft./ P'Nat.or/ "L"ft.%ri /"LPG
6. Carports; Windows—Doors
7tdtility Clearance
7. Elec.
Card -BI
ate Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. n' g•Requirements—Setbacks—Easements
Card -BI
Date
Date Card -BI Date
POOLS (Plans) OK except N's
1. Setbacks—Easements
2. Fo •ngs; Size—Spacing—Marriage Line
2. Soils; Compaction—Structure Stability
3. Gas•,MH Test—Demand—Valve—Connector
3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining
4.ricity; MH Test—Crossovers—Breakers—Clearances
?
4, Elec.; Receptacles and Lighting; Distances—GFI
Drain; MH Test—Fall—Flex Connector
5. Elec.; Pool Lighting; 15 volts—GFI
6. Wat ; MH Test—Regulator—Connector
6. Elec.; Enclosures; Conduit Entries—Terminals—Listed
er and Sewer Connected—C/O to Grade—HD Approval
7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater
G�nd Electricity Tagged
8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg.
Boxes—Enclosures—Panel boards—Ins. to Main in Conduit
9. Ex• ; Insp.—Sketch
1 Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test—Water Supply Test
Card B -I
Date Z/ and -BI Date
Card -BI
Date Card -BI Date
Card B-1
Date Card -BI Date
1 Card -BI
Date Card -BI Date
IL
= OK f
= Not OK s '
= Not Applicable
= Not Ready RESIDENTIAL (Single and Duplex)
,
Date
UNDERFLOOR Plans OK except #'s
_Date
FRAMING (Continued)
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
51.
52.
53.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Siding -Nailing -Veneer
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
55.
Shear Walls; Nailing -Bolts
9. Gas Pipe; Size -Anchors
10.Water
Pipe; Test-Anchors-Regulator-Seryice Test
11.
Electric; Underground
12.Plenums
& Ducts; Clearance -Material -Support -Ins.
13.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except q's
14. Water Ht.; Vent -Access -Combustion Air
57.
58.
Smoke Detector
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
64.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date
Date Card -BI Date
ELECTRICAL Permit OK except q's
66.
Elec. Outlets & Receptacles at Kit. Counter
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21.
Elec. Receptacles Spacing -Lights &Switches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
22.
Size Boxes & No. of Conductors -Stapled
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23. Romex Installed Close to Edge of Studs & C.J.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Foam- Looked in Attic El Yes
Insulation- Foam-LDec�
25.
2 Appliance Circuits in Kitchen &Conductor Size
73.
Guard Rails & Construction -Post Caps
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral ❑Yes El No
75.
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
28.
Service -Riser Conductors & Ground -Main Disconnect
76.
Stucco; Brown -Finish
29.
Equip. Clearances; Panels-Motors-Mech. Equip.
77,
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
30.
Clothes Closet -Light -Shower Light
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
Water Well; Disconnect, Electrical, Plumbing
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Date Card -BI Date
81.
82.
Ventilation throughout House
Glass Protection
Card B-1 Date Card -BI Date
Date
MECHANICAL (Permit) OK except H's
31. A.C. Ducts; Insulation & Support
83.
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/O to Grade -HD Approval
32.
Vent Fan; Exhaust above Insulation
86.
Energy Compliance Certificate -Other Certificates
33.
Condensate Drain & Overflow; Size & Grade
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Comments at Final:
Date FRAMING(Plans) OK except q's
36.
Sills; Proper Material & Anchors
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38.
Bearing Walls over Girders & Floor Nailing
39.Draft
Stop in Walls (rat proof)
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
Header & Beam -Size & Bearing
42.
Hangers -Post Caps -Anchors -Connectors
43.Cing.
44.
Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-_Rfn_g_._ _
Fireplace Ties or Type A Flue -Fireplace Throat
45.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
46.
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
47.
Garage Fire Protection Framing
(NOTE: An entry must be made each time youvisit jobsite)
MOBILEHOME INSTALLATION ACCEPTANCE
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE
OROVILLE, CALIFORNIA — 534-4541
PERMIT N0,
Address or location of mobilehome
Owner's name9i
Owner's address
Insignia or hud number _
Manufacturer's name
Serial number of V.I.N._ P 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.
a DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 534-4541
SKy.way and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CAMN 111% IM
WKWECTt!®N ®TIKE
BUILDING OR PROPERTY ADDRESS
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.
Insoector.:
/ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
VVVIJ 7 County Center Drive - Oroville, OaMforniq�!J5965 - Telephone 916/534-4541
APPLICATION AND PERMIT
P RMIT NO.v
ASSESSOR PARCEL NUMB R
Z(PING
BUILDING PERMIT
OWNER,
t, F
TELEPH E
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS c C 1 ai% c/o
C
T LEPHONE
-72 —26 `i9
CON RA MAILING ADDRESS
�& TO•S2 / /
Fireplace
CONSTRUCTION LENDER
U11NO2N ,,
Total Valuation Is
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$�
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
ys 3 . //l
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater Or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehomeJ2- Other
SPECIFY
Building sewer
5.00
Mobile Home S I G I W
10.00 e
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ installation0%ther ❑
Describe work:
-JJ..�•
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP 00 S
ORLESS
10.00
• '!'�
'� hi,NEW
Main service EA. ADD'L 100 AMP
2.50
CONST.(DWELLING OCCUP.&
OR ACDNS. ACC. BLDGS.
,
2/20sgft
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.
L@
License No. .V6 1,91, S' Classification <:—/r
❑ 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 CONSTR U TI.OUTLET
NON-RESID BRANCH CIRCUITS 2.50 ea
NEW CONSTR ( POWER APPARATUS &)
NON -REST D. SINGLE OUTLET CIR.
Ex. OCCup(OUTLETS OR FIXTURES
eSO
A
FIXED APPLNS, OR
Ex. DCCUp. OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
�I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
_+
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said ounty in co equen a of granting of this permit.
%� Date
Signator of Applicant — Owner❑ Contractor Q Agent,
An A 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 $
TOTAL PERMIT FEE $ 120
ocCUP. GROUP
I TYPE OF CONST.
PARCEL
I PD
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOO PUBLIC
By -
PER Date ate
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
%
/
Receipt No.
WHITE-D.P.W., YELLOW-ASSe SSOR, • PINK-INSPECTORGOLDENROD-APPLICANT
BUTTE COUNTY.DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.*
PHONE: 534-4541
MOBILEHOME INSTALLATION SHEET
1. Owner's name:
2. Installer's name:
3. Is the site currently under permit? Yet No
(If yes, furnish permit number OR.
Is the site an existing site? Yes No 73�-r
(If yes, furnish two (2) plot plans.)
4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and
clear of.all setbacks.and easements? Yes No
(If no, clarify
5. What is the mobilehome electrical rating? ----------------------- l s- 0 Amps
6. What is the mobilehome site service rating? ---------------------- C) Amps
7.. What is the mobilehome site circuit breaker rating? ------------- Amps
8. Is there any other electric load to be,served by the mobilehome
siteservice? ------------------------------------------ Yes No
(If yes, identify the load and size: (Load) (Amps)
9. What is the mobilehome site gas pipe size? ---------- 7--
-------- Na
10. What is the type of gas service? - ------------------ 7
11. What is the gas pipe length from meter or tank to themobile e?
12. What is the mobilehome gas demand? --------------- ---------------------- ---- (B
(This information not required if pipe length less than 6 natural a
or less than 50 ft. on LPG.)
T -A
BUTTE
COUNTY
BUILDING DEPARTMENT'
A P RR 0 V E,
D
MOBILEHOME SUPPORT DATA
If 'ofher than single wide,
Mobilehome Mf r.J�i �yP��r �"� S%ArC1rX��furnish Setup Model No. 3 e Year
Width ,9 I (ft.) Box Length _(ft.) Tagalong or Expando Size ft. x ft.
(SHOW SUPPORT DETAILS BELOW)
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).
All center supports measured from front of
mobilehome unless otherwise specified.
Footings (check one)
Single P -1r. Wood either
at, 4
(ft.)(in.)
(ft.)(in.)
O1 d
(ft j (in.)
54 ` o tf
� 3b
(in.) (in.)
i x3o
(in.) (in.)
*If center piers are other than drawn above,
-a raw im-locations, spacing, and dimensions.
�i� ( C <---Tagalong or Expando,'
�y x
show support -details.
X
-- Typical Support
(in. (in.) Footing Size
-- Max. Pier Spacing
(ft.)(in.)
-- Max. Overhang
L_ "0
(ft.)(in.)
pressure treated or
._
_
foundation grade.
6. v
x3o
(ft.)(in:)
(in.) (in.)
,
2. Other: (specify)
Center support
locations*
Center support
footing sizes
..
Supporta (check one)
(in.)
1: Concrete block.
7 i
01.
1-1,4301
/7' t/ 36K b [:]..2i
Other. (specify)
(ft.)(in.)
(in.) (in.)
at, 4
(ft.)(in.)
(ft.)(in.)
O1 d
(ft j (in.)
54 ` o tf
� 3b
(in.) (in.)
i x3o
(in.) (in.)
*If center piers are other than drawn above,
-a raw im-locations, spacing, and dimensions.
�i� ( C <---Tagalong or Expando,'
�y x
show support -details.
X
-- Typical Support
(in. (in.) Footing Size
-- Max. Pier Spacing
(ft.)(in.)
-- Max. Overhang
L_ "0
(ft.)(in.)
AP # os—
OWNER s -OWNER
PERMIT'lk
MH UT IL . CLEARANCE AT
INSPECTOR
ELECTRIC
GAS.
Support Compaction
Struc. Test Re .
Service
.Size
Other.
Load
Type
Pipe
Size
Length
YES NO .YES NO
Return to DPW AGRICULTURAL STATEMENT -OF ACKNOWLEDGEMENT trit,eL lei 0. Fly;, i;�CU,tO >
FOR RESIDENTIAL DEVELOPMEREQUEST
ATTHc REQUESSTT OOF
NT I OF BUT TE O , itiil3a
F ,
Section 26-8.1 of the Butte County Code requires:._this acknowledgement' n SIN
be recorded prior to issuance of a building permit,'; '
1985 JUN; I0 PM 3: 44I.
The property described herein is adjacent to land or included ���t_, Kw�
within an area zoned for agricultural purposes, .and residents of this ELEANOR -1'•T. 8L.L %t_
may be subject to inconveniences or discomfort arising from CLERK -RECORDER FEE
property Y J g _ J
the use of agricultural chemicals, including, but not limited to herbicides, pesticides,
and fertilizers; and from the pursuit of agricultural operations including, but not limited
to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural zones which have as a
priority use for productive agricultural purposes, and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or disconform from normal,
necessary farm operations.
All that real property situate in the County of Butte, State of California, described
as follows:
14./x.. ��—D'j=3/
01AII/7-' /0
-1-1� 7. 7/
��4,�40rsE f'i�E-s
W/ Date:
'l6 ���-
PROPERTY OWNERS
State of California ) On this the loth day of June , 19s_, before
Butte ) SS. me, the undersigned Notary Public, personally appeared
County of )
*FRANK L. AIKINS & PATRICIA AIKINS*
/ Personally known to me. LX/ Proved. -to me on the basis
of satisfactory evidence.
to be the person(s) whose names) are " subscribed to
the within instrument and acknowledged that
.;r°r.� VICTORIA L. ;3ULLOG;< executed the same for the purposes therein contained.
f ' f f OTAP.Y PUBIC — CATFFURNIA � IN WITNESS WHEREOF, I . hereunto set my hand and official seal.
BUTTE COUNTY c
+' Ply Commission Exwes Janafy to.
otary Public
Present A.P. No.
eN40 OF 6)OC,UMENI
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
y ' i
ASSESS R P RCEL'N ^ME
_ sJ
ZON G
�
BUILDING PERMIT
OWNER r � Ir1S
TE EPHONE
SQ.FT. OCC, BUILDING VA UATION
OWNER'S MAILING gyADDS
Rn C
_V
CONT CT!R' NAME
TEL Ot
CO/Q7�iA T •S MAILING ADDR SS
r 'a
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICEWlSE NO.
�
Plan Checking Fee
$ �no�
r
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDR SS
J6AJQ
T_
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION A E,L RCEL MAP
�— 349^0)i
Each qas water heater or vent
5.00
Gas piping system 1 -5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex❑ Mobilehomee Other
SPECIFY
Building sewer
5.00
Mobile Home
110-00e4
TYPE OF WORKPermit
New El Addition❑ Remodel❑ Utilities Installation❑ Other❑
Describe work: —
Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00 -
Main service 100 AMP ORV OR LESS10.00
Main service EA. ADD'L 100 AMP
—440
2.50 en
NEW CONST. / DWELLING OCCUP.&`
OR ADDNS. ( ACC. BLDGS.
t
2�
I ZQ3Q ft
CONTRACTORS LICENSE LAW
I declare der penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions ode a d my license is in full for a and effect.
License No. Classification
❑ I, as the owner, or my enpioyees 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 CO ID R BRANCH CIRCTITS 2.50 ea
NEW CONSTR. POWER APPARATUS &
NON-RESID. (SINGLE OUTLET CISR
20050C
Ex. Occup(o OR FIXTURES SAL030
FIXED A
Ex. Occup. OUTLETS P(RESID,)LNS REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 ^,00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
�ve placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
O I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
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 of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all H bil' es, 'udgments, osts, and expenses which may in any way accrue
:gains d Co my in co s quence of th granting of this/permit. y�
%� Dae _G� /(/ L
Signature of Applicant — Owner ❑ Contractor Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over3 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
I PARC
PD-1;Df
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DI CTOR O BLIC
p
BYDaate16
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
6-1-i?L _
Receipt No. -5-7V60
WHITE-D.P.W., YELLOW -ASSESS: R, PINK -INSPECTOR, GOLDENROD -APPLICANT
W
CPO
o2,Q X30
r _+
NOT
.'..9AW10-40 9,All Materials & Workmanship Shall Be in
Accordance with Recognized Good Prod" s and
of a quality prescribed for the Specified use the
Uniform Building,* Plurt4bing & Mechanical C es nd
the National Eleoriccd Cadeo
�C�ab \
;.v This set of cans and If
ands ations MUST b4
at,
kept on the * 6 at all times an 't is unlawful +0
make any hanges or alterations a same without
rmission from the Depart rent of Public
)a
rks, Co f Butte. ` I
utqi` i
�fmwithin
con�ectionst
11 b*
0 the obileho fg1th
dire tly behind or with n the
half
Af the roadside (lef. the
mobil home.
A
F00 0
SQ-�- OaA
M -jot
e T-1-ITeoviotome.
am4 setback of 5iii
pproperty lines a%fdsetbOck
of 50ft. from t14 road
,,tedine shll �'�pment
ructures or eqOYXOPT
st '
for a 2 ft. eave o�( - e
C20 --s e fkl
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