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Home My WebLink About028-063-025a 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: 10115 PALERMO HONCUT HWY Owner: Permit No: B07-0317 APN: 028-063-025 CARMONA, CARLOS LOPEZ & Issued Date: 02/20/2007 By KEJ Permit type: MISCELLANEOUS 10129 PALERMO HONCUT HW Subtype: Gas Reconnect OROVILLE, CA 95966 Expiration Date: 02/20/2008 Description: REPLACE EXISTING GAS LINES A (530) 743-7716 Occupancy: Zoning: Contractor Applicant: Square Footage: UNKNOWN CARMONA, CARLOS LOPEZ Building Garage Remdl/Addn 10129 PALERMO HONCUT If i OROVILLE CA 95966 ' Other Porch/Patio Total (530)743-7716 FEE INFORMATION DBP Gas System $55.00 Total Charged: $55.00 Fees Paid: $55.00 Balance Due: $0.00 Receipt No: B1894 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 UNKNOWN / / 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 appl cant 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 X basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil of not more than five hundred dollars 02/20/2007 penalty [$500]; Please check one of the following: Contractors Signature Date ❑ 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 WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: HAVE the work himself or herself or through his or her own employees, provided that such improvements ❑I 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 byYYY••�i� 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. My Workers' Compensation insurance carrier and policy number are; The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Cartier. Policy Number: Exp. Date: (This section need not be completedis if the permit or one hundred ollars ($100) or ess. ❑ I AM EXEMPT under Section B. & P.C. for this reason: CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SSUED, 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' , ��02/20/2007 X compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions. X k k 2/20/2007 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 State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, injury, including death, and property damage caused arising out oof, or in any way connected with ,o the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the prop owner am ori;d to act on the property owners behalf. CONSTRUCTION LENDING AGENCY C 02/20/2007 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Pe ittee [SIGN] Pflnt Dat p the performance of the work for which this permit is issued. (3097 civ. code) IY CJS Own, Owner 1:1 Contractor OR. ElAgent for Owner ❑Agent for Contractor �=' FILE COPY Lender's Address City State Zip i 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 APPLICATION .Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name 'n ,r 2b6 irDt't�ar� C/�� Mailing Address I Q�nr City I Ui 0 - - City l/ EFa E-mail— APPLICANT INFORMATION CONTRACTOR CONTRACTOR Name City Address - - City Fax State Zip Phone Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address - - City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE PERMIT NO. C? uq •BIN # PROJECTLOCATION Zoning Flood Zone SRA Yes No MlILLLW.� WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must he shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK: Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const.