HomeMy WebLinkAbout026-241-012BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
a BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP042346
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 08/06/2004 APN: 026-241-012-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 7605 OCCIDENTAL AVE PAL
Date: Contractor.
Map Index:
Description: CHNG WIND (6) DR LL, REMOD BA,_
KITCH REPLACE FU('_ -I,
C� Q
tf
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
Owner: HAWJ KOU K
signed statement that he or she is licensed pursuant to the provisions of
HER JAY & SAI XIONG
the Contractor's State License Law (Chapter 9 commencing with Section
7605 OCCIDENTAL AVE
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
PALERMO, CA 95968-9604
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: HAWJ KOU K
PP
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
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
Contractor:
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
"6---y
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #:
❑ I 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.
Architect:
❑ I have and will maintain workers' compensation insurance, as
Engineer:
g
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy #:
Valuation: $0.00
1k I certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
.forthwith comply with those provisions.
Date:
Applicant
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
]
code, interest, and attorney's fees.
J)4,—�I—
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
This permit is�undle provisions of the Butte County Code ?nt /
Resolutions toch fees have been paid .+ //\\`1/jl/,
1WV
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By: Date:
PERMIT EXPIRES ON: J C9
Date
Address:
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes./
v
Print Name: l� b �-1 t� Z�l�lc'.% Signature:
Date: 9-16-04),
kd- Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
r
0
a'
0
BUTTE COUNTY
0 DEPARTMENT OF DEVELOPMENT SERVICES
0 BUILDING PERMIT APPLICATION
0 AND SUBMITTAL REQUIREMENTS
0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
0 OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY" -
VSA
CONTRACTOR
OWNER
Last Name
City
irst Name
k. cA
Address
Phone
Citylp
E-mail
StateC
Zip
Ph ne3
6,�e
Fax
E-mail
An -,vi
VSA
CONTRACTOR
Name
Address
City
Ste
Zip
Phone
ax
E-mail
. Li #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zp
City
Fax
tate
F75
Phone
Book
Fax
E-mail
Planner
to License Number
APPLICANT NAME
Name
Address
City
State
Zp
Phone
Fax
E-mail
APPLICANT SIGNATURE
Xv `
For office use only:
Zoning
Property
Flood Zone
Cross Street
SRA
I Yes
I No
Occ.
Type Const
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
BP
BIN #
LOCATION
AP#
Property
City
Cross Street
SRA
WORKER'S COMPENSATION
Policy Num
Carrier
If hiring anyone other than license,ntractors, a certificate of worker's
compensation must be shown at the a of permit issuance.
LENDING AGE Y
Name
Address
Description or Scope of Work:-,
t129
Sq. Footage C
❑ 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.
ived by:
Amount: Bldg
SRA
Receipt ,l)
(1�
Sheriff
SMIP
Other
Date: �
'"� 11
Total
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND WINK
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPERI
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXESI).
❑ 4. Letter from Engineer or Architect for truss design review.
❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to
mobile or modular homes.)
❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 8. Sanitation and site plan approval from the Environmental Health Department.
❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and talcs in triplicate, (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
Mobile, Manufactured, or Modular homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑ 1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑ 3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4.
Letter from Engineer or Architect for truss design review.
❑ 5.
2 Energy compliance design and supporting documentation (if required).
❑ 6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7.
Statement of Intent for Non -heated and A/C (if required).
❑ 8.
Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
❑ 9.
Letter of intent.
❑ 10.
Hazardous Material Form.
❑ 11.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
:AFORMSWILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ASSESSOR PARCEL NUMBER
Proposed Building Use: Counter Technician: Clz'�_Date: �V '
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order tg apply.
O 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. .
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxes!
O 5. Letter from Engineer or Architect for truss design review.
❑ 6. Energy compliance design and supporting documentation in duplicate.
❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, '(C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
0 9. 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.
❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate
O 11. Site plan and business license approval from the City of Biggs
❑ 12. Letter of intent for non-residential buildings
❑ 13. Detached Accessory Building Form filled out by the owner
❑ 14. Hazardous Material Form
❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable.
❑ 16. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 17. Fire Sprinklers............................................................................................
❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........
❑ 20. Erosion Control Plan Required........................................................................ ........
O 21. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 22. City of Chico Plumbing permit........................................................................
O 23. California Department of Forestry plan approval ❑ paid. Sent by: .............
❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check:
❑ 25. Contact Land Development about _ Improvements, _ Drainage .........................
❑ 26. NPDES Form.............................................................................................
❑ 27. Encroachment Permit for driveway from the Public Works Dept ...........................
❑ 28. Pre -Inspection for required.......
❑ 29. Contractor's license information. (Number, Name Style, Classification) ...................
30. Worker's Compensation Carrie and Policy Number ..........................................
31. Owner -Builder VerificationGiven to owner, _Mailed to owner) .....................
❑ 32. Letter of Signature authorization ...................................... :.............................
❑ 33. Recorded copy of Agricultural Acknowledgment Statement .................................
❑ 34. Manufactured home utility clearance..............:................................................
❑ .35. Existing violations and/or expired permits.........................................................
❑ 36. Deed Restriction.........................................................................................
1137. ❑ Grant Deed, ❑ M.H. Titl�-/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
38. Other:
39. Other: NOY
When Issued Telephone , and hold for pickup.
1 have been informed of the above itemg and requirements for obtaining a building permit.
Applicant: -- -<-
1. Index permit applic tion for he ab v i s numbered:
2. Additional items r6quired r
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by
Plans reviewed by: Date: Plans approved by:
Structural reviewed by: Date: Structural approved by:
Note transfer by: Date:
Date: X-6 'vq
Plan Check Letter
Yellow: Building Division
Date:
Date:
Date
Date:
O.B.-1
OWNER -]BUILDER VESICATION
Attention Property Owner:
An "owner -builder". building pemnit has been applied for in your name and bearing your signature.
Please complete and return this information at your earliest opportunity to avoid unnecessary. delay
in processing and issuing your building permit. No building permit will be issued until this
verification is received.
01,I personally plan to rovide the ma or labor and materials for construction of the proposed
P P J p p
property improvement: YES)& NO ❑
2 I HAVE M- HAVE NOT ❑ signed an application for a building pemnit for the proposed work.
. I have contracted with the following person (firm) to provide the proposed constivcdom
NAME:
\ ADDRESS: CITY..
PHONE: 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
1 NAME:
ADDRESS. CITY.
PHONE: CONTRACTOR'S LICENSE N.O.
the work indicated: - - -
NAM]& ADDRESS `PHONE TYPE OR WORK
�GNED:
PROPERTYOW M- ;
DATE:
NOTA: 77cu Owner -Builder Verykation is required by Section 19831 and 19831 of the
California Health and Safety Code. This verVkadon must be completed and
returned to our office before we are permitfed to issue the permit.
OWNER BUILDER INFORMATION
Dear Property Owner.
-B. -L
An a PHCa rim for a bmlftg pew has been submitted in yoU r name �g yourself as the builder property
rovemenic specified.
For your protection, You should be aware aid as "0wner-bm1def' you are the responsible party ofrecord on such
a p=31t Bmi ft Pennits are nbt requaed to 6e signed by property owners unless they are personalUy perfo
own work. If your work is being performed by someone other than ourse inning heir
liability if that person applies for the Y you may Protect yourself from possible
Proper pmoft in his or her name.
license fromContracm toate required by law to be licensed and bonded by the State of CaMmia anal to have a business
�Y or CGM31y. They are also required by law P�their hcense
apply. number on all Perm for which they
If you plan to do your own wor14 with the exception of various trades tint YOU plan to subcontract, you should
be aware of the fDlbv ing inf'omnation far your benefit and protection:
+ If you employ or otherwise engage any Persons other than your immediate fmjy, and the work (including materials
and other costs) is $300 or more for the entire project; and sur
s then You may be an employer h persons are not licensed as contractors or
sub
♦ If you are an emploM you most register with the State and Federal Go
subject to several obligations inclndnrg state fbderal _ �� as an employer and you are
WDA comPeasatron tae, disability insurance costs, me tax wiliUholdirrg; pens al social rebut i n taxes,
♦ 11= may be financial risks far. � �Pl°S'�. �mpensaiioa conirz'bUlions.
with respect to wot�'s compensatkm fi=ame out these obligations, and these risks are especiajly serious
♦ For more speck i0fDnn31iDn about Y= obligations Under Federal Law
if yon wish, the U.S. Small Business - • .react the Internal Revenue Service, (and,
State I.aw, contact fire D � ). For more sP'„cific fi&=,, tion about your obligations Under
eP ofBenefit Payments and the Division of industrial Accidents.
If the start n is hftu d for sale, property owners who are not licensed
work are, allowed to perfinim, personally or thmngh their own emPkY�, gout a licensed contractor contractors��> 0 ceder Ind
conditions.
A frequent practice of unlicensed persons pmfessing to be =&actors is m secure an aowner builder" building
permit, eaoneously imply�g $� $:e gropeziy owner is providing his or h� own
permits are oat to be signed labor and material personally. Building-
= by Property owners Unless
bfMiWion about &reused 'are Pig own work ers
Y or at 1020 N rs Y be obtained by factors State License Board in Y=
Please � � �� Sado. GA. 95814.
= Buildw Yenfication" on the reverse side of rias form so that we can confirm that you
are aware of tlYese mai#ers. The b��g P� will not be issued Untn the verification is resumed.
V027-- T Fier Owner-BaAc& rrjVeoMMrWa is ran*ed by Section 1983# ofthe C Vornfa He&l& mrd Safety Coda
nxrmrn
Il®
�j3. G�,,�, �� Vie„
LAP C-0 C/
W-9
Butte County Department of Development Services
YVONNE CHRISTOPHER, DIRECTOR www.buffecounty.netidds
7 County Center Drive
Oroville, CA 95965
(530) 538.7601 Telephone
(530) 538.7785 Facsimile
ADMINISTRATION * BUILDING * GIS * PLANNING
Aucrust 3, 2004
K.ou J. 1-lawj, Tay, Her &Sai. Xiong
7605 Occidental Ave. -
Palermo, Ca. 95968
RE: Building Code Violation
Location: 7605 Occidental Ave. Palermo Ca. 95968
AP#: 026-241-012
Dear: Kou J. Hawj, Jay Her & Sai Xiong
This is a courtesy notice to notify you that you are in violation of the Butte County Code, at the
above -referenced location, as follows:
Failure to obtain the required permits, inspections and approvals from this office to re-
model the interior of a single -.family residence and install new windows.
Since permits and inspections are required for the above work, please submit three (3) complete
sets of plans, apply for the required permits, and pay the appropriate fees. All work must stop
until these permits are issued and you are authorized by our field inspector to proceed. The field
authorization cannot be made until the existing work is inspected and approved.
It is the County's goal to obtain voluntary compliance with the Butte County Code. However,
you should be advised that Butte County has an active Code Enforcement Program which
provides an effective means of enforcement if voluntary compliance is not obtained.
Enforcement may be pursued through the issuance of citations, fines and the recording of a
Notice of Violation including a description of the action necessary to abate the violation.
You have thirty (30) days to voluntarily comply with the above directions or to present an
acceptable plan for abatement or corrective actions to be taken by you. Should you have any
questions concerning this matter, please contact Michael Vieira in this office at the address or
telephone number listed above.
e ly,
Mic ael Vieira
Bui ding Officia
BB: ms
cc: Assessor
4D
BUTTE COUNTY DEVELOPMENT SERVICES
COMPLAINT FORM
This information is not available to the public!!!!!!!,
DO NOT COPY FOR THE PUBLIC OR THE FIELD INSPECTOR!!
The following information is required for Housing Complaints and`the
Complainant MUST BE the person living at the complaint address!
Complainant:
Address:
Phone Number:
The above information is not available to the public!!!!!!!
(2)
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
effect.
License Class f 'cense Number: 76,
Date:, _ Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
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 (8500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed. contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
PERMIT NO.
BP061241
Issued Date: 05/24/2006 APN: 026-241-015-000
Site Address: 1817 WILLIAMS AVE PAL
Map Index:
Description: NEW ELECTRICAL PANEL
Owner: HAWJ KOU K ETAL
HER JAY & SAI XIONG
7605 OCCIDENTIAL AVE
PALERMO, CA 95968-9604
Applicant: PAUL'S ELECTRIC
625 MISSION OLIVE RD
OROVILLE, CA 95966
530-589-4100
Contractor: PAUL'S ELECTRIC
625 MISSION OLIVE RD
OROVILLE, CA 95966
530-589-4100
License #: 376492
Architect:
Engineer:
Carrier: I Total Square Ft:
Poli y #:
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 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 tthh ss,etQprovisions
.
Date:
Applicant:Q 9,dU r
WARNING: Failure to secure kers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars (8100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
Valuation:
Census Code:
55.
5-2LA-OG
0 S. F.
$0.00
is hereby issued under the applicable provisions of the Butte County Code and/or
to do work indi ted above for which fees have been paid.
BB 5_24_0(p J""
1 0��t . _ I�,�YI�f Jn Date: -24-0 (W
I PERMIT EXPIRES ON:-- c)" 1.'j I ) {
Address: (Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable t/ohe
ed 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 ownauthorized agent the owner. Iagree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substancal form or docum t of Butte County. I hereby
authorize re Asent 'vesof Butte C unnty to enter upon the above mentioned property for inspection p rpo
Print Name: L �l �e �L . Signature:
Date:
❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. c. Bunning vermit ui-ie-ua pg i
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR fNSPEC7'ION#: 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"
CONTRACTOR
OWNER INFORMATION -
Last Name
4
irst Na mS
Zip .5;F4�
Phone
Fax
Address '
/ r
Cit
E-mail
St
Lot #
Planner
Date Approved:
P one —
Fax
2
E-mail
CONTRACTOR
Name
Addres
CN r, L r C-� f
to
Zip .5;F4�
Phone
Fax
E-mail
� � � Z
Ctass J
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
tate
Zip
Phone
Fax
E-mail
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
For office use only:
Zoning
P erty Address I( �tC
Flood Zoe
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.
N
BIN #
PROJECT LOCATION
AP#
P erty Address I( �tC
y
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensatiort must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Page 1 of 2
cription or ope of Work:
Sq FT- Living' Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: 6 + Amount: `55
.0 Bldg
SRA
Receipt 5 V t Sheriff
SMIP
Date: l� Other
co
Total
REV 8-12-05
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply fog a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (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 en ig neer.
❑ 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. Building Permit Application Without Required Clearances Form
❑ 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.
❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑ 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 8-12-05
]
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT No. `
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING 0,01
BUILDING PERMIT
OWNER
/.
a`t�1 �/" -.�?�-
TELEPHONE
S. .r-CSS1541
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTO •SRAM
TELEPHONE
CONTRACTOR'S MAI G" ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS �a.�t,�
ZR-) �llR vl�' Jr-
Permit fee
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTUR /�
SFE] Duplex❑ Mobilehome❑ Other ,�/.-If0_
( SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mob le Home S G W
0.00 ea
TYPE OF WORK
New ❑ Addition • Remodel ❑ Utilities ❑ instal lation❑ f Other',]
Describe work:
P/=.5, <E:e ((F` ro 14fj(,
Permit Fee
$
Contractor
ELECTRICAL PERMIT
, -FiJingFee 10.00
Main service a00V OR LESS
t00 AMP OR LESS
i�10.00 r.
Main service EA. ADD•L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
VI, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.a ,
OR ADONS. ACC. BLOGS. 20sq ft
NEW CONSTR. U I.OUTLET 2,50 ea
NON.RESID .BRA C CIRC ITS
POWER APPARATUS &)
%SINGLE OUTLET CIR.
EX. Occup OUTLETS OR FIXTURESeA 0 0
FIXED APPLNS. OR
EX. OCCUp. OUTLETS (RESID.) EA.� 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
g 15.00/ Lc
IV&P S '
Permit Fee s
WORKMEN'S COMPENSATION INSURANCE
I declare under. penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
- to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
=
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
�I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said,County in consequence of'the(granting of this permit.
/ t � ✓
X -' { �-- i /f -2- - "U, Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required For excavations over 5'0" deep and demolition or construct-
ion of structures overr
stories in height. %� . „Q✓�,`
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE $
OCCUP.
CONST.TYPE
ISCHOOLIF.10151PA1111.1
PD
Ho
ISSUE
_/
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above: for. which
DIRECTOR,gF PUBLIC
By ,;�Date
PERMIT EXPIRES Date_
the applicable provi-
resolutions to do
fees have been paid.
WORKS
�% p f�
y�J
l3
x
Receipt NO. �'/ I6V �" 50i �� �V 4140 J �
WHITE-D.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR, GOLDENROD -APPLICANT
L0
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PE IT N0. ` Irv/
ASSESSOR PARCEL NUMBERZONING
-3 --
-
BUILDING PERMIT
OWNER
/Z
TELEPHONE
�v
SO. FT. OCC. BUILDING VAL4ATION
'
RE�/SjS
OWNER'S MAILING ADD49 4414jek) (/ V
CONTRACT O 'S NAM
TELEPHONE
CONTRACTOR'S MAIWNG ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2,00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5,00
USE OF STRUCTUR
SF ❑ Duplex[] Mobilehome❑ Other �o -44
If SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea.
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities [:1 Installation Other]
Describe work: C.C1 va
r� (�r �( �c-��
Permit Fee
$
Contractor
ELECTRICAL PERMIT
'Fi 'ng Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
0.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
�I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ 1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.6i,
OR ADONS, ACC. SLOGS. l22sgft
NEW CONSTR. TI -OUTLET
NON-RESID BRANCH CIRCUITS) 2.50 ea
POWER APPARATUS e
SINGLE OUTLET CIR.
Ex. OCcup(OUTLETS OR FIXTURES .220 0 00090
FIXED APPLNS, OR
Ex. Occup. OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee s
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
,V I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Penult Fee
=
Contractor
I certify that I have read this application and state that the above information
1s correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities judgments, costs, and xpenses which may in any way accrue
against ounty in consequ nce o h9 nting of this permit.
X Datee6-K- E --
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required For excavations over 5' " deep and demolition or construct-
ion of structures over 3 storiesinheight. g
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE $
OCCUP.
CONST.TYPC
SCHOOL
PLOOD
PARCCL
PD
I HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated abo for which
I C R PUBLIC
By
PE MIT tkPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date -�
Receipt No. � � % . '� /
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK-INSPEC W . GOLDENROD -APPLICANT
COUNTY OF BUTTE -.Department of Public Works
7 County Center v Drive, Oroville, CA 95965 Phone: 916-538-7541
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.
/'l. I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
r2. I (have/hive 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 City
Phone Contractors License No.
4. J plan to provide portions of this work, but I have hired the following person
to coordinate, supervise, and provide the major work:
Name
Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name Address . Phone Type of Work
Signed:
Property Owner S
Social Security Number
Date a 47
%
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVtLLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.. `'✓
OWNER�C4TCl-�1%rc i`��iR_�17� A. P. No.
Proposed Building Use P(JL4, CiP Building Inspector Date
At time of permit application, I was advised the following data must be submitted priorto permit processing and/or issuance:
DATE RECEIVED APPROVED
1. All items have been submitted . ....................................
2. Plot plans in duplicate/triplicate, signed by preparer of plans........
3. Complete plans in duplicate/triplicate, signed by preparer of plans . .
4. Complete engineered plans and calcs, with wet signature on plans ..
5. Energy Design Compliance and supporting documentation .........
6. Statement of Intent for Non -Heated and AC Buildings ..............
7. Engineered truss details and layout in duplicate (required prior to plan check)
8.–MobiLehome installation data including manufacturer's installation
ructions ` q9... ............................................
es of $ �(/
Chico Urban Area fees paid ........................................
11. Park fees paid ............................................
12. School District fees paid ..................
13. Sanitation approval from Health Department ...
14. City of Chico plumbing_ permit ......................................
15. Plot plan and business license approval from City of
(see City for other requirements)
16. Planning approval for (A) Use: (B) Parking:
17. Improvements may be required.
.8. Driveway permit (construction approval required prior to occupanAin�gtn'spcltoKr--f�-D�:,
19. Pre -Inspection for ���a/�'►'�— required . (Date)
20. Contractor's license information (No., Name Style, Classification) .......
21. Certificate of Workmans Compensation Insurance ....................
45 22. Ow 'r -Builder Verification (Given to owner ❑, Mail to owner ❑) ........
23. ecorded copy of Agricultural Acknowledgment Statement ............
Letter of signature authorization .................:...................
. ,/Nee d S9f✓ pec.,. r-
26.
When you issue the permit, proc s as Ilows: Mail to owner. Mail to contractor.
Telephone d hold for pickup at office. Deliver w/inspector.
Other.
QV jApplicant e
—A&Date X �k
g
Copy of plans sent Health Dept., Fire Dept., Other Date
The following data must be submitted prior to permit )Mn.cN�c a new item not checked above).
1. Index permit for above items No.
2. Addi onal items requ' d:
Contractor, designer, owner, was advised of above required data by_phone--naiI—counter by date
Contractor, designer, owner, was advised of above required data b
9 q y—phone —ma ll—counter by date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy—DPW
-7�
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR //PA�RCEL NUMBER
.•JJJJ �- 11
ZONING;
BUILDING PERMIT
OWNER
_
TELEPHONE
S0. FT. OCC. BUILDING VALUATION
OWNER'S M (LING ADORE-
/
CONTRALTO 'S N ME,
TELEPHONE
CONTRACTOR'S MAI C—ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 1000
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2,00
�wA n
CSC ,
Solar or heat pump water heater
20.00
LOT NO. SUBDIVISION NAME PARCEL MAP
1
Water piping
5.00
Each qas water heater or vent
5,00
USE OF STRUCTUR
SF [_1 Duplex❑ Mobilehome❑ Other
SPECT FY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities ❑ Installation[] Other,V
Describe work: �JF'z- Ln
11 1
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00'
Main service 100 AMP OR0V OR LESS10.00
Main service EA. ADO'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
El 1, as the owner, or my employees with wages as their sole. compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ ossa (Sec. owner, am exclusively contracting with licensed contract- 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.y ,
OR ADONS. ( ACC. SLOGS. /20sgft
NEW CONSTR. U TI.OUT LET
No -RESID BRANCH CIRC., TS2.50 ea
POWER APPARATUS e
SINGLE OUTLET CIR. /
20@ aD
Ex. Occup(OUTLETS OR FIXTURES 5AL@3t
FIXED APINIS
EX. Occup. OUTLETS P(RESID )REA.) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
P452� Jv
Permit Fee $
(
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed -on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply -with such
provisions or this pemiit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
g
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition of construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE
occuP.
CON3T.TyPtJ
15CNOOL11110001PARCILI
PD
I NO
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No. �J /'
WNITC-O.P.W., YELLOW-ASDL33011, PINK -INSPECTOR, GOLDENROD -APPLICANT
�. nJ`C%� � r7J
� h°``s{
r
�o �/�
�D I � � � �� S �`'��
r
i
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C
Butte County Department of Development Services
NOTES 7 County Center Drive, Oroville, CA 95965
(530) 538.7601 www.buttecounty.00VOIS
RESIDENTIAL
APN: V �� 7 Permit No.
/,
- - Owner.
r Site Address:
o
Contractor
i Type of Permit: G
h
i
h
!=Y � OFFICE COPY — — —�
Address
GAS
fff Meter By Date ,
' ELECTRIC'"t�
I� Meter By
L -
SPECIAL CONDITIONS
CHECKED BY
Q SRA
Q FLOOD CERTIFICATE EQUIRED
Q FIRE SPRINKLERS REQUIRED
Q SPECIAL INSPECTION ITEMS
Q VERIFY
Q USE PERMIT CONDITIONS
—]SUB
-STANDARD HOUSING LETTER
Q ENCROACHMENT PERMIT
Q REINSPECTION FEE PAID
Q ENV HLTH CLEARANCE
E
DATE JOB FINALED:
SIGNATURE:
+=OK
0 - Not OK
MANUFACTURED HOMES
MISCELLANEOUS..
DATE PERMANENT FOUNDATION SOFT -SET
1 ZoningSetbacks-Easements
2 Soils; Special MH Support Sketch
3 Sewer; Loctn-Test; Fall/C/O-Concrete
4 Wtr; Loctn-Test-Easement Needed -Regulator
5 Elec Loctn-Clrncs-Grnd 'Am -Concrete
6 Yard Gas; Loctn-Test-Wrap 'Nat or LP❑
Inch Sz Ft Lngth
7 Bickng; SzSpacing-Marriage Line
8 Gas; MH Test-Demand-Valve-Dnnctr
9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs
10 Drain; MH Test -Fall -Flex Cnnctr
11 Wtr & Sewer Connected -C/O to Grade
12 Gas and Electricity Tagged
13 Tie Downs 0 Foundation 0
14 Exits
15 Cert of Occupancy
16 HUD LabeUlnsignia Numbers Serial Numbers
--.DATE D E C K S'C O V E R S'C A R P O R T S'G A R A G E S
1 ZoningSetbacks-Easements
2 Ftgs; SoilsSz-DpthSpacing-CnnctrsSteel
3 Decks, Girders/Joists-Dcking-Brcing
Stairs-Guard/Handrails
4 Wood Awn; Posts-Beams4fts-CnnctrsShthg•
Frmg-Brcng
5 Alum Awn; Columns-CnnetnsSpiice-Decal-Enclsrs
6 Carports; Wndws-Doors
7 Electric
8 Frmg; Sills-AnchrsStuds-Rftrs-Trusses
9 Siding; Nailing-VeneerStucco-Lath
10 Root; Shthg-Rooting
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
DATE POOLS
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcis/Lting; Distance-GFI
5 Elec Pool Lting; 15 volts-GFI
6 Elec.Enclsrs; Conduit Entries -Terminals -Listed .
7 Elec Banding; Metal w/5'-Crcitng Egp-Htr
8 Elec Gmdng; Eqp w/5' Crcitng Egp-Pool Ightg
Boxes-Enclsrs-prnlboardsansultn.to Main Conduit
9 Health Dept Apprvl
10 P1mb; Cir Test-Wtr Supply Test
11 Lt Niche
12 Enclsr; Fencing -Alarms
13 Bonding, Diving board or. Slide
o'er e`'el 00
Oates �S c rya
Pool Drawing
+=OK
0 - Nol
RESIDENTIAL (Single & Duplex)
DATE JUNDERFLOOR
DATE
IPLUMBING
1 Zoning -Setbacks -Easements -Flood -Slope
53 Wtr Htr; Vent Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg DRth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth
55 DWV; Test Fittings & Anchr. Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
56 Shwr Pan; Test, First fir -Tub Ace
5 Stemwalls Main; Steel-Blockouts-Wrapped
57 Test Tub & Shwr, 2nd fir - Tub Acc
6 Stemwails Garage; Steel-Blockouts Wrapped
58 Gas Pipe; Sz & Anchrs
6a Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Piping
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
11 Wtr Pipe; Test-Anchrs-RgltrService Test
12 Elec Undrgrnd
DATE
IM E C H A N'1 C A L
13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn
61 AC Ducts insuitn & Support
14 GirdersSllis-SillsBolts-Joists-Vnts-Cripples
62 Vent Fan, Exhaust abv Insultn
15 Acc & Vntitn
63 Condensate Drain & Ovrfiw, Sz & Grade
16 Insulation
64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Acc & Pitfrm If Furnace in attic
41
DATE
DATE FRAMING
17 Sills Proper Materials & Anchrs
DATE
7F-1 N A L
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
66 Ext Steps -Door & SldeLt Prtctn-Landings
19 Bearing Walls over Girders.& fir Nailing
67 Smoke Detector
20 Draft Stop in Walls (rat proof)"
68 Furnace Vnts-Clmc-Comb, Air-Cnnctr
21 Fire Stops; Furred CeilingsStairs-Chasers-Tubs
In Garage; abv-fir-Ducts-Mach Prtctn
22 Headers & BeamsSi & Bearing
69 Bedroom Exiting
23 Hangers -Post Caps-Anchrs-Cnnctns
70 GFI & Bath Fxtrs & Tub Acc-Spa
24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg
71 GFI Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
72 Elec Trim & Subpnl, Breaker Szs & Labels
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Cimc-Hearth
28 Garage Fire Prtctn Framing -RC Channel
75 Elec Outlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall .& Opngs
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc
30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits
77 Elec Outlets & Rcptcls at Ktchn Counter
31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn
78 Garage Fire Door; Swing -Landing -Closure
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
79 AC Duct In Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Clrnc-Com Air Cnnctr-PRV; abv fir
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrfir Acc
Mech Prtctn; LPG Appince Undr House 3' drain
35 Glazing Area -Glass PrtctnSkyLts-Plastic .
81 Plmb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnis
83 insultn-Foam-Looked in Attic
38 insultn-Walls-Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiitration-Walls-Wndws
85 Fndn Vnts & Crawl Hole Door D & Wood -Earth
rn e
86 Clmc Drnge Planters � Yes ❑ No
87 Stucco Brown -Finish
88 AC Unit Dscnnct, Elec-Plmb
89 Vnts abv Roof, Plmb-Appinc-Frplc-Cirnc to Opngs
DATE JELECTRICAL
90 Wtr Well, Dscnnct, Elec, Plmb
40 Fxtr & Trnsfrmr Clrnc4ns Prtctn
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92 Vntitn thru House
42 Sz Boxes & No Of Cndctrs Stapled
93 Glass Prtctn
43 Romex Installed Close to Edge of Studs & CJ
94 Corrections from previous Irispctns
44 Eqp Grnd made up w/Mech Fstnrs
95 Gas Test -Meters Tagged, Gas-Elec
45 Grndng Electrode Bond Gas & Wtr
96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz 9 QCU or ❑AL
98 Address Posted
AC Wire Sz oa QCU or ❑AL
99 Fire Sprinkler
48 Range Clic Qa ❑ CU or ❑AL
Oven Circ Q CU or [DAL
Insulated Neutral ❑Yes ❑No
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnis-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license Is In full force and
effect.
License Class (� 'cense Number: �7fv
Date:,_ Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to Its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
Intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Dale: Owner:
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 the Labor Code, for the performance of
the work for which this permit Is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Poli y #:
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 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 compjy with th �s,ec(provisions.
Date:
Applicant: Q l
WARNING: Failure to secure kers' compensation coverage Is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
PERMIT NO.
BP061241
Issued Date: 05/24/2006 APN: 026-241-015-000
Site Address: 1817 WILLIAMS AVE PAL
Map Index:
Description: NEW ELECTRICAL PANEL
Owner: HAWJ KOU K ETAL
HER JAY & SAI XIONG
7605 OCCIDENTIAL AVE
PALERMO, CA 95968-9604
Applicant: PAUL'S ELECTRIC
625 MISSION OLIVE RD
OROVILLE, CA 95966
530-589-4100
Contractor: PAUL'S ELECTRIC
625 MISSION OLIVE RD
OROVILLE, CA 95966
530-589-4100
License #: 376492
Architect:
Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
CONSTRUCTION LENDING AGENCY This permit Is hereby issued under the applicable provisions of the Butte Coumy Code and/or
I hereby affirm that there Is a construction lending agency for the Res ' ns to do work indi ted above for which fees have been paid. �1)r
performance of the work for which this permit is issued (Sec 3097 Civ.) Date: 5-/ `f -� (0
Name: By'
PERMIT EXPIRES ON: 5-" 2�0�
Address: (Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code Is not applicabl/any
ed 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 oauthorized agent the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substaal form or docum t of Butte County. I hereby
authorize re _ese-t 'ves of ButteC/9uQnt,y to�enter upon the above mentioned property for inspection p r
Print Name: L �'�t/ I d�7��� Signature:
Date:
❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1