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HomeMy WebLinkAbout039-210-0694 B.Mi ELLEN 39-21-69 CEi o St, Chicp /-� 4 Contr Cornelius & Son, Paradi s�� Permit #3798-83B (Class A/SF) 3 21-69 2995-'90P M ELLEN, B.M. 3638 Chico Street, Chico (new propand service/HVAC)SF F3H' 69 04- 603 HYLLIS CO ST, CHICO INALED ESIGNERS -SOYDING 2200 SQF039-210-069 ANEOUS Re -Roof KE -ROOF: 40 YR COMP_ (42 SQ) 3638 CHICO ST ELLEN, FAMILY -TRUST -�s�. i �a 39-21-69 92_27, ELLEN, Phyllis & B.M: �= 3638 Chico St, Chico Ag Exemption'Permit , �tractor;•truck, walnut orchard equip) X 69 ` is �-��4` �."'��art":1C>+►+��� � • � � � ..� l��h�, . �. r :;.� � .j�,f'�t?ei'-_�a•!� U t k 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: 3638 CHICO ST Owner: Permit No: B07-1539 APN: 039-210-069 ELLEN, FAMILY TRUST Permit type: MISCELLANEOUS 3638 CHICO ST Issued Date: 07/16/2007 By KCG Subtype: Re -Roof CHICO, CA 95928 Expiration Date: 07/15/2008 Description: RE -ROOF: 40 YR COMP (42 SQ) Occupancy: Zoning: A20 Contractor Applicant: Square Footage: BOE ROOFING BOE ROOFING Building Garage Remdl/Addn 3126 JOHNNY LANE 3126 JOHNNY LANE CHICO, CA 95973 CHICO, CA 95973 Other Porch/Patio Total (530)342-4919 (530)342-4919 FEE INFORMATION DBMSC Re -Roofing $258.50 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires BOE ROOFING 820046 / C39 / 05/31/2007 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X %%rt'C°'�— 07/16/2007 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I 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 u 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: STATE FUND Policy Number.713-0017668 Exp. Date:08/01/2007 (This section need not a completed if the permit is for on- a uillars ($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 /� �. 07/16/2007 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) Lender's Address City State Zip $258. Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION $258.50 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 al aged 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.). ❑I, 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 1 07/16/2007 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. 9t 9 e i /?o/_7 07/16/2007 Owner. Contractor OR;Agent for Owner ❑Agent for Contractor FILE COPY y �VTTF BUTTE COUNTY 0 o DEPARTMENT OF DEVELOPMENT SERVICES o o BUILDING PERMIT APPLICATION. 0 o OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 o-y��- o A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: w. w.buttecounty.net/dds UN "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name ,/1(,Qei� First Name ph/ y� MailingAddress 3 6 3 F C Hi C C) .571-, City C141Co State CA Zip 9S 9z $ Phone1/_ y5-_ L! gyp Fax E-mail CONTRACTOR Name /30C AOOrfN(r Address 3126 'f a #AlIvY /- P . City v/C U State CA Zip q�-q 73 Phone 3 y2 _ yq 19 Fax. E-mail Lic. # �z v G Class C 3 APPLICANT INFORMATION ARCHITECT/ENGINEER Name city Address Zip City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address city State Zip Phone Fax E-mail APPLICANT SIGNATURE X W -4"60,c . PROJECT LOCATION AP# V c7IT, 19-10 - O Property Address 6 g �y�CO S City COCO PERMIT NO. BIN # WORKER'S COMPENSATION Policy Number 713-/ 76'99-05— Carrier- F9/vl( If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK: ��µ10✓LS �5•/S i �1NU— ��0� SNS i �9 L L yv y/t C o �+�r f-' z47 Scl FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA IYes INo Occ. Type Const. 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.netldds PERMIT NO. BP041603 LICENSED CONTRACTORS DECLARATION I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date' 06/04/2004 APN: 039-210-069-000 ' the Business and Professions Code, and my license is in full force and p C/ y / Cl 4rYi' �✓ % J LicenseNumber: `/ b effect.jj%% License ss: Site Address' 3638 CHICO ST CHI Date: 0 I Contractor. / `'L��� r�' �'f- %' x Map Index' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: 2200 ft siding vinyl 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••ELLEN B M & PHYLLIS to its issuance, also requires the applicant for such permit to file a DBA ELLEN FAMILY TRUST signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 3638 CHICO ST 7000) of Division 3 of the Business and Professions Code) or that he or CHICO, CA 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 �G / 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: ELLEN B M & PHYLLIS 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 j and Professions Code. The Contractors' State License Law does 7 not apply to an owner of property who builds or improves thereon, Contractor:. K DESIGNERS and who contracts for such projects with a contractor(s) licensed 2440 GOLD RIVER DR pursuant to.the Contractors' State License Law.). GOLD RIVER, CA ❑ I am Exempt under Article 3 of the Business and Professions Code 95742 916-631-9300 Date: Owner: 1 I License #: 498806 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 i Architect: li/is issued. I have and will maintain workers' compensation insurance, as I 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 and policy number are: Carrier: ��-�� I �. `A ,• 0 S. F. Total Square Ft: ,, ,� Policy#: Q I S,< E©� >>r Valuation: $0.00 ❑ 1 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, t �� and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwit comp y witch those provisions. o Date: `1 11 - ti,e� ;'CL , t. (7 Applicant: � If 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 dd_1 'codeattorney's-fees.— inierest,-and CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the pplicable provisions of the Butte County Cods ?nrvar Resolution for which fees have been paid. This permi�9� performance of the work for which this permit is issued (Sec 3097 Civ.) � gy: Date: I ' Name: , S— (Y, - 4' PERMIT EXPIRES ON: Address: Date ❑ 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. 1 hereby authorize represent ves of Butte County to enter u on the above mentioned property for inspection purposes. ; �. i �)i �y �j :� //p k (Ia iI =J f�C %� �% r"Q Signature: :�1/6� Print Name: v� C7 Date: / 0 Owner Zf Contractor ❑ Agent for Owner fd Agent for Contractor 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. BP041603 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: 06/04/2004 APN: 039-210-069-000 the Business and Professions Code, and my license is in full force and effect. nr , License Cl 61 � y� License Number: �'(� �� �j s : Site Address: 3638 CHICO ST CHI Date: 3a 0( Contractor: P ��� ! ' �" Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: 2200 ft siding vinyl 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: ELLEN B M & PHYLLIS to its issuance, also requires the applicant for such permit to file a DBA ELLEN FAMILY TRUST signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 3638 CHICO ST 7000) of Division 3 of the Business and Professions Code) or that he or CHICO, CA 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 Code: The Contractors' State License Law does not apply to an Applicant: ELLEN B M & PHYLLIS 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 not apply to an owner of property who builds or improves thereon, Contractor: K DESIGNERS and who contracts for such projects with a contractor(s) licensed 2440 GOLD RIVER DR pursuant to the Contractors' State License Law.). GOLD RIVER, CA ❑ 1 am Exempt under Article 3 of the Business and Professions Code 95742 916-631-9300 Date: owner: License #: 498806 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: 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 and policy number are: S �� 1FZckd Carrier. Total Square Ft: 0 S. F. Policy #: Q I SI — df30 3 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 fortthwit comp)y with those provisions. 6 o 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 T compensation, damages as provided for in Section 3706 of the Labor �Cyy 1 1 code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby is ed under the applicable provisions of the Butte County Coda ?n7 Resolution for fees have been 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.) o v indicate above which paid. �N- v Name: Date: By: ,, � 10 11 6 Address: PERMIT EXPIRES ON: ' Date ❑ 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. ❑ 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 represent ves of Butte CouDtto enter u on the a ove Qentioned property for inspection purposes. ly/C.V�J Q / /P, �� (%� `�� Print Name: r/� Signature: A `1 Date: ❑ Owner 0/contractor ❑ Agent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVELLE: (530) 538-7636 - CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION OWNER NameI 1 P g 2 Address • � -3 8 W City State Zip �v Pho e, 30 -3 Y3_� Fax E-mail APPLICANT NAME CONTRACTOR Name s �1 !1 Addres yo GOt l/� .Or. Cir,, -,/d ver State CA Zip P4_74 6 3j — y3©p Fax E-mail Planner u APPLICANT NAME ARCHITECT/ENGINEER Name Ci ee Address I Zipgrgy City No State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT NAME Name Address .1 5 , , I ev Ci ee Stal22X I Zipgrgy eT'&yFax KE-ma No il APPLICANT SIGNATURE X �4�p r For office use only: Zoning Flood Zone SRA Yes . No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. W I te0�j "Wi ffl1 LOCATION AP#O �.;n O 6 Property Address (/ Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address _7criptio r Scope f W 0 .1 1 Vt 4V Sq. Footage 0 Structure Built without Permits 11 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 I aid 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 L K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 Received by: Amount: d `"1` 1 - 6—Bldg SRA Receipt #: Sheriff q66R6_5 SMIP Date: 4 � f; � + Other "1 Total REV 4-30-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! ❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXESI). ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to mobile or modular homes.) ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 8. Detached Accessory Building Form, filled out by the property owner (if required). , ❑ 9. Sanitation and site plan approval from the Environmental Health Department., ❑ 10. 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 stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ` ❑ 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. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 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 calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 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. OVER FOR BUILDING PERMIT APPLICATION KAFORMSSUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: (916) 538-7541 t, AGRICULTURAL BUILDING EXEMPTION PERMIT PERMIT NO. 9-0,277 - Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm implements, hay, grain, poultry, livestock, or other horticulutral products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. ASSES ARCEL NO. _ O ZONING ^0 OWN „^ e /o n PHONE NO. _ � OW R' A D ESSGd �) I �� y 7 LOC ION OF BUILDING n USE BUILDING r Y"�u < �' aka ynet ©✓` cc f �a rd SIZE OF STRUCTUR /� XS.L— SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME STEEL CONCRETE OTHER (Specify) TYPE OF SIDINGROOF eta COVER are FLOOR T& f ESTIMATED COST OF CONSTRUCTION AG Buildings shall comply with the building front, side, and rear yard requirements of the applicable County Ordinances as foll ws:41 FRONT D tet- - !!L— SIDES -2-r REAR .2-.S AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a mobilehome, and 23 feet from a commercial building. AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I declare under penalty of perjury that the building will be used as stated above and the proposed use conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will contact the Department of Public Works and will obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date 6tj / Fi �� Signature of Owner Permit Fee -fit S—U. Z) The above described AG Building is exempt from a building permit. Receipt No. Director of Public Works FL00 1 PARCEL P.D. ROOFING I ISSUE By Dater- - Z— White - DPW, Yellow - Assessor, Pink - B.I., Goldenrod - Applicant f OWNER , COUNTY OF BUTTE - DEPARTMENT OF, PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER ORIV.E !� ORbVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPOCATIQ BATA SHEET �LPermit No. �� • Proposed Building Use Building Inspector At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED —_Z1. All items have been submitted . .................................... 2. Plot plans in duplicate/triplicate, signed by preparer of plans ........ 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form .....:.................... e 6. Energy Design Compliance and supporting documentation ......... �`.. 7. Statement of Intent for Non -Heated and AC Buildings .............. '1'*61 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions....................................................... 10. Fees of $ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid ..................................................... f- 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval fo0r,(A) Use: • (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner o) ..... 24. Recorded copy of Agricultural Acknowledgment Statement .........\ 25. Letter of signature authorization .................................. . 26. 27. When you issue the permit, process as follows: Mail to owner: Mail to contractor. Telephone and hold for pickup'at r office. Deliver w/inspector. Other Applicant 1 .Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items -No. 2. Additional, items required: t Contractor, designer, owner, was advised of above required data by_phone._rnail—counter by .date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by – Date Sets of plans on hA in '" File cabinet AP folder Copy—DPW I/ -:'r+""",.K`f�.^:.-+a��•!�'i:•,=3-ri'i'9-•��;i+c'y+�%%ff'Fm�{r,";'�Y.r.'fl""'�.y.'���'�%►��1�U`�:i-`�=Pa�S^�:%�`'+�Y`l�Y-Ex'k�,-�.5.��;`�::�s�yw:y.�'".;,#raiF�;.�• :•w:'�..�r'"^^ -••- 30-21-69 :2995-0P,M ELLEN, B. M. 3638 Chico Street, Chico (new propand service/HVAC)SF o baq foeNkd. . .. • . , �s-l- .1 �� awe• r , �a� {.:�1'4:...1i!±ii[T :'`��i'- • + i 1 ��rT' 4 f�" ,�-'�•�j � ��v.• '. .L. .K'1. = � ,� � �if�� �.�YwTi�41�r2 a+�'�'S':, -x'' .e'4 '• �a"�'1 �'+�f� :�_.•4.. �.• �. r., ..'.. _ t''3'?'��. P`Y. �... 1. ,i.,,, � '7K.� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N0. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION! AND'PERMIT ASSESSOR PARCEL NUMBER' .. 39-210-069 ZONING _ BUILDING PERMIT OWNER BEllen TELEPHONE SO. FT. DCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 3638 Chico St., Chico 95928 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS ' Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee$ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 3638 Cbirn St., Chinn Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF[3 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 1 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00e TYPE OF WORK New❑ Addition❑ Remodel❑ Utilitiesg Installation❑ Other❑ Describe -work: New Propane Service HVAC _ Permit Fee $15.00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main Service EA, ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury(check one): p Y ) ❑ I am licensed under provisions of Chapt. 9, Div. 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 compen- will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ® I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUR.&` OR ADDNS. ( ACC. BLDGS. / 2h¢sgft NEW CONSTR MULTI -OUTLET NON-RESID BRANCH CIRCUIT S IRC ITS 2.50 ea POWER APPARATUS & SINGLE OUTLET CIR. ' Ex. Occup( OR FIXTURES10! \\ Ex. Occup. our LETS PRESID IRE A./sation, Temporary service Mobile Home Facilities Misc. Wiring15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. © 1 shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating 116.00 6.00 Dual Pack lin Coog 4 Ton 1 11.00 1.00 Hood 3.00 Ventilation Permit Fee $27 00 Contractor 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 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 against said County in consequeAce of the granting of this ppermi�t. �} q X Date 75 yb —/d Signature of Applicant — Owner ! Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST TYPE TOTAL FEE $ 42.00 HAZ I CUA PARK I SCHL I FLD I PAR I PD HD ISSUE I/ This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees DIRECTOR F PUBLIC BY �' PERM 4XPIRES Date the applicable provi- resolutions to do have been paid. WORKS ,� 19-� Date 9 4 Receipt No. 70768 WHITE -D. P. W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLIOAfION AND PERMITAl I PEMIT NO. ASSESSOR PARCEL NUMBER 39-210-069 ZONING _ BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING LUATION OWNER'S MAILING ADDRESS 3638 Qhiro'St., Chico 95928 CONTRACTOR'S NAME Ownpr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Pian Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR. ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 163R Chirn qt-. Chirn Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF[I Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 1 5.00 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00e TYPE OF WORK' New❑ Addition❑ Remodel❑ Utilities Installation❑ Other [J Describe work: New Propane Service HVAC _ Permit Fee $15.00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑NON.RESID I am licensed under provisions Of Chapt. 9, Div. 3 of the BusinesS and Professions Code and my license is in full force and effect. License No. Classification Fl 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.N A ) , 2/x sqft NEw CONSTFL ULTB OUTLET BRANCH CIRC ITS 2.50 ea 0ea POWER APPARATUS &) SINGLE OUTLET CIR. ) OUTLETS OR FIXTURES p o EX. Occup( 8AL®30 AL0 FIXED APL S Ex. Occup. OUTLETS PRESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. bVirin g 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department 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 W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor r MECHANICAL PERMIT Filing Fee 10.00 Heating 1 16.00 6.00 pUal pack Cooling g 4 Ton 1 11.00 1 .00 Hood 3.00 Ventilation Permit Fee $27.00 Contractor 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 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 against said County in consequ ce of the granting of this permit. X - Date � � Signature of Applicant — owneA Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 42.00 HAz CUA PARK SCHL ELo PAR Po Ho Issu€ This permit is nereby issued under sions of the Butte County Code and/or work indicated above for which fees DIRECTOR F PUBLIC By PER XPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date A ZQjy�i/Q� �� f a Receipt No. 70768 WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT �:-,,.%..-v'rM.""fd,. `. ..• .:., •. .. }. _, r.. � �y. L r ? _:'r?;:.r'•ri0'.'f �. v.•"�,r, 1+.�.r....• ^'^+'- '�'r+sw.tiar.•�''.eX� �ktliT` .i .f.�t . ! � �.... .*9.. , �!:�'" , ! , ^�,�"���� .r '�a � • ' � .;3 . ...e. . .. r, COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541 APRLIOAT;ON AND PERMIT ASSESSOR PARCEL NUMBER��� Q�j ZONI Zi� BUILDING PERMIT O WNFTEL d yyj �L L �I/ PHONE SO. FT. OCC. BUILDING VALUATION O WNER'S'MAILING ADD /iJ �✓/ ` 0 COy�T TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS — Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS - C I CO Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5,00 Each qas water heater or vent 5,00 USE OF STRUCTURE SF�Duplex❑ Mobilehome❑ Other . /TTTT ���\` SPECIFY Gas piping system 1 - 5 outlets5.00It G, Building sewer 5.00 Mobile Home S G W 10.00e TYPE OF WORK New❑ Addition[] Remodel[] Utilities,�Installation ❑ Other[]. Q< �r Descfibe work: F� r - 12 t/ i C VA Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR00V OR LESS10.00 CONTRACTORS LICENSE -LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification FlAPLFIXED I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service EA. AOD-L too AMP 2.50 NEW CONST- DWELLING OCCUP.& OR AODNS. ( ACC. BLDGS./=¢sgft , NEW CONSTR ULT' -OUTLET NO N.RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup( OR FIXTURES e@50C 2ALO 30 NS Ex. OCCup. OUTLETS (RESID .)OR EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or aCertificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee . 10.00 Heating/_,490— PIP , 490 Cooling �, 0 Hood 3,00 Ventilation Permit Fee $ - Q Contractor 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 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 against sa Count in conse ence of the granting of this permit. %�� �"'� �� Date Signature of Applicant — Owner K Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee 5 OCC CONST TYPE TOTAL FEE $ HAz I CUA PARK �SCHL I FLD PAR PD HDI ISSUE Th;s permit is hereby issued under Bions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date Receipt No. WHITE-O.P.W.. TELLOW-ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE =-Department of Public Works 7 County Center Drive, Oroville, CA 95965 OWNER -BUILDER VERIFICATION Attention Property Owner: Phone: 916-53$_7541 An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes 9 --o) t 2. I (have/.} for the proposed work. signed an application for a building permit 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have.contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work S igned : Property Owner Social Security N tuber Date —_ , — 2jJ NOTE: This Owner -Builder Verification is sent to you as. required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. wilp- COUNTY OF BUTTE - DEPARTMENT .OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE,-,OROVILt:E, OF 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. OWNER !'�i mil//,�/%/ A. P. No. �3 Proposed Building Use C��TS% //t/CJ Building Inspector Date At time of permit application, I was advised the following data must be.submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted . ............................. . 2. Plot plans in duplicate/triplicate, signed by preparer of plans ....... . 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form .......................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings' ............... 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions......................................................... 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-inspec. request to Building Inspector (Date) 21. Contractor's license information (No., Name Style, Classifications ... r •.r•- 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... t 26. 27. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w./inspector. Other Applicant_ `-�late= Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By. The following data must be submitted prior to permit issuance 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by_phone---nail—counter by ..date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked Sets of plans on hold in Copy—DPW Date Plans approved by File cabinet AP folder Date C DLA ►mss. ����' Seo -rt kv, �Lfl -TL oy r W P061Q4 tA// t . COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center. Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. b' ASSESSOP RCEL NUMF� - Z°NliiG BUILDING PERMIT OWNER - TELEPHONE SQ. FT. OCC. BUILDING VAL10ATION OWNER'S MAILING ADDRESS / ! C NTACTOR'S NAME C TELEPHONE CONTRACT R'S MAIL N RESS 3 �L i Fireplace 000 CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ • 10,00 LENDER'S MAILING ADDRESS Permit Fee $ S� ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARC ECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ' BUIL�.DING ADDRESS IS � 3i Ly PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New ❑ Addition ❑ RemodeI R Uti lities ❑ Installation ❑ Other ❑ Describe work: `A — �1�([i-- /llJ�. Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR011 OR LESS10.00 Main service EA. ADD'L 100 AMP 2'.50 NEW CONST. DWELLING OCCUP.&` OR ADONS. ( ACC. BLDGS. / 2I/20sq ft - CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 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 compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR ULTI-OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS. NEW CONSTR POWER APPARATUS & NON.R ESID. SINGLE OUTLET CIR. ( 20050C Ex. Occup(OUTLETS OR FIXTURES 9AL®300 FIXED APPLNS. OR Ex. OCCUp- OUTLETS (RESID.) EA.� 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. rV I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 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 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, osts, and expenses which may in any way accrue against aid (;ouW irl c equence of the granting of this permit. g C '� Datel Z _ 7 Si .turaof Applicant — OwnerContractor ❑ Agent ❑ An'OSHA permit is required for excXLions over 5'0" deep and demolition or construct- ion of structures over 3stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST. PARCEL PD HD IssuE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIR CTOR OF PUBLIC BY PERMIT EXPIR the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. Z/ri� WHITE-D.P.W., YELLOW -ASSESS R, PINK -INSPECTOR, GOLDENROD -APPLICANT