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065-360-019 02-0793
GREGCROBERT & E LYN
6449 CAL:_S CT, MR
CONT: EXECUTI IOM S3oa
NEW MH EX SITE PER. PNDN
065.360.019 02-1856
GREGG, ROBERT, ;
6449 CALLITRIS CT., MAGALIA
CONT: EXECUTIVE HOMES
REPLACE GAS LINE
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NOTES Qccin=NTlAi
065-360-019 02-0793
GREGG, ROBERT & EVELYN
PERMIT 6449 CALLITRIS CT, MAGALIA
CONT: EXECUTIVE HOMES
NEW MH EX SITE PERM FNDN
THE HCD FORM 433A FOR THIS MH CANNOT
RECORDED UNTIL ONE OF THE FOLLOWING HAS
1 BEEN TURNED IN TO THE BUILDING DIVISION:
(1) LICENSE PLATE(S) OR DECAL (THE
INSPECTOR MUST RETREIVE).
t (2) STATEMENT OF FACTS (ONLY ON NEW
MH' S).
INSPECTOR TO VERIFY SERIAL & LABEL #'S.
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
# OFFICE COPY
Address
GAS
Meter By D
' ELECT
Meter B Dant�:
JOB FINALED (Date)
Signature ���%
./= OK
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
0 = Not OK
1.
- = Not Applicable
MOBILE HOMES
= Not Ready '
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
Date MOBILE ME UTILITIES (Plans) OK except #'s
L.Zo
' Requirements -Setbacks -Easements
. Soils ecial MH Support Sketch
Wood Awn.; Posts- Beams- Rftrs.-Connectors
Shthg.-Frg-Bracing
ewer; Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; location-Clearances-Grnd-/ /Amp -Concrete
6. Gas; Location-Test-Wrap;-19,PL'ft.
/
/'Nat. or/ /-L"ft./ /'LPG
7. Well Clearance & Disconnect
8. Utility Clearance
i
Date Card B-1 Date Card B-1 )
Date Card B-1 Date Card B-1
Date MOBILE H9ME INSTALLATION (Plans) OK except #'s
oning Requirements -Setbacks -Easements
V
/2 ootings; Size -Spacing -Marriage Line
eot'_fectric' ; MH Test -Crossovers -Breakers -Clearances
5 in H Test -Fall -Flex Connector
ate MH Test -Regulator -Connector
7_45 -ter -and Sewer Connected -C/O to Grade -HD Approval
@ifs and Electricity Tagged
9. Tie Do ns -Type -Installation Cert.
1 zits; Insp.-Sketch
11. Cert. of Occupancy
ermanent Foundation Only; License Decal
Date ® Card Date Card B-1
Date Car -1 Date Card B-1
Lj a,�l 0 2Tj
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs.-Connectors
Shthg.-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panelboards-Ins. to Main in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
,/ = OK
0 = Not OK
- = Not Applicable = Not Ready
RESIDENTIAL (;
Date
Underfloor (Plans) OK except #'s
Hangers -Post Caps-Anchors-Cannectors
1.
Zoning -Setbacks -Easements -Flood -Slope
Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Ring.
2.
Fig., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Fig. Depth
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
Garage Fire Protection Framing
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
Property Line Firewall & Openings
6a.
Hold Downs and Special Anchors
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
7.
Slab, Steel -Wrapped
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
8.
Piers -Fireplace Ftg.-Steel
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
Siding -Nailing Veneer
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
11.
Water Pipe; Test -Anchors -Regulator -Service Test
Glazing Area -Glass Protection -Skylights -Plastic
12.
Electric Underground
Shear Walls; Nailing -Bolts
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
Brace Interior/Exterior Wall Panels
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
Insulation -Walls -Ceilings
15.
Access & Ventilation
Infiltration -Walls -Windows
16.
Insulation
Date
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Ext. Steps -Door & Sidelight Protection -Landings
17.
Water Htr.; Vent -Access -Combustion Air Baffle
Smoke Detector
18.
Water Pipe; Test & Anchor -Nail Protection
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
Bedroom Exiting
20.
Shower Pan; Test, First Floor -Tub Access
G.F.I. & Bath Fixtures & Tub Access -Spa
21.
Test Tub & Shower, Second Floor -Tub Access
Elec. Trim & Subpanel, Breaker Sizes & Labels
22.
Gas Pipe; Sixe & Anchors
Stairs & Rails
70.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Elec. Outlets & Receptacles at Kit. Counter
23.
Fixture & Transformer Clearance -Ins. Protection
Garage Fire Door; Swing -Landing -Closure
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
A.C. Duct in Garage -Damper
25.
Size Boxes & No. of Conductors Stapled
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
26.
Romex Installed Close to Edge of Studs & C.J.
Plb., Elec. & Mech. Equip. Listed for Location
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
Insulation -Foam -Looked in Attic
29.
Subleed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At
Guard Rails & Deck Construction -Post Caps
30.
Range Circle / / ga Cu or Al -Oven Circ. / / ga Cu or At
Insulated Neutral Q Yes O No
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
31.
Service -Riser Conductors & Ground Main Disconnect
Clearance Looked under Floor Q Yes
32.
Equip. Clearances Panels-Motors-Mech. Equip.
Following Instld./Drive D Yes D No/Walks D Yes D No/Planters D Yes ❑ No
33.
Clothes Closet Light -Shower Light -Spa Light
Stucco Brown -Finish
34.
Smoke Detector
A.C. Unit Disconnect, Electrical -Plumbing
85.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
87.
MECHANICAL (Permit) OK except #'s
35.
A.C. Ducts Insulation & Support
36.
Vent Fan, Exhaust above insulation
37.
Condensate Drain & Overflow, Size & Grade
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
39.
Attic Access & Platform if Furnace in Attic
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Date
FRAMING (Permit) OK except #'s
Card B-1 Date Card B-1
40.
Sits Proper Materials & Anchors
Card B-1 Date Card B-1
41.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
45.
Headers & Beams -Size & Bearing
P ingle & Duplex)
Date
FRAMING (Continued)
46.
Hangers -Post Caps-Anchors-Cannectors
47.
Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Ring.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skylights -Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor Q Yes
82.
Following Instld./Drive D Yes D No/Walks D Yes D No/Planters D Yes ❑ No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
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:
FLEETWOOD HOMES OF CALIFORNIA, INC.
18 N. PIONEER AVE.
PO BOX 1308 '
WOODLAND, CA. 95776 MC# 17
Date of Manufacture HUD label No.(s)
PFS764701
PFS764702
Manufacturer's Serial Number(s) and Model Unit Designation
SUNCREST 5603B
CAFL217A25735—SC13
CAFL217B25735—SC13
Design Approval by (D.A.P.I.A.) PFS
CORP.
This manufactured home is designed to comply with the federal manufactured home
constructionand safety standards in force at time of manufacture.
(For additional information, consult owner's manual.)
The factory installed equipment includes:
Floors........................................................................
Equipment Manufacturer
Model Designation
For Heating COLEMAN
DGAT070
For Cooking WHIRLPOOL
SF315P
Refrigerator WHIRLPOOL
ETBCH
Water Heater RHEEM
21I40T
Smoke Detector XIDDE
1275E
Garbage Disposal MONARCH
820XL
HOME CONSTRUCTED FOR X ZONE I ZONE II ZONE III EXP. "D"
This home has not been designed for the higher wind pressure and anchoring provisions required for
ocean/coastal areas and should not be located within 1500' of the coastline In Wind Zones II and III,
unless the home and its anchoring and foundation system have been designed for the increased
requirements specified for Exposure D in ANSI/ASCE 7 - 88.
This home has ( ) has not (X) been equipped with storm shutters or other protective coverings for
windows and exterior door openings. For homes designed to be located in Wind Zones II and III,
which have not been provided with shutters or equivalent covering devices, It is strongly recommended
that the home be made ready to be equipped with these devices in accordance with the method
recommended in manufacturers printed instructions.
TI
III
Design roof load zone map: X North 40 psf X South 20 psf
X Middle 30 psf Other psf
NORTH
COMFORT HEATING
This manufactured home has been thermally insulated to conform with the requirements of the federal
manufactured home construction and safely standards for all locations within Uo value Zone
1, 2 , 3 . (See map at bottom)
Heating equipment manufacturer and model (See list at left).
The listed healing equipment has the capacity to maintain an average 70 degrees Fahrenheit
temperature in this home at outdoor temperatures of — 4 4 degrees Fahrenheit
To maximize furnace operating economy, and to conserve energy, it is recommended that this home
be installed where the outdoor winter design temperature (97 1/2%) is not higher than —10
degrees Fahrenheit.
The above information has been calculated assuming a maximum wind velocity of 15 mph at standard
atmospheric pressure.
COMFORT COOLING
F]Air conditioner provided at factory (Alternate 1)
Air conditioner manufacturer and model (see list at left).
Certified capacity B.T.U./hour in accordance with the appropriate air conditioning and
refrigeration institute standards.
The central air conditioning system provided in this home has been sized assuring an orientation of
the front (hitch end) of the home facing . On this basis the system is designed to
Maintain an indoor temperature of 75°F when outdoor temperatures are °F dry bulb and
°F wet bulb.
The temperature to which this home can be cooled will change depending upon the amount of
exposure of the windows of this home to the sun's radiant heal. Therefore, the home's heat gains will
vary dependent upon its orientation to the sun and any permanent shading provided. Information
concerning the calculation of cooling loads at various locations, window exposures and shadings are
provided in Chapter 22 of the 1989 edition of the ASHRAE Handbook of Fundamentals.
Information necessary to calculate cooling loads at various locations and orientations is provided in the
special comfort cooling information provided with this home.
Air conditioner not provided at factory (Alternate II)
The air distribution system of this home is suitable for the installation of central air conditioning.
The supply air distribution system installed in this home is sized for a manufactured home central air
conditioning system of up to 6 3 , 5 0 0 B.T.U. /hr. rated capacity which are certified in accordance
with the appropriate air conditioning and refrigeration institute standards, when the air circulators of
such air conditioners are rated at 0.3 inch water column static pressure or greater for the cooling air
delivered to the manufactured home supply air duct system.
Information necessary to calculate cooling loads at various locations and orientations is provided in the
special comfort cooling information provided with this manufactured home.
To determine the required capadty of equipment to cool a home efficiently and economically, a cooling
load (heat gain) calculation is required. The cooling load is dependent on the orientation, location and
the structure of the home. Central air conditioners operate most efficiently and provide the greatest
comfort when their capacity closely approximates the calculated cooling load. Each home's air
conditioner should be sized in accordance with Chapter 22 of the American Society of Heating,
Refrigerating and Air Conditioning Engineers (ASHRAE) Handbook of Fundamentals 1989 edition,
once the location and orientation are known.
INFORMATION PROVIDED BY THE MANUFACTURER
NECESSARY TO CALCULATE SENSIBLE HEAT GAIN
Walls (without windows and doors) ....................................
"U" -06
Ceiling and roofs of light color .........................................
U. .03
Ceilings and roofs of dark color .......................................
"U" .03
Floors........................................................................
"U" .05
Air duds in floor...........................................................
-U" .05
Air duds In ceiling.........................................................
"U" NA
Air ducts installed outside the home .................................
"U" . 2 5
The following are the duct areas in this home:
Air ducts in floor...........................................................
90 sq. ft.
Air ducts in ceiling..........................................................
NA sq. ft.
Air ducts outside the home ...............................................
56 .5 sq. ft.
U/O VALUE ZONE MAP
WA
NH
MT NO
VT ME
OR MN
ID SD WI
WY MI
NY INA
RI
NV NE IA
IL IN OH
PA CT
NJ
UT CO
,,,, DE
SC ZONES U -VALUES
AL OA 1
LA MS 0 0.116
L. AK TX 2
V H FL 3. 0.096
0 0.079
.`
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
BUTTE -COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE CA 95965
COPY of Document Recorded
05 -Jul -2002 2002-0034847
Has not been compared with
original
BUTTE COUNTY RECORDER
SPACE ABOVE THIS LINE FOR RECORDER USE ONLY
NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH,
INSTALLATION ON A FOUNDATION SYSTEM
Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section
18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described
hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be
indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents
to all persons thereafter dealing with the real property.
DONALD R MATOUSEK REV TRUST
BUTTE COUNTY BUILDING DIVISION
REAL PROPERTY OWNERILESSOR
LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY
6449 CALLITRIS CT.
7 COUNTY CENTER DRIVE
MAILING ADDRESS
MAILING ADDRESS
MAGALIA BUTTE CA
95954
OROVILLE, BUTTE, CA 95965
CITY COUNTY STATE
SAME
_ ZIP
CITY COUNTY STATE ZIP
0270793 /(530)538-7541
INSTALLATION MAILING ADDRESS, IF DIFFERENT
BUI D 4XERMIT N TELEPHONE NUMBER
07/03/02
CITY COUNTY STATE
ROBERT AND EVELYN GREGG
ZIP
FFI L DATE
IG ACTURE OF LOCAL A91M,
EXECUTIVE S
UNIT OWNER (if also property owner, write "SAME")
DEALER NAME (if not a dealer sale, write "NONE")
6450 IMPERIAL WAY
92081 .
MAILING ADDRESS
DEALER LICENSE NO.
MAGALIA BUTTE CA
95954
CITY COUNTY STATE
ZIP
UNIT DESCRIPTION
FLEETWOOD
2002
SUNCREST
MANUFACTURER'S NAME
CAFL217A/B25735-SC13
DATE OF MANUFACTURE
25'8"
MODEL NAMEINUMBER
X 60'
PFS0764701/2
SERIAL NUMBER(S)
LENGTH X WIDTH
INSIGNIA/LABEL NUMBER(S)
REAL PROPERTY LEGAL DESCRIPTION
ASSESSOR'S PARCEL NUMBER
A.P. # 065-360-019
SEE ATTACHED
HCD FORM 433(A) REV. 8/91
WHITE -County Recorder CANARY - HCD PINK - Applicant GOLDENROD- Building Dept
FOUNDATION SYSTEM
CERTIFICATE OF OCCUPANCY
BUILDING PERMIT NUMBER: 02-0793
Address or location of unit: 6449 CALLITRIS CT., MAGALIA, CA. 95954
Legal Description of Real Property: A.P.# 065-360-019
SEE ATTACHED
(x) Mobilehome/Manufactured Home
() Commercial Coach
Has been affixed to the real property above by installation on a foundation system
pursuant to Health and Safety Code Section 18551.
Owner's name: ROBERT AND EVELYN GREGG
Owner's address: 6450 IMPERIAL WAY, MAGALIA, CA. 95954
INSIGNIA OR HUD NUMBER: PFS0764701/2
SERIAL NUMBER OR V.I.N.: CAFL217AIB25735-SC13
MANUFACTURER'S NAME: FLEETWOOD YEAR: 2002
r
OFFICIAL APPROVING INSTALLATION
DATE: 07/03/02
PHONE:
H.C.D. 513C
(530) 538-7541
LEGAL DESCRIPTION
A.P. #065-360-019
All that certain real property situate in the County of Butte, State of California, described as follows:
Lot 191, as shown on that certain Map entitled, "SIERRA DEL ORO ESTATES UNIT NO.
3", which Map was recorded in the Office of the Recorder of the County of Butte, State of
California, on June 3, 1968 in Book 35 of Maps, at Pages 27, 28 and 29. '
EXCEPTING THEREFROM all of the valuable minerals beneath the surface of the said land
with the right to mine and extract said minerals, it being agreed and understood that in all
mining operations the surface of said lands will be protected against damage and that all such
mining shall be carried on from tunnels, shafts or drifts having their orifices outside of the
surface of the above described realty, all as excepted and reserved in the Deed from Magalia
Mining Company, a corporation, to E.D. Stort, et ux, recorded September 4, 1947 in Book 423
of Butte County Official Records, at page 385.
AP No. 065-360-019
FILE No.848 06/19
'02 PM 03:17 ID:EXECUTIVE HOMES FAX:530 891 8753 PAGE 2
• ; , .,,,,,•� t.1
92001
'
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STATIE OF
BUSINESS, TRANSPORTATION AND HIOUSING AGENCY
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DEPARTMENT OF HOUSING ANO OOMMUNITY DEVELOPMENT^DIVISIONOP CODES ANO STANDARDSs
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MANUFACTURED HOUSING PROGRAM
CRrCO
MANUFACTURER CERTIFICATE OF ORIGIN
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RECTION MANUFACTURER AERIAL NUMBER
e
1 CAFL217A2373S-8013
:...2, AFL217a25739-BC13
TRANBPOATER NAME:
' D • 'R TXJMSPORT '
TRANePOATFw Ann.....
Bx P.
0' 80X 279
DESTINATION FOR UNIT DESCRIBED ABOVE:
TRANSFEREE DE81aNAT1oN:
7Te of TRANSFER:"A
• ; , .,,,,,•� t.1
92001
'
�'�
06/1/1002••
' v' 'I
CRrCO
cu
�/ ' '
9.997!
St■a
Z,
' •- � -
.. ..
�::•a•ir.''e:•f.•i.!'t'ml.t:ai%4�i' �,1.',:
87 LOIIIo
CI
63111 i
81eti
it
j
NCO INBIONIA OR NUO ueK NUMBER
T1
IENOTIf
INN
WIDTH INCHES
WEIOHT POUNDS I
pre0764701
720
134
: 24,720
P700764702
720
154
21,520 '
I
DUltlum
I "nil" untiv penfi9y of PbI,pY u11Q4w IM low# of In. Bt.io of cw rrN. IRI IM aft.. Ioct. Bti In,! And corky,
Executed an 06/14/2002 WOODLAND
SIGNATURE OF AUTHORIZED AGENT:
[MVILITION: ORIGINAL (PINK)
f:(1PY I (WHITS)
COPY 2 (ve"OWI
10 403.0 • Side 1 .(7/97) Y (GOLDENROD)
POLO
CA
2 95998 "
i
G ,
I`= Teti:INVENTUIIY CREGI10R. UNLESN TORRE IB NONE, THEN fORWARD TO THE PUNCNANFR (OffALiR OR TRANBFEREE).
7WAR THE DEYANTMFNT AT P.O. BOX te;B. OACRAMENTO, CA 110812-1020. WITHIN FIVE (BI DAYS OK RELEASE.
NEA TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITB DESTINATION.
BE RETAINEO BY THE MANUFACTURER.
0
FILE No . 635 05/21 '02 PM 12:59 I D :EXECUTIVE HOMES FAX :530 891 8753 PAGE 4
RTATI! uF CA1.111011NIA 1TV
9lISINliSS,'1'IlANSI'(Nl'rA'noN AND HOUSINU AGENCY
OFT'ARTMENT 0P 110USING AND COMMUNITY DEVLLGPMNNT
DJVI910N OF COMS AND ITANDARLA •
RF.6191"RATION AND TITLING 1'ROORAM
tr Me
STATL'MENT OF FRMS
'Phis unit is a: ❑ Mobilelwme ❑ Commer:ial Coach ❑ Floating 1 tome ❑ Tnlck Camper
Decal (License) No.(s) Trade Nlrme Serial No.(s)
VV9P-313
UWe, the undersigned, hereby state:
Dealer Report of Salo #
'I"he Above Described Unit Has Been Placed On An Approved Foundation System In Accordance With
18551 Of The Health And Safety Code.
I/We further agree to indemnify rued save harmless the Director of flousing Lind Community Development, State of
California, wxl subsequent pwuhasers of said unit, for any loss they may suffer resulting from registnttion of die
above-described unit in Calilbmia, or from issuance of a California certificate of title covering the same.
1/We certify under penalty ot'perjuty that the foregoing is true Lind correct.
Executed on ° d at .
(U .) (City) (State)
Prin.led name(P)
Address /I 30VA L saa.d-�
City 0 LL -Q - , State
MD 476.6 (ALIV 17/00)
/:03/21'1/02 12:10 BIDWELL TITLE CUSTOMER SERUICE 4 530 891 8753
NO.099 P003
9b •39056
Recording Regm%W By I
BlINFI,I, T1T11F & F'SCROW CO.
