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HomeMy WebLinkAbout027-260-015l6� WHEELER, Kenneth U. 3259B � FIRE DAMAGE REPORT DATE:- Corner ATE:Corner of Louis & Daly, Palermo CONTR: C&G Builders Inc., 1610 Harrison St., (alum.siding & windows - 2 houses) Oakland 1306-2616 027-260-015 MISCELLANEOUS HVAC Changc Out REPLACE DUCTWORK 2970 LOUIS AVE -- LAND, DAVID W & MARJORY M 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: 2970 LOUIS AVE Owner: Permit No: B06-26)16 APN: 027-260-015 LAND, DAVID W & MARJORY Issued Date: 11/07/2006 By KCG Permit type: MISCELLANEOUS 2970 LOUIS AVENUE Subtype: HVAC Change Out OROVILLE, CA 95966 Expiration Date: 11/07/2007 Description: REPLACE DUCT WORK Occupancy: Zoning: R1 Contractor Applicant: Square Footage: GALLAGHER'S HEATING & AIR GALLAGHER'S HEATING &, Building Garage Remdl/Addn PO BOX 35 PO BOX 35 LOS MOLINOS, CA 96055 LOS MOLINOS, CA 96055 Other Porch/Patio Total (530) 384-2444 (530) 384-2444 . FEE INFORMATION Heat Pump (Package Unit) $55.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires GALLAGHER'S HEATING & AIF 777334 / C20 C38 / 04/30/2008 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a d e I. 11/07/2006 Cb-AICT010ignature Date WORKERS' COMPENSATION DECLARATION I I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier: State Fund Policy Number:713-0013855 Exp. Date:05/01/2007 (This section need not be completed if the permit is or one un red dollars ($100) or ess. ❑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 olCalifornia, and agree that if I should become subject to the workers' compensates provis ns of Section 3700 of the Labor Code, I shall forthwith comply with those 11/07/2006 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State • Zip Li Balance Due: $0.00 Receipt No: B793 OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500); Please check one of the following: I ❑I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). E1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). riI AM EXEMPT under Section B. & P.C. for this Owners Signature 11/07/2006 ` Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnity, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte , m ounty erAer t§ above myntioned property for inspection purposes. I hgreby certify that I am the 1/07/2006 name Irermmee FAUNJ _ rrint Date Owner ContractorOR; Agent for Owner Agent for Contractor FILE COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" _____APPLIP,4NT SIGNATURE � e For office use only: OWNER INFORMATION Last Name r „ _s H dot7 C ► Addres Firs e Address © L&Lj,,r S A v e—) City Zip��7J State Zi Phone !� r / Fax E-mail Class _____APPLIP,4NT SIGNATURE � e For office use only: CONTRACTOR Name r „ _s H dot7 C ► Addres ez�5— City al/nos Stat Zip��7J Phon 5R � ( d `T � V4 LA i —t I Fax E-mails Planner Lic. # �.1, Class _____APPLIP,4NT SIGNATURE � e For office use only: ARCHITECT/ENGINEER Name r „ _s H dot7 C ► Address ez�5— City al/nos State Zip Phone Book Fax E-mail Planner Slate License Number _____APPLIP,4NT SIGNATURE � e For office use only: APPLICANT INFORMATION Nameat r „ _s H dot7 C ► Address 20 ez�5— City Lo al/nos waterA Zi Phone Oz Book Fax E-mail Planner _____APPLIP,4NT SIGNATURE � e For office use only: Zoning Property Address LQ - U I Flood Zone ISRAI WORKER'S COMPENSATION Yes • No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. RP rfiNk BIN 4 PROJECT LOCATION AP# 02 - 0- 015 Property Address LQ - U C' m Cross Street WORKER'S COMPENSATION Policy Number Carrier i If hiring anyone other than license conVactors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: cc &Lkct coo Ir - Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): OVER FOR SUBMITTAL REQUIREMENTS �L K:\FORMS\BUILDINO,FORMS\BldgApplSubRgmts.doc Page 1 of EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: {� , Amount: Bldg I ' SRA Receipt #:� Sheriff SMIP Date: � �y r_1 Other 00 lb 1 Other Total REV 8-12-05 FIRE DAMAGE REPORT OWNER: ,�,-�� DATE:`` 5 LOCATION: n A.j�,Ave, A. P. # (_0 a 7 a --(0d CONTRACTOR: DATE TO INSPECTOR: o PERMIT HISTORY ( ) NONE Building Description: Commercial/Usage: _ Residential # of Units: ZO G: ( FOLLOWS: BUILDING INSPECTOR'S REPORT Currently Occupied' (- ) Yes AbandonedNacant: Electric: Gas: ( ) No Electric Currently ( ) On ( ) Off Condition of Electric Currently ( ) On ( ) off Condition Sanitation: Plumbing Worldng () Yes () No Obvious Sewage Problems ( ) Yes ( ) No Mobile Home Condition of Utilities:( ) Damaged -Requires Permit ( ) Undamaged —No Permit Required Description of Damaged Area: /y O O u r— . CL D A/O Acz= rTp Estimate Cost of Repairs: Condition of Foundation: ( ) Good ( ) Poor Explain if repairs needed: Inspector: Sketch building on reverse and indicate area of damage. Date: /---z 01K 02�-Zo0-0t1; CDF/BUTTE COUNTY FIRE INCIDENT LOG DATE 1 2/1 712 0 0 3 REPORT TIME 12:49 LOCATION 2970 LOUIS AVE RP MARJORIE INCIDENT NUMBER LOCAL FIRE NUMBE STATE FIRE NUMBER CASE NUMBER PHONE NUMBER 532-1515 WILDLAND FIRES ❑ ESTIMATED ACRES STRUCTURE FIRE RESIDENTIAL OTHER FIRE MEDICAL AIDS PSAIOTHER HAZ MAT COMMENTS FIRE AROUND FLUE ON ROOF EMD ❑ OES ❑ 14757 LOGGED B JAMC ®® I A I ew nl Fl,w RO COLBY 678 I wst Ctotw Flm MRru.c BI wxtCnsw a MEDICS -- PRA R13 ECC ❑ �® REPORT METHO r9717-- FIRE 11 FIRE INFORMATION FIRE INFO SENT HO E-MAIL BY JAMC TO 7 -DAY LOGGED ❑ INITIALS TAMC INCIDENT NAM LAND START DATE 12/17/2003 START TIME 8:00 DIAMOND # 2.0 CAUSE EQUIPMENT LAND USE IDOMESTIC^ ACRES 0 TYPE OF ACRE DIAMOND 5 ONLY $ DAMAGE TYPE ALL OTHER DOLLAR DAMAGE Soo 0.00; SAVE F�50000.00 INJURIESIFATALITIES ❑ # CIVILIAN INJURIES r-7# CIVILIAN FATALITIES r # FF INJURIE r u # FF FATALITIES r 0 FC -40 INFORMATION ♦ ': New Incident + f FC -40 ❑ DATE OF FC -40 INC AGENCY INC # INC P# FC -40 COMP DATE® FC -40 COMP BY r County Notifications ❑ EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑ 'AMAGE REPORT 11171111c '11 W 7D Corner of Louis & Daly, Palermo CONTR: C&d—Bd—iIders Inc., 1610 Harrison (alum.siding & windows - 2 houses) Oakland