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RESIDENTIAL
PERMIT NO. 0207:q 10--OIQ
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS_
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date)
Signature
J=OK
0 = Not OK
. = NotReadyable
Card B-1 Date Card B-1
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1.
1.
Zoning Requirements -Setbacks -Easements
Footings; Size -Spacing -Marriage Line
2.
Soils; Special MH Support Sketch
4.
3.
Sewer; Location -Test -Fall -C/O -Concrete
Drain; MH Test -Fall -Flex Connector
4.
Water;'Location-Test-Easement Needed (Sketch)
7.
5.
Electricity; Location-Clearances-Grnd-/ . /Amp -Concrete
Gas and Electricity Tagged
6.
Gas; Location -Test -Wrap; / . /" L 'ft.
/ P Nat. or/ /" L "ft./ P LPG
10.
7.
Well Clearance & Disconnect
Cert. of Occupancy
8.
Utility Clearance
10.
Roof; Shthg-Roofing_
Date
Card B-1 Date Card B-1
Date
Card B-1 ` Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector
7.
Water and Sewer Connected -C/O to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Cert.
10.
Exits; Insp.-Sketch
11.
Cert. of Occupancy
11. Verify #'s with Office
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date ,
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date PERMANENT END SYSTEM (ONLY)
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Blocking
4.
Gas; MH Test -Demand -Valve
5.
Electricity; MH Test
6.
Water; MH Test
7.
Water and Sewer. Connected
8.
Gas and Electricity Tagged
9.
Exits
10.
License Decals
11. Verify #'s with Office
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
MISCELLANEOUS
Date ,
DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils=Size-Depth-Spacing-Connectors-Steel
3.
Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs-Connectors
Shthg-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills=Anchors-Studs-Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing_
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/51 -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. -
Boxes- Enc losures- Panelboards-Ins. to Main Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
12.
Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
J=OK
0 = Not OK
- = Nat Applicable
. = Not Ready
RESIDENTIAL (Single & Duplex)
Date UNDERFLOOR (Plans) OK except #'s
1.
Zoning -Setbacks -Easements -Flood -Slope
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5.
Stemwalls, Main; Steel - Bloc kouts-Wrapped
6.
Stemwalls, Garage; Steel -Blockouts-Wrapped
6a.
Hold Downs and Special Anchors
7.
Slab, Steel -Wrapped
8.
Piers -Fireplace Ftg.-Steel
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10.
UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11.
Water Pipe; Test -Anchors -Regulator -Service Test
12.
Electric Underground
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
Date
15.
Access & Ventilation
47.
16.
Insulation
48.
Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
Date
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
Card B-1 Date Card B-1
Date
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17.
Water Htr.; Vent -Access -Combustion Air Baffle
18.
Water Pipe; Test & Anchor -Nail Protection
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
20.
Shower Pan; Test, First Floor -Tub Access
21.
Test Tub & Shower, Second Floor -Tub Access
22.
Gas Pipe; Sixe & Anchors
23.
Fire Sprinkler; Test
59.
Glazing Area -Glass Protection -Skylights -Plastic
Date
60.
Card B-1 Date Card B-1
Date
61.
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Insulation -Walls -Ceilings
24.
Fixture & Transformer Clearance -Ins. Protection
Infiltration -Walls -Windows
25.
Elec. Receptacles Spacing -Lights & Switches at Doors
Card B-1 Date Card B-1
26.
Size Boxes & No. of Conductors Stapled
Card B-1 Date Card B-1
27.
Romex Installed Close to Edge of Studs & C.J.
28.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29.
2 Appliance Circuits in Kitchen & Conductor Size GFI
30.
Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
31.
Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al
Insulated Neutral ❑ Yes ❑ No
32.
Service -Riser Conductors & Ground Main Disconnect
33.
Equip. Clearances Panels-Motors-Mech. Equip.
34.
Clothes Closet Light -Shower Light -Spa Light
35.
Smoke Detector
72.
Elec. Outlets at Wood Panel, Int. & Ext.
Date
73.
Card B-1 Date Card B-1
Date
74.
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
Garage Fire Door; Swing -Landing -Closure
36.
A.C. Ducts Insulation & Support
A.C. Duct in Garage -Damper
37.
Vent Fan, Exhaust above insulation
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
38.
Condensate Drain & Overflow, Size & Grade
Plb.; Elec. & Mech. Equip. Listed for Location
39.
Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
Elec. Receptacles in Garage (F.FI.)-Romex Protection
40.
Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41.
Sills Proper Materials & Anchors
83.
42.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
84.
43.
Bearing Walls over Girders & Floor Nailing
85.
44.
Draft Stop in Walls (rat proof)
86.
45.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
87.
46.
Headers & Beams -Size & Bearing
Date
FRAMING (Continued)
47.
Hangers -Post Caps -Anchors -Connectors
48.
Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng.
49.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
50.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52.
Garage Fire Protection Framing -RC Channel
53.
Property Line Firewall & Openings
54.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57.
Siding -Nailing Veneer
58.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59.
Glazing Area -Glass Protection -Skylights -Plastic
60.
Shear Walls; Nailing -Bolts
61.
Brace Interior/Exterior Wall Panels
62.
Insulation -Walls -Ceilings
63.
Infiltration -Walls -Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
64.
Ext. Steps -Door & Sidelight Protection -Landings
65.
Smoke Detector
66.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67.
Bedroom Exiting
68.
G.F.I. & Bath Fixtures & Tub Access -Spa
69.
Elec. Trim & Subpanel, Breaker Sizes & Labels
70.
Stairs & Rails
71.
Fireplace or Stove, Clearance -Hearth
72.
Elec. Outlets at Wood Panel, Int. & Ext.
73.
Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74.
Elec. Outlets & Receptacles at Kit. Counter
75.
Garage Fire Door; Swing -Landing -Closure
76.
A.C. Duct in Garage -Damper
77.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78.
Plb.; Elec. & Mech. Equip. Listed for Location
79.
Elec. Receptacles in Garage (F.FI.)-Romex Protection
80.
Insulation -Foam -Looked in Attic
81.
Guard Rails & Deck Construction -Post Caps
82.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
83.
Following Instld./Drive ❑ Yes ❑ No/Walks O Yes ❑ No/Planters ❑ Yes O No
84.
Stucco Brown -Finish
85.
A.C. Unit Disconnect, Electrical -Plumbing
86.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87.
Water Well, Disconnect, Electrical, Plumbing
88.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
89.
Ventilation Throughout House
90.
Glass Protection
91.
Corrections from Previous Inspections
92.
Gas Test -Meters Tagged, Gas -Electric
93.
Water & Sewer Connected -C/O to Grade -HD Approval
94.
Energy Compliance Certificate -Other Certificates
95.
Address Posted
96.
Fire Sprinkler
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
i
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,
BP042929.
LICENSED CONTRACTORS DECLARATION
I hereby affinn under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 10/07/2004 APN: 030-410-012-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number.
Site Address: 1245 ZACK CIR ORO
Date: Contractor.
Map Index:
Description: TEAR OFF REROOF W/COMP (8SQ)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Seca 7031.5
Business and Professions Code: Any city or county which requires a
Owner:. MARTIN LUKE W
permit to construct, alter, improve, demolish, or repair any structure, prior
•
to its issuance, also requires the applicant for such permit to file a
1245 ZACK CIR
signed statement that he or she is licensed pursuant to the provisions of
OROVILLE, CA
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
95965-4340
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
I, as owner of the property, or my employees with wages as their
sole compensation, will do the .work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: MARTIN ,LUKE W
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.).
❑ 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
Contractor:
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.). .
❑ I am Exempt under Article 3 of Business andel Professions Code
I0 ' -O V v AA-B
Date: Owner:
License #:
WORKERS' COMPENSATION DECLARATION
I 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' compensafion, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Architect:
is issued.
k Engineer:
❑ I have and will maintain workers` compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Cartier:
Total Square Ft:'` 0 S.F. '
Valuation: $0.00
Policy #:
Census Code:
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 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.
Date:
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor.
code, interest, -and attorney's fees.
S '
CONSTRUCTION LENDING AGENCY
This permit Is hereby issued under the,applicable provisions of the Butte County Cada ?niUor
I hereby affirm that there is a construction lending agency for the,
for this is issued (Sec 3097 Civ.)
caabove or ev
Resolutions to do work 'indicated fwhich fes have been paid.
performance of the work which permit
By. Date: !_� o
Name:
o
PERMIT EXPIRES ON:
Address:
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. l 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 purpose
Print Name: L b k r/ 1'�i ~ Signature:
lel -:7-
7_7
Date:
Owner 0 Contractor 0 Agent for Owner 0 Agent for Contractor .
7
BUTTE COUNTY
rTF';C.-4000 DEPARTMENT _OF DEVELOPMENT SERVIC3 11 ES '
BUILDING PERMIT
o `24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)X#:
OFFICE #: (530) 538-7541 FA(530)538-2140
WEBSITE:',, www.buttecounty.neAdds
LICENSED CONTRACTORS DECLARATION
'I '
hereby affirm., under penalty of perjury, that am licensed. under,
provisions of Chapter 9 (commencing with Skbon'7000) of Division 3 of ,
° ;Issued. Date: 1-0/07/2004 APN• 030-410-012-000
the Business and Professions, Code; and my,license is, in full force and ".
effect.
License Class: License Number.
Y:
Site Address: •1245 ZACK CIR ORO .,
Date: Contractor. '
Map Index:
DeSCription: TEAR OFF REROOF W/COMP (8SO)
OWNER -BUILDER DECLARATION ,
"perjury
I hereby affirm under penalty of that 1' am exempt from •the
Contractors' State License taw 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. MARTIN LUKE W "
to its issuance, also requires the applicant for such permit to file a'
1245 ZACK CIR
signed statement that he or'she is licensed pursuant to the provisions of .
•. t
OROVILLE, CA'
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
95965340 . "(
sheds exempt therefrom and 'the basis for the alleged exemption: Any
violation of Section,. 7031.5 by any. applicant for a permit subjects the
"
applicant to a civil penalty of not more than five hundred dollars ($500).):
I, as owner of the property,. or my employees with wages as their
sole compensation; will do the work, and' the structure is not
intended or offered for sale (Sec.: 7044, Business and Professions
Applicant' MARTIN LUKE W..
Code: The Contractors' State License Law does not apply toan
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 howeverAhe building or impro%ements'are sold within one'
year of completion, the owner -builder will have 'the burden of
.
proving that he or she did notbuild-or improve •for the purpose of
"
sale.).
❑ ofexclusively contracting with
fto
licensed contractors toconstruct the project(Sec. 7044;, Business
and Professions Code. 'the'Contractors'slate License Law does
COntraCtOr
not apply to an owner of property who builds or improves thereon,
acrd who contracts for such projects .with a,contractor(s) licensed
pursuant to the Contractors: State License Law.).
❑ . I am Exempt under Article3 of Business and Professions Code
D " • t
Owner: � �iJ
_ 4
� •
Date: .p .
License #7 `
WORKERS' COMPENSATION DECLARATION
I hereby affirm under, penalty of perl'ury one of the following declarations:
❑' l have and will maintain a certificate of consent to self -insure :for
workers' compensation, as provided forbySection 3700 of the
Labor Code, for the performance of the work for which this permit
Architect:
is issued. -
Engineer:
❑ I have and will maintain' workers' compensation insurance, as
required by Section 3700.the Labor Code; for the performance of
the work for which this permit is issued, My workers' compensation
insurance earner and policy number are:
CartierTOtaI
Square Ft:. 0 .S.F.
Valuation: $0.00'
Census Code:
Policy a:
Q9 '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 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, l shall
'forthwith comply with those provisions.
Date:
2✓/-
Applicant: R'^'L. /�
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and .one
hundred thousand dollars ($100,000), in addition to the cost of
,
compensation; damages as provided for in Section 3706 of the.Labor
code, interest, and attorney's tees.
,
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable°provisions'of the Butte County Code end/or
Resolutions to do indicated above for which fees,have,been paid
1 hereby arm that there is a construction lending agency for.the
affirm
rk
performance of the work for which this permit is.issued (Sec 3097 Civ.) '
-
By. Date. �,y - 0>�
Name: ..
.
j
PERMIT EXPIRES ON:
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 inaccordance with Section 19827.5 of California Health '& Safety Code is not applicable toithe 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 after the substance'of any officialform or document of Butte County. Thereby
authorize representatives of Butte County to enter upon the above rrientioned'property for inspection purpose
L'u k �14 h� l
Print Name: -e W Signature
Dater
Owner ❑ Contractor ❑ Agent'for Owner , D, Agent for Contractor.,
0
0
0
BUTTE COUNTY, r�
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 53873636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REO UIRED AT TIME OF APPLICATION
"PLEASE PRINT CLEARLY**.,
OWNER
Last Nany4,(Y hf .-
4 •a,
irst Name2 U %C
Address S c C I Vr c
CityDYov,���
State eA
.Z1pgo-�-9�
Phone 6-73 — g 2 9 q
lax. -.1 306'
E-mail / U L► Ct ki @-w e b
.-
Name
'�7rlli�i
Phone
City
Zip
Phone Fax
E-mail State thense Number
ARCHITECT/ENGINEER
Name
Address
City
Zip
Phone Fax
E-mail State thense Number
APPLICANT NAME
Name
Address
City
Zip
Phone Fax
E-mail
APPLICANT SIGNATURE
X
For office use only
OVER
Zoning
Property Address
J a q S- Zac.� ...Ci rc l
Hood Zone
I
SRA
17yes.
No
Occ.
Type Const
Subdivision Name
Map Book
Page
Planner
-Date Approved---
pproved:-
PERMIT
NO,
G S IV,
BP
BIN #
LOCATION
AP#
Property Address
J a q S- Zac.� ...Ci rc l
City
pravi��2
Crass Street
fele lit 1 Lf t� 5
WORKER'S . COMPENSATION
Policy Number
Carrier
tf hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time ofpermit issuance.
LENDING AGENCY
Name
Address
OWER FOR SUBMITTAL REQUIREMENTS,
�i..��n••n�n� n� nu.n r/\11..nil'11J�11�-If.. i1D��t- J<- I]...... � ..
Description -or Scope of
Sq. Footage �Q D
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: ' `' Bldg
SRA
Receipt t Sheriff
SMIP
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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 LEGIBLEAND IN INK
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paperl
❑ 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 comprance 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 fid 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).
El 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
meTuncis 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
;heck fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
'AFORMSWILDING F0RMS1BIdgApp1SubRgmts.doc Page 2 of 2 REV 7-77-nA
:. O.B.-1.
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 verifi"cation is received.
CI personally. plan to :provide the major labor and materials for construction of'the', -
proposed prope ty,improvement : YE", NO[ ].
I HAVE HAVE NOT[ .] _signed an application for a building permit for the.
proposed .work..:
I have contracted". with the, following person (firm) to ..provide the -proposed*
construction: .
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
I plan to provide portions , of this .work, but I. have hired the following persona, to
coordinate, supervise, and provide the major work: `
NAME: :
ADDRESS: , . CITY:
PHONE: CONTRACTOR'S LICENSE NO.
I will provide some of the work but L have, contracted (hired) the following persons -to
provide the work indicated:
NAME ' 'ADDRESS : PHONE TYPE OYORK t
:
IGNED: �(
PROPERTY OWNER./ ,i tai ''I. IE,
S 'Y R•
DATE
NOTE: This owner -Builder- Verification is required by. Section 19831 and
19832. of the California Health and Safety Code.
.Thi&verifcation must be completed and returned to our office before
we"are permitted to issue the permit.
May 1995 2:26
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
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:
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including
materials and other costs) is $300 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments 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.
0 There may be financial risks for you if you do not carry out these obligations, and these risks are especially
serious with respect to worker's compensation insurance.
0 For more specific information about your obligations under Federal Law, contract the Internal Revenue
Service (and, if you wish,'the U.S. Small Business Administration). For more specific information about your
obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or subcontractor, only
under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbuilder"
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 contracting the Contractors State License
Board in your community or at 1020 N Street, Sacramento, 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 matters. The building permit will not be issued until the verification is returned
'. Vie* C.B.O.
Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
May 1995 2.27