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HomeMy WebLinkAbout064-220-006RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO:- BUTTE Or BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE CA 95965 COPY of Document Recorded 23 -Apr -2003 2003-0025592 Has not been compared with original BUTTE COUNTY RECORDER SPACE ABOVE THIS LINE FOR RECORDER USE ONLY 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. WALLACE W. SQUIRES AND PHYLLIS.J. SQUIRES REAL PROPERTY OWNER/LESSOR 7 COUNTY CENTER DRIVE 2104 NORCO DR. MAILING ADDRESS MAILING ADDRESS OROVILLE BUTTE CA NORCO RIVERSIDE CA 91760 CITY COUNTY STATE ZIP 6118 GULIFORD CIRCLE BUILD G PERMIT NO./ TELEPHONE NUMBER INSTALLATION MAILING ADDRESS, IF DIFFERENT 04/17/03 MAGALIA BUTTE CA 95954 CITY COUNTY STATE ZIP ED AND MARILYN SULLIVAN UNIT OWNER (if also property owner, write "SAME") 14602 ASHEVILLE DRIVE MAILING ADDRESS MAGALIA, BUTTE, CA 95954 CITY COUNTY STATE ZIP 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 02-3457 530 538-7541 BUILD G PERMIT NO./ TELEPHONE NUMBER F , i�,?'I771'l���i ,),,/,1 04/17/03 SIGNATURE OF LOCAL AGENCY OFFICIAL DATE COUSIN GARY'S DEALER NAME (if not a dealer sale, write "NONE") 91265 DEALER LICENSE NO. SKYLINE HOMES INC 2003 WOODFIELD / P219 -CT MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER 17 -70 -0461 -R -A/13 66'X 26' ULI 543889/9 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) REAL PROPERTY LEGAL DESCRIPTION SEE ATTACHED ASSESSOR'S PARCEL NUMBER AP # 064-220-006 HCD FORM 433(A) REV. 8/91 W I ITE - County Recorder CANARY - HCD PINK - Applicant GOLDENROD- Building Dept. BUILDING PERMIT NUMBER: 02-3457 Address or location of unit: 6118 GULIFORD CIRCLE, MAGALIA CA 95954 Legal Description of Real Property: AP # 064-220-006 SEE ATTACHED (x) Mobilehome/Mamifactured Home () Commercial Coach Has been affixed to the real property above by installation on a foundation system pursuant to Health. acid Safety Code Section 18551. Owner's name: ED AND MARILYN SULLIVAN Owner's address: 14602 ASHEVILLE DRIVE, MAGALIA CA 95954 INSIGNIA OR I-1 U D NU1\113ER: ULI 543889/90 SERIAL NUMBER OR V.I.N.: 17 -70 -0461 -R -AB MANUFACTURER'S NAME: SKYLINE HOMES INC. YE :2003 OFFICIAL APPRO' / (ATG INSTALLATION: �y DATE: 4-17-03 PHONE: (530) 538-7541 H.C.D. 513C " EXHIBIT A" RE; VACANT LAND, MAGALIA, CA WALLACE W. & PHYLLIS J. SQUIRES ALL THAT CERTAIN REAL PROPERTY SITUATED IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: PARCEL L LOT 166 AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PARADISE PINES UNIT 14" RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JULY 15, 1971, IN THE BOOK 38 OF MAPS, AT PAGES 37, 38, 39, 40, AND 41. INCLUSIVE. EXCEPTING THEREFROM, ALL MINERALS, OIL, GAS, ASPHALTUM AND OTHER HYDROCARBON SUBSTANCES, WITH PROVISION THAT ANY AND ALL MINING OPERATIONS SHALL BE DONE FROM ORIFICES OUTSIDE THE SURFACE AREA OF THE LAND DESCRIBED HEREIN, AND THAT NO DAMAGE SHALL BE DONE THO THE SURFACE OF SAID LAND. PARCEL 2: A NON-EXCLUSIVE EASEMENT OVER LOTS A, B, AND C (THE COMMON AREAS) OF SAID PARADISE PINES UNIT 14 AND THE LOTS DESIGNATED FOR COMMON AND RECREATION AREAS AS DESCRIBED IN THE DECLARATIONS OF ANNEXATION FOR UNITS IV, VI, VII, X, XI, XII, XIII, AND XIV AS DESCRIBED IN PARCEL 3. FEE TITLE TO THE REAL PROPERTY DESCRIBED IN PARCEL 2 SHALL BE AND IS VESTED IN THE HEREINBELOW REFERED TO ASSOCIATION FOR THE COMMON USE AND ENJOYMENT OF THE OWNERS OF LOTS IN PARADISE PINES UNIT 14 AND IN ANY OTHER TRACTS HERETOFORE AND HEREAFTER ANNEXED, AS MORE FULLY SET OUT IN THE SAID DECLARATION HEREINAFTER REFERRED TO. PARCEL 3: A MEMBERSHIP APPURTENANT TO THE LOT DESCRIBED AS PARCEL 1 HEREOF, IN THE PARADISE PINES PROPERTY OWNERS ASSOCIATION, A NON-PROFIT CORPORATION, THE FEE OWNER OF THE COMMON AREAS. SUBJECT TO: COVENANTS, CONDITIONS, RESTRICTIONS, RESERVATIONS, RIGHTS, RIGHTS-OF-WAY, AND EASEMENTS NOW OF RECORD. THIS CONVEYANCE IS MADE AND ACCEPTED AND SAID PROPERTY IS HEREBY GRANTED UPON AND SUBJECT TO THAT CERTAIN DECLARATION OF COVENANTS, CONDITIONS AND RESTRICTIONS RECORDED ON SEPTEMBER 4, 1970, IN BOOK 1632, PAGE 578, OF THE OFFICIAL RECORDS, OF SAID COUNTY, AMENDED BY AN INSTRUMENT RECORDED ON OCTOBER 16, 1970, IN BOOK 1639, PAGE 433, AND AN INSTRUMENT RECORDED ON MARCH 16, 1971, IN BOOK 1663, PAGE 343, OF THE OFFICIAL RECORDS OF SAID COUNTY, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT IV, RECORDED ON OCTOBER 16, 970, IN BOOK 1639, PAGE 437, AND THE DECLARATION OD ANNEXATION FOR PARADISE PINES UNIT IV, RECORDED ON OCTOBER 16,1970, IN BOOK 1639 PAGE 440, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT VI, RECORDED ON OCTOBER 16, 1970, IN BOOK 1639, PAGE 440, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT VIII, RECORDED ON NOVEMBER 4, 1970, IN BOOK 1642, PAGE 210, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT X, RECORDED ON DECEMBER 15, 1970, IN BOOK 1649, PAGE 528, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XI, RECORDED ON JUNE 10, 1971, IN BOOK 1680, PAGE 206, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIII, RECORDED ON JUNE 28, 1971, IN BOOK 1683, PAGE 399, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIII, RECORDED ON AUGUST 9, 1971, IN BOOK 1692, PAGE 306, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIV, RECORDED ON AUGUST 9, 1971, IN BOOK 1692, PAGE 304, ALL RECORDED IN THE OFFICIAL RECORDS, OF THE BUTTE COUNTY RECORDER AND THE COVENANTS, CONDITIONS, RIGHTS, RESTRICTIONS, EASEMENTS, RESERVATIONS, BENEFITS AND BURDENS THEREIN CONTAINED EACH AND ALL OF WHICH ARE HEREBY EXPREDDLY INCORPERATED BY REFERENCE AS THOUGH SET OUT HEREIN IN FULL. 02/28/2003 07:33 5303429174 CHICO BLDG SYSTEMS PAGE 03 �F T OF BUSINESS. TRANS 0 TATTIIOOL(( N)..,HOU N�AGF�NC.V.•_. UMBER, DEPARTME dlTlll�lbl�i W>r�O N1..:. r'�F °•. � - ._ .... ... .... __ ..... _. .....--. _ �8r — D2�VEEdPhiEldT'- 1IC� .... ••- — -• .r-..yc - - w•. 34 MAN FACTURER••CER�i'9F9CA►TE..-OF O'RlGltl.;:,r: U NUMBER OF LFD.(SlldGLE FAMILY DWElLINO)„ _MUMFI, MULT.l�UNIT. MANUFACT3IRED.HOUSING .. TRANSPORTABLE SECTIONS ..f7777 • r .r OCCUPANCY'GROUR :....:. ;..... ... ANUFACTURER'NAME' " - " , •.' - MANUFACTURER LTCENSE'NUMBER:' SKYLINE HOMES INC 00 0.NUFACTURER ADDRESS: SUGGESTED RETAIL PRICE: WOODFIELD P2-19,— ­CT 02/20/2003 NAME OF DEALER•OR TRANSFEREE (OWNERSHIP TRANSFERRED TO): ' CALIF, DEALER NUMBER OR TRANSFEREE DESIGNATION: DATE OF TRANSFER: ENTFlP DEALER OR TRANSFEREE ADDRESS:02120/7003 (Sada XENIA AVE ­ SOUTR SUITE 300 SECTION MANUFACTURER SERIAL NUMBER 16 . -0461—R-R .. . TRANSPORTER NAME: n L n TRA1dCDAOT TRANSPORTER ADDRESS: (SVL0. BOX 179 DESTINATION FOR UNIT DESCRIBED ('ADEN VALLEY .CO INSIGNIA OR HUD LABEL NUMBER DURHAM 1 ae.tey ulteer Pelta d u -- - •• •, a�.. a y �' IVY Pal rY ur10er hIe )etre N Ina State Of Celilbrtpe Pwl Ute BOOve letla are 41r otttl 0011eLY. E.awlae on (Date) 1 L. Suaill SIGNATURE F AUTHORIZED AGENT t• MR '46- • '55416 LENGTH WIDTH WEIGHT INCHES INCHES POUNDS CA ..95938 DISTRI�Unnal-�' ORIGINAL (PINK) FORWARD TO THE INVENTORY CREDITOR, UNLESS THERE IS NONE. THEN FORWARD TO THE PURCHASER (DEALER OR TRANSFEREE). COPY t (WHITE) FORWARD TO THE DEPARTMENT AT P.O. BOK 1828. SACRAMENTO. CA 95812-1828, WITHIN FIVE (S) DAYS OF RELEASE, COPY 2 (YELLOW) OELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION. COPY ] (GOLDENROD) TO BE RETAINED BY THE MANUFACTURER. HCD 483.0 - SI02.1 • 7/971 J tat a* STATE OF CALIFORNIA s-� DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT { DIVISION OF CODES AND STANDARDS REGISTRATION AND TITLING SECTION STATEMENT OF'FACTS its unit is.'.a: Mobilehome E] Commercial Coach Floating Home Truck Camper !cal (License) No.(s) Trade Name Serial No.(s) /We, the undersigned, hereby state that the unit described above: �ac_ e -d 0 r) cL, e r mano- v\-+ �0 U. rdwfioV%�, iffiant,further agrees to indemnify and save harmless the Director of Housing and Community levelopment, State.of..California, and subsequent purchasers of said unit, for any loss they iay suffer resulting from registration of the above-described unit in California, or from ssuance of a Cal.i_fornia certificate of title covering the same. :/We certify under penalty of perjury that the foregoing is true and correct. ixecuted on r/ --Q -at ,111 C,0 , 0e (City) (State) Signature of each of iant Addr City HCO 416.6 (Rev 11/86) Printed name of each affiant CQUSin CC14t-y S 140ry-)eS 2Z�' e--5 State COUSIN GARY'S HOMEF _... 13468 HWY 99 7 q ( I (j Chico, CA 95973 1 / / ►fit ,i,,},•, HCD # 91265 • Contromr'a License # 295412 F27 Sz ► _ g�"z� �,p(1 PHONE (530) 343-8494 FAX (530) 343-8496 7'Z NOTICE: THIS FORM IS COPYRIGHTED AND REPRODUCTION OF ALL OR PART IS STRICTLY FORBIDDEN. MANUFACTURED H0f4E PURCHASE O DER AND FEDERAL DISCLOSURE STATEME T PURCHASER:` _ ' GATE; f 91 ZEE- -DORESS: PIONE: aY p7:3 °JL(� 1 Subba to do brans on"andilions stoned on both sides of this agreement Seller agrees to sell and Purclwser agrees to puxho" the following MFD./MSL Horne MArQ: MODEL 9. RQOMS APPROX. "I INCL. � NEW S' TOW GAR/FJIVZS.I ADDEfLi� S wr 3 L o USED 'SER NUMYEA APPpO HUD OR MCD N OT. OF MFG. Qfyl .AR., .:..t,:: D L. County. TME wr OF TME MFDMeL. HOME EXCLUDES YnC QSTEO PRICES FOR THESE Ivems. so. Fr. LIVIND AREA AP • T.OW YAR. ._!!/.WMEELS.5 5 E4HEEL HUBS. _TIRES, 12 EE&XLES 7/6 MFD. NOME PRICE GAT4 MPD: DRQ.. ; ESCROW OPEN . 6TKaA7THER USED HOME SALES TAY, IF ANV, 05Y SOLO PRIOR TO 711/e0) � ITEMIZED -ACCESSORIES AND THEIR COSTS; SEE ADDENDUMS) fit; B COW CIRCLEQ.-.AQ.DENDUMACHED HERETOr A .......... . .. ,PM 'e -1+B IER..TO. SIT.E..AP.PROVA �.0, J-2 S Cin Ix 776,; c- CIa,...�.Vs, y?97...°a...._...._...._. ::::?• _ TOTAL ACCESSORIES (OUTSIDE HOME) 4 1E@fT1t3t1t'SU 8Ct t0 � F. ,,� w TOTAL MFG. HOME 8 ACCESSORIES SALES TAX (ITEMS NOT INTEGRAL TO HOME) il :ec ant Approval, FOUNDATION SYSTEM IMMIX M e TRADE-IN DESCRIPTION DELIVERY SET UP MAKE MODEL SSBI ZZFE.. HCD.FEES IN�UFiANCE PREMIUM (ONLY IF SOLD BY, DEALER) i L$' t�• 0, s ' " ' AMouNT owr.Nc Accou"T No. ESCROW .FEES SCHOOL FEES OTHER / PRE PAID TAXES _ TO W A ESS/PHONE DOC. FEE (NOT A GOVERNME 1.ItOTAL CASH PRICE THE MANUFACTURER STATES THAT INSULATION HAS BEEN INSTALLED IN THIS HOME AS FOLLOWS: (NEW ONLY) TYPE THICKNESS IT FACTOR I ALLOWANCE ON TRADE-IN 9 LESS'BAL. DUE ABOVE ; NET ALLOWANCE PAID HEREWITH CASH BEFORE DEL. ROOF EXTERIOR WALLS 4 FLOOR t)I�I(� Ihln1;.:: .. :•;trrlr in:h deo c• this r••r DESIGNATED DEPOSIT :huc Llat)ility !;.n:i` (INC. IN ON. PMT) is not •,•.ipvlciiai i)y rete; :�,)rc•ente'tt 2. 1E55 BUYERS DOWN PA) 3. UNPAID RAL. ON CASH ! elf the.dealar Is also licensed as a real estate broker, the sale of fl: i»anufactured home or mobilehome being installed on a 4. FINANCE CHARGE foundation system pursuant to Section 18551 may be S. ANNUAL PERCENTAGE R, included in the purchase document for the underlying real 6. TOTAL PAYMENT AMOUI property, provided that the requirements of HSC SEC. 7, UNPAID BALA 18035.3 are met." 8. TOTAL RED PAYME THE DEAL[ INSTALLA T IS: NAME Skycrest Enterprises LIC. a UY5412 ..1 . .— .. —' J. BUSINESS ADDRESS 13468 HWY 99 In the event trio manufactured home cannot bo dellvered 'and/or' Inspection cornpleten Clri Chico CA ZIP 9597 within Ins agreed delivery lime ova to nonperformance oy the buyer. buyer agrees to one 01 Ins I011owing ei the Option of 66l'er. either (t) to pay S 3 A Contractor is required by taw to be licensed and regulated by the charges per day until a manufaciuma nome Installation acceptance or tenilicnle o• occupancy is aDlainea in addition to all orner consideration owing or (2) pay Ins sum Contractors State License Board, P.O. Box 26000 Sacramento, CA 95827. 1' of S in lieu of iota' consideration. Z0 w39Vd SW31SAS FM-lfi nn THn h/ TIZ7hCnCr. hr. •hTcnn'7 12/13/02 12:55 BIDWELL TITLE 3 5303425174 85-00344 95-0003441 rt,- F-ee 9. OU RECORDING REQUESTED BY: I Check 9.00 Alliance for Mature Americans Recorded I 04ficial Records 1 WREN RECORDED, MAIL TO, Cotinty of I Wallace & Phyllis Squires Butte 1 2109 Norco Drive Candace J. Grubbe I Norco, CA 91760 Recorder I 9:02om 4 -Jen -95 t PURL. YS 2 NO.567 P002 SPACE ABOVE THIS LINE: FOR RECORDER'S USE QU=ITCLAIM DEED APN 064-220.006 o nc unaersignca gmntor(s) Oeclarets): -t1115 conveyance transfers the grantor's interest into a Revocable Living TTsl R & T 1 1411. There is no consideration for this transfer and is excluded from reappraisal under Proansoion 13, 1.c., CaIifomia Const. 13 A. Section I, et, seq. (Doettntentary Transfer"fax - 0 - ) Wallace W. Squires and Phyllis J. Squires, husband and wife, as joint tenants hereby REMISES, RELEASES AND QUITCLAIMS to: TI?E WALLACE W. & PHYLLIS J. SQUIF.F-S FAMILY TRUST DATED4-112ez. ,1994 WALLACE WEBSTER SQUIRES AND PHYLLIS JEANNE SQUIRES, as Trustors) and Trustee(s) the following described real property in the City of Magalia, County of Butte, State of California See "Exhibit A" attached hereto and made a pan hereof. More commonly known AS: vacant land DATED: L 2 f;j�rP7 '? rf STATE OF C,41FORNIA )ss, County of// Wallace t •- Phyllig�J. Sq � j' " On .!494be fore ane Phvtits 1 5�u�re` known to ate (or proved to me on the basis of satisfactoryevidenc:) to be the person(s) whose name(s) isare subseribcd to the within instrument and a^knowledged to me that he/shehhey executed the same in hisAer•their authorized rapaci7. 00), and that by his,%cdtheirl signatures) on this instrument the person(s) or the entity upon hehalf of which persons) acted, executed the instrument. WI T NCSS nay hand and official seal QW, GUIN' i 1001256 HDTARY PAx - CASA argot County J e� calm emus St&L 6, 129; _: 5�gnaan L1i"y/(. �qt� rt -111% ,4r ti t:Agr►pF•1C1.ALNOt'. RY91'011v1 tela�J i ssmerats to— Wallace axItis ScuAires Y 9_91060. Name Address City, State & Zio " EXHIBIT A" RE; VACANT LAND, MAGALIA, CA WALLACE W. & PHYLLIS J. SQUIRES ALL THAT CERTAIN REAL PROPERTY SITUATED IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: PARCEL L LOT 166 AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PARADISE PINES UNIT 14" RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JULY 15, 1971, IN THE BOOK 38 OF MAPS, AT PAGES 37, 38, 39, 40, AND 41. INCLUSIVE. EXCEPTING THEREFROM, ALL MINERALS, OIL, GAS, ASPHALTUM AND OTHER HYDROCARBON SUBSTANCES, WITH PROVISION THAT ANY AND ALL MINING OPERATIONS SHALL BE DONE FROM ORIFICES OUTSIDE THE SURFACE AREA OF THE LAND DESCRIBED HEREIN, AND THAT NO DAMAGE SHALL BE DONE THO THE SURFACE OF SAID LAND. PARCEL 2: A NON-EXCLUSIVE EASEMENT OVER LOTS A, B, AND C (THE COMMON AREAS) OF SAID PARADISE PINES UNIT 14 AND THE LOTS DESIGNATED FOR COMMON AND RECREATION AREAS AS DESCRIBED IN THE DECLARATIONS OF ANNEXATION FOR UNITS IV, VI, VII, X, XI, XII, XIII, AND XIV AS DESCRIBED IN PARCEL 3. FEE TITLE TO THE REAL PROPERTY DESCRIBED IN PARCEL 2 SHALL BE AND IS VESTED IN THE HEREINBELOW REFERED TO ASSOCIATION FOR THE COMMON USE AND ENJOYMENT OF THE OWNERS OF LOTS IN PARADISE PINES UNIT 14 AND IN ANY OTHER TRACTS HERETOFORE AND HEREAFTER ANNEXED, AS MORE FULLY SET OUT IN THE SAID DECLARATION HEREINAFTER REFERRED TO. PARCEL 3: A MEMBERSHIP APPURTENANT TO THE LOT DESCRIBED AS PARCEL 1 HEREOF, IN THE PARADISE PINES PROPERTY OWNERS ASSOCIATION, A NON-PROFIT CORPORATION, THE FEE OWNER OF THE COMMON AREAS. SUBJECT TO: COVENANTS, CONDITIONS, RESTRICTIONS, RESERVATIONS, RIGHTS, RIGHTS-OF-WAY, AND EASEMENTS NOW OF RECORD. THIS CONVEYANCE IS MADE AND ACCEPTED AND SAID PROPERTY IS HEREBY GRANTED UPON AND SUBJECT TO THAT CERTAIN DECLARATION OF COVENANTS, CONDITIONS AND RESTRICTIONS RECORDED ON SEPTEMBER 4, 1970, IN BOOK 1632, PAGE 578, OF THE OFFICIAL RECORDS, OF SAID COUNTY, AMENDED BY AN INSTRUMENT RECORDED ON OCTOBER 16, 1970, IN BOOK 1639, PAGE 433, AND AN INSTRUMENT RECORDED ON MARCH 16, 1971, IN BOOK 1663, PAGE 343, OF THE OFFICIAL RECORDS OF SAID COUNTY, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT IV, RECORDED ON OCTOBER 16, 970, IN BOOK 1639, PAGE 437, AND THE DECLARATION OD ANNEXATION FOR PARADISE PINES UNIT IV, RECORDED ON OCTOBER 16,1970, IN BOOK 1639 PAGE 440, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT VI, RECORDED ON OCTOBER 16, 1970, IN BOOK 1639, PAGE 440, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT VIII, RECORDED ON NOVEMBER 4, 1970, IN BOOK 1642, PAGE 210, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT X, RECORDED ON DECEMBER 15, 1970, IN BOOK 1649, PAGE 528, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XI, RECORDED ON JUNE 10, 1971, IN BOOK 1680, PAGE 206, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIII, RECORDED ON JUNE 28, 1971, IN BOOK 1683, PAGE 399, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIII, RECORDED ON AUGUST 9, 1971, IN BOOK 1692, PAGE 306, AND THE DECLARATION OF ANNEXATION FOR PARADISE PINES UNIT XIV, RECORDED ON AUGUST 9, 1971, IN BOOK 1692, PAGE 304, ALL RECORDED IN THE OFFICIAL RECORDS, OF THE BUTTE COUNTY RECORDER AND THE COVENANTS, CONDITIONS, RIGHTS, RESTRICTIONS, EASEMENTS, RESERVATIONS, BENEFITS AND BURDENS THEREIN CONTAINED EACH AND ALL OF WHICH ARE HEREBY EXPREDDLY INCORPERATED BY REFERENCE AS THOUGH SET OUT HEREIN IN FULL. -HiC.D0-. ATTACH CHECK . .................. NOTES RESIDENTIAL PERMIT NO. -* t 023457 064=220-006 - LLIS SQU. S, W XLLACE/P M galia' ( of � Guliford Circle, 4 Slcycrest Enterprises New MH Pew Fnd New Site 11 SPECIAL CONDITIONS 11 SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER I JOB FINALED (Date) / v . i Signature h CHECKED BY 4-/-[ -+-63 U i l a J'= OK 0=-NotOK NotApplic. = Not Readyable Card B-1 Date Card B-1 MO ILE 'HOMES Date MOB HOME UTILITIES (Plans) OK except #'s MOBILE HOME INSTALLATION (Plans) OK except #'s 01 Zoning Requirements -Setbacks -Easements Date . 2. Soils; Special MH Support Sketch 3. Gas; MH Test -Demand -Valve -Connector 3. Sewer; Location -Test -Fall -C/O -Concrete (A 4. Water; Location -Test -Easement Needed (Sketch) 6. Water; MH Test -Regulator -Connector • " 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Siding; Nailing -Veneer -Stucco -Mesh 6. Gas; Location -Test -Wrap;-/ /" L 'ft. / P Nat. or / /" L "ft./ P LPG 9. Tie Downs -Type -Installation Cert. 7. Well Clearance & Disconnect Braced Wall Panels 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 Footings; Soils -Size -Depth -Spacing -Connectors -Steel 1. Zoning Requirements -Setbacks -Easements Date . 2. Footings; Size -Spacing -Marriage Line - Date Card 3. Gas; MH Test -Demand -Valve -Connector Card B-1 4. Electricity; MH Test -Crossovers -Breakers -Clearances (A 5. Drain; MH Test -Fall -Flex Connector . /LI 3 9'9k� 6. Water; MH Test -Regulator -Connector • " ,Q 7. Water and Sewer Connected -C/O to Grade -HD Approval Siding; Nailing -Veneer -Stucco -Mesh 8. Gas and Electricity Tagged., ' 9. Tie Downs -Type -Installation Cert. Ext.; Steps -Doors -Landings 10. Exits; Insp.-Sketch Braced Wall Panels 11. Cert. of Occupancy Date - Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) jF&Vng Requirements -Setbacks -Easements tings; Size -Spacing -Marriage Line a5iMH Test -Demand -Valve ectricity; MH Test H Test \ aW and Sewer Connected AOA 6 Onse Decals Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s •1. 1 erify #'s with Office 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Date . G Card B-1 Date Card Date Card B-1 Date., Card -B,9' -I' (A ' uti L VS /LI 3 9'9k� 8. ,Q �o. AOA 6 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; 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-Con nectors 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 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, 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- Enclosures- Panel boards -Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date . Card B-1 J=OK 0 = Not OK Re RESIDENTIAL (Single & Duplex) - = Not Applicable . =Not Ready Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors * 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 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 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 23. Fire Sprinkler; Test Date Card B-1 Date Card B-1 Date , -Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or All Insulated Neutral O Yes O No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. 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 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purl in -Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter: 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post CaDS 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor Cl Yes 83. Following Instld./Drive O Yes Cl No/Walks O Yes O No/Planters O Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House t , 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler 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: INTER -DEPARTMENTAL MEMORANDUM TO: BUILDING DIVISION, OROVILLE FROM: ENVIR. HEALTH, CHICO DATE: CQ RELEASE ENV. HEALTH HOLD ON BUILD G FINAL FOR: OWNER NAME:W Q, SEPTIC: WELL: C -;Q(7 ADDRESS/LOCATION: 4 GI Comments: GL/memos/releasehold �.t \, COUNTY OF„BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County�Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 EERMIT NO. (Rev. 12/96) .w APPLICATION AND PERMIT t/ S ASSESSOR PARCEL NUMBER 0164-220-0061? ZONING 'r BUILDING PERMIT OWNER Squires Wallace and Phyllis TELEPHONE” 521-9723 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 2104 Norco Drive Norco CA 91760 CONTRACTOR'S NAME Sk cre■IMtFnte rise$ 342-2692 TE LEPHONE CONTRACTORS MAILING ADDRESS 13468E 99 Chico CA 95973 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER �' LICENSE NO. Filing Fee' $ 20.00 Permit Fee R^ $ `304-00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan CheckingFee $ BUILD I G D S liford Circle Mattalia uA Energy Plan Checking Fee $ $ r PERMIT FEE $ 347 W LOT NO. SUBDNISIONS NAME -,T. PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 1 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other ' SPECIFv Solar or heat pump water heater 23.00``•-. Water piping 15.00 Each gas water heater or vent 15.00 r ' TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work? New MH Perm Fnd New site Gas piping system 1 - 5 outlets 15.00 tZ Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ X15 oo. ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200AORLESS 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 lass y ,/ Lic. No.� �7�i �.y°, ! ,. OWNER -BUILDER DECLARATION I hereby affiN 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 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' com _ensation insurance carrier and policy number are: Carrier '4 76 7,'" t ! Policy Number ,/!" 34 34 (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 compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. + X___ Date .�',� �r"� - Signage of Applicant :-0 Owner ❑ Contractor ❑ 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. ( a ACC. BLOS. 3.5¢FT_ p1OµgESID. muLTI.OUTLET P7.50 14 POWER APPARATUS a SINGLE OUTLET CIR. 20 EX. OCCU OUTLET OR FIXTURES @ 1'� BAL @ •50 Ex. Occup. o. Ra,O °ERA. 5.C6 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 43.00 MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling�I Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 455,90 HAZ. D. FE IMP ooD CDP pgRCFyr V pp HDA V/ �SSUE� IVworkers' This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. g o o � By t i'�� �'�� `' Date :y - rw p� PERMIT EXPIRES ON Date � Receipt NO. % q al ` d WHITE-O.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �w.�.f'-".r�r•yr�F1'""A�"'�9A.r �1--.�...�,-.^' v-.a.rrv-lv-�"`�i�s'�7+.v�.o��aY•...-�.�•ui,_.•�`uW�'ylr"`+T'�'�'aYV+.lTmrh�+ . COUNTY OF BUTTE'* • BUILDING DIVISION Y DEPARTMENT OF DEVELOPMENT.SERVICES 411 Main Street - Chico, CA'- (530) 891-2751 '- 7 County Center Drive - Oroville, CA - (530) 538-7541 - CORRECTION NOTICE ,. OWNEA 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. 0 104 �I. t i' 3 4. N s i' i DatezgS O Inspecto REV 10/92 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 /A I ✓ c"�— 7�67 O—WN,KR 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 c act this office immediately. Date Inspector REV 10/92 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 OWNER 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. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541, , EMIT NO. ."Rev. 12/96) 1 APPLICATION AND PERMIT ` ASSESSOR PARCEL NUMBER e o ZONING BUILDING PERMIT OWNER Squires, Wallace and Ph llis TE LEP 5219 23 ' SFFr.OCC., BUILDING VALUATION � . OWNERS MAILING ADDRESS ' 2104 Norco Drive Norco CA 91760 CONTRACTOR'S NAME Sk crest_EnterDrises 342-2692 TELEPHONE CONTRACTORS "UNG ADDRESS 13468 E Hwy 99 Chico CA 95973 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Flinq Fee $ 20.00 Permit Fee $ 4 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking'Fee $ 23.00 BUIL?'Jifs GulifOrd Circle Maoali-a CA Energy Plan Checking Fee PERMIT FEE $ $ SA7 -nn LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New .❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: New MH Perm I'nd New site Gas piping system 1 - 5 outlets 15.00 5-.-9 Building sewer 15.00 Mobile Home IS I G W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 800V OR LIES5 Main Service 200AOR LIE SS 23.00 -1 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 f I OTCe and effect. Q/ Q �C'� License Class �� Lic. No. /J ��. / --1 L/ OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the. performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers'npAtion insy� cgrrier and policy number are: Carrier �/9-7 f� a Mein Service TO 46.00so CCU000A WEE200A NEW CONST. DWELLING Occup. OR ADDNS. a ACC. BLOS. so 3.5¢FT; NON-RESIDT' MULTI.OUTLET @7,50 POWER APPARATUS a SINGLE ourLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 Q 1.00 BAL 50 R. Ex. Occup. OFlxuriEis A o) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number is -'9393140 (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 f I should become subject to the workers' compensatio provisions of section 3700 of the Labor Code, I shall forthwith comply wi those provisions. Date ` e of App i nt - ❑ caner ❑Contractor ❑Agent permit is required or excavations over 60" deep and demoliti n or construction POSHA of structures over 3 stories in hei ht. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 4 5. HA2. D. FE IMP CDF PARC PD HD U This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. � 2 Date s� r Dat Receipt No. aeg WHITE-D.D.S.-B.D. CANARY -AS ESS R PINK -INSPECTOR GOLDENROD -APPLICANT -, -r-�Fr: "Y^ Yv ,_�:.. ^R :s+a *7�"'R'F ,"at' •.•-„-r...�.�.- �.z�mr-7�K� w.: a^gym "�'aa sr�.+...-r....,�F:;.-x.•....�...,r-r-vis.p.,,,,. r*n�!.�.-,->w w •�- , - I, D�. Sys COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (53b 5, 8-7541 Fax (530)538-2140 PERMIT APPLICATION IJIWA SHEET OWNER: ASSESSOR PARCEL NUMBER (D 'T a a� U\ Proposed Building Use: Counter Technician: Date: �o� Items required in order to appl for a permit. All boxes MUST be checked OR marked NA in order to apply. . Plot plans, 3 or 4 sets, signedty the preparer of the plans. �—Complete plans, 3 or 4 sets, signed by the preparer of the plans. "'0 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Energy compliance design and supporting documentation in duplicate. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. ❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans„`n triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................ ❑ 9. Plot plan and business license approval from the City of Biggs .................................... ❑ 10. Letter of intent for non-residential buildings......................................................... _ ❑ 11. Detached Accessory Building Form filled out by the owner ..................................... ❑ 12. Hazardous Material Form............................................................................... _ ❑ 13. Other .... Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) u f a-,, [.. ....... 3 �14. Fees as shown on the attached Schedule of Fees Due Sheet...'.. k� < n^� 5. Statement of Intent for Non -heated and A/C Buildings ................................... ... g a Sanitation and plot plan approval from the Environmental Health Depdr me`ntin City of Chico Plumbing permit ...........................................:... California Department of Forestry plan approvaWaid. Sent. b ❑ 19. Planning approval for (A) Use: O i< (B)Parking: (C P el Check: PP ontact Land Development about ❑ Improvements, ❑ Drainage .....................ncroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). re -Inspection for required ................ ontractor's license information. (Number, NUne St le, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. ❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... ❑ 26, Letter of Signature authorization.................................................................... ❑ 2r. Recorded copy of Agricultural Acknowledgment Statement .................................... 08. Manufactured home utility clearance............................................................... ❑ 29. Existing violations and/or expired permits......................................................... ❑ 30. nt Deed`L M,H. Title/Statement of Facts, OI Letter from Legal Owner, C eck to H.C.D. $ 0 �— ❑ 31.t0 her: When issued Telephone -- and hold for pickup. I have been informed of the above item"nd requirements for obtaining a building permit. Applicant: 1. Index#Fr it application for the above it s numbered: moi' Plan Check Letter 2. Additional items required ;on ontrac r, designer, owner, was advised cf th above data by phone, ❑ mail, ❑ counter, by _Date: Z; actor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: IL •✓ Date: L' Z 3� d 3 Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Buildinp,,OiVision ey E.N. USE ONLY Piot Pian Attached deer f411 n A c a Sent Sm G.D. TO: Building Dep menti- _ , FROM: E tal He �� SUBJ --Sanitation-Clearance U I r LA �WCILA,Rc I/ Owner Location AP# Plan Approved fo • Sewage Disposal Water Supply: Public Private Well Clearance forwelling. Other I _a6,0rt� Hold final for. Final clearance 0. NOTE: Environmental 'Health Specialist 8/96 1c) D2Q!�� Date C? '3 � COUNTY OF BUTTE 1. DEPARTMENT OF DEVELOPMENT SERVICES = BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541 SCHEDULE OF FEES DI)E �6 OWNER A.P. # PROPOSED BUILDING USE DATE /.� D— RECEIPT # DATE REC. 1. BUILDING PERMIT FEES Balance Due ....................... $ Additional Fees Due ................. $ Additional Fees Due .......... :...... $ Revised Plan Checking Fee .......��A-a .$*�:" SCHOOL DISTRICT FEES ,^ (paid at District Office) (Available after Plan Check) v!� 3. SHERIFF FEES (paid at Building Division) Residential x $360.00 Units Commercial (sq. ft.) ............... x $0.03 = $ Sq. ft. _ 4. URBAN AREA FEES (paid at Building Division) Residential ................... —x—=$ # Units Amt. Commercial (sq. ft.) ............ —x—=$ Sq. ft. Amt. 5. RECREATIONAL DISTRICT FEES (paid at District Office) (Available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK $89.00 (paid at Building Division) 8. WATER TENDER FEES (Battalion # ) $200.00 (paid at Building Division) 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) IMEG Il . 10):7 At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees may be changed during the plan checking propess. .--,CANT DA I Pursuant tNT overnment Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original - Buiding Div. 2nd Copy - Applicant 3rd Copy - Owner ' (Rev. 6/00) ./TY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75 1� ,Rev. 12/96) APPLICATION AND PERMIT ._......,..... �.....a ww.ocn + b �')V — 006 ZONING , .—// OWNER TrT O" �)) OWNERS 9Z� kUAJNQ ADDRESS Y AITEU!" COMRACTOR'S NAME SKYCRES T ENT " - 342-2694 GDNT TD WPI/ ?% 9 E. CHICO CA 95973 CONSTRUCTION LENDER LENDER'S MNLWG ADORE85 ARCHITECT OR ENGINEER LICENSE NO. ARCHRECT OR ENGINEERS MAIUNG ADDRESS BUILDING ADDRESS 7 t L LOT NO SU NIS N8 NAME PARCEL MAP USEOFSTRUCTURE SF ❑ Duplex ❑ MobilehomeOther sPECIFr TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: N.J-'e ' PLUMBING PERMIT *PERMIT $� S SRA $ SHERIFF $ OTHER $ $ AMOUNT RECEIVED $ 94) *RECEIPT NUMBER4�!W. �- *TO BE PUT INTO COMPUTER 3��y3� BUILDING PERMIT SO. FT. OCC. BUILDING VA PERMIT NO. f 1 L'— n Fireplace Fling Fee 20.00 Main Service Total Valuation $ ��• OR BAL .SO Filing Fee $ 20.00 Permit Fee 46.00 Plan Checking Fee S Energy Plan Checking Fee $ NON-RESID. MULTI.OUTLET / POWER APPARATim . BRANCH S PERMIT FEE i PLUMBING PERMIT Fling Fee 20.00- 0.00 Each Each Trap 7.00 Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W Q20.00 PERMIT FEE I S ELECTRICAL PERMIT Fling Fee 20.00 Main Service 800V OR LEsa ��• OR BAL .SO x. oR LESS 23.00 � Main Service xoaA TO 1000A 46.00 NEw coNST. oR ADONs. OwELLNG occuP. a Acc, elna. 3.50so NON-RESID. MULTI.OUTLET / POWER APPARATim . BRANCH @7.50 Ex. Occup. OUTLET OR FIXTURES 20 ® 1.00 Ex. OCCU ��• OR BAL .SO UTU'FIXED trrlt� os REslo. EA 5.00 Tem2orary Service 23.00 Mobile Home Facilities 20.p0 M Wiring-� ,23.00 "PERMIT FEE MEANICAL PERMIT CHFling Fee 20 00 6.50 PERMIT FEP- I $ Mobile Home5;i6J6 Energy Inspe OCC CONS'� $9��� �.-- ��Z +1^ EL 65UE his permit is hereby issued under the applicable provisions I the Butte County Code and/or Resolutions to do work dicated above for which fees have been paid. By PERMIT EXPIRES ON Date 4".7 •.. School District A.P. Number Property Owner I � t BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) + c Building Department No. Jurisdiction: =,"City County Property Location/Address Subdivision' i • r Residential Development I IFV No of Living MobPfe ome Units Installation Commercial/Industrial New Addition 0 a - .3 1/ Lot No.so lm ................................................................................................................... --f € Sq. Footage / Cp Addition/ 'Supplemental to (Group R) Conversion Permit # _ .................._(No foundation inspection;: 1 Sq. Footage (Including Exterior Roofed Areas) / ;�=/ / k/�? 1% Date (door Planes jreviiewed by School District Personnel) Dis =ct Identification No. � ' vrev Nff School District certifies that (Applicant) 3y2 ztas (Street Address , (Phone Number) CA �V-73 (City) (State) (Zip Code) 7 has complied with the requirements of ResolubonANo. by payment of $ representing / �r square feet. AB 2926 $ r FULL MITIGATION $ School District Representative ' 0 �• ..� Date Paid by Check rr/Il?/ Remarks: U Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 660201a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees' in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (budding department), Pink (school district) feeform.xls (10/98)dmm F r 1 1:2z. Y� - 02/19/2.003 11:14 5303429174 w IC_ r CHICO-BL'DG"SYSTEMS. i PAGE 04 (MENTAL HEALTH B 19 2003 t CALIFORNIA �. N®T�: . The attached, Fire Safe S. the at�aCh�d eireme 5t b 6omWeWd fie- ids 6 j Con, Pequiremenis Pap 15 Cu Jo;r� I z M.H.L-2 ............................ ........................... ........................... ............................ ........................... ......................::::; . Mobilehome Manufacturer: ' - . SKYLINE -ft" I - t ' .2, Manufacture Year:' T i •2002 ' If other than single'wide�furnish Setup Model -Number: / r,. --,c" .', r•.,� P 219CT • T -,, _ Width: 26' (ft.) Length::66'_(ft.) Tagalong, or Expando Size . (ft.) x . (ft'.) , On all mobilehomes manufactured after October 7. 4973, -furnish manufacturer's `< r7. io installation manual and structural setup sheets. FOOTINGS: ] .Other: - dbesc SUPPORTS: Concrete block [X] Other: €121 ' Provide Tie Down Specifications for all Mobilehomes:. 