HomeMy WebLinkAbout028-140-009A�
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ermit #349-77B(rer'oof/SF)
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028-140-009 99-0918'
TITTLE, Jehy
203 Tennessee Lane, Bangor
Conti: Tlion�pson's Triple'T Electnc
electfic
028-140-009� '3,0-3238
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JACOBSON, MISTY
BANGOR
pi
203 TENNESSEE LN,
Cont: KB SPENCER INC
NEW HVAC UNIT
-1306-'2253, '0 28-140-009
MISCLLAN"EOUS,-�.'Orivate Gdra�eShop
GARAGE/SHOP (1600
EE
203 TENNESS LN
JACOBSEN, MICHAEL & MIST
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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
VVEBSITE: www.buttecounty.net\dds
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. if Class / Expires
LANCASTER BILLY CSLB-869482 / B / 12/31/2007
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 and effect.
X 10/24/2006
Contractors Signature Date
I 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.
F-1 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;
Balance Due: $0.00 Receipt No:
OWNER I BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractors License
Law for the following reason (Sec. 70311.5), 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 Contractors 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:
D1, 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.).
1, 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
Contractor's License Law.).
Carrier: otdua runu Policy Number:238,002 1'9 Ep Dal,:05/01/2007
(This section need not be completed if the permit is or on. nFe-d dollars ($100)-o—r _Ie_ss_T_
F� I AM EXEMPT under Section B. & P.C. for this reast
1E�. 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'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith cornply with those
provisions.
X 10/24/2006
Signature uate
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
'he performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address
city state Zip
I X 10/24/2006
Owner's Signature Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or Occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection puToses
,1,6ereby certify that I am the
property owner or am authorized to act on th prop rty. rI5a>J.,1
AV"A61L -TAW,250J 10/24/2006
1`4�71 Owner Contractor OR: Agent for Owner Agent for Contractor
X^J El 1:1 El
FILE COPY
PROJECT INFORMATION
Site Address: 203 TENNESSEE LN
Owner:
Permit No: B06-2253
APN: 028-140-009
JACOBSEN, MICHAEL & MISTI
Issued Date: 10/24/2006 By J<EJ
Permit type: MISCELLANEOUS
PO BOX 364
Subtype: Private Garage/Shop
BANGOR, CA 95914
Expiration Date: 10/24/2007
Description: GARAGE/SHOP (1600)
(530) 679-0997
Occupancy: Zoning: A5
Contractor
Applicant:
Square Footage:
LANCASTER BILLY
JACOBSEN, MICHAEL & Ml��
Building Garage Remdl/Addn
11 REGENT LOOP
PO BOX 364
1,600
OROVILLE, CA 95966
BANGOR, CA 95914
Other Porch/Patio Total
(530) 679-0997
1,600
FEE INFORMATION
Fire Ping Appi Fee (SRA) -Bldg
$109.98
Fire Ping Appi Fee (SRA) -Fire-
$95.00
Garage - Wood Frame
$527.90
Garage - Wood Frame Plan Check
$351.94
SMIF - Residential
$3.80
Total Charged: $1,088.62 Fees Paid: $1.088.62 1
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. if Class / Expires
LANCASTER BILLY CSLB-869482 / B / 12/31/2007
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 and effect.
X 10/24/2006
Contractors Signature Date
I 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.
F-1 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;
Balance Due: $0.00 Receipt No:
OWNER I BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractors License
Law for the following reason (Sec. 70311.5), 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 Contractors 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:
D1, 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.).
1, 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
Contractor's License Law.).
Carrier: otdua runu Policy Number:238,002 1'9 Ep Dal,:05/01/2007
(This section need not be completed if the permit is or on. nFe-d dollars ($100)-o—r _Ie_ss_T_
F� I AM EXEMPT under Section B. & P.C. for this reast
1E�. 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'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith cornply with those
provisions.
X 10/24/2006
Signature uate
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
'he performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address
city state Zip
I X 10/24/2006
Owner's Signature Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or Occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection puToses
,1,6ereby certify that I am the
property owner or am authorized to act on th prop rty. rI5a>J.,1
AV"A61L -TAW,250J 10/24/2006
1`4�71 Owner Contractor OR: Agent for Owner Agent for Contractor
X^J El 1:1 El
FILE COPY
I
BUTTE COUNTY PERMIT
DEPARTMENT OF DEVELOPMENT SERVICES NO.
