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069-360-011
f .�, ry 4 .,+may -�...r +'�,Aa''a. �"'�.�i�...'•`.r�. � ,.,,+r:�,+,.,,w�� r,�. ,ry, ..,,�...,,- - ; _. _. s-=�...- _ .ww-• _.ems .� _ - _ ._ _ .. -- f 9§9-360-'001 >=d02 1176 41~ tJWES, William H. - 112-72B3� 57-72B; _ Iv10ELR_E NY- JAMES; N 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: 128 RIVERVIEW DR Owner: Permit No: B07-2133 APN: 069-360-001 DUNCAN, WILLIAM Issued Date: 10/12/2007 By GLB Permit type: MISCELLANEOUS 128 RIVERVIEW DR Subtype: Electric Panel OROVILLE, CA 95966 Expiration Date: 10/11/2008 Description: REPLACE EX 100 AMP SERVICE T (530) 589-4864 Occupancy: Zoning: AR1 Contractor Applicant: Square Footage: GARY LEESE DUNCAN, WILLIAM Building Garage Remdl/Addn 21 TARN CIRCLE 1128 RIVERVIEW DR OROVILLE, CA 95966 OROVILLE, CA 95966 Other Porch/Patio Total (530) 589-1536 (530) 589-4864 FEE INFORMATION DBE Single Phase Service-Resid $58.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires GARY LEESE 798509 / B / 8/31/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 10/12/2007 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: I ❑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 performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of 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: SURETY OF THE PApolicy Number: 6330153 Exp. Date: (This section need not be completed if the permit is or one hundred dollars ($100)or est s.) f ElI 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. ' X 10/12/2007 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a constructiori lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lender's Address City State Zip $58.00 Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION 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, 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 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 for 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 [$500j; Please check one of the following: 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 Contractor's License 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 are not intended 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 ove for the purpose of sale.). AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED l(/J CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors 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 Contractor's License Law.). ❑ 1 AM EXEMPT under Section B. 8 P.C. for this 10/12/2007 Owner's Signature Date hereby certify that I have read this application and state that the above information is correct. I agree ,I to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, 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 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 own r or am authorized to act on the property owner's behalf. \� ",v . • � v, r T ,,, 10/12/2007 Xowner Contractor OR. E]Agent for Owner Agent for Contractor �'" FILE COPY C; BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty.neVdds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name UA;641v First Name $ILL y1G1� 1 Mailing Address j2.8 (t.-►VF-RVIB-w CityOP-0 V 1 L - L -F- Stat is Phone _ Fax E-mail APPL CANT SIGNATURE X PERMIT NO. ;��1 a BIN # PROJECT LOCATION AP# ©�q-3�0-Oolp-006 Property Address 2_8 P City o tza V0- GAJ— 4 WORKER'S COMPENSATION Policy Number /V A — CDNT2/+GT HA:' No Carrier E- lf hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name A) 0" Address DESCRIPTION OR SCOPE OF WORK: r_-Pz.q15T) Al 00 3r --,e V)&E- LA -17 -Al /VEw Zdo Ai /Yl/i-1it.1 Sq FT- Living Garage Open v ❑ , Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: CONTRACTOR Name �I'�W-V Address -L 1 T►4 fLPJ C l 2e -,L F - City O ® it I LL ~ State CA- Zip q,5-7 &4 Phone 530-5�8 Fax E-mail r� 1 I.,00, cow, Lic.# V -799 Q Class Vl3 APPL CANT SIGNATURE X PERMIT NO. ;��1 a BIN # PROJECT LOCATION AP# ©�q-3�0-Oolp-006 Property Address 2_8 P City o tza V0- GAJ— 4 WORKER'S COMPENSATION Policy Number /V A — CDNT2/+GT HA:' No Carrier E- lf hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name A) 0" Address DESCRIPTION OR SCOPE OF WORK: r_-Pz.q15T) Al 00 3r --,e V)&E- LA -17 -Al /VEw Zdo Ai /Yl/i-1it.1 Sq FT- Living Garage Open v ❑ , Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: ARCHITECT/ENGINEER Name — NonJr-- Address SRA City I No State Zip Phone Fax E-rnnif, State License Number APPL CANT SIGNATURE X PERMIT NO. ;��1 a BIN # PROJECT LOCATION AP# ©�q-3�0-Oolp-006 Property Address 2_8 P City o tza V0- GAJ— 4 WORKER'S COMPENSATION Policy Number /V A — CDNT2/+GT HA:' No Carrier E- lf hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name A) 0" Address DESCRIPTION OR SCOPE OF WORK: r_-Pz.q15T) Al 00 3r --,e V)&E- LA -17 -Al /VEw Zdo Ai /Yl/i-1it.1 Sq FT- Living Garage Open v ❑ , Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: APPLICANT INFORMATION Name Fv-S Address SRA City I No State Zip Phone Fax E-mail APPL CANT SIGNATURE X PERMIT NO. ;��1 a BIN # PROJECT LOCATION AP# ©�q-3�0-Oolp-006 Property Address 2_8 P City o tza V0- GAJ— 4 WORKER'S COMPENSATION Policy Number /V A — CDNT2/+GT HA:' No Carrier E- lf hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name A) 0" Address DESCRIPTION OR SCOPE OF WORK: r_-Pz.q15T) Al 00 3r --,e V)&E- LA -17 -Al /VEw Zdo Ai /Yl/i-1it.1 Sq FT- Living Garage Open v ❑ , Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. Type Const. 4-;� 51- 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. BP061765 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF'ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penally 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 for 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).): Q�.. 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 fo 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.). O I, as owner. of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' Slate 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.). ❑ 1 am Exempt under A u ' ess and Professions Code Date: d 156 czt — wne •' WORKERS' COMPENSATION DECLARATION I hereby affirm under penally 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 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: Policy t& 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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith c9mply with those provisions. Date: Appll nl: - 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. Issued Date: 08/04/2006 APN: 069-360-001-000 Site Address: 128 RIVERVIEW DR ORO Map Index: Description: OPEN DECK (602) Owner: DUNCAN WILLIAM J & VICKI J 128 RIVERVIEW DR OROVILLE, CA 95966-9421 Applicant: DUNCAN WILLIAM J & VICKI J 128 RIVERVIEW DR OROVILLE, CA 95966-9421 (530) 589-4864 Contractor: License #: Architect: Engineer: Total Square Ft: 602 S.F. Valuation: $6,020.00 Census Code: q ao,o0 #4�31"ln `7-2�-0CA f q 0.60 CONSTRUCTION LENDING AGENCY This permit Is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to do work indicate a ove for which fees have been paid. Q /� performance of the work for which this permit Is Issued (Sec 3097 Civ.) Date:79 9 -1 1 co Name: ey. - PERMIT EXPIRES ON: Address: ❑ 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 d 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 substannce f �cia rm or current of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for Inspectlon . _ des. , w Print &.owner 0 Contractor ❑ Agent for Owner ❑ Agent for Contractor (o 0 0 0 \0 0) 0 0 e o 0) 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 OFAPPLICATION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** AP,PLtQ4NT INFORMATION OWNER INFORMATION Last Name h Address irst Name Address Itate Zip x City Lic. # State Zip [� Phon 5 L/ Fax -------- E-mai AP,PLtQ4NT INFORMATION CONTRACTOR Name City 6y ` le- Address Zip City Phone Itate Zip x E-mail Lic. # Class AP,PLtQ4NT INFORMATION ARCHITECT/ENGINEER Name City 6y ` le- Address Zip City Fax — ate Zip Phone V Fax E-mail Planner State License Number AP,PLtQ4NT INFORMATION Name Address Ie �,,> �Y City 6y ` le- Stat Zip Phone?L) !� < Fax — E-mail AP NT SIGNATURE � ��ji ;e, For office use onI : Zoning Flood Zone I X I SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\B1dgApp1SubRgmts.doc PERMIT NO. BPI. BIN # PROJECT LOCATION API 0 Property -Address Ci , Cros Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must he shown at the time of permit issuance. LgNDING AGENCY Name Address Description or Scope of Work: Sq FT- Living Garage Open Cov ❑ 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 required. 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. Page 1 of 2 Received by: - ,�1 Amount: - Bldg 'p� alp SRA Receipt #: � 3►3 Sheriff 77 SMIP `] Date: �I- r'_ 03 Other 1 l[� %� (} l `y• Total REV 8-12-05 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bidgs: (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 enqineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). u 7. Worker's Compensation Carrier and Policy Number.. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. El 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538-7541. . EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 ,...r-. �.� .�-=+a,�ti.�7.!'. `W �ti!c �.w�W3%' �'�l�tV`►'J�'a``�+...r•4i0S}°'��''*"Frr�4�r"•-�,^ia`►X.iir.,.�`.7'rye+7�iy�.w-n:3.�,�,�1].r'CY..�yr�i.r''.L-1; t.j 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 �I105 OWNER: ASSESSOR PARCEL NUMBER t )l - �/1 1' ren I Proposed Building Use: O tC Permit Technician: Kobe Date: / ' `) Ite s equired in order tg a ply fora permit. All boxes MUST be checked OR marked NA in order to apply. 1. Site plans 3 - r sets, signed by the preparer of the plans. 2. Complete plan , 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. ❑ 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 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) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in 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 must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. \SIV 11. Hazardous Material Form 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other Rening items needed to issue the permit. (May require additional plan review upon receipt o_ f tie following items.) 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico`fjOroville, as applicable ❑ 15. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... \„� 18. Erosion Control Plan Required......................................................................... tl R Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 20. City of Chico Plumbing permit....................................................................... ❑ 21. Site plan and business license approval from the City of Biggs .............................. ❑/ 22. California Department of Forestry plan approval ❑ paid. Sent by: ........... 23. Planning approval for (A) Use:QL4__ (B) Parking: (C) Parcel Check:. ✓ .. ❑ 24. Contact Land Development about _ Improvements, _ Drainage ........................ .1 i ,, (commercial p . projects only). Sent by: ...................... OILM 26. NPDESrFormReview commercial ro.ects....................................................... '} ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 29. Worker's Compensation Carrier and Policy Number ..............:........................... `[r7 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits.., ....................................................... ❑ 34. Deed Restriction.......................................................................................... ❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO ......................... ❑ 36. Other: ❑ 37. Other: When issued Telephone asa � � e1� and hold for pickup. I have been informe8,9 t� bove items and requirements for obtaining a building permit. Appu nt �` Date: 1. Index permit'6ppl6tiomf r a ve items mbered: Plan Chec L tter 2. Additional items required I 9k/ Contractor, designer, ner s'adwsed above data by' • phone, ❑ mail; ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data byi ❑ phone, ❑ mail, ❑ coup�r, i Date: Plans reviewed byDate: "�B� Plans approved by: i l Date: _ • if G Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division K/BuildinglPlan Check/Data Sheets/data sheet page 2 9.27.05 _n TO: FROM: Building Division — Development Services Environmental Health y Plot Plan Attached E.H. Floor Plan Attached Sent to BD/DS / SUBJECT: Sanitation Clearance wrier Location AP# Plan Approved for: Sewage Disposal: _ Water Supply: Public Private Well Clearance for dwelling. Other Hold final for: Final clearance O.K. for: NOTE: // --�-i - 7/37/ L* Envir m nt I H alth Specialist Date Building Clearance 9/2005 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner App Date DUNCAN 7/21/2006 APN No: 069-360-001 Permit Type: I I"'] Subtype: Permit No: BP 061765 Permit Desc: �J New 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION $150.00 Plan Check portion of Permit Fee $60.00 $90.00 2 FEMA RYes Flood Elevation Review $109.98 0 3 SRA* Yes Fire Plan Check - Non -Refundable $95.00 0 (State Responsibility Area) Building Inspection $109.98 0 - $204.98 NON-REFUNDABLE portion of fees due at application $60.00 FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $60.00 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT $90.60 $90.00 $0.60 l�u Balance of Building Permit Fee RECEIPT DATE Tech/Asst 456313 7/21/06 Kourtni 4 Balance of Building Permit Fees (from No. 1 above) 5 SMTP* - Strong Motion Instrumentation Program (Enter amount from permit system) 6 Additional Plan Check Fees (NON-REFUNDABLE) 7 Other*: 7a Other*: 8 IMPACT FEES - RESIDENTIAL* Applications After 04/15/06 Per Dwelling SFD a er Dwelling D CHICO STORM DRAINAGE MASTER PLAN County 4249.11 3183.54 New construction, vacant land, on 1 acre or less - Enter 1 or less acre value Chico Urban Area 6146.23 4538.82 775 SUDAD Ditch EI Medio Fire District 3249.97 2385.76 North Chico Specific Plan SR -1, SR -3, SR-1/PD R-1 8801.091 8897.09 7395.04 7491.04 o R-2 8390.091 R-3 7604.091 6984.04 6198.04 Processing Fee is automatically added to impact fee total 9 WATER TENDER FEE (Not collected when impact Fees Applicable) Enter Bat.# 0 $100.00 DRAINAGE FEES* 10 CHICO STORM DRAINAGE MASTER PLAN 770 Butte Creek 771 Comanche Creek New construction, vacant land, on 1 acre or less - Enter 1 or less acre value 772 Little Chico Creek 773 Big Chico Creek 774 Lindo Channel 775 SUDAD Ditch 776 Mud -Sycamore Creek 777 PV Ditch Per Dwelli MH 7289.40 RECEIPT DATE Tech/Asst � 0 $100.00 $200.00 $9,088 $6,776 $8,267 $7,211 $6,275 RECEIPT DATE Tech/Asst $8, 893 10a More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW ALJ 11 THERMALITO DRAINAGE AREA $684 Maximum Per each new living unit on existing lots where full drainage fees have not been paid 11a Temporary Dwelling 1 $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO ISSUANCE OF PERMIT. Forms will be prepared after plan check is completed for applicant to take to respective district office. 12 SCHOOL DISTRICT FEES* 12a RECREATION DISTRICT FEES* At the time of permit application, I was ed the above fees are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking process. l App 'cant: Date: < Pursuant to GovernmiaLcode_ioK602T, you are hereby notified those Items followed by an " " may have been imp ed on yo project. You have 90 days from the date of approval of the porject or from the impostion of the above referenced items during which you may protest. The reXuirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residerifial 041506 Butte County Department of Development Services ADMINISTRATION `BUILDING `GIS t PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your naive 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 of otherwise engage any persons other than your immediate family, and the work (including materials and other 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 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 contractor 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. Sincerely, Y 2 Scott Rutherford Chief Building Inspector NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OWNER -BUILDER 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. I personally plan to provide the major labor and material for construction of this proposed property improvement: YES .K -'x- I NO [ ]. 2. I HAVE [],HAVE NOT [ ] signed an application for a building permit for the proposed 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 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. Butte County Department ofDevelopzlent Selwnces 7 County Center Drive oroville, CA 959650 ° (530) 538-7601 Telephone ° cay (530) 538-7785 Facsimile OUIA BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES [ request and authorize the Building Division to process this building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatoryentities, including but not limited to, Planning, Environmental Health, Land Development, County Fire, and Agriculture. I hereby acknowledge: a I need to submit applications for septic and/or. well to Butte County Environmental Health immediately. 0 I ant required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained a I am responsible for notifying Development Services, in writing, to stop processing of the application and to arrange for'disposition of plans The Building Division will process the application through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building plans to the Building Division. Once the plans examination process begins, there will be no refund of plans examination fees. Any changes requiring. submission of amended plans to the Building Division will incur additional fees. Within one year from the date of application for a building permit, all other required permits and clearances from other..entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances will void the application. Typically other required permits/clearances include, but are not limited to, verification the parcel was legally created., adherence to.all mitigations and conditions imposed on the parcel at time of creation, as well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Building site address: •;�� /' - - APN: 54612�` t_�_aL Permit No.: I have readAte9ove-referenced dtood and accept the terms and conditions as expressed herein as indicated by my submission building permit application and my signature below: r,tr-,.T A -rT ro U n-0 A DDT MANT ATE e, WTM'ENr a T TF� Or: r O o==, i1 O 0 0 c�U A�etic WORDS Department C 'o u n t i J. Michael Crump - Director of Public o f B u t' Works LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville, CA 95965 (530) 53B-7266 (FAX) 538-7171 National 'Pollutant Discharge 'Elim.ination System (NPDES) Phase II Construction Storm Water , Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement jLESS THAN 1 ACRE1 Project Description: (/ and/or �/ (/ Project Location Parcel Number: a6? By signing below, I, the project owner/owner's 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 build -outs 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 Control 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 a project that disturbs one acre or more of land may result in' revocation of grading and/or other permits or other sanctions provided by laws Signe( Title: Date: %�oZ / /0A Less than 1 Acre NPDES & SWPPP Compliance Certification Butte County Storm Water Management Program O6S. VWTTE COUN BUILDING DIVISIC . � VED APP 6 6• TYP. 1._ '(f G PLYWOOD C �- - FRMIJG . ,t=r CLIP= • 2' x 12° STni STRIlJGER. .. '�'xl2'PIF. 5 '' (an 4�}'Lit` ni.n. ireetiai TOP VIEW .. .. HE klogfilL :NOT SNOUT tJ7 •FDR CLARITY. 2"KW DECKIIJG '(ALT) Z4-gV*DF*9.-`re- . 3/1 60LT ' paced -50 -Fhtt+ a- • GIRDERS _ _ y'I s�hzcannot I'ls' TAG PLYWOOD, CC EXT. .. 2V4' � �oa n�J +h • MOBILE IIDME OR DECK oc za : l CLIP (EA. MAX. "2 F+n rRr�i � 2'K4.. PRESSU� E- rtc z r� GUARDRAIL �-{—' : - (�}Hla' RFDW00D'11ATE' - e MIN. BOLTS i 4 ,110, DECKIIJG' • GIRDER 4 • , :, - ,Hy� ;fl PRECAST 4x9" POST to -30-03 W TER ,AdFQU4TE-DIAGONAL e I�r BRACING.TYPICAL U-91DEAM1/1L 29ff • • - •- lo• • ' • BOUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS �ri`�N, F'OOT!]U(ti T County Center Drive — orovllla. California 95985 Telephone: IR -7943 I \ ': COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 02-1176 ASSESSOR PARCEL NUMBER 069-360-001 AR -1 ZONING BUILDING PERMIT OWNER X-Jv ES MCELREAVY TELEPHONE SO. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS 128 RIVERVIE14 OROVILLE CA 95966 1560 "RM�IOFING cA2934 TELEPO NE 533. 11595sMILLE}:RESS H.NK RD., OROVILLE CA 95965 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Film Fee $ 20.00 Permit Fee $ ' UU ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ B L IaGAPD�`VIEW DR. , OROVILLE CA 95966 Energy Plan Checking Fee $ PERMIT FEE $ 60.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: RE ROOF 26 Sq Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W Ca20.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 Main Service ZDOA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed) under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class 01— :5,9 Lic. No. S 3 tF3 y OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO IODOA 46.00NEW CONST. DWELLING OCCUR OR ADDNS. ( & ACC. BLDS. s0 3.5¢FT. NEW ST. RANCHO RCUT 97.50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FDRURES 20 O I'50 BAL o .so Ex. Occup. OFuc"EEO�A AE3ID.OEA 5.00 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: ❑ 1 have and will maintain a certificate of consent to self -insure. for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier �f &c.1ct MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number `Z/ 3— , -I i :2_1 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Date �l(�— Q Signat ref Applicant - TO Owner A Contractor ❑ Agent An OSHA ermit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 60.00 HAZ. D. FEES IMP I FLOOD I CDF PARCEL I Po HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Co and/or Resolutions to do work indicated a ove for whi f es have been paid. Date 5-10-2002 PERMIT EXPIRES ON 5-10-2003 Date Receipt NO. 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, California 95965 - Telephone (530) 538-7541 PE MIT NO. IRev.12/96) APPLICATION AND PERMIT ('�� -) (� to ASSESSOR PARCEL NUMBER ZONI R_ BUILDINGPERMIT -OWNER MC_CLr-ea e TELEPHONE .a SO. FT. OCC. BUILDING VALUATION _ OWNER'S MAILING ADD SS (C) VC, IPS 5(0 CONTRACTOR'S NAM TELEPHONE COMRAC TORS MAIUNO AD E Mjye ) uc/ILI ^„ /-TJ•CC� CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuatlon $ _ _ ARCHfTECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ �� ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS/ ,/ ' ' 1 t i)e `r� Energy Plan Checking Fee $ PERMIT FEE $ coo LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 1 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater — 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ 7odeLD Utilities ❑ Installation ❑ Other ❑ Describe Work: e tp Gas piping system 1 - 5 outlets 1 5.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Feel 20.00 LEss Main Service 2oeoov0A ORoR LESS 23.00 "PEPAIT FEE PAM s , SRA SHERIFF O � AAkb NT RECEIVED : wR� W�E� �� A To im Pir Iii o compim Main Service 200A To I000A 1 46.00 NEW CONST. DWELLING OCCUP. , OR ADDNS. ( & ACC. BLDS. 3.5CsFr° NEW CONS . MULTI -OUTLET NGN•REs1O. @7.50 POWER APPARATUS -- 6SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FDRURES BAL @ Ex. Occup. OUT ELETS RESID.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy InspectCONSTion Fee $ TOTAL FEE $ HAZ. 0. FEES I IMP I FLOOD I COF PARCEL I PD I HDI ISSUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXPIRES ON provisions to do work paid. re Receipt No. WHITE-D.D.S.-B.D. CANARY PINK -INSPECTOR GOLDENROD -APPLICANT .. .,. ...... �..-� ._r:�a-�.�x�:3dEs'a: +:4�asm�.R F,.r .- .,. �.-. .. ..,P.�.j�.� .t M>�r i�5�t�iX.YSd`s+k`L'�t�'W � .+- . _ i _ . �,4 ; .. .; ; . COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 02-1176 ASSESSOR PARCEL NUMBER 069 ._0-Wi W 7—,W—'W l ZONING AR -1 BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 128 RIVERVIEW ORL'VILiE CA 95966 1560 AWN WFING TELEPHONE 533-2934 CONTRACTORS MAILING ADDRESS 11595 MIUM PEAK RD. OIitOVILIE CA 95965 CONSTRUCTION LENDER f Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUT `iW RVIE,W DR., OROVILLE CA 95966 Energy Plan Checking Fee $ $ PERMIT FEE S 60.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: RE ROOF 26 Sq Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service o,', v ss 23.00 LICENSED CONTRACTOR'S DECLARATION 1 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. p License Class C • Lic. No. S -3,--) L / OWNER -BUILDER D" LARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 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 CoA TO 46.00 CCU000A NEW CONST. DWELLNJG OCCUP. OR ADDNS. ( a ACC. BLns. SO 3.5¢T: �N H'.R°SIo MULTI.OUTLET @7,50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. OCCU OUTLET OR FDRURES.50 �L 0 1.00 Ex. Occup. OUA Io.°EED 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier te F4.%.,A d Policy Number 11.. — (The above sections need not be completed rf the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X "'-•'�— Date- 1(7)- n Signat re f Applicant - ❑ Owner ,Bl Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 60.00 MAZ. D. FEES IMP I FLOOD I CDF PARCEL I PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code .and/or Resolutions to do work indicated above for which fees have been paid. ; By 'y,`%///�� i 6 Date `�-1U-ii01[ PERMIT EXPIRES ON 3 -1i' -2(k_" Data Receipt No. ''�' WHITE-D.D.S.-B.D. 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