HomeMy WebLinkAbout017-010-033Betty and Terry Linzy
14164 Centerville Rd,. Chico s -
Permit # 1680-82B,E(add garage, 'Caz'pfvrt,
living room and open deck)SF
Permit#2269-83B(lst renewal/1680-82)
Permit#2277-84B(2nd renewal/1680-82)
-01%9� - - - - - - -
Permit#1964-85B(3rd renewal/1680-82)
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1 1 PER14IT#95-2458
LINZY,. Betty & Terry
s
14164 Centerville Rd., Chico /
- C6mplete BP#82=1680
017-010-033 05-0310
CLARK, JOHN
14164 CENTERVILLE RD, CHICO
Cont: BAIRD R�O�OFINGp CO
REROOF
0.19-633 05-2324
CLARK, JOHN
14164 CENTERVILLE RD, CHICO
Cont: QUEVEDO CONSTRUCTION
SKYLIGHT
017-010-033 06-0177
CLARK, JOHN
14164 CENTERVILLE RD, CHICO
Cont: QUEVEDO CONSTRUCTION
REMODEL EX BATHROOM /SF
ZP.NETTIj 4-15 , Robert ' s 322-67B
X34 -67P
e1s Humbug app. •0 Mi. ,no. of Hell owri
CONTR: Harland Fisher, 6070 Lower Wyandotte Rd
(new single family) Oroville
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0/7- oio -0331
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PERMIT
PERMIT EXPIRES
1 i
OWNER -Betty Linzy,
Owner
�1 3
ASSESSOR PARCEL % •--
LOCATION 14164 Centerville Rd, Ch],:co
I
Temp. Power Pole
Called PG&E _
Temp. Elec. Service
Called PG&E
Temp. Gas Service
Cal led PG&E
JOB FINALED (Date)
Signature
J = OK
0 = Not OK
= Not Applicable
* = Not Ready
t ° '
MOBILEHOMES MISCELLANEOg"e
Date
MOBILEHOME UTILITIES (Plans) OK except k's
Date
DECKS, COVERS, CARPORTt, ETC. (Plans) G . ,zcept h
1. Zoning Requirements -Setbacks -Easements
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch_.•
3. Sewer; Location -Test -Fall -C/0 -Concrete
_
2. Footings; Size -Depth -Spacing -Connectors
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts- Beams-Rftrs.-Connec.-Shthg.-Rfg. • Bracing
5. Electricity; Location-Clearances-Grnd.-/ ' / Amp -Concrete
5. Alum. Awn.; Columns-Connections-Splice-Decal-Enc,os„-es
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card - BI Date .
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date _
POOLS (Plans) OK except k's
1. Setbacks -Easements r
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability `
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances
_
4. Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/O to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
0
-."o
yJ = OK
0 = Not OK
- = Not Applicable
* = Not Ready
RESIDENTIAL
RESIDENTIAL (Single and Duplex)
r
Dat
UND FLOOR (Plans) OK except H's
Date FRAMING Continued
Zoning requirements -Setbacks -Easements
-49. P erty Line Firewall & Openings
2. FW., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
tg., Garage; Soils -Steel- / /" Ftg. Depth
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
. Ply ood on Roof Overhang tti s Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
iding-Nailing-Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. Piers -Fireplace Ftg.-Steel
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
-54. Glazing Area -Glass Protection -Skylights -Plastic
S&_S ailing -Bol
9. Gas Pipe; Size -Anchors
10. Water Pipe; Test -Anchors -Regulator -Service Test
11. Electric; Underground
12. Plenums & Ducts; Clearance -Material -Support -Ins.
13. Girders -Sills -A25 hor Bolts -Joists -Vents -Cripples
Card -BI Date U ►2_Card-BI Date
YQ r;n 1R brier- 47
t
Card -BI Date rd -BI Date
Card -BI Date Card -BI Date
Card -BI
L, Dat a► ��i. Card-BI2_ Date
Date FINAL (Plans) OK except q's
Card -BI Date U/7 Card -BI Dat
Date
PLUMBING (Permit) OK except q's
5 Ext. Steps -Door & Sidelight Protection -Landings
(W. Smoke Detector
rM? Water Ht.; Vent -Access -Combustion Air
Furnace; Vents -Clearance -Comb. Air -Connector -
Inarage; Above Floor-Ducts-Mech. Protection
Water st &Anchors -Nail Protection
j6 D.W.V.; Test-Fttngs & nchors-Nail Protection
edroom Exiting
1Z-- Shower Pan; Test, FirstFloor-Tub Access
6V, G.F.I. & Bath Fixtures & Tub Access
�$. Test Tub & Shower, 2nd F or -Tub Access
6Y Elec. Trim & Subpanel; Breaker Sizes -Labels
_
Pipe; Size & Anchors
6,7,./Stairs & Rails
_1_Ae-6as
63/ Fireplace or Stove; Clearances -Hearth
Card -BI
Date Card -BI Date
64 Elec. Outlets at Wood Panel; Int. & Ext.
65/ Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
6 EIec. Outlets & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except N's
6 Garage Fire Door; Swing -Landing -Closer
66. A.C. Duct in Garage -Damper
,Qe.-X xture & Transformer Clearance -Ins. Protection
9. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
c. Receptacles Spacing -Lights &Switches at Doors
Size Boxes & No. of Conductors -Stapled
7,01 Plb., Elec. &Mech. Equip. Listed for Location
ex Installed Close to Edge of Studs & C.J.
. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water
4£� Insulation -Foam -Looked in Attic ❑Yes
-
4k"2 Appliance Circuits in Kitchen &Conductor Size
f7�(, Guard Rails &Deck Construction -Post Caps
•3Gt Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI
dn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At,
Insulated Neutral ❑Yes ❑No
�*� �ollowin instld.: Drive
g ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ED Yes 11 No
.2& Service -Riser Conductors &Ground -Main Disconnect
JS -Stucco; Brown -Finish
Qer Equip. Clearances; Panels-Motors-Mech. Equip.
