HomeMy WebLinkAbout078-280-065A.P.#03v-G24--e
USE PERMIT #97-10
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HOLY -TEMPLET
4290 V C Road, Oroville
Cow: Owner
4291
addition to church
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HOLYTEMPLEV
4290 V C RD., OROVILLE
CONTR: THOMAS FARH ELL p
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RESIDENTIAL
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036-021-049 01 -OM -2 -
HOLY TEMPLE .
4290 V C RD., OROVILLE
CONTR: THOMAS FARNELL
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY
Address
CHECKED
BY
GAS Date -
Meter By
ELECTRIC
Meter By
k
JOB FINALED (Date)
il Signature
= OK
0 = Not OK
- = Not Applicable
* = Not Ready
i ' ` C)
MOBILE HOMES
Date
MOBILE HOME. UTILITIES (Plans) OK except #'s
Date
1.
Zoning Requirements -Setbacks -Easements
Card B-1
2.
Soils; Special•MH Support Sketch
Date
3.
Sewer; Location -Test -Fall -C/O -Concrete
9.
4.
Water; Location -Test -Easement Needed (Sketch)
10.
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
11.
6.
Gas; Location -Test - Wrap;-/ /" L'ft.
/ /'Nat. or/ /"L"ft./ PLPG
12.
7.
Well Clearance & Disconnect -
8.
Utility Clearance
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Date
FINAL (Plans) OK except #'s
Card B-1 Date Card B-1
Date
Setbacks -Easements
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
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 Can.
10.
Exits; Insp.-Sketch
11.
Can. of Occuparicy
Date
12.
Permanent Foundation Only; License Decal
r 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
Date
Card B-1
Date
Card B-1
Date
Card B-1
Date
Card B-1
9.
Siding; Nailing -Veneer -Stucco -Mesh
s
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
s
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
FINAL (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-Panelboards-Ins. to Main in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
✓ = OK
0 = Not OK
- = Not Applicable
= Not Ready
RESIDENTIAL (;
Date
Underfloor (Plans) OK except #'s
Hangers -Post Caps -Anchors -Connectors
1.
Zoning -Setbacks -Easements -Flood -Slope
Cling. Joist-Rftr. Ties-Purlin-Roff Brac.-Truss-Shting. -Ring.
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
4.
Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
5.
Stemwalls, Main; Steel- Blockouts-Wrapped
Garage Fire Protection Framing
6.
Stemwalls, Garage; Steel- Blockouts-Wrapped
Property Line Firewall & Openings
6a.
Hold Downs and Special Anchors
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
7.
Slab, Steel -Wrapped
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
8.
Piers -Fireplace Ftg.-Steel
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
Siding -Nailing Veneer
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
11.
Water Pipe; Test -Anchors -Regulator -Service Test
Glazing Area -Glass Protection -Skylights -Plastic
12.
Electric Underground
Shear Walls; Nailing -Bolts
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
Brace Interior/Exterior Wall Panels
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
Insulation -Walls -Ceilings
15.
Access & Ventilation
1 nfiltration-Walls-Windows
16.
Insulation
Date
Date
Date
Card B-1 Date Card B-1
Date
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
Ext. Steps -Door & Sidelight Protection -Landings
17.
Water Htr.; Vent -Access -Combustion Air Baffle
Smoke Detector
18.
Water Pipe; Test & Anchor -Nail Protection
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
19
D.W.V.; Test Fittings & Anchor -Nail Protection
Bedroom Exiting
20.
Shower Pan; Test, First Floor -Tub Access
G.F.I. & Bath Fixtures & Tub Access -Spa
21.
Test Tub & Shower, Second Floor -Tub Access
Elec. Trim & Subpanel, Breaker Sizes & Labels
22.
Gas Pipe; Sixe & Anchors
Stairs & Rails
70.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
Elec. Outlets & Receptacles at Kit. Counter
23.
Fixture & Transformer Clearance -Ins. Protection
Garage Fire Door; Swing -Landing -Closure
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
A.C. Duct in Garage -Damper
25.
Size Boxes & No. of Conductors Stapled
Wtr. Hir.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
26.
Romex Installed Close to Edge of Studs & C.J.
Plb., Elec. & Mech. Equip. Listed for Location
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
Insulation -Foam -Looked in Attic
29.
Subteed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or At
Guard Rails & Deck Construction -Post Caps
30.
Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or Al
Insulated Neutral ❑ Yes ❑ No
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
31.
Service -Riser Conductors & Ground Main Disconnect
Clearance Looked under Floor ❑ Yes
32.
Equip. Clearances Panels-Motors-Mech. Equip.
Following Instld./Drive J Yes D No/Walks D Yes J No/Planters J Yes J No
33.
Clothes Closet Light -Shower Light -Spa Light
Stucco Brown -Finish
34.
Smoke Detector
A.C. Unit Disconnect, Electrical -Plumbing
85.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
Ventilation Throughout House
35.
A.C. Ducts Insulation & Support
Glass Protection
36.
Vent Fan, Exhaust above insulation
Corrections from Previous Inspections
37.
Condensate Drain & Overflow, Size & Grade
Gas Test -Meters Tagged, Gas -Electric
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
Water & Sewer Connected -C/O to Grade -HD Approval
39.
Attic Access & Platform it Furnace in Attic
Energy Compliance Certificate -Other Certificates
94.
Address Posted
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
Date
40.
Sills Proper Materials & Anchors
Comments at Final:
41.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
45.
Headers & Beams -Size & Bearing
jingle & Duplex)
Date
FRAMING (Continued)
46.
Hangers -Post Caps -Anchors -Connectors
47.
Cling. Joist-Rftr. Ties-Purlin-Roff Brac.-Truss-Shting. -Ring.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skylights -Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
1 nfiltration-Walls-Windows
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Hir.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
82.
Following Instld./Drive J Yes D No/Walks D Yes J No/Planters J Yes J No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
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:
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - bUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT a F
ASSESSOR PARCEL NUMBER
036-021-049
ZONING
Al)
BUILDING PERMIT
OWNER
HOLY TRESS
TELEPHONE_`
SO. FT. OCC. BUILDING VALUATION
2.364 _
.OWNERS MAILING ADDRESS
4290 V C RD. ORAVILLE. CA
CONTRACTOR'S NAME
OWNER
TELEPHONE
5114-5"i
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
THOMAS FARNBU (PASTOR)Fireplace
LENDER'S MAILING ADDRESS
P
Total Valuation $
L'!s_iliR._n{l
ARCHITECT OR ENGINEER
LICENSE NO.
Fee
$ 20.00
—Filing
Fee
a
$ w%�
ECT OR ENGINEERS MAILING ADDRESS
ARCHITECT
Plan Checking Fee
$ A09 --D *
BUILDINGADDRESS
42$0 V C MORO V. LE CA
Energy Plan Checking Fee
-'-"
$
$
PERMIT FEE
$!�
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other C=CH
SPECIFY
Each Trap
7.00 r
Solar or heat pump water heater
23.00
Water piping
15.001 t_,
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: ADDITION TO t',MIRCR
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00}-_ry-, GD
Mobile Home I S I G I W
Q20.00
PERMIT FEE
$ 72.00
ELECTRICAL PERMIT
Fling Fee 20.00
OOOV LESS
Main Service zooAORORLEss
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
`0- 1, 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.
❑ 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
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
Policy Number
(The above sections need not be completed If the permit is for work of a valuation
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 f I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those, provisions.
X—,L..tfit, �P �f�"✓s �J✓1''� Date ,,.,C., / 4`��
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.
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP. SO
OR ADDNS. ( 8 ACC. BLDS. 3.5QFT:
IN,pµR6ID, MULTI.OtlTLET 97.50, 45,+60
POWER APPARATUS -
8 SINGLE OUTLET CIR.
.00
EX. Occup. OUTLET OR FIXTURES BAL ®1.50
Ex. Occup. ..FIXEDAPP
RE1�SID.OE. 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $ $$.00
MECHANICAL PERMIT Fling Fee 20.00
Heating .
Cooling 30.00
�r
Hood 6.50
Ventilation
PERMIT FEI: $
Mobile Home Installation Fee $
' Energy Inspection Fee $of
Occ
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IT
a
FLOOD
CDDF
TACEL
�PD
HD
ISSUE
cr
This permit is hereby Issued under
the Butte County Code and/or
in
indicated above for which fees have
.By / r .Vl 'i
Y .
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date
"d
(Date)
ReceiptNo.
WHITE-D.D.S.-B.D. . CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
036-021-049 01-0382
HOLY TEMPLE
4290 V C RD., OROVILLE
CONTR: THOMAS FARNELL
ADDITION TO CHURCH
MASONRY WALLS N E S W
1st Lift
2nd Lift
3rd Lift
4th Lift
5th Lift
6th Lift
FIRE WALLS (Occupancy, Area Property)
Gypsum Board 1st Layer 2nd Layer
Walls
Ceilin s
COMMERCIAL
036-021-049 99-0768 —�
HOLY TEMPLE TEMPLY
4290 V C Road, Oroville
Contr: Owner
addition to church
i
V=OK
O=Not OK
- = Not Applicable
= Not Ready
!/COMMERCIAL
Date UNDE OOR Plans OK except #'s
oni -Setbacks-Easements-Flood-Slope-Soil Report
g., Main; Soils-Ufer Ground.-Ftg. Depth
3 old Downs -Bolts -Straps -Embedment -Hair Pins
4. Concrete -PSI -Cert -SP. insp.-Loc.
5. Stemwalls, Main; Steel -Bloc kouts-Wrapped
6. Reinf. Steel -Grade -Placement
7. Slab; Steel -Wrapped -Wire Mesh
8. Piers -Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground, Underslab
13. Pienums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Masonry -Rebar -Lifts
Date Card B-1 ��� Date Card B-1
Date Card B-1 Date Card B-1
Date PLUMBING (Permit) OK except #'s
16. Water Htr.; Vent -Access -Combustion Air -Baffle
41 7. Water Pipe; Test & Anchor -Nail Protection
8. D.W.V.; Test -Fittings & Anchor -Nail Protection
19. Sinks -Floor -Grease Trap
20. Hand icap-W/C-Backi ng
21. Gas Pipe; Size & Anchors - Firewall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
Ingle Phase -Three Phase -Equip. Bond
24,61'e ' -Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Mech. Fastners-Bond Gas & Water
27. Wiring -90° -Protected -Color Coded
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga.
Cu or Al
29. Fire Resistive- Fixture-Conduit-G.F.I.-Susp. Ceiling
dt,ice-Riser Conductors & Ground -Main Disconnect
. Equip. Clearances Panels-Motors-Mech. Equip.
' 32. Fire Wall Penetrations
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MECHANICAL (Permit) OK except #'s
33. A.C. ucts Insulation & Support
ent Fan; Exhaust above insulation
35. Co ensate Drain & Overflow; Size & Grade
Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet
37. Attic Access & Platform if Furnance in Attic
38. H. V.A.C.-Ventilation-Roof Access
39. Smoke & Fire Dampers
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FRA NG Plans OK except #'s
467 Sils roper Material & Anchors -Hold Downs
44-1�apStuds-Nailing, Spacing & Bracing -Plates -Sound
4 . B mg Walls over Girders & Floor Nailing
42! D t Stop in Walls (rat proof)
F' a Stops; Furred Ceilings -Stairs -Chases
Headers & Beam -Size & Bearing -Support Fix.
Date JJ3AMING (Continued) `
4 Hangers -Post Caps-Anchors-Connector3
oof Shthing-Nailing-Diap.Chord Splice
48. Firewall-Doors-Area-Occp.-Prop.
4 . tic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50. Glu -Lam cert. -Placement -Support
i i ing - urlin-Girders
52. Property Line Firewall & Openings
53--15-t. Doors -Handicap Access
adroom-Rise-Run-Landing-Fire Protection
5 ood on Roof Overhang -Attic Vents -Rafter Outriggers
W59Nailing Veneer
57. ng -Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58. Glazing Area -Glass Protection -Skylights -Plastic -Fire Port.
. She Walls -Plywood-Nailing-Conn to Roof
60. I ulation-Walls-Ceilings
/ Infiltration -Walls -Windows
62. Corridors -Openings -Fire Protection -Framing
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63. Ext. Steps -Door & Sidelight Protection -Landings
64. Exits -Size -Number -Placement
65. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
66. Sprinklers -Placement -Test
67. Suspended Ceiling-Seismic-Wires-Elec-Light & Mech.
68. Elec. Trim & Subpanel; Breaker Sizes & Labels
69. Stairs & Rails
70. Handicap -Door Levers -Fin. Floor
71. Elec. Outlets at Wood Panel; Int. & Ext.
72. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
Above Floor-Mech. Protection
73. Plb., Elec. & Mech. Equip. Listed for Location
74. Insulation -Foam -Looked in Attic ❑ Yes
75. Guard Rails & Deck Construction -Post Caps
76. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
77. Stucco; Brown -Finish
78. A.C. Unit; Disconnect, Electrical, Plumbing
79. Vents Above Roof; Plbg.-Appliance-Fireplace.-Clearance to
Openings
80. Water Well; Disconnect, Electrical, Plumbing
81. Exterior Elec. Trim; G.F.I. Receptacle -Underground
82. Off Site -Parking -Handicap
83. Glass Protection
84. Corrections from Previous Inspections
85. Gas Test -Meters Tagged; Gas -Electric
86. Water & Sewer Connected -C/O to Grade -HD Approval
87. Energy Compliance Certificate -Other Certificates
88. Roofing Certificate -Fire Rating
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:
Certificate of Occupancy
(NOTE: An entry must be made each time you visit the job site)
(Rev.12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 ERMIT O.
: 411 APPLICATION AND PERMIT 441_/hl
ASSESSOR PARCEL NUMBETi o3L 021 049
-"LU
ZONING AR
BUILDING PERMIT
OWNER HOLLY'
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
4V. W
OWNER'S MAILING ADDRESS
4290 V C ROAD, OROVILLE
CONTRACTOR'S NAMET
OVER -
3
53H3-5641
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER THOMAS FARNELL (PASTOR)
LENDER'S MAILING ADDRESS
C
ylf@„ f i,r,8 �J �J,� 'i • W
Total Valuation is
ARCHfTECT OR ENGINEER
LICENSE NO.
$ 20.00
—FilingFee
Permit Fee $ 762.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $ 9- TO
BUILDING ADDRESS
4290 V C ROAD OROVILLE
Energy Plan Checking Fee $ 23.00
$
PERMIT FEE $(
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 1 7.00 7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other CMCH
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00 t5 DO
Each gas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: ADDITION TO CWRCH
Gas piping system 1 - 5 outlets 15.00 1 S M
Building sewer 15.00
Mobile Home IS I GI W - @20.00
PERMIT FEE $
ELECTRICAL PERMIT Fling Fee 20.00
Main Service ( zo."oa. S 23.00 )� 17
LICENSED CONTRACTOR'S 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 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:
1, 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
Main Service 200A TO I000A 46.00
NEW CONST. DWELLING OCCUP. SO
OR ADONS. ( 8 ACC. BUDS. 3.5Q FT,
NO -REs UT' RMANCH CIRCUITS A 97.50 A
POWEPPARATUS
8 SINGLR AE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES SAL @ I:50
INS
Ex. Occup. ourELETS RES DOEA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
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
oithwith comply with those provisions.
/
Date 4/,n A%/19
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.
MECHANICAL PERMIT Filing Fee 20.00
Heating 2
Cooling 14t). rv)
Hood 6.50
Ventilation
PERMIT FEE $ 80.0
Mobile Home Installation Fee $
Energy Inspection Fee $ 46.U0
Occ
CONST. TYPE
TOTAL FEE $
FE IMP
A
FLOOD
...-
CDF
' PARCEL
PD
HD
r,
5S E�'
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
�- �, Date f J /� !,
BY Iy (1(1' t JJ�� _
PERMIT EXPIRES ON _U / A) -7/J �) /
Date '
Receipt No. $1513 •30
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
a
HOLY TEMPLE CHURCH OF GOD IN CHRIST
4290 V-C Avenue, Oroville
Contrc LaGrone Htg & AC
�. Permit#1841-81P,E,M(install 2 evap
� coolers). church
F
k CR
/Uc)
016 (,io(G/ c
r COUNTY OF BUTTE - DEPAR`MENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, Califoinia 9f*65 - Telephone 916/534-4541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS -
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
___ _.-_ _ ___. — __ __.. _ - _
CONSTRUCTION LEND—ER UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 3:00
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
LOT NO.
SUBDIVISION NAME<
PARCEL' MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehome ❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installation[' Other ❑
Describe work: —
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service jp0 AMP ORV OR LESS5.00
Main service EA. ADD'L too AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ACDNS. ACC. BLDGS.
22 sq it
CONTRACTORS LICENSE LAWNEW
I declare 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.
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
COS_ULTI-OUTLET
NON.NT: R ESIDBRANCH CIRCUITS)
2,50 ea
NEW CONSTNON-RESID, SINGLE OUTLET CIR. POWER APPARATUS IN
R
(/
ExOccup(ourLETs OR FIXTURES 50 �' 25C.
BAL@t
APPLES, OR
Ex. Occu OUTLETS
p•(DUTLETS (RESID.) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee
$
Contractor
MECHANICAL PERMIT
Filing Fee 5.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (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.
Heating
Cooling
Hood
2.00
Ventilation
Permit Fee
Contractor
$
1 certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby 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
against said County in consequence of the granting of this permit.
rVAX Date
Signature of Applicant — Owner '" Contractor D� Agent ❑"
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Land Development Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP I
TYPE OF CONST.
I
PARCEL
77
ND
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS PERMIT NOL
CJ/7 County Center Drive - OroviWe, Cal`rornia 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT C.
ASS PARCEL NUMBER
z°"'NG
BUILDING PERMIT
OWNERj
TELEPHGO�NEE
e
SQ. FT. OCC. BUILDING VALUATION
OWNER's MAIL ADCrRE7SS gOf-
ONTRACTOR'S NA
/
TELEPHONE
-5_33 >®Z
CONTRACTOR 's MAIL 'G ADDRE S
CONSTRUCTION LENDER
UNKNOWN
Fireplace
Total Valuation is
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS0%2
PLUMBING PERMIT
Fi ling Fee jV00
Each Trap
2.00
Repair drainage or vent piping
2.00
rn
Water piping
LOT NO.
SUBDIVISION NAMEPARCEL
MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF❑ Duplex❑ Mobilehome❑ Other l'l�r�'LJ
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti Iities ❑ Installation ❑ Other
Describe work: "7"a :.�,r. 7=a//— 62 4 ,,yz4a
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee J&.00.
Main service 800V OR LE 000 AMP ORLESS5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADONS. ACC, BLDGS.
22 sq ft
CONTRACTORS LICENSE LAW
I declare 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.
�3
License No. �/ aiClassification C��n - & /_ y
❑ 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
NEW CONSTR LTI-OUTLET
NON.RESID. BRANCH CIRC ITS 2.50 ea
NEW CONSTR (POWER APPARATUS &
NON RES,D. (SINGLE OUTLET CIR,
Ex. Occup(OUTLETS OR FIXTURES BAL@1
eAL@10t
EX. Occup.( FIXED APP LNS, OR
p.(OUTLETS (RESID.) EA.) 2.00 ��
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $ yoe7
Contractor
MECHANICAL PERMIT
FiIingFee /0.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
i;_—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.
Heating
CoolingOrmO
Hood
2.00
Ventilation
Permit Fee
$ 0'19
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize:representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 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
against s 'd County in cons qu of the grant' n of this permit.
X — e " Qate
Ir�/
Signature of Applicant — Owner Contractor Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct -R
ion of structures o``�er 3 stories in height.
Mobile Home Installation Fee
$
Land Development Fee $
TOTAL PERMIT FEE $ , v0
OCCUP. GROUP
I TYPE OF CONST,
PARCEL
PD
HD
ssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
F PUBLIC
BY
PERMIT EXPIFYES Dat
the applicable provi-
resolutions to do
fees have been aid.
p
WORKS
Date
—Q /-- y
Receipt No.�-Z�!
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDEN ROD-APPL I CANT
Od t?I/n/ti/T/�lrT/
10610 0
41,
1/0 �N '4 a®
6
Od t?I/n/ti/T/�lrT/
10610 0
41,
1/0 �N '4 a®
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
O r/w
._ 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541BE�MT§:).
(Rev. 12/96) 1 APPLICATION AND PERMIT 99--0
ASSESSOR PARCEL NUMBER 036-021-049
ZONING AR
BUILDINGPERMIT
OWNER
HOLY TEMPLE �
TELEPHONE
FQ.OCC.BUILDING VALUATION
748.00
1344270
OWNER'S MAILING ADDRESS
V C ROAD, OROVILLE
CONTRACTOR'S NAME
OWNER
TELEPHONE '
533-5641
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENDER THOMAS r ARNELL (PASTOR)
134 748.00
LENDER'SMAILING ADDRESS
'
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee $ 20.00
Permit Fee $ 762.00
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee $ 495-30
BUILDING ADDRESS
4290 V C ROAD OR VILLE
Energy Plan Checking Fee $ 23.00
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other CHURCH
SPECIFY
Each Trap 7.00 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: ADDITION TO CHURCH
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.0015 0c)
Mobile Home I S I G I W @20.00
PERMIT FEE S79
-no
ELECTRICAL PERMIT Fling Feel 20.00
OR .ss 23.00 2 no
Main Service zoos
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class LIC. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
1, 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
Main Service To 46. 00
WEE200A
CCU000A
NEW CONST. DWELLING OCCUP. SO
So
OR ADONS. ( 8 A.C. BUDS. 3.5¢FT,
ITLET
NON•R SIIDT ANCS.I CIRCUITS 1 97.50
POWER APPARATUS
a SINGLE OUTLET CIR.
EX. Occup. OUTLET OR FIXTURES aAL %ISO
Ex. Occup. OUTLEEDTs RESID.OEA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE $
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number ere:
Carrier
Policy' Number
(T6e 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
hwith comply with those visions.
_ Date _
4ga 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.
MECHANICAL PERMIT Filing Fee 20.00
Heating 2 in on
Cooling
Hood 6.50
Ventilation
PERMIT FEE S 80.00
Mobile Home Installation Fee $
Energy Inspection Fee $ 46.00
occ
CONST. TYPE86.30
TOTAL FEE $
HA FEIMP
FL000 '
.—
CDF PARCEL PD
HD
t
'ISS
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
7 /16
17/66
By _ Date (Jw�
PERMIT EXPIRES ON
D to
Receipt No. 264788 / $1586.30
WHITE-D.D.S.-B. D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
®''�'t '- �'►r-"�1Er'.ci'M*Io'LS8#V �� t✓' '2 .n'�T'f�� T+� � p. in- :>R' :•;:' ',zu 3�>,C^rt r. y..
OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
-r CENTER DRIVE - OROVILLE, CALIFORNIA 95965: TELEPHONE (530) 538-7541 r • r
PERMIT APPLICATION DATA SHEET
OWNER�4d � )T M f3LF- ASSESSOR PARCEL NUMBER:_��� -0 �2 � �('j C� Q/
Proposed Building se: C,4C i� _� �n Building Inspector: Date: (,/ _..-r' _ S
=-fi-T-f = 4 �— —f
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
Date Received By
111. All items have been submitted-----------------------------------------------------------------------------
O
Rlot plans, 3/4 sets, signed by the preparer of plans. ---------------------------------------------------703. Complete plans, 3/4 sets, signed by the preparer of plans. ---------------------------------------------
04. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans.
ngineered truss details and layout in duplicate (required prior to plan review) No faxes! ---------
6
nergy Design Compliance and supporting documentation. -------------------------------------------
❑ 7. Statement of Intent for Non -Heated and A/C Buildings. ------------------------------------------------
❑8. Ha ardous Material Form. ------------------------------------------------------------------------------------------
❑ 9. Manufactured Home data and installation t' q" . ns�'t b � g �T ie o ifications-------------------
❑elatifornia
of $ (1/R/C�tr _ {I
------------------------ - - - -------- ----
ct fees as shown on the attached schedule. - ---� ----- ------ ---- - f`��- �_t-�► --
❑ Department of Forestry plan approval/fees.---------------------------------------------------------
❑ 13. Flood elevation certificate. --------------
L Sanitation and plot planapprov&
❑ 15. City of Chico plumbing permit. -------
1 Oj 6. Plot plan and business license approval from the City of Biggs. ---------------------------------------------
1�iod '
Planning approval for (A) Use: ()K (B) Parking: Ole 2I ----- 4-1z -1 U_
a4s.
Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel. ---- -----------------
0 19.
-------019. Encroachment Permit for driveway (construction approval prior to occupancy).----------------------------
020.
-------=------------------
❑20. Pre -inspection for
required. Request to Building Inspector on
021. Contractor's license information. (Number, Name Style, Classification).
022. Workers' Compensation carrier and policy number. -----------------------
023. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑). -
024. Letter of signature authorization. --------------------------------------------
025. Recorded copy of Agricultural Acknowledgment Statement. -------------
❑ 26. Letter of intent on building use. ----------------------------------------------
❑ 27. Manufactured Home utility clearance.-----------------------------------------------------------.
