HomeMy WebLinkAbout060-110-043060-110-043 05-0730a
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750 HUMBOLDT RD, BUTTE
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CONT: OWNER
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BUTTE COUNTY PERMIT NO.
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT BPO50730
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
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: 03/18/2005 APN: 060-110-043-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:
Site Address: 7566 HUMBOLDT RD BMD
Date: �_ Contractor:
Map Index:
Description: RE LOCATE & UP GRADE ELECTRICAL
_ p
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Slate License Law for the following reason (Sec. 7031.5
SERVICE
Business and Professions Code: Any city or county which requires a
permit to construct, alter. Improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to rile a
Owner: RILEY, JOHN C.
signed statement that he or she is licensed pursuant to the provisions of
P.O. BOX 18398
the Contractor's Slate License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
SOUTH LAKE TAHOE CA
she is exempt therefrom and the basis for the alleged exemption. Any
96151
violation of Section 7031.5 by any applicant for a permit subjects the
aappliicca/ntso a civil penalty of not more than rive hundred dollars ($500).):
530-542-2669
l�V I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
Applicant: RILEY, JOHN C.
such work himself or herself or through his or her own employees,
P.O. BOX 18398
provided that such Improvements are not Intended or offered for
sale. If however, the building or Improvements are sold within one
SOUTH LAKE TAHOE CA
year of completion, the owner -builder will have the burden of
96151
proving that he or she did not build or improve for the purpose of
530-542-2669
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' Slate License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor:
pursuant to the Contractors State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
Dale: " `� Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #:
❑ 1 have and will maintain a certificate of consent to self -Insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Is Issued.
❑ I have and will maintain workers' compensation Insurance, as
Architect:
required by Section 3700 the Labor Code, for the performance of
Engineer:
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 #:
Valuation: $0.00
Q? 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
Census Code:
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.
Dale:
%��
Applicant: r `` - -
WARNING: Fallure 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.
' /v,
14W
CONSTRUCTION LENDING AGENCY"
This permit I h eby Issued under tfj licable-provisions of -the Butte County -Code -and/or : ,
--
I hereby affirm that there Is a construction lending agency for the
of the work for which this is issued (Sec 3097 CIV.)
Resolutions to o work Indicated ove t r uyhich fees have been paid.
G4�w
performance permit
By� Date:
Name:
PERMIT EXPIRES ON:
Address:
❑ 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.
❑ Notification In accordance with Section 19827.5 of California Health & Safely Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information Is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize rer entatives of Butte County to enter upon the above mentioned property for inspection pur o s.
Print Name:L Signature:
Date:
0 -Owner ❑ Contractor W Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01.16-04 pp 1
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
Website: www.buttecounty.nettdds
**PLEASE PRINT CLEARLY**
OWNER7C.1,NyxC .
Last Name ,Q ug
irst me
Address ) 83918
Cityi;0uTt1 'Lfl K� al t
State C R
Zip Q ( t S'
P one 542-266ct
Fax
Email rl If ,o(py 1 @ SU-GrLo13AL . fleT
APPLICANT NAME
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Const.
Fax
E-mail
Map Book
Lic. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Const.
Fax
E-mail
Map Book
State License Number
APPLICANT NAME
Name OLWe&
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
i
X P"
t
For office use only:
AP#
�6a- >I11) - 6q3 -Doo
Zoning
City
AE+m5
Flood Zone
SRA
ee
No
Occ.Type
Const.
Subdivision Name
Address
Map Book
I Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
NO.
W- 673
P
BIN #
LOCATION
AP#
�6a- >I11) - 6q3 -Doo
Prop Address
f (o fi(AA4 0
City
AE+m5
cross Street�� � �Z
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
Address
Description or Scope of Work:
Ion
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
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 department costs are not
refundable.
GJ _ --
4-1
Received by: Amount: 1. Bldg
SRA
Receipt #: ya57 Sheriff
SMIP
11 L_l 6 / �y G� Other I I
Date: _
Total
Page 1 of 2
REV 7-27-04
dr
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit.
INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑
1.
Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑
2.
Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑
3.
Engineered truss details and layouts in duplicate (if required). No faxes!
El
4.
Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑
5.
Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
E]6.
Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑
7.
Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑
8.
Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑
9.
Site plan and business license approval from the City of Biggs.
❑
10.
Letter of intent for non-residential buildings.
❑
11.
Detached Accessory Building Form filled out by the owner (if required).
❑
12.
Hazardous Material Form (for Commercial Buildings only).
❑
13.
Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review
(May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538.7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KIFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04