HomeMy WebLinkAbout078-340-012MILDRED WYMAN 0'3— 3 Lf UIOI
123 Edgemont Dr, ORoville ,
Permit#4002-88E(elec ser`ch)SF
i
,04-1735
TRIPLE PLAY PARTNERSHIP;u',
123 EDGE DR, OROVILLE'•,
Cont: GREENE ROOFINGl :
�- T T
��� ♦ � � ■ �
r�
��■■� --
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.neAdds
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
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Date: Contractor.
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
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 State 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).):
0� 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
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' 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.).
❑ I am Exempt under Articli 3 of the Businass and Professions Code
Date: 7 1 121k-1 J'Owner:
WORKERS' COMPENSATION DECLATION /
1 hereby affirm under penalty of perjury one of the fbIlowing declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Policy #:
I certify that in the performance of the work for which this permit is
issued, 1 shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNING: Failure secure workswmpensation. co rage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
PERMIT NO.
BP041736
Issued Date: 06/15/2004 1 APN: 036-450-012-000
Site Address: 123 EDGEMONT DR ORO
Map Index:
Description: demo house, sq ft unknown
Owner: TRIPLE PLAY PARTNERSHIP
PO BOX 1190
DURHAM,CA
95938
530-891-7968
Applicant: TRIPLE PLAY PARTNERSHIP
Contractor:
License #:
Architect:
Engineer:
Total Square Ft:
Valuation:
Census Code:
CONSTRUCTION LENDING AGENCY This
I hereby affirm that there is a construction lending agency for the Res(
performance of the evork for which this permit is issued (Sec 3097 Civ.)
Name: By'-
PERMIT EXPIRES
0 S. F.
$0.00
icable provisions of the Butte County Cods ar
which fees have been paid. /� /
, , — n.r� kms/ l
Address: _ 1 u (Date
❑ 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 8 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 repr sentatives of Butte ounty to enter upon the above mentioned property for inspection p oses.
A t
Print Name: A Signature:
Date:
YOwner ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHIC 0: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
NER
Na '\
Address
City
State
Zip
Phone
Fax
E-mail
APPL CANT NAME
CONTRACTOR
Name
City
Addres
Zip
City
Fa
State
Zip
Phone
Type Const.
Fax
E-mail
Map Book
Lic. #
Class
APPL CANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fa
State
Zip
Phone
Type Const.
Fax
E-mail
Map Book
State License Number
APPL CANT NAME
Name
Address
City
tate
Zip
Phone
Fa
E-mail
APPLICANT SIGNATURE
X
For office us n o
Zoning
Bldg
Flood Zone
SRA
SRA
Yes
I No
Occ.
Date:
15 b
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
PERMIT
ANO.
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
es ' t'onorScope of Wo
Sq. Footage
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
Page 1 of 2
REV 4-30-04
Re eiv d by: Amount:
Bldg
SRA
Receipt
Sheriff
SMTP
Date:
15 b
Other
Total
Page 1 of 2
REV 4-30-04
SUBMITTAL 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 ININK.
Residential, New, Remodels, Additions, and Accessory Structures:
❑; 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 3 Complete sets.of plans, signed by -the preparer. NO GRAPHPAPER!
❑ 3. 3 Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
11, \ calculations:. '� '�
[3
-4. 2 Engineered trussldetails and layouts (if required) (NO FAXES!).
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. 2 Energy compliance design and supporting documentation: (Note: Not required for additions to
mobile or modular homes.)
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 8. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 9. Sanitation and site plan approval from the Environmental Health Department.
❑ 10. Metal Buildings: (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.
Mobile, Manufactured, or Modular Homes:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information,
❑ 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER!
❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations,
with code analysis.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4. Letter from Engineer or Architect for truss design review.
❑ 5. 2 Energy compliance design and supporting documentation (if required).
❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑ 7. Statement of Intent for Non -heated and A/C (if required).
❑ 8. Metal Buildings: (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.
❑ 9... Letter of intent.
❑ 10. Hazardous Material Form.
❑ 11. Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 4-30-04
O.B.-1
OVERIFICATION
�%'Vl`T�]�-1�UII�D�R ,'6TE .
Atteniion. Property
Ah'. -6 d6e' building pemut has been applied for in your name and bearing your signature.
Please complete and return this information at your earliest opportui ity.to' avoid unnecessary delay .. '
m -processing. and• issuing,your building permit.+No .building penult will be issued• until. this
verification is received. r
01.'
Ifpersonally' plan to provide th major, P P
labor and materials for construction of the " ro osed
property improvement YES 1 } NO ❑ -
(jPI, HAVE 13, NOT signed' anapp
cation
for a,building pemait for the proposed woik-
I have contracted with the following person (firm) to provide the proposed construction: ,
NAME:
ADDRESS: � - CITY: '
PHONE: • CONTRACTOR'S LICENSE NO.
�. -
. I plan, to. provide portions of this work, but have hired then followuig person
and o coordinate,
supervise, aprovide the major work: c
NAME: ,
ADDRESS• CITY:
PHONE: CONTRACTOR'S LICENSE NO.
S. I will provide some of.the work bur I•have'contracted (hired) the following persons to .provide
the work indicated:
e
NAME -ADDRESS + PHONE' .; TYPE VOF WORK
IDJ
ED:
PROPERTYOWNER:
DATE:
kx
NOTE:, .." - , Thu Owner -Builder Yerifkation is regriired by sect`ioiz 19831 and 19532 of the
Cakfornia Bealth and Safety Code. This veWiication mist be completed and
returned to our office before we are permitted to issue the permit ,
:OAR,
t -
r
x
OWNER BUILDER INFORMATION
Dear Property Owner.
0- •B•— 1
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, You should be aware that as "owner -builder" you are the responsible party ofrecord on such
a permit Building permits are not required to be signed by property owners unless they are personally performing their
own worm If your work is being performed by someone other than youuselt; 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 ova work; with the exception of various trades that you plan to subcontrac> you should
be aware of the following information for your benefit and protection:
0 If you employ or otherwise eni pge any persons other f tan your immediate &Mily, and the work (Including materials
and other costs) is $3oo or more for the entire project; and such persons are not licensed as contractors or
subcontractors, then you may4 be an employer.
0 If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security
workers compensation imsurmce, disab ' fences,
qty ice costs, and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these ob
with respect to worlmr's compensation hisuran ce ligations, and these risks are especially serious
♦ For more specific infomration about your obligations under Federal Law, contract the Interval Revenzie Service (and,
if yon 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 toerform their
work personally, or through their own employees, without a licensed contractor or subcontractor, only undepr limited
conditions.
. A frequent practice of unlicensed
persons professing to be contractors is to secure an owner burldea" building
P=D% eaoneously implying that the property owner is providing his or her own labor and material erso
pemiLs are not required to be P may Building
signed by property owners unless they are Performing their own work personally.
InfxirmaQion about ho rased contractors may be obtained by contracting the Contractors State License Board in your
community or at 102014 Street,. Sacramento, CA 95814.
Please complete the "OavaeY Builder Verification" on the reverse side of fins form so that we can confirm that you
are aware of these matte. The building permit will not be issued until the verification is retumed.
Iv!i 1 C. Vi ira, C.B.O:
Budding Inspection
NOTA T%ir Owner-Bualderli formation is required by Section 19830 of the California Health and Safety Code
OVER
Demolition Permits '
Asbestos Notification Statement 1
Date ooe
AP# f�o
Pursuant to section 19827.5 of the California Health and Safety Code, all.
demolition permit applicants are required to fill out this form.
"19827.5. A demolition permit shall not be issued by any city, county,
city and county, or state and local..agency which is authorized to issue
demolition permits as to any building or structure. except upon the --receipt
from the permit,applicant of a copy of each.written asbestos notification
regarding the building that has been required to be submitted to the United
States Environmental Protection Agency or to a designated state agency, or.
both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations,
or the successor to that part. The permit may be issued without the applicant
submitting a copy of the written notification if the applicant declares that
the notification is not applicable to the scheduled 'demolition project. The
permitting agency may require the applicant to make the declaration in writing;
or it may incorporate the applicant's response on the demolition permit appli-
cation."
Attached is a copy of'my written asbestos notification to the United States
Environmental Protection Agency for the demolition project located at
Signature of -Applicant
6R
7
I hereby declare that a written asbestos notification to the United States
Environmental Protection Agency is not applicable to this demolition project.
•
�ignatTf Applic nt
2/19/91
t -
RECORDING REQUESTED BY:
Fidelity National Title Company of California
Escrow No.: 04 -106166 -OC
Locate No.: CAFM0958-M8.0001-0000106166
Title No.: 04106166
When Recorded Mail Document
and Tax Statement To:
Triple Play Partnership
pkr Wkfvt CA q526
26
IJJIIIIIIlIIIIlIlIIlIJlilJililllll
2004—X032367
Recorded
I REC FEE13.00
Official. Records
I TAX 82,50
County Of
I
BUTTE
CANDACE J. GRUBB5
I'
Recorder
I
RDSEMARY DICKSON
I
Assistant
I Jason
02:00PM 28 -May -2004
I Page 1 of 3
APN: 036-450-012 SPACE ABOVE THIS UNE FOR RECORDER'S USE
GRANT DEED
The undersigned grantor(s) declare(s) .,
Documentary transfer tax is $82.50
{ X ] computed on full value of property conveyed, or
[ ] computed on full value less value of liens or encumbrances remaining at time of sale,
[ J Unincorporated Area City of Oraville,
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, . Kenneth E. Wyman. a married
man and Dawn D. Drummond, a married woman, as tenants in common
hereby GRANT(S) to Triple Play Partnership, a General Partnership
the following described real property in the City of Oroville, County of Butte, State of California:
SEE EXHIBIT 'WATTACHED HERETO AND MADE A PART HEREOF
DATED: May 17, 2004
STATE OF CALIFORNIA
COUNTY OF O S&W
ON Yl I 004 f' - before me,
f1 + Ce. R -s perso ally appeared ,
KejAne-4-KE. W awe
p@i%nally knewft to me roved to me on the basis of
satisfactory evidence) to be the personW whose name(*
is/ark subscribed to the within instrument and
acknowledged to me that he/.!�W/tbn executed the same
in his/WtYPW authorized capacity", and that by
his/b-Cr/OrW signature(Kon the instrument the person(,A,
or the entity upon behalf of which the personN acted,
executed the instrument.
`rh )'<v b -e '&,'cr, / f3
�� j n
Sof o� co- I orr1f4ri -
nneth E. Wyman ,
Dawn D. Drummond
CONSMCE L. PAYNE
Comminlon # 1410909
%71
Witness:my nit and official sealNotary Pulft - Canfornio
. Alameda County
y Comm-, 00e3Apr 13, 2007
Signature
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 7196) GRANT DEED
(grant)(3-04)
+h e
J
p
4 n •
Escrow No.: 04106166 -CC
Locate No.: CAFNT0958-0958-0001-0000106166
Title No.: 04106166
EXHIBIT "A"
THE LAND REFERRED TO HEREIN BELOW IS SITUATED IN THE UNINCORPORATED AREA, COUNTY OF BUTTE, STATE OF
CALIFORNIA, AND IS DESCRIBED AS FOLLOWS:
A PORTION OF LOT 300 AS SHOWN ON THAT CERTAIN MAP ENTI'T'LED, "OFFICIAL MAP OF OROVILLE-WYANDOTTE FRUIT
LANDS UNIT NO. 6" WHICH MAP WAS FILED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF
CALIFORNIA, ON MARCH 8, 1929 IN BOOK "10" OF MAPS, AT PAGES 3A, 4A AND 5A, DESCRIBED AS FOLLOWS:
COMMENCING ON THE NORTHERLY LINE OF SAID LOT 300, SOUTH 520 32' WEST 355.0 FEET FROM THE SOUTHWESTERLY
LINE OF OROVILLE-GARDEN RANCH ROAD, SAID POINT OF COMMENCEMENT BEING ATTHE NORTHEASTERLY CORNER OF
THAT PARCEL OF LAND DESCRIBED IN DEED DATED MARCH 23, 1946 IN THE OFFICE OF THE RECORDEROF THE COUNTY
OF BUTTE, STATE OF CALIFORNIA, IN BOOK "390" OF OFFICIAL RECORDS AT PAGE 375; THENCE ALONG THE EASTERLY
LINE OF SAID BEALL PARCEL, SOUTH 12° 16' EAST 255.0 FEETTO THE TRUE POINT OF BEGINNING FOR PARCEL OF LAND
HEREIN DESCRIBED; THENCE CONTINUING ALONG THE EASTERLY LINE OF SAID BEALL PARCEL, SOUTH 120 16. EAST
257.91 FEETTO THE SOUTHEASTERLY CORNER THEREOF ON THE SOUTHERLY LINE OF SAID LOT 300; THENCE ALONG
SAID SOUTHERLY LINE OF LOT 300, SOUTH 520 32' WEST 232.15 FEET TO THE SOUTHEASTERLY CORNER OF THAT
PARCEL OF LAND DESCRIBED IN DEED DATED MARCH 25TH, 1948 FROM JASON B. BEALL, ET UX TO GLENN BAKER ET UX
AND RECORDED MARCH 30, 1948 IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA,
IN BOOK "474" OF OFFICIAL RECORDS PAGE 131; THENCE NORTHERLY ALONG THE EASTERLY LINE OF SAID BAKER
PARCEL, 135.0 FEET TO THE NORTHEASTERLY CORNERTHEREOF; THENCE WESTERLY ALONG THE NORTHERLY LINE OF
SAID BAKER PARCEL, 140.0 FEET TO THE WESTERLY LINE OF SAID LOT 300, IN THE CENTERLINE OF EDGEMONT DRIVE;
THENCE NORTHERLY ALONG SAID WESTERLY LINE OF LOT 300, AN ARC OF CURVE TO LEFT WITH RADIUS OF 500 FEET, A
DISTANCE OF 8.41 FEET; THENCE CONTINUING ALONG SAID WESTERLY LINE OF LOT 300, NORTH 12° 41' WEST A
DISTANCE OF 122.5 FEET TO A POINT SOUTH 12° 41' EAST A DISTANCE OF 255.0 FEET FROM THE NORTHWESTERLY
CORNER OF SAID LOT 300; THENCE NORTH 520 32' EAST 354.0 FEET MORE OR LESS TO THE TRUE POINT OF BEGINNING.
RECORDING REQUESTED SgBY:
gj8RUNJLZD7 21 P1= /�Rpow Co. �•
WBEN RECORDED RETURN TO:
TRIPLE PLAY PARTNERSHIP
P.O. BOX 1190
DURHAM, CA 95938
that:
20QDZ-3----Q5g2Q!�eo-7�
Recorded I REC FEE 16.00
.Official Records i
CougkOf
CANDACE J. GRUBBS I
Recorder I
ROSEMARY DICKSON I--
Assistant I Barbara
MGM M 02—Apr-2003 I Page 1 of 4
STATEMENT OFPARTNE.?SHIP
TRIPLE PLA YPAR
TNERSHIP
TRIPLE PLAY PARTNERSHIP, declares that it is a general partnership and
1. The name of the partnership is TRIPLE PLAY PARTNERSHIP;
2. The names of each of the partners are:
RANDOLPH C. YBANEZ
WILLIAM V. YBANEZ
LOUIS YBANEZ . '
3. The partners named in this Statement are all of the partners.
4. The partnership was' formed pursuant to an Agreement of General
Partnership between the parties dated February 20, 2003, for the purpose of
developing, owning, operating and. maintaining real property and real property
investments. '
5. No conveyance of title or any interest in the above described real property
held by the partnership may be made except upon the written consent of all parties by
an instrument executed and acknowledged in the partnership name by all partners.
EXECUTED on February 20, 2003, at Chico, California.
ANDOLP C. YB A AEZ WILLIAM V. YB Z
orl
LOUkS YB Z Aq �T �
!� 2
Gb^Ib1SIv`- 1
'7, ;
t
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION -ASID PERMIT
R1
IT ,T�NO.��
A$$8 OR PAR 4QAL NUMBER
/4G,!-" ,Gc ,,
ZONING
,�
BUILDING PERMIT:'
OWNERh If�J,LJ'
I � rte
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OW R.:.S MAILING AD RESS f � /
r96 - i�C3J(�+� G i Gd
CONTRACTOR'S ',AME TELEPHONE
_)fur
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
I
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE -NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS -
Penalty
$
BUILDING ADDRESS f
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
l
l
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 Lk Duplex❑ Mobilehome❑ Other
i SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] ,Other
r
Describe work:
EH
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
r
OR Main service io00o AMP ORSLESS
10.00 ��}•u )
Main service EA. ADD'L 100 AMP
2.50^"x'
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
)
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER
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)
owner, am exclusively contracting with licensed contract- 7044)
❑ 1,a as
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.ai ,/a¢sgft
OR ACDNS. ACC. BLDGS.
NEW CONSTR. ULTI.OUTLET
N ON.RESID BRA CH CIRCU ITS 2.50 ea
APPARATUS el
(SINGLE OUTLET CIR. /
Ex. OCcup(OUTLETS OR FIXTURES 20050t
eAL090
FIXED APPLNS. OR
EX. Occup. OUTLETS (RESIO.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
.t L— c�
Permit Fee 1 $
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.
IX 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.
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
:
Contractor
II 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 CountyotD'
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
liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner ❑ 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.
CONST.TYPL
SCHOOL
FLOOD
PARCEL
PD
I H
7all
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
1"/ 1/l .i—�
; �
PERMfT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Dated Z ' i Imo'
r G
/L • .r
.1 ABy
Receipt No. AL
WNITE-D.P.W., YELLOW-AS$9350R. PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PEAAAIT NO.
,J 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATIO.N. AND. PERMIT d
ASSE-4 OR PA[jtr=NUMB€R
(—1 !O)~-
ZONING
BUILDING PER T
OWNN EESR
n
'J'
TELEPHONE
SQ.FT. 0�.`C. BUILD NG VALUATION
OI Ng - MAI G AD ESS'`~,
•CJv
CONTRACTOR'S UAME
TELEPHONE
DNTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
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
r
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
mi (
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each aas water heater or vent
5,00
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S G W
0.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other
Describe w rk: j" j
I
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
0V OR L
Main service 1000 AMP ORSLESS
1 10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BUSlness
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)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service EA. ADD'L 100 AMP
2.50 ��–
NEW CONST. DWELLING OCCUP.bI
OR ADDNS. ACC, BLDGS. , /20sgft
NEW CONSTR U LOUT LET
NON•R ESID .BRA CH CIRC ITS 2.50 ea
POWER APPARATUS .&)
SINGLE OUTLET cIR.
Ex. OCCU OUTLETS OR FIXTURES
p 20®50CeALe 30
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.� 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
g 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ 1 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.
LAI 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 shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
g
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 said County in consequence of the granting of this permit.
X YI�I�„�,� hlAJ�
-s4 Date /A -/3`f_
Signature of Applicant – OwnerContractor ❑ 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.
CONST.TYPC
PARCEL
PD
N
99U
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By.
PER EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date Z'�t^gid
Receipt No.
WHITE-D.P.W., YELLOW-ASOESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT.0 PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.
OWNER //II A. P. No. � -
Proposed BuildijUse _O�0 J1P.(. /��i Building Inspector Date
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
1. 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. Energy Design Compliance and supporting documentation .........
6. Statement of Intent for Non -Heated and AC Buildings ..............
7. Engineered truss details and layout in duplicate (required prior to plan check)
8. Mobilehome installation data including manufacturer's installation
instructions.......................................................
9. Fees of $ ..........................
10. Chico Urban Area fees paid ........................................
11. Park fees paid .....................................................
12. School District fees paid .................
13. Sanitation approval from Health Department ...
14. City of Chico plumbing permit ......................................
15. Plot plan and business license approval from City of
(see City for other requirements)
16. Planning approval for (A) Use: (B) Parking: .........
17. Improvements may be required.
18. Driveway permit (construction approval required prior to occupancy) ...
19 Pre -Inspection for �� � required , , , Pre-Inspec. request to
q Building Inspector LoY 3/ (Date)
20. Contractor's license information (No., Name Style, Classification) .......
21. Certificate of Workmans Compensation Insurance ....................
22. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ........
23. Recorded copy of Agricultural Acknowledgment Statement ............
24. Letter of signature authorization .....................................
25.
26.
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at _office. Deliver w/inspector.
Other
Appl ican. 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 of above required data by—phone —mail—counter by date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy—DPW
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATI.O_N
Attention. Property Owner:
An 'owner -builder" building permit.has been -applied for in your name and -bearing
your signature.-
Please
ignature.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 m terials for construction of.
the proposed property improvement (yes or no)
2. I (have/have not) fjctvC signed an application for a building permit
for the proposed work.
3.' I have contracted with the following person (firm) to provide the proposed
construction:.
Name
Address City
Phone 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
A0110 ou
Signed:
Property Owner —w �-
Social Security Number ,
Date 1,,2-/3-gre
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 PERMIT NO.
APPLICATION ,AND PERMIT
_ AS OR PA L NUMB R ,ZONING
OWNER BUILDING PERMIT-
ERMIT-
TELEPHONE
TELEPHONE-
• SO. FT. OCC. BUILDING VALUATION
Ow
Of MAI D ESS
G A
• COrJTR ACT R'S AME
TELEPHO E
ONTRACTOR'S MAILING ADDRESS
I
CONSTRUCTION LENDER
Fireplace
UNKNOWN
Total Valuation __
Filing Fee
$
LENDER'S MAILING ADDRESS
•
ARCHITECT OR ENGINEER
0.00
Permit Fee $
LICENSE No.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee $'
•
BUILDING ADDRESS
Penalty $ 1
I
6�
Permlt fee $
PLUMBING PERMIT Filing Fee 10.00
Each Trap 200
Solar
LOT NO. SUBDIVISION NAME
or heat pump water heater 20.00
PARCEL MAP
Water piping 500
Each pas water heater or vent 5,00
USE OF STRUCTURE
SF Duplex[I MobilehomeE]
Gas piping system 1 - 5 outlets 5.00
Building sewer 5.00
Other
SPECIFY
TYPE OF WORK
Mobile Home S G W � 0.00 ea
'
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation [] Other M
Permlt Fee
Describe W rk' /
$
Contractor
ELECTRICAL PERMIT Filing Fee 10.00
Main service 100 AMP ORLESS10.00
CONTRACTORS LICENSE LAW
Main service EA. ADD'L 100 AMP 2.50 ----
NEW CONST. / DWELLING OC -CU P. ail /2QS ft
OR ADDNS. 1 ACC. BLDGS. q
I declare under penalty of perjury (check one):
'
❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code
NEW CONSTR.MULTI,OUTLET
NON.RESID BRANCH CIRC ITS 2.50 ea
(POWER APPARATUS e�
SINGLE OUTLET CIR.
and my license is in full force and effect.
License No.
Classification
I, as the owner, or my employees with
Ex. Occup OUTLETS OR FIXTURES20930C
209930
FIXED APPLNS. OR
EX. Occup. OUTLETS (RESID.) EA.) 2.00
wages as their sole compen-
sation, will do the work,and the structure is intended
not or offered
for sale. (Sec. 7044)
Temporary service 10.00
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
Mobile Home Facilities 15.00
❑ I am exempt under Sec. , Business and Professions Code
Misc. Wiring 15.00
for this reason
Permit Fee 1 $
WORKMEN'S COMPENSATION INSURANCE
Contractor
I declare under penalty of perjury (check one):
MECHANICAL PERMIT
❑ The -permit is for $100.00 (valuation) or less.
Filing Fee 10.00
Heating
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or it Certificate
of Consent to Self -Insure.
Cooling
I shall not employ any person in any manner so as to become subject
Hood
to the W. C. laws of California.
3.00
Notice to Applicant: If after making this statement, should you become subject
to
Ventilation
the W. C. provisions of the Labor Code, you must forthwith comply with
such
provisions or this permit shall be deemed revoked.
$
LPermitee
or
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County
ome InstallationFee $
Ordinances and State Laws relating
to building construction, and hereby authorize representatives
Energy Inspection Fee $
of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep
TOTAL PERMIT FEE5
harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against
OCCUP. CONOT.TTPC SCHOOLPLooD PAR$cL POO ssuE
said County in consequence of the granting of this permit.
x=��l'�r""''�'"
Date /02'/�-�
This permit is hereby issued under the applicable provi-
Signature of Applicant — Owner Contractor Agent 1:1g ❑
sions of the Butte County Code and/or resolutions to do
work indicated above for
An OSHA permit is required for excavations over 5'0" deep and demolition or Construct-
ion of structures over 3 stories in height.
which fees have been paid.
DIRECTOR OF PUBLIC WORKS
Receipt No.
By
WHITE-D.P.W., YELLOW-ASeESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
Date
PERMIT EXPIRES Date
,