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HomeMy WebLinkAbout005-401-006` . � .~~-- ���� -54014 �k���` ^ .��~�1355 Boucher.Ave, Chico � ~ ~~ . � .~~-- ���� -54014 �k���` ^ .��~�1355 Boucher.Ave, Chico � COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMI .7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541, S/i APPLICATION AND PERMIT 000 ASSESSOR PARCEL NUMBER S® Q - O 6 ZONING BUILDING PERMIT owN R f (fox TELEPHONE 45' q3-)7 SQ. FT. OCC. BUILDING VALUATION lU o a OW �'S MAILING 7 13ADDRESS /,7 7 I CONTRACTOR'S NAME d W �✓ •er TELEPHONE , CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ O LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ S O ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 9-7, PLUMBING PERMIT Filing Fee 10.00 lv©/,cG Qr I%e Each Trap 2,00 1\ j�G c7 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other Describe work: Permit Fee S' Contractor ELECTRICAL PERMIT Filing Fee 10.00 \ Main eoov OR LESS n service AMP OR LESS 10.00' Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCC 1`9 OR ADONS. ACC. BLDGS. / , ���Sgft NEW CONSTR I.OUTLET NO N.R I- .BRA CH CIRC ITS 2.50 ea POWER APPARATUS e SINGLE OUTLET CIR. I Ex. OCCUp(OUTLETS OR FIXTURES eLO 30 2AL@aD FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00, Temporary service 10.00' Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. E] I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. VI shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit,shal I be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3,00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection 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 agai t sa' County�in?suence of the gr nting of this permit. • X 'r 2--Z Z Date Signor re of Applicant — Owner❑ Contractor ElAge An OSHA permit is required for excavations over 5'0" deep an demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ c9%• _5 0 occuP. CON5T.TYP1J SCHOOL FLOOD PARCEL PD I ND I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date_ Receipt No. 3a2 WNITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT V i' - - S.. .1. .^ ,n -. ... � y._ r F . COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE'- ORbVItLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. OWNER �_����?l A. P. Nott .'S� MIDI" Ooh Proposed Building Us .M 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, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans .. 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Energy Design Compliance and supporting documentation ......... 6. Statement of Intent for Non -Heated and AC Buildings .............. 7. Engineered truss details and layout in duplicate (required prior to plan check) 8. Mobilehome installation data including manufacturer's installation instructions....................................................... 9. Fees of $ .......................... 10. Chico Urban Area fees paid ........................................ 11. Park fees paid ..................................................... 12. School District fees paid ................. 13. Sanitation approval from Health Department ... 14. City of Chico plumbing permit ...................................... 15. Plot plan and business license approval from City of (see City for other requirements) 16. Planning approval for (A) Use: (B) Parking: ......... 17. Improvements may be required. 18. Driveway permit (construction approval required prior to occupancy) ... 19. Pre -Inspection for required ...... Pre-Inspec. request to Building Inspector (Date) 20. Contractor's license information (No., Name Style, Classification) ....... Certificate of Workmans Compensation Insurance ......... 