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HomeMy WebLinkAbout027-090-033COMPLAINT TO INSPECTOR 027=09-0-033 93-964 E MEDRANO, RUBEN 28.19 LOUIS AVE, PAL 0 _ �EL C SERV/SF 027-09-0-033 -- - -- -- - - ---- - - — - - MEDRANO, RUBEN _ 93-965 E 2821 LOUIS AVE, PALERMO n 3 E� E SERV/SF 027-09-0-033 _ 93-966 E MEDRANO, RUBEN 2823 LOUIS AVEL PALERMO EE EC'SERV/SF 027-09-0-033 93-967 E MEDRANO, RUBEN 2825_,LOUIS AVE, PALERM EL C ER' OSF B07-2466 027-090-033 MISCELLANEOUS Remodel REROOF 30SQ.'SAVINDOWS 10/DOOR 2825 LOUIS AVE MEDRANO RUBEN & GRAC, 027-09-0-033 93-2321 E MEDRANO, RUBEN 2817 LOUIS AVE, 'PALERMO --E ,'EC 'SERV/SF 9&7 --7 j. OFFICE COPY Address GAS Meter 13 E�E CTR Date Meter Pate COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive : Oroville, California 95965 - Telephone (916) 538-754 22 rAPPLICATION AND PERMIT - ASSESSOR PARCEL NUMBER 02733 ZONING BUILDING PERMIT OWNER Ruben '3edrano TELEPHONE 533^2351 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 24Palermo 95968 •t CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS PERMIT FEE $ 2817 Louis Ave Palermo PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 I I Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL•.MAP PARCEL. Each gas water heater or vent 15.00 USE OF STRUCTURE SF 9 Duplex ❑ Mobilehome ❑ Other a SPECIFr Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 1 @20.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities IN Installation ❑ Other ❑ Describe Work: New Main Serwue 1 PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 2"" OR LESS ) 200A OR LESS 2300 • . Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( 8 ACC. BLDS. ) SO. 3.5C FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ 1 am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification D I, as the owner, 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) ❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ I am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) a SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BAL @ 1.Or500 Ex. Occup.FIXED APPWS. OR (OUTLETS (RESID.) EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20,00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. O I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $43.00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. 1- ' f .� 7-, "'• - X; .r _ Date i ��>� Signaiure of Applicant - ❑ Owner Contractor ❑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 $ OCC CONST. TYPE TOTAL FEE $ 43.00 HAZ- 1 D. FEES IMP I FOOD I CDF I PARCEL I PD HD ISSU This permit is hereby Issued under the applicable provisions P Y PP of the Butte County Code and/or Resolutions to do work indicated al ove for which fees have b.en paid. I �� OF PUB DIRE T LIC ORKS By •" � � / Dater ti''' V/1 `"}.� PERMIT EXPIRES ON / l`j /Date/ r 143660 Receipt WHITE-D.D.CANARY-ASSESSOR PINK•INSPECTOR GOLDENROD -APPLICANT .D. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMEN- SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-754rOv� W. APPLICATION- ANI0 PERMIT // ASSESSOR PARCEL NUMBER ZONING ' BUILDING PERMIT 027-090-033 A`5 OWNER Ruben Medrano TELEPHONE 533-2351 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAIDNG ADDRESS Ir - P.O. Box 24 Palermo 95968 CONTRACTOR'S NAME TELEPHONE Owner CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER ucENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS = Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS PERMIT FEE $ PLUMBING PERMIT Filing Fee 20.00 2817 Lon J s, Ave Pa I erma Each Trap 7.00 Solar or heat pump water heater 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15,00 Each gas water heater or vent 15.00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 SF IN Duplex ❑ Mobilehome ❑ Other Mobile Home S G W @20'00 SPECIFY TYPE OF WORK PERMIT FEE $ New ❑ Addition ❑ Remodel ❑ Utilities a Installation ❑ Other ❑ Contractor Describe Work: New Main Service ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 101 OR LESS 00AORLESS I 1 23.00 23.0 Main Service ( 200A To 1000A ) 46.00 NEW CONST. DWELLING OCCUP. - OR ADDNS. ( & ACC. BLOS. I 3.5CSO. FT. NEW CONST. MULTI -OUTLET •NON-RESID. ( BRANCH CIRCUITS I @7.50 CONTRACTORS LICENSE LAW ( POWERAPPARATUS ) I declare under penalty of perjury (check one) & SINGLE OUTLET CIR. O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Ex. Occup. ( OUTLET OR FIXTURES )T9, Professions Code and my license is in full force and effect. Ex. Occu FIXED APPWS. OR p'(OUTLETS License No. Classification IRESID.1 EA. I, as the owner, or my employees with wages as their sole compensation, will do Temporary Service the work, and the structure is not intended or offered for sale. (Sec 7044) Mobile Home Facilities O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) Misc. Wiring ❑ I am exempt under Sec. Business and Professions Code 23.00 forthis reason WORKER'S COMPENSATION INSURANCE PERMIT FEE $ 43.00 1 declare under penalty of perjury (check one): Contractor ❑ This permit is for $100.00 (valuation) or less. MECHANICAL PERMIT Filing Fee 20.00 ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Heating Certificate of Consent to Self -insure. Cooling l5d I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Hood 6.50 Notice to Applicant: If after making this statement, should you become subject to the Ventilation Worker's Compensation provisions of the Labor Code, you must forthwith comply with PERMIT FEE $ such provisions or this permit will be revoked. Contractor I certify that I have read this application and state that the above information is correct. Mobile Home Installation Fee $ I agree to comply to all Butte County Ordinances and California State Laws relating to Energy Inspection Fee $ building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. occ CONST. TYPE TOTAL FEE $ I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said HAZ• D. FEES IMP FLOOD COF PARCEL PO I HD I ISSU County in consequence of the granting ofthis permit. I I I I X /'/'�''i�'j Date This permit is hereby issued under the applicable provisions Signature of Applicant - Owner Contractor Agent of the Butte Count Code and/or Resolutions to do work y An OSHA permit is required for excavations over 5"0" deep and demolition or indicate ab ve n paid. construction of structures over 3 stories in height. DIRORKS ey =_ff� Receipt No. 143660 ZsVz�x4, WHITE-D.D.S.-B.O. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT PERMIT EXPIRES ON (Date) ` COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBS . v�7- A— - QEL3 IONII& A , BUILDING PERMIT OWNER TELEPHONE .Z35 I SQ. FT. " OCC. BUILDING VALUATION OWNER'S Z AMINO ADORE �g /��M o .9 S9 /v 8 PFACTO - - .. ' coN Q'R�I�A`y�E TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 2B/7 Ov,s PERMIT FEE S PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SFX Duplex EIMobilehome O Other SPECIFY Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W @20.00 TYPE OF WORK New O Addition ❑ nR'emodel �O//fJ Utilities ❑ Installatio%X Other El Describe Work: /Uew /l/f.4,ni Sc ro(c PERMIT FEE $ Contractor ELECTRICAL PERMIT Fling Fee 20.00 Main Service ( 00ORLESS 200AAOR LESS ) 23.00 219-002 Main Service ( 200A TO IOOOA ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. I 6 ACC. BLDS. ) so, 3.5C FT. NEW CONST. MULTI -OUTLET "NON"RESID. ( BRANCH CIRCUITS ) @7.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification J O I, as the owner, 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) O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) O 1 am exempt under Sec. Business and Professions Code forthis reason ( POWER APPARATUS A SINGLE OUTLET CIR. / Ex. Occup. ( OUTLET OR FIXTURES ) e20 @ 1. 0 50 FIXED APPLNS. OR Ex. Occup. p' (OUTLETS (RESID.1 EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): O This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. O I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ j. on Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant - O Owner ❑ Contractor O 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 Is occ CONST. TYPE TOTAL FEES 3 �� HAI. I D. FEES I IMP FLOOD CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS ByDate PERMIT EXPIRES ON (Date) pt No./y3Z0 E -D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - Department A f Public Works 7 County Center Drive, Aroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner:. An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to.provide the major labor -and materials for construction of the proposed property improvement (yes or no) 2. I (have/have not) y e S signed an application for a building permit for the proposed work. 3. I have contracted with the following person.(firm) to provide the proposed construction: Name Address City Phone 'Contractors License No. 4: I plan to provide'portions-of this work,.but-I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors Lidense No.' 5. I will provide some of the work -but I have contracted (hired) the following persons to piovide .the work indicated: Name Address Phone Type of Work Signed: Property Owner Social Security Number Date NOTE: This Owner -Builder Verification is sent to..you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. '� ..far ... ��.. - _ ,�.��,, - � - � .-... _ � ,.- .. _ ... ,. .. :.ri,, . .. TN • v .r , Y • � a i • j • �� i j' e �,a�,. r j �.... � �:i%� _ E �—' .� ,._ � COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS / 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPMATMN Agh PFRUIT PERMIT ASSESSOR PARCEL NUMBER 33 OWNER ZONING A-5 BUILDING PERMIT Ruben ''tefirnno TELEPHONE 533-2351 SO. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS P 0.41 fiox Palermo 95968 CONTRACTOR'SN A M E r)wn,-r TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LEDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee A Palermo PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF FK]Duplex ❑ Mobi lehome ❑ Other SPECIFY i Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 9 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities L`J Installation❑ Other ❑ Describe work: Mew Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS J 18.50 18.5 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ t am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. Classification I i I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000AI 37.50 NEW CONST. DWELLING OCCUP.d+\ 3.64 sq.ft. OR ADDNS. ACC. BLDGS. / NEW CONSTP- U TI -OUTLET NON_R ESID BRANCH CIRC ITS @ 5.00 APPARATUS 61 SINGLE OUTLET CIR. / Ex. OCcup(OUTLETS OR FIXTURES 20 @ 76 Ex. DCCUp. FIXED APPLNS REA.) 3.00 OUTLETS 4RESID,I Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 Pre -Inspection Permit Fee S WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X t )' ` ' s� Date I — (� (' , 7 Signature of Applicant — Owner Contractor � !/rgeryta� ❑ An OSHA / �/ w permit is required for excavations over 5'0" ep and demolition or construct- ion of structures over 3 stories in i t. y✓�J .� Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 5..: D" �pQ aI HAz 1 0FEES I IMP I FLOOD I CDF PARCEL PD HD ISSUE I i This permit is hereby issued under the applicable provi- sions of the But�i Icl oun y Code and/or resolutions to do ` work indicated ,above fgrr�hich fees have been paid. /DIRE t�IO.R�QF PUBLIC WORKS R d By li�� Date 7 PERMIT EXPIRE$ Date / 9' 1-16 od Receipt No. + WHITE-D.P.W.• YELLOW-ASSEeSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - OEPAR'TMENT OF PUBLIC WORKS 7"0 7 County Center Drive - Oroville, California 95.965 - Telephone: 916/538-7541 APPLICATION AND PERMIT 3P3ERMIT ASSESSOR PARCEL NUMBER 027-090-033 ZONING A-5 BUILDING PERMIT OWNER Ruben Medrano TELEPHONE 533-2351 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS Box 24 Palermo 95968 CONTRACTOR'S NAME Ownpr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 1 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF E Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 1 615.001 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities[E Installation ❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS I 1 18.50 18.50 CONTRACTORS LICENSE LAW I declare under penalty of p y perjury y (Check One): El am licensed under provisions Of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000AI 137.50 NEW CONST. ( DWELLING OCCUP.N\ OR ADDNS. ACC. BLDGS. II 3.64sq.1t. NEW CONSTR ULTI-OUTLET NON ESID BRANCH CIRC ITS @/� l: 5.00 ( POWER APPARATUS &) SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 @ 76 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring -15.00 Pre—Inspection 11 20.00120.00 Permit Fee $-,; -� WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject L-- to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject- to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. �i X -L7-t ti DatekJ_ �' -/ of Applicant — Owne Contractor E eryt-0 An OSHA permit is required for ex o afions over 5'0" ep and demolition or construct- ion of structures over 3 stories in i t. � S Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE v TOTAL FEE $ ' �p� HAz DFEES IMP FLOOD cOF PARCEL PD HD ISSUE This permit is hereby issued under the sionsSignature of the But ou Code and/or hick fees Work ;4W UBLIC By PE IT XPI • ES Date applicable provi- resolutions to do have been paid. WORKS ate flAb v Receipt No. 136002 t�� .• /S' WHITE -D. P. W,. YELLOW -ASSESSOR, IN -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 - TELEPHONE'(916) 538-7541 P,ERMITAPPLICATION DATA SHEET U62.�/ OWNER %Y � ANc� A. P. No. 4 2- 7 - DTO - a 3Z Proposed Building Use lzk/ SBuilding Inspector /20 Date 111A9_11-3_ At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE'RECENED'. BY 1. All items have been submitted......................................... 2. Plot plans, 3/4 sets, signed by preparer of plans . ........................... 3_ Complete plans, 3/4 sets, signed by preparer of plans . ..................... . .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation. ................... 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets ............. 10. Fees of $........................................... 11. Impact fees as shown on attached schedule . ............................. . 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . .................. 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . ........................................... 16: Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. ........... 19. �. Driveway permit (construction appral required prior to occupancy). .. . . Pre -inspection forRZZAl1•is Yrc/iAY-/y.tlr required. s ��a4�� 21. .. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner Mail to owner ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ...................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . .....................:........: . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. Whe you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephones"?'; -?5S/ and hold for pickup at 0/-o&, office. Deliver with inspector. Other Parcel Creation Acreage ApplicantL/ -U,$e Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date - Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Contractor, designer, owner, was advised of above required data by _ phone _ mail r 'Plans checked by Date Plans approved by Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works Counter by _ Date. Counter by._.Date Date _COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please.complete and return this information at your earliest.opportunity to avoid unnecessary delay in:processing and issuing your building permit. No building permit will be issued until this verification is received. 01. I personally plan to provide the major labor and materials for construction of the proposed property improvement (}s or no) �C9S I (have/have not) /��� V�. signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following -person to coordinate, supervise, and provide the major work: Name Address City . Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to .provide the work indicated: Name Address Phone Type of Work Signed: Property Owner Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required ft`S11ions 19831 and 19832 of the -California Health and -Safety Code.- Icy 0 This verification must be completed and returned to our office re we are per - to issue the permit. COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916;'538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 0 2-7 - 0`'70- 3.3 ZONING —� BUILDING PERMIT OWNER �,� od., ,V TELEPHONE 533 -23 51 SO. FT. OCC. BUILDING VALUATION OWNER'S MAI IG ADDRESS 140 o .0NX 2 PWelnc o C ?5 CONTRfTOR'5 NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit tee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 1 7.00 Each qas water heater or vent 1 7.00 USE OF STRUCTURE SFNDuplexMobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home ISI GJWJ @ 15.00 TYPE OF WORK New ❑ Addition ❑/j/ Remodel ,F� utilities N� Installation ❑ Other ❑ Describe work: y�w /�'I iN S�l�yjC-e— Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200V OR LESS 00A OR LESS 18.50 cam• 541 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered" for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000AI 37.50 NEW CONST. / DWELLING OCCUP.&) OR ADONS. 1 ACC. BLDGS. 3.64sV.ft. NEWCONSTR ULT"OUTLET NON-RESID BRANCH CIRCUITS) @ 5.00 /POWER APPARATUS 111 SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 20 7641 Ex. OCCUp. OUTLETS RESID )FIXED APPLNSRE A.� I 3.00 Temporary service, 15:00 - Mobile- Home -Facilities Misc. Wiring g '15.00 Ile : f"� V_, - fir Permit Fee $ S3. Sc1 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ 1 shall not employ any person in any manner so as to become subject to the W. C, laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE I TOTAL FEE $ HAz 1 0FEES I IMP I FLOOD I COF PARCEL PO MD ISSUE This permit is hereby issued under the applicable provi- j sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. /3&60o- W NITC-O. P, W., TEL LOW•ASe [390 R, PINK -INSPECTOR. GOLD EN ROa-APPLICANT f, i 1 f, 1 i a i FF COPY t :. � s, -. t Addres(� GAS t Meter By ELECTRIC' Date_ M ter By �Y + Date/ ", I � a • COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKSPER T N0. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 .� APPMAT(m AN(1 PFPUIT ASSESSOR PARCEL NUMBER OWNER ZONING A-5 BUILDING PERMIT Ruben Medrano TELEPHONE 533--2351 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS x 24 Palermo "568 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 2821 Lettit Ave.,Palermo PLUMBING PLUMBING PERMIT Filing Fee 15.00 Trap 5.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ® Duplex❑ Mobilehome❑ Other i SPECIFY i Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities[` Installation❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 00V OR LE Main service 200AORLESS 18.50 CONTRACTORS LICENSE LAW 1 declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BuSlneS$/POWER and Professions node and my license Is In full force and effect. License No. Classification X I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A) 37.50 NEW CONST. ( DWELLING OCCUPM 3.64sq.ft. OR ADDNS. ACC. BLDGS. I NEW CONSTR ULTI-OUTLET NON ESID BRANCH CIRC ITS @ 5.00 APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES20 @ 76 FIXED Ex. Occup. OUTLETSP(RESID )REA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee t-3� O WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee ; Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue at said County in consequence of the granting of this permit. X . , r ,- ,"—Z 4 - I - t _ � 2 Date Signature of Applicant — Owner contractor ❑� g nt An OSHA permit is required for excavations over 5'0" d p and demolition or construct- ion of structures over 3_stori s in.h fight. / S Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $3�-SD- �SSv HAz 1 0FEES I IMP I FLOOD I COF PARCEL I PD I HD ISsuE i This permit is hereby Issued under the applicable rovi- P Y PP P sions of the Butte County Code and/or resolutions to do work indicate bo,,y� for'irhich fees have been paid. ECTOR,0F PUBLIC WORKS i ai By l �-f ate PERMIT EXPIRES Date Receipt No. Jk vv #/05)L)` j WHIT[-O.P.W., YELLOW-ASSESSOR,/PINK-INSPECTOR, GOLDENROD -A PLICANT ' w COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P R 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 027-090-033 ZONING A-5 BUILDING PERMIT OWNER Ruben Medrano TELEPHONE 533-2351 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O.B x 24 Palermo 568 CONTRACTOR'S NAME nwnpr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 1.55,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 2821 Louis Ave., Palermo PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ® Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities ® Installation ❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 1 18.50 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑I am licensed under p provisions of Cha t. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification the owner, or my employees with wages as their sole compen- CN�`Iation,will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A, 37.50 NEW CONST. / DWELLING OCCUP.6� OR ADDNS, l ACC. BLDGS. 3.64 sq.ft. NEW CONSTR. MULTI -OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 /POWER APPARATUS 6\ I SINGLE OUTLET CIR. EX. OCCU 20 76 P OUTLETS OR FIXTURES FIXED APPLNS. ORas Ex. Occup. OUTLETS (RESID.) EA.1 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g -15.00 f5 c Permit Fee $.fie L WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate -,of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting o is permit. X Lz Dat (I' Signature of Applicant — Own r Contractor t An OSHA permit is required fore ations over 5'0" d p and demolition or construct- ion of structures over 3 stories in h fight. S Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $- J4 85-0 HAz 1 DFEES I IMP I FLOOD I COF PARCEL I PD I HO I ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicate bo f hich fees have been ai . p F PUBLIC WORKS By 4 LL ate PERMIT EXPIRES Date ! 136002 lgoa ,, Receipt No. WHITE-D.P.W.• YELLOW -ASSESSOR, PI K -INSPECTOR. GOLDENROD -A PLICANT rvr r� `� "`•�'1-."'�-w_ -e wi�'t�.."I`'Lr 11` :.y;F a..,.c .✓�'^-�� r i � ...r!-v'-`efr.��r.,.,... � .._.,, 7.� � ,.y `�^.rye'^• �r'��.xri•a,-,.�.'�'1�..•.��,'1��..-d ` - ti ��Y `� ' COUNTYOF BUTTE -DEPARTMENT OF'DEVFLOPMENTSERVICES -BUILDING DIVISION V 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER Aa4wj A. P. No. 0 z 7 - 0"0 - p 3'3 Proposed Building Use Aeek/ SG%UiG,S" Building Inspector A910 Date 1151/1/19A2 --S If At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted......................................... 2. Plot plans, 3/4 sets, signed by preparer of plans . ......................... . 3, Complete plans, 3/4 sets, signed by preparer of plans . ..................... . .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form. ............................................. 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ ......................................... . 11. Impact fees as shown on attached schedule. ............................. . 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . .......................................: . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. ......... . 19. Driveway permit (construction aPpr al required prior to occupancy). .. .. ... . 20. Pre -inspection for 'L� Frea ildin, �°n ..ue p IfA2 ZA/GLS �Q/��/�'�' _required . . to Building Inspector �� (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner . .......... . 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ........................................ . 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :........ . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ....................................... 32. Plan check list . ..................................................... 33. .34. Whe you issue the permit, process as follows: Mail to owner. Mail to contractor. TelephoneS33-235/ and hold for pickup at DGo o office. Deliver with inspector. Other Parcel Creation Acreage 'Applicant j t -P &7 Doe Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date 41 Contractor, designer, owner, was advised of above required data by _ phone -mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER=BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit - will be issued until this verification is received. I personally plan to provide -,the major labor and materials for construction of the proposed property improvement (�(s or no) 0 T (have/have not-) IV',4 V(e signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. -I plan to provide.portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: /% Property Owner R�t.�t�G�-G✓l Social Security Number Date NOTE: This Owner -Builder Verification is sent to,you as required by Sections 19831 and 19832 of.the:California-Health and Safety Code. - - This verification must be completed and returned to our offfT ���,t},,efo we are per' mitted to issue the permit. �Gvy�p�i�d6, �9 COUNTY OF BUTTE - DE'PAR'TMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER OoZ7' O —D33 ZONIN „�- BUILDING PERMIT OWNER/� v1 Wit/ lune, jni o TELEPHONE 533 - 23 5i SO. FT. OCC. BUILDING VALUATION OWNS 'S MAI ING ADDRESS I/n (i e� 0 �� E7 CONT�: AC'S NAME YTOR TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 155,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 2.82 Gaya eras Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap I 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 1 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New❑ Addition Remodel❑ Utilities Installation❑ Other ❑ Describe work: ,�j�et,�i (� iii✓ SP�fY) Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200V OR LESS 00AORLESS 18.50 CONTRACTORS LICENSE LAW 1 declare under penalty of perjury p y p I y (check one): ❑ I am licensed under provisions of Chapt. 9, DIV. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. Classification as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract - ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000AI 37.50 NEW CONST. DWELLING OCCUP.aI\ 3.37.564 t. OR ADONS. ACC. BLDGS. lI NEw CONST R. ULT LOUT LET NON_R ESID BRANCH CIRC ITS @ 5.00 APPARATUS &) (SINGLE OUTLET CIR. / Ex. Occup\OUTLETS OR FIXTURES 20 V 7154 FIXED API, Ex. OCCUp. OUTLETS PIRESID IKEA.) j 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Penult Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIirig Fee 15.00 Heating Cooling Hood 6.50 Ventilation Penult Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County or Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County' in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct. ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ 33v r+Az DFEES IMP FL000 coF PARCEL PO n0 IS This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do `Mork indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. 136Gb0- WMITC-D.H.W., 7ELL0W-A$e C99OR, HINx-IN 9PCCTOR. Gala EN Ra D -APPLICANT ' i' /.s.� ,y.. '�{� � - � � r .. V .. �. '�i. � 4. .. u - ..�. •6 ..i �_ � .. t.: y✓i' ., n; Y 4,• j + 1 1 4 OFFICE C9TY ` ) v`(" r .5 Addres ' �r ' GAS` Da..`;+� � + Meter By ELECTRI Da e Meter. By' �i COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville; CaliforAia 95965 - Telephone: 916/538-7541 APPLICATION ANn PFRUIT PERMIT O. ASSESSOR PARCEL NUMBER 027-090-033 OWNER ZONING A-5 BUILDING PERMIT Ruben Medrano TELEPHONE 533-2351 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. 130x 24, Palermo 95968 CONTRACTOR'S NAM E Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee �R�� c7r if3 Ave. Palermo PLUMBING PLUMBING PERMIT Filing Fee 15.00 Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Q Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G IW @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities [n Installation❑ Other ❑ Describe work: New ruin Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee U.15.00 Main service 600V OR LESS j 18.50 1ti 200A OR LESS r CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) El I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000AI 37.50 NEW CONST. / DWELLING OCCUP.6\ 3.6Q sq.ft. OR ADDNS. 1 ACC. BLDGS. / NEW CONSTFt UL I.OUTLET _NON ESID BRANCH CIRC ITS @ 5.00 APPARATUS e� SINGLE OUTLET CIR. 20 76 Ex. Occup(OUTLETS OR FIXTURESFIXED ALNS.Ex. Occup. OUTLETS.((RESID.)REA.1 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 Permit Fee s33.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor Al�, cp MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 il l Ventilation Vent Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X ,. `� ' t -n-1 -4 Date I { — (A % % Signature of Applicant — Owner%,Contractor ❑ Agn;� An OSHA permit is required for ezeavations over 5'0" deep and demolition or construct- ion of structures over 3 stories,in height. L �,� Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ 3 .►SA -y$ HAz 1 0FEES I IMP I FLOOD I COF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provi- sions of the Bute County Code and/or resolutions to do ` f Work indicated a�Dve�for which fees have been paid. y / 617TOR OF PUBLIC WORKS B // / " N y�' ate /�� PERMIT EXPIRES Date — n Receipt No. 0 �� ltci�e%�� - %5D� / WHITE -D. P. W., TEL LOW-A88[880Jt! PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT.OF PUBLIC WORKS PERMIT 0. 7 County Center Drive - Oroville, Califo(iiia,959A - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 027-090-033 ZONING A-5 BUILDING PERMIT OWNER Ruben Medrano TELEPHONE 533-2351 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. BOx 24, Palermo 95968 CONTRACTOR'SNAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ Palermo PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ® Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities M Installation❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORRLESS 1 18.50 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification as the owner, Or my employees with wages as their sole compen- at ion, will do the work,and the structure Is not intended or offered bf-or sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000A) _37.50 NEW CONST. / DWELLING OCCUP.p(\ 3.6Q sq.ft. OR ADDNS. 1 ACC. BLDGS. // NEW CONSTR. ULT' -OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 (POW OWER APPARATUS h\ SINGLE OUTLET C'R. EX. OCCUp(OUTLETS OR FIXTURES 20 76 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID,) EA.) 1 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00)!5.00ors. Misc. Wiring -15.00 Permit Fee $ 33.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Not ce to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. �t� Contractor a60 MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against ail liabilities, judgments, costs, and expenses which may in any way accrue aga,iF�st said County in consequence of the granting of this permits` �y X �"e"'t �,G,�/�y� Date " (u " I Signature of Applicant — Owner Contractor ❑ Ag An OSHA permit ;s required for ovations aver S'0" eep and demolition or construct- of structures over 3 stories •i height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ -33.6-�j8� HAZ DFEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the e C unty Code and/or resolutions to do work indi t a v or which fees have been p ;d?ion or PUBLIC WOR By ate�6 PERMIT EXPIRES Date /6 9 Receipt No. 136002 ' 1��5(Xj i$ ✓ WNITC-D.P.W., YELLOW-ASSE930 PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DEVELOPIAENTSERVICES -BUILDING DIVISION 7 COUNTYCENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMITAPPLICATION DATA SHEET OWNER rbe,✓ ,%✓l � .4ND A. P. No. O Z- 7 - 010 - a 33 Proposed Building Use lek/ 5 c,-OlL�5 Building Inspector /to Date -11119-12-:r At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE' RECEIVED BY 1. All items have been submitted......................................... 2. Plot plans, 3/4 sets, signed by preparer of plans . ........................... 3_ Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets:- ............ . 10. Fees of $......................................... . 11. Impact fees as shown on attached schedule . ................................. 12. California Department of Forestry plan approval/fees. ................ ............ 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department: ............. 15. City of Chico plumbing permit . .......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. .............. 17. Planning approval for (A) Use: (B) Parking: ........ 18. Contact Land Development about (A) Improvements (B) Drainage. ............ 19. Driveway permit (construction approval required prior to occupancy).. ............. 20. Pre -inspection for t/gZZAI�Js Yr'o% 10AW required. .. s ";,�� r;� g3 Date 21. Contractor's license information. (No., Name Style, Classification). ................. . 22- Certificate of Workmans Compensation Insurance . ............................ 23. Owner -Builder Verification (Given to owner , Mail to owner )............ 24. Recorded copy of Agricultural Acknowledgement Statement . ................. . 25. Letter of signature authorization . ................................ ........d.. . 26. Copy of recorded deed of parcel creation and 60 right of way to a public roa.... . 27.- Letter of intent on building use . ................................::...... . 28. Mobilehome utility clearance . ......................................... . 29. Documentation of legal access . ....................................... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ...................................................... 33. .34. ou issue the permit, process as follows: Mail to owner. Mail to contractor. !ff7TeIephones-?-3-ZS!5/_ and hold for pickup at oeo ,., office. Deliver with inspector. Other Parcel Creation / Acreage Applicant Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date - Copy of plans sent Health Dept. Fire Dept. Other Date- By The following data must be submitted prior to permit issuance: (Circle new item not checked. above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail- Counter -by _ Date - Contractor, designer, owner,<was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works 3 COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: .916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary.delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the ma' r labor and materials for construction of the proposed property improvement ( es or no)_K� 5 JI /have not) �U A VC signed an application for a building permit havfor the proposed work. 3. I have contracted with the following person (firm) to provide the.proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, -.but I have hired the following person to coordinate, supervise, and provide the major work:' ..Name Address City. Phone Contractors License.No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property Owner Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of -.the California Health. and -Safety_ Code..- . - afi� 4 l add This verification must be completed and returned to our o' ffice be fMeWfflipdre per- mitted to issue the permit. • aunsaioA.0 OO U COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER dZ%-Q 0 --D33 ZONING - BUILDING PERMIT OWNER �J �N u� TELEPHONE 5-33-2351 SO. FT. OCC. BUILDING VALUATION OWNER'SMAILING ADDRESS , . ,max Z - � ���e.-M n 44 95 CONTRACTOR'S NAME eJe__ TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER - LICENSE ND. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 1 7.00 Each qas water heater or vent 1 7.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other �T SPECIFY Gas piping system 1 - 5 outlets 1 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition El/Remo el ❑ Uti lities Al, Installation[] Other ❑ Describe work: GW f/i%i��,/l�!'' Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50J•/ -SO CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No.. ClassificationAl I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract - ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000A1 37.50 NEW CONST. DWELLING OCCUP.9 OR AODNS. ACC. BLDGS. // 3.64 sq.ft. NEW CONST_ ULTI-OUTLET NON.RES10 BRANCH CIRC ITS @ 5.00 POWER APPARATUS &) -SINGLE OUTLET CSR. Ex. Occup(OUTLETS OR FIXTURES 20 76d r&drA FIXED APLNS.❑ Ex. Occup. OUTLETS PRESID IREA.) j 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ 33.5 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LContractor Contractor MECHANICAL PERMIT FiIirig Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ I cCrUry Ina[ 1nave reaa inls application and state that the above info rmaton is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over stories in height. Receipt No. 13640e>Z WNITE-D.P.W.. YELLOW-ASDE970R, PINK -INSPECTOR. GOLDENROD -APPLICANT Mobile Home installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 33� ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date fi 027-09-0-033 937967-E MEDRANO, RUBEN - 2825 LOUIS AVE, PALERMO •ELEC SERV / SF . 7 4 t 'OFFICE COPY % t LAdyDICy F-1 ZONING A-5 p e ', SQ. FT. OCC. BUILDING VALUATION COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION ANb PERMIT PERMIT NO. ASSESS,6R PARCEL NUMBER n?.7-09n-033 OWNER ZONING A-5 BUILDING PERMIT Ruben Medrarto TELEPHONE 533-2351 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 24 Palermo 95968 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ Ri i A P Palermo PLUMBING PLUMBING PERMIT Filing Fee 15.00 Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF.Q Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 1 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities n Installation ❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 18.50 . U CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification Q I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or, offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO I000A1 37.50 NEW CONST. ( DWELLING OCCUP.d+\ 3.64sq.ft. OR ADDNS. ACC. BLDGS. / NEW NON •RESID R. BRANCH CIRCMULTI-OUTLETI TS @ 5.00 /POWER APPARATUS R) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 @ 76 Ex. Occup. OUTLETS (RESID )KEA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring "15.00 .DO Pre -Inspection !0. 2 ". Permit Fee $ COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I�1 I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you becomelsubject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor 1A 19. -SWORKMEN'S MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X ` f Date 0— { f " J Signature of Applicant — Owner ❑Q Contractor ❑ /, ,,r h'I An OSHA /� permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in eight. (- r_ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE 55--5° I HAz I DFEES I IMP I FLOOD I CDF PARCEL PD I HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte ounty C de and/or resolutions to do work indicate abov for hich fees have been aid. I p IRE O PUBLIC WORKS & �l By Date PFKMIVEXPOIES Date `o' 1 r 05� _ �� o� Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Cali%rnia 95065 - Telephone: 916/538-7541 APPLICATION AND PERMIT �_v PERMIT NO. ASSE'SS'OR PARCEL NUMBER 027-090-033 ZONING A-5 BUILDING PERMIT OWNER Ruben Medrano TELEPHONE 533-2351 SQA FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 24 Palermo 95968 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN C Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF EI Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ® Installation ❑ Other ❑ Describe work: New Main Service Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 200A OR LESS 1 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under p ❑ provisions of Cha t. 9, Div. 3 of the BUS Ines$ and Professions Code and my license IS In full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO t000A) 37.50 NEW CONST. DWELLING OCCUP.yd\ OR ADDNS. ACC, BLDGS. / 3.60 sq.ft. NEW CONSTR. MULTI -OUTLET NON .R .RESBRANCH CIRCUITS) @ 5.00 (POWER APPARATUS &) SINGLE OUTLET CIR. EX. OCCUp(OUTLETS OR FIXTURES 20 @ 76 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring S 00ors. -15.00 Pre -Inspection 1 2C.00 20.00 Permit Fee $ 53.50 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. (j I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor 6 9.!50 MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the CountyOt Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in cons,egquence of the granting, of this permit. C� X < - `'e C�l%L Date - I I Signature of Applicant — Owner ® Contractor ❑ An OSHA q permit is re sired for ei ations over S'0'Lde emolition or construct -p ion of structures over 3 stories in ei ht.AtCA Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ �° HAz DfEES IMP FLOOD COF PARCEL PD HD ISSUE This permit is hereby issued under the sions of tWButtounty C de and/or work indiv fo hich fees PUBLIC BY P PIRES Date applicable provi- � resolutions to do have been paid. WORKS Date y�L Receipt No. 136002 t�si _ M3700 WHITE-O.P.W., YELLOW -ASSESSOR, PI K-NSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 P.ERMIT APPLICATION DATASHEET OWNER 'Ude %�► /ANt� A. P. No. O 2- 7 - 010 - o Proposed Building Use Building Inspector /20 Date At time of permit application, I was advised the following data must be submitted prior to permit. processing and/or issuance: DATE RECENEW By 1. All items have been submitted......................................... 2. Plot plans, 3/4 sets, signed by preparer of plans . ........................... 3_ Complete plans, 3/4 sets, signed by preparer of plans . ....................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings.. ....................... . 8. Engineered truss details and layout in duplicate (required prior to plan- check)........ 9. Mobil home data and manufacturer's installation instructions, 2 sets_ ............... 10. Fees of$ ......................................... 11. Impact fees as shown on attached schedule . ............................... 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . .................. 14. Sanitation and plot plan approval Health Department . ............. 15. City of Chico plumbing permit ......................................... . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: ........ 18. Contact Land Development about (A) Improvements (B) Drainage. ........... . 19. 20. Driveway permit (construction appral required prior to occupancy).......... , .. . Pre -inspection for i�AZZAId- Yr'o%/-/y.s�•� required- a iia .. 21. Contractor's license information. (No., Name Style, Classification) . ................ 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner _�. .......... . 24. Recorded copy of Agricultural Acknowledgement Statement . ................... 25. Letter of signature authorization . ......................................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ....................................... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan checklist...................................................... 33. 34. Whe you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone,q3 3 - X35/ and hold for pickup at office. Deliver with inspector. Other Parcel Creation Applicant 4L - Copy of Haz-Mat form sent Health Dept. Fire Dept. .Air Pollution- Date. Copy of plans sent Health Dept. Fire Dept. Other --.Date-- By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer; owner, was advised of above required data by _ phone _ mail,: Countevbya_ Datet Contractor, designer, owner, was advised of above required data by _ phone•_ mail: Counterbyr_ Date, Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works �, COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your.name and bearing your signature. Please complete and'return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued. until this verification is received. I personally plan to provide.the major labor and materials for construction of the.proposed property improvement (yKs or'no) , e, I (have/have not) QJ -pr (le, signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan- to provide portions of this Work, but I -have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide.the work indicated: Name Address Phone Type of Work Signed: Property Owner Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required y SIPt=ons 19831 and 19832 of the California Health and Safety Code.- -- - -��0 � i � � This verification must be completed and returned to our office orLMAve are per- mitted to issue the permit. �pv COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER .?'7-090 - p ZONING A _S BUILDING PERMIT OWNER eohelt)e "- No TELEPHONE 533- 23 SO. FT. OCC. BUILDING VALUATION OWNE 5 MAILING ADDRESS n J )9 C) .01/erm'D 59G� CONTRACTOR'S NAME dCdNe*!�_ TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS '`n, U �� �l�Y/rl� Permit fee $ PLUMBING PERMIT Filing Fee 15.00 2f�ZS Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF FO' Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home I S I G I W @ 15.00 TYPE OF WORK New ❑ Addition Remodel 1Utilitiey$K Installation[] Other ❑ Describe work: ���.0 serol G e Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 8_5-p CONTRACTORS LICENSE LAW I declare under penalty of p y perjury lur y (check one): ElI am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO IOOOA1 37.50 NEW CONST. DWELLING OCCUP.y` 3.6Qsq.ft. OR ADONS. ACG. SLOGS. II NEW CONSTR. ETI -OUTLET NON.RESID BRANCH CIRC ITS @5.00 POWER APPARATUS F1 SINGLE OUTLET CIR. Ex. OCCup(OUTLETS OR FIXTURES 1111-0 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) I 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 7'/,-- r :/ Za " Permit Fee $ 573- 5c'9 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct. ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ HAz OFEES IMP I FLOOD I CDF PARCEL PD IID SSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date M --- „_ /.369007- I PRE -INSPECTION ;. OWNER: �� �� /ISD DATE LOCATION: 028/` ;2 2�'a , �8Z3 �' A. P. - # OZ 7- CONTRACTOR: dWNr ZONING J .PRE -INSPECTION FOR: i%U�i1iZL� .-l,�Ai✓ts` ADP ��u/ S2�v+ceS �� �f l < </ Gt c�us�s �N�-:.... o......_.._,s�•yE_.:�ll,sc Gli�%LYiV� f%sv�s�-opt % P/ G�t�c� �"•����E Xl7 Grous DATE TO INSPECTOR= PERMIT HISTORY: NONE AS.FOLLOWS: �. TYPE OF OCCUPANCY '7' ' — {�6UIse FIELD INFORMATION ,. .•� BUILDING .USAGE: TENNANT• 4 ' E21OCCUPIED EZ/HAS ELECTRIC F�AS GASEQ--HAS. SANITATION FACILITIES e [� HEATED -COOLED PERSON CONTACTED //1/) 1. C X?� OTHER COMMENTS: C 6�EC✓C /W S /,o f'U��ln C o vvl ►� �-� �.t'J,�Cu! �� yiJ Lo c Ly �S � e o, �Z._Y Ca,�r,�.�-r� ' t JA.7 Te ACTION RECOMMENDED: o N04D ' ISSUE 0 HOLD FOR OTHER: L� 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: 2825 LOUIS AVE Owner: Permit NO: B07-2466 APN: 027-090-033 MEDRANO RUBEN & GRAC, Issued Date: 12/05/2007 By TMP Permit type: MISCELLANEOUS P O BOX 24 Subtype: Remodel PALERMO, CA 95968 Expiration Date: 12/04/2008 Description: REROOF 30SQ.'S/WINDOWS 10/DO (530) 533-2351 Occupancy: Zoning: A5 Contractor Applicant: Square Footage: OWNER MEDRANO RUBEN & GRAC, Building Garage Remdl/Addn P O BOX 24 PALERMO, CA 95968 Other Porch/Patio Total (530)533-2351 FEE INFORMATION DBMSC Remodel -Residential $379.93 Total Charged: $379.93 Fees Paid: $379.93 Balance Due: $0.00 Receipt No: B5516 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License OWNER / / Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, , also requires the applicant for such permit to file a signed statement that he or she is licensed I HEREBY 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 pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 X 12/05/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; check one of the following: Contractor's Signature Date AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE W(0MPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR WORKERS'COMPENSATION DECLARATION — OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ❑ I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier: Policy Number: Exp. Date: (This section need not a completed if the permit is or one hundred ollars ($100) or less. ❑ I AM EXEMPT under Section B. & P.C. for this reason: ❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' X-1��-1-2/05/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions. X 12/05/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and Slate laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. 1 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 HUNDRED THOUSAND DOLLARS $100,000 ADDITION TO THE COST OF COMPENSATION, ( ) injury, including death, and property damage caused arising out of, in any way connected with ,'IN DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the issuance of this permit. I hereby acknowledge thatt is issuance of this pea rmit does not authorize the 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. 1 hereby certify that I am the property owner or am authorized to act on the property owner's behalf. CONSTRUCTION LENDING AGENCY - - -12/05/2007 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Na a of Permittee [SIGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner Contractor OR; DAgent for Owner Agent for Contractor FILE COPY. Lender's Address City State Zip 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty:neVdlds "PLEASE PRINT CLEARLY" APPLICANT INFORMATION OWNER INFORMATION Last Name a First re Mailing Address - City State State Zip Phones _ Fax Fax E-mail Lic. # APPLICANT INFORMATION CONTRACTOR Name City Address Zip fQ�� I City State Zip Phone Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip fQ�� I City State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Iyubal Address W City '�— State Zip fQ�� I Phone—Fax t E-mail APPLICANT SIGNATURE X r PERMIT NO. e�6.2 - BIN # PROJECT LOCATION API 9 .� Property Address City oroy C WORKER'S COMPENSATION Policy Number A Carrier 0& 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 VIA— Address —Address _DESCRIPTION OR SCOPE OF WORK: S t Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood7ETy—peConst. SRA Yes No Occ. 'Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. n If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal n income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks to you if you do not cavy out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perforin their work personally or through thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. I PERSONALLY P TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. " OR NO) 2. I (DE/HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: ADDRESS CITY PHONE CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: ADDRESS CITY PHONE CONTRACTORS LICENSE NO 5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED: NAME ADDRESS PHONE TYPE OF WORK Description: REROOF 30SQ.'S/WINDOWS 10/DOORS2/SIDING 166 LN.FT. Reference Number: B07-2466 Applicant Name: MEDRANO RUBEN & GRAC, Owner's Name: MEDRANOftUBEIIJ & GRA/C, AP Signature of Property Owner: (/� Date :027-090-033 0