HomeMy WebLinkAbout064-230-010s
- n _ �4J - _� .,,;fir-' �".• _. _ -
64-23=1
' MP;s"
FOX, Pete ' .R•'3
c14765 Carnegie Rd,'Ma:galia*'
Griew
1ji v •��v.,
. ` 64-23-10
Permit#67 91P,
`(lpg serves e dual pak/s'f).
"064=23'0=010;• '92-3569P
♦ ,i
ROUNDTREE, Nathan
14765 Carnegie,.Rd;"Paradi'se-
(sf/gas'to ,dryer),:,,,Contr:Art Stone Plmb-
064-230-010 KrV 064236
ROUNDTREE, NATHA
14765.CARN I {
Cont: GREE r; F f w
RE ROOF 1 sY mfr *c�`ty t
,F
I
s
- n _ �4J - _� .,,;fir-' �".• _. _ -
64-23=1
' MP;s"
FOX, Pete ' .R•'3
c14765 Carnegie Rd,'Ma:galia*'
Griew
1ji v •��v.,
. ` 64-23-10
Permit#67 91P,
`(lpg serves e dual pak/s'f).
"064=23'0=010;• '92-3569P
♦ ,i
ROUNDTREE, Nathan
14765 Carnegie,.Rd;"Paradi'se-
(sf/gas'to ,dryer),:,,,Contr:Art Stone Plmb-
064-230-010 KrV 064236
ROUNDTREE, NATHA
14765.CARN I {
Cont: GREE r; F f w
RE ROOF 1 sY mfr *c�`ty t
j
064-230-010 06-1236
ROUNDTREE,-NATHAN-` L—, " Ci
NOTES 14765'.CARNEGIE RD, MAGALIA -
Cont:: GREENE & SON ROOFING:r{
RE ROOF
WE_S I-D_L N -11-A L
APN:
Owner.
Site Address:
Contractor:
Type of Permit:
Permit No.
CHECKED BY
" SRA
Q FLOOD CERTIFICATE EQUIRED
Q FIRE SPRINKLERS REQUIRED
Q SPECIAL INSPECTION ITEMS
Q VERIFY i
Q USE PERMIT CONDITIONS
FISUB-STANDARD HOUSING LETTER
❑ ENCROACHMENT PERMIT
Q REINSPECTION FEE PAID
F I ENV HLTH CLEARANCE.
R
DATE JOB FINALED: r `5 3 V
SIGNATURE: v
+=OK
0 = Not OK
MANUFACTURED HOMES
MISCELLANEOUS
DATE PERMANENT FOUNDATION Lj SOFT -SET
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch
3 Sewer; Loctn-Test; Fall/C/O-Concrete
4 Wtr; Loctn-Test-Easement Needed -Regulator
5 Elec Loctn-Clrncs-Grnd "Amp -Concrete
6 Yard Gas; Loctn-Test-Wrap Nat ❑ or LPO
Inch Sz Ft Lngth
7 Blckng; SzSpacing-Marriage Line
8 Gas; MH Test-Demand-Valve-Cnnctr
9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs •
10 Drain; MH Test -Fall -Flex Cnnctr
11 Wtr & Sewer. Connected -C/O to Grade
12 Gas and Electilcity Tagged
13 Tie Downs ❑ Foundation ❑
14 Exits
15 Cert of Occupancy
16 HUD Label insignia Numbers Serial Numbers
DATE D E C K S -CO V E R S•C A R P O R T S'G A R A G E S
1 Zoning -Setbacks -Easements
2 Ftgs; SoilsSz-DpthSpacing-CnnctrsSteel
3 Decks, Girders/Joists-Dcking-Brcing .
Stairs-Guard/Handrails ` L.
4 Wood Awn; Posts-Beams-Rfirs-CnnctrsShthg.
Frmg-Brcng
5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs
6 Carports; Wndws-Doors _
7 Electric
8 Frmg; Sills-AnchrsStuds-Rftrs=Trusses
9 Siding; Nailing -Veneer -Stucco -Lath
10 Roof; Shthg-Roofing
11 Ext; Steps -Doors -Landings
12 Braced Wall pnis
°�
DATE JPOOL.S
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
5 Elec Pool lting; 15 volts-GFI
6 Elec Encisrs; Conduit Entries -Terminals -listed
7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg
Boxes-Encisrs-pnlboards-Insultn to Main Conduit
9 Health Dept Apprvl "
10 Plmb; Cir Test-Wtr Supply Test
11 Lt Niche ,
12 Enclsr, Fencing -Alarms
13 Bonding, Diving board or Slide
Ole y4 �y
Pool Drawing
+=OK
I RESIDENTIAL (Single & Duplex)
DATE JUNDERFLOOR
DATE
IPLUMBING
1 Zoning -Setbacks -Easements -Flood -Slope
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg DRth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth
55 DWV; Test Fittings & Anchr. Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
56 Shwr Pan; Test, First fir -Tub Ace
5 Stemwalls Main; Steel-Blockouts-Wrapped
57 Test Tub & Shwr, 2nd fir - Tub Ace
6 Stemwalls Garage; Steel-Blockouts-Wrapped
58 Gas Pipe; Sz & Anchrs
6a Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Piping
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test
°
0
10 UF, Gas Pipe; Sz Anchrs-Sz Test
°$
11 Wtr Pipe; Test-Anchrs-RgltrService Test
12_ Elec Undrgrnd
DATE
IM E C H A N I C A L
13 Plenums & Ducts; Clrnc-MaterialSupportdnsultn
61 AC Ducts Insultn & Support
14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples
62 Vent Fan, Exhaust abv Insultn
15 Ace & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16 Insulation
64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Ace & Pltfrm if Furnace in attic
DATE IFRAMING
17 Sills Proper Materials & Anchrs
DATE
IFINAL
18 Wails Studs -Nailing Spacing & Braces -Plates -Sound
66 Ext Steps -Door & SideLt Prtctn-Landings
19 Bearing Walls over Girders & fir Nailing
67 Smoke Detector
20 Draft Stop in Walls (rat proof)
68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr
21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
In Garage; abv-flr-Ducts-Mach Prtctn
22 Headers & Beams -Si &'Bearing
69 Bedroom Exiting
23 Hangers -Post Caps-Anchrs-Cinnctns
70 GFI & Bath Fxtrs & Tub AccSpa
24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg
71 GFI Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clrnc
72 Elec Trim & Subpnl, Breaker Szs & Labels
26 Attic Ace; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Clrnc-Hearth
28 Garage Fire Prtctn Framing -RC Channel
75 Elec Outlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall & Opngs
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc
30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits
77 Elec Outlets & Rcptcls at Ktchn Counter
31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn
78 Garage Fire Door; Swing -Landing -Closure
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Clrnc-Com Air Cnnctr-PRV; abv fir
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Ace
Mech Prtctn; LPG Appince Undr House 3" drain
35 Glazing Area -Glass PrtctnSkyLts-Plastic
81 Pimb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace InUExt Wall pnls
83 Insultn-Foam-Looked in Attic
38 Insultn-Walls-Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiltration-Walls-Wndws
85 Fndn Vnts & Crawl Hole Door Drn e & Wood -Earth
86 Clrnc Drnge Planters 0 Yes ❑ No
o' m`.1� o�, 0
87 Stucco Brown -Finish
88 AC Unit Dscnnct, Elec-Pimb
89 Vnts abv Roof, Pimb-Appinc-Frpic-Clrnc to Opngs
DATE JELEETRICAL
90 Wtr Well, Dscnnct, Elec, Pimb
40 Fxtr & Trnsfrmr Clrnc4ns Prtctn
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92 Vntltn thru House
42 Sz Boxes & No Of Cndctrs Stapled
93 Glass Prtctn
43 Romex Installed Close to Edge of Studs & CJ
94 Corrections from previous Inspctns
44 Eqp Grnd made up w/Mech Fstnrs
95 Gas Test -Meters Tagged, Gas-Elec
45 Grndng Electrode Bond Gas & Wtr
96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz , DCU or DAL
98 Address Posted
AC Wire Sz , OCU or DAL
99 Fire Sprinkler
48 Range Clic ga 0 C or DAL
Oven Circ ga OCU or DAL
Insulated Neutral [--]Yes D No
00
°.s 00
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Cirncs pnis-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
i'
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is In full force and
effect. Q
License Class : -3 _J LiceenJ� .e Jese Number: 2/�/ r7
,95
DateSZ1/-Z)Z Contractor: /»-Pq nn!✓i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penally of not more than five hundred dollars ($500).):
❑ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed, contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). .
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
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.
0__f -have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurancecarrier and policy number are:
Carrier: STr4-7`Q7Sfil-�ti A
/
Policy #: % 75SL
L -�
PERMIT NO.
BP061236
Issued Date: 05/24/2006 APN: 064-230-010-000
Site Address: 14765 CARNEGIE RD MAG
Map Index:
Description: re roof (25)
Owner: ROUNDTREE NATHAN E & MYRTLE E
14765 CARNEGIE RD
MAGALIA, CA
95954-9107
Applicant: GREENE & SON ROOFING
PO BOX 2467
PARADISE, CA 95967-2467
530-873-3940
Contractor: GREENE & SON ROOFING
PO BOX 2467
PARADISE, CA 95967-2467
530-873-3940
License #: 275057
Architect:
Engineer:
Total Square Ft:
Valuation:
❑ I certify that in the performance of the work for which this permit is Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
0 S. F.
$0.00
z`r
CONSTRUCTION LENDING AGENCY This per is hereby i su u er he pplicable provisions of the Butte County Code and/or
1 hereby affirm that there is a construction lending agency for the Reso ions to do wo indicat d abo for which fees have been paid. (�
performance of the work for which this permit is issued (Sec 3097 Civ.) ' By:
j Date: / � Y�
Name: y
l- PERMIT EXPIRES ON:
19 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that 1 have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby,
authorize representatives//of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: Gi [ rS���df�-�- _ Signature:oj
Date: 2-5c —o
❑ Owner
❑ Contractor
❑ Agent for Owner
❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
BUTTE COUNTY
O DEPARTMENT OF DEVELOPMENT SERVICES
O BUILDING PERMIT APPLICATION
O AND SUBMITTAL REQUIREMENTS
O 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
O OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
APP (CANT SIGNATURE
X A�
For office use only:
ARCHITECT/ENGINEER
OWNER INFORMATION
Name
Last Name
SRA
j
first N
jA 4 I'
SCJ
Address
/
/'✓Q
U 3', P
� r
City
Stat
<6
State
1
Zip
Phone
7
Z �
Fax
391111b Fax
E-mail
Lic. #
CI s
APP (CANT SIGNATURE
X A�
For office use only:
ARCHITECT/ENGINEER
CONTRACTOR
Name
Address
SRA
City
No
State
Address
el D
L
City
E-mail
Stat
Zi
Phone
F
391111b Fax
E-mail
Lic. #
CI s
APP (CANT SIGNATURE
X A�
For office use only:
ARCHITECT/ENGINEER
Name
ff
�—
Address
SRA
City
No
State
Zip
EPhone
Map Book
Fax
E-mail
Planner
State License Number
APP (CANT SIGNATURE
X A�
For office use only:
APPLICANT INFORMATION
Name
ff
�—
Address
SRA
City
No
State
Zip
Phone
Map Book
Fax
E-mail
Planner
APP (CANT SIGNATURE
X A�
For office use only:
Zoning
Property Address //I
Flood Zone
Cross Street
—111-19
SRA
I Yes I
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
UVLK FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
BP b l lz
BIN #
PROJECT LOCATION
Property Address //I
City )
Cross Street
—111-19
WORKER'S COMPtNSATION
Policy Number
3� z
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name _
Address
Descri tion or Scope of Work:
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by:
Cg'
Receipt #:-0
q�
;1106
Date �Z
Amount: Ad � ��Bldg
I I / i .Z / . -- Total I
Page 1 of 2
REV 8-12-05
1
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans,
all in duplicate
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer:
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings.
