HomeMy WebLinkAbout065-360-01265-36-12
B NOSMAN
14829 ��1 Oro -Drive, lot 204, SDO#3,Mag
Permit#795--84P,,E MH)
ELEC 44-11-S Zoo A .
GAS 5�-r/-8 y Lp6r
SUPPORT STRUCTURE Q /.W
COMPACTION TEST RE
Permit ��1126-.:°4 _ 65-36-12
II '(install,
ISSUED MH)
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Pe it ��1127-84B g/ ) 65-36-12
(-awnirr MH
FIRE*',
REPORT
. FC -16 (1 /130)
2 ORIGIN! LOCATION
v
DI ORDER NU -p__
REG. R.U. INCIDENT NO. START
FIRE NUMBER
2EG AjU: NO. ;"thru
SEC`
TOWNSHIPIQI,N
SII
RANGE ®E
NATIONAL FOREST, FIRE DIST., CITY -a STREET NO.,
ETC.
�S
—211 W
d•X w
MO. • MATE YEAR . UNTY
FIRE NAME:
MILES
3
DIRECTION
„ El IN.
NATIONAL FOREST, FIRE DIST., CITY -a STREET NO.,
ETC.
Number
off a Nana 1
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gw f/A !♦//�"y �t j�JrJs- y`
11
INCIDENT TYPE ;► �t%
FIRE ZI PALS ALA O T
Bl l 10/rb lJk
V
4A RESPONSIBILITY 4B
STATE ZONE STATUTORY
O❑ WILDLAND BURNED OR THREATENED 'RESPONSIBILITY
30 CDF LOCAL GOVT. CONTRACT �O AT .ORIGIN)
0 ❑ UNPROTECTED ❑ STATE
O ❑ ASSIST OTHER AGENCY (Not City)
❑ U.S.F.S.
_ LOCAL ZONE ❑ B.L.M.
0 _ ❑ GDF LOCAL GOVT. CONTRACT ❑ B.I.A.
O ❑ ASSIST OTHER AGENCY (Not City)
OTHERFEDERAL
FEDERAL ZONE ❑ OTHER
®8 ❑ ASSIST "FED. AGENCY (Not Mil.)
O ❑. CDF LOCAL GOVT. CONTRACT
MISC. AND OTHER
0 . ❑ ASSIST CITY, CONTRACT CO., MIL, OTHER
PEIMUSE {STARTS IN ) 2 OR .O. ONLY) * "
❑ LIGHTNING ❑ DE IS ❑ PLAY W/FIRE
❑ CAMPFIRE 1 ❑
ART
R ION ❑OTHER/MISC.
SMOKING EQUIPMENT
rLAD.SE {STARTS IN'OR B ONLY)
IC ❑ FOREST INDUSTRY
ARM ❑ RECREATION
❑ OTHER 1NDUSTRY•COMRCL. '•
❑ ROAD ❑ WILDLAND .
❑ UTILITY, RAILROAD ❑ NON-WILDLAND -
❑ UTILITY, ELECTRIC ❑ OTHER
n DAMAGE (6i n'. > OR n ONLY)
7
s DAMAGE
Number
off a Nana 1
1
2 a/or 8
5
TIMBER a/OR
•
YOUNG GROWTH
: ; J..£
WILDLAND VEGETATION
Other than T a Y G
is • ,
AGRICULTURAL PROD
other than T a .Y G
DWELLINGS
a/OR CONTENTS
OTHER STRUCTURES
a OR CONTENTS
000,�Ip
i�
VEHICLES a CONTENTS
OTHER
TOTAL
$
1^rJfJsl�..
ACRES OF VEGETATION BURNED
ON ARRIVAL (0 VEGETATION FIRES ONLY)
9 SIZE DISTANCE (Origin to head) .
- ACRES ` FEET
WEATHER ESTIMATE AT SCEN
WIND SPEED (M.P.H.) DIRECTION (FROM) TEMPERATURE ('F),
Q,
OVER PLEASE
. corr�aso-tao-ot ta'",
91979-7&99-07 ICOM*&*,'
I 0 •ORDER 'NUMBER
ORGAN-
IZATION
REG.
R.U.
INCIDENT NO.
YEAR
PERSON
HOURS
AIRCRAFT
FLT. HRS.
i
1
SECOND REPORT I
,,.�
GO TO 12
I AAICAIIT. IN 1 ST_ nr ?ND. —nnrt ,enrlw by Lmlceull r'
FIRST REPORTre
ORGAN-
IZATION
r/T/
SITE
• FIRE CONTAINED
PERSON
HOURS
AIRCRAFT
FLT. HRS.
i
NAME:
SECOND REPORT I
,,.�
+•►
....�-
SITE
/1 rDCW /nVCDUCAn
DCrnDn
rUME:
FIRST ATTACK BY CDF
ORGAN-
IZATION
/110)
!J' ;z 50
• FIRE CONTAINED
PERSON
HOURS
AIRCRAFT
FLT. HRS.
1ST. ATK�' 1
CREW ' or f �.:' ti "r I
it
s i
1,CDF
/1 rDCW /nVCDUCAn
DCrnDn
11 CDF STATE & LOCAL GOVT. CONTRACT
CREW NAME
ORGAN-
IZATION
PERSON
HOURS
AIRCRAFT
FLT. HRS.
CDF STATE & LOCAL GOVT. CONTRACT
CREW NAME
ORGAN-
IZATION
PERSON
HOURS
AIRCRAFT
FLT. HRS.
1ST. ATK�' 1
CREW ' or f �.:' ti "r I
it
s i
1,CDF
• f
•
s
t
q
CDF OVERHEAD -TOTAL
ON T 8 FIRES, ENTER,.
TOTALS BELOW
•
>
;1
U.S.F.S. (Incl. Overhead) TOTAL
*X
s.'n '
OTHER FEDERAL (Ind. Overhead) TOTAL
FIRE DIST.4 OTHER LOCAL TOTAL
-
PAID HOURLY (E.F.F.) TOTALS
;
VOLUNTEERS (Unpaid) TOTAL
❑ FC -18B (Additional crew activity) ATTACHED
i1 nDIPSIMAI DCDnDT RV.
13B COMMENT__
MAP IS: ® ONE SECTION ❑ FOUR SECTIONS ❑ MAP ATTACHED
el
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,.�. Co
L
W6
APPROVED BY --
14
Y:
14 MA SIG
TITLE
i
DATE
f f
I
INTI
DATE
fi
it
V
/I$ _ ,may
�U
i
PERMIT NO. 1127-84B
PERMIT EXPIRES
OWNER BETTY OSMAN.
CONTR. OWNER t
ASSESSOR PARCEL 65-36-12
LOCATION 14829 Del Oro Dr, Lot 204, Magalia
Temp. Power Pole_
Called PG&E _
z
Temp. Elec. Service
l
Called PG&F
} Temp. Gas Sei
Called PG
s
7
JOB FINALE[
Signature
V = OK
O = Not OK
- = Not Applicable MOBILEHOMES MISCELLANEOUS
= Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except N's I
Date
DECKS, CO S, CARPORTS, ETC. (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
1. n'ng Requirements -Setbacks -Easements
2. Soils: Special MH Support -Sketch
2. ..bogs; Size -Depth -Spacing -Connectors
3. Decks: Girders and/or Joists -Decking -Bracing -Stairs -Rails_
3. Sewer; Location -Test -Fall -C/0 -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
4. W�2 wn.: Posts- Beams- Rflrs.-Connec.-Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
SII:AIurn. Awn. Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports: Windows -Doors
- ---- - -
Card -BI
7. Utility Clearance ------------
Date Card -BI Date
--
Card -BI
7, Elec--_-.-----_---.---
Card -BI _Date --...--- .-
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date _
Date
MOBILEHOME INSTALLATION (Plans) OK except N's
Date
POOLS (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
1. Setbacks -Easements
2. Soils: Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure: Steel-Connections-Thickness-Dead_Men_-Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances
4, Elec.; Receptacles and Lighting; Distances-GFI
5. Drain: MH Test -Fall -Flex Connector
5. Elec.: Pool Lighting: 15 volts-GFI
6.• Water: MH Test -Regulator -Connector
6. Elec.: Enclosures: Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/O to Grade -HD Approval
7. Elec.: Bonding: Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghig.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Exits; Insp.-Sketch _
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Card B -I
Date Card -BI Date
Date Card -BI Date
_Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date -
J = OK
0 = Not OK
- = Not Applicable
dk = Not Read)
RESMEi TIAL (Single and Duplex)
Dale UNDERFLOOR (Plans) OK except k's
_ 1.
Zoning requirements -Setbacks --Easements
2.
Ftg., Main: Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
-_------3.
Fig Garage; Soils -Steel-. / /" Fty Depth -----
4.
