HomeMy WebLinkAbout079-200-044War T. Ambrose 5637 Coach Dr.
mm�
q #44 nrn"i 111
Pe mit #5 9P(util.,
ELEC._/- 31 -
GAS Z- -3i-,FQ
SUPPORT STRUCTURE RRQ%,A/0
COMPACTION TEST REQ. _>%ge.)
contr:Loyd's Elec., oroville
_r_mit #1682-79E(elec. & y
5637 Coach Dr lot 4 rr age Mz
Oroville
contr- hn Doremus '_.',&'-1ico
Pe t #212
s d
Ted Bellenir
5637 Coach Dr., lot Oroville
contr: Andrson Awning Serv., Ch- 0
ermit #2777-:81B(new awn
-8
contr:Ande;son Awnw �rVServ-, Chico
Permit #302
deck/mr— !081B = porch & covered
071, 4200ft"� r[ _mj I
I
L�
PERMIT NO.
PERMIT EXPIRES
Ted Bellenir
OWNER
14
Anderson Aming &.M Serv., Chico
CONTR.
ASSESSOR PARCEL 8-12-44
LOCATION 5637 Coach Dr.., Oroville
Temp. Power Pole
Called PG&E
Temp. Elec. S
Called P(
Temp. Gas Se
Called PC.
I
JOB FINALEI
Signature
V = OK
0 = Not OK
— = Not Applicable MOBILEHOMES
= Not Ready
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except #'s
'Date
DECKS, F
.2L4�RS, CARPORTS, ETC. (Plans) OK except O's
1. Zoning Requ irements—Setbacks— Easements
I on i �eequ irements—Setbac ks— Easements
2. Soils; Special MH Support—Sketch
2 otings; Size—Depth—Spacing—Connec - tors
3. Sewer; Location—Test—Fall-C/0—Concrete
3. Decks; Girders and/or Joists—Decking—Bracing—StairS7Rails
4. Water; Local i on— Tes t— Easement Needed (Sketch)
4. Wood Awn.; Posts—Beams—Rftrs.�Connec.—Shthg.—Rfg.—Bracing
5 . Electricity; Location—Clearances—Grnd.—/ Amp—Concrete
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
6. Gas; Location—Test—Wrap: P'Nat. or/ /"L"tt./ P' LPG
f?,-<arports; Windows—Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card- BI Date
CpK-BI
&q)Date)P—S il—r2ea,d-B I Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements—Setbacks—Easements
dard-Bl
Date
— Date Card -BI Date
POOLS (Plans) OK except #'s
1. Setbacks— Easements
2. Footings; Size—Spacing—Marriage Line
2. Soils; Compact i on—Structure Stability
3. Gas; MH Test7Demand—Valve—Connector
4. Electricity; MH Test—Crossovers—Breakers—Clearances
3. Pool Structure; Stee I —Connect i ons—Th ic knes s—Dead Men—Lining
4. Elec.; Receptacles and Lighting; Distances—GFI
5. Drain; MH Test—Fall—Flex Connector
5. Elec.; Pool Lighting; 15 volts—GFI
6. Water; MH Test—Regulator—Connector.
6. Elec.; Enclosures; Conduit Entries—Terminals—Listed
7. Water and Sewer Connected—C/0 to Grade—HD Approval
7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg.
Boxes—Enc losures—Pane I boards— Ins. to Main in Conduit
9. Exits; Insp.—Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test—Water Supply Test
Card B -I
Date Card -31 Date
Cud -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
I U, ,
0
%1 OK
0 Not OK
Not Applicable
Not Ready RESIDENTIAL (Single and Duplex)
Date
UNDERFLOOR (Plans) OK except# s
Date
FRAMING (Continued)
1.
Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- Ftg. Depth
49.
Ext. Doors -One 3' -Check Garagb-3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -R ise-Rbn-Landing-F ire Protection
4.
Ftg., Porches'&'Decks; Soils -Steel- / / Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5.
Stemwalls, Main; Stee I -B lockouts -Wrapped -S lab
52.
Siding -Nailing -Veneer I
6.
Sternwalls, Garage; Stee I -B lo6kouts-Wrapped-S lab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underfir. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protect i on -Sky I i ghts-P last ic
8.
DXV.: Fall-Fittings-Test-2,way C/0 -Sewer Test
55.
Shear Walls; Nailing -Bolts
9. Gas Pipe; Size -Anchors
10.
Water Pipe; Test-Anchors-Regu lator-Sery ice Test
11. 'Electric; Underground
12.
Plenums & Ducts; Clearance -Material -Support -Ins.
13.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
FINAL (Plans) OK except #'s
56. Ext. Steps -Door & Sidelight Protect ion- Land i ngs
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except #'s
14. Water Ht.; Vent- Access -Combustion Air
57.
Smoke Detector I
58.
Furnace; Vents -Clearance -Comb. Air -Connector-'
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
DXV.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting I
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub A!ccess
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breakerl S izes- Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails 1
63.
Fireplace or Stove; Clearances -Hearth
Card -Bl
Date Card -BI Date
64.
Elec. Outlets at Wood Panel; In't. & Ext.
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles atlKit. Counter
Date
ELECTRICAL (Permit) OK ex�ept #'s
67.
Garage Fire Door; Swing-Landijng-C loser
68.
A.C. Duct in Garage -Damper 1
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -C learance-Cohib. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21.,
E.Iec.. Receptacles Spacing -Lights & Switches at Doors
70.
Plb., Elec. & Mech Equip. Lisied for Location
22.
Size Boxes & No. of Conductors -Stapled
71.
Receptacles in Garage; (P.F.I.)-Romex Protec.
23.
Romex Installed Close to Edge of Studs & C.J.
72.
-Elec.
1 nsu lat ion -Foam- Looked in At�ic El Yes
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
73.
Guard Rails & Deck.Constructi6n-Post Caps
25.
2 Appliance Circuits in Kitchen & Conductor Size
74.
Fdn. Vents & C rawl Hole Door- I LDrainage & Wood -Earth Clearance
Looked under Floor D Yes
26. Subleed Wire Size ga. Cu or AI-A.C. Wire Size ga. Cu or Al
27.
Range Circ. / / ga. Cu or Al -Oven C.irc. ga. Cu or A 1,
Insulated Neutral CYes ONo '
75.
Following instld.: Drive es No; Walks E] Yes [] No;
Planters DYes E]No
28.
Service -Riser Conductors & Ground -Main Disconnect
76.
77.
Stucco; Brown -Finish
A.C. Unit; Disconnect-Girnces-Brkr. & Cond. Size -115V Outlet
29.
30.
Equip. Clearances; Pane I s-Motors-Mech. Equip.
Clothes Closet Light -Shower Light
78.
Vents Above Roof; Plbg.-Appliance-Firepi.-Clearance to Opngs.
79.
Water Well; Disconnect, Electrical, Plumbing
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Date Card -BI Date
81.
Ventilation throughout House
Card B -I
Date Card -BI Date
82.
GI -ass Protection
Date
MECHANICAL (Permit) OK except #'s
83.
Eorrections from Previous Inspections
84.
85.
86.
Gas Test -Meters Tagged; Gas,L-Electric
Water & Sewer Connected-C/d to Grade -HD Approval
Energy Compliance Certificate -Other Certificates
31. A.C. Ducts: Insulation & Support
32.
33.
Vent Fan; Exhaust above Insulation
Condensate Drain & Overflow; Size & Grade
34.
Furnace -Vent; Access -Comb. A'ir-Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI
Date Card -Bl' Date
Card -BI
Date Card -BI Date
Card -BI
Card -61
Date Card -1311 Date
Date Card-Bli Date
Card -61 Date Card -BI Date
Date
FRAMING(Plans) OK except #'s
Comments at Final:
36.
Sills; Proper Material & Anchors
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38.
Bearing Walls over Girders & Floor Nailing
39.
Draft Stop in Walls (rat proof)
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
Header & Beam -Size & Bearing
42.
43.
44.
Hangers -Post Caps -Anchors -Connectors
CIng. oist-Rftr. Ties-Purlin- Roof Brac.-Truss-Shthng.-Rfnp.
Fireplace Ties or Type A Flue -Fireplace Throat
45.
Attic Access; Size & Romex Protect i on -Draft Stop -Ins. Baffles
46.
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
47.
Garage Fire Protection Framing
(NOTE: Anentrymust be made each time youvisit jobsite)
PERMIT NO,.�/,,
VNC�),7�7�7
COUNTY OF BUTTIf - DEPARTMENT OF PUBLIC WORKS
7 Couniy Center Drive - O�oville, California 95965 - Telephone 916/534-454
APPLICATION AND PERMIT,
ASSESSOR PARCEL 7JBER
ZO G
V.
BUILDING PERMIT
WNE
0 T R
TELEPHONE
SQ.FT. OCC. BUILDING VA�UATION
-4
OWNER'S MAILINIMADDRESS
(in g, !M!C
_5637
CO TRACTOR'S NAME
TELEPHONE
C TRACT AILING ADDRffirSS
aif �11 g ;K
Fireplace
CONSTRUCTION LENEFE(A
Al r) Al
Total Valuation
q� a C-_>
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 2-9100-
,,R ENG1,N ER
A:��] T E ZCT 0
LICENSE NO.
