HomeMy WebLinkAboutB17-2288 064-690-028BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
'24 HOUR INSPECTION (IVR)#:530.538.4365
:OFFICE#: 530.538.7601 FAX#:530.538.7785
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Site Address: 14868 HICKOK CT
Owner:
Permit. No: B17-2288
CONNOLLY, MICHAELS LIVI
APN: 064-690-028
Pen -nit type: MISCELLANEOUS"
PO BOX 1363
Issued Datc: 9/26/2017 By JMD
Subtype: DEMOLITION
CHICO, CA 95927
Expiration Date: 9/26/2018
Description: DEMO MH (FIRE DAMAGED)
Occupancy: Zoning: gT_1
Contractor
Applicant:
Square Footage:
OWNER/BUILDER
CONNOLLY, MICHAEL
Building' Garage Remdl/Addn
0 0 0
PO BOX 1363
CHICO, CA 95927
Other 1 Porch/Patio Total
5303436303
0 0 0
LICENSED CONTRACTOR'S DECLARATION
OWNER] BUILDER
DECLARATION t;t—
I �
Contractor (Name) State Contractors License No. I Class Expires
I hereby affirm under penalty of perjury that I am exempt fi.m the Contractors' State License Law for
OWNER/BUILDER
the reason(s) indicated below by the checkmark(s) I haveplaced next to the applicable item(s) (Section
7031.5, Business and Professions Code: Any city or count! that requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issu�nce, also requires the applicant for the
HEREBY AFFIIiM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9
I .
permit to file a signed statement that he or she is licensed. oursuant to the provisions of the Contractors'
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license,,
State License Law (Chapter 9 (commencing with Section r)00) of Division 3 of the Business and
in full force and effect.
Professions Code) or that he or she is exempt from licensL-e and the basis for the alleged exemption.
X
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).):
as owner of the property, or my employees wM wages as their sole compensation, will
Contractor's Signature Date
di,
o U all of orU portions of the work, and the stucture is not intended or offered for sale
(Section 7044, Business and Professions Code: Thie Contractors' State License Law does not
apply to an owner of property who, through employLmas' or personal effort, builds or improves the
property, provided that the improvements are not in.13nded or offered for sale. If, however, the
building or improvement is sold within on" year of completion, the Owner -Builder will have the
1!�o �*.IMORKERS%COMPENSATION DECLARATION P
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
Elhe a and will maintain a certificate of consent to self -insure for workers'
comvensation,
burden of proving that it was not built or
improved for the purpose of sale.).
issued by the Director of Industrial Rotations as provided for by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy
No.
1. as owner of the property, am exclusively contiitcting with licensed Contractors to
construct the project (Section 7044, Business andprofessions Code: The Contractors' State
I have an� will maintain workers' pensation insurance, as required by Section 3700 of
the Labor Code, for the performancecoofrtnhe work for which this permit is issued. My workers'
License Law does not apply to an owner of property who builds or improves thereon, and who
contracts for the projects with a licensed Contractor pursuant to the Contractors' State License
compensation insurance carrier and policy number are:
Law.).
�arrier. Policy Number: Exp. Date:
I am exempt from licensure under the Contracto2is' State License Law for the following
Elreason:
artily that, in the performance of the work for which this permit is issued, I shall not
El
.,mc ploy 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
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owner's Signature Date
provisions.
X
PERMIT -APPLICANT, DECLARATION "K,
Signature Date
By my signature below, I certify to each of the folt)wing:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS
I am L) a California licensed contractor or U th6 property owner* or L) authorized to
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
act on the property owner's behalr*.
I have read this construction permit application ajid the information I have provided is
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN
correct.
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
I agree to comply with all applicable city and county ordinances and state laws relating
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
to building construction.
I authorize representatives of this city or county io enter the above -identified property
for inspection purposes. California Licensed Cor1racior, Property Owner* or
Authorized Agent**: *requires separate verificatic�i form —requires separate
k 7 CONSTRUCTION LENDINGAGENCY-DECLARATIOW..
I hereby affirm under penalty of perjury that there is a construction lending agency for the
authorization form
P:rformance of the work for which this permit is issued (Section 3097, Civil Code).
L. nder's Name and Address
X
name of Permittee (SIGN) Print Date
Lenders Name & Address city State Zip
F.7771�, " 7-T - h, U7, -Pq "Ir FEE INFORAIATION
Total Fees: $203.98 Fees Paid: $203.98
Balance Due: (None) Job Value: $5,000.00