0 i rjoiA . j I 11" �, �1 �!' i i, : i Pier Footings Sizes and Location . . SINGLE WIDE MULTI -WIDE I . Lane 1 se 1 Lane 2 Line 2 ............ ............................ ................................ ...... ! Lane 2 Main Beams Line 2 ..---•.................................................•--.................................. Lane 3 Line i Line 2 ............. .................................... .................. .......................... -r Main Beams Lane 2 ............. ................. .....••................ .......-----.......................... ' Line 1 Lane 5 ............................... Tag or Triple 0i Line a ............................................. , Lane 1 Line 1 Piers: Line 1 Openings: Size minimum: • ; 1' i x : Size minimum: 1- [18.5] x [18.5] Spacing maximum: Each side of openings_ From ends-maximum:with width over: 4' 0" Line 2 Piers: Line 4 Piers: .. Size minimum: 18.5 x [18.51 Size minimum: , ' , x Spacing maximum: - ^ 7' 0" -1 Spacing maximum: From ends -maximum: 2' 0" . From ends - Line 3 Roof Loads: Size minimum: Location (from rear)_ Line 5 Roof Loads_ _ Size minimum: Location (from rear): i,;": t , , - 37x18.5 37x18.5 1914" 387" ,►• 1A- ,_ P219WST6 FNDTN :.. � -�4,1E SUPPORTS: Concrete block [X] Other: : ,, s 1. ' • ; • .1 , Provide Tie Down Specifications for all Mobilehomes::. -in f , + < < 1 , ° ii--. Pier Footings Sizes and Location SINGLE WIDE MULTI -WIDE Line 1 Tart 1 Lane 2 Lane 2� , Lane 2 ........................................ Main Be.... ------............------.. Line 2 Lane 1 Lane 3 ' Line2 i.......................................... .......... .. .............. 3 ---------------------------------------- Main Be...... .................................... Line 2 Lane 1 ............................................. Lane 5 Tag or Triple Lane 4 Lane 1 Line 1 Piers: Line 1 Openings: Size minimum: "i I ]XI I Size minimum: [ 18.5] x [ 18.5] Spacing maximum: Each side of openings From ends -maximum: with width over: 4' 0" c Line 2 Piers: Line 4 Piers: Size minimum: 18.5 x [18.51 Size J ]XI Ir: Spacing maximum: 7' 0" Spacing maximum: From ends -maximum: 2' 0" From ends -maximum: " Line 3 Roof Loads: Size minimum: Location (from rear): Line 5 Roof Loads Size minimum: Location (from rear): 37x18.5 37x18.5 , I - . I I I I I I - I d - 19'4" 387" P21 99M S'TD FNDTN it FP • 11 OPT ME ahiS DOM 9'-B* c REWWM AM ISSUZO ey ONFOMOT� ASSMSO&Ij SERVIUS MAR I i 2002 OAM - UNDEWMWERS "Bo"n ciiiis. wc. 7 ,,-,,:OPI WNTY IT/A I OPT IMAM FU 101 9321 VOL SEC 4 ILL Si PC, 6-76N 30# CENTERLINE SUPPORT REQUIREMENTS WAIN BY YM THIS MT IS TO' BE INSERlED NTH SUPPLEMENT TO FIELD INSTALLATTON MANUAL FOR UAIE':. W/04/m .30# ROOF ZDW SNOW LOAD. SEE ABOVE PRINT FOR LOAD REQUIREMENTS AND LOCATOS 30) mw 776626-XK-2B-CATH P219 -CT OPTION 4TH BEDROOM APPROVED Butte county muffly UP I 1UN UUUK E D lowI{" I Illi■fli■■ ■1 I 1■■■■f■■■■if■iM_�■r ■■ =■I ■■■■■■�� I■■■■■■■■■■■f■■■■■■■f�■ `i■■ ■I ■■i■► -1 I � • � � It■■i■■■i■fi■flit■■■■►■ i■' ■I ■ S1,11 1■■■■ ■■■ff■■■■f0■■■■■■■i■■iil ■ ■■rl■■■■ 1 �'1■■tf■■■■moi■■■■■■■■■l---:I■■■� ■ ■ 1■■■ ■■■■■■ ■■■ 'i I I■r \■ ■■■■■ ■■tf■ ■f■f0■ ■■f�illft•1■I ■■■�■ 1■■t■ ■f■9f■ 1 ■■■■■■�aGl Irrl ■tI■.\ i■NINE ■■t■■■i■■■■ 1■■■L i�--a. ■%■■11■■■iff■■■■iff■■ 1■■■■11■iI■ffr■I •---■ `■■■■ff■f■■■■f■■ 1■f■ft■Itfi■Itfl ■■■■■■f■■■■■■' It■■■ ■ft11■I �■■■r-------- 1■■■■�f■llfl ■t1,. 111\'x` tf�tl !sfsi-ssssaalvoi LlMASTER . •�t i 60 iQftLI i i .9maii,■■■■■ La !A ■ is■i ■■ -r�f■■■ • ■ -■■ - illiopen : ■ r • 14' C 8 202 hico, Califomia OPTION 1/2 BATH CDF FIRE SAFE REQUIREMENTS AP# PERMIT # NAME Under authority of PRC 4290, the following checked items are required by the Butte County Fire Department and are made a part of this permit. -These requirements are minimums and will be superseded by Butte County local regulations which equal or exceed these standards. Field inspections will be made by the Butte County Building Department for compliance. (] 1272.00 Maintenance of Defensible Space. To ensure continued _1 maintenance of properties in conformance with these standards and measures and to assure continued avail- ability, access and utilization of the defensible space provided for in these standards, annual maintenance must be provide for by the land owner. Driveway Standards 1273.02 Surface. All driveway surfaces and structures (bridges, (� 1273.07 culverts and other appartezant structures which supple- ment the roadway bed or shoulders) shall provide unob- structed access to conventional drive vehicles, includ- ing sedans and fire apparatus weighing up to 40,000 pounds. �4 1273.03 Grade. Not to exceed 16 percent unless paved. 1273.04 Driveway Radius [ 1. No roadway shall have a horizontal inside radius of curvature of less than 50 feet and additional sur- face width of 4 feet shall be added to curves of 50- 100 feet radius; 2 feet to those from 100-200 feet. [�1 2. The length of vertical curves in roadways exclusive of gutters, ditches and drainage structures designed to hold or divert water shall be not less than 100 feet. [ 1 1273.05 Turnarounds. If required, will have a minimum turning radius of 40 feet.from the center of the road. ] 1273.05 Turnouts. Shall be a minimum of 10 feet wide and 30 feet long with a minimum 25 foot taper on each end. 1270.10 Width. All driveways shall provide a minimum 10 foot traffic lane and unobstructed vertical clearance of 15 feet along its entire length. Page 1 oatf .3--, 6 0 � 02--- 34E, . . '�au tetZS 4 h)AIAr-6 AP # PERMIT # NAME [�] 1273.10 Turnouts. Driveways exceeding 150 feet in length, but '1 less than 800 feet in length, shall provide a turnout near the midpoint of the driveway. Where a driveway exceeds 800 feet, turnouts shall be provided no more than 400 feet apart. [�] 1273.10 Turnaround. A turnaround shall be provided .at all building sites on driveways over 300 feet in length and shall be within 50 feet of the building. 1273.11 Gates 1. Gate entrances shall be at least two feet wider than the roadway it serves., [� 2. The gates must be located at least 30 feet from the .roadway and shall open to allow a vehicle to stop without obstructing traffic on that roadway. Ar, LN 3. Where a one-way road with a single traffic lane provides entrance, a 50 foot turning radius shall be used. Fuel Modification n 1276.01 Setback for Structure Defensible Space. 1. All parcels 1 acre and larger shall provide a mini- mum 30 foot setback for buildings and accessory buildings from ul] property lines and/or the center of the road. [v I .2. For parcels less than 1 acre, local jurisdiction shall provide for the same practical effect. See Other Requirements below. 1276.02 Disposal of Vegetation and Fuels. Disposal, including chipping, burying, burning or removal to a landfill site approved by the local jurisdiction, of flammable vegetation and fuels caused by site development and construction, road and driveway construction and fuel modification shall be completed prior to completion of road construction )r fi_ial inspection of a building permit. Page 2 of 3 AP # •PERMIT # NAME Other Requirements [ ] If Building Setback is 15 to 30 Feet: - Class A or B roof - Enclosed eaves [ If Building Setback is Less Than 15 Feet Choose any 3 of the"following: - Metal or no'doors on side toward property line with insuffi- cient setback - Class A or B roof with enclosed eaves - Interior automatic sprinkler system per NFPA 13D - Glass area not to exceed 10% of wall area toward property line with insufficient setback - Siding from the following list: l Stucco -•3 coat Hardi-Board or Plank Masonry Masonry veneer Metal Other Butte County Fire Department approved materials Date Signature, Page 3 of 3 } r 01/23/2003 14:23 5303429174 CHICO BLDG SYSTEMS PAGE 01 ro�Cousin Gary's Homes 13468 Highway 99� Chico, CA 95973-9479 dba Chico Building Systems To: P-1 110-01 ze Phone: Fax: CC: Date: Number of pages Including cover sheet: From: (2, Phone: (530) 342-2694 Fax: (530) 342-9174 Remarks: () Urgent () For Your Review () Reply ASAP () Please Comment �O /l N �/� w hie 3v5taq 01/23/2003 14:23 5303429174 lY AI C I :F l=6J0.' c7j c< m a) 4L CHICO BLDG SYSTEMS PE PAGE 02 1 7 gin 01/23/2003 14:23 5303429174 CHICO BLDG SYSTEMS :;=g 0. c7j c< m Aae (lo PAGE 02 Flo BUTTE MINTY - o'"WADIN"loG DEPARTMENT AFFRONED 02/25/2003 11:57 5303429174 CHICO BLDG SYSTEMS PAGE 01 Cousin Gary's Homes 13469 Highway 99 Chico, CA 95973-9479 dba Chico Building Systems To: Phone: Fax: CC: Number of pages Including cover sheet:. From: Phone: (330) 342-2694 Fax: (630) 342-9174 Remarks: ( ) Urgent ( ) For Your RevleW ( ) Reply ASAP ( ) Please Comment R ENCROACHMENT PERMIT County of Butte Department of Public Works 7 Count Center Drive Oroville, CA 95965 Phone (530) 538-7157 Ext. 2016 Fax: (530) 5384356 Download Forms: www.buttecounty.net/publicworks/forms.htnl NOTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE Phone (530) 538-7157 Ext. 2016 Permit Number Q 300 749 District APPLICATION I / WE, the undersigned, hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads and highways, all in accordance with County ordinances and general laws. All information except signature must be typed or legibly rinted. 