HomeMy WebLinkAbout079-180-015,PERMIT#96-2833,.
JACKSON, Julian fi
3378 Oro Bangor Hwy, Oroville
Cont: Skyline-Ent.
Roof Mtn Pkg Unit/SF /
- 02-0411
JOHNSON FAMILY TRUST
3378 ORO BANGOR, OROVILLE
TERMITE REPAIR
F
JOHNSON FAMILY TRUST t 4-25 7
' 3378 ORO BANGOR HWY, ORG-vamlE
Cont: HAROLD BILLINGSL
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' DICK, C. H.
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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.
LICENSED CONTRACTORS DECLARATION
1 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: 09/03/2004 APN' 036-113-007-000
the Business and Professions Code, and my license is in full farce and
effect.
License Class: License Number:
Site Address: 3378 ORO BANGOR HWY ORO
Date: Contractor:
i Map Index:
Description: RE -ROOF (24 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
Owner: JOHNSON JULIAN S FAMILY TRUST
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
C/O JOHNSON DOROTHY F TRUSTEE
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
3378 ORO BANGOR
she is exempt therefrom and the basis for the alleged exemption. Any
OROVILLE, CA 95966-7112
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: JOHNSON JULIAN S FAMILY TRUST
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
, C/O JOHNSON DOROTHY F TRUSTEE
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
3378 ORO BANGOR
proving that he or she did not build or improve for the purpose of
OROVILLE, CA 95966-7112
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.).
Contractor' HAROLD L BILLINGSLEY
'
❑ 1 am Exempt under Article3 f he Business and P fes ions de
r
2660 WILLIAMS AVENUE
Date:wner:
_. PALERMO, CA 95968
(530) 534-5823
ORKERS' COMPENSATIO ECLAR ION
1 hereby affirm under penalty of perjury one of the following declarations:
r
❑ 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
License #: 456565 p
Labor Code, for the performance of the work for which this permit
is issued.
❑ I have insurance, as
and will maintain workers' compensation
i 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 carrier and policy number are:
I
Carrier:
0 S.F.
Total Square Ft: lU "/
Valuation' $0.00
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,
..-
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.
C
Date:
Applicant:
WARNING: Failure to se re workersmpensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
A-113 s d 137 60 `7/a/04—
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.
CONSTRUCTION LENDING AGENCY -
This permit is h reby issued under the applicable provisions of the Butte County Cody+ ?nfVOr
I hereby affirm that there is a construction lending agency for the
Resolutions to o work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Or
/kms Dale:
Name:
By
PERMIT IRES ON: ey' 3 -OS
Address:
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 & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
1 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 f t ow er. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substanc of any official form or docum 1 Butt Count hereby
authorize representatives of Butte County to enter up n the above mentioned property for inspection purpo s.
,
�.�
Print Name: L. Signature: �C / vi%r3�
A 7
Date:
Owner ❑ Contractor 13Agent for Owner L3Agent 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.nehdids
PERMIT NO.
BP042587
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: 09/03/2004 APN• 036-113-007-000
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Site Address: 3378 ORO BANGOR HWY ORO
Date: Contractor:
Map Index:
Description: RE -ROOF (24 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
Owner: JOHNSON JULIAN S FAMILY TRUST
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
CIO JOHNSON DOROTHY F TRUSTEE
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
$378 ORO BANGOR
she is exempt therefrom and the basis for the alleged exemption. Any
OROVILLE, CA 95966-7112
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).):
O 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: JOHNSON JULIAN S FAMILY TRUST
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
C/O JOHNSON DOROTHY F TRUSTEE
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
3378 ORO BANGOR
proving that he or she did not build or improve for the purpose of
OROVILLE, CA 95966-7112
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.).
Contractor: HAROLD L BILLINGSLEY
❑ 1 am Exempt under Article 3 he Business a�,��de2660
WILLIAMS AVENUE
Date: '�wner:PALERMO,
CA 95968
(530) 534-5823
ORKERS' COMPENSATIO ECLAR ION
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 #: 456565
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
❑ 1 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 carrier and policy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy #:
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: A A6 1A,
Applicant: /
WARNING: Failure to se re workers' mpensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
zk
-1135437 16c) q/3/�¢
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.
CONSTRUCTION LENDING AGENCY
This permit is reby issued under the applicable provisions of the Butte County Code ?nrvor
I hereby affirm that there is a construction lending agency for the
Resolutions to o work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
BY Date:
PERMIT IRES ON: q 3 -OS
Address:
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 & 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 f th ow er. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substanc of any official form or docum t Butt Count hereby
authorize representatives of Butte County to enter up n the above mentioned property for inspection purpo s.
Print Name: Signature: '
Date:
Owner ElContractor ❑ Agent for Owner 0 Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
i 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 REO UIRED AT TIME OF APPLICATION
.A "PLEASE PRINT CLEARLY"
4A
CONTRACTOR
Name
.'Air,�
Address
FZip
Address
. 9
C
city/
4A
CONTRACTOR
Name
Name
Address
FZip
Address
Fax
C
city/
Phone
State
Fax
Phone.—�
S� J�
Fax
E-mail
Uc
C�
4A
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
FZip
City
Fax
State
rp
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name - /
Address
City
State
FZip
Phone
Fax
E-mail -
For office use onff- 17
Zoning
Property Address
3378 QJ26 �A-r.L6b2.
Flood Zone
I I
SRA
Yes
No
Occ.
Type Const
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
BP pc ,511
111MLI
LOCATION
AP#
03� � 1 f3 •oat
Property Address
3378 QJ26 �A-r.L6b2.
city�r�
�o2p
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
Sq. Footage
❑ Structure Built Mthout 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.
II Received by: Amount 137 Sn Bldg I I
SRA
Receipt #: 4'' Z3 S U Sheriff
OVER FOR SUBMITTAL REQUIREMENTS 1 11
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
Date: q.3.04
SMIP
Other
(37.5-0 Total
REV 7-27-04
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 l)V WK
❑ 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 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. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application 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
KAFORMSWILDING F0RMSIBIdgApp1SubRgmts.d0c Page 2 of 2
REV 7-27-04
(Rev. 12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530),538-7541
APPLICATION AND PERMIT
PERMIT NO.
02-0411
ASSESSOR PARCEL NUMBER 036-113-007
ZOdNIIN'G
BUILDING PERMIT
OWNER JOHNSON FAMILY TRUST
T533.0872
SO. FT. OCC. BUILDING VALUATION
EST 4,000.00
DWNEASppDVilnp EE�gg
IV 0 BANGOR , OROVILLE 95966
CONTRACT9A'SVN iT.R.T
TELEPHONE
CONTRACTOR'S MAILING ADDRESS - -
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 4 000.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 63.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
3378 ORO BANGOR OROVILLE
Energy Plan Checking Fee $
$
PERMIT FEE S 83.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF di Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each as water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other IR
Describe Work: TERMITE REPAIR RtERLASE -DR 9
T �' RST, �'�1N�i�D
DAMAGE. MTNTMAE SIDING, 12ARTIAI 51111$190R
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W 920.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
0OR LESS
Main Service . ' OR LESS 23.00
LICENSED CONTRACTOR'S 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.POWER
License Class LIC. NO.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
C 1R. I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO I000A 46.00NEW
CONST. DWELUNG OOCUP. so
OR ADDNS. ( 8 ACC. S.3.5¢FT.
NOWRESID. OUTLET 97.50
APPARATUS
8 SINGLE OLET UTOIR.
Ex, OCCU OIJTIET OR FDTTUREs 9A .0 @ I 0
Ex. Occup. pflxuntTs PPMD� 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE S
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 is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
(, I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that f I should become subject to the
workers' compensan provis' 66 o action 3700 of the Labor Code, I shall
fo with comply wit'thos:Ov'sion
l
X Date
Sig a of Applic - 1P Ow/ r ❑ ontractor ❑ Agent
An OSHA permit is required for e4avations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 83.00
HAZ.
p. FEES
IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
XX
This permit is hereby issued under the applicable provisions
of the Butte,County Code and/or Resolutions to do work
which fees have been paid.
•a`� . Q�
VBy
DateReceiptNo.
ON
Date
UU
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
t
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r337.
6-13
°` -007
PERMIT#96-
2833CKSON, Julian
Oro Bangor Hwy, Oro
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COUNTY OF BUTTE- DEPARTMENT OF DEJELORMENT SERVICES -BUILDING D VISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538 541 PERMIT NO.
APPLICATION AND PERMIT 6 - V8-7_:�
ASSES�QIrCq�N'U'wT-NV/
+j�
ZONING
'
BUIL INGPERMIT
OWNER
TOili�HNSON
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
^�JrMaIAN
OWNE��1 J gNO:J %ANGOR RWY a OROVILLE 95966
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Fling Fee $
20.00
LENDER'S MAILING ADDRESS
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty $
BUILOI3SG, ES6RO BANGOR MY, OROVIUZ
33 /1LLfi
PERMITFEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF ❑XDuplex ❑ Mobilehome ❑ Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Is
Describe Work: ROOF MOS PRG UNIT
r
Mobile Home IS I GI W 1
920.00
PERMITFEE $
.
Contractor
ELECTRICAL PERMIT20.'00
Filin Fee
Main Service a oR LESS
( zooA oR )
23.00
...
Main Service ( 200A TO I000A )
46.00
LICENSED CONTRACTOR'S 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 's in full force and effect.
License Class CSD e/J 67 Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUP.
OR ACDNS. ( a ACC. BLDS. )
SD.
3.5Q FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
@7.50
POWER APPARATUS
(a SINGLE OUTLET CIR. )
Ex. Occup. (OUTLET OR FIXTURES)
SAL Q I:s°o
FIXED APPWS. OR
EX. OCCU p• ( OUTLETS (RESID.) EA)
t
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE $
Contractor
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 is issued. ';
I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy numbe;.are:
Carrier �.s-�Z` it'���1
MECHANICAL PERMIT
Filing Fee 20.00
9
Heating ow
15.(X)
Cooling 1
•
Hood
6.50
Ventilation
PERMITFEE $
50.00
Contractor
Policy Number ` &IZ5 G y0 Z'
(The above sections need not be completed if;the permit is for work of a valuation
of one hundred dollars ($100) or less.)-
❑ 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 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 provi ions.
)�/yY% �/� __ Date _1�� �6
Signature of Applicant - ❑ Owner ��tractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construction of
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee Is
occ
CONST. TYPE
I
TOTAL FEE $ 160.00
HA2.
I D. FEES
IMP
FLOOD
CDF PARCEL PD HD
TE
�(
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or R s6lutions to do work
indicat d bove for w i h fees hake been paid.
/
B f ,t�i/
> /,/V/ Date 12/26/96
PERMITEXPIRESON 12/29/97
I (Date)
ReceiptNo. 2M618
WHITE-D.D.S.-R.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE- DEPARTMENTioF DEVELOPMENT SERVICES -BUILDING
N
7 County Center Drive - Oroville, California 95965-- Telephone (916) 5PERMIT NO.
APPLICATION AND PERMIT `,-28
ISE s�L C,�N"ro3E�07
1N1
ZONING
BUI ING PERMIT
OWNE�ULIAJOHNSON
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
DW"337rarsbANGOR HWY, OROVILLE 95966
CONTRACTOR'S NAME
qKYTTNE ENT
TELEPHONE
CONTRACTORS MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNI04OWN
Total Valuation is
Fling Fee $
20.00
LENDER'S MAIUNG ADDRESS
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty $
BUILD3378ESORO BANGOR HW, OROVILLE
PERMITFEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
LAT NO.
SUBDIVISION'S NAME
PARCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF ❑XDuplex ❑ Mobilehome ❑ Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00 15-00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other
Describe Work: ROOF MOUNTED PKG UNIT
Mobile Home I S I GI W 1
@20.00
PERMITFEE s
35.00
Contractor
ELECTRICAL PERMIT
Filina Fee 20:00
Main ServiceE00V OR LESS
( 200A OR LESS )
23.00
Main Service ( 200A TO I000A )
46.00
LICENSED CONTRACTOR'S 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 -s in full force and effect.
License Class ZM e17 62. Lic. No. 5 7 ®<°/
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DW8.ELLING OCCUR
OR (
SO.
CNS.
NEW CONST.MULTI.OUTLET
NON-RESID. ( BRANCH CIRCUITS )
97.50
POWER APPARATUS
(8 SINGLE OUTLET CIR. )
Ex. Occup. ( OUTLET OR FIXTURES ) 1
20 �' 00 5..00g
SAL .50
Ex. Occup. (OFIXED P LNS. OR
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE $
25.00
Contractor
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 is issued.
I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' com nsation illsurance arner ark policy number are:
Carriers
MECHANICAL PERMIT
Filing Fee 20.00
9
Heating 60,000
15.00
Cooling 3 TON
15.00
Hood
6.50
Ventilation
PERMITFEE $
50.00
Contractor
Policy Number lire/O y® Z.—
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 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 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 provi ions.
�Date
Signature of Applicant - ❑ Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee is
Energy Inspection Fee Is
OCC
CONST. TYPE
TOTAL FEE $ 160.00
HAZ.
1 D. FEES
IMP FLOOD
CDF PARCEL PD HD
ISSUE
X
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Re lutions to do work
indic /adbove for w ' h fees h e en paid.
yWOLF I Date 12/26/96
PERMITEXPIRESON 12/26/97
I (Date)
Receipt No. 90961 R y
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT