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Home My WebLink About039-170-021. 11 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP043528 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: 12/15/2004 APN: 039-170-021-000 the Business and Professions Code, and my license is in full force and effect. License Class: - e20 License Numbe(43 4 G t3 Site Address: 2350 DAYTON RD CHI Date:I2-15 Od Contractor. &,WFIL Q%rup Map Index: Description: CHANGE OUT GAS FURNACE 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 Owner: DAVES WILLIS & SUZANNE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 2350 DAYTON ROAD signed statement that he or she is licensed pursuant to the provisions of CHICO, CA 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 95928 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).): ❑ 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 Applicant: DAVES WILLIS & SUZANNE Code: The Contractors' State 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.). ❑ 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 Contractor: AF�TIC AIRF OF CHICO INC 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.). 2350 PARK AVENUE ❑ 1 am Exempt under Article 3 of the Business and Professions Code CHICO, CA 95928 530-895-3330 Date: Owner: License #: 234913 WORKERS' COMPENSATION DECLARATION 1 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 Architect: issued. Engineer: W I 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: -Ac -p- Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: Policy #:'Sr1A \ 19S Ztl t GO ❑ 1 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: 1. Z - ) t;7 '94 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 interest, fees. code, and attorney's S -7t # VPmss CONSTRUCTION LENDING AGENCY This permit is h reby issued under thea livable provisions of the Butte County CodR and/or or hereby affirm that there is a construction lending agency for the Resolutions to o work indicated abo a fo which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) / Name: Z ��/� By: ^ Date: c (J —� PERMIT EXPIRES ON: Z ��- Date Address: ❑ 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. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ 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. I hereby authorize representatives of Butte County toenterupon the above mentioned property for inspection purposes. Print Name: _?+� At . 1j Signature: Date: ❑ Owner ❑ Contractor &-Agent for Owner 13 Agent for Contractor f' ti BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP DATE: / / APN:O� � / rIL7 ZONING: { �` OWNER'S LAST NAME: -DA0 Q OWNER'S FIRST NAME: W %I s PHONE.0 -? 011 STREET ADDRESS: FAX CITY, ZIP: ^ E-MAIL: SITE ADDRESS: �AYY1 CITY, ZIP: NEAREST CROSS STREET: TRACT/LOT P. APPLICANT NAME: PHONE STREET ADDRESS: FAX CITY, ZIP: E-MAIL* CONTRACTOR NAME: PHONE STREET ADDRESS: S 235'0�A�� FAX CITY, ZIP: Q s� E-MAIL LICENSE NUMBER LICENSE TYPE: ARCHITECT/ENGINEER NAME: - PHONE STREET ADDRESS: FAX CITY, ZIP: LICENSE NUMBER: E-MAIL DESCRIPTION OR SCOPE OF WORK: G, ❑ 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 fees 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. For office use only: Notes: Application Received by: Date: Receipt number: ///'5`7 Y9 06# Amount Received: �S