HomeMy WebLinkAbout026-181-027(C
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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.
BP040933
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: 04/05/2004 APN' 026-181-027-000
the Business and Professions Code, and my license is in full force and
'
effect.
License Class: License Number:
Site Address: 2152 WILLIAMS AVE PAL
Date: Contractor:
Map Index:
Description: RE -ROOF (12 SQ)
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
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: LOPEZ DIANNA ETAL
to its issuance, also requires the applicant for such permit to file a
LOPEZ MANUEL
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
2152 WILLIAMS AVE
7000) of Division 3 of the Business and Professions Code) or that he or
PALERMO, CA 95968-9633
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 cf 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: LOPEZ DIANNA ETAL
PP
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
LOPEZ MANUEL
such work himself or herself or through his or her own employees,
2152 WILLIAMS AVE
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
PALERMO, CA 95968-9633
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:
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
License #:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaratioIthe
EII have and will maintain a certificate of consent to self -insure
workers' compensation, as provided for by Section 3700 of
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
1 certify that in the performance of the work for which this permit is
Census Code:
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 provisions.
Date: 44 4
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.
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CONSTRUCTION LENDING AGENCY
This permit's 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
Resolutions o do work indicat d above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
` &/5
Name:
By: Date: rr
PERM V EXPIRES ON: !416106
Address:
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 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 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: Zp ..� �r� Q� 4-p� �^�— Signature:�,��__�.----
00,
Date:
,&Owner ❑ Contractor ❑, Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
. BUILDING PERMIT APPLICATION
24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538=7541 .
PERMIT NO.
BP os -0433
DATE:APN:
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ZONING:
OWNERS LAST NAME:
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OWNER'S FIRST AME:
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PHONE
STREET ADDRESS: 1
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FAX:
CITY, ZIP:
2r
E-MAIL:
SITE ADDRESS: _ v -�
CITY. ZIP:
NEAREST CROSS STREET:
LL 1/
TRACT/LOT P.
APPLICANT NAME:
PHONE:
STREET ADDRESS:
FAX
CRY, ZIP:
E-MAIL
CONTRACTOR NAME:
PHONE:
STREET ADDRESS:
FAX:
CRY, ZIP:
E-MAIL'
LICENSE NUMBER:
LICENSE TYPE:
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX:
CITY, ZIP:
LICENSE NUMBER:
E-MAIL
DESCRIPTION OR SCOPE OF WORK: (zE . IQco i z
❑ 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: Date: s��SloA—
Receipt number: 51 5 5d5 Amount Received:
,4
OW WR -]BUILDER VESICATION
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 be issued until this
verification is received.
01- -I personally plan to provide the major labor and materials for construction of the proposed
property improvement: YES NO 13'.
IG) HAVE I 13 HAVE NOT E3 signed an application for a building permit for the proposed work
I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
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
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SIGNED:
PROPERTYOWNER:
SACEC--SER:
DATE:
NOTE: This Owner -Builder Verifuation is required by Section 19831 and 19832 of the
California Health and Safety Code- This verification must be completed and
returned to our offece before we are permitted to issue the permit.
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QB• -1
► OWNER BUILDER INFORMATION
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 fie 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 word 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 mcome tax withholding, federal social security taxes,
workers compensation insm>rance, disability insurance costs, and unemployment compensation contributions.
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.
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 short m -e 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 ]united
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit, emneously 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 Id 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. Ile building permit will not be issued until the verification is returned.
I
3'. &'
C. Vi ira, C.B.O.
r, Building Inspection
NOTE; nis Owner-Builderinfomudan is required by Secdon 19830 of the California Health acrd Safety Code
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