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026-222-006
26-222-6 ANGU . R. BELSER 7763 rwin Ave, Palermo >Permit #4624=78B (reroo' ; --d'arport 026-222-006 02-0587 ' RODRIQUES, URIEL 77631 ) AVE, PALERMO RE --o -0 2- 026-222-006 026-222-006 02-1903 RODRIGUEZ>AVE., URIEL �� NALED 7763 IRWPAL ma�c, NAL! CONT: RATH �1O.0 REPLACER HEATER 026-222-006 03=0695 RODRIQUEZ, URIEL INAL� 7763 IRWIN AVE, PALE REPLACE WINDOWS & Si 026-222-006 03- 8 RODRIZUEZ, URIEL �NALED 7763 IRWIN AVE, PALERMO REPAIR FOUNDATION 7 17-b 026-222-006 ,03-0 99 RODRIQUES, URIEL , 7763 IRWIN; PALERMO j 'ADD WINDOWS TO BP#03-0695 I D 026-222-006 — 05-1342 RODRIGUEZ, URIEL 7763 IRWIN AVE_, PALERMO Cont: OWNER STUCCO r - ELSER, Angus 689-69B 6-222-6'' 7763 Irwin Av .,. Palermo t rQ 21 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. BPO51342 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 t 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: 05/23/2005 APN: 026=222-006-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 7763 IRWIN AVE PAL. Date: Contractor: Map Index: Description: stucco application on house (1577) 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 a Owner: RODRIQUEZ URIEL & YOLANDA 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 P O BOX 503 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).): 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 Applicant: RODRIQUEZ URIEL & YOLANDA 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 P O BOX 503 sale. If however, the building or improvements are sold within one f 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 P(ofessions 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 th Business and Professions Code r^ Date:, 6C ner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 1 have and will maintain a certificate of consent to self -insure for 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 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 s/: Total Square Ft: 0 S. F. 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: o and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall S/ forthwwith comply with those provisions. Date: ✓ — J n(J Q (((��� Applicant: �_fl�n X � WARNING: Failure to secure workers' compensation coverage is • Z unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of ��� ���� L� 3 compensation, damages as provided for in Section 3706 of the Labor code• interest, and attorney's fees. 111 CONSTRUCTION LENDING AGENCY. This per is hereby iss er pplicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the of the work for which this is issued 3097 Civ.) Resol ons to do or ' icate bove r which fees have been paid. -- � performance permit (Sec Name: -sr BY Date: 2 3: --©e, Address: PERMIT EXPIRES ON:^ Dafe ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby '6uthorize representafves of Butte Count to enter upon the above mentioned property for inspection purposes. r n � Print Name: Signature: Date: .5� t� Owner 0 Contractor ❑ 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) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER Last Name 12vo1-2/6UL first Name iJ�l� Address —7-76 1 /11v�e_ /��C� City telp)wState ( Zip �'_" 6ef Phone --6 3/8 Fax E-mail APPLICANT NAME CONTRACTOR Name �J N &r -z Address Zip City Fax State Zip Phone Map Book Fax E-mail Planner 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 6�r ,, 3 KQL5 V Ir For office use only: Zoning Propert`xAddress 7 "7 b :�> 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. BP45-/ 3 y BIN # LOCATION AP#02b Propert`xAddress 7 "7 b :�> 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 Page 1 of 2 Description or Scope of Work: ye-L'r— S`i�/ 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. S� Received by: Amount: 19 2 � Bldg SRA Receipttr l� Sheriff LI /V V SMIP Date• ', Other 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 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 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 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541� gpeff NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER r A;Z �^',L f/•"'/� �1 ZONING BUILDING PERMIT OWNERCrJ ,/ lE I V TELEPHONE L3 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS :ltii�� CYC I�GCc�ri�r�r CONTRACTOR'S NAME t TELEPHONE CONTRACTOR'S MAIUNG ADDRESS + r ` CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 2 0.0 0 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS -774. A1,11 /1 Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF goDuplex ❑ Mobilehome O Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent ' 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation -0 Other O Describe Work: jet W � /� //1-47 Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S 1, ;G,/ ELECTRICAL PERMIT Filing Fee 20.00 Main Service p A 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 4 y .. ( l t_ Lic. NO. 4 t, :a� 7 c. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for 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 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 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 '. C ; \ . ' : w s ` Policy Number ;'-, --I , r:: `, U7_ (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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. X ; .',.? Date ! *r Signature of Applicant - ❑ Owner ❑ Contractor O' Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 storiesin height. Main Service To 46.00 W:U200A CCU000A NEW CONST. DWEWNG OCCUP. SO OR ( 8 ACC. S.3.5¢Fr. CNS. NON-R6ID. MULTI -OUTLET IRCUITS 97.50 POWER AP 6PAT s• - 8 SINGLE OUTLET CIR. @ ''50 Ex. Occup. OUTLET OR FDRURES BAL @ .so Ex. Occup. OFUTIEEDT3 R.16OEA.5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ =HAD IMP FLOOD CDF PARCEL PD HD ISS This permit is reby issued under the pplicable provisions of the Butte unty Code and/or�R evolutions to do work indicated,a ve for which fees,hav been paid. By ate PERMIT EXPIRES ON eller/ " Dale Receipt No. >> a / /I % � i . &w WHITE-D.D.S.-B.D. CANARY -ASSESSOR,' -7 PINK -INSPECTOR GOLDENROD -APPLICANT 026-222-006 X02-1903 RODRIGUEZ, URIEL 7763 IRWIN AVE., PALERMO CONT: RICHARD HEATH est ASSOC. REPLACE WATER HEATER .a ' 1 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center DriveOroville, California 95965 • Telephone (530) 538-754 P R T UQ_ (Rev. � APPLICATION AND -PERMIT 3 - eco ASSESSOR PARCEL NUMBER 026-222-006 1 ZONING BUILDING PERMIT OWNER TELEPHONE I SO, FT, OCC. BUILDING VALUATION CONT EST 11000.00 .OWNERS MAIAT ADDRESS P-0. BOX 503 PALERMO, CA 95968 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 1. 000.00 ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 25 .00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 7763 IRWIN AVE. PALERMO CA 95968 Energy Plan Checking Fee $ $ PERMIT FEE $ 45.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF EX Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 1 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel IN Utilities ❑ Installation ❑ Other ❑ Describe Work: ��REPLACE FOUR WINDOWS ANDRE SIDE C�M/l( /y L11 AJ�h'9 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 600VOR UE 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.P License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License aw for the following reason: 0571, 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. ❑ I am exempt under Sec. Business and Professions Code for this reason Main Service 200AWEE TO +000A 46.00 NEW CONST. DWELLINGOCCUP. OR ADDNS. ( 8 A.C. BLOS. 3,5¢50. FT. FSO" N.R.,D ' MULTI.OUTLET @7.50 OWER APPARATUS 8 SINOLE OUTLET C IR. Ex. Occup.ourLEr OR FIXTURES 20 � , °° BAL o .50 Ex. Occup. our rs RFLYEDM.) A_ 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE S 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 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if 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, 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 forth) ith comply with those provisions. 1.( A It Date " Igna ure o At- caner ntr r ❑ Agent An OSHA permit is required for excavations overv. deep and demolition or constructio of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 45.00 FEES IMP FLOOD COF PARCEL PO 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. ByDate 311111-13 PERMIT EXPIRES ON 3/I L /--to ReceiptNo. 37 -Se q 5. 0 WHITE-D.D.S.-B.D. CANARY -ASSESSOR_ PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Orovills, Cedifornia 95965 • Telephone (530) 536-1541 — pmt 0• w 12196) APPL[CATIONANDPERMIT �s ss P 27°"o BUILDING PERMIT n a✓�t g L(4 :E.��� sQ. FT. OCC. sun_ma VALUATION _ N4Ed9C.IfDDA3 oxo oa eamus i su�oA=lt wu� '/ USEOFSir�t1CTURE '— ;F,P� Dupimc D 6bboahome O Ober Om n K *?M= FEE PUD $ SRI $ SHWFF:OTM.$ . ru-epls�e r Total YahtaBon 8 Rho Fee S Pam* Fee Pian cha:kjmQ Fee Energy Pian ChezWng Fee S �I-Uffl�rTFO; Each Trio slam 1 - 5 aatllets saww H=s is G1 w POM F:—= S 7.D 23.0 15.0 15.0 15.D 15.0 20.00 20. 171CAL PERMIT Fang Fee 20.00 Sarvia f omn MDD $gam sm% tD f■a■i► 4SOD Im " oust a UaL sm mms=m @7S0 �ss�aa 1 am= oA Fcmmm FCSRETPPLIS OE AAA' • CU S SAD arwy Swvr=e MOD e Haase Facuas MOD 1'�irm 29.00 PERiVIIT Fri S FE -M aCAL PERMIT Fig Fee 20.DD ng 6.50 Pnmm Fc""ES Nbbbe Hmns Inst�on Fee = Energy hrspecon Fee $ 'Ream Nv/ V�� C- ` �r OT,'�L FEE $ ToOgg � � COMM w:L d Fra FSD7D CDF PARr9 PD 11�is perms! heresy Issued under the appi�able prayspns Of fhe Butte Caurdy Cade andior Resohi5otts b do work bd•�afed above for whidn fees have been paid By Ae iptNa PEnWT EXPRES ON wFRtE.�_e_s .o_e ea■QiR.L�S=SSCA FtuK•nSPcCiDR �aOLG-_TROD-�iPPLICANf wed ..• O.B.- I 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 the proposed property improvement: YES NO ❑ 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: CITY: CONTRACTOR'S LICENSE NO. 4. 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: will-UUX CITY: CONTRACTOR'S LICENSE NO. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: - UIW► IN ADDRESS PHONE TYPE OF WORK SIGNED: 'I J'� � PROPERTYOWNER: ER: ' / DATE: 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. OVER O.B.- 1' OWNER BUILDER INFORMATION I 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. t 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: ♦ 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. ♦ 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. ♦ 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 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 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. rely, MF Vi ira, C.B.O. M,uilding Inspection NOTE. This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code OVER COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUI ING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (5 0) 538-754 P R .IT N0. (13e�.12i9ei APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 026-222-006 ZONING BUILDING PERMIT OWNER RODRIQUEZoURIELCUNT: TELEPHONE SO. FT. OCC. BUILDING VALUATION � ST 1 VUU . VU .OWNER'S MAILING ADDRESS P.O.503 PALERMO. CA 95968 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER [Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 1000.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 25.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 7763 IRWIN AVE. PALERMO CA 95965 Energy Plan Checking Fee $ $ PERMIT FEE $ 45.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF OC Duplex ❑ Mobilehome ❑ Other sPECIFv Each Trap 7.00 - 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 Q Utilities ❑ Installation ❑ Other ❑ Describe Work: REPLACE FOUR WINDOWS AND RE SIDE 0A^4O.�. dZf< &'Y'a Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home s G W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 800VOR LE Main Service ODA 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.POWER License Class Lic. No. OWNER -BUILDER DECLARATION ' I hereby affirm under penalty of perjury that I am exempt from the Contractors License w for the following reason: W01, 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. ❑ 1, 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 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( a ACC. BLDs. sO 3.5QFT: NoµR6IDMULTIT" OUCET @7.50 APPARATUS b SINGLE OUTLET CIR. EX. Occup. OUTLET OR FDRURES .00 BAL @ 1. 0 Ex. Occup. DflxuTLEEDrsA A= ) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 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. ❑ 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 Policy Number (The above sections need not be completed if 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, 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 forth ith comply with those provisions. p f DXPDate Signature `of Applicant - 0 Owner 0VntrEctgr ❑ Agent J/` An OSHA permit is required for excavations over�'0" deep and demolition or constructiofi. of structures over 3 stories in height. y I MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE _S Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 45.00 HA2. D. FEES IMP I FLOOD I CDF PARCEL I 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. yBy _Date !rZ-4 PERMIT EXPIRES ON // L/ Ie - Receipt No. ���' yC�' �� WHITE-D.D.S.-B.D. CANARY -ASSESSOR' PINK -INSPECTOR GOLDENROD -APPLICANT 'NOTES RESIDENTIAL 77 t 026-222-006 ' ' 03-0695 - PERMIT NO. _RODRIQUEZ, URI L-- 7 7763 IRWIN AVE, ALERMO REPLACE WIND WS & SIDING 09- I a R T i SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER 0 I t IL JOB o JOB FINALED ( t ` Signature , J = OK 0 = Not OK Not } = Not Readyable 1. Zoning Requirements -Setbacks -Easements MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 1. Zoning Requirements -Setbacks -Easements 5. 2. Soils; Special MH Support Sketch Carports; Windows -Doors 3. Sewer; Location -Test -Fall -C/O -Concrete 8. 4. -Water; Location -Test -Easement Needed (Sketch) Siding; Nailing -Veneer -Stucco -Mesh 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 11. 6. Gas; Location -Test -Wrap;-/ " /" L 'ft. / P Nat. or / /" L "ft./ P LPG Braced Wall Panels 7. Well Clearance & Disconnect 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card.6-1 "Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy f Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements " 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 _ Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-Con nectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s. 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panel boards- Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors 23. Fire Sprinkler; Test 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. Date 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water Date 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI Date 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or At Insulated Neutral O Yes O No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector 69. Elec. Trim & Subpanel, Breaker Sizes & Labels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs-Nailino SDacinq & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes _ 83. Following Instlol./Drive Cl Yes 0 No/Walks 0 Yes 0 No/Planters 0 Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT_13-07 g ASSESSOR PARCEL NUMBER 026-222-006 ZONING BUILDING PERMIT OWNER i RODRI UES URIEL TELEPHONE Sp, FT, OCC. BUILDING VALUATION CONT ST 500.00 . OWNERS MAILING ADDRESS P.O. BOX 503 PALERMO, -CA 95968 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ 500:00 ARCHITECT OR ENGINEER LICENSE NO. —Fling Fee $ 20.00 Permit Fee $ 15.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 7763 IRWIN AVENUE Energy Plan Checking Fee $ $ PERMIT FEE $ LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF IX Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel YJ Utilities ❑ Installation ❑ Other ❑ Describe work: ADI WINDOW 0 WITH BP# 03-0695 Gas piping stem 1 - 5 outlets 15.00 -Building sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 800VOR LESS Main Service zo.A 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.POWER License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law ff the following reason: —Lf 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. ❑ 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 200A TO tOooA 46.00 NEW CONST. DW ELLG OCCUP. IN OR ADDNS. ( a ACC. BLAS. s0 3.5¢FT, NOEWN. sloT' MULTI.CH OUTLEI 97,50 APPARATUS a SINGLE OurLEr C1 R. Ex. OCCU OUTLET OR FIXTURES 20 @ 1.00 BAL Q .30 Ex. Occup. OUrIEEDTSA .=6.