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025-340-029
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 PERMIT NO. BPO43113 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: 12/14/2004 APN: 025-340-029-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 33 FAVORITE COURT ORO Date: Contractor. Map Index: Description: NSF(2166)GAR(576)COV(334) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: ROBERT BIRKHOLZ 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 P O BOX 865 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 PALERMO, CA 95968 she is exempt therefrom and the basis for the alleged exemption. Any (530) 520-5789 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 Applicant: ROBERT BIRKHOLZ 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, P O BOX 865 provided that such improvements are not intended or offered for PALERMO, CA 95968 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of (530) 520-5789 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 Contractor: 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 w.). ❑ 1 am Exempt under Article 3 oft usine rofessions Code/ Date/�2�4?16wner: License #: WORKERS'COWrPENSA,TfON PEiCILEARATION I hereby affirm under penalty of perj a 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 Architect: is issued. Engineer: ❑ 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: Total Square Ft: 3076 S.F. Valuation: $159,958.00 Census Code: Policy#: I certify that in the performance of the work for which this permit is issued, 1 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 rrovisions. Date: 111�2'— Applicant: WARNIN : Failure to se a ers' compensation coverage is unlawful, and shall subject employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages s provided for in Section 3706 of the Labor �� code, interest, and attorney's fees. L �6�9 �� �G- CONSTRUCTION LENDING AGENCY This permit is hereby issuednder the applicable provisions of the Butte Cnunty CodR an or I hereby affirm that there is a construction lending agency for the the for this is issued 3097 Civ.) Resolutions to do is ed above -f r which fees have been paid. performance of work which permit (Sec Name: By: Date' v Address: PERMIT EXPIRES ON: ate ❑ 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 qf1he owner. I agree to comply with all county arid state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any o doc utte County. I hereby 7or authorize represe ss of Butte County t enter upon th ve mentionedproperty for inspection purposes. �r Print Name: «/t/L./ ,�/ TL/[ Signature: Date: ,Z Owner 13 Contractor ❑ Agent for Owner ❑ Agent for Contractor l $ 01018q. s Y 1Ajj11dot, BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES f)q 2✓ g3 BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CI -UCO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION "PLEASE PRINT CLEARLY" APPLICANT NAME ��II�J��I ■��'J �I Address Zip City Fax State Zip -Phone APPLICANT NAME CONTRACTOR Name City Address Zip City Fax State Zip -Phone Address -Fa E-mail Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Address Fax E-mail State License Number APPLICANT NAME Name L� Address City State Zip Phone Fax E-mail For office use only: Zoning / Z Food Zone SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BP BIN LOCATION Property s City 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 —Nam Address OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 o description or Scope of Work: Sq. Footage SF�� 5-1 ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Amount: li�dg CS SRA Receipt #: Sheriff g0o6Zb C<1 SMTP Qther Date: �� 2 S 6 *3_3670;0!al f RFV 7-27-n4 -71 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a 'INCOMPLETE permit. 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 paperl ❑ 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 faxesl ❑ 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 A/C 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). 17_9.3-.anitationand-site-plan-apprnvalfrom tbe-EnmronmentaLH.ealtb Depadment. 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. Workers 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 KAFORMSIBUILDING F0RMS%B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 M N � Butte County Department of Development Services YVONNE CHRISTOPHER, DIRECTOR County Center Drive roville, CA 95965 30) 538-7601 Telephone 30) 538-7785 Facsimile TO: FROM: M SUBJECT: 1 Q DATE: I WILLDAN O�UTtFO 0 , 1. ,; 0 0 0 UN Scott Rutherford (530) 538-7160 srutherford()buttecounty.net Plans Transmittal For Review Per Contract 10/26/2004 Applicant: Birkholtz, Robert Permit 04-3113 Project Type.: NSF/Gar/Cov APN: 025-340-029 100% 70% - Plan Check Fees $ 1,193.83 $ 835.68 $ 1,193.83 $ 835.68 WILLDAN Fee $ 835.68 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate Building Plans Truss Calculations Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET 02-7 -/0 4* OWNER: /20r;:&Y2 TT ��%zic. �-� ASSESSOR PARCEL NUMBER 4L Proposed Building Use: Al 5 Counter Technician: � Date: /6/7S-_Iesel Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ' 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. q 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. 1� 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. 0 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst. (B) Marriage line info, (C) Floor Plan, (D) Tie down or find plans, all in duplicate. ❑ 9. 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ X14. Hazardous Material Form I . 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other R fining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ \ 19. Soils Report and/or Engineered Foundation required ........................................... ........ t23. rosion Control Plan Required........................................................................ ........ ees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ ity of Chico Plumbing permit........................................................................ ❑ alifornia Department of For stry plan approval ❑ paid. Sent by: ............. 0 �lanning approval (A) Use:MB)Parking: (C) Parcel Check: ❑ _ 25. Contact Land Development about _ Improvements, _ Drainage ......................... c� 26. NPDES Form...................................................................I......................... FEVT_ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... . 0 30. Worker's Compensation Carrie and Policy Number .......................................... 31. Owner -Builder Verification (Given to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization......................................:............................. ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 3 . Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... 3 DeefiR�striction......................................................................................... t Grant eed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑Check to H.C.D. $ ❑ 8.10the. ❑ 39. Other: When issued Telephone !t=:) and hold for pickup. 1 have been inf irrmea of th&_aj�bve items and 'regyiremegts-tor obtaining a building permit. Applicant/ Date: 1. Index�pei it ppl ci ation for the above ifems numbe d: Plan Check Letter �I L 2. Additional items require Contractor, design , owner -a vised of the above data by phone, ❑ mail, ❑ counter, by Date: S Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by. Date: Plans reviewed by: Date: Plans approved by: Date Structural reviewed by: Date: i I Structural approved by: Date: Note transfer by: Date: Yellow: Building Division -1-1, *L E.H. USE ONLY Plot Plan Attached Floor Plan Attached Sant to S.D. ! TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance a&ev"Id C -7-Z- _ Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public Private Well Clearance for o,"" dwelling. Other & Hold final for: Final. clearance O.K. for: NOTE: 0,- 1 q. 9 Z-F-6'eoo0r!-=2 A c A9-•cJ -o-1 W4 5 Environmental Health 8/96 Date COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES OWNER �-0�7C�-[�7 %�-IL(-{� L A.P. # PROPROSED BUILDING USE DATE 2. RECEIPT # DATE REC. 1. BUILDING PERMIT FEES --- Balance Due ..................... $ --- Additional Fees Due........... $ evised Plan Checking Fee.... $ + 2. SCHOOL DISTRICT FEES OY20 U 6— (paid at School District Office) (form available a er Plan Check) 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ _ Units Commercial (sq. ftg.)..... X $0.03 = $ _ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit)..... X _$ _ # Units Amt. Commercial (Sq. Ftg.).... X = $ Sq. Fig. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $89.00 (paid at Building Division) J 8. WATER TENDER FEES BATTALION # $200.00 (paid. at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ......... X = $ Sq. Ftg. Amt. 10. OTHER At time of permit applicati advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed dur a pl APPLICANT DATE�O'O�� Pursuant to Government Code Section 02 ou are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approv a project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) oDepartment of Public. Works _° C o u n t y. o f B u t t e O ° J. Michael Crump, Director LAND DEVELOPMENT DIVISION O / Storm Water Management Program 7 County Center Drive O"II CA 95965 rove e, � Av@IC �ypP5 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE1 Project Description: Project Location and/or Parcel Number: A2,5—'- By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require 'a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. . I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04 O.B.- I 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 e issued until this verification is received. I % I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES[DC] NO[ 2 j. I HAVEV] HAVE NOT[ ] signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 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: CITY: HONE: CONTRACTOR'S LICENSE NO. 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 SIGNED: PROPERTY OWNER: DATE: 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. May 1995 2.26 O.B.-1 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 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 you plan to subcontract, you should be aware of the following information for your benefit and protection: 0 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 incnrance, disability insurance costs, and unemployment compensation contributions. 0 There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. 0 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 ifformation about your obligations under State Law, contact the Department of Benefit Payinents 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 "ownerbuilder" 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 C. Vie* C.B.O. Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. May 1995 2.27 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) 1 : ISchool District / A.P. Number L G Property Owner D Property Location/Address is Subdivision I Building Department No. Jurisdiction: City County Residential DevelopmentQ NWOg Mobile Home Units Installation Commercial/Industrial Q Q New Addition Lot No. Sq. Footage Addition/ 'Supplemental to "T(Group R) Conversion Permit # *(No foundation inspection) ................................................................................................_..., Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage (Including Exterior Roofed Areas) Dade District Identification. No. 0,5'01$ Q 1 j hj b)r, At 046 School District certifies that i -� \ y - (Applicant) (Applicant) 33 FAVDrI (Street Address) (Phone Number) has complied with the requirements of Resolution No. l representing cX D square feet. District Paid by Check # Remarks: us (State) \1. (Zip Code) g by payment of $ """' 2926 $ FULL MRIGATION $ is-IM=nL Date MoBce: You may protest the imposition of the fess Identified above by subs ting a written protest to the District, In compliance with Govomino Code Section 66020(a), within 90 days from the date teas are paid. Failure to submit a tiny written protest wlll'prohibit you from challenging the Imposition of the fees In any court adlorL K, subsequent to the School District Representative signing this Butte County Schools Impact Fee CeRl6eatlon Form, the School District Is entified by the applicable Local Planning Agency that this prood Is being reviewed under the California Environmental Quality Act (CEQA� thls pro)ed maybe subled to additional school fess to fully mltigate.fis impact on the school csbi4ft schools. White (applicant), Yellow (building department), Pink (school district) feefomh.xis (10/03)dmm 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 PERMIT NO. BP043365 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: 12/14/2004 APN: 025-340-029-000 the Business and Professions Code, and my license is in full force and effect. -n S Z 0 / License Class: License Number: b