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HomeMy WebLinkAbout078-210-002 BUTTE COUNTY DEVELOPMENT SERVICES COMPLAINT FORM This information is not available to the public!!! ► ! ! r DO NOT COPY FOR THE PUBLIC OR THE FIELD INSPECTOR!! The following information is required for Housing Complaints and the. Complainant MUST. BE the person living at, the complaint address! Complainant: Address: Phone Number: The above information is not available to the public!!!?..?'..? (2) K\FORMS\CompWnl Form mvl.doc 6 1 �� BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that 1 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 : License Number: Date: Contractor: 'OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractors' Stale License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior 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 the Contractor's Stale License Law (Chapter 9 commencing with Section 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 Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' Stale 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, provided that such Improvements are not Intended or offered for 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.). ' tk I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' Slate License Law does not apply to an owner of property who builds or Improves thereon, and who contracls.for such projects with a contractor(s) licensed pursuant to the Contractors' Stale License Law.). ❑ 1 am Exempt under Article 3 of the Busine d Professions Code Dale: i 05 Owner{ le�"� WORKERS' COMPENSATION DECLARATION I hereby affirm under penally 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 the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation insurance carrier and policy number are: Policy #: L 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 fort w' comply with those provisions. Date: Applicant: WARNING: Fallure 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 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.) Address: PERMIT NO. BPO50867 Issued Date: 04/05/2005 APN: 036-350-002-000 Site Address: 5254 FARLEY ST ORO Map Index: Description: new roof mount pkg unit Owner: LAUGHLIN, CHARLES 5254 FARLEY ST. OROVILLE, CA. 95966 Applicant: LAUGHLIN, CHARLES 5254 FARLEY ST. OROVILLE, CA. 95966 Contractor: DE AIR COMPANY 2710 E FEATHER RIVER BLVD OROVILLE, CA 95965 530-534-8691 License #: 478347 Architect: Engineer: Total Square Ft: Valuation: Census Code: owr This perm' s hereby Resolutighs to do vg PERMIT EXPIRES ON: 0 S. F. $0.00 y ,6 provisions of the Butte County Code and/or fees have been paid. Date: ❑ 1 hereby certify that the use of•lhis facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification In accordance with Section 19627.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I her certify that I have read this application, that lhe'above information Is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it Is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes) Prihl Name'C./A1 Signature: Dale: 11%;jOwner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.netldds "PLEASE PRINT CLEARLY" OWNER Last Namef t -AU CM wa i Name � s Address Ls,,, Fut C-� City Stu g Stateo Zip G .5prr (,( Phone 53�3�_$�Z—� Fax E-mail APPLICANT NAME CONTRACTOR Name Al2 Address Zip City Fax State Zip Phone Page Fax E-mail Date Approved: Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Page Fax E mail Date Approved: State License Number APPLICANT NAME Name arJ Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Prope�Addre� ,�� 5l �'� Flood Zone SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: PERMIT NO. BP 0 BIN # LOCATION Prope�Addre� ,�� 5l �'� City Cross Street t 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: /N &'AZL /✓L,,,V %'4 &j Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 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. Receyed by: (161-2 Receipt #: CA \4�� Amount: �� Bldg Date: N16 Total REV 7-27-04 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. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) .Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (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-siqned 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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538.7541. EXPIRATION OF APPLICATION 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. 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. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 LICENSED CONTRACTORS DECLARATION 1 hereby affirm under penally 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: License Number: Date: Contractor: 'OWNER -BUILDER DECLARATION I hereby affirm under penally 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 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 the Contractor's Slate License Law (Chapter 9 commencing with Section 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 Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' Slate 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, provided that such Improvements are not Intended or offered for 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 and Professions Code. The Contractors' Slate 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.). O 1 am Exempt under Article 3 of the Buqjn!!!T�,to Professions Code Dale: $ Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penally 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 the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy #: 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 lh se provisions. Dale: �SIDrj Applicant: WARNING: Fallure 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 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Sec 3097 Civ.) PERMIT NO. BPO50868 Issued Date: 04/05/2005 APN: 036-350-002-000 Site Address: 5254 FARLEY ST ORO Map Index: Description: re roof 12 sq Owner: LAUGHLIN, CHARLES 5254 FARLEY ST OROVILLE, CA 95966 Applicant: LAUGHLIN, CHARLES 5254 FARLEY ST OROVILLE, CA 95966 Contractor: License #: Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: y2�sz y_s-off I hereb steed y6der the ap icab provisions of the Butte County Code and/or to do ork Indlofited ab ov or vy ees have been paid. -� % Date: / ` 5 p �IAF3 nN- C'.� \ t� K Address: (Dale ❑ 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 stale laws relating to building construction. 1 acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purpo�»_�_ Prih1 Name: n X21-9_5 9AUr1JSignature Dale: Owner ❑ Contractor ❑ Agent for -Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pp 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 APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last Name irst Name Address City Slate Zip q�� Phone0 5� _ �Z-� Fax E-mail CONTRACTOR Name Km uOa�b Address Address City City State Zip Phone Phone Fax E-mail E-mail Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone T70t # Fax E-mail State License Number APPLICANT NAME Name CSW Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Property_Ad �e� s � — Flood Zone Cross Street SRA I Yes No Occ. IType Const. Subdivision Name Map Book Page T70t # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 0 PERMIT NO. BPD j BIN # LOCATION AP# 0�6­ 6d Property_Ad �e� s � — � City Cross Street 2 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: cp 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. f Received bAmount: ye 01 fid �/j Bldg SRA Receipt #: l� Date: b� Sheriff SMIP Other Total 2 REV 7-27-04 a 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. (Note: Not required for additions to mobile or modular homes.) ❑ 5. • Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION 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. 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. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 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. 16 B. C. Building Permit 01-16-04 pp 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: 02/24/2005 APN: 036-350-002-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 5254 FARLEY ST ORO Date: Contractor: Map Index: . Description: remodel home 500 sf OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 permit to construct, alter,improve,demolish, or repair any structure, prior Owner: LAUGHLIN, CHARLES AND LORI ANN 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 the Contractors State License Law (Chapter 9 commencing with Section 5254 FARLEY ST 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA. she is exempt therefrom and the basis for the alleged exemption. Any 95966 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).): 14 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 Applicant: LAUGHLIN, CHARLES AND LORI ANN such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one 5254 FARLEY ST year of completion, the owner -builder will have the burden of OROVILLE, CA. proving that he or she did not build or improve for the purpose of 95966 sale.). Q� 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 am Exempt under Article 3 of the Bus�pefis ar�d Professions Code Peds- /G/ -2.4 -OS «f's�J Date: Owner. WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation Engineer: insurance carrier and policy number are: Carrier: otal Square Ft: 0 S. F. Policy #: I certify that in the performance of the work for which this permit is issued, I shall not employ any in any manner so as to Valuation: $0.00 person become subject to the workers' compensation laws of California, Census Code: 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: -�`t'Q� �' �7 � G Applicant: 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 I/ compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the This permit i ereby issue der t applicable provisions of the Butte County Code and/or Resolution to do work in Gated a ve for Viffich fees have been paid. c (% performance of the work for which this permit is issued (Sec 3097 Civ.) /2� L .-2 Date: Name: By: `/~ G v Address: PERMI EXPIRES ON: 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 official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: 0AW1E 5 L_Au�r AL(N Signature: Date: Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pp 1 N° �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 APPLICATION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER Last Name NLI n) first NameCNAI�s Address 52 54 Vim, S� City Stated Zip Ct59W Phone 530.5 3 Z- $ Zy Fax E-mail LJail4llUn� O CtT-►of CQ J I L ., OR(;� APPLICANT NAME CONTRACTOR Name owe CityState oapv>.t� Address %cl Fp City Fax State Zip Phone Lot # Fax E-mail Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name CityState oapv>.t� Address %cl Fp City Fax State Zip Phone Lot # Fax E-mail State License Number APPLICANT NAME Name Address rJZS'� CityState oapv>.t� C4 %cl Fp Phone 5-�-Z-� Fax E-mail UwctauNc.@ C11 -t (T�- oaZrJlue. oe /��j APPLICANT SIGNATURE X (lam- �� For office use only: Zoning Property Address SZSy �T Flood Zone I SRA t Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BPOOV6 BIN # LOCATION AP# 03 c -2.50-t0 Z Property Address SZSy �T City D2ovlllP Cross Street r -fes �s -YLUM�yS 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: pe�y"o1ML2 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 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. Received by: Amount: �' 57 7 Bldg C C.�j SRA Receipt #:� t f Sheriff 1 `�`� SUP vilit Date: il 2t_ j 10� 1 14 I I Total I Page 1 of 2 REV 7-27-04 1 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. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for.Non-heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. . ❑ 7. Metal bldgs: (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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION 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. 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. OVER FOR BUILDING PERMIT APPLICATION KIFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 •.c_ ar'j. ,:' N Sw:g9` ._�i J">,d�`vx`d' r•c[ r._.:..."•Y.v'4+r`' `� _ -111 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 [>4 ] NO [ ]. 2. I HAVE [X] 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: 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: 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: 21 2y l 0-5, 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 11/42004 Butte County' Department of Development Services ADMINISTRATION ° BUILDING t GIS' PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538.2140 Facsimile S=r.%'F,.�-'�s'...T�.s.'�.�'`�?..z ''?'=...R :�'�it`-'.2:�h y'ys?•7%`.'.r,Y".+slfc2t7'.��.'..'-'.0';�?i�«::-�ta�i';v�..+r:< 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 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 contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by 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 permit will not be issued until the verification is returned. Micyael C. Vieirl C.B.O. Mailager, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. . IAC RECORDING REQUESTED BY Mid Valley Title & Escrow Company AND WHEN RECORDED MAIL TO: Charles and Lori Laughlin 5254 FARLEY STREET OROVILLE, CA 95966 A. P. N .: 036-350-002-000 ZeGDGD4—GD0-74Gr4I► Recorded Official Records County Of BUTi E CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 02:00PM 03 -Dec -2004 REC FEE 10.00 Kathy Rage 1 of 2 Space Above This Line for Recorder's Use Only GRANT DEED File No.: 0403-1669267 (MM) The Undersigned Grantor(s) Declare(s): DOCUMENTARY TRANSFER TAX $ CITY TRANSFER TAX $0.00; SURVEY MONUMENT FEE$ BONA FIDE GIFT 11911 BONA FIDE GIFT X computed on the consideration or full value of property conveyed, OR computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, X unincorporated area; [ ] City of , and Exempt from transfer tax; Reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Charles W. Laughlin, a married man hereby GRANT(s) to Charles W. Laughlin and Lori Ann Laughlin, husband and wife, as Joint Tenants the following described property in the unincorporated area of , County of Butte, State of California: LOT 16, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "MAP OF OAKDALE HEIGHTS UNIT NO. 2", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON MAY 19, 1955, IN BOOK 21 OF MAPS, AT PAGE(S) 36 AND 37. Dated: 11/30/2004 Mail Tax Statements To: SAME AS ABOVE A.P.N.: 036-350-002-000 Charles W. Laughlin STATE OF CALIFORNIA )SS COUNTY BUTTE ) OF Grant Deed - continued File No.: 0403- 1669267 (MM) Date: 11/30/2004 On NOVEMBER 30, 2004, before me, MARY A. THOMPSON, NOTARY personally appeared CHARLES W. LAUGHLIN personally kiiown to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature My Commission Notary Name: Page 2 of 2 This area for official notarial seal MARY A. THOMPSON a Commission #1351470 n U Notary Public - California � Butte County � Notary Phone: My Comm. Exp. APR. 15, 2006 Notary Registration Number: County of Principal Place of Business: k5. :t4d i:. RECORDING REQUESTED BY Mid Valley Title & Escrow Company AND WHEN RECORDED MAIL TO: Charles W. Laughlin 5254 Farley Street ' Oroville, CA 95966 A. P. N .: 036-350-002-000 2 IZI jZ1 z+ — ep 017 4.01 Recorded I REC FEE 13.00 Official Records I County Of BUTTE CANDACE J. GRUBBS I Recorder I ROSEMARY DICKSON I Assistant I Kathy 02:OONM 03 -Dec -2004 I Page 1 of 3 Space Above This Line for Recorder's Use Only File No.: 0403-1669267 (MM) INTERSPOUSAL TRANSFER GRANT DEED (Excluded from Reappraisal under California Constitution Article 13A ❑ 1 et seq.) The Undersigned Grantor(s) declare(s): DOCUMENTARY TRANSFER TAX $; CITY TRANSFER TAX $; This conveyance is EXEMPT from the imposition of the Documentary Transfer Tax pursuant to ❑ 11927(a) of the Revenue and Taxation Code and transfers community, quasi -community, or quasi -marital property assets between spouses for the purpose of effecting a division of community, quasi -community, or quasi -marital t decreeing a dissolution of the marriage or legal separation, by a property which is required by a judgmen judgment of nullity, or by any other judgment ororderrendered of purluant to the Family judgment or order.Code, or by a written agreement between the spouses, executed incontemplation f the This is an Interspousal Transfer and not achange in p as aetransfernto a 63 ospouse eo rformers pousel�n Code, and transfer by Grantor(s) Is excluded from reappraisal connection with a property settlement agreement or decree of dissolution of a marriage or legal separation. FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Lori Ann Laughlin, spouse of the grantee herein hereby GRANTS to Charles W.. Laughlin, a married man as his sole and separate property the following described property in the unincorporated area of , County of Butte, State of California: Attached hereto as Exhibit A. It is the express intent of the Grantor, being the spouse of the Grantee, to convey all right tale and interest of the Grantor, community or otherwise, in and to the herein described property Grantee as his/her sole and separate property. Dated: 11 30 2004 Lori Ann Laughli Mail Tax Statments To: SAME AS ABOVE ----------------------------------------- A.P.N.: 036-350-002-000 File No.: 0403-1669267 (MM) STATE OF CALIFORNIA } } ss. COUNTY OF BUTTE } On NOVEMBER 30, 2004 before me, MARY A. THOMPSON . NOTARY ,personally appeared LORI ANN LAUGHLIN personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. This area for official MARY A. THOMPSON ,.:::: notarial seal Commission #1351470 `i n EL Notary Public - California � Sign re v Butte County t 1 My Comm. Exp. APR. 15, 2006 My Corrfr9fssion Expires: Notary Name: Notary Phone: Notary Registration Number: County of Principal Place of Business: Page 2 A.P.N.: 036-350-002-000 File No.: 0403-1669267 (MM) EXHIBIT A LOT 16, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "MAP OF OAKDALE HEIGHTS UNIT NO. 2", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON MAY 19, 1955, IN BOOK 21 OF MAPS, AT PAGE(S) 36 AND 37.