HomeMy WebLinkAbout066-070-002r 66-07-2 F.
Taylor;
F�80 Shaw Cir., lot 86, PPCC#l, Magali£
contr: Gary Mullanix, Paradise
IRE DAMIAGE REPORTPermit #66 9B, Pj�E,M(new s
family)
DATE: �.;
66-07-02 4, fikti
Cont: M.T. Clemmer Const.. .
Permit #532-86B,8',M(conv existarage
to game' room) r1 �S/
066`070-002 sI : ' ,ti ,
APPLEBA - < f 04 2456
MIKE µ - .
_6499S MAGALIA . #'
riE t
;Cont CiiICO, ELEC _ •�� *'
.MISC ELEC t;r� ` "`..��' �,, `•, _'' �. ��
{' 04-2923
66 070-002 r -; �'., >5
AI'1'LEBAUM; MICHAFL
6499,SHAW CIRCLE, MAGALIA "' f
,Cont: SOUDAN CONSTRUCTION a '
-'IFdRF DAM ~'GE REPAIRS x
s '
a a3u TTE (glIV j
` D COUN G
MAY 2 0 2005
DEVELOPMENT
SERVICES
County of Butte
Oroville, California
GENERAL CLAIM
CLAIMANT: Chico Electric
ADDRESS: 36 West Eaton Road
CITY & STATE: Chico. CA 95973
nATF nF (:I AIM- (15/1 i/n5
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY
AMOUNT
Refund Claim - See attached calculation sheet APN: 066-070-002
Permit No.: 70-4,-i456--'--7
PAID
RETAINED
REFUND
Development Services
$ 109.98
$ 54.99
$ 54.99
THERM DRNG
$ -
$ _
$ _
SMIP
$
$ _
$
SHR
$
$ _
$ _
TUA
$
$ _
TOTAL
$ 109.98
$ 54.99
$ 54.99
:.:>:Bi2EAltDOWN ::`::.:':.:::::$UIS.G:ET;::
AC OUNT::::AMgUNT::
101001 DVLPMNT SVC
440-001
4210500
$ 54.99
.......
%w :"
1011822 THERM DRNG
18001
280
$ -
1011430 SMIP
1001
280
$
1011811 SHR
1800
280
$
1011816 TUA
1800
280
$ -
TOTAL
1 $ 54.99
$ 54.99
i, the unaersignea, oeaare unser penalty or perjury that the services or articles claimed have been performed or delivered, and that this
claim is true and correct as stated.
Dated this If day of_2005, at ��_, Calif
gnature of claimant
o( y-'(� (JA PQJ
1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or
delivered and that there is a Budget Appropriation or Specific Board Approval (Check onai
me.
Dated this day o`�� 2005. at Oroville Ca ►'�C J
Department Head or Authorized Deputy
Dept. SEE Exp.
Code BREAKDOWN Code PAYABLE FROM FUND
vU NU I wK1 I t t3tLUVV 11115 LINt - AUDITOR'S USE ONLY
)EPT & SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT.
REFUND CALCULATION SHEET
• :.-
.
CLAIMANT:
Chico Electric
ADDRESS:
36 West Eaton Road
CITY & STATE:
Chico, CA 95973
DATE OF CLAIM:
05/12/05 APN:
066-070-002
RECEIPT INFORMATION
NUMBER:
406647
DATE:
8/19/2004
ISSUED TO:
Chico Electric
-
CHECK #:
013229?
s
AMOUNT:
$109.98
r "
PERMIT #:
04-2456
"
-Yes No Yes No
Yes
No
PRIOR REFUNDS:
X
FEES VERIFIED
X
REFUND BREAKDOWN
4
Title BLDG
THRM DRNG
AUD SUSP
SHER DEV FEE
THRM URBN ,
Fund 0010
1800
1001
x.1800`
E•' 1800,'
Dept 440-001
rHRM DRN
(SMIP)
z!,(SHR)
JUA)�,,
Accnt 4210500
280
280
280
,280s,
Cashl 101001
1011822
1011430
;1011811`
� 1014816
DETAIL
PAID RETAIN REFUND°
BLDG
'Time 109.98
......
....................
....:.
...... .
Tiling from Plan Check 0.00 0.00 0.00
Plan Check/Filing
0.25 27.50
0.00 0.00 0.00
:::::::::::
'::::::::::.:::::::::::::::::::::::::
::::::::::::::::::
Inspection
0.00
0.00 0.001 0.00:::::::::::
e
BLDG__FES
OTHER BLDG
:::::::::<
><:<»:::
Misc Electrical 109.98 109.98 109.98
>:.:.>:.:::.:::::
0.00 0.00
'
REFUND PROCESS FEE
54.99
54.99 54.99 -54.99::::'
.......
.::::: ....
>:•:•>:•:
i?}:::•?:•:•i
1 ..
BUILDING TOTAL
109.98 54.99 54.99 54.99
>:
..........
....................
:.:::
::::::::::
::::.:.::.:::
..........
::.:::.:::
THERM DRNGo.00
o.00
:: >:>::::: >
>:: >:::::
,§MIP 0.00
- 0.00
SHR 0.00 c t
; ` :0.00
TUA',;:.i` t . rE.. _ �,"-� ' - i . c'+<< - 'w, x-rY' �' - i..:->0:00' ^`�`1 ,, • �:;iy..:.:_ e'•' 1 Via:.,-r-+t� R.^ - �r...."t;++�.}�
c:
0.00
$ 109.98 $ 54.99 $ 54.99 $ . . 54.99
APPROVAL
CHECK: $54.99
Date Reviewed
5/12/2005 DIFFERENCE: $0.00
'
Michael Vieira
(Should be blank)
Building Manager
,
, .
`
Thursday, May 12, 2005
' . Development Services
'
BUILDING-DIVISIM Ver. '1.0-
'` r
Counter I
Person Tammie
Fund 10 (Bldg Permits)
$109.98
-
SRA Fees (Fire)
$0.00
Payment Date
8/19/2004
I SHR Fees (Sheriff)
$0.00
Permit Number
04-2456
' SMIP
$0.00'
Receipt Number
406647
( Copies/Document Sales
$0.00
Check Number or Cash
013229
I CUA (Chico, Urban Area)
�- $0.00
Parcel Number
066-070-002
I TUA (Therm. Urban Area)
$0.00
Applicant
[MIKE APPLEBAUM
I Water Tender Btln
$00.00'
West Chico Fire Station
$0.00
Received From
CHICO ELECTRIC.
Witness Fees
� $0.00
Total Received"y
!
Recorders Fees (N.O.C) •
F----Lo00
,$109.98 )
Thermalito Drainage
$0.00
Total Fees To Collect
f x$109'98 '
i R )
Oroville Area Traffic
$0.00
~
NSF (Non Sufficient Funds)
$0.00
Notice of Violation
$0.00
NCSP Trails System$0.00
NCSP Roads/Bridges
$0.00
`.
NCSP Storm Drainage
$0.00
•
NCSP Fire Station
1==O00
NCSP Parks Type
$0
..
Value
$0.00
County of Butte
Oroville, California
GENERAL CLAIM
CLAIMANT: Chico Electric
ADDRESS: 36 West Eaton Road 9157`? 3
CITY & STATE: Chico, CA
nATF r1F r'1 AIM- nral i/n..i
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY
AMOUNT
Refund Claim - See attached calculation sheet APN: 066-070-002
Permit NO.: 04-
PAID
RETAINED
REFUND
!
Development Service .2`45t7
$ 109.98
$ 54.99
$ 54.99
THERM DRNG
$ -
$ -
$ -
SMIP
$ _
$
$
SHR
$ _
$ _
$ _
TUA
$ -
$
TOTAL
$ l o9.98
$ 54.99
$ 54.99
............
.............
............
:::::::::::::::::::::::::::::::::::I3i2EA
O
.•... .....
<:':::"
.............................................
..............................
.............................................
DOWN:;::::::::::::::::4UDGET::::AAGCOUNT::::AMOUN:T::
..............
..............
.............
..............
.............
..............
.............
DVLPMNT SVC
440-001
4210500
$ 54.99
1011822 THERM DRNG
1800
280
$ -
1011430 SMTP
1001
280
$ -
1011811 SHR
1800
280
$ -
1011816 TUAI
18001
280
$
TOTAL
1
1 $ 54.99
1 $ 54.99
I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this
claim is true and correct as stated.
Dated this day of 2005, at Calif.
Signature of Claimant
I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or
delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same.
Dated this day of , 2005, at Oroville Calif.
Department Head or Authorized Deputy
Dept. SEE Exp.
Code BREAKDOWN Code PAYABLE FROM FUND
UU NU 1 WKI I t tftLUVV 1 Nib LINt - AUUI 1 UK'5 Will: ONLY
DEPT & SUB PROD I SUB. OBJ CLAIM NO. I INV NO. I INV. DATE I ENCUMB. GROSS AMT.
o�UTrF0 Butte County Department of Development Services
C Building Division
O O
C 7 County Center Drive
O
c0U N �y Oroville, CA 95965 (530) 538-7541
REFUND REQUEST APPLICATION
REFUND POLICY - Butte County Code 3-41(t)
1. Refunds can only be made upon written request by the person who paid the fees, whose name is on
the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt.
2. The request must be made within two years from the date of fee payments on permits not issued, and two
years from the date of permit issuance for permits issued -if no construction work has been done.
3. Filing fees and plan check fees for work plans checked are not refundable.
4. Fees paid to other County Departments are not covered by this claim.
INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be
generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the
receipt) and return to Development Services for payment processing.
CLAIMANT'S NAME:
MAILING ADDRESS:
PHONE:
RECEIPT AMOUNT: I. � oc .% v
Check those fees which you wish to have considered for refund:
Building Permit Fees
=Other (specify): _
=Sheriff Fees
=SRA Fees (CDF Fire Planning)
(Plans for cancelled permits will be disposed of within 10 working days upon submission of a
Request for Refund. If you want the plans, you may pick them up prior to that time.
Signature
K:/Forms/Refund Application 08220
Date
r
PERMIT #:
04-
REFUND CALCULATION SHEET
CLAIMANT:
Chico Electric '
ADDRESS:
36 West Eaton Road
CITY & STATE:
Chico, CA
DATE OF CLAIM:
05/12/05 APN: 066-070-002
No
RECEIPT INFORMATION
NUMBER:
406647
DATE:
8/19/2004
ISSUED TO:
Chico Electric
CHECK #:
013229?
AMOUNT:
$109.98
r
PERMIT #:
04-
ya
PERMIT #:
04-
ya
Yes
No
Yes
No
Yes
No
PRIOR REFUNDS:
X
FEES VERIFIED
X
` REFUND BREAKDOWN
Title
BLDG
THRM DRNG
AUD SUSP
SHER DEV FEE
THRM URBN
Fund
0010
1800
1001
"j1800
Dept
440-001
rHRM DRN
(SMIP)
: (SHR)
;f(TUA) ;
Accnt
4210500
280
280
L`
;.280,.' '
'r 280`
Cash
.101001
1011822
1011430
'.1011811
`10118161.
DETAIL PAID RETAIN
REFUND
BLDG
Time 109.98
:::::::::::
Filin from Plan Check 0.00 0.00 0.00
:::::::::::::::::::::::::::::
Plan Check/Filing0.25
27.50
0.00
0.00
0.00
Inspection
0.00
0.00
0.00
0.00
::::::::::::::::::::
::::::::::
::::::::::::..
BLDG FEES
OTHER BLDG
:*:*:.::.:::::::::::::::
: '
Misc Electrical 109.98 109.98 109.98
:::':::::::
0.00:::::::::::::::::
:::::::::
REFUND PROCESS FEE
r 54.99
54.99
-54.99
-54.99
•::::::::: -""*:•
: : ::::
: :: : ::::::
:::
BUILDING TOTAL
109.98
54.99
54.99
54.99
:::::::::
..........
::: >: »::
....................
..........
THERM DRNG 0.00::::::::::::::::
>:
>' ......•..
,§MIP 0.00
0:00::::::::
...:.:.:....:.
SHR0.06
TUA
Ar ; 0,00
r: {;
r
. 0.00
$ 109.98 . $
54.99
$ 54.99
$ 54.99
$ -
$ -
$' . - .` $
APPROVAL
CHECK:
$54.99
Date Reviewed
5/12/2005
DIFFERENCE:
$0.00
Michael Vieira
(Should be blank)
Building Manager
WANT: Chico Electric
tESS: 36 West Eaton Road
& STATE: Chico, CA
:OF CLAIM: 11/09/04 APN: 066-070-002
NUMBER:
DATE:
ISSUED TO:
CHECK #:
AMOUNT:.
PERMIT #:
R REFUNDS:
RECEIPT INFORMATION
406647
08/19/2004
Chico Electric
013229?
$109.98
04-3031 _
;;N.�
Yes No Yes
No I Yes
X
Title
BLDG
THRM DRNO
AUD SUSP
•HER DEV F
•THRM URBN
Fund
0070
';,1800
1001
r 1800 ,.
Dept
440-001
H_ RM DRN
(SMIP)
.-(SHR)
`800^
tR (TUA)
'
Accnt
4210500
280
280.280:2.
.'280. �
_
Cash
101001
.1011822
-
1011430
01011811
1618161,
DETAIL PAID RETAIN
REFUND
BLDGr7, Time 109.98
.'...'
Filin from Plan Check).0.000.00
0.00:::::::::
PlanCheck/Filin 0.25 27.50
0.00
0.00
0.00
Ins eCtian 1 0.00
0.00
1 0.001
0.00
...............
BLDG FEES-
OTHER BLDG , -.... , .t : _:_
.. .:...-_
.. - ,. -'.. : ,, ..
_
........ :.
MiscElectrical ..
109.98
109.98
109.98
i::•i}}}:•ii:•?}??:
':
I
0.00
0.00:<•:•}}iii:::::::::
•REFUND PROCESS FEE - .54.99
54.99 - -54.99
-54.99
.:':':':':':':':'
:'
BUILDING TOTAL , *
a 'r 9 98
` " 54.99 '' 54.99
_ .._
54.99
THERM DRNG ' 0.00
0.00
SMTP : �' a • .0.00
0.00
-
0 .. 00
.
TSHR
}h
" w
lO.O
109.98
4.99 $ 54.99
$ 5.99
$
APPROVAL -
CHECK: $54.99
Date Reviewed
05/05/2005
DIFFERENCE: $0.00
- Michael ann
(Should be blank)
M
Building Manager
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netldds
PERMIT NO.
BP042466
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date' 08/26/2004 APN: 066-070-002-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : e. \ O License Number:
Site Address: 6499 SHAW CIR MAG
Date: B- ^d`i Contractor. r—\ L% El0_
Map Index:
Description: MISC. ELECTRIC
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: APPLEBAUM MICHAEL KEITH 8r CANDIDA
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
MARIE
signed statement that he or she is licensed pursuant to the provisions of
P O BOX 25
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
MAGALIA, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95954-0025
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
Applicant: APPLEBAUM MICHAEL KEITH 8r CANDIDA
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
MARIE
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: CHICO ELECTRIC
❑ I am Exempt under Article 3 of the Business and Professions Code
36 WEST EATON ROAD
Date: Owner:
CHICO, CA 95973
(530) 891-1933
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of pery'ury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -insure for
License #: 454345
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
Architect:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Engineer'
insurance carrier and policy number are:
Carrier:
Policy #: 'LLq �;)
Total Square Ft: 0 S.F.
❑ I certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
Census Code:
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.
Date: g - --X4— .LA
Applicant:
WARNING: Failure to secure workers'co ensation coverage is
unlawful, and shall subject an employer to cri al penalties and one
hundred thousand dollars ($100,000), in ad ion to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY -
This permit is hereby issued under the applicable provisions of the Butte County Code ?nrUor
I hereby affirm that there is a construction lending agency for the
Resolutions coo indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Y •� -Q
Name:
By: Date. �V
PERMIT EXPIRES N: 6_57
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: i ,J Signature:
Date: U
0 Owner .h Contractor ❑ Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
APPLICANT NAME
OWNER
Last Nam
City
irst Name
ck
Addressk�
,N-,.
Address
Zip
City
-.A.r.1 LCL
City
Zip S
State
Zip
Fax
C6 -A —��►3
Phone
Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
City
Address
ck
Addressk�
Fax
State
Zip
City
State
Zip S
Phone
State License Number
Fax
C6 -A —��►3
E-mail
Lic''l5�13�1
l
las
S
o
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Name
Fax
E-mail
Date Approved:
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X \
For office u e only:
Zoning
Property Address
Flood Zone
Cross Street
SRAYe
No
Occ.
Type Const.
Subdivision Name
Map BooTage71
Name
Lot #
Planner
Date Approved:
PERMIT
NO. l
6Y� 2415
BP
BIN #
ijLOO
LOCATION
IOO j
AP# .. D GCS
Property Address
Cross Street
WORKER'S COMPENSATION
Policy Number
•tel a- v�:. -� 5 q a - e
Carrier
If hiring anyone other than license ontractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Description or Scope of Work:
lS
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: Amount: �D 4 0 Bldg
LL'' /,, /� SRA
Receipt #A6 && i 2 Sheriff
vav',3222-1 SMIP
-1 q-oll
Other
- R r Total
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for'i
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl
❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, -wet -stamped and signed, in duplicate (if required).
❑ 9. Site 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 (if required).
❑ 12. Hazardous Material Form (for Commercial Buildings only).
❑ 13. Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑ 2. Impact Fees.
❑ 3. California Department of Forestry plan approval (if required).
❑ 4. NPDES Form.
❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 6. Contractor's license information. (Number, Name Style, Classification).
❑ 7. Worker's Compensation Carrier and Policy Number.
❑ 8. Owner -Builder Verificationfif required).
❑ 9. Letter of Signature authorization (if required).
❑ 10. Recorded copy of Agricultural Acknowledgment Statement.
❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
So Fo
DATE 1=71=
REPORT TIME 18:07
INCIDENT NUMBER
EVENT NUMBE
LOCAL FIRE NUMBE
STATE FIRE NUMBER
CASE NUMBER
LOCATION 16499 SHAW CIR
RP RON PHONE NUMBER 864-8111
WILDLAND FIRES ❑ ESTIMATED ACRES
STRUCTURE FIRE RESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PSA/OTHER
HA2 MAT
COMMENTS
LT SMOKE
SHOWING
EMD ❑ OES ❑
kv-*7 Oro G-07o-o0z
026 LOGGED B JK
i
EI aFti:nral Firw RO MANSON
Eli
81' aat S�tAte circ nrr�e. BI 138B
__j .: i aaf( aaw $ MEDICS
PRA =2_j ECC ❑
______J REPORT METHO 911
FIRE INFORMATION
FIRE INFO SENT HO JEMAIL BY JK TO 33
7 -DAY LOGGED INITIALS MB
INCIDENT NAM I SHAW
START DATE 7/26/20041 START TIME
DIAMOND # P.1-1.8
CAUSE:UNDETERMINED J
LAND USE DOMESTIC
ACRES �0� TYPE OF ACRE
DIAMOND 5 ONLY $ DAMAGE TYPE
DOLLAR DAMAGE20000.00 SAVE 220000.00
�� �j
INJURIES/FATALITIES ❑
# CIVILIAN INJURIjE
#CIVILIAN FATALITIES# FF INJURIE # FF FATALITIES
FC -40 INFORMATION
�- Newincldenf -: FC -40 ❑ DATE OF FC -40 INC !
F._�
AGENCY INC # 9 INC P#
FC -40 COMP DATE _ FC -40 COMP BY
County Notifications EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑
FIRE DAMAGE REPORT
OWNER: P_ U DATE:
LOCATION: (911q aau,, f jf, lit, A. P. # rTQ �U
CONTRACTOR: L6&r)(, � (�t. ZONING: %
DATE TO INSPECTOR: PERMIT HISTORY ( ) NONE (AAS FOLLOWS:
BUILDING INSPECTOR'S REPORT
Building Description: '
Commercial/Usage:
Residential # of Units:
Currently Occupied � s ( ) No
AbandonedNacant:
L
Electric:
Electric Currently( ( ) Off
d
Condition of Electric t
Gas:
Currently �( ) Off
Condition
4
Sanitation:
Plumbing Worldng (res ( ) No
Obvious Sewage Problems ( ) Yes (
Mobile Home Condition of Utilities: ( ) Damaged - Requires Permit
Description of Damaged Area:
140 0-G e --d
Estimate Cost of Repairs:
( ) Undamaged — No Permit Required
Condition of Foundation: (Y Good ( ) Poor
a
Explain if repairs needed: _
Inspector: "
Sketch building on reverse and 'indicate area of damage.
Date: 1 b�
' L
PRE -INSPECTION REPORT
OWNER: DATE: �rlC—��
LOCATION:&W/1/1.A.P. #
CONTRACTOR: ZONING: R
REASON FOR PRE -INSPECTION
DATE TO INSPECTOR: 'l PERMIT HISTORY ( ) NONE ( ) SEE ATTACHED
BUILDING INSPECTOR'S REPORT
Building Description:
Commercial/Usage:
Residential # of Units:
Currently Occupied ( ) Yes
AbandonedNacant:
Electric:
Electric Currently ( ) On
Condition of Electric
Gas:
( ) No
( ) Off
Currently ( ) On ( ) Off
Condition
Sanitation:
Plumbing Working ( ) Yes ( ) No
Obvious Sewage Problems ( ) Yes ( ) No
ACTION RECOMMENDED:
Hold for permits or verify: _
Inspector:
Mobile home # of Units:
Y
ISSUE ( ) Yes ( ) No
4
Date:
DATE
REPORT TIME r77 18 071
7
LOCATION 16499 SHAW CIR
RP RON
kp-tV OG & -070 -00-2-
INCIDENT NUMBER! 7 -8937
EVENT NUMBE LOGGED B JK
LOCAL FIRE NUM: RO MANSON
77-1
UM
STATE FIRE NUMBER 3811 BI 1388
CASE NUMBER 1.50 MEDICS
PRA V2 ECC ❑
PHONE NUMBER 1864-8111 REPORT METHO 911-7777777717.j
WILDLAND FIRES 11 ESTIMATED ACRES F-7
STRUCTURE FIRE RESIDENTIAL
OTHER FIRE
MEDICAL AIDS
PSA/OTHER
HAZ MAT F -
COMMENTS
LT SMOKE
SHOWING
EMD 11 OEs El
FIRE INFORMATION
FIRE INFO SENT HO 1EMAIL
BY JK TO 33
7 -DAY LOGGED INITIALS
INCIDENT NAM SHAW i
... . ......
START DATE 26�120�041 START TIME
DIAMOND# rl.1-1.8
CAUSE UNDETERMINED
LAND USE DOMESTIC i
ACRES OI TYPE OF ACRE
DIAMOND 5 ONLY $ DAMAGE TYPE uMI
DOLLAR DAMAGE 20000.0 SAVE 220000.001
_7
INJURIES/FATALITIES 0
#CIVILIAN INJURIES 01 #CIVILIAN FATALITIES 01
#FFINJURIE 0 # FF FATALITIES
FC -40 INFORMATION
FC -40 ❑ DATE OF FC -40 INC r
§1K
...........
AGENCY INC # INC P#
FC -40 COMP DATEFC-40 COMP BY
. r
......... ......
County Notifications EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer * El
OT BUTTE
oF0 DEPARTMENT OF DEVELOPMENT SERVICES
0 0 BUILDING PERMIT APPLICATION
0 0 AND SUBMITTAL REQUIREMENTS
O = �_:�: = 0 24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
COv N�y OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
APPLICANT NAME
OWNER
Last Na m@
City
irst Name
b
Address
Y -VN V --e-
Address
City��.
Zips
State
Zi
o
' ex \ ^ C1 3'-N
Planner
5`F
Phone
S -k o - S (,=,
Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
City
Address
G
Address
Fax
City
Sta e&
Zips
Phon
E-mail
Fax
' ex \ ^ C1 3'-N
Planner
—7 _
E-mail
u iA
CIS
3" S
o
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Subdivision Name
Fax
E-mail
Page
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office u e only:
i]LOO )CATIIOOjN
AP# _ D G(J
Zoning
ity
Flood Zone
Sheriff
SRA
Y No
Occ.
If hiring anyone other than licenselcontractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
Type Const.
Subdivision Name
Address
Map Book
Page
Lot #
Planner
Date Approved:
PERMIT
21 -5
BP
BIN #
Description or Scope of Work:
IS
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
OVER FOR SUBMITTAL REQUIREMENTS it
KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: /P Amount:
i]LOO )CATIIOOjN
AP# _ D G(J
Prop rty Address
ity
Cross Street
Sheriff
WORKER'S COMPENSATION
Policy Number
k
Carrier
If hiring anyone other than licenselcontractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
IS
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
OVER FOR SUBMITTAL REQUIREMENTS it
KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: /P Amount:
4 0 Bldg
SRA
Receipt #:'7v �6PIO
vaV1 °l
Sheriff
SMIP
Other
Total
REV 7-27-04
Ll
00.
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP042923
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 10/06/2004 APN: 066-070-002-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:1p7 l�//
Site Address: 6499 SHAW CIR MAG
Date: old—cu— Contractor. Q.. �,t.okj axxC '&J"A)
Map Index:
Description: FIRE DMG RPLC 2X2 SHTNG & ROOF, (314)
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the
DRYVVL 1 BRAC
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
Owner: APPLEBAUM MICHAEL KEITH 8r CANDIDA
signed statement that he or she is licensed pursuant to the provisions of
MARIE
the Contractor's State License Law (Chapter 9 commencing with Section
P O BOX 25
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
MAGALIA, CA
violation of Section 7031.5 by any applicant for a permit subjects the
95954-0025
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
Applicant.. SOUDAN.CONSTRUCTION ROGER
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
50 HASSLER COURT
sale.).
OROVILLE, CA 95966
❑ 1, as owner of the property, am exclusively contracting with
(530) 589-0799
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
rsoudanconstruction@hotmail.com
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: SOUDAN CONSTRUCTION, ROGER
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
50 HASSLER COURT
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
OROVILLE, CA 95966
❑ 1 have and will maintain a certificate of consent to self -insure for
(530) 589-0799
workers' compensation, as provided for by Section 3700 of the
rsoudanconstruction@hotmail.com
Labor Code, for the performance of the work for which this permit
issued.
License #: 697778
_mss
I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier d policy number are:
Architect:
Engineer:
Engineer:
Carrier:
Policy O-2 Z-7
❑ 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
Total Square Ft:. 0 S. F.
become subject to the workers' compensation laws of California,
Valuation:
and agree that if I should become subject to the workers'
$0.00
compensation provisions of Section 3700 of the Labor Code, I shall
Census Code'
forthwith comply with those provisions.
,
Date:
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
417 O -*z� 19. 40 4 -
7,&
CONSTRUCTION LENDING AGENCY
This pe hereby issued under the applicable provisions of the Butte County CodA and/or
1 hereby affirm that there is a construction lending agency for the
Resoluti ns do work indicated above for which fees have been paid.
performance of tqe work for which this permit is issued (Sec 3097 Civ.)
By: Date: I b o 4
Name:
PER IT PIRES ON: (O. 4. • OG—
SAddress:
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner a duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substanc of an o ' " I form or document of Butte County. I hereby -
authorize re en fives of Butte County to enter upo . the above mentioned property for inspection purpj ses.
Print Name: 0111J �J ' " 'Signature: +
IA,)
Date: �� (D 0 4
•
13 Owner U Contractor ❑ Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REO UIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
OWNER
Last Name
First Name
PA
Address la C"�cls
City M A0
Statee
Zp 1 ..
_lam
Phone g7 _�
Fax
E -mad
APPLI CANT NAME
CONTRACTOR
Name.
Cr z
✓J�i• (" Yum
Address 9
State
City UlVr); e
Phone
State,,4
zjP q5 �
Phone SSS -b'15
Book
Fax SIB S_0"1 � 3
E-mail
Planner
UC.#G5-n
Class
1
APPLI CANT NAME
ARCHITECT/ENGINEER
Name
Address
Address
State
City
Phone
State
Trp
Phone
Book
Fax
Email
Planner
State license Number
APPLI CANT NAME
Name
Property Address U � e AJ
-1 �
Address
City
State
Zip
Phone
Fax
E-mail
/ APPLICANT SIGNATURE
X �= - :j
For office use only:
Zoning
Property Address U � e AJ
-1 �
Flood Zone
Cross SII;
��4
SRA
I Yes
No
Occ.
Type Const
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BP 042q.-)-3
BIN #
LOCATION
AP#
Property Address U � e AJ
-1 �
City r,
Cross SII;
��4
WORKER'S COMPENSATION
Policy Number
Carrier
1f hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
I
Address
Description or Scope of Work:
0 t� Y-6by V4 G�
Sq. Footage bylecAnl
❑ Structure Built WIhout Permits \\ n
❑ Proposed Change of Occupancy,'O` )C-
(Note
1C(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: Amount 1-197.4q11. Bldg
SRA
Receipt # q-17 71,0 . Sheriff
SMIP
Date: t p/G I Other
�¢
1 t q• q L Total
DCS/ 7 'f7 r%A
SUBMITTAL & PERMIT REQUIREMENTS „
The following drawings and specifications must be submitted to the Building Division in order to apply fora.
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLEAND IN INK
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl
❑ 4.. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or find plans, all in duplicate.
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
119. Site 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 (if required).
❑ 12. Hazardous Material Form (for Commercial Buildings only).
❑ 13. Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑ 2. Impact Fees.
❑ 3. California Department of Forestry plan approval (if required).
❑ 4. NPDES Form.
❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 6. Contractors license information. (Number, Name Style, Classification).
❑ 7. Workers Compensation Carrier and Policy Number.
❑ 8. Owner -Builder Verification (if required).
❑ 9. Letter of Signature authorization (if required).
❑ 10. Recorded copy of Agricultural Acknowledgment Statement.
❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
metunas can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
;heck fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
.AFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-M
`PERMIT NO. 532-86B E M
r PERMIT EXPIRES
OWNER HARRY TAYLOR
CONTR. M;T, CLEMMER CONST.
ASSESSOR PARCEL 66-07-02
LOCATION 6499 Shaw Circle, Magalia
Temp. Power Pole
Called PG&E
Temp. Elec. Service
t
Called PG&E /
Temp. Gas Service
Cal led PG&E
JOB FINALED (Date)
Signati
r
w
E
ti
Temp. Power Pole
Called PG&E
Temp. Elec. Service
t
Called PG&E /
Temp. Gas Service
Cal led PG&E
JOB FINALED (Date)
Signati
V = OK
0 = Not OK
- = Not Applicable MOBILEHOMES
* = Not Ready
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except q's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rig.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows-Doois
7. Utility Clearance
7. Elec.
Card -BI
Card -BI
Date
Date Card -BI Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except k's
1. Zoning Requirements -Setbacks -Easements
Card -BI
Card -BI
Date
Date Card -BI Date
Date Card -BI Date
POOLS (Plans) OK except If's
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4, Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-.GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipmb6t=Heater•
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool' Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Health Department Approval
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
V = OK
0 = Not OK
- = Not Applicable
= Not Ready RESIDENTIAL (Single and Duplex)
�
Date
UNDERFLOOR Plans OK except #'s
Date FR
IN Continued
1. Zoning requirements -Setbacks -Easements
47.
rty Line Firewall & Openings
2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
xt. Doors -One 3' -Check Garage -3rd story, 2 exits
3. Fig., Garage; Soils -Steel- / /" Ftg. Depth
50
tairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
5
idiri -Nailing-Veneer
Stemwalls, Gj#age; Steel-Blockouts-Wrapped-Slab
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. Piers-Firep - el
54.
lazing Area -Glass Protection -Skylights -Plastic
_
ting est -2 way C/O -Sewer Test
55.
Sh Walls; Nailing -Bolts
9. e; Size -A DL6ors
1 ter Pipe; Test Anchors -Regulator -Service Test
11. Electric; Unde round
_
12. Plenums & cts; Clearance -Material -Support -Ins.
i
13. Girders- i Is -Anchor Bolts -Joists -Vents -Cripples
Card -BI
, ate Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date Fly lans) OK except q's
Card -BI Date Card -BI Date
Date
_
PLUMBING (Permit) OK except H's
14. Water Ht.; Vent -Access -Combustion Air
15. Water Pipe; Test & Anchors -Nail Protection
5
Ex teps-Door & Sidelight Protection -Landings
57
moke Detector-
59
; encs -Clearance -Comb. Air -Connector -
In Garage; Abo Ducts -Meeh. Protection
-Bet -room Exiting
16. D.W.V.; Test-Fttngs & Anchors -Nail Protection
_
17. Shower Pan; Test, First Floor -Tub Access
60.
tr ath Fixtures & Tub Access
18. Test Tub & Shower, 2nd Floor -Tub Access
6
Trim & Subpanel; Breaker Sizes -Labels
_
19. Gas Pipe; Size & Anchors
6
Lairs & Rails
learances-Hearth
lec. Outlets aiJNcod Panel; Int. & Ext.
Card -BI
Date Card -BI Datei
. ixt. & Appliance; Grnd,-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
+ets &-Receptacles at Kit. Counter
rage ire oor; Swing -Landing -Closer
Date
ELEC AL Permit OK except p's
rage -Damper
2 ix_ e & Transformer Clearance -Ins. Protection
6
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In age; ove oorT�ec -Protection
_
21T -_Receptacles Spacing -Lights & Switches at Doors
20!S'oxes 8 No. of Conductors -Stapled
70.
Ib., Elec. & Mech. Equip. Listed for Location
eceptacles in Garage; (G F. Protec.
2 Rory Installed Close to Edge of Studs & C.J.
-
2 . Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72
elation - poked in Attic ❑ Yes
eck Construction -Post Caps
_-__
ppliance Circuits in Kitchen & Conductor Size
2 e ire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At
27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral _,Yes ]No
28. S_vi_ce-Riser Conductors & Ground -Main Disconnect
7
ole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
75.
Following instld.: Drive es [-)No; Walks Yes C]No;
Planters ❑Yes GNo
29. Equ . Clearances; Panels-Motors-Mech. Equip.
nit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
Card B-IAI-Date
Card B -I
30. Clothe Closet Light -Shower Light
C,/'�CJCard-BI _ Date
/i
Date Card -BI Date
7$
ents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
Disconnect, Electrical, Plumbing
89je6terior
Elec. Trim; G.F.I. Receptacle -Underground
anon throughout House
82!
la�rotection
Date
MEC NICAL (Permit) OK except
83.
rrections fr evious Inspections
g
es eters Tagged, Gas -Electric
_
Card -BI
Card -BI
rt
A.C. Ducts_Insulation &Support _ _
3 Vent Fan; Exhaust above Insulation _ _
33. Condensate Drain & Overflow; Size & Grade _ _ _ _
34. urnace-Vent; Access -Comb. Air -Return Air Vent _-_ 115V outlet
35. ttic Access & Platform if Furnace in Attic
p ---- - - -- -
/�% Date�r�//yf Card -BI _ Date -
�YT� Date 7-%, Card -BI Date
§f r
& Sewer Connected -C/O to Grade -HD Approval
86.
nergy Compliance Certificate -Other Certificates
-
Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FR MI Plans) OK except N's
Comments at Final:
--._
36 f
/ ;As, Proper Material & An_chors _ _
37 ails: Studs -Nailing, Spacing & Bracing -Plates -Sound
ing Walls over Girders & F_loor-Nailing
3r top in Walls (rat proof)
4 _ _ e Stops: Furred Ceilings -Stairs -Chases -Tub
41111 der & Beam -Size & Bearing
4ers-Post Caps -Anchors -Connectors
43'. '.__. Joi Ir. Ties-Purlin-Roof Brac.-Truss-Shthng.-Ring.
place Ties or Type A Flue -Fireplace Throat
4 Attic A Size & Romex Protection -Draft Stop -Ins. Battles _
Bdrm. Win Exiting Doors -Sill Hg_t. & Dimensions
rage Fire Protection Framing
- -_
-
-
(NOTE: An entry must be made each time youvisit jobsite)
Owner:
I'ermi.t No.
E N E It G `t C E R "T 'I F•' I C A T 10 N
6499 Shaw.Ci-r., Magalia
LOCATION � __ A.l',,No.
DF..SCRTI'TION OV INSULATION
ROOF
Material _
Thickness(inchea)
EXTERIOR WALL
Material. F cralass
Thickness(inches) 3!s"
CEILING
Batt or Blanket Type
Thickness(inches)
Loose Fill Type F1 hPrg1 a ss
Minimum Thickness(Inches) 11�►
Area covered(ft. )_ )58
FLOOR, ELEVATED
Material. _
Thickness(inches)
FLOOR, SLAB
Material.
Thickness(inches) _
Width(inches)
FOUNDATION WALL
Material
Thickness(inches)___
Brand Name__
Thermal Resistance (R Value) -..
Brand Name C=r .a i nt e - -
Thermal Resistance(R Value)_ZLj_l
Brand Name
Thermal Resistance(R Value)___
Brand Name,r,eZ.t�"4jt TT
Number of Bags �13Wt . per bag -24-
Thermal Resistanc�(R Vali.►e)�_ �
Brand Name
Thermal Resi.sthnce(lt Valuc) _
Brand Name _
Thermal Resistance(R Value)__
Brand Name_
Thermal Resistance(It Value)_
I hereby certify that the above insulation was installed in tl►e above building
in con.fo a nce with the State` f-CnJifornia Energy Requirements.
H fns Inau i� on CO.,, Inc. #378407 _
-JVLM-N f,Ita 1 1 `�- STNI'r, COWRACTOR's
SJ:C
fkE: ' OF INSTALLATION APPLICATOR
4-11-86
DATE,
I hereby certify the above insulation and all required items as shown on tile-
Building
lleBuilding Department approved plans and attachments have been installed as
required by the State of California Energy Requirements.
All eriuipment, devices and materials are of the cltuality prescribed or are
Spec I(' ical.ly approved by the St:.aCc of CaLi,furnia.
FIRM NAME OWNER (Please print)
SIG14ATURE OF GENERAL CONTRACTOR OWNER.
STATE; CONTRACTOR'S .LlCI:NS6•NO.
DATE,
THIS CF.R'rIFICATE MUST BP. ON FILE WITH THE BUILDING UEPAE'MENT PRIOR TO ."I NAL
INSPECTION APPROVAL AND A COPY SHALL BE POSTED IJI'111TN THE' BUILDING .
January 1981.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 S _
APPLICATION Al"i PERMIT
ASSES PARCEL NUMBER
d
ZONING
BUILDING PERMIT
OWN'E
L
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
c-
OWNER Al IN ADD E ell
f
nd
C T ACT R• NAM /
All
ELEP ONE
j r
CON R CT R'S MAILING DRESS P
_ `
Fireplace
CONSTRUCTION T EN R
UN NOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILIITG ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$ 51.
ARCHIT C OR E GINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS r
.Permit fee M 1K$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.SUBDIVISION
NAME
P RCEL MAP
Water piping
5,00
Each qas water heater or vent
'5.00
USE OF STRUCTURE
SFDuplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00ea
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities ❑ Installation] ther
Describe work: I G !�
ermlt Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare der penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code a d y license is in full forc and effect.
License No. 2 Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
oR ADDNST C DWELIN
DWELLED �)
'/zQsgft
NEWCONSTRL MULT'_0UTLET
NON.RESIO BRANCH CIRC ITS
2.SOea
/POWER APPARATUS e
(SINGLE OUTLET CIR. )
EX. OCcup(OUTLETS OR FIXTURES
20@SOQ
DAL030
FIXED APLNS.
Ex. Occup. OUTLETS P(RESID )REA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. byirin g
15.00
Permit Fee
$ S d
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
i a Certificate of Workmen's Compensation Insurance or a Certificate
�€-Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating '
Cooling
g
Hood
3.00
Ventilation
Permit Fee
$ s
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
N,Putte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
i all liabilities, judgments, costs, and expenses which may in any way accrue
i against said Cou ty in consequence of the granting of this permit.
X 3,o�U.—�-�.
Date
Signature of Appli ant — Owner ❑ Contractor gent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-DIRE=OFLIC
ion of structures over 3 stories i eight.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE , $
OCC U P.
CON ST.TYPC
FLOo CES
(��/
PD HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
BY
PER EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date 7-1 2--pl.
Zi
Receipt No.w5m
WHITE -D. r. W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT O,F PUBLIC WORKS - BUILDING DIVON
7 COUNTY CENTER DRIVE - OROVILL'E, CALIFORNIA 95965 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET
Permit No. /� 0
OWNERor,/I[i �O /� - A. P. No.
Proposed Building Use ./r/. �fGA ,/ Z4.,
Permit Fee Based Upon: Complete Contract Price �Valuation1,gX4i7_
Other(E""xpIai n) l
Building Inspector ��:.� ��G'/�.i� Date 7' /eg"0 6.
At time of permit application, I was advised the following data must be submitted prior to permit processing
andJor issuance: DATE RECEIVED, APPROVED
,e=1. All items have been submitted.. . . . . . . . .
2.,, Plot plans in duplicate./triplicate. . . . . . . . . .
3. Complete plans in duplicate./triplicate.
4. Complete engineered plans and calcs. . . . . . . . . . _
5. Plans with Energy Design Compliance Statement. . . . . .
6. State. Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . .
9. Letter of signature authorization. . . . . . . . . .
10. Sanitation approval from Health Dept.
11. Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance.
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner0, Mail to owner )
15. Improvements may be required. . . . . . . . . . . .
16. Mobilehome Installation Data. . . . .
•
17. Pre -Inspection for RequiredPre-Inspec. request to . Building Inspector (Date)
18. Recorded copy of Agricultural Acknowledgment Statement.
19. Other
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone l77.�.. J(6—q and hold for pickup at office. Deliver w.
/inspector.
Other
Applicant �� Date 3^
Copy of plans sent Health Dept., Fire Dept., Other Date
During. the plan checking process, the -following data must be submitted prior to permit issuance:
(For required items not checked above at time of application, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by
Telephone Mail Other
By Date
Plans checked by Date - 3- Z—�Jo
Plans approved by Date
Other:
Copy—DPW
dlz
���f� t/.!/d�it. �ave� ii�/fd� �i �7✓
/J Og Coin/,r/ OuT
.)