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. ❑ 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 permitis issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation kOf one hundred dollars ($100) or less.) 2rl 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 tho a provisions. ° X ate ( - Q Signature of Applicant - Owner ❑ Contfictorl ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation `. PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ DCC CONST. TYPE TOTAL FEE $ 35.00 HAZ. I D FEES IMP I FLOOD CDF PARCEL I p0 71 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. By 07 Date PERMIT EXPIRES ON 31; � t / e e Receipt No. R -75-76A107350d WHITE-D.D.S.-B.D. CANARY S SSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTS- DEPARTMENT OF DEVELOPMENT SERVICES - ILDIHG DIVISION 7 County Center Drive o Orovilter CaFdomia 95965 1- Telephone 0) 533-1541 1 - PEN&T No. APPLICATION AND PERMIT arum BUILDING PERMIT n �4C" E SQ. FT. 0= sulLDING VALUATION �/1 c n � W= Oct mcmAcm= oat , =H= Ca eMss MUM A== a `7 artm cuam mm"t warts USEOFS ieRu=RE �F'f Duplex D l flobDahams O Ober sP�rar TYPE OFWORK Hae 0 Ada► = 0 R=cddlp t qM= D hshbr= 0 Obert' Dee=rbs Wein �•--y� r� /j C *PaJAiT FEE P. Alb .SRA OTM.. AAOVW R:CMYED "RUO i NJWm 3 75 76 0 TO Dow Km Z?" COMM �u cNocv i m" I I 4LOD IOW Valuation ��,-'p �- mb Fee S 20.DD Permit Fes �a�awa Pian Chemo Fee mnm as � em cls � -%wV Pian Checkhg Fes s S.OD Tem s 23RD PmmIT r -E- $ S - U c7 PLL IESINGa -PERMIT ZSAD FiTmg Fee 20.D0 Eafi T 7.D0 Soisr or had wrier heater s 23.0D Wates pig FEng Fee 2D. D0 15.00 -%:b P= water he--br or vwft 1 S.DD Q= 1 -5 oatlleb i S.DD §"me wore? 1 15.00 POT F" S EZ..C'�e lel. P -17M I I FTng Fee 20.D0 Marto Saiv= m" I I 4LOD oat ( "411=Lmr Lsf_ C7SD • �a�awa E O mnm as � em cls � MED APPUM OR mmem m• S.OD Tem Sarvi: s 23RD Nbbla Herne Fades 2 DD N65:14� ZSAD PE�BIT Fi.:a s E kH=d CAL PERMrT FEng Fee 2D. D0 6.50 PERNIFT FEE I s Nb66e Hams kmta Son Fee $ BMW hnA=on Fee $ o" "-� "PE [TOTAL FEE $ 3,r:� a IL P3 I EV I P -=D I =F I P=:a I PD I HD I SME This pend is hereby issued under the appBable pruvsiaas ai The Hine County Code and/or Aesoiubm b do work b3ealed above for WWW fees have been Pani. 9y r'te�iptPio. PERMIT E ?IBES ON Nt►tRt.D.n.e _e.n r_tuc¢r_ebs�soo pme.0.5P6G'iaR vaL�_r�IFtQ0.APPLt�AHr - Dsie O.B.- I 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. -10 personally plan to provide the major labor and materials for construction of the proposed property improvement: YES NO El I HAVE 0 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: CITY• PHO:7��CONTRACTOR'S LICENSE 4. I plan to provide p ons of this work, but I have hir e following person to coordinate, supervise, and providemajor work: NAME: ADDRESS: CITY: PHONE: CONTRA 'S LICENSE NO. 5. I will provide some o e work but I have contracted ' d) the following persons to provide the work indicat NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER: –\,�—=:,CV--�,,,,-v DATE: o� 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 OVER OWNER BUILDER INFORMATION Dear Property Owner: O.B.-1 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: ♦ 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. ♦ 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. ♦ 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 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 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. qrely, Mic el C. Vi ira, C.B.O. M ger, Building Inspection NOTE. This Owner -Builder Information is, required by Section 19830 of the California Health and Safety Code � i • FOR BUILDING DIVISION USE: Receipt Information:— - _.: v \1 Number: -- - - -- Date: ` --16 '6 IssuedTo: Amount: IS f Go Fees Retained: Processing Fee: $ Bldg Filing Fee: $ Plbg Filing Fee: $ Elec-Filing Feer -----r._.--. $ _ .. . __ _ _ _ --_ - -- •---�MechFiling'Fee' """' _ _$... _ ._ _ .. _ __ _ _ �. . _ _ _. Energy P/C Fee: $ Plan Check Fee: $ Inspection Fee: $ SRA Fee: $ Total amount Retained $ TOTAL REFUND DUE $ REFUND CLAIM APPLICATION MAILING ADD_ RESS- 2>VC) S� 4A-- `� CG:u Cv CSA �t s`1Z� ASSES SORRARC EL.#:�, 026-222-006 RECEIPT=NUMB€R(S) 353980 Request a_refund--of_fees paid on the above receipt number(s) for the following reasons: C01'3TRACTOF HAS CAt3Ci,ED PROJECT. XPi ------fun,, r_a_ny applicable fees in the following categories: (Check those categories whichy_o.0 wish to have refunded.) Building Permit Fees ( ) Sheriff Fees ( ) SRA Fees (CDF Fire Planning) ( ) Urban Area Fees Disposition of -Plans:-,. ( ) Plans returned to me at counter ( ) Please mail plans to me at above address. ( ) Please dispose of plans. L�L SIGNATURE DATE—t '7 - PLEASE DATE AND SIGN THE ATTACHED COUNTY OF BUTTE GENERAL CLAIM FORM. DO NOT COMPLETE ANY OTHER INFORMATION ON THAT FORM. COUNTY OF BUTTE Oroville, California GENERAL -CLAIM CLAIMANT: CITY & STATE:-- DATE TATE:-DATE OF CLAIM: " IMPORTANT.- SEE INSTRUCTIONS ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECE/VINr. annn4 nR SFRV/rFc DATE DESCRIPTION .OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT • 1 TOTAL I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true an as stated. ` l� Dated � this �J,--day_of_ �u.�\ —�20a GWXC. C� Calif. Signature of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that t Budget Appropriation [ ] or Specific Board Approval [ ] (Check one) for the same. Dated this day of 20_, at Calif. Department Head or Authorized Deputy Dept. Code Exp. Code PAYABLE FROM Dept. Code Exp. Code PAYABLE FROM De t Code Ex . Code PAYABLE FROM DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. INSTRUCTIONS TO CLAIMANTS All claims against the county must be itemized, giving dates and character of service rendered or work performed, quantities, description and unit prices of articles furnished or delivered. Claims must be certified by the claimant and submitted to the Department head for approval. Uponapproval the Department head will forward claim to County Auditorfor payment procedure. Do not file with the County Auditor first. Claims should be presented to officials for approval immediately upon completion of services requested or material ordered. Compliance with above will expedite payment of claim, failure to do so may delay payment considerably. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541NO. (Rev. 12/96) APPLICATION AND PERMIT AR-1AT ASSESSOR PARCEL NUMBER j' /1� C ZONING - BUILDINGPERMIT OWNER . TELEPHONE SO. FT. OCC. BUILDING VALUATION .OWNERS MAILING ADDRESS -7,1-'- CONTRACTOR'S NAME sbCl & s TELEPHONE CONTRACTORS MAIUNG APORESS , CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Plan Checking Fee $ BUILDINGADDRESS"77 L/?- �e p `w Al lVn•'1! 1/�_ 'Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE / SF Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition,❑ emodel ❑ Utilities ❑ Installation //❑ Other ❑ Describe Work: :'.'s Uf JT j�li �7G Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 20oA 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. `� p �7 License Class TL -\L pG-LO Lic. No. �O �4 `. DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ 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 TO LOooA 46.00So NEW CONST. DWEWNG OCCUP. W: OR ADONS. ( a ACC. BLDS. SO 3.5¢FT_ =RESID MULTI -OUTLET 97,50 POWER APPARATUS a SINGLE OtlT1,.ET CIR. Ex, Occup. OUTLET OR FIXTURES&,L 20 @ 100 .50OWNER-BUILDER Ex. Occup. of EeDrs p6Ip.0EA 1 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT 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. ,0-'i 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' co pensation insuran�(e carrier and pol' y number are: Carrier S�Ic c�cr��a \`^S �Ut �� Policy Number k%V_1S 'S aZ (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 4ffoh1with ly h those provisions. X Dpfe -7-(L26-z-_ Signature of Applicant - ❑ Owner ❑ Contractor Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ U(r� HAZ. D. FEES IMP FLooD CDF PARC PD HD ISS This permit is reby issued under the pplicable provisions of the Bu unty Code and/ebolutions to do work indicated ve for which fee av been paid. c ) _ By ♦✓f '- ate/ '( PERMIT EXPIRES ON Date Receipt No. WHITE-D.D.S.-B. D. CA ARV-ASSE SO PI K- SPECTOR GOLDENROD -APPLICANT L R414 ............... Richard Heath and Associates, Inc. 310 Salem Street, Suite B • Chico, California 95928 • 530-898-1323 • 530-898-1325 fax -OG July 22, 2002 County of Butte Building Department 7 County Center Drive Oroville, CA 95965 To Whom It May Concern: On July 16, 2002 permit number New 2002 was pulled for 7763 Irwin Avenue in Palermo. The permit was pulled for the replacement of the hot water heater but due to our programs limitations we were unable to bring it up to code. Richard Heath & Associates is a contractor for PG&E's Energy Partners Program and this program does not allow monies for retrofit. Due to the above circumstances we were unable to complete the job and therefore request a refund for the cost of the unused permit. Please call Tami at (530) 898-1253 if any further information is needed. Sincerely, va",�r0 Tami Prothero Administrative Assistant Alameda Chico Fresno Los Angeles JUL 2 3 2002 911E COUNT PLANNING OIVISION Sacramento San Diego r- 1 026-222-006 02-0587 RODRIQUES, URIEL/ I 7763 IRWIN AVE, PALERMO REROOF i i I COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION X 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT"'" 02-0587 ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT - OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION A SQ 840.00 OWNERS MAILING ADDRESS 7263 TRWTM AVE., PAT -ERM 05068 CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS ' Total Valuation $ ARCHITECT OR ENGINEER LICENSE. NO. Filing Fee $ 20.00 Permit fee $ 23,00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING Af D�Cf✓ IRKN AYE, pUMM ! J Energy Plan Checking Fee $ $ PERMIT FEE $ 43 LOT NO. SUBDIVISIONS NAME PARCEL MAP 111 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE j SF In Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Otherr❑ Describe Work: Raw W/MW Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200A 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.POWER License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑' 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. ❑ 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 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. a ACC. BLDS. SO 3.50FT. Y. NON-REE,sln MULTI -OUTLET 97.50 APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 Q 1.00 BAL p .so Ex. Occup. OIxT�S Aa D OR US 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 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. ❑ 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 Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed ff 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, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that ff I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. �OA�y p ' ` * 3 . ` n X <1 i � Date r � (,% Signature of Applicant - Rt OwneV ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" dee and demolition or construction of structurs over 3 stories in height. P Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE 43.00.1. TOTAL FEE $ HAZ. p. FEES IMP FLOOD COF PARCEL PD HD ISSUE AY This permit is hereby issued.under the applicable provisions in the Butte County Code and/or Resolutions to do work indicated a Ove for which fees have been paid. �j '� + 'By Date54-69! /, PERMIT EX PIRES-,,ON* i Is 16 Dere Receipt No. ✓✓ ' ( WHITE-D.D.S.-B.D. CANARY -ASS SOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION, 7 County Center Drive • Oroville, CGalifoo,nia 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 02-0587 ASSESSOR PARCEL NUMBER 026-222-006 ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION ± 840.00 . OWNERS MAILING ADDRESS 7761 AVF.9 PALERMO Q5968 WT�l CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 840.00 ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 23.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGlygi IRWIN AVE, PALERMO Energy Pian Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF 12 Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 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 ❑ Otherb Describe Work: REROOF W/COMP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200A 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.P License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 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. ❑ 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 200A TO 1000A 46.00 NEW CONST. OW EWNO OCCUP. SO OR ADDNS. ( a ACC. S.3.5¢FT. HON-REESIOT. MULTI.OUTLET 97,50 OWER APPARATUS a SINGLE OUTLET C IR. 20 Q ' 00 Ex. Occu OUTLET OR FOcruREs BAL @ .50 Ex. Occup. OFlrLErsRES oREA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 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. ❑ 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 Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) .f I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to 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. e X Date ' 1 — (J� Signature of Applican - @ OwneV ❑ 00itractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in heigh MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 43.00 HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUE X This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated a ve for which fees have been paid. Date PERMIT EXPIRESiO,N Date Receipt No. , WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT R B. ��.• a '� OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signatim. 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 the proposed property improvement: YES 0 NO 0 2. I HAVE HAVE NOT 0 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: 1*/K/ e / hl) nC4 Y' ( d\ L'/ e, 7 • v ADDRESS: �:Z;t k3 / F- I I it Al l iJ CITY: (e- Y Y"` o PHONE: 533 b � l R CONTRACTOR'S LICENSE NO. 4. 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: PHO` E: CITY: 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: Q,1 0 PROPERTYOWNER: 0?)n'f'W SOCIAL SECURITY NUMBER: D ATE: K - NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be -completed exd returned to our office before we are permitted to issue the permit: OVER OWNER BUILDER INFORMATION Dear Property Owne-: 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 parry 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: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed as contractors or subcontractors. hen you may be an employer. ♦ 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. ♦ 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 Srate Law, contact the Department of Benefit Payments and he 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 tinder 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 contracting the Contractors State License Board in your community or at 1030 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. I4icly, l C. Vi ira, C.B.O. r, BuildingInspection NOTE: This Owner -Builder Information is required by Section 19830 of du Calilornla Health and•Sajery Coda OVER COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 ` Telephone: 534-4541 APPLICATION AND PERMIT aumarize represeniarlves or the county or twtte to enter upon the above-mentioned property for inspection purposes. X f / Date Signature of Permitee or Agent Receipt No. - White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -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 PUBLIC WORKS By Date Building permit expires Date - BUILDING Owner _` L C f r _ SO. FT. OCC. BUILDING VALUATION Mailing Address; - Telephone No. Contractor Mailing Address , Fireplace Total Valuation Telephone Na. Permit Fee Building Address _ _ L y " Plan Checking Fee&/or Penalty Permit Fee y r , r PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trao 1.50 Repair drainage or vent piping 1.50 A. P. No. Zoning 8 Planning Water piping 1.50 Each gas water heater or vent 1.50 Fees W.C. Sanitation, .Fire Dept. FireZone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Bldg. Plans Rec''d, I Parcel A rovol Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑; Permit Fee $ $ nr F ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 Single Family Q Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW CONST OR ADDNS. ACCLBLDGS.LING CCUP. S\ 120 sq ft I 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 st le of: Y NEW CON STR BRANCHCIRMULTI-OUTLET NON -REBID BRANCH CIRCUITS 2.50ea NEW CONSTR. (POWER APPARATUS 11 NON-RESID. SINGLE OUTLET CIR. Ex. OCCUo(OUTLETS OR FIXTURES 50@250 BAL@1 Ex. OCCU FIXED APPLNS. OR p•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ❑ 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. ❑ I 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 Na FEEPERMIT 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 Land Development Fee $ TOTAL PERMIT FEE $ ''"' aumarize represeniarlves or the county or twtte to enter upon the above-mentioned property for inspection purposes. X f / Date Signature of Permitee or Agent Receipt No. - White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -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 PUBLIC WORKS By Date Building permit expires Date - COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive Oroville, California 95965 y Telephone: 534:4541 y APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X 1 Ail / d X, rh / Date Signature of Permitee or Agent Receipt No. �%E e p ;;)— White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -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 PUBLIC WORKS BY e _—�-Ot�— 1-L/1� IK Date P— a—" 2-P Building permit expires Date �' �-- BUILDING Owner ^/6, k s JP, 23c --L S e --r— SQ. FT. OCC. BUILDING VALUATION Mailing Address ' 74 9�rW N �vL Telephone No. Contractor Mailing Address N��a— Fireplace Total Valuation amp. va Telephone No. Permit Fee Building AddressPlan �"( H V e' Checking Fee&/or Penalty Permit Fee 4,d -e-, PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 f A. P. No. (.. 2�-`Z ^ 1© Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 44 -C. FireDept. FireZone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Plans Parcel A rovol Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ rR.e POO AV t-°"' ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 600V OR LESS Main service 100 AMP OR LESS 5•00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD•L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 1.00 NEW OR ADDNST // DWEt ACCLBLDGS.LING CCUP. 4') 2¢sgft 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: %� NEW RESID. BRANCH CIRCUITS) NON RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS 6 NON RESID. SINGLE OUTLET CIR. Ex. Occuo(OUTLETS OR FIXTIIRES BAL@; Ex. Occu FIXED APPLNS. OR p•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 �f am exempt from the Contractors License Laws of the State of Cal ifomia. 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. ❑I 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 Land Development Fee $ TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X 1 Ail / d X, rh / Date Signature of Permitee or Agent Receipt No. �%E e p ;;)— White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -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 PUBLIC WORKS BY e _—�-Ot�— 1-L/1� IK Date P— a—" 2-P Building permit expires Date �' �-- I 4- R ,026-222-006 03-0698 i. RODRIZ, EZ, URIEL ,7763 IRW1N AVE, PALERMO. REPAIR FOUNDATION t 9 I COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - UILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone 530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 3 Ot!n9 ASSESSOR PARCEL NUMBER U14b—L1—M � ZONING BUILDING PERMIT OWNER OtuEURAQUEZS URIEL TELEPHONE 533-0318 SQ. FT. OCC. BUILDING VALUATION g28 Cd 10. 'O 9 28303.00 L.O. 13ONG X ADDRESS PALERMO CA 95968 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ 90280.w. ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 117.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ u"97' RWIN AVE. PALERMO, CA 95968 Energy Plan Checking Fee $ $ r PERMIT FEE $ 137.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF O Duplex ❑ Mobilehome ❑ Other i SPECIFY Each Trap 7.00 Solar or heat pump 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 O w REPAIR CORNER SECTION OF FOUNDATION Describe' , Work: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION , RM W 1 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 m licen e s In II forcA and effect. ^ Y^ y ri \ -� License Clas Li o. \ 111 -� OWNER -BUILDER DECLAAATIION> /' I hereby affirm under penalty of perjury that I am exempt4rom the Contractors License Law for the following reason: lPt l -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. rty, am exclusively contracting with licensed contractors ❑ I, as owner of the tjeat. to construct the p❑ 1 am exempt unde�. �Busi> ess and Professions Code for this reason WORKERS •,O ENSATIONI ECLARATION 1 hereby affirm under penalty of perju ne of the following declarations: ❑ 1 have and will maintain a certifl t f onsent to self -insure for workers' com ensatiop�T-- s provided for b Mod '0 3700 of the Labor Code, for the performanceb the ork fo((��which this pe?riRihi Issued. ❑ I have and l�m iniawork�er3�c mpensatil n isurance, as required by Section 3700 of the bor�Cod , for thea pe rman f ork for which this permit is issued. My workers' coma ns tion i sura ce ca He nd policy number are: Carrier Policy Number r (The above sec gt ons nee"be complete if the permit is for work of a valuation of one hundred dollars (�100).,or less.) certify that in tl`e pertorm ncg of the work for which this permit is issued, 1 shall not employ any\pefs6n 'Z,any manner so as to become subject to workers' C I al'rforil a, and agree that if I should become subject to the workers' com ensa��o�rov signs of section 3700 of the Labor Code, I shall forth it�omp h'ttT� a p.oGisions. X e -+ /-3— Signature of Applicant -Nn Owner V Contr6c7iarAgent 1-4 An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 100DA 46.00 NEW CONST. DWEWNG OCCUP, SO OR a ACC. BLDS. 3.5¢FT; .EONS NEW CONST. MULTI -OUTLET NON•REs10. c 97.50 POWER APPARATUS a SINGLE 0UfLET CIR. 20 @ 1.00 Ex. Occup. OUTLET OR FD(TURES SAL o .50 FOCED APPLNS. OR Ex. Occup. ouTLErs REslp. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Coolin Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ coral. TYPE TOTAL FEE $ 137.00 HAZ. p, FEES IMP FLOOD CDF PARCEL 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. By Date PERMIT EXPIRES ON Defe Receipt No. S —70 3S .J�I % WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PER �NO. (Rev. 12/96) APPLICATION AND PERMIT Da --0&9 MI S S ORP NUMB - :n-0`66 ZONING BUILDING PERMIT OWNER RODRIQUEZ, URIEL TELEPHONE 533-0318 SO. FT. OCC. BUILDING VALUATION . OWNERMAILING NG ADDRESS P.O. BOX 503 PALERMO CA 95968 928 @ 10. 0 9.280.00 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ 9,280.00 ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ 117.00 Plan Checkin Fee $ BUILDING ADDRESS 7763 IRWIN AVE. PALERMO CA 95968 Energy Plan Checking Fee $ $ PERMIT FEE $ 137.00 LOT NO. SUBDIVISION'S NAME ' PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF N Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 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 IX Describe work: REPAIR CORNER SECTION OF FOUNDATION Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S I G I W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Feel 20.00 600VOR LESS Main Service zo.A 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 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License w for 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 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. ❑ 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP, SO OR ADDNS. ( & ACC. BLDS. 3.5QFT. = RE41DT. MULTI.OUTLETCIRCUITS @7,50 POWER APPARATUS 881NOLE OUTLET CIR. Ex. Occup. OUTLET OR FDMRES BAL @':50 Ex. Occup. ouTEtFrs RESio.OEE 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Policy Number (The above sections need not be completed if the permit is for work of a valuation yf one hundred dollars ($100) or less.) t\®�/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. XMq&t:� e� (gnat re of Applicant - • .t Owner Contrfor (PAgent An OSHA permit is requir for excavations over 60" deep and demolition or construction of structures over 3 stories in height.I Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 137.00 HAZ. D. FEES IMP] FLOOD CDF PARCEL p0 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. 2ByVU11�.,"4e.Date J PERMIT EXPIRES ON D le Receipt No. 3 SRO f 13 %- &" WHITE-D.D.S.-B.D. CANARY -A SE SOR PINK -INSPECTOR GOLDENROD -APPLICANT 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. 0 I personally plan to provide the ajor labor and materials for construction of the proposed property impr ement : YES NO ❑ I HAVE ff 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: RESS: CITY: PHO CONTRACTOR'S LICENSE NO. '4. I plan to pro ' e portions of this work, but I have hired the following person to coordinate, supervise, and pro a the major work: NAME: ADDRESS: CITY: PHONE: CO CTOR'S LICENSE NO. 5. I will provide some of the work but I have con ted (hired) the following persons to provide the work indicated: NAME ADDRESS PHO TYPE OF WORK SIGNED: PROPERTYOWNER: DATE: 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. OVER az- I OWNER BUILDER INFORMATION I 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: ♦ 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 subcontractorsi then you may be an employer. ♦ 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. ♦ 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 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 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. rely, A Mc el C. Vi ira, C.B.O. M ger, Building Inspection NOTE. This Owner -Builder Information is. required by Section 19830 of the California Health and Safety Code. OVER 4 .026422-'006� 03-0799 R -EL RODRIQUES, 6RI�L j 7 1 7763 RWIN , 7LE 0 763 IRWIN ' PALERMO . WINDOWS T Bp ADD WINDOWS TO'BP#03-0695 fir %,uUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-754 PERMIT NO. (Rev.12/96) APPLICATION AND PERMIT _ U� 3- 0 7 Y !� ASSESSOR PARCEL NUMBER 026-222-101106 ZONING BUILDING PERMIT OWNER RODRIQUES2 URIEL TELEPHONE SO, FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS P.U. BOX 503 PALERMO CA 95968 /+ 7� CO bl T HIST f�/7 fl � U V . L U CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ JUU. ' ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ 15.00 Plan Checking Fee $ BUILDING ADDRESS 6 A 95968 Energy Plan Checking Fee $ $ PERMIT FEE $ 5. LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF I;k Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 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: ANSWINDOW ' WITH BP# 03-0695 0 Gas i in stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W@20.00 4 PERMIT FEE $ ELECTRICAL PERMIT I Filing Fee 20.00 Main Service '..A oA'ss 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, ( g ) and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: --I21011, 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 200A TO 1000A 46.00NEW CONST. DWELLING OCCUP. OR ADONS. ( a ACC. BIDS. s0 3.52FT. N CO'1 ' MULTI.OUTLET NON•RESID. @7.50 POWER APPARATUS a SINGLE OLRLEr CIR. Ex. Occu ounETORFWWRES XL0': a Ex. Occup. DlFl�TELEr^ RES o) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. ❑ 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 Policy Number (The above sections need not be completed 4 the permit is for work of a valuation of one hundred dollars ($100) or less.) .Cv� 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. X _ toI — Q Signature of Applicant - Owner ❑ Contrefictor J13 Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 35.00 HAZ D FEES IMP FLooD CDF PARCEL PD HO 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. By PERMIT EXPIRES ON Date ReceiptNo. WHITE-D.D.S.-B.D. CANARY -A SESSOR PINK -INSPECTOR GOLDENROD -APPLICANT