HomeMy WebLinkAbout026-280-009BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address: 7595 OCCIDENTAL AVE
Owner:
Permit No: B06-2617
APN: 026-280-009
WRIGHT, PAULINE L LIVING
Issued Date: 11/07/2006 By KCG
Permit type: MISCELLANEOUS
7595 OCCIDENTAL AVE
Subtype: HVAC Change Out
PALERMO, CA 95968
Expiration Date: 11/07/2007
Description: CHANGE TO GAS PACKAGE HVAI
Occupancy: Zoning: U
Contractor
Applicant:
Square Footage:
GALLAGHER'S HEATING & AIR
GALLAGHER'S HEATING & .
Building Garage RemdUAddn
PO BOX 35
PO BOX 35
LOS MOLINOS, CA 96055
LOS MOLINOS, CA 96055
Other Porch/Patio Total
(530) 384-2444
(530) 384-2444
FEE INFORMATION
Heat Pump (Package Unit) $55.00
Total Charged: $55.00 Fees Paid: $55.00
Balance Due: $0.00 Receipt No: B794
LICENSED CONTRACTOR'S DECLARATION
OWNER / BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
GALLAGHER'S HEATING & AIF 777334 / C20 C38 / 04/30/2008
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
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
I HEREBY AFFI UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9
( encing w' ection 7000) of Division 3 of the Business and Professions Code, and my license
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
is n orae d ff
of Division 3 of the Business and Professions Code or that he or she is exempt therefrom and the
] P
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
11/07/2006
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
&b-'n'trac4A ignature Date
❑ 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
WORKERS' COMPENSATION DECLARATION
OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
the work himself or herself or through his or her own employees, provided that such improvements
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not intended or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of completion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
improve for the purpose of sale.).
HAVE AND WILL MAINTAIN WORKER'S COMPENSATION
6slection
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
INSURANCE, as required by
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractor's License Law dows not apply to an owner of the property who builds or improves
My Workers' Compensation insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
State Fund 713-0013855 05/01/2007
Carrier: Policy Number: Exp. Date:
Contractor's License Law.).
(This section need not be completed if the permit is oris or on�llars ($100) or less.)
❑ I AM EXEMPT under Section B. & P.C. for this reason:
❑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'
X 11/07/2006
compensation ns of Section 3700 of the Labor Code, I shall forthwith comply with those
Owners Signature Date
Eprovis*
rovisions.
11/07/2006
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and Slate laws relating to building
Ig ture Date
RNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
injury, including death, and property damage caused arising out of, or in any way connected with
HUNDRED THOUSAND DOLLARS $100,000, IN ADDITION TO THE COST OF COMPENSATION,
( )
the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occup ncy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
County to n r the above mentioned property for inspection purposes. I hereby certify that I am the
Pr erty r am a horize o on t o e is be alf.
CONSTRUCTION LENDING AGENCY
11/07/2006
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Nam Fffmittee [SIGN] rint Date
the performance of the work for which this permit is issued. (3097 civ. code)
11 Owner 1:1 Contractor OR. Agent for Owner J2JAgent for Contractor
FILE COPY
Lender's Address City State Zip
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"
For office use only: .
OWNER INFORMATION
Last Name
i
044
Addres
irst Nam
Address �7SOJ�kOL)-(n.,
'
City
{J
Phon 554
State
J
Zig
Phoner
Date Approved:
Fax
E-mail
For office use only: .
CONTRACTOR
Name
r ., _s H voq C
Addres
66 K, �
CityStat
'
State
ZipU7�—.7
Phon 554
`-
?4U it f
Fax
E-mai��F
l
Date Approved:
Lic. #T1_1
Class
For office use only: .
ARCHITECT/ENGINEER
Name
r ., _s H voq C
Address
66 K, �
City
'
State
Zip
Phone
Page
Fax
E-mail
Date Approved:
State License Number
For office use only: .
APPLICANT INFORMATION
Name GaI
r ., _s H voq C
Address
212
66 K, �
City
'
Stale
CA
Zi
Phone
Page
Fax
E-mail
Date Approved:
For office use only: .
Zoning
Flood Zone
SRA
Yes
- No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
BIN 9
PROJECT LOCATION
AP# M Qo
PrAddress
RCity PH -c
rer
Cross Street
WORKER'S COMPENSATION
Policy Numb ` r oo � 1
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description r Scone of Work:
; 5-�
a- b S i G Gt~,C "V
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.
M
I I Received by: VD, Amount: Bldg I I
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDIN6.FORMS\BldgApplSubRgmts.doc Page 1 of
Receipt #:8�A
Na #
Date: � I - 'o
SRA
Sheriff
SMIP
Other
I Total
REV 8-12-05