1. Applicant's Name: 11azz en 1 a. Company Name: 2. Address: 3. Phone: 4. As;sqos Parcel Number 5. Location of Work to be Done 6. Applicant's Signature 7• Date: CONTRACTOR'S INFORMATION 8. Contractor's N 9. Address 10. Phone: _ Q 11. Fax: 12. Contractor's License Number� 13. Cern tate of Insurance: Yes B --NO: ❑ 14. Contractor's Sign 14a. Date Si 15. Authorized Agent -- T,ATE OF WORK TO BE DONE 16. Please Check: Curb: ❑ Gutter: Sidewalk: ❑ 17. Driveway (List Type): C/ _ `PERMIT P. Other: GRANTED In compliance with the above request, and subject to all terms, conditions (including those on page 2 of this permit form) and special conditions written below, perrrussion is hereby ted. 19. Conditions H C✓ A K o R TO VNn CL Pro e-- Pr. T an n.. o tV� Bo 12 o u 04 D Underground Service Alert .SA. must be notified two working days prior to any excavation. 800-227-2600 20. XAU work shall conform to accompanying: Detail kK Plans 0 Special Conditions �O 21. Date Issued Z 22. Expiration Date: )O 23 Surety- , �S Mike Crump, Director of Public Works By: ** Note: If permits are faxed to any number besides (530) 5384356, they can be delayed up to one wok. Page 1 of 2 General Conditions — See Page 2 TO LARRY PAINTER RETURN TO au00 ER ML SITE PLAN REVIEW APPLICATION Date: AP# C� iaLi 22--�-' 0 © tp7 • Permit Number (if applicable) D 2-- 3 H 5 S APPLICANT INFORMATII,ON Parcel Size: Owners Name: {�(0� Address: f) kI.a (.A"C S l� Yt • I —I D+ °� I �i�11 tP� ° lc1 Telephone No. Situs Address: C= « I l-CT�(�, C p; Proposed Use: Residential ' New Single Family Residential ❑ Single Family Addition ❑ Single Family Remodel ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family - - • ,-Non-residential ❑ New Commercial ❑ Commercial Addition ❑ Commercial Remodel ❑ New Industrial ❑ Industrial Addition ❑ Industrial Remodel Other Septic ❑ Well ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary):. DO NOT WRITE BELOW THIS LINE DEVELOPMENT SER VICES INFORMATION (For Staff Use) S Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ® Snow Load Area: -r O -J'T _ • ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) 0 SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See attache ) • Flood Zone: • Flood Panel No.:C3 �-j p -p '� Index Date: 6 – ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance -------------------------------_------------ ---______--__------------------- ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: — Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 • • Zoning Code Streets & Highways Fire Prevention Subdivision Map Front 2.0 G -J 1 L_ Fo p.1� d 12 G L Side Side Street 2.� (_ T y LC—� GT Rear Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 • • Applicable Developuient Fees: Water Tender ❑ Standard Fees Amount F-1 • Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other -------------------------------------- Subdivision Map Special Fees Formula ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other•(per map) * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By. •❑ .Deeds: A Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained'Road: . ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: - n U .i ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel - ❑ Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 12 Subdivision Map/Parcel Map: PAq-AD *, S S F1A> pS Map Date of Recording: Lot: ) to & ❑ Use Per Use Permit Permit Number: Book: 3 Date of Approval: Page: 38)L • Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control P must be prepared by a registered civil engineer or other qualified professional and go submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender. Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for roa ❑ • Page 4 of 5 Summary of Speck Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 ' - ' son - ■ ■ I NONE NEM MME E No ■ ME MENEM No 0 ilimmom NMI IMEN No ■ ME MOMMEM MMmMmmmmMMmMMM Ml MEN NONE ■IN MEN M ■ Ml MMME No NEONMEN moms■■ 5 ONE■ mm immoo ENRON Sm a ME M millimpassmas 0 man ■ ■ ■ 0 ■ NN EE t���NNER I SEEM MEN M 0 w ■��.■ En momm"Ev 5 0 EN Ni■N■ NN\ ■MEMNMENE■ Immill e 9 0 0 N. MEMEMO ■O ONEa0RAMENEMIMMEN WEENEM ONE ■15 so IN .1111 muilil mmas HEIM MENERERMEM MOON MENEM ■ 0 0 IIIi NEON ■MEMO NEN■ MEN OEM IVINUMEENHUNIVA INEME n■mummam so 0 MON FEE M MEMO N MEN No asamems 0 ME 90- MMOMMOMEMEN mmmmummm u 0 ME 0 m rd ■E 0 Effillimmuorl�NE_BE m Emumm MENEM u im ■ME ■■■■■E on on, ON �■NONE M MEN 0 I CLAIMANT: ADDRESS: CITY & STATE: DATE OF CLAIM: County of Butte Oroville, California GENERAL CLAIM REO-1VE,p j+JTTF C MINT y. 03 FEB 20 AN 1/: 35 Sky Crest Enterprises *JLi'U.a CON n()LLER 13468 Hwy 99 East - - `—IMPORTANT: Chico, CA 95973 SEE INSTRUCTIONS ON REVERSE SIDE 1/30/2003 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY AMOUNT Reason for the Over payment Refund: Blag Permit App No.: 02-3458 AP No: '064-2207006 Receipt No.: 369438 Receipt Date: < 12/18/02; Bldg Permit Fees: Owner's Name: Wallace Squires TOTAL FEES PAID: $234.14 TOTAL FEES RETAINED (Breakdown Below): $187.14 Building Permit Filing Fees: Plan Checking Fee: Plumbing Permit Filing Fees: Energy Plan Checking Fee: Electrical Permit Filing Fees: Refund Processing Fee: Mechanical Permit Filing Fees: Inspection Fee: SRA Fee: $47.00 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claimistrue and correct as stated Dated this day of, 2003, at �L Calif. , ice_ Signature of Otaimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above hav performed or delivered and that there is a Budget Appropriation or Specific oar oval (Che k�one) for the same. s Fes Dated this day of F 2003, at _Oroville Calif. Departm4ht Head or Authorized Deputy Dept. Code 440-001 Exp. Code 4210500 PAYABLE FROM Construction Permits FUND Dept. Code Exp. Code PAYABLE FRO FUND Dept P Exp. Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT & SUB. PROJ. SUB. OBJ CLAIM NO. INV. NO. INV. DATE ENCUMB GROSS AMT. , Oct PILE COPY County of Butte 66VWT Oroville° California 03 F.E3. 14 GENERAL.CLAIM �� �1. 32 CLAIMANT: Sky Crest -Enterprises E� F ADDRESS:- - . 13468 Hwy 99 East IMPORTANT: ciTYj i,sTATe Chico, CA 959.73. SEE�INSTRUCTIONS ,...:. ' ON REVERSE SIDE. DATE OF CLA[6:. a'• .. 1/30/2003 ' SUBMIT-CLAWTO'DEPARTMENT R4FCEIVING GOODS OR SERVICES DATE ,, 5 DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY) AMOUNT :Reason for the a'r xa �� 3 cr i °ksf c: ra;:rttr,tis 1 a z a k I r 'red x ......x� RQfU t1 d .. , w...t—,IMF EsIcig Pe No.: ;,02�3�45$,�;k � � �� �P No:�®64�2�2;�0, 00:6.:�...�.��•,:���� ' Receipt No.:369438 & I4 Receipt Date ;,�2=/1$/02,; Bldg Permit Fees: PH Owner's Name: 1�IfaCn@gUlfe�Si"�Ii�n TOTAL FEES,PAID: $234.14 TOTAL FEES RETAINED (Breakdown Below): $187.14 x� Building Permit Filing Fees , Plan Checking FeeME Me° Pluivtbing`.Permit Filing Fees�� Energy Plan Checking Fee: �g£;� 2 6 %� �k ,x L As Electrical Permit Filing Fees ,: w SEEM, �l Refund Processin Fee: ' � ' BU li E GOU�I `%giPIgig.`f g,; z 14U01TOR �#z. . Mechanical Permit Filing Fees:,��, IAF lnspection.Fee:`t` i,z,.. SRA' Fee::. ° $47 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true'and correct as stated . /oo Dated this / day o, 2003 at 3���(90`1l� Calif: �— Sig natur of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above h erformed or delivered -and thatch re is a - Budget Appropriation or Speci c Bo oval.( k one) r the same. Dated this' day of 2003, at_Oroville Cali ~ ' Departmen Head or,Authorized Deputy Dept. Code' 440-001 Exp: Code . 4210500 PAYABLE FRO Construct' u*Permits FUND. Dept: Code Exp. Code .PAYABLE FROM FUND Dept: Code Exp. Code • PAYABLE FROM ° FUND NfIT WRITE RCif1\A/ TLJIC 1 u!C w u °a DEPT & SUB; 1.S/D00 % PROJ. SUB. OBJ CLAIM NO. O S 'INV. NO.; I INV. DATE ENCUMB GROSS AMT. 7, OZJ— CLAIMANT: Sky Crest Enterprises FILE ' C®Py County of Butte Oroville, California GENERAL CLAIM ADDRESS: 13468 Hwy 99 East IMPORTANT: CITY & STATE: Chico, CA 95973 SEE INSTRUCTIONS ON REVERSE SIDE DATE OF CLAIM: 1/30/2003 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELA AMOUNT Reason for the Ove,payment .. Refund: Blog Permit App :- No.: 02=3458; ;:..: AP No. :064,. 220 00:6" - Receipt No.: 369438 :.' Receipt Date ,:; 1 ZIP 8�Q2 Bldg Permit Fees: �. 