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021-050-015
- 021-050-015 94—'1'108E/� SCOLLAN, & SC,OLLAN ...�__ 1400 Ld e7LIBERTY RD , �GRIDLEY,�/"1 /�• CONT;:yBERRYFELECTRIC RELOCATE ELE.SER/SF 021-05050-015 06-1522' WILEY;,THOMAS r • _ _ 1400 W LIBERTY RD, GRIDLEY , - Cont -`OWNER y ° ELEC RE -CONNECT, v v - . Butte County Department of Development Services ur aitFa NOTES 7 County Center Drive, Oroviile, CA 95965 .. , (530) 538-7601. t www. byttgcounty. neVdd s • ' RESIDENTIA-L ' BELECRE—CONNECT 06-152 APN:S } Pitl11146 OMA .,,;,.`. GRIDLEY ' r OwnerERTY RD, i e ' Y _ i ( ER ' Site Add } Contractor. ' • j Type of Permit: > OFFICE COPY Address GAS Meter By Date 'ELECTRIC Meter By.(,— Date ' 1. _ .- ' -SPECIAL CONDITIONS CHECKED BY Q SRA - + Q FLOOD CERTIFICATE EQUIRED Q FIRE SPRINKLERS REQUIRED Q SPECIAL INSPECTION ITEMS Q VERIFY ' Q USE PERMIT CONDITIONS Q SUBSTANDARD HOUSING LETTER Q ENCROACHMENT PERMIT Q REINSPECTION FEE PAID 0 ENV HLTH CLEARANCE s " DATE JOB+FINALED / * ISIGNATURE: mti • `- iyTY ' -SPECIAL CONDITIONS CHECKED BY Q SRA - + Q FLOOD CERTIFICATE EQUIRED Q FIRE SPRINKLERS REQUIRED Q SPECIAL INSPECTION ITEMS Q VERIFY ' Q USE PERMIT CONDITIONS Q SUBSTANDARD HOUSING LETTER Q ENCROACHMENT PERMIT Q REINSPECTION FEE PAID 0 ENV HLTH CLEARANCE s " DATE JOB+FINALED / * ISIGNATURE: mti • 0 Not OK RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR DATE IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Gmd Fig Dp!h 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Fig Garage; SoilsSteel-Elec Grnd Ftg Dpth 55 DWV; Test Fittings & Anchr. Nail -Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First fir -Tub Acc 5 Stemwalis Wain; Steel-Blockouts-Wrapped 57 Test Tub & Shwr, 2nd fir - Tub Acc 6 Stemwalls Garage; Steel-Blockouts Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas.Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12. Elec Undrgrnd DATE IM E C H A N"I C A L 13 Plenums & Ducts; Cirnc-MaterialSupport4nsultn 61 AC Ducts Insultri & Support ' • 14 GirdersSills-SillsBolts-Joists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn 15 Acc & Vntttn 63 Condensate Drain & Ovrfiw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc 8 Pitfrin If Furnace in attic DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE FINAL 18 Walls Studs-Nallirig Spacing & Braces -Plates -Sound 66 Ext Steps -Door & SldeLt Prtctn-Landings 19 Bearing Walls over Girders .& fir Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof)" 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr 21 Fire Stops, :Furred ceilingsStairs-Chasers-Tubs In Garage; abv-flr-Ducts-Mech Prtctn 22 Headers & Bea" &"Bearing" "69 Bedroom Exiting 23 Hangers-Posf"Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rttr Ties-Purlin-Roof Brac TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue=Frpic Throat Clmc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz & Rmz Pitctn-braIt Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or kitting DoorsSill Ht & Dimensions 74 Frplc or Stove, Clmc-Hearth 28 Garage Fire Prtctri Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int &Ext 29 Prprty Line Firewall & Opngs " " 76 Ktchn, Fxtr & Appinc; GmdAir-Gap-Cooking Clrnc 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landirig-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Gutrgrs 79 AC Duct in Garage -Damper. 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-Cimc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls In Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wali pnls 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps " 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 Clrnc Dmge Planters ❑ Yes ❑ No opo �_1�do �� 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Pimb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd DATE ELECTRICAL 40 Fxtr & Trnsfrmr Clrncdns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 VnUtn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Irispctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga ❑ CU orDAL .98 Address Posted AC Wire Sz ya ❑ CU or ❑AL 99 Fire Sprinkler 48 Range Ckc pa ❑ CU or ❑ AL Oven Circ oa ❑ CU or DAL Insulated Neutral ❑Yes F-1 No VO 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Cirncs pnis-Motors-Mech Eqp 51 Clothes Closet LtShwr Lt -Spa Lt 52 Smoke Detector o=OK 0 - Not OK. >` MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 ZoningSetbacks-Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FaIUC/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Gmd .Amp -Concrete 6 Yard Gas; Loctn-Test Wrap Nat ❑ or LPO Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Cimcs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD LabeUlnsignia Numbers Serial Numbers --DATE D E C KS -C O V E R S'C A R P O R T S'G A R A G E S 1 Zoning -Setbacks -Easements 2 Ftgs; SoilsSz-DpthSpacing-CnnctrsSteel 3 Decks, Glyders/Jolsts-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs-CnnctrsShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs 6 Carports; Wndws-Doors T Electric 8 Frmg; Sills-AnchrsStuds-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wail pnls DATE JPOOLS 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 EIec.Ericlsrs; Conduit Entries Terminals -Listed 7"Elec Banding; Metal w/5'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes-En6lsrs-66lb6ards4nsultn 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 cY 0`� o'er It Pool Drawing ,r- COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive * Oroville, CA 9 (530) 538-7541 CORRECTION NOTICE 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 call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector as indicated below. F_ � K4 4W 4 Date Inspector -5 REV 4/05 Phone # - FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 a 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. BP061522 B. C. Building Permit 01-16-04 pg 1 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: 06/23/2006 APN: 021-050-015-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 1400 W LIBERTY RD GRI Map Index: Date: Contractor: Description: RECONNECT ELECTRIC FOR WELL ONLY 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: WILEY, THOMAS AND MERIDEE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 12830 CARSON HWY 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 FALLON, NV she is exempt therefrom and the basis for the alleged exemption. Any 89406 violation of Section 7031.5 by any applicant for a permit subjects the 775-867-2399 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 Code: The Contractors' State License Law does not apply to an Applicant: WILEY, THOMAS AND MERIDEE 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 12830 CARSON HWY sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of FALLON, NV proving that he or she.did not build or improve for the purpose of 89406 sale.). 775-867-2399 ❑ I, as owner of the property, am exclusively contracting with licensed. contractors to construct the project (Sec. 7044, Business _ and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: ❑ I am Exempt under Article 3 of a Business and Professions Code r —1-3G Date: Owner.lls 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 License #: 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 Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy #: I certify that in the performance of the work for which this permit is Valuation: $0.00 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. Date: -Z 3.-0 6 ApplicariL, CX 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 of compensation, damages as provided for in Section 3706 of the Labor��(��� �^ code, interest, and attorney's fees. J CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable -provisions of the Butie County Code and/or I hereby affirm that there is a construction lending agency for the the for which this is issued (Sec 3097 Civ.) Resolutions to do in icated a ve for which fees have been paid. performance of work permit BY:Date: Name: 'U ' PERMIT 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 of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. d f►'11�CS ' 1/e'l 1-J/ 1e- Signature - Print Name: r r (0 Date: Date: Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 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 OFAPPLICATION - Website: www.buttecbunty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name ` , i .� first mag Address , 1 Z B 3 0' Ca�s� � f -1-w• . City I o� City State Zip 9 yo Phone, 5 SG7 y3 �lQ Fax, ,7 5- E -mail • Co De // /Lonc"ia✓� . rt,e,7'". / 1 F ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone LENDING AGENCY 77 City' E-mail Planner State License Number Pho- E-mail APPLICANT INFORMATION ' ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone LENDING AGENCY Fax E-mail Planner State License Number APPLICANT INFORMATION ' Name boner Address City State Zip Phone Fax E-mail PERMIT " NO. BP ; BIN # PROJECT LOCATION AP# Property Address - ( H 0 0 tJ- L � be-,- (U C' '�/ r�JU Cross Street 7: 17 6 SRA 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. Subdivision Name Map LENDING AGENCY Name Address - t Description or SpRe of Work- Sq FT- Living Garage Open ` Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy ' (Note previous use): EXPIRATION OF'A"PPLICATION 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 1 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 APPLICANT SIGNATURE ` refundable. - X For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const. Subdivision Name Map Book PageLot # Planner Date Approved: Received b : Amount: 515j Bldg SRA a Receipt #: Sheriff. SMIP r f Other Dat : I � � • OVER FOR SUBMITTAL REQUIREMENTS L Total K \Ff1RMC\RI III IIIN(: F(1Rt•AC\RIrinAnnlCihRnmtc tint. Paoe 1 of 2 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 neededto 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.) f �_` ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. L ❑ 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 KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 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 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 material for construction of this proposed property improvement: YES ] NO[ ]. , 2. I HAVE [x ] HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. .I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: 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: PROPERTY OWNER: DATE: - 6 ;Z3=0,6 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. Rev'd 11/4/2004 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile www.buttecounty.net/dds OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner-builder" 'building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to -be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321-CSLB (2752) or by accessing their website at www.CSLB.ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, -A-PRIW, Scott Rutherford �I Manager, Building Division NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. 021-050-015',-",14"' 9411,10SE SCOLLAN-.&'SCOLLAN,I, t 1400.-W. LIBERTY kb,.',. GRIDLEY: CONT; BERRY ELECTRIC RELOCATE ELE I. ER% 7" OFFICE Cop , dress w- eter v' —'k" L12L'- Date e'ELECTRJC� Meter Date J, U i lc % A- / . tn. '{ �. .,,.aN�'..i".•aq: '��_�„ .. r�;,,,...1 "'T' .- r ... , R " F+�-_'T.'h7 w�' _Firms^-��'TR ^. .M^ � !'s9C:.i +f a COUNTY UNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION 71County Center Drive - Oroville, California 95965 - Telephone 1916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 021-050415 ZONING A40 BUILDING PERMIT OWNER SCOLLAN & SCOLLAN TELEPHONE SQ. FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 3130 AMERICAN RIVER DR SAM, 95864 CONTRACTOR'S NAME BERRY ELECTRIC TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 14U0 W. LIBERTY RD PERMIT FEE $ GRIDLEY PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15.00 Each gas water heater or vent 15.00 USE OF STRUCTURE SF 8XDuplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer~ 15.00 Mobile Home S G I W @20.00 TYPE OF WORK New O Addition O Remodel ❑ Utilities ❑ InstallatiorJq0 Other ❑ RELOCATE SERVICE Describe Work: PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service 1 800V OR LELESS SS ) 200A OR 23.00 23.00 Main Service 1 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. 1 8 ACC. BLDS. ) SD, 3.5C FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions C e and my license is in full force and effect. License No. C/ Classification ('-/U ❑ I, as the owner, 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) O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ I am exempt under Sec. Business and Professions Code for this reason NEW CONST. MULTI -OUTLET -NON -RESID. 1 BRANCH CIRCUITS ) @7.50 1 POWER APPARATUS ) 8 SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BA2001.00 00 Ex. Occup.FIxEDAPPNS.Ofl ( OUTLETS (RESID.) EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 .23,00 PRE INSPEr. WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): -0"This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. -n -I shall not employany person in any mannerso asto become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or'this permit will be revoked. PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. 1 agree to comply to all Butte County Ordinances and California 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 against said County in consequence of the granting of this permit. X ,4C--� l A , Date y-�a ' 9q Signature of Applicant - ❑ OWPIer a Contractor ❑ Agent 1 An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ t occ CONST. TYPE TOTAL FEE $ 8900 HAZ. I D. FEES I IMP I FLQfJ(Z JLfj CDF PARCEL P) HD ISSUE v 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. By C11 PERMIT EXPIRES ON lDetel 162398 ReceiptNo. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 021-05.0-015 94-1 108E' SCOLLAN & SCOLLAN 1400 W. LIBERTY RD-,.GRIDLEY CONT; BERRY ELECTRIC RELOCATE ELE SER/SF 021-050-015 94-1108E SCOLLAN & SCOLLAN 1400 W. LIBERTY RD., GRIDLEY CONT; BERRY ELECTRIC RELOCATE ELE SER/SF COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 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 J11 - CORRECTION NOTICE 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 a planation, please contact this office immediately. Date REV 10192 is )65 1,9- Inspector !oFe'#717 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 -Telepho4.ne (916) 538-7541 PERMIT No. APPLICATION AND, PERMIT ��- ASSESSOR PARCEL NUMBER 021-050-015 ZONING A40 BUILDING PERMIT OWNER SCOLLAN & SCOLLAN TELEPHONE SQ. FT. OCC. BUILDING VAL ATION OWNER'S MAILING ADDRESS 3130 AMERICAN RIVER DR SACTO, 95864 CONTRACTOR'S NAME BERRY ELECTRIC TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 1400 W. LIBERTY RD PERMIT FEE $ GRIDLEY PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF NX Duplex O Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 TYPE OF WORK New O Addition O Remodel ❑ Utilities O Installation, Other ❑ Describework: RELOCATE SERVICE PERMIT FEE 1 $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( BOOv OR LESS ) 200A OR LESS 23.00 23,00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. OLDS. ) 3.50 FT.Sp, CONTRACTORS LICENSE LAW( I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Coq a and my license is in full force and effect. License No. r Classification ()-%O O I, as the owner, or my etnployees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec 7044) O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 1 am exempt under Sec. Business and Professions Code93-00 forthis reason NEW CONST. MULTI -OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BAL. @ 1:0500 Ex. Occup.FIXED APPLNS. OR (OUTLETS IRESID.1 EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE TNSRRC 23 00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): -WThis permit is for $100.00 (valuation) or less. O 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. -ffTshall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ - 89 00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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. 1 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. X C Date y -oto 9y Signature of Applicant O 0 8 -Contractor El Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ocC CONST. TYPETOTAL FEE $ I 89.00 HAZ• I D. FEES I IMP I FLOODCDF XX PARCEL PD HD ISSUE 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. / Q By 4Dat 2 V PERMIT EXPIRES ON 2 9s, (Dat I ReceiptNo. 162398 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER Q 1 -- 1/ l 0 20 `g0 7 BUILDING PERMIT o111p w TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWN S M ING ADDRESS �A-J 4 CON7F NAME kT ,�+ PHONE r S CONTRACTOR'S mmia4 ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS he Wd , f PERMIT FEE $ r; elC PLUMBING PERMIT Filing Fee 20.00 Each Trap 7,00 Solar or heat pump water heater 23.00 - Water piping 15.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SFT Duplex ❑ Mobilehome O Other SPECIFY Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W @20.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other I Describe Work: Re lip �'— �� C N lJ f �� PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( `'011 Less ) 200A OR LESS 23.00 Main Service ( 200A TO IOOOA ) 46.00 NEW CONST. DWELLING OCC UP. OR ADONS. ( & ACC. BLOS. ) S0. 3.50 FT, CONTRACTORS LICENSE LAW( I declare under penalty of perjury (check one) ,0-1 am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Co a and my license is in full force and effect. License No. e�%[l %7U Classification `-/� ❑ I, as the owner,o— r�ployees with wages as their sole compensation, 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 contractors. (Sec 7044) ❑ I am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET •NON-RESID. ( BRANCH CIRCUITS ) @7.50 POWER APPARATUS ) a SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BA20 @ 1.000 Ex. Occup.FIXED (REST .OR (OUTLETS RESID.) EA. ) ^ 5•CD Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 t90 I t e. Insly V WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Cie tificate of Consent to Self -insure. I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. ERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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 against said County in consequence of the granting of this permit. X A aALA— Date /- aCJ-91/ Signature of'Applicant -4TOwner ©'C-ontractor ❑Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ - Q MAz• I D. FEES I IMP I F.LOo COF PARCEL PD HD ISSUE 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. By Date PERMIT EXPIRES ON /Dere/ Receipt No. WHITE-D.D.S.-B.D. CANARY -AS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 96,965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER SCO C-C�(16? A P. o. Proposed Building Use Ci C r �C S Building Inspector Date C� At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3_ Complete plans, 3/4 sets, signed by preparer of plans . ..................... . .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5.. Hazardous Material Form . .............................................. ............ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ .......................................... 11. Impact fees as shown on attached schedule. ............................. . 12. California Department of Forestry plan approval/fees. ........................ . 13. Flood elevation letter (100 year flood) by California Engineer ................... 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit. ......................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (constructj'on approval required prior to occupancy). . . 20. Pre -inspection for (� (�- C r i required. .. to Build 9 �spector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . ..................... ..... . 23. Owner -Builder Verification (Given to owner , Mail to owner ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. Letter of intent on building use . ........................................ . 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access. ...... 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When .you issue the t, process as follows: Mail to wner. Mail to contractor. Telephone - / S S i and hold for pickup at r o office. Deliver with inspector. Other Parcel Creation Acreage Applicant - Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works PRE-INSPECTI%O/N �[ / OWNER: ✓� . �C O / (C� 6� DATE " ((� o LOCATION: 1 "l"OC� �• l_: ber c(� rJlh A. P. # U CONTRACTOR: C P t C .(-ll T t C.- ZONING PRE -INSPECTION FOR: r iJ DATE TO INSPECTOR - -tt A:�, PERMIT HISTORY: NONE AS FOLLOWS: TYPE OF OCCUPANCY -----------------------------------------=------------------------------------------- ------------------------------------------------------------------------------------- FIELD - INFORMATION BUILDING USAGE: TENNANT: [� OCCUPIED F__] HEATED -COOLED OTHER COMMENTS: ACTION RECOMMENDED: ISSUE OTHER: BY HAS ELECTRIC Q NAS GAS Q HAS SANITATION FACILITIES [-I PERSON CONTACTED HOLD FOR ;64 DATE s COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES•- BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASSESSOR PA7ELNLWKR IDS-. Q 1 -- t1pI/ 15 ZD" 0 1q V BUILDING PERMIT pyy CMCJ Q TELEPHONE SO. FT. OCC. BUILDING VALUATION OWN 9 MAI O ADORE39 CONTRAAME PHONE r� r' S CONTRACTOR'S MAIL04 ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ tENoen•s MauNc ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ SUILORNG ADDRESS PERMIT FEE $ C PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 - Water piping 15.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF/)�i Duplex ❑ Mobilehome O Other sPECIFr Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 TYPE OF WORK New O Addition O Remodel ❑ Utilities O Installation O Other Describe Work: P l O (2- V- LJ 1, �� PERMIT FEE $ Contractor ELECTRICAL PERMIT Fling Fee 20.00 Main Service ( "OR LESS ) 200A OR LESS 23.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 6 ACC. SLOS. ) 3.5C FTSO . NEW CONST. MULTI.OUTLET •NON.RESID. ( BRANCH CIRCUITS ) @7.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) -O'l am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. .Q9,,1 ' 77 LI Classification C -!L - ❑ I, as the owner, 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) O 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 1 am exempt under Sec. , Business and Professions Code for this reason ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) SL.@1:60 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA. ) ( - 5.00 Temporary Service 28,00 Mobile Home Facilities 20,00 Misc. Wiring . 23 OO tip Fte -T WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): O This permit is for $100.00 (valuation) or less. O 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Cie tificate of Consent to Self -insure. shall not employ any person in any manner so as to become subject to -the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. 'PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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. 1 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. X Date c , 1 l�O__ d(- -��/ n ature of --0 i o Signature 'Applicant --0wner O"- ntractor O Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. . Mobile Home Installation Fee $ Energy Inspection Fee $ occ cONST. TYPE TOTAL FEE $ HAZ• 1 O. FEES IMP I FLOG COG PARCEL PD NO ISSUE This permit is hereby issued under the applicable provisions of the Butte Count y Code and/or Resolutions to do work indicated above for which fees have been paid. By Date PERMIT EXPIRES ON (Dare) Receipt No. 013 m:::: WHITE-O.D.S.-B.D. CANARY -AS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 . 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 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Date: Contractor: 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 to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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 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 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.). O I, as owner of the property, am exclusively contracting with licensed. contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of a Business and Professions Code r Date: Lil —a I owner°, / Q` - 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 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: Policy #: 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 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. Date: -Z3 —U 6 Applican L 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 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 performance of the work for which this permit is issued (Sec 3097 Civ.) Name: Address: PERMIT NO. BP061522 Issued Date: 06/23/2006 APN: 021-050-015-000 Site Address: 1400 W LIBERTY RD GRI Map Index:. Description: RECONNECT ELECTRIC FOR WELL ONLY Owner: WILEY, THOMAS AND MERIDEE 12830 CARSON HWY FALLON, NV 89406 775-867-2399 Applicant: WILEY, THOMAS AND MERIDEE 12830 CARSON HWY FALLON, NV 89406 775-867-2399 Contractor: License #: Architect: Engineer: otal Square Ft: 0 S. F. Valuation:' $0.00 Census Code: s hereby -issued under the applicable provisions of the Butte County Code and/or, to do in (sated abgve for which fees have been paid. ~ "j %� neo: `-'� •U'� 6 � . PERMIT EXPIRES Cl 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. Cl Notification in accordance with Section 19627.5 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. I hereby authorize.repree6ee"nttatives of Butte County to enter upon the above mentioned property for inspection purposes / Print Name: r f��Qs`' v r 1� Signature: Date:�'�`— Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-34 pg 1