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Home My WebLink About026-124-009777 026-124-009 00-2365 WANGBERG, MELVYN 2274 ESPERANZA AVE., PALERMO CONTR:OWNER Opv 6 RE ROOF I6 SQ COMP` 5, in" B06-2607 026-124-009' MISCELLANEOUS Gas Reconnect . RE -LOCATE GAS METER�/ /' oC"/1�.�'1� F 2274 ESPERANZA AVE % WANGBERG, MELVYN CURTISS & BA BUTTE COUNTY U DEPARTMENT OF DEVELOPMENT SERVICES INSPECTION CARD 24 Hour Inspection Line: (530) 538-7636 (Oroville) (530) 891-2834 (Chico) Office: (530) 538-7541 Fax: (530) 538-2140 Website: www.buttecounty.net/dds Permit No: B06-2601 Issued: 11/06/2006 Address: 2274 ESPERANZA AVE PALERMO APN: 026-124-009 Permit Subtype: Gas Reconnect Owner: WANGBERG, MELVYN CURTISS & BA Applicant: HEAL DANIEL PLUMBING Description: RE -LOCATE GAS METER MUST BE ON JOB SITE JOB SHALL BE READY PRIOR TO CALLING FOR INSPECTION. THE INSPECTION CARD AND APPROVED PLANS MUST BE AVAILABLE FOR EACH INSPECTION OR THE INSPECTION WILL NOT BE MADE AND A RE -INSPECTION FEE MAY BE ASSESSED. ALL PLAN REVISIONS MUST BE APPROVED BY THE COUNTY BEFORE PROCEEDING Inspection Type IVR INSP DATE Setbacks 132 Foundations / Footings 111 Pier/Column Footings 122 Grade Beams 114 Eufer Ground 216 Forms/Steel/Holdowns 122 Do Not Pour Concrete Until Above are Signed Pre -Slab 124 Gas Test 404 Masonry Grout 120 Masonry Bond Beam 119 Underfloor Framing 149 Underfloor Ducts 319 Shear Transfer 136 Under Floor Plumbing 412 Under Slab Plumbing 411 Gas Piping 403 Do Not Install Floor Sheathing or Slab Until Above Signed Rough Framing 128 Rough Plumbing 406 Rough Mechanical 316 Rough Electrical 208 Gas Piping 403 Roof Nail 129 Shower Pan/Tub Test 408 Fire Sprinkler 702 Do Not Insulate Until Above Signed Wall Insulation 117 Ceiling Insulation 118 Do Not Cover Until Above Signed T -Bar Ceiling /RC 145 Gas Test 404 — 1 - Stucco Lath 142 Stucco Scratch 143 Stucco Brown 144 Building Final 802 Electrical Final 803 Mechanical Final 809 Plumbing Final 813 Project Final 801 - Inspection Type IVR INSP DATE r OFFICE COPY Bldg Permit: � Address: GAS By; 1,22 Dater Electric By Date: NOTES PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE. IF WORK HAS COMMENCED, YOU MAY PAY FOR A 1 YEAR RENEWAL 30 DAYS PRIOR TO EXPIRATION Inspector Copy TT r BUTTE .COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT M 0C .24 HOUR INSPECTION #:(530)`538-7636 (OROVILLE) (530) 891-2834 (CHICO) s OFFICE #:(530) 538-7541 FAX#: (530)-538 2140 WEBSITE: www.buttecounty.net\dds < PROJECT INFORMATION Site Address 2214:ESPER4,NZA AVE Owner: Permit NO: B06-2607 APN: '026-124=009 , WANGBERG, MELVYN CURTIS Issued Date: 11/06/2006 By AAM 'Permit type: "`MISCELLANEOUS 22,74. ESPERANZA AVE Gas'Reconnect. PALERMO, CA 95968 Expiration Date: 1Subtype1/06/2007- Description , RE -LOCATE GAS METER '- Occupancy: Zoning:;U Contractor ; : Applicant: Square Footage: HEAL DANIEL PLUMBING HEAL DANIEL PLUMBING ° Building :. Garage Remdl/Addn 12206 MERIDIAN ROAD 12206 MERIDIAN ROAD ' CHICO CA 95973 CHICO, CA 95973 Other Porch/Patio Total` (530) 345-2142 (530) 345-2142 ' FEE INFORMATION Gas System,(enter outlets)` $55.00 Total Charged: $55.00 Fees Paid: $55.00 Balance Due: $0.00 Receipt No: B781 ' r ' LICENSED -CONTRACTOR'S DECLARATION ' . OWNER /;BUILDER DECLARATION Contractor (Name) - State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License HEAL- DAN IEL'PLUMBING 393518 / C36 '/ Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that - requires a perinit to constrict, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed _ I HEREBY AF RM UNDER'PENALTY OF PERJURY that I'am licensed under provisions of Chapter 9 (commence h'Section 7000) of Division 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) s in full for a effect: of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 11/06/2006 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: - - CO tractors -Signature Date ❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE,WORK, AND THE STRUCTURE IS NOT INTENDED OR COMPENSATION DECLARATION .WORKERS' - - - - OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License •, Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: EI HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR - are not intended or offered for sale. If, however, the building or improvement is,sold within one , WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the pwner-builder will have the burden of proof that he or she did not build or, performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, by ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED as required CONTRACTORS TO CONSTRUCT THE PROJECT (Sac. 7044; Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves „ My Workers' Compansation insurance carrier and policy number are, thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the State Fund 238782-05 Came,. Policy Number: Exp. Date ' Contractors License Law.). (This section nee not competed if the permit is or once undr�ollars ($100) or ass. < I AM EXEMPT under Section B. & P.C. for this reason: ❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS X 11/06/2006 . . 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' - compensetion'provisions of Section 3700 of the Labor Code, I shall forthwith comply with those , Owner's Signature Date provision' . •. '-' - X11/06/2006,' I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building - ,Sign ure - - -. ate WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE injury, including death, and property damage caused by, arising out of, in any connected with HUNDRED THOUSAND DOLLARS $100,000 , IN ADDITION TO THE COST OF COMPENSATION, ( ) the issuance of this permit. I hereby acknowledge that issuance of this pea rmit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for insion purposes. I hereby certify that I am the pr owner or am auth hied to act on a property owners behalf. CONSTRUCTION, LENDING`AGENCY _.. _ - - .. 11/06/2006 -. N~ of Permittee [ N] Prinl Date I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Owner Contractor, Owner OR; E]Agent for E]Agent for Contractor MI :FILE COPY' ;. , Leudet s AddressCity • ' State ` Zip BUTTE COUNTY OTT . PERIGIIT o� Fo DEPARTMENT' OF DEVELOPMENT SERVICES -'BUILDING PERMIT. APPLICATION .NO .: o: o o. O AND`SUBMITTAL REQUIREMENTS _ OFFICE #: (530) 538-7541, FAX #: (530)•538-2140' o�►o, A, FEE WILL BE REQUIRED AT TIME OFAPPLICAT ION . . o o Website: www.buttec6unty.net/dds -BIN # CQIJN "PLEASE PRINT CLEARLY" OWNER INFORMATION -PROJECT LOCATION`.,`_ Last Name �' r irst.Name. AP# Mailing Address SZ Property Add City. ress ' City $ta Zi -717 p Z Cross Street Phone. Fax S Email WORKER'S COMPENSATION Policy Numbg CONTRACTOR Name : Carrier ` Address ,ZZO ffhlring anyone other than license contractors, a rtficate of worker's - compensation must be shown at the time of permit issuance. City C/' State Z' LENDING AGENCY Phone`Fax Name �y5 Zlq� E-mail Lic. # / C 3 b Address Description or Scope of Work: Sq FT- Living , Garage Open Cov_ Ll Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): ARCH/TELT/EN Name VEER Address` .' . City: State ' Phone` 1 Fax • E-mail State Licensc Tip Number - W APPLICANT INFORMATION Name,c, Address City State Zip ; Phone Fax E-mail APPLICANT SIGNATURE 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 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. X Received by: Amount Bldg 2z&J2 SRA = For office use only: -Zoning. Flood Zone SRA Yes No ` Type Const. Subdivision Name. Map Book Page ,Lot # Planner Date Approved: 0261124-009 00-2365 WANGBERG, MELVYN 2274 ESPERANZA AVE., PALERMO CON TR: OWNER ARE ROOF 16 SQ COMP COUNTY.OF'BUTTE.