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HomeMy WebLinkAbout028-250-01511 28-25-15 ROBERT WILLIAMS S/S Los Verjeles, 4/ mi SE Laporte Rd, Bangor fA� 1 Permit#282'1-84B(reroof/S� a 028-250-01.5 06-0046 13-ROWN, LYNN 1.72 LOS VERJE.LES .RD, BANGOR' Cont: O\VN ER AG BUILDING r IN. ---Io F(C�Z: i u� l BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds r 4 ; PROJECT INFORMATION Site Address: 172 LOS VERJELES RD Owner: Permit No: B08-1062 APN: 028-250-015 LYNN BROWN Issued Date: 06/06/2008 By KCG Permit type: MISCELLANEOUS 172 LOS VERJELES RD Subtype: Permit to Complete BANGOR, CA 95914 Expiration Date: 06/06/2009 Description: DET GARAGE: REPLACES BP06-1( (530) 679-0263 Occupancy: Zoning: U Contractor Applicant: Square Footage: ALLAN DINGMAN ALLAN DINGMAN Building Garage Remdl/Addn PO BOX 767 PO BOX 767 WINDSOR, CA 95492 WINDSOR, CA 95492 Other Porch/Patio Total (707) 292-7371 (707) 292-7371 ;, �-�,;,._ . FEE INFORMATION DBOMSC Supplemental Inspection $329.94 9-j2!, LICENSED CONTRACTOR'S',DECLARATION Contractor (Name) State Contractors License No. / Class / Expires ALLAN DINGMAN 323738 / B A / � -3-,09' I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Diviatun 3 of the Business and Professions Code, and my license is in full force aodaffett. I• 1 Contractors Signature Date IB ��l,-i�WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier: Policy Number: Exp. Date: _ (This section need not be competed if the permit is for one hundred dollars ($100) or EI CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. X 06/06/2008 Signature " l/ Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State Zip ees Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500); Please check one of the following: ❑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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: ix 06/06/2008 Owners Signature Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnity, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or a ulh rized to act on the rop y owner's behalf. i - � a4 A, >, &4 ,&A6&612008 Name of Permittee [SION] Print Date Owner Contractor OR. FlAgent for Owner ❑Agent for Contractor FILE COPY �V T TFBUTTE COUNTY PERMIT 0 o DEPARTMENT OF DEVELOPMENT SERVICES NO. ° ° BUILDING PERMIT APPLICATION. 0 o OFFICE #: (5')0)5')8-7541 FAX #: (530) 538-2140 c - 3 -ab- c A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: w. rw.buttecounty.net/dds B # **PLEASE PRI T CLEARLY** OWNER 1N Last Name First Name Mailing Address City Phone x'37 Phoney Fax E-mail FORMATION P86JECTLOCATION /72 Zos VrfT&75� aye %IrU �l/,rin. q6q( I CONTRACTOR Name . Nift-, ®� Address A City W.�J'G/z State Zip Z Phone x'37 FaxO�, 00 E-mail Lic. #32373,9_ 2 3 � Class R=l ARC/H/ITECT/ NGIN ER Name �1/ 7�✓ / /� Dek [� Address State City / / PhoneM S ��G`6� tate Zip Fax E-mail State License Nu APP CANT INFORMATlO Name' Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X 1 Ifh gi o pen: S COMPENSATION it thy, licen c rs, a certificate of worker's be shownat t&d o ermit issuance. L)ENDI GIAGENCY DESCRIPTION OR SCOPE OF WORK: Zoning Flood Zone FCo4 %6 2022 es No Sq FT- Living Gaya�e Opp ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use'): For office use only: Zoning Flood Zone SRA es No Occ. , Type Const. 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) 538-2140 Fax www.buttecounty.net/dds PERMIT APPLICATION DATA SHEET Reference Number: B07-1673 Date: 08/02/2007 Location: 172 LOS VERJELES RD Parcel Number: 028-250-015 Owner Name: BROWN, MARY LYNN By: TMP Sub Type: SFD-Custom/Model Phone: Description: NSF 1276 SO.FT./ COV. P. 532 SOFT. The above permit application has the following Clearances required prior to permit issuance. Please contact each department indicated below regarding specific requirements pertaining to your permit application. Yes No DRAINAGE DISTRICTS ❑ ❑ Thermalito Irrigation District, 410 Grand Avenue, Oroville CA 95965 - (530) 533-0740 ❑ ❑ LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 533-2000 ❑ ❑ City of Chico, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 I■ ■ 7 ■ PARKS & RECREATION DISTRICTS Chico Area Recreation District, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 Durham Park & Recreation District, 9447 Midway, Durham CA 95938 - (530) 345-1921 Feather River Recreaction & Park District, 1200 Myers Street, Oroville CA 95966 - (530) 533-2011 Paradise Parks & Recreation, 6626 Skyway, Paradise CA 95969 - (530) 872-6393 