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039-470-015
J.3Y 47-15 + N` JAMES B. DAVIS 1 r: SE cor Lone Pine & Cosby,Chico `. Permit#5824 r80B reroof/SF �� =039-470-015, ,. 05 0078 ` ,HERNANDEZ, SILVIAk =3795 COSBY AVE, CHICO' Cont:OWNER o NEW ELEC PANEL-1. r -t • r , , , •',(, (gip AS ��. - � ,. � �"` _�; � o J I Q f, j r � G ( �O/FFICEE�COPY� Address - `777 t 66313k i6 GAS Meter By EL T ECTRIC ' Meter By Date/4` JOB FINALED-03 Signatur . NOTES RESIDENTIAL . PERMIT NO. —'0397470-_1'5 ^� -^^ 05'0078 HERNANDEZ, SILVIA 3795 COSBY AVE, CHICO *_ r. Cont: OWNER " ' ! • NEW ELEC PANEL a I I n SPECIAL CONDITIONS CHECKED ' SRA BY FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS ' VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER � G ( �O/FFICEE�COPY� Address - `777 t 66313k i6 GAS Meter By EL T ECTRIC ' Meter By Date/4` JOB FINALED-03 Signatur J=OK 0 = Not OK . = Not Readyable MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L'ft. / P Nat. or/ /" L "ft./ P LPG MISCELLANEOUS Date 7. Well Clearance & Disconnect 1. 8. Utility Clearance 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails Date Wood Awn.; Posts- Beams- Rftrs-Connectors Shthg-Frg-Bracing Card B-1 Date Card B-1 Date Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except Ws 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 Date 8. Gas and Electricity Tagged Date 9. Tie Downs -Type -Installation Cert. Date 10. Exits; Insp.-Sketch 1. 11. Cert. of Occupancy 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining Date Elec.; Receptacles and Lighting, Distance-GFI Card B-1 Date Card B-1 Date Elec.; Pool Lighting; 15 Volts-GFI 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 Date 8. Gas and Electricity Tagged Date 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 -Lining 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- Bloc kouts-Wrapped 6. Stemwalls, Garage; Steel- Bloc kouts-Wrapped 6a. Hold Downs and Special Anchors 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 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe; Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 69. 21. Test Tub & Shower, Second Floor -Tub Access 70. 22. Gas Pipe; Sixe & Anchors 71. 23. Fire Sprinkler; Test 72. Elec. Outlets at Wood Panel, Int. & Ext. Date Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance Card B-1 Date Card B-1 Date Elec. Outlets & Receptacles at Kit. Counter Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu c7 Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes O No _ 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector 87. Water Well, Disconnect, Electrical, Plumbing Date 88. Card B-1 Date Card B-1 Date 89. Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Glass Protection 36. A.C. Ducts Insulation & Support Corrections from Previous Inspections 37. Vent Fan, Exhaust above insulation Gas Test -Meters Tagged, Gas -Electric 38. Condensate Drain & Overflow, Size & Grade Water & Sewer Connected -C/O to Grade -HD Approval 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet Energy Compliance Certificate -Other Certificates 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 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 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 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 O Yes _ 83. Following Instld./Drive O Yes O No/Walks O Yes O No/Planters O Yes O No 84. Stucco Brown -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 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: BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVIL'LE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.neAdds 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: License Number: Date: - Contractor. 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 State 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 five hundred dollars ($500).): 1, as owner of the properly, 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 Profdssions Code. The Contractors' Slate 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 :37ofe Business nd Professions Code Date: Owner: / "i WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self -insure .for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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: Carrier: Policy 2� I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 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. PERMIT N.O. BP05007.8 Issued Date: 01/20/2005 APN: 039-470-015-000 Site Address: 3795 COSBY AVE CHI Map Index: Description: install new elec panel Owner: HERNANDEZ, SYLVIA 3795 COSBY AVE CHICO, CA 95928 Applicant: HERNANDEZ, SYLVIA 3795 COSBY AVE CHICO, CA 95928 Contractor: License #: Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: CONSTRUCTION LENDING AGENCY This I hereby affirm that there Is a construction lending agency for the Res performance of the work for which this permit Is issued (Sec 3097 Clv.) Name: By'- Address: iereby%issued-underthe a ice a provisions•of the-8utte•County.C.oda anrt/or do work lea e�abov for Vic fees have been paid. IF ON: ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. . O Notification In accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. O Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge It is unlawful to alter the substance of any official form or document of Suite County. I hereby authorize representatives of Butte ounty to enter upon the ova mentioned property for Inspection purposes. . Print Name: r! ` Signature: Date: ❑ Owner ❑ Contractor Agent for Owner ❑ Agent for Contractor ,oil COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County CenterlDrive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER:�� �� �% L ASSESSOR PARCEL NUMBER Proposed Building Use: �� P �C - Counter Technician: C Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. / ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. ❑ 11. Site plan and business license approval from the City of Biggs. ❑ 12. Letter of intent for non-residential buildings. ❑ 13. Detached Accessory Building Form filled out by the owner. ❑ 14. Hazardous Material Form. ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers ❑ 18. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office ❑ 19. Soils Report and/or Engineered Foundation required. ❑ 20. Erosion Control Plan Required. ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet. ❑ 22. City of Chico Plumbing permit. ❑ 23. California Department of Forestry plan approval ❑ paid. ❑ 24. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _Drainage. ❑ 26. NPDES Form ❑ 27. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 28. Pre -Inspection for required. ❑ 29. Contractor's license information. (Number, Name Style, Classification). ��31. 30. Worker's Compensation Carrier and Policy Nu er. Owner -Builder Verification (_ Given to owner, ailed to owner). ❑ 32. Letter of Signature authorization. ❑ 33. Recorded copy of Agricultural Acknowledgment Statement. ❑ 34. Manufactured home utility clearance. ❑ 35. Existing violations and/or expired permits. ❑ / 36. Deed Restriction. D' 37. �R( Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: Z&AJ S When issued Telephone 1112- 7_32 7 and hold for pickup. I have been informed f the above ' ms and requirements for obtaining a building permit. Applicant: Date: '---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. Original -Applicant COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION... - i 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET00 r� OWNER: ` /AV�i j% �`- ASSESSOR PARCEL NUMBER D / - 7 7O - S Proposed Building Use: P I/c - Counter Technician: Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ - 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs 0 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16: Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ . 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. ❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ /30. Worker's Compensation Carrier and Policy Number .......................................... p 31. Owner -Builder Verification (_ Given to owner, Ailed to owner) ..................... ❑ 32. Letter of Signature authorization ................... ........ ............. ..........................::. ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance...........:................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... 37. Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. 1156her: ❑ 39. Other: A-2ALL-ten / 777dyv-j/?5mV When issued Telephone - and hold for pickup. I have been informed of the above it ms and requirements for obtaining a building permit. Applicant: MY, Date: 1. Index permit ppli ation or ti e he above ms tlmmbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by' ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division 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 "PLEASE PRINT CLEARLY" OWNER Last Name \ Y� Cl First Name i Address City r See'- Zip Sri Z6 Phones _5- 3 4 Fax E-mail APPLICANT SIGNATURE 1 A .=4XC,& 44 For office use only: CONTRACTOR Name v. c Address C s'6V ct v e City Lot # State Zip Phone Address Fax E-mail - S Lic. # Class APPLICANT SIGNATURE 1 A .=4XC,& 44 For office use only: ARCHITECT/ENGINEER Name v. c Address C s'6V ct v e City Lot # state rp Phone Address Fax E-mail - S State Ucense Number APPLICANT SIGNATURE 1 A .=4XC,& 44 For office use only: APPLICANT NAME Name v. c Address C s'6V ct v e City Lot # Ste Zip Ci 597 6 Phone Address Fax 53cs �3 - S E-mail APPLICANT SIGNATURE 1 A .=4XC,& 44 For office use only: Zoning Flood Zone SRA Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BP BIN # LOCATION AN -LA-40— - 0© Property Address 5 Cos City co Cross Street , In e 42 1 n 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 K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of Z Description or Scope of Work: iv&-Kv 67-6---r- 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 Amount: Bldg SRA Receipt #� / ,z Sheriff SMIP Other Date: � �� � �- 2a2i__L_t0tal KtV (-17-U4 Butte County Department of Development Services urr ADMINISTRATION' BUILDING • GIS `PLANNING o �o BUTTE - 0 0 7 County Center Drive COUNTY Oroville,CA 95965 ne JAN 2 0 2005 0-_=�=jo (530) 538-7541 538.2140 Facsimile DEVELOPMENT ( SERVICES U N Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the bi Ider of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state, and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally_or..through their own.. employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, Califomia.95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. i6� Mic el C. Vieirl C.B.O. Ma4ager, Building Inspection NOTE: This Owner -Builder Information is required. by Section 19830 of the California Health and Safety Code. A--rTti : e&YtVS �L tL•�•S,m }S'�.n�'';.`.aiC!.ct.a;i�Y.�".s..k`'e.•v'?�L:.:R.SEt[ :ci1`S `r�nsy �N2O '�F•.r.. Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building pernait. No building permit will be issued until this verification is received. 1. I personally plan to providea mayor labor and material for construction of this proposed property improvement: YESt�] NO[ ]. 2. I HAVE [ HAVE NOT [ ) signed an application for a building permit for the proposed work. / 4 ` 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: _ ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER DATE: _=� u NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 APN: 039-470-015 To Protect the:Security of this Deed of Trust, Trustor Agrees: By the execution and delivery of this Deed of Trust and the note secured hereby, that provisions (1) to (14), inclusive, of the fictitious Deed of Trust recorded in Santa Barbara County and Sonoma County October 18, 1961, and In all other counties October 23, 1961, in the book and at the page of Oficial Records in the office of the county recorder of the county where said property is located, noted below opposite the name of such county, viz: COUNTY BOOK PAGE COUNTY BOOK PAGE COUNTY BOOK PAGE COUNTY BOOK PAGE Alameda 435. 684 Kings 792 833 Place' 895 301 Sierra . 29 335 . Alpine 1 250. lake. 362 39 . • Plumas 151: 5 . Siskiyou.. 468 .181. Amador 104 348 Lassen 171 471 Riverside 3005 523 Solan- 1105 182 Butte 1145 1 Los Angeles T2055 899 Sacramento 4331 62 Sonoma 1851 689 Calaveras 145 152 Madera 810. 170 San Benito 271 383 Stanislaus 1715 456 Colusa 296 617 Marin 1508 339 San Bernardino 5567 61' Sutter 572 297 Contra Costa 3978 47 Mariposa 77 292 San Francisco A332 905 Tehama 401 289 Del Norte 78 414 Mendocino 579 530 San Joaquin 2470 311 Trinity - 93 366 EI Dorado 568 456 Merced 1547 538 San Luis Obispo 1151 12 Tulare 2294 275 Fresno 4626 572 Modoc 184 851 San Mateo 4078 420 Tuolumne 135 47 Glenn 422 184 Mono 52 429 Santa Barbara 1878 , 860 Ventura 2062 386 Humboldt 657 5.27 Monterey 2194 538 Santa Clara 5336 341 Yolo 653 245. Imperial 1091 501 Napa 639 86 Santa Cruz 1431 494 Yuba 334 486 Inyo 147 598 Nevada 305 320 Shasta 684 528 Kern 3427 60 Orange 5889 611 San Diego Series 2 Book 1961, Page 183887 which provisions, identical in all counties, (printed on the attached unrecorded pages) are hereby adopted and incorporated herein and made a part hereof as fully as though set forth herein at length; that Trustor will observe and perform said provisions; and that the references to property, obligations and parties in said provisions shall be construed to refer to the property, obligations, and parties set forth in this Deed of Trust. The undersigned Trustor requests that a copy of any Notice of Default and of any Notice of Sale hereunder be mailed to him at his aridrpss hereinbefore set forth. STATE OF CALIFORNIA COUNTY OF Butte ON December 16, 2004 before me, the undersigned Notary Public personally appeared Silvia Hernandez personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Silvia Hernandez .. --•• JANET R. HERBERT D N COMM. d 1351382 �p NOTARY PUBLIC-CAUFORWA y Q _ COUNTY OF BUTTE w Comm. Expires April 17. 2006 INITIALS FD -221C (Rev. 9/94) SHORT FORM DEED OF TRUST WITH ACCELERATION Page 2 of 4 (deedofta) RECORDING REQUESTED BY: Fidelity National Title Company of California Escrow No.: 04 -216127 -JT Locate No.: CAFNT0958-0958-0002-0000216127 Title No.: 04-216127 When Recorded Mail Document To: James Davis and Denise Stokes APN: 0391470-015 We herewith certify this to be a true and correct copy of the original Fd ' al Title By SPACE ABOVE THIS LINE FOR RECORDER'S USE SHORT FORM DEED OF TRUST AND ASSIGNMENT OF RENTS THIS DEED OF TRUST, made December 9, 2004 , between. Silvia Hernandez, an unmarried woman herein called TRUSTOR, whose address is 3795 Cosby Avenue Chico, CA 959281 Fidelity National Title Company of California, a California corporation, herein called TRUSTEE, and . James Davis, as his sole and separate property and Denice Stokes, as her sole and separate property, each as to an undivided 500/o interest . , herein called BENEFICIARY, WITNESSETH: That Trustor IRREVOCABLY GRANTS, TRANSFERS AND ASSIGNS to TRUSTEE INTRUST, WITH POWER OF SALE, that property. in Butte County, California, described as: Anything herein to the contrary notwithstanding, in the event of a voluntary sale, transfer or conveyance of all or any portion of the property described herein, any indebtedness or obligation due under the Note secured hereby, shall at the option of the holder hereof, immediately become due and payable. TOGETHER WITH the rents, issues and profits thereof, SUBJECT, HOWEVER, to the right, power and authority given to and conferred upon Beneficiary by paragraph (10) of the provisions incorporated herein by reference to collect and apply such rents, issues and profits. For the Purpose of Securing: 1. Performance of each agreement of Trustor incorporated by reference or contained herein. 2. Payment of the indebtedness evidenced by one Promissory Note of even date herewith, and any extension or renewal thereof, in the principal sum of $60,000.00 executed by Trustor in favor of Beneficiary or order. 3. Payment of such further sums as the then record owner of said property hereafter may borrow from Beneficiary, when evidenced by another note (or notes) reciting it is so secured. INITIALS_ FD -221C (Rev. 9/94) SHORT FORM DEED OF TRUST WITH ACCELERATION Page 1 of 4 (deedofta)(09-04) �Z FROM :CHICO BOX•& POSTAL FAX NO. :530+343+3331 Jan. 21 2005 10:11AM P1 RECORDING REQUESTED BYof : National Title Company escrow Hee o4 -216127 -JT Locate tW., CAFNT0958-0958.0002-0000216127 Title Ne.: 04-216127 when Recorded Mall Document and Tax statement To., K Ms. Silvla Hernandez 813 MilAer Ave. Chico, CA 95928 �0QJ4---0m�7QJ94 . Recorded offiRecords I REC FEE 13. to i TAX 187.00 county 1 BUTTE CANDACE J. GRUBBSReco I ' er ROSEMARY DICKSON I Assistant 02a PM 17 -Dec -E004 I Travis I Page i of 3 APN: 039-470.015 SPACE ABOVE THIS UNE FOR TMLUKCKuar. '� GRANT DEED U The undersigned grarttor(s) declare(le) Documentary transfer tax In $287.00 x ] computed on full value of property conveyed, or ] computed on full value less value of liens or encumbrances remaining at time of sale, [ ] Unincorporated Area C11y of Chico, FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, lames Davis, as his sole and separate property and Denloe Stokes, as her sole and seperete property hereby GRANT(S) to Silvia Hernandez, an unmarried woman the following described real property In the City of Chico, County of Butte, State of California: See Exhibit "A" attached DATED: December 9, 2004 STATE OF CALIFORNIA L�9rC COUNTY OF ON Z4-, -a before me, the undersl n_ed_ Notary Publ►c— personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the personnel whose nameN Is/dm subscribed to the within Instrument and acknowledged to me that he/she/Qhey executed the same In his/?W/thir authorized capacity(tar), and that by his/h*/tllelr signature( on the Instrument the personN), or the entity upon behalf of which the person(h acted, executed the Instrument. Witness mt;0 Q Signature8i�� )am Davis ---g-. 0� Signed in Counter -part Denlce Stokes MIKE commlasion # r I 13 swaev Notary PubUC . COtlrornlo Placer County 6MyC0MM.EXPtrq&0ctII.M.i MAIL TAX STATEMENTS AS DIRECTED ABOVE FO -213 (08v 7/96) GRANT DEED (grant)(09-04) ' =a PERMIT NO. 5824-80R PERMIT EXPIRES 11/24/81 OWNER NAMES B. DAVIS CONTR. owner ASSESSOR PARCEL 39-47-15 LOCATION SF cor Lone Pine ,& Cosb - ChiCC Temp. Power Pole— Called PG&E _ Temp. Elec. Service Called PG&E_ Temp. Gas Service _ Cal led PG&/ JOB FIN Signat = OK i = Not OK = Not Applicable MOBILEHOMES MISCELLANEOUS = Not Ready Date MOBILEHOME UTILITIES -.(Plans) OK except H's 1. Zoning Requirements -Setbacks -Easements Date DECKS, COVERS, CARPORTS, ETC. (Pians) OK except p's 1• Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rig.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ /"L"ft./' /"Nat.or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except !1's 1. Zoning Requirements -Setbacks -Easements Card -BI Date Date Card -BI Date POOLS (Plans) OK except N's 1. Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Gas; MH Test -Demand -Valve -Connector 3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 4• Elec.; Receptacles and Lighting; Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Water and Sewer Connected -C/0 to Grade -HD Approval 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater B. Gas and Electricity Tagged 8. Elec.; Grounding; Equip.w/5'-Circulating Equip. -Pool Lghtg. Boxes -Enc losures- Pane lboards-Ins. to Main in Conduit 9. Exits; Insp.-Sketch 10. Cert. of Occupancy 9. Health Department 'Approval 10. Plumb; Cir. Test -Water Supply Test Card B -I Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date J = OK 0 = Not OK t ~ - = Not Applicable RESIDENTIAL (Single and Duplex) = Not Ready Date UNDERFLOOR Plans OK exce t#'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 52. 53. Siding -Nailing -Veneer Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Card -BI Date Date t Card -BI Date Date Card -BI Date FINAL (Plans) OK exce t q's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except p's 14. Water Ht.; Vent -Access -Combustion Air 15. Water Pipe; Test & Anchors -Nail Protection 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 61. 62. Elec. Trim & Subpanel; Breaker Sizes -Labels Stairs & Rails 19. Gas Pipe; Size & Anchors 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except N's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 21. Elec. Receptacles Spacing -Lights &Switches at Doors 70. Plb., Elec. & Mech. Equip. Listed for Location 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 72. Insulation -Foam -Looked in Attic E] Yes 73. Guard Rails & Deck Construction -Post Caps 25. 2 Appliance Circuits in Kitchen &Conductor Size 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 74. 75. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters Dyes []No 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Neutral ❑Yes ❑No 28. Service -Riser Conductors & Ground -Main Disconnect 76. 77. Stucco; Brown -Finish A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 29. Equip. Clearances; Panels-Motors-Mech. Equip. 30. Clothes Closet Light -Shower Light 78. 79. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. Water Well; Disconnect, Electrical, Plumbing Card B -I Date Card -BI Date 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. Ventilation throughout House Card B -I Date Date Card -BI Date MECHANICAL (Permit) OK except H's 31. A.C. Ducts; Insulation & Support 82. Glass Protection 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 85. Water & Sewer Connected -C/O to Grade -HD Approval 32. Vent Fan; Exhaust above Insulation 86. Energy Compliance Certificate -Other Certificates 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date FRAMING 36. Plans OK except q's Sills; Proper Material & Anchors 37. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound _ 38. Bearing Walls over Girders & Floor Nailing 39. Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub / 41. 42. 43. 44. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rf Fireplace Ties or Type A Flue -Fireplace Throat 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions _ 47, Garage Fire Protection Framing (NOTE: An entry must be made each time youvisit jobsite) l COUNTY OF BUTTE - DE�P_ARTIb'ENT OF PUBLIC WORKS RMIT 0. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 U APPLICATION AND PERMIT ASS SSO PARCEL NUMBER cf,/f ZONING J— 00 BUILDING PERMI /�le OWNEA �Gf,"s X TELEPHONE SO. FT. OCC. BUILDING VALUATION o OWNER' MAILIr ADORES } CO TRACTOR'S NAME Q, - TELEPHONE CONTRACTOR'S AILING ADDRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ Fre), o0 ' LENDER'S MAILING ADDRESS Permit Fee $ o ARCHITECT OR ENGINEER A/V10y X, LICENSE NO. Plan Checking Fee ,$ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $2e9l 67o BUILD[ DDRESS PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF Duplex❑ Mobilehome❑ SPECIFY Building sewer 'Other sprinkler system 42.00 TYPE OF WORK New ❑ Addition Remode ❑ Utilities ❑ Installation❑ Other Describe work: OD 1� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 00V OR LESS Main service 600 AMP OR LESS 1 5•0D Main service EA. ADD'L 100 AMP 2.50 NEW CONST.(DWELLING OCCUP OR ADDNS. .& ACC. BLDGS. 20sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR U TI -OUTLET 2,50 ea NON.R ESID BRANCH CIRC ITS NEW CONSTR. NON.RESID, ( SINGLE OUTLET CIR. POWER APPARATUS 9� sD@tea Ex. OCCUp(o.UTLETS OR FIXTURES BAL@6 FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 3.00 WORKMEN'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should.you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 2.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot 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 c equence of the granting of this permit. XDate �� Sig ure of Applicant - Owner Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structuress 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE $ 0 v OCCUP. GROUP TYPE OF CONST. PARCEL PD I HD I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which RECTOR OF PUBLIC PERMIT t the applicable provi- resolutions to do fees have been paid. WORKS o - 1over Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD-APPLI CANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA. 95965 OWNER -BUILDER VERIF ICAT ION , Attention Property Owner: r Phone: 916-534-4541.' An "owner -builder" building permit has been applied for in your name and bearing your signature. , Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and -issuing your build- ing permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no)" 2. I (have/have not) signed an application for a building permit for the propose work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No., 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following , persons to provide the work indicated:, Name Address Phone Type of Work S igned : Property Owner Social Security ber Date NOTE: This Owner -Builder Verification is sent to you as required'by Sections 19831 and 19832 of .the California Health'and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit.