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Home My WebLink About028-310-00528-31-5 C. Gilkey �,�,�� W/S LaPorte Rd., no. -of k xa. Bangor + Permit 1110-72 (Siding) r7 61111-73 028-310-005 04-2622 WINSTEAD, DEBORAH 54 KIMMIE LN, BANGOR Cont: CLIFF CRAFT BUILDERS CHIMNEY REPAIRS CA3 t� BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT '' 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLEf (530)891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP042622 • LICENSED CONTRACTORS DECLARATION ` I hereby affirm under penalty of perjury that I' am licensed under r ' , provisions of Chapter 9 (commencing with Section 7000) of Division 3 of •• Issued Date: 09/08/2004 APN: 028-310-005=000 the Business and Professions Code, and my license is in full force and License Class : License Number: Site Address: 54 KIMMIE, LN: BAN Date: —0 Contractor '( / Map Index: Description: CHIMNEY REPAIRS 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: WINSTEAD.DEBORAH KAY permit to construct, alter, improve, demolish, or repair any structure, prior , - to its issuance, also requires the applicant for -such permit to file a DBA D & L FARM & GARDEN signed statement that he or she is licensed pursuant to the provisions of P O BOX 147 the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or BANGOR, CA 95914 she is exempt therefrom and the basis for the alleged. exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ' I ❑ I, as owner of the property, or my employees with wages as their , sole compensation, will do the work, and the' structure is not ` 4 intended or offered for sale (Sec. 7044, Business and Professions Applicant: WINSTEAD DEBORAH KAY Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does < such work himself or herself or through his or her, own employees, 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.). f. . ❑ I, as owner of the property, am exclusively' contracting with ' licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Li?iw does Contractor:. CLIFF -CRAFT BUILDERS 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.). 11450 CQOTER TERRACE ❑ I am Exempt under Article 3 of the Business and Professions Code OROVILLE, CA 95965 530-533-4719 • .' Date: Owner: ' License #: 394080 WORKERS' COMPENSATION DECLARATION r 1 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 perfornance of the work for+which this permit Architect: is issued. Engineer: El 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 - t insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy #: Valuation: $0.00 ` Census Code: 1 certify that in fhe of the work for which this is performance permit issued, 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 i to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 9'm ' O 4( Date: Applicant: • WARNING: Failure secure workers' compensation coverage is .to unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in - addition I to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. _ CONSTRUCTION LENDING AGENCY, This permit is hereby issued under the applicable provisions of the Butte County CO&I anfUor I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Resolutions t • wo c indicated above for which_ fees have been paid. 4' G Y Name: - By: Date: v PERMIT EXPIRES- N: G a r 5 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, 1 handling and use of hazardous materials. 0 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. U. Attached are copies of the required E.P.A. notification forms. . 0 this 1 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.' 1 agree to comply with all county and state laws relating to 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 mentioned property for inspection purposes. Print Name: (tel iff07-VI A// / /V Signature: Date: / ❑ Owner x 1, ' Contractor ❑ Agent for Owner ❑ Agent for Contractor T Y 1.. .; + . - BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS X24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" CONTRACTOR OWNER Last Name c [i!dam e Address PhoneFax City E-mails�� Z �� State Zip 9&71y Phone 0 7 v Fax E-mail State License Number CONTRACTOR Namellr Address City , State?meq- I Zip PhoneFax .,� f'-' % .5'33 E-mails�� Z �� Lis. #3 9 g cl Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Type Const Fax E-mail Map Book State License Number APPLICANT NAME Name /+/ z -- Address City State c Zip Phone 3 y Fax E-mail APPLICANT SIGNATURE X For o Ice use only: AP# og- 0 - �1 U U� Zoning City Flood Zone SRA I Yes No Occ. Type Const Subdivision Name Address / Map Book Page Lot # Planner Date Approved: PERMIT NO. BT' BIN # �j LOCATION AP# og- 0 - �1 U U� Property Addr . ss City Cross Street 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 / OVER FOR SUBMITTAL REQUIREMENTS II K:WORMSMILDING FORMS\BIdgApplSubRgmts.doc Page 1 of 2 Description or Scope of Work: Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Receipt Date Amount: u Bldg Sheriff SMIP REV 7-27-04 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 LEGIBtEAND 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 faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). — ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application 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 Keiunds can oniy 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 KAFORMSBUILDING F0RMS1BIdgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 PERMIT NUMBER - B 1110-172B r P E PERMIT EXPIRES l -/6� 7.3 OWNER C. Gilkey CONTR: (hn,Pr LOCATION (A.P. 28-3-3-5 ) W/5 La Porte Rd. N. of Upham Rd., Bangor ti —��-7.:s t; COUNTY SOF BMTTE Department of Public Works BUILDING INSPECTION RECORD Zoning Setback Forms Foundation Piers & Girders Fireplace Rgh. Plumbing Bond Beam Lath & Plaster Rein. Steel Gas Piping & Test Found. Vents Framing Plmg. Topout Rough Elec. Wtr. Htr. Furnace Kitchen Vent Firewall Garage Vents Sanitation & Water ELECTRIC GAS BUILDING Temporary Temporary Cert. of Occup. Final Final Final t0 --`/ i DATE REMARKS OR CORRECTIONS - (:� F - 3-1 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 - Telephone: 534-4541 APPLICATION AND PERMIT auuiuilcc IONICJVJlL0tIVCS ui uie %IUMrty ui outte to enter upon ine above-mentioned property for inspection purposes. X Signature of Permitee or Agent Receipt No. Date 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 By Date BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ Building Address PLUMBING No. @ FEE PERMIT FILING FEE $2.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W.C. Sanitation Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking I Plans Parcel Declaration Parcel Ma P 60' R/W provements Improvements Lawn sprinkler system 2.00 Bldg. Plans Recd I Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 - Main service incl. 1 meter Additional meters, each 1.00 Single Family ❑ Duplex ❑ Mobil Home ❑ Others ❑ Sub -panel (12 or less) (more than 12) Range, Cook -top or Oven 1.00 Water Heater or Space Heater. 1.00 Light fixtures 2ff5 bal all) Receps., switches & fix outlets 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: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. Classification Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of 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. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the 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 $ auuiuilcc IONICJVJlL0tIVCS ui uie %IUMrty ui outte to enter upon ine above-mentioned property for inspection purposes. X Signature of Permitee or Agent Receipt No. Date 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 By Date COUNTY OF BUTTE — IDEP4RTMENT OF PUBLIC 7 County Center Drive — Orovi Ile, California 95965 Telephone: 533-1230, Ext. 259 APPLICATION AND PERMIT WOR%#l� J authorize representatives or the county of butte to enter upon the above-mentioned property for inspection purposes. LWX z2gft,io. e, 21, pate �f'- Signature off Peermitee or Agent Receipt No. ,Z(Q_/ 2-3 _ White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 By—� Date Building Permit Expires Date ��% BUILDING Owner C, SQ. FT. OCC. BUILDING VALUATION Mailing Address Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Permit Fee $ •00 O Building Address PLUMBING No. @ FEE PERMIT FILING FEE $2.00 Icz Each Trap 1.50 ` Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No, r— % — �r Zoning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .50 Fire Zone Fire Dept. Sanitation Planning Building sewer 5.00 Plans � / Fees v W. C. R/W Encroachment Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ OTHER Permit Fee $ $ ' ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) USE OF STRUCTURE Single Family Duplex ❑ Others ❑ Range, dryer or water heater 1.00 Oven, Cook -top or space heater 1.00 Light fixtures Receps., switches & fix outlets ima 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: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Misc. wiring License No. Classification �i am exempt from the Contractors License Laws of the State of 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. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation 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 tate Fee or StrDg Motion $0.07 /$1000 Evaluation nate entFor S prrogram07 $ , TOT AL PERMIT FEE $ 15 C) authorize representatives or the county of butte to enter upon the above-mentioned property for inspection purposes. LWX z2gft,io. e, 21, pate �f'- Signature off Peermitee or Agent Receipt No. ,Z(Q_/ 2-3 _ White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 By—� Date Building Permit Expires Date ��%