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025-110-007
a_ I( 025-110-007 PERMIT#94-2940 L TREVINO -1J� 3035 MACK LN., 13IGGS CONT: A. AMES COMPANY b ELE SER CH/SF + '� r 025-110-007 05-0522 TREVINO, ANNA MARIA 3635 MACK LN, BIGGS CUNT: O WNEIt NEW SIDING ti 71� 025-110-007 PERMIT# -94-2940 TREVINO 3035 MACK LN., BIGGS CONT: A. AMES COMPANY ELE SER CH/SF ti OFFICE COPY Address GAS Meter By Date ELECTRIC Meter By Dat .A T/jilt'✓ L`E 'COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT No. APPLICATION AND PERMIT 01`40 ASSESSOR PARCEL NUMBER Ott+•J- ll110' W7 ZONING, A5 BUILDING PERMIT OWNER IN( TELEPHONE SQ, FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1035 MACK LANE CONTRACTOR'S NAME A. AWS WTANY TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 3035 MACK LN PERMIT FEE $ BIGGS PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE ��r SF7 Duplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile HoS G W me @20.00 TYPE OF WORK New ❑ Addition C1 Remodel ❑ UtilitiesyJ Installation ❑ Other ❑ Describe Work: REPLACE 100 AMP ELECrRIC SERVICE PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 'OV OR LESS ) 200A OR LESS 23.00 • Main Service ( 200A TO t000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. BLDS. ) g 3.50 FT0,, CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and m license is in full force and effect. License No.`s'('' (,,� Classification !i � i:. t� ? (( ❑ I, as the owner, or`my employees with wages as their sole dompensation, 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 contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL. @ .50 Ex. Occup.FIXED APPLNS. OR OUTLETS (RESID.) EA (. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 z PRE INSPEC. 20. WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. O' I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 86 .00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling 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 Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. 1 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 ),,-44,(�1Ji•( ( ,441 1 L L% Date /v Signati re of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ocC CONST. TYPE TOTAL FEE $ HAZ. I D. FEES I IMP I FLOOD CDF PARCEL PO HD Is$UE_ This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for whi h fees have been By T g (�y PERMIT EXPIRES ON ,%' "" ,dal !' Iustei provisions to do work paid. Date ./'�' `.� ..000.1 170455 Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF/DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICAYOWAND PERMIT 4�Ll - a1`40 ASSESSOR PARCEL NUMBER 025-110-007. ZONING A5 BUILDING PERMIT OWNER MR TREVINO TELEPHONESO, FT- OCC. BUILDING VALU ON OWNER'S MAILING ADDRESS 3035 MACK I.ANF CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ ARCHITECT OR ENGINEER - LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 3035 MACK LN PERMIT FEE $ BIGGS PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15.00 Each gas water heater or vent 15.00 USE OF STRUCTURE SFS Duplex O Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 me Mobile HoS G W @20.00 TYPE OF WORK New O Addition O Remodel ❑ Utilities XX Installation ❑ Other O Describework: REPLACE 100 AMP ELECTRIC SERVICE PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 600V OR LESS 00AORLESS ) 23.00 23.00 Main Service ( 200A TO 1000A ) 46.00 DWELLING OCCUP. NEW CONST. DW8, OR ADDNS. ( ACC. BLOS. ) SO , 3.5C FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and m license is in full force and effect. License No. Classification [� ._ G Q . G ?�(a O I, as the ow er, or my employees with wages as t emir sole ompensa ion, will do the work, and the structure is not intended or offered for sale. (Sec 7044) O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET •NON-RESIO. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) B SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) B20 @ 1.00 FIXED APPws. oR EX. Occup. ( OUTLETS IflESID.I EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23.00 PRE INSPEC. 20.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): O This permit is for $100.00 (valuation) or less. O I have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a certificate of Consent to Self -insure. kill shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 86.00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. 1 agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of 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 /l9 - �'�- �L� Sign of Applicant - O Owner O Contractor O Agent �— An SHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ DCC CONsr. TrPE TOTAL FEE $ HAZ. I D. FEES I IMP I FLOOD I CDF PARCEL PD HD Is$UE 11 This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for whi h fees have been paid. By Date % �t h PERMIT EXPIRES ON �B'-G? /— lDarel Receipt No. 170455 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COU-NTYOF BUTTE:. DEPARTMENT OFDEVELOPMENT,SERVICES -BUILDING DIVISION 7 COUNTY CENTER DkIV E - OROVILLEI-CALIFORNIA95965 -TELEPHONE (916)538-7541-1 -J' PERMIT APPLICATION DATASHEET OWNER .7 re�-V, t7 ,A7P- No. IA119 Proposed Building Use C- t L 1�r >L Building Inspector D;te At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: � ^ oxn, ncvcwco BY . ---~---__ 1. All items have been . . . . . . . . . . . . . . . . . . . . ._-_-----__ ---__----_ �' �-------- .. Plot 3/4 sets, signed— by preparer of , . . . . . . . . . . . ' ' ' ' ' ' ' ' ' ' ' ---------- ---------- -_---__-' ^_Complete�-,__ _ ,__ . . . � � � . . � . . . . . � � . . . . � . .. --_-------- --__-----_ 4.Engineered plans and uakm.3/4sets, with wet signature mnplans . ............. -------__ 5. Hazardous Material Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . . . . ._---__---_ _----__--- 6. Energy Design Compliance and supporting documentation . . . . . . . . . . . . . . . . . . . _---_---_- ----______ ' 7.Statement ofIntent for Non -Heated and A/C Buildings ...................... '' �---------- G. Engineered truss details and layout in duplicate (required prior to plan check). ' S. Mobilehome data and manufacturer's installation instructions, 2sets . . . . . . . . . . . .___________ ' --------- 10. Fees of $ ......................................... -_-_--��_ 11. Impact fees as shown on attached ocheduka. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._----_----- __--_----- . _-_-_---_ 12. California Department ofForestry plan approval/fees.. . . .� . . . . . . . . . . . . . . . . . .__----_--_ -_--------- 13. Flood elevation letter (1OOyear flood) bvCalifornia Engineer . .................. 14. Sanitation and plot plan approval Health Depnrtmerd. . . . . . . . . . . . .---_------_ ^ 15. -City ofChkm plumbing permit . .. . . . . ... . ... . ... . . . . . .. . . . . . . . . . ... . . . . ._----__---- -_--------- 16. from City ofB 17. Planning approval for (\) Use: (U) Parking: ^^[bntactLand Development about (A) Improvements (B) Drainage ............ ___________ ~- Driveway permit (construct'" ............. ion �20. P---,---__ t. Building +`---------' 21. Contractor's license /nfomnaUon.(No,Name Style, Classification) . .............. � --------_ 22. Certificate ofVVorkmmnaCompensation Insurance ........................... ______________________ ` --------_ 23. Owner -Builder Verification (Given hoowner ____. Mail hoowner ). ............ 24. Recorded copy ofAgricultural Acknowledgement Statement . .................. ---------- 25. Letter mfsignature authorization . . . . . . . . . . . . . . � . . . . . . . . . . . . . . . . . . . . . . . . . .___________ ---------- 26. recorded deed ofpmroe oreodonand 0Oright ofvvoytompub|icnomd. .....27. ---------' �io�erofintent onbuilding use . ......................����...............-__-----_-_ _---------- 2l K8ob|ehoma ud|hv clearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .--_------__ 29. Documentation oflegal access . . . ` I and (B)Parcel meets zoning area and frontage raquinemnenbo�`�����������...� -------___ ~� 31 Existing d . ' - 32. Plan . ' %l ^ . ` 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for t office. Deliver with inspector. CVher Parcel Creation Acreage Applicant Date Copy ofHoa-K4atform sent Health Dept. Fire Dept. Air Pollution Date ----CoRyofplans sent Health Dept. _____ Fire Dept. Other _____Date By_________ 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: Contractor, designer, owner, was advised of Dete__________ Contractor, designer, owner, was advised pfabove required data by Date Plans checked by Date Plans approved, Date-" Sets of plans on hold in File cabinet AP folder Copy ' Department cfPublic Works OWNER: LOCAT Xr � / re U � Yl �% DATE /9g I CONTRA PRE -INSPECTION /� �� A.P. #t'/ID-"h�� RACTOR:^� , /L% /'Vl (1 S �© ZONING —ted PRE -INSPECTION FOR: ,y �� r f r , C_. oeP r DATE TO INSPECTOR ------------------------------------------------------------------------------------- PERMIT HISTORY: NONE AS FOLLOWS: `— TYPE OF OCCUPANCY_ -------------------------------------------------- --------------------------------------------------- 1 FIELD - INFORMATION BUILDING USAGE: TENNANT: [� OCCUPIED D HAS ELECTRIC HAS GAS HAS SANITATION FACILITIES Q HEATED -COOLED PERSON CONTACTED OTHER COMMENTS: ACTION RECOMMENDED: ISSUE HOLD FOR e OTHER: BY DATE A0 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES : BUILDING DIVISION T 7 County Center Drive - Oroville; CalifoPnia 95965 - Telephone (916 53& 541 - PERMIT No. �APPLICAtl ' IVrAND PER' MITA : • rN� � � +.0�. ~ :'�ili r,2� ...."'C.' IONMY ryt �' .j:: cR��� `e+lry - x f. �w7'-_�:Sa"h. .4) ° .. '� aC.`FT. ^ �occ: B hidNo VALVAR loft" J OIMNEK'1 .. - t. CON•a; ` ... S " -_,t "•�,°,�-•,,'..r�.�u{?,,?...t ,'x`t�s�rd 4 �'�.��z?�..4'. _ ;:kL�L.•Kf.tt':. t.f,r_. ,., .. .:','I't f'.•.. ��• CONTRACTOR"; MARINO AGGRESS f... ' ... __ - . • Fireplace - ;;:; �•. - . cowaTrRDcnoN LaROEe LNINOWN Total Valuation S LINGER'; MARINO ADDRESS Filing Fee $ 20.00 Permit Fee 8 ANCWMCT OR ENGINEER UCENSi NO. Plan Checking Fee 8 ARCWFECT OR ENGINEER'S MARINO ADDRESS Energy Plan Checking Fee $ Penalty 8 BUILDING ADOREss PERMIT FEE $ . PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23,00 LOT NO. SUBDIVISION'S NAME p Water piping 15.00 Each gas water heater or vent 15,00 USE OF STRUCTURE SFA Duplex O Mobilehome O Other sPECIcv Gas piping system 1 - 5 outlets 15,00 Building sewer 15.00Mobile Home S G W @20.00 TYPE OF WORK New O Addition O Remod. Utilities Installation O Other ❑ DescribeWork: �—' — Q F _ �� 1� Y; L� , PERMIT FEE 8 Contractor ELECTRICAL PERMIT Fling Fee 20.00 SOO 08 LESS Main Service ( A OR LESS ) 23.00 Main Service 200A TO IOOOA ) 46.00 NEW CONST. OWEILNO OCCUP. Sa OR ADONS. ( •ACC. BLDS. ) 3.5Ci FT, CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification O 1, as the owner, 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) O 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 1 am exempt under Sec. , Business and Professions Code forthis reason WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): O This permit is for 8100.00 (valuation) or less. O 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. O 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. NEW CONST. MULTI -OUTLET •NON-RESID. I BRANCH CIRCUITS ) @7.50 POWER APPARATUS ( a SINGLE OUTLET CRR. ) Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ I.00 SAL. .50 Ex. Occup. FIXED APS. OR p- (OPLNUTLETS (RESID.1 A. ) 5.00 Temporary Service 3.00 Mobile Home Facilities 20.00 c. Wiring 23.00 3,.0 r+e _ .•e PERMIT FEE 8 Contractor MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE 8 I certifythat 1 have read this application and state that the above information is correct. 1 agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of 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 ities, judgments, costs, and expenses which may in any way accrue against said Cou-ity in consequence of the granting of this permit. X Date Signature of Applicant - O Owner O Contractor O Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Contractor Mobile Home Installation Fee 8 Energy Inspection Fee 8 occ CONST. TYPE TOTAL FEE $ HAZ. D. FEES I NIP I FLOOD I CDF PARCEL PD HO 6S IE 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 paid. By Date PERMIT EXPIRES ON (Date) Receipt No. WHITE-O.D.S.-S.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD- APPLICANT AREA HousiNe AOKoRtTY WRT.TER. COUNTY "J%hway, RQ fox �31y. Yuba City GIh 95992 * (534 Ct t-0.,22 f Loan Commitment Request Applicant: Annamarie Grigsby To: County of Butte Loan Committee 025x-110 - ooi GP OFA. Primary Applicant �1 A Name: Annamarie Grigsby Address: 3035 Mack Lane Biggs, CA 95917 Date: 10/20/04 File #: 224 Co -Applicant Name: Household Information Property Information Annual Income: $6,790 Single -Family Household Size: 2, Annamarie & boyfriend Tenure: Owner -Occupied q- pqq ® e) blq 1p Work Needed: Annamarie and her boyfriend started work on her septic system but ran out of money. She is asking for emergency grant funds to finish the work. The tank and the diverter box are in but the leach lines need to be finished. Ms. Grigsby is requesting funds for parts, labor for leach field work, 1 %2" drain rock and rock delivery. At this point, Annamarie does not have a fully functioning septic system. Total Project Estimate: $1,962.85 Emergency Grant: $1,962.85 Escrow: -0- Contingency: -0- Annamarie received estimates from Dave Hughes, Oroville Products and Granite Construction Company for total of $1,962.85. Our in-house estimate for the same scope of work is $3,477.36. Underwriting Considerations: The verified annual household income of $6,790 is based on Annamarie's 2003 tax return, which is less than 50% of the median income for Butte County. Current monthly housing expenses of $567.50 is 100% of her income based on her 2003 tax return. Currently, neither Annamarie nor her boyfriend are employed. Since applicant is requesting an emergency grant, information relating to credit history, property value and loan -to -value ratio were not investigated. Project will be funded from CDBG PI. Grant approval is also not subject to income reviews. 1 f Recommendation: The Consolidated Area Housing Authority of Sutter County recommends the approval of an emergency grant in the amount of $1,962.85 to Ms. Annamarie Grigsby for needed parts and labor to complete her septic system leach field. Loan Committee: Approve nie _ Date 1— �� -d Jane Dolan,'Uutte County Supery�sor Date Butte County Supervisor Approved/Denied Date Deborah Debrunner, Butte County Principal Analyst (Ap!p�rove-'enied /) Date nifer acarthy, Butte Coy ty Program Manager Comments/Basis or Denial: ButteCo:LoanComm224 N FA ,_.. I. I i i I i t I i I 1=040.00+ 400. 54+ 522.31+ 1,962-85* J 0•* Oroville Products Porta -Pony Rentals, Septic Tank Manufacturing, Plumbing & Pipe SuPPIY... . 6900 Lincoln Blvd Oroville, CA 95966 530-5347670 ^ rp t� t,us'wmer s vraer [vo. [nvozc@ NO. -A .. '4' !,! Name: �—' V r P �f��Rr- I S 2-� Date: Address: Phone: ( ) SOLD BY' CASH CHECK C.O.D. I CHARGE ON ACCT. MDSERTD. PAID OUT DESCRIPTION PRICE AMOUNT ,QUANTITY c- . , tom'.. L.� U jj' V W LA L (� r I I i TAX Received By TOTAL L %} ;./fianfr you f sRAnITE ConSTRUCTIon EOMPRny lINcE 3 6o✓+ //z Dra ,,• Ro C, k3 eta . b a D -e- (v" 7S. ©O kc �r E rvtG k D2 <<�2 -7p _ o o Ao,r- ./ �6�a / c4,gry e $ 6-d- d, , 3 Oroville Area Box 1630 Orovi lie, CA 95965 Phone 530/534-7616 FAX 530/534-9420 ' c9 CAHASC 448 Garden Hwy. ..------ Yuba City, Ca. 95992 1 888 671 0220 Estimate Date°:'' 10/15/2004 1 Customer,': Jots`:.'`:'.:: `Project Subtotal "Project Total Amount:.--- 9.36 mount::: 9.36 2,809.11 6.68 668.25 3,477.36 3,477.36 Total I 3,477.36 BUTTE COUNTY PERMIT NO. DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) BPO50522 OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION 1 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 Issued Date: 02/25/2005 APN: 025-110-007-000 effect. License Class: License Number: Site Address: 3035 -MACK LN BIG Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Description: NEW SIDING 20 SQ.'s Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: TREVINO ANNA MARIA GRIGSBY 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 3035 MACK LN 7000) of Division 3 of the Business and Professions Code) or that he or BIGGS, CA 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 95917 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 Applicant: TREVINO ANNA MARIA GRIGSBY 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 3035 MACK LN 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 BIGGS, CA sale.). 95917 O 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.). Contractor: ❑ 1 am Exempt under Article of the Business and Prpfessi�Code Dale: Owne 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 License #: Labor Code, for the performance of the work for which this permit Is Issued. O 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Engineer: Carrier: Policy #: Total Square Ft: 0 S. F. Z, 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 Valuation: $0.00 become subject to the workers' compensation laws of California, Census Code: 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: • ' �i Applicant: V' WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby Issued under the plicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to work Indicate4 ab e f r ryhich fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Date: Name: Byi / 2 - PERMIT EXPIRES ON: Address: Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19627.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. Cl 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 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 men(joonned property for inspection pur ses. �/� e�i�� Signature: Print Name: Dale: .5z .1 Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pq 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 APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last NrR I ( Cyt /✓� in NQrrteC C In /h b 6 l� �l/ Address 3 ' „f ,v City ' G (�✓5 stateC� , �i / ? Phone / $ _ d ? (O Fax E-mail APPLICANT NAME CONTRACTOR Name City Address Zip City Fax State Zip Phone Map Book Fax E-mail Planner Lic. # Class 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 Address City Slate Zip Phone Fax E-mail APPLICANT SIGNATURE X h4wd-77 �"'- V_ V , / - For office use only: Zoning Propedd rty or!�,S- Flood Zone cross Street 016 G 5 f/ IV t f SRA 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. a5 BIN # LOCATION AP# Propedd rty or!�,S- cross Street 016 G 5 f/ IV t f WORKER'S COMPENSATION Policy Number 1 n 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 &Z Address Page 1 of 2 ascription or S ope 0 ork: `7 14- C` Sq. Footage S O ❑ Structure Built without Permits ❑ Proposed Change of dccupancy (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: _�P_ Amount: Receipt#: 425,11S / Date: ll�Bldg SRA Sheriff SMIP I Other Total REV 7-27-04 4F . 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. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and 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). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. 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, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application 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 7-27-04 N '3Ei1xkRI I=CA-AIO;; .iL..hL.`aed..:a.SLs'_'S$i..iLa4.3'vl.,+F..1.�13(t ..,t ran'^>•'•: .4.> 2°.'". !.si7�n�.`31 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 ajor labor and material for construction of this proposed property improvement: YES [ ] NO [ ' ]. 2. I HAVE [X] HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. `I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK r SIGNED: F % Ii3 NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services ADMINISTRATION * BUILDING * GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538.2140 Facsimile WON��B ILS IO Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their ''own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. C. Vieirq, C.B.O. Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.