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Home My WebLink About024-140-053AP* a2 4-Ig0-05� No Flt C*o Q � 5 $(p i BUTTE COUNTY 0 TTF0 DEPARTMENT OF DEVELOPMENT SERVICES O BUILDING PERMIT 0 0 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) o ' -o OFFICE #: (530) 538-7541 FAX4�11 18-2140 WEBSITE: www.bCt r�� CA- \W �\W 'S UN (k - 0, �� LICENSED CONTRACTORS DE(URI , S P, PERMIT NO. BP041457 I hereby affirm under penalty of perjury thj lv" ��j P� G RS 053 provisions of Chapter 9 (commencing with Sectio GR'I'P :.-05/21/2004 APN: 024 -140 -OW -000 the Business and Professions Code, and my liven p�yiC• CIO effect. License Class : G d`U C 3 e License Numbe n" C P - Site Address: 22-34 E EVANS REIMER RD GRI Date: 7- U`� Contractor..GO66-1 ^t,_ •�� I Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: Owner: 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 / is issued. ca 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: — -9— 9 Policy #: 15 fz(.ylp_ �o rr- itis F(Ahal Description: CHANGE OUT SPLIT SYSTEM HVAC Owner: HAURY BECKY 234 E EVANS REIMER RD GRIDLEY, CA 95948-9543 Applicant: GALLAGHER'S HEATING & AIR - E. HWY 99 LOS MOLINAS, CA 800-892-3556 Contractor: GALLAGHER'S HEATING & AIR E. HWY 99 LOS MOLINAS, CA 800-892-3556 License #: 777334 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 ❑ I certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Address: reCC 0 G This permit is he/€by�ssued under tN applic Resolutions todo wo** indicated Wo* for.4 PERMIT EXPIRES ON: have been paid. Date: T-2-- 0)� ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the Afan ly authorize agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the subscia um nt utte County. 1 hereby authorize represen s of Butte County to entter/u'pon the bove mentioned property for inspection p—� Print Name: &Yfi S. Wa 11"P's Signature: Date: S ��r' IQ V ❑ Owner ❑ Contractor ly Agent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION OWNER Name Lt d— Address aK^�ar�s IeQc� City & v-,, U Statt Zip Phone Fax E-mail CONTRACTOR Name Ga jtQ 5 Ifu (r G Address G 6O City tywr t Sta e� gZi -5 Phone% W g q Z 3�5 Fax E-mail Li 3 3 y Clas c APPLICANT NAME ARCHITECT/ENGINEER Name City C$u C -o Address Zip 't 5-152-q City Fax State Zip Phone Page Fax E-mail Date Approved: State License Number APPLICANT NAME Name Q ►'S Address 7 S `� City C$u C -o State yT Zip 't 5-152-q one''S Fax E-mail —WAKYII�' L r � For office use only: Zoning Flood Zone Receipt #: ()� SRA Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BPl BIN # LOCATION AP# OZ`4 - i q 0 053 Property Address Cross Street WORKER'S COMPENSATION Policy Number 1—, 24 d'S ^ v •� Carrier oma/ :�;n "l n If hiring anyone other than license contr tors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Descript' nor cope of Work: cJk O ✓/l �,tc 2 add / c, 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. Received by` IjAmount: � J () Bldg SRA Receipt #: ()� Sheriff SMIP Date: Z M Other Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04 SUBMITTAL 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. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! ❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 9. Sanitation and site plan approval from the Environmental Health Department. ❑ 10. Metal Buildings: (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 beengineer. Mobile, Manufactured, or Modular homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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 b t� 'neer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04