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Home My WebLink About025-200-143BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 409 E GRIDLEY RD Owner: Permit NO: B06-2635 APN: 025-200-143 BROUILLARD, ANNE Issued Date: 11/09/2006 BY TMP Permit type: MISCELLANEOUS 409 E GRIDLEY RD Subtype: Re -Roof GRIDLEY, CA 95948 Expiration Date: 11/09/2007 Description: RE -ROOF 49 SQ.'S COMP Occupancy: Zoning: Contractor Applicant: Square Footage: RICHARDS ROOFING RICHARDS ROOFING Building Garage RemdUAddn 2472 ELM ST 2472 ELM ST LIVE OAK, CA 95953 LIVE OAK, CA 95953 (530)695-2632 (530)695-2632 Other Porch/Patio Total FEE INFORMATION Re -Roofing $275.00 Total Charged: $275.00 Fees Paid: $275.00 Balance Due: $0.00 Receipt No: B823 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License RICHARDS ROOFING 775873 C 39 / / 3,3/-Og Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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 Pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 X 11/09/2006 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractor's Signature Date 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 License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: HAVE the work himself or herself or through his or her own employees, provided that such improvements ❑I AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractors License Law dows not apply to an owner of the property who builds or improves My Workers' Compansation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). r ��+Lyi24 ` Q92,0 Carrier G � Policy Number J , 0 Exp. Date: (This sac oon nee not be competed if the permit is or on�llars ($100) or less. I AM EXEMPT under Section B. & P.C. for this reason: ❑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 1 should become subject to the workers'X 11/09/2006 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions. Xl 11/09/2006 I hereby certify that I have read this application and slate that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building SI nature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or am au orized to act on the property owners behalf. CONSTRUCTION LENDING AGENCY ,Q � 11/09/2006 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Permi ee [;QP] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner ER Contractor OR; Agent for Owner ❑Agent for Contractor FILE COPY Lender's Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buffecounty.net/dds "PLEASE PRINT CLEARLY" CONTRACTOR OWNER INFORMATION Last Name 6�ee / irst N me Mailing Address�v 9 A'OST G.eid.� /Z City Zip 3S63 State Zip Phone Lic. # r) S S Fax E-mail Planner CONTRACTOR Name �16 G Name Address � 2— Address C4 City G11,67 State C�9 Zip 3S63 Phone �� 61 � Z�a3Z Fax E-mail Lic. # r) S S Class 3j ---•--APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Map Book Fax E-mail Planner State License Number ---•--APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: AP# D 25- -ZOO —/ A/3 Zoning City Flood Zone SRA Yes No Occ. Policy Number Type Const. Subdivision Name LENDING AGENCY Map Book Page Lot # Planner Date Approved: PERMIT NO. ma", 35 BIN # PROJEC T� LOCATION AP# D 25- -ZOO —/ A/3 Property Address40� F�-T AemiLq C� f �� City Cross Street WORKER'S COMPENSATION Policy Number Carrier 571,W� /'k� 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: 61 Sq FT- Living Garage Open Cov ❑ 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. ad Received by:� Amount: 756 Bldg SRA Receipt #: Sheriff SMIP Other ther // CI��v 2 %5, " Total