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Home My WebLink About058-520-054BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 4293 PEACEFUL TR Owner: Permit No: B07-0687 APN: 058-520-054 SAMUELSON, RANDY & JACKI Issued Date: 05/31/2007 By KCG Permit type: RESIDENTIAL 696 E 19TH ST Subtype: SFD-Custom/Model CHICO, CA 95928 Expiration Date: 05/30/2008 Description: NSF (2479) GAR (576) COV (623) (530) 343-6124 Occupancy: R-3 Zoning: Contractor Applicant: Square Footage: SAMUELSON, RANDY & JAC Building Garage Remdl/Addn 696 E 19TH ST 2,479 576 CHICO, CA 95928 Other Porch/Patio Total (530)343- 6124 . 623 3,678 FEE INFORMATION CWIF SF $2,411.06 DBFIRE Fire Inspection (SRA) R $102.70 CWIF SF $2,132.89 DBFIRE SRA Fire Plan Review (S $102.70 , CWIFAUD Impact Processing Audi $50.00 DBSMIP Residential $16.11 CWIFDDS Impact Processing Fee $50.00 ; DB R3 Dwelling -Custom, Model $1,908.27 DB R3 Dwelling -Custom, Mode[ $1,272.18 DB SRA Fire Plan Check Fee $109.98 Total Charged: $8,231.59 Fees Paid: $8,231.59 DBEH Building Review Fee $75.70 Balance Due: $0.00 Receipt No: B3311 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 X 05/31/2007 the applicant to a civil penalty of not more than five hundred dollars [$500); Please check one of the following: Contractors Signature Date yyy 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 WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractors License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). Carrier: Policy Number: Exp. Date: (This section need not be completed if the permit is for one hundred dollars ($100) or less.) ❑IAM EXEMPT under Section B. & P.C. for this reason: �( I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �l 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'05/31/2007 comp tion provis' of Section 3700 of the Labor Code, I shall forthwith comply with those Owner nature Date X 05/31/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: /A1LuRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, WARNING: AILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE injury, including death, and property damage caused by, arising outt oof, , or for in any way connected with HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ccupa of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. o ent the above mentioned property for inspection purposes. I hereby certify that I am the gertyown=athrized to ad he prope owners behalf. CONSTRUCTION LENDING AGENCY 05/31/2007 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for NaPermittee [SIGN] Print Date rm the performance of the work for which this permit is issued. (3097 civ. code) (Owner ❑ Contractor OR. Agent for Owner 11 Agent for Contractor ` FILE COPY Lenders Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last h1arnem N 9L19 ivni -Al, Mai mg d s 9�t' City C G U State Trp qsu Phone j ^ Fax E-mail ;91 PERMIT NO. 61 BIN # PROJECT LOCATION CONTRACTOR Name ti Et? -- Address Q (lI City Carrier State Zip Phone �2 Fax E-mail Planner Lic. # Class PERMIT NO. 61 BIN # PROJECT LOCATION ARCHITECT/ENGINEER Name O 6 Nl 6_7 Z f-It— Address Q (lI City Carrier State Zip Phone �2 Fax E-mail Planner State License Number PERMIT NO. 61 BIN # PROJECT LOCATION APPLICANT INFORMATION Name �V D A41K ,( Address Q (lI CityState/J Carrier _ Cl 'j,Phone . �2 Fax E-mail Planner PERMIT NO. 61 BIN # PROJECT LOCATION 6 AP# QO --5,210 ProAy Adder L 7 2 Ci Cross Street AOUD WORKER'S COMPENSATION Policy Number 6 Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. Typb Const. LENDING AGENCY Name Address Description or Scope of Work: % rA /) 0^7% j w I -AD u SE Sq FT- Livingcrag Open Cov ❑ Structure"Built without Permits ❑ Proposed Change of Occupancy (Note previous use): 'a 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. APPLICANT SIGNATURE Received by: X For office nl Zoning Flood Zone SRA Yes No Occ. Typb Const. Subdivision Name Map Book Page Lot # Planner Date Approved: Receipt #: AmountCOT�' / o Bldg �- SRA Sheriff (� '7C. 700ther � 7 -3" Notal ILD -M,3 V yove (l C- M Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530)538-7785 Fax www.buttecounty.net/dds PERMIT APPLICATION DATA SHEET Reference Number: B07-0687 Date: 04/03/2007 Location: 0 PEACEFUL TR By: GLB Parcel Number: 058-520-054 Sub Type: SFD-Custom/Model Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: (530) 343-6124 Description: NSF (2479) GAR (576) COV (623) The above permit application has the following Clearances required prior to permit issuance. Please contact each department indicated below regarding specific requirements pertaining to your permit application. Yes No ❑ ❑ ❑ ❑ DRAINAGE DISTRICTS Thermalito Irrigation District, 410 Grand Avenue, Oroville CA 95965 - (530) 533-0740 LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 533-2000 City of Chico, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 PARKS & RECREATION DISTRICTS Chico Area Recreation District, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 Durham Park & Recreation District, 9447 Midway, Durham CA 95938 - (530) 345-1921 Feather River Recreaction & Park District, 1200 Myers Street, Oroville CA 95966 - (530) 533-2011 'Paradise Parks & Recreation, 6626 Skyway, Paradise CA 95969 - (530) 872-6393 SCHOOL DISTRICTS Biggs Unified School District, 300 B Street, Biggs CA 95917 - (530) 868-1281 Chico Unified School District, 1163 East 7th Street, Chico CA 95926 - (530) 891-3006 Durham Unified School District, 4920 Putney Drive, Durham CA 95938 - (530) 895-4675 Gridley School District, 429 Magnolia, Gridley CA 95948 - (530) 846-4723 Marysville School District, 1919 B Street, Marysville CA 95901 - (530) 741-6000 Oroville Elementary School District, 2795 Yard Street, Oroville CA 95966 - (530) 532-3000 Oroville Union High, 2211 Washington Ave, Oroville CA 95966 - (530) 538-2300 Ext: 105 Paradise Unified School District, 6696 Clark Road, Paradise CA 95969 - (530) 872-6400 OTHER Recorded copy of Agricultural Acknowledgment Statement- See Attached Instructions City of Biggs Planning Department, 301 Street Biggs CA 95917 - (530) 868-5447 Other: r Sixth T,j . 4 � � -FP Gni Other: ❑ Other: Signature of Property Owner: Date: 04/03/2007 FILE Butte County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 75965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds o�p`��Q0. o SIC O 0 0 0 0 National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-0687 Date: 04/03/2007 Location: 0 PEACEFUL TR By: GLB Parcel Number: 058-520-054 Sub Type: SFD-Custom/Model Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: (530) 343-6124 Description: NSF (2479) GAR (576) COV (623) By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or other santions provided by law. Signed: Title: D CeJ R/ FILE Date: 04/03/2007 BUTTE COUNTY FEE SUMMARY Printed: 04/03/2007 7 County Center Drive 3:03 pm Oroville, CA 75965 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Permit Number: -B07-0687 Job Address: 0 PEACEFUL TR Contractor: Fee Description Account Number Fee Amount Paid Date Pmt Amt _CWIF SF 0010-050-4617998-101001 $50.00 CWIFDDS Impact Processing Fee CWIFFIREF SF 1851-0-280-1011852 $366.35 0010-440001-4617999-1010 .$50.00 CWIFFIREVE SF 1851-0-280-1011853 $707.16 CWIFSHERFVE SF 1840-0-280-1011842 CWIFPWRDS SF 1831-0-280-1011001 $1,337.55 $664.81 CWIFGGVE SF DB R3 Dwelling -Custom, Model $306.61 CWIFLBRYF SF 1825-0-280-1011826 $240.89 DBF DWLNG CSTM/MDL N Plan Rvv 0010-440001-4210500-1010 -.$1,272.18 04/03/2007 $1,272.18 DBF DWLNG CSTM/MDL N Permit F4 0010-440001-4210500-1010 -$1,908.27 $312.99 CWIFSHERFJL SF DBEH Building Review Fee $288.00 DBSMIP Residential 0021-540013-4614901-1010 $75.70 04/03/2007 $75.70 DBFIRE Fire Inspection -_(SRA) R 0100-450001-4617240-1010 $102.70 04/03/2007 $102.70 DBFIRE SRA Fire Plan Review (S 0100-450001-4617240-1010 $102.70 04/03/2007 $102.70 DB SRA Fire Plan Check Fee 0010-440001-4210500-1010 $109.98 CWIFAUD Impact Processing Audi 0010-050-4617998-101001 $50.00 CWIFDDS Impact Processing Fee 0010-440001-4617999-1010 .