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Home My WebLink About040-260-005(C ._, —1 Butte County Department of Development Services ur naEn NOTES 7 County Center Drive, Oroville, CA 95965 (530) 538-7601 www,buttecounty.n@Vdds •cOp'• 1 RESIDENTIAL o--740-665 APN: O Permit No. Owner. Site Address: J V D Sa -5/0 Contractor. Type of Permit: 22 OFFICE COPY Address L-0— em GAS Meter ByDate ELECTR Meter By Date CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: •=OK n = mm nuc MANUFACTURED HOMES MISCELLANEOUS - DATE I Lj PERMANENT FOUNDATIONSOFTSET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FalUC/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Dimes-Grnd 'Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap : Nat O or LPO Inch Sz Ft Lngth 7 Blckng; SzSpaclng-Marriage Llne 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test -Crossovers -Breakers -Cures 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs O Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/insignia Numbers Serial Numbers '_DATE D E C K S'C O V E R S'C A R P O R T S •GARAGE S 1 ZoningSetbacks-Easements 2 Ftgs; SailsSz•DpthSpacing-CnnctrsSteel 3 Decks, Girders/Jotsts-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-RRrs-CnnctmShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-AnchrsStuds-Rftrs Trusses 9 Siding; Nailing VengerStucco-Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls 4 00 DATE 113OOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Reptcls/Wng; Distance-GFI 5 Elec Pool Lting; 15 volts-GFI 6 Elec.Enclsrs; Conduit Entries Terminals -Listed 7'Elec Bonding; Metal w/5'-Drcitng Egp-Htr 8 Elec Gmdng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes-Endlsrs-pnlboaidsansultn to Main Conduit 9 Health Dept App'M 10 'Pimb; Cir Test-Wtr Supply Test 11 Lt Niche , 12 Enolsr, Fencing -Alarms 13 Bonding, Diving board or Slide 4P d d$ Oil or mss' dr �lip Pool Drawing RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR DATE IPLUMBING I comng-,:iemacKs-Casements-rrooaslope 2 Ftg Main; Soils-Elec Gmd Ftg Dpth 3 Ftg Garage; SoilsSteel-Elec Gmd Ftg Dpth 4 Ftg Parches/Decks; Soils -Steel Ftg Dpth 5 Stemwalls Main; Steel-Blockouts-Wrapped 6 Stemwalls Garage; Steel-Blockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgIUService Test 12• Elec Undrgmd 13 Plenums & Ducts; Clrne-MaterialSupportansultn 14 GirdersSlits-Anchr Bolts-Joists-Vnts-Cripples 15 Ace & VnUtn 16 Insulation Ord 0� DATE JFRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Wails over Girders.4 flr Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops, Furred CeilingsStairs-Chasers-Tubs 22 Headers &.BeamsSi &'Bearing' 23 Hangers -Post Caps-Anchrs-Cnnctns 24 Ceiling Jolst-IMTies-Purlin-Roof Brac-TnusShthg 25 Frple Ties' or Type A FIue=FrPlc Throat Cime 26 Attic Act; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctri Framing -RC Channel 29 Prprty Line Firewall & Opngs' 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm4Use-Run4Landing-Fire Prtctn 32 Plywd on Roof Ovrhng Attic Vnts-Rftr Outrgrs 33 Siding -Nailing Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Ace 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace IntiExt Wall pnls 38 Insultn-W ails -Ceilings 39 Infiltration -Walls -W ndws DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndetrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Gmd made up w/Meth Fstnrs 45 Gmdng Electrode Bond Gas & Wtr 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz , Q CU or ❑ AL AC Wire Sz ya ❑ CU or ❑AL 48 Range Clic . Q CU or Q AL Oven Circ ea Q CU or FJ AL Insulated Neutral ❑Yes 0 N 49 Service -Riser Cndctrs & Gmd Main Dscnnet 50 Eqp Clrncs pnls-Motors-Meth Eqp 51 Clothes Closet LtShwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr.Nail Prtctn 56 Shwr Pan; Test, Fust fir -Tub Ace 57 Test Tub & Shwr, 2nd fir - Tub Ace 58 Gas Pipe; Sz & Anchrs 59 Fire Sprinkler; Test 60 Yard Gas.Piping DATE MECHANICAL 61 AC Ducts Insults & Support 62 Vent Fan, Exhaust abv Insulin 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Ace & Pitfrm if Furnace in attic o$ aT 4e s' DATE IFINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Clmc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Meth Prtctn 69 Bedroom Exiting 70 GFI A Bath Fxtrs & Tub Ace -Spa 71 GFI Are Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, Clmc-Hearth 75 Elec Outlets at Wood Pnl, int & Ext 76 Ktchn, Fxtr & Appinc; Gmd Air -Gap -Cooking Clmc 77 Elec Outlets & Rcptcls ai Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct in Garage -Damper. 80 Wtr Htr, Vnts-ClmcCom Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Pimb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Cirnc Dmge Planters Q Yes Q No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Pimb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Clmc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgmd 92 Vntltn thru House 93 Glass Prtctn 94 Corrections from previous Irispctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler 4 pis 4 �y BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netldds PERMIT NO. BP061760 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: 07/21/2006 APN • 040-260-005-000 the Business and Professions Code, and my license is in full force and effect. (� — License Class : License Number: O ✓1070 51-1z/Lp �`�' ANG Site Address: S ' Dale: 0 Contractor. Map Index: Description: ELECTRIC FOR AT & T CABINET eSCrI p 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: AT & T 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).): ❑ 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: SIERRA ENGINEERING COMPANY, INC pP 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, 1201 WEST WIND DR provided that such improvements are not intended or offered for CHICO, CA sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 95926 proving that he or she did not build or improve for the purpose of 530-521-6308 sale.). ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed Contractor: SIERRA ENGINEERING COMPANY, INC pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code 1201 WEST WIND DR CHICO, CA Date: Owner: 95926 ' 530-521-6308 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for License #: 836700 workers' compensation, as provided for by Section 3700 of the - Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance carrier a d policy number are: Carrier: Policy #: Total Square Ft: 0 S. F. ❑ I certify that in the performance of the work for which this permit is Valuation: $0.00 issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. �� h � U Date: - Applicant: WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. • CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the This permit is hereby issued under the applicable provisions of the Bette County Coda ?nNOr Resoluti n de.work • icat ve for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) BY Date: . 71,2tln 6, Name: PERMIT EXPIRES ON: Address: ate ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly aup3okized 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 r document of Butte County. 1 hereby authorize representatives of ButteCountyto enter upon the above mentioned property for inspection pu JAM is l'L-( S � ivv� Print Name: ' 1 o Signature: Date: 0 owner Contractor ❑ Agent for Owner ❑ Agent for Contractor P l BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netldds PERMIT NO. BP061760 . 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: 07/21/2006 APN: 040-260-005-000 the Business and Professions Code, and my license is in full force and L, License Class: License Number: �.np74b Site Address: UjIS Date: �% 0 Contractor. 51"d;N`x' CO-�N� Map Index: �C Description: ELECTRIC FOR AT & T CABINET 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: AT & T 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).): ❑ 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: SIERRA ENGINEERING COMPANY, INC PP 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, 1201 WEST WIND DR provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one CHICO, CA year of completion, the owner -builder will have the burden of 95926 proving that he or she did not build or improve for the purpose of 530-521-6308 sale.). ❑ 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 not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed ' Contractor: SIERRA ENGINEERING COMPANY, INC pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code 1201 WEST WIND DR CHICO, CA Date: Owner: 95926 530-521-6308 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 License #: 836700 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation Engineer: insurance carrier a d policy number are: Carrier: Policy u: Total Square Ft: 0 S. F. ❑ I certify that in the performance of the work for which this permit is Valuation: $0.00 issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: - WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Coda 2ndlor I hereby affirm that there is a construction lending agency for the Resoluti n do, work ' icat ve for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) p`/ Name: By: Date: [[ �t Address: PERMIT EXPIRES ON: ate ,11 ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly au ized 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 orm r document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection pu is i—Ge Print Name: 1 r Signature: Date: 7 I21 bin ❑ Owner Contractor 0 Agent for Owner 0 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last NameA5944��„ L Tf e Cr c irst Name Address CityD&O 1/1 L[. State Zipf,SF�� Phone S3 ?& Fax E-mail CONTRACTOR Name �tl�hR.l� �Il fti t;�Yz-InIC� Address. 2m t >✓� �� l �� h Ci city G�-\ c o City Stat Zip" Phone SZ X30 g Phone Fax S30 J;FL/-)y`/3 E-mail @ E-mail Lic. # Class t4Z1?Ke_r Irl APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail A LICANT SIGNATURE X For WE use only: Zoning Pro erty Address j, f Due — &12 /477- RD �rrU 5 O OA 20 Flood Zone C oss Street -P6(A44A,-4 SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BP 0&' BIN # PROJECT LOCATION AP# O� �Poo� � S Pro erty Address j, f Due — &12 /477- RD �rrU 5 O OA 20 City 1 Aq414AWA C oss Street -P6(A44A,-4 WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: G2 - IIV 5, r -o R— ELtJ %a T t� I Neif Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. 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. Page 1 of 2 Received by: Amount: . Bldg Receipt #: 4S 30% Date: _7 ;q 6 SRA Sheriff SMIP Other S Total REV 8-12-05 . -4 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan'review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public.Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. O 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSSUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 ENCROACHMENT PERMIT County of Butte Department of Public Works 7 Count Center Drive Oroville, CA 95965 Phone (530) 538-7157 Ext. 2016 Fax: (530) 538-4356 Download Forms: www.buttecounty.net/publicworks/forms.htm] NOTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE Phone 530 538-7157 Ext. 2016 Permit Number os T District Z. APPLICATION I / WE, the undersigned, hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads and highways, all in accordance with County ordinances and general laws. All information except signature must be typed or legibly rinted. 1. Applicant's Name: MARK 5. HOOK (AGENT FOR OF SBC) Ia. Company Name: 515C CALIFORNIA 2. Address: 2540 CACTUS AVE., CHICO, CA 95973 513C JOB # 5553387 3. Phone: (530) 894-2537 4. Assessor's Parcel Number: 040-026-005 5. Location of Work to be Done W5 OF LOTT ROAD OFF OF DURHAM PENTZ ROAD, SEE ATTACHED OWG5 Tl, El, E2 AND E3. 6. Applicant's Signature MARK 5. HOOK 7. Date: June 1.4, 2005 CONTRACTOR'S INFORMATION 8. Contractor's Name TO BE DETERMINED IN BID PROCESS 9. Address 10. Phone: 11. Fax: 12. Contractor's License Number. 13. Certificate of Insurance: Yes ❑ No: ❑ 14. Contractor's Signature: 14a. Date Signed: 15. Authorized Agent: TYPE OF WORK TO BE DONE 16. Please Check: Curb: ❑ Gutter: ❑ Sidewalk: ❑ 17. Driveway (List Type): 18. Other. TRENCHING IN DIRT, PLACING 513C ELECT. CABINET. PERMIT GRANTED In compliance with the above request, and subject to all terms, conditions (including those on page 2 of this permit form) and special conditions written below, ertnission is hereby granted. 19. Conditions e� eA0 q e e ✓' Q ri ;d -e 6/11-1 VO a Ca dic r, e�e ® r0 lef r o rr! e P r 0 X41 G nd v, is 3 10 '' d ('a 1 7 a a e O -S P Un round Service Alert U.S.A. must be notified two working days prior to any a cavation. 800-227-2600 20. VAII work shall conform to accompanying: Detail ❑ Plans Special Conditions ❑ 21. Date Issued Q „ - 22. Expiration Date: 18. V LO 23 Surety: Mike Crump, Director of Public Works By: "Note: If permits are faxed to any number besides (530) 538-4356, they can be de}ayed up to one week. Page I of 2 General Conditions — See Page 2