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DAVID
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cont; OWNER
RE UILDSM/CARPORT
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2630 V-6 ROAD, OROVILLE
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RESIDENTIAL
.PERMIT NO. D78 — 510 '0 7�
X52 05-2338
SCRUBY, DAVID
2630 V-6 ROAD, OROVILLE
Cont: OWNER
DECK
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
CHECKED
BY
= OK
-Not OK
Not yahle
- Ready
eadMOBILE HOMES
=Not Ready
Date MOBILE HOME UTILITIES (Plans) OK except Vs
1. Zoning Requirements -Setbacks -Easements
2. Sols; Special MH Support Sketch
3. Sewer, Location -Test -Fall -CIO -Concrete
4. Water, Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L'fL
/ P Nat or/ /" L'ftJ P LPG
.7. Well Clearance & Disconnect
8. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except is
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
S. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert of Occupancy
ISCE6LAN EOUS
Date RS, CARPORTS, GARAGES (Plans) OK except g's
o ' equirements-Setbacks-Easements'
o.t..Sg Soils=Size-Depth-Spacing-Connectors-Steel
3415cks, Girders and/or Joists -Decking -Bracing -Stars -Rails
4. Wood Awn.; Posts-Beams-Rfirs-Connectors
t Shthg-Frg-Bracing
5 Aum Avm •r�t� �„--• - closures
6 r`yq nrtS; 1"rndni m-DnnrS
7`trir�
10. R hthg-Roofing
1 ; Steps-Doors-Larjd
1. B, aced
Date J Card B-1 Date Cana B 1
Date - - Card B71 I J 9 Date Card B
Date POOLS (Plan`s),OK except fi's
1. Setbacks -Easements
2. Soils; Compaction -Structure StabTrty
3. Pool Structure; Steel -Connections -Thickness
l Dead Men -Lining
t 4. Elec.; Receptacles and Lighting, Distance-GFI
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Dec.; Enclosures. Conduit Entries -Terminals -Listed
7. Elm; Bonding; Metal w/5'-Cirxilating Equip. -Heater
� 8. Dec.; Grounding; Equip. w/5' Circulating Equip. -Pool L9ht .
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
12. Enclosure; Fencing -Alarms
.Date Card B-1 Date Car.d B-1
Date Card B-1 Date Card B-1
Date
Cana B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Blocking
4. Gas-, MH Test -Demand -Valve
5. Electricity; MH Test
6. Water, MH Test
7. Water and Sewer Connected
8. Gas and Electricity Tagged
9. Exits
10. License Decals
11. Verify #'s with Office
Date
Card B-1 Date -
Card B-1
Date
Card B-1 Date
Card -B_1
ISCE6LAN EOUS
Date RS, CARPORTS, GARAGES (Plans) OK except g's
o ' equirements-Setbacks-Easements'
o.t..Sg Soils=Size-Depth-Spacing-Connectors-Steel
3415cks, Girders and/or Joists -Decking -Bracing -Stars -Rails
4. Wood Awn.; Posts-Beams-Rfirs-Connectors
t Shthg-Frg-Bracing
5 Aum Avm •r�t� �„--• - closures
6 r`yq nrtS; 1"rndni m-DnnrS
7`trir�
10. R hthg-Roofing
1 ; Steps-Doors-Larjd
1. B, aced
Date J Card B-1 Date Cana B 1
Date - - Card B71 I J 9 Date Card B
Date POOLS (Plan`s),OK except fi's
1. Setbacks -Easements
2. Soils; Compaction -Structure StabTrty
3. Pool Structure; Steel -Connections -Thickness
l Dead Men -Lining
t 4. Elec.; Receptacles and Lighting, Distance-GFI
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Dec.; Enclosures. Conduit Entries -Terminals -Listed
7. Elm; Bonding; Metal w/5'-Cirxilating Equip. -Heater
� 8. Dec.; Grounding; Equip. w/5' Circulating Equip. -Pool L9ht .
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
12. Enclosure; Fencing -Alarms
.Date Card B-1 Date Car.d B-1
Date Card B-1 Date Card B-1
= OK
= Not OK
= Not App6aLk
Not Rtady
RESIDENTIAL (Single & Duplex)
tate UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Gmd.-/ P Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Gmd. / /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ P Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
_ 8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall-Frtting-Test-2 Way C/0 -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except #'s
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
19. D.W.V.; Test Fittings & Anchor -Nail Protection
-20. Shower Pan, Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler, Test
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Date
24. Fixture & Transformer Clearance -Ins. Protection
Date
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. SIZE Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or AI
31. Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or Al
Insulated Neutral O Yes O No
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels -Motors -Meth. Equip..
34. Clothes Closet Light -Shower Light -Spa Light
35. Smoke Detector
74. Elec. Outlets & Receptacles at Kit Counter
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except "s
41. Sills Proper Materials & Anchors
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting: Rtng.
49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm Windows or Exiting Doors -Sill HL & Dimensions
52. Garage Fre Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding-Nairing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Botts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int & Ext.
73. Kit Fixt. & Appriance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit Counter
75. Garage Fre Door, Swing -Landing -Closure
76. A.C. Duct in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor -Meth. Protection
78. Plb.; Bec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.El.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
83. Following InsddAMve O Yes O No/Walks O Yes O No/Planters O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Pibg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
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:
NOTES RESIDENTIAL I
04-314
-
PERMI'' - - - - - 6
.3 SC'RUBY', UA:VfL5
dJ �.l Tip �'� c� �"
Ip 3 V6 I< ()A ORO V I L I..I_
ont: O�lrvL:x _ i
I�.cBVILn s.F w� c AHP _
DETACH FOR SERVING UTILITY.
Address 2_6'o'
GAS
Meter By Date
ELECTRIC -
Meter By Date%�
ti
a SPECIAL.CONDITIONS
(�Q W FLM,C
,F CHECKED
BY
SRA ..,�
• ; ; FLOOD CERTIFICATE REQ. r
i FIRE SPRINKLERS REQ. �-
SPECIAL INSPECTION ITEMS
_ VERIFY '
USE PERMIT CONDITIONS';
SUB -STANDARD HOUISING LETTER'
x
e.
i
A
3 -2j
l - M�-JOB FINALED (D _
Signature
/ilk
J=OK
0 = Not OK
= Not Applicable
. = Not Ready
Date U
FIVLOOR (Plans) OK ex
RESIDENTIAL (Single -& Duplex)
I.
2. Fjg., Main; Soils-Elec. .-/ /" Ftg. Depth
., Garage; Soils-Steel-Elec. Gm / / Ftg. Depth
tg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
temwalls, Main; Steel- Bloc kouts-Wrapped
emwalls, Garage; Steel- Bloc kouts-Wra ed
6a old Downs and Special Anchors
Date Card B-1, • Date Card B-1
Date - ELECT CAL (Permit) OK except #'s
Transformer Cleauiaeellns. Protection 4
let. Receptacles Sp g -Lights & Switches at Doors
lz - oxes & No. of Conductors Stapled
7. omex Installed Close to Edqe of Studs & C.J.
ui . Ground made up w/Mech Fastener okd'Gas & vWr er .
re
Appliance Circuits in Kitchen & Conductor Size GFI
0. Sybfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
3j/Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insul ted Neutral O Yes O No
ervice-Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels-Motors-Mech. Equip.
34. C106s Closet Light -Shower Light -Spa Light
moke Detector
Date d --]"b$ Card B-1 Uf Date Card B-1
Date Card B-1 Date Card B-1
Date MEC NICAL (Permit) OK except #'s
3 H.C. • ucts Insulation & Support
ent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. F ace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet.
Attic Access & Platform if Furnace in Attic
Date q Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Permit) OK except #'s
Sp Proper Materials & Anchors
Walls Studs -Nailing Spacing & Braces -Plates -Sound
tng Walls over Girders & Floor Nailing
Stop in Walls (rat proof)
Fire St ps, Furred Ceilings Cha s -T
4 aders & Beams -Size & Bearing
Date FRAMING (Continued)
i 4 . a rs-Post Caps -Anchors -Connectors
41'rling. Joist- ftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fir plat ies orType AFlue-Firep lace Throat Clearance
tii ize & Romex Protection -Draft Stop -Ins. Baffles
(MBdrm.%WrqcjqF Exiting Doors Sill Ht. &Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54.
'9' D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
55.
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
y ood on Roof Overhang -Attic Vents -Rafter Outriggers
1-1o."
Water Pipe; Test -Anchors -Regulator -Service Test
58.
'U)/Glazing
12.
Electric Underground
Shear Walls; Nailing -Bolts
1.3
--Plenums & Ducts; Clearance -Material -Support -Ins.
62.
1
irders-Sills-Anchor Bolts-Joists-Vents-Crippies
Infiltration-Walls-Windows/Z,+,
Date ///,Olt Card B-1 Date Card -15-1
Access & Ventilation
and Date Card B-1
16.
Insulation
Water VeArDisconnect, Electrical, Plumbing
88.
rior Elec. Trim, G.F.I. Receptacle -Underground
Date0
V alio Throughout House
Card B-1 Date �S� �� Card
Date
Date
Card B-1 tivV Date Card B-1
PLUM ING (Permit) OK except #'s
Corrections from Previous Inspections
92.
to tr.; Vent -Access -Combustion Air Baffle
A'"
1
er Pipe; Test & Anchor -Nail Protection
1
.W.V.; Test Fittings & Anchor -Nail Protection
20.
Shower Pan; Test, First Floor -Tub Access
21.
BwrTub & Shower, Second Floor -Tub Access
2
. Gas Pipe; Sixe & Anchors
23.
Fire Sprinkler; Test
Date
Card B-1 - Date Card B-1
Date Card B-1, • Date Card B-1
Date - ELECT CAL (Permit) OK except #'s
Transformer Cleauiaeellns. Protection 4
let. Receptacles Sp g -Lights & Switches at Doors
lz - oxes & No. of Conductors Stapled
7. omex Installed Close to Edqe of Studs & C.J.
ui . Ground made up w/Mech Fastener okd'Gas & vWr er .
re
Appliance Circuits in Kitchen & Conductor Size GFI
0. Sybfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
3j/Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insul ted Neutral O Yes O No
ervice-Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels-Motors-Mech. Equip.
34. C106s Closet Light -Shower Light -Spa Light
moke Detector
Date d --]"b$ Card B-1 Uf Date Card B-1
Date Card B-1 Date Card B-1
Date MEC NICAL (Permit) OK except #'s
3 H.C. • ucts Insulation & Support
ent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. F ace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet.
Attic Access & Platform if Furnace in Attic
Date q Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Permit) OK except #'s
Sp Proper Materials & Anchors
Walls Studs -Nailing Spacing & Braces -Plates -Sound
tng Walls over Girders & Floor Nailing
Stop in Walls (rat proof)
Fire St ps, Furred Ceilings Cha s -T
4 aders & Beams -Size & Bearing
Date FRAMING (Continued)
i 4 . a rs-Post Caps -Anchors -Connectors
41'rling. Joist- ftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fir plat ies orType AFlue-Firep lace Throat Clearance
tii ize & Romex Protection -Draft Stop -Ins. Baffles
(MBdrm.%WrqcjqF Exiting Doors Sill Ht. &Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits '
55.
-St r5; Width -Headroom -Rise -Run -Landing -Fire Protection
79.
y ood on Roof Overhang -Attic Vents -Rafter Outriggers
5.7 --Sidi
ng- Nailing Veneer .
58.
'U)/Glazing
Stucco Mesh -Drip Screed -Fd: Vents-Underflr. Access
Area -Glass Protection -Skylights -Plastic
0.
Shear Walls; Nailing -Bolts
61.
Brace Interior/Exterior Panels
62.
Insulation -Walls -Ceilings
+ 84
Infiltration-Walls-Windows/Z,+,
Date ///,Olt Card B-1 Date Card -15-1
Date
and Date Card B-1
Date • F
tans) O xc pt #'s
VE . t s -Door & Sidelight Protection -La
SmXe Detector
6 urna Vents -clearance -Comb, Air -Connector -
In rage; Above Floor-Ducts-Mech. Protection
67-Sedroom Exiting i
G.F ath Fixtures & Tub Access - a
eye-slec. Trim & Subpanel, Bre ke tzes & Label
0. Stairs & Rails
71. F place or Stove, Clearance -Hearth
7 EI . Outlets ood Panel, Int. & Ext.
it . & Appliance; Ground -Air -Gap -Cooking Clearance r
lec. Ou is &Receptacles at Kit. Counter
5. Gar Fire Door; Swing -Landing -Closure " +
76. Duct -in Garage -Damper
96. Fire Sprinkl
Date - 4 Card B-1 a Date Card B-1
Date r Card B-1 Date Card B-1
Date Card B 1 Date Card B-1
Comments at Final: -
n ,
n Garage; Above Floor-Mech. Protection s/
8.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
fiftc. Receptacles in Garage (FF.I.)-Romex Protection
8Cr
l9ab lation- Foam- Looked in Attic
81
-Rails & Deck Construction -Post Caps
. Fdn. V s & Crawl Hole Door Drainage & Wood -Earth
rance Looked under Floor- O YesBer'FollgMN
Instld./Drive O Yes 0 No/Walks 0 Yes O No/Planters 0 Yes O No
+ 84
ucco Brown -Finish
5.
11 . Unit Disconnect, Electrical -Plumbing
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87.
Water VeArDisconnect, Electrical, Plumbing
88.
rior Elec. Trim, G.F.I. Receptacle -Underground
of c
V alio Throughout House
.
GI Protection
9 .
Corrections from Previous Inspections
92.
Gas Test- ers Tagged, Gas -Electric
A'"
W ewer Connected -C/O to Grade -HD Approval
rgy Compliance Certificate -Other Certificates
Address Posted
96. Fire Sprinkl
Date - 4 Card B-1 a Date Card B-1
Date r Card B-1 Date Card B-1
Date Card B 1 Date Card B-1
Comments at Final: -
n ,
J=OK
0 = Not OK
. = NotReadyable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6. Gas; Location -Test-Wrap; -/ , /" L 'ft.
/ P Nat. or/ /" L "ft./ P LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector �.
7.
Water and Sewer Connected -C/O to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PERMANENT END SYSTEM (ONLY)
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer Connected
8.
Gas anti Electricity Tagged
' 9.
Exits
10.
License Decals
11.
Verify #'s with Office
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card 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, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enc losures- Panel boards- Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
12
INSULATION CERTIFICATE IC -1
Z X30 V -(o Y10 I e
m er an treet City
�URIe
Description of Installation
1. ROOF
Material
Thickness (inches)
2. CEILING
Batt or Blanket Type
- Thickness (inches) Z'
u
visa
Brand Name
Thermal Resistance (R -Value)
Brand Name K O&U r
Thermal Resistance (R -Value) - 3Y
Loose Fill Type 15 (t) W V\ l Yl Brand Name
Contractor/s min installed weight/ftz Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value)
3. EXTERIOR WALL
Frame Type •2 )LH Wood
A. Cavity Insulation (
Material i I Li S
Thicknes's (inches) 31 `
B . Exterior Foam Sheathing
Material
Thickness (inches)
Brand Name kv r a X +
Thermal Resistance (R -Value)
Brand Name '
Thermal Resistance (R -Value)
4. RAISED FLOOR ff ff-- �Jj
Material t� j
1 Brand Name �r _6kV\ 5 ► kA't i ( L"
Thickness (inches) n Thermal Resistance (R -Value) _R 1
5. SLAB FLOOR/PERIMETER
Material
Thickness (inches)
Perimeter Insulation Depth (inches)
6. FOUNDATION WALL
Material
Thickness (inches)
Declaration
Brand Name I
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
I hereby certify that the above insulation was installed in the building at the above location in conformance
with the current Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of
Regulations) as indicated on the Certificate of Compliance, where applicable.
21 31 A-3--/7-06 V� LiAlle Ca n s�`r d 4� )q
Ft at
em xs ignature, e Installing bubcontractor o.Name)
General- Contractor (Co. Name) OR Owner
Item #s Signature, Date F Tnstalling SuIbcontractor(Co.Name)
General Contractor (Co. Name) OR Owner
Item
Revised July 1995
Signature, Date Installing Subcontractor(Co.Name)
General Contractor (Co. Name) OR Owner
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP052338
B. C. Building Permit 01-16-04 pg 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 09/27/2005 APN: 036-104-052-000
the Business and Professions Code, and my license is in full force and
effect
Site Address: 2630 V-6 RD. ORO
License Class : License Number:
Map Index:
Date: Contractor:
Description: OPEN DECK(168)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: SCRUBY DAVID M ETAL
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
SCRUBY VICKIE L
signed statement that he or she is licensed pursuant to the provisions of
50 WALLY B LN
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
OROVILLE, CA 95966-5632
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applic nt to a civil penalty of not more than five hundred dollars ($500).):
I, as owner of the property, or my employees.with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: SCRUBY DAVID M ETAL
Code: The Contractors' State License Law does not apply to an
SCRUBY VICKIE L
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
50 WALLY B LN
provided that such improvements are not intended or offered for
OROVILLE, CA 95966-5632
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor:
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I amemp under Articlath iness and ssions Code
Zd
Date: Owner:/11---
License #:
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
Architect:
is issued.
Engineer:
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code; for the performance of
n
the work for which this permit is issued. My workers' compensation
-
insurance carrier and policy number are:
Carrier:
Total Square Ft: 16.8 S.F.
Polis #:
Valuation: $1,680.00
Census Code:
I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
kA/
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith compl with those provisions.
/1
11
Date: Z� 0 S
C
�' 1
Applicant:
WARNING: Failure to secure workers' compensation cov age is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit i reby issued un r the a icab,!p provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Resolutio to do work indit ed abov orwpKh fees have been paid.
By: Date:
Name:
PERMIT EXPIRES ON: -
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly autfi • rized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge itis unlawful to alter the subs ante of any officia for or documentgift tte County. I hereby
authorize representatives ofButte County to en er upon the above mentioned property for inspection p po ! .
Signature:
Print Name:
Date: Z�
u✓
ner ❑ Contractor ❑ Agent for Owner ❑ Agent fr Contractor
B. C. Building Permit 01-16-04 pg 1
I'
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2534
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.b6ttecounty.net/dds
.:I t "PLEASE PRINT CLEARLY"
OWNER INFORMATION
Last Na
Name
First Nam
Address
s
Zip
City 0-02-e% / E L L E—
StateCc4—
Zip S
Phone �S f_7
Fax
E-mail
Fax
APPLICANT INFORMATION
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
_
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT
SIGNATURE
X Di
kt&_�Lzl
For office use only:
Zoning
AP#
Flood Zone
Property Address
0
SRA
Ye
No
Occ.
Type Const. ; J
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
(35-23 3
BP.--.
BIN #
��
Description or Scope of Work:
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
I I Received by (
Aunt: . cc)—Bldg I f
Page 1 of 2
SRA
Receipt #: Sheriff
SMIP
.} Other
Dat
• Total
REV 8-12-05
PROJECT LOCATION
AP#
Property Address
0
16
City
Cross Street
Q
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
��
Description or Scope of Work:
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
I I Received by (
Aunt: . cc)—Bldg I f
Page 1 of 2
SRA
Receipt #: Sheriff
SMIP
.} Other
Dat
• Total
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 A/C 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).
❑ 7.
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
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
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: V1 C' s` 1-0 fiqASSESSOR PARCEL NUMBER/) ~
Proposed BuildingUse: Maxi ��' l� Permit Technician: Date:
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. y
�r-�- 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.
❑ 4. Engineered truss details and layouts in duplicate. No faxes!
❑ 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 AIC 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. Letter of intent for non-residential buildings
❑ 12. Hazardous Material Form
:jb" 13. Acknowledgement of building permit application without required clearances.
❑ 14. Other
Re ting items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
.15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico&I-Oroville, as applicable
❑ 16. Fire Sprinklers............................................................................................
.bl 17. - Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 18. Soils Report and/or Engineered Foundation required ...........................................
l2O 1 Erosion Control Plan Required........................................................................
ees as shown on the attached Schedule of Fees Due Sheet ..............................
❑. 21. City of Chico Plumbing permit........................................................................
❑ 22. Site plan and business license approval from the City of Biggs ..............................
❑ 23. California Department of Forestry plan approval ❑ paid. Sent by:
24. Planning approval for (A) Use: �(B)Parking: (C) Parcel Check:.1 ..... o2a o✓�
❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................
26. NPDES Form...............................................................................................
❑ 27. Encroachment Permit for driveway from the Public Works Dept ...........................
❑ 28. Contractor's license information. (Number, Name Style, Classification) ...................
❑ 29. Worker's Compensation Carrier and Policy Number ..........................................
,1- 30. Owner -Builder Verification (L##"Given to owner, _Mailed to owner) .....................
❑ 31. Letter of Signature authorization....................................................................
❑ 32. Recorded copy of Agricultural Acknowledgment Statement .................................
❑ 33. Existing violations and/or expired permits.........................................................
❑ 34. Deed Restriction..........................................................................................
❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO .........................
❑ 36. Other:
❑ 37. Other:
When issued Telephone a� �.� n and hold for pickup.
I have been inf r ed of the -rove items and rel irements for obtaining a building permit.
Applicant: Date:
1. Index permit application for the above items numbered: Plan Check Letter
2. Additional items re wired fZ /S
Contractor, designer owned, as advised of the above data by 9 phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the abo a data by ❑ phone, ❑ mail, ❑• counter, by Date:
Plans reviewed by: .]_Date: 13 Plans approved by: -,:rV Date: q 1 -.-, D
Structural reviewed by: Date: Structural approved by:. Date:
Note transfer by: Date:
Yellow: Building Division
rS- 2 3 3 B'
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PHONE (530)538-7541, FAX (530)538-2140
SCHEDULE OF RECEIPT OF FEES
Website: www.buttecounty.net/dds
OWNER (/
PROPROSED BUILDING USE
j�vl. BUILDING PERMIT FEES GJ
--- Balance Due ..................... $
--- FEMA Flood elevation review ... $
--- Additional plan checking Fee.... $
2. SCHOOL DISTRICT FEES
(paid at School District Office) (form available after Plan Check)
3. SHERIFF FEES (paid at Building Division)
Residential............ X $360.00 =$
Units
Commercial (sq. ftg.)..... X $0.03 = $
Sq.Ftg.
4. RECREATION DISTRICT FEES
(paid at Recreation District Office) (form available after Plan Check)
5. RESIDENTIAL DEVELOPMENT IMPACT FEES
COUNTY WIDE (per dwelling) $
CHICO URBAN AREA (per dwelling) $
EL MEDIO FIRE DISTRICT (per dwelling) $
NORTH CHICO SPECIFIC PLAN (per dwelling) Zoning
6. SRA FIRE INSPECTION AND PLAN CHECK FEE
$204.98 (paid at Building Division)
$
A. P. #
DATE
RECEIPT # DATE REC.
WATER TENDER FEES BATTALION #
$200.00 (paid at Building Division) 0
SMIP ( 17
9. OTHER
10. OTHER
11. OTHER
At time of permit application, I wa dvised the above fees are required to be paid prior to issuance of the permit. These fees
may be changed durin a plan a in(g process.
V***�APPLICANT �l 1�_ DATE �) ��� ('J�
Pursuant to Government Code Section 66020F, you are hereby notified that items, 2, 3, 415, 6, 8, 9, and 10 above may have been imposed on your project. You
have 90 days from the date of approval of the project or from the imposition of the ab ov mentioned items during which you may protest. The requirements for a
protest are specified in Government Code Section 66020(a).
Original -Building Division Yellow -Applicant Pink -Owner (rev. 3/05)
Department o.f Public Works
"� C o u n t y o f B U t t e
LAND DEVELOPMENT DIVISION
Michael Crump, DIf2CrOfStorm Water Management Program
'V V® 7 County Center Dcive
`. ACCO VNay s / oroviiie. CA 95965
(530) 538-7266
AUC VVdF� (FAX) 538-7171
National PollutantDischarge . Elimination System (NPDES) Phase 11
Construction Storm Water Permit and Storm Water Pollution Prevention
Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE
Project Description:
-2 33�
Project Location andlor Parcel Number: -
By signing below, L the project owner/owner's agent, certify that this project WII.,L NOT DISTURB
1 acre or more of land, and that L 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 andlor inaccurate information or failure to apply for a Construction
Storin Water Permit from the State of California Regional Water Quality Control Board for a project
that disturbs one .acre or mole of land may result in revocation of grading and/or other permits or other
sanctions provided by law.
Signed:
Title:
Date:
P
�ir . •.7s:.. ,._ :`.fit �t�: .� , ., :: , , ,. .:
MIA
Attention Property Owner:
,An "owner -builder" building permit has been applied for in your name and bearing your
signature.
Please complete and.return this information at your earliest opportunity to avoid unnecessary
delay in processing and issuing your building permit. No building Permit will be issued until this
verification is,received.'
1. I personally plan to provide the major labor and material for construction of this proposed
property improvement: YESJ>�NO [ ].
2. I HAVEHAVE NOT [ ] signed an application for a building permit for the proposed
work.
3. I have contracted with the following person (firm) to provide the proposed construction:
NAME: _
ADDRESS:
PHONE:
CONTRACTOR'S LICENSE NO:
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise, and provide the major work:
NAME:
ADDRESS
PHONE: �� p — 1 �} (o CONTRACTOR'S LICENSE NO: (.;7-
5.
'i7
5. I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTY OWNER:
DATE:
NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before we are permitted to issue the
permit.
Rev'd 11/42004
Butte County Department of Development Services
ADMINISTRATION' BUILDING' GIS 4 PLANNING
7 County Center Drive
Oroville, CA 95965
(530) 538-7541 Telephone
(530) 538-2140 Facsimile
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the 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 your plan to subcontract, you should be
aware of the following information for your benefit and protection:
o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
o If you are an employer, you must register with the state and federal government 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.
o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to workers' compensation insurance.
o For more specific information about your obligations under federal law, contact 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 contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware
of these matters. The building permit will not be issued until the verification is returned.
UL
Mic el C. Vieir4 C.B.O.
Marlager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
Butte County. Department of Development Selvrces
�Tr
�`F
o'n.;o
7 County Center Drive
o
Oroville, CA 95965,
(530) 538-7601 Telephone
(530) 538-7785 Facsimile
BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES
I request and authorize the Building Division to process this building pen -nit 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:
o I need to submit applications for septic andlor 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.
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 require
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 6btain 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 t6. 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: (> �� C�'� APN-- h — < <%y
Building site address: -ZG-�;y V ( Permit No.: as— 21-:53
I have read, understoo and accept the terms and conditions as expressed herein as indicated by my
submission of the abo e Teferen wilding permit application and my signature below:
a5
SIGNATURE OF APPLICANT DATE
E.H. USE ONLY
Piot Plan Attached
Floes Plan Attached
Sana to B.D. /
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
e a, 1 � � �= /- — a?- (-, 2 3 0 V--- (e — V—eI5-z-,
Owner Location AP#
Plan- Approved for: Sewage Disposal Water Supply: Public Private Well
Clearance for welling. Other /off x 5�
Hold final for:
Final clearaannce O.K. for:
NOTE: " /
Environmental Health
8/96
SITE PLAN REVIEW APPLICATION
Date: I 3a 0q AP# 426
Permit Number (if applicable)
APPLICANT INFORMATION Parcel Size:
Owners Name:
Owners Address:
Telephone No.:,��
Situs Address:
Proposed Use:
Residential
'New Single Family Residential
❑ Single Family Addition ❑ Single Family Remodel
❑ Mobile Home
Residential Accessory 6vt�, 11).e �$��� 3 3
Permanent Second Dwellin ,
❑ Temporary Mobile Home (Aunt Minnie)
❑ Temporary Travel Trailer
❑ Multi -family
Non-residential
❑ New Commercial I*
ca,
❑ Commercial Addition ❑ Commercial Remodel _
❑ New Industrial
❑ Industrial Addition ❑ Industrial Remodel
Other
❑ Septic ❑ Well
❑ Agricultural Exempt Building
❑ Other:
Brief Explanation (if necessary):
DO NOT WRITE BELOW THIS LINE
DEVELOPMENT SERVICES INFORMATION (For Staff Use)
IN Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval
Site Plan Stamped'Approved
11
By Date
Page 1 of 5
ALL ITEMS CHECKED APPLY TO THE PROPERTY
Parcel Is In:
❑ Snow Load Area:
❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract
❑ Nitrate Action Plan (See Environmental Health for standards)
❑ Watershed Protection Overlay Zone (See attached standards and requirements)
N Expansive Soils (Test for expansive soils and if verified proper foundation design required)
SRA - (CDF to determine specific requirements)
.100 -Year Flood Plain: (See attached)
Flood Zone: X
Flood Panel No.: O(r,�p �G d 9�S Index Date: a20 00
❑ Sacramento River Reclamation District (Approval must be obtained from the alif rnia Reclamation Board)
❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board)
❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements)
❑ Chapman/Mulberry (See attached standards and requirements)
❑ Cohasset Area (See attached standards and requirements)
❑ Grading Zone (See attached handout)
Use Requires:
❑ Use Permit ❑ Minor Use Permit ❑ `Administrative Permit
❑ Minor Variance ❑ Variance
---------________--------------_—_--------------------- -----------
❑ Detached Building Use Form ❑ Encroachment -Permit
❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement
Zoning: 14 K
' & D2 -
Applicable Building Setbacks:
❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks.
Page 2of5
Zoning Code
Streets & Highways
Fire Prevention
Subdivision Map
Front
261
SideTj-
0'
Side Street
Rear
S- f
c3 0
Height
Waterway
N/A
N/A
N/A
❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks.
Page 2of5
r
Applicable Development Fees:
Standard Fees Amount
❑ Fire
❑ School*
❑ Parks/Recreation
❑ Roads
❑ Sheriff
Drainage
❑ NCSP/CSA 87
❑ Chico Urban Area —Road
❑ Thermalito Impact
❑ Other
Formula
3
------------------------------------------------------------------------ -------------- ---------------------
Subdivision
------------------------------------- -----=---------------------------------------
Subdivision Map Special Fees
❑ Water ,Tender
❑ Road Improvement ..
❑ North Oroville Area
❑ Other (per map) _
* Check with school district to verify actual fee if pre -application review. A final determination will be made -at the time of
the building permit.
Parcel Created By
Deeds:
Date of Creation: Legal Access Provided: ❑ No &Yes
Deed of Reference:' / 9/q /(Qg700 Legal Access Required* ❑ o K Yes
Parcel Frontage on Publicl Maintained Road: Road'Name:
g y ❑ No ❑'Yes, Road Name:
Complies with County Standards for Deed Creation:❑ No ❑ Yes
Comments:
Parcel Deemed to be legal wA4 '
❑ Verify Legal Parcel 71 Verify Legal Access E] Provide Deed of Creation
❑ Obtain a Certificate of Compliance
❑. Obtain a Merger ❑ Obtain a Lot Line Adjustment
El Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23).
❑ Construct road to: ❑ Meet Parcel size required by zone
❑ Meet current Environmental Health Department requirements
Page 3 of 5
❑ Subdivision Map/Parcel Map:
Map Date of Recording:
Lot: Book: Page:
❑ Use Permit/Minor Use Permit
Permit Number:
Date of Approval:
Parcel Map/Subdivision Map/Use Permit Conditions
❑ Comply with the following Conditions of Approval:
❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290
❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the
National Fire Protection Association Standard for installation of sprinkler systems in one
and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized
community water system, with hydrants that meet the Fire Department specifications, serves
the parcel.
❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission
requirements of the California Clean Air Act of 1988, as amended.
❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan
must be prepared by a registered civil engineer or other qualified professional and be
submitted to and approved by the Department of Public Works.
❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate
Battalion Water Tender Fund may be required.
❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil
construction associated with residential development.. Approved dust control measures are
found in the fugitive dust control plan for the site approved by the Butte County Air Quality
Management District, a copy of which can be obtained from the Butte County Department
of Development Services, Building Division."
❑ Engineered foundations are required.
❑ Class A roofs are required.
❑ Property owners responsible for roa
Page 4 of 5
0
u
Summary of Specific Requirements:
This information provided in this summary is based on the application information and on the best available data at the time
of review.
CALarrys\Building Permit Site Plan Reviewl.doc
Page 5 of 5
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 JANUARY 21, 2.005
PROPERTY
DAVIa SCRUBY
State of California
County of BUTTE
On JANUARY 21', 2005 before me,
MARY A. THOMPSON, NOTARY
personally appeared DAVID SCRURY personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature Seal: MARY A. THOMPSON
Commission #1351470 n
Fn
a- otary Public - California -°
Butte County �
A.P. # 035-104-052 My Comm. Exp. APR. 15, 2006 y
AND WHEN RECORDED MAIL TC «:
5 _ 4 1 4 7
BUTTE COUNTY BUILDING DIVISION
Recorded
Official Records
1 REC FEE 10.00
I COPIES 3.00
7 COUNTY CENTER DRIVE
Count OfBUTk
I
OROVILLE, CA 95965
CANDACE J. GRUBBS
I
Recorder
ROSEMARY DICKSON
1
Assistant
1 Andrew
02:22PM 21 -Jan -2005
I Page i of 2
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 JANUARY 21, 2.005
PROPERTY
DAVIa SCRUBY
State of California
County of BUTTE
On JANUARY 21', 2005 before me,
MARY A. THOMPSON, NOTARY
personally appeared DAVID SCRURY personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature Seal: MARY A. THOMPSON
Commission #1351470 n
Fn
a- otary Public - California -°
Butte County �
A.P. # 035-104-052 My Comm. Exp. APR. 15, 2006 y
RECEIPT FOR PROPERTY PURCHASED AT TAX.SALE
BUTTE COUNTY TAX COLLECTOR'S OFFICE
2002-249 Sale Date. -_;9u&.' 24, 2002 Assessor's Parcel Number: 036-104-052-000
RECEIPT IS HEREBY ACKNOWLEDGED FOR PAYMENT ON ITEM # 2002-249
for the sum of:
in (cash) (negotiable paper) subject to collection from:
W(Dollars)
This is the purchase price for the following described parcel of real property which was sold
at public auction. for delinquent property taxes this date in accordance with Chapter 7, Part 6,
Division 1 of the Revenue and Taxation Code.
Description:
A portion of Lot 1, in Block 25 of Villa Verona, according to the official Map thereof, filed
in the office of the Recorder of the County of Butte, State of California, January 17, 1889 and
being more particularly described as follows; Commencing at the Northwest corner of said Lot 1;
thence East along the centerline of the V-6 road, a distance of 30.0 feet; thence South a
distance of 30.0 feet to the intersection of the East line of the V -E road with the South line
of the V-6 road; thence East along the South line of the V-6 road, a distance of 150.5 feet;
thence South a distance of 182.4 feet to.the true point of beginning for the parcel of land
herein described; thence from said true point of beginning, continuing South a'distance of
182.4 feet; thence East a distance of 150.3 feet; thence North a distance 182.4 feet; thence
West a distance of 150.5 feet to the point of beginning. RESERVING THEREFROM for road purposes,
the East 30 feet thereof. TOGETHER WITH all right of ways and easements pertinent thereto.
After recordation, the deed will be mailed to you by the But-te County Recorder's office.
Dick Puelicher
BUTTE COUNTY TAX COLLECTOR
VOT
oTIro
o, o
Chu 14
By:". an
Deputy Tax Collector
Dated this 24th daay, of June, 2002
Amount Bid: $-�V�� Recorder's Transfer Tax collected (Not
included �in purchase price) :
$ T /
How will title be vested? Phv1 r) /Lf se,"61 .� vi i e �� SW6 1` �J0, 7e_Jfi
And mail to at �J^� l.N�}�-�
BUTTE COUNTY,
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.ndlildds
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is In full force and
effect.
License Class: License Number:
Date: , Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any ci(y.or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9. commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the. alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
4' I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is -not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such Improvements are not intended or offered for
sale. If however, the building or Improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Profdssions Code. The Contractors' Slate License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
❑ lam xe pt under Article 3 of the I siness an rofesslons Code
Date: 121 Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of pedury 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.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit Is Issued. My workers' compensation
insurance carrier and policy number are:
Carrier.
Policy M
�( I certify that in the performance of the work for which this permit Is
issued, 1 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 subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply wit those provisions.
Date: ( 2 k 04
Applicant:
WARNING: rallure to secure workers' compens tion coverage Is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
PERMIT NO.
BP043146
Issued Date: 01/21/2005 APN: 036-104-052-000
Site Address: 2630 V-6 RD ORO
Map Index:
Description: NSF (1152)CARPORT(384)COV(84)
Owner: SCRUBY DAVID M ETAL
SCRUBY VICKIE L
50 WALLY B LN
OROVILLE, CA 95966-5632
Applicant: SCRUBY DAVID. M ETAL
SCRUBY VICKIE L
50 WALLY B LN
OROVILLE, CA 95966-5632
Contractor:
License #:
Architect:
Engineer:
Total Square Ft: 1608 S.F.
Valuation: $82,176.00
Census Code:
4-13 08 a 44, ;k% I o > � 7. 0 4-
4(9234- 1 14-4. 2 Jl I a+ os
CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte Cnunly Codn anrvor u
I hereby affirm that there Is a construction lending agency for the Resolutions" do work Indicated above for which fees have been paid.
performance of the work for which this permit Is issued (Sec 3097 Civ.) By. j� = LCr� Dale:
Name:
PER IT E PIRES ON: ( a 16o
Address: I (Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification In accordance with Section 19827.5 of California Health & Safely Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information is correct, and thatl am the owner or the duty authorized agent of the owner.. I agree to comply with
all county and state laws relating to building construction. I acknowledge it Is unlawful to alter the substance of any offi a form or docume t of Butte County. thereby
authorize representatives of Butte County to enter upon the above mentioned property for Inspection pu oses.
Print Name: PN1 ` J A � 5 CYC (-!,I signature:
Date: . `1-2 1 �V,
0 Contractor
❑ Agent for Owner
❑ Agent for Contractor
BP043146
issued Date: 01/21/2005 APN: 036-104-052-000
Site Address: 2630 V-6 RD ORO
Map Index:
Description: NSF (1152)CARPORT(384)COV(84)
Owner. SCRUBY DAVID M ETAL
SCRUBY VICKIE L
50 WALLY B LN
OROVILLE, CA 95966-5632
Applicant: SCRUBY DAVID M ETAL
SCRUBY VICKIE L
50 WALLY B LN
OROVILLE, CA 95966-5632
Contactor.
License #.-
Architect:
:
Architect:
Engineer:
Total Square Ft: 1608 S.F.
Valuation: $82,176.00
Census Code:
Za�g.s7/ wirlida,
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES 9i5 ��
BUILDING PERMIT APPLICATION 6y0 �9
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
OWNER
Last Name�C �Z U B
irs e
Address50 WA g LA -A)42 -E
City 012m] ��-
Zip 6/
3�
Zi'q-5%
`�v
PhoneLgCt �2
JJ T
EFa
E-mail
4 �
CONTRACT R
Name -' , ;
ll
Address - J .
City Stat Zipt
-Phone
E-mail ry Lic." Class
APPLICANT NAME
ARCHITECT/ GINEER
Name
City tip0�1Zi.Lt�.
Address
Zip 6/
3�
City
Fax 5S9 — 46 e
State \
Zip
Phone
Address
Fax \
E-mail
State License Number
APPLICANT NAME
Name t 0 L�
Address GU �l 9 t✓/P6�'
City tip0�1Zi.Lt�.
State
Zip 6/
3�
Phone 5091-ct ( 8�
Fax 5S9 — 46 e
E-mail
A P CANT SIGNATURE
X
For office use only:
Zoning Flood Zone SRA I Yes I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
BP043 1-14
BIN
e3i
LOCATION
AP# b4- — d 5�Z &nrO
Property Address �
P-0 Arm
City
Atli C.L E
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
-Name -
Address
Des ription or Scope of Work:
Sq. Foota Ca
(19j-
0, Structure Built without Permits Q
❑ Proposed Change of Occupancy (�
(Note previous use):
Page 1 of 2
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
required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by:� Amount: I (44-?7—Bldg
204 • 'zy S SRA
Receipt #: 41306;). Sheriff
SMIP
Other
Date: i p • y�. Off- •
1349 2-5 Total
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
p rmit. INCOMPLETrrSUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK
kite plans, or 4Aets, signed by the preparer of the plans. No graph paperl
omplete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paperl) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl
d 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings..
❑ 11. Detached Accessory Building Form filled out by the owner (if required).
,/2 ❑ 12. Hazardous Material Form (for Commercial Buildings only).
Cd�3 S_anitation-and_site Dlan-aDDmyal ftom-the_EuirDnmentaLHealth�enadroenf_ �� o • i �'� �- ��n L�
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required). ,
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be' made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
Butte County Department of Development Services Tr
YVONNE CHRISTOPHER, DIRECTOR oo��\ I oo n
0 0
7 County Center Drive u =4- _Q .' o
Oroville, CA 95965
(530) 538.7601 Telephone CDU N �y
(530) 538.7785 Facsimile
M TO: WILLDAN
FROM: Scott Rutherford -(530) 538-7160
srutherford d)buttecounty.net
♦_�♦ SUBJECT: Plans Transmittal For Review Per Contract .
O DATE: 1111/2004
Applicant: Scrub , David Permit 104=3146 _ -
Project Type: NSF/Gar/Cov APN: 036-104-052
'100% 70%
Plan Check Fees $ •915.42 $ 640.79
` $ 915.42. $ 640.79
WILLDAN Fee $ 640.79 -
Copies Attached: Qty
Chk
Application
- Site Plan Review
FEMA Elevation Certificate
Building Plans
Truss Calculations
Energy Calculations
Structural-,Calculations
Residential Plan Review Guide
Residential'Construction Requirements
Other
Other
-
r
.._ r•��,-•�:.. �--..-:•,j-.�,�...._...w__._.r.,. F�'."`�„�•;-y:..'..:tYi'r�'-�-^'-.P'•5�:.:::-,..a!�.-.^^r.p^•�+�-�.��.;,:���;..v ,.ate_ --•.. .;.� �;Z� _,..-_ �_�... .`;�--_
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: STc 12 t. L >R) ASSESSOR PARCEL NUMBER
�.l pow �7;
Proposed Building Use: �� S F / It 5.2) A 7 --AR. P.0 #V -r- Coui'iter Technician: Date:
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to hpply.
,0 1. Site plan, or 4 sets, signed by the preparer of the plans. .
16 2. Complete ansa or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered pla , 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxes!
❑ 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) Data sheets and installation inst, (B) 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. Site plan and business license approval from the City of Biggs
❑ 12. Letter of intent for non-residential buildings
❑ 13. Detached Accessory Building Form filled out by the owner
❑ 14. Hazardous Material Form
r l�P 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. Lo�v�r p
'491' 16 Other N -mw- LLP Lr-nMa r- rzat- 7 c_.!sem-a"
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 17. Fire Sprinklers............................................................................................
❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........
20. Erosion Control Plan Required........................................................................ ........
(DFees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 22. City of Chico Plumbing permit........................................................................
23. California Department of Forestry plan approval maid. Sent by: � e....! 4 z7 o SF rr oq-
24. Planning approval (A) Use: 4�(B)Parking: (C) Parcel Check: t 3� 6
0 25. Contact Land Development about _ Improvements, _ Drainage ::..............:........
26. NPDES Form ..........................
27. Encroachment Permit for driveway from the Public Works Dept ...........................
❑ 28. Pre -Inspection for required.......
❑ 29. Contractor's license information. (Number, Name Style, Classification) ...................
❑� 30. Worker's Compensation Carrier and Policy Number ..........................................
31. Owner -Builder Verification liven to owner, _Mailed to owner) .....................
Letter of Signature authorization .................................... .'......................
......
33 Recorded copy. of Agricultural Acknowledgment Statement .................................
(6� 4. Manufactured home utility clearance...............................................................
❑ -35. Existing violations and/or expired permits.........................................................
El 36. Deed Restriction.........................................................................................
❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
❑ 38. Other:
❑ 39. Other:
When issued Telephone 5 4Be_7 . -7 r iS"1 and hold for pickup.
I
I have been infor ed ofthe above items and requirements for obtaining a building permit.
Applicant: Date:
1. Index permit ap ion or ove items mbered: J I Plan Check Letter f
2. Additional items required %
Contractor, designer, owner,' as advised of the above data by�pl oh6-nmaill, obnter, by C G�Date:
1_1Contractor, designer, -owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: I i I Date:
Structural reviewed by: i Date: Structural approved by: ' Date:
Note transfer by: Date:
Yellow: Building Division
sf
R
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
.7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541
SCHEDULE OF RECEIPT OF FEES
OWNER . C 4Lt-L-09 y A.P. # eD3,(0 • 14c> 4 b.5=.
PROPROSED BUILDING USE #JS F(1 15 D A-rr cAQAoa-r /30t) DATE ► o . s7 . o �—
RECEIPT # DATE REC.
1. BUILDING PERMIT FEES
--- Balance Due ..................... $
--- Additional Fees Due........... $
--- Revised Plan Checking Fee.... $
2. SCHOOL DISTRICT FEES C)O-ov t l—L—E -Z .S 4- /
(paid at School District Office) (form available after Plan Check)' r� " y 1 ,I �J
` r
3. SHERIFF FEES (paid at Building Division)
Residential............ I X $360.00 _ $ 1 Q-1011 LO- 1 b S
Units
Commercial (sq. fig.).
4. URBAN AREA FEES
Residential (per unit)..
X $0.03 = $
X
# Units Amt.
(paid at Building Division)
Commercial (Sq. Ftg.).... X = $
\ Sq. Fig. Amt.
5. RECREATION DISTRICT FEES
(paid at Recreation District Office) (form available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK FEE
49%W(paid at Building Division)
+.9 J6
8. WATER TENDER FEES BATTALION #
$200.00 (paid. at Building Division)
9. NORTH CHICO SPECIFIC PLAN (paid at Building Division)
Residential Zone X = $
Zone # Units Amt.
Commercial (sq. ftg.) ......... X =1$
+-13081 1 • a . 0.4••
- d Sq. Ftg. Amt.
(4 10. OTHER SH 1 F- Sp a� 4-1 � z3 4-- 1 0 5
At 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 pla he_ckkinAg process.
APPLICANT 11 � T I Is vl DATE Ih (17-1) tAd,
Pursuant to Government Code Section 66020, you are hereby notified that itetiis, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You
have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a
protest are specified in Government Code Section 66020(a).
Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003)
ENCROACHMENT PERMIT
County of Butte Department of Public Works
7 Count Center Drive Oroville, CA 95965 Phone (530) 538-7157 Ext. 2016 Fax: (530) 538-4356
Download Forms: www.buttecounty.net/publicworks/forms.htmi
NOTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE
Phone (530) 538-7157 Ext. 2016
Permit Number
District
APP--LIC—A-T-IO i -
I WE, the undersigned, hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads
id highways, all in accordance with County ordinances and general laws. (All information except signature must be typed or legibly rinted.
Applicant's Name: C
la. Company Name:
Address:
Phone:
4. Assessor's Parcel Number. to
Location of Work to be Done
Applicant's Signature
7. Date: /Q, 127 _ 0
CONTRACTOR'S INFORMATION
Contractor's Name
Address
0. Phone: /
i l ax:
2. Contractor's License Number:
3 rficate of Insurance: Yes ❑ No: ❑
4. Contractor's Signature:
14a. Date Signed:
5. Authorized Agent:
TYP OF WORK TO BE DONE
6. Please Check: Curb: ❑ Gutter: ❑ Sidewalk: ❑
17. If Driveway List Type:
8. Other Work - Describe:
19. Plans Attached:
❑ Yes ❑ No
PERMIT GRANTED
n compliance with the above request; and subjectto all terms, conditions (incl uding.those on.page 2 of this permit form) and special conditions written below,
-ermission is hereby ranted.
.0. Conditions
df /`
Jnder round Service Alert .S.A must be notified two working days prior to any excavation. 800-227-2600
I. ❑ All work shall conform to accompanying: Detail ❑ Plans ❑ Special Conditions ❑
:2. Date Issued
23. Expiration Date:
24. Surety:
15. Date Paid:
26. Amount Paid: 27.
Paid By:
28. Receipt No.:
\lake Crump, Director of Public Works
By:
-or County
29. Final Inspection Date:
30. Inspected By:
❑ Complet - OK 17 Complete -- Not OK
❑ Additipfdal Comments Attached
u:eoniy '
31. Comments:
gote: if permits are faxed to any number besides (530) 5384356, they can be delayed up to one week.
Page 1 of 2
GENERAL, CONDMONS
It is understood and agreed that the County has prior right to the use of its rights of way. It is further understood and agreed by the Permittee that the
1 of any work under this permit shall constitute an acceptance of all the provisions contained herein and failure on the Permittee's part to comply with any
sion will be cause for revocation of this permit Except as otherwise provided for public agencies and franchise holders, this permit is revocable at any time.
permit is to be on job at all times while the work is being done.
All work shag be done subject to the supervision of and to the satisfaction of the Pubric Works Department of the County of Butte. The Permittee shall,
times, during the progress of the work, keep the County Highway in as neat and dean a condition as is possible and upon complefion of the work granted
i, shag leave the County Highway in a thoroughly neat•, dean, and usable condition.
The Permittee agrees by the acceptance of this permit to properly maintain any encroachment placed by the Permittee on any pad of the County
vay and to immediately repair any injury to any portion of the highway, which occurs as a result of the encroachment, until such time as the Permittee may
ieved of the responsbirity of such encroachment by the County Department of Public Works.
It is further agreed by the Permittee that whenever construction, reconstruction, or maintenance work upon the highway may require the instigation
led herein shall, upon request of time County Department of Public Works, be immediately moved by and at the sole expense of the Permittee.
No material used for fill or backfill in the construction of the encroachment shall be borrowed or taken from within the County right of way.
At least one lane of any public road, und& the jurisdiction of the Board of Supervisors of Butte County, and other public roads junclioning or
:cling therewith, shag be kept open for travel by the general public at all times. No public road under the jurisdiction of the Board shag be dosed to travel by
:neral public without special permission, in wrifing, from the Board of Supervisors.
The Permittee, by the acceptance of this permit, shag assume fug responsibility for all fiabitity for personal injury or damage to property which may arise
the work herein permitted or which may arise out of the failure on the part of the Permittee to do the work provided for under this permit In the event any
of such liability is made against the County of Butte or any department, official, or employee thereof, the Permittee shag defend, indemnify, and hold them
act of them harmless for such claim.
All excavations shall be backfilled and compacted immediately after work therein has been completed. Trenches shag not be left open farther than 300
advance of pipe laying operafions or 200 feet to the rear thereof, unless otherwise permitted by the Engineer. Unless othe.,rwise permitted under the
d Conditions, baddill shag be place and mechanically compacted in such a manner that the relative compaction throughout the entire fig within the County
ght of way shag conform to the percentage of compaction as stated below. Permittee shag notify foreman 24 hours before backfilling and/or paving.
a The relative compaction from the bottom of excavation to a plane five feet (6) below finish surface grades shag be no less than ninety
percent (90%) as determined by Test Method No. Calif. 216.0 of the Materials and Research department State of California, Transportation
Department, Division of Highways, or other approved test method.
h The relative compaction from a plane five feet (5) below the finish surface grade to said finish surface grad shag be no less than ninety-five
percent (95%) as determined by the above testing method. Permittee shall bear all costs and responsibility for compaction tests.
c The relative compaction from a plane five feet (5) below the finish surface grade to said finish surface grad shag be no less than ninety five
percent (95%) as determined by the above testing method. Permittee shag bear all costs and responsibility for compaction tests.
Material for use as trench backfill in any existing or proposed roadway section shag be sand, shag be place in 8 lifts, and be compacted to a
relative compaction of not less than 95516.
Material for use as backfill in roadside gutter excavations shag be the native material and be comparted to a relative compaction of not less than
Any pavement aAfing shag be scored, or saw cut before trenching
Minimum depth of cover over all underground facilities shag be 30 inches, except drainage cutverfs.
All installations, parallel with roadway, shag be placed as dose to the right-of-way fine as possible. No portion of the backfig(s) shag be compacted
by ponding or jeTmg. ,
All pavements, curbs, gutters, sidewalks, borrow ditches, pipes, headwaAs, road signs, trees, shrubbery. and/or other permanent road faa'fities
impaired by or as a result of construction operations at the construction site(s), or at other ground(s) occupied by materials and/or equipment,
shag be restored Immediately upon bacldlr ung or the excavation to time original grades and cross secftions, and to a condition as good as, or better
than, existed prior to the consbuction.
Ag surfacing materials of roadways and driveway approaches ani or damaged by or as a result of construction operations, shall be replaced
within ONE WEEK following the baddiil ling of excavation. weather permitting, with compacted layers of surf -acing materials at least as thick as the
existing; and no less than two inches (2) of asphalt concrete over eight inches (8') of aggregate base, according to current California State
Specitoptions.
Whenever necessary to secure p,.mhission from abutting property owners. such authority mist be seared by the Permrttee prior to starling work.
The future safety and convenience of time traveling public shag be given every ocinsidemlion in the {oration and type of construction. Permittee shat{
D be placed, erected, and maintained all waning signals, fights, barricades, signs, and other devices or measures essential to safeguard travel by the
pubric over and at the site of work authorized herein.
if the construction work covered by this permit is to be done by a private contractor hired by the appfipnt, applicant shag notify contractor as to the
conditions and requirements contained herein.
Page 2 of 2-
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your
signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will
be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the
proposed property. improvement: YESj4— NO[ ]. ;
* 2. I • HAVL�, HAVE NOT[ ] sig ied an application for a building permit for the
proposed work.
il. I have contracted with the following person (firm) to provide the proposed
construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
I plan to provide portions of this work, but I have hired the following person to
coordinate, supervise, and provide the major work:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
x PROPERTY OWNER:
NOTE: This owner -Builder Verification is required by Section_ 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before
we are permitted to issue the permit.
May 1995 2.26
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:
0 If you employ or otherwise engage any persons other than your immediate family, and -the work (including
materials and other costs) is $300 or more for -the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
0 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.
0 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.
0 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 "ownerbuilder"
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 contractors 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
Michel C. Veir, C.B.O.
ger, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
May 1995 2.27
VpRSO�T tom?
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Department
J. Michael Crump, Director
Public Works
LAND DEVELOPMENT DIVISION
Storm Water Management Program
7 County Center Drive
Oroville, CA 95965
(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 9 ACRE1
Project Description:
Project Location and/or Parcel Number: D JG — ( [ ll —04;
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 l Acre NPDES & SWPPP Compliance Certification
Butte County Storm Water Management Program
Revised 5/24/04
School District
A.P. Number I
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
)ypLleyn Building Department No.
-/()41 01!5 . Jurisdiction: City =county
Property Owner
4.
Property Locatlon/Addrbss
Subdivision
Commercial/Industrial
NOW A AddYdon
Department
Lot No.
...................................
........................ ................. 7 ................ .
Sq. Footage
Ma
Addition/ *Supplemental to
(Group R)
Permit #
Conversion
*(No foundation Inspection)
L......................... ............................................. ! .............................
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
(including Exterior
Roofed Areas)
:1
13 leis-,
)
Dell
District identification No. to x
Lie- -0 V" School �district certifies that (Applicantf
X6 -3
(Street Address) (Phone Number)
to (40
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. by payment of $
representing T' ;I— square feet. IAB 2926 $
PFULL MMGATION $
School 15ii—strict Representative Date
Paid by Check # *
Remarks:
Nofte: You may protest the Imposition of the fess kiendfled above by submitting a wften protest to the DIstrK In compliance with
Government Code Section 66020(a), within 90 days from the date feet are paid. Failure to submit a timely written protest vAll'pr*Mbtt
you from challoqlng the ImposKlon at the fen in any court action.
N, subsequent to the School District Representative stoning this Butte county Schools Impact Fee CertlfICAWLForm6 the School District Is
rhotlllsd by the applicable Local Planning Agency that this project: Is being revWmed under the California Environmental Quality Act (CEQAh
thle project may be sub)ad to additional school fees to fully niftaiiiii.ft Impact on the school db&kft schools.
White (applicant), Yellow (building department), Pink (school district) feeform.)b 0 0/031dinin
-rp
f AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
Recorded
.Official Records
County Of
8U I I_E
CAINDACE .i. GRUBBS
Recorder
ROSEMARY DICRS014
Assistant
02 : 2LPii l 21 -Jan -2005
I REC FEE 100. L7,,o
I COPIES 3, 00
1
I
I
1
i
1 Andrew
I Page i of e
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 JANUARY 21. 2005,
State of California
County of BUTTE
D cSCV-V�--k 01\�
PROPERTY
DAVIJS SCRUBY
On JANUARY 21, 2005 before me,
MARY A. THOMPSON, NOTARY
personally appeared DAVID SCRUBY personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature -)D� �- Seal: MARY A. THOMPSON
Fn Commission #1351470 n
a Notary Public -California
M C Butte County ' `�'
y' omm. Exp. APR. 15,..200 A _ ty
A.P. # 036-104-052
iiiri rvic rlCVrL'iCl ruA%-n.i�r,l! Lil lA1i
BUTTE COUNTY TAX COLLECTOR'S OFFICE
2002-249 Sale Date: June 24, 2002 Assessor's Parcel Number: 036-104-052-000
4
RECEIPT IS HEREBY ACKNOWLEDGED FOR PAYMENT ON ITEM # 2002-249
�g
for the sum ofXUAAt4pG (Dollars)
in (cash) L/ (negotiable paper) subject to collection from:
01 C 4!&'L OR -01 e a --F,
This is the purchase price for the following described parcel of real property which was sold
at public auction for delinquent property taxes this date in accordance with Chapter 7, Part 6,
Division 1 of the Revenue and Taxation Code.
Description:
A portion of Lot 1, in Block 25 of Villa Verona, according to the official Map thereof, filed
in the office of the Recorder of the County of Butte, State of California, January 17, 1889 ane
being more particularly described as follows; Commencing at the Northwest corner of said Lot 1;
thence East along the centerline of the V-6 road, a distance of 30.0 feet; thence South a
distance of 30.0 feet to the intersection of the East line of the V -E road with the South line
of the V-6 road; thence East along the South line of the V-6 road, a distance of 150.5 feet;
thence South a distance of 182.4 feet to the true point of beginning for the parcel of land
herein described; thence from said true point of beginning, continuing South a distance of
182.4 feet; thence East a distance of 150.3 feet; thence North a distance 182.4 feet; thence
West a distance of 150.5 feet to the point of beginning. RESERVING THEREFROM for road purposes,
the East 30 feet thereof. TOGETHER WITH all right of ways and easements pertinent thereto.
After recordation, the deed will be mailed to you by the Butte County Recorder's office.
0VT`TE
o � o
c�U:N.
Dated this 24th day. of June, 2002
Amount Bid: $ I ucj
Dick Puelicher
BUTTE COUNTY TAX COLLECTOR
By:
Deputy Tax Collector
Recorder's Transfer -Ta x collected (Not
included in purchase price):
$ `r 9.
How will title be vested? /TV/ ID /1-1r�l'r & V1lop'l�fCl� `..-i 6�.enl,%J1/% / Jq
And mail to at
Signa
Signatu
Lake Oroville
PERMIT NO.:
95-04
Area Public Utility District
1960 Elgin Street
OROVILLE, CALIFORNIA 95966
533-2000
DISTRICT APPROVAL AND
VERIFICATION, OF INSPECTION
BUILDING SEWERS
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 by Butte County of a Building or an Occupancy Permit, a copy of this verification
form, signed off by'Lake Oroville Area Public Utility District, must be submitted to Butte County.
'Date: December 30, 2004.
Applicant: Dave Scruby
Applicant Address: 50 Wally B Lane Oroville CA 959.66
Applicant Phone No.: 871-8642 pager
Property Locationys(s): v-6 R3. Oroville CA 95966.
A.P. No.(s): 036-104-052
Fees due:
Application for service
Estimated tank installation of $5122.31 paid .
LOAPUD Capcity Chg $1,690, LOAPUD Connection fee $650 paid
Pd. 10/25/04 Receipt #5913
ipprovedk� W4.
OROVILLE. AREA-
P'BdC UTILITY. DISTRICT
Inspection(s) made and successful test(s) observed:
(7
L(— 0ciZ `kc7
Lake Oroville Area Public Utility District release to close. permit:
Date: O5 By: LJ�
Date: - OS
A W I LLDAN
Serving Public Agencies
January 12, 2005
Scott Rutherford
Butte County Building Department
7 County Center Drive
Oroville, CA 95965
(530) 538-7169
(530) 538-2140 FAX
SUBJECT: COUNTY OF BUTTE PLAN REVIEW APPROVAL
117 C Street
Marysville, California 95901
530/749.2373 fax 530/749.2199
www.willdan.com
Willdan Project No:
14353-1239
Jurisdiction Job No:
04-3146
Assessor's Parcel No:
036-104-052
Description:
Scruby New Single Family Dwelling .
Dear Mr. Rutherford:
Willdan has completed a plan review of submitted plans and documents for the above referenced project
and recommends your approval with the conditions noted on the 2"d page of this letter. The plans and
documents provided for this review that have been found in compliance with the applicable codes are:
• :Plans: Two (2) copies sheets through 9, dated 07-14-04, Revision dated 12/18/04 by David
Scruby.
• Energy Calculations: Two (2) copies dated 09-20-04 by Mary Runnells
The plans have been stamped with the Willdan approval stamp and dated the date of this letter. According to
our previous letters relating to this project, the superseded plans and documents will be discarded within 10 .
days unless we receive other instructions.
On the pages to follow is the identification of the codes and standards applicable to the project, a code
analysis, conditions -of -approval and identification of any deferred submittals.
APPLICABLE CODES r
Unless noted otherwise, all comments are based on requirements of 'the 2001 California Building,
Standards Code found in the California Code of Regulations, Title 24:
• 'Part 2; known as the California Building Code and abbreviated herein as "CBC':
c
• Part 3, known as the California Electrical Code and abbreviated herein as "CEC"
- • • Part 4, known as the California Mechanical Code and abbreviated herein as "CMC"
• Part 5,•known as the California Plumbing Code'and abbreviated herein as "CPC"
• • Part 6, known as the California Energy Code; and Energy Commission Standards, and .
f abbreviated herein as "CECS" «
CODE ANALYSIS
r
Type of
• Type of
Sprinklers
Stories'
J." Floor
2" Floor
Total Sq Ft -
Occupant
.Construction .
Sq Ft
Sq Ft • .
•R-3
V -N
No
1
1152
NA
1152
U-1
V -N
No
1.'
384
NA J
384
Covered_
V -N
No
1
*84, ' '
NA -
*84.
Porch
_
.x
i
CONDITIONS OF APPROVAL . .
1. "Approval is contingent uponthe review, requirements and •appr'oval of other departments -- -
and/or agencies that have jurisdiction over this project. ` «
- 2. Revisions and/or notes as red -lined on the plans. �• '
r • 3. - All • an sheets shall be signed b desi ner or person responsible for the'plans as required b
P g Y g P P P eq Y••" ,
-- California Health & Safety Code Section 5536.1.
4. *Permit application building areas ipecified'in the scope -of -work shall be reconciled with plans
to Butte County's satisfaction. ,
. `
DEFERRED SUBMITTALS
Our plan review reveals no deferred submittals noted at this time. ,
SPECIAL INSPECTION NEEDS ►
Our plan review reveals no special inspection needs pursuant to CBC 1701. ;
Sincerely,
x{
s
Michael LeBeau'
ti Plans Examiner t '
Cc: Alice Mefford, E-mail: amefford@buttecounty.net
David Scruby 50 Wally B Lane, Oroville, CA 95966 (fax) 589-4686 '
Page 2 of 2. County cif l.3utte Pe..nni.t .Number 04-31.16
- ' 4'4`il.ldau f?rciiectNumber I.d35,-12_x9
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APPROVED
tte County
Envi o m®ntal ealth
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Department of Development Services
Building Division
7 County Center Drive
oroville, CA 95965
(530) 538-7541 (530) 538-2140 FAX .
GUARDRAIL DETAIL HANDOUT
Nailing shall comply with Table UBC 23-11-B-1.
Lumber shall be at least Douglas Fir #2 or better (D.F. #2).,
Minimum concrete compressive strength shall be 2,500 psi at 28 days. (UBC 1922.2.4)
Minimum underfloor clearances from finish grade to wood joists is 18"; (UBC 2306.3)
and minimum 12" from the finish grade to wood girders or treated wood is required.
No wood shall be placed closer than 6" to earth unless it is foundation grade or
pressure treated. (USC 2320.13)
4'
! Max.
4' Max.
36" Min.
iR
U)
Top of SIDE VIEW
Deck
Min. 2x pressure treated ledger
Min. 2 — 3/8" x`T-w lag
bolts or screws.
TYPICAL LEDGER
If the deck/porch is 30" Pier posts greater
or greater above the than 3 feet in height
finish grade a guardrail is need to be diagonally
required. braced between posts
4 - 16d nails or
an approved
post base connection
If using precast piers,
wet set precast pier
into concrete footing
Guardrail 1997 U8C.xls
4" Max.
Min. 4 x 4 post
@ 5'- 0" 0. c.
Intermediate rails
spacing shall
prevent the
passage of a 4"
diameter sphere.
Top of 3/4" clearance
Joist to the edge of
-- 4 --the wood
member joist
Min. 2 - 1/2"
dia. thru
bolts reg6ired.
GUARDRAIL
An approved post
i
------------
12" x 12" Footing
TYPICAL PIER FOOTING
8" Min. embedment
cap connection
Girder
or connect girder
and post with
1/2" plywd gussett
Post
and 3 - 16d nails
top & bottom
Bi
JMin.
i
------------
12" x 12" Footing
TYPICAL PIER FOOTING
8" Min. embedment
Y
Department of Development Services
Building Division
7 County Center Drive
oroville, CA 95965
(530) 538-7541 (530) 538-2140 FAX -
HANDRAIL DETAIL HANDOUT
Nailing shall comply with Table 23 -II -B-1.
Minimum underfloor clearances from finish grade to wood joists is 18"; (UBC 2306.3)
and minimum 12" from the finish grade to wood girders or treated wood is required.
Minimum concrete compressive strength shall be 2,500 psi at 28 days. (UBC 1922.2.4)
Stairs serving 3000 sq.ft.and greater, risers shall be 7" max and treads 11 min.
The dimension difference between the smallest and largest tread run or riser height
within any flight of stairs can not exceed 3/8" (UBC 1003.3.3.3.3)
Stair stringers shall be anchored to primary structure. Toenails subject to
withdraw are not acceptable anchors (2320.13).
4" Max.
36" Min.
Top of 4" Max
Top of peck W
Joist �rrrn v
Anchor stair
stringers to the
primary structure
with an approved
ioist hanger and
screws, lags, M.B.
Pier posts greater
than 3 feet in height
need to be diagonally
braced between
posts.
4 - 1 fid nails
or an approved
post base
connection
If using
precast piers,
wet set
precast pier
!nin concrete
IarIIIR r
M
3-12 1-114- 3-12
' Marc to 4,6ar,
1 -12' Min. 2-12'
Intermediate rails
4' Max. spacing shall prevent 1-12•
the passage of a 4" 3-11Z
• may-
diameter sphere. 1-114"
to
2-112-
4-
.124- Max. HANDRAILS
1 -1rz •Mia
_ H andrail
height 34"-38"
4-- s"Min. Not Acceptable
4 x 4 post min.
9"Min
•• Girder
6"Max
Post
An approved post cap connection or
connect girder & post with 1/2' plywd
guss—ett &-3�16d nails top & bottom
11 t 3-2x12
in. Stringers
12 x 12 footing
a" Min. embedment 1
Attach
1 stringer to
---'� sill plate with
Min. clear width
at stairs shall
be 36"
Min. 2 - 1/2"
di a. thru
bolts required
Min. 2x pressure
treated sill plate
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OF BUTTE DEPARTMENT OF PUBLIC WORKS
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7 County Center Drive — 0mvI116.0811fornim95965
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