HomeMy WebLinkAbout063-290-054FK1
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M. (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally 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.
License Class : License Number:
Dale: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
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 file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's Stale License Law (Chapter 9 commehcing with Section
7000) 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 the
applicant to a civil penally of not more than five hundred dollars ($500).):
® I, as owner of the properly, 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 taw does not apply to an
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are intended or offered for
sale. If however, the building or Improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he'or she did not build or improve for the purpose of
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' State. 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
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business -and Pro sslons Code
Date: _ l //7 � Owner: �' �nd
WORKERS' COMPENSATION DECLARATION
I 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 the Labor Code, for the performance of
the work for which this permit is Issued. My workers' compensation
Insurance carrier and policy number are:
Carrier:
Policy #:
PERMIT NO.
BPO53093
Issued Date: 11/17/2005 APN: 063-290-054-000
Site Address: 100 CANYON SHADOWS RD CHI
Map Index:
Description: ELECTRICAL GATE INSTALLATION &
LIGHTS
Owner: HALL-ISOM INVESTMENTS
P.O. BOX 821
CHICO CA
95927
(530) 893-4232 (530) 893-1725
guy@cal-flor.com
Applicant: BRUCE HALL
4551 AL ROAD
CHICO CA
95928
(530) 534-1426 x130 (530) 534-0306
bruce@cal-flor.com
Contractor:
License #:
Architect:
Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
I certify that in the performance of the work for which this permit is Census Code:
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'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Dale:
Applicant:
WARNING: Failure 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Address:
This pe fnit Is heAby Issued under
Resol tions to,,,#b work Indicsated a
By: ,
PERMIT EXPIRES ON:
_,,o
bte provisions of the Butte County Code and/or
Ich fees have been paid.
Dale:
❑ 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 & Safety 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 stale 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 representatives of Butte County to enter upon the above mentioned property for inspection purposes. , , ,j„
Print Name: D /t Lt C r-- /"f A LL Signature:
Dale:
-J9 Owner
❑ Contractor
❑ Agent for Owner
❑ Agent for Contractor
B. C. Building Permit 01-16.04 pg 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 OFAPPLICATION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY**
OWNER INFORMATION
Last NameI I . r
First Name /
Address gZ +
City
State CA-
Zip'q5R 2'.
Phone g93- N 2-3Z-
Fax
E-mail G1 � (9 Chi F �o r , C okki
APPLICANT INFORMATION
CONTRACTOR
Name
Address L� ss f
Address
City r cU
City
State G4
State
Zip
Phone
Fax ✓ 3 y - 03 0 >o
Fax
E mail
Planner
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
Address L� ss f
Address
City r cU
City
State G4
State
Zip
Phone
Fax ✓ 3 y - 03 0 >o
Fax
E mail
Planner
State License Number
APPLICANT INFORMATION
Name
(
Address L� ss f
4
City r cU
es
State G4
Zip BSc! Z�9
Phone �3y-lNz6
x 13o
Fax ✓ 3 y - 03 0 >o
E-mail
. /CJ rr r C O
APPLICANT SIGNATURE
X 2ent-__ ,
/v(
For office use only:
Zoning
(
Flood Zone
Cross Street
// (az 32,
SRA
es
No
Occ. 1
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BP:-.
BIN #
PROJECT LOCATION
AP# 0L3 _ 2aO- oJt_'Y
Property Address
City
c� aw_ C
Cross Street
// (az 32,
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must he shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
<!: lc ✓rte (5ce Ae- In A'.
Gni r �7f C ow -e6-
Sq FT- Living 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
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.
Received by- Amount: &JBldg
SRA
Receipt #: S1 V `0 Sheriff
co /31 SMIP
r
e:
l /`— / Y% `�� - - LJ G Total
K:\FORMS\BUILDING FORMS\BldgAPPISubRgmts.doc Page 1 of 2 REV 8-12-05
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!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form
❑ 12. Hazardous Material Form (for Commercial Buildings only).
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.
❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑ 12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit 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
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
Hall — Isom Properties, Inc..
704 West Eighth Avenue, Chico, CA 95928
Phone: 530/893-4232 *Fax: 530/893-1725
November 16, 2005
Butte County Dept. of Development Services
7 County Center Drive
Oroville, CA 95965
To Whom It May Concern:
I have asked my son Bruce Hall to take charge of the permit process for electrical
gate installation located on property owned by the Hall -Isom Partnership, parcel
#053-290-054. Butte County, at Santos Road and Canyon Shadows Road.
-ISOM PARTNERSHIP
H.'Hall) -
General Partner
j;AS0100hVQV139: Main Assess"uiry
Nov 4 7, 2005 '11:45 an)
_ Asmt #
Fee # d63-290-054-000
Name HALL-ISOM INVESTMENT COMPANY
_Status ACTIVE Status Date
Addr1 iTPb BOX 821
Tax 000 INORMAL OWNERSHIP
TRA 062016
Addr2 CHICO CA 95927-0821 �µ
- - _ — Situs
Addr3 BaseDt 01 101 /1 980
Addr4 _._ Land 67;261
' � Timber Preserve
Structure 0'
AgPres
'
Comments 6329005400 CONVERTED 09/08/88 Fixtures 0
Etal
Growing 0
�'
Creating Doc# 198582003800 Date F
Bonds TotalL&1 61,261`
�' _
Current Doc# 200280003913 Date 01/25/2002 Fix. RP 01
_
'`= r Multi Situs
Killing Doc# - Date MH PP 0'
Asmt Desc 160.29 AC HWY 32 SuplCnt : PP 0
c Flagg
Zoning [U�SH�� Owell 0 r 910 MH Exempt 0
`Asmt PP Pen Net
�67261.
Acres/Sq Ft N/C 063
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