HomeMy WebLinkAbout025-090-03525-09-35 h
G. L. Gillispie nQ / �lf (
W/S Dos Rios Rd.,1 00'So.of E.Biggs
Hwy, Biggs
(reroof & enclose patio for garden room/.
SF)
�Ytq l (Y6125-09=3
rmit#4174-79B(lst. renewal/1061-78)SF
025-090-035 05-0511
GILLSPIE; ROSEMARIF
29.17 DOS RIOS RD, BIGGS
Cont' COMM ACTION A
REP WALL HTR
025-090-035 t 05-1913-
GILLISPIE, ROSEMARIE
2917 DOS RIOS RD, BIGGS
Cont: RL CASEY CONTRUCTION
RE- ROOF
0
J
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25-09-35 h
G. L. Gillispie nQ / �lf (
W/S Dos Rios Rd.,1 00'So.of E.Biggs
Hwy, Biggs
(reroof & enclose patio for garden room/.
SF)
�Ytq l (Y6125-09=3
rmit#4174-79B(lst. renewal/1061-78)SF
025-090-035 05-0511
GILLSPIE; ROSEMARIF
29.17 DOS RIOS RD, BIGGS
Cont' COMM ACTION A
REP WALL HTR
025-090-035 t 05-1913-
GILLISPIE, ROSEMARIE
2917 DOS RIOS RD, BIGGS
Cont: RL CASEY CONTRUCTION
RE- ROOF
0
J
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (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
the Business and Professions Code, and my license is in full force and
effect.
License Class L' se Nu
Date.27 Contractor:
OWNER -BUILDER DECLARATION k
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:
❑ I 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,
❑ 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:
Policy #:
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to 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 sec 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:
PERMIT NO.
BP051913
Issued Date: 07/19/2005 APN: 025-090-035-000
Site Address: 2917 DOS RIOS RD BIG
Map Index:
Description: re roof 32 squares
Owner: GILLISPIE ROSEMARIE
2917 DOS RIOS RD
BIGGS, CA
95917-9730
•AppLicant:,,R L CASEY,CO.NSTRUCTION.
PO BOX 128
BIGGS, CA.
95917
Contractor: R L CASEY CONSTRUCTION
PO BOX 128
BIGGS, CA.
95917
License #: 353979
Architect:
Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
5/
v
N
l�
This perm# "s herebyT�ndl'cated
under a applicable provisions of the Bntte County Cody mrUor
Resotuti s to do a9-bove# which fees have been paid.
By: 7Date: J
PERMIT EXPIRES ON: / —
❑ 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 8 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 13?p ounty to enter upon the above mentioned property for inspection pu
Print Name: Q_ _\ ra C U Signature:
Date: /
❑ OwnerontlGilC Tactor O 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 •OFAPPLICATION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
OWNER -
Last Nam
F'rst Name
Address
Cit r
St to
Zip
y
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
CONTRACTOR
Name
food Zone
Address
`
City ^ c 1.
I No
State�o �
1.
Zi S
Phoney �^ zFax
Book
Fax
E-mail
Planner
Lic.�3S 7
Clash l
APPLICANT SIGNATURE
X
For office use only:
ARCHITECT/ENGINEER
Name
food Zone
Address
`
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT SIGNATURE
X
For office use only:
APPLICANT NAME
NameAddress
food Zone
Cross Street
SRA
City
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
APPLICANT SIGNATURE
X
For office use only:
Zoning
Propert?!Of / - DS /2rD
/
food Zone
Cross Street
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.
BIN #
LOCATIONAPI
/'
Propert?!Of / - DS /2rD
/
Fcily�
Cross Street
WORKER'S COMPENSATION
Policy Number
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
Description or Scope of Work:
9C-7-mo0F �z s
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.
Page 1 of 2
REV 2-24-05
S"�
Received b Amount:
7�
V
Bldg
SRA
j
Receipt #: t,I V�
k I
Sheriff
SMIP
Irl S_
Date- I� r"(/
Other
Total
Page 1 of 2
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.
ANaIXAIMZto]AT_IaaIRUN &R,I
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
NOTES
RESIDENTIAL
PERMIT NO. 025-05C-035____-----_
GILLSPIE, ROSEMARIE
2917 DOS RIOS RD, BIGGS
Cont: COMM ACTION AGENCY
_REP WALL HTR
�Y
SPECIAL CONDITIONS
CHECKED
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
i
JOB FINALED (Date)
Signature
J=OK
0 = Not OK
= Not Applicable
. = Not Ready -
I
RESIDENTIAL (Single &_Duplex)
Date
UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /" 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
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
'119. 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
72. Elec. Outlets at Wood Panel, Int. & Ext.
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-A.C. Wire Size/ /ga Cu or Al
31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insulated Neutral ❑ 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
87. Water Well, 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. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform if 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
Comments at Final:
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Wags (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 A Flue -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-Underfir. 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 -Wal Is -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. Duct 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 (F.F.I.)-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 Instld./Drive O Yes 0 No/Walks 0 Yes O No/Planters 0 Yes 0 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:
J=OK
0 = Not OK
: = NotReadyable
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Soils; Special MH Support Sketch
4.
3.
Sewer; Location -Test -Fall -C/O -Concrete
5.
4.
Water; Location -Test -Easement Needed (Sketch)
6.
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
6.
Gas; Location -Test -Wrap;-/ P' L 'ft.
/ P Nat. or/ P' L "ft./ P LPG
7.
Well Clearance & Disconnect
8.
Utility Clearance
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
Date
12.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Card B-1 Date Card B-1
1.
Zoning Requirements -Setbacks -Easements
Card B-1 Date Card B-1
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
2.
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
5.
Drain; MH Test -Fall -Flex Connector
Elec.; Receptacles and Lighting, Distance-GFI
6.
Water; MH Test -Regulator -Connector
Elec.; Pool Lighting; 15 Volts-GFI
7.
Water and Sewer Connected -C/O to Grade -HD Approval
Elec.; Enclosures; Conduit Entries -Terminals -Listed
8.
Gas and Electricity Tagged
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
9.
Tie Downs -Type -Installation Cert.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures-Panelboards-Ins. to Main Conduit
10.
Exits; Insp.-Sketch
Health Department Approval
11.
Cert. of Occupancy
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
.12.
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM -(ONLY)
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer Connected
8.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11. Verify #'s with Office
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-GFI
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
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHIGO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license Is in full force and
effect. 4,27,9-42e License Class : ` License Number:: 4, 2 72 42e
Dale: ''$ �Q onlracloc
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
permit to construct, alter. Improve, demolish, or repair any structure, prior
to its Issuance, also requires the applicant for such permit to rile a
signed statement that he or she Is licensed pursuant to the provisions of
the Contractor's Stale 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 rive hundred dollars ($500).):
O 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' Stale 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' Slate 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' Stale License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Dale: Owner: -
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally 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.
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: /afr� t' ->/�� 7� t
Policy 0: / !�- ceo S
❑ 1 certify that In the performance of the work for which this permit Is
Issued. I shall not employ any person In any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisldns of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Dale:
Applicant / 4
WARNING: Fallure to secu 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.
PERMIT NO.
BPO50611
Issued Date: 03/08/2005 APN: 025-090-035-000
Site Address: 2917 DOS RIOS RD BIG
Map Index:
Description: replace wall heater
Owner: GILLISPIE ROSEMARIE
2917 DOS RIOS RD
BIGGS, CA
95917-9730
Applicant: COMMUNITY ACTION AGENCY OF BUTTE
COUNTY INC.
2640 SOUTH 5TH AVENUE
OROVILLE, CA 95965
(530)538-7559
Contractor: COMMUNITY ACTION AGENCY OF BUTTE
COUNTY INC.
2640 SOUTH 5TH AVENUE
OROVILLE, CA 95965
(530)538-7559
License #: 617201
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
0 S. F.
$0.00
_1 V
CONSTRUCTION LENDING AGENCY This permit I ereby Issued der t pplicable provisions of the Butte County Code and/or
I hereby affirm that there Is a construction lending agency for the Resolullo to do wor nd led ove f. hich fees have been paid. 1
performance of the work for which this permit is issued'(Sec 3097 Civ.) By. ' D ate: � 6 J
Name: .
PERMIT EXPIRES ON: 0
Address: _ 1 (Dare
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safely Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
1 hereby certify that I have read this application, that the above information Is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and stale laws relating to building construction. I acknowledge it Is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: C '� �'�4'2 CS Pt n ji!:2 Signature:
Date:
O Owner
❑ Contractor
❑ Agent for Owner
❑ Agent for Contractor
C;. �. vu"w"M rmum --- vH
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
effect. /
License Class :-,& License Number:
Dale: 3 s$-dZContractor.
'OWNER -BUILDER DECLARAiTON
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Slate 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 Stale 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' Slate 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.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Dale: Owner:
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
Labor Code, for the performance of the work for which this permit
Is Issued.
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: Zd � t' k1=;t l /t! S
Policy
❑ 1 certify that in the performance of the work for which this permit Is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation taws of California,
and agree that if 1 should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Dale: �' 1
Applicant:
WARNING: Failure to securg 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
1 hereby affirm that there Is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
PERMIT NO.
BPO50611
Issued Date: 03/08/2005 APN: 025-090-035-000
Site Address: 2917 DOS RIOS RD BIG
Map Index:
Description: replace wall heater
Owner: GILLISPIE ROSEMARIE
2917 DOS RIOS RD
BIGGS, CA
95917-9730
Applicant: COMMUNITY ACTION AGENCY OF BUTTE
COUNTY INC.
2640 SOUTH 5TH AVENUE
OROVILLE, CA 95965
(530)538-7559
Contractor: COMMUNITY ACTION AGENCY OF BUTTE
COUNTY INC.
2640 SOUTH 5TH AVENUE
OROVILLE, CA 95965
(530)538-7559
License #: 617201
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
do
PERMIT EXPIRES
i¢y161 5-
provisions of the Butte
fees have been paid.
Code and/or
Address: I " (Dale)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely 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 1s 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 purposes.
Print Name: 74!> <_ <t,42 Pi• Signature:
Dale:
❑ Owner
❑ Contractor
❑ Agent for Owner
❑ Agent for Contractor
O. % oullU1114 rC1111R V 1. 1-4 VH 1
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 APPLICA TION
Website: www.butt.ecounty.net/dds
"'PLEASE PRINT CLEARLY"
APPLICANT NAME
OWNER
Last Namer�
City
Name
i�
Address
i C_ t .00
Address
o
17
`
City
Zip
State
Zip
a
6
GL
Phone
E-mail
Fax
Lic. #
6
Cla s
E-mail
0
,-
APPLICANT NAME
CONTRACTOR
Name
City
Address
Zip
Address
Fax
2Z
o
City
State �]
Zip
Planner
State License Number
6
Phone
Fax
E-mail
Lic. #
6
Cla s
0
,-
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name _ m
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
or office use only:
Zoning
Prop
Property Address
2 O
Flood Zone
Cross Street
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
5-061
BIN #
LOCATION
AP#
2=15O � �
Prop
Property Address
2 O
City
Cross Street
SRA
WORKER'S COMPENSATION
Policy Number
Carrier
t
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
/YO
Address
Description or Scope of Work:
3 5., lz,42d Wc,Pl t
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
�rm�
1 _
b : Amount:
Bldg
SRA
Receipt #: b I
Sheriff
SMIP
Date: (fly ��
_ O Other
Total
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 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. ' r ,,..
❑ 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. DetachedrAccessor)rBuilding, 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 Plannirig
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 Fortn.
❑
5.
Encroachment Petrriit'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. 1
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
K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05
�tPEf4MIT NO.
3'f
s r PERMIT EXPIRES Rftw:::�
'OWNER G. L. Gillispie
r'
CONTR. owner
'LOCATION (A.P. 25-09-35 )
W/S Dos Rios Rd.,app.1000'S.of E. Biggs Hwy
Biggs
cep
r
. U
t
Temp. Power Pole
Called PG&E
Temp Elec. Serv.
Called PG&E
T mp. Gas Serv.
Called PG&E
JOB
FINALED
(Date)
ig ture)
• „"� Jr
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION -RECORD
BVILDyNG BUILDING (Cont'd) PLUMBING
Firewall
Parapets
Restroom Finish
Windows --/
SidInG ^- �!
Roof Sheathing
Roofing fts
Fdn. Ve
Garage Vents
Insulation
Prov. for physically
handicapped
Conformance of ex.
structure
Final
Soil Piping
1st Floor
2nd Floor
3rd Floor
Topout
Water Pi in
Sewer
Fixtures
Water Htr.
Heaters
Appliances
Gas Piping Test
Temp. Gas
Patio I FIREPLACE I Final I
rootln s Footinq ELECTRICAL
Masonry Walls Throat Rou h
Reinf. Steel _ Final FlYturac
IRE
T
Mesh M CHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal
Water Piping Sewer Gas Piping
OBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS
(NCTE:.An entry must be made on this form each time you visit the job site.)
r
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
V
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X - r ate G ��
Signature of Permitee or Agen
Receipt No. 575
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been aid.
, �ECTO-R O;ELIC WORKS
0 11111111t
ME WIM
Building permit1bio'xpires Dates -/3-Z56
BUILDING
Owner
SQ. F OCC. BUILDING VALUATION
Mailing Address /Z/-. po`jam
�^ �
Telephone No. 6;' -
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee 144-
Building Address k
//5 �ca� � � C/7
Plant ng Fee&/or Penalty
Permit Fee /
Fee
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trao 1.50
Repair drainage or vent piping 1.50
A. P. No. �5-45'- S -
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F s
Sa Ion
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
4rTg--P-1ans Recd
Parcel Approval
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
permit Fee $
$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Single Family Duplex Mobil Home ❑ Others ❑
Main service EA. ADD'L too AMP 2.50
Main service OVER 25.00
100 AMPP OR LESS O
Main service EA. ADD'L 100 AMP 1.00
NEW OR ADDNST // DWE%ACCLBLDGSLING CCUP. B\ 22sgft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style
le of:
NEW CONSTR. BRANCH CIRCUITS)
NON-RESID l BRANCH CIRCUITS 2.50ea
NEWCONSTR. POWER APPARATUS 9
NON -RESID. SINGLE OUTLET CIR.
Ex. OccuD(OUTLETS OR FIXTIIRES B �E1
Ex. Occup. FIXED APPLNS. OR
p• OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
JK I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL N0.1 @ FEEPERMIT
FILING FEE J$3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
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
Land Development Fee
$
TOTAL PERMIT FEE
$ l OG
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X - r ate G ��
Signature of Permitee or Agen
Receipt No. 575
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been aid.
, �ECTO-R O;ELIC WORKS
0 11111111t
ME WIM
Building permit1bio'xpires Dates -/3-Z56
6161
Odom O17und dO 'lddQ
BUn6 dO ,ut4noO
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965 /OtC/ / %
Telephone: 534-4541 /
APPLICATION AND PERMIT AA
authorize representatives or the county or t3utte to enter upon the
above-mentioned property for inspection purposes.
e
X Date %
Signature of Permitee or 450ent
Receipt No. 1:74c9-IS—
White-D.P.W.
:74c9 -I —
White-D.P.W. – Yellow -Assessor – Pink -Inspector – Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have(n paid.
DIRECTO OF PUBLIC WORKS
BYDater 7 O
�//ilding permit expire�ate 3-1 : " 7,F
BUILDING
Ownerw
SQ. FT. OCC. BUILDING VALUATION
Mailing Addresslet
5 U
/]/9
(�
Tele hyrn
Contractor
Mailing Address
Fireplace
Total Valuation Sd
Telephone No.
Permit Fee
01
Building Address
ef
PlanCheckingFee&/or Penalty
Permit Fee
PLUMBING No.1 @ I FEE
'
PERMIT FILING FEE J$3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
C
A. P. No. �s OrJ — tS~'Zonin
&Planning
Water piping 1.50
Each gas water heater or vent 1.50
F
3artitettron
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Pias
Parcel
Declaration
Parcel Map
60' /W
Improve me is
Each additional outlet .30
Building sewer 5.00
7
Bldg R�
Parcel A roval
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
Permit Fee $
Ls i
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3.00
Main service e00v OR LESS
100 AMP LESS 5.00
Single FamilyDuplex Mobil Home ❑ Others
O_ ❑
-L
Main service EA. ADD100 AMP 2.50
Main service 10 0 AMP VER OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
NEW CONST DWELING
OR ADDNS. ACCLBLDGS.CCUP, 9) 20sgft
CONTRACTORS LICENSE LAW
1 am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
NEW CONSTR. BRANCH CIRCUITS)
NON -REBID BRANCH CIRCUITS) 2.50ea
NEWCONSTR./POWER APPARATUS 9
NON. RESID. %SINGLE OUTLET CIR.
Ex. OCCUD(OUTLETS OR FIXTIiRES g @ 15
Ex. Occup.(/ FIXED APPLNS, OR
OUTLETS (RESID,) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
am exempt from the Contractors License Laws of the State of Cal ifomia.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
�Icertify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No.1 FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
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
Land Development Fee
$
TOTAL PERMIT FEE
authorize representatives or the county or t3utte to enter upon the
above-mentioned property for inspection purposes.
e
X Date %
Signature of Permitee or 450ent
Receipt No. 1:74c9-IS—
White-D.P.W.
:74c9 -I —
White-D.P.W. – Yellow -Assessor – Pink -Inspector – Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have(n paid.
DIRECTO OF PUBLIC WORKS
BYDater 7 O
�//ilding permit expire�ate 3-1 : " 7,F
NOTE:—Ali Mr-k-,41rls Workmrr„!yip S,�,tl! Be in
icps and Qtn^t�
of a aunlit•- Tr- Ae `n,. -.rPerl use in the
On;form StAdir ' Mcdhanka; Codes drtd
L a the National Hectrical Code.
this set of plans and spscifica;ions. T,VSi be
a
-5ept, on tl�e } .'
p to at il f; ,. 5 a7%1it it
I make anyh y:= 'v
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written permisson from the Department of Public
Works, County of Butte,
r0/? 0 v x-=0
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