HomeMy WebLinkAbout069-530-007(C
NOV-03-2006 03:24 PM LOAPUD
5305331750 P-02
t
TN o.: 40-06
ty. District
Lake .0roville ;area Public Ut
1980n. Street .
OROVMZ, CALIFORNIA P8986
(530).533-2000
oisIrRICT APPAOVAL AND VERIFIC/
OF BUILDING SEWERS INSPECTI
This verification form must.be submitted to'. the ,Butte County Depa
Department prlor to Issuance of a' b.ullding or occupancy per0(whic
Prior to final -approval of a Building or'an Occupancy Permit by Butte
form; signed otf.by Lake Oroville Area Public Utlllty District, must besu
Date: June 22, . 2006
Applicant: >babert- IMarquez
Applicant Address: -342 1AQsion oliva -Rd. Groville. CA
599-0559
..Applicant Phone No.:
Property'Locatlons(s)'- 43 omn Dr. 0MVille CA 95.966
lqm Univ 7 Lot,: 7
A.P. N0.(s): 069-530-007
Fe9s due: fiI1 fees .raid a9 of .6/2.112006
Now single family .c'sri alling.
Application for service approved: _.4
Pt RTJC -i
Inspection(q) made and successful tests) observed: '
Locatlon:-,�d�i
Lake Oroville Area Public Utility District rel so to clo pe it: -
Date:
t:Date:By: l�
- In Service - Locked Out
White - Customer Green -'O*9F7net Yellow. - Cus"rnnst
ent of Public Works Bullding
rer is applicable. .
inty, a copy of this verlfication
Itted. to* Butte County.
,E AREA
DISTRICT
FOS Rhal Gold -FOS,
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.net\dds
PROJECT INFORMATION
Site Address: 43 OMAN DR
Owner:
Permit No: 06-14$4
APN: 069-530-007
ROBERT MARQUEZ
Issued Date: el-RO-996 By TMP
Permit type: RESIDENTIAL
OMAN
DR
Subtype: NSF/GAR
OROVILLE, CA 95966
Expiration Date: -4-07
Description: NSF/GAR
(530) 589-0558
Occupancy: R-3 Zoning:
Contractor
Applicant:
Square Footage:
DAVED ALVES
ROBERT
MARQUEZ
Building Garage Remdl/Addn
958 BIRD ST
OMAN DR
2,892 543
OROVILLE, CA 95965
OROVILLE, CA 95966
Other PorTotal
(530) 693-0750
(530) 589-0558
1,062io
1 062 4,497
FEE INFORMATION
County Impact - SFD $2,244.02
Dwelling - Custom, Model $2,064.97
Fund 10 BLDG $1,486.62
Impact Processing Auditor $50.00
Impact Processing DDS $50.00
Res Impact Fees - SFD $2,005.09
SMIP - Residential $21.80
Total Charged: $8,017.50 Fees Paid: $8,017.50
SRA Fees $95.00
Balance Due: $0.00 Receipt No: B200
LICENSED CONTRACTOR'S DECLARATION
OWNER / BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
DAVED ALVES 387267 / /
Law for the following reason (See. 7031.5), Business and Professions Code: Any city or county that
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 signed statement that he or she is licensed
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
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
is in full force and effect.
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 violation of Section 7031.5 by any applicant for a permit subjects
X
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
Contractor's Signature Date
❑ 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
WORKERS' COMPENSATION DECLARATION
OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
the work himself or herself or through his or her own employees, provided that such improvements
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not into d or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of pletion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
imp a for the purpose of sale.).
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractors License Law dows not apply to an owner of the property who builds or improves
My Workers' Compensation insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractors License Law.).
Carrier: Policy Number: Exp. Date:
(This sect on need not be completed if the permit is for one hundred dollars ($100) or less.)
❑ I AM EXEMPT under Section B. & P.C. for this reason:
CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
X d
ISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation laws of California, and agree that if I should become su 'pct to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall rlhwith comply with those
Owner's Signature Date
provi
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
Signature Date
WARNING: FAILURE TO SECURE WORKERS OMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
injury, including death, and property damage caused arising out of, or in any way connected with
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
property owner or am authorized to act on the property owners behalf.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Permittee [SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
❑ Owner ❑ Contractor OR; 11 Agent for Owner Agent for Contractor
FILE
Lenders Address City State Zip
BUTTE COUNTY FEE SUMMARY
Permit Number: 06-1484
Job Address: OMAN DR
7 County Center Drive
Oroville, CA 75965
Department of Development Services
Phone (530) 538-7541 Fax (530) 538-2140
Contractor: DAVED ALVES
958 BIRD ST OROVILLE, CA 95965
Printed: 09/20/2006
3:31 pm
Fee Description Account Number Fee Amount Paid Date Pmt Amt
County Impact - SFD
SF - Public Works - Veh/Egp
1851-0-280-1011853
$658.17
09/20/2006
$658.17
SF - Public Works - Roads
1831-0-280-1011001
$1,244.88
09/20/2006
$1,244.88
SF - Public Works - Facility
1851-0-280-1011852
$340.97
09/20/2006
$340.97
Dwelling - Custom, Model
N - Permit Fee
0010-4400014210500-1010
$2,064.97
09/20/2006
$2,064.97
SRA Fees
$95.00
07/05/2006
$95.00
$1,486.62
07/05/2006
$1,486.62
Impact Processing Auditor
0010-050-4617998-101001
$50.00
09/20/2006
$50.00
Impact Processing DDS
0010-440001-4617999-1010
$50.00
09/20/2006
$50.00
Res Impact Fees - SFD
SF - Library Facility
1825-0-280-1011826
$224.20
09/20/2006
$224.20
SF - Sheriff Facility
1840-0-280-1011841
$291.31
09/20/2006
$291.31
SF - Sheriff- Jail
1800-0-280-1011811
$288.00
09/20/2006
$288.00
SF - Library Materials
1825-0-280-1011827
$150.82
09/20/2006
$150.82
SF - SheriffVeh/Egp
1840-0-280-1011842
$142.14
09/20/2006
$142.14
SF - Gen Govt - Veh/Egp
1810-0-280-101001
$285.37
09/20/2006
$285.37
SF - Gen Govt - Facility
1808-0-280-101001
$618.75
09/20/2006
$618.75
SF - Library Vehicles
1825-0-280-1011828
$4.50
09/20/2006
$4.50
SMIP - Residential
1001-0-280-1011298
$21.80
09/20/2006
$21.80
Printed By: Tammie Powell
89017.50 $89017.50
Balance Due: $0.00
At the time of permit application, I was advised the above fees are required prior ro issuance of the permit. These fees may be changed during the plan
checking process.
Signature:
Date: 09/20/2006
Pursuant to Government code Section 66020, you are herby notified those items listed above may been imposed on your project. You have 90 days from
the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a
protest are specified in Government Code Section 66020(a).
rl\\10111�`I1/EiG
I W 10-72 SAM
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SV ES 1 ��
BUILDING PERMIT APPLICATIO
AND SUBMITTAL REQUIREMENTS
24 HOUR fNSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-28
OFFICE 9: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www,.buttecounty.net/dds
"PLEASE PRINT CLEARLY" Y
.5
C
"OWNER INFORMATION
Name
Last Name
Addres
_
Fi a e
WE M0i
cLf
Ug
a
Address
•
_ Q
State License Number
er
Date Approved:
Cit CO U 1 l
S1—&
Zip Satz
Phon
. �
Fax
E-mail
C
.5
C
., O:
Name
I
l
Addres
_
Zip
WE M0i
Fax
S e Zi
Phone
Fax
E-mail
Page
State License Number
Planner
Date Approved:
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
.5
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APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
I
l
Address
Zip
City
Fax
S e Zi
Phone
Fax
E-mail
Page
State License Number
APPLICANT INFORMATION
Name - -
Address
City
State
Zip
Phone
Fax
E-mail
UM -0, F.W, M
For office use nly:
ZoningI
I
Flood Zone
Propert res
SRA
it D t f
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT`>�
P.
BIN
Description or Scope of Work:
AISP
Sq FT- Living ,rage • Open Coy&
❑ Structure tiiwluiou Permits /UU
- ❑ 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. t Amount: 960 � Bldg
SRA
Receipt #. � Sheriff
Iv
SMIP
03
f l
Dat,, ( C/!l� a L U /• &27otal I I
K•\Fr)PhAC\RI III nim(-, Fr1RhAC\RIr1nAnn1SiihRnmtc rfnc Pace 1 of 2
REV 8-12-05
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
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 faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form .
❑ 12. Hazardous Material Form (for Commercial Buildings only).
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).
117. Worker's 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. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑ 12. Sanitation and site plan approval from the Environmental Health Department. .
If you have questions or would like additional information regarding this process, please contact a
Permit 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
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE, CA 95965
www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140
RECEIPT OF FEES SCHEDULE - RESIDENTIAL
Owner MARQUEZ, ROBERT APN No: 069-530) 007 Permit Type: _ Subtype: I I V
App Date: 6/21/2006 Permit No: BP 06-1484 Permit Desc: �❑_
1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION
Plan Check portion of Permit Fee
2 FEMA Rx
Yes Flood Elevation Review $109.98
3 SRA* Yes Fire Plan Check - Non -Refundable $95.00
(State Responsibility Area) Building Inspection $109.98
NON-REFUNDABLE portion of fees due at application
$3,441.61
$1,376.64' $2,064.97 Balance of Building Permit Fee
0
$95.00 $204.98
$109.98
$1,471.64
FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $1,581.62
FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $6,435.88
RECEIPT DATE Tech/A&st d
455886 6/21/06 Ll_f !�
At the time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan
checking process.
Applicant: Date:
Pursuant t ove Kent code ion 66 20, you a ereby notified those Items followed by an "*" may have been imposed on your project. You have 90 days
from the date of approval of the o 'ect or rom the impostion of the above referenced items during which you may protest. The requirements for a protest are
specified in Goverment Code Secti 660 (a). K:/Building/Forms/Schedule of Receipt Fees Residential 041506
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 NUMBER
Proposed Building Use: Permit Technician: Date: e
Items required in order to apply for a permit All boxes MUST be checked OR marked NA in order to apply.
1. Site plans, 3 or 4 sets, signed by the preparer of the plans.
�- 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
J6 4. Engineered truss details and layouts in duplicate. No faxesl
❑ 5. Letter from Engineer or Architect for truss design review.
6. Energy compliance design and supporting documentation in duplicate.
❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
❑ 9. 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.
❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate.
❑ 11. Hazardous Material Form
,f' 12. Acknowledgement of building permit application without required clearances.
• ❑ 13. Other
ming items needed to issue the permit (May require additional plan review upon receipt of the �f9llowing items.)
iv -14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico L,Oroville, as applicable'30-erte/+(
❑ 15. Fire Sprinklers.............................................................................................
❑ 16. Agricultural Buffer dr and site plan apr from the Ag Commissioner Sent by
❑ 17. Soils Report and/or Engineered Foundation required ...........................................
18. Erosion Control Plan Required........................................................................
19. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 20. City of Chico Plumbing permit........................................................................
El ,, 21. Site plan and business license approval from the City of Biggs ..............................
22. California Department of Forestry plan approval aid. Sent by:�l/.....:'S G
23. Planning approval for (A) Use: -09- (B) Parking: (C) Parcel Check:.......
24. Contact Land Development about _ Improvements, _ Drainage ........................
Cl 25. Fire Marshall Review (commercial projects only). Sent by: ......................
26. NPDES Form....................................................................................
27. Encroachment Permit for driveway from the Public Works Dept ...............
.�v Contractor's license information. (Number, Name Style, Classification) ...................
Worker's Compensation Carrier and Policy Number ..........................................
0. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................
31. Letter of Signature authorization....................................................................
Recorded copy of Agricultural Acknowledgment Statement .................................
33. Existing violations and/or expired permits.........................................................
❑ 34. Deed Restriction..........................................................................................
32: Other. r ❑ Legal descriptio ❑ M Title, t' � a search, a��I-istration or MCO .........................
❑ 37, Other.
When issued TelephoneL°r�/f'. f 2C/'�w/O'�U%t?i- and hold for pickup.
I have been informe4 ofthe above items and requirements for obtaining a building permit.
Applicant Date: ; -
1. Indm2emm applicati , or thkabove i s- Plan Check Letter
2. Additional items r
Contractor, designer ner, ad is€d. t abov data by ❑ n , mail, counter, by Date:
Contractor, designer, owner, was Avi ed of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the ab ve a 1 ❑ phone, El mail, 01 count Date: `
Plans reviewed by � Date: Plans approved by: Date:
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
?'AND WHEN RECORDED MAIL TO:
'J
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
2006-0031662
Recorded I REC FEE 10,00
Official Records I
County of I COPIES 2.50
Butte I CONFORKED COPY 1.00
CMACE J. GNBBS I
County Clerk-Recorderl
I
OD
02:24PM 21 -Jun -2006 I Page 1 of 2
IIII III III I Ilii 1111111111 illi 111 11
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes,
and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm
operations.
All that real property situate in the County of Butte, State of California, described as follows:
14fbC !V,/,
Date0j - A/- 01 PROPERTY OWNERS:
State of California
County of &14<,
On Su w,- Z 1 zoo 41 before me,
3G -1S LA)-5tr . Nmol
personally appearedYViGr Gic Z' personally
-knowm4e-me (or proved to me on the basi of satisfactory evidence) to be the personTssj whose name(&) is/are subscribed
to the within instrument and acknowledged to me that he/she/t#ey executed the same in his/her/their authorized
capacity(ies), and that by his/her!• Mr signature(s) on the instrument, the persons) or the entity upon behalf of which
the person(# acted, executed the instrument.
WITNESS my h nd andoffici seal.
Signature Seal:
JAMES LAMA R KINSER
''Loll
COMM. #1377185
A.P. # 069-530 -60--7 NOTARY PUBLIC - CALIFORNIA
BUTTE COUNTY
H Ivry Comm. Expires Sept. 28, 2006
l
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, DESCRIBED AS FOLLOWS:
LOT 7, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "KELLY RIDGE ESTATES UNIT NO.
719
, WHICH MAP WAS FILED IN. THE OFFICE OF THE RECORDER OF THE COUNTY OF
BUTTE, STATE OF CALIFORNIA, ON JUNE 16, 1981, IN BOOK 80 OF MAPS AT PAGES 80,81
AND 82.
AP NO. 069-530-007
P
k
r
BUTTE COUNTY SCHOOLS IMPACT,FEE CERTIFICATION FORM
(One form per Building)
School District Building Department. No.
A.P. Numbep� J Q Jurisdiction: Q pity County
Property Owner
Property Location/Address
� e)
Subdivision Lot No.
Residential Development E: Sq. Footage a�
��
No
of
LiVing Mobile Home Addition/ *Supplemental to (Group. R)
Units Installation Conversion Permit #
*(No foundation ....inspection)
...................
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document),
Commercial/Industrial
New Addition
TrT
Building Department
Sq. Footage
(Including Exterior
Roofed Areas)
� - �-cam - � � .
Date
District Identification No.
School District certifies that d -V-+ YN-10-&3
(Applicbt) J
(Street Address) (Phone Number)
(City)
(State)
(Zip
has complied with the requirem ents of Resolution No. c) 0 (o --O Q by payment of $
representing -1- square feet. VB 2926 $
kULL MITIGATION $
School District
Paid by Check # Remarks: 6 61\-5'po--oo-7
Date
Paid
6[ —J— 0 k,,,
You may protest the Imposition of the fen Identified above by submitting a written protest.to the District, In compliance with
Govomment Code Section 66020(a), within 90 days from th is date fen are paid. Failure to submit a timely written protest will prohibit
you from challenging" lnqxxfton of the fees In any cokrt action.
N, subsequent to the School District Representative signing this Butte County Schools Impact Fee CaMcallon Form, the School District is
notified by the applicable Local Planning Agency that this project Is be" ovtwired under the California Environmental Quaft Act (CEQA),
this Drolect may be sublect to additional school fees to hft millaste Its ImioaeI on the school dsbWs schools.
White (school district), Yellow (building department), Pink (applicant). feeformids (3M5)dMM
BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM
-EATHER RIVER RECREATION AND PARK DISTRICT (FRRPD)
0 CHICO AREA RECREATION AND PARK DISTRICT (CARD)
❑ PARADISE RECREATION AND PARK DISTRICT (PRPD)
❑ DURHAM RECREATION AND PARK DISTRICT (DRPD)
Assessor ParcelNumber (s) Building Pen -nit Number 00.
Property Owner (s)�;
Project Location /Address
Subdivision Name
V New Development
Y\.
Assessable Sq. Ftge 6�\U 1 c?
Type of Residential Development (check one)
Single Family -Detached Single Family -Attached
Alteration/Addition(s) Non -Residential to Residential
Mobile home Mobile home replacement
Demo Permit (date issued )
Comments:
Building Department
Date
Multi -Family Dwelling
verified by Assessor Department
verifled by Building Department
0 FRRP9 ❑ CARD ❑ PRPD D DRPD certifies that:
Applicant Name PhoneiberV�xZ��� Q
W Ve &
Mailing Address City State Zip
Has complied with requirements of the Butte County Board of Supervisors Resolution No
by Payment of:
Dwelling Units @ $
Square Feet @ $ _
Remarks:
(( L' 6, per unit for a total of $ /� d
Paid by CheckNo( by Cash:
per sq foot for a total of $
Receipt No:
Rl��1072
V
PERMIT NO.: 48-06
Lake Oroville Area Public Utility District
1960 Elgin Street
OROVILLE, CALIFORNIA 95966
(530) 533-2000
DISTRICT APPROVAL AND VERIFICATION
OF BUILDING SEWERS INSPECTION
This verification form must be submitted to the Butte County Department of Public Works Building
Department prior to issuance of a building or occupancy permit, whichever is applicable.
Prior to final approval of a Building or an Occupancy Permit by Butte County, a copy of this verification
form, signed off.by Lake Oroville Area Public Utility District, must be submitted to Butte County.
Date:
June 22, 2006
Applicant:
Robert Marquez
Applicant Address:
342 Mission Olive Rd. Oroville CA 95966
Applicant Phone No.:
589-0558
Property Locations(s):
43 Oman Dr. Oroville CA 95966
KRE Unit 7 Lot 7
A.P. No.(s):
069-530-007
Fees due:
All fees paid as of 6/21,2006
New single family dwelling.
Application for service approved:
PUBLIC
Inspection(s) made and successful test(s) observed:
Location:
Lake Oroville Area Public Utility District release to close permit:
Date:
❑ - In Service
By:
❑ - Locked Out
White - Customer Green - Office Fina/
,r� titcr�ft
DISTRICT
Date:
Yellow - CustomerFinal Pink - FCSFinal Gold -FOS
pp��TT Department art ent ®f Public Works,
0 0 �
C o u n t y o f B u t t e
0
7 County Center Drive
0
Oroville, CA 95965
0
L, y J. Michael Crump, Director (530)538-7681
Q U N'( (FAX) 538-7171
poetic V4 Shawn H. O'Brien, Assistant Director
Assessors Parcel Number: co % Building permit # P619 0 l41 JEI�/
Owners Name:
Owners Mailing Address:
Property Address:
ENCROACHMENT PERMIT ACCEPTED:
PERMIT NUMBER:
ENCROACHMENT PERMIT EXEMPTION:
Reason for exemption:
Not a County maintained road
r] Existing driveway conforms to County S-31 standard
Other
Approved by
Printed Name
i
Title
Date 2/—
CONDITIONS FOR EXEMPTING A DRIVEWAY PERMIT
i. An existing home with a driveway 10 years or older and doesn't cause any problems with
the county road or drainage.
2. An existing home with only minor remodeling or repairs.
AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
COPY of Document Recorded
21 -Jun -2006 2006-0031662
Has not been compared with
original
BUTTE COUNTY RECORDER
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes,
and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County'has established agricultural purposes and residents within said zones and on
adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm
operations.
All that real property situate in the County of Butte, State of California, described as follows:
Date___ G- 9%- Cb PROPERTY OWNERS:
State of California
County of 13",44y -
On JT. no c, y 14 2004, before me, �J
Sc, -'S 4,. ""' 1<<lJSCr , No—,6kry PC., hII
personally appeared 6e\in,.c4 040 rJur- Y persomlly
-knmvrrt-me (or proved to me on. the basdof satisfactory evidence) to be the personlsj whose name(&•) is/am subscribed
to. the within instrument and acknowledged to me that he/she/t#tey executed the same in his/her/their authorized
capacity(ies), and that by his/her4heir signature(t) on the instrument, the persons) or the entity upon behalf of which
the person(s} acted, executed the instrument.
-WITNESS my h nd and official seal.
Signature ,Jiv r--- 41�� Seal:
iNVIEJ LANinR KINSER )
CO's?
ltd. ii377185
A.P.# 069-530 00-''�•"tet
J ` � `7 t44THR1 rtJ3! !C CALIFORNA
\� BUTTE COUNTY
v a= tl:; (:n• -,.-r. �_Xmres Sept.
28, 2006
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, DESCRIBED AS FOLLOWS:
LOT 7, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "KELLY RIDGE ESTATES UNIT NO.
759
, WHICH MAP WAS FILED IN. THE OFFICE OF THE RECORDER OF THE COUNTY OF
BUTTE, STATE OF CALIFORNIA, ON JUNE 16,1981, IN BOOK 80 OF MAPS AT PAGES 80,81
AND 82.
AP NO. 069-530-007
1
200 6-00292$7
RECORDING REQUESTED BY
Recorded I k`rC FEE 10.0
Ufficial Records I
County of I
AND WHEN RECORDED MAIL TO
C'►iVD'1lButteGkUbBS I
Name Robert Marquez
County Clerk-Recorderl
Street 342 Mission Olive Road
Address
I
F OD
010:230 08-3un-2006 I gage 1 of 2
City, State
Zap Oroville CA 95966
Order No.
SPACE ABOVE THIS LINE FOR RECORDER'S USE _
GRANT DEED
Parcel No. 069-530-007_
The Undersigned Grantor(s) Declare(s)
Documentary Transfer Taxis $R&T 11911 Bona Fide Gift r .
❑ City/Town of
✓ computed on full value of 'interest or property conveyed, or
✓ Unincorporated Area
❑ full value less value of liens or encumbrances remaining at
the time of sale
❑ Monument Fee of $10.00
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
John Marquez and Diana Marquez,
husband and wife
hereby GRANT(s) to
Robert Marquez, a married man as
his sole and separate property
the following real property in the ❑ City of
✓ Unincorporated Area
County of Butte, State of California:
SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF
AT'rquez
Document Date: June 8, 2006
State of California
County of Butte } SS.
On June 8, 2006 before me,
Notary Public, personally appeared
John Marcruez and Diana Marquez
P e (or proved to me on the basis of satisfactory
evidence) to be the person(sy whose name(CW/are subscribed to the
within instrument and acknowledged to me that4+esbe/they executed
the same in hss+er/their authorized capacityo, , and that by
his4eN/their signature&, on the instrument the person(,, or the entity
upon behalf of which the person(�s�' cted, executed the instrument.