-77--A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
.3a. -Clothes Closet Light -Shower Light
.38.�Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
,Z9. Water Well; Disconnect, Electrical, Plumbing
96. Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
j/ Date Q 'L Card -BI Date
Ventilation throughout House
Card B -I
Date Card -BI Date
J. Glass Protection
Date
MECHANICAL (P .it) OK except N's
Corrections from Previous Inspections
n" Gas Test -Meters Tagged; Gas -Electric
.a4+ A.C.. Ducts Insulation & Support
--Water & Sewer Connected -C/0 to Grade -HD Approval
Vent Fan; aust above Insulation
_95
nergy Compliance Certificate -Other Certificates
X33. Condensate Dra Overflow; Size & Grade
34. Furnace -Vent; Acces omb. Air -Return Air Vent -115V outlet
35. Attic Access & Platform t Furnace in Attic
Card -BI Date Card -BI Date
Card -BI Date Card -BI Date
Card -BI Date Card -BI Date
Card -BI _ Date _ _ Ca - BI Date
Card -BI Date Card -BI Date
Date
FRA G(Plans) OK except q's
Comments at Fi al.,
3 _Si_lls; Proper Material & Anchors
_-
3t./G IIs; Studs -Nailing, Spacing & Bracing -Plates -Sound
3 Bearing Walls overFlo®& FloNailing
3�raft Stop in Walls (rat proof)
40. Ejxe Stops; Furred Ceilings -Stairs -Chases -Tub nn
4iH20er& Beam -Size & Bearing
i angers -Post Caps -Anchors -Connectors
43. Cing. Joist-Rftr. Ties -P -Roof Brac.-Truss-Shthng.-Rfng.
F.LiLeelace Ties o ype A FI Fireplace Throat
�^
Attic Access; Size &_Romex Protection -Draft Stop -Ins. Baffles
7
Bdr ._Windows or Exiting Doors -Sill Hgt. & Dimensions _
arage Fire_Protection Framing
(NOTE: An entry must be made each time youvisit jobsite)
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COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERRMIT NO.
APPLICATION AND PERMIT "
ASSESSOR PARCEL NUMBER
—370-033
ZONING
FR20
BUILDING RMIT
OWNER
BETTY ZY
TELEPHONE
345-1129
SO. FT. OCC. UILDING VALUATION
OWNERS MAILING ADDRESS
1 Al 61L CIENTERVITIE. RD, 0 95928
EST 7,060
CONTRACTOR'S NAME
OWNER
TELEPHONE
CONTRACTORS MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOW N
Total Valuation Is
LENDER'S MAILING ADDRESS
Fling Fee $ 20,00
Permit Fee $ 90.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Energy Plan Checking Fee $
Penalty $
BUILDING ADDRESS 14164 CENTERVILLE RE),
PERMITFEE $ 110.00
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Solar or heat pump water heater 23.00
USEOFSTRUCTURE
SF IN Duplex ❑ Mobilehome ❑ Other
SPECIFY
Water piping 15.00
Each gas water heater or vent 15.00
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other X]
Describe Work: COMPLETE WORK STARTED UNDER 82-1680
Mobile Home IS I GI W @20.00
PERMITFEE $
Contractor
ELECTRICAL PERMIT Filina Fee 20:00
Main Service000V OR LESS
( 200A OR LESS ) 23.00
Main Service ( 200A TO 1000A ) 46.00
LICENSED CONTRACTOR'S DECLARATION
1 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.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law V 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
NEW CONST. DWELLING OCCUR s0.
OR ADDNS. ( a ACC. BLDS. ) 3.5¢ FT.
NEW CONST.MULTI.OUTLET
NON-RESID. ( BRANCH CIRCUITS ) 97.50
( POWER APPARATUS a )
a SINGLE ourLEr R.
Ex. Occup. ( OUTLET OR FIXTURES ) 20 Q 1.00
BAL 50
EX. Occup. OUTLETS (RESID.)
( ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMITFEE $
Contractor
WORKERS' COMPENSATION DECLARATION
I 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' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMITFEE $
Contractor
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
/of one hundred dollars ($100) or less.)
b/ I certify that in the performance of the work for which this permit is issued, I shall
not employ any p Zn in any manner so as to become subject to workers'
compensation laws f alifornia, and agree that if I should become subject to the
workers' compens do provisions of section 3700 of the Labor Code, I shall
orthwith comply it those rovisions.
c�
X __ Date
Sign ure of cant ,� er ❑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 Is
(�c3
11
Y_LE
TOTAL FEE $ 110.0
HAZ. D. FEES
IMP
FLOOD
CDF
PARCEL
PD HD
SSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
1
r S
By C Date /(� _3
PERMITEXPIRESON /0 — 3 --96
(Date)
Receipt No. / p --1f1,-5— e). o
I
WHITE-D.D.S.-E.D. CANARY -ASS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUT -f E
DEPARTMENT OFRUBUrC WORKS
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
CORRECTION NOTICE
L, /,-,/ 7 P6/y-
OWNER PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
is completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
njk9 '// A- �,e
C
Van—
Date Ir Inspector (2
REV 11 /91
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico - Phone: 891'-2751 -
7 County Center Drive, Oroville - Phone: 534-4541
Skyway and Elliott Road, Paradise - Phone: 872-2961, Ext. 57
�ORREC'TION NOTICE
BUILDING OR. PROPERTY ADDRESS
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
- -��e --) , -- // ,
;'OV /I-
;(Z�i I I /Z- / V :' 4"4
-1 --/ ' / C - "-.1 f e I— – - — I
'� 11P
'j,
/ - A 1 1
L -rr
'\0 till
Inspector Date
SMOKE DETECTOR INSTALLATION CERTIFICATE
BUILDING OWNER
BUILDING LOCATI
When the valuation of an addition, alteration or repair to a Group R Occupancy(dwelling
units, hotels and apartment houses,) exceeds $1,000 and a permit is required, or when one or
more sleeping rooms are added or created in existing Group R Occupancies, smokeAetectors
shall be installed in accordance with the 1991 Uniform Building Code, section 1210 (a).
In general, section 1210 (a) specifies that in new construction a smoke detector be installed
in:
(1) Each sleeping room, and at a point centrally located in the corridor or area giving
access to each separate sleeping area. Where the ceiling height of a room open
to the hallway serving the bedrooms exceeds that of the hallway by twenty-four
(24) inches or more, smoke detectors shall be installed in the hallway and in the
adjacent room.
(2) In each story and in basements, and on each level containing a sleeping area.
Such detector(s) shall receive their primary power from the building wiring and be equipped
with a battery backup.
When the valuation of an addition, alteration or repair to a residence exceeds $1000 and a
permit is required, smoke detectors shall be installed in each existing sleeping room, and
centrally located within each sleeping area if one is not currently installed. Such detectors
may be solely battery operated.
A repair, alteration or addition applies to a deck addition, wood stove installation, re -roof,
vinyl or aluminum siding, and remodel or additional square footage to an existing residence.
Declaration
I hereby certify that the above smoke detector (s) were installed in the building at the above
location in conformance with the 1991 Uniform Building Code, section 1210 (a).
LAN
Building
Signature
(Please Print)
State Contractors License No.
Date
This completed certificate must be provided to the building department prior to final.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND, PERMIT
P RMIT
ASSESSOR PARCEL NUMBER
i
ZONING
BUILDING PERMIT
DOWN ER
e a
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S IVAILING ADOR S
O TRACT R'S NA TELEPHONE
All%LL.- 2 i
ONTRAC OR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing FeeIf
$ 10.00
LENDER'S MAILING ADDRESS
Permit FeeJr—
$
ARCHITECT OR ENGINEERLICENSE
NO.
Plan Checking Fee
$
Energy Plan Checking Fee
Penalty
$_
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
BUILDING ADDRESS
`"�~' �����fs �� �� `
Permit fee
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
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 G W
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ OtherR
Describe work: _
1IMain
Tfi
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
service Boov OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
}' CONTRACTORS LICENSE LAW
i
i I declare under pen y of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
F and Professions Code and my license Is in full force and effect.
IEx.
License No. Classification
❑ 1, as the owner, or my employees with wages as their sole compen-
jsation, 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 oCCUP.4` ,2Qsgft
OR AODNS. ACC. BLDGS. / 2�
NEW CONSTR MULTI -OUTLET
NON-RESID BRANCH CIRCUITS) 2.50 ea
(POWER APPARATUS e)
SINGLE OUTLET CIR.
Occup(OUTLETS OR FIXTURES 2AL@
eLm30so
FIXED APPLNS. OR
Ex. Occup. oUTLETs (RESID,) EA.)
2.00
Temporary service 10.00
Mobile Home Facilities
15.00
Misc. byirin 15.00
9
Permit Fee $
RKMEN'S COMPENSATION INSURANCE
I declare under FInalty 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.
Contractor
MECHANICAL PERMIT
FiIingFee 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
against said County in consequence of the granting of this permit.
Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required For excavations over 5'0" deeo and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE
$
occuP.
CONST.TVPc
I
I FLAaD
PARCEL
I Po
I I40
1-1 _91M E
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
Bv.__
:'i EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
7 -?__.0-"
Receipt No. _
WHITE-D.P.W.. rcLLow-Nsretosa• .�H,Pec�aa. raLOr.x+.on�r,P�LlcevT���
COUNTY, OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND'PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
�—
ZONING
BUILDING PERMIT
OWNER
TECEPHONE
SQ. FT.' OCC. BUILDING VALUATION
NER'S AIL NG DDRESS
C T A TO 'S N
•O JIM
HOWE
CTO 'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee .
$'
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ 777- 7_5—
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
r-O'1Lc.Q
Water piping
5.00
LOT NO.
SUBDIVISION NAMEPARCEL
MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex❑ Mobilehome❑ Other�11&CJf�
SPECIFY
Building sewer
5.00
Mobile Home S G W
10.00 e
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti I i t i e s ❑ Installation ❑ Other ❑
Describe work:
J010""J AQA&�/f *'A11661-9100
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 00V OR LESS
1AMP OR LESS
10.00
Q / r✓
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ACC. BLDGS.
2t/ZQsgft
NTRACTORS LICENSE LAW
I declare under pe y 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 thi reason
NEW CONSTR. ULT' -OUTLET 2,50 ea
NON.R ESID BRANCH CIRCUITS)
NEW CONSTR POWER APPARATUS &)
NON.RESID. SINGLE OUTLET CIR.
Ex. OccuP20e50e
OR FIXTURES BAL@300
. FIXED A PLNS R
Ex. OCCUp. OUTLETS (RESID )EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare underlipenalty 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.
'A �Q 1 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' ydu must�fotthwith comply with such
provisions or this permit shall be deeme'd'revoked.
MECHANICAL PERMIT
Filing Feb 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
til"t,l lg "`°`
1 certify that I have read this appliieetio� andr6,tateii thit the above information
is correct. I agree to comply to all Co`6MV "rdlnances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above- ntioned property for inspection purposes.
I also agree to save, indemnif and keep harmless the County of Butte against
all liab' ties, judgments, c s, and expenses which may in a y way accrue
again aid C u ty in con uence of the granting of this permi
X Date
���yJJ..++
Signature of Applic n OW erpQ a tractor ❑ Agent ❑
An OSHA permit is required for excov`ation over 5'0" deep and demolition or construct-
ion of structures over 3 stories
ss-tin 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
DIRE OR OF LIC
By ��
PERMIT EXPIRES Date—
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date — �
:7 -P -0–j66
Receipt No.r/stD23
WHITE-D.P.W.. YELLOW-ASSFSSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
5861- 6 lnr
s a "'Om e �o urvno�3a
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
ASSESSOR PARCELNUMBER
'03-0- _3
ZONING
F
BUILDING PERMIT
OWNER
e - T-
TELEPHONE
SO. FT. OCCI BUILDING VALUATION
OWNER'S MAILING DDR SS
ISI �l e I 'c
NTRACTOR'S NAME AME
n�
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
INSTRUCTION LENDER
LA0-,/
UNKNOWN
Total Valuation $
Filing Fee $ 10.00
LENDER'S MAILING ADDRESS
Permit Fee $ 1,215
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee ,$
Penalty $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee $
BUILDING ADDRESS
PLUMBING PERMIT Filing Fee 10.00
i ql 'lLe— Pal.
/
Each Trap 2.00
Solar Water Heater 20.00
dhl C -D
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 STRUCT RE
SF Duplex ❑ Mobi lehome ❑ Other � d i -,Innes
SPECIFY
Building sewer 5.00
Mobile Home S G W 10-00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Deescriwork:
? f`oYmlt ' la �D
P�I rL
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee 10.00
BOOV OR LESS
Main Se(VICe 600 AMP OR LESS 10.00
H,^�,I�
M
oC�c
Main service EA. ADD'L 600 AMP 2.50
NEW CONST. / DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS. 2I/20sgft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check one):
F1NON-RESID.
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
fort k1sLPson
NEW CONSTR U TI -OUTLET 2,50 ea
NON-RESID BRANCH CIRC ITS
NEW CONSTR ( POWER APPARATUS
SINGLE OUTLET CIR. &�
zo®soe
Ex. Occup(OUTLETS OR FIXTURES SAL®ao
FIXED ALNS
Ex. TS P(RESI)REA.) 2.00
OUTLETS D.
-Occup.
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare un a pe ally 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.
1 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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indem if and keep harmless the County of Butte against
all Iia ities, judgments, sts, and expenses which may in any way accrue
again said unty in co equence of the granting of this per it.
/1 6 �
X Date
Ignature of Ap an - OW Contractor ❑ Agent ❑
ion of structures over3 stories in height.
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-02M
Mobile Home Installation Fee $
TOTAL PERMIT FEE $ ����
OCCUP. GROUP I
TYPE OF CONST.
PARCEL
PD
ND
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.
UBLIC WORKS
BY Date
PERMIT EXPIRES Dat
Receipt No.� A -6--p
�
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
C°
�rn�g d0
f
1
+
'
f
+ t
t
,
' S
t
f
t ,
F
C°
�rn�g d0
f
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CQ. 95965 Phone; 916=534-4541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing permit. No building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction
of the proposed property improvement (yes or no)
2. .I (have/have not) signed an application for a building
permit for the proposed work. -
3. I have contracted with'the following person (firm) to provide the proposed
construction:
Name
Address. City
Phone Contractors License No.
4. I plan to provide portions of this work* but I have hired the following
person to coordinate, supervise, and provide the major work:
Name
.Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
S igned :
Property Owner
Social Security umber
Date
NOTE: This Owner -Builder Verification is.sent to you as required Iby Sections 19831
and 19832 of the California Health and Safety -Code.
This verification must be completed and returned to our office before we are
permitted to issue the permit.
�x •.� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
k 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
/P�ERMI/T N
ASS SS R PAR L�NUMB R
..
ooC�
ZONING
BUILDING PERMIT
OW
TELEPHONE
SQ. FT. OCC -1 BUILDING VALUATION
OWN R''S^MAILI ADDRESS ,
W
CONTRAO 'S AME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 407jY
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ �
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee '10.00
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION NAMEPARCEL
MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTUR
SF ❑ Duplex ❑ Mobi lehome ❑ Other � —
ECI FY
Building sewer
5.00
Mobile Home S G W
10-00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lilies ❑ Installation ❑ Other
Descr be work:
IV700V
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
OR LESS
Main service (00 AMP OR LESS
1
10.00
Main service EA. ADD'L too AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS.
2t/20sq ft
CONTRACTORS LICENSE LAW
I declare under pen y 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 CONSTR. ULT' -OUTLET 2.50 ea
NO N.RESID BRANCH CIRC ITS
NEW CONSTR POWER APPARATUS &
NON.RESID. (SINGLE OUTLET CIR.
20®500
Ex. Occup(o XD OR FIXTURES 9AL®30
FIXED APPLNSOR
EX. Occup. OUTLETS (RESI.D.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
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.
MECHANICAL PERMIT
Filing Fee 10.00
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
aid County 1 conseq i� ce of the granting of this permit. (
X Date ,r/'2—L/ 3
ignature of Ap ican – Owner ractor ❑ 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 $ �J
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRE C QR OF PU
L
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
IC WORKS
y
Dat- 7-
— ` a -
Receipt No. Fi 9( C)By
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
\ COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
OWNER -BUILDER VERIF ICAT ION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your nameand bearing,
your signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing permit. No building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction
of the proposed property improvement (yes or no)
2. I (have/have not) signed an application for a building
permit for the proposed work.
3.
I have contracted with the
construction:
Name
Address.
Phone
following person (firm) to provide the proposed
City
Contractors License No.
4. I plan to provide portions of this work, but I have hired the following
person to coordinate, supervise, and provide the major work:
Name
5.
Address City
Phone Contractors License No.
I will provide some of the work but Ihave contracted (hired) the following
persons to provide the work indicated:.
Signed:
Property Owner
Social Se -c r number -
Date
NOTE: This Owner -Builder Verification is sent to you as required by'Sections 19831
and 19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are
permitted to issue the permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - OroviIIe, California 95965 - aeIephone 916/534-4541
APPLICATION AND PERMIT
1 (,PER40.
MIT —2 -2--
ASSE SO PARCEL NUMBER ^^
r
ZO NG
BUILDING PERMIT
OWNYR
EL P ONE
SQ. FT. OCC. BUILDING VALUATION
OWNER' MAILING A ,,yyE��S CL 11
�CJ V I r
Ail P1
CONT A TOR'S NAME
1)
TE P E
�{
CONTRACTOR'S MAILING ADD SS
Firdlplace7 I
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
- $ 1.0.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
,$' i 25
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDR s5 ejaeXPLUMBING
PERMIT
Filing Fee 19,AO
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent
5,00
Gas piping system 1 - 5 outlets
,_ / USE OF STRUCTURE
SF Lam' Duplex❑ Mobilehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
� � TYPE OF WORK
New ❑ Addition I� Remodel ❑ Uti Iiti s ❑ Instal lation ❑ Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP OR00V OR SLESS
5.00
Main service EA. ADD'L 100 AMP
2,50
NEW CONST''DW UP.51
OR ADDNS. ACC. L G
I 2,�gft
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 UT ET 2.SOea
NON -RES'., CIRCUITS)
NEW CONST R. I POWER APPARATUS 6)
NON-RESID, `SINGLE OUTLET CIR.
Ex. Occup OUTLETS OR FIXTURES BAL@1
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID,) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
1 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
S
Contractor
1 certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all ii ilities, judgments, o ts, and expenses which may in any way accrue
agai t said Cou ty in c s uence of the granting of this permit.
XDate ..-
Signature of App' an - Own Contractor ❑ Ag
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $
OCCUP. CROUP
P OF C ST.
PA EL
PD
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF BLIC
By- =Fft 4 —,
PERMIT EXPIRES Date//
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date %�--��e,./y
`�-
stories
Receipt No. b k -3 ��
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
r.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
71COUNTY CENTER DRIVE - OROVILLE, CALIFO�N A J45 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET
_ Permit No.
OWNER A. P. No.
Proposed Building Use
Permit Fee Based Upon: omplete COW ct Price DPW Valuation
-t l (Explain)
06
Building Inspector Date
At time of permit application, I was advis d the following data must be submitted prior to permit processing
and/or issuance: DATE RECEIVED APPROVED
1. All items,have been submitted. . . . . . . . . . . .
2. Plot plans in duplicate/triplicate. . . . . . . . . . .
3. Complete plans in duplicate. /triplicate. . . . . . . . .
Complete engineered plans and calcs. . . . . . . . . . h
5. Plans with Energy Design Compliance Statement. . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorizatio .�
�. 0. Sanitation approval from Health Dept. • . . % 7/
11. Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner[], Mail to owner ❑ )
15. Improvements may be required. . . . . . . . . . ..
16. Mobilehome Installation Data. . . . . . . . •. .
Pre-Inspec. request to
17. Pre -Inspection for Required. Building Inspector (Date)
18. Other
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other
Applicant
FA
Copy of plans sent Health Dept., Fire Dept., Other V Date y
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of ap kation, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by
By
Plans checked by -
Plans approved by
Other:
Copy—D'
Telephone Mail
Date
Date
Date
Other
TO: Building Department
FROM.
Environmental Health, Chico
SUBJECT: .SApitation Clearance
C/
Z4 A�( -3a
Owner 'Location AP#
Plan'approv.ed for: sewage disposal water supply
Hold fin . a. 1 for:.., 'water supply
Fina.1 clearance O.K. for: water supply
Clearance for bedroom mobile home. Other
Note***
Sanitarian
2,0 -F�
Date
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name"and bearing
your signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing,your build-
ing permit. No building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction
of the proposed property improvement (yes or no) wE.
2. I (have/have not) V_ signed an application for a building
permit for the proposed work.
3. .
construction:
Name
Address City
Phone Contractors License No.
4. J Dlan to Drovide pgrflons of , ave ireFI-Thi-F-T-3rTowing
person to coordinate, supervise, and provide the major work:
Name
Address City
Phone Contractors License No.
5.p of *he- -'b - T -have cont-iactud--(M ReRdT-Tmerfo owing
persons to provide the work indicated:
Name Address Phone Type of Work
S igned :
Property Owner
Social Secu ity number - —
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831
and 19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are
permitted to issue the permit.
MOTES
�HflW �R 1°ld.J ®fir
I
11
Butte County Department of Development Services.
7 County Center Drive, Oroville, CA 95965 --
(530) 538-7601 vnvw.buttecoLinty neVdds
RESIDENTIAL
AP N: Permit No.
Owner. 017-010-033 06-0177 1
CLARK, -JOHN — t
Site Address: �^ 14164 CENTERVILLE RD, CHICO �.
—Cont- QUEVEDO CONSTRUCTION
Contractor. i -REMODEL _ EX BATHROOM /SF
Type of Permit:- T —
SPECIAL CONDITIONS
CHECKED BY
SRA
FLOOD CERTIFICATE EQUIRED
FIRE SPRINKLERS REQUIRED
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUBSTANDARD HOUSING LE_ TTER
ENCROACHMENT PERMIT
REINSPECTION FEE PAID
ENV HLTH CLEARANCE
DATE JOB FINALED Y—
SIGNATURE:
OK
u.,r nK
MANUFACTURED HOMES
MISCELLANEOUS
DATE PERMANENT FOUNDATION SOFT -SET
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch .
3 Sewer; Loctn-Test; Fall/C/0-Concrete
4 Wtr, Loctn-Test-Easement Needed -Regulator
5 Elec Loctn-Clrncs-Grnd Amp -Concrete
6 Yard Gas; Loctn-Test-Wrap . Nat Q or LPQ
Inch Sz Ft Lngth
7 Blckng; Sz-Spacing-Marriage Line
8 Gas; MH Test-Demand-Valve-Cnnctr
9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs
10 Drain; MH Test -Fall -Flex Cnnctr
11 Wtr & Sewer Connected -C/0 to Grade
12 Gas and Electricity Tagged
13 Tie Downs Q Foundation Q
14 Exits
15 Cert of Occupancy
16 HUD Label/Insignia Numbers Serial Numbers
DATE ID E C K S -C O V E R S`C A R P O RTS `G A RAG E S
1 Zoning -Setbacks -Easements
2 Ftgs; Soils -Sz-DpthSpacing -CnnctrsSteeI
3 Decks, Girders/Joists-Dcking-Brcing
Stairs-Guard/Handrails
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg
Frmg-Brcng
5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs
6 Carports; Wndws-Doors
7 Electric
8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses
9 Siding; Nailing -Veneer -Stucco -Lath
10 Roof; Shthg-Roofing
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
DATE IPOOLS
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
5 Elec Pool Lting; 15 volts-GFI
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr
8 Elec Grndng; Eqp w/5' CrcItng Eqp-Pool Ightg
Bones-Enclsrs-pnlboards4nsultn to.Main Conduit
9 Health Dept Apprvl
10 Plmb; Cir Test-Wtr Supply Test
11 Lt Niche
12 Enclsr; Fencing -Alarms
13 Bonding, Diving board or Slide
`` P `c
s`
40
Pool Drawing
OK
Not OK
RESIDENTIAL (Single & Duplex) l
DATE JUNDERFLOOR
DATE IPLUMBING
1 Zoning -Setbacks -Easements -Flood -Slope
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg Dpth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.
55 D V; Test Fitti s & Anchr Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
5�vgr Pan; T�irst flr-Tub Acc
5 Stemwalls Main; Steel-Blockouts-Wrapped
57 Test Tub & Shwr, 2nd flr - Tub-Acc
6 Stemwalls Garage; Steel-Blockouts -Wrap ped
58 Gas Pipe; Sz & Anchrs
69 Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Pipin
8 Piers-Frplc Ftg-Steel
9DWV;Fall-Fitting-Test-2-wayCIO-Sewer Test
72 Elec Trim & Subpnl, Breaker Sis & Labels
10 UF, Gas Pipe; Sz Anchrs-Sz Test
73 Stairs, Guard/Handrails
1.l Wtr Pipe; Test-Anchrs-Rgltr-Service Test
74 Frplc or Stove, Clrnc-Hearth
12 Elec Undrgrnd
DATE M E C H A N I C A L
13 Plenums & Ducts-, Clrnc-MaterialSupport4nsultn
61 AC Ducts Insultn & Support
14 Girders-Sills-Anchr Bolts Joists-Vnts-Cripples
62 Vent Fan, Exhaust abv Insultn
15 Acc & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16•Insulation
64 Furnace -Vent Acc-Comb Air RtmNent 11S Outlet
33 Siding -Nailing Veneer
65 Attic Acc & Pltfrm if Furnace in attic
c` c`
DATE IFRAMING
t+ 4
0
17 Sills Proper Materials & Anchrs
DATE IFINAL
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
66 Ext Steps -Door & SideLt Prtctn-Landings
19 Bearing Walls over Girders & fir Nailing
67 Smoke Detector
20 Draft Stop in Walls (rat proof)
68 Furnace Vnts-Ctrnc-Comb, Air-Cnnctr
21 Fire Stops, Furred Ceilings -Stairs -Chasers Tubs
In Garage; abv-flr-Ducts-Mech Prtctn
22 Headers & Beams-Sz & Bearing
69 Bedroom Exiting
23 Hangers -Post Caps-Anchrs-Cnnctns
70 GFI & Bath Fxtrs & Tub Acc-Spa
24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac TrussShthg
71 GFI Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
72 Elec Trim & Subpnl, Breaker Sis & Labels
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Clrnc-Hearth
28 Garage Fire Prtctn Framing -RC Channel
75 Elec Outlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall & Opngs
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc
30 Ext Doors -One T -Check Garage 3rd Story, 2 Exits
77 Elec Outlets & Rcptcls at Ktchn Counter
31 Stairs; Width-Hdrm-Rise-Run -Landing -Fire Prtctn
78 Garage Fire Door, Swing -Landing -Closure
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80. Wtr Htr; Vnts-ClmcCom'Air Cnnctr-PRV; abv fir
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrtlr Acc
Mech Prtctn; LPG Appince Undr House 3" drain
35 Glazing Area -Glass Prtctn-SkyLts-Plastic
81 Plmb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolls
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnls
83 Insultn-Foam-Looked in Attic
38 Ins ultn-Walls-Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiltration-Walls-Wndws
85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
Z �Qd s2� /t�Ap 2S
86 CImc Drnge Planters ❑ Yes ❑ No
87 Stucco Brown -Finish
o'er m
88 AC Unit Dscnnct, Elec-Plmb
89 Vnts abv Roof, Plmb-Appinc-Frplc-CImc to Opngs
DATE JELECTRICAL
90 Wtr Well, Dscnnct, Elec, Plmb
0 tr & Trnsfrmr CImc4ns Prtctn
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
le,.-Rcptcls Spacing-Lts & Switches at Doors
92 Vntltn thru House
oxes& No Of Cndctrs Stapled
93 Glass Prtctn
ex Installed Close to Edge of Studs & CJ
Fqp
94 Corrections from previous Inspctns
Grnd made up w/Mech Fstnrs
95 Gas Test -Meters Tagged, Gas-Elec
'45-Grndng Electrode Bond Gas & Wtr
96 Wtr & Sewer Cnnctd-C10 to grade -HD Apprvl
-46-2-Rppinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
-#�Sabfeed Wire Sz ga ❑ CU or ❑AL
98 Address Posted
AC Wire Sz ga ❑ CU or ❑ AL
99 Fire Sprinkler
--"-Range Circ ga ❑CU or ❑AL
Oven Circ ya ❑ CU or ❑ AL
Insulated Neutral ❑Yes ❑No
x-49 SE, vice -Riser Cndctrs & Grnd Main Dscnnct
50 Fqp Irncs pnis-Motors-Mech Eqp
64-G'sthes Closet Lt-Shwr Lt -Spa Lt
_5 ,,Sx a ke Dttpr
�L'JL�
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR. INSPECTION VIM) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541
PERMIT NO.
BP052324
PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE
OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 08/30/2005 APN: 01 -
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
0
effect. -
License Class : License Number.
Site Address: 14164 CENTERVILLE RD CHI
Map Index:
Date: Contractor.
Description: 1 skylight
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: CLARK JOHN
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
,
14164 CENTERVILLE RD
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
the Contractor's State License Law (Chapter 9 commencing with Section
95928
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).):
❑ 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
Applicant: CLARK, JOHN
Code: The Contractors' State License Law does not apply to an
14164 CENTERVILLE RD.
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
CHICO, CA.
provided that such improvements are not intended or offered for
95928
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
Contractor: QUEVEDO CONSTRUCTION COMPANY
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.).
12039 CENTERVILLE RD
❑ I am Exempt under Article 3 of the Business an rofes i ns Code
CHICO, CA
95928
Date:' owner:
530-342-3472
License #: 589377
WORKERS' COMPEN ATION DECLARATION
I 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.
Architect:
❑ 1 have and will maintain workers' compensation insurance, as
Engineer:
required by Section 3700 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:
Total Square Ft: 0 S.F.
Policy #:
Valuation: $0.00
1 certify that in the performance of the work for which this permit is,
Census Code:
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
\
D
forthwith comply with those provisions.
)
Date: V171
Applicant: i
C
WARNING: Uure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided, for .in.Section37_0.6 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 permit is h r6by issued un r the ap lice a provisions of the Butte County Code and/or
Resolutions do:work'indic t above to w• h fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By: /,�
`C
Date: V
Address:
PERMIT EXPIRES ON: r—
Date
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ • Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I
hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent 911%owner. I gee to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any ial fo docu
r t of B tte Co my I hereby
authorize representatives of Butte Count Io enter up�tjeCLo mentioned property for inspection purposes
(\ Il
Print Name: J (�\IJi in li ✓1�1\
: Signature:
Date: qj r 19
Owrier ❑ Contractor ❑ Agent o Owner 0 Agent for Contractor
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 OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLYxr
OWNER INFORMATION
Last Name CL /t,(�
t�
First Name-7-�1
1�
Address I L{ ( r 1 _r'I
C e V, � (V A (.Qc'�P &
`(�
City C k O
Stat �
Zip a5 9 a U
Phone W 3q _ g a q
Fax
E-mail WkCS v S. 2 u—
v
APPLICANT INFORMATION
CONTRACTOR
Name ��
uP tv
Address j
cedevul, Ra
City C l C 0
Fax
StatA
Z�5_ a
Phone
Book
Fax
E-mail
Planner
Licee .� 3 -
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
Foris use only:
Zoning
Property Address
i 1c0 K �v ICe
Flood Zone
Cross Street
oln� k (;7 wi tDS 4t S H 1
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
Z
BIN It
PROJECT LOCATION
AP# 0 / 7 -- 0 / d -- d �
Property Address
i 1c0 K �v ICe
City
t �o
Cross Street
oln� k (;7 wi tDS 4t S H 1
141ORKER'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
Page 1 of 2
Description or Scope of Work:
6 6
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 b Amount: V Bldg
N
SRA
Receipt #: l Sheriff
'27
SMIP
Other
Date r -;70"-b1 I 1 ? 0iTotal
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 paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 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 bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings.
❑ 11. 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).
❑
.4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ 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 fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
NOTES
i
RESIDENTIAL
PERMIT NO. __L 017 -010-M _ _ -- 05.
CLARK, JOHN
14164 CENTERVILLE RD, CHICO
Cont: BAIRD ROOFrNTG CO
REROOF
11 SPECIAL CONDITIONS 11
111
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
� - tee &0/&
�Y�� Aa No apVa/uXt
JOB FINA LED (Date)
Signature
V_ �
J=OK
0 = Not OK
. = NotReadyable
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Soils; Special MH Support Sketch
3.
Sewer; Location -Test -Fall -C/O -Concrete
4.
Water; Location -Test -Easement Needed (Sketch)
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete .
6.
Gas; Location -Test -Wrap;-/ /" L 'ft.
/ P Nat. or / P' L "ft./ P LPG
7.
Well Clearance & Disconnect
8.
Utility Clearance
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Card B-1 Date Card B-1
1.
Zoning Requirements -Setbacks -Easements
Card B-1 Date Card B-1
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector
7.
Water and Sewer Connected -C/O to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
Card B-1 Date Card B-1
1.
Zoning Requirements -Setbacks -Easements
Card B-1 Date Card B-1
2.
Footings; Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer Connected .
B.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11.
Verify #'s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panelboards-Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
J=OK
0 = Not OK
- = Not Applicable
. = Not Ready
RESIDENTIAL (Single & Duplex)
Date
UNDERFLOOR (Plans) OK except #'s
1.
Zoning -Setbacks -Easements -Flood -Slope
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5. Stemwalls, Main; Steel -Bloc kouts-Wrapped
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
6.
Stemwalls, Garage; Steel- Bloc kouts-Wrapped
Garage Fire Protection Framing -RC Channel
6a.
Hold Downs and Special Anchors
Property Line Firewall & Openings
7.
Slab, Steel -Wrapped
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
8.
Piers -Fireplace Ftg.-Steel
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
Siding -Nailing Veneer
11.
Water Pipe; Test -Anchors -Regulator -Service Test
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
12.
Electric Underground
Glazing Area -Glass Protection -Skylights -Plastic
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
Shear Walls; Nailing -Bolts
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
Brace Interior/Exterior Wall Panels
15.
Access & Ventilation
Insulation -Walls -Ceilings
16.
Insulation
Infiltration -Walls -Windows
Date
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Ext. Steps -Door & Sidelight Protection -Landings
17.
Water Htr.; Vent -Access -Combustion Air Baffle
Smoke Detector
18.
Water Pipe; Test & Anchor -Nail Protection
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
Bedroom Exiting
20.
Shower Pan; Test, First Floor -Tub Access
G.F.I. & Bath Fixtures & Tub Access -Spa
21.
Test Tub & Shower, Second Floor -Tub Access
Elec. Trim & Subpanel, Breaker Sizes & Labels
22.
Gas Pipe; Sixe & Anchors
Stairs & Rails
23.
Fire Sprinkler; Test
Fireplace or Stove, Clearance -Hearth
72.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
75.
24.
Fixture & Transformer Clearance -Ins. Protection
76.
25.
Elec. Receptacles Spacing -Lights & Switches at Doors
77.
26.
Size Boxes & No. of Conductors Stapled
78.
27.
Romex Installed Close to Edge of Studs & C.J.
79.
28.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
80.
29.
2 Appliance Circuits in Kitchen & Conductor Size GFI
81.
30.
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or AI
82.
31.
Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insulated Neutral O Yes 0 No
32.
Service -Riser Conductors & Ground Main Disconnect
83.
33.
Equip. Clearances Panels-Motors-Mech. Equip.
84.
34.
Clothes Closet Light -Shower Light -Spa Light
85.
35.
Smoke Detector
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
Date
Water Well, Disconnect, Electrical, Plumbing
Card B-1 Date Card B-1
Date
Exterior Elec. Trim, G.F.I. Receptacle -Underground
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36.
A.C. Ducts Insulation & Support
37.
Vent Fan, Exhaust above insulation
38.
Condensate Drain & Overflow, Size & Grade
39.
Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40.
Attic Access & Platform if Furnace in Attic
Date
95.
Card B-1 Date Card B-1
Date
96.
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
Card B-1 Date Card B-1
41.
Sills Proper Materials & Anchors
Card B-1 Date Card B-1
42.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
Card B-1 Date Card B-1
43.
Bearing Walls over Girders & Floor Nailing
44.
Draft Stop in Walls (rat proof)
45.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46.
Headers & Beams -Size & Bearing
Date
FRAMING (Continued)
47.
Hangers -Post Caps -Anchors -Connectors
48.
Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52.
Garage Fire Protection Framing -RC Channel
53.
Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57.
Siding -Nailing Veneer
58.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59.
Glazing Area -Glass Protection -Skylights -Plastic
60.
Shear Walls; Nailing -Bolts
61.
Brace Interior/Exterior Wall Panels
62.
Insulation -Walls -Ceilings
63.
Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
64.
Ext. Steps -Door & Sidelight Protection -Landings
65.
Smoke Detector
66.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67.
Bedroom Exiting
68.
G.F.I. & Bath Fixtures & Tub Access -Spa
69.
Elec. Trim & Subpanel, Breaker Sizes & Labels
70.
Stairs & Rails
71.
Fireplace or Stove, Clearance -Hearth
72.
Elec. Outlets at Wood Panel, Int. & Ext.
73.
Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74.
Elec. Outlets & Receptacles at Kit. Counter
75.
Garage Fire Door; Swing -Landing -Closure
76.
A.C. Duct in Garage -Damper
77.
Wtr. Htr; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80.
Insulation -Foam -Looked in Attic
81.
Guard Rails & Deck Construction -Post Caps
82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
_
83.
Following Instld./Drive 0 Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes 0 No
84.
Stucco Brown -Finish
85.
A.C. Unit Disconnect, Electrical -Plumbing
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87.
Water Well, Disconnect, Electrical, Plumbing
88.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
89.
Ventilation Throughout House
90.
Glass Protection
91.
Corrections from Previous Inspections
92.
Gas Test -Meters Tagged, Gas -Electric
93.
Water & Sewer Connected -C/O to Grade -HD Approval
94.
Energy Compliance Certificate -Other Certificates
95.
Address Posted
96.
Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
EIDTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
DUI�DING PERMIT
24 HOUR INSPECTION #: (536) 538-7636 (OROVIL'LE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE4 www.buttecounty.neAcIft
r
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally 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. q // 6
License Class: ✓� License Number. _,.1 /!
Date:i?L�/ Conlractor.AIA/ow A 08/8 l�
�OWNER-BUILDER DECLARATION
I hereby affirm under penally of perjury [hot I am exempt from the
Contractors' Slate 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
to Its Issuance, also requires the applicant for such permit to Ole a
signed statement that he or she Is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she Is exempt therefrom and the basis for (he'alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
appticanl to a civil penally of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is not
Intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
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-bullder will have the burden of
proving (hat 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 Profasslons Code. The Contractors' Slate 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' Slate License Lew.).
❑ -lam Exempt under Article 3 of the Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I 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.
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
Insurance carrier and policy number are:
Carrier:_'A rAL � 0A1, er+
Policy M 4Q Cf " 316 / f . T,
❑ 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 agree that if I should become subject to the workers'
compensation provisions of Secllon 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNING: Failure to secure workers' compensation coverage Is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000). In addition to the cost or
compensation, damages as provided for In Section 3708 of the Labor
code; Interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there Is a construction lending agency for the
performance or the work for which this permit Is Issued (Sec 3097 Clv.)
Name:
Address:
PERMIT NO.
50310
7 jet,, # O P7 - Old- 0 3_�
Issued Date: 02/07/2005 APN: 011-370-033-000
Site Address: 14164 CENTERVILLE RD CHI
Map Index:
Description: RE ROOF COMP 13 SQ.'S FRONT SIDE
ONLY
Owner: JOHN CLARK
14164 CENTERVILLE RD
CHICO CA
95928
(530) 898-1983
Applicant: BAIRD ROOFING CO
11025 MIDWAY
CHICO, CA 95928
530-342-1631
Contractor: BAIRD ROOFING CO
11025 MIDWAY
CHICO, CA 95928
530-342-1631
License #: 631460
Architect:
Engineer:
al Square Ft: 0 S. F.
Valuation: $0.00
ensus Code:
permit Is her�eby Issued under
rlutlons to d'o work Indicated al
PERMIT EXPIRES ON: ,.)— - I [ _,
which fees have been paid.
Date: c -;Q "—
❑ 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 & Safely Code Is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above Information Is correct, and that'I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge Il; la unlawful to alter the substance of any o Ictal form or document of idlJCount . I hereby
authorize representatives of Butte County to enter upon the above mentioned properly for Inspection purposes.
Print Name: 1.7
Signature:
Dale:
0 Owner 0 Contractor ❑ Agent for Owner Agent for Contractor
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 REO UIRED AT TIME OF APPLICA TION
Website: "ww.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
CONTRACTOR
OWNER
Last Name
/
City d
l
irst Nam e�(j ' q
Address
Phone
City /' � /
lel CA
Email
State � f
/
o�
_
Phone
f1 _J
Fax
E-mail
State License Number
CONTRACTOR
, /�
Name 1 6,J4 /
!� /o
Address , -� Kl vI
/
City d
l
Stat e�
Zi
Phone
Fax �L
Email
Lic., ' / l0
- z
Af APPLICANT SIGNATURE
X
For offideAse only:
ARCHITECT/ENGINEER
Name
X
Address
Cross Street
City
I Yes I No
State _7177.
Zip
Phone
Subdivision Name
Fax
E mail
Page
State License Number
Af APPLICANT SIGNATURE
X
For offideAse only:
APPLICANT NAME
Name
X
Address
Cross Street
City
I Yes I No
State
Zip
Phone
Subdivision Name
Fax
E-mail
Page
Af APPLICANT SIGNATURE
X
For offideAse only:
API O
Zoning
Property Address
Flood Zone
Cross Street
SRA
I Yes I No
Occ.
Carrier
Type Const.
Subdivision Name
LENDING AGENCY
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
06—
BP
BIN 9
LOCATION
API O
Property Address
City
Cross Street
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
Page 1 of 2
Description or Scope of Work:
Sq.. Footage -
❑ Structure Built without Per its
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
c�
Received by: Amount: io. Bldg
SRA
Receipt #: Sheriff
Other
Date: ! r 00 ',
MTotal
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑ 5. Statement of Intent for Non -heated and A/C for -Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings.
❑ 11. Detached Accessory Building Form filled out by the owner (if required).
❑ 12. Hazardous Material Form (for Commercial Buildings only).
❑ 13. Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.) -
❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑ - 2. Impact Fees.-
El
ees:❑ 3..Californi.a-Department of.Forestry plan approval (if required).
�...,«.:
❑ 4. NPDES Form.
❑ 5. "Encrdb6Kment-Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 6. Contractor's -license: information. (Number, Name Style, Classification).
❑ 7. Worker's Compensation Carrier and Policy Number.
❑ 8. Owner -Builder Verification (if required).
❑ 9. Letter of Signature authorization (if required).
❑ 10. Recorded copy of Agricultural Acknowledgment Statement.
❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538.7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within'two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
ti
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
:1111Z:1111WA
PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
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: 01/25/2006 APN: 017-010-033-000
the Business and Professions Code, and my license is in full force and
effect.
y/
1 f(0qL -
License Class : License Number:
Site Address'
Map Index:
Date: Contractor:
Description: REMODEL EX BATHROOM/SF
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: CLARK, JOHN
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
14164 CENTERVILLE RD
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
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
95928
she is exempt therefrom and the basis for the alleged exemption. Any
(53)342-8217
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: CLARK, JOHN
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
14164 CENTERVILLE RD
such work himself or herself or through his or her own employees,
CHICO, CA
provided that such improvements are not intended or offered for
95928
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
(53)342-8217
proving that he or she did not build or improve for the purpose of
sale.).
1, as owner of the property, am exclusively contracting with
licensed to the 7044, Business
contractors construct project (Sec.
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
Contractor: QUEVEDO CONSTRUCTION COMPANY
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
12039 CENTERVILLE RD
❑ I am Exempt under Article 3 of th Business and 'Code
CHICO, CA
�pfess
i _ a5,
95928
Date: Owner:
530-342-3472
WORKERS' COMP ATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #: 589377
❑ 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.
Architect:
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Engineer:
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy#:
Valuation: $0.00
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
Census Code:
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
i -as -(1P
Date: ^ N !2N in
r `
—
Applicant:
WARNING: Fa re to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
This permit is hereby issued under the applicable provisions of the Butte Cou ty Code and_ /or
Resolu ' n to 10 work indicated abo for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
gy Date:
Name:
PE IT EXPIRES ON:
Address:
Date
❑ 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 agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document utte C ty. I here by
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
iv
0� T. G I a r Signature:
Print Name: `'
ate:)4caner
❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
>' C1�ITf 11�)
BUTTE COUNTY PERMIT
DEPARTMENT OF DEVELOPMENT SERVICES NO
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 BP
OFFICE #: (530) 538-7541 BIN #
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
**PLEASE PRINT CLEARLY**
Last Name /' rirsl Name abld1 V1 I
11 , � / �Q,V�
Address LJ`(DLI C enter v\ k R
City C 6 Co State c� Zip Qi5qa
Phone 3�a _?a 14 Fax
E-mail ,tclaf k @ C su's ,e tx
CONTRACTOR
Name QVeVdc) 00Y15iU(,ilon C oirn pn
Address lab3q Cen1(erVAe N_
City C l i o
State CAS
I Zip qi 57ga s
Phone 3,�a _ 3H - a
Fax
E-mail
1.ic.#5g
Class
ARCHITECT/ENGINEER
Name
Address
City State Zip
Phone Fax
E-mail State License Number
APPLICANT SI NATURE
X`
For o ce'use only:
APPLICANT NAME
Name
CS Wy" 0-0, 6
1
Address
SRA
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
APPLICANT SI NATURE
X`
For o ce'use only:
Zoning
Received by:
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
rwcD cnD c11ORRITTAI RGnIIIRFMFNT_q
LOCATION
AP#
Propertyd ess (H � 4 city ( r C d
Cross Street km R'4"� ::� Vn , 61 G wG
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
Descriptiorl or Scope f Work:
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
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:
Amount Bldg
SRA
Receipt k.
Sheriff
SMTP
Other
Date:
_
�o Total
r
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1.
3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑ 2.
3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
OR
3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4.
Letter from Engineer or Architect for truss design review.
❑ 5.
2 Energy compliance design and supporting documentation. (Note: Not required for additions to
mobile or modular homes.)
❑ 6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7.
Detached Accessory Building Form, filled out by the property owner (if required).
❑ 8.
Sanitation and site plan approval from the Environmental Health Department.
❑ .9.
Metal Buildings: (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.
Mobile, Manufactured, or Modular Homes:
❑ 1. . 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 4 Engineered plans with wet signature on plans AND 2.sets of stamped and signed calculations,
with code analysis.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4. Letter from Engineer or Architect for truss design review.
❑ 5. 2 Energy compliance design and supporting documentation (if required).
❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7. Statement of Intent for Non -heated and A/C (if required).
❑ 8. Metal Buildings: (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.
❑ 9. Letter of intent.
❑ 10. Hazardous Material Form.
❑ 11. Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
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