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HomeMy WebLinkAbout078-210-001-3 6 -- 798I 3540-90E VANTONGEREN, Evelyn 5236 Farley St, Orovil-le Contr: Ames Company (repair elec sery/sf) i $36-3�6�99- PERMIT#95-2694 ' GEROY Heather 5236 Farley St. ;:Oroville Reroof/SF VAN TONGEREN, Lindsay G. 12$3-70$1 5236 Farley St., Oroville CONTR: Custom Exteriors Inc., 2523 Tesla Wj (:enclose garage door opening Sacrame�, & install vinyl siding & rock veneer) I elm& j 7R��ro.of 350-001 PERMIT#95-2694Y, Heather"Farley St., Oroville /SF COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 .County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASS�SSOFj PARCELNUMBER U;ib-35-0-001 ZONING BUILDING Pr MIT OWNER HEATHER GEROY TELEPHONE SO, FT, OCC. UILDING VALUATION OWNERS MAILING ADDRESS 5236 FAR17-Y ST OROVITIR CA 9 966 25 60 1500 CONTRACTOR'S NAME ()IV TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER NONE UNMOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ 35.M ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS PERMITFEE $ 55.E PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT No. SUBDIVISION'S NAME PARCEL MAP Solar Or heat pump water heater 23.00 USEOFSTRUCTURE SF Q Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK v New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: REROOF W/100,4P Mobile Home I S I G W @20.00 PERMITFEE S Contractor ELECTRICAL PERMIT Filina Fee 20.00 Main Service EOOV OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO wOOA ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: XI, 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 NEW CONST. DWELLING OCCUP. OR ADONS. ( d ACC. BLDS. ) SO. 3.5Q FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ,POWER ( POWER APPARATUS ) OUTLET CIR. Ex. Occup. (oust ET OR FIXTURES) 0 1.00 SAL L 50 Ex. Occup. OUTLEETS RES D.) EA ( ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor 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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. —y X Date Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee Is occ CONST. TYPE TOTAL FEE $ 55.00 HAZ. I D. FEES I IMP I FLOOD I CDF PARCEL I PID HD SSUE This permit is hereby issued under ttie applicable provisions of the Butte County Code and/or Resolutions to do work indicated -above for which fees have been paid. B; �/YI !`� l/;'�'r..( /Vt Date 10�25��5 PERMITEXPIRESON 1026/96 (Date) Receipt No. IU0234 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 (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 036-35-0-001 ZONING BUILDINGP MIT OWNER HEATHER GEROY TELEPHONE SO, Fr, OCC.UILDING VALUATION ?_5 60 1500 OWNERS MAILING ADDRESS 5236 r CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER NONE UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ 35.00 ARCHITECT OR ENGINEER TinNr LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER's MAILING ADDRESS Penalty $ BUILDING ADDRESS 9936 FARLEY ST- OROVITLE PERMITFEE $ 55,00 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF EX Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑' Other Describe Work: REROOF W/COI14P Mobile Home I S I G W @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filina Fee 20:00 Main Service000v OR LESS ( z00A OR LEss ) 23.00 Main Service ( 200A To 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 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 NEW CONST. OR ADONS. DWELLING OCCUP. ( a ACC. BUDS. ) so. 3.5¢ FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) a SINGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES) 00 20 @ -50 BAL .50 Ex. Occup. OUTLEEDTs (RESID.j ERA ( ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor 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 PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. nn // X� l/S —_ Date _ Signature of Applicant - ❑Owner ntractor ❑ Agent An OSHA permit is required for excavation 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 $ 55.00 , HA2. D. FEES IMP FLOOD CDF PARCEL PD HD ISSU This permit is hereby issued under the of the Butte County Code and/or indicat Bove for whi h fees h B PERMITEXPIRESON applicable provisions Re lutions to do work e en paid. Date 10/ 26/95 10/26/96 (Date) Receipt No. 136234 I WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay. in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed pro erty improvement: YESA NO[ ]. 2. I HAVE HAVE NOT[ ] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following personto coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide'the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: SOCIAL SECURITY NUMBER: DATE: /O— COM 9� NOTE: This owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER O.B.- I Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property improvements specified For your protection, you should be aware that as "owner -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 taw 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: 0 If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. 0 If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. 0 There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. 0 For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbuilder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by 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 1020 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. Sin,Gbreiv. r Michail C. Vieira, C.B.O. Manager, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. OVER >�{�1'7F't"T ' "c,,.�`'�'��`''�..}''`�ti�Y "-'S `' "°"��:�. .�:�.�`j+�'��•."� j+.f.X�`i•^av '�•.+r�t"C%r-y.�vJS-'� i •_'�'#- pq „^?*.,�y� '.�•:1•,l s/�.+';, +,tom i 36-35-01 3540-90E VANTONGEREN, Evelyn 5236 Farley St., Oroville Contr: Ames Company (repair elec sery/sf) It \ OFFICE COPY Address����c=�/ f fya GAS Meter By f _ Date ELECTRIC Meter By DatelL� ,'.sem I • i` toll ��a COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville,,CaliforNa 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT r.� ..•, �vr 'J PERMIT NO. ASSE$SO•R-PARCEL NUMBER 1 ZONING Rl BUILDING PERMIT OWNER TELEPHONE Eyev V eren SO. FT. OCC.1 BUILDING VALUATION OWNER'S AILING ADDR SS le St Oroville 95966 I CONTRACTOR'S NA E Q-) TELEPHONE 742-7212 CONTRACTOR'S MAIL NG ADDRESS 9 G St, Marysville Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS - Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 5236 Farlev St Oroville Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 SF [jj( Duplex❑ Mobilehome❑ Other Mobile Home S G W 10.0:0:e SPECIFY TYPE OF WORK New Addition Remodel❑ Utilities Installation❑ Other ❑ Permit Fee $ Describe work: REpair 100 amp service Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service SS too AMP OV OR R LESS 10.00 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I deCla under penalty of perjury (check one): I am licensed under provisions Of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect.SINGLE License NO. /o Gci�� Classification ❑ I, as the owner, or my employees with wages as their sole compen- NEW CONST. DWELLING oCCUP.&` OR ADONIS. ACC. BLDGS. I , 2/20sq ft NEW CONSTR. MULTI -OUTLET NON•RESID BRANCH CIRCTITS 2.50 ea POWER APPARAUS & OUTLET CIR. Ep OUTLETS TLETS OR FIXTURES Ex. Occup( 20 @ aaa eALO30 Ex. Occup. OUTLETS (RESID )REAJ 2.00 sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 15.00 ❑ I am exempt under Sec. , Business and Professions Code pre inspection 15.00 Permit Fee $ 50.00 for this reason WORKMEN'S COMPENSATION INSURANCE Contractor I declare under penalty of perjury (check one): MECHANICAL PERMIT FiIingFee 10.00 ❑ The permit is for $100.00 (valuation) or less. Heating ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling g Hood 3.00 I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit, shall be deemed revoked. Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information Mobile Home Installation Fee $ Energy Inspection Fee $ is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue OCC CONST TYPE TOTAL AL FEE $ 5 0 .00 0 HAz cuA PARK EE PAR PD HD against said County in consequence of the granting of this permit. /This %� �,1 Gi 1 ` t Its Date r - �% r ' fyy Signature of Applicant — Owner g pp ❑ Contractor ❑ Agent ❑ An"OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees r DIRECTOR OF PUBLIC r / r,• f ;/ BY PERMIT EXPIRES Datel the applicable provi- resolutions to do have been aid. n p WORKS Date - ,� Receipt No. 741')1 WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541' 747 Elliott Road, Paradise — Phone: 872-6307 CORRECTION NOTICE PERMIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Date 1 V ` /D �d I n s p e c t o &4 COUNTY OF BUTTE - DEPAP�TMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER ZONING , - R1 BUILDING PERMI OWNER epn TELEPHONE SO. FT. OCC. BUILDING V UATION OWNER'S AILING ADDR SS OrnVill 6 CONTR CTOR'S NA E TELEPHONE PLYNG 742-7212 CON TOR'S ADDRESS Fireplace CONSTRUCTION L NDER UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ a Penalty $ BUILDING ADDRESS Permit fee $ v'11e PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5,00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 SF a Duplex[] Mobilehome❑ Other Mobile Home S I G I W 10.O0e SPECIFY TYPE OF WORK New ❑ Addition ❑ Remodel ❑ UtilitiesH Installation❑ Other ❑ Permit Fee $ Describe work: REpair 100 amp Service _ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR1 OR LESS10.00 10.00 Main service EA. ADD'L too AMP 2.50 CONTRACTORS LICENSE LAW NEW CONST. DWELLING OCCUP.&) OR ADDNS. ACG. ,�2 Osq ft I declar under penalty of perjury (Check One): BLDGS. NEW CONSTR r ULT' -OUTLET I am licensed under provisions Of Chapt. 9, Div. 3 of the Business NON•RESID BRANCH CIRC ITS POWER APPARATUS &) 2.50 ea and Professions Code and my license is in full force and effect. SINGLE OUTLET CIR. ) License No. _I % f: �P/ Classification Ex. OCCU OUTLETS OR FIXTURES f 20@SO¢ BAL@30 ❑ I, as the owner, or my employees with wages as their sole compen- Ex. Occup. OUTLETS (RESID )REA.) 2.00 sation, will do the work,and the structure is not intended or offered Temporary service 10.00 for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- Mobile Home Facilities 15.00 ors. (Sec. 7044) Misc. Wiring 15.00 15,00 ❑ I am exempt under Sec. , Business and Professions Code pre inspection 15.00 for this reason Permit Fee $ 50,00 Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): MECHANICAL PERMIT Filing Fee 10.00 ❑ The permit is for $100.00 (valuation) or less. Heating ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. Cooling �l shall not employ any person in any manner so as to become subject Hood 3,00 to the W. C. laws of California. Ventilation Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such permit Fee $ provisions or this permit shall be deemed revoked. Contractor I certify that I have read this application and state that the above information Mobile Home Installation Fee $ is correct. I agree to comply to all County Ordinances and State Laws relating Energy Inspection Fee $ to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. :)Cc CONST TYPE I also agree to save, indemnify and keep harmless the County of Butte against TOTAL FEE $ 50.00 all liabilities, judgments, costs, and expenses which may in any way accrue HAZ I CUA PARK SCHL FLO PD HD ISs against said County i consequence of the granting of this permit. I JPAR XThis permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do Sign cure of Applicant — Owner [:1Contractor E]Agent El work in 'cated above for which fees have been paid. A OSHA permit is required for excavations over 5'0" deep and demolition or construct- DI T OF PU L WORKS ion of structures over 3 stories in height. Receipt No.74, 23 Date // /9,0 WHITE-O.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT PERMIT EXPIRES Date COUNTY OF BUTTE - DEPARTMENT 0*`1_IC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVI&E, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET �/1 Permit No. OWNER PvLa/vti, ' ©� l�f A. P No. 'S Proposed Building Use E -Cl I'— Building Inspector A. Date �� l At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted . .................................... 2. Plot plans in duplicate/triplicate, signed by preparer of plans ........ 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . ' 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form .......................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions....................................................... 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (constructi7n ap royal required prior to occupancy) 0. Pre -Inspection for C C r ► C--� required Pre-Inspec. request to Building Inspector 0 (Date) 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... 26. 27. When you issue the permit, process as follows: Mail to owner. ^ Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other Applicant Date�Q Copy of Haz-Mat corm sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By. The following data must be submitted prior to permit issuance: (Circle new item,not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone---jnail—counter by .date Contractor, designer, owner, was advised of above required data by—phone —ma II—counter by date Plans checked by Sets of plans on hold in Copy—DPW Date Plans approved by File cabinet AP folder Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS-'•~ PERMIT NO 7 County Center Drive - Oroville, ,California 95965 -Telephone: 9151:538-7541... APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 10�(; — rJ — ZONI BUILDING. PERMIT O NE,R D _ OL TELEPHONE SO. FT. OCC. BUILDING VALUATION r.LE R'S PAAI LI-NTs�AD RI -SS //// K 1 t r o v t �- CONTRACTOR'S N E TEL PHONE CONTRACTOR'S MAILINGDOR�ESS i �r S� - /�� i srrr,'// Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation S LENDER'S MAILING ADDRESS Filing Fee S 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS �/� �+ 5� /'Q Y ' l Permit tee $ ' PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5,00 Each qas water heater or vent 5,00 USE OF STRUCTURE SFDuplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W O.00e TYPE OF WORK New❑ Addition[] Remodel❑ Utilities Ins Ilation❑I Other ❑ Describe work: d i I � 'r, U � C Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600v OR LESS 100 AMP OR LESS 10.00 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑1 am licensed under p provisions of Cha t. 9, Div. 3 Of the Business and Professions -Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service EA. ADO'L 100 AMP 2.50 NEW CONST. r DWELLING occuP.e OR ADDNS. \ ACC. BLOGS. . I vrsgft NEW CONSTR. ULTI.OUTLET NON.RESIO BRANCH CIRC ITS 2.50 ea (POWER APPARATUS e1 l SINGLE OUTLET CIR. / Ex. OCcup�OUTLETS OR FIXTURES 20@SOt eAL030a Ex: Occup. OUTLETS FIXED PIRESID 1LNS REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring. 15.00 / & — yr S Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for S100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3,00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. 1 agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also also to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X- Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or constr;,ct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ ,%� HAZ CUA PARK I SCHL I Fn PAR Po I Ho I ISSUE Tn's permit is hereby issued unaer sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date Receipt No. 124 WNITE-O.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT PRE -INSPECTION-, OWNER: �vc- Vcl n _�d Y1 DATE /CV9 9 C Ci LOCATION: '56 "zca Vg0V (lF A.P. # c36 CONTRACTOR:. A&v7&1S c h'f 194'0 ZONING ---------------------------- ---- ---------------------- - - - ------ - ------------------- PRE -INSPECTION FOR: �p pCt ; Y' (6 CT �` i C_ �C� V` ✓ e� DATE TO INSPECTOR fD /Q (? PERMIT HISTORY: NONE AS FOLLOWS:pf - i. &4 a r - TYPE OF OCCUPANCY Z -0 ------------------------------------------------- FIELD - INFORMATION BUILDING USAGE: TENNANT: tj A/C r*lN I [� OCCUPIED D HAS ELECTRIC �GAS 'SANITATION FACILITIES E ATED-COOLED " PERSON CONTACTED OTHER COMMENTS: ACTION RECOMMENDED: ISSUE HOLD FOR OTHER: BY DATE ,moo