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HomeMy WebLinkAbout021-080-076'r7(, 021-080-076 PERMIT#95-2189 SPENCER, Betty p , 1880 Laurel, Gridley MOg e` - Cont; Ely Roofing Reroof/SF M HIM on i • i i e4wd*Of . ✓ Ufte. OROVILL.E, CALIFORNIA GENERAL CLAIM CLAIMANT: Ely Roofing Inc ADDRESS: 13291 Contractors Dr CITY & STATE: Chico CA 95973 IMPORTANT: SEE INSTRUCTIONS DATE OF CLAIM: 18 Sept 1995 ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT 9-18-95 Building permit for roofing at 1880 Laurel - Gridley 128 00 Butte Co clerical error. TOTAL 128"00 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Dated this 18 t h day of .......�5»e t 199 5. .................................. ............ • ....... Calif.et................................• Calif .. .. .. .. .. .. ......... ........ Signature of Claimant orifled.,above ve be n performed or de- I, the undersigned, hereby certify that. to the best of my knowledge, the services or arUzfr and that there is a Budget ApproprlationO or Specific Boerd ApprovalO (Checko eu e. I �- Dated this...... 19TH .................. da ,r SEPTEMBER 19 95at OROVILLE caur�Y .......................... ..... .............................. . ........ ... . ............... ... ......... ........» .............artment ead or, Authorized Deputy cde ......440-002 ................. Code.........4210500.................PAYABLE FROM ..... CONSTR.dCTION PERMITS.............. .... FUND DO NOT WRITE BELOW THIS LINE — AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. CLAIMANT'S NAME MAILING ADDRESS REFUND CLAIM APPLICATION ASSESSOR PARCEL Vo PERMIT # RECEIPT NUMBER (S)l71 Request a refund of fees paid on the above receipt number(s) for the following reasons: �J} Please refund any apvlicable fees in the following catecoriev. (Check those categories which.you wish to have refunded.) Building Permiit Fees [ ] Sheriff Fees [ ] SRA Fee (CDF Fire Planning) [ ]. Urban Area Fees Disposition [ ] of plans: Plans returned to me at counter. [ ] Please mail plans to me at above address. [ ] Please dispose of plans. r SIGNATURE DATE FOR BUILDING DIVISION USE: 0 Receipt Information: Number: Date: Issued To: Amount: $ a _ 6 c) Fees Retained: Processing Fee: $ Bldg Filing Fee $ Plbg Filing Fee $ Elec Filing Fee $ Mech Filing Fee $ Energy P/C Fee $ Plan Check Fee $ Inspection Fee $ Total Amount Retained $ TOTAL REFUND DUE 9//-3 r COUNTY OF BUTTE - DEPARTM'9NT OF DEVELOPMENT SERVICES - BUILDING DIVISI 7 County Center Drive - doville, California 95965 - Telephone (916) 538-754 MIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 021-080-076 ZONING BUILDING PERMIT DBett Spencer 846-3745 SO. FT. OCC. BUILDING VALUATION 600 8050 OWNERS MAILING ADDRESS PO Box 368 Gridley CA 95948 CONTRACTOR'S NAME Ely Roofing Inc TELEPHONE 343-7663 CONTRACTORS MAILING ADDRESS 13291 Contractors DM Chico CA 95973 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAIUNG ADDRESS Permit Fee $ 108.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADORESS 1880 Laurel — Gridley PERMITFEE $ PLUMBINGPERMIT 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 ZI 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: remove & replace roofing w/ lite tile - 46 s q s Mobile Home I S 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 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 C -1 , C - 3 9 Lic. No. 607386 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for 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 OR ADDNS. ( a ACC. BLDS. ) SO. 3.50 FT. NEW CONST./ MULTI.OUTLET NON-RESID. \ BRANCH CIRCUITS ) @7.50 ( & SIPOWER APPARATUS ) NGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES ) 20 @ 1.00 LCL �° Ex. Occup. (ouFIXED APPLNS. TLErsjR s D.� Fa) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor 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 is issued. Al 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 State Fund MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number 538-148 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 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 s. forthwith complyiRIZI X �,CeiC-eC� Date _ 9-6-95 Signatilre of Applicant - ❑ Owner a 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 Is Energy Inspection Fee is ocC CONST. TYPE TOTAL FEE $ 128.00 HAZ. I D. FEES I IMP I FLOOD CDF pARC0. PD HD ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have B applicable provisions Resolutions to do work been paid. Date a 1111 (Datf) Receipt No.PERMITEXPIRESON WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE- DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASSESSORPARCELNU MISER 021-080-076 ZONING BUILDING PERMIT OWNER Sett Spencer TELEPHONE 846-3745 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS PO Box 368 Gridley CA 95948 00 8050 CONTRACTOR'S NAME Elv Roofing Inc TELEPHONE 343-7663 CONTRACTORS MAILING ADDRESS 13291 Contractors Dr Chico CA 95973 Fireplace CONSTRUCTION LENDER UNMOWN Total Valuation s LENDER'S MAILING ADDRESS - Filing Fee $ 20.00 Permit Fee $ 108.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee '$ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Energy Plan Checking Fee $ Penalty $ BUIL.DINGADDREss 1880 Laurel — Gridley PERMITFEE $ PLUMBINGPERMIT Fling Fee 20.00 Each Trap 7.00 LAT NO. SUBDIVISIONS NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF 10 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 remove & replace roofing W� Describe Work: p g lite tile - 4 6 S q S Mobile Home I S I GI W @20.00 PERMITFEE s Contractor ELECTRICAL PERMIT Filino Fee 20:00 Mein Service( eoev OR LESS 200A OR LESS 23.00 Main Service ( 20*A To L000A ) 46.00 LICENSED CONTRACTOR'S 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 II force and effect. License Class C -1 C - 3 9 Lic. No. 607386 OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for 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 OR ADONS. & ACC. BIDS. ) sO. 3.50 FT. NEW CONST. MULTI.OUTLET NON•RESID. ( BRANCH CIRCUITS ) @7.50 ( IWC APPARATUS 6 SINGLE OUTLET C10. ) Ex. Occup. OUTLET OR FIXTURES 20 ® L.00 BALM '50 Ex. Occup. (O� �a D 02, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor 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 is issued. jV I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' comnsation �isuragce carrier and policy number are: I Carrier t a t er'Und Policy Number 538-148 (rhe above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 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 wit se provisions. X Date 9`6=95 Signat a of Applicant - ❑ Owner a[ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories In height MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE s Contractor Mobile Home Installation Fee s - Energy Inspection Fee s occ CONST. TYPE TOTAL FEE $ 128.00 HAZY 1 D. FEES I IMP I FLOOD CDF PARCEL PD HD ISsuE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have BY PERMITEXPIRES ON applicable provisions Resolutions to do work been paid. Date (Date) Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF • BUTTE 185355, OF RECEIPT C ORD AR E ISSUING FEC PT A9 1 Received from The Sum of Fo,,�MA -* at Received: D ©� V Received ByLVA�--� CASH Title CHECK j9 By . OAVOO BUSINESS FORMS • (918) 7438511 • .. it I