Site Address: 33 FAVORITE COURT ORO Date: I �Z Contractor wS e Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: FIRE SPRINKLERS FOR BP043365 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: BIRKHOLZ, WAYNE to its issuance, also requires the applicant for such permit to file a 300 SUNNYBROOK LN. signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section OROVILLE, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95965 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 Applicant: BIRKHOLZ, WAYNE owner of property who builds or improves thereon, and who does 300 SUNNYBROOK LN. such work himself or herself or through his or her own employees, OROVILLE, CA provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one 95965 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, Contractor: SQUYRES JR, WILLIAM and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). P 0 BOX 3176 ❑ 1 am Exempt under Article 3 of the Business and Professions Code CH ICO, CA 95927 Date: Owner: License #:.275206 WORKERS' COMPENSATION DECLARATION 1 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 Architect: is issued. ❑ I have and will maintain workers' compensation insurance, as Engineer: 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: Total Square Ft: 0 S. F. Policy#: Valuation: $0.00 I certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any persons any manner or 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: v �109- Applicant: WARNING: Failure to secure workers' corn nsation 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 This permit is hereby issued under the applicable provisions of the Butte County C da 2nrU r Resoluti do work i ated ve f which fees have been paid. x performance of the work for which this permit is issued (Sec 3097 Civ.) 7to By Date: v Name: l Address:P11 PERMIT EXPIRES ON: Dat ❑ 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 & 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 for ocu of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection p oses. Print Name: CI V14 rC 5 Signature: 1 Q - 10 Date: I 1 ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY PERMIT DEPARTMENT OF DEVELOPMENT SERVICES NO. BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS t' 2 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 BPC)L 7 OFFICE #: (530) 538-7541 BIN # A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" CONTRACTOR Name r"— � k �S Address (J� Q� City C c O S�e p ZI )'39-o I s1' --10)Z Fax� - PE-mail Lic. # 27Z0 Cl J I APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City State Zip Phone Fax E-mail State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT - NATURE X For offi a use`only: Zoning Flood -ene Sheriff SMIP Other D =Total SRA Yes No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS 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: W u� m Q. Eiis nVi rr S�e 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 Received by: Amount (��9n '5 G o99 `— Bldg SRA Receipt #: Z Date: J l 6 Sheriff SMIP Other D =Total KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 6-16-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 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. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. 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 by the engineer. 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 GRAPHPAPER! ❑ 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 by the engineer. ❑ 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 Ic SWILDING F0RMS1BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION •J 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: �!2<< �- ASSESSOR PARCEL NUMBER ©��r -��� r� Proposed Building Use: / ��L ��> Counter Technician: �i Date: �f/ G`/ l �- Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. O 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! O 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in Planning approval for (A) Use: (B)Parking: (C) Parcel Check: duplicate. ❑ 9. 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 26. NPDES Form must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Site plan and business license approval from the City of Biggs. ❑ 12. Letter of intent for non-residential buildings. ❑ 13. Detached Accessory Building Form filled out by the owner. O 14. Hazardous Material Form. ❑ 15. Sanitation'and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Rema ag-items needed to issue the permit. (May require additional plan review upon receipt of the following items.) p' 17. Fire Sprinklers p bi-" Gm `s L ❑ 18. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office ❑ 19. Soils Report and/or Engineered Foundation required. ❑ 20. Erosion Control Plan Required. ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet. ❑ 22. City of Chico Plumbing permit. ❑ 23. California Department of Forestry plan approval ❑ paid. ❑ 24. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: O 25. Contact Land Development about _ Improvements, _Drainage. ❑ 26. NPDES Form O 27. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 28. Pre -Inspection for required. O 29. Contractor's license information. (Number, Name Style, Classification). ❑ 30. Worker's Compensation Carrier and Policy Number. ❑ 31. Owner -Builder Verification ( _ Given to owner, _ Mailed to owner). O 32. Letter of Signature authorization. ❑ 33. Recorded copy of Agricultural Acknowledgment Statement. ❑ 34. Manufactured home utility clearance. ❑ 35. Existing violations and/or expired permits. ❑ 36. Deed Restriction. O 37. ❑ Grant Deed, O M.H. Title/Statement of Facts, O Letter from Legal Owner, O Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the-abov-e items and requirements for obtaining a building permit. Applicant: Date: - Z y cS EXPIRATION OF APPLICATION Applications for which a permit hat' -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. Original -Applicant VA t :y% COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION AV, 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: ASSESSOR ASSESSOR PARCEL NUMBER y Proposed Building Use: / /de '1>' 01 -?1 twee c j Counter Technician: Date �� /,2f_�� A L Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to"' ply ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans.. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaini ms needed to issue the permit. (May require additional plan review upon receipt of the following items.) 2-1 17. Fire Sprinklers......... jR *-ry 6.& t G ....................................................... ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. ❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization.................................................................... ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits. ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the_above items and requirements for obtaining a building permit. Applicant: ! Date: 6 1. Index pep pp ication for the above it s numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, v0s advised of the abo e daja by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: 1W Date: 1;3AY Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division W1 LLDAN M Iarys Street Msville, California 95901 Serving Public Agencies 530/749.2373 fax 530/749.2199 www.willdan.com November 22, 2004 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 (530) 538-7169 (530) 538-2140 FAX SUBJECT: COUNTY OF BUTTE PLAN REVIEW APPROVAL Willdan Project No: 14353-1206 Jurisdiction Job No: 04-3113 Assessor's Parcel No: 025-340-029 Description: Birkholtz Residence, Favorite Court, Oroville Dear Mr. Rutherford: Willdan has completed a plan review of submitted plans and documents for the above referenced project and recommends your approval with the conditions noted on the 2nd page of this letter. The plans and documents provided for this review that have been found in compliance with the applicable codes are: * Plans: Two (2) copies dated 09/14/04 by Matthew McKisson, Architect * Energy Calculations: Two (2) copies dated 09/14/04 by Curt Keen * Truss Calculations: Two (2) copies by Erickson Building Components The plans have been stamped with the Willdan approval stamp and dated the date of this letter. See below for the identification of the codes and standards applicable to the project, a code analysis, conditions -of -approval and identification of any deferred submittals. APPLICABLE CODES Unless noted otherwise, all comments are based on requirements of the 2001 California Building Standards Code found in the California Code of Regulations, Title 24: • Part 2, known as the California Building Code and abbreviated herein as "CBC". • Part 3, known as the California Electrical Code and abbreviated herein as "CEC". Part 4, known as the California Mechanical Code and abbreviated herein as "CMC". Part 5, known as the California Plumbing Code and abbreviated herein as "CPC". Part 6, known as the California Energy Code, and Energy Commission Standards, and abbreviated herein as "CECS". W I LLDAN Serving Public Agencies CODE ANALYSIS Type of Type of 1" Floor 2" Floor Sprinklers Stories Total Sq Ft Occupancy Construction Sq Ft Sq Ft R-3 V -N No 1, 2166 NA 2166 U-1 V -N No 1 576 NA 576 Covered V -N No 1 334 NA 334 Porch(s) CONDITIONS OF APPROVAL 1. Approval is contingent upon the review, requirements and approval of other departments and/or agencies that have jurisdiction over this project. 2. Revisions and/or notes as red -lined on the plans. DEFERRED SUBMITTALS Our plan review reveals no deferred submittals noted at this time. SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. Sincerely, Isaac Kuster Plans Examiner Cc: Alice Mefford, E-mail: amefford@buttecounty.net f Robert Birkholtz, P.O. Box 865, Palermo, CA 95968 Gordon Wright, P.E. Plan Check Engineer r Page 2 of 2 County of. Butte Permit Number 04-3 1 l 3 W illd.an Project Number .14353-1206 RECORDING REQUESTED EY Financial Title Company AND WHEN RECORDED MAIL TO Name Robert Allan Birkholz Street P.O. Box 865 Address Palermo, CA 95968 city,state-.7 LF -L. 4L -)I_ ( L6� tZ+ Zip tF ll Order No. 42449999 -853 -LAS ►bo2)►21oj� RECORDING REQUESTED BY•. MID VALLEY TITLE GRANT DEED Recorded Official Records COUP Of CAMCE J. GRUBBS Recorder ROSEMARY DICKSON Assistant @9360AN 30 -Sep -2N4 SPACE ABOVE THIS LINE FOR I REC FEE 10.00 TAX 71.50 I t t I I Kathy I Page i of 2 USE THE UNDERSIGNED GRANTOR(s) DECLARE(s) Documentary Transfer Tax is $,'7 t.56 _ City of or Q Unic:orporated rea ❑ computed on full value of interest -or property conveyed, or City Conveyance Tax is $ IZ full value less value of liens or encumbrances remaining at Parcel No. 025-240-083 the time of sale FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Ronald Birkholz and Kimberly Birkholz, husband and wife as joint tenants hereby GRANT(s) to Robert Allan BirkhOIZ .a .married man the following real property: S e__ f i �� sC i2 f ,v ii o C�7—c Gdti 2¢ Dated: September 16, 2004 STATE OF CALIFORNIA //• COUNTY OF ub/9 I S.S. On 5tiE, —14}' before me, .b C0.. a Notary Public in and for said County and State, personally appear e- 8 personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ie . and that by his/her/their signature(s) on the instrument th"Med er., s), or the entity upon behalf orhan h ch theftcial rson acted, ex' t 1 instrument. WITNESS m\d\and a . d , Ronald Birkhole Kirribbrly Birkholz . i" DEBBBE C. HEUERg 0 COMN9. # 9285492 4 -as. NOTARY PUBLIC - CALIFORNIA SUTTER COUNTY cicoas°` r COMM. EXP. NOV. 28, 2004 - Signature —1v `— (This area for official notarial seal) order Number: 0401-1603121 Page Number: 5 LEGAL DESCRIPTION i' Real property in the unincorporated area of the County of Butte, State of California, described as follows: PARCEL I: PARCEL 3, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE; STATE OF CALIFORNIA, ON MAY 22, 2002, IN BOOK 154 OF MAPS, AT PAGE(S) 15 AND 16. PARCEL II: A NON-EXCLUSIVE EASEMENT FOR ROAD AND PUBLIC UTILITY PURPOSES ACROSS THE NORTHERLY 60 FEET OF PARCELS 1 AND 2 AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON MAY 22, 2002, IN BOOK 154 OF MAPS, AT PAGES) 15 AND 16. APN:025-240-083 Mid valley Title. & Escrow Company FA STYE PLAN REVIEW APPLICATION Date: Permit Number (if applicable) a q -3F/ 3 AP# 0215--3 YO -0.12-1 APPLICANT INFORMAT1061r_� Owners Name: Parcel Size: '� ? QGL.CiS &�&evz, p Owners Address:too• . 6 ox 0 �.� /'� o coot� !