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-341-043 04-1393
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3735 HILLDALE AVE, OROVILLE
HVAC
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+Cont: GALLAGHER'S HEAT NG
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-2994
3735 HILDALE
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SPECIAL CONDITIONS
CHECKED BY
SRA .
❑ FLOOD CERTIFICATE EQUIRED
❑ FIRE SPRINKLERS REQUIRED
❑ SPECIAL INSPECTION ITEMS
❑ VERIFY
❑ USE PERMIT CONDITIONS
❑ SUB -STANDARD HOUSING LETTER
❑ ENCROACHMENT PERMIT
❑ REINSPECTION FEE PAID
❑ ENV HLTH CLEARANCE
El
DATE JOB FINALED:
SIGNATURE:
OK V
MANUFACTURED HOMES''
MISCELLANEOUS
DATE ' PERMANENT FOUNDATION SOFT -SET
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch
3 Sewer; Loctn-Test; Fall/C/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-Breakers-Clrncs
10 Drain; MH Test -Fall -Flex Cnnctr
11 Wtr 8. Sewer Connected C10 to Grade
12 Gas and Electricity Tagged
13 Tie Downs 0 Foundation' Q
14 Exits'
15 Cert of Occupancy
16 HUD Label/Insignia Numbers Serial Numbers
x
DATE ID E C K S`C O V E R S+C A R P O R T S `G A R A G E S
1 Zoning -Setbacks -Easements
i 2 Ftgs; Soils -Sz-Dpth-Spacing-Cnnctrs Steel
3 Decks, Girders/Joists-Dcking-Brcing
Stairs-Guard/Handrails
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg
Frmg-Brcng
5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs
6 Carports; Wndws-Doors
7 Electric
- 8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses
9 ,Siding; Nailing -Veneer -Stucco -Lath
10 Roof; Shthg-Roofing
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
DATE jPOOLS
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability'
3 Pool Structure;. Steel-Cnnctns-Thickness. .
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
�. 5 Elec Pool Lting; 15 volts-GFl
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal wf5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w15' Crcltng Eqp-Pool Ightg
Bones-Enclsrs-pnlboards-Insultn to Main Conduit
9 Health Dept Apprvl .'
10 Plmb;. Cir Test-Wtr Supply Test '
11 • Lt Niche
12 Enclsr, Fencing -Alarms
13 Bonding, Diving board or Slide
c
°+ °� +
'
-
Pool Drawing
•
i
= OK r
0 = Not OK
RESIDENTIAL (Single & Duplex)
DAit JUNDERFLOOR
1 Zoning -Setbacks -Easements -Flood -Slope
2 Ftg Main; Soils-Elec Grnd Ftg Dpth
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
5 Stemwalls Main; Steel-Blockouts-Wrapped
6 Stemwalls Garage; Steel-Blockouts-Wrapped•
6a Hold Downs and Special Anchrs
7 Slab, Steel Wrapped
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
1l Wtr Pipe; Test-Anchrs-Rgltr•Service Test
12 Elec Undrgrnd
13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn
14 Girders-Sills-Anchr BoltsJoists-Vnts-Cripples
15 Acc & Vntltn
16 Insulation
mac` c
DATE IFRAMING
17 Sills Proper Materials & Anchrs
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
19 Bearing Walls over Girders & fir Nailing
20 Draft Stop in Walls (rat proof)
21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
22 Headers & Beams-Sz & Bearing
23 Hangers -Post Caps-Anchrs-Cnnctns
24 Ceiling Joist-Rftr Ties -Purl in -Roof Brac-TrussShthg
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
28 Garage Fire Prtctn Framing -RC Ctiannel
29 Prprty Line Firewall & Opngs
30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits
31 Stairs; Wi dth-Hdrm-Rise-Run -Landing -Fire Prtctn
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
33 Siding -Nailing Veneer
34 Stucco Lath -Weep Screed-Fndtri Vnts-Undrflr Acc
35 Glazing Area -Glass Prtctn-SkyLts-Plastic
36 Shear Walls; Nailing -Bolts
37 Brace Int/Ext Wall pnls
38 Insulin -Walls -Ceilings
39 Infiltration -W ails-Wndws
off• o`c oma• ��
DATE JELECTRICAL
40 Fxtr & Tmsfrmr Clmc4ns Prtctn
41 Elec Rcptcls Spacing-Lts & Switches at Doors
42 Sz Boxes & No Of Cndctrs Stapled
43 Romex Installed Close to Edge of Studs & CJ
44 Eqp Grnd made up w/Mech Fstnrs
45 Grndng Electrode Bond Gas & Wtr
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
47 Subfeed Wire Sz ga ❑ CU or QAL
AC Wire Sz 93 ❑CU or El AL
48 Range Circ , OCU or QAL
Oven Circ ea QCU or QAL
Insulated Neutral Q Yes Q No
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnls-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
DATE IPLUMBING
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
54 Wtr Pipe; Test & Anchr-Nail Prtctn
55 DWV; Test Fittings & Anchr Nail Prtctn
56 Shwr Pan; Test, First flr-Tub Acc
57 Test Tub & Shwr, 2nd flr - Tub•Acc
58 Gas Pipe; Sz & Anchrs
59 Fire Sprinkler; Test
60 Yard Gas Piping
DATE MECHANICAL
61 AC Ducts Insultn & Support
62 Vent Fan, Exhaust abv Insultn
63 Condensate Drain & Ovrflw, Sz & Grade
64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Acc & Pltfrm if Furnace in attic
li P c`
DATE F A L
t Steps -Door & SideLt Prtctn-Landings
moke Detector
Furnace Vnts-Clrnc-Comb, Air-Cnnctr
I Garage; abv-flr-Ducts-Mech Prtctn
droom Exiting
GFI & Bath Fxtrs & Tub Acc-Spa
Arc Fault
2 ec Trim & Subpnl, Breaker Szs & Labels
tairs, Guard/Handrails
4 Frplc or Stove, Cirnc-Hearth
Elec Outlets at Wood Pnl, Int & Ext
tchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking CImc.
lec Outlets & Rcptcls at Ktchn Counter
Garage Fire Door; Swing -Landing -Closure
7 AC Duct in Garage -Damper
Wtr Htr; Vnts-Clmc-Com Air Cnnctr-PRV; abv fir
ch Prtctn; LPG Appince Undr House 3" drain
mb; Elec & Mech Eqp Listed for Loctn
82 lec Rcptcls in Garage (GFI) Romex Prtctn
Insultn-Foam-Looked in Attic
Guard Rails & Deck Cnstrctn-Post Caps
Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
6 Clrnc Drnge Planters Q Yes [:]No
Stucco Brown -Finish
Unit Dscnnct, Elec-Plmb
nts abv Roof, Plmb-Appinc-Frplc-Clrnc to Opngs
Wtr Well, Dscnnct, Elec, Plmb
91 t Elec Trim, GFI Rcptcl-Undrgrnd
V tltn thru House
Glass Prtctn
94 Corrections from previous Inspctns
Gas Test -Meters Tagged, Gas-Elec
6 Wtr & Sewer Cnnctd-CIO to grade -HD Apprvl
7 rgy Cmpinc Cert -Other Certs
ddress Posted
99 Fire Sprinkler
Ise
s
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.neAdds
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
the Business and Professions Code, and my license is in full force and
effect.