PERMIT NO. 6649-79B,P;E,M
PERMIT EXPIRES
OWNER L. Taylor
Gary Mullanix, Paradise
CONTR.
LOCATIOW (A.P.
66-07-2
80 Shaw Cir., lot 86, PPCC#I,Magalia
d
re" cc
f D/C
I
I
I I
e..
741
47,
a/
Temp. Power Pole
Called PG&E _
em . Elec ,Serv.
Call ecl'PG&E
Temp. //G,as Serv.
Ca ed PG&E
LED
(Date)
(Si ature)
COWS /-fj
S111-2 11V,,*POWZ
1-2
/7-
,V121 9 /V IVO
'oy p jun'
�-
of -l/
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS-
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
I
Piers
Garage
_ Footings
Stemwa I I
�C
Slab
Carport
o
Footings
lU°
Slab
t
Patio 10&/
Footings
Masonry Walls
Reint. Steel
Bond Bea
Framing
Stucco
Mesh
v
Scratch
Brown
N
Finish
vA
Interior Lath
d[ .DO AWiec. reaestai S
Water Piping Gas Piping
ew
MOSILEH2&EINSTA LATION--------------Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS `
!/-L/- 7 y�/d� Ei✓�.eoGcG�s %� 7 .�' S, a.J .✓p�c>� s�o�f %a - %�� kro� Bi�� �. f7�Go�l
QS7 44
�• ® sND��do� J; rl � � �YGLp>o.v�.s d.� 9`.�G�/G -- lG,u s5� at! i°%�l�v�,6 �•�G,w v.Ja/fa/�at
V1;4Ed_ CAd OF l` 2 Wr �r 4./'' /rzoA.(,-r
�/����r u,�d>� ,✓��P! 6/ocfl cos7,`,c, � �, ��O��cs' mac p�//ed ov> o�
0z �/✓ O lli � � 4 GG£t f �O G ��a t/ od1S G iC k'/ £�✓� j
Flo -ra
ac/"`f 7? -An en rt"y must be made on this form each time you visit the job site.)
0
44�
N�7v -;7f' Z20<2
Z -7)v,
p
�yv SG� l
o3yj
JoD�
6676
..,��3 �r•.x��t, �.�o ?gip �, ��m�r�,r
.v3�z3bof .S 3161 3OVA 7.V 7
�
sPN� X33Prs3�>�3pr'��
n"/
rad
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� >.
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-
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-
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- �
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-
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- _
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- _
RESIDENTIAL
ENERGY CONSERVATION STANDARDS
CONSTRUCTION COMPLIANCE CERTIFICATE
THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN
INSTALLED IN CONFORMANCE WITH CURRENT ENERGY CONSERVATION REGULATIONS
AT £,'O Shaw Circle, Mafialia
(location)
BUILDING PERMIT NO.
A.P. NO.
THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS:
(Check each item or write N/A if not'applicable)
INSULATION:
GLAZING:
Slab Edge
Single Glazed
Fdn. Walls '®°
Special (Insulated)
Floors N/A
CERT. & LABELED WDS.
Walls R11
& SLIDING DRS.
Ste's
Ceiling/Roof R19
WEATHERSTRIPPED DRS.
Ducts
BACK- DAMPERED FANS
Circulating Pipes ae-
INTERMITTENT IGNITIONVICES�r�
APPROVED HEATER.
CERT. APPPLIANCES
#m
APPROVED WATER HtATER kp-
r
\
I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE BEEN INSTALLED
IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIREMENTS AND AGREE TO
THE COMPLETENESS OF THIS CERTIFICATE AS SUBMITTED.
Insulation Applicator Name NI
Signature of .
Insulation Applicator.
General Contractor/ Owner Name iter
e print
State Contractors
License No. 212461
/ (please print)
Signature of e
General Contractor/Owner Date -
State Contractors
License No.
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO
REQUESTING FINAL INSPECTION AND SHALL BE POSTED IN A CONSPICUOUS LOCATION
WITHIN THE DWELLING.
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE•CURREHT ENERGY REGULATIONS,
CALIFORNIA ADMINISTRATIVE CODE. TITLE•25. STATE OF CALIFORNIA. IN THE BUILDING LOCATED AT:
80 -Shaw Circle: _ M g lia
ree o Number
Y
EXTERIOR MALLS
Manufacturer J M Thickness/Type 3:1111 R Value 11
i
CEILINGS vaulted
Batts: Manufacturer J M Thickness 6 1, R Value 19
Blown: Manufacturer lin i t P m p---- Thickness Sit No. Begs 22 Mt./Bag
Sq. Ft. Covered 1008 R Value 19
FLOORS
Manufacturer ...cS s �� Thickness/Type R Value
Manufacturer Thickness/Type R Value
FOUNDATION MALLS
Manufacturer. Thlok ess/Type R value
GENERAL CONTRACTOR �A —I�P LICENSE NUMBER
By TITLE DATE
INSULATI^ CONTRAC'PRN.Yr/ Wj.SQN INSULATIONLICENSE NUMBER 212461
ITLE Vice Pres, DATE 3-5-80
M E C H A N I C A L
❑ Permit
❑
Underflo6K Stage
❑ Underfloor Supply Plenum: (1) One-story. (2) Clearances. (3) Combustible
material. (4) Insulation and vapor barrier. (5) Access. (6) Catch.
receptacles and registers. (7) Fire -stopping. (8) Boots. (9) Supply
ducts. (10) Gas lines and plumbing cleanouts.
® Ducts: (1) Size. (2) Materials. (3) Support. (4) Fittings. (5).Wrapping.
(6) Insulation. (7) Clearances - ground, crawlspace, cleanouts,
plumbing, etc.
❑ Combustion Air: (1) Size.
❑ Refrigerant Piping: (1) Material. (2) Support. (3) Fittings. (4) Insulation.
❑ Framing Stage
❑ Heating: (1) Approved appliances. (2) Accessibility..(3) Clearances.
(4) Combustion air.
❑ Vent and Connector: (1) Approved. (2) Size. (3) Clearances. (4) Cap.
(5) Termination.
❑ Ducts: (1) Materials. (2) Size. (3) Support. (4) Fittings. (5) Insulation.
(6) Fire Damper.
❑ Refrigerant Piping: (1) Material. (2) Support. (3) Fittings. (4) Insulation.
(5) Condensate drain.'
F inal
Heating: (1) Accessibility. (2) Combustion air. (3) Safety controls.
F-1
(4) Electrical connection. (5) Fuel shut-off.
❑ Cooling: (1) Accessibility. (2) Support. (3) Controls. (4) Pressure relief
valves. (5) Class 2 refrigerant.
I
5/79
4
P L U M B I N G
Check List
❑ Permit
❑ Underfloor Stage
❑ D.W.V.: (1) Sizing. (2) Materials. (3) Fittings. (4) Grade & Support.
(5) Cleanouts & Accessibility. (6) Clearances. (7) Rough -in Locations:
❑ r (8) Wrapping. (9) Test - including "Ts". (10) Additional test not
xequired.*
❑ Water: (1) Sizing. (2) Materials. (3) Support. (4) Test. (5) Wrapping.
❑* (6) Dissimilar metals. (7) Service regulator installed or not required.*
® Gas: (1) Sizing. (2) Materials. (3) Support. (4) Log Lighter. (5) Wrapping.
❑
Framing Stage (Top Out)
D.W.V.: (1) Size. (2) Vent Area & Termination. (3) Materials. (4) Fittings.
(5) Grade & Support. (6) Cleanouts. (7) Traps. (8) Nail Protection.
(9) Plumbing Access. (10) Toilet Clearances. (11) Shower size.
(12) Shower Pan Test. (13) Vents — turns, horiz., runs, loop, wet, etc.
❑'` (14) Additional 2nd floor test not required.*
❑ Water: (1) Pipe Test. (2) :Mixer Valves. (3) Support. (4) Roof drains.
❑ Gas: (1) Size. (2) Materials. (3) PR Valve Drain.
❑ Water Heater: (1) Vent. (2).Location. .(3).PR Valve Drain.
❑
Final
1-1—D.W.V.: (1) Connected to sewer system. (2) Special systems.
❑ Water: (1) Water Source. (2) Shut-off. (3) Anti -siphon Valves.
❑ Gast (1) Test. (2) Connectors.
❑ Water Heater: (1) Location. (2) Accessibility. (3) Clearances. (4) Stability.
(5) 18" Garage Floor. (6) Mechanical protection. (7) Combustion Air.
(8) Draft Diverter. (9) Vent Connector. (10) Vent. (11) Shut-off and
connector. (12) PR Valve & Drain.
[],Fixtures: (1) Approved. (2) Stability. (3) Clearances. (4), Trapped.
(5) Connections. (6) Cross -connections. (7) Dishwasher Air 'Gap.
5/79
)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WO-n-
7
OR7 County Center Drive — Oroville, California 95965
M Telephone: 614-4541
APPLICATION AND PERMIT /�/ 7 -
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date 12) Z-6
Signa tu If PerfArtee or Agent
Receipt No. d 1 n GIS
White-D.P.W. – Yellow -Assessor – Pink -Inspector – Goldenrod -Applicant
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.
DIRECTO/R� OFPUBLICWORKS
By �%''� `�� Date C I --A- O- 7�
BifiIding permit expires Date 41- -Z d
BUILDING
Owner �� La
SQ. FT. OCC. I BUILDING VALUATION
S 0, OC��
Mailing Address
sn ®8
Telephone No.
Gp�r 10. Q®
Contractor L . '
Mailing Address
Fireplace ®d
Total Valuation 71:7 q
Or
Telephone No.
Permit Fee
Building Address tis Gc .
Plan Checking Fee&/or Penalty
Permit Fee
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 23,F (�(�
Each Trapef 1.50
Repair drainage or vent piping 1.50
A. P. No. -r Q -7 a--
-ZIning lanning
Water piping 1.50
Each gas water heater or vent 1.50
F
S Fire Dept.
Fire Zone
Usl0ermit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
arcel
Declaration
Parcel p
60' R/W
Improv ents
Each additional outlet .30
Building sewer 5.00
Bldg. ns Roo-ecd
Par A roval
Plans Approval
Lawn sprinkler system 2.00
NEW ffiJ ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $ a 0
.$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 ,aQ
Main service 600V OR LESS
100 AMP OR LESS 5•00
Single Family39 Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD•L 100 AMP 2.50
Main service OVER 25.00
100 AMPP OR LESS O
,J7
Main service EA. ADD'L 100 AMP 1.00
NEW CON OR ADDNST. D A4G�9CCUP. h) 22sgft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
le Of:
/
Cta.v^L M lu� (�(.Ilf L S! �' �CL
NEW , MULTI-OUTCILET
NON-RESIESIDBRANCH CI12.50ea
NEW CONSTR (POWER APPARATUS a
NON-RESID. ,SINGLE OUTLET CIR.
Ex. OccuD{OUTLETS OR FIXTtIRES) S L ,2
FIXED APPLNSSt
EX. Occup. OUTLETS (RESI.DO.) REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. 1-910 T�/ ?3 Classification
Misc. Wiring 6.25
l.d<+
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ UZZOILVZVE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating /0t>1}j47--1.j,
v
Cooling L ,(gyp
Ventilation
Hood 2.00
Permit Fee $ , cb
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$ �"
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date 12) Z-6
Signa tu If PerfArtee or Agent
Receipt No. d 1 n GIS
White-D.P.W. – Yellow -Assessor – Pink -Inspector – Goldenrod -Applicant
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.
DIRECTO/R� OFPUBLICWORKS
By �%''� `�� Date C I --A- O- 7�
BifiIding permit expires Date 41- -Z d
RESIDENTIAL PLAN CHECKING GUIDE
(S.F., DUPLEX, & MISC. ONLY)
Bldg.
A. P.
Permit # eLl., '"/
# G G - o -0--2
A. GENERAL /
Zoning requirements.(sideyards and parking).
_,2< Valuation.
43! Signature by R.C.E. or Architect (if required)."
B. PLOT PLAN
Complete parcel size and dimensions.
t2n` Setbackq, sideyards, easements, etc.
'3 Other buildings or structures.'
KGrading, fills, drainage.
C FLOOR PLAN
Complete to scale plan with dimensions.
Required windows for light and ventilation (Sec. 1405).
�3! Required windows for second exit (Sec. 1404).
Allowable glazing for energy requirements (20% max. per.State law).
Human impact glass (Sec. 5406).
�6 ! Required room sizes, ceiling heights (Sec. 1407).
l7� G.F.C.I.'s in baths and exterior outlets (Sec. 210-8).
,.8!' Light fixtures, switches, receptacles, and exterior receptacles for maintenance of
mechanical equipment.
Locations of water heater, heating & cooling equipment, other electrical or gas
equipment, and plumbing fixtures.
1� Garage firewall, door size, and closer (Sec. 503(d)(4)).
XI. 1 - 3'0" exterior exit door (Sec. 3303d).
Fireplace location.
Smoke detectors (Sec. 1413).
lilUKHL _LI lA1LJ �� r+++°+�+
Foundation:plan complete enough to construct bu.ildin.g--.�
Floor construction details complete enough to construct building.
Elevations.and wall construction details complete enough to construct building.
Roof construction details complete enoueH--to construct buiidtnK.-----,
Fireplace construction details and calcs if over one-story in height.
Sufficient data.and details to satisfy energy insulation requirements (State law).
E. MISCELLANEOUS ITEMS TO LOOK OUT FOR
X CCX plywood on exposed locations and
Stairway details (Sec. 3305).
Guardrail details (Sec. 1716).
Brick or*stone veneer (Chapter 30).
�.�Exterior p1a:terr
-w
screeds (Sec.
6. Proper roof itch for roof covering
. a ter ties or bearine ridee beam.
overhangs.
4706 & 4708).
hapter 32).
,u:- varage aoor or porcn neaaer sizes.
Adequate bracing.
Living area over garage - complete 1 -hour separation required including supporting
walls and posts, etc.
Two (2) exits on three-story dwellings (Sec. 3302).
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