Fig.. Porches & Decks; Soils -Steel-- / /" Ftg_. Depth
5 Slerrnvalls, Main: Steel-Blockouts-_Wrapped-S!ab
Equip_Ground made up w_/Mech. Fasteners -Bond Gas & Water
Sie_m_w_alls Garage;_Steel-Blockouts-Wrapped-Slab
_6.
- -- - 7.
Piers -Fireplace Ftg.-_Steel --_-_-_ - - ---
8.
D.W.V.: Fall -Fittings -Test -2 grey C/O -Sewer Test
------
Range Circ. / / ga. Cu or AI -Oven Circ. 1 / ga. Cu or Al,
Gas Pipe: Size -Anchors
10.
_--
_
Water Pipe; Test-Anchors-Regulator-Seryice
11.Elect.ic:
_Test _
Underground
1_2_
Plenums & Ducts; Clearance_-Malet ial-Support -Iits.
13.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI Date Card -BI Date
Card -BI Date Card -BI Date
Date PLUMBING (Permit) OK except H's
14. Water Ht.: Vent -Access -Combustion Air
15. Water Pipe: Test & Anchors -Nail Protection
_ 16. D.W.V._: Test_-_F_ttngs_& Anchors -Nail Protection
1_7. Shower Pan: Test, First _F_loor-Tub Access
18. _Test Tub & Shower, 2nd Floor -Tub Access__
9. Gas Pipe; Size & Anchors
Gard -BI Date Card -BI _Date
Card -BI Date Card -BI Date
Date ELECTRICAL (Permit) OK except q's
20.
_
Fixture _& _Transformer Clearance -Ins. Protection
21.
Viler,. Receptacles_ Spacing -Lights & Switches at Doors
_ 22.
_
Size Boxes & No. of Cond_uc_tors--Stapled_
_ - 23.
RornexInstalle_d Close to Edge of Studs & C.J.
21.
Equip_Ground made up w_/Mech. Fasteners -Bond Gas & Water
- _
25.
2 Appliance_ Circuits in Kitchen & Conductor Size
_
- 26.
Subfeed _Wire Size / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At
27
Range Circ. / / ga. Cu or AI -Oven Circ. 1 / ga. Cu or Al,
- -
Insulated Neutral ' 'Yes
28.
_`1_No
Service -Rise. Conductors & Ground_-fhain Disconnect
29.
Equip. Clearances: Pane ls-_Motors-Mech. Equip.
-
30.
Clothes Closet Light -Shower Light
Card B -I
Date Card -Bi Date
Card B-!
Date Card -BI Date
Date MECHANICAL (Permit) OK except N's
31.
--- -32.
A.C. Ducts: Insulation & Support
-- ---- -__-----_--_-
37.
Vent Fan; Exhaust above Insulation
33.
Condensate Drain & Overflow; Size & Grade
34.
Furnace_ -Vent: Access -Comb. Air -Return Air Vent_-i_1_5_V_outlet _
35.
Attic Access & Platform if Furnace in Attic
Card -BI -._.
-' Date - - Card -BI Date -- - -----
Card-BI
Date Card -BI Date
Date FRAMING(Plans) OK except q's
_ 36.
Sills; Proper Material & Anchors
37.
Walls. Studs -Nailing__ Spacing & Bracing -Plates -Sound
- - - ----
38.
Bearing Walls over Girders & Ftoor Nailing
- - - - ..- -- ----------
39.
-
Draft Stop in Wa!ls (rat prnof)
40.
Fir(, Stops: Furred Ce_iliUs-SiairS_Chases-Tub-- _---_
41.
Heade-. &Beam -Size & Bearing
42.
Hangers -Post Caps -Anchors -Connectors
43.
Clnu. Jo si-Rhr. Ties-Purlin-Roof BrtC.-Truss-Shlhng.-Rfng.
44.
F'ireplacd Ties or Type A Flue -Fireplace Throat
45.
Atuc Access Size & Romex Protection -Draft Stop -Ins. Baffles-~
46.
Parnt. Windov+S or Exiting D' 00r 11 Dnnensions
47.
_.... _
Caragr: Fire Proteciior. Fiduiinq
46. Property Line Firevrall & Openings
49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection_
51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
52. Siding -Nailing -Veneer
53. Stucco Mesh -Drip Screed-Fdn. Vents-Underfli. Access
54. Glazing Area -Glass Protection -Skylights -Plastic
55. Shear Walls; Nailing -Bolts
Date
Card -BI Date
Card -BI Date
Card -81 Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
57. Smoke Detector
58. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
_ 59. Bedroom Exiting
60. G.F.I. & Bath Fixtures & Tub Access
61. Elec. Trim & Subpanei; Breaker Sizes -Labels
62. Stairs & Rails -
_ 63. Fireplace or Stove; Clearances -Hearth _
64. Elec. Outlets at Wood Panel; Int. & Ext.
65. Kit. Fixt. & Appliance; Grnd.-Air Gap --Cooking Clearance
_ 66. Elec. Outlets & Receptacles at Kit. Counter _
67. Garage Fire Door; Swing -Landing -Closer
_ 68. A.C. Duct in Garage -Damper __-
69. Wir. Mr.: Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
70._Plb., Elec. & Mech. Equip. Listed for Location _
71. Elec. Receptacles in Garage: (G.F.I.)-Romex Pr_otec.
72. Insulation -Foam -Looked in Attic ❑Yes
73. Guard Rails & Deck Construction -Post Caps
74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
-- Looked under Floor L7 Yes
75. Following instld.: Drive U Yes [, No; Walks [-: Yes f i No;
Planters [-]Yes ❑No
76. Stucco: Brown -Finish
77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opng_s.
79. Water Well; Disconnect, Electrical, Plumbing _
80. Exterior Elec. Trim; G.F.I. Receptacle -Underground
81. Ventilation throughout House _
82. Glass Protection
83. Corrections from Previous Inspections
84. Gas Test -Meters Tagged: Gas -Electric _
_ 85. Water & Sewer Connected -C/O to Grade -HD Approval
86. Energy Compliance Certificate -Other Certificates
Card -BI DateCard-BI Date_ _
Card -BI Date_ Card -81 Date _
Card -BI Date Card -BI Date
Comments at Final:
(NOTE Anent:yuwSI be ni.idr each time yon visit lob site)
Card -BI
Date
Card -BI
Date_
Card -BI
Date
Date
Card -BI Date
Card -BI Date
Card -81 Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
57. Smoke Detector
58. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
_ 59. Bedroom Exiting
60. G.F.I. & Bath Fixtures & Tub Access
61. Elec. Trim & Subpanei; Breaker Sizes -Labels
62. Stairs & Rails -
_ 63. Fireplace or Stove; Clearances -Hearth _
64. Elec. Outlets at Wood Panel; Int. & Ext.
65. Kit. Fixt. & Appliance; Grnd.-Air Gap --Cooking Clearance
_ 66. Elec. Outlets & Receptacles at Kit. Counter _
67. Garage Fire Door; Swing -Landing -Closer
_ 68. A.C. Duct in Garage -Damper __-
69. Wir. Mr.: Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
70._Plb., Elec. & Mech. Equip. Listed for Location _
71. Elec. Receptacles in Garage: (G.F.I.)-Romex Pr_otec.
72. Insulation -Foam -Looked in Attic ❑Yes
73. Guard Rails & Deck Construction -Post Caps
74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
-- Looked under Floor L7 Yes
75. Following instld.: Drive U Yes [, No; Walks [-: Yes f i No;
Planters [-]Yes ❑No
76. Stucco: Brown -Finish
77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opng_s.
79. Water Well; Disconnect, Electrical, Plumbing _
80. Exterior Elec. Trim; G.F.I. Receptacle -Underground
81. Ventilation throughout House _
82. Glass Protection
83. Corrections from Previous Inspections
84. Gas Test -Meters Tagged: Gas -Electric _
_ 85. Water & Sewer Connected -C/O to Grade -HD Approval
86. Energy Compliance Certificate -Other Certificates
Card -BI DateCard-BI Date_ _
Card -BI Date_ Card -81 Date _
Card -BI Date Card -BI Date
Comments at Final:
(NOTE Anent:yuwSI be ni.idr each time yon visit lob site)
PERMIT NO. l ! 795-84P,E(NH)
PERMIT EXPIRES
OWNER BETTY OSMAN
CONTR. H Ray Sharp
ASSESSOR PARCEL 65-36-12
LOCATION 14829 Del Oro Drive, Magalia
lot 204, SDO#3
OFFICE COPY
Temp. Po�
Address
Calle
IGAS
Temp. EI Meter By��
I ELECTRIC
Meter By.
Ca 11 Dat��F i
Temp. Gas Servicie ---
Cal led PG&E
JOB FINALED (Date)
Signature
V = OK
O Not OK
- Not Applicable
- Not Ready
MOBILEHOMES
MISCELLANEOUS
Date M HOMf UTILITIES (Plans) OK except N's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except ft's
Zon' Requirements—Setbacks—Easements
2. oils pecial MH Support—Sketch
1, Zoning Requirements—Setbacks—Easements _
2. Footings; Size—Depth—Spacing—Connectors
3. ew , ocation—Test—Fall-C/0—Concrete
3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails
4 ater; Location—Test—Easement Needed (Sketch)
4, Wood Awn.; Posts— Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing_
lectricity; Location—Clearances—Grnd.—/ Amp—Concrete
_
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
6 as; Location-Test—Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows—Doors•
7. ility Clearance
7. Elec.
Card -B Date27� f Card -BI Date
Card -BI
Date Card -BI Date
Card -BI KPI1, Date Card -BI Date
Card -BI
Date Card -BI Date
Date MOBILEF1OME INSTALLATION (Plans) OK except H's
1 rymfFtequirements—Setbacks—Easements
Date
_
POOLS (Plans) OK except N's
1. Setbacks—Easements
2. oo 'ngs; Size—Spacing—Marriage Line
2. Soils; Compaction—Structure Stability
3. as• MH Test—Demand—Valve—Connector
3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining
le tricity; MH Test—Crossovers—Breakers—Clearances
4. Elec.; Receptacles and Lighting; Distances—GFI
rain; MH Test—Fall—Flex Connector
5. Elec.; Pool Lighting; 15 volts—GFI
6. Wr; MH Test—Regulator—Connector
6. Elec.: Enclosures; Conduit Entries—Terminals—Listed
7`Water and Sewer Connected—C/O to Grade—HD Approval
7, Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater
Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg.
Boxes—Enclosures—Panel boards—Ins. to Main in Conduit
!)YMf; Insp.—Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test—Water Supply Test
u
Card B -I Date -30.9-r Card -BI Date
Card -BI
Date Card -BI Date
Card B -I Date Card -BI Date
Card -BI
Date Card -BI Date
J = OK
0 = Not OK y
- = Noty'able
:{� = Not Ready RESIDENTIAL (Si-inand Duplex)
Date
UNDERFLOOR Plans OK except k's
Date
FRAMING (Continued)
1.
Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4.
Fig., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
___
5.
Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
-
8.
D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
55.
Shear Walls; Nailing -Bolts
9. Gas Pipe; Size -Anchors
10.
Water Pipe; Test -Anchors -Regulator -Service Test
11.
Electric; Underground
12.
Plenums & Ducts; Clearance -Material -Support -Ins.
13.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI
Date Card -BI -Date-
ateCard-BI
Card-BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except H's
57.
Smoke Detector
_
14.
15.
Water Ht.; Vent -Access -Combustion Air
Water Pipe; Test & Anchors -Nail Protection
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
_
17.
Shower Pan; Test, First Floor -Tub Access
60:
G.F.I. & Bath Fixtures & Tub Access
18.
19_._
Test Tub & Shower, 2nd Floor -Tub Access
Gas Pipe; Size & Anchors
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
64.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets& Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except N's
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor -Meth. Protection
21.
Elec. Receptacles Spacing -Lights & Switches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
_
22.
Size Boxes & No. of Conductors -Stapled
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23. Romex Installed Close to Edge of Studs & C.J.
_
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72,
Insulation -Foam -Looked in Attic ED Yes
-
25.
2 Appliance Circuits in Kitchen & Conductor Size
73.
Guard Rails & Deck Construction -Post Caps
26.
Subteed Wire Size / / ga. Cu or AI-A.C: Wire Size / / ga. Cu or Al
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth. Clearance
Looked under Floor ❑ Yes
__
-
27.
28.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
r
Insulated Neutral ,_Yes ❑N°
Service -Riser Conductors & Ground -Main Disconnect
75.
Following instld.: Drive Yes No; Walks Yes
9 ❑ ❑ ❑ No:
Planters ❑Yes 0 -No
76.
Stucco; Brown -Finish
- ___29.
_
30.
Equip. Clearances; Panels-Motors-Mech. Equip.
Clothes Closet Light -Shower Light
77.
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
79.
80.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
Water Well; Disconnect, Electrical, Plumbing
Exterior Elec. Trim; G.F.I. Receptacle -Underground
----------------------------
Card BB=1
Card B -I
-
--_.-
__Date_ __-- Card -BI _- Date -_--
Date Card -BI Date
81.
Ventilation throughout House
82.
83.
Glass Protection _
Corrections from Previous Inspections
Date MECHANICAL (Permit) OK except N's
- 31. A.C. Ducts; Insulation &Support _-
84.
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/O to Grade -HD Approval
_
32.
33.
Vent Fan_ Exhaust above Insulation _ --
Condensate Drain _& Overilow; Size & Grade
86,
Energy Compliance Certificate -Other Certificates
----.3.4.-
Card -BI
Card -BI
Date
Furnace -Vent; -Access -Comb. Air -Return Air Vent -115V outlet
35. Attic Access & Platform if Furnace in Attic
Date Card -BI _ Date
Date Card -BI Date
FRAMING(Plans) OK except q's
36. Sills; Proper Material & Anchors
_ 37. Walls; Studs -Nailing, Spacing & Bracing-Plates-S_oun_d
38. Bearing Walls_ over Girders & FI_oor Nailing---
39. Draft Stop in Walls (rat proof)
40. _Fire Stops; Furred Ceilings -Stairs -Chases -Tub
Card -BI Date Card -BI Date
Card -BI Date Card -BI Date
Card -BI Date Card -BI Date
Comments at Final:
41.
42.
43.
44.
45
46.
47.
Header & Beam -Size & Bearing
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Ring.
Fireplace Ties or Type A Flue -Fireplace Throat
Attic Access: Size & Rom Protection-Draft_Stop-Ins. Baffles
Bdrm. Windows or Exiling Doors -Sill Hgt. & Dimensions
Garage Fire Protection Framing
(NOTE: An entry must be made each time youvisit jobsite)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE
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.
/ ,
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with therequirements
of the California_ Administrative Code, Title 25, Chapter 5, under perm t`
number IZZ-- for the following location:
Owner
Owner's Address �•�-
Mobilehome Mfg. 412,41 � IIJ4 � Model Al Year A2
Insignia No. ��14 Serial No.////"Y
It is hereby certified for occupancy at the above described location and
may be occupied.
f r� Director ofPublicWoeks
Date 7%" % By,.�'175�/.-iii
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED "
White - Owner, Yellow - Installer, Pink - D.P.W.
J
COUNTY OF BUTTE - DEI ARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT NO_
4/ li6
4/
ASSESSOR PARCEL NUMBER
6 Z
ZONING
BUILDING PERMIT
OWNER
s
TELEPHONE
$Q, FT. OCC. BUILDING VALUATI N
OWNER'S MAILING AIDDR S
-/// 7die GI��D Fi�4G
,CONTRACTOR'S NA
r0,.,U rA
TELEPHONE
. CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADORE
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
Ooeti P_-
PLUMBING PERMIT
Filing Fee 10.00
L A
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION NAME
s 3
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehome,)j�' Other
SPECIFY
Building sewer
5.00
Mobile Home JSJGJWJ
10.00 e
TYPE OF WORK
New ❑ Addition ❑ R�emode1 ❑ Utilities ❑ Installation ❑ Other IZ
Describe work: ,il�/(I-� I rap, 4h 7�1.� ��
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 800V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS.
t
2h2sgft
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 m license is in full force and effect.
Y
License No. 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)
U i, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR MULTI -OUTLET 2.50 ea
NON-RESID BRANCH CIRC ITS
NEW CONST R. (POWER APPARATUS &')
NON -RESID. \ SINGLE OUTLET CIR.
zo Qsot
Ex. Occup(o XTS OR FIXTURES 9AL030
FIXEEDD APP LHS. OR
EX. Occup. OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
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
9f Consent to Self -Insure.
�l 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 shal I be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also a ree to save, indemnifyAnd keep harmless the County of Butte against
all li i ities, judgments, co s, a d xpenses hich may in any way accrue
agai aid County in cons uen the gran ' g of this ermit.
r Date %
Signctur of Applicant — Owner Can ctor ❑ Agent
An 0 A permit is required for excavation over 5'0" deep and demolition or construct-
ion of structures.overr 3 stories in height.
Mobile Home Installation Fee $
O o
TOTAL PERMIT FEE $
OCCUP. GROUP
TYPE OF CONST.
PARQEL
V/
Pq
V/
ND
IS § E
V
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO OF PUBLIC
BY
PE T EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date 4�
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
;�f
COUNTY OF BUTTE - DEPARTMENT OF IIJBLIC WORKS PER T NO.
�7 County Center Drive - Oroville, California95965 - Telephone 916/534-4541 -41"PLICATION AND PERMIT
ASSESSOR PARCEL, NUMBER --
s-3 (o--( Z__,BUILDING
ZONING
PERMI
OWNER
TELEPHONE
FT. OCC, BUILDING VALUATI
adSO.
OWNER'S MA LING A D ESS
i! vM��2Lf40.! (
TR/�If TOR'S NAME )� � �)
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UN -KNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ ,30
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ /
Penalty
$
ARCHITECT OR ENGINEER'S M LING ADDRESS
Permit fee
$
BUILDING ADDRESS
'9Z EGdo
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
2V tf
SUBDIVISION NAME
S t) ® 3
PARCEL MAP
Each qas water heater or vpdf
5.00
Gas piping system 1 - 5 utlets
5.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi IehomeA]--Other
SPECIFY
Building sewer
5.00
Mobile Home GJWJ
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other EV
Describe work: la K 110 Aw"t �j 6 -
Permit Fee
$
Contractor
ELECTRICAL ERMIT
Filing Fee 10.00
Main service 600V OR L SS
100 AMP O LESS
10.00
Main service EA. ADD'L 00 AMP
2.50
NEW CONST. DWELLING CCUP.&
OR ADDNS. ACC. BLDG
1
h2sq ft
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. 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
or sale. (Sec. 7044)
N11I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTRULTI.OUT ET 2.50 ea
NON.RESID BRANCH CI C ITS
NEW CON ST R. /POWER APPARATUS &1
NON.RESID. %SINGLE OUTLEV CIR.
Ex. Occup\OUTLETS OR FI TURES eAL@30t
FIXED APPLNS. OR
Ex. Occup. OUTLETS (REST .) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PER IT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ 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
y to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and eep armless the County of Butte against
liabilities, judgments, costs, nd enses w ich may in any way accrue
agains d County in conseque a granti of this permit.
X Date %%"
Signature o Applicant — O ner Contra r Agent
An OSHA permit is required for excavations ov 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
��
TOTAL PERMIT FEE $
OCCUP. GROUP
TY E of C NST.
�PAR;Ey]
/
HD
Isall
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO PUBLIC
By /
PE EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date —� � �p J
1rc,�d 5
Receipt No. 1/1 /��/
WHITE-O.P.W.. •EL W- SESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
•
r
A ' f ~ /� �v
v
///�/
M
` � ..
���
•
4
•,
� � � V��V ,
,...r � --- -- --
• a .. .� .. .
.. �
R
BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH
Division of Sanitation
695 Oleander Ave., Chico 2430 Bird ..St..;,, Oroville
TRAILER LIVING PERMIT FOR ONE TRAILER
P 0 S T I N T R A I L E R W I N D O W F A C I N G R 0 A D W A Y
---- --------- ------ ------ -------
Issued to: MRS. ISAAC OSTMAN
For trailer (describe): License No. 3176199 - 401 - White - Roadliner
Located: 812 Nord A.ve.-s Chico, California
For period of time: No time limit
This permit is revocable if unsanitary conditions are found in or around the trailer.
This permit is issued for the person, trailer and location shown he �.d is not
transferable.
Date: October 20, 1967
S9 -965R Registered Sanitarian
►
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AN PERMIT
PERMIT NO.
n/1
ASSESSOR PARCEL NUMB R
ZO NG
BUILDING PERMIT
OWNER
E
TELEPHONE:SO.
!/!f JJ� t�3�J
FT. OCC. BUILDING VALUATION
OWNER'S MAILING AD SS
lvM tj= 7�- U L'66�'
CONTRACTOR'S RAME TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
C
Total Valuation $
Filing Fee
$
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
ygZ� Dc [. Div >
PLUMBING PERMIT
Filing Fee 10.00
�C �U
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
20
SUBDIVISION NAME
!90 J
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex❑ MobilehomeR-' Other
SPECIFY
Building sewer
5.00
Mobile Home W
10.00 ea 30
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities )� Installation ❑ Other ❑
Describe work:
Permit Fee
$ O
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service &00V OR LESS
100 AMP OR LESS
10.00 /O —
Main service EA. ADD•L 100 AMP
2.50 0 -IL
NEW CONST. ( DWELLING OCCUP.&
OR ADDNS. C ACC. BLDGS.
1
2/20sq ft
CONTRACTORS LICENSE LAWNEW
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. 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)
EAI, as the owner, am exclusively contracting with licensed contract -
(Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
CONSTR ULT' -OUTLET 2,50 ea
NON-RESID BRANCH CIRCUITS)
NEW CONSTR (POWER APPARATUS .&')
NON RES (SINGLE OUTLET CIR.
Ex. Occu / 20®soe
P\o OR FIXTURES 9AL®soQ
FIXED
FIXED APP LHS. OR
Ex. OCCUp. OUTLETS (RESID•) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 /
Misc. Wiring 15.00
Permit Fee $ 37,50
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should yob become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyof
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County i consequence of the granting of this per it.
R 3 7.0/g�
Date
Signature of 4plicant — Owner Contractor ❑ Agent ❑
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 $
Sd
TOTAL PERMIT FEE $
OCCUP. GROUP
TYPE OF CONST.)rJ
PARC
PD 171
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for w 'ch
DI OF BLIC
BY
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
^�
D to Ot
'r
Receipt No. 141 /
WHITE-D.P.W., YELLOW -ASSESSOR• PINK -INSPECTOR, GOLDENROD -APPLICANT
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENTOF=FICIAL REOOR4c ' .
9VIPTE COUNT 'Y-CAJ_sr
FOR RESIDENTIAL DEVELOPMENT ilEvo11-G REQUESTED 4.
Jpnorl
Section 26-8.1 of the Butte County Code requires this acknowledgement iR ?7 11
be recorded prior to issuance of a building permit.
The property described herein is adjacent to land or included CL1 FiK _ wE1:C1MER
within an area zoned for agricultural purposes, and residents of
this property may be subject to inconveniences or discomfort arising _
from the use of agricultural chemicals, including, but not limited tole rb, ,
pesticides, and fertilizers; and from the pursuit of agricultural operations including,
but not limited to cultivation, plowing, spraying, pruning, and harvesting which occa-
sionally generate dust, smoke, noise, and odor. Butte County 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 discomfort from normal, necessary farm operations.
All that real property situate in the County of Butte, State of California,
described as follows:
Lot: 204, as shown on that certain map entitled "SIERRA `DEL ORO ES'CATE3tUN
NO, 311, which. map was 'filed" in the office of the' Recorder of the County ofButt
State -of California, June 3, 1968•, in Book- 35. of Maps, at pages, 27, .28 -and 29.
EXCEPTING and RESERVING THEREFROM all of the valuable minerals beneath the
surface -of said land with the right to mine and extract said minerals "it being bd
t; , g agr* Y.
and' understood that in all mining operations the surface of said land will be protected,
against damage and that all mining shall be carried on from tunnels,'shafts..or' drifts` '
having their orifices outside of the surface area of -the above described realty,; all es
excepted and reserved in that certain Deed from the Magalt.a Mining : Com a y, ra
corporation, to E.D. Storts, et ux, recorded_ September 4 -if -4 -947 --in Book 423 of But
County Official Records,, at page 385:.
y4A "vt .
PROPERTY OWNERS:
T-1 WORMS)IN
State of ) On this the day of , 19 ,
SS. before me, the undersigned Notary Public, personally
County of ) appeared
Present A.P.
known to me to be the person(s) whose name(s)
subscribed to the within instrument and acknowledged
that executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
Notary Public
NO.
On this 91 t;t day of Marrh in the year
1984 , before me
Colleen Bottini , a Notary Public, State of California,
duly commissioned and sworn, personally appeared
Tcaar Mstman anfl Ratt�7T _0,-t-M8n ,
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person g whose names are
subscribed to the within instrument, and acknowledged to me o
that the y executed the same.
IN WITNESS WHEREOF I have hereunto set my hand and affixed (%
my official seal in the State .of California County of
Butte on the date set forth above
in this certificate.
STATE OF CALIFORNIA
COUNTY OF
.r
OFFICIAL SEAL!
Colleen Bottinl
NOTARY PUBLIC — CALI('URNIA
PRINCIPAL OFFICE IN
BUTTE COUNTY
�rDar.P
llll� COMMISSIod Explres November 2; 1984
This document is onty a general form which may be proper for use in simple transactions and in no tT1
way acts, or is intended to act, as a substitute for the advice on an attorney. The publisher does not r n
make any warranty, either express or implied as to the legal validity of any provision or the Notary anPublic, State of California C�
suitability of these forms in y specific transaction.
My commission expires 1172-84
Cowdery's Form No. 32—Acknowledgement to Notary Public -Individuals (c.c. sec. 1189.)
END OF DOCUME'
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