Plan Checking Fee
$ /0-00
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ og� OD
BUILDING AD15RESS
&4 3 2 e ma&. -4 A2&d,'&4, L -o -r q4
PLUMBING PERMIT
FilingFee -'10.00
hav t33
Each Trap
2.00
Repair drainage or vent piping
5.00
V
Water piping
LOT NO. SUBDIVISION NAME PARCEL MAP
Ll q ft�a4.0_ a I
Each qas water heater or vent
5.00
Gas piping system 1 5 outlets
'J USE OF STRUCTURE
SFEJ DupleX'F-1 Mobilehome5��Other SPECIFY
Building sewer -
Lawn sp rinkler system
5.00
.
TYPE OF -WORK
New No Addition 9-1*' Remodel[:] Utilities[—] InstallationD Other [I
Describe work: aA,1,:,a L� //,I/
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Fi I ing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
5.00
Main service EA. ADD -L 100 AMP
2.50
NEW CONST. I DWELLING OCCUP.5i
OR ADONS. % ACC. BLDGS.
20 sq it
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No
)X7 Classification
1, as the owner, or my employees with wages as their sole compen—
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)'
El 1, as the.owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
F1 I am exempt under Sec. Business and Professions Code
for this reason
N NSTR. MULT [-OUTLET
EWCO SID. (BRAN U ITS) 2.50 ea
NON -.E CH CIRC
NEW CONSTR. I POWER APPARATUS &
NON-RESID. %SINGLE OUTLET CIR .
Ex. TLETS OR FIXTURES 50 @ 250
=Occup 0. BAL@100
OCCUP.(FIXF-D APPLNS OR
Ex. OUTLETS (RESI'D.) EA.) 2.00
Temporary service 10.00
__
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
F! I ing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F-] The permit is for $100.00 (valuation) or less.
FL -+--1 have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of,Consent to Self -Insure.
F] I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith Comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation'
Permit Fee
$
Contractor
I certify that I have read this applicatiori and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said C unty in 9nsecyence of the granting of this per it.
X n e 77a
iIQ — Dat 23/)7/—
Signature of Applicant - Owner El Contractor Agentlo f
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $
/
OCCUP. CROUP
M-1
I TYPE OF CONST.
IPARCFLI
PO
1
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated. above for which
1 0 OF PUBLIC
By- IT—f
PERddT EXPI-RIES Date
the applicable provi7
resolutions to do
fees have been paid.
WORKS
D a t e Z,_
—,a—?
7
s 57
FFR' e c e i p t No. 0�.� J
TE-O.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD-APPLI CANT
�COUNTYJOF_BUTTE - DEPARTMtNT OF PUBLIC WORKS --BUILDING DIVISION
7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET
A Permit No.
OWNER
Proposed Building Use
Permit Fee Based U Complete Contract Price
Building Inspector Other (Explain)
A. P. No.
t
DPW Valuation
Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or 011suance: DATE RECEIVED APPROVED
1 . All items have been submitted . . . . . . . . . . . .
2. Plot plans in duplicate./tripli*cate . . . . . . . . . . .
Complete plans in duplicate/triplicate. . . . . . . . .
4. Complete engineered plans and calc�s . . . . . . . . . .
5. Plans with Energy Design Compliance Statement . . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
--a9 - Letter of signature authorization.
-0—Sanitation approval from QIL&CAAY� e
1A. Planning approval for (A) Use: — (B) Parking:-
04zi' 2. Certificate of Workmen's Compensation Insurance. . . . * * ? /11aA j I
13. Contractor's License Information (no., name style, classif.) . I
14. Owner -Builder Verification (Given to ownerEl, Mail to ownerEj)
15. Improvements may be required . . . . . . . . . . . .
16. Mobilehome Installation Data .. . . . . . . . . .
j Pre-Ins;ec. request to
17. Pre -Inspection for Require( - Building Inspector —(Dole)
.18. Other
__00#
When you issue the permit, process a's follows: _400�Aail to owner. k000 Mail to contractor.
Telephone and hold for pickup at —office. —Deliver w/inspector.
Other
Applicant LJJ,� Date 7 1231W_
Copy of plans sent —Health Dept., —Fire Dept., —Othe'r Date
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of applic ti ircle item.)
1. -Index permit for above Items No. NZ
2. Additional items required: le�
(Contractor, Designer, Owner) was advised of above required data by —Telephone -----.IMail —Other
Plans checked by -
Plans approved by
Other
Copy—DPW
By Date
Date
Date
TJ2,rJ 6
54131
ANDERSON AWNINd
AND
MOBILE HOME SERVICE Lic . . No. 378187
P.O. Box 4Q7 * Chico, CA 95927
(916) 342-6881
A setback of
5 ft. from the
Property Iiiies
and a setback
of 50ft. fro
-n the road
centerline shall
be clear of
structures Ir
equipment except
for a 2 ft. efive
overhang.
NOTE:—All 'Materials & Wor manship Shall Ye frt�
Accordance with Recoqni-,ed Good Pr-lnfic,3s and
of a quality, prescrl�(_-d -�or %-hr Soec;fied use in the
Uniform Building, Plumbing & N achanical Codes and
the National Electrical Code.
This set of plans cind spec*
.!fjcr..+;
ion, MIJST�e
kept on the job at all -�rnes rind 1+ is Lm!etwffill +0
make any changes or al+gr,_+'-ons on r,r,.me wn,$Out
wriften permission from f he Department of, Pu6lic
Works, County of Butte.
BUTTE COUNTY
BUILDING DEPARTME1
z
APPROVED
44
/ Xz,
Cf)UNTY OF BUTTE - DEPARTMENT OF PUBLIC WORkS PERMIT NO
7 County Ce�,nter Drive - Oroville, California 95965 - �elephone 916/534-4541
APPLICATION AND PERMIT -
ASS ESSO E�_P A R C EL BER
W —ZX'
OPO C-1
BUILDING PERMI��
OWNER
7_019 /, 3_0
TELEPHONE
SQ. FT. Opp. BUILDING V,ALIUATION
:0V TZ0 �/o 0
—
OWNER'SMAILING DIR Sj
'307
/0 0
TIELEPWONE
xcdeg 11,0V
CONTRACTOR'S MAILING #0 S
Je 0 r 7
Fireplace
.-%9
COfiSTRUCTION LENDER
/V 0
Total Valuation I $ 1'71&
Filing Fee $ 10.00
—
LENDER'S MAILING ADDRESS
Permit Fee $ 00
ARCKITEC'S OR E G1 EER
_,��AIZZM 22,49W&
E NO.
:5
Plan Checking Fee $
Penalty $
ARCHITECT OR ENGIVE�ER'S MAILING ADDRESS
U'In, 7—
Permit fee $
BUILDING ADDRESS
PLUMBING PERMIT FilingFee 10.00
r
Each Trap 2.00
Repair drainage or vent piping 5.00
U
Water piping
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent 5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SFEI DuplexF] Mobilehomeg��O.ther SPECIFY
Building sewer
Lawn sprinkler system 5.00
TYPE OF WORK
New WW Addition El' Remodel[- Utilities Installation El Other
Describe work: jo aA-e-W a:;e, Jgel
Permit Fee $
Contractor
ELECTRICAL PERMIT Fi'l i ng Fee 10.00
6011 OR LESS
Main service 100 AMP OR LESS 5.00
Main service EA. ADD -L 100 AMP 2-.50
NEW CONST DWELLING OCCUP.51)
OR ADDNS.' ACC. BLDGS. 20 sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
Q 1, as the owner, or my employees with wages as their sole comp6n-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044) 1
1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
F1 I am exempt under Sec. —,.Business and Professions Code
for this reason
NEW CONSTR MULT"OUTLET 2.50 ea
.."Er
NO " D. BRANCH CIRCUITS)
NEW CONSTR I POWER APPARATUS.9
NON-RESID. % SINGLE OUTLET CIR
150 250
Ex. UTLETS OR FIXTURES BA@L@10t
=Occup 0
IXED APP OR
(F (LN5
Ex. Occup. OUTLETS RESI*D.) EA.) 1 2.00
Temporary service - 10.00
Mobile Home Facilities 15-00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT Fi ing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
E] The permit is for $100.00 (valuation) or less.
X__L_-1_1ave placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: It after making this statement, should you bec&me subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood 3.00
Ventilation �:J
Permit Fee S
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
againj��aid County in co quen e of the granting of this permit
X Date x,
Signature of Applicant - Owner El Contractor E] Agent [� - /
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
n of structures over 3 stories in height.
Mobile Home, Installation Fee
TOTAL PERMIT FEE $ 0
occu OUP
TYPE OF CONST.
V
[—I
PARCEL
PD
HE)
I ISSUE
This permit is hereby issued under the applicable provi-
sions of the Butte County Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTT50F PUBLIC WORKS
Bv Date 7-p/
- PMIT E - XPIRES Date
P E
rReceipt No. 6-5911 Z -
w. I T.-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDEN ROD-APPL I CANT
OWNER
COUNTY OP BUTTE -'DEPARTMENT OF
�PUBLIC WORKS -BUILDING DIVISION
7.c..OUNTY CENT ERil,"bRiVE� -, OROVILLE, CALIFORNIA 95965 - TELEPHONE' �(1'6/534-45411
PERMIT APPLICATION DATA SHEET
Permit No.
-7-
� I
Proposed Building Use
Permit Fee Based Upon: Complete Contract Price —DPW Valuation
A. P. N o.
O/ther (Explain)
Building Inspecto LkVj - Date 19 f
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or issuance*. DATE RECEIVED APPROVED
;��1. All items have been submitted . . . . . . . . . . . .
2. Plot plans in duplicate/triplicate . . . . . . . . . . .
3. Complete plans in duplicate/triplicate. . . . . . . . .
4. Complete engineered plans and calcs.
5. Plans with Energy Design Compliance Statement . . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . . .
9. Letter of signature authorization . . . . . . . . . . .
10. Sanitation approval from SaA_cxQ,,_ _!&L.AA;�&alth Dept. . .
11. Planning approval for (A) Use: qB) Parking:— .
12. Certificate of Workmen's Compensation Insurance . . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to ownerEl, Mai I to ownerE])
15. Improvements may be required . . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . . . . .
4 Pre-Inspec. request to
17. Pre -Inspection for Required. Building Inspector (Date)
Other
When you i ssue the perm i t, process as f o I I ows: — Ma i I to owner. ___�_�_Mail to contractor.
Telephone — and h Id for pickup at —office. —Deliver w/inspector.
Other 00 A-54 V Rn ry , :- � - - 0- 1 rl C: --CA /_
Applicant Date
Copy of plans sent —,Health Dept., —Fire Dept., _Oth6FfC Date
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of application, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by —Telephone —Mail —Other
Plans checked by -
Plans approved bv
Other
i
Copy -DPW �
By
Date
Date
Date
'Trzo %C-LLE1-P%1;L
5-Z'3 7 Cz.4-,4
45,41
ANDERSON AWNINd
AND
MOBILE HOME SERVICE Lic. No. 378187
4LJ
A setback of 5 ft.
CP
property lines an
a setback
lad
of 50ft. from the
Ck& C16 -
o
centerline shall be
CP
C11 -
J
ment except
4Q*/
A�
60
0
.�o
1Yr
L
P.O. Box 487 9 Chico, CA 95927
(916) 342-6881
io
This set of plans and specifications MUST ge
kept on the jo6 at all times and if is unlawful to
mal -e any changes or altern+ions on some without
wri ' ffen permission from the Department of Public
Works*,'County of Butte.
3 9
v
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
A setback of 5 ft.
rom the
property lines an
a setback
lad
of 50ft. from the
centerline shall be
clear of
structures or equit
ment except
for a 2 ft- eave overhang,
v
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
12 It V. M tt aA.0
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ANDERSON AWNING
AND
MOBILE HOME SERVICE
P.O. Box 4b7 9 Chico, CA 95927
rl 3 A n)4 A AV (916,) 342-6881
.LN3VUTVd3(l e N101ins
,kiNnoo 3un,
'4
ov
C.0" t \'k
Q -7-
t:
to
p".
1�2
vu
er
Llc. No. 378187
. I'
-,538-'192
PERMIT NO.
PERMIT EXPIRES'
RREN AMBROSt
CONTR. OWner
LOCATION �(A.P.8-12-44
,�2646 Monte Vista Ave, Space 44, Oro
7 10A
Temp. ower Pole
P
C'/G& - E*
Iled P
Tem . Elec. Serv. Sla zl� /,140V/
TiCalled PG&E
C
p. Gas Serv. W/
Called PG&E.
0
j B
FINACED-
(Date)
(Signature)00'
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS
BUILUING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Set k Atrewall Sol[ Piping
I
Forms Pa4pits 1st Floor
I
!MNainidg. Res4om Finish 2nd Floor
0
Foot 's Windoks 3rd Floor
S St I
temw 11 Siding Topout
Slab Roof Shelthing Water Piping
Piers Roofing Sewer
Garage Fdn. Vents Fixtures
Footinas Garage Vents Water Htr.
Stemwa I I Insulation Heaters
Slab Prov. for 1p� sical, Appliances
Carport 1. ndicappej
Conformance of ex. Gas Piping & Test
Footings structure Temp. Gas
Slab Final Sanitation
Patio FIRE ACE Final
Footings Footing ELECTRICAL
Masonry Walls Throat Rough
ReInf. Steel Final Fixtures
Bond Beam FIRE SPRINKLEA$ Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MECHANICAL Gird. Fault Prot.
Scratch Heatina Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOME UTILITIE ------------------- Elec- Servicec Elec. Pedestal
'114 / y I / %--d I
Water Piping \-),4 Sewer 6-- ( - —7,q ' A—V Gas Piping '7,x—
=1 E OWN&A 11S� .............. Support /- 4ez,7-7— Elec. Continuity C.4-4-4
WaterPiping ')00� Drainage V// Gas Pipinq
DATE REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
CERTIFICATE OF OCCUPANCY
This mobilebome has been installed in accordance with the =ements
of the California Administrative Code, Title 25, Chapter 5, permit
number 2— ! -' / - '" for the following location:
Owner
Owner's Address
Mobilehome Mfg. Model Year
Insignia No. Serial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
Date By
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow - Installer, Pink - D.P.W.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WOR PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telepl�onp 9116/ /4-4510 -Z
_Q zsaz Sz
APPLICATION AND PERMIT
ASSESSOR P CEL TER
g - �2 -Lluq
ZONING
BUILDING PERMIT
OWNER —e -
MR &E bAllge-
TELEPHONE
SQ.FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
V� E
COyjg�71R. S BU
Tf4gH�
C;bTRACTO SMAIL OIDDRESS
21 - M7
Fireplace
CONSTRUCTION LENDER
UNKNOWN
I
Total Valuation is
Filing Fee
$ 10.00
-
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINTLIER
E NO.
Plan Checking Fee /L/
$ /0.00
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
B��RESP
4jW/
_,4tg,
DR-
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO SUBDIV E
C4;Wg6 C-7 IWA10 /Z-
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF Duplexn Mobilehomejj-40ther SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New R Addition Ej Remodel[:] UtpffltlesEl ;Opst Ilation Other
Describe work: r --OP- V77L- 6-e)V
Permit Fee
$
contractor
ELECTRICAL PERMIT
F i'l i ng Fee 10.00
600V OR LESS
Main service 100 AMP OR LESS
5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST DWELLING OCCUP.5j)
OR ADONS. ACC.BLDGS.
20 sq it
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
1 am licensed unde� provisions of Chapt. 9, Div. 3 of the Business
and Professions Code my license is in full force and effect.
I
License No. _cl Classification e-61
1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
0 1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONSTR. MULYI*OUTLET 2.50 ea
N....E.�'D. BRANCH CIRCUITS)
NEW_CONSTRL (POWER APPARATUS.&)
NON RESID. SINGLE OUTLET CIR
50 @ 259�
E-AX6 OCCUP(OUTLETS OR FIXTURES BAL@10T
FIXED APPLNS. OR
Ex. Occup.(!DUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities
15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
The permit is for $100-00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
F] I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith Comply with such
provisions or this permit shal I be deemed revoked.
Heating
Cooling
od
3.00
Ventilation
Permit Fee
S
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
again aid County in consequence of the granting of this permit.
g ain aid Uo ate
X
g ature of Applicant - OwnerEl Contractor ��PAgent D
�A 0 .ri.
n OSHA permit is required for excavations over 5'0" deep and demolition or construct-
/ion of structures over 3 stories in height.
Mobile Home installation Fee $ 00
TOTAL PERMIT FEE $ a d
occuP. GROUP I
TYPE OF CONST.
F
PARCEL
PC
No
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO F PUBLIC
I-,—
By =,Date
I - I
P T EXPIRES Date
the applicable provi7
resolutions to do
fees have been paid.
WORKS
6- t
,��6 , f —
Receipt No.— V��_
WHITE-O.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPLI CANT
MOBILEHOME
SUPPbRT DATA
If ot�er than single wide,
de Setup Model No. Year
Mobilehome Mfr.
furnish
Width at;-)
Box Lengttk_a�(ft.)
Tagalong.or Expando Size ft. x
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes
manufactured after October* 7, �19713,i furnish manufactur6r's installation
manual and structural
setup sheets '(if not on file with the County of Butte).
All center supports
measured from front of
mobilehom'e*unless
otherwise specified.
Footings (check one)
Single
10 Wood 'either.
pressure treated or
foundation grade.
(ft.)(in.)
(in.) (in.)
2... Other. (specify)
Center support
locations*
Center support
footing sizes
SupOorts.(check one)
I.;' Concrete' block.'
r
1 2 Othe sip ec if y)
(f t.) (in..)
(in;) (in..).
<�-�agalong or Exp�ndo,
show suppoft-details.
(in.) (in.)
x -_Z
Typical Support
(in.) (in.) Footing Size.
(ft.) (inj
-(in.) (in.)
Max,. Pier Spacing'
(ft.)(in.)
Max. Overhang
(ft.4(in.)
(in.)j (in.)
(ft.)(in* Y.
84'', TTE C OUNW
BUILDINO b�PARTMNt
APPROVED
*1f c.imter piers are other than drawn above,
and
,,-71
BUTTE COUNTY'DEPARTMENT OF PUBLIC WORKS
T -County Center Drive, Oroville, CA.
PHONE: 534-4541.
..MOBILEHOME INSTALLATION SHEET
2. Installer's name: .92g!�2
Z&XO-Z,�
Amp a
3. Is the site curi��Ily
under permit? 'Yeh_7T'�
No
(If yes, furnish
permit number
OR
a TZ7
Is the site an existing site?
