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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
'OFFICE #: (530) 538-7541
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally 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: f License Number: / )2
Dale: 3 Contractor: J"'rf Ile • l� c,/ . l a
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' Slate License Law for the following reason (Sec. 7031.5
Business and Professions Code- Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior
to its Issuance, also requires the applicant for such permit to rile a
signed statement that he or she Is licensed pursuant to the provisions of
the Contractor's Slate License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penally of not more than rive hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is not
Intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors' Slate License Law does not apply to an
owner of property who builds or Improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such Improvements are not Intended or offered for
sale. If however, the building or Improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or Improve.for the purpose of
sale.).'
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' Stale License Law does
not apply to an owner of properly who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code
Dale: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
O 1 have and will maintain a certificate of consent to self -Insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
Is Issued.
❑ 1 have and will maintain workers' compensation Insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit Is issued. My workers' compensation
Insurance carrierandpolicy number are:
Carrier:
Policy N: �/ ir� 33✓�% r% O—.
❑ I certify that in the performance of the work for which this permit Is
issued, 1 shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that If I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provvi ns.
Dale:
Applicant:
WARNING: Fallure to secure workers' compensation coverage Is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), In addition to the cost of
compensation, damages as provided for In Section 3706 of the Labor
code, Interest, and attorney's fees.
PERMIT NO.
BP050763
Issued Date: 03/23/2005 APN: 036-101-034-000
Site Address: 2533 V-6 RD ORO
Map Index:
Description: replace 9 windows
Owner: TAYLOR CLIFFORD D & SHEILA L
2533 V 6 RD
OROVILLE, CA
95966-7114
Applicant: P F REILLY &,COMPANY INC
3028 ESPLANADE
SUITE F.95973
530-898-0833
Contractor: P F REILLY & COMPANY INC
3028 ESPLANADE
SUITE F 95973
530-898-0833
License #: 711037
Architect:
Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code: CRO
' r
I '
l71
CONSTRUCTION LENDING AGENCY This permit Is . a Eby Is ued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there Is a construction lending agency for the Resolulio o do work I led a vd for hrch fees have been paid. 7
performance of the work for which this permit is issued (Sec 3097 CIV.)
BY Dale:
Name:
PERMIT EXPIRES ON:
Address: - _ (Date)
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage,
handling and use of hazardous materials.
O Notification In accordance with Section 19827.5 of California Health & Safely Code is not applicable to the scheduled construction of this pro 'act.
O Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information Is correct, and that I am the o>�ainy
authorized gent of the owner. I agree to comply with
all county and slate laws relating to building construction. I acknowledge it Is unlawful to alter the substal form or ocument o�ounty. I hereby
authorize representatives o ButteCounty to enter upon the above mentioned property for inspection pur
Prihl Nam
a: (/ Signature:
Date:
❑ Owner ❑ Contractor Mtge t for OwnerAgent for Contractor
ts. %,. nuuamp rennn v 1- 10 4 v4 i
.I—
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICA TION
Website: www.buttecounty.net/dds
**PLEASE PRINT CLEARLY**
CONTRACTOR
OWNER
Last Name .
City (_/2 -C"v
irst m
Address'.57Y.7
Q
City
E-mail
State/v
Zip
Pho . ,
Fax
E-mail
State License Number
CONTRACTOR
NameJI;, A:�
U
AddressY.�.
City (_/2 -C"v
State
Zip 3
Phone8 U8��3
Fax
E-mail
Lic. # 03
Class.)
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Page
Fax
E-mail
Date Approved:
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
For office use only:
Zoning
PropertAddress � � 6 2`'
-
Flood Zone
Cross Street
SRA
I Yes I No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
C
PERMIT
NO.
BPDS076
BIN #
LOCATION
AP# �y o6_ —10 ,_ 03l�
/
PropertAddress � � 6 2`'
-
City
Cross Street
SRA
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
Date: `�, `�� T%
LENDING AGENCY
Name
Address
1 Description or Scope of Work:
i L1
� / 6s -t/ .5 •.�
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Page 1 of 2
REV 7-2/-U4
Received b, Amount:
Bldg
C�
SRA
Receipt #: _ 1
Sheriff
SMIP
�
�
Other
Date: `�, `�� T%
� Vie,
_Total
Page 1 of 2
REV 7-2/-U4
SUBMITTAL & PERMIT REQUIREMENTS
The -following drawings and specifications must be submitted to the Building Division in order to apply for a
permit.
INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑
1.
Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑
2.
Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑
3.
Engineered truss details and layouts in duplicate (if required). No faxes!
❑
4.
Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑
5. ,.
Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑
6.
Manufactured homes: (A) Data sheets and installation inst,;(B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑
7.
Metal bidgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑
8.
Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑
9.
Site plan and business license approval from the City of Biggs.
❑
10.
Letter of intent for non-residential buildings.
❑
11.
Detached Accessory Building Form filled out by the owner (if required).
❑
12.
Hazardous Material Form (for Commercial Buildings only).
❑
13.
Sanitation and site plan approval from the Environmental Health Department.
Remaining
items needed to issue the permit. Additional items may be required after Plan Check and Planning
review
(May
require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04