WITNESS my
Signature
and official sal.
MAIL TAX STATEMENTS TO:
Diana Marquez
J. Brown, Notary Pub810
FOR NOTARY SEAL OR STAMP
s. CJ. OMM415 boo 9
NOTARY PUBUC-CAUFOP,NIA 0
BUTTE COUNTY n
COMM. EXP. FEB. 10, 2009'".
)EED
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, DESCRIBED AS FOLLOWS:
LOT 7, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "KELLY RIDGE ESTATES UNIT NO.
791, WHICH MAP WAS FILED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF
BUTTE, STATE OF CALIFORNIA, ON JUNE 16,1981, IN BOOK 80 OF MAPS AT PAGES 80,81
AND 82.
AP NO. 069-530-007
p
4
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-5366 Facsimile
ADMINISTRATION * BUILDING * .PLANNING
July 12, 2006
Robert Marquez
342 Mission Olive Road
Oroville, CA 95966
Subject: Building Permit 06-1484 (APN 069-530-007); New House
Dear Mr. Marquez,
The Butte County Department of Development Services, Planning Division, has reviewed the
submitted permit application, and requires the following revisions to your site plan in order to
continue the review:
❑ Creation Deed
❑ Site Plan Resubmit — Follow Requirements
❑ Erosion Control Plan
® Setback Conformance
❑ Watershed Protection Zone
® Front Yard
❑ Cohasset Specific Plan
❑ Side Yard
❑ Subdivision Map Note
❑ Rear Yard
❑ Off -Street Parking; Development Standards
❑ Special Setback or Parcel Limitation
❑
Parking for Specified Use
❑
Federal Aid Road/Arterial
❑
Lot & Landscaping Requirements
❑
Easement
❑ Oak Tree Plan
❑
Subdivision Map Condition/Note
❑ SRA Setback*
❑North Chico Specific Plan — Erosion Control
❑ Fire Sprinklers*
❑ Notification Only — No Action Required
Other: The R-1 zone requires a 20' setback from ultimate edge of the right of way.
The requested information, or notification, is described on the included hand-outs. You will also
be given some brief direction, on the following page, of how the information should be
submitted or returned to the County. Should you have further questions please contact the
Planning Division between the hours of 7:30 a.m. and 4:30 p.m. Monday through Friday at (530)
538-7601, or the appropriate Department/Division identified in the handout.
Si . rely
Lana A,
dler
r Contract Planner
'4'24-120. 10 R-1 through R-4 site requirements.
Chapter 24 ZONING*
Article III. Zone Districts*
24-120.10 R-1 through R-4 site requirements.
The following minimum requirements shall be observed, except where specifically modified for
conditional uses. The minimum requirements shall be those for the zone as designated on the
zoning map:
Split single-family on zero lot line N/A 4000 4000 4000
(halfplex)
* Comment: conform to the provisions of Butte County building code section 26-3.5
** On public sewage disposal service. All other lots to meet requirements of the environmental
Page 1 of 2
i,,+.TIATA/CT4APTFR?4/Artir.le TTT 7.-. 7/12/2006
24-120.10 R-1 through R-4 site requirements. Page 2 of 2
health division for septic systems, the minimum lot sizes may be required to be larger.
(Ord. No. 3176, § 1(Exh. A), 1-24-95)
httn://municinalcode-,.1exisnexis.com/codes/6utteco/ DATA/CHAPTER24/Article III Z... 7/12/2006
GENERAL NOTES:
9NEET J S CET P
L ALL O/STANCES SHOWN W?N/N JAQE /O
_ THE g/W L/NE
�4• <ba aC ^ iJ 2 ALL AREAS SHOWN ARE $ROSS ACRES
I'e""' / *AOTE: TM/S OV9T4NCE WAS CACC Sr Wl5rRACT/NB
THE O/ST SHOWN ON 49 M 17 FRCM9 TME LIST
EA MENT sEWEg s•rt aso9- E SHOWN AV 99 R5 72
KEY
1 MAY
�I 4.yv3•R9•
F�au
]Jl- `� ,-=9/�'� •4 p32-f'i[)S �p^ /91>3 J>?
p U7a��.[�E , er LEGEND
\ j�J d•'SO i7G9• 0! L30) �i Vis. 4Z �� \�' o PO/NT
/ya C4P ..,,,
L•Oao4j 5 0 f po' A, �. vi "4- I b
/Soo O NOTN/N6 POLING OR SET, D/MENS/ON
\ 32 i0i SET �6'iE1:644 TAGGED RCE /4240
7' 0
x79 34. , j 3D .37/ AC. 6R. 3 � L • 43.39 �..• I ', �\ � �' SET /L¢°/Rt7N P/AE TAGGED RCE /0160
'30 OA� 5 14 h Q p .4D (:� �\ qT }( FOUND MONUMENT AS .WTED
J� L �,51 BOG 55.1 -14 4i \ - EASEMENT G/NE
8 . ,,,.R• 3M' `� P- O5� ! %D�, 05' 91 06 j6 �� % _ $ ' PuE. PUBLIC UT/uTY EASEMENT
l ... d•Oii e/' ^ • I D.E. QPA/NAGE EASEMENT
185- �07�• •Q7 S �• N'�Z 5097 Qrl� 46 °' \\� ,U <S.S> RC-CORO/NR7RMA ONPL-,e WP(�K43FVGE27
l� Al 00 aT°iV />G )7'[•32./9'- L ws `Ib
r` \ d•G'4x 25.99J N73'/,3•'3?ff. Q .T77�C=•QY7 .Gxy y ;. \� 'q^1 C SET9rAMOAROBUTTECt7ACCESS UNTy$TREETtMzKlumEmrs
J �� [•3439' (/?'399) d•// 60'03 41 \ ,Lp•' �� W 0 SET RA/L ROAD SP/KE fAT BC jec OFle CURVES)
d•U'dYo O/' :`' 4f `d•3347b0' a°[ •Om =/0./9 /157
. .7T �'• G /45.00 0
............. ' - R•71�C•/9.0]' .-.0 /9 AC BR. C .0.CORD/RFORMAT/ONPSR 338372
F$9 ] m \ 10'L B9.L. BUlLO/NB SETBACK UNE
...�� ^ '�;x.4'//59' .?9B AC. GR. V�o 1 Qe 6.391Y 191ri' �`- IJI N. 03• /7O O- q !,
��I a•x)s (.1a/d' [p9P.o4- Si $� .77'
S.S.E. .'a ^0 .aG5��' •n , •0 -
N.OD a7'W 2/509 ,89.$5) R•s9 ? ID ° a KELLY R/OGE
07-4 W.9?_ 1a1x A.49 ?41 _ y._.R, 4/. m m ^ gti\l '- a
ro'ss.E. i /ao00' o.9e'-.... �' Al.,o, W ^` Z m
os3x'liw �iIL• �$ 88 pav
JF m v l/5.00, 44 8 g 4S 8 $no
I 3`• �Rro 9S 8�g ghg aW 9 alb $ a�306AC b =`, aa�ev L.3°o oa ES U/V/T 7
ESTA T
1�1 OMi V I�,m^ .914AC.GR. 1Y,BAC, SR.O �7 b`Oy� 7f/ V1I I W$'��'� �ahl d•A0•PO Y `i ,� / y ` `7 .987 AC. C'T. V1I M
•V ry (/�'6.9t Oi 4) 3E• ./99 AC OR. oa 2-20.00 V\�== -� 41Q7 .arm �'• O.�
8 ti ✓ Y Y e•9 n:'oa' $ .�ses�
� d Y'4596" l•Oi SI =_., 55.00 ��� d•02'/9'00• O
BY 00 3�' L•3L59 ,/� w
$ DRIVE 4B.4<_ a/.1a' s� w.1 9a' A PORT/ON OF THE SOUTH HALF
R•/17o' ,R•Isocm. OMAN a6,w /p4.00' N.IS 5757
d 0.49' je•on?4 ' o9oa' R X21. 'OF SECT/ON I T, 19 N., R. 4 E. M.D.M.,
"'C•/09.44 4.09.Ox 44' d•l Ox 4a' /: �.L. /4./4 2700 •.•.... 49.00' 38200' gi R•10.�' a
d.i• _ G:49. /O'R,/904 Lv(.9./O 49.00' .
<•44.4�,9'n• d•dA73] d•1 mSI' d•3.0037 6R�' MOS• 9z'n w'" 0 1 BUTTE COUNTY , CALIFORNIA
C.GO.W' 6643' r- "�4�077T� •.� `O' 49 O2 SCALE: /=50'
��)a '''R•L13o Fi�o6`"_ L• Dace o .�..4.Q�so�1i
8ia-5177
�&4L 3 �d .Y33ACOyI/1te'W $ OWNER E SUBDIVIDER
.159 AC. GR. .x5
6R .147 AC. GR. .Ff'7 AC GR. .147 AC GR. .Y3 AC �'� v
o- o- S$ 2 8.°�g .x]/�c,BR_ II SOUTHERN CALIFORNIA
3 m° 8 8 ; `� ,` i .O $ 8 $ ` �.t'• 18�; o$ FINANCIAL CORPORATION
Jo ti 9 0 n �� p� $$ $ (p go 0 5 Y s " R•xoo4•sp I $� g',8 Rte' I n 9/00 WLLSHIRE BLVD., SUITE /003
8 8 u g % o h Y d.69'rs, a Y .y . A• B4•Ri'OI' w
L-29/ BEVERLY Halts CAL/PoRNIA
�d.g q7 y7. -� •-__ Y LO's. S.E_ Z` __ � •�-�- �--• �r �•._r -T - 49.99 �a4-L+>�' J " D//�� /� ENGINEER
C' x.65' d•9 a9s7• d•9005Y d•9 oa??' -COOPER, ROOOLF a ASSOCIATES
c_74.o
ds So'4�5=, -'"s e'- �' a7a4' p,rD40'aR< 42--'' /?/VE
R•/ -- - /L 0591'/7 TAGOEOL - Fo.z'LR SACRAMENTO, CALIFORNIA
. o TA60EDRCE
" --� e4nz NUARY, /9B/
1 'FT. LIb 4CL690 STRIP rewen'PTal.e 19av2 OAKS JA
ROYAL v�e�a.e 144
_ ACREAGE
BASIS OF BEAR/N6 3
AREA OF LOTS /-0 /NCCUdNG INGRESS,
ALL BEARIMS5 S/'vWN MEREON ARE EORESS L SUPPORT EASEMENT I$•971 A.0
REFERENCED TO THE WCST L/NE OF ROYAL 'APER OG COTA a 289 AC
04KES DRIVE AS SA/D DRIVE /9 SMOWNON
U 'KEILYRIOOEE5TA TES UN/TNO. 1B.'�F/CED TOTdi. /6.GG/ AC
43 JM % J /N MAP 00M 49 AT MC-- 17, RECORDS a=
BUTTE CYX/NTY
_ SHEET 2 OF 3 SHEETS
Butte CountyDepartmellt ol'Developinei2t Sel-vlces °�`'TrF°
7 County Center Drive L
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-7785 Facsimile cou
BUILDING PERNIIT APPLICATION WITHOUT REQUIRED CLEARANCES
I request and authorize the Building Division to process this building permit application through the plans
examination process WITHOUT first obtaining all necessary, related permits and clearances from other
regulatory entities, including but not limited to, Planning, Environmental Health, Land Development,
County Fire, and Agriculture.
I hereby acknowledge:
• I need to submit applications for septic and/or well to Butte County Environmental Health
immediately.
• I am required to bring the approved Environmental Health site plan and approved sanitation
clearance to the Building Division as soon as clearance is obtained
• I am responsible for notifying Development Services, in writing, to stop processing of the
application and to arrange for disposition of plans.
i.
The Building Division will process the application through the plans examination process, as submitted,
without input from other regulatory entities that could prohibit issuance of the building permit or r uire
submission of amended building plans to the Building Division. Once the plans examination process
begins, there will be no refund of plans examination fees. Any changes requiring submission of amended
plans to the Building Division will incur additional fees. '
Within one year from the date of application for a building permit, all other required permits and clearances
from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances
will void the application.
Typically other required permits/clearances include, but are not limited to, verification the parcel was
legally created, adherence to. all mitigations and conditions imposed on the parcel at time of creation, as well
as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture
buffer zones, and habitat/species).
Please print:
Applicant Name:
Building site addri
[ have read, understood and accept the
submission of the above -referenced by
SIGNATUR$ O
PernitNo.:
and conditions as expressed herein as indicated by my
permit application and my signature below:
DATE
0& Department of Public Works
County of Butte
J. Michael Crump, LAND DEVELOPMENT DIVISION
o / Storm Water Management Program
Director 7 County Center Drive
Oroville, CA 95965
°VQI1c WOP,�S (530) 538-7266
(FAX) 538-7171
National Pollutant Discharge Elimination System (NPDES) Phase II
Construction Storm Water Permit and Storm Water Pollution Prevention
Plan (SWPPP) Acknowledgement (LESS THAN 1 ACRE
Project Description:
-66L --
Project Location and/or Parcel Number: CJS/ q" v ,3O -66r?
By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB
1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water
Permit from the State of California Regional Water Quality Control Board. Phased projects that
contain multiple site build -outs of less than one acre but when combined with subsequent phases total
more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of
California Regional Water Quality Control Board.
I am aware that submitting false and/or inaccurate information or failure to apply for a Construction
Storm Water Permit from the State of California Regional Water Quality Control Board for a project
that disturbs one acre or more of land may result in revocation of grading and/or other permits or other
sanctions provided by law. /
Signed:
Title:
_..__..—_Date: ._.
Less than I Acre NPDES & SWPPP Compliance Certification
Butte County Stone Water Management Program
lwx
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