HomeMy WebLinkAbout068-160-0890
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068-16-0-089 00-1313
WILSON, CLAUDE
3837 OLIVE HWY, OROVILLE
CONTR: OWNERF/dj//e
INSTALL GAS LINE C AIR/HEAT
068-16-"89 00-1568
WILSON, CLAUDE
3837 OLIVEHWY., OROVILLE
CONTR: OWNER F/gaQ
2 WATER HEATERS
4
CARL NELSON� Eq � �`✓ Z y��i �7 - - _ _ -- —
Building Plans Examiner ; --
1
C. 3UTTE.COUNTY---- —: -- - -
Land of Natural Wealth and Beauty ° ®F DEVELOPMENT SERVICES .
DEPARTMENT OF DEVELOPMENT SERVICES ° _y¢ o o s PERMIT APPLICATION
7 COUNTY CENTER DR. • OROVILLE. CA 95965 ° o
(530) 538-7541 MAINC°®�N,�•d 30) 538-7541 FAX #: (53 .0) 538-2140_ _ _
(530) 538-2875 DIRECT (530) 538-2140 FAX
WBESITE: www.buttecounty.net/dds REQUIRED AT TIME OFAPPLICATION
E-MAIL: cnelson®buttecounty.net Re: www.buttecounty.net/dds ,
,ASE PRINT CLEARLY"
V
APPLICANT INFORMATION
OWNER INFORMATION
Last Name
City
First Name
Mailing Address
38 37 OL,MS OWY
City
State
State
Zip
Phone
Fax
Fax
E-mail
Lic. #
APPLICANT INFORMATION
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Fax
E-mail
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address ..
Zip
City
Fax
State
Flip
Phone
Fax
E-mail
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
PROJECT LOCATION
AP#10616- 1,60- 0g.
Property Address
City
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.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
�►' � G�r.l r rIl s �d-�' �J
/JA
/0&_
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
Flood Zone
SRA
Yes
No
Occ.
Type Const.
r .
068-16-0-089 '004568
j f t .''`WILSON,. CLAUDE
3837 OLIVE HWY., OROVII.LLE .
k. CONTR: OWNER r
{ 2 WATER HEATERS
0
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDINGLDIVIS101i
7 County Center Drive • Oroville, California 95965 • Telephone (530) 5384541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT Al zl7r
i
ASSESSOR PARCEL NUMBER 068--160-M
ZONING
BUILDING PERMIT
OWNER DUDE WILSON
UD
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 3837 OLIVE Hn. OROVILLE 95966
CONTRACTOR'S NAME
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 $
BUILDINGADDRESS WE '
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF'ID Duplex ❑ Mobilehome ❑ Other
�.+.. SPECIFY
Each Trap 7.00
Solar or heat pump water heater 23.00 j
Water piping 15.00 :t
Each as water heater or vent 15.00 lJ
30 0.0
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Unities ❑ Installation ❑ Others
Describe Work: TrjA'jR RRATFRO
I„
�J
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00 "
Mobile Home I S I G W @20.00
PERMIT FEE $ 50.00
�•,
ELECTRICAL PERMIT Fling Fee 20.00
OOOV OR LESS
Main .Service 20.A OR LESS 23.00
L
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 Contract ors 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 To LOCU00A 46.00so
WEE200A
NEW CONST. DWEWNG OCCUP. SO
OR ADDNS. ( & ACC. BLDS. 3.50FT,
NEW CONST. MULTI.OUTLET
NON-RESID. @7.50
ER APPARATUS
8 PSINOWGLE OUTLET CIR.
EX. OCCU OUTLET OR FIXTURES Bq ' S0
vTEDAPPLNS.OR
Ex. Occup. ovn LETS REBID. EA. 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I 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 i
performance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work forwhich this permitis 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 should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith'comply with those provisions.
n '
r X} Date _
`Signaturerof Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee
occ
CONST. TYPE
TOTAL FEE $ 50.00
HAZ.
D. FEES IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
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.
/
y -P I / Date !!!
PERMIT EXPIRES ON V ��
Dafe
ReceiptNo. 3r.r� o� 7u nou•uu
WHITE-D.D.S.-B.D.AC NARY -A SESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
M
a
CaUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
' J 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
4;Ae
ASSESSOR PARCEL NUMBER 068-160-089
ZONING
BUILDING PERMIT
OWNER CLAUDE WILSON
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS 3837 OLIVE HWY, OROVILLE 95966
CONTRACTOR'S NAME
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
$
BUILDINGADDRESS SAME
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF I� 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
2 15.00 30.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other X]
Describe Work: 9 WATER 14:ATF.R$
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S G W
@20.00
PERMIT FEE
$ 50.00
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service zo.A OR LESS
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, 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.
