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Home My WebLink About031-370-045IT • }'r slllf�� 31 0-045 03-3518 k KINS, WESLEY 25 SU-17ER MILL RD, OROVI LLE F t Cont: CLASSIC SPAS fNC NEWTOOL i 10 pit •t , ,. it i1 r .T .. r •ir`1rF .. , i , - '_��. to t Fi >,... 1A �, r{'''.fi A .,w v•t - t • y - t County of Butte Oroville, Califomia GENERAL CLAIM CLAIMANT: Wesley Hawkins ADDRESS: 25 Suffers Mill Road CITY & STATE: Oroville, CA 95965 DATE OF CLAIM: 03/08/04 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY AMOUNT Refund Claim - See attached calculation sheet APN: 031-370-045 Permit No 03-3518 PAID RETAINED REFUND Development Services $ 505.95 $ - $ 505.95 SRA $ - $ - $ - Sheriff $ - $ - $ - Other: $ - $ $ - TOTAL $ 505.95 $ - $ 505.95 ............................................... ............. ............................................... ............. :::::::::::::::::::•: :.:. o...... ................................................ ................................................ BREAi If ?VST;:::::::::::::::::BADGET::::ACCOUNT::::A1Vi0U1!T;: ............... ............... .............. .............................. .............. ............................... ............... ................ Development Services 440-001 4210500 $ 505.95 SRA 0100 4617240 $ - Sheriff 280 1011811 $ - Other $ - TOTAL $ 505.95 $ 505.95 1, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered and that this claim is true and correct as stated. "27,Q_ Dated this day of / �/ i�� , 2004, at a Calif. of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified abo4e have been performed or delivered and that there is as Budget Appropriation or Specific Board Approval (Check o the same. Dated this 1' ' day of ffill 004, at Oroville Cali Department Head or Authorized Deputy Dept. SEE Exp. Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT & SUB PROJ SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT. 31 %/Oy Butte County Department of Development Services YVONNE CHRISTOPHER, DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile ADMINISTRATION * BUILDING * GIS * PLANNING March 8, 2004 Wesley Hawkins 25 Sutters Mill Road. Oroville, CA 95965 RE: Permit No. 03-3518 APN#031-370-045 Owner: same On 11/13/03, a deposit was made in the amount of $505.95, of which $0.00 was retained. The remaining fees will be reimbursed to you. Please sign, date, and return the enclosed claim form to this office. Once we receive the claim form, we will then process your refund in the amount of $505.95. Should you have any questions, please contact this office Monday through Friday, 8:00 a.m. to 4:00 p.m., at 538-6869. Sincerely, laA.Q—� Diane Lewellen , OA III Administrative Division enclosure 03-3518.2.1tr I. REFUND CALCULATION SHEET I LAIMANT: Wesley Hawkins DDRESS: 25 Suffers Mill Road CITY & STATE: Oroville, CA 95965 DATE OF CLAIM: 01/08/04 APN: 031-370-045 RECEIPT INFORMATION REFUND CALCULATION SHEET CLAIMANT: Wesley Hawkins ADDRESS: 25 Suffers Mill Road CITY & STATE: Oroville, CA 95965 DATE OF CLAIM: 01/08/04 APN: 031-370-045 RECEIPT INFORMATION NUMBER: 393748 DATE: 11/13/2003 ISSUED TO: Wesley Hawkins CHECK #: 4985 AMOUNT: $505.95 PERMIT #: 03-351$ Yes No Yes No Yes No PRIOR REFUNDS: X FEES VERIFIED X REFUND BREAKD WN BL SRA NJ SHERI , DETAIL PAID RETAIN REFUND 420-0 siia 0 411, 1021811 BLDG FILING FEES Buildin 20.00 20.00 Plumbinq 20.00 20.00 Electric 20.00 20.00 Mechanical RX PLAN CHECK Plan Check 157.95 157.95 Energy INSPECTION :,:.:.i ::.. :.:.:.::::::.::.> Energy SRA -BLDG Building $46 PERMIT FEES Building 243.00 243.00 243.00 .• :•.:: Plumbing 15.00 15.00 15.00 ... ..:•. : Electric 30.00 30.00 30.00 ::::::::• :.:::::: :::•. :. Mechanical OTHER BLDG X. Overcharge :.::::::::: :::::::::::: REFUND PROCESS FEE 25.00 -25.0025.00 BUILDING TOTAL 505.95 242.95 263.00 263.00 .......................... ..:: """".."""" ::::':�:*:*:*:* ............. ::::::: .......................... ............ ::::........ : SRA - FIRE- SRA - FIRE >: Fire $43 .... ....•.•.•.. .........•.•.•. SHERIFF - $360 SHERIFF Sheriff OTHER NON -BLDG OTHER $ 505.95 $ 242.95 @ $ 263.00 $ - $ $ - $ - 263.00 BLDG SRA SHERIFF 440-001 0100 280 4210500 4617240 1011811 CHECK: $263.00 DIFFERENCE: (Should be blank) APPROVAL Date Reviewed 1/14 004 Michael V ana ' %z Building Manager COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75 PERKMT NO. (Rev. 12/96) APPLICATIONAND PERMIT ASSESSOR PARCEL NUMBER ZONING A BUILDING PERMIT OPINE NONE ,7 a IaNG - ?5 SI=ERS MITI RD QRHU.1111F CA 95965 SO. FT, OCC. BUILDING VALUATION 2 37099. CONTRACTOR'S NAME TELEPHONE CONTRACTORSMAILING ADD22 11,00 MEWDY RD CA -0,590-1- CONSTRUCTION LENDER ' [Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ 243.00 Pian Checking Fee $ 197,95 BUILDING ADDRESS 2.5 Sl M11-1- R OROVILLE Energy Plan Checking Fee $ -=ER -D $ PERMIT FEE $ 420.95 LAT NO. SUBDIVISIONS NAME PARCEL MAP 11 f_91 199 PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other NEW POOL sPECIFv Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New QXAddition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Gas piping sy2tem 1 - 5 outlets 15.00 Buildina sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S 35,00 ELECTRICAL PERMIT Fling Fee 20.00 Main Service eoov oR .ss zoOA OR LE 23.00 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. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service 200A TO 1000A 46,00 NEW CONST. DWELLING Occup - OR ADDNS. ( 6 ACC. BLDS. So 3.5Q FT. R61DT MULTI.OUTLET NCH CIRCUITS @7,50 POWER APPARATUS 8 SINGLE OURET CIR. Ex. Occup. OUTLET OR FIXTURES 20 00 BAL 0 .50 Ex. Occup. ouTE,,ssRM-.oea 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 POOL ELECTRIC 30.00 PERMIT FEE $ MECHANICAL PERMIT Fling Feel 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X _ Date ,/•- -e23 Signa of Applicant - Owner ❑ Contractor ❑ Agent An CrSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE HAZ. _ D. FEES IMP FLOOD _� CDF _ PARC Po HD ISSU This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicate above for which fees ve been paid. B Dte PERMIT EXPIRES ON Date Receipt No. WHITE-D.D.S.-B.D. CANA Y -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .,, COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telgephone (530) 53$4 5-d D2196) APPLICATION AND PEF�i� IT ((�� zowNo BUILDING PERMIT ESSORPARCELNUMBEA /J 1 TELEPNON so. Fr, OCC. BUILDING VALUATION S NG ss I..J`� MIONE C1\ Y Y �S9 O 16TRUCnoNLENDSR Fireplace LEWSM MMUNG ADDRESS Total valuation $ �" LICENSE N0. Finn Fee '$ 20.00 HR ARCECT OR ENGINEER Permit Fee $ ARCMMOT ORE &WMS HOLM ADDREss Plan Checking Fee $ smmr ADDRESS a ;C Energy Pian Checldng Fee $ F&A-71 A �- NO is� 's s i - J PERMIT FEE susonnslDNSNAM+E PAROEI MAP PLUMBING PERMIT LOT nro`� �� 2 Z 6', �^9 Each Tr ap �,�I USEOFSTRUCTURE Solar or heat um water heater S2Duplex 0 Mobiiehome 0 Other Water piping // _ sPMFY Each gas water heater or vent TYPE OF WORK Gas piping system 1 - 5 outlets New 0. Addition O Re odes 0 Utiilfes 0 In 0 Other 0 Building sewer S G W G Mobile Home Describe Work: PERMIT FEE S APW r ECTRICAL PERMIT n Service oo�o°a LamarnServiceCONST. DwFJLm OOCLIP. DDNS. A ACC. OWL PERMIT, FEE PAID SRA SHERIFF OTHER S AMOUNT RECEIVED $ ?5e)5,9_5 DATE RECEIVED �l S ting Fee 20.00 7.00 23.00 15.00 15.00 15.00 15.00 @20.00 Feel 20.00 @7.50 Ex. Occup. oLRLET OR FDMRB ani Ea .so FDMD Ex. Occu urLEns Puao DRQ 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 tAsc. Witft 7 23.00 J �- PERMIT FEE $ MECHANICAL PERMIT FiTin, Fee 20.00 Heating, Cooling Hood 6.50 PERMIT FEt S Mobile Home Installation Fee $ Energy Inspection Fee $ CONST' nPE=TOTEE $ NAL 10. FEES I JMV I FLOOD CDF PPAM I yj ND FssL>E This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By Date • • J f > .l COUNTY 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 OWNER: At ASSESSOR PARCEL NUMBER Proposed Building Use: +C✓ �lV �� , Counter Technician: Date: ,Jtems required in order to apply for a permit. All boxes MUST'be checked OR marked NA in order t ply. " 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. t3. 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 faxes! ❑ 5. Energy compliance design and supporting documentation in duplicate. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or Ind plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are receivee. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ............................... ❑ 9. Site plan and business license approval from the City of Biggs ................................... ❑ 10. Letter of intent for non-residential buildings........................................................ ❑ 11. Detached Accessory Building Form filled out by the owner ...................................... ❑ 12. Hazardous Material Form.............................................................................. ❑ 13. Fire Sprinklers......................................................................:..................... ❑ 14. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 15. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 16:• Fees as shown on the attached Schedule of Fees Due Sheet ........................................ 41Statement of Intent for Non -heated and AIC Buildings ................................ Sanitation and site plan approval from the Environmental Health Dpartment in 1 19. City of Chico Plumbing permit ................................................ _ ........ 0.20. California Department of Forestry plan approval ❑ paid. Sent by- ...................... ❑ 21. Planning approval for (A) Use: O )= (B)Parking: (C) Par:;el Check: 11-) $- ❑ 22. Contact Land Development about ❑ Improvements, ❑ Drainage ❑ 23. NPDES Form......................................................................_..................... ❑ 24. Encroachment Permit for driveway from the Public Works Dept ..... _.......................... ❑ 25. Pre -Inspection for required ................ ❑ 26. Contractor's license information. (Number, Name Style, Classification) ...................... . ❑ 27. Worker's Compensation Carrier and Policy Number ............................................ ❑ 28. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner)_ ................... ❑ 29. Letter of Signature authorization.................................................................... ❑ 30. Recorded copy of Agricultural Acknowledgment Statement ................................... ❑ 31. Manufactured home utility clearance................................................................ ❑ 32. Existing violations and/or expired permits......................................................... ❑ 33. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 34. Other: When issued TelephoneI 'Id'ho Por pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant: �✓� - pp Date: %/- /3 U3 1. Index permit app',Kation for the above items numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ maill ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: -Date: a 3 Structural reviewed by: Date: O Structural appro•ed by: Date: O o Note transfer by: Date: Yellow: Builcing Division Butte County Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develo ment Services for payment Processing. CLAIMANT'S NAME: MAILING ADDRESS: �,' 11L W ��4-prwry 1/t// PHONE: (5,3 -o ) 3 - k -5 -Y -G ASSESSOR'S PARCEL NO.: .� - 2 2 O [Please use one claim form per permit.] BLDG PERMIT NO.: L L-- --Recei Receipt t No. 1 Receipt No. 2 Recei t No. 3 % �{ RECEIPT NO.: RECEIPT DATE: i L / L - L/ o 3 r-c—)C) S, _5-\/ GC,, q 9 ,�,S RECEIPT AMOUNT: REASON FOR REFUND REQUEST: , sKow `47 PreAlc /L'< a?c Check those fees which you wish to have considered for refund: [Building Permit FeesSheriff Fees [SRA Fees (CDF Fire Planning) [Other (specify): , Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. Z5��4 /-Z� S i g n aUde K:/Forms/Refund Application 082203 (31/pg f 04 -% %\/ �-1Z9/03 Date