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HomeMy WebLinkAbout028-078-012r E� i . f C; -)g c�7 r E� i . f O io'le BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO). OFFICE #: (530) 538-7541 . PERMIT NO. BPO51522 B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 06/13/2005 APN: 028-078-012-000 the Business and Professions Code, and my license is In full force and effect. /��-•� !�� License Class: 10 License Number�(,`/�(2I� Site Address: 1368 LOWER HONCUT RD HON Datia i tis Contractor `.0` o r Fl ec-17 C Map Index: Description: temp power pole for cleanup) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stale License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: HATZIS GEORGE to its issuance, also requires the applicant for such permit to file a 3190 WOODSIDE ROAD signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section WOODSIDE, CA 7000) of Division 3 of the Business and Professions Code) or that he or 94062 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: BARKER ELECTRIC PP Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, P O BOX 8915 provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one CHICO, CA 95927 year of completion, the owner -builder will have the burden of 530-342-4806 proving that he or she did not build or improve for the purpose of sale.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: BARKER ELECTRIC and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). P O BOX 8915 ❑ I am Exempt under Article 3 of the Business and Professions Code CHICO, CA 95927 530-342-4806 Date: Owner: License #: 626363 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy#: Valuation: $0.00 v Census Code: 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 011 O become subject to the workers' compensation laws of California, r and agree that if I should become subject to the workers' 7Ivy compensation provisions of Section 3700 of the Labor Code, I shall fort/-hwith comply with those provisions. Date: !� Ap(.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is h eby i e nder pplicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Resolutions do w rri*ated ove i4lwhich fees have been paid. �^6 BY Date: Name: PERMIT EXPIRES ON: Address: Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the cluo authorized agent of the owner. I agree to comply with Butte County. I hereby all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of an ffi ial form or document o authorize representatives of Butte County to enter upon the above mentioned property for inspection / nppu/r�-o�es. (�J((e,Ee— r Print Name: X Jo V Signat fe: Date: ❑ Owner ❑ Contractor ❑ Agent for Owner /Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last Name irst Named Ls Address q W�—� S' ID e! ­o R,/ Cit es-fS� p� State ZipgVC 2 Fax Fax EE -ma APPLICANT NAME CONTRACTOR Nam /+_Y_` C Add < 5 City O Fax ate 7� Subdivision Name Ph �-3 _ , 1 Fax E-mail Date Approved: 'c. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State 7`1-P Subdivision Name Phone Page Fax E-mail Date Approved: State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE ('K_� 57, For office use only: Zoning Flood Zone -- 0`7 &- © l 2 SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BPO:57/S BIN # Page 1 of 2 Description or Scope of Work: Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be 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: N Bldg l� l bo SRA Receipt #: Sheriff SMIP � D11� / Other ate: Total REV 2-24-05 9 LOCATION AP#©2 -- 0`7 &- © l 2 P7 rrty�ddgress Bw�L �G v City 6�Q CrossStreet WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Description or Scope of Work: Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be 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: N Bldg l� l bo SRA Receipt #: Sheriff SMIP � D11� / Other ate: Total REV 2-24-05 9 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. - Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations, ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ .6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 12. Sanitation and site plan approval from the Environmental Health Department, If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 C C<�E - BUTTE COUNTY DEVELOPMENT SERVICES -eemplai:st Date:e-1- - r, Owner: Owner: C��O�'4� 17G�ZlS Address: f)1,90 L sia e lam' Wood 5q'n'�; a si4e Location: A4 4 1W A.P.# Zoning: Li Supervisorial District: Taken By: Lei' 1" BUILDING- HEALTH �r PLANNING i CAUTION: Yes No PERMIT HISTORY ON FILE: Z NONE, AS FOLLOWS: u. FIELD INFORMATION: TENANT: Address: 0 Description 9f ViQlation: OTHER COMMENTS: Approximate Building/Mobile Home Size: Approximate Building/Mobile Home Age: , Under Construction Built by/for: _ Has Power Written Notice Describe Action Taken: ACTION OMMENDED• Present Owner Previous Owner Occupied j Has Gas �• Has Sanitation Facilities Given & Attached Person Contacted 4 t Information Only, File 30 Day Letter 10 Day e er By: Date: Hold for Days Complaint Unfounded Other COMPLAINANT: ADDRESS: PHONE NUMBER: OTHER COMMENTS• { PAGE `T OF CDF / BCFD DAILY INCIDENT LOG JAY/DATE FROM 0800 Tim_ / - % DAY/DATE TO 0800 ..•,i ,.V I) t+t«tttt^«t+tttt+tttttttttttttt+tt++t+ttttttttttttt+.�4«t�wtt�.t+t�«««tt«ttt:tt V MISC.: ++ttt+tttt+tttttttttttttttttttttttttttttttttt+tt+tt++tt�+t«tom INC; FIRE # NAME �Zl>NCG�� TYPE'/" ttttttt+ttttttt REPOR TIME O START TIME U CONTR L TIME a23 U R.O. 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