Yes
No
(If yes, furnish
two (2) plot plans.)
natural
4. Will the mobilehome be located at least
5 ft. away from septic tank
clear of, all setbacks
and easements?
Yes
No
(If no, clarify
5. What is the mobilehome electrical rating? -----------------------
.6. -What is the mobilehome site service rating? ---------------------
7.. What is the mobilehome site circuit breaker rating? -------------
8. Is there any other electric load to be served by the mobilehome
siteservice? -------------------------------------------------- I
(If yes, identify the load and size: (Load)
9. What is the mobilehome site gas pipe size? -----------------------
X
10. What is the type of gas service? ----------------------------- Nati
.11. What is the gas pipe length from meter or tank to the mobilehome?
12. What is the mobilehome gas demand? ---------------------------------
.(This information not re�quired if pipe length less than 6 ft'.
or less than 50 ft. on LPG.)
Amps
Amp a
N
N0,77
—(Arqps)'-
a TZ7
LPG I
(BTU)
natural
gas..
' I , . 1 , , Jr " *� -
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 9556�'
Telephone: 534-4541
APPLICATION ANb PERMIT
& -,; 5 � t�- -
2
White-D.P.W. — Yellow -Assessor — Pink -inspector — Goldenrod-Appli cant Building permit expires Date V
1 2
BUILDING
Owner
SO. F T. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Contractor
Mailing Address
Fireplace
Total Valuation
T lephone No.
Permit Fee .
Building Address
Plan Checking Fee &/or Penalty
Permit Fee $
e,t
PLUMBING No.1 @ I FEE
PERMIT FILING FEE $3.00
Each TraD 1.50
Repair drainage or vent piping 1.50
qA. P.�Io. 75---A&
, / I ZPfqnC n . i g
Water piping 1.50
Each gas water heater or vent 1.50
�%s J\t1c.
i Q
FireDept.
FireZone Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
kParki'ng
Plans
I Parce!
Declaration
[Parcel Map I
— __
�0' R/W
\ Improvements
Each additional outlet .30
Building sewer 5.00
Bldg. AN. Rec'd
S
P roval PI
Lawn sprinkler system 2.00
NEW ADDITION UTILITIESn OTHER
Permit Fee $
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
600V OR LESS
Main service 100 AMP OR LESS 5.00
Single Family Duplex Mobil Home Lzi Others
Main service EA. ADD -L 100 AMP 2.50
Main service 0,0'0`EA'M6.000vR LESS 25.00
Main servIce EA. AOD'L 100 AMP 1.00
NEW CONST f DWELLING OCCUP. Si
OR ADDNS. * ( ACC. BLDGS. 120sq ft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
NE W C ON STP_ ULTI-OUTLET
N , -R ESID, (MBRANCH CIRCUITS)l J2.50eal
NEW CONSTFL (POWER APPARATUS 8
NON-RESID. SINGLE OUTLET CIR. J I I
Ex. Occur)(OUTLETS OR FIXTIIRES 50 @ 250 1
IBAL@IW
F16XED APPLNS. OR
Ex. Occup. 0 WETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of Cal ifornia.
Permit Fee $
!$
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions ot Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
E] I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
R�certify that in the performance of the work for which this
ermit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.001
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
W, Date
Signature of Permitee or Agent
ell -
Qn-ir%t k1r, KI(I a -7,(,,
Land Development Fee
$
TOTAL PERMIT FEE
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for.which fees have been paid.
QIWCT?l 4F UB I WORKS
1 4 a . .
1�11
By- la f�q Date
/ !V J
White-D.P.W. — Yellow -Assessor — Pink -inspector — Goldenrod-Appli cant Building permit expires Date V
1 2
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California,95965 '
Telephone: 534-4541
APPLICATION AND PERMIT
author ze representatives of the County of Butte to enter upon the
above -Mentioned property for inspection purposes.
Date -7=
Si/gnature of Permite, or A t
Receipt No. ff r( aq
White-D.P.W. - Yellow -Assessor - Pink -inspector - Goldenrod-Appli cant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
R - 0 IC WORKS
%4r;r Date
Q V_ I - -
Building permit expires Date _!� 43
BUILDING
Owner
SO. FT. OCC. BUILDING VALUATION
Mailing Address :3 2-5 A AA
Telephone No.
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee
Building Address L
Plan Checking Fee &/or Penalty
Permit Fee $
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Tral) 1.50
Repair drainage or vent piping 1.50
A. P. No.
1
z 11 N9 fP anning
Water piping 1.501
Each gas water heater or vent 1.50
619's"I
l4t�
SWA41,49A
FireDept.