BUILDING PERMIT APPLICATION
AND. SUBMITTAL REQUIREMENTS
24 HOUR FNSPECTION4: OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834 BPQk�4
OFFICE #: (530) 538-7541
A FEE WILL BEREQUIREDAT TIME OFAPPLICATION
Website: www.buttecounty.net/dds
*.*PLEASE PRINT CLEARLY"i. 0'Pzqq0_ 0
OWNER INFORMATION
Last Name
Te
r ils",
Address
City 11;10GoR_ r's�
I zipc�V14
Phon
E-maif—
-77,A
al
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Ls �m
Book
Fax
E-mail
Planner
Lic. #gl
1 Cla ss
-77,A
al
APPLICANT INFORMATION
ARCHITECTIENGINEER
Name 1
1�4_
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Pro rt Address
1% 3
Flood Zone
Cross Street 0
SRA
I Yes
No
Occ. I
Type Const.
Subdivision Name Map
Book
I Page
Fo�
Planner
I Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PRO,JECT LOCA TION.
AP# . ... ...
Pro rt Address
1% 3
Cross Street 0
WORKER'S COMPENSATION.
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
, z w, , . - /—, I " /' r-- --) -
V U f V
Sq FT- Living Garage Open Cov
0 Structure Built without Permits
El Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF ATPLICATION
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: Bldg
�160 SRA
Receipt #: Sheriff
Date:
SMIP
Total
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.
0 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
0 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.
0 3. Engineered truss details and layouts in duplicate (if required). No faxes!
0 4. Energy compliance design and supporting documentation in duplicate.
0 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings,
0 6. Manufactured homes: (A) Install'ation manual, (B) Marriage line info,'(C) Flo6r Plan, (D) Tie down'6r fnd plans,
all in duplicate
0 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 enginee .
0 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
0 9. Site plan and business license approval from the City of Biggs.
0 10. Lefler of intent for non-residential buildings.
0 11. Building Permit Application Without Required Clearances Form
0 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.)
0
1 .
Agricultural Buffer clearance and site plan approval from the Ag Commissioners office (if re4uired).
0
2.
Impact Fees.
0
3.
California Department of Forestry plan approval (if required).
El
4.
NPIDES Form.
0
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0
6.
Contractor's license information. (Number, Name Style, Classification).
El
7.
Worker's Compensation Carrier and Policy Number.
0
8.
Owner -Builder Verification (if required).
0
9.
Letter of Signature authorization (if required).
0
10.
Recorded copy of Agricultural Acknowledgment Statement.
0
11.
0 Legal description from current recorded grant deed, 0 Copy of M.H. Title, Title transfer, or MCO.
El
.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\B1dgApp1SubRqmts.doc Page 2 of 2 REV 8-12-05
Department of Development Services
Building Division
7 County Center Drive
Oroville, CA 95965
(530) 538-7541 (530) 538-2140 FAX
SPECIAL INSPECTION NOTE
For Building Permit # 8P A*ssessor's Parcel # (40 -6t'5?
Special Inspections — California Building Code section 1701: In addition to the inspections
required by Section 108, the owner or engineer or architect of record acting as the owner's agent
shall employ one or more special inspectors who shall provide inspections during construction
on the types of work listed under Section 1701.5. The special inspector shall be a qualified
person who shall demonstrate competence, to the satisfaction of the building. official, for
inspection of the particular type of construction or operation requiring special inspection.
Duties and Responsibilities of the Special Inspector:
1. The special inspector shallobserve the work assigned for conformance with the approved
design, drawings and specifications.
2. The special inspector shall furnish inspection reports to the building official and the engineer
or architect of record. All discrepancies shall be brought to the immediate attention of the
contractor for correction, then, if uncorrected, to the proper design authority and to the building
official.
3. The special inspector shall submit a final signed report to the Butte County Building Division
stating whether the work requiring special inspection was, to the best of his or her knowledge, in
conformance with the approved plans and specifications and the applicable provisions of this
code.
4. The special inspector shall advise the contractor that Butte County Building Division
inspections cannot be delegated to him or her, so inspections must also be made by the Butte
County Building Division.
5. Any change in special inspection firms made after permit issuance shall be approved by the
Butte County Building Division prior to the new firm performing any inspections.
6. Special inspections are in addition to the regular inspections performed by the Butte County
Building Division. Butte County inspection approval and sign off is not to be construed as
authorization to proceed with work which obscures, covers or otherwise prevents proper special
inspection.
Special Inspection is required for the following items:
0 Reinforced Concrete (Taking of test specimens, placement of reinforcing and placing of concrete).
0 Structural Masonry
g High Strength Bolting
0 Welding
• Bolts Installed in Concrete
• Other:
Name of Special Inspection Company: 4,Q2?LIET�? Me=/ 4) (�2
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 75965
(530) 538-7601 Telephone
(530) 538-7785 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 protectyourselffrom
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 foryour benefit and
protection:
13 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.
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
a 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 carry 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 unders state law, contact the Department of Benerit Payments and the Division ofIndustrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform thier work personally or through thier own employees,
without a license contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons prefessing 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 requir3ed 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
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. 1 PERSONALLY PLAN To DkQVLDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT. (YES Oq2jO
,y
2. 1 (HAVEIHAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK.
3. 1 HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION:
NAME 13 -, I I 1� z Ating e rc- F_
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO Xg6??tT_Q
4. 1 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. 1 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: GARAGE/SHOP (1600)
Reference NLunber: B06-2253
Applicant Name: JACOBSEN, MICHAEL & MIST
Signature of Property Ovmer: Date:
BUTTE COUNTY FEE SUMMARY
7 County Center Drive
Oroville, CA 75965
Department of Development Services
Phone (530) 538-7541 Fax (530) 538-2140
Permit Number: B06-2253
Job Address: 203 TENNESSEE LN
Contractor:
Printed: 09/20/2006
2:12 pm
Fee Description Account Number Fee Amount Paid Date Pmt Amt
Fire Plng AppI Fee (SRA) -Fire -
0100 -450001-4617240-1010 $95.00 09/20/2006 $95.00
Fire Plng Appl Fee (SRA) -Bldg
0010-440001-4210500-1010 $109.98
Garage - Wood Frame
0010-440001-4210500-1010 $527.90
Garage - Wood Frame Plan Check
0010-440001-4210500-1010 $351.94 09/20/2006 $351.94
SMIP - Residential
Printed By: Alice Mefford
1001-0-280-1011298 $3.80
19088.62 1 $446.94
Balance Due: $641.68
At the time of permit application, I was advised the above fees are required prior ro issuance of the permit. These fees, may be changed during the plan
checking process.
Signature:_ Date: 09/20/2006
Pursuant to Government code Section 66020, you are herby notified those items listed above may been imposed on your project. You have 90 days from
the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a
protest are specified in Government Code Section 66020(a).
Butte County Department of Public Works
J. MICHAEL CRUMP, DIRECTOR
LAND DEVELOPMENT DIVISION
Storm Water Managment Program
7 County Center Drive
Oroville, CA 75965
(530) 538-7266 Telephone
(530) 538-7171 Fax
www.buttecounty.net/dds
(((OC
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0
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0
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National pollutant Disharche Elimination System (NPDES) Phase 11 Construction Storm
Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment
[LESS THAN 1 ACRE I
Reference Number: B06-2253
Location: 203 TENNESSEE LN
Parcel Number: 028-140-009
Owner Name: JACOBSEN, MICHAEL & MISTY
Description: GARAGE/SHOP (1600)
Date: 09/20/2006
By: AAM
Sub Type: Private Garaee/Shop
Phone: (530) 679-0997
By signing below, I the project owner/6wners' agent, certify that this project WILL NOT DISTURB 1 acre or more
of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California
Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but
when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm
Water Permit from the state of California Regional Water Quality Board.
I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water
Permit from the State of Califomia Regional Water Quality Control Board for this project that disturbes one acre or
more of land may result in revocation of grading and/or other permits or other santions provided by law.
Signed:
Title:
FILE
Date: 09/20/2006
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 75965
(530) 538-7601 Telephone
(530) 538-7785 Fax
www.buttecounty.net/dds
NOTICE TO BUILDERS '
Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In
addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental
Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to
expedite your permit:
0 Make sure your application is complete.
0 Be responsive to requests from County departments for any additional materials or requirements.
The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes
without a complete application adds to processing time.
Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not
started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to
expiration an indefinite number of times, provided construction progress has been documented by the Building Division during
each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In
order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking
and documentation may be required. Upon completion of work covered by this permit, please contact this office for final
inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is
issued without a final inspection.
EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY
Application for which a permit has not been issued will expire one year after date of application.
Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications
(not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are
for Plan Check and administration. The Plan Check portion of fees is reftindable only if the permit is cancelled or withdrawn
before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of
$54.99 to process the refund application will be assessed. Reftinds on permits (issued) may be requested prior to the expiration
of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any
refund amount) to determine no work was done.
Fee/refund information can be read on-line at http://municir)alcodes.lexisnexis.com/codesibutteco/
Reference Number: B06-2253
Location: 203 TENNESSEE LN
Parcel Number: 028-140-009
Date: 09/20/2006
Owner Name: JACOBSEN, MICHAEL & MISTY Phone: (530) 679-0997
Description: GARAGE/SHOP (1600)
Signature of Property Owner:ZIZ� Date: 09/20/2006
FILE
COUNTY OF -BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 9 Telephone (530) 538-7541
(Rev. 12/96) APPLICATION AND PERMIT 63 - _nlw
ASSESSOR PARCEL NUMBER 028-140-009
ZONING
BUILDINGPERMIT
OWNER
JACOBSON, MISTY
TELEPHONE
670-0997
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
PO BOX 5727, BANGOR 95914
CONTRACTOR'S NAME -
K. B. SPENCER INC.
TE E8307
8gUUNG ADDRESS
CON`rRACFj7 HASSM AVE, YUBA CITY 95991
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
203 TENNESSEE IN, BANGOR
Energy Plan Checking Fee $
$
PERMIT FEE
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.001
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome 0 Other
SPECIFY
Trap
7.00
—Each
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Other 0
Describe Work: NEW HVAC UNIT
piping syste!n 1 - 5 outlets
15.00
—Gas
Building sewer
15.00
Home ISI GI W1
@?20.00
-Mobile
PERMIT FEE
ELECTRICAL PERMIT
Filing Fee 20.00
500V OR UE::
Main Service OA OR LE
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (Commencin I se� 7 �0) of Division 3 of the Business and Rxqlfessions Code,
c s
and my I en 2 16S ?1 fu f Od effect. 0. C
License Class V Lic. N At4p C(CQ—
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, asownerof theproperty, ormy employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
0 1 have and will maintain workers' compensation Insurance, as required by Section
3700ofthe Labor Code, for the performance of workAr which this permitis issued.
My workers' compa,���ce c rrier and golicy. number are:
Carrier AAAA
Policy Number _-V A - —
(The above sections neea'n6t fie �:Fmpffited ifthe permit is -for work of a valuation
of one hundred dollars ($100) or less.)
0 1 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 workers'
compens n laws of California, and agree that if I should become subject to the
worker ' mpensation provisions of section 3700 of the Labor C all
f I ply with those provisions.
X nglk - A-1
Xat
p-licant - 0* Owner 0 i5o_ L�
Signatu�e_Jf Ap niactor Ag -en,
An OSHA permit is required for excavati!gsoyer 5101. epa demolition or construction
of structures
'NA stor!M ip4,eJigh
ReceiptNo.
Main Service 200A TO 1000A
46.00
NEW CONST. Ow�.LUNG UP. so
OR ADONS. S. 3.50FT.'
.. ff
= C ON MULT-0 —
ST =1 C%RCUITS 97.50
I D
OWER APPARATUS
PSIN.. OLrT. C..
20 @ 1.00
Ex. Occup. OUTLET OR FIXTURES BAL @ .50
O.FIXED APP . OR
Ex. Occup. J.= .) EA, 5.00
Temporary Service 23.00
-
Mobile Home Facilities 20.00
Wiring 23.00
—Misc.
I
PERMIT FEE
MECHANICAL PERMIT Filing Fee 20.00
Heating 5-10N 15.00
Cooling 25.00
Hood 6.50
Ventilation
PERMIT FEiE 60.00
Mobile Home Installation Fee
Energy Inspection Fee $
occ CONST. TYPE
TOTALFEE$ 60.00
HAZ. I D. FEES IMP OD CDF PARCEL I PD
I
F_ I
This permit is hereby issued under the applicable provisions
of '11
f e Butt unty Code and/or Resolutions to do work
e
%�,- 9,C0
indice Bdutt ve for 4hich fees have been paid.
4) lel
By Date
PERMIT EXPIRES ON
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 , Telephone (530)
A LICATION AND PERMIT
Rev.12/96) ZOWNG BUILDING PERMIT
.ASSESSOR PARCEL 14UMBER aig I- / 0 0
SQ. FT. OCC. BUILDING VALUATION
OWNER
OWNERS S 7- 7
cojaTRUcTiON LENDM
LEND FVS MAILNG ADDRESS
ARc rEcT OR ENCJNEER
AR OR ENGINEER'S MAILING ADDRESS
LOT _,O
I SUBDrVISIONS NAME
USEOFSTRUCTURE
SF 0 Duplex 0 Mobilehome Cl Other
TYPE OF WORK
New 13 Addition E3 PAftded E3 U6009s r-3 ln4&
r)pncribe, Work: qji'd� ff—I
45q I 5(_
1
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee, 20-00
Total Valuation
23.00
UCEME NO.
—
Filinci Fee
$
rES. MULTI -OUTLET C&7.50
UESNM! PRAMPH Cmmm
Permit Fee $
Ex. occup. ovnEr OR Fwnmm ELAL .50
FDMDAPPLNS. 0"
Ex. Occup. OUTLETS (RESIN El 5.00
Plan Checkinq Fee
Mobile Home Facilities 20.00
Misc. Wiring 23.00
Energy Plan Checking Fee
MECHANICAL PERMIT Filing Fee 20,D0
Heating f7 T 02� is
$
Hood 6.50
gOEL
4$;/;)
$
Mobile Home Installation Fee $
—
Energy rispection Fee $
PLUMBING PERMIT
CONST. TYPE
ITOTAL $
Filing Fee
Each Trap
7.00
I o. FEES IMP
Solar or heat pump water heater
I COF
23.00
Water piping
15.DO
Each gas water heater or vent
15.00
Gas piping system I - 5 outlets
15.DO
Building sewer
15.
