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Home My WebLink About061-540-006tr : I pmd 1 ....� 'moi €� i' tl; i t , r / i. , '1 �F' r � 3l [' �f 3 r rr r y. j? 'l.1: 9681 ORO-QUrNCY HWY, BERRY CREEK .`tlt A1� OWNER �� ! 4, • 1, r. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, Califo;nia 95965 • Telephone (530) 538-7541 T N (Rev. 12/96) APPLICATION AND PERMIT ®�� ASSESSOR PARCEL NUMBER r ZONING BUILDING PERMIT OWNER TELEPHONE C_ SO, Fr, OCC. BUILDING VALUATION . OWNEF.'S MAILING ADDR sS C. CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDERS MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS o A81 01R0 LEE BERRY UEEK Energy Plan Checking Fee $ QUINCY $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ UHlifies ❑ Installation ❑ Other ❑ Describe Work: MTSC WIRING RITE In FIRE DAMAGE FOR RANGE R, C:nnKmp Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 • Main Service 00ov OR LESS zoOA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.P License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. a ACC. BLD S. So 3.5¢FT: NNEW .RESID. MULT." CIRCUITS @7,50 OWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURESSAL @':550 Ex. Occup. DurElrOrsA R�ID,oE. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23 00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that f I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall f with pl _with those provisions. -" X Date P.Igna ure o pli nt -10 Owner ❑ Contractor ❑ Agent/ An OSHA permit is required for excavati over 60" deep and demolition or construction of structures 3 o e' I r -2TZ - Receipt No. WHITE•D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ HAZ. I D. FEES IMP FLOOD ISS This p mit is hereby issued under the applicable provisions of th utte County Coe and/or Resolutions to do work indic to abo for whic fees have been paid. By Dat ' ' PERMIT EXPIRES ON O Q Oto OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the a*or labor and materials for construction of the proposed property imp r ement : YES NO ❑ 2. I HAVE HAVE NOT Elsigned 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: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIG N Y1 D' R POPEROWNER: CO AT�T.Y- r�r�rrv,.,Tn.,r�ua DATE: NOTE. This Owner -Builder Verification is required by ,Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER i�.. O.B.-1 I OWNER BUILDER INFORMATION I Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of 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 $300 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 Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, Mic el C. Vi ira, C.B.O. M ger, Building Inspection NOTE. This Owner-BuWerinformation is required 4 Section 19830 of the California Health and Safety Code OWNER: FIRE DAMAGE REPORT DATE: /d`6-/0, LOCATION: 1pd / UrD (-.( UJ A. P. # (JS! , Y-U—QQ CONTRACTOR: ZONING: DATE TO INSPECTOR: PERMIT HISTORY( NONE ( ) AS FOLLOWS: _ { /1 BUILDING INSPECTOR'S REPORT Building Description: Commercial/Usage: .i Residential # of Units: Currently Occupied ( ) Yes ( ) No Abandoned/Vacant: Electric: Electric Currently O On ( ) Off • Condition of Electric Gas: Currently O On ( ) Off Condition Sanitation: Plumbing Working ( ) Yes ( ) No Obvious Sewage Problems ( ) Yes ( ) No Mobile Home Condition of Utilities: ( ) Damaged - Requires Permit ( ) Undamaged – No Permit Required Description of Damaged Area: Estimate Cost of Repairs: Condition of Foundation: ( ) Good ( ) Poor Explain if repairs needed: Inspector:rl Date: p Sketch building on reverse and indicate area of damage. "k s a(�( sW0-o0G 7 1 /BUTTE COUNTY FIRE INCIDENT LO DATE 09/23/2003 REPORT TIME 1:08 LOCATION INCIDENT NUMBER J__ 11181 LOGGED BY IMB LOCAL FIRE NUMBER � � ant � �?� Fiw RO FMELISTATE FIRE NUMBER 496 air* Fi.n BI CASE NUMBER i1 MEDICS PHONE NUMBER WILDLAND FIRES ❑ ESTIMATED ACRES i STRUCTURE FIRE RESIDENTIAL OTHER FIRE i MEDICAL AIDS G PRA 231 ECC ❑ 189-0286 I REPORT METHOD 911 FIRE INFORMATION FIRE INFO SENT HOW EMAIL BY MB TO STA 62 7 -DAY LOGGED INITIALS JAMC INCIDENT NAME QUINCY PSAIOTHER START DATE 11 09123/20031 START TIME 1:00 HAZ MAT DIAMOND # 1.1-1.8 COMMENTS CAUSE ELECTRICAL POWER FIRE IN THE LAND USE DOMESTIC BASEMENT ACRES 01 TYPE OF ACRES DIAMOND 6 ONLY $ DAMAGE TYPE DOLLAR DAMAGE 1200.00 SAVE 80000.001 INJURIESIFATALITIES ❑ i # CIVILIAN INJURIES_ J # CIVILIAN FATALITIES 0 1 EMD ❑ OES ❑ # FF INJURIES 0# FF FATALITIES 1 FC -40 INFORMATION { ♦ New Incident FC -40 ❑ DATE OF FC -40 INC AGENCY INC # INC P# I FC 40 COMP DATE I FC -40 COMP BY U� t County Notifications ® EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