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HomeMy WebLinkAbout005-465-009A_ iY 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 PROJECT INFORMATION Site Address: 2170 1/2 LAUREL ST Owner: Permit NO: B08-1809 APN: 005-465-009 RODRIGUEZ, MONICA & SALV Issued Date: 09/04/2008 By KCG Permtype: MISCELLANEOUS PO BOX 8814it Subtype: Gas Reconnect CHICO, CA 95927 - Expiration Date: 09/04/2009 Description: RE -CONNECT GAS (530) 570-2805 Occupancy: Zoning: AR Contractor Applicant: Square Footage: RODRIGUEZ, MONICA & SAI Building Garage Remdl/Addn PO BOX 8814 CHICO, CA 95927 Other Porch/Patio Total (530)570-2805 FEE INFORMATION DBP Gas System (enter outlets) $59.00 Total Charged: $59.00 Fees Paid: $59.00 Balance Due: $0.00 Receipt No: B8465 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 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my lice-rse pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 09/04/2008 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractors Signature Date l/ V. 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 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 WILL the work himself or herself or through his or her own employees, provided that such improvements ❑I MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. . improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractors License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). Cartier: Policy Number. Exp. Date: (This section need not a completed if the permit is for onhundredellars ($100) or less.) ❑ I AM EXEMPT under Section B. 8 P.C. for this reason: 1 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 a ree that if I should become subject to the workers' 09/04/2008 com nsa o rovisions of Section of the La Code, I shall forthwith comply with those visions. -/ Owner's Signature Date X 09/04/2008 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 �� 't! SlgflatUre 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, injury, including death, and property damage caused arising out of, in any way connected with the issuance of this permit. I hereby acknowledge thatt is issuance of this pea rmit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned party for inspection urposes. 17 reby certify that I am the pro o ner or m autho ' d to on the o rs behalf. CONSTRUCTION LENDING AGENCY party �. 09/04/2008 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for a e o Permittee [SIGN] Print ! Date the performance of the work for which this permit is issued. (3097 civ. code) /,fRPwner 1:1 Contractor OR: Agent for Owner Agent for Contractor FILE COPY Lender's Address City State Zip .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 OWNER -BUILDER INFORMATION 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 you plan to subcontract, you should be aware of the following information for your benefit and protection: ° 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. ° 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. There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° 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 thier own employees, without a license 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 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. J PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. 1 PERSONALLY PLANTO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. QOR NO) 2. I OV /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 CONTRACTORS LICENSE 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 CITY PHONE CONTRACTORS 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 Description: RE -CONNECT GAS Reference Number: B08-1809 Applicant Name: RODRIGUEZ, MONICA & SALVADOR Owner's Name: RODRIGUE 0 ICA & SALVA R AP # : 005-465-009 Signature of Property Owner: r Date: i i1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION" OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OVVNER INFORMATION Last Name City Firse a Mailing Address _ City � IL/ 66 State State Phone 0 2 aS Fax E-mail State License Number APPLICANT INFORMATION CONTRACTOR Name City Address Zip City Fax State Zip Phone Fax E-mail State License Number Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Fax E mail State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLLCAfl72SIGNATURE X Ci PROJECT LOCATION API 005-_ )-^ C 6 Property AddressD t 2 S Q City /) L C 6 WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than licensed 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: a 2 — S r 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 I Yes I No Occ. Type Const. - rtjAl 005-465-009 7 f 02-3292 'mooRE, RONALD 2170,L.AUREL, CHICO CONT: GREENE ... & SON ROOFING] RE -ROOF COUNTY OF•BUTTE - DEPARTMENT OF;DEVELOPMENT SERVICES - BUILQING DIVISION , 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 7. 04 (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER i ��I _ L ,1� ZONING BUILDINGPERMIT OWNER rj lVo(IK N11�4v TELEPHONE SO. FT. OCC. BUILDING VALUATION ! OWNER'S MAILING ADDRESS CONTRACTOR'S NAME^ / / TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER - Fireplace LENDER'S MAILING ADDRESS Total Valuation $ o ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 17 6& ARCHITECT OR ENGINEER'S MAIUNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ P 14f �1 r PERMIT FEE $ ,[o LOT NO. SUBDNISIOWS N&ME PARCEL'MAP PLUMBING PERMIT Fling Fee 0.00 Each Trap 7.00 USEOFSTRUCTURE /�� SF Er Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: �( 11, 4N� LAW,- /l �7 / /) LAI S T •4 l4 / Q 4 Gas piping stem 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W 920.00 PERMIT FEE $ 1 ELECTRICAL PERMIT Fling Fee 20.00 LESS Main Service 'OvA zoOA oR OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION r I hereby affirm under penalty of perjury that I am licensed under provisid"ns'` of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in Jull force and effect. y Lic. No. License Class 95Q� 7 -DECLARATION 1 hereby affirm under'penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. _ ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and,�wU maintain a certificate of consent to self -insure for workers' com erls�fjan, as prQvlded' fQcj byectip`�i7 0� of the Labor Code, for the perforY . ncelaf the Ork-�fo�.kbith thi pdFm ii . issued. /I have and will maintain workers)"compensation Inr�surance, as required by Section 3700 of the Labor Code, for the performance of wdrk for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier i !� Main Service 200A TO IOOOA 46.00 NEW CONST. OWELLINO OCCUP. OR ADDNS. OT.LT BLps. s0 3.5QFT: �NjON,REOSID. MULTI.OUTLET @7,50 POWER APPARATUS a SpJGLE OURET CIR. Ex. Occu OUTLETORF(TUREs BAS 1: 0OWNER-BUILDER Ex. Occup. ouTLEtDrsa� D)OeA 5.00 Temporary Service 1 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Conlin Hood 6.50 Ventilation PERMIT FEE $ Policy Number /2/_T -1 122 l z (The above sections need not be completed if the permit is for work.of a valuation of one hundred dollars ($100).or less.) 11 1 certify that in the performance of the work for which this permit is issued, I shall not employ an peraontin any manner so es to become subject to workers' compensation laws of Callfor�ia, and agree.th'at if I,should become subject to the workers' compensatiori'Jprovlslons of,sect'" 3700 of the Labor Code, I shall forthwith comply with those provisiops.', 1\ \�(� X <:"f �n �. .- i Date �� "1 �' - 0� Signature of Applicant - ❑ Owner eQ: Cgntractor ❑ AgentAn OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height./ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ , �U HAZ. p, FEES IMP FLOOD _ CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte�County Code2andlor6solutions indicated•a` ve for which ((( /'� By .r-2 i PERMIT EXPIRES ON the applicable provisions to do work been paid. Date Date Receipt No. �i t-% ,'7 ^ 3.�ri WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 4Y''' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 Oz - (Rev. 12/96) z-(Rev.12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 005 • -� ; ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION .OWNERS Mf47 DRES/' / 7S_„X U l 40 CONTRACTOR'S NAME >W& TELEPHONE CONTRACTORS MAIUNG ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuatiow $ 12 20 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ •2 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILOINGADDRE] I Energy Plan Checking Fee $ $ �P a PERMIT FEE $ LOT NO. SUBDNIS IONS ME PARCEL MAP PLUMBING PERMIT Fling Fee Lfo.00 Each Trap 7.00 USEOFSTRUCTURE SFDuplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities�^❑/� Installation ❑ //Other ❑ Describe Work:L >Vy i//�T/>YC('�� . �/7yc�? /1% Gas piping sy2tem 1 - 5 outlets 15.00 Buildin sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service ' vA OR LEESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in II ffo(r(C�j and effect. 6-� License Class / LIC. NO. 9%�®� / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages astheir sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service To , 46.00so WEE200A CU00A NEW CONST. DWELLING OCCUP. OR ADONS. ( a ACC. BLD S. S° 3.5¢FT: �µp ONST. MULTI.OUTLET Qa 7,50 POWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 ' BAL �. 0 Ex. Occup. oLITrs IXEDRE51D.LNS°EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 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. K1700have and will maintain workers' compensation insurance, as required by Section 3of the Labor Code, for the performance of work for which this permit is issued. My workers' coenorl insurarri r and policy number are: Carrier Policy Number �/. -A j2 Z;z 0 7 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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 •th those provisions. X Date �� ZlO _ Signature of A plicant - ❑ Owner ontractor ❑ Agent An OSHA permit is required for excavations over 60” deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ (/Q HAZ. D. FEES IMP I FLOOD I CDF PARCEL PD HD I ISD This permit is�ereby issued under the Butte'Eounty Code and/or ind:741ve for which fees h By PERMIT EXPIRES ON the applicable provisions : *solutions to do work been paid. Date Date Receipt No. Q co WHITE-D.D.S.-B.D. C NARY -ASS SS PINK -INSPECTOR GOLDENROD -APPLICANT r 005-465-009" 02-3291 BEELER, SUSAN 2170 V2 LAUREL, CHICO CONT: GRIENE &r SON ROOFING RE -ROOF COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 (Rev. 12/96) APPLICATION AND PERMIT (f ASSESSOR PARCEL NUMBER 00 C?t_ �( T) ZONING BUILDINGPERMIT OWNER TELEPHONE `� r OWNERS UNG ADDRESS V r SO. FT. OCC. BUILDING VALUATION / �n , 1/ % c ti Ji �► CONTAACTOFVS NAME 00eTE s dA .• HONE CONTRACTORS MAILING ADDRESS CONSTR TION LENDER 411 Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ L1I ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADD SS Energy Plan Checking Fee >r PERMIT FEE $ „ W LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other �0 v4A Describe Work: ' 7 , Gas piping system 1 - 5 outlets 15.00 Build ng sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 a00R UE Main Service 200, OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. .,�- �!i �i r% OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 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. �Q I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance care r and policy number are: Carrier ,S /��� 7!�!/ Main Service TO I 46.00 WEU200A NEW CONST. DWELLMK3 OCCUP. U OR ADDNS. ( d ACC. BLOS. SO 3.5¢FT, MULTI. OUTLET CIRCUITS NON-REOSID. T. @7,50 POWER APPARATUS A SINGLE OUTLET CIR. Ex. OCCU OUTLET OR FIXTURES B20 ® I.000 FUCED APLNS. . OR Ex. Occup. OUTLETS P=EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number '? -► /_1,0 Z i (The above section ens ed not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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 - .,s'. -'-'_-rte-* `-°""" Date z1 z z- Signature of Applicant - ❑ Owner -Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ �� �� , 10 Haz. I D. FEES IMP I FLOOD CDF PARCEL PD HD I ISSUE This permit is hereby Issued under the applicable provisions of the Butte -aunty Code and/or Resolutions to do work indicated'ab �e for which fees have been paid. / % / '� ' / By ...RRR..IAAA Date K J7 PERMIT EXPIRES ON F? V bete ReceiptNo. �? �? on WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT KA i✓ " COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 T (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBERoo� //9/ v f ZONING BUILDING PERMIT OWNER SLA S TELEPHONE SO. FT. OCC. BUILDING VALUATION .OWNERS NG ADDRE� A C e -0s ` / CO 'S NAMETE HONE CONI T MAILING 1 CONS TR TION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ . BUILDING ADD Ss / .0/` Energy Plan Checking Fee $ f C_ e4i PERMIT FEE $ LOT NO. SUBDNISIOWS AME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SFDuplex ❑ Mobilehome ❑ Other ' SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other> Describe Work: _ � i �t' AA !�I'7' / ex2) Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 20.AORLESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in 1l force and effect. License Class -3 Lic. No. Z 7 �d� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ti ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DV=NG OCCUP. s0 OR ADDNS. ( a ACC. S.3.5¢FT. NON-A°SID. MULTI -OUTLET 97,50 POWER APPARATUS a SINGLE OUTLEr CIR. Ex. Occup. OUTLET OR FDCTUREs BAL @': 0 Ex. Occup.OUTLEEDTS AE�SID°E, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 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 required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' comps on insurance arrigr and policy number are: Carrier �� d Policy Number — ©,,P ' 3 p % (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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 ith those provisions. d X . Date '- 'z-- Signature of Applicant - ❑ Owner ontractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE ,�/ TOTAL FEE $ o HAZ. D. FEES IMP I FLOOD I CDF PARCEL PD HD ISSUE This permit is reby issued under the applicable provisions of the Butt unty Code and/or Resolutions to do work indicated ab ve for which fees a been paid. BY Q4 ate PERMIT EXPIRES ON I Date Receipt No. 34W d,G WHITE-D.D.S.-B.D. CA ARY-ASSE S PINK -INSPECTOR GOLDENROD -APPLICANT