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Home My WebLink About071-440-004r. M��#9V7- 542 COLE, L.W. (�.yc L ?/9 347 Rockerfry re L. 14. COLE 347 ROC ELLER ROAD, BERRY CRK SU NDARD SF 12/19/96 Repair Ele & Plbg/SF 6 PERMIT #97-2436 COLE, Leonard 347 Rockerfeller Rd., Berry Creek Woodstove/SF �iNAG��'9g41 LW COLE 071-020-096 PERMIT #97-0542 347 ROCKERFELL•ER RD BERRY CREEK . 1. ` '.til• � �.. ' �O.•" 1'n COUNTY OF BUTTE- DEPARTMENT OF?DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville; California 95965 - Telephone (916) 538-754 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT' ASSESSOR PARCEL NUMBER 71--020-096 ZONING BUILDINGPERMIT OWNER 1W COLE TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 7810 ELSIE AVE SACROMENIIO, 95928 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS - J, Total Valuation $ ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 347 ROCRERFELLER RD I Energy Plan Checking Fee $ $ BERRY CREEK PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑Y Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 $4,6 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑X Describe Work: A. .k. ^ A G r' ,L r �tt'/ Gas piping system t - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE $ 6; ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class LIC. NO. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ;91 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 1000A . 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( .ACC. BLD.. So 3.5¢FT; IN,DtREES'.. MULTI.OU CL.IT'S 97,50 POWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ I'50 BAL @ .50 Ex. Occup. OUTLETSPRES D.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 .4p PERMIT FEE $ 446.6 WORKERS' COMPENSATION DECLARATION I hereby affirm under. penalty of perjury one of the following, declarations: ❑ 1 have and will maintain a `certificate of con sent'to'self-insure for workers'—Cooling compensation, as provided for by section 3700 of the Labor Code, for the performance of the. work for which this permit is issued. ❑ .I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of woik.for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier r MECHANICAL, PERMIT Filing Fee 20.00 Heating Hood 6.50 Ventilation PERMIT FEE $ Policy Number '" (The above sections need not be completed if the permit is'for work of a valuation of one hundred dollars ($100) or less.)_ I certify that in the performance of the work for which this permit is issued, I shall / not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation- provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X�I,. . �Date7.�l�� i Sig' ature of Applicant -,ff Owner' ❑ Contractor ❑, Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height: Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $, HA2. I D. FEES IMP FLOOD I COF PARCEL PO HO 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. n By tlr+ Date O� 0 PERMIT EXPIRES ON 3 Date Receipt NO. L1tlJl1� WHITE -D.D.S.•B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIO 7 County Center Drive - Oroville, California 9965 - Telephone (916) 535�y oPERMIT NO. (Rev.12/96) APPLICA110MAND PERMIT ASSESSOR PARCEL NUMBER 71-020-096 ZONING ILDING PERMIT OWNER LW COLE TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 7810 ELSIE AVE SACROMENTO, 95928 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 347 ROCKERFELLER RD Energy Plan Checking Fee $ BERRY CREEK $ PERMIT FEE $ LOT NO. S UBDNISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑X 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 ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑X nn Describe Work: �K a, �— a , , P C f— i7 J_ e°-ZZe—, Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 6 Mobile Home S G W 920.00 PERMIT FEE $ 40 ELECTRICAL PERMIT Filing Fee 20.00 Main Service .0 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.POWER License Class LIC. NO. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 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 I000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 6 ACC. B SO NCN.RES o. m� _, �� @7.50 APPARATUS S SINGLE OUTLET CIR. Ex. Occup. OR FIXTURES 2L@'.0° BAouTLEr L @ .SO FIXED EX. Occup. OUTLETSPRES D.OE0. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 .(A PERMIT FEE $ 3- WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Date!�_A_1(25 KFR� Sig ature of Applica t -)!rOwne ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 50" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ HAZ. I D. FEES IMP I FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. A�+ By i Date PERMIT EXPIRES N 3 S' 1 pato Receipt No. 218305 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 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 maj labor and materials for construction of the proposed property improvement: YES NO[ J. ' .2. I HAVE, HAVE NOT[ J 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: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NADIE: ADDRESS: CITY• PHONE: . CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide•the work indicated: NAINfE ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: SOCIAL SECURITY NUMBER: NOTE: This owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completer) and returned to our office before we are permitted to issue the permit. OVER J r Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified_ For your protection, you should be aware that as "owner -builder" you are the responsible party of record ot required to be signed by property owners unless they are personally on such a permit Building permits are n is being performed by someone other than yourself. you may Protect performing their own work If your work yourself from possrble liability if that person applies for the proper permit in his or her name. Contractors are. required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: I _ 0 If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed. as contractors or subcontractors, then you may be an employer. 0 If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security tares, workers compensation insurance, disability insurance costs, and unemployment compensation contnbutions. 0 There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. 0 For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through. their own employees, without a licensed, contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing -to be contractors is to secure an "ownerbuilder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by properly owners unless they are performing their own work personally. information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95314. Please complete the Owner Builder Verification" on the reverse side of this form so that Zve can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely Michail C. Vierra, C.B.O. ,tanager, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safetv Code. OVER cif•-_..�. December 19, 1996 county DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH Orovilllle, CA 5965 r Drive El Chico, CA 95928 1469 Humboldt Road, Suite 100 O o� Ile, CA 9596unty Center Drive TEL: (916) 538-7282 TEL: (916) 891-2727 TEL: (916) 538-7281 FAX: (916) 538-2165 FAX: (916) 895-6512 FAX: (916) 538-2140 L. W. Cole and M. H. Family Revocable Trust Leonard W. and Marlene H. Cole, Trustees 7810 Elsie Avenue Sacramento, CA 95828 RE: substandard house1--3=-TRockerfeller Road, Berry Creek, CA 95916, AP# -071-0Y2:0-0:9"6 Dear Mr. and Mrs. Cole: On December 18, 1996, in the presence of, and with the permission of the tenants, I inspected your rental dwelling at the above stated address. The "following, but not limited to, substandard... items were discovered: 1. The rear door is off the hinge. 2. There is exposed electrical wiring at the swamp cooler, and in the basement. 3. In the basement, one light fixture does not work and another will not shut off. Both lights need protective covers. . 4. The tenant claims that the reset button on the hot. water heater must be pushed to turn -on the hot water heater.. The tenant claims he has received an electrical shock when pushing" the reset button. There are exposed electrical wires next to the reset button. 5. An electrical switch in the living room needs a protective cover. 6. There are water stains on the ceiling in the kitchen. area indicating that the roof leaks. The tenant claims that water leaks into the house through the unused wood stove exhaust_ vents in the living room 7. The waste water pipe under the kitchen sink leaks. 8. The bathroom lavatory sink "P" trap leaks and the pipe to the hot water faucet leaks. 9. The light in the bathroom needs a protective cover. A CLEAN INDOOR AIR ENVIRONMENT FOR A HEALTHIER TOMORROW i'i December 19, 1996 L. W. Cole and M. H. Family Revocable Trust Page 2 10. There are small holes in the wood stove that could let glowing sparks into the house. 11. The window and doors throughout the house are not weathertight. 12. The washing machine and kitchen sink's waste water flow onto the surface of the ground. I suspect that the toilet water will also overflow from the "septic tank" in the winter. 13. The smoke alarm has no battery and the tenant claims that it does not work even when a new battery is installed. With respect to the above items, your rental dwelling is. substandard according to the state of California Housing Code, Section 17920.3, a copy of which is enclosed for your information. You are hereby notified to comply with the above stated code within thirty (30) days from receipt of this letter .by correcting the above stated items. If the septic system needs complete. replacement, a permit is required from the Butte County Health Department and a permit fee of two hundred and twenty dollars ($220.00) is required. An application for a permit is enclosed for your convenience. Some of the corrections will require permits from the Butte County Building Department, 7 County Center Drive, Oroville, CA 95965, Phone (916) 538-7541, and you must obtain the necessary permits before making the repairs. If you have any questions regarding this letter, please contact.me at'the above listed address or telephone number between 8:00 - 10:00 a.m. Monday through Thursday. Very truly yours, Edward L. Overhouse, R.E..H.S. Division of Environmental Health ;'�/`"cc: Mike Vierra, Butte County Building Department EO/mm/a:cole.ltr COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSEdn: � I alm BUILDING PERMIT DINT R� COLE ONE b SO. FT. OCC. BUILDING VALUATION OWNS MAILING AD SS J'810 1' E AMQUE , SAM 9_%28 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Fee $ 20.00 —Filing Permit Fee $ .15.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILD) t ORK(1CKERMI.ER ROAD BERRY CREEK Energy Plan Checking Fee $ $ PERMIT FEE $ • Ot LOT NO. SUBDIVISION'S NAME PARCEL MA,, PLUMBING PERMIT 'Filing'Fee 20.00 USEOFSTRUCTURE SF ❑y Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 1 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 ❑ Remodel ❑ Utilities ❑ Installation ❑ Other f Describe Work: WOODBURnNG STOVE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 1@20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service zoo, oR '.ss' 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 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 I WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. It 11 y `C. X �< . r-( / Date /_/ �_�_ Signature of Applicant- WOwner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service ( 200A TO I000A 46.00 NEW CONST. DWELLING OCCUP. SO OR ADDNS. ( a ACC. BIDS. 3.50FT. NEW CONS. NON -RES OT MULTHOUTLET 97.50 8 PSINOWGLER E OUTLET CIR. APPARATUS zo @ ,.00 EX. Occup. OUTLET OR FIXTURES BAL @ .50 APPLN1 Ex. Occup. ouTLEErS(RES o.) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ - MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE 7 Ull TOTAL FEE $ HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. , J By Date v v , I PERMIT EXPIRESONrwReceiptNo. / / Dale z3 //.S% HITE-D.D.S.-B.D. CANARY -ASSESSOR PINK•INSPECTOR GOLDENROD -APPLICANT .w.yi_!"'�+.•i�r � .'.�:!'""2°�.�ti"•'e'e7�-Tf«t_ '-+7�i`�'!T7>JS'^� �. ..•. `htf'Y ... r-..�n "�-.:r«-Y. ti;y�,r, { COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street, Chico, CA - (916) 891-2751 ' 7 County Center Drive, Oroville, CA - (916) 538-7541 CORRECTION NOTICE „Y OWNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work =• is complete ..If you have any questions pertaining to this matter, or need additional explanation, ,5, please cghtdct this office immediately. 0 'G G eX f e 4 f,9, -J �---I' Chi & .A -C O N.vr r f Date/l /a- 17 Inspector /C t,1�5� l� �- REV 10/ COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDINGDIVIS N 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-75 97_a PERMI No. (Rev. 12/96) APPLICATION AND PERMIT ASSEbWW=96 loxxxNARX BtALDINGPERMIT ow" LEONARD COLE TM 8942 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 7810 ELSIE AVENUE, SACTO 95828 CONTRACTOR'S NAME TELEPHONE ' CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace A 1,900 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 $ BUILDING ADDRESS 347 ROCKERFELLER ROAD BERRY CREEK Energy Plan Checking Fee $ $ PERMIT FEE S 55. OLE LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑X 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 IftX Describe Work: WOODBURNING STOVE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S -IGT-WT @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 800v oR LESS Main Service zo.A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class LIC. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affir Lcler penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall fo hwith comply with those provisions. X c __*ate �� _ Sign lure of Applicant - ['Owner ❑Contractor ❑Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service To 46.00 NEW CONST. OWEW EE NG OCCUCUP. so OR ADDNS. ( d ACC. BUDS. 3.50FT. NE COS. NON-RESNDT CTI OUTCUT. @7.50 PowER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 .00 BAL@'.50 Ex. Occup. ourLEETS RES D.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE, 0 TOTAL FEE $ HAZ. 0. FEES IMP FLOOD CDF PARCEL I PD I 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 Date PERMIT EX RES N ale Receipt No. a116477-3 /% WHITE-D.D.S.-B.D. CANA Y -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT M 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. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES: NO (3 2. I HAHAVE NOT ❑ signed an application for a building permit for the proposed work. 3. I have contra ted with the following person (firm) to provide the proposed construction: - NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: - PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK 3 SIGNED: PROPERTYOWNER: �� „ l SOCIAL SECURITY NUMBER: 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 OVER OWNER BUILDER INFORMATION I Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner-buildee, you are the responsible parry of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractprs may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" bn the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. +irely, Vi ira,C.B.O. uilding Inspection NOTE. This Owner-Builder.Injormation is required by Section 19830 of the California Healdt and Safety Code OVER