Mobile Home I S J G I W I
@D20.00
20.00
20.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee, 20-00
( 8011V OR
Main Service .0. I=
23.00
PERMIT FEE PAID
SRA
SHERIFF $
OTHER $
$
AMOUNT RECEIVED 0
0
DATE RECEIVED
RFCFIPT 3q0q�a
Main'Service ( 46.00
NEW CONST. OWELUMM OCCUP. 3.50
OR ADDUS. & ACC. IMMS.
rES. MULTI -OUTLET C&7.50
UESNM! PRAMPH Cmmm
S1NrLE 0 Cm
Ex. occup. ovnEr OR Fwnmm ELAL .50
FDMDAPPLNS. 0"
Ex. Occup. OUTLETS (RESIN El 5.00
Temporary Service 23.OD
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 20,D0
Heating f7 T 02� is
Cooling —
Hood 6.50
Ventilation
4$;/;)
PERMIT FEIE
Mobile Home Installation Fee $
—
Energy rispection Fee $
CCC
CONST. TYPE
ITOTAL $
HAL
I o. FEES IMP
5FEE
I FLOOD
I COF
CEL
pD
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.
By Date
PERMIT EXPIRES ON Pale)
PERMIT INFORMATION:
CUSTOMER NAME:
PHYSICAL ADDRESS:
MAILING ADDRESS: 57 a 7
PHONE#
WORKMAN'S COMP INFORMATION: STATE FUND
(916) 924-5072
POLICY #1616799-03
EXP DATE 4-11-04
LICENSE INFORM, ATION CONTRACTOR'S LIC #664429 Exp. 2-28-06
TYPE,- C20
CITY LICENSE # EXP.
DETAILED WORK ORDER
VALUATION AMOUNT: $ 7A4-0-
CONTACTINFO:
R.B. Spencer, Inc.
118 8 Hassett Ave.
Yuba City, CA 95991
tel:(530) 674-8307
fax:(530) 674-9333
029-1 - 40"009 -9,9--0-918
TITfLE, Jerry,
203 Tennessee Lane, Bangor
Contr: Th�mpson's Triple T Electric
electric i
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMITgo.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 028-140-009
ZONING A5
BUILDINGPERMIT
OWNER TITTLE, JERRY
TELEPHONE
SO. Fr. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
203 TENMSEE UNE. BANGOR
CONTRACTOR'S NAME MEMIOTELEPHONE
THOMPSON'S TRIPLE "T" Z72--8932
CONTRACTOR'S MAILING ADDRESS
P.O. BOX 8779 PEN VALIEY, CA 959"
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
I
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
ILI CENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee $
BUILDINGADDRESS 203 TENVMEE LANE9 BA14GOR
Energy Plan Checking Fee
PERMIT FEE
LOTNO.
SUSIDNISION'S NAME
IPARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF CX Duplex EI Mobilehome 0 Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities A Installation 0 Other 0
Describe Work:
—Gas piping system I - 5 outlets
15.00
Building sewer
15.00
Mobile Home F� W�
@D20.00
PERMIT FEE $
ELECTRICAL PERMIT
Filing Fee 20-00
Main Service �".' . v. o' RR ' ss s'
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing �fith Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class 0 Lic. No. 70
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, 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.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, forthe performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensationArovisions of section 3700 of the Labor Code, I shall
it,"116se provisions.
forthwO comply w;h
X Date
Signature of -Applicant - 13 - Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A TO 1000A
46.00
NEW CONST. NG OCCUR
OR ADDNS. 01"
A CC. ...
S'67
3.50 FT.
NEW CONST. MULTI-OUT.L.ET
NON-RESID. BRANCH CIR ITS @7.50
,POWER APPARATUS
SINGLE OUTLET CIR
Ex. Occup. OUTLET OR FUTURES 20 @ 1-00
BAL @ .50
UTXED AP NS OR, 5.00
Occup. ETS (PLES,6.) E
—Ex.
Temporary Service 23.00
Mobile Home Facilities
20.00
Misc. Wiring 23.0023.00
FRE—INSPECTION
23.00 23—.M-
PERMIT FEE 89.00
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEiE $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 89.00
HAZ.
D. FEES 'MP
FLOOD
I CDF
PARCEL P.
-D
ISSUE
This permit is hereby issued under the applicable provis'ions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
PERMIT EXPIRES ON
I
Receipt N...2-
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
OWNER:
0
PRE -INSPECTION
DATE
LOCATION: ;Z -o -"3 qz, rLe- 55 A.P. #
CONTRACTOR: F7 -L VEA 42 P1 I
-�; F7;-;jt,-"'7-zq/ec--ZONING 14- 'Ir
If I
PRE -INSPECTION FOR:
DATE TO INSPECTOR__�V
PERMIT HISTORY: NONE AS FOLLOWS:
TYPE OF OCCUPANCY
FIELD - INFORMATION
BUILDING USAGE:
TENNANT:
[�j OCCUPIED ELECTRIC F:] HAS'GAS F]HAS SANITATION FACILITIES
HEATED-COPLED PERSON CONTACTED
OTHER COMMENTS:
ACTION DED:
SSUE HOLD FOR
OTHER:
COUNTY -OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDINa- DIVISION
7 County Center Drive -, Oroville, California 95965 o Telephone (530) 538-754*1
(Flev. f2/96) '.% ..APPLICATIONAND PERMIT
PERMIT NO.
2 ;6 Iq o _,0 c>j'_
BUILDING PERMIT
OWWA Je-1—j-
Ta""ONG
SO. Fr. OCC. BUILDING VALUATION
OV00%j WAA010 ADOAUS
2 c) 3
7'— H"M
77,-,7�
jumce"ONE
V24 _722-e1_3Z_
Z&_
'T�� NOAD
r,7;7
COWTNAMM LFmvt
L&WOM MAILING ADOAUS
Fire I..
Total Valuation
AACHrMCT OA E"WHEIM
NO.
Filina Fee 20.00
Permit Fee
AACWTTCT 04 040INEMI MOULING ADOMS
Plan Checking Fee $
SULDM AWAnS
:zz" L
Energy Plan Checking Fee
G cx�,' vz--
PERMIT FEE $
LOT NO.
IIIJIM)"C" MME
r,!�e t EL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF Pe"'Duplax CO Wbilehome 13 Other
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
Now (3 Addition 0 Remodel 0 Utilities 0-11-n'stillation 0 Other 0
Describe Work:
Gas piping system I - 5 outlets 15.00
Building sower 15.00
WbReHome ISIGIWI
PERMIT FEE
ELECTRICAL PERMIT Filing Fee 20.00
600v OR LIES11 —
Main Service 200A OA LM 23.002_440
Main Service 20" TO 1000A 46.00
NM COMT. WUL— occup, 3.5031L
OR ADONS. & AM. 0-08.
NM COMT. MULTI -OUTLET
NOZ.AESID. @7.50
L
Ex. Occup. ounEr ost =elm
"mAD L SAL 0 :so
Ex. Occup. Mo. ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Msc. Wiring 23. 0
PERMIT FEE 6
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood B.So
Ventilation
PERMIT FEIE S
Wbile Home Installation Fee
Energy Inspection Fee
Occ
--T'-P' ITOTAL FEE$
K&L
0. RD � IMP 1
0
1 CO"
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.
By Date
PERMIT EXPIRES ON
I (Dws)
ReceiptNo. 7—
WHITE-D.D.S.-S.D. SOR p.tjjc.jNSPECTOA GOLDEN I'FOC)*APPLICANT
,I - . -,n - �,.
%(COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
(Rev. 12/96) 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 028-140-009
ZONING A5
BUILDINGPERMIT
OWNER TITTLE, JERRY
TELEPHONE
SO. Fr. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
203 TENNESSEE LANE, BANGOR
COMPACTORS NAME 4TELEPHONE
THOMPSON'S TRIPLE 'IT" ELECTRI
272-8932
CONTRACTORS MAILING ADDRESS
P.O. BOX 877, PENN VALLEY, CA 95946
CONSTRUCTION LENDER
LENDER'! MAILING ADDRESS
Fireplace
Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
—Total
—Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee
$
BUILDINGAIDDRESS 203 TENNESSEE LANE, BANGOR
Energy Plan Checking Fee
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF 11 Duplex 0 Mobilehome 0 Other
SPECIFY
—Each Trap
7.00
Solar or heat PUMP water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities A installation 0 Other [I
Describe Work:
Gas piping system I - 5 outlets
15.00
Building sewer
15.00
-Mobile Home G W
@D20.00
PERMIT FEE
S
ELECTRICAL PERMIT
Filing Fee 20.00
( 600V 08 L�E
Main Service ." 0. L
23.00 2:J - UU
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing %�ith Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No. 20!e!�
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, 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.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A A—
46.00
NEW CONST. DWELLING OCCUR
OR ADDNS. & ACC. BLDS.
so.
3.50FT..
NEW CO 5 UTL.E',r
N-.ES"1`DT C'RC T.
.=O
@7.50
OWEI APPARATUS
&P3I.GfE CUTLET CIR
Ex. Occup. OUTLET OR FDffURES
20 @ 1.00
SAL 9_50
—Ex. Occup. .,F,T,EErA '(R.%.)0E,.
5.00
- Temporary Service
23.00
- Mobile Home Facilities
20.00
- Misc. Wiring
23.00 23.00
PRE—INSPECTION
23.00 23.00
PERMIT FEE
$ Ac). nn
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700of the Labor Code, forthe performanceof workforwhich this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT
Filing Fee 26.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEt
S
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensatioin,*rovisions of section 3700 of the Labor Code, I shall
f omply 'N��ithose provisions.
X Date f
Sig-nata—re-779p-plicant - EF—Owner 0 Contracto-r 0 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTALFEE$ 89.00
.Z
D FEES
FLOOD
CDF
I
P CEL
PO
I HD
I ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for w i h fees have
" ( A&"ate
PERMIT EXPIRES ON
_
the applicable provisions
Resolutions to do work
been paid.
::�c
6 *- L-:�-oon
(Date) I
ReceiptNo.;2- 6 418 q0
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
(Rev. 12/96)
I
C%UNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 * Telephone (530) 538-7541 PER
4w- 1
APPLICATION AND PERMIT M/37-
ASSESSORPAM&MAIM 5
zom��
BUILDING PERMIT
OWN" Z_
TV.0-moNe
SO. Fr. OCC. BUILDING VALUATION
OWMMI MOWUNG ADOAUS
7�'
7RAI'1641 MIJU10 ADDPEW
e /IV bl�lll
—b
COMITM.KTION LEWER
LEMOM MOUUNG ADOMS
Fireplace
Total Valuation
ARCHITECT 0A D"KIM
No.
Filina Fee
20.00
Permit Fee
ARCHITECT OR 04CIVEMS MAJUNO ADOMS
Plan Checkina Fee
$
OULOM AMPESS
Energy Plan Checking Fee
$
$
PERMIT FEE $
LOT 140.
SUBDIVIS10" NAM
P�ftft MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF a""Duplex 0 Wbflehome 0 Other
GPM"
Each Trap
7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent
15.00
TYPE OF Wo
New 0 Addition 0 Remodel 0 U11111ties rin't'llation 0
Describe Work:
Other 0
Gas piping system I - 5 outlets
15.00
Building tower 15.00
Wbfle Home IS1 G1 W1 @20.0
PERMIT FEE
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service ( =OR=
23.00 2_'&.00
Main Service 20" TO 100M 46.00
NEW CONST. owalim occup. 3.50 Go.
OR ADONS. 4 -ACC. -OLDS. FT.
NLW 1.0M 1. MULTI-OUTLEr
No',.AESID. BRAWN NMXM @7.50
Ex. Occup. wnzr oR FwnstEs SAL .50
Ex. Occup. MD-A"mL,"86-10- L 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Wsc. Wiring 23.00
e, 19 ,Z3,
PERMIT FEE
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood e.50
Ventilation
PERMIT FEt S
Wbile Home Installation Fee
Energy Inspection Fee
occ
CO -T. TYPE
ITOTAL FEE $
0 1 'up I
Am"
I co'?�17
1Q
I 'E,
ReceiptNo. X-9—t9yo
WHITE -D.D.S. .13.
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.
By
PERMIT EXPIRES ON
Date —
349-77B
iPERMIT NO.
PERMIT EXPIRES
OWNER Vic Strower
-CONTR. W. R. Kreiger, Sacramento
28-14-9
LOCATION (A.P.
E/S Tennessee Ln.,app.k mi.S.of LaPorte;Rd.,
app.-14.mi.E.of Bangor Cut Off Rd., Bangor Area
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
Z
' V B
FINALED
(Date
(SigrftTre)
Setback
Forms
Main Bldg
Footing�
Sternwal
Slab
Piers
Garage
Footing
Stemwa I
Slab
Carport_
Footing
Slab
Patio
COUNTY OP BUTTE — DEPARTAENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
LDING BUILD(ING (Cgnt'd) PLUMBING
i
Firewall
Soil Plpin�
Parapets
1st FloA
Restroom Finish
2nd FlooA
Windows
3rd Floorl
Siding
Topout I
Roof Sheathing J A
Water Pipingi
Roo f I n g
Sewer
Fdn. Vents
Fixtures
Garage Vents
Insulation V
Water Htr.
Heaters
Prov. for ph sically
handica pew ex. A
Conformance of
structure
Appliances
Gas Piping & Tkst
Temp. Gas
Final
J Sanitation
-PIREPLACi
Final
Footings Footing ELAECITRICAL
Masonry Walls Throat Rough
Reinf. Steel Final Fixtures
Bond Beam FIRE hPROKLERS Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MEC�ANICAL Grd. Fault Prot.
Scratch Heating A Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
DATE REMARKS OR ORRECTIONS
00,
(NOTE: An entry must be made on thIs form each time you visit the job site.)
B VGOR TRAC T
Al UNI, T NO.'
y2o
75.45AC. 2 1 68AG 9 7AC
52 5)
50
'All 49
5..12 A C
T
60
102 57 58
.59 6.17 A G
-7
Pli
14 40,42Ac:t
A N
>
61 d 5.31AC
62
115
F 0-117C t, c 496A
5B
TIN
'1335 3
'COLONY C ONNS TA D T
T 17 N. R.5 E. MOD. B. a.m.,
f
(P
C4
17
59.77AG
1335.3.
20
19 G)
G) 18
41 A f,.
VI
%J
18.3 4 AC,l
22-66AC.
119SD9
///5.99
4.45
2 4.45
50
9.7-3AC.'
�17
11295.51
22 C6
16.343 A C.
28.
5��e
.
1271.0.
101098
38
148.85AC.
23
29
T 17 N.R 5E. M-6.8. 8M.
Tax Area Code
Of 04 52-02
2 6 56.
14 6 9.6 3 AC
c�
(P-5
I 1 326, 08.
PCI.. "A
4.38 Ac*
cp.
q)
190.3 M;
.43
1>1
0
18,12AC.-
30
2 7.5 AC.
qn.
ca
0
3
40.
n 6
COUNTY OF'SUTTE DEPARTMENT OF PUBLIC WORKS
7 County Center Dfive-," Oroville, California 95965
Telephone: 534-4541 77
APPLICATION AND PERMIT V_ I, -,-
I
BUILDING
Owner 6z 1, a 4-ro
SO. F T. OCC. BUILDING VALUATION
?_
Mailing Address 13,viRoa,-CA.
-
V T I
6 eqone No.
4
Fireplace
Contractor aX
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
S!�O &4473
Telephor?e No.
Permit Fee $
$
Building Address Olt', 11 ixesse-e
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
3r4IV%4_ t
Each Trap 1.50
14 "L�
Repair drainage or vent piping 1.50
Water piping 1.50
,4- a A0A-,rW Y4/ JIM& F, CIZ 4,111F.
ch gas water heater or vent 1.50
A. P. No. -0- 00A zo � "M 01M.
&-Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fe -LI1
ev I
W. (Y
fttz�
I F ire Dept.
_ning
Fi re Zone Use Permit
Building sewer 5.00
EQA
IParking
Plans
I Parcel
Declaration
Parcel Map
I
60' R/W
I
I Improvements
Lawn sprinkler system 2.�O
Bldg--P+URT-R-ec'd I
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ADDITIONF] UTILITIES OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
ain service 600V OR LESS
M 100 AMP OR LESS 5.00
Main service EA. ADD'L_ 100 AMP 2.50
Single Family DK Duplex El Mobil Home 0 Others 0
OVER 600V
Main service 100 AMP OR LESS 25.00
Main service EA. ADD -L 100 AMP 1.00
NEW CONST. DWELLING OCCUP. I
OR ADDNS. ACC.BLDGS. 20sq ft.
NEW CONSTR. (MULTI -OUTLET
NON-RESID, BRANCH CIRCUITS) 2.50eal
NEW.CONSTF;L (POWER APPARATUS
NON RESID. SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
(eale(OLOM to
Ex. Occup(OUTLETS OR FIXTURES) _BA@L 2@51004
FIXED A PLNS OR
Ex. Occup.(OUTLETSP(RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No.. L105*10032_ Classification 0--3q1 C,Eip�
Misc. Wiring 6.25
I amexempt from theContractors License Lawsof theStateof California.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
certify that in the performance of the work for which this
0 plermit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
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
TOTAL PERMIT FEE is
u - - -1—aull u vvo v I IV UU11ty U U11LUI UPUH Int!
bove-mentioned pr"�erty for insp'ection pu'rp'oustetus. Lu
x "M"VY W , &aa -e2,, Date 177
Signature of Permitee or Agent
Receipt No.
White-D.P.W. - Yellow -Assessor - Pink -inspector - Goldenrod -Applicant
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
Date
�i'lding �permit =xpir=Date
I
RV
IZ61
S)Ivo
61 011anddo 'Id Cl
luna -40A.LNnoo 3