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HomeMy WebLinkAbout039-100-007039-100-007 PERMIT#94-2503 d� KNUDSEN, VIOLET _ _ e`wH 895 LIBERTY LN., CH Ori// /7 CONV FROM LPG TO NATURAL GA S/0/ / 039-100-007 04-2869 POUNDSTONE, CRAIG 895 LIBERTY LN CHICO Cont: FOUR SEASONS ROOFING RE -ROOF (15 SQ) r BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP042869 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: 09/30/2004 APN: 039-100-007-000 the Business and Professions Code, and my license is in full force and effect. Licensee Class : C3 License Number: U � 0 Site Address: 895 LIBERTY LN CHI Date: l— �! Contractor: t0rX slsq_�Zws Map Index: Description: RE -ROOF (15 SQ) OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the fallowing reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: pOUNDSTONE CRAIG REVOCABLE LIVING permit to construct, alter, improve, demolish, or repair any structure, prior . to its issuance, also requires the applicant for such permit to file a TRUST signed statement that he or she is licensed pursuant to the provisions of POUNDSTONE CRAIG TRUSTEE 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 3280 SHELTERING OAK CT she is exempt therefrom and the basis for the alleged exemption. Any CHICO, CA 95973 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: FOUR SEASONS ROOFING pp such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for #11 COMMERCE COURT sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of SUITE #1 95928 proving that he or she did not build or improve for the purpose of 530-895-0418 sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor: FOUR SEASONS ROOFING pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code #11 COMMERCE COURT SUITE #1 95928 Date: Owner: 530-895-0418 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License #: 659073 ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, Architect: as Engineer: required by Section 3700 the Labor Code, for the performance of g the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier:— arrier:Policy#: 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, 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: 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 q . 3O • compensation, damages as provided for in Section 3706 of the Labor 04 code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is h by issued under the applicable provisions of the Butte County CodR anrVor I hereby affirm that there is a construction lending agency for the Resolutions to d work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) / / C/ ',3 3 0 d4 Name: B Date: PERMI X RES ON: 3 D • O Address: Date 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 & 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 oeu ent of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. r Print Name: FE : JV 1l Signature: Q l — *3;0 -rJ3 Date: 0 Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor 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 REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWN R Last Name t1e rrst Name Address 3 Z 0 S e e (� City r �� Stat" Zp?Sr( 3 Phone c(Z _ g� Z Fax E-mail CONTRACTOR Name. --� u _Sbs 16te Address �c City J., (to State- Zip 75- ag- Phone _6ef(� Fax E-mail Lic. #6673 I Classc3? APPLI CANT NAME ARCHITECT/ENGINEER Name City t�o Address Zip Qj_,� Z� City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLI CANT NAME Name 1-o - Sets Address r 0411"esr� ^ f e / l City t�o State, �/r1_ Zip Qj_,� Z� Phone 9-q�5-- O q1 Fax E-mail APPLIC NT GNATURE X ,For office use only: Zoning Property Address e c� G/- 1V Flood Zone Cross Street S5- 7/4 SRA I Yes No Occ. I Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BPa-f-2.94-9 QM LOCATION AN 034 •loo • 00 Property Address e c� G/- 1V City f Cross Street S5- 7/4 WORKER'S COMPENSATION Policy Number 85:5 Carrier . Zz qU if hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time ofpermit Issuance. LENDING AGENCY Name Address Description or Scope of Work: Sq. Footage /,_S 00 ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. II Received by: kil Amount: I I S• Bldg I I OVER FOR SUBMITTAL REQUIREMENTS 11 A--- 4 -en Receipt M ¢ 12 70 Date: g- 30. 04 - SRA Sheriff SMIP Other 1 1 Total Cn/ 7 nl ^A SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. ALL PLANS MUST BE LEGIBLE AND /N INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paperl ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractors license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS KeTuncis can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan -heck fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION ,,AFORMSIBUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 7-77-n& r 039-100-007 PERMIT#94-2503 KNUDSEN, VIOLET + 895 LIBERTY LN.,.CHICO CONV FROM LPG TO NATURAL GA��S F� S e! r • f �a F _ 7 AZ7 ------------ /�-�- OFFICE COPY µ g h2 Address " � GAS Date w-094, Meter By ELECTRIC _ /• Meter By a , .t i LAV 4 • � sJ .Ai 1 COUNTY OF BUTTE - DEPARTMENT OF D§iVELOaPMENT SERVICES - BUILDING DIVISION 7 County Center Drive- Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND -PERMIT ASSESSOR PARCEL NUMBER Cad M ,nr ZONING _ BUILDING PERMIT OWNER le TELEPHONE SQ. FT, OCC. BUILDING VALUATION ' OWNER'S MAILING ADDRESS CONTRACTOR'S NAME ' TELEPHONE ,f CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee` $ Penalty $ BUILDING ADDRESS PERMIT FEE $ PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15.00 Each gas water heater or vent 15.00 USE OF STRUCTURE (\� SF,,,©"- Duplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W @20.00 TYPE OF WORK New ❑ Addition ElRemodel ❑ Utilities ❑ Installation ❑ Other{ ! Describe Work: ( ,n OA�L) � � CCN r��NA }�2 Com- PERMIT FEE $ .00 Contractor ELECTRICAL PERMIT Filing Fee 20.00 /� A /` /,� Q Y,r.,I..�Q /®T�� Main Service ( BOOV OR LESS ) 200A OR LESS 23.00 •+• Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLINGO, OR ADDNS. ( 8 ACC. BLDSCCUP. ) g0. 3.50 FT. NEW CONST. MULTI -OUTLET -NON-RESID. ( BRANCH CIRCUITS ) @7.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ 1 am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, 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) �, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ I am exempt under Sec. Business and Professions Code forthis reason ( POW ER APPARATUS ) 6 SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) BAL. @ t.5o Ex. Occup.FIXED APPWS. OR (OUTLETS IRESID.1 EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California.E Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Contractor I certify that 1 have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue gainst said County in consequence of the granting of this permit. X / / i , �) i,t�--�-i: Date Signature of Applicant -0LOwner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $.Qa--- HAZ- I D. FEES IMP I FLOOD I CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above f r which fees have been paid. ` 9 By Dat eA�,��L, PERMIT EXPIRES ON_ (' ,�%j r (betel r � `f �/ Receipt No. / 7 3 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF�DI VEa7PMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT`��� ASSESSOR PARCEL NUMBER® -3^ N1• _ L0,0— ZONING _/L BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS t094121 " e CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILINA ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS q C �.7 PERMIT FEE $ el PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15.00 Each gas water heater or vent 15.00 USE OF STRUCTURE S uplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 5 outlets 15.00 S, Building sewer 15.00 ' Mobile Home S G W @20.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other /1 Describe Work: / 'Qf�(�� $�`�� -�rcv� 1� pT PERMIT FEE $ S� Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service( BOOV OR LESS OR LESS ) 23.00 J Main Service ( 200A TO IOOOA ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BLOS. ) SO. 3.5. FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compensation, will do �jhe work, and the structure is not intended or offered for sale. (Sec 7044) as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ 'I am exempt under Sec. Business and Professions Code forthis reason WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a 1Certificate of Consent to Self -insure. 14shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 POW ER APPARATUS (8 SINGLE OUTLET CIR. ) Ex. Occup. ( OUTLET OR FIXTURES ) __i0__@ I.00 BAL. .50 Ex. Occup. FIXED APPWS. Ofl p ( OUTLETS IRESID.) EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ I certify that I have read this application and state that the above information is correct. I agree to comply to all Butte County Ordinances and California State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accr a ainst said County in consequence of the granting of this permit. X Date Signature of Applicant caner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Contractor Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEES �S .�— HAZ. D. FEES ,IMP FLOOD COF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions of the Butte my Code and/or Resolutions to do work indicate a ove f r whicees have been paid. BY Date I�Z5 PERMIT EXPIRES ON !De tel 2 Receipt No. J 77 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT