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Home My WebLink About042-160-044r BUTTE COUNTY DEPARTMENT'OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060768 B. C. Building Permit 01-16-04 pg 1 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: 04/05/2006 APN: 042-160-044-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 1938 W SACRAMENTO AVE CHI Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: ELECTRICAL SERVICE CHANGE 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: HULL JEFFREY W & ERIN M WADE 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 1940 WEST SACRAMENTO AVE 7000) of Division 3 of the Business and Professions Code) or that he or CHICO, CA 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 95926 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 Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: HULL JEFFREY W & ERIN M WADE 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 1940 WEST SACRAMENTO AVE year of completion, the owner -builder will have the burden of CHICO, CA proving that he or she did not build or improve for the purpose of sale.). 95926 I, as owner of the property, am exclusively contracting with (530) 826-3362 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 pursuant to the Contractors' State License Law.). Contractor: MARION MAX HULL ❑ 1 am xe pt under Article 3 of the Business and Professions Code PO BOX 1096 Vlfswner: lI P, HAMILTON CITY, CA Date: 95951 WORKERS' COMPENSATION DECLARATION (530) 826-3362 LIC# 548909 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 License #: 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 and policy number are: Carrier: Policy #: otal Square Ft: 0 S.F. C1 certify that in the performance of the work for which this permit is to Valuation: $0.00 issued, I shall not employ any person in any manner so as 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 oo forthwith comply with those provisions. Date: � ) " J— 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 Code and/or I hereby affirm that there is a construction lending agency for the Resolutionto do work indicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) �A in l 1 IN y� Date: LA - 5_0(p Name: By. J C PERMIT EXPIRES ON: 4` E;_07 Address: - Date ❑ 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 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 repr6sentat�ives of Butte County to enter upon the above mentioned property for inspection purposes Print Name: (/�) VV U`lSignature: �- 7/0R) Date: 7 Tr Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2534 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name U �� F irst Name e �e Address ` 'e SUi�(�lVel£✓1-1 D Ave, City GV-, (moo Fax Slate CA Zip X15X12� Phone -30 16-7 Fax E-mail 21�1(�GPe `i"�eGh�t,o fb C'C�",(A✓v� rl V) CONTRACTOR Name M �k rILAt Address R O 3-V City H MVO,, State,,/ Zip r^ Phon" D 3 Z Fax E-mail Lic.� $qo (� Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City /I t 6;D Address Z�pp q,5 2/ �P City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name Z'r' Address I /,, / ' 14V6 City /I t 6;D State Z�pp q,5 2/ �P Phone �2O Fax E-mail -e w U d e 1,t CAn i&D w Pc/1 CD APPLICANT SIGNATURE X �v� �i✓��.�- For office use only: Zoning Property Address Flood Zone Cross Street SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. BIN # PROJECT LOCATION . AP# ( l V - OLiLA Property Address City Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license confractors, a cerfificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: 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 renewlaction 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. Received by: , V • Amount: it Ess • CIO Bldg SRA Receipt #: q qa Sheriff (Ntg-4 (v U SMIP Other Dater -G-0 4 (30 Total 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 AIC 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 bV 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 . b 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. ❑ 11. ❑ Legal description from current recorded grant deed, ElCopy 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060497 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury. that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and Issued Date: 03/02/2006 APN: 042-160-044-000 effect. License Class : License Number: Site Address: 1938 W SACRAMENTO AVE CHI Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: re roof 12 sq. 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. HULL JEFFREY W & ERIN M WADE 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 1940 WEST SACRAMENTO AVE 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 CHICO, CA violation of Section 7031.5 by any applicant for a permit.subjects,the ' , . 95926 applicant to a civil penalty of not more than five hundred dollars ($500).)t- I, as owner of the roe ,� property, rty, or my employees with wages�as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: HULL JEFFREY W & ERIN M WADE 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 1940 WEST SACRAMENTO AVE 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 CHICO, CA sale.). 95926 ❑ 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 pursuant to the Contractors' State License Law.). Contractor: ❑ 1 am Exempt under Article 3 of the Business a d Professions Code Date: Z O Owner: ? 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 License #: 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 the work for which this permit is issued. My workers' compensation Architect: insurance carrier and policy number are: Engineer: Carrier: Policy #: 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 Total Square Ft: 0 S. F. Valuation: $0.00 become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' Census Code: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 3 Applicant: 6 WARNING: Failure to secure workers' compensation coverage, is unlawful, and shall subject an employer to criminal penaltiesandone 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 h y ssu oder th�q. applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the of the work for which this permit is issued (Sec 3097 Civ.) Resolution do work in icated a ve for hich fees have been paid. — --Q performance BY Date: Name: —7 PERMIT EXPIRES ON: K—_; 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 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 purposes. JP Print Name: bW Signature: 77�� Ir b Date: t/ e .• caner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 D 1 0 \ M0 BUTTE COUNTY O DEPARTMENT OF DEVELOPMENT SERVICES 0 BUILDING PERMIT APPLICATION o AND SUBMITTAL REQUIREMENTS O 24 HOU_ R INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 o 'OFFICE #: (530) 538-7541 ( A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last Name . n n C XW First Name�e Address r C( 4 0 D $'b So C t K ✓`�2_ City Clljn t C.0 State Zip Phone 530 —Sbb—1 (S Fax E-mail j V\) ✓\"u @ v� F ►, 0 . US-,V� APPLICANT NAME CONTRACTOR Name City Cil i fN Address Zip o� si Zb City Fax State . Zip Phone Book Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Cil i fN Address Zip o� si Zb City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT NAME Name Je _( 4 , O Q Address (It4 0 Wo S t S t^C,/,; Yv A,,,k%3 Av--p— City Cil i fN State C Zip o� si Zb Phone S-;'� S.l(S� Fax E-mail J ✓J iM�Q Q @� r oil , c,w�_ APPLICANT SIG ATURE X For office use nly: Zoning Property Address (Iq 3 G w Q S bSaC . {Atil`C o Flood Zone Cross Street C\ UVlt,wt�,0 SRA Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT OG -0497 BP BIN # LOCATION AP# D L/2 D '7 y Property Address (Iq 3 G w Q S bSaC . {Atil`C o CIS Cit c;�7 Cross Street C\ UVlt,wt�,0 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: V%.tnIJ f o Sq. Footage ((� ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Amount: _ C Receipt OVER FOR SUBMITTAL Rt(QUIRtIVItN 15 ( < KAFORMSWILDING FORMS\BIdgApplSubRgmts.doc' Page 1 of 2 IP 7 Total SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. 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 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 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 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 GRAPHPAPER! ❑ 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 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060496 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjurythat I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 03/02/2006 APN: 042-160-044-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 1938 W SACRAMENTO AVE CHI Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: new elec service 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: HULL JEFFREY W & ERIN M WADE 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 1940 WEST SACRAMENTO AVE 7000) of Division 3 of the Business and Professions Code) or that he or CHICO, CA 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 95926 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 Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who doesHULL Applicant: JEFFREY W & ERIN M WADE such work himself or herself or through his or her own employees, provided that suchimprovements are not intended or offered .for sale. If however, the building or improvements are sold within one 1940 WEST SACRAMENTO AVE 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 CHICO, CA sale.). 95926 ❑ 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 pursuant to the Contractors' State License Law.). Contractor: ❑ 1 am Exempt under Article 3 of the Business and Professions Code 3 z 06 Owner: Date: 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 License #: 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 insurance carrier and policy number are: Engineer: Carrier: Policy #: I certify that in the performance of the work for which this permit.is Total Square Ft: 0 S. F. issued, I shall not employ any person in any manner so as to Valuation: $0.00 �� become subject to the workers' compensation laws of California, q and agree that if I should become subject to the workers' Census Code: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: I O ��-66 Applicant: C 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 i ' ere issuedmader thgFapplicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the p rformance of the work for which this permit is issued (Sec 3097 Civ.) Resoluti to do ork in Gated ab a for which fees have been paid. Date: v N me: BY Address: PERMIT EXPIRES ON: (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 farms. . I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to after the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County upon the above mentioned property for inspection purpose s. j,��t000enter YA Print Name: `+J" Signature: Date: 3 I 1 I OL --%4swner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY PERMIT DEPARTMENT OF DEVELOPMENT SERVICES NO. BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS /`� C� 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834 BP o v y - OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION BIN # Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name i 1 11 0 irst Name�p Address ( r? 'P 0 WoS-b S�.Cvc.mRn'I"r, A✓`e� City C 1,11 Cao State C Zip cl S9 U Phone 5 3 O — Slm6 Fax E-mail J V) y1 X c 11 lot), C-,o,�v� CONTRACTOR. Name MA . Address F,. O. 6o X l ,D96 City a yn J'j'0'j C( State CA ZIP CI' 9 S j Phone Sib -%26- 33L7., Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City C4,i co Address zip C1 S g Z City Fax State . Zip Phone Book Fax ' Email Planner State License Number APPLICANT INFORMATION Name • J p r, 4 �!) Address _0 3 S c'C r"-oj0J id v ---- City C4,i co State C A zip C1 S g Z Phone Fax E-mail For office use onl Zoning Property Address r a p S p a C 1 0 J Flood Zone Cross Street �tUnW�� WORKER'S SRA I Yes I No Occ. Type Const. Subdivision Name - ' Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PROJECTLOCATION ! AP# eq y2 1600 7 Property Address r a p S p a C 1 0 J City CIAC Cross Street �tUnW�� WORKER'S - COMPENSATION -Policy Number Carrier If hiring anyone other than license contractors, a certiricate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: KOW -e Sq FT- Living Garage Open Cov O Structure Built without Permits O 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 requir8d. 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. —70 Received by:� Amount: Bldg SRA Receipt #: Sheriff f, u SMIP Other Date: 21�/2'ob Total