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HomeMy WebLinkAbout062-730-027~~ ' ' �--r����-------------'----------'--- / / | | � ' \ / � , . ^ JIMMY & MARY GONZALES 42-43-2a412 Rockerfeller Rd, Berry CreeFkPermit #3831-89P,Elc--Te N ' � \ . ~ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO�] r 7 b ounty Center Drive - Oroville,falifgrnia 95965 - Telephone: 916/538=541 �/ . ��7 1 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER >�; - C - 2a ZONING BUILDING PERMIT OWNERTELEPH T�n� GD-./ Z'11} It �s ONE s� - 0 S O. FT. OCC. j T BUILDING VALUATION OWNER'S MAILING ADDRESS . • P, o. _? 3 S f t: rt �2 C a I f& CONTRACTOR'S NAME1 raCCR /c C c rr .r nJ H -J S ): �✓ - 31 , i r (L TELEPHONE ' CONTRACTOR'S MAILING ADDRESS (!R C 2je Fireplace CONSTRUCTION LENDER , , UNKNOWN Total Valuation $ Filing Fee t $ 10,00 LENDER'S MAILING ADDRESS r Permit Fee $ ARCHITECT OR ENGINEER - . , LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS - UCjLfir2f�PCcf"siZ hri,r; Permit fee $ PLUMBING PERMIT Filing Fee 10.00 ! u Each Trap 2.06 g nn?/t yR C21C� Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME +. PARCEL MAP t Water piping 5.00 j , Oa Each qas water heater or vent 5.001, 0 b USE OF STRUCTURE SF Xt Duplex❑ Mobilehome❑ Other a SPECIFY III, Gas piping system 1 - 5 outlets 5.00` Building sewer 5.00• _ Mobile Home is G W 10.00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ® Describe work: C O. r F,J �&n A a f o^I C 0 �1 �/� f p Q _ v W r N (qtr,/ ;1! 11 (A t AM S Permit Fee $ Contractor .; ELECTRICAL PERMIT FilingFe,� 10.00 _ �jn + wAI-�rz. t3 + R(L Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSET I declare under penalty of perjury (check one): _ ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, Or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I• am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.Ik OR ADDNS. ACC. BLDGS. ) + + 2/20sgft NEW CONSTR. ULTI.OUTLET NO N.RES'D BRANCH CIRC ITS 2.50 ea POWER APPARATUS I! SINGLE OUTLET CIR. ) OUTLETS OR FIXTURES Ex. Occup(zAL030 .20@030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA. 2.00 Temporary service 10.001 Mobile Home Facilities 15.00 Misc. Wiring 15.00 _ �p Permit Fee $ r, 00 Contractor 61 WORKMEN'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree'to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue agains said County in consequence of the granting of this permit. f X "maeny-- I/1- 3 _'r y Date Sit gaf re of Applicant - - OWner'l Contractor ❑ Agent ❑ A OSHA permit is 'required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE C_ o0 TOTAL FEE $ E HAz CUA PARK SCHL PAR PD HD Iss r� This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which fees RE, TOR O PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date Receipt No. �� �'� /-'- �� 5 %J n ��? �• vu .NIT! -D. P•.•. •ELLOW-A.28E9.20R, PINK -IN SP Ea TOR. Ga LDEXRa D -APPLICANT COUNTY OF BUTTE _ y DEPARTMENT OF PUBLIC WORKS a 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, OroviIIe — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE n1A/nIFR ° or-mAI T'nin A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please' notify this office when correction of work is completed. If yoj have any question pertaining to this, matter, or need additional explanation, pie -ase contact this office Immediately. Date——�/' / Inspector '00�// r. COUNTY OF BUTTE -�Dt it v1ENT OF PUBLIC WORKS 7 County Center Drive - Orovirie Cal ornia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO ASSESSOR PARCEL NUMBER _24 1 ZONING BUILDING PERMIT OWNER I J-1 /,,\ Ga,.�z (-iss TELEPHONE 589- 064S SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P, o. 3 S 8,S4 /Z CONTRACTOR'S NAME�t-t1.�C_ ri v v ,T o ff -J s �? w— r31.. c -r-2 TELEPHONE 5 8 5 �2�3 CONTRACTOR'S MAILING ADDRESS &A-tT- Zfn/G 47 Irt evl Cej, Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Si 0a Each qas water heater or vent 5.00 S,0(5 USE OF STRUCTURE SF ;RT Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 5,0-6 Building sewer 5.00 Mobile Home S I G I W 10.00e . TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other J�t Describe work: C d ( FJ FiA r( o/f CO C-1 V 94 ra A-` _ ,&))c t4 tea! iiRa C�s2 ��O Mmes \ Permit Fee $ Z S , ab Contractor ELECTRICAL PERMIT Filing Fee 10.00 A T -M A `7 8001 OR LESS Main service 100 AMP OR LESS 10.00 Main service EA. AOD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions Of Chapt. 9, Div. 3 of the BuSlnesS and Professions Code and my license Is In full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP:6+ OR ACDNS. ACC. BLDGS. , /z¢sgft NEW CONSTR RANCH TLIET NO N•R ESID BRANCH CIRC ITS CIRCUITS) 2,50 ea (POWER APPARATUS e) SINGLE OUTLET CIR. Ex. Occu Occup(OUTLETS OR FIXTURES 20 ® e0c eAL030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 06 Permit Fee $ , WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation. permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue agaipgryaid County in consequence of the granting of this permit. X Date //— 1-3 Sin ure of Appl cant - -ner Contractor ❑ Agent ❑ A OSHA permit is required for excavations over 5'0" deep and demolition or Construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE 50i 00 - TOTAL FEE $� ALSCHL HAz CUA PARK I FLD I PAR 17D I Iss This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which fees RE TORO PUBLIC By PERMIT EXPIRES Date_ the applicable provi- resolutions to do have been paid. WORKS Date �� �� t3 p �� 3a� Z ao S� 36 S / S. as Receipt No. 3� WHITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT r TIP COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Orovil,le, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION IF 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 taajor labor and materials for construction of the proposed property improvement (yes or n®) l 2. I (have/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 this work, but I have hired the following person to coordi ate supervise, and provide the major work: Name Address ` •i✓c. City 161, __& cl=l�- 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 Signed: Property Owner Social Security N r Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831.and 19832 of the California Health and Safety Code. This verification must be completed and.returned to our office before we are per- mitted to issue the permit. 3990-88E Jimmy Gonzales 12 Rockerfeller Rd. Berry Creek M COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS ...-,PEjiMT NO. 7 County Center Drive - Oroville, realifornia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSE SPARCEL NUMBE *^ ZONING BUILDING PERMIT owNEa. TP 'Ho,1N€ J&9 (/f( SQ. FT. OCC. BUILDING VALUATION ' OWNER' MAIL IG ADDRESS ^� P. ax 94� CONT CTOR S E TEL- P ONE CONTRACTOR'S MAILING ADDRESS Fireplace CONST CTION LENDER UNKNOWN Total Valuation Is LENDER©MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee $ ARC 41TECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS r Permit fee $ PLUMBING PERMIT Filing Fee 10.00 ^ Each Trap 2,00 MSolar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5,00 Each qas water heater or vent 5.00 USE OF STRUCTURE SFA] Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home 10 nope TYPE OF WORK New ❑ Addition ❑ emodel ❑ U •i�lit'es ❑ Installation❑ Other Describe wWk: f 0 C. 4 1 C, j `vi 0 Permit Fee Z Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, Of my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.31 OR ACDNS. ACC. BLDGS. /:¢sqa NEW CONSTR U TI -OUTLET NO N.RESID .BRA CH CIRCU, TS2.50 ea POWER APPARATUS e SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 201150,eA1-030 FIXED . OR E%• DCCUp. OUTLETS TS (RES(RESI D.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00Mi . Wiring g 15.00 F ^ n l Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. {� I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions'of;the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating - Cooling g Hood 3.00 Ventilation permit Fee; $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize<represent atives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in con quenc[,ee off the granting of this permit. X Date �� -/2D Sig ure 04-,A-';pplicant — 9 nor Contractor ❑ Agent ❑ An OSHAC ermit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ ocCUP. CONST.TYPE I-ICHOOLIFWODIPARCrLI PD I ND 59 This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which -/ R TO,�i OF PUBLIC % By / PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been aid. P WORKS - Date (Z^ Q- C/ / ` / 14 L� Receipt No. ! WHITE-D.P.W.. YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Caltfornle 95965 - Telephone: 916/538-7541 APPLICATION AfID PERMIT T N0. D � ASSE SO PARCEL UMBER ZONIPU BUILDING PER IT OWNo TELEPHUJE SQ. FT. OCC. BUILDING VALUATION OW ER' MAIL G ADDRESS Pw CONT TOR TEL P ONE CONTRACTOR' MA; LING ADDRESS Fireplace CONST CTION LENDER VL 0— UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee ,$ 10.00 Permit Fee $ ARCHIT T OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS r � ) Permit fee = PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 CLI Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SFX Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Be odel ❑ U ' 't'es ❑ Installation ❑ OtherA Describe Ck: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 60V R 00 AMP ORSLESS 0.00 111 ZY, CONTRACTORS LICENSE LAW 1 declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Busines$ and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service EA. ADD L 100 AMP2.50 NEW CONST. DWELLING OCCUP.N ACC.TB OUTLET h2sqft New 412.50ea CCONSTR� NON-RESID 'BRANCH CIRCUITS) POWER APPARATUS &) SINGLE OUTLET CIR. Ex. OCCU OUTLETS OR FIXTURES 20050* p eALO 30 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Mi2j. Wiring 15.00 n Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shal I be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3,00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, c ts, and expenses which may in any way accrue agai st said County in con quence of the granting of this permit. %� Date 2 Sig ure pplicant — ner [ Contractor ❑ Agent F-1 An OSHA ermit is required for excavations over 5'0" deep and demolition or construct -PUBLIC ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ Occup. CONST*TYPFJ SCHOOL FLOOD PARCEL PD I ND Iss This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which OF PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS O� Date ^a Z ..- Receipt No. WHITE-D.P.W.. YELLOW-ASSE330R, PINK -INSPECTOR, GOLDENROD -APPLICANT ..,..:'rWr M' Y'..'v: a': 7r'a.P'r,{p •{iR".wt,•a+.." "'..�:.',.4'a 1^x.y.�..._._.•s 1 w --ate -._... . ,.. .... : . I I} COUNTY OF BUTTE - DEPARTMENT, �:'P,UBLIC WORKS - BUILDING DIV.IS`ION e,.ark• I.S I 7 COUNTY CENTEF DRIVE - OROVILLE, ,-ALIFORNIA 95965 - TELEPHONE: 916/538-7541 ' P=RMIT APPLICATION DATA SHEET �-- n f- Permit No. OWNER —J A. P. No. Proposed Building Use �`C , Building Inspector-- Date At time of permit application, I was advisee the following da=a must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. ........... ......................... 2. Plot plans in duplicate/triplcate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans .. 4. Complete engineered plans and calcs, with wet signature on plans . . 5. Energy Design Compliance and supporting documentation ......... 6. Statement of Intent for Non -Heated and AC Buildings .............. ) 7. Engineered truss details and layout in duplicate ;required prior to plan check) 8. Mobilehome installation data including manufacturer's installation instructions....................................................... 9. Fees of $ .......................... 10. Chico Urban Area fees paid ........................................ 11. Park fees paid ..................................................... 12. School District tes paid ................. 13. Sanitation approval from Health Department ... 14. City of Chico plumbing. permit ................ ........... ... . 15. Plot plan and business license approval from City of (see City for other requirements) 16. Planning approval for (A) Use: (B) PErking: 17. Improvements may be required. p8. Driveway permit (constru ttii10-i a proval required prior to occupancy) . / , Pre -Inspection for " 11 r , � Pre-Inspec. requesq;a, p—a required Building Inspector!`/ --,,,—(Date) 20. Contractor's license informat•on (No., Name Style, Classification) ....... 21. Certificate of Workmans Compensation Insurance .................... 22. Owner -Builder Verification (Given to owner ❑ Mail to owner ❑) ........ 23. Recorded copy of Agricultural Acknowledgment Statement ............ 24. Letter of signature authorizaton..................................... 25. 26. When you issue the permit, process as follows: —K— Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other Applicant!/ . a Date - Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items Mo. 2. Additional items required: Contractor, designer, owner, was advises of above required data by_phone_—naiI—counter by date Contractor, designer, owner, was advises of above required data by—phone —ma II—counter by date Plans checked by Sets of plans on hold in Copy—DPW Date Plans approved by File cabinet AP folder Date r COUNTY OF'BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 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 major labor and materials for construction of the proposed property improvement (yes or no) 2. I (have/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 this work, but I have hired the following person to coordinate, supervise, and provide the major work': Name 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 Signed: Property Owner Social Security Nu be �: Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. CONTRACTORS LICENSE LAW j U Y OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 C , ty ter Drive - Orovil✓e, Callfprnla 95965 - Telephone: 916/538-7541 APPLICKI.OM, AND PERMIT ASSE SO PARCEL NUMB R ' ZONIN _ OWN BUILDING PERMIT - I declare under penalty of perjury (check one): TELEPH OW ER• MAIL ADDRESS G CCNT TOR Af5g SO. FT. OCC. BUILDING VALUATION I i " and Professions Code and my license is in full force and effect. TEL P ONE License No. Classification as the owner, EX. OCcup(OUTLETS OR FIXTURES 20&50t DAL& 30 FIXED APP LNS. or my employees with wages as their sole comPen- OR Ex. OCCU P• OUTLETS (RESIO.) EA.) 2.00 sation, will do the work,and the structure is not intendNd or offered for sale. (Sec. 7044) CONTRACTOR' MA;LING ADDRESS ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) { • CONST CTION LENDER UNKNOWN Mi. Wiring 15.00 -. Fireplace i Total Valuation ,$ for this reason Filing Fee $ 10.00 LENDER'S MAILING ADDRESS ARCHIT T OR ENGINEERPermit Fee I declare under penalty of perjury (check one): MECHANICAL PERMIT LI<TENSE No. Plan Checking Fee ❑ I have placed on file with the County of Butte Building Department ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking ee $ BUILDING ADDRESS Penalty $ I shall not employ any person in any manner so as to become subjectto r. C i Permit fee $ 3.00 PLUMBING PERMIT Filing Fee 10.00 the C. provisions of the Labor Code, you must forthwith compiy with such provisions or this permit shall be deemed Each Trap 200 revoked. LOT NO. SUBDIVISION NAME PARCEL MAP Solar or heat pump water heater 20.00 Water piping 5 Mobile Home Installation Fee $ Each qas water heater or vent 5,00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other Building sewer 5.00 SPECIFY TYPE OF WORK Mobile Home S G W 05 0 ea New ❑ Addition ❑ Re ode I ❑ U ' 'ties ❑ Installation [] Other Describe k ..OM3T.TTPC Permit Fee $ Contractor .Loon C ELECTRICAL PERMIT Filing Fee 10.00 ND sl agai st said County in con quence of the granting of this permit. Main service 61$00 AMP ORSLESS 10.00 M' CONTRACTORS LICENSE LAW a(n service EA. ADD'L 100 AMP 2.50 I declare under penalty of perjury (check one): NEW CONST. DWELLING OCCUP.y\ �ZQS It ORADDNS. ACC. BLDGS. / q ❑NEW I am licensed under provisions of Chapt. 9, Div. 3 of the BU$Ine$$ CONSTR U TI -OUTLET N.N•RESID BRANCH CIRC ITS 2.50 ea and Professions Code and my license is in full force and effect. (POWER APPARATUS e) SINGLE OUTLET CIR. License No. Classification as the owner, EX. OCcup(OUTLETS OR FIXTURES 20&50t DAL& 30 FIXED APP LNS. or my employees with wages as their sole comPen- OR Ex. OCCU P• OUTLETS (RESIO.) EA.) 2.00 sation, will do the work,and the structure is not intendNd or offered for sale. (Sec. 7044) Temporary service 10.00 ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Mobile Home Facilities 15.00 ElI am exempt under Sec. , Business and Professions Code Mi. Wiring 15.00 -. n for this reason Permit Fee $ WORKMEN'S COMPENSATION INSURANCE Contractor I declare under penalty of perjury (check one): MECHANICAL PERMIT ❑ The permit is for $100.00 (valuation) or less. FiIingFee 10.00 ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subjectto M the W. C. laws of California. 3.00 Notice to Applicant: If after making this statement, should you become subject to W. the C. provisions of the Labor Code, you must forthwith compiy with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct. I agree to comply to all County Mobile Home Installation Fee $ Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte Energy Inspection Fee $ to enter upon the above-mentioned property for inspection purposes. I also TOTAL PERMIT FEE $ agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, c ts, and expenses which may in any way accrue O7 CUP• ..OM3T.TTPC lcNooL .Loon PARCCL PD ND sl agai st said County in con quence of the granting of this permit. X Date This This permit is hereby issued under the applicable Sig ure pplicant — nor[ Contractor ElAgent ❑ provi- sions of the Butte County Code and/or resolutions to do work indicated above for An OSHA ermit is required for excavations over 5'0" deep and demolition or construct• ion of structures over 3 stories in height. which fees have been paid. DIRECTOR OF PUBLIC WORKS Receipt No. C BY Date WHIT! -O. r. W., YELLOW CS 5011, PINK -INSPECTOR, GOLOlN ROD-AP•LICANT PERMIT EXPIRES Date