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BUTTE COUNTY PERMIT NO.
DEPARTMENT OF DEVELOPMENT SERVICES BP040576
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
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: 03/04/2004 APN • 021-260-039-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 1266 RICHINS AVE GRI
Date: Contractor.
Map Index:
Description: NEW ELECTRICAL SERVICE
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: ANTHONY JOSEPH LUIS
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
1266 RICHINS AVE.,
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
MARYSVI LLE CA 95901
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
t to a civil penalty of not more than five hundred dollars ($500).):
:71,
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: ANTHONY JOSEPH LUIS
Code: The Contractors' State License Law does not apply to an
PP
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 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:
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 the Business and Professions Code
Date: Owner:
License #:-_ =�=
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
i OFFICE COPY
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Architect: Address
is issued.
O 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
GAS Date
insurance carrier and policy number are:
Meter By
Carrier.
ELECTRIC D
rBY
Total Square Ft: � Meter By ,
Policy #:
Valuation: ,
❑ 1 certify that in the performance of the work for which this permit is
Census Code: �/ ^
issued, 1 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'
.J ////
compensation provisions action 3700 of the Labor Code, I shall
Q
forthwith comply those provisions.
p
Date:
_4�5w
/94
Applicant:
/, Cd
et CAT(:
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
This permit is ereby issued under the applicable provisions of the Butte County Code and/or
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.)^
Resol ons do work indicated o e for which fees have been paid.
Name:
BY Date:
Address:
PERMIT EXPIRES ON:
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 purpos s
�C L, ``' t s
Print Name: / Signature`
Date: 3 —,�AK
q3 Uwner ❑ Contractor ❑ 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 #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.neAdds
PERMIT NO.
BP040576
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: 03/04/2004 APN: 021-260-039-000
the Business and Professions Code, and my license is in full force and
effect.
License Mass : License Number:
Site Address: 1266 RICHINS AVE GRI
Date: Contractor.
Map Index:
Description: NEW ELECTRICAL SERVICE
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: ANTHONY JOSEPH LUIS
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
1266 RICHINS AVE.,
7000) of Division 3 of the Business and Professions Code) or that he or
MARYSVILLE CA 95901
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
t to a civil penalty of not more than five hundred dollars ($500).):
:71,
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: ANTHONY JOSEPH LUIS
pp
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
not apply to an owner of property who builds or improves thereon,
Contractor:
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 the Business and Professions Code
Date: Owner:
License #:
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
Architect:
is issued.
❑ I 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
❑ I certify that in the performance of the work for which this permit is
Census Code:
issued, 1 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:
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 of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is ereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resol ons7 do work indicated o e for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)_
1/_it ,E��
�l
Name:
BY Date: (J�
— 'Y +O S
Address:
PERMIT EXPIRES ON:
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.
Cl 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 to enter upon the above mentioned property for inspection purpos s
/Buttte'County
Print Name: �O 1 v(S Signatures (�f�
Date: 3 ""��i'� % 5
q2/Owner 13 Contractor ❑ Agent for Owner ❑ Agent for Contractor
I�
1
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 Jor labor and materials for construction of the proposed
property improvement: YES �� NO ❑
2. I HAVE 13 HAVE NOT 13 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: may:
PHONE: CONTRACTOR'S 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:
PHONE: CONTRACT'OR'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 WORD
SIGNED:
PROPERTYOWNER: A '
SOCIAL SECURITY NUMEEM
DATE:_ 3 _ o
NOTE: This Owner Builder Verification is required by Section 19831 and 19832 of the
California Health and Safety Coda This verification must be completed and
returned to our office before we are permitted to issue the permit.
OVER
oB_1.
.
I OWNER BUILDER INFORMATION
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified
For your protection, you should be aware that as "owner -builder" you are the responsible party ofrecord 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 you plan to subcontract, you should
be aware of the following information for your benefit and protection:
♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is S300'or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments 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.
♦ There may be financial risks for you if you do not cant' out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific information about your obligations under Federal Law, contract 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 contractors is to secure an "owner budder" building
pemmmk 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 contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters, The building permit will not be issued until the verification is returned.
J
ly,1 C. Vi ira, C.B.O.
er, Building Inspection
NOTE: This Owxer BuMderlxformation is required by Section 19930 of the California Health and Safety Code
OVER
r
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
0q(,�2�
DATE:
APN:ZONING:
eq r
NEAREST CROSS STREET:
TRACT/LOT#:
SITE ADDRESS: C
CITY, ZIP.
L
OWNER NAME: h fn
rZy2-'lO
�S�G-
STREET ADDRESS:
FAX
CITY, ZIP:�_ /y�
E-MAIL
APPLICANT NAME: U
rs
PHONE:-
HONESTREET
STREETADDRESS:
FAX:
CITY, ZIP:
E-MAIL
CONTRACTOR NAME:
PHONE
STREET ADDRESS:
FAX:
CRY, ZIP:
E-MAIL
LICENSE NUMBER:
LICENSE TYPE
ARCHITECT/ENGINEER NAME:
PHONE
STREET ADDRESS:
FAX:
CITY, ZIP:
UCENSE NUMBER
E-MAIL;
DESCRIPTION OR SCOPE OF WORK:
❑ 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 fees 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.
For office use only:
Notes:
Application Received by:clp Date:
Receipt number: 3650140 Amount Received: !`D . a�
(CJ 'T
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: A-1 f �) Q/-�( / , j r r jf0h / kt e 1/ C ASSESSOR PARCEL NUMBER
Proposed Building Use: X &) P 1p,- ! , S P /V Counter Technician: " Date: 3z -1-
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxes!
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. Energy compliance design and supporting documentation in duplicate.
❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
❑ 9. 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.
❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate
❑ 11. Site plan and business license approval from the City of Biggs
❑ 12. Letter of intent for non-residential buildings
❑ 13. Detached Accessory Building Form filled out by the owner
❑ 14. Hazardous Material Form
❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable.
❑ 16. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 17. Fire Sprinklers.:...........................................................................................
❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 19. Soils Report and/or Engineered Foundation required ........................................... .......
❑ 20. Erosion Control Plan Required........................................................................ ........
❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 22. City of Chico Plumbing permit........................................................................
❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: .............
❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check:
❑ 25. Contact Land Development about _ Improvements, _ Drainage .........................
❑ 26. NPDES Form.............................................................................................
❑ 27. Encroachment Permit for driveway from the Public Works Dept ...........................
p/ 28. Pre -Inspection for required.......
❑ 29. Contractor's license information. (Number, Name Style, Classification) ...................
❑ 30. Worker's Compensation Carrier and Policy Number ..........................................
❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................
❑ 32. Letter of Signature authorization....................................................................
❑ 33. Recorded copy of Agricultural Acknowledgment Statement .................................
❑ 34. Manufactured home utility clearance...............................................................
❑ 35. Existing violations and/or expired permits........................................................
❑ 36. Deed Restriction.........................................................................................
❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
❑ 38. Other:
❑ 39. Other:
When issued Telephone <- 0 S? F: /3 / h,oi and hold for pickup.
I have been informed of the above items and requirements for obtaining a building permit.
Applicants 6�c1�� Date: - D
1. Index permit application for the above items numbered: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: Date
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
PRE -INSPECTION REPORT
OWNER: A.? h on k / to & eoh L /l l S DATE: 3- (_-' a''7
LOCATION: �cr��lL(n 1 L° yl nS,�.� A:P. #
CONTRACTOR: �4 ZONING:
REASON FOR PRE -INSPECTION
DATE TO INSPECTOR:- PERMIT HISTORY ((,'NONE ( ) SEE ATTACHED
BUILDING INSPECTOR'S REPORT
Building Description:
Commercial/Usage:
Residential # of Units:
Currently Occupied { V)N/le s
AbandonedNacant:
Electric:
Electric Currently
Condition of Electric
Gas:
Currently
Condition dA /— -
Sanitation:
( ) No
( ) On ( WI/Off
l./tif F3 P -6t& Pc/
(&-)'On () Off
Plumbing Worldng ( ) Yes ( ) No
Obvious Sewage Problems ( ) Yes (0,f4o
ACTION RECOMMENDED: ISSUE
Mobile home # of Units:
a *C -)W/ � 640t440jeE5 T�a-1
Vs ( ) No
Insp
Date:
SKETCH BUILDINGS ON REVERSE AND INDICATE LOCATION ON PROPERTY.
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO.)
OFFICE #: (530) 538-7541
PERMIT NO.
ozj()
DATE
3- -d
APN:
ZONING:
s
NEAREST CROSS STREET:
TRACT/LOT#1
SITE ADDRESS: C Ale,
CITY, ZIP:
L
OWNER NAME:PHONE
_A r3 4hrnYl
636 -
STREET ADDRESS: %ter, -p
CITY, ZIP:
FAX:
E -ML:
APPLICANT NAME: U
Is
PHONE
STREET ADDRESS:
FAX:
CITY, ZIP:
E-MAIL
CONTRACTOR NAME:
PHONE
STREET ADDRESS:
FAX:
CITY, ZIP:
E-MAIL
UCENSE NUMBER
UCENSE TYPE
ARCHITECT/ENGINEER NAME:
PHONE
STREET ADDRESS:
FAX:
CIN, ZIP:
LICENSE NUMBER
E-MAIL•
DESCRIPTION OR SCOPE OF WORK:
❑ 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 fees 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.
For office use only:
Notes:
Application Received b : Date: 4D
PP Y
/o Amount Received:
Receipt number: 3 6�50 14 G
0 K44 lo2r-:)�
;0 ':
PRE -INSPECTION REPORT
OWNER: 4 %a Aoy)u A&eof 1' L (l !S DATE: 3- 1—a''7
LOCATION: 22(2(2 l r n S' . f A.P.
CONTRACTOR: ZONING:
REASON FOR PRE-INSPECTION���iG p�'t-. �Jt/.
DATE TO INSPECTOR:3 PERMIT HISTORY (1 INTONE ( ) SEE ATTACHED
BUILDING INSPECTOR'S REPORT
Building Description:
Commercial/Usage:
Residential # of Units:
Currently Occupied ( ) Yes ( ) No `
Abandoned/Vacant:
Electric:
Gas:
Electric Currently ( ) On ( ) Off
Condition of Electric
Currently ( ) On ( ) Off
Condition
Sanitation:
Plumbing Working ( ) Yes ( ) No
Obvious Sewage Problems ( ) Yes ( ) No
Mobile home # of Units:
ACTION RECOMAMNDED: ISSUE ( ) Yes ( ) No
Hold for permits or verify:
Inspector:
Date:
4L,uV9rru RTTTT .n'FNf_'C (1N RFVTR!�F ANn INDICATE LOCATION ON PROPERTY.