HomeMy WebLinkAbout024-160-033�11306-2870 024-160-033 _-N
"MISCELLANEOUS HVAC -Change Out
'.HVAC CHANGE OUT
484 HWY 99 A W, 1
� - 4_0
SW.1.�,NSON, SCOTTD FAMILY LP
0
ow
I
24-16 ZL
Jim Ar�:ld i
SE cor LIX ve. &
I I.S.0 idl y
5527 P(ne resta ant)
7
New oz,,�,
24-16-33
ri.'&�A , Kh an
cor of Hwy 99 & Turner Ave.,
1 1 784 - addit &
G'r-i; d e- y
i
Permit #1784- additi &
1
remodel/restaurant >
24-1
Contr: S 1 -(-.raft " onst, ParadisE
Lf.rmit 523-81P.,E,M(p1bg/ -ele,
(.M>Mec 784-81)restaurant
24-16-33
FRANK MEYERS
484 HWy 99, Gridley
Contr: Cogeneration.Powi.Sact—
_ 7
PErmit#3543-87P,E(plbg &ele for
co generation plant) restaurant
24-16-3�3�
ContR': Tabish-'Const.
Permit:#1278-90�(install vi; si Ing/co
24-16-33
Permit#763-91B,P,E,,M
(repai`rs7`re`staurant'�-' - -
2-1 -33
_B
Permit#955-21
(mansard roof/restau rant)
— 1050-91B
24-16-33
KLEIN, Darrellyne-
484 Hwy 99, Gridley eyers)
�050-91B*
(trans owner from Frank M
24-16-33'
Permit L11135-9 1B Lnt)
(enlarge window/rQtaura
**lob
001.1
emu*
:_O 93::_1_138_B�,-p
024�-16-0033__----
KLEIN, DARRELLYNE (THE CROSSROADS Q
484 HIVY'99, GRIDLEY
L
484 HI . 99 G
CONTR:_JIM ' FAY
4
CO T j FA
N R - - IM oeve*-
PL C Sj
FREPLACE . GREASE TRAPAESTAURANT
024-160-033 PERMIT#94-2273
KLEIN, DARRELLINE LC L�(1-7 1,90
14
484 HWY 99., GRIDLEY
ELE WIRING/RESTAURANT
024-160-033 PERMIT #95-1818
THOMPSON, Ray
486 Hwy 99E, Gridley 0- �.h
Reroof/SF " /, 7-7// d A
B06-2860 -024-160-033)
MISCELLANEOUS Re -Roof
Re -roof 20 sq cornp & 23 sq Urethane foa
484 HWY 99
SWENSON, SCOTT D FAMILY LP
C�AO�
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6/99)
TO: Department of Alcoholic Beverage Control
1900 Churn Creek Rd.
Ste. 215
Redding, CA 96002
(5 30)224-4830
State of California
File Number: 451511
Receipt Number: 1605264
Geographical Code: 0400
Copies Mailed Date: March 16,, 2007
Issued Date:
I
DISTRICT SERVING LOCATION: REDDING
First Owner: HHIYRO-LLC
Name of Business: CROSSROADS RESTAURANT
Location of Business:
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Type of license(s): 41
Transferor's license/name:
484 HIGHWAY 99 .
GRIDLEY, -CA 95948-9333
BUTTE
No Census Tract 0034.
1631 GREENWOOD WAY
YUBA CITY, CA 95993-1727
425668 / WARD RICHARD Dropping Partner: " Yes No _$_
License Type Transaction Type Fee Type
41 ON -SALE BEER AND PERSON TO PERSON TRA.NSF NA
41 ON -SALE BEER AND ANNUAL FEE NA
41 ON -SALE BEER AND STATE FINGERPRINTS NA
Master
D--U-a
Date
Fee
y
1-0.
03/.13/07.
$150.00
1,
0
03/13/07
$304.00
N
3
03/13/07
$117.00
Total
$571.00
Have you ever been convicted of a felony? N o
Have you ever violated any provisions of the Alcoholic Beverage Control Act, o'r regulations of the
Department pertaining to the Act? No
Explain any "Yes" answer to the above questions on an attachment which shall be deemed part of this application.
Applicant agrees (a) that any manager employed in an on -sale licensed premise will have all the
qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the
provisions of the Alcoholic Beverage Control Act.
STATE OF CALIFORNIA County of BUTTE Date: March 16, 2007
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is an applicant, or one of the applicants, or an
executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that
he has read the foregoing and knows the contents thereof and that each of the above statements therein made are true; (3) that no person other
than the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the license(s) for
which this application is made; (4) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
agreement entered into more than ninety (90) days preceding the day on which the transfer application is filed with the Department or to gain or
establish a preference to or for any creditor ' or transferor or to defraud or injure any creditor of transferor; (5) that the transfer application may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s? Applicant Signature(s)
HILLPRO LLC
See 211 �ignature Page
BUTTE
COUNTY
MAR 2 2 '2007
DEVELOPMENT
SERVICES
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address: 484 HWY 99
Owner:
Permit No: B06-2860
APN: 024-160-033
SWENSON, SCOTT D FAMILY L
Issued Date: 01/30/2007 BY KCG
Permit type: MISCELLANEOUS
363 G ST
Subtype: Re -Roof
LINCOLN, CA 95648
Expiration Date: 01/30/2008
Description: Re -roof 20 sq comp & 23 sq Urethane
(530) 846-6574
Occupancy: Zoning: A40 0
Contractor
Applicant:
Square Footage:
TOMLINSON R V CONSTRUCTION INC
TOMLINSON R V CONSTRU(
Building Garage RemdUAddn
PO BOX 549
PO BOX 549
YUBA CITY, CA 95992
YUBA CITY, CA 95992
Other Porch/Patio Total
(530) 755-0438
(530) 755-0438
1
FEE INFORMATION
Re -Roofing $247.50
Total Charged: $247.50 Fees Paid: $247.50
Balance Due: $0.00 Receipt No: B1669
LICENSED CONTRACTOR'S DECLARATION
OWNER I BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
TOMLINSON R V CONSTRUCTI 818075 / C39 B / 03/31/2007
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license
pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000)
f Ilf d ff ct
a
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
01/30/2007
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
Contractor's Signature Date
1. 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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
WORKERS"COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
I HAVE AND
the work himself or herself or through his or her own employees, provided that such improvements
WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not intended or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of completion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
improve for the purpose of sale.).
I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
1, As OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractor's License Law clows not apply to an owner of the property who builds or improves
My Workers' Compansation insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Carrier: Policy Number: Exp Date:
'is-To—rone
(This sectio-n--n-ee-d-n-ot-be-c-o-m-pTeted if the permit hundred doIIars'($100)_o_rIe_s_s.T_
0 1 AM EXEMPT under Section B. & P.C. for this reason:
04,/CEr TIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
SSU
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'
X 01/30/2007
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owner's Signature Date
provisions.
01/30/2007
1 hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
Signature Date
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEYS FEES.
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
p y owner or am_2.4orized;o act on the property owners behalf
1470 e V, ',- �c /. Zodf /30/2007
g
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Iffafteof PiFfmiffee [SIGN] Date
the performance of the work for which this permit is issued. (3097 civ. code)
I-Fw
Owner 1:1 Contractor OR: E]Agent for . Owner G2Kgent for Contractor
FILE COPY
Lenders Address city State zip
1-2/113/2aa& 10t22 755-4479 RVt TOMLINSON CSTG-T PAGE 02
t (a 65 - S-5
I mo --1
T BUTTE COUNTY PERWT
DEPARTMENT GF DEVELOPMENT SERVICES
0 0 SUILI)INCe PERMIT XPPLICATION NO.
AND SUBMITTAL REQUIREMENTS
OMCE 0: (530) 539-7541 PAX 0: (S30) 528-2146
A F F E F F,-, &L J;E R EQ Vjj Z 50 A T TIME OF A PPL I G 4 TION
Wtbql*-e-cWWW'hW1fteo%%t7'nWdd§ DIN N
"PLEASE PRINT CLEARLY**
OWNER INFORMATION
Last Nam Swenson `%cott
484 HiahwaV 9.
c"y Gridley___- S"CA zP 95948
Mons 530-846-6574
COMMCMIR
Name R.V Tomfinson Construction, Inc
Ad*= P 0 Bx 292 (225 California St)
city Sutter
Z'P9,5982
Pno"O 530.755-0438 530-755-4479
EV"I IE 06 1
I . . onasbc��a',..n-it 80751
C'Mr,39
APPLICANYWORMATION --
ARCHITECTMNGINEER
Addrm
Same as above
CN,
Addfm
Phorts I—
city
F%fiW
slate
1p
Mne
Fox
E-nuil
LIMM
APPLICANYWORMATION --
Ra"'Adall Tornfinso_n - 6 V Tomlinson Co=nnc-
Addrm
Same as above
CN,
ZO
Phorts I—
E-rrail
—APPLICANT SIGNATURE
X Presiden4
Foroffloweartiv:
zoning F100 Zone Yes I No
Ocrl.
I Type Censt
Sub&*Oan FUrni
Map Book
I Page Lot#
F%fiW
1 00 AWmd:
ro
PRCUE - CT - LOCA77ON
APO Crossroads Restaurant
LnAMW- 1 py
4 4 Highway 99 ridle
CM99 SbW
I Turner Ave
WORKER'S C_
OMPEA SA TION
t
Poky Number Exempt (See Certificate attached)
Caffier
0 "', ww'ar'.- cow ftniacewe mm-ne-ii6m-, a of workor's
%�--M�Amn must be sham at the time Opennif Issuance.
LENDIING AGENCY
Nam
Unknown
AdMew
D=rliplloa' or Scqm 'd Work.
Tear off & replace 20 q Composition shingles,
and 23 sg Urethane foam 69 - C(3 SC�
Sq FT- LMnq Garage Open COY,
LJ SVucture Built w9hout Permits
E3 Proposed Cluntge of Occupancy
(Note previous use);
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the daie of applicAtiod. m otday to renew action c in an
applicati-cm aft- expinition., a q -.w applicsCion, plons " fee will be
required.
REQUEST FOR REFUNDS
Reftinds cRn only be made upon written request by the pman who
paid Cit &c. 1 -he mquest must be madc prior to the expiration of the
permit and no construction work bas been done. Filing fees, plan
check fm rw work plan checked and other department cof tr. are not
refimdable.
Rem -ked by:
Amouf 9q7- 50 Bldg
SRA
Recelptl1k —Shw
SMIP
n,0 -(0 q Other
12/18/2006 10�22 755-4479 IRV, TOMLINSON GSTCT PAGE 03
Independent Staffing Solutions
P.O. Iffox 446
Irwar—andanca, CA 93,526
R V Toffainsan Construction
PO Box 649
Yuba CIty, CA 95992
S
TMIS EVIDI�NCE- OF COVERAGE AS A MATTER Of INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER71FICATE
DQE9 NOT AMEND, E)CI END OR AL71SR THE COVERAGE AFFORDED BY THE
COVERAGE RIFLON.
INSURER
Q
ENMITY Ar -FORDING COVERAGE
THE COVERAGES5 LISTED ISELOVII HAVE !B99 -N 16SUE9 TO THE ENTITY NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMEN7,
TERM OR CONDITION OF'ANY CONTRACT OR OTHER, DOCUMENT WITH RESPECT TO WHICH TMIS cenftAft MAY SE ISSUED OR MAY PERTAIN, THE
coveRAOt A40R6915 Iii(fkg GEIRMT FICATE OF COVERAGE DESCRIBED HEREIN IS SUBJ13CT To ALL THS TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
COVERAGE. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY FAID CLAIMS.
left"
TYPED OF COVE -PAGE
- I
POLICY NUMBER
POLCY FROBOYNS
DATE IMMOM)
POLICY EXPIRATION
DATE (MMIDONY)
LIMITS
GENERAL LIA131LITY
=---IwwEAL GEWOWL LIA811TV
__H CLAM MAW = OCCUR
BACH OCCURRENCE
FIRE DAMAGE (Any efte No) ' S
MEO EXP (Any one pl� S
PERSONAL & ADV INJURY $
".1
GENERAL AGGREGATE
dRBGAffT &Pftt.
Lj Lot
pFioaU=-00?AP1OPACG
AUTOMOBILE LIABILITY.
%my AV?O
AkL6iW46AUTM
3C"EDULED ^0109
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
SMO WrOs
BODILY INJURY $
FNE-FrTY DAMAGE
Per occl6entY -
G &RAGE LIABILITY
HANY AUTO
AUTO ONLY - EA ACCIDENT
OTMER THAN SA
AUTO ONLYf I
EXCESS LfAlf-Ury
EACH OGGURANC*
IMPECIATE
QCCVR CLAIM6 WAVE
RCDUCML[
11MMM's
A
OCCUPArONAL INJURY
INDFMNIrV AND MIEDICAL BENEFIT
COVERAIII!
13,9100010301
03/25-M
1 0312SIO7
FL DISEASE -EMPLOYEE
EL DISEASE - LIMIT $1 MIL
EL EACH ACC[CENT
DE.SCRIPMON OF 6-PERA—TIONgn�E)CA'rlONSNgHlCLE3/EXCLUSIONS ADDED BY ENDORE3EMENT/SPFCIAL PF40VISIGF49
This cov-srage Is a"ad Only to ft a-.rrpioym orovidad !0 the Staffing elle nt q5ted some, Welver0i'SUbroplign I- oppliCabla (o the above-mentioned
Coverage.
Re:
CERTIFICATE HOLDER Ix I I CANCELLATION
This document Is- to be ustd for either bld
purposes or for evidence of coverage purposes
only,
SHOULD ANY OF THE ABOVE DESCRIBED COVERAGE BE CANCELL 50 BEFORE TMt V111RATION OATF
THEROF, THE ISSUING ENT17Y WILL ENDEAVOR TO MAIL U_gAys wwrwri woMe Ira rmg
cEFmFrCATI! HOLOCP NAMED TO THE LEFT. BUT FAILURE TO DO 30 SMALL IMPOSE 40 09VQATtON
OR LIABILITY Of ANV KIND,
AUTMORIZED REPRESENTATIVE
Phone- Fax:
12/18/2006 10:22 755-4479 RV: TOMLINSON CSTCT PAGE 01
R V TOMLINSON CONSTRUCTION, IMC,
Phone: (5-30� 755-0438
Fax� (630) 756-447S
License No: 818075
P 0 Box 292 Sutter, CA 95982
FACSIMILE TRANSMITTAL SHEET
TW
Building Dept From: Donna
Company: Date: 12118/2006
Fax Number. 538-2140 Total Pages: 3
Phone Number:
Re:
—Urgent _ For Review __Yloase comment _ Please Reply _k.. Hard Copy Hand Carried
NOTESICONWENTS,*
Permit application for re -roofing Crossroads Restaurant Randall Tomlinson will
be In to pick it up.
WGrkers' Certification b�
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
,INSPECTION CARD
24 Hour Inspection Line: (530) 538-7636 (Oroville) (530) 891-2834 (Chico)
Office: (530) 538-7541 Fax: (530) 538-2140 Website: www.buttecounty.net/dds
Permit No: B06-2870 Issued: 12/19/2006
Address: 484 HWY 99 GRIDLEY
APN: 024-160-033 Permit Subtype: HVAC Change
Owner: SWENSON, SCOTT D FAMILY LP
Applicant: R B SPENCER INC
Description: HVAC CHANGE OUT
MUST BE ON JOB SITE
JOB SHALL BE READY PRIOR TO CALLING FOR
INSPECTION. THE INSPECTION CARD AND
APPROVED PLANS MUST BE AVAILABLE FOR EACH
INSPECTION OR THE INSPECTION WILL NOT BE
MADE AND A RE -INSPECTION FEE MAY BE
ASSESSED.
ALL PLAN REVISIONS MUST BE APPROVED BY THE COUNTY BEFORE PROCEEDING
Inspection Type
IVR INSP DATE
Set =ac s
—132
Foundations / Footings
III
Pier/Column Footings
122
Grade Beams
114
Eufer Ground
216
Forms/Steel[Holdowns
122
Do Not Pour Concrete Until Above are Signed
Pre -Slab
124
Gas Test
404
Masonry Grout
120
Masonry Bond Beam
119
Underfloor Framing
149
Underfloor Ducts
319
Shear Transfer
136
Under Floor Plumbing
412
Under Slab Plumbing
411
Gas Piping
403
Do Not Install Floor Sheathing or Slab Until Abov Signed
Rough Framing
128
Rough Plumbing
406
Rough Mechanical
316
Rough Electrical
208
Gas Piping
403
Roof Nail
129
Shower Pan/Tub Test
408
Fire Sprinkler
702
Do Not Insulate Until Above Signed
Wall Insulation
117
Ceiling Insulation
4118
Do Not ver Until Above Signed
T -Bar Ceiling / RC
145
Gas Test
404
Stucco Lath
142
Stucco Scratch
143
Stucco Brown
144
Building Final
802
Electrical Final
803
Mechanical Final
809
Plumbing Final
Project Final ,e'
813 _Fq
I FO 1 –7
PERMI'I'S BECOME NULL AND VOID I YEAR
COMMENCED, YOU MAY PAY FOR A 1 YEAR RENEWAL 30 DAYS PRIOR TO EXPIRATION
Inspector Copy
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
PdrmitNumbdr
§0-6m2�0--01
Site Address
An installation certificate is required. to be posted at the building site or made available for all appropriate inspections. (The
information provided on ffiis form is required) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at.occupancy, per Section 10- 1 03(a).
HVAC SYSTEMS:
Heating Eq uipm ent
Equip Type
(pkg. heat pump)
CF -C Certified Mfr.
Name and Model
Number _
# of
Idenfical
Sys(erw
Fffiriency
(AFUEj e(c.)
(2�&- I R v al ue)
Due(
Location
(attic, etc.)
Doc( or
Piping
R -value
Heating
Load
(Blu/hr)
-Heating
Capacity
(Btu/hr)
0.acka-ge.Aic'
Prvant;
6mmm4gnno
13.0
Attic
—4.
148000
Lb
Cooling Equipment
Equip Type
(pkg. heat pump)
CEC Certified Mfr.
Narneand Model
Number
# of
Identical
Systems
-Eflicle . ney
(SEER or EER)
(;->CF� I R v al tie)
Duct
Location
(attic, etc.)
Due(
R -Value
Cooling
Load
(Bia/hr)
Cooling
Capacity
(Btu/hr)
Package At]
7
13.0
Attic.
—_4
148000
[48000
1. > symbol reads greater than or equal to i4ihat is indicated on the:CF-IR value..
Tnclude both SEER, and EER if compliance credit for high EER air conditioner is claimed.
IX— 11, the undersigned, verify that equipment listed above is: 1) Is the actual equipment installed, 2) equivalent . to or
more efficient than that specified in the certificate of compliance.(Form CF-.lR) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured'devices (from theAppliance Efjzciency Regulations or Part 6), where applicable.
InstaAng Subcontractor (Co. Name) OR General
Colaktor (C OR Owner
kb�. Spen�er-lncl
Sign
Date: 6_1 /_d�jo_7]
Copies to: BUIOLDrNG DEPARTW79, IIERS RATER (IF APPLrCA]BLF,) BUMDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R
Permit Number
�_8 —4- 9 §-H-Wy b Trd I ��yK�5 §4b 1 -7 B067�_6'f_01
Site Address
INSTALLER COMPLIANCE STATEMENT FOR DUCTLEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: v0' [X_._�"ested at Final V [3 Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
FX] Remove at least one supply and one return.register, and verify that the spaces between the -register boot and the.interior
finishing wall are properly sealed.
FX-", If the house rough -in duct leakage test was conducted without an air handler installed-, inspect the connection points
between the air handler and the supply and-retum plenums to verify that the, connection.poin ts are properly sealed.
i�-lnspect alljoints to ensure that no cloth backed rubber adhesive duct tape.is used
IX.New Distribution system is fully ducted (i.e., does not use building.cavities as plenums or platforms returns in lieu of
,o'13DUCT LEAKAGE REDUCTION
Procedures for rwLd verification and dia-enostic testinty ofair distribution sysMms are availab& in R4CM. ADDPndir RC4-?
NEW CONSTRUCTION:
R.B.-Spencer-Incl
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
I
Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated (Nominal: V' 15�.Cooling V 0 Heating) or vO' 0 Measured
2.
If Fan Flow is Calculated as 400. cfm/ton x number of tons or as 21.7 cfm/(kBta/hr) x Heating
11 _6CO
I Capacity in Thousands of BftAr output, enter total calculated or measured fan flow in CFM her4:
3
Pass if Leakage Percen tage:� 6% for Final or.!� 4% at Rough -in:
1
0 Pass 0 Fail
[100 x r_(Line # 1) /—(Line# 2)11
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
4
System Alteration and/or Equipment Change -Out.
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
5
Duct System Alteration and/or Equipment Change -Out.
E2_ 6-6
Enter Reduction in Leakage for Altered Duct System
6
ine # 4) Minus (Line #.5)] - (Only if Applicable)
7
Enter, Tested Leakage Flow in CFM to Outside (Only if Applicable)
Entire New Duct System - Pass if Leakage Percentage!5'61/10 for Final
-
8
I [ 100 x L_(Line # 5) / Line # 2)]]
0 Pass 0 Fail
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or IfVAC Equipment Change-
V/
Out Use one of the following four Test or Verification Standards for compliance:
9
Pass if Leakage Percentage 5 15% [ 100 x Line # 5) / i f��hb_ (Line # 2)]]
[R�Pass 0 Fail
10
Pass if Leakage to Outside Percentage !9 10% [100 x [ (Line # 7) / (Line # 2)]
0 Pass 0 Fail
Pass if Leakage Reduction Percentage �: 60% [100 x r (Line # 6) / (Line # 4)]]
and Verification by Smoke Test and Visual Inspection
0 Pass 0 Fail
r2
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ibspe
0 Pass 0 Fail
Pass if One of Lines #.9 through # 12 pass
X I Fail
[-'Pass
-/' EI, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements.'for
compliance credit. 1, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and
Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards.
installing Subcogtractor (Co. Name) OR General
C?K c - r (C
�Wfe) OR Owner
Fla�f ', .
R.B.-Spencer-Incl
Si 6,17
Date� 6-1/_02/07J
V 'Z_'
Copies to: BUILDING DEPARTMENT, LRS RATER (IF APPLICABLE) BU]fLDrNG OWNER AT OCCUPANCY
Residential Compliance Forms September 2005
CERTIFICATE OF FIELD VERIFICATION& DIAGNOSTIC. TESTING, %(Page 1%af s) CF4R-
P * mt Address
B Ld Ider Nam
,B'LLil&r C6nty,-t Ir �stai in-
g.Contractorl
R.B. Spencer 1W
7elepl�one,
Plan Numbev
0
HERS Rater
R6 M__elffnil��]
7elepbone,
760-7_68-J2_2_81
Sample Group Number '31
2
-Cornpl iance. Metbod (Prexi ipti ve.)
Ll 600
ClirvateZone
Cvti fyi ng Signatwe
(Electronically signed) I
01/02/M'Dale�
Sample House N -mber'
Pirm
EnaIasys.00'rp.!__
ALTERATTONS: Duct -Sygem audl/o� BVAC Equipraeut Cb au%'e-out
HEM P rovi&r
tbp'cAl
StreetAddress:
250 c�rn'pino Avel
E nle�r 7ested Laskage, P bkw i n CPM from CP -61k: Pre-Tayto'f EArd ng,15 uc'l SyM'm Prior b
D uU.Systern A Iteration a nd/or Equipmerit Cha ngp-Out.
Calexico cA k�31 j
HERS . RATER CO MPLI ANC E STATEM ENT
The hD use was:Y' 0 -Tea Lod Appm vc5d as paTt o Fsample Lcsfin�, bu L was Tfol,le;�L�d'
As the HEM raw providi n,&, diagnostic� testi ng a nd f ield veri fication I mni fy that the bouse. identif ied on tb is for rn compl ies. w itli
.tbe,di, n rernents as cbml6ed -/on-tb is, Lrm. U%e HER& rater must cbe4A a nd,veri fy1bat the neAw
I>tdin i ti re correcA tape is used before a CP -,4R may be released on emy teFted buildi ng, TbeHUM
M'.� F
rater a no a. proper Ij completed a nd signed CF -6R bas b&w recei'ved for 15e, mmple. and tzleA
bLLlld* '9$.
7
,Ze i nsla I ler bas provided a copy of CP -6R (I nat I lation Certi ficate.).
Eir J��tw D i7tribution system,is f ul ly ducted (i.e., does not use building, qavities as ple�n LL= or iaifz>rmr�liLrn�inlieLLOfZILLi--l�).
p
6r ewsys hem clol.k bicked. Tubber ad hesi Ye duct Lape is ins Lal led. Tnasfic_ and dfaw bands am used in
LeTns w
ccrrnbinaficrn wi Lh clol,h backed, tubbcr adhesi Ye - d ml. L* Lo seal leaks al. d wCoonncr-Lion's.
I
V, rxyrNrwm RuQurIkFMENT-s FoRDucrLEATCAUEREDUCTTON commuNcE cRFDrr
PrObe6cresfOrfieyd djagA0.9fk fesfin ofair disfribufjoytswients are aLfulable "t RA CM Appe.PAX R C4.3
1) wl, Diagnce Lic Leakage Tesiing Res ul Is
WUW
CONSTRUMCN:
DLLa P ressur i2ation Test Results (C'FM @ 25 Pa I )
MeaALred
Values
I
Emu Tested Leala�ge� P love in CPM:
2
Pan F love: CalculateA (Komi na 1: v' 0 Gnol i ng, V 0 Heati ri�) o r V 0,Measured
EnIp.r total Pan Plow in CPM:
Ll 600
ve
3
'Pase if Lealcage, Percutage.:5' 6% [.1 OD.8 [_(Li ne, W 1) / _'(Li ne, W 2)]]
0 Pass 0 Pail-
ALTERATTONS: Duct -Sygem audl/o� BVAC Equipraeut Cb au%'e-out
4
E nle�r 7ested Laskage, P bkw i n CPM from CP -61k: Pre-Tayto'f EArd ng,15 uc'l SyM'm Prior b
D uU.Systern A Iteration a nd/or Equipmerit Cha ngp-Out.
5
Enie� ' r 7e?o Lealc�g� P bkw i n CPM:, FinEd Test of New Dud System or-Alte.red Durn System
for Dud,System A heration and/or Bqdipment Cbange�-Out..
6
E nipr ReAuction i n Lealc�ge for Altered Dua Systm [_(Li ne, W 4) �,Min us. Line. W 5)]
(Only if Appi ic.'able)
7
En le�r Tened Lealmge. P love i n CPM,tobutyide. (On ly'i f Applicable) .
,a
R nti re. New Dupt Systern - Paw i f Lealcage, Percentage.:5 6%
[100X r (Line 1N 5) 1 Lire*2)]],
0 Pass -0 Fail
OR . VERTMA7117ON'STANDARDS! For Altered Duct Syst�Tn aud/4r.RVAC,"IpTn�ent Cbiu%e-�t
. . . I . -1 - . .. .
Use oue of the &1'6wiu% four Testor VeWlc atlou St aud ards for c6nipliauce!
/,,
Pass i f Leakage Percentage:5 15% f I 00.x [ _'L2 0 6 n e W /'_.�1_6 _00' (L i n e W
Ll 2.9
Pass 0 Pail
10
Pass i f Leakage to,O utside PementAge.:5'I 0% [1 00.x. [—(L ine, W 7) (Li ne. -N 2)]]
0 Pass 0 Pail
IY
Pws-ifL�almge�l�edurn.ion Psrcentage� 60% [100x [_(E�in�_�6) (Liiie441)]f
. I I . I . I .
and Veri fication by 3 molce.Test a rid Visual Inqwtion
0 Pass.0 Pail
Pass] f Seal i nj of a 11 Aco—wsible� Leaks and Ver if ication by. Smob-, Test add Visual I rispedi6n.
0 Pass. 0 Pai I
Pass If One of Lties #'9-tbrou%b 12 pass
IX.Pass 11 %il
'NeffizexbW Apfil 2WS
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
YVEBSITE: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address:
484 HWY 99
Owner:
Pennit No: B06-2870
APN:
024-160-033
SWENSON, SCOTT D FAMILY
L
Permit type:
MISCELLANEOUS
363 G ST
Issued Date: 12/19/2006 BY KCG
Subtype:
HVAC Change Out
LINCOLN, CA 95648
Expiration Date: 12/19/2007
Description:
HVAC CHANGE OUT
(916) 645-7800
Occupancy: Zoning: A40 0
R B SPENCER INC
1188 HASSETT AVENUE
YUBA CITY, CA 95993
(530) 674-8307
R B SPENCER INC
1188 HASSETT AVENUE
YUBA CITY, CA 95993
(530) 674-8307
FEE INFORMATION
Heat Pump (Package Unit) $55.00
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
R B SPENCER INC 664429 / C-20 C-38 / 02/28/2007
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter
k6itrimencinYwitM,ection 7000) of Division 3 of the Business and Professions Code, and my license
12/19/2006
Date
I WORKERS"COMPENSATION DECLARATION I
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
W'r�HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
S Clio
Section 3700 of 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 Zenith insurance CO Policy Number: Z066827303 Ep. Date:04/1112007
(This section need not be completed it me permit is tor one hundred dollars ($100)_or_1e_s_sT_
FI CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
DISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Ycompensat:ftf California. and agree that if I should become subject to the workers'
—Sorripensal ?I ns of Section 3700 of the Labor Code, I shall forthwith comply with those
12/19/2006
Signature — I-' Date
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEYS FEES.
Building
Other
$55.00 Fees
uare tbotage:
Garage Remdl/Addn
Porch/Patio Total
Balance Due: $0.00 Receipt No:
I OWNER / BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
pursuant to the provisions of the Contractor's 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];
Please check one of the following:
1. 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 License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.).
1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (See. 7044, Business and Provessions Code:
The Contractors License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractors License Law.).
El I AM EXEMPT under Section B. & P.C. for this
1 12/19/2006
Ix
I Owner's Signature Date
I CONSTRUCTION LENDING AGENCY k �m
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lender's Address city State Zip
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the Aissuance f IN .
is permit. I hereby acknowledge that issuance of this permit does not authorize the
use or o ncy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County fie above mentioned property for inspection purposes. I hereby certify that I am the
0
or am au property owner's behalf.
5or!yd to act on the
'00, 12/19/2006
WardlF–oWermittee [SIGN] int Date
Owner , ZorrOR: 1:1 Agent for Ovvne�WAgent for Contractor
FILE COPY
BUTTE COUNTY . .
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
A FEE WLEL BE REQ UIRED A T TIME OF APPLIC4 TION
Website: www.buftecounty.net/dds
"PLEASE PRINT CLEARLY"
.q OWNER INFORMATION
Amur�,"j
r
Mailing Address
Cy
Subdivision Name
Zi
Phony/
lax
E-mail
For office use oni Y:
CONTRACTOR
Name
Occ.
Addres
Subdivision Name
city
Page
Sta
ZV5
EPhone
Name
F
E-mail
Lic.
��/ (I-
For office use oni Y:
ARCHITECTIENGINEER
Name
Occ.
Address
Subdivision Name
city
Page
State
Zip
EPhone
Name
Fax
_m
Ea
State License Number
For office use oni Y:
APPLICANT INFORMATION
Name
Occ.
Addre
Subdivision Name
city
Page
Sta
1
Phone
Name
Fax
E-mail
For office use oni Y:
Zoning Flood Zone
sRA I Yes T—No
Occ.
I Type Const.
Subdivision Name
Map Book
Page
Lot #
!Pla nner
f —
Date App roved: -
I
PERAUT
NO.
OG 3101
BIN H
PROJECTLOCATION
AP# —02.q-160- 03b
P
,Wdr!;�s
Cross'Street'
WORKER'S CO MPENSATION
Policy Numb
Carrier -�744
If hiring anyone other than license contractors, a certificate of workers
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Descr ption or Scope of Work:
Sq FT- Living Garage Open Cov
0 Structure Built without Permits
13 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.
t C__ r10
Received by: Amount: DS_ Bldg
Receipt #:'6 aq[
SRA
Sheriff
Date: 0"3 Other
1 Total
024-160-033t �ERMiT#94-2273
--T
-KTETN, 9RR=ENE
484 HWY 99, GRIDLEY,
ELE WIRING/RiESTAURANT
� vAlvytll
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-754 PERMIT NO.
APPLICATION AND PERMIT f!�� �) 2s
ASSESSOR PARCEL NUMBER 024-160-033 ZONIN k4lQ
BUILDING PERMIT
OWNER TELEPHONE
DARRMINE KLEIN(CROSSROADS RL 824-6058
SQ. FT. OCC. BUILDING VALUATION
OWNEWS MAILING ADDRESS 73 H011rTS AV'p STHOME)
CONTRACTOR'S NAME
BOB STRANG ElEr.
TELEPHONE
_933-2M5
CONTRACTOR'S MAILING ADDRESS
] 1577 HITIDALE OROVITIE,
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation
LENDER'S MAILING ADDRESS
Filing Fee $ 20.00
Permit Fee
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
Energy Plan Checking Fee
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
BUILDING ADDRESS 484 MTY 99
PERMIT FEE $
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
Solar or heat pump water heater 23.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Water piping 15.00
Each gas water heater or vent 15.00
USE OF STRUCTURE
SF 0 Duplex 0 Mobilehome El Other RESTAURANT
SPECIFY
Gas piping system 1 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W @20.00
TYPE OF WORK
New Q Addition 0 Remodel C1 Utilities Q Installation Q Other
DescribeWork: CLEAN UP qAZAPMUS E17C WIRIING
PERMIT FEE $
Contractor
ELECTRICAL PERMIT Filing Fee 20.00
Main Service '"R LESS
200A 0 LESS 23.00
Main Service 200A TO IOGOA 46.00
NEW CONST. DWELLING OCCUR
OR AODNS. & ACC. BLOS. 3.5 0 S(T.'
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
ID I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. el;6- r re Classification c_: - o'd
0 1, as the owner, -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)
0 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
0 1 am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
NON.RESID. BRANCH CIRCUITS @7
POWER APPARATUS
SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES 20 @ 1.00
BAL. Ca So
Ex. Occup. ( OFIXED A'PLNS. OR
_. UTLITS (RESID.) EA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
WORKER'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
Q This permit is for $100.00 (valuation) or less.
0 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
I shall not employ any person 1 i
;hanymannerso asto becomesub ecttothe Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
Contractor
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation L
PERMIT FEE $
Contractor
I certifythat I have read this application and state thatthe above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
entei 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
County in consequence of the gran ing f this permit.
X e Date ;'�e
72 4 4e�_ h,
Signkure of Ap. I, .—r El Contra�c�k--O_Agent j,�/
An OSHA permit is required for excavatidnii over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
I
TOTAL FEE $ 66-00
HAZ.
1 0. FEES
I IMP
I FLOOD -I
CDF
PARCEL I PD
I HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do w ork
indi cated i6ove for which fees have been �aid.
B
PERMITEXPIRESON
Ma re)
Receipt No. 167291
WHITE-O.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD-APPLI CANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone. 916.'538-7541
APPLICATION AND PERMIT
PERMIT N
ASSESSOR PARCEL NUMBER
024-160-033
ZONING
A —40
BUILDING PERMIT
OWNER
The Crossroads (Darrellyne Klein)
TELEPHONE
SQ.FT. OCC. BUILDING VALUATION
OWNER*S MAILING ADDRESS
484 Hwy. 99 E., Gridley 95948
CONTRACTOR'S NAME
Jim Fav Backhoe
TELEP ONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
None
UNKNOWN
Total Valuation Is
Filing Fee
$ %X=
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
. None
LICENSE NO.
Plan Checking Fee
$ 40.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$40.00
PLUMBING PERMIT
FilingFee 1 15.00
484 HwV 99, Gridley
Each Trap
1 5.00i
Solar or heat pump water heater
1 20.001
LOT NO.
USDIVISION NAME
1
PARCEL MAP
1
Water piping
1 7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SF R DuplexR MobilehomeR Other RPSt"Allrant
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
1 15.00 15.00
Mobile Home S I G I W
615.00
TYPE OF WORK
Newl r_ " Addition D RemodelE] Utilities[�] InstallationD Other R
Describe work: Replace Grease Trap
Permit Fee
$30.00
Contractor
ELECTRICAL PERMIT
FilingFee 15.00
Main service 600V OR LESS
200A OR LESS
18.50
Main service 200A TO I OOOA)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License �,Io. Classification
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.-, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUPM
OR ADDNS. AC C. BLDG S.
3.6$ sq.ft.1
W CONS" MULT'-OUTLF
N E - T
NO -RESI-, BRANCH CIRCUITS)
@ 5.00
(POWER APPARATUS &)
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
��20 @ 763o
OCCUP. FIXED APPLNS. OR
Ex. OUTLETS (RESID.) EA.)
3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
I
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
1 � The permit is for $100.00 (valuation) or less.
E] I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
FilingFee 15.00
Heating
Cooling
Hood
6.5
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
I s correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned 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 County in consequence of the granting of this permit.
X Date
Signature of Applicant Owner E] Contractor 11 Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee 41
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $ 70.00
HAZ
I D FEES I
IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date
140567
Receipt No.
11.1_1_.�-ASSESSOR. PiNK-INSPECTOR. GOLDENROD-APPL I CANT
A
COUNTY OF BUTTE - DEPARTMENT OF QEVU
,OPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE_,CALIFORNIA95965 -TELEPHONE (916)538-7541
PERMIT APPLICATION DATA SHEET
OWNER 7 Lioss Y'cad S A. P. N o OP Al - & - (9! �3
Proposed Building Use Q Tf'o Building Inspector (ih Date 2
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1 . All items have been submitted . ............
2. Plot plans, 3/4 sets, signed by preparer of plans . ..........................
3, Complete plans, 3/4 sets, signed by preparer of plans . ......................
4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5.. Hazardous Material Form . ........ ....................................
6. Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check).
9. Mobilehome data and manufacturer's installation instructions, 2 sets . ...........
10. Fees Of $ . .........................................
11. Impact fees as shown on attached schedule . ..............................
12. California Department of Forestry plan approval/fees .........................
13. Flood elevation letter (100 year flood) by California Engineer ...................
14. Sanitation and plot plan approval . Health Department . ............
15, City of Chico plumbing permit . .........................................
16. Plot plan and business license approval from City of Biggs/Gridley . .............
17. Planning approval for (A) Use: (B) Parking:
18. Contact Land Development about (A) Improvements (B) Drainage . ...........
19. Driveway permit (construction approval required prior to occupancy). P4,;!�sp*e . cli . o; r�q* est
20. Pre -inspection for required. to Building Inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23. Owner -Builder Verificatio* n (Given to owner , Mail to owner ) ............
24. Recorded copy of Agricultural Acknowledgement Statement . ............
25. Letter of signature authorization . ..................................
26. Copy of recorded deed of parcel creation and 60 right of way to a public road.
27. Letter of intent on building use . .........................................
28. Mobilehome utility clearance . ..........................................
29. Documentation of legal access . ..................... ..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
When you issue the permit, process as follows:
X Telephone Im – L�Pqind hold for pickL
_!3L11
Other n1a
Parcel Creation
Acreage 6�0 14 in �Q_ C ex r f e- Y"
— Mail to owner. Mail to contractor.
p at 0 re) office. Deliver with inspector.
Applicant
Date Apy_�,27 /71_�
Copy of Haz-Mat form sent Health Dept. _ Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. _ Other Date By
The following data must be submitted prior to
1. Index permit for above items No.
2. Additional items required:
ance: (Circle new item not checked above).
Contractor, designergEn�), was advised of above required data by phone — mail Counter lb#��Date I
Contractor, designer, owner, was advised of above required data by phone — mail Counter by Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
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7 1
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (916) 538-7541
FAX: (916) 538-2140
Darrellyne Kein DATE: May 17, 1993
The Crossroads Restaurant
484 Highway 99 E. RE: Proposed Grease Interceptor
Gridley, CA 95948
Dear Ms. Kein: A. P: - 024-160-033 — B.P.# 93-1138
With reference to the above subject, attached is:
Plan check list
Red marked calculations
Red marked plans
Other:
ACTION REQUIRED:
Comply with plan check list
Resubmit plans with revisions as required
Resubmit calculations with revisions as required.
Remarks: — Calculations in accordance with appendix H of the 1991 Uniform Plumb ng
Code indicate that a grease interceptor with a capacity of 4,000
gallons is required. Provide plans and specifications for the propo5ed
grease interceptor.
If you should have any questions, please call (916) 538-7541 , between 3:00 & 5:00.
Verv-trulv vours
Jo��,.R. HeAry
Plan Check Engineer
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BUTTE COUNTY DEPARTMENT'OF PUBLIC HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
1469 HUMBOLDT ROAD 7 COUNTY CENTER DRIVE 747 ELLIOTT ROAD
CHICO, CALIFORNIA 95928 OROVILLE, CALIFORNIA 95965 PARADISE, CALIFORNIA 95969
(916) 891-2727 (916) 538-7281 (916) 872-6308
APPLICATION FOR PERMIT TO CONSTRUCT A SEWAGE DISPOSAL SYSTEM
Owner's Name Assessor's Parcel No.
Applicant's Name Phone No.
Mailing Address
1. Construction Site
(Street and number or direction and distance to nearest crossroad)
2.
Lot Size feet x - f eet.
— acres
3.
APPLICATION FOR: New system for new building El
Auxiliary or secondary system 11
Repair of or addition to old system
New system to replace existing facilities El
4.
Type of building to be served by proposed system:
Mobile Home E] (size No. Bedrooms Garbage disposal?
House No. Bedrooms
Garbage disposal?
Other (specify)
5.
Water supply- for premises: (Must be safe, potable water)
Community 0 Private well 0 Other
Water s upply for ajoining properties:
Community [:1 Private well 13 Other
6.
WORKMEN'S COMPENSATION INSURANCE
I have placed on file with the County of Butte a certificate of Workmen's
I am swore of the provisions of So6lon 3700 of the California Libor Code.
Compensation Insurance.
Which requires every employer to be Insured against liability for Workmen's
11
Compensation.
1 certify that in the performance of the work for which this permit Is
Issued I shall not employ any person In any manner to is to become subject to
the Workmen's Compensation Laws of California.
7.
SCALE PLOT PLAN TO BE FURNISHED
Sketch to scale on reverse side hereof, or attach scale sketch of plot plan of the premises showing:
a. Property lines.
b. Location of all proposed and existing buildings,
structures, driveways and parking areas.
c: Location of large trees, rocks, or other obstacles.
d. Location of any well, spring, creek or other body of
water on the parcel and within 100feetof property line.
e. Show direction and approximate amount of slope.
f. Source of water.
g. Water lines.
h. Set back lines and easements.
i. Proposed sewage disposal system and area for
replacement.
. I hereby state that the information above and on the reverse side hereof or attached hereto is correct and
true to the best of my knowledge. I understand that the permit must be obtained before any construction is
begun either onthe building or on the sewage disposal system, and that a satisfactory, inspection of thesystem
is required beforethe new building or dwelling may be occupied orthesystem backfilled, or putinto use. I also
understand that a safe potable water must be supplied to the new building or dwelling before occupancy can
take place.
Signed
Date
Owner Authorized agent 0 Licensed contractor 0
(An original letter of authorization must accompany this application in order for
an authorized agent to sign.)
FOR OFFICE USE ONLY
Legal Darcel? Zonin Usepermitted?
Access Rcpt. go. Amount
Water plans cleared Potable water
rnMMAnt
S4-57SR
IF,
BUTTE COUNTY DEPARTMENT OF HEALTH
FOOD PROGRAM OFFICIAL INSPECTION REPORT
OBAI NAME-
B E CORRECTED. - THE NUMBERS REFERENCED, CORRESPOND TO VIOLATIONS OF THE CALIF. UNIFORM
DATE
iLa
I
I
ADDRESS
r k
RECHECK DATE
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744'
OWNERIOPERATOR
COMPUTER NUMBER
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MAILING ADDRESS
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TIME IN
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SERVICE
TIME OUT
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OFFICE ADDRESS AND PHONE NUMBER
RECEIVED BY:
APPLICABLE LAW
PERMIT LICENSE
1469 Humboldt Avenue 7 County Canter Drive 747 Won Road
THE NUMBERS AND/OR ITEMS CITED BELOW REPRESENT HEALTH AND SAF= VIOLATIONS WHICH MUST
B E CORRECTED. - THE NUMBERS REFERENCED, CORRESPOND TO VIOLATIONS OF THE CALIF. UNIFORM
RETAIL FOOD FACILITIES LAW LISTED ON THE REVERSE SIDE.
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OFFICE ADDRESS AND PHONE NUMBER
RECEIVED BY:
ESTAB. STATUS: (MARK ONE)
CA
1469 Humboldt Avenue 7 County Canter Drive 747 Won Road
SANITARIAN*
1ZL'.r-�-) /--X'-0-/o
77 78 79 80 81
EF� G [-]. A L F pf-]
Chico. California 9S028 Oroville. California SS966 Paradise, California SS969
(9161 891-2727 1916) 538-7281 1916) 872-6308
13 0
I PAGE OF ��
S184
BUTTE COUNTY DEPARTMENT OF HEALTH
FOOD PROGRAM OFFICIAL INSPECTION REPORT
OBAINAME
C�-c�-5 -7cj4ce-L
DATE
4 -
ADDRESS
RECHECK DATE
OWNERIOPERATOR
COMPUTER NUM9ER
/& jZx
MAILING ADDRESS
TIME IN
PROGRAMIELEMENT
)1, -,.-,?4
5l-
TIME OUT
APPLICABLE LAW —
PERK41T LICENSE
THE NUMBERS AND/OR ITEMS CITED BELOW REPRESENT HEALTH AND SAFFIY VIOLATIONS WHICH MUST
B E CORRECTED. - THE NUMBERS REFERENCED,. CORRESPOND TO VIOLATIONS OF THE CALIF. UNIFORM
RETAIL FOOD FACILITIES LAW LISTED ON THE REVERSE SIDE.
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ESTAB. STATUS: (MARK ONE)
77 78 79 80
EF] GF -] A[] F 1--] P F] 1
OFFICE ADDRESS AND PHONEAUMBER
1469 Humboldt Avenue 7 County Center Orive 747 Elliott Road
:phico. California 96928 Orovills, California 96966 Paradise. California 96969
1116) 891-2727 19161538-7281 1916) 872-6308
0 1-3 11
RECEIVED BY:
SANITARIAN:
PAGE 5 OF
5184
BUTTE COUNTY DEPARTMENT OF HEALTH
FOOD PROGRAM OFFICIAL INSPECTION REPORT
OBA I NA7
OATE
AOORESS
RECHECK OATE
OWNERIOPERATOR
COMPfjl`!�,U�78-ER
MAILING ADORESS
TIME IN
PROGRAMIELEMENT
//C J -
SERVICE,
TIME OUT
APPLICABLE LAW
PERK41T LICENSE -
THE NUMBERS AND/OR ITEMS CITED BELOW REPRESENT HEALTH AND SAFETY VIOLATIONS WHICH MUST
BE CORRECrED. - THE- NUMBERS REFERENCED , CORRESPOND TO VIOLATIONS OF THE CALIF. UNIFORM
RErAIL FOOD FACILITIES LAW LISTED.ON THE REVERSE SIDE.
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ESTAB. STATUS: (MARK ONE)
77 78 79 80 81
E [—] G A [] F 17' P
OFFICE -ADDRESS- AND PHONE. NUMBER
14069 Humboldt Avenue 7 County Center Drive 747 Elliott Road
Chico, California 96928 Oroville. California 95966 Paradise. C&Ufomia 96969
19161891-2727 (916) S38-7281 (910) 872-6308
13 1:1 '
L 0
RECEIVED BY:
SANITARIAN:
PAGE OF
L
5184
BUTTE COUNTY bEPARfMENT OF HEALTH
FOOD PROGRAM OFFICIAL INSPECTION REPORT
OGAiNA
DATE
ADDRESS
RECHECK DATE
OWNERIOPERATOR
COMPUTER NUMBER
MAILING ADDRESS
TIME IN
PROGRAMI ELEMENT
SERVICE
TIME OUT
APPLICABLE LAW
PERMIT LICENSE
THE NUMBERS AND/OR ITEMS CITED BELOW REPRESENT HEALTH AND SAFEIY VIOLATIONS WHICH MUST
BE CORRECTED.- THE -NUMBERS REFERENCED, CORRESPOND TO VIOLATIONS.OF THE CALIF. UNIFORM.
RETAIL FOOD FACIL ITIES LAW LISTED ON THE REVERSE SIDE.
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OFFICE ADDRESS AND PHONE NUMBER
RECEIVED BY:
ESTAB. STATUS:'(M4RK ONb)
1469 Humboldt Avenue 7 County Canter Drive 747 Elliott Road
SANITARIAN:
77 - 78 79 80 81
Chico. California 96928 Oroville. California 96966 Paradise. California 95969
EF-] G r—] A[] F I—] Pr� 1 i
! 1116) 891-2727 1916) 538-7281 (916) 872.6=
1:1 11
PAGE OF ig .4
5184
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A\ALABLE UPON REQUEST
zMATERIAL SPECIFICATIONS:
A-CCNCRETE� PORTLAND CEMENT TYPE
11 MINIMLIM COMPRESSIVE STRENGTH
�600 PSL AT 28 DAY,%
B.REINR)FCING BAR INTERMEDIATE
GRADE ASTM A615
CREINFdtING Wa-DED WIRE MESH
ASTM A185
PRECAST UNIT COATED INSIDE WITH
AN APPROVED PROTECTIVE COATING.
4 ALL DIMENSIONS+ OR - NOT TO BE
USED FORCONSTRUCtION PURPOSES
UNLESS CERTIFIED
5 PR TR �$P%Vffil) ON
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890 SOUTH �-� ARROVO PKWY.
PASADM, CALIFORN A 91105
3000 TO 450D GALLON CAPACIT Y
GREASE INTERCEPTOR
TYPICAL FOR LOS ANGELES COUNTY
I AND VARIOUS AREAS IN CALIFORNIA
DWG. NO 8028
DATE 9-19-78
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1 AM VARIOUS AREAS IN CALIFORNIA
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DATE 9-19-78
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B MI*,ALJM COMPRESS XSTREM
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3- laKINFOFICING BAR INTERMEDIATE
GRADE ASTM A615
C. VN- WO -DED WIRE MESH
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DATE 9-19-78
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024-160-033 PERM-I'T#95-1818.�...
THOMPSON, Ray
486"Hwy 99E*, Gridley
Reroof/SF
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I
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916),538-75 PERMIT
APPLICATION AND PERMIT
ASSESSOR Mmmam
BUILDINGPERMIT
0
TELEPHONE
-so. Fr,.-, - - OCC. BUILDING -VALUATION
Qar)
7
TBEF
CONfRACTOR's MOUILING ADDRESS
Fireplace
KNOWN
Total valuation S
Filing Fee
20 -OC
LEMOM ADDRESS
Permit Fee
AIRCHITECT Oil qQINEZIR
4_1e_,9 no
LID I EME NQ
I - .
Plan Checking Fee
Energy Plan Checking Fee
—
ARCHIMCT OR ENGNEERS MAILING ADDRESS
Penalty
OUILSIMADDRESS
49-6, Hw -,;z 9Y. (0 'P
PERMITFEE S
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
SUBMSIONS
PAAwCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF Duplex 0 Mobilehome 0 Other.
SPECIFY
Each gas water heater or vent
15.00
Gas piping'system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New C3 Addition Cl Remodel 13 Ulilides E3 Instsilation 0 Other
Describe Work: r ro'� I/At / 1")
Mobile Home ISIGI
@20.00
PERMITFEE
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
600V OR Liss
Main Service 200A On LESS
23.00
Main Service 200A TO 1000A
46.00
LICENSED CONTRACTOR*S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000.) of Division 3 of the Business and Professions Code,
and my license is in full force and effect
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contiractors License
Law for the following reason:
1. as owner of the property. or my employees with wages as their sale compensation,
will do the work, and the structure is not intended or offered for nale.
1, as owner of the property. am exclusively contracting with licensed contractors
to construct the project.
1 am exempt under Sec. Business and Professions Code for this
reason — WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code. for the performance of work for which this permit is issued.
- My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is.for work of a valuation
of one hundred dollars ($100) or less.).
'0 1 certify that in the performance of the work for which this perm - it ii issued. I shall
not employ -.any person in any manner so as to become subject to workers'
compensation laws of California. and agireii that if I should become subject tor the
workers' compensation provisions Of section 3700 of the Labor Code. I shall
forthwith comply with o -se provisions.
X I Date
Sk, pplicant - 0 Owns 0 Contractor. 0 Agent
4.,,]IOf
An OSHA permit is required for excavations over To' deep and de molitlan or construction
NEW CONST. DWELUNG OCC SOL
OR ADONS. & ACC. awsup. 3.5c Fr.
NEW CONST. ZIULTI-OUTLET
NON-RESIO. BRANCH CIRCUrn 7.50
APO ER APPARATfR
S;W4GLE
OUTLET OR FIXTURES 209 1.00
Ex. Occup. ( I 11AL Q .50
FIXED A -1.14S. OR N
Ex. Occup. ( OUTLEM (FIESID.) EA i 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMITFEE
Contractor
MECHANICAL PERMIT Filing Fee 20 -OC
Heating
Cooling
Hood 6.50
Ventilation
PERMITFEE S
Contractor
Mobile Home Installation Fee
Energy Inspection Fee Is
OCC
CONST. TYPE
I
ITOTALFEE$
Z. 1 0, FEES I imix I FLOOD 1 COP PARCEL PO I NO I GSLI
This permit is hereby issued under me applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated,dbove for which fees have been paid.
J
By oste 1A Al
COUNTY OF BUTTE - DEPARTMENT OFSEV�LOPMENT SERVICES - BUIXLDINIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) -754i�.,,, ,PERMIT NC
APPLICATION AND PERMIT
ASSESS ELNUMSER J/
ZONING
U ILDINGPERMIT
OWNER
'04 An MA 10 VA
TELEPNI0NE
SO. FT._ 40CC. BUILDING VALUATION
00"TRAM: ,, NAr -
COWRACTOR'S WJUNG ADDRESS
Fireplace
CONSTRUCTIO LENDER
0--
UNKNOWN
Total Valuation $
Filing Fee $ 20.00
.77
LENDER'S MAILING ADDRESS
Permit Fee $
ARCH(M.1 Otr
--0— 1) __ -
14 jER(?
LICENSE NO.
I
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECTOR ENGWEERS MAILING ADDRESS
Penalty $
BURAMADDRESS 66"
48-(S lVw y
PERMITFEE $
PLUMBINGPERMIT Filing Fee 20.00
Each Trap 7.00
UDTNO.
SUBDIVISIONS KAM
1
PARCEL MAP
1
Solar or heat pump water heater 23.00
Water piping 15.00
USEOFSTRUCTURE
SFkf Duplex 0 'Mabilehome 13 Other
-- SPECIFY
Each gas water heater or vent 15.00
Gas piping'system I - 5 outlets 15.00
Building sewer 15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilitie 13 flation [3 Other
es o-
Describe Work: Pon
Mobile Home ISI GI W1 @D20.00
I.
PERMITFEE
Contractor
ELECTRICAL PERMIT Rlinq Fee 20.
OV OR LESS
Main Service 6.00A OR LESS 23.00
Main Service 200A TO 1000A 46.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Secton 7000) of Division 3 of the Business and Professions Code.
and my license is in full force anc( effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
1. as owner of the property, army employees with wages astheir sale compensation,
will do the work, and the structure is not intended or offered for sale.
1. as owner of the property. am exclusively contracting with licensed contractors
to construct the project
1 am exempt under Sec. Business and Professions Code for this
reason WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation insurance. as required by Section
3700of the Labor Code. for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ.any perso . n- in any manner so as to become subject to Workers'
compensation laws of California. and agree that if I should become subject Ito the
workers' compensation provisions of section 3700 of'the Labor Code. I shall
'ie prqvisions.
forthwith comply with to/a
Date
SiJKaiLme- O-&APPlic-ant - 0 Ownel 0 Contractor. 0 Agent
An OSHA permit is required for excavations over 60' deep and demolition or construction
of structures over 3 stories in height'..
NEW CONST. DWELLING OCCUP.
OR ADONS. & ACC. SLDS. 3.5. S."
NEW CONST. MVLTI-CUTLET
NON-RESID. BRANCH CIRCUITS 97.50
EA APPARATUS
1 PS9. %W
'GLE CUMLET C;;;
Ex. Occup. OUTLET OR FUTURES 20 @ 1.00
SAL Q .50
UP FIXED APP 'NS..OR
Ex. Occ OUTLETS (RLESID) EA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
--
PERMITFEE S
Contractor
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMITFEE S
Contractor
Mobile Home installation Fee Is
Energy Inspection Fee
OCC
CONST. TYPE
TOTAL FEE $ on
HAL 1 0. FEES I IMP FLOOD I COF PA�CEL P0 NO ISSUE
This permit is hereby issued under ine applicable provisions
0 f the Butte County Code and/or Resolutions to. do work
indicat for which fees havp bjeen pai
By Date
PERMITEXPIRESON PXI/
NSA W-1. 4-1
:51 *
OWNER: ��aLEe_41A_12_ kfe_�L DATE
LOCATION: A. P. #Z� 13;
�4 a q
CONTRACTOR: ZONING
---------- ---------
PRE-INSPECTION FOR:
DATE TO INSPECTOR
PERMIT HISTORY: E3' NONE AS FOLLOWS:�,__=
TYPE OF OCCUPANCY
FIELD - INFORMATION
BUILDING USAGE:
TENNANT:
OCCUPIED HAS ELECTRIC F]W.IS GAS HAS SANITATION FACILITIES
HEATED -COOLED PERSON CONTACTED
OTHER COMMENTS: C /0 g,2r--P C�OVUa.4-r/_ ,,-J
r
ACTION RECOMMENDED: ��jor,�r ck4-L-5 -50 cov'v 17 --
ISSUE H&H)-F�
C
M/N
ol
L) ', -r
DATE
�7
k// r -y/
CoVou—r 4
Oco/u
Jim Ar old
SE cor LLr ve., &
3
a S.O idley
P 5527 P(new restalant)
%,,Double V/V 24-16-3-3
ri'a,
�A Khon
cor f Hwy 99 & Turner Ave.,
Gridley
Permit #17;84- additi & A
remodel/restaurant Ai- Ain -M
2 4 - 16
Contr: S 1- raft onst, Paradis
9,,rmit 523-81P,E,M(p1bg/.-e1e-,
mecV?7842-3818)rPesEtaurant .
24-16-33
FRANK MEYERS
484 HWy 99, Gridley o' /A-V
Contr: Cogeneration Pow Sac 0
.4
PErmit#3543-87P,E(plbg &ele for
co generation plant) restaurant
24-16- H� .1
ContR: Tabish Const. I Aql
Permit#1278-90B(install vi 1 sid.ng/coi
24-16-33
Permit#763-91B,P,E,M
(repai'rs-7'restaurane�4 - ( V19
24-16-
PermitkK�-91.
(mansard roof/restaurant)
24-16-33 1050-9 B.
KLEIN, Darrellyne�
484 Hwy 99, Gridley eyers)
(trans owner from Frank M
24-16-33,
Permit#1135-91B
(enlarje -window/restaurant
UZ4-lb-0-033 93-1138 B P
KLEIN, DARRELLYNE (THE CROSSROADS,,
484 H14Y 99, GRIDLEY
CONTR: ij�j FAY
REPLACE GREASE TRAP/RESTAURANT
GE ZZ,
OF
CDF / BCFD DAILY INCIDENT LOG
JAY/DATE FROM 080Q 1 DAY/DATE TO 0800/-,-Z�
i * ** ** ** * * * * *** ******* **-*** *** *** * * ** if * * * * * **-**
V, �,� '.
PIA -lo,
i
Z�AVW: u I MtK tvulr: MtUIL..3
LAND USE: ACRE/TYPE TOTAL
OWNER/TENANT WRA
R.P. r, I Ll B.I.
MISC.:
M Q3 L.:
CAUSE: ENGINES: CDF BCFD I CO# OFFICER:
DAMAGE: so WT 007 CREW AA AT Hr
v MISC.:
INC # FIRE40.4023 NAME 5,-cka_a TYPE
REPORT TIME (1-3 STA TIME ;? -15ORTROL TIME Y,9 R.O. Bkotof)- STA. '13
LOCATION: 6, ld,�eC, 6 HK)V 4u,�Ple F- 6 Ako!4 99 BAT. 3
C�,/CAUSE: 114111- JI-sk ENGINF-S-- MF f BCFD 2, CO#7812�hJFFICER;
Z DAMAGE: & so WT DOZ CREW AA AT K
S VED: 77- OTHER EOUIP: MEDICS
OWNF-RfTENANT Lht, �Lfj .4VAa--f4CZ2 WRA
R.P. B.I.
MISC.:
s BAT.
BCFD- CO# !T?, OFFICER:
DOZ CREW AA AT HC
v MISC.:
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California9,5965 - Telephone (916) 538 75 RMIT NO.
APPLICATIaN-Arb PERMIT !���'*73
ASSESSOR PARCEL NUMBER 024-160-033
ZONING A40
PILDING PERMIT
OWNER
DARRELLINE KLEIN(CROSSROADS R?,.
TELEPHONE
824-6058
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS 73 HOTITS AVE, STHOME)
CONTIFIACTOR'S NAME
BOB STRANG FLEG
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
1 1977 14TILDAT.E. DROVIT.T.F.
Fireplace :r
CONSTRUCTION LENDER
—Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee $
Penalty $
13UILDING ADDRESS 484 HWY 99
PERMIT FEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Water piping
15.00
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF El Duplex Q Mobilehome 0 Other RESTAURANT
SPECIry
TYPE OF WORK
New 0 Addition 1:1 Remodel El Utilities 0 Installation Q Other it
DescribeWork: CLEAN UP HAZARDOUS ELEC WIRING
Gas piping system 1 5 outlets
15.00
Building sewer
15.00
Mobile Home S G I W
@20.00
PERMIT FEE $
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service 2101V 01 LESS I
OOA OR LESS 1
23.00
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. & ACC. BLDS.
3.5 0 STO.
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force, and eftect.
License No. </A-1-0 _T2 Classification e--,oa
1, a s the owrfer, -or my employees with wage—s as their sole compensation, will do
the work, and the structure is not intended or offered for sale. (Sec 7044)
I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
1:1 1 am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
NON-RESID. BRANCH CIRC ITS
@7.50
0 ER APPARATUS
PSIWN :T R.
.LE UTLr
Ex. Occup. OUTLET OR rIXTURES
20 @ 1.00
BAL. @ .50
Ex. Occup. OFIXED APPLNS, OR
UTLETS (RESID.) EA.
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring 2
23.00 46.00
I
I
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
0 This permit is for $100.00 (valuation) or less.
0 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
11 Certificate of Consent to Self -insure.
JWL I'Shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
66.00
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Contractor
I certifythat I have read this application and state thatthe above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
entet 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
County in consequence of the grantingpf this permit.
xcm -14�_ Z� Date el��
SignAt5re of Applicant- - 0_0w_n—er '1:1 Cont ac --I Agent r
r 0�
An OSHA permit is required for excavatir&.ver 75"0" deep and demolition or
construction of structures over 3 stories in height.
I
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONS TYPE
TOTAL FEE $ 66.00
HAZ.
I D. FEES
IMP
I FLO7
CDF
PARCEL I PD
I HD
III
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
in2dicalta ove for whZ'chf have b
, &
z4, hz.
B — law If Z L..f
PERMIT EXPIRES ON (Date)
provisions
to do work
n aid.
ate I, 9
n,
6 1#�)
ReceiptNo. 167991
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD-APPLIC ANT I
COUNTY -OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541
APPLICATION ARID PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER 0 , 4�)� 3
,_ 16L
/_/D
BUILDING PERMIT
OWNER����
TELEPHOP49
rq-dL11w)
SQ. Fr. OCC. BUILDING VALUATION
OWNEWS MAI,,7,ro�
CONTRAC:;��
TELEPHONE
CON=AJUNG AODRE�,
:2:7
Fireplace
CONSTRUCTION LENDER
XNo N
UN U
Total Valuation $
UENDEWS MAJUNG ADDRESS
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
ARCHITECT OR ENGINEEWS MAILING ADDRESS
—Energy Plan Checking Fee $
Penalty $
BUILDING ADDRESS
PERMIT FEE $
L
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
LOT NO.
SUBDIVISION'S NAME __T�MAP
Water piping
15.00
Each gas water heater or
15.00
USE OF STRUCTURE
SF 0 Duplex 0 Mobilehome Q Other er�—()k AtIrl—
SPECIFY
4vent—
Gas piping system 1 5 outlets
"u
15.00
Building sewer
15.00
Mobile Home S G W I
@20.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities Q Installation El Other'k—
DescribeWork: _4C HIAT 2,41Z
PERMIT FEE
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service ( '"ORLE S )
200A 0 LESS
23.00
Main Service ( 200A TO I OOOA )
46.00
NEW CONST. DWELLING OCCUP. I
OR ADDNS. & ACC. OLDS. 1
a
3.50 sFr.'
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
Q I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. Classification
0 1, as the owner, 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)
0 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
0 1 am exempt under Sec. Business and Professions Code
for this reason
WORKER'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
Q This permit is for $100.00 (valuation) or less.
1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
0 Ishall not employ any person in any manner so asto become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
NEW CONST. MULTI -OUTLET ---
NON-RESID. BRANCH CIRCUITS
@7.50
0 ER APPARATUS
TWN GLE OUTLET C IR
Ex. Occup. OUTLET OR FIXTURES
20 @ 1.00
BAL. @ .50
Ex. Occup. URTX�E0 AP N O�R
ET. 'ar s
'.6 A.
5.00
Temporary Service
—Facilities
23.00
Mobile Home
20.00
Misc. Wiring
23.00
PER FEE $
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
—
Hood
6.50
Ventilation
PERMIT FEE $
—
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
eritet upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the Co 'nt f B a against all
liabilities, judgments, costs, and expenses which may in any wayy occrure a s sai
ag * t
County in consequence of the granting of this permit.
X Date 7
(�a
Signature of Applicant - 0 Owner 0 Contractor Q Agent __7__
An OSHA permit is required for excava-ions over 5"0" dee�and demolition or
construction of structures over 3 stories in height.
Contractor
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONSI_ TYPE
TOTAL FEE $
HAZ.
1 0. FEE�
IMP
I F1O;O
I COF
I pX*EL
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.
By Date
PERMIT EXPIRES ON
(Date)
ReceiptNo. h6p !zz
WHITE-D.D.S.-S.D. 'CANARY-ASgESSOR PINK -INSPECTOR GOLDEN ROD-APPLIC ANT
COUNTY OF.BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, Ci;lifornia �5965 - Telephone: 916/538-7541
"' I -
APPLICATION AND PERMIT
A'SSeSSOR CEL NUMBER
2
ZONING
A—/.n I
BUILDING PERMIT
OWN
F P.
TELrPH`CTNE
SO. FT. OCC. BUILDING VALUATION
9
.W"';JWyUW,AMEd1ey, CA 9594F --
CONTRACTOR'S NAME'
TabiSh Construction
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
�,igr�M Gol d CJ = 1 e, Suite M
Fireplace
CONSTRUC ER
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 80.50
ARCHITECT OR ENGINEER __Ji7FFF_N
S E N 0.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
Ba4INP ADD E
Hwy KssGridley (Ellen's Country Diner)
Permit fee
$ 90.50
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME _7ARCEL
1
MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFEI DuplexF] MobilehomeF-1 Other CmImircial
SPECIFY
Gas piping system 1 - 5 outlets
1 5.00 1
Building sewer
5.00
Mobile Home S I G I W
10.00 e
TYPE OF WORK
New[ Addition 0 RemodeIE] Utilities[] InstallationE' Other
Describe work: install vinyl siding
I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
Main service II01V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADO'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of'perjury (check one):
2_11 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—'5'473 0_6A Classification
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
F] I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.&)
OR ACDNS. ACC.BLDGS.
21/20sq It
NEW CONSTR. MULT _T
'-OUTLF
NON-RESIO. BRANCH CIRCUITS)
2.50 ea 1
(POWER APPARATUS.&)
SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
1.20@50t
AL@ 30C
FIXED APPLNS OR
Ex. -Occup. OUTLETS (RESI'D.) EA.)
1 2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
I
15.00
I
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
[_� The permit is for $100.00 (valuation) or less.
IV I have placed on file with the County of Butte Building Department
LP a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure. I
I shall not employ any person in any manne . r so as to b4ome subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become sul,ject
to the.W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
FilingFee 10.00
Heating
Cooling
Hood
3.00
Venti lation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butt . e against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequenc the granting of this permit.
X /;_1J1H`92Z Id 2�"Wxll Date
Sign. fu a of Applicant — 0 4",C] Contractory Agent
e
Ane0`S'HA permit iS re ired foT y
.v. yi,, excavations over 5'0" deep and demolition or construct-
on of structures r stories in height.
Mobile Home Installation Fee $,
Energy Inspection Fee
OCC I
CONSTTYPE
16TAL FEE $
90.5011-
CUA [PAII��
I SCHL
I FLD
I �AR
JPD
I HD,J;,
ISSUE
Th's permit is nereby issued undbr.the
si�ns of the Butte Count, , dnrl,or
work indicated above for which' fees
I R E� /10
B y
PERMIT EXPIRES Date—
icable provi-
iutions to do
have been paid.
WORKS
Date
rReceipt'No. 66847
WHITE-D.P.W.. YELLOW-ASSfSSOR, PINK -INSPECTOR. GOLDENROD-APPLI CANT
COUNTY OF BUTTE - D'EP"A'RT'IENT_ OF PUBLIC WORKS PE - RMIT
0 it
7 County Center Drive - roli . --,,Call*ornia 95965 - Telephone: 916/538-7541
—
APPLICATION AND'PERMIT
ASSESSOR PARCEL NUMBER
24-16-11
ZONING
A -4p
BUILDING PERMIT
OWNER
FRANK & ELLEN MEYER
TELE_PHCrN E
SQ. FT. OCC. BUILDING VALUATION
0 wg2v - tJWy I", AttrMley, CA 95948
9 9GO
CONTRACTOR'S NAME
Tabish Construction
TELEPHONE
,
CONTRACTOR'S MAILING ADDRESS
" "' 5 ld Circle-, Suite M
Fireplace
1$
CONSTRUC�M';�ME9()
UNKNOWN
Total Valuation
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 80.50
ARCHITECT OR ENGINEER
LICENEE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
484 Hwy 99, Gridley (Ellen's Country Diner)
Permit fee
$ 90.50
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
Water piping
.5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFEI DuplexF� Mobilehomen Other Commercial -
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10-00 ea
TYPE OF WORK
New n Add i t i on [1 Remodel El Ut i I i t i e s [:] I n sta I I at i onEl Other El
Describe work: install vinyl sidinR
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
main service 111V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
L i cense No. Classification
F1 1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.N)
OR ADDNS. (ACC.BLDGS.
V20sq it
NEW.CON_9TR. MULT'_OUTLET
NON RES'D, BRANCH CIRCUITS)
2.50 ea
(POWER APPARATUS.&)
-SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
0 @ 50C j
52AL@300
OCCUP. FIXED APPLNS. OR
Ex. OUTLETS (RESIO.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
-FT
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F� 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 shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Venti lation
—
I
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
1 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 County in consequenc the granting of this permit.
Date
�Si g n " of Applicant 0 Contractor)z AgentEl
.r
An SHA permit is required fo�4xcavations over 54" deep and demolition or construct-
ion of str ctures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
90.50
TOTAL FEE $
HAZ
I CUA
[!��FLD
I PAR
PD
I H
T.h;. s permit is hereby issued under
---ns oi the Butte County Code and/or
work indicated abo e for which fees
7,
_AR� OR4J PUBLIC
C12�11
Bv_ I - - I —
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
Date le
& -
Receipt No. 66847
WHITE-O.P.W.. YELLOW-ASSr.SSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
m AjAtwuo � aly
0
q_0 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPL!r;kT110N ANn PFIQUIT
PERMIT NO.
ASSESSOR PARCEI_ NUMBER
0 ?_4 - I (,_a - ()3-,2 -
OWNER
ZONING
.
BUILDING PERMIT
&Lz�
TELEPHONE
SQ.FT. OCC. BUILDING VALU'ATION
OWNFR*S MAILING ADDRESS —
4 04 E� 9SCM
CONTRACTOR'S NAMV qq —
9 !�_, a
Fa bi �� &Mhmu 65 -an
ITELEPHONE
CONTRACTOR'S MAILING ADDRESS
1) *2) IS S Wn/U;EL Ir(d k4�_-h I A4;k
Fireplace
CONSTRUCTION LENDER
�UN---WN
Total Valuatiogn
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGINEER S
EN E NO.
Filing Fee
$ 1
10.00
Permit Fee
'P.
-Plan Checking Fee
$
— 86,
$
ARCHITECT OR ENGINEER'S MAILING 7_00RESS
BUILDING ADDRESS
fatm's 60 o wry ID I mog
Energy Plan Checking Fee
$
Penalty
Permit fee
$
$
'4 8 4- H WJ` qq
PLUMBING PERMIT
FilingFee 10-00
LOT NO. SUBDIVISION NAME PARCEL MAP
- I I
Each Trap
2.00
Solar or heat pump water heater
-Water piping
20.00
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF DuplexE] Mobilehomek] Other 6M0"x4A,(_(_i0
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00 -
Mobile Home W
S:�
10.00
TYPE OF WORK
New 0 AdditionE] Remodelo UtilitiesEj InstallationEl Other El
Describe work: W4 UP _. 1) 41
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
lZin service SOOV OR L.E 'SS
100 AMP OR L.ESS
10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.,
License No. 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)
I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
E] I am exempt under Sec.-, Business and Professions Code
for this reason
Main service EA. AOD'L 100 AMP
2.50
NEW CONST DWELLING OCCUP.&)
OR ADONS, ACC. BLDGS.
2V20sqft
NEW CONSTR_____7ULTI-OUTL ET
NON-RESID_ BRANCH CIRCUITS)
2.50 ea
SJOWER APPARATUS &)
PNGLE OUTLET CIR
Ex. Occup(O*UTLETS OR FIXTURES
20@50C
5 AL9 30;
Ex. Occup. 01IXED APPLNS, * .-IR —1
UTLETS (RESIC.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
- Misc. Wiring
15.00
HEN
Permit Fee
$
WO KMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F_� The permit is for $100.00 (valuation) or less.
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
ome s u bect
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
_om I
,ly e 'u b e ct
to the W. C. provisions of the Labor Code, you must forthwith comply with such
w, S1
th Uc h
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMI
Fi I ing Fee 10.00
Heating
!tFeelO,00
Cooling
H 0
Hood
3.00
Ventilation
P , I
Permit Fee
$
Co,
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection pur poses.
I also agree to save, indemnify and keep harmless the County of Butte agai
all liabilities, judgments, costs, and expenses which may in any way acc nst
against said County in consequence of the granting of this permit. rue
X
Date
Signature of Applicant — O�ner [I Contractor E] Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy inspection Fee
_[ToTAL
occ
CONST TYPE
FEE $
HAZ
CUA
PARK
I SCHL
I FLO
I PAR
P—
Th's permit is hereby issued under
sions oi the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
Date
R ece ipt No. li 610 A 4-1 _QA '76. <-A
WHITE-O.P.W.. YELLOW-ASSE330R.-PINK -INSPECTOR. GOLDEN ROD-APPL I CANT
q,3 -
X
k IF"
A5
COUNTY OF. BUTTE - DE RTMENT OF PUBLIC WORKS..
7 Co t� Center Drive - oroville, California 95965 - Telephone: 916/538-7.541
APPLICATION -AND -PERMIT
PERMIT NO.
ASSESS P tR NUMBER
�:) 01 -,3�3 , I.
ZONING
I
BUILD ING PERMIT
OWNER
/ r&v) A V ed. r
0 E,
Tkl;c g5l
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILIN� ADDRESS
4 114)tl � T, � -, & r; d to v�
CON(R�ACTOR'S NAME I f
�e 14 41 V n 4
X 01) r 10 k, (-)0 1A) r V, 0 - 44,
TELEPHONE
CONTRACTOR'S AILING . ADDR74JV4
V / 0 re 9017
Fireplace
'CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS —
Permit Fee
$
ARCHITECTOR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS —
Penalty
$
BUI�LDING ADDRESS
4R4 9 9 7-/,, no r -
Permit fee
$
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO.
BDIVISION NAME
SU C_
PARCEL MAP
J'i f
Water piping
5.00 5,00
. as water heater or vent
Each q
5.00 S" (X)
USE OF STRUCTURE
SFEJ DuplexFJ MobilehomeR - Other Girif-irrAl
SPECIFY
Gas piping system 1 - 5 outlets
5.00 Oro
Building sewer
5.00
_F_T_
Mobile Home SFG W
10-00 ea�
TYPE OF WORK
NewEl Addition [:1 R del[:] Utilities, installatio Other
Describe work: p
CX9 - 6 41e.ft Y^r P/1-1 01
i— i
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
600V OR LESS
Main service 100 AMP OR LESS
10.00
Main service EA. ADO -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I de are under penalty of perjury (check.one):
c1l
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professlofts Code a_pd my license is in full Jorce and effect.
License No.601185 i? i I
— Classification
El 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 I, as the owner, am exclusively contracting with licensed 'contract-
ors. (Sec. 7044) V V
Fj I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST.
OR ...NS. ( DWELLING OCCUP.81,
ACC. BLDGS. - A�- 21V20sqft
NEW CONSTFL MULTI-OUTLET� S
NON-RESID, 2RAN C H C'� C U' TO 2.50 ea
WER PF�RTITUS
P3___ T
(SINGLE OUTLET CIR.89
Ex. OCCUP( OUTLETS OR FIXTURES 20050c
ALG 30;
FIXED APPLNS. OR
Up. OUTLETS (RESID.) EA.) 2.0
—Ex.*bcc
�Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00 /�, ()o
/ " 1`�- __-kf1,50 115.06
Permit Fee Or $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
The permit is for $100.00 (valuationy or less.
XI have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any rr�anner so as to become subject
to the W. C. laws of California.
l4otice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FilingFee 10-00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information'
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection �Ourposes.
I also agree)to save, indemnity and keep harmless the County 6f Butte against
all liabililiis, judgments, costs, and expenses which may in any way accrue
against,,gaid County n consequence of the grariting of this permit. _� U
X Date - /0-f/4( - . -
w e-0 Cantroc'or%A--- A�;ntf_�
Signature of Applicant 0 n r t JN
An OSHA permit is ry .- d f' r excava'tions over 5'0" deep and demolition or construct-
u, re 0
ion of structures v r storie s in height.
Mobile Home Installation Fee
$
Energy Inspection Fee
TOTAL PERMIT FEE $
occup,
I CO.ST.TYPEI
--r7FLOODIPARCEL.1
PD
This permit is hereby issued under
sions-of the Butte County.Code and/or
work indicated above for which
DIRECTO OF PUBLIC
By
PMIT EXPIRES Date
I
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date 74'7
7- 00
I .
Receipt No. -
WHITE-D.P.W.. YELLOW-ASSE SOR: PI�K�im'sprCTOR� GOLDENROD-APPL I CANT
V_
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, Califorpla 95965 - Telephone: 916/538-754
APPLICATIOW AND"PERMIT
_ASS:�OR PtR?& rl�UM 5559
ZONING
BUILDING PERMIT
V is- r,;
TPLEVIC�
SO. FT. OCC. BUILDING
VALUATION
OWNE��MAILINY,DORESS
14 to L/
CON7
,�'Tr'S,,N;� IE 0- A we (20
X 10
T��5,PHONE_
'CONY -1 A TOR'S AILING'ADDR74/
Fireplace
CO NSTRUCTION LENDER ]UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER*S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS Z�w q 9 �/—a rAer" A/
Permit fee
$
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
UBDIVISION NAME
is
PARCEL MAP
U
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTARE
( C) - %ovi
SF R DuplexF� Mobilehome[1 Other GVP-Vte�yAi 't &
SPECIFY
Gas piping system 1 - 5 outlets
5. 00 0,e)
Building sewer
5.00
Mobile Home S I G I W=
Li 0 .00 ea�
TYPE OF WORK
NewF� Addition [:1 del UtilitiE Installati Other
Describe work: - 0 V1'_
Ab ��Tc-c+ 0 "C A
I I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Fi ling Fee 10.00
main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE -LAW
I de lar under penalty of perjury (check.one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
X and Profess* s Code a my license is in full J.Qrce and effect.
igl
License No. ?01185 —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)
0 1, as the owner, am exclusively contracting with licensed UUFILfdGt-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUP.5d)
OR ADDNS. ACC.BLDGS.
21/2 Osq f t
NEW CONSTR. MULTI -OUTLET
NON-RESID. BRA CH CIRC . ITS) 2.50 ea I
PO ER APPARATUS.&)
SINW
GLE OUTLET CIR
Ex. OCCUP( OUTLETS OR FIXTURES .20 @ 50C
AL0300
FIXED APPLNS. OR I
Ex. Occup. OUTLETS (RESIO.) EA.1 2.00
Temporary service
10.00
Mobile Home Facilities 15.00
Misc. Wiring 15-00 /,6-- oc
Ptj�-_ -J1113062 1 /S10
Permit Fee $ 0
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F] The permit is for $100.00 (valuation) or less.
XI 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 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.
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have.read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County ot
Butte to enter upon the above-mentioned property for inspection purposes.
I also ag�qe)to save, indemnify and keep harmless the County of Butte against
:11 liabilAjAs, ludgmeAs, costs, and expenses which may in any way accrue
gainst 4 d County onsequerLpe of the granting of this permit.
- a@4 Daie
Signature of Applicant Owner 0 Contractor N Agent
An OSHA permit is re
ve yIuired for excavations over 5'0" deep and demolition or construct
ion of structures a r stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee
TOTAL PERMIT FEE $ i CA
OCCUP]
CONST.TYPEJ
I FLOOOJPARCEL.J
P11
I No
I ISSUE
This permit is hereby issued under
sions of the Butte County. Code and/or
work indicated above for which
DIRECTO OF PUBLIC
(�') _ " I
By
PEPOT EXPIRES Date
the applicable prov i -
resolutions to do
fees have been paid.
WORKS
Date Z2
Z-7- .4iF
Receipt NO.
WHITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
COUNTY OF BUTTE - DEPARTMENT,'OF R. "BLIC WORKS BUILDING D'ViSION
i* U
7 COUNTY CENTER DRIVE - ORO\NLLE;*6Lt'FORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT A.F�LICATIOA' DATA S�AtET
Permit No.
OWNER— A. P. No.
Proposed Building Use Building k - Inspector_z2 Dat
At time of permit application, I was advised the following data -must be submitted prior to permit processing
and/orissuance: DATE RECEIVED APPROVED
1. All �tems have been submitted . . . * . . . . . . . . .
2. Plot plans in duplicate/triplicate, signed by preparer of plans.
3. Complete plans in duplicate/triplicate, signed by preparer of plans.
4. Complete engineered plans and calcs, with wet signature on plans.
5. Plans with Energy Design Compliance Statement . . . . . .
6. School District "Fees Paid" Stamp on Floor Plan.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorization . . . . . . . . . . .
— ---Health- Dept.
10., Sanitation approval, from
0' 'fl JPlanning approval for (A) Use: — (B) Parking: -
2 t2 . . Certificate of Workmen's Compensation Insurance.
e
13. Contractor's License Information (no., name style, classif.)
14*��Owner-Bui Ider Verif ication (G iven to owner El, Mai I to owner
15. lmprov�ments may be required . . . . . . . . . . . .
16. Mobilehome Installatjo a p. . . . . . . . . . . .
p ' - P,e-Inrpec. request I cl ff7j/
FAre-Inspection Required. Building Inspector
Dote) -
0-.18,' Recorded copy of A''gricultural Acknowledgment Statement.
—19. Driveway Permit.
__20. Plot plan approval -from-city-of- N 10
21.
-22.
When you issue th iermit, process as follows: —Mail to owner, —Mail to contractor.
Telephone Or S'I'7V and hold for pickup afl).0") -office, —Deliver w/linspector.
T
Other 5- d9 (-
Applill� Q:a t e 46 42 7 ZX:f
Copy of plans sent Health Dept.[--ZFir(e Dept., Other— Date
The following data must be submitted prior to permit issuance: (Circle new item not checkbd above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone--inail c I by— date— , lie -
Contractor, designer, owner, was advised c! above required data by—phone—mail I r by— date
Plans checked by Date Plans approved by4 —Date
Sets of plans on hold in —Fi le cabinet . _AP folder
Copy—DPW
KENNETH WILLIAMSON, P.E. 674-5470
COGENERATION I C.OMPPNY, INC.
ER
6565 Sunset Bouievard. suite 424. LOS';ngeies, CA 90028
. (213) �o-0000
0
N ()T 1-manshlo Shall Be Tim
I FE—ZA11 Mla4-erlcils r. oil
Ae-M-3.: mice -al-th Rez c::'l Good 1,-ast:1r1Cs and,
u5e ir, -1,he
Cf a qu�."i-y Prie5c�-'----�
kMcch. Ica
Un'forrn 1 C -des; ond
the t4ciional k1oc.i.-ical Cade.
PA T
"IG"VVAY 99
fills teg e4 pleRs and CPO tions MUST b
kept . on the job at all times and it is unlav�ful t'
makle any cha.,�ges or a! te-rations on same withot.
. weitten permisson from 1he Depirtment of Publi
Worki, County of Butte.
mAoi Powee PAtie'L
zoo AtAp 10 15CRvice
;0
A setback of 5 ft. from the
property lin-es and a setback
of 50ft- fro -,n t1he road
centedine shali be clear of
il, !,-icnt except
structul-es or eau P
for a 2 ft. eave. overhang.
:690 -R7
BUTTE COUNTY MY PLACE' CAFE, q8q HI C,4w&,y 99
BUILDING DEPARTMEN' GRIOLES() CA. 9SS'48'
ZY:
APPROVED 'S'C'&LE:
z7 oc-7,? 7 1 Dp,-rF.
No -ie-.
CO&E rA UI1J,-r IS 1A0d#,.J-riFD on A CEMEL.1-, I SLA8 'q "Y(Oi X
W) C:>Ffr/CE- MIC?-0P1Z0CC-S'5'0P- 'WiLL A10uAj-rC-j*3, okj
VVALt- I- TOE 13LIC< ROOM
C3��- 8�LE c -rai CAL. 1$ 2400 AMP, SI&Je-g-G PPAS6
CC)6CN IMSTAL-L.A-r10I\k
141!5T,qtL6;r1VA1 or- ' eC4C-;0j
&All 7-. 511,4eL Cc"Re-,�' A1171-1
I-,e,'4W41F IAI 57"61IbA15 4/57146
7MICROPRor-sSSOR, Otj WALL
1 1-3 RACK ROOM
4)\s tA.6 rER
F�
I>
Cc>c.xE.N
-ra woT wArim svivice
Q POIMER J -IMP -5-
12
c4y> WA -re It
F EED -'�
17-0 CAL WATER -,A1j6<
OLP WA-rER REAr--k—,
a
MAIN PO%NE;L PAN EL
BUTTE COONT�
BUILDING DEPARTMENI
APPROVED
vvA."rasa our--, WA-reR f -W
IftillbE P07,413LE alfrE,,� uoss- &AA16e--1-1
0�4PF /C) d. P. C
PLUMBINIS INSTALLATION
7
_[I"-rY(>G L COPPIM PIRG WITW
I" URT14AtJFr 1"TUCAT(oq
No. 2476
(24 Exp. 6-30-90
J\AY PLACE
GRIDLEY, 4-2is'"s
ou-r
—E)OSTIN& CoLD WA-rrm rzeea
DRAWN1 4-cw�
PRiMARY VOLTA(�C
Zc>o A, 1 0 SERV I c or
HEAvY DUTY
Sv\ii -rCI4 (60A)
M ) 4 Itj
m ) t ou-r
I MAIN BRGAKeR
P (200A 10) -
APPLICAMTS
LOAD
RELAYS AND ;PROPOSED SETT'ING
DEV.
mr-a �moD
No.
RGLAY,
NO -
27
UNDER\/0L-tA,6S
ARGA, 6-2-03
59
OVERVOI-TA.GE
A RQ A (6-203
81-6
0VGR-FRGQvj-=Nr-y
kR6k 6-328
8(- u
LimDeR-r-RC-0, U6Wr-Y'
ARCqA (6-320o
76 A PUSE-USED AS 0�/E-RcuRRawr PEVICE
N OTC
SECTION 4(,-3 otj P6�E 'c>v'lG. ustwc. FIC.. 11A%
I)ISCONNEC-T S\N(-TC4-1) W�sco / RRU-!--Z4pl2.-St>c3a-
3) ALL SERVICCS PRO%/joeo -13y prpja
LINE f3FZeAV-GR
((.OA 1 0)
2*7 59 Boo glu
BUTTE COUNTY
BUILDING DEPARTMEN'
APPROVED
Ritxw',6E - OF 9IZ!0P05,ffl>
SE.T T I t-% G 5 'S G; T T ('14 e- S
0 — I 10 v 10 F� v
'130---ilsov ll�qv MY PLACE Ckl=E
6 2. HZ'w/I 1;EC 489
'5'?) H:F- u -i / 1 5 E C. GRIDLEY� CA, A59418
CP -10
-70A FUSS
S f, rose "I'?
'3:jldD 3:)Yld AW
P4 1 v
-0 0- 1.7
N N 0 -D
3.7 v
ino
t;p
A
T .3.L
N 1 0 F- 10.
C
co
c
z :4
m
m -L-.)3Nr4O;PSTjCj
a
0 0\
> c
70 Z
3DN\V�JIN3
.30 ]A�J3S
I
0
I
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville. Callfc�rnia 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSnPltF17Z� 111�UMEI
ZONING
BUILDING PERMIT
TPL. ot�
L,L
SO. FT. OCC. BUILDING
VALUATION
OWNE
,4�W4MAILINIW'DDRESS &
CON C 'S NAM
_
X -%r-L44 VIIJ 10 0 V
IV
TELEPHONE
�v / -Z�om
C 0 N T R� TO R' S - --A I L 1�
4. _ C o-EIM/�, S—to �Jy 905181
Fireplace
'CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER*S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
9 9
Permit fee
$
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME _L MAP
PARCF
U !I tj
Water piping
5.00
Each q as water heater or vent "
5.00 ,sS-. 00
00
USE OF STRUCT
/��RE
SF[:] DuplexR MobilehomeED] Oth r Gem(Ly,40 %'0,1
SPECIFY
Gas piping system 1 - 5 outlets
5.00 15-
Building sewer
_100
5.00
Mobile Home I S I G JW I
10-00ea
TYPE OF WORK
NewF� AdditionE:1 delEl utiiiti nstallatio Other
Describe work: cl- PTo_ cl 1�� If
t.) P/a
I
Permit Fee
$ 115- loci
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
main service 6001 OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
e la
I d Xr under penalty of perjury (check -one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professi Code my license is in full J_Qrce and effect.
License No. —Classification
El I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
1, as the owner, am exclusively contracting with licensed UVIIUCICL-
ors. (Sec. 7044)
E] I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.&
OR ADDNS. ACC. BLDGS. 21/20sq it
NEW if6i�§TR. "ULT' -OUTLET
BRANCH CIRCUITS) 2.50 ea
_NON*RESID,
(POWER ARPARATUS.5)
SINGLE OUTLET CIR
0050t -
Ex. Occup(OUTLETS OR FIXTURES 30*
FIXED APPLNS. OR
Ex. Occup. I
OUTLETS (RESID.) EA.1 2.00 1
Temporary service 10.00
-
Mobile Home Facilities 15.00
Misc. Wiring 15.00 k�, oc
_1"ri- 7.bj�,�gp 1 1 /6,00
Permit Fee $ — sv 0 0
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
R The permit is for $100.00 (valuation) or less.
XI have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to -the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
V ent i I at i on
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
g,,!, to s 'v
I also ag e, indemnify and keep harmless the County of Butte against
'a
all liabi S , j t� d, Wqs, costs, and expenses which may in any way accrue
against County onsequerLce of the granting of this permit.
X -)e-ea /0, --
Date
Signature of Applicant Owner 0 Contractor X AgentO
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee
TOTAL PERMIT FEE $
occup,
I CON3T,IYPEI
I
I FLO
HD
I ISSUF
This permit is hereby issued under
sions of the Butte County. Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No._6 .3
WHITE-D.P.W..
to
COGENERATION PGfEtIt COMPANY, INQ
6565 Sunest bouieward, Suite 424. Lao Angeles. CA 9=8 0 (213) 461-ODOO
COGEN PCWM Cp-10.
GENERAL SPEC.IFICATIONS
nAW POWER: 208VAC to 240VAC,, single or
3-oiaser 460VAC 3-phase
OUTTM POWER: 10. 5101 3-phase
9.5XW single ou-me
FUEL CONSUMPTION: 140j000 BTU/Hr.
FUEL SOURCE: Natural Gaa or LP Gas
USABLE HEAT: 800000 alwHr.
D UITY CYCLE: Continuous
CONIROL SYSTEM: Automatic, solid-state electronics.
EFFICIENCY: 82% combined electrical and thermal
Noug LEVEL: 60 db at 6 feet
OPERATING TE*ERATURE: -20.F to +120 F (ambient)
DIMENSIONS: 72" 4=g x 29" wide x 36" high
WFJW: 700 lbs.
NAMENANCE: Manufacturer's re0offoended service at
750 -hour intervals.
/- .- - - A " ." M41
6u IAI Lj I C,/ -
PRE -INSPECTION
OWNER: DATE
LOCATION';::
CONTRACTOR: q 97
E TW6F_ /LJ VE ZONING
PRE -INSPECTION FOR:
DATE TO INSPECTOR
PERMIT HISTORY: El NONE 14. AS FdLLOWS:- r,_��Cjej (9 IZ- -1
TYPE OF OCCUPANCY
BUILDING USAGE:
TENNANT:
FIELD - INFORMATION
i
19T7
OCCUPIED HAS ELECTRIC F::] F'AS GAS E:]HAS SANITATION FACILITIES
0 HEATED -COOLED
PERSON CONTACTED
/, I , - f �-
OTHER COMMENTS: ;K ao-44
azg �r ELL") �eff
Z-06 116� 0 �22 �&2 azz a -ss -
o 72�i 13 r2 /I A 0 L9 10 Yn A i IV ijV' A2 4) IV // JV ,I- h�t T
ACTION RECOMMENDEA�' E&A— M", -4
i el_
LA ISSUE HOLD FOR
BY
DATE
eouw*
OROVILLE, CALIFA—NIA
GENERAL CLAIM
James W. Arnold
CLAIMANT:
P.O. Box 234
ADDRESS:
Bangor, CA. 95914
CITY & STATE: IMPORTANT:
Feb. 22, 1911 SEE INSTRUCTIONS
DATE OF CLAIM: ON REVERSE SIDE
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)-
AMOUNT
Not going to build. (Permit Appin. #5527-76B,P Receipt #152489
AP 24-16-20)
Building permit fee $464.25
Retain fee
p �an check 1-54.75
Amount of.refund.due ------------ $309.50
Plumbing permit fee $ 22.50
Amount of refund due ------------ $ ii.50
TOTAL REFUND DUE ------------- w--,$329.00
$329.00
TOTAL
$319.00
1, the undersigned, declare under penal ty of perjury that the services or articles claimed have been performed drdelive . re d, and that this
claim is true and correct as stated.
Dated this .................................. day of ............................. . 19 ....... at ................................. Calif . .............
ignature of Clalman�,", ... ' ......
1, the undersigned. hereby certify that, to the beat of my knowledge, the services or'articles specified above have been performed or de-
livered and that there is a- Budget Appropriation E) or Specific Board ApprovalF-1 (Checkone) for the same.
........... ......... .
Dated this ............... 22nd .......... day of .. Feb .................. 19 7.7 .' at 0 . ro . v . i . 1 . 1 . e ....... , Calif . .. ..................................................................................
Department Head or Authorized Deputy
Dept. Exp.
Code ............................................ Code ................................................ PAYABLE FROM ............................... ............................................... ........... FUND
DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
VENDOR
CODE
DEPT.
& SUB.
PROJ.
SUB.
OBJ.
CLAIM
NO.
INVOICE
NO.
INVOICE
DATE
DISC.
GROSS
AMOUNT
ENCUMB.
SUB -DIST.
* /I
0
. r I . 4
I NSTRU CT 10 N'S'... -to -CLAIMANT.S
All claims against the county must be. iternized, giving dates. and,
character of service rendered or -work pvrformed, quantities,, de-,
scription and unit prices2of artlic ies-furn i shed or delivered.
Claims must be certified'by the claimant --and submitted to.the De-
partment head for approval. Upon approval the Department head
will forward claim to Countj Auditor for payment procedure. Do
not file with the County Auditor first. -
Claims should be presented to officials for approval immediately
upon completion of services requested or material ordered.
Claims are paid every Tuesday; however, same must be approved by
officials and in Auditor's office before preceeding Wednesday noon.
Compliance with above will expedite payment of claim, failure to do
so may delay payment considerably.
AMW
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 53A-4541 -76
APPLICArIONA D PERMIT Y,
dLit lor—e represeniaL VeS 01 the Counly of Buiie to enter upon the
ab�ve-�entioned propl�rty for ins tion purposes.
AX41jet�� WA - 264 ' I dlleld�l ate /0
ignoture of Ilermitee or Agent
Receipt No. &EIR 4/0VIC/
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
Building permit expires Date
BUILDING
Owner T;�127 XCA,04,0
SQ. FT. OCC. BUILDING VALUATION
Y 17!!�:029(y 00
Mailing Address /20 - RX. 3 �/
44 Ala 0-
Telephone No.
16717—
Fireplace
Contractor
Total Valuation 0 C), 0
Mai I ing Address
Permit Fee
lanCheckingFee 7 151
I
Telephone No.
1
Permit Fee $ 416 -r/ -,?- Ell
1101 Z A
Building Address C04 A, -z,;-/2— vl--
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 3 - 0 C>.
Each Trap Lo 1.50 0
Repair drainage or vent piping 1.50
Water piping 0
Each gas water heater or vent 1.50
A. P. No, ;7 (0
Gas piping system 1 - 5 outlets 1.50. /,O±;- 0
Each additional outlet .30
FeL-fV4e =Sanitation FireDept.1 Fi re Zone U��t�
EQA IParking Parcel Parcel Map 60' R/W IAM#e%fns '��awn
Plans Declaration
Building sewer 5.00
sprinkler system 2.00
L
ParceV Zroval
Plans �ADproval
Permit Fee $
$
NEW ADDITION UTILITIES OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Main service EA. ADD -L 100 AMP 2.50
Single Family Duplex Mobi I Home E] Others [4
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADD -L 100 AMP 1.00
NEW CONST. I DWELLING OCCUR. &)
OR ADDNS. % ACC. BLDGS , 20sqft
NEW CONSTP_ -OUTLET
NON.RE.'.. (MULTI I
BRANCH CIRCU Ts)-2.50ea
NEW.CONSTSL f POWER APPARATUS &)
NON RESID. % SINGLE OUTLET CIR .
CONTRkCTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Ex. Occup (OUTLETS OR FIXTURES) 50 @ 250
BAL @ 100
Ex. Occup. ( FIXED A P PLNS OR
OUTLETS (RESI'D.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
_1arn exempt from the Contractors License Laws of the State of California.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
EJ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
P�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.
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
I :
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.001
Permit Fee $
TOTAL PERMIT FEE
$ IT 75
dLit lor—e represeniaL VeS 01 the Counly of Buiie to enter upon the
ab�ve-�entioned propl�rty for ins tion purposes.
AX41jet�� WA - 264 ' I dlleld�l ate /0
ignoture of Ilermitee or Agent
Receipt No. &EIR 4/0VIC/
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
Building permit expires Date
MASONRY WALLS N E S W
lst Lift
2nd Lift
3rd Lift
4th Lift
5th Lift
f6th Lift
FIRE WALLS (0 cupancy, Area, Prop rtv)
Gypsum Board lst Layer 2nd Layer
Walls
Ceilings
COMMERCIAL
1135-91B
IKEEIN, Ddrrelly'ne
484 Hwy 99,--iGridley
i(ehlarge wind ow/restaurant) 4-,;24-qQ
7,u
JOB FINALED Mato
Signature
CERTIFICATE OF OCCUPANCY lis- ED (Date)
Signature,
t
JOB FINALED Mato
Signature
CERTIFICATE OF OCCUPANCY lis- ED (Date)
Signature,
V OK
0 Not OK
Not Applicable
Not Ready
COMMERCIA4
Date UNDERFLOOR (Plans) OK except #'s
1. Zoning-Setbacks-Easements-Flood-Slope-SoiI Report
2. Fig., Main; Soils-Ufer Ground.-Ftg. Depth
3. Hold Downs -Bolts -Straps -Embedment -Hair Pins
4. Concrete -PSI -Cert -SP. insp.-Loc.
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Reinf. Steel -Grade- Placement
7. Slab; Steel -Wrap ped-Wi re Mesh
8. Piers -Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground, Underslab
13. Pienums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Masonry -Rebar -Lifts
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except #'s
16. Water Htr.; Vent -Access -Combustion Air -Baffle
17. Water Pipe; Test & Anchor -Nail Protection
18. D.W.V.; Test -Fittings & Anchor -Nail Protection
19. Sinks -Floor -Grease Trap
20. Hand icap-W/C-Backi ng
21. Gas Pipe; Size & Anchors - Firewall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -ins. Protection
23. Single Phase -Three Phase -Equip. Bond
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water
27. Wiring -90* -Protected -Color Coded
28. Subfeed Wire Size ga. Cu or Al-A.C. Wire Size ga.
Cu or Al
29. Fire Res istive-Fi xt ure-Co nd ui t -G. F. 1. -Susp. Ceiling
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panel s- Motors-Mec h. Equip.
32. Fire Wall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 -Date Card B-1
Date MECHANICAL (Permit) OK except #'s
33. A.C. Ducts Insulation & Support
34. Vent Fan; Exhaust above insulation
35. Condensate Drain & Overflow; Size & Grade
36. Furnance-Vent; Access -Comb. Air -Return Air Vent -1 15 outlet
37. Attic Access & Platform if Furnance in Attic
38. F4. V.A. C. -Venti lation- Roof Access
39. Smoke & Fire Dampers
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
40. Sils, Proper Material & Anchors -Hold Downs
41. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
42. Bearing Walls over Girders & Floor Nailing
43. Draft Stop in Walls (rat proof)
4_4. Fire Stops; Furred Ceiling s -Stairs -Chases
45. Headers & Beam -Size & Bearing -Support Fix.
Date FRAMING (Continued)
46. Hangers -P ost Caps-Anchors-Ponnectors
47. Roof Shthing-Nailing-Diap.Chord Splici
48. Firewall-Doors-Area-Occp.-Prop.
49. Attic Access; Size & Romex Protection -Draft Stop -ins. Baffles
50. Glu -Lam cert. -Placement -Support
51. Steel Buildings-Purlin-Girders
52. Property Line Firewall & Openings
53. Ext. Doors -Handicap Access
54. Stairs; Width -Head room -Ri se -Run- Landing -Fire Protection
55. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56. Siding -Nailing Veneer
57. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access
58. Glazing Area -Glass Protection -Skylights -Plastic -Fire Port.
59. Shear Walls -Plywood-Nailing-Conn to Roof
60. Insulation -Walls -Ceilings
61. Infiltration -Walls -Windows
62. Corridors -Openings -Fire Protection- Fra mi ng
A ET P , Z I
Date Card BtL_J/Q_/ Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
63. Ext. Steps -Door & Sidelight Protection- Land i ngs
64. Exits -Size -Number -Placement
65. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66. Sprinklers -Placement -Test
67. -Suspended Ce il ing-Seism ic-Wi res-Elec- Light & Mach.
68. Elec. Trim & Subpanel; Breaker Sizes & Labels
69. Stairs & Rails
70. Handicap -Door Levers -Fin. Floor
71. Elec. Outlets at Wood Panel; Int. & Ext.
72. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
Above Floor-Mech. Protection
73. Plb., Elec. & Mach. Equip. Listed for Location
74.. Insulation -Foam -Looked in Attic 0 Yes
75. Guard Rails & Deck Construction -Post Caps
76. Fdn. Vents & Crawl Hole Door-Draina & Wood -Earth
Clearance Looked under Floor Yes
77. Stucco; Brown -Finish
78. A.C. Unit; Disconnect, Electrical, Plumbing
79. Vents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
Openings
80. Water Well; Disconnect, Electrical, Plumbing
81. Exterior Elec. Trim; G.F.I. Receptacle-Unde rg round
82. Off Site -Parking -Handicap
83. Glass Protection
84. Corrections from Previous Inspections
85. Gas Test -Meters Tagged; Gas -Electric
86. Water & Sewer Connected -C/O to Grade -HD Approval
87. Energy Compliance Certificate -Other Certificates
88. Roofing Certificate -Fire Rating
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:
Certificate of Occupancy
(NOTE: An entry must be made each time you visit the job site)
COUNTY OF BUTTE � b5PARTME-_NT OF PU13LIC WORKS , PERMIT NO.
.1,06UMY Cdht0f WIVISI � OMVIllej 0121111f6thia 06065 - TelephbrIO'o 916/558-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBE-R
I':.
_24-1_6-avi
ZONING
A40--_
-------- I - - _ - _ . - . 9 1
13UILDING PERMIT
owbEaRrrellyne Cole Klein
T946 P M`14
SQ. FT. OCC, BUILDING VALUATION
200.00
OW�IT'AMA�,ING tDDR
ol s ane',ssGridley 95948
C06TRACTOR'S NAME
wner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
__TUN�N
Fireplace
COrTReICT'ON LENDER
on
Total Valuation 1$ 200.00 -
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
10.00
ARCHITECT OR ENGINEER
None
LICENSE NO.
Plan Checking Fee
$ 15.00
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BU�g4NG ADDRESS
Hwy 99, Gridley
Permit fee
$ 35.00
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
717"'
MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF [:1 DuplexF� MobilehomeE] Other rGmaii/rept-
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
1 5.00
— _F_T_
Mobile Home STG W
00e�
TYPE OF WORK.
New R Addition [:1 Remodel [:1 Utilities [:1 Installation El Other ET
Describe work: enlarge window in south wall
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 1 10.00.
main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. AOD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1 I am licensed under provisions of Chapt. 9, Div. 3 of the Busines S
and Professions Code and my license is in full force and effect.
cerise No. Classification.
I -VI I -
L-Iff 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 I, as the owner, am exclusively contracting with licensed contiaut-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. I DWELLING OCCUP.N
OR ADDNS. 1, ACC, BLDGS.
21/4sqft
NEW CONSTR. MULT'_OUTLET
NO N.R ES, . RANCH CIRCUITS
2.50 ea
POWER APPARATUS.&)
(SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
20@50t
.15AL0 309�
FIXED APPLNS. OR I
Ex. Occup. OUTLETS (RESID.) EA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one)':
The permit is for $100.00 (valuation) or less.
E:] I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed.revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
—
Permit Fee
_I
$
Contractor
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 La ws relating
to building construction, and hereby authorize representatives of the Counlyot
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 pny wa�yl, accru
against said County in consequence of the gra ting of this p r
Da e
Signature of Applicant — wner Ej�_ —Contractor 1:1 Agen-11
An OSHA permit is required or excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
i
Energy Inspection Fee $
PE
TOTAL FEE $ 35.00
This permit is hereby issued unaer the applicable provi-
si�A of the Butte County. Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
B Date '2' Lq
P IT EXPIRES Date
Receipt No. 88677/35.00
F TC-D.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR. 'GOLDENROD-APPLI CANT
OWNER
COUNTY OF BUTTE - DEPARTMENI OF ' PUBLIC WORKS - BUILDING DIVISION
IJ4111E* IRNIA 95965 - TELEPHONE: 916/538-7541
7 COUNTY-6ENTER DRIVE -6 by' -ALIFO"
PERMIT APPLICATION -DATA SHEET Permit No. 0
XM el
A. P. No.
Propose6 Building Use 15ilding Inspector X-�_ Date T-1 I—
I
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
1. All items have been submitted . .................................... DATE RECEIVED APPROVED
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. Complete plans in duplicate/triplicate, signed by preparer of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation ..........
7. Statement of Intent for Non -Heated and AC Buildings .... : I I I * * * * * *
8. Engineered truss details and layout.' iri,duplicate (required prior to plan check)
9. Mobilehome installation data incl*bding manufacturer's installation
instructions .......................................................
10. Fees of $
11. Chico Urban Area fees paid .......................................
12. Park fees paid ....................................................
13. School District fees paid ..............
14. Sanitation,approval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) Use:—(B) Parking: . ......
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
20. Pre -inspection for -required ... Pre-Inspec. request to
Building Inspector —(Date)
21. Contractor's license informatin- (No., Name Style, Classification
22 ' Certificate of W6rkmans C6m'-pensation Insurance ..................
C29 23. Owner-Builder(Yerification (Given to owner 0, Mail to owner 0) .....
24. Recorded copy of Agricultural Acknowledgment Statement .........
25. Letter of signature authorization ...................................
26.
27.
When yq�ui issue the per t process as follows: o owner. �iil to contractor.
Mc
*91FTelephone < or kup t ORO office. —Deliver w/inspector.
Other ny 7 Af
Applica.:U����_� 0 Date
Copy of Hlaz-Mat form sent —Health Dept. —Fire Dept. -----Air Pollution Date
Copy of plans sent -----Health Dept. —Fire Dept. —Other— . Date— By—
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above'Jtems No.
2. Additional items requir�d:
Contractor, designer, owner, was advised of above required data by —phone---jnai I —counter by
Contractor, designer, owner, was advised of above required data by—phone —mal I —counter by
Plans checked by
Copy—DPW
Date Plans approved by
Sets of plans on hold in —File cabinet _AP folder
date
date
Date
COUNTY OF BUTTE,- Dep�rtment of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
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. 1 personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
2. 1 (have/have not) \rl_� signed an application for a building permit
for.the proposed work.
3. 1 have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. 1 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 Contractors License No.
5. 1 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 OwneX—_7ZZ�i
Social Security:-- �_GmRr
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
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BUTTS couNTY
WILI)ING DEPARTmc_�,i
APPROVED
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - OrovIlle, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER 0_33
ZONIN -40
BUILDING PERMIT
OWNER
jo,q)�WetIlegle- �Ilelll
TELEPHONE
"
SQ.FT. OCC. BUILDING VALUATION
1)
00. 00
OWNER'S MAILING ADDRESS —
6,Y6-5077
3 Ro//zIg- 1-,q NL A,4 qS
CONTRACTOR'S NAME
C) bi/ve/2
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER NVIVr
UNKNOWN
Total Valuation 1$ .200-00
LENDER'S MAILING ADDRESS
Filing Fee $ 10.00
Permit Fee [0-00
ARCHITEC T OR ENGINE
-NolvE
LICENSE NO.
..$
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINE S MAILING A5E;RESS
;V
Penalty $
BUILDING ADDRESS
Permit fee $
PLUMBING PERMIT Fii ingFee 10.00
Each Trap 2.00
Solar or heat pump water heater 20.00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
Water piping - 5.00
Each gas w ater heater or vent 5.00
USE OF STRUCTURE
SFE] DuplexF� Mobilehome[] Other L1"616fA41X,---,Sr
SP Ell FY
Gas piping system 1 - 5 outlets 5.00
—Building
sewer 5.00
Mobile Home S I G I W 10-00ea
TYPE OF WORK
New F1 Add * ition [I Remodel[:] Utilities[] InstallationEl Other
Describe work: ZW1,412Ckf_ WINPOW I�J SoU�111 JVA
I
Permit Fee $
Contractor
ELECTRICAL PERMIT FilingFee 10.00.
OOV OR LESS
Main service 6100 AMP OR LESS 10.00
Main service EA. ADO -1- 100 AMP 2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions -Code and my license is in full force and effect.
License No. 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)
ED I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING occup-ai)
OR ADONS. ' ( ACC. T BLDGS. �Ihtsqft
NEW CONSTR. MULTI-OUTLiET
NO N.RES'.. B RA NC . C, RC , TS) 1.2.50 ea
POWER APPARATU
SINGLE OUTLET CISR.&)
120@50t
Ex. OCCUP(OUTLETS OR FIXTURES SALO 300
OCCUP. FIXED APPLNS OR
Ex. 0 UTLETS (RESI*D.) EA.) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one)*:
E] The permit is for $100.00 (valuation) or less.
Ej I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed.revoked.
Contractor
MECHANICAL PERMIT FilingFee 10.00
Heating
Cooling
L
Hood 3.00
Ventilation
Fernilt Fee $
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countycit
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte agains t
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant - Owner F-1 Contractor Agent E]
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in Veight.
Mobile Home Installation Fee $
Energy Inspection Fee
occ
CONST TYPE
TOTAL FEE $
HAL
I CUA -I
PARK-
SCHL
I FLD
I CDF
I PAR
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11 HD.JISSUE
This permit is hereby issued unaer tne appiicable provi-
si�i;s oi the Butte County. Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
Receipt No. &dc-/
WHITZ-O.P.W., YELLOW-ASSC3504 PINx-INSPECTOR. -GOLDENROD-APPL I CANT
MASONRY WALLS N E S W
Ist Lift
12nd Lift
3rd Lift
4th Lift
5th Lift
.6th Lift
FIRE WALLS (0 cupancy, Area, Prop rtv)
Gypsum Board 1st Layer 2nd Layer
Walls
Ceilings
COMMERCIAL
24-16-33 955-91B
MEYERS, Frank
484 Hwy 99, Gridley
(mansard roof/restaurant)-4/-/91- '7 .
