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Home My WebLink About068-120-0471 • ,•_A _ V ...'� .f i w.. - 4... - sem.._ .rte - � � :.. x�M� BALES,yKenneth =993 V"-✓. t M 068 ,120047x{, e.BUSKIRK,jRIDBERT'f`°St- `''t y26 AGI EN DR.,O OROVILLEN,, ,h +2Lot 3, Glen Dr opposite Glen Circle ;Cont: GALLAGHERS HEATING ^{�r„', M. u Oroville C/O HVAC`tr'3yy '`., contractor: Layton & Son, Rt. 2, Box:2789y=�-- L ! r 1 / lil,s" >I _ f � " � r 4 . P / lil,s" >I _ r' BUTTE COUNTY PERMIT NO. DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT Bp050677 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICfO) OFFICE #: (530) 538-7541 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 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 03/14/2005 APN: 068-120-047-000 the Business and Professions Code, and my license is in full force and effect. cu) 1 3:3 License tClass License. Dater l' 4'Contract Site Address: 263 GLEN DR ORO Map Index: r OWNER -BUIL ER DECLA ATION I hereby affirm under penalty of perjury that I am exempt from the Description: CHANGE OUT NEW HVAC UNIT 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: BUSKIRK ROBERT GENE & LULA B JT 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 State License Law (Chapter 9 commencing with Section 263 GLEN DR 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA she is exempt therefrom and the basis for the alleged exemption. Any 95966 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).): Cl 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' Stale License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: GALLAGHER'S HEATING & AIR such work himself or herself or through his or her own employees,' provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one E. HWY 99 year of completion, the owner -builder will have the burden of LOS MOLINAS, CA proving that he or she did not build or improve for the purpose of sale:). 800-892-3556 ❑ 1, 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 Contractor: GALLAGHER'S HEATING &AIR pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of the Business and Professions Code E. HWY 99 LOS MOLINAS, CA Date: owner: 800-892-3556 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: License M 777334 O 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 01 --is issued. 0 1 have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code,, for the performance of Engineer: the work for which this permit is issued. My workers' compensation insurance carrier and policy numberare: Carrier: Policy#: otal Square Ft: 0 S. F. ❑ 1 certify that in the performance of the work for which this permit is Valuation: $0.00 issued, I shall not employ any person in any manner so as to Census Code: 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'th those provisions. ' 7-o Date: Applica WARNIN Failure t secure workers' compensation coverage is WARNIN Faliure 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.Gc, CONSTRUCTION LENDING AGENCY This permit is hereby issued under the i le provisions of the Butte County Code and/or 1 hereby affirm that there is a construction lending agency for the of the work for which this is Issued (Sec 3097 Civ.) Resolutions to do vy, rk indicated aUov for yvh h fees have been paid. / performance permit By:_ Date: Name: _ Address: PERMIT EXPIRES ON: Dale ❑ 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: Date: ❑ Owner 13h'Agent for Contractor ❑ Owner ❑ Contractor Agent for B. C. Buildinq Permit 01-16.04 pq 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 OF APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last Name b s t k, First Name ` r Address Q_ 3 �, 1 �� 'Dv— City or C/ �� \ � `� State C A Zip in Phone Fax E-mail CONTRACTOR Name 07CLI10, 5 4 V P C_ Address6 r �_,) ` 35 City 1,�;l U� I R 0, StateG� ZipGbOSS Phone 3 Fax E-mail Lic. #Class 11 3-3LI Tab C 36 APPLICANT NAME ARCHITECT/ENGINEER Name City S i 1 S Address Zip 4, City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT NAME Name ( t+/ A _ Address City S i 1 S State Zip 4, Phone Fax E-mail PPLICANT SIGNATURE X 4 ` For ffice use only: Zoning Property Address 1.10 l eh r Flood Zone Cross Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PE-��RMIT BIN # LOCATION AP# 0 Property Address 1.10 l eh r City CSF v l>? Cross Street WORKER'S COMPENSATION Policy Number 1' 2si�3S� Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: C41 v c- Sq. Footage ❑ 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: Bldg SRA Receipt #` Sheriff C / SMIP I v , Other l/ � v Other I I // t S✓- Total Page 1 of 2 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. �j 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 inst, (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 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"rdriveway 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 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 KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 Job Name: Buskirk, Bob Job Street Address: 263 Glen Dr Job city/State/Zip: Oroville, CA 95966 - ® Property Owner same as above " Owner's Name: ' Owner's Street Address: Owner's City/State/Zip: w. Job Description: Special horizontal under.house split system. - ❑ New Cut -in ® Change out r, Permit Type: ❑ Building ®'Mechanical ❑ Electrical ❑ Plumbing - Estimated Value: 6000 i Contractor's Name: Gallagher's HVAC Phone: (530) 384-2444 ; Mailing Address: P.O. Box 35, Los Molinos, CA 96055 Gallagher's Heating & Air Conditioning Inc. Form Wednesday, March 09, 2005 i . Rev: 11/2004 ',