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COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING, DIVISION
7 County Center0rive • Oroville, California 95965 • Telephone (530) 53,8'-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT -` ✓
ASSESSOR PARCEL NUMBER - - �% ., /
`J
ZONINA ` !
/
BUILDING PERMIT
OWNER
M r►�1 ��- � 1 r
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
. OWNERS MAILING ADDRE �/'
CONTRACTOR'S NAME s, � LP/`•/• j�qM
^"V ��/
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS / (r
Energy Plan Checking Fee $
PERMIT FEE $
LOT NO.
SUBDNISIOWS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF,2000Duplex ❑ Mobilehome ❑ Other
SPECIFY IEach
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
gas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities 13 Installation ❑ Other
Describe Work:, e//!e Crit / �"A J ► G I+" ;
=
Gas piping system 1 - 5 outlets 15.00
Buildingsewer 15.00
Mobile Home I S I G I W 920.00
PERMIT FEE $
ELECTRICAL PERMIT Fling Fee 20.00
Main Service z0.V. oA mss 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.
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.
7'C]; 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
WORKERS' COMPENSATION DECLARATION
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 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
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP. SO
OR ADDIS. ( a ACC. BLDS. 3.5¢x.
1Np11 R61D, MUL 11 Cl LEf 97.50
POWER APPARATUS
a SINGLE OUTLET CIR.
Ex. Occup. aa0 ° 1.00
OUTLET OR FDRUREs .50
FIXED APPLNS. OR
Ex. Occup. ouTLErs RES10, EAS 5.00
Temporary Service 3 23.00
Mobile Home Facilities 20.00
Misc. Wiring23.00
PERMIT FEE $
MECHANICAL PERMIT Fling 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.)
Q' 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 provisions.
X Iem FVVI Date ` v Z
Signature of Applicant - ❑ Owner ❑ Contractor 14,Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in heght.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $'E."
Cc—
HAZ.
p. FEES IMP
FLOOD
I COF
I PARCEL
I PD
I HD
I$SyE
V
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.
/ �� - �+
By Cl[� Date
PERMIT EXPIRES ON �'/6 3
I r Date
Receipt No. 31)" .. 24
WHITE-D.D.S.-B.D. CANARYASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
z i COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING ,DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (530) 5� -7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT ✓ a _�
ASSESSOR PARCEL NUMBER / ` ..
�7 l
ZONIN ` 1
/
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
.OWNERS MAIUV ADOR () e—,`1 7`�
v VV.; Ile r'
V
CONTRACTOR'S NAME _pa L''
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
10-7
Energy Plan Checking Fee
$
//--
$
PERMIT FEE
S
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling 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
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other
Describe Work: e, e_(rt I C �//I.J D G
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
920.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
600V OR LESS
Main Service 20OA OR LESS
23.00 Z.3 —
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 Llc. 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
Main Service 200A TO I 000
46.00
NEW CONST. DW ELJNG OCCUP.
OR ADDNS. ( 8 ACC. S.
SO
3.5¢FT;
ptOµq�IDT MULTI -OUTLET
97.50
APPARATUS
d SINGLE OUTLET C1 R.
Ex. OCCu OUTLET OR FDffURES
20 @''50
SAL @ .50
Ex. Occup. GFucuTE, ETSR� 1 E
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.
❑ 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
Fling 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.)
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 it I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X�!� Date ^�`-(�Z
Sig a of Applicant - ❑ Owner ❑ Contractor Agent
An SHA peris required for excavations over 60" deep and demolition or construction
of structures over 3 stories in he)ght.
Mobile Home Installation Fee
$
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
PO
HD
I$S
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
I I
the applicable provisions
Resolutions to do work
been paid.
Qlate 3 �Q
J
IfDet.
Receipt No. J 1 WO . •0
WHITE-D.D.S.-B.D. CANARYTASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
Ty COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ' I " l S ASSESSOR PARCEL NUMBER
Proposed Building Use: ¢ 1 L Ly� < <� / ✓ �` ✓� Counter Technician: '" Date: `C> Z'—
Items required in order to apply fora permit. All boxes,NWST be checked OR marked NA in order to apply.
AAL Plot plans, 3 or 4 sets, signed by the preparer of the plans. ,}
2. Complete plans, 3 or 4 sets; signbd' by the preparer of the plans.
3. Engineered plans, 3 or 4 seas, with wet signature on plans AND 2 sets of stamped and signed calculations.
41. Engineered truss details and"fayouts'in dupli6ate9' No faxes!
5. Energy compliance design and supporting documentation in duplicate.
/*6 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
nm, Metal_ buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D)"Nor plans in triplicate. All of these must be stamped and wet -signed by the engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be
indexed and returned to the plan review line-up when required items are received.
Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate....... ..........................
❑ 9.) Plot 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 ................... :.................
❑ 12:. Hazardous Material Form...............................................................................
X
13: Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 14. Fees as shown on the attached Schedule of Fees Due Sheet .......................................
❑ 15: Statement of Intent for Non -heated and A/C Buildings .............................................
❑ 16. Sanitation and plot plan approval from the Environmental Health Department in
❑ 17. City of Chico Plumbing permit.........................................................................
❑ 181 California Department of Forestry plan approval ❑ paid. Sent by: ......................
❑ 19. Planning approval for. (A) Use: (B)Parking: (C) Parcel Check:
❑ 24. Contact Land Development about ❑ Improvements, ❑ Drainage ...............................
1. Encroachment Permit for drivpway from the Public Works Dept. (construction approval prior to occupancy).
ko 22. Pre -Inspection for G / Ger t I- rte') required ................
❑ 23. Contractor's license information. (Number, Name Style, Classification) .......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:................................
❑ 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) .....................
❑ 261 Letter of Signature authorization....................................................................
❑ 27. Recorded copy of Agricultural Acknowledgment Statement ....................................
❑ 28. Manufactured home utility clearance...... �........................................................
❑ 29. Existing violations and/or expired permits.........................................................
0'30: ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $
'0 31. Other: ,
When issued Telephone cl""" is —7& - '7 � ' r and hold for pickup.
r
o <� �c
I have been informed oftheabove items and re uirements for obtaining a building permit.
Applicant: Date:
1. Index permit application for the above items numbered:.,
2. Additional items required r31'`•'
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by
Plans reviewed by: Date: Plans approved by:
Structural reviewed by: Date: Structural approved by:
Note transfer.by: Date:
Yellow: Building Division
i. Ire
Plan Check Letter
Date:
_Date:
Date:
Date_
—:�:�
JD Ellison -
`�%�
�����
1
r
-.PRE-INSPECTION REP01?F,,-.-
OWNER:
•
LOCATION:
CONTRACTOR:
PRE-INSPETION FOR:
DATE TO INSPECTOR: (J PERMIT
DATE:
A.P. #.-
ZONING:
-
ZONING:
( ) AS FOLLOWS:
BUILDING INSPECTOR'S REPORT
Building Description:
Commercial/Usage:
Residential/# of Units:_
Currently Occupied
Abandoned/Vacant s
Electric:
Yes No Electric currently On Off
Condition of Electric j
Gas:F
Natural Propane_ None i Currently On__,ZOff
Obvious Problems:
Sanitation: I
Plumbing Working
Well Working Potable Water
Obvious SewageProblems
Comments:
ACTION RECOMMENDED: LSSUE:,.,� r HOLD FOR
Inspecto - Date_ — ( 4r')��
Sketch buildings on reverse and indicate location on property