❑28. Existing violations and/or expired permits. ------------------------------------------------------
1:129. 11433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $
030. Other:
When you issue the permit, processus follows ❑ Mail to owner,
el hone 3 3 S� '- 4 and hold for pickup
Copy of Haz-Mat form sent VIealth Department, %pFire Depai
Copy of plans sent ❑ Health Department,,iFire Department, ❑
1. Index permit application for the above items numbered:
to contractor.
office. ❑ Deliver with inspector.
(Date)
Date: 11_1_ /X1✓ 7 �114
Date: yrz 7-eW By:
Date:, 'It •3p_,eE-`f By:
Plan Check List
2. Additional items required: All
Contractor, 89Gier er was advised of the above required data by ❑ phone, ail, ❑ Building Division counter, by Date: Ki
Contractor, designer wn was advised of the above required data by ❑ phone, ❑ mailg Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division -counter, by Date:
Contractor, designer, owner, wm advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Plans reviewed by: Date: t k Plans approved by: Date:
Sets of plans on hold in�XPlan Cabinet, 0 A.P. folder. Note transfer by: Dater
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signat<u+e.
Please complete and return this information at your earliest opportunity to avoid unnecessary dela3i
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
property improvement: YES 14 NO 13.
2. I HAVES HAVE NOT O signed an application for a building permit for the proposed Wolk;
3. I have contracted with the following person (firm) to provide the proposed construction;.°a:
L1AM -
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to provide portions of this work, but I have hired the following person to' 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 prpvide
the Work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED: p/
PROPERTYOWNER.
SOCIAL SECURITY NUMBER:
DATE: `02!I
NOTE: This Owner -Builder Verification is required by Section 198.31 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
OWNER BUILDER INFORMATION 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-buildee, you are the responsible parry oflecord 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 thatt 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.
Ifyou plan to do your work, with a exception of various trades that you plan to subcontract, you should .
be aware of the folio ormation for your nefit and protection:
♦ If you emp or otherwise engage any pers ns other than your immediate family, and the work (including materials
and othe costs) is 5300 or more for th entire project, and such persons are not licensed as contractors or
subcon ctors, " en you may be an emp yer.
♦ If you an e toyer, y - u must reg' ter with the State and Federal Governments as an employer and you -are
subject to se ding state. and. federal income tax withholding, federal social security taxes, :..:
workers compensation insurance, disability insurance costs, and unemployment compensation contributions',-.
♦ 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. "
♦ 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 "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 contraggrs may be obiained by contracting the Contactors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" bn 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 retumed.
41rely,
l C. Vi iia, CB.O.
r, Building Inspection
NOTE: This Owner-Builder,lnformation is required by Section 19830 of the California Heafth and Safety Code.
OVER
OWNER
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541
SCHEDULE OF FEES DUE
Lam/ -- -,77E i�
PROPOSED BUILDING USE(A"� &.
1. BUILDING PERMIT FEES
-- Balance Due ................ $
t
-- Additional Fees Due ............ $
-- Additional Fees Due ........... $
-- Revised Plan Checking Fee ....... $
/SCHOOL DISTRICT FEES 0 O (G
;de
trict Office) 6WE FACA) � 0/9Q0"5 1ke
FEES (paid at Building Division)
tial ........ x $360.00 = $
Units
Commercial (sq.ft.)... L' x
Sq. Ft.
4. URBAN AREA FEES (paid at Building Division)
Residential (per unit) . x : = $.
#Units Amt.
Commercial (sq.ft.) .. x =$
Sq.Ft. Amt.
5. RECREATION DISTRICT FEES (paid at District Office)
6. THERMALITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid at Building Division)
8. WATER TENDER FEES (Battalion # )
$200.00 (paid at Building Division)
9. CSA 87 'TRAFFIC FEE $2500.00 (paid at Building Division)
10. OTHER
A. P. # d -OO'—I -'U'K
DATE —
RECEIPT # DATE REC
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit.
These fees may be changed during the plan checking process.•
DATE
Pursuant to Government Code Section 66020, you are hereby notified that items 2,3,4,5,6,8,9, and 10 above may have been imposed on your
project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may
protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original -Building Div. 2nd Copy - Applicant 3rd Copy - Owner
(Rev. 2/97)
S {/".7 ` s1�"f.�'ii^r?wli"i�t`it3k r ; ia`:, j rr: n,,� t"'4 :��. ti r•., .�,'. % t
1 "r
COUNTY OF BUTTE1K ek,
DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ,
7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541
SCHEDULE OF FEES DUE
OWNER
PROPOSED BUILDING
1. BUILDING PERMIT FEES
-- Balance Due ................ $
-- Additional Fees Due ........... $
-- Additional Fees Due ........... $
-- Revised Plan Checking Fee ....:.. $
_V62.. SCHOOL DISTRICT FEES O (Z O
aid at District Office),
kesidential
HERIFF FEES (paid at Building Division)
...:.. x $360.00 $
Units
Commercial (sq.ft.)... �,�oy x $0.03_
Sq. Ft.
4: URBAN AREA FEES (paid at Building Division)
' Residential (per .unit) . x : _ $
' . #Units . Amt.
Commercial (sq.ft.) .. x =$
`. Sq. Ft. Amt.,
5. RECREATION DISTRICT FEES (paid at District Office)
6. THERMAL•ITO DRAINAGE DISTRICT FEES
$510.00 (paid at Building Division)
7. SRA FIRE INSPECTION AND PLAN CHECK
$89.00 (paid. at Building Division)
8. WATER TENDER FEES (Battalion # )
$200.00 (paid at Building Division)
• 9. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division)
10. OTHER
e`
A.P. # d36
DATE C /
RECEIPT # DATE REC
4
At time of permit application, I was advised the above fees are required to be paid prior to issuance of the building permit.
These fees may be changed during the plan checking process.
APPLICANT
v
Pursuant to Government Code Section 66020, you are hereby notified that items 2,3,4,5,6,819, and 10 above may have been imposed on your
project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may
protest. The requirements for a protest are specified in Government Code Section 66020(a).
Original -Building Div. 2nd Copy - Applicant, 3rd Copy - Owner (Rev. 2/97)
COMMER CAL PLAN CHECKING G UTA (19 94) U. B. C.
OWNER: Tsmec`- BUILDfNG PERMIT NUMBER: -0768
PLAN CHECKER: AP. NUMBER: 036- (1Z I -0 T7
A. GENERAL:
Zoning requirements, Planning approval.
.V
Valuation.
Plans signed by an engineer or'architect.
,41"
Proper description or work on application.
5.
Existing violations on property.
—. 6.
Items on data sheet (W.C., fees, Health, Impact Fees, License Law, etc.).
Q
Improvements or drainage, Land Development approval. '
R PLOT PLAN.•
Complete parcel size and dimensions.
.i
Setbacks, sideyards, easements, etc.
�!
Other buildings or structures.
A!
Grading, fills, drainage.
Flood hazard.
Special conditions on creation map (noise, C.D.F., sprinklers, foundations, etc.
F.A.U. & F.A.S. road set back.
8�
Building or utilities across lot lines (Lot Merger).
G . OCCUPANCYREQUIREMENTS:
to
Building use:
Occupancy Group:
Building floor area:
Basic allowable floor area:
Type of Construction:
OccupantLoad:
sq. ft. Total allowable floor area:
Basis for increase:
--er Compliance with, specific occupancy requi.relment.
-2' Occupancy separations (Section 302).
Area separations (Section 504.6).
4. Firewalls due to location on property (Section 503). '
.5— Maximum height requirements (Section 506).
9" Draft stops (Section 1505).
Ventilation and special hazards requirements (Section 3).
Automatic fire sprinkler system (Section 904).
9. Fire alarm systems (Section 310.10).
K Mechanical code requirements (Grease hood w/fire sprinkler system - Section 507).
1T Environmental Health Review - (a) Restaurant Act, (b) Commercial Pool, (c) H Occupancies.
,-2" Smoke detection system.
0. C.D.F. or tate Fire an re
.l -r Electrical Code Requirements (Medical - Article 517, Assembly - Article 518, etc.).
Physical Disability Requirements (Title 24).
�kr Wholesale Food Manufacturing (Plans to state DFIS/FDB).
TYPE OF CONSTRUCTION REQUIREMENTS:
X Roof covering requirements (Section 1503).
Parapet walls (Section 709.4).
/ Toilet room floors and walls (Section 807).
�4. Guardrails (Section 509).
April 1996 3.4
April 1996 3.5
Detailed typeInstruction requirements.
Proper roof pit . ror roof covering (Section 1507 & 1508).
