HomeMy WebLinkAbout043-480-005043-480-005 rte, n4 01-1334
DITH '
816 COLLINDALE CR.,CHICO �ra Sol
CONTR: DRYROT
043-480-005 01-1383
SMITH, VIRGIL & JUDY
816 COLINDALE CT. CHICO
CONT: A JACKS ROOFING
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043-480-005 01-1383
SMITH, VIRGIL & JUDY
816 COLINDALE CT. CHICO
CONT: A JACKS ROOFING
RE ROOF
COUNTY OF BUTTE -`DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERMIT NO.
(Rev.12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER ..w Ti2
ZONING
BUILDING PERMIT
,
OWNER / ;"' �j -fA
l
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
`U
CONTRACTOR'S NAME /nom ,,'//X.y yy.
♦ /
TELEP NE
��
CONTRACTORS MAILING ADDRESS q
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $ f
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ Z
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE S
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE '
SF Duplex ❑ Mobilehome ❑ Other
SPECIFY .46
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK /'�
New ❑ Addition ❑ Remodel�0 Utilities ❑ Installation ❑ OtheC
Describe Work:
Gas piping stem 1 - 5 outlets 15.00
Buildin sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee ,x,.,20.00
Main Service A OR LESS 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. / S�
License Class C, i`1 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: 'TemporaryService
❑ 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
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.
jrl I 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 /j At'A
Policy Number lneCl /-7i 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'HAz.
compensation laws o-# California, and agree that if I should become subject to the
workers' corLn`se ' ry provisions of section 3700 of the Labor Code, I shall`
forthwith c,,omply'�vi ose provisions.
'of
X/ Date V' 6//
Signature of_/Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A TO t000A 46.00
NEW CONST. DWELLING OCCUP. s0
OR ADDNS. ( :
NO .c.0,D. - MULTI -OUTLET @7,50
POWER APPARATUS
a SINGLE OLmET CIR.
OUTLET OR FIXTURES O 100
20 00
Ex. Occup.
Ex. Occup. OUTLEEDTs RES D.D� 5.00
23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEI: $
Mobile Home Installation Fee $
Energy Inspection Fee $
DCC
CONST. TYPE
TOTAL FEE $ g.
D FEES IMP
FLOOD
CDF
PARCEL
PD
HD
ISSU
This permit is hereby issued under the applicable provisions
the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
/
By ate
PERMIT EXPIRES ONy/A/
eta
Receipt No. �► 9 Uel
WHITE-D.D.S.-B.D. CANARY-ASSES4 R PINK -INSPECTOR GOLDENROD -APPLICANT
r
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERMIT NO.
(Rev.12/96) APPLICATION AND PERMIT o _,,_.V
3
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
owNEAs MAILING ADDRESS LIZ G�
l
o
CONTRACTOR'S NAME`' •f�'�t�
w VI ,4
TrP�E�Z��
CONTRACTORS MAILING ADDRES 1,ai; Aide
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation is yp
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
2
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE S
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
/
SF J]/ Duplex ❑ Mobilehome ❑ Other
sPECIPY
Each Trap
7.00
Solar or heat um water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other
Describe Work: x�(%
Gas piping system'i - 5 outlets
15.00
Building sewer15.00
Mobile Home S G W
920.00
PERMIT FEE S
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service 200A OR LESS
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 N for and effect. ����/j/
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:
❑ 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
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.
0/1 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' com ensatiog insuranc carr�s end policy number are:
Carrier A<4�¢S(�i(if
Policy Number ln^C7
(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
not employ any person In any manner so as to become subject to workers'
compensation law California, and agree that if I should become subject to the
workers' co provisions of section 3700 of the Labor Code, I shall
forthwith ose provisions.
elIf—,/%
X Dateyl
Signature otxppTil ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service YOGA TO 1000A 46.00
NEW CONST. DWELLING OCCUP. s0
OR ADDNS. ( a ACC. BLOS. 3.50FT.
=REE,sIU MNIC, UTLET
97.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
YO °'•00
Ex. Occup. OUTLET OR FIXTURES s„L o ,50
Ex. Occup.ouxn�s RAID°� 5.00
Temporary Service 23.00
Mobile Home Facilities
20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt S
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ YPE
TOTAL FEE $ 2—
3HAZ.
IM�=� D
t
HD
ISS
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.
By jDate
PERMIT EXPIRES ON 4
I 1pt.)
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSES R PINK -INSPECTOR GOLDENROD -APPLICANT I
NOTES
RESIDENTIAL
043-480-005
ENGLESBY-SMITH, JUDITH 01-1334
816 COLLINDALE CR., CHICO
CO.NTR: DRYROT
it
4
of
to - Qt
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION, ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
4.
013 FINALED (D e
Signature z
,/ = OK
0 = Not OK
- = Not Applicable =Not Ready
MOBILE HOMES t
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
Zoning Requirements -Setbacks -Easements
2.
Soils; Special MH Support Sketch
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Sewer; Location -Test -Fall -C/O -Concrete
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Water; Location -Test -Easement Needed (Sketch)
MOBILE HOME INSTALLATION (Plans) OK except #'s
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
Zoning Requirements -Setbacks -Easements
6.
Gas; Location -Test -Wrap;-/ /" L'ft.
/ /'Nat. or/ /"L"ft./ /'LPG
Footings; Size -Spacing -Marriage Line
7.
Well Clearance & Disconnect
8.
Utility Clearance
Date
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
Date
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
Card B-1 Date Card B-1
Date
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
5.
Drain; MH Test -Fall -Flex Connector
6.
Water; MH Test -Regulator -Connector
7.
Water and Sewer Connected -C/O to Grade -HD Approval
8.
Gas and Electricity Tagged
9.
Tie Downs -Type -Installation Can.
Date
10.
Exits; Insp.-Sketch
Date
11.
Cert. of Occupancy
Date
12.
Permanent Foundation Only; License Decal
1.
Setbacks -Easements
Date
2.
Card B-1 Date Card B-1
Date
3.
Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts-Beams-Rftrs.-Connectors
Shthg.-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills -Anchors- Studs- Rftrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip, w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures- Panelboards-Ins. to Main in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card B-1
Date
Card 13-1 Date Card B-1
V= OK
0 = Not OK
- = Not Applicable RESIDENTIAL (Single & Duplex)
• = Not Ready
Date Underfloor (Plans) OK except #'s Date
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth
5. Stemwalls, Main; Ste el-Blockouts-Wrapped
FRAMING (Continued)
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
6a.
Hold Downs and Special Anchors
7.
Slab, Steel -Wrapped
8.
Piers -Fireplace Ftg.-Steel
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
11.
Water Pipe; Test -Anchors -Regulator -Service Test
12.
Electric Underground
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15.
Access & Ventilation
16.
Insulation
58.
Glazing Area -Glass Protection -Skylights -Plastic
Date
59.
Card B-1 Date Card B-1
Date
60.
Card B-1 Date Card B-1
Date
61.
PLUMBING (Permit) OK except #'s
17.
W r r.; Vent -Access -Combustion Air Baffle
er Pipe; Test & Anchor -Nail Protection
Date
�% �� Card B-1 Date Card B-1
D.W.V.; Test Fittings & Anchor -Nail Protection
20.
Shower Pan; Test, First Floor -Tub Access
21.
Test Tub & Shower, Second Floor -Tub Access
63.
22.
Gas Pipe; Sixe & Anchors
64.
Smoke Detector
Date
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
Card B-1Date Card B-1
Date
Be rd`om Exiting
Card B-1 Date Card B-1
Date
G.F.I. & Bath Fixtures & Tub Access -Spa
ELECTRICAL (Permit) OK except #'s
68.
23.
Fixtu & Transformer Clearance -Ins. Protection
69.
Stairs & Rails
ec,Xeceptacles Spacing -Lights & Switches at Doors
70.
Q,le&
Boxes & No. of Conductors Stapled
71.
26.
Romex Installed Close to Edge of Studs & C.J.
72.
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
73.
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
74.
29.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At
75.
30.
Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At
Insulated Neutral ❑ Yes O No
76.
31.
Service -Riser Conductors & Ground Main Disconnect
77.
32.
Equip. Clearances Panels-Motors-Mech. Equip.
78.
33.
Clothes Closet Light -Shower Light -Spa Light
79.
34.
Smoke Detector
80.
Guard Rails & Deck Construction -Post Caps
Date r - 7-��
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
35.
A.C. Ducts Insulation & Support
36.
Vent Fan, Exhaust above insulation
37.
Condensate Drain & Overflow, Size & Grade
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
39.
Attic Access & Platform if Furnace in Attic
87.
Exterior Elec Trim, G.F.I. Receptacle -Underground
88.
Ventilati Throughout House
Date
89.
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
91.
FRAG (Permit) OK except #'s
92.
Sill roper Materials & Anchors
qjjXaIIs
Studs -Nailing Spacing & Braces -Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
Date
Date
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
Date
45.
Headers & Beams -Size & Bearing
FRAMING (Continued)
46.
Hangers -Post Caps -Anchors -Connectors
47.
Cling. Joist-Rftr. Ties- Purlin-Rolf Brac.-Truss-Shting.-Rfng.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Ratter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skylights -Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
Infiltration -Walls -Windows
Date
�% �� Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66.
Be rd`om Exiting
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
82.
Following Instld./Drive J Yes J No/Walks J Yes J No/Planters J Yes D No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec Trim, G.F.I. Receptacle -Underground
88.
Ventilati Throughout House
89.
GI Protection
orrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
Date
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
4i .�+"e•`�i&.�L;{G„`l!�s.� �.h���i!'�5..,.}.'�.r�w...,......hi..tr:>.,.'aw
COUNTY OF BUTTE
• BUILDING DIVISION
ti
.r,
DEPARTMENT OF DEVELOPMENT SERVICES
w`
411 Main Street • Chico, CA • (530) 891-2751
..
7 County Center Drive • Oroville, CA • (530)-538-7541
CORRECTION NOTICE
4'
OWNER PERMIT NO:
}'
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
r
please contact this office immediately.
f•� 7
1-91
4
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f•� 7
4
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:--.3
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/
Date Inspector
/-
REV 10/92 f`
xa
t COUNTY OF BUTTE X'
-BUILDING DIVISION...:.: .
DEPARTMENT OF..DEVELOPMENT'SERVICES
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
.CORRECTION NOTICE
' OWN R PERM T NO.
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
'Y is completed. If you have any questions pertaining to this matter, or need additional explana3ion,
r. please contact this office immediately. a F
e
r �)
Date Inspector / —
REV 10/92 i
>
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
• 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT ��"/3 3
ASSESSOR PARCEL NUMBER 11 _
7 ye - o�--
ZONING
BUILDING PERMIT
OWNER
L -
TELEPHONE
.S' 7- 5 M?
SO. FT. OCC. BUILDING VALUATION
(� (
v o
.OWNERS MAI NGGADORESt
' 1� c o Cedn o 96 0 73
CONTRACTOR'S NAME
V
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
�� o
ARCHITECT OR ENGINEER
LICENSE NO.
Flirt Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS B' C, 1 � t,��1�1c r
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF,P� Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump 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: ,lor
Gas piping system 1 - 5 outlets
15.00
Buildingsewer
15.00
Mobile Home I S G W
920.00
PERMIT FEE S
L
ELECTRICAL PERMIT
Filing Feel 20.00
"OOVORLES
Main Service 2o.A OR LESS
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.
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:
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
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' compensation insurance carrier and policy number are:
Carrier
Main Service 200A TO I000A
46.00
NEW CONST. DW ELIJNG OCCUP.
OR ADDNS. ( 8 ACC. S.
SO
3.5¢FT.
DpµR61� MULTI.OUTLET
97.50
PGWER APPARATLIS
a sINGLE OLrnEr C..
Ex. Occup. OUTLET OR FIXTURES
20°'•0°
BAS p .so
FIX
Ex. Occup.G,InF°S RE,D,DE
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE t
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEt $
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 L Com'/ Date ('0
SignaturetoApplicant - Owner ❑ Contractor ❑ Agent
AnOSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC CONS4TYPE `��
OTAL FEE $
E.AP FLOOD CDF ISSUE
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
indicated above for which fees have been
B o
PE MIT EXPIRES ON
provisions
to do work
paid.
atec/
/ Z.
eta
ReceiptNo.L0300
WHITE-D.D.S.-B.D. CANARY -A ESSO - PINK -INSPECTOR GOLDENROD -APPLICANT
III
s
i O.B. l
OWNER-BUILDER,VERIFICATION I
Attention Property Owner:
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 NO 0
2. I HAVE �,r HAVE NOT ❑ signed an application for a building permit for the proposed work.
3. I have contracted with the following person. f rm) to.provi4e_the•proposed construction:
NAME:
PHONE:
CONTRACTOR'S 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: CONTRACTOR'S 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: � 1 � (�-Sub,� Ste^ �\
PROPERTYOWNER: \ �!
SOCIAL SECURITY NUMBER:
DATE: S- z C7` Z O --C)- i
NOTE. This Owner -Builder Verification is required by Section 19831 and 19832 of the
California Health and Safety Code. This verification must be completed and
returned to our oJylce before we are permitted to Issue the permit
10"f •7
OWNER BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvemetts specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such
a permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself Brom possible
liability if that person applies for the proper permit in his or her name.
Contractors aro required by law to be licensed and bonded by the State of California and to have'a business
license from the city or county. They are also required by law to put their license number on all permits for which they
apply;
If yOd pltid to i0jrour own work with the exeepdon of various trades that you plan to subcontract you should
be aware of the following information for your benefit and protection: '
♦ If you employ or otherwise engage any persons other than your immediate family, and the work (mchrding,ma vials
and other costs) is $300 or more for the entim.project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
♦ If you am an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security. taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
♦ Thee may be financial risks for you ifyou do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
+Mage"r.,'�BuViid
ira, C.B.O.
ing inspection
NOTE. This Owner -Builder Information is required by Section 19810 of the Cal jornla Health and Safety Coda
OVER