HomeMy WebLinkAbout030-430-027TEMIT# '671"*19
9.
-'EWIN&, -'R6ge�
-16 . 191"i6th 0' r 0v� i '
Con t - '� Ke i th, Orm�dn,
Rero6f / SF
030-430-027 05-1904
WILKENSON, ANGELA
1619 16TH ST, OROVILLE
Cont: POOL BUILDERS INC
POOL
SPIKER, Kenneth 2991B
24GOP-
3035E
1619 16th St., Thermallto
CONTR': Bob Jeremiah, 9 Acacia 1'lv!e. Fl,orovil. (I
(New, -sing�e family)
AL I - r 11
, 3�3,
s:11 q�' ,71 -,641? so
44
U N�
PERM ITS'BECOM E NULL AND VOID 1 YEAR,FROM TH t:1 DATE. 6FAS suANCE, 'OR IF WORK IS'D ONE IN VIOLATION'OF ANY�* C OUNTY OR STATE.LAWS.
LICENSED CONTRACTOR'S DECLARATION
:i h-e!Feby' am rm u'ha_6r','pe4ty,of_ p�rju6.Jh.at. 1. p.m., -,licensed � yq�der...
issued Date: 07/28/2005
provislons of Chapter 9 (com men ng with Section 7000), of Divis on: 3 of
a 16 1 In full force and
the Busir�es�' nd Professions Code and my Ilden s
S:
effe6t.
License Class: N m6el:
pqnse u
Map Indli X:"
Date: Contractor_ L
i 9 /61� cot'
�_riptio`n': NEW PQQL-,-MASTER-#Ol
-516
OWNER -BUILDER DEqLARKT16-W
I hereby. affir m under penalty- of- perjury- that I am exampt...from the
. .. .....
Contractors' State License L . aw;.�'f'.o"Y--'Ih'-e;'f'611'6W'I'�'g",t6666h '(Seb."7031.5
0" ner"WI LKENSON,z�
W
Business and Professions, Code;'. Aby city or:'coUnly iwhl6h requires a.
permil.to construct, alter, Impr6V d emollsh,- or fe pair any structur,e, pdo r
1619 16TH -ST.'.
to'. Its Issuance, also req'uiresJthe: applicant;. for such�permlt.lo file a',
-6r
OROVILLE,, CA.
Slgned'sfatement that he she,is.ildensed pursuant,to. the provisions of
5 9 6 5:
the Contractor's'-State1icens6 Law" c ornmericing.with.Sect,on,
.(Chbp1er,9
7000) of D IvIsIon 3 of the Business and Professions Code) or that he,or
she, is exempt therefrom �hd 66 -basis *for the,,alleged- exemptloh. Any,
violatioK�of Section 7031.5 by any-appIIcant-for:'a:permI1 subjects'the,�
.,applicant to a civil *al(y of n6l.more than five huhdred.dollars (Wb).)�
I.- as owner. of the property, or my, employees. Wth.wages as their
compensation. - will -do;, the work,. and.;the structure. is not
A liccint:,�POOL BUILDERS
pp I
Intended or offered for sale -(Sec. 7044, Business: and.Professlons
Code: The db'ntra�' State Llcehse�Law,does not.'apply'to:an
Gtors,
..;- owner of prol3kty'who builds or -improves thereon;.and who does
THORNTREE #23
such work himself or hersdifor through -.his or: her- own employees.
C HICO::CA�..95973,.
provided ' that '-s ' uch.Improveirnefits are not in te-naed or offered for
ver', the building.,qr,im yq ents are sold within one
sale. If howe prq T "..; P.." "R.
530-899-8988
year of �compleflon� the owner -builder will have 'the urden of
SKIMMERRCH@AOL:COM
proving that he or she did,. not build or�lmprove for.the purpose of
sale.):
0 1. as owner ofAhe property, -am exclusively contracting with
licensed contractors. to construct the project (Sec.. 7044, Business
Contractor:� POOL BUILDERS
and Professlo�s.Code�,:--the.Contrgctors' State Licerise. Law does,
not aliply Wari owner I of-prop6r ty. Who. but Ids or Improve s thereon,
and who tontracts',for such p'rpje'cts.With7 a -contractor(s) licensed
3080 THORNTREE #23,
pursuant to the Contra . ctois'�Slate License Law.).*
CHICO; CA 95973 -
0 1 am 'Exempt Ond6r Article 3 1 of the Business and Professions Code
530-899�8988 -
SKIMMERRCHgAOL:COM
Date:, owner:.
ns
Lice e'#: 833994
WORKERS'-COMIRENSATION DECLARATION
.
I hereby affir , m under penalty of,�erjury one of the following declarations:
c
0 1 fiave and will rn�lntaln a certificate of:. onsent,to self7insure for .
workers' compensatlon.� for by -Section 3700 of the
Architect:
Labor �Code'.'f&`Ih'e performance. of the work for which this permit'
Engineer: j"
Is issued
om�
ihave and will 'maintain wor ers c pensatlon Insurance, as
n' 2i7
Jequired by Sectlo ' 00 the�' Labor Code, for the performance of
workeri'com einsation
the wbrk'for which this O.ermit is issued. My P
cy num er are:
insurance C'arde�rand-poll b
T 0 S. F
Carrier: UIfA�2 6�
Valuation: KOO
Policy 0`6 i; zo 4, 0
Census- Code:
0 1 certify that In fhe performance of the work for which this permit Is
Issued, I sh I all. not employ.. any perso in any manner, so as to -
become subject to the workers' compensation laws � of Callfoirn a�,
and, agree th'at�'If- 1� should become subject to the'wofkers'.
com 7 r Code, I shall-,
�ensatlon provisions of Sktion 3 60 of the,La bo
forthwith compl�,w'lth fh osei,provision s.
te: t
Qh
,b
A' licant.,
I �AA*
J'T
koverage 'is
WARNING; Failure to secure workers' compensation
unlawful, and sh 11 subject an. employer to criminal penalties andone.
hundred thousand dollars ($100,600), In addition to the cost of
tion 3706 of the -L
compensation, damages, as. provided for In Sec abor
code, interest; and attorney's fees..
,�CONSTRLICTION L ENDING -AGENCY
I hereby affirm that there is a c on�tructi6n lending agency for the
ihe is Issued (Sec 3097.Cl�.)
d/ -
This, perrniUls Kierebi issUed-unddr the'* visions of the !Butte County Code an or
a.ppilcable.'pro
I it �p do work Indicate ve for which fee� have been paid.
ReSprU orkS
performanc6 of work for-whi6h this: permit
By: Date7 Z�
Name:
9--:6 co
PERMIT EXPIRES ON:
Address:
(Date)
Hea afet Cod which regulate the-storeige,
0 1 h�ereby certify that the use of this facility shall comply with Sections. 255 1 05, 25533, and 25534 of'the California Ith and
handling and use of hazardous materials...
.
nc scheduled construction of this projecL
fie Noll e.wIth Section 11�827.5 of California Health & Safety Code Is not applicable to the
fic�'aiion-ln accorda
0 Allached'aee 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 owne r or the d6ly authorized agent of [he owner. I agree to comply with
. County. h er 66Y
wledge it ls'u6lawful,to alter the substance of any official form or document of Butte
and staid la I ws relating,W building.cons I tructl . on. lackno I .
.all,county
entioned ropeky for Inspection purp
I Butte Co upon the above m p
WW"atives o unty, to enter
Print'Name� Signature:
Date:
�,Ql Owne Contractor Agent for Owner .0 Agent for 'on rec,or
r
--PER
COUNTY MIT,NO.
T 7'
ENT SE
ARTMENT�,"OFIQE �j LQPM RVICES
0 '0
BPO51904
.,,�'15U.14PIN9 PERMIT
0.
6; 0 OROVIILLE).(1530)�891..-,28 1CO)
!'(530),53&7636:(� �419"
-0 0
T16 MAOOY5384541
0
y. . ......
PERMITS BECOME NULL-ANDVOIDA. YEAR, FROMTHE� bAtE,OF,'ISsUANcE1,'bJi� wW6RK'I'S`bONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
T
LICENSED CONTRACTORS DECLAk�kflOtC'��`�
64
I here15 . y I affirm rider penal't�,�j,*,��-'�'r'jyryt�.q.U..I,p
Issued Date: 7/. 28/2005 APN: 0304 30-0,21-000'
_M,J.q�nLe
of Chapter 9 (coriimi�rio -§edt!p�,7000):of.DIvIs on.3-bt..
.
.provisions
,the Business and Professions Codii�'ana.r�y jlcens�eli6i� 611 force and
Site SS:
,effect.
s n
Licens� Class: T 3� gqq 4:
-Map,index:,,..,�
D�ate: contractor,.,
kri
ptio n: EW- PO 0 L`MASTER- #0 1-5 187
OWNER -BUILDER It A [ON
'4ereby affirm under penalty -.,6f- perjury�.-Ihat- I.,am,.exemptJromAhe
'Contractors' State'License. Law,for,:Ithe, 611owlh5,t-e6e6h�,'(Sed.*,".7031.5,".�
'and'Professions ':'��Any:;c 'UntytWhIch
W
OW Re r:- IEKENSON-'.ANGEM'
C y or"co requires &
Business od
permit ' to construct,'alter, Imp't4,'d% m6116K repair,any!structureivprion:
ro e or
1619 16TKS
to Its Issuancje, 'also requirEi�,�t�e��applicdnt�..for:!such,�oqrmit�,tot file,,a.,
:,ilgned statement that he or, she Is')icehsed'pursuant�to, the provisions of
95965
Ahe Contractor's State Lice nse'LaW(dh apter'9 c6mmeridiig. %vith',Sectiont,
ons
70bi:i�'6f Division 3 of the Buslri r -
aqd�,Pro!ess th�at helo
"r— -.r c-
she is exempt therefrom and ilib"basii for !the,;aII6g e-8:exempi(on.'- -Xny
violation of Section 7031.5 by �ppca�.!..fo� a,permit su Jects t e
agy
applicant to a civil.,penalty of not.more than.five huMfed-dollars ($�00).):
0 as owner of the property,. or Ty'e-plbyiei'��ith-w6de�',a§�'iffiir'-
4
sole comp6nsation. will do � th6'�:'w'6 rk,"a'hd - the-itructuie-Jis; :not'
I - ... �1� :,', Pplicant;,.POOL'BUILDERS
Intended or offered for said. (Sec:., 7044,'Bus i�esi, and Pr�fiii��Ioins,
Code: Thii Contractors' State Llcense;�Law!doestnot applytt p an,,
'owner of property who builds:or-,improves � thereon. �endwho, does..
4b80 THORNTREE #23
such work himself or,hersdlf-lorthrough-hls-o�r
'f
G H tQ.
provided that such improxements-.are no(J.016nded o(- offe(6d
530-899-8988
within
sale. If however, the buIIding:,pQ1mp one.
year of completion,.the ovmer-builderi�wlll -,have--the 13�`rl�(;W
proving that he or she -did; nohbuild -ortimp �Vej�r-,toe purpose of
sale.).
C3 1, as. owner of the property- �am -excluslvely�contractlng-,with
----------
licensed contractors to constru�t the project (Sec. 7044, Business
POOL BUILDERS
and Professions Code. --The Contractors'. State, License -Law does
.. ... ....
not a0ply.to an owner of &06rty�Who"bullds-,or I miprovesjhereon,�.
and who contracts for su8h� orojects,wlth,� a'contractor(s) licensed .
1 3080 THORNTREE #23 ......
pursuant to.the Con traclors�: Sta I&' Lice rise Law.,).
CHICO, CA 95973
I am Exempt underArticle 3,of,th� Business and,P�q essiqn�,Code,
t'530 -899-,,8988-
t, t,
SKIMMERRCH@-AOL.COM
Date: Owner:'
-Li-e 83'
P..n. e
WORKERS' comOtNsATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a,,certificate;of; consent. to.
Workers' c I ompensation, 66 pr&Ided'. for -'by Section 37.00 :of the
-7---:�Arc-hitecf.'
Labor Code, for the pe rfo rmance,� of th e,. work. for which this,permit
En in
gipe
is issued.
I have and will maintain workers' compensation ins�u�� pc I e, as
I . -
-required by Section 3700 th , e Labor Code, for the . perform a nc . e of
the work for which this permi tis.issued-My.workers'compe ati6h'
insurance carrier and. pollc�. number ar6.
Total S pare Ft: 0 S. F.
Carrier:— zmeaff-
Naluatiow, . $0.!.00.,
Policy
Census Code:
0 1 certify that In the performance of the work for which this permit is
issued, I shall not emplo�..any person In any manner so as to
become subject to the workers', corn pensaUofi taws of California,
sub h
and agree that if I shbuld become 'ect...to 1. e,'workers'
1. . � �, ihe�
compensatlo n provisions olf,Section * 3 00o Labor Code, I shall
d forthwith comply with those pi�ovisloqs.
0
Dalte-:-7 A
Applicant: -F
46
Lveraige
WARNING: Failure to secure workers' compensat�on Js,
"unlawful, and shall subject �an:temployer to,c.riminal.,p!an�IU!D�,,a.�d,..o.ne.
,hundred thousand dollars ($100 000),' 16 addition -to -the . cost of,;
.
co - mpensation, damages as provided:fo, In Section 3706 of the Labor
code, interest, and attorney's fees:, ,
CONSTRUCTION " LENDING AGENCY'
This permit is hereby issued under the p.pplicable provisions of the Butte County Code�and/or
I hereby affirm that there is a construction lending-jig.ricy
the for whidh this is Issued (Sec 3097 Civ.)
ns-ta o work Indicated apove fc, been paid.
'Resolutio r which fees have
d
fl '-2-
performa nce of work permif
B" D.,
Y.: te�7
Name:,
PERMIT EXPIRES ON:_
Address:
(Date)
- 0 1 hereby certify that the use of this facility shall comply with - SectIons 1 25 1 505, 25533, and 25534 of the California Health and Safety Code, which regulate the st.orage,
handling and use of hazardous materials...
vl�' Notification In accordarice With Section 1D027.5 of California Health',& Safety Code is not applicable to the scheduled construction of this project. -
0 Attached are copies of the.requlr . ed E.P.A. notification forms.
I hereby certify that I have read . th I Is application, that the.above Info I rrnatlon Is correct, and that I am the owner or the duly authorized agent of the owner.., I agree to comply wilh
,all county and state laws relating to buildlng,construcilon. I acknowledge.it Is unlawful to alter the substance of any official form or document of Butte County. I hereby
'tiuthorize rep,rasai:Vives of Butte.Cqun up-on,the abovime.ritioned property for Inspection purpo(es.`
ty to enter
kClc gnatur
'Print Nam-e: Sl e:
y
Date:
owner Cchtradtor't i "�O AgentforOw ne'r-...., ... ... Agent for Contractor
BUTTE COUNTY
-.DE.PARTMENT OF �DEVEL.;OPMENT -SERVICES",
0
BUILDING'PERMIT APPLICATION'
ENTS
kr4;�,, -N
UMSUBMIT�7:,Al� REQVIREM
24- HOUR INSPECTION#:,OROVILLE: (530) �38-.7�636,-.CHICO:�(530).891'-2834
0 OFFICE #: (530) 538-7541
A FEE WILL BE REQUIREDATTIME OFAPPLICATION:
Website: www.buttecounty.net/dds.,,,
"PLEASE PRINT CLEARLY*,,
Me F, M 7:1
Name!
OVER FOR $,U.BM1TTAL'REQ.U1R,.1EMENTS
LOCATION,
�'AP#
gr\,
-.Property Address C1
1".'CrossStree
WORKER!S COMPENSA TlOff.
Pnlir.v Nijmhp.r
12-0 (a d
Carrier
UDee-III/ I
Ithiring anyone other than license, contractors, a certificat ' e o7worke�s
c9mpenution must.be,shown at the time of permit issuance. _j
LENDING AGENCY
Name
Address,.
Description "Cope of Work:
I W642-000.0 r00L.-
Sq. Footage
El Structure Built without Permits -
El Proposed Change of0ccupancy,
(Note previous use):
EXPIRATION OF APPLICATION.
A plications for which,a',permit has not been issued will expire one
p
year,aft&.the date of Application. In.order to renew,action on an
application Aher' expii I ation, a new application, plans and fee will be
reouir'ed.
REQUEST FOR REFUNDS
Ref�nds can. only be, made upon written'request by the person who
paid the fee. The request must be m ade 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.
KAFORMS\BUILDING FORMS\BldgAppISu,,bRqmts.:doc -.,Page 1 of 2 REV 2-24-05
ARCHITECTIENGINEER
Name
Address
City
'StaT_�11
p
Phone
Fax
!E-mail
State License Number:-.
OVER FOR $,U.BM1TTAL'REQ.U1R,.1EMENTS
LOCATION,
�'AP#
gr\,
-.Property Address C1
1".'CrossStree
WORKER!S COMPENSA TlOff.
Pnlir.v Nijmhp.r
12-0 (a d
Carrier
UDee-III/ I
Ithiring anyone other than license, contractors, a certificat ' e o7worke�s
c9mpenution must.be,shown at the time of permit issuance. _j
LENDING AGENCY
Name
Address,.
Description "Cope of Work:
I W642-000.0 r00L.-
Sq. Footage
El Structure Built without Permits -
El Proposed Change of0ccupancy,
(Note previous use):
EXPIRATION OF APPLICATION.
A plications for which,a',permit has not been issued will expire one
p
year,aft&.the date of Application. In.order to renew,action on an
application Aher' expii I ation, a new application, plans and fee will be
reouir'ed.
REQUEST FOR REFUNDS
Ref�nds can. only be, made upon written'request by the person who
paid the fee. The request must be m ade 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.
KAFORMS\BUILDING FORMS\BldgAppISu,,bRqmts.:doc -.,Page 1 of 2 REV 2-24-05
CQUNTYi OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
www.buttecounty.het/dds
30-
OWNEk: ASSESSOR PARCEL NU�MBER
,Proposed Building Use:. Permit Technician. 6% Date: -711 OTI_
Items required in order tb apply'for a permit. All boxes MUST be checked OR marked NA in order to apply.
1 . Site plans, 3 or 4 sets, signed -by the preparer of the plans.
2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
4. Engineered truss details and layouts in duplicate. No faxesl
5. Letter from Engineer or Architect for truss design review.
0 6. Energy compliance design and supporting documentation in duplicate.
E) 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
0 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or frid plans, all in
duplicate.
0 9. Metal bldgs: (A) Metal Bldg Plans, (8) Frid plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these
must be stamped and wet-si-qned by the enginee .
D 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate.
0 11. Letter of intent for non-residential buildings.
0 12. Hazardous Material Form.
0 13. Acknowledgement of building permit application without required clearances.
0 14. Other
Remaining items needed to issue the permit. (Fjay require additional plan review upon receipt of the following items.)
0 15. Sanitation and site plan approval from the Environmental Health Department in 0 Chico 0 Oroville, as applicable
0 16. Fire Sprinklers
0 17. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office
El 18. Soils Report and/or Engineered Foundation required.
0 19. Erosion Control Plan Required.
0 20. Fees as shown on the attached Schedule of Fees Due Sheet.
0 21. City of Chico Plumbing permit.
0 22. Site plan and business license approval from the City of Biggs.
23. California Department of Forestry plan approval 0 paid.
24. Planning approval for (A) Use: -(B)Parking: _(C) Parcel Check:
0 25. Contact Land Development about - Improvements, -Drainage.
26. NPDES Form
0 27. Encroachment Permit for driveway from the Public Works Dept.' (construction approval prior to occupancy).
0 28. Contractor's license information. (Number, Name Style, Classification).
0 29. Worker's Compensation Carder and Policy Number.
0 30. Owner -Builder Verification ( - Given to owner, - Mailed to owner).
11 31. Letter of Signature authorization.
E) 32. Recorded copy of Agricultural Acknowledgment Statement.
0 33. Existing violations and/or expired permits.
0 34. Deed Restriction.
0 35. 0 Legal d d tion, 0 M.H. Title, title sparch, registration or MCO
21, 36. Other: en3 0_� C) U.WN&_A:�f
0 37. Other:
When issued Telephone !�999 ___T� M and hold for pickup.
I have been informed of the above items and requirements for obtaining a building permit.
Applicant.. Gz:) Date:
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, and other department costs are not refundable.
Original -Applicant
Lf
OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive,, Oroville, CA, 9596��Phone (530)538-7541 Fax (530)538-2140
PE'R'M*'1T APPLI"CA'TION DATA SHEET -
OWNER: ASSESSOR PARCEL NUMBER D3 0 - 430-
-71,Proposed Building Use: Permit Technician4w)�,. Date:
Iteras required in order fb apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
1 . Site plans, 3 or 4 sets, signed by the preparer of the plans.
2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
El 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
0 4. Engineered truss details ' and layouts in duplicate. No faxes!
El 5. Letter from Engineer or Architect for truss design review.
El 6. Energy compliance design and supporting documentation in duplicate.
7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
8. Manufactured home s: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or frid plans, all in
duplicate.
9. Metal bldgs: (A) Metal Bldg Plans, (B) Frid 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 enginee .
El 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate.
11 11. Letter of intent for non-residential buildings
1-1 12. Hazardous Material Form
0 13. Acknowledgement of building permit application without required clearances.
Fl 14. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
15.
Sanitation and site plan approval from the Environmental Health Department in E3 Chico 0 Oroville, as applicable-,
.16.
Fire Sprinklers .................................. I .........................................................
I T:
Agricultural Buffer cIr and site plan apr from the Ag Commissioner Sent by-..
18.
Soils Report and/or'Engineered Foundation required ...........................................
0
`,19
Erosion Control Plan Required.... ..............................................................
11
20.
Fees as shown on the attached Schedule of Fees Due Sheet ..............................
Ei
21.
City of Chico Plumbing permit ........................................................................
El
22.
Site plan and business license approval from the City of Biggs ..............................
iEl
?/
23.
24.
California Department of Forestry plan approval 0 paid. Sent by: .......
Planning approval for (A) Use: 6 K_ (B)Parking: _(C) Parcel Check: 4/ .....
El
25.
Contact Land Development about - Improvements, - Drainage ............. / ...........
26.
........... * ........ .......... ...... ...............
NPDES Form ........ ...............
27.
Encroachment Permit for driveway from the Public Works Dept ..................... ** ....
28.
Contractor's license information. (Number, Name Style, Classification) ...................
29.
Worker's Compensation Carder and Policy Number ..........................................
30.
Owner -Builder Verification Given to owner, -Mailed to owner) .....................
31.
Letter of Signature authorization ....................................................................
EJ
32.
Recorded copy of Agricultural Acknowledgment Statement .................................
Q,
33.
Existing violations and/or expired permits .......................................................
0
34.
Deed Restriction ..........................................................................................
0
35.
36.
0 Legal description, El M.H. Title, title rch, registration or MCO .........................
Otheri r-oc) k I
-f
1:3
37.
Other:
When issued Telephone C-629 9 -qg e? and hold for pickup.
I have been informed of the above items and requirements for obtaining a building permit.
ro r -A. GZ> -711
Applicant: 19"_r Date:
1. Index permit applicatiAor the above items numbered: Plan Check LeAer
2. Additional items required-'
C -Eo: �ntraco , esigner, owner, was advised of the above data by *,6 phone, 0 mail, 0 counter, by Date: �7 -2'9 - OS
tv4F&;teKdesigner, owner, was advised of the above data by 0 phone, El mail, 0 counter, by Date:
Contractor, designer, owner, was advised of the above data by 0 phone, El mail, 0 counter, b Date:
Plans reviewed by- Dat Plans approved by: Date:
A Structural approved by: 4V,
Structural review�e�d by: Datee:: /4& 1 Date: 2
Note transfer by: Date: J
Yellow: Building
030-430-021--.. PERMIT#96,-1199
EWING, Rog6r
1619,16th St, Oroville
Cont:'Keith Orman'
Reroof/SF
I
i
F
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING'DlyjWN
7 County Center Drive -:Oroville, Caiif6rA 9'�965 - Telep�one (916) 538-75'41 PERMIT NO.
APPLICATIONAND PERMIT
ASSESSOR I PARCEL NUMBER 030-43-027
ZON NG
AR
eo"IBUI LDING PERM It
OWNER
ROGER MING'
TM1462
sQ. Fr. occ. BUILDING VALUATION
20 1.
2M. 00
OWNERS MAILING ADDRESS
1619 16TH ST OROVILLE
CONTRACfOR'S NAME
MTH 0"
NE
CONTRACTOR'S MAILING ADDRn BOX 455 BANGOR, 95914
Fireplace
CONSTRUCTION LENDER
NKNOWN
Total Valuation $ 1,
2W. 00
Filing Fee
$ 20.00
LENDER'S MAILING ADDRESS
Permit Fee
$ _11.00
ARCHITEC I T OR ENGINEER
LICEASE NO.
Plan Checking Fee
$
Energy Plan Ch6i�ing Fee
$
ARCHITECT OR ENGINEER'S mAiUNG ADDRESS
Penalty
$
BUILDING ADDRESS
1619 16TH ST
PERMITIFEE
$ 51.00
PLUMBINGPERMIT
Filing Fee 20.00
OROVILLE
Each Trap
7.00
LOT NO.
SUBDI'VISION'S NAME
IPARCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF 91 Duplex 0 Mobilehome 11 Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPEOFWORK
New 0 Addition 11 Remodel 0 Ublibes 0 Installabon Other 0
Describe Work: REROIDF W/C01P
Mobile Home .1 S I GI W 1
920.00
PERMITFEE
1$
Contractor
ELECTRICAL PERMIT
Filina Fee 20.00.
Main Service 500V OR LESS
200A OR LESS
23.00
Main Service 200A TO 1600A
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,
and my license is in full force and effect.
License Class if- :? 9 Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I'am exempt 6om the Contractors License
Law for the following reason:
0 1, 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.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Cocle for this
reason
NEW CONST. DWEWNG OCCUR
OR ADDNS. & ACC. BLDS.
SO.
3.50 FT.
NEW CONST. MULTI -OUTLET
NOWRESID. BRANCH CIRCUITS
97.50
&POWER us
( SINGLEAOPUPTALREATTCIR
Ex. Occup. ( OUTLET OR FDCTURES
20 @ 1.00
BAL (4 .50
Ex. Occup. F XED APPLNS. OR
( OUTLETS (RESID.) EA.
5.00
Tem,porary Service
23.00
Mobile Home Facilities
20.00
Misc.'Wiring
23.00
PERMITIFEE
$
Contractor
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
I have and will maintain workers' compensation insurance, as required by Section
3700of the Labor Code, for the performance of work for which this permitis issued.
My workers' compensation,insurInce carrier and policy number are:
Carrier
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
C - ontractor
Policy Number /'//I
(The above sections need not be completed)f the permit is for work of a valuation
of one hundred dollars ($100) or less.) . " I i
0 1 certify'that in the performance of the work for which.this permit is issued, I shall
not employ any person in any manner, so 'as to become subject to workers"
compensation laws of California, and'agree that if I should become subject to the.,;
workers' compensation provisions of section 370b of the Labor Code, I shall.
forthwith comply with those provisions
X '.�:-Date�
Signature"'of Applicant 0 Owner 0 (:�Ontractor Q�Agent
An OSHA permit is required for excavations over 60" deep a,nddemolition or constructon
of structures over 3 stories in height.
Mobile Home Initallation Fee
$
EnergyzInspection Fee Is
Occ
CO T. TYPE
ITOTALFEE$
51.00
1"
1XZ!,
� D. FEES
I imp
FLOOD
CDF
PARCEL I PD HD
ISSUE
Th -is permit is hereby issued under the
of the Butte County Code and/or
i,ndicated above for which fees have
By
PERMIT EXPIRES ON/
applicable provisions
Resolutions to do work
been paid.
Date 3
(Data)
Receipt No. 201716
I WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
"v
COUNTY OF BUTTE- DEPARTMENT OF-DEVC-LOPMENT SERVICES -BUILDING DIVI
7 County Center Drive - Oroville;4'C�lifo6a 95965 - Telephone (9>16)53 _?�i PERMIT . 0.
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 030-43-027
ZONING AR
."'BUILDING PERMIT
OWNER ROGER EWING
TM -1462
SQ. Fr. OCC. BUILDING VALUATION
20 i,2oo-no
OWNER'S MAILING ADDRESS 1619 16TH ST OROVILLE
__[:iE-NE
CONTRACTORS NAME KEITH OkAN
CONTRACTOR'S MAILING ADDPV6 BOX 455 BANGOR, 95914
Fireplace
CONSTRUCTION LENDER
UNMOWN
Total Valuation $ 1,2UU.UU
Filing Fee
$ 20.00
UENDER'S MAILING ADDRESS
_7�
Permit Fee
$ -ii-on
ARCHITECT OR ENGINEER
E NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty
$
BUtLDINGADDRESS
1619 16TH ST
PERMITFEE
s 51.00
OROVILLE
__7�ELMAP
PLUMBINGPERMIT
Filing Fee 20.00
Each Trap
7.00
LOT NO.
S UBDI'VIS IONS NAME
Solar or heat pump water heater
23.00
Water piping
—
-15.00
USEOFSTRUCTURE
SF )p Duplex 0 Mobilehome 0 Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities 0 Installation EX Other 0
Describe Work: REROOF W/COMP
Mobile Home I S I GI W 1
920.00
PERMITFEE
$
Contractor
ELECTRICAL PERMIT
Alinq Fee 20.*00
Main Service 600V OR LESS
200A OR LESS
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,
and my license is in full force and effect.
License Class Lic. No.
CFWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the * following reason:
0 11 asgwnerof theproperty, or my employees with wages as their sole compensation,
will 'do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
I 'am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUR
OR ADDNS. & ACC. BLDS.
3.5it F'or.
NEW CONST MULTI -OUTLET
NOWRESID. BRANCH CIRCUITS
97.50
&POWER US
SINGLEAOPUPTALREArTCIFL
Ex. Occup. ( OUTLET OR FIXTURES
BAL I
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
Contractor
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
I have and will maintain workers' compensation insurance, as required by Section
3700ofthe Labor Code, for the performance of work for which this permit is issued.
My workers' compenpation insur ce carrie and policy number are:
Carrier yi4 -� -e T, ;7
MECHANICALPERMIT
Filing Fee 2 0;0 , 0
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
Contractor
Policy Number k5/0 -i7_279 - Y's—
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor
forth I with those provisions.
X !;zz: � . a, — Date
Signatur(!rof Applicant - 0 Owner 0 Contractui jex,.Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over�3 stories in height.
Mobile Home Installation Fee
7
-
Energy Inspection Fee Is
Occ
CO T. TYPE
ITOTALFEE$
51.00'.�.
HAZ I
D. FEES
I IMP
I FLOOD _F
CDF
PARCE7L PO HD I
ISSUE
This permit is hereby issued under.the
of the Butte County Code and/or
indicated above for which fees have
By
PERMITEXPIRES
applicable provisions, --
Resolutions to o -"..w ork�*
been paid.
Date
(Date)
ReceiptNo. 201716:,
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
PLANNING DIVISION - BUILDING P'�WAPPROVAL
Pse: Date:
Parking: Landsca
ping:
Other:
Signature:
v
a SPA GENERAL
SPECIFICATIONS
SPA TYPE: MDL A
DIMENSION:
DEPTH:
COLOR TOTAL GALLONS
r'
SPA JETS TILE
HEATER:
PUMP & MOTOR:
AIR BLOWER:
GAS LINEN
!. PLUMBING FOR SPA:
ELECTRICAL: CLOCK:
°. EXCAVATION:.
s DECKING
MISCELLANEOUS:
SOLAR GENERAL J:
SPECIFICATIONS
SQ.. FT. POOL SO. FT. PANEL.
.1 PANEL TYPE PANEL SIZE
NUMBER PANELS PLUMB RUN
AUTOMATIC MANUAL
THERMOMETERS BOOSTER PUMP
SINGLE 0 DOUBLE O ELECTRIC BY:
JOB NO.
MAP BOOK NO.
LEGAL DESCRIPTION
'v
LOT N0.
TRACT NO.
BOOK PAGE BLOCK
ESCROW CLOSE
TENTATIVE DIG DATE
PERMIT OFFICE
MGR.
SALESMAN
OWNER:
TO DETERMINE
►Itw-nw.` nw �ac��cIf