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Home My WebLink About065-090-01365-090-013 06-0864 FISCHER i ei Cir t } -- . • }, pUT7�- ARFa 6232 MCREYNOLDS CT, MAGALIA MOTES � " Cont: OWNER I5 ELEC SERV RESIDENTIAL APN- Permit No. Owner- Site wnerSite Address: Contractor. Type of Permit. / 77OFFICE Copy Address 3 -2 - GAS I4`G GAS Meter gy ELECT Date- Meter T DatP Z 0 5 SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION fTEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID' ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: Wo CHECKED BY = OK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FalUC/O-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap . Nat Q or LPQ Inch Sz Ft Lngth 7 Blckng; Sz-Spacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test -Crossovers -Brea kers-Cl rncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr 8, Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged 13 Tie Downs 0 Foundation Q 14 Exits 15 Cert of Occupancy 16 HUD LabeUlnsignia Numbers Serial Numbers DATE D E C KS -C O V E R S'C A R P O R T S `GARAGE S 1 Zoning -Setbacks -Easements 2 Ftgs; Soils -Sz-Dpth-Spacing-Cnnctrs-Steel 3 Decks, Girders/Joists-Dcking-Brcinj " Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg Frmg-Brcng . 5 Alum Awn; Columns-CnnctnsSplice-Deral-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-Anchrs-Studs-Rttrs-Trusses. 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall prils y a` DATE JPOOLS 1 Setbacks -Easements 2 Soils; CompactionStructure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/L6ng; Distance-GFI 5 Elec Pool Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg Bakes-EnclsrsTrilboards-Insultn to Main Conduit 9 Health Dept Apprvl 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enctsr; Fencing -Alarms 13 Bonding, Diving board or Slide Is - 0 Pool Drawing OK = Not OK _ RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR DATE IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg Opth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Opth_ 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth ' 56 Shwr Pan; Test First flr-Tub Acc 5 Stemwalls Main; Steel-Blockouts-Wrapped 57 Test Tub & Shwr, 2nd fir - Tub-Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 64 Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 1.t Wtr Pipe; Test-Anchrs-Rgltr-Service Test 12 Elec Undrgrnd DATE IMECHANICAL 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 61 AC Ducts Insultn & Support 14 GirdersSills-Anchr BoltsJoists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn 15 Acc & Vntltn 63 Condensate Drain & Ovrflw, Sz & Grade 16• Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic ° °` o' o - DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE IFINAL 18 Walls Studs -Nailing Spacing & Braces-PlatesSound 66 Ext Steps -Door & SideLt Prtctn-Landings 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof) 68 Furnace Vnts-CImc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-fir-Ducts'-Mech Prtctn 22 Headers & Beams-Sz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFl & Bath Fxtrs & Tub Ar-cSpa 24 Ceiling Joist-Rffr Ties-Purlin-Roof Brac TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frplc Throat Clmc 72 Elec Trim & Subpnl, Breaker Sts & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop4ns Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Clmc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc 30 Ext Doors -One T -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door, Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rffr Outrgrs 79 AC Duct in Garage -Damper 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-DImc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrtlr Acc Mech Prtctn; LPG Appince Undr House 3- drain 35 Glazing Area -Glass Prtctn-SkyLis-Plastic 81 Plmb; Elec & Mech Eqp Listed for Lottn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnls 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters 1:1YesDNo 4`87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Clmc to Opngs DATE JELECTRICAL 90 Wtr Well, Dscnnct, Elec, Plmb 40 Fxtr & Tmsfrmr Clmcans Prtctn 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Gmdng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprv) 46 2 Appinc Cirrs in Kichn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga ❑CU or DAL . 98 Address Posted AC Wire Sz w D CU or DAL 99. Fire Sprinkler 4$ Range Circ ga CU or AL 'Oven Circ ga D CU or DAL Insulated Neutral DYes DNo 49 Service -Riser Cndctrs & Grnd Main Dsr-nnct' 50 Eqp CImcs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060864 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/17/2006 APN: 065-090-013-000 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. Site Address: 6232 MCREYNOLDS CT MAG License Class : License Number: Map Index: Date: Contractor: Description: ELECTRICAL SERVICE OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the UP-GRADE/REPLACE HOT WATER HEATER 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 Owner: FISCHER, STAN C. to its issuance, also requires the applicant for such permit to file a P.O. BOX 1740 signed statement that he or she is licensed pursuant to the provisions of the Contractor's Stale License Law (Chapter 9 commencing with Section MAGALIA, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95954 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 (530) 873-4389 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 Applicant: FISCHER, STAN C. owner of property who builds or improves thereon, and who does P.O. BOX 1740 such work himself or herself or through his, or her own employees, provided that such improvements are not intended or offered for MAGALIA, CA sale. If however, the building or improvements are sold within one 95954 year of completion, the owner -builder will have the burden of 873-4389 proving that he or she did not build or improve for the purpose of (530) sale.). h L4� 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, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 amExempt under Article 3 of the Business and Professions Code 4 —Z Date: I Owner: `%564 r! , License #: 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. Architect: ❑ I have and will maintain workers' compensation insurance, as Engineer: 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: Total Square Ft: 0 S. F. Policy #: 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. -i k 7 - C Date: (0 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. /J CONSTRUCTION LENDING AGENCY This permit is here))y issued under thepppVable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to dp ork indicated abov6 for hick fees have been paid. performance of the work foryy�vhich this permit is issued (Sec 3097 Civ.) r' ,, f Z- Name: �l/G'-F By: Date: PERMIT EXPIRES ON: Address: Date ❑ 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 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 representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: _ f'/SC+/L(a _ Signature: Date: ner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 4 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060864 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/17/2006 APN: 065-090-013-000 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. Site Address: 6232 MCREYNOLDS CT MAG License Class : License Number: Map Index: Date: Contractor: Description: ELECTRICAL SERVICE OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the UP-GRADE/REPLACE HOT WATER HEATER 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 Owner: FISCHER, STAN C. to its issuance, also requires the applicant for such permit to file a P.O. BOX 1740 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section MAGALIA, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95954 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 (530) 873-4389 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 Applicant: FISCHER, STAN C. owner of property who builds or improves thereon, and who does P.O. BOX 1740 such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for MAGALIA, CA sale. If however, the building or improvements are sold within one 95954 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 (530) 873-4389 shale.). 'las I-- 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, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 aim Exempt under Article 3 of the Business and Professions Code 4 Date: - Z Owner: f 256a!i d - License #: 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. Architect: ❑ I have and will maintain workers' compensation insurance, as Engineer: 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: Total Square Ft: 0 S. F. Policy #: Valuation: $0.00 6d' 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. _ k 7 Date: ,�� Applicant: g!M Ley. 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 This permit is here y issued under thea iFable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to do ork indicated above for hich fees have been paid. performance of the workfor hich this permit is issued (Sec 3097 Civ.) , _ Name: (p , — 64 By: 99 �7 Date: PERMIT EXPIRES ON: Date) 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 & 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 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 representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: Z2 /i;ci( Signature: Date: �" t 17 — 0 &1 ner ❑ 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"' APPLICANT INFORMATION OWNER INFORMATION Last Name� City First Nffaavy Aej Address City ` - / ?//0 . Stag i, Zip Phone ? State Fax E-mail Book APPLICANT INFORMATION CONTRACTOR Name OG2I�l► City Address Zip City Fax State Zip Phone Book Fax E-mail Planner Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Book Fax E mail Planner State License Number APPLICANT INFORMATION Name �U Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X ' For office use only: Zoning Property Address .6 23Z l'Ll Flood Zone Cross Street SRA es No Occ. Type Const. I ) �V Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. ` - (B . BIN N PROJECT LOCATION. AP# Property Address .6 23Z l'Ll City G -r Cross Street 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. ❑ Structure Built without Permits LENDING AGENCY Name Address 09 Description or Scope of Work: ;Me ^ Sq FT- Living GarMe 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 Amount: : �a Z, Co Bldg Receipt #: 4 S06 Sheriff eSTT ChAlP Other Dat /_ C 7�� Total f- - 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 A/C 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 �1 ❑' 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 OWNER -BUILDER VERIFICATION Attention Property Owner: J 6e C,�l�s 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 ma labor and material for construction of this proposed property improvement: YES [NO [ ]. 2. I HAVE [' AVE NOT f ] 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: PHONE: CONTRACTOR'S 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: 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 SIGNED: PROPERTY OWNER: DATE: -4 1-7- d 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. Rev'd 11/4/2004 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR l PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile www.buttecounty.net/dds OWNER -BUILDER INFORMATION Dear Property Owner: 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 your plan to subcontract, you should be aware of the following information for your benefit and protection: o 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. o 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. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o 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 their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner-builder"=Buildin g 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-CSLB (2752) or by accessing their website at www.CSLB.ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, Scott Rutherford Manager, Building Diviion NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. 065-090-013 ► 06-0865 Bd FISCHER, STAN N O T E S , 6232 MCREYNOLDS CT, MAGALIA i -Cont: OWNER (Si Isb I RESIDENTIAL APN: Owner. Site Address Contractor. Type of Permit: Permit No. cv C) e5� sc". .t i ( r sG_3 ' SPECIAL CONDITIONS CHECKED BY 0 SRA ❑ FLOOD CERTIFICATE EQUIRED 0 FIRE SPRINKLERS REQUIRED ❑ SPECIAL INSPECTION ITEMS Q VERIFY 1 Q USE PERMIT CONDITIONS ❑ SUBSTANDARD HOUSING LETTER Q ENCROACHMENT PERMIT i Q REINSPECTION FEE PAID Q ENV HLTH CLEARANCE DATE JOB FINALED: I�'1 I 0 9v4� ,SIGNATURE: = OK 0 = Not OK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION Lj SOFT -SET DATE D E C K S'C O V E R S'C A RPO RTS 'G A R A G ES 1 Zoning -Setbacks -Easements 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 2 Ftgs; Soils-Sz-0pthSpacing-Cnnctrs-Steel 3 Sewer, Loctn-Test; Fall/C/O-Concrete 3 Decks, Girders/Joists-Dcking-Brcing 4 Wtr; Loctn-Test-Easement Needed -Regulator Stairs-Guard/Handrails 5 Elec Loctn-DIrncs-Grnd Amp -Concrete 4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg 6 Yard Gas; Loctn-Test-Wrap . Nat Q or LP❑ Frmg-Brcng Inch Sz Ft Lngth 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 7 Blckng; Sz-Spacing-Marriage Line 6 Carports; Wndws-Doors 8 Gas; MH Test-Demand-Valve-Cnnctr 7 Electric 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 8 Frmg; Sills-Anchrs -Studs -Rftrs-Trusses 10 Drain; MH Test -Fall -Flex Cnnctr 9 Siding; Nailing -Veneer -Stucco -lath , ' 1.1 Wtr & Sewer Connected -CIO to Grade 10 Roof; Shthg-Roofing 12 Gas and Electricity Tagged 11 Ext; Steps -Doors -Landings 13 Tie Downs Q Foundation 0 12 Braced Wall pnls 14 Exits 15 Cert of Occupancy ° 4. ode 16 HUD Label/Insignia Numbers Serial Numbers DATE POOLS 1 Setbacks -Easements 2 Soils; CompactiionStructure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool Lting; 15 volts-GFI o� o' 0 6 Elec Enclsrs• Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w15'-Crcltng Egp-Htr 8 Elec Grndng; Eqp w15'.Crclfig Eqp-Pool Ightg 136kes-EnclsrsTnlboards-lnsultn to Main Conduit 9 Health Dept Apprvi 10 Plmb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Encisr, Fencing -Alarms 13 Bonding, Diving board or Slide • o'er e` Pool Drawing OK Not OK RESIDENTIAL (Single & Duplex's DATE JUNDERFLOOR DATE IPLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg Opth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth. 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First fir -Tub Acc 5 Stemwalls Main; Steel -Blackouts -Wrapped 57 Test Tub & Shwr, 2nd flr - Tub-Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler- Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 1-t Wtr Pipe; Test-Anchrs-Rgitr-Service Test 12 Elec Undrgrnd DATE IMECHANICAL 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 61 AC Ducts Insultn & Support 14 Girders-Sills-Anchr BoltsJoists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insultn 15 Acc & Vntltn 63 Condensate Drain & Ovrflw, Sz & Grade 16_ Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm if Furnace in attic �c 0\c r \mac _ DATE IFRAMIN73 17 Sills Proper Materials & Anchrs DATE FINAL 18 Walls Studs -Nailing Spacing & Braces-PlatesSound 66 Ext Steps -Door & SideLt Prtctn-Landings 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop in Walls (rat proof) 68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-flr-Ducts-Meth Prtctn 22 Headers & BearrrsSz & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frplc Throat Clmc 72 Elec Trim & Subpnl, Breaker Sts & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Clmc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc, Grnd-Air-Gap-Cooking Clrnc 30 Ext Doors -One T -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdnn-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door, Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 79 AC Duct in Garage -Damper ' 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-ClmcCom Air Cnnctr-PRV; abv fir 34 Stucco lath -Weep Screed-Fndtn Vnts-Undrflr Acc Mech Prtctn- LPG Appince Undr House 3- drain 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 Plmb; Elec & Mech Eqp Listed for Lottn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFQ Romex Prtctn 37 Brace Int/Ext Wall pnls 83 Insultn-Foam-Looked in Attic 38 Insultn-Walls-Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters DYes DNo s` 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-Clrnc to Opngs DATE JELECTRICAL 90 Wtr Well, Dscnnct, Elec, Plmb 40 Fxtr & Tmsfrmr Clmcans Prtctn 91. Ext Elec Trim, GFI Rcptcl-Undrgrnd 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprv) 46 2 Appinc Cirrs in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz ga ❑ CU or DAL 98 Address Posted AC Wire Sz ea ❑CU or DAL 99 Fire Sprinkler 48 Range Circ ga DCU or DAL Oven Circ ga D CU or D AL Insulated Neutral Dyes ONO 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp CImcs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060865 PERMITS BECOME NULL AND VOID 1 YEAR,FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/17/2006 APN: 065-090-013-000 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. Site Address: 6232 MCREYNOLDS CT MAG License Class : License Number: Map Index: Date: Contractor: Description: RE ROOF COMP 15 SQ.'S 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 Owner: FISCHER, STAN C. permit to construct, alter, improve, demolish, or repair any structure, prior P.O. BOX 1740 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 MAGALIA, CA the Contractor's State License Law (Chapter 9 commencing with Section 95954 7000) of Division 3 of the Business and Professions Code) or that he or 873 she is exempt therefrom and the basis for the alleged exemption. Any (530) -4389 - violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 Applicant: FISCHER, STAN C. Code: The Contractors' State License Law does not apply to an P.O. BOX 1740 owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, MAGALIA, CA provided that such improvements are not intended or offered for 95954 sale. If however, the building or improvements are sold within one (530 ) 873-4389 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 Contractor: 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 Professions Code �-•` Date: �l (% Owner: L� ,c License #: 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 Architect: Labor Code, for the performance of the work for which this permit is issued. Engineer: ❑ I 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: Total Square Ft: 0 S. F. Valuation: $0.00 Policy#: Census Code: 61- 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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. _ 1-7- b -4Date: Applicant:1 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 This permit is hereby issued under the -applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions t do work indicated aliov or which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) 1 A .; j ? .i_Z% By: i Date: Name: Lfz PERMIT EXPIRES ON: Address: Date ❑ I 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 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 representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: Signature: -7— Date: -� ! r Winer ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP060865 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 04/17/2006 APN: 065-090-013-000 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. Site Address: 6232 MCREYNOLDS CT MAG License Class : License Number: Map Index: Date: Contractor: Description: RE ROOF COMP 15 SQ.'S 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 Owner: FISCHER, STAN C. permit to construct, alter, improve, demolish, or repair any structure, prior P.O. BOX 1740 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 MAGALIA, CA the Contractor's State License Law (Chapter 9 commencing with Section 95954 7000) of Division 3 of the Business and Professions Code) or that he or 873 she is exempt therefrom and the basis for the alleged exemption. Any (530) -4389 - violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 Applicant: FISCHER, STAN C. Code: The Contractors' State License Law does not apply to an P.O. BOX 1740 owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, MAGALIA, CA provided that such improvements are not intended or offered for 95954 sale. If however, the building or improvements are sold within one (530 ) 873-4389 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 Contractor: 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 Professions Code Date: Owner: '4 ` 61661 License #: ��- 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 Architect: Labor Code, for the performance of the work for which this permit is issued. Engineer: ❑ I 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: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: Policy#: 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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. — f7 (� Date: Applicant:_1 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. 44 i! 46 s - ot' `� CONSTRUCTION LENDING AGENCY This permit is hereby issued under thea plicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions t • do work indicated ab'ov or which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) 0 Name: A By: Date: PERMIT EXPIRES ON: r/ — / (Date) 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 & 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 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 representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: Signature: — Date: r-�'—� — lr—>(D • S Winer ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 OWNER -BUILDER VERIFICATION ��)6 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 MW labor and material for construction of this proposed property improvement: YES [tej [ ]. 2. I HAVE HAVE NOT f ] 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: PHONE: CONTRACTOR'S 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: 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 SIGNED: PROPERTY OWNER: DATE: . :4 1-7- d S 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. Rev'd 11/4/2004