HomeMy WebLinkAbout026-111-003BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (630) 638-7636 (OROVILLE) (630) 891-2834 (CHICO)
OFFICE #: (530) 638-7641
PERMIT NO.
BP053117
PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
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: 11/21/2005 APN: 026-111-003-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 1931 NORTH VILLA AVE PAL
Date: Contractor:
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: INSTALL PELLET STOVE
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: BEACHAMP RONALD & LISA
to its issuance, also requires the applicant for such permit to file a
1931 N VILLA AVE
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
PALERMO, CA
7000) of Division 3 of the Business and Professions Code) or that he or
95968
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
(530)532-4282
applicant to a civil penalty of not more than rive hundred dollars ($500).):
AI, 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' Stale License Law does not apply to an
Applicant: BEACHAMP RONALD & LISA
owner of property who builds or improves thereon, and who does
1931 N VILLA AVE
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
PALERMO, CA
sale. If however, the building or improvements are sold within one
95968
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
(530)532-4282
sale.).
O I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
Contractor:
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\ aV Professions Code
I a )-cis
Date: Owner:
License #:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
Architect:
❑ 1 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
❑ 1 certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
I n
I
compensation provisions of Section 3700 of the Labor Code, I shall
.�
v
forthwith comply with those provisions.
Date:
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 permit is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
ResoI tions to-do work indica d above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
BY Date: I L
PERMIT EXPIRES 1r 21 - 01
Address:
ON: n
Date)
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or docume of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name:./ 5�% �� tnJ (I.fi'l�) Signature:
/
Date:
.Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP053196
PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
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: 12/05/2005 APN: 026-111-003-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:
Site Address: 1931 NORTH VILLA AVE PAL
Map Index: .
Date: Contractor: ••
Description: install wood stove
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: BEAUCHAMP, RONALD AND LISA
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
1931 NORTH VILLA AVE
the Contractor's State License Law (Chapter 9 commencing with Section
OROVILLE, CA
7000) of Division 3 of thq Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
95965-3004
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 anBEAUCHAMP,
Applicant: RONALD AND LISA
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
1931 NORTH VILLA AVE
sale. If however, the building or improvements are sold within one
OROVILLE, CA
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
95965-3004
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor:
❑ I am Exempt under Article 3 of the B siness and Prof sions Co e
Date: AA Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a. certificate of Consent to self -insure for
License #:
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
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
Policy #:
Total Square Ft: 0 S. F.
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
Valuation: $0.00
become subject to the workers' compensation laws of California,
Census Code:
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith complywith those provisions.
Date:
l Y
/
Applicant'
WARNING: Failure to secure workers' compensation coverage is
/ Z
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 per K is hereby issued u er the ap icable rovisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
of the work for which this is issued (Sec 3097 Civ.)
Resoluti ns to do work indic ed above f r whic ees have been paid.
��^ --
performance permit
BY — Date: 6
J/'
Name:
4� '—-6
6 L
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.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all"county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document f Butte County. I here .y
authorize representatives of Butte County toenterupon the above mentioned property for inspectionpurposes:
Print Name: �5�f '/�/�//% Signatu "e:
/6.��
5
Date: /
❑ ❑ Owner ❑ Agent for Contractor
,0-10"wner Contractor Agent for
r
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
"PLEASE PRINT CLEARLY"
I!
APPLICANT SIGNATURE
X
office use only:
OWNER
Last Name
Flood Zone
irst Name
s
Address
Ilk
City
State
State x,
Zip G�
Pho e
_
Fax
E-mail
Lic. #
I!
APPLICANT SIGNATURE
X
office use only:
CONTRACTOR
Name
Flood Zone
Address
SRA
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
Lic. #
Class
I!
APPLICANT SIGNATURE
X
office use only:
ARCHITECT/ENGINEER
Name
Flood Zone
Address
SRA
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
I!
APPLICANT SIGNATURE
X
office use only:
APPLICANT NAME
Name
Flood Zone
Address
SRA
City
I No
State
Zip
Phone
Book
Fax
E-mail
Planner
I!
APPLICANT SIGNATURE
X
office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
BP05_ 5196
BIN h
LOCATION
APO
Property Ad
N, City
Cross Street L
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:
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
refundable.
OVER FOR SUBMITTAL REQUIREMENTS L
KAFORMSMiLDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Received b&. p Amount:
Com" ZtJ
Receipt #'�' 5 D
L�
�D
Date:, -",l` j
SRA
Sheriff
SMIP
REV 6-16-04
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
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 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\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP061047
B. C. Building Permit 01-16-04 pg 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 05/08/2006 APN: 026-111-003-000
the Business and Professions Code, and my license is in full force and
effect. s
License class : r_-10 License Number: L
Site Address: 1931 NORTH VILLA AVE PAL
Dater Contractor: /o �^ �rv�rr
���TM Index:
Description: UPGRADE PANEL TO 200.AMP
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: BEACHAMP, RONALD AND LISA
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
1931 NORTH VILLA AVE
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
she is exempt therefrom and the basis for the alleged exemption. Any
95968
violation of Section 7031.5 by any applicant for a permit subjects the
530-532-4282
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
Applicant: FEATHER RIVER ELECTRIC
such work himself or herself or through his or her own employees,
6549 UPPER PALERMO RD.
provided that such improvements are not intended or offered for
OROVILLE, CA.
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
95966
proving that he or she did not build or improve for the purpose of
530-532-9176
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: FEATHER RIVER ELECTRIC
pursuant to the Contractors' State License Law.).
6549 UPPER PALERMO RD.
❑ 1 am Exempt under Article 3 of the Business and Professions Code
OROVILLE, CA.
95966
Date: Owner:
530-532-9176
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #: 844828
❑ 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.
Architect:
❑ 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:
tM
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant: 4.4:;4
WARNING: Failure 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.
�•J � r
CONSTRUCTION LENDING AGENCY
This permit is hereby issu d yfiderthe-Applicable provisions of the Butie County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutions to do i ated abov for which fees have been paid.
eeq
performance of the work for which this permit is issued (Sec 3097 Civ.)
S' 9 ' G
Name:
By: DDate:
Address:
PERMIT EXPIRES ON:
Date
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: L4 05 Signature:
Date: ��v
❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY*
CONTRACTOR
OWNER INFORMATION
Last Name(�
Address L
F' Nam
Address 3
✓, "
City
p
G Zipcts-6
Stat
ZipgS
I
Phone_ L
2
Fax53 �—
E-mail
aC�
CONTRACTOR
Name
`
Address L
,ev caw a
y�
Cilo^Ovc 1(c
City
States�C'
p
G Zipcts-6
Phone3- Gl
s
Phone
Fax
E-mail
E-mail
aC�
qss
APPLICANT SIGNATURE
For office us nly:
ARCHITECT/ENGINEER
Name
e e� V� c
Address
Addre
City
City
State
Zip
Phone
Phone
Fax
E-mail
E-mail
State License Number
APPLICANT SIGNATURE
For office us nly:
APPLICANT INFORMATION
Name�
e e� V� c
`
Addre
G
11 O
City
l
Stara
Zipq
oe
Phone
Faxes
E-mail
APPLICANT SIGNATURE
For office us nly:
Zoning Flood Zone SRA
I Yes No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
fir- I(Al
BIN #
Description or Scope of Work:
J C- Q If
ailo e L o Z eo
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
PROJECT LOCATION
AP#
Propel,
cTdjs
UV �t
CQ d`QO
Cross Street
SRA
Receipt #:
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
Other
Address
-�_�
Description or Scope of Work:
J C- Q If
ailo e L o Z eo
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Page 1 of 3
REV 8-12-05
Amount:
Bldg
SRA
Receipt #:
Sheriff
qsD-75-73
SMIP
Date:
]
Other
-�_�
Total
I
Page 1 of 3
REV 8-12-05
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a .
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form
❑ 12. Hazardous Material Form (for Commercial Buildings only).
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Legal description from current recorded.grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑
12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit Assistant at (530) 538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required,
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees -for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 3 REV 8-12-05
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND. SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 591-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY*
APPLICANT INFORMATION
OWNER INFORMATION
Last Nam
yary
First Name Lisa PL
Address
, i Q /� u �
/'�
City pCt
State
State N
l�
Zip Ip
Z�
Phone
,� a
Fax
E-mail
L�•5� � N G � C CAn�C!ggT n�7
APPLICANT INFORMATION
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property Address
N. v. Lam- ��
Flood Zone
Cross Street
SRA
I Yes
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BIN #
.PROJECT LOCATION
AP# 02-6- i 0D
Property Address
N. v. Lam- ��
City
o PCt I t?m p
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
Name
Address
Description or Scope of Work:
� � l7 O o�ed •
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction_ work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: K,6. Amount: 411000 Bldg
SRA
Receipt #1065$ Sheriff
SMIP
Other
Date: f - �— 0• 00
Total
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form
❑ 12. Hazardous Material Form (for Commercial Buildings only).
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May
require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑ .
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑
12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit 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
UFORMSOUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your
signature.-
Please
ignature:Please complete and return this information at your earliest opportunity to avoid unnecessary
delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
1. I personally plan to provide the major labor and material for construction of this proposed
property improvement: YES ] NO [ ].
2. I HAVE [/X ] HAVE NOT [ ] signed an application for a building permit for the proposed
work.
3. I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS:
PHONE: CONTRACTOR'S LICENSE NO:
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise, and provide the major work: '
NAME:
ADDRESS:
PHONE: CONTRACTOR'S LICENSE NO:
5. I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTY
DATE: _�,l/17,�P���C� IR 4 .9 e4's-_
NOTE: This Owner -Builder verification is required by Section 19831 and --19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before we are permitted to issue the
permit.'
Rev'd 11/4/2004
Butte County Department of Development Services
ADMINISTRATION * BUILDING `GIS `PLANNING
7 County Center Drive
Oroville, CA 95965
(530) 538-7541 Telephone
(530) 538-2140 Facsimile
OWNER -BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their own
work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if
that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the city or county. They are also required by law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be
aware of the following information for your benefit and protection:
o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
o If you are an employer, you must register with the state and federal government as an employer and you are subject
to several obligations including state and federal income tax withholding, federal social security taxes, workers'
compensation insurance, disability insurance costs, and unemployment compensation contributions.
o There may be financial risks for you if you do not cant' out these obligations, and these risks are especially serious
with respect to workers' compensation insurance.
o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
state law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perfonn 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 contractor is to secure an "owner -builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware
of these matters. The building permit will not be issued until the verification is returned.
Sincerely,
Scott Rutherford
Chief Building Inspector
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
Butte County Department of Development Services. eurrE ARE^
!: N O T E S 7 County Center Drive, Oroville, CA 95965 • I
• .. (530) 538-7601 - vnvw.buttecountynetidds .coONsy
RESIDENTIA'L'
AP N- Permit No.
=r Owner. — --- - -- -- -
Site Addresscl_026-111-003 05-3196 1
Contractor BEAUCHAMP, RONALD
—1931•NORTH VILLA AVE, PALERMO_,,,
Type of Permit:--ont- OWNER'Wood S+6'Ve
_ I
l
SPECIAL CONDITIONS
CHECKED BY
SRA
FLOOD CERTIFICATE EQUIRED
FIRE SPRINKLERS REQUIRED
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
ENCROACHMENT PERMIT
REINSPECTION FEE PAID'
= OK
o = Not OK
MANUFACTURED HOMES
MISCELLANEOUS
DATE I Lj PERMANENT FOUNDATION SOFT -SET
DATE D E C K S'C O V E R S'C A R P O R T S 'GARAGE S
1 Zoning -Setbacks -Easements
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch
2 Ftg§; Soils-Sz-Dpth-Spacing-CnnctisSteel
3 Sewer; Loctn-Test; Fall/C/0-Concrete
3 Decks, Girders/Joists-Dcking-Brcing
4 Wtr; Loctn-Test-Easement Needed -Regulator
Stairs-Guard/Handrails
5 Elec Loctn-Clrncs-Grnd Amp -Concrete
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg .
6 Yard Gas; Loctn-Test-Wrap Nat O or LPO
Frmg-Brcng
Inch Sz Ft Lngth
5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs_
7 Blckng; Sz-Spacing-Marriage Line
6 Carports•, Wndws-Doors
8 Gas; MH Test-Demand-Valve-Cnnctr
7 Electric
9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs
8 Frmg; Sills-Anchrs-Stu ds-Rftrs-Trusses
10 Drain; MH Test -Fall -Flex Cnnctr
9 Siding; Nailing -Veneer -Stucco -Lath
11 Wtr & Sewer Connected -C/O to Grade
10 Roof; Shthg-Roofing
12 Gas and Electricity Tagged
11 Ext; Steps -Doors -Landings
13 Tie Downs O . Foundation O
12 Braced Wall pnls
14 Exits
15 Cert of Occu anc
p y I
16 HUD Label/Insignia Numbers Serial Numbers de
_ '1 Setbacks -Easements
_ 2 Soils; Compact, onStructure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
5 Elec Pool Lting} 15 volts-GFI
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w15'-Crcltng Eqp-Htr .
8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg
Bakes-Enclsrs-pnlboards-Insultn to Main Conduit
_ 9 Health Dept Apprvl
_ 10 Plmb; Cir Test-Wtr Supply Test
_ 11 Lt Niche
_ 12 Encisr; Fencing Alarms
_ 13 Bonding, Divinl3 board or Slide
C
Drawing
OK
= Not OK
RESIDENTIAL (Single &
Duplex)
DATE JUNDERFLOOR
DATE
PLUMBING
1 Zoning -Setbacks -Easements -Flood -Slope
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg Dpth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.
55 DWV; Test Fittings & Anchr Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
56 Shwr Pan; Test, First flr-Tub Acc
5 Stemwalls Main; Steel-Blockouts-Wrapped
57 Test Tub & Shwr, 2nd Flr - Tub-Acc
6 Stemwalls Garage; Steel-Blockouts-Wrapped
58 Gas Pipe; Sz & Anchrs
6a Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Piping
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
tt Wtr Pipe; Test-Anchrs-Rgltr-Service Test
12 Elec Undrgmd
DATE
IMECHANICAL
13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn
61 AC Ducts Insultn & Support
14 Girders -Sills-Anchr Bolts -Joists -Vnts-Cripples
62 Vent Fan, Exhaust abv Insultn
15 Acc & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16. Insulation
64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Acc & Pltfrm if Furnace in attic
UAlt IFRAMING
17 Sills Proper Materials & Anchrs
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
19 Bearing Walls over Girders & fir Nailing
20 Draft Stop in Walls (rat proof)
21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
22 Headers & Beams-Sz & Bearing
23 Hangers -Post Caps-Anchrs-Cnnctns
24 Ceiling Joist-Rffr Ties-Purlin-Roof Brac-TrussShthg
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
28 Garage Fire Prtctn Framing -RC Channel
29 Prprty Line Firewall & Opngs
30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits
31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
33 Siding -Nailing Veneer
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc
35 Glazing Area -Glass Prtctn -SkyLts-Plas tic
36 Shear Walls; Nailing -Bolts
37 Brace Int/Ext Wall pnls
38 Insultn-Walls-Ceilings
39 Infiltration-Walls-Wndws
DATE JELECTRICAL
40 Fxtr & Tmsfrmr Clmcans Prtctn
41 Elec Rcptcls Spacing-Lts & Switches at Doors
42 Sz Boxes & No Of Cndctrs Stapled
43 Romex Installed Close to Edge of Studs & CJ
44 Eqp Grnd made up w/Mech Fstnrs
45 Gmdng Electrode Bond Gas & Wtr
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
47 Subfeed Wire Sz ga ❑ CU or ❑ AL
AC Wire Sz 9a ❑ CU or ❑ AL
48 Range Circ ga ❑ CU or F-1 AL
Oven Circ ga ❑ CU or ❑ AL
Insulated Neutral ❑ Yes ❑ No
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnls-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
FINAL
66 Ext Steps -Door & SideLt Prtctn-Landings
67 Smoke Detector
68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr
In Garage; abv-flr-Ducts-Meth Prtctn
69 Bedroom Exiting
70 GFI & Bath Fxtrs & Tub Acc-Spa
71 GFI Arc Fault
72 Elec Trim & Subpnl, Breaker Sis & Labels
73 Stairs, Guard/Handrails
74 Frplc or Stove, Cimc-Hearth
75 Elec Outlets at Wood Pnl, Int & Ext
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc
77 Elec Outlets & Rcptcls at Ktchn Counter
78'Garage Fire Door, Swing -Landing -Closure
79 AC Duct in Garage -Damper
80 Wtr Htr, Vnts-Cimc-Com Air Cnnctr-PRV; abv fir
Mech Prtctn; LPG Appince Undr House 3" drain
81 Plmb; Elec & Mech Eqp Listed for Loctn
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
83 Insultn-Foam-Looked in Attic
84 Guard Rails & Deck Cnstrctn-Post Caps
85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
86 Clrnc Dmge Planters ❑ Yes ❑ No
87 Stucco Brown -Finish
88 AC Unit Dscnnct, Elec-Plmb
89 Wits abv Roof, Plmb-Appinc-Frpic-Clmc to Opngs
90 Wtr Well, Dscnnct, Elec, Plmb
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
92 Vntltn thru House
93 Glass Prtctn
94 Corrections from previous Inspctns
95 Gas Test -Meters Tagged, Gas-Elec
96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl
97 Energy Cmpinc Cert -Other Certs
98 Address Posted
99 Fire Sprinkler
10\'$ °ice 4
0
Feather River Electric Inc.
- r Commercial & Industrial • Fire Alarm & Communication r
A
OFFICE: ..................... 530.534.1269
FAX: .......................... 530.533.8019
ROD JONES ..............530.693.0808JIM WILLIAMS .:........ 530.205.6321•s ,..- .
6549 Upper Palermo Rd. CHRIS TEDDER ..........530.300.7919 i
Oroville, CA 95966 DAMON SHELTON ...530.870.7225 +
,N
• d
j
4
;r