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Home My WebLink About078-320-035� __ - - -- err CSEMD) •' v BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAM (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP042401 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 08/13/2004 APN: the Business and Professions Code, and my license is in full force and effect. License Class: 0,_ License Number: Site Address: 2713 OAK KNOLL WAY ORO f Dater `j Contractor. Map Index: Description: RE -ROOF HOUSE (6 SQ.) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a e Owner: LOUGHEED LILLIAN MANNING SS 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 2713 OAK KNOLL WAY the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or OROVILLE, CA she is exempt therefrom and the basis for the alleged exemption. Any 95966 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: LOUGHEED LILLIAN MANNING SS owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, S provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: GEORGE ROOFING ❑ 1 am Exempt under Article 3 of the Business and Professions Code 6810 LINCOLN BLVD Date: Owner: OROVILLE, CA 95966 (530) 533-6393 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for License #: 452266 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. AI have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer: insurance carder and policy number e: Cartier: 11Z_ Total Square Ft: 0 S. F. Policy #: OS � :1 7� —O :2 -- ❑ I certify that in the performance of the work for which this permit is Valuation: $0.00 issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 9 —/ 3 —t' Applicant: Q� WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars in addition the cost of /' /� providedfor 0 compensation, damages as provided for in Section 3706 of the Labor /code, interest, and attorney's fees. /j,Cy./!L!'/� C��412,7,U q CONSTRUCTION LENDING AGENCY This p it is her y sue under Ito applicable provisions of the Butte County Coda andior I hereby affirm that there is a construction lending agency for the Resol io to d w c' d' e b is fees ha been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By Date: PERMIT EXPIRES ON: Date Address: ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Prinl Name: Signature: Date: _ W-13 "t%7 j� El Owner ❑ Contractor _-XAgent for Owner 13 Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICANT SIGNATURE X Shirley Trew - Aflej for�Geo a oo m i For office use I : OWNER Name Lillian Manning Lougheed Address 2713 Oak Knoll Way City Oroville State CA Zip 95966 Phone 530-533-7891 Fax E-mail Lic.# APPLICANT SIGNATURE X Shirley Trew - Aflej for�Geo a oo m i For office use I : CONTRACTOR Name GEORGE ROOFING Address 6810 Lincoln Blvd City Oroville State CA Zip Phone (530) 533-6393 Fax (530) 533-0287 E-mail dan@abcgc.com Lic.# Class dan@abcgc.com 452266 1 C39 APPLICANT SIGNATURE X Shirley Trew - Aflej for�Geo a oo m i For office use I : ARCHITECT/ENGINEER Name NIA Address 6810 Linocln Blvd City Oroville State CA Zip Phone (530)533-6393 Fax E-mail dan@abcgc.com State License Number APPLICANT SIGNATURE X Shirley Trew - Aflej for�Geo a oo m i For office use I : APPLICANT NAME Name GEORGE ROOFING Address 6810 Linocln Blvd City Oroville State CA Zip 95966 Phone (530)533-6393 Fax (530)533-0287 E-mail dan@abcgc.com APPLICANT SIGNATURE X Shirley Trew - Aflej for�Geo a oo m i For office use I : LOCATION Zoning Flood Zone SRA Yes No Occ. 2713 Oak Knoll Way Oroville, Ca. 95966 Type Const. Subdivision Name Dat / 2 d Map Book Page Lot # Planner Date Approved: PERMIT NO. xNO BP BIN # WORKER'S COMPENSATION Policy Number 272-596-02 Carrier STATE FUND 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 Reroof - House - Torch -down Sq. Footage 6 Squares ❑ 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. 6ce ved by: LOCATION AP# 11W _ 00'� Property Address 2713 Oak Knoll Way Oroville, Ca. 95966 Cross Street Other WORKER'S COMPENSATION Policy Number 272-596-02 Carrier STATE FUND 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 Reroof - House - Torch -down Sq. Footage 6 Squares ❑ 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. 6ce ved by: Amount: o Bldg Lfk ..... SRA Receipt M +17,74 Sheriff SMIP Other Dat / 2 d Total REV: George Roofing