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028-110-034
HAROLD.JOHNSON- 300' off NIS LaPorte Rd., 600' E. of Pleasant Grove, Bangor Permit #1481-82B;P,E,M(New SF) 28-11-$g M Permit.1719-82P(Solar Wtr. Htr./1481 !vor Permit ��g650- , V new Pmt gar) '028-;1'1'0-034 04=306IR JOHNSON, ARD '1636 PLEASANT GROVE. LN, BANGO Ccrlr: nWN! ER I XF INAL82 -14S l ,1719 ka• 17 (9 �3• V ZrRl rio�HNSON,ARD -034 04-3088 ON, ARD PLEASANT GROVE LN, BANGOR OWNER IL.DING 0-034 05-0364 1636 PLEASANT GiZOVE LN, B GOR Cont: TOM JACKSON ELEC SRV CHNG _ 0 . - a 0 � � � I� ;.,,. :� I No BUILDING DIVISION COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE — OROVILLE, CALIFORNIA 95965 — TELEPHONE: (530) 538-7541 AGRICULTURAL BUILDING EXEMPTION PERMIT PERMIT r'N`( 30 �G v l Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. ASSESSOR PARCEL NO 026 r // 0 —03 ZONING A- OWNER — PHONE NO. OWNE 'SADDRESS I LE�s�v v 029- 10 h 9 s9 LOCATION OF BUILDING Lt �9 S o (J�� Q- rJ .D�X �� %'�lz�� � • ��%� �'IGlN1� ��/mss USE OF BUILDING SIZE OF &RUCT16RE 4D_ SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL CONCRETE OTHER (Specify) TYPE OF SIDING ROOF COVERING FLOOR TYPE em e -c ESTIMATED COST OFCONSTRUCTION —C'0 AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as follows: / 1—IL-2— FRONT SIDES REAR AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated about, and the purposed use confirms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date /U — uQ Signature of Owneell� Permit Fee X� The above describeOZ Building is exempt from a building permit. FLOOD I PA Wl- P.g. ROOF G ISSUE• Receipt No. l/ Manager Buildin Division B Date White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod —Applicant NOTES RESIDENTIAL k PERMIT N0. - 020-110 034 05-0364 4 JOHNSON, ARD 1636 PLEASANT GROVE LN, BANGOR Cont: TOM JACKSON ELEC SRV CHNG td 1 h SPECIAL CONDITIONS CHECKED BY -SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER k � - I OFFICE COPY t' '< Address •i GAS Meter By Date ELECTRIC s Meter By I Da 5 Y - aJOB FINALED (Date) 8' Signature J=OK 0 = Not OK . No Readyable MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s .1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ P' L 'ft. / P Nat. or/ P' L "ft./ P LPG 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date T Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 , Date Card B-1 Date PERMANENT END SYSTEM (ONLY): 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage -,Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verifv #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing' -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-Connectors Shthg-Frg-Bracing , 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors " 7. _Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B=1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; -15 Volts=GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panelboards-Ins. to Main Conduit 9. Health`Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche - 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 < Date Card B-1 v J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 1. Zoning -Setbacks -Easements -Flood -Slope 55. 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 56. 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 57. 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 58. 5. Stemwalls, Main; Steel-Blockouts-Wrapped _ 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 60. 6a. Hold Downs and Special Anchors 61. 7. Slab, Steel -Wrapped 62. 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test Date 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test Date 11. Water Pipe; Test -Anchors -Regulator -Service Test _ 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation 68. G.F.I. & Bath Fixtures & Tub Access -Spa Date 69. Card B-1 Date Card B-1 Date 70. Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Fireplace or Stove, Clearance -Hearth 17. Water Htr; Vent -Access -Combustion Air Baffle Elec. Outlets at Wood Panel, Int. & Ext. 18. Water Pipe; Test & Anchor -Nail Protection Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 19. D.W.V.; Test Fittings & Anchor -Nail Protection Elec. Outlets & Receptacles at Kit. Counter 20. Shower Pan; Test, First Floor -Tub Access 75. 21. Test Tub & Shower, Second Floor -Tub Access 76. 22. Gas Pipe; Sixe & Anchors 77. 23. Fire Sprinkler; Test 78. Plb.; Elec. & Mech. Equip. Listed for Location Date Elec. Receptacles in Garage (F.F.I.)-Romex Protection Card B-1 Date Card B-1 Date Insulation -Foam -Looked in Attic Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors _ 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 88. 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes 0 No 89. 32. Service -Riser Conductors & Ground Main Disconnect 90. 33. Equip. Clearances Panels-Motors-Mech. Equip. 91. 34. Clothes Closet Light -Shower Light -Spa Light 92. 35. Smoke Detector 93. Water & Sewer Connected -C/O to Grade -HD Approval Date Energy Compliance Certificate -Other Certificates Card B-1 Date Card B-1 Date Address Posted Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Date 36. A.C. Ducts Insulation & Support Date 37. Vent Fan, Exhaust above insulation Date 38. Condensate Drain & Overflow, Size & Grade Comments at Final: 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51, Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes _ 83. Following Instld./Drive 0 Yes 0 No/Walks O Yes 0 No/Planters 0 Yes 0 No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BPO50364 B. C. Building Permit 01-16-04 pq 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 02/10/2005 APN: 028-110-034-000 the Business and Professions Code, and my license is in full force and effect. r - License Class :<' ,C-7 License Number: Site Address: 1636 PLEASANT GROVE LN BAN Date: ' Contractor: Map Index: Description: ELE SER CHANGE p OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a JOHNSON ARD L & JEANETTA M 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 O BOX 31 the Contractor's State License Law (Chapter 9 commencing with Section P 7000) of Division 3 of the Business and Professions Code) or that he or BANGOR, CA she is exempt therefrom and the basis for the alleged exemption. Any 95914-0031 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).): ❑ 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' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: ELECTRIC COMPANY such work himself or herself or through his or her own employees, JACKSON TOM provided that such improvements are not intended or offered for , sale. If however, the building or improvements are sold within one 1736 RUSHING ST year of completion, the owner -builder will have the burden of YUBA CITY, CA 95993 proving that he or she did not build or improve for the purpose of sale.). (530)218-6704 ❑ 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: ELECTRIC COMPANY pursuant to the Contractors' State License Law.). JACKSON, TOM ❑ 1 am Exempt under Article 3 of the Business and Professions Code 1736 RUSHING ST YUBA CITY, CA 95993 Date: Owner: (530)218-6704 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 818855 ❑ 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. ❑ 1 have and will maintain workers' compensation insurance, as Architect: 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: 0 S.F. Policy#: I certify that in the performance of the work for which this permit is Valuation: $0.00 ((( issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the for this is issued (Sec 3097 Civ.) This permit is hereby Issued under the applicable provisions of the Butte County Code and/or - Resolution t o work indicate above h fees have been paid. /0 0. performance of the work which permit By ate: Name: 1 PERMIT EXPIRES ON: Address: ate) ❑ 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 & 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 a_o ized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any offic[affo or document of Butte County. I hereby authorize representatives of Butte County two enter upon the above mentioned property for inspection purposes. Print Name:::: �1 S / � � Signature: 01 Date: i��� O Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pq 1 n BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 BP050364 B. C. Building Permit 01-16-04 pq 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 02/10/2005 APN: 028-110-034-000 the Business and Professions Code, and my license is in full force and effect. e— License Class :r License Number: Site Address: 1636 PLEASANT GROVE LN BAN Date: Contractor: Map Index: Description: ELE SER CHANGE p OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: JOHNSON ARD L & JEANETTA M to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section P 0 BOX 31 7000) of Division 3 of the Business and Professions Code) or that he or BANGOR, CA she is exempt therefrom and the basis for the alleged exemption. Any 95914-0031 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: ELECTRIC COMPANY such work himself or herself or through his or her own employees, JACKSON, TOM provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one 1736 RUSHING ST year of completion, the owner -builder will have the burden of YUBA CITY, CA 95993 proving that he or she did not build or improve for the purpose of sale.). (530)218-6704 ❑ 1, 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: ELECTRIC COMPANY pursuant to the Contractors' State License Law.). JACKSON, TOM ❑ 1 am Exempt under Article 3 of the Business and Professions Code 1736 RUSHING ST YUBA CITY, CA 95993 Date: owner: (530)218-6704 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: License #: 818855 ❑ 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. ❑ 1 have and will maintain workers' compensation insurance, as Architect: 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: 0 S. F. Policy #: ( I certify that in the performance of the work for which this permit is Valuation: $0.00 ( issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisidns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the appl'cable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Resolutionp toodo wok 'indicated above h fees have been paid. 404, Name: BY ate: ^^�� PERMIT EXPIRES ON: v� Address: ate) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the dulya ized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any offic' fo or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: _—��� /5 SOS Signature: Date:��/ ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pq 1 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 OF APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last Name irst Na Address 24540� La City State Zip Phone r Fax E-mail 'fit N/ 7.0 i C. (l7.7 /7 - , CONTRACTOR Name L . w / I.� r Address, 14ild I No Ire I Zip .: li 'pay '00 007� E-mail i State License Number sWK J eI i � 'fit N/ 7.0 i C. (l7.7 /7 - , 21 i For office use only: .01 AR HITECT/ENGINEER Name Flood Zone Address SRA City I No State Zip Phone LP Fax E-mail i State License Number 21 i For office use only: .01 APPLICANT Property Address�! Flood Zone Address, SRA I Yes I No Occ. Type Const. movaos"r—S, LP Page Lot # i 21 i For office use only: .01 Zoning Property Address�! Flood Zone Cross Street Z=4 " & - SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BIN # LOCATION AN Property Address�! Cit Cross Street Z=4 " & - WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address / Description or S ope of Work: 'f– Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be 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. I I Received by* Amount: Bldg I I Page 1 of 2 Receipt #:_q Date: a.-// ( 0f SRA Sheriff SMIP Other SJ Total REV 7-27-04 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper.!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538.7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 • ! BUTTE, COUNTY DEPARTMENT OF DEVELOPMENT SERVICES. ! BUILDING PERMIT - 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) ' OFFICE #: (530) 538-7541 FAM (530)538-2140 r " WEBSITE: www.buttecotinty.neUdds PERMIT NO. BP043062 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury ,that 1 am licensed under ' provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 10/19/2004 APN: 028-110-034-000 the Business and Professions Code, and my license' is in full force and effect. License Class: License Number: Site Address: 1636 PLEASANT+GROVE LN BAN 6 Date:. Contractor. Map Index: Description: 1 X TIME FINAL FOR 1481-82,1719-82 & 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 3650-83 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure; prior JOHNSON ARD L & JEANETTA M to its issuance, also requires the applicant for such permit to file a Owner: signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section p O BOX 31 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 BANGOR, CA violation of Section 7031.5.by any applicant for a�permit subjects the 95914-0031 a applicant to civil penalty of not more than five hundred dollars ($500).): 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' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, Applicant: JOHNSON ARD L &rJEANETTA M provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one P O BOX 31 year of completion, the owner -builder will have the burden of proving that he or she did not build or, improve for the purpose of BANGOR, CA sale.). 95914-0031 ❑ 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 pursuant to the Contractors' State License Law.). Contractor: ❑ 1 am Exempt under Article 3 of the Business and Pr f Code 1 �_OC Date: ner: WORKERS' COM SATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: t ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the License #: Labor Code, for the performance of the work for which this permit is issued. ' ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Engineer: Carrier. Policy #: 1 certify that in the performance of the work for which this permit is Total Square Ft: 0 S. F. issued. I shall not employ any person in any manner so as to Valuation'' $0.00 become. subject to the workers' compensation laws of California, and agree that if 11 should become subject to the workers' Census Code: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. GU ' Date: - - � I Applicark. r ' /, F ilure to secure worker co ensation coverage is WARNINid: unlawful, all subject an employer o 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 7 code, interest, and attorney's fees. i CONSTRUCTION LENDING AGENCY This permit.' hereby issued under the applicable provisions of the Butte County -Coda anrUor I hereby affirm that there is a construction lending agency for the Resolutions t do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) ' i - By: Date: Name: PE IT XPIRES ON: ' • n 5 Address: Date ❑ 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 & 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 county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. i Print Name: sol t� N 4 cl d 1� S R.) Sig ature: i✓ / �C Date: ❑ Contractor 0--A-gent for Owner ❑ Agent for Contractor w 'i COUNTY OF BUTTE - DEPARTMENT OF WUBLIC WORKS PERMIT NO. _ 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541-- APPLICATIA AND"PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT/V/ OWNERTQC ��� TELEPHONE SO. FT. OCC, BUILDING VALUATION OW R'S MAIL NG ADDRESS CO TR CTO NAME CS�oher TELEPHO E CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER A UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 46C. ARCHITECT OR ENGINEER IN LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING DDRE 7 PLUMBING PERMIT Filin Fee 10.00 9 Each Trap 2.00 Solar Water Heater 20.00 r Water piping 5.00 LOT NO. SUBDIVISION NAME PARC MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUC RE ^�} �1 SF [:1Duplex ❑ Mobi lehome ❑ Other �l • ��- P SPECIE Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New P' Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. I DWELLI & OR ADDNS. C ACC. BL 1 Zh0Sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F]NON-RESID, I am licensed under provisions of Chapt. 9, Div. 3 of the Business d Professions Code and m license is in full force and effect. Y License 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) ❑ 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 ULT' -OUTLET 2.50 ea -RESID BRANCH CIRCUITS)- _NON NEW CONSTR. / POWER APPARATUS &)\ \SINGLE OUTLET CIR. 1 Ex. Occu 20@50C P�OUTLETS OR FIXTURES BAL0300 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate o"t to Self -Insure. shallhall 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 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the 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_ again said County in consequence of the granting of this permit. X Date O o� �.3 Signar r of Applicant — nar Contractor 11 Agent ❑ 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 $ TOTAL PERMIT FEE $ oc UP, GROUP I 7OWST. PAR L P ND , ISS This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIREC OR OF PUBLIC BY PE IT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date 4'3 Receipt No. © 2Q N Q, WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION ' 7 COUNTY CENTER DRIVE - OROVILLE, CALwORNIA 95965 TELEPHONE: 916/534-4541 . 4 - • PERMIT APPLICATION DATA SHEET Permit No. OWNER A. P. No. 0) 0 t1 co—Q/ Proposed Building Use—( �1 _�- Permit Fee Based Upon: Complete Contract Price -/6PW Valuation _— ,Ot-h �er '(Explain) Building Inspector L`� /�/� Date ' 9 -'� `�- '2 �� t j At time of permit application, I was advised_ toe following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . Plot plans in dupli•caWXtriplicate. . . . . . . . . . . =z.S— Complete plans `Hn-ft ic9ttpi/triplicate. . . . . . . . . 4. Complete engineered-ptaa;s 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 $ . . . . . . Letter of signature authorization. 1 . Sanitation approval from '7) %c�~' Health Dept. vv� u 11. Planning approval for (A) Urge: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner0, Mail to ownerE]) 15. Improvements may be required. . . . . . . . . . . . 16. Mobi lehome Installation Data. . . . . . . . •Pre-Inspec.request to 17. Pre -Inspection for Required. Building Inspector (Data` 18. Other i .y When you. issue the permit, process as follows: Mail to owner. Mail to contractor. � Telephones -'4, i� 2 and hold for pickup at office. Deliver w/inspector. Other rt--�„ .r�... Date Applicant � .* .�., .. -� 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 Plans checked by Plans aDDroved bt Other: Date Date Copy—DPW , To: Building ding Department From: Environmental. Health Sanitation Clearance te-a& �er Oon M. f Plan approved for: sewage disposal. Water supply Hold final for: dater supply? � �» Final clearance O.K. for: Water supply Clearance for _ bedroom house/mobilehome or oths= NOTE COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541 OWNER -BUILDER VERIF ICAT ION 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no)�,�. 2. I (have/have not) X 6 c�,_� 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. City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have persons to provide the work indicated: Name Address S igned : Prop Soci Date contracted (hired) the following Phone Type of Work �'s yid 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. 0 0 ,��s��e\ Inter-Departmentia` IrAemorandum FROM: SUBJECT: DATE: COUNTY OF BUTTE - DEPARTMENT OF PUBLX6/534-4541 7 County Center Drive - Orovilie, California 95965 - Telephon APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NBER % ZON NG -Is BUILDING PERMIT 07 j &lb o—o� so T�E�AHON� fj y�/ S0. FT. OCC. BUILDING VALUATION OVj(�EbS.MAI✓L_ GG ADDRESS ^ O ^ �G/• 00 X CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINE LICENSE NO. Plan Checking Fee .$ Penalty $ ARCHITECT OR ENG[EER'S MAILING ADDRESS Permit fee $ BUILDI G ADDRESS _LD S PLL&14^f j PLUMBING PERMIT Filing Fee 10.00 G% L/ A iI�TC- z� ' Each Trap 2.00 Repair drainage or vent piping 5.00 �101L_ Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF G+ Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawns 'nkler system 5.00 C LAYL/ TYPE OF WORK es ❑ �tallation ❑ Other New ❑ Addition ❑l Remodel ❑ Ut71, Describe work: �OLL /Z'2� Permit Fee $ O C) Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service e00V OR LESS 600 AMP OR LESS 5.00 Main service EA. ADD'L 600 AMP 2-.50 NEW CONST. DWELLING OCCUP.6I\ OR ADDNS. ACC. BLDGS. l 2�sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F1NON-RESID. 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 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) 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 NON.RESID P-BRANCH CIRCTITS 2.50 ea D, NEW CONST R. I POWER APPARATUS 6� \SINGLE OUTLET CIR, 50 @ zsm Ex. Occup OUTLETS OR FIXTURES BAL@1 IXEDAPPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00"- Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate r 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. Heating Cooling Hood 3.00 Ventilation permit Fee S Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot 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, Jud ts, costs, and expenses which may in any way accrue agai t said County n sequenc of the granting of this permit. G %� Date .�� O Signa �,Aof Applicant— caner on tractor ❑ Agent ❑ An 0 permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ O (� OCCUP. GROUP I TYPE OF CONST. PARCEL PD I ND I ISSUE This rmit is hereby issued under so s f the tte C unty Code and/or w k i ed abo a fos which E O�iR,OF/PUBLIC B ✓��i/y PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS p� b _Z/0 /Date% ^( 10 —17— `� Receipt No. L g 41V 9 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORM 7 County Center Drive, Oroville, CA. 95965 PHONE: 916-534-4541 Harold ,Tohnson P.O. Sox 31 RE: Bangor, CA 95914 With reference to the above subject: / / Attached is: DATE June 10, 1982 Building Permit Appin #1481-82 A. P. # 28-11-28 Application for permit Mobilehome Utilities Installation Sheet Building Plans Mobilehome installation Information Shee Engr. Calcs Typical Plan Sheet Labor Code Information List of Codes Enforced OTHER We need the following information: Permit application signed and completed where indicated with all copies returned. Fees of $ payable to Butte County Treasurer. Certificate of Workmen's Compensation Insurance or check exemption statement.' Contractors License Lac.* information or check exemption statement. Letter authorizing signature of Complete plans in including plot plans. Plot plans in Structural details in Complete plans in prepared by registered civil engineer or architect. Engr. calcs.. segs of plans in accordance with the changes marked in red. Sanitation approval from Butte County Health Department at: 196 Memorial Way, Chico 7 County Center Dr., Oroville Skyway & Elliott Rd., Paradise Planning approval from Butte County Planning Department, 'Oroville, for Copy of recorded parcel declaration. Recorded copy of deed showing 7 County Center Drive, /XXY OTHER (1) Water heater location does not comply with Uniform Plumbing Code. Relocate out of bath and/or bedroom. (2) Provide additional plans - showing sheathing, floor joist and girder size, wall framing and exterior cover. Roof framing - sheathing and roof material 1 set elevations. Should you have any questions concerning the above, please contact this office. JFG:dd (D.F.) Yours very truly, Clay Castleberry Director of Publi Works Glan er Chief Building Inspector COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE MIT / g 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT a,,r„� - / Q* ASSESSOR PARCEL NUMBER 28-7.1-28 ZONI G A- BUILDING PERMIT OWNER HAROLD JOHNSON TELEPHONE 679-2320 SQ. FT. OCC. BUILDING VALUATION 1st Renewal OWNER'S MAILING ADDRESS P.O. Box 31 Bangor, CA 95914 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER None UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee 2 of Original p $ 87.00 ARCHITECT OR ENGINEER None LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ 97.00 BUILDING ADDRESS 300' off NIS LaPorte Rd, app 600 E of Pleasant PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Grove, Bangor Solar Water Heater 20.00 Water piping 5.00 LOT NO. TUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SFEN Duplex[] Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I W 10.00e TYPE OF WORK New F-1 Addition El Remodel[:] utilities[:] Installation❑ Other Describe work: 1st Renewal of Permit #1481-82- Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 000V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. I DWELLING OCCUP.� OR ADDNS. % ACC. BLDGS. I 21/20saft _ CONTRACTORS LICENSE LAW i I declare under penalty of perjury (Check one): I ❑ 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 ❑ 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) ❑ 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 ULTI.OUTLET 2,50 ea NON-RESID BRANCH CIRCUITS) NEW CONSTR.POWER APPARATUS .&) NON-RESID• SINGLE OUTLET CIR. Ex. OCCUpt,OUTLETS OR FIXTURES DAL@90Q FIXED APPLN5. OR EX. Occup. OUTLETS (RESID•I EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE 1 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. 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 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 Date Signature of Applicant — Owner ❑ 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 $ TOTAL PERMIT FEE $ 97.00 OCCUP. GROUP I TYPE OF CONST. PARCEL PO HD IBSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By �IDate PERMIT EXPIRES Date 6-1 • -84 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT d ! COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORK PERMIT N0. _ 7 County Center Drive - Oroville, California 95965 - Telephone 916/53 4541 APPLICATION AND PERMIT ASSF`SSOR"PA CEL UMB R �g _ �J_ --- ZO ING r, BUILDING PERMIT N9601 y� —0�/ S,jv9 079601,b ��Nf,r tet% BUILDING VAL ION �Q.FOCC. OW �E0 MAI��G (gyp DR\EJ. j,-�'�Lt/J �f CONTRACTOR'SNAME 11 TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace Or.a-1 CONSTRUCTION LEND R UNKNOWN Total Valuation $ O, Filing Fee 10.00 LENDER'S MAILING ADDRESS dm Permit Fee $ -va ARCHITECT OR EN -GI NEERENSE NO. Plan Checking Fee $, Ov Penalty $ ARCHITECT OR ENWINEER'S MAILING ADDRESS Permit fee $ .00 BUIL ING ADDRESS �C cJ � 49016,• /000 PLUMBING PERMIT Filing Fee 10.'00 - O Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping eQ� LOT NO. SUB IVISION NAME A r PARCEL MAP Each gas water heater or vent 5,00 t Gas piping system 1 - 5 outlets USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Building sewer 5 0 V Lawn sprinkler system 5.00 _ --� TYPE OF WORK New Addition❑ Remodel❑ Utilities [I Installation[] Other❑ Describe work: Permit Fee $ , 00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service DOOV OR LESS 100 AMP OR LESS Main service EA. ADD'L 100 A 2.50 Q, O NEW CONST.DWELLING OC OR ADDNS. ( ACC. BLDGS. ` / ♦ 6sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑NON-RESID, 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business50 and Professions Code and my license is in full force and effect. License 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) ❑ 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 .OUT LET 2,50 ea NON-RESID BRANCH CIRC ITS NEW CONSTR (POWER APPARATUS & (SINGLE OUTLET CIR. @ 23Q Ex. OCCUp OUTLETS OR FIXTURESBAL@1 Ex. QCCUp.�OFIXED PLNS R UTLETS (RESID )EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT FiIirig Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): The permit is for $100.00 (valuation) or less. f have placed on file with the County of Butte Building Department Certificate of Workmen's Compensation Insurance or a Certificate Consent to Self -Insure. shall not employ any person in any manner so as to become subject o 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 WOOD Cooling „(Qa Hood 3.00 00 Ventilation Permit Fee 7, 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 of 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 equence of the granting of this permit. X �, �� Date Signature of Applicant — Owner ❑ 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 $ . 90 TOTAL PERMIT FEE $ , OC CUP.. GROUP I TYPE OF CONST. PARCE PD -A Issu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIR TOR OF ELIC By PERMIT EXPIRES Date _ the applicable provi- resolutions to do fees have been paid. WORKS t e Receipt No.3 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT 'Returnto . DPW • , AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8.1 of the Butte. County Code requires this acknowledgement E9Jl ba—re^ cd prior to issuance of a building permit. , c.0 Hr" • � DY1 The. property described herein is adjacent to land or included JUS within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort arising ELEANOR MDE from the .use of agricultural chemicals, including, but not limited to tib i , F pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occa- sionally generate dust, smoke, noise,'' -and odor. Butte County has established -agricul- tural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All' thdt real pruNarLy rjLLurtl-s- fit L•lut (:4)m%l y +,I' It'll: 1 r.., :.11:ghc oi: Cn11LnPFii_q. descried as follows: Lot 57, according to that certain Map entitled, "BJ1KM TRACT, UNIT ND. 1",:,Ohich Map tM filed in'.the office of the Pacozder of the Oounty of Butte, state of r ' California, September 251. 1911, in Map Book 7, page.50. A� �'.. �j# Date 6/.3/82 --= PROPERTY OWNERS: Ilk California June 82 State of ) On this the 3 'day of 19 , ! ) SS. before me, the undersigned Notary.N.blic, personally, County,of Butte ) appeared Harold R. Johnson and Jeanette Johnson known to me to be the person(s) whose name(s) subscribd to the within instrument and acknowledged OFFICIAL SEAL T ' that executed the same for the purposes BETTY ANN SENTNER + s�therein contained. NOTARY PUBLIC - CALIFORNIA 3UT1E coin .r IN WITNESS WHEREOF,' I .hereunto set my hand and official Mly comm expires Y ?',, 1 Pr seal: + ota Public Betty'Ann Sentner Present A.P. NO. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET Permit No. p OWNER �JW � ) JJv�50"/ A. P. No. �D Zf Proposed Building Use, Permit Fee Based'Upox: / Complete Contract Price 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. . . . . . . . . . . . 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. S. Fees of $ . . . . . . . 9 � Letter of signature authorization. 3/�. Sanitation approval from A -_ Health Dept.. 1sPlanning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. 1 Contractor's License Information (no., name�.s-,tyyl/class if.) �� 4. Owner -Builder Verification (Given to ownerLl'; Mail to ownerEl) 15. Improvements may be required. . . . . . . . . . . . 16. Mobi lehome Installation Data. . . . . . . . . . . 1�Pre-Inspec. request to (Date)-, Pre -Inspection for `` //&Required. Building Inspector 4 18. Other' Ei. aC., Whenyo ssue the permit, process as follows: Mail to owner. Mail to contractor. 7t/Telephone 67 Z'370an old jor pickup at office. Deliver w/inspector. Other i Applicant Copy of ,plans sent Hea'Ith Dept., Fire Dept., Other Date SIburing 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 Bye, /1) Date Plans checked by Date Plans approved by ZZ Date r Other: Other �/ Copy—DPW I To BulUdIng #Depkrt.ment From, Hcaalth Su -b je * : Sanita=rion. Clearance wiz r - °.�" +' a=3 oF :Flan appro ,ed ..for -. 1 sewage disposal vrater supply Hold final for: ! Wat-sr supply Final. clearance O.K. fo2l :learan e fors.bedroom � �oms� Other — vraaae.9�sastw»aarnvi '�asl�rTMrrn#mx �A�ssiueawaew•r�e�w+rr. af5•auwc'sao4uwsa�ws�raavarunvf. Clearance. for addition of water supply Date To: Building Oepar`ument Y 1 From: �°_nvir.or�r;�enc,=.l Health �o r cS � � ^ „_• . Cc,�� G J dl Subject: Sanit1zti o Clearance S aC 0::r_er Location - - 10:V Plan Vpprotired for: Se?,raoe disposal - crater supply Hold final for: water supply Final clearance. O. K. for: crater supply Clearance for (2,,, bed.room tdJ� home. Other P•VOT✓}1 E AZLJ.- & F Sanitarian Pate Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT 8i�"1V64� FOR RESIDENTIAL DEVELOPMENT • 0CFIG'A'_ kE' i)ii Jzz Section 26-8.1 of the Butte County Code requires this acknowledgement bg_Xecorded prior to issuance of a building permit. Ilk as �� The property described herein is adjacent to land or includedS� U 7}� within an area zoned for agricultural purposes, and residents of { this property may be subject to inconveniences or discomfort arising EL�iNOR M.cCKCR from the use of agricultural chemicals, including, but not limited to t��ieROER pesticides, and fertilizers; and from the pursuit of agricultural operations including, EE but not limited to cultivation, plowing, spraying, pruning, and harvesting which occa- sionally generate dust, smoke, noise, and odor. Butte County has established agricul- tural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. .-__All that real property situate in the County of Butte, State of California, described as follows: Date: 6/3/82 State of California ) On this the 3 day of June 19 82 , Butte ) SS. before me,'the undersigned Notary Public, personally County of ) appeared Harold R. Johnson and Jeanetta Johnson Wil, a known to me to be the person(s) whose name(s) subscrib d to the within instrument and acknowledged 7NOTARY OFFICIAL SEAL that executed the ' same for the purposes BETTY ANN SENTNER �am�s , • PUBLIC - CALIFORNIA therein contained. Bi1TTE COUNTY IN WITNESS WHEREOF, I hereunto set my hand and official 4y comm. expires JAM 24, 1986 e� seal. otary Public Betty Ann Sentner Present A.P. NO. 1111 END OF DOCUMENT-;, California, t 57, according to that certain Map entitled, "BANODR TRACT, UNIT NO. 1", which p was filed in the office of the Recorder of tie County of Butte, State of Septenber 25, 1911, in Map Book 7, page 50. COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541 OWNER -BUILDER VERIF ICAT ION 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) �. 2. I (have/have not) Jsigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed constructAo�, Y Address City, Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the,following person to coordinate, supervise, and provide the major work: Name 5. Address City Phone Contractors License No. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Signed: Property Owner , Social ecurity number Dater_ -4.- OR- r 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. Return to DPW sz-16956 AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR RESIDENTIAL DEVELOPMENT OFFjr:A._ Section 26-8.1 of the Butte County Code requires this acknowledgeme �Or)Ri35 Rn` '� be recorded prior to issuance of a building permit. 0 8 9 38 QV 1 � The property described herein is adjacent to land or included - within an area zoned for agricultural purposes, and residents of ELEANOR N.BECKER CLERK- RECORDER this property may be subject to inconveniences or discomfort arising EE from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occa- sionally generate dust, smoke, noise, and odor. Butte County has established agricul- tural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: Lot 21, as shown on that certain map entitled, "PARADISE` PINES UNIT 11", recorded in the office of the Recorder of the County of Butte,State of California, on December 17, 1970 in Book 38, pages 17, 18 and 19. EXCEPTING THEREFROM, all minerals, oil, gas, asphaltum and other hydrocarbon substances, with provision that any and all mining operations shall be done from orifices outside the surface area of the land described herein and that no damage shall be done to the surface of said land. Date: June 4, 1982 OWNERS: Z7 State of Calif. ) On this the day of lg SS. before me, the undersigned Not Public, personally County of Butte ) appeared Harold C. Johnson and Josephine R. Johnson known to me to be the person(s) whose name(s) are JANtCE L. JENSEN subscribed to the within instrument and acknowledged NOTARY PUBLIC ,i 4 that th P executed the same for the purposes Butte County therein contained. State t California IN WITNESS WHEREOF I hereunto set my hand and official M �orYitYiis9fon Expires Aug. 2, 1982�.� seal. Notary Publi Present A.P. N0, END Or DOCUtv',,FN3 tv R