0. „`.. Owner's Name: Wallace `Squires TOTAL FEES PAID: $234.14 TOTAL FEES RETAINED (Breakdown Below): $187.14 Building Permit Filing Fees: u Plan Checking Fee: Plumbing Permit Filing Fees ,,: Energy Plan Checking Fee: Electrical Permit Filing Fees: # ` Refund Processing Fee: = Mechanical Permit Filing Fees: r Inspection Fee:ff r SRA Fee: $47.00 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated Dated this �, day of • 2003, at d'F%Ll i �L Y Calif. Signature of p aimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above hav performed or delivered and that there is a Appropriation or Specific oar oval (Ch ek�one) for the same. / 4 �Budget Fes s Dated this day of 2003, at _Oroville Calif. Departm96 Head or Authorized Deputy Dept. Code 440-001 Exp. Code 4210500 PAYABLE FROM I Construction Permits FUND Dept. Code Exp. Code PAYABLE FROld FUND Dept. Code Exp. Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT & SUB. PROJ. SUB. OBJ CLAIM NO. INV. NO. INV. DATE ENCUMB GROSS AMT. NOTES RESIDENTIAL F , t PERMIT NO. 064'-220=006 ' ; 02-3458 t ' Squres 'Wallace 4 `� G'ulif&tl Circle, Magalia 22 X,22 Garage , i cR) I f } SPECIAL CONDITIONS CHECKED BY } SRA a FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER 1 Wo 0 C� lGriGt OFFICE COPY f FA i D Date f JOB FINALED (Date) Signature 66,4 i - J - OK 0 = Not OK . = Not Readyable Soils; Compaction -Structure Stability MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s Elec.; Receptacles and Lighting, Distance-GFI 1. Zoning Requirements -Setbacks -Easements 6. 2. Soils; Special MH Support Sketch 7. 3. Sewer; Location -Test -Fall -C/O -Concrete Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panelboards-Ins. to Main Conduit 4. Water; Location -Test -Easement Needed (Sketch) 10. 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Lioht Niche 6. Gas; Location -Test -Wrap;-/ /" L 'ft. / P Nat. or/ /" L "ft./ P 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. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECK - O RS, CARPORTS, GARAGES (Plans) OK except #'s Ljoo.ZoKifia Requirements -Setbacks -Easements ootings; 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 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- Enclosures- Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Lioht Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s . 1. Zoning -Setbacks -Easements -Flood -Slope 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 57. Siding -Nailing Veneer 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 60. Shear Walls; Nailing -Bolts 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 63. Infiltration -Walls -Windows 11. Water Pipe; Test -Anchors -Regulator -Service Test Date 12. Electric Underground FINAL (Plans) OK except #'s 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 15. Access & Ventilation 16. Insulation 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails Date 71. Fireplace or Stove, Clearance -Hearth Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date 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 80. Insulation -Foam -Looked in Attic 22. Gas Pipe; Sixe & Anchors 23. Fire Sprinkler; Test Clearance Looked under Floor ❑ Yes 83. Following Instld./Drive O Yes 0 No/Walks O Yes 0 No/Planters 0 Yes O No Date 84. Stucco Brown -Finish Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 90. Glass Protection 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 93. Water & Sewer Connected -C/O to Grade -HD Approval 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 96. Fire Sprinkler 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al Date 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes O No Card B-1 Date Card B-1 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. 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 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth _ Clearance Looked under Floor ❑ Yes 83. Following Instld./Drive O Yes 0 No/Walks O Yes 0 No/Planters 0 Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler 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: " ,CODUTY OF -,BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 Cdunty'C6nter Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 1) e Li S ASSESSOR PARCEL NUMBER - ZONING BUILDINGPERMIT OWNER r N4 ' A, a — i` f J TELEPHONE _ SQ. FT. OCC. BUILDING VALUATION 11 7 OWNER'S MAIUNG ADOR SS L CONTRACTOR'S NAME sed 342-2604 TELEPHONE ' CONTRACTO 5 MAAWNG ADDRESS A Q E clju)05971 CONSTRUCTION LENDER - - ... Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 109,00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING DRESS % . ! I,. , ,� -. X Gulifard C' 1 Q Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDNISION'S NAME PARCEL MAP PLUMBING PERMIT Fling Fee Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other Qara$e SPECIFY Solar or heat pump water heater 23.00 Water piping15.00 • Each gas water heater or vent 15.00 TYPE OF WORK New X61 Addition ❑ Remodel ❑ Utilities ❑ installation ❑ Other ❑ Describe Work: 22X22 garage Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I WF__ 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 600VOR LESS Main Service 2o0A 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.POWER License Class f,' _ Lic. No. I i s .: 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. SO OR ADDNS. a Acc. eanS. 3.50Fr. NEW pESID. T. BRANCH MULTI -OUTLET 97,50 APPARATUS a SINGLE OUTLET CIR. OUTLET OR FIXTURES 20 @ 1'00 Ex. Occup.BAL @ .50 Ex. Occup. OFIx 05 Aa ) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ -q4 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers compensation insurance carrier and policy number are: Carrier '- MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number �/_J, Z bO %Jlr. (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 comply wit those provisions. Date �--- = ���/ Signature of Applicant -/_ ❑ Owner ❑ Contractor ❑ Agent/ An -OSHA permit is required fol excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 187.94 HA2. ..... D. FEES IMP �., FLOOD COF PAR ppJ HDI ; IJ ISSUE j This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. ! 1 �7 :71 By � � ��r Date �l S� PERMIT EXPIRES ON r Date Receipt No.T� ,Q''`L;/. 1 / WHITE -0.D.S.`-B.'. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Sent By: BUTTE CO ENVIRONMENTALHEALTH; 530 895 6512; TO: FROM: all Apr -17-03 9:43AM; Page 2/2 9108 Phe Amarnd Plam PI" A %i 0001 V 4.Q. 11: w Building Dep,41�t l 1C; � 1 E�vlrpnmental H�h��_�__ , Sanitation Clearance jao cam n Location AP# Plan ApproveddfoE; Sewage Disposal Water Supply: Public - Private Well tA Clearance for„ iiwelling. Other _ \c1► rY, r-r� G,O (. ►n �{� �d �.n rip, 'Mold final fpr: 1 Final clearance Ok for: NOTE: Environmental 8/96 Specialist 911-7)66 `�- 1'(;c0_,le Date COUNTY OF'BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 220-006 1 ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION 484 11 2,719-n .OWNERS IUNG ADDRESS 91n9 Norco Dr-i-i.re- Nor C4 Q 1764 -on CONTRACTOR'S NAME rises; 342-269A TELEPHONE CONTRACTO S MAILING ADDRESS '' n 99 E czhi-an C,4 9-5973 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Felin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING DRE S GuZ-ford Circle Maaal$ Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling ee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other garage SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New )C] Addition ❑ Remodel ❑ U61'Ities ❑ Installation ❑ Other ❑ Describe Work: 22�" 22 o rage Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 800VMain Service A 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 f l force and effect. License Class -� Lic. No. IW I?3D OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, 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. DW EWNG OCCUR OR ADDNS. ( a ACC. S. SO 3.50: NON-R61D. MULTI -OUTLET 97,50 POWER APPARATUS B SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FDCTURES 20 @ 1.00 SAL @ .so Ex. Occup. oUTLEEDTSA EsID I AEA, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ Qr, QA WORKERS' COMPENSATION DECLARATION I 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. 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' cim�Tnnsatir insu�nce carrier and policy number are: Carriers r j' Policy Number ZIT 3 (The above sections need not be completed 0 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 should become subject to the workers' compensate provisions of section 3700 of the Labor Code, I shall forthwith comply wi those provisions. X Date Sre of AppTcnt - ❑ ner ❑ Contractor ❑ Agen SHA permit is required f excavations over 60" deep and demolition or construction of structures over 3 stories in he'ght. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Mobile Home Installation Fee Is Energy Inspection Fee $ occ CONST. TYPE TOT L FEE $p HAZ. D. FEES IMP FLOOD CDF PAR L H is?, E This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date Defe rReceiptN0-7?,&0 ITE•D.D.S.• C N ASS PINK -INSPECTOR GOLDENROD -APPLICANT -A ...A:I y ...`7 'r!7.r� i.a n ;')<Tf 7' {j�R'i(r{PVtl�.1i^l y'1^.( '..t�a[:r•fi> 1y', �V '7' :f. r.�w ,..F � . ;TT .a l{or" 'AA T T` COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)58-7541 Fax (530)538-2140 PERMIT APPLICATION ARTA SHEET a OWNER: j ASSESSOR PARCEL NUMBER /tp 9 - D- ,a - 6 Proposed Building Use:in 'd qzn,-Counter Technician: C/7``�F Date: �.x ^,/ g".' Items required in order to app or a permit. All boxes MUST be checked OR marked NA in order to apply. 1.. Plot plans, 3 or 4 sets, signed�y the preparer of the plans. . Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Energy compliance design and supporting documentation in duplicate. ❑ 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. ❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate.... ❑ 9. Plot plan and business license approval from the City of Biggs....... ❑ 10. Letter of intent for non-residential buildings ............................. ❑ 11. Detached Accessory Building Form filled out by the owner......... ❑ 12. Hazardous Material Form... ----. . . . ... . . . _ .......... _ . ❑ 13. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 4. Fees as shown on the attached Schedule of Fees Due Sheet ....................................... NZ r7. ement of Intent for Non -heated and A/C Buildings ...................................... ,...... itation and plot plan approval from the Environmental Health Department in of Chico Plumbing permit.....................................................................ifornia Department of Forestry plan approval aid. e, OV ��IP. ..,?? . -., IVX? nning approval for (A) Use: Q � (B)Par tng: (C) Parcel Check: ❑ AO. Contact Land Development about ❑ Improvements, ❑ Drainage ............................... 21. ncroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 22. Pre -Inspection for required ................ ❑ 23. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. ❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... ❑ 26. Letter of Signature authorization.................................................................... ❑ 27. Recorded copy°of Agricultural Acknowledgment Statement .................................... ❑ 28. Manufactured home utility clearance............................................................... ❑ 29. Existing violations and/or expired permits......................................................... ❑ 30. ❑ Grant -Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 31. Other: When issued Telephone and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant: /—A.—Date: 1. Index, ermit application for thea ve items nu ered: Plan Check etter L Ad ' 'onal items required 2d designer, owner, was a ove data byF gr phone, ❑ mail, ❑ counter, by — Date: Contractor, designer, owner was advised of the ab ve dat by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: 0:00 Date:. Plans approved by: Date: b3 Structural reviewed by: Date'l Structural approved by: Date: Note transfer by: Date: Yellnw' Rnildino Nvicinn COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7, County Center Drive Oroville, California 95965 • Telephone (530) 538-7541 P MIT NO. (Rev.IZ/96) APPLICATION AN-D-PERFA `I' — ASSESSOR PARCEL NUMBER zowNo 1 BUILDING PERMIT TeLePNONe S0. FT. OCC. BUILDING VALUATION Q+ws+v ADDRESS 0 / _ - - ' 1 SKYCREST ENTERPRISESa+rrnDNe 342-2694 DDS, MAIINO ADDRF9S RICO CA 95973 CONSTRUCTION LENDER LENDER? MAIUNo ADORE" Fireplace ARCNYrF.CT OR ENGLNEEA Total Valuation a LICENSE No. Filin Fee �� OR ENGINEER'S�� ADORE" Permit Fee 5 20.00 �— b auaowoAooREaG L�Ae24 C7,e /�d` Plan Checkin Fee Energ Plan I S Nie Checking Fee S A� b ' 1DT w.� %ptp °18°'VeiD1+ PARCEL NAP PERMIT FEE S PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE Each Trap 7.00 SFO Duplex O Mobllehome Other �. ,p Solar or heat um water heater �0 C s Waterpipingt _ 5.00 TYPE OF WORK Each as water heater or vent 15.00 � Now CC�YAdditxxt Remodel ��atiOn O Other O Gas I In stem =5 outlets 15.00 Describe Work: Bulldln sew 15.00 _ �( "-;1 Mobile me S G W I 920.00 PERMIT FEE T ELECTRICAL PERMIT Filing Fee 20.00 r—T�---+- �(NO Main Service •OOV OR LEss 200A OR LESS i ! 23.00 � Main Service 200A TO 1000A DDMB DWE1I OCCUP. 46.0 I �� OR ADDNS. 1 ACC. BLDG. NONae MD. MULTFOUTLET 3.5¢81°. Q7.50 POWER APPARATUS 1 g *PERMIT $ 02 7 � Ex. Occup. ourtEr OR FIXTURES HXED ew ®r_3 Ex. OCCU ��. oR o ResiD. EA. Temporary Service 5.00 23.00 SRA $ i Mobile Home Facilities _ I 20.00 Mlac. Wiring r 23.00 SHERIFF $ PERMIT FEE _ MECHANICAL PERMIT Filing Fee 20.00 OTHER $ Hentin Coollngq Hood 8.50 $ Ventilation — PERMIT FES ! $ $ Mobile Home Installation Fee I b Energy Inspection Fee 5 AMOUNT RECEIVED $occ CONST. Type 1 TO 'L FEE 3 RQ. D. FEES i P FLOOD COF EL ✓ i � This permit Is hereby Issued under the applicable provisions *RECEIPT NUMBER �� Of m9 Butte County code and/or Resolutions to do Work Indicated above for which fees have been paid. *TO BE PUT INTO COMPUTER By Date PERMIT EXPIRES ON /^wro/ — — I County of Butte Oroville, California GENERAL CLAIM CLAIMANT: Sky Crest Enterprises 9 ADDRESS: 13468 Hwy 99 East IMPORTANT: CITY & STATE: Chico, CA 95973 SEE INSTRUCTIONS ON REVERSE SIDE DATE OF CLAIM: 1/30/2003 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY AMOUNT Reason for the Over payment s Refund f -..:.: Blog Permit App �. Y n No.: 02` 3:458 AP No 1064, 220 Receipt No.: 369438 `,. Receipt Date „ .12/1:8./,02; Bldg Permit Fees..;. Owner's Name: ��/a1lace:Sr TOTAL FEES PAID: $234.14 .'... ` TOTAL FEES RETAINED (Breakdown Below): $187.14 ' Building Permit Filing Fees i' ` :: Plan Checking Fee ac % Plumbing Permit Filing Fees }G: Energy Plan Checking Fee: Electrical Permit Filing Fees '_� ,, ::, r ...;"?.,.,.. Refund Processing Fee: S Mechanical Permit Filing Fees Inspection Fee. SRA Fee 47.00 ............. ....... . I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated Dated this day o2003,at Signaturotf Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above h erformed or delivered and that th re is a Budget Appropriation or Speci c Bo oval ( k one) r the same. /y� Dated this day of 2003, at _Oroville Cali . Departmen Head or Authorized Deputy Dept. Code 440-001 Exp. Code 4210500 PAYABLE FRO Construct' n Permits FUND Dept. Code Exp. Code PAYABLE FROM FUND Dept. Code Exp. Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT & SUB. PROJ. SUB. OBJ CLAIM NO. INV. NO. INV. DATE ENCUMB GROSS AMT. FOR BUILDING DIVISION USE ON Receipt Information: Number: Date:- . o rbl- Issued To: Amount: Fees Retained: BP#®- 3y56' BP# Processing Fee: $ Processing Fee: $ Bldg Filing Fee: $ Bldg Filing Fee: $ Plbg Filing Fee: $ Plbg Filing Fee: $ t t Elec Filing Fee: $ Elec Filing Fee: $ Mech_ Filing Fee: $ Mech Filing Fee: $ Energy P/C Fee: $ Energy P/C Fee: $ Plan Check Fee: $ Plan Check Fee: $ Inspection Fee: $ Inspection Fee: $ SRA P/C Fee: $ SRA P/C Fee: $ Other: $ Other: $ Total Amount Retained: $ TOTAL REFUND DUE:$ 4 $ Amount from 440-001 $ Amount from $ Amount from $ Amount from $ J:\My DocumentAREFUND CLAIM APPLICATION.doc 12/17/02 °OUTrF0 , Butte County Department of Development Services Building Division ° ..r *.. o.. ° UN �y REFUND CLAIM APPLICATION REQUEST FOR REFUND Refunds can only be made upon written request by the person who paid the fee(s). The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing 'fees, plan check fees for work plan checked are not refundable. Fees paid to other County Departments are not covered by this claim. [Butte County Code Section 3-41(t)] CLAIMANT'S NAME: MAILING ADDRESS:01 ASSESSOR'S PARCEL #: tp _CSO l4 BUILDING PERMIT # RECEIPT NUMBER(S): A request for refund of fees paid on the above receipt number(s) is for the following reasons: Please refund any applicable fees in the following categories: (Check those fees which you wish to have refunded.) ( ) Building Permit Fees ( ) Sheriff Fees ( ) SRA Fees (CDF Fire Planning) ( ) Other (specify): Disposition of Plans: ( ) Plans returned to me at counter ( ) Please mail plans to me at above address ( ) Please dispose of plans Signature Date A COUNTY OF BUTTE GENERAL CLAIM FORM WILL BE MAILED TO YOU FOR SIGNATURE AFTER REVIEW BY BUILDING OFFICIAL. J:WIy Documents\REFUND CLAIM APPLICATION.doc 12/17/02 CLAIMAN' ADDRESS CITY & ST % COUNTY OF BUTTE Oroville, California ' GENERAL CLAIM DATE OF CLAIM: / — -�24 l -=/- SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES IMPORTANT.• SEE INSTRUCTIONS ON REVERSE SIDE DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TOAVOID DELAY) AMOUNT .. TOO k �' — GO , TOTAL '. the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. 11 Dated this day of , 19_, at . Calif. Signature of Claimant 1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and .hat there is a Budget Appropriation ( ) or Specific Board Approval ( ) (Check one) for the same. sated this day of , 19_, at Calif. Department Head or Authorized Deputy ept. Code ?ept. Code rept Code Exp. Code PAYABLE FROM FUND Exp. Code PAYABLE FROM FUND Exp. Code PAYABLE FROM FUN DO NOT WRITE BELOW THIS LINE • AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT.