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HomeMy WebLinkAbout039-560-025,039-56 0 025 93 2016 E 'BARGER,r ARL NE ` 365.ROSE AVE, CHICO CONTR: FRANK AZEVEDO MOVE ELEC SERV/MH /� 9 039-560-025 PERMIT#96-1873 BORGES, Arline 365 Rose Ave., Chico Gas Stove & Line/SF i ;5'- c7i 611 �� ® � �;," ; � �i 0..4 0 Cf: it<;w,-'Pf�,�,.�`�.`v"�"�3.,•**gip I 039-560-025 PERMIT#96-1873 BORGES, Arline 365 Rose Ave., Chico Gas Stove &.Line/SF .- - gam-./'? r } OFFICE COPY i Address GAS Meter By ELECTRIC Date ** Meter By Date Q X COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION PERMS NO. 7 -County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 _ APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 039-560-025 ZONING BUILDING PERMIT OWNER Al=L , E BORGES TELEPHONE 342-5190 SQ. FT. OCC. BUILDING VALUATION OWNERS MAKING ADDRESS :3b5 NOSE AYE.,= CHICO CA 95928-9625 CONTRACTOR'S NAME P,O*,i DAU11MR TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Fling Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS 365 ROSE AVE. CHICO PERMITFEE $ PLUMBINGPERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP Solar or heat pump Water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SFDuplex ❑ Mobilehome ❑ Other �: SPECIFY Jr. Each gas water heater or vent 15.00 15.00 Gas piping system 1 - 5 outlets 15.00 15.00 Building sewer 15.00 TYPE OF WORK -4 New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other. Describe Work: GAS STOVE Lite TINE a Mobile Home S G W+'- 920.00 PERMITFEE $ 30.00 Contractor ELECTRICAL PERMITFilin Fee 20.00 Main Service EOOV OR LESS ( zooA 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, 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: ❑ 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. ❑' 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 NEW CONST. OWELLING OCCUP. OR ADDNS. ( , ACC. BLDS. ) So. 3.50 FT. NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 WER (3Fs NGLE OU LETTUS C R. ) Ex. Occup. (OUTLET OR FIXTURES BA2L Q 1.500 00 Ex. Occup. OUTLETS (RES D.OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE S 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. ❑ 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 MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor 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, 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. X'_i .�; .,�? " ' ^+ ______ Date - 7 _ Signature of Applicant - 13 Owner ❑ Contractor ❑ 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 $ occ CONST. TYPE TOTAL FEE $ 50.00 HAZ. I D. FEES IMP FLOOD CDF PARCEL PD HD SSU This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. I "/� •" By " r ✓�'` �. Date / PERMITEXPIRESON� / I(Date) Receipt No. 1707,3 �Z— ' WHITE-D.D.S.-B.D. • CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Ia! X COUNTY OF BUTTE -DEPARTMENT OF BEVELbPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT 96 -/A7 3 ASSESSOR PARCEL NUMBER 039-560-025 ZONING BUILDING PERMIT OWNER ARLINE BORGES TELEPHONE 342-5190 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 365 ROSE AEE. NXX CHICO CA' 95928-9625 CONTRACTOR'S NAME RON BAULMER TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNIwOWN Total Valuation --T$ Filing Fee $ 20.00 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 $ BUILDINGADDRESS 365 ROSE AVE. CHICO PERMITFEE _ PLUMBINGPERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF tXX Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 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 n Describe Work: GAS STOVE 9 LINE Mobile Home S G W @20.00 PERMITFEE $ 50.00 Contractor ELECTRICAL PERMIT Filina Fee 20:00 Main Service EOeV OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO l000A ) 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 in full force and effect. License Class Lic. No. 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 6ompensation, 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 NEW CONST. DWELLING OCCUP. OR ACDNS. ( 8 ACC. BLDS. ) SO. 3.50 FT. NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 POWER APPARATUS ( d SINGLE OUTLET CIR. ) Ex. Occup. (OUTLET OR FIXTURES) BAL @ 1•0so0 PPLNS. Ex. Occup. (GFIXEEDrs PES D.OEA) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE _ Contractor 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 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 MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor 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.) l!r 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 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 —��--- Signature of Applica Owner ❑ Contractor ❑ 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 $ 50.00 HAZ. I D. FEES I IMP I FLOOD CDF PARCEL PD HD ISSU This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have B- PERMITEXPIRESON 8 applicable provisions Resolutions to do work been paid. Date 411b 9 (Date) Receipt No. ZO2 3 2Z WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT � r,1w "_.'.� wM.iLrt��1'!�' �C: '�'�. twr-' -nv--,..lw•.• r ve-i;, 5�7-la ti'N47`4� twy,-. .:-rr:I'v t.n�. COUNTYOF BUTTE - DEPARTMENTOF DEQ" PMENTSERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATASHEET i OWNER �.c ,O A. P. No 039 - S6o -o Z5 '/,�-` Proposed Building Use F C-tj `� Building Inspector (/ Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted. . 2. Plot plans, 3/4 sets, signed by preparer of -plans. ......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting _documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ .......................................... 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . ......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development.about (A) Improvements (B) Drainage. ....... . 19. Driveway permit (construction approval required prior to occupancy). . . u" `64°�20. Pre -inspection for required. to Bu;;d;ny Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access. ........' :............ :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . .............. 31. Existing violations/expired permits . ............................ �...,......,. 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: X_k4ail to owner. Mail to contractor. Telephone and hold for pickup at - office. Deliver with inspector. Other Parcel Creation L? Acreage Applicant -17 Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE 31, BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916)•538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 ) CORRECTION NOTIOE 1 PERMIT 'N0. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify 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. (; A�6 T951 'ekz'4'0 /o M'/tee. tks dti �ive� v ea-� , Date �(�--� �—C((o Inspector W— REV 10192 COUNTY OF BUTTE BUILDING DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA (916) 872-6307 CORRECTION NOTICE 30z OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify 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. f�iloc.r� � (�S/ �2 /�fw Gii✓Pc, az7 - Y+ i` Date Inspector rr REV 10/92 a Q . 4 it , -56-0-025 ` BARGER, ARLINE 93-2016 E 365 ROSE AVE, CHICO CONTR: FRANK AZEVEDO MOVE ELEC SERV/MH p� �f OFFICE COPY Address 3c05 Koss A U P` GAS Meter By Date ELECTRIC ��y1 Meter By �Date Y COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7441 moi_. �f,/� APPLICATION,ANI) PERMIT ASSESSO PA CEL NUMBER 0 9-50-025 ZONING 1 BUILDING PERMIT OWNEArlene C. Barger jP" SQ. FT. OCC. BUILDING VALUATION OWNE3 J Rose A"a.,5 Chico 95928 CONT$Aanr Aievedo, Jr• CRS 1800735 T -"iii ' CONT2329'a irl L�t reet,ES(ttico 95928 1 Fireplace P CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee Energy Plan Checking Fee A$ $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS I Permit fee $ PLUMBING PERMIT Filing Fee 15.00 365 Rolle Ave., Chico + Each Trap 5.00 ;. Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEj MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex[] Mobilehomep Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 1 5.00 TYPE OF WORK New J Addition, :; Remodel❑ Utilities❑ Installation C, ther EX Describe work: Relocate Existing FFiectrie Serviiie_ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200A OR LESS 18.50 F8.35 Main service 200A TO 1000A> 37.50 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 an J 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 intendedo� offered for sale. (Sec. 7044) a ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST./ DWELLING OCCUP.&\ OR ADONS. ( ACC. BLDGS. // 3.6$sq.ft. NEWCONSTR ULTI.OUTLET NON •RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS &) (SINGLE OUTLET CIR, I Ex. Occup(OUTLETS OR FIXTURES 20 76d AL 4F;A FIXED APPLNS. OR Ex. Occup. OUTLETS (RE510.) EA.) 3.00 1. Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 1 15.00 15.00 F`�re—lnspectiori 1 20.00 20.00 Permit Fee s68.50 Contractor — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 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. MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 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. X __ C r n t " Date J 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 S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE • 50 HAz 1 DFEES I IMP I FLOOD COF PARCEL I PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees D E T F UBLIC B [' "�1� _L, Y PERMIT EXPIRES FD5 applicable provi- resolutions to do have been paid.(� WORKS ate i Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 !. 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE i��2c��s N�-v✓ OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify 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. W N -S V, 9- C, A 1Z Ac E- T �� ►1 � 5 E c 6, - R- - '2!7z-1--�' c A"'Z R- C-7-- 2J\1,N'N 70 '%Q9- 10EfZ Date Inspector REV 10/92 COUNTY OF BUTTE - DEPARTMENT OF PUB I W S PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telepho 1 ,`53 -7541 _ APPLICATION AND PERMIT vk–J ASSESSO PARCEL NUMBER 039-560-025 ZONING BUILDING PERMIT OWNER Arlene C. Barger TELEPHONE 342-5190 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 365 Rose Ave., Chico 95928 CONTRACTOR'S Azevedo, Jr. CRS 1800735 T95~1� CONTRACTOR'S MAILING ADDRESS 2329 Fair Street, Chico 95928 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 15.00 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 15.00 365 Rose Ave., Chico Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome® Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New u Addition Ej Remodel Ci Utilities ❑ Installation E] Other [ Describe work: ]Rpl nr-at(- Fxi cti ng Electric Service _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 1 18.50 18.50 Main service 200A TO 1000A) 37.50 CONTRACTORS LICENSE LAW I declare under penalty of p y perjury y (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 CONST./ DWELLING OCCUPM OR ACDNS. (ACC. BLDGS. 3.64sq.ft. NEW CONST R.MULTI-OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS &) (SINGLE OUTLET CIR. ) Ex. OCCup(OUTLETS OR FIXTURES 20 76d Ex. OCCUp. OUTLETS ((RESID )FIXED APPLNS. REA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 15.00 0 20.00 Permit Fee $ 68.50 Contractor — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 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 consequence of the granting of this permit. G X Date 6 –.A?– 7 _5 Signature of Applicant — OwnerVI Contractor E]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 S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ 68.50 HAz I DFEES I IMP I FLOOo I CDF I PARCEL I PD HD IssuE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DI T F UBLIC By PERMIT EXPIRES-0-aW-- ro applicable provi- resolutions to do have been paid. WORKS ate % k?/ n 141127 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT ",.^�s ,yy„y..y{+rs•.Y,Jn� !'-�a,�y7+^4'jf`Y'�t6...J""'x��n-'jn� y�`r.,.K ^c--... -,�.ijV ...._... .. COUNTY OF BUTTE - DEPARTMENTOF-DEV�I-OPMENTSE,ft ES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TE ON (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER A. P. No. Proposed Building Use 19 Building Inspector LDate (,-Q13 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ..................................... . 2. Plot plans, 3/4 sets, signed by preparer of plans . ......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ....... .................................... . 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ....................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .. . 9. Mobilehome data and manufacturer's installation instructions; 2 sets. ............ 10. Fees of $.......................................... ` 11. Impact fees as shown on attached schedule. ............................. . 12. California Department of Forestry plan approval/fees......................... 13. Flood elevation letter (100 year flood) by California Engineer ................... 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit . ......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ......... 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. ... f 20. Pre -inspection fo( Q1�c required. .. a ";I�e sp� aca� ll IF 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . ...................:...... 23. Owner -Builder Verification (Given to owner , Mail to owner ............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ....................................... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed Panel (B) Parcel meets zoning area and frontage requirements. .'............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ................................................. . 33. ' -34. When you issue the permit, process as follows:_ Mail to owner.' Mail to contractor. 0 Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Z��%rt�'� C IJ Date g' Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date _ Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: 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 _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION 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 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 ( es)or no) 2. Ihave have not) ��.,o signed an application for a building permit for t e proposed 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: NameAz AAddress Phone Type of Work Sign ed : / C, Property Owner (�itl/�1-tp Social Security Number - Date " Q, l ?5 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. BUTTE COUNTY DEVELOPMENT SERVI • Ptd Cempi-arnt- Date: �a O A . P . # ( 5(0 - Owner: -i�J(4i{�Q �.p Zoning: Address: ���05 0� 0A.4- Supervisorial/ District: Taken By: Low_ . Location: VIOLATION TYPE: BUILDING HEALTH PLANNING C9MPBAr1qT? ii,- 10PA V-C� CAUTION• Yes No PERMIT HISTORY ON FILE: NONE AS FOLLOWS: FIELD INFORMATION: TENANT: Description of Violation: Address: + OTHER COMMENTS: Approximate Building/Mobile Home Size: Approximate Building/Mobile Home Age: Under Construction Built by/for: _ Present Owner Previous Owner it Occupied Has Power _� Has Gas ,�L Has Sanitation Facilities Written Notice Given & Attached Person Contacted Describe Action Taken: t s ACTION RECOMMENDED: i Information Only, File Hold for Days 30 Day Letter Complaint Unfounded 10 Day Letter _ Other By: Date: COMPLAINANT: ADDRESS: PHONE NUMBER: I OTHER COMMENTS'•