HomeMy WebLinkAbout028-140-0110
,28 14 1'1•- r: «.r 'I 92 1752Ef i
CAMPBELL;, Charles &= Jo ..�,.�
-177,Tennessee,hane Bangor�6�yY�*
h
(upgraderelectr cal,'servlce7SF)'"` t
.047-440-042",, . ,� 1 2386
i WILSON, JERMEY*
13821 `GARNER L
Cont CHICO ELE RI P, } n
EIEC PANELT/O �3 "
i�
a
rt •
0
,28 14 1'1•- r: «.r 'I 92 1752Ef i
CAMPBELL;, Charles &= Jo ..�,.�
-177,Tennessee,hane Bangor�6�yY�*
h
(upgraderelectr cal,'servlce7SF)'"` t
.047-440-042",, . ,� 1 2386
i WILSON, JERMEY*
13821 `GARNER L
Cont CHICO ELE RI P, } n
EIEC PANELT/O �3 "
NOTES RESIDENTIAL
PERMIT NO.
. 028-140-01----�.,_'`""`-- 05-2375 .
CAMPBELL, CHARLES
177 TENNESSEE LN, BANGOR
Cont: OWNER
ELEC SERV
}
r �< SPECIAL CONDITIONS
CHECKED
}' BY
• SRA
FLOOD CERTIFICATE REQ.
t �.,• FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
. -- --: VERIFY-
I
1 USE PERMIT CONDITIONS
SUB-STAN DAR D"HOUSING LETTER
OFF DRo 6RAc6,o2
t
'.'OFFICE COPY
Address
f GAS .
' Meter By Date
ELECTRIC /�
Meter By Date
-905
JOB_ FINALED (Date)
' Signature
4=OK
o = Not OK
. - Not ae
Ready
@ p
StlppnOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except I#'s
i. Zoning Requirements -Setbacks -Easements
2. Sols; Special MH Support Sketch -
3. Sewer, Location -Test -Fail -C/O -Concrete
4. Water, Location -Test -Easement Needed (Sketch)
5. Electricity, Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;=/ P L'fL
/ P Nat or / /" L "ftl P LPG
7. • Well Clearance & Disconnect
8. UtiTrty Clearance .
Date
Card B-1 Date ; -Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except li's
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test-Defiand-Valve-Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test-Regulator-Connectot
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged '
9. Tie Downs -Type -Installation Cert
10. Exits; Insp.-Sketch
11. Cert of Occupancy '
Date Card B-1 • Date Card B-1
Date Card B-1 Date'. Card B-1
Date PERMANENT END SYSTEM (ONLY)
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Blocking
4. Gas; MH TesVDemand-Valve
S. -Electricity; MH Test .
6. Water, MH Test
7. Water and Sewer Connected
8. Gas and Electricity Tagged
9. Exits
10. License Decals
11. Verify $'s with Office .
Date Card B-1 - Date Card B-.1
Date Card B-1 Date Card B-1
11f ISCELLeAWOVS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except f's
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. 'Wood Awn.; Posts-Beams-Rftrs-Connectors
Shthg-Frg-Bracing
S. Alum. Awn.; Columns -Connections -Spruce -Decal -Enclosures
6.• Carports; Windows -Doors .
7. Electric
8. Fang.; Sills-Anchors-Studs-Rftrs Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof, Shthg-Roofing -
11. Ext.' Steps -Doors -Landings
12. Braced Wall Panels
Date Card B-1 Date Card B-1
Date Card B-1 Date " Card B-.1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction-S&iucture Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance -GA
5. Elec.; Pod Lightutg; 15 Volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec ; Bonding; Metal w/5' -Circulating `Equip: Heater
8. Elec.; Grounding; Equip. w/5',Cir6ulating Equip.' -Pool L.ghtg.
Boxes=Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Apprntral
10. _ Plumb.; Cir. Test -Water Supply Test
l l..Ught Niche
12. Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
1=0K - . ' 4
r =.Not OK
= Not Appliabte
= 116t Ready
,
RESIDENTIAL (Single & Duplex)
i
Date UNDERFLOOR (Plans) OK except #'s
1. ' Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Sols-Elec. Gmd.-/ . /" Ftg. Depth
3. Ftg., Garage; Sols-Steel-Elec. Gmd.-/ /" Ftg. Depth
4.' Ftg., Porches & Decks; Soils -Steel-/ _. / . Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a Hold Downs and Special Anchors, r
7. Slab, Steel -Wrapped • .
8. Piers -Fireplace Ftg.-Steel • - -
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF, Gas Pipe; Sae Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
y
Date Card B-1 Dater Card B-1
Date Card B-1 ;,Date-. i - Cant B-1
Date PLUMBING (Permit) OK except #'s
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
19.; D.W.V.;.Test Fittings & Anchor -Nail Protection
20.' Shower Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe &'Anchors _
23. Fire Sprinkler, Test-
Date Card B-1 - Date _ Card B-1
Date ;, , Card B-1 T' " Date "- ; .: `Card 6=1'
Date ELECTRICAL (Permit) .OK except #'s
24. Fixture & Transformer Clea'ra e&16s: Protection
25. Dec. Receptacles Spacing -Lights & Switches at Doors
26. Site Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Sizel /ga. Cu or AI-A.C. Wire Size/ /ga Cu or AI
'31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI
. Insulated Neutral ❑ Yes O No
Date FRAMING (Continued)
_- 47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting: Rtng.
49. Fireplace Tres or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdnn. Windows or Exiting Doors -Sill HL & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer -
58. ,Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59: ,Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts '
61. Brace Interior/Exterior Wall Panels •'
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B -1.:'r,: ;- Date Card B-1
Date FINAL (Plans) OK except #'s .-
64. Ext. Steps -Door & Sidelight.Protection-Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Dec. Trim & Subpanel, Breaker Sizes& Labels
70. Stairs & Rails r,
71, Fireplace or Stove; Clearance -Hearth.
72. Elec. Outlets at Wood Panel,, Int. & Ext.,.-
73. Kit Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Dec. Outlets & Receptacles at KiL Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Dud in Garage -Damper: i, ;-.s c�•;q. ':
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
-- in Garage; Above Floor -Meth. Projection -
` 78:"Plb.; Bed. & Medi. Equip: Listed for Location '
79:"Flee.-Rece0tacles in Garage (REQ-Romex Protection
' 807Insulation-Foam-Looked in'Attic
"81:'Guard Rails•& Deck Construction=Post Caps
82 - Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth ` -
Clearance Looked under Floor ' -'O Yes �
83:' Following InstldJDrive O Yes O No/Walks O Yei" O Na/Plartters O Yes' 0 No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical. Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels -Motors -Meth. Equip.
34. Clothes.Closet Light -Shower Light -Spa Light
i
35. Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s )
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform ff Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41. Sills Proper Materials & Anchors
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
_- 47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting: Rtng.
49. Fireplace Tres or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdnn. Windows or Exiting Doors -Sill HL & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer -
58. ,Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59: ,Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts '
61. Brace Interior/Exterior Wall Panels •'
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B -1.:'r,: ;- Date Card B-1
Date FINAL (Plans) OK except #'s .-
64. Ext. Steps -Door & Sidelight.Protection-Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Dec. Trim & Subpanel, Breaker Sizes& Labels
70. Stairs & Rails r,
71, Fireplace or Stove; Clearance -Hearth.
72. Elec. Outlets at Wood Panel,, Int. & Ext.,.-
73. Kit Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Dec. Outlets & Receptacles at KiL Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Dud in Garage -Damper: i, ;-.s c�•;q. ':
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
-- in Garage; Above Floor -Meth. Projection -
` 78:"Plb.; Bed. & Medi. Equip: Listed for Location '
79:"Flee.-Rece0tacles in Garage (REQ-Romex Protection
' 807Insulation-Foam-Looked in'Attic
"81:'Guard Rails•& Deck Construction=Post Caps
82 - Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth ` -
Clearance Looked under Floor ' -'O Yes �
83:' Following InstldJDrive O Yes O No/Walks O Yei" O Na/Plartters O Yes' 0 No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical. Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
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.
BP052375
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 09/06/2005 APN: 028-140-011-000
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
effect.
Site Address: 177 TENNESSEE LN BAN
License Class : License Number:
Map Index: .
Date: Contractor:
Description: elec service upgrade
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for. the following reason (Sec. 7031.5
Business and Professions Code:.Any•city or county which requires a
Owner: CAMPBELL CHARLES & JO JT
permit to construct, alter, improve, demolish, or repair any structure, prior
P O BOX 149
to its issuance, also requires the applicant for such permit to file a
BANGOR, CA
signed statement that he or she is licensed pursuant, to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
95914
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).):
.� I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
Applicant: CAMPBELL CHARLES & JO JT
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' Slate License Law does not apply to an
P O BOX 149
owner of property who builds or improves thereon, and who does
BANGOR, CA
such work himself or herself or through his or her own employees,
95914
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
Contractor:
and Professions Code. The Contractors'.State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Da6��� Owner:
-
License #:
WORKERS' COMPENSATION DECLARATION
I 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
Architect:
Labor Code, for the performance of the work for which this permit
Engineer:
is issued.
❑ 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:
Total Square Ft: 0 S.F.
Carrier.
Valuation: $0.00
#:
Census Code:
PPPolicy
1�7 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
J
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 comply with those provisions. rt
Date: [ —,(7)
Applicant:G✓!//�
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 i erebyiss� i applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutio to do wo k,ind' ted ove f hich fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
J\
Date:
Name:
By:
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 duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentio ed property for inspection purposes.or
Print Name:�� Signature:
Date:9-
0wner ❑ Contractor 0 Agent for Owner 0 Agent for Contractor
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**
APPLICANT INFORMATION
OWNER INFORMATION
Last Name
�� 1
First0- me brcliQ
Address /��7
7Q vAJ ca .C/✓ ,
City z
State
Sl e
'i'9
„51
Phone 3 (D
71- 3 g
Fax
E-mail
Lic. #
APPLICANT INFORMATION
CONTRACTOR
Name
City
Address
Zip 9 3
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip 9 3
City
Fax
State
Zip
Phone
Book
Fax
E mail
Planner
State License Number
APPLICANT INFORMATION
Name CPt nn '06L Ch (t` Q S
Address 14
/7-? Q.N tiles 5 0-4—
City
StU
Zip 9 3
Pho 30-0-79_ P
3
Fax
E -mail
APPLICANT SIGNATURE
For office use only:
Zoning
Property Address
Flood Zone
Cross Street
in t
SRA
I Yes
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgAPo1SubRgmts.doc
PERMIT
NO.
BP 4!�. 5_'Z
BIN #
PROJECT LOCATION
AP#O 0
Property Address
City
Cross Street
in t
SMIP
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:
J4:54,10_anew tlzc.Tric,,
as S
Sq FT- Living Garage Open Cov
❑ 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:
l�
Bldg
SRA '
Receipt
Sheriff
SMIP
Date:
Other
` _
Total
Page 1 of 2
REV 8-12-05
N
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 manual, (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. Lefler of intent for non-residential buildings.
❑ 11. Building Permit Application Without Required Clearances Form
❑ 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. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑ 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
KAFORMSIBUILDING F0RMS161dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
o a_.... .
IL
CA
Attention Property Owner:
An "owner -builder" building permithas been applied for in your name and beating 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
�- 2.
3.
I personally plan to provide thmajor labor and material for construction of this proposed
property ' provement: YES [�] NO [ ].
I HAVE HAVE NOT [ J signed an application for a building permit for the proposed
work.
I have contracted with the following person (firm) to provide the proposed construction:
NAME: •
ADDRESS:
PHONE:
CONTRACTOR'S 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:
NAME: _
ADDRESS:
PHONE:
CONTRACTOR'S 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;-��
DATE:
NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before we are permitted to issue the
permit. ��
Butte County Department of Development Services
ADMINISTRATION ° BUILDING ` GIS t PLANNING
7 County Center Drive
Oroville, CA 95965
(530) 538-7541 Telephone
(530) 538-2140 Facsimile
Dear Property Owner
o o
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 your plan to subcontract, you should be
aware of the following information for your benefit and protection:
o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
o 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 income tax withholding, federal social security taxes, workers'
compensation insurance, disability insurance costs, and unemployment compensation contributions.
o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to workers' compensation insurance.
o 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 perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors 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 in your
community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware
of these matters. The building permit will not be issued until the verification is returned.
C. Vieirl C.B.O.
Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
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n
28-14-11 92-1752E
CAMPBELL, Charles & Jo
177 Tennessee Lane,IBangor
�,"• (upgrade electrical service/SF)
l
OFFICE COPY
Address
GAS
r Meter gy
Mete CB RIC Date.
Datef
COUNTY OF BUTTE - DEPARTMENT OF'PUBLIC WORKS
7 County Center Drive - Oroville, Callforni$ 95965 - Telephone: 916.'538-7541
APPLICATION AND PERMIT
PERMIT NO.
r1 Sr�
ASSESSOR PARCEL NUMBER
28-140-011
ZONING
A 5
BUILDING PERMIT
OWNER
CHARLES & JO CAMPBELL
TELEPHONE
679-2384
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
P.O. BOX 149 BANGOR
CONTRACTOR'S NAME
LONG ELECTRIC #447066
TELEPHONE
679-2569
CONTRACTOR'S MAILING ADDRESS
P.O. BOX 128 BANGOR
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
n
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
177 TF..PT'tdESSEE LANE BANGOR 95914
Permit tee
PLUMBING PERMIT
FilingFee 15.00
Each Trap
1 5.00
Solar or heat pump water heater
1 20.00
LOT NO.SUBDIVISION
NAME
PARCE- 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
Newer Addit on L_J Remodel❑ Utilities Installation( Other ❑
Describe work: UPGRADE SERVICE _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main servi C6` 600V OR LESS -
200A OR LESS
18.50 •
_
Main service 20GATO1000AI
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check One):
❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
�and Professions Code and my license Is In full force ant effect.
License No. Classification
❑ I. as the owner, or my employees with wages as their solecompen-
satior, will do the work,and the structure is not intended op offered
for sale. (Sec. 7044)
as the owner, am exclusively contracting with licensed contract-Misc.
ors. (:Sec. 7044)
I am exempt under Sec., Business and Professims Code
this reason
NEW CONST. ( DWELLING 0CCUP.S\
OR ADDNS. ACC. BLOGS. //
_37.50
3.60 sq.ft.
NEW CONSTR ULT' -OUTLET
NON-RESID• BRANCH CIRC ITS
@ 5.00
POWER APPARATUS e
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
20 76d
EX. OCCU FIXED APP LNS. OR
p. OUTLETS IRESI0.1 EA.)
I 3.00
Temporary service
15.00
Mobile Home Facilities
�Virin
9❑
d15.00I,
PRE LNSFfor
Permit Fee
$
Contractor
—
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.
MECHANICAL PERMIT
FilingFee 1 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 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 t. _. `.1 - .��lA Date i 1�, _
Signature of Applicant — O ner ® Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition of ons„uct”
ion of structures over 3 stories in height.
Receipt No. r��y
Mobile Home Installation Fee $
Ener Inspection Fee $
9Y
occ CON6TTYPE
TOTAL FEE $ 53.50
HAz
OFEES IMP FLOOD CDF
PARCEL PO HD Issu
'
This pg-"" Issued under the applicable provi-
4Qn$ of the Butt
work indica ab e ode and/or resolutions to do
'p(R OR ' h fees have been paid.
B / WORKS
Y
PER IT EXPIRES Date 4 Dfate
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
C
CORRECTION NOTICE
CA&
OWNER PERMIT NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address land should be corrected. Please notify this office when correction of work
is completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact s office immediately.
4�
-- I
N,
S
REV 11/91
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drlve - Oroville, Callfornla 95965 - Telephone: 918.'538-7541
APPLICATION AND PERMIT
PERMIT NO.
9)_
ASSESSOR PARCEL NUMBER
28-140-011
ZONING
A 5
BUILDING PERMIT
OWNER
CHARLES & JO CAMPBELL
TELEPHONE
679-2384
SO. FT., OCC. BUILDING VALU. TION
OWNER'S MAILING ADDRESS
P.O. BOX 149 BANGOR
CONTRACTOR'S NAME
LONG ELECTRIC#447066
TELEPHONE
679-2569
CONTRACTOR'S MAILING ADDRESS
P.O. BOX 128 BANGOR
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADo1775 TENNESSEE LANE BANGOR 95914
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
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SF El 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 L. Addition ❑ Remodel ❑ Utilities IX -1 Installation] Other ❑
Describe work: GRADE SERVICE _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600V OR LESS
200A OR LESS
18.50 18.50
Main service 200ATO1OooA)
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BusinessPOWER
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
NEW CONST.(DWELLING OCCUP.&`
OR ADONIS. ACC. BLDGS. I
_37.50
3.6Qsq.ft.
NEW CONSTR.MULTI-OUTLET
NON-RESID• BRANCH CIRC ITS
@ 5 00
APPARATUS &)
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
2076
FIXED APPLNS.
Ex. Occup. OUTLETS ((RESID )REA.)
I 3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
9
15.00
PRE INSP
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.
{� I shall not employ any person in any manner so as to become subject
Ste' 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 2 A`L
Date (D ' "1
Signature f Applicant — Owner," Contractor ❑ Agent ❑
An IDS p rmit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ CONST TYPE
TOTAL FEE
$ 53.50
HAz
I DFEES I
IMP
I FLOOD
I CDF
PARCEL
I PD
I Ho
ISSU
This permit is hereby issued under the applicable provi-
sions of the Butte County,ode and/or resolutions to do
work indica ab e f hich fees have been paid.
R F PUBLIC WORKS
By D to
PERMIT EX IRE Date Z
Receipt No.
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
_. 1
� 1
COUNTY OF BUTTE „MEPARTMEVT OF PUBLIC WO ``- BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541
PERMIT APPLICATION DATA SHEET
OWNER o p��
Proposed Building Use C- S ff Building.lnspector Date
At time of permit application, I was advised the following data must be,submitted prior to permit processing and/or issuance:
r DATE RECEIVED BY
1,
All items have been submitted. .......-".�............................. .
2.
Plot plans, 3/4 sets, signed by prep6rer 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 . ................ _,.,1:........................ .
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. ..................
`s•.
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. ....:a:.......
17.
Planning approval for (A) Use: (B) Parking: ...... .
18.
Contact Land Development about (A) Improvements (B) Drainage. ...........
.Driveway permit (co approval required prior to occupancy). .. ..........
Pre for C�i +•Pre -Inspection requee
l
-�
20.
-inspection required. .. to Building inspector
%t)
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. ...Y`:. .. ................................ .
28.
Mobilehome utility clearance. ,......................... .
29.
Documentation of legal access . ....................... I ....... :........
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.
-
When you issue the permit, process as follows:y Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector. /
Other i
Parcel Creation
Acreage Applicant
Copy of Haz-Mat form sent , Health Dept. Fire Dept. A ' 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
PRE -INSPECTION
OWNER: S r(,f / V e&.L I DATE
LOCATION : / 77 ,�Xlo/6�S5; �� , ,��•# �� '�� ^�
CONTRACTOR: ZONING
----------- _
PRE -INSPECTION. FOR: y 7 [/ I� X
PERMIT HISTORY: El' NONE Ejj AS FOLLOWS:
TYPE OF OCCUPANCY
BUILDING USAGE:
FIELD - INFORMATION
TENNANT:s
ED
OCC ED /HAS ELECTRIC
HEATED -COOLED �JPERSON
OTHER COMMENTS:
ACTIO RECOMMENDED:
ISSUE HOLD FOR
OTHER:
DATE TO INSPECTOR
S GAS HAS SANITATION FACILITIES
CONTACTED