HomeMy WebLinkAbout026-221-005Ji
AP 26-221-5 f
THOMAS HOVER
7796 Irwin -Ave., Palermo�'
contr: Foothill Const., Pa rn o6 75—
Permit# 826-75B(reroof)
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026-22-1-005, l ,t 95-0137 B
YAWS, Betty
Ry
7796 Trw;n Avenue, Pulcrmo t
(reroof/SF) Christiansen.& Son Roofing
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int
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026-221-005 05-1160
RODRIGUEZ, URIEL
7796 IRWIN AVE, PALERMO
t
Cont: OWNER
REP 1- WNDWS
12'
026-221-005 05-1279
RODRIGUEZ, URIEL
7796 IRWIN AVE, PALERMO
;
CONT: OWNER
STUCCO SIDING2 SQ.
�.
026-221-005 05-1321
�2
RODRIGUEZ, URIEL
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7796 IRWIN AVE, PALERMO
Cont: OWNER
STUCCO,SIDNG,LAUND RM,GAR
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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
PERMIT NO.
BP051321
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: 05/19/2005 APN: 026-221-005-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number.
Site Address: 7796 IRWIN AVE PAL
Date: Contractor:
Map Index:
Description: stucco siding on det laundry rm, det gar. (400)
OWNER -BUILDER DECLARATION
1 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 aRODRIGUEZ,
Owner: URIEL AND KRISTINA
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
7796 IRWIN 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
applicAnt to a civil penalty of not more than five hundred dollars ($500).):
as owner of the property, or my employees with wages as their
sole compensation, will do the work, and -the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
Applicant: RODRIGUEZ, URIEL AND KRISTINA
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
7796 IRWIN AVE
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
PALERMO,. CA
proving that he or she did not build or improve for the purpose of
95968
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 Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Cl 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.
❑ 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: _
Square Ft: 0 S. F.
�
Policy #:
1/ //Total
d 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
Code:
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3760 of the Lab Code, I shall
forthwith comply with lho a provi ions.
Census
DO
Date: v! ' �' _ e7
01
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 he y issueciAnder the,appli provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutions t o work cafe` bove for hich ees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
BY Date:
/ 6'
PERMIT EXPIRES ON:
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 18827.5 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 Cogoty. I hereby
ioned property for inspection purposes.
'authorize representatives of Butte County to enter upon th;M/
_� � Signature: �
Print Name:
/ p c�
Date: �L( — l
�.❑ Owner 0 Contractor ❑ Agent for Owner 0 Agent for Contractor
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.
BP0512,79
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: 05/13/2005 APN: 026-221-005-000
the Business and Professions Code, and my license is in full force and
effect.
Site Address: 7796 IRWIN AVE PAL
License Class : License Number:
Map Index:
Date: Contractor:
Description: NEW STUCCO SIDING FOR RESIDENCE 12
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the
SQ.1S
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: URIEL S. AND KRISTINA RODRIGUEZ
to its issuance, also requires the applicant for such permi` to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7796 IRWIN AVE
7000) 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
PALERMO CA
violation of Section 7031.5 by any applicant for a permit subjects the
95968
applicant to a civil penalty of not more than five hundred dollars ($500).):
(530) 538-8437
-
1; 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: UREIL S. RODRIGUEZ
such work himself or herself or through his or her own employees,
PP
provided that such improvements are not intended or offered for
7796 IRWIN AVE.
sale. If however, the building or improvements are sold within one
PALERMO 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
95968
sale.).
(530) 538-8437
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors. to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor:
pursuant to the Contractors' State License Law.).
❑ I am Exempt -under Article 3 of the Business and Profess " ns Code
Date: — 3 ®Of Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0. 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:
insw ante carrier and policy number are:
Carrier:
Policy#:
Total Square Ft: 0 S. F.
certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
Census Code:
become subject to the workers' compensation laws of California;
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith complywith those provisions.
Date: J .-7
Applicant: 4E.9
WARNING: Failure to secure workers' compensa ' n 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.
� P) �/ /t � j�` 60
CONSTRUCTION LENDING AGENCY
This permit is ereby/issued under t pplp17i/cable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutions do work indicated aVoviY for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
„ ..
Name:
By: Date:
�(
Address:
PERMIT EXPIRES ON: �/ i J
(Date)
O 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 18827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
O 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 repr s tatives of Butte Cou ty to en er upon the above ntioned property for inspection purpo es. ( /
� v
Print Name: h CIO O v Signature: l e
Date:
O Owner ❑ Contractor ❑ Agent for Owner 0 Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR rNSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
OWNER
Last Name`
`
First Na /
Address
City pale f m
State
Zip
Phone,,.,
Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name -//
City
CO
OW O
Address
Fax
State
Y`Gv t h llue
City
er
Fax
StateG ��
Zip ,? 96g
Pho eS3D
3 g —8ci3
Fax
E-mail
Lic. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property Address
Flood Zone
Cross Street
SRA
I Yes I
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.
05 ` / W7
BP
BIN #
LOCATION
API
` (J(J
Property Address
City
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:
boily
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
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.
Received bylp_ Amount:
Bldg
�
Receipt #: // �5/( /r
SRA
Sheriff
019i;h
SMIP
Page 1 of 2
Date,.
�3� D
Other
C4 Total
REV 2-24-05
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 AIC for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) installation inst, (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. Detached Accessory Building Form filled out by the owner (if required).
❑ 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.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts.
❑
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 2 REV 2-24-05
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891=2834 (CHICO)
OFFICE M. (630) 538-7541
PERMIT NO.
BP051160
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 05/02/2005 APN: 026-221-005-000
the Business and Professions Code, and my license Is in full force and
effect.
License Class : License Number: Site Address: 7796 IRWIN AVE PAL
Date: Contractor: Map Index:
'OWNER -BUILDER DECLARATION
1 hereby affirm under penally of perjury that I am exempt from the Description: replace 10 windows
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a RODRIGUEZ, URIEL AND KRISTINA
permit to construct, alter, Improve, demolish, or repair any structure, prior 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 Contractors State License Law (Chapter 9 commencing with Section. 7796 IRWIN 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 Secllon 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than rive hundred dollars ($500).):
I/ 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 RODFZIGUEZ, URIEL AND KRISTINA
owner of properly who builds or Improves thereon, and who does Applicant:
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 7796 IRWIN AVE
year of completion, the owner -builder will have the burden of PALERMO, CA.
proving that he or she did not build or Improve for the purpose of
sale.). 95968
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Pfo(essJons Code. The Contractors' Stale 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' Stale License Low.). Contractor:
❑ 1 am Exempt under Article 33 of the Bu ness 4nd Profession ode
Dale: — 0 2 _p Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for
workers' compensation, as provided for by Section 3700 of the License #:
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 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:
Policy f{:
` / Total Square Ft: 0 S.F..
❑/ I certify that In the performance of the work for which this permit Is Valuation: $0.00
Issued, 1 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 provisidns of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Data: D Z-� L
Applicant: V • .
WARNING: Fallure 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 p it Is hereby Issue nder in applica provisions of the Bulla County Code and/or
I hereby affirm that (here Is a construction tending agency for the Reso lions to do n cats j bo a for p h fees have been paid.
performance of the work for which this permit Is Issued (Sec 3097 Civ.) By Date:
Name:- �r— `�•— D t/
PER EXPIRES ON:
(Date)
Address:
O I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage,
handling and use of hazardous materials.
ealth &Safely Code Is not applicable to the scheduled conslruclion of This project.
O Notification in accordance with Section 19627.5 of California H
O 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 slate 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 C unty to enter upon the ab mentioned property for Inspection purposes.
v t Z 67
Prihl Name: $ � Signature: •
Date: _ Z
wner
❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Buildinn Permit 01-16-04 on 1
0
AMI;, c3I;n aS :,'" '$'::"6 _'x + = <n"^.:= :.�L':wS"',"�'.^.oi <`s,�:..: ... v.w.:_;, :, W..::; e:,.w n t
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your
signature.
Please complete and return this infonnation at your earliest opportunity to avoid unnecessary
delay in processing and issuing your building permit'. No building pen -nit will be issued until this
verification is received.
r�K I personally plan to provide the > dor labor and material for construction of this proposed
property improvement: YES [ ] NO [ ].
2. I HAVE [ ] 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 OWNER:
DATE: f— 6 Z— 6 S V
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 11/42004
a
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
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.
0 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 carry 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 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 "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.
C. Vieir4 C.B.O.
Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
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
Website: www.buttecounty.net/dds
**PLEASE PRINT CLEARLY"
APPLICANT SIGNATURE
X « oC"v U
i
For office use only:
OWNER
Las arra ,
Flood Zone
First Name,
C� r Q
City
O
Address
vv /cv d -
City C,)
-f' rA
Address
State G
Zip 9, o
Phoo e> _ `
TZG�� (4-C-6=- %0 wl N aw
Fax
E-mail
APPLICANT SIGNATURE
X « oC"v U
i
For office use only:
ARCHITECT/ENGINEER
CONTRACTOR
Flood Zone
Name
/ )
City
State
Zip
Phone
t7uz Z
Address
E-mail
Planner
✓
TZG�� (4-C-6=- %0 wl N aw
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
City 19
JQr M
State CA
1p 75Q,g
1""75960
506
-538
ll
Fax
E-mail
Lic. #
Class
APPLICANT SIGNATURE
X « oC"v U
i
For office use only:
ARCHITECT/ENGINEER
Name
Flood Zone
Address
_
City
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT SIGNATURE
X « oC"v U
i
For office use only:
APPLICANT NAME
Name
Flood Zone
Addr s
_
City Icy
State G
Zip qs o
Phone
Book
Fax
E-mail
Planner
APPLICANT SIGNATURE
X « oC"v U
i
For office use only:
Zoning
Property Address
6 2t,�,N AVt�
Flood Zone
Cross Street
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
160
BIN #
LOCATION
APIC 9Z& _ ZZ I - - ws
Property Address
6 2t,�,N AVt�
City
P
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certirrcate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
TZG�� (4-C-6=- %0 wl N aw
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.
Received by:
CC
Receipt
Amount: Bldg
Date:
Other
-Z -{j�
Total
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 2-24-05
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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 inst, (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. Detached Accessory Building Form filled out by the owner.(if required).
❑ 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.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts.
❑
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
issued; however, on issued permits refunds can only be made if no construction work has
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
of permit issuance for permits
been done. Filing fees, plan
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05
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026=22 1-005
95-0137 B
YAWS, Betty
s# 7796 Irwin Avenue, Palermo
��.
(reroof/SF) Christiansen & Son Roofing
i
t
COUNTY OF BUTTE - DEPARTMENT OF DFVELOPMENT SERVICES - BUILDING ISION
7 County Center Drive - Oroyille, California 93965 - Telephone (916) 53 - 541PERMIT NO.
APPLJCATION AND PERMIT - Qt :�7
ASSESSOR PARCEL NUMBER 26-221-5
ZONING
/BUILDING PERMIT
OWNERnay -
BETTY YAWS
TEPHONE 722 .;
LE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
6227 GUNTHER AVE
21 N 60 1,260.00
CONTRACTOR'S NAME
4
& SON 00FING
TELEPHCHRISTIANSSEN
1,532-9338
CONTRACTOR'S MAILING ADDYJ 1W J12n (1'T OROVILtE, 95965
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $
20,00
Permit Fee $
31 .00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
$
���'{ AVEenalty
BUILDING ADDRESS ,77% IRWIN E
7V L
PERMIT FEE $51.00
PALERMO
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Water piping
15.00
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF � Duplex ❑ Mobilehome ❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
@20.00
TYPE OF WORK
New ❑ Addition 1:1Remodel ❑ Utilities ❑ Installation 1:1Other ElContractor
Describe Work: REROOF
PERMIT FEE $
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service"0'OR LESS
( 200A OR LESS )
23.00
Main Service ( 200A TO 1000A )
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( & ACC. BLDS. )
So
3.50 FT.
NEW CONST. MULTI -OUTLET
.NON RESID. ( BRANCH CIRCUITS )
@7.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
)10 I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. �- 3' Classification %'1g� i
❑ I, as the owner, 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)
O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
EII am exempt under Sec. Business and Professions Code
forthis reason
( POWER APPARATUS )
B SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
20 @ 1.00
BALE. .50
Ex. Occup.FIXED APPwS. OR
( OUTLETS IRESID.I EA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the.County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Contractor
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
County in consequenceof the granting of this permit.
Date /�(�/�
Signature of Applicant - U Owner Contractor ❑ At
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee. $
Occ
CONST. TYPE
TOTAL FEES 51.00
rThis
HAZ.
I D. FEES
I IMP
I F100D
I CDE
I PARCEL I PD
1 HO
ISSUE
permit is hereby issued under the applicable provisions
the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
Date 1
l/
PERMIT EXPIRES ON Of IDa to
ReceiptNo. 171228
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
or
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES
7 County Center Drive - Oroville, California 95965 - Telephone
APPLICATION AND PERMIT
- BUILDING ISION
(916) 53 - 541 PERMIT NO.
ASSESSOR PARCEL NUMEEfl 26-221-5
U ZONING
BUILDING PERMIT
OWNER BETTY YAWS
TE2PHONE 2
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
6227 GUNTHER AVE
21 6O 1 260.