G,do, o 1-167909 -1,111R
AND WHEN RECORDED MAIL TO 94-031905s: Rec Fee 9.00
I DOC 25.30
Name Recorded I Check 34.30
S:,eoi DVItA)d K. Matou nok
ada.� 2202 Sweetwater Drive Official Records I
oa
v San L,e"ndzvr CA 94578. CoButteunty oi
C,i 8 I
Candace J. Grubbs I
Recorder I
8:00am 19 -Sep -94 I BWTC MD 2
API Grant Deed
THIS FORM F11RNISHFA BY "WELL "TLE 6 ESCROW COMPANY
Tile undersigned grantor(s) declarc(s):
0ocumcnfury transfer tux is S 25.30 + mobile
t x) compufcd on full value of property conveyed, or
f ) cumputcd on full V311,10 of liens and encumbrances remaining at time of sale.
` ( *, 'Jnincorporatcd arca: ( ) I.and
FOR A VALUAIfLG CONSIDERATION, receipt of which Is hereby acknowledged, FkNA C. MATOUSI li , ,t w i tiow
perch), GRANT(5) to DONALD R. MATOUSEK, a siMle titan
the fallowing described real property In the ton i ncorporat ed are.) County of Ittt 1 t r.
St:nC of California:
o:FF, TNF ATTACIlF-b SCIIFDUI,F. C FOR I,FGA1, DESCRTpTION
h,flf,rl: Atigiist l5, 1994
�C _CEJ )�•�� � ��
h:l'nd C. �1,ttrwtrr k
S1n14 of C;1lilantiu SS.
I Cl;unty or Butte
()it—_ZIiyus L 22, 1(3(34 before me. the undendgned,•a-litla ty Public In and for said Stoic personally appeared
�•-'---- lifilh arca for afCcinl notarial scull
Ism.1111ally known to me (r,r lmwcd to me alt dx twits of wtds&►•tory
er'irk lee l lobe file lk wm(>) wiuti-;C n{utk(s) idem suhsCdtted to the widdn SANDRA M. UNVILLEI�
iu.tnu fn rn :frnt iR Ii1111N'llyt( l'i) Io t11C tlt:n h�xltc/tlky e><mtltd the f4a11C In C COMM. 0991)551 11 r
1 iisAwild lcir audurrved capac curd that by hisftrAhf:Ir signattai'(s) NOTARY Pu5LI0-CALIFOHNtA p
nn thr itim imcist Or Iwsnn(s) nr ate entity uprnt b►haif.orHi.ich dk Bum COUNTY
lx•��,xd.} ,,,int exmille 1 IN: ifauunknl, t,iy C mm. fxpl,of, MMS 5.1097
ll'1'I'N1�.�S nf�� nand :u,d nllici:fl mal, - '
MAIL TAY, aTATFUENTS TO Ill'dtlt,�n 11 i,(141t•p5iq_..a:�QKE� - - r.—•---._.--- -.
i, l l •UI• I1•n, fl;,q•I l
03/?1i02 12:10 BIDWELL TITLE CUSTOMER SERVICE 4 530 891 8753 NO.099 P004
0( y
11
94-39056
Order No. 3-167809
SCHEDULE C
The land referred to herein is described as follows:
All that certain real property situate in the County of Butte, State of
California, described as follows:
Lot 191, as shown on that certain Map entitled, "Sierra Uel Oro Estates
Unit No. 3", which Map was recorded in the office of the Recorder of the
County of Butte, State of California, on June 3, 1968 in Book 35 of Maps,
at pages 27, 28 and 29.
EXCEPTING THEREFROM all of the valuable minerals beneath the surface of
the said land with the right to mine w.,d extrept said minerals, it being
agreed and understood that in all mining operations tho surface of said
lands will be protected against damage and that all such mining shall be
carried on from tunnels, shafts or drifts having their orifices outside
of the surface of the above described realty, all as excepted and
reserved in the Deed from Magalia,Mining Company, a corporation, to E. D.
Start , et ux, recorded September 4, 1947 in Book 423 of Butte County
Official Records, at page 385.
AP No. 065-360-019
END OF DOCUMENT
0,
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541, PgDg1T Q.7
(Rev. 12/96) APPLICATION AND PERMIT - ,
ASSESSOR PARCEL NUMBER •
065-360-019
ZONING
BUILDING PERMIT
OWNER
T1 z; T
TELEPHONE
_
SO. FT. OCC. BUILDING VALUATION
1539 R 83 106.00
OWNERS MAIUNG ADDRESS
6450 IMPERIAL WY MAGALIA CA 95954
CONTRACTOR'S NAME
=CUTIVE HOMES
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
3042 ESPLANADE CHICO CA 95973
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Fee $ 20.00
-Filing
Permit Fee 567.50/2 $ 283.75
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $ 184.40
BUILDING ADDRESS
6449 CALLITP'IS COUPMAGALI
Energy Plan Checking Fee $
$
PERMIT FEE $ 488.15
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome M Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New 6 Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: NEW MH PERM FND (REPLACEMENT)
Gas piping system t - 5 outlets 15.00 15.00
Building sewer 15.00
Mobile Home ISI GI W1 1 920.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
"OOVORLE
Main Service 2o0A OR LESS 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect. / _
License Class L' y� Lic. No. LAC6? 8 5
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permitis issued.
My workers' compenan in ance mer and policy number are:
Carrier tio49 k
Policy Number
(The above sections need not be completed ' the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith com ly with th e provisi�Kof
X Date ' U
Signature pplicant -❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
oWLZ;&jJf structures over 3 stories in height.
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP. SO
OR ADDNS. ( a ACC. OCS. 3.5QFY:
KK)µREOSID. MULTI•oUTLET 97,50
FOWER APPARATUS
8 SINGLE OUTLET CIR.
20 @ 100
Ex. Occup. OUTLET OR FIXTURES BAL @ .50
FIXED APPLNS. OR
Ex. Occup. 5.00
OUTLETS 8610. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
Pre -inspection 1 23.00123.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $ 538.15
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. rrPE
T TL FEE $
HAZ.
D. FEES P
FL
P L
H
ISSUE
This permit is hereby issued under the applicable provisions
the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
By ��`%� °�etj�6 D to 0 A 1 16
PERMIT EXPIRES ON 0 60
Date
Receipt No. 343728 X224.40
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
VIP,
'I'm 12./U19 ._
'FIAtltL'_tUll I
m 4 t ton r!^In/.1 �
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IrICII/IECr Oft It71I w.20 Qu
EnIr„�12t /l0. .—..-.____-.... _......_—__.
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--.12
---- --- - ----------- --- ...------ --- - -- - - Flan Checldn Cee S
-- E1191(1Y 1'100 Checking Fog f
Sf�1*1 fl nlornnv+�
3_ b I'I_U
r,�n^EI. u•r -- ....- -..__..__... ---..__._._...-- --- ` /
J i �s ��T2q
Lot --.-._.....g
� F41)IFJG F'En1,11'f r"ilia f"e, 2o.()()
S1 r--Yz
USE OPSintlr;�f�1f1F ..Encu crap __. 7:nm
SF Cl Duplex (A Mobil -homy y1j, Uthor
irEcFi-.._._..--...._
1rrF OF Wont;
Nmv� nddillon U ff1giI,o lrl 1.:1 (_4iGflon CI FISInMllpll r_1/�OIll�r f.l - ---
U ec,,rIt " Work: as ,ge1C ,. 11�.•.1N.. Q _..__
SNDA LOAD7-0( _7-0
FFLmuv 1 XJ �y c��
S
"PERMIT FF'F_ 1'nt.F.i
PA
51 -IF -:R:1.1' f'
OT E.R
AMOVIAT RCCE-.L e:1.)
gni-D-D..--------
"IiECC1.F�r NVMIAER
q-a,�c-�K
" TC) FIFA PVT INTO CaMPVrr_--It - -- --
Solar or hent pump Water heater
I'Em rr FEE
23.00
-- Wnlrlr..t'IPir.:y.. _
is 00 _
Each as water healer cr vent_
eoov on tEss
2oae On lEs4 �-
15.33
Ong hlpfnq nyslem 1 - 5 oullele
— -----------
Ivlalll Sorvlc9
1 5. 00
-f3ulWeRvrer
-- -in-Rp Power
--
_ _
---'15.33
- ---
l.lobile 1101119
Q520.00
rE111.111FEE R
1AECI IAIJICAL rEnlAll F(Ib1g rn 1 23.03
• 'oo inp
-
Ifo -.._.._... ..._ - a._,a
Venlllnllon
Mobile 1101119 Inslnllalion 1:09 R
_n�Igy Insp9011011 Fog R
Oct!__.. ---------
.. __....... .. ._.._..
rcr nl_ rr_-r
� IEES 1 l
Ih1e parmil In horeby lnnuold folder Ilia 111 pII,:Rb1g prnvl+inn+
of 111e nolle Courtly Coda "rid/or n000lullonq in Flo vrr+Flt
I1101CnIad nbov9 for Whidl loan have b -en rnld.
fly - -....DAt-
rrnlrllr r=xrinr:s olt
I'Em rr FEE
_
.........
.............—...-._.-�-- --
lvlalll $e1V1C9
eoov on tEss
2oae On lEs4 �-
23.00
Ivlalll Sorvlc9
20.0t nnen
�.--to I-'— �-
_
413.00.UU
i� c oTF I. ... _.
on I.00I14.
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- -- ,-.1----w!yn.
-
revitil.Du1LEIIrum. On
o.l_Fa
--
--
- - -
lemeoraly Service-- --
23.00
Mobile I lome
---
Facilities
23.33
23.UU
rE111.111FEE R
1AECI IAIJICAL rEnlAll F(Ib1g rn 1 23.03
• 'oo inp
-
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Mobile 1101119 Inslnllalion 1:09 R
_n�Igy Insp9011011 Fog R
Oct!__.. ---------
.. __....... .. ._.._..
rcr nl_ rr_-r
� IEES 1 l
Ih1e parmil In horeby lnnuold folder Ilia 111 pII,:Rb1g prnvl+inn+
of 111e nolle Courtly Coda "rid/or n000lullonq in Flo vrr+Flt
I1101CnIad nbov9 for Whidl loan have b -en rnld.
fly - -....DAt-
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4
' t
-T' vnl, .
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 NUMB R 0
N
Proposed Building Use: 1 ' t WCounter Technician: Date: 4141 D a
Items required in order to apply tor a per it. All boxes MUST be checked OR marked NA in order to apply.
1.. Plot plans, 3 or 4 sets, signed by the preparer of the plans.
2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
4. Engineered truss details and layouts in duplicate. No faxes!
5. Energy compliance design and supporting documentation in duplicate.
Ift)6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be
indexed and returned to the plan review line-up when required items are received.
Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
❑ 9. Plot plan and business license approval from the City of Biggs ....................................
❑ 10. Letter of intent for non-residential buildings.........................................................
❑ 11. Detached Accessory Building Form filled out by the owner ..................................... '
❑ 12. Hazardous Material Form...............................................................................
❑ 13. Other
ining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
tSanitation
s as shown on the attached Schedule of Fees Due Sheet .......................................
tement of Intent for Non -heated and A/C Buildings ......................................
and plot plan approval from the Environmental Health De me in t ty of Chico Plumbing permit .......................... .. ............
ifornia Department of Forestry plan approval paid. Sent by:Y...nning approval for (A) Use: o IC (B)Parking: (C) Parcel heck:
❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ...............................
❑p2l. Encroachment Permi4-for driveway fron, the Pub ' W9r�s Dept. (construction pr val ru'jgr to occu nc .
2. Pre -Inspection for �X s( Ti required.. l.Vu� a
❑ 23. Contractor's license information. (Nun%er, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number .............................................
❑ 15. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) .....................
'lid6. Letter of Signature authorization....................................................................
7. Recorded copy of Agricultural Acknowledgment Statement ....................................
❑ 28. Manufactured home c earanc ............................ !..................... ...........
❑ 29. E 'sting violati s d/or expired permits........*... ........................... . .
❑ 30. Grant Dee H. Title/Statement of Facts Cg Letter from Legal Owner, Check to H.C.D. $
❑ 31. Other:
When issued Telephone and hold for pickup.
I have been informed of�tbeAbove items a
uirements for obtaining a bui ding pp mit.
o %
V— Date.
1. Index permit application for the ab a iVOTered: Plan Check Letter
2. Additional items required
designer, owner, was ad d f above data by phone, ❑ mail, ❑ counter, by Date: 3v 0 L
Contractor, designer, ow , was advised of the abov dat by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: _� Date: y kl2 Plans approved by: /A/J Date: qlnwo L
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
E.M. USE ONLY
Plot Plan Attached
FlOO/Plan Atta ad
Sant to B.O.
Q,�6a g i -rJ 1 i* l p- s r+- Coy � lG
Owner Location P#
Plan Approved for: Sewage Disposa�<
Clearance forwelling. Other M
Hold final for:
Water Supply: Pripate Well
Final clearance O.K. for:
NOTE:
9/7
J. I
Envi nmenta ealth Specialist Date
8/96
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE. CALIFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER. ----
PROPOSED BUILDING USE
BUILDING PERMIT FEES
BalanceDue ........................................................ $
--Additional Fees Due ............................................ $
--Additional Fees Due ............................................ $
--Revised Plan Checking Fee ................................. $
SCHOOL DISTRICT FEES POLACW] 1��
(paid at District Office) CS
3. SHERIFF FEES (paid at Building Division)
Residential .................................... x $360.00 = $
Units
� s
Commercial (sq. ft.) ...................... x $0.03 = $
Sq. ft.
4. URBAN AREA FEES
Residential ............................ x = $
# Units Amt.
Commercial (Sq. ft.) ............. x = $
Sq. ft. Amt.
5. RECREATION DISTRICT FEES
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
47. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion # )
$200.00 (paid at Building Division)
9. CSA 87 TRAFFIC FEE
$2500.00 (paid at Building Division)
10. OTHER
A.P. #
DATE ql�LO�
RECEIPT # DATE REC.
y'3'<0-
At
time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees
may be changed during the plan checkin process.
O
APPLICANT DATE
Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been
imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original - Building Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 6/00)
iIr
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DMSION
7 COUNTY CENTER DRM?
OROVILLE, CA 95%5
COPY of Document Recorded
08 -May -2002 2002-0023657
Hae 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, priming, 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:
PLEASE SEE ATTACHED
Date12�/ , �C;C�� PROPERTY OWNERS:
Robert Gregg`' Emglyn Gregg
State of Califolnia
County of e -40'725 -
On
-4 '725=
On A`V /, A610 2 before me, J1PV15r CC'Lrf' le
personally appeared —I IiL%-aI2-t � 4`,-v12 EY�L.t/y /�C` personally
(mown to me (or proved to we on the basis of satisfactory evidence) to be the persons) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/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 official seal. JANET CLARK
Commission # 12.58479
Signature Seal:z
Caliicrnn
autta County
A.P. #�� -a_0 /(7
Attachment to: Agricultural Statement of Acknowledgment
for Residential Development
Property Owners: Robert and Evelyn Gregg
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL TIIAT CERTAIN REAL PROPER'L'Y SITUATE INT If E COUNTY OF BUT"1'E, STATE
OF CALIFORNIA, DESCRIBED AS FOLLOWS:
LOT 191, AS SHOWN ON THAT CERTAIN ANAP ENTITLED, "SIERRA DEL 0110 ESTA'T'ES
UNIT NO. 3", WHICH MAP WAS RECORDED IN THE OFFICE OF THE, RECORDI,11 OF
THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON JUNE 3, 1968 IN 110010 35 OF
NIAPS, AT PAGES 27,28 AND 29.
EXCEPTING THEREFROM ALL OF THE VALUABLE MINERALS BENEATII TIIE
SURFACE OF THE SAID LAND WI'1'II THE RIGIIT 1'O A71NE AND EXTRACT SAID
MINERALS, IT BEING AGREED AND UNDERS'T'OOD THAT IN ALL MINING
OPERATIONS THE SURFACE OF SAID LANDS WILL BE PROTECTED AGAINST
DAMAGE AND THAT ALL SUCH MINING SHALL BE CARRIED ON FRONT TUNNELS,
SHAFTS Olt DRIFTS HAVING THEIR ORIFICES OUTSIDE OF THE SURFACE OF TIIE
ABOVE DESCRIBED REALTY, ALI, AS EXCEPTED AND RESERVED 1N THE DEED
FROM AVIAGALIA MINING COMPANY, A CORPORATION, TO E. 1). STOR'I'S, E'I' UX,
RECORDED SEPTEMBER 4, 1947 IN BOOK 423 OF BUTTE COUNTY OFFICIAL
RECORDS, AT PAGE 385.
AP NO. 065-360-019
9,,Q %3�
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
JOne form per Building)
• School District �(/l�V, ', ^ Building Department No.
A.P. Number O Jurisdiction: Cityi j� iC
� ounty
Property Owner AAI c �/ ��. c--
`— v -e 1 u %1
Property Location/Address
Subdivision
Lot No.
.......... ..........
Residential Development
No of Living Mobile Home Addition/ *Supplemental to
Units Installation Conversion Permit #
'(No foundation inspection):
.......................................................:r..............;........................................
Commercial/Industrial
r New Addition
IV / A
Building Department Representative
Irioor rians reviewed ov scnooi uistnct rersonnel
District Identification No. ` UC. e --
School District certifies that
RI
Sq. Footage„
roup R j
S4Foage
(Including Exterior
Roofed Areas)
L4 Ut
Date
400,
/ (Applicant)
g� - Gyy 2-
(Street Address) ✓
(Phone Number)
(City) (State)
has complied with the requirements of Resolution No.
representing square feet.
School District Representative
Paid by Check # Remarks:
(Zip Code)
by payment of $
AB 2926 $
FULL MITIGATION $
30 -G
Date
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xls (10/98)dmm
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 • Telephone (530) 538-7541 O 7—('sM� moo•
(Rev. 12/96) APPLICATION AND PERMIT �(p
ASSESSOR PARCEL NUMBERZONING
BUILDING PERMIT
OWNER /��jjL C
0(!�V�
T LEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
CONTRACT R'S E
/- 9
CONTRACTOR , .// /1D S
CONSTRUCTION LENDER
Fireplace
LENDER'S MA,UNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filin Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS C—�
Energy Plan Checking Fee
$
/4--
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEO STRUCTURE
SF uplex ❑ Mobilehome Other
SPECIFY
Solar or heat um water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work:`
Gas piping stem 1 - 5 outlets
15.00 C(%
Building sewer
15.00
Mobile Home S G W
@20.00
PERMIT FEE
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service 200, OR LESS
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is i f Il�fp]�ce and effect. (/ Q Lj Q
License Class l Lic. No. �X. '1 �� C��
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' orrn�pensation in uaance car I r and policy number are:
Carrier �T-0 •-{—� r-) I _
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUR
OR ADONS. ( & ACC. BLDS.
so.
3.50Fr_
NON N•R61D MULTI.OUTLET
97,50
aPOWELRLE OvfLErU R.
PSTN. IR
OR FaTUR
Ex. Occup.BAL
20 @ 1.00
@ .50
Ex. Occup. OiTLEETS RE�S,D.OFRA.
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
$
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Policy Number�P�. 5 =
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
orkers' co pensation provisions of section 3700 of the Labor Code, I shall
rthwith co ply with provision
X Dat % ��
Signature of Applicant - Owner ontractor Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height
Mobile Home Installation Fee
$
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $
FEES IMP
I FLOOD
I COF
PARCEL
PO
I HD
I ISSU
This permit is hereby issued under
Ofthe Butte unty Code and/or
indicated a for which fees a
By—ate
PERMIT EXPIRES ON �/
the applicable provisions
esolutions to do work
been paid.
7
(Data)
Receipt No.
WHITE-D.D.S.-TF C NARY -A E SOR PINK -INSPECTOR GOLDENROD -APPLICANT