FireZone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
IParking
Plans
I Parcel
I Declaration
Parcel Map
I I
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Rrd-g-PTVM-R".d=
Parcel Approval
Plans Approval
Lawn sprinkler system -00
FF=
NEW ADDITION UTILITIES OTHER
Permit Fee $
i$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Single Family Duplex Mobil HomeQ] Others
600V OR LESS
Main service 100 AMP OR LESS 5.00
Main service EA. AOD'L 100 AMP 2.50 ;Z, 5-0
Main service OVER 60. V
100 AMP OR LESS 25.00
Main service EA. ADD -L 100 AMP 1.00
NEW CONST. I DWELLING OCCUP. N
OR ADDNS. % ACC. BLDGS. �20sq ft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
" 0 _967619.'C'
NEW.CONSTR. (MULTI -OUTLET
NON RESID. BRANCH CIRCUITS 12.50ea
NEW.CONSTR. (POWER APPARATUS 6
NON RESID. SINGLE OUTLET CH . :4
-
Ex. OCCUD(OUTLETS OR FIXT11RES - 5BC)AOL @2"
FIXED A LNS. OR
Ex. Occup. (OUT LETSPP(RESID.) EA) 2.001
Temporary service 10.00
Mobile Home Facilities 15.0
License No. - Z,� Classification
Misc. Wiring 6.25
-
E] I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions ot Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
r -,1,4 -have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL N0.1 I@ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$
1A
TOTAL PERMIT FEE
author ze representatives of the County of Butte to enter upon the
above -Mentioned property for inspection purposes.
Date -7=
Si/gnature of Permite, or A t
Receipt No. ff r( aq
White-D.P.W. - Yellow -Assessor - Pink -inspector - Goldenrod-Appli cant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
R - 0 IC WORKS
%4r;r Date
Q V_ I - -
Building permit expires Date _!� 43
NdW-!W� h4gK4'als,4ZZ1Workrnanship Shall Be in
Accordqnce;, with G,;�4 Prmefices and
of a quality ora-criilm-4 4or +he Snecified use the
U 'niform B nq, PlumYng & M04
uil8i . -Code.
tl�p. _Nm� !anal , Flectri , cal
2.41 L
'Th
I e A4 -Setb(tek shal be 5 fl
.:side,
P er+Y* ihe anc I..29'ft,
the"road, :)'r
e Miffi
mum of a 2 ft. C,
qve Overhang I
ouf of all easei nerifs. I
—P/;,/ -
All utility. q n
located Within 4
th i rd siction\,:)f
on -the left lro'-, id)
h:ome.
WC4 7'laV
-IA
I
nections shall UO
ft.- outside the r*ear
. the mobile home
side of the mobile
3R
nt MUSTF
.ihis sei of plans and specificatio WOA/T 0 T M 4`1� E 9
(ept. on the job at all times and it is.unlawftA�W-'
'BUTTE COUNTY
,nake any changes or alterationg" o:k _N1
WILD IN _P
written permisson from the Department of Public G.DP—PATMP
Works, County.of Butte.
&/ D
APPRO'v
Prior t ' o final approval by Butte County of a Building or an Occupancy Permit, a
copy of this verification form, signed off by North Burbank Public Utility District,
must be submitted to Butte County.
Applicant:
Applicant Address:
Applicant Phone No.:
Property Location(s)-
A. P. No. (s):
Fees Paid:
THEODORE E. BELLENIR
930 Chamnaane North. Calistova. CA 9451.5..
5637 Coach Drive, Oroville 095965
Carriage Manor Subdivision Lot 44
002-1-2-0-044-0
Application for service approved:
4�L
North Burbank
May 20,.1981 Public Utility District
Inspection(s) made and successful test(s) observed:
Location: Date:
By:
North Burbank Public Utility District release to close permit:
Date:
M
Telephone
-533-2 000,
North Burba'ATublic
Utility.District".
1960 EWn Street.
OROVILLE, CALIFORNIA 95965
DISTRICT APPROVAL AND
47-81
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
.,7 f
building or occupancy
permit, whichever is applicable.
Prior t ' o final approval by Butte County of a Building or an Occupancy Permit, a
copy of this verification form, signed off by North Burbank Public Utility District,
must be submitted to Butte County.
Applicant:
Applicant Address:
Applicant Phone No.:
Property Location(s)-
A. P. No. (s):
Fees Paid:
THEODORE E. BELLENIR
930 Chamnaane North. Calistova. CA 9451.5..
5637 Coach Drive, Oroville 095965
Carriage Manor Subdivision Lot 44
002-1-2-0-044-0
Application for service approved:
4�L
North Burbank
May 20,.1981 Public Utility District
Inspection(s) made and successful test(s) observed:
Location: Date:
By:
North Burbank Public Utility District release to close permit:
Date:
M