HomeMy WebLinkAbout078-190-009Elsie Lackey
5426 Walmer R . , (k'ovil le
Permit #4256- 6B(reroof/SF)
036,f8 -OM 02-2786
LACKEY, ELSIE
5426 WALMER RD., OROVILLE
RE -TAG GAS '& GAS WATER HTR.
'636-182 916- 05-282
LACKEY TRUSTEE, ELSIE
5426 WALMER RD, OROVILLE
Cont: OWNER ��1^
DECK
05-2823
LACKEY TRUSTEE, ELSIE
5426 WALMER RDN, OROVILLE
Cont: OWNER
RE ROOF
to -00
1f•
M.
E E Butte County Department of Development Services.. ouT>e,
N ® T S 7 County Center Drive, Oroville, CA 95965 . _
.
(530) 538-7601 v~.buttecounty netiddsOC�UN�y•
RESIDENTIAL
s APN: Permit No.
05-2824"
Owner: jj'036-182-016 1ELSIE 4 LACKEY TRU "
Site Address: 5426 WALMER RD,
Cont: OWNER-- - -- -- ----- --- - --�
Contractor. DECK c
I
-7,
i
. t
Type of Permit:-
i
{1� i
1415-4
t '
c,
r
a
CHECKED BY
SRA
FLOOD CERTIFICATE EQUIRED
FIRE SPRINKLERS REQUIRED
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
ENCROACHMENT PERMIT
REINSPECTION FEE PAID
ENV HLTH CLEARANCE
t-�
ty 9
1
.r
s
t
:DATE JOB FINALED:
SIGNATURE:
. .. A
= OK
0 = Not OK
MANUFACTURED HOMES
MISCELLANEOUS
DATE PERMANENT FOUNDATION SOFT -SET
DATE D E C K S*C O V E R S*C A R P O R T S *G A R A G E S
1 Zoning -Setbacks -Easements
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch
3 Sewer; Loctn-Test; Fall/C/O-Concrete
2 Ftgs; SoilsSz-Dpth-Spacing-CnnctrsSteel
3 Decks, Girders/Joists-Dcking-Brcing
4 Wtr; Loctn-Test-Easement Needed -Regulator
Stairs-Guard/Handrails
5 Elec Loctn-Clrncs-Grnd Amp -Concrete
6 Yard Gas; Loctn-Test-Wrap Nat O or LPO
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg
Frmg-Brcng
Inch Sz Ft Lngth
5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs
7 Blckng; Sz-Spacing-Marriage Line
6 Carports; Wndws-Doors
8 Gas; MH Test-Demand-Valve-Cnnctr
7 Electric'
9 Elec MH Cntnty Test-Crossovers-Breakers-Cirncs
8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses
10 Drain; MH Test -Fall -Flex Cnnctr. . 1
9 Siding; Nailing -Veneer -Stucco -Lath
11 Wtr & Sewer Connected -C/O to'Grade
10 Roof; Shthg-Roofing '
12 Gas and Electricity Tagged
13 Tie Downs O Foundation O
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
14 Exits
15 Cert of Occupancy
16 HUD Label/Insignia Numbers Serial Numbers
DATE IPOOLS
1
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
4 Elec Rcptcls/Lting; Distance-GFI
°,.� 0• °,,o o`er
5 Elec Pool Lting; 15 volts-GFI
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg
Bones-Enclsrs-pniboards-Insultn to Main Conduit
'
.9 Health Dept A ,
P PPrvI
10 Plmb; Cir Test-Wtr Supply Test
"11 Lt Niche
12 Enclsr, Fencing -Alarms
13 Bonding, Diving board or Slide
I
Pool Drawing ,
l
i
r
=OK
0=Not
RESIDENTIAL (Single & Duplex)
DATE JUNDERFLOOR
UAtt
IPLUMBING
1 Zoning-Setbacks-Easements-FloodSlope
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg Dpth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.
55 DWV; Test Fittings & Anchr Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
56 Shwr Pan; Test, First fir -Tub Acc
5 Stemwalls Main; Steel -BI ockouts-Wrapped
57 Test Tub & Shwr, 2nd fir - Tub.Acc
6 Stemwalls Garage; Steel-Blockouts-Wrapped•
58 Gas Pipe; Sz & Anchrs
6a Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Piping
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way C/O -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
1.1 Wtr Pipe; Test-Anchrs-Rgltr-Service Test
12 Elec Undrgrnd
DATE
IMECHANICAL
13 Plenums & Ducts; Cirnc-MaterialSupport4nsultn
61 AC Ducts lnsultn & Support
14 GirdersSills-Anchr BoltsJoists-Vnts-Cripples
62 Vent Fan, Exhaust abv Insultn
15 Acc & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16 Insulation
64 Furnace -Vent Acc-Comb Air RtrnIVent 115 Outlet
65 Attic Acc & Pltfrm if Furnace in attic
DATE IFRAMING
17 Sills Proper Materials & Anchrs
DATE
FINAL
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
66 Ext Steps -Door & SideLt Prtctn-Landings
19 Bearing Walls over Girders & fir Nailing
67 Smoke Detector
20 Draft Stop in Walls (rat proof)
68 Furnace Vnts-Clrnc-Comb, Air-Cnnctr
21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
In Garage; abv-flr-Ducts-Meth Prtctn
22 Headers & Beams-Sz & Bearing
69 Bedroom Exiting
23 Hangers -Post Caps-Anchrs-Cnnctns
70 GFI & Bath Fxtrs & Tub Acc-Spa
24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg
71 GFI Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clrnc
72 Elec Trim & Subpnl, Breaker Szs & Labels
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Clrnc-Hearth
28 Garage Fire Prtctn Framing -RC Channel
75 Elec Outlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall & Opngs
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Cirnc
30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits
77 Elec Outlets & Rcptcls at Ktchn Counter
31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn
78 Garage Fire Door; Swing -Landing -Closure
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Clmc-Com Air Cnnctr-PRV; abv ftr
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc
Mech Prtctn; LPG Appince Undr House 3' drain
35 Glazing Area -Glass Prtctn-SkyLts-Plastic
81 Plmb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnls
83 lnsultn-Foam-Looked in Attic
38 Insultn-Walls-Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiltration-Walls-Wndws
85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
86 Cirnc Drnge Planters ❑ Yes ❑ No
87 Stucco Brown -Finish
88 AC Unit Dscnnct, Elec-Plmb
89 Vnts abv Roof, Plmb-Appinc-Frplc-Cirnc to Opngs
DATE JELECTRICAL
90 Wtr Well, Dscnnct, Elec, Plmb
40 Fxtr & Trnsfrmr Clrnc4ns Prtctn
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92 Vntltn thru House
42 Sz Boxes & No Of Cndctrs Stapled
93 Glass Prtctn
43 Romex Installed Close to Edge of Studs & CJ
94 Corrections from previous Inspctns
44 Eqp Grnd made up w/Mech Fstnrs
95 Gas Test -Meters Tagged, Gas-Elec
45 Grndng Electrode Bond Gas & Wtr
96 Wtr & Sewer Cnnctd-C10 to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz ga ❑CU or ❑AL
98 Address Posted
AC Wire Sz ga ❑CU or F-1 AL
99 Fire Sprinkler
48 Range Circ ga ❑ CU or ❑AL
Oven Circ ga ❑ CU or ❑ AL
Insulated Neutral [::]Yes ❑ No
a`
441
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnis-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
f
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.
BPO52824
R R Rnnriinn PPrma n1.16-04 00 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 10/12/2005 APN: 036-182-016-000
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.
Site Address: 5426 WALMER RD ORO
License Class : License Number.
Map Index:
Date: Contractor:
Description: rebuild existing deck
OWNER -BUILDER DECLARATION
I hereby affirm under penally of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: LACKEY FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
LACKEY ELSIE ARCENA TRUSTEE
to its issuance, also requires the applicant for such permit to file a
4975 VIRGINIA AVE
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
OROVILLE, CA 95966
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
Applicant: LACKEY FAMILY TRUST
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
LACKEY ELSIE ARCENA TRUSTEE
owner of property who builds or improves thereon, and who does
4975 VIRGINIA AVE
such work himself or herself or through his or her own employees,
for
OROVILLE, CA 95966
provided that such improvements are not intended or offered
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.).
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
Contractor:
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' Slate License Law.).
❑ 1 am Exempt under Article 3 of usiness an fessi Code
l
Date: r7S Owner:
License #:
WORKERS' COMPENSATION D CLARATION
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
Architect:
Labor Code, for the performance of the work for which this permit
Engineer:
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Total Square Ft: 0 S. F.
Carrier:
Valuation: $0.00
Policy #:
Census Code:
0
I certify that in the performance of the work for which this permit is
�
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
I
WARNING: Failure tos cure 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.
CONSTRUCTION LENDING AGENCY
This permit is reby issued Dd r th plicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
for this is issued (Sec 3097 Civ.)B
Resolutio o do work i ed a ve fo hich fees have been paid.
i�
performance of the work which permit
y Date:
Name:
PERMIT EXPIRES ON: /[ �r 'Q4�
Address:
(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 o icial form or document of County. I hereby
uthorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
�%� e+" 2A �7
Print Name: `�JD"" Signature: -
_V
�� �� dJ
Dater
4wner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
R R Rnnriinn PPrma n1.16-04 00 1
r
`.
C036-182-01 t 05-282.3 OUiTt ��
k! �' LACKEY TRUSTEE,'ELSIE
N ® T {E S 5426 WALMER RD, OROVILLE " '•.
Cont: OWNER CSU Nty•
RE ROOF .
p78-/V-oo9
ADM: Permit No.
Owner:
Site Address:
Contractor.
Type of Permit: _
- t
V
r
Y
i
t
'r
r
SPECIAL CONDITIONS
CHECKED BY
Q SRA
Q FLOOD CERTIFICATE EQUIRED
Y
Q FIRE SPRINKLERS REQUIRED
SPECIAL INSPECTION ITEMS
VERIFY
Q USE PERMIT CONDITIONS
Q SUB -STANDARD HOUSING LETTER
Q ENCROACHMENT PERMIT
Q REINSPECTION FEE PAID
ENV HLTH CLEARANCE
0
Ac.
DATE JOB
01
FINALED: , V '
SIGNATURE:
= OK
0 = Not OK ;-,
MANUFACTURED HOMES
MISCELLANEOUS
DATE I Lj PERMANENT FOUNDATION Lj SOFT -SET
DATE D E C K S`C O V E R S`C A R P O R T S `GARAGE S
1 Zoning -Setbacks -Easements
1 Zoning -Setbacks -Easements
2 Soils; Special MH Support Sketch
2 Ftgs; Soils -Sz-Dpth-Spacing-CnnctrsSteeI
3 Sewer; Loctn-Test; Fall/C/O-Concrete
3 Decks, Girders/Joists-Dcking-Brcing
4 Wtr; Loctn-Test-Easement Needed -Regulator
Stairs-Guard/Handrails
5 Elec Loctn-Clrncs-Grnd Amp -Concrete
6 Yard Gas; Loctn-Test-Wrap Nat Q or LPO
4 Wood Awn; Posts-Beams-Rftrs-Cnnctrs-Shthg
Frmg-Brcng
Inch Sz Ft Lngth
5 Alum Awn; Columns'CnnctnsSplice-Decal-Ericlsrs
7 Blckng; Sz-Spacing-Marriage Line
6 Carports•, Wndws-Doors
8 Gas; MH Test-Demand-Valve-Cnnctr
7 Electric
9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs
8 Frmg; Sills-Anchrs-Studs-Rftrs-Trusses
10Drain; MH Test -Fall -Flex Cnnctr
9 Siding; Nailing-Veneer-,Stucco-Lath11
Wtr & Sewer Connected -C/O to Grade
10 Roof; Shthg-Roofing
12 Gas and Electricity Tagged
13 Tie Downs Q Foundation Q
11 Ext; Steps -Doors -Landings
12 Braced Wall pnls
14 Exits
15 Cert of Occupancy
16 HUD Label/Insignia Numbers Serial Numbers
mac` c`
DATE IPOOLS
1 Setbacks -Easements
2 Soils; Compaction -Structure Stability
3 Pool Structure; Steel-Cnnctns-Thickness
Dead Men -Lining
i
4 Elec Rcptcls/Lting; Distance-GFI
5 Elec Pool Lting; 15 volts-GFI
6 Elec Enclsrs; Conduit Entries -Terminals -Listed
7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr
8 Elec Grndng; Eqp w/5' Crcltng Eqp-Pool Ightg
Bones-Enclsrs-pnlboards-Insultn to Main Conduit
9 Health Dept Apprvl
10 Plmb; Cir Test-Wtr Supply Test
11 Lt Niche
12 Enclsr; Fencing -Alarms
`
13 Bonding, Diving board or Slide.
= OK
0 = Not OK
RESIDENTIAL (Single & Duplex) -
DATE JUNDERFLOOR
DATE PLUMBING
1 Zoning -Setbacks -Easements- FloodSlope
53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle
2 Ftg Main; Soils-Elec Grnd Ftg Dpth
54 Wtr Pipe; Test & Anchr-Nail Prtctn
3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth.
55 DWV; Test Fittings & Anchr Nail Prtctn
4 Ftg Porches/Decks; Soils -Steel Ftg Dpth
56 Shwr Pan; Test, First flr-Tub Acc
5 Stemwalls Main; Steel -Blackouts -Wrapped
57 Test Tub & Shwr, 2nd fir - Tub. Acc
6 Stemwalls Garage; Steel-Blockouts-Wrapped•
58 Gas Pipe; Sz & Anchrs
6a Hold Downs and Special Anchrs
59 Fire Sprinkler; Test
7 Slab, Steel Wrapped
60 Yard Gas Piping
8 Piers-Frplc Ftg-Steel
9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test
10 UF, Gas Pipe; Sz Anchrs-Sz Test
11 Wtr Pipe; Test-Anchrs-RgltrService Test
DATE IMECHANICAL
12 Elec Undrgrnd
61 AC Ducts Insultn & Support
13 Plenums & Ducts; Cirnc-MaterialSupport4nsultn
14 GirdersSills-Anchr Bolts -Joists -Vnts -Cripples
62 Vent Fan, Exhaust abv Insultn
_
15 Acc & Vntltn
63 Condensate Drain & Ovrflw, Sz & Grade
16 Insulation
64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet
65 Attic Acc & Pltfrm if Furnace in attic
v
Oaf PJS O°A 0\3' Ar
DATE IFRAMING
17 Sills Proper Materials & Anchrs
DATE IFINAL
66 Ext Steps -Door & SideLt Prtctn-Landings
18 Walls Studs -Nailing Spacing & Braces -Plates -Sound
19 Bearing Walls over Girders & fir Nailing
67 Smoke Detector
20 Draft Stop in Walls (rat proof)
68 Furnace Vnts-Cirnc-Comb, Air-Cnnctr
21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
In Garage; abv-flr-Ducts-Mech Prtctn
22 Headers & Beams-Sz & Bearing
69 Bedroom Exiting
23 Hangers -Post Caps-Anchrs-Cnnctns
70 GFI & Bath Fxtrs & Tub AccSpa
24 Ceiling Joist-Rftr Ties -Purl in -Roof Brac-TrussShthg
71 GFI Arc Fault
25 Frplc Ties or Type A Flue-Frplc Throat Clmc
72 Elec Trim & Subpnl, Breaker Szs & Labels
26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles
73 Stairs, Guard/Handrails
27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions
74 Frplc or Stove, Clrnc-Hearth
28 Garage Fire Prtctn Framing -RC Channel
75 Elec Outlets at Wood Pnl, Int & Ext
29 Prprty Line Firewall & Opngs
76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Cirnc
30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits
77 Elec Outlets & Rcptcls at Ktchn Counter
31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn
78 Garage Fire Door; Swing -Landing -Closure
32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs
79 AC Duct in Garage -Damper
33 Siding -Nailing Veneer
80 Wtr Htr; Vnts-Clmc-Com Air Cnnctr-PRV; abv fir
34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc
Mech Prtctn; LPG Appince Undr House 3" drain
35 Glazing Area -Glass Prtctn-SkyLts-Plastic
81 Plmb; Elec & Mech Eqp Listed for Loctn
36 Shear Walls; Nailing -Bolts
82 Elec Rcptcls in Garage (GFI) Romex Prtctn
37 Brace Int/Ext Wall pnls
83 Insultn-Foam-Looked in Attic
38 Insultn-Walls-Ceilings
84 Guard Rails & Deck Cnstrctn-Post Caps
39 Infiltration-Walls-Wndws
85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth
86 Cirnc Drnge Planters ❑Yes [:]No
87 Stucco Brown -Finish
88 AC Unit Dscnnct, Elec-Plmb
89 Vnts abv Roof, Plmb-Appinc-Frplc-Cirnc to Opngs
90 Wtr Well, Dscnnct, Elec, Plmb
91 Ext Elec Trim, GFI Rcptcl-Undrgrnd
DATE JELECTRICAL
40 Fxtr & Trnsfrmr Clrnc4ns Prtctn
41 Elec Rcptcls Spacing-Lts & Switches at Doors
92 Vntltn thru House
42 Sz Boxes & No Of Cndctrs Stapled
93 Glass Prtctn
43 Romex Installed Close to Edge of Studs & CJ
94 Corrections from previous Inspctns
44 Eqp Grnd made up w/Mech Fstnrs
95 Gas Test -Meters Tagged, Gas-Elec
45 Grndng Electrode Bond Gas & Wtr
96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl
46 2 Appinc Cires in Ktchn & Cndctr Sz GFI
97 Energy Cmpinc Cert -Other Certs
47 Subfeed Wire Sz ga ❑CU or ❑AL
98 Address Posted
AC Wire Sz ga ❑ CU or ❑ AL
99 Fire Sprinkler
48 Range Circ sa ❑CU or El AL
Oven Circ ga ❑ CU or ❑ AL
Insulated Neutral ❑ Yes ❑ No
o`' 0.\� a` 0\s
49 Service -Riser Cndctrs & Grnd Main Dscnnct
50 Eqp Clrncs pnls-Motors-Mech Eqp
51 Clothes Closet Lt-Shwr Lt -Spa Lt
52 Smoke Detector
4.
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.
BPO52823
H . .unn MP , 111 -1b -n4 nu 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 10/12/2005 APN: 036-182-016-000
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
I
the Business and Professions Code, and my license is in full force and
effect.
Site Address: 5426 WALMER RD ORO
License Class: License Number: '
Map Index:
Date: Contractor:
Description: re roof 18 squares
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Slate License Law for the following reason (Sec.. 7031.5
Business and Professions Code: Any city or county which requires a
. Owner: LACKEY FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
LACKEY ELSI E ARCENA TRUSTEE
to its issuance, also requires the applicant for such permit to rile a
signed statement that he or she Is licensed pursuant to the provisions of
4975 VIRGINIA AVE
the Contractor's Stale License Law (Chapter 9 commencing with Section
OROVILLE, CA 95966
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penally of not more than five hundred dollars ($500).):
,[d I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
Applicant: LACKEY FAMILY TRUST
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' Slate License Law does not apply to an
LACKEY ELSIE ARCENA TRUSTEE
owner of property who builds or improves thereon, and who does
4975 VIRGINIA AVE
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
OROVILLE, CA 95966
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.).
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
Contractor:
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.).
❑ I am Exempt under Article 3 of the iness a d Pr ss ons e
Date: Zo -1-7-05 Owner:
License #:
WORKERS' COMPENSATION DEC ARATION
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
Architect:
Labor Code, for the performance of the work for which this permit
Engineer:
is issued.
❑ 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Total Square Ft: 0 S. F.
Carrier.
Valuation: $0.00
Policy u:
Census Code: r
I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
I
compensation provisions of Section 3700 of the Labor Code, I shall
/� I
forthwith comply with those provisions.
Date:
Applicant:
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.
CONSTRUCTION LENDING AGENCY
This permit is her yissued under ap cable 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.)
Resolutions to o work pidii:a above or wh' fees have been paid. �!ll
BY Date:"�
Name:
PERMIT EXPIRES ON:
Address:
Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely 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.
Cl 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 (ficial form or d ument o to County. I hereby
authorize representatives of Butte Countytoenter upon the above mentioned property for inspection purposes
Print Name:�!� P� /�-1"''y' `— `� Signature:
Dater
owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
H . .unn MP , 111 -1b -n4 nu 1
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.
BP052824
Q r. Riiilrfinn Pcrmir n1-16-04 no 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 10/12/2005 APN: 036-182-016-000
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.
Site Address: 5426 WALMER RD ORO
License Class : License Number:
Map Index:
Date: Contractor:
Description: rebuild existing deck
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: LACKEY FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
LACKEY ELSIE ARCENA TRUSTEE
to its issuance, also requires the applicant for such permit to file a
4975 VIRGINIA AVE
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's Slate License Law (Chapter 9 commencing with Section
OROVILLE, CA 95966
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
1, as owner of the properly, or my employees with wages as their
sole compensation, will do the work, and the structure is not
Applicant: LACKEY FAMILY TRUST
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
LACKEY ELSIE ARCENA TRUSTEE
owner of property who builds or improves thereon, and who does
4975 VIRGINIA AVE
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
OROVILLE, CA 95966
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.).
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
Contractor:
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.).
❑ 1 am Exempt under Article 3 of usiness an fessi Code
Dater Owner:
License #:
WORKERS' COMPENSATION D CLARATION
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
Architect:
Labor Code, for the performance of the work for which this permit
Engineer:
is issued.
❑ 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Total Square Ft: 0 S. F.
Carrier:
Valuation: $0.00
Policy #:
Census Code:
I certify that in the performance of the work for which this permit is
—
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date: �� Z ^-� S�
0/
q
r 7
Applicant:
041—
I
WARNING: Failure to cure workers' compensation coverage is
I Q
unlawful, and shall subject an employer to criminal penalties and one
l
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.
CONSTRUCTION LENDING AGENCY
This permit is reby issued r th plicable provisions of the Butte County Code and/or
have been
I hereby affirm that there is a construction lending agency for the
the for which this is issued (Sec 3097 Civ.)
Resolutio o do work i ed a ve to hich fees paid.
performance of work permit
BY Date:
Name:
PERMIT EXPIRES ON:
Address:
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 o icial form or document of County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
2�7
Print Name: !%Z ��' Signature:
Date:
,downer ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
Q r. Riiilrfinn Pcrmir n1-16-04 no 1
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**
OWNER
Last Name—
l^
irst Name
r
Address -5-
4
City
Stat
Zip
Phone
Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
r.
Address
Zip
City
Fax
State
Zip
Phone
Page7
Fax
E-mail
Date Approved:
Lic. #
Class
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Page7
Fax
E-mail
Date Approved:
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
WjrFS
47-777
ENO
,
Fir r
For office use only:
Zoning
Properi
Flood Zone
SRA
Yes
No
Occ.
Type Const.
Subdivision Name
Map Book
Page7
Lot #
1
Planner
Date Approved:
PERMIT
NO.
BP 65-20 3
BIN #
LOCATION
AP# 0,2716—/ 9 2!—Or6
Properi
City
Cross Street
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:
Sq. Footage
❑ 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.
OVER FOR SUBMITTAL REQUIREMENTS L
KAFORMSWILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Received by:
l�
Receipt #: �� I
Date:
I� v
(:�60Amount: Bldg
SRA
Sheriff
SMIP
Other
Total
REV 6-16-04
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora 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 GRAPH PAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER!
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 engineer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 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 -sinned 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
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
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.
BP052823
R r. wmninn wprmit m-in-ua no i
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
Issued Date: 10/12/2005 APN: 036-182-016-000
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.
Site Address: 5426 WALMER RD ORO
License Class : License Number:
Map Index:
Date: Contractor:
Description: re roof 18 squares
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec.. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: LACKEY FAMILY TRUST
permit to construct, alter, improve, demolish, or repair any structure, prior
LACKEY ELSIE ARCENA TRUSTEE
to its issuance, also requires the applicant for such permit to file a
4975 VIRGINIA AVE
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
OROVILLE, CA 95966
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penally 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
Applicant: LACKEY FAMILY TRUST
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
LACKEY ELSIE ARCENA TRUSTEE
owner of property who builds or improves thereon, and who does
4975 VIRGINIA AVE
such work himself or herself or through his or her own employees,
intended for
OROVILLE, CA 95966
provided that such improvements are not or offered
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
Contractor:
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.).
ClI am Exempt under Article 3 of the iness a d Pr ssions e
Date: 4o- _0s Owner:
License #:
WORKERS' COMPENSATION DEC ARATION
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
Architect:
Labor Code, for the performance of the work for which this permit
Engineer:
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Total Square Ft: 0 S. F.
Carrier:
Valuation: $0.00
Policy #:
Census Code:
0
I certify that in the performance of the work for which this permit is
5
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
0(0forthwithh
comply with those provisions.
Date: v • G l%�
v� ` 1 �/(//J
Applicant:
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.
CONSTRUCTION LENDING AGENCY
This permit is her issued under ap ca le provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutions to o work i diCa above or wh' fees have been paid. / �l
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
B y Date
PERMIT EXPIRES ON:
Address:
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 fficial form or do ument o to County. I hereby
authorize representatives of Butte Countytoenter upon the above mentioned property for inspection purposes
Print Name: �% e� /� /` `7 Signature:
Date:
/Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
R r. wmninn wprmit m-in-ua no i
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 APPLICA TION
**PLEASE PRINT CLEARLY**
`�,
WE
Imo—/
For offic use only:
OWNER
Last Name
G i/
/C�
irst
Address
City
City
�
State
Zip
Phone
Fax
Fax
E -mai
Lic. #
`�,
WE
Imo—/
For offic use only:
CONTRACTOR
Name
= —S C
Address
SRA
City
Address
State
Fzip
Phone
� D G .
Fax
E-mail
E-mail
Lic. #
Class
`�,
WE
Imo—/
For offic use only:
ARCHITECT/ENGINEER
Name
Name
Address
SRA
City
Address
State
Zip
Phone
� D G .
Fax
E-mail
E-mail
State License Number
`�,
WE
Imo—/
For offic use only:
APPLICANT NAME
Name
Propert ddr
SRA
I Yes
Address
Occ.
Type Const.
City
Phone
� D G .
Statlid e
Fax
Zip
E-mail
Date Approved:
LENDING AGENCY
`�,
WE
Imo—/
For offic use only:
Zoning
Flood Zone
Propert ddr
SRA
I Yes
No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
W014,
.v
BIN #
D criptio r Scope f Wor
�6 O � �
Sq. Footage 1 �� E)
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has n6t 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.
OVER FOR SUBMITTAL REQUIREMENTS IL
KAFORMSWILDING F0RMS01dgApplSubRgmts.doc Page 1 of 2
Received by-� Amount:
H
Receipt_
2 �S
Date:
r�
Bldg
IV
SRA
Sheriff
SMIP
Total
REV 6-16-04
LOCATION
Propert ddr
Cross Street
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
D criptio r Scope f Wor
�6 O � �
Sq. Footage 1 �� E)
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has n6t 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.
OVER FOR SUBMITTAL REQUIREMENTS IL
KAFORMSWILDING F0RMS01dgApplSubRgmts.doc Page 1 of 2
Received by-� Amount:
H
Receipt_
2 �S
Date:
r�
Bldg
IV
SRA
Sheriff
SMIP
Total
REV 6-16-04
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply
fora 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 GRAPH PAPER!
❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER!
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.
o 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 engineer.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 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.
o 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) 53.8-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMSSUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04
A,OUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75oAl,,,�g T NO.
(Rev. 12/96) APPLICATION AND PERMIT �� JYj CP
ASSUSSO,i PAqR, U1.�8¢i6
JlO—J O
ZONING
BUILDING PERMIT
OWNERTELEPHONE
ELSIE LACT:FY
533-6538
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
5426 WAL E -R RD...OROVILLE, CA 95966
CON�TRRACCT�O7R'ST 7NAME
ULVC�N014LV
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 5426 WALMER RD. OROVILLE
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF E3 Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.0015.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other)7
Describe Work: RE -TAG GAS AND GAS WATER EATER
Gas piping sy2tem 1 - 5 outlets
15.0015.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE
$ 50,00
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service '*OA 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,
will do the work, and the structure is not intended or offered for sale.
i 1, 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. DW EWNG OCCUP.
OR ADDNS. ( 8 ACC. S.
SO
3.5¢Fr.
NON -R SID. MULTI.OUTLET
@7,50
POWER APPARATUS
8 SINGLE OUTLET CIA.
EX. OCCU OUTLET OR FDRURFS
20 ' .00
B@So
FUCED APPLNS. OR
EX. Occup.ouTLers RESID. E0.
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00
PERMIT FEE
$
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
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 #I`?se provisions.
/) ( }}�� �/
Date M — /•—%3a _
LXVnature of Applicant - Owner ❑ Con actor ❑ Agent
An OSHA permit 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 $ 50.00
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
I PD
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
`
By
PERMIT EXPIRES J 11)
the applicable provisions
Resolutions to do work
been paid.
O /•, �1�
Date / V
Date
Receipt No.
WHITE-O.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT N
(Rev. H2/96) APPLICATION AND PERMIT
ASSESSOR PARCELNUMBEA- 3G_
ZONING
BUILDINGPERMIT
OWNER
TELEPHONE
5
SO. FT. OCC. BUILDING VALUATION
_-
OWNER'S MARL; ADDRESS IVV, C/%
AS NAMETELEPHONE
Cot RACT/O'��
_ ` uj'y
-- --
CONTRACTORS MAILING ADORESS
CONSTRUCTION LENDER
Fireplace
-
LENDER'S MAIUNG ADDRESS
Total Valuation $
__
ARCHrrECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20 CC
Permit Fee
$-
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
s
_
BUILDING ADDRESS
Energy Plan Checking Fee
$
S
�ZJ (
PERMIT FEE
$
LOT NO. SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Feel 20.00
Each Trap
7.00,
USEOFSTRUCTURE
SF Duplex ❑ Mobilehome ❑ Other
sPECIFr
Solar or heat pump water heater
23.00r
Water piping
15.00
Each gas water heater or vent
1 5.00;
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other
Describe Work:�.O
Gas piping system 1 - 5 outlets
Building sewer
15.00
Mobile Home S G rN
@20.00
PERMIT FEE
$ 1 37-3
ELECTRICAL PERMIT
Fling Fee! 20.00
Main Service '.*."ARSS
23.00;
----.
*PEP AIT FEE PA10
n .R/1
SI
SHERIFF
0.T14M�
AAO* v*1T REceXWO
W46" NVAM n
TO In Pir on* compi
Main Service 200A TO 1000A 46.00;
NEW CONST. DWELLING OCCUP.
OR ADONS. ( & ACC. BIDS.
NEW CONST. MULTI.OUTLET
NON-RESID. CIRCUITS @7_SO;
POWER APPARATUS
8 SINGLE. OIJfIET CIR.
OUTLET OR FIXTURES
Ex. Occup.ant
20 (q 1.00
.so .
FIXED Ft' NS. OR 5.00
Ex. Occup. pUTLETS RESID. EA _
Temporary Service 23.00
Mobile Home Facilities 20.001
Misc. Wiring 23.00 —
I-
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating _--
Cooling
Hood 6.50 -
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee s ��
c
CONST. TYPEE
TOTAL FEES DC7
EOcS
HAZ.
I D. FEES I IMP
I FLOOD I GDF PARCEL I PD HD i 65_
This permit is hereby issued under the
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
applicable provisions
Resolutions to do wor'
been paid.
Date
Dere
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
r r PERMIT NO. 4256-76B
PERMIT EXPIRES
..
OWNER Elsie Lackey
t _ CONTR. wowner
LOCATION (A.P. 36-182-16 )
'5426 Walmer Rd., Oroville
Temp. Power Pole
1 Called PG&E
Temp. Elec. Serv.
ee Called PG&E
t emp. Gas Serv.
Called PG&E "
JOB
FINALED
(Date)
t (Sig if.1fu re)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING' BUILDING (Cont'd) PLUMBING
Setback Firewall
Soil Piping
Forms Parapets
1st Floor
Main Bldg. Restroom Finish
2nd Floor
Footings Windows -
3rd Floor
Stemwall Siding
To out
Slab Roof Sheathing
Water Piping
Piers Roofing //Z
Sewer
Garage Fdn. Vents
Fixtures
Footings Garage Vents
Stemwa I I Insulation
Water Htr.
Heaters
Slab Prov. for physically
handicaped
Carport Conformance of ex
Footin s structure
Appliances
Gas Piping &Test
Temp. Gas
Slab Final
Sanitation
Patio FIREPLACE
Final
Footings Footing V,
ELE
TRICAL
Masonry Walls Throat
Rough
Reinf. Steel Final
Fixtures
Bond Beam FIRh SPRINKLERS
Motors
Framing Test
Water Htr.
Stucco Final
Subpanels
Mesh ME HANICAL
Grd. Fault Prot.
Scratch Heating
Service
Brown Cooling
Temp. Pole
j
Finish Ducts
Underground
Interior Lath Ventilation
Permanent
Door Closer Final
Final
DA/TE REMARKS OR CORRECTI NS
i
f
(NOTE: An entry must be made on this form each time you visit the job site.)
t
JCOUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
aumurlce representatives or the county OT tsutte to enter upon the
above-mentioned property for inspection purposes.
x� , 0(- Iea Date
Signature of Permitee orAg�
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
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.
DIRECTOR PUBLIC WORKS
BY Date 7 —3 o— i
ilding permit expires Date — % 3 0— ? 7
BUILDING
Owner L Gx
�� �
�
SQ. FT. OCC. BUILDING V LUATION
Q
Mailing Address U, (24.
OAOV ( 11
T elrep hone No
Fireplace
Contractor
Total Valuation
Mai I i ng Address '
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
�L
Building Address �Y (j �� o2
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
t
OROi / .64 L
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
/ G
A. P. No.
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
I
Each additional outlet30
Fees
W.C.
sa^if�tir�^
Fire Dept. Fire Zone
Use Permit
Building sewer 5.00
EQA
ParkingI
Plans
Parcel
Declaration
Parcel Ma P
60' R/W
Improvements—
Lawn sprinkler system 2.00
f3k�g Fe]
nr 4held 4
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER RL
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 6001 OR LESS
100 AMP OR LESS 5.00
Main service EA. ADD•L 100 AMP 2.50
Single Family Z Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADD•L 100 AMP 1.00
NEW CONST. ( DWELING LCCUP. &\
OR ADONS. ACCBLDGS. / 20sgft
NEW CONSTR MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS) _ 2.50ea
_
'
NEW CONSTRPOWER APPARATUS
/&
NON-RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:Ex.
Ex. Occup(OUTLETS OR FIXTURES)@2-1
BALC�
Occup. FIXED APPLNS. OR
P'(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
19 1 am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance. •
®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 theWorkmen's Compensation Laws of
California. • '
'I
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
TOTAL PERMIT FEE
$
aumurlce representatives or the county OT tsutte to enter upon the
above-mentioned property for inspection purposes.
x� , 0(- Iea Date
Signature of Permitee orAg�
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
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.
DIRECTOR PUBLIC WORKS
BY Date 7 —3 o— i
ilding permit expires Date — % 3 0— ? 7