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HomeMy WebLinkAbout042-320-042B07-0627 042-320-042 MISCELLANEOUS Remodel ROOF STRUCTURE REPLACEMENT 1410 GLENWOOD AVE 1/2 JONES, DONALD E 42-32-42 a DON•& LINDA JONES vqDIVERSIFIED.PROjECTS INC. ' 1410 Glenwood, Chico%' Contr: Richard Garske 429-67B 926-67P Permit#2566-85B(reroof/duplexo) ._. _ - E Lot 12, Green Acres Sub., Chico 2-32-4 042-320-042 01-0383 Lot (new JONES DONALD 1417 GLEENWOOD AVE., CO9'a9- CONTR: THOMPSON MAINTE CE REROOF OVERLAY 30 SQ FT CO r f' 8/0 lqlq Wog% � Se �✓1 � � - yr^np-,rw+. : •q�r�ar 1 i< 042-320-042 01-0383 JONES, DONALD 1417 GLEENWOOD AVE., CHICO CONTR: THOMPSON MAINTENANCE REROOF OVERLAY 30 SQ FT COMP OF L COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDINt DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 yP,ERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT C -� -'/:I '' � `' ASSESSOR PARCEL NUMBER. L! 1 o � 0 — r 1 G � r .- =D p a BUILDING PERMIT OWNER` f ` n �y ELEP TMO�E r♦ , �/ SO. FT. OCC. BUILDING VALUATION 'J r .i � r^ l i I � U • f -� 4� OWNERS "NG ADDPTS , � T CONTRACJCR'S NAME . 1 A ,.,,II' r lit r'1 -C)-) ,% 16 L ,1i i" C TELEPHONE K C!► 1'L Jai CONTRACTORS MAILING ADDRESS 1r r CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ � f' ()() •(;r ARCHITECT OR ENGINEER LICENSE NO. Filina Fee •$ 2 0.0 0 Permit Fee ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS �� ;� , ��� r �_� _� Energy Plan Checking Fee $ 'L.-� r PERMIT FEE S/ , f , 9 ) LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex �t:7 Mobilehome ❑ Other '..L' 1" tt Fv Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: '' tet. (IJ4 _ I , - 2 U Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 LESS Main Service '.*.vzooAOv ORORLEss 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. _ _ r - , , License Class - Lic. No. ,_ - �_.� ' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, 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 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. 'L] 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' compensation Insurance carrier and policy number are: Carrier Policy Number I t-1 (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' C ompensation 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. / Y X I , c , -. r` " Date 7 (4 . '- �' 1 Signature of Applicant -0 Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Main Service TO LOooA 46.LINfi NEW CONST. D00 W0. WELL OCCP. so OR ADDNS. & ACC. BLDsU.3 . 5¢SOFT. N N.RESID, - MULTI.OUTLET @7,50 POWER APPARATUS 8 SINGLE OIrILET CIR. OUTLET OR FIXTURES Fes, Occup. BA0®'s0o Ex. Occup. ounFrs EM.oEE 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE ,��, I TOTAL FEE $ HA=. D FEES IMP FLAOD CDF pARC0. p0 HD ISSUE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. L B �7 1 .� i r rr� , r �'�,� Date Y PERMIT EXPIRES ON para Receipt No. ; Z! -1) J i 1 J WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 019 M2 T r-..f-.-.:-"---.-`.ryyl-�-�'�'y,�-r`.�+r+'.�"��._.-. �-�„`..�.r- ti.-r�,y....��..-...-r.��`,.-...-I":�...,-.�^'-.'.'�'-^"^"'`.'".`�'-..'YH"''•"'.r'�"..__---.-�- .-..-r ..--.-.�- COUNTY 6F BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 _ PERMIT No. (Rev. 12/96) APPLICATION AND-PERMITC ASSESSOR PARCEL NUMB ^J _ zOL��{PJ�G I L BUILDING PERMIT OWNER °NE a -S SO. FT. OCC. BUILDING VALUATION Gs .aa OWNERS � NJIiE$S /7 /1(� UY (�'IL's►lJal/, `�.J` CONI R'S NAME TELEPHONE COJRfLCJG. S NO o CONSTRUCTION LEADER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ -co ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ r ov ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS I / I r/47 VI Energy Plan Checking Fee $ - $ PERMIT FEE $ , LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE� SF ❑ Duplex Mobilehome ❑ Other / ULA sllIECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ -©� Describe Work: J � l �1'ti� Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION 1 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 f13 force and effect. // ¢ License Class Lic. No. lfl 5U �S 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 zoo& To L 46.00so CCU00A NEW CONST. DWEWNo OCCUP. ORs•( 3.5QF°. NON-RESID. CONST. Mu&ir�i o 97.50 POWER APPARATUS a sINGLE ounFr cIR.20 Occu OUTLET OR FIXTURES @ 100 00 Ex. Occup. ouTLEEDTs(RR� o.°pe 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 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' comp sation insuranc carder and policy number are: Carrier (A S'f (e _ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 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 T'Date � (t s, ta' , Signature of Applicant - 0 Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC _ CONST. TYPE TOTAL FEE $ I . H&Z D IMP I FLOOD I CDF PARCEL Po I HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicat above for which fees have been paid. By Date PERMIT EXPIRES ON '1i0i'6e�- I Mat(?) ReceiptNo. d 4115 , OD WHITE-D.O.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT FI a . . q6r.- C��/0-1925- (11 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS PERMIT NO. ~' 7 County Center Drive - Oroville, OAlifornia95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER - L�N�a —r ASPS TELEPHONE �S/�- S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS - :.2 ! h h k/ yi Ave— V e— '- C_0' J 0,0, C,%4 • VA CONTRACTOR'S NAME `� r K', C,�uiA �AKS TELEPHONE CONTRACTOR'S MAILING ADDRESS Gf V1Vki c^ T C , r 0. CA. °ice �� i,Fireplace CONSTRUCTION LENDER - ob'yo UNKNOWN Total Valuation $ FilingFee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER ; LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS /y/(1 PLUMBING PERMIT Filing Fee 10.00 (-, [� / 4 • ���� i Each Trap 2.00 Solar Water Heater 20.00 - Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex Q. Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I W 10-00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ OtherE, Describe work: — 0A,. Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee. ,' '10.00 Main service 100V OR LESS 100 AMP OR LESS ``10.00' / t f� Main service EA. ADD'L 100'',AMP 2.50 NEW CONST./ DWELLING OCCUP.&) OR ADDNS. 1 ACC. BLDGS. ' ' 'L��y�SQft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. '0 �' License No. y`>7^'���Classification t--'3 � ❑ I, as the owner, or my employees with wages as their sole compen-' sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR. ULTI.OUTLET 2,50 ea NON-RESID BRANCH CIRC ITS NEW CONSTR. POWER APPARATUS .&) RES NON-RESID. SINGLE OUTLET CIR. 20@BOC Ex. p�o OR FIXTURES gAl®30 FIXED A Ex. Occup. OUTLETS P(RESID IKEA. 2.00 p Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. O� I have placed on file with the County of Butte Building Department y' a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence.of the granting of this permit. X �, �11>�// %r6/���[�il� `��rC1�YD�, �?/fix /��'� Date Signature of Applicant Owner Or Contractor❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures stories in height. Mobile Home Installation Fee $ �jJO TOTAL PERMIT FEE $ /J OCCUP. GROUP I TYPE OF CONST, PARCEL PD I ND I ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. A DIRECTOR OF PUBLIC WORKS By .s' -i1. � �/f/f'%i'% Date �/�IR PERMIT EXPIRES Date 9 « �k/ Joveer3 Receipt No. "r'/� �� p WHITE-D.P.W., YELLOW-ASSeSSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE i DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, OroviIIe — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE ,�5�6- S3 A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, pleaAe contact this office immediately. Inspector Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville,,,CajiJorq,ia 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. s ASSESSOR PA =EL MBER, ATL ZONING BUILDING PERMIT OWNER e --S TELEPHONE 342n=42 SO. FT. OCC. BUILDING VALUATI N OWNER'S MAILING ADDRE2109 1 Vl�• CONT CTO 'S NAME oUr 'Itlill TELEPHONE CONTRACTOR'S MAILING ADDRESS 6 /�f r a_ 2 q Fireplace Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ V BUILDING ADDRESS / PLUMBING PERMIT Filing Fee 10.00 9� Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ DuplexD< Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other -g Describe work: — Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADO'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 21/20sgft CONTRACTORS LICENSE LAW I de c a e under penalty of perjury (Check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. [��J��j �% License No. 1 92,23 Classification _ C,-3 `% ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR U TI.OUTLET 2,50 ea NO BRANCH CIRC ITS NEW CONSTR. POWER APPARATUS & NON-RESID. ( SINGLE OUTLET CIR. z0®g0e Ts OR FIXTURES 6AL®3o Ex. OCCUP. FIXED FIXED APPLNS, OR EX. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under,penalty of perjury (check one): ❑ The permit, istfor $100.00 (valuation) or less. I have placed on,jilelwith the County of Butte Building Department e''fCertif.icate of Workmen's Compensation Insurance or a Certificate ir,lrgt. of CotSsen„tePf=lrbe. ❑ I shall not e�pb� any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in onsequence o the gra ting of this per it. X Date Sig tore of Applic — OwneV Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct-IDIREM ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ ��f✓ OCCUP. GROUP I TYPE of CONST. I PARCEL PD I HD I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which OF IP10 B PaMIT PIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date C7 I Receipt No. WHITE-D.P.W., YELLOW-ASSFSSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT SO % as �id03�g�� �1f10� Butte County Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY - Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued -if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return CLAIMANT'S NAME: 2n MAILING ADDRESS: PHONE: ASSESSOR'S PARCEL NO.: Q L 2__ - 2 Z [Please use one claim form per permit.] BLDG PERMIT NO.:� //ll Receipt No. 1 Receipt No. 2 Receipt No. 3 Zaq _ RECEIPT NO.: / 2r I/ o r] / / / / RECEIPT DATE: 2 30, 11 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: _ 0U2(- 6V rq O� no. O)eA I ,ea ro vi e ee na Check those fees which you wish to have considered for refund: E2 Building Permit Fees =Sheriff Fees =SRA Fees (CDF Fire Planning) Other (specify): n VPGZ e Plans for cancelled permits will be disposed of within 10 working days upon submission of a Request for Refund. If you want the plans, you may ick them up prior to that time. Signature Date K:/Forms/Refund Application 082203 ,c\�� 4 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.net\dds PROJECT INFORMATION Site Address: 1410 GLENWOOD AVE 1/2 APN: 042-320-042 Owner: JONES, DONALD E Permit N0: B07-0627 Issued Date: 04/04/2007 By TMP Expiration Date: 04/03/2008 Occupancy: Zoning: R3 Permit type: MISCELLANEOUS Subtype: Remodel Description: ROOF STRUCTURE REPLACEMEP 2108 FERN AVE CHICO, CA 95926 (530) 342-5226 RONALD W BUNCH #9 LAGUNA COURT CHICO, CA 95928 (530)891-1104 DBEH Building Review Fee DBMSC Remodel -Residential RONALD W BUNCH #9 LAGUNA COURT CHICO, CA 95928 (530)891-1104 FEE INFORMATION $75.70 $1,154.79 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires RONALD W BUNCH 378313 / B / 07/31/2007 I HEREBY AFFIRM UNDE PERJURY that I am licensed under provisions of Chapter (commencing ilh Se tion 7 D' sion 3 of the Business and Professions Code, and my license is in full for an act. X 04/04/2007 Contractors Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY 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. E AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compansation insurance carrier and policy number are; Carrier: State Fund Policy Number: 046-0002425 Exp. Date:01/01/2008 (This section need not be completed if the permit is or one hundred dollars ($100) or est s.) ❑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 become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' compensation provisio t' 700 of the Labor Code, I shall forthwith comply with those X 04/04/2007 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. Building Garage Remdl/Addn 1,175 Other Porch/Patio Total $1 Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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]; Please check one of the following: ❑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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are notintended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof 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 Provessions Code: The Contractors License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: I 04/04/2007 Owners Signature Date CONSTRUCTION LENDING AGENCY I I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State Zip I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless! Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the prope r oram rized to act on the property owners behalf. "J 04/04/2007 Name of Permittee [SIGN] Print Date ❑ Owner ontractor OR. Agent for Owner ❑Agent for Contractor FILE COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Nam A&910L 4- fq First Name pN MailingA���, �� E City / fo Zip State Com! Zip Phone Z- S ZZG Phone $•!� Fax E-mail CONTRACTOR Name , onl vrv�G� Name Address Address City State Zip «e Zip 2� Phone $•!� Fax E-mail Lic. #37� l3 Class -� APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip q City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name � _._ �.._..� 4 nl �tiNG� _ Address /".g e.., N ot. Gr— City State, Zip q Phone Fax E-mail PROJECT LOCATION AP#O -3 Z.O- O V12— Property Address S//7 �£.v wooer City //Cy !�li2o PERMIT NO. BIN # WORKER'S COMPENSATION Policy Number o 9e- - 2 -as - Carrier 6'�7- 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: i 1�ittd0ulS . fie- � � S � Sq FT- Livirn, Garage?, ��S Open Cov E-1 Structure Built without Permits ❑ Proposed Change of Occupancy ;Note previous use): M 1'7;-1 o five use only: _ I Zoning TT Food Zone SRA Yes I No Occ. Type Const. Butte County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 75965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds C pQt7ME1y�. National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-0627 Date: 03/27/2007 Location: 1410 GLENWOOD AVE 1/2 By: TMP Parcel Number: 042-320-042 Sub Type: Remodel Owner Name: JONES, DONALD E Phone: (530) 342-5226 Description: ROOF STRUCTURE REPLACEMENT(BURN REPAIRS) By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or other santions provided by law. Signed: Title: FILE Date: 03/27/2007 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. 0 Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municipalcodes.lexisnexis.com/codesibutteco/ Reference Number: B07-0627 Location: 1410 GLENWOOD AVE 1/2 Parcel Number: 042-320-042 Date: 03/27/2007 Owner Name: JONES, DONALD E Phone: (530) 342-5226 Description: ROOF STRUCTURE REPLACEMENT(BURN REPAIRS) Signature of Property Owner: Date: 03/27/2007 FILE d� A•+ta . lji Fav e♦ i� P:. V i f � � x: �., "�..� int $'� ♦.r�� '., e t ♦ .yy. ^.,�'t� � `F * �'4i �h,» � ,yr, tie e 4�Fy) � =" yyyy j 4 ���? 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