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Home My WebLink About079-190-028r too tj ' PERMIT#97 -'1838 " �. r S ;, ,{:= w-KENNICOTT :,CONSTRUCTION CO. 'C 387 -70B ' 'CROP Jeffrey;&,Deborah (cooler) ----281-70E ` ;2565 Monte •Vista.', Oroville �, 7 Reroof/SF .F 467-70E 413- OP 2565 Monte Vista Ave . , Oroville -LOT 17g (new single family) .�14 KENNICOTT CONSTRUCTION CO. 274-70B- ' v t ( cooler) '---281-70,E r 1 2565 Monte Vista Ave., Oroville ®� r (new single family)a 4/15/' OTE: AFTER FOUNDATION POURED, OWNER kCTDED' i. ATO CHANGE SIZE & DESIGN OF HOUSE. FOUNDATION -- _ - - - REMOVED. SEE N PERMIT #3 -70B F 1 v v Buzs- 119t - -2 M SCELL OUS `Windo Glass Door W E 2565 MONT AV CROPLEY JEFFREY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 2565 MONTE VISTA AVE Owner: Permit No: B08-1197 APN: 079-190-028 CROPLEY JEFFREY A &, Issued Date: 06/20/2008 By TMP Permit type: MISCELLANEOUS 2565 MONTE VISTA AVE Subtype: Window/Glass Door OROVILLE, CA 95966 Expiration Date: 06/20/2009 Description: WINDOW REPLACEMENT 3 (530) 534-5252 Occupancy: Zoning: RI Contractor Applicant: Square Footage: CROPLEY JEFFREY A &, Building Garage Remdl/Addn 2565 MONTE VISTA AVE OROVILLE, CA 95966 Other Porch/Patio Total (530)534-5252 FEE INFORMATION DBMSC Window/Sldng GIs Dr -Rept $119.00 Total Charged: $119.00 Fees Paid: $119.00 Balance Due: $0.00 Receipt No: B7768 LICENSED CONTRACTOR'S DECLARATION OWNER I BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. 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 X 06/20/2008 the applicant to a civil penalty of not more than five hundred dollars [$500]; P�leaassecheck one of the following: Contractors Signature Date ,�j I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE E3' E COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by ❑ ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractors License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the t Contractors License Law.). Carrier: Policy Number: Exp. Date: (This section nee not be completed if the permit is or one hundreddollars ($100) or ess. I AM EXEMPT under Section B. 8 P.C. for this reason: I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, and agree that if I should become subject to the workers'X QV 06/20/2008 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Owner's S' n ure Date provisions. X 06/20/2008 I hereby certify that I have read this application and state that the above information is coned. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnity, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE injury, including death, and property damage caused arising out of, in any way connected with HUNDRED THOUSAND DOLLARS $'100,000, IN ADDITION TO THE COST OF COMPENSATION, ( ) the issuance of this permit. I hereby acknowledge thatt is issuance of this pea rmit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. Count to enter the above mentione� County pro for inspectio purposes. I hereby certify that I am the property owner or ama Drize to ct t p�o R rs ehalf. CONSTRUCTION LENDING AGENCY 06/20/2008 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name of Permia IG U Prl t nn Date e the performance of the work for which this permit is issued. (3097 civ. code) • U � i Owner ❑ Contractor OR; E]Agent for Owner Agent for Contractor FILE COPY Lenders Address City State Zip I BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 - CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.nettdds **PLEASE PRINT CLEARLY** OWNER INFORMATION Last Nam o r I =irstName-, e` Address r ' ` Cily ® r() V I I�' State Zip Phone Z Fax E-mail - APPLICANT INFORMATION 5 ARCHITECT/ENGINEER Name Crtyo�,� ✓ /) .I Address Phone 3 -52 Cdy State Zip Phone, Fax E-mail State License Number APPLICANT INFORMATION 5 Name � /r _O l�o Address yyl , ' 1 /144— 1/;',< � Crtyo�,� ✓ /) .I Stat ef n zip bb Phone 3 -52 Fax E-mail E-mail LAN �nal fafA ror orrice use onl – Zoning Flood Zone . SRA Yes No Occ• Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: PROJECT LOCATION ..., API �7 q Pro rty AP -M t an4p- UIck Aw vv"r% rvr% OUDIVII I IAL KLUUIREMENTS I KAFORMSOUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 3 COMPENSATION Policy Number Carrier PERMIT NO. BIN # J 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 FT- Living Garage Open Cov ❑ 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, anew 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: Bldg SRA Receipt #: - Sheriff SMIP Date: Other Total q. o REV 6-12-05 a SUBMITTAL & PERMIT REQUIREMENTS, The following drawings and specifications must be submitted to the Building Division in order to apply for a ' permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph 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 faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Installation manual, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate ❑ 7. Metal bidgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Building Permit Application Without Required Clearances Form ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Bufferclearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). 4. _ NPDES_Form..-- ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, -Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). " ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530) 538.7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance -for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan " check fees -for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSSUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 3 REV 8-12-05 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal ° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks to you if you do not cavy out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. I PERSONALLY PL,ANJO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. YES R NO) 2. I JOHAVE NOT) 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 THE 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 Description: WINDOW REPLACEMENT 3 Reference Number: B08-1197 Applicant Name: CROPLEY JEFFREY A &, Owner's Name: CROPLEY JEFF Y AP h � a & Signature of Property Owner: P Date: :079-190-028 �2 g � yf�yfd`A� :"1�1: �vx'!'F4':�"."+�Yi:T,1T 9'S�.m3''r^' "C g -;'r y►!. i • a 01 036-570-042 PERMIT#97-1838 CROPLEY, Jeffrey & Deborah 2565 Monte Vista., Oroville Reroof/SF /!J��I •r�1 (/��p/�7 \ COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-754111-e /(?21T NO. (Rev. 12/96) APPLICATION AND PERMIT 911- -I X ASSES3JW.�2 Z°"�"° BUIL211NGPERMIT OWNER Jeffrey and deborsh cropley TELEPHONE S FT. OCC. BUILDING VALUATION OWNERS W ADDRESS Monte vista, oroville CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Fee $ 20.00 —Filing Permit Fee $ 33.00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDING ADD SSS A n T' 7.SL, fflANE VISTA, OX�QVILL.. Ener Plan Checking Fee $ Energy g $ PERMIT FEE t 53.00 LOT NO. S UBDNISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑,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 X New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: REROOF/CORP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service 2ooAORLL S 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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.PowEPPARATUs License Class LIC. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law W the following reason: 89 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 Main Service ( 200A TO I000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( a Acc. S. so 3.52FT. =gE°s;oT MULTI -OUTLET @7.50 d SINGLR AE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 Q 1.00 BAL so Ex. Occup. o."TMsAPPRWESSID. ORa 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 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. ❑ 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 number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ 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.) C 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 if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wit thosd—provisions. Date !? 1 / _ `SIgnat-6re of A plic t - ❑'Owner EYContr for ❑ Agent /^— er' '0"dee and demolition or construction An (jSctures v is required for excavations ov 5 p of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE 53.00 TOTAL FEE $ HA2. I D. FEES IMP FLOOD CDF PARCEL PO ND Issu This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated,, above for which fees have been paid. 1 It"0 t / ' ! ` / Date I '• �r�r BY Y X PERMIT EXPIRES ON v I Defe Receipt No. 224332 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT J COUNTY OF BUTTE- DEPARTMENT OF tnEVELOPMENT SERVICES - BUILDING DIVIS 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-75 RMIT NO. (Re,V12/96> APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 036-57-0-042 ZONING ' BUIL • NG PERMIT OWNER Jeffrey and deborah cropley TELEPHONE SO. Ff. OCC. BUILDING VALUATION 23 138E) OWNERS MAILING ADDRESS 2565 monte vista, oroville CONTRACTOR'S NAME - OWNER TELEPHONE ' CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 33.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 2565 MONTE VISTA, OROVILLE Energy Plan Checking Fee $ $. PERMIT FEE S 53.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other X 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 j{ New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work:F�.J(',nMp Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT I Filing Feel 20.00 - 800OR LESS Main Service ZD.VA OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 i (commencing with Section 7000 of Division 3 of the Business and Professions Code, ( g ) and my license is in full force and effect. License Class LIC. No. OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law 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 Main Service ( 200A TO I000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BUDS, SO 3.50FT. NEW CONST. MULTI- OUTLET NON-RESID. ANC CI CUI 97•50 POWER APPARATUS 8 SINGLE OUTLET CR. Ex. Occup. OUTLET OR FIXTURES 20 BAS @':So PPLNS Ex. Occup. ouTitDrs RES D.OEA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE $ 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 FEE $ 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.) ud 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 if I should become subject to theFEES workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply wit tho rovisions. X Date gn re o plica ❑ wner Contr or ❑ Agent An H r It is r uired for excavations ova 5'0" deep and demolition or construction of s ructures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 53.00 . IMP FLOOD COF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have / ' / By /t.0 [ PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. �ry� 7D�t o 7 i Def ReceiptNo. w,ITE•D.D.S.•B.D. CAN SOR PINK -INSPECTOR GOLDENROD -APPLICANT OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I personally plan to provide the major labor and materials for construction of the proposed property imp vement : YES NO ❑ 2. I HAVE HAVE NOT ❑ signed an application for a building permit for the proposed work. I have contracted with the followingPerson (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CITY: CONTRACTOR'S 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: CONTRACTOR'S 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 SIGNED: PROPERTYOWNER SOCIAL SECURITY DATE: NOTE. This Owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. OVER OWNER BUILDER INFORMATION Dear Property Owner: O.B.- I 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 parry of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ 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 taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you if you do not cant' out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, Mic el C. Vi ira, C.B.O. Ma ger, Building Inspection NOTE. This Oivner-Builder Information is required by Section 19830 of the California Health and Safety Code. OVER