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Home My WebLink About042-590-005o y 2.5'0 •vc GEORhF , RgniaN 42-59-05 3230 Bay Ave, Chico /I ' Permit#3596-88E(ele ser)SF 5 ` f LOT LINE ADJUSTMENT AP # 042-590-079 04-3226 PROVOST, THOMAS 3230. BAY AVE, CHICO NEW POLE & ELEC PANEL i • � 4. i �F r l I W02 A r I im IM CtI4 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 OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" CONTRACTOR OWNER Last Name PV -O �— irst Name "T►�ow.a r Addr ss kza A City City State A Zip 3 Phon53U Z� —3i 3 Faxjo�rycE 3�— 3111 E-mail r ov �b 7L, CdKA CONTRACTOR ARCHITECT/ENGINEER Name n Address Address City Fax City State C) Zipqs Phone 3 k4 t W�> 4 Fax E-mail E-mail Lic. C APPLICANT NAME ARCHITECT/ENGINEER Name n Address Zip City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT NAME Name 6 Address City State Zip Phone Fax E-mail GNATURE X For office use only: Zoning Property Address o-3. Vt. Flood Zone Cross Street SRA ves No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc 1 PERMIT NO.�� P BIN # LOCATION API 4F9 6. 2 Property Address o-3. Vt. C' ICc) Cross Street ❑ Structure Built without Permits 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. Date 1 LENDING AGENCY Name Address Description or Scope of Work: / A DG Amount: /to Bldg 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. Page o. Received by: Amount: /to Bldg Ct' k SRA Re ipt' i , (-'`/� Sheriff T1 SMIP Date 1 Other 6 Total s� I RFV 7-27-04 Page o. - �-vC� 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. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: �v Y ASSESSOR PARCEL NUMBER O ' Proposed Building Use: Counter Technician. Date: 14 Items required in order to apply` or a permft�All boxes MUST be checked OR marked NA in order apply. ' O 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet "signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! O 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. O 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. O 9. 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. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs O 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. O 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ O 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. O 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. Cl 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form .......................................... __----- O / 27. Encroachment Permit for driv way,rom the Public Works Dept ........................... 28. Pre -Inspection for Q Q( required,...... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization......................................:............................. ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. l 1 I have been informed of the above items and requirements for obtaining a building permit. 1\ J Applicant: Date: 1. Index permit application for the above items numbered: Plan Check L tier 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, O counter, by Date: Plans reviewed by: Date: Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division Department C o u n t s J. Michael Crump, Director Warner C. Phillips, Assistant Director August 2, 2002 Thomas Provost 3230 Bay Avenue Chico, CA 95973 Re: Lot Line Adjustment AP 042-590-004 & 005 Dear Mr. Provost: Public f 6 u t Works LAND DEVELOPMENT DIVISION 7 County Center Drive Oroville, CA 95965 (530) 538-7266 (FAX) 538-7171 On August 2, 2002, the Department of Public Works made the finding that the Lot Line Adjustment on the above referenced property is exempt from environmental review, and approved the project subject to the conditions on the attached page. Should you appeal the decision of the Department of Public Works, please submit your appeal, in writing, with the appeal fee of $50.00, to the Clerk of the Board of Supervisors, 25 County Center Drive, Oroville, California, prior to 4:00 p.m., August 12, 2002. The conditions of approval must be met within thirty-six (36) months from the date of approval by the Department of Public Works or the approval will be considered null and void. Development of proposed Parcel 1 will be limited by the requirements of the Nitrate Action Plan. Contact the Chico office of Environmental Health, (530) 891-2727, 411 Mail Street, Chico, CA. If you have any questions concerning this matter, please contact this office at (530) 538-7266, Monday through Friday, 8:00 a.m. to 4:00 p.m. Sincerely, 9� 4 Stuart Edell Manager, Land Development Division SE/kp Attachment cc: Environmental Health Department x/Building Division Feeney Engineering Thomas Provost, Lot Line Adjustment, AP 042-590-004 & 005, Modify the common boundary between 2 parcels located on the southeasterly corner of Bay Avenue and Almond Grove Court, Chico area. Engineer: Feeney Engineering. 1. New lot or parcel lines shall comply with setback requirements of applicable zoning and building ordinances. 2. Deeds and plats (if required) shall be submitted to the Department of Public Works, Land Development Division for checking and approval prior to recordation and shall contain the notes specified below. 3. Provide documentation from a title company of the applicant's choice verifying that any deed of trust affected has been partially re -conveyed or modified to reflect the lot line adjustment and to prevent the creation of any additional lot or parcel. 4. Prior to recordation of deeds, provide documentation verifying payment of taxes as required by Subsection (b) of Section 20-95 of the Butte County Code and as specified in Article 8 of Chapter 4 of Division 2 of Title 7 of the Government Code, commencing with Section 66492. 5. Prepare a plat showing approved Lot Line Adjustment. 6. Record plat with deeds if one or more of original lots or parcels was created by map. If a record of survey is prepared to show the lot line adjustment, recording of a plat is not required. 7. Rerecord documents 89-12177 and 89-12178 using the correct legal description as created by Deed recorded January 18, 1985, under Recorder's Serial No. 85-1674, to effect that Boundary Line Modification approved by the County of Butte on February 27, 1984. BUILDING DMSION CONDITION: 8. Verify utility services are provided / maintained on each parcel. Deed Note (To be placed on any deed to effect lot line adjustment) The purpose of this deed is to effect a lot line adjustment as approved by the Butte County Director of Public Works on The above described lands are to be combined with and become a part of those lands as described in the deed to as filed for record in Butte County Official Records at Serial Number Book at Page . No additional lots or parcels are created hereby. The scope of review of said lot line adjustment was limited as specified in Government Code Section 66412(d), and approval of it does not constitute assurance that future applications for building permits or other land use entitlements on the modified lots or parcels will be approved by the County of Butte. Plat Note (To be placed on any required Plat) This plat does not constitute a legal description of the lots or parcels depicted and does not show all easements of record on or affecting said lots or parcels. ■ Lot Line Adjustment Conditions of Approval - Butte County ■ &Wdt� of igutte OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: Darlene Jeffries ADDRESS: 3230 Bay Avenue I CITY & STATE: Chic(), CA 95926 IMPORTANT: SEE INSTRUCTIONS DATE OF CLAIM: May 16, 1989 ON REVERSE SIDE cLIft"tT rLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT Owner has decided not to do work. Building Permit #3596-88E, dateri 1119188, Rpreipt 246 412942-59-51 Electrical Permit Fees Paid ---------------- --- $ 37.50Rptain Filing 10.00 e-------- -------------------- 2750 Refund Due --------------------------------------15.00 . Retain Pre -inspection Fee--------------------- TOTAL REFUND DUE ----------------------------------------M-50 TOTAL 12 50 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or del claim is true and correct as stated. ,/ Dated this ....................... day o[ ....... ........ 19,et....�CL..i/.�........ Calif• ....F.:L.`_STt�i+��""�r....... 7II Signature of ClaimeQ red, a� thatithis / .. / I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above hav bee performed or de. livered and that there is a Budget Appropriation a or Specific Board Approval ❑ (Check one) forW e.Dated thio tday or......May,.•_,,,;,•,,,,19 89, at Orovile,,, caul ........................ ...... ............ . . ..:..... ..... ...... ................................ent Heed or Authorized D ep Dept. 440-002 Exp• 4210500 PermitsCode............................................ Code ................................................PAYABLE FROM .....................P�r ................................................................. FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. ,I 4-o -t,-t -A- .. . ..... ........ . . . . . . . . . . . . 4n JC 4-o -t,-t -A- I ��.:, .,t, � . .... c _ .. . � � ., . � �� - "' � '� � •� ,� i i . - Svc ce- NC -7-A r�P�a �t+��c�ri�t�.✓ r . J _ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NOV, 7 C6unty Center Drive - Oroville, California 959651- Telephone: 916/538-_7541 ` APPLICATION AND PERMIT J ASSESSOR PARCEL NUMBER. 4/ f _ 5 - ZONING . , BUILDING PERMIT OWNERTELEPHONE (S eo rq e A. r SO. FT. OCC. BUILDING VALUATION OWNER'S'] MAI LIN ADDRESS V Y\C+ V CONTRACTOR'S NAME _ ,0 - TELEPHONE 1 CONTRACTOR'S MAILrNG ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN LENDER'S MAILING -ADDRESS l - + Total Valuation Is Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,4 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 //�� J Each Trap 2.00 % Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME ' PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF] Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home Is 10.00.a T' PE OF WORK New❑ Addition[] Remodel U,,tiilities❑ Installation❑ Other❑ Describe work: U iMti. PTV 1C:N �. Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 ` Main service 10ov OR LESS 100 AMP OR LESS 10.00 041 Main service EA. ADD'L 100 AMP 2.50 G CONTRACTORS LICENSE LAW 1 ,%. `I •s ' 1.OR I declare under penalty'of (check one): ❑' I am licensed un�er provisions of Chapt. 9, Div. 3 of the Business '� and Professions Co"" "and my license is in full force and effect. License No. Classification - -2/1', as the"owner, or my employees with wages as their sole compen- sation, will do tbe,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 CONST. ( DWELLING OccuP.B , ACDNS. C ACC. BLDGS. /22sq ft NEW CONSTR MU TI -OUTLET NON.RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS .&) -.i _� SINGLE OUTLET CIR. ' Ex. Occup(OUTLETS OR FIXTURES eA 120@0C FIXED APPLNS. OR \ EX. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 I (e ✓t Permit Fee Y $ Contractor WORKMEN'S COMPENSATION INSURANCE I decl €under penalty of perjury (check one): The permit is for $100.00 (valuation) or less: ❑ I have placed on file with the County of BZItte Building Department 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. MECHANICAL PERMIT Filing Fee 10.00 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. 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 consequence of the granting of this permit. X � �~ �� ` ! //,� Date �� , — � of / '/ner❑ Contractor ❑ Agent ❑ Signature of Applicant — �� Ow An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occu P. CONST.TYPE SCHOOL FLOOD PARCEL PD HD 59U This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC '] By �.�' /% PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date U,7 (/4 ��"' -7 -! Receipt No. P as L1 6 5 WHITE-D.P.W.. YELLOW-ASDESSa R. PINK -INSPECTOR. GOLDENROD -APPLICANT ��► iG z-eV4 %�C�T COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKSPERMIT N0. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-754103 1l APPLICATION ANDi PERMIT UU ASSESSOR PARCEL NUMBER J ZONING BUILDING PERMIT OWNER Co eo s- TELEPHONE 3 -03�`� .SQ. FT. DCC. BUILDING VALUATION OWNER'S MAILIN ADDRESS ,�t f i u `� C-0 CONTRACTOR'S NAME J Q TELEPHONE CONTRACTOR'S MAIL NG ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Pennit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee .$ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty BUILDING ADDRESS Permit fee !$ S PERMIT Filing Fee 10.00 /1PLUMBING U G` �� Each Trap 2.00 ( VC -0 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 0.00 a T E OF WORK Utilities ❑ Installation❑ Other 101 New ❑ Addition ❑ Remod906 Describe work: Weru ic.&, Permit Fee S Contractor ELECTRICAL PERMIT Filing Fee 10.00 v Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. AOD'L 100 AMP 2.50 G CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check One): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the wbrk,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) F1I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTOR ADDNS. . / DWELLING OCCUP.alACC. BLDGS. I \ ) yx¢sgft NEW CONSTR U TI.OUTLET 2.50 ea NON-RESID BRANCH CIRCUITS) POWER APPARATUS &) SINGLE OUTLET CIR. zo®soe Ex. Occup OUTLETS OR FIXTURES SAL030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wi ing 15.00 t^e i v► 1• l Permit Fee Contractor WORKMEN'S COMPENSATION INSURANCE I decl under penalty of perjury (check one): The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department 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. MECHANICAL PERMIT Filing Fee 10.00 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 nd expenses which may in any way accru all liabil' fes, judgme ts,piu� again t id Co my in one of the granting of this permit. X Date O er ElContractor ❑ Agent ❑ Signature of ApplicanVqlredi An OSHA permit is rorexcavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ �O OCCuP. COHST.TYPIJ ISCHOOLIFLOODIPARCELI P11 HD ssu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR QF PUBLIC BY PER EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. 01• �!O WHITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT I ` rri`I. 7x.�i'^�:= Y*i.!'r,._} c .- - �. - �. !1J► . r i��.�'�.Ii�h.S"fir-�'' .1""�1-�G•fi �,. :�y I ` r.. fit: ;,�,,, ,,, `� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION d ; 7 COUNTY CENTER DRIVE - OROVILLE, q-� LIFM!'JA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET V/ Permit No. OWNER (-:>eyr,-,e A Proposed Building Use A. P. No. _ Building Inspector (DII. Date At time of permit application, I was advised the following data must be submitted prior to permit processing and1or issuance: DATE RECEIVED APPROVED 1. All items have been submitted 2. 3. 4. 5. 6. 7 8. 9. -10. 11. -12. -13. -14. -15. -16. -17. -18. -19. -20. -21. -22. Plot plans in duplicate. /triplicate, signed by preparer of plans. . Complete plans 'in duplicate./triplicate, signed by preparer of plans. Complete engineered plans and calcs, with wet signature on plans. Plans with Energy Design Compliance Statement. . . . . . School District "Fees Paid" Stamp on Floor Plan. Statement of Intent for Non -Heated and AC Buildings. Fees of $ ,,* . . . , , . , Letter of signature authorization. .,,�:'r. . . . . . Sanitation approval from Health Dept. . . Planning approval for (A) Use: (B) Parking: . Certificate of Workmen's Compensation Insurance. . . . . . Contractor's License Information (no., name style, classif.) Owner -Builder Verification (Given to owner [I, Mail to owner ❑ ) Improvements may be required. , . . . . . . . . . . Mob'IlehI m n o a Installat' Data o ... Pre-Inspec.request to Pre -Inspection for Required. Building Inspector Recorded copy of Agricultural Acknowledgment Statement. Driveway Permit. Plot plan approval from city of Engineered trusses'in duplicate (required prior top n check)._ CUA FEES RECETPT A (Date) �r r When you issue the permit, process as follows_: Mail to owner,, _Mail to contractor. Telephone and hold for pickup at -office/ Deliver w/inspector. Other Applicant K4 1A Copy of plans sent Health Dept., Fire Dept., 1 Other ' ' ` Date The following data must be submitted prior to permit issuance: (Circle new item not checked#above;. 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner,.was advised of above required data by_phone---'nail—counter by date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW 4 COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 OWNER -BUILDER VERIFICATION Attention Property Owner: Phone: 916 -538 -7541 - An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) 2. -I (have/have not) signed an application for a building permit for the proposed worc. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address . Phone Type of Work Signed: 0 2 , Property Owner A,2_ Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to,our office before we are per- mitted to issue the permit. R ;ESSOR PARCEL NUMBER NEE a s [ J R � Coeor C �, NER'S MAILIN ADDRESS C 7 'OF BUTTE - DEPARTMENT OC WORKS nter Drive - Oroville. CalifornZL :916/538-7541 APPLICATION A, ZONING N LU TELEPHON PERMIT NO. BUILDING PERMIT OCC. I BUILDING VALUATION CONSTRUCTION LENDER a service EA. ADD'L 100 AMP I declare under penalty of- perjury (check one): Fireplace El-" I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and license NEW CONSTR. U LOU L T NON-REBID BRA IR ITS APPARATUS e� UNKNOWN Total Valuation $ Filing Fee LENDER'S MAILING ADDRESS i ARCHITECT OR ENGINEER sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) Pennit Fee ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Mobile Home Facilities LICENSE No. -Plan Checking Fee Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS BUILDING ADDRESS Permit Fee Penalty Contractor under penalty of perjury (check one): I dec?"The Permit fee (� PLUMBING PERMIT Heating v a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Each Trap LOT NO. SUBDI IISION NAME Solar or heat pump water heater Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, PARCEL MAP Water piping Permit Fee Each Ras water neater or vent USE OF STRUCTURE Mobile Home Installation Fee Gas piping system 1 - 5 outlets SF Jk Duplex[ Mobilehomel] Other property purposes. I also agree to save, indemnify and keep harmless the County Building sewer i SPECIFY Mobi!e Home S I G I W T E OF WORK New ❑ Addition ❑ Remodel Utilities ❑ Installation[] Other ❑ Permit Fee Des r' e w rk' LL., -. rv% C e_.. Uontractor ELECTRICAL PERMIT -� Main service SDov OR LESS 00 AMP OR LESS M' CONTRACTORS (CENSE LAW a service EA. ADD'L 100 AMP I declare under penalty of- perjury (check one): NEW CONST. ( DWELLING OCCUP.$) OR ADONS. ACC. aLOGS. El-" I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and license NEW CONSTR. U LOU L T NON-REBID BRA IR ITS APPARATUS e� my is in full force and effect. License No. (POWER SINGLE OUTLET GIR. Classification as the owner, or my employees with wages as their sole compen- Ex, OCCUp OUTLETS OR FIXTURES CD -P�I. Ex. Occup. ouTL ETS PIRE. sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) IKEA. Temporary service ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Mobile Home Facilities Misc. Wiring ❑ I am exempt under Sec. , Business and Professions Code e ? W ; for this reason Permit Fee WORKMEN'S COMPENSATION INSURANCE Contractor under penalty of perjury (check one): I dec?"The MECHANICAL PERMIT permit is for $100.00 (valuation) or less. Heating I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling Ishall not employ any person in any manner so as to become subject to the W. C. laws of California. Hood Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, Ventilation you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 Mobile Home Installation Fee Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned for inspection Energy Inspection Fee property purposes. I also agree to save, indemnify and keep harmless the County TOTAL PERMIT FEE of Butte against all liabil' ies, judgme ts, sts, nd expenses which may in any way accru again t id Cownty in on e u e of the granting of this permit. 711111-11 -- OCC( /. CON ST.TT�t scNooL ►Loon .I S Fi!ing Fee 10.00 2.50 2'12(1 2.50 ea 2.00 10.00 15.00 15.00 s 10 10.00 Filing Fee 1 10.00 3.00 s S $ 37r50 *CtLI ID 1 ND I ISSY[ X Date — This permit is hereby issued under the applicable provl- Signature of Applicant 0 er sions of the Butte County Code and/Or resolutions 10 do ❑ Contractor ❑ Agon- ❑ work indicated above for which fees have been paid. An OSHA permit is rJq red or excavations over 510" deep and demolition or construct- ion of structures over 3 stories in height. DIRECTOR OF PUBLIC WORKS Receipt No. By Date WN IT[•D.-.W., ItLL0W ASe[SSOR. PINK -IN SItCTORI GOLD PROD -AP LICANT PERMIT EXPIRES Date