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073-180-021
I 73-18-21 Darwin R. Hary ` Npmi. NIS Oro-Forbestown Rd.,on pri,rd.,app.1000'E.of New York Flats Rd.,�For.bestown Permit Yk304-78P,E(relocate util on exis . sit�j1K S ELEC, GAS 149 9 ..Say ' SUPP T STRUCTURE*REQ COMPACTION TEST REQ Permiitt;,4 25-78MHI I sus u-e"d ' 11-7Y '73-18-21` t i s 198-90B;"E HENRY, Darwin CONTR::'William:V. Marihugh Const. �n v 541`1..Forliestown,,Rd, For-bestown �j1'vl (MH CABANA & RAMADA)T 5 . ;r 73-18-21'- 4 199-/90B HENRY, Darwin •CONTR: WilliaV: Marihugh. Constt 541.1 Forbestown Rd, Forbest'.own' PVT. DET. -GARAGE) - 073 -18-0-021 #98-1679 WILSON, CYNTHIA 5411 FORBESTOWN RD. FORBESTOWN UNKNOWN RETAG ELEC SERVICE rlkW L' I tis. Onwril ��� I I mmom k RESIDENTIAL 90 BJ 73-18-21 199-90B HENRY, Darwin CONTR: William V.•Marihugh Const. 5411•Forbestown Rd, Forbestown (PVT. DET: GARAGE) JOB FINALE Signature J=OK 0 = Not OK '. - = Not Applicable MOBILE HOIO!ES It - =Not Ready � � � - f Date MOBILE HOME UTILITIES (Plans)!OK except tf's. 1. Zoning Requirements-Setbacks-Easements.r. t...: ' 2. • Soils; Special MH Support Sketch - = ' -i,3: •Sewer;•L•ocation=Test=Fall-CLO Concrete:.?: `.. { •4.•Water;.'Location-Test=Easement Needed:(Sketch) �'--'&-Electricity,:,Location,-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / • f Left, - / /"Nat. oO PSL" ft./-. /" LPG 7.- Utility Clearance:,,,',,..; 7i Date Card, B-1. ,-Date „ Card B-1 Date !Card: B,1 ..:. „.> ,Oate : Card B-1 Data MOBILE HOME INSTALLATION (Plans) OK.except #'s 1. Zoning Requirements -Setbacks. Easements.,; . 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve . Connector 4. Electricity; MH -Test -Crossovers -Breakers -Clearances 5. ,D,rain; MH Test -Fell -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/0 to, Grade -HD -Approval 8. Gas and Electricity Tagged .. 9. Exits; Insp.-Sketch 10. Cert; of;Occupancry, ...:. ^. s .;r �•.;. . Date Card B-1" Date . Card B-1 Date Card 8-1 z " Date.- Card B=1 �:MI,CELLANEOUS Date DECKSMOVERS, CARPORTS,.GARAGES,. Plans OK,ezce t #'s 2,1 y 40 Z Hing Requirements -Setbacks -Easements •. Footings; -Soils=Size-Depth-Spacing-Connectors-Steel ts-Dec ki ng=Bracing-Stairs-Rails os s= earns=Rftrs�=Coonectors`. Shthg Rfg.-Bracing , .j -Connections-Spl ice-Decal-Enclosu res oors. . Wig; Sils-Anchors-Studs-Rftis-Trusses Si 'hg; Nailing -Veneer -Stucco -Mesh Roof; Shthg-Roofing 1.3+�x•E�-6tePs.f]pors;Landings„+.,,,,. •, , Date,.J,tl�.0 Card B.71 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK cept #'s 1._ Setbacks -Easements 2.rlSOW Compaction -Structure Stability , 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining - 4. Elec.; Receptacles and, Lighting;. Distances-GFI 5. Elec.; Pool; Lighting; 15 volts-GFl 6. Elec.;Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5'-Circulating;Equip.-Heater. '8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main °in -Conduit 9,.,Health Department Approval 10, Plumb.; Cir. Test -Water Supply Test Date Card -B-1 Date Card B-1 Date Card B-1 Date Card 134 J=OK 0 = Not OK - = Not Applicable RESIDENTIAL (Single & Duplex) • = Not Ready Date UNDERFLOOR (Plans) OK except #'s Date FRAMING (Continued) 1. Zoning-Setbacks-Easements-Flood-Slope 45. Hangers-Post Caps-Anchors-Connectors 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng. 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 47. Fireplace Ties or Type A Flue-Fireplace Throat clearance 4. Ftg., Porches & Decks; Soils-Steel-/ /Ftg. Depth 48. Attic Access; Size & Romex Protection-Draft Stop-Ins. Baffles 5. Stemwalls, Main; Steel -Block outs-Wrapped 49. Bdrm. Windows or Exiting Doors-Sill Hgt. & Dimensions 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 50. Garage Fire Protection Framing 6a. Hold Downs and Special Anchors 51. Property Line Firewall & Openings 7. Slab; Steel-Wrapped 52. Ext. Doors-One T-Check Garage-3rd Story, 2 Exits 8. Piers-Fireplace Ftg.-Steel 53. Stairs; Width-Headroom-Rise-Run-Landing-Fire Protection 9. D.W.V.; Fall-Fitting-Test-2 Way C/0-Sewer Test 54. plywood on Roof Overhang-Attic Vents-Rafter Outriggers 10. Gas Pipe; Size-Anchors 55. Siding-Nailing Veneer 11. Water Pipe; Test-Anchor-Regulator-Service Test 56. Stucco Mesh-Drip Screed-Fd. Vents-Underflr. Access 12. Electric; Underground 57. Glazing Area-Glass Protection-Skylights-Plastic. 13. Pienums & Ducts; Clearance-Material-Support-Ins. 58. Shear Walls; Nailing-Bolts 14. Girders-Sills-Anchor Bolts-Joists-Vents-Cripples 59. Insulation-Walls-Ceilings 15. Insulation 60. Infiltration-Walls-Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Date Card B-1 Date Card B-1 16. Water Htr.; Vent-Access-Combustion Air-Baffle Date FINAL (Plans) OK except #'s 17. Water Pipe; Test & Anchor-Nail Protection 61. Ext. Steps-Door & Sidelight Protection-Landings 18. D.W.V.; Test -Fittings & Anchor-Nail Protection 62. Smoke Detector 19. Shower Pan; Test, First Floor-Tub Access 63. Furnace; Vents-Clearance-Comb. Air-Connector- 20. Test Tub & Shower, Second Floor-Tub Access In Garage; Above Floor-Ducts-Mech. Protection 21. Gas Pipe; Size & Anchors 64. Bedroom Exiting 65. G.F.I. & Bath Fixtures & Tub Access-Spa Date Card B71 Date Card B-1 66. Elec. Trim & Subpanel; Breaker Sizes & Labels Date Card B-1 Date Card B-1 67. Stairs & Rails Date ELECTRICAL (Permit) OK except #'s 68. Fireplace or Stove; Clearances-Hearth 22. Fixture & Transformer Clearance-Ins. Protection 69. Elec. Outlets at Wood Panel; Int. & Ext. 23. Elec. Receptacles Spacing-Lights & Switches at Doors 70. Kit.Fixt. & Appliance; Grnd.-Air Gap-Cooking Clearance 24. Size Boxes & No. of Conductors-Stapled 71. Elec. Outlets & Receptacles at Kit. Counter 25. Romex Installed Close to Edge of Studs & C.J. 72. Garage Fire Door; Swing-Landing-Closer 26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water 73. A.C. Duct in Garage-Damper 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI 74. Wtr. Htr.; Vents-Clearance-Comb. Air-Connector-P.R.V. 28. Subfeed' Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. In Garage; Above Floor-Mech. Protection Cu or At 75. Plb., Elec. & Mech. Equip. Listed for Location 29. Range Circ. / / ga. Cu or AI-Oven Circ. / / ga. Cu or Al. 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection Insulated Neutral 0 Yes 0 No 77. Insulation-Foam-Looked in Attic 0 Yes 30. Service-Riser Conductors & Ground-Main Disconnect 78. Guard Rails & Deck Construction-Post Caps 31. Equip. Clearances Panels-Motors-Mech. Equip. 79. Fdn. Vents & Crawl Hole Door-Drainage & Wood-Earth 32. Clothes Closet Light-Shower Light-Spa Light Clearance Looked under Floor 0 Yes 33. Smoke Detector 80. Following instld.; Drive 0 Yes 0 No; Walks 0 Yes 0 No; Planters 0 Yes 0 No 81. Stucco; Brown-Finish Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to Date MECHANICAL (Permit) OK except #'s Openings 34. A.C. Ducts Insulation & Support 84. Water Well; Disconnect, Electrical, Plumbing 35. Vent Fan; Exhaust above insulation 85. Exterior Elec. Trim; G.F.I. Receptacle-Underground 36. Condensate Drain & Overflow; Size & Grade 86. Ventilation Throughout House 37. Furnance-Vent; Access-Comb. Air-Return Air Vent-115 outlet 87, Glass Protection 38. Attic Access & Platform if Furnance in Attic 88. Corrections from Previous Inspections 89. Gas Test-Meters Tagged; Gas-Electric 90. Water & Sewer Connected-C/O to Grade-HD Approval Date Card B-1 Date Card B-1 91. Energy Compliance Certificate-Other Certificates Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s Date Card B-1 Date Card B-1 39. Sils, Proper Material & Anchors Date Card B-1 Date Card B-1 40. Walls Studs-Nailing, Spacing & Bracing-Plates-Sound Date Card B-1 Date Card B-1 41. Bearing Walls over Girders & Floor Nailing Comments at Final: 42. Draft Stop in Walls (rat proof) 43. Fire Stops; Furred Ceilings-Stairs-Chases-Tub 44. Headers & Beam-Size & Bearing (NOTE: An entry must be made each time you visit job site) v Ile COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville,.California 95965 - Telephone: 916/538-7 1 APPLICFION`AND PERMIT J 7 (J S R^P A_ EL NU BtR ASS)"I ZONI G BUILDING PERMIT o WlqVR (\ ")' I^ TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWJ R'S MAI G 70R i U91 C NTR` R'S AAME TEL Y[J C TRA TAS MAILING A DRE S ]Z v g ` Fireplace CO T UCTION DER 9 " UNKNOWN Total Valuation4-$ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ AR HI ECTr`^OOR ENGINEER Avo r) LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESSr©P©� ` yx Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 F©r Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTU %� SF ❑ Duplex[]Mobilehome❑ Other rV �/C l`X�lna SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G W 10.006 TYPE OF WORK New 'M Addition❑ Remodel❑ Utilities❑ Installation❑ Other El Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): _© I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professlo Code and my license Is In full force and effect. s License No. Classification r ❑ 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 NEW CONST. I DWELLING OCCUR OR ADDNS. C ACC. BLDGS. 2/20sq ft NEW CONSTR ULTI.OUTLET NON.RESID BRANCH CIRCUITS 2.50 ea POWER APPARATUS &) SINGLE OUTLET CIR. / EX, DCCUp�OUTLETS OR FIXTURES 20@60¢ 8 L030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESIOJ EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor 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 a Certificate of Workmen's Compensation Insurance or a Certificate of 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ 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 County of Butte to enter upon the above-mentionedroperty for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and ex enses which may in any way accrue a ainSt said Countyin conseque of thgranting of this permit. \V1 ( X t Date 1 Signature of Applicant — Owner ❑ Canr ctar Agent ❑ An OSHA permit is required For excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ HAz CLIA PARK SCHL FLD PAR PD HD ISS This permit is hereby issued -under sions of the Butte County Code and/or work indicated above for which fees DIRECTOR O UBLIC By PERMI PIKES Date the applicable provi- resolutions to do have been paid. WORKS ate �� _3 2--1 4 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT �_ _ _ x., �;.�,T�t.'3q,ss5�•-..'�_r�...;4:_i-��i',t.aC•,_}i'`ur�x, .:J �_-; .. COUNTY OF BUTTE - DEPARTMENT QF PUBLIC WORKS - BUILDING DIV 5ION <?+a 7 COUNTY CENTER DRIVE - ORd4iJ 1J1FORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. OWNER Nis l% A. P. No. LI Proposed Building Use /Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED ' 1. All items have been submitted.................... �. 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5.- Hazardous Material Form .......................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. , 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation , instructions....................................................... 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... School Districtlf es paid .............. yl.Sanitation approval from (0 c� U ! HealtDepartment . City of Chico plumbing permit. . 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning. approval for (A) Use: (B) Parking: 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) . 20. Pre -Inspection for required Pre-Inspec. request to Building In ector (Date) 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .... IR_f1�.?0 P.W . 23. Owner -Builder Verification (Given to owner o, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... 26. 27. When you issue theetrrmit, proces as follows: Mail to owner. Mail to contractor. Telephone 49 and hold for pickup at n(r)_office. Deliver w/inspector. Other Applicant W. V , �yf W./ Date, -s Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitte prior to per 't issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone_JnaiI—counter by ..date Contractor, designer, owner, was advised of above required data by—phone —ma il—counter by date Plans checked by Date J � — tans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW s TO Buildinq Department. - FROM: Environmental Health SUBJECT: Sanitation Clearance owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Hold final for: Water Supply Final clearance O.R. for: Water Supply Clearance for bedroom mobile home. Other 1 1'PO MIT NO. 304-78P,E J �• PERMIT EXPIRES • OWNER Darwin R. Henry owner CONTR. ` LOCATION (A.P. 73-18-21• ) App.200'off N/S Oro-Forbestown Rd., on pri € ' Rd, app.1000'E.of New York Flats Rd., Forbestown ti AA -lot � a •p Y .. .a l •t { . � r 4 Temp. Power Pole Called PG&E 1 Temp. Elec. Serv. j Called PG&E q�f? Temp. Gas Serv. • o.3 'Called PG&E JOB FINALED % i (Date) ; 1 (Signature,),t% \ t y t. 4 � 1 r. t 1'PO MIT NO. 304-78P,E J �• PERMIT EXPIRES • OWNER Darwin R. Henry owner CONTR. ` LOCATION (A.P. 73-18-21• ) App.200'off N/S Oro-Forbestown Rd., on pri € ' Rd, app.1000'E.of New York Flats Rd., Forbestown ti AA -lot � a •p Y .. .a l •t { . � r 4 Temp. Power Pole Called PG&E 1 Temp. Elec. Serv. j Called PG&E q�f? Temp. Gas Serv. • o.3 'Called PG&E JOB FINALED % i (Date) ; 1 (Signature,),t% \ t Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLEft Motors Framing Test Water Htr. Stucco Final Subpanel/ Mesh MECHANICAL Grd. F It Prot. Scratth Heatl Servi B n Coo ng T mp. Pole F ish D is oder round In rior Lath ntilation Permanent oor Closer anal Final MOBILEHOME UTILITIES----- -------- --- Elec- Service 'j. ,f� Elec. Pedestal Water Piping �/ jSewer �, - Gas Piping 7 M0816EMOME INSTA LATI N --------------Support Elec. Continuity 1,2- Water Piping Drainage Gas Piping 4/—/ DATE - - REMARKS OR CORRECTIONS L, jcmc c r,0W iAl C) s i�nr I- 7-,0 020 X00 4 5a ` ��� a�G At-& S o C PPS <_� Ana CAW -6,P (NOTE: An entry must be made on this form each time you visit the job site.) --� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS " `'• BUILDING INSPECT)bN RECORD BUILDING BUILDING (Cont'd) PLUMBING Se ck S I PipinFor NA(ewall 7 t Floor Mai Bldg. m Finish 2n Floor Fo tins 3rd Noor Stem all Sidina To out Slab Roof Shea'*Ing Water Pipi)kg ' Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physical n ed Confforormance of ex. C structure V Appliances Gas PI In & Test Temp. as Slab Final A Sanitation Patio REP ACE Final Footincis Footing E ECTRIC L Masonry Walls Throat Rou h Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLEft Motors Framing Test Water Htr. Stucco Final Subpanel/ Mesh MECHANICAL Grd. F It Prot. Scratth Heatl Servi B n Coo ng T mp. Pole F ish D is oder round In rior Lath ntilation Permanent oor Closer anal Final MOBILEHOME UTILITIES----- -------- --- Elec- Service 'j. ,f� Elec. Pedestal Water Piping �/ jSewer �, - Gas Piping 7 M0816EMOME INSTA LATI N --------------Support Elec. Continuity 1,2- Water Piping Drainage Gas Piping 4/—/ DATE - - REMARKS OR CORRECTIONS L, jcmc c r,0W iAl C) s i�nr I- 7-,0 020 X00 4 5a ` ��� a�G At-& S o C PPS <_� Ana CAW -6,P (NOTE: An entry must be made on this form each time you visit the job site.) 0 r At t 1 Y MOBILEHOME INSTALLATION INSPECTION CHECK LIST , ' ,,,... 1. Is the mobilehome located with required separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does the mobilehome have.required clearances above ground? (Sec.5085) Yes_ No 3. Are footings and supports properly sized, spaced, and braced as per approved plans? • (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes_ No 4. Is the mobilehome level? (Sec. 5088) Yes_ No ' 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No 6. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec'. 5566) Yes No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes No C. Backflow - If coach is not State of California -approved, does station have backflow device and pressure -relief valve? Yes_ No + 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes_ No B. Does it have minimum k" per foot slope and is it properly supported? Yes_ No C. Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe? Yes No D. If coach is not State of California approved, does station have required trap and vent? Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome gas line itilet without reductions other than.the mobilehome connector. Yes 4_ o_ B. Tes .OK as per following procedure? Yeses Open all appliance connector valves. 2-.:r'Shut off appliance burner and pilot valves. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. Connect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C.' Are all appliance vents properly installed? Yes o A"' 9. Electrical A. Is service large enough to provide adit-quateiamperage-to mobilehome (must equal rating of mobilehome with a minimum of 100 amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes No B. Is there,proper clearances around panels? Yes No C. Is power supply cord,or feeder assembly properly fused? Yes No_ D. Is continuity test satisfactory as per the following procedure? Yes_ No 1. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle Length Width Vehicle Serial No. State Identification No. Additional Information or Comments: COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date ' 2 3 -71 Signature of Pe itee or Agent 77 Receipt No. O 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 bee aid. DIRECTOR 0 P BLIC WORKS BY Date �— 46 —7 F U permit expires Date �— z� 7 BUILDING Owner Sam SQ. FT. I OCC. BUILDING VALUATION Mailing Address �) Telephone No Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee Building Address 1'� ll' � @S PLUMBING No. @ FEE PERMIT FILING FEE $3.00 � Each Trap 1.50 ©f Repair drainage or vent piping 1.50 Water piping 1.50 AeA AJ 110 vt AS. G b Each gas water heater or vent 1.50 �0 0k A. P. No. O'�. Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet 30 Fe Saf)akon I Fire Dept. Fire Zone Use Pen -nit Building sewer 5.00 EQA I Parking Plans Parcel Declaration Parcel M 60' R/W Im rovemen s P Lawn sprinkler system 2.00 Bldg. 11114s Recd Parcelproval Pla Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 M600V OR LESS main service 100 AMP OR LESS 5.00 1 Main service EA. ADD•L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600V 100 AMP OR LESS 25.00 Main service EA. ADD -L foo AMP 1.00 NEW CONST. DWELLING OCCUP. & OR ADONS. ( ACC. BLDGS. 2�sgft NEW CONSTR. (MULTI -OUTLET NON.RESID. BRANCH CIRCUITS) 2.50ea NEW CONSTR. /POWER APPARATUS &) NON-RESID. (SINGLE OUTLET CIR. 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 style of: Ex. Occup(OUTLETS OR FIXTURES)BA@L@1Z5Q Ex. OCCU F16XED APPLNS. O TLETS (RESID.) EA) 2.00 P• ( OUR Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 Tam exempt from the Contractors License Laws of the State of California. Permit Fee 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. certify that in the performance of the work for which this per 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 Cooling Ventilation Hood 1 1 2.00 Permit Fee 1 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 TOTAL PERMIT F E authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date ' 2 3 -71 Signature of Pe itee or Agent 77 Receipt No. O 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 bee aid. DIRECTOR 0 P BLIC WORKS BY Date �— 46 —7 F U permit expires Date �— z� 7 , ' NOTE:—All KIA-11 triols f-: �'dr-r'; Be Accorda an�wiih. Ror,.�.m" , ► s^,.. ,i p....�; .P� ll' of a qu dity presrari! e-1 for ;he Sne,!;"ed use in f6 Uniform Building, ralumYng & Mlrnhanical Codes and. the National Electrical Code. this set of plans and specifications ,MLJ51 bm kept on the jab ..t all times and ,it is ��nlHwlul to i ms car alterations on s.;;ne wlr� mage any Chang p rmisso.> ;rom he. De,; oul Written Written e ; '1Vnrks. C00nty f t3ttP. All utilitj connections shall be located wi hin 4 ft. cutside the rear third sectbn of the mobile horse on the left (road). side- of the mobile home. the . hall be 5 ft. from r.\ The Setback V side property, line and 50. ft. from the •p Centerline of tlj.. I°c�a, pertniiring a a)" en _ morn of a 2 ft. e�a� overhang but .�-. out, of aU easeme 45% Septic system and location o to be 'as pca utte COL my Health Dept, R�- quirernent . rA pr Ii wil° be required for the "bilehome, � 1��. So y —7f -- --- --- —i BUTTE COUNTY ' Ra tlt...G DEPARTMENT APPROVED . f l MOB ILEHOME SUPPORT DATA. r H tither than single wide, Mobilehome Mfr. furnish Setup Model No. Year. 7,� Width 1 6�(ft.) Box Length �,�(ft.) Tagalong or Expando Size ft. x ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973; furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). Ail center supports measured from front of mobilehome unless otherwise specified. Footings (check one) Single 1. Wood either AA pressure treated of foundation grade. (ft.)(i :) (in.) (in.) 0 2. Other (specify. Center suppo t Center sup ort locations* footing izes Supports (check one (in.) 1. Concrete block. x 2. Other (specify) (ft.)(in.) (i .) (in.) • <---Tagalong or Expando, show support details. (ft.)(in.) in.) (in.) x -- Typical Support in.) (in.) Footing Size (f .)(in.) (in.) (in.)/-- Max.-Pier Spacing (ft.)(in.) s X_ --Max. Overhang (ft.) (in.) (in.) (in. (ft.)(in.) COU10 RO\4 *If center piers are other than drawn above, draw in locations, spacing, and dimensions. BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: L{1 2. Installer's name: ��' 3. Is the site currently under permit? Yes / No ( If yes, furnish permit number J� .- — �% ) OR Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes //-'/ No / / (If no, clarify ) 5. What is the mobilehome electrical rating? ----------------------- �� C'� Amps 6. What is the mobilehome-site service•rating?