F1 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 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( & ACC. BWS.
SO
3.5¢FT.
NEW
gESID. T. MULTI -OUTLET
@7.50
APPARATus
PoINGCIR. WE.
&P OUTLET
Ex. OCCU ounEr DR FocruREs
20 �'�0°
BAL @ .SO
Ex. Occup. OUTE�°SA RESD.O
, EA-
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
$
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
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
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.)
QD 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
wor rscompensation provisions of section 3700 of the Labor Code, I shall
mply with those provisions.
X .J Date
natur f Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSH permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 50.00
HA2.
D. FEES IMP
FLOOD I
CDF
PARCEL
PD
I HD
I ISSU
This permit is hereby issued under
of the Butte County Code and/or
indicated bove for which fees have
/
y ,L,L',�
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
�� JVD
Da �✓
Det
Receipt No. O 50.00
WHITE-O.D.S.-B.D. CANARY-AJ"SESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
.,,COUNTY
07 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT 60 - SSS
A111`EII'DRPA"C&N11 BER g'
mNNO
BUILDING PERMIT
owNEa
i
T[t�LgNE
SO. FT. OCC. BUILDING VALUATION
OWNERSADORESS D'
CONTRACrOR•/ /MME
TELEPHONE
CON RACTOR'll MAILING ADDRESS
CONSTRUCTION LENDER
LFire
LENDER'S M UNIG ADDRESS
lace
Total Valuation $
ARCNIrECT OR ENOINEER
LICENSE NO.
Flin Fee b 20.00
ARCWMCr OR ENOMEER'S MALINO ADDRESS
Permit Fee E
Plan Checking Fee S
OULDINOADDRESS
Energy Plan ' Checking Fee S
b
PERMIT FEE t
LOT NO.
SUeOWSIONIS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF Duplex ❑ Mobilehome ❑ Other
9xcsv
Each Tra 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00 po '
TYPE OF WORK
New ❑ Addition ❑ ',R',e^^model ❑ Utilities ❑ Installation
Describe Wor W ,
❑ Other �1
Gas piping system 1 - S outlets 15.00
Buildingsewer 15.00
Mobile Home ISI GI W1 e20.00
PERMIT FEE $ SQ. LU I
ELECTRICAL PERMIT Filing Fee 20.00
"
Mein Service 000. OR LESS
2aoA OR LESS 23.00
'
(�
.
Main Service 200A TO 1000A 46.00
NEW CONST. DWElldqOCCUP. 3.5Cso.
OR AOONS. L ACC. OCS. '
NEW COT.
O 10. MULT,_T 97,50
POWER APPAfiATUS
8 SINOLE OUTLET CIR
EX. Occup. oLmFr ORFwTURE3 20'a
BAL .SO
Ex. Occup. ounce SID )ERA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring
+23,00
PERMIT FEE S
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 8.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspectioh�-F,ee
$
yT'OTAL
OCC
CONST. TYPE
FEE $ SQ .
.
t7 I
IMP
I ROOD
I CAF
PARCEL
I PO
ISSUE
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.
By Date
PERMIT EXPIRES ON
ro
..�z�Fy;. ..:-�r'.�: .r�nu.�8t'.r..,•,•.u.z, �,..•,—.... ,�....,A,yyr,,.w.•-tea;rr *wq...�, .•. ,qc• +u 3�� '"".l�r�r� ,F^4• �^x�yT,• .....�i,.4 Ty.i� .'r�,+r'. ,•'.�
r 068-16-0-089 ' ' 00-1313
-. - WILSON, CLAUDE '
3837 OLIVE-HWY, OROVILLE
CONTR: OWNER
:* INSTALL GAS LINE & AIR/HEAT
i .
OFFICE COPY
'r• Address
GAS
Meter By. Date_7� �.
E C
Met
•
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
�0'_ 7 County Center Drive • Oroville, California 959 Teleph ne (530) 538-7541 PERMIT NO.
(ReW.12/96) APPLICATION AN PERMIT' &V-- mg,
ASSESSOR PARCEL NUMBER 068-160-,W9
ZONING
BUILDING PERMIT "
OWNER CLAUDE WILSON
TELEPHONE
533-6965
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 3837 OLIVE HWY OROVILU 95966 1
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAIUNG ADDRESS
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
I
Permit Fee $
Plan Checking Fee $
BUILDING ADDRESS
SAM
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCELIMAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE I
SF ❑ Duplex ❑ Mobilehome ❑ Other I
SPECIFY r
Each Trap
7.00
Solar or heat um water heater
23.00
Water piping
15.00
Each gaswater heater or vent
CL5. Q4-{
TYPE OF WORK i
i}
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation CSR Other O
Describe Work: INSTALL GAS LIN$fAIR7fR>t?AT '
CENTRAL DUCT WORK. �
Gas piping system 1 - 5 outlets
15 • QO „� �j • G
Building sewer
15.00 "
Mobile Home S G W
@20.00
PERMIT FEE $
35.00
b
ELECTRICAL PERMIT
Fling Fee 20.00
- -
• I
800V0"LESS
Main Service 200. OR LESS
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.1
License Class Lic. No. `
OWNER -BUILDER DECLARATION I
I hereby affirm under penalty of perjury that'[ am exempt from the Contractors License
Law for the following reason: ,
❑ 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 1
Main Service 200A TO lOooA
46.00
NEW CONST. pWEWNG OCCUP.
OR ADDNS. ( s ACC. BLOs.
SO
3.50FT:
NEW CONST. MULTI -O
NON -REBID. UTLETTS
@7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. OCCU OUTLET OR FIXTURES
20 Q 1'00
BAL .SO
.FIXED APPLNS. OR
Ex. Occup. OUTLETS REBID. Ea
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE $
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 permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT
Fling Fee 20.00
Heating DUAL
30.00
Cooling
Hood
6.50
Ventilation
PERMIT F.
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 shallTOTAL
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.
17
X 1 i,�/o...+_� ___ Date?
Signature ofiApplicant - Q,.Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
FEE $ AS nn
HAZ.
D. FEES IMP
I FLOOD I
CDF
PARCEL
PD
HD
ISSUE
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.
(`
�By ��
/ Ci v--F)ate �-1
`� ,. / r
PERMIT EXPIRES ON
Date
ReceiptNo, 4? V.6-00
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
J
I
COUNTY OF BUTTE
BUILDING DIVISION
- DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
,
)S,�n
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
completed. If you have any questions pertaining to this matter, or need additional explanation,
please cjontact this office immediately.
// I /, 4 , X '& �' � AV � C-- L
' ,�_ - :ff-'.I / . 7 1/
Date -,
REV 1
Inspector leiw
0
tOUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541�y®� PERMIT NO.
(Ret.12/96) , APPLICATION AND PERMIT �OIII- T
ASSESSOR PARCEL NUMBER 068-160-089
ZONING
BUILDING PERMIT tI
OWNER CLAUDE WILSON
TE533N LEPHOE 6965
SQ. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 3837 OLIVE HWY OROVILLE 95966
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
[Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
SAME
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
-
Solar or heat um water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation QX Other ❑
Describe Work: INSTALL GAS LINJAIRIHEAT FURNACE
CENTRAL DUCT WORK
Gas piping system 1 - 5 outlets
15.00 15.00`
Building sewer
15.00
Mobile Home IS I GI WF—'
920.00
PERMIT FEE S
35.00
ELECTRICAL PERMIT
Fling Fee 1 20.00
Main Service eoov oR LEss
2o0A OR IESS
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
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
If 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 if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
1�
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.
` %
X _ Date
Signature cipApplicant - wner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service To 46.00so
WEE200A
CCU000A
NEW CONST. DWELLING OCCUP. SO
OR ADD S.. ( d ACC. BLDS. 3.5¢FT.
,., REsloT' MULTI.OUTLET 97.50
POWER APPARATUS
S SINGLE OUTLET CIR.
Ex. OCcu ou ET OR FIXTURESzo @ I.5
BAL 0 .500
Ex. Occup. OUTLEEDTSA q IES p.OEA 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating DUAL '30-00
Cooling
Hood 6.50
Ventilation
PERMIT F
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
HAZ
D FEES IMP
I FLOOD
I COF
PARCEL
Po
HD
IS
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for w ich fees have been paid.
)
i/ O ZlyL—'Bate
PERMIT EXP RES ON 10
Date
ReceiptNo. J��
WHITE-D.D.S.-B.D. CANA Y -ASS SS R PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
i 7 County Center Drive a Orovillet California. 95965 • Telephone (530) 538-7541 PERS
tRev.12AM APPLICATION AND PERMIT
Ase»ot'atana►et�CCJ _ Q 1 p— c: f
m"'s
BUILDING PERMIT
SO. FT. OCC. BUILDING VALUATION
OWMM„ tAA M Ao01lfe
S
o0wrRA=*,8 w�.st
Tstshow
00WV.gCToR1 wartD ADOMM
COWTlItcrioM mot
Fireplace
tMOM WAR2w ADORas
Total Valuation S
AACWKCT OR V"MM
ucost NO'
FGn Fee'
=
20
Permit Fee
i
ARCMrn= OR ojDsraets UNUND ADORl7e
Plan Checking Fee
S
C
Energy Plan Checking Fee
=
i
PERMIT FEE
PERMIT
_
uor►a
e�°r1e'N"++e
r""c� MAP
PERMIT
Fling Fee
20
Each Tr
7.00
USEOFSTRUCTURE
SF O Duplex O Mobilehome O Other
s°W"
Soler or hent pump water heater
23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New O Addition O Remood�ell,�0 LXKes �0 instalation W
Descrlbe Work: J,G,&X amid 1!!G�iI�
&tiLbid
Other O
Gas piping !ystem 1 - 5 outlets
15.00 /,S
Building sewer 15.00
Mobile Home I S I G I W Q20.00
PERMIT FEE = C
ELECTRICAL PERMIT
Filing Fee
20
Main Service = oR tris
23.00
�
Main Service 200A To toom
48.00
New COW.- OwBLs+O o«vv, so.
OR ADONS. a AGC. ans. 3.Stn,
' �tnnartu:r Q7.50
POWER AMAMTIR
• ! OtlRET p0.
Ex. Occu ovndT oR PwruRO SAL .lp
Ex. Occup. otn 0 �,c. a 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Wsc. Wiring 23.00
PERMIT FEE _
MECHANICAL PERMIT Fling Fee 20
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt !
Mobile Home Installation Fee fi
Energy Inspection Fee =
«`
COST ,~Pe
TOTAL FEES
��► RDOD Wr FARM' rD
wtL
0. MES
This permit is hereby issued under the applicable provis
of the Butte County Code and/or Resolutions to do v
indicated above for which fees have been paid.
By Date
/
67c-
,
PERMIT EXPIRES ON —
rra!
i- 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 buildingpermit. No building peMTt,will...:
be issued until this verification is received.
G 1. I personally plan to provide the major labor and materials for construction of the,
MP
ed-.roperty improvement : YESM NO[
Z. I HAVE[ HAVE
NOT - ]signed ari: application for. a buu7ding permit_ for�the
Pr work.... r _
3. I have contracted with the following person (firm) : to - provide+ -the proposed
construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S. LICENSE NO:=
4. I plan to provide portions of this work, but I have hired the following person to
coordinate, supervise, and provide the major work:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
5. .I will provide some of the work but I have contracted (hired) the following$ersons to
provide the work indicated:
NAME ADDRESS PHONE TYPE OF WORK,-
SIGNED:
ORK:.
SIGNED:
PROPERTY OWNER:
S
DATE:
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California Health and Safety Code.
May 1995
This verification must be completed and returned to our office before
we are permitted to issue the permit.
2.26
f
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 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 you plan to subcontract, you
should be aware of the following information for your benefit and protection:
0 If you employ or otherwise engage any.persons other than your immediate family, and the work (including
'materials and other costs) is $300 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
0 . 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 unemployi ientcompensation contributions.
0 There may be.financial risks.for you if you do not carry out these obligations,"and these risks are especially
serious with respect to worker's compensation insurance.
0 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 "ownerbuilder"
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 contractors may be obtained by contracting the Contractors State License
Board in your community or at 1020 N Street, Sacramento, CA. 9581.4.
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
Sincerely,
Michael C. Vieira, C.B.O.
Manager, Building Inspection
NOTE: This Ovvmer-Builder Information is required by Section 19830 of the California Health and Safety Code.
2.27
` May 1995
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SIT E PLAN
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Assessors Parcel Number,
Owner Name
Address / Phone No.
Site Location
Contact Nave
000 - 11IM-1 scate: 1--.=
Phone
FOR OFFICE U8E ONLY PROVIDE FOR ALL
Zoning: ADJACENT PARCELS
SIZE"'):
General Plan Desig: ZONING:
Size, Ams GEN PLAN:
U
4.0(r SES:
u