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HomeMy WebLinkAbout025-340-062i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netldds • f PERMIT NO. BP040880 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: 04/01/2004 APN: 025-340-062-000 the Business and Professions Code, and my license is in full force and effect. C Z� �,��, L. -7 y'Y44 License Class : Lic n e umber: Site Address: 1117 PALERMO RD PAL Date: ContFactor. Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: INSTALL ROOFTOP HEAT PUMP (2 TON) 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: ROOSEVELT JOYCE to its issuance, also requires the applicant for such permit to file a 2287 STUMP DR signed statement that he or she is licensed pursuant to the provisions of the Contractor's Slate License Law (Chapter 9 commencing with Section OROVILLE, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95966-7300 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: ROOSEVELT JOYCE owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: THRESHER HEATING AND A/C and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code 10 BO -Y -LE LANE OROVILLE, CA 95966 Date: owner: 530-534-5002 thresh@usa.com WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 747884 ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation ► //f insurance carrier and policy number are: Carrier: i Total Square Ft: 0 S. F. Policy #: I certify that in the performance of the work for which this permit is Valuation: $0.00 issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensationprovisions of Section 3700 of the Labor Code, I shall forthwithwithcomply wit thos provisions. Date: Applicant: 5�5 —� WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This ge. t is h eb ss e a li a �e r isions th Butte County C de a /or I hereby affirm that there is a construction lending agency for the Resolurdo rk' id' e r e h e n paid. performance of the work for which this permit is issued (Sec 3097 Civ.) % 4• Name: By: Date: L05— V Address: PERMIT EXPIRES ON: Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. d Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the dyly horized 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 ar yofficial f rm or document of Butte C Aty. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes, j 4,/- - Print Name: G✓r Signature: Date: Jam/ 'r 0 Owner Contractor ❑ *Agent for Owner ❑ Agent for Contractor I BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netkdds PERMIT NO. BP040880 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: 04/01/2004 APN: 025-340-062-000 the Business and Professions Code, and my license is in full force and effect. C ZU, �� . -7 y 0 License Class.-, Lic n e umber: Site Address: 1117 PALERMO RD PAL Date: 7 Contractor: _ Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: INSTALL ROOFTOP HEAT PUMP (2 TON) 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: ROOSEVELT JOYCE to its issuance, also requires the applicant for such permit to file a 2287 STUMP DR 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 95966-7300 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: ROOSEVELT JOYCE owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: THRESHER HEATING AND A/C and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code 10 BO -Y -LE LANE OROVILLE, CA 95966 Date: owner: 530-534-5002 thresh@usa.com usa.com WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 747884 ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Squareft:l 0 S. F. Valuation: $0.00 Policy#: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to Census Code: become subject to the workers' compensation laws of California, and agree that :if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wit thosprovisions. Date: Applicant: Y WARNING: Failure to secure workers' compensation coverage{ist )- unlawful, and shall subject an employer to criminal penalties and one' hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This pe t is h eb ss e a a e r isinns th Butte County C de a /or I hereby affirm that there is a construction lending agency for the Resolurso rk ' d' e r e h e n paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By: Date: V Address: PERMIT EXPIRES ON:L05— Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. I -Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the d ty- horized 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 fficial f rm or document of Butte C Aty. I hereby authorize representatives of Butte County to enterupon the above mentioned property for inspection purposes JSignature: Print Name: 'n Date: �7/y ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERMIT NO. BP DATE: O � APN: ZONING: OWNER'SLAST NAME: OWNER'S FIRST NAME: PS" oo � ve, /4- 'le STRc� f: 7 2r FAX CITY, ZIP r61/� l/2 S�'i6� E-MAIL: SITE AD RESS: 9 .7 I �+ r/y0 CITY. ZIP. O�Gn/Yta NEAREST CROSS STREET: rVe/w %v �� �wcr - la - �I 2 TRACTlLOT ti: APPLICANT NAME: I PHONE: STREET ADDRESS: FAX CITY. ZIP: E-MAIL CONTRACTOR NAME: PHONE J3 S 3,v S o2 / l�reSF�r ��f-inn ain� 14 STREET ADDRESS: � d 1,� _' -' �i•[.. Qty FAX _ 011.'+//�� cmr, ZIP: 11 IQ 9S'�f d � f� KSh Gl I/Slc .L'vm, f O J LICENSE NUMBER LICENSE TYPE:: ARCHITECT/ENGINEER NAME: PHONE STREET ADDRESS: FAX CITY. ZIP; LICENSE NUMBER E-MAIL: DESCRIPTION OR SCOPE OF WORK: d -27i?S-4 �L' k ❑ Structure Built without permits ❑ Proposed Change of Occupancy (note previous use) EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. For office use only: Notes: Application Received by: (/L/ Date: Receipt number: Amount Received:���_� V BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netldds PERMIT NO. BP040956 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: 04/07/2004 APN: 025-340-062-000 the Business and Professions Code, and my license is in full force and effect.�j License Class: C' O License Number: ZZ:' ` Site Address: 1117 PALERMO RD PAL Date: ti - i Contractor. 1-KJf ;g �2��6`� Map Index: Description: C/O ELEC. SERV. PANEL 200 AMP & ADD 50 p OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 AMP CIRC. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a Owner: ROOSEVELT JOYCE signed statement that he or she is licensed pursuant to the provisions of 2287 STUMP the Contractor's State License Law (Chapter 9 commencing with Section DR 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA she is exempt therefrom and the basis for the alleged exemption. Any 95966-7300 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 t Code: The Contractors' State License Law does not apply to an I owner of property who builds or improves thereon, and who does Applicant: ROOSEVELT JOYCE such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor: HURST, MIKE pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code 15 OAKCREST DRIVE OROVILLE, CA 95966 Date: Owner: 530-589-5330 MIKE-TERRI@SBCGLOBAL.NET WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 335967 ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of Engineer: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Valuation: $0.00 Policy#: •'I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to Census Code: 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 rrthose provisions. Date: 4 �` �f e►-/����C� Applicant WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This rm' is he by ss a and r t . ap lic ble•pro'vision of the Butte County ode an or affirm I hereby arm that there is a construction lending agency for the Re • s 10 w a e v icl .fee. he b n paid. . performance of the work for which this permit is issued (Sec 3097 Civ.) L ; I , D /7 Name: By: I Date: PERMIT EXPIRES ON: ate Address: ❑ 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 isnot applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of.the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Quite County. I hereby authorize representatives of Butte ounty to enter upon the above mentioned property for inspection purpos � (�( e Print Name: /�nTI �J� Signature: Date: rI`- ? —09 ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. DATE: 22K ZONING: APN: elg5M-& I l �E: OWNE ' LAS7AM:N OWNER'S IRST NAME: io �E -ate STREET ADD FAX: CITY, ZIP: AtbYQ2Z 6 4?, 5 E-MAIL: SITE ADDRESS'-. / CITY, ZIP: NEAREST CROSS STREET: TRACT/LOT APPLICANT NAME: PHONE: STREET ADDRESS: FAX: CITY, ZIP: E-MAIL: CONTRACTOR NAME: PHONE: STREET ADDRESS: FAX CITY. ZIP: E-MAIL' LICENSE NUMBEFtr LICENSE TYPE: ARCHITECT/ENGINEER NAME: PHONE: STREET ADDRESS: FAX: CITY, ZIP: LICENSE NUMBER: E-MAIL* DESCRIPTION OR SCOPE OF WORK: 1-7,04 ❑ Structure Built without permits ❑ Proposed Change of Occupancy (note previous use) EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. For office use only: Notes: i Application Received by: Date: , %� Receipt number: `�� /`"� ^] Amount Receiv0141"