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HomeMy WebLinkAbout031-246-01731-246- 031- 2. �{ • o '� DARLENE SMITH - 715 Colusa Ave., Oroville a. e : 7 Contr s A & C Plumbing._Co______________ r Permit ##2048-76P (rep. gas pipe fitting) SF, ,031-246-017 06-1258. y 1 DUVALL, DARLENE 715 COLUSA AVE, OROVILLE Cont: GEORGE ROOFING RE ROOF B06-2504 031-246-017 MISCELLANEOUS Wall Furnace CHANGE OUT WALL FURNACE • �a7-0243 ' 715 COLUSA AVE DUVALL, DARLENE R. n 4 4. oi� CWD BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES INSPECTION CARD 24 Hour Inspection Line: (530) 538-7636 (Oroville) (530) 891-2834 (Chico) Office: (530) 538-7541 Fax: (530) 538-2140 Website: www.buttecounty.net/dds Permit No: B06-2504 Issued: 10/23/2006 Address: 715 COLUSA AVE OROVILLE APN: 031-246-017 Permit Subtype: Wall Furnace Owner: DUVALL, DARLENE R Applicant: ARTIC AIRE OF CHICO INC Description: CHANGE OUT WALL FURNACE MUST BE ON JOB SITE JOB SHALL BE READY PRIOR TO CALLING FOR INSPECTION. THE INSPECTION CARD AND APPROVED PLANS MUST BE AVAILABLE FOR EACH INSPECTION OR THE INSPECTION WILL NOT BE MADE AND A RE -INSPECTION FEE MAY BE ASSESSED. ALL PLAN REVISIONS MUST BE APPROVED BY THE COUNTY BEFORE PROCEEDING Inspection Type IVR INSP DATE Setbacks 132 Foundations / Footings 111 Pier/Column Footings 122 Grade Beams 114 Eufer Ground 216 Forms/Steel/Holdowns 122 Do Not Pour Concrete Until Above are Signed Pre -Slab 124 Gas Test 404 Masonry Grout 120 Masonry Bond Beam 119 Underfloor Framing 149 Underfloor Ducts 319 Shear Transfer 136 Under Floor Plumbing 412 Under Slab Plumbing 411 Gas Piping 403 Do Not Install Floor Sheathing or Slab Until Above Signed Rough Framing 128 Rough Plumbing 406 Rough Mechanical 316 Rough Electrical 208 Gas Piping 403 Roof Nail 129 Shower Pan/Tub Test 408 Fire Sprinkler 702 Do Not Insulate Until Above Signed Wall Insulation 117 Ceiling Insulation 118 Do Not Cover Until Above Signed T -Bar Ceiling / RC 145 Gas Test 404 Stucco Lath 142 Stucco Scratch 143 Stucco Brown 144 Building Final 802 Electrical Final 803 Mechanical Final 809 Plumbing Final 813 Project Final 801 PERMITS BECOME NULL AND VOID 1 YEAR FRO 1, I: r_Vy COMMENCED, YOU MAY PAY FOR A 1 YEAR RENEWAL 30 DAYS PRIOR TO EXPIRATION Inspector Copy BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVII.LLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#:'(530) 53&2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION_ Site Address: 715 COLUSA AVE Owner: permit No: 606-2504 APN: 031-246-017 DUVALL, DARLENE R Issued Date: 10/23/2006 By KCG Permit type: MISCELLANEOUS 715 COLUSA AVE Subtype: Wall Furnace OROVILLE, CA 95965 Expiration Date: 10/23/2007 Description: CHANGE OUT WALL FURNACE (530) 533-5145. Occupancy: Zoning: AR Contractor Applicant:- Square Footage: ARTIC AIRE OF CHICO INC ARTIC AIRE OF CHICO INC Building Garage Remdl/Addn 2350 PARK AVENUE 2350 PARK AVENUE CHICO, CA 95928 CHICO, CA 95928 Other Porch/Patio Total (530) 895-3330 (530) 895-3330 FEE INFORMATION Heater (Wall) $55.00 V LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires - ARTIC AIRE OF CHICO INC CSLB-234913 / c2 c20 / 01/31/2008 1 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. X • 10/23/2006 Contractor's Signature, Date 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' 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 WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier: ACE AMERICAN INSPolicy Number: RSCC4444706A Exp. Date:12/31/2006 (This section nee not a completed if the permit is oris or onshundred dodollars ($100) or less. ❑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. X 10/23/2006 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Tota► Charged: $55.00 Fees Paid: .$55.00' Balance Due: $0.00 Receipt No: B627 OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 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 penalty of not more than five hundred dollars [$500]; Please check one of the following: ❑I,'AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). , EI, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves, thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: X ' 10/23/2006 Owner's Signature Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or am authorized to act on the property owner's behalf. 10/23/2006 Name of Permittee [SIGN] Print Date EJOwner 1:1 Contractor OR. DAgent for Owner Agent for Lender's Address City' State Zip - INSPECTOR COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT_ INFORMATION Site Address: 715 COLUSA AVE Owner: Permit NO: B06-2504 APN: - 031-246-017 DUVALL, DARLENE R Issued Date: 10/23/2006 By KCG Permit type: MISCELLANEOUS 715 COLUSA AVE Subtype: Wall FurnaceOROVILLE, CA 95965 , ' Expiration Date: 10/23/2007 Description: CHANGE OUT WALL FURNACE (530) 533-5145 Occupancy: Zoning: AR, Contractor Applicant: Square Footage: ARTIC AIRE OF CHICO INC ARTIC AIRE OF CHICO INC Building Garage Remdl/Addn 2350 PARK AVENUE_ 2350 PARK AVENUE CHICO, CA 95928 CHICO, CA 95928 Other Porch/Patio Total (530)895-3330 (530)895-3330 , J __. - ,_ FEE INFORMATION Heater (Wall) $55.00 Total Charged: $55.00 Balance Due:' ' $0.00 Receipt No: B627 LICENSED CONTRACTOR'S DECLARATION OWNER /BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License. ARTIC AIRE OF CHICO INC CSLB-234913 / C2 c20 / 01/31/2008 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 also requires the applicant for such permit to file a signed statement that he or she is licensed (co e c ng with Section 7000) of Division 3 of the Business and Professions Code, and my license Pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) ,sru force and gffec 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 X A A ! % to. ` 1, 10/23/2006 the applicant to a civil penalty of not more than five hundred dollars [$500]; Date 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' 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 WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Aly Workers' Compensation insurance carrier and policy number are; Carrier. ACE AMERICAN INSpolicy Number:RSCC4444706A Exp. Date:12/31/2006 (This section need not a completed if the permit is or onT r red ($100) or less.) ❑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 provi ions. ' X 10/23/2006 Sign ture Date WARNING: F LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION:LENDING AGENCY' a I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State , Zip Please check one of the following: EI, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 improvement is sold within one year of completion, the owner -builder will have the burden of proof 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 Provessions Code: The Contractors License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the. Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: ( 10/23/2006 Owners Signature Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte Coun)y to enter the above mentioned property for inspection purposes. I hereby certify that I am the p o rty owor a"thoriz,,d to act op tqe property owners, behalf. - RIO /i�Ti 0 t-9 �1 del r-rie_ Go 1 S 10/23/2006 Owner 1:1Contractor OR Agent for Ow er Agent for FILE COPY 9 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last Name first Name Address c City State Zip(q� Q �1 v Phone vn� _t) I LIE—) _I"�J Fax E-mail APPLICANT NAME CONTRACTOR Name Name Address Phone _ Fax _ . Q City Y' State Address Phone Book City E-mail State Zi X10 Phone - ax _ Fax,-,,-,-,— E-mail E-mail Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City O State Address Phone _ Fax _ . Q City I No State Zip Phone Book Fax E-mail Planner State License Number APPLICANT NAME Name . Address '� City O State Zipq z `iii Phone _ Fax _ . Q E-mail �i♦.f+ 1 1 � � A For office use only: Zoning Property AddreX Flood Zone Cross Street SRA Yes I No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BIN # LOCATION AP# 0 31-2y - 117 Property AddreX City Vl l� Cross Street WORKER'S COMPENSATION Policy Number {�# Carrier { If hiring anyone other than license contractors, a certificateof�workees compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: 1 w' cN Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. 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. OVER FOR SUBMITTAL REQUIREMENTS It K:\FORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 1 of 2 Received by: �, Amount CP Bldg V SRA Receipt #: �621 r Sheriff U ll(I"I&n� SMIP Date: I o q3'0 Total REV 6-16-04 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Telephone: 534-4541 r APPLICATIOWAND PERMIT dutnunLe representatives of the County of ttutte to enter upon the above-mentioned property for inspection purposes. `.1 Date Signature of Permitee or Agent Receipt No. /�' <, � '­ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY �- Date �' (J Building permit expires Date ky BUILDING Owner ! j SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor �,.-� Total Valuation MailingAddress `; '") ' '`� `<a Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee $ Building Address 9� PLUMBING No. @ FEE PERMIT FILING FEE.� $3.00 Zze-Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 p A. P. No. f ice' ^, Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 FKes -WQ.- Sanitatien- Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W I Improvements Lawn sprinkler system 2.00 BiAg.�RZ+E"'d Parcel Approval I Plans Approval Permit Fee $ $ 1-115 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER EJ_ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 •-.)- } �' X,,,, ) Main 600v OR LESS n service 100 AMP OR LESS 5.00 _ Main service EA. ADD'L 100 AMP 2.50 Single Family ©�- Duplex ❑ Mobil Home ❑ Others ❑ Main service OVER 100 AMP OR LESS 25.00 Main service EA. ADD -L 100 AMP 1.00 NEW CONST. DWELING OR ADDNS. ( ACCLBLDGS. OCCUP. &) 20sgft NEW CONSTR. MULTI -OUTLET NON -RF -SID. BRANCH CIRCUITS) 2.50ea NEW CONSTPOWER APPARATUS NON- R. RESID. (SINGLE OUTLET CIR.fi CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Ex. Occup(OUTLETS OR FIXTURES)@25C 704 Ex. Occu FIXED APP LNS. OR p•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ Ly Z dutnunLe representatives of the County of ttutte to enter upon the above-mentioned property for inspection purposes. `.1 Date Signature of Permitee or Agent Receipt No. /�' <, � '­ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY �- Date �' (J Building permit expires Date ky COUNTY OF BUTTE — DEPARTMENT OF, PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone* 534-4541 APPLICATION KW PERMIT O L� '7G authorize representatives of the County of Butte to enter upon the above-mentioned property for.inspection purposes. X Date Signature of Permitee or Agent / c Receipt No. ` q.� 415, , White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By DateOA6 4ele �>T/ Building permit expires Date BUILDING Owner D SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor L C?) Total Valuation Mailing Address 3 �� / S d - Permit Fee Plan Checking Fee &/or Penalty lepho a No. Permit Fee' $ Building Address 69 [v !/Q 7z 1 PLUMBING' No. @ FEE PERMIT FILING FEE $3.00 !/D V G Each Trap. 1.50 Repair drainage or vent piping, 1.50 Water piping 1.50 Each gas water heater or vent 1.50 j A. P. No. ` (m Zoning & Planning Gas piping system 1 - 5 outlets 1.50 , Each additional outlet .30 Fees -am" trorr I Fire Dept. Fire Zone Use Pen -nit Building sewer 5.00 EQA Parking. Plans Parcel Declaration Parcel Ma p 60' R/W Improvements p Lawn sprinkler system 2.00 / e r f� e— Udq--P4arrs-17-6773 Parcel Approval Plans Approval Permit Fee -. $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 •f ,'P4?-, k) I i AC e Main service 100 AMP ORS LESS 5.00 Main service EA. ADO'L 100 AMP 2.50 Single Family ©Duplex ❑ Mobil Home ❑ Others ❑ Main service OVER 600V 100 AMP OR LESS 25,00 Main service/ EA. .ADO'L 100 AMP 1,00 NEW CONST.DWELING OR ADDNS. ( ACCLBLDGS. OCCUP. &) 2(tsgft - NEW CONST R. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS) 2.50ea ,. ' NEW CONSTR, (POWER APPARATUS &) NON RES,D. (SINGLE OUTLET CIR. - CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name le Of' Ex. Occup(OUTLETS OR FIXTURES) P@1 BAL�1 FIXED APLNSORSt Ex. Occup. (OUTEA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No�Classification Misc. Wiring 6,25 4 ❑ I am exempt from the Contractors License Laws of the State of Cal Ifomia. Permit Fee - $ $, WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ WI have placed on file with the County of Butte a certificate of - orkmen's Compensation Insurance. I certify that iri the performance of the work for which this permit is issued I shall not employ any person in any manner s as to become subject to the Workmen's Compensation Laws of California.' MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling 'Ventilation Hood 2.00 Permit'Fee $ $ I certify that I have read this application and state that the above information•is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby. I TOTAL -PERMIT FEE is authorize representatives of the County of Butte to enter upon the above-mentioned property for.inspection purposes. X Date Signature of Permitee or Agent / c Receipt No. ` q.� 415, , White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By DateOA6 4ele �>T/ Building permit expires Date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE 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 the Business and Professions Code, and my license is in full force and effect. �-SaZ eZlolo License CCClass: C'39 License NumberA s: Date) Contractor: 'ate r2. da"^ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to rile a signed statement that he or she is licensed pursuant to the provisions of 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 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 penally of not more than five hundred dollars ($500).): O 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' Slate 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.). O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code Dale: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 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. AI 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: � Carrier: &Ia �& 7`G(/JLdL - PERMIT NO. BP061258 E, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. Issued Date: 05/25/2006 APN: 031-246-017-000 Site Address: 715 COLUSA AVE ORO Map Index: Description: RE -ROOF 15 SQ.'S COMP Owner: DUVALL DARLENE R 715 COLUSA AVE OROVILLE, CA 95965-4034 Applicant: GEORGE ROOFING 6810 LINCOLN BLVD OROVILLE, CA 95966 (530) 533-6393 Contractor: GEORGE ROOFING 6810 LINCOLN BLVD OROVILLE, CA 95966 (530) 533-6393 License #: 452266 Architect: Engineer: Policy#: Diaz -S919 - Notal Square Ft: O 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: 7-�'� - 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Address: Valuation: Census Code: 50 0 S. F. $0.00 M, l ooF_0 This permit is hereby issued u r the applicable provisions of the Butte County Code and/or Resol 'dns, o do work indica ed bove for which fees have been paid. G� By:. Date: C_'7 c -AD PERMIT EXPIRES ON: O 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. O • Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project. O Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. l hereby 2uthorize representatives of Butte County to enter upon the above mentioned properly for Inspection purps: ! Print Name: S * 1 ju e y =A g L4; Signature Date: el — 9& Q Owner ❑ Contractor XAgent for Owner O Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICANT SIGNATURE X For office use only: OWNER Name Darlene Duvall Address 715 Colusa Ave. city Oroville State CA Zip 95965 Phone 533-5145 Fax E-mail Lic.# APPLICANT SIGNATURE X For office use only: CONTRACTOR Name GEORGE ROOFING Address 6810 Lincoln Blvd City Oroville State CA Zip Phone (530) 533-6393 Fax (530) 533-0287 E-mail dan@abcgc.com Lic.# Class dan@abcgc.com 452266 C39 APPLICANT SIGNATURE X For office use only: ARCHITECT/ENGINEER Name N/A Address 6810 Lincoln Blvd ; City Oroville State CA Zip Phone (530)533-6393 Fax E-mail dan@abcgc.com State License Number APPLICANT SIGNATURE X For office use only: APPLICANT NAME Name GEORGE ROOFING Address 6810 Lincoln Blvd ; City Oroville State CA Zip 95966 Phone (530)533-6393 Fax (530)533-0287 E-mail dan@abcgc.com APPLICANT SIGNATURE X For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: LOCATION Property Address 715 Colusa Ave Oroville, Ca. 95965 Cross Street PERMIT NO. NO. BP BIN # WORKER'S COMPENSATION Policy Number 272-596 Carrier STATE FUND If hiring anyone other than license contractors, a certificate of workers compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work Reroof - House - Com Sq. Footage 15 ❑ 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 required. 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: TP. Amount: --da,60 Bldg Receipt #: SRA Sheriff SMIP Other 10. GV Total REV: George Roofing