--------------------- 6i� ��_ Amps 7. What is the mobilehome site circuit breaker rating? ------------- ��� Amps 8. Is there any other electric load to be served by the mobilehome (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.). site service? --------------------------------------------------- Yes No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- ��� (in.) 10. What is the type of gas service? ----------------------------- Natural / / LPG / L4--- 11. What is the gas pipe length from meter or tank to the mobilehome? LLD (ft.) 12. What is the mobilehome gas demand? ------------------------------ (BTU) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.). _ COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Canter Drive — Oroville, California 95965 Telephone: 534-4541 �� of APP ` LIGATION AND PERMIT aumonze_represeniatives or mea unty of "'utte io enter upon me ave mentio ed property for insp -tion purposes. Date ` Signature of Per aeeee or Agent Receipt No. / � W - r 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 ich fees have been paid. D R CTO F PU IC WORKS By Dat 7-7 Building permit expires Date / BUILDING Owner ! SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor 4 41 12 A)lFireplace Mailing Address Total Valuation Telephone No. Permit Fee Building Address/ OV4 -,OL� &AS Plan Checking Fee&/or Penalty Permit Fee PLUMBING No. @ FEE / _ �4 PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. .... — / Zoning &Planning Water piping 1.50 Each gas water heater or vent 1.50 F Sarritaiiclp I Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA I Parking Plans I Parcel Declaration Parcel Ma P 60' R/W Improvements P Each additional outlet .30 Building sewer 5.00 �� Re Bldg. Plrett�c'd Parcel oval Plan oval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHERCR permit Fee $ $ A0 ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP 00V OR LESS 5.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD•L 100 AMP 2.50 Main service OVER 100 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW CONST.OR ADDNS. ACCLBL GS.LING CCUP. 7i1 2¢Sgft f 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 style of: NEW CONSTR BRANCH CIRCUITS) NON.RESID. (MULTI BRANCH CIRCUITS 2.50ea � NEW CONSTR. POWER APPARATUS 8 NON.RESID. SINGLE OUTLET CIR. Ex. Occuo(OUTLETS OR FIXTIIRES 5 L� FIXED APPLNS. OR Ex. Occup. (OUTLETS IRESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 1 am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE 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. j( I certify that in the performance of the work for which this ermit is issued I shall not employ any person in any manner sod s to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ 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 I gnrl QPvelU—M-Q1LF-W$ TOTAL PERMIT FEE $ v aumonze_represeniatives or mea unty of "'utte io enter upon me ave mentio ed property for insp -tion purposes. Date ` Signature of Per aeeee or Agent Receipt No. / � W - r 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 ich fees have been paid. D R CTO F PU IC WORKS By Dat 7-7 Building permit expires Date / BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS SPECIAL INSPECTION REPORT Owner: Address: Tenant: Building Location: Y%f, ,,?DD a-- i Type of Inspection requested: b /% 1. Housing 2. Financing 4. Other (specify) Ve ti .Nej, ) yorK F ll.'bs 3. Change of A. P. # *7 3 Date of Inspection .317 Inspector�i to ttte-S`6Ip Present use of building: 0C �� A. Sanitation (Housing) 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities: 7. Natural light and. ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: '12. Connection to water supply: 13. Rubbish and garbage facilities: 14. Comments: B. Structural 1. Piers and footings: 2. 3. 4. 5. 6. Floor construction: Wall construction: Ceiling and roof construction: Fireplaces: Comments: C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments• D. Plumbing 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4. Comments: (continued on back)' M E. Other 1 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazards: 4. Weather protection: 5. Underfloor and attic ventilation: 6. Comments: I F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Restroom floors and walls: 5. Exits: 6. Improvements: 7. Zoning: 8. Comments: ield Problems or Violations 1. Problems or violation (give com,glete desc�iptign) 2. What action taken (give complete description): 3. What action recommended: T% A. Information only - file. T7 B. Hold for ten (10) days, then write letter. C. Write letter. /% D. COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street - Chico, CA - (530) 891-2751 7 County Center Drive - Oroville, CA - (530) 538-7541 CORRECTION NOTICE PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. S V'/ �tD iyv�a �et -41 (COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSQRP,pyCEi LIMB ZONING BUILDING PERMIT OWNER CYNTHIA WILSON TELEPHONE 675-0233 SO. FT. OCC. BUILDING VALUATION OW"ERS II{NG,VJES�7, FORMTOWN CA 95941 CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING D ss sFORBESTOWN ROAD, FORBES'TOW� Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDNSIOWS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 ` Each Trap 7.00 USEOFSTRUCTURE yy SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or'heat um water heater 23.00 Water piping 15.00 . Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other OL' Describe Work: RETAG ELEC SER f I r Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 - PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 aOOV OR LIE Main Service zoOA OR LESS 23.00 23 pp LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and .Professions Code, and my license is in full force and effect.P ' License Class Lic. No. OWNER -BUILDER DECLARATION I I hereby affirm under penalty of perjury that I am exempt from the Contractors License yaw for the following reason: 'Fs7 I, as owner of the property, or my employees with wages as their sole compensation, f\ will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed `contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 ' NEW CONST. DW UNG ffLIP. OR ADDNS. ( 8 ACC. BLDS. SO 3.50FT. A°�IDT. MULTI -OUTLET @7.50 OWER APPARATUS 8 SINGLE OUTLET CIR.' Ex. Occup. OUTLET OR FDRURES RAL @ 1.50 FIXED All OR Ex. Occup. ounErs RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirin -23.00 PERMIT FEE : 43.00 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure, for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required•by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier. MECHANICAL PERMIT. Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) (IX, I certify that in'the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with'those provisions. - 3 a Xof ?'t� T x l Gf f%1ti��1 Date � ' c� I � � Signature/of Applicant - IOwner ❑Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction+ of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ - OCC ti CONST. TYPE TOTAL FEE $ 43 00. HAZ. D: FEE, IMP I FLOOD I CDF PARCEL PD I HD I ISSUE This permit is hereby issued under,the applicable provisions the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. -- Byl�f`_> Date `r i/ PERMIT EXPIRES' ON i / t f Dete ReceiptNo.Ql.)tgl4y� WHITE-D.D.S.-B.D. t ANARY-ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 073-180-021 Permit # 1 CYNTHIA WILSON 5411 FORBESTOWN ROAD RE -TAG ELECTRIC SERVICE a OFFICE COPY Address GAS Meter By ELECTRIC \�a Meter By ,A V +' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION - 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT N0. (Rev.12/96) APPLICATIONAND HERMIT ASsessU7, JEE11g±P 021 ZONING U BUILDING PERMIT OWNERCYNT HIAlJWILSON WILSON TE 675E 0133 SO. FT. OCC. BUILDING VALUATION OWNER FORBESTOWN CA 95941 CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER ' Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILD1f�gii sFORBESTOWN ROAD, FORBESTOWN L� l l Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE y SF © Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other CA Describe Work: RFTAG FIRC SFR Gas piping system t - 5 outlets 15.00 1 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service • mon oa ',ss 23.00 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.P License Class Lic. No. OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury that I am exempt from the Contractors License w for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main Service 200A TO 1000A 46.00NEW CONST. DWELLING occuP. OR ADDNS. ( a ACC. BLDS. so 3.5¢FT; NEWO9 RESIDT' MULTI.OUTLEr @7,50 OWER APPARATUS a SINGLE OUTLET CI R. Ex. Occup. ounErOR FDMRES 20 1.00 BPL p'.50 FIXI Ex. Occup. ouT�rs alo.°F. PA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of*consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. q /� Date 7 -,21"p--,21"p-/ �J IDiatur of Applicant - P3,Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 1 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEI: $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ = 43.00- HAz. D FEES IMP FLOOD CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been I VV By ��It Date PERMIT EXPIRES ON < a«l�'7 provisions to do work paid. �'Z O to ReceiptNo. WHITE-D.D.S.-B.D. CANARY.ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT i COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev.12/96) APPLICATION AND PERMIT q Q ,� ASSESSOR PARCEL NUMBER ® ? s v C/ U r fn zowMe L) BUILDING PERMIT ow�ER TELEDHON! SO, Fr, OCC. BUILDING VALUATION OWN MAID ADDRESS yiD 6 76,61;:s C,6 = CONTRACTORS NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MNLNG ADDRESS Fireplace Total Valuation s ARCHITECT OR ENGINEER LICENSE NO. —FilingFee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS C� � r Energy Plan Checking Fee $ S PERMIT FEE S LOT NO. SUBDNISIONSHME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF O Duplex ❑ Mobilehome 14 Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New O Addition ❑ Remodel O UtlGties ❑ Installation O Other Describe Work: Af_� Q� y��/ U Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE ti ' ELECTRICAL PERMIT Fling Fee 20.00 Main Service =OORR 23.00 [�( LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code, and my license Is in full force and effect License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project O 1 am exempt under Sec. , Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Date Signature of Applicant - ❑ Owner ❑ Contractor O Agent An OSHA permit is required for excavations over 90' deep and demolition or construction of structures over 3 stories in height Main Service TO IOWA 46.00 NEW CONST.mous G OCCUP. 3.50 FgE a ACC. erns• T. ra GON NpµgEglp, ' MULTFOUTLET @7.50 POWER APPARATus a swmE ountT as Ex. Occup. OLRLETOR R (TURES 20 ®' SAL 0 .w Ex. Occup. o.°REA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 13.50 Ventilation PERMIT FEt S Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE; HAZ 1 0. FEES IMP I FLOOD COF PARCEL PD HD ISSUE This permit is hereby Issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXPIRES ON provisions to do work paid. to Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 121 OWNER -BUILDER VERIFICATION Attention Property Owner: Aw"owner-builder" building permit has been applied for in your name and bearing your signaau+e.: Please complete and return this information at your earliest opportunity to avoid unnecessary delaq in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and materials for construction of the proposed 01. property improvement: YES)d NO E3 i I HAVE HAVE NOT E3 signed an application for a building permit for the proposed wow . 3. I have contracted with the following person (firm) to provide the proposed consttuction:.::::; NAME: t _ s ADDRESS: CITY: 4. PHONE: CONTRACTOR'S LICENSE NO. ,::rdina I plan to provide portions of this work, but I have lured the.following person to supervise, and provide the major work: NAME: ADDRESS: CITY; 44 PHONE: CONTRACTOR'S LICENSE NO. A 5. I will provide some of the work but I have contracted (hired) the following persons to prgvide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER:�1,,p SOCIAL SECURITY NUMBER:_, � DATE: - -" NOTE: This Owner -Builder Verification is required by Se--c-tion 19931—ff-19U California Health and Safety Code. This verification must be -completed iod returned to our office before we are permitted to issue the permit. OVER • OWNER BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed as contractors' or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, . workers compensation insurance, disability insurance costs, and unemployment compensation contributions: ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance.. ' ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service.(and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractprs may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. 4icy, C. Vi ira, C.B.O. r, Building Inspection NOTE: This Owner-Builder,Informado n is required by Seetlon 19830 of the Califontia Healdi and Safety Code - OVER RESIDENTIAL 73-18-21 198=90B,E HENRY, Darwin CONTR: William.V. Marihugh Const. 5411 Forbestown Rd, Forbestown (MH CABANA & RAMADA) i f l • 1 , JOB FINALE Signature J=OK O=Not OK ' - = Not Applicable Not Ready RESIDENTIAL (Single & Duplex) ' = Date UNDE FLOOR (Plans) OK except #'s zoni g=Setbacks-Easements-Flood-Slope k2 -ft -g., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth teel-Elec. Grnd.-/ /" Ftg. Depth Porches & Decks; Soils -Steel-/ /Ftg. DeptQiim ; Stemwalls, Main; Steel-Blockouts-Wrapped ed 6a. Hold Downs and Special Anchors iers 9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test 10. Gas Pipe; Size -Anchors 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Insulation Date tj Card B-1 Date Card B-1 Date Card B-1 kJ Date Card B-1 Date LUMBING Permit OK except #'s . Water HIr.; Vent -Access -Combustion Air -Baffle 1 Water Pipe; Test & Anchor -Nail Protection 1 D.W.V.; Test -Fittings & Anchor -Nail Protection 1 Shower Pan; Test, First Floor -Tub Access 2 . Test Tub & Shower, Second Floor -Tub Access 2J, Gas Pipe; Size & Anchors Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date EL RICAL Permit OK except #'s F' ture & Transformer Clearance -Ins. Protection Elec. Receptacles Spacing -Lights & Switches at Doors 4. Si Boxes & No. of Conductors -Stapled h,oAex Installed Close to Edge of Studs & C.J. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water liance Circuts in Kitchen & Conductor Size/GFI ubfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al ,28 -+?&%e Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes 11 No ,ler-Sm,yi6e-Riser Conductors & Ground -Main Disconnect yeEquip. Clearances Panels-Motors-Mech. Equip. -32_etottres-Closet Light -Shower Light -Spa Light -33.7S_mo_ke Detector DateF,-)4- Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date IV ECHANICAL (Permit) OK except #'s A.C. Ducts Insulation & Support Vent Fan; Exhaust above insulation 31R. Condensate Drain & Overflow; Size & Grade 3 . Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet 31 . Attic Access & Platform if Furnance in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRA NG (Plans) OK except #'s Si , Proper Material & Anchors Walls tuds-Nailing, Spacing & Bracing -Plates -Sound 4 earl Walls over Girders & Floor Nailing 42 • t`Stop in Walls (rat proof) 0. ire tops; Furred Ceilings -Stairs -Chases -Tub eaders & Beam -Size & Bearinq Date FRAMING (Continued) gers-Post Caps -Anchors -Connectors 4 . Cing. Joist-Rftr. ties-Purlin—roof Brac-Truss-Shthng.-Rfng. -44 --fireplace Ties or Type A Flue -Fireplace Throat clearance i �f3'Atilc Access; Size & Romex Protection -Draft Stop -Ins. Baffles rm. Windows or Exiting Doors -Sill Hgt. & Dimensions ge'Fire Protection Framing Pro erty Line Firewall & Openings xt. Doors -One 3' -Check Garage -3rd Story, 2 Exits .53Width-Head room -Rise-Run-Landing-Fire Protection lyw od on Roof Overhang -Attic Vents -Rafter Outriggers 95 -Nailing Veneer h -Drip Screed -Fd. Vents-Underflr. Access Glazing Area -Glass Protection -Skylights -Plastic. r Walls; Nailing -pat% _q ca eg.-'I'nsulation-WaW&--1,"e-iliggr 60. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL Plans) OK a ept #'s ' Ext. Steps -Door & Sidelight Protection -Landings tents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection xi mg fixtures & Tub Access -Spa .�BrSubpanel; Breaker Sizes & Labels ai s %1-FirepWeeror-^Mve; Clearances -Hearth t Elec. Outlets at Wood Panel; Int. & Ext. M. 144,F-* Appliance; Grnd.-Air Gap -Cooking Clearance ets eceptacles at Kit. Counter r; Swing -Landing -Closer ge-Damper r_ance-Comb. Air-Connector-P.R.V. In Garage; Above Floor-Mech. Protection quip. Listed for Location Garage; (G.F.I.)-Romex Protection Insulation -Foam -Looked in Attic e Yes Guard Rails & Deck Construction -Post Caps Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor O Yes Following instld.; Driv ❑ Yes o; Walks O Yes No; Planters 11 Yes ONo -81"9tnece Brown -Finish nect, Electrical, Plumbing o , Plbg.-Appliance-Fireplace.-Clearance to Openings connect, Electrical. Plumbing im; G.F.I. Receptacle -Underground r ughout House Glass Protection �§ Corrections from Previous Inspections agged; Gas -Electric ected-C/O to Grade -HD Approval 79i�-6erupliance Certificate -Other Certificates Date �// Card B-1 Date Card B -1 - Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: (NOTE: An entry must be made each time you visit job site) J=OK 0 = Not OK -=Not Applicable ' = Not Ready MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. $ewer; Location -Test -Fall -C/0 Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity;"Location-Clearences-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap: / PV'ft. / P'Nat. or/ P L" ft./ /"LPG 7. Utility Clearance Date Card B-1 , , Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks Easements.. 2. Footings; Size -Spacing -Marriage, Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/0 to Grade -HD Approval 8. Gas and Electricity Tagged 9. Exits; Insp.-Sketch 10. Cert. of Occupancy Date Card B•1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECK OVERS, CARPORTS, GARAGES Plans OK except #'s Zon' g Requirements -Setbacks -Easements footings; Soils -Size -Depth -Spacing -Connectors -Steel /or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Coonectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.;Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater '8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 ;;47 z/ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKSPER IT No ; 7 County Center Drive - Oroville,'C,alifornia 95965 - Telephone: 916/538-754 0 APPLICAT.10"O PERMIT A ES OR PA CEL N MBER _ ZONI G BUILDING PERMIT ow R TEL H CITE� SQ. FT. 0 C. I BUILDING VALUATION O ER,f MAI LI ADDRESS __ © /1 U Ll1J `[/ I� 3 O 7 ACTOR'S N.4 E EL PHONE 4 r` pq- PNT5clr9AILIN ADDRESS � L/ Fireplace CO 5 RUCTI N LENDER JUNKNOWt4 Total Valuation $ Filing Fee $ 10 QO LE DER'S MAILING ADDRESS Permit Fee $ _ C ITECT(`^+O-•R ENGINEER /JJARCHIOTECT LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRES:�—� . r Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 ✓` Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex[] MobilehomeOther SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW 1 10.00e TYPE OF WORK New ❑ Addition ❑ Remodel Uti ities ❑ Insta�llati ❑ Ot r Describe work: roe Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR100AMP OR LOR LESS 1 10.00 Main service EA. AOD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in ful force and effect. License No. ycS ��Q Classification JL/ ^1 F1 1, 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 T ( DWELLIN GOCCUP. ' oR ADDNSS. 2y2QSgft all NEw CONSTR ULTI.OUTLET NON-RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup( OR FIXTURES 200500 BAL030 Ex. Occup. OUTLETS PRESID )FIXED APLNS. REA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor 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 a Certificate of Workmen's Compensation Insurance or a Certificate of 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ 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 Butte to enter upon the above-mentioned roperty for inspection purposes. I also agree to save, indemnify and keep armless the County of Butte against all liabilities, judgments, costs, and ex enses which may in any way accrue agawnst said CountV,in consequen a of th granting of this permit.This Date �^ �� �n Signature of Applicant — Owner ❑ Cont ctor Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST TYPE TOTAL FEE $ .-- HAz cuA PARK SCHL EE r/ PA `� PD H ISSUE permit is nereby issued undX sions of the Butte County Code and/or work indicated above for which fees DIRECTOR F PUBLIC / By (� PER EXPIRES Date resolutions to do have been paid. WORKS Date .7— /— Fa fit^ Receipt No. � © WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF -PUBLIC WORKS - BUILDING MSI N cn o 7 COUNTY CENTER DRIVE OROVILLE, CAL F �F IA 95965 - TELEPHONE: 916/538-7541 �('A • -, PERMIT APPLICATION DATA SHEET Permit No. OWNER In A4/A). P. No. �t (� Proposed Building Use �" B.uilding Inspector C� Date At time of permit application, I was advised the following data must be submitted prior to permit proessing and/or issuance: DATE ECEIV D APPROVED 1. All items have been submitted. ..... 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans .. 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form ........................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions....................................................... 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 3'. S hool Dist iy et fees paid .............. 4. Sanitation approval from ��'Q I/ y Health Department 15. City of Chico plumbing permit ..................................... - 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) x.2 Contractor's license information (No., Name Style, Classifications ... 2. Certificate of Workmans Compensation Insurance .ok-/7 9�.rSFi4.... 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... 26. .r 27. _ When you issue the permit, process as follows: Mail to owner. Mail to contractor. V Teiephonelo 12qand hold for pickup at -C..M off ice. �} Deliver w/inspector.' Other n w V %Q J. �, Applicant Date Copy of plans sent Health Dept., Fire The following data must be submitted prior 1. Index permit for above items No. 2. Additional items required: Other Date suance: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by_phone---nail—counter by ..date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked Date/ 77el-1// Plans approved by Sets of plans on hold in . File cabinet AP folder Copy—DPW' f Date TO Building Department °{ FROM: Environmental Health SUBJECT: Sanitation Clearance 73, Owner Location AP#. Plan Approved for: Sewage Disposal Water Supply Hold final for: Final clearance O.R. for: Clearance for bedroom mobile home. Water Supply MR. Supply Other _ Al r NOTE �** * Sanitaria 5Ae