HomeMy WebLinkAbout039-260-029I
19
39-26-2
App for determination
39=26-29 .-358-91P,E,M
MUNJAR, Earl & Margaret
(heating & AC)•ArticiAire ._ p'
+ 3471tDurham,Dayton Rd, Durham
a
039-260-029.- ti '04-
SOUTHAM, TODD �' AAL
3471 -DURHAM. DAYTON HWY �_•�
DURHAM
Cont: G&R ROOFING.'-.,
RE-ROOFt 2 ,SQ
w. 9:)
1
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CMI :fix �I
15
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.neAdds
PERMIT NO.
BP042495
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: 08/25/2004 APN• 039-260-029-000
the Business and Professions Code, and my license is in full force and
effect. c -7 x,13
� License Number:
Licensce�a;6�
Site Address: 3471 DURHAM DAYTON HWY DUR
Date: U Contractor. `- P-
Map Index:
Description: RE -ROOF (52 SQ)
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
Owner: SOUTHAM TODD & KIRSTEN
to its issuance, also requires the applicant for such permit to file a
3471 DURHAM DAYTON
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
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
95928
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant- for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Applicant: G & R ROOFING
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,
2587 NORD AVENUE
provided that such improvements are not intended or offered for
CHICO CA 95973
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
(530) 894-6537
proving that he or she did not build or improve for the purpose of
sale.):
O 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor: G & R ROOFING
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.).
2587 NORD AVENUE
❑ 1 am Exempt under Article 3 of the Business and Professions Code
CHICO, CA 95973
(530) 894-6537
Date: Owner:
License #: 773913
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.
O 1 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:
Carrier: =lLL�-"'( Vtq(,
Total Square Ft: 0 S. F.
�I %
Policy #: '7)3—(-)3 v�' l �lfj��
Valuation: $0.00
Census Code:
`
❑ 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'
�(�–l•r
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: I '3L-
tI/ '
ApplicaaL-1
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�Cj�6q ( I
compensation, damages as provided for in Section 3706 of the Labor
J
code, interest, and attorney's fees.
i
CONSTRUCTION LENDING AGENCY
This permit is her by issued under the applicable provisions of the Butte County CodR anrt/or
I hereby affirm that there is a construction lending agency for the
Resolutions to do ork indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
By: Date:
Name:
PERMIT E 6P ES ON:
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.
❑ 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 stale laws relating to building construction. I acknowledge it is unlawful to alter the substa ce of any official form or docu en of Butte County. I hereby
authorize representatives of Butte County to ente upon the above mentioned property, for inspection pub os s.
^ uJ
Print Name: Y " r \ Signat re:
�I
Date:
;Agent
❑ Owner ❑ Contractor for Owner 6Ag.nt for Contractor
t
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION At: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP042495
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: 08/25/2004 APN: 039-260-029-000
the Business and Professions Code, and my license is in full force and
effect. 1 x,13
License Class : , License Number:
Site Address: 3471 DURHAM DAYTON HWY DUR
Date: `� d�l Contractor.U4
Map Index:
Description: RE -ROOF (52 SQ)
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
Owner: SOUTHAM TODD & KIRSTEN
to its issuance, also requires the applicant for such permit to file a
3471 DURHAM DAYTON
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
95928
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sate (Sec. 7044, Business and Professions
Applicant: G & R ROOFING
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,
2587 NORD AVENUE
provided that such improvements are not intended or offered for
CHICO, CA 95973
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
(530) 894-6537
proving that he or she did not build or improve for the purpose of
sale.).
O I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
Contractor: G & R ROOFING
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.).
2587 NORD AVENUE
❑ I am Exempt under Article 3 of the Business and Professions Code
CHICO, CA 95973
(530) 894-6537
Date: Owner:
License #: 773913
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:
his 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:
Cartier: a -v1
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
j
Policy #: 1 �� (9�
❑ 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 mply with those provisions.
Date:
ApplicaWL
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!) 4:::. q (- 3o
compensation, damages as provided for in Section 3706 of the Labor
Z . 5—v
J I
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is her by issued under the applicable provisions of the Butte County Code ?ncvor
1 hereby affirm that there is a construction lending agency for the
Resolutions to do ork indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
• $ 2S rte—/
Name:
By: c Date:
PERMIT E P kES ON: &' Z S' 0 5
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.
O 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 substa ce of any official form or docu n of Butte County. I hereby
authorize representatives of Butte County to entm upon the above mentioned property for inspection pu os S.
-
Print Name:, vim/ " T \ Signat re :
q�4 t4
Date:
;Agent
0 Owner 0 Contractor for Owner Agent for Contractor
G & R ROOFING
2587 NORD AVE
CHICO, CA 95973-8759
PHONE: 530-894-6537
FAX: 530-345-7143
CELL: 530-518-7760
TO WHOM IT MAY CONCERN:
I, FRANCES E. RIOS, OF G.& R ROOFING GIVE AUTHORITION FOR FLORENCE Q.
BEESON TO PURCHASE PERMIT AND LICENSE FOR G & R ROOFING.
THAN YOU
FRANCES E. RIOS
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
APPLICANT SIGNATURE
For office use only:
blwftl�_11 WE
CONTRACTOR
Name
ur
Address
—�
City
Yes
Sta
APPLICANT SIGNATURE
For office use only:
CONTRACTOR
Name
ur
Address
—�
City
Yes
Sta
Zip
Zips I31-7
Phone q 1 _
3
Fax _ -71
E-mail
State License Number
Lic. # 3 091
ClPs
APPLICANT SIGNATURE
For office use only:
ARCHITECT/ENGINEER
Name
ur
Address
—�
City
Yes
State
Zip
Phone
G_3
J
Fax
E-mail
Map Book
State License Number
APPLICANT SIGNATURE
For office use only:
APPLICANT NAME
NameIt
ur
.Address
—�
City --
Yes
StIN
Zi
Phone (()
"I
G_3
J
Fax'3� 5_ -7
E -mail
Map Book
APPLICANT SIGNATURE
For office use only:
Zoning
Flood Zone
SRA
Yes
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BP p +:z4-75
r -Mr.
LOCATION
AP# o3C-i• Z o o Z9
Property Address c)q7l �UJ"
Cross Street
WORKER'S COMPENSATION
Policy Number Ir
Carrier �1,5fAd
,- L,
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. Footage
❑ 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: 162-11 Amount5:S S • So Bldg
SRA
Receipt #: 40 4 Sheriff
SMIP
Date:s/v+ Other
8/a
3�. • S a Total
a
I��+t�;� .�' F!"" -!•t. �'.�a,��'�d�!'t.•.�,M,r..vr•;!-.*."'�"1�;"t�+,.�i^'���� t�.�',.`,d�' ����Y.tin •,f'•..�:�Z•y�•si•*w.Y-.+'�
LA
Date3-( -`l ✓/ Date
.
� 9"
•
COUNTY OF BUTTE - DEPA2TMENT OF PUBLIC WORKS PERMIT NO./
7 County Center Drive - Oroville• Cal'ornia 95965 - Telephone: 916/538-7541 %
APPLICATIOI AND PERMIT
ASSESSOR PARCEL NUMBER
39-26-29
ZONIR
k0
'
BUILDING PERMIT
OWNER
Earl & Margaret Mun ar
TELEIHONE
94_W8
SQ. FT. OCC.1 BUILDING VALUATION
OWNER'S MAILING ADDRESS j
3471 Durham -Dayton Rd. Durham 95938
CONTRACTOR'S NAME
Artic Aire
TELE ONE
18953330
CONTRACTOR'S MAILING ADDRESS
2838 H . 32 CHico 95926
Fireplace
CONSTRUCTION LENDER
UNKN WN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICEtiE 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
3471 Durham -Dayton Rd., Durham
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
i
PARCEL MAP
I
Water piping
5.00
Each qas water heater or vent
5.00
r USE OF STRUCTURE
SF[N Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
1 5.00 5.00
Building sewer
5.00
Mobile Home J S I G JW I10.00e
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] ;Other ®
Describe work: Remove Split System and install dial _
Pak/Gas/Elec.
Permit Fee
$15.00
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100V OR OR L
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):
^I`�/
ISI 1 am licensed under provisions of Chapt. 9, Div. 3 of th?BuslnesS
and Professions Code and my license is in full force iid effect.
`, G
License No. � Jy q/ 3 Classification I
❑ 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
„forsale. (Sec. 7044)
❑ I', `as the owner, am exclusively contracting with licenseecontract
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and ProfessIons Code
for this reason
NEW CONST. DWELLING OCCUP.&)
OR ADDNS. ( ACC. BLDGS. I
,
2/z�sgft
NEW CONSTR. ULTI.OUTLET
NON•RESID BRANCH CIRC ITS
2.50 ea
POWER APPARATUS.1%)
(SINGLE OUTLET CIR.
Ex. Occup(ouTLETs OR FIXTURES
20@50¢
DAL@30
FIXED APPLNS. OR
EX. Occup. OUTLETS (RESID.) EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. IVirin g
15.00 .00
1 15
Permit Fee
$25.00
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
Q/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.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
1 7.50 7.50
Dual Pak
Cooling
1 11.00 11.00
Hood
3.00
Ventilation
Permit Fee
$28.50
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, costs, and expenses which may in any way accrue
against sai.d.C.Qunty.in consequence of the granting of this permit.
X Date .2 -/� - �/
Signature of Applicant - Owner Contractor Agent ❑
EJLrJ
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 i$
OCC
CONST TYPE
a
TOTAL FEE 68.50
AL
HAz
CUA
PARK
FLo
PAR
PO
HD
Issu
Th;s permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
.-c A f%
D)REE IiS�R OF PU73L1C
�n ��
y t ^ r (�
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
Date
�-
,
Receipt No.
WNITE-O.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
. . �. ..........
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION'AND-PERMIT
ASSESSOR PARCEL NUMBER
39-26-29
ZONING-
A-20
BUILDING PERMIT
OWNER
Earl & Margaret Mun'ar
TELEPHONE
94-2928
SQ. FT. OCC. BUILDING VALUATION
I
OWNER'S MAILING ADDRESS
3471 Durham -Dayton Rd. Durham 95938
CONTRACTOR'S NAME
Artic Aire
TELEPHONE
895-3330
CONTRACTOR'S MAILING ADDRESS
2838 Hwy. 32 CHico 95926
Fireplace
CONSTRUCTION LENDERUNKNOWN
Total Valuation $ ..
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
Durham-Dayton3471
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAMEPARCEL
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 5,00
Building sewer
5.00
Mobile Home -FS-FG-FW
10.00 e
TYPE OF WORK
New ❑ Addition [_1 Remodel ❑ Utilities ❑ Installation❑ Other FC]
Describe work: _ Remove Split System and install dual _
Pak/Gas/Elec. -
Permit Fee
$15.00
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
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.,23y J/ 3 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
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ACDNS. ACC. BLOGS.
2h4Sq ft
NEW CONSTR. MULTI -OUTLET
NO N.R ESID BRANCH CRC., TS
2.50 ea
POWER APPARATUS
SINGLE OUTLET CIR.tr )
Ex. Occup(OUTLETS OR FIXTURES
20 @ 306
9AL@30
D APLNS.
Ex. Occup. outLETS (RESID )REA.)
1 2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 1 9100
Permit Fee
§
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
[i�e-1 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
MECHANICAL PERMIT
FiIIng Fee 10.00
Heating
1 17.50 1 7.50
Dual Pak
Conlin g
1 Ll . 001 11.00
Hood
3,00
Ventilation
permit Fee
§28,50
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 sal unty in consequence of the granting of this permit.
L fir-
%� �"" Date -1 a - 9
Signature of Applicant — Owner ❑ Contractor CV,f 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 $ 68.50
HAZ
I CUA I
PARK
I SCHL
I FLD
PAR
I PD
I HD
Issu
This permit is hereby issued under
sions of the Butte County Code and/or
work icated above for which f
D R.OF P
y
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
s, have been paid.'
WORKS
Date
Receipt No. 83341
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
- COUNTY OF BUTTE - DEPARTMENT,OF- PUBLIC WORKS - BUILDING DIVISION
4 V
7 COUNTY CENTIV ROVILLE, c&L�ORNPA 95965 - TELEPHONE: 916/538-7541
_ WIT -APPLICATION DATA SHEET `
PP
/fin ,� / (V q M• Permit No.
OWNER—.. /�'(y/V � I A. P. No -
Proposed
.Proposed Building UseBuilding 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 ................................... c ..................
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 .................. I...................
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 ...
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 ............
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_ �s.?,�L�Date �Z /
Copy of plans sent Health Dept., Fire Dept., Other Date
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:
Contractor, designer, owner, was advised of above required data. by_phone_ mail 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 hold in . File cabinet AP folder r.
Copy—DPW %N,
COUNTY OF BUTTE -EQ PARTMENT OF'PUBLIC C WORKS PERMIT N0.
7 County Center Drive - Oroville, California 95965 - Telephone: 9161538-7541
_. ,ARPLICATIA AND PERMIT
ASSESSOR PARCEL NUMBER
3 — 621
ZONING
✓ A-0
BUILDING PERMIT f
OWNER
�L ��- M�N���
944 T LEPHONE
Z`/a
S0. FT. OCC. BUILDING VALUATION I
OWNER'S MAILING ADDRESS
CONT A TOR'S NAME��'9�
/��
IY%�/-
TELEPHONE
-33 a
CONTRA TORS MAILING ADDRESS
3 —e-- //k -z) ISJ,2
j
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation
LENDER'S MAILING ADDRESS
Filing Fee -
$ .1000
Permit Fee
$
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
g
BUI NG ADDRESS 7�
Permit fee
$
1-1,4 61 C:�9 3
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
SFDuplex[] Mobilehome❑ Other
sPECIFv
Gas piping system 1 - 5 outlets
5.00 p D
Building sewer5.00
Mobile Home S G W
0.00e
TYPE OF WORK
New Addition [-I Remodel E] Utilities❑ Installation❑ Other,E
Describe work: -bS L -T Sq S ti
AAID /VST L LIA L 6,45 G
Permit Fee
$ Siad
Contractor
ELECTRICAL PERMIT
Filing Fee 1 10.00
Main service 800V OR LESS
100 AMP OR LESS
10.00
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
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
Main service EA. ADD'L 100 AMP
2,50
NEW CONST. DWELLING OCCUPM
OR ADONS. ACC. BLOCS.
, esgft
NEW CONST R. MULTI -OUTLET
NON-RES10 BRANCH CIRC ITS
2.50 ea
�PowER APPARATUS .&)
SINGLE OUTLET CIR.
Ex. OCCU OUTLETS OR FIXTURES
P�
20030t
1.20050t
Ex. Occup. Our ETS D AP(LNS
RESID )REA.)
1 2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 O
Permit Fee
s
- 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
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%
S
LJ^
Cooling//17'0-
/ U (�
Hood
g 00
Ventilation
Permit Fee
S ,
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 consequence of the granting of this permit.
XThis
Date
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 $ ��� SD
HAz
I CUA
PARK
SCHL
FLD
PAR
PD
Ho
I ISSUE
permit is hereby issued under
sions 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-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
W9
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43 objects) ",:10 bytes (Disk free space; 1.98OB)
W9
M
Elizabeth Ann Staples
P. 0. Box 367
Durham, CA 95938
Dear Ms. Stapels:
gutteCountg
LAN D OF NATURAL W E A L T H AND BEAUTY
DEPARTMENT OF PUBLIC WORKS
WILLIAM (Bill) CHEFF, Director
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965
Telephone: (916) 5 538.7266
RONALD D. McELROY
Deputy Director
March 1, 1989
RE: AP 39-26-39 and 29 combined as one
Application for Determination
Pursuant to our letter of February.15, 1989, at the regular meeting
of the Butte County Subdivision Violation Commiteee held on March 1,
1989, the committee granted a Certificate of Compliance for the above -
referenced property combining AP 39-26-29 and 39 into one legal parcel.
There is a fifteen -day appeal period before this Certificate can be
recorded unless you sign and return the enclosed waiver waiving your
right to appeal the committee's.decision.
If you have any questions regarding this matter, please contact this
office.
Very truly yours,
William Cheff
Director of Public'Works
ifl'AA
J hn Mendonsa
Assistant Director
JM/ds
attachment
cc Planning
Environmental Health
Building Department._..