HomeMy WebLinkAbout029-100-067(Rev.12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754,„ PERMIT NO.
APPLICATION AND PERMITy
ASS P ° LIM ER
ZONING A-5
BUILDING PERMIT
OWNERTELEPHONE
Lundbe FFarms, -
SO, FT, OCC. BUILDING VALUATION
. OWNERS MAILING ADDRESS
PO Box
cont es
144 22 3,1
CONTRACTOR'S NAME
ra 892 8866
TELEPHONE
CONTRACTORS MAILING ADD S
�' 32 aicn CA 95972
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS "- --
Fireplace
Total Valuation 1$233,168.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 1 108.50
ARCHITECT OR ENGINEERS MAIUNG ADDRESS
Plan Checking Fee $
BUILDIrIGnrD
� It Rice Ste
Energy Plan Checking Fee $
$
PERMIT FEE $ 1849.05
LOT NO.
SUBDNIS X)NS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other commercial
SPECIFY
Each Trap 7.00
-
Solar or heat um water heater 23.00
Water piping 15.00
Each as water heater or vent 15.00
TYPE OF WORK
New gJ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: new StruC for ri cP rirvPr
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
Main Service 200, OR LESS 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
—baw for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A J 46.00
NEW CONST. DWELLING OCCUR sG
OR ADDNS. ( & ACC. BLDS. 3.5QFT.
T.
NO"ON.pESID. MULTI.OUTLET @7.50.
POWER APP,RATus 2 .50 15.00
8 SINGLE OUTLET CIR.
Ex. Occup. ourETOR FIXTURES SAL p 1. 0
Ex. Occup. ovr PR 6.) _, 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $ -35.00
WORKERS' COMPENSATION DECLARATION
1 eby 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.
❑ I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
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.)
❑ 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'
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.
/�.� D �
ture of Applicant - ❑ Owner ❑ .Contracto Agent
kAn HA permit is required for excavations over 5'0" deep and demolition or cons tr ction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 1884.05
HAZ. FE IMP 000 DF PARCEL I PO I HD
ISSU
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
fees have been paid.
C /
indiig;"
BY Dat J
.PeRS�44
Defe
Receipt No. 0Z J
WHITE-D.D.S.-B. D. CANARY- SE R PINK -INSPECTOR GOLDENROD- PPLI AN
P�
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDINGIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (530) 536 541 PERMIT NO
%X2/96) APPLICATIONAND PERMIT
19 SESSORPARCFINUMBER ' 71-5BUILDING PERMIT
NER ' NE ,/ SQ. FT. OCC. BUILDING VALUATION
4 ,N� C, ti L !�
ply r16 ADD 6 i /�
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C, Ii _
COM/M Y OR' {,NAME (/�, T
-S5 7-3
NSTRUCnON LENDER
LENDER'S MAILING ADDRESS
ARCNRECT OR ENGINEER
ARCMTECT OR ENGINEERS MAILING ADDRESS
IDT NO. I SUBDIVISIONS NAME
USEOFSTRUCTUgE R
SF O Duplex O Mobilehome O Other C�-n IAC A ,ir c 0. \T
sPEc�r
e TYPE OF WORK
New 1 Addition ❑ Remodel- Utilities ❑ Installation O Other O
Describe Work:
Fireplace
Total Valuation S
Firing Fee
Permit Fee
Plan Checking Fee
Energy Plan Checking Fee
S
S
PERMIT FEE
PLUMBING PERMIT
t
Filing Fee
Each Tr
7.00
Solar or hea . • m water heater
23.00
Water niolno
15.00
Each gas water heater o nt
15.00
Gas piping system 1 - 5 outlets
1 5.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
j�D
,0�
20.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee
20.00
Main Service 20SA ORLESS
23.OD
Main Service 200A To 1000A
46.00
NEIN CONST: pwOC
. 5.CUP.
OR ADDNS. ( i ACCgypp 610
3.5C
I p7.
oNs • MuLTFounzr
NDN-RESID.
@7.50
POWER APP ucs
1 8 SINGLE OUTLET CI0.
fF
7
� Tc) c)
EX. Occup. OUTLET OR FIXTURESBAL
O I.yp .
Ex. Occup. ,frT�,sAFs D PPLNS °�L
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00
I PERMIT FEE _ 75.5-' IO U
I MECHANICAL PERMIT Filing Fee 1 20.00
Hood I I 6.sD
Ventilation
'PERMIT FEL: 3\.
Mobile Home Installation Fee t
Energy Inspection Fee S �>
Dcc CONST. TYPE TOTAL FEES
-Z. I D. FEES I IMP I Fbw CDF I PARCEL I PD I ND 6SUr
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 _
'OiN' 4 °'� ."Tnyr" , a I►n °-'*#5%. s �A.1' +►1►i�►ro.IpLW �l�i'.i�
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ASSESSOR PARCEL NUMBER
/n�� / �O
Proposed Building Use: � ) � 6�- Counter Technician: Date:
Items required in order to apply for permit. All bo MUST be checked OR marked NA in ord r to apply.
.. Plot plans, 3 or 4 sets, signeclk the preparer of the plans.
Complete plans, 3 or 4 sets, signed by the preparer of the plans.
3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxes!
❑ 5. Energy compliance design and supporting documentation in duplicate.
❑ 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The.permit will be
indexed and returned to the plan review line-up when required items are received.
Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
❑ 9. Plot 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 .....................................
❑ 12. Hazardous Material Form............................................................................... _
❑ 13. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
14. Fees as shown on the attached Schedule of Fees Due Sheet.......................................12 _
15. Statement of Intent for Non -heated and A/C Buildings ..................................... n....i�_
1 16:,,,,Sanitation and plot plan approval from the Environmental Health Department in
❑ 17. City of Chico Plumbing permit........................................................................
❑ 18. California Department of Forestry plan approval ❑ paid. Sent -by: ...................... _
❑ 19. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: _
❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ............................... _
❑ 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 22. Pre -Inspection for required ................ _
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. _
❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) .....................
❑ 26. Letter of Signature authorization.................................................................... _
❑ 27. Recorded copy of Agricultural Acknowledgment Statement ................................... _
❑ 28. Manufactured home utility clearance............................................................`... _
❑ 29. Existing violations and/or expired permits......................................................... _
❑ 30. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
❑ 31. Other:
When issued Telephone fJ a S� and hold for pickup.
I have been informed of the above items and requirements for obtaining a building permit.
Applicant:" %�/'!. �- Date:
1. Index permit application for the above items numbered: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised cfthe above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: Date:
Structural reviewed by: Date: Structural approved by: ` ' Date:
Note transfer by: Date:
Yello v.,';BuildinP Division
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COUNTx OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER
PROPOSED BUILDING USE
J 0
1. BUILDING PERMIT FEES `
Balance Due ....................... $ J�
Additional Fees Due ................. $
Additional Fees Due ................. $
Revised Plan Checking Fee .............$
2. SCHOOL DISTRICT FEES
(paid at District Office) (Available after Plan Check)
3. SHERIFF FEES (paid at Building Division)
Residential ...................... x $360.00 = $
Units
Commercial (sq. ft.) ............... x $0.03 = $
Sq. ft.
4. URBAN AREA FEES (paid at Building Division)
Residential ................... -x-=$
# Units Amt.
Commercial (sq. ft.) ............ -x_=$
Sq. ft. Amt.
5. RECREATIONAL DISTRICT FEES
(paid at District Office) (Available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion #
$200.00 (paid at Building Division)
9. CSA 87 TRAFFIC FEE
$2500.00 (paid at Building Division)
10. OTHER
A.P.#�/�U��A %
DATE
RECEIPT # DATE REC.
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees
may be changed during the plan checking process.
APPLICANT
DATE
Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been
imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original - Buiding Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 6/00)
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PROJECT NAME
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JOB NO: 8119
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20 Declaration Drive
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Phone: (530) 893-1600 Fax: (530) 893-2113
Web Site: www.northstareng.com
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