HomeMy WebLinkAbout064-690-009ENCROACHMENT PERMIT,
County of Butte Department of Public Works 34 -36�
7 Count Center Drive Oroville, CA 95965 Phone (530) 538-7157 Ext. 2016 Fax: (530) 538-4356
Download Forms: www.buttecounty.net/publicworks/forms.htmi I S S kAJ
:40TIFY COUNTY 24 HU u &b t5 Er ORE w ORK IS TO BE DONE
Permit Number
istrict
Phone (530) 538-7157 Ext. 2016
e!? Alik;
-PL-1-eA-T-10N
-E, . hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads
the undersignqd,
accordance with County ordinances and general laws. (All information ex pt siknature must be typed or legibly printed.)
--c
�ighways, al 0 mpany Name:
e- F' —a
I'dress: r /-Ar y
L4
4. ssessor's Parcel Nurfiber.
one: r?
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. 7. Dite:
*i6jfit -s-Siiriaturd-
CONTRACTOR'S INFORMATION
D—
ntractor t ame IL L-
.ddress
W, .-0 - -,z Cf
-/ a M - - .1
�hont:
Contractor's License Nurnota. -42 r- - - -27 OPT- Jlf-- 13. Certificate of Insurance: Yes El No:
14a. Date Signed:
co
/(-�i tor's Signature:
Autnori�Age-t�
TYPIE OF WORK TO BE DONE
Please Check: Curb: Gutter: El Sidewalk: El
17. If Dnveway List Type:
-
Other Work - Describe:
19. Plans Attached:
� Yes 0 No
PER1\11T GRANTED
:*mpliance with the above request. and subject to all terms, conditions (including those on page 2 ofthis permit form) and special conditions written below,
-mission is hereby granted.
Conditions -Q
t ,Z: C 0 V11
C
iderground Service Alert (U.S.A-) must be notified two working days prior to any excavation. 800-227-2600
ina: Detail El Plans 0 Special Conditions IkT
,/IV* All work shall conform to accompany ,
23. Expiration Date:
Date Issued 4,
24. Surety:
u -
Date Paid: 26.-Arnou t Paid �27 Paid BY: -
2 8. Receipt No
rump, Director of Public Works zsza
ion Date-. 30�isptcltl
–T29 inal Inspection Date: 30. Inspr.Ma By:
1ett�d-��-�>--/ 0 Completed-NotOK
et'
Miti �ona
�'Fin.l
rCounty �By
-hed
I Comments Attar
I Comn
Q.1y-
3 1. Comments: OK
I t--(,/ I - lr�
ote: If perm are faxe-d o any number besides (530) 5384356, they can be delayed up to one week.
P— I nf 2
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-TS41 FAX#: (530)538-2140
WEBSITE: www.buttecounty.neAdds
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.
License Class: License Number:
Date: - Contractor.
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 penalty 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 LicenseLaw 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.).
X1. as owner of the properly, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Profdssions 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.).
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:
0 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.
EI I 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
insurance carder and policy number are:
Carrier.
Policy #:
I certify that in the performance of the work for which this permit Is
issued, I shall not employ any person in any manner so as to
become subject to 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.
Dais: Z Z / !I / %- a 0 r —
Applicant: M, /,4.0Tte7-r-JLr_
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the
performance of the work for which this permit Is issued (Sec 3097 CIv.)
Name:
Address:
PERMIT NO.
BP043068
Issued Date: 01/19/2005 APN: 064-690-009-000
Site Address: 14818 COLTER WA* Y MAG
Map Index:
Description: NSF(1601)GAR(400)OPN(449)COV(64)
Owner: HOSTETTER REVOCABLE IV TRUST
HOSTETTER KARL M & THELMA M
TRUSTEES
14824 COLTER WAY
MAGALIA, CA 95954
Applicant: HOSTETTER REVOCABLE IV TRUST
HOSTETTER KARL M & THELMA M
TRUSTEES
14824 COLTER WAY
MAGALIA, CA 95954
Contractor: VERN DARYL HALL
7166 BEVERLY LANE
PARADISE CA
95969
(530) 521-0711
License #:
Architect:
Engineer: HUBLEY, MICHAEL D.
Total Square Ft: 2514 S.F.
Valuation: $119,179.00
Census Code:
.41 At n,00&4 1) 3-1?
This permit is hereby issued un r the applicable provisions of the BiAte County 000 Anctlor
ResoMionsJb do work nd, I ove for which fees have been paid.
By. � 7,= — Date:
PERMIT EXPIRES ON:
0 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.
0 Notification In accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
0 Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information is correct, and th ' atl 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: KAX L M , /—�,O Jf 7- -Signature:
Date: 7— .0 a
Or'owner
0 Contractor
Q Agent for Owner
C3 Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES 105-6,916
BUILDING PERMIT APPLICATION C/ -9
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED A T TIME OF APPLICA TION
"PLEASE PRINT CLEARLY"
OWNER
CONTRACTOR
Last Name /_/ .
rirst Name
ddress
zip
:2 �:
-'city
C
Addres
S/919 2- 1 C
A
city A CA L;I-)
'ate,,�. A
�-17
Phone
Fax
Lic. #
Atlle.1:21V
E-mail
ARCHITECTIENGINEER
CONTRACTOR
Name
City
f A IL D I �'-k
ddress
zip
:2 �:
-'city
Fax
,.e
State
Tip
/Phone
TO
-Fax
E-mail
I Date Approved:
Lic. #
Atlle.1:21V
r)
ARCHITECTIENGINEER
liim—e
St 12 e-�Q
Address
6,
City
f A IL D I �'-k
State
C
zip
:2 �:
Phone
Fax
,.e
E-mail
State License Number
APPLICANTNAME
Name
Address
City
Sta
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X �-' - /'4
For office use only:
AP# eNZA-
Zoning 1 12-1
1 Flood Zone I X I SRA No
Occ.
WORKER'S COMPENSATION
I Type Const.
Subdivision Name
4thiring anyone other than license contractors, a cerdficate of worker's
compensation must be shown at the time of permit issuance.
Map Book
I Page
TO
Planner
I Date Approved:
PERMIT
NO.
BP-C43eYe�81
I BINA,41 I
LOCATION
AP# eNZA-
Property dress
V\L
city
I
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
4thiring anyone other than license contractors, a cerdficate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
-Narn
Address
Description or Scope of Work:
r 1 (-45 1 ) A--77-
'DFx� (44-1) C4:,,v O-Gc�
Sq. Footage
0 Structure Built without Permits
0 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
Reffinds 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
Received by: Amount: -1-0 Bldg
9 95 SRA
Receipt#: +13e:)53 _-___Sheriff
I Date: j e) - p 0 - 0,+
OVER FOR SUBMITTAL REQUIREMENTS L,
K:XFORMSXBUILDING FORMS\BldgAppISubRqmts.doc Page 1 of 2
SMIP
----Other
19 Total
REV 7-27-04
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 INIC
0� a!
" %` "
1.
6
Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paperl
Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paperl) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
E]
3.
Engineered truss details and layouts in duplicate (if required). No faxes!
0
4.
Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes'.)
0
5.
Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
13 '6.
Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
0
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.
0
8.
Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
0
9.
Site plan and business license approval from the City of Biggs.
0
10.
Letter of intent for non-residential buildings.
0
11.
Detached Accessory Building Form filled out by the owner (if required).
0
12.
Hazardous Material Form (for Commercia[Buildings only).
-3—Sadtation-aridite-pl.arLap.pmyaLfrom-tbe-EnMronm.entaLH-eanD-epartment-
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.)
0
1 .
Agricultural Buffer clearance and site plan approval from the Ag Commissioners office (if required).
El
2.
Impact Fees.
El
3.
California Department of Forestry plan approval (if required).
0
4.
NPDES Form.
0
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0
6.
Contractor's license information. (Number, Name Style, Classification).
0
7.
Worker's Compensation Carrier and Policy Number.
0
8.
Owner -Builder Verification (if required).
0
9.
Letter of Signature authorization (if required).
0
10.
Recorded copy of Agricultural Acknowledgment Statement.
0
11.
0 Grant Deed, E3 M.H. Title/Statement of Facts, 0 Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application 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
KAFORMSMILDING F0RMS\B1dgApp1SubRqmts.doc Page 2 of 2 REV 7-27-04
Applicant: I Hostetter, Karl Permit 104-3068
Project Type: FNSF/Att. Gar/Open Dk/Cov.Dk APN: 1064- 90-009
100% 70%
Plan Check Fees $ 1,056.96 739.87
$ 1,056.96 $ 739.87
IWILLDAN Fee $ 739.87
Copies Attached: Qty
Chk
Application
Site Plan Review
FEMA Elevation Certificate
Building Plans
Truss Calculations
Energy Calculations
Structural Calculations
Residential Plan Review Guide
Residential Construction Requirements
Other
Other
Butte County Department ofDevelopment Services %3Tr
YVONNE CHRISTOPHER, DIRECTOR 0 0 0
100
0 0
7 County Center Drive 0
0 0
Oroville, CA 95965
co
(530) 538-7601 Telephone
(530) 538-7785 Facsimile
TO: WILLDAN
qrm
FROM: Scott Rutherford (530) 538-7160
T�
srutherford(ftuttecounty.ne
SUBJECT: Plans Transmittal For Review Per Contract
DATE: 10/22/2004
Applicant: I Hostetter, Karl Permit 104-3068
Project Type: FNSF/Att. Gar/Open Dk/Cov.Dk APN: 1064- 90-009
100% 70%
Plan Check Fees $ 1,056.96 739.87
$ 1,056.96 $ 739.87
IWILLDAN Fee $ 739.87
Copies Attached: Qty
Chk
Application
Site Plan Review
FEMA Elevation Certificate
Building Plans
Truss Calculations
Energy Calculations
Structural Calculations
Residential Plan Review Guide
Residential Construction Requirements
Other
Other
e)PZ4304ob
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: -ASSESSOR PARCEL NUMBER e:>,r,,4 - 6.-)o
Proposed Building Use: IJ -5 F Counter Technician: L--)-,-4 A- Date: 10 -
Items required in orde�t, ) o apply for a permit. All boxes MUST be checked OR marked NA in order tolapply.
1 . Site plans, ��pr 4 sets, signed by the preparer of the plans.
0. 2. Complete plbns, 3 or 4 sets, signed by the preparer of the plans.
3. Engineered plans, ft, r 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
4. Engineered truss dbfails and layouts in duplicate. No faxes!
21 5. Letter from Engineer or Architect for truss design review.
'X 6. Energy compliance design and supporting documentation in duplicate.
0 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
0 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
0 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of lhese
must be stamped and wet -signed by the enginee .
0 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate
0 11. Site plan and business license approval from the City of B:iggs
0 12. Letter of intent for non-residential buildings
0 13. Detached Accessory Building Form filled out by the owner
0 14. Hazardous Material Form
15. Sanitation and site plan approval from the Environmental Health Department in C�dhico 13 Oroville, as applicable.
16. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
0 17. Fire Sprinklers .............................................................................................
0 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by_..
0 19. Soils Report and/or Engineered Foundation required ........................................... ........
2
.a_Erosion Control Plan Required
U�lees as shown on the attached Schedule of Fees Due Sheet ..............................
0 22. City of Chico Plumbing permit ....................... ' *:d" � .............. * .... -----
23. California Department of ForStV plan approvai'VpDai . entby: LH 5F
24. Planning approval (A) Use: _Qj�=413)Parking: _(C) Parcel C�ec�k
25. Contact Land Development about - Improvements, - Drainage ........
0 ($NPIDESForm .........................................................
27. ncroachment Permit for driveway from the Public Works* ......... *..* .............
8. )Pre -Inspection for required .......
[;�,- fT29"�on tractor's license information. (Number, Name Style, Classification) ...................
Gg,' �,�Worker's Compensation Carrier and Policy Number ..................................
31. Owner -Builder Verification (_ Given to owner, -Mailed to owner) ..............
32. Letter of Signature authorization ......................................................... * ........
33. Recorded copy of Agricultural Acknowledgment Statement ...................... * .... * * ....
0 34. Manufactured home utility clearance ...............................................................
0 35. Existing violations and/or expired permits .........................................................
0 36. Deed Restriction ..................................... ** .........
0 37. 0 Grant Deed, 0 M.H. Title/Statement of Facts, 0 Letter from Legal Owner, 0 Check to H.C.D. $
0 38. Other. -
0 39. Other:
When issued Telephone and hold for pickup.
I have been informed of the above items and requirements for obtaining a building permit.
Applicant: f jae, Q40=2te2 Date- Z
1. Index permit'application for the a6ove ifems _n�mbered: Plan Check Letter
2. Additional items required -AJ 0
Confractor, designer own was advised of the above dX43f 2�e, 0 t'darnter, by`T�a - te:
Contractor, designer, ner, was advised of the above data by 0 phone, 0 mail, 0 counte�, Y Date:
Date: Plans approved by: 11 A- Date.: 4�
Plans reviewed byi
Structural reviewed b i Date., Structural approved by: Date� n
Note transfer by: Dat
Yellow: Building Division
TO: Building Department
FROM: Environmental Health
BJE Sanitation Clearance
Owner
Plan Apor v MId3 Tf : Sewage Disposa
9
Clear@nc , o dwelling. Other
Hold final for:
Final clearance O.K. for:
NOTE:
E. H. U S�, E rg N
Flat Plan Artachad VI..)-
Aaaa, Man Attachs4
sent to S.D.
213 -
Lo'catio'n Al
Wati SUP (Fublic Private re 11 A__
8/96
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541
SCHEDULE OF RECEIPT OF FEES
0 WN E R T T U- P-
PROPROSED BUILDING USE JS F (I 40p) A --FT 6AP- ' 4-00)
or_>at.4
1. BUILDING PERMIT FEES
--- Balance Due .....................
--- Additional Fees Due ........... $
--- Revised Plan Checking Fee..., $
2. SCHOOL DISTRICT FEES CL
(paid at School District Office) (form available aft- --
3. SHERIFF FEES (paid at Building Division)
Residential ............ I X $360.00
Units
A. P. # ce—_4- - 6 c;in - c�e5 e7
DATE 6 4D - _-)�o , 4 -
RECEIPT # DATE REC.
Commercial (sq. ftg.)..... X $0.03 $
Sq.Ftg.
4. URBAN AREA FEES (paid at Building Division)
Residential (per unit) - - - - - x = $
# Units Amt.
Commercial (Sq. Ftg.).... x $
Sq. Ftg. Amt.
5. RECREATION DISTRICT FEES
(paid at Recreation District Office) (form available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. S -RA FIRE INSPECTION AND PLAN CHECK FEE
S99.00 ( aid at Building Division)
.2-04—'145
8. WATER TENDER FEES BATTALION #
$200.00 (paid at Building Division)
9. NORTH CHICO SPECIFIC PLAN (paid at Building Division)
Residential Zone X $
Zone # Units Amt.
Commercial (sq. ftg.) ......... $
4-1-3033 10 - _26 ; 04 -
Sq. Ftg. Amt.
10. OTHER
4 7F
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. 'these fees
may be chang�d during the plan checking process.
APPLICANT lCe2,( DATE / 49 /-z-
Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You
have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requiremenis for a
protest are specified in Government Code Section 66020(a).
Original-Bui Wing Division Yellow -Applicant Pink -Owner (rev. 2/2003)
Department
J. Michael Crump, Director
Public Works
LAND DEVELOPMENT DIVISION
Storm Water Management Program
7 County Center Drive
Oroville, CA 95965
(530) 538-7266
(FAX) 538-7171
National Pollutant Discharge Elimination System (NPDES) Phase 11
Construction Storm Water Permit and Storm Water Pollution Prevention
Plan (SWPPP) Acknowledgement fLESS THAN I ACRE
Project Description:
Project Location and/or Parcel Number: C) (-, C_/ — 6 C� C7 -- 0 0 C�_
By signing below, 1, the project owner/owner's agent, certify that this project WILL NOT DISTURB
I'acre or more of land and that 1, therefore, do not need to apply for a Construction Storm Water Permit
from the State of California Regional Water Quality Control Board. Phased projects that contain
multiple site build -outs of less than one acre but when combined with subsequent phases total more
than one acre of disturbed soil will require a Construction Storm Water Permit from the State of
California Regional Water Quality Control Board.
I am aware that submitting false and/or inaccurate information or failure to apply for a Construction
Storm Water Permit from the State of California Regional Water Quality Control Board for a project
that disturbs one acre or more of land may rdsult in revocation of grading and/or other permits or other
sanctions provided by law.
Signed:
Title:
Date:
Less than I Acre NPDES & SVTPPP Compliance Certification
Butte County Storm Water Management Program
Revised 5/24/04
BOB MANGRUM
4ERGYCONSULTA�IT
530-876-9616
-ECHANICAL DESIGN
PARADISE M
Title 24 Residential - Title 24 Commercial
UC: 11518627 -
TITLE 24 SUMMARY
JOB NAME:'
H.E.R.S. VERIFICATION REQUIRE, D
YE S NO
INSULATION:
ATTIC
WALL
FLOOR
SLAB
F14CNESTRATION: S-7-AM10AAf) A�J,,-� 4-oto62�- v1A)KL-
"U" VALUE, 0, 91//.
0,
SHGC O -Z lo, 0 5 0 6 0 �.(o
A �1
SHADING
I-1VAC SYSTEM:,
SQUARE FOOTAGE /W
HE, ATING btu's = HSPF' AFUE:
COOLING btu's = SEER:
WATER HE ATING SYSTEM:
GAL. STORAGE GAS
E NERGY F ACTOR
GASINSTANT
RADIANT ROOF:
YES:
NO:
HOUSE WRAP:
NO:
5655 ALM014 D S TRE E-T
PARADISE,.CA .95969
530-977-3979 FAX
Oct 13 04 02:15p
� Xr
�r
AAAA12Tecch
VERTECH ENGINEERING 530 999 1102 p.2
October 13, 2004
Vert"icalTechnology
Engineering
30 RD U& AP- #2W, Up, CA, 99-P5
PK (5M) 89�-M6 F& (530) 899-11C2
RE: Hostetter Residence, Paradise, CA
To Whom it May Concern:
I have reviewed the truss calculations by Design Assistance dated 9-20-04 and 10-7-
04 and have found that the trusses appear to be designed in accordance with the
general design concept of the structural documents. The specific design shall remain
the responsibility of the engineer who has sealed the calculations.
V
AND WHEN RECORDED MAIL TO -
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
CC3PY of Document Recorded
09-Ko4-2004 2004-0068750
Has not been compared with
original
BUTTE COUNTY RECORDER
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit The property described herein is adjacent to land or included within an area zoned for agricultural purposes,
and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm
operations.
All that real property situate in the County of Butte, State of California, described as follows:
L ej 'r A V 5- � 0 o iL/ -f- H P, r c- -4
Z_ C L% t-1 F", P L- A S f2
0 0 -4 -Tr'- � --, C 6 U A__r_ � 0
F CJ 'N —'7 L -.f /L., -e f a ) I C� ') 0 1 - /ki .13 0
lr7 -2— - A., Z) -2 4 A/, A -
Date PROPERTY OWNERS:
EPA
State of California
County of 'Buxtc
On—U,c,t dir, ;FVt>'l — before me,
personally appeared a -4,d 7helerm_ tlosyle-ffei- personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s),Ware subscribed
to the within instrument and acknowledged to me that haWWthey executed the same in bisAher/their authorized
capacity(ies), and ibat by hkAwMheirsignature(s)on the instrumen tb,�Ret2op_(s) fteenflVSpan e Ifofwhich
_pQ �' te
the person(s) acted, executed the instrument. IaLEY PAMRSON I
WITNESS my hand and official seaL Commission # 14"378
Notary Pubsc.- Canomia If
Signature Seal: &ft cw*
42 0-- my Cmnm. Ex" 00 7.2004
A.P. # 0 C !-i. — 6 7 0 — (-) () 9
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N;�V WILLDAN
Serving Public Agencies
January 8, 2005
Scott Rutherford
Butte County Building Department
7 County Center Drive
Oroville, CA 95965
(530) 538-7169
(530) 538-2140 FAX
SUBJECT: COUNTY OF BUTTE PLAN REVIEW APPROVAL
117 C Street
Marysville, California 95901
530/749.2373 fax 530/749.2199
www.wilidan.com
Willdan Project No:
14353-1203
Jurisdiction Job No:
04-3068
Assessor's Parcel No:
064-690-009
Description:
Hostetter Residence
Dear Mr. Rutherford:
Willclan has completed a plan review of submitted plans and documents for the above referenced project
and recommends your approval with the conditions noted on the 2 rid page of this letter. The revisions were
in response to a previous plan review and comments listed in our letter dated November 15, 2004. The
plans and documents provided for this review that have been found in compliance with the applicable
codes are:
1. Plans: Two (2) copies I IxI7 Site Plan and sheets I through 7, dated 09-04 revised 12/13/04,
by Brant Nightingale Designs and sheets SN, SDI & SD2 dated 9/17/04 revised 12/7/04 by
Michael Hubley, S.E., and sheets H- I through H-3 dated 8/15/03 by Hardy Frames, Inc.
2. Structural Calculations: Two (2) copies dated 10-06-04 and two (2) copies Response To Plan
Check addendum dated 12/13/04, by Vertical Technology Engineering -Michael Hubley, S.E..
3. Ener2y Calculations: Two (2) copies dated 10-04-04, by Robert Mangrum.
4. Truss Calculations: Two (2) copies dated 09-20-04, by Mark Wegener, P.E.
5. Miscellaneous: Two (2) copies Engineer of Record's Truss Conformance Review Letter dated
10/13/04 by Mike Hubley, S.E.
The plans have been stamped with the Willdan approval stamp and dated the date of this letter. According to
our previous letters relating to this project the superseded plans and documents will be discarded within 10
days unless we receive other instructions.
On the pages to follow is the identification of the codes and standards applicable to the project, a code
analysis, conditions -of -approval and identification of any deferred submittals.
117 C Street
WILLDAN Marysville, California 95901
Serving Public Agencies 530/749.2373 fax 530/749.2199
www.willdan.com
APPLICABLE CODES
Unless noted otherwise, all comments are based on requirements. of the 2001 California Building
Standards Code found in the California Code of Regulations, Title 24:
• Part 2, known as the California Building Code and abbreviated herein as "CBC".
• Part 3, known as the California Electrical Code and abbreviated herein as "CEC".
• Part 4, known as the California Mechanical Code and abbreviated herein as "CMC".
• Part 5, known As the California Plumbing Code and abbreviated herein as "CPC".
• Part 6, known as the California Energy Code, and Energy Commission Standards, and
abbreviated herein as "CECS".
CODE ANALYSIS
Our plan review revealed the following information regarding the occupancy designation, type of
construction, and other pertinent features. This information is consistent with that shown on the plans.
Typeof
Typeof
Sprinklers Stories
1" Floor
2 d Floor
Total Sq Ft
Occupa
Construction
Sq Ft
Sq Ft
Am"
---
R-3
V -N
N/a 1
1,601
N/a
1,601
U-1
V -N
N/a 1
400
N/a
400
Open Porch
V -N
N/a 1
449
N/a
449
Gazebo
V -N
N/a 1
64
N/a
64
CONDITIONS OF APPROVAL
1. Approval is contingent upon the review, requirements and approval of other departments
and/or agencies that have jurisdiction over this project.
2. All plan sheets shall be signed by designer or person responsible for the plans as required by
California Health & Safety Code Section 5536.1.
SPECIAL INSPECTION NEEDS
Our plan review reveals no Special Inspection needs pursuant to CBC 1701.
DEFERRED SUBMITTALS
None required.
Sincerely,
Richard Essenwanger
Plans Examiner
CC: Alice Mefford, amefford(a-)buttecounty.net
Brant Nightingale, 6457 Skyway, Paradise, CA 9596.9 FAX'(530) 877-4589
Karl Hostetter, 1-4824 Colter Way, Magalia, CA,,95954; Email: khth62@*aol.com
,iae 2 of 2
N Butte County 04-3068
Willdan 143.5 3 - 1.2,103TC21:
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICA TION FORM
(One form per Building)
School District
A.P. Number Jurisdiction: city
Property Owner
Property LocationlAddress
MR,
Building Department No.
jCounty
Ar
Subdivision
Lot No. .
Residential Development
Sq. Footage
No oflUving
Mobile Home
Addition/
*Supplemental to
(Group R)
Units
Installation
Conversion
Permit #
....................................................................................................
*(No foundation inspection)
Deed Restricted Sq. Footage
(Attach a signed copy
of Deed Restriction and Notice of Limited Use Facility document)
T:t'
Commercial/industrial
Sq. Footage_
New
Addition
(Including Exterior
Roofed Areas)
Building Department Representative
Date
No. , L,9,6— - 1!v 09
ek:�'&A School District certifies that K M. Por
V (Applicant)
lq,?
(Street Address) (Phone Number)
/A- C
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. by payment of $
square feet.
Representative
Paid by Check # Remarks:
lit
Date
Notice: You may protest the Imposition of the fees Identified above by submitting a written protest to the District,,in compliance with
Govemment Code Section 66020(a), within 90 days from the date fees ars7j,61d. Failure to submit a timely written protest will'prohlbit
you ftom chalk"Ing the Imposition of the fen In any court action.
ff. subsequent to the School District Represerdathri signing Oft Suits County Schools Impact Fee CartiftationFonn, the School District Is
OR by the applicable Local Planning Agency that this Project Is being reviewed under the California Environments! Otiality Act (CEQA�
thlep ai r may be subiedto additional school fen to full� ~*.Its Impact onthe school disbuft schools.
White (applicant), Yellow (building department), Pink (school district) feeform.)ds 0 0103)dmm
License Detail
Page 1 of 2
License Detail CALIFORkIA CONTRA(ZTORS STATE LICER
Contractor License # 416508
D I S C L A I M E R
A license status check provides information taken from the CSLB license data base. BeforE
on this information, you should be aware of the following limitations:
• CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject t(
complaint disclosure, a link for complaint disclosure will appear below. Click on the lin
button to obtain complaint and/or legal action information.
• Per B&P 7071.17, only construction related civil judgments known to the CSLB are di:
• Arbitrations are not listed unless the contractor fails to comply with the terms of the
arbitration.
• Due to workload, there may be relevant information that has not yet been entered ont
Board's license data base.
Extract Date: 01/19/2005
* * * Business Information * * *
VERN DARYL HALL
7166 BEVERLY LANE
PARADISE, CA 95969
Business Phone Number: (530) 521-0711
Entity: Sole Ownership
Issue Date: 01/07/1982 Expire Date: 01/31/2006
* * * License Status * * *
This license is current and active. All information below should be reviewed.
* * * Classifications * * *
I Description
�IGENERAL BUILDING CONTRAQ—TOR
* * * Bonding Information * * *
CONTRACTOR'S BOND: This license filed Contractor's Bond number 907916 in the ami
$10,000 with the bonding company
SURETY COMPANY OF THE PACIFIC.
http://www2.cslb.ca.gov/CSLB–LIBRARY/License+Detail.asp 01/19/2005
License Detail
Effective Date: 01/01/2004
Contractor's Bond ing-KListory
* * * Workers Compensation Information * * *
Page 2 of 2
This license is exempt from having workers compensation insurance; they certified that theN
employees at this time.
Effective Date: 08/19/1991 Expire Date: None
Personnel List
License Number Request Contractor Name Re- uest Personnel Name Re uest
Salesp.2rson Request Salesperson Name Re uest
@ 2005 State of California. Conditions of Use Privacy Policy.
http://www2.cslb.ca.gov/CSLB—LIBRARY/License+Detail.asp 01/19/2005
Page I of I
Jones, Karen E
To: khth621 @aol.com
Subject: Building permit
Karl,
Your building permit #04-3068 has been returned from Willclan and is here to be
completed at the Butte County Building Dept. at 7 County Center Dr, Oroville. There are
several items still required in order to f inish your permit. I was unable to contact you by
phone, it kept ringing. Please call us at your earliest convenience to f ind out what you still
need to do. 538-7541
Karen E. Jones
Plan Application Assistant 11
Building Division
Development Services
C>
01/12/2005
/7 -
ENCROACHMENT PERMIT
County of Butte Department of Public Works
7 Count Center Drive Oroville, CA 95%5 Phone (530) 538-7157 Ext. 2016 Fmc (530) 5394356
Download Forms. www.bunewmtynd/publieworksffbrmshtinI
OTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE pem"Un"er- DisWa
Phone (530) 539-7157 Ext. 2016 /19
AjTmeMHON
the undersiptA huvby apply ta, the Counly of Btluc fbr an enavadinwd pamdt to do tht Wowing work WMIffor ovcrdw County mads
;;'W� all w acwnjanee wA CounLy %dinum and Wmal laws. (AD mftmaMM MOCIPt 511natint must be typed or WIN x
licanfsNanit:
Ia. company NW=
A
C 0 c -e &,:r Ar CIN-- 5--p s- y
4. Assc=Ws Nice! Nuff6w.
it'
7 'y V
ition of Wo* to be Done
- C?, -"x - /A C x r 0 L^ /-r A- -f
Doe:
-1QN
CONTRACrOWS MFORMAI
/4 A L t- JL
Iress t�166 ff-eU_Q&C7-
6A_'+0;T_e
one,.
intmcWs license Wainber V -e 1- 72:
13. of 110sailinct: y es El NO:
)nuacws sqpm=
EC==ffmft
14L Daft SWmet
I SE
;thorized Agent
TYPE OF WORK TO BE DONE
me Chax. Cab: Gutter 0 Sidewak 0
17. U Ddvcmy Lid
ther work - D=mbe-
19.Pbm
in yes 0 NO
FERMff GRANTED
npli-ce wn ft abm mlom and =bjed to all ftrM condffions Cmdadft6m OR RV 2 Oft& Pumb UM)nd WCW 0000ffimffta bd.,
ission is beFft gmnt&
ondifion s
C
:E-
CC); 0 kC_ Ck QLe-,
xgromW Saviec Alut (U.SA) anat be noffitd tm wwkim dns pfi6f to MY =Mn*M SW227-26M
IF All work shall confonn to acconipanying. Debil 0 Plans 0 Special Condifions,,ff
We Issued 23. EMhadon Dat rx 24. Swety.
A RecciptWo
oea n2"Y 1 26. Aniom3ftV ;&02:z
ce Crump, Director of Public e,-A.A zmr. By:
29. Fi=J Insp=tion D= 30. Invociat W. 0 Carnplew - OK Lol 0 Completed —Not OK
MW 7 1 . . I , 0 Additional Contmeift Mwbed
If mmits am fned to anv
U4ft (530) 53&4356. they can be debyed op to ame vack
Jan 13, 2005.max
NOTE:
-PAVEMEW To EXTEND
AT JZ CROSS SLOPE
OR UATCH EXISTING .
ROADWAY CROSS SLOPE.
-PRIVATE DRIVEWAY FIELD REVIEW Al
Jan 13, 2005 (2).max
-.1ATION: DATe
EDGE OF E)OSTING PAVEMENT
(EP)
REMM MIN. DISTANCE:
bTRIGT^.
RMrr*.
-- ----- ---
15
FEED UNUT OF' ROADWAY
:)RIVEWAY LOOA 731-)
TIOM
3TANCE TO NEAREST INTERSECTIOM
""�EA
z
GHT DISTANCE
12* MIN.
3
2V MAYL TO BE
:NAw 0
IF POOR - REOMAMDATION TO IMPROVE-.
FN
R/W
0 CUT BANK
El REMOVE VEGETATION (TEMPORARY)
a 07HER (EXPLAIN)
10** M IN.
13MCENT-TOPQ
• FLAT*
• CULSILOPE --FL
"CL SLOPE
0 CURB AND GUTTER
e -A'6 DIKE
OTE:
E3 EXIST. DIST. I TO EP_FFT
'IMF GR�EATER THAN
10ZVP� OR DOWN
)FWNAGE RECOMMENDAMONS.-
REFER TO EN61NEERING.
El SVALE
0 CULVERT MAYL 1 FOOT VERT. RISE "OR DROP
PER 10 FEET IiOFdZ. 01§TAHCE..
'v r n'
MIN. DIST. J7.
UIN. DEPTH TOC__FT. EP
DIAMETER IN. 'ST_
QGST; -DIST.
LENGTH
MIN.
MIN_
FL
Dist
0 - OTiHER (EXPLAIN)_ 2X
NOTE:
-PAVEMEW To EXTEND
AT JZ CROSS SLOPE
OR UATCH EXISTING .
ROADWAY CROSS SLOPE.
-PRIVATE DRIVEWAY FIELD REVIEW Al
Jan 13, 2005 (2).max
F
SITE PLAN REVIEW APPLICATION
Date: If AP# 0 6 6 ��) ")o ?
Permit Number (if applicable) 0 30&Y Bin Number
A PPLICA]VT INFORMA TION Parcel Size:
-5 ze IL/74-
Owners Name:
Owners Address: (10 &7-z5l— tc, q Ot
Telephone No.: Email:
Situs Address: 1617 C_ e) L_
Proposed Use:
Ne dewntial
e Single Family Residential
F� Single Family Addition
F� Mobile Home
F-1 Residential Accessory
F� Permanent Second Dwelling
F� Temporary Mobile Home (Aunt Minnie)
F� Temporary Travel Trailer
F-1 Multi -family
Non-residential
F-1 New Commercial
Fj Commercial Addition
F-1 New Industrial
F� Industrial Addition
Other
Septic
Agricultural Exempt Building
F-1 Other:
Bfief Explanation (if necessary):
[:] Single Family Remodel
RUTM -M
COUNTY
AUG — 6 2004
DEVELOPMENT
SERVICES
F-1 Comme, ial Remodel
F� Industrial Remodel
D Well
[j Agricultural Buffer Form [I Applicable [:1 N/A
DO NOT WRITE BELOW THIS LINE
DEVELOPAfENT SER VICES flVFORMA TION (For Staff Use)
Approved Conditionally Approved 0 Resolve Problems Prior to Approval
SiZn Sta ipe, 1_�pprbved
Date
By
Page I of 5
ALL ITEMS CHECKED APPLY TO THE PROPERTY
Parcel Is In:
M
Snow Load Area: - -242V
Land Conservation Act M inimum. Acreage:- Verify residence can be built per contract
El Nitrate Action Plan (See Environmental Health for stand- ds)
El Watershed Protection Overlay Zone (See attached standaards and requirements)
EJ Expansive Soils (Test for expansive soils and if verified proper foundation design required)
0 SRA - (CDF to determine specific requirements)
I 00 -Year Flood Plain: (See attached)
Flood Zone: X
Flood Panel No.: CV -,-o -le- 6 CA 00 Index Date: 46 —
Sacramento River Reclamation District (Approval must be obtained from tl�e California Reclamation Board)
El Feather River Reclamation District (Appro I must be obtained from the' California Reclamation Board)
F� North Chico Specific Plan (See Developmevnat Fees Section and attached standards and requirements)
Ej Chapman/MulberTy (See attached standards and requirements)
E] Cohasset Area (See attached standards and requirements)
Ej Grading Zone (See attached handout)
E] Oroville Enterprise Zone
Use Requires:
F-1 Use.Permit El Minor Use Permit El Administrative permit
E] Minor Variance [3 Variance
El Detached Building Use Form Encroachment Permit
F-1 Agricultural Worker Affidavit E3 Agricultural Acknowledgement Statement
Zoning:_
Applicable Building Setbacks:
Zoning Code Streets & Highways I Fire Prevention Subdivision i�ia—p
Front
Side
i e EpreventionSubdivision Map
Side Street
Rear
Height
Waterway N/A N/A N/A
7 Setbacks drawn on site Plan. - IM CDF approval needed for encroachments into sRA setbacks.
Page 2 of 5
Applicable Development Fees:
Standard Fees Amount Formula
Fj Fire
F -I School*
Parks/Recreation
Roads'
F -I Sheriff
F Drainage
F NCSP/CSA 87
F� Chico Urban Area - Road
F-1 Thermalito Drainage Area
F� Thermalito Urban:Area
F� Other
----------------------------------- --------------------------------------- -------------------------------
Subdivision Map Special Fees -
7
Water Tender
Road Improvement
North Oroville Area
E]
Other (per map)
Check with school district to verify actual fee if pre-ap�lication review. A final determination win be made at the time c
the building permit
Parcel Created By
F� Deeds:
Date of Creation: Legal Access Provided: [] No El Ye;
Deed of Reference: Legal Access Required El No Ye:
Parcel Frontage on Publicly Maintained Road: No F� Yes, Road Name:
Complies with Cou�ty Standards for Deed Creation:Fj No F-1 Yes
Comments:
7 Par6el Deemed to be legal
F� Verify Legal Parcel E] Verify Legal Access Provide Deed of Creation
F -I Obtain a Certificate of Compliance/Notice of Compliance
F� bbtain a Merger [1 Obtain a Lot Line Adjustment
Fj Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23).
F -j Construct road to: F-1 Meet Parcel size required by zone
F -I Meet current Enviromnental Health Department requirements
Page 3 of 5
7 Subdivision Mal)/Parcel Man:
Map Date of Recording: T
10. (110
I
Lot: 147
Ej Use Permit/Minor Use Permit
Permit Number:
Book: Page:
Date of Approval:
Parcel Map/Subdivision Map/Use Permit Conditions
El Comply with the following Conditions of Approval: El Attached F -I None
Fj Meet the Fire Safe Regulations of Butte County and P.R.C. 4290
El Automatic fire suppression sprinkler systems shall be installed in accordance with the
National Fire Protection Association Standard for installation of sprinkler systems in one
and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized
community water system, with hydrants that meet the Fire Department specifications, serves
the parcel.
F -I Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission
requirements of the California Clean Air Act of 1988, as amended.
El Provide an erosion control plan for building and land disturbance. I The Erosion Control Plan
must be prepared by a registered civil engineer or other qualified professional and be
submitted to and approved by the Department of Public Works.
In lieu of a pressurized water system or water storage tank; payment into the appropriate
Battalion Water Tender Fund may be required.
El Measures shall be taken to control fugitive dust emissions from all driveway and other civil
construction associated with residential development. Approved dust control measures are
found in the fugitive dust control plan for the site approved by the Butte County Air Quality
Management District, a copy of which can be obtained from the Butte County Department
of Development Services, Building Division." -
El Engineered foundations are required.
[I Class A roofs are required.
El Property owners responsible for road maintenance, and stop sign maintenance.
ISO
Page 4 of 5
9 1
W
0
Summary of Specific Requirenients:
This information provided in this summary is based on the application information and on the best available data at the time
of review.
CALaTrys\Building Permit Site Plan Reviewl.doc
Page 5- of 5
BUTTE COUNTY
—.4
AGRICULTURAL BUFFER NOTIFICATION AND/OR CHiC9,
UNUSUAL CIRCUMSTANCES REQUEST
Butte County requires a 300 foot buffer between neighboring agricultural operations and a residence. This
dimension is based on environmental assessments and studies. The Agricultural Commissioner may identify
unusual circumstances where the 300 foot buffer cannot be met on existing parcels. This exception is not
available for lots being created, divided or subdivided.
Owner or Authorized Agent must complete the following and return with the reqUired . site plan to:
Development Services Department, 7 County Center Drive, Oroville, CA (530) 538-76 01
Name: o Phone: 3 0 -S,9 3 -V q o R
Mailing Address: /k/.
E -Mail address- 2- Ow- A 6
Assessor's Parcel Number. 0 ( /, Y ' (," '7,::9 — 0 c7
Reason you believe you qualify for the unusual circumstances exception:
Iro-Z 2P1, Ly Zzday
Owner or Authorized Agent's signature Date
UNUSUAL CIRCUMSTANCES DEFINITION:
An exceptional or extraordinary condition where the existing lot size or shape or an existing improv6ment
(well, septic systems, structures etc.) does not allow for the standard condition of a 300-fbot buffer zone.
SITE PLAN REQUIREMENT: submit 4 copies with this form
Refer to the Site Plan Submittal handout for specific requirements
.......................................................................................................................................... ........
Internal Dept Contact Info:
El tnv. Health 0 Planning [I Building 0 Other
Contact Person: Phone:
FORWARD THIS FORM TO LARRY IN DEVELOPMENT SERVICES FOR PROCESSING
�0 r*:i,c* u**lt'*u* *r'a' I* .......................................................
DISCRETIONARY PERMITS (Plannina) MINISTERIAL PERMITS (Building)
Exception Recommended Exception Granted with the
Exception NOT Recommended . following conditions:
P C -p- Reason/Condftions/Specific setbacks. from adjacent agricultural operations:
. I t,-k�
Agricultural Department Signature: Date:
YMC 711/03
r\IoT
eqi� t,�=P 5,,0
Agricultural Department Signature: Date:
YMC 711/03
BUTTE COUNTY PUBLIC HEALTH DEPARTMENT
Division of Environmental
P. 0. BOX 5364 -.;-, r
411 Main Street 7 County Center Drive
Oroville, CA 95965
Chico, CA 95928 AUG 1015 2004 (530) 538-7281
(530) 891-2727 FAX (530) 538-7785
FAX (530) 895-6512 (a
CHICO, C,4,J_1 R-J"PIMA
APPLICATION FOR PERMIT TO CONSTRUCT A SEWAGE bISPOSAL SYSTEM
/'k P
Owner's Name 1:10 �- ±:f -t-T4--lf Assessor's Parcel No.o C q ooc�
Applicant'sName Phone No.
Mailing Address /,4 L -�- __z; te- 4.
1. Construction Site 0 �4__CR L -c- A_
6, -')'7 -7 7.7.
ksfreefananUJnDerori
e-
2. Lot Size feet x
3. APPLICATION FOR:
-A (
/'l A 6— -('a C -� - 9
(/4-- A- 1-7
A-,
�a`nstance to nearebL U��[Udy)
3
cres
New system for new building El Auxiliary or secondary system
Repair of or addition to old system El New system to replace existing facilities
4. Ty0e-of building to be served by proposed system:
E] Mobile Home (size No. Bedrooms Garbage Disposal?
(Z House No. Bedrooms Garbage Disposal? �,-E 57
Other (Specify)
5. Water supply for premises: (Must be safe, potable water)
Water supply for adjoining properties:
6. WORKER'S COMPENSATION INSURANCE
Community 0 Private Well E] Other
Community F] Private Well r_1 Other
I am aware of the provisions of Section 3700 of the California Labor Code, which requires every employer to be insured
against liability for Worker's Compensation.
0 1 have placed on file with the County of Butte a Certification of Worker's Compensation Insurance.
I certify.that in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to be subject to the Worker's Compensation Laws'of California.
7. SITE PLAN TO BE FURNISHED - Draw to scale on site plan the following:
a. Property lines. * e. Show direction and approximate amount of slope.
b. Location of all proposed and existing buildings, f. Source of water.
Structures, driveways and parking area. g. Water lines.
c. Location of large trees, rocks, or other obstacles. h. Set back lines and easement.
d. Location of any well, spring, creek or other body 1. Proposed sewage disposal system and area for
of water on the.parcel and within 100 feet of property line. replacement.
I hereby state that the information above or attached hereto is correct and true to the best of my knowledge. I
understand that the ermit must be obtained before any construction is begun either on the building or on the sewage
disposal system, anTthat a satisfactory inspection of the system is re red before the new building or dwelling may be
occupied or the system backfilled, or put into use. I also understand 'thuait a safe potable water must be supplied to the
new building or dwelling before occupancy can take place.
Signed 1<:,t� ),—, a Owner RJ Authorized Agent E] Licensed Contractor F'-1
Date— 0 (An original letter of authorization must accompany this application
in order for an authorized agent to sign).
FOR OFFICE USE ONLY
Legal parcel? Zoning --Use permi ? Access
Water plans cleared- Potable water, —Receipt No-_�UQ /7---.AmounFy
Comment
Okpp/SewDisposalSys/i 1/2003
LARWIN OLVELOPIACNIS. INC. A CORPORATiOh AS OWNER OF THE LA *05 INCLUDED
WITMI,I 'PARADISE PINES UNIT NO. 2' AS END H WITHIN
T14E COLORED BORDER LINE ON THE ANNEXED MAP AID OROVILLE ;ITLF. CO PANY.
AND TITLE INSURANCE AND TRUST CO.. AS
IRUSTCLS UNDER RECORD DEEDS OF TRUST. 00 HEREBY CERTIFY T"AT 'It. ARE THE
ONI. Y PEOSONS WHOSE CONsENr IS NECESSARY TO PA S S CLEA A T i TLE TO SAID LAND
AN D WE CONSENT To lMr. IlREPAnA 1. ION AND RECOROA71 ON OF q- —P - SHO Vill
WITHIN THE COLORED BORDER LINES. THOSE PORrI DNS OF THE SXYWAY
FREMONT DRIVE. M ASTERSON WAY. KLAMAT14 COURTI)ALTON WAY. OR IDGEN
COURT. FARGO COURr. COLTER WAY, CODY COURT. COLTER COURT. AND H. CYOK
COURT,Ull.SHO"N'WITIlIN THE COLORED BOR?ER LINES ON SAID MAP AnE 14EM E 8 Y
0 F FER F A OFO CA' ION FOR FUSLIC USE FO%COUNTY R!AO PURPOSCS. WE ALSO
OFFER FOR DEDICATION. AND DO HEREBY DE D IC IE F OR S.ECIFIC PURPOSES. THE
FOLLOWING: 'Efl.
I A) RIGHTS OF WAY AND EASEMENTS FOR WATER, GAS. SEV. AMU DRAINAGE
P AVD Fo A OVERHEAD AND UNDERGROUND WIRES FOR CLEC7RIC AND TELEPHONE
IPES T E I It U ING THERETO.
SERVI�E_ OG THER W T ANY A14D ALL APP RTENANCES APPERTAIN
04 COVE " AND UNDER THOS E S 7 RIP 5 OF L AND DEC:GN ITED'PUQLI� U ILITY
CAi MEII T. CONTIGUOUS TO THE REAR AND /OA SO DEL NES OF LOTS AND OF THE
WI orms SHOWN H EREON.
I B) EASEMENTS FOR LIGH T AND AIR OVER TH05E STRIPS OF LAND LY114G BEIVE-E
ME
T�E FRONT ANDIOR SIDEL I _S OF L 0 T 5 AND THE Ll N rS S H DOW HEREON AND OLSIG-
NAIED'SET BACK LINE: SAID STRIPS TO BE KEPT 0 PiN AND FREE OF BUILDING S '
Cl At GHTS OF WA AMC EASEMENTS FOR ORAINAGE P IPLS TOGETHER WITH ANY AND
I C A G STr.!p
Iki.t. A P PURTE AN E S �P?E,TAIMIN THERETO ON. OVER. AND UNDER THOSE
0 F LA N C DL S I GNATED ORA MADE EASEMENT'IN THE LOCATIONS AND OF THE WIDTHS
S MOWN HE AEON
,0% CAS
I ;ES EMENTS FOR POLES AND OVERHEAD AN D UND ERGROUND ANCHORS. GUYS.
CONDUITS AND APPURTENANCES T14ERET FOR CLECRIC AND COMMU ICATION
SERVICES INCLUDING THE A I GHT TO 7 AN DSREM - A S OFTEI AS NECESSARY
RIM OVE TH W
T A EES. LIMBS, AND BRUSH. IN THE LOCATION AND ;F E ID"LS SHOWN HEREON.
IE) A E S E RVATiO.45 PROHIBITING VEHICULAR INGRESS AND/Or EGRESS OYER ANL
ACROSS THOSE STRIPS OF LAND ABUTTING THE SXYW4Y AND
DESIGNATED '.40 VEHICULAR ACCESS STRIPNGHjRE N.,
� A A 0 EGRESS ON. OVER AND
(FROSSIGH 'I OFOWAYWAND EASEMENTS FO I A _S A 2
140,00 FEET . LOTS 11
AD rHE S UTH ESTERLY OF 5 �� ll� 1,1� 14. 31. 3 �Ly
35. AND 3 6 . T4 E SOU THWESTERLY 136 FEET OF L OT A.07 !,,TiE SOUTHE
235 FEET OF LO T 16 '. THE SOUIHERL Y 25, FEET OF L - W THE NO TN -
EASTERLY 20 FEET OFLOT 2, 3 AND 4. T HE SOUTHEASTERLY COR.4E 0" LO T I
BEARING NORTHWEST AND SOUTHEAST 40 FEET AND NORTHEAST AND SOUTH-WEST
30 FEET, THE NORTHWEST PORTION OF LOTS IOOANO to I THAT WILL VARY IN WIDTH AS
SHOWN. AND ALL FOR COMMON DRIVEWAY PURPOSES.
I r F tNSUR C OPT COMPANY. A CAL lFl§N AT AS TRUSTEES
_,g
ga i
4w_pq
STA�C .; L� I.,
COD T, 7
ON IE -NE. 1141 UlOE4111;111D. A NOTARY
APPEARED
RESPECTIVELY OF TITLE INSURANCE A--- l- NT. . —1. 1.
CORFORATI ON �H 'C , E XICUTED THE FOREGO CERIIFICA KAIR-7m ME
To BE TH E PERSON WHO EXECUTED T14E F 0 KG E TIFIII :ON HSLF
OF THE CORPORATION TH REIN Rb ACKNOWLEOGEDI�ll UCH
E
r.nqfORATION EXECUTED T w_..
ammm -
-'Tr
#'�OmMISSIGN EXir"-AC
A
LARWIN DEVELOPMENTS. INC. . A CORPORATION. AS OWNER
ed- ��_
PaC-PREPOENT ASSISTANT SECRETARY
STATE OF CALIFORNIA I SS
COUNTY OF BUTTE I
ON THIS IN DAY OF a,& . .970. BEFORE ME. THE UNDERSIGNED. A AlOfARY
C.U�
�p Ty OF BUTTE,,P�RIONALLY APPEARED 'R
"Uat�lt` IN 4 'EA- RrR'
AND GRANT 0IN EFOR THE KN 'N TO TO BE THE EXECUTIVE VICE PRESIDENT
ASSISTANT SECRETARY. RESPECTIVELY OF LARWIN OEVELOPMENTS. INC. A
CORrORATION. VH!CIl EXECUTED THE FOREGOING CERTIFICATE, AND KNOWN TO ME
To BE THE PERSONS WHO EXECUTED THE FOREGOING CERTIF;CATE ON BEHALF OF
TH C CORPO RAT I ON THEREIN NANIEO. AND ACKNOWLEDGED TO ME THAT SUCH CORP -
OWI ON E X ECU TE IT Y�E S AME.
NOTARY PUSLIC,=�._ -A
My CoMhIISSI ON _EX_FI RES
ORfX Tl� E A�COMPANY A CORPORATION. AS TRUSTEES
04w
STAIC OF CALIFORNIA I SS
COUNTY OF eurlE 1
0.4 THIS.91:!-VAY OF i0A)d . 1970. BEFORE ME. THE UNOERSIG', A NOTllY
ED'
Pl)%"AN T
�,�,D FOR THE COUNTY OF_h.j _.�_,,P,l .1 L,:I.. A - PPE.RE.�%
;r ir El AN (Yd
KNOWN TO ME TO Be Tll�dzawp og
_4 I_*
RESPE TIVELY. OF OROVILLE TITLE 'C6 A CALIFORNIA
WHICH EXECUTED THE FOREGOING CERTtF;CAT�. AND KNOWN TO ME TO BE THE
pCpslXS '.YMO EXECUTED THE FOREGOING CERT:FICATE ON SCIIALF OF THE COR-
P RAIION 114ERE;N NAME0, AND ACKNOWLEDGED TO ME THAT SUCH CORPORATION
EIECLIIC� 7HE SAME.
NOTARY FUBLIC'
my CoMmisslow Oiplottawm A$gr"
I U ON AL D D. MCCOMMICK. 60 HERESY CERTIFY THAT I AM A REGISTERED CIVII
ANN r
ENGINEER OF THE STATE Or CALIFORNIA. THAI IHE E X D `1 P OF
IFARIDIIE PINES U T COPRICTLY R2PRElE41S A 11RILY
M , UNOE N
ADSHOTIM 11 My T. AT IT I RUEIA 0 COMPLETE
AS TIIAT _111E t4o*Ny��6,11� �VOWNI THERECN ARE SET IN THE A CORRECT
Fo S ITION AND A#C�
THE SURVEY To BE RETRACED.
I, A
OOII'Ll D. MCCORMICK. A.0 E. 9C33
�I. F.M. SEELY, JR. . AUDITOREOFRTHEOCOUMTY OF BUTT %A STATE OF CALIFORNIA
DO HEREBY CERTIFY THAr THEN A E N LI E NS AGAINST RADISE PINES UNIT NO.2'
AS HEREON SET FORTH. OR Ult PAI 0 S JATE . COUNTY
M �ICTIPALXOS LOCAL TAXE SPECIAL ASS E SSMENTS CO-.LECTEDFASOTA�PE
ED S6AI.
�F OR SP CIALS O:E SSMVNIS No I YET PAYABLE TAX 5 A S E
X . P TA E E A S
ASSESSMENTS %yIjjkM AR�,,A LIEN BUT NOT YE I PAYABLE , E�TIMATC TO BE IN
THE AMOUNT OF
A46EML4�0_.MAI TOR
I . ALBERT J. WALSH. DIRECTOR OF PLANNING OF THE PLAN NIrAG COAMISSION OF
THE COUNTY OF BUTTE, STATE OF CALIFORNIA DO HEREBY ( a T I FY THAI THE
A.l-NEXSD FINAL 14AP 0 'PARADISE PINES UNIT NO. 2'
Co N . ORMS SUeSl AXIT I ALLY Vl I TH THE DESJ�Zly
OIAS APPROVED By THIS !K7QE IENIATI.VE 14AP WHICH
OR or PLANNING
Zff
CIER
I CLAY CASTLEBERRY . DIRECTOR OF PUBLIC WORKS OF THE COUNTY OF SUITE.
I iA Fo E F
TE OF CALI RNI A 00 HEREBY CERTIFY THAT -1 HAVE EXAMINED T 114AL
MAP OF 'PARADISE PINES UNIT NO. 2o THAT IT IS
SUBSTANTIALLY THE SAME AS APPEARED ON THE TENTATIVE A P ON F OLE A.".
ANY APPROVED ALTERATI DNS THEREOF. THAT ALL PROVO S 10145 OF THE SUB
DIV1510.11 MAP ACT OF THE STATE OF CA'_IFORN IA AM 0 LOCAL OADINA'JCES
APPLICABLE AT THE T 'Mr 0 F APP A OVAL 0 F SA 1 0 1 E S TATIVE MA P " AVE BE EN
COMPLIED WITH. AND I AM SATISFIED THAT SAID VAP IS TECHICALLY CORRECT.
C A �U C
DIRE TO OF F BLI WORKS. COUNTY OF BUTTE
1. CLARK A. NELSON. COUNTY CLERK OF THE COUNT-.' OF VTT.E. 5 ATE OF CALI-
FORNIA. 00 HEREBY CERTIFY THAT 0.4 THE'.V DAY OF 11
BUTTE COUNTY BOARD OF SUPF.RVI SOnS PFF;CI ALLY APPR(lVrD T SU..?ljST"l
'V 'OD
MAP 0 E *PARADISE PINES UNIT NO. 2 THE RrCEIP OF
SATISFACTO Ry SECURITY IN THE AUDITORS ESTIMATED AMOUNT OFi�;LR;Z.TCQ TO
I NSURC PAYMEN T OF TAX ES rmlc� A A E A L; EN BUT 140T YET PAYABLE WAS
ACKNOWL EDGED THOSE PORIIONS OF THE SKYWAY FREMCNT
DRIVE. MASTERSON WAY. KLAMATH COURT.OALTON WAY. BRIDGER COURT. FARGO
COU AT. Co LTER WAY, CODY COURT. COLTER COURT. AND 4 ICKOK COURT. AS
5 10',114 WITHIN THE COLORED BORDCR LINES 0" SAID MAP. ANOOFFERED F A
DEO ICATION FOR PUBLIC US E WE RE ACC EPT E 9 ON BEM,�Lf -07-1MG RUDL I C For,
COLN TY ROAD PURPOSES.
CLARK A. NELSON. COUNTY �LtHK
BY DEPUTY --
RECORDED IN THE OFFICE OF lHE RECORDER 0' BUTTE COUNTY. STATE OF CALI-
A;CATCTHE.REOUCST OF OPOVIL E TO . COMPANY AT MINUTES PAST
A
0 LO K _fL M E J_P_ DAY OF 1-70. IN ROOK-Jff-- OF
MA9S AT PA G CS V, , ECORDINIG NUMB A
LO ISE KLUENUER. BUTTE COUNTY RECORDER
Dy DEPUTY
SUBDIVISION NO. bg
PARADISE PINES UNIT NO. 2
PTN. S: E. 1/4, SEC. 14 , T 2 3 N., R.3 E., M. D. M.
BUTTE COUNTY , CALIFORNIA
MAY, 1970
-MURRAY a McCORMICK INC.
CIVIL ENGINEERS LAND SURVEYORS
1912 F ST. SACRAMENTO CALIFORNIA
SHEET I OF 4 SHEETS
------------ ------
, ;", , ,
I&
177
17
7�
175 171
4
lK'
6 'N Ir. N\
A,
7
17?
7
97
Z
/S7 k
A!
-7 /.-z I,;;
9;7
71
ilk
zor a
j -sr-I
-177�1 11
S�S,Fr 3
L OrS
Is.aal
LEGEND:
CALCULATED POINT ... ..... ...... ..... .... ..... ........... .......
OVERHANG EASEMENT ... ..... .. ... . . .. ........... ..............
SET BACK LIN E .. . ... . ......... ..... . . ... ......
PUBLIC UTILITY �ASEMENT (P.U.E.� .. ... ............
__Z_- �q:ec:f
DRAINAGE EASEMENT (D.E.1 .... ... .........................
PEDESTRIAN EASEMENT (PED. ES.T.)
SET CENTERLINE MONUMEM . . ..... . ..................... . .... .... .......... ... Is
sEr 2'.� 3' IRON PIPE TAGGED R.C.E. 9033.
PRIVATE DRIVEWAY f.ASE.%IE,4T IP.D.E.)
ALL LOT CORNERS NOT 11MICATED BY THE ABOVE SYMBOLS
TO BE MARKED BY 3/4' 6RON QIN V�ITH TAG R.C.E. 9033
BASIS OF BEARING -
THE 'NEST LINE OF 'SIERRA D -L ORO ESTATES UNIT NO. 4'
SHOWN' AS N 00' 48 12' E OX THE MAP F I LED 114 THE OFF I CE
OF HE RECORDER OF aUrIE CoUrITY IN MAI' ROOK 35 AT
PAGIS AS. 45,AND 50.
SUBDIVISION NO.
1, /,�. . N D, 2 u - , \ PA ADISE PINES uoll 1 0. 2-
PTN. S.E. 1/4, SEC. 14 T23 N., R.3E., M.D.M.
B U T T E COUNTY I CALIFORNIA
IcV SCALE- 1"- 100' MAY 1970
/a 7 ' %� 1� . . , � I .
MURRAY 0 McCORMICK INC.
CIVIL ENGINEERS LAND SURVEYORS
1912 F SACRAMENTO. CALIFORNIA
ST`E
SHE T 4 OF 4 SHEETS
�FiF x�er r s
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
Recorded
Official Records
County Of
BUTTE
CANDACE J. GRUBBS
Recorder
ROSEMARY DICKSON
Assistant
10:509M 09 -Nov -2N4
I REC FEE 7.00
1 CONFORM 1.00
I
I
I Alyce
I Page I of I
A 'RICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the, Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultura. I I purposes,
and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm
operations.
All. that real property situate in the County of Butte, State of California, described as follows:
L a T ( o "7 A 5' 5- � 0 L- A./ — iL/ — —
Datd_ ZO 2-oe(-J PROPERTY OWNERS:
/Vo
�, L "/� I'l, 1-) 0 7' It -el-7'zog
State of California
County of
On .2 before me,
personall� appeared 4ar / � fip'r- Dersonally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)yare subscribed
to the within instrument and acknowledged to me that-ho4be/they executed the same in 449&er/their authorized
capacity(ies), and that by4&Aier/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and o al seal.
KILEY PAMRWN
Signature Seal: Commkom # 1444378
nulary rug= - %mummla.,
euftcww
7ffl Cornm.ftimOC17,20
A.P. #- 0 C — — — MY —001"010"MW
/t— Z- -C A
17 -t 11
1) r-- o U A--r-
F
o !-\J /L, --e
f C7� ') 0 0 0
Y
lr7 -2— ')3 A- A..,b q
A- 7,
Datd_ ZO 2-oe(-J PROPERTY OWNERS:
/Vo
�, L "/� I'l, 1-) 0 7' It -el-7'zog
State of California
County of
On .2 before me,
personall� appeared 4ar / � fip'r- Dersonally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)yare subscribed
to the within instrument and acknowledged to me that-ho4be/they executed the same in 449&er/their authorized
capacity(ies), and that by4&Aier/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and o al seal.
KILEY PAMRWN
Signature Seal: Commkom # 1444378
nulary rug= - %mummla.,
euftcww
7ffl Cornm.ftimOC17,20
A.P. #- 0 C — — — MY —001"010"MW
old,
4�6 tL
4
RECE-17VED
DEC 8 2004
BUTTE COUNTY
DEVELOPMENTSERVICES
I V
Wat; i X.� I iml
NOTES
RESIDENTIAL
PERMIT NO. _'064-.6�o-o69
1-10STET-11R., KARL
u -)ALL C O'LTER. WAY, MAGAL1,11.
Com' HALL & YOUNG
NEI,�-SINGLE FAtl/IILY
It
I
04-3068 )
SPECIAL COND17IONS
CHECKED
BY
SRA'
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETT ER
OOF'16E Cdl�Y'
Address
GAS
/140
Meter BL4
k,
ELECTRIC
Meter By�� bate
JOB FINALED (Date)—
Sighature
4 = OK
0 = Not OK
Not Applicable
Not Ready
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1 .
Zoning Req uirements-Setbacks- Easements
2.
Soils; Special MH Support Sketch
3.
Sewer; Location -Test -Fall -C/0 -Concrete
4.
Water; Location -Test- Easement Needed (Sketch)
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6.
Gas; Location -Test -Wrap;-/ P' L 'ft.
/ P Nat. or / /" L "ft./ P LPG
7.
Well Clearance & Disconnect
8.
Utility Clear ance
10.
Roof; Shthg-Roofing
11.
Ext.; Steps- Doors- Land i ngs
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Card B-1 Date Card B-1
1 .
Zoning Req uirements-Setbacks- Easements
Card B-1 Date Card B-1
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- Regu lator-Connector
7.
Water and Sewer Connected -C/0 to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
Card B-1 Date Card B-1
1
. Zoning Requirements -Setbacks -Easements
Card B-1 Date Card B-1
2.
Footings; Size-Spaci ng- Marriage Line
3.
Blocking
4.
Gas; MH Test- Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11.
Verify #s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1 .
Zoning Requ i rements-Setbacks- Easements
2.
Footings; Soils-Size-Depth-Spacing-Connectors-SteeI
3.
Decks, Girders and/or Joists- Decking- Bracing -Stairs- Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg- Frg- Bracing
5.
Alum. Awn.; Colu mns-Con nections-SpI ice- Decal- Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nai I i ng -Veneer-Stucco- Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps- Doors- Land i ngs
12.
. Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except Vs
1 .
Setbacks- Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals- Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panel boards- Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
= OK
= Not OK
= Not Applicable
= Not Ready
RESIDENTIAL (Single & Duplex)
Date UNPERFLOOR (Plans) OK except #'s
.,Z,oning-S tbacks-Easements-Flood-Slope
4C, Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 1,
X Ytg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Uepth
4" Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5!�:2emwalls, Main; Steel- Blockouts-Wrapped
Aer_Stemwalls, Garage; Steel- Blockouts-Wrapped
64' Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. P 6/.V; Fall- Fitting -Test-2 Way C/0 -Sewer Test
[!�-:k 44er.'-LIF, Gas Pipe; Size Anchors -Yard Gas Pip04',Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance- Material -Support- Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Date:712W Card B-1 %tiT Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) 01K except #'s
1;�7�Water Htr.; Vent -Access -Combustion Air Baffle
$&."W-ater Pipe; Test & Anchor -Nail Protection
+97 D.W.V.; Test Fittings & Anchor -Nail Protection
20. Shower Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
C,ur'Gas Pipe; Sixe & Anchors HOUS6 OK "VC'Ci
23. Fire Sprinkler; Test I-
Date)O -29-OS-Card B-1 Date _Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
24. Fixture & Transformer Clearance -Ins. Protecti n
Q5.-Elec. Receptacles Spacing -Lights & Switches at Doors
2§,S4ze Boxes & No. of Conductors Stapled
2-4--RT-ex Installed Close to Edge of Studs & C.J.
20,Tquip. Ground made up w/Mech Fasteners -Bond Gas & Water
Q-qe-2-Appliance Circuits in Kitchen & Conductor Size GFI
3Qe-'50bfeed Wire Size/ /ga. Cu or Al-A.C. Wire Size/ /ga Cu or A
�jT' �ange Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or Al
Insulated Neutral Q Yes Q No
32r---,'�e-rvice-Riser Conductors & Ground Main Disconnect
Q3-<q-uip. Clearances Panels- Motors-Mech. Equip.
34_-G4othes Closet Light -Shower Light -Spa Light
35-4Koke Detector
Date 10 -28 -01' Card 8-1 r-" S. Date Card B-1
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
36--A-.0
oeo�ucts Insulation & Support
LU?17ent Fan, Exhaust above insulation
Ta��bndensate Drain & Overflow, Size & Grade
a3--Furnace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40-19ftic Access & Plafform if Furnace in Attic
Datelo -F Ig -C- Date Card B-1
S7Card B-1 %
Datejo-31.. oy- Card B-1 Date Card B-1
Date FRAMING (Permit) OK except #'s
44,-ffilFs Proper Materials & Anchors
42-)tVa'lls Studs -Nailing Spacing & Braces -Plates -Sound
43_.Jiearing Walls over Girders & Floor Nailing
44,__Qraft Stop ih Walls (rat proof]l
45�ire Stops, Furred Ceilings -Stairs -Chasers -Tubs
4§,Alreaders & Beams -Size & Bearing
Date FRA_MJNG (Continued)
4-r H�.Wers-Post Caps -Anchors -Connectors
44,Tling. Joist-Rftr. Ties-Purlin-Roff Brac.-Truss-Shting.-Rtng.
!!�ace Ties or Type A Flue -Fireplace Throat Clearance
"-Attic Access; Size & Romex Protection -Draft Stop -Ins. BaffFe-s
75if.;-B-drm. Windows or Exiting Doors -Sill Ht. & Dimensions
fp) Garage Fire Protection Framing -RC Channel
(51)Property Line Firewall & Openings 61JCC0SC- EA+VC-S
Doors -One T -Check Garage 3rd Story, 2 Exits
55.'Stairs; Width- H eadroom- Rise- Ru n- Landing- Fire Protection
56 -Plywood on Roof Overhang -Attic Vents -Rafter Outriggers;
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underf1r. Access
59-15razing Area -Glass Protection-Skylig hts- Plastic
Shear Walls; Nailing -Bolts A -Is-< or�14D
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
40--Tn'Filtration-Walls-Windows
Date,O -ZY Card B-1 Ud� & Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #s
6*.'�Ext. Steps -Door & Sidelight Protection -Landings
66. Smoke Detector
65,17urnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor- Ducts -M ech. Protection
6
7.-�eclroorn Exiting
6,a-1G.Fl. &-ftth Fixtures & Tub Access-SOa
69Ztlec. Trim & Subpanel, Breaker Sizes & Labels
-7415�-6tairs & Rails
7J. -Fireplace or Stove, C learance- Hearth
72,-115lec. Outlets at Wood Panel, Int. & Ext.
it. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74',Elec. Outlets & Receptacles at Kit. Counter
7 -Ir Garage Fire Door; Swing- Land i ng -Closure
7eA.C. Duct in Garage -Damper
7.?o.o�Wtr. Htr.; Vents -Clearance -Comb. Air Connector- P. R.V.
jn Garage; Above Floor-Mech. Protection
78' Plb.; Elec. & Mech. Equip. Listed for Location
7-K Elec. Receptacles in Garage (F.F.I.)-Romex Protection
89/ Insulation- Foam- Looked in Attic
8/r. Guard Rails & Deck Construction- Post Caps
82,/Fdn. VBents & Crawl Hole Door Drainaqe & Wood -Earth
Clearance Looked under Floor 0 Yes
86. Zj�owing Instld./Drive 0 Yes :1 No/Walks Q Yes 0 No/Planters 0 Yes 0 No
84A.Stucco Brown -Finish
8e�.C. Unit Disconnect, Electrical- Plumbing
6. ents Above Roof, Pibg-Appliance-Fireplace-Clearance to Openings
17. ater Well, Disconnect, Electrical, Plumbing
48. pterior Elec. Trim, G.F.I. Receptacle- Underground
80JVentilation Throughout House
9 . Glass Protection
911�z brrections from Previous Inspections
9�. Gas Test -Meters Tagged, Gas -Electric
,93. Water & Sewer Connected -C/O to Grade -HD Approval
40r Energy Compliance Certificate -Other Certificates
W. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
MIEMORANDUM
To: Debra Simmons, Butte County Building Inspector
From: Steve Fowler, Butte County Life Safety Officer
Date: October 31, 2005
Re: Verne Hall -- 14818 Coulter Way
Fire Dept. Plan Review
The following are the fire department requirements for BP# 04-3068, AP # 064-690-009.
Enclosed eaves are not required on this home as the "CDF Fire Safe Requirements"
document I initialed on 11/02/2004 did not list them as a requirement under the more strict
"Other Requirements." Even though I marked the building setback as between 15 and 30
feet, Mr. Hall chose to build the home under the more strict requirements which allowed
him to "choose any 3 of the following..." and did not require a Class A or B roof and
enclosed eaves with the other 3—it was one of the choices. I have a copy of the document
to add to the permit file if you wish.
This a gross mistake on my part and I believe it accidentally happened while I was
redesigning the form. I have spoken to Fire Captain Darren Read who normallydoes these
and he said to allow the pen -nit sign -off without the enclosed eaves.
VerticalTechnology
er Engineering
M Rb Lrrb kee #MD, Cim, CA, 955925
Ph. (EW) 89M716 Fax (530) 899-11C2
AAAA ecch
September 29, 2005
RE- Hostetter Residence, Colter Way, Magalia, CA
To Whom it May Concern-
Double2x6 DF#2 studs at 16" o'.c. may be substituted for the single 2x6 DF#1 studs
-at 12"o.c. called out in detail 8/SD1 of the plans for the* residence at the above
address.
ce'.,'SJ ce
fJ*
S 4X
Jan -20-00 07:23A wbdc. 9ibr.8"s'2831 P.02
APA.LAMAAW%
Certificate of Con'formance
Certif icat I e 052736
THIS IS To CERTIFY that the glued laminated timber pr6ducts identified with a collective mark of
Engineered Wood Systems (EWS) were manufactured in accorda-in—ce wit-fi'the app ica-bie _s iiid—ards
and associated specifications indicated below:
ANSI Standard Al 90.1-1992, For Wood Products - Structural Glued
Laminated Timber
NER-486 Glued Laminated Timber Combinations And "GAP"
Computer Program For Determining Design Stresses
AITC 117-93 - Manufacturing �- Standard Specifications For Structural
Glued Laminated Timber Of Softwood'Species
IT IS HEREBY CERTIFIED that the APA EWS trademarked sirU`6tui�al glued laiminated timber members
were produced in a manufacturing facility subject to regular audi ts in accordance with the Engineered'
Wood Systems (EWS) Quality Assurance Program. Routine audits include inspection of the
manufacturing process and evaluation of the in -plant OA program with adequate sampling to verity
conformance to industry standards for lumber grade and glueline bond quality.
W00,04,P*
lop
r"
X
0 io
0* ft
Sit I
#0111
taw q(LA (av".,, 4c,
CD VL CC> (+IeLl - CU. -e- -2<4F L/ L( 1441_�
by . 4�L k A&-� '
Thomas G. Williamson
Executive Vice President
ENCINEERED "OOD SYSMAS is a rematea corporation of APA — r"E EN&NEERED KbOD ASSOC(ArION
701.lSouth Ift street - P.0.�Bm 11700 - Tacoma. WA 08411-0700
Tnkm*wne: (253) WS-NOO - Fax Nurnber: (zs3) SsS.7206
Manufacturer Insulation Fact ShM ' CertainTeedll
This is CertainTeed Corporationlnsubafe4 film
Weed!M
Fiber Glass Blowing Insulation
CertainTeed Corporation
P.O. Box 860
Valley For'ge, PA 19482 A,
THERMAL PERFORMANCE—HORIZONTAL OPEN BLOW
The following thermal performances are achieved at weights and coverages specified when insulation is installed with
pneumatic equipment in a horizontal open blow application:
R -VALUE
BAGS PER
1000 SQ. FT.
MAXIMUM
SQ. FT. PER BAG
MINIMUM WEIGHT-
POUNDS PER SQ. FT.
MINIMUM
THICKNESS
To obta in a.
Thermal Resistance
(R) of:
1 Bags pe r
00 sq. ft.
of net area:
Con tents of bag
should not cover
more than: (sj.. ft.)
Weight per sq. ft. of
installe insulation should
not be less than: (lbs.)
Should not be
less than:
(in.)
60
36.5
27
0.986
22
49
29.6
34
0.800
181/2
44
26.4
38
0.712
163/4
38
22.8
44
0.615
143/4
30
18.0
56
0.485
12
26
15.5
65
0.418
1072
22
13.1
77 k-.
0.353
9
19
11.1
90
0.301
7114
13
7.7
129 1
0.209
51/2
I 1 1
6.6
151 1,
0.179
4 3/4
R -values are determined in accordance with ASTM C 687 and 51'8. Complies with ASTM C 764 as Type I insulation.
THERMAL PERFORMANCE—SIDEWALL RETROFIT APPLICATION
When installed with pneumatic equipment in sidewalls, the foll6wing thermal performances are achieved at the
thicknesses, weights and coverages specified. Based on a desig density of 1.6 pcf/25.6 Kg/ml.
READ THIS BEFORE YOU BUY'
What you should know about R -Values.
The chart shows the R -Value of this insulation. R means resistance to heat flow. The higher the R -
Value, the greater the insulating power. Compare insulation R -Values before you buy.
There are other factors to consider. The amount of insulation you need depends mainly on the
climate you live in. Also, your fuel savings from insulation will depend upon the climate, the type
and size of your house, the amo6nt of insulation already in your house, and your fuel use
patterns and family size. If you buy too much insulation, it will cost you more than what you'll
save on fuel.
To get the marked R -Value, it is essential that this insulation be installed properly.
0
k
BAGS PER
MAXIMUM
MINIMUM WEIGHT-
MINIMUM
R -VALUE
1000 SQ. FT.
SQ. FT. PER BAG
POUNDS PER SQ. FT.
THICKNESS
To obtain a
Bags per
Con tents of bag
Weight per sq. ft. of
Should not be
Thermal Resistance
00 sq. ft.
should not cover
installe insulation should
less than:
(R) of:
of net area:
more than: (sq. ft.)
not be less than: (Ibs.)
(in.)
29
35.8
28
0.967
7114
22
27.2
37
0.733
572
16
19.8
51
0.533
4
15
17.9
56
'0.483
31/8
1 14
1 17.3
58
0.467'
3/2
READ THIS BEFORE YOU BUY'
What you should know about R -Values.
The chart shows the R -Value of this insulation. R means resistance to heat flow. The higher the R -
Value, the greater the insulating power. Compare insulation R -Values before you buy.
There are other factors to consider. The amount of insulation you need depends mainly on the
climate you live in. Also, your fuel savings from insulation will depend upon the climate, the type
and size of your house, the amo6nt of insulation already in your house, and your fuel use
patterns and family size. If you buy too much insulation, it will cost you more than what you'll
save on fuel.
To get the marked R -Value, it is essential that this insulation be installed properly.
0
CertainTeedM InsulSaW4.
40 Builders Statement Fiber Glass Blowing Insulation
Homeowner Name / Jobsite Name
Home Address
4�2 - , k
Installer/Contractor (sign) Company Name Date
Builder (sign) Company Name Date
Inspected By (sign if required) Date
0
R -VALUE
BAGS PER
1000 SQ. FT.
MAXIMUM
SQ. FT. PER BAG
MINIMUM WEIGHT-
POUNDS PER SQ. FT.
INSTALLED
MINIMUM THICKNESS
To obtain a
Thermal Resistance
(R) of:
Bags per
1000 sq. ft.
of net area:
Contents of bag
should not cover
more than: (sq. ft.)
Weight per sq. ft. of
installed insulation should
not be less than: Obs.)
Should not be
less than:
Cin.)
60
36.5
27
0.986
22
49
29.6
34
0.800
18%
44
26.4
38
0.712
163/4
38
22.8
44
0.615
143/4
30
18.0
56
0.485
12
26
15.5
65
g77
0.418
10'/2
22
13.1
FLOORS
0.353
9
19
11.1
go
90
0.301
71/4
11 13
7.7
129
0.209
5/2
6.6
1'51
0.179
41/4
THERMAL PERFORMANCE—ATTIC BLOWING APPLICATION
• In accordance with the chart above, you must install the minimum number of bags per 1,000 sq. ft. of net area for each
R -Value listed.
• The maximum net coverage must not exceed that specified for each R -Value.
• The installed insulation must be at or above the specified minimum thickness for each R -Value.
• Failure to install the required minimum weight per sq. ft. of insulation at or above the minimum thickness will result in
reduced R -Value.
• This product should not be mixed with other blown insulations or the thermal claims will become invalid.
DANGER: RECESSED LIGHT FIXTURES—TO PREVENT OVERHEATING, DO NOT INSULATE ON TOP OR WITHIN 3" OF
SUCH DEVICES. DOES NOT APPLY TO TYPE IC LIGHT FIXTURES OR TO FLUORESCENT FIXTURES WITH
THERMALLY PROTECTED BALLASTS.
30-24-233 Builders Statement A Saint-Gobain Company @2003 CertainTeed Corporation 10/03
R -VALUE
THICKNESS
AREA(SQ.Ft)
I NSULSAFE 4 (V)
BAGS USED
BATTS/ROLLS (V)
CEILINGS
WALLS
0�
Z9
S4�)
FLOORS
THERMAL PERFORMANCE—ATTIC BLOWING APPLICATION
• In accordance with the chart above, you must install the minimum number of bags per 1,000 sq. ft. of net area for each
R -Value listed.
• The maximum net coverage must not exceed that specified for each R -Value.
• The installed insulation must be at or above the specified minimum thickness for each R -Value.
• Failure to install the required minimum weight per sq. ft. of insulation at or above the minimum thickness will result in
reduced R -Value.
• This product should not be mixed with other blown insulations or the thermal claims will become invalid.
DANGER: RECESSED LIGHT FIXTURES—TO PREVENT OVERHEATING, DO NOT INSULATE ON TOP OR WITHIN 3" OF
SUCH DEVICES. DOES NOT APPLY TO TYPE IC LIGHT FIXTURES OR TO FLUORESCENT FIXTURES WITH
THERMALLY PROTECTED BALLASTS.
30-24-233 Builders Statement A Saint-Gobain Company @2003 CertainTeed Corporation 10/03
Jan OG OQ 01:21p CEC
653-7480 P.1,
JINSTALLATION CERTIFICATE (Page I of 12) CF -6R
Site Address —FpermitNtimber
11 1�—,
Installatibn certificates (CF -6R) aye required for cach and- every dwelling unit. When the installation of measures that require
field vcrification and diagnostic testing is complete, the builder or the budder's subcontractor shall compicte. diagnostic
testing and the procedures specified in this section, When the installation is complete, the builder or the budder's
subcontractor shall cornplctc the CF -6R (Installation Certificate), and keep it at the building site for review by the building
department. The- builder also shall provide a copy of the Installa'tion Certificate to the HERS rater -for any measures requiring
field verification and diagnostic testing., per Section 10-1 03(a),
WATER HEATING SYSTFM",-
CEC Gcftifle�
_,I f N-
Heatcr -NA fr N am L�,
P .
'I �_7 NJ Lej
oc
Typ� Model Number
Distrihution
Type.
(Std, Poitit-
af-usc, CtO
if 4 of Ratcd Input
Recirculation, Identical (kW or Tank Volume
Control T�,p- S I Btulbr) Ilorls)
POO
C-tc--I
Efficiericy Stand�by�
2 Lo_ 2 2
E)�
R R Loss R 7,.
W, F -'C
-K
I For small gas storage (rated input of less than or cqual to 75,000 Bru/hr), electric resistance and heat pump water
heaters, list Energy Factor (EF). For larp gas storage water heaters (rated input of greater than 75,000 Btu/11r)' ' list
Recovery (RE).. Thermal Efflicienuy, Standby Los% and Rated Input. For instantaneous gaswater heaters, list Thermal
Efficicncv and Rated Input.
R- 12 external insulation is mandatory for S[01`ai�c water beaters with an energy factor of less than 0.58.
vitchen Piping:
If indicated on the C ' FAR, all hot water pipi=ng �: 34 inches in diameter that runs from the hot water source to the kitchen
fixtures is insulated.
Faucets & Shower Heads:
All faucets and showerlicads installed are certificd to the Energy Commission, puxsuant to Title 24, Part 6, Section I 11.
Central Water "eating in Buildings with PelultipleDwelling Units (required for prescriptive)
EIAII hL)t water piping in main circulating loop is insulated to requirements of §1500)
[]Central hot water systems serving six'or fewer dwelling units X".-Ilich have (1) less than 25' of distrib . ution piping
OLltdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insulation on disnibution piping
that meets the requirements of Section 1506)
[]Central hot water systetris serving.rnore than 6 dwelling units - presence of either a time control or a time/ternperaturc
control
El T, the undersigned, vcrifV that equipment listed above my signature is: 1) the actual equipment installed; 2)
equivalent to or more efficient than that specified in the certificate of compliance (Form CF -I R) submitied for compliance
with the Ener�y Eflicienc
y Standards for residential buildings: and 3) equipment that meets or exceeds the appropriate
requirements for ninnuf9cturcd deAces (fi-orn flieAppliance.Ejt7cienc), Regul�tions or Pan 6), where applicable. .
Installing Subcontractor (Co. Narne) OR General
Contractor (Co. Name) OR Owner 1> k
Date: 1 &0
Copirs ro: BUILDING DEPARTNWNT, H ERS RATER (IF APPLICABLE) BtflLDIN(; OWNER AT OCCUPANCY
Residenlial Compliance FOMS September 2005
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
— 0&744 I(Ai" lW&k,14
Site Address Permit Number
An installation certificate is required to be posted at the building site or made available for all apl�ropriate inspections, (the
information provided on this form is required) After completion of final inspection, a copy must.be provided to the building
department (upon request) and the building owner at occupancy,per Section 10- 1 03(a).
RVAC SYSTEMS-..
Heatifig EqWpineis I
Equip Type
(pkg. heat pump)
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
(AFUE, etc-)
(2tCF-IR value)
Duct
Locaelon
(attic, etc.)
Duct or
Piping
R-valui
Heating
Load
(Bftdhr)
Heating
Capacity
(]BftLft)
Systems
(ZCF- I R value)
(attic, etc.)
7V
'(244wi-
(Bftift)
cco
J'000
ecyl_
Cooling Equipment
CEC Certified Mfir-
Equip Type Name and Model
# of
Identical
Efficiency
(SEER or EER)
Duct
Location
Duct
Cooling
Load
Cooling
Capacity
(pk - 4nt_RWM_9_ Nurpber
Systems
(ZCF- I R value)
(attic, etc.)
R -value
-(Btuthr)
(Bftift)
J'000
ecyl_
1. > symbol reads greater didn or equal to what is indicated on the CF -JR value.
include both SEER and EER if compliance credit for high EER air conditioner is claimed.
1, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient.than that specified in the certificate of compliance (Form CF -IR) submitted for compliance with - the Energy
Efficiency Standards for residential buildings,and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from the Appliance Ej iciency Regulations, or Part 6), where applicable.
.T
WATI,'�-11(3 K�S
fM.N KS REF R 1 3E -ZA T i
Z_
Installing Subcontractor (Co. Name)
Signatu=, ate
OR General Contractor (Co. Name) OR. Owner
COPY TO: Building Department
HERS, Rater (if applicable)
Building Owner at Occupancy
Residential Compliance Forms March 2005