HomeMy WebLinkAbout066-050-003066-050-003 03-1663
JAMES
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NEW SINGLE FAMILY HEALTH CLEAPAPANCE
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NOTES RESIDENTIAL
066-050-003 03-1663
M ,
e PERMIT NO. _-JAES; CHARLES ----'
ANDOVER;- MAGALIA
NEWSfSINGLE FAMILY
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SPECIAL CONDITIONS
CHECKED.
BY ,.
SRA
FLOOD CERTIFICATE REQ. =
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY -
USE PERMIT CONDITIONS
' - SUB -STANDARD HOUSING LETTER
I } r
OFFICE
COPY
Address `* N
GASJ
Meter By Date
ELECTR C 'g f0�
Meter By Date
��IFzJ /•
JOB FINALED (Date)
Signature
-R
lit-
OFFICE
COPY
Address `* N
GASJ
Meter By Date
ELECTR C 'g f0�
Meter By Date
��IFzJ /•
JOB FINALED (Date)
Signature
J=OK
0 = Not OK
= Not`Ready
MOBILE HOMES
=Not Ready
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L 'ft.
/ P Nat. or/ /" L "ft./ P LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date
Card B-1 Date . Card B-1
Date
Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector
7.
Water and Sewer Connected -C/O to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
6.
Carports; Windows -Doors
1. Zoning Requirements -Setbacks -Easements
Electric
8.
2. Footings; Size -Spacing -Marriage Line
9.
Siding; Nailing -Veneer -Stucco -Mesh
3. Blocking
11.
Ext.; Steps -Doors -Landings
4. Gas; MH Test -Demand -Valve
Braced Wall Panels
7.
5. Electricity; MH Test
8.
6. Water; MH Test
9.
7. Water and Sewer Connected
10.
8. Gas and Electricity Tagged
11.
9. Exits
12. Enclosure; Fencing -Alarms
10. License Decals
11. Verify #'s with Office
Card B-1 Date Card B-1
Date
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning 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 13-1
Date
POOLS (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panel boards- Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12. Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
J=OK
0 = Not OK
Re RESIDENTIAL (Single & Duplex)
- = Not Applicable
. =Not Ready
Date UNDERFLOOR (Plans) OK except #'s
2.• FWr, Main; Soils-Elec. Grn4_-V /" Ftg. Depth
3r-'Ftg,, Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
Porches & Decks; Soils -Steel-/ /" Ftg. Depth
ymwalls, Main; Steel-Blockouts-Wrapped
65-. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
i Fire lace Ftg.-Steel
W.V.; Fall -Fitting -Test -2 Wa C est
10. UF, Gas Pipe; Size Anchor ar Gas'Piping? Size Test
W'Water Pipe; Test -Anchors -Reg ce Test
12. Electric Underground
1kPlenums & Ducts; Clearance -Material -Support -Ins.
o +i-G_r rs-Sills-Anchor Bolts-Joists-Vents-Crippies
1@'Access & Ventilation
16. Insulation
Date Card B-1 a Card B-1
Date ,_0,(, Card B-1 Date Card B-1
Date 1 PLUMBING (Permit) OK except #'s
17/Water Htr.: Vent -Access -Combustion Air Baffle
- Q Shower Pan; Test, First Floor -Tub Ac—c 9s
24 -.-Test Tub & Shower, Second Floor -Tub Access
22. -Gas Pipe; Sixe & Anchors
&.7S! Fire Sprinkler; Test
Date Q% - and B-1 Date Card B-1
Date 3 $ — Card B-1 Date Card B-1
Date ELESjRICAL (Permit) OK except #'s
24. -Fixture & Transformer Clearance -Ins. Protection
2 Elec. Receptacles Spacing -Lights & Switches at Doors
2fjl Size Boxes & No. of Conductors Stapled
27/Romex Installed Close to Edge of Studs & C.Ji ,
2§4quip. Ground made up w/Mech Fastene 2nd & Wa
2000"2 Appliance Circuits in Kitchen & Conductor Size GFI
0, Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al J
Insulated Neutral ❑ Yes O No q?rf 0
3 ervice- Riser Conductors & Ground Main Disconnect
3 . Equip. Clearances Panels-Motors-Mech. Equip.
3 lothes Closet Light -Shower Light -Spa Light
'1000emoke Detector
Date Card B-1 Date Card B-1
Date Car B-1 Date Card B-1
Date ME ANICAL (Permit) OK except #'s
A.C. Ducts Insulation & Support
4 ,,/ent Fan, Exhaust above insulation
,Q8. -Condensate Drain & Overflow, Size & Grade
3WFurnace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40-9nic Access & PI a orm if Furnace in Attic
Date rd B-1 Date Card B-1
p Ca
Date 3 &Z Card B-1 Date Card B-1
Date FRA ING (Permit) OK except #'s
41 ills Proper Materials & Anchors
41 oe Walls Studs -Nailing Spacing & Braces -Plates -Sound
49' Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Walls (rat proof)
F Stops, Furred Ceilings -Stairs -Chasers -Tubs
Headers & Beams -Size & Bearing
Date FR!MING (Continued)
Hangers -Post Caps -Anchors -Connectors
4e'. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
,&6' Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Sor' Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions CP
Garage Fire Protection Framing -RC Channel -10
Property Line Firewall & Openings
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
455r,Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
Wr Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
.-X;I- eSiding-Nailing Veneer
68r-94ucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
5q,odlazing Area-Glas rotection-Skylights-Plastic
hear Ells; N X ng -Bolts
04 6 a nt i Exterior .5K nels ) q
J1440-16 nsulatio alts -Ceilings
63. Infiltration -Walls -Windows
Date 7 Card B-1 (-- D to �/ 4'i� Card B-1
Date and B-1 ate _ / 017 Card B-1
Date FINAL (Plans) K except #'s
W Smoke Detector
Furnace Vents -clearance -Comb, Air-Connector-
arage; Above Floor-Ducts-Mech. Protection
edroom Exiting
.I. & Bath Fixtures & Tub Access -Spa
K. Elec. Trim & Subpanel, Breaker Sizes & Labels
Stairs & Rails
7 . 5ireplace or Stove, Clearance -Hearth
. _wc. Outlets at Wood Panel, Int. & Ext.
�Xt. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
9. Pec. Outlets & Receptacles at Kit. Counter
Gwage Fire Door; Swing -Landing -Closure
7 . A.„ -Duct in Gar e -Damper
7 tr. Htr.; Ve -Clearance-Comb. Air Connector -P . .
in Garage; Above Floor-Mech. Protection
72!.::P b.; Elec. & Mech. Equip. Listed for Location
7`. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
8,1”' Guard Rails & Deck Construction -Post Caps
8 . Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
_ Clearance Looked u er Floor O Yes
Following Instld./Drive Yes O No/Walks Yes O No/Planters O Yes No
44 tucco Brown -Finish
8 A.C. Unit Disconnect, Electrical -Plumbing
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
1tYeter Well, Disconnect, Electrical, Plumbing
8 . xterior Elec. Trim, G.F.I. Receptacle -Underground
8 .Ventilation Throughout House
9 Glass Protection
9L --,Corrections from Previous Inspections
92. as T65,Meters Tagged, Gas -Electric 9 ->de 'ev'01G
99' Wa & Sewer Connected -C/O to Grade -HD Approval
nergy Compliance Certificate -Other Certificates
Address Posted
-U6—Fire Sprinkler
Date O Card 8-1 Date Card B-1
Date ,Oy Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
03/10/2004 16:16 5303431124 J!_4 r � � 8'
- WESTERNWOODS EWP" PAGE 01/01
APAAffffwiVh
=Vff&J`:
Certificate of Conformance
Certificate 054086
THIS IS TO CERTIFY that the glued laminated timber products identified with a collective mark of
Engineered Wood Systems (EWS) were manufactured In accordance with the applicable standards
and associated specifications indicated below:
ANSI Standard A190.1-1992, For Wood Products — Structural Glued
Laminated Timber
NER-486 Glued Laminated Timber Combinations And "GAP"
Computer Program For Determining Design Stresses
AITC 117-93 — Manufacturing — Standard Specifications For Structural
Glued Laminated Timber Of Softwood Species
IT IS HEREBY CERTIFIED that the APA EWS trademarked structural glued laminated timber members
.were produced in a manufacturing facility subject to regular audits in accordance with the Engineered
Wood Systems (EWS) Quality Assurance Program. Routine audits include inspection of the
manufacturing process and evaluation of the in -plant QA program with adequate sampling to verify
conformance to industry standards for lumber grade and glueline bond quality.
���•�t 0 ,W 0 0 **00
�s SEAL ~
: %W cm
f`H IN
11nu11k
by
Thomas G. Williamson
Executive Vice President
ENGINEERED WOOD SYSTEMS Is a related oorpormn of APA — THE ENGINEERED WOOD ASSOCIATION
7011 South 19th Skeet - P.O. Box 11700 - Tacoma, WA 99411.0700
Telephone: (253) 565.6600 - Fax Number. (253) 565-7266
03/10/2004 16:16 5303431124 WESTERNWOODS EWP PAGE 01/01
RVIV40lwi�
APA
Certificate of Conformance
Certificate 054086
THIS IS TO CERTIFY that the glued laminated timber products identified with a collective mark of
Engineered Wood Systems (EWS) were manufactured in accordance With the applicable standards
and associated specifications indicated below:
ANSI Standard A190.1-1992, For Wood Products – Structural Glued
Laminated Timber
NER-486 Glued Laminated Timber Combinations And "GAP"
Computer Program For Determining Design Stresses
AITC 117-93 – Manufacturing – Standard Specifications For Structural
Glued Laminated Timber Of Softwood Species
IT IS HEREBY CERTIFIED that the APA EWS trademarked structural glued laminated timber members
were produced in a manufacturing facility subject to regular audits in accordance with the Engineered
Wood Systems (EWS) Quality Assurance Program. Routine audits include inspection of the
manufacturing process and evaluation of the in -plant QA program with adequate sampling to verify
conformance to industry standards for lumber grade and glueline bond quality.
00
"ss SEAL �~
it I N GA
411111M�
by . /fL I — _AQX,,,'
—,
Thomas G. Williamson
Executive Vice President
ENGINEERED WOOD SYSTEMS Is a related oorporatlon of APA — THE ENGINEERED WOOD ASSOCIATION
7011 South 18th Street - P.O. Box 11700 - Tacoma. WA 96411.0700
Telephone: (253) 565.6600 - Fax Number: (253) 565-7266
03/10/2004 16:16 5303431124 t WESTERNWOODS EWP PAGE 01/01
APA=Vv&
Certificate of Conformance
Certificate 054 0 8 6
THIS IS TO CERTIFY that the glued laminated timber products identified with a collective mark of
Engineered Wood Systems (EWS) were manufactured in accordance with the applicable standards
and associated specifications indicated below:
ANSI Standard A190.1-1992, For Wood Products — Structural Glued
Laminated Timber
NER-486 Glued Laminated Timber Combinations And "GAP"
Computer Program For Determining Design Stresses -
AITC 117-93 — Manufacturing — Standard Specifications For Structural
Glued Laminated Timber Of Softwood Species
IT IS HEREBY CERTIFIED that the APA EWS trademarked structural glued laminated timber members
were produced in a manufacturing facility subject to regular audits in accordance with the Engineered
Wood Systems (EWS) Quality Assurance Program. Routine audits include inspection of the
manufacturing process and evaluation of the in -plant QA program with adequate sampling to verify
conformance to industry standards.for lumber grade and glueline bond quality.
00
�•w���qtV 0 RA
s SEAL ac
�4000,,,ly4
Sh
IN
1111110
/�t.rJ�,
by
Thomas'G. Williamson
Executive Vice President
ENGINEERED WOOD SYSTEMS Is a related corporation of APA — THE ENGINEERED WWD ASSOCIATION
7011 South 19th Street - P.O. Box 11700 • Tacoma, WA 98411-0700
Telephone: (253) 565-6600 • Fax Number: (253) 566-7266
INSULATION CERTIFICATE Job Number: 3983
Steve Forehand
Andover, Magalia
Contractor/Owner Name
Job Address (street, city, state)
3
County
Subdivision Name Lot Number
DESCRIPTION
1.
ROOF
Material:
Brand Name:
Thickness (inches):
Thermal Resistance (R -Value):
2.
CEILING
Batt or Blanket Type: Fiberglass
Brand Name: Johns Manville/Knauf
Thickness (inches): 12
Thermal Resistance (R -Value): 38
Loose Fill Type: Fiberglass
Brand Name: Johns Manville/Knauf
Minimum Installed Weight/ft .642. Ib
Minimum Thickness: 15'/Z inches
Installed weight per square foot to achieve Thermal Resistance (R -Value) of: 38
3.
EXTERIOR WALL
Frame Type:
A. Cavity Insulation
Material: Fiberglass
Brand Name: Johns Manville/Knauf
Thickness (inches): 3'h
Thermal Resistance (R -Value): 13
B. Exterior Foam Sheathing
Material:
Brand Name:
Thickness (inches):
Thermal Resistance (R -Value):
4.
RAISED FLOOR
Material: Fiberglass
Brand Name: JohnsManville/Knauf
Thickness (inches): 6 '/4
Thermal Resistance (R -Value): 19
5.
SLAB FLOOR/PEREWETER
Material:
Brand Name:
Thickness (inches):
Thermal Resistance (R -Value):
Perimeter Insulation Depth:
6.
FOUNDATION WALL
Material:
Brand Name:
Thickness (inches):
Thermal Resistance (R -Value):
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in
conformance with the current Energy Efficiency Standards for residential buildings (Title 24, Part
6, California Code of R ations) as ' ica n the rtificate of Compliance, where applicable.
Chico Insulation
Item Number's AVatiure and DateI�^ k Installing Subcontractor (Co. Name) or
3 -16T --,-4j :General Contractor (Co. Name) or Owner
Item Number's Signature and Date
Installing Subcontractor (Co. Name) or
General'Contractor (Co. Name) or Owner
t.. -: .�,::,. . .. . -ti.�i: -,:.. ,.. ..f.,, ....:.. � .. ,, :._... -� .-� ,�....+..,...'-.�.y�..''i t... � .._-b�r+�.Y„ `may:-.;.�.^%v:^+-...,.. • ..
COUNTY OF BUTTE . . . .
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
OWNER
PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
i
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Date Inspector -
REV 10/92
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751 ,
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
s
A`nICs O)
OWNER PERMIT NO.
A
A routine inspectiog&dicates that the following violations of butte county Ordinances exist at the
above address d should be corrected. Please notice this office when correction of work is
completed. If u have any questions pertaining to this matter, or need additional explanation,
please cont t this office immediately.
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Date Inspector -
REV 10/92
,. .
a�rM. COUNTY OF BUTTE
BUILDING DIVISION
-
_:—DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
N7 County Center Drive • Oroville, CA • (530) 538-7541
s.•
CORRECTION NOTICE
A(w7 (65?
OWNER NjPERMIT NO.
E` A routine inspection indicates that the following violations of butte county Ordinances exist at the
!a above address' and should be corrected. Please notice this office when correction of work is
r completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
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,„ Date 1 Inspector C og /` r.----
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Date /0115-, ov Inspector
REV 10/92
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street - Chico, CA 9 (530) 891-2751
7 County Center Drive * Oroville, CA * (530) 538-7541
CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
rc_ k--N P", Q
Date /0115-, ov Inspector
REV 10/92
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
u
PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
Lei yo C CL4i f-
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Htv IV/VZ
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
>t 7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
o
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,*
\please contact this office immediately.
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Date / �3 Inspector A
REV 10/92 k '
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 • Telephone (530) 538-7541 PERMIT No.
(Rev.12r96) APPLICATION AND PERMIT C 3 -/C&
ASSESSOR PARCEL NUMBER
" 06.6-050-003
ZONING
R-1
BUILDING PERMIT
OWNER
JAMES CHARLES & KAY
TELEPHONE
877-8827
SO, Fr, OCC. BUILDING VALUATION
OWN 'S MAILING ADDRESS 521-51971861
X391 DELIA WY PARADEHE 95969
1 no
583 U 10 494.00
CONTRACTOR'S NAME
NER
TELEPHONE
153 cov 1 989.00
CONTRACTORS MAILING ADDRESS
355 oven 2,485/00
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace 1.500.00
Total Valuation $ 116 .962.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
04
Permit Fee $ 699.00
Plan CheckingFee $ 454.3
BUILDING ADDRESS
ANDOVER
Energy Plan Checking Fee $ 23.00
$
PERMIT FEE $ I 196,35
LOT NO.
SUBDIVISIONS NAME
38-57 60
PARCEL MAP
PLUMBING PERMIT
USEOFSTRUCTURE
SF M Duplex ❑ Mobilehome ❑ Other
Each Trap 17.00
Solar or heat um water heater
Water piping 5.SPECIFv
MilinFeoe20.00
Each as water heater or vent
5'��Gas
TYPE OF WORK
New M Addition ❑ Remodel ❑ Ulili6es ❑ Installation ❑ Other ❑
Describe Work: I BED IRWM
i in stem 1 - 5 outlets
Buildin sewer 5.00
Mobile Home S G W
PERMIT FEE $ 15
ELECTRICAL PERMIT Fling Fee 20.00
V LE
Main Service . OOR R LESS 23.00 23000
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.P
License Class Lic. No.
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 ereby 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' compensation insurance carrier and policy number are:
Carrier
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLINGOCCUP. SO
OR ADONS. a ACC. Bins. 3.5¢x: 85. 54
NEW CONS . MULTI -OUTLET 97,50
OWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES BAL p �.w
Ex. Occup. ovn. aE�s1D.oeA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE $ 12$.54
MECHANICAL PERMIT Fling Fee 20.00
Heating 1 5_0C
Cooling 15.0
Hood 6.50 6.
Ventilation
4.50 11-9
PERMIT FEE $ 70,00
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X to -- / ` ®�
nature of Applica t - Ow 11Contracto Agent
An OSHA permit is requir d for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $ (F6 ��
Occ
R-3
CONST. TYPE
VN T TA L FEE $ 1.597.89
HAZ. D IMP
I FLOOD
I CDF
PARC0.
PD
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ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
By Date l
PERMIT EXPIRES l (J
le
ReceiptNo. 1 584.91
WHITE-D.D.S.-B.D. CANARWAV61ESSOR PINK- SPECTOR GOL NROD-APPLI T
�jr�'�fr�$gRf�N��Y'vp"'w.,aw-rMes-•'r..n .,,f,..�,f__,�.u.�..r-�,.o.—mow. ....y� _� _
,y. 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 NV ER 0(0) 003
Proposed Building Use: I �� Counter Technician: `t>2v Date: 6 /3
Items required in order to apply fora permit. All boxes MUST be checked OR marked NA in order to apply.
1.. Plot plans, 3 or 4 sets, signed.ty the.preparer of the plans.
02. 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!
V5. Energy compliance design and supporting documentation in duplicate.
❑ 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.vDetached Accessory Building Form filled out by the owner .....................................
07i2,.-Razardous Material Form...............................................................................
❑ 'f3. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
CW—f-ees as shown on the attached Schedule of Fees Due Sheet......................................
El15. Statement of Intent for Non -heated and A/C Buildings .............................................
16. Sanitation and plot plan approval from the Environmental Health Department in
17. City of Chico Plumbing permit...........................................�"0.
California Department of Forestry plan approval # paid. Sent.. .................... 1" v7ulfo
19. Planning approval for (A) Use: O) (B)Parking: (C) Parcel Check: _ Ir
20. Contact Land Development about ❑ Improvements, ❑ Drainage ..............................
21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
22. Pre -Inspection for required ................
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:..............................
❑ 25. Owner -Builder Verification (El Given to owner, ❑ Mailed to owner) .....................
26. Letter of Signature authorization....................................................................
Recorded copy of Agricultural Acknowledgment Statement ....................................
28. Manufactured home utility clearance...............................................................
01 29. Existing violations and/or expired permits.........................................................
❑ 30. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
❑ 31. Other:
When issued Telephone cA and hold for pickup.
•I have been informed of theabove items and requirements for obtaining a building permit.
PPicant: 61a: Cp e�
1. Index permit applicZi for the above items numbered: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised cf the above data by./ 0 phone, ❑ mail, ❑ counter, by Date: _
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: Date:
Structural reviewed by: Date: Structural approved by: Date: 01 6
Note transfer by: Date:
Yellow: Buildine NV.iwin --" -
E.H. USE QNL*
` Plot PIM Attached
Floor Plu Attached
Sea to B.D.
TO: Building .Department b b 3
FROM: Environmental Health 3
SUBJECT: Sanitation Clearance
0
(O(p 770a
InC4 _
Owner Location . AP#
Plan Approved fo • Sewage Disposal Water Supply: Public Private Well
Clearance for�edroom a home: {Other
Hold final for:
Final clearance OX.. for:
NOTE: ,
Environmental Health Specialist
8/92
Date
R
BUTTE. COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
School District /� u "�-' Building Department No.
A.P. Number .4 %p Q AUC/ Jurisdiction: City County
Property Owner
Property Location/Address 4
Subdivision Lot No.
Residential Development
Commercial/Industrial
Building Department Represer
Distjct Identification No. /
(Street AAdress1l
(Ci(y)
v y
o9 -1 -Vying► � Mobile ,,Home..�,,y� Addition/.,T^ •Supplement_al t� 3
Units Installation"Conversion Permit #
`(No foundation inspe
......................................................................................................
New Addition
imoor clans revieweo oy Scnool Uistnct Personnel)
41&a
(1e School District -certifies that
has complied with the requirements of Resolution No.
representing I,� �•� `f square feet.-1
School District Representative
Paid by Check # V2Remarks:
(State)
Sq. Footage Ito
Groe—
u R
Sq. Footage
(Including Exterior'
Roofed Areas)
J-
Date
(App i�cant)
x'77- v 2/
(Phone Number)
(Zip Code)
by payment of $ 3 / v�•
AB 2926 1 S
FULL MITIGATION $
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(x), 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
0