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Home My WebLink About039-210-097COMPLAINT TO INSPECTOR 11/r%o k d 039-21 -097 PERMIT#96-0698 MARTIN, o Martha 3611 Hegan Ln. , ico -cont: J. -B. Construct' 4' ��i•ol Remodel Kitchen/SF 039-210-097—` 04-3606 MARTIN, THOMAS 3611 HEGAN LN, CHICO CONT: JB CONST CO / J REMODEL LAUNDRY RM 039-210-097 06-0095 MARTIN 3611 HEGAN LN, CHICO • , Cont: OWNER GAS LINE r,lyk& 111816 039-210-097 06-0503 MARTIN, THOMAS 3611 HEGAN LN, CHICO CONT: J B CONSTRUCTION RE ROOF a •/jam • U 7 ENVIRONMENTAL HEALTH CLEARARANCE DATE 9 -1-03 K a■ BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 3611 HEGAN LN Owner: Permit NO: B08-1253 APN: 039-210-097 MARTIN THOMAS & MARS, Issued Date: 07/01/2008 By KEJ Permit type: MISCELLANEOUS 3611 HEGAN LN Subtype: Electric Panel CHICO, CA 95928 Expiration Date: 07/01/2009 Description: REPLACE MAIN SERVICE PANEL (530) 342-2051 Occupancy: Zoning: A20 Contractor Applicant: Square Footage: BARBARA ENTERPRISES BARBARA ENTERPRISES Building Garage Remdl/Addn P O BOX 366 P O BOX 366 FOREST RANCH, CA 95942 FOREST RANCH, CA 95942 (530)345-5729 (530)345-5729 Other Porch/Patio Total FEE INFORMATION DBE Single Phase Service-Resid $59.00 Total Charged: $59.00 Fees Paid: $59.00 Balance Due: $0.00 Receipt No: B7861 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License BARBARA ENTERPRISES 801766 / C10 / 12/31/2009 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 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (command "h Section 7000) of Divis' of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business Professions Code] is in full f fid effects and or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil than five hundred dollars 07/01/2008 penalty of not more [$500]; Please check one of the following: Contractor's Signature Date ❑ 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION - I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier. Policy Number: Exp. Date: (This s Ilion need not be completed if the permit is for one undyed dollars ($100) or less.) ❑ I AM EXEMPT under Section B. & P.C. for this reason: 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' X 07/01/2008 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's Signature Date provisions c X 0!it1/01/2008 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 Sidliarure Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 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, 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 DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or ccupanc of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. Cou t e above mentioned property for inspection purposes. I hereby certify that I am the pr or a authorized to act on the props owners behalf. CONSTRUCTION LENDING AGENCY zkyo /�bi0 07/01/2008 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for ame of Permittee [SIGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) ❑ Owner ontractor OR. Agent for Owner Agent for Contractor FILE COPY Lender's Address City State Zip .i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION" OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 o - A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Ko �► Website: www.buttecounty.net/dds OV N� PLEASE PRINT CLEARLY "When filed, this application and all supporting material becomes subject to the California Public Records Act. All PERMIT NO. BIN # public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Name1 /9A?16A /�_ f��= 5p8 Last Name AAR PWAI City �M First Name 0M Mailing Address Phone _ �_52Z_q Fax 3 �._6 City 7)4,7710j~State Lic. # Sb / 7 Class Zipq,03B- Phone 3 E-mail Fax 'RIt— % p -A/3 E-mail 3t'o .l I e— eLol CONTRACTOR Name1 /9A?16A /�_ f��= 5p8 Address ( 1 A47 -r �� City �M State c6 Zip 1903k I Phone _ �_52Z_q Fax 3 �._6 E-mail do a 114 ,i 60 M C CLs+, >�e.-+ Lic. # Sb / 7 Class APPLICANT INFORMATION ARCHITECTIENGINEER Name V Address Tip C City Fax 3_� State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name AyllD /2. Address9 p ,3 / �� a7T �� / City VUe4 A^ Stated Tip C Phone 3 , Fax 3_� E-mail (P, ce vri a s +, r)a+ APPLICANT SIGN RE X�--- PROJECT LOCATION APO 039-210 -0q7-000 Property Address 3 <P 11 city vvz.44� 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 DESCRIPTION OR SCOPE OF WORK. Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning FloodZone SRA Yes No Occ. Type Const. x *1 Butte County Department of Development Services. IN O T E' S 7 County Center Drive, Oroville, CA 95965 (530 ) 538-7601 vnnv.bugeco�mtY neVdds -eV. YE RRE+t RESIDENTIAL APN: Permit No. Owner 039-210-097 06-0503 MARTIN, THOMAS 13611 Site Address: HEGAN LN, CHICO CONT: J B CONSTRUCTION Contractor. 1. RE ROOF Type of Permit_ --- 4 k I CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE a _ co - DATE JOB FINALED: SIGNATURE: CS. Lim .DSA JvllP^Lx �1 OK MANUFACTURED HOMES MISCELLANEOUS DATE I Lj PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; Fall/C/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap . Nat ❑ or LPO Inch Sz Ft Lngth 7 Blckng; Sz-Spacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ . Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers DATE ID E C K S -C O V E R S`C A R P O R T S `G A R A G ES 1 Zoning -Setbacks -Easements 2 Ftgs; Soils -Sz-DpthSpacing-Cnnctrs-Steel 3 Decks, Girders/Joists-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls P r °'o ° o DATE IPOOLS 1 Setbacks -Easements 2 Soils; CompactionStructure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr 8 Elec Grndng; Eqp w/5' CrcItng Eqp-Pool Ightg Bdxes7Enclsrs-pniboards4nsultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing Alarms 13 Bonding, Diving board or Slide 41 `C Pool Drawing • t = OK = Not RESIDENTIAL (Sing(& & Duplex) DATE JUNOERFLOOR I DATE IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 2 Fig Main; Soils-Elec Grnd Fig Opth 3 Fig Garage; Soils-Steel-Elec Grnd Fig Dpth; 4 Fig Porches/Decks; Soils -Steel Ftg Dpth 5 Stemwalls Main; Steel -6lockouts -Wrapped 6 Stemwalls Garage; Steel-Blockouts-Wrapped 69 Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc FtgSteel 9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 1l Wtr Pipe; Test-Anchrs-Rgltr-Service Test 12 Elec Undrgrnd 13 Plenums & Ducts; Cfmc-MaterialSupport-Insultn 14 Girders-Sills-Anchr BoltsJoists-Vnts-Cripples 15 Acc & Vntltn 16 Insulation l DATE IFRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs -Nailing Spacing & Braces-PlatesSound 19 Bearing Walls over Girders & fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 22 Headers & Beams-Sz & Bearing 23 Hangers -Post Caps-Anchrs-Cnnctns 24 Ceiling Joist-Rftr Ties -Purli n -Roof Brac-TrussShthg 25 Frplc Ties or Type A Flue-Frplc Throat Clmc 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctn Framing -RC Ctiannel 29 Prprty Line Firewall & Opngs 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrrn-Rise-Run-Landing-Fire Prtctn 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 33 Siding -Nailing Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Walt pnls 38 Insultn-Walls-Ceilings 39 Infiltration-Walls-Wndws o'er o` o'er m DATE JELECTRICAL 40 Fxtr & Tmsfrmr Clmc-Ins Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz e' ❑ CU or ❑AL AC Wire Sz ea Q CU or [:1 AL 48 Range Circ ga ❑CU orQAL Oven Circ qa ❑ CU or ❑ AL Insulated Neutral Yes ❑ No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrnrs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr Nail Prtctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub. Acc 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas Piping DATE IMECHANICAL 61 AC Ducts Insulin & Support 62 Vent Fan, Exhaust abv Insultn 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air RtrnfVent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic DATE IFINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace VnLs-CImc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Mech Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Sts & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Clrnc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct in Garage -Damper 80 Wtr Htr; Vnts-Clrnc-Com Air Cnnctr-PRV-, abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Plmb; Elec & Mech Eqp Listed for LoCtn 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Dmge Planters QYes ON. 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Pimb 89 Vnts abv Roof, Plmb-Appinc-Frplc-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntitn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99. Fire Sprinkler J_ _ BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060503 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. 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: 03/03/2006 APN: 039-210-097-000 the Business and Professions Code, and my license is in full force and effect. ] License Class: License Number: �J'y//Z Site Address: 3611 HEGAN LN CHI Dater Contractor: •� Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: RE -ROOF (70 SQ) 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: MARTIN THOMAS & MARSHA TRUST 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 State License Law (Chapter 9 commencing with Section MARTIN THOMAS B & MARSHA A 7000) of Division 3 of the Business and Professions Code) or that he or TRUSTEES she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7.031.5 by any applicant for a permit subjects the 3611 HEGAN LN applicant to a civil penalty of not more than five hundred dollars ($500).): CHICO, CA 95928 ❑ 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 such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for Applicant: J B CONSTRUCTION COMPANY 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.).' ., P O BOX 1516 ❑ I, as owner of the property, am exclusively contracting;with 1 ' CHICO, CA 95927 licensed contractors to construct the project (Sec. 7044, Business (530) 895-1573 and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Contractor: J B CONSTRUCTION COMPANY Date: Owner: P O BOX 1516 WORKERS' COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for CHICO, CA 95927 workers' compensation, as provided for by Section 3700 of the (530) 895-1573 Labor Code, for the performance of the work for which this permit i issued. I have and will maintain workers' compensation insurance, as License #! 4.30112 . 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 numb r are: Architect: Carrier: "i'L � - -Engineer: Policy #: ❑ 1 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, Total Square Ft: 0 S. F. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Valuation: $0.00 forthwith comply with those provisions. Census Co�de:�` Date: i�,�3—dl� o0 T • DDJ. Applicant: Jam' •� J�1�C� r, W is WARNING: Failure to secure workers' compensation' coverage unlawful, and shall subject an employer to criminal penalties and one the hundred thousand dollars (8100,000), In addition to cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONST CTION LENDING AGENCY . _. _ _ _ This.pe,mit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there s a construction lending agency for the Resolutions to o work indicated ove for wnlcn fees have been paio. - performance of the wor for which this permit is issued (Sec 3097 Civ.) //fi�r(— �, Dale: ) ' l /1f� Name: B y' n PERMIT EXPIR S ON: Address: (Date) ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 2553.3, 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 Califorriia 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 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 slate laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butt ounty. I hereby authorize represent ti es of Butte County to enter upn the above mentioned property for inspection purpose . Print Name: '\�L. Signature: bate:3 —D ❑ Owner Contractor ( ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 k' BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERMIT NO. BP060503 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. 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: 03/03/2006 APN: 039-210-097-000 the Business and Professions Code, and my license is in full force and effect. q?D112 License Class: � License Number: i Site Address: 3611 HEGAN LN CHI Date:c� Contractor: % Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: RE -ROOF (70 SQ) 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: MARTIN THOMAS &MARSHA TRUST 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 State License Law (Chapter 9 commencing with Section MARTIN THOMAS B &MARSHA A 7000) of Division 3 of the Business and Professions Code) or that he or TRUSTEES 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 3611 HEGAN LN applicant to a civil penalty of not more than five hundred dollars ($500).); CHICO, CA 95928 ❑ 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 such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for Applicant: J B CONSTRUCTION COMPANY 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.). P O BOX 1516 ❑ I, as owner of the property, am exclusively contracting with CHICO, CA 95927 licensed contractors to construct the project (Sec. 7044, Business' (530) 895-1573 and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code Contractor: J B CONSTRUCTION COMPANY Date: Owner: P O BOX 1516 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 CHICO, CA 95927 workers' compensation, as provided for by Section 3700 of the (530) 895-1573 Labor Code, for the performance of the work for which this permit i 'slued. I have and will maintain workers' compensation insurance, as License #t'430112 . required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrierand po//lici numb rare: �y ��T�Y'1�- Architect: Carrier: !� M_IV1 Engineer: _ Policy#: 12S C D ❑ 1 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, Total Square Ft: 0 S.F,.— and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Valuation: $0.00 forthwith comply with those provisions. Census Code::�' Date: (y;� Applicant: J lJ� •oO ' WARNING: Failure to secure workers' compensation',coverage>-is unlawful, and shall subject an employer to criminal penalties and one in to the hundred thousand dollars ($100,000), addition cost' of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONST CTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there s a construction lending agency for the Resolutions to work indicated ove for which fees have been paid. performance of the wor for which this permit is issued (Sec 3097 Civ.) x % B Date: .l " l / 1� y' Name: ` C�� Address: PERMIT EXPIR S ON: J (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 8 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 Butt , ounty. I hereby CC�ounty to enter up n the above mentioned property for inspection purpose . authorize representatives of Butte County % Print Name: `�.1 �T�� Signature: Date: —pb��s ❑ Owner Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 s' �%jT.r BUTTE COUNTY o O DEPARTMENT OF DEVELOPMENT SERVICES O i O BUILDING PERMIT APPLICATION 0 ° AND SUBMITTAL REQUIREMENTS 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 QU �'�y A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION **PLEASE PRINT CLEARLY** CONTRACTOR OWNER Last Name j� City First Name I Address ( Stag City State Stater Zip �Z Phone Fax 1?q57_C:'?214 Fax E-mail Clas CONTRACTOR Name1 a.74,14.v4 Name City Address o x City Stag Zip f5-fz7 State Zip Phone Phone Fax 1?q57_C:'?214 E-mail uc. # Y o// Clas APPLICANT SIGNATURE X PERMIT NO. BPO�o BIN # LOCATION ARCHITECT/ENGINEER Name City Address .tet City Policy Number O State Zip Phone LENDING AGENCY Fax E-mail Phone State License Number APPLICANT SIGNATURE X PERMIT NO. BPO�o BIN # LOCATION APPLICANT NAME Name City Ja— .tet Address Policy Number O Carrier o / City LENDING AGENCY State Zip S9�7 Phone s 7 3 Fax 995--o ePJ E-mail LL��!/al� c- •� o.�c APPLICANT SIGNATURE X PERMIT NO. BPO�o BIN # LOCATION AP# _ Q� -a Property Address City Cross Street SRA WORKER'S COMPENSATION Policy Number O Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. Subdivision Name Map LENDING AGENCY Name Address V117 - Description or Scope of Work: 4LP=>00—P r Oe' G✓o0 / Sq. Footage '�� -.1-e u ❑ Structure Built without Permit ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION i 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 or office use only: Zoning Flood Zone SRA I Yes No Occ. Type Const. , Subdivision Name Map Book Page Lot # Planner Date Approved: REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: 6, Amount: .05."o Bldg SRA Receipts�l V#:qg 2 $ Sheriff r Ili;.. SMIP IDate:3 - �-' 0 C OVER FOR SUBMITTAL REQUIREMENTS 11 K:\FORMS\BUILDING F0RMS1BldgApp1SubRgmts.doc Page 1 of 2 Other Total REV 6-16-04 SUBMITTAL REQUIREMENTS _ The following drawings and specifications must be submitted to the Building Division in order to apply fora 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 GRAPHPAPER! ❑ .2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 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. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). o 7. Detached Accessory Building Form, filled out by the property owner (if required). O 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. 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 GRAPH PAPER! ❑ 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 Butte County Department of Development Services. eoTre �� N ® T E S 7 County Center Drive, Oroville, CA 95965 •` cow (530) 538-7601 vrww.buttecountyneUdds RESIDENTIAL APN: �I D � Permit No. �� -� Owner: Site Address: -_ w 'e s P. K- Contractor. Type of Permit: SPECIAL CONDITIONS CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: ( / l/ SIGNATURE: = OK = Not OK MANUFACTURED HOMES MISCELLANEOUS DATE j PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; Fall/C/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator. 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap NatE—] or LPQ Inch Sz Ft Lngth 7 Blckng; Sz-Spacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs Q Foundation Q 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers DATE D E C K S'C O V E R S'C A R P O R T S `GARAGE S 1 Zoning -Setbacks -Easements 2 Ftgs; Soils-Sz-DpthSpacing-CnnctrsSteel 3 Decks, Girders/Joists-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts -Beams -Rftrs-Cnnctrs-Shthg Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Encisrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls 4P .c ° °`s °: � DATE IPOOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcis/Lting; Distance-GFI 5 Elec Pool Lting; 15 volts-GFl 6 Elec Enclsrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcitng Eqp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Bdxes-Enclsrs-pniboards-Insultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide s Pool Drawing = OK 0 = Not RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR DATE IPLUMBING I Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg Dpth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth. 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First flr-Tub Acc 5 Stemwalls Main; Steel -Blockouts-Wrapped 57 Test Tub & Shwr, 2nd fir - Tub, Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped• 58 Gas Pipe; Sz & Anchrs 69 Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way C/0 -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test °9° 1:1 Wtr Pipe; Test-Anchrs-RgltrService Test 12 Elec Undrgrnd DATE M E C H A N [CAL 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 61 AC Ducts lnsultn & Support 14 Girders-Sills-Anchr Bolts 4oists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn 15 Acc & Vntltn 63 Condensate Drain & Ovrflw, Sz & Grade 16. Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic Ize- DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE F INA L 66 Ext Steps -Door & SideLt Prtctn-Landings 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof) 68 Furnace Vnts-Cirnc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-flr-Ducts-Mech Prtctn 22 Headers & Beams-Sz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frpic Throat Clmc 72 Elec Trim & Subpnl, Breaker Sts & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop4ns Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Cimc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 79 AC Duct in Garage -Damper 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-Clmc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndbi Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnis 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters Q Yes [_]No 87 Stucco Brown -Finish e� o'° d� 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-CImc: to Opngs 90 Wtr Well, Dscnnct, Elec, Plmb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga ❑ CU or ❑AL 98 Address Posted AC Wire Sz ❑ CU or ❑ AL 99 Fire Sprinkler 48 Range Circ QCU or ❑AL Oven Circ ga QCU or QAL Insulated Neutral ❑ Yes Q No o'° a °'`° °..r 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Cirncs pnis-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (536) 538-7541 PERMIT NO. BP060095 . B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 01/17/2006 APN: 039-210-097-000 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 ll effect. e Site Address: 3611 HEGAN LN CHI License Class: License Number: Map Index: Date: Contractor: Description: INSTALL GAS LINE 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: MARTIN •THOMAS & MARSHA TRUST 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 MARTIN THOMAS B & MARSHA A the Contractor's State License Law (Chapter 9 commencing with Section TRUSTEES 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any 3611 HEGAN LN violation of Section 7031.5 by any applicant for a permit subjects the CHICO, CA 95928 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' Stale 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, Applicant: MARTIN THOMAS & MARSHA TRUST 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 MARTIN THOMAS B & MARSHA A proving that he or she did not build or improve for the purpose of. TRUS'T'EES sale.). 3611 HEGAN LN 1, as owner of the property, am exclusively contracting with CHICO, CA 95928 licensed contractors to construct the project (Sec. 7044, Business (530) 342-20510 and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I aal3diOwn derArti a Business rof ions deContractor: HEAL, DANIEL PLUMBING Date: 12206 MERIDIAN ROAD WORKERS' OMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: CHICO, CA 95973 ❑ 1 have and will maintain a certificate of consent to self -insure for - (530) 345-2142 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. License #: 393518 ❑ 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: Architect: Engineer: Carrier: Policy M ❑ 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 Total Square Ft: 0 S. F. become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' Valuation: $0.00 compensation provisions of Section 3700 of the Labor Code, I shall Census Code: forthwith comply with those provisions. Date: t U —. a 3q Applicant: WARNING: Failure to secure workers' compensation coverage is _ 7_ /�% / OI5 unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section •3706 of the Labor code, interest, and attorney's fees. - CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or 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.) Resolution to do work inclitateP above for which fees have been paid. 1 -1 T O (6 BY Date: Name: - ' 0 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 Safely 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 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 B unty. I hereb authorize representatives of Butte County to enter upon the. b vee�mention d -property for inspection pu Print Name: r'C V/jl"r Signature: ( L Date: .Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 '1 u BUTTE COUNTY PERMIT DEPARTMENT OF DEVELOPMENT SERVICES NO. BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS //'' 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 591-2834 BP 0601 — OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION BIN # Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER INFORMATION CONTRACTOR Name of 'm lcal,4 City State Zi Phone 3i / _ `2, Fax ,� E-mail ,,Sl e A ,16,1 d c4!20? APPLICANT INFORMATION CONTRACTOR Name -� Addre$s L City lCs State . Phone Faxes /9 2 E-mail Lic.4f 9 Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City ` C U Address SRA City Fax 611�S State . Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name—, t" Asross �Pn�7 City ` C U S? SRA Phone � _ � Fax 611�S / Email �� WNr. ffrA 0- X 019 1 AIR! For office use only: Zoning Asross �Pn�7 Flood Zone Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Tot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PROJECT LOCATION AN _ n , h ` O Asross �Pn�7 (� 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 Description o Scope of W rk: J14 15:, Sq FT- Living G rage Open Cov ❑ 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. Received by: 6 Amount: ''l Bldg SRA Receipt #:413V Sheriff SMIP Other Date: / l b `,� 5 co Total 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 BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 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 faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A1C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bidgs: (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. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). 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. Califomia 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. Coritractor's 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. ❑ Legal description from current recorded grant deed,, El Copy of M.H. Title, Title transfer, or MCO. O 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit 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 Refunds 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 check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\81dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 .�..� I =f "` ENVIRONMENTAL 039-210--_097 PERMIT#96=0698 HEALTH CLEARARANCE MARTIN, o Martha 3611 Hegan Ln. , ico hq DATE Ct -1(0-OS Cont: J.B. Construct' �•��•a� Remodel Kitchen/SF NOTES RESIDENTIAL �__0 PERMIT NO. _ 390-Q97 ___ —1 04-3606 MARTIN,_THOMAS o L,! ,/ d e2.,1 S tr�� ! 3611 HEGAN LN, CHICO CONT: JB CONST CO .t ca 6�O6c� g j REMODEL LAUNDRY RM 1 ti 4 t 1 4! 11 SPECIAL CONDITIONS 11 SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER JOB FINALED (Date) Signature r CHECKED BY J=OK 0 = Not OK able . = otReady Carports; Windows -Doors MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 1. Zoning Requirements -Setbacks -Easements 10. 2. Soils; Special MH Support Sketch Ext.; Steps -Doors -Landings 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) Card B-1 Date Card B-1 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Date POOLS (Plans) OK except #'s 6. Gas; Location -Test -Wrap;-/ P' L 'ft. / P Nat. or / /" L "ft./ P LPG 2. 7. Well Clearance & Disconnect Pool Structure; Steel -Connections -Thickness Dead Men-Linino 8. Utility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams- Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men-Linino 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panel boards- Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12: Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 54. 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test Mesh -Drip Screed -Fd. Vents-Underflr. Access j 12. Electric Underground Glazing Area -Glass Protection -Skylights -Plastic 13. Plenums & Ducts; Clearance -Material -Support -Ins. Shear Walls; Nailing -Bolts 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies Brace Interior/Exterior Wall Panels 15. Access & Ventilation Insulation -Walls -Ceilings 16. Insulation Infiltration -Walls -Windows Date Date Date Card B-1 Date Card B-1 Date Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Ext. Steps -Door & Sidelight Protection -Landings 17. Water Htr.; Vent -Access -Combustion Air Baffle Smoke Detector 18. Water Pipe; Test & Anchor -Nail Protection Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection Bedroom Exiting 20. Shower Pan; Test, First Floor -Tub Access G.F.I. & Bath Fixtures & Tub Access -Spa 21. Test Tub & Shower, Second Floor -Tub Access Elec. Trim & Subpanel, Breaker Sizes & Labels 22. Gas Pipe; Sixe & Anchors Stairs & Rails 23. Fire Sprinkler; Test Fireplace or Stove, Clearance -Hearth 72. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 75. 24. Fixture & Transformer Clearance -Ins. Protection 76. 25. Elec. Receptacles Spacing -Lights & Switches at Doors 77. 26. Size Boxes & No. of Conductors Stapled 78. 27. Romex Installed Close to Edge of Studs & C.J. 79. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 80. 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 81. 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 82. 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral ❑ Yes ❑ No 32. Service -Riser Conductors & Ground Main Disconnect 83. 33. Equip. Clearances Panels-Motors-Mech. Equip. 81,,6tucco 34. Clothes Closet Light -Shower Light -Spa Light 85. 35. Smoke Detector 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings Date Water Well, Disconnect, Electrical, Plumbing Card B-1 Date Card B-1 Date Exterior Elec. Trim, G.F.I. Receptacle -Underground Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 94. 40. Attic Access & Platform if Furnace in Attic Date Address Posted Card B-1 Date Card B-1 Date Fire Sprinkler Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s Date 41. Sills Proper Materials & Anchors Date 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound Comments at Final: 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 5BO."Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access j 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes _ 83. Following Instld./Drive O Yes O NoMalks O Yes O No/Planters O Yes O No 81,,6tucco Browr(Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date OC Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: '�� kwoto n: .........." 'COUNTY OF BUTTE BUILDING DIVISION '' G DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE OWNER PERMIT NO. Y' A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact the Building Inspector as indicated below. 1�3 7 Date , / Inspector REV 4/05 Phone # FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVIL•LE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP043606 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of -perjury that I am licensed under - Issued Date: provisions of Chapter 9 (commencing with Section, 7000) of Division 3 of 12/22/2004 APN: 039-210-097-000 the Business and Professions Code, and my license is in full force and effect. Site Address: License Class: U C �— �alcerise Number: y?O// 2 1 3611 HEGAN LN CHI Date: — 2-D`�Contractor.J,,�A ia�csl� J6 4-4,5+ Map Index: OWNER -BUILDER DECLARATION Description: REMODEL LAUNDRY ROOM 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 Cade: Any city or county which requires aMARTIN THOMAS & MARSHA TRUST permit to construct, alter, improve, demolish; or repair any structure,, prior Owner: 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 MARTIN THOMAS B & MARSHA A the Contractor's State License Law (Chapter 9 commencing with Section TRUSTEES 7000) of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any 3611 HEGAN LN violation of Section 7031.5 by any applicant for a permit subjects the CHICO,'CA 95928 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 J B CONSTRUCTION COMPANY such work himself or herself or through his or her own employees. Applicant: 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 P O BOX 1516 sale.). CHICO, CA 95927 ❑ 1, as owner of the property, am exclusively contracting with (530) 895-1573 licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or, improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: J B CONSTRUCTION COMPANY ❑ •I am Exempt under Article 3 of the Business and Professions Code Date: Owner: WORKERS' COMPENSATION DECLARATION P O BOX 1516 _ I hereby affirm under penalty of perjury one of the following declarations: CHICO, CA 95927 ❑ 1 have and will maintain a certificate of consent to self -insure for (530) 895-1573 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. License #: 430112 ❑ 1 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: Architect: Engineer: Carrier. +,t �_ /—�..f Policy M-00,2 foSo — .?r) ❑ 1 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 Total Square Ft: 0 S. F. become subject to the workers' compensation laws of California, Valuation: $0.00 and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall Census Code: forthwith comply with those provisions. 97 Date: Applicant. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one / L/ hundred thousand dollars ($100,000), in addition to the cost of Z compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is by issued under the applicable provisions of the Biifte County CodA anrUor I hereby affirm that there is a construction lending agency for the Resolutio o do work dl ate above fo which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Clv.) `C, Z 2 l Name: By1-4Q ` Date: PER EXPIRES ON: - �� d Address: 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. 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'l 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 to enter upon the above mentioned property for inspection purposes. Print Name:_�� diA�� 'Signature: Date: ❑ Owner Av Contractor 0 Agent for Owner 0 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 REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds .* *PLEASE PRINT CLEARLY** CONTRACTOR OWNER Last Name21 City / - O State irst Name Address f i4 City Gk" Phone Sttl- 7_;p 9�5-�2e Phone 2� OS PageLot Fax E-mail Approved: CONTRACTOR Name 39 �f AddressPO Aox City / - O State Zip 9_;W7 Phone 99S �7 73 Fax E-mail Lic.# 3011 C st EN Name ARCHITECT/ENGINEER 00 Address Address rp City State State Zip Phone E-mail Fax E-mail PageLot State License Number APPLICANT NAME Name zit �s Address rp Ciry ! State 1 Zip �D2 7 Phone Fax E-mail .40 or office use only: Zoning Pronertv Address/ n , Flood Zone Cross Street SRA ves No Occ. Type Const. Subdivision Name Map Book PageLot # PlannerDate Approved: OVER FOR SUBMITTAL REQUIREMENTS KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc P 1 PERMIT NO. BPOY 5 BIN # LOCATION Q� '% AP# l Pronertv Address/ n , CityG l "-t Cross Street WORKER'S COMPENSATION Policy Number o0�80�_a0O Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. �j �f �C�/ C/ [/ LENDING AGENCY Name Address Description yrpcope of Wor i✓ a 4( p NCL i JL44 Acpik Sq. Footage O 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. LI Received by: Amount: Bldg SRA Receipt #: Sheriff �j �f �C�/ C/ [/ SMIP Other Date: d �7 I , / Total s RFV 7_77_nd Y 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 BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 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 faxes! ❑ 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 AIC 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. Contractor's 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 Refunds 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 check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVIL'LE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.netldds LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: 6 c_�aicense Number: C/ X011 2 - Date: — Z-0gContraclor: J,3 % OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish; or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Slate License Law (Chapter 9. commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a, permit subjects the applicant to a civil penalty of not more than rive 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 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 Profassions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for worteers' 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, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is Issued. My woirkers' compensation insurance (carrier and policy number are: Carrier. Policy #: 00,27N,50—.20Q`" ❑ 1 certify that in the performance of the work for which this permit Is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Sec 3097 Civ.) Address: PERMIT NO. BP043606 Issued Date:. 12/22/2004 APN: 039-210-097-000 Site Address: 3611 HEGAN LN CHI Map Index: Description: REMODEL LAUNDRY ROOM Owner: MARTIN THOMAS & MARSHA TRUST MARTIN THOMAS B & MARSHA A TRUSTEES 3611 HEGAN LN CHICO, CA 95928 Applicant: J B CONSTRUCTION COMPANY P O BOX 1516 CHICO, CA 95927 (530) 895-1573 Contractor: J B CONSTRUCTION COMPANY P O BOX 1516 CHICO, CA 95927 (530) 895-1573 . License #: 430112 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: Fn,rr.:i' Ke:7by issued under the applicable provisions of the Butte Cnunly rlution o do work I ate abovef which fees have been paid. �1 ii.21.— Date: 2 EXPIRES ON: 2- c! .2-/D ❑ 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'( am the owner or the duly authorized agent of the owner. I agree to comply with all county and stale 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 to enter upon the above mentioned property for Inspection purposes. 1 i Print Name: �1 _ U �d[i4 L'CIQ 'Signature: Date: ❑ `Owner AM Contractor ❑ Agent for Owner - ❑ Agent for Contractor COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE OWNER CGhri 'C/-4/ V -71 PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. E.H. USE ONLY Rot Ran Attached Ran Anachad aP Sent to aA. MCI ICS TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance /r01W?-7Z,A' 3Co �� .�� i�ili4� 9- -,V Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public Private Well Clearance for dwelling. Other E2�kal-212el 74 Hold final for: /�✓ i� Finalc earance O.K. for: NOTE: Environmental Health Specialist Date 8/96 4�1 ` 3611 Hegan Ln. 'Chic' Cont: J.B.- Construct"ion Remodel Kitchen/SF K COUNTY OF BUTTE- DEPARTMENTOF DEVELOPMENT SERVICES- BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541' PERM T NO. APPLICATION AND PERMIT ASSESSORPARCELNUMBER 039-210-097 ZONING A20 BUILDING PERMIT OWNER Ts TOM & MARTHA MARTIN TELEPHONE 342-2051 SO. FT. OCC. BUILDING VALUATION P19T 1500 OWNERS MATING ADDRESS 3611 N V. CHICO95928 CONTRACTOR'S NAME J.B CONaSnUCTION TELEPHONE 895-1373 CONTRACTORS MAIUNG ADDRESS TCO 95027 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 35.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS 3611 HEGAN LN 00100PLUMBING PERMITFEE $ 55.00 PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDrvISIONS NAME PARCEL MAP SOIflf Of heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF IN Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ U5lities ❑ Installation ❑ Other ❑ Describe Work: KITCHEN Ri WD& Mobile Home I S I GI W @20.00 PERMITFEE $ 35.00 Contractor ELECTRICAL PERMIT Filina Fee 20.00 Main Service .000V OR LESS ( zooA OR Less ) 23.00 _8 Main Service ( 200A TO I000A ) 46.00 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 i full force and effect. +� License Class LIC. No. 4 3DI I +l OWNER -BUILDER DECLARATION I 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 reasonMECHANICAL NEW CONST. DWELLING OCCUR DR Ns. ( a ACD. BUDS. ) SO. 3.5Q FT. NEW CONST. MULTI -OUTLET C NON-RESID. ( BRANCH CIRCUITS ) @7.50 (a SIINGLE OUTLET CSR. ) Ex. Occup. ( OUTLET OR FIXTURES) 20BAL O 1.00 FIXED APPWS. OR Ex. Occup. ( OUTLETS (RESID.) EA ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23.00 PERMITFEE $ 43.00 Contractor 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 is issued. I 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 C, i ,.- A c _ - J �- •, .. r i; CO. � PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE S Contractor Policy Number WC. ). )_L, (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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. ef _ / ! _ Date _� - e76 gnature of Applicant - ❑Owner ontractor ❑Agent An OSHA 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 Is OCC CONST. TYPE TOTAL FEE $ 133.00 HAZ. 1 D. FEES I IMP I FLOOD I CDF ;ZFC9 PD I HD I ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have B Gte y PERMITEXPIRESON applicable provisions Resolutions to do work been paid. (Date) Receipt No. 115'03 (o WHITE•D.D.S-.•B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 7t COUNTY OF BUTTE- DEPARTMENT QF DEVELOPMENT SERVICES -BUILDING DMS 7 County Center Drive - Oroville, California 95965 - Telephone (916) 57 9� QPERM NO. . APPLICATION AND PERMIT66) ASSESSOR PARCEL NUMBER 039-210-097 ZONING A20 B DING PERMIT OWNER 15M TOM & MARTHA MARTIN TELEPHONE 342-2051 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 3611 HEGAN LN, CHICO 95928 9ST 1900 CONTRACTOR'S NAME J B R TELEPHONE 895-1373 CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNIDJOWN Total Valuation Is Filing Fee $ 20,00 LENDER'S MAILING ADDRESS Permit Fee $ 35.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS 3611 HEGAN LN,C ICO PERMITFEE 55.00 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LAT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF EX Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: KITCHEN REMODEL Mobile Home S G I W @20.00 PERMITFEE $ 35.00 Contractor ELECTRICAL PERMIT Filina Fee 20:00 Main Service 00OV OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO I000A ) 46.00 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, A and my license is full force and effect. License Class 0 Lic. No. 9 ;10112 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 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 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'om ensation insurance carrier and policy number are: Carrier � ,�'M, ..l> CG- NEW CONST. DWELLING OCCUR OR ACDNS. ( 8 ACC. BLDS. ) Q. 3.5¢ F7. NEW CONST.MULTI-OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) 8 SINGLE OUTLET CIR. Ex. Occup. (ourlEr OR FIXTURES) 2U 0 I.50 a4� so Ex. Occup. ( OUTLETS ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23.00 PERMITFEE 43.001 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number L S 1 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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 hwith comply with those pr visions. X Date _�— gnature of Applicant - ❑Owner ontractor ❑ Agent An OSHA permit is required for excavations over 50" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 133.0 HAZ. I D. FEES I IMP I FLOOD CDF PARCEL PD I HD I ISSUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By PERMITEXPIRESON I o provisions to do work paid. 'Z S- e) Receipt No. S03 !O WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE —DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLIC&Idl AND PERMIT ASSESSOR PARCELNUMBER _ 2 -�/. ZONING 41 O BUILDING PERMIT OWNER / � J / T�2 "E �C�% SO. FT. OCC. BUILDING VALUATION OWNER'S 1MN)NG ADDRESS / i ^,JIL D / 2 �,^J (- '/ �/� /bNAME(/ TELEPFIO"E CONTRACTOWS \ - y/ V\ 1QVS C'�•.�,.S�x.-� e �1� ,ice S s = lf^73 n UNO ADRESSCONTRAC/9�/,tr. /^ Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Fling Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 3 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAIUNG ADDRESS Penalty $ BUILDINGADORESS •l � (o PERMITFEE $ PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 LOT NO. SUSDNISIONSNAME PARCEL MAP Solar or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE Duplex E3Mobilehome ❑ Other SAID, -Up SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ �� / p, / C.� I Describe Work: /(+-�G�l�� /< e� � o' Mobile Home I S I GI W I @20.00 PERMITFEE S Contractor ELECTRICAL PERMIT Filinq Fee 20.00 • Main Service000v OR LESS ` ( 200A OR LESS / 23.00 Main Service ( 200A TO 1000A ) 46.00 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 I 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. ❑ 1, 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 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 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 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.) ❑ 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 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 Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 50" deep and demolition or construction of structures over 3 stories in height. .NEW CONST. DWELLING OCCUR OR ADONS. ( a ACC. ) SLOSLICENSED SO. 3.5¢ Fr. NEW CONST. MULTI.OUTLET ` UTLE NON•RESID. ( BRANCH CIRCUITS / 97.50 ER SINGL APPARATUS (a SINGLE OUTLET CIA. Ex. Occup. (OUTLET OR FIXTURES eAL 20 Q''00 , Ex. Occup. ( OUTTLETs (RD.) EA ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 7i PERMITFEE $ Contractor MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE S I Contractor 1 Mobile Home Installation Fee $ Energy Inspection Fee Is 9 Occ CONST. TYPE TOTAL FEE $ 3� MAL. 1 0. FEES I IMP I FLOOD I COF I PAR ELI PD I HD I sSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have By PERMITEXPIRESON applicable provisions Resolutions to do work been paid. Date (Date) Receipt No. WHITE-O.D.S.-B.O. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .., �' `. ;' � � _ f ... II i i� f f i �' 1' 4 1 ' 1' �. J r!Q 1 l I. i i 1 f _ f' �'.,. ... !� I. l 1 4 lf``f f Ii k !.- (i`t� f. { f 1 I � 4 t �' {�F. 3 I �. �� I �, . ,' -. _ . _ ... .. �' __ _ .. .. _ r ._ .. �� . , ,. � � �� .., �-