J%
Attic access and ventilation (Section 1505).
Roof drainage(Section 1506).
A,"-
Skylights Section (2409 & 2603).
Stages and platforms (Section 405).
Interior wall and ceiling finish (Section 801).
12.
Fire resistive requirements. Walls, floor, ceiling, penetrations (Section 702).
L3.-
Wall and ceiling covering installation (Section 2500).
1
Glass, glazing, Human Impact - Safety Glazing (Section 713.9 & 2406).
Foam Plastic (Section 1715).
E.
STAIRS, EXITS AND OCCUPANT LOADS:
-%
General Exit Requirements (Section 1001.4 & 1006.3).
1Y.
Number of exits, width and locations (Section 1003).
Z".
Doors (Section 1004).
4"
Corridors and exterior exit balconies (Section 1005).
e5
Stairways, rise and run, width, winders, and construction (Section 1006).
Horizontal exit (Section 1008).
Exit and smoke proof enclosures (Section 1009).
Exit signs and illuminations (Section 1013).
Aisles and seating (Section 1014 & 1015).
1�
Exits for occupancy groups (Sections 1016 - 1019).
Jer
Floor level exit signs (Title 24 & Section 1013).
F.
MISCELLANEO US REQUIREMENTS:
,a-
Masonry chimney (Section 3102).
/Y.
Veneer (Section 1403).
Special Inspection per U.B.C. Section 1701).
a. High Strength Bolting.
b. Field Welding.
C. Masoiu-v (full stress).
d. Concrete (f c>2500psi).
Special Certifications - Mill Certificates.
Expansive soil - Special design.
,6!
Cut/Fill slopes, compaction tests, grading.
Noise requirements (Planning, Appendix Section 1208).
Weld electrode, welder certificate.
G.
ENGINEERING REQUIRE.HENTS:
,fi
Complete calculations, correct design criteria.
Complete shear transfer details, roof to foundation.
Complete structural material specifications.
Shear wall anchorage based upon wall shear.
Roof diaphragm chord, collector, drag struts.
Combined tension and shear @ steel RF anchor bolts.
Braced roof and wall bays.
H.
OTHER:
April 1996 3.5
E
•
Department of-Devel-opment Services
Building Division
7 County Center Drive
Oroville, CA 95965
(530) 538-7541 (530) 538-2140 FAX
CODE ANALYSIS
Occupancy Group: Type Type of Construction: Occupant Load:
Uniform Building Code 1003.2.2.2.1: In determining the occupant load, all portions of a building shall be presumed
to be occupied at the same time.
Building Use: C N LA
Uniform Building Code — Table 10-B - Egress width per person served
Occupant load x 0.2 = Horizontal exit width required in inches: 30 , 8,
Occupant load x 0.3 = Stairway exit width required in inches:
Total exit width provided:'r
Fire Sprinklers: Yes No N
Maximum travel distance to exits: Non-sprinkled=200': Sprinkled=250':
Number of exits required 2(UBC — Table 10-A): ;— Number of exits provided: 2
Indicate on the building plans The Exit Access3, The Exit4, and The Exit Discharges.
Basic Allowable Floor Area — UBC Table 5-B: 60,00
Height of Building: Stories: 1 Feet: y O ai c°wl--�
Allowable area increases (UBC section 505):
Separation on two sides:
Minimum yard width > 20' x 1.25% = Allowable increase (50% Max.) x 1.25%
Separation on three sides:
Minimum yard width > 20'x 2.50% = Allowable increase (100% Max.) x 2.5%
Separation on all sides:
Minimum yard width > 20' x 5% = Allowable increase (100% Max.) x 5%
Automatic Sprinkler System:
Allowable area x 3 for one-story buildings.
Allowable area x 2 for buildings of more than one-story.
Total Allowable Floor Area: 6000 Building Floor Area: 439 2
1- Refer to UBC Table 10-B for H-1, H-2. H-3, H-7, I-1, and I-2 occupancy requirements for egress width.
2- UBC 1004.2.4 — Where two or more exits are required from any level or portion of the building, at least two of the exits shall be placed a
distance apart equal to not less than one half of the length of the maximum overall diagonal dimension of the area served measured in a
straight line between the center of such exits. Additional exits shall be arranged a reasonable distance apart so that if one becomes blocked,
the others will be available.
3- UBC 1004.1: The exit access is that portion of a means of egress system between any occupied point in a building or structure and a door of
the exit.
1 of 2
4- _ UBC 1005.1: The exit is that portion of the means of egress system between the exit access and the exit discharge or the public way.
5- UBC 1006.1: The exit discharge is that portion of the means of egress system between the exit and the public way.
USE PERMIT
BUTTE COUNTY PLANNING COMMISSION
MAR - 3 1951
DATE: (Certified Mail Rec.)
UP 97-10
PERMIT NO.
036-021-049
ASSESSOR'S PARCEL NO.
Pursuant to the provisions of the Zoning Ordinance of the County of Butte and the special
conditions set forth below: Farnell Thomas is hereby granted a Use Permit in accordance
with application filed: October 7, 1996, to allow a new 2,304 sq. ft. structure on .51 acres
located on the west side of V -C Road approximately 200 feet south of V-7 Road in south
Oroville, in an area zoned AR (Agricultural Residential).
Failure to comply with the conditions specified herein as the basis for approval of
application and issuance of Permit, constitutes cause for the revocation of said
permit in accordance with the procedures set forth in the Butte County Zoning
Ordinance, including Butte County Code Sec. 24-62.
2. Unless otherwise provided for in a special condition to this use permit, all
conditions must be completed by the Permittee within 24 months of the
delivery of the countersigned permit to the Permittee.
3. Minor changes may be approved administratively by the Directors of
Development Services, Environmental Health, or Public Works upon receipt
of a substantiated written request by the applicant, or their respective
designee. Prior to such approval, verification shall be made by each
Department or Division that the modification is consistent with the
application, fees paid and environmental determination as conditionally
approved. Changes deemed to be major or significant in nature shall require
a formal application for amendment.
4. If any use for which a use permit has been granted is not established within
two years of the date of receipt of the countersigned permit by the Permittee,
the permit shall become null and void and reapplication and a new permit
shall be required to establish the use.
5. The terms and conditions of this permit shall run with the land and shall be
binding upon and be to the benefit of the heirs, legal representatives,
successors, and assigns of the Permittee.
Section 1: Environmental Findings.
A. Upon careful and deliberate review of the project and the project site environs, the
proposed structure will have no significant environmental effects and has been
determined to meet the criteria for a Categorical Exemption under Section 15303
of the California Environmental Quality Act guidelines; and
B. The design and improvements of the proposed project will not cause environmental
damage to fish or wildlife or their habitat and is Deminimus; and
Section 2: Zoning Ordinance Findings.
A. The proposed use will not impair the integrity and character of the zone in which the
land lies, and that the use would not be unreasonably incompatible with, or injurious
to, surrounding property, or be detrimental to the health and general welfare of the
persons residing or working in the neighborhood or to the general health, safety,
and welfare of the residents of the County; and
B. The proposed project is conditionally, consistent with the AR Zone and is a
Secondary Use under the Agricultural Residential General Plan designation; and
Section 3: Action.
A. Subject to the findings indicated in Sections 1 and 2 of this report, move to approve
the Use Permit for Farnell Thomas on APN 036-021-049 to allow a new 2,304 sq.
ft. structure. Approval shall be subject to the following conditions:
B. Conditions of Approval:
1. All external light fixtures shall be shielded in a manner that insures direct light does
not project beyond property boundaries. Existing fixtures shall be replaced with
suitable light fixtures at the time of building permit issuance.
2. Prior to paving the parking surface the applicant shall submit a drainage plan to the
Department of Public Works that shall specify how all drainage from the paved
surface will be detained on site and or conveyed to the nearest natural or publicly
maintained drainage channel or facility and shall provide that there shall be no
increase in the peak flow runoff to said channel or facility.
3. The use of the new structure is approved as a sanctuary without any kitchen,
bathroom or accessory uses. Any additional uses will require a review by the
Department of Development Services for a determination of consistency with this
use permit.
4. The applicant shall construct the gravel 21 space parking area as depicted in the
site plan prior to occupancy of the new building.
5. Applicant must comply with all other applicable Federal, State and local statutes,
ordinances and regulations.
6. Building identification and/or addresses shall be installed in conformance with Public
Resources Code 4290 and shall be posted at the beginning of building construction
and maintained continuously thereafter.
7. Provide an all weather access to all structures, which is designed to carry a 40,000
pound fire apparatus at least 10 feet wide with a 15 foot vertical clearance.
8. The new structure shall connect to the Lake Oroville Area Public Utilities District for
any sewer service.
9. The new structure shall connect to the Oroville Wyandotte Irrigation District for any
water service.
DyL
1 A covenant, in a form acceptable to the Director of Public Works and County
Counsel, shall be required to be recorded to ensure the submittal of road and
drainage improvement plans and require the installation and construction of the
street frontage improvements on V -C Road to RS -2A standard, including, but not
limited to P.C.C. vertical curb, gutter, and sidewalk and the required street section
when such improvements are installed on surrounding properties.
11. Prior to the recordation of the issuance of building permits'a plan for a permanent
solution for drainage shall be submitted to and approved by the Department of
Public Works. The drainage plans shall specify how drainage waters shall be
detained on site and or conveyed to the nearest natural or publicly maintained
drainage channel or facility and shall provide that there shall be no increase in the
peak flow runoff to said channel or facility.
I hereby decl^.e under penalty -of re1JI ..y hat I have read the foregcin5 condit�cns; that, the
4• VI \31 111M♦ 41 Ir 4\ 1 V
are in fact the conditions which were imposed upon the granting of this use permit, and that I agree_
to abide fully by said conditions.
Dated: _ �@ %-�i`,�7 / `zp�
Applicant
NOTE: Issuance of this Use Permit does not waive requirement of obtaining Building and Health
Department permits before starting construction, nor does it waive any other requirements.
1 1
Butte County Planning Commission Chairman
CC: Land Development Division
Building Division
Health Department
Department of Forestry
_rte utte Fount
j PLANNING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (916) 538-7601
FAX: (916) 538-7785
March 3, 1997
Farnell Thomas
2880 Ft. Wayne' St.
Oroville, CA 95966
CERTIFIED MAIL
Re: Use Permit, AP 036=021-049
Dear Mr. Thomas:
Enclosed is your validated Use Permit No. UP 97-10 to expand an existing church building on a .5
acre parcel in an AR (Agricultural -Residential) zone located on the west side of V -C Road
`approximately 200 feet south of V-7 Road in the Oroville Area.
Should you have any.questions regarding this matter, please contact this office between 8:00 a.m. and
4:00 p.m., Monday through Thursday.
Sincerely;
Thomas A. Parilo
Director of Development Services
Paula Atterberry
Office Assistant III
Enc.
cc: Land Development Division
Building. Division
Environmental Health
Department of Forestry
j:\1emp\up7
A7.D..5.7 f'�l�'= ''/:'=:f f''�`.. �$ �=. �1''rl"t' f� ; . --._.
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•Q
1 APPROVED
Development Plan
x DATE JAN 23 1997 O o m
USE'PERMIT VARIANCE cn
cz
. MINOR U.P. ADM.PERMIT_ -J
PLANNING COMMISS. 2 cm o
PLANNING MANAGER
siy �- (F'>•i y�f7*i 'j,�s,:.-.A s�Y.iy�.1r...,.,�� �. '*..
BUTTE COUNTY SCHOOLS IMPACT.FEE CERTIFICATION FORM
(One form per Building)
School District -Ofzoy ( a f- Building Department No.
A.P. Number 1,46 - 02 r - ()7 9 Jurisdiction: City County
Property Owner g0 0 TT £aA Pc r N u 2 c ii OF Git %ti/ 215 T
Property Location/Address if
C
KOA A
Subdivision
Lot No.
Residential Development
0
€ Sq, Footage
No of Living
Mobile Home
Addition/
'Supplemental to (Group R)
Units
Installation
Conversion
Permit #
•'
*(No foundation inspection):.
Commercial/Industrial
1
0
New Addition
Building Department Representative
(Floor Plans reviewed by School District
District Identification No.��
�Q School District certifies that
:Sq. Footage ' [� 7
(Including Exterior
Roofed Areas)
Date
�sv
VC --
(Street Address) (Phone Number)
(City) (Stattee)D ' / (Zip Code)
has complied with the requirements of Resolution No. / 0 —,,4 7 by payment of $
representing square feet. AB 2926 $
FULL MITIGATION $
School District Representative Date
Paid by Check # Remarks: i jjC.0�1�t (►
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in with
Government Code Section 660201a), within 90 days from the date fees are paid. Failure to submit a timely written protest'will prohibit
;you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xis 00198)dmm
BUTTE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
HAZARDOUS MATERIALS AND EMMISSIONS QUESTIONNAIRE
(A Building Permit cannot be approved. without this completed form.)
BUILDING PERMIT NUMBER AIN 036 `,IJ(ff -0
91
pro
�'
AddNature ress
1. Does your business or that of your tennants handle, store, or transport hazardous materials?
KNO ❑ YES
NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or
physical or chemical characteristics, poses a significant present or potential hazard to human
health and safety or to the evironment if released into the the workplace or the environment.
"Hazardous Materials" include, but are not limited .to, hazardous chemicals, hazardous waste,
paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material which
a handler or the administering agency has a reasonable basis for believing to be injurious to the
health and safety of persons or harmful to the environment if released.
2. Do you or will your future tenants handle store, or transport 55 gallons, 500 pounds, or 200 cubic feet (at
standard temperature 4 pressure), or formulation containing hazardous material?
X NO ❑ YES
891-2727
If you answered YES to 1 or 2, contact the Butte County Environmemtal Health Department (916-tfi1gh for
a review of the project.
3. Is the business/facility/operation to be located within 1000 feet or the outer boundry of a school or
school site?
X NO ❑ YES
IF YES, name of school.
4. Does the business/facility/operation have the potential to emit any air pollutants; e.g., dust, soot, odors,
fumes, vapors, or other volatile compounds?
X -NO ❑ YES
IF YES, contact the Butte County Air Pollution Control District (916-891-2882) for permit requirements.
Owner or Authorized Company Representative
(Signature) (Date)
BCEHD BCAPCD
The applicant has met or is meeting the applicable requirements of Section 25505,
25533, and 25534 of the Health and Safety Code and the requirements for a permit
from the Butte County Air Pollution Control District.
0 The Above Regulations Do Not Apply To This Facility.
BCEHD Signature. Date
BCAPCD Signature
Date
WHITE -Building Dept ❑ YELLOW- Env. Health ❑. PINK - APCD 0 GOLDENROD- Fire Dept.
66 P Foy
P.EP2Nt i r
Project: 6HvrZ f
A. P. NO.:
AFTER RECORDING, RETURN TO:
BUTTE COUNTY LAND -
DEVELOPMENT DIVISION
AGREEMENT RUNNING WITH THE LAND FOR INSTALLATION
OF CURBS, GUTTERS, SIDEWALKS AND OTHER URBAN IMPROVEMENTS
WHEREAS, the undersigned are presently the owners of that land commonly known as
A.P. 0234,-00-1-049 , located in Butte County, California, the
legal description of which is set forth on EXHIBIT A, attached hereto and incorporated herein and;
WHEREAS, said owners propose to develop said land by parcel map or a commercial or multi-
family development, and hereby specifically agree that when the County of Butte determines in its
discretion that it is_in the best interest of this particular area to install curbs, gutters and sidewalks, or
other urban improvements,, the undersigned or their successor in interest, upon notification by County of
Butte, hereby consent to said installation and agree to install the same upon demand of the County, at
their own expense or at the expense of their successor in interest. The undersigned or their successor
in interest, hereby agree that such improvements may be installed by County and become a lien upon
the property.
The undersigned hereby agree to cooperate and support the County of Butte in obtaining the
permission and approval of property -owners within any assessment district, within w, rich the above-
described property is included, formed for the purpose of installation of curbs, gutters', sidewalks 'or other
urban improvements.
In consideration of the foregoing and other good and valuable consideration, the undersigned
owners of said parcel, expressly agree that the foregoing shall be an agreement running with the land
and shall be binding upon their heirs and all successors in interest.
Dated Signature of owner of
Dated Signature of owner of record ,
SIGNATURES MUST BE NOTARIZED
Forms%greement Running with the Land
IIIIIIIIIIIIIIIIIIIIIIIIIIII
b\J1 � N
►�
� (�
1 999-00 1 9249
Recorded
OfficialyyROf,
I REC FEE
I COPIES
13.00
2.00
Count
BUT Te�
CANDACE J: GRUBBS
I
Recorder
I
ROSEMARY DICKSON
I i�
Assistant
I, Vickie
11:54AM 05 -May -1999
I Page 1 of 3
AGREEMENT RUNNING WITH THE LAND FOR INSTALLATION
OF CURBS, GUTTERS, SIDEWALKS AND OTHER URBAN IMPROVEMENTS
WHEREAS, the undersigned are presently the owners of that land commonly known as
A.P. 0234,-00-1-049 , located in Butte County, California, the
legal description of which is set forth on EXHIBIT A, attached hereto and incorporated herein and;
WHEREAS, said owners propose to develop said land by parcel map or a commercial or multi-
family development, and hereby specifically agree that when the County of Butte determines in its
discretion that it is_in the best interest of this particular area to install curbs, gutters and sidewalks, or
other urban improvements,, the undersigned or their successor in interest, upon notification by County of
Butte, hereby consent to said installation and agree to install the same upon demand of the County, at
their own expense or at the expense of their successor in interest. The undersigned or their successor
in interest, hereby agree that such improvements may be installed by County and become a lien upon
the property.
The undersigned hereby agree to cooperate and support the County of Butte in obtaining the
permission and approval of property -owners within any assessment district, within w, rich the above-
described property is included, formed for the purpose of installation of curbs, gutters', sidewalks 'or other
urban improvements.
In consideration of the foregoing and other good and valuable consideration, the undersigned
owners of said parcel, expressly agree that the foregoing shall be an agreement running with the land
and shall be binding upon their heirs and all successors in interest.
Dated Signature of owner of
Dated Signature of owner of record ,
SIGNATURES MUST BE NOTARIZED
Forms%greement Running with the Land
I' RCCORWNO R[OV[/TLD ey
w.. rHoly Tomple Church of God in Owl
..:� I.290 V C Avonue
Oft a LOrovilla, Ca. %965 i
.r w w.wra, w
r -�
Same as above.
OfFIGIA; ,. :"
DJTTE C"t'
DEC 3
CLARK A. ni:SOr.
OLERA-RECOItOER
f li!
39931
of AC[ Ae0V9 THIS LJN< FOR RCCORoZR•i vac
Individual Grant Deed
.0 ..,... n, ... INM IOe...YeNU..ae aT eieow TMA IMaV.awa •. • M
Tba undemg"j Rraetar Is) a) r
f)aevaxaury tr*rrlar tai a _
( ) eumpm.d na full Tahn of property oaaeryed, or
( ) compukd on full Felix IM ealw of Ileac and eerambraneaa remalaloE at tlMW of "le.
I ) Unlacornoratad *reel ( ) Chy of cad
WIT
'ed" $.,I I- nee 1 .
ed0•.e. r a.c•" •�"
FOR A VALUABLE CONSIDF.RATIO.N, reeaript of which is herby adnowltdiged. lARIfEU THM3, OOLLI
CRAVES and DOROTHY m 'biHm, as Triatesa of IiOLY TENPLE C110-4 (N G:.O IN CHRIST
hereby CRANr(S) le FAR= I THCK43, DOLLY GRAM, DOPXIM M DAA::EL, JOHYhls M. U,"WIS,
MAZr3 GILL cad DARQ31 THOMAS, %a Tnuteoo of HOLY TEMPLE CHW,.CH OF GOD IN CIOtJ ;T
the follorin j deaeejbrd ml propeny In fix
C"W" of Butte . Slaw Of Callfornlas
A part of Lot 1 in Block 18 of Villa Verona, Butte County, Calitorniu,
according to the official Map thereo•:, recorded in the office of the
Recorder of the County of Butte, State of California, January 17, 1949,
doscribed as followss
1
CMIMENCING at the Northeast corner of said Lot 1, said point being -in the
centerline of a County Roadt thence South 89. 13' Watt, along the Northerly
line of said Lot + and the centerline of the County Road, a distance of
163.03 feet to a points thence South 0. 11' 304 East, a distance of 256.37
fiat to the true ?tint of beginnin7 for thn parcel of land heroin defscribod
thence North 00 :l' 30" West, a dijranaa of 60.0 fact to a point, thence
North 800 13' Cast, A distance of 163.03 edit to a point on tho East lino
of said Lot•. 1, said point being in the centerline of t'sle County Roa-e1
thence South along tno East line of said 1.0t 4, and Ma cantorline of
said County Road, a distance of 100 feet te, a points thence South 89. 13' 15
West, to a point on the West boundary of said tat 0 thence Northerly e
along the West boundary of said Lot 4, a distance of 40 feet to the South -fes;
west cornir of that certain parcol•of land describad in Dead from Butte ul
County Title Company, a corporation, to Arthar Williams, at ux, rcccrded I
December 19, 1950, under 1lutte County Recorder's Serial No. 79791 thence
North 89. 13' East, 162.38 feet to the Southeast corner of the parcel of
land doncribed in Dood from Butte County Title Company, a cc•rporaticn, G.D
to Curtis Robinson, at ex, recorded December 19, 1950, under Butte County ►+-�
Recorder's Serial No. 7978, and the true point of beginnin•; of the G
parcel of land heroin described.
4
a ,
STATE OF California
COUNTY OF Butte
On , before me, Cynthia A. Costa
Da n , a Notary Public
personally appeared 1-ew
Name(s) of signer(s)
me*r proved to me on the basis of
satisfactory evidence) to be the person(s) whose names) is/are
subscribed to the within instrument and acknowledged to me
that he/she/they executed the same in his/her/their authorized CYNTHIA A COSTA
capacity(ies), and that by his/her/their signatures) on the MCOMW 1109501
instrument the. person(s), or the, entity upon behalf of which :ROTARY PUBO -CALIFORNIA 0
the person(s) acted, executed the instrument. Q COUNTY OF BUTTE w
"�
My Comm. Explrss Oct. 30. 1000
WITNES ly hand and official seal.
,4
(This area for official notorial seal)
Signature of otary Cynthia" A. Costa
This Notary is attached to that certain-1[1/LE�/(iC�Ni ,dated E81 1 .9 T
0
A
RECEIVED
JUN 1,6.1999
BUTTE COUNTY
BUILDING DIVISION
December 10, 1999
Department of Development Services
Building Division
7 County Center Drive
Oroville, CA 95965
(530)538-7541 (530) 538-2140 FAX
Holy Temple Church of God in Christ
4290 V Cave
Oroville, CA. 95966
Assessor Parcel Number: 036-021-049
Building Permit Number: 99-0768
This office reviewed and approved the above referenced revised building plans. Comply with the
following items prior to the issuance of the building permit:
1. Existing restroom facilities and drinking fountain must be made accessible for the disabled.
This has been noted on the building plans.
2. Contact Land Development about improvements.
3. Sheriff fees = $69.12.
If you wish to discuss any requirements, you may contact me at (530) 538-7541 between the
hours of 1:00 p.m. and 4:00 p.m., Monday through Friday.
Sincerely,
Glenn Gibbons
Plans Examiner
1 of 1
DEC-10-99 11:00 AM EL MEDLO FIRE DEPT 530 533.9606 P.01
EL MEDIO FIRE DISTRICT
COUNTY OF-BUTTE
3515 MYERS STREET OROVILLE. CALIFORNIA 95965
PPiOIQE`S'33I4484
TO: Mr. Glenn Givins
After reviewing the plans for the addition.to the Holy Temple
Church of God in Christ at 4290 V C road I have-found no reason
for delay in that project.
Chief Ohlhausen
C',c L RECEIVE®
NOV 1.1 1999
- BUTTE COUNTY
rD `� e BUILDING DIVISION
0-41
l
e2 ee e,�
C av� �,, k r- -6 :*:& v py
Ge -.c,
1o. Se -el
1("ice. To
ti ccir 5 I eiMe�rs cJ �� I o• 4• q `i t 3• g 6
L
,� l e z4 C-11.
A
-
f
L A N D O F NATURAL WEALTH A N D B E A U T Y
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (53,0) 538-7541
FAX: (530) 538-2140
April 23, 1999
Holy Temple Church of God in Christ
4290 V Cave
Oroville, CA. 95966
Assessor Parcel Number: 036-021-049
Building Permit Number: 99-0768
This office reviewed the above referenced building plans. Please respond in writing to
each comment by creating a response letter. Indicate which detail, specification, or
calculation shows the requested information. Your complete and clear responses will
expedite the re -check and approval of this project. Please be sure to include on the
resubmittal the engineer's "wet" stamp, signature, registration number and expiration
date on all sheets of plans depicting the designed elements and cover sheets of
calculations. Provide additional information and/or make revisions to plans,
specifications and calculations as follows:
1. Engineered truss details and layout in duplicate (required prior to plan review) No
faxes!
2. Provide a complete code analysis for the existing building and the addition.
3. Plot plan, drawn to scale and signed by the preparer, with the path of travel and
parking shown.
4. The number of parking spaces will be determined by the Planning Division and the
number of disabled parking spaces are'based upon the amount of parking spaces.
Accessible spaces shall be located on the shortest accessible route to the accessible
entrance to the building.
5. Provide a lateral analysis foi• the new building.
6. A complete floor plan of the existing building will be required. Show the occupancy
of each area of the building. Indicate the location of the restroom facilities and the
accessibility to the disabled in the existing building.
7. Energy design compliance and supporting documentation.
8. Accessibility for the disabled is required throughout the new building, including the
platform. Disproportionate cost will apply to all other existing areas.
9. All areas of the remodel must be made accessible. The location of the seating for the
disabled within the Sanctuary must be arranged to allow fixed companion seating
adjacent to the wheelchair space (CBC '1104B.3.5). CBC Table 11B-1 shall determine
the number of wheelchair seating spaces.
10. High expansive soil is indicated in this area. The building foundation must be
designed for this condition.
11. Obtain Planning Division approval.
12. Contact Land Development about improvements.
13. Balance of Building Permit fees will be determined when the revised building plans
have been received.
14. Building plans will need to be reviewed by the Fire Marshall when the revised
building plans are received.
15. Complete and return the enclosed Hazardous Materials and Emissions Questionnaire.
16. Plan review has been discontinued due to the above mentioned items.
If you wish to discuss any requirements, you may contact me at (530) 538-7541 between
the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday.
Sincerely;
Glenn Gibbons
Plans Examiner
C.C. Thomas W. Norlie
2
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive Oroville, California 95965 • Telephone (530) 538-7541 PERMIT N(
(Rev. 12/96) APPLICATION AND RERMIT"
ASSESSOR PARCEL NUMBER
036-021-049
ZONING
BUILDING PERMIT
OWNER
HOLY TEMPLE
TELEPHO
SO. FT. OCC. BUILDING VALUATION
2,364
.OWNERS MAILING ADDRESS
4290 V C RD. OROVILLE C
CONTRACTOR'S NAME
OWNER
TELEPHONE
_
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
TMAILI GSARNELL
Fireplace
MAILING
LENDER'SAI
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20
Permit Fee $
,3
ARCHITECT OR ENGINEERS MAILING ADDRESS
Pian Checking Fee $
BUILDINGADDRESS
4290 V Q RD -ORO VILLE, CA
Energy Plan Checking Fee $
$
PERMIT FEE $-39
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap 1
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other CHURCH
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00 Je5,.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: 14
Gas piping system 1 - 5 outlets
15.00 . 0
Building sewer
15.0 .00
Mobile Home I S I G W
Q20.00
PERMIT FEE S
72.00
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service "OA OR LESS
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following rdason:
�- 1, 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.
,❑ 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service zouA TO 1000A
48.00
NEW CONST. DWELLING UP.
OR ADONS. ( 8 ACC. BIDS.
s0
3.5¢NT.
NON -REBID. T. MULTI.OUTLET
@7.50
POWER APPARATUS
8 SINGLE OUTLET CI0.
TU
Ex. Occup. OUTLET OR FIXRES
„ @ 100
SAL ,,y0
Ex. Occup. oU S RAID°El
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE $
88-00
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
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.)
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
f Rhwith comply with those rovisions.
X Date r�
Sig ature 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.
MECHANICAL PERMIT Fling Fee 20.00
Heating 2
Cooling 2
Hood
6.50
Ventilation
PERMIT FEi= S
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST TYPE d
TOTAL FEE $
HAz.
D. FEES IMP
X X
FLOOD
CDP
X
PARCEL ro
X X
HD
ISS
This permit is hereby Issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for Aich fees have been paid.
ate
PERMIT EXPIRES ON —�
rReceipt No.
ITE-D.D.S.- .D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD-APPLICANT(Date)
COUNTY OF BUTTE • DEPARTMENT OF DEVELOPMENT SERVICES • BUILDING DIVISION
7 County Center Drive a Oroville, California 95M • Telephone (530) 538.7541 PERMIT NO.
(Ror,tygs) 036 -CA/ —ot4`? APPLICATION AND PERMIT
as.a.oa.r�leaK+�•sw -
aD1'p
BUILDING PERMIT
own'rl
owwte
TmMO"a
SO. FT. OCC. BUILDING VALUATION
---------------
WAM
wawo Aooles.
cow7wJCrlolr u moot
Fireplace
hoose WARM A0000"
Total Valuation =
an
UCV499 N°•
Figno Fee = 20.00
Permit Fee
A%GWM= a or08M wae+s .DMU
Plan Checking Fee S
oe1Oa0°"ers
Energy Plan Checking Fee =
i
PERMIT FEE _
Won
ausavrars wl►w �
nwua w►
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
i USEOF8TRUCTURE
SF O Duplex O Mobilehome O Other
Solar or heat pump water heater 29.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New O Addition O Remodel O FMee O Insulation O Otlwr
Describe Work:
Gas piping Wstem 1 - 5 outlets 15.00
Building sewor 15.00
Moble Home ISIGIWI QgFqr42
PERMIT FEE _
ELECTRICAL PERMIT FI an,00
Main Service = a mss 29.00
*PERMIT FEE PAID �
SRA
SHERIFF $
OTHER $
a;
AMOUNT RECEIVED
*RECEIPT NUMBER
* TO BE PUT INTO COM
Main Service aeon, TO IOWA 48.00
owtuap occur. 3.SeM
OR Aoow. ' a ncc. aux. rr•
NMW rum 1.
ON110i0. Yul,TFOYTIlr @7.50
/OwQ AMAMT{A
a
EX. Occup. olmar oil PMWD ew Z -A
Ex. Occu . ou M aro a 5.00
Temporary Service 23.00
Moble Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE _
PERMIT Filing Fee 20.00
in
Healing
CooGn
Hood 6.50
Ventilation
PERMIT FEt f
Moble Home installation Fee $
Energy Inspection Fee s
C`C
CONST. "PC TOTAL. FEE S
-j-
°. no Hr
"°°°
cor
""`a
ro
"
sauc
This permit Is hereby Issued under the applicable Provisions
of the Butte County Code and/or Resolution$ to do work
Indicated above for which fees have been paid.
By Date --
PERMIT EXPIRES ON
MIN h
6 ate`:
Lya-
1;utte tount
L A N D O F N AT U RA L W EA L T H A N D B E A U T Y
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE • OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (530) 538-7541
FAX: (530) 538-2140
Re: Building Permit # 99-0768
Expiration Date: 1-27-01
A.P.# 036-021-049
With reference to the above subject, our records indicate that your building permit expires on the above date
and your permit falls into one of the category marked below:
[ Permit work started, but not completed. Permit may be renewed for 'h the original building permit
fee (plus a $20.00 filing fee). The renewal permit will extend the building permit for an additional
year from the original expiration date. Should you not renew your permit within 30 days of the
expiration date, all work must cease until a new building permit has been issued. For your convenience,
we are enclosing a renewal application form and owner -builder form to be completed and signed by
you where indicated and returned to this office together with the fee shown. Please return all copies
of the application form.
[ ] No inspections have been made on permit work. Inspections are required to verify code compliance. .
We are unable to renew a permit where the work has not been started and inspected prior to permit
expiration. After expiration of your permit, no work may be started until a new permit has been issued.
[ ] A final inspection has not been made on permit work. Final inspection approval is required before
occupancy. Our field inspector has verified that the building is occupied. Occupancy must cease until
a final inspection can be made and final approval given. You have 30 days to voluntarily cease
occupancy or to present an acceptable plan for abatement or corrective actions to be taken by you.
If OswVtfurds are in error or should you have any questions concerning this matter, please contact the
office.
Thank you for your, prompt attention concerning this matter.
YgVrs very truly,
C. Vieua, C.B.O.
Building Inspection
MCV:lt
Attachments
Chico Office - 411 Main Street, Chico / 891-2751
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 4abor and materials for construction of the
proposed property improvement: YESIM 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: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I .plan to provide portions of this work,' but I have hired the following persod to
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.per-sons to
provide the work indicated: w
NAADDRESS PHONE TYPE OF'WORK
ME
SIGNED:
PROPERTY OWNER /
S ER:
DATE:
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California Health`atd Safety-Code.-
This
afety Code.
This verification must be completed and returned to our office before
we are permitted to issue the permit.
►J -,
O.B.-1
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 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 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 compensationcontributions.
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 Iniernal 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.
4 `'-
t ,
i ply, MicVi ira, C.B.O..
uilding Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.