HomeMy WebLinkAbout078-310-024' f P
CHUCK�UACOBSENcv,v
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2;89 -V6 --Rd,`• OR&ViTle�•
—87E(new ele.ser/SF)
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B07 -041I 'lam` �_ 078-310-024
RESIDENTIALSFD-Custom/Model
NSF DWELLING, EX 8ITE(1399) "
2589 V-6 RD }
KOMBRINK, WILLIAM & MARIE
B07-1788. 078-310-024
MISCELLANEOUS Fireplace/Wood Stove
INSTALL WOOD STOVE 9
2589,V-6
RD.
SHERRICK, WILLIAM & DONNA
oa-as �..
O
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds .'
PROJECT INFORMATION'. e= -
y
Site Address: 2589 V-6 RD
Owner:
Permit NO: B07-1788
APN: 078-310-024
SHERRICK, WILLIAM & DONN
Issued Date: 08/22/2007 By KCG
Permit type: MISCELLANEOUS'
2609 V-6 RD
Subtype: Fireplace/Wood Stove
OROVILLE, CA 95966
Expiration Date: 08/21/2008
Description: INSTALL WOOD STOVE
(530) 534-7036
Occupancy: Zoning:
Contractor
Applicant:
Square Footage:
SHERRICK, WILLIAM & DOP
Building Garage •Remdl/Addn
2609 V-6 RD
OROVILLE, CA 95966
Other Porch/Patio Total
(530)534-7036
FEE INFORMATION _ x -
DBMSC Fireplace Pre-fab/Metal $116.00
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
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.
X 08/22/2007
Contractor's Signature Date
WORKERSCOMPENSATION DECLARATION '
'
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers' Compensation insurance carrier and policy number are;
Cartier: Policy Number: Exp. Date:
(This section need not be competed if the permitis or on7 ehundred 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 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 C de, I shall forthwith comply with those .
provisions.
X 08/22/2007
Signature Date
WARNING: FAILURE TO SECURE WORKERS' C MPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
CONSTRUCTION LENDING,AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lenders Address,
City State Zip
$116.00
Balance Due: $0.00 Receipt No:. B4328
OWNER / BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof that he or she did not build or
improve for the purpose of sale.).
ElI, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ I AM EXEMPT under Section B. & P.C. for this
08/22/2007
Owners Signature Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned 94perty for inspection purposes. I hereby certify that I am the
property o;l;ner or am au%0yed toAt on the property owners behalf.
Owner 1:1 Contractor OR DAgent for Owner Agent for Contractor
FILE COPY
�QT BUTTE COUNTY
0 o DEPARTMENT OF DEVELOPMENT SERVICES
o o BUILDING PERMIT APPLICATION.
0 0 OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
o__ _ �, - o A FEE WILL BE REO UIRED AT TIME OF APPLICATION
Website: w. tw.buttecounty.net/dds
�OUN� **PLEASE PRINT CLEARLY**
APPLICANT INFORMATION
OWNER INFORMATION
Last N e
c
City 13v )ZG� Stat�?,�
First Name
ZL /fid
Mailing Address
r
City
State
Zipr-
Phones 4
Fax
F
E-mail
Lic. #
APPLICANT INFORMATION
CONTRACTOR
Name
City 13v )ZG� Stat�?,�
Address
Phone F
S 36 ;S5 3476
City
No
State
Zip
Phone
Fax
E-mail
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City 13v )ZG� Stat�?,�
Address
Phone F
S 36 ;S5 3476
City
No
State
Zip
Phone
Fax
E-mail
State License Number
APPLICANT INFORMATION
Name,*
ilL c
Address v G
City 13v )ZG� Stat�?,�
Zipet
v.
Phone F
S 36 ;S5 3476
E-mail
APPLICANT SIGNATURE
X
PERMIT
NO.
607-OS16
BIN #
PROJECT LOCATION
AP# a A6
Property Addres
CityQ LGG G'� ..
WORKER'S COMPENSATION .
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Sq FT- Living. G Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
Flood Zone
SRA
Yes
No
Occ.
Type Const.
'Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-2140 Fax
www.buttecounty.net/dds
OWNER -BUILDER INFORMATION
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed
by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from
possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by
law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and
protection:
° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire
project and such persons are not licensed as contractors or subcontractors, then you may be an employer.
° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal
° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions.
There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance.
° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business
Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through thier own employees,
without a license contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is
providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321
-CLSB (2752) or by accessing thier website at www.CSLB.ca.gov.
PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE
AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED.
OWNER BUILDER VERIFICATION
PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING
PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED.
1. I PERSONALLY PL TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT�OR NO)
v
2.((HAV ^ VE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK.
3. 1 HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION:
NAME
ADDRESS CITY,
PHONE CONTRACTORS LICENSE NO
4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE
THE MAJOR WORK:
NAME
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED:
NAME ADDRESS PHONE TYPE OF WORK
Description: INSTALL WOOD STOVE
Reference Number: B07-1788
Applicant Name: SHERRICK, WILLIAM & DONNA
Owner's Name: SHERRICK, WILLIAM &DON�NAA AP ;
Signature of Property Owner:i�> a Date
078-310-024
.0 -Z9 -<5 7
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24. HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license
is in full force and effect.
X 04/02/2007
Contractor's Signature Date
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. -
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers' Compensation insurance carrier and policy number are;
Carrier: Policy Number: Exp. Date:
(This section need not be completed if the permit—is—For ona hundred dollars ($100) or less.)
X71 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
(LSM ISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
provisio "
j( 04/02/2007
Signa ure Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lender's Address
City State Zip
Balance Due: $0.00 Receipt No: B2424
. OWNER / BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500];
Please check one of the following:
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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof 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 Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ I AM EXEMPT under Section B. 8 P.C. for this reason:
Owner's Signature
04/02/2007
Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
property owner or am authorized to a;j on the property o is behalf.
e n .a 04/02/2007
Owner 1:1 Contractor OR.Agent for Owner ElAgent for Contractor
FILE COPY
PROJECT INFORMATION
Site Address: 2589 V-6 RD
Owner:
Permit NO: B07-0411
APN: 078-310-024
SHERRICK, WILLIAM & DONN
Issued Date: 04/02/2007 By' GLB
Permit type: RESIDENTIAL
2609 V-6 RD
Subtype: SFD-Custom/Model
OROVILLE, CA 95966
Expiration Date: 04/01/2008
Description: NSF DWELLING, EX SITE(1399)
(530) 534-7036
Occupancy: R-3 Zoning:
Contractor
Applicant:
Square Footage:
WILLIAM SHERRICK
Building Garage Remdl/Addn
2609 V-6 RD
1,399 440
OROVILLE, CA 95966
Other Porch/Patio Total
(530) 534-7036
1,839
FEE INFORMATION
DB R3 Dwelling -Custom, Model
$1,458.05
DB R3 Dwelling -Custom, Model
$972.03
DB SRA Fire Plan Check Fee
$109.98
DBFIRE Fire Inspection (SRA) R
$102.70
DBFIRE SRA Fire Plan Review (S
$102.70
DBSMIP Residential
$10.15
Total Charged:
$2,755.61 Fees Paid: $2,755.61
LICENSED CONTRACTOR'S DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license
is in full force and effect.
X 04/02/2007
Contractor's Signature Date
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. -
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers' Compensation insurance carrier and policy number are;
Carrier: Policy Number: Exp. Date:
(This section need not be completed if the permit—is—For ona hundred dollars ($100) or less.)
X71 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
(LSM ISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
provisio "
j( 04/02/2007
Signa ure Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
the performance of the work for which this permit is issued. (3097 civ. code)
Lender's Address
City State Zip
Balance Due: $0.00 Receipt No: B2424
. OWNER / BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500];
Please check one of the following:
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 Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
the 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 improvement is sold within one
year of completion, the owner -builder will have the burden of proof 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 Provessions Code:
The Contractor's License Law dows not apply to an owner of the property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ I AM EXEMPT under Section B. 8 P.C. for this reason:
Owner's Signature
04/02/2007
Date
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
injury, including death, and property damage caused by, arising out of, or in any way connected with
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
property owner or am authorized to a;j on the property o is behalf.
e n .a 04/02/2007
Owner 1:1 Contractor OR.Agent for Owner ElAgent for Contractor
FILE COPY
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
A FEE WILL BE REQUIRED AT TIME OFAPPLICATION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
APPLICANT SIGNATURE
X v
PROJECT LOCATION
AP#
Property Sdress�
City
PERMIT
NO.
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Ca..cJ I a 4C/ i 1 AJ ®)Z' Ajc
t/ y4 O 4
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
OWNER INFORMATION
Last Nae
SRA I es No
First Na�nt
Mailing Add
Z&
g
City Q
State
StateC�
zipz
Phone
Fax
Fax
E-mail
Lic. #
APPLICANT SIGNATURE
X v
PROJECT LOCATION
AP#
Property Sdress�
City
PERMIT
NO.
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Ca..cJ I a 4C/ i 1 AJ ®)Z' Ajc
t/ y4 O 4
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
CONTRACTOR
Name
SRA I es No
Address
p Const.
City
State
Zip
Phone
PhoneFax
,5
Fax
E-mail
Lic. #
Class
APPLICANT SIGNATURE
X v
PROJECT LOCATION
AP#
Property Sdress�
City
PERMIT
NO.
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Ca..cJ I a 4C/ i 1 AJ ®)Z' Ajc
t/ y4 O 4
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
ARCHITECT/ENGINEER
Name
SRA I es No
Address
p Const.
City
State
Zip
Phone
PhoneFax
,5
Fax
E-mail
State License Number
APPLICANT SIGNATURE
X v
PROJECT LOCATION
AP#
Property Sdress�
City
PERMIT
NO.
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Ca..cJ I a 4C/ i 1 AJ ®)Z' Ajc
t/ y4 O 4
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
APPLICANT INFORMATION
Name
SRA I es No
Occ.
p Const.
Address
City
State
Zipe,—, ! ��
PhoneFax
,5
O
E-mail
APPLICANT SIGNATURE
X v
PROJECT LOCATION
AP#
Property Sdress�
City
PERMIT
NO.
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Ca..cJ I a 4C/ i 1 AJ ®)Z' Ajc
t/ y4 O 4
Sq FT- Living Garage Open Cov
❑ • Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
Flood Zone
SRA I es No
Occ.
p Const.
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 75965
(530) 538-7601 Telephone
(530) 538-7785 Fax
www.buttecounty.net/dds
PERMIT APPLICATION DATA SHEET
Reference Number: B07-0411 Date: 03/02/2007
Location: 2589 V-6 RD By: KCG
Parcel Number: 078-310-024 Sub Type: SFD-Custom/Model
Owner Name: KOMBRINK, WILLIAM & MARIE Phone:
Description: NSF DWELLING, EX SITE(1399)
The above permit application has the following Clearances required prior to permit issuance. Please contact each department
indicated below regarding specific requirements pertaining to your permit application.
Yes
No
DRAINAGE DISTRICTS
❑
Thermalito Irrigation District, 410 Grand Avenue, Oroville CA 95965 - (530) 533-0740
❑
LOAPUD, 1960 Elgin Street, Oroville CA 95966 - (530) 533-2000
E]
City of Chico, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711
PARKS & RECREATION DISTRICTS
❑
Chico Area Recreation District, 545 Vallombrosa, Chico CA 95926 - (530) 895-4711
Durham Park & Recreation District, 9447 Midway, Durham CA 95938 - (530) 345-1921
Father River Recreaction & Park District, 1200 Myers Street, Oroville CA 95966 - (530) 533-2011
61mv A0 011w -
F1
❑
Paradise Parks & Recreation, 6626 Skyway, Paradise CA 95969 - (530) 872-6393
SCHOOL DISTRICTS
❑
Biggs Unified School District, 300 B Street, Biggs CA 95917 - (530) 868-1281
❑
Chico Unified School District, 1163 East 7th Street, Chico CA 95926 - (530) 891-3006
E]
Durham Unified School District, 4920 Putney Drive, Durham CA 95938 - (530) 895-4675
Gridley School District, 429 Magnolia, Gridley CA 95948 - (530)*846-4723
Marysville School District, 1919 B Street, Marysville CA 95901 - (530) 741-6000
Q u�l a Eleemeenrtary School District, 2795 Yard Street, Oroville CA 95966 - (530) 532-3000
Oroville Union High, 2211 Washington Ave, Oroville CA 95966 - (530) 538-2300 Ext: 105
Paradise Unified School District, 6696 Clark Road, Paradise CA 95969 - (530) 872-6400
OTHER
Recorded copy of Agricultural Acknowledgment Statement- See Attached Instructions
City of Biggs Planning Department,. 3016 Sixth Street Biggs CA 95917 - (530) 868-5447
Other:
Other:
Other:
Signature of Property Owner:�Date: 03/02/2007
FILE
BUTTE COUNTY FEE SUMMARY
7 County Center Drive
'Oroville, CA 75965
Permit Number: B07-0411
Job Address: 2589 V-6 RD
Contractor:
Department of Development Services
Phone (530) 538-7541 Fax (530) 538-2140
Printed: 03/02/2007
4:10 pm
Fee Description
Account Number
Fee Amount
Paid Date
Pmt Amt
DB R3 Dwelling -Custom, Model
DBF DWLNG CSTM/MDL N Plan Rvv
0010-440001-4210500-1010
$972.03
03/02/2007
$972.03
DBF DWLNG CSTM/MDL N Permit F(
0010-440001-4210500-1010
$1,458.05
DBFIRE Fire Inspection (SRA) R
0100-450001-4617240-1010
$102.70
03/02/2007
$102.70
DBFIRE SRA Fire Plan Review (S
0100-450001-4617240-1010
$102.70
03/02/2007
$102..70
DB SRA Fire Plan Check Fee
0010-440001-4210500-1010
$109.98
DBSMIP Residential
1001-0-280-1011298
$10.15
2,755.61
$1,177.43
Printed By: Kourtni Graham Balance Due: $1,578.18
At the time of permit application, I was advised the above fees are required prior to issuance of the permit. These fees may change during the plan
checking process.
Signature: Date: 03/02/2007
Pursuant to Government code Section 66020, you are hereby notified those items listed above may have been imposed on your project. You have 90 days
from the date of approval of the project or from the impostion of the above referenced items during which you may request a protest. The requirments
for a protest are specified in Government Code Section 66020(a).
di R
RECORDING REQUESTED BY
Bidwell Title & Escrow Corr any
3 C� AND WHEN RECORDED MAIL TO
Naine William E. Sherrick
Street
Address 2589 V-6 -
Road
Oroville, CA 95966
City, State
Zip
Order No. 0022$929-002
1111111 lI111li! 11!11 l flll fl 1111 l 11
Recorded I REC FEE 10.00
Official Records 1
County of I
Butte I
CAIdDACE J. GRUBBS I
County Clerk-Recorderl
I
I CW
09:NAM 17 -Jan -2007 1 Page 1 of 2
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Parcel No. 078-310-024 GRANT DEED AQy
THIS FORM FURNISHED BY BIDWELL TITLE & ESCROW COMPANY t7n
The Undersigned Grantor(s) Declarers) Documentary Transfer Tax is $P— -r ( q
❑ City/Town of 0 computed on full value of interest or property conveyed, or
0 Unincorporated Area ❑ full value less value of liens or encumbrances remaining at
the time of sale
❑ Monument Fee of $10.00
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
William E. Sherrick, who acquired title as William Sherrick, and Donna J. Sherrick,
hereby GRANT(s) to
William E. Sherrick and Donna J. Sherrick, husband and wife, as Joint Tenants
the following real property in the ❑ City of
County of Butte, State of California:
0 Unincorporated Area
SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF
William E. Sherrick Donna J. S116rrick
y
Document Date: January 8, 2007
State of California
County of Butte
On. %'' i 0
SS.
before me,
Notary Public, personally appeared (,A.7111d ,
rrl c l c..
Personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed
the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand'aa' d official �eal. ^ �j
Signature
FOR NOTARY SEAL OR STAMP'
MAIL TAX STATEMENTS TO: Same as Above
/ BTEC/GRANTDEED
e
JODIE FINATO
COMM. 15531595
J-0
PJOTF:R`1 PUBUGGA1_IF02041A e'
t
;..
Cutnrri. E;; iras eC;a• E,;, 9r,09
•_ ,,��;�,,v-�:,.,,;; V�v�%•w�Sr�-,r�r%�iv�-,..z V"eI.•V"'rJ'
MAIL TAX STATEMENTS TO: Same as Above
/ BTEC/GRANTDEED
Order No. 00228929-002
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS:
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS
FOLLOWS:
A PORTION OF LOT 4, BLOCK 23 OF VILLA VERONA SUBDIVISION, ACCORDING TO THE OFFICIAL MAP THEREOF
RECORDED JANUARY 17, 1889 IN BUTTE COUNTY RECORDERS OFFICE MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT A POINT IN THE CENTER LINE OF AN "UNAMED STREET", (NOW KNOWN AS V-6 ROAD), SAID
POINT BEING THE SOUTHWEST CORNER OF SAID LOT 4, BLOCK 23 OF VILLA VERONA SUBDIVISION; THENCE
EAST ALONG THE CENTER OF SAID STREET 330 FEET TO THE TRUE POINT OF BEGINNING FOR THE HEREIN
DESCRIBED PARCEL OF LAND; THENCE AT RIGHT ANGLES NORTH ALONG THE LINE BETWEEN LOTS 4 AND 5 OF
SAID BLOCK 23,264 FEET; THENCE AT RIGHT ANGLES WEST, 164 FEET TO THE NORTHEAST CORNER OF THAT
PARCEL- OF LAND DESCRIBED IN A DEED TO CHARLES M. JACOBSON RECORDED UNDER BUTTE COUNTY
RECORDER'S SERIAL NUMBER 92-26050 BUTTE COUNTY RECORDERS OFFICE; THENCE SOUTH ALONG THE EAST
LINE OF SAID JACOBSON PARCEL 264 FEET TO THE SOUTHEAST CORNER OF SAID JACOBSON PARCEL, SAID POINT
BEING IN THE CENTER OF SAID V-6 ROAD; THENCE EAST ALONG SAID CENTER OF V-6 ROAD, 164 FEET TO THE
POINT OF BEGINNING AND THE END OF THIS DESCRIPTION.
THE BASIS OF BEARINGS FOR THIS DESCRIPTION IS THE CENTERLINE OF SAID V-6 ROAD TAKEN AS EAST.
THIS DESCRIPTION REDEFINES THAT PARCEL OF LAND AFTER THE BOUNDARY LINE MODIFICATION APPROVED
BY THE BUTTE COUNTY ADVISORY AGENCY ON DECEMBER 16, 1991 AN NO NEW PARCELS ARE BEING CREATED.
AP NO. 078-310-024
Butte County Department of Public Works
J. MICHAEL CRUMP, DIRECTOR
LAND DEVELOPMENT DIVISION
Storm Water Managment Program
7 County Center Drive .
Oroville, CA 75965
(530) 538-7266 Telephone
(530) 538-7171 Fax
www.buttecounty.net/dds
O
O
O
O
0
W'��g
National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm
Water Permit and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgment
[LESS THAN 1 ACRE 1
Reference Number:
B07-0411
Date: 03/02/2007
Location:
2589 V-6 RD
By: KCG
Parcel Number:
078-310-024
Sub Type: SFD-Custom/Model
Owner Name:
KOMBRINK, WILLIAM & MARIE
Phone:
Description:
NSF DWELLING, EX SITE(1399)
By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more
of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California
Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but
when combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm
Water Permit from the state, of California Regional Water Quality Board.
I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water
Permit from the State of California Regional Water Quality Control Board for this project that disturbes one acre or
more of land may result in revocation of grading and/or other permits or other santions provided by law.
Signed:a-
Title: a.,0
FILE
Dater 03/02/2007
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 75965
(530) 538-7601 Telephone
(530) 538-7785 Fax
www.buttecounty.net/dds
OWNER -BUILDER INFORMATION
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed
by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from
possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by
law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and
protection:
° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire
project and such persons are not licensed as contractors or subcontractors, then you may be an employer.
° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal
° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions.
There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance.
° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business
Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through thier own employees,
without a license contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is
providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321
-CLSB (2752) or by accessing thier website at www.CSLB.ca.gov.
PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE
AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED.
OWNER BUILDER VERIFICATION
PLEASE COMPLETE THIS FORMAS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING
PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED.
I PERSONALLY PLAN TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT. OOR NO)
2. I (HAVE/HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK.
I HAV ONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION:
E
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE
THE MAJOR WORK:
NAME
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED:
NAME ADDRESS PHONE TYPE OF WORK
Description: NSF DWELLING, EX SITE(1399)
Reference Number: B07-0411
Applicant Name: WILLIAM SHERRICK
Owner's Name: KOMBRINK, WILLIAM & MARIE AP # : 078-310-024
Signature of Property Owner: {����,,, Date: 3— ;Z —<57
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 75965
(530) 538-7601 Telephone
(530) 538-7785 Fax
www.buttecounty.net/dds
NOTICE TO BUILDERS
Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In
addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental
Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to
expedite your permit:
0 Make sure your application is complete.
0 Be responsive to requests from County departments for any additional materials or requirements.
The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes
without a complete application adds to processing time.
Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not
started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to
expiration an indefinite number of times, provided construction progress has been documented by the Building Division during
each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In
order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking
and documentation may be required. Upon completion of work covered by this permit, please contact this office for final
inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is
issued without a final inspection.
EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY
Application for which a permit has not been issued will expire one year after date of application.
Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications
(not yet issued) must be requested within two years from the date of fee payment. Fees paid at the time of application are
for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn
before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge of
$54.99 to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration
of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any
refund amount) to determine no work was done.
Fee/refund information can be read on-line at http://municipalcodes.lexisnexis.com/codesibutteco/
Reference Number: B07-0411 Date: 03/02/2007
Location: 2589 V-6 RD
Parcel Number: 078-310-024
Owner Name: KOMBRINK, WILLIAM & MARIE Phone:
Description: NSF DWELLING, EX SITE(1399)
Signature of Property Owner: Date: 03/02/2007
FILE
M
d
P�
-eh
P
P
n d1 we itQAD
I _
A RESIDENCE FOR: OO[AVOR MOlsi
BILL SERRICK
O `
2589 VH8 ROAD OmVOr aaovuPO ou 1"7
i7 95mOROVILLE CALIF. 83988 TOM41M
(m) eu-ww
rAX
(m) w-sm
r AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95965
COPY of Document Recorded
13 -Mar -2007 2007-0012119
Has not been compared with
original
BUTTE COUNTY RECORDER
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes,.
and,residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones. and on '
adjacent property should be prepared to accept, such inconvenience or discomfort from normal, necessary farm
operations.
All that real property situate in the County of Butte, State of California, described as follows,
DatePROPERTY OWNERS:
1
Wilms EAV"_.0 54.eFrl'& DOi1r/r! -:!�w _s6ei-hiCt�'
r i
State of California
County of (3u r
On MAr-c_1\ before me,
personally appeared W i 111Ly%,x E8 u,r p L G.JCJ I wit» 11JG 3Fr. t� �I.e�t`l� IC . {>e�69Ae�ly
- muwn-tv-me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his4ker/their authorized
capacity(ies); and that by hisAwr/their signature(s) on the instrument, the person(s) or the entity upon behalf of which
the person(s) acted, executed the instrument.
WITNESS my hand and official seal. t
�,. JAMES LAMAR KINSER
Signature. Seal: -COMM. #1695391
• NOTARY PUBLIC f CALL 0M
~ BUTTE COUMY ••
A.P. # m % -- Z IQ — 01L 91 CM. FxDiros Sept 23, 2010
,i ,• ,� ,_ Order No. .00228929-002
EXHIBIT A
THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS
ALL THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS
FOLLOWS:
A PORTION OF LOT 4, BLOCK 23 OF VILLA VERONA SUBDMSION, ACCORDING TO THE OFFICIAL MAP THEREOF
RECORDED JANUARY 17, 1889 IN BUTTE COUNTY RECORDERS OFFICE MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT A POINT IN THE CENTER LINE OF AN "UNAMED STREET", (NOW KNOWN AS V-6 ROAD), SAID
POINT BEING THE SOUTHWEST CORNER OF SAID LOT 4, BLOCK 23 OF VILLA VERONA SUBDMSION; THENCE
EAST ALONG THE CENTER OF SAID STREET 330 FEET TO THE_TRUE POINT OF BEGINNING FOR THE HEREIN
DESCRIBED PARCEL OF LAND; THENCE AT RIGHT ANGLES NORTH ALONG THE LINE BETWEEN LOTS 4 AND 5 OF
SAID BLOCK 23,264 FEET; THENCE AT RIGHT ANGLES WEST, 164 FEET TO THE..NORTHEAST CORNER OF THAT
PARCEL OF LAND DESCRIBED INA DEED TO CHARLES M. JACOBSON RECORDED UNDER BUTTE COUNTY
RECORDER'S SERIAL NUMBER 92-26050 BUTTE COUNTY RECORDERS OFFICE; THENCE SOUTH ALONG THE EAST
LINE OF SAID JACOBSON PARCEL 264 FEET TO THE SOUTHEAST CORNER OF SAID JACOBSON PARCEL, SAID POINT
BEING IN THE CENTER OF SAID V-6 ROAD; THENCE EAST ALONG SAID CENTER OF .V-6 ROAD, 164 FEET TO THE
POINT OF BEGINNING AND THE END OF THIS DESCRIPTION.
THE BASIS OF BEARINGS FOR THIS DESCRIPTION IS THE CENTERLINE OF SAID V-6 ROAD TAKEN AS EAST.
THIS DESCRIPTION REDEFINES. THAT PARCEL OF LAND AFTER THE BOUNDARY LINE MODIFICATION APPROVED
BY THE BUTTE COUNTY ADVISORY AGENCY ON DECEMBER 16, 1991 AN NO NEW PARCELS ARE BEING CREATED.
AP NO. 078-310-024
PERMIT NO.:
16-07
Lake Oroville Area Public, Utility District
1960 Elgin Street
OROVILLE, CALIFORNIA 95966
(530) 533=2000
DISTRICT APPROVAL AND VERIFICATION
OF BUILDING SEWERS INSPECTION
This verification form must be submitted to the Butte County Department of Public Works Building
Department prior to issuance of a building or occupancy permit, whichever is applicable.
Prior to final approval of a Building or an Occupancy Permit by Butte County, a copy of this verification
form, signed off.by Lake Oroville Area Public Utility District, must be submitted to Butte County.
Date:
Applicant:
March- 9, 2007
DOnna Sherrick
Applicant Address: 2609 V-6 Rd., Oroville, CA 95966
Applicant Phone No.: (530) 534-7036
Property Locations(s): 2589 V- 6 Rd.
Villa Verona Subdivision, Lot #4, Block #23
A. P. NO.(s): 036-101-063-V / 078-310-024-V
Fees due: No fees due/connecting to existing sewer
New Single Family Dwelling
Application for service
E OROVILLE AREA
C UTILITY DISTRICT
Inspection(s) made and successful test(s) observed:
Location:
M
Lake Oroville Area Public Utility District release to close permit:
Date:
❑ - In Service
By:
❑ - Locked Out
Date:
White - Customer Green - Office Final Yellow - CustomerFinal Pink - FOS Fina/ Gold -FOS
RESIDENTIAL BUILDING. RECORD
Jtt.rJy�yG..br rY Iit°ItP/
ADDRESS
DESCRIPTION OF BUILDING
,f PARCEL
SHEET____2OF 2- SHEETS
CLASS d SHAPE
CONSTRUCTION
STRUCTURAL
EXTERIOR
ROOF
LIGHTING
AIR CONDITION
ROOM AND FINISH DETAIL
Unit
Areo
i rr -- •
Unit
Cost
Light
nit
Cost.
Frame
Unit
Cost
Stucco on
Fla t 14Pifch
Cost
Wiring_Realing
Cost
nit
Cost
Cooling
FLOORS
ROOMS 8 / Z
FLOOR FINISH
Moterlol Grade TRIM
INTERIOR FINISH
_
Sub -Standard
1,.." xu "- Y4r
i/ S�e��a
_
f Goble /
0
K.T.
Conduil
forced
Cleon'q
wolfs
Ceilings
ARCHITECTURE
_
Standard
Sheathing
Siding "x °
Hip /
B.X.
Coble
Gravity
!tumid.
All
"c1
Above-Stondord
Concrete Block
Shed 14
Fixtures
Wall Unit
Stories
Special
B.$ B. FEE_
Cut Up
Few
Cheap_
Ent Holl
t .'
-
' T.Y_ PE
Brick
Shingle
Dormers
Avg.
Afed.
Floor Unit
Living
Use ) Desi
n
FOUNDATION
Adobe
_
Shake
_
Roft "x -
Alany
Special
Zone Unit
Dining
i
Single
Double
Concrete
Reinforced
,)(
Floor ✓oisi: •
/$ : s. "x �'= L`1'
B. 8 B. T4-6. G.
Gutters
I
PLUMBING
Central ••
Bed
_
Duplex
_
_
Brick
2-9 'x ~
Brick
Shingle
poad Sid.
Bed
AeortrnenI
Wood
Sub -Floor
Stone
Shake
Oil Burner
Flol-Court
Piers
Concrete Floor
WINDOWS
Tile
Sink
pry s p .- :i G%
j
1.3
/
NORMAL % GOOD'
Aloiel
_'
D•H Casement
We Trim
Laundry
M -B. TU.
/ dfi
5 -
_
Insulated Ceilings
Melol Josh
Compo.;/
Water Hth-Auto.
lFireploce
Kitchen
Units
l/envy
Insulated Walls
Screens
Compo. Shingle
Drain 8d.1 Moleriol:
�, Lgth: Ft.
Slosh:
CON57-RUCTION
_Light
RECORD
EFFEC.
YEAR
APPR.
YEAR
NORMAL
% GOOD
_Water-Softner
RATING (E,G,A,F,P)
BATH DETAIL
_
-- pd mit
No. For
Ant Dote
Amount
Age Remamg
g Life
Tob/e %
Cond. Arch. Func. Con-
. AHr. Plan farm
Sloro es ce Work
Cupb'd Closet mhshp
Fl. No. FINISH FIXTURES SHOWER
Floors Wolts We Lo.
Tub T . e Grade t Q G.D. Finish
LzLi `
I
l )
d if /3
_
/965-
(� t
SPECIAL
FEATURES
'
Book Cases
Built-in Beds
Venetian Blinds
Shutters
RltZts COMPUTATION
Appraiser &
Date
'—,
Unit
Areo
Unit Cost'
Cost
Unit
Cost
Cost
nit
Cost.
Cost
Unit
Cost
Cosi
unit
Cost
Cost
unit
Cost
Cost
nit
Cost
Cost Unit.
Cost
Cost
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I
T RFP, -.,O
BUT
COU
r
EVELOP NT
TOTA L
pry s p .- :i G%
j
1.3
/
NORMAL % GOOD'
R. C. L. N. D
r� i3'
U LI
/ dfi
5 -
MISCELLANEOUS STRUCTURES
Structure
Foundl
Cons.
Ext.
Roof
Floor
Int.
Size etc.
--
�
v
COMPUTATIONS
OF
��ru•- z� ��4� S'c��rk IgXc. � rad
P
Remarks:
/`/� �r�-�•- �.�: �- r- fN ter.• �_ cY` �t: ..-: %"'`•
30
A RESIDENCE FOR: 10"Volt MOIIE'�
BILL SHERRICK Vor ORMUZ CAUFOMA 95993
Q R F V-6 ROAD cm vo Box �9a
TI OROVIU.E CALIF. 95966 TEuonq [
(530 `max -0300
(530) 334-5299
tfo'
School District
A.P. Number
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
F—Itn3tvAlOyAl Building Department No. I
n Q (� n Tax R e Area No.
cp`3l �"y) .9 Jurisdiction: City County
Property Owner 0,4k"r
rl!
l't
Property Location/Address
25�q Ni
-co Qa . ` J►''ay, Ik 0A
a r,
Subdivision
Lot No.
Residential Development
Q
0 0
Sq. Footage 13gq
�- Noof iving Mobile Home
Addition/ 'Supplemental to
(Group R)
Units Installation
Conversion Permit #
Cr. Demo - ( �4 )
`(No foundation inspection)
..................................................................................................
existing sq. ft. see attached
Net total sq. ft.
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Commercial/Industrial = . 0
New Addition
District Identification No. —1 914 q
Sq. Footage
-2- 01
Date
Ova J-,* Lt.,�e_w• School District certifies that V., S ka- v V- t Q_tz
(Payor)
(Including Exterior
Roofed Areas)
(Street Address) (City) (State) (Zip Code) (Phone Number)
has complied with the requirements of Resolution No. O S -6 to o °I by payment of $ -? .g
representing 'iS square feet. IA13 2926 $
FULL MITIGATION $
C
School District I
Date
Paid by Check # Remarks:3 l a off.{
rs k eg :). _ Q, 3
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), 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 (CEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (school district), Yellow (building department), Pink (applicant) feefom,.xls (12i06)7mm
BUTTO�JI� TY DEVELOPMENT FEE CERTIFICATION FORM
FSEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD)
❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD)
❑ PARADISE RECREATION AND PARK DISTRICT (PRPD)
0 DURHAM RECREATION AND PARK DISTRICT (DRPD)
Assessor Parcel Number (s) %Qj- 3 10- 02A Building Permit Number 1)4 l
Property Owner (s)
Project Location /A
Subdivision'Name
Assessable Sq. Ftge L399
Type of Residential Development (check one)
New Development _�YSingle Family -Detached Single Family -Attached
Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling
Mobile home Mobile home replacement verified by Assessor Department
Demo Permit (date issued ) verified by Building Department
Comments: eD�Qcl�td ��� 50. �. e�bin w��h I��a �+ sinale-
T� �
0
Buildinj Department Repres five Date
BrfiRPD ❑ CARD 0 PRPD ❑ DRPD certifies that:
� 5
Znneik, a,
Applicant Name Phone Number
1). (aCfi UCo I�.C11-ric O r0y i 1 IC i 0� Asci (o Co
Address
City State Zip
Has complied with re uireme9nts of the Butte County Board of Supervisors Resolution No.
by Payment of. l %Cry • Clj
Dwelling Units @ $ per unit for a total of $
Square Feet @ $ per sq foot for a total of $
Remarks:
Paid by Check No:. Paid by Cash:
Receipt No:
Recreation and ParkoUiEtrict Representative v Date
,.. r ,. �, .. . s,,.:�h� .0 x�. .+ca•r.�,,r ,� ,•�� -r �, `,; t 3377'81E 8, -71
. ir.
Chuck` Jacobson
- '2589 V-6
I Oroville +
OFFICE COPY
Address
ry r =ry Date
ELECTRIC /� j�
_ � • � • Meter By Da � 77--
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS ' PERMIT NO.
7 County Center Drive - Oroville, California95965 - Telephone: 916/538-7541 !'
%!' /
APPLICATION .AND PERMIT
ASSE35SOR PARCEL NUMBER
A�l _ _ G j�
ZONING
BUILDING PERMIT
OWNER/
TELEPHONE
SO, FT. OCC, BUILDING VALUATION
OWNER'S MAI LI ADDRESS
5 /
CONTRACTOR'S NAME
/�.. 5,. 1.
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
_
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
`
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
' PLUMBING PERMIT
Filing Fee 10.00
!�
Each Trap
2.00
/ 1/10 J If
Solar or heat pump water heater
20.00 '
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF 0 Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00. e,
Building sewer
5.00
Mobile Home I S I G JWT
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Q
Describe work: _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00 /� -"
Main service EA. AOD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check.one):
E -1I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.SINGLE
License No. Classification
Q 1, 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)
❑ 1 am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.6i\/z¢sgft
OR ADONS. ACC. BLDGS. I
NEW CONSTR. MULTI.OUTLET 2,50 ea
NON-RESID BRANCH CIRC ITS
POWER APPARATUS e
OUTLET CIR.
Ex. OCcup(OUTLETS OR FIXTURES 200301
Is A1030
\
EX. OCCUp. OUTLETS PI LEST D.)RE A.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring - 15.00 %
_
Permit Fee $ }
Contractor
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.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. 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.
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.
X r t '' - `, + Date
Signature of Applicant — r Owner Q Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
TOTAL PERMIT FEE $ _ 0
occuP.
coNST.T7
I
I FLOOD
PARCEL
PD
ND
ss
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 �'- f r f ,
Receipt No. rJ� �
WHITE-D.P.W.. YELLOW-ASSE330R, PINx-INsPEcTOR.GOLDENROD-APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO. (�
A SS F,S,SO PARCEL NUMBER
ZONING
BUILDING PERMIT
Ow>."
/`/ e
TELEPHONE
SQ. FT. OCC. BUILDING VA ATION
OWNE 'S MAI LI ADD S t
S /P U
CO RAC R• NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
,$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF 0 Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S G W
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service e00V OR LESS
100 AMP. OR LESS
00
10.l�),
Main service EA. ADD -L 100 AMP
2.50
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.
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-
NEW CONST. DWELLING Occ UP.s
I
OR ADDNS. ACC. BLDGS. /2 Osq ft
NEW CONSTR. MULTI -OUTLET
NON-RESID BRANCH CIRC ITS 2.50 ea
/POWER APPARATUS el
(SINGLE OUTLET CIR, I
p OUTLETS OR FIXTURES aAL030
Ex. OCCU 2O @30
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00 f�
_
T__ 5
Permit Fee $ .
Contractor
. S '----
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.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. 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 againstoeeuP.
all liabilities, judgments, costs, and expenses which may in any way accrue
against id ounty in clonsequence of the granting of this permit.
X Date o
Signature of Applicant - Owner R) Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
TOTAL PERMIT FEE $
CONST.TYPe
I
I FLOOD
PARCEL
PD
ND
ss
This permit is hereby issued under
sions of the Butte County. Code and/or
work indicated above for which
DIRECTO OF PUBLIC
By
PE50T EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date p
o r 17- �8 d
Receipt No. a
WNITC-D. P. W.. YELLOW-ASSC330R, PIN -INSPECTOR, GOLDENROD -APPLICANT
1'.
. J ., .'�''�.•-f..1.v.'T..i-rv- per.: .-:.' �'iZ �.rM� .vJ�..+rKi..•^^".'L y.(w. �. rµ4r ' F q�. ". .,., �� ! Y'
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC,' WORKS - BUILDING DIVISION `
7 COUNTY CENTER DRIVE - OROVILI,;-;G�r%RNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.—
OWNER—
o.OWNER COQ�L-- A. PNo.
Proposed BuildingsUse tiL%C Building Inspector X /� Date 1�'
At time of permit application, I was advised the following data must be submitted prior to permit processing
�A,and/or issuance:, DATE RECEIVED APPROVED
�1. All items have been submitted. . . . . . . . . . . .
2. Plot plans in duplicate/triplicate, signed by preparer of plans. _
3. Complete plans in duplicate/triplicate, signed by preparer of plans.
4. Complete engineered plans and calcs, with wet signature on plans.
5. Plans with Energy Design Compliance Statement. . . . . .
6. School District "Fees Paid" Stamp on Floor Plan.
7
8.
9.
10.
11.
12.
13.
_ 14.
15.
16.
17.
18,
19.
20.
21.
22–
Statement
Statement of Intent for Non -Heated and AC Buildings.
Fees of $ . . . . . . . .
Letter of signature authorization. . . . . . . .
Sanitation approval from _ Health Dept. . .
Planning approval for (A) Use: (B) Parking: .
Certificate of Workmen's Compensation Insurance. . . . . .
Contractor's License Information (no., name style, classif.)
Owner -Builder Verification (Given to owner❑, Mail to owner ❑ )
Improvements may be required.
Mobi lehome Installation Data. . . . . . . . . .
Pre-Inspec. request to
Pre -Inspection for__.-___-_ -. _ ...___.__ _ Required. R.;Idi'o Inspector
Recorded.,copy of Agricultural Acknowledgment Statement.
Driveway Permit.
Plot plan approval from city of
When you issue the permit, process as follows: _lf—Mail to owner, —
Telephone and hold for pickup at office,
Other
Mail to contractor-
-Deliver w/inspector.
Applicant Date
Copy of plans sent Health Dept.; Fire Dept., Other Date
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No,
2. Additional items required:
Contractor, designer, owner, was advised of above required data by_phone--nail_counter by date
Contractor, designer, owner, was advised c' above required data by_phone_mail, counter by date
e
Plans checked
Sets of plans on hold in
Copy—DPW
Date Plans approved by
File cabinet AP folder
Date
(Dote)
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive,.Oroyille., CA 95965 Phone: 916-538-7541.
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder'.' building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit
will:be issued until this verification is received.
1. I personally plan to provide the.major. labor and materials for construction of
the proposed property improvement (yes or no) 3
,2. I ( aue/have not) 1- c VIF signed an application for a building permit
for the proposed work.
I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors 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 Contractors License No.
5. I will provide some of the work�but I have contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner.R4Z2--)'lt .
Social Security Number
Date /c-,
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832.of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATIN AMPERMIT
PERMIT NO.
ASS9SO PARCEL NUMBER —OS7�
ZONING
BUILDING PERMIT
OW `
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNE 'S MAILING ADD 5 / t
3:2
COhfTRAC R' NAME
TELEPHONE
�r
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation
Filing Fee
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
G_
J
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAMEPARCEL
MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF /0 Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home I S I G JW 1
110.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Instailation❑ Other E�
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
I00 AMP OR LESS
10.00
Main service EA. ADD•L 100 AMP
2.50
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.
License No. Classification
1, 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)
❑ 1 am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. ( DWELLING OCCUP.6d
OR ACDNS. \ ACI:. BLDGS. 2/20sq it
NEW CONSTR MULTI -OUTLET 2.50 ea
NON•RESID BRANCH CIRC ITS
POWER APPARATUS e
(SINGLE OUTLET CIR.
0 50C
Ex. Occup( OR FIXTURES 2AL@30
9ALo
FIXED APP LNS. OR
EX. OCCUp. OUTLETS (RESID.) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring '15.00
— 5^_
Permit Fee
Contractor
$
~—
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
C 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 musQQ.rthwith,comply with.,such
provisions or this permit shall be deemed revoked.--�'�°'` * `' ""'-- "-°�`-n'
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. 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 id unty in Trisequence of the granting of this permit.
S. X �L Date
Signature of Applicant — Owner JW Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee
TOTAL PERMIT FEE $
occup.
C0NST*TYPFJ
I
t1LM-.JPARCELJ
PO
ND
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No.
SIL
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