� Telephone No.: Situs Address: Proposed Use: Residential ® New Single Family Residential ❑ Single Family Addition ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other ❑ Septic ❑Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): It %_9 /64/ ❑ Single Family Remodel ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) N Approved in Conditionally Approved ❑ Resolve Problems Prior to Approval Site Plan Stamped Approved' By ADate G Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY 1 Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) , , " . El Watershed Protection Overlay Zone •(See attached standards and -requirements) / N Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) , ❑ 100 -Year Flood Plain: (See attached) • Flood Zone: - _ • Flood Panel No.: (o 007C09 BGS. Index Date: (P ❑ Sacramento River Reclamation District (Approval must be obtained from the Califo 'a Reclamation Board) El Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance ❑ Detached Building Use Form ❑ Encroachment -Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: AA, oZ '�a GP-Af— Applicable Building Setbacks: ,-h--<46 ❑ Setbacks drawn on site Plan. ❑ GDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front 02-61 50 74o".S Side Side Street Rear Height /01 30' 8• S• %,• Waterway N/A N/A N/A ,-h--<46 ❑ Setbacks drawn on site Plan. ❑ GDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Applicable Development Fees: Standard Fees Amount Formula Fire R School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other ---------------------------------------------------------------------------------------------------------=--------------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) ' Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By ❑. Deeds: Date of Creation: Legal Access Provided: ❑ No ❑ Yes Deed of Reference: Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel •❑ Verify Legal Access ❑Provide.Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 GJas 42s',2ya"o73 Subdivision Map/Parcel Map: Map Date of Recording: 5Qa- Lot: j Book: �> ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: Page: all Parcel Map/Subdivision Map/Use Permit Conditions 10 Comply with the following Conditions of Approval: a Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ® Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development.. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for roa 07 Page 4 of 5 t x Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CAL,arrys\Building Permit Site Plan Reviewl.doc Page 5 of 5 5-,3-,23 Butte County Department of Development Services YVONNE CHRISTOPHER, DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile ADMINISTRATION * BUILDING * GIS * PLANNING November 29, 2004 Robert Birkholtz P.O. Box 865 . Palermo, CA 95968 Subject: APIC— 025-340-029 Dear Mr. Birkholtz, The Butte County Department of Development Services, Planning Department, has reviewed and approved the submitted Building Permit Application 04-3113, for a new house. Attached, please find a copy of the parcel map and map conditions for your parcel that was recorded in 2002. In these conditions, it states that you are required to have automatic fire suppression sprinkler systems installed in all new residential structures. For issuance of your Building Permit, you will be required to submit plans for fire suppression sprinklers. Please submit these plans as soon as possible for review. Should you have any questions please feel free to contact me between the hours of 8:00 a.m. and 4:00 p.m. Monday through Friday at (530) 538-7601. For more information about what is required for fire suppression sprinklers plans, you can reach the Building Department at .(530) 538-7541. 6;anaa inc ely, Adler Assistant Planner ALL WELL SITES ARE LEACHFIELD FREE AREAS. / / �j//, �; PARCEL 1':• / j; ,'i'.�•'�/ LEGEND BSL BUILDING SETBACK UNE �/l USABLE SEWAGE DISPOSAL AREAS NOTES CONTINUED 7. BUILDING IDENTIFICATION AND/OR ADDRESSES. SHALL BE INSTALLED IN CONFORMANCE WITH PUBUC�RESOURCES CODE 4290 AND SHALL BE POSTED AT THE BEGINNING OF BUILDING CONSTRUCTION AND MAINTAINED CONTINUOUSLY .J�MEREAFTER . 8. PROVIDE AN ALL WEATHER ACCESS 0j AT LEAST 10 FEET NIDE AND WITH A VERTICAL CLEARANCE OF 15 FEET THAT WILL ACCOMMODATE A 40.000 POUND FIRE APPARATUS TO ALL STRUCTURES. 9. NO PUBLIC ENTITY SHALL BE RESPONSIBLE FOR THE MAINTENANCE OF THE STOP SIGN. IN ACCORDANCE WITH CIVIL CODE SECTION 845, MAINTENANCE OF THE ROAD, INCLUDING THE STOP SIGN SHALL BE SHARED BY THOSE PROPERTIES WITH A LEGAL INTEREST IN THE PRIVATE RIGHT-OF-WAY OR EASEMENT. 10. DEVELOPMENT OF THESE PARCELS MAY REQUIRE DESIGN h CONSTRUCTION OF STANDARD DETENTION FACILITIES OR OTHER APPROVED METHODS OF CONTROLLING ADDITIONAL RUNOFF CREATED BY DEVELOPMENT OF THESE PARCELS. BUTTE COUNTY WORKS PUBUC WORKS MUST BE CONTACTED PRIOR TO DEVELOPMENT, AND THE PROPOSED METHOD OF CONTROLLING ADDITIONAL RUNOFF MUST BE APPROVED BY THIS DEPARTMENT PRIOR TO ISSUANCE OF ANY DEVELOPMENT PERMITS. 30' BSL 30' BSL es0�� \;/ CVE-OEC AC /PARCEL 3'j 8SL SCALE: 1" = 100' THIS ADDITIONAL MAP SHEET SHOWS ADDITIONAL INFORMATION, IS FOR INFORMATIONAL PURPOSES ONLY, DESCRIBING CONDITIONS AS OF THE DATE OF FILING AND IS NOT INTENDED TO AFFECT RECORD TITLE INTEREST. NOTES: I. MEASURES SHALL BE TAKEN TO CONTROL FUGITIVE DUST EMISSIONS FROM ALL DRIVEWAY AND OTHER CML CONSTRUCTION ASSOCIATED WITH RESIDENTIAL DEVELOPMENT 2. DEVELOPMENT IMPACT FEE FOR SHERIFF'S FACILITIES SHALL BE PAID PURSUANT TO THE PROVISIONS OF CHAPTER 3, ARTICLE II OF THE BUTTE COUNTY CODE. PRIOR TO ISSUANCE OF BUILDING PERMITS. THE FEE AMOUNT WILL BE DETERMINED AND CALCULATED AS OF THE DATE OF APPLI- CATION FOR THE BUILDING PERMIT. 3. A DEVELOPMENT IMPACT FEE FOR SCHOOL FACILITIES SHALL BE PAID PRIOR TO ISSUANCE OF BUILDING PERMITS THE FEE AMOUNT WILL BE DETERMINED AND CALCULATED AS OF THE DATE OF APPLICATION FOR THE BUILDING PERMITS. 4. THE BUILDING SETBACK FROM THE SIDE AND REAR PROPERTY LINES SHALL BE AT LEAST 30 FEET. 5. FIRE SUPPRESSION SPRINKLER SYSTEMS SHALL BE INSTALLED IN ALL NEW RESIDENTIAL STRUCTURES IN ACCORDANCE WTH THE NATIONAL FIRE PROTECTION ASSO- CIATION STANDARD FOR THE INSTALLATION OF SPRINKLER SYSTEMS IN ONE AND TWO FAMILY DWELLINGS AND MOBILE HOMES, NFPA STANDARD 130, UNLESS A PRESSURIZED COMMUNITY WATER SYSTEM, WITH HYDRANTS THAT MEET FIRE DEPARTMENT SPECIFICATIONS, SERVES THE PARCELS. 6. DEVELOPMENT OF THESE PARCELS MAY REQUIRE PAYMENT INTO THE WATER TENDER FUND. PARCEL MAP OF PARCEL 1, 53 MAPS 23 A PORTION OF THE NORTH 1/2 OF THE SW 1/4 OF SEC. 1, T.18N. R.3E. IN THE UNINCORPORATED AREA OF BUTTE COUNTY, CALIFORNIA FOR TED RUNGE .» k /sy P.9'rt /6 FOUND 3/4" I.P. TAGGED LS 3728 PER (R) 2 �f M! n pN .. l4Np e o/J�p, P.14 Q'.Ovlgt 1. fp4/�, <i .$ ajti ia, W45 /' z No. 29132 a.) OF........... SURVEYOR'S STATEMENT COUNTY SURVEYOR'S STATEMENT THIS MAP WAS PREPARED BY ME OR UNDER MY DIRECTION AND IS I HAVE EXAMINED THIS MAP AND IT IS SUBSTANTIALLY THE SAME AS BASED ON A. FIELD SURVEY AND COMPIIlED FROM RECORD DATA IN IT APPEARED ON THE TENTATIVE MAP AND ANY APPROVED CONANDFOORCMAN ORD A,NCE WITH EATETHEREMENTS OF REOUEST OF��DSUBDIVISION MAP ACT ALTERATION THEREOF. ALI. OF THE PROVISIONS OF THE SUBDIVISION RRUUffJJGGEE MAP ACT AND LOCAL ORDINANCES APPLICABLE AT THE TIME OF ON OCTOB R 1-Oy_ 200 U I HEREBY STATE THAT THIS PARCEL MAP APPROVAL OF THE TENTATIVE MAP HAVE BEEN COMPLIED WITH AND SUBSTANTIALLY CONFORMS TO THE APPROVED OR CONDITIONALLY APPROVED TENTATIVE MAP, IF ANY. THE MONUMENTS SHOWN HEREON THE 60' I AM SAISnTISFIED THAT THIS MAP IS TECHNICALLY CORRECT. ARE OF THE CHARACTER AND OCCUPY THE POSITIONS INDICATED AND EASEMENT W @PUBUC SERVICE OFFERED FOR ARE SUFFICIENT TO ENABLE THE SURVEY TO BE RETRACED. DEDICATION IS NOT ACCEPTED BY BUTTE COUNTY AT THIS TIME. SMART T. EDELL RCE 29132 DEPUTY BUTTE COUNTY SURVEYOR RONALD L. GRAVES P.L.S. 4085 REGISTRATION EXPIRES 3/31/03 BASIS OF BEARINGS (B.O.B.) FOUND 3/4' I.P. �rl� TAGGED LS 3728 PER (R) THE EAST LINE OF PARCEL 3 TAKEN BETWEEN FOUND 1089.44' (R)(R2)(C) N 86'44'09" E (R)(R2)(C) LS 3728 PER (R))((R1\)(R2)(R3) 1056.22' (R)(R2)(M) n 352.08' (M) FAV E - 352.07' ' v --t N 86'44'09' E (C) CO T 718.41' (C)----- - — R=-------- 60' MADE R/W 6: PUBLIC J --------- 20.00' (R)J SERVICE EASEMENT TO BE Q RESERVED IN DEEDS AND ` ` 20.00• (C) S 0375'51' E (C)` 33.22' OFFERED FOR DEDICATION a PARCEL 2 �? (C) TO BUTTE COUNTY. m o on 2.79 ACRES ,� n e PARCEL 1 I •I rvry 2.79 ACRES (R) 2 x_M- STRIP TO BUTTE COUNTY PER 1975 O.R. 524 , 392.10' (M) ' 392.10' (M) 52 M 52 1176.32' (R)(M) N 86'41'45' E (R)(M) --------------- FOUND 3/4" I.P. TAGGED LS 3728 PER (R) 2 �f M! n pN .. l4Np e o/J�p, P.14 Q'.Ovlgt 1. fp4/�, <i .$ ajti ia, W45 /' z No. 29132 a.) OF........... SURVEYOR'S STATEMENT COUNTY SURVEYOR'S STATEMENT THIS MAP WAS PREPARED BY ME OR UNDER MY DIRECTION AND IS I HAVE EXAMINED THIS MAP AND IT IS SUBSTANTIALLY THE SAME AS BASED ON A. FIELD SURVEY AND COMPIIlED FROM RECORD DATA IN IT APPEARED ON THE TENTATIVE MAP AND ANY APPROVED CONANDFOORCMAN ORD A,NCE WITH EATETHEREMENTS OF REOUEST OF��DSUBDIVISION MAP ACT ALTERATION THEREOF. ALI. OF THE PROVISIONS OF THE SUBDIVISION RRUUffJJGGEE MAP ACT AND LOCAL ORDINANCES APPLICABLE AT THE TIME OF ON OCTOB R 1-Oy_ 200 U I HEREBY STATE THAT THIS PARCEL MAP APPROVAL OF THE TENTATIVE MAP HAVE BEEN COMPLIED WITH AND SUBSTANTIALLY CONFORMS TO THE APPROVED OR CONDITIONALLY APPROVED TENTATIVE MAP, IF ANY. THE MONUMENTS SHOWN HEREON THE 60' I AM SAISnTISFIED THAT THIS MAP IS TECHNICALLY CORRECT. ARE OF THE CHARACTER AND OCCUPY THE POSITIONS INDICATED AND EASEMENT W @PUBUC SERVICE OFFERED FOR ARE SUFFICIENT TO ENABLE THE SURVEY TO BE RETRACED. DEDICATION IS NOT ACCEPTED BY BUTTE COUNTY AT THIS TIME. SMART T. EDELL RCE 29132 DEPUTY BUTTE COUNTY SURVEYOR RONALD L. GRAVES P.L.S. 4085 REGISTRATION EXPIRES 3/31/03 352.07' (M) �SITE .-. PARCEL3 2.78 ACRES m W m z (M) 70 FOUND 3/4' I.P. BASIS OF BEARINGS (B.O.B.) FOUND CENTER 1/4 THE BASIS OF BEARINGS FOR THIS PARCEL MAP IS CORNER,SECTION 1 THE EAST LINE OF PARCEL 3 TAKEN BETWEEN FOUND 3/4' I.P. TAGGED MONUMENTS AS NORTH 02'54'06" EAST...(R)(Rl)(R3) LS 3728 PER (R))((R1\)(R2)(R3) X 1 SCALE: 1" = 100' 352.07' (M) �SITE .-. PARCEL3 2.78 ACRES m W m z (M) 70 FOUND 3/4' I.P. TAGGED LS 3728 LEGEND PER (R) ' X FOUND MONUMENT AS NOTED 9 FOUND 1/4 CORNER AS NOTED • SET 1/2' REBAR TAGGED PLS 4085 O CALCULATED PONT, NOTHING SET (M) MEASURED (C) CALCULATED (R) 53 M23 (R1) 52 M 52 (112) 123 M 99 (R3) 144 M 67 P.S.E. PUBLIC SERVICE EASEMENT R/W RIGHT-OF-WAY RECORDER'S STATEMENT FILED THIS 11✓D DAY OF // A'l 2001 AT :ni IN BOOK /Ty OF MAPS AT PAGE(S)!�fl!_ AT THE REOUEST OF RON GRAVES &_&$ws- - d S.;,(1L AL+41pe1-oo ie CCANDACE J. SS. BUTTE COUNTY cCOROER LOCATION MAP PARCEL MAP OF PARCEL 1, 53 MAPS 23 A PORTION OF THE NORTH 1/2 OF THS SW 1/4 OF SEC. 1, T. 18N. R.3E. IN THE UNINCORPORATED AREA OF BUTTE COUNTY, CALIFORNIA FOR TED RUNGE NOTE: AN OWNER'S STATEMENT IS BEING CONCURRENTLY RECORDED IN THE OFFICE OF THE BUTTE COUNTY RECORDER UNDER SERIAL NUMBER 10y 2.-co2614S ___ SHEET i OF 2 ROn Graves APO 25-24-83 ENGNEMS suRVmAs & associates P.O. BOX 986 OROVILLE. CAL 95965 Ph. (530)534-9587 RAP 00-155 BOuT` /S�f /9/1GE /s - SW V4 SECT/ON /. T/BN .r.e BK. 52 MAPS fC SZ THIS MAP WAS THE muiAEMENTS N $6.96'4`7'.1 N 86' 4l •09- E PARCEL / 8.96 A.. 4/'43- E 9.44 //76.32' PARCEL 2 9.26' A, IV 86°39'48"E /296.42" I I I 1 � PARCEL ( 3 �—•� \ � \ \ Q � \ W Za N 86' 38' 09' E \ V \ W PARCEL 4 \1 ' //.OS A.. \ 3§;..�c..x�%9Fnzz:a�.7s�7•;nas,tm\..,v:,:.rn�*a,-wn-�Fw-.:L�arra, Nor +t:arx /169.88' es /II�� Ay CAs IFB-1 AbE / EI COUNTY SIRVEYOR t-5 $ — 2'5 -•� C //4 CORNER BASIS OF BEARING - F' Iscu/eN / µµM TKE B-11" OF BBAR/N6 IJ rwe EAST PAbPISIr/ [/NE AND It /DENr/CAJ rO r,YE N. J E o/ fEL'r/ON R 3E AS SNOWN ---p RECel0E0 /N BK Sl of ,A MAPS Ar PD S2 ANO WAS ESTABL/SNeD Br /NOSE ^� MaNUMEN/S SNO N w5 FOONO. LEGEND �Y • fd• !/I-//LJl7l8 rFA MAP RECORoeD Bk. sS 1(iY b. SLT J/I' /P L S 172E O CALCUtArFD 4'L/ lk STATE OF CALIFORNIA . COUNT/ OF BUTTE av rub. 4- r47S , BF/OA'Q pE, TNF UNP/RL/ON FD, A NOTARY PUBLIC, /N ANO "R rNE S/Nr! of fo4N/q, emb INb TNCR%N, DO</ CATMA//l4`/v�ON6n AND SWOLN PIISOAAtLy APPEALED Oeu R.[]O LdW/.V KNOwN In roe TO jr rNE PECS.N .N0 ElECOTEO THE INSr-f—t.r ON BEHALF ON rwE C'OlPoA:Pr/ON JNEEF/N ' � ����`�'O"" t ANO AC/INOWLFDe6'D r0 MF THAT SoCN CMPoE G �� w mA•..:;. CD TNF SAME. /� �+I'�i�•ow:.W/rN s ror NAND Ano w-i.r/AL sewL ryyM ERS CERTIFICATE I DAY/D V IVORCI AS OW -10 o/rNE LAND AS S~Ao' NEeEDN, AND BUrre [9UNr/ r rLE coMP Nr As r~reE • L/NDER DEED OF revsr DATFD DEC. a,, /9S7 wN0 QeCOeOFO N BK. 9/3 AC. AF eSI NN eeBr Ceer/r/ M 4 WF ARE 7" OWL/ PElseNE WN09E CONSENT /S, NECESSAI/ /D PASJ CLEAA' r/TLE r0 S". LAND.AwD WF ' NEIEB/ CONSENT ro —1 PRE'PglgT//IN AWO EECOEDI"" O/ sA O MAP q1 SAVNN N/!N/N TMC CC &A v BA'A ' n N BLC�G CTOk N7y T/�LC (O. q • SHLew �ylee-f,Qe IF -,V§ Vq/!^�A(� i7LI'Nw- `' STATE OF CALIFORNIA d CPtwrr, O / /9A.f EEEOAE MF, rNE UNDEJ/LNFD: A —ARU H PPOLIC /N AND feL >✓E 3m— Of Cw4/sA'N RFL/D/NQ rA,E'lE/N DUL/C M/zfi 60 AND 5w".-4 PElf wvw[LY APPEARED, DAV/D V Mote/ XN ,U rO ME rOBE rt! -e j W NOlf NAME /J 5U4L CR,BEO rO TAE W/MVH /NJ/.Po-- AND ACA'NA✓<EDLED rNArNEE Ek IED 1W SAME. W/rNE63 Mr NANO 4NOOrfaC qt SEAL , crmm L Eeu, LYNN O:STA� . '+JIh : M1.TUt.;4 PtaA PAR f FnAlgl Nl10 "{ OF A POR770AI of TIME N l/? of THE SW l/d OF SEC I 7-/8N RJE FOR DAVID V. MORRI WE FILED FOR WE D THIS 1Z DAY OF JrJ._T^ q ,.0 ,1975 , AT KENDALL ENG/NEEf7/NG �� M BOOA OF MAPS AT FADE �..G7�1 AT THE REQUEST OP_.lJl IA hr 17SI ORO.OAM BLVD. SURE 2 �ND. OROVILLE,CAUPoRNIA 95965 - (916) 534-7550 L FAUNTY LHTY KL ENOCR RECORDER JOB R0.7O Lq SHEET _OF_ y lo�a'�oy O CLAIMANT: ADDRESS: CITY & STATE: nATF nP rl Alnn- County of Butte Oroville, California GENERAL CLAIM Ronald Birkholz 36 Grover Lane Oroville, CA 95965 1n/1gInA SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELA AMOUNT Refund Claim - See attached calculation sheet APN: 025-340-029 Permit No: C4-1629 PAID RETAINED REFUND Development Services $ 3,431.31 $ 109.98 $ 3,321.33 THERM DRNG $ - $ - $ - SMIP $ 18.62 $ - $ SHR $ 305.01 $ - $ - TUA $ - $ - TOTAL $ 3,754.94 $ 109.98 $ 3,321.33 :::BREAKflU1�V:N ..............::: BUQGET::: ACCQUNT : AOUiVT: 101001 DVLPMNT SVC 440-001 4210500 $ 3,321.33 1011822 THERM DRNG 1800 280 $ - 1011430 SMTP 1001 280 $ 18.62 1011811 SHR 1800 280 $ 305.01 1011816 TUA 1800 280 $ - TOTAL $ 3,644.96 $ 3,644.96 I, the undersigned, declare under penalty of perjury that the services or articles claimed nave peen penormeo or oeirvere a mac cnis claim is true and correct as stated. T. Dated this day of �, 2004, at OZvf 'Ir— , Calif. Signat of 1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that there is a Budget Appropriation or Specific Board Approval (Check o';De e for the same. Y7 n� e R Dated this day of —�, 2004, at Oroville ; f !Wl Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND UV NV 1 VVKI 1 C 6CLVVV I I.11J LINO - AUUI I VK J UJC %J111-1 DEPT & SUB PROD I SUB. OBJ I CLAIM NO. I INV N0. I INV. DATE I ENCUMB. I GROSS AMT. __ Butte County Department of Development Services e13 ° 7 County Center Drive °- Oroville, CA 95965 ° l (530) 538.7601 Telephone (530) 538-7785 Facsimile UN ADMINISTRATION * BUILDING * .GIS * PLANNING October 15, 2004 Ronald..Birkholz 36 Grover Lane _ Oroville, CA 95965 RE: Permit No. 04-1.629 APN#025-340-029 Owner: Sante On 6/7/2004, a deposit was, made in the amount of $3,754.94, of which $109.98 was retained. The remaining fees will be reimbursed to you. Please sign, date, and return the enclosed claim form to this office. Once we receive the claim form, we will then process your refund in the amount of $3,644.96. Should you have any questions, please contact this office Monday through Friday, 8:00 a.m. to 4:00 p.m., at 538-6869. Sincerely, Diane Lewellen , OA III Administrative Division enclosure CLAIMANT: Ronald Birkhotz ADDRESS: 36 Grover Lane CITY & STATE: Oroville, CA 95965 DATE OF CLAIM: 08/05/04 APN: 025-340-029 NUMBER: DATE: ISSUED TO: CHECK 0: AMOUNT: PERMIT #: REFUNDS: DETAIL BLDG TOTAL' 04-1629 APPROVAL Date Reviewed Michael Vieira Building Manager • Tide Fund Dept Accnt Cash BLDG 0010 440-001 4210500 101001. THRM DRNG 1800 rHRM DRN 280. 1.011822 AUD SUSP 1001 (SMIP) 280 1011430 SHER DEV FEI 1800 (SHR) 280 1011811 THRM URBN .- 1800 (TUA) 280 1011818 PAID RETAIN REFUND 3376.32 ........ :':•:•:•:•:•:•:• }:•i:•:•?X• ::: ........ i?i: }iii}: . :• :• : • :: ?i?.;....._.} 54.99 -54.99 -54.99 1350.53 1350.53 1350.53 2025.79 1 2025.791 2025.79:::::::::•:•:::•:•::• 54.99 54.99 54.99::::::::':'??i}?}:: 0.00 0.00 :::::::::;:;•;::;; 54.99 -54.99 -54.99 'i?}}}ii: 3431.31 109.98 3321.33 3321.33 ?i???: is . 0.00 0.00:{:. 18.62 18.62 18.62 '- .305.01 305.01.: ..•^ ^.. ._.. - 305.01 -• ;.- ..., ^ .:.'-0.00,.. -'...... -_ ...._......- .._- -- - 0.00 $ 3,754.94 $ 109.98 $ 3,644.96 $ 3,321.33 $ $ 18.62 $ 305.01 $ - CHECK: - $3,644.96 3/20 DIFFERENCE: $0.00 (Should be blank) Butte County Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) I. Refunds can only be made upon written request by the person who paid the fees, whose name is on t he receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued -if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develo ment Services for Dayment processin . CLAIMANT'S NAME: MAILING ADDRESS: PHONE: ('9 ) ASSESSOR'S PARCEL NO.: S- 3V o-02 9 ✓ [Please use one claim form per permit.] BLDG PERMIT NO. (QL.. ./ Receipt No. 1 Receipt No. 2 Receipt No. 3 L b Z RECEIPT NO.: RECEIPT DATE: RECEIPT AMOUNT: 9 y ✓� ✓ T REASON FOR REFUND REQUEST: 0&,ee • D - �� ltSD Check those fees which you wish to have considered for refund: [Building Permit Fees =Sheriff Fees =SRA Fees (CDF Fire Planning) =Other (specify): Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. A re K:/Forms/Refun plication 082203 Date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPL N AND SUBMITTAL REQUI 24 HOUR INSPECTION#: OROVILLE: (530 6-7) • CO: (530) 891-2834 OFFICE #: (530) 5 -75 A FEE WILL BE REQUIRED AT T E OFAP ICATION LN OWNER Name 't„ o_ Address kc City ®1'a0 l f c St&/j ZiR/S &- Phone _ y`7 2 Fax E-mail Date Approved: LN J APPLICANT NAME CONTRACTOR Name City Address 4 1 ©% City U - to Zip Phone Page Fax E-mail Date Approved: Lic. # C ss J APPLICANT NAME ARCHITECT/ENGINEER Name City Address 4 1 ©% City U - State Zip 9 Phone Page Fax E-mail Date Approved: State License Number J APPLICANT NAME Name d&0(_ Address City State Fli Phone Fax E-mail F�Pvmo -wro:20 . OF —1-0-0 00000_�__�_Wwd 00 F r office use only-, Zoning Flood Zone I A SRA Yes Occ. I I Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. 6y I(qpq BP I BIN # LOCATION AP# -51_eo - C) Property Address GT'� Cross,,Street 11 c 'o 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 Addr s Description or Scope of Work: Coy S'40tade ❑ropo e Bu out Permits ❑ Pd Change of Occupancy (Note(previous use): EXP;*ATI1DNb,FMPLICATI0N Applications for w ' a -permit has not been issued will expire one year afte he date of application. In order to renew action on an application er expiration, a new application, plans and fee will be REQUEST FO REFUNDS Refunds can only . made upon written request by the person who paid the fee. The req est must be made prior to the expiration of the permit and no constru 'on work has been done. Filing fees, plan check fees for work plan ecked and other department costs are not refundable. KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 Received by: An Receipt #: 2;L Dater IO SRA �P Sherif �SMIP Other Ly Total REV 4- 0-04 SUBMITTAL REQUIREMENTS The following drawings and spec ,'cagons must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITeAIS' WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. qF Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! ❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation. (Note: Not required for,additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 9. Sanitation and site plan approval from the Environmental Health Department. ❑ 10. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings.: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 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 KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04 �' - i �. . '• , _ r.. _ „t �. ,... •.ff\: .":: 'TirX' :WY:•t ^'f`qK49"d,o- 1' 1^451 ;. ,..,,. IJ.ate.. � COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIO 7 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PER-M7'IT APPLICATION DATA SHEET OWNER: ` ` ASSESSOR PARCEL NUMBER 6D" • > t "� Proposed Building Use: ti V Counter Technician: Date: v G Items required in ordert ao pply for a permit. All boxes MUST be checked OR marked NA in order toQpply. ,9 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . Q 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and.signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. 0on 6. Energy compliance design and supporting documentation in duplicate. O 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. 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. 1.❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ - 13. Detached Accessory Building Form filled out by the owner ❑ 14. Haiardous Material Form 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. "O'er 16. Other Regaining itE4msineeded to issue the permit. (May require additional plan review upon receipt of the following items.) [� 17. Fire Sprinklers............................................................................................ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ - 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ / 20 -Erosion Control -Plan Required........................................................................ ........ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ / 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. �f 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... 26. NPDES Form...�......................................................................................... 12V- ' 27. Encroachment; Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for + required....... ❑ 29. Contractnr'c Bronco infnrmntinn Mitmhcr Kinme Ctvlo r neeifirntinnl \ li ❑ 30. Worker'; 31. Owner -E 32. Letter of 33. Recorde ❑ 34. Manufac ❑ 35. Existing ❑ 36. Deed RE ❑ 37. ❑ Gran ❑ 38. Other:_ ❑ 39. Other:_ When issued Telephor I have been informed Applicant 1. Index,p'rmit applicatio 2. Additional items require Contractor, designer, owl Contractor, designer, owl Plans reviewed by: Structural reviewed by: _ Note transfer by: T ellm. amuuiy urvisun COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES .99 OWNER 1 I A.P. # PROPROSED BUILDING USEEr DATE RECEIPT # DATE REC. 1. BUILDING PERMIT FEES --- Balance Due ..................... --- Additional Fees Due........ Z- Revised Plan Checking Fee.... $ -- 2. SCHOOL DISTRICT FEES (paid at School District Office) (form available after Plan Check 3. SHERIFF FEES (paid at Building Division) Residential............ X $360.00 =$ U ts Commercial (sq. ftg.).. 4. URBAN AREA FEES X $0.03 = $ Sq.Ftg. (paid at Building Division) Residential (per unit)..... X = $ ii Units Amt. Commercial (Sq. Ftg.).... X = $ . Sq. Ftg. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $89.00 (paid at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. Commercial (sq. ftg.) ......... X = $ Sq. F Amt. 10. OTHER '(Q At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking proc�� APPLICANT DATE Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) O.B.-1 O'V`►TNER-BUIIJDER VERIFICATION Attention Property Owner: An "owner-buildee' 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--constr-uction- of-the-pr-oposed-- property improvement: YES NO ❑ I HAVE ❑ HAVE NOT & signed an application for a building permit for thero osed work. P P . I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: CI'T'Y: PHONE: CONTRACTOR'S LICENSE NO. 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: CITY: PHONE: CONTRACTOR'S LICENSE NO. $. 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 SIGNED: PROPERTYOWNER, DATE:_1d' ,1,-,7 6 * 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 OWNER BUILDER MO TION Dear Property Owner. O.B.--f- An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For yourprotection, you should be aware that as "owner -binder" 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 regoimd by law to be licensed and bonded by the State-of.California-and to -have a-business- licensefirm time city of duRaj .They M 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 infMniation for your benefit and protection; d If you employ or otherwise engage any persons other than your immediate family, and the work (Including mair� and other costs) is 5300 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 mast register with. time 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 contnbutions. There may be financial risks for you ifyou do not carry out these obligations, and these risk are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract time Internal Revenue Service (and, ifyou wish, time U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and time Division of Industrial Accidents. If time sft=tm 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 Iimited conditions. A frequent practice of unlicensed Persons Professing to be contractors is to secure an "owner builder" budding 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_ min --- Infarmation-about lien csed- - —trac—— Pe1fOg their -own work -personalty.— contors may be obtained by contracting the Contractors State License Board in your comminity or at 1020 N Street, Sacramento, CA. 95814. Please corPlete the "Owner Builder Verification" on the reverse side of this form so that we can conium that you are aware of these matters. The building permit will not be issued until time verification is retaine& l', lv1i I C. Vi ira, C.B.O. Building Inspection NOTE: 1Ais Owner -Builder LVo?"Udon is required by Section 19830 of the California Health and Safety Code, OVER ti A V 5 �QCIC WO�� Department Michael Crump, Director Public Works LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville, CA 95965 (530) 538-7266 (FAX) 538-7171 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement rLESS THAN 1 ACREI Project Description: - �R rk I Jo I Z Project Location and/or Parcel Number: /�7_jV,14e By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: ��- Date: Less than 1 Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program Revised 5/24/04