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HomeMy WebLinkAbout069-300-036(t 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 PROJECT INFORMATION Site Address: 6245 JACK HILL DRIVE Owner: Permit No: B07-1240 APN: 069-300-036 SONDRA SIMPSON Issued Date: 07/30/2007 By KCG Permit type: RESIDENTIAL 6767 ALISAL ST Subtype: SFD-Custom/Model PLEASONTON, CA 94566 Expiration Date: 07/29/2008 Description: NSF - 2 STORY 3274' GAR 1883' (925) 846-2241 Occupancy: R-3 Zoning: RT1 Contractor Applicant: Square Footage: BETTER BUILDERS CONSTRUCTION BETTER BUILDERS CONSTR Building Garage Remdl/Addn 5263 ROYAL OAKS DRIVE 5263 ROYAL OAKS DRIVE 3,274 1,883 OROVILLE, CA 95966 OROVILLE, CA 95966 (530)589-2574 (530)589-2574 Other Porch/Patio Total 5,157 FEE INFORMATION CWIF SF $2,132.89 DBFIRE Fire Inspection (SRA) R $102.70 CWIF SF $2,411.06 DBFIRE SRA Fire Plan Review (S $102.70 CWIFAUD Impact Processing Audi $50.00 DBSMIP Residential $21,28 CWIFDDS Impact Processing Fee $50.00 DB R3 Dwelling -Custom, Mode[ $1,647.87 DB R3 Dwelling -Custom, Model $2,282.56 DB SRA Fire Plan Check Fee $115.98 DBFIRE Fire Inspection (SRA) R $102.70 Total Charged: $9,019.74 Fees Paid: $9,019.74 74 Balance Due: $0.00 Receipt No: B4056 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires BETTER BUILDERS CONSTRU 323225 / B / 07/31/2007 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 also requires the applicant for such permit to file a signed statement that he or she is licensed (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) s in full force and effect. of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the ,^� X V basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil than five hundred lMop 07/30/2007 /weas penalty of not more dollars [$500]; Please check one of the following: Contractor's Signaatuurre Date ❑ 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (sec. 7044, Business and Professions Code: The Contractor's License WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements ❑ 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 are notintended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ill Section 3700 of the Labor Code, for ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the State Fund 713-0011835 10/01/2007 Carrier: Policy Number: Exp. Date: Contractor's License Law.). (This section need not a completed if the permit is or one hun re ollars ($100) or less. - ❑ I AM EXEMPT under Section B. 8 P.C. for this reason: ❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' X 07/30/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owners Signature Date provisions. X 1�1C� 07/30/2007 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County Signature Date ordinances, rules, regulations, and State laws relating to building WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its agents and employees from any and all claims and liability for personal HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Bath, a, injury, including death, and property damage caused t is arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property owner or am authorized to act on the property owners behalf. CONSTRUCTION LENDING AGENCY A(-5 07/30/2007 in I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is construction lending agency for Name of Per ittee [SIGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner 1:1 Contractor OR; E]Agent for Owner�jAgent for Contractor FILE COPY jam'! Lenders Address City State Zip Receipt Number: B3409 Permit Number: B07-1240 BUTTE COUNTY RECEIPT 7 County Center Drive Oroville, CA 95965 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Date Paid: 6/7/2007 Received By: AAM APN:069-300-036 Pay Method: Check 26758 Paid By: BETTER BUILDERS CONSTRUCTION Printed: 6/7/2007 9:56 am Fee Description Account Number Fee Amount DB R3 Dwelling -Custom, Model DBF DWLNG CSTM/MDL N Permit Fe 0010-440001-4210500-1010 $75.70 DBF DWLNG CSTM/MDL N Plan Rvw 0010-440001-4210500-1010 $1,572.17 DBFIRE Fire Inspection (SRA) R 0100-450001-4617240-1010 $102.70 DBFIRE SRA Fire Plan Review (S 0100-450001-4617240-1010 $102.70 Total Fees Paid: $19853.27 BUTTE COUNTY FEE SUMMARY Printed: 6/7/2007 7 County Center Drive 9:39 am Oroville, CA 95965 Permit Number: B07-1240 Job Address: 0 Department of Development Services Phone (530) 538-7541 Fax (530) 538-2140 Contractor: BETTER BUILDERS CONSTRUCTION 5263 ROYAL OAKS DRIVE OROVILLE, CA 95966 Fee Description Account Number Fee Amount Paid Date Pmt Amt CWIF SF CWIFFIREF SF 1851-0-280-1011852 $366.35 CWIFFIREVE SF 1851-0-280-1011853 $707.16 CWIFPWRDS SF 1831-0-280-1011001 $1,337.55 DB R3 Dwelling -Custom, Model DBF DWLNG CSTM/MDL N Permit FE 0010-440001-4210500-1010 $2,282.56 DBF DWLNG CSTM/MDL N Permit F( 0010-440001-4210500-1010 $75.70 6/7/2007 $75.70 DBF DWLNG CSTM/MDL N Plan Rvv 0010-440001-4210500-1010 $1,572.17 6/7/2007 $1,572.17 DBFIRE Fire Inspection (SRA) R 0100-450001-4617240-1010 $102.70 0100-450001-4617240-1010 $102.70 6/7/2007 $102.70 DBFIRE SRA Fire Plan Review (S 0100-450001-4617240-1010 $102.70 6/7/2007 $102.70 DB SRA Fire Plan Check Fee 0010-440001-4210500-1010 $115.98 CWIFAUD Impact Processing Audi 0010-050-4617998-101001 $50.00 CWIFDDS Impact Processing Fee 0010-440001-4617999-1010 $50.00 CWIF SF CWIFGGF SF 1808-0-280-101001 $664.81 CWIFLBRYF SF 1825-0-280-1011826 $240.89 CWIFLBRYM SF 1825-0-280-1011827 $162.04 CWIFSHERFJL SF 1800-0-280-1011811 $288.00 CWIFSHERFVE SF 1840-0-280-1011842 $152.72 CWIFLBRYV SF 1825-0-280-1011828 $4.83 CWIFSHERFF SF 1840-0-280-1011841 $312.99 CWIFGGVE SF 1810-0-280-101001 $306.61 DBSMIP Residential 1001-0-280-1011298 $21.28 99019.74 $19853.27 Printed By: Gwyn Benedict Balance Due: $7,166.47 At the time of permit application, I was advised the above fees are required prior to issuance of the permit. The fees may change during the plan checking process. Signature: Date: 6/7/2007 Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments for a protest are specified in Government Code Section 66020(a). AW WHEN RECORDED MAIL TO: SUITE COUNTRY BUILDING DIVISION 7 COUNTRY CENTER DRIVE OROVILLE, CA 93965 COPY of Document Recorded 22–Jury-200'/ Has not been compared with original NU i i E CUUN I'Y 8E1C'URDER AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgement to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited°to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and .harvesting which occasionally. -generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: Date Lot 401, as shown on that certain map entitled, "Kelly Ridge Estates Unit 4C", filed in the off cc of the County Recorder of Butte County, California, on Nlay 2, 1978, in book 66 of maps, at page(s) 9 thru 13 inclusive. Stat; of Calif is ) County of ) On personally appeared T _ personally known to me (or pso to be the perso • whose namesCWis/w subscribed to the within instrument and acknowledged to me that.ho/she`tky executed the same in 4k/her/t authorized capacitylia<, and that by hWher/t signaturef s)'on the instrument, the perso54 acted, executed the instrument. WITLESS m h and off •ial seal iL Signature h1g� Seal: ROSALYN SIMON ---- d — N Comm. # 1470945 NOW PUBLIC• CALIFORNIA N A.P.4 – - 69-300-036 My,comm. Expires FEB. 17.2008 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds PERMIT APPLICATION DATA SHEET Reference Number: B07-1240 Date: 6/7/2007 Location: 0 By: GLB Parcel Number: 069-300-036 Sub Type: SFD-Custom/Model Owner Name: SONDRA SEMPSON Phone: (925) 846-2241 Description: NSF - 2 STORY 3274' GAR 1883' The above permit application has the following Clearances required prior to permit issuance. Please contact each department indicated below regarding specific requirements pertaining to your permit application. Yes No DRAINAGE DISTRICTS Thermalito Irrigation District, 410 Grand Avenue, Oroville CA 95965 - (530) 533-0740 LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 533-2000 City of Chico, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 PARKS & RECREATION DISTRICTS Chico Area Recreation District, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711 Durham Park & Recreation District, 9447 Midway, Durham CA 95938 - (530) 345-1921 Feather River Recreaction & Park District, 1200 Myers Street, Oroville CA 95966 - (530) 533-2011 Paradise Parks & Recreation, 6626 Skyway, Paradise CA 95969 - (530) 872-6393 ED r Other: Signature of Property Owner: Date: 6/7/2007 FILE SCHOOL DISTRICTS Biggs Unified School District, 300 B Street, Biggs CA 95917 - (530) 868-1281 �. Chico Unified School District, 1163 East 7th Street, Chico CA 95926 - (530) 891-3006 ❑ ❑ Durham Unified School District, 4920 Putney Drive, Durham CA 95938 - (530) 895-4675 ❑ ❑ Gridley School District, 429 Magnolia, Gridley CA 95948 - (530) 846-4723 1:1 ❑ Marysville School District, 1919 B Street, Marysville CA 95901 - (530) 741-6000 ❑ Oroville Elementary School District, 2795 Yard Street, Oroville CA 95966 - (530) 532-3000 ❑ El Oroville Union High, 2211 Washington Ave, Oroville CA 95966 - (530) 538-2300 Ext: 105 E Paradise Unified School District, 6696 Clark Road, Paradise CA 95969 - (530) 872-6400 OTHER Recorded copy of Agricultural Acknowledgment Statement- See Attached Instructions City of Biggs Planning Department, 3016 Sixth Street Biggs CA 95917 - (530) 868-5447 Other: E] ❑ .Other: ED r Other: Signature of Property Owner: Date: 6/7/2007 FILE Butte County Department of Public Works I. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 95965 (530) 538-7266 Telephone (530) 538-7171 Fax www.buttecounty.net/dds National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1 ACRE 1 Reference Number: B07-1240 Location: 0 Parcel Number: 069-300-036 Owner Name: SONDRA SIMPSON Description: NSF - 2 STORY 3274' GAR 1883' Date: 6/7/2007 By: GLB Sub Type: SFD-Custom/Model Phone: (925) 846-2241 By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board for this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or other santions provided by law. Signed: \I \"Y, Title: e04W t -de iu1 FILE Date: 6/7/2007 California Department of Forestry and Fire Protection Butte County Fire Department Fire Prevention Bureau 176 Nelson Avenue, Oroville CA 95965 (530) 538-7888 Office, (530) 538-2105 Fax Reference Number: B07-1240 Location: 0 Parcel Number: 069-300-036 Owner Name: SONDRA SIlVIPSON Description: NSF - 2 STORY 3274' GAR 1883' Date: 6/7/2007 By: GLB Sub Type: SFD-Custom/Model Phone: (925) 846-2241 To meet the requirements of Government Code section 51182 and Public Resource Code 4291, the Butte County Development Services -Building Department requires a pre -construction inspection to pro -actively provide the below building and site requirements to the property owner. Your property is located within the State Responsibility Area (SRA) of Butte County. All development within the SRA is.required to meet the below requirements: ✓ Public Resources Code 4290 ✓ Public Resources Code 4291 ✓ California Building Code, Chapter 7A ✓ Butte County Improvement Standards Requirements prior to scheduling the pre -inspection: ✓ Full plan submittal to Butte County Development Services -Building Division ✓ Driveway and building pad must be identified on site ✓ Structure location must be staked out on the building site Requests for inspections shall be made a minimum of 72 hours in advance by calling the Fire Prevention Bureau's 24 hour inspection line at (530) 538-6837, ext. 169, (When the recording comes on, enter the extension number). For the pre -inspections, the property owner or authorized agent is required to meet the inspector at the construction site with two hard copies of the site plan. I have read and understand the above pre -inspection requirements. 6/7/2007- Date /7/2007- Date Signatur All of the Fire Safe Requirements are posted on the Butte County Fire Department website at http://buttefire.org/Fireprevention/protplan/protplan.html Rev'd 5/7/07 . FILE Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds NOTICE TO BUILDERS Before'your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit: 0 Make sure your application is complete. 0 Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion -of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications (not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of $54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municiDalcodes.lexisnexis.com/codes/butteco/ Reference Number: B07-1240 Location: Parcel Number: 069-300-036 Date: 6/7/2007 Owner Name: SONDRA SIMPSON Phone: (925) 846-2241 Description: NSF - 2 STORY 3274' GAR 1883' Signature of Property Owner: Date: 6/7/2007 FILE PERMIT NO.: 38-07 Lake Oroville Area Public Utility District 1960 Elgin Street OROVILLE, CALIFORNIA 95966 (530) 533-2000 DISTRICT APPROVAL AND VERIFICATION _OF BUILDING SEWERS INSPECTION This verification form must be submitted to the Butte County Department of Public Works Building Department prior to issuance of a building or occupancy permit, whichever is applicable. Prior to final approval of a Building or an Occupancy Permit by Butte County, a copy of this verification form, signed off.by-Lake Oroville Area Public Utility District, must be submitted to Butte County. Date: June 6, 2007 Applicant: Better Builders Applicant Address: 5263 Royal Oaks Dr, Oroville, CA 95966 Applicant Phone No:: (530) 589-2574 Property Locations(s): 6245 Jack Hill Dr, Oroville, CA 95966 Kelly Ridge Estates - Unit 4C lot #401 A. P. NO..(s): 069-300-036 Fees due: All fees paid as of June 6, 2007 New single family dwelling Application for service approved: OROVILLE AREA PUBLIC UTILITY DISTRICT Inspection(s) made and successful test(s) observed: Location: Date: Lake Oroville Area Public Utility District release to close permit: Date: By: ❑ - In Service ❑ - Locked Out Whits - riiclnmar Green - O iia Fina/ Yellow - Customer Fina/ Pink -FOS Fina/ Gold -FOS hereinafter' referred to .as ."applicant', being •tfie property a er or ownais agent:destnng sewer service, hereby.; requests Lake: Orovtlle Area.Pu6ltc .Utility Distract, hereinafter r erred to as CSisindr to`connect widarit`s sew�ige Jrsposaf 6ne.to Districtssanitary sewer system;and to provide sewerage service. 1 2 Location of propertyC�2�� l^� �I ` - AP.# = J r (10 Subdivision: 2S t�YH G Loi# Block#: Property Annexed `No. of E.D:U.'s this. permit:. . ❑ . Property. Not Annexed ❑ .Pioperty Mriexa6on in. Progress Multiplication: Factor: C, Kind of Service: *Monthly Charges: �� t.v Capacity.Charge: , ( Residential 0. Residence.&. Owner . Connection Fee: ❑ Rental;(sngle:famiy) , � - . Rental.{ditiPlez) ❑ -Apartment SC -OR Facility Charge: ❑.:Industrial E Co nthercial.... � otal Amount Payable This Permit; It Site plan reviewed Jobsite:reviewed Remarks: 2.W The service applied for,. hereby,shall;.be' in.accordance;:witti;the.conditionsyheFeinafter. set,;fdrth. and the., ordinances, rules, regiilatrdns. and pgltcres adopted, or to:be adopted, by the Board of,Directors of Distnrt; all of which Applicant agrees..to abtde,..by and. fully perform Appiign't .agrees`.io pay for such ser%c:e at rates .and charges: as are established by-Distet-from tirie'to time. Signature of Applicant Name of. Ownei•. if not'Applicant SAOS 12a t.C` ask r. .tU�cA 'Mailing A dress -of Applicant Mailing Address of:Owner.. . Phone # of Applicant j��l'- 2'j�� Phone# of Owner CONDITIONS:OFACCEP*ANCE_OF SEWERAGE SEP2UICE 1: 1p.accepting this application, Dastnct does .not holditsetf,liable.Zo<ApPlrcant for failure to perform: any. of the obligations imposed upon"tk ortassurnect byatt=uner thrstapplicatfon rf such fa1ui'e tie caused by accident;: Act of God, fire, stnkes, Hots;- war, leek of :capacrty in SC -?CSR tteatmentdrsposal plant or'Distncts lines: to handle the seWage:or•. rayother cause beyond reasonable bo ob"of Di`stnct, 2. Installation'of.the.sewer.serVioe lif a pertinentto this appl'�cation`shall conform in all respects10 [district's specifications..: .3:Allrstrucfurps,;feicrn � : i%:inaterials, n r�eisi+ed�itl.and,�ietariin ;walls�shall::be�'laced:onrthe a ro <so. �' .o�dr» �rs��ri�sTa) : .=i�ia'"►�'ia a i>�,:.:- ' .4: Applicant shall .stere i r r s) gas nee `s°s�atry' Mom tie.. Coiinij� of Butte. prior to doing any work, including. encroachment petmrts when work is Wrthrn cQtinty nght of, way 5. Instaltat -.' of the sub/ed sewer Mb shall tie at the sole cost and expenS:e,of Applicant 6. Actual oonnechon of the sublectsewerservtce'iine to bsttict's'sewer. mainline shall=be accomplished by District staff 7. AIl:woric:shail:beinspect& approved byQrsltct: . 8. S.Ub ect to ttae acation forrri. may: be issued as the District's permit 9. This permit: is valid for one .(I,),year.:;if..work.,is;,ncit;:c6m.pleted;wdhip said.:year, permit renewal.mn be required, t ether wiif . a ent bf an increase in ca " ` fee; connection fee and/or SCAR. Facit' Char e. equ og p ay* Y i Pac�Y dY 9 Payment. .of .Fees/Charges., required 'prior to>LA .final KE.= -.U P..D. irispectio Pa: ent r'ebeived :by Date: Receipt # By. ❑ CASH HECK # 2 �l 6 $ . permit 3 `Mon ly charge payable at the current'rate at time of connection. BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) School District v X11 I I P U�'LP V1 %Z l/ Building Department No. ._.- Tax Rate Area No. A.P. Number ��� G 2, (, jurisdiction: = City ©County Property Owner V Property Location/Address —7 —Dy D v I I Subdivision Residential Development No of Living Mobile Home Units Installation Commercial/Industrial [� Q New Addition Build District Identification No. _ 4 ( (Street Lot No. ..................................................................................... _ ........... , 0 Addition/ 'Supplemental to Conversion Permit # '(No foundation inspection) € .................................................................................................. F�6;3 I L�� () 05T I •cis ^� Q ' Sq. Footage � �"1 (Group R) Cr. Demo - ( ) existing sq. ft. see attached i Net total sq. ft. Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage (Including Exterior Roofed Areas) 7— ,'Date( -- 'Date N -A44 �c�y _� School District certifies that "`(Payor) I (Zip Code) S (Phone Number) has complied with the requirements of Resolution No. A r 1, _c- qt by payment of $ b 10 l 0, (0 Z representing1 square feet. B 2926 $ FULL MITIGATION $ School Date Paid by Check # Z to _ .r J Notice: You may 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 (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (school district), Yellow (building department), Pink (applicant) feeform.xls (12/06)dmm BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM &-rEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) ❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD) 0 PARADISE RECREATION AND PARK DISTRICT (PRPD) ❑ DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) 0 Building Permit Number4 O Property Owner (s) Project Location /Address at c Caw IJ`i VKy Subdivision Name Assessable Sq. Ftge Type of Residential Development (check one) New Development Single Family -Detached Single Family -Attached Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling Mobile home Mobile home replacement verified by Assessor Department Demo Permit (date issued ) verified by Building Department Comments: G�� C� ❑ FRRPD 0 CARD-, ❑ PRPD 0 DRPD certifies that: S hd rcA m Ps Qo\) Applicant Name Phone Number Mailing Address City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: I 1 O Dwelling Units @ $ Square Feet @ $ Remarks: . per unit for a total of $ per sq foot for a total of $ Paid by Check No) 69 Paid by na h: Receipt No: 2 )':/ 0 Recreation and park District Representative Date BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE i#: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BEREOUIRED AT TIRE OFAPPLICATION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY-"' OWNER INFORMATION Last Name First Namer .�Z.n Name Mailing Address `? , City StateC a. 0 Zip 9YS6 Phone Fax Address i'3 E-mail APPLICANT INFORMATION ARCHITECTIENGINEER CONTRACTOR City Name ..11 City J/ State 1 tMt. t. tt&a 4d Address i'3 ?a of o.•tis R City State �Isr Zip s �t Phone Fax , a Y E-mail Lic. # S Class S APPLICANT INFORMATION ARCHITECTIENGINEER Name City Addtess Tzip City Fax State Zip Phone Fax E-mail ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): State License Number APPLICANT INFORMATION Name Address City State Tzip Phone Fax E-mail APPLICANT SIGNATURE ID (Z PERMIT NO. fie! .t BIN .A i PROJECT LOCATION AP# 104.9 - A Property Address 0s City WORKER'S COMPENSATION Policy Number / G %Y 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: jU.s F' Flood Zone SRA I ves No Occ. Type tonst. I Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): ` For office y: Zoning Flood Zone SRA I ves No Occ. Type tonst. I