HomeMy WebLinkAbout007-250-017007-250-017
04-1102
DEWALL, DAVID & KAREN
998 E EATON RD, CHICO�NA�E
Cont GREENE ROOFING
f 3o 0
NEW HVAC
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BUTTE COUNTY PERMIT NO.
DEPARTMENT OF DEVELOPMENT SERVICES /BP041102
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
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date' 04/20/2004 APN- 007-250-017-000
the Business and Professions Code, and my license is in full force and
effect. �! +c' l
License Class :�_ License Number: z4s- � .L i
Site Address: 998 E EATON RD CHI
Date: LI '2—J-" Contractor: lqUtML4A0 AAtl,
q Map Index:
Description: NEW HVAC
p
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 am exempt from the
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
-DEWALL DAVID A & KAREN A CB DVA
Owner. ( )
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
998 EATON RD
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
CHICO CA
she is exempt therefrom and the basis for the alleged exemption. Any
95973-7649
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
DEWALL DAVID A & KAREN A CB DVA
Applicant: ( )
such 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 improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: MCCLELLAND AIR CONDITIONING, INC
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
690 THUNDERBOLT STREET
C.HICO, CA 95973
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
(530) 891-6202
❑ 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
License #: 345121
is issued.
Cl I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Architect: �`'n / ►� V r v
insurance carrier and policy number are:
,^
Carrier:
v 1(N
Engineer:
Policy #:
❑ 1 certify that in the performance of the work for which this permit is
Total Square Ft: 0 S. F.
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
Valuation: $0.00
and agree that if I should become subject to the workers'Census
Code:
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
r)4 0
7Dale.
-//-3q6— Z
Applicant.
lot
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
77�
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
This pe it f ere y i un r e ap licable provisions of the Butte County ode and r
Ras�1' ",' r,^ .o d o is fee have been paid.
performance of the work for which this permit is Issued (Sec 3097 Civ.)
BY Date: D�
Name:
PERMIT EXPIRES ON:
Address:
Dat
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information is correct, and that I am the owner or the duly authorized gent of the owner. i agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of ,ny official form o current of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purpo
Print Name: l�-k%1�1.1�li`� /_Jt % l f% Signatur .
Ll
L1
Date:
❑ ❑ 0 Agent for Owner 1,d<gent for Contractor
Owner Contractor
.#Ift 11�
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.netWds
PERMIT NO.
BP041102
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 04/20/2004 APN: 007-250-017-000
the Business and Professions Code, and my license is in full force and
effect. �/ i�^
License Class: J License Number: z4 J- I Z,
Site Address: 998 E EATON RD CHI
Date: li -W Contractor: Na
Map Index:
Description: NEW HVAC
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Stale License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: DEWALL DAVID A & KAREN A (CB DVA)
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 Slate License Law (Chapter 9 commencing with Section
998 EATON RD
7000) of Division 3 of the Business and Professions Code) or that he or
CHICO, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95973-7649
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
. DEWALL DAVID A & KAREN A CB DVA
Applicant. ( )
such 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 improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' Stale License Law.).
Contractor: MCCLELLAND AIR CONDITIONING, INC
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
690 THUNDERBOLT STREET
CHICO, CA 95973
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
(530) 891-6202
❑ 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
License #: 345121
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Architect:
insurance carrier and policy number are:
Engineer:
r--
Carrier: S
Policy #: % I -Z3Y
❑ 1 certify that in the performance of the work for which this permit is
Total Square Ft: 0 S. F.
issued, 1 shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
Valuation: $0.00
and agree that if I should become subject to the workers'
Census Code'
compensation provisions of Section 3700 of the Labor Code, I shall
-
forthwith comply with those provisions.
Date: Y k-1610
Applicant.
`
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
�1
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
This pe it i lere y i un r e ap licable provisions of the Butte County ode and r
Reso n o d o is fee have been paid. �,46
performance of the work for which this permit Is issued (Sec 3097 Civ.)
Name:
By. Date:
PERMIT EXPIRES ON:
Daf
Address:
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized gent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of ny official form o cument of Butte County. I hereby
authorize representatives of Butte County two enter upon the above mentioned property for inspection purpo
Print Name: Kc, Lau,&�L/
/2 / -(r ( JQM Z-" Signatur .
L1 -;_'0-0q
Date:
0 Owner ❑ Contractor ❑ Agent for Owner U-Kg'ent for
Contractor
BUTTE COUNTY .
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
04 01
DATE: -7-0-C)(4
APN•
a O
ZONING:
NEAREST CROSS STREET:. iA N Prp
TRACT/LOT#:
SITE ADDRESS
, I
CITY,ZIP:
OWNER NAME: j
PHONE:
Gii
STREET ADDRESS:
FAX:
CITY, ZIP:
E-MAIL:
APPLICANT NAMP-:
PHONE:
STREET ADDRESS:
FAX.
CITY, ZIP:
E-MAIL:
CONTRACTOR NAME:
PHONE:
McClelland Air Conditioning Inc
530-891-6202
STREET ADDRESS:
"
690 Thunderbolt Street
30-891-5137
CITY, ZIP:
Chico,CA 95973
E-MAIL:
scott@mcclelland j
LICENSE NUMBER:
345121
LICENSE TYPE: C-20
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX.
CITY, ZIP:
LICENSE NUMBER:
E-MAIL:
DESCRIPTION OR SCOPE OF WORK:
yj
❑ 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 fees will be required.
RFnI ICCT CnD 011=11=1 1Km0
V.\ .\L. VIVVV
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
For office use only.
Notes:
Application Received by:
Receipt number: 9
I
Date:
Amount Received:`
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