HomeMy WebLinkAbout069-380-024S
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1069-380-024 04-2350 - r
360 RIVERVIEW DR, OR
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Cont: GREENE'& SON R 4 -22;-,
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.net\dds
PERMIT NO.
BP042350
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: 08/09/2004 APN: 069-380-024-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : G 3 9 license Number: �S O s-
Site Address: 360 RIVERVIEW DR ORO
Date: —OL Contractor. j 7
Map Index:
Description: RE -ROOF (50 SQ.) HOUSE & ATTACHED
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
GARAGE
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
Owner: FLINK CARL
signed statement that he or she is licensed pursuant to the provisions of
360 RIVERVIEW DR
the Contractor's State License Law (Chapter 9 commencing with Section
OROVILLE, CA
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
95966-7807
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 sate (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
Applicant: FLINK CARL
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 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
Contractor: GREENE & SON ROOFING
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
PO BOX 2467
❑ I am Exempt under Article 3 of the Business and Professions Code
PARADISE, CA 95967-2467
Date: Owner:
530-873-3940
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #: 275057
❑ 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.
Architect:
❑ 1 have and will maintain workers' compensation insurance, as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurances carder and policy number are:
/y09
Carrier:
Total Square Ft: 0 S. F. v
i� 9
Policy #:/ j Z�
Valuation: $0.00
❑ 1 certify that in the performance of the work for which this permit is
Census Code:
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 s provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
G
CONSTRUCTION LENDING AGENCY
tic le provisions of the Butte County Cody a, nrVor
This p it is he h is d nDdJ
I hereby affirm that there is a construction lending agency for the
Re of io to o w ich ee hbeen paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
v/7
Name
UX
By: Date:
EXPIRES
Address:
PERMIT ON: t%
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. 1 acknowledge it is unlawful to alter the substance of any official to r document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Name: 'Y�e�'� Q
Print Signature: vti
/y ph
Date:
❑ Owner ,W,—Contractor 0 Agent for Owner ❑ Agent for Contractor
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.
BP042350
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: 08/09/2004 APN: 069-380-024-000
the Business and Professions Code, and my license is in full force and
effect. /� p
License Class: C� 3 / License Number: !� O
Site Address: 360 RIVERVIEW DR ORO
Date: Contractor.
Map Index:
Description: RE -ROOF (50 SQ.) HOUSE & ATTACHED
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
GARAGE
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
Owner: FLINK CARL
signed statement that he or she is licensed pursuant to the provisions of
360 RIVERVIEW DR
the Contractor's State License Law (Chapter 9 commencing with Section
OROVILLE, CA
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
95966-7807
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
Applicant: FLINK CARL
pp
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.).
❑ 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: GREENE & SON ROOFING
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
PO BOX 2467
PARADISE, CA 95967-2467
Date: Owner:
530-873-3940
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
License #: 275057
❑ 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.
Architect:
❑ 1 have and will maintain workers' compensation insurance, as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurancec�{arrrder`►and policy number are:
o�1
Carrier: Fa -TC
Total Square Ft: 0 S. F.
V �j to
Policy #: � 2,
Valuation: $0.00
❑ I certify that in the performance of the work for which this permit is
Census Code:
issued. 1 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 s provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY ` -
This p i s Fie ti is d un a he ap lice le provisions of the Butte County Codes anrtlor
1 hereby affirm that there is a construction lending agency for the
Re of io to o w d o f ich ee h been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
By: r Date:
PERMIT EXPIRES D
Address:
ON:
Date
❑ 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 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 fo r document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: L• �Y �f°��
Signature:
Date:
0 Owner Eontractor ❑ Agent for Owner 13 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
"PLEASE PRINT CLEARLY"
APPLICANT NAME
OWNER
Last Name,
irst e
Address
E v "
City D
`,�f
Stat ,
Zi
Phone
20 , l
Fax
E-mail
Planner
APPLICANT NAME
CONTRACTOR
Name
e Q n
cl
Address-
b
City
Fax
St
Zip
Phone
Fax
E-mail
Planner
Uc. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name ca_�"4p AQ4f A�IVP15y
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property,2ress ' (b
f 1 r
�Stt
Flood Zone
-
Cross et
C
SRA
I Yes
I No
Occ.
Type Const
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
-y
B
BIN #
LOCATION
AN 0& j�f
Property,2ress ' (b
f 1 r
�Stt
C'
'
-
Cross et
C
�s SRA
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work
Of
t
Sq. Footage ��p
❑ 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.
�,
Rec ' d by:
Amount v Bldg
P��[
�s SRA
Receipt #:
Sheriff
W
SMIP
_ Other
Total
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 GRAPHPAPERI
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPERI
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
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 engiijeer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI
❑ 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
:AFORMSWILDING F6RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04