HomeMy WebLinkAbout026-192-007r
j 026-192-007 04-1692
SADRIN, STEPHEN
2450 WILLIAMS AVE, PALERMO
Cont: N/A
RE -ROOF 21 SQ
I
11
07
SIMCO CONSTRUCTION 1810-72B,tP;E,M
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2452 Williams Ave., Palermo t
(new single family)����
026-1.927007. A602-6_99- a
JENNIFER SADRIN.
2450 WILLIAMS AVE., PALERMO
AG. BLDG. ' A'
0
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.neAdds
PERMIT NO.
BP041692
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: 06/10/2004 APN' 026-192-007-000
'
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 2450 WILLIAMS AVE PAL
Date: Contractor:
Map Index:
Description: tearoff reroof W/comp
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
.SADRIN STEPHEN M 8r JENNIFER A
Owner.
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
the Contractor's Slate License Law (Chapter 9 commencing with Section
2450 WILLIAMS AVE
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
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: SADRIN STEPHEN M 8r JENNIFER A
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,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor:
❑ II am Exempt under Article o the Busm Code
Datev 0 Owner: ' :Jessi.nss
WORKERS'COPOOSATIOWDECLARATION
I hereby affirm under penaltooKpedury one of the following declarations:
❑ I 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.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
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
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 with those provisions.
/mply
6 `
Date:
Applicant:
WARNI 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.
4
CONSTRUCTION LENDING AGENCY
This permit is hereby i sued under the applicable provisions of the Butte County Code anryor
I hereby affirm that there is a construction lending agency for the
Resolution Indic d above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By Date:
- 5 0
FID
Address:
PERMIT EXPIRES ON. -5
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 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 r the duly auage4f f the owner. I agree to comply with
r doou nt othorized
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substan of ny official fo f Butte County. I hereby
authorize repre ntatives of ButtCo my to enter the ab ve mentioned property for inspection purp ses.
Print Name:` i°V1 I Signature:
4 v Q
Date:
gwner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-283,
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
4 OWNER
Name '
Address
i I I AVtl-
CityVO;tk
State
Zip /96
Phone J3 `�t�
Fax
E-mail 15 Sri . V1 U
APPLICANT NAME
CONTRACTOR
Name
,
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
Lic. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
AP LICAN IGNATURE
X
Fo Ice use onl
Zoning
Flood Zone
SRA
Yes
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO�
' l
c9
BP
BIN #
LOCATION
API -7
Property Address
-2Lf C o Au-.
Cross Street a� 11;�K� `
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
Descriptl n or Scope of Wo.1':
Sq. Footage l I)n
❑ 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.
Receipt #:/�
Date:
Amount:
SRA
Sheriff
SMIP
Other
K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 1 of 2 REV 4-30-04
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 GRAPHPAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER!
❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to
mobile or modular homes.)
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 8. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 9. Sanitation and site plan approval from the Environmental Health Department.
❑ 10. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑
1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑
2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑
3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑
4.
Letter from Engineer or Architect for truss design review.
❑
5.
2 Energy compliance design and supporting documentation (if required).
❑
6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑
7.
Statement of Intent for Non -heated and A/C (if required).
❑
8.
Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed b the engineer.
eer
❑
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
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 430-04
O.B.-1
OWNER -BUILDER VERIFICATION
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
1/I personally plan to provide the major labor and materials for construction of thero osed
P P
nperty improvement: YES ❑ NO ❑
2. I HAVE ❑ HAVE NOT ❑ signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction:
N_4M:
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
tb-- work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER.
DATE: `,C_.
NOTL: This Owner -Builder Verrftcalon 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 issuee the permit
OVER
OWNER BUILDER INFORMATION
Dear Property Owner.
OB. -1
An application for a budding pewit has been submitted in your name listing yourself as the builder of property
improvements specified.
For yourprOtection, you should be aware that as "owner-bullder" you are the responsible party ofrecord on such
a permit Budding pemhits are not required to lie 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 too have a business
license from the city or county. They are also required by law to port 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:
4 If you employ or otherwise engage any persons other than your immediate f umly, and the work (mchuiing 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 Govemmeats 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.
There may be financial risks for you if you do not cagy out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific infomhation about your obligations under Federal Law, contract the Intemal Revenue Service (and,
if YOU wish, the U.S. Small Business Admin' ). 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,
conditions. without a licensed contractor or subcontractor, only under limited
•
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner bmIder" building
permit, enMeously implying that the property owner is prong his or her own labor and materialers
permits are not required to be signed by property owners unless they are perf�g their own work .Building
Ink mabon about licensed moors may be obtained P °may'
by g the Cofactors 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 brat we can confirm that you
are aware of these matters. The buildmg Pmmit Will not be issued until the verification is returned.
ly,
M 1 G Vi hra, CB.O.
,Budding Inspection
NOT Z- Y9"' Owner-Bru7der1af0r WW' n is required by Secdon.14830 ofthe C-Wo,,k Health and Safety Code:
OVER
BUILDING DIVISION
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: (530) 538-7541
AGRICULTURAL BUILDING EXEMPTION PERMIT /3
PERMIT NO.
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public.
ASSESSOR PARyO. i �.
4
ZONING
AR I
OWNER
PHONE NO.S ( 1
/
@@
OW�V ADDRESCn
LO TIQ F BUILDING I II a
�t4 Q
USE OF BUILDING -
SIZE OF STRUCTURE
SQ. FT.
TYPE OF CONSTRUCTION:
WOOD FRAME - STEEL CONCRETE OTHER (Specify)
TYPE OF SIDING
RO F COVERIN
FLOOR TYPE
(Q1
ESTIMATED COST OF CONSTRUCTION
®D° Do
$
AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as
follows:
FRONT 55 r SIDES r v REAR
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building.
AG BuildVinqs greater than 1000 sq. ft ' floor area shall be located a minimum of 23 feet from a residence and a
mobilehVr and 40 feet fro a comr rcial byilding.
I declar6-d6der penalty of perjury that the building will be used as stated about, and the purposed use confirms with the
AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and
obtain any necessary permits, inspections, and approvals to comp lyith the requirements in a ct at that time and before
occupancy.
Date ( Signature of Owner
Permit(ee $$60.0 The above described A ilding is exempt from a b M ding permit.
Receipt No. ��- F- I
)rl) VL I P.D I RO NG I ISS
ka � Manager Building Divislog,
By Date
White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant