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Home My WebLink About065-410-003AP 6.5-41-3 OHN FERRO -- ��j�S� 2-5-(Y Jack Pine, lot 28, PP#3, Mag. contr: Ancel Ballard, Paradise Permit# 4172-74B,E(cabana & deck, MH) %2 S —; , 065-41 '0-003 LAGUSIS, NICK 15052 JACK PINE WAY. MAGALIA OWNER RETAG ELECT r ' i a f 0 i s � 4 o 0 i �ANIOOR. a a. "' Date: 2/2/2010 .Z"."`°'` DEPARTMENT OF FORESTRY & FIRE PROTECTION Page I of 4 C FIRE REPORT ` O F FC-18 State " CAS`Y ar "1999 Incrden ## BTU 004124aFre# 001,63 Ex sure#000; ' 1x Fire Name: JACK FDID 04035; BUT Order Agency#: BTU-1999 Protection Resp: 2.0 STATE ZONE-LOCAL GOVT CONTRACT (SCHED A DPA) Auto-Mutual Aid: 1 MUTUAL AID, RECEIVED FROM ANOTHER FIRE DEPT Situation Found 1: 110 STRUCTURE FIRE; NOT INCLUDED IN #12.0 OR #13.0 Situation Found 2: Situation Found 3: Situation Found 4: Incident Address/Location: 15052 JACKPINE MAGALIA Room/Apt.: Zip Code: 95954 Census: 000000 CENSUS TRACT UNDETERMINED OR NOT REPORTED Temp: 72 Dispatch Level: Weather: 2 CLOUDY Code: 00 OCCUPANT/OWNER Name: LAGUSIS PETE Address: 15052 JACKPINE ' Room/Apt: City: MAGALIA State: CA Zip Code:95954 Telephone: Code: PO 3617 GALLAGHER CIR Name: LAGUSIS NICK Address:CA Zip Code: 94509 Room/Apt: City: ATTIOCH State: Telephone: 9257574959 1/4 Section: NE Section: 14 Township: 23. N/S: N Base Meridian: MT. DIABLO Range: 03 E/W: E Response Area: Al Battalion: 01 FHSZ: 00000Z Prop Mgmt: 1 PRIVATE TAX-PAYING PROPERTY +. Gen Prop Use: 41 ONE- OR TWO-FAMILY RESIDENTIAL USE Spec Prop Use: 411 ONE-FAMILY DWELLING: YEAR ROUND USE Building Code: R30 Structure Status: 2 IN USE W/FURNISHINGS IN PLACE, PROPERTY BEING USED Occupied: 2 Mobile Property: 99 MOBILE PROPERTY TYPE NOT CLASSIFIED' DATE and TIME Estimated Start: 05/10/1999 13:15:00 First Report: 05/10/1999 13:43:00 Method of Alarm: 7 TELEPHONE TIE-LINE TO FIRE DEPARTMENT (911 SYSTEM) Lookout: Second Report: Method of Alarm: Lookout: Date: 2/2/2010 Pn 7 nf,4 Fire Report First Enroute: 05/10/1999 13:45:00 First On Scene: 05/10/1999 13:50:00 Contained: 05/10/1999 14:10:00 Controlled: 05/10/1999 14:10:00 End Time: 05/10/1999 16:00:00 CASUALTY Injuries Fatalities Fire Service: 0 0 Non -Fire Service: 0 0 Completed for all Fires Billable Fire: Type Action Taken 1: 13 EXTINGUISHMENT, SALVAGE AND OVERHAUL Type Action Taken 2: 71 INVESTIGATE Type Action Taken 3: 64 PROVIDE PUBLIC AND MEDIA INFORMATION Type Action Taken 4: Area of Origin: 24 KITCHEN, COOKING AREA Level of Origin: A 1 Horz Dist from Orig: 0; Equip Inv in Ign: .20 COOKING EQUIPMENT; INSUFFICIENT INFORMATION Form of Heat: 99 FORM OF HEAT OF IGNITION NOT CLASSIFIED _ABOVE Certainty: 1 CERTAIN Ignition Factor: 210 RECKLESS - FAILURE TO USE ORDINARY CARE Certainty: 4 BEST ESTIMATE Contributing Factorl: 212 CARELESS ACT Contributing Factor2: 216 MAINTENANCE INADEQUATE Resp Person #I -Occupation: 000 Sex: M Age: 41 Resp Person #2 -Occupation: Sex: Age: 0 Resp Person #3 -Occupation: Sex: Age: 0 Type of Material Ign: 14 LP -GAS Certainty: 4 BEST ESTIMATE Form of Material Ign: 66 PIPE, DUCT, CONDUIT, HOSE Certainty: 2 Method of Extinguish: 6 WATER FROM HYDRANT, DRAFT, OR STANDPIPE Violation #1 -Section: Code: Violation #2 -Section: Code: Fire Report Date: 2/2/2010 VEGETATION FIRE Size: Dist to Head: 0 Flame Length: 0 Elevation: 0 Behavior: % Slope: 0 Aspect: Fuel Model: Wind Speed: 0 Wind Dir: Burnin Index: 0 Structures Destroyed: 0 Damaged: 0 Threatened: _ '0 ACRES BURNED BY VEGETATION TYPE WITHIN DIRECT PROTECTION A CATEGORY Timber Grass Woodland Arg Prod Brush Totals State 0 0 0 0 0 0 Local 0 0 0 0 0 0 Totals 0 0 0 0 0 0 ACRES BURNED BY STATUTORY RESPONSIBILITY WITHIN STATE DIRECT PROTECTION A State 0 United States Forest Service (USFS) 0 Bureau of Land Management (BLM) 0 Bureau of Indian Affairs (BIA) 0 National Park Service (NPS) 0 Bureau of Reclamation 0 Other Federal 0 Other 0 Total 0 DOLLAR DAMAGE CATEGORY CDF State/Fed Local Totals Vehicle $0 $0 $250 $250 Dwelling $0 $0 $45,000 $45,000 Other Structure $0 $0 $0 $0 Other Improvements $0 $0 $0 $0 Contents $0 $0 $0 $0 Timber $0 $0 $0 $0 Agricultural Product $0 $0 $0 $0 Wildland $0 $0 $0 $0 Other $0 $0 $0 $0 Total $0 $0 $45,250 $45,250 Fire Report Date: 2/2/2010 TOTAL RESOURCES Schedule A Engines: 1 Federal Engines: 0 Schedule A Truck: 0 Emergency Fire Fighter: 0 Schedule A Squad: 1 Other Local Agency: 1 Schedule B Engines: 1 Overhead: 1 Schedule B Dozers: 0 Call When Needed Helicopter: 0 CDF Fire Crews: 0 Helicopter: 0 Air Attack: 0 Private Equipment: 0 Air Tankers: 0 Paid Persons: 8 Fire Crews: 0 Volunteers: 4 COMNIENTS FAULTY PROPANE HOOK-UP TO INDOOR COOK STOVE. Special Studies: REPORTING OFFICER Name: LLOYD ROMINE Title: FC, FIRE CAPTAIN -A, FIRE CAPTAIN -B, HFEO Date: 5/10/1999 The undersigned hereby certifies this report is a true copy of the record on file: Signature: Title: Date: Fire Report 'i Y• ,PERMIT NO. 4172-74B,E P E S G M n i�. ,.jMH UTIL. ,l 4PERM1T NO. • - t �j PERMIT EXPIRES OWNER __ John Ferro CONTR. Ancel Ballard, Paradise LOCATION (A.P. 65-41-3 ) 250 Jack Pine, lot 28, PP##3, Magalia r . I 6 Temp. Power Pole / Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB s� FINALED / (Date) (Sign re) r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING I BUILDING (Cont'd) I PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall - Siding To out r Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures _ Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. ' structureTemp. Gas Piping & Test Gas Slab Final Z Sanitation Patio F REPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough —7 Reinf. Steel Final Fixtures 'Bond Bea FIRE SPRINKLERS Motors Framing Z." Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole _ Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS -L r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WO S 7 County Center Drive — brotrilIe? California 95965- Tele hone: 534-4541 / OC APPLICATION AND PERMIT BUILDING OwnerSQ. %rrd FT. OCC. BUILDING VALUATION :Q Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address f Permit Fee Plan Checking Fee &/or Penalty T le hon eNo Permit Fee $ $ J& 101 Building Address C PLUMBING No. @ FEE PERMIT FILING FEE $2.00 Each Trap 1.50 .L a Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 �`.- ,�/ A. P. No. �J Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W io Fire Dept. FFire Zone Use Permit Building sewer 5.00 EQA Parking Plans J Parcel eclaration P parcel Ma P 60' R/W Imp ro ments Lawn sprinkler system 2.00 Bldg. Plansec'd Par Approvol PI s Approvol Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 _ Q -a Main service incl. 1 meter � C_- Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family ❑ Duplex ❑ Mobil Home Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures aRRO-0 R ps., switc & fix 22t ets 6'0 CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of:^ 84� / �W l Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. 26;ZJ77 Classification / Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ T $ F 'Z WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. j I have placed on file with the County of Butte a certificate of J� Workmen's Compensation Insurance. ❑ 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 Workmen's Compensation Laws of California. 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 MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ TOTAL PERMIT FEE $ � � autnunce representatives of the county of t3utte to enter upon the above-mentioned property for iinnsspppeection purposes. X loe�l A4yeA '544-1) — Date Signatureof Permitee or Agent / Receipt No. / 2 1-7 Ag ! Y White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 911 PUBLIC WORKS 13 Date-`.> — 2-1 % Y Ilding permit expires Date.............L:`'...-Z1` 72� COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 P RMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 065-41-0-003 ZONING I RT -1 BUILDING PERMIT OWNER NICK LAGUSIS TELEPHONE SO. FT. OCC. BUILDING VALUATION . OWNER'S MAILING ADDRESS 15052 JACK PINE WAY MAGALIA CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER . Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ 15052 JACK PINE WAY MAGALTA $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF X] Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑X Describe Work: RETAG ELECTRIC SERVICE Gas i in stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200AORLESS 23.00 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors license Law for the following reason: I( I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service sow To i000a 46.00 NEw CONST. owEwNG occuP. ( NRA 3.5QF°. CONST. Muir�i ou�rLFST NON•RESID. @7.50 POWER APPARATUS a SINGLE ourtEr C.. Ex. Occup.20 OUTLET OR FIXTURES Q 1'00 BAL @ .so Ex. Occup. ounFrs RES D.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 00 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compen tion provisions of section 3700 of the Labor Code, I shall fo' ithwith c ply ithithose provisions. + X t^/ Date — a- J Sif ur of 'ppli ❑ wner ❑ Contractor ❑ Agent An OSHA perm) 's requir excavations over 5'0" deep and demolition or construction of structures over asin height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEI= $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ A �.A. D. FEES IMP FLOOD CDF PARCEL HD ISSUE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above 7�ihlfees have been paid. ? ^ `� �7 ate C� PERMIT EXPIRES ON -2 30 ate Receipt No. 244802 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT,. (Rev.12/96) COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUM89R 0 D [I Z -M a1 77 BUILDING PERMIT OWNER 1-4661G [/ TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS n L AINFE w\-1 44t4&d4-(A CONTRACTORS NAME TEU]MIONE CONTRACTORS MODUNG ADDRESS CONSTRUCTION LENDER LENDERS MAIUNG ADDRESS Fireplace Total Valuation S ARCHITECT OR ENGINEER LICENSE NO. Filing Fee S 20.00 Permit Fee S ARCMTECT OR ENGNEERS MA6UNG ADDRESS Plan Checking Fee $ WLDNG ADDRESS Energy Plan Checking Fee S S PERMIT FEE $ IDT No. SUBDIVISIONS NAME PArrcel MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex O Mobilehome O Other SPECS Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel O Udrldes O Installation O Other O Describe Work: �c %— � LK S9W2L Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G I W (920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service OR' M.' 23.00 p� LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ❑ 1 am exempt under Sec. , Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 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 pePmit is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) O 1 certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in any manner so as to become subject to 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 she.. forthwith comply with those provisions. X Date Signature of Applicant - O Owner O Contractor O Agent An OSHA permit is required for excavations over 50• deep and demolition or construction of structures over 3 stories in height Main Service 2WA TO 1000A 46,00 NEW CONST. OWEilNO OCCUP. SO. OR ADDNS. a Ate. mss, 3.50FT. 1pµRE810. AWM- unET @7,50 PowER APPARATus rV sNGLE ovnEt art Ex. Occu ovrTFTGR raTTUREs SAL @ o Ex. Occup. APPS pZ p� 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE t `� , .Br" MECHANICAL PERMIT Filing Fee 20.00 Heating Conlin Hood 6.50 Ventilation PERMIT FEt f Mobile Home Installation Fee S Energy Inspection Fee S Occ CONST. TYPE TOTAL FEE $ ,,,� D IMPROODCDP PARCEL Po HD ssuE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXPIRES ON provisions to do work paid. Ta Receipt No. - WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLOENROD-APPLICANT AI I V _: OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signIMM. 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 im rovement : YES NO 2. I HA HAVE NOT 13 signed an application for a building permit for the proposed woo& 3. I have contracted with the following person (firm) to provide the proposed const iction: : . .. -IES: - — -- - - – _ ._ _. _ _.....: • - _ ADDRESS: CITY; .., PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following peMn to coordinate; supervise, and provide the major work:. NAME: • 4 ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER:� SOCIAL SECURITY NUMBER: DATE;_ q 3� -- (�v ( - -- "NOTE: -This Owner -Builder Verification is required by Section I98.31—ff79Ue— California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit OVER OWNER BUILDER INFORMATION .I Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible parry 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 5300 or more for the entire project, and such persons are not. licensed as contractorsebr subcontractors, then you may be an employer. . 9.1 ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, Workers compensation insurance, disability insurance costs, and unemployment compensation' contributions:':'' ♦ There may be financial risks for you if you do not c out these obligations; and these risks are es , ecial `' `"' Y Y Y QTY � p ly}serrous . with respect to worker's compensation insurance.. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service: (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building" permits are not required to be signed by property owners unless they are performing their own work personally. - Information about licensed contractprs may be obtained by contracting the Contractors State License Board in your .-.- community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. +irely, Vi ira, C.B.O. ,uilding Inspection NOTE: This Owner-Builder,Information is required by Section 19830 of the California Healdi and Safety Code OVER - k' r) I) 7 t. k' r) I) t. #F . � {, ;, ,, k' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING) DIVISION 7 County Center Drive --•-Oroville, Californias 95965 • Telephone (530) 538-7541/W_ j ;PERMIT N0. (Rev. 12/96) APPLICATION AND PERMIT lt�j ASSESSOR PARCEL NUMBER ` nVVyl!� ZONINGT, BUILDING PERMIT OWNER NICK LAGUSIS TELEPHONE SO. FT. OCC. BUILDING VALUATION . OWNER'S MAIUNG ADDRESS ' 15052 JACK PIPE WAY MAGALIA CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation is ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS 150523jAeR ME WAY M&LIZ-1A$ Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 1 7.00 USEOFSTRUCTURE SF X1 Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑K M Describe Work: RETAG ELEIC SERVICE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 6R LESS Main Service 2D0DA0VOOR LESS 23.00 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.POWER License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: p° 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed 0 the permit is for work of a valuation of one hundred dollars ($100) or less.) t O' 1 certify that in the performance of the work for which this permit is issued, I shall %. not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that 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 �_-�, _ .. _ ` I 1 11 X r �. ; : .'� i "` _ Date f f _ Signature of Applicant -&Owner ❑ Contractor ❑ Agent An OSHA Perm it,is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service zooA TO ,000A 46.00 NEW CONST. DWELLING OCCUP. SO OR ADDNS. ( a ACC. BLDs. 3.50x: p°OIIDDT. MULTI-,_,cTS @7,50 APPARATUS a SINGLE OUTLET CR. .00 EX. Occup. OUTLET OR FDnURES BAL @ I 0 FUCED APPLNSD. Ex. Occup. u.ED EORA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cootie Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ �+ nn f D. FEES IMP FLOOD COF PARCEL PD HD SSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. B Date�... 3 d y _340 PERMIT EXPIRES ON ate Receipt No. 244bUL WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT