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Home My WebLink About078-380-061BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP043163 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 10/29/2004 APN: 036-111-047-000 the Business and Professions Code, and my license is in full force and effect. License Class License Number / Site Address: 1-+-c4y` Date: l? Contractor.o�� / c> Map Index: Description: TEMP POWER FOR FUTURE LOT DEVEL 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: MERRELL &ASSOCIATES INC. 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 1309 SAN PEDRO AVE 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 CERES, CA 95303 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).): ❑ 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: MERRELL & ASSOCIATES, INC. 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, 1309 SAN PEDRO AVE provided that such improvements are not intended or offered for CERES, CA 95303 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 doesContractor• MERRELL L� lO��r AUC not apply to an owner of property who builds'or improves thereon, and who contracts for such projects with a contractor(s) licensed • 1309 SAN PEDRO AVE pursuant to the Contractors' State License Law.). CERES, CA -0/l am Exempt under A 'ck3 oft" Business and Professions Code 95307 Date � �Ow e 209-602-2654 License #: 694869 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: ❑ 1 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: Total Square Ft: 0 S.F. Valuation: $0.00 Census Code: Policy #: ❑ 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the This permit is hereby issued under the applicable -provisions of the Bufte County Code ?n or Resolutio t do Yindr w ich fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) A�bovork /� 0 Name: BY //I t Date: PERMIT EXPIRES 6� Address: ON: Da ❑ 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 authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives ofButte to enter upon the above mentioned property for inspectio ones �,County 46/ '` � �— Print Namer,i kAQQ Signat Date: a)`Z --0 ner ontractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CI -ICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION "PLEASE PRINT CLEARLY" APP (CANT NAME OWNER Last Name ` e,- ?L .A `e5 RIG irst Name Address` A,-e— City c s� Zip Stated Zik� ,> PhoneZ� 6cz_Z.G5_ % Fax2c� ,,',3L-L9Dta6 E-mail APP (CANT NAME CONTRACTOR Name -s Address Zii�S:�o City State Zip -Phone _a E-mail Lic. # Class APP (CANT NAME ARCHITECT/ENGINEER Name -s Address Zii�S:�o City Fax2,9 State Zip Phone Address Fax E-mail State License Number APP (CANT NAME Name Address City CJ!9� Stag ,,, Zii�S:�o Phone 20'7-602 `r Fax2,9 E-mail S3 f, e04,6 APPLICANT SIGNATURE For office use only: Zoning Flood Zone SRA I Yes No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP OV -Yb BIN # LOCATION AN 63� Property Address 6 Com' - vfco City dIZ�, Cross Street WORKER'S COMPENSATION Policy Number Po4-9d DU 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 -Nam Address Description or Scope of Work: Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received bye Amount: �?a Bldg C'Vyrr SRA Receipt #: Sheriff SMIP Date: Other K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 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 ` permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND /N INIC ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6'. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). —D _13—Sanitation-and-site-plan-a e-Envlronmental-Heap Depadroent. 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. Workers Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this\process, contact a Permit Application Assistant at (530)538.7541. . _ 1, 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 I BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.neAdds PERMIT NO. BP042770 LICENSED CONTRACTORS DECLARATION 4-7I 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: 09/21/2004 APN: 036-111-8-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 3389 ORO BANGOR HWY ORO Date: Contractor. Map Index: Description: DEMO SF(978)GAR(576) 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: MERRELL &ASSOCIATES permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 1309 SAN PEDRO AVE signed statement that he or she is licensed pursuant to the provisions of CERES, CA 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 95307 she is exempt therefrom and the basis for the alleged exemption. Any 209-538-8646 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: MERRELL & ASSOCIATES 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 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) nsed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Art' o the sine nd Professions Code Date` ew r: License #: WORKERS' C ATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for -.by Section 3700 of the Labor Code, for the performance of the work for. which this permit Architect: is issued. Engineer: ❑ 1 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 Total Square Ft: 0 S.F. Valuation: $0.00 Census Code: Policy a: 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, and agree that if I should become subject to the compensation provisions of Section 3700 of the Labor Code, e, I shall fortith comply with those ovisions.Ace ate: (` Applicant: WARNING: allure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the ap licabliFprovisions of the Butte County Cade ?nrunr- I hereby affirm that there is a construction lending agency for the Resoluti s o doh ork indicated above W which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) /j Name: B Date: t� PERMIT EXPIRES ON: W Address: (Efate) ❑ 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 authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the subst f any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspectio urpos s- Print Name: % /�' ek - �c �� Signatu . Date: l `— pyl 0 Owner giGontractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last Name Iirst Name ; t Address City 016)Z85 States +4- Zip ?530 7 Phone �. Fax E-mail APPLICANT SIGNATURE For office use only: CONTRACTOR Name Address2� Address City City State Zip Phone Fax E-mail E-mail 4ic. # E ct 8D7 Class .C -3:r 3 i APPLICANT SIGNATURE For office use only: ARCHITECT/ENGINEER Name X156 Cf Address SRA City State Tip Phone Fax E-mail State License Nu r APPLICANT SIGNATURE For office use only: APPLICANT NAME Name X156 Cf Address SRA City No State Zap Phone Map Book Fax E-mail Planner APPLICANT SIGNATURE For office use only: Zoning Pro rty Address 3� Set Ott Flood Zone Cross Street SRA I Yes No Occ. I Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BIN # LOCATION AP# d q7� Pro rty Address 3� Set Ott City -0 tlxcl Cross Street WORKER'S COMPENSATION Policy Number / Carrier If hiring anyone other t6an 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: de m o Dose v� &r , Sq. Footage 9-i( 1,�Oose76 b'0 y ❑ 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 Received by Amount: Bldg I SRA Receipt M 41 P -N q- Sheriff OVER FOR SUBMITTAL REQUIREMENTS II K TORIASWILDING FORMS\BldQADDlSubRgmts.doc Page 1 of 2 Date: SMIP Other I �S- 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 permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license. approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ - 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder 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 pen -nit 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 meTunds can oniy be made upon written request �by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSWILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 t>r 7' r Ca/e RESIDENTIAL BUILDING RECORD _ ADDRESS u z<" 3°:.�!.J,a7s " 33 0 r PARCEL 3l� ^-f/"-- �� j OLn 5/�-. ., SHEET Appraiser 8 Dote Unit Area Unit cost D3, SA COMPUTATION �L� T;m j ~ Unit nitUnit os t �� Cost Cost Cosf Cost �r= r rc : �I OF __SHEETS sCl Cost 725- Zoo DESCRIPTION OF BUILDING :LASS@SHAPE CONSTRUCTION STRUCTURAL EXTERIOR ROOF - Light K Frame �'� Stucco on LIGHT/NG F/oJ /q Pitch Wiring lR CONDITION Heotin ROOM AND FINISH DETAIL Sub -standard "x :.t "_ • ![,ac P1,P ;! Goble /q 0,4 Coolie 9' 9" ROOMS FLOORS FLOOR FINISH INTERIOR FINISH TRIM IRCH/TECTUREi Standard Sheothin 9 Sid' "x Hip /q job X.T. Conduit Forced efii'a. B l 2 Material Grode Wo//a Cei/in s Above -Standard B/oCIC % ?� Shed / B X. Fixtures Coble 6rovity Aimos A// /� Stories TYPE Specio/ 8.48. T. 8 G. r?�; j dls:1i a` Cut Up leaning /tumid. Few X Cheap Centro/ Zone(/rc Ent. ala// Brick Shing/es Dormers �( Av . Medium f/oorUn Wo//Un. Living ISE DE51GN FOUNDAT/ON ON Adobe Sin /e 9 Floor joisJ: Shakes B&B. T. BG. Many Spec Dining ' Double Reinforced lot:5(x i oc Gutters Rodiont Duro/ex Brio4 , 21e• ^XF.- Brick PLUAIB/NG Apar/menf Wood Sub Floor Stone Shing/e Poor Good Ij. Bed Flat-Cour> ( Piers Concret¢F/oar WINDOWS Shake Ti/e Oi/Burner Mote/ X 0. H. Cosemen/ Tile trim Futures X &0101-Heoter M. -B T.U. /nsuloled Ceilin s Mefo/Bosh / Composition M-B.T.U. / i Y Automotic Firep/ace Kitchen Units Li h} Neovy Insulated Wo//s Screens Compo. Shin /e < Gos ` p CONSTRUCTION RECORD ° EfFEC. NORMAL f° GOOD Elect. DroinBd. Mo%ria% IJC L91h, -' F' SP/ash: Permit APPR. RATING E G A F P > > l 1/0. Far Amount Dole YEAR YEAR Age Remoin9 9 rob/e ► Coed Arch. Func. Con- Stora eSpoce Worn- BATH DETAIL Lite Attr P/on form. upb'd /oset hshio FI. No. ,,_.__FINISH F,_.__ F/XTURS SHOWER Appraiser 8 Dote Unit Area Unit cost D3, SA COMPUTATION �L� T;m j ~ Unit nitUnit os t �� Cost Cost Cosf Cost �r= r rc : �I .fit C sCl Cost 725- Zoo .7.550 2.7S- 1250— P1,P 0,4 8 o job W TOTAL NORMAL % GOOD R. C. L. N. D. r o l A 1 S.30- n 7l y3 Py y sj Cost pup" 2e�0 Finish SPECIAL FEATURES Built- I? Beds I I benetion Blinds SPECIAL Book Cases Shutters (�3S/4C. SOD F - ?-72- Unit ost Cost 725- 70 1�o .7.550 2.7S- 1250— Costuntr Cost 051 y A Demolition Permits . Asbestos Notification Statement' Date AP# Pursuant to section 19827.5 of the California Health and Safety Code, all demolition permit applicants are required to fill out this form. "19827.5. A demolition permit shall not be issued by any city, county, city and county, or state and local agency which is authorized to issue demolition permits as to any building or structure except upon the receipt from the permit applicant of a copy of each written asbestos notification regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project. The permitting agency may require the applicant to make -the declaration in writing, or it may incorporate the applicant's response on.the demolition permit appli— cation." Attached is a copy of my written asbestos notification to the United States Environmental Protection Agency for the demolition project located at. Signature of Applicant 6g I hereby.declare that a.written asbestos notification to the United States Environmental Protection Agency is not applicable to this demolition project. Signature of Applicant 2/19/91 �'``"� -�� RECORDING REQUESTED BY i(Ilffllllfllllltillllitllfflllill Bidwell Title &Escrow Company 210214—=+Q�1044601 1 Recorded I REC FEE Official Records I TAX 10.1 69.30 AND 3'iPHEN RECORDED MAIL TO Chun$ y Of - Nome Merrell &Associates, Inc. BUTE T CANDACE J. -GRUBBS sue aaarer ss 1309 San Pedro Ave Recoer ROSEMARY DICKSON I Assistant I Shauna City, State z�n Ceres, Ca 95303 09:80AN 23 -Jul -2084 I Page 1 of 2 Order No. 00217318-001 SPACE ABOVE THIS LINE FOR RECORDER'S USE ParcelNo. 036-111-024 GRANT DEED a THIS FORM FURNISHED BY BIDWELL TITLE & ESCROW COMPANY The Undersigned Grantors) Declare(s) Documentary Transfer Tax is $ 6 9.3 0 ❑ City/Town of ✓Unincorporated Area ✓ computed on full value of interest or property conveyed, or ❑ full value less value of liens or encumbrances remaining at the time of sale ❑ Monument Fee of $10.00, . FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Thomas.A. Turk and Nancy E. Turk, husband and wife hereby GRANT(s) to Merrell & Associates, Inc.,.a California Corporation the following real property in the ❑ City of ✓ Unincorporated Area County of Butte, State of California: SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF h mas A. rk NaftyE. rk Document Date: July 22, 2004 State of California County of Butte } SS. On July 22, 2004 , before me, the undersigned, a Notary Public in and for said County and State, personally appeared Thomas A. Turk and Nancy E. Turk Personally known to me ( FOR NOTARY SEAL OR STAMP cuidence) to be the person(s) whose name(s)}' are subscribed to the within instrument and acknowledged to me that he/eWthey executed the same in his4w/their . authorized capacity(ies), and that by 4tisfher/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ^�'°•.. JANIE CLARK WITNESS m an and official seal. 0 ��` Comm. #1312686 fi} NOTARY PUBLIC CALIFORNIA 0 BUTTE COUNTY i Signature My Commisslon ExpVes Jul. 9, 2005 MAIL TAX STATEMENTS TO: Order No. 00217318-001 EXHIBIT A THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: PARCEL 4, AS SHOWN ON THAT CERTAIN PARCEL MAP WHICH MAP WAS FILED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON DECEMBER 31, 2003 IN BOOK 159 OF MAPS, AT PAGES 4 AND 5. AP NO. 036-111-024 (PORTION) Date: SEP 21 2004 This is to certify that, if bearing the purple seal of this office, this is a true copy of the document filed with the Butte County Clerk -Recorder's Office. Candace J. Grubbs Butte County Clerk -Recorder By: � I dag % c , Deputy