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Home My WebLink About022-210-078BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION tl: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP051912 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: 07/19/2005 APN: 022-210-078-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 177 DENIZ 13ROS LN GRI Map Index: Date: Contractor: Description: DEMO HOUSE 900 SQ.FT. OWNER -BUILDER DECLARATION I hereby affirm under penally 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: GSJ COMPANY LLC • .... - "- permit to construct, alter, improve, demolish, or repair any structure, prior 1115 ORLANDO AVE to its issuance,,. -also requires the applicant for such permit to file- a signed stafemeniihat'he or she is licensed pursuant to the provisions of. ROSEVILLE CA the Contractor's State' License Law (Chapter 9'corimencing with Section 95661 7000), of'DiviSion 3, of theBusiness and Professions Code) or that he or . ,• .• ; she is "exempt therefrom and the basis for the,alleged exemption. Any: (916-257-5623. FAX (916) 676-2870 violation of Secti.69`7031.5 by any applicant for a permit.subjects the.. DICkC�QiDUnmOreCOmmU111t12S.COm applicant to:a.civil penalty, of not more than five hundred dollars ($500).):': ❑ 1, as ownerof the property, or my employees with wages as their sole compensation, will do the work, and the structure is not _itttended..oc;offered,for,sale.,(Sec.,7oM,•.Business_and.;Professions,. , .•...,..,, . Applicant: GS.J COM.PANY::LLC :,.:. Code: The. Contfactors':State License Law. does not apply to an 1115 ORLANDO AVE owner of. property who:builds or improvesahereon, and who does ROSEVILLE CA such work. himself or herself or through. his or her own. employees, .-provided that such improvements, are not, intended or.offered for 95661 sale:"If however, the building or improvements are sold within one 916-257-5623 FAX 916 676-2870 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 DickC@DunmoreCommunities.com sale.). I;:: as:, owner,.,.ot,.the.,.pr.operty, ..am. exclusively .:contracting ,.with. licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: not.appjy 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 t s.and Profes • ns Code. Datel ' OOwner. License #: 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 Architect: Labor Code,.for_the performance of the work for which. this permit is issued . Engineer:.. [:.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'carrierand policy -number aarre::; .. - Carrier: ice ' �k s� C� Total Square Ft: 0 S. F. Valuation: $0.00 ' Polic� �� y # 1 ! �i :.... ...., +in Census Code: ❑ 1 certify that lhe,performance ofthe.,work for which this'permit is issued,*t.shall .not employ, r 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: Fa'lure 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 form Section 3706 of the Labor ,.code, -interest, and attorney's fees. CONSTRUCTION LENDING AGENCY --A This permit is t%reby issued under the applicable provisions of the BuRe Cnunty Code ?nrVpr I hereby•affirm:that there is a construction lending agency for the Resolutions ti� do work indicated atiove for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) 0 �•�17, B / l/%f�lX�GJ Name:' .i ( !/% Date: / PERMIT EXPIRES Z Address: 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., l acknowledge itis unlawful to alter the substance of an official f or document of Butte unty. 1 hereby authorize representatives of Butte County to enter upon the atiove mentioned property for inspection es. Print_Name: �L cz�� 7�S Sign ure: Date:. CIOwner ❑ Contractor Agent for Owner 0 Agent for Contractor 1AS01001AfQv139.- Main Assessor f !' 03:14 pm # Fee # 022 210-078-000'.. Name JGSJ COMPANY LLCAsmt ,i Status ACTIVE Status Date r Addrl 198 CIRBY WAY #135 -' - - Tax 000 TNORAIAL OWNERSHIP TRA 0?5 014 Addr2 R0SEVILLE_CA 95678-6430 M Situs 177 UENIZ BROS LN GRIDLEY 7 _ Addr3 '�'' •'S t,`'Jr BaseDt 03!19!2004';NORM - - Land 400,815 Addr4 � �� Timber Preserve ' _- -- - --' �- -- —Structure 104,904, r-' AgPres Fixtures 0 Comments 12221007800 CONVERTED 09!08/88. Etal Growing 01 Creating Doc# 198789999999 ; Date F Bonds Total L&I 505,7191 Current Doc# 200480015226_J Date 0041 Fix. RP 0� Killing Doc# v Date '� Multi Situs ! F' Flag1 MH PP 0, Asmt Desc DENIZ EROS LANE SuplCntF F' Flagg PP Oj . Zoning A40 00 DwellF0i 910 MH Exempt 04 '- -" Net 505,719 Acres/S Ft 237.83 NIC 022 rIAsmt PP Pen q r' Tax PP Pen RIC#F F. Appeal Pending T/R Dt F—'I E! Split Pending R/C Staf PHY OWN EXP TAX HON ATT SIT APR. PCL J. f.- ► ►� . -; Find I'l�_l 1cmorgan, 07/01/.2005.3:44:20 PM 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 REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER ame First Name Id e Phon/a - c5-7 -6 ,3 Fn City Ph Fax PCO ail ' CONTRACTOR Name Name Address Address Phon/a - c5-7 -6 ,3 Fn City State Zip Pho G Fa Book E m Li y y ss` ' ARCHITECT/ENGINEER Name A�lnl Address Phon/a - c5-7 -6 ,3 Fn City No State Zip Phone Book Fax E-mail Planner State License Number APPLICANT NAME N G rYLS Addre s I— Zia C Stag o Zip lo�o� Phon/a - c5-7 -6 ,3 Fn g¢ eff�N JO For office use o ly: Zoning AP# Flood Zone Property Address SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT OS -1 q12- BP 1ZBP BIN # Page 1 of 2 Description or Scope of Work: Sq. Footage ❑ 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 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. w Received by: 71 P Amount:�Bldg SRA Receipt #: / J J S Sheriff t %//� SMIP Other Dart-e� / �`'/ ' ��_S <55 C J Total REV 2-24-05 LOCATION AP# - / o- D2( Property Address Ci Cross Stree WORKER'S COMPENSATION Policy Number Carrier 2 !s If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Description or Scope of Work: Sq. Footage ❑ 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 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. w Received by: 71 P Amount:�Bldg SRA Receipt #: / J J S Sheriff t %//� SMIP Other Dart-e� / �`'/ ' ��_S <55 C J Total REV 2-24-05 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 A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). 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. ❑ 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05