7 6,3 -
JOB FINALED (D te
SIgnature
CERTIFICATE OF OCCUPANCY ISSUED (Date)
Signature-
0
V=OK
0 Not OK
Not Applicable
Not Ready
COMMERCIAL.
Date UNDERFLOOR (Plans) OK except #'s
1. Zon i ng -Setbacks- Ease ments- Flood -Slope-So i I Report
2. Ftg., Main; Soils-Ufer Ground.-Ftg. Depth
3. Hold Down s- Bo I ts-Straps-Embed me nt-Hal r Pins
4. Concrete -PSI -Cert -SP. insp.-Loc.
5. Sternwalls, Main; Steel-Blockouts-Wrapped
6. Reinf. Steel -G rade-Placement
7. Slab; Steel -Wrapped -Wire Mesh
8. Piers -Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground, Underslab
13. Pienums & Ducts; Clearance -Material -Support -ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Masonry -Rebar -Lifts
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except #'s
16. Water Htr.; Vent -Access -Combustion Air -Baffle
17. Water Pipe; Test & Anchor -Nail Protection
18. D.W.V.; Test -Fittings & Anchor -Nail Protection
19. Sinks -Floor -Grease Trap
20. Hand icap-W/C-Backi ng
21. Gas Pipe; Size & Anchors - Firewall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Single Phase -Three Phase -Equip. Bond
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water
27. Wiring -90* -Protected -Color Coded
28. Subfeed Wire Size ga. Cu or At-A.C. Wire Size ga.
Cu or Al
29. Fire Resistive-Fixture-Conduit-G.F.I.-Susp. Ceiling
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panel s- Motors- Mec h. Equip.
32. Fire Wall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 - Date Card B-1
Date MECHANICAL (Permit) OK except #'s
33. A.C. Ducts Insulation & Support
34. Vent Fan; Exhaust above insulation
35. Condensate Drain & Overflow; Size & Grade
36. Furnance-Vent; Access -Comb. Air -Return Air Vent -1 15 outlet
37. Attic Access & Platform if Furnance in Attic
38. Fi.V.A.C.-Ventilation-Roof Access
39. Smoke & Fire Dampers
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
40. Sils, Proper Material & Anchors -Hold Downs
41. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
4�Aearing Walls over Girders & Floor Nailing
\,,43. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceiling�-Stairs-Chases
-s,-1-45. Headers & Beam -Size & Bearina-SUDDort Fix.
Date / FRAMING (Continued)
t,_46'Hangers-Post Caps-Anchor&'-Connectprs
47. Roof Shthing-Nailing-Diap.Chord Splice -
48. Firewall-Doors-Area-Occp.-Prop.
49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50. Glu -Lam cert. -Placement -Support
51. Steel Buildings-Purlin-Girders
t_-IJ2--P-ro-�erty Line Firewall & Openings
53. Ext. Doors -Handicap Access
54. Stairs; Width -Headrdo m -Ri se-Run-Landi ng -Fire Protection
55. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56. Siding -Nailing Veneer
57. Stucco Mesh -Drip Screed -Fd. Vents-UnderfIr. Access
58. Glazing Area -Glass Protection -Skyl ights-Plastic-Fi re Port.
59. Shear Walls -Plywood-Nailing-Conr, to Roof
60. Insulation -Walls -Ceilings
61. Infiltration -Walls -Windows
62. Corriclors-Openings-Fire Protection- Fra mi ng
Date Card B-I�k -.,/ Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
63. Ext. Steps -Door & Sidelight Protection- Land I ngs
64. Exits -Size -Number -Placement
65. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66. Sprinklers -Placement -Test
67. Suspended Ceiling-Seismic-Wires-Elec-Light & Mech.
68. Elec. Trim & Subpanel; Breaker Sizes & Labels
69. Stairs & Rails
70. Handicap -Door Levers -Fin. Floor
71. Elec. Outlets at Wood Panel; Int. & Ext.
72. Wtr. Htr.; Vents -Clearance -Comb. Air -Connector- . P. R. V.
Above Floor-Mech. Protection
73. Plb., Elec. & Mech. Equip. Listed for Location
74. Insulation -Foam -Looked in Attic 0 Yes
75. Guard Rails & Deck Construction -Post Caps
76. Fdn. Vents & Crawl Hole Door-Drainag & Wood -Earth
Clearance Looked under Floor Yes
77. Stucco; Brown -Finish
78. A.C. Unit; Disconnect, Electrical, Plumbing
79. Vents Above Roof; PI bg.-App I ia nce-Fi rep lace. -Cl ea rance to
Openings
80. Water Well; Disconnect, Electrical, Plumbing
81. Exterior Elec. Trim; G.F.I. Receptacle -Underground
82. Off Site-Parking-Hanclicap
83. Glass Protection
84. Corrections from Previous Inspections
85. Gas Test -Meters Tagged; Gas -Electric
86. Water & Sewer Connected -C/O to Gracle-HD Approval
87. Energy Compliance Certificate -Other Certificates
88. Roofing Certificate -Fire Rating
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:
Certificate of Occunancv
(NOTE: An entry must be made each time you visit the job site)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
't7 Ociun�y center Drive - oroville, California 95965 - Telephone: 916/538-7541
APPLI.CATION AND PERMIT
PERMIT NO.
A
ASSESSOR PARCEL NUMBER ZONING
24-16-033 A40
BUILDING PERMIT
OWNER P0
Frank Meyers �4
SQ. FT. OCC. BUILDING VALUATION
est. 19000
OWNER'S MAILING ADDRESS
71 Hollis, GridleV 95948
CONTRACTOR'S NAME
Owner
ONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
None
Total Valuation is
Filing Fee
$ '0.00
LENDER's MAILING ADDRESS
Pe—nit Fee
$ 17.50
ARCHITECT OR E.1171,-41EEP
None
C EZTJS_E NO.
Plan Checking Fee
$ 15.00
Energy Plan Checking Fee
ARCHITECT OR ENGiNEER-S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
484 Hwv. 99, Gridley
Permit fee
$ 42.50
PLUMBING PERMIT
FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFO DuplexF_� MobilehomeF_1 Other COMM/reSt
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.007
Mobile Home S I G I W
11 0.00 Pa.
TYPE OF WORK
NewF] Addition Remode I F1 Uti lities F] InstallationEl OtheXE]
Describe work: mansard roof
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1 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. 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)
I, as the owner, am exclusively contracting with licensed contiact-
ors. (Sec. 7044)
1 am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST. I DWELLING OCCUP.5d
OR ADDNS. I ACC, SLOGS.
21/4sqft
NE NSTR MULT'_OUT L I- T 2-
N -RE BRANCH CI RC., TS
NOW CO S'..
2.50 ea
(POWER APPARATUS.&)
SINGLE OUTLET CIR
Ex. Occup(OUTLETS OR FIXTURES
1.20 @ 50C
AL@309
FIXED APPLNS OR
Ex. Occup. OUTLETS (RESID.) EA.)
1 2.00
Temporary service
1 10.00
Mobile Home Facilities
—
15.00
Misc. Wiring
15.00
:E.
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F-] The permit is for $100.00 (valuation) or less.
E:] I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed.revoked.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purpo es.
1 also agree to save, indemnify and keep harmless the County of Buttse against
all liabilities, judgments, costs, and expenses which may in any wa,
against said County in consequence of the granting of this permit.
X Date e4- h-/
Signature of Applicant Owner ra ContractorEJ Agent [71
L93 -i
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy inspection Fee $
0
C0NSJ.P#Pr_
TOTAL FEE $ 42.50
1
-1
��� FL5, DF
lPfJ_
PD
I
11 HD.JIPE
This permit is hereby issued unaer tne
si�ns oi the Butte County. Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By_
PERMFeEX'PIRES Date—
applicable provi-
resolutions to do
have been paid.
WORKS
te
�4( <_
Receipt NO. LIC --i
WHITE-O.P.W.. YELLOW-ASSE35OR, PINK -INSPECTOR. GOLDENROD-APPL I CANT
I'll
COUNTY OF BUTTE - DEPARTMENT OF PftLI'C-WORkS 7 BUILDING DIVISION
7 COUNTY CENTER DRIVE - 0,�OVILIE"CAILIFORNIA 95965 -�_T15LEPHONE: 916/538-7541
AtIOWDATA SHEET
PERMIT APPLICA
Permit No.
OWNER A. P. No.
ell �F,
)ectoj� V141
Proposed Building Use KOO E Building Inspec A P — Date
At time of permit application, I was advised the following �data must be submitted prior to permit processing apd/or issuance:
DATE RECEIVED APPROVED
1. All items have been submitted . ....................................
t plans in duplicate/triplicate, signed by preparer of plans ........
om
plete plans in duplicate/triplicate, signed by preparer. of plans
E04.?Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to plan check)
9. Mobilehome installation data including manufacturer's installation
instructions.......................................................
10. Fees of $
11. Chico Urban Area fees paid .......................................
12. Park fees paid ....................................................
13. School District fees paid ..............
14. Sanitation approval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) Use:—(B) Parking: . ......
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
20. Pre -Inspection for required ... Pre-inspec. request to
Building Inspector —(Date)
21. Contractor's license information (No., Name Style, Classification) ...
:�%�22. Certificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner 0, Mail to owner 0) .....
24. Recorded copy of Agricultural Acknowledgment Statement .........
_25. Lettex-of, sionntijrp qijthr)ri7Afinn
— Telephone and hold for pickup at —office. _
Other
Mail to contractor.
Deliver w/inspector.
Copy of H.az-Mat form sent —Health Dept. —Fire Dept. ----Air Pollution Date
Copyofplanssent ____HeaIthDept. —FireDept. —Other— Date— By_
Th ' e following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items recLuired:
Contractor, designer, owner, was advised of above required data by—phone--mai I —counter by
Contractor, designer, owner, was advised of above requir�d data by—phone —mal I —counter by
Plans checked by
Sets of plans on hold in
Copy—DPW
Date Plans approved by
.File cabinet _AP folder
date
date
Date
COUNTY OF BUTTE.—Dep artment of Public Works
7 County Center Drive, Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention Property Owner:
Phone: 916-538-7541
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.
I personally plan' to provide the majpr labor and materials for construction of
the proposed property improvement (yes or no)
2. 1 (have/have not) signed an application for a building permit
for the proposed work.
3. 1 have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. 1 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 Contractors License No.
5. 1 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
Social. Security Number
Dat -,A4/
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - OrovIlle, California 95965 - Telephone: 916/538-7541
-3 �S APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PAR AiiWE5*ffi&
ZO ;1' (�O
BUILDING PERMIT
OWNER
Ele-ANk Z&e,40s,
TELEPHONE
So. FT. OCC. BUILDING VALUATION
Wo
OWNER*s K4AILING ADDRESS I E 4�.
�J� I OEM 7/ IXOLI-15
CONTRA-CTOR' N , AM
6) W.,(/
TIELEPHONC/ U'
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
Filing Fee $ '.0.00
LENDER'S MAILING ADDRESS
Penn;.! Fae $ 1-7, '�-V
ARCHI7FCT OR Z�-,INEEP
T ICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS Ce-
/Y I _7
Permit fee $
PLUMBING FilingFee 10.00
-2� 7—
-PERMIT
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUSOOVISION NAME
1
M A P
Water piping
5.00
Each cias water heater or vent
5.00
USE OF STRUCTURE 7__
SF [-] DuplexF� Mobilehomef--1 Other
SPECIF
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I IN I T--FO.00
ei�
TYPE OF WORK
New F1 Addition R emode I Utilities [I InstallationEl Other;�
Describe work:
Permit Fee $
Contractor
ELECTRICAL PERMIT FilingFee 10.00
main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1 I 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.
El 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)
1, as the owner, am exclusively contracting with licensed CUIILIIIL;L-
ors. (Sec. 7044)
F_J I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST ( DWELLING OCCUP.ai)
OR AODNS. ' ACC. BLDGS.
2/2(tsqft
NEW CONSTR. MULTI,OUT LET
NON . RESID, BRANCH CIRCUITS)
2.50 ea
(POWER APPARATUS IN
SINGLE OUTLET CIR.
Ex. Occup( OUTLETS OR FIXTURES
0050t
1.2AI. 30t
FIXED APPLNS R
Ex. Occup. OUTLETS (RESI'DO I E A.)
1 2.00
Temporary service
10.00
Mobile Home Facilities
-
15.00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
The permit is for $100.00 _(valuation) or less.
--[]—I -have-placed o6-HIEF-Wifth'the C6untTbf-BOtt6-BUi-rdiri�FD6-partFnihf-
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 subj ect
to the W. C. provisions of -the Labor -Code, you must forthwith comply-wi th.such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT Filing Fee 10.00
Heating
Cooling
Hood 3.00
Ventilation
ermit Fee $
Contractor
Cot
I certify that I.have read this application and state that the above information
is correct. I agree to comply to all -County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned 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 County in consequence of -the granting of this -per mit.
X Date
Signature of Applicant OwnerEl Contractor Agent
An OSHA permit is required for excavations over 5'0". deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
Energy inspect -ion Fee
occ
EH
CONST TYPE
TOTALFEE
A Z.
CUA PARK
SCHL
1. F I.P.
CD�_
I PAR
J.P0
HD.
SSU , E
This permit is hereby issued uncer tne applicable provi-
sions oi the Butte County.Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
Receipt No.
W NlTr-D.P.w.. YELLOW-ASSE330R, PINK -INSPECTOR. GOLDEN ROD-APPL I CANT
COMMERCIAL
MASONRY WALLS N E S W
1st Lift
12nd Lift
3rd Lift
4th Lift
5th Lift
6th Lift
FIRE WALLS (0 cupancy, Area, Prop rtv)
Gypsum Board 1st Layer 2nd Layer
Walls
Ceilings
Fle-OA) 7--
01261 br.,L
Z4-10—JJ
MEYER, Frank
484 Hwy 99, Gridley
(repairs/restaurant)
.JOB FINALE
Signature
CERTIFICAI
Signature
763-91B,P,E,M
--2 -2- -15-((3 - 97
V OK
0 Not OK
Not Applicable
Not Ready
COMME9CIAL
Date
UNDERFLOOR (Plans) OK except #'s
1. Zoning-Setbacks-Easements-Flood-Slope-SoiI Report
2. Ftg., Main; Soils-Ufer Ground.-Ftg. Depth
3. Hold Downs -Bolts -Straps -Ern bed ment-Hai r Pins
4. Concrete -PSI -Cert -SP. insp.-Loc.
5. Sternwalls, Main; Steel-Blockouts-Wrapped
6. Reinf. Steel -Grade- Placement
7. Slab; Steel -Wrapped -Wire Mesh
8. Piers -Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground, Underslab
13. Pienums & Ducts; Clearance -Material -Support -ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Masonry -Rebar -Lifts
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
16. Water Htr.; Vent -Access -Combustion Air -Baffle
17. Water Pipe; Test & Anchbr-Nail Protection
18. D.W.V.; Test -Fittings & AncDor-Nail Protection
V,-'19. Sinks -Floor -Grease Trap
20. Hand icap-W/C-Backi ng
21. Gas Pipe; Size & Anchors - Firewall Penetrations
0
Date,Z7-;O'ff� Card B]t;K Date Card B-1
Date- Card B-1__ Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -ins. Protection
23. Single Phase -Three Phase -Equip. Bond
24. SizeJJaxes & No. of Conductors -Stapled
omex Installed Close to Edge of Studs & C.J.
je!!:�(260-:quip. Ground made up w/Mech. Fastners-Bond �'4s & WaK
- '*2f Wiring -90* -Protected -Color C�ded
28. Subfeed Wire Size ga. Cu or AI-A.C. Wire Size ga.
Cu or Al
29. Fire Resistive-Fixture-Conduit-G.F.I.-Susp. Ceiling
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Pane Is -Motors- Mech. Equip.
32. Fire Wall Penetrations
Date 10 Card B-�Z�' Date Card B-1
Date Card 13-1\�- Date Card B-1
Date MECHANICAL (Permit) OK except #'s
33. A.C. Ducts Insulation & Support
34. Vent Fan; Exhaust above insulation
35. Condensate Drain & Overflow; Size & Grade
36. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet
37. Attic Access & Platform if Furnance in Attic
38. Fi.V.A.C.-Ventilation-Roof Access
39. Smoke & Fire Dampers
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except #'s
40. Sils, Proper Material & Anchors -Hold Downs
41. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
42. Bearing Walls over Girders & Floor Nailing
43. Draft Stop in Walls (rat proof)
44. Fire Stops; Furred Ceilings -Stairs -Chases
45. Headers & Beam -Size & Bearing -Support Fix.
Date.' FRAMING (Continued)
46. Hangers -P ost Caps -Anchors -Connectors
47. Roof Shthing-Nailing-Diap.Chord Splice
48. Fi rewal I- Doo rs-Area-Occp.- Prop.
49. Attic Access; Size & Romex Protection -Draft Stop -ins. Baffles
50. Glu-Larn cert. -Placement -Support
51. Steel Buildings-Purlin-Girders
52. Property Line Firewall & Openings
53. Ext. Doors -Handicap Access
54. Stairs; Wi dth-Head room -Ri se -Ru n-Landi ng -Fire Protection
55. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56. Siding -Nailing Veneer
57. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access
58. Glazing Area -Glass Protection -Skylights -Plastic -Fire Port. -
59. Shear Walls -Plywood-Nailing-Conn to Roof
60. Insulation -Walls -Ceilings
61. Infiltration -Walls -Windows
62. Corridors -Openings -Fire Protection -Framing
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Pjans) OK except #'s
--ft;;�teps-Door & Sidelight Protection -Landings
vl"_64. Ex its-Size-Nurn bar- Placement
65. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
-.---65.-gp-rinklers-Placement-Test
----7=_Qt786ipended Ceiling-Seismic-Wires-Elec-Light & Mach.
L_-`(:'%�A.lec. Trim & Subpanel; Breaker Sizes & Labels
---6T-Stairs & Rails
Lr�H,�Oicap- Door Levers -Fin. Floor
�f�lec. Outlets at Wood Panel; Int. & Ext.
L-T--w6r. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
Above Floor-Mech. Protection
%,--1-3 Plb., Elec. & Mach. Equip. Listed for Location
r-�nsu lation - Foa m- Looked in Attic 0 Yes
uard Rails & Deck construction -Post Caps
ft-nVents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor U Yes
771-:P11-cco: Brown -Finish
8.-A-6. U it; Disconnect, Electrical, Plumbing
Vents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
OpeDiogs
Be-W-ater -ell; Disconnect, Electrical, Plumbing
Lefr�xterior Elec. Trim; G.F.I. Receptacle-Underg round
t, -_-T2_ 611 Site -Parking -Handicap
N�-_,�Glass Protection -
184. Corrections from Previous Inspections
,aj,.Cia�est-Meters Tagged; Gas -Electric
��6. �r & sewer connected -C/0 to Grade -HD Approval
\,---MEnergy Compliance Certificate -Other Certificates
88. Roofing Certificate -Fire Rating
ZJ
Dat 5R//,sard B- P��Q� Date Card B-1
t`���ate Card B-1
Date L '( Card B-1 V Date Card B-1
Comments at Final:
Certificate of Occupancy
(NOTE: An entry must be made each time you visit the job site)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memori.al.Way, Chico — Phone: 891-2751
7 County Cent6r Driv6, Oroville — Phone: 538-7541
747 Elliott Road, Paradise — Phone: 872-6307
CORRECTION NOTICE
k
5WNEFF— PERMIT r4o.
A routine inspection indicates that the following violations of County Ordinance
'exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need 5qgtional explanation, please contact this office immediately.
am SION
PIP
0 W -W
jilIF 01, momosle - ��-N-
7% E -0—M
Dat/
4-15
:�7/ Inspec
Owfier:. 410U.�ZEI�) Permit No. 763-7/
ENERGY CERTIF ICAT ION
Z6 -3-3
LOCATION A.P. No.
DESCRIPTION OF INSULATION
ROOF
Material Brand Name
Thickness(inches) Thermal Resistance (R Value) R-30
)( EXTERIOR WALL
Material I . . f, Y /V2
T�ic-kne-6s—(i—nch—es;—�:-,-'�,"-��
CEILING
Batt.or Blanket Type
Thickness(inches)
Loose'Fill Type�__
Minimum ThicknesWnches)
Area covered(ft.
FLOOR, ELEVATED
Material
Thickness(tnches)
FLOOR, SLAB
Material
�Thickness(inches)
Width(inches)
FOUNDATION WALL
Material
Thi6kness(inches)
Brand Name 6 W-0- - C 01w / /V
Thermal Resistance(R.Value) &3
Brand Name 0 tx.),e A., CO I -A/ 1.
Thermal Resistance(R Value)
Brand Name
Number of Bags_ Wt. per bag lb.
Thermal Resistance(R Value)
Brand Name
Thermal Resistance(R Value)
Brand Name
Thermal Resistance(R Value)
Brand Name.
Thermal Resistance(R Value)
L
I hereby certify that -the above insulation was installed in the above building
in conformaned-with the State of Californ.UEner& Req"rements,
12 L -
OWNER STATE'CONTRACTOR'S LICENSE NO.
v""�IGNATURE OF IOTALLAtfON APPLICATOR DATE
I hereby certify the above insulation and all required items as shown on the
Building Department approved plans and attachments have been installed as
required by the State -of California Energy Requirements.
All equipment, devices and materials*are of the quality prescribed or are
specifically approved by the State of California.
17
FIRM NAME/OWNER ase pr nt, STATE CONTRACTOR'S LICENSE NO.
7 -Mr--
stmaTWCF (iEWRAL cb%TkAcToRTo—wNER DATE
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL
INSPECTION APPROVAL AND A. COPY SHALL BE POSTED WITHIN THE BUILDING . '
January 1984 N
COUNTY OF BUTTS - DEPARTM61NT OF PUBLIC WORKS PUR1111111
7 county 0,,Qnt@f DFIVQ - OfQVIII0, Ogllfofnlg 96006 - T@I@phon@: 016/630-7641
— 1� I
APPLICATION AND PERMIT a,
A 9 1§3�49 ?N
_JffJ6 F4WMBr=M "N 1919-467w*
It 6 -
BUILDING PERMIT 1 ' 1
"Va'"rrellyne Klein T M-5
80,12T. 000. BUILDING VALUATION
0 S toaanReg,"Gridley 95948
'06TRACTOR'N NAM% __7
W er
69PHONK
CONTRACTOR'$ MAILING ADOP49SI
Fireplace
COYTReU'T'ON LENDER
on
UNKNOWN
I
Total Valuation 1$
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee trnnRfPr/nwnPr_
$ 10.00
ARCHITECT OR ENGINEER
None
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR MNGINECR'3 MAILING ADORM33
Penalty
$
SUILDING ADD "ass
484 Hwy. 99, Gridley
Permit fee
PLUMBING PERMIT
FillngFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO. SUBDIVISION NAME MAP
Water piping,
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF[I Duplex7 MobllehomeF� Other comm/rest
SPECIFY
Gas piping , system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home FS F G7W
0.00 ea�
TYPE OF WORK
NewD AdditionD Remodel[:] Utilities[D Installation[] Otherg
Describe work: transfer owner per permit#955-91
I I
-i
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00.
Main service 6001 OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
[eicense No. Classification.
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El I, as the owner, am exclusively contracting with licensed cunnaut-
ors. (Sec. 7044)
F1 I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUP.N)
OR ACDNS.* ( ACC. SLOGS.
21/20sq ft
NEW CONSTR. MULTI -OUTLET
O..RES'D TS)
EIRA.C. CRCU,
2.50ea
_N
(ROWER APPARATUS
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
0050c
1.2ALO 30f
F IXED APPLINIS OR
Ex. Occup. OUTLETS I RESI*D.) EA.)
1 2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
Permit Fee
$
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
Ml�lo Consent to Self -insure.
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.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating
Cooling
Hood
3.00
Venti lation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte agains t
all liabilities, judgments, costs, and expenses which m4ayin ny ay accrue
1 ay accrue
against said County in consequence of the granting of this per t.
k
X r� - \( D . Date
--- Q:3 �
Signature of Applicant — Owner Contractor 11 Agent
An OSHA Permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspec_tion ee $
occ TYPE
TOTAL FEE $ 10.00
HAL I CUA I PARK SCHL I FL���
T hi'���e y �Issued unaer
si�ns oi the Butte County. Code and/or
work indicated abe ve Icros
DIRECTOR OF PUBLIC
B
PERM17WXF;IRES Date--
PD HD. I ISSP
the appilcable provi-
resolutions to do
have been paid.
WORKS
Date .9-1, F1
Receipt No. 88487/10.00
WHITE-O.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD-APPLI CANT
COUNTY OF BUTTE DEPARTMEk�%F` PUBLIC WORKS BUILDING DIVISION
7 COUNTY CENTER DRIVE - QROVIC�1-. CALI,�JRNIA 95965 - TELEPHONE: 916/538-7541
11 �;�_ ii -A M:" .
PERMIT APPLICA , DATA SHEET
OWN E R.. k116 iXj' Permit No. Z 0
A. P. N o.
Proposed Building Use 1AAA1,:5A1& oo, Pdildib� Inspector OZO Date !�_-Zz-
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1 . All items have been submitted . ...................................
2. Plot plans in duplicate/triplicate, signed by preparer of plans ........
3. Complete plans fn duplicate/triplicate, signed by preparer of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material, Form ................................
6. Energy Design Complianc ' e and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to p*lan check)
9. Mobilehome installation data including manufacturer's installation
instructions.......................................................
10. Fees of $
11. Chico Urban Area fees paid .......................................
12 * ' Park fees paid ....................................................
13. School District fees paid ..............
14. Sanitation approval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for'(A) Use:—(B) Parking: -
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
20. Pre -inspection for required ... Pr,-inspec. request to
Building Inspector (Date)
21. Contractor's license information (No., Name Style, Classification) ...
22. Certificate of Workmans Compensation Insurance ..................
-23. Ow��i>,Builder Verification (Given to owner 0, Mail to owner 0) .....
orded copy of Agricultural Acknowledgment Statement ..........
of signature authorization ...................................
26.
27.
Mai I to owner. -Mail to contractor.
pickup at —office. Deliver w/inspector.
Other
Applica nk Date_�Ydu &I
Copy of H.az-Mat form sent —Health Dept. —Fire Dept. —'---Air Pollution Date
Copy 9f plans sent —,Health Dept. —Fire Dept. —Other— Date— By—
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
N Contractor, designer, owner, was advised of above required data by—phone---mai I —counter by—.date
Contractor, designer, owner, was advised of abdve required data by—phone —mal I —counter by— date
Plans checked by— - Date -Plans approved by Date
— Sets of plans on hold in — Fi le cabi net _AP folder
Copy—DPW
Ap,,r.,il 1-1, 1991
To Whom it might concern:
I Frank and*Ellen Myers transfer all fee's and permitts
pertaining to Ellens Cou'ntry Dinner, 484 Hwy 990 Gridley,
to the new owner Darrellyne Cole Klein.
Frank Myers 6;r
Ellen Myers
COUNTY OF BUTTE.- Department of Public Works
7 County Center Drive, O��ille, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
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. 1 personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
2. 1 (have/have not) signed an application for a building permit
for the proposed �o_rk.0
3. 1 have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. 1 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 Contractors License No.
5. 1 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 L
Social Secqit N mber
Date 4// f2u
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
couOy OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Orovillo, California 06066 - T@I@phon@: 016/630-7641
APPLICATtON AND PERMIT
PORMIT NO,
fzr6 NUM91104
:2, y — 0 _S3
F -J'
ZONIFTi AZ
BUILDING PERMIT
Dacrelkgv �e k le I tJ
de6 - �23
SO. FT. OCC. BUILDING VALUATION
-
OWNSM 11MAILING A00mass (
Zd r, drey
I
CONTRACTORTrWM.
n UJ ly6z
TELK HONK
CONTRACTOR'3 MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
N0A11e
UNKNOWN
Total Valuation Is
Filing Fee $ 10.00
LENDER'S MAILING ADDRESS
Permit Fee LZ C/Z �OLAJ/<J Ls
10"00
ARCHITECT OR ENGINEER
3E NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
7 0 ar.,
Permit fee $
PLUMBING PERMIT FilingFee 10.00
Each Trap
1 2.00
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
Each qas water heater or vent
--5.00
5.00
USE OF STRUCTURE
SF0 DuplexF� Mobilehome[D Other QAd
4PECIFY
as piping system 1 - 5 outlets
'Building
5.00
sewer
5.00
Mob i I e Home S FG_FW_F_
0.00 ea.
TYPE OF WORK I
NewR Addition[] Remodelo Utilities[] Instailat
_jonF Other
Describe work: QW14-fifle-
I I
Permit Fee $
Contractor
ELECTRICAL PERMIT FilingFee 10.00.
Main service OOV OR LESS
00 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El I 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.
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 I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUP.0i)
OR ADDNS. ACC. BLOGS.
Z/20sq It
NEW CONSTR. MULTI -OUTLET
N
1 0 RESID, BRANCH CIRCUITS)
.2.50 ea
POWER APPARATUS 6)
(SINGL _ _UTLET CIR
F 0
Ex. Occup(OUTLETS OR FIXTURES
20050C
DAL@ 30V
FIXED APPLNS OR
—Ex. Occup. OUTLETS (RESI*D. I E A.)
2.00
Temporary service
10.00
Mobile Home Facilities
15-00
Misc. Wiring
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F-1 The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Fi I Ing Fee 10.00
Heating
Cooling
Hood
3.00
Venti lation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County 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 County in consequence of the granting of this permit.
X Date
Signature of Applicant - Owner D Contractor AgentF
An OSHA permit is requireo fa! e?cjav�airions over 5'0" deep and demolition or can struct-
ion of structures over 3 stories in Ppight.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST PE
TOTAL FEE $ 0 0
HAL
I CUA- I PARK I SCHL
I FLO
COF
I PAR
PO
HD,
SSUE
11
T.h'.s permit is hereby issued unaer tne appilcabie provi-
si ons of the Butte County. Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
Receipt No. OU 7Qt')110'9f'
WHITE-O.P.W., TELLOW-ASSE330F� PIN K -INSPECTOR. GOLD ENROO-APPL I CANT
COUNTY OF BUTTE - DEPARTMENT Or' PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, C�lifornia 95965 - Telephone: 916/538-7541 763-91
APPLICATION ANO PERMIT
ASSESSOR PARCEL NUMBER
24-16-33
ZONING
A40
BUILDING PERMIT
OWNER
Frank Meye-r (ellens Country Diner)
TELEPHONE
846-5074
SQ. FT. OCC. BUILDING VALUATION
est 1,500
OWNER S MAILING ADDRESS
12236 Robinson Rd, Gridley 95948
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 25.00
ARCHITECT OR FN.-,1,14EER _7
CENSE NO.
Plan Checking Fee
$ 15.00
Energy Plan Checking Fee
ARCHITECT OR ENGINEER'S MAILING ADDRESS
ft(
$ so -on
BUILDING ADDRESS
484 Hwy 99
Permit fee
$
PLUMBING PERMIT FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
UBDIVISION NAME
1
PARCEL MAP
Water piping
5.00 5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFEI DuplexF� MobilehomeF_J Other Comm Restaurant
SPECIFY
Gas piping system I - 5 outlets
5.00
Building sewer __F_
5.00
Mobile Home S I G I W
10-00 ea'
TYPE OF WORK
NewO Addition [:1 Remode 10 Uti lities [I Instal lation El Other MK
Describe work: Repair trusses, windows, sheetrock, elec
htr, wtr piping IFIZiq
Permit Fee
$ 15.00
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
IF
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El I 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.
F9 I, as the owner, or my employees with wages as their sole compen_
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
0 1, as the owner, am exclusively contracting with licensed L;UIILIUL;I-
ors. (Sec. 7044)
F_J I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCUP.N)
OR ADDNS. ACC.BLDGS.
21/20sqft
NEW CONSTFL MULTI -OUTLET
NON-RESIC. BRANCH CIRCUITS)
2.50 ea I
(POWER APPARATUS &I
SINGLE OUTLET CIR. I
Ex. OCCUP(OUTLETS OR FIXTURE
L_
20050C
DA09 300
OCCUP FIXED APPLNS. OR I
Ex. * OUTLETS IRESID.) EA.1
_
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 15.00
Permit Fee
$ 25.00
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.
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.
Contractor
MECHANICAL PERMIT
Fi I ing Fee 10.00
Heating reinstall
6.00
Cool i ng
Hood
3.00 :3 - UU
Ventilation
3.00
Permit Fee
$ 22.00
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.
1 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 County in consequence of the granting of this permit.
X !�Z# q 0,!L/ Date —
Signature of Applicant dOwner;K Contractor E] Agent Ej
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $ 112.00,/
_T���DF
HAZ.
I CUA- I PARK
I PAR
PD
11 HD,JIS
ly
This permit is hereby issued under the
si�ns of !he ^tte County. Code and/or
wo dic aboV6 foL which fees
0
I F PUBLIC
B Wy
P ��& J, / 0122_fq—?_
P MIT EXPIRES Date -
1 4
applicable provi-
resolutions to do
have been paid.
WORKS/
rAt,: 21W
------
Receipt No. 23722
WHITE-D.P.W.. YELLOW-ASSrSSOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT
COUNTY OF BUTTE - DEPARTMENT QFPUBLIC WORKS - BUILDING DIVISION
7 Clb��,t ;tENTER DRIVE - (jROVILLE,,GALIFORNIA 95965 - TELEPHONE: 916/538-7541
OWNER
Proposed Building Use
rCATI' T
PERMIT APPL 'ON DATA SHEET/)
ermit No.
P No
e'w
Iding Inspector ��7e Date
0 (� t
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
_Izi. All items have been submitted . ....................................
2. Plot plans in duplicate/triplicate, signed by preparer of -plari� ........
3. Complete plans in duplicate/triplicate, signed by preparer. of plans
4. Complete engineered plans and calcs, with wet signature on plans
5. Hazardous Material Form ..........................................
6. Energy Design Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to plan check)
9. Mobilehome installation data including manufacturer's installation
instructions .......................................................
10. Fees of $ ........................
11. Chico Urban Area fees paid .............. r, .........................
12. Park fees paid ....................................................
13. School District fees paid ..............
14. Sanitation approval from Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval froTn City of
(see City for other requirements)
17. Planning approval for (A) Use: -(B) Parking: . ......
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
20. Pre -inspection for required ... Pre-Inspec. request to
Building Inspector (Date)
:�1. contractor's license information (No., Name Style, Classification) . ..
22. Certificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner 0, Mail to owner 11) .....
24. Recorded copy of Agricultural Ac'knowledgment Statement .........
25. Letter of signature authorization ...................................
26.
27.
When you issue the permit proc s follows: -Mai I t r. -Mail to contractor.
1 111-07 hold for pickup at ffice. -Deliver w/inspector.
Telephone 5U_14�Z07
0 ir
the
Applicant
Copy of Haz-Mat for�Aent -%Health Dept. -Fire Dept. ----Air Pollution bate
Copy of plans sent _,'__H�alth Dept. -FireDept. -Other- Date- By.
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone---mai I —counter by—date
Contractor, design6r,,owner, was advised of above required data by—phone —mal I —counter by— date
Plans checked by Date Plan d by 11 1,
�Approve —Date
k
- Sets of plans on hold in —File cabinet --- L-`A`P f o I d e r
Copy—DPW
I IL
COUNTY OF BUTTE - DeVartmebt of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
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. 1 personally plan to provide the malor-\Iabor and materials for construction of
the proposed property improvemen ) or no)
2. &ave/pave not) signed an application for a building permit
or roposed work.
3. 1 have contracted with the following person
construction:
Name
Address
(firm) to provide the proposed
Phone Contractors License No.
City
4. 1 plan to provide portions of this work, but I have hiredLthe following person
to coordinate, supervise, and provide the major work:
Name
Address City
Phone Contractors License No.
5. 1 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
igned:
Property Owner
Social Security Number
Date � 7J
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE"LTN0.
7 Cou I nt . y penter Drive - OrovIlle, California 95965 - Telephone: 916/538-7541 -76?,�5
APPLICATION AND PERMIT
0
ASSESSOR PARC L NUMBER
6P 1-1-746 -3
ZON
BUILDING PERMIT
OWNER
FA4,v1-*' 44 C-q6lt-
SO. FT. OCC. BUILDING VALUATION
OWNER'S MA�ILJNG ADDRESS
lee6"k-5o'cl
C04��2V -7TELEPHONE
,r'S N
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENOER
UNKNOWN
Total Valuation is
Filing Fee $ '.0.00
LENCER'S MAILING ADDRESS
Per -1; I F --e $
ARCH.17SCT OR L.1-,INEER
NSE NO.
Plan Che ---King Fee $
Energy Plan Checking Fee $
ARCHI�ECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDIN SS
Permit fee $ 67, 67 d
PLUMBING PERMIT FilingFee 10.00
Each Trap
2.00
Solar or heat pump water heater
20-00
LOT NO.
SUBDIVISION NAME
1
PARCEL MAP
Water piping
5.00 4�-, 9
Each gas w ater heater or vent
5.00 1
USE OF STRUCTURE
SFEI DuplexF� MobilehomeF� Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home
10.00 ea
TYPE OF WORK
New R Add i t i on [:1 Remodel EJ Utilities[] InstallationEl OtherxN
Describe work: fleek 112 W1KD0(,X)13
Permit Fee
$ 1061
Contractor
ELECTRICAL PERMIT
Fi I i ng Fee 10.00
60
Main service I OV OR LESS
00 AMP OR LESS
10.00
Main service EA. ADD -L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. 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 I, as the owner, am exclusively contracting with licensed %.UII&I0(;L-
ors. (Sec. 7044)
F� I am exempt under Sec.—, Business and Professions Code
for this reason
NEW CONST DWELLING OCCLIPAW)
OR ADONS.' ACC.ELOGS
21/20sqft
NF LET
-W CONSTP
- MULT'-OUT
N N -RE S 10, .ANC. CIRCUITS)
2.50 ea I
- . . POWER APPARATUS &)
SINGLE OUTLET CIR.
Ex. OCCUP(OUTLETS OR FIXTURES_
A' L'05300eg
FIXED APPLNS. OR
Ex. -Occup, OUTLETS (RESID.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.001
Misc. Wiring
15.00 1
A
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
FilingFee 10.00
Heating e.EhVSZZU-4—
11000I /,,o
Cooling
Hood
3.00 :3
Ventilation
3190
Permit Fee
$ 9) 0
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned 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 County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner [I Contractor 13 Agentf-1
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of st uctures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee
occ
CONST TYPE
TOTAL FEE $
HAL
I CUA
I PARK SCHL
I FLO
I CDF
I PAR
PO
HD.
I ISSUE
This permit is hereby issued unaer tne applicable provi-
sions oi the Butte County. Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
B Date
PERMIT EXPIRES Date
Receipt No. ar&z—
W"ITC-D.P.W.. `rELLOW-A38r35OR. PINK -INSPECTOR. GOLD ENROo-APPL I CANT
Mon's
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LUMBER SPECIFICATIONS Top Ch
91 HEM - FIR -,2
Top Chard 2x 4 4r5,
Sollom Chgrd Webs
T 2- -3151
80t Chord 2Z 4 02 HEM -FIR T 3- -3151
8 2- W 1 2550 W 2 -546
2459 . 3 700 W 4 -349
B
Standard Unifor ' Loadin (m)
TCLL - 20. 0; TCDL - lomo.
Web MEM. 2x 4 STANDARD HEM -FIR T 4- -2348
3- 2344 w 5 B34 W 6 -605
B 4- 0 W 7 2439 W a 28
SCOL9.
Increase - 1.250
LIVE LOAD DEFLECTION BASED ON L/240
WEB 1. 7 To rd
2X 4 #1 HEM - FIR T PI-CO0724
Bottom Chord WenS
B 1- 0.086 W 1 0 471 W 2 0.107
T 2 0 910
1 3: 0:910
2- 0 655 W 3 0:388 W 4 0.069
Ba 3 0:627 W 5 - 0.462 W 6 - 0.1ig
4- 0 7 6
BEARING REGUIREMENTS T . I
EGUIREM�E
81 L �t
8 4: 0 096 W 7 0.450 W B - o.o15
C T��
BEARING ACT. SIZE REG. SIZE LBS
7�R
(BT SIM
1 7
50 1�.
71 3.50 ln. 1.50 In so
T 1-50 In: 80
�04
1/4"PANEL POINT SP
4 LICES AF LOCATEO�12, IN.
FROM EITHER 0 ;1_
O_ hTlS.
TC OR BC _35 4-PAMC POINTS.
WAKE PROVISIONS�FOR
AOEQuA DRAIN GEI
T �MTE_ A
ICBD., THIS TRUSS HAS BEEN DESIGNED IN
ACCORDANCE
WITH ICBO RESEARCH REPORT 1607.
R-50DO
HOLDING VALUES ARE 203 PSI IN
SOUTHERN PWJOUGLAS FIA -LARCH AND 152
PSI IN HE14-Fl SPAUCE-PINE-FrR.
BUILDING DEPARTNAEN
PLATE CONNECTING THE END DIAGONAL WEB MUST
EXTEND 2* HORIZON7ALLY PAST THE END CORNER
OF THE WEB ONTO THE TOP CHORD. PLATE ABOVE
Top CHORD MY BE TRIMMED OR FOLDED OVER THE
APPROVED
TOP CHORD * NO MORE THAN A 1/2' GAP IS PERM-
ITTED BETWEEN THE BEARING AND END WES.
PLATING BASED ON GREEK LUXBER AT TIME
OF MANUFACTURE.
5-8-0
6-6-15
2-0-0 32105 4860
1-8 0-4 —a_ 1630 2445 6475
PLATE CODE er DATE
R50 UBC- 24. 00" 0. C. 1-2 26/91
---00
A -TrusPlus Design
DWG#8-75373 I FILE#
5-9- 12
5-2-4 5-il-9
23-8-12 OVERALL SPAN
I A10
lffAtlkLW,jlk6W.A SYSIEM
TRUSWAL SYSIEFAS CORPOP-ATK)N
IL & i
ELLEN -S, COUNTRY DINER / LAS PLUMAS / G.D.- / Version 2.00
2430
-C 2-0-0
-T-
CA L I V
/ 3/15' - 1*
0'1 Y4
f
4e D:a
T NO.
PERMIT EXPIRES
OWNER Double V/V Restaurant
(Knan A Knan)
owner
CONTR.
24-16-20
ASSESSOR PARCEL
SE corner of Hwy 99 & Turner Ave,
LOCATION
Gijdley
2-2- -
4@
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gas Service Al
CalledPG&E ,A
JOB FINALED (Date) j^
Signature
%I = OK
0 = Not OK
- = Not Applicable MOBILEHOMES
= Not Ready
I I r
MISCELLANEOUS
Dale
MOBILEHOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
Da te
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except #'s
1. Zoning Req6 i rements-Setbac ks- Easements
2. Footings: Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists-Decking-Bracing-Stairs-Raits
4. Water; Loc at i on- Test- 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: / /"L"ft./ /" Nat. or/ L"ft./ LPG.
7. Utility Clearance
6. Carports; Windows -Doors
7. Elec.
Card -BI
Date Card- B I Date
Card -BI
Date Card -131 Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Card -BI
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 Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
3. Pool Structure; Stee I -Connect i ons -Th ickness-Dead Men -Lining
4. Elec.; Receptacles and Lighting; Distances-GF1
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' -C irculating Equip. -Pool Lgh(g.
Boxes -Enc I osures- Pane I boards- Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Departmen . t Approval
10. Plumb; Cir. Test -Water Supply Test
Card B-1
-Date Card -BI Date
Card -131
Date Card -Bl Date
Card B-1
Date Card -Bl Date
Card -BI
Date Card -Bl Date
k
A
0
41
V = OK
0 = Not OK
Not Applicable
Not Ready RESIDENTIAL (Sin-gle and Duplex)
Date
UNDFELIFLOOR (Plans) OK except#'s
Date
FRAMLNG-(Continued) q4 i %
ient.5,-Setpas- Easements
4&,e'P�2�rty
1111
Line Firewall & Opinings
2P*rTg., Main; Ftg. Depth
4A,--1Sxt.
Doors -one
-%-.Wg.-,-dvrMJU-,-So-irs-S-teel- Ftj. E5epth
WkM"-Hea 6aod+o@--F-ire-FYotee+KH;�_
4. ?TT.7,-PUrc-Fe-s-&_Decks; Soils -Steel- / /" Ftg. Depth
5--,R18awAHt9-,M7M-STe-6 I -B lockouts -Wrapped -S lab
vt21�__
C52. -Sid
od on Roof Overhang -Attic Vents -Rafter Outriggers
ing-Nai I ing-Veneer
6--S"wwwaff�I.; Steel-Blockouts-Wrapped-Slab
53.
-unde,11r. Accesg-
mers Ireplace Ftg-Steel
9<��g
Area -Glass Protect i on -Sky I ights-P last ic
Test -2 way C/0 -Sewer Test
25e�Shear
Walls; Nailing -Bolts
9,4a&.Eipaj.�e -A nc hors
1G.- Wate. Pipe, Tvsr=Anchors-Regu lator-Sery ice Test
1 1,-E+mtm--urTe-rg--r5-u7d
12 --PtermMT7977u-c7s-,-Clearance-materi a I -Support- Ins.
8i.dem-SIV.-A ichor Bolts-Joist�,-VeAts-Cripples
Card -B
Card -BI Date
I
Card
-BI
Date Card Date
Card -B]
Date Card -61 Date
Card -B
40
DateK-,/K- Card -BI Date
R6
Date
FINAL_(Plans) OK except #'s
Card -BI Date Card -BI Date
Date
P!,UWH<Go__(Permit) OK except #'s
Steps -Door & Sidelight Protection -Landings
57.-SM75"ITe-tector
'
Vent- Access -Combust ion Air
58.
Fi-r--,--*Nlaat,&-.G4eersTrcir--I:Urnb,,Air-Connector-
In Garage; Above Floor-Ducts-Mech. Protection
i6v-'Wat9,x,Pipe; Test & Anchors -Nail Protection
10,-lT.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
BM1.0111 EXTITIn-9
17. Showep
60.
. . . a Ix u
18. T�e*t:�-8rffllvwgl, 211d
km-r-tiec.
Trim & Subpanel; Breaker Sizes -Labels
W�as Pipe; Size & Anchors
62.
63.
G eaFenees-Huarthr-
Card-B'7;,-
Datab� Card -BI Date
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -B11
Date
Date Card -BI Date
ELECTSXAL (Permit) OK except #'s
66.
-1-- QW -1- Reeepkeelee-sim��
67.
G
68.
69.
A G, Pti.t n Mamp-Mmp9'r
Wtr. Htr.; Vents -C learance-Comb- Amr-Connectar-F.R.V
in Uarage-,AMve F loor::-Mech. Protection
zb--'f-
i�x�e & Transformer Clearance -Ins. Protection
E12S.-Rticeptacles Spacing -Lights & Switches at Doors
7&_-PVElec.
& Mach. Equip. Listed for Location
Zaeoirize_aoxes & No. of Conductors -Stapled
71.
-!)-ReME P atec.
a%,��ognjewIfi`stal led Close to Edge of Studs & C.J.
2�.�quip. Ground made u p w/Mech. Fasteners -Bond Gas & Water
Zg,--1-nsu
lat ion -Foam- Looked in Attic Enge5
73.
%e -d Rails & gee - . , . __ - ('�P� -
. .
25.
74.
F _e-&-Wvad-lT8rMT-C"arance
L ":k d =d' Floor
o e e'r E) Yes
26. S)OXed50k Size ga. Cu or Al-A.C. Wire Size ga. Cu or Al
37. Ran e Circ. ga. Cu 3? Al,
Ins ed Neutr I EJYes E3 No
!!qf�
00P.
5�
76.
llowing instid.: Drive [] Yes 0 No; Walks Ej Yes [-] No;
P pla' nters El Yes 11 No
&Wee kewm-PtnM17-
24wg'e�Riser Conductors & Ground -Main Disconnect
a%o-'Squip. Clearances; Pane I s-Motors-Mech. Equip.
Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
30_-C����-wer �ig
Lao' -Vents
Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
Waisp Wellmi-g�, �ec r i c a �,u rn Mn g
lillgo-15x-terior
Elec. Trim; G.F.I. Receptacle -Underground
Card B-1 e"i-ft-VI Card -BI Date
EJ.
X1,M01,10- th-,gh-,
Card B-1
Date Card -BI Date
Ak.
Date
MECH�� (Perrrit) OK except #'s
CoEEWions from Previous Inspections
gA.-OTas
T -Meters Tagged; Gas -Electric
_e5 t
21*-,oA&�cts; insulation & Support
& Sewe Connected -C/O to Grade -HD Approval
Fan; Exhaust above Insulation
awEnergy
Comliance Certificate -Other Certificates
33. Condensate Drain & Overflow; Size & Grade
IDI-- g7> D C -C
34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
e At-r"crr i s<,"&- c&kq- Dr -
in Attic
e!b&-C,
,4o'.1 -
W
Card-Bteo�_
24 AgAfAfff"-
pjp4rt
to
Date /_0�t_ndE-
4 /Card -Bl Date
Card- Date Date
Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date
Comments at Final:
ard-BI Date Card -BI Date
Date FRAMWer(Plans) OK except #'s ja A-PWAO-4-0 ?4w
j6j'Sills; Proper material & Anchors
tuds-Nailing, Spacing & Bracing -Plates -Sound
VL ,*'4 0.0 .e
LOW % 4� ow P, "wPPT �
3?�'_Bearing Walls over Girders & Floor Nailing
nglT�-�
L/ a "7 - V
I ps; Furred Ceilings -Stairs -Chases -Tub
�_rr I
0��HaUjaps-Post Caps -Anchors -Conn
g .0 -Tr -Shthng.-Rfng.
j ist Wftr. foes Purlin Roof Brac. jes
44.
V,**'A_tt,E_Access; Size & Romex Protect i on -Draft Stop -Ins. Baffles
46. ns
47. G ming
(NOTE: Anentrymust be made each time youvisit jobsite)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
C.ERTIFICATE OF OCCUPANCY
This building has been constructed and completed in accordance with the
requirements of the Uniform Building Code under permit number 1784-81
for the following:
Use Classification - REstaurant
Address or Location 484 Hwy 99, Gridley'
Group B-2 occupancy; Type V—N construction.
It is hereby certified for the occupancy described above and may be
occupied.
Director of Public Works
Date 10129/87 By J.
POST IN A CONSPXCUOUS PLACE
(Over)
W,O"T'-rc E
A new Certificate of Occupancy is required if the use or occupancy
of this building changes.
I This Certificate of Occupancy shall be posted in a conspicuous place
and is not to be removed by other than the Building Inspector.
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORRS-- —
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE
BUILDING OR PROPERTY ADDRESS,
A routine inspection Indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, 'please contact this office immediately.
L 7/4 co" 01 r,-0^6
-6 7&0 Z.4 tA-1
orwo 4.4 /t XA /C E -
Date
InspectorA Jyff�4ix,-j
-COUNTY OF. BUTTE
DEPXRTMENT OF PUBLIC WORK�"
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 534-4541
Skyway and"Ffliot�,,Road, Paradise — Phone: 872-2961, Ext:
CORRECTION NOTICE
/15 �_ - �' /
BUILDING OR PROPERTY ADDRESS
A routine inspection Indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
All,
Inspector
COUNTY OF BUTTE
D�PARTIVIENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center,Drive, Orovi Ile — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone:.872-2961, Ext. 57
CORRECTION NOftdE
IQ i=E S 7WAAt-, 7—
BUILDING OR PROPERTY ADDRESS
A routine Inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
(�D'0 ko-ADM104(�,IDF— RAE-�,77k0OAlk
A;7 7S
r-
mNd1e1EczP 41-1-
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a( D&L IiN-11--6 -SA(c364,VA/C,,- /40tJ
Z�66 b 5 / Zoi— 4-J,4--', Zw-'7�zp?
Date—
rum, Mmn
- Alle-
COUNTY OF BUTTE
DEPA RTMENT OF PUBLIC WORKS,
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive', Oroville — Phone: 534-4541
Skyway.and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE, -
.BUILDING OR PROPERTY ADDREgS
A routine inspection Indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, 'please contact this office Immediately.
I
I n s p e c t o r / �a W/X-tw'"r, Date -2--/-5
Cr
7,
Mu
at. Y (i�m 0
41
1 layer SPECIFICATION
Roofing, 2 layers ' No. 15 Asphalt Felt,
and Gravel or Slag Surfacing.
For wood and plywoocl,�
precast and poured gypsum,
precast nailable concrete
and insulated decks.
0" to 1/2" in 12".
5.80 psf.
gravel surfacing-------,
60# asphalt
flood coat —
.
5 asphalt felt
25* a sphalt
Materials—Approx. weight per 100 sq. ft. roof area.
mopping
5 asphalt felt
DUO -COLO
SPECIFICATION roofing
sheathing
FELTS -2 Layers No. 15 Asphalt Felt .....................
30 lbs.
wood deck
gravel surfacing
600 asphalt
flood coat -
#15 asphalt felt
25# anha�lt
moppini #15 asphalt felt
36
.SPECIFICATION roofing
gypsum deck
ailable d F1
tj .1 i 11 A,
Preparatory Work—Roof deck shall be clean, dry, smooth, properly graded
to drains and shall conform to USG Roof Deck Standards.
Materials—Approx. weight per 100 sq. ft. roof area.
.SPECIFICATION roofing
gypsum deck
ailable d F1
tj .1 i 11 A,
Preparatory Work—Roof deck shall be clean, dry, smooth, properly graded
to drains and shall conform to USG Roof Deck Standards.
Materials—Approx. weight per 100 sq. ft. roof area.
BASE SHEET -1 Layer SPECIFICATION Base and
Ply Roofing ..............................
40 lbs.
FELTS -2 Layers No. 15 Asphalt Felt .....................
30 lbs.
ASPH A LT— Dead -Level Grade —
Mopping between Sheets .....................
50 lbs.
Flood Coat for Gravel .........................
60 lbs.
SURFACING—Gravel (Slag -300 lbs.) ......................
400 lbs.
NOTE: Weights shown are norninal.
APPLICATION—
On Wood Decks—A single -ply protective layer of DUO -COLOR Sheathing
Paper shall first be applied by shower -nailing sufficietly to hold in place.
Base sheet shall then be applied by nailing 9" o.c. along lower edge and
18" o.c. through centerline of sheet using 1:2-ga. 1/2 --head galvanized
roofing nails 7/8" long or of SLIfficient length to penetrate sheathing 3/4".
On Poured Gypsum Decks—Base sheet shall be attached with 1-1/2' ' ES
NAIL-TITE plain -finish nails providing 1-1/4" penetration, spaced 9"
apart along lapped edge and 18" apart through centerline of sheet.
On Metal Edge Gypsum Plank—Base sheet shall be attached with 6d square -
Cut tapered, bright -steel nails providing 1 -1 /2" penetration, driven through
tin discs 1-1/2" min. dia., spaced 12" apart long lower edge.
On Plywood Decks—Base sheet shall be applied by spot -mopping with hot
asphalt. Spots shall be 18" in diameter and 30" o.c. and/or base sheets
shall be nailed 9" o.c. along lower edge L.Jsing Simplex or Squarehead ring -
shank nails of sufficient length to penetrate through deck.
On Decks With Rigid Roof Insulation—(Select appropriate specification
from page 77.)
Starting at low points of roof, base sheet shall first be applied shingle -
fashion, without wrinkles or buckles, with 2" overlap and 34" exposure.
wo layers of No. 15 asphalt felt shall then be applied with 19" overlap
and 17" exposure. Ends shal.1 lap 6". Layers of roofing shall be bonded
together with a uniform and complete mopping of hot asphalt, using
approximately 25 lbs. per sq. The temperature of roofing asphalt shall not
exceed 450'F in the heating kettle, with application at approx. 400*F.
Cant strips shall be provided at all intersections of. roof surfaces with verti-
cal walls, parapets and curbs. Roofing layers shall be turned up against
cant strip and trimmed evenly with Upper edge of cant strip.
Roofing shall fit neatly around all pipes, vents, drains and skylight curbs
and be sealed with plastic roof cement. Metal flanges of gutters, gravel
guards, pipes, vents, etc., shall be embedded in hot asphalt between layers
of roofing. Edges shall be sealed in roofing with 6" -wide aspha I t-satu rated
web fabric, mopped on.
A uniform, heavy coat of SUPER-TITE Dead Level Grade Asphalt shall
be poured over the roofing layers, using approximately 60 lbs. per sq. Into
this flood coat, while hot, a complete covering of gravel shall be thoroughly
and uniformly embedded. Gravel shall be 1/4" to 5/8" in size and clean,
dry, hard and opaque.
Base Flashing or Counter Flashing
(For flashing endorsement, select specification from page 75.)
10/72
N
0
N
R E S
I D E N T
I A L
B U
I L D
I N G S
ENERGY
CONSERVATION
STANDARDS
CONSTRUCTION COMPLIANCE CERTIFICATE
I HEREBY CERTIFY, BASED UPON PERSONAL KNOWLEDGE, THAT THE
WORK APPEARS -TO HAVE BEEN PERFORMED AND THAT THE�MATERIALS
USED AND INSTALLED APPEAR IN EVERY MATERIAL RESPECT TO'BE
IN-COMPLTANCE WITH THE APPROVED PLANS AND SPECIFICATIONS
FOR 1784 - S/ (Building Permit Number)
�2, (UBC Occupancy Type)
h14) (Location)
Signer's Name AIIIAll /o/ov
(please pr
Sig nature *Ly� Date
Job Capacity
(contractor, engineer, owner, etc.)
Chapter 6 of the Energy Conservation Design Manual reads in part .... "must
be signed by -the building owner, or the general building contractor, the
'design architect, design engineer, or an approved.inspector'or inspection
agency ..... . The certificate.presumes a personal knowledge of the work
and materials used; this means knowledge obtained from periodic, diligent
site visits and reports from others engaged on the site.'.'
11
Simpson
Simpson Building Supply Company
Santa Clara Distribution Center 500 MATHEW STREET
SANTA CLARA, CALIFORNIA 95050 (408) 985-2911
July 17, 1981
Double 'IV" Cafe
484 Highway 99
-Gridley, CA. --9-5.9,48
Attn: Tom Skelly
TheGlUe Lam -Beams shipped to you per our order #61204
are 5-1 /8 x 10-1-2 pi ece 1/14! - and 5-1 /8 - x "16-'-.1-2 piece'1/211
both a portion of the -Glue Lam Beams ship�ped to*'us for -
stock per our order #25053 from Standard Struttures Inc..
The AITC..'certificate is enclosed.
Sincerely,
SIMPSON BUILDIN� SUPPLY CO.
ames Lan.gjahr-
Shipping Supervisor
ATTACHMENT
JUL 2 1981
n r
CE'R IFICATE OF CONF RMANur-
CROW
1HE UNDERS16NED MANUFACTURER HEREBY CERTIFIES
are marked
that the products identified below and onattarbW sheets Nos.
with the collective mark of the Amefi= Institute of Timber lonstlurtlon_(AIT�) and are
manufactured in accordance with the manufamfing and fabricatinq provisions of
the Uniform Building Code as modified by jr-Bo 3327-8U.
and that such manufacture has been at our plan tin— Santa Rosa2 CA which
plant has a quality control system approved by the inspection Bureau of the American Institute
of Timber Construction and inspected periodically by such Bureau. The undersigned manufacturer
further certifie . s that the work has been done in -,accordance with the applicable job specifications.
One (1) lamination 0.41 specific gravity, top or compression face and
tension face
(2) laminations 0.41 specific gravity, bottom or
_V"E: simp. stk/25053
JOB LOCATION: 500 Mathew St.., Santa Clar
25053 613/81 _ MFGR-S ORDER NO. _VL- 29 5 8L—
JL��
CUSTOMER'S ORDER NO. DATE .
Glulams per contract acknowledgment dated 6/3/8 -/2
COMPANY
SIGNATUR
TITLE Q3A Llity control Dir ADDRESS DATE
AITC HEREBY CERTIFIES that the said company at its said plant is licensed by
the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Mark in
respect of products which comply with applicable provisions of said code and report(s), that the
adequacy of the quality control 'system in effect at said plant is periodically inspected and verified by
TE OF TIMBER CONSTRUCTION, and that, in
the Inspection Bureau of the AMERICAN INSTITU I ing
lying with applicable manufacturi
the judgment of the undersigned, said. company is capable of cOmP - said plant.
and testi . ng provisiom.'of said code and repart(s)-in.'retpect of -products manufactured at
Conformance with the said code and report(s) in respect of any specific or particular product is the
hereunder being that the said company is
sole responsibility of the manufacturer; AITC's certificate plant is periodically
qualified to produce a product meeting the said code and report(s) and that its
inspected and verified by the AITC Inspection Bureau.
AITC Certificate No. t 6 U Sig -ed for
-RICAN INSTITUTE OF.TIMBER CONSTRUCTION
Jack Minnect
Paul R. Beattie irector, Inspection Bureau
7xecutive Vice President F TIMBER CONSTRUCTION
(D 1980 AMERICAN INSTITLITE 0
AITC FORM IBCE
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC K SE
7 Cointy Cdnter Dri'h - Oroville, California 95965 - Telephone 6/534-454(9
V APPLICATION ANY PERMIT,
ASSESS AR)E 151�b ZOXG __1
U—UM
BUILDING PERMIT
OWNE TELEPHONE
C7� KhR h �;7
SQ.FT. OCC. BUILDING
VALUATION
OW ER S MAIL G ADDRESS
q-K,V-
0,aA
CONTRAC TELEPHONE
Cp 9!?
6 0
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee 06
$ L_VLL1.&4=
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee 8Z,00
$ _459 -leer
Penalty
$
ARCHITECT OR ENGINEER'S MAILING� ADDRESS
Permit fee
$
B U& N A D 0 R ECZ �N5:2,r Q il? —1-0 I_ 1
PLUMBING PERMIT
Fi ling Fee 10.00
L
Each Trap
2.00
Repair drainage or vent piping
5.00
rl
) 0,,A
Water piping
LOT NO.
SUBDIVISION NAME
PARCEL tAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUC
SF [I Duplexn Mobilehomen Other
SPECIFY
Building sewer
Lawn sprinkler system
TP
—
-.00
TYPE OF WORK
New n Addit R'emodelK UtilitiesEl InstallationEl Other E]
Describe work:.2�1 1E In I B�" e
V%Q !&trP_,a C�% all — D C_ Z;ite
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 6001 OR LESS
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 it
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
iness
El .1 am licensed under provisions of Chapt. 9, Div. 3 of the Busf
and Professions Code and my license is in full force and e fect.
License No. 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)
1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
F] I am exempt under Sec.--, Business and Professions Code
for this reason
NEW CONSTPL(MULTI-OUTLET
..i.i.RES'D, BRANCH CIRCUITS)
2.50 ea
NEW CONSTK I POWER APPARATUS 6)
NON-RESID. %SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
50 @ 25C
IBAL@10t
�(OIUXED APPLISIS OR
Ex. Occu . TL ETS (-RFSI'D.) EA.)
2.00 4
Temporary service
10.00
Mobile Home Facilities
15-00
Misc. Wiring
7.50
Permit Fee
$
Contractor
MECHANICAL PERMIT
FilingFee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
F-] The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith Comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County 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 liabflities, jud ts, &o ""' hKxpenses which may in any way accrue
agai y aid Caiinty in e rnce of t he granting of . this permit.
V,�Jn , 5--/ g — C?
Dat -
SignaU 0 p lic�lnt�- '� N6fer6� ControctorEl Agent El
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in heigly. I
Mobile Home Installation Fee $
TOTAL PERMIT FEE C2/
OCCUP. GROUP
2-�i
I j)PF Oj4ONST.
I
JPA;J
:;y
�
ISSUC
�7
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR UBLIC
n
By
FJERMI-�/XP'FRES Date
.
the applicable provi-
resolutions to do'
have been paid.
WORKS
ate 7
,hL /.-
Receipt
WHITE-D.P.W.. YELLOW -ASSESSOR, 4NK-INSPECTOR. GOLDENROD-APPLIC./T
OWNER
COUNTY OF BUTTf-,rDEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
I .'
._�7 COUNTY CENTER DRIVE - OROVILLE, TEtf'EPHONE: 916/534-4541
N I A 95965
PERMIT APPLICATION DATA SHEET
A It A Permit No.
A. P. No.,t2 Q( -f �,- 2-0
Proposed Building Use \S N'_9 ":)-A ,
Permit Fee Based Upon: —Complete Contract Price —DPW Valuation
lain)
W
Building Inspecto Date
At time of permit application, I was advised theVfollowing data must be submitted prior to permit processing
and/orissuance: DATE RECEIVED APPROVED
1. All items have been submitted.
2. Plot plans in duplicate/triplicate . . . . . . . . . . ...
3 Complete plans in duplicate./tri I*cate. . . . . . . .
Complete engineered plans an;��.
5 Plans with Energy Design Compliance Statj ent . . . . ...
614-742 IF C
&� State Energy Forms No. ALL rLpccw
&7 Statement of Intent for Non -Heated and AC Buildings.
8 Fees of $
k9,, Letter of signature authorizatigA . . . . . . . . . . .
�_, 90- Sanitation approval from Health Dept /41
11. Planning approval for (A) Use: (B) 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 ownerEl)
15. Improvements may be required . . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . . . . .
Pre-Inspec. request to
17. Pre -Inspection for Rep,,ired. Building Ins r —(Date).
10A 0
When you issue th; pe s follows: — Mai I to owner. —Mail to contractor.
I,fj,ni proces a
Telephone- and hold for pickup at 7.) t= -office. —Del.iver w/inspector.
Other —1,
Applicant W. 4J' Lfl:4// Date
Copy of plans sent _)�C_Health Dept., _35�_Fire Dept., —Other Date 57-7-7-t-1
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked abov t *rn of anlipation, circle item.)
? -1. Index permit for above Items No. I�K
2. Additional items required:-AwoW
(Contracto<Z15�4��w`asadivised 'ofabov"ereq ir
u
By
Plans checked by -
Plans approved by -
Other: .000-
Copy—DPW
_T -11
Date
Date 1/, -
a
To: BLLUdlng Departmerit,
From: Envi.ronmental Realth I
Subject: SanitaItion Clearan.,e
Plan approved for: Sewage di.sposal Water Supply
Hold final for: Water S)upply
Final clearance O.K. -for-, liater Supply
Clearance f or bedroom moo I -Le nome. Other
Note * * *_
san
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
OWNER -BUILDER VERIFICATION
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 in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing permit. No building permit will be issued until this verification is received.
1. 1 personally plan to provide the major labor and materials for construction
I of the proposed property improvement �yes or no) )VO
2. 1 (have/have not) YA VE signed an application for a'building
permit for the proposed work.
3. 1 have contracted with the following person (firm) to provide the proposed
construction:
Nam
NOIJ /V
Address City
Phone Contractors License No.
4. 1 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 Contractors License No.
5. 1 will provide some of the work but I have contracted �hir'ed) the following
persons to provide the work indicated:
Name Address Phone Type of Work
S igned:
Property Owner WAY A YPAII
Social Security'number ?_!�
Date A4" //?) 14,9)
NOTE: This Owner -Builder Verification is sent to you as required by Sections 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.
n
MULTIPLE FAMILY AND CONIAERCIA� PLAN CHECKING GUIDE Page I' -
Bldg. Perm3jt # 1-7 84
OWNER A. P. #
A. 't,,CENERAL
1��Zoning requirements (sideyards, special conditions).
aluation.
igniture by R.G.E. or Architect (if required). Ca Zilations.
s
L iggs.
t�
v 0
inprovements and drainage ---Land Dev.,DPW; City of Chico; C3.ty o Bigi
C Complete plot plan with dimensions, easements, otheribuildings, and other pertinent data,
Iee previous permits and plans in file for expired permits, change of use, etc.
B. OCCUPANCY REQUIREMENTS
1. Building use
2. Occupancy Class Type of Constr.
3. Building floor area 7.5 3 T &N. 4% j;_�tq.ft. Occupant Load
4. Total allowable floor area &OW 4- -sq.ft.
Basic allowable floor area "Oo sq.ft.
Basis for increase . r- 5L 7&r -q- jors inc . . Aoe-' Aub C"
54L.Additidn"lterations,
aQ repairs exceeding 50% (Sq. 104).
&'.N%�,�Ince
with occupancy g-roup-reqnTre-m-en-fg-tehmpre-rs 5-13).
.?I.'
occupancy separations (Sec. 503).
offo.0"
Area separations (Sec. 505).
4;.*0'
Firewalls due to location on property (Sec. 504).
10'.7'
Maximum height requirements (Sec.. 507).
W0.0"
Attic separations (Sec. 3025).
120.'
Ventilation and special hazards requirements (Chapters 6-13).
le.
Fire extinguishing systems (Chapter 38); Fire alarm systems (Sec.
809 & 909).
1*0.*'
Mechanical code requirements. (Grease Hood w/fire sprinkler sxstem
- Chapter 20).
Health Dept. Plan Review' -(a) Restau t Act; (b) Commercial Pool.
JW.
Smoke detection system.
ire Dept. Plan Review and/or Fire Marshal Plan Approval.
VLK.
.Electrical
Code Requirements (Pools or hazardous occ.) (Art. 680'&
500's).
C. TUES OF CONSTRUCTION REQUIREMENTS
-Fire retardant roof coverings (Sec. 1704).
rapet walls (Sec. 1709).
' Arl.� To let room floors and walls (See. 1711).
Physically handicapped (Sec. 1711 & Table 33A).
5��Guardrails (Sec. 1716).
Detailed types of construction requirements (Chapters
Proper roof pitch for roof covering (Chapter 32).
;;.***�Attic access and ventilation (Sec. 3205).
.0". Roof drainage (Sec. 3207).
180.' Skylights (Chapters 34 & 52).
MI." Stages and platforms (Chapter'39).
Interior wall and ceiling finish (Chapter 42).
Fire resistive requirements (Chapter 43).
Wall and ceiling coverings (Chapter 47).
Glass and glazing (Chapter 54).
Building Materials - Check: Grade, Species, Allowable
Example: (Glu -lam Beams w/ certif. 24F ext.grade).
17-22).
Human Impact (Sec. 5406).
Stresses, Ext. or Int. -- *
Page 2
MULTIPLE FAMILY.AND COMMERCIAL-PL&N CHECKING GUIDE (continued)
1K_ STAIRS, EXITS, AND OCCUPANT LOADS
General Exit Requirements (Sec. 3301) (Post occ. load, etc.).
Number of exits, width and locations (Sec. 3302).
Doors (Sec. 3303).
Corridors'and exterior exit balconies (Sec. 3304).
Stairways, rise & run, width, winders, and construction.(Sec. 3305)..
IV.' Horizontal exit (Sec. 3307).
Exit and smokeproof enclosures (Sec. 3308 & 3309).
Exit signs and illumination (Sec. 3312).
Aisles & seating (Sec. 3313).
JO." Exits 'for occupancy groups A-E (Sec. 3315-3319).
j!
Z --ENGINEERING REGULATIONS. DESIGN. QUALITY. MATERIALS, AND DETAILED REQUIREMENTS
'L>< Complete plans sufficient to show how building is proposed to be constructed and to
-4,erify conformance with Chapters 23-29. Plans must include plot plan, floor plan,
foundation plan, elevations, and complete structurai'details..
Energy design, calcs, and necessary details (State law).
Veneer (Chapter 30).
Chimneys.and fireplaces (Chapter 37). Engineered plans if required.
Plastics (Chapter 52).
,io.5-Excavation and grading (Chapter 70).
#T. Continuous or Special Inspection (Sec. 305).
06ro., Factory or other certification.
k"Soils or.compaction data.
Noise regulations.
Footing reinf. Min. Two'#4 bars (cont.).
Engineering.Calc(s) should include:
(a) Roof Ceiling.
(b) Floor Ceiling.
(c) Foundation.
(d) Walls -- Large openings? (consider lateral).
(e) Lateral: 1. Roof Diaphram.
2. Shear Walls.
3.- Anchorage & Tie -downs.
4. Connections thru-out.
(f) Retaining Walls.
10
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville. California 95965 - Telephone 916/534-45
APPLICATIOVAND'PERMIT Ak wl I
ASSESSOR PA L. NU R
.-2 Z' _ Zo
ZONINA
11
BUILDING PERMITP I
0 ER A;,E pop
MUBLE V ST _/qAj7
TELEPHONE
SQ.FT. OCC.1 BUILDING VALUATION
OWNER'S MAILING ACIPRESS
_
co NAME &OAJ '51—
-!�FZEEL
T LEPHONE
-7
19)7 56/0
C74ggR*S 81LING A
Fireplace
CONSTRUCTION LENDER
UNKN(6WN
Total Valuation $
Filing Fee
$ 10.00
LENDER*S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR,;��Z� 77'
NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
.
Permit fee
$
BUILD NG ADD E
15 E M24/Eel /4jy 47q 7�voe
PLUMBING PERMIT
FilingFee 10.00
AV
Each Trap
2
61 2.00
Repair drainage or vent piping
5.00
P_/ L)Ley
Water piping
6.. o 0
LOT NO.
SU BDIVISION NAME
PARCEL MAP
1
Each qas water heater or vent
5-00
5.00
Gas piping system I - 5 outlets
_10 2
C
1 _00
1
USE OF STRUCTURE
SF[:] Duplexf-1 MobilehomeF-1 Other- E�M)P-141101T_
SPECIFY
Building sewer
Lawn sprinkler system
5.00 5�0 0
00 _00
TYPE,OF WORK
New R Addition [:1 RemodeCl Utilities Ins lllation[] Other
Describe work: PZ-041161AJ4,
Permit Fee
$ .00
ontractor
ELECTRICAL PERMIT
FilingFee 10.00
main service 6011 01 LESS
100 AMP OR LESS
5.00
Main serviceEA. ADD -L 100 AMP
2.50 00
NEW CONST. ( DWELLING OCCUP.ej)
OR ADDNS. ACC.BLDGS.
20 sq it
CONTRACTORS LICENSE LAW
I dec one):
_1�nder penalty of perjury (check
1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
if
and Professions Codp and my license is in full force and e fect.
License No.-, 1 101 Classification
El 1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
I am exempt under Sec.—, Business and Professions Code
for this reason
.........................
NEW CONSTR(MULTI-OUTLET
NON.RESID, BRANCH CIRCUITS) q 2.50eal21Z,SV
NEW C ONSTFL ( POWER APPARATUS 6) '
NON-RESID. SINGLE OUTLET CIR.
50 @ 25�
Ex. Occup(OUTLETS OR 'FIXTURES BAL @ 100
(OFIXED APPLNS OR
Ex. Occup. UTLETS_ (RrSI-D.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.5 0
4 ff D 1,51 S.
PARP Ulivc 0Z
-VT
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.
9-<- have placed on -file with the County of Butte Building Department-
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as t6 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.
I
Heating loe 0C
HEP -T 2064 P
Cooling 4-T-
3 *7 �5_0 12 -SO
Hood Call"
1 80-00 (00.00
Venti lation
_; 2,00 17.0v
r__, V/4 -P
12 p6r- C01 [o,e;o
Permit Fee
Q_3 A_C�b
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.
1 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 unty in con=seceoJ.the granting of this permit.
X I I ZZ J Date--7-- lo'5 -
Signature of Applicant Owner El actor �Agent R
An OSHA permit is required for excovations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE
OCCUP. GROUP
I TYPE OF CONST.
IPARCELI
P
This permit is hereby issued under
sions of the Butte County Code and/or
t
work ' indica ed above for which
DIREC 0 'OF PUBLIC
By <��
PE EXPIRES Date___4
I Tfi_� "
the applicable provi-
resolutions to do'
fees have been paid.
WORKS
Da e' 7,
Receipt NO. !!Ug 7
WHITE-O.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROO-APPLI CANT
- __ -
I IL
COUNTY OF BUTTE DEPARTMENT'OF PUBLIC WORKS BUILDING'DIVISION
7 CO��NTy CENTER DRIVE -PROVILLE, G�ALIFORNIA 95965 - TELEPHONE: 11 916/534-4541
PERMIT APPLICATION DATA SHEET
Permit No.
OWNER A. P. No. L,/ -
Proposed Bfuilding Use "4 kR-
Permit FeABase(:Upo:n: --Complete Contract Pr . ice DPW Valuation
Other (Explain)
Building Inspector
Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or issuance: DATE RECEIVED APPROVED
1. All items have been submitted . . . . . I .. . . . . . .
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 Health Dept.
11 ' ,,-'Planning approval for (A) Use: — (B) Parking:—
L4zl'2'. Certificate of Workmen's Compensation Insurance . . . . . . gill
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Giv ' en to ownerEl, Mai I to owner F�
15. Improvements may be required . . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . . . . .
P,,-Inspec. request to
17. Pre -inspection for Required. Building Inspector (Date)
18. Other
When you issue the permit, process as follows: —Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. —Deliver w/inspector.
Other
Applicant-/ 7,41f, lep
Date -7 -4 -
Copy of plans sent —Health Dept., —Fire Dept., —Other 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
By Date
Plans checked by Date
Plans approved by Date
Other:
Copy—DPW
.41
UILDING DATA FORM
BUILDING ENVELOPE COMPLIANCE
Project Title
Location C 101( -
Project Designer DO 1,J 044-D
F orm 1
Documented by 6411D
Date
Checked by
Date
SITE DESCRIPTION
Location Code Number (from Table 2 of Appendix 1)
1
Latitude
2
Degree Days -heating (from Table 2 of Appendix 1)
3 �Z<Q Q CD
SF, Solar Factor (from Fig. 4.1.17 or Table 2 of Appendix 1)
4
AT, ASHRAE design temp — 78� (from Table 2 of
Z�Z
Appendix 1)
5
BLDG. DESCRIPTION
Occupancy Type Code Number (from Table 1 of Appendix 1)
6
Gross heated floor area, sq. ft.
7
Number of floors
8
Ground Floor Perimeter, ft.
9
Longest diagonal dimension at ground floor, ft.
10
Height, ft.
Record the detailed materials data on the Materials Data Form - Form 2
I Wall
Surface Areas
Aopaqu� wall
.12
Awindow
13
Adoor
14
Total Aow Line 12 + 13 + 14
15 e,
Heat Transf er Coef f icients (see Section 4.1.8)
1
winter
wall
16 0 , 0
(heatingl
Uwindow
17 10 60 C7
Ud,,,
18 0 -A �2
summer
(cooling)
UW
19
U
Udoor
Xi
21 01 -Teo
Shading coefficient of glass, (from Table 3 of Appendix 1)
SC
22 -0
Weight of Wall Construction, lb/ft 2
w'
23
Mass Correction Factor (from Fig. 4.1.16)
MCF
24
Equivalent Temperature Difference (from Fig. 4.1.16)
TDeq
25
Roof
Surface Areas
Aopaq ue roof
26
A skylight
27
Total
Aor (26 + 27)
28
% skylights
(27/28)
29
Note: If Line 29 is 5% or greater, automatic figh t -sensitive
switching systems are required in the area figh led by sky-
figh t.
Enter the -difference between line 27 and 5% of line 28, or
zero, whichever is the greater
30
Enter the sum of line 26 and line 30
31
BUILDING DATA OORM — BUILDING ENVELOPE COMPLIANCE
PROJECTTITLE
Ile
Heat Transfer Coefficients (See Section 4.1.8)
winter
(heating)
summer
(cooling)
Shading Coefficient of skylight (from Table 3 of Appendix 1)
Mass Coefficient (from Fig. 4.1.16)
Absorptance (from Fig. 4.1.16)
Floor
Floor Area over unheated space
U -value for floor
HEATING DESIGN CRITERION
Standard Uow (from Fig. 4.1.2)
Standard Uor (from Fig. 4.1.3)
Standard Uof (from Fig. 4.1.4)
Maximum allowable Uo (from Fig. 4.1.1)
Proposed Uow (from Fig. 4.1.7)
Proposed Uor (f rom F ig. 4. 1. 10)
Proposed Uof (from line 40)
Proposed Uo (from Fig. 4.1.1)
Note: Uor is calculated from the equation of Fig. 4. 1. 10 for
the proposed building using the value from line 30 for the area
of skylights, and the value from line 31 for the overall roof
area A or
C OOLING DESIGN CRITERION
Standard OTTWw (from Fig. 4.1.15)
Standard OTTVr (41 x line 44)
Standard OTTV (from Fig. 4.1.13) 21
Proposed OTTVW (from Fig. 4.1.14)
Proposed OTTVr (f rorn F ig. 4.1.14)
Proposed OTTV (from Fig. 4.1.13)
Page 2 of Form 1
Uroof 32
Uskylight 33
ur 34,
us 35
SCs 36
Mc 37
Ac, 38 0,79
Aof 39
Uof 40
43 (f) - -4 �
44
45
46 0'-L99
47
48 0
49
50 0, 1 1
Line 50 must not
exceed line 46
52
53
54
55
IM? 56
Line 56 must not
exceed line 53
Note: 0 TTVr for the proposed buildh)g is valcidated from
the equatioit of Fig. 4.1.14 using the value from line 27 r the
area of skylights, and the value from line 28 for the overall roof
area A or
CD. TT 7VW
'D o
'i, 4.06
Ci
6 6, '7- '21 '2 3
Iz F5 6D
2 Z. er
.............. .
l< Al-
5Fx C�,t
:07T:q
X 3o 57�- 4- 0
0. 7�T
-79
. .... .....
.. . ...... .
1 0,�3 0
XA s
MATERIALS DATA FORM
BUILDING ENVELOPE COMPLIANCE
C-Pr—E
Project Title
Location
ProjectDosigner 6eo' A,. E)Or-4,�DF4-c)
Form 2
Documented by 6AD
Date (o 4 N
Chocked by
Date
Wall Wall Type I
U2
12
12
Weight of wall construction, lb/ft2 (see Sec. 4.1.8)
w 1
1
11Z
Heat Transfer Coefficient (see Sec. 4.1.8)
2
15
Surface Areas (attach sheets to document any additional
Orientation
3.
NO rZT14
compass orientations)
Are
4
Area
18
Orientatio:
5
6
19
Area
20
Wall Type 3
Orientation
7
So L) 14
21
Area
8
22
Surface Areas (Attach sheets to document any additional
Orientation
9
compass orientations)
Area
Ares
10
Orientation
Wall Type 2
Weight of wall construction, lb/ft2 W2 11
Heat Transfer Coefficient
U2
12
Surface Areas (Attach sheets to document any additional
Orientation
13
compass orientations)
Area
14
Orientation
15
Arm
16
Orientation
17
Area
18
Orientation
19
Area
20
Wall Type 3
Weight of wall construction, Ib/ft2
W3
21
Heat Transfer Coefficient
U3
22
Surface Areas (Attach sheets to document any additional
Orientation
23
compass orientations)
Area
24
Orientation
25
Area
26
Orientation
27
Area
28
Orientation
29
Area
30
MATERIALS DATA FORM — BUILDING ENVELOPE COMPLIANCE
61
Pqp 2 of Form 2
2c-;, u t c.
PROJECT TITLE A/ C -
62
Surface Areas (Attach sheets to document any additional
Orientation
63
compass orientations)
Wall Type 4
64
Weight of wall construction, lb/ft2
W4
31
Surface Areas (Attach sheets to document any additional
U4
32
compass orientations)
Orientation
33
Area
Area
34
Orientation
Orientation
35
Area
Area
36
Orientation
37
Area
38
Orientation
39
Area
40
Glass Type 1
Shading coefficient (from Table 3 of Appendix 1 or mfrs. data)
41 0,
Heat Transfer Coefficient (from mfrs. data)
42 0,
Surface Areas (Attach sheets to document any additional
Orientation
43 NO W-7 4
compass orientations)
Area
44
Orientation
45
Area
46 A�o
Orientation
47 Sn 0 114
Area
48—
Orientation
49 — \v
Area
50
Glass Type 2
Shading coefficient (from Table 3 of Appendix 1 or mfrs. data)
51
Heat Transf er Coeff icient (f rom mf rs. data)
52
Surface Areas (Attach sheets to document any additional
Orientation
53
compass orientations)
Area
54
Orientation
55
Area
56
Orientation
57
Area
68
Orientation
59
Area
60
Glass Type 3
Shading coefficient (from Table 3 of Appendix 1 or mfrs. data)
61
Heat Transf er Coeff icient (f rom mf rs.data)
62
Surface Areas (Attach sheets to document any additional
Orientation
63
compass orientations)
Area
64
Orientation
65
Area
66
Orientation
67
Area
68
Orientation
69
Area
70
MATERIALS DATA FORM— BUILDING ENVELOPE COMPLIANCE
CAPf=_
*PROJECT TI TLE
S��
I Roof
6
Page 3 of Form 2
Glass Type 4
Shading coefficient (from Table 3 of Appendix 1 or mf rs. data)
71
Heat Transfer Coefficient (from mfrs. data)
72
Surface Areas (Attach sheets to document any additional Orientation
73
compass orientations). Area
74
Orientation
75
Area
76
Orientation
77
Area
78
Orientation
79
Area
80
Roof Type 1
Weight of roof construction, lb/ft2 (see Section 4.1.8)
81
Heat Transfer Coefficient (see Section 4. 1. 8)
82 C) 0
Surface Area (Attach sheets to document any additional roof types)
83
Skylight Area
84
Skylight Shading Coefficient (from Table 3 of Appendix 1)
85
Skviiaht Heat Transfer Coefficient (U -value)
86
Floor Floor Type 1 (floors over non -air conditioned spaces only)
Weight of floor construction, lb/ft2 (see Section 4.1.8)
Heat Transfer Coefficient (see Section 4.1.8)
Surface Area (attach sheets to document any additional floor types)
Doors A G !S�
Surface Area
Heat Transfer Coefficient W -value, see Table 4 of Appendix 1)
87
88
89
90
91
HEAT TRANSFER COEFFICIENT
PROPOSED CONSTRUCTION ASSEMBLY
Form 3
List of Construction Components
R
1- k/V
2. 4�/,5 P. P5
4.- -57/8) e?
5.
6.
7.
8.
Inside Surface Air Film
cooling
heating
Sketch of Construction Assembly
Outside Surface Air Film
1-7
WEIGHT: IWO
cooling
heating
Check one:
Total Resistance Rt
cooling
heati ng
Wall
Roof
U -Value (I/Rt)
cooling
heating
Floor
HEAT TRANSFER COEFFICIENT
PROPOSED CONSTRUCTION ASSEMBLY
Sketch of Construction Assembly
V
WEIGHT: Ib/ft2
Check one:
Wall
Roof
Floor
Form 3
-c � /
List of Construction Components
heating
R
1. -,D U (L -'T U 0 0 F I f -,A 6
cooling
heating
2. P L--� 0 0 [D
(OIL
3— 1 1'Z z5 e A C— IF=
.8c
4. 0 :5 LJL 4 'T I C -D t --A
1'1� 0-, 0
5. 52/E)4 6q --l( F C)
r7 �O
6.
7.
8.
Inside Surface Air Film
cooling
heating
Outside Surface Air Film , 'ZI; .1-7
Total Resistance R,
U -Value (I/Rt)
cooling
heating
cooling
heating
'03
1,110111til
Form 4
DOCUMENTATION FORM
HVAC SYSTEMS COMPLIANCE (Complete for each system)
Documenti� by 64D
Project Title
Date
Location'
ProjectDesigner Checked by
Date
DESIGN CONDITIONS
Building occupancy type (Table 1 of Appendix 1)
1)
Project Latitude (Table 2 of Appendix
Heating Degree Days (Table 2 of Appendix 1)
HEATING LOAD DOCUMENTATION (Attach calculations)
Outdoor Design Temperature, Winter, OF
-7, -z
Wind Speed, mph
15
Wind direction
I ndoor . Design Temperature, OF
Temperature of adjacent unheated spaces, OF
Transmission Heating Losses, Btu/hr
14-13
Infiltration Air, CFM
Heat Loss From Infiltration, Btu/hr
Ventilation Air, CFM
Heat From Ventilation, Btu/hr
2-gl6c'o
Loss
-rC44- C�n
Outdoor Air for Special Processes, CFM V I =—�J)
Heat Loss from Process Air, Btu/hr
Other Heat Losses (describe), Btu/hr
Heat Gain from Lights, Equipment, People, etc. Btu/hr
-7 E7,
Total Heat Losses, Btu/hr
COOLING LOAD DOCUMENTATION (Attach calculations)
Outdoor Design Temperature, summer, dry bulb, OF
too
Outdoor Design Temperature, summer, wet bulb, OF
OF
7 Z
Indoor Design Temperature,
Transmission heat gain, Btu/hr
Infiltration Air, CFM
Heat Gain from Infiltration, Btu/hr oe
Outdoor Air for Special Processes, CFM ( 1417C+PE=:m�
Heat gain for process air, Btu/hr
Solar Heat Gain Through Windows, etc., Btu/hr
Heat Gain from Other SoUrces, Btu/hr
Total Cooling Load, Btu/hr
V I
/
T!S
-T 1�
pEe
.44
-Z
'57
'ZO
T—z--
Li A,,.
>,' 4,o
-le zfo.
If
.4-0
'Zo
1
-7 C-1
>< o 9
IT
r*' 47
T!S
pEe
.44
&4;7.
(h Ll
/ �Z/IE-/ .-
14
W
0:7)
(144 4P6
\L �,t
c) 40
�xo-q
"L -S,
66,
4,, 7 5
7. (5
Ll
..... .........
Bard Packaged Heat Pumps are ye . ar Iround
comfort control systems that are housed in one
single compact package. The desired tem-
perature for living spaces during any season,
is obtained by setting wall thermostat. Sturdy.
steel cabinet's that house all components and
controls receive a g4lvannbal coating for extra.
protection before being attractively finished in
durable polyester baked -o. - I enamel. Factory
assembled units are shipped prewired and
r)recharnbd with R22 read for I
Ila 1 11 y
installation. These 'units fit almost anyplace
without structural changes and will operate
Z
efficiently with or without ductwork. Versatile
-homes, bus I nesses,
applications include.
schools, modular structures and home im-.,
U ModelPH48
provement projects.
L 1s%T E 0
POWERFUL FAN MOTOR moves air quietly with more efficiency
for effective heal exchange. Built-in overload protection is Stan-
UdlU Y11 d1i IflUdels.
ELECTRIC HEAT STRIPS with'aiuit'
omatic limit and thermo cut-off
HEAT PUMP COMPRESSOR is equippedwith crankcase healer:�
z are -ifi,oiption,
available'as 6 built
dl!... VIM
d cled with internal overloa pr ssurejelief valve and
su aces expel heat eth-- KF
UMINUM FINNED COPPER m &t e
: ... ...... slug device.,
'�uirecl�bysjstem._.,.., �: T,
crently as re 7
-SUCTION ACCUMULATOR protects the compressor fr re -
501
HI H PRESSURE SWITCH provides additional protection for the r-, om
G Irigeraml food, back and prevents damage to the compressor
h6ril pump symani;::
hemmu
ELECT61CAL COMPONENTS AND CONTRI LS are accessible for
EMERGENCY HEAT RELAY lamr,la.cuillulti(Jus opulalruil 01
easier servlce�
the system.
positive,. quic, re-
TIME-TEMPERATUI DEFROST lassures
HIGH AND LOWSIDE GAUGE PORTS arestandard equipment for
moyal of, frost it all operating temperatures. easier maintenance.
INTERNAL. FUSING is:built-in od.singl�'.phise'imdclels that are
d OPTIONAL OUTDOOR THERMOSTAT controls'compressot op.
equipRe with elecliic�.heat stiips:hiying,a,'ratihd-ot.,15KW
eration- and supplemental electric heat strips for maximum
r re:
m . 0 opq(ating economy. J.
-LLATIONS
TYPICAL INSTA
Outdoor slab
)nstallation inslallation
ielains valuable
on root
s )ace
allows total lloo., space
0 Ideal for lns:dc,
utilizati 11 of
thfu-lhe-wall
work area.
installation.
p
A
ROOF HOOD ACCESSORY DIMENSIONS IN INCHES
A B C
*..Eliminates outside sturdily cciris�truclIed,
ductwork tor -root.
& heavily insulated. PH24 & PH30 381/4 32 23iA
-al piicat tons.
C
to p
quipped with fresh PH31 & PH36 381A 38 1/8 1 1 241A
o -install.. air intake.' PH48-1 1 4P giv.,
k .4 Eas
NOTE: Accessory is also designed for Bard
Packaged Air Conditioners of this same
2'� inodel series.
BARD MANUFACTURING CO. BRYAN, OHIO 43506
.Form PH-15CT
Lithom U.S.A.
PH24
PH30 PH311 PH36-1
PHOO
156 000
PHOO (3)
t56,0?Q
58,000
C HE
ILEUM Aa
;� "W,;6-7
, � - F,� -�K
36,000
-_PH4871 PH48
t47,000 t47,000
Cooling Capacity BTU 29,500 36,000
23,000 28,000
Hi -Temp Heatino BTU* 23,000 29,000 30,000 40,000
40,000
47,000 47,000
58,000
Lo -Temp Heatina BTU*
1*2,500
14,000 17,000 26,000
26,000
27,000
27,000
33,000
33.000
MODEL BTUH 240V AMP
Electrical - Less KW
Cooling Watts -
3200
1 4100 3800 5400
5200
6200
6000
7000
6800
5KW 17.065 20.8
Hi -Temp Heating Watts
2800
.
3400 3450 4900
4700
5200
5000
6100
9KW-3ph 30,600 21.7
- Lo -Temp Heating Watts
2300
3100 7-- ---
3000 4200
---
4100
4400
I OKW 34,130 41.7
Ooeralino Voltage Rance
197-253
207-253 197-253 197-253
187-264
197-253
__4300
187-264
_5200
197-253
___51
15K W 51,195 62.5
-
- Min. Circuit Ampacity
21
- - -
25 29 33
22
39
30
44
_187-21�6�A
34
I KW-3ph 51195 36.2
- Field Wire Size"
#10
#to- #10---#8
#10
35A
__#8
60A
#10
45A
#6
60A
#8
�18KW-3ph 43.4
Delay Fuse - Max. 30A 40A 35A 50A
50A
20KW 68.260 83.3
'Total Unit Amps-
17.4
20.9 18.2 27.5
18.5
32.7
25.7
37.2
29.2
�!,l v t ;t in t is,
"' Table, h6ati lerfal,
meni
_ ni e., ni _,rt
t
'nI, , ni� 6
Compressor - Circuit A PSC PSC PSC PSC
PSC
PSC
Volts 208/230 230 2081230 208/230
208/230
208/230 208/230
208/230
208/230
Rated Load 13 16.5 13.2 22.5
13.5
26 19
29
21
Lock Rotor Amps 60 76 68 103
72
115 93
Fan Motor & Condenser
INDOOR BLOWER PERFORMANCE
- Fan Motor - HP/RPM - I/2/lOT5 1/2/1075 l./5/1050 1/5/11050
1/5/1050
1/3/825 1/3/825
1/2/1075
1/2/1075
- Fan Motor - Amps -
4 4
4.4 1.6 1.6 _
1.6
2.8
2.8
4.3
4.3
CFM -DRY COIL WITH FILTER
Fan - DIA/CFM
1811760 2012100 2011/2100
2012100
2413300
2413300
24'73500
2413500
E. S. P. PH24 PH ---
in HzO PH30 PH36-1 P148-11] PH60-1
Face Area
- Sq.Ft./Row/Fins per in. 3.75/3/14 3.75/3/14 5.04/3/14
5.04/3114
7.7/2/14 7.7/2/14
7.7/3/12
7.7/3/1
Motor & Ewaparator
DDIO-6
-5zO4/3/i4
0010-6 DD10-8 DD10-8
ODIO-B
DD10-10
OD10-10
D010-10
.0 975 1500 2350 2350
- Blower Motor - HP/RPM
Common
Common 1/3/1075 1/3/1075
1/3/1075
1/211075
1/2/1075
_DDIO-10
1/2/1075
1/2/1075
.10 925 1450 2155 2160
- Blower Motor'- Amps
w/Fan
w/Fan 3.4 3.4
3.4
3.9
3.9
3.9
3.9
.20 870 1400 1980 2000
CFNI LR4tej�j
880
1300
1300
1760
1760
1860
1860
.30 820 1350 1800 1820
Face Area
Sq.FL4RCLw/Ei "Sur ig..
Refrigeran 22
08/3/12
2,_
47 oz.
.,.2.08/3/12 3.21/311 1
-11__._,. - . ___ q_ .�..?!/3/ 3
47 oz. 82 oz. 69 oz.
1 1
.3.2 /3/ 3
62 oz.
_. 4.0313/12
104 oz.
4,03/3/12
104 oz.
196/4/14
122
3 96/4/14
122
.40 765 1300 1630 1640
7- - - .
,()
Shipping Weight Lbs_._1
1., 300
1
__ 300- 355 355
3�
5
462
459
oz.
502
oz
494_
,'J1E O'COP"PEROOR
-A';
:For addiltonal heating capacity add the Kw from Table No. I
60* Copper Wire Size
-Basic unit only- does not include supplemental heaters from Table No. I. Refer to Table No. 2 for heateramps.
tDeduct 1000 Btu for 208 Volt Operation.
EER
MODEL COOLING
851 951
PH24 8.2 7.2
COP
HI -TEMP
HEATING
LO -TEMP
HEATING
Ar- U -NO
If .4*Z
�MODEL PH24 I PH30 PH31 PH36-1 PH36-1131 PH48-1 PH48-1(3) PH60-1 PH60-1
471F
.2.4
1171
1.6
Standard KIN
1,9�K�
1,OKW 1 OKW 1 1KW
9KW
1 OKW
KVV + 10K 9KW
PH30 7.8
6.8
2.5
1.3
Max. Installed KW
'Internal
W
W 15KW' 1 ;w-'
15K...
20 KW _i__1_82K_W
20KIN*
8.9
7.8
2.6
1.7
Fusing Built In.
-PH36-1---
6.7--
2.4-
1.8
."Ast
r
NOMINAL
CABINET DIMENSIONS (Inches)
4 `ft
DUCT OPENINGS (Inches)
Discharge Return Air R
-7.5
PH48-1 8.6
7.6
PH48-1 3 Ph 8.8
7 8
2.8
-1.8
1.8
PH60-1 9.1
8.0
2.8
1.9
_�H§Q- 1_3 Eh .1 2.9 1.9
EER -Energy Efficiency Ratio Btuh
Unit Wattage
COP-Coelficient of pellminalwo 811,11
Una Wattage x 3.413
I III d
, r0i to, � ort,nt'sen a as a�guw e,Jt1s,
to eleiftfjqail�fconnec I
4 LE'edrical Code4hd -all eit�
I Ides.
wil.
Uivclytclloqk�ilrustil Wirt..
Tie,
K ;pevificalions �u fact to
1 i
li:h 'go '11 41
�1. K_tll Wt4
A B C H i K D
MODEL E F G
PH24 23% 40 32 17/8 211/a 11 24 6 .1
N
23 V4 40 32 1 7/a 21 Va 11 24 6 24 12
�`t, 'L 17
4
PH31 24 Y4 423/,6 38 % 7/8 20% 11 V4 33 6 _i3 14
PH36-1 241/4 421/,6 38% 7A 201/8 11 Y4 33 6 33 14
PH48-1 311/4 50 42 1% 227/a 161A 38 10 �8 1
PH60-1 311A 50 42 1 % 227/a 161/4 38 10 38 16
BARD MANUFACTURING CO. BRYAN, OHIO 43506
.Form PH-15CT
Lithom U.S.A.
Page 2 of Form 4
TEMPERATURE CONTROL
Attach manufacturer's data or other, give specification or drawing reference which shows in detail the following information:
REFERENCE
(page or sheet
JA -
capability to sequence heating and cooling
temperature control device set point limits
temperature set point range between full heating and full cooling
setback and shutoff controls
capability to terminate heating at, 7(fF and cooling at 76�F
Indicate drawing or specification reference where the temperature control device requirements given below are documented.
An automatic temperature control device shall be provided for:
* each separate HVAC system A-1
* �each zone
SIMULTANEOUS HEATING AND COOLING
The following requirements apply to the use of new energy.and need not be complied with when recovered energy is used to
control temperature.
in each case, when resetting hot and cold deck temperatures, on representative zone may be chosen to represent no more than
ten zones with similar heating or cooling requirements.
Concurrent operation of independent heating and cooling systems serving common spaces must provide either or both of the
controls given below. List reference specification page or drawing number where control requirements can be verified.
REFERENCE
Sequential temperature control of heating and cooling systems
Automatic reset of heating temperature, to limit energy input only to that level
to offset heat loss due to transmission and infiltration.
Reheat systems — give reference specifications page or drawing number which will show compliance with the following
when reheating 20% or more of the total air in the system.
• When serving multiple zones, controls must automatically reset the cold air
supply to the highest temperature level of the zone requiring the most
cooling.
• Single zone rehea - t systems shall be controlled to sequence heating and
cooling.
i
17-78685
Page 3 of Form 4
Dual -duct or multizone systems — give reference specifications, page or drawing number which will show compliance with
the following:
REFERENCE
* Hot deck temperature — must be automatically reset to the lowest
temperature necessary to satisfy the zone requiring the most
heating.
* Cold deck temperature — must be automatically reset to the highest
temperature necessary to satisfy the zone requiring the most
cooling.
Recooling systems — give reference specifications page or drawing number which shows compliance with the following if
"recooling 20% or more of the total air in the system.
Controls must automatically reset the temperature of heated
supply air to the lowest temperature necessary to satisfy the
zone requiring the most heating.
NVAC SYSTEM RESTRICTIONS & SPECIAL REQUIREMENTS
Several HVAC System types have special requirements or restrictions. In this section, the type of system used in the design
must be listed and any special restrictions given here referenced to show compliance. Supply references to proper specifi-
cations or drawing page numbers.
Type HVAC Systems Used — List type of system to be used here (include all systems for heating or cooling in the building)
include reference for specifications for each system.
c re- -T
Constant volume reheat system — when serving both interior and exterior zones — separate cooling coils are required if the
exterior zone exceeds 20% of the total air quantity through the cooling coil.
REFERENCE
1�
Page 4 of Form 4
DUAL DUCT AND MULTIZONE SYSTEMS
Constant volume duct.or multizone systems which utilize new energy to simultaneously heat and cool air streams which
are subsequently mixed for temperature control are prohibited for buildings larger than 20,000 square feet of conditioned
space. If used, the air leakage for dampers utilized for the mixing of heating and cooling air shall be limited to a maximum
leakage of 3% of the total air quantity handled by the dampers when operating at the maximum system pressure to which
the dampers will be subjected. Manufacturer's label or nameplate shall state leakage rates.
REFERENCE
Economizer Cycle — For each cooling fan system, for other than dual -duct or multizone systems, which serve zones' -
having toial 'cooling capacity greater than 134,000 Btu/hr or more than 5,000 CFM must have an economizer cycle un-
less one of the exceptions, allowed is claimed.
REFERENCE
Electric Resistance Heating System's — These systems shall not be used unless the total electric resistance heating installed
capacity is less than 101/6 (ten.percent) of the total building space heating capacity or a life cycle cost analysis, Form 8
(see Section 4.2 of this manual) ' shows an alternate system. life cycle cost exceeds that of the electric resistance system.
Give reference if less than 10% or include Form 8 if calculating life cycle cost.
REFERENCE
MECHANICAL AND GRAVITY VENTILATION
Mechanical ventilation Dampers which are automatically interlocked and closed on fan shutdown are required.
REFERENCE
Gravi ty Ventilators — Either automatic or readily accessible manually operated dampers must be provided for all open-
ings to the outside with the exception of combustion air openings.
REFERENCE
POWER CONSUMPTION IN FANS
REFERENCE
Constant volume system
Total Supply Air Quantity, CFM
Total Pressure of Supply Fans, Inches of Water
Total Supply Air Quantity Adjusted for Process Loads, CFM
Net Fan Performance Index (FP0
Variable volume system
Total supply Air Quantity at Maximum Flow, CPM
Total Pressure of Supply Fans at Maximum Flow Inches of Water
Page 5 of Form 4
POWER'CONSUMPTION IN FANS (continued)
Fan Performance Index at Maximum Flow (FPlm), CFM
Variable Volume Adjustment Constant
Adjusted for Performance Index, FPla
PIPING AND DUCT INSULATION AND DUCT CONSTRUCTION
References to the piping insulation, duct insulation and duct construction requirements presented in Section 4.2 of the
Energy Conservation Design Manual must be given below:
REFERENCE A4
Form 6
DOCUMENTATION FORM &
HVAC EaU.IPMENT COMPLIANCE
References giving the specification page or drawing sheet number or manufacturer's data must be submitted to demonstrate corn-
pliance with Division 6 of the standards.
ELECTRICALLY OPERATED COOLING Standard rating capacity, Btu/hr
SYSTEM EQUIPMENT Minimum EER (COP)
Reference
ABSCIRPTION WATER CHILLING Heat source (check one)
COOLING SYSTEM EQUIPMENT Direct fired (gas -oil)
Indirect fired (steam -hot water)
Minimum EER (COP)
Reference
COMBUSTION HEATING EQUIPMENT Minimum combustion efficiency at
(Oil and gas-fired comfort maximum rated output
heating equipment— Reference
ELECTRICALLY OPERATED HEATING Minimum EER (COP)
-HEAT PUMPS Reference 44kdF,
Supplementary Heater Control -1:11,47, 0 P/A G�
Reference OAAUP,
..ELECTRICAL RESISTANCE SPACE REFERENCE FOR FULL -LOAD ENERGY
INPUT AND OUTPUT
HEATING EQUIPMENT
REQUIREMENT FOR MAINTENANCE FOR MANUFACTURER'S MAINTENANCE AND,
FULL AND PARTIAL CAPACITY AND STAND-BY INPUT(S) AND OUTPUT(S)
SPECIFICATION REFERENCE
I
DOCUMENTATION FORM Form 14
DOCUMENTATION OF MANDATORY STANDARDS
FOR ENER-GY BUDGET COMPLIANCE
0
Attach, for reference manufacturers data or give specification section or drawing number which shows in detail the compliance
withthe
following standards (show N/A when not applicable).
I.
T 20-1405(c)
Air Leakage R equirement, Window
Reference
2.
T20 -1495(d)'
Air Leakage Requirement, Doors
Reference A-4
3.
T20 -1495(e)
Caulking and Sealing
Reference A-4
4.
T20 -1495(g)
Elevator Shaft Vents
Reference
5
T20 -1503(a)
Temperature Control
Reference AL
6
T20 -1503(b)
Zoning for Temperature Control
Reference tQ /A
7.
T20 -1503(c)
Control Setback and Shutoff
Reference
8.1
T201 505
Mechanical and Gravity Ventilatiori
Reference
.9.'
T20-1507
Piping Insulation
Reference 14 /A
10.
T20-1508
Air Handling Duct System Insulation
Reference /A- I
111.'
T20-1509
Duct Construction
Reference A
12.
T20-1521 (a)
Water Heaters, Storage Tanks, Boilers
A
and Piping — Performance Efficiency
Reference
13.
T20-1 521 (b)
Combination Service Water Heating/
Space Heating Boilers
Reference N
14.'
T20 -'i 521 (c)
Temperature Controls
Reference
15.
T20-1523
Pump Operation
Referencc Z�s
16.
T20-1530
Electric Distribution Systems
Reference 'F-
17.
T20-1541 (b)
Lighting Standards
Reference E I
-DOCUMENTATION FORM
BUILDING LIGHTING COMPLIANCE
Fo rm 5
Project Title Documented by
Locatiort- Date 18 M-A-tf (S
Project Designer 4D Checked by
Date
Room Room RCR., Task Areas Note Sq. Ft. No. Sq. Ft. Total Watts Allotted Design
No. Sq. Ft. Appl. MCC. Occ. /Task Sq. Ft. /Sq. Ft. Watts Watts'
93 0
V I i"J 1 t� (4, W/A,
d130
1,4
1 �3 2-
15315
54
0-G
O—GIAVO�AOW
[00,
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6>
Of
F E C C=
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e0c),
IZ7
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Page Total
i
DOCUMENTATION FORM
BUILDING LIGHTING COMPLIANCE
For rn 5
'ProjectTitle V X/ Documented by
Location, 69-,-,j,4-Y (19 C- Date 18 M -AIV
Project Designer ;2CDf,\/ CD L4- (0 Checked by
Date
Room Room RCR- Task Areas Note Sq. Ft. No. Sq. Ft. Total Watts Allotted Design
No. Sq. Ft. Appl. /Occ. Oct. /Task Sq. Ft. /Sq. Ft. Watts Watts
Page Total
-- ---------
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13315
5.6r
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3-
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e15
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F P I C e �-
A,
To-T4,f, s
Page Total
-- ---------
Page Total
DOCUMENTATION FORM 'Form 5
BUILDING LIGHTING COMPLIANCE
Project Title v X/ Documented by
Location Date -
Project Designer Checked by
Date
Room Room RCR. Task Areas Note Sq. Ft. No. Sq. Ft. Total Watts Allotted Design
No. Sq. Ft. Appl. MCC. /Task Sq. Ft. /S q. Ft.. Wa tts Watts
W/A,
—.1—occ.
!'130
.
1�302-
0,Z
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Page Total
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4 -
June -17, 1981
Mt. Lew Osteen
:�Enforcement Officer
Board of Architectural Examiners
0 Street
'.'.Sacramento, CA 95814
RE:� Double V/V Cafe Remodel Project
Dear Mr. Osteen:
Per our phone conversation on Monday,.June 8, 1981,.the
following is a description of the above mentioned project:.
RESTAURANT REMODEL - Removed a load
bearing wall 20 feet.long and replaced
with glulam beam -'supported by.timber..
columns and appropriately sized concrete,.
footings. on this beam rests � of
existing roof/ceiling plus the new
roof structure of "Truss Joists" 23
feet long. Finished space 20 feet
wide x 471-4" long (includes restrooms).
The plans were submitted for a permit to be issued by Butte
County Building Department on May 18, 1981 by the
roperty..
owner, Mr. Kahn A. Kahn. The permit wag i*ssued on' -.:June 10 1981'.�`,"
-On May 28, 1981, the Butte County Building.Departmeht 'all
C. ed
to inform us that m "Building De
y signer's." License'.1s
11N
o good" for this job since the.�Engineers Law states that,'
-the maximum span is
25 feet between load bearing walls..,
In order to expedite the project Gordon W. North . ... ...
anA.I.A.,:.
who drew the plans from our design, under my signature,,sig'ned-..
.,...them for us so that the county would accept them. This was
on May 28, 1981.
The county contacted our client and made the same- statement
type of work.I was'-,
that my license was "No good" for the
-doing. This, of course, prompted the client to question
our situation and honesty. He did so by calling us on
May 29,. 1981.
ou
WAM
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
Address El 695 Oleander Avenue. P.O. Box 1100 )0(7 County Center Drive 747 Elliott Road
Reply to Chico, California 95927 Oroville, California 95965 Paradise, California 95969
Telephone: 916/891-2727 TelRphona: 916/534-4281 Telephone: 916/872-2961, Ext. 59
-George A. Donoho
Re.g..Building Designer
650 Kentucky Street
Gridley, CA 95948
Dear Mr. Donoho:
may 19,. 1981
Re: Double V/V Cafe
Hwy�99, Gridley, CA
The plans for the above identified restaurant have been reviewed by this depart-
ment for compliance with the California Restaurant Act, Division 22, Chapter 11,
California Health and Safety Code. The following additions or corrections
be required for compliance with those regulations.
1. The floor surfaces in the kitchen, counter area, toilet rooms, walk-in cooler,
dressing room,.and store room shall be of such material as to be easily cleanable,
with a minimum six inch high coved top set base at floor -wall juncture and at the
ba.se of all permanently mounted equipment and cabinets..
2. Walls and ceilings in the kitchen, counter area, toi ' let rooms, walk-in cooler,
dressing room and store room shall be light-colored, smooth, washable material
similar to a gloss or semi -gloss oil based enamel paint. Blown -in acoustical*
ceilings are not acceptable. If acoustical tile is proposed for these areas,
submit samples to this department for approval prior to installation.
3- Provide.self-closing., outward opening doors or self-�closing screen doors on
exterior exit doors for fly control.
4. Provide an approved hood, exhaust system and ducts, including grease filters,
grease gutters, grease receptacle, and necessary make-up air provisions over all
cooking, frying., grilling, and broiler facilities. Provide hood and 'exhaust over
dish washing machineif installed.
5. Provide self-closing devices on toilet room doors. Provide hot and cold water
to toilet lavatory sinks. Provide permanently mounted soap, paper towelarid toilet.
paper dispensers in both toilet rooms.
6. Provide a room or enclosure separate from toilets, or any food storage or
preparation area where employees may change and store their outergarments.
j � I �
Page_ 2
Proiride indirect drain to sewer for ice machine waste drain.
8. All shelving, back bar, counter, under -counter area, wood work tables, other
than wood topped bakery or butcher tables shall be sealed or painted so as to be
smooth and cleanable. 'No bare wood permitted. All open seams on non-movable
equipment shall be sealed with silicon bead or eauivalent'.
9. Provide a metal three compartment sink, with metal drainboards and backsplash.
with hot and cold water for dishwashing (N.S.F. or equivalent grade). If dish-
washing machine is installed, it shall conPorm to Standard No.3 of the ' National
Sanitation Foundation, 'as amended in September, 1956, and shall be installed and
operated in accordance with.that Standard. A hood'and exhaust vent shall be
provided over the dishwasher.
10. Provide a concrete storage pad for trash and garbage containers. Covered,,
leak -proof, fly -tight- trash and garbage containers shall be provided..
11. Flourescent lights in kitci;en shall have shielded tubes or coverings. No
exposed tubes.
Please provide corrected plans showing these addit-ions.
If you have any questions, please contact me at'the @'bove listed address or
telephone number.
Very truly yours,
Howard J. Snyder,'4r., �.S.
Division of Environmental'Health
HJS/bjc
cc-: Public Works Steve Bowman
lea)
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