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Home My WebLink About030-430-031A.P. 30-43-31 C.E. McElyea 1659 16th St., Oroville Permit 245-71B (add scrld patio) AP 30-43-31 JACK BERRY I 1659 16th St., Orovillee4 ,Permit# 1366-75B(recons ruct stor. room 030-430-031 04-1913 BERRY, JEFFREY 1659 1 ' 6TH STN, OROVILLE A" Cont: OWNER REROOF/SF 030-430-031 05-2756 BERRY, JEFFERY 1659 16TH ST, OROVILLE Cont: OWNER STUCCO f j F51 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT O)� 0 -7636 (OROVILLE) (530) 891-2834 (CHICO) 24 HOUR INSPECTION PL. (530) 538 OFFICEA (530) 538-7541, B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby' affirm under penalty of perjury Ahat I am, licensed under Date: 10/05/2005 APN: 010-430-031 _000 - provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession's Code; and my license is in full force and - Site Address: 1659 16T H . ST ORO .effect. License Class License Number. Map. Index: Date: Contractor. Description: re Stucco (750) OWNER -BUILDER DECLARATION I herebi.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 Owner: BERRY JEFFREY S. permit to construct, alter, improve, demolish, or repair any structure, prior rfile 1659 16TH,ST to its issuance, also requires the applicant for such permit to a signed statern ent that he or. she is licensed pursuant to the provisions of OROVILLE, CA the Contractors State License Law (Chapter 9 commencing with Section 95965 7000) of Division 3 of the Business and Professions Code) or that he or 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 I penalty of not more than five hundred dollars ($5 00).): 1, as,o . wrier of the'property, or� my employees with Wages as their sole compensation, will do the work, *and the str ucture is not, intended or offered for sale . (Sec. -7044, Business and Professions Applicant: BERRY, JEFFREY.S. Code: The Contractors' State'License Law does not apply to an 1659 16TH ST owner . of prop er ty who builds or improves thereon, and who does OROVI.LLE,'CA such work himself or herself or through, his or her own employees, provide d that such r improvements are not intended or offered for 95965 sale. If however,'the building or improvements are sold within one %year of completion the owndr-builder will have.the burden of proving that he or she did not build or improve for the purpose of sale.). 1. a s owner of' the property, am exclusively contracting with' licensed contractors to constru ct the project (Sec. 7044, Busin ess ..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.). CI I am Exempt under Article 3 of thq Pusiness and Professions Code to Date: License.#: NSAtION DECLA WORKERS' COMA RATION 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 Architect . Labor Code, for the performa6De of the work for which this permit is issued. Engineer: 0 1 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: Card.er:-- Total Square Ft: 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 sb as to 0-7 become subject to the workers' compensation laws of California, and agree that if I should -become subject to the workers' Section 3700 the Labor Code, I shall compensation provisions of of forthwith comply with those provisions. Date: Applicant: WARNING:: ilur 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. CONSTRUCTION LENDING AGENCY This permit isK the a ica rovisions of the Butte Count ty Code and/or ereby i�pued un p I'hereby affirm that there Is a construction lending agency for the Resol.utions o do jork indi abov or h f I ees have been paid. r�;b' ;7' performance of the work for which this, permit. is issued (Sec 309 7 Civ.) Date'. : Name: Bv: PERMI�EXPIRE`S' ON: S1 Address: (Date) I 0 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. Q Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. 0 -Attached. are copies of the required E.P�A. notification forms. I : I .1 . I hereby c I e . rtify that I ha I ve . read this'. application, that the ab ove information is I correcti and that I am the owner or the duty authori zed a ge n t of t h e owrier. I'agre6 to 6 ornply with I 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: �2 Signature: Print Name: Date: /1/0 wrier Contractor 0 Agent for Owner C3 Agent for Contractor B. C. Building Permit 01-16-04 pg 1 MvId MWE OWNER Last e tic rirst Nam :4� Address . . lip S'_ city Statt7,, t f� Zip: Phone Fax Fax CONTRACTOR -Name 4l U, e_ 61;2 tf,.A!� Address city 7—FZj�_.b stata., -L WORKER'S COMPENSATION Phone Fax E-mail # 7.7z3e1 -1 C1 ss APPLICANT SIGNATURE X For ofte use only: ARCHITECTIENGINEER Name &VR C) Ivie Address -L WORKER'S COMPENSATION City Yes,.. State z ip Phone Type Const Fax E-mail �Page State License Numl>er. APPLICANT SIGNATURE X For ofte use only: APPLICANT NAME Name &VR C) Ivie Address -L WORKER'S COMPENSATION .city Yes,.. State Zip Phone Type Const Fax E-mail �Page APPLICANT SIGNATURE X For ofte use only: Zoning ty FloDd zone -L WORKER'S COMPENSATION SRA Yes,.. No Occ. Name Type Const Subdivision Name Map Book �Page 101, Planner. Date A pp,r oved:. OVER FOR SUBMITTAL KEQUIKEMEN I b LOCATION Property Address Z66, 16 ty Cross Street 2 A, L/4- ,!2 -L WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of work.er's compensation must be show . n at the -time of permit issuance. LENDING -AGENCY Name Address - �Sq. Footage 0 Structure Built vvithout Permits 13 Propoged Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has n6i been I s -sued. will expire one p ye.ar after the date.of application. In order to renew action gn an applicatic� n,after expiration, a. ne.w application, plans and feewill be required. REQUEST FOR REFUNDS Refunds can o . nly be made upon written request by the person *ho 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 reidndable.� SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply forapermit. -INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALLPLANSMUSTBE. LEGIBLE AND IN INK, Residential, New, Remodels, Additions, and Accessory Structures: El 1 . 3 Site Plans, signed by the preparer. NO GRAPHPAPER! Ei 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engin6ered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. 1:1 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). [3 4. Letter from Engineer or Architect for truss design review. 0 5. 2 Energy compliance design and supporting documentation. (7Vote: Not requiredfor additions to mobile or modular homes.) 0 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). 0 7. Detached Accessory Building Form, filled out by the property owner (if required). 8. Sanitation and site plan approval from the Environmental Health Department. El 9. 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 stqMed and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: El 1 3 Site Plans, signed.by the preparer. NO GRAPHTAPER! Ei 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. Ei 6. Sanitation and site plan approval from the Environmental Health Department. o 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: El 1 . 4 Site Plans, signed by the, preparer. NO GRAPH PAPER! o 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 cales in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be s1galped and wet -signed. by the engineer. o 9. Letter of intent. o 10. Hazardous Material Form. 13 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 (53 0) 53 8-754 1. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRqmts.doc Page 2 of 2 REV 6-16-04 BUTTE COUNTY DEPARTMENT.-OF-Di�VELOPMENT�-�SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)- OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEIBSITE: www.buffecounty.netWds PERMIT NO. BPO41913 I LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of pedury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: o�/29/2oO4 APN: 030-430-031-000 the Business and Professions Code, and my license is in full force and. effect. License Class: License Number Site Address: 1659 16TH ST ORO Date: C . ontractor Map Index:' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l,am exempt. from the Description: RE ROOF 18 SQ. COMP' 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, after, improve, demolish, or repair any structure, prior Owner: BERRY JEFFREY S to its issuance, also requires the applicant for such permit to file a 1659 16TH ST signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section OROVILLE, cA 7000) of Division 3 of the Business and Professions Code) or that he or . 95965 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).): 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 (Sec. 7044, -Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: BERRY- JEFFREY S 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 hot 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 b,uild & improve for the purpose of sale.). 1, 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, Contractor:r 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 the sin s a Professions Code Date: Owner License #: WOORKERS'COMPENSAYION DECLARATION' I hereby affirm under penalty of pedury one of the following declarations: El I have and will maintain a certificate of consent to -self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. I have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier an&,Folicy number are.: .Ca Mer. Total Square Ft: 0 S.F. . Policy #: Valuation: $0.00 I certify that in the performance of the work for which this permit is Census Code: 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. 12W 9 V Date: l6o A�plicant: 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. CONSTRUCTION LENDING AGENCY T his P#Mit Is h eb is a I e Ii ble pro fth 8 fte County Cods so r 0,.n. ' " or I hereby affirm that there is a construction lending agency for the Reroldt 4 to o i 0 c .-,e b p.:d. 0,,, io performance of the work for which this perTnit is issued (Sec 3097 div.) B Name: PERMIT EXPIRES ON: Addres s: Y" I 4LI -.�ate) I EI 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. 13 Notification in accordanc e with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. 0 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 official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purpos -r(- 3: 7A Print Name: Signature: 09. Date: er EI Contractor L3 Agent for Owner L3 Agent for Contractor UT BUTTE,':.COUNTY 0 '0 DEPARTMENT OF DiVELOPMENT 9E"RVICES 0 70 BUILDING PERMIT APPLICATION 0 -REQUIREMENTS AND SUBMITTAL 0 24 HOUR INSPECTION#: OROVILLEt (530) 538-7636 -'CHICO: (530) 891m2834 0 0 OFFICE #: (530) 538-7541 A FEE WILL'BE REQUIRED AT TIME OF APPLICA TION, i -*-DT V ACV IDIDTXT9r d-T-VAbT 'V'*'k- - OWNER Last Name irst Name Address C ly 6 Awe zi p Phone -0 x E-mail APPLICANT NAME CONTRACTOR Name City 06)t)d(jt< Address 4 city- - Fax State 7Zi p-. Phone Book Fax E-mail-; t Planner Uc. # class APPLICANT NAME ARCHITECTIENGINEER Name City 06)t)d(jt< Address 4 ,city Fax State TIP, Phone Book Fax E-mail t Planner State License Number APPLICANT NAME Name Address 16 City 06)t)d(jt< State 4 Phone 53 0 5 7 Fax E-mail PERMYT NO.: BP BIN# - Description or Scope of Work: P& ROOP-� W- S -C o .�e c6 Sq. Footage /Pb -0 F 6Lr' 11 Structure Built without Permits, 0 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 appli . cation. In order to renew action on an application after expiration, a'neW application, plans and fee will be reauired. REQUEST FOR REFUNDS Refunds can only be made upon written request by'the person who paid the fee..'The request must be.rhade prior to the expiriition of the pem-dt and no,constniction work has been done. Filing fees, plan APPLICANT SIGNA TURE, refii�dable. X Received by:-flo Amount. A6. C/0 Bldg For office.use oafy:' L OCA TION AP# . 0307 Property Address . 16 !� f, 4 City Cross gS�et L eA- A) b A L) -TypeConst" Subdivision Name Map Book WORKER'S COMPENSATION Policy Number t Planner -Carrier ff hiring anyonepther than license contra ' ctors, a certfflcate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: P& ROOP-� W- S -C o .�e c6 Sq. Footage /Pb -0 F 6Lr' 11 Structure Built without Permits, 0 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 appli . cation. In order to renew action on an application after expiration, a'neW application, plans and fee will be reauired. REQUEST FOR REFUNDS Refunds can only be made upon written request by'the person who paid the fee..'The request must be.rhade prior to the expiriition of the pem-dt and no,constniction work has been done. Filing fees, plan APPLICANT SIGNA TURE, refii�dable. X Received by:-flo Amount. A6. C/0 Bldg For office.use oafy:' Zoning IF166dZone1 SRA:[Yes __71 No 00C. -TypeConst" Subdivision Name Map Book Page t Planner Da te Ap prov ed: SRA Receipt Sheriff -MIP Other, Dat : � .�D OVER FOR SUBMITTAL REQUIREMENTS Total K:\FORMS\BUILDING F0RMS\l31dgApplSubRqmts.dDC Pa le 1 of REV 6-16-D4 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS W.TLL NOT BE A CCEPTED. ALL PLANS MUST BE LEGIBLE AND I1V INK. Residential, New, Remodels, Additions, and Accessory Structures: 0 1 - 3 Site Plans, signed by the preparer. NO GRAPH PAPER! 11 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPERI OR 3 Sets Engineered plans (ifrequited) -with wet signature on plans� AND 2 sets of stamped and signed calculations. El 3. 2 Engineered truss details and layouts (if required) (7V0 FAXES0. 0 4. Letter from Engineer or Architect for -truss design review. 0 5. 2 Energy compliance design and supporting documentation. (7Vote: Not requiredfor"additions to mobile or modular homes.) El 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). 0 7. Detached Accessory Building Form, filled out by the property owner (if requited). 1:1 8. Sanitation and site plan approval from the Environmental Health Department. 0 9. Me I ial Buildings: (A) Metar 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. Mobile, Manufactured, or Modular Homes: Ei 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI El 2. 2 Data sheets and installation instruction manual. 0 3. 2 Marriage line information. 11 4. 2 Floor plans. 0 5. 2 Engineered Tie Downs or Foundation p lans. 13 6. Sanitation and site planapproval from the Environmental Health Department. Ei 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: 13 1 . 4 Site Plans, signed by the preparer. NO GRAPHPAPER! El 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. o 3. 2 Engineered truss details and layouts (if required) (NO FAXE8!)'. 11 4. Letter from Engineer or Architect for truss design review. El 5. 2 Energy compliance design and support ing documentation (if required). 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). F -i 7. Statement of Intent for Non -heated and A/C (if required). ci 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 sLaWed and wet-sig—ned by the engineer. o 9. Letter of intent. 0 10. Hazardous Material Form. 1:1 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. '� . i FOR BUILDING PERMIT APPLICATION NG F0RM31dgApp1SubRqmts.doc Page 2 of 2 REV 6-16-04 OVvqNER-BUILDERVERITICATION Attention Property Owner:' An'cowner-builder" building permit has bwa applied for in your name and bearing your signature. Please complete and retam this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit No building permit will. be issued until ffiis verification is remived. 01 personally� plan to provide the major labor and materials f6r construction of the proposed NO E3 property ent: YES 2;1 HAVEk HAVE NOT E3 Signed an application for a building permit for the proposed WO& I have contracted with the following person (firm.) tD provide the proposed construcfion: NAM:E:— ADDRESS: CITY: P90NE: CONTRACIPORIS LICENSE NO. 4. 1 plan to provide portions oif this work, but I have hired the following person to coordinate, supervise. and provide the m�or worla NAME. ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. 1 will provide some of the work but I have contracted (hired) tho following the vmr)c indicated: persons to provide NAMIE ADDRESS PHONE TYPE OF WORK: NOTE., This.Owner-Builder YerYkadon is required by Section 19831 and 19832 of the Cahfornia Heakh =d S4kty CO& This varbCalion must be coWleted and be returned to our office fore we are permiued to issue the permit r OWNER BUILDER INF- ORMATION Dear Property Owner - An appUcation for a building pmmit has be�= submiftd in Your name listing yourself as The Wilder of propmly vedfied. For Your PrOt=6CA you should be avvare did as "Owner -builder- you are the responsible pa* ofrecord on such a pennit Building p=nb am not MT&ed to, Se s*ked by property ovM= Unless they own work- If your wcak is being pea*rmed by samwne other than yoursey M-0 P=O� perfOlIning their liability ifffia P=On aPPHeS for the proper pa� fil his or her name. . you May Protect yomelf from possible ContractOrs am requit-ed. by law to be licensed and bonded b� the State Of Ca�� and to haVe a business license from the city or wmty- They an also r`TIked by law tc) Put their license munber on er apply. all p m for which they Ifyou plan to do your awn work with tho =eption of Various trades that You plan to subc*ntract, you should be aw= of the Mlowh2g- , inf�mation for yow bmefit and protecfim + IfYOU employ Or OtherWige engage any P=CnS Other IhM your iMM30di2tO &Mfly, aad the wcak Cmcluding materials and Other costs) is $300 or mom for the enff" project , and Mr then You may be an =ployer. �h pMwM are not licen�ed as contractors or + If you am an eMPlOYw- you must register W'& 'be State and Federal Govermne= as an e=9loyer and yam are subject to weral obligations Including state and Wwa mcome ta withhoMh3g. fbderd socW woulay =es. Wod= WMPM-qad= kMM2Ce, dMbIBY 10�=� CDA96 aad UM13PIUYMZMLt Comp=atica wntaltiom + There may be financial rish for you ifyou do not cany out these DbHgatons, and them rsh are espe� s With respect to wozimes compmsation fimrame. MiCIM + 'Formore spwific h&=3Ikm about)vur obligafiow under ]Federal law, cm&,Kt the bterml Rovenne Sez-vi= (a4 ifYOU WW the U-3. Small Business Admkiqtndm� For MOM VXMC kffimmdon about Your obligadons under Stft Law; contact the Depmtnent OfBewf't PrJM2=b and the DNisicu of b&stW Amidents. lf the stn� 13 kIZRd5d for Sale� PTOP� owners who am not HcensBd 0=11 -dam are allawed to pm-tonn their work P=OnaUy or throuA theIr OYM em*Yfts, Without a licensed COUtaCtOr Or subconfrmtOr, OnIY under ffinited conditioaL A freVent Practice Of Mlicensed persons proftsing to be, Mnfrad= is to sIc= 11, 'o,= bmIdw- building P=M4 MMWM'y =PbMg that the property Ow= n prowding his or her own labor m3d m3bmal P=Dnally. Building permits an not rKlaired to be signed by propmty own= Iml they an pafimning &* OWA WOEk P=DnaUy. bftn,dm about li=md MMMCtm may be Obtained by mnt� the Cwtr� State U== Board m your or at 'Mo M Sbv&, Sa`M==dN CA. 95814. 'Ider Verra=bW on 'be MVCM Mde Of d= fDEM So did We can coe= that you nWBM 'M O=Pkft the "OW Ple are 'ware Of ffie$O mattm& The buffifing p== will not be issued unM the veriScagon Is mt� r-IrIT=M.3-JI [Bill. NO2z. YM 0wiw-Baffdm-Iqfonnaffon 's mqWmdby SecdOM -19830 Of &e CWMda Heah* amdSafety Co& M IV t" .e -- 7't .!PERMIT NO. 1366-75B P E M "MH UTIL. PERMIT NO. �PERMIT EXPIRES 'OWNER Jack Berry 1CONTR I LOCATION (A.P. 30-43-31 1 1659 16t� St., Oroville Temp. Power Pole Called PQ&E Temp. Elec. S�erv. Called PG&E �ry Temp. Gas Serv. Called PG&E 1/10 B FINALED (Datef (Signafure) Footings- COUNTY OF BUTTE DEPARTMENT OF PUBLIC, WORKS BUILDING. INSPECTION RECORD BUI��NG BUILDING (Cont'd) PLUMBING Setbac��_ Firewall Soil Piping Forms-. arapets 1st Floor Main B11 'Restroom Finish -2nd Floor Footi Windm—, 3rd Floor Sterriv Mesh Topout Slab' Roof Sheath4 Water Piping Piers Roofing Cooling Garage _7s�Sewer Fdn. Vents Fixtures Footings Garage Vents Water Htr. -1-1, Stemwa I I Slab Prov. for physically handicapp ed Heaters Appliances Carport Footings Conformance of ex. structure Gas Piping & Test Temp. Gas Slab Final 76— Sanitation Patio FIREPLACE Final Footings- Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures -Bond Beam FIRE SPRINKLERS Motors F r m i n Test�_, Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent: Door Closer Final Final DATE REMARKS OR CORRECTIONS --1 2 =UNf Y-bF -BUTTE :DEPARTMENT' F'� OR 0 PUBLIC W r Dri,ve,- O�oville' Califorrildq8065 7.C6unty ente Tel.eplilone: 534-4541� --&,T,.j0N AND.PERMIT APPLIC representatives is'6ns of eby issued'under,the-app V i property specti the Butte C66rfty Cbd6 and/or 'resoluiions o do a b 6 authori ze. *of the, County ot Butte to enter. upon. the This permi f is, �e� ove:mentioned' for.iri es� I icable -pr �qn purpos t rk indicated 4bove for whi6hlfbes fiave.been paid. TQR-.O DIREC 3LIC WORKS "X U )ate t re ee or Agent !g a ernit By:�� Date R pf ecei 0. 44JC�2 P b C't'o r GoJI den rbd-X' P I i C a Bui ding :perrni,t.exp. .1 %WHite-.D.P.W. Ye'llow"As issoh,�,P'ink,-ln's' nt IN)s Dhte ..... ............... —BUILDING ,Qwn r SQ: -FT. OCC �bbl LD�ING;,,YALUATION. a M �i I:i ng Aidress -T�N�h6ne'No. % F i repl aq C oiitr�actor 14 Total Valuation Mailing Address' Per mit-Fe6 PI ari Clikki no i�alty` Fee &/or Pc eleph6hd N�.' Peniiit..176e' $ $ r jBu I 10i ng Add ess 7 _i -PLUMBING' No. R FEE .4 PERMIT, 'P.:iLINb"FEE $2.00 5 EacK:-Trbp 1.�5o �Repaii:drai t n age, or -ven piping t '!-.50 V Y�AL '4.50, KPIPT9* '�Fach gas� ��dter heater or vqM A.,P. No..' '�'ni , ng '-:,,GAs,pjping Zoriing'&�,Plan t syst'errf.1,-.5 o6 lets Each-additi nalo6tfet o -30 F AiTf- I 9.w'w*fthtM- I D -6 p,t I re.Zoh.e: U: s e'P, mn i t : BurIding;,*§ew'e'r' 5.00 Q X Parking.[_' 'Pa6del .,Ppclarati TT�a 14- M p /w .1[m L w�n' -system 2.00 prinkler EiA <j I rs R,;,cd P 6 ri__,,, P r. V d 7, 'PI Mrs AP R Permi t Fee $ N E, W" ADD ON,]a TIE� qTHER'[:] t:LECTRICAL No. FEE PERMIT FIL-ING'FEE Main 'servic'e inci.'l-meter '�Addilibnal mijfers, each* 1.00 Sub�panel 'r(l 2. or less): (nore thdri) 2)- mi D -"H-o m Y.: ��,�up �bil R n" Cook -top, ge, _ojr oven 1.00'', .. ... W jr'Heater,or Space'H'&ater 1 . 00' - ate Light fixt qres:.. bal 10 w Receps., e 'S' itch"s& fix outlets CONTRA"PTORS'-LICENSE:, LAW � - I . , I , I am licerised'�uhder'the- provisions of ,6hap,ter '9� Div 3',-'�-`of t'h'6- ia� Staee_bf,,�Pa I i forn"'i B u -s -ii n' e* s s & Profe�sions: Code' under the: name st'y,l,e 9'f -*i Hood, E�.. Fan'or F,.A. Furn. Motor. Evap, codldr,g�r.disp. or D.W. 1.00 n '� Heat, Air conditi.o e.r o pump water pump Mobil 146me F.6ci ities. 5.bo, j �.Temp., Power 5.00 Pole ens -e N 6- i -cat i on,- i,c' Class s n Mi c. wi ri t,:fromrthe-Contr6ct6rs, License Laws of Ahe State of Cali fornia. 'W , ORK . M E . N9S' , :COMPENSATION-INSURANC E'� �,`I,.am.,:aware, i's'b'f-S66ti'on37o0 6'f%the Cal[forini of. the.'proyi si.o� Labgr Code, which-'requires�6�br''6mpl�yer;to .6e in�6red-agaihst li-�ibility 'Y �for.Workmen' s-Compens4ilon' [1 -j,; -have, placed on f'iie"- wj tt� th6 Count�'6*f Bult6, a '6.ertifica e of;,, "Wd rk'��6's'Compen s at ion lb su ran ce., ertify"jth6t of, the '..w6rk-for wh i ch Ith i s, I p�ermi-t, I - S _,jr . Ssued I shall, -:hot employ jqq . y, . person in any -.-ma n I ne r 't enis,,Com 0 as to ect ti6n,Laws _joe� Vorkn Iff 2 11 .- , pens -a orni a. �x MECHANICAL'� No' @ FEE t 'RERMI f'Fl LI N(j'FEE $3. 00 Heating" f, CoolL ing Ventilation,, Ho'od, 'Perini t. Fee $ $ f — 1� ; 1%, I have read this: -,appli'cati'on and state that tfid ab6v6' �in ormation,i.s..�coirec I a9'r6e`0com�pjIy*`to. all Countybrdinanc6s a I construct io�_ an nd �"St6te L�iws 'e 1�fi g 'to bui Idi n I h6reby T Tb',�L EE 'PERMIT F_. representatives is'6ns of eby issued'under,the-app V i property specti the Butte C66rfty Cbd6 and/or 'resoluiions o do a b 6 authori ze. *of the, County ot Butte to enter. upon. the This permi f is, �e� ove:mentioned' for.iri es� I icable -pr �qn purpos t rk indicated 4bove for whi6hlfbes fiave.been paid. TQR-.O DIREC 3LIC WORKS "X U )ate t re ee or Agent !g a ernit By:�� Date R pf ecei 0. 44JC�2 P b C't'o r GoJI den rbd-X' P I i C a Bui ding :perrni,t.exp. .1 %WHite-.D.P.W. Ye'llow"As issoh,�,P'ink,-ln's' nt IN)s Dhte ..... ............... . . . , - , - 1. � I . 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I �j " T;j " ! * 1�� . _ ., , - r _. , r. . - 1 , Y .,I, ' - - , 'a . ", ,I . . '1`, -,:,- �', . , , - :301 - " I , - , ,�-'.,-.�,,�� .6,+�;�-,' - , , ': , ,�_�',Z'-"��', -, 6" � 9-1 I , �� - __;; r '' , � � 4 ' -_ ,,, r, , . - I , " ��"'N� �, " _ , - - �, " - , - . I "in C'�-- ,,- - , " , ", - . I - �7 - � � , , _.:.: �' - � r_L ,, _ � " .,-�i r � - , ��, .� - - . `�.�- ; . .W:,% . - .1" , � , _ , , - - �,!� �,�,� . . � � I - �_, �, , . " - � � � � ; --- - �. '7 - '* "' . --' -' � . . � .. +',.r, t,� 5 _ � �-,�`��.��.' ff, ... �r7 _� . ", . . , � - �� V , ,Z . � , ,' __� - - �'7'kr' . , COUNTY OF BUTTE Department of., -,Public Works BUILDING' IkSPECTIOA' RECORD' Zoning Setback Forms - Foundation Piers.& Girders Fireplace Rgh. ' Plumbing Bond Bea . m Lath & Plaster Rein. Steel Gas Piping & Test Found. Vents Framing -Plmg. T opout Rough Elec. Wtr. Htr.. Furnace Kitchen Vent Firewall Garage Vents Sanitation & Water ELECTRIC GAS BUILDING Temporary Temporary Cert. of O.ccup. Final Final Final DATE REMARKS OR CORRECTION S v DEPARTMENT P U BL IC i WORKS OF COUNTY OF BUTTE �7 County Center Drive.. Oroville, California 95965 Phone: 533-1230, Ext. 259 A P P L 10 A -T 1 0 N A N D 8 U I L 0 1 N 0 P E R M I T. Peimittee Owner v Mailisig Address Xe�- Contractor 'Sanitation Mailing Address BLDG. Address A. P. No. V-3 - Fire Zone- Zoning .-Planning Plans Fees W. C R/W En cro achilient 0 - NEW ADDITION. REP Ai Rs ED OTHER 0 Others Multi USli'P6F STRUCTURE Sii'fWly,�� Duplex E::] Dwelling E::] Others F 0 U N.P A T 1�_O N MATERIAL EXTERIOR PIERS -Indth at Top Width at Bottom Depth in Ground SO. FT. OCC. BUILDING VALUA TION R.W. PLATE (Sill) Size 'SPACING SPAN V Girders joists - Ist Floor joists - 2nd Floor Fireplace joists - Ceiling Total Valuation Exterior Studs or, Permit Fee Interior Studs Plan Checking Fee &/or Penalty Roof Rafters T 0 tal Permit Fee Bearing Walls UUNTRAUTURS LICENSE LAW A. LICENSED CONTRA:CTORS COMPLETE THE FOLLOWING: I am licensed under the provisions of Chapter 9, Div. 3, of the State of Call , fornia Busines* s & Professions Code under the name. style of .. . ............... . .... ...... . ............. ............. ............ .................................................................................................................... . ............................. . ............ License No . ........ . .......... . .... . Classification ............ . . .............................. . and certify that the aforesaid license is in -full force and effect. B.- OWNER -BUILDER & OTHERS COMPLETE THE FOLLOWING: I gun exempt from the Contractors License Laws of the State of California under Sec. 7031.5 because (check on0 F__j I am the owner of the above property and I will contract to have all of the above work performed by licensed contractors. (Sec. 7044). I am the owner of the above property and do not intend to offer -it for sale -for one year from the date of completion of the improvements. (Sec., 7044); - I . "i. . . . . .. . .- - I . .- _. Basis, it any, for other statutory exemption..." ......... . ............. .............. ; ................................................................ ........................ ......................... . ................................................................................................................................................ ......................... ! ................... .............. ! ............ ............. .... WORKMEN'S COMPENSATION' INSURANCE I am aware of the provisions of Section 3700 of the'California Lab.or.4Code.which. requires every erpp!�yer to be insured a s' lia�il, in�tiorl_ ity for Workmen's Compensation. I have'placed on file with.'the County of -Butte a- cert.ificate of compliance or proof of :.e pursuant to Sectioh 3900. I certify that I have read this application and state that the This BUILDING PERMIT is -he relby issued under the appli- above information is correct. I agree to comply to all County cable provisions- 'of County�- . resolutions and/or 'ordinances. ordinances -'and State Laws relating to building construction, and hereby authorize represent�ktives of the County --of Butte to enter upon the,. above-mentio,ned -,property. for inspection purposes. DIRECTOR- OF PUBLIC WORKS X. SiG . N AT . R . E ...... �_p Date ..By Date ... ........ .............. Receipt N ............... ........ Permit Expires Date .................................. V ; e_� THERMALITO IRRIGATION DISTRICT 410 GRAND AVENUE OROVILLE, CALIFORNIA 95965 TELEPHONE 533-0740 q 16 - 41 3 1 CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT -7 7 Service Address: 41 Owner's Name: Date: Address: Acct. No: A. P. No.: Phone: No. Units: Applicant/Agent: /z/ A/� Agents Proof: Address: Fees: Phone: Application Arrearage Preliminary Review By�— Date:.,/,'- ".7 CSA 26 Remarks: SC -0 R 1st Mo. S.C. Other Total Fees Collected By: Date: Field Review By��14�,00 /Z"c Date: Remarks: as s) A J? A 7 4 .2— n- AJI .MONTHLY SERVICE CHARGES. WILL COMMENCE AUTOMATICALLY UPON: El Date of TID approval of completed building sewer (early connection). 30 days after date above, or on date of D.P.W- approval of completed building sewer, which ever comes first ("existing construction", prior to Mar.. 5, 1 4) 180 days after date above, or on date of D.P.W'.'ap'. proval of completed building sewer, which ever comes first ("new construction", after Mar. 5, 1974). DISTRIBUTION: WHITE - TID, YELLOW APPLICANT, PINK - DPW, GOLDENROD - DPW to TID OK Nt 0K M NUFACTURED�HOMES. �:MISCE.LLANEQUS' DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning-Setbacks-Easem.ents 2 Soils; Special MH Support Sketch 3 Sewer;, Loctn -Test; Fall/C/0-Concrete, .4 Wtr; Loctn-Teit-Easeme'nt Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Co . ncrete 6 Yard, Gas; Loctnjest-Wrap -.Nat 'or LPF7 Inch Sz Ft Lngth 7 BlIckng; Sz-Spacirig-Maeriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9. Elec MH Cntnty T6�t-Crossovers-BreakL-r's-Cirnes 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer. Connected -C/O to Grade 12 6as,and Electricity Tagged .13 Tie Downs Foundation 14 Exits 15 Cert of Occupancy 16 HUD Label/insignia Numbers Serial Numbers DATE -TD—ECKS-COVERS-CARPORTS-GARAGES 1 Zoning -Setbacks -Easements Ftgs; Solls;-Sz-Dpth-Spakcing-dnnctr��t6eI 3 Decks, G irders/J oists-Dcking-Brc ing Stairs-Guard/Handrails 4 Wood Awn; P.osts-Bearns-Rftr swCnnctrs-Shthg Frm6-Brcng 5 Alum Awn; Coli�mns-Cnnctris�-Splice-Decal-Encisrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchr . s- . S . tuds-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath '10 Roof; Shthg-Roofino 11 Ext; Steps -Doors-Landings 12 Braced Wall pnis . 00 0 41�. 10 DATE IP -OOLS I Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnrictns-Thickness Dead Men-Lihing 4. 4 Elec Rcptcls/Lting; Distance-GFI. 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries -Termina Is -Listed 7 Elec Bonding; Metal w15'-CrcItng Eqp-Htr 8 Elec Grndng; Eqp w/5' Crcftng Eqp-Pool Ightg Bokes-EncIsrs-pn1bolards-Insultri to Main Conduit 9 Health Dept Apprvl 10 PImb; Cir Test�Wtr Supply T e s t 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide 40 411 de Pool Dr awing . = OK 0 = Not OK �_DATE RESIDENTIAL (Single & Duplex) _FPLUM DATE B ING _JUNDERFLOOR I Zon ing-�Setbacks-Easements-Flood-S lope 53 Wtr Htr; Vent-,Acc-Cmbstn Air Baffle, 2 Ftg Mal ' n; Soils-Elec Grnd Ftg Dpth 54 Wtr Pipe� Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.. 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Teit, First fir -Tub Acc 5 Sternwalls Main; Steel-Blockouts-Wrapped 57 Test Tub & Shwr, 2nd fir Tub Acc 6 Sternwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test 40 10 UF, Gas Pipe; Sz Anchrs-Sz Test 1.1 Wtr Pipe; Test-Anchrs-Rgitr-Service Test DATE IMECHANICAL 12 Elec Undrgrnd 61 AC Ducts lnsultn & Support 13 Plenums & Ducts; Clrnc-Material-Support-insultn 14 Girders -S i I Is-Anchr Bolts -J oists-Vnts -C ripples 62 Vent Fan, Exhaust abv lnsultn 15 Acc & Vntltn 63 Condensate Drain & OvrfIw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn[Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace In attic 4# DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE F I N -A L 66 Ext Steps -Door & SideLt Prtctn-Landings 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop In Walls (rat proof) 68 Furnace Vnts-Cirnc-Comb, Air-Cnnctr 21 Fire Stops, Furred Cel I ings-Stai rs-Chasers -Tubs In Garage; abv-flr-Ducts-Mech Prtctn 22 Headers & Beams-Sz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-Truss-Shthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frplc Throat CIrnc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz & Rrnx: Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Cirnc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood PnI, Int & Ext 29 Prprty Une Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Cirnc 30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrh aWAtt!1.9 Vnts-Rftr 0 rs 79 AC Duct In Garage -Damper 33 Siding -Nailing fe5-- r 1- Zts-Undrfir 80 Wtr Htr; Vnts-Clrnc-Corn Air Cnnctr-PRV; abv fir ID—t 05 34 Stu co LaoatKe;;��d-Fndtn N Acc Mech Prtctn; LPG Appince Undr House 3' drain QjAn 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 PImb; Elec & Mech Eqp Usted for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnis 83 Ins u ltn-Foam -Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiftration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drn e & Wood -Earth El 86_�Vnc Drnge Plante Yes El No e'rStucco Brown -Finish 46� 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, PImb-AppInc-Frplc-CIrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI RcptcI-Undrgrnd DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up wtMech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/0 to grade -HD Apprvi 46 2 Appinc Circs In Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga CU orFIAL 98 Address Posted AC Wire Sz CLI or F JAL 99 Fire Sprinkler 48 Range Circ CU orFIAL Oven Circ cu or FIAL Insulated Neutral Yes D No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pn Is -Motors -Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector BUTTE COUNTY DEPARTMENT OF DEVELOPMENTSERVICES BUILDINC; PERMIT : 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7MI FAX#: (530)538-12140 WEBSITE: www.buttecounty.netkidds PERMIT NO. BP"1 913. 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: 06/29/2004 APN: 030-430-031-000 the Business and Professions Code, and my license is in full force and effect. License Class License Number: Site Address: 1659 16TH ST ORO Date: Contractor ;Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: kE ROOF 18 SQ. COMP 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: BERRY JEFFREY S to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 1659 16TH ST the Contractor's State License Law (Chapter 9 commencing with Section OROVILLE, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95965 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).): 1, as owner of the property, or my employees with wages as their sole corripensation, 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 Applicant: BERRY JEFFREYS 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 a 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.). 1, 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, Contractor:. and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). lam Exempt underArficle 3 of!hepysin s,�qd Professions Code Date: Z�& Owner: W I VOORKERS'COMPE44SAYION DECLARATION License #: I hereby affirm under penalty of perjury one of the following declarations: C3 I have and will maintain a certificate of consent to self4nsure for workers'. compensation, as pr6vided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. 0 1 have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which 6is permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 SR� Policy #: Valuation: $0.00 Census Code: I certify that in the performance of the work for which this permit is issued, 1. 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: 60 L/ Applicant'. F 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. z�mit-ls-heh 7J Ii bl of -the BlAe count -LENDING AGEN CY - - - - —This -p �b 'I ill a. i e fpropsi( I hereby affirm that there is a co . nstruction lending agency for the Re I io to oi ve been paid. CONSTRUCTION performance of the work for which this permit is issued (Sec 3097 Civ.) tX&V f Name: By. rT PERMIT EXPIRES ON 64 12 q 1AIn Address: _46ate) 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. 0 Notification in accordance with Section 19 . 827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. Ll 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, official form or document of Butte County. .1 hereby authorize representatives of Butte'County to enter upon the above mentioned property for inspection Signature: PrintName: .Date:- ner Q Contractor 0 Agent for Owner L3 Agent for Contractor