22. Owner -Builder Verification (Given to owner a, Mail to owner ;�e... . 23. Recorded copy of Agricultural Acknowledgment Statement ............ 24. Letter of signature authorization ......................\ ............. . 25. 26. When you issue the permit, process as follows:I'Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. nth, --r Copy of plans sent Health Dept., Fire Dept,, Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. el 2. Additional items required: I i Contractor, designer, owner, was advised of above required data by_phone---naiI—counter by date Contractor, designer, owner, was advised of above required data by—phone —ma II—counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW all i O RE REP ®RT FC -18 (3/86) n ORIGIN LOCATION ORDER NUMBER TOWNSHIP®N e RANGE ME NATIONAL FOREST, FIRE DIST., CRY 6 STREET NO., ETC REG. R.U. INCIDENT NO. Q FALSE ALARM--CaO TO _ START_ MO. DATE YEAR COUNTY ! ' BLOCK 10 RANCH -FARM ❑ RECREATION { • y DUMP - r ❑ WILDLAND RESPONSIBILITY FIDE AIIIMRFD 4A FIRE NAME: 0 ❑ WILDLAND BURNED OR THREATENEDRESPONSIBILITY ❑ CDF LOCAL. GOVT. CONTRACT (O AT ORIGIN) 1 SEC. TOWNSHIP®N e RANGE ME NATIONAL FOREST, FIRE DIST., CRY 6 STREET NO., ETC ❑ CAMPFIRE Ell I LL���t-NR�-----1 >� s - y o 1-- . MILES DIRECTIONFROM IN. NATIONAL FOREST, FIRE DIST., CRY 6 STREET NO., ETC ❑ CAMPFIRE IN TYPE U ' V OR VL -ONLY) DjCjAUSE ❑ UGHTNING DENT ❑ CAMPFIRE 3 FIRE Q FALSE ALARM--CaO TO _ LAND USE (STARTS 1N 1 2 5 OR 8 ONLY) b aOMESTIC- . BLOCK 10 RANCH -FARM ❑ RECREATION { • y DUMP - r ❑ WILDLAND RESPONSIBILITY ❑ .NON-WILOLAND 4A 46 J STATE ZONE STATUTORY 0 ❑ WILDLAND BURNED OR THREATENEDRESPONSIBILITY ❑ CDF LOCAL. GOVT. CONTRACT (O AT ORIGIN) 3© O❑ UNPROTECTED City) (Other dm_ T & Y ❑STATE ❑ ASSIST OTHER AGENCY (Not [IU.S.FS. 0 LOCAL ZONE CDF LOCAL GOVT. CONTRACT ❑ B.LJN ❑ �O �{ 0 ❑ ASSIST OTHER AGENCY (Not City) ❑ OTHER FE -DE d/OR CONTENTS FEDERAL ZONE FED. AGENCY (Not Mr1.) ❑ OTHER, OASSIST 8 ❑ CDF LOCAL GOVT. CONTRACT O❑ MISC. AND OTHER ASSIST CITY, CONTRACT CO., 4)OTI� (STARTS iN U ' V OR VL -ONLY) DjCjAUSE ❑ UGHTNING f:] DE IS ❑ PLAY W/FIRE ❑ CAMPFIRE 13 ARSON JW OTHER/MISC. ❑ SMOKING ❑ EQUIPMENT " LAND USE (STARTS 1N 1 2 5 OR 8 ONLY) b aOMESTIC- . f El FOREST :INDUSTRY RANCH -FARM ❑ RECREATION { • y DUMP ❑ OTHER INDUSTRY-COMRCL_ ❑ ROAD ' . ❑ WILDLAND ❑ UTILITY, RAILROAD ❑ .NON-WILOLAND ❑ LmUTY, ELECTRIC ❑ OTHER DAMAGE A 4�) <1� OR .n ONLY► 7 • DIRECT PROTECTION ACRES BURNED : DAMAGE - ' Number f off b Neve l 1 a/or I> - TIMBER 3/OR ' f •'^'' YOUNG GROWTH WILDIAND VEGETATION Oahu thm T & Y AGRICULTURAL PROD (Other dm_ T & Y DWELLINGS' &/OR CONTENTS �O OTHER STRUCTURES d/OR CONTENTS VEHICLES 3 CONTENTS OTHER w . TOTAL 4.� . • ACRES OF VEGETATION BURNED AGENCY • DIRECT PROTECTION ACRES BURNED CDF 0 OTHER TOTAL' - SIZE ACRES BURNED VEG. TYPE TIMBER WOOD LAND BRUSH AGRIC - PROD. CDF TOTAI i '< A APE OR LESS >% STATUT. z. • •' z: RESPON. 0 ACRES BURNED <: B 6 ACR %?%OF C10-99 ACRES STATE E] D 100-299 ACRES ry% US.F.S. E 306-999 ACRES F 1000-1999 ACRES 121 r B.I.A. , { E G 5000 ACRES OR MORE y. B.O.R. OTHER ---------------- ? s w .:::. ' �-/• OTHER i •>-.'',}i?L:wtwYii.;'.n{;::ia<.{{�..y:�;N:'i: •- .Sx;; l: % ! f }� F J'• ..?:w..; {; .." ./.,rd:•.3..',>;':'ry:.4-irk}: .•{:`:: ;�}::-::: .- me{ -:::;'x;;, i/::.:-: .,:a,,..:;.;.}....gS:::ti::ar2....>::-:.::r•:::4:-::tix.;-{...1:..:;CG•/.i;`':�:a• •, ..v:; }:...vv::: .v}};v:.v,._:.v..v}:!/.{{c•:;..{.l!i'/..};.}}:•ii �::� r:}:{x..:':.u::...:.. r:.... r..:...n n............ n.v:..Y............... n ii: ON ARRIVAL (O VEGETATION FIRES ONLY) D—S DISTANCE (060 to bead) ACRES FEET ' WEATHER TE AT ; WIND SPEED (t"JL) DIRECTION (FROM) TEMPERATURE {'F) OVER PLEASE CDF 7540-1300118 86 39W