$50.00 CWIF SF CWIFSHERFVE SF 1840-0-280-1011842 $152.72 CWIFGGF SF 1808-0-280-101001 $664.81 CWIFGGVE SF 1810-0-280-101001 $306.61 CWIFLBRYF SF 1825-0-280-1011826 $240.89 CWIFLBRYM SF 1825-0-280-1011827 $162.04 CWIFLBRYV SF 1825-0-280-1011828 $4.83 CWIFSHERFF SF 1840-0-280-1011841 $312.99 CWIFSHERFJL SF 1800-0-280-1011811 $288.00 DBSMIP Residential 1001-0-280-1011298 916.11 Printed By: Gwyn Benedict 89231.59 $19553.28 Balance Due: $6,678.31 At the time of permit application, I was a ' ed the above fees are required prior to issuance of the permit. These fees may change during the plan checking process. Signature: Date: 04/03/2007 Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a protest are specified in Government Code Section 66020(a). Butte .County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA '75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. 0 Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municipalcodes.lexisnexis.com/codesibutteco/ Reference Number: B07-0687 Date: 04/03/2007 Location: 0 PEACEFUL TR Parcel Number: 058-520-054 Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: (530) 343-6124 Description: NSF (2479) GAR (576) COV (623) Signature of Property Owner: � / Date: 04/03/2007 FILE Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements 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 from possible liability ifthat person applies for the proper permit in his or her name. Contractors are 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 you plan to do your own work, with the exception 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 (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal government 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. ° There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact 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 thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor 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 contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. I PERSONALLY PL TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT.R NO) 0 I(A�HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 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 THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: NAME ADDRESS PHONE CITY CONTRACTORS LICENSE NO 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 Description: NSF (2479) GAR (576) COV (623) Reference Number: B07-0687 Applicant Name: SAMUELSON, RANDY & JACKIE L MC Owner's Name: SAMUELSON, Y & CKIE L MC AP # Signature of Property Owner: Date: 058-520-054 �-3-0 1� J" BUTTE OUNTY DEVELOPMENT FEE CERTIFICATION FORM FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) ❑ICO, AREA RECREATION AND PARK DISTRICT (CARD) PARADISE RECREATION AND PARK DISTRICT (PRPD) 0 PURRAM[.RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) Building Permit Number. �(��%- oC 1 Property Owner (s) i 11 Project Location /Address Subdivision Name Assessable Sq. Ftge 2A 7 q Type of Residential Development.(check one) New Development Single Family -Detached Single Family -Attached Alteration/Addition(s) Non -Residential to. Residential Multi -Family Dwelling Mobile home Mobile home replacement verified by Assessor Department Demo Permit (date issued ) verified by Building Department Comments: W -M on 0 FRRPD ❑ CARD D'fRPD 0 DRP1D certifies that: n Applicant Nam e, 5t Phone Number ri' Mailing Address c City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: q Dwelling Units @ $ per unit fora total of $ I Square Feet @ $ rj O per sq foot for a total of $ , a3 q - Sb Remarks: Paid by Check No: . Paid by Cash: Receipt No: Recreation and'Park District Representative Date �---r-�r-�-'�.'�.. ti-.r.�-�-��....,.-.v- �..+�...�-,M:._;r,�,;:tC:r.:.t�.,uirwr ..,Ycw�r%^:: � s+�.,,n:,,,�; aa.:�...c��:..,.. s.