HomeMy WebLinkAbout027-060-060BUTTE COUNTY
DEPARTMENT OF DEVVLOPMENT SERVICES
INSPECTION CARD
24 Hour Inspection Line: (530) 538-7636 (Oroville) (530) 891-2834 (Chico)
Office: (530) 538-7541 Fax: (530) 538-2''140 Website: www.buttecounty.net/dds
Permit No:
B06-2456 Issued: 10/17/2006
Address:
346 CYNTHIANN LN PALERMO
APN:
027-060-060 Permit Subtype: Remodel
Owner:
DANIEL, LISA C & MARC TRAVIS
Applicant:
BUILDRITE CONSTRUCTION & RESTO
Description: REPLACE WATER DAMAGED DRYWALL
MUST BE ON JOB SITE
JOB SHALL BE READY PRIOR TO CALLING FOR
INSPECTION. THE INSPECTION CARD AND
APPROVED PLANS MUST BE AVAILABLE FOR EACH
INSPECTION OR THE INSPECTION WILL NOT BE
MADE AND A RE -INSPECTION FEE MAY BE
ASSESSED.
ALL PLAN REVISIONS MUST BE APPROVED BY THE COUNTY BEFORE PROCEEDING
Inspection Type
IVR INSP DATE
Setbacks
132
Foundations / Footings
111
Pier/Column Footings
122
Grade Beams
114
Eufer Ground
216
Forms/Steel/Holdowns
122
Do Not Pour Concrete Until Above are Signed
Pre -Slab
124
Gas Test
404
Masonry Grout
120
Masonry Bond Beam
119
Underfloor Framing
149
Underfloor Ducts
319
Shear Transfer
136
Under Floor Plumbing
412
Under Slab Plumbing
411
Gas Piping
403
Do Not Install Floor Sheathing or Slab Until Above Signed
Rough Framing
128
Rough Plumbing
406
Rough Mechanical
316
Rough Electrical
208
Gas Piping
403
Roof Nail
129
Shower Pan/Tub Test
408
Fire Sprinkler
702
Do Not Insulate Until Above Signed
Wall Insulation
117
Ceiling Insulation
118
Do Not Cover Until Above Signed
T -Bar Ceiling / RC
145
Gas Test
404
Stucco Lath
142
Stucco Scratch
143
Stucco Brown
144
Building Fina
802
Electrical Final
803
Mechanical Final
809
Plumbing Final
813
Project Final
801
Q�
PERMITS BECOME NULL ANIY VOID 1 YEAR FROM THE DATE OF ISSUANCE. IF WORK HA
COMMENCED, YOU MAY PAY FOR A 1 YEAR RENEWAL 30 DAYS PRIOR TO EXPIRATION
Inspector Copy
yY
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please call for re -inspection when correction of
work is completed. If you have any questions pertaining to this matter, or need additional -1
explanation, please contact the Building Inspector as indicated below. ;
/ J
Date, t l Inspector
REV 4/05 Phone #
�� ..
FOR RE -INSPECTION CALL: 538-7636 OR 891-2834
. . . . . . . . . . . . . . . . . . . . 1. l ; .... . . . . . . . . . . .
. -
COUNTY OF BUTTE
`
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please call for re -inspection when correction of
work is completed. If you have any questions pertaining to this matter, or need additional -1
explanation, please contact the Building Inspector as indicated below. ;
/ J
Date, t l Inspector
REV 4/05 Phone #
�� ..
FOR RE -INSPECTION CALL: 538-7636 OR 891-2834
x
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 County Center Drive • Oroville, CA • (530) 538-7541 --
CORRECTION NOTICE
UWNER PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at R
the above address and should be corrected. Please call for re -inspection when correction of
work is completed. If you have any questions pertaining to this matter, or need additional
explanation, please contact the Building Inspector as indicated below.
C31 S.
i V a
r N
Date Inspector
REV 4/05 Phone # c S '
FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 9
':tet
1 r'
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
PROJECT INFORMATION
Site Address: 346 CYNTHIANN LN.
Owner:
Permit NO: B06-2456
APN: 027-060-060
DANIEL, LISA C & MARC TRA
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
Issued Date: 10/17/2006 By KCG
_
Permit type': MISCELLANEOUS
346 CYNTHIANN LN
Subtype: Remodel
OROVILLE, CA 95966
Expiration Date: 10/17/2007
Description: REPLACE WATER DAMAGED DR.
-
Occupancy: Zoning: ARMS
Contractor
Applicant:
Square Footage:
BUILDRITE CONSTRUCTION & RESTO
BUILDRITE CONSTRUCTIOP
Building Garage Remdl/Addn
1200 W EAST AVENUE
1200 W EAST AVENUE
;
CHICO, CA 95926
CHICO, CA 95926
Other Porch/Patio Total
(530)891-0333
(530)891-0333
;
FEE INFORMATION
Supplemental Inspection $109.98
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
BUILDRITE CONSTRUCTION & CSLB-689238 / B C15 / 05/31/2008
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:
X 10/17/2006
Contractor's Signature Date
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.
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
_ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers' Compensation insurance carrier and policy number are;
Cartier: GRANITE STATE IN:Policy Number: WC1967449 Exp. Dale:03/01/2007
(This section need not be completed if the permit is or one hundred ollars ($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 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. '
total unargea: 31U9.98 tees rata: $111.119.98
Balance Due: $0.00 Receipt NO:' B548
tr OWNER /BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
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
pursuant to the provisions of the Contractor's 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];
Please check one of the following:.
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 License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.). I -
FI, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 I AM EXEMPT under Section B. a P.C. for this reason:
t
X 10/17/2006'
- Owner's Signature Date
X 10/17/2006
I hereby certify that I have read this application and state that the above information is cored. I agree
Signature Date
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
WARNING: FAILURE 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 by, arising out of, 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 that issuance of this pea rmit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occupancy -of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
-County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
CONSTRUCTION LENDING AGENCY
property owner or am authorized to act on the property owner's behalf.
1 10/17/2006
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Permittee [SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code) I
r . _ .
Owner Contractor OR Agent for Owner Agent for Contractor
Lenders Address City State zip INSPECTOR COPY -
=Y = 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
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class /, Expires
BUILDRITE CONSTRUCTION & CSLB-689238 / B C15 / 05/31/2008
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 ful /and:�ct. ,
10/17/2006
Contractor's Si Date
WOR ERS' 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
pend nce of the work for which this permit is issued.
AVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of 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: GRANITE STATE IN -Policy Number: WC1967449 Exp. Date:03/01/2007
(This section need not be completed a the permit is or 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 the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
compensation provisio s of Section 3700 of the Labor Code, I shall forthwith comply with those
provisi s.
X l 10/17/2006
Signature Date
WARNING: FAILUR E RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF.COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address .
City State . Zip
Total Charged: $109.98 , Fees Paid: $109.98
Balance Due: $0.00 Receipt No: B548
OWNER/ BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
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
pursuant to the provisions of the Contractor's 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);
Please check one of the following:
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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.).
EI, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursbant to the
Contractor's License Law.).
❑ I AM EXEMPT under Section B. & P.C. for this reason:
Owners Signature
10%17/2006
Date
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 State laws relating to building
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
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
gopefj y n ar am thorizedd to act on the pro arty owner' behalf.
:, # t�C_ 10/17/2006
Owner, ' Contractor OR: El Agent for Owneggent for Contractor
FILE COPY
PROJECT INFORMATION
Site Address: 346 CYNTHIANN LN
Owner:
Permit NO: B06-2456
APN: 027-060-060
DANIEL, LISA C &'MARC TRA
Issued Date: 10/17/2606 By KCG
Pen -nit -type: MISCELLANEOUS
346 CYNTHIANN LN
Subtype: Remodel
OROVILLE, CA 95966
Expiration Date: 10/17/2007
Description: REPLACE WATER DAMAGED DR:
Occupancy: Zoning: ARMS
Contractor
Applicant:
Square Footage:
BUILDRITE CONSTRUCTION & RESTO
BUILDRIT.E CONSTRUCTIOr
Building Garage Remdl/Addn
1200 W EAST AVENUE
1200 W EAST AVENUE
CHICO, CA 95926
CHICO, CA 95926
Other . Porch/Patio Total
(530)891-0333
(530)891-0333
FEE INFORMATION
Supplemental Inspection.
$109.98
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class /, Expires
BUILDRITE CONSTRUCTION & CSLB-689238 / B C15 / 05/31/2008
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 ful /and:�ct. ,
10/17/2006
Contractor's Si Date
WOR ERS' 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
pend nce of the work for which this permit is issued.
AVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of 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: GRANITE STATE IN -Policy Number: WC1967449 Exp. Date:03/01/2007
(This section need not be completed a the permit is or 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 the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
compensation provisio s of Section 3700 of the Labor Code, I shall forthwith comply with those
provisi s.
X l 10/17/2006
Signature Date
WARNING: FAILUR E RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF.COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address .
City State . Zip
Total Charged: $109.98 , Fees Paid: $109.98
Balance Due: $0.00 Receipt No: B548
OWNER/ BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
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
pursuant to the provisions of the Contractor's 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);
Please check one of the following:
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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.).
EI, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursbant to the
Contractor's License Law.).
❑ I AM EXEMPT under Section B. & P.C. for this reason:
Owners Signature
10%17/2006
Date
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 State laws relating to building
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
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
gopefj y n ar am thorizedd to act on the pro arty owner' behalf.
:, # t�C_ 10/17/2006
Owner, ' Contractor OR: El Agent for Owneggent for Contractor
FILE COPY
_Z ._ 4
BUTTE COUN'T'Y
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
APPLICANTVGNAJUPE
1, NOR, .—FoRn
For office use only:
OYVNgR
INFORMATION
Last N
r
A
o�
irst Name
Mailing
r s
N
City
i
Zip
Phon F _
Statel
Zip
E-mail
Lic. t�' O C� �
Fax
E-mail
APPLICANTVGNAJUPE
1, NOR, .—FoRn
For office use only:
CONTRACTOR
Name
44
m
Address
Type Const.
Address
Map Book
State
City C
Phone
Stat
Zip
Phon F _
3
Fax
E-mail
Lic. t�' O C� �
C.I�ss C�
APPLICANTVGNAJUPE
1, NOR, .—FoRn
For office use only:
ARCHITECT/ENGINEER
Name
44
m
Address
Type Const.
City
Map Book
State
Zip
Phone
E-mail
Fax
E-mail
State License Number
APPLICANTVGNAJUPE
1, NOR, .—FoRn
For office use only:
-.-----APPLICANT INFORMATION
Name
Address
44
m
City
Type Const.
State,/'
Map Book
Phone
3
Fax
y
E-mail
APPLICANTVGNAJUPE
1, NOR, .—FoRn
For office use only:
Zoning Flood Zone
SRA I Yes
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
IS
BIN #
PROJECT LOCATION
AP#
Property Add s
3 ah n
Cit
Cross ree
WORKER'S COMPENSATION
Policy Number n
j
Carrie
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
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.
IReceived by: Ur Amount: * 1 Bldg I
SRA
Receipt #: Sher
&A C623J
Date: 10�17CG, W
SMIP
Total
n or cope of Work:
De7IT-P
GIC N Q WtAA,,j
Lj
Rpmt �a
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
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.
IReceived by: Ur Amount: * 1 Bldg I
SRA
Receipt #: Sher
&A C623J
Date: 10�17CG, W
SMIP
Total
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT :SERVICES
BUILDINd 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
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
effect.
License Class: C lL " nse Number:%_�_
Date: A, //m�7 Contractor: S
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.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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.
O 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:
Policy #:
D--I`�.erlify 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 those provisions.
Date: d '
Applicant: DIE
PERMIT NO.
BP041714
r
1
Issued Date: 06/16/2004' APN: 027-060-060-000
Site Address: 346 CYNTHIANN LN PAL
Map Index:
Description: REPL ELEC SVC 200 AMP
Owner: DANIEL MARC TRAVIS &
CRUIKSHANK-DANIEL LISA
346 CYNTHIANN LN
OROVILLE, CA
95966-8022
4
f Applicant: PAUL'S ELECTRIC
625 MISSION OLIVE RD
OROVILLE, CA 95966
! 530-589-4100
t
I
I
Contractor: PAUL'S ELECTRIC
625 MISSION OLIVE RD
f OROVILLE, CA 95966
530-589-4100
License #: 376492
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject ari 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.
OFFICE COPY
Address
-Pat -
ELECTRIC
Meter By - Date
� *4
$110--, C, , l 4 • o4 --
CONSTRUCTION LENDING AGENCY This permif is hereby issued under the applicable provisions of the Butte County Gods 2nr7/or
I hereby affirm that there is a construction lending agency for the. Resolution to do work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.) _� C, . 1 0+Name: By:—Z — Date:
PERIT XPIRES ON: �o • 116 • O S
Address: mate)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage,
handling and use of hazardous materials.
❑ 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 t ner or the duly Guth zed 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 s bstance of any offi ' orm or document of Butte County. I hereby
authorize rep ves of Butte County to enter upon the above mentioned property for inspection durposes.
Print Name: L \��=l�iJ�=ice—_ Signature:
Date:
❑ Owner Contractor ❑ Agent for Owner 13 Agent for Contractor
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street- Chico, CA •- (530) 891 -�751
k.
El ,
7 County Center Drive •.0roville, CA * (530) 538-7541
'CORRECTION NOTICE
Z ZZ Y
-OWNER PERMIT NO.
I',` =A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction .of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
Z,
35.
4,
si Er
Date Inspector
REV 10/92..
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.
BP042216
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 07/26/2004 APN: 027-060-060-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 346 CYNTHIANN LN PAL
Date: Contractor.
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: REPLACE EX HVAC
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: DANIEL MARC TRAVIS &
to its issuance, also requires the applicant for such permit to file a
CRUIKSHANK-DANIEL LISA
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
346 CYNTHIANN LN
7000) of Division 3 of the Business and Professions Code) or that he or
OROVILLE, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95966-8022
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
Applicant: DANIEL MARC TRAVIS &
such work himself or herself or through his or her own employees,
CRUIKSHANK-DANIEL LISA '
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.).
1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: SUBURBAN PROPANE LP
❑ 1 am Exempt under Article 3 of tha8usiness and Profepsioo Code
P O BOX 206
Date: Ownr-
WHIPPANY, NJ 07981-0206
(973) 503-9102
-L
WORKERS' CO ENSATION DECLARATION
1 hereby affirm under penalty of peryury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for
License N: 722767
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
❑ 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy #:
I certify that in the performance of the work for which this permit is
Valuation: $0.00
issued. I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
Census Code:
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: ailure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This pe rani erebissued under the applicable provisions of the Butte County Coda anrvnr /{
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.)
Res 6rk indicated above for which fees have been paid. .
- b
Name:
By: �y Dayte:
Address:
PERMIT EXPIR S 0 : (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.
❑ 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 represe tatives of Butte County to enter upon the above mentioned property for inspection purpos
Print Name: � Signature:
Date: Ll
��` ---✓✓✓
ywner 13 Contractor ❑ Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY"
PERMIT
NO.
f:Ii►F:i
APPLICANT NAME
Name
Address
City State Zip
Phone Fax
E-mail 1
APPLICANT SIGNATURE
X
For office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ. I
Type Const
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a cerfificafe of worker's .
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work: _ ,f
Sq. Footage
❑ 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
Refimds 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
refimdable.
Received by: Amount: Bldg
--A ff SRA
Receipt'#: Sheriff
qo(A�6
SMIP
Date: /�� Other
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 WINS.
Residential, New, Remodels, Additions, and Accessory Structures:
❑
1.
3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑
2.
3 Complete sets of plans, signed by the preparer. NO GR,4PHPAPER!
OR
3 Sets Engineered. plans (if required) with wet signature on plans AND2. sets of stamped and signed
calculations.
❑
3.
2 Engineered truss details and layouts (if -required) (1VO FAXES!). F
.❑
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 calcs in triplicate, (C) Elevations in .
triplicate, (D) Floor plans in triplicate, All of these must be stamued and wet-signed'by the engineer.
Mobile, Manufactured, or Modular Homes:
❑ .
1.
3 Site Plans, signed by the preparer. NO GRAPHPAPER.i
❑
2.
2 Data sheets and installation instruction manual. `
❑
3.
2 Marriage line information. +
❑
4..
2 Floor plans..
❑
5.
.t
2 Engineered Tie Downs or Foundation plans. • `
o
6.
Sanitation and site. plan, approval from the Environmental Health Depaftinent.
❑
7.
C'
2 Flood Elevation Certificate, wet -stamped and signed (if required).. ;
Commercial, New, Additions and Remodels:
❑ 1. 4 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑ 2. 4 Engineered plans with wet signature on plans ANIS 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
'TOPWSSUILDING FORMS\BIdgApp1SubRgmts.doc Pam 2 of 9
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.
BP041714
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: 06/16/2004 APN'' 027-060-060-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: Number: 7& 1( 9 7—
Site Address: 346 CYNTHIANN LN PAL
;nse
Date: Contractor. G S
Map Index:
Description: REPL ELEC SVC 200 AMP
OWNER -BUILDER DECLARATION
I hereby affirm under penaltyalty of of perjury that I am exempt from the
p
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
DANIEL MARC TRAVIS &
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner:
to its issuance, also requires the applicant for such permit to file a
CRUIKSHANK-DANIEL LISA
signed statement that he or she is licensed pursuant to the provisions of
346 CYNTHIANN LN
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
OROVILLE, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95966-8022
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
Applicant: PAUL'S ELECTRIC
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
625 MISSION OLIVE RD
year of completion, the owner -builder will have the burden of
OROVILLE, CA 95966
proving that he or she did not build or improve for the purpose of
530-589-4100
sale.).
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: PAUL'S ELECTRIC
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
625 MISSION OLIVE RD
OROVILLE, CA 95966
Date: Owner:
530-589-4100
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #' 376492
'
❑ 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
Architect:
required by Section 3700 the Labor Code, for the performance of
Engineer:
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#:
Dl_r_-�rtity that in the performance of the work for which this permit is
Valuation: $0.00
issued, 1 shall not employ any person in any manner so as to
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: d 7
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
damages for in Section 3706 the Labor
compensation, as provided of
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable provisions of the Butte County Code. end/or
I hereby affirm that there is a construction lending agency for the
Resolution to do work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
� 6 (� • 04
By: nL— ` t�a�c -'^ Date:
Name:
lv • I • O
PER IT PIRES ON: 5
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 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 amt ner or the duly auth zed agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge itis unlawful to alter the s pstance of any offi ' orm or document of Butte County. I hereby
authorize re ves of ButteCountyto enter upon the above mentioned property for inspection Ourposes.
Print Narr `` L Signature:
Date:
0 Owner Contractor 13 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
OWNER
Name Q ,l
Address
City
City
State
Zi
s p
State
Ile
Phone _5-3�c q(0
Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
City
Address
Zip
Address
s p
State
Ile
Cit
Map Book
State
Zip
v t`
State License Number
C
Pho J;� e, fi ti
Fax
E-mail
Lic. #
CI�sIs /0
Z
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
I/ XN1X
For office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BPo41-714
BIN #
LOCATION
AP# 0�7� �(oO . ofo
Property Address
34-& C NTrr,.4,,jJ o,eo
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by: k-) ,1c-- Amount: ( I Q. — Bldg
Receipt #: 4-04s::759 1,
Date: (o� 4-104,
SRA
Sheriff
SMIP
Other
L92_:=Total
REV 4-30-04
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations. ,
❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to
mobile or modular homes.)
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 8. Detached Accessory Building Form, filled out by the property owner (if required).,
❑ 9. Sanitation and site plan approval from the Environmental Health Department.
❑ 10. 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.
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
KAFORMS\BUILDING F0RMS\BIdgAPP1SubRgmts.doc Page 2 of 2
REV 430-04
:t PRE -INSPECTION REPORT'
OWNER: �,o�;,) c Wit— DATE: 1 4- 04
LOCATION: 34-& CY&4T�4 AT%lkl k; A.P. #. b?7• 60co • 0(60
CONTRACTOR: ZONING:
REASON FOR PRE -INSPECTION
DATE TO INSPECTOR: - b PERMIT HISTOR x ,) NONE ) SEE ATTACHED
BUILDING INSPECTOR'S REPORT TM
Building Description:
Commercial/Usage: .
Residential # of Units: Mobile home # of Units:
Currently Occupied r 0 A Yes ( ) No
Abandoned/Vacant: 111
Electric: ,
,
Electric Currently On ( ) Off
Condition of Electric
Gas: ,
Currently (,)On ( ) Off
Condition
Sanitation:
Plumbing Working ( ) Yes ( ) No 1. ,
Obvious. Sewage Problems ( ) Yes ( ) No
ACTION RECOMMENDED: ISSUE Yes ( ) No i
Hold for permits or verify:
.Inspector: � ' r � - . Date:
WRTCYT RTTTT,DTNGS' nN REVERSE AND•INDICATE LOCATION ON PROPERTY: