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Home My WebLink About073-370-023Q i.-; ti^' ^. J Af 'I(irt`!. `T9,7.1r''*i� 4v '.'^4Y�v".s-r -�-- r. � .. � � 0 73-37 O�3�4 4' 0- 3-310-023 OL T 4 ''o -0492', S*T,A�fSiHibd WILLIAM;.: 11891 Po. " .- ..* -4" RTE RD, CLIPPER SL S& 0 , MitLS., GAS LINES & H20 VENT I OFFICE Copy Address ry GAS Meter B DaO ELECTRIC Meter By ZJ COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - UILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephon (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT nit-049 ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER William 0,tAf,-"hA1t 675-2696 TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS ?fills CA 95930 CONTRACTOR'S NAME `per CZ TELEPHONE CONTRACTORS MAILING ADDRESS. CONSTRUCTION LENDER. LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 1 89 La P 1 @S Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other i SPECIFY i Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent —Buildingsewer 15.00 5+00 TYPE OF WORKGas New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Ixas lines &M Wo vent l piping system t - 5 outlets 15.00 5.00 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 I . aOOV OR LE Main Service 200" OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION 1 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. License Class i - '' 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: ITemporary ,111I, 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 OCCUR ORADDNS CC. BUDS. 3.50SO =RES,.. MU11 IRQUITS @7.50 PowER APPARATUS a sINGLE OUTLET cIR. DR EX. Occup. OUTLET OR FUREs .00 BAL 20 @ 1. 0 Ex. Occup. ou ,EE% palp,OERq 5.00 Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 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. ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and=policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) �1 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 complyWhW those provisions. . _ X ;_/'�^'fir`_ _- Datey Signature of Applicant -'Q Owner ❑ 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 Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 50.00 HAZ. D. FEES IMP FLooD CDF PARCEL PO HD ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have By 1 i",`!'i'/ i(i '1%L1 Ll PERMIT EXPIRES ON,. applicable provisions Resolutions to do work been paid. Date .1_1A Date Receipt No. 5 ^� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT r 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 -04n2 ASSESSOR PARCEL NUMBER 071-170-091 ZONING BUILDING PERMIT OWNER TELEPHONE SO, FT, OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS M Box 1iPPP_r_ Mi I Is Ca 9_5930 CONTRACTOR'S NAME owner TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Flin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 11891 La Porte Road clipp;er Milles Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling 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 L5. 00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Ulilities ❑ Installation ❑ Other ❑ Describe Work: Qas lines and H2o vent Gas piping system 1 - 5 outlets 15.0019 Building sewer 15.00 Mobile Home I S I G I W I@20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 OOOVMain Service 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, ( 9 ) and my license is in full force and effect. License Class('—(o 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 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 Main Service 200A TO IOOOA 46.00 NEW CONST. DWELLING OCCUP. s0 OR ADDNS. ( a ACC. BLDS. 3.5¢FT: NEW CONS ' MULTI -OUTLET NON-REs10. C 97.50 POWGLEER APPARATUS 8 SIN OUTLET CIR.Ex. Occup. OUTLET OR FIXTURES BALI p'so Ex. Occup. o untDrs RESID.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE S MECHANICAL PERMIT Fling 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 mfrf i se provisions. Date /�/ U3 natu pplicant - Owner ❑ Contractor ❑ Agent An OS permit is required f r excavations over 60" deep and demolition or construction of ctures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 50.00 HAz. D PEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County C and/or Resolutions to do work indicated bove for w ich f es have been paid. By Date PERMIT EXPIRES ON 6 V— ate Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT IN r Yt -. .- _ � ��_ .M \n. v -�•K• 1 ..' � u .gryL wwn.{...:t .. : v,.� : Jr��. `!'"' .. . 'b73-370-023 02-1867 , tr. STAFSHOLT, WILLIAM• 11891 LAPORTE RD., CLIPPER MILLS NEW ELECTRIC'- SERVICE PANEL & ;L SUB PANEL P2- ®Z 22`73if I OFFICE COPY Address GAS Meter By Date ELECTRIC Meter By Da�� . ,- i .�. � : 3:w a �tr�wA . .. ,. � , z r ^ „•-y,,>.. v •;n u: [:...-r.�.�� ri .. :a, r . 4 .r3+.1:q•. ^„ ,., .. - ... • " COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DI, ��' • '� .r 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538=7541 PE T NO. (Rev.12/96) . _�, - APPLICATION AND PERMIT 4 -` �Z ITS? ASSESSOR PARCEL NUMBER 07311370-023 ZONING q BUILDING PERMIT OWNER Stefsholt. 41 TELEPHONE 675-26%.. SQ. FT. OCC. i. 'BUILDING VALUATION OWNEWS MAIUNG ADDRESS_., PO Boz 2C ClipM Mills CA 95930 CO RACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING DRESS 112 y1 La Porte Road Clipper (mills CA _ Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP �- PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE I SF ❑ (Duplex ❑ Mobilehome ❑ Other .�� SPECIFY I 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 'r New 0�70ition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ rI Describe Work: WW elect Sow panel sub Mel SLMobile s piping system 1 - 5 outlets 15.00 Building sewer 15.00 Home S G W @20.00 PERMIT FEE $ ( ELECTRICAVPERMIT' Fling Fee 20.00 + I Main Service 200A OR LESS 23.00 .00 } LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury. that I am licensed under provisioris of Chapter 9 (comrgencing 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 followingreason: I, as owner of th roperty, 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. - ❑ I am exempt under Sec. Business and Professions Code for this reason 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. ensation insurance, as required by Section 3700 of the Labor Co e, foahce of woik for which this permit is issued. ❑ I have and will maintain wo�in My workers' compensa ocarrier en policy number are: Carrier Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCURSO OR ADDNS. a Acc. sLDs. 3.5Q�: NEW CONST. MULTI -OUTLET NON-RESID. / I 97.50 POWER APPARATUS a SINGLE ourLEr cw. EX. Occup. CUTLET OR FIXTURES 20 Q x.00 BAL.Q r.50 FIXEO Ex. Occup. Gin RRESIo.ok 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23. 00 P.. Inamtion PERMIT FEE t MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMlt, $ Policy Number (The above sections need n om 1d pe ' 'e: \e it is for work of a valuation of one hundred dollars ($100)le f I certify that in the performance th for which+this permit is issued, I shall not employ any person in any anner so 0 become subject to workers' compensation laws of California, nd 4g ee rf should become subject to the workers' compensa-06n provisio s o ctio 700 of the Labor Code, I shall forthwith comply,vAh those prow ns. _ Date / / f,Applicant - ❑ Owner ❑ Contractor Q Agent Signature Kues An OSHmlt is required for excavations over 5'0" deep and demolition or construction of strucver 3 stories in height. MobileiHome Installs ion $ Energy Inspectio L, e $ Occ j� T.L PE TOTAL ,EE $gq.pp AZ. D: FEES IMPS FLOOD CDP PARCEL PD HO ISSUEO _ TKis per her'Aby issued under the applicable provisions of theJ Bu unty Code and/or Resolutions tc do work indicated a ve for which (fees have been paid. f� /V 7 By Date PERMIT EXPIRES ON 7 /(_ G Date .+s 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 Q 2 PIITNO (RevPF.WIT .12/96) , APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ` 073-370-023 ZONING BUILDING PERMIT OWNER Sta.fsholt William TELEPHONE SQ. FT. OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS PO Box 96 Cli er Mills CA 95930 COfJZRACTOeRLS NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER [Fireplace LENDER'S MAULING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUIL I G DRE1SS La Porte Road Clipper mills CA Energy Plan Checking Fee $ $ PERMIT FEE $ 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: New elect SeTv panel/sub panel— L7c r Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service '..AORLESS 23.00 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 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: 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 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 Main Service TO 46.00 WEE200A CCU000A NEW CONST. DWELLING OCCUP. OR ADONS. ( a ACC. BLDS. SO 3.5¢FT: HON-a°SIOT. MULTI.OUTLET 97,50 POWER APPARATUS PSIN. a swGLE ourL� cIR. Ex. Occup. OR FDRUREs s20 p 1.00 Ex. Occup. ouri�s ASID.°ER.A 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 23.00 Pre— Inspection PERMIT FEE _ MECHANICAL PERMIT Fling 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 J 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' compens i6n provisions of section 3700 of the Labor Code, I shall fo hwith cc Beoprovisions. /' Date //,R1 Signature pplicant - ❑ Owner ❑ Contractor ❑ Agent An OSH ermit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $89.00 01 HAZ. I D. FEES IMP FLOOD CDF PARCE Po HD I U This permit is hereby issued under the of the Butte County Code and/or Indic ab a for hich fees have B PERMIT EXPIRES ON applicable provisions Resolutions to do work been paid. Date ®,tj Dafe Receipt No. k WHITE-D.D.S.-B.D. CANARY-ASSE SOR PINK -INSPECTOR GOLDENROD -APPLICANT ....,y,--mm...,-M-Fyq�.�,.o•"°`c'S6rir'$•'r _�.r''''."' ysa�,. - •sc�[;�+r /r v �d COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION ne 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 SA PERMIT APPLICATION DATA SHEET OWNER:�l'�� O ASSESSOR PARCEL NUMBER Proposed Building Use: Counter Technician: Date: 7— o Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ❑ 1.. Plot plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. ;Engineered truss details and layouts in duplicate. No faxes! ❑ 5. 'Energy compliance design and supporting documentation in duplicate. ❑ 6. pManufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. ❑ 7.. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed b tengineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. Date Received By ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ....................... ❑ 9. Plot plan and business license approval from the City of Biggs ........................... ❑ 101 Letter of intent for non-residential buildings ................................................ ❑ 11= Detached Accessory Building Form filled out by the owner ............................ ;❑ 12. Hazardous Material Form..................................................................... . ❑ 13. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 14. Fees as shown on the attached Schedule of Fees Due Sheet ....................................... ❑ 15. Statement of Intent for Non -heated and A/C Buildings ............................................. ❑ 16. Sanitation and plot plan approval from the Environmental Health Department in ❑ 17. City of Chico Plumbing permit......................................................................... ❑ 18. California Department of Forestry plan approval ❑ paid. Sent by: ...................... ❑ 19. Planning approval for (A) Use: (B Parking: (C)' Parcel Check: ❑ 20. Contact Land Development about Improvem ts, ❑Drainage ............................... ; ❑ �1. Encroachment Permit fo i wa h .P Works ept. (construction approval prior to occupancy). 22. Pre -Inspection for required ................ ❑ 23. Contractor's license information. (Number, Name Style, Classification) ...................... ❑ 24. Worker's Compensation Carrier and Policy Number ..............:.............................. r ❑ 25 Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... ❑ 26. Letter of Signature authorization.................................................................... ❑ 27. Recorded copy of Agricultural Acknowledgment Statement .................................... ❑ 28. Manufactured home utility clearance............................................................... ❑ 29. Existing violations and/or expired permits......................................................... ❑ 30. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 31. Other: Wherr issued Telephone (O "1 S • 7i and hold for pickup. I have been inf med of the a • e and requirements for obtaining a building permit. Appli t Date: 1. Index peV application for the'labove items numbered: 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by _ Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by _ Plans reviewed by: Date: Plans approved by: Structural reviewed by: Date: Structural approved by: Note transfer by: Date: Yellow: Building Division Plan Check Letter Date: Date: Date: _Date: ;e - OWNER -BUILDER VERIFICATION Aaencion Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your sipoee, Please complete and return this information at your earliest opportunity to avoid unneotstaty May in processing and issuing your building permit. No building permit will be issued until this verification is received. personally plan to provide the major labor and materials for construction of the proposed roperty improvement: YE&6, NO O 2HAVF04-, HAVE NOT E3 signed an application for a building permit for the proposed WG& I have contracted with the following person (firm) to provide the proposed eonstruetio®: 4 NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO. I plan to provide portions of this work, supervise, and provide the major work: N. -MME: ADDRESS: PHONE: but I have hired the following person to coordinate, CITY: 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: NAtiiE ADDRESS PHONE TYPE OF WORK NOTE: This Owner -Builder Verification is required by Section 19831 and 19831 oVde California Health and Safety Code. This verification must be tompkted and returned to our office before we are permitted to issue the permit OVER OWNER BUILDER INFOR1ti1ATION Dear Protea: 0w -;e7: 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 parry of mord 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. ♦ [f 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 tarty 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 In temal Revenue Service (and, if You wish, the G.S. Small Business Administration). For more specific information about your obligations under Sate Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the strucn:re is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1030 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. t rely, -'Mic el C. Vidim C.B.O. (vI ger, Building Inspection NOTE: This Owner -Builder Information is required by Section 19810 of rbe Calitornla Health and Sajery Cods OVER 11 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION A' 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541+��EER�.Mfr NO, (Rev. 12/96) APPLICATION AND PERMIT �` S ASSESSOR PARCEL NUMBER 0 ♦ — % ZONING BUILDING PERMIT OWNER j4Ti T TAM CT Tc T TELEPHONE LC Gtr SO. FT. OCC. BUILDING VALUATION EST oOWNERSHI A P AA T DVIO M QCQ1^ �� CONTRACTOR'S NAME .. - --- 4 " TELEPHONE M -I la CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace „A" 1.500. LENDER'S MAILING ADDRESS Total Valuation $ Z ori ARCHITECT OR ENGINEER LICENSE NO. Filing Fee � $ 20.00 Permit Fee $ Q ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 11891 LA PORTE RD. CLIPPER MILLS Energy Plan Checking Fee $ $ . PERMIT FEE $ 83.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE S001, Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 1 S Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel MUtilities ❑ Installation ❑ Other ❑ Describe Work: REPLACE 12 WINDOWS, REPLACE WOODSTOVE FLUE, REPLACE WATER PIPING Gas piping sy2tem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S G W @20.00 PERMIT FEE $ -45 ELECTRICAL PERMIT Fling Feel 20.00 V OR LES Main Service . ' 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: I, as owner of the property, or my employees with wages as their sole compensation, 140will 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 1000A 46.00 TOING NEW CONSTDWELLEIL . CUP. SO OCCU OR ADDNS. ( & ACC. BLDS. . Fr. NEW CONST. MULTI.OUTLET NOFFRESID. C @7.50 OWER APPARATUS b PSINGLE OUTLEr CIR. 20 Q 1.00 Ex. Occup. OUTLET OR FDRURES BAL @ ,50 Ex. Occup. Dflx"EEDD A REQS oF':, 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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.) Id 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—i I se provisions.. 111X� �� :� Date �' ��. %:�ignature,of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction1 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 I TOTAL FEE $ 11-8.00 HAI. D. FEES IMP I FLOOD I CDF I PARCEL I PD I HD ISSu This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. t / / �� r 01-n B y .( e. t /13J13Q /// Date &974- PERMIT EXPIRES ONt �efe Receipt No. tial �}�� WHITE -D. -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) 538-75.� E MIT NO. (Rev. 12/96) APPLICATION AND PERMIT c ASSESSOR PARCEL NUMBER 073- a ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION EST 1,800, OWNER'S i;U UNG ADDRESS - GA 9593A 6� CLIPPER MILLS CONTRACTOR'S NAME 9 TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace "All 1,500. 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 11891 LA PORTE RD. CLIPPER MILLS Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SFX"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 MXUtilities ❑ Installation ❑ Other ❑ Describe Work: REPLACE 12 WTN1)nWS..., RF.PT.AC'.F. WOODSTOVE FLUE, REPLACE WATER PIPING 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 Fee 20.00 FSSFling 500VMain 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.8 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: 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. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. Business and Professions Code for this reason Main Service TO 100A 46.00 NEW CONST. DWEL W:0 LING CUP. SO OR ADDNS. ( a ACC. Bins. 3.5QFT: NONNEW REOSI. MULTI.OUTLET 97,50 R A PSINGOUTLET OWELEPPARATUCIR.S Ex. OCCU . OUTLET OR FIXTUREs BAL @ 1.00 Ex. Occup.20 GunFrs RES1OfEUNSA 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 permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed 4 the permit is for work of a valuation of one hundred dollars ($100) or less.) 5( 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' compens tbn provisions of section 3700 of the Labor Code, I shall hwith fth se provisions. Date (/� nature Applicant - ❑ Owner ❑ Contractor ❑ Agent An O A permit is required for excavations over 60” deep and demolition or construction of ructures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FO= $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 12-00 HAZ. I D. FEES IMP I FLOOD COf pggCEL PO HD ISSU This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. ^. B Da e PERMIT EXPIRES O o2- I A-te) Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT O`VNER-BUILDER VERIFICATION Aaencion Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your sigtftpa+e• Please complete and return this information at your earliest opportunity to avoid unaaesett�idigr in processing and issuing your building permit. No building permit will be issued ua:il:this verification is received. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES 0 NO O I HAVEA, HAVE NOT C3 signed an application for a building permit for the proposed vm& ,. I have contracted with the following person vide the proposed ) p�Oconstrueda�: ADDRESS: //fib' �. �.-� �i crrY• PHONE:5 3i G 7S_ /" 4 COiNTRACTOR'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: I ADDRESS: PH0N-E: CITY: 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 S GNED: PROPERTYO DATE: NOTE: This Owner -Builder VerYlieation is required by Section 19831 and 19831 VFI%e California Health and Safety Code. This verification must be coMpleted mrd returned to our office before we are permitted to issue the permit [912 Of �