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HomeMy WebLinkAbout030-212-040- �3o=.ala -oda 030-212-040 PERMITM95-2422 MICHAEL, Henry 984 Harlan, Oroville�� Cont; Chuck's Electric Ele Ser Ch/SF _ 030-212-040 I56 MICHAEL; HENRY IIdpLED 984 HARLAN AVE, OROVILL( .j y. Cont: OWNER REROOF 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.netWds PERMIT NO. ✓BP041563 P_)� LICENSED CONTRACTORS 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 Issued Date: 06/01/2004 APN: 030-212-040-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address' 984 HARLAN AVE ORO Date: Contractor. Map Index: Description: RE -ROOF (6 SQ) 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 permit to construct, alter, improve, demolish, or repair any structure, prior Owner: MICHAEL HENRY & FRANCES FAMILY to its issuance, also requires the applicant for sugh..permit to file a TRUST signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section MICHAEL FRANCES D TRUSTEE 7000) of Division 3 of the Business and Professions Code) or that he or 984 HARLAN AVE she is exempt therefrom and the basis for the alleged exemption. Any OROVILLE, CA 95965-4138 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).): IV 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: MICHAEL HENRY & FRANCES FAMILY such work himself or herself or through his or her own employees, TRUST provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one MICHAEL FRANCES D TRUSTEE year of completion, the owner -builder will have the burden of 984 HARLAN AVE proving that fie or she did not build or improve for the purpose of \ OROVILLE, CA 95965-4138 sale.). '❑ 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 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.). Contractor: ❑ 1 am Exempt under Article 3 of the Business Code `and /JPr�offeesssiions� Date: 4) —0 - OwneC5)_ f' J_ < Lait2m-� 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 License #: 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 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Architect: vI I insurance carrier and policy number are: Engineer: l Carrier: CA 6` n - � � v /^• Total Square Ft: 0 S. F. Policy #: Certify that in the performance of the work for which this permit is Valuation' $0.00 issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, Census Code: L _ae and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall '- f forthwith comply with those provisions. Date:y�n� Applical 7 1 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 I4o4 4,o( o, 114- dp" I1O.� code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Bette County CodR and/or 1 hereby affirm that there is a construction lending agency for the Resolutio s to do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) By: ^�-� L Date: Name: PE IT XPIRES ON: ' 05 Address: Date ❑ I 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 mentioned property for inspection purposes. Print Name: V a h S j t7 ba- ) a- P_ I Signaturcl�•^"_01i .d Date: "0 ner Cl Contractor ❑ Agent for Owner ❑ Agent for Contractor 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 PERMIT NO. BP041563 LICENSED CONTRACTORS 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 Issued Date: 06/01/2004 APN: 030-212-040-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 984 HARLAN AVE ORO Date: Contractor. Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: RE -ROOF (6 SQ) Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: MICHAEL HENRY & FRANCES FAMILY to its issuance, also requires the applicant for such permit to file a TRUST signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section MICHAEL FRANCES D TRUSTEE 7000) of Division 3 of the Business and Professions Code) or that he or 984 HARLAN AVE she is exempt therefrom and the basis for the alleged exemption. Any OROVILLE, CA 95965-4138 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).): `N' 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: MICHAEL HENRY & FRANCES FAMILY such work himself or herself or through his or her own employees, TRUST provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one MICHAEL FRANCES D TRUSTEE year of completion, the owner -builder will have the burden of 984 HARLAN AVE proving that he or she did not build or improve for the purpose of sale.). OROVILLE, CA 95965-4138 ❑ 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 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.). Contractor: ❑ I am Exempt under Article 3 of the Business Code �and /JProfessions Date: .4_Q Own �1( 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 License #: 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 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation Engineer: g insurance carrier and policy number are: Carrier: Policy #: Total Square Ft: 0 S. F. 9/1 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 Valuation' $0.00 become subject to the workers' compensation laws of California, Census Code: 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. Date: F D ct( D Applica�. 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 4- P code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code ancyor I hereby affirm that there is a construction lending agency for the Resolutio s to do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By: Date: PE IT XPIRES ON: 05 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 mentioned property for inspection purposes. o Print Name: V a j'1 c_ S I f f l C I'1 & P � Signaturc---, Date: '' % ' 6 y lSd'Owner ❑ Contractor ❑ Agent for Owner ❑ 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 OF APPLICATION OWNER Name --r—vQ n e I Address Iva k 4 v v City O`` v I ,I State Zip 95 96 S Phone 30 -S 3 - 43 Fax E-mail . APPLICANT NAME CONTRACTOR Name ow Na✓Q Address Zip City Fax _T_ State Zip Phone Map Book Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP 6+1 BIN # LOCATION AP# o3fl•s1�. o4,cn-coc Property Address 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 Description or.Scope of Work: t2E . Rock � 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: Amount: 110.- . Bldg l SRA Receipt #: 4O% a 14 Sheriff SMIP Date:Other to 1 •a4' low K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 1 of 2 REV 4-30-04 SUBMITTAL REQUIREMENTS The. following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! ❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 9. Sanitation and site plan approval from the Environmental Health Department. ❑ 10. Metal Buildings: (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 eng=ineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04 O.B.-1 OWNER -BUILDER VERIFICATION Attention Property Owner: 'An "owner -builder" building permit has been applied for in your name and bearing 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. (3_I_personally__plan,to_provide_the_major-labor--and-matetials-for--con-str-uction of -the -proposed- - property improvement: YES 0,-' NO ❑ Q I HAVE 2( HAVE NOT ❑ signed an application for a building permit for the proposed work co with the following person (firm) to provide the proposed construction: NAME: ADDRESS: CITY.. PHONE: CONTRACTOR'S LICENSE NO. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 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: 1 PROPERTYOWNER: SOCA.SECTY N0J 10 : DATE: NOTE: This Owner -Builder Veriftwation is required by Section 19831 and 19532 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 �i � OWNER BUII,DEIi INFORMATION Dear Property owner An application imp specified. r a building permit has been submitted in your name listing yourself as the builder of property rovementS For yourprotecdon, you should be aware that as "owner -binder" you are the responsible party ofrecord on such a permit Building permits are not required to fie signed by property owners unless theyare own work If your work is being performed erso P' performing their 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 bmded.by_the Stat.- -of California and to have a business license from the city of cou*. lhey 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: d If you employ or otherwise engage any Persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed as contractors or subcOniractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and. you are subject to seveial obligations including state and federal income tax withholding, fbderal social security taxes, workers compensation insuuance, ftabiUy, insurance costs, and unemployment compensation contributions. t There may be financial risks for you ifyou do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific kfomuatian about your obligations under Federal Law, coact the Internal Reverie 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" budding Peunff, eaoneously implying that the prOPmrty owner is providing his or her own labor and material personally. Building Permits are not required to be signed by property owners unless are e_i adon-abouut licensed -contractors may, be obtained b P their.o_wa own -work -personally. community or at 1020 Id Sire S y contracting the Contractors State License Board in your , CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matxers. The building peimit Will riot be issued umbl the verification is returned. lY, �1 lv!i 1 C. Vi iia, C.B.O. er, Building Inspection NOTM Y'lls Owner-Buflder Information is required by Section 11830 of the Caffforeia Health and Safety Code '030-212-040 PERMIT#95-2422, MICHAEL,. Henry 984 Harlan, Oroville Cont;,Chuck's Elec - tric Ele-Ser,Ch/SF, OFFICE COPY 0000,� AddressZ--a '00�� GAS Meter By--, D . ate .ELECTRIC Meter By Dat -�6 r CO'INTY OF BUTTE= DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION ..,.,.,, 7 County Center -Drive - Oroville, California 95965 - Telephone (916) 538-7541 �PERMIT NO. APPLICAYION AND PERMIT ASSESSOR PARCEL NUMBER 030412-040 ZONI BUILDING PERMIT OWNER HERY MICHAEL TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 984 HOLM OROVIM CONTRACTOR'S NAME aluco i:ilIIZIC �i'� TELEPHONE CONTRACTORS MAILING ADDRESS - Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Fling Fee $ 20,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS >rT 984 HARLAN PERMITFEE $ OROVILLE PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDNISHIN'S NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF 1I Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other. Describe Work: Ei%C SERV CHANGE Mobile Home I S I G W 1 @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.0(0 Main Service ( 200OR LESS ) 200AA OR LESS 23.00 23-00 Main Service ( 200A TO 1000A ) 46.00 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,�v'�ER and my license is in full force and effect. yy License Class 10 Lic. No. "f 9 06 (1 OWNER -BUILDER DECLARATION 1 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 NEW CONST. DWELLING OCCUP. OR ADDNS. ( a ACC. BLDS. ) SO . 3.50 FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 APPARATUS a SINGLE OUTLET CIR. / Ex. Occup. ( OUTLET OR FIXTURES ) 209 1.00 B'L 5° EX. OCCLIp. ( OUTLETS RES D.) EA) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE INSPECT 23,( PERMITFEE $ 66.00 Contractor WORKERS' COMPENSATION DECLARATION 1 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 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 insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor 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.)' 1111111certifythat 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 rovlslons. ` /1, X P/ ;/t h / '__ Date Ja - _ Signature of Applicant"- ❑ Owner Contractor ❑ Agent An OSHA OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TY Pfd TOTAL FEE $ HAZ. I D. FEES IMP FLOOD COF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. B Ctl /tom Ui 1 J` .I dZIA5 y Date 9Receipt PERMITEXPIRESON /a (Date) No. i>�Jr5�5 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION _ 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541_ P NO. APPLICATION ASID PERMIT ASSESSOR PARCEL NUMBER 030-212=040 ZONING BUILDIN�ERMIT OWNER HENRY MICHAEL f TELEPHONE SO, FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 984 HARLAN OROVILLE CONTRACTOR'S NAME CHUCKS ELECTRIC TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNIOVOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ ARCHITECT OR ENGINEER ucENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDINGADDRESS 984 cIARLAN PERMITFEE $ OROVILLE PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23,00 USEOFSTRUCTURE SF YT] Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other IN Describe Work: ELE RV C:HAN E ERY Mobile Home S G W @20.00 g Contractor ELECTRICAL PERMIT Filina Fee 20:00 Main Service ( eOovo.LESSSS ) 200A OR LE 23.00 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 with Section 7000 of Division 3 of the Business and Professions Code, (commencing ) and m license is ij; full force and effect. License Class ` /10 Lic. No. ��©6 K OWNER -BUILDER DECLARATION 1 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 NEW CONST. DWELLING OCCUR OR ( 8 ACC. BLDS. ) SO, 3.5¢ FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 POWER APPARATUS 8 (SINGLE OUTLET CIR. ) Ex. Occup. (OUTLET OR FOS. RES ) BAL 0 I.50 Ex. Occup, OUTLETs (RESID.) ( ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE INSPECT 23. PERMITFEE $ 66,00 Contractor WORKERS' COMPENSATION DECLARATION 1 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 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 insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation �f one hundred dollars ($100) or less.) W I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forth ith comply with those provisions. X of A--�� Date Sign ure pplicant - ❑ Owner Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee Is Energy Inspection Fee Is Occ CONST. TYPE TOTAL FEE $ JISSUE HAZ. I D. FEES I IMP I FLOOD I CDF PARCEL I PD I 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 /atte PERMITEXPIRESON (Oat ) Receipt No. 185595 WHITE-D.D.S..B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT '11111111 1 7sf�iN , I q3 J' COUNTYOF BUTTE - DEPAR MENTOFDEVEL'OPMENTSERVICES - BUILDING DIVISION d ri f .�, •, 7 COUNTY CENTER DRIVE - OROVIL'LE, CAT1FORNIA95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEE 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 �- 1-1.2-64b OWNER 1 No. 030-D Proposed Building Use S Building Inspecto Date a Cl At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: r t DATE RECEIVED BY 1, All items have been submitted. .... .................................. . 2. Plot plans, 3/4 sets, signed by preparer 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 . ............ ., ............................. . 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 . ................. . 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. ............. •'`� 17. Planning approval'for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (constru ion approval required prior to occupancy). Pre4nspection requeW Pre for 20. -inspection 0 required. .. to Building Inspector (Date) 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 . ......................................... e'28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :.................. 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 . ...................................... A 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. =liver - Telephone and hold for pickup at office. with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. ,.Fire Dept. Air 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). fi 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 OWNER: LOCATION: CONTRACTOR: l _(2.L/;z� PRE -INSPECTION FOR: 6 Y SL PERmrr HISTORY: NONE [ ]AS FOLLOWS: TYPE OF OCCUPANCY: ilding Description: [ ] Commercial/Usage: _ Gag: ] Residential/# of Units: J Currently Occupied. ] AbandonedNacant. DATE: S A.P.#:D-�I�—O�C� ZONING: DATE TO INSPECTOR: BUILDING INSPECTOR'S REPORT 100 [ ] Yes [ ] No Electric is currently : [ ] On [� Off Condition of electrical? V66-k- Mobile Home: Yes[ ] No[ Natural [,J-'1�r_opane[ ] None[ ] Currently On[ ] Off[ ] Obvious problems: :ion: Plumbing working Yes[ Well: Yes[ ] No[-,]"'� Potable water: Yes[ ] No[ ] Obvious Sewage Problems: � Recommended: [ ]Issue [ ]Hold for: Date: 161)%t