HomeMy WebLinkAbout017-270-030TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
-�S/—
E.H. USE ONLY
Plot Plan Attached
Floor Plan Attached
Sent to B.D..Z-Z'710 -V/-Y
7�w 06,.Aemah (fa hfko-k- Z,.,, - NO ce, t- -.4 017
Owner Location AP#
Plan Approved for: Sewage Disposal -,Y Water Supply:' Public Private Well
Clearance for dwelfifm
t. Other (2,4o46 41/7�e� but*ldt-s4.
Hold final for:
Final clearance O.K. for -
NOTE:
&6116� / -E #S
Environmental Health Specialist
8/96
Z-77
Date
BUTTE COUNTY FNNpf
RMIT
DEPARTMENT OF DEVELOPMENT SERVICES ��.5.9j _BUILDING PERMIT APPLICATIONOOr)6r`AND SUBMITTAL REQUIREMENTS a24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICA TION
BIN �;ij
Website: www.buttecounty.neUdds
-
"PLEASE PRINT. CLEARLY**
OWNER
Last Name n40-TQt('-144 ] r
irst Name
ON
Address (Sol V -t H bIL
City C-14 (co State CA
Phone (. I ` Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
PAIU
Address
Address
City
j_ j00[�
Tstate
Zip
Phone
State A
Fax
E-mail
Z¢3
Lic. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
PAIU
, P6 e,1 1 E_
Address
2v f-Ay
tZ Dr -
city
C H (co
!!LPae
State A
Zip
Phones,.
Z¢3
Fax r�
E-mail
State License Number
�-
C - 4 Z.Ot4-Fe
APPLICANT NAME
Name
Address 3 S 'per
City
Stat
SRJ Yes j
Phone 591+Oi1`
Fax
E-mail
/ ; P41CANTSIGNATURE
For offWe use only:
Zonin
Property AddressCity
(S01 C9U PK
Flood Zone
I
SRJ Yes j
No
Occ.
Type Const.
Subdivision Name Map
!!LPae
LENDING AGENCY
Lot #
Planner
Date Approved:
LOCATION
AP# ?.27'30
Property AddressCity
(S01 C9U PK
c.t�r co
Cross Street
S lC K- wis 7 -
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
Description or Scope of Work:
Sq. Footage
O 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.
j.
Received by` Amount: a7 ` _7
se G a
!,,(f Q��1 "��j SRA .
Receipt #: 14 ` U ° 8 Sheriff
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OVER FOR SUBMI I I AL MtUU1Mr-1V1r-N t J
K•\Fr)RMS\BUILDING FORMS\BldgApPISubRgmts.doc Page 1 of 2
Date: /_�
Total
KLV /-L/-V'+
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 .at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will
be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the
proposed ro erty improvement :YES M NO[ ].
2. I HAVEM HAVE NOT[ ] sig �e an application for a building permit for the
proposed *61k.
3. I have contracted with. the following p on (firm) to provide the proposed
construction:
NAME: '"r(Drn
ADDRESS: le -"3 crl 1? _ CITY: L 60
PHONE: CONTRACTOR'S LICENSE NO. d
4. I plan to provide portions of this work, but I have hired the following ' person-fo
coordinate, supervise, and provide the major work:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated: =
NAME ADDRESS PHONE TYPE OF WORK
SIGNED: I / TE
PROPERTY OWNER:
SOCIAL SECURITY NUMBER: -
Ago
DATE: / 0-- ;� 6 — 0
NOTE: This owner -Builder Verification is required by Section 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.
OVER
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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
One form per Building)
School District ! C H ( D
A.P. Number — yL. 3-0 Jurisdicti n: City
Property Owner 1�, ��✓ �N«fir /�/J
Property Location/Address ?j Cees Lj t7 r.J
Subdivision
Residential Development
r
X
No o+ Living
MobileHome
Units
Installation
Building Department No.
�Gounty
r
Lot No.
C6C
................................................... .................................................................
;
Sq. Footage Z
Addition/ *Supplemental to (Group R)
Conversion Permit #
'(No foundation inspection);
Commercial/Industrial O Sq. Footage
New Addition (Including Exterior
Roofed Areas)
_Buildng fje ent Representative Date x
Irioor mans, reviewea Dy acnooi uistnct rersonneo
District Identification No.
School District certifies that
Address) ` nn ll
/I A /'*
(City)"
has complied with the requirements of Resolution No.
representing (�5 square feet.
t.
kie J ,
School District Representative
Paid by Check N , Remarks:
(Applicant) s
[J
(Phone Number)
(State) (Zip Code)
7/ O %QCJQ' by payment of $ L4
AB 2926 S
FULL MITIGATION b
i1 3d Q
Date
'Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEGA),
i
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow'(building department), Pink (school district) feeform.xls (10/961dmm
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