❑ 11. Building Permit Application Without Required Clearances Form
❑ 12. Hazardous Material Form (for Commercial Buildings only).
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑
12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit Assistant at (530) 538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
-'�C;�t.;�!.`,SiC�yhi+�.t�, , �. (.���.,Y� �'�f•';.:r`��'1�`j'i `.i {; .�t�.i.fir�. ;"tr, Y ,
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
�—
BUILDING PERMIT
OWNER
INATHAN ROTJNDTREE
TELEPHONE
873-3246
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
14765 CARNWIP ROAD PARADISE 95969
CONTRACTOR'S NAME
ART STONE PLUMBING
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
615 PEARSOT; PARADISE 95969
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS
5 CARNFGIE ROAD PARADISE
Permit fee
$
PLUMBING PERMIT
FilingFee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SF & Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00 5.00
Building sewer
15.00
Mobile Home S I G JW I
@ 15.00
TYPE OF WORK
New❑ AdditionA❑ �ernoRdll I eUtilities❑ Installation❑ Other ❑
Describe work: ��
Permit Fee
$ 20.00
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600V OR ESS
200AORLLESS
18.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Ski 4p 05_1,15 Classification L +" . 3 _
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service 200ATO1000A)
37.50
NEW CONST.( DWELLING OCCUP.tr)
OR ADDNS. ACC. BLDGS. I
3.6Qsq.h.
NEW CONSTR ULTI-OUTLET
NO N.RES.D BRANCH CIRC ITS
@ 5.00
POWER APPARATUS tr
(SINGLE OUTLET CIR. )
Ex. Occup( OUTLETS OR FIXTURES
20 764
FIXED
APLN Ex. Occup. OUTLETS (PRESID.)REA.)
I 3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. 6Virin g
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ he permit is for $100.00 (valuation) or less.
LrJ have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filirig Fee 15.00
Heating
Cooling
g
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilit-les, judgments, costs, and expenses which may in any way accrue
against/�fd Coou'n'ty" consequence of the granting of this permit.
X date �� ' ` '
Signature of Applicant — Owner ❑ Contractor Agent
Owner
An OSHA permit is required for excavations over 5't)" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee
$
OCC
CONST TYPE
TOTAL FEE $ 20.00
HAz
DFEES
IMP
FLOOD
CDF
PARCEL
Po
H D
ISSUE
This --permit is hereby issued under the
sions of the Butte Code and/or
work indie�ated a v.' f r which fees
I DIR11! OF PUBLIC
By _ t t
PERMIT EXPIRES Date
applicable provi
resolutions to do
have been paid.
WORKS
Date
'`9
122816
Receipt No.
WHITE-D.P.W., YELLQW-ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATI&N AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
n64_?,1n_n1nBUILDING
ZON IIJ
PERMIT
OWNER
NATHAN ROUNDTREE
TELEPHONE
873-3246
SO. FT. OCC.1 BUILDING VALUATION
OWNER'S MAILING ADDRESS
14765 CARNEGIE ROAD PARADISE 95969
CONTRACTOR'S NAME
ART STONE PLUMBING
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
615 PEARSON PARADISE 95969
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
LENDER'S MAILING ADDRESS
Filing Fee $ 15.00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee $
Penalty $
BUILDING ADDRESSPermit
14765 CARNEGIE ROAD PARADISE
fee $
PLUMBING PERMIT Filing Fee 15.00
Each Trap 5.00
Solar or heat pump water heater 20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF ® Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00 5.00
Building sewer 15.00
Mobile Home S I GW @ 15.00
TYPE OF WORK
New Addition Remodel❑ Utilities[] Installation❑ Other ❑
Describe work: GAS TO DRYER
Permit Fee $
0
Contractor
ELECTRICAL PERMIT Filing Fee 15.00
Main service 200A OR 0V OR LESS 18.50
CONTRACTORS LICENSE LAW
I declar nder penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license Is In full force and effect.
License No. -545 SSS Classification 60
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed Contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service 200ATO1000A, 37.50
NEW CONST. ( DWELLING OCCUP.51 3.64 sq.ft.
OR ADDNS. ACC. BLDGS. I)
NEW CONSTR MULTI -OUTLET
NON-RESID BRANCH CIRC ITS @ 5.00
(POWER APPARATUS 6)
SINGLE OUTLET CIR.
Ex. Occup(DUTLETS OR FIXTURES 20 76
EX. DCCUp. OUTLETS PIRESID )REA.� 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ he permit is for $100.00 (valuation) or less.
LTJ have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT Filing Fee 15.00
Heating
Cooling
Hood 6.50
Ventilation
Et
Permit Fee $
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
es, judgments, costs, and expenses which may in any way accrue
agad Count consequence of the granting of this permit.
all agyrp
X OlY221LE�0 ate �o —�% "'
Signature of Applicant — Owner ❑ Contractor Agent011
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE
$ n nol
HAz
DFEES'
IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
Th' ermit is here y issued under the applicable provi-
ons f t Butte• o Code and/or resolutions to do
work ndi ated a ov r which fees have been paid
DIR O PUBLIC WORKS /0/d 1
Da o
PER EXPIRES Date
Receipt No. 122816
WMITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
064(— Z30 —t°1 /�'
Z NI G
� .�
BUILDING PERMIT
OWNER -
)104kp VL 010L,L%,Xol 4 lee
TELEPHONE
X73- �yb
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
X765- 0 li ,rn `a62 d
CONTRACTOR'S NAME ITELEPHONE
19 Y_ _f o nt \(A,lrIla, lh
CONTRACTOR'S MAILING ADDRESS p
S P P rSD►1 a rctdis.e /S �/6G
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS r
/ r%6.5-' r n -gotf l��
Permit fee
$
PLUMBING PERMIT
Filing Fee
15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.SUBDIVISION
NAME
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
Gas piping system 1 - 5 outlets
5.00
S 20
Sp�kDuplex❑ Mobilehome❑ Other
Building sewer
15.00
Mobile Home S I G W
@ 15.00
SPECIFY
TYPE OF WORK
New ❑ Addition[J Remodel ❑ Utilities[] Installation ❑ Other
Permit Fee
$ O o�
Describe work: _
Contractor
gas +0 � V,
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600V OR LESS
200A OR LESS
18.50
_
Main service 200ATO1000A1
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
ElNON-RESID
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license Is In full force and effect.
License No. Classification
NEW CONST. DWELLING OCCUPM
oR ADDNS. ( ACC, BLD -GS.
NEW CONSTFL ULTI.OUTLET
BRANCH CIRC ITS
POWER APPARATUS e
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
_37.50
3.60 sq.lt.
@ 5.00
20 76
❑ I, as the owner, or my employees with wages as their sole compen-
Ex. Occup. OUTLETS FIXED PR
RESID IEA.�
I 3.00
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
(] I, as the owner, am exclusively contracting with licensed contract
ors. (Sec. 7044)
Temporary service
Mobile Home Facilities
Misc. Iyirin g
15.00
15.00
15.00
L) I am exempt under Sec. . Business and Professions Code
for this reason
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
MECHANICAL PERMIT
Filing Fee 15.00
❑ The permit is for $100.00 (valuation) or less.
Heating
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
Cooling
g
❑ I shall not employ any person in any manner so as to become subject
Hood
6.50
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Ventilation
Permit Fee
Contractor
$
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC CONST TYPE Q
TOTAL FEE $ °_ 0 0 -
HAz 1 1) FEES IMP FLOOD CDF PARCEL PD I HD ISSUE
X Date
This permit is hereby issued under the applicable provi-
si nature of Applicant — owner ❑ Agent ❑
g pp ❑ Cs over
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
sions of the Butte County Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
r/
Receipt No.2 07 1S
By
PERMIT EXPIRES Date
Date
WHITE-O.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
ri'r1h-•��,'+'�H/y,',"����il�`7fj1��f�^'4t'y�r`iy{'��"+`r�P �'�'�`"•'�I��i�.IT7ir�1�Y• �n4;/�"1«YiK'1"is��"Y1�fd�jr{i`7�=j%�(�ib'r,.�r��F��T.as 6��
,• „ `i', a Tf
COUNTY OF BUTTE.' PARTMENT,OF PUBLIC WO,jFS .BUILDING DIVISION
7 COUNTY CENTER DRIVE' OROVILLE, C/.LIFORNIA 95965-'TEL'EPHONE (916) 538-7541
PERMIT APPLICATION DATA SHEET
OWNER
0 (A rd TY4 A. P. No. 067 -.930- 0/0
Proposed Building Use Building Inspector k iO Date /0 � Z -
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1,
All items have been submitted. ......... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
Plot plans, 3/4 sets, signed by preparer of plans . ......................... .
3.
Complete plans, 3/4 sets, signed by preparer of plans . ..................... .
4.
Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5.
Hazardous Material Form . ............................................
6.
Energy Design Compliance and supporting documentation: ..................
7.
Statement of Intent for Non -Heated and A/C Buildings . ......................
8.
Engineered truss details and layout in duplicate (required prior to plan check). ....
9.
Mobilehome data and manufacturer's installation instructions, 2 sets. ...........
10.
Fees of$ ..........................................
11.
Impact fees as shown on attached schedule . ..............................
12.
California Department of Forestry plan approval/fees. ....................... .
13.
Flood elevation letter (100 year flood) by California Engineer . ................. .
14.
Sanitation and plot plan approval Health Department . .............
15.
City of Chico plumbing permit . .........................................
16.
Plot plan and business license approval from City of Biggs/Gridley. .............
17.
Planning approval for (A) Use: (B) Parking: . ........
18.
Contact Land Development about (A) Improvements (B) Drainage. .......... .
19.
Driveway permit (construction approval required prior to occupancy).
20.
Pre-Inapedio' req�e-
Pre -inspection for required. . to Building �nspector (Date)
21.
Contractor's license information. (No., Name Style, Classification) . ..............
22.
Certificate of Workmans Compensation Insurance . ..........................
23.
24.
Owner -Builder Verification (Given to owner Mail to owner_) ...
Recorded copy of Agricultural Acknowledgement Statement ............... .
25.
Letter of signature authorization. .. ...... .................. .
26.
Copy of recorded deed of parcel creation and 60 right of way to a public road. .....
27.
Letter of intent on building use . ........................... .............. .
28.
Mobilehome utility clearance . ..........................................
29.
Documentation of legal access . ........................................
30.
Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31.
Existing violations/expired permits . ......................................
32.
Plan check list . ....................................
. ................
33.
34.
When you issue the permit,- process as follows: Mail to owner. Mail to contractor.
Telephoneand hold for pickup at office. Deliver with inspector.
Other
Parcel Creation
Acreage
Applicant Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
'2. Additional items required:
Contractor, designer, owner, was advised of above required data by _ phone -mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works .,`
u
JOB FINALE
Signature
RESIDENTIAL
64-23-10
4263-89B,P,E,M
'FQX' Pete g 'Ma alfa
144765 Carnegie Rd,.'- g
i
(new SF)
of
Al; ASleaJ
dh $�.ew oZ 5
Q% L�
f'
pl,
tiJ
B.
j^
's
x
�4
i
P
JOB FINALE
Signature
• t' - 1
J=OK
O =Not OK
= Not Applicatr'e RESIDENTIAL (Single
= Not Ready
Date UN RFLOOR PI s OK except #'s
V Z%n et c s)Easementsflood-Slope
P. -fig., Main; Soils-Elec. G146.42/" Ftg. Depth
g., Garage; Soils -Steel -Flet. Grnd.-I' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
& Duplex)
Date FRAMING (Continued)
Ha ers-Post Caps -Anchors -Connectors
At;ffng. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng. --Is
7. Fireplace Ties or Type A Flue -Fireplace Throat clearance
A41 -Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
11
to walls, Mam, Steel-Blockouts-Wrapped �9. drm. Windows or Exiting Doors -Sill Hgt. & Dimensions
temwalls, Garage; Steel -Bloc kouts-Wrapped rage Fire Protection Framing pa
6a. Hold Downs and Special Anchors:I & 7
7. Slab; Steel-Wrapped-Fi
ier .-Steel
W.V.; Fa ttin est -2 Wa C/O- ewer Test
10. Ga Pipe; Size -Anchors
1 ater Pipe; Test -Anchor egulator- rvice Test
12. tric; Underground
1 Pie ms & Ducts; Clearance -Material -Support -Ins.
1 irders-Sills-Anchor Bolts -Joists -Vents -Cripples
15. Insulation
Date Card B-1 '2 l -4a Date Card B-1
Date Card B-1 °I-S'-�i�o Date Card B-1
Date PLU G Permit OK except #'s
W r Htr.; Vent -Access -Combustion Air -Baffle
Wate Pipe; Test & Anchor -Nail Protection
V.; Test -Fittings & Anchor -Nail Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower, Second Floor -Tub Access
21. Gas Pipe; Size & Anchors
Date_2,61-/Card B-1 Date Card B-1
rc
Date Card B-1 Date Card B-1
Date ELECTRICAL Permit OK except #'s
ix re & Transformer Clearance -Ins. Protection
Ele . Receptacles Spacing -Lights & Switches at Doors
2 . Si Boxes & No. of Conductors -Stapled
Ro ex Installed Close to Edge of Studs & C.J.
E uip. Ground made up w/Mech. Fastners-Bond Gas & Water
27'2 Appliance Circuts in Kitchen & Conductor Size/GFI
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga.
Cu or Al
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral 0 Yes 0 No
30 rvice-Riser Conductors & Ground -Main Disconnect
3 quip. Clearances Panels-Motors-Mech. Equip.
32. CI .thes Closet Light -Shower Light -Spa Light
Smoke Detector
Date - 6ard B-1� Date Card B-1
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
34. A.C. Ducts Insulation & Support
p -Tent Fan; Exhaust above insulation
36. Condensate Drain & Overflow; Size & Grade
37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet
38. Attic Access & Platform if Furnance in Attic
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
39.` Sila!Proper Material & Anchors
40-Wa tuds-Nailing, Spacing & Bracing -Plates -Sound
4 . ems' Walls over Girders & Floor Nailing
42!Dr top in Walls (rat proof)
4 . it tops; Furred Ceilings -Stairs -Chases -Tub
4 eaders & Beam -Size & Bearino
Pr perty Le Frewal Openings Qi
Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits
53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection Zi
plywood on Roof Overhang -Attic Vents -Rafter Outriggers „
Siding -Nailing Veneer
eco Mesh -Drip Screed -Fd. Vents-Underflr. Access
Glazi Area -Glass Protection -Skylights -Plastic,
58. 5045r Walls; Nailing -Bolts
VoInsulation-Wills-Ceilings
60. Infiltration -Walls -Windows
Date Card B- Date Card B-1
Date . Card B-1 Date Card B-1
Date FINAL (Plans) OK/except #'s
Y,*"Ext. Steps -Door & Sidelight Protection -Landings
6 . Smoke Detector
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
6,e -Bedroom Exiting
. G.F.I. & Bath Fixtures & Tub Access -Spa
6 . Elec. Trim & Subpanel; Breaker Sizes & Labels
Stairs & Rails
68--'F'ireplace or Stove; Clearances -Hearth
69. lec. Outlets at Wood Panel; Int. & Ext.
76. it.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
7 ::2f utlets & Receptacle Kit. Counter
arage Fire Door; -Landing-Closer
73. A. . uct in Garage -Damper
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage; Above Floor-Mech. Protection ate/
7 Plb., Elec. & Mech. Equip. Listed for Location
76. lec. Receptacles in Garage; (G.F.I.)-Romex Protection
7 . Insulation -Foam -Looked in Attic Yes
7.8 Guard Rails & Deck Construction -Post Caps
79,,�. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
80.,Following instld.; Drive Yes ❑ No; Walks dYes 0 No;
Planters 0 Yes "o
81. Stucco; Brown -Finish
81-<-C. Unit; Disconnect, Electrical, Plumbing
8�ents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
Openings
84. Water Well; Disconnect, Electrical, Plumbing
83 Exterio Elec. Trim; G.F.I. Receptacle -Underground
eir V elation Throughout House
lass Protection
8 Corrections from Previous Inspections
as Test -Meters Tagged; Gas -Electric
W. -Water & Sewer Connected -C/O to Grade -HD Approval
ergy Compliance Certificate -Other Certificates
Date Card B-1 Date Card B-1
Date g,,,C/ Card B-1 �17Date Card B-1
Date Card B-1 . Date Card B-1
Comments at Final:
(NOTE: An entry must be made each time you visit job site)
J=OK -
O = Not OK
Not
= Not Readyable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O Concrete
4. Water: Location -Test -Easement Needed (Sketch)
I 5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / /"L"ft.
/ /"Nat. or/ /"L"ft./ /"LPG
7. Utility Clearance
Date Card B-1 Date Card B-1
Date . Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'a
1. Zoning Requirements -Setbacks Easements '
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS r r
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-PaneIboa rds-Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
COUNTY OF BUTTE I
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541'
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
e
-aJ��e't '!'4X S
r :C 9
/f
Date O� Inspector
i
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS s
196 Memorial Way, Chico — Phone:.891-2751
7 County Center Drive, Orovi Ile — Phone: 538-7541'
747 Elliott Road, Paradise — Phone: 872-6307.
CORRECTION NOTICE
OWNED PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining" to this
matter,Xneed additional explanation, please contact this office immediately.
-�-/�-9U
Date i/i �T Inspector
�— . tic -c .ace �3'Cy';`.-'`"�'T�.'*,y-R-.xs.....,.� t.,,-..,,.....���,r_„�,:.,,+��p2�y,'y�trta.�Kw:Y7•wa
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
- 7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
�ox y�G 3- gy
OWNER PERMIT NO.
A routine Inspection indicates that the following violations of County Ordinance
exist at the ab o address and should be corrected. Please notify this office
when correct' of work is completed. If you have any question pertaining to this
matter, o need additional explanation, please contact this office Immediately.
4. o SSa .s. 4.-e ,GP� A^,# t'FS 6snf_
2 '—r0V / 0.n/ G(GO-C T,/W.1
Inspector Date
a- r` COUNTY OF BUTTE �.
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751 `t
7 County Center Drive, Orovi Ile — Phone: 538-7541
747 Elliott Road, Paradise— Phone: 872-6307
-1
CORRECTION NOTICE'
OWNER PERMIT' NO.
A routine Inspection indicates that the following violations of County Ordinance =`{
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter,
^or need additional explanation, please contact this office .immediately.
O Cdl r
Inspector /ems' !/ Date_? - a r -go
ENERGY CERTIFICATION
LOCATION
A. P. NO.
ROOF
Material
Thickness
EXTERIOR WALL
Material_. FIBERGLASS
Thickness (lr►clies)!
CEILING-`—`
13rnnd
Thermal Resistance R Value
Brand Name CERTAINTEED _
_ Thermal .Resistance (R Value),'
Batt or Blanket Type FIBERGLASS
Thickness (Inches)//�"
Brand DlameCERTAINT.EED__ a
�Priermal
Loose Fill T YPe__FIBERGLASS.___
Resistance R Value
( )--�
Brand NameCERTAINTEED
Minimum Thickness (Inches) /a''
No. of Bags_0L� Weight/Baq25__lbs
Area Covered (Sq. Ft. )-17/__
Thermal Resistance (R Valu*
FLOOR,ELEVATED
Haterial FIBE.RGLASS_
Thickness
Brand Name CERTAINTEED
Inches)—
—__,-�,"_----_-- Thermal. Resistance (R Value). -/9
FLOOR, SLAB
Material
Br-and Name
Thickness (1Tiches)__ —
_'Thermal Resistance (R Value)
FOUNDATION WALL
_
Material
Brand Name
T ickness(Inches)--. _
_.___._.-._ _.... .
Thermal Resistance (R V�lrae)
I HEREBY CERTIFY THAT THE ABOVE
ABOVE BUILDING
INSULATIOR WAS INSTALLED TN TEIE
IN CONFORMANCE WITH TETE STATE OF CALIFORNIA .ENERGY
REQU I REMEeITS .
13tLWKiN.S_..INDU:STR].ES_jN.4____.-•-----•-_ _-._____- 7.9407_
Firm Marne/Owner State Contractor's License No.
Signature
Date
I HEREBY CERTIFY THE ABOVE INSULATION AND ALL REQUIRED ITFAIS AS
SHOWN ON THE BUILDING DEPARTMENT APPROVED PLANS AND ATTACIIMFNTS
HAVE BEEN INSTALLED AS REQUIRED BY THE S'T'ATE OF CALIFORNIA ENERGY
REQUIREMENTS.
F1, m Mame/o
/w
Jner
Sig'pature Gen. Cotitra�ctor/-Owner
Date-------. .._ -..._...-----
Date
_=-1,�"_ ... .. -,. r+ — r S -.+.� .�. ..- ti�:�' r-•.- +l"e7[`•+r+' "'��" `yf'"; "'Ii►."�"`—�V� ���� 'Tib'
�. 64 -23 -IO 1673-91P,M `
'� `�•.• _, •�. ;•,• `FOX,, Pete
{ 14765 Carnegie Rd, Magalia
(lpg service `& dual. pak/sf)3_
Yt '
" OFFICE COPY
Address
GAS �-J .' •�%�
Meter By Date
ELEC RIC
Meter B Date
i
.�,.,. _........r•p.l .�,` '�33�'7* -. i-�r+�r�Yx%y71'e-. x - r �� - .m ...f � ,1, � ,. � .{9„ y, ,....,�• T,.-,e.��� :Tf --,. �,r
' COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 -County Center Drive - Oroville, California 95965 -,Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NU BER
kN
64023-1&1 k*T
ZONING
BUILDING PERMIT
'SO.
OWNER
Pete Fox
TELEPHONE
873-0378
FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
14201 Racine Circe Ma alfa 95954
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS
14765 Carne ie Ma alis
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
79
SUBDIVISION NAME
p cc Unit 4
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF X' Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00 5.00
Building sewer
5.00
Mobile Home S I G I W
0.00e
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities l.bl, XInstallation❑ Other ❑
Describe work: 1 -PG service & dual nak
re permit#4263-89
Permit Fee
$ 15.00
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Profess 1.Code and my license is in full{ force and effect.
License No. /-aL Classification I�
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ontract-
ors.
ors.(Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING 0CCUP.9
OR AODNS. ( ACC. BLDGS.
z2
0SQft
NEW CONSTR ULT I.OUTLET
NON-RESID BRANCH CIRC ITS
2,50 ea
POWER APPARATUS ��
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
aA 05Oa
EX. Occup. OUTLETS IIRESID.)REAJ
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. byirin g
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
6.00
dual aIC
Cooling
11.50
Hood
3,00
Ventilation
Permit Fee
$ 2750
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs and expenses which may in any way accrue
County in conse ce pf-the granting of this permit.
X `lf�rl�/1�,.%.. ! r
"�rI Date
Signaturej/of Applicant — Owner Q/ Contractor ❑ Agent ❑
An OSHA permit is' required for'excovations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $ 42.50
E
HAZ
cup
PARK
SCHL
PAR
PD
_f
HD
Issu
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR F PUBLIC
BY � � �
PEDMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
Date_
Receipt Na � / Z *7Z .
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR,' GOLDENROD -APPLICANT
COU,0NTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
i J County Center Drive - Otoville, California 95965 - Telephone: 916/538-7541 (/•� rJ7 ?--9 / /
APPLICATION AND PERMIT j A
ASSESSOR PARCEL NUMBER
64-23-10
ZONING
BUILDING PERMIT
OWNER
Pete Fox
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
14201 Racine Circle Ma alfa 95954
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
VNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS
14765 Carnegie, Ma alia
Permit fel
$
PLUMBING PERMIT
Filing Fee 10.00
r
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
79
SUBDIVISION NAME
cC Unit 4
PARCEL MAP
Water piping
5,00
Each qas water heater or vent
5,00
USE OF STRUCTURE
SFU Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00 5.00
Building sewer
5.00
Mobile Home I S I G JW 1
10.00e
TYPE OF WORK
New Addition [:J Remodel❑ Utilities aXlnstallation❑ Other ❑
Describe work: LEG -,Prvi rP & renal nak
re pprmit-#4263—R9
Permit Fee
$ 15,00
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service SS
100 AMP OV OR R LESS
10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Profess s Code and my license Is In full force and effect.
License No.�tl Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS.
2�,4sgft
NEW CONSTR ULT' -OUTLET
NON.RESID BRANCH CIRC ITS
2.50 ea
(POWER APPARATUS e)
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
BAL030
FIXED APLNS.
EX. OCCUp. OUTLETS PRESID )REA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
6.00
dual pak
Cooling
11.50
Hood
3,00
Ventilation
Permit Fee
$ 27.50
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs and expenses which may in any way accrue
again id County& copse u ce!!7 ran ing of this ppermit.q /
XDate ✓ ' ! / I
Signa�,r,.,..1 Applicant — Owner [t,Y Controctor ❑ Agent ❑
An permit is required for excavations over 5'0" deep and demolition or construct-
ion rctures oov7e�3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $
42.50
HAZ
CUA
PARK
SCHL
FLO
PAR
PD
HD
Issu
Th;s permit is Hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR F PUBLIC
By�Date
PEOT EXPIRES Date-
the applicable provi-
resolutions to do
have been paid.
WORKS
�f_7—J?�—f'�
J —,7, 9Z_
Receipt No. / % 1
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
r • Gopy of Haz-Mat form sent Health Dept. re Dept. Air Pollution Date
Copy of plans sent Health Dept.. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by_phone_-naiI—counter by ..date
Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by
Copy—DPW
Date Plans approved by
Sets of plans on hold in File cabinet AP folder
Date
COUNTY OF BUTTE - DEPARTMENi'*0F PUBLIC WORKS -BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVII:L'E� CALIFORNIA 95965 -TELEPHONE: 916/538-7541
PERMIT APLI.GATION DATA SHEET
Permit No.
OWNER
0 i c,o A. P. No. _-
' Proposed Builaing
Use G 'Buding Inspector S ' /Date 3 % 7
• At time of
ermit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
-DATE RECEIVED APPROVED
1.
All items have,been submitted. .....................................
2.
Plot plans in duplicate/triplicate,'signed by preparer of plans ........
3.
Complete plans in duplicate/triplicate, signed by preparer. of plans . .
4.
Complete engineered ..plans and calcs; with wet signature on plans ..
5.
Hazardous Material Form ..........................................
6.
Energy Design Compliance and supporting documentation .........
7.
Statement of Intent for Non -Heated and AC Buildings ...............
8.
Engineered truss details and layout in duplicate (required prior to plan check)
9.
Mobilehome installation data including manufacturer's installation
instructions....................................................... -
10.
Fees of $ ........................
11.
Chico Urban Area fees paid .......................................
12.
Park fees paid ......................................................
13.
School District fees paid ..............
14.
Sanitation approval from Health Department,
15.
City of Chico plumbing permit .....................................
16.
Plot plan and business license approval from City of
(see City for other requirements)
17.
Planning approval for (A) Use: (B) Parking:
18.
Improvements may be required. Contact Land Development Section DPW
19.
Driveway permit (construction approval required prior to occupancy) �•'
20.
21.
Pre -Inspection for :- required Pre-Inspec. request to
" Building Inspector (Dateio
Contractor's license information (No., Mame Style, Classification) ...
22.
Certificate of Workmans Compensation Insurance ..................
23.
Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .....
24.
Recorded copy of Agricultural Acknowledgment Statement .::-.a....
25.
Letter of signature authorization .................................. .
26.
27.
When
you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w. /inspector.
Other
Applicant
• �•,.,. :�;,���
Date
r • Gopy of Haz-Mat form sent Health Dept. re Dept. Air Pollution Date
Copy of plans sent Health Dept.. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by_phone_-naiI—counter by ..date
Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by
Copy—DPW
Date Plans approved by
Sets of plans on hold in File cabinet AP folder
Date
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Orov.ille, Call'fornia 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
2, Z
ASSESSOR PARCEL NUMBER
6v- 2 3-
Z
BUILDING PERMIT
O WNER-//e ��✓ rO�
//��C.._
TELEPHON
SO. FT. OCC. BUILDING VALUATION
3 J5-0 D
OWNER'S MAILING ADD,%ESS
2 0 I<a- !� �/
L�
J O .SkfilD�
CONTR CR'S NAME
TELEPHONE
1n6 4160
CONT'RACTOR'S MAILING ADDRESS
Fireplace t 11 O
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ 69
LENDER'S MAILING ADDRESS
Filing Fee $ 10.00
Permit Fee $ 3
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESSl C
Q
5 G
Permit fee 9 �
$ S3
PLUMBING PERMIT Filing Fee 10:00
_
Each Trap 2.00 160
Solar or eat pumpater heaterG 20.00 10 0'-'
LOT NO.
7
SUBDIVISION NAME
��
PARCEL 'M?AP
��' �3 C
Water piping 5.00
Each qas water heater or vent 5.00
USE OF STRUCTURE
SF DuplexMobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer - 5.00
Mobile Home ISI G I W 1 10.00e
TYPE OF WORK
New 0 Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work:
Permit Fee $ �[ 6
Contractor
ELECTRICAL PERMIT Filing Fee 10.00
Main service 1000 AMP 1 OR ORSLESS D 10.00 /0.eE
Mai serviceOST./ A. ADDLLING100 AMP 2.50 /1 •�
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Profess s Code d my license is in full force and effect.
License No. 2 Classification
r
❑ I, as the owner, or my employees with wages as their sole compen-•
sation, will do the work,and the structure is not intended or.offered.
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors.(Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
c
OR ADDNS. ( ACC. BLDGS.OCVf1/22sgft
NEW CON5TR. ULT' -OUTLET
NON-RESID BRANCH CIRC ITS 2.SOea
POWER APPARATUS tr
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 20®506
BALD 30
FIXED
Ex. OCCUp- OUT ETS P(RESID )KEA,) 2.00
Temporary service
Mobile Home Facilities 15.00
Misc. Wiring 15.00
'
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHA ICAL PER IT Filing Fee 10.00
Heating / U / �-
Cooling 3 b /�—
Hood / 3.00 _7 c o
Ventilation6
it Fee
perm $ 36 aP,
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Lawsrelating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
again id County i onsequence of the granting of this rmit.
Date
5i nature of Applicant — Owner ❑ Contractor Agent ❑
An OSHA permit is required for excavations over 5'0" deep and de 1' i ^�.ry t-
ion of structures over 3 stories in height. x.33 Y"
Mobile Home Installation Fee $ -
Energy Inspection Fee $ ���
cc
3
T PE
TOTAL FEE $ 93�
HAZ
cuA
PARK
SCHL
FLD R PD
HD
suE
Th;s permit is hereby issued under the applicable provi-
sions of the Butte County. Code and/or resolutions to do
work indicated above for which fees have been, paid.
�• R CTO F ELIC WORKS
BY Date /
PERMIT EXRIRES Date �
Receipt No. z ` u C �a
WHITE-D.P.W.. YELLOW-ASSESSOR./PINK-INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE -'DEPARTMEN-'f - OF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - ORCVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERT,T APPLICATION DATA SHEET
No.—
OWNER 2e4c > A. P. No.
Proposed Building Use Building Inspector Datelz-
At time of permit application, I was advised the following data must,be-submifted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1 . All items have been submitted . .. ......................... * * * * * * * *
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. Complete plans in duplicate/triplicate, signed by preparer of plans
4. Complete engineered plans and calcs, with wet signature on plans . .
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to plan check)
9. Mobilehome installation data including manufacturer's installation
instructions........ -�AX-of ....................................
Fees of $_ .5�07 0 . ........................
11. Chico Urban Area fees paid .......................................
19 P fees paid ... % ............................................
*qV a P-"* 6( %.-A, School District fees paid .............. S�WVO
4. Sanitation approval from! Q:1 "143, S Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) Use:—(B) Parking:—
Improvements may be required. Contact Land Development Section DPW
�2
veway permit (construction approval required prior to occupancy) , -
Pre -Inspection for required ... Pre-Inspec. request to
Building Inspector (Date)
_*1� cprocintractor's license information (No., Name Style, Classification)
22. Certificate of Workmans Compensation Insurance ..................
I.. wner-Builder Verification (Given to owner 0, Mail to owner 0) .....
Ow I
Recorded copy of Agricultural Acknowledgment Statement .........
Ic
r
i io
Le-tter of sig t pthorization ...................................
j3a ure a
27�
When you issue the permit, process as follows: Mai I to owner. Mail to contractor.
TelephoneVQ 03Z? and hold for pickup at —office. —Deliver w/inspector.
Other
Applicc Cht- Datea-/Fv
, __�/
Copy of plans sent — Health Dept., —Fire Dept., — Other—Date
The following data must be submitted prior to ti an - (C 4ircji, - em not checked above).
A _Sew i I
1. Index permit for above items No.
2. Additional items required: F R
L
_P(
Contractor, desig as advised of above required data by e___rnai I —counter b J/— - d,t
Contractor, deslgjnEjE�as advised of above required data by—phone—mall—co u nter bM dat:
_'e '310 ' e
Plans checked b,12tv— —Date PI'ans approved by Date
Sets of plans on hold in Fi 10 cabinet _AP folder
?
Copy—DPW
s
i
TO: Building Department
FROM: Encroachment Permit Section
RE: Driveway Clearance
2fe
q,7&1.S Cir e
X AP #
owner locatio
Driveway permit f�� �� G has been issued for the above property.
date
si ature
..d...�.�.�,•-wu�.w---` -"C J..vy__ ..e.L _+. � .. -- ...+.. mow... N. .�...vw f..nl�r. w.r .r6+.J...�.::.2 mss..._... . .... �.... ,
TO Buildina Department
FROM:.* Environmental. Health
SUBJECT: Sanitation Clearance
Omer Locatio AP#
�
Plan Approved for: Sewage Disposal Water Supply&a) -o
Hold f inal for:
Final clearance O.R. for:
` Clearance to edroom t3�e home.
Sa
Water Supply
Water Supply
Other
0
RESIDENTIAL PLAN CHECKING GUIDE
MISCELLANEOUS ITEMS TO LOOK OUT FOR (CONT'D)
Exterior plaster - weep screeds (Sec. 4706).
Proper roof pitch for roof covering (Chapter 32).
oof covering type - (fire hazard).
Rafter ties or bearing ridge beam.
C. Garage door or porch header sizes.
Adequate bracing.
. Living area over garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
11. Two exits on three-story dwellings (Sec. 3303 & see Mezannines - 1716).
Attic access and ventilation (Sec. 3205).-
Underfloor
205).Underfloor access and ventilation (Sec. 2516).
Combustion air for fuel burning appliances.
Noise requirements on duplexes.
Adobe soils - special foundation design.
Retaining walls requiring design.
I., 'Unusual shape., size, or split level house requiring lateral design.
'MIlFlashing at all exterior openings..
5/89
RESIDENTIAL? PLAN CHECKING GUIDE
(S.F., DUPLEX & MIS C. ONLY)
Bldg. Permit #-2� �g
OWNER PETE I "g, A.P. # (;.4 -23-60
GENERAL
',Zoning requirements: (sideyards
,2 Valuation.
.� Plans signed by designer.
Energy Design and Compliance.
Existing violations on property.
Items on data sheet.
PLOT PLAN
and number of permitted living units).
Complete parcel size and dimensions.
y/oSetbacks, sideyards, easements, etc.
�3�.Other buildings or structures.
4 Grading, fills, drainage.
Mood hazard.
Special conditions on creation map or
,,Special
& FAS road setback.
FT.nnp PT.A N
compliance document.
5/89
Complete to scale plan with dimensions.
Required -windows for light and ventilation (Sec. 1205).
Required windows for second exit (Sec. 1204).
Skylights (Chapter 34 & Sec. 5207).
Human impact glass (Sec. 5406).
Requjr7d room sizes, ceiling heights (Sec. 1207).
GFCIn baths, garage, and exterior outlets (Article 210-8).
Light.fi.xtures, switches, receptacles, and exterior receptacles for maintenance
of mechanical equipment.
Locations of water heater, heating and cooling equipment, other electrical or
gas equipment, and plumbing fixtures.
. Garage firewall, door size, and closer (Sec. 503(d)(3)).
- 3'0" exterior exit door (Sec. 3304(e)).
. Fireplace and wood stove location, alcoves, and clearance.
3 -. 'Smoke detectors (Sec. 1210).
DETAILS
S^ Foundation plan complete enough to construct building.
Sr`icL Floor construction details complete enough to construct building.
CK" J Elevations and wall construction details complete enough to construct
I/ e Roof construction details complete enough to construct building.
\I�
-5+—Fireplace construction details and cal.cs.if necessary.
---.
MISCELLANEOUS ITEMS TO LOOK OUT FOR
Stairway details: landings, rise and run, head clearance, handrails
Guardrail details (Sec. 1711 & 3306(j)).
Brick or stone veneer (Chapter 30).
building.
(Sec. 3306).
r
OWNER'S NAME: 7n )C RECEIVED
PERMIT NUMBER:
A . P. # :
DATE -6
RESIDENTIAL F] NON RESIDENTIAL
RECEIVED
BY [��
TIME 9i�0 O
REQUIRED PRIOR TO PERMIT ISSUANCE
FROM DATA.SHEET REQUESTED BY PLAN CHECKER
[] OTHER
---------------------------------------
REQUESTED BY CORRECTION NOTICE [] YES [ NO ITEM:
LOCATION—IN BUILDING WHERE CHANGE OCCURS: ?NICA i� n ? /J' A�
--———————— — — — — ——
-----------
WHEN APPROVED, PROCESS AS FOLLOWS:
Mail to owner
(Address
Mail to contractor
(Name and Address) 7 1 1
Call �7,� Q�''%� and hold for pickup atCe office.
Deliver with next inspection.
REVISED PLAN CHECK FEES PAID:
$15.00 $30.00 Additional Fees Not Required
Retufn to DPW
.,
Section
requires
prior to
AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT -.. 9 32
FOR RESIDENTIAL DEVELOPMENT
26-8.1 of the Butte County Code
this acknowledgement be recorded
issuance of a building permit. .
The property described herein is adjacent .z;,
to land or included within an area zoned
90-401932 I Rec Fee, " 5.00 1";
for agricultural purposes,.,.and residentsCheck`-, 5-.,06
of this property may bei.subject to incon- Recorded' I '
veniences or discomfort (,arising from the . Off i'cia 1. Records
use of agricultural chemicals, • including, County of
t.
but not limited to herbicides, pesticides, ,Butte.
and fertilizers; and from the pursuit Candace J. Grubbs'
of agricultural operations including, r Recorder
but not limited to cultivation, plowing, "g;02am 16-Jan-90.,BG ',.1
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise,. and odor.^Butte u
Conty_ has established agricul.- _
tural zones which have as a priority use for -,productive agricultural purposes, and residents
within said zones and on adjacent property' should,be prepared to accept such inconvenience
or disconform from normal, necessary farm operations.
All that 'real property situate in the County of Butte, State of California, described` asq—
fo'llows:
'All that certain realro
pperty situate in the County of Butte,
California, described as follows:
Lot 79, as shown on that certain map entitled, "PARADISE PINES
recorded in the Office of the Recorder of"the County of Butte,
California, on July 15, 1971, in Book 38 of Maps, at pages 37,
and 41, inclusive.
State of .;
UNIT 14",
State of
38, 39, 40
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 to the surface of said land.
AP No. 064-230-010 y` -- -- _ ---- -- ---
Date:
I
1
I
I
January 10, 1990
State of Cai; f )
Butte )
County of )
On this the ],a,}— day of
SS. the undersigned Notary Public
Peter P. Fox & Judith -K. Fox
tom_, I 1J.W 17 i
I 1 .
, 19 90 before me,
rsonally appeared
O F F I C I A L 3 E A L personally known to me. H Proved to me on the basis
r� MARIE J. McCONNELL - of satisfactory evidence.
NOTARY PUBLIC - CALIFORNIA -
COUNTY OF BUTTE lo be the person(s) whose name(s)
o..
Comm. Exp. April 23, 1990 tubscribed to the within instrument and acknowledged that they
-
aee�e�o�euaerce�oeaee��a�onea�ueeoitnaeonouoouoeot�xecutedthe same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal.
,--�
Present A.P. No. LA3
A
y Public
END OF DOCUMENT
—x
_ (1,
ITER FOX BUILDER (9
Lie. ,ilW25 • 573.0376
14201 RACINE CIR.
MAGAUA, CA 95954ENERGY •CERTIFICATION
ao QS-, ?,
LOCATION A.
nT
MATERIAL
BRAND NAME
THICKNESS
THERMAL R-SISTANCE (R VALUE)
EXTERIOR WALL
.
MATERIAL FIBEGLASS
BRAND NAME~+; CERTAINTEED
THICKNESS (INCHES)
THERMAL RESISTANCE (R ''VALUE)
CEILING
') ,
BATT OR BLANKET TYPE FIBERGLASS_
BRAND NAME CERTAINTEED
TiiICKNESS IQ --- -- -
_
THERMAL RESIS T ANCE-_(R V� ALUEY-
LOOSE FILL TYPE_FIBERGLASS
BRAND NAME CERT,gII EED
MINIMUM THICKNESS (INCHES)
NUMBER OF BAGS ,; ' ",WT PER BAG 25 LB
AREA COVERED (SQ FT)
THERMAL RESISTANCE, VALUE)
FLOOR, ELEVATED
-..(R
MATERIAL FIBE G ASS
BRAND NAME CERTAINTEED
THICKNESS (INCHES) ����
_
THERMAL RESISTANCE (R VALUE)
FLOOR, SLAB
"
MATERIAL
BRAND NAME
THICKNESS (INCHES)
THERMAL RESISTANCE (R VALUE)
FOUNDATION WALL
MATERIAL
BRAND NAME
THICKNESS (INCHES)
THERMAL RESISTANCE (R VALUE)
I HEREBY CERTIFY THAT THE ABOVE INSULATION WAS INSTALLED IN THE
ABOVE BUILDING IN CONFORMANCE WITH THE STATE -OF CALIFORNIA ENERGY
REQUIREMENTS.
HAWKINS INSULATION 379407
FIRM NAME/OWNER
STATE CONTRACTOR'S LICENSE NO.
SIGNATURE DATE
I HEREBY CERTIFY THE ABOVE INSULATION AND ALL REQUIRED ITEMS AS SHOWN
ON THE BUILDING DEPARTMENT APPROVED PLANS AND ATTACHMENTS HAVE BEEN
INSTALLED AS REQUIRED BY THE STATE OF CALIFORNIA ENERGY REQUIREMENTS.
ALL EQUIPMENT, DEVICES AND MERTIALS ARE OF THE QUALITY -PRESCRIBED OR
ARE SPECIFICALLY APPROVED BY THE STATE OF CALIFORNIA.
FIRM NAME/OWNER
SIGNATURE GEN. CONTRACTOR/OWNER
STATE CONTRACTOR'S LICENSE NO.
DATE
-1-
Aw
,s .�.,, ,.. .. -^"✓„t.a"a-+.•.v+ra.'tiM.... •:..�-..s..+ti .:1',te"V rir'.w .-rvf `.(,r"`..i''+w.U^1..y....ri:^.+--h�.a.........rr•�•+i:.-"..�+..w.�-.ire" .-. .. ..
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM,
(One Form per Building.) % `:' f»”
A.P. Number (01-1-19, 3— �U 'Building Department No.
School District, pctl+ adctS�f City F__1+ CountyQ Jurisdiction
Property Owner
Project Location/Address.
Subdivision Lot N ber'.
Residential Development:
Sq. Footage
# of Living MHI Addition (Group R)
Units
+ .,..- ...«...wKa.w.+::�K-__ Y-+. .- _ _. � .:;e•. ;y,., t ,. .« .. ..w . ^i 2�., p .. ..., Mw - . .. ^ .yi -C.-......� r- w.. „.....r ..
Commercial/Industrial: Sq. Footage
New Addition (Including Exterior.
Roofed Areas)
f Building Department Representative. Date
t
(Floor`Plans reviewed by School District Personnel)
District Id No. �U U
(Applicant +Natie)
School District certifies that
g7� 0
(Phone Number)
(Street Address) /r
:(Ci'ty ( State) ( Zip Code)
has complied with the requirements of Resolution No..
by the payment of $ representing 1 / square feet.
() '�qO74,9_ g -A') � kol
'S-c•1Tool District Representative I Date'
PAID BY CHECK NO.
BANK NO
PAID BY CASH
REMARKS:
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
5/Af/<S
Ll
-5-'o 170"
3r, ,A1101-1 -WORD R191L
Cid(=-1
PUL tt-776A)
E00-1
LOCATE .31-70KE fiLr9l?1-7 IN Cf/VTER fIALC
6020 54,/DC-fZ R.B. roo 4.0 SLIDC-I-z
ip-
f /V G
SE UP
ffING I m
Q)
k9
S TER q9 f)RPE r
21
Cl/9/iT-,= 7.
t
IELF EPOLe
117 . .
Z
o 17-1* ING
19 0 X 7-9"
\9
0
C04. L)
Y) 04-e
-1 L
_j I _-_- ----
Lli 0 V\.
BED R001`7 RIO
zl/q!�—
zs ;K IP,
li =z:
02 v zc-:- Li �/pp REF,2.
.0
I SEE
/V
STEP 54, 09 13
V//V YL
FL -0111
p,91v.
S/-/EE7-fZ6CK TO fZOOF
CLO5.
3 ONE ilQUR FIR tH CtW-)E
030 51- CHI,--- 5
50-f- 5LID&Z DOUBLE �,49 A 2 /9 G, E
v -=,rz v
-.9
-7'/,-' 5 WITH C405r-,2
U,
2"x G" CC -11 -WC, OVI5715 24-"Olv
- 12 ["1
LOC,,97E 5, 70KF 19- 1
V. V.
V,
4"X14"49,ffA-7 ov -VERHE,,9D DR.
H. /G o V--/? El -?D Gq"?,qG E Doo2
17
. Certificate of Compliance: Residential Climate Zone 11
E?E , Mandatory Measures Checklist: Residential - - "' MF -111
Fox
Project Title / t NOTE. lownse residential buildings subject to the Standards must contain these meaaua regardless of the compliance •. '
approach used. Item marked with an asterisk (•) may be superseded by more stringent eomylianoe requirt rents fisted
C Building Permit # an the Certificate of Compliance When this checklist is incorporated into the permit docSrmentsthe fdnaq noted shall 1111
'Project Address AA
- .. -•� .. :....... _ for the
be considered by all panics as binding minimum component performance specifications marnnatay measures
�� - - whathei they are shown elsewhere in the doctunents or on this checklist only.
AAA.J Checked By/ ace
Documentation Author Telephone Fntorcement Agency Use Only Vii' DESCRIMON DESIGNER ENFORCFJtEM
Building Envelope Measures
Glass Area GI •,42.5352(a)r Minimum ceiling insulation R-19 weighted avenge. _
BUILDING DATA North
/ �� 42.5353tb: loose fill insulation mamtfacturer i Labeled R•Value-
'• Condttlo Floor Area ( Number of Stories4East • ' 42.5352(0: Minimum wall insulation in framed walls R-11 weighted average (does not apply to
: Sla S nor , Number Of .Units South eateriarmass walLt>. - -
West . • 42=5352(:}, Slab edge insulation - water absorption rate no grcuo than 0.3%, water vapor
�SIn a Family Detached (SFD) [ ] Addition Alone transmission rate no greater than z0 pnarnlmcb __. _._....._ . _
[ ] Single Family Attached (SFA) [ ] Existing Building Skylight _ 42-5311: Insulation specified or installed mocks California Energy Commission (CECT quality
[ ] Multi -Fault Total 21 standards. Indicate type and forth. --
y (MF) [ l Existing -Plus -Addition �_ . 2 t
_ . 42-5352(t): vapor barriers mandatory in Climate I.ornrs 14 and 16 only. -
f :42;5317: Infilbation/EafdtntionControls i
BUILDING SHELL INSULATION.'. a. Doors and windows between conditioned and unconditioned spaces designed to limit air
leakage.
.. ro
b. Dow and windows certified.
Component Irisulati0n : ,.. -: Loeat�Otr/EAmme,'lts - c. Doors and windows weatherstnpped: all joints and penetrations caulked and sealed
T R -Value (attic, .tet ares 4 r lac, etc.) 12.5352(e: special infiltration barrier installed w comply with 42-5331 menta CFC quality :..
9
Wall :............. 12.5352(4: Installation of ucplae
Wall..... .... I. Masonry and factory-buiU fireplaces have
ROOF . ....... '` a. Tight fining. closeable metal r glass door
Roof'c. Flue dampa and outside air intake with damper and control
... control
2. N000ntinuous burning gas ilots alkrwed..
Floor ............. Iwo;;Kis FLOO It' ,' NVACandPlumbing System Measures
e F100r:............ - 1243SU and 2-5303: Space conditioning cgmpmen sizing: attach calculations.- M :
a_ Slab Edge.....:. , ;
42-3352(h) and 2-5313 Setback Unersrnoatx on al' applicable heating systems. ` '
GLAZING _ 97
. installed and
I3e
Shading' - • .' - � •- - 5316�(b constructed.
.. Docks
.,. .. . • VICes , Exhaust systems
' '1
:...' 42- r insulated 10 l 6 trMc
12- k
' Glazing,. Area Glass Type Interior Exterior - Y •, Overhang Framin i
i 12,5314(0: Gas•fuW space heating equipment has intermittent ignition device
Orientation $ - g , g Type 12-5314: HVAC equipment, water Maims. shoaerheads and faucets certified by the CEC —
(sin double) ' otter blind, etc.) (shadescreett etc-) (yes/no) (met Wood) 1z:3352( Water heater insulation blanket (R-12 or greater) or combined interior)eaterw
:imulatian (R-16 or greater): fust 5 feet of pipes closest to tan insulated (R-3 or greater).
NorthJA 12.5312(Eaeeytion n: Pipe insulation on steam and steam condensate rerun ger resin attesting .. .
North :piping
East (� J ^�' ... i ' 4 +, _,� . 12-5319(d: Swimming Pool Hwting _
1. Systtm has -
East ( ) : i • . ' ( :i : - i on/off switch On heater.
Snatch (✓� ii b. Wcuhcryroof instruction plate on heater.
�•_.•
L Plum to allow for solar.
t t
- --
South'.. (. ) .; •...:..... _- - - -- z.7�percetnt efficiency..
West (�" ^. ,.-MIC Clock
}3.:, cover. �„at-:t^. _ •: r r__ M1.
West � - 5. Directional watt inlet ,._ •• ....�... ,._._ - - '
'LightinYandApplianceMeasures
Skylight....:..
42=5352(& Lighting - 25 lumenywatt or greater for general lighting in kitchens and bathrooms.
THERMAL MA = , _ .
SS i ! ...1 t 42=5314(0: Cas fired appliances equipped with intermittent ignition devices.
' Type/Covering Area ThickneSs
- . r- : 4(s: Refrigerators, refrigerator-freaers• 6eercrs and ntorescent tamp ballasts certified ti
.• .,, , ...t ..: � 42-531 ,
(slab/ x sed, tile, etc.) s inches LOeation/Descri tion Itchen, bath, etc. I Dy`the CEC•Indicate make and model number.
M1
JCOMPLIANCE STATEMF.IV'T ........... ... _... _. _.., , . . r ,.: _ •. . _. p
'Ihis;certifiCUC of compliance lists tb. bw1 ' fcatw and ormance fications needed to comply with
: Mile 24. Chapter 2-53 amend Titie 20. C' p4ir2. Subchapter 4. performance
1 of the California Administrative code- This
certificate has been signed by the individual with overall design responsibility and the buildingowner. who shall
HVAC SYSTEMS Minimum Duct :a ! retain a copy of it and transmit the certificate aro nay subsequent purdlaser of the building. _
Type (furnace, air Efficiency Location ; _ Duct Output;.' ` Manufacturer / Model # v I :
conditioner, heat urn )•. (SE, SEER.HSPF) (attic, etc. R -Value tuh ' �'• r // Designer
-- ) o approved al �I 1 Building O r
" TAT2ic, .�_Z L e Address: —
-'4Y �G' Address: 12 -
Tc
�P P.r.�•P�.t 2� .
J n T_
Tekphone
• Maximum Furnace Heating Output: � s • Btuh �'+ :_� _ : 111 � Lie. 0: ,
HOT WATER SYSTEMS Tank Manufacturer/Model # f`^'" ✓ j
--System Type (storage gas:'eek:)- _ (city (or;aPProved equal) ---!--—_—SDecial-Feature(s) -- _
CDlMrTAT ICV.A'rTrot`CfD'1►.t•ADTIerAAA--..--I.......,:c--------- I
r
Documentation Author
Name
TitWFtln:
Ad&=:r
Enforcement Agency
Name:
A9ertey:
Telephone
ng insulation
Specification
-48
Number of stories
+
One
WR
Two
Three
-103
-49
32
R-19 -8
-4
.2
R-30 .2
-1
.1
R38 0
0
0
0.08
4
3
0.50 -176
-84
-54
0.30 -102
-49
32
0.10 -26
-13
-8
- 0.08 -18
-9
-6.. .
' 0.06 -11
-5
-4
0.04 -4
-2
-1
0.02 4
2
1
a 0.00 11
1
- 5
3
--
30
1 7. Wall Insulation
Number of stories
-4
' Single-
Single -
Two
Family
Family
Multi -
R -value Detached
Attached
Family
R-0 -68
-51
34
R-11 0
0
0
R-13 2
2
1
R-19 8
6
4
U -value
Specification
-48
-69
0.80
-153
-114
-76
0.50
-91
-68
-46
0.30
-47
-36
-24
_ 0.10
0
0
0
0.08
4
3
2
0.06
9
7
5
0.04
14
11
7
i 0.02
19
.14
10
0.00
24
18
12
3
8
35
3. Raised Floor Insulation
-19
- -__--
Insulation In Floor
--
30
-61 -21
Number of stories
-4
R -value
One
Two
Three
R-0
-17
-8
-5 ;
R-11
.3
-2
-1
R-19 '
0
0
0
R-30
3
1
1
U -value
-49 -15
_8
-1
----.0.60 .
444
.70
.46
0.50 "'
-120
-58
38
0.40
-95
-46
30
0.30
-69
34
-22
0.20
-43
21
-14
0.10
-17
-8
-5
0.08
-11
-6
:. -4
0.06
-6
-3
.2
0.04
-1
0
--
01-
0.02
0.02
4
2
1
0.00
10
5
3
Controlled Ventilation Crawlspace
-26 3
2
Number of stories
12
R -value
One
Two
Three
R-0
-11
-7
-5
R-5
-4
-4
3
R-11
.2
-2
-2
R-19
-1
:, -2
.2
' 4. Slab Edge Insulation
7
--
14
Number of Stories
13
R -value
One
Two
Three
' R-0
0
0
0
R-5
8
5
2
R-7
8
6
3
F2 factor
10
3 9
11
0.90
-4
3
.1
0.80
-1
-1
0
_ 0.70. ._ ._...-2----___
8
2_._......__...1._-.
14
0.60
6
4
2
0.50
9
6
3
0.40
12
8
4
S. Infiltration (Air Leakage)
7..Shading (Shade Open)
Specification
-48
-69
Points
na
16
Standard ''
-42
+ 6
0 '
na
• 6. Glass`Heat Loss , ,.._-.--•,..._.�._._.... -
Total
-35
(percent glass x SC)
-46
U -value
12
Percent
--
.51 to
.41 to
.31 to 0.30 or
Glass
Single Double
.60
.50
.40
less
50
-121 -53
.39
.24
-10
4
40
-90 37
.26
.14
3
8
35
-75 -29
-19
.9
1
10
30
-61 -21
-13
-4
4
12
29
-58 -20
-12
3
5
12
28
-55 -18
.10
-2
5
13
27
-52 -17
-9
-2
6
13
26
-49 -15
_8
-1
7
14
25
-46 -14
.7
0
7
14
24
-43 -12
.5
1
8
14
23
-40 -ti
-4
- 2
8
15
22
37 -9
3
3
9
15
21
34 -7
-2
4
10
15
20
31 -6
0
5
10
16
19
-29 .4
1
6
11
16
18
-26 3
2
7
12
16
17
-23 -1
3
8
12
17
16
-20 0
4
9
13
17
15
-17 1
6
10
14
17
14
-14 3
7
10
14
18 I
13
-12 4
8
11
15
18
12
-9 6
9
12
15
19
11
-6 7
10
13
16
,
19
10
3 9
11
14
17
19
9
-1 10
13
15
17
20
8
2 -- 12 -
14
16,
18
20
7..Shading (Shade Open)
-14
-48
-69
-64
na
16
-12
-42
-59
Effective Pem:tt Class
na
14
-10
-35
(percent glass x SC)
-46
Effective
12
-8
--
- - -
%Glass
North
East South West
Skylight
18
.5
1 _ 4
1
na
16
4
2 5
1
na
14
4
2 5
1
na
12
3_
3 5
2
na
11
3
3 5
2
na
10
2
3 5
2
1
9
2
3 5
2
2
8
2
3" 5
2
2
7
1
3 4
2
2 -
6
1
3 4
2
3.,_
5
1
2 4
2
3
4
0
2 3
1
3
3
0
1 2
1
3
2
0
0 1
0
3
1
-1
-1 -1
-1
2-
0
.1
.2 -4
-2
0
na = not allowed
13
7.0 6
9
IB. Shading (Shade Closed)
Effective Percent Class
(Percent glass x SC)
Effective
%Glass North East South West Slgfiot
18
-14
-48
-69
-64
na
16
-12
-42
-59
-55
na
14
-10
-35
-50
-46
na
12
-8
-29
-40
37
na
11
-7
-26
36
33
na
10
3
-23
31
.29
-74 "
9
-5
-20
-27
-25
-65
8
-5
-17
-23
-21.
.56
7
-4
-14
-19
-18
-47
---6 ----...3....__._91
2 4
._.....,15
5
_ .14 ....
_38 .._.- ..
5
.2
-9
-11
-10
-30
4
-1
3
3
-7
-23
3
0
-4
-5
-4
-16
2
1
-1
-2
-1
-9
1
1
1
1
1
-4
0
2
3
4
3
0
na . not allowed
12
6.0 5
-
10 12
9. Interior Thermal Mass
Interior
Slab Floor
Raised Floor
SEER
Mass
Stones
Stories
(assume; ducts In attic)
/CFA One Two Three One
Two
Three
0.0 -8
-5
-4 -2
-1
-1
0.1 -8
-5
•3 -1
0
0
- : +5
`' +15
-'more
0.5 -6
•3
-1 1
1
2
0.7 -5
-2
-1 1
2
2
0.9 -5
-1
0 2
3
_ 3
1.1 -4
-1
1 3
4
4
-1.3 -3
0
2 3
4
5
1.5 -3
1
2 4
5
5
20 -1
2
4 5
6
7
25 0
3
5 7
7
8
3.0 1
4
6 8
8
9
3.5 2
5
7 9
9
10
4.0 3
6
8 9
10
10
4.5 3
7
8 10
11
11
5.0 4
7
9 11
12
12
5.5 5
8
9 11
12
12
6.0 5
8
10 12
13
13
6.5 6
9
10 12
13
13
7.0 6
9
11 13
13
14
7.5 " 6
10
11 13
14
14
8.0 7
10
11 13
14
14
8.5 7 10
12 13 -
14
15
10. Exterior Wall Thermal Mass
7.0
Exterior
Wall
Suple.:.
Si
0
0
8.0
Family
Ftjr -
Multi
.-
Mass
Detached
Attached
" _ _ Famly .
0.00
0
0
0
22
0.20
3
2
1
11.0
0.40
5
4
3
8
0.60
8
26 22
18
14
0.80
10
8 5
29 24
20
1.00
13
10
7
56
1.20
13
12
8
I.
1.40
12-
13
9
Stories
1.60
10
13
11..-
One
1.80
10
12
12
-2
2-00
10
11
13
2
11. Heating System
Single -Family Detached and
Attached ~
0.7
t
I Unit Size (sQ
1.3
Water
SE or
HSPF
1700
,
(assumes ducts In attic)
,
Credit
or l+ to
Sum of 1-6
10
Of
-25 or -24 to
-14 to -4 to
+6 to
16 or
SE HSPF
less .-15 ..
-5 +5
+15
more
0.72 6.60
0 0
0 0
0
0
0.75 6.88
3 3
3 2
2
1
0.80 -7.33
8- 7
6 5
4
3
0.85 7.79
13 11
10 8
7
5
0.90 8.25
17 15
13 11
9
7
0.95 8.71
20 18
-15 13
11
8
-15
Effective SE or HSPF
1.6
_ - (SE or HSPF x duct efficiency)
-1 .1
Effective -25 or -24 to -14 to .4 to +6 to 16 or
SE HSPF less -15
-5 +5
+15 more
0.30 275
-73 -64
-56 -47
38
.30
na 3.41
-45 -39
-34 -29
-24
.18
0.40 3.67
-34 -30
-26 .22
.18
-14
0.50 4.58
.10 -9
-8 .7
.5
-4
0.56 5.13
0 0
0 0
0
0
0.60 5.50
5 5
.4 3
3
2 •,
0.70 6.42
17 15
13 11
9
7
0.80 7.33
25 22
19 16
13
10
0.90 8.25
32 28
24 20
17
13
1.00 9.17
37 32
28 24
19
15
Zonal Control Adjustment
4 _-3
System Type
3
Muld-Family (Indlvidual
units)
36
Resistance
10 9
7 6
4
3
Other
6 5
4 3
2
2
12. Cooling System
SEER
(assume; ducts In attic)
Interior Mass/CFA
Sim of 7-10
-25 or -2410 441o,
-410
+610
16 or
'--SER lest
--.15
- : +5
`' +15
-'more
8.0
-14
-12 -10
-8
.6
-4
8.5
-9
-7 -6
-5
-4
3
8.9
-5
-4 -4
-3
-2
-2
9.0
-4
3 -3
-2
-2
-1
9.5
0
0 0
0
0
0
10.0
4
3 3
2
2
1
10.5
7
6 5
4
3
2
11.0
10
9 7
6
4
3
�. 120
15
13 11
9
7
5
13.0
20
17- 14•--
12
9
6
90%
95%
Effective SEER
120% 125-
25`.•=•
.--M--0
--Mx-
0�--0.2-0.4.
�---0.2
(SEER xduct efficiency)
0.4-
046
0.8
Stm of 7-10
Effeclivd-25 a ,24 b -1410
410
+6 b
16 or
SEER less
-15 S
+5
+15
more
5.0
30
-25 -21
-17
-13
-9 I
6.0
-12
-11 -9
-7
3
-4
6.6
-5
-4 -4
3
--2
-2
7.0
0
0 0
0
0
0
8.0
9
8 6
5
4
3
9.0
16
14 12
9
7
5
10.0
22
19 _ 16
13
10
7
11.0
26
" 23 19
15
12
8
120
30
26 22
18
14
9
13.0
33
29 24
20
15
10
i
Zonal Control Adjustment
56
30%
10
8 7
6
4
.3
'
No Cooling System Installed
2
Stories
24
26
28
I
One
` -5
•4 -4
3
-2
-2
Two +
3
3 2
2
2
1
Single -Family Detached and
Attached ~
0.7
09
I Unit Size (sQ
1.3
Water
1.7
1199 11200
1700
2200
2700
Heater
Credit
or l+ to
to
10
Of
Type
Type 'fess i 1699
2199_
2699
4.9
t SG
None
0 0
0..
- 0
more
0
or
Solar
12 8
6
5
4
- HP -
HWR
8 5
4
3
3
1.4
WSB
5 3
3
2
2
4.6
POU
8 5.
4
3
3 _..
SE
None
37 -24
-18
-15
-12
1.6
Solar
-1 .1
-1
0
0
28
HWR
-18 -12
-9
-7
3
4.1
WSB...
-25 -16
-12
-10'
-8
5.3
POU
-18 -12
-9
_7
.6 .
IG
None
-5 1-2
1.7
-2
-2
23
Solar
7,_ 5
-4
3
2
3.5
POU
3 2
1
1
1
IE
None
-28 -19
-14
-11
-9
6.1
Solar
8 5
4
3
3
1.7
POU
-10 3
.5
4 _-3
;
3
Muld-Family (Indlvidual
units)
36
3.8
4
Unit
Size (SO
4.7
4.9
Water
Healer
Credit
699 700
1200
17W
2200
Type _Type
or to
less_ 1199
to
1689
10
219ti
or
more
SG
None
0 0
0
0
0 i
or
Solar
14 7
5
4
3 .
HP
HWR
9 5
3
2
2
5.6
WSB
9 t41)
3
2
2
1.3
POU
9 5'
3
2
2
SE
None
-45 -23
-15
-11
-9
M,41 4
Solar
2 1
1
0
0
5.3
HWR
"-23" -12
-8
-6
'-5
-
WSB
- -25-.._-13 .....g._...6_..._..5
1.6
1.8
..
22
i'_QU---0 -x_8_.-6
26
-5
IG
None
-8 -4
.3
-2
f 2
-
Solar
6. 3
2
1
, 1
5.6
POU
1_O
0
0
_0
IE
None
30 -15
_
-10
-8
6-
25
26
Solar
18 9
6
4
4
3.8
POU
-8 -4
.3
-2
2
rolnt bystem summary: (aimate Gone 11
SCORE CARD
Measures Point Scores i
1. Ceiling Insulation--__._..�.T_�_ . 1
V-alue [3 1 U -value [0.030] ! .
2. Wall Insulation _ �r ^ ' __ `- - -•
R- aloe Ll1] U -value [0.098]
3. Raised Floor Insulation r q; or
R -value f 191 - U-value[0.037]
y4. Slab Edge Insulation or -
R -value [0] F2 factor [0.77] 1
5. • InfiItration Standard '
`. _....
6. Glass Heat LOSS-
Type
[double] U -value [0.65] _ % Total Glass 1161 Sum 1.6
7. Shading (Shade Open)
% SIC Eff. %Glass
a. North X
b. East 2. x - = l.! O
.- - c. South -- --- - • X I = �•, �, `� '
d. West x -}-
e. Skylight 4. x
t3U
8. Shading (Shade Closed) 1
% Glaqs SC Eff. % Glass
a. North r x j� = os
b. East 2, x _
c. South •S x -`-
d. West X -- _ •,
e. Skylight .• x
9. Interior Thermal Mass _ TYPE 1 MASS AREA . 0%
COND. FLOOR AREA
InteriorNus/CFA
10. Exterior Wall Mass 0 - TYPE 2 MASS AREA ail
ND. L OR AREA ---
Exterior Wall Mass Sum 7-]0
11. Heating System �'f� x
Zonal Control? ( Y / N) SE or HSPF Duct Efficiency 1678) Effective SE or
10.771 __........._ .HSPF [0-W5.15j-- _
12. Cooling Systemf'•-
Zonal Control? ( Y / N) SEER 19-51 %ct ficiency [0.741 Effective SEER [7.03]
13. Water HeatingISG] it none] . }�
Point Totak ,;
Interior Mass/CFA
. TYPE PASS
Ic,tw -t.b)
4~TYPE
1
KhSS
(UIMC a 4.2,
le:
ex sed,slab)
O%
5%
10%
15%
20%
25%
30% 35% 40%
45% 50%
55%
60%
65i-
70%
7S%
80%
WY-
90%
95%
100% 105% 110% its%
120% 125-
25`.•=•
.--M--0
--Mx-
0�--0.2-0.4.
�---0.2
0.4-
046
0.8
1.1•-1.3--•1.5-•1.7
1.L•
__
23
25
2.7"29-`3.2'3.4
"3.6"3.8"4-"'4.2`4.4-'4.6-"4.6•'5
53
10%0.2
0.4
0.6
0.6
1
1.2
1.4
1.5
1.9
21
23
2S
27
2.9
3.1
3.3
3.5
3.7
4
4.2
4.4
4.6
4.8
5
5.2
5.4
20%
0.3
0.6
0.8
1
1.2
1.4
1.6
1.8
2
22
24
27
29
3.1
3.3
SS
A7
1.9
4.1
4.3
4.5
4.8
5
52
5.4
56
30%
0.5
0.7
0.9
1.1
1.4
1.6
1.8
2
22
24
26
28
3
32
3.5
3.7
19
4.1
4.3
4.5
4.7
4.9
5.1
S.3
5.6
5 8
40Y.
0.7
09
1.1
1.3
1.5
1.7
1.9
22
24
26
28
3
3.2
3.4
3.6
3.6
4
4.3
4.5
4.7
4.9
5.1
5.3
5.5
5.7
5.9
SOY.
0.9
1.1
1.3
15
1.7
to
21
23
25
27
3
32
1.4
3.6
A8
4
42
4.4
4.6
4.8
5.1
5.3
5.5
5.7
5.9
6.1
SS%
0.9
1.1
1.4
1.6
1.6
2
2.2
24
2.6
28
3
32
3.5
3.7
3.9
4.1
49
4.5
4.7
4.9
5.1
5.3
5.6
5.8
6
6.2
60%
1
12
1.4
1.7
1.9
21
23
25
2.7
29
11
1.3
3.5
3.8
4
4.2
4.4
4.6
4.8
' 5
5.2
5.4
5.6
5.9
6.1
63
65%
1.1
1.3
1.5
1.7
1.9
22
24
26
2.8
3
3.2
3.4
36
3.8
4
4.3
4.5
4.7
4.9
5.1
5.3
55
5.7
5.9
6.1
6.4
70%
1.2
1.4
1.6
1.8
2
22
25
21_
2.9
3.1
3.3
1.5
3.7
3.9
4.1
4.3
4.6
4.8
5
5.2
5.4
5.6
58
6
6.2
64
75%
1.3
15
1.7
1.9
21
23
2.5
27
3
3.2
U
1.6
M,41 4
4.2
4.4
4.8
4.8
5.1
5.3
5.S
5.7
5.9
6.1
6.3
6.5
WY.
1.4
1.6
1.8
2
22
24
26
2.8
3
3.3
3.5
3.7
3.9
4.1
4.3
4.5
4.7
4.9
5.1
54
5.6
5.8
6
62
64
66
85%
90%"
1.4
1.5
1.7
1.7
1.9
2
2.1
2.2
2.3
24
25
26
2.7
2.8
29
3
3.1
3.2
3.3
3.4
3.5
3.6
3.8
4
4.2
4.4
4.6
4.8.
5
52
64
5.6
5.9
6.1
63
65
67
95%
1.6
1.8
2
22
25
27
29
3.1
33
3.5
3.7
3.8
3.9
4.1
4.1
4.3
4.3
4.5
4.6
4.7
4.8
4.9
5
5.1
5.2
53
5.4
SS
5.6
5.7
5.8
5.9
6.2
64
66
68
100Y.
1.7
1.9
21
2.3
25
28
3
32
3.4
3.6
ae
4
4.2
4.4
4.6
4.9
5.1
5.3
55
5.7
5.9
6
6.1
6.2
6.3
6.4
6.5
6.7
6.7
6.9
7
105%
1.8
2
22
2.4
2.6
28
3
3.3
3.5 "
3.7
3.9
4.1
4.3
45
4.7
4.9
5.1
5.4
5.6
5.8
6
6.2
6.4
6.6
68
7
110%
to
21
2.3
25
27
29
St
1.3
3.6
3.8
4
4.2
4.4
4.6
4.8
5
52
5.4
5.7
5.9
6.1
6.3
6.5
6.7
69
7.1
115%
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6
3.8
4.1
4.3
4.5
4.7
4.9
S.1
5.3
5.5
5.7
5.9
6.2
6.4
6.6
6.8
7
7.2
120%
2
2.3
2.5
2.7
29
1.1
1.3
3.5
1.7
3.9
4.1
4.4
4.6
4.8
S
5.2
5.4
5.6
58
6
6.2
6.5
6.7
6.9
7.1. •
7.3
125%
21
23
25
2.8
3
3.2
1.4
3.6
3.8
4
42
4.4
4.6
4.9
5.1
5.3
55
5.7
5.9
6.1
6.3
6.5
6.7
7
7.2
7.4
rolnt bystem summary: (aimate Gone 11
SCORE CARD
Measures Point Scores i
1. Ceiling Insulation--__._..�.T_�_ . 1
V-alue [3 1 U -value [0.030] ! .
2. Wall Insulation _ �r ^ ' __ `- - -•
R- aloe Ll1] U -value [0.098]
3. Raised Floor Insulation r q; or
R -value f 191 - U-value[0.037]
y4. Slab Edge Insulation or -
R -value [0] F2 factor [0.77] 1
5. • InfiItration Standard '
`. _....
6. Glass Heat LOSS-
Type
[double] U -value [0.65] _ % Total Glass 1161 Sum 1.6
7. Shading (Shade Open)
% SIC Eff. %Glass
a. North X
b. East 2. x - = l.! O
.- - c. South -- --- - • X I = �•, �, `� '
d. West x -}-
e. Skylight 4. x
t3U
8. Shading (Shade Closed) 1
% Glaqs SC Eff. % Glass
a. North r x j� = os
b. East 2, x _
c. South •S x -`-
d. West X -- _ •,
e. Skylight .• x
9. Interior Thermal Mass _ TYPE 1 MASS AREA . 0%
COND. FLOOR AREA
InteriorNus/CFA
10. Exterior Wall Mass 0 - TYPE 2 MASS AREA ail
ND. L OR AREA ---
Exterior Wall Mass Sum 7-]0
11. Heating System �'f� x
Zonal Control? ( Y / N) SE or HSPF Duct Efficiency 1678) Effective SE or
10.771 __........._ .HSPF [0-W5.15j-- _
12. Cooling Systemf'•-
Zonal Control? ( Y / N) SEER 19-51 %ct ficiency [0.741 Effective SEER [7.03]
13. Water HeatingISG] it none] . }�
Point Totak ,;
77-
rf7
0". r,
,;X� 4,
Jo
5
N IRW, 11:1 1 1 1 . I I : I '' I . I . I I I I I . , , I , I I I — 7---— 1 �� I I -- - �11111 . 11 -h-iu j - W-" " - "
ii I . - I -
TM Jkl 7" TTINT 77?
�%03