- DEPARTMENT OF DEVELOPMENT SERVICES= BUILDING.DIVISION 7 County. Center Drive • Oroville, California 95965" Telephone (530)'538:-754 ER IT NO. tv (Rev.12/96) APPLICATION AND PERMIT�`�� VIEG OR PA))RfCELNUMBUER l _'. ti� ZONING BUILDINGPERMIT OWNER MUM id GB G : TELEPHONE 5 x 051 SO. FT. OCC. -BUILDING VALUATION M1q� 960' I' 0 . OWNER'S MAILING ADDRESS 2274 ESPERANZA AVE.. -PALUM, CA 95968 , CONTRACTOR'S NAME + (WINS TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ . ARCHMECT OR ENGINEER LICENSE NO. Filin Fee - $ - ��20.0/yy0 Permit Fee - $ 25-00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINOADDRESs 2274> ESPERANZA AVE. PAL�RN�O Energy Plan Checking Fee $ $ PERMIT FEE $ 45.W. LOT NO.S UBDNIs IONS NAME PARCEL MAP PLUMBING PERMIT .Fling Fee 20.00 Each•Trap 7.00 USEOFSTRUCTURE SF ,[5X Duplex "❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater Or vent :. '15.00 TYPE"OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: MOOF 16 SQ ow Gas piping system 1 - 5 outlets. 15.00 Building sewer 15.00 - Mobile Home IS I GI W @20.00 PERMIT FEE. t ELECTRICAL PERMIT' Fling Fee 20.00 OOov.OR LESS. Main Service zooA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby. affirm under penalty of perjury that I am exempt from the Contractors License Law fof the following reason: l 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. J ❑ I, as owner of the.property, am exclusively contracting with licensed contractors. r to construct the project. \ ❑ 1 am exempt under Sec. Business and Professions Code for thisPERMIT reason Service @GGA TO ,oaoA 46.60'o ' NEW NEW CONST. DWEIUNG OCCUP. � SO OR ADDNS. ( a ACC. BLDS. 3.50FT. MULTF Ipµq�Ip OUTLUI 97,50 POWER APPARATUS" SwGLE GunFT & B20 ® sa Ex. Occup. OUTLET OR FMRFS PLNS. OR 5.00 F'UCED A',R='.,'& Ex. Occup.ounETs RESIO. EA Temporary Service 23:00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 FEE' $ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will 'maintain a certificate of consent to self -insure for workers' compensation,. as provided for by section 3700 of the Labor Code, for the performance of the work for -which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor; Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating f Cooling - , Hood 6.50 Ventilation PERMIT FEI= $. Policy Number I he above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) f0/ I certify that in the. performance of the work for which this permit is issued, I shall not employ any person In any. manner so as to become subject to 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. D61 k , � __ .ate 'Signature of A Flicant - 60� ner Co tractor ❑ Agent An OSHA permit is required fortiexcavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 45.00 'HAZ. D PEES IMP I FLOOD CDF PARCEL 1, PD HD ISSUE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work Indicated above for which fees have been paid. B Date W / PERMIT EXPIRES ON� � 0 /0 I re Receipt No. WHITE-D.D.S.-B.D. CAN -RYfASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ILI COUNTY OF'BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive o Oroville, California 95965 • Telephone (530) 538-754 IT NO. (Rev. 12/96) APPLICATION AND PERMIT - 3f ° t1gORna 513 ZON1NO BUILDING PERMIT OWNER MELVYN WANGBERG TELEPHONE 534- 511 SO. FT. OCC. BUILDING VALUATION 960 OWNERS MAILING ADDRESS 2274 ESPERANZA AVE. PALERMO CA 95968 CO�NTT�RA�CTOR'S NAME 0 W LV l:il\ TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 25.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 2274 ESPERANZA AVE. PALERMO Energy Plan Checking Fee $ $ PERMIT FEE $ 45.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF Y Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: REROOF 16 SQ COMP Gas piping system 1 - 5 outlets 15.00 Building sewer15.00 Mobile Home S G W1 920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service z�oono.R 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereb affirm under penalty of perjury that I am exempt from the Contractors License Law f the following reason: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service sow To 46.00 NEW CONST. DWELLING OCCUP. 3.5aso. CC ( .LDS. P. N CONST.EW MUACC. UTLET NON-RESID. @7.50 POWER APPARATUS 6 SINGLE OUTLET CIR. 20 Ex. Occup. °U� OR FD(TURES BALL @'.500 0 FIXED APPLNS. OR Ex. Occup. oUTLETs RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirin 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by Section of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ L3700 Pol'cy Number Ae above sections need not be completed 4 the permit is for work of a valuation of one hundred dollars ($100) or less.) 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 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 tho provisions. Date Ignature o�icant ner C or ❑ Agent An OSHA permit is required xcava over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 45.00 RAZ. D. FEES IMP I FLOOD I CDF PARCEL I PD HD I ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. g D4e,!! &0 B(71 U PERMIT EXPIREKg S O ReceiptNo. ICWHITE-D.D.S.-B.D. CANARY ASSESSOR PINK -INSPECTOR GOLDENROD-APPLANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION . - 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 P T NO'. (Rev. APPLICATION AND PERMIT �Q' A89ESSORPARCELNUMBER a� ZONING BUILDING PERMIT OWNER - - - L -j W O.,5.a� g� � TELEPHONE I 53 50 _ SO.. FT. OCC. BUILDING VALUATION' 4 MA&M ADDRESS Via? c P �9 r,�a. ✓�v � r�� 9 S,7w OONTRACTOWa NAME TELEPHONE CONTRACTORS,MAIGNO' ADDRESS. CONSTRUCTION LENDER - Fire •lace - LMER•S.MAKM ADDRESS Total Valuation E ARCHITECTCR,ENOINEER •. - - ' LICENSE NO. - Filin Fee S 20.00 Permit Fee .ARCHITECT OR ENGINEERS MABJN3 ADDRESS Plan CheckingFee S euRDWGADDRESS'.Energy Plan Checking Fee 14LLi4o G>Q 5 PERMIT FEE E LOT NO.. suBDIV13 ns NAME; PARCEL MAP PLUMBING PERMIT Filing Fee .20,00 Each Trap 7.00 USEOFSTRUCTURE' 'SF Duplex ❑.,,Mobilehome ❑ Other SPECFY Solar or heat um water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Describe Work: l2 K.o Ges piping stem t - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W 920:00 PERMIT FEE S ELECTRICAL PERMIT FilingFee 20.00 LES Main Service "'w OOR Lss 23.00 ' - - - . - .. ,. - - .. ~ *PERMIT FEE; PAID $ $RA $ SHERIFF $ OTHER $ $ . AMOUNT RECEIVED. " $ - ��QC *RECEIPT' NUMBER .. ; .�_� ° TO BE PUT ;INTO COMPUTER. Main Service tow TO IOWA " 46.00 NEW CONST. DWELLMO OCCUP. - 3.5Qso OA ADDNS. i ACC..0CC. NEW CONS 1. NOIiRESID. MULTFOIlTL.tT @7,50 POWER APPAA L - SMOLE OUTLET CIR OUTLET OR FOITURES 40 ® I.00 EX. OCCU SAL .s0 Ex. Occu unETs R .OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE t MECHANICAL PERMIT Fling Fee 20.00 Heating Coolie Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ - KAZ- D. FEES IMP ROOD CDF PARCEL PO �. ISSUE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to •do .work indicated above for which fees have been paid. r By Date PERMIT EXPIRES ON Pate) 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 porth.nity . to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. 1 personally plan to provide the m r labor and materials for construction of the property improvement NO 2. HAVE NOT[ signed an application for a building permit for the pgwprk 3. 1 have contracted with the following person (firm) to provide theproposed construction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. 1 plan to provide portions of this work, . but I have hired the following ' person . Ao coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: . CONTRACTOR'S LICENSE NO. 5. 1 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:* SOCIAL SECURITY NUMBER: DATE: OTE: 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. OVER 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 insurance, 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 information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbudder" 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:, - Smarel , Micha 1 C. Vieira, C.B.O. Manager, Building Inspection" NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OVER