00
CONTRACTOR'S NAME CHRISTIANSSEN & SON ROOFING
NE
532- 9338
CONTRACTOR'S MAILING ADDRff 1966 12TH ST OROVILLE, 95965
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee S
20.00
Permit Fee S31.00
ARCHITECT OR ENGINF-ER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS 7796 IRWIN AVE
PERMIT FEE $
51. 0
PALERMO
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
LOT NO. SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF 6 Dupl•:x O Mobilehome O Other
SPECIFY
Gas piping system 1 5 outlets
15.00
Building sewer
15.00
Mobile Home S G I W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel CIUtilities ❑ Installation ❑ Other ElContractor
Describe Work: REROOF
PERMIT FEE $
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service ( 101 OR LESS )
200A OR LESS
23.00
Main Service ( 200A TO IOOOA )
46.00
NEW CONST. DWELLING OCCUP.SO,
OR ADDNS. ( & ACC. BLDS. )
3.5C FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
@7.50
CONTRACTORS LICENSE LAW
I de lare under penalty of perjury (check one)
I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professins Code and my license is in full force and effect.
Licerse No. �— 39 Classification 6$•- �]GY'��
C) 1, as the owner, or my employees with wages as their sole compensation, will do
the work, and the structure is not intended cr offered for sale. (Sec 7044)
❑ I, as :he owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ I am axempt under Sec. Business and Professions Code
forthis reason
( POWERAPPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
BA2L0 @ 1.00
.OR
FIXED fRESID.1 EA. )
Ex. Occup. (OUTLETS RESI
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the County of Butte Dept. of Development Services,
BuiLling Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such prcvisions or this permit will be revoked.
PERMIT FEE $
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Contractor
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
County in consequence of the granting of this permit.
X i Date�
Signature of Applicant EI Owner Contractor CI Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEES 51.00
HAZ.
I D. FEES
I IMP
I FLOOD
I COF
PARCEL PD
I HD
ISSUE
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
4indicatedor which f shave been
ON
IDe to
provisions
to do work
paid.
ateReceipt
No. 171228
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
i T
;PERMIT NO. 826-75B
P
T
E
M
;MH UTIL.
JPERMIT NO.
PERMIT EXPIRES—( �? —76
OWNER Thomas Hover.
;CONTR. Foothill Construction, Palermo
.LOCATION (A.P. 26-221-05
*17796 Irwin Ave., Palermo
e
t
4}
•:a
h
Temp. Power Pole
Called PG&
r
Temp. Elec. Serv. r Called PG&E
Temp. Gas Serv.
t Called PG&E
_ JOB
FINALED
(Signature)
l
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd)
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Siding
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
ewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwall
Slab
Prov. for physically
handicapped
Heaters
Appliances
Carport
Footings
Conformance of ex.
structure
Gas Pipin & Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
DATE
REMARKS OR CORRECTIONS
COUNTY OF BUTTE —-DEPATMENT OF PUBLIC W � ] ��
7 County Center Drive — Oroville, California 95965 \4a
�p
Tel epAone: 534-4541
APPLICATION AND PERMIT
autnurize representatives or the county of Butte to enter upon the
above-mentioned property for inspection purposes.
X /2Ny Date �J
Signature offa �f Pe`�miteeor�Agent C
Receipt No. 0
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Golde•irod-Applicant
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.
DIRECTOR OF BLIC WORKS
BY Date :1—r 2--7)'
B Iding permit expires Date ...........................................
BUILDING
Owner 7 I I0#tltiW O
Q. FT. OCC. BUILDING V UATION
Mailing Address
Telephone No.
Fireplace
I
Contractor fii2fC° 0f'U,v
Total Valuation
Mailing Address 7S
Permit Fee
Plan Checking Fee&/or Penalty
Telephone o.
]
Permit Fee $
$ t
Building AddressA?UZZA
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. —�� — S
Zoning& Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
FSS
454,Seiritatitm"
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma P
60' R/W Improvements
provements
Lawn sprinkler system 2.00
61T§"TtanT1ec'd I
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ADDITION ❑ UTILITI S ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
1?0 OF
Main service incl. 1 meter
Additional meters, each 1.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Sub -panel (12 or less) (more than 12)
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
Light fixtures —± bal Jlo
Receps., switches & fix outlets
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of: �f
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W.. 1.00
Air conditioner or heat pump
Waterum
P P
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No. Classification
Misc. wiring
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
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 the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
TOTAL PERMITI FEE
$
autnurize representatives or the county of Butte to enter upon the
above-mentioned property for inspection purposes.
X /2Ny Date �J
Signature offa �f Pe`�miteeor�Agent C
Receipt No. 0
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Golde•irod-Applicant
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.
DIRECTOR OF BLIC WORKS
BY Date :1—r 2--7)'
B Iding permit expires Date ...........................................