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HomeMy WebLinkAbout078-230-0049;6 569 904 05-0627 DAVIS, LEANOR 7 43 ROSITA WAY, OROVILLE SMITH, Jack C. 942-71B Cont: COMM ACTION AGENCY 870-71E WALL HTR 896-71P7 43 Rosita Way, Orovill x,7_9, Q p q OS -0625 ( convert garage to be om & ba' Q DAVIS, LEANOR u 43 ROSITA WY, OROVILLE r �3 O —,C)Q t Cont: COMM ACTION AGENCY Q WTR HTR j I is 04 M r r1 ft.7 MATES RESIDENTIAL PERMIT NO. x036-560-004 05-0628 1 DAVIS, LEANOR 43 ROSITA WYN, OROVILLE Cont: COMM AC'CION AGENCY WTR HTR 11 SPECIAL CONDITIONS 11 CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER • JOB FINALED (Date) ,)br Signature iiU I It L;UUN I Y DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FtKIVII 1 IVU. BP050628' B. C. Building Permit 01-16-04 pp 1 LICENSED CONTRACTORS DECLARATION I 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 Issued Date: 03/08/2005 APN: 036-560-004-000 effect. License Class License Number: Date: -3--'43 `�ntractor: Site Address: 43 ROSITA WAY ORO Map Index: OWNER-BtXCDER DECLARAT I hereby affirm under penalty or perjury that I am exempt from the Contractors' Slate License Law for the following reason (Sec. 7031.5 Description: water heater 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 Owner: DAVIS LEANOR JANE SS signed statement that he or she is licensed pursuant to the provisions of 43 ROSITA WAY 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 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 penally of not more than rive hundred dollars (8500).): ❑ 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 Applicant: COMMUNITY ACTION AGENCY OF BUTTE such work himself or herself or through his or her own employees, COUNTY INC. 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 2640 SOUTH 5TH AVENUE proving that he or she did not build or Improve for the purpose of OROVILLE CA 95965 sale.). , (530)538-7559 ❑ 1, 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.). Contractor: COMMUNITY ACTION AGENCY OF BUTTE ❑ 1 am Exempt under Article 3 of the Business and Professions Code COUNTY INC. Dale: owner: 2640 SOUTH 5TH AVENUE OROVILLE, CA 95965 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: (530)538-7559 Cl I 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 License #: 617201 / 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 Architect: insurance carrier and policy number are: Engineer: Carrier: 41-y A� Policy #: ❑ 1 certify that in the performance of the work for which this permit Is Total Square Ft: 0 S. F. issued, I shall not employ any person in any manner so as to Valuation: $0.00 become subject to the workers' compensation laws of California, and agree that if 1 should become subject to the workers' Census Code: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure lo* secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars (8100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the LaborI�� code, interest, and attorney's fees. Il CONSTRUCTION LENDING AGENCY This permit is hereblv Issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolulidns ork Ind l sled above for %yMch fees have been paid. t - performance of the work for which this permit is Issued (Sec 3097 Civ.) -. Name: By: Date PERMIT EXPIRES 0 : 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. ❑ 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. 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.- urposes:Print PrintName: 2 Signature: � T Date: J 0 Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pp 1 J=OK 0 = Not OK . = NotReadyable DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location -Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L 'ft. / P Nat. or/ /" L "ft./ P LPG 7. Well Clearance & Disconnect 8. Utility Clearance 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date 12. Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s Card B-1 Date Card B-1 1. Zoning Requirements -Setbacks -Easements Card B-1 Date Card B-1 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche Date 12. Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) Card B-1 Date Card B-1 1. Zoning Requirements -Setbacks -Easements Card B-1 Date Card B-1 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water; MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams-Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining. 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes -Enclosures- Panel boards- Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /' Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth 5. Stemwalls, Main; Steel- Blockouts-Wrapped 6. Stemwalls, Garage; Steel- Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation Insulation -Walls -Ceilings 16. Insulation 63. Infiltration -Wal Is -Windows Date Date Card B-1 Date Card B-1 Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 64. 17. Water Htr.; Vent -Access -Combustion Air Baffle 65. 18. Water Pipe; Test & Anchor -Nail Protection 66. 19. D.W.V.; Test Fittings & Anchor -Nail Protection 67. 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access G.F.I. & Bath Fixtures & Tub Access -Spa 22. Gas Pipe; Sixe & Anchors Elec. Trim & Subpanel, Breaker Sizes & Labels 23. Fire Sprinkler; Test Stairs & Rails 71. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 74. 24. Fixture & Transformer Clearance -Ins. Protection 75. 25. Elec. Receptacles Spacing -Lights & Switches at Doors 76. 26. Size Boxes & No. of Conductors Stapled 77. 27. Romex Installed Close to Edge of Studs & C.J. 78. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 79. 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or At Insulated Neutral O Yes 0 No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. _ 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector 85. A.C. Unit Disconnect, Electrical -Plumbing Date 86. Card B-1 Date Card B-1 Date 87. Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Exterior Elec. Trim, G.F.I. Receptacle -Underground 36. A.C. Ducts Insulation & Support Ventilation Throughout House 37. Vent Fan, Exhaust above insulation Glass Protection 38. Condensate Drain & Overflow, Size & Grade Corrections from Previous Inspections 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet Gas Test -Meters Tagged, Gas -Electric 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 96. 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Wal Is -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes _ 83. Following Instld./Drive 0 Yes 0 No/Walks 0 Yes O No/Planters 0 Yes 0 No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: UU I It l:UUN I Y 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 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. �O / License Class : license Number: Dale: Contractor 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 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 State 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' State License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Dale: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 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 ❑ 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 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:Wg4 1si. Applicant: v `Te/ 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 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.) HtKIV111 IVU. BP050627 Issued Date: 03/08/2005 APN: 036-560-004-000 Site Address: 43 ROSITA WAY ORO Map Index: Description: WALL HEATER Owner: DAVIS LEANOR JANE SS 43 ROSITA WAY OROVILLE, CA 95966 Applicant: COMMUNITY ACTION AGENCY OF BUTTE COUNTY INC. 2640 SOUTH 5TH AVENUE OROVILLE, CA 95965 (530)538-7559 Contractor: COMMUNITY ACTION AGENCY OF BUTTE COUNTY INC. 2640 SOUTH 5TH AVENUE OROVILLE, CA 95965 (530)538-7559 License #: 617201 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: This permit Is hereby 1; Resolulip$sifo do work PERMIT EXPIRES applicable provisions of the Butte County Cope and/or )for grachffees have been paid. / Address: - L /(Dafelf Cl I 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. I acknowledge it Is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of ulte County to enter upon the above mentioned properly for inspection purposes. - Print Name: Signature: Date: �. © Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04. pg 1 BUTTE COUNTY �����0 DEPARTMENT OF DEVELOPMENT SERVICES \\I 0 BUILDING PERMIT APPLICATION o AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 0 OFFICE ll: (530) 538-7541 - A FEE WILL BE REQUIRED AT TIME OFAPPLICATION 00 Website: www.buttecounty.net/dds ""PLEASE PRINT CLEARLY* APPLICANT NAME OWNER Last Name Name irst Nam Zip City ea Address 3 R Address 5" � y t- -7a -City J State ip _ © O ( C _5 Phone Fax E-mail APPLICANT NAME CONTRACTOR Name Name Address Zip City Fax State Address 5" � y Page City E-mail State Zip Phone _. Fax E-mail Lic. # 1 Class L `_ 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 Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Property Address R q3 1 Flood Zone Cross Street SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL KI=UU1KtIVttN t s K �Fnannc�Ri in nimr. FnRMS�RIdaAonlSubRamts.doc PERMIT TT BIN # LOCATION AP# 3 -S :0Yem Property Address R q3 1 City c ovw Cross Street WORKER'S COMPENSATION Policy Number d t' 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 required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Page 1 of 2 bF7,,�_ Received by: Amount: Bldg SRA Receipt #: Sheriff SMIP 0 Date:3 Other Total REV 2-24-05 UU I It L;UUIV I Y 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 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. Y License Class : � License Number: Date: 3-'8--4*--litinlractor: OWNER-BIJIMER DECLARATImN— 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 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 State 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 penally of not more than five hundred dollars (8500).): ❑ 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' State License Law does not apply to an owner of properly 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 the Business and Professions Code Dale: Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 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. ,Ifi 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: Carrier: Policy #: ❑ 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 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, 1 shall forthwith comply with those provisions. Dale: Applicant: FtKIVll I IVU. BPO50628 Issued Date: 03/08/2005 APN: 036-560-004-000 Site Address: 43 R08 -ITA WAY ORO Map Index: Description: water heater Owner: DAVIS LEANOR JANE SS 43 ROSITA WAY OROVILLE, CA 95966 Applicant: COMMUNITY ACTION AGENCY OF BUTTE COUNTY INC. 2640 SOUTH 5TH AVENUE OROVILLE, CA 95965 (530)538-7559 Contractor: COMMUNITY ACTION AGENCY OF BUTTE COUNTY INC. 2640 SOUTH 5TH AVENUE OROVILLE, CA 95965 (530)538-7559 License #: 617201 Architect: Engineer:. Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars (8100,000), In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor -)� code, interest, and attorney's fees.1 4 �/✓-1 CONSTRUCTION LENDING AGENCY This permit ls.herebv Issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutild s t ork Ind led above for WNch fees have been paid. performance of the work for which this permit is Issued (Sec 3097 C[v.) 3 ` Name: Bv: jDate. PERMIT EXPIRES O �U Address: _ (Dalel O 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the:st:.:irage, 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. O 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 tc comply with all county and slate laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. L hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: —J4!1 ��� "/0 —r�Q 6t_2,-) Signature: sj © Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for CDRractof B. C. Building Permit 01-16-04 pq 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 If: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER Last Name irst Name City L a Address 3 f Address City Q O State C i Phone Fax E-mail APPLICANT NAME CONTRACTOR Name City Address Zip Address 5 <!)'r(n Cityf Zip State Zip Fax E-mail State License Number Phone_ Fax ?— E-mail Lic. # 1 Clads APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Planner Fax E-mail State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Flood Zone SRA I Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\B1dgApp1SubRgmts.doc PERMIT NO. BP. Cl,?8 BIN # LOCATION AP# 3 - 56 O�dm Property Address R CityMO�, Cross Street WORKER'S COMPENSATION Policy Number d r' 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 Page 1 of 2 on or Scope of Work: Sq. Footage LJ Structure Built without Permits O 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 b . Amount: V Bldg SRA Receipt #: Sheriff SMIP Date) j�� Other l� Total REV 2-24-05 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non-Residential'Build'ings. ❑ . 6. Manufactured homes: (A) 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). 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. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538-7541. 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 2-24-05