HomeMy WebLinkAbout024-100-074i 24-10-74 -i
" f s 92-1530B �
SCOTT, _Collette r
1082 Larkin Rd, Gridley
reroof/sf
024-100-074 0�
SCOTT COLETTE.+'
1082 LARKIN RD, GRIDLEY sNZE -
Cont: H -H CUSTOM HMS 0�7
REROOF 30,SO. _
a
CQ - , -1 -��
t1' ' �■.'
NOTES
RESIDENTIAL
PERMIT NO.
024-100-074 rt 05-1599
SCOTT, COLETTE
1082 LARKIN RDN, GRIDLEY
Cont: H -H CUSTOM HMS
REROOF30SQ
SPECIAL CONDITIONS
CHECKED
RV
-SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB ;FINALED (Date)
Signature ��
= OK
= Not OK
= Not Reaoable MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer, Location -Test -Fall -C/O -Concrete
4. Water. Location -Test -Easement Needed (Sketch)
S. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ ' L'ft.
/ P Nat. or/ /" L'ft1 P LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test-Regulator-Connecto?
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert of Occupancy
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
4. Wood Awn.; Posts-Beams-Rftrs-Connectors
Shthg-Frg-Bracing
1. Zoning Requirements -Setbacks -Easements
5. Alum. Awn., Columns -Connections -Splice -Decal -Enclosures
2. Footings; Size -Spacing -Marriage Line
7. Electric
3. Blocking
8. Frmg., Sills-Anchors-Studs-Rftrs-Trusses
4. Gas; MH Test -Demand -Valve
10. Roof; Shthg-Roofing
5. Electricity; MH Test
11. Ext.; Steps -Doors -Landings
6. Water, MH Test
7. Water and Sewer Connected
Card B-1 Date Card B-1
Date
8. Gas and Electricity Tagged
Date
POOLS (Plans) OK except #'s
9. Exits
1. Setbacks -Easements
10. License Decals
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
11. Verify #'s with Office
4. Elec.; Receptacles and Lighting, Distance -GA
5. Elec.; Pool Lighting; 15 Volts-GFI
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs-Connectors
Shthg-Frg-Bracing
5. Alum. Awn., Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg., Sills-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
12. Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance -GA
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
12. Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
= OK
= Not OK
= Not Applicable
= Not Ready
RESIDENTIAL (Single & Duplex)
Date UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Gmd.-/ r Ftg. Depth
3. Ftg_, Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
Date
Card B-1 Date Card B-1
Date
Cana B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Date
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
19. D.W.V.; Test Fittings & Anchor -Nail Protection
20. Shower Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler, Test
70. Stairs & Rails
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
24. Fixture & Transformer Clearance -Ins. Protection
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or AI
31. Range Circle/ /ga Cu or Al -Oven Circ. / /ga Cu or Al
Insulated Neutral O Yes O No
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels-Motors-Mech. Equip.
34. Clothes Closet Light -Shower Light -Spa Light
35. Smoke Detector
85. A.C. Unit Disconnect, Electrical -Plumbing
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform ff Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
Date
41. Sills Proper Materials & Anchors
Date
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
Date
43. Bearing Walls over Girders & Floor Nailing
Comments at Final:
44. Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Dud in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (EE1.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
83. Following InstldA)M 0 Yes 0 No/Walks O Yes O No/Planters O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle- Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
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.net\dds
PERMIT NO.
BPO51599
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: 06/20/2005 APN: 024-100-074-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number: `L 9 rj �>>
Site Address: 1082 LARKIN RD GRI
Date:/,-- 0,Contractor. c��igTc ,. &_24
Map Index:
Description: RE ROOF COMP 30 SQ.'S
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: SCOTT COLETTE S
permit to construct, alter, improve, demolish, or repair any structure, prior
1082 LARKI N ROAD
to its issuance:: also requires the applicant for such permit to file• a'
signed statement thathe or she is licensed pursuant to the proGisions of.
GRIDLEY;.CA..-:.'
the Contractor's State License Law (Chapter 9 commencing`with Section
95948-9717
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).): .
D I, as -oWrier 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,sate_(Sec,.7044,..Business_and.Professions„
AppllCant:, H -H CUSTOM BUILDING„
Code: The- Contractors' State License.Law does pot apply to an
HOMER HUBER
owner of property who builds or improves thereon, and who does
195 WASHINGTON STREET
such work himself or herself. or through his or her own employees,
provided that such improvements are not intended or offered for
GRIDLEY, CA 95948
sale. If however, the•building or improvements are sold within one
530 846-0874
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.).
❑..,,.I,.As. .owner-of...the...property, .am ,,exclusively... contracting with.
licensed contractors:to construct.the.project (Sec. 7044, Business
and Professions Code, The Contractors' State License Law does
Contractor: H -H CUSTOM -BUILDING
not apply to an of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' Stale License.Law.).
195 WASHINGTON STREET
'GRIDLEY,
CA 95948
GRI EY,46-'
❑ I am Exempt under Article 3 of the Business. and Professions Code
74.
Date: :'Owner -
Owner:WORKERS!COMPENSATION
License #:`299922
WORKERS! COMPENSATIODECLARATION
I herebyaffirm under penalty of perjury one of the following declarations:
❑ I have' and -will maintain a certificate of consent to selNnsure 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:
I .have and will: maintairv..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 `S'�7F t .�
Total Square Ft: 0 S. F.
Policy M
Valuation: $0.00
Census Code:
P- I certify that •iri-therWforriance ofahe work for which this permit is
issued.. 1' shall -not empfoy any -person in any manner so as to
become subject to the workers' compensation laws of California,
and. agree• that if l should become' subject to the, workers'
compensation, provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: Z G5
Applicant:.:....:....: �:. :... .:....._,,,. :.; ..-._.:,,...-...., ..::...
WARNING: :. Failure to secure workers' compensation' coverage. is
unlawful,: and':shall subject an employer to criminal penalties and one
hundred'�Ahousarid '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..
Qto- �1 U
7
CONSTRUCT!ON LENDING AGENCY
This pe7-n is her y issued under, t pl.i ble provisions of the 13utte County Coda anrl/or --
I hereby.'affirm that there is a construction lending agency for the
Resol ions to work ina ve f r whit fees have been paid.
performance of the work for which this permit is'issued (Sec 3097 Civ:)
Name:
By. Date:[(% -
�f
Address:
PERMIT EXPIRES 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 8 Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the .requjred 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. 1 agree to comply with
' all county and state laws relating to building construction.. I acknowledge it is unlawful to alter the substance of any officio form or document of Butte County. 1 hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purpos
Print Name: -�J� ' j_7f + Signature:
Date:
IO Owner : Contractor O Agent for Owner ❑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
FA
PERMIT NO.
BPOS1599
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: 06/20/2005 APN: 024-100-074-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number: 2 9922,z-
Site Address: 1082 LARKIN RD GRI
Date: -Z/-c: Contractor:dc,'7e, $�..14
Map Index:
Description: RE ROOF COMP 30 SQ.'S
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: SCOTT COLETTE S - -
permit to construct, alter, improve, demolish, or repair any structure, prior
1082 LARKI N ROAD
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 df;
GRIDLEY,-CA
the Contractor's State License Law (Chapter 9'commencing with Section
' 95948-9717 »
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" Seciipn 7031.5 by any applicant fora per'rnii.subjects the
,
applicant to`a Civil1penalty 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
a,ntended;or,offered,for sale,(Sec, 7oa4,,Business,and Profgssions
Applicant:, H -H CUSTOM BUILDING„ y rt w
Code: The Contractors' State License Law does -not apply to an
HOMER HUBER
owner of property Who, builds or improves thereon, and who does
such work himself or herself or through his or -her own employees,
195 WASHINGTON STREET
provided_ that such improvements are not intended or offered for
GRIDLEY, CA 95948
sale. If however, the building or improvements are sold within one
(530 ) 846-0874
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. ,gas,, .owner. _of, .the: property, . am- .exclusively. - contracting ,with.
licensed contrectdrs:to constructthe. project (Sec. 7044, Business
and Professions -Code, The Contractors' State License Law does
Contractor: H -H CUSTOM -BUILDING
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.).
195 WASHINGTON STREET'
-'"
GRIDLEY, CA 95948
O : I am. Exempt under Article 3 of the Business and Professions Code'
(530) 84620874:-
Date: Owner:
License #:'299922 :..
;.•WORKERS! COMPENSATION DECLARATION'
I herebyaffirm under penalty of perjury one of the following dedarations:
❑ -.I have* and will maintain a certificate of consent to self -insure for
woikers.',compensation, as provided for by Section 3700 of the
Architect:
Labor -Code, for the performance of the work for which this permit
issued. _ _
Engineer:
_Ts
CI 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. .',5:�t7'i!` t- (
r 2r,-^
Total Square Ft: 0 S. F.
Valuation: $0.00
`-
Policy #:` '7!C 7,2-6<
Census Code:
�✓I certify that in'dherperformance ofthe- workfor which this permit is
issued'; • I' shall •not empfby-any- person in any manner so as -to
become subject tor 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 o5
Applicant:
WARNING: :`Failure to secureworkers' compensation coverage, is
unlawful,'and'shall subject an employer to crim'inal'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 attorneys fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under licable provisions of the Butte Cnunty Code andlor
I hereby'affirm that there is a construction lending agency for the
Resol ions to d work indicated r which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ:)
Wae
Name:
By: Date:
Address:
PERMIT EXPIRES ON: -
Date
Q I hereby certify that the use;ofrthis 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 accordahce-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 ].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 officia form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purpos
Print Name:�J-� r�f`p Signature:
Date: ?/—c 5�
❑ Owner _ Contractor ❑ Agent for Owner ❑ Agent for Contractor .
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 OFAPPLICA TION
Website: www.buttecounty.net/dds
**PLEASE PRINT CLEARLY**
APPLICANT NAME
OWNER
Last a
Name
Fi Naa __.-
2 E
Address
Address
Fax
State
City 4A ,
Phone
State,
Zip q62�
Phone
Fax
Fax
9cl
E mailL'!
E-mail
# 9
APPLICANT NAME
CONTRACTOR
Name
Name
Address
Zi
Address
Fax
State
City
L
Phone
Ste
Fax
I Zip 5 v
Ph '?� 6
State License Number
Fax
9cl
E mailL'!
# 9
ZZ
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City r ,
Address
Zi
City
Fax
State
Zip
Phone
/
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City r ,
State
Zi
Phone y
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property Address
Flood Zone
Cross Stree
`X)
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
1/11315 15
BIN #
LOCATION
AP# O _ /,M,
A Jf7
(�
Property Address
City
Cross Stree
`X)
WORKER'S COMPENSATION
Policy Number
6 32- a
Carrier
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:
e Q06F
Sq. Footage
oa
❑ 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.
�u
Received by: Amount: Bldg
/ SRA
Receipt M. l Sheriff
9 SMIP
Date:
Other
_C_
Total
REV 2-24-05
r'
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
- 11�. .�7�. /"7C'S:U cN1.. r€Y•` ♦ i�D"r t�."" - , yfj.:. �'f . `4,}q: 'K�:.Ycy`'�'�:..�.
24-10-74
92-1530B
SCGTT, Collette
102 Larkin
reroof/sf Rd, Gridley
1 .
`
IN
WA 6 "frq e."Mgt%fn-X,70"Irl ..
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO
a 7 County Center Drive - Orovlllet California 95965 - Telephone: 916538-7541 11Z... /��
APPLICATION AND PERMIT J
ASSESSOR PARCEL NUMBER
024-100-074
ZONING,
A 10
BUILDING PERMIT
OWNER
CQUE'I'fE SOM
TELEPHONE
846-2053
S0, FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
1082 LARKIN ROAD GRIDLEY 95948
19 SO cow 1140
CONTRACTOR'S NAME
OWNER
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee $ 15.00
Permit Fee $ 25.50
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
1062LARKIN ROAD GRIDLEY 95948
Permit tee $ 40,50
PLUMBING PERMIT Filing Fee 15.00
Each Trap 5.00
Solar or heat pump water heater 20.00
LO TdN O.ry•,'
SUBDIVISION NAME
"
PARCEL MAP
Water piping 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF �. Duplex ❑.,:Mobilehome❑ Other
' SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 15.00
Mobile Home S I G I W @15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installation ❑ Other ❑
Describe work: _ RERME Of"
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee 15.00
'
Main service 600VORLESS j$,50
200A OR LESS
Main service 200ATO1000AI 37.50
CONTRACTORS LICENSE LAW
I declare under enalt of ur check one
p Y P er J Y( )•
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
I, as the owner, or my employees with wages as their sole compen-
sation, 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 contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.&) 3.54 sq.ft.
OR ACDNS. ACC. BLDGS.
NEW CONSTR. ULTI-OUTLET
NON-RESID BRANCH CIRC ITS @ 5•00
POWER APPARATUS &)
(SINGLE OUTLET CIR. )
Ex. Occup(OUTLETS OR FIXTURES 209761
FIXED APPLNS. OR
EX. DCCUp. OUTLETS (RESI D.) EA.) I 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. 6yirin 15.00
9
Permit Fee $
—
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
�_,t of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT Filing Fee 15.00
Heating
Cooling
g
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 County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
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 liabi ties, judgments, costs, arrV expenses which may in any way accrue
against' ai oun consequert of the r of this permit.
X / �� S /� — ,9—
�U� - Date
Signature of Applicant — Owner Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST TYPE
TOTAL FEE $ 40.50
HAz
0FEES
IMP
FLOOD
CDF
PARCEL
PO
HO
ISSUE
This permit is hereby issued under the applicable provi
sions of the Butte County Code and/or resolutions to do
work indic.3ted abover which fees have been paid.��&C,`k �O
OF PUBLIC WORKS
By C/'� Dates
PERMTt EXPIRES Date 9/x rs
Receipt NO.115�878 40.50
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Orovllle, Callfprnla 96986 - Telephone: 916/538.7541
APPLICATION AND PERMIT
PERMIT NO.
�Z- h5L3o
ee
024-100-074 ,.
N
A 10
BUILDING PERMIT
WN R
COLLETTE SCOTT
e HONG
846-2053
SO. FT. OCC. BUILDING 9ALU61IO
OWNER'S MAILING ADDRESS
1082 LARKIN ROAD GRIDLEY 95948
�+
1 S CO 1140
CONTRACTOR'SNAME
OWNER
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation I $ 1140
LENDER'S MAILING ADDRESS
Filing Fee $ 15,00
Permit Fee $ 25.50
ARCHITECT OR ENGINEER
LICENSE No.
Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee $
Penalty $
BUILDING ADDRESS
1082 LARKIN ROAD GRIDLEY 95948
Permit fee $ 40.50
PLUMBING PERMIT Filing Fee 15.00
Each Trap 5.00
Solar or heat pump water heater 20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF KI Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 15.00
Mobile Home S I G I W @ 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installation ❑ Other ❑
Describe work: RF.RQ(E COMP _
FI
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee 15.00
Main service ESS
200AOR00V OR LLESS 18.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
I, as the owner, or my employees with wages as their sole compen-
sation, 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 contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service 200ATO1000A1 37.50
NEW CONST.(DWELLING OCCUP.&) 3.6asq.ft.
ACC. BLDGS. /
NEW CONSTR.ULTI.OUTLET
NON.RESID BRANCH CIRC ITS @ 5.00
POWER APPARATUS e
(SINGLE OUTLET CIR. )
Ex. OCCUp(OUTLETS OR FIXTURES 20 75
dA 4F;
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.) I 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring '15.00
Permit Fee $
—
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT Filing Fee 15.00
Heating
Cooling
g
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 County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and eep harmless the County of Butte against
all liabi 'ties, judgments, costs, expenses which may in any way accrue
again ai u conseque of the r of this permit.
X Date _
Signature of Applicant — Owner Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEES 40.50
HAz
DFEES
IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under the applicable provi-
sions of the Butte County Code and/or resolutions to do
which fees have been paid.
work �;�
PUBLIC WORKS
By Dater 9PL f
PERMIT EXPIRES Date �� Zi
Receipt No. 5f�7R 4t7.5C)
WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
f�'Svr -� h' .'f'P4.�„w„ i is",/P"'lrvM1'� X4•+1"" ' ar. v' -'p,7 "99::..x. 'vr: gin, w--77
R
COUNTY OF BUTTEYPARTMET OF PUBLIC WO BUILDING BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLEI,�F�LIFORNIA 95965 - TELEPHONE (916) 538-7541,E
PERMIT APPLICATION DATA SHEET
OWNER Cd e � 4�_ A. 7 '! 00 -7
A. P. No.
Proposed Building UseBuilding Inspector Dat
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.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
All items have been submitted . ........................................
Plot plans, 3/4 sets, signed by preparer of plans . ..........................
Complete plans, 3/4 sets, signed by preparer of plans ...... .
Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
Hazardous Material Form . ............................................
Energy Design Compliance and supporting documentation . ..................
Statement of Intent for Non -Heated and A/C Buildings . ......................
Engineered truss details and layout in duplicate (required prior to plan check). ....
Mobilehome data and manufacturer's installation instructions, 2 sets. ...........
Feesof$ .......................................... '
Impact fees as shown on attached schedule . ..............................
California Department of Forestry plan approval/fees. ........................
Flood elevation letter (100 year flood) by California Engineer . ................. .
Sanitation and plot plan approval Health Department . .............
City of Chico plumbing permit. ........................................ .
Plot plan and business license approval from City of Biggs/Gridley. .............
Planning approval for (A) Use: (B) Parking: . ........
Contact Land Development about (A) Improvements (B) Drainage. .......... .
Driveway permit (construction approval required prior to occupancy). .. .. .
Pre -Inspection request
Pre -inspection for required. . to 80ding Inspector (Date)
Contractor's license information. (No., Name Style, Classification) . ..............
Certificate of Workmans Compensation Insurance . ..........................
Owner -Builder Verification (Given to owner , Mail to owner ) ............
Recorded copy of Agricultural Acknowledgement Statement . ................. .
Letter of signature authorization . ........................................
Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
Letter of intent on building use . .........................................
Mobilehome utility clearance . ..........................................
Documentation of legal access . ........................................
Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . .............. .
Existing violations/expired permits . ......................................
Plan check list . .....................................................
When you issue the permit, process as follows. Mail to owner.
Telephone and hold for picku
Other
Parcel Creation /
Acreage Applicant
Copy of Haz-Mat form sent Health Dept. Fire Dept.
Copy of plans sent Health Dept. Fire Dept. Other
Mail to contractor.
- office. 4 Deliver with inspector.
Air Pollution Date
Date
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:
Date
By
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Contractor, designer, owner, was advised of abov required data by _ phone _ mail Counter by _ Date
Plans checked by Date Plans approved by I Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville. California 95965 - Telephone: 916.'538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMB '�
ZON1N - to
BUILDING PERMIT
OWNER
0 fte. cc) f�
TELEPHONE
F uG 2053
S0. FT. OCC. BUILDING VALUATION
/17 s
OWNER 10 MAILING ADD OL k
`/rte' I �I✓\[
CONTRAPPC��T��O'/R�'SNAME
�/ V Y 1. -P—((—
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDERUNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS -
Filing Fee -
$ 15,00
Permit Fee
$
ARCHITECT OR ENGINEER _
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
-$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 15.00
!�
(
Each Trap
1 5.00
Solar or heat pump water heater
1 20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
Eachqas water heater or vent
USE OF STRUCTURE
SDuplex❑ Mobilehome❑ Other
__ \\ SPECT FY
Gas piping system 1 - 5 outlets
ELL—
Building sewer
15.00
Mobile Home S I G I W
@ 15.00
TYPE OF WORK �—�
New U Addition Remod C tilities ❑ Installation Cl Oth
Describe work: e c
Permit Fee
$
Contractor
ELECTRICAL PERMIT
[_
Filing Fee 15.00
Main service 200V OR LESS
00A OR LESS
18.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
` License .Jo. Classification
❑ I. as the owner, or my employees with wages as their sole compen-
sation, 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 contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. Business and Professions Code
for this reason
Main service 20CATO 1000A1
37.50
NEW CONST./ DWELLING OCCUP. f\
OR ACDNS. l ACC. BLDGS. /
3.66 sq.ft.
NEW CONST Ft.ULTI.OUT LET
NON.RESI BRANCH CIRC ITS
@ 5.00
POWER APPARATUS e
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
20 76d
Ex. Occup. OUTLETS I ESID IRE A.�
1 3.00
Temporary service
1 15.00
Mobile Home Facilities
15.00
Misc. Wiring
g
15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
FiIingFee 15.00
Heating
Cooling
g
Hood A
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 County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
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 Date
Si nature of Applicant — Owner
9 pp ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEES0-70
Q`
HA2
11 FEES I
IMP
I FLOOD
I CDF
PARCEL
I PD
I HO
ISSUE
This permit is hereby issued under the
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
BY
PERMIT EXPIRES Date
applicable provi-
resolutions to do
have been paid.
WORKS
Date
��Sg��/\ S
Receipt No. (�
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
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 materials for construction of
the proposed property improvement (yes or no)
2. I hav /have not) /j¢(/ P - 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 City
Phone Contractors 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 City
Phone Contractors 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
Social Security Number
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the ..California-.Healt-h. and Safety Code,-
This
ode.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.