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Home My WebLink About042-770-024BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060393 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 Issued Date: 02/21/2006 APN: 042-770-024-000 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 : C3 % License Number: �5!FO73 Site Address: 755 CHURCHILL DR CHI �Map Z/ Date: aoPj Z Index: Description: RE -ROOF (45 SQ) OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: SAMPSON MARTHA F SS permit to construct, alter, improve, demolish, or repair any structure, prior 755 CHURCHILL DRIVE 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 CHICO, CA the Contractor's State License Law (Chapter 9 commenting with. Section 95926 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 Applicant: FOUR SEASONS ROOFING Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does #11 COMMERCE COURT such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for SUITE #1 95928 sale. If however, the building or improvements are sold within one 530-895-0418 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 Contractor: FOUR SEASONS ROOFING 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.). #11 COMMERCE COURT SUITE #1 95928530-895-0418 ❑ I am Exempt under Article 3 of the Business and Professions Code Date: Owner: License #: 659073 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: C)-,' I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Architect: Labor Code, for the performance of the work for which this permit is issued. Engineer: ❑ 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: Carrier:—a rim sh_-44 Total Square Ft: 0 S. F. Valuation: $0.00 Policy#: Census Code: ❑ 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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 40 {; 2- Gl O� Applicant: WARNING: Failure to ecure 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 Resolio to do w, rk indicate above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) aY9- �1.v�r� Name: _ By: Date: 1 � R 29J — Address: PERMIT EXPIRES ON: lJ I (Date) ❑ 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 state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official for or document of Butte County. I hereby authorize representatives of Butte/County to enter upon the above mentioned property for inspection purposes. � T Print Name: �- kl Ctyl Signature: Date: Z L! O ❑ Owner ❑ Contractor ❑ Agent for Owner Agent for Contractor B. C. Building Permit 01-16-04 pg 1 ti BUTTE COUNTY PERMIT 0 DEPARTMENT OF DEVELOPMENT SERVICES NO. i 0 BUILDING PERMIT APPLICATION v O = 0 AND SUBMITTAL REQUIREMENTS o _ 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 BPOOO 0_.=_p; 0 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION BIN # 011 N Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY-* CONTRACTOR OWNER INFORMATION Last Name C r.�C S� First Name C �Gcv► Address 55 rc�110 dr city Cil� ; C v Fax Slate Zip? 7 Phone 3 L/ 2 _ J 0 b56 Fax E-mail State License Number CONTRACTOR Name Address l C0 MW-fe-t: 4 / City G� 10 State C� Zip Cr Z� Phone y-_ v Lf (9/ Fax E-mail Lic. #�S �D ClasL 3 7 APPLICANT INFORMATION ARCHITECT/ENGINEER Name City , (4 C o Address 7 City Fax State . Zip Phone Book Fax E-mail Planner State License Number APPLICANT INFORMATION Name Address I l Comrv>tirr� ��- . City , (4 C o State State Cly- 7 Phone C�� / Fax E-mail PL/ ANT SIGNATURE /_ Z V X .X9 For offic use only: Zoning Property Address t,-rG r h Ar 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 PROJECT LOCATION r / Property Address t,-rG r h Ar City "Co Cross Street WORKER'S COMPENSATION Policy Numbe Carrier Cr�`r„ � 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 t Description or Scope of Work: �I e,,r O f g 4,, r a,J r,v ,( t -z ro o -C w l.-fo-f L% 57 - 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 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: K, V ' Amount: 2:q-7 ✓ Bldg SRA Receipt #: �� `t� U 1 Sheriff SMIP Date: 2" Y— /1.r 1 C)"" /� I Other �2LI7• �� 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 INKS ❑ . 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 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. Building Permit Application Without Required Clearances Form ❑ 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). .� q 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, ❑ Copy 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 KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV B-12-05 r' 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 INKS ❑ . 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 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. Building Permit Application Without Required Clearances Form ❑ 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). .� q 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, ❑ Copy 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 KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV B-12-05