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Home My WebLink About026-260-010 (8)-26-10 Otto ta Ij 26 0 HanserL- E/S Lone Tree Rd., 1.2 M/i.N.of Pilermc Rd., Oroville contr: Lincoln Village Mobile Homes,Ox. Permit p2j45-77P,E(qil.,MH) ELE SUP STRUCTURE REQ, COMPACTION TEST REQ, COMPLAINT GIVEN TO IN SPECTORt 26=26-10 contr:.Lincoln.-V-i-llage-MH, Oroville Building code violation 30 day Permit it2446-77MHI!&- Issued Building code violation 10 day 026-260-010 06-1995 AIRSE, SUZY-ILLE, - 01 LONE TREE RD, OROV OWNER COMPLAINT To INSPECTOR 'A 0 TN,sPECTOP- "COMPLAINT I ,- r -� d Di U FOR FROM Ckq_o /�Z-� D �� TIME DATE PHONE 0 URGENT! ---- - �----------= - -� �? --------------------- ---- q_ ------------------------------- - ---- -------------------- ----- ------------------ --- ------------------- ----------- --------------------- --- - ------------------------------------- Y _ COUNTY OF%BUTTt_ — DEPARTMENT OF PUBLIC WORKS -• � 7 County Center Drive — Uroville, California 95965 �% ' Telephone: 534-14541 / /! 7 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 0_72 Signot e) (.0 of Permitee orr�Agent / Receipt No. /� / S - 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 be aid. DIRECTOR F UBLIC WORKS By Date_ �� % ' 72- ending permit expires Date Z j"-7 BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Telephone No. Fireplace Contractor G� �� & Total Valuation Mailing Address • ,7 ° Q dal, Permit Fee + Plan Checking Fee &/or Penalty ` Telephone No .7 Permit Fee $ I Building Address �� PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Qv E A • • 0n! I- TtLe 2" (yl t Each Trap 1.50 f'KL' Repair drainage or vent piping 1.50 Water piping 400 Z-oning VerifieAv Each gas water heater or vent 1.50 A. P. No. p� ✓ 6's�f/ A_ Zo Gas piping system 1 - 5 outlets Each additional outlet .30 F S l oonn Fire Dept. Fire Zone Use Permit Building sewer -b-99 U EQA Parking plans = °cl'a�d Iti Parc? l Map 60' R/W Improvements Lawn sprinkler system 2.00 Bldg. Plans Recd Parcel Approval ans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 5.00 p0 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home [K Others ❑ Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 ' NEW LING O OR ADDNST ( ACCLBLDGS.CCUP. &) 20sgft NEW CONSTR. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS) 12.50ea NEW CONSTPOWER APPARATUS &) NON- R. RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name styI of: SCI 1V C'o( ti J, �1�pt M_ y� fl,l1 S Ex. Occup(OUTLETS OR FIXTURES)50 @254 109 FIXED APLNT. Ex. Occup. (OUTLETS P(RESID )REA) 2.00 Temporary service 10.00 �JILY `itY LLk1L 1.1CJ P. ()A(/C(,C Mobile Home Facilities 15.00 / 1 �1 n,,` License No. 3-2 9� Classification _ Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ dme O $ WORKMEN'S COMPENSATION INSURANCE I•am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability Workmen's or Workmen's Compensation. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2. Permit Fee $i $ 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 .1400 TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 0_72 Signot e) (.0 of Permitee orr�Agent / Receipt No. /� / S - 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 be aid. DIRECTOR F UBLIC WORKS By Date_ �� % ' 72- ending permit expires Date Z j"-7 V . _ COUNTY OF BUT — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive – Uroville, California 95965 i /�/ —77 Telephone: 534,4541 111 APPLICATION AND PERMIT V/ Parcel 4pr.weo< BUILDING Permit Fee Owner l on o te,, FT,. OCC. BUILDING VALUA7I,QN ELECTRICAL No. YSQ. Mai I i ng Address 9 n $3.00 L r� A: 04tO Telephone Lr 5.00 Fireplace Contractor Z. JAIC-0f– AZ 9 141, otal Valuation Mailing Address 2 _ 4,11V, J &ViD ermit Fee 25.00 Plan Checking Fee&/or Penalty 1.00 Tele phone o. Permit Fee 2¢sgft Building Address k7— 2- je 9 2 PLUMBING No. FEE PERMIT FILING FEE �" __ _$3.. 00_ [ [C9 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Ex. Occup(OUTLETS OR FIXTURES) Each gas water heater or vent 1.50 A. P. No. ®2G Z� ^ �?/d - Zoning & Planning Gas piping system 1 - 5 outlets 1.50 10.00 Each additional outlet .30 FVWJ W . Sai;"aiarl Fire Dept. FireZone Use Permit Building sewer 5.00 EQA I Parking Plans I Parcel Declaration Parcel Ma P I 60' R/W I Im rovements P Lawn sprinkler system 2.00 $3.00 BldgYlans Recd Parcel 4pr.weo< PI4Ys Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 A J E OR LESS Main service 100 AMP OR LESS 100 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600 100 AMP OR LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 NEW CONST DWELING OR ADDNS. ( ACCLBLDGS.CCUP. &) 2¢sgft NEW CONSTR. MULTI -OUTLET NON.RESID. (BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS &) NON.RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name le of: Z)/V(–O(–A tf'1LL14(�-� /"/®I�� Ex. Occup(OUTLETS OR FIXTURES) BAL21 004 (FIXED APPLNS ORst Ex. OCCuP• TS (RESID,) EA) 2•00 Temporary service 10.00 1 U Z. W4C, 4,AJ t9leavAUX Mobile Home Facilities 15.00 License No.3 Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. �( I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X I��L Date Signature oftPewrmiree or Agent Receipt No. (a i•�� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant t TOTAL PERMIT FEE I $ 3d 10 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. DIRECTO F PUBLIC WORKS By 4/ildin`g permit expires Date 7?_ ' 7� 307 7001 1940 aoo, 8430 8143 J I U.S. POOSTAGE PAI OROVILLE.CA.+ 95965 NOAMOUNTT $16D] 959b3—'- 00048949=0: ■ VFX 1• iv f r / ij. 1 if a ,` y�.y r+1 ,� •, l • yAti.' IY S ce JISkM • � li � 1 1 .. . + �. jai-i.4 •i � f rr a'fL If • • ■ VFX 026 --2�h -O/D ; �� 4V r ~ -Peachy Kean Way 26-26070I o I L•Y tt�rr• ytl�� • • law • '11. iff�r�: y. y✓ f t $.` ':- rat•` .4'xa r K ' i • r 4 •1 r.t ` - y ( • w 4 w �cn rn m ob�nn oo acn rt I a1-4 fm rrt N yH rt.. 00 x r v o IM -33 N r o m •,. N W 7+ o W H m 4-A V H n j�0 F~,M � °� co ba m m v 14 21 OQ N m o M l• r r m m s main Assessor Nim? OTTO EUGENE SR AsmF# _1_a Fee # 026.260 010 OOO J� Status Status. ACTIVE� Status Date f� Addrl 307 LONE TREE ROAD= - - - - Tax 000 NORMAL OWNERSHIP f TRA 092 007 Addr2 OROVILLE CA 95965 ��j Situs 1307 LONE TREE RD- -PAL Addr3 Base Dt 01!01!1979_ Addr4- - - -�� ---- — Land 4,597 AgP.res Structure 11,272 LijEtel Fixtures 0 Comments 2626001000 CONVERTEW,-.09!08788 �'' ' p -- - - J - - l� Notes Growing 0 Creating D oc#j 198819999999 Date �) Bonds �� A —� Total L&I 15,869' Current Doc# 200080015484 Date 04l28l2000' Multi Situs - µ Fix. RF Killing Doc# _ Date��l� Flag! MH PP _ 0 j Flagg Asmt Desc 307 LONE TREE RD f SuplCnt 0 I PP 0, �` - - Exempt 7,000; Zoning ARMHS ; Dweio—] I QjAsmt PP Pen r Net Acres 0.00NIC 026 Tax PP Pen R/C#F i ' Appeal Pendin]R/C TIR Dt ;Split Pending State Hy 5WN EXP TAX HON A T SIT APR, j . Find �_ _ �ILOLIJ11saj 07125/20013:27:21 PM _ A FCounty tLE WITH:he Board of Supervisor's Office COUNTY OF BU'T'�'E . RESERVt FOR FILING Sr,�1p Center Drive CLAIM FOR DAMAGES Oroville, CA 95963 TO PERSON OR PROPERTY CLAIM / L(l BOARD OF SUPE Vi INSTRUCTIONS JUN 1.0 2003 as 1. Read entire claim form before filing. 2. See reverse side for diagram upon which to locate place of accident. UNI 1 OROVILLE CALIFORNIA 3. This claim form must -be signed on the reverse side at the bottom. 4. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET., - O F � II' ! EXALDFORAi IA Name of Claimant Date of Birth of Claimant BSD 11-26-27 Suzy Fairse and Otto Hansen Sr. 1-6-58 Home Address of Claimant P.0 B B 456 City, State and Zip Code . Home Telephone Number Berry Creek, CA 307 Lone Tree Rd, Oroville 533-5691 Mailing Address of Claimant City, State and Zip Code Occupation of Claimant Same as above Disabled Business Address of Claimant City, State and Zip Code Business Telephone Number Give address and telephone number to which you desire notices or communications to be sent Claimant's Social Security Number regarding this claim: 307 Lone Tree Rd., Oroville, CA 533-117 552-94-9403/ When did DAMAGE or INJURY ocur? Names of any county employees involved in INJUP or DAMAGE Date, 1_�,_,.,�-200 prese t Sgt. Collins BCSO, Butte County, If claim is for Equitable Indemnity, give date ► Officer ha p o'r t e, BCSO,-Scott McKenzie claimant served with the complaint: Officer Lorimer, BCSO, and all other Date 0 f Where,did,DAMAGE or. INJURY occur? Describe fully and locate on diagram on reverse side of this sheet. Where appropriate, give street names, addresses and measurements from lanes:' `30.7 Lone _ Tree Rd. Confirmed P•syclidlo'gical•-Abuse of an Ehler left unattended -until Lt. Panchesson redeived pressure from Suzy Describe in detail how the DAMAGE or occurr• BCSO, D.A., County Counsel, Butte County Planning and Building allowed or failed to.•take action in protecting the rights and serving us under protection of the law. and all re a. guilty .of malfeasance of office or oath."' as a re-tult we have been psych61ogically` damaged. Why do you claim lthe County isresponsible?. BCSO w.was denying us equal protection under the The county allowed"building to occur over our 15' easement that n is against cou.ty.code, that allowance caused lawsuits.to be filed against ;us and. excessive use of the intended nc.w icsy! and. Describe in detail each. INJURY or DAMAGE. - Elder abuse has 4-a-e'tir °prevalent and denied action on our behal f BCSO and the D.A. owed'us a duty to step in and 'cite for the crime of elder abuse in Re: to Otto Hansen Sr. Butte County Planning and building, was asked to set a hearing in the matter of illegal.. at cf s •r W �l S � 1��5�t rk.e lb 9 t Ca! Dr,►.w�nq � �.yY�.� � �. � '� `_"�. :�: THIS CLAIM MUST BE SIGNED ON REVERSE SIDE The amount claimed, as of the date of presentation of this claim, is computed as follows: Demages incurred to date (exact )• a0,0 Estimated proMMhte damages as far as known: Damage to property. S Future expenses formedical and hospital care.......... S I Z, o o p Expenses for medical and hospital care...... S 0d0 Future loss of earnings .............................................. $ Loss of earnings .......................................... S/D 000 _ Other prospective special damages........................... $te_ Special damages for ..................................... S 0 000 Prospective general damages .................................... Sir -Oa b ; Total estimate prospective dwnages ............. Sto -i.p General damages ........................................... 0 0 Total damages incurred to date ..................... S 2 Total amount claimed as of date of presentation of this claim ................. $ '%`fes 000. Was damage -and/or injury investigated by poli ?Yes- ifs , City oun or tate b�U'l'f'�P � . T ! ny► �c.. � Where paramedics or ambulance called'.) so, name. provider ambulance If injured, state.date, time, name and address of doctor of your first visit WITNESSES to DAMAGE or INJURY: List all persons and addresses of persons known to have information: Name CSG. v�. Address c7 `iS v &%cv lvcatV- Phone 5 f- Y 3 Z Name ori Address - r CA ri 12 V Phone Name p r n 5010 Address Phone :53V -2:2a f DOCTORS and HOSPITALS: Hospital Address Date Hospitalized Doctor Sw Address 2. 7_ �_ t ca-e�_ _ -Date of Treatment Doctor Address Date of Treatment MEAD CAREFULLY For all accident claims place on following diagram names of streets, including North, East, South and West; indicate place oflaccident by "X" and by showing house numbers or distances to street corners. If County vehicle was involved, designate by letter "A" location of County vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw County vehicle, location of County vehicle at time of accident by "A -l" and location of yourself or your vehicle at the time of the accident by "B -r and the point of impact by "X." NOTE. If diagram below does root fit the situation, attach hereto a proper diagram signed by claimant. SIDEWALK CURB CURB PARKWAY /7 SIDEWALK Signature of Claimant or person filing on his behalf Type/Print Name: Date: giving relationship t C ant: did ,� NO AI S MUST BE Fl ')WITH BUTTE COUNTY'S CLERK OF " 'BOARD'S OFFICE (Gov. Code Sec. 915a). .presentation of a false claim is a felony (Pen. cwe Sec. 72). !.9 BUTTE CDL)NT� DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" / v OWNER INFORMATION CONTRACTOR Name 69&9e&i2 Address SRA City 771 State Zip Phone APPLICANT INFORMATION CONTRACTOR Name 69&9e&i2 Address SRA City 771 State Zip Phone Map Book Fax E-mail Planner Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name C' Address SRA City 771 State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name Address C' Stat SRA Ph 15— ;? 771 E-mail APPLICANT SIGN,► &MRIF� For office use only: Zoning Propedy.' e Flood Zone Cross reet k4zz�� #zj&_ SRA I Yes Policy Number Occ. Type Const. Subdivision'Name Map Book Page Lot# Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. v, V/ BIN # PROJECT LOCATION AIV Propedy.' e Ci Cross reet k4zz�� #zj&_ WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Descript' n or Scope of Work: Sq FT- Living Garage pen Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. ' /Pg Received by' (? mount: 2 � • 9(2,Bldg SRA /, r Receipt #: o 9q Sheriff Nspw SMIP D�;poo l `Z �OOther l Total REV 8-12-05 SUBMITTAL & PERMIT REQUIREMENTS. The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and, layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. =� ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans,. (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for nori-residential buildings. ❑ . 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon .receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ;. ❑ 2. Impact Fees. ❑ 3. 'California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Workers Compensation, Carrier and Policy Number. ❑ 8. Owner. -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental. Health Department. If you have questions or would like, additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can.only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 COUNTY OF BUTTE -DEPARTMENT OF QEVELO,PMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA .95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: �S ASSESSOR PARCEL NUMBER- Proposed UMBE Proposed Building Use: i�1/� . h Permit Technician: Date: ms It required in order to appl y Fmit. All oxes MUST be checked OR marked NA in order to apply. 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. { ❑ 3. Engineered. plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. 11. Hazardous Material Form 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other R�rt �alning items needed to issue the permit. (May require additional plan review upon receipt of the following items.) CI,¢aran P2 w�b6- t a R 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable ❑ 15. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... ❑ 18 rosion Control Plan Required........................................................................ 9. ees as shown on the attached Schedule of Fees Due Sheet .............................. City of Chico Plumbing permit........................................................................ ❑ 21. Site plan and business license approval from the City of Biggs .............................. ❑ 22.,Q alifomia Department of Forestry plan approval ❑ paid. Sent by: .......... ®� .Planning approval for (A) Use: c �L (B) Parking: (C) Parcel Check:.. ✓ .... WL29764 ❑ 24. Contact Land Development about _Improvements, _Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ........... F/ 26 PDES Form............................................................................................. ncroachment Permit for driveway from the Public Works Dept ........................... �l �/ 9 a� ❑ Contractor's license information. (Number, Name Style, Classification) ................... ❑ .29. Workers Compensation Carrier and Policy Number .......................................... 5- 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, titre search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone a_XJ'sir% 2 2-64061 (Wold for pickup. I have been informed of the above items nd requirements for obtaining a building permit. - - X Applicant: e Vii" ! _ Date: , 1-2- 1. Index permi application for�the above items numbered: Plan Check Lette 2. Additional items required or Contractor, designer s advised of the above data by ❑ phone, ail, ❑ counter, byi�. Date: Contractor, designer, owner, was advised of the above data by ❑ phone, mail, ❑ counter, by Date: Contractor, designer, owner, w s advised of the abo a to by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: ZA Date: , Structural reviewed b . Date: Structural approved by: Date: Note transfer by: Date: ,G. Yellow: Building Division K/Building/Plan Check/Data Sheets/data sheet page 2 9.27.05 c� Butte County. Department ol'Development Sem'Ces �17 0 Y;. 7 County Center Drive Oroville, CA 95965 ° '—.,;, Q` ° (530) 538-7601 Telephoney° 0UNI (530) 538-7785 Facsimile )BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this building pen -nit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental' Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: 0 I need to submit applications for septic and/or well to Butte County Environmental Health immediately. • I ani required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained 0 I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for disposition of plans ,. The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or r uire submission of amended building plans to the Building Division.. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring submission of amended plans to the Building Division will incur additional fees. ' Within one year from the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required perp its/clearances include, but are not limited to, verification the parcel was legally created, adherence to_all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name: �U?�-Q �rs APN: Oo)IO�AO 0 - Building site address: 'J l� 1%+Q Permit No.: (.fes" 2 ` O I have read, understood and accept the terms and conditions as expressed herein as indicated by my submissio f the above-referen building permit application and my signature below: SIGNATURE OF PPL ANT DATE °� Department ®f Public' orks o C o u n t y o f B u t t e 0 7 County Center Drive 0 Oroville, CA 95965 L0 J. Michael Crump, Director (530)538-7681 (FAX) 538-7171 p S vet�c w°F� Shawn H. O'Brien, Assistant Director Assessors Parcel Number:/99i Z0-010 Building permit # Owners Name: off ycrn 5 e/1 Owners Mailing Address: Property Address: 39 7 die -7r-�l ENCROACHMENT PERMIT ACCEPTED: PERMIT NUMBER: ENCROACHMENT PERMIT EXEMPTION: Reason for exemption: [] Not a County maintained road Existing driveway conforms to County S-31 standard Other f{ Approved byell" Printed Name e;�6 TitleiI Date 14 U CONDITIONS FOR EXEMPTING A DRIVEWAY PERMIT An existing home with a driveway 10 years or older and doesn't cause any problems with the county road or drainage. 2. An existing home with only minor remodeling or repairs. P P4iTME/YT T TF OCOP y `� o co u o��, Department of Public Works a�1 C-ounty of Butte a I' LAND DEVELOPMENT DIVISION I J. Michael Crump, f� Storm Water Management Program C //' Director 7County Center Wive Oroville, CA 95965 Av �5 (530) 538-7266 QLtC WAP (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water. Permit and Storm. Water Pollution Prevention Plan (SWPPP) Acknowledgement rLESS THAN 1 ACRE Project Description: Project Location and/or Parcel Number: By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: 2,2 A .11 . N j �j[. +i . ..1• i['.{Y'✓Y{� )4.�_. �.i�g, Win• •.L•� _ F .F 5 .4'�_ ♦ ♦ ify�Pq � .• Y 333G.r • 5 d • t " 4 �TF.LkJ� �`L y4 'r ., rt• - r �, •iaC�.� .. �.ya. -iif AIT 1r - . S� 4 • ! T Tis i i ti Cy L i ,. � �dJ�l •11144... • s f ++ as Fs jr,.4 �r e`• s j •t r, , t ti • _. a. a� t �Au � 1 son•� • p:," t Y-, � • R11 �y.a• r °..T � �a . J1/01/2001 11: 30 5305331173 SUZY -- PAGE 03 PHOTO S1 -9 COMES ACCEPTED_ INSTRUCTION kESUk_W_AL_ HINATURF V.W n2owwler, .Aang.tyer the elvessel UM 004' . unt lo( theA -'J OW It 0% etc.) ip. spouse, 6 MENU bras -4 :.Stqff me M11. of ownership. Fai!lz plate or -4 2W W, 100 J* The 0- cW miles, and to the best ••.qV knowledge r9fleCts tho ("ph so"" . ... - JfN . %NW#, WY rig Dow PISCIWOKY 13 Odoff* t 49.94 NOT'JhV ."R7,V{lea U*"eds the odometer mechar, limits or. NA Explain odorr�iter-*disc re pancy. her this s!!t2j IqPT 4,.;.K,0 (M%. .&W BUYER VIP` I acknowlad'90-ift adaMetei ramuMiglaradthe- (Acts 42f the 4&j.'.6 r. 1 0,1;;,: M,57r.7-t_der Vic!K_% e of the Slate of VeliftwMe Owl the Information I have prowi*4; Is trua&W correct. d7 40 ...b.; X Tuft X 81rol"TURE f. DATE OL13;APWRS X ZNIF surc zW DWnUW PWK I SELLER' I certify under paWlty of perjury under the laws of the Shm of Califtmie Char rhe information I have provided is true and fo V T row .440AAMAE DATG CIL 10 V WMER • X 41- 4. 8 IPPMT j�lk -..*'. - A X DA%T" rNowt • %%W OAQF&u 64TAT, ap tab Fq V Wi -.qf Y lgdIIWQ (PRWT NA"M 777P M f"r-*l' 0- -00*@Mq a, hood to pwnv#,,,Ap &S rogLiked by favw Porti. 4%.Anomer DAM X w."W SP04nfi a P0 -W X . . _ 1 _. i .... `.. 'f .- : a :. t. 11/01/2001 11:30 G oyv, 5305331173 io 'A b -a SUZY PAGE 02 -sem Sum Az, ( 0 a4 , H � BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 ° CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.nettdds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name �I r q irsm_e, '2— (/ 1J Addre Ci StapA_ Zi Phone -�-y� �, t1 �7 __2? _J E-mail CONTRACTOR Name (' r se otj nv' Address A - City State Zip Phone Fax E-mail Lic. # Class ap Book ARCHITECT/ENGINEER Name , Address City State Zip Phone Fax E mail State License Numbe A APPLICANT INFORMATION Name Address C' State zjy J l Fax E-mail —�JV i fP- For office use only: Zoning Propepc d ,e j Q Flood Zone Cross S t SRA Yes No Occ. ype Const. Subdivision Name Ir ap Book Page Lot # Planner Date Approved: PERMIT NO PROJECT LOCATION Propepc d ,e j Q City Cross S t WORKS 'S COMPENSATION Policy Number Carrier r If hirin any oth r than license contractors, a certificate of worker's compo all m st shown at the time of permit issuance. LENDING AGENCY Nae / ess Des riptlo n or S; Mope of Wo k: i ``�� `(�� Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): OVER FOR SUBMITTAL REQUIREMENTS L, K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS ' Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by� A"mount"? Bldg TT11 SRA ° Receipt #: O _Sheriff ell _ SMIP Date: <Z3 --f <3-_/; Other q Total REV 8-12-05 L_ SUBMITTAL &PERMIT REQUIREMENTS ti.. The following drawings and specifications' `mus t be submitted to the Building Division in order to apply -for a s permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK �' ❑ 1. Site plans, 3 or 4 sets, signed by*the preparer of the plans. No graph'paper.► Ei 2. Complete plans, 3 or 4 sets, signed by,the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets,'with wet signature on plans AND 2 sets of stamped and signed calculations. Y ❑ 3. Engineered truss details and layouts,in duplicate (if required). No faxesl ❑ 4. Energy compliance design; nd supporting documentation in duplicate. -A., - ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. %0 6. Manufactured home`s: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans,` ' all in duplicate _- `•❑ 7. Metal bldgs: (A) Metal Bldg Plans, '(B).Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. 1,, _ ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business licen'4'approval from the City of Biggs. ' .. ❑ 10. Letter of intent for non-residential buildings. a 4` ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt'of the following items.)' ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). D 2. Impact Fees. _ .R :• ❑ 3. California Department of Forestry plan approval (if required).. `c ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for'driveway from the Public Works Dept. construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). - } ❑ 7. Worker's Compensation Carrier and Policy Number..-. ❑ 8. Owner -Builder Verification (if required).'' ' ❑ 9. Letter of Signature authorization (if required).►° �' `� ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. w, ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have'questions or would like additional information regarding this process, please contact a . -� Permit Assistant at (530) 538-7541. 4� EXPIRATION OF APPLICATION _ Applications for which a permit has not been issued will expire one year after.date of application. In order to renew .action, ' on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS = k` Refunds can only be made upon written request by the person who paid the fee. The request must be made withintwo, years from the date of fee paymenti.on permits not issued, and two years from the date of permit issuance for permits. issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan . check fees for work checked and other department costs are not refundable. plan s OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS161dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 �' OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your naive and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the ma' Lr labor andmaterial for construction of this proposed property imp,r �ement: YES [ O [ ]. 2. I HAVE [ :J HAVE NOT [ ] signed an application for a building permit for the proposed work. I I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide -the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF .WORK SIGNED: PROPERTY OWNER: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile www.buttecou nty.netldds OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property, improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other -,than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to, be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they, apply. If you plan to do your own work, wiih-the exception of various trades that your plan to subcontract, you should be . aware of the following information for your'benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or, subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not cant' out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about. your obligations under federal law, contact the Internal Revenue Service (and; if you wish, the U.S.- Small- Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" 'building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321-CSLB (2752) or by accessing their website•at www.CSLB.ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Scott Rutherford Manager, Building Diviion NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION. 7 County Center Drive, Oroville, CA .95965 Phone (530)538-7541 Fax (530)538-2140 V ! y /q�� PERMIT APPLICATION DATA SHEET `/4n OWNER: I S ASSESSOR PARCEL NUMBER Proposed Building Use: Permit Technician: Date: Ityems required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. � 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. if- 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl y ❑ 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. ;1 ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. El 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Hazardous Material Form f' 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other .ReVngining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) OW 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable ❑ 15. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... ❑ Erosion Control Plan Required........................................................................ Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 20. City of Chico Plumbing permit........................................................................ Cl 21. Site plan and business license approval from the City of Biggs .............................. ❑ 22. California Department of Forestry plan approval ❑ paid. Sent by: 23. Planning approval for (A) Use: ()X.(B) Parking: (C) Parcel Check:.. ✓ ..... �. D ❑ 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. fire Marshall Review (commercial projects only). Sent by: ...................... 'r 26 PDES Form............................................................................................. ncroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ .29. Worker's Compensation Carrigr and Policy Number .......................................... j� 30. Owner -Builder Verification (/ Given to owner, _Mailed to owner).: ................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... - ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued TelephoneD 879 9 and hold for pickup. I have been infdrmed of the above items and requirements for obtaining a building permit. Applicant: X Al I Date: 1. Index permit ap ti ation foylhetab ve items n bered: Plan Check Letter 2. Additional items required •1 ��1'' Contractor, designer, owner, was advised the above data by ❑ phone, ❑ mail„ ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above d t by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: //►'✓ Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division K/Building/Plan Check/Data Sheets/data sheet page 2 9.27.05 1 '1, T TO: Building Division — D elopment Services FROM: Environmental Health Plot Plan Adarh( Y Floor Plan Attazhed-� Sent to BD/DS / 1 S DECT: Sanitation Clearance Al �T, Ow r Location AP# Plan Approved for: Sewage Disposal------,-, ater Supplly% , ub is Private Well Clearance for dwelling. Other �%� Hold final for. Final clearance O.K. for: L MOTE: Environ`men4al Health Specialist Building Clearance 9/2005 4--) Date y BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecountV.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner FARISE, SUZY APN No: 026-260-010 Permit Type: ` Subtype: App Date: 8/18/2006 Permit No: BP 06-1995 Permit Desc: 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION $852.35 Plan Check portion of Permit Fee $340.94 $511.41 Balance of Building Permit Fee 2 FEMA Yes Flood Elevation Review $109.98 0 3 SRA* RYes Fire Plan Check - Non -Refundable $95.00 0 _ (State Responsibility Areal Building Inspection $109.98 0 - $204.98 NON-REFUNDABLE portion of fees due at application $340.94 FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $340.94 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $514.65 $511.41 $3.24 RECEIPT DATE Tech/Asst 8/18106 Tammie 4 5 6 7 7a 8 9 10 Balance of Building Permit Fees (from No. 1 above) SMIP* - Strong Motion Instrumentation Program (Enter amount from permit system) Additional Plan Check Fees (NON-REFUNDABLE) Other*: Other*: IMPAR I rttb - Kt,IUtN I IAL` I Per Dwelling Per Dwelling Per Dwelling Applications After 04/15/06 ,> SFD MFD MH County 4249.11 3183.54 3238.72 Chico Urban Area 6146.23 4538.82 EI Medio Fire District 3249.97 2385.76 North Chico Specific Plan SR -1, SR -3, SR-1/PD 0 R-1 ° R-2 R-3 8801.091 8897.09 8390.091 7604.091 7395.04 7491.04 6984.04 6198.04 Processing Fee is automatically added to impact fee total 0 WATER TENDER FEE (Not collected when Impact Fees Applicable( Enter Bat.# Temporary Dwelling $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. DRAINAGE FEES* 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* Palermo Union High School 092 CHICO STORM DRAINAGE MASTER PLAN 1W 770 Butte Creek 771 Comanche Creek 8486.40 8582.40 8075.40 7289.40 RECEIPT DATE Tech/Asst $100.00 $200.00 1oa 11 11a New construction, vacant land, on 1 acre or less - Enter 1 or less acre value 772 Little Chico Creek $9,088 RECEIPT DATE Tech/Asst 773 Big Chico Creek $6,776 774 Lindo Channel $8,267 775 SUDAD Ditch $7,211 776 Mud -Sycamore Creek $6,275 777 PV Ditch $8,893 More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW THERMALITO DRAINAGE AREA 1 $684 Maximum Per each new living unit on existing lots where full drainage fees have not been paid Temporary Dwelling $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO ISSUANCE OF PERMIT. Forms will be prepared after plan check is completed for applicant to take to respective district office. 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* Palermo Union High School 092 1W I 1W At the time of permit application, I checking process. the above fees are re ' e o be paid prior to issuance of the permit These fees may be changed during the plan Applicant: / �J Pursuant to Gov ment code Section 6602 ou a e her from the date of approval of the porject or fr m the i post specified in Goverment Code Section 66020(a). Date: notified those Items followed by an "*" may have been imposed on your project You have 90 days of the above referenced items during which you may protest. The requirements for a protest are K:/Building/Forms/Schedule of Receipt Fees Residential 041506 i p�P pg�kT O� • • Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile ADMINISTRATION * BUILDING * PLANNING Aug 31 st, 2006 Suzy Fairse 307 Lone Tree Rd. Oroville, Ca. 95965 Assessor Parcel Number: 026-260-010 Building Permit Number: 06-1995 Thank you for submitting the plans for your building project. The plans have been reviewed and comments are listed below. Please respond in writing to each item by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Your complete and clear response will expedite the re- check and approval of this project. COMMENTS: 1. Ceiling joists are over permissible span. Use 2x8 @ 16" O.C. or break up span with interior wall and corresponding footing. 2. Show ridge board on plan. 3. Provide foundation plan in plan view for both structures. 4. Provide detail for 2' 8" brace wall panels for brace walls under 4' feet. 5. Provide correct insulation values for 2x4 wall framing. See energy calcs. 6. Composition shingles are not permitted on roof pitch of less than 2:12 /Z 7. A Deed Restriction and Limited Use Facility must be recorded to limit the use of the sun room. The deed restriction will state that the sun room will not be heated or cooled, or used for living or sleeping. This deed restriction will be prepared by Butte County and must be signed, notarized and recorded by the property owner. Please provide a copy of the vesting grant deed for the property so that we may prepare the deed restriction. If you wish to discuss any of these requirements, please call (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. Please refer to your Data Sheet for remaining non -plan check items. (You received this form when you applied for your permit.) The counter staff will answer any questions concerning the Data Sheet. Mike McGee Building Inspector r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT. 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.neAdds PERMIT NO. BP062018 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 09/15/2006 APN: 026-260-010-000 the Business and Professions Code, and my license is in full force and effect. License Class: License,Number: Site Address: 307 LONE TREE RD PAL Date: Contractor: Map Index: Description: DETACHED GARAGE 672 SQ.FT. OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a HANSEN OTTO EUGENE ETAL permit to construct, alter, improve, demolish, or repair any structure, prior Owner: 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 307 LONE TREE RD the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA she is exempt therefrom and the basis for the alleged exemption. Any 95965-9669 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their , sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: HANSEN OTTO ETAL such work himself or herself or throughhis or tier own employees, FAIRSE, SUZY provided that such improvements are not intended or offered for 307 LONETREE RD sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of OROVILLE, CA 95965 proving that he or she did not build or improve for the purpose of 530 533-1 173 sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor: pursuant to the Contractors' State License Law.). O_, I am Exempt under Article 3 o the Business and ofessions Code Date: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: ❑ 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. Architect: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation " insurance carrier and policy number are: Carrier: Total Square Ft: 672 S.F. Policy #: 1 certify that in the performance of the work for which this permit is Valuation: $16,128.00 Census Code: issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cod(, forthwith comply with ttho a p,ovisionrs , ,) • 2}UI "l Date: V V Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. _CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Buffe County Code anrllor I hereby affirm that there is a construction lending agency for the Resot do s to do work Indic ted a ve for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.)il I BY: Date: `` fir 1 t ,� /1 J C8 Name: 15 ryry - j Address: PERMIT EXPIRES ON: —t Date O I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all co0nty and state laws relating to building construction. I acknowledge it is unlawful to alter the'substance Many official form or docum t of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purpos Print Name: 2 �Q S �. Signature: l Date: ❑ Owner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor 0 i L . fiy I ? pSW ENT 61� II 0 e an ent ®f Public Works 0 C o u n t y o f B u t t e 7 County Center Drive 0 Oroville, CA 95965 O J. Michael Crump, Director (530)538-7681 (FAX) 538-7171 Shawn H. O'Brien, Assistant Director Assessors Parcel Number:r%Z ,,20,permit # Owners Name: 0 f a Ya/15 e/i Owners Mailing Address: Property Address: 30 7 die -7r-e, ENCROACHMENT PERMIT ACCEPTED: PERMIT NUMBER: ENCROACHMENT PERMIT EXEMPTION: Reason for exemption: [� Not a County maintained road Existing driveway conforms to County S-31 standard (� Other / ff Approved by Printed Name Title Date // U CONDITIONS FOR EXEMPTING A DRIVEWAY PERMIT 1. An existing home with a driveway 10 years or older and doesn't cause any problems with the county road or drainage. 2. An existing home with only minor remodeling or.repairs. ~ i I i i {I{ 1 i 026-260-009, 026-260-008 6-260-0 t g 0 . 026-260-014 1r,_ {{ r OF Ion t +'Ai {71K 4 . I W o 1 Ij c Title:- Date':'- Description.,. itle:.Date:-~Description, j 06 Ilk I I ;i V ,, ! -ee•� �11 _ a 9t�• � lA � A e I { a F Ik 1Title: ••. !` Date:.,: ' i, Description:, Lim kkkkummmmommm-WEL o 1 Ij c Title:- Date':'- Description.,. itle:.Date:-~Description, j 06 AN 026-260-010 6/24/02 Page 1 Ilk Title:. Date: Description:, AN 026-260-010 6/24/02 Page 1 a Alid } i �• ct � - "� •°�p�, i' � • ,✓. b+ ^,4•V �; �p �- it Title: Date: s Description:, ?' IQZ',��,�� I� I — � o •A r1i� I r. Title:. r Date: Description:, ; -- i '-- _ I � i I! i1) I�r i �� F �/ • ,�. ,ill e_ i� it Title:. ` Date:1 Description:,�! IQZ',��,�� I� I — � o •A r1i� I r. Title:. r Date: Description:, ; AP# 026-260-010 6/24/02 Page 2 -- i- '-- _ _— -- —" � I! i1) f 1 Title:. i, i f .� 3r, w Date: .• r M 1 Description:, AP# 026-260-010 6/24/02 Page 2 AN 026-260-010 6/24/02 Page 3 t AN 026-260-010 6/24/02 Page 3 IPF N0. ----•445-77P,E .,.-- . PERMIT EXPIRES 4AWpIFR Otto Hansen '-CONTR. Lincoln Village MHs, Orovil LOCATION (A.P. 26-26-10 E/S Lone Tree, 1.2 mi..N.of Palermo Rd., (Signature) i r • 4 I r • . '? -Power ~ _ Temp Pole t Called PG&E v, Temp. Elea Serv. Called PG&E Temp. Gas Serv. I� r Caned P15& -E- 1 JOB FINALED (Date) (Signature) i r • COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING A BUILDING (Cont'd) PLUMBING Fornio Parltpets 1 t Floor Mai Bldg. Rest om Finish 2n Floor Fo ins WindloyX 3rd Noor Stemall Siding To out Slab N Roof Sheahing Water PIpIXg Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwal l Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov, for physical handica ed Conformance of ex., structure V Appliances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio REP ACE Final Footin s Footing EJtECTRIC L Masonry Walls Throat Rou h Reinf. Steel Final Fixtures Bond Bea FIRE SPRINKLEA Motors rFraminn. Tse.• W. #.. Yf. Mesh MECHANICAL Grd. Fa6lt Prot. Scra h N Heatl 16Servl Brg4n X I Coo no T ma. Pole nish X D is nder round erior Lath entllation Permanent oor Closer anal Inal MOBILEHOME UTILITIES Elec. Servicerj �Z 9 7 Elec. Pedestal Water Piping Sewer 51-- ZS 10V Gas Piping .a.� E ME INST LLATI N • • • • • - • - - - - - - Support j-' 77 777 77Elec. Continuity �� 7 Water Piping Drainage � � -7 %" `>d Gas Piping DATE REMARKS OR CORRECTIONS '70-(77 red ot,� s 717 7 L (NOTE: An entry must be made on this form each time you visit the job site.) t;JI3Ti I PiU�i.ls LIS7'ALLATER4 INSPECTION'CIIECh LIST 1. Is the mobilehome: loc�ited wii_li required separation from lot lines and buildings andgenerally conform to plot plan? YcsNo_ '. Does the mobile -home have required clearances above ground? (Sec.5085) Yes No 3. 'Are footings and supports properly sized, spaced, and braced as\�er approved plans? (Note possible variation at spring shackles.) (Sec: 5082 & 5083) Yes X. No 4. Is the mobilehome level.? (Sec. 5088) Yes/` No� 5. If m�e ti�a —a—single unit, are crossoveJr connections properly installed? (Sec. 5088) Yes_ No 5. Water A. .Is flgxi-ble connector of adequate size and properly installed (1/2" ID min.)? (Sec. 556 YPs7-TTTNo , B. Test - Does water piping withstand working pressure or 50 lbs, air. test? Yed No C. Backflow- Tfcoac 'G ncr Stat,_O.E_EalifOrniU approved, does station have backflow dev and pressure -relief valve? Yes No .. 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes ; No B. Does it have minimum z," per foot slope and is it properly supported? Yes No ,C:. Are any leaks detected in drainage system after runnin 3 -gallons of water through each fixture including washing machine standpipe? Yes No4 D. If-c-oael3—i-s—n—S-tate—e-f—C ifornia approved, does station have required trap and vent? Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft, long? Note: All piping is to be at least as large as the mobi ehome gas line inlet without reductions other than the mobilehome connector. Yes No B. Test OK as per following procedure? Yes No 1. Open all appliance connector valves. / 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min, without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly i.nstal'led? Yes , No 1 1 1 9. Electrical A. Is service Large enougl. to provide adequate amperage to mobilehome (must equal rating of mobi_lellome caith a s;iniu!:um of 100 amp) and other facilities on lot, i.e. , water pumps, Zara -e, cabana, etc.? Yes No B. Is therl-� proper_ clearances around panels? Yes No C. Is power supply cord or feeder assembly properly fused? Yes No_ D. Is continuity test satisfactory as per the following procedure? Yes No 1. De -energize electrical wiring syste:a of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors,. including neutral conductor, havE: been disconnected. 3. Switch all breakers and switches in '.the mobilehome to the "on" position. 4. Connect one load of a test instrument to the mobilehome grounding conductor and apply Lite oilier Lead to each roob1LE1,L01lle Supply COT1LLtiCtOr, iliCleiufiig neutral. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, ,alter line), including fixtures and'appliances, shall be tested for continuity from such equipment and the grounding conductor. 1 6. Upon completion of the above procedure, the, power supply cord or feeder assembly corlductor.s shall. be connected to the site service equipment. A further continuity te;L shall then be made between the grounding electrode and the chassis of the Mobilehome.- Upon sati_sfactory completion of the electrical.tests, the lot or site service equipment may be approves( for. energizing. Tsjob std signed by Health Department for water and sanitation? 1'.. If everything ol:ay, sign off 'card and to services. MOB IL i .MILL DATA Manufacturer and/ear Namestyle Ler.gth CP Width vehicle Serial No. y State Identif.icat:ion No. z y� °.dc: L t Tonal Infor-na t i un or Comments: a BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 .,,,wvvw.buftecountV.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner FAIRSE, SUZY APN No: 026-260-010 Permit Type: _ Subtype: App Date: 8/22/2006 Permit No: BP 06-2018 Permit Desc: 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION Plan Check portion of Permit Fee 2 FEMABYes Flood Elevation Review- $109.98 3 SRA* Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 NON-REFUNDABLE portion of fees due at aDDlicatinn $549.90 $219.96 $329.94 Balance of Building Permit Fee 0 0 0 1= $204.98 FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION . $219.96 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $331.55 $329.94 14-4 $1.61 RECEIPT DATE Tech/Asst 460994 8/22/06 Tammie 5 6 7 7a 8 9 10 --�a'. - c U41U1119 ream[ rees tTrOm NO. 9 above) SMTP* - Strong Motion Instrumentation Program (Enter amount from permit system) Additional Plan Check Fees (NON-REFUNDABLE) Other*: Other*: ttvlt'Al: 1 tttS - RESIDENTIAL*Per Dwelling Per Dwelling Per Dwelling Applications After 04/15/06 ,� SFD ,� MFD MH County 4249.11 3183.54 ,� 3238.72 Chico Urban Area 6146.23 453882 5648.44 EI Medio Fire District 3249.97 238 .76 2422.68 North Chico Specific Plan p� SR -1, SR -3, SR-1/PD 8801.09 7395.04 8486.40 R-1 8897.09 7491.04 8582.40 �0 R-2 9- V 8390.09--7-6984.04 8075.40 R-3 9 6198.04 7289.40 RECEIPT DATE Tech/Asst I F_ impact Processing Fee is automatically added to mpact fee total 0 $100.00 WATER TENDER FEE that collected when Impact Fees applicable) Enter Bat.# $200.00 DRAINAGE FEES* CHICO STORM DRAINAGE MASTER PLAN 1770 Butte Creek $7,997 1 1771 1 - New New construction, vacant land, on 1 acre or less - Enter 1 or less acre value omanche Creek 772 Little Chico Creek $8,34 $9,08E 773 Big Chico Creek $6 776 774 Lmdo Channel $8 267 775 SUDAD Ditch $7,211 776 Mud -Sycamore Creek $6 275 777 PV Ditch $8,893 10a More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW 11 THERMALITO DRAINAGE AREA $684 Maximum Per each new living unit on existing lots where full drainage fees have not been paid 11a Temporary Dwelling $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO is is completed for applicant to take to respective district office. 12 SCHOOL DISTRICT FEES' 12a RECREATION DISTRICT FEES' RECEIPT DATE Tech/Asst - _F i -I ISI OF PERMIT. Forms will be prepared after plan check At the time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking process. Applicant: Date: Pursuant to Government code Section 66020, you are hereby notified those Items followed by an "" may have been imposed on your project. You have 90 days from the date of approval of the porject or from the impostion of the above referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 041506 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile www.buttecounty.net/dds OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ' o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations 'including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" 'building permit, erroneously implying that the property owner is providing his or her own labor and material personally. 'Building permits are not required to -be signed by property owners unless they are performing their own work personally. Information about ' licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321-CSLB (2752) or by accessing their website at www.CSLB.ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Scott Rutherford Manager, Building Diviion NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OWNER -BUILDER VERIFICATION / V Attention Property Owner: An "owner -builder" building pen -nit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the fnaj bor and material for construction of this proposed propertyimpr meet: YES [ NO [ ]. 2. I HAVE [ HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME:. ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: F4 DATE: Z NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 % � .