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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BPO43171
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: 10/29/2004 APN: 026-280-023-000
the Business and Professions Code, and my license is in full force and
effect.'325% %
License Class: �-1y License Number:
Site Address: 7515 OCCIDENTAL AVE PAL
/0 -OL /I /fk2. lkri-��12 c
Date: 0 a O Contractor:
/'C Map Index:
Description: ELECTRIC SERVICE UP GRADE TO 100 AMP
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
Owner: SOUTHWEST MARKETING LTD
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 5196
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
SAN CLEMENTE, CA
she is exempt therefrom and the basis for the alleged exemption. Any
92674-5196
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).):
O 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: SOUTHWEST MARKETING LTD
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.).
Contractor: HURST, MIKE
❑ I am Exempt under Article 3 of the Business and Professions Code
15 OAKCREST DRIVE
Date: Owner:
OROVILLE, CA 95966
530-589-5330
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
MIKE-TERRI@SBCGLOBAL.NET
❑ 1 have and will maintain a certificate of consent to self -insure for
License #: 335967
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
f 1 have and will maintain workers' compensation insurance, as
Architect:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:,
/
S �e % /t
Carrier: 0J
Total Square Ft: 0 S. F.
Policy #:
❑ 1 certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
Census Code:
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith 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 at fees.
G
- . _ - CONSTRUCTION LENDING AGENCY--
This permit is hreby issued under th licable provisions -6f the Butte County Cods ?nrVor
1 hereby affirm that there is a construction lending agency for the
Resol ions twflo work indicated ab e f r whictlfees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By Date:
O r
Address:
PERMIT EXPIRES ON:
Date
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
O Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
O Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official tort/�/ or document of Butte County. I hereby
authorize represen tiviso�ff Butte ounty to enter upon the above mentioned property for inspection pu e
Print Name: ,\ c— rJ I Signature: C G
Date:
❑ Owner .IQ\Contractor ❑ Agent for Owner 13 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 OF APPLICATION
Website: www.buttecounty.netidds
"PLEASE PRINT CLEARLY"'
CONTRACTOR
Name t Ee- t
Address GC / ke- re r,
City i'DVI
Sia
Zip5l
Phone.5733
Fax
E-mail
Lic 3S
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APP 1CANT SIGNATURE
X,
For office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
1/1- Sir7l
BIN #
LOCATION
AP#
Pr pe y ddressO � City
Cross Street l
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
OVER FOR SUBMITTAL REQUIREMENTS 11
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Description or Scope of Work:
&ill. r
Sq. Footage .
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: Amount L 5-5- Bldg
SRA
Receipt #:111'94n6� Sheriff
CJ' < SMIP
Date
Total
REV 7-27-04
I
r NOTES RESIDENTIAL
PERMIT NO.
—"026-280-023 , �_
1 '- ; 04-0283
SOUTHWEST MARKETING,
t 3 i 7515 OCCIDENTAL AVE, PALERMO
LCONT: DAVE BOLT
Lf '� 11yi ADDITION & REMODEL
- S
SPECIAL CONDITIONS
CHECKED
- _ BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS'
i SUB -STANDARD HOUSING LETTER
' 'OFFICE COPY � w
Address "�'41
r 1
GAS A 4m5
Meter By Date
ELEC I
M ter / Date
F s v
r. JOB FINALED (Date)
t
f' Signature
I
J=OK
0 = Not OK
= NotNo Applic
Readyab1e MOBILE HOMES
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/0 -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd-/ . /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L 'ft.
/ P Nat. or / /" L "ft./ P LPG
7. Well Clearance & Disconnect
B. Utility Clearance
Date Card B-1 Date Card B=1
Date Card B-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/0 to Grade -HD Approval
8. Gas -and Electricity Tagged
9. Tie Downs-Type-Installation.Cert.
10. Exits; Insp.-Sketch
11. Cert. of Occupancy
Date
Card B-1 Date -
Card B-1
Date
Card B-1 Date
Card B-1
Date
PERMANENT END SYSTEM (ONLY)
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
5..
t. .1. Zoning Requirements -Setbacks -Easements
6.
Carports; Windows -Doors
2. Footings; Size -Spacing -Marriage Line
8.
Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
3. Blocking
Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
4. Gas; MH Test -Demand -Valve
12.
Braced Wall Panels
5. Electricity; MH Test
Date
6. Water; MH Test
Date
Card B-1 Date Card B-1
7. Water and Sewer Connected
1.
Setbacks -Easements
8. Gas and Electricity Tagged
Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
9. Exits
Elec.; Receptacles and Lighting, Distance-GFI
5.
10. License Decals
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
11. Verify #'s with Office
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panel boards -I ns. to Main Conduit
9.
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-Connectors
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 -I ns. 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 ffil i fill ••
Not Applicable _� T _' r RESIDENTIAL_(:
Ready ?iJ �t -r c .2' q;. )� +i
D to YNEItRFLOOR (Plans)•OK except #'s
":1;iZoning-Setbacks=Easements-Flood-Slope
Main; Soils=Elec. Grnd.:/ tg.'Depth
Ftg:; Garage; Soils Steel-Elec. Grnd:-/ 'd: /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/, , •1f /" Ftg. Depth
=n;�•+Ics'� '>•�5.' Sternwalls, Main; SteekBlockouts-Wrapped
6. Stemwalls, Garage; Steel=Blockouts=Wrapped
6a. Hold Downs and Special Anchors cd 130'3
7. Slab, Steel -Wrapped = Lr- • i
8. Pier - ire lace Ft Steel %' i +' 'f.r' :] au;c .E
Qoo6W.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. PI s &Ducts; Clearance -Material -Support -Ins. '+
Gir -Sills-Anchor Bolts-Joists-Vents-Crippies j,au
ccess & Ventilationt9ass NO emr;.4) $•.;OO=H )*3(1
16. Insulation
. °;id6'. S fJt�sli;, � OJ;1EC,r'iC•�
Date �, Card B-1 ` io t :::- .uC-I Date -Card B-1
Date Card B-1 Date''t-1 b`• Card B-1
Date PLUMBING (Permit) OK except #'s> t1 - ' y
17. Water Htr.; Veht=Access-Combustion Air Baffle
']x=18.'`!Water Pipe;'Test &'Anchor -Nail Protection
'D.W.V.; Test' Fittings &Anchor -Nail Protection
20.; Sbower. Pan; Test, First Floor -Tub Access; .6
c' c 21:"•-Test'Tub &'Shower,zSecond Floor -Tub Access
22. Gas Pipe; Sixe & Anchors m~s+ 3 ' nr:,._,r i 9
23. Fire Sprinkler; -Test +9 "-"-P 0 '7-11
J� TO
J
Date Card B-1 Date 0 'Card B-1
Date Card B-1 Date Card B-1
Date - Ij L ELECTRICAL (Pemiit) OK except #'s s,) a==�u
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.
28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
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 Al
Insulated Neutral O Yes ❑ No
42. Walls Studs -Nailing Spacing & 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
Vv 04 +
'ingle_&_Duplex)' a-
e tc _. c • s i<rws;g ' �r 1;_'1 ru 3,100H 131SOM Mr -13
Date FRAMING (Continued) - .
47. Hangers -Post Caps=Anchors=Connectors
48. Cling,Joist-Rftr.,Ties=Purlin-Roll Bract-Truss-Shting.-Rtng.
" 49� Fireplace Ties or-TypeA Flue -Fireplace Throat Clearance
,q:3ionoJ-•a+ 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 )IJ li.'.N .
54. Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
r•d b,s'57. Siding -Nailing Veneer r -y Lilt
U b1s'58. Stucco Mesh -Drip Screed -Fd. Vents:Underflr. Access s,•dl
41 ts59:4GlaiingArea-Glass Protection=Skylights antic 5s=,4
60.,:Shear. Walls; Nailinq-Bolts p.0 ^01
61. Brace Interior/Exterio Wall Panels-,nuvo? .S
62. Insulation-Walls=Ceilin :cJ-ta,F }{r. r;ij e
as=^-,63?Infiltration-Walls-Windo Ntv?.rtrr.s'J
Date Card B 1 # an•r0., D'Card B-1
Date Car B:1 io'k._CDate- 1-1N4 oCardB-1
Date r01cIQ ,FINA Plans) OK except
64e . SteDs-Door &Sideliaht'Protection-Landinas
65!Smoke Detector ""11+••-(, uQY+ --1;-c _ ' + e
32. Service -Riser Conductors & Ground Main Disconnect
66. Furn eVents-clearance-Comb; Air -Connector-
I age; Above Floor -Ducts -Meeh. Protection,
33. Equip. Clearances Panels-Motors-Mech. Equip.
. B room Exiting
34. Clothes Closet Light -Shower Light -Spa Light
G.F.I. & Bath Fixtures & Tub Access -Spa
35. Smoke Detector
y i,)G•69. Elec. Trim & Subpanel, Breaker Sizes'&Labels
Wtr. H_tr.; Vents_-Clearance=Combr_Air.Con nector-P.R.V.
in Garage; Above Floor-Mech. Protection' _
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
81.
36. A.C. Ducts Insulation & Support
82.
37. Vent Fan, Exhaust above insulation
r-9 b•r.J
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 -Nailing Spacing & 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
Vv 04 +
'ingle_&_Duplex)' a-
e tc _. c • s i<rws;g ' �r 1;_'1 ru 3,100H 131SOM Mr -13
Date FRAMING (Continued) - .
47. Hangers -Post Caps=Anchors=Connectors
48. Cling,Joist-Rftr.,Ties=Purlin-Roll Bract-Truss-Shting.-Rtng.
" 49� Fireplace Ties or-TypeA Flue -Fireplace Throat Clearance
,q:3ionoJ-•a+ 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 )IJ li.'.N .
54. Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
r•d b,s'57. Siding -Nailing Veneer r -y Lilt
U b1s'58. Stucco Mesh -Drip Screed -Fd. Vents:Underflr. Access s,•dl
41 ts59:4GlaiingArea-Glass Protection=Skylights antic 5s=,4
60.,:Shear. Walls; Nailinq-Bolts p.0 ^01
61. Brace Interior/Exterio Wall Panels-,nuvo? .S
62. Insulation-Walls=Ceilin :cJ-ta,F }{r. r;ij e
as=^-,63?Infiltration-Walls-Windo Ntv?.rtrr.s'J
Date Card B 1 # an•r0., D'Card B-1
Date Car B:1 io'k._CDate- 1-1N4 oCardB-1
Date r01cIQ ,FINA Plans) OK except
64e . SteDs-Door &Sideliaht'Protection-Landinas
65!Smoke Detector ""11+••-(, uQY+ --1;-c _ ' + e
P. Fixt. & Appliance; Ground-Air-Gap:Cooking Clearan
66. Furn eVents-clearance-Comb; Air -Connector-
I age; Above Floor -Ducts -Meeh. Protection,
Elec. Outlets & Receptacles at Kit. Counter''
. B room Exiting
Garage Fire Door; Swing -Landing -Closure '
G.F.I. & Bath Fixtures & Tub Access -Spa
A.C. Duct in Garage -Damper A ' OotnEjr=,
y i,)G•69. Elec. Trim & Subpanel, Breaker Sizes'&Labels
Wtr. H_tr.; Vents_-Clearance=Combr_Air.Con nector-P.R.V.
in Garage; Above Floor-Mech. Protection' _
WV 170. Stairs & Rails -i" " r.ri
/rs
71. Fire IaceorStove,Clearance-Hearthl,^4,;:;
r. a
72. ec: Outlets at Wood Panel; int.'& Ext:a',
/
d3.
P. Fixt. & Appliance; Ground-Air-Gap:Cooking Clearan
X.
Elec. Outlets & Receptacles at Kit. Counter''
75.
Garage Fire Door; Swing -Landing -Closure '
76.
A.C. Duct in Garage -Damper A ' OotnEjr=,
77.
Wtr. H_tr.; Vents_-Clearance=Combr_Air.Con nector-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 Atticl tm,%,�.0 .u'
81.
Guard Rails & Deck Construction -Post Caps '
82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
r-9 b•r.J
Clearance Looked under Floor t Ea. Yes J , • i
r Et b is.83. Following Instld./Drive ❑ Yes ❑ NoMalks ❑ Yes ❑ No/Planters ❑ Yes ❑ 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. Ve • ation Throughout House
Glass Protection
C rrec ns from Previous Inspections
L� 0 9 G est -Meters Tagged, Gas -Electric / JW/ j 11elL,4 bJ
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date 2 '6 Card B-1 1. Date Card B-1
Date -_Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
r., --,,,,- COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
t _ 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754,.�EPIT NO.
(Rev. 12/§6) APPLICATION AND PERMIT ���'�
ASSESSOR PARCEL NUMBER
Z°"'"°
BU I LD1 NG P ERM IT
TELEPH NE
s0. FT. CC. BUILDING VALUATION
22 1t o®
E ""� 5 I(qL � n 1 m cn
G2'
-�
RACTOR'S
T HONE
,
•NEfI[CTO MAIUN°Apj�R�$, � �� ( ( j /
.
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ i Coco
ARCHITECT OR ENGINEER
LICENSE NO.
Fee $ 20.00
-Filings
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESQ, ,6 . ^ i kt J
J J C/l_ cI ,
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDNISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF 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 Utilities ❑ Installation ❑ Other ❑
Describe Work: I I r
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00 I
Mobile Home I S I G I W @20.00
PERMIT FEE $
!H rC
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.
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
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 tOOOA 46.00
NEW CONST. DWELLING OCS. SO •�
OR ADDNS. J 8 ACC. BLDS. 3.50x, 1
P10" EW pRES DT' MULTI.OU CUT BRANCH UITS @7.50
POWER APPARATUS
8 SINGLE OUTLE•r CIR.
20 ° 1.00
Ex. Occup. OUTLET OR FDRUREs BAL @ .50
Ex. Occup. °Flx�e Aa OR 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring23.00
PERMIT FEE S --
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50 ISC
Ventilation
PERMIT FEE $ —
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
lJof 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
forthwith comply with those provisions.
X Date
Sig atu P1 ' ant - ❑ Owner ❑ Contractor l" Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $ (p�
Occ
CONST. TYPE
TOT Al_ FEE $ s n� •
HAz
D FEES
ro0
(
coy
PwC
D SUE
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 T ��—
I T/ Date
ReceiptNo. $ 325.9 5 3g416 13 // 5537 3,9 54,q a-.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR F1114K-INSPECTOR GOLDENROD -APPLICANT
e
J COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT VIC UILDING DIVISION
- 7 County Center Drive Oroville, California 95965 Te phon 30) 538-7541 PER T NO.
(Rev.12/96) APPLICATION ANDP
ASSESSOR PARCEL NUMBER -
ZONING /
ILDING PERMIT
owNE
Y ,
TE NE
S FT. O UILDING VALUATION
OW 'S U ADDRESS
U
1
OR'S E TELEPHONE
'AD
Tq�S MAID 6 . ^ �)C,
'"'
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ . - ��-
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS^r' �) Q�
IJ
Energy Plan Checking Fee $
$
q
PERMIT FEE $
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP ,
PLUMBING PERMIT.. Fling Fee 0.00
Each Trap 7.00
USEOFSTRUCTURE t J �e
SF. Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00 --
Each gas water heater or vent 15. 0 0
TYPE OF WORK
New ❑ Addition RemodeUdlities ❑ • Installation Other ❑
X
Describe Work:
0 ) - Mm . 1'U
Gas i in stem 1 - 5 outlets 15.00
Buildin sewer 15.00t��S—
Mobile Home S G W @20.00
PERMIT FEE 3 ---�
ELECTRICAL PERMIT Fling Fee 20.00
V OR LESS
Main Service . ' OR LESS 23.00 �-
i 0C)95 C
�� ��
PERMIT FEE PAID $ vvv���l
_
SRA$
SHERIFF $
Main Service 200A TO 1000A 46.00
NEIN CONST. DW ff OCCUP. SO w
OR ADDNS. 8 ACC. BIOS. 3.5¢Fr.
NOµHESID. ANCHclgcurTs OUTLET @7.50
�DR�AT�
8 SINGLE OUREr UCS, R.
Ex. Occup. ovrE-rOR FORURES B20 @ 1.00
.50
FU(ED APPLNS. OR 5.00
Ex. Occup. OURE7S =. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 1 20.00
OTHER
AMOUNT RECEIVED $
DATE RECEIVED •
RECEIPT
I Hood . 1 1 6.50 rtl. Z�Iu I
PERMIT FEE 1 $ J /
Mobile Home Installation Fee $
Energy Inspection Fee $
ccc CONST. TM� TO AL FEE $
HAZ p. FEES OD CDF T+' CEL H ISSUE
IJVV
This permit is hereby issued and r 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
are
TO: ) Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
E.N. USE ONLY
Stat Plan Anachad �
Floor Plan Atuc"d
:Sent to G.D. All
r
Owner location
AP#
Plan Approved for: Sewage Disposal -. ` Water Supply: Public Private Well
Clearance for dwelling. Other
Hold final for:
Final clearance O.K. for:
NOTE:
Environmental Health Specialist
8/96
Date
ririb%.'''i'y1'��Crrr:?-iY4iw�'.,r�'n°w�a'�TA►t7Y�'t'('a.+n;,.,'i+p�,tx'��...•'Py,�%�"*G,.?�.:.�-�:t��..-ti;.u�'i�IF"�Yi�'�I$�,;�'�`"`r�Fr"�RYvc"r+ii;•.;C".'s�"S'�Ct''.",�,y_,�,.,�,:...�,�,..,.,�,_,�.
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)530541 Fax (530)538-2140
PERM T APPLICATION DATA SHEET
OWNER: ASSESSOR PARCEL NUMBER
Proposed Building Use: c ' o A4CL Counter Technician: Date: G
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in orde o apply. �'
/ - �1. Site plans, 3 or 4 sets, signed by the preparer of the plans.- MeW Si40 flar►b 11fP�. � -19,0 'P'
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!
0 5. Letter from Engineer or Architect for truss design review.
�[5 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.
D 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
❑ 11. Site plan and business license approval from the City of Biggs
❑ 12. Letter of intent for non-residential buildings (i
❑ 13. Detached Accessory Building Form filled out by the owner a h "� t
❑ 14. Hazardous Material Form C CP
�fi 15. Sanitation and'site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable.
❑ 16. Other U
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 D K
❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........
❑ 20. Erosion Control Plan Required........................................................................ ........
01 21. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 22. City of Chico Plumbing permit........................................................................
❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. O L
O 24. Planning approval (A) Use:OK (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 Carrier and Policy Number ..........................................
❑ 31. Owner -Builder Verification (_ Given 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.........................................................................................
❑ 37. ❑ Grant D ed, ❑ M.H. Tile/Statement of Facts ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
38. Other. aft o LiJ�- � G�r•l �G� �� �,,� �,�
❑ 39. Other: �� �K,
When issued Telephone C-7 nd hold for pickup.
� v -
I have been informed of the above items and requirements for obtaining a building permit.
Applicant, _. Date: 0cf
1. Index perrWapplid'alloiffor t ove items numbered: Ian Check Letter
2. Additional items required
designer, owner, w vise69f the abo! a d'aLa_byp ❑ mail, ❑ counter, by Date: 1 Cf
Contractor, designe owner, as advisedtof the above data�by phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: / Plans approved by: Date
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
, COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES — BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541
SCHEDULE OF RECEIPT OF FEES
OWNER M(:�C�A 6 \
PROPROSED BUILDING USE CU �dcl-4�6y-\
1. BUILDING PERMIT FEES L
--- Balance Due .....................
--- Additional Fees Due........... $
--- Revised Plan Checking Fee.... $
2. SCHOOL DISTRICT FEESYle Y ! \
(paid at School District Office) (orm available after Play c k
,ak3. SHERIFF FEES (paid at Building Division)
Residential............ X $360.00 =$
A.P. # -O. AOS' Ua�
DATE
RECEIPT # DATE REC.
Commercial (sq. ftg.)..... X $0.03 = $
Sq.Ftg.
4. URBAN AREA FEES (paid at Building Division)
Residential (per unit)..... X = $ _
# Units Amt.
Commercial (Sq. Ftg.).... X = $ _
Sq. Ftg. Amt.
5. RECREATION DISTRICT FEES
(paid at Recreation District Office) (form available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK FEE
$89.00 (paid at Building Division)
8. WATER TENDER FEES BATTALION #
$200.00 (paid, at Building Division)
9. NORTH CHICO SPECIFIC PLAN (paid at Building Division)
Residential Zone _
Zone
Commercial (sq. ftg.) .........
10. OTHER
X =$
# Units Amt.
X =$
Sq. Ftg. Amt.
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees
may be changed during the plan checking process.
APPLICANT A2 DATE �F
Pursuant to Government Code Section 020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You
have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a
protest are specified in Government Code Section 66020(a).
Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003)
National Pollutant Discharge Elimination System (NPDES) Phase II
.Construction Storm . Water Permit and Storm Water Pollution
Prevention Plan (SWPPP) Acknowledgement [LESS THAN 1 ACRE1
Project Title: ` rA-Y LUQ 6-
By signing below, I, the project owner/owner's agent, certify that I am aware that a construction
project that disturbs 1 acre or more of land requires a Construction Storm Water Permit from the
State Water Resources Control Board and that it is my responsibility to submit a Notice of Intent
(N.O.I.), a Storm Water Pollution Prevention Plan (SWPPP), and a check for $700.00 made
payable to the State Water Resources Control Board to obtain such a permit if my project
disturbs 1 acre or more of land. I, fiu-ther, certify that this project will not disturb 1 acre or
more of land. I am aware that submitting false and/or inaccurate information may result in
revocation of grading and/or other permits or other sanctions provided by law.
M�
.�mac
•
rl
0
,
35
Vry
Lf)
L�_f
L irri
,_,, l
'�-• .� BUTsTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
sr _ (One form per Building)
0-16A L.)L)D
School District
A.P. Number
Property Owner
1 Building Department No.
0XP Jurisdiction: City jCounty
Property Location/A
Subdivision
Residential Development Q Q
No of Living Mobile Home
Units Installation
Conversion Permit #
*(No foundation
Lot No.
to
. Footage
�O4
S4 �
(Group R)
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Commercial/Industrial Q Q Sq. Footage
New Addition (Including Exterior
Roofed as)
Building Department Representattive Date
District Identification No.. 04-014 3
'C)ito I 1 e, L. 1(!UYi g'I a� School District certifies that
.,r
LTb
(Applicant)
lye
(Phone Number)
(City) (state) p (Zip Code) 1
has complied with the requirements of Resolution No. j OS / U by payment of $
representing . U v square feet. 2926 $
FULL MRIGAI to $
�ou`zq- d I 1&0 f04 -
school District Representative Date
Paid by Check 8 !V Remarks:
Notice: You may protest the Imposition of the fees Iderrtltied above by submitting s written protest to the District, In compliance with
Government code Section 66020(1), within 90 days from the data fees are 0M. Failure to submit a tlmely_;wrkten protest will'prohlbit
you from challenging the Imposition of the fees In any court action.
If, subsequent to the School DNMW Representative signing tills Butte County Schools Impact Fee certification Form, the School District Is 1
r
ON by the applicable Local Planning Agency that this project is being rwlewed under the California Environmental Qualky Act (CEQA),
thls prepet may be subject to additional school fees to fully nrtigste.ks Impact on the school disblct's schools.
White (applicant), Yellow (building department), Pink (school. district) feeform.rds (10/03)dmm
.................................................................
.............................................................
County Subdivision Name
DESCRIPTION OF INSTALLATION
1. ROOF
Lot Number
3. EXTERIOR WALL
........................................................................
.................................................................
Frame
A. Cavity Insulation
Material:
ate al:
........................................................................
.........................................................
Thickness
( ) ........................................................
B. Exterior Foam Sheathing
....................................................................:...
Material: ['
........................................................................
Thicknessinches :>
( )........................................................
4. RAISED FLOOR
........................................................................
Material:
Thicknessinches
( )........................................................
5. SLAB FLOOR/PERIMETER
Material:'
........................................................................
........................................................
Thickness (inches):'`
Perimeter Insulation Depth Inches: ::::::::::::::::::::::
6. FOUNDATION WALL
........................................................................
Material........................................................................
Thickness (inches)::::::::
.......................................................
Brand Name:;;
.......................................................
Thermal Resistance (R -Value):''`
.......................................................
Brand Name:
.......................................................
:::::::::::::::::::
Thermal Resistance(R-Value)::::::::::::::::::::::::::::::::::::::::::::::::
.......................................................
Br N
and ams:
Thermal Resistance (R -Value):: s°
.......................................................
Brand Name:[
Thermal Resistance
-V
.......................................................
Brand
Thermal Resistance (R -Value)
;'
Item Number's Signature and Date Installing Subcontractor (Co. Name) or
General Contractor (Co. Name) or Owner
0q_0(;;e3
Southwest marketing LLC
P.O. Box 5196 * San Clemente, CA 92674
(949) 240-4796 : Ph
(775) 320-0155 : eFax
E-mail: Taylor(a-MulletTeam.coma
FAX COVER LETTER
DATE: January 30, 2004
TIME: 11:49 AM
TO: Plan Check Department
Butte County: (City of Palermo)
zi'+O
FAX NUNMER: (530) 538
FROM: Taylor C. Fletcher
NUMBER OF PAGES (INCLUDING THIS PAGE)
Please find attached documents per your request relative to the submittal of
remodel plans for the property located at 7515 Occidental Avenue, Palermo,
CA 95960.
ConfidgrAliality Statcrncpt
This communication is intended only for the person to Whom it is addressed. It may contain information that is
protected from disclosure to third persons under applicable )aw because it is confidential. If the reader of this message
is not the intended recipient, you are ;hereby notified that you maybe violating a legally protected confidential or
privileged communication and that any review, dissemination, distribution, and/or copying of this communication or
any portion of it is strictly prohibited: IF YOU MAVE RECEIVED THIS COMMUNICATION IN ERROR please
notify me immediately by telephone and return throriginal message to us at the above address via Post. Thank you in
advance for your cooperation and consideration of this matter.
Southwest Marketing LLC
P.O. 5196
San Clemente, CA 92674
January 30, 2004
To Whom ItMayConcern:
This leiter is to be taken as our full and complete authorization that Peggy
Jamison and or Dan Jamison are acting as agents for Southwest Marketing LLC.
As duly authorized manager of the subject limited liability company, I hereby
authorize this agency relationship as noted by my signature below. It you have
any questions with regard to this authorization, please do not hesitate to contact
me at (949) 240-4796.
Southwest Marketing LLC • agency authorization for Jamison
Southwest Marketing LLC
P.O. 5196
San Clemente, CA 92674
(949) 240-4796
January 30, 2004'
Butte County Building Department (City of Palermo)
Subject Property' 7515 Occidental Avenue, Palermo, CA 95960
To Building Department / Plan Check:
We are currently submitting plans for remodel work at the subject property noted
above. Please note that Peggy Jamison is acting as our agent on the subject
property. If you have any questions or concerns with regard to this agency
relationship, please do not hesitate to contact me at (949) 240-4796.
I am also -enclosing copies of the Southwest Marketing LLC documentation
showing that I am manager and owner of the subject limited liability company.
Southwest Marketing is the legal owner of the property in question. Please do
not hesitate to contact me if you need any further information in this regard.
Sincerely&wner/Man
thwest Marketing LLC
7515 Occidenial- Itr- Butte Co. Building Dept.
R
at
A.Q�4%,
SECRETARY OF STATE
CERTIFICATE OF REGISTRATION
1, KEVIN SHELLEY, Secretary of State of the State of California, hereby
certify.
That on the 1 Ith day of April, 2003, SOUTHWEST MARKETING, A LIMITED
LIABILITY COMPANY, complied with the requirements of California law in effect
on that date for the purpose of registering to transact intrastate business in the
State of California; and further purports to be a limited liability company
organized and existing under the laws of the State of Wyoming as SOUTHWEST
MARKETING, A LIMITED LIABILITY COMPANY and that as of said date said
limited liability company became and now is duly registered and authorized to
transact Intrastate business in the State of California, subject, however, to any
licensing requirements otherwise imposed by the laws of this State.
IN WITNESS WHEREOF, I execute
this certificate and affix the Great
Seal of the State of California this
19th day of April, 2003.
KEVIN SHELLEY
Secretary of State
NP.24 A (REV. 1.03) 09P 03 74700
ROISTERED AGENCY SERVICES 19076357430
ARTICLES OF AMENDMENT TO ARTICLES OF ORGANIZATION
FOR
SOUTHWEST MARKETING, A LIMITED LIABILITY COMPANY
The Articles. of Organization of. Southwest Marketing, a Limited
Liability Company are hereby amended as follows:
AMENPMENJ
1. Article 9 i® hereby amended to read as follows:
9. Naaa9lmont., The Company is to be managed by a manager, 'The name
and address of the manager who is to serve as manager until his
successor or successors is or are elected and qualify is:
Mr. Taylor Fletcher
P.O. Box 5196
San Clement®, CA 92672
The above amendment is adopted in accordanoe with the operating
agreement or with the consent of all members.
Dated this Z cv day of �ir�.� Q , 2002.
Man gar T,G
EA SE GAILY
Plot Pian Attechod
r. Floor Plan Attsctead
Sent to G.D.
V ---TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
Owner Location AP#
Plan Approved for: Sewage Disposal--, Vl9ater Supply: Public Private W II
Clearance for",,. dwelling. Other
Hold final for:
Final clearance O.K. for:
NOTE:
Environmental Health Specialist
8/96 V!
s��v
P"4ivlNGDIVISION -
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