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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
AGRICULTURAL BUILDING EXEMPTION 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: DEER MEADOW ROAD
Owner:
Permit No: B07-0849
APN: 061-630-020
HOLLINGWORTH, JOHN L ET
Issued Date: 07/16/2007 By KCG
Permit type: MISCELLANEOUS
20 CELENA CT
Subtype: Ag Exempt
OROVILLE,
CA 95966
Expiration Date: 07/15/2008
Description: AG BUILDING- 44X28 (1232) FARM
(530) 589-4225
Occupancy: Zoning: U 00
Contractor
Applicant:
Square Footage:
HOLLINGWORTH, JOHN L ETAL JT
HOLLINGWORTH, JOHN L E
Building Garage Remdl/Addn
20 CELENA CT
20 CELENA CT
OROVILLE, CA 95966
OROVILLE, CA 95966
Other Porch/Patio Total
(530)589-4225
(530)589-4225
FEE INFORMATION
DBEH Building Review Fee $75.70
DBOMSCF Ag Exemption Permit $109.98
Total Charged: $185.68 Fees Paid: $185.68
Balance Due: $0.00 ' Receipt No: B2734
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
HOLLINGWORTH, JOHN L ETA OL:CRW_00402095 / /
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 permit subjects
X 07/16/2007
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
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
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
HAVE
the work himself or herself or through his or her own employees, provided that such improvements
❑I 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, as required by
E]
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
Section
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. Date:
(This section need not be competed if the permit is or one hundred dollars ($100) or less.
❑ 1 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 of California, and agree that if I should become subject to the workers'
X 07/16/2007
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owners Signature Date
provisions.
X 07/16/2007
1 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
HUNDRED THOUSAND DOLLARS $100,000, IN ADDITION TO THE COST OF COMPENSATION,
( )
injury, including death, and property damage caused arising out of, in any way connected with
the issuance of this permit. I hereby acknowledge thatt is issuance of this pea rmit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
property owner or am authorized to act on the property ownefs behalf.
07/16/2007
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Permittee [SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
❑ Owner ❑ Contractor OR. DAgent for Owner DAgent for Contractor
ASSESSOR COPY
Lenders Address City State Zip I
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
AGRICULTURAL BUILDING EXEMPTION STATEMENT
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house
farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of
human habitation or a place of employment where agricultural products are processed, treated or packaged, nor
shall it be a place used by the public.
Buildings used for purposes other than described above or that are located in a flood hazard zone are not eligible for
an agricultural exemption.
Authorization of an agricultural exemption permit by the Department of Development Services does not preclude any
requirements and/or review by the Butte County Public Works Department, Butte County Fire Department, Butte
County Environmental Health, or any state and federal agencies.
Initials AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
Initials AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence,
10 feet from a manufactured home, and 23 feet from a commercial/industrial buildings
Initials AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum 23 feet from a
residence and a manufactured home, and 40 feet from a commercial/industrial buildings
Site Address: DEER MEADOW ROAD
Permit No: '1107-0849
APN: 061-630-020
Square Footage:
Permit Type: MISCELLANEOUS
Occupancy:
Permit Subtype: Ag Exempt
Zoning: U 00
Description: AG BUILDING- 44X28 (1232) FARM EQUIP
Required Setbacks:
Applicant: HOLLINGWORTH, JOHN L ETAL JT
Front: 20' Side: 20' Rear: 20'
20 CELENA CT
OROVILLECA95966
Type of Construction:
(530) 589-4225
Type of Siding: T-111
Owner: HOLLINGWORTH, JOHN L ETAL JT
Est. Const. Cost: $ 10,000.00
20 CELENA CT
OROVILLE, CA 95966
Roof Covering: Compostion
(530) 589-4225
Floor Type: Wood
I declare under penalty of perjury that the building will be used as stated above, and the proposed use
conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will
contact the Building Division and obtain the necessary permits, inspections
and approvals to comply with the
requirements in effect at that time and prior to occupancy.
Signature of owner:
Date: 04/20/2007
ASSESSOR COPY
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
AGRICULTURAL BUILDING EXEMPTION 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: DEER MEADOW ROAD
Owner:
Permit NO: B07-0849
APN: 061-630-020
HOLLINGWORTH, JOHN L ET
Issued Date: 07/16/2007 By KCG
Permit type: MISCELLANEOUS
20 CELENA CT
Subtype: Ag Exempt
OROVILLE,
CA 95966
Expiration Date: 07/15/2008
Description: AG BUILDING- 44X28 (1232) FARM
(530) 589-4225
Occupancy: Zoning: U 00
Contractor
Applicant:
Square Footage:
HOLLINGWORTH, JOHN L ETAL JT
HOLLINGWORTH, JOHN L E
Building Garage Remdl/Addn
20 CELENA CT
20 CELENA CT
OROVILLE, CA 95966
OROVILLE, CA 95966
Other Porch/Patio Total
(530)589-4225
(530)589-4225
FEE INFORMATION
DBEH Building Review Fee $75.70
DBOMSCF Ag Exemption Permit $109.98
Total Charged: $185.68 Fees Paid: $185.68
Balance Due: $0.00 Receipt No: B2734
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
HOLLINGWORTH, JOHN L ETA OL:CRW_00402095 / /
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 permit subjects
X 07/16/2007
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
Contractor's 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
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
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
HAVE
the work himself or herself or through his or her own employees, provided that such improvements
❑I 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
❑ 1, 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.
My Workers' Compensation insurance carrier and
The Contractor's License Law dows not apply to an owner of the property who builds or improves
policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Cartier: Policy Number: Exp. Date:
(This section need not a completed if the permit is or one hundred dollars($100) or less.
❑ I AM EXEMPT under Section B. & P.C. for this reason:
[QI 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'
t? 07/16/2007
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owners Signature Date
provisions.
X 07/16/2007
1 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
HUNDRED THOUSAND DOLLARS $100,000, IN ADDITION TO THE COST OF COMPENSATION,
( )
injury, including death, and property damage caused arising out of, or in any way connected with
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
P operty owner o am authorized to act on1he property owner's behalf.
CONSTRUCTION LENDING AGENCY
j 07/16/2007
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Pe i ee [SIG Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
Owner ❑ Contractor OR.Agent for Owner Agent for Contractor
FILE COPY
Lender's Address City State Zip
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
AGRICULTURAL BUILDING EXEMPTION STATEMENT
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house
farm implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of
human habitation or a place of employment where agricultural products are processed, treated or packaged, nor
shall it be a place used by the public.
Buildings used for purposes other than described above or that are located in a flood hazard zone are not eligible for
an agricultural exemption.
Authorization of an agricultural exemption permit by the Department of Development Services does not preclude any
requirements and/or review by the Butte County Public Works Department, Butte County Fire Department, Butte
County Environmental Health, or any state and federal agencies.
Initials ag AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
Initials4AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from .a residence,
10 feet from a manufactured home, and 23 feet from a commercial/industrial buildings
Initials a A AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum 23 feet from a
residence and a manufactured home, and 40 feet from a commercial/industrial buildings
Site Address: DEER MEADOW ROAD
Permit No: B07-0849
APN: 061-630-020
Square Footage:
Permit Type: MISCELLANEOUS
Occupancy:
Permit Subtype: Ag Exempt
Zoning: U 00
Description: AG BUILDING- 44X28 (1232) FARM EQUIP
Required Setbacks:
Applicant: HOLLINGWORTH, JOHN L ETAL JT
Front: 20' Side: 20' Rear: 20'
20 CELENA CT
OROVILLECA95966
Type of Construction:
(530) 589-4225
Type of Siding: T-111
Owner: HOLLINGWORTH, JOHN L ETAL JT
Est. Const. Cost: $ 10,000.00
20 CELENA CT
OROVILLE, CA 95966
Roof Covering: Compostion
(530) 589-4225
Floor Type: Wood
I declare under penalty of perjury that the building will be used as stated above, and the proposed use
conforms with the AG Building definition. If any change in use or occupancy of the building is made, I will
contact the Building Division and obtain the necessary permits, inspections
and approvals to comply with the
requirements in effect at that time and prior to occupancy.
Signature of owner:
Date: 04/20/2007
FILE COPY
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
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 INFORMATION
Last Name I t I�/ rG rT F' ON,ame m i c
Mailing Addr ss h
City Pa uZE
St_
Zip S
Phones _ ���
Fax's -p
bb T
E-mail
APPLICANT INFORMATION
CONTRA TOR
Name
City 4'AU / 1 -e - L F
Address
Zip
✓
City
Fax
State
Zip
Phone
Fax
E-mail
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City 4'AU / 1 -e - L F
-Address
Zip
✓
City
Fax
State
Zip
Phone
Fax
E-mail
State License Number
APPLICANT INFORMATION
Name Aa b my ty 'I1 ja #A1 e 4�vw7'1_-_
Address ,
?U C2 L e Gum
City 4'AU / 1 -e - L F
State C
Zip
✓
Phone S8- _
Fax
E-mail .
APPLICANT SIGNATURE
X
PERMIT
NO.
0.0
BIN #
PROJECTLOCATION
/P�ROJ,�rV
API (4 . `(/)v' o'�, 0
Property Address �. f
cJ`N
FloodSRA
Zone
City
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
4DES_CRIPT/OAt-OR:SCOPE• OF -WORK:
&I r"/V 'L
ZuILE `
F"9'A 0`7
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
FloodSRA
Zone
I Yes
I No
Occ.
Type Const.
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) 538-2140 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.
1. I PERSONALLY PTO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT. YE OR NO)
2. I OV 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 Cl
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: AG BUILDING- 44X28 (1232)
Reference Number: B07-0849
Applicant Name: HOLLINGWORTH, JOHN L ETAL JT
Owner's Name: HOLLINGWORTH, JOHN L ETAL JT AP # : 061-630- 20
Signature of Property Owner: p� &&e�e Date: OI7
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