HomeMy WebLinkAbout025-190-0850
025-190-085
AYALA,MANUEL
04 -II
2174 HWY 99, BIGGS
INALE
CONT: GREENE & SON ROOF
G - Zo
RE-ROOF20SQ
025-190-085
AYALA, MANUELINALEi
2174 HWY 99 E, BIGGS
Cont: SPENCER INC
- -0
HEATING & A/C
0
A
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netldds
,.
ERMIT NO.'
P041499
LICENSED CONTRACTORS DECLARATION
" ,
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 05/25/2004 APN: 025-190-085-000
the Business and Professions Code, and my license is in full force and
effect. /
License Class : G AZO License Number: �6�I �Z
-
Site Address: 2174 HWY 99 BIG
Date: 5 1 Lvirky Contractor: I�g !w ec 7,"G
Map Index:
Description: HEATING &AIR CONDITIONING
p
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
INSTALLATION
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
I Owner: AYALA MANUEL ETAL
signed statement that he or she is licensed pursuant to the provisions of
MILLER CINDY J
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
2174 HWY 99 E
she is exempt therefrom and the basis for the alleged exemption. Any
BIGGS, CA 95917-9717
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
I
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: AYALA MANUEL ETAL
such work himself or herself or through his or her own employees,
I
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
f
year of completion, the owner -builder will have the burden of
f
proving that he or she did not build or improve for the purpose of
i
sale.).
y
O I, as owner of the property, am exclusively contracting with
ty
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
Contractor: SPENCER INC., R.B.
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
1188 HASSETT AVENUE
YUBA CITY, CA 95993
Date: Owner:
530-674-8307
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #: 664429
❑ I have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
f
Labor Code, for the performance of the work for which this permit
is issued.
Architect:
O I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Engineer:
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
I `
I
Carrier: Z evi i f (. — 14 o h
Total Square Ft: 0.F. J
s
Valuation: $0.00
Policy#: Z
E3 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
i
forthwithcomply with those provisions.
Date:
1,56,
Applicant:Oh/r'�/
r�
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 p i she by i s d the li vision of the Butte Count Coda 2nrUor
I hereby affirm that there is a construction lending agency for the
Re s to wo c ' d o fo i h es av "paid. _
performance of the work for which this permit is issued (Sic 3097
Name:
By: Date:
PERMIT EXPIRES ON: -
Address:
(Dare)
Cl I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. 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 the above mentioned property for inspection purposes.
upon
4K Signature:
Print Name: Ir(/!'lor� aS (�'l/!14
Date: —r—
❑ Owner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor
FM
5C -S Cv4&5C71s^1 r4o-L 0As UN6
Su"04 7
I r
S . t
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netldds
PERMIT NO.
BP041499
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 05/25/2004 APN: 025-190-085-000
the Business and Professions Code, and my license is in full force and
effect.�Z
License Class : G �Zd 'License Number: O
Site Address: 2174 HWY 99 BIG
Date: Z 9 Contractor: g 5M ,=cC .T ^ G
Map Index:
HEATING & AIR CONDITIONING
Description:
OWNER -BUILDER DECLARATION
I hereby affirm under penaltyalto of of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
INSTALLATION
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
Owner•' AYALA MANUEL ETAL
signed statement that he or she is licensed pursuant to the provisions of
MILLER CINDY J
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
2174 HWY 99 E
she is exempt therefrom and the basis for the alleged exemption. Any
BIGGS, CA 95917-9717
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
Applicant: AYALA MANUEL ETAL
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
Contractor: SPENCER INC., R.B.
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
1188 HASSETT AVENUE
YUBA CITY, CA 95993
Date: Owner:
530-674-8307
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License M 664429
❑ 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.
Aechitect:
ElI have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Engineer:
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier: Z e -K; 1 L — A a h
Total Square Ft: 0 S. F.
Valuation: $0.00
Policy #: Z -0 A5 9'Z 2 30 1
13I 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:
Applicant:_T,,76
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 p i s he by i s d the li vision of the Butte Count Code ?nrUOr
-I hereby affirm that there is a construction lending -agency forthe
-Re s to w d o fo i e av paid.-
aid.
performance
performance of the work for which this permit is issued (Sec 3097 Civ.)
JI
Name:
By: Date:
PERMIT EXPIRES OW
Da e
Address:
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. 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: 9 I'l A o" - Signature:
Date:
❑ Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
APPLICANT�NAM�E
OWNER
Name •A
Mi` er
Address
)'
City
Fax
State
ZiA 1ps y 7
Phone
7
Fax
E-mail
Fax 6 >, - 31 U Z
APPLICANT�NAM�E
CONTRACTOR
Name Pb
d„,1
Address
Zip
City
Fax
City �
G
State G
Zlp 5
Phone
X30 7
Fax 6 >, - 31 U Z
E-mail
Lic. # �z-i
Class .
G -2a
APPLICANT�NAM�E
ARCHITECT/ENGINEER
Name
d„,1
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
PlannerI
State License Number
APPLICANT�NAM�E
Name �,� e al L.�✓Ut'r- ���
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
PlannerI
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO. � /�
BP'A' `i 1
BIN #
//LLOCAATION
AP# / % V 0 85
Property Address
�olr� L
Cross Street
WORKER'S COMPENSATION
Policy Number
Z d� 0
Carrier
2e,t` +(, _Tv15 — Aei,
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:
i n d , I- G �1 a ios.
Sq. Footage
❑ Structure Built vrithout 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.
e %'ved by: Amount Bldg
SRA
Receipt #: Sheriff
SMIP
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 4-30-04
otal
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora 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
❑
3.
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
❑
7.
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
❑
11.
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed b tengineer.
Mobile,
Manufactured, or Modular Homes:
❑
1.
3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑
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, the he en ' eer.
❑
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
r �
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
` CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
.r P12O V/ D e s u P,0007 FDlL G /9 S t -i AJ L .
A c lZo 55 2obf; �f /j- T 6(j,4(,L ,
� � '64-
:f-
.k:
f
aL
N,t '
p
Date Inspector
V/C-7
REV 10/92
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.netldds
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.
Date: Contractor.
OWNER -BUILDER DECLARATION
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 penally 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 or 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 33't'e""kof the Business and Professions Code
Dater Owner. C:`
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
❑ 1 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
O 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 provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
JPERMIT NO.
V BP041168
Issued Date: 04/23/2004 APN: 025-190-085-000
Site Address: 2174 HWY 99 BIG
Map Index:
Description: RE -ROOF (20 SQ)
Owner: AYALA MANUEL ETAL
MILLER CINDY J
2174HWY99E
BIGGS, CA 95917-9717
Applicant: AYALA MANUEL ETA_L.:
t _ MILLER CINDY J
2174HWY99E
` BIGGS, CA 95917-9717
,
Contractor: GREENE & SON ROOFING
PO BOX 2467
PARADISE, CA 95967-2467
530-873-3940
License #: 275057
Architect:
Engineer:
Total Square Ft: 0 S. F.
i Valuation:. $0.00
Census Code:
WARNING: Failure to secure workers' compensation coverage Is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the coat of
compensation, damages as provided for in Section 3706 of the Labor 3Cr ej re%
code, Interest, and attorney's fees.
5--
:$ 1(0 .— 41= 3/o4 -
CONSTRUCTION LENDING AGENCY This permit Is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there Is a construction lending agency for the Resolution to do work indicated above for which fees have been paid.
performance of the work for which this permit Is Issued (Sec 3097 Civ.) By. I►ar ! Date: 4--23-,!--n)4
Name:
PER EXPIRES ON: 4- .33 .4> 5
Address:
Cl 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.
O Notification in accordance with Section 19827.6 of California Health & Safety Code is not applicable to the scheduled construction of this project.
O 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 Butte County to enter upon the above mentioned property for Inspection purposes.
Print Name: N 'J tom' ` 1 �l'� Signature:
Date: ° -Z3
WI Owner
❑ Contractor
❑ Agent for Owner
❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7838 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE All: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netldds
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:
Date: Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Stale 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 Slate 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).):
❑ 1, 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
Dater Owner:y' ,aAA_,-,
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.
❑ 1 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
❑ 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 provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
PERMIT NO.
BP041168
Issued Date: 04/23/2004 APN: 025-190-085-000
Site Address: 2174 HWY 99 BIG
Map Index:
Description: RE -ROOF (20 SQ)
Owner: AYALA MANUEL ETAL
MILLER CINDY J
2174 HWY 99 E
BIGGS, CA 95917-9717
Applicant: AYALA MANUEL ETA_L,
MILLER CINDY J
2174HWY 99E
BIGGS, CA 95917-9717
Contractor: GREENE & SON ROOFING
PO BOX 2467
PARADISE, CA 95967-2467
530-873-3940
License #: 275057
Architect:
Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
Applicant:
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 3708 of the Labor 3Ct cj 34-7 ( (0 4/33/0 -1 -
code,
0¢code, Interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there Is a construction lending agency for the Resolution to do work indicated above for which tees have been paid.
performance of the work for which this permit Is Issued (Sec 3097 Civ.)
Name: BY ^`•- Date:
PER EXPIRES ON: 4 3 -e>5
Address: Mate)
O 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 & Safely Code is not applicable to the scheduled construction of this project.
O Attached are copies of the required E.P.A. notification fortes.
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 Butte County to enter upon the above mentioned property for Inspection purposes.
Print Name: d� JS r" LL� '` Signature
Date: l 0 4
AOwner
0 Contractor
❑ Agent for Owner
❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP 04 1168
DATE:
APN. Ozo S 19 O O gs-
ZONING:
OWNER'S LAST NAME:
M( LC 2
OWNER'S FIRST NAME:
C✓4�,J/�S
PHONE
9lei (0 199.�i
STREET ADDRESS: 1 1 9
FAX
CITY, ZIP.(�,
YL.
E-MAIL:
SITE ADDRE
CITY, ZIP:
NEAREST CROSS STREET:
TRACT/LOT P.
APPLICANT NAME:
PHONE:
STREET ADDRESS:
FAX:
CITY, ZIP-
E-MAIL
CONTRACTOR NAME: r'pO I N
PHONE.
STREET ADDRESS: �Q
7
FAX
CITY, ZIP: ^ 0�
E-MAIL
LICENSE NUMBER.
LICENSE TYPE: G
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX:
CITY, ZIP:
LICENSE NUMBER:
E-MAIL:
DESCRIPTION OR SCOPE OF WORK:
❑ 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 fees will be required.
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.
For office use only:
Notes:
Application Received by: lz� Date: 4123104 --
Receipt number: 3 q �7 Amount Received:
O.B.- I
OWNER -]BUILDER VERIFICATION
Attention Property Owner:
An "owner-buildei" 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.
I personally plan to provide the major labor and materials for construction of the proposed -
property improvement: YES? NO ❑
-'2. I HAVE•. HAVE NOT ❑ signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: may:
PHONE: CONTRACTOR'S LICENSE NO. -
4.
O:4. I plan to provide portions of this work, but I have hired the following person to coordinate,
supervise, and provide the major work:
NAME.
ADDRESS: may.
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 WORD
D1lr1NrLv:
4 PROPERTY0
SOCMAL SELL i3 - E -R:-
4DATE: --+ -, 2-3 •0 4
NOTE. This Owner Bewilder Verification is required by .flection 19531 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.
OVER
OB. -I
I OWNER BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party ofrecord 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 you plan to subcontract, you should
be aware of the following information for your benefit and protection:
♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $300' or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments 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.
♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
uran
with respect to worker's compensation insce.
For more specific information about your obligations under Federal Law, contract 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 contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
J
ly.1 C. Vi ira, C.B.O.
er, Building Inspection
NOTE. This Owner-Builderlxfomudon is required by Sedkn 19830 of the California Health and Safety Code
OVER