•F:�-;'v..;,+1. _ :.,n,. _ v - ... .. BUTTE COUNTY°SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) School District Lira I I It, Un Inh + fah Building Department No. -r,0 Tax'ate Area No. A.P. Number �� +' nF;� Jurisdiction: = City County Property Owner Property Location/Address T±n ff Cul Th Omni, i, V A Subdivision t: Residential Development Erl Q No of Living Mobile Home Units Installation Commercial/Industrial 0 Q New Addition Lot No. 0 Addition/ 'Supplemental to Conversion Permit # '(No foundation inspection) .................................................................................................... Sq. Footage ? V `1 (Group R) Cr. Demo - ( ) existing sq. ft. see attached Net total sq. ft. . Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) District Identification No. 070109 (Street Address) Sq. Footage (Including Exterior Roofed Areas) Date School District certifies that (Payor) (State) (Zip Code) A ^ 113S�L (Phone Number) has complied with the requirements of Resolution No. . t es5 CA n by payment of $ �-, ( Csa representing square feet. B 2926 $ FULL MITIGATION $ Paid by Check # Remarks: 0 Date Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit you from challenging the imposition of the fees in any court action. If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (school district), Yellow (building department), Pink (applicant) feeform.xls (12/06)dmm BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds 12— PROJECT INFORMATION Site Add ' , P ACEFUL TR Owner: Permit N0: B07-0689 APN: 058-520-054 SAMUELSON, RANDY & JACKI Issued Date: 5/31/2007 By GLB Permit type: MISCELLANEOUS 696 E 19TH ST Subtype: Private Garage/Shop CHICO, CA 95928 Expiration Date: 5/30/2008 Description: DETACHED SHOP 960' (530) 343-6124 Occupancy: Zoning: Contractor Applicant: Square Footage:' SAMUELSON, RANDY & JAC Building Garage Remdl/Addn 696 E 19TH ST 576 CHICO, CA 95928 Other Porch/Patio Total (530)343-6124 576 FEE INFORMATION DBEH Building Review Fee $75.70 DBF GARAGE -Wood Frame Plan Che $219.96 DBFIRE Fire Inspection (SRA) R $102.70 DBFIRE SRA Fire Plan Review (S $102.70 DBMSC Garage Wood Frame $350.34 DBOMSCF Fire Safe Standards Re $109.98 Total Charged: $961.38 Fees Paid: $961.38 Balance Due: $0.00 Receipt No: B3312 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 peril subjects X 5/31/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractors Signature Date 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 WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are notintended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier. Policy Number: Exp. Dale: (This section need not be completed if the permit is for one hundred dollars ($100) or less.) ❑ I AM EXEMPT under Section B. & P.C. for this reason: 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 f California, and agree that if I should become subject to the workers' 5/31/2007 compensation pr i ions of Section 3700 of the Labor Code, I shall forthwith comply with those Owne ignature Date pro ' ns. X 5/31/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signatu Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE including death, and property damage caused arising out of, or in any way connected with o,o the HUNDRED THOUSAND DOLLARS $700,000 , IN ADDITION TO THE COST OF COMPENSATION, ( ) isry, t is the issuance oft ' peril. I hereby acknowledge that issuance of this peril does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use o ccupa of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. C nt to ent a above mentioned property for inspection purposes. I hereby certify that I am the ro rty own or a uthorized ct on the p perty owner's behalf. CONSTRUCTION LENDING AGENCY �i7 Sr 5/31/2007 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for N O Permittee [SIGN] PI• t Date the performance of the work for which this peril is issued. (3097 civ. code) Owner Contractor OFz. Agent for Owner ❑Agent for Contractor FILE COPY Lender's Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" r V-1. OWNER INFORMATION Last e Sot) m,6---rZ�� i ame Mailing/s d ss �/L�� -r City (, State Ila • Zip �� Phone _ Z Fax E-mail Lic. # r V-1. CONTRACTOR Name Sot) m,6---rZ�� Address I Yes City ` State Zip Phone 3 1a Fax E-mail Date Approved: Lic. # Class r V-1. PERMIT NO. BIN PROJECT LOCATION ARCHITECT/ENGINEER Name Sot) m,6---rZ�� Address I Yes City ` State Zip Phone 3 1a Fax E-mail Date Approved: State License Number PERMIT NO. BIN PROJECT LOCATION APPLICANT INFORMATION NameAN AwtGt�E2S� Address I Yes City/ ` State'cQ If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. Phone 3 1a Fax E-mail Date Approved: PERMIT NO. BIN PROJECT LOCATION AP# d Sr Pro edy Addres L ity Cross St eet 1& 96A)0 (Z A -D I Yes WORKER'S COMPENSATION Policy Number QA g:r- Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. Book LENDING AGENCY Name Address Description or Scope of Wor : P 2 Sq FT- Living Garage .'Open Cov ❑ Structure Built without Permit ❑ 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. APP /CANT SIGNATURE X Received by: For office use only: Zoning I SW I Yes No 0cc, Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: Receipt #: Date: Amount: &--I t • r"lag o F • 7(SRA Sheriff SMIP 7 7y L Other 0/ 'v.6Total Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. O Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municipalcodes.lexisnexis.com/codes/butteco/ Reference Number: B07-0689 Date: 04/03/2007 Location: 0 PEACEFUL TR Parcel Number: 058-520-054 Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: (530) 343-6124 Description: DETACHED SHOP 960' Signature of Property Owner: Date: 04/03/2007 FILE Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds PERMIT APPLICATION DATA SHEET Reference Number: B07-0689 Date: 04/03/2007 Location: 0 PEACEFUL TR By: GLB Parcel Number: 058-520-054 Su ype: Private Garage/Shop Owner Name: SAMUELSON, RANDY & JACKIE L MC hone: (530) 343-6124 Description: DETACHED SHOP 960' The above permit application has the following Clearances required prior to pe t issuance. Please contact each department indicated below regarding specific requirements pertaining to your permit applic ion. Yes No DRAINAGE DIST Thermalito Irrigation District, 410 Grand Avenue, Orov5 - (530) 533-0740 ❑ ❑ LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 5',Y33-00 ❑ City of Chico, 545 Vallombrosa, Chico CA 95926 - (530 Chico Area Recreation District, 545 Vallombrosa, hico CA 95926 - (530) 895-4711 Durham Park & Recreation District, 9447 Mid ay, Durham CA 95938 - (530) 345-1921 Feather River Recreaction & Park District, 00 Myers Street, Oroville CA 95966 - (530) 533-2011 Paradise Parks & Recreation, 6626 Skyw , Paradise CA 95969 - (530) 872-6393 ❑ Biggs Unified School District, 300 B eet, Biggs CA 95917 - (530) 868-1281 ❑ Chico Unified School District, 116 East 7th Street, Chico CA 95926 - (530) 891-3006 ❑ ❑ Durham Unified School Distric 4920 Putney Drive, Durham CA 95938 - (530) 895-4675 Gridley School District, 429 agnolia, Gridley CA 95948 - (530) 846-4723 Marysville School District 919 B Street, Marysville CA 95901 - (530) 741-6000 Oroville Elementary Sc of District, 2795 Yard Street, Oroville CA 95966 - (530) 532-3000 Oroville Union High, 11 Washington Ave, Oroville CA 95966 - (530) 538-2300 Ext:105 Paradise Unified Sc ool District, 6696 Clark Road, Paradise CA 95969 - (530) 872-6400 OTHER Recorded copy Agricultural Acknowledgment Statement- See Attached Instructions E] ❑ City of Biggs anning Department, 3016 Sixth Street Biggs CA 95917 - (530) 868-5447 0 E] Other: ❑ ❑ Other: ❑ ❑ Other: n Signature of Property Owner: �K /S Date: 04/03/2007 FILE Butte County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 75965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-0689 Location: 0 PEACEFUL TR Parcel Number: 058-520-054 Owner Name: SAMUELSON, RANDY & JACKIE L MC Description: DETACHED SHOP 960' Date: 04/03/2007 By: GLB Sub Type: Private Garage/Shop Phone: (530)343-6124 By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the S, ate of California Regional Water Quality Control Board for this project that disturbes one acre or more of land may'result in revocation of grading and/or other permits or other santions provided by law. Signed: Title: dZr G• -r X -- FILE Date: 04/03/2007 BUTTE COUNTY FEE SUMMARY Permit Number: B07-0689 7 County Center Drive Oroville, CA 75965 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Job Address: 0 PEACEFUL TR Contractor: Printed: 04/03/2007 3:16 pm Fee Description Account Number Fee Amount Paid Date Pmt Amt DBEH Building Review Fee 0021-540013-4614901-1010 $75.70 04/03/2007 $75.70 DBFIRE Fire Inspection (SRA) R 0100-450001-4617240-1010 $102.70 04/03/2007 $102.70 DBOMSCF Fire Safe Standards Re 0010-4400014210500-1010 ' 1109.98 DBFIRE SRA Fire Plan Review (S 0100-4500014617240-1010 $102.70 04/03/2007 $102.70 DBMSC Garage Wood Frame 0010-440001-4210500-1010 9329.94 DBF GARAGE -Wood Frame Plan Che 0010440001-4210500-1010 $219.96 04/03/2007 $219.96 940.98 $501.06,, Printed By: Gwyn Benedict Balance Due: $439.92 At the time of permit applicatio was advised the above fees are required prior to issuance of the permit. These fees may change during the plan checking process. ZSignature: Date: 04/03/2007 Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a protest are specified in Government Code Section 66020(a). Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements 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 from possible liability if that person applies for the proper permit in his or her name. Contractors are 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 you plan to do your own work, with the exception 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 (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal government 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. There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact 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 thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor 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 contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. I PERSONALLY PLAMO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. R NO) I 6�]HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: ADDRESS PHONE CITY CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: 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 Description: DETACHED SHOP 960' Reference Number: B07-0689 Applicant Name: SAMUELSON, RANDY & JACKIE L MC Owner's Name: SAMUELSON, & J KIE L MC AP # : 058-520-054 Signature of Property Owner: Date: / — ,3 —Q 2 .:,._•a A AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 COPY of Document Recorded 11 -Apr -2007 2007-0017559 Has not been compared vith original BUTTE COUNTY RECORDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, .necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: State of California County of X7.19 On AVIOG. /09 2ar7 personally appeared ersonally known to me (or proved to me oA the basis of satisfacto evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my h d and officia seal. A LAURA HARTER Comm. ,# 1476090 ` Signature Z Seal:i;�_�7_ PIOTARy PUBLIC-CAl1i0RNIA N BulteCouMy �My Comm. Expires 6fp&.12,2066 ''� A.P. UM. 620_ 66-4 PARCEL A 3 PARCEL 2, AS THE SAME ARE SHOWN ON THAT CERTAIN PARCEL MAP BEING "A PORTION OF THE SOUTH HALF OF THE SOUTHEAST QUARTER OF SECTION 26, AND A PORTION OF GOVERNMENT LOTS 1 AND B, OF THE NORTHEAST QUARTER OF SECTION 35, ALL IN T 22 N, R 4 E, M.D.M., UNINCORPORATED AREA OF BUTTE COUNTY, CALIF.", FILED FOR RECORD IN THE OFFICE OF THE == COUNTY RECORDER OF TFZ COUNTY OF BUTTE, STATE OF CALIFORNIA, ON AUGUST 2, 1995 IN t' BOOK 136 OF MAPS AT PAGES 91 9; AND 93. RESERVING THEREFROM AN EASEMENT FOR ROAD, PUBLIC UTILITY AND DRAINAGE PURPOSES OVER ' THAT PORTION THEREOF LYING WITHIN WHAT CERTAIN 60.00 WIDE FASEMENT DESIGNATED AS r PEACEFUL TRAIL. SAID EASEMENT TO BE FOR THE BENEFIT OF AND APPURTENANT TO THE REMAINING• LAND OF THE GRANTOR HEREIN AND SHALL INURE TO THE BENEFIT OF AND MAY BE USED BY ALL PERSONS WHO MAY HERSAFTFA BECOME T= OWNERS OF ANY PARTS OR PORTIONS OF SAID APPURTENANT LAND. AP NO. 058-520-059 PARCEI, B I AN EASEMENT FOR ROAD, PUBLIC UTILITY AND DRAINAGE PURPOSES OVER THOSE PORTIONS OF PARCELS 1 AND 3, LYING WITHIN THAT CERTAIN CUL-DE-SAC AND 60.00 WIDE EASEMENT DESIGNATED AS "PEACEFUL TRAIL'S ON THAT CERTAIN PARCEL MAP, FILED FOR RECORD IN THE O1+FICE OF THE COUNTY RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON AUGUST 2, 1995 IN BOOK 136 OF MAPS, AT PAGES 91, 92 AM 93. BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 0 PEACEFUL TR Owner: Permit No: B07-0688 APN: 058-520-054 SAMUELSON, RANDY & JACKI Issued Date: 5/31/2007 By GLB Permit type: MISCELLANEOUS 696 E 19TH ST Subtype: Fire Suppression CHICO, CA 95928 Expiration Date: 5/30/2008 Description: FIRE SPRINKLERS FOR B07-0687 Occupancy: ' Zoning: Contractor Applicant: Square Footage: SQUYRES WILLIAM F JR SAMUELSON, RANDY & JAC Building Garage Remdl/Addn P O BOX 3176 696 E 19TH ST CHICO, CA 95927 CHICO, CA 95928 Other Porch/Patio Total (530)345-1012 FEE INFORMATION DBOMSCF Fire Protection Engine $109.98 Total Charged: $109.98 Fees Paid: $109.98 Balance Due: $0.00 Receipt No: B2482 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License SQUYRES WILLIAM F JR 275206 / C16 / 10/31/2007 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 Pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 peril subjects X 5/31/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; a check one of the following: Pl?,,, Contractor's Signature Date AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE OMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED ❑I as required by CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractors License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Carrier: State Fund Policy Numb 1617846 10/1/2007 er: Exp. Date: Contractors License Law.). (This section need not be completed if the permit is for one a h�llars ($100) or less.) ❑IAM under Se B. 8 P.C. for this reason: ��_/ 7 ICS/ I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1�-�J ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compen n laws of Ca' mia, and agree that if I should become subject to the workers' X 5/31/2007 comp sati n provision of action 3700 of the Labor Code, I shall forthwith comply with those wners t e Date pro io X 5/31/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE injury, includi g death, and property damage caused by, arising out of, or in any way connected with HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the issuance f this permit. I hereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND vor occu ncy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. my to ter the bove mentioned property for inspection purposes. I hereby certify that I am the Party ner or m authoriz act on the oparty owners behalf. 14XI,0 s1 5/31/2007 CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Nalitrof Permittee [SIGN] int Date the performance of the work for which this peril is issued. (3097 civ. code) OwnerAgent for Owner Agent for Contractor ❑ Contractor OR FILE COPY Lenders Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATI Last Name M •c Suh irs e A Mailing Address City State Zip Phone Fax E-mail CONTRACTOR Name _ v YS Address Ox t'i r cityC X11 c o She � 11 Phone � � � �- Fax E-mail Uc.# -��zo� Mass Fax __ ..._ ARCHITECT/ENGINEER Name City Address C City Policy Number Carrier State . Flip Phone Fax Fax E-mail State License Number __ ..._ AFFLICA' NT INFORMATION Name City Address 011 Y1f) < City Policy Number Carrier State Zip Phone Fax ADPL ir—A TSI N TURI ' -- �^ For office ust: only: __ Zoning Fi o.' Zone FSRA Occ, Ty const Subdivision Name I i�,';am Boolt Page Yes I No Lot # PERMIT No. b(e �1_ BIN # PROJECT LOCATiOON AP# � S' $ — S2p� V �� Property Address City Cross Street l Ts�rd 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. LENDING AGENCY Name A ' Address x Description or Scope of -Work: 1 le WJ 'Ir e '0 Y 1 V J %' S1 e 1^x'1 Sq FT- Li 'ng 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 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 peen done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Amount: 'Idg SRA Receipt #: Sheriff -- M'P I t Date:e1 1 Total Planner I Date Approved: I —s Butte County Department of Development Services TIM SNELLWGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds PERMIT APPLICATION DATA SHEET Reference Number: B07-0688 Date: 04/03/ 07 Location: 0 PEACEFUL TR By: G Parcel Number: 058-520-054 Sub Type: ire Suppression Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: Description: FIRE SPRINKLERS FOR B07-0687 The above permit application has the following Clearances required prior to permit i indicated below regarding specific requirements pertaining to your permit application. Yes No DRAINAGE DISTRICTS 11 ❑ Thermalito Irrigation District, 410 Grand Avenue, Oroville CA 95965 - (530) ❑ ❑ LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 533-2000 ❑ ❑ City of Chico, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 TION contact each department Chico Area Recreation District, 545 Vallombrosa, Chico CA 9592 - (530) 895-4711 Durham Park & Recreation District, 9447 Midway, Durham C 95938 - (530) 345-1921 Feather River Recreaction & Park District, 1200 Myers Stre , Oroville CA 95966 - (530) 533-2011 Paradise Parks & Recreation, 6626 Skyway, Paradise CA 9'5969 - (530) 872-6393 Biggs Unified School District, 300 B Street, Biggs C 5917 - (530) 868-1281 Chico Unified School District, 1163 East 7th Stree Chico CA 95926 - (530) 891-3006 Durham Unified School District, 4920 Putney ive, Durham CA 95938 - (530) 895-4675 Gridley School District, 429 Magnolia, Marysville School District, 1919 B Stri Oroville Elementary School District, 2 Oroville Union High, 2211 Washin or. Grid y CA 95948 - (530) 846-4723 et arysville CA 95901 - (530) 741-6000 95 Yard Street, Oroville CA 95966 - (530) 532-3000 Ave, Oroville CA 95966 - (530) 538-2300 Ext: 105 Paradise Unified School District 6696 Clark Road, Paradise CA 95969 - (530) 872-6400 E] ❑ Recorded copy of Agri E] ❑ City of Biggs Planning Other: Other: Other: Signature of Property Owner: OTHER Acknowledgment Statement- See Attached Instructions hent, 3016 Sixth Street Biggs CA 95917 - (530) 868-5447 FILE Date: 04/03/2007 Butte County Department of Development Services TIM SALLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. 0 Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municipalcodes.lexisnexis.com/codes/butteco/ Reference Number: B07-0688 Location: 0 PEACEFUL TR Parcel Number: 058-520-054 Date: 04/03/2007 Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: Description: FIRE SPRINKLERS FOR B07-0687 Signature of Property Owner: Date: 04/03/2007 FILE BUTTE COUNTY FEE SUMMARY 7 County Center Drive Oroville, CA 75965 Permit Number: B07-0688 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Job Address: 0 PEACEFUL TR Contractor: SQUYRES WILLIAM F JR P O BOX 3176 CHICO, CA 95927 Printed: 04/03/2007 3:01 pm Fee Description Account Number Fee Amount Paid Date Pmt Amt DBOMSCF Fire Protection Engine 0010-440001-4210500-1010 $109.98 04/03/2007 $109.98 109.98 $109.98 Printed By: Gwyn Benedict Balance Due: $0.00 At the time of permit application, I was ad ' the above fees are required prior to issuance of the permit. These fees may change during the plan checking process. Signature: Date: 04/03/2007 Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments , for a protest are specified in Government Code Section 66020(a). Butte .County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 75965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-0688 Date: 04/03/2007 Location: 0 PEACEFUL TR By: GLB Parcel Number: 058-520-054 Sub Type: Fire Suppression Owner Name: SAMUELSON, RANDY & JACKIE L MC Phone: Description: FIRE SPRINKLERS FOR B07-0687 By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or other santions provided by law. 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