HomeMy WebLinkAbout065-360-027IyB�IUPLAt� '°•
CONT:SKYCREST
NEW MH NEW SITE
NOTES
RESIDENTIAL
065-360-027/ 02=0289
BALOGH,ADAM
I4 941 UPLAND RD, MAGALIA
CONT: SKYCREST ENT
U� l
NEW MH NEW SITE PERM FNDD
THE HCD FORM 433A FOR THIS MH CANNOT BE
RECORDED UNTIL ONE OF THE FOLLOWING HAS
BEEN TURNED INTO THE BUILDING DIVISION:
(1) LICENSE PLATE(S) OR DECAL (THE
INSPECTOR MUST RETREIVE).
(2) STATEMENT OF FACTS (ONLY ON
NEW MH'S).
+ INSPECTOR TO VERIFY SERIAL & LABEL #'S.
l
JOB FINALED (Date)/ / ,
16? --
Signature
4--3.3315W
9V._70 --ow-- /0
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY
Address
GAS Dom"
Meter
ELEC IC Date
Meter B
CHECKED
BY
V= OK
0 ="Not OK
= Not Applicable
` = Not Ready
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Zoning Requirements -Setbacks -Easements
1.
Zoning Requirements -Setbacks -Easements
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
2.
Soils; Special MH Support Sketch
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
3.
Sewer; Location -Test -Fall -C/O -Concrete
Wood Awn.; Posts- Beams- Rftrs.-Connectors
Shthg.-Frg-Bracing
4.
Water; Location -Test -Easement Needed (Sketch)
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
Carports; Windows -Doors
6.
Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or / /"L'ft./ /'LPG.
Electric
7.
Well Clearance 8 Disconnect
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
8.
Utility Clearance
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
1.
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
2.
5.
Drain; MH Test -Fall -Flex Connector
3.
6.
Water; MH Test -Regulator -Connector
4.
7.
Water and Sewer Connected -C/O to Grade -HD Approval
5.
8.
Gas and Electricity Tagged
6.
9.
Tie Downs -Type -Installation Can.
7.
10.
Exits; Insp.-Sketch
8.
11.
Cert. of Occupancy
9.
12.
Permanent Foundation Only; License Decal
10.
Plumb.; Cir. Test -Water Supply Test
Date
Light Niche
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 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
V= OK
0 = Not OK
- = Not Read able
=Not Ready
RESIDENTIAL (;
Date
FRAMING (Continued) `
Underfloor (Plans) OK except #'s
46.
1.
Zoning -Setbacks -Easements -Flood -Slope
47.
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
48.
3.
Fig., Garage; Soils-Steel-Elec. Grnd.-/ f' Ftg. Depth
49.
4.
Ftg., Porches & Decks; Soils -Steel-/ F Ftg. Depth
50.
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
51.
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
52.
6a.
Hold Downs and Special Anchors
53.
7.
Slab, Steel -Wrapped
54.
8.
Piers -Fireplace Ftg.-Steel
55.
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
56.
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
57.
11.
Water Pipe; Test -Anchors -Regulator -Service Test
58.
12.
Electric Underground
59.
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
60.
14.
Girders -Sills -Anchor Bolts -Joists- Vent s-Crippies
61.
15.
Access & Ventilation
62.
16.
Insulation
Date
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
PLUMBING (Permit) OK except #'s
63.
17.
Water Htr.; Vent -Access -Combustion Air Battle
64.
18.
Water Pipe; Test & Anchor -Nail Protection
65.
19
D.W.V.; Test Fittings & Anchor -Nail Protection
66.
20.
Shower Pan; Test, First Floor -Tub Access
67.
21.
Test Tub & Shower, Second Floor -Tub Access
68.
22.
Gas Pipe; Sixe & Anchors
69.
Stairs & Rails
Date
Fireplace or Stove, Clearance -Hearth
Card B-1 Date Card B-1
Date
Elec. Outlets at Wood Panel, Int. & Ext.
Card B-1 Date Card B-1
Date
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
ELECTRICAL (Permit) OK except #'s
73.
23.
Fixture & Transformer Clearance -Ins. Protection
74.
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
75.
25.
Size Boxes & No. of Conductors Stapled
76.
26.
Romex Installed Close to Edge of Studs & C.J.
77.
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
78.
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
79.
29.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At
80.
30.
Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or Al
Insulated Neutral ❑ Yes D No
81.
31.
Service -Riser Conductors & Ground Main Disconnect
32.
Equip. Clearances Panels-Motors-Mech. Equip.
82.
33.
Clothes Closet Light -Shower Light -Spa Light
83.
34.
Smoke Detector
84.
A.C. Unit Disconnect, Electrical -Plumbing
Date
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
Card B-1 Date Card B-1
Date
Water Well, Disconnect, Electrical, Plumbing
Card B-1 Date Card B-1
Date
Exterior Elec. Trim, G.F.I. Receptacle -Underground
MECHANICAL (Permit) OK except #'s
88.
35.
A.C. Ducts Insulation & Support
89.
36.
Vent Fan, Exhaust above insulation
90.
37.
Condensate Drain & Overflow, Size & Grade
91.
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
92.
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
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
FRAMING (Permit) OK except #'s
40.
Sills Proper Materials & Anchors
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
jingle & Duplex) +.
Date
FRAMING (Continued) `
46.
Hangers -Post Caps -Anchors -Connectors
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 -Drab 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-Mech. 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 O Yes
82.
Following Instld./Drive J Yes J No/Walks J Yes J No/Planters J 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:
INTER -DEPARTMENTAL MEMORANDUM
TO: BUILDING DIVISION, OROVILLE
FROM: V�) �ca, , ENVIR. HEALTH, CHICO
DATE: ,
RELEASE ENV. HEALTH HOLD ON BUILDING FINAL FOR:
OWNER NAME: SEPTIC: WELL:
��� -C�2 ADD RE
A'#: �� QS "' l
Comments:
GUmemostreleasehold
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERW NO.
(Rev. 1245) APPLICATION ANDPERIVrIT
G
AS R ARCEL►A1ZO
Qa %
W N
�
BUILDING PERMIT
«� +
Y
TELEPHONE
gp• Fr. OCC. BUILDING VALUATION
. OWNER'S MAILING ADDRESS
v
CONTRACTOR'S NAME V
SKYCREST ENTERPRISES
TELEPHONE
342-2694
CONTRACTOR4 MALM ADDRESS
13468 WY 99 E.. CHICO CA 95973
CONSTRUOTLON LENDER
i
LENDER'S MAJUNG ADDRESS
Fire lace
Total Valuation
AACHRECT OR ENGINEEii
LICENSFN O.
FiIIn Fee b
20.00
ARCWECr OR ENOWEER'S WILING ADDRESS
BUIIDINGADDREsa C
.. t
Permit Fee �? b
Plan CheckingFee b
Energy Plan Checking Fee b
J
) ir"I SSE2VZ+'(> zr, OuPA 6s -r-
b
PERMIT FEE _
^
LOTNO. Ink n
SUaONjSIDN11NkkAE .>
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobllehom4 Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00 -�
TYPE OF WORK
New� Addition Re el ❑ Utilities ❑ Installatlon"A Other ❑
Describe Work: �� % / H L y� Z. YY� . FOGtf ������
Each as water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00 -
Buildingsewer
15.00
Mobile Home S G W
Coj20.00
PERMIT FEE S
ELECTRICAL PERMIT
Filing Feel 20.00
Main Service aOOV OR LESS
2ooA OR LE68
23.00
IS -Novo L•O inlotzl _, ?-1501L>-T0 3 f3`1 4 l -
Lim Q
a/
"`
*PERMIT $
SRA $
I
SHERIFF $ �%�. ` (
OTHER $
$
Main Service w SoTO I—A
48.00
CONST.
OR CNS DW LCCUP.
3.5�so.
NO"ESID. " MULTBRANCH I -OUTLET
97.50
POWER APPARATUS
88WG O CI
Ex. Occup. OUTLET OR FUTURES
20 o I'0°
a'LL '°
Ex. Occup. F1XED APPLNS. oR
oLmETs RE91D. EA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
MECHANICAL PERMIT
Filing Fee 20.00
Coolin
oolln
Hood
8.50
Ventilation
$
PERMIT FEt S
Mobile Home Installation Fee b
_
AMOUNT RECEIVED $ = �' �. I
*RECEIPT NUMBER �v�
*TO BE PUT INTO COMPUTER
Energy Inspection Fee b
OCC
CONST. r� O AL FEES
HAZ
I
176
FLOOD
-i
CDr
6SU
This permit Is hereby Issued under the applicable provisions
of the Butte CountyCode and/or Resolutions to do work
Indicated above for hich fees have been paid.
By Date
PERMIT EXPIRES ON
(Date)
1
a
T
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev.12/96r APPLICATION AND PERMIT 02-9289
ASSESSOR PARCEL NUMBER
065-360-027
ZONING
RT1
BUILDING PERMIT
OWNER
ADAM
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
946 51084
OWNERS MAI„fig, SS
U�p:Lann Rn, Magaiia
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
1-1468 14WY99 E, C14TCO 99971
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 51084
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee 423.50/2 $
211.75
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee $
23.00
BUILDING ADDRESS
7UPLAND RD, MAGALIA
Energy Plan Checking Fee $
$
PERMIT FEE $
254.75
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome I)p 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 ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation 13 Other ❑
Describe Work: NEW MH NEW SITE PERM FNDN
f3 R- -
Gas piping system 1 - 5 outlets
15.00 15.00
Building sewer
15.00 15,00
Mobile Home I S I G I WF_
@20.00
PERMIT FEE $
65.00
ELECTRICAL PERMIT
Fling Fee 20.00
600V0LE
Main Service zoOA OR LESS
23.00 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(* in ft}II force end effect. G \
License Class ` L-/ % Lic. No. a / // ”
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.
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' compensa n Insurance carrier an policy number are:
Carrier �� Ftp )1
Policy Number a L 3R- G,
(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
work compensation provisions of section 3700 of the Labor Code, I shall
fo w' h comply with th se provisions.
Date /-0)
Sig atu o App Ica` t - ❑ Owner ❑ Contra ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service TO
46.
NEW CONST. DWELLING OCCUP
CU.
OR ADONS. ( & ACC. BLDS.
so SO
3.5¢FT.
NON-RESID. T.MULTI.OUTLET 97.50
POWER APPARATUS
a SINGLE Our. CIR.
Ex. OCCU OUTLET OR FDCTURES BAL4,.O
OFOCU E%A R. p OEA 5.00
Ex. Occup.
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $ 43.00
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 362.75
HAZ.
--
D. ES I
FLOOD
__
C F
PX
p�ggEL
P�
v
A
ISSUE
x
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated indicated above for which fees have been paid.
ByE4W4? D to �Z
PERMIT EXPIRES ON
De
Receipt No. 343202/$811.75
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
r
,! `+ BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
#► �1, r
e�.:..� •..: w� (One form per Building)
School District Building Department No.
A.P. Number oul;'-�L.Vo' 00el Jurisdiction: City County
Property Owner OA 14d(2A YY--,
Property Location/Address ��
r Subdivision Lot No.
...................................................................................................................
Residential Development ' Sq. Footage C ,Q
No of Living Mo I ome Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
*(No foundation inspection):
Commercial/Industrial
New Addition
Sq. Footage
(Including Exterior
Roofed Areas)
Date
Irioor rians reviewea oy scnooi uistnct versonnep
Distri t Identification No. 40 4;� _o 42 6
School District certifies that
(Applicant)
(Street Address) (Phone Number)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No.
representing (Jd square feet.
School District Representative
]. A . A /
f
Paid by Check # Remarks:
• o
by payment of $ 36
AB 2926 $
FULL MITIGATION $
Date
I
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.
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A
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 X,--" /vNIry ✓ ) v_ rT r war
1. BUILDING PERMIT FEES
--Balance Due ........................................................
--Additional Fees Due ............................................ $
--Additional Fees Due ............................................ $
--Revised Plan Checking Fee ................................. $
2. SCHOOL DISTRICT FEES
(paid at District Office)
e 6 -Al 3. SHERIFF FEES (paid at Building Division)
Residential .................................... x $360.00 = $
Units
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)
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. #COS �J CO
DATE
RECEIPT # DATE REC.
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees
may be changed during the plan checking process.
APPLIC
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)
� I?,,
t j
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
-�bO06 &0
OWNER: C�� SESSOR PARCEL NUMBER
Proposed Building Use: MK div✓ > m Counter Technician: Date: 6�
V
uired in order to apply for a permit. All boxes MUST be checked OR ma d NA in order to apply.
plans, 3 or 4 sets, signed by the preparer of the plans.
plete plans, 3 or 4 sets, signed by the preparer of the plans.
/;pit 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
lA 4. Engineered truss details and layouts in duplicate. No faxes!
A5. Energy compliance design and supporting documentation in duplicate.
0/6. Manufactured homes: (,"Data sheets and installation instructions, (B) Marriage line information, (Floor Plan, QeTie down or
foundation plans, all in duplicate.
/J6 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
j_r ing items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
Fees as shown on the attached Schedule of Fees Due Sheet .......................................
Statement of Intent for Non -heated and A/C Buildings .................................
Sanitation andplot plan approval from the Environmental Health Department in
City of Chico Plumbing permit.......................................................................:
#FLS. California Department of Forestry lan approval 1D-Kaid. Sent by:
❑ 19. Planning approval for (A) Use: O(B)Parking: (C) Pa cel Check:
❑ X0. Contact Land Development about ❑ Improvements, ❑ Drainage ...............................
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). /
❑ 22. Pre -Inspection for required ................ 7 7
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:..............................
❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) .....................
❑ 26. Letter of Signature authorization....................................................................
Recorded copy of Agricultural Acknowledgment Statement ....................................
❑ 28. Manufactured home utility clearance...............................................................
�❑ 29.E 'sting violations and/or expired permits.........,..g... ...................
30�Grant Deed�LH. Title/&atw� t-�f_Earts, �Q etter from Legal Owne , Check to H.C.D. $
❑ 31. Other:
When issued Telephone and hold for pickup.
I have been infor d of the above items requirements for obtaining a building permit.
Applicant: , �► e:
�ndex permit application for the above items numbereev
Plan Check Letter
2. ' nal items required
Contra , designer, owner, was advised of the above data by pho , ❑ mail, ❑ counter, by Date: 2S �Z—
ontr , designer, owner, was advised of the ab ve d a by ❑ phone, ❑ mail, ❑ counter, by Date: y 2% o
Plans reviewed by: (ZDate: Z Plans approved by: Na
Date: i is
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
6Z
7 N
TO: Building De ent
FROM: Envir ental Health
SUBJECT: S itation Clearance
Plot Plan Anecl
t Floor Plan Ann h d
Sento B.D.
b�
Ol
Owner Lo ation AP#
Pla Approved for: Sewage Disposal X ) Water Supply: Public Private Well
Cil arance for u dwelling. Other
Ho final for: 1 r
Final clearance O.K. I:
NOTE:
8/96
ealth Specialist
Date
LAKKY i'Alh'. LK
om: CWICO ENV. HEALTH
. ❑ APPROVED
029 g
Genera/ info�n>'ab%on
Clio 1(!�
MONALLY APPROVED ❑ RESOLVE PROBLEMS PRIOR TO APPROVAL I
PERMIT CLEARANCE
��2 9 2002
Date: (
)wners Name: al_ -i iy .�a(ce_-i
)wners Address:
Wilding Site Address
Parcel Acreage:e—
Provertyrinformation
Zoni Code
Street & Highways
Fire Prevention
Subdivision Ma
Front
G 0 C/
'ermit Type:
❑ Agriculture Building ❑ Commercial
❑ Industrial
Mobile Home SFD ❑ Residential Accessory
Side street
❑ 2nd Dwelling ❑ Multi -Family >2 units per parcel w
Septic ❑ Well ❑ Other
:one District:
' `� 1
Heioht
Date of Zoning Ordinance:
general Plan:
Development Agreement:
Ise Permit:
Variance:
)arcel Is In:
Land Conservation Agreement
Z No
❑ Yes, check use
Minimum Acreage:
Nitrate Action Plan
® No
❑ Yes
Violation Area
® No
❑ Yes
® No
E]Yes
E]Chico E]D2N F]Cohasset
Specific Plan
® No
❑ Yes, check use
Enterprise Zone
No
❑ Yes
I & !� C,
Number:
Floodplain
Zone: Panel
® No
Yes
❑
Watershed Protection Zone
>roposed Use
Complies With: 0 General Plan
® Zoning
,roposed Use
Requires: ❑ Use Permit
❑
Minor Use Permit
❑ Administrative Permit ❑ Accessory Building Use
:ommercial/Industrial/Multi-Family Uses:
Parking: ❑ Parking Requirements are OK as Shown
Landscaping: ❑ Landscaping Requirements are OK as Shown
Road and Drainage Improvements Required: ❑ No ❑ Yes
,00licable Setbacks:
❑ Other
❑ Other
Zoni Code
Street & Highways
Fire Prevention
Subdivision Ma
Front
G 0 C/
Side
3
Side street
Rear
v
Heioht
=nvironmental Health Issues:
Septic Permit Review: Agriculture Affidavit Required ❑ No ❑ Yes
Well Permit Review: Designated Well Site ❑ No ❑ Yes
Land Development Review: Drainage Plan (Com/Ind/Multi) ❑ No ❑ Yes
,arcel Created by:
❑ Deeds Date of Creation: Legal Access Provided: ❑ No ❑ Yes
Deed Reference: Legal Access Required: ❑ No ❑ Yes
Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name:
Complies with County Standards for Deed Creation: ❑ No ❑ Yes
Comments:
mZT29An, 7>e -L- civ
IS Map Date of Recording:
3- 6 - g
Lot: 18 3 Block:
Book: J Page:
J2�
onditions That Must be Met Prior to Issuance of Permit:
❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Creation Deed
❑ Comply with condition no. of conditions of approval for the
❑ Obtain a Certificate of Compliance (See Planning Division for application).
❑ Construction across property lines is not permitted (See Land Development for a Merger Application/Lot Line Adjustment).
❑ Comply with Old Subdivision Lot Ordinance (Maps Recorded Prior to Book 17 of Maps Page 23).
❑ Construct road to ❑ Meet parcel size required by zone ❑ Meet current EHD requirements.
❑ Other
-2neral Comments:
SNovJ -70 3E5'�
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DMSION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
COPY of Document Recorded
11" 1
19 -Feb -2002 2002-0008225
Has not been compared with
original
BUTTE COUNTY RECORDER
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the butte County Code require 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 plowing,
spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and order. Butte County has established or
discomfort from normal, necessary farm operations.
All that real property situate in the County of Butte, State of California, described as follows:
SEE ATTACHED LEGAL DESCRIPTION
Date re 6 ZIla a PROPERTY OWNERS:
X
Adam Balogh
X
State of California
County of
On of - /- O Z before me,
.m XVfPV,✓ 6;«7r
personally appeared A/JA%rn V446r= Al personally
a -ie be (or proved to me on the basis of satisfactory evidence) to be the person.] whose name.W is/are subscribed to
the within instrument and acknowledged to we that he/Am/!trey executed the same in his/berkfivir authorized
capacity(bQj, and that by his/kerlbeir signature^on the instrument, the personKor the entity upon behalf of which the
personA acted, executed the instrument.
WITNESS my hand and official seal.
Signature Seal:
• M. SUSAN GLATZ
COMM -1 121310664
84
m� NOTARY PUSUC--CAUFORRIA
Q COUNTY OF BUTTE
Comm. Expires Oct. 16, 2004
A.P. # 065-360-027
Order No. 206669
EXHIBIT "ONE"
Lot 183, 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, pages 27, 28, and 29.
Excepting and reserving therefrom all of the valuabl.e.minerals beneath the surface of
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 area of the above described realty, all as
excepted and reserved in the deed from the Magalia Mining Company, a corporation, to
E.D. Storts et ux, recorded September 4, 1947, in Book 423, of Butte County Official
Records, at page 385.
Assessor's Parcel No: 065-360-027-000
M & M Equipment
452 Mann Nolta Ridge Road
Cohasset, Ca. 95973
(530) 343-6244
LIC # 646049
February 13, 2002
1"=20'
Cousin Ga • Adam Balogh
Gary's 9
Upland Rd
Magalia Ca.
AP #065-360-027
Proposal for: Septic Syst rr
170' Leach Field
36" Rock under Pipe
0 PG&E Pole
Water Meter 10 Utility Easement
NOTE: 63'
Replacement Area
See The Attached 63'
Residentia Co tru ti r Replacement Area
Reauirements
63'
Pages 23'
40' /Proposed 20 : 5'
/ Leach Fields
42' /
rhe attached Fire Saft /
lr*104merfts must be wmph led
as sPecitiW and Approved 45'5,
by C.D.F. , 5'
House $,
Proposed Water Parking 24 X 40 —
Supply Line &
r,Driveway
Proposed Propane
Tank 22'
and Supply Line
oiL - aaV7
13UTTE COUNTY
BUILDING DEPARTMEN-t
APPROVED rlI.�
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REVIEWED BY
BUTTE CO. FIRE DEPT.
CALIF. DEPT. of FORESTRY
❑ approved as submitted
® approved with conditions
attached Aheet. 31
-Signature V Date
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M &M Equipment
452 Mann Nolta Ridge R adonmental Health
Cohasset, Ca. 95973
(530) 343-6244 FEB 1 4 2002
LIC # 646049 Chico, California
February 13, 2002
1"= 20'
Water Meter
Proposed Water
Supply Line
a PG&E Pole
Cousin Gary's / Adam Balogh'
Upland Rd
Magalia Ca.
AP #065-360-027
Proposal for: Septic System
170' Leach Field
36" Rock under Pipe
10' Utility Easement
7 -----------------------------------------------------------
63'
Replacement Area
63'
Replacement Area
63'
.0000
40' /Proposed '
.0000
20' S
_./
Leach Fields
42' /
6'
/ ❑ ❑
45'
/ 5'
/ / 5'
House $,
Parking 24 X 40
Driveway
Proposed Propane
Tank 22'
and Supply Line
NOTE: 'A
See The Attached
Residential Constructior
RR mets
h— —Pages
APPROVED
Butte County
Environmental Health
2412-
a
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t
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•01/,25/2002, 16:06 5303429174 CNICO B�_DG SYSTEMS PAGE 02
C..)
2S' -S"
ic ---
fill
p 2 v z Environmental Health
ic
- QO
JAN Z 5 2002
6 Chico, Califomia
A
APPROVE=D
Butte County
Environmental Health
ozo J.
A�
9
i
M.H.I.-2
::::::::.::.::.:.:.:.:::::.:............................................................................... .
Mobilehome Manufacturer: Manufacture Year ,app 7
If other than single wide, furnish Setup Model Number: 1/����,tir�G �3 7Ga fir' f
Width:, -)6 (ft.) Length: G_(ft.) Tagalong or Expando Size (ft.) x (ft.)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's
installation manual and structural setup sheets.
FOOTINGS: Wood pressure tre ted or foundation grade [ Other:
SUPPORTS: Concrete block [ Other:
Provide Tie Down Specifications for all Mobilehomes:
Line 1 Piers: Line 1 Openings:
Size minimum: I ]XI I Size minimum: ] x
Spacing maximum: Each side of openings
From ends -maximum: with width over: 7 "
Line 2 Piers: Line 4 Piers:
Size minimum: ,? x 2 Size minimum:]XI I
Spacing maximum: Spacing maximum: "
From ends -maximum: From ends -maximum: "
Line 3 Roof Loads:
Size minimum:
Location (from rear)
Line 5 Roof Loads:
Size minimum:
Location (from rear):
Pier Footings Sizes and Location
SINGLE WIDE MULTI -WIDE
Luce I
Lire I
Line 2
............................................................................................
Luce 2
Line 2
Main Beams
............................................................................................
Line 2
Line I
Line 3
............................................................... I............................
Lure 2
Main Beams
............................................................................................
Line 2
Line
.............................................
Line
Tag or Triple
Line a
Line I
Line 1 Piers: Line 1 Openings:
Size minimum: I ]XI I Size minimum: ] x
Spacing maximum: Each side of openings
From ends -maximum: with width over: 7 "
Line 2 Piers: Line 4 Piers:
Size minimum: ,? x 2 Size minimum:]XI I
Spacing maximum: Spacing maximum: "
From ends -maximum: From ends -maximum: "
Line 3 Roof Loads:
Size minimum:
Location (from rear)
Line 5 Roof Loads:
Size minimum:
Location (from rear):
M.H.I.-2 ..
4 . Is the site currently under permit? Yes [ ]
5 . Is the site an existing site: Yes [ ]
6 . What is the electrical rating of the mobilehome?
7 . What is the mobilehome site circuit breaker rating?
8 . What is the electrical rating of the mobilehome site?
No Permit No.
No [ ] (If yes, furnish two plot plans).
/FrJ Amperes.
Z Amperes.
_ Amperes.
9 . Is the main service remote from the mobilehome site? Yes [ ] No If it is, what is
the rating? Amperes.
10 . Is there any other electric load to be se d by the mobdehome site electric service
(i.e. well, garage, etc.)? Yes [ No [ J 'If yes, please identify the load and size:
a) The mobilehome site:
Load - Amperes -
b) The main service:
Load -
Amperes -
11 . Type of gasservice at mobilehome site: Natural [ ] Propane None
12 . Size of V_as pipe at the mobilehome site from the meter or tank: inches.
13 . What is the gas pipe length from the meter or tank to the mobilehome? &
14 . What is the mobilehome gas demand? BTU.*
*(This information is not required. if the pipe length is less than 6 feet on natural gas or
less than 50 feet on propane).
THE OTHER SIDE OF THIS FORM MUST BE COMPLETED IN ORDER TO
PROCESS THIS PERMIT APPLICATION
fA.
Il
2"x 2"x 3/16"
STEEL ANGLE
DETAIL "A"
CHASSIS FRAME
1/4" GRIPPER PLATE
(2) REQUIRED
1/4" GRIPPER BASE
1/2-13UNC—A307 x 4"
BOLT WITH NUTS
(4) REQUIRED
3/8" CAD PLATED BOLT, NUT do WASHER
COUNTER BORED FLUSH WITH BOTTOM
AT 8" O.C. (8) REQUIRED
01 1/2" SCH 40 PIPE RISER WITH — L-1 01/2" ADJUSTER HOLES AND 3/8"THICK TOP PLATE
02" SCH 40 PIPE STAND WITH TWO
01/2" ADJUSTER HOLES
ABESCO ABS PAD #503
STEEL FRAME
SEE DETAIL "A
1/4" STAND BASE
ABESCO ABS PAD #503
36" MAX
TO BOTTOM
OF PAD
01/2"x 3" C.R.
LOCK PIN WITH
01/8" BRIDGE
PIN
r"
J
COACH "C" FRAME -
2" CHANNEL
1/4"x1-1/4"-
TEK STS
(2) REQUIRED
1 /4" GRIPPER
BASE
1/4" GRIPPER
PLATE
1/2" BOLT —�
(2) REQUIRED
3/8"x 6"x 6"
STEEL PLATE
1/2" A307 BOLT-- C—BEAM
(2) REQUIRED ATTACHMENT
r_ 10.00__. 1
0 0
10.00 x
09/16 HOLE (TYP)
STAND BASE
TOP VIEW
COACH "J" FRAME
1/4"x1-1/4"
TEK STS
(4) REQUIRED
1/4" GRIPPER
BASE
1/2" A307 BOLT
(4) REQUIRED
J—BEAM
ATTACHMENT
I
8" 1/2" DIA. HOLE �(8) PLACES
I� 30"
STEEL FRAME
TOP VIEW
STATE APPROVAL
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37 TUF-1 PERMANENT bu go CO
z.
FOUNDATION SYSTEM "' o a
3U l DINt DEeA SIE . z
ABESCO-GUS GUARD COMPANY °1 - A
5851 FLORIN - PERKINS ROAD-
SACRAMENTO, CA 95823 r r ,R OV D
PH: (800) 382-8831
FAX: (916) 383-5207 WAYNE T. POLVADO, PE—LISTING NO. F94249 SHEET i or 3
p
1/2"x 3 1/2"
1/2"x 8" LONG -
WIDTHftOFOMEHOME
26 40UP
3/4" DIA, x 18" LG. -
(4) REQUIRED
EXPANSION ANCHOR
ANCHOR BOLT
12
44'-I" to 66'
(4) REQUIRED
(4) REQUIRED
12 18
3/8" CAD PLATED BOLT, NUT & WASHER
16
16
16 22
COUNTER BORED FLUSH WITH BOTTOM
• • • .•
:r1�RiT�11
_�r�
AT 8" O.C. (8) REQUIRED
n1�111
mlTl
CONCRETE PAD INSTALLATION
o
u
CHASSIS FRAME
1/4" GRIPPER PLATE
(2) REQUIRED
1/4" GRIPPER BASE
1/2-13UNC-A307 x 4"
BOLT WITH NUTS
(4) REQUIRED
01 1/2" SCH 40 PIPE RISER WITH m
01/2" ADJUSTER HOLES AND 3/8"
THICK TOP PLATE o
02" SCH 40 PIPE STAND WITH TWO -
01/2" ADJUSTER HOLES i
0
ABESCO ABS PAD #503
STEEL FRAME
POURED IN PLACE 16xl6xl2 CONCRETE _
FOUNDATION INSTALLATION :��I�i � (1 r_rl ���l��n��� �
LIGHT HEAVY -WEIGHT
PLASTIC PAD INSTALLATION
36" MAX
TO BOTTOM MULTI
UNITS SINGLE WIDE UNITS
OF PAD
01/2"x 3" C.R.
rev.
37 TUF-1 PERMANENT
FOUNDATION SYSTEM
18 1/2"
LOCK PIN WITH
01 /8" BRIDGE
PIN
r"
I
LENGTH OF
24
WIDTHftOFOMEHOME
26 40UP
TO 44'
8
8
12
44'-I" to 66'
12
12
12 18
OVER 66'
16
16
16 22
LENGTH OF WIDTH OF HOME
HOME 10 12 14 16
UP TO 44' 6 6 6 6
44'-1" to 66' 8 8 8 8
OVER 66' 10 10 10 10
NUMBER OF TUF-i REQUIRED NUMBER OF TUF-1 REQUIRED
NOTE: SINGLE WIDE UNITS REQUIRE (4) E -Z TIE PADS. GUS GUARD TUF-1 PIERS ARE
TO BE PLACED AT APPROXIMATELY EQUAL INTERVALS ALONG EACH FRAME RAIL.
A131'"SCO-GUS GUARD COMPANY
5851 FLORIN - PERKINS ROAD
SACRAMENTO, CA 95823
PH: (800) 382-8831
FAX: (916) 383-5207 1 WAYNE T. POLVADO, PE -LISTING NO. F94249 SHEET 3 or 3
:- STATE APPROVAL
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FAX: (916) 383-5207 1 WAYNE T. POLVADO, PE -LISTING NO. F94249 SHEET 3 or 3
GENERAL NOTES GUS GUARD TUF-1
1. DESIGN LOADS: LIVE LOAD - 30 LB.
FLOOR LIVE LOAD - 40 PSF
WIND LOAD - 80 MPH EXPOSURE "C"
SEISMIC ZONE "4"
* SNOW LOAD 100 PSF (SEE NOTE #15)
2, THIS FOUNDATION SYSTEM IS DESIGNED TO BE CONSTRUCTED ON
A FAIRLY LEVEL SITE WITH NO EXISTING SOIL PROBLEMS.
3. CHASSIS BEAM SUPPORTS SHALL BE LOCATED AND SIZED FOR THE LOADS
AS SHOWN IN THE "MOBILE HOME INSTALLATION INSTRUCTIONS".
4. IN AREAS WHERE DIFFERENTIAL SETTLEMENT (D.S.) CAN OCCUR,
MANUFACTURED HOME SHALL BE READJUSTED WHEN DS EXCEEDS 1/4",
OR WHEN IT WILL ADVERSELY AFFECT MOBILE HOME UNIT.
5. CARRY ALL FOOTINGS DOWN TO FIRM, UNDISTURBED SOIL. FOOTINGS
ARE DESIGNED FOR 1,000 PSF TOTAL LOAD SOIL PRESSURE, AND
SHALL BE COMPATIBLE WITH LOCAL SOIL CONDITIONS. COMPACTED SAND
MAY BE USED TO FILL LOCAL VOIDS UNDER PADS.
6. STRUCTURAL STEEL: FABRICATED ACCORDING TO AISC SPECIFICATION.
WELD ACCORDING TO AWS SPECIFICATIONS. ELECTRODES -370 PLATES -ASTM
A36 BOLTS -SAE GR 5=ASTM A449=ASTM A3725.
7, THE GUS GUARD ASSEMBLIES SHOWN ON THIS PAGE SHALL BE LISTED AND
LABELED BY BSK AND ASSOCIATES FOR THE FOLLOWING LOADS:
ALLOWABLE LOADS: HORIZONTAL VERTICAL
GUS GUARD TUF-1 - 2200# 6000#
GUS GUARD MCP PAD 2200/ 6000/]
GUS GUARD E -Z TIE PAD 22001 6000#
8. DURING PRELIMINARY INSPECTION, THE ESTIMATOR SHALL ENSURE THAT
MOBILE HOME CHASSIS BEAMS ARE OF STANDARD SECTION.
9. EXISTING COACHES MAY BE RETROFITTED TO RESIST SEISMIC FORCES BY
INSTALLING GUS GUARD TUF-i UNITS AS SHOWN ON THIS PAGE OF TYPICAL
FOUNDATION PLANS.
10. THE GUS GUARD TUF-1 SYSTEMS ARE SAFE FOR INSTALLATION IN FLOOD
PLAIN AREAS WHERE DEPTH OF FLOODING DOES NOT EXCEED THE HEIGHT
OF THREE FEET.
11. MULTIPLE UNIT INSTALLATION IS ACCEPTABLE PROVIDED
THE NUMBER OF TUF-1 UNITS UNDER EACH UNIT IS
THE SAME AS SHOWN REQUIRED PER EACH UNIT.
12. SINGLE -WIDE UNITS REQUIRE ADDITIONAL RESTRAINT. • (SEE SHEET #3)
13. ALL METAL COMPONENTS AND ATTACHMENTS ITEMS SHALL BE PROTECTIVE COATED.
14. WHEN CONCRETE SLAB IS IN EXISTANCE, PAD IS NOT
16. FOUNDATION BLOCKS 16'x 16"x12" POURED IN PLACE AT GROUND LEVEL MAY
BE USED AT INSTALLERS DISCRETION ALTERNATIVE TO PADS.
SINGLE WIDE COACHES DOUBLE/MULTIPLE COACHES
E= 2' MIN. /,.8' MAX. E= 2' MIN. / I V MAX.
S= 6' MIN. /16' MAX. S= 6' MIN. / 22' MAX.
VARIES, 10'-70' (SEE TABLE ON SHEET #3)
E -------- S — — + S ---- I ► S �1 E�
Ll u
u❑
a
u
RIDGE BEAM',SUPPORT
AS
REQUIRED BY
MANUFACTURER
11 f�
ED
(TYPICAL) a ❑
❑
o
8'
NOM.
�Z�
OM.
/PADS IN ANY PAIR MAY BE
STANDARD M.H. FOUNDATION
ROTATED 90 DEGREES OR
PIERS AS RECOMMENDED BY
PVC SERIES
OFFSET TO OTHER SIDE TO
THE MANUFACTURER OR THE
SUPPORT
AVOID CLEARANCE PROBLEMS.
ENGINEER. TYPICAL THROUGHOUT
PAD (TYP)
D � v
N,o. 17918
Exp.
O
REQUIRED. ANCHOR STAND TO CONCRETE SLAB WITH TUF — 1 PERMANENT
FOUR (4) 1/2"x 3 1/2" EXPANSION ANCHORS. FOUNDATION SYSTEM
15. GUS GUARD TUF-1 FOUNDATION SYSTEM PROVIDES
ALLOWABLE SNOW LOAD TO 100 PSF WHEN INSTALLED A13ESCO-GUS GUARD COMPANY
WITH EXISTING STANDARDS REQUIRED BY COACH 5851 FLORIN - PERKINS ROAD
MANUFACTURER OR REPLACE THEM ON A ONE TO SACRAMENTO, CA 95823
ONE BASIS. PH: (800) 382-8831
FAX: (916) 383-5207
_ STATE APPROVAL
rf IS 12y
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WAYNE T. POLVADO, PE -LISTING NO. F94249 SHEET 2 o1 3
LT
I
CENTERLINE SUPPORT REQUIREMENTS
-k, T I. I.::.. �,s t I: J�
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FPLF 9321
--
SEC. 4
ILI. 51 PG. 6-71E
DFAM 9" VAN
DE S-, P. P TiO.-Il Rf q
7
*T3 c 1 11
!t f
3700 - CT
3700CT/4024
- CATHEDRAL THRU-OUT (946 SQ.FT.)
CATKOAAt THAV-00t F
LMNG ROOM
21'-4"
BUTTE COUNTY
$UILDING DEPARTMEW
AP#
CDF FIRE SAFE REQUIREMENTS
oz -0 2JF
PERMIT #
NAME
Under authority of PRC 4290, the following checked items are required
by the Butte County Fire Department and are made a part of this permit.
These requirements are minimums and will be superseded by Butte County
local regulations which equal or exceed these standards. Field
inspections will be made by the Butte County Building Department for
compliance.
( 1272.00 Maintenance of Defensible Space. To ensure continued
'1 maintenance of properties in conformance with these
standards and measures and to assure continued avail-
ability, access and utilization of the defensible space
provided for in these standards, annual maintenance
must be provide for by the land owner.
Driveway Standards
1273.02 Surface. All driveway surfaces and structures (bridges,
1273.07. culverts and other appurtenant structures which supple-
ment the roadway bed or shoulders) shall provide unob-
structed access to conventional drive vehicles, includ-
ing sedans and fire apparatus weighing up to 40,000
pounds.
[
1273.03
Grade. Not to exceed 16 percent unless paved.
1273.04
Driveway Radius
1. No roadway shall have a horizontal inside radius of
curvature of less than 50 feet and additional sur-
face width of 4 feet shall be added to curves of 50-
100 feet radius; 2 feet to those from 100-200 feet.
2. The length of vertial curves in roadways exclusive
of gutters, ditches and drainage structures designed
to hold or divert water shall be not less than 100
feet.
ll�
1273.05
Turnarounds. If required, will have a minimum turning
radius of 40 feet from the center of the road.
1273.05
Turnouts. Shall be a minimum of 10 feet wide and 30
feet long with a minimum 25 foot taper on each end.
[�]
1270.10
Width. All driveways shall provide a minimum 10 foot
traffic lane and unobstructed vertical clearance of 15
feet along its entire length.
Page 1 of - 3.-,
6 S^ - 3 to —72- ? d Z -o L_O 14�z��zf 4'ej
AP .# - PERMIT # NAME
[�] 1273.10 Turnouts. Driveways exceeding 150 feet in length, but
II less than 800 feet in length, shall provide a turnout
near the midpoint of the driveway. Where a driveway
exceeds 800 feet, turnouts shall be provided no more
than 400 feet apart.
[}(� 1273.10 Turnaround. A turnaround shall be provided at all
/- building sites on driveways over 300 feet in length and
shall be within 50 feet of the building.
S
1273.11 Gates
[ 1. Gate entrances shall be at least two feet wider than
the roadway it serves.
2. The gates must be located at least 30 feet from the
roadway and shall open to allow a vehicle to stop
without obstructing traffic on that roadway..
[ 3. Where a one-way road with a single traffic lane
provides entrance, a 50 foot turning radius shall be
used.
Fuel Modification
1276.01 Setback for Structure Defensible Space.
[ ] 1. All parvels 1 acre and larger shall provide a mini-
mum 30 foot setback for buildings and accessory
buildings from 411 property lines and/or the center
of the road.
[ 2. For parcels less than 1 acre, local jurisdiction
shall provide for the same practical effect. See
Other Requirements below.
1276.02 Disposal of Vegetation and Fuels. Disposal, including
chipping, burying, burning or removal to a landfill site
approved by the local jurisdiction, of flammable
vegetation and fuels caused by site development and
construction, road and driveway construction and fuel
modification shall be completed prior to completion of
road construction �r fi:ial inspection of a building
permit.
Page 2 of 3
ti
6 S^ - 3 to —72- ? d Z -o L_O 14�z��zf 4'ej
AP .# - PERMIT # NAME
[�] 1273.10 Turnouts. Driveways exceeding 150 feet in length, but
II less than 800 feet in length, shall provide a turnout
near the midpoint of the driveway. Where a driveway
exceeds 800 feet, turnouts shall be provided no more
than 400 feet apart.
[}(� 1273.10 Turnaround. A turnaround shall be provided at all
/- building sites on driveways over 300 feet in length and
shall be within 50 feet of the building.
S
1273.11 Gates
[ 1. Gate entrances shall be at least two feet wider than
the roadway it serves.
2. The gates must be located at least 30 feet from the
roadway and shall open to allow a vehicle to stop
without obstructing traffic on that roadway..
[ 3. Where a one-way road with a single traffic lane
provides entrance, a 50 foot turning radius shall be
used.
Fuel Modification
1276.01 Setback for Structure Defensible Space.
[ ] 1. All parvels 1 acre and larger shall provide a mini-
mum 30 foot setback for buildings and accessory
buildings from 411 property lines and/or the center
of the road.
[ 2. For parcels less than 1 acre, local jurisdiction
shall provide for the same practical effect. See
Other Requirements below.
1276.02 Disposal of Vegetation and Fuels. Disposal, including
chipping, burying, burning or removal to a landfill site
approved by the local jurisdiction, of flammable
vegetation and fuels caused by site development and
construction, road and driveway construction and fuel
modification shall be completed prior to completion of
road construction �r fi:ial inspection of a building
permit.
Page 2 of 3
it
h
AP # PERMIT # NAME
Other Requirements
[ J If Building Setback is 15 to 30 Feet:
- Class A or B roof
- Enclosed eaves
;[ If"Building Setback is Less Than 15 Feet
Choose any 3of the following:
- Metal or no',doors on side toward property line with insuffi-
cient setback
- Class A or B roof with enclosed eaves
- Interior automatic sprinkler system per NFPA 13D
- Glass area not to exceed _0% of wall area toward property
line with insufficient setback
- Siding from the following list:
Stucco - 3 coat
Hardi-Board or Plank
Masonry
Masonry veneer
Metal
Other Butte County Fire Department approved materials
[J
�r 1 -02 -
Date Signature
Page 3 of 3
CDF FIRE SAFE REQUIREMENTS
AP# PERMIT #
9 -Lor -4 �V} f0��-m
NAME
Under authority of PRC 4290, the following checked items are required
by the Butte County Fire Department and are made apart of this permit.
These requirements are minimums and will be superseded by Butte County
local regulations which equal or exceed these standards. Field
inspections will be made by the Butte County Building Department for
compliance.
1272.00 Maintenance of Defensible Space. To ensure continued
1 maintenance of properties in conformance with these
standards and measures and to assure continued avail-
ability, access and utilization of the defensible space
provided for in these standards, annual maintenance
must be provide for by the land owner.
Driveway Standards
[ 1273.02 Surface. All driveway surfaces and structures (bridges,
1273.07 culverts and other app-arteaant structures which supple-
ment the roadway bed or shoulders) shall provide unob-
structed access to conventional drive vehicles, includ-
ing sedans and fire apparatus weighing up to 40,000
pounds.
[ 1273.03 Grade. Not to exceed 16 percent unless paved.
1273.04 Driveway Radius
((] 1. No roadway shall have a horizontal inside radius of
f" curvature of less than 50 feet and additional sur-
face width of 4 feet shall be added to curves of 50-
100 feet radius; 2 feet to those from 100-200 feet.
[�] 2. The length of vertical -curves in roadways exclusive
I of gutters, ditches and drainage structures designed
to hold or divert water shall be not less than 100
feet.
I 1273.05 Turnarounds. If required, will have a minimum turning
I radius of 40 feet from the center of the road.
[�l 1273.05 Turnouts. Shall be a minimum of 10 feet wide and 30
feet long with a minimum 25 foot taper on each end.
[K] 1270.10 Width. All driveways shall provide a minimum 10 foot
traf f is lane and unobstructed vertical clearance of 15
feet along its entire length.
Page 1 of 3
J
AP # PERMIT # NAME
[ 1273.10 Turnouts. Driveways exceeding 150 feet in length, but
less than 800 feet in length, shall provide a turnout
near the midpoint of the driveway. Where a driveway
exceeds 800 feet, turnouts shall be provided no more
than 400 feet apart.
[ 1273.10 Turnaround. A turnaround shall be provided at all
building sites on driveways over 300 feet in length and
shall be within 50 feet of the building.
1273.11 Gates
[ 1. Gate entrances shall be at least two feet wider than
the roadway it serves.
2. The gates must be located at least 30 feet from the
roadway and shall open to allow a vehicle to stop
without obstructing traffic on that roadway.
[)C] 3. Where a one-way road with a single traffic lane
provides entrance, a 50 foot turning radius shall be
used.
Fuel Modification
1276.01 Setback for Structure Defensible Space.
[ ] 1. All parvels 1 acre aid larger shall provide a mini-
mum 30 foot setback for buildings and accessory
buildings from 411 property lines and/or the center
of the road.
2. For parcels less than 1 acre, local jurisdiction
shall provide for the same practical effect. See
Other Requirements below.
1276.02 Disposal of Vegetation and Fuels. Disposal, including
chipping, burying, burning or removal to a landfill site
approved by the local jurisdiction, of flammable
vegetation and fuels caused by site development and
construction, road and driveway construction and fuel
modification shall be completed prior to completion of
road construction )r fi_ial inspection of a building
permit.
Page 2 of 3
-7 Av611
AP # PERMIT # NAME
Other Requirements
[ J If Building Setback is 15 to 30 Feet:
- Class A or B roof
- Enclosed eaves
If Building Setback is Less Than 15 Feet
\ Choose any 3 of the following:
- Metal or no doors on side toward property line with insuffi-
cient setback
- Class A or B roof with enclosed eaves
- Interior automatic sprinkler system per NFPA 13D
- Glass area not to exceed 10% of wall area toward property
line with insufficient setback
- Siding from the following list:
Stucco - 3 coat
Hardi-Board or Plank
Masonry
Masonry veneer
Metal
Other Butte County Fire Department approved materials
�--S-D
2 -
Date
Date Signature
Page 3 of 3
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE CA 95965
COPY of Document Recorded
20 -Mar -2002 2002-0014334
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.
ROBERT L. AND BABIA F. GULICK
BUTTE COUNTY BUILDING DIVISION
REAL PROPERTY OWNERILESSOR
LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY
10241 DESERT HILLS DR.
7 COUNTY CENTER DRIVE
MAILING ADDRESS
MAILING ADDRESS
SUN CITY MARICOPA AZ
85351
OROVILLE, BUTTE, CA 95965
CITY COUNTY STATE
ZIP
CITY COUNTY STATE ZIP
14861 UPLAND RD.
(530)538-7541
INSTALLATION MAILING ADDRESS, IF DIFFERENT
BUILDING PERK IT NO TELEPHONE NUMBER
MAGALIA BUTTE CA
95954
4V, LLC. 3-20-02
CITY COUNTY STATE
ZIP
SIGNATURE OF LOCAL AGENCYj10CI L DATE
ADAM BALOGH
COUSIN GARY'
UNIT OWNER (if also property owner, write "SAME")
DEALER NAME (if not a dealer sale, write "NONE")
14861 UPLAND DR.
91265
MAILING ADDRESS
DEALER LICENSE NO.
MAGALIA BUTTE CA
95954
CITY COUNTY STATE
ZIP
UNIT DESCRIPTION
SKYLINE
2002
WESTBROOK 370OCT
MANUFACTURER'S NAME
DATE OF MANUFACTURE MODEL NAME/NUMBER
8V-70-0513-P-B/A
40 X 23'8"
ULI533315/6
SERIAL NUMBER(S)
LENGTH X WIDTH
INSIGNIA/LABEL NUMBER(S)
REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S
PARCEL NUMBER
A.P. # 065-360-027
SEE ATTACHED
HCD FORM 433(A) REV. 8/91
WHITE -County Recorder CANARY - HCD PINK -Applicant GOLDENROD -Building Dept.
FOUNDATION 4ION SYSTEM
'CERTIFICATE -OF OCCUPANCY
BUILDING PERMIT NUMBER: 02-0289
Address or location of unit: 14861 UPLAND RD., MAGALIA, CA. 95954
Legal Description of Real Property: A.P.# 065-360-027
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: ADAM BALOGH
Owner's address: 14861 UPLAND DR, MAGALIA, CA. 95954
INSIGNIA OR HUD NUMBER: ULI533315/6
SERIAL NUMBER OR V.I.N.: 8V-70-0513-P-A/B
MANUFACTURER'S NAME: SKYLINE YEAR: 2002
OFFICIAL APPROVING INSTALLATION:
i
DATE: 3-20-02
PHONE: (530) 538-7541
H.C.D. 513C
JCI,, -2")' 01(N10N) 13:43 FIDELI T'r
Fall Tax 3111 Tot
Robert L. cglicll Jr.
7216 North 54th Ara.
dlandaloa A71S406 853M
..
• � -, t b r
`TIONAL TEL:330899
dCTTE :"1: •'
-CORCSkt...
t 't ,VOYyON. TAX 1CtOLLECTCX
CLaRQ A'.
CLC�K-pEcakct�
F
P. 004
o r+TAX OF ED TO PURCHASER W REAL ►ROWTV ;
Toom
Duty Sotd end Convir0d to tM Sun of Calif-xrlia for �Ft'ras Yaw 1�--Mue"
LoOlY Lm+»d and a Lion on tM Rsal T:oppdy 1121j8 i'FAX PAQ
SALE OJMMER
This deed. txtween the Tax 00110aOf of =
County, ectinq on behalf o' the State of Gtifornia ("SELLER -1.
Robert L. Gulick, Jr. and 8ehis t. cv.lsclt, @oebaaad and vlfe.68 joist T,olalats
("PURCHASER 1.
described lxrtln vaflid� tt+a SELLER said
conveys to PURCHASER the real Pry Mattlr 15'
19x1
to the PURCHASER pursuant to a public ouetioa Sartla o_.-�---i
in actordanae with the provisions of Chapter 7 within Pan 6 Of Oivis.Or1 1
SCO.oC
landan
Secrlon J69S.3/ of the Revenue d Taxat'of or $ �
n Codt• t
Nine Tsovaand Tito gnadred and Ro/100"s's 'r�'aa" '��aa�aa������sa•
+_sem ob•r,Cted LO este yte.
taxing agency I rants to tysc PURCHASER
Sale -
in accordance with law, the SELLER hereby q p55•.. t ��____,
that real Property situjted ir, said CovntY. Stoical CJsa
litomia. deibad s4f0ttOwl-
lore particularly daseribsd as follomel t
r teal Oro areata• 3ait �.
LAt leo. 183 as ehow on tbA% certain Map ottttled Sierra
vhicn Map lana recorded in the ofrita of tb• accord+r of the Caenty of
Lforwia. . as June 3 1966 is Eco: 35 of,�-���"
3utto. State of Cal
�, .•.., co •.airs+
28 and 29. w-- o• .. .
EXCEPTim all minerals. as eccoptod of record.
STATE OF CALIFORNIA
at.
lutea CoUMTr
EXECVTEOON
-r. C •
On t ono omo*'"4 d.•.
to me 10 W Il.0th the Ta. C,otlaenot or said Cw+� r sod tM �.caned 'r*Urns as
OW,mo,9 pe.tiondly oopeareb before Inc ✓d oe"o"4*d"d h o'na
Tat G+bWa• r<
CLARK A. NELSON
u( rai f.f��• (•�
LorA uP3 :9,410
van
" OF oc>cvkA '1r
e
X
IV
V)
2
aii
Order No. 206669
EXHIBIT "ONE"
Lot 183, 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, 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 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 area of the above described realty, all as
excepted and reserved in the deed from the Magalia Mining Company, a corporation, to
E.D. Storts et ux, recorded September 4, 1947, in Book 423, of Butte County Official
Records, at page 385.
Assessor's Parcel No: 065-360-027-000
2
.03/20/2002 14:39 5303429174 CHICO BLDG SYSTEMS PAGE 01
�pTQc STATE OF -CALIFORNIA NUMBER:
BUSINESS, TRANSPORTATION AND HOUSING AGENCY g �; g g 1 R 8
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
•
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGRAM
MANUFACTURER CERTIFICATE OF ORIGIN
❑
CHECK IF THIS 18 A DUPLICATE MCO -ENTER ORIGINAL MCO NO.
MANUFACTURED HOME OR MULTI -UNIT MANUFACTURED HOUSING
UMBER OF
RANSPORTABLE SECTIONS
EN SFO (SINGLE FAMILY DWELLING) ❑ MUMH (MULTI -UNIT MANUFACTURED HOUSINGJ:N
COMMERCIAL COACH:
OCCUPANCY GROUP
MANUFACTURER NAME:
MANUFACTURER LICENSE NUMBER:
SKYLINE HOMES INC
90002
MANUFACTURER ADDRESS:
SUGGESTED RETAIL PRICE:
sl 20 EAST BEAKER STREET W00WAND Cf -,taw 95776
$ 43,059.00
ZI
MANU ACTURER TRADE NAME:
MODEL NAME AND/OR NUMBER:
DATE OF MANUFACTURE
WESTBROOK
3700 -CTB
3/7/2001
NAME OF DEALER OR TRANSFEREE (OWNERSHIP TRANSFERRED TO).
CALIF. DEALER NUMBER OR
DATE OF TRANSFER:
TRANSFEREE DESIGNATION:
SKYCREST ENTERPRISES/COUSIN GARY'S HOMES
3/8/2002
DEALER OR TRANSFEREE ADDRESS.
6,11468 (twY 99 wco CA 51e5973
Z�
INVENTORY CREDITOR NAME:
TEXTRON FINANCIAL CORP
INVENTORY CREDITOR ADDRESS:
st1 1 XENIA AVE SOUTH SUITE 300 DEN VALLEY
stair
1416
SECTION MANUFACTURER SERIAL NUMBER NCO INSIGNIA OR HUD VSEL NUMBER LENGTH WIDTH WEIGHT
1-6
INCHES CHEF POUNDS
- - -
14,108
- - - -
15,388
TRANSPORTER NAME:
b b R TRANSPORT
TRANSPORTER ADDRESS
A
surf P.O. BOX 179 DURHAM 0xe
95938
c
DESTINATION FOR UNIT DEBCR41ED ABOVE:
2
(NAME)COUSIN GARY' O(swam)
C slaw
2.
105"4 Un0W PaI4b at PM^ ~ M W Of 90 SUA. Of Q00MAG dlat Me dbcw (Ws we VM &V POn*m
ExooAodm 3/8/2002 r WOODLAND
l
CA
SIONATURE OF AUT RUED AGENT; v •• •
i
D1013119J ON: ORIGINAL (PINK) FORWARD TO THE INVENTORY CREOITOR• UNLESS THERE IS NONE. THEN FORWARD TO THE PURCHASER (DEALER OR TRANSFEREE).
COPY I (LMIITC) FORWAAO TO THE DEPARTMENT AT P.O. BOX 1B2B• SACRAMENTO. CA 95812.1028. WITHIN FIVE IS) DAYS OF RELEASE.
COPY 2 (YELLOW) DELIVER TO THE TRANSPORTER TO ACCOMPANY THE UNIT TO ITS DESTINATION.
COPY a (GOLOENROO) TO BE RETAINED BY THE MANUFACTURER.
NCD 483.0 - SMe 1 - (7197)
STATE OF CALIFORNIA Ta`'
BUSINESS, TRANSPORTATION AND HOUSING AGENCY T°
DEPARTMENT OF HOUSING AND CON 4UNTTY DEVELOPMENT
DMSION OF CODES AND STANDARDS
REGISTRATION AND TITLING PROGRAM
STATEMENT OF FACTS
This unit is a: M Mobilehome El Commercial Coach 0 Floating Home 0 Truck Camper
Decal (License) No.(s) Trade Name Serial No.(s)
coIC 326
I/We, the undersigned, hereby state:
'/-) . � _ )CLC_ � - U r, L c`-
y P
I/We further agree to indemnify and save harmless the Director of Housing and Community Development, State
of California, and subsequent purchasers of said unit, for any loss they may suffer resulting from registration of
the above-described unit in California, or from issuance of a California certificate of title covering the same.
I/We certify under penalty of perjury that the foregoing is true and correct.
Executed on -1 I at
(Date) (City) (State)
Signature(s)
Printed name(s)
Co�=.;
O
r
'i�
City J�,�� State
MCD 476.6 (REV 9/91)
^^
A•
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL TO:
NAME
STREET
ADDRESS
CITY,
STATE
anal ZIP
SPACE ABOVE THIS LINE FOR RECORDER USF OAII Y
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.
Ica: ,, C rl' IS Jk
REAL PROPERTY OWNER/LESSOR LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF. OCCUPANCY
10d4 l -Deser+ Is f-,
MAILING ADDRESS MAILING ADDRESS
Sun ` \'
CITY COUNTY SiA.YE_ ZIP cm COUNTY
-� STATE ZIP
INSTALLATION MAILING0 RESS, IF DI FER T, BUILDING PERMIT NO.
TELEPHONE NUMBER
mI0AIL;, - I/� e-n�9��
CITY V COUNTY STATE lIP SIGNATURE OF LOCAL AGENCY OFFICIAL
nn �� DATE
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CITY I/ COUNTY STA TE ZIP
UNIT DESCRIPTION
SERIAL NUMBER(S)
REAL PROPERTY LEGAL DESCRIPTION
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DATE OF MANUFACTURE - MODEL
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ASSESSOR'S PARCEL NUMBER
HCD FORM 433(A) Rev. 8/91
WHITE—County Recorder CANARY—NCD PINK—Applicant GOLDENROD—Building Dept.
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