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Home My WebLink About042-170-086IJUIItUUUNIT DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 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 effect. ^'� License Class License Number: / Dale: .2�J O2'—Contractor: �",p JeAjAY1 RLea%_'o 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 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 Slate 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 Code: The Contractors' Slate 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 thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: Owner: WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the following declarations: ❑ I 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. ❑ 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 insurance carrier and policy number are: nc Carrier: 0 1-'L-KIVII 1 IVU. BP050557 Issued Date: 03/02/2005 APN: 042-170-086-000 Site Address: 3262 W -SACRAMENTO AVE CHI Map Index: Description: RE ROOF COMP 23 SQ.'S Owner: WAYNE ERICSON 1717 MUIR AVE CHICO CA 95926 (530) 345-4222 Applicant: FOUR SEASONS ROOFING #11 COMMERCE COURT SUITE #1 95928 530-895-.0418 Contractor: FOUR SEASONS ROOFING #11 COMMERCE COURT SUITE #1 95928 530-895-0418 License #: 659073 Architect: Engineer: Policy #:=/u L4 CoI Total Square Ft: Valuation: ❑ 1 certify that in the performance of the work for which this permit Is Census Code: issued, I 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: /72 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. 0 S. F. $0.00 CONSTRUCTION LENDING AGENCY This permit Is h reby Issued under I hereby affirm that there is a construction lending agency for the Resolu rbns to o work Indicated�' performance of the work for which this permit is Issued (Sec 3097 Civ.) Name: PERMIT EXPIRES ON: G Address: /�mw_� 137.s"(! 1 a provisions of the Butte County Code and/or t fees have been paid. . Date: , 01:2Z ❑ 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 authorized agent of the owner. I agree to comply with all county and slate laws relating to building construction. I acknowledge It Is unlawful to alter the substance of any official form or docum utte C thereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Prlht Name: ( 'XI's I, �i V 6 ) lU^ CA Signature: Date: cJ ❑ Owner ❑ Contractor ❑ Agent for Owner gent for Contractor B. G, tiuuoing vermit ui-iti-uv pg i 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 OF APPLICA TION Website: www.buttecounty.nettdds "PLEASE PRINT CLEARLY" For office use only: OWNER Last .Name 1, irst Npme Address..., > oyl Ave,— City 1 State Zip fq p J (.t Phone FCJ City Fax E-mail State For office use only: CONTRACTOR Name Name �ot �- 1'J IA Address c + «� L City i E-mail State Zip if aA Planner State License Number Phone Fax E-mail is # (523 ss For office use only: ARCHITECT/ENGINEER Name �s + r Address City Stat State Zip Phone E-mail Fax E-mail Planner State License Number For office use only: APPLICANT NAME Name �s + r Address City Stat zipo Phone - Fax E-mail Page For office use only: Zoning Pro erty Address dj Flood Zone Cross Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT Os 651's- BP BIN # LOCATION AP# W Pro erty Address dj City "co Cross Street WORKER'S COMPENSATION Policy Number Carrier J' 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 - Desc�iption or Scope of Work: Sq. Footage LJ 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. II Received by: —P, Amount: %3 '�� SO BldgI SRA Receipt #: �zS�;k ? Sheriff CK916 `)2'a SMIP I ( Date:. Other `sem Total Page 1 of 2 REV 2-24-05 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 inst, (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application 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 KAFORMSWILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05