SCHOOL DISTRICTS Biggs Unified School District, 300 B Street, Biggs CA 95917 - (530) 868-1281 Chico Unified School District, 1163 East 7th Street, Chico CA 95926 - (530) 891-3006 Durham Unified School District, 4920 Putney Drive, Durham CA 95938 - (530) 895-4675 Gridley School District, 429 Magnolia, Gridley CA 95948 - (530) 846-4723 Marysville School District, 1919 B Street, Marysville CA 95901 - (530) 741-6000 Oroville Elementary School District, 2795 Yard Street, Oroville CA 95966 - (530) 532-3000 Oroville Union High, 2211 Washington Ave, Oroville CA 95966 - (530) 538-2300 Ext: 105 Paradise Unified School District, 6696 Clark Road, Paradise CA 95969 - (530) 872-6400 OTHER Recorded copy of Agricultural Acknowledgment Statement- See Attached Instructions City of Other: Other: ❑ ❑ Other: Signature of Property Owner: Date: 08/02/2007 FILE BUTTE COUNTY FEE SUMMARY Printed: 08/02/2007 7 County Center Drive 1:25 pm Oroville, CA 95965 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Permit Number: B07-1673 Job Address: 172 LOS VERJELES RD Contractor: ALLAN DINGMAN PO BOX 767 WINDSOR, CA 95492 Fee Description Account Number Fee Amount Paid Date Pmt Amt CWIF SF CWIFFIREVE SF 1851-0-280-1011853 $707.16 CWIFFIREF SF 1851-0-280-1011852 $366.35 CWIFPWRDS SF 1831-0-280-1011001 $1,337.55 DB R3 Dwelling -Custom, Model DBF DWLNG CSTM/MDL N Plan Rvv 0010-440001-4210500-1010 $1,003.51 08/02/2007 $1,003.51 DBF DWLNG CSTM/MDL N Permit F( 0010-440001-4210500-1010 $1,505.27 DBEH Building Review Fee 0021-540013-4614901-1010 .$75.70 08/02/2007 $75.70 DBFIRE Fire Inspection (SRA) 0100-450001-4617240-1010 $102.70 0100-450001-4617240-1010 $102.70 08/02/2007 $102.70 DBOMSCF Fire Safe Standards Re 0010-440001-4210500-1010 $115.98 DBFIRE SRA Fire Plan Review (S 0100-450001-4617240-1010 $102.70 08/02/2007 $102.70 CWIFAUD Impact Processing Audi — 0010-050-4617998-101001 $50.00 CWIFDDS Impact Processing Fee 0010-440001-4617999-1010 $50.00 CWIF SF CWIFGGF SF 1808-0-280-101001 $664.81 CWIFGGVE SF 1810-0-280-101001 $306.61 CWIFLBRYF SF 1825-0-280-1011826 $240.89 CWIFLBRYM SF 1825-0-280-1011827 $162.04 CWIFSHERFJL SF 1800-0-280-1011811 $288.00 CWIFLBRYV SF 1825-0-280-1011828 $4.83 CWIFSHERFF SF 1840-0-280-1011841 $312.99 CWIFSHERFVE SF 1840-0-280-1011842 $152.72 DBSMIP Residential 1001-0-280-1011298 $9.15 Printed By: Tammie Powell 79661.66 $1,284.61 Balance Due: $6,377.05 At the time of permit application, I was advised the above fees are required prior to issuance of the permit. These fees mmay change during the plan checking process. V/ zl�— I Signature: Date: 08/02/2007 Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a protest are specified in Government Code Section 66020(a). Butte County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 95965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds 0 .0 0 0 0 trc wak`�`` National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-1673 Date: 08/02/2007 Location: 172 LOS VERJELES RD By: TMP Parcel Number: 028-250-015 Owner Name: BROWN, MARY LYNN Description: NSF 1276 SQ.FT./ COV. P. 532 SQ.FT. Sub Type: SFD-Custom/Model Phone: By signing below, I the project owner/owners' 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 buildouts 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 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 this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or other santions provided by law. Signed: 'a;� Title: FILE Date: 08/02/2007 California Department of Forestry and Fire Protection Butte County Fire Department Fire Prevention Bureau 176 Nelson Avenue, Oroville CA 95965 (530) 538-7888 Office, (530) 538-2105 Fax Reference Number: B07-1673 Date: 08/02/2007 Location: 172 LOS VERJELES RD By: TMP Parcel Number: 028-250-015 Sub Type: SFD-Custom/Model Owner Name: BROWN, MARY LYNN Phone: Description: NSF 1276 SO.FT./ COV. P. 532 SOFT. To meet the requirements of Government Code section 51182 and Public Resource Code 4291, Butte County requires a pre -construction inspection to pro -actively provide the below building and site requirements to the property owner. Your property is located within the State Responsibility Area (SRA) of Butte County. SRA is required to meet the below requirements: ✓ Public Resources Code 4290 ✓ Public Resources Code 4291 ✓ California Building Code, Chapter 7A ✓ Butte County Improvement Standards Requirements prior to scheduling the pre -inspection: ✓ Full plan submittal to Butte County Development Services -Building Division ✓ Driveway and building pad must be identified on site ✓ Structure location must be staked out on the building site All development within the Requests for inspections shall be made a minimum of 72 hours in advance by calling the Fire Prevention Bureau's 24 hour inspection line at (530) 538-6837, ext. 169, (When the recording comes on, enter the extension number). For the pre -inspections, the property owner or authorized agent is required to meet the inspector at the construction site with two hard copies of the site plan. I have read and understand the above pre -inspection requirements. 08/02/2007 Date Rev'd 5/7/07 ft�__ � Signature All of the Fire Safe Requirements are posted on the Butte County Fire Department website at http://buttefire.org/Fireprevention/protplan/prott)lan.html FILE 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) 538-2140 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. O Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municit)alcodes.lexisnexis.com/codes/butteco/ Reference Number: B07-1673 Location: 172 LOS VERJELES RD Parcel Number: 028-250-015 Date: 08/02/2007 Owner Name: BROWN, MARY LYNN Phone: Description: NSF 1276 SQ.FT./ COV. P. 532 SQ.FT. Signature of Property Owner: Date: 08/02/2007 FILE BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION_ Site Address: 172 LOS VERJELES RD Owner: Permit No: B07-0340 APN: 028-250-015 BROWN, MARY LYNN Issued Date: 02/22/2007 By GLB Permit type: MISCELLANEOUS PO BOX 163 Subtype: Electric Panel BANGOR, CA 95914 Expiration Date: 02/22/2008 Description: ELECTRICAL PANEL UPGRADE Occupancy: Zoning: U Contractor Applicant: Square Footage: ALLAN DINGMAN ALLAN DINGMAN Building Garage RemdUAddn PO BOX 767 PO BOX 767 WINDSOR, CA 95492 WINDSOR, CA 95492 Other Porch/Patio Total (707) 292-7371 (707) 292-7371 FEE INFORMATION DBE Single Phase Service-Resid $55.00 Total Charged: $55.00 Fees Paid: $55.00 Balance Due: $0.00 Receipt No: B1927 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License ALLAN DINGMAN 323738 / B A / 11/30/2007 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div' 'on 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and a ect. ' of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 02/22/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractors Signature Date ❑ 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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: HAVE AND the work himself or herself or through his or her own employees, provided that such improvements WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR E]I are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; The Contractors License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Cartier. Policy Number. Exp. Date: (This section need not a completed if the permit is or one hundred dollars ($100) or less. ❑ 1 AM EXEMPT under Section B. & P.C. for this reason: ❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers'X 02/22/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owners Signature Date provisions. X 02/22/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS $100,000 IN ADDITION TO THE COST OF COMPENSATION, ( ) including death, and property damage caused arising out of, or in any way connected with , DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the is the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the t is use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the props own r r am auth=rTfte property owner's behalf. CONSTRUCTION LENDING AGENCY 02/22/2007 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Permittee [ GN Pri Date the performance of the work for which this permit is issued. (3097 civ, code) Owner 11 Contractor OR E]Agent for Owner ❑Agent for Contractor FILE COPY Lenders Address City State Zip UTr BUTTE.COUNTY PERMIT o Fo DEPARTMENT OF DEVELOPMENT SERVICES NO. `i 0 o BUILDING PERMIT APPLICATION U 0 o OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 o `—�� o A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttetounty.net/dds BIN # c�UN'�y **PLEASE PRINT CLEARLY** OWNER INFORMATION Last Name (� I &/ First Name Mailing Address City ��� t7 State LJ� Zip /. l (� Phone. Fax E-mail CONTRACTOR Name Address /DD I�UX 76 % City/. 1 khdA State C# Zip Phone70-2 , 7a, 73 7/ Fax -7v7 • fi%6� 7 DO E-mail qd/ AI, 60,W Lic. # 2;�3 Class PROJECT LOCATION API .p% r� -O/S— Property Address / Os, / /. City Ole h V WORKER'S COMPENSATION Policy Nu b 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 SCOPE OF WORK: NEV 01,P C)I'A CLEC e Sq FT- Living Garage Open Cov ❑ • Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA Yes APPLICAAVT SIGNATURE Occ. Type Const. X ^ No ARCHITECT/ENGINEER Name Address City State Zip Phone Fax E-mail State License Number PROJECT LOCATION API .p% r� -O/S— Property Address / Os, / /. City Ole h V WORKER'S COMPENSATION Policy Nu b 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 SCOPE OF WORK: NEV 01,P C)I'A CLEC e Sq FT- Living Garage Open Cov ❑ • Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA Yes APPLICAAVT SIGNATURE Occ. Type Const. X ^ No APPLICANT INFORMATION Name _9,0x1119 L Address City State Zip Phone Fax E-mail PROJECT LOCATION API .p% r� -O/S— Property Address / Os, / /. City Ole h V WORKER'S COMPENSATION Policy Nu b 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 SCOPE OF WORK: NEV 01,P C)I'A CLEC e Sq FT- Living Garage Open Cov ❑ • Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA Yes APPLICAAVT SIGNATURE Occ. Type Const. X ^ 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 NO. 0��04� Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to ouse arm 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. <�<e- as o - o1A ZONING OWNER PHONE NO: OWNER' A RESS U - 1 tN `'l LOCATION OF BUIDING s 156aL, 'USE OF BUILDING r r & SIZE OF STRUCTURE 2 ((op y'X'=SO. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL CONCRETE OTHER (Specify) TYPE OF SIDINJ Woo ROOF CO ERI G FLO R TYPE �� ESTIMATED COST OF CONSTRUCTION $ 0CIO ,GU AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as follows: o � ` trmjyy;m ISO nlfhif4l al PD/ InfovIn 90 ) FRONT SIDES - 921 REAR ``I&t!r 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 G Signature of Owner AA Permit Fee -$109.98 The above described AG Building is exempt from a building permit. FLOOD PARCEL PE D. i ROOFING ISSU Receipt No.�, (J ✓ +/ V/ Manager B din ivision B Date White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod —Applicant BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds OWNER ALLAN DINGMAN 9693 WARNER VALLEY RD CHESTER, CA 96020 (707)292-7371 Building Garage Remdl/Addn 576 Other Porch/Patio Total 576 FEE INFORMATION PROJECT INFORMATION $329.94 Site Address: 172 LOS VERJELES RD SMIP - Residential Owner: SRA Fees Permit No: 06-1621 APN: 028-250-015 LYNN BROWN Permit type: MISCELLANEOUS 172 LOS VERJELES RD Issued Date: 11/06/2006 By KCG Subtype: Private Garage/Shop BANGOR, CA 95914 Expiration Date: 11/06/2007 Description: GARAGE(DET) (530) 679-0263 Occupancy: Zoning: OWNER ALLAN DINGMAN 9693 WARNER VALLEY RD CHESTER, CA 96020 (707)292-7371 Building Garage Remdl/Addn 576 Other Porch/Patio Total 576 , t LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires OWNER I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 11/06/2006 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier: Policy Number: Exp. Date: (This section need not be competed if the permit is for one hundred dollars ($100) es—or s ) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. A-,% _ I X L�ll,�%J 11/06/2006 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. :,. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lender's Address City State Zip Total Charged: $756.26 Fees Paid: Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: ®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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). El1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors License Law claws not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason:_ 11/06/2006 Owner's Signature 14' Date hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. 1 hereby certify that I am the propelly owner qs arp%uthorized to act on Oe property ovmees behalf. ❑ Owner ❑ Contractor OR:Agent for Owner OAgent for Contractor FILE COPY FEE INFORMATION Fund 10 BLDG $329.94 Garage - Wood Frame $329.94 SMIP - Residential $1.38 SRA Fees $95.00 , t LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires OWNER I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 11/06/2006 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier: Policy Number: Exp. Date: (This section need not be competed if the permit is for one hundred dollars ($100) es—or s ) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. A-,% _ I X L�ll,�%J 11/06/2006 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. :,. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lender's Address City State Zip Total Charged: $756.26 Fees Paid: Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: ®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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). El1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors License Law claws not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason:_ 11/06/2006 Owner's Signature 14' Date hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. 1 hereby certify that I am the propelly owner qs arp%uthorized to act on Oe property ovmees behalf. ❑ Owner ❑ Contractor OR:Agent for Owner OAgent for Contractor FILE COPY 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 OFAPPLICATION Website: www.buttecounty.nettdds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name /w irst Name � w Address L / R� City BIL -6d2 State Com` Zip q5-9/ Phone Fax o- 79-0 63 E-mail APPLICANT INFORMATION CONTRACTO Name Address Zip'�6_'O2a City Fax State Zip Phone LENDING AGENCY Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name Cdyl�•lshi Address Zip'�6_'O2a City Fax State Zip Phone LENDING AGENCY Fax W E-mail State License Number APPLICANT INFORMATION Name Address Cdyl�•lshi StateC#- Zip'�6_'O2a Phone167-7 7/ Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning I Flood Zone Property Address�•. / 7.2 G,1' ,�AUIL� SRANo Cross�Street L Occ• I Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: uv CK r*UK )ut5M1I IAL REQUIREMENTS U KAFORM BUILDING FORMS1BldgApplSubRgmts.doc Page 1 of 3 PERMIT vc- BIN #„ PROJECT LOCATION Property Address�•. / 7.2 G,1' ,�AUIL� Cit�j %bio Cross�Street L 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 Rescri tion or Scope of Work: Sq FT- Living Garage Open 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 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: Q r Receipt V5�0�6 Date:✓) t rip I (k Amount: D19- 1� Bldg ` SRA Sheriff SMIP MAI 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 paperl ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) gR 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 AIC 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 bidgs: (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. 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). -0_._.__._4_NPDESForm_.._.__..___.___..---._...._...____...-:--.--._...:...-----.--_.------._.__..._.__.._.._.___._._:__.._..._._._..__.__..-.-..__----.--.---_.--.._.___ ❑ 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 Carder 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 fe-es-for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSMILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 3 REV 8-12-05 ��'� .-;fir �:f• -.^+.-'�, .-� r.. .:'�W'?"tiEti.:IJriaw•'�.t1:�,. �r�+�l,.�:.:� .,Yx+v-�A•-j X'�. .:tr4.s'�'ri.�V�4'+fi�:�r1`i �:r,.>"`�'�iRasF'.in-`e�Mr�.7s•-.^i eJ'c-v .li'" a COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA .95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT'APPLICATION DATA -SHEET OWNER: Y\ ASSESSOR PARCEL NUMBER _ Com_ .g Proposed Building Use: rl C Permit Technician: Date: �O Items required in order to apply for a permit. II boxes�MUST be checked OR marked NA in order -to apply. 1. Site plans, 3 or 4 sets, signed by t 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 Reirnaiging items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 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 ........................................... O> ; Erosion Control Plan Required........................................................................ rr Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 20. City of Chico Plumbing permit........................................................................ Z 4Site plan and business license approval from the Cit,of Biggs.:.......... California Department of Forestry plan approval Laid. Send �R.... / Planning approval for (A) Use: (B) Parking: (C) Parcel Chec :......7. C9 ❑f5_1 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ...................... 26. NPDES Form ..... :...................................................................................... . 2 Encroachment Permit for driveway from the Public Works Dept.........................*f ❑ . Contractor's license information. (Number, Name Style, Classification) ................... ❑ 90. Worker's Compensation Carrier and Policy Number/ ........................................ _ . Owner Builder Verification (_Given to owner, ✓Mailed to owner) .......... 0./ .. ..�]- Letter of Signature authorization............................................................:....... Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 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 Telephone _ \�� • and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant: ALL Date: / ' lJ " V r 1. Index permit application for the e mid' b Plan Check Letter 2, Additional items re- Contractor, design - as vise of the a p e, ail, ❑counter, Date: ,2_ Contractor, designer, owner, was advised of the above data by ❑ pho e, ❑ mail, ❑ counter, by Date: Contractor, designer, o advised of the abov dat by ❑ phone, ❑ mail, ❑ co at Date: Plans reviewed by: Date: G Plans approved by: Date: - Ob 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 :.r TO: Building Division = Development Service�s,.r pw^ SERVICES . FROM: Environmental Health SUBJECT: Sanitation Clearance Plot Plan Attached Floor Plan Attached Sent to BD/DS / -7-7- o co LM v^ '707 -,d -901 --?37/ t Owner Location AP# Plan Approved for: Sewage Disposal: � Water Supply: Public Private Wel Clearance for dwelling. Other s— ( X Z Y (Atn 0 ! -- N11 .a)1A ^—h ) v Hold final for: Final clearance O.K. for: NOTE: EnMnmental Health Specialist Building Clearance 9/2005 I �11 —'T----��_. Date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner BROWN, LYNN APN No: 028-250-015 Permit Type: Subtype: App Date: 7/6/2006 Permit No: BP 06-1621 Permit Desc: 1 1_7�1 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION Plan Check portion of Permit Fee 2 FEMA Yes Flood Elevation Review $109.98 3 SRA* Rx Yes Fire Plan Check - Non -Refundable $95.00 (State Responsibility Area) Building Inspection $109.98 NON-REFUNDABLE portion of fees due at application $549.90 $219.96 $329.94 Balance of Building Permit Fee 0 $95.00 $204.98 $109.98 $314.96 FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $424.94 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $331.32 $329.94 $1.38 RECEIPTDATE Tech/Asst Q6(- 4 5 6 7 7a 8 9 10 Balance of Building Permit Fees (from No. 1 above) SMTP* - Strong Motion Instrumentation Program (Enter amount from permit system) Additional Plan Check Fees (NON-REFUNDABLE) Other*: Other*: MYAG 11•tt5 - Kt51UtN I IAL` RECEIPT DATE Tech/Asst � Per Dwelling Per Dwelling 4pplications After 04/15/06 ,c SFD MFD County 4249.11 3183. Chico Urban Area 6146.23 4538. EI Medio Fire District 3249.97 2385. North Chico Specific Plan A SR -1, SR -3, SR-1/PD I 8801.09r 7395. �c R-1 0 ° 8897.09 7491. R-2 1 8390.091 6984. R-3 1 7604.091 6198.041 Processing Fee is automatically added to impact fee total 0 WATER TENDER FEE (Not collected when impact Fees Applicable) Enter Bat.# DRAINAGE FEES* CHICO STORM DRAINAGE 770 Butte Creek Per MH 3238.72 5648.44 2422.68 8486.40 RECEIPT DATE Tech/Asst � 8582.40 8075.40 7289.40 $100.00 $200.00 10a 11 11a MASTER PLAN 771 Comanche Creek $8,341 RECEIPT DATE Tech/Asst New Construction, vacant land, on 1 acre or less - Enter 1 or less acre value 772 Little Chico Creek $9,088 773 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* 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:a&'�Q Date: '74-a Pursuant to Government code Section 66020, you Whereby 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 c BUTTE COUNTY FEE SUMMARY 7 County Center Drive Oroville, CA 75965 Printed: 11/02/2006 1:41 pm • Department of Development Services • • Phone (530) 538-7541 , Fax (530) 538-2140 cov NIS �N4 Permit Number: 06-1621O� Job Address: 172 LOS VERJELES RD Contractor: OWNER Fee Description Account Number Fee A unt Paid Date Pmt Amt Garage - Wood Frame Plan Check 0010-440001-4210500-1010 k' $219.96 SRA Fees $95.00 07/06/2006 $95.00 $329.94 07/06/2006 $329.94 SMIP - Residential 1001-0-280-1011298 $1.38 646.28 Printed By: Tammie Powell Balance Due: $424.94 At the time of permit application, I was advised the above fees are required prior ro issuance of the permit. These fees may be changed during the plan checking process. Signature: Date: 11/02/2006 Pursuant to Government code. Section 66020, you are herby notified those items listed above may been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a protest are specified in Government Code Section 66020(a). .32 2006-0040695 AND WHEN RECORDED MAIL TO: Recorded I REC FEE 7.00 Official Records BUTTE COUNTY BUILDING DIVISION Bu Count? e I of I MWOM COPY 1.00 7 COUNTY CENTER DRIVE CANDACE t 6Rl1BBS I OROVILLE, CA 95965 County Clerk-Recorderl I I CW f 02:52PN 08 -Aug -M I Page 1 of 1 IIIIIIIIII�IIiIiIIIIIIIIIIIIIIIIII i AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations I including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, (J,J smoke, noise, and odor. Butte County has established 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: LC4 (OL(I a-5 sktowv, DO --16,4 e ¢.e4z& I, (kir "-ii'(.cj , /'Tows, + "uY-'', - Ld tr +kL (�''�►ce '-� lie_ Cr »� (2�'�� ' &44- Ca+1 ,C�.i;�1a.� 0,1111a.cG, 2-(, (� 01 ig°ok. -1, + (/hA-lo6, o-4 Poj�f-q) ,-'' ` 6--4 �e�4 vCAb� (1 Y°`" -'2570 -0 1 S Date IF - PROPERTY OWNERS: / I i State of California ) County of al7�ee ) On 1&100'407(110' before me, / 116jA2 �GIiB/jf�ii✓� �I/47��Zy �L/��jG personally appeared /yo24 y,A,✓ QDeo`✓,✓ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and offi ial seal. @dp,My RICHARD FEUERSTEIN Seal: 5COMM. #1568619 NOTARY PUBLIC - CALIFORNIA BUTTE COUNTY Comm. Expires April 13, 2009 A.P.# 02–J --2-S(,-0(57 4 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 8 -Aug -2006 2006-0040695 Has not been compared with original BUTTE COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building. permit. `The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort 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 occasionally generate dust, smoke, noise, and odor. Butte County has established 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: %`i� s SGwwv► ov► -OA-4 ¢.amu i (hair& t n -1 -ii -lc o'� , "Tour .+ "U.Y-'', 4 eei t r -('kL C`' ►ee c' -i I� e Cv 4"j (eaoroC�-' 8w C , C�,(;rn 0.� oY, Iha rc G, 2-(( -b CbLt r °� ►Jw i Q,CoyY/t,¢� U[7��'� ' P,x i s� �;g -Y �.e�re-.{YaY►► a,l 1-i'G�.A-+ �Oor%� .l lu 02S- Z45-blI c,ji--2Sv-O(51oZ�-zs6-v(L Date ]E - F -O(. PROPERTY OWNERS: State of California ) County of aooee ) On �� ��''DG before me, iGtii,o2 ���Z ii✓ A-00 �Ay 14..E/vc personally appeared /y�'.oX ky,4V goeaA J personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. RICHARD FEUERSTEIN Signature Seal: o C6MNi.1#1568619 0 NOTARY PUBLIC - CALIFORNIA ° BUTTE COUNTY "My Comm. Expires April 13, 2009 A.P.# 02.-1--Z5o-0(5 BUTTE COUNTY AUG 0 8 ?RIM Sr_, R.VI 1(.P a j OWNER -BUILDER VERIFICATION ' J30TTE � c OUNTY .Q� JUL 2 12006 Attention Property Owner: DEVELOPMENT SERVICES An "owner -builder" building permit has been applied for in your'name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1.personally plan to provide the m� jor labor and material for construction of this proposed roperty improvement: YES[,/] NO[ ]. 2 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: DATE: '? ZU C- NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. 1 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.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, , )t ; Scott Rutherford �II Manager, Building Division NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. Butte County Department of"Developnent Services-: °�vrr0 .. 7 County Center Drive o Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile SUN, 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: I need to submit applications for septic and/or well to Butte County Environmental Health immediately. • I am required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained • 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 permits/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: 2).) Applicant Name: !7 �i'G�� 44 AMk--APN: 02 �- Z -D ` 01r Building site address:/ 7,9- h ds �/ ' lk r /C� Permit No.: I have read, understood and accept the terms and conditions as expressed herein submission of the above -referenced building permit application and my signature below SIGNATURE OF APP CANT as indicated by my T-. 0�- dt/, DATE '1- =oL FA QQRIUEY% aIV 6VTTF o r o Ij 0 0 01-\� Department of Public Works 0 1' C o u m y o f B u t t e 0 ° 1 J. Michael Crump, LAND DEVELOPMENT DIVISION o i� Storm Water Management Program �'. Director 7 County Center Drive Oroville, CA 95965 A�'e�lC WOP�S )530) 538-7266 )FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE] Project Description: t Project Location and/or Parcel Number: 7Z L4J 1xGiz1kf • —6'ki 0� By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB I 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: / U Title: x6rl-'�— --- - Date: -- 7 _6 - Ll — ---- --- Inst than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Permit#2821-84B R Williams Los Verjeles; Bangor A e r / _ I r I � t r t a COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER 1 TELEPHONE SQ. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS .r CONTRACTOR'S NAME ( TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER j UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ h - ARCHITECT OR ENGINEER I 'J LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS' Permit fee $ BUILDING ADDRESS i r PLUMBING PERMIT Filing Fee 10.00 : h Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home I S I G W 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ i Installation ❑ Other ❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR00V OR LESS10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. ( DWELLING OCCUP.8, OR ADDNS. L ACC. BLDGS. 1 2/20sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ 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 CONSTIRULTI.OUTLET 2,50 ea NON.R ESID BRANCH CIRC ITS NEW CONSTR POWER APPARATUS &) NON.RESID. SINGLE OUTLET CIR. Ex. Occu 20IT50a P�o OR FIXTURES eAL@300 FIXED A FIXED APP LNS. OR Ex. Occup. OUTLETS (RESID.) EA.� 1 2.00 Temporary service 1 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 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 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 $ 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 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 $ - OCCUP. GROUP I TYPE OF CONST. I PARCEL PD I HD I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC , By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date ' Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N0. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATIONAND ftRMIT uu ASS SR PARCEL NUMBER b— 1 ZONING BUILDING PERMIT OWNS 1 aein Sh TELEPHONE SQ. FT. OCC. BUILDING VALUATION O ER'S AILING ADDR C NTRAC 1 01'S N ME D 1Ah� TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ 4, 00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING DDRESS 1 S r PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PACCEL MAP Each qas water heater or vent 5,00 Gas piping system 1 - 5 outlets 1 5.00 _ USE OF STRUCTURE SF IjKDuplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I W 10.00 e TYPE OF WORK New ❑ Additio Remodel[] Utilities ❑ Installation Other Describe work: I Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 2t/2PSgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR. ULTI.OUTLET 2.50 ea NON.RESID BRANCH CIRC ITS NEW CONST R. POWER APPARATUS & NON.RESID. SINGLE OUTLET CIR. Ex. Occu / 206506 P\o FIXTURES BAL®30 FIXED FIXED APPLNS. OR APP 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 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 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 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence offtthe granting of this permit. X ������y�� c✓ Date _s — ��/'� Signaruricant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structuresover 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ s OCCUP. GROUP I TYPE OF CONST. JPARCELJ PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. PECTO)lOF PUBLIC WORKS BY - Date PERMIT EXPIRES ate ��^� J'_ Receipt No. of �`�0 / WHITE-D.P.W., TEL La W -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT 14 SPECIAL INSPECTION REPORT Owner: yK,06Q A—, W, t a4,14 -9 A. P. # Address:,2i' Date of Ins ion 8-3 /-spy Tenant: Ins pec to Building Locations 5 S QVY-'JOS 2_; Type of Inspection requested: 1. Housing / /.2. Financing / / 3. Change of Occupancy to �. Other (specify) Present use of building: A. Sanitation (Housing) 1 • iJ�tcr nlnect . 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. B. Struc 1. 2. 3. 4. 5. . U. uommenLs: C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments: Plumbing 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4. Comments: E. Other 1. Maintenance and repair: i-' 2. Fire hazards: 3. Safety hazards: 4. Weather protection: 5. Underfloor and attic ventilation: 6. Comments: F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: _ 4. Restroom floors and walls: 5. Exits: 6. Improvements: 7. Zoning: 8. Comments: G. Field Problems or Violations 1. Problem rnro�lat�ypy�+ '(give com lete description) 2. atact'on taken (give complete',description): t t 3. at action recommended: tl A. Information only - file. B. Hold for ten days, then write letter. %% C. Write letter. / /,D. Other: