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HomeMy WebLinkAbout078-310-090.. ...,_ ar.�, ..-: w.,� iY:,," s.-_,.....+....-w,::.-sv.:m:ayc:ew-.t+:r.�...xr....:�...aew.• ... �;�+r. -. 7 073-310-090 06-2053 DORSEY, Geo. 39108 SAMPSON,BERTHA 2615 OAK KNOLL WAY, OROVILLE ` Cont OWNER ADDITION -KITCHEN ` 2615 Oak Knoll, Oroville., �CONTR: Gene Martin, 2937 Garden Ranch Rd., (addition) Oroville 1306-2312 078-310-090 MISCELLANEOUS Siding/Stucco SIDING- VINYL 150 LINEAR PT 2615 OAK KNOLL WAY SAMPSON, MELVIN ROBERT 8, BER DORSEY;. George W. 5_4 t V-5 Road approx 300' East of V -g E Oroville 1 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 I' Contractor Applicant: Square Footage: OWNER SAMPSON MELVIN. ROBERT Building Garage Remdl/Addn .2615 OAK KNOLL WAY 486 OROVILLE, CA 95966 Other Porch/Patio Total (530) 387-3616 ' 486 FEE INFORMATION Fund 10 BLDG _ .$450.92 Room Addition - First Story $511.41 SMIP - Residential - $3.16 SRA Fees $95.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires OWNER 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 09/28/2006 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: EI 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 or one a hundred dollars ($100) or less.) -Total Charged: $1,060.49 Fees Paid: $1,060.49 Balance Due: $0.00 Receipt No: B318 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 Contractors 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 Contractors 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.). ❑1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT.THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors 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 Contractors License Law.). ❑ 1 AM EXEMPT under Section B. & P.C: for this reason: - 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 ag a that if I should become subject to the workers' 09/28/2006 compen tion provisions of Section 370 f the Labor Code, I shall forthwith comply with thoseQ4 W1 �pcouis Owner's Signature Date 09/28/2006 Sigriature 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) I hereby certify that I have read this application and slate 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 t e above mentioned property for inspection purposes. 1 hereby certify that I am the Top y er am authorized to act on the property owners behalf. w . A,-t'�GQ .,/ i 09/28/2006 Owner Lender's Address City - State Zip 0 Contractor_ ' OR:Agent for Owner E]Agent for Contractor FILE COPY PROJECT INFORMATION Site Address: 2615 OAK KNOLL WAY Owner: Permit No: 06-2053 APN: 078-310-090 SAMPSON MELVIN ROBERT & Permit type: MISCELLANEOUS 2615 OAK KNOLL WAY Issued Date: 09/28/2006 By KCG Subtype: Room Addn-First Stry OROVILLE, CA 95966 Expiration Date: 09/23/2007' Description: ADDITION- KITCHEN (530) 387-3616 Occupancy: R-3 Zoning: Contractor Applicant: Square Footage: OWNER SAMPSON MELVIN. ROBERT Building Garage Remdl/Addn .2615 OAK KNOLL WAY 486 OROVILLE, CA 95966 Other Porch/Patio Total (530) 387-3616 ' 486 FEE INFORMATION Fund 10 BLDG _ .$450.92 Room Addition - First Story $511.41 SMIP - Residential - $3.16 SRA Fees $95.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires OWNER 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 09/28/2006 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: EI 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 or one a hundred dollars ($100) or less.) -Total Charged: $1,060.49 Fees Paid: $1,060.49 Balance Due: $0.00 Receipt No: B318 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 Contractors 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 Contractors 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.). ❑1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT.THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractors 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 Contractors License Law.). ❑ 1 AM EXEMPT under Section B. & P.C: for this reason: - 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 ag a that if I should become subject to the workers' 09/28/2006 compen tion provisions of Section 370 f the Labor Code, I shall forthwith comply with thoseQ4 W1 �pcouis Owner's Signature Date 09/28/2006 Sigriature 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) I hereby certify that I have read this application and slate 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 t e above mentioned property for inspection purposes. 1 hereby certify that I am the Top y er am authorized to act on the property owners behalf. w . A,-t'�GQ .,/ i 09/28/2006 Owner Lender's Address City - State Zip 0 Contractor_ ' OR:Agent for Owner E]Agent for Contractor FILE COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.netldds "PLEASE PRINT CLEARLY" APPLICANT INFORMATION OWNER INFORMATION Last Name SD Al first me Address eitl,. City n, �� State n �I Zip �- �G Phone _ / d F �(�/D`t E-mail , G APPLICANT INFORMATION CONTRACTOR Name City Address City \ State Zip Phone �, / Fax E-mail Page Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address City \ State 7ip�6 Phone3�1- �, / Fax E-mail Page State License Number APPLICANT INFORMATION Name Address W/5 - City St to P ne % ,3/lp FAY-AY— (3 E-mail 0 WIEN=d Igoffiff&.502004MVA� :4 KA E'%�i_�I0 For office use onl API 67 VQ-3/0—(D2n Zoningfif City Flood Zone SRA I es A No Occ. If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. Type Const. Subdivision Name Address Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMSWILDING FORMS\BldgApplSubRgmts.doc 0 M &l ,— PERMIT NO. BP No - BIN # PROJECT LOCATION API 67 VQ-3/0—(D2n Property Address City Cross Street V� 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 Desccdpt'on or Scope of Work: Sq FT- Living Garage Open Cov ❑ Structure 9diltWithout 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. Received by7-p Amount: 3Tp • / Bldg �V SRA Receipt #: J-V�lu45 Sheriff c" ?� SUP Date:// ��'([ G,� ^4 Other Y �LD `� l S• / o- Total Page 1 of 2 gS � t REV 8-12-05 .r r "A SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a per it. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IMINK 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! C3' 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 faxesl li� 4. Energy compliance design and-supporting documentation in duplicate. ❑ 5. Statement'of Intent fdr Non-heated and A/C for Non-Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. . ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538.7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can'only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS1BIdgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 �'qe:C...`'^"y'""'if'�`�' � ;_�: M.'t...�`.. �� 1'�r."'�.'^.,}�r.L+r,ti.....tw�_K#m�ri�t.: yr ' 4 " r•�'�„' -. ` 7 '�._ .. '. ,;� . , .. .� .. . , � .... . �n � .�'��. COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA .95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: ASSESSOR PARCEL NUMBER �� v O V �) Q Proposed Building Use: Permit Technician:40K Date: Items required in order to apply for 4ermit. All boxes MUST be checked OR marked NA In order to apply. .t 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. .X7 4. Engineered truss details and layouts in duplicate. No faxesl ❑ 5. Letter from Engineer or Architect for truss design review. ;0-- 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate. i .0_ 11. Hazardous Material Form 12. Acknowledgement of building permit application without required clearances. ❑ 13. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 14. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable 1115. Fire Sprinklers............................................................................................ ❑ 16. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 17. Soils Report and/or Engineered Foundation required ........................................... 18. Erosion Control Plan Required........................................................................ 19. Fees as shown on the attached Schedule of Fees Due Sheet .............................. 20. City of Chico Plumbing permit........................................................................ ❑r 21. Site plan and business license approval from the City of Biggs........ S�IV . 22. California Department of Forestry plan approval 17 paid. Sent by:e' AN.- ,AN.- .vow K10. I 23. Planning approval for (A) Use: SIL (B) Parking: (C) Parcel Check: ...... I o 0 24. Contact Land Development about _ Improvements, _ Drainage ........................ ❑ 25. Fire Marshall Review (commercial projects only). Sent by: ........I ............. -�_ 26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Contractor's license information. (Number, Name Style, Classification) ................... ❑ .29. Worker's Compensation Carrier and Policy Number .......................................... ❑ 30. Owner -Builder Verification ( _ Given to owner, _Mailed to owner) ..................... ❑ 31. Letter of Signature authorization.................................................................... ❑ 32. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 33. Existing violations and/or expired permits......................................................... ❑ 34. Deed Restriction.......................................................................................... 4 g� , 35. ❑ Legal descriptio , M.H. T)',tle, title search, registration or MCO ......................... 36. Other: 1-09 , Q CLI ❑ 37. Other: When issued I have been nforrged of the above it ms and requirements for obtaining a building permit. Applicant: Z_f, i �, / Date: 1. Index permit application for�the above items nu;6ere� ' PI Ch k L' Her 2. Additional items `�_ �/ Contractor, design &, , was advised of the above data by phone, ❑ mail, ❑ counter,7b�y Date. Contractor, designer, owne advised of the above data by ❑ phone, ❑mail, ❑ counter Date: Contractor, designer a vised of the v + by ❑ phone, ❑ mail, ❑ me Date: Plans reviewed by: Date: o(o Plans approved by: Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division K/Building/Plan Check/Data Sheets/data sheet page 2 9.27.05 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 www.buttecounty.net/dds PHONE (530) 538-7541 FAX 538-2140 RECEIPT OF FEES SCHEDULE - RESIDENTIAL Owner SAMPSON APN No: 078-310-090 Permit Type: '-]Subtype: App Date: 8/25/2006 Permit No: BP 06-2053 Permit Desc: 1 BUILDING PERMIT FEES ESTIMATED AT APPLICATION $852.35 Plan Check portion of Permit Fee $340.94 $511.41 Balance of Building Permit Fee 2 FEMAYes Flood Elevation Review $109.98 0 3 SRA* BX Yes .Fire Plan Check - Non -Refundable $95.00 $95.00_ (State Responsibility Area) Building Inspection $109.98 $109.98 1 - $204.98 NON-REFUNDABLE portion of fees due at application $435.94 RECEIPT DATE Tech/Asst FEES DUE AND PAYABLE AT TIME OF PERMIT APPLICATION $545.92 FEES (BELOW) DUE PRIOR TO ISSUANCE OF PERMIT ( $514.57 y oatancc ut ounuuty rtnnu rtes arum mu. I duuvef 770 Butte Creek $7,997 771 Comanche Creek $8,341 5 SMIP* - Strong Motion Instrumentation Program (Enter amount from permit system) 6 Additional Plan Check Fees (NON-REFUNDABLE) 776 Mud -Sycamore Creek $6,27° 7 Other*: 7a Other*: 8 IMPACT FEES - RESIDENTIAL* Per Dwelling Per Dwelling Per Dwelling MH Applications After 04/15/06 SFD MFD County 4249.11 3183.54 3238. Chico Urban Area 6146.23 4538.82 5648. EI Medio Fire District 3249.97 2385.76 2422. North Chico Specific Plan A SR -1, SR -3, SR-1/PD 1 8801.091 7395.041 8486. R-1 o 8897.09 7491.04 8582. R-7 1 AIM ()Ql AQAA nd RmF / jl.I . i 1 • • � 1 1� Ri�1� R-3 1 7604.091 6198.041 7289.40 RECEIPT DATE Tech/Asst Processing Fee is automatically added to impact fee total 0 $100.00 9 WATER TENDER FEE (Not collected when impact Fees Applicable( Enter Bat.# $200.00 DRAINAGE FEES* 10 CHICO STORM DRAINAGE MASTER PLAN 770 Butte Creek $7,997 771 Comanche Creek $8,341 New construction, vacant land, on 1 acre or less - Enter 1 or less acre value 772 Little Chico Creek $9,08E 773 Big Chico Creek $6,77E 774 Lindo Channel $8,267 775 SUDAD Ditch $7,211 776 Mud -Sycamore Creek $6,27° 777 PV Ditch $8,893 10a More than 1 acre, existing buildings - fees to be assessed by Public Works Fee Determination Sheet Needed - Enter amount determined by PW 11 THERMALITO DRAINAGE AREA 1 $684 Maximum Per each new living unit on existing lots where full drainage fees have not been paid 11a Temporary Dwelling 1 $136 At time of building permit $136 annual renewal fee for first 4 renewals. Not to exceed $684. PROOF OF PAYMENT OF FEES (BELOW) MUST BE RECEIVED PRIOR TO ISSUAI' is completed for applicant to take to respective district office. n 12 SCHOOL DISTRICT FEES* Oroville Elementary 091 --GiLAe t ® frm 12a RECREATION DISTRICT FEES* I 1'W RECEIPT DATE Tech/Asst E OF PERMIT. Forms will be prepared after plan check At the time of permit applicatiop, I was advised the a`� are required to be paid prior to issuance of the permit. These fees may be changed during the plan checking process. ` ' Appli n • 01 2(;o Date: Pursuant to Government code Secti n 66020, yo notif d those 4It s followed by an "*" may have been imp—osed on your project. You have 90 days from the date of approval of the por' ct or from the impostion of the above referenced items during which you may protest. The requirements for a protest are specified in Goverment Code Section 66020(a). K:/Building/Forms/Schedule of Receipt Fees Residential 041506 LAKE OROVILLE AREA PUBLIC UTILITY DISTRICT 1960 Elgin Street ♦ Oroville, CA 95966 ♦ (530)533-2000 ♦ (530)533-1750 fax SEWER CLEARANCEAUTHOR/ZAT/ON No District Permit Required . Y 3p.,�_k&A ` )Lmw5O hereinafter referred to as "Applicant", being the property owner -dr owner's agent desiring sewer clearance, hereby requests Lake Oroville Area Public' Utility District, hereinafter referred to as "District", to authorize sewer clearance for the property(ies) below. I2 Property address: Z(�l _c��i� �a�1 w nth A.P: #: ��Jto-090 Subdivision: V i (lC, y ex -t no_ Lot #: Block #: ,No. of E.D.U.'s at this locati Multiplication Factor: /1 Monthly Charges: Service currently provided: Resid ntial ` /. Residence of.Owner• -❑ Apartment ❑ Industrial ❑ Rental (single family) ❑ Commercial ❑ Rental (duplex) (� ❑ Site. plan reviewed Jobsite reviewedy� Remarks: lCti The sewer clearance applied for hereby, shall be -in accordance the "ordinances, rules,'.regulations and policies. adopted, or to be adopted, by the Board of Directors of District, all of which Applicant agrees to abide by and fully perform. The proposed project shall in no way impact the current. sew r service provide by the r encroach upon any District utility easements. Applicant Signature A rized Disgra Signature Applicant Print Name Applicant Mailing Address Date•of Clearance Applicant Phone Number Applicant Fax Number t School District A.P. Number Property Owner Property Location BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) 91 Building Department No. 0'/ D'. it _21) �l�Jurisdiction: Q City County Subdivision Lot No. ................................................................................... Residential Development Q Q Q Sq. Footage No'of Living Mobile Home dditioN *Supplemental to (Group. R) Units Installation Conversion Permit # '• *(No foundation inspection) :........................................................................................ Commercial/Industrial Representative 0 Addition Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq. Footage (Including Exterior Roofed Areas) Date District Identification No. 4 School District certifies that B C R6 (Applicant (Street Address) (Phone Number) (City) (State) Code) has complied with the requirements of Resolution No. D S -a to —O by payment of $ LL representing �} R to square feet. rB 2926L MITIGATION $ School District R - g-0 to Date Paid by Check # (,� Remarks: 0—'1l 0 Notice : You may protest the Imposition of the fees Identified above by submitting a written proiest.to the District, In compliance with Govem. m- Cods Section 66020(a), within 90 days from the date teas are paid. Failure to submit a timely wrNten protest will prohibit you from challenging the Imposition of the fees In any'court action. K, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Foran, the School Distrk! is notified by tiro applicable Local Planning Agency that this project is being reviewed under the CalNornla Environnwntal Qualitii Act (CEOA), this project may be subject to additional school fees to fully midgatp its Impact on the school dW&Ws schools. White (school district), Yellow (building department), Pink (applicant). feeform,xls (3M5 ` I� OWNER-BUILDER`VERIFICATION . r Attention Property Owner: An "owner -builder" building pen -nit 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 m •or labor and material for construction of this proposed property improvement: YES [ NO [ ]. 22 I HAVE [t/] HAVE NOT [ ] signed an application fora building permit for the proposed work. r - 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: + 4. I•plan to provide portions of the work, but I have hired the following person to coordinate, supervise, andprovide the major work: 1 NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some 6f the work but I have contracted, (hired) the following persons to provide the work indicated:. NAME + ADDRESS. • PHONE TYPE OF WORK 1 , SIGNED: PROPERTY OWNER. i DATE: � -NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code.. This verification must be completed and,retumed to'our office before we are permitted to issue the permit. Rev'd 11/4/2004 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) 538-7785 Facsimile www.buttecounty.netldds OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be 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-CSLB (2752) or by accessing their website at www.CSLB.ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building pen -nit will not be issued until the verification is returned. Sincerely, Scott Rutherford Manager, Building Divi ion NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. Butte Cour2tyDepartmellt ol'Develop7ientSel-vices o�uTrFo Y,. 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone cam. {y (530) 538-7785 Facsimile 4 ' BUILDING PERMIT APPLICATION WITHOUT REQUIRED CLEARANCES I request and authorize the Building Division to process this'building permit application through the plans examination process WITHOUT first obtaining all necessary, related permits and clearances from other regulatory entities, including but not limited to, Planning, Environmental Health,. Land Development, County Fire, 'and Agriculture.. , I hereby acknowledge:' E F, • I need to submit applications for septic and/or well to Butte County Environmental. Health immediately. • I ain required to bring the approved Environmental Health site plan and approved sanitation clearance to the Building Division as soon as clearance is obtained • .I am responsible for notifying Developmelit Services, in writing, to stop processing of the application and to arrange for disposition of plans The Building Division will process the application. through the plans examination process, as submitted, without input from other regulatory entities that could prohibit issuance of the building permit or require submission of amended building plans to the Building. Division. Once. the plans examination process begins, there will be no refund of plans examination fees. Any. changes requiring submission of. amended plans to the Building Division will incur additional fees. Within one year from'the date of application for a building permit, all other required permits and clearances from other entities must be obtained for the permit to be issued. Failure to obtain these permits/clearances willvoid the application. ' Typically other required perrnits/clearances include, but are not limited to, verification the parcel was legally created, adherence to. all mitigations and conditions -imposed on the parcel at time of creation, as 'well as zoning requirements, legal access, and applicable set -backs and environmental issues (fire, agriculture buffer zones, and habitat/species). Please print: Applicant Name:�'' cS4 APN: Building site address: Permit No.: ov /&, I :have read, understood and accept the terms and conditions as expressed herein as indicated by' my submission of the ab o=fefereneed-b ding permit application and my signature below: SIGNATU OF APPLICANT DATE owe vTTT.°�.� tm�n of -Public.Work �e�par C o u n t y o f B., u t t - 'e v � o�LAND DEVELOPMENT DIVISION 1 J./Michael Crump, Storm Water Management Program o. yQ w \ CO DIeeCtOf-7County Center Drive U N oroville, CA 95965 (530) 538-7266' AGQLfC (FAX) 538-7'171 ; National Pollutant Discharge Elimination System (NPDES)Phase II Construction Storm Water. Permit and. StormWater Pollution `Prevention Plan (SWPPP) Acknowledgement .w ;, (LESS THAN ACRE1 Project Description: Project Location and/or Parcel Number: - - +7. r . By"signing below, I, the project owner/owner's agent, certify.that-this project WILL NOT DISTURB I acre or more of land and that L 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 build -outs 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 Control 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 a project that disturbs one acre or more of land may result in revocation of grading and/or other "permits -orlother sanctions provided by la Signed: _ .Title: ; _Date'/ s`/� -- BUTTE COUNTY DEPARTMENT OF DEVEI;OPMENT 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 contractor Applicant: Square Footage: NINE BROTHERS VINYL SIDING NINE BROTHERS VINYL SID. Building Garage Remdl/Addn 7744 ORPHEUM WAY 7744 ORPHEUM WAY' ANTELOPE, CA 95843 ANTELOPE, CA 95843 Other Porch/Patio Total 91675252 91675252 FEE INFORMATION Siding/Stucco - Stone / Brick $110.00 LICENSED CONTRACTOR'S DECLARATION 'Contractor (Name) State Contractors License No. / Class / Expires NINE BROTHERS VINYL SIDINI COOOOOO540 / D41'/ I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of P1vision 3 the B mass and Professions Code, and my license is in full force and effect. X , /C/, 09/27/2006 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; STATE FUND Total Charged: ^ $110.00 Fees Paid:. $110.00 Balance Due: $0.00 Receipt No: B292 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 peril subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: _ ❑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 (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 down 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 2290032143 p ,Contractors License Law.). Carrier: PolicyNumber: Exp. Date: (This section need not a completed if the permit is oris or on�ndred dodollars ($100) or less.) • ❑ I AM EXEMPT under Section B. & P.C. for this reason:_ ElI 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' X 09/27/2006 compensation provisions of Sectio 3700 of t abor de, I shall forthwith comply with those provisions. X /t 09/27/2006 Signature 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 peril is issued. (3097 civ. code) Lender's Address City ` State Zip Owner's 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 hereb/erope7 'V dge that issuance of this permit does not authorize the use oroccupancy of any 'eco or subsidewalk. I hereby authorize representatives of Butte County t�tera m nfor inspection purposes. I hereby certify that I am the yuth edtprop rty owner's behalf. / 1111k. ' 09/27/2006' name or Permittee PIUNJ Print L—/ ,#(� / le��Date - Owner Contractor OR. ❑JAge/nt for Owner Agent for Contractor FILE COPY PROJECT INFORMATION Site Address: 2615 OAK KNOLL WAY Owner: Permit NO: B06-2312 APN: 078-310-090 SAMPSON, MELVIN ROBERT Permit type: MISCELLANEOUS 2615 OAK KNOLL WAY Issued Date: 09/27/2006 By KEJ 'Subtype: Siding/Stucco OROVILLE, CA 95966 Expiration Date: 09/22/2007 Description: SIDING- VINYL 150 LINEAR FT Occupancy: Zoning: AR -r/2 contractor Applicant: Square Footage: NINE BROTHERS VINYL SIDING NINE BROTHERS VINYL SID. Building Garage Remdl/Addn 7744 ORPHEUM WAY 7744 ORPHEUM WAY' ANTELOPE, CA 95843 ANTELOPE, CA 95843 Other Porch/Patio Total 91675252 91675252 FEE INFORMATION Siding/Stucco - Stone / Brick $110.00 LICENSED CONTRACTOR'S DECLARATION 'Contractor (Name) State Contractors License No. / Class / Expires NINE BROTHERS VINYL SIDINI COOOOOO540 / D41'/ I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of P1vision 3 the B mass and Professions Code, and my license is in full force and effect. X , /C/, 09/27/2006 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; STATE FUND Total Charged: ^ $110.00 Fees Paid:. $110.00 Balance Due: $0.00 Receipt No: B292 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 peril subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: _ ❑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 (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 down 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 2290032143 p ,Contractors License Law.). Carrier: PolicyNumber: Exp. Date: (This section need not a completed if the permit is oris or on�ndred dodollars ($100) or less.) • ❑ I AM EXEMPT under Section B. & P.C. for this reason:_ ElI 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' X 09/27/2006 compensation provisions of Sectio 3700 of t abor de, I shall forthwith comply with those provisions. X /t 09/27/2006 Signature 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 peril is issued. (3097 civ. code) Lender's Address City ` State Zip Owner's 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 hereb/erope7 'V dge that issuance of this permit does not authorize the use oroccupancy of any 'eco or subsidewalk. I hereby authorize representatives of Butte County t�tera m nfor inspection purposes. I hereby certify that I am the yuth edtprop rty owner's behalf. / 1111k. ' 09/27/2006' name or Permittee PIUNJ Print L—/ ,#(� / le��Date - Owner Contractor OR. ❑JAge/nt for Owner Agent for Contractor FILE COPY BUTTE COUNTY PERMIT DEPARTMENT OF DEVELOPMENT SERVICES NO. BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS J 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION BIN # Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER INFORMATION Last Name M �A/ Name,li,,,, first nm P Address 2-61,5- Qele it gAlolZ igaV City 0 /zo I/ .� State fA Zip 9 p 6 6 Phone S 8% Fax E-mail Lic. #9 CONTRACTOR ARCHITECT/ENGINEER Name,li,,,, Address Vag k,e.cw r City State W7- Zip 3 Phon�i Fax Phone E-mail Lic. #9 2 Clasb� APPLICANT INFORMATION ARCHITECT/ENGINEER Name CityCV� Address Zip �7O City Fax State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT INFORMATION NameN.koZ_4 /tlC�ll.I�GC Address AC `Aa Ok' 41 AcA t� CityCV� States q �lT Zip �7O Ph 9�6 %CJ — 36 ) Fax E-mail APPLI AN SIGNATURE X For office use only: Zoning Propert �( Flood Zone SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: UVLK F -UK SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PROJECT LOCATION API Propert �( Cross Street WORKER'S COMPENSATION Policy Number 22 Carrier _5 / If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Description or Scope of Work: 1I N�3. >/ ASq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. by: Amount: I (O Bldg Receipt #: Sheriff SMIP DateP'1 % Other `{' Total REV 8-12-05 f: SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additionalinformation regarding this process, please contact a Permit Assistant at (530) 538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 �...._ ,; *...,;.r.,.. a .� - fl �` ." � � - V _ .� �.. ,. � `� -. it � . 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FT) fA \� %� ” d+. g ROOM - y en y p v , UTILITY R R manual -on occupan CEPT CLOSETS efficacy O BROOMS lEX pR Dimmer � 1 t High a, _ „�, , �y u `S3. 0 9 s.a::'• Hi INTERIO sensor ALL OTHER cu ancy OR manual -on oc P TO BUILDINGS - O �i�J wlmanual-onlautomatic off Hi h efficacy G ATTACHED � a N . LIGH otion sensor ��� 1 ` OUTDOOR TIN x trolled by m a? �, �' q �Y ''}• High efficacy OR con 1 s Hig AND photo control N { o< < �,gN�s,"'T`�" * �.. �. , ' �� 1I°r F R_ switch i/J/►�� }P�� ' '- jZ- ..' 0 ; iPLO C 4 AIN fjSCI�BD 2.46 c id PLANS for �I t Refer to spOVER ot s and information additional n i for this project ' r '(tEVISION: BY# 3 Date t o L3 1016 � /� ✓ .r/l. ' � '''"'\ � ,, j � ,�' y�� � hyo � � � � � ' R P - 4 i'", � ,. _ a'` 4 BE ST FANS T� OUTSIALL EXHAUDE AIR rp E® TO a,�, a?�=Q !lEidT z, � {�., � .�a a n°