HomeMy WebLinkAbout073-390-032073-390-002 06-1363
MILLAR, WARREN
11984 LA PORTE RD, CLIPPER MILLS
Cont: OWNER
DEMO(PORTION OF HOME)
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OWNER -BUILDER VERIFICATION AUG 14 2006
DEVELOPA M +IVT
SERVICES
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 [ ✓] NO [ ].
2. I HAVE [ ] HAVE NOT [ �igned an application for a building permit for the proposed
work.
3. I have contracted with the following person/(firm) to provide the proposed cons 'on:
NAME: G'�/ Gt- (/l�e !'j l /l G> �/
ADDRESS: 1 q F L/ Z tiOv C v M 1 I S
PHONE: 6'30 & 7 S 2 3 a3 CONTRACTok, 9 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:
I
114
- I?S930
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 OWNER:
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.
Rev'd 11/4/2004
Butte County Department of Development S'er-vices
ADMINISTRATION `BUILDING' GIS `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 or 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 pern►it will not be issued until the verification is returned.
Sincerely,
Scott Rutherford
Chief Building Inspector
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
. 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.
BP061363
B. C. Building Permit 01-16-04 pg 1
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: 06/08/2006 APN: 073-390-002-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:
Site Address: 11984 LA PORTE RD CLP
Map Index:
Date: Contractor:
Description: DEMO PORTION OF HOME, REMOVE
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
KITCHEN, BR AND FRONT PORCH LEAVE
Contractors' State License Law for the following reason (Sec. 7031.5
-
Business and Professions Code: Any city or county which requires a
ORIGINAL HOME
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
Owner: MILLAR WARREN
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
1282 STABLER LN #630
she is exempt therefrom and the basis for the alleged exemption. Any
YUBA CITY, CA
violation of Section 7031.5 by any applicant for a permit subjects the
95993-2650
applicant to a civil penalty of not more than five hundred dollars ($500).):
1"s
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
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
Applicant: MILLAR WARREN
provided that such improvements are not intended or offered for
1282 STABLER LN #630
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
YUBA CITY, CA
proving that he or she did not build or improve for the purpose of
95993-2650
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
pursuant to the Contractors' State License Law.).
Contractor:
❑ I Exemptunder Article 3 of the Business and Profes ' ode
�a�m�
Owner:
Date:
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
License #:
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
Architect:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
�=• '
TotaiSquare Ft: 0 S. F.
Policy #:
I certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
Census Code:
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: o 6, 0
Applicant: f/V
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.
U
— CONSTRUCTION LENDING AGENCY — —
—This permit by.i ued u the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
Resolutio o k indicated ab 3e o`wt5ich.fees have been paid.
Name:
By: /Date:
Address:
PERMIT EXPIRES O v
Date
O 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 form or document of But ty. I hereby
authorize representativesof Butte County to enter Ton the above mentioned property for inspection purposes
v j 6/ /l
,
Print Name: �- / Signature:
1s
V G o ^D ("
Date:
❑ Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
B. C. Building Permit 01-16-04 pg 1
BUTTE COUNTY PEANUT
DEPARTMENT OF DEVELOPMENT SERVICES NO.
BUILDING PERMIT APPLICATION /� l
AND SUBMITTAL REQUIREMENTS
Vla
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 up
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICATION BIN h
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
0WjNER INFORMATION
Last Name / I/
irst Name Gj I/{�P ✓�
Address / P S ✓ p kU 30 Pti6 3aS
City V /
State
Zip g67Z�c✓3
Phone(f;3v 3
Fax
Email Wbv,j tiI/e-515cOJ76 t tit', vie
APPLICANT INFORMATION
CONTRACTOR
Name
Address S
Address
City Y� 1
City
State
State
Zip
Phone
Fax
Fax
E-mail
SMIP
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
Address S
Address
City Y� 1
City
State
State
Zip
Phone
Fax
Fax
E-mail
SMIP
State License Number
APPLICANT INFORMATION
Name
Zoning
Address S
✓ L� 4�30
City Y� 1
WORKER'S COMPENSATION
State
Z'p96 qy 3
Phon0 v 30% ��/ /
Map Book
Fax
E-mail
Planner
APPLICANT SI URE
X
For office use only:
AP# C)-73-390-00 --I-
Zoning
Ci y
e� , r pP,, /W 11
Flood Zone SRA I Yes No
Occ.
WORKER'S COMPENSATION
Type Const.
Subdivision Name
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
Map Book
Page
Lot #
Planner
SMIP
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PROJECT LOCATION
AP# C)-73-390-00 --I-
Property Address
1 19 S'� CA Pv ✓ e (Ca(
Ci y
e� , r pP,, /W 11
Cross Street
Bldg
WORKER'S COMPENSATION
Policy Number t1
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
pescripti9n or Scope of Work:
-e kvo // vl Li U old( a- li a re'q S
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 3
REV 8-12-05
R
y: Amount:
Bldg
SRA
Receipt #:
Sheriff
SMIP
Date:J_
l�
�' )
�p
Other
Total
Page 1 of 3
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 AIC 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 engineer.
❑ 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).
❑
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.
❑
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.
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.
C 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.
i
OVER FOR BUILDING PERMIT APPLICATION
' F
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 3 REV 8-12-05
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 theajor labor and material for construction of this proposed
property improvement: YES .K] NO [ ].
2. I HAVE HAVE NOT [ J signed an application for a building permit for the proposed
work-
3.
ork3. 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:
S. I will provide some of the work but I have contracted (hired) the following persons to provide
th&work indicated:
NAME ADDRESS PHONE. TYPE OF WORK
:7)aL► Yov�,ce—
SIGNED:
PROPERTY OWNER
DATE:
NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California
Health and Safety Code.
t
Butte County Department of Development Services �AJj
or�o
ADMINISTRATION `BUILDING `GIS `PLANNING /
o o
o o
7 County Center Drive o __.s�_-- `t o
Oroville, CA 95965 0
(530) 538-7541 Telephone C0U
(530) 538-2140 Facsimile
OWNER -BUILDER INFORMATION
Dear Property Owner.
An application for a building permit has been submitted in your name 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 or 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 subjed
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 insluance.
o For more specific information about your obligations under federal law, contact the Inteanal 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 owneis 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, Califoinia 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,
ScottRutherford4102!
Chief Building Inspector
...,--:—A I— C—+;-- t oQ zn of tl,o ('olifnrni7 APalth and Cafi-ty rndr_