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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buffecounty.netIdds
PERMIT NO.
BP042876
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 10/01/2004 APN: 047-490-007-000
the Business and Professions Code, and my license is in full force and
affect.
License Class: License Number:
Site Address: 5400 NORD HWY CHI
Date: Contractor:
Map Index:
Description: reroof W/comp (18) also gufters
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: BRIAN ILLES
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
5400 NORD HWY
signed statement that he or she is licensed pursuant to the provisions of
CHICO, CA
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
95973
she is exempt therefrom and the basis for the alleged exemption. Any
530-865-3000
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).):
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 (Sec. 7044, Business and Professions
Applicant: BRIAN ILLES
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
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
Contractoc. UPSTATE CONSTRUCTION
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
6299 ROAD 25
pursuant to the Contractors' State License Law.).
ORLAND,CA
LI I am Exempt under Article 3 of the Business and rofessionsCode
lrtM�
95963
Date: W=1 �_
530-865-3000
__Oqwnerll�
License #: 818285
WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
13 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
Architect:
is issued.
Engineer:
13 1 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 carder and policy number are:
Cartier:
Total Square Ft: 0 S -F
Policy #:
Valuation: $0.00
Census Code:
)9— 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 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: 10 — I — (2j
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
This permit he y issu under the applicable provisions of the Butte County Codp anevor
Resolution. 0 1' icate4 above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By: Date:
PERMIT EXPIRES OIJ (Date) i
Address:
0 1 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.
0 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
E3 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 form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
PrInt Name -7
Signature:
Date:—/D
Owner Ll Contractor 0 Agent for Owner Q Agent for Contractor
i
I rA
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.neAdds
PERMIT NO.
BP042775
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
I
Issued Date: 09/21/2004 APN: 047-490-007-000
the Business and Professions Code, and my license is in full force and
effect. C 11
LicenseClass: L)o License Number:C
Site Address: 5400 NORD HWY CHI
I
Date:clk �,11 IbLI Contractor: --a
Rapindex:
Description: HVAC CHANGE OUT
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury.Jhat 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: LIGHTY MARK W & TERESA N
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
PO BOX 899
signed statement that he or she is licensed pursuant to the provisions of
ROUGH & READY, CA
the Contractor's State License Law (Chapter 9 commencing with Section
95975-0899
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).):
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 (Sec. 7044. Business and Professions
Applicant: ST CLAIR, ROBERT
Code: The Contractors' State License Law does not apply to an
owner of property. who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
2361 HOLLY AVE
provided that such improvements are not intended or offered for
CHICO, CA 95926
sale. If however, the building or improvements are sold within one
530-898-9889
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.).
1, as owner of the property, am exclusively contracting with
licensed contractors to construct the pi�oject (Sec. 7044, Business
and Professions Code. The, Contractors' State License Law does
Contractor: ST CLAIR, ROBERT
not ap�ly to an owner of pr6perty who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
2361 HOLLY AVE
CHICO, CA 95926
1 am Exempt under Article 3 of the Business and Professions Code
530-898-9889
Date: Owner:
License #: 838755
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0* 1 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: k—
LI 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:
cl
Carrier:
Policy #:
T
Total Square Ft: 0 S. F. 9,
----
Valuation: $0.00 ffd
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.
01 f;�l — c) k_j
Date: -S
I
Oro.
Applicant ri
WARNING: Failure to secure workers' compensation coverage is
unlawfuF—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—
I hereby affirm that there is a construction lending agency for the
..This permit is hereby issued under the applicable provisions of the Eli ifte County Code ?nlvor
Resolutioni to/do Vrk indic;;WhiEh`f6_eifi_av6 been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
By: Z Date: 4/.42
Name:
I
PERMIT EXPIRES ON - r �?�
Address:
(DIfe)
• I hereby cerlify 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 f.an� Ifici I form or document of Butte County. I hereby
authorize repre.seTtatyes of Butte County to enter upon the above mentioned property for inspection purpo
"I ,
L-162 6'a
Print Name: 'Sk Signature: I
V ./I %-.Jl
Date: 4
Owner Q Contractor El Agent for Owner 0 Agent for Contractor
I—
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.net%dds
PERMIT NO.
BP042775
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
I
Issued Date: 09/21/2004 APN: 047-490-007-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: Cla-0- License Number:C(��S.
Site Address: 5400 NORD HWY CHI
Date: Contractor: Ubev_,� e"i /)
�_3a z:50 Lua
Map Index:
Description: HVAC CHANGE OUT
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: LIGHTY MARK W & TERESA N
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
PO BOX 899
signed statement that he or she is licensed pursuant to the provisions of
ROUGH & READY, CA
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
95975-0899
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).):
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 (Sec. 7044, Business and Professions
Applicant: ST CLAIR, ROBERT
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
2361 HOLLY AVE
provided that such improvements are not intended or offered for
CHICO, CA 95926
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
530-898-9889
proving that he or she did not build or improve for the purpose of
sale.).
1, 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: ST CLAIR, ROBERT
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.).
2361 HOLLY AVE
IZI I am Exempt under Article 3 of the Business and Professions Code
CHICO, CA 95926
530-898-9889
Date: Owner:
License #: 838755
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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
Architect:
is issued.
Engineer:
0 1 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 carder and policy number are:
Carrier:
Total Square Ft: 0 S. F
Valuation: $0.00
Census Code:
Policy #:
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: q I _r) q
Applican (01 nA 54 CID V
-t
WARNING: Failure to se, —.,npensation 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 LENDINIG�_AGENCY_4
I hereby affirm that there is a construction lending agency for the
This permit is hereby issued under the applicableprovisions of the Butte County Code of
Resolutiong toAo work indicat hich fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By*** Date:
4�� -
Address:
IV
PERMIT EXPIRES ON: '
�
I (D,4te)
C3 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.
Q Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
CI 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 f an official form or document of Butte County. I hereby
authorize repre+setat', Butte County to enter upon the above mentioned property for inspection purp s
kesoff
Print Name: Signature: r) p
-04 Date:
Lo-ner El Contractor L3 Agent for Owner 0 Agent for Contractor
0
0
0
BUTTECOUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CIUCO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQ ULIZED A T T1W OF APPLICA TION
"PLEASE PRINT CLEARLY"
OWNER
Last Name
Name
aT 8
rA
Address P100 Akh/
Zip
city
State j
state
-Ci"(
Phone
1 ��14
Fax
E-mail
APPLICANTNAME
ARCHIM—TIEN61NEER
Name
city
Address
Zip
city
Fax
state
7-51
Phone
Book
Fax
E-mail
Slate Ucense Number
APPLICANTNAME
Name
Address
city
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office Use only:
Zoning
Property Address
'Sq co tjoy-j
Fl6od Zone
F��s-s TSeet
SRA
, WORKER'S COMPENSATION
Policy Number
Occ. I
Type Const.
Subdivision Name Map
Book
I Page
Lot #
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BPt)q')7-?.
BIN #
LOCATION
AP# rVj --7_4qo__(D
k -OF r 07
Property Address
'Sq co tjoy-j
I cr'Ll
F��s-s TSeet
, WORKER'S COMPENSATION
Policy Number
CarTler
If hiring anyone other than license contractors, a certificate of workees
ance.
compensation must 6e shown at the time of permit lssu:�ffl
LENDING AGENCY
Name
Address
Description or Scon f Work -
HAIR( rG A n �:' �
U �j
Sq. Footage
• Structure Built v4thout 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 fof work plan checked and other department costs are not
refundable.
Received by-. Amount Bldg
SRA
Receipt P Sheriff
SMIP
Date: Other
T a,
I otal
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. �INCOMPLETE SUBMITTALS MLL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK
0 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paperl
0 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.
0 3. Engineered truss details and layouts in duplicate (if required). No faxesl
0 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.),
El 5. Statemeni oi Iritent' for Non -heated an d- A/C for Non -Residential Buildings.
0 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.
11 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 stanlDed and wet -signed by the engineer.
11 8. Flood Elevation Certificate, wet -.stamped and signed, in duplicate (if required).
0 9. Site plan and business license approval from the City of Biggs.
11 10. Lefterof intent for non-residential buildings.
El 11. Detached Accessory Building Form filled out by the owner (if required). -
0 12. Hazardous Material Form (for Commercial Buildings only).
0 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.)
0 1 . Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
0 2. Impact Fees.
0 3. California Department of Forestry plan approval (if required).
r_1 4. NPDES Form.
0 5. Encroa�h rn'ent Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
0 6. Contractor's license lnfbrma�don. (Number, Name Style, Classification).
0 7. Workers Compensation Carder and Policy Number.
0 8. Owner -Builder Verification (if required).
0 9. Letter of Signature authorization (if required).
0 10. Recorded copy of Agricultural Acknowledgment Statement.
0 11. 11 Grant Deed, 13 M.H. Title/Statement of Facts, 0 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
Ketunds can only be made upon written request by the person who paid the fee. The request must be made within two
vears from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
ssued; however, on issued permits refunds can only be made if no construction work has been done.- Filing fees, plan
,heck fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
�\FORMSXBUILDING F0RMS\B1dgApp1SubRqmtS.doc Page 2 of 2 P;:%/ 7-97-f%A
Butte County Department ofDevelopment Services
YVONNE CHRISTOPHER, DIRECTOR www.buttecounty.net/dds
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-7785 Facsimile
ADMINISTRATION * BUILDING * GIS * PLANNING
August 30, 2004
Brian Illes
5400 Nord Hwy.
Chico, Ca. 95973
RE: Building Code Violation
Location: 5400 Nord Hwy. Chico, Ca. 95973
AP#: 047-490-007
Dear: BrIan. 4les
This is a courtesy notice to notify you that you are in violation of the Butte County Code, at the
above -referenced location, as follows:
Failure to obtain the required permits, inspections and approvals fi-o-m this officefor the
re -roof of a single-family residence.
Since pennits and inspections are required for the above work, please submit three (3) complete
sets of plans, apply for the required permits, and pay the appropriate fees. All work must stop
until these pennits are issued and you are authorized by our field inspector to proceed. The field
authorization cannot be made until the existing work is inspected and approved.
It is the County's goal to obtain voluntary compliance with the Butte County Code. However,
you should be advised that Butte County has an active Code Enforcement Program which
provides an effective means of enforcement if voluntary compliance is not obtained.
Enforcement may be pursued through the issuance of citations, fines and the recording of a
Notice of Violation including a description of the action necessary to abate the violation.
You have thirty CLO) days to voluntarily comply with the above directions or to present an
acceptable plan for abatement or corrective actions to be taken by you. Should you have any
questions concerning this matter, please contact Michael Vieira in this office at the address or
telephone number listed above.
#A--,
Mic 1 1
,taael V'e'rall
d
d,
Bui in2 Official
MV: ms
cc: Assessor
JAS0100Y0,12-9: Assessor Inquiry
Auq27,2004 lz'-30pyn�
N5meFE7BRIAN
��rrl #
Fee 41047-490-0-7-000
- -
3tatus JACTIVE St tus Date
A'Jdrl 15400 NORD HWY
ax fdb� [NORMAL OWNERSHIP
TRA F2 -02t
Addr2 I CHI CO CA 95973-8930
Situs F5400 NORD HVfY CHICO
Addr31- All
Base D t [ET1 —9/200�-�
Addr4l
Land 77,928
O�Timber Preserve
L
ctructure 935-3
ff4gPres
Comments i'mg655uEONVER-ED 0'--./08/88
Fixtures 13
r -q Etal
Creating Doc#11�801�2E�7�46 Date
Gior-ving 13
Current D oc# 2004R 0015390 Date -FO 3-119 2 0 0 4. i
�' 0. Bonds 1 otal L& 1 171,441
Fi�- RP 0
Doc# Date
t H ulti S itus
MH PP 0
.Kiling
Asmt DescJ5400 NORD H77�-�! Sup[Cntf—'—';
Flagl
Ml Fl�g2 PID
ZoningFAR 00
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i.
��Dwell�
. I 1 0
A cresiSq Ft N /C FG -47,-
U Asmt PP Pen N et
T24 Tax PP Pen F.A'C#[-
0. Appeal Pending T/R DtF—
j SplitPending p,/CStatF—
r
P�Y'l--o-W-N L-Ecp TAX
NON ATT SIT
APFI BCL
f in�j-gd_A
r?oq-- iaupt�on, 08J 11004 10:33:22 AM
t1d
FIRE DAMAGE REPORT -
LOCATION:
CONTRACTOR:
/4 3 PERPvHT HISTORY: NONE )AS
DATE TO INSPECTOR: -7,5(,()
FOLLOWS:
DATE: 7/8//03
A.P. #�F��)-(T-77IM032�p
ZONING: - Ae
BULDING INSPECTOR'S REPORT
Building Description: I . I I
Commercial/Usage:
Residential/# of Units:'
Currently Occupied )�� -
Abandoned[Vacant K6
Electric: Yes No
Condition of Electric
Electric currently On Off vl�,
Gas: Natural Propane None Currently On Off
Obvious
Problems:
Sanitation:
Plumbing W I orking
Well Working Potable Water
Obvious SewageProblems I%V*AIJ�5
Description of Damaged Area:_U rV Al ru A, e,,
Estimate Valuation of Damaged Area:
Condition of Foundation:_w
Mobile Home: Condition of Utilities: f
Inspector:
Sketch building on reverse and indicate area of damage.
CQ
Date
J
C)q-7 -qqo- o13
CDF/BUTTE COUNTY FIRE INCIDENT LOG
DATE [1071�2�71�2001 INCIDENT NUMBER r 8506J LOGGEDBY
REPORT TIME 4:00 LOCAL FIRE NUMBER E77-77777 RO
STATE FIRE NUMBER -11 BI
CASE NUMBER ----7 MEDICS
I r
LOCATION 115400 NORD HWY X CARMEN LN PRA �T53
RPI PHONENUMBER 865-1277 REPORT METHOD F!l I
WILDLAND FIRES El ESTIMATED ACRES 170i FIRE INFORMATION
STRUCTURE FIRE IFIESIDENTIAL FIRE INFO SENT HOW BY
OTHER FIRE 7 -DAY LOGGED INITIALS r�B
MEDICAL AIDS INCIDENT NAME
PSA/OTHER START DATE [ME
TO U-1
0:01
HAZ MAT I I . DIAMOND # 5.0
COMMENTS CAUSE TRICAL POWER.
FIRE IN THE LANC
BEDROOM –r_i
ACRES r 0 TYPE OF ACRESr-7—
DIAMOND 5 ONLY $ DAMAGE TYPE ALL OTHER
7!� — 11,
DOLLAR DAMAGE 0.00 SAVE' DOI
INJURIES/FATALITIES
EMD El OES 1-1 # CIVILIAN INJURIES EZ5 #CIVILIAN FATALITIES =0
# FF INJURIESF-0 # FF FATALITIES 01
FC -40 INFORMATION
N ew Inc ident FC -4o El DATE OF FC -40 INC
AGENCY INC# INC P#
FC -40 COMP DATE FC -40 COM P BY
County Notifications EARS Hard Copy Recieved Ej EARS Checked Agenst EARS Computer
;V�
County of Butte
Oroville, California
GENERAL CLAIM
CLAIMANT:
ADDRESS:
G & R Roofi
2587 Nord Avenue
CITY & STATE: Chico, CA 95973
DATE OF CLAIM: 05/17/04
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
Refund Claim - See attached calculation sheet APN: 047-490-007
Permit No.: 04-0654
PAID
RETAINED I
REFUND
.Development
Services
$ 165.00
$ 54.99
$ 110.01
SRA
$ -
$ -
$ -
Sheriff
$' -
$ -
$
.Other:
$ -
$
$ -
TOTAL
$ 165.00
$ 54.99
$ 110.01
...............................................
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-.:::B - G T:::
..............................
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-AQQOXfNTj::AM6tNr:::
...... 6. A .....
..............
...............
Development Services
440-001
4210500
S 110.01
SRA
0100
4617240
S
Sheriff
280
1011811
$
Other
$
TOTAL[
$ 110.01
$ 110.0-11
1, the undersigned, declare under penalty of pedury that the services or articles claimed have been performed or delivered, and that this
claim is true and correct as stated.
Dated this day of V&Zly . 2004, at Calif.
Signature of Claimant
1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or
delivered and that there is a Budget Appropriation or Specific Board Approval (Check one f e sam
r th, e.
Dated this day of 2004, at Oroville
Department Head or Authorized Deputy
Dept. SEE Exp.
Code BREAKDOWN —Code PAYABLE FROM 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.
VA
a
vexlw?�l pp7erz—
DAI� �OVC'IZ, - (V'00"�
w/o Ferw Rs� 4)��
Butte County Department ofDevelopment Services
YVONNE CHRISTOPHER, DIRECTOR
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-7785 Facsimile
ADMINISTRATION * BUILDING * GIS * PLANNING
May 17, 2004
G & R Roofin-
2587 Nord Avenue
Chico, CA 95973
RE: Permit No. 04-0654 APN#047-490-007 Owner: Mark Lighty
On 3/9/2004, a deposit was made in the amount of $165.00, of which $54.99 was
retained. The remaining fees will be reimbursed to you. Please sign, date, and return the
enclosed claim form to this office. Once we receive the claim form, we will then process
your refund in the amount of $110.0 1.
Should you have any questions, please contact this office Monday through Friday, 8:00
a.m. to 4:00 p.m., at 538-6869.
Sincerely,
Diane Lewellen, OA III
Administrative Division
enclosure
04-0654.1tr,
I
I REFUND CALCULATION SHEET I
LAIMANT: G & R Roofin
ADDRESS: 2587 Nord Avenue
CITY & STATE: Chico, CA 95973
DATE OF CLAIM: 03/16/04 APN: 047-490-007
RECEIPT INFORMATION
NUMBER: 395129
DATE: 03/09/2004
ISSUED TO: G & R Roofin
CHECK #: 5556
AMOUNT: $165.00
PERMIT #: 04-0654
Yes
PRIOR REFUNDS:
FEES VERIFIED
DETAIL
BLDG
FILING FEES
Mechanical
PLAN CHECK
Plan Check
Energy
INSPECTION
PERMIT FEES
Building
Plumbing
Electric
Mechanical
OTHER BLDG
Overcharge
REFUND PROCESS FEE
BUILDING TOTAL
SRA - FIRE
Fire $43 1
SHERIFF - $360
Sheriff I
OTHER NON -BLDG
APPROVAL
Date Reviewed
Michael Vieira
Building Manager
Yes I No I Yes
x I
REFUND BREAKDOWN
BLDG
AAA AA4
PAID I RETAIN REFUND 4210500
165.00
M — 1
$ 165. 0 OT$
0100 280
4617240 1011811
.............. ..........................
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...... * ..................... ...........
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.............. ..........................
........................
165.00
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-54.99
......................
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-54.99
110.01
110.01
..............
..........................
................
CHECK: $110.01
DIFFERENCE:
Monday, May 17,2004
Counter Paula
Person
Devel6jirfien.t Service!�
BUILDING DIVISION Ver. 1.0
. .... ..... .
Payment Date
Permit Number
Receipt Number
Check Number or Cash
Parcel Number
Applicant
3/9/2004
BP040654
395129
5556
047-490-007
MARK LIGHTY
Received From
$165.0�_]
G & R ROOFING
Total Received
5.00 —
Total Fees To Collect ij $165.00
Notes:
Fund 10 (Bldg Permits)
$165.0�_]
SRA Fees (Fire)
$0.00
SHR Fees (Sheriff)
$0.00
SMIP
$0.0 ?1
Copies/ Document Sales
$0.00
CUA (Chico Urban Area)
F- $0.221
TUA (Therm. Urban Area)
$0.2�j
Water Tender BtIn #=
$0.00
West Chico Fire Station
$0.0
22J
Witness Fees
$0.00 1
Recorders Fees (N.O.C)
�0-0–oj
Thermalito Drainage
$0.00
Oroville Area Traffic
$0.00
NSF (Non Sufficient Funds)
$0.2�j
Notice of Violation
NCSP Trails System
E -Lo -22-1
NCSP Roads/Bridges
$0.00
NCSP Storm Drainage
.$0.00
NCSP Fire Station
$0.22j
NCSP Parks Type =E
---L0-00
Value 1
$0.00
11� �Oumfc
Butte County Department ofDevelopment 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
t he 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 to Developme Services for Dayment processing.
CLAIMANT'S NAME.
-7
MAILING ADDRESS:
PHONE:
gyq 4��15-7
ASSESSOR'S PARCEL NO.:
-7
[Please use one claim form per permit.]
BLDG PERMIT NO.: PyP
2:1
RECEIPT NO.:
- Receipt No. I
Receipt No. 2
Receipt No. 3
RECEIPT DATE:
RECEIPT AMOUNT:
IL
SID
REASON FOR REFUND REQUESV"
ev� pverl>,�� 0
Check those fee hich you wish to have considered for refund:
ESO"Building Permit Fees Sheriff Fees SRA Fees (CDF Fire Planning)
Other (specify):
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 pick them up prior to that time.
Signature
K/Forms/Refund Application 082203
Date
�®1 ; �
� i �• • • t ► •..
'�♦
� `� , � �� �
• � �..
��� � I
-d=
Butte County Department ofDevelopment Services
Building Division
7 County Center Drive
Oroville, CA 95965
(530) 538-7541
REFUND REQUEST APPLICATION
REFUND POLICY - Butte County Code 3-41 (t)
I . Refunds can only be made upon written request by the person who paid the fees, whose name is on
t he 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 checkea 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 to Developme Services for payment processing.
CLAIMANT'S NAME'
-67 oe
MAILING ADDRESS:
A_67W-2
PHONE:--.
ASSESSOR'S PARCEL NO.:
4 q6 -.0 0 -7
[Please use one claim form per permit) rV
BLDG PERMIT NO.:
RECEIPT NO.:
Receipt No. 1
Receipt No. 2
Receipt No. 3
RECEIPT DATE:
RECEIPT AMOUNT:
04Z,-6Ze-CR(0 SID
REASON FOR REFUND REQUES
0 10 b6L tL4 '0"e
P '.;
Check those fee!�7-which you wish to have considered for refund:
[���Building Permit Fees Sheriff Fees SRA Fees (CDF Fire Planning)
Other (specify):
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 pick them up prior to that time.
Signature
K:/Forms/Refund Application 082203
Date
MR
4
I
I
0
0
0
0
0
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.netIdds
PERMIT NO.
P040654 -
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 03/09/2004 APN: 047-490-007-000
ISite
the Business and Professions Code, and my license is in full force and
effect.
7 391-3
License Class Li rise Number:
Address: 5400 NORD HWY CHI
Date: Contrac (_ieefdr
Map Index:
Description: RE -ROOF HOUSE (28 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
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: LIGHTY MARK W & TERESA N
to its issuance, also requires the applicant for such permit to file- a
PO BOX 899
signed statement that he or she is licensed, pursuant to the provisions of
the Contractor's State- License Law (Chapter 9 commencin 6 with Section
ROUGH & READY-, CA
7000) of Division 3 of the Business and Professions Code) or that tie. or
95975-0899
she; is exempt therefrom", and the basis for the alleged exemption: Any.
violation. of Section 703-1.5 by any applicant for a' permit,subj6cts the..
applicant to a,ci vi�l'pifiialty of not more than five hundred dciliars,�000).):_.'
as &jn'er,6f'fhe 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
thg"tbriri8rc�r!'"Statie License Law does not apply to an
Applicaft. LIGHTTY MARK W &,TERESA-N-
owner of property who builds or improves thereon, and who does
such work himself or herself or throbgh his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the buildin*g or improvements are sold within one
year of completion, the owner -builder will have the burden of
..proving that he or she did not build or improve for the. purpose of
sale.).
.9—..I",as'.g'WnipE_o�.,,the.pr.pp!Zqy,.?rp exd�!y*y',9Iy.'.c_oQtraclJn g_With
.
licensed contractors to construct the project- (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to.an owner I of property who builds or improves thereon,
Contractor: G & R ROOFING
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
2587 NORD AVENUE
I am Exempt under Article 3 of the Business and Professions Code
CHICO, CA 95973
(530) 894-6537
Date: Owner:
License #: 773913
WiDRIKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:.,
(3 1 have and.will maintain a certificate of consent to self -insure for
woftrs' comp66sation, as provided for by Section 3700 of the
- _
L6bo r codpjorthe performance of the work f6r which this permit
Architect:
s issued.
haNi6 'and Will maintain workers' compensation - ihsurance,"as
Engineer:
required -by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' co rpensation
insurance carrier and pAicy number are:
Carrier:
otal Square Ft: 0 S. F.
1
Policy;V-M,46-� di
Valuation: $0.00
-certify tha�t'i'n' tha_pa`r`f`orman*c'e 'of t1h,e work fo-r-w1hich this per6t is
Census Code:
issued,,I.sh - all..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.
Dat a:
Applicant:— -
WARNINd.- Failure* to secu4 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 periblI is h eb is u u de he a Ii ble provisions of the Butte County Code nd/or
I hereby affirm that there is a construction lending agency for the
Res.1 n to I d r ich f s have been paid.
performance of the work for which ihis perntit is lbsudd (Set� 3097 Civ.)
Name:
By: Dat
PERMIT EXPIRES ON:
(Dafe)
Address:
b ' I herebjce�rtify 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.
11 Notification in ac6ordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
0 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 t1heo ner 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 su st e foJ,doKcument:of�Butt1eCounty. I
authorize representatives of Butte Co t t t�f upon the above mentioned property for in. ecti pu s
p 0
�hereby
,�-- [ ZQ b S,
e ript N9,Te: ana re
tu
Date:
Q Owner ontractor El Agent for Owner 0 Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP
OOL06�( I
DATE:
APN:
7
ZONING:
OWNE S LA TNAME:
OW IRST NAME:
PHONE:
STREET ADDRES�/5
,4
FAX:
CITY, ZIP:
E-MAIL:
SITE ADDRESS:
CITY, ZIP: &g&ll,
NEAREST CROSS STREE7.
TFbACT/LOT P
APPLICANT NAME:
PHONE:
STREETADDRESS:
FAX,
CITY, ZIP:
E-MAIL:
CONTRACTOR NAME:'
PHOW// 01
64a53 7
STREET - ADDRESS: 7 rM IM
FAX,
CITY, ZI P:
E-MAIL:
LICENSE NUMBER:
LICEN E TYP
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX,
CITY, ZIP:
LICENSE NUMBER:
E-MAIL:
DESCRIPTION OR SCOf/� OF WORK: A
U Structure Built without permits
El 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 fees will be required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to
the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan
checked and other de�artment costs are not refundable.
For office use only:
Notes:
Appli cation Received by: Date:
Receipt number: Amount Received
Master application 3-"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: wwwbuttecounty.net\dds
PERMIT NO
BP0428767
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 10/01/2004 APN: 047-490-007-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number: Site Address: 5400 NORD HWY CHI
Date: Contractor: Map Index:
OWNER -BUILDER DECLARATION Description: reroof W/comp (18) also gufters
I hereby affirm under penalty of perjury that I am exempt from the
Contractcrs' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior Owner: BRIAN ILLES
to its issuance, also requires the applicant for such permit to file a 5400 NORD HWY
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section CHICO, CA
7000) of Division 3 of the Business and Professions Code) or that he or 95973
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 530-865-3000
applicant to a civil penalty of not more than five hundred dollars (S500).):
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 (Sec. 7044, Business and Professions Applicant: BRIAN ILLES
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon, Contractoc. UPSTATE CONSTRUCTION
and who contracts for such projects with a contractor(s) licensed 6299 ROAD 25
pursuant to the Contractors' State License Law.). ORLAND,CA
I am Exempt under Article 3 of the Business and rofessionsCode 95963
:1
530-865-3000
Date: wne
WORKERS'COMPENSATION DECLARATION License 818285
1 hereby affirm under penalty of perjury one of the following declarations:
13 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 Architect:
is issued. Engineer:
C3 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. Total Square Ft: 0 S. F.
Policy #: Valukion: $0.00
I certify that in the performance of the work for which this permit is Census Code:
issued. I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and *agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: I o — I — C,-��
Applicant
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY -This pe;wmitls he— y issuep under the applicable provisions of the Bijtte County Code andlor
I hereby affirm that there is a construction lending agency for the Resolutions -t - p 11% i dicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name: By:_ Date: o
Address: PERMIT EXPIRES DO
(DdICI I
U 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 ow ner. 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 form or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned properly for inspection purposes.
Print NameZVZ_k P,�t� Signature:
Date: 10-1— 04,
0 Owner Q Contractor 0 Agent for Owner IZI Agent for Contractor