License Class: �— License Number:.7 -7 7 3 3 Y
Date: .S 1 `1 G y Contractor. rQ L6_1AW5 fimc
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis foir the alleged exemption. Any
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
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.). r
❑' 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 ofproperty 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:
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.
Gy 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: �� cc 2 C6 `nom 1 ,�� �� ( ✓1 G
Policy #: a U .
❑ 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 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.
Date:
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.
PERMIT NO.
BP041393
Issued Date: 05/14/2004 APN: 068-341-043-000
Site Address: 3735 HILDALE AVE ORO
Map Index:
Description: HVAC
Owner: COPP DWAYNE & ANTOINETTE
3735 HILDALE AVE
OROVILLE, CA
95966-9501
Applicant: GALLAGHER'S HEATING & AIR
E. HWY 99
LOS MOLINAS, CA
800-892-3556
Contractor: GALLAGHER'S HEATING & AIR
E. HWY 99 , .
LOS. MOLINAS, CA
800-892-3556 .
License #: 777334
Architect:
Engineer: '
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
COUNTY OF BUTTE
BUILDING DIVISION , r
DEPARTMENT OF DEVELOPMENT SERVICES
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
OWNER
—y3 -;> l
PERMIT NO. l
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please call for re -inspection when correction of
work is completed. If you have any questions pertaining to this matter, or need additional
explanation, please contact the Building Inspector as indicated below.
C, v e r c—c z__ ,P .
LC -)o it- rA-.Ar n � f � v �n 10 A n t �
' r
s
A
Date Z Z ' \O Inspector Gm Jk i cjl kA ,n) Q n
REV 4/05 Phone # S3 �? ki
FOR RE -INSPECTION CALL: 538-7636 OR 891-2834
SPECIAL CONDITIONS
CHECKED BY
SRA '
FLOOD CERTIFICATE EQUIRED
FIRE SPRINKLERS REQUIRED,
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUBSTANDARD HOUSING LETTER
ENCROACHMENT PERMIT
REINSPECTION FEE PAID
ENV HLTH CLEARANCE
DATE JOB FINALED:
SIGNATURE:
t
OK
0 = Not OK ..1. - ..
M'ANUFACT.URED HOMES
MIS.CELlAN. EOUS
DATE Lj PERMANENT FOUNDATION Lj SOFT -SET
DATE D E C K S -C O V E R S`C A R P O R T S `G A R A'G E S
1 Zoning -Setbacks -Easements
1 Zoning -Setbacks -Easements r
2 Soils; Special MH Support Sketch
2 Ftgs; Soils -Sz-Dpth-Spacing-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 Clrncs-GrndAmp-Concrete
4.Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg ! ,
�6 Yard Gas; Loctn-Test-Wrap Nat Q or ' LPQ
Frmg-Brcng . 1
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
11 Wtr & Sewer Connected -C/O to Grade
10 Roof; Shthg-Roofing
12 Gas and Electricity Tagged
11 Ext; Steps -Doors -Landings
13 Tie Downs Q Foundation Q
12 Braced Wall pnls
14 Exits
15 Cert of Occupancy
s
16 HUD Label/insignia Numbers Serial Numbers
DATE POOLS
1 Setbacks -Easements'
2 Soils; CompactionStructure Stability
3 Pool Structure; Steei-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
'
5 Elec Pool Lting; 15 volts-GF1
4e�? °' •
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w15' Crcltng Eqp-Pool Ightg
Bones-Enclsrs=pnlboards-Insultn to Main Conduit
9 Health Dept Apprvl ...
10 Plmb; Cir Test-Wtr Supply Test '
11 Lt Niche
12 Enclsr; Fencing -Alarms
13 Bonding, Diving board or Slide
t
= OK
0 = 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 Dpth
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 flr-Tub Acc
5 Stemwalls Main; Steel-Blockouts-Wrapped
57 Test Tub & Shwr, 2nd flr - Tub-Acc
6 Stemwalls Garage; Steel -Blockouts-Wrapped
58 Gas Pipe; Sz & Anchrs
69 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
o m
i.t Wtr Pipe; Test-Anchrs-Rgltr-Service Test
12 Elec Undrgmd
DATE MECHANICAL
13 Plenums & Ducts; Clrnc-MaterialSupport-Insultn
N61 AC Ducts Insultn & Support
14 Girders-Sills-Anchr B oltsJ oists-Vnts -Cripples
62 Vent Fan, Exhaust abv Insultn
15 Acc & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16. Insulation
r' 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Acc & Pltfrm if Furnace in attic
C 0
DATE IFRAMING
17 Sills Proper Materials & Anchrs
DATE F I A L
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
t 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
Garage; abv-flr-Ducts-Meth Prtctn
22 Headers & Beams-Sz & Bearing
- JIn
5r5 edroom Exiting
23 Hangers -Post Caps-AnchrsCnnctnsSiFI
& Bath Fxtrs & Tub Acc-Spa
_
24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg
I Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
lec Trim & Subpnl, Breaker Szs & Labels
e 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Clrnc-Hearth
_05 28 Garage Fire Prtctn Framing -RC Ctiannel
75JOutlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall & Opngs
?el tchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clmc
30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits
lec 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-Rftr Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Clmc-Com Air Cnnctr-PRV; abv fir
34 Stucco Lath -Weep Screed-Fndbi Vnts-Undrflr Acc
Mech Prtctn; LPG Appince Undr House 3" drain
35 Glazing Area -Glass Prtctn-SkyLts-Plastic
841�lmb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnis
83 Insultn-Foam-Looked in Attic
38 Insulin -Walls -Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiltration-Walls-Wndws
.Be'*Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
86 CImc Drnge Planters ❑Yes ❑No
87 Stucco Brown -Finish
-AC
81r' Unit Dscnnct, Elec-Plmb
S-�Krits abv Roof, Plmb-Appinc-Frplc-Clmc to Opngs
90 Wtr Well, Dscnnct, Elec, Plmb
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
DATE JELECTRICAL
40 Fxtr & Trnsfrmr Clmc4ns Prtctn
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92'Vntltn thru House
42 Sz Boxes & No Of Cndctrs Stapled
92'061ass 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 W & Sewer Cnnctd-C/O to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
nergy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz Ga ❑ CU or ❑AL
201Cddress Posted
AC Wire Sz ga ❑ CU or El AL
99 Fire Sprinkler
48 Range Circ ga ❑CU or ❑AL
Oven Circ F-1 [:JAL
ga CU or
r� —
Insulated Neutral ❑ Yes ❑ No
o+" �l . I—G — C_
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnis-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
COUNTY OF BUTTI' - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 oTelephone (530) 538-754/1 RM�TNO•
12/96) APPLICATION AND PERMIT 03
ASSESSOR PARCEL NUMBER
"SP —043
ZONING
r,
BUILDING PERMIT
OWNER
COPP,. Dlyj,` i 'a a -
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
20 790.00
OWNER'S MAILING ADDRESS
3735 H11DAIR AVE..— ,, 6 —170
4y250.00
CONTRACTOR'S NAME
U ITN'. T<
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENOER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $45.040 00
ARCHITECT OR ENGINEER
LICENSE NO.
Fills Fee $ 20.00
Permit Fee $ 388.50
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $ 252-90
BUILDING ADD RESS
37 5 H-11,I)ATE �. 2
Energy Plan Checking Fee $ 23,00
$
PERMIT FEE $684.00
LOT NO.
SUBDNISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each qas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
�'110D�,
Describe Work: �',llDIT�_OiQ (OX�." '
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W 920.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
noon 00 R' LLEss 23.00s
Main Service e0ov GR Es
Main Service 200A TO 1000A 46.00
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 f91 the following reason:
as owner of the property, or my employees with wages as their sole compensation,
wlll 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.
O 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUP, so.
OR ADONS. & ACC. BIDS. 3.50 FT. 52. 30
NEW CONST. MULTI -OUTLET X17.50
'N tRESID. B ANC CIRCUITS
POWER APPARATUCS
&SINGLE OUTLET IR
20 @ 100
Ex. Occup. OUTLET OR FD(TURES BAI_ @ .50
FIXED APPLNS. OR S.00
Ex. Occup. ourLFrs REBID. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
I 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 Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation ..
PERMIT FEE $ 50.50
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.)
M,'l 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 1 should become subject to the
wor ers' compensation provisions of section 3700 of the Labor Code, I shall
rt ith comply -with t e provisions.
'C.titJ �i�DateL t="
��na_tu�reTof Apcant - C�Owne j Contractor ❑ Agent
An OSHA permit ill equired for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee I $
Energy Inspection Fee 1$46.00
occ
CONST. TYPE
- TOTAL FEE $ 989.80
H D.FEES IMP
FLOW
CDF
I PARCEL
PD
HD
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/ -
By Dat
PERMIT EXPIRES ON 9
ate
ReceiptNo. ?]()()ALL ';355 till//
wHiTE-O.D.S.•B.D. CANARY -ASSES R PINK -INSPECTOR GOLDENROD -APPLICANT
insulation Certificate
e n BUILDING PER -
BUILDING . OWNER I./t ¢l
BUILDING LOCATION : -3 7
Description of Installation
ROOF Brand Name
MaterialValue
Thickness (inches) Thermal Resistance (R- )
4
CEILING.Brand Name Vt lrl S I�
Batt or Blanket Type 13�- Thermal Resistance. -Value) Q
Thickness (inches) g:m grand Name
Loose Fill Type inches
Contractor's minimum installed weight/ft lb Minimum thickness
Manufacturer's installed wei gh t Per uare foot to acheive Thermal Resistance (R -Value)
EXTERIOR -WALL Cet�Aci I e e p
Brand Name
MaterialI�Cy Value R�13
Thickness (inches) Thermal Resistance '(R -Value) _
RAISED FLOOR I II
Material Brand Name t1
Thickness (inches) �o `f
Thermal Resistance (R -Value)
SLAB FLOOR ..
Brand Name
MaterialValue
Thickness (inches) Thermal Resistance (.R )
Width (inches)
FOUNDATION WALL
_Material Brand Name
Thickness (inches)
'" ,�ermal Resistance (R -Value)
Declaration `
cation in conformance
I hereby certify that the above insulation was installed in the building at thetabocontainve 10ed n T tle 24 of the with
the current Building Energy Efficiency Standards for new residential bg
Califo Administrative C de.
Lice a Number
General or uildetj '
Date
Signature and Title ,
License Number
sub -Contractor (Insulation Installer)
Date
Signature and Title
THIS CERTIFICATE -MUST BE PROVIDED.TO THE'BUILDING DEPARTMENT.PRIOR TO FINAL INSPECTION
APPROVAL AND A COPY SHALL BE POSTED WITHIN THE BUILDING.
JANUARY 1993
U SRA
❑ FLOOD CERTIFICATE EQUIREO
❑FIRE SPRINKLERS REQUIRED
❑ SPECIAL INSPECTION ITEMS
❑ VERIFY
❑ USE PERMIT CONDITIONS
❑ SUB -STANDARD HOUSING LETTER
❑ ENCROACHMENT PERMIT
❑ REINSPECTION FEE PAID '
Q ENV HLTH CLEARANCE
MANUFACTURED HOMES
MISCELLANEOUS
DATE PERMANENT FOUNDATION SOFT -SET
1 Zoning -Setbacks -Easements '
2 Soils; Special MH Support Sketch
3 Sewer, Loctn-Test; Fall/CIO-Concrete
4 Wtr; Loctn-Test-Easement Needed -Regulator
5 Elec Loctn-Clrncs-Grnd Amp -Concrete
6 Yard Gas; Loctn-Test-Wrap Nat ❑ 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-Breakers-Clrncs
10 Drain; MH Test -Fall -Flex Cnnctr
11 Wtr & Sewer Connected -C/O to Grade
12 Gas and Electricity Tagged
13 Tie Downs Q Foundation Q
14 Exits
15 Cert of Occupancy
16 HUD Label/Insignia Numbers Serial Numbers °�
DATE ID E C K S'C O V E_R S'C A R P O R T S `G A R A G E S
1 Zoning -Setbacks -Easements
2 Ftgs; Soils-Sz-Dpth-Spacing-CnnctrsSteel
3 Decks, Girders/Joists-Dcking-Brcing
Stairs-Guard/Handrails
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg
Frmg-Brcng
5 Alum Awn; Columns-Cnnctns-Splice-Decal-Enclsrs
6 Carports; Wndws-Doors
7 Electric
8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses
9 Siding; Nailing -Veneer -Stucco -Lath .
10 Roof; Shthg-Roofing
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
a`c
°�' °e
DATE. IPOOLS
1 Setbacks -Easements
2 Soils; CompactionStructure Stability
3 Pool Structure; Steel -Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls1Lting;.Distanc&GF1
5 Elec Pool Lting; 15 volts-GFl
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg
Bones-Enclsrs=pnlboards-Insultmto Main Conduit
9 Health Dept Apprvl
10 Plmb; Cir Test-Wtr Supply Test
11 Lt Niche
12 Encisr; Fencing -Alarms
13 Bonding, Diving board or Slide
A F
Pool Drawing s.
7 77
7
= OK
0 = 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 Dpth
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 flr-Tub Acc
5 Stemwalls Main; Steel -8lockouts -Wrapped
57 Test Tub & Shwr, 2nd fir - Tub•Acc
6 Stemwalls Garage; Steel-Blockouts-Wrapped
58 Gas Pipe; Sz & Anchrs
621 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 C/0 -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
1.1 Wtr Pipe; Test-Anchrs-Rgltr-Service Test
12 Elec Undrgrnd
DATE MECHANICAL
13 Plenums & Ducts; Clrnc-MaterialSupport-insults
61 AC Ducts Insultn & Support
14 Girders-Sills-Anchr Bolts -Joists -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
0'0 m o'er m
0
DATE IFRAMING
17 Sills Proper Materials & Anchrs
DATE F I N A L
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
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-flr-Ducts-Mech Prtctn
22 Headers & Beams-Sz & 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 Cimc
72 Elec Trim & Subpnl, Breaker Szs & Labels
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doorsill Ht & Dimensions
74 Frplc or Stove, Cirnc-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-Rfir Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Cimc-Com 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 Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnis
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 [:]Yes ONO
87 Stucco Brown -Finish
o`er o`c o'er e`er
88 AC Unit Dscnnct, Elec-Plmb
89 Vnts abv Roof, Plmb-Appinc-Frplc-Clrnc to Opngs
90 Wtr Well, Dscnnct, Elec, Plmb
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
DATE JELECTRICAL
40 Fxtr & Trnsfrmr Cimc-Ins Prtctn
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92 Vntitn 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-CIO to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz as ❑ CU or ❑AL
98 Address Posted
AC Wire Sz ga ❑CU or ❑AL
99 Fire Sprinkler
48 Range Circ ga 0 c or ❑AL
Oven Circ ga QCU or ❑ AL
Insulated Neutral ❑Yes ONO
o+`� 41
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnls-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
1Z
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.
BPO52994
B. C. Building Permit 01-16-04 pg 1
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: 11/04/2005 APN: 068-341-043-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 3735 HILDALE AVE ORO
Date: Contractor:
Map Index:
Description: demo existing garage
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner: COPP DWAYNE & ANTOINETTE
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 Contractors State License Law (Chapter 9 commencing with Section
3735 HILDALE AVE
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
violation of Section 7031.5 by any applicant for a permit subjects the
95966-9501.
applicant to a civil penalty of not more than five hundred dollars ($500).):
t.r 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
owner of property who builds or improves thereon, and who does
Applicant: COPP DWAYNE & ANTOINETTE
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
3735 HILDALE AVE'
r"
year of completion, the owner -builder will have the burden of
OROVILLE, CA
proving that he or she did not build or improve for the purpose of
sale.). ,
95966-9501
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with 'a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor:
❑ I am Exempt under Article 3 o"he Business anAProfessions Code
Date -��-G� Owner:%
WORKERS' COMPENSATION'DECLARATION
I 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
License #:
Labor Code, for the performance of the work for which this permit
is issued.
❑ I have and will -maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
/ J
t/
Policy #:
Total Square Ft: 0,S.F.
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
ValUatiOn: $0.00
become subject to the workers' compensation laws of California,
Census Code:
and agree that if I should become subject to the workers'
r ,1
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
C 1
Dater
Applicant:
WARNING:. Failure to secure workers' compensation coverage Is
I�
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 h y issued the ap cable ovisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
performance of the.work forwhich'lhis-permit is issued (Sec 3097 Civ:) -�-
Resolutions t do work ind'e d above r whi fees have been paid.
--- 7 '" =_� -:- r. - //"--
Name:
By: Date:
Address:
PERMIT EXPIRES ON:
(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 ofButte County to enter upon the above mentioned property for inspection purpos
Print Name: rrmoi' Y) e C-611 I Signature:
Date: /—L/ -y ,
1
Owner, ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
"PLEASE PRINT CLEARLY"
OWNER
Last.,Name
i Name
N
Addreso� 5J 3 /11 GSC!
//p AV `e
CitY�it 0 r/��� P
?eG
Z S�lo�a
PS�U
Fax
E-mail
APPLICANT SIGNATURE
I
For office use only:
CONTRACTOR
Name
tL��
Address
SRA
City
I No
State
Zip .
Phone
Map Book
Fax
E-mail
Planner
Lic. #
Class
APPLICANT SIGNATURE
I
For office use only:
ARCHITECT/ENGINEER
Name
Flood Zone
Address
SRA
City
I No
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
APPLICANT SIGNATURE
I
For office use only:
APPLICANT NAME
Name
Flood Zone
Address
SRA
City
I No
State
Zip
Phone
Map Book
Fax
E-mail
Planner
APPLICANT SIGNATURE
I
For office use only:
Zoning
Property Address/ /� 14
�s , C� oe
Flood Zone
Cross Street
�Y` U
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
BPo5 Zqq
BIN #
LOCATION
AP#D�08 d f! 1— _ C)I/
Property Address/ /� 14
�s , C� oe
city
Cross Street
�Y` U
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
OVER FOR SUBMITTAL REQUIREMENTS I
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Description or Scope of Work:
Lt-22� o
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.
Recei�ve/dyb�.._
Receipt #:
Date:
I I-
Amount:15 5!!�Bldg
Total
REV 6-16-04
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
for a permit. INCOMPLETE SUBMITTALS WILL NOT BEA CCEPTED. ALL PLANS MUST BE
LEGIBLE AND IN INK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1.
3 Site Plans, signed by the preparer: NO GRAPHPAPER!
❑ 2.
3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
OR
3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4.
Letter from Engineer or Architect for truss design review.
❑ 5.
2 Energy compliance design and supporting documentation. (Note: Not required for additions to
Letter from Engineer or Architect for truss design review.
mobile or modular homes.)
❑ 6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7.
Detached Accessory Building Form, filled out by the property owner (if required).
❑ 8.
Sanitation and site plan approval from the Environmental Health Department.
❑ 9.
Metal Buildings: (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.
Mobile, Manufactured, or Modular Homes:
❑ 1.
3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2.
2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑
1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑
2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑
3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑
4.
Letter from Engineer or Architect for truss design review.
❑
5.
2 Energy compliance design and supporting documentation (if required).
❑
6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑
7.
Statement of Intent for Non -heated and A/C (if required).
❑
8.
Metal Buildings: (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.
❑
9.
Letter of intent.
❑
10.
Hazardous Material Form.
❑
11.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
f
,�.'' -°x �`.-1'••'^; •� Sys ��'.
,c
OWE.,
;� J
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.
�. I personally plan to provide the inr labor and material for construction of this proposed
property improvement: -YES [ ✓] NO [ ].
�2. I HAVE HAVE NOT [ ] signed an application for a building permit for the proposed .
1 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:
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 1)/4/2DD4 t .
Butte County Department of Development Services ��rr�
ADMINISTRATION `BUILDING' GIS `PLANNING o 0
7 County Center Drive o /� o
Oroville, CA 95965 0 - - o
j -:_��
(530) 538-7541 Telephone � o �.
(530) 538-2140 Facsimile C�UNty
Dear Property Owner-
An
wner
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 othtr costs) is $200 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 Ind"ustrW 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 contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N Street, Sacramento, California 95814.
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.
Micvael C. Vieir+ C.B.O.
Mailager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
BALANCE OF FEES SHEE. T
DATE:
PERMIT #:
ASSESSOR PARCEL #:
OWNER'S NAME:
0
r ,
FEES (Amount and Purpose):
,
BALANCE OF FEES:
$
ADDITIONAL FEES:
$
REVISED PLAN CHECK:
$
SHERIFF FEE (commercial only):
$
SRA:
$
COPY FEES ($1 or more)
$
.DRAINAGE
$ '
BASIN
BC RESIDENTIAL IMPACT
County Wide - Chico Urban
El Medio North Chico Specific
- $
WATER TENDER FEES
$
BATTALION .#
FEMA
$ .
SMIP
$
f
OTHER
g
RECEIPT NUMBER(S)..
RE
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140 -
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP041393
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: 05/14/2004 APN• 068-341-043-000
the Business and Professions Code, and my license is in full force and
effect. C d o CZ?? 3'(
License Class: License 7
Site Address' 3735 HILDALE AVE ORO
/Number:
Date: S `/ G Y Contractor: C y 4 �1 �✓S
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: HVAC
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: COPP DWAYNE & ANTOINETTE
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
3735 HILDALE AVE
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
violation of Section 7031.5 by any applicant for a permit subjects the
95966-9501
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
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
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor' GALLAGHER'S HEATING & AIR
'
pursuant to the Contractors' State License Law.).
❑ 1 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 #• 777334
1 have and will maintain a certificate of consent to self -insure for
13'
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the perfornance of the work for which this permit
is issued.
• 52/ 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 number are:
11 �
�)! "f C6 �t{
Carrier. �c y„•/� 1 n� rid
Total Square Ft: 0 S. F.
Pony #: I -? 019 2 3 — U'2
Valuation: $0.00
❑ 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
` 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 with those provisions.
Date:
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable provisions of the Bmtte County C:O&I anftr
I hereby affirm that there is a construction lending agency for the
Resolutions to do work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
�i
� /4 �T
Name:
B y: Date:
PERMI XPIRES ON: 5' 14 -05
Date
Address:
O 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 own or th duly a thorize gent of the owner. I agree to comply with
all county and stateI s relating to building construction. I acknowledge it is unlawful to alter the su.bstan e f a officia or um f u e County. I hereby
authorize represent_6 sof Butte County to enterupon the above mentioned property for inspection • s
///
Print Name:U,L —"�
Signature:
Date: Z1 `1 6 Y
0 Owner ❑ Contractor W14gent for Owner ❑ Agent for Contractor
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 APPLICATION
OWNER
Name C v
Address 3 3
City 0 Y00,
Stat
Zipg 06 6
Phone 5 33 03F 3
Fax
E-mail
CONTRACTOR
Name 1L4111V
s ,c i
r �3�
Address ® O
G V
City LC6 4 S
City
St ttA
4M06 S�
[Phone a a 8 q1 35 51
Phone
Fax
E-mail
E-mail
Lic. #
-7 3 `
Class
c38
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City L o s 1,n� s
Address
ZiP9 6
City
Fax
State
Zip
Phone
Type Const.
Fax
E-mail
Map Book
State License Number
APPLICANT NAME
Name '(2
Address G S�
City L o s 1,n� s
State �
ZiP9 6
Phon%20 22- h -S
Fax
E-mail
For office use onl
Zoning
Flood Zone
SRA
ves
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BPo-F -139
BIN #
LOCATION
AP# d 6-8.3 4-1. 0 43
Property Address
Cross Street
WORKER'S COMPENSATION
Policy Number .03
Carrier
If hiring anyone other than license contr tors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
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:
Receipt #: 4_0GO7,(o
Date: 151 14-6j,
5C---,
Sheriff
Other
K:\FORMS\BUILDING F0RMS\BldgApp1SubRgmts.doc Page 1 of 2 REV 4-30-04
SUBMITTAL 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.
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 4. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to
mobile or modular homes.)
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 8. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 9. Sanitation and site plan approval from the Environmental Health Department.
❑ 10. Metal Buildings: (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 b t� 'neer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑ 1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑ 3.
2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4.
Letter from Engineer or Architect for truss design review.
❑ 5.
2 Energy compliance design and supporting documentation (if required).
❑ 6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7.
Statement of Intent for Non -heated and A/C (if required).
❑ 8.
Metal Buildings: (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.
❑ 9..
Letter of intent.
❑ 10.
Hazardous Material Form.
❑ 11.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04
r .
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
r 7 County Center DriveOroville, California 95965 • Telephone (530) 538-7541�yT�o.
(Rev. 12/96) APPLICATION AND PERMIT / 2,
ASSESSOR PARCEL NUMBER
4- 0
ZONING
BUILDING PERMIT
oWN q
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
ORWILLE. Gk 9596-r.
CO COR TELEPHONE
CO MAIUNG ADDRESS
CONSTRUCTION LENDER
Fireplace TT LT
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Film Fee $
20.00
Permit Fee $
35 0o
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
2200
BUILDING ADDRESS
Energy Plan Checking Fee $
-
$
PERMIT FEE $
7P nn
LAT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 1
7.00
Solar or heat pump water heater 1
23.00
Water piping 1
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: T1STAT.T. WOOD RURNTNC, FTRF.PT.AC'F.
Gas piping system 1- 5 outlets
15.00
Building sewer
15.00
Mobile Home I S G W
@20.00
PERMIT FEE $
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.FOWER
License Class Llc. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
E* --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 WA TO LDOA
46.00
NEW CONST. DWELLING OCCUP.
OR ACDNS. ( a Acc. BLDs.
3.5¢xS°:
NOµq°� DT MULTI OUTLET
@7.50
APPARATUS
a SINGLE OUTLET CIR.
Ex. OCCU OUTLET OR FD(TUREs
BAp .0 r 0
Ex. Occup. OuTitDTSA Eslo.°R
R
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
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
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
� f 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 f I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
=ith tho a provisions.
X _ Date �� ' �,�
Signature of App cant - 111'Own 00 Contractor ❑ Agent
An OSHA permit is required for excavover ' " deep and demolition or construction
'
of structures r s r sin ei t .11
Receipt No.
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 $ o
HAZ.
D. FEES IMP FLOOD CDF PARCEL PD
HD
ISSU
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.
n
�yo
PERMIT EXPIRES ON z
Dete
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
I
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Orovilllae, •C�alifornila� 95965 • Telephone (530) 538-75410 . - 75/
(Rev.12/96) APPLICATION PERMIT !� J /
ZONING BUILDING PERMIT
fSSFSSORPARCEL NUMB ;J (J
OWNER A � In /� / /�A p j "�F' �;SO• FT• OCC, BUILDING VALUATION
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUJG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
ucENSENo.
Filing Fee
$
20.00
Permit Fee'
$
?J
ARCIQrECT OR ENGWEERS MALING ADDRESS
Plan CheckingFee
$
SUILDPIG ADORM
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO. SUBDN6IDNS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
Solar or heat pump wateraheater23.00
Water piping
15.00
SF ❑ Duplex ❑ Mobilehome ❑
Other
sP�tN
Each gas water heater or15.00
TYPE OF WORK
Gas i in stem 1 - 5 o15.00
New ❑ Addition❑ emodel ❑
Has ❑ Installs' Other
Building sewer
15.00
Mobile Home S G W
@20.00
Describe Work:
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service on LE.ss
23.00
Main Service 200A TO t000A
46.00
DwEi1.NG OCCUP.
3.5aS .
8 ACC. ELDS.
MULTI-ounFr
@7.50
FEE PAID
$
POWER APESMGLE CI0.OR
EEY-Occup,
.PERMIT
FIXTURES
20 @ t.5000
ani @ .so
Ex. Occup. un�s IFS D)A LNS
5.00
SRA$
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring23.00
SHERIFF
$
PERMIT FEE
$
MECHANICAL PERMIT
Fling Fee 20.00
OTHER
$
Heating
Cooling
Hood
6.50
Ventilation
$
$
AMOUNT RECEIVED $
DATE RECEIVED
DCirCIPT ±t
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
CCC CONST. -PE
TOTAL FEE $
MAZ ImFmI IMP I FLOOD I CDF I PARCEL PD I'S'SUE
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
PERMIT EXPIRES ON
Date
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 17. Fire Sprinklers............................................................................................
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
R PAR N MBE
OWNER: ASSESSOR CEL NUMBE
Proposed Building Use: Counter Technician: v t Date: /
Items required
❑ 1.
in order to apply for a p rmit. All boxes MUST be checked OR marked NA in rder to apply.
Site plans, 3 or 4 sets, signed by the preparer of the plans.
........
2.
Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
3.
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑
4.
Engineered truss details and layouts in duplicate. No faxes!
O
5.
Letter from Engineer or Architect for truss design review.
❑
6.
Energy compliance design and supporting documentation in duplicate.
❑
7.
Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑
8.
Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
❑ 30. Worker's Compensation Carrier and Policy Number .......................................:..
duplicate.
❑
9.
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
❑ 33. Recorded copy of Agricultural Acknowledgment Statement .................................
must be stamped and wet -signed by the engineer.
❑
10.
Flood Elevation Certificate, wet -stamped and signed, in duplicate
❑
11.
Site plan and business license approval from the City of Biggs
' ❑
12.
Letter of intent for non-residential buildings
❑
13.
Detached Accessory Building Form filled out by the owner
O
14.
Hazardous Material Form
0
15.
Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable.
❑
16.
Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 17. Fire Sprinklers............................................................................................
❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 19. Soils Report and/or Engineered Foundation required ...........................................
........
❑ 20. Erosion Control Plan Required........................................................................
........
❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 22. City of Chico Plumbing permit........................................................................
❑ 23. California Department of Forestry plan approval O paid. Sent by: .............
❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check:
❑ 25. Contact Land Development about _ Improvements, _ Drainage .................:.......
O26. NPDES Form.............................................................................................
O 27. Encroachment Permit for driveway from the Public Works Dept ...........................
❑ 28. Pre -Inspection for required.......
❑ 29. Contractor's license information. (Number, Name Style, Classification) ...................
❑ 30. Worker's Compensation Carrier and Policy Number .......................................:..
O 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................
❑ 32. Letter of Signature authorization....................................................................
❑ 33. Recorded copy of Agricultural Acknowledgment Statement .................................
❑ 34. Manufactured home utility clearance...............................................................
❑ 35. Existing violations and/or expired permits.........................................................
❑ 36. Deed Restriction.........................................................................................
O 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, O Check to H.C.D. $
❑ 38. Other:
❑ 39. Other: /f- 2 4;2(2,?)
When issued Telephone ��/ �� and hold for pickup.
I have been iinnfs)rmed of the above items and requirements for obtaining a building permit.
Applicant: Date:
1. Index permit application fo the above items u bered:
Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised of the above data by . ❑ phone, ❑ mail, ❑ counter, by
Date:
Contractor, designer, own s advised of the abov da ❑ phone, ❑ mail, ❑ counte by
Plans reviewed by: -A# Date: Z // Plans approved by:
Date
Date': / p
Structural reviewed by: Date: t Structural approved by:
Date:
Note transfer by: Date:
Yellow: Building Division
O.B.-1
OWNER=BUIILD]ER VERIFICATION
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. personally plan to provide the major labor and materials for construction of the proposed
property improvement : YES NO
I HAVE HAVE NOT ❑ signed an application for a building permit for the proposed work.
3. 1- have contracted with the following person (firm) to provide the proposed construction:
NAME: .
ADDRESS: .CITY: .
PHONE: CON'TRACTOR'S LICENSE NO. -
4. I plan to provide portions of•t1 . 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 persons to provide
the work indicated: ,
NAME ADDRESS PHONE 'TYPE OF WORD
s
NOTE. v. This Owner-Builder:YeYif'"cation 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
OVER
O.B.-1
I OWNER BUILDER INFORMATION
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 otherthan yourself; you may protect yourself from possible
t ^ liability if that person applies for the proper permit in his or her name.
x:
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
i 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 $300' or more fbi 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 unemployment compensation contributions.
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.
♦ 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 contractors 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.
i
ely,
Mi el C. Vi ira, C.B.O.
M ger, Building Inspection
NOTE: This Owner -Builder lnform aon is required by Section -79830 of the California Heafth and Safely Code
OVER
-A:.
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COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 RMIT NO.
3- D�71
b7ev.12/96) APPLICATION AND PERMIT L�
ASSESSOR PARCEL NUMBER
";-35•-341-043
ZONING
f
BUILDING PERMIT
OWNER
cOPP,. DWAYi'a I.
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
20 790.00
' . OWNERS MAIUNG ADDRESS
-;OV -- - ri A C SG,
3735 HIIDATEAVE 0
CONTRACTOR'S NAME TELEPHONE
U•Ti1'-Ti
170 4 250.00
remodel- 20,000.0-0
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $45..040.00
ARCHITECT OR ENGINEER
LICENSE NO.
Flina Fee $ 20.00
Permit Fee $ 388.50
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $ 252-50
BUILDINGADDRESS
3735 - -: �. -
Energy Plan Checking Fee $ 23.00
$
PERMIT FEE $684.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7 7.00
USEOFSTRUCTURE
SF ❑ 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 ❑
il�illT�_ONQ cic
Describe Work: 1 I`1ODjML
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
V LESS
Main Service 60 "'0.A GOR R 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.PSINOLE
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law �f the following reason:
IfF '• as owner of the property, or my employees with wages as their sole compensation,
wIII 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 ,CCUOOOA 46.00
NEW CONST. DWELLING OCCUP. SO
W:
OR ADDNS. ( a ACC. eLD& 3.5Q
NPN p�,pT MULTI -OUTLET @7,50
8 OUTLET OWER APPARATUCIR.S .
Ex, Occup. SAL @ 1.000
OUTLET OR FIXTURES
PLNS. OR 5.00
FlXED A'(Ra-.,0E.
Ex. Occup.ouTLErs REs10. EA.
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.
I 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.)
9?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
wor ers' compensation provisions of section 3700 of the Labor Code, I shall
ith comply with tbQe provisions.
.7„ ^�,t ^ ��
X �/ Date 'a(
nature of App cant - II -Owns Contractor ❑ Agent
An OSHA permit i required for excavations over 60" deep and demolition or construction/l3
of structures over 3 stories in height.
MECHANICAL PERMIT Filing Fee 20.00
Heating
Coolin
Hood 6.50
Ventilation
PERMIT FEE $ 50.50
Mobile Home Installation Fee $
Energy Inspection Fee 1$46.00
Occ
CONST. TYPE
TOTAL FEE $ 989- Rn
H
D. FEES IMP
FLO
CDF
PARCEL
i
PD
ND JSSYC
�.
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 t Da / 9 V
PERMIT EXPIRES ON 1 V
efe
ReceiptNo. ?7OQ) <;�5�i 5� //
WHITE-D.D.S.•B.D. CANARY -ASSES aR PINK -INSPECTOR GOLDENROD -APPLICANT
�---r)UNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 53 54 R o.
(Rev,12/96) APPLICATION AND PERMIT ✓ �3 - D �� .
AssesoaaARcarJuemER S_ _ ZO—e BUILDING PERMIT
L 6 MONS SO. FT. I OCC. SUILDING VALUATION
�. _._�....._ _ _ , 3 _ a Q .
coffR=an Run
IWO MfW'RDRS MWUNG ADDR=
GDLG7RLR:SIDN LEVER
FR4 MIZIM AMR03
ARM= OR ENMUME t
ARM= DR e9MIEM UALM ADMEW
Lorm cmommcmW-NE
0
USEOFSTRUC'iURE
SF P(, Dup1mc 0 Mobilehome O Other
sr+�r
TYPE OF WORK
•New 0 AddEon K Remodel k us5es 0 6 tawon O Other 0
Describe worta d ;Its SE
*PERMIT FEE Pub
SRA
OTMSHERIFF ,
•
*R_' "J _3700 3 C/
4 TO MLdT INTO COQ
Total Valuation Is
Mho Fee $
Permit Fee $
Pian CheeMn Fee S ,
Energy Plan Checidng Fee S 021 , (�
5
PERMIT FEE S 1, rR 14 f
20.00
Each Trap
7.0 o Lp
Solar or heat purnp water heater
23.00
Water piping
15.00 ,
Each gas wader heater or vent
15.00
Gas piping spism 1 - 5 outlets
15.00 Lr. 60
Building sewer I
1 15.001 Is -n
Mobile Home 13 1 G I W
@20.00
PERMIT FEE
S
. dv
ELECTMOAL PERMIT
Firing Fee
20.00
Mair Service =9=
28.00
g3. dC
Mair Service 2M To IOWA
46.00
M 65ML
DRAD18$
`g-S:f-T.
3c
L,OR.a MM 11NL7F o111LST
@7.50
Iaw81 APFARA7U9
a sa�LP Dtrrl_.rr e:La
Er. -Occup. cuw OR FKTURMeNL
tO M
.Stt
x.
EOecrr. OME °Ek
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
um Wiring
23.00
PERili1IT FEE
S
MECHANICAL PERMIT
Filing Fee
20.00
Heating
Cooling
Hood
6.50
(e .
ventilason
4( Sb
PERMIT FEE:
S
,
Mobile Home Installa5on Fee
S
Energy Inspection Fee
,
i��omotmor�eo
This permit is hereby issued under the applicable provisions
01 the Butte County Code and/or Resolutions to do work
Indicated above for which fees have been paid.
By . Date
Receipft. PERMIT EXPIRES ON
WHITE-D.D.S.•B.D. CANARY -ASSESSOR PINK.INSPECTOR GOLDENROD -APPLICANT ���
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive;'Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: Dwcc!(h e �� Art ,6t AjP,He. CO1'pASSESSORPARCELNUMBER O&$ —J7 -7I -Oqi
'�hProposed Building Use: ( � 't - 4 f Lei Counter Technician: iA-- Date: C (0
Items. required in order to'apply for a permit. All boxes MUST be checked OR marked NA in order tidapply.
� Plot plans, 3 or 4 sets, signed�y the preparer of the plans.
9 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ Engineered truss details and layouts in duplicate. No faxes! a
5. Energy compliance design and supporting documentation in duplicate.
❑ 6. Manufactured homes: (A) Data sheets'and installation instructions, (B) Marriage line information, (C). Floor Plan, (D) Tie down or
foundation'splans, all.in durilicate.
❑ 7. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The.permit will be
indexed and returned to the plan review line-up when required items are received.
- Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
❑ 9. Plot 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`..`.....................I .............
❑ 12. Hazardous Material Form..................:............................................................. _
❑ 13. Other _
maining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
14. ees as shown on the attached Schedule of Fees Due Sheet ...................>...................
Statement of Intent for Non -heated and A/C Buildings .............................................
16. Sanitation and plot plan approval from the Environmental Health De rtment in
0�1.7. City of Chico Plumbing permit .......................�../. ....................
�] 18. California Department of Forestry plan approval UJ'paid. Sent_ by. I ..................
0 19. Planning approval for (A) Use: (B)Parking: (C) Par el Check:
❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ....................... f,� .....
❑ 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑ 22. Pre -Inspection. for required ................
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and,Policy Number..............:..."s...........................
❑ 25. Owner -Builder Verification (❑ Given�to owner, ❑ Mailed to owner)�,�.................
❑ 26. Letter of Signature authorization ............................................... , . ....................
❑ 27. Recorded copy of Agricultural Acknowledgment Statement ................ .......... ?........
❑ 28. Manufactured home utility clearance.............................................°':................
❑ 29. Existing violations and/or expired permits ..........................................::...:.
❑ 30. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑Check to H.C.D. $
❑ 31. Other: `
When issued Telephone _ and hold for pickup.
I have been info 'ed of the above items and requirements for obtaining a building permit.
41
y y
Applicant: ate:
1. Index permit application for the above items numb ed: Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised cf the above data by ❑ phone, ❑ mail, ❑ counter, by Date: _
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: Date:
Structural reviewed by: Date: Structural approved by: 4 Date:
Note transfer by: Date:
Vellnw- Ruilrlino n;i is n
.-. .. .. � ., -Y. '�^•,lam+- .. .. ..-� ,.r:r.+v�.rt.., ..�^.r ..,.. : .r+K=. -... .. . n... -y.. *• ..-....-+.. (x. � ^s� , _ ...-.rr. •�
E.H. USE ONLY
F'lot Plan AKechodd
Floor Man Anechad�—
Sen4 to 8.0ei —� �O
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
_7:DUjr4Vtj-t q1
e - Owner Location AP#
Plan Approved for: Sewage Disposi t—ater Supply: Public Private ll
Clearance for dwelling. Other J ) n0 T��
Hold final for: s
Final clearance O.K. for:
NOTE:
/ 4-4—
Environmental Health Specialist Date
8/96
a
1
• a
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
SCHEDULE OF FEES DUE
OWNER
XYlo Vv. v�..YY��v A.P... n�„R_ �cLl_N�2
PRL)UILDING
D BUILDING USE � 'tl V '��' -�—Y
PERMIT FEES do3 (.�Balance Due ....................... l
Additional Fees Due ................. $
Additional Fees Due .......... :...... $
Revised Plan Checking Fee .............$
GI
2. HOOL DISTRICT FEES ���� oe c,
paid at District Office) (Available after Plan Check) _
3. SHERIFF FEES (paid at Building Division)
Residential ...................... x $360.00 = $
s Units
Commercial (sq. ft:) ............... x $0.03 = $
Sq. ft.
4. URBAN AREA FEES (paid at Building Division)
Residential ...................—x—=$
# Units Amt.
Commercial (sq. ft.) ............ 'x = $
Sq. ft. Amt.
5. RECREATIONAL DISTRICT FEES
(paid at District Office) (Available after Plan Check)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion # )
$200.00 (paid at Building Division)
9. CSA 87 TRAFFIC FEE
$2500.00 (paid at Building Division)
P #
_ DATE
all Q?
RECEIPT # DATE REC.
10. OTHER
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit. These fees ,
may be changed during the plan checking process. ,
APPLICANT
DATE C�A ` 7
ba ,
Pursuant to Government Code Section 66020, you are hereby notified that items 2, 3, 4, 5, 6, 7, 8, 9, and 10 above may have been
imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned
items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original - Buiding Div. 2nd Copy - Applicant 3rd Copy - Owner (Rev. 6/00)
OWNER-BUILDERNERIFICATION
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 willbeissued until this
verification is received.` t
I personally plan to provide the major labor and materials for construction of the proposed
property improvement-: 'YES gk"' : NO ❑
Q2 I HAVE W- HAVE NOT ❑ signed an application for a building permit for the proposed work.
w 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 -1 have hired the following person 'to coordinate,
supervise, and provide the major work:
NAME:
ADDRESS: •CITY: ~ '
• t t
,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
PROPERTYOWNER:
DATE: r
NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of the j
California Health and Safety Code. This verification must be completed; and
returned to our office before we are permitted to issue the permit.
.;x, OVER
OWNER BUILDER INFORMATION
Dear Property Owner:
O.B. I,
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:
♦ 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.
♦ 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 carry out these obligations, and these risks are especially serious
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 contractors 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. E
4rely, -
A
C. Vi ira, C.B.O.
, Building Inspection
NOTE. This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
OVER
A
BUTTE. COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM.
'(One form per Building)
School District Building Department No.
A.P. Number C)L9$ Jurisdiction: 0 Clty County
Prop" Owner
Property Location/Ac
Subdivision
Residential Development
Commercial/Industrial
Building
New
Addftion
Lot No.
............................ ;. . ........................................ ..............................
Sq. Footage
upplemental to
(Group R)
Conversion Permit #
*(No foundation inspection
........................................... .....................................................................
Sq. Footage
(Including Exterior
Roofed Areas)
.9
Date
imoor rians reviewed by bcnooi uistrict Fersonneu
District Identification No. S k 0
School District certifies that C-6,oe
(Applicant)
5
(Street Address) (Phone Number)
e-
Icity) (State) (Zip Code)
has complied with the requirements.of Resolution No.
reppesenting 3 S -squarefeet.
School
Paid by Check # Remarks:
—0 X -a—c 0 by payment of $
JpAii 2926
IFULL MITIGATION $
Date
Notice: You rriay'protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written,protest will prohibit
You from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White. (applicant), Yellow (building department), Pink (school district) feeform.x1s 110/98)dmm
No*of Living
Mobile Home
Onits.
Installation
New
Addftion
Lot No.
............................ ;. . ........................................ ..............................
Sq. Footage
upplemental to
(Group R)
Conversion Permit #
*(No foundation inspection
........................................... .....................................................................
Sq. Footage
(Including Exterior
Roofed Areas)
.9
Date
imoor rians reviewed by bcnooi uistrict Fersonneu
District Identification No. S k 0
School District certifies that C-6,oe
(Applicant)
5
(Street Address) (Phone Number)
e-
Icity) (State) (Zip Code)
has complied with the requirements.of Resolution No.
reppesenting 3 S -squarefeet.
School
Paid by Check # Remarks:
—0 X -a—c 0 by payment of $
JpAii 2926
IFULL MITIGATION $
Date
Notice: You rriay'protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written,protest will prohibit
You from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White. (applicant), Yellow (building department), Pink (school district) feeform.x1s 110/98)dmm
V
f
C4
qj-
CIS—t
- --
lie
9
v
Vil -
*P RIP
O
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•
s
el-
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