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HomeMy WebLinkAbout017-300-0244 i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds ERMIT NO. BP042569 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: 09/02/2004 APN: 011-680-024-000 the Business and Professions Code, and my license is in full force and effect. License Class : 7`✓ y3�/S License Number: AsGSD Site Address: Date: '11210!Z Contractor � ��� 6G4�ee7XIC. Map Index: Description: replace meter well OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the pge community` Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: MIK ASSOCIATES permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a X P O BOX 1477 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 95927 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).): ( 1-1 r-_ -L( 2115C,k� ❑ 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: MIK ASSOCIATES 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 -builder will have the burden of proving that he or she did not build or improve for the purpose of r 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: CHICO ELECTRIC 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.). 36 WEST EATON ROAD ❑ I am Exempt under Article 3 of the Business and Professions Code CHICO, CA 95973 (530) 891-1933 Date: Owner: I License M 454345 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑, 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: 1 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: ��%�- �'t'� C' Total Square F1 OFFICE COPY ValuatiolI address Census CodE . Policy #: 077 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 GAS become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' Meter By Date compensation provisions of Section 3700 of the Labor Code, 1 shall ELECTRI forthwith com ly with those provisions. Mete f By Date l� Date. —/ Applicant: y WARNING: F ure 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 s provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This er'ti i 's hereb issued under the applicable provisions of ihe`Bntte Caunty Coda anrtlor, --- I hereby affirm that there is a construction lending agency for the Re ns do ork indicated aboe for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) BY Date: Name: S PERMIT EXPI E ON: Address: 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 & 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 cored, 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 of Butte County. I hereby authorize representatives of ButtefaQunty to enter upon the above mentioned property for inspection purposes. fV'11-� Print Name: t��l'c�Gss tJ�'AGy�•9 �'X Signature:___/'/', Date: 0 Owner 0 Contractor 0 Agent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP042569 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: 09/02/2004 APN: 011-680-024-000 the Business and Professions Code, and my license is in full force and effect. // w-,G S As License Class : �TSy3c�License Number: C�i� Site Address: �LIJIlz— Date: `% Contractor. 01&e -D Map Index: Description: replace a meter community w p P p9 ty ell 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 permit to construct, alter, improve, demolish, or repair any structure, prior Owner: MIK ASSOCIATES to its issuance, also requires the applicant for such permit to file a P O BOX 1477 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 95927 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: MIK ASSOCIATES 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 -builder will have the burden of 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 contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor:. CHICO ELECTRIC 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.). 36 WEST EATON ROAD ❑ I am Exempt under Article 3 of the Business and Professions Code CHICO, CA 95973 (530) 891-1933 Date: Owner: License #: 454345 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 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 Architect: is issued. Engineer: . 1 have and will maintain workers' compensation insurance, as 2i 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: - Ct�r' Total Square Ft: 0 S.F. ,fes- Policy#: 071Z 00001612- Valuation: $0.00 Census Code: 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 Section 3700 of the Labor Code, I shall forthwith com ly with those provisions. Date: o Applicant: WARNING: F ure 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 This e ' 's hereb issued under the applicable provisions of the Butte County Coda anril I hereby affirm that there is a construction lending agency for the Re ns do ork indicated abo a for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By Date: 4 Address: PERMIT EXPI E ON: 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 & 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 of Butte County. 1 hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: J"I'yilnSignature: Date: 0 Owner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor MIR) BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" - NameGc��ZiC- Address .. State �� Zip 757'7 3 Phon 530 8W—'!f'33 CONTRACTOR NameGc��ZiC- Address City �„�Co State �� Zip 757'7 3 Phon 530 8W—'!f'33 Fax X30) 5W--4-➢Y E-mail Lic. #k/5y y5- Class, AP LICANT SIGNATURE X Zl--? 9Z�_ I For offs use only: ARCHITECT/ENGINEER Name City_ Address 4,,)657- ,J657-City City I Y—es—F State Zip Phone Type Const Fax E-mail Map Book State License Number AP LICANT SIGNATURE X Zl--? 9Z�_ I For offs use only: APPLICANT NAME Name City_ Address 3 4,,)657- ,J657-City City ( )0_eO I Y—es—F State �.� zjp95�7 3 Phone S9(!1 Type Const Fax E-mail Map Book AP LICANT SIGNATURE X Zl--? 9Z�_ I For offs use only: AP# 0//-(080-02L-/- 0ao Zoning City_ Flood Zone SRA SRA I Y—es—F No Occ. LENDING AGENCY-,- GENCYName Type Const Subdivision Name ' Total Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. B BIN # LOCATION AP# 0//-(080-02L-/- 0ao Property Address 447,-- - City_ Cross Street SRA WORKER'S COMPENSATION Policy Number • 2'? Z. --D 000-59 2 - Carrier Carrier STsr If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY-,- GENCYName Name Address Description or Scope of Work: R'&PLLr-eE 106845 Sq. Footage 0 Structure Built without Permits 0 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. KAFORMSWILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 7-27-04 Received by: Amount: l Bldg _Wy SRA Receipt #: Sheriff SMTP Date: Other ' Total KAFORMSWILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 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 t permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND /N 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 faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) Y� ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. Ia *;, ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Flo;r Plan, (D) Tie'down or fnd plans, all in duplicate. �- ❑ 7. Metal bld s: A Metal Bldg Plans, ' �''' 9 () g (B) Fnd plans and calcs in triplicate, (C) Elevations irittriplicate. (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. ❑ 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. ❑ 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 meTunos can oniy 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 KAFORMSOUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 BLUFFS SUB., PTN. NE 114 SEC. 3, T. 21 N. RIE M.D.B. &M. 1. 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