HomeMy WebLinkAbout042-090-027--'SAYLES,- Paul. _ -�--99-66B_
042-090-027 OS -1838 .56-66P
SAYLES, PAUL D 178-66E
2803 HWY 32, CHICO
Cont: MCCLELLAND AIR w�s Hwy. 32 app. tel' mi. N. Kennedy Ave,
REPLACE SPLIT A/C SYS CONTR: - CLEMENS CONSTAUCTION CO. , Chid
(new.sin le family) 3r) I O
G
Frr
NOTES + VRESIDENTIAL
;PERMIT NO. _r 042-090-027` _ _05-1832
SAYLES, PAUL
2803 HWY 32, CHICO
Cont: MCCLELLAND AIR
REPLACE SPLIT A/C SYS
f
f
1
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
i
f�
Nt.
JOB FINALED (Date) Of,(05
µ_
' Signature
CHECKED II
BY
J=OK
0= Not OK
_ = Not Applicable
. =Nat Ready
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-Gmd-/ /Amp -Concrete .
6. Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or/ /" L "ftl P LPG
7. Well Clearance & Disconnect
8. Utility Clearance
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
Date
1. Zoning Requirements -Setbacks -Easements
Date
2. Footings; Size -Spacing -Marriage Line
1 Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert of Occupancy
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
Date
Cana B-1 Date Card B-1
Date
Cana B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
Date
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Blocking
4. Gas; MH Test -Demand -Valve
5. Electricity; MH Test "
6. Water, MH Test
7. Water and Sewer Connected
8. Gas and Electricity Tagged
9. Exits
10. License Decals
11. Verify #'s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
)ate
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
S. 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 Voles-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-Panelboards-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
'=OK
= Not OK
Not Applicable
= Not Ready
RESIDENTIAL (Single & Duplex)
)ate UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Gmd.-/ /" Ftg. Depth
3.Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/0 -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
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 AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdnn. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One T -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 -Softs
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 0 Yes
83. Following InstldJDrive 0 Yes 0 No/Walks 0 Yes 0 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. Fre 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:
Date
Card B-1 Date Card B-1
Date
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
21.Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler, Test
Date
Card B-1 Date Card B-1
Date
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 or Al
31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI
Insulated Neutral O Yes O No
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels -Motors -Meth. Equip.
34. Clothes Closet Light -Shower Light -Spa Light
35. Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
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 AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdnn. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One T -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 -Softs
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 0 Yes
83. Following InstldJDrive 0 Yes 0 No/Walks 0 Yes 0 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. Fre 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:
m.:;v'!�'.S�•Y.�if��i"�is-7C.il3is�a:.'�i%t`��..•ri`-`'�.r -�..i-+s.s.`+i,,,`.�•�g:.D.�Fi"k^crV�s^.a�.::.L�.'.Ji�is�i:.
. COUNTY OF BUTTE
BUILDING DIVISION r
DEPARTMENT OF DEVELOPMENT SERVICES
7 County Center Drive - Oroville, CA - (530) 538-7541
CORRECTION NOTICE
��� i� 5 mss- ����
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 -call for re -inspection when correction of
work is completed. If you have any questions pertaining to this matter, or need additional
explan ion, please contact the Building Inspector as.indicated below.
{ i -
Al
Date ` Inspector �1 .�
REV 4/05
FOR RE-INSPECTIOIV.CALL:' 538-7636 OR 891-2834 _
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BPO51838
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: 07/13/2005 APN: 042-090-027-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: - U License Number: l
c�
Site Address: 2803 HWY 32 CHI
Date: (� Contractor: 1"I e cI, �e--
Map Index:
Description: replace split a/c heat system
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Slate 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: SAYLES PAUL M & ANNA L
to its issuance, also requires the applicant for such permit to file a
2803 HWY 32
signed statement that he or she is licensed pursuant to the provisions of
CHICO CA
the Contractor's Stale License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
95926
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: MCCLELLAND AIR CONDITIONING, 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,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
801 MARAUDER ST.
year of completion, the owner -builder will have the burden of
CHICO, CA 95973
proving that he or she did not build or improve for the purpose of
(530) 891-6202
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: MCCLELLAND AIR CONDITIONING, INC
pursuant to the Contractors' State License Law.).
O 1 am Exempt under Article 3 of the Business and Professions Code
801 MARAUDER ST.
Date: Owner:
CHICO, CA 95973
(530) 891-6202
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 #: 345121
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 insurance,
workers' compensation 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 carrierandpolicy number are:
Carrier:
7/
Policy At:
Total Square Ft: 0 S. F.
❑ 1 certify that in the performance of the work for which this permit is
issued, I in
Valuation: $0.00
shall not employ any person 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.
q �7
Date:
/
Applicant:
WARNING: Failure to seal e'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 her 0y—is- u and a app cable provisions of the Butte County Code enrVor
1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Resolutions to o work 1 Ica d above for hic 4ees have been paid.
�, '7-1 3 —Q
Name:
By: Date.
PERMIT EXPIRES ON:
Address:
Date
I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
r handling and use of hazardous materials.
O Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
1 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 Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection pure s.
'� �CS
Print Name: •./L4 l 'e— v ti Signature:
Date: ' ' 1`3
.❑ Owner ❑ Contractor Agent for Owner ❑ Agent for Contractor
1
BUTTE COUNTY
DEPARTMENT -OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE M (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.netldds
PERMIT NO.
BPO51838
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: 07/13/2005 APN: 042-090-027-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: - iJ License Number: ��la
Site Address: 2803 HWY 32 CHI
Date: �� (i✓ Contractor: /�cCC��/ !�
Map Index:
Description: replace split a/c heat system
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: SAYLES PAUL M & ANNA L
to its issuance, also requires the applicant for such permit to file a
2803 HWY 32
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
95926
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: MCCLELLAND AIR CONDITIONING, INC
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
801 MARAUDER ST.
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
CHICO, CA 95973
proving that he or she did not build or improve for the purpose of
(530) 891-6202
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: MCCLELLAND AIR CONDITIONING, INC
pursuant the Contractors' State License Law.).
Ito
O 1 am Exempt under Article 3 of the Business and Professions Code
801 MARAUDER ST.
Date: owner:
CHICO, CA 95973
(530) 891-6202
WORKERS' COMPENSATION DECLARATION
1 herebyaffirm under penalty of perjury one of the following declarations:
y
❑ 1 have and will maintain a certificate of consent to self -insure for
t
License M 345121
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
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 and policy number are:
�7-4 7-L°.-
Carrier: d ZM/ C
G O % /
Policy #:.
Total Square Ft: 0 S. F.
❑
1 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, I shall
forthwith comply with those provisions.
f
Date: C 3 '
I//��
Applicant:
/ I
/
WARNING: Failure to se a 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 her y issue un a app cable provisions of the Butte County Code ?nrvor
I hereby affirm that there is a construction lending agency for the
performance of the work for which this is issued (Sec 3097 Civ.)
Resolutions to o work i ca d above for hic ees have been paid.
`r7-1 �Q
permit
Name:
BY Date: /
PERMIT `%,
Address:
EXPIRES ON:
Dale r
I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owriedt or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance'of any official form or document of Butte County. I hereby
authorize representatives of Butte County to enter the above mentioned property for inspection pure s.
)upon
t✓' 1 �l/1T� S d,,,,-,
Print Name:/�Pi / Signature: ,12,.
Date: J r'—
0 Owner O Contractor t, Agent for Owner 13 Agent for Contractor
BUTTE COUNTY PERIIZIT
DEPARTMENT'OF DEVELOPMENT SERVICES NO.
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE M (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION BIN #
"PLEASE PRINT CLEARLY"
APPLICANT NAME
Name
Address McClelland Air COnd. Inc
City Slate
Zip
Phone Fax
E-mail
APPLICANT SIGNATURE
X a..�
For office use
Zoning
Occ.
I Planner
LOCATION
OWNER
Last Name SAY
Cit
irst,N}�e
Address
Address
City 4f C�
Carrier
State Fund
,
#Fax
Zip %S
Phone
State CA
E-mail
891-6202
APPLICANT NAME
Name
Address McClelland Air COnd. Inc
City Slate
Zip
Phone Fax
E-mail
APPLICANT SIGNATURE
X a..�
For office use
Zoning
Occ.
I Planner
LOCATION
CONTRACTOR
Name
Cit
Cross Street
M Air ond.Inc
Address
Policy Number
00471
Carrier
State Fund
801 Maruader Street
City
Chico
State CA
Zip 95973
Phone
891-6202
Fax 891-5137
E-mail
Dc• # 3 4 5121
Clash -2
APPLICANT NAME
Name
Address McClelland Air COnd. Inc
City Slate
Zip
Phone Fax
E-mail
APPLICANT SIGNATURE
X a..�
For office use
Zoning
Occ.
I Planner
LOCATION
AN .-- O '�1D r 0
Property Address
3 �
Cit
Cross Street
WORKER'S COMPENSATION
Policy Number
00471
Carrier
State Fund
if hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time ofpermit issuance.
LENDING AGENCY
Name
Address
Description or S ope of Work:
�itCe. ,x L/c4,7� S yS -,,w
Sq. Footage
O Proposed Change of 0ccupancy-
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to "renew action on an
application after expiration, a new application', plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Received by;,„
G r/
Flood Zone SRA Yes No
Type Const. Receipt #4114 �`Map Book Page Lot #
Approved:
OVER FOR SUBMITTAL REQUIREMENTS L
K:1F0RMS161m nINr; FnRMR\P1r1nAr.n1RrnhPni. ,i ,
Date j`3 -P
Amount:=Bldg
SRA
Sheriff
SMTP.
Total