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Home My WebLink About029-110-014Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 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 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 you plan to subcontract, you should be aware of the following information for your benefit and protection: ° 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 ° 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 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 thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing 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 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's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. 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. I PERSONALLY PLAN TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. (YES OR NO) 2. I (HAVE/HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: NAME ADDRESS CITY PHONE CONTRACTORS 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 CITY PHONE CONTRACTORS 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 Description: RE -ROOF SF(38 SQ) Reference Number: B07-1602 Applicant Name: FOUR COUNTIES ROOFING Owner's Name: LUNDBERG HARLAN D & CAROLYN AP # : 029-110-014 Signature of Property Owner: Date: 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 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 5317 CHURCH ST Owner: Permit NO: B07-1602 APN: 029-110-014 LUNDBERG HARLAN D & CAR Issued Date: 07/24/2007 By KCG Permit type: MISCELLANEOUS P O BOX 337 Subtype: Re -Roof RICHVALE, CA 95974 Expiration Date: 07/23/2008 Description: RE -ROOF SF(38 SQ) (530) 882-4349 Occupancy: Zoning: ARMH Contractor Applicant: Square Footage: FOUR COUNTIES ROOFING FOUR COUNTIES ROOFING Building Garage Remdl/Addn 3 CRUSADER COURT 3 CRUSADER COURT CHICO, CA 95973 CHICO, CA 95973 (530)343-1416 (530)343-1416 Other Porch/Patio Total FEE INFORMATION DBMSC Re -Roofing $230.00 Total Charged: $230.00 Fees Paid: $230.00 Balance Due: $0.00 Receipt No: B4002 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License FOUR COUNTIES ROOFING 774554 / B C39 / 02/29/2008 Law for the following reason (Sec. 7031.5), 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 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 pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and eff of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the X basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil of not more than five hundred dollars 07/24/2007 penalty [$500]; Please check one of the following: Contractors Signature i Date ❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: HAVE AND WILL MAINTAIN the work himself or herself or through his or her own employees, provided that such improvements ❑I A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ❑ I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 the Labor Code, I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: of for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; The Contractor's 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 Cartier. State Fund Policy Number.2720000573 Exp. Date:10/01/2007 Contractor's License Law.). (This section need not a completed if the permit is or one hundre dollars ($100) or less. ❑ 1 AM EXEMPT under Section B. 8 P.C. for this reason: CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS pI 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 to the workers' X 07/24/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions X 07/24/2007 1 hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 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, injury, including death, and property damage caused arising out of, or in any way connected with DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the pr pe wr ram authorized to ct on he property owner's behalf. CONSTRUCTION LENDING AGENCY 7Eotlf/vo ,� 07/24/2007 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Permittee [SIGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner El Contractor OR: Agent for Owner ❑Agent for Contractor FILE COPY Lender's Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF: tPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" APPL ANT SIGNATURE X < For office use only: OWNER INFORMATION Last Name / U l irst NamerTl�A / N Mailing AddreeD �o x 331 City R-I'Civ 4 1, state Ztp g 7!( Phone �c g y, Fax E-mail Class C3 APPL ANT SIGNATURE X < For office use only: CONTRACTOR Name Four Counties Roofing Address3 Crusader Court City Chico State CA ZIP95973 Phone 343-1416 Fax 343-5274 E-mail E-mail Lie. # 7745541 Class C3 APPL ANT SIGNATURE X < For office use only: ARCHITECT/ENGINEER Name Four Counties Roofing Address 3 Cursader Court City Chico State Zip Phone 343-1416 Fax E-mail State License Number APPL ANT SIGNATURE X < For office use only: APPLICANT INFORMATION Name Four Counties Roofing Address 3 Cursader Court City Chico State CA ZiP95973 Phone 343-1416 Fax 343-5274 E-mail APPL ANT SIGNATURE X < For office use only: Zoning Flood Zone SRA ves No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL KhQUIKtMtN I J PERMIT NO. BP BIN # PROJECT LOCATION APO D — D Property Address ,;--31'7 City Cross Street WORKER'S COMPENSATION Policy Number 573-2003 Carrier State Comp. Ins. Fund If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit Issuance. Other LENDING AGENCY Name Address Description or Scope of Work: Tte A V o F F 0Y 3 8' Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use).- EXPIRATION se): 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 wili 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. � OD Received by: �j Amount: IVB Bldg SRA r Receipt ;t Q I C� Sheriff SMIP Other : 1 Date ' 2� '0 Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 3 2- 0 REV 8-11-06 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, (E) Manufactured Home Support Data (form available on our website) 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 (if building in the City of Biggs). ❑ 10. Letter 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 permits 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). If your project is located in State Responsibility Area (SRA), you are required to meet the SRA Fire Safe Requirements sheet. ❑ 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. ❑ 13. Planning Division approval for parcel check, use and parking (if required). If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. A FEE WILL BE REQUIRED AT TIME OF APPLICATION. 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 KAFORMSSUILDING F0RMS181dgApp1SubRgmts.doc Page 2 of 2 REV 8-11-06 A. P. 29-11-14 &15 HARLAN LUNDBERG W/S 4th St., 500' N. of Main St., Richvale CONTR: Truman Wilson, Y. C. Permit 878-74B,P,E,M (New SF) 029-110-014 02-0413 - LUNDBERG,'HARLAN 5317 CHURCH ST., RICHVALE CONT: IDEAL PLUMBING V �� SEWER REPLACEMENT�' 6 1 1 A. P. 29-11-14 &15 HARLAN LUNDBERG W/S 4th St., 500' N. of Main St., Richvale CONTR: Truman Wilson, Y. C. Permit 878-74B,P,E,M (New SF) 029-110-014 02-0413 - LUNDBERG,'HARLAN 5317 CHURCH ST., RICHVALE CONT: IDEAL PLUMBING V �� SEWER REPLACEMENT�' 6 r�CN i. QUI �- '' t er; 029-110-014 02-0413 . LUNDBERG, HARLAN 5317 CHURCH ST., RICHVALE CONT:. IDEAL PLUMBING SEWER REPLACEMENT rr t er; 029-110-014 02-0413 . LUNDBERG, HARLAN 5317 CHURCH ST., RICHVALE CONT:. IDEAL PLUMBING SEWER REPLACEMENT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT l ASSESSOR PARCEL NUMBER 029-110-014 ZONING 1A R BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADORES PO BOX -1-17 RIGM1 E CA 05974 CONTRACTOR'S NAME ID qr. TELEPHONE 75NSIOO CONTRACTORS MAILING ADDRESS 31 EAL DR- VJBA CITY, CA Z CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 531% C,>tfMM ST. RIGfVMZ CA 95974 Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF Q� Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other IN Describe Work: SEWER RELAC ME Rr Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 15,00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 a00V OR LESS Main Service 20.A 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, a0d my license is I full f rce and effect. +� License Class Lic. No. X I 1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law 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. ❑ 1, 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 1 46.00 NEW coNsr. DwEu�Nc occuP. WEU200A NG U ORAo �S. ( . 3.5QF° MUALCTI ST NONµRESID. I @7.50 POWER APPARATUS 8 SINGLE OUTLET CIR. EX. Occup. OURET OR FDCTUREs 50 BAL @ ':00 FlXED APPLNS. OR Ex. Occup. ounETs RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 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 performance of the work for which this permit is issued. ❑ 1 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 ins rance carrier and policy number are: Carrier 4 Policy Number Ne f (The above sections need o 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' compensatio provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. 'X Date / OR Signature a - ❑ Owner 'Contractor ❑ Agent An OSHA ermit is required for excavations over 5'0" deep and demolition or construction A structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 35.00 HAZ. I D. FEES IMP I FLOOD I COF PARCEL I PO HO 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. '} / L.Y, it Date 1 PERMIT EXPIRES(0)JN Date Receipt No.y ti �iL li�. , .; UC) WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 1r 1 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT Db2— YU � ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TtLEPHONE 882-4349 SO. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRES PO BOX 117 RIC1NALE, CA 95974 CONTRACTOR'S NAME IDEAL PTIMUNG TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 5317 CHURCH ST. RICHVALE Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑x Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other IN Describe Work: SEWER RELACEMENT Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 800V 0 Main Service 20.AORLfSS 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, apd my license is i full f rce and effect. ^�c License Class Lic. No. / 7 I OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law 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 To 46.00 CCU000A NEW CONST. DW LING OCCUP. W OR ADDNS. ( a ACC. S. SO .50so 3.52 FT. NON -ID. ' MULTI -OUTLET 97.50 POWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ I'50 sAL @ .so Ex. Occup. QUXT ED s PREESSIp.OEA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION I tiereby 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. ❑ 1 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 instrance carrier and policy number are: Carrier Policy Number— (The above sections need no 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' compensatio provisions of section 3700 of the Labor Code, I shall forthwith comply with ose provisions. 'X Date �� Signature YA,7pI&ntr Owner °Contractor ❑ Agent An OSH errk is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 2.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 35.00 HAZ. D. FEES IMP I FLOOD CDF PARCEL I PO HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By I PERMIT EXPIRES the applicable provisions Resolutions to do work been paid. ate t� a Date Receipt No. 3 S 0v WHITE-D.D.S.-B.D. CANA -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ti f COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT --'` ASSESSD P ELNUMBER ZONING BUILDING PERMIT OWNER TELEPHONE�3 SO. FT. OCC. BUILDING VALUATION OWNER'S(LING ADD SS iG vaQe C �r S 7 CONTRA TOR'SE , TELEPHONE 0 /0D CONTRACTORS MAILING ADDRESS 3i a CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS � U Energy Plan Checking Fee $ ark- S�rI $ PERMIT FEE $ LOT NO. SUSDNISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20:00 USEOFSTRUCTURE F Duplex ❑ Mobilehome ❑ 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 ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: % n ��/n r'� Q R o v� Gas piping system 1- 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 , PERMIT FEE S s •U 0 ELECTRICAL PERMIT Fling Feel 20.00 "00OR UE Main Service 200A VORLESS 23.00 - *PERAUT FEE Nab s � � � " SM SHERIFF s O THM AA O* VNT RECEMED MCBwRM / C , ` " TO 1111 K!T zwo CONIPVTER Main Service 200A TO IDDOA 46.00 NEW CONST.// DWELUNG OCCUP. 3 550. OR ADDNS. \ & ACC. BLDS. FT. NEW CONST. MULTI -OUTLET NON•RESID. C @7.50 POWER APPARATUS d SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ I.00 BAL @ .50 EX. OCCU FIXED APPLNS. OR OUTLETS RESID. EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20. DO Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Deo CONST.TYPETYPETOTAL FEE $ HAZ. I D. FEES I IMP I FLOOD I COF PARCEL I PO HD 1`SUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisiois Resolutions to do work been paid. Date (Date) Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ' � t r I f e Y' PERMIT NO. 878-74B,P,E,M P E M MH UTIL. PERMIT NO. PERMIT EXPIRES 44-2? —7 OWNER Harlan Lundberg rONTR. Truman Wilson, Y.C. LOCATION (A.P. 29-11-14 & 15 ) W%S 4th St., 500' N. of Main, Richvale 4 f J r ' 7 4 t Temp. Power Pole Called PG&E Temp. Elea Serv.� „ Called PG&E Temp. Gas Serv. :; Called PG&E JOB C+ / 1 vv/ FINALED / s� C� / (Date) (Signature) COUNTY OF BUTTE = DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback ✓ Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finist 2nd Floor Footings Windows 3rd Floor Stemwall �� ' _Siding To out Slab Roof Sheathing Water Pi in Piers G Roofing Sewer — Garage Fdn. Vents 'j--3 Fixtures Footings_ +' Garage Vents Water Htr., Stemwall 13 Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structur Gas Pipihg & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing - ELECTRICAL Masonry Walls Throat Rou h Zif Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr` — Stucco Final Subpanels Mesh Ar 3 /. MECHANICAL Grd. Fault Prot, Scratch Heating Servic - Brown Cooling Temp. Pole Finish Ducts - Underground Interior Lath Venti on Pe nt ` Door Closer Fina Final DATE REMARKS OR CORRECTIONS -�y— /' r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Orovi Ile, California 95965 Tdephone: 534-4541 APPLICATION AND PERMIT ouuiurtce representaiives or the County of Butte to enter upon the above-mentioned property for inspection purposes. x -, k " /4 flwtFate Signature of Permitee or Agent �,O�' Receipt No. ` O/ White-D.P.W. — Yellow-AsseAP i�pector — 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 OR PUBLIC WORKS BY Date— �"— wilding per�itexp�iresate ............... ^ BUILDING Owner SQ. FT. OCC. BUILDING VAL ATION Mailing Address (tJ Telephone No. Fireplace � Contractor t Total Valuation /O Mailing Address Permit Fee Plan Checking Fee &/or Penalty pho e No. No. Permit Fee $ $ r Building AddressU/S 61J r_fkI .� PLUMBING No. @ FEE PERMIT FILING FEE $2.00 f 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. N .` .� 1,57 Zoning & Planning Gas piping system 1 - 5 outlets 1.50 ou�� 26452 Each additional outlet .30 4145 a Fire Dept. Fire Zone Use Pen -nit Building sewer 5.00 EQA Parkin arcel Plans Declaration Parcel Ma P 60' R/W Im provements Lawn sprinkler system 2.00 Bldg. PIa4,-rec'd P Approval s Appro val Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Sub -p el (12 or Tess) (more than 12) R al,06 e, Cook -top or Oven 1.00 (� Water Heater or Space Heater 1.00 Light fixtures . ball d10 Rew., swi s & fix: is 2 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: a I-- /r O/V HQ116d, Ex. Fan or F. A. Furn. Motor 1.00 Evap. cooler, gar. isp. or 16.W. 1.00 C2,00 Air conditioner or heat pumps o Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 r7 License No. 2 "7Misc. 0 2 ? � Classification 1..� wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE I 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.1 @ FEE PERMIT FILING FEE $3.00Q 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 C TOTAL PERMIT FEE ouuiurtce representaiives or the County of Butte to enter upon the above-mentioned property for inspection purposes. x -, k " /4 flwtFate Signature of Permitee or Agent �,O�' Receipt No. ` O/ White-D.P.W. — Yellow-AsseAP i�pector — 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 OR PUBLIC WORKS BY Date— �"— wilding per�itexp�iresate ............... ^