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Home My WebLink About042-100-006Butte County Department of Development Services. a0urrfe AREA NOTES 7 County Center Drive, Oroville, CA 95965 (530)538-7601 v{ww.buttecatntyneVdds°uN�y• RESIDENTIAL APN: Permit No. Owner: 042-100-006 05-2885 DROBNY,DONALD Site Address: _ 2812 KENNEDY AVE, CHICO Cont: GALLAGHER'S HEATING contractor. _ FURNANCE Type of Permit: a Y 11� Lt' f• CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER . ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: O / SIGNATURE: = OK 0 = Not OK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; Fall/C/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap Nat ❑ or LP❑ Inch Sz Ft Lngth 7 Blckng; Sz-Spacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs ❑ Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers DATE ID EC K S`C OV ERS -CARPO RTS `G A R A G E S 1 Zoning -Setbacks -Easements 2 Ftp; Soils-Sz-Dpth-Spacing-CnnctrsSteel 3 Decks, Girders/Joists-Dcking-Brcing . Stairs-Guard/Handrails 4 Wood Awn; Posts -Beams-Rftrs-Cn n ctrs-S hthg Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls ° 0.4 DATE IPOOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool Lting; 15 volts-GFl 6 Elec Enclsrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes-Enclsrs-pniboards-Insultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide 4 . Pool Drawing =OK 0 = Not RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR DATE PLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg Dpth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth. 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First flr-Tub Acc 5 Stemwalls Main; Steel -Blockouts-Wrapped 57 Test Tub & Shwr, 2nd fir - Tub•Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frpic 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-Rgitr-Service Test DATE IMECHANICAL 12 Elec Undrgrnd 61 AC Ducts Insultn & Support 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 14 Girders-Sills-Anchr BoltsJoists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn _ 15 Acc & Vntltn 63 Condensate Drain & Ovrflw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE IFINAL 66 Ext Steps -Door & SideLt Prtctn-Landings 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof) 68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-flr-Ducts-Mech Prtctn 22 Headers & Beams-Sz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg 71 GFI Arc Fault 25 Frpic Ties or Type A Flue-Frpic Throat Clrnc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doorsill Ht & Dimensions 74 Frplc or Stove, Cirnc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 79 AC Duct in Garage -Damper 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-CIrnc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndtri Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnls 83 Insultn-Foam-Looked in Attic. 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters ❑ Yes ❑ No 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vrits abv Roof, Plmb-Appinc-Frpic-CImc to Opngs 90 Wtr Well, Dscnnct, Elec, Plmb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga ❑ CU or DAL 98 Address Posted AC Wire Sz ga ❑ CU or 0 A 99 Fire Sprinkler 48 Range Circ ga ❑ CU or ❑AL Oven Circ ga ❑ CU or ❑ AL Insulated Neutral ❑ Yes ❑ No o>`' o•`c o+`' o`s 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector 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 LICENSED CONTRACTORS DECLARATION I hereby affirm under penally 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./ -"1 1/ -1-732 License ClassCJ� C 3B License Number: l J`j Date: 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).): ❑ I, as owner of the property, or my employees with wages as their sale 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 Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves the and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code Date: Owner. 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. 1Fo 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: St&+L R'V�1y t�Uyl� IL Policy #: `�6J 5 `' [X.('dJ !f ❑ 1 certify that in the performance of the work for which this permit is issued. 1 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: 0 1 t Applican . AAAAA 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 NO. BP052885 Issued Date: 10/19/2005 APN: 042-100-006-000 Site Address: 2812 KENNEDY AVE CHI Map Index: Description: FURNACE REPLACEMENT & DUCT WORK Owner: DROBNY DONALD F LIVING TRUST C/O DROBNY DONALD F TRUSTEE 2812 KENNEDY AVE CHICO, CA 95973-9607 Applicant: GALLAGHER'S HEATING & AIR PO BOX 35 LOS MOLINAS, CA 96055 800-892-3556 Contractor: GALLAGHER'S HEATING & AIR PO BOX 35 LOS MOLINAS, CA 96055 800-892-3556 License #: 777334 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Coda BnrVpr I hereby affirm that there is a construction lending agency for the Resolutions to do work indlcat d above for which fees have been paid. performance of the work for which this.permit is issued (Sec 3097 Civ.) la-M-05 � _ � i� -0 J C Name: BY f ((�� Date: lT "� PERMIT EXPIRES ON: 10-I"I Address: , . _. _ , ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am'the owner or the duly aut orized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of anyI icial fo document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspectign purposes. ��J Print Name: If-d-UVSignature Date:f/v � q J 0 Owner ❑ Contractor ❑ Agent for Owner b1gent 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 "PLEASE PRINT CLEARLY" APPLICANT NAME OWNER Last Name(7fobny Name irst Name (�) Address ag a a q1 City Chi Y I State Staco te(tee Zip Phone Zip Fax E-mail Fax APPLICANT NAME CONTRACTOR Name Name 14166, Zip O 55 Address Fax State City 1 �.,, l� D [I Stat Zip Phone _ Planner Fax E-mail Lic. #—] 7 1 APPLICANT NAME ARCHITECT/ENGINEER Name City S r�/1J D I Igo V 1 Address Zip O 55 City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT NAME Name (2— c I Addie 20 . City S r�/1J D I Igo V 1 S1 6 q- I ' Zip O 55 Phon e Fax E-mail APP4LICANT SIGNATURE For office use only: Zoning Property Address Flood Zone Cross Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. M BIN # LOCATION AP# D�2 _ 6 Property Address LtC+ Wo Cross Street ❑ Structure Built without Permits WORKER'S COMPENSATION r_ 0-0 O , Policy Number 1 ?,0 5t5___-� Carrier �16(_i u n d 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: kep(ac� and ce. ri LtC+ Wo Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): OVER FOR SUBMITTAL REQUIREMENTS K:\FORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 1 of 2 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. rrReceived by: K,l�� Amount: 55.00 Bldg SRA Receipt #: l 1 Sheriff SMIP Date: I - I q-(� Other U Total REV 6-16-04 SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed ❑ 3. calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to ❑ 7. mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in ❑ 11. triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 } Slr, .- �. .+. },oi.,`.aif kt ..nY^r .i 'F.t y.fr a_T. ...,r., .. s.:_� d� lRfiyii•_. "".1C ... 042-100-006 03-2749 DROBNY,DONALD 2812 KENNEDY AVE, CHI.CO Cont: G & RROOFING REROOF W/ COMP. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, Califo nia 93965 • Telephone (530) 538-7541 fP MI '0 (Rev. 12/96) APPLICATION AND PERMIT --J/10 ASSESSOR PARCEL NUMBER I111gX 042-100-006 ZONING BUILDING PERMIT ' - OWNER DROBNY DONALD TELEPHONE SO. FT OCC. BUILDING VALUATION OWN 5 MAILING ADDRESS 812 KENNEDY AVE. 1880@60 1780.00 CONTRACTOR'S NAME G&R ROOFING TELEPHONE 844-6537 CONTRACTOR'S MARING ADDRESS 2587 NORD AVE. CHICO CA. /11 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 1980.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $C' 20.00 Permit Fee $ 45500 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ t BUILDING AI2 KENNEDY AVE CHICO I Energy Plan Checking Fee $ $ PERMIT FEE $ 65.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: COMP TEAR OFF REPLACE WITH COMP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Qpile Home s G w @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 LESS Main Service OA OR LESS 23.00 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. 1 ) �/ / 1. OWNER -BUILDER DECLARATION I 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 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 Main Service 200AWEE TO ,-Coon 46.00 NEW CONST. DWELLING OCCUP. 3.5QF7, OR ADDNS. ( .SLOT NEW CONST. MULACC. NON-RESID. c @7.50 POWER APPARATUS 8 SINGLE OUTLET CIR. 20 @ ,.s, Ex. OCCu OUTLET OR FD(TUREs BAL @ .50 Ex. Occup. 0�FIX� R� D.DEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE S 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. 171 I have and will maintain workers' compensation insurance, as required by Section lk 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 %.5' r Policy Number �/ - Ci L ► 0 —) (A /y (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 /f (` Signature of Applicant - ❑ Owner ®.»Contractor ❑ Agent An OSHA permit is required for exaVations over 5'0" deep and demolition or construction of structures o6e 3�st nesfih eig l MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 65. 00 J HAZ. I D. FEES P IM..�.....,.,., FLOOD CDF PARCEL PD HD'uE This permit is hereby issued under the applicable provisions of the Butte, -County Coe end/or Resolutions to do work indit ted a�ove f whEz e been paid. In B LAA'j Date /A (/ Y r r /� PER EXPIRES ON 1 1 / �M V Date i ReceiptNo.� -� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville,'California 95965 • Telephone (530) 538-75412, (Rev. 12/96) APPLICATION AND PERMIT J ASSESSOR PARCEL NUMBER RXXXX 042-100-006 ZONING BUILDING PERMIT OWNER DROBNY' DONALD TELEPHONE SO. FT. OCC. BUILDING VALUATION 1980@60 1980.00 OWNER'S MAILING ADDRESS 2812 KENNEDY AVE. CONTRACTOR'S NAME G&R ROOFING TELEPHONE 894-6537 CONTRACTOR'S MAILING ADDRESS 2587 NORD AVE. CHICO CA. CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ i980.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 45.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 2812 KENNEDY AVE CHICO Energy Plan Checking Fee $ $ PERMIT FEE $ 65.00 LAT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: COMP TEAR OFF REPLACE WITH COMP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 le Home S G w @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200'. OR LESS 23.00 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 C 3 � Lic. No. `7 -7 3 � / 5 OWNER -BUILDER DECLARATI I 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 astheir 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 Main Service zoOA TO 1000A 46.00 NEW CONST. DWEWNG OCCUP. OR ADDNS. a ACC. BLD.. SO 3.5QFT; NOWRESID. MULT,' CI CUTITS @7,50 POWER APPARATUS 8 SINGLE OLfTIET CIR. Ex. OCCU . OUTLET OR FIXTURES 20 @''00 BAL O .50 Ex. Occup. oimF°APP REESIO)0E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ 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' c mp nsatiinsurance carrier and policy number are: Carrier � & MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number 7/7-01, n r) 7, (_ (The above sections need not be completed ff the permit r 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 ff I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. _ Date ,/ 4areo Applicant - ❑ Own motor ❑ Age An OSHA permit is required for ex tions over 60" deep and demolition or construction of structur I Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 65 00 HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD 6 E This permit is hereby issued under the the ButtuntyCo a and/or in ted o e f whi fees have B PERMIT EXPIRES ON VD applicable provisions Resolutions to do work been paid. Dat to Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APP