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Home My WebLink About078-340-030�! T'; . {•,y�i;��..�' F - i '; •. i - � � t> r �:! 1 3�i"-,;, ttLt1�;!'i0 i} r,st� -;F, I,;' A 3 y,� �r,- (` (. *t�i Fl ri te -. �,#X��. is i!� ssy it%,k�'�' tt" A`l1i r Sit�•/.: r 5 sf +.tt.'}tiJ��,�y � t t I:QFey i it ;..'�• N a • E ~mak FOi eft i�{ t �J tJ !1 f -� t - YaZt f� �.: rr {f {u +� Sj + h J . .k L aEt �i J41 � S t it1� f. .f , Y e`�. ® • kS7 �;�} �S��iif�5i ji7 t .. . j • _ F ;i�: ��+ t' E..9t�st{�sr (lilt. t' /... i f .,f gk2q; � 'i,.t-•';£'.t! 7r}ftF'�. ># !t --i J�` jt r _ i IP' S ', r x n S c 1: r 4 •� It e > t }I 1 �: } et d e eAa t •,,v t j' r f >rr �—r< riltff 1[ ` t•Y r 71' d t {i 1., ��{y ! ,• j ZN . 1 1� 1 ." v �- ..}! }i,. tit f �Yr•� r rA �t tYd tti c :. y • �' S I+ r t.. 1 ! °! '{i .tf� ;1 'L y 't . r. dij! IE Y�) i��. 1 y' f F }' • • � • • • � R �xt�s � iit.,�EEs�i j fi:, i�p, d tEr}�n 3 ``E�i�S , :z -- trt ��,. ��tEi i ti f i t o ,p iv c t 1 e.s ' • • S eS x.' i Jt f ti i t Sl N 4"-4 r r y s tE i Ht e S r AY i d f e t'; ,�1'; �t�i fud1 (. ip r..i3. 4t iCir t. N ?` p { P fir✓ t S 4 ii t! r �; �diF i i� ,,. i , r . ; „ wii�: ett i -. � if41 •� dr �i .: ;: ,4t i r t r"`' 1'. { � y{` �E.rF xi z :! i ! rr, 3 $ { t .y i i li%4� ;•. t �' ! rtr - t � G • ;- ' t : 'y stir' ".S �!`� c'S - 1/ >y,��t 5 5 E l� ir3 o t Y . 6* 44 ,� r! t t ' • • " i tib r 01 1� 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.net\dds PERMIT NO/ BP042902 V 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: 10/05/2004 APN: 036-450-030-000 the Business and Professions Code, and my license is in full force and effect. License class: �-3 % License Number: .S 71 s y Site Address: 65 INGLEWOOD DR ORO Date: Contractor: 1 Map Index: OWNER43UILDER DECLARATION j Description: REROOF W/COMP 21 SID 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 i Owner: CROSBY PHILLIP W & BEULAH permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a i 65 INGLEWOOD DR signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA the Contractor's State License Law (Chapter 9 commencing with Section t 7000) of Division 3 of the Business and Professions Code) or that he or j 95966 she is exempt therefrom and the basis for the alleged exemption. Any 1 violation of Section 7031.5 by any applicant for a permit subjects the I applicant to a civil penalty of not more than five hundred dollars ($500).): r a ❑ 1, as owner of the property, or my employees with wages as their t sole compensation, will do the work, and the structure is not j intended or offered for sale (Sec. 7044,. Business and Professions Applicant: CROSBY PHILLIP W & BEULAH 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, r 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 r 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 COntPBCtOr' ALLADIN ROOFING ' 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.). P O BOX 4262 ❑ I am Exempt under Article 3 of the Business and Professions Code OROVILLE, CA 95965 (530) 533-2934 Date: Owner: WORKERS' COMPENSATION DECLARATION License #: 532834 I hereby affirm under penalty of perjury one of the following 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 Architect: is issued. Engineer: 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 t insurancecarrier �and policy number are: /I Carrier: S/Cl /-P �� v, Total Square Ft: 0 S.F. Policy #: 7� fes_/ % O j/ . Valuation: $0.00 1 '� Census Code: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree 'that if I should become subject to the workers' I\ compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions. Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful• and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages s provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit i�°h eby iss ed under the applicable provisions of the Butte County Cody ?nrVor I hereby affirm that there is a construction lending agency for the Resolutions t d ndicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) �,� Name: By: Date: � r 4 PERMIT EXPIRES ON Address: Date ❑ I 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. Print Name:!? %'' ! r (tJ Signature: Date: 0 Owner 9 /Contractor ❑ Agent for Owner 0 Agent for Contractor 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 PERMIT NO. BP042902 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: 10/05/2004 APN: 036-450-030-000 the Business and Professions Code, and my license is in full force and effect. License Class: 0--,3 % License Number: -531y—?y Site Address: 65 INGLEWOOD DR ORO Date: Contractor: Map Index: Description: REROOF W/COMP 21 SID 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 Owner: CROSBY PHILLIP W & BEULAH to its issuance, also requires the applicant for such permit to file a 65 INGLEWOOD DR signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA 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 95966 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).): ❑ 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 Applicant: CROSBY PHILLIP W & BEULAH 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 Contractor:. ALLADIN ROOFING 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.). P O BOX 4262 ❑ I am Exempt under Article 3 of the Business and Professions Code OROVILLE, CA 95965 (530) 533-2934 Date: Owner: License #: 532834 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 workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: 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: S Carrier: � � Total Square Ft: 0 S. F. Policy #: 7/ 3-9 % % D 5/ Valuation: $0.00 Census Code: ❑ 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: % 6— �":— Oy Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 37.06 of the Labor code, interest, and attorney's fees. �J',►," CONSTRUCTION LENDING AGENCY This permiti °h eby iss ed under the applicable provisions of the Butte County Coda andlor I hereby affirm that there is a construction lending agency for the Resolutions t d ndicated above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ:) G� Name: BY /1 Date: U ' /)Date Address: PERMIT EXPIRES ON(,�_ ) ❑ I 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. thereby authorize representatives of Butte County toenter upon the above mentioned property for inspection purposes. Print Name:`] /"' / �C / U Signature: Date: 13 Owner 9`/Contractor ❑ Agent for Owner ❑ Agent for Contractor J �vTrBUTTE F0 DEPARTMENT oFDEVELOPMENT SERVICES o BUILDING PERMIT APPLICATION �. AND SUBMITTAL REQUIREMENTS _`- � 0 24 HOUR INSPECTIONM OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834 o - o OFFICE #: (530) 538-7541 CQ UN A FEE WLLL BE REO UIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" APPLICANT NAME OWNER Last Name NameMle_M, lFirskNr Address Address D City OY v City State Zip �� 6 Phone Zip Fax E-mail 3 APPLICANT NAME ARCHITECT/ENGINEER CONTRACTOR NameMle_M, Address 1 A I p`d� Address D Fax City V �bI f ( Phone State , Zip Phone S-13 _ .27 3 Fax E-mail Date Approved: Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Subdnrision Name Fax E-mail Page State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For offs e 4.se or) : AP# 7� Zoning Flood Zone I Cross Street SRA I Yes No Occ. If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time ofpennit issuance. Type Const Subdnrision Name Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. X70 9 BIN # LOCATION AP# 7� Property Addre City Cross Street WORKER'S COMPENSATION Policy Number —71 3_ 2977 _ a Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time ofpennit issuance. LENDING AGENCY Name Address Description or Scope of Work: ; 7 e Sq. Footage Te ❑ Structure Built vi thout 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 by. Amount I (D Bldg 4z'�'- SRA Receipt #: !�-( Z�q-rj� Sheriff SMIP `�b14 05-- Othe Date: l Totalr SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to applyfor a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEG/BLEAND /N INIC O 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paperl ❑ 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 ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal 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. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permiL 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). 7 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). :1 6. Contractor's license information. (Number, Name Style, Classification). 7. Worker's Compensation Carrier("and Policy Number. 8. Owner -Builder Verification (if required). 7 9. Letter of Signature authorization (if required). 3 10. Recorded copy of Agricultural Acknowledgment Statement. 7 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). f you have questions or would like additional information regarding this process, contact a Permit kpplication 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 -n-an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS .eTunas can oniy be made upon written request by the person who paid the fee. The request must be made within two cars from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits :sued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan Teck fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION TORMSSUILDING F0RMS\B1dgApp1SubRamts.doc Pana 7 of 7