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HomeMy WebLinkAbout064-500-069064-50-0-06996-1681 B FREEBORG, Bob 14*L 8�aolo 14031 Pineland Circle, Magalia (reroof/comp)SF Ely Roofing 064-500-069 06-1235 FREEBORG, ROBERT 14031 PINELAND CIR, MAGALIA Cont: GREENE & SON R OFING RE ROOF S•25 -o(, 2 U11 NOTES 064-500-069 . 06-1235 �0or nam+ FREEBORG,ROBERT '. 14031 `PINELAND CIR, MAGALIA = Cont: GREENE & SON ROOFING 1U y' RE ROOF APN: OMf/-jd -,0 41 Permit No. Owner: . Site Address:/ / O,5 ?(/! 4po, / Z6� Contractor: Q Type of Permit: 0145, C/a CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: F +=OK 0 = Not OK MANUFACTURED HOMES MISCELLANEOUS DATE PERMANENT FOUNDATION SOFT -SET 1 Zoning -Setbacks -Easements 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FaIUC/O-Concrete 4 WV; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grnd Amp -Concrete 6 Yard Gas; Loctn-Test-Wrap Nat ❑ or LP[::] Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage Line 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Clrncs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electficity Tagged 13 Tie Downs ❑ Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers DATE ID E C K S -CO V E R S•C A R P O R T S •G A R A G E S 1 Zoning -Setbacks -Easements 2 Ftgs; SoilsSz-DpthSpacing-CnnctrsSteel 3 Decks, Girders/Joists-0cking-Brcing . Stairs-Guard/Handrails . 4 Wood Awn; Posts-Beams-RfVs-CnnctrsShthg• Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-AnchrsStuds-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnis ye ya DATE JPOOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool. Lting; 15 volts-GFI 6 Elec Enclsrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcltng Eqp-Htr 8 Elec Grndng; Eqp w/5' Crcitng Eqp-Pool Ightg Boxes-Enclsrs-pelboards-Insultn to Main Conduit 9 Health Dept Apprvl 10 'Plmb; Cir Test -WV Supply Test 11 Lt Niche . 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide Ole 4 °'s 00 0 Pool Drawing +=OK 0 - Not OK RESIDENTIAL (Single & Duplex) GATE JUNDERFLOOR DATE 1PLUMBING 1 Zoning -Setbacks -Easements -Flood -Slope 53 Wtr Htr; Vent-Acc-Cmbstn Air Baffle 2 Ftg Main; Soils-Elec Grnd Ftg DRth 54 Wtr Pipe; Test & Anchr-Nail Prtctn 3 Ftg Garage; Soils-Steel-Elec Grnd Ftg Dpth 55 DWV; Test Fittings & Anchr Nail Prtctn 4 Ftg Porches/Decks; Soils -Steel Ftg Dpth 56 Shwr Pan; Test, First fir -Tub Acc 5 Stemwalls Main; Steel-Blockouts-Wrapped 57 Test Tub '& Shwr, 2nd fir - Tub Acc 6 Stemwalls Garage; Steel-Blockouts-Wrapped 58 Gas Pipe; Sz & Anchrs 6a Hold Downs and Special Anchrs 59 Fire Sprinkler; Test 7 Slab, Steel Wrapped 60 Yard Gas Piping 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 41 s 10 UF, Gas Pipe; Sz Anchrs-Sz Test 0 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12_ Elec Undrgrnd DATE IMECHAN I C A L 13 Plenums & Ducts; Clrnc-MaterialSupport4nsultn 61 AC Ducts Insultn & Support 14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples 62 Vent Fan, Exhaust abv Insulin 15 Acc & Vntitn 63 Condensate Drain & Ovrflw, Sz & Grade 16 Insulation 64 Furnace -Vent Acc-Comb Air Rtrn/Vent 115 Outlet 65 Attic Acc & Pltfrm If Furnace in attic " DATE IFRAMING 17 Sills Proper Materials & Anchrs DATE F I N A L 18 Wails Studs -Nailing Spacing & Braces -Plates -Sound 66 Ext Steps -Door & SldeLt Prtctn-Landings 19 Bearing Walls over Girders & fir Nailing 67 Smoke Detector 20 Draft Stop In Walls (rat proof) 68 Furnace Vnts-Clmc-Comb, Air-Cnnctr 21 Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs In Garage; abv-fir-Ducts-Mech Prtctn 22 Headers & Beams -Si & Bearing 69 Bedroom Exiting 23 Hangers -Post Caps-Anchrs-Cnnctns 70 GFI & Bath Fxtrs & Tub Acc-Spa 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg 71 GFI Arc Fault 25 Frplc Ties or Type A Flue-Frplc Throat Clrnc 72 Elec Trim & Subpnl, Breaker Szs & Labels 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 73 Stairs, Guard/Handrails 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 74 Frplc or Stove, Clrnc-Hearth 28 Garage Fire Prtctn Framing -RC Channel 75 Elec Outlets at Wood Pnl, Int & Ext 29 Prprty Line Firewall & Opngs 76 Ktchn, Fxtr & Appinc; Grnd-Air-Gap-Cooking Clrnc 30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits 77 Elec Outlets & Rcptcls at Ktchn Counter 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 78 Garage Fire Door; Swing -Landing -Closure 32 Plywd on Roof Ovrhng-Attic Vnts-Rftr Outrgrs 79 AC Duct in Garage -Damper 33 Siding -Nailing Veneer 80 Wtr Htr; Vnts-Clrnc-Com Air Cnnctr-PRV; abv fir 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc Mech Prtctn; LPG Appince Undr House 3" drain 35 Glazing Area -Glass Prtctn-SkyLts-Plastic 81 Plmb; Elec & Mech Eqp Listed for Loctn 36 Shear Walls; Nailing -Bolts 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 37 Brace Int/Ext Wall pnls 83 Insultn-Foam-Looked in Attic 38 Insulin -Walls -Ceilings 84 Guard Rails & Deck Cnstrctn-Post Caps 39 Infiltration-Walls-Wndws 85 Fndn Vnts & Crawl Hole Door Drnge & Wood -Earth 86 Clrnc Drnge Planters [--]Yes O No s o' o`s o'`" �• 87 Stucco Brown -Finish 88 AC Unit Dscnnct, Elec-Plmb 89 Vnts abv Roof, Plmb-Appinc-Frplc-Cirnc to Opngs DATE JELECTRICAL 90 Wtr Well, Dscnnct, Elec, Pimb 40 Fxtr & Trnsfrmr Clrnc-Ins Prtctn 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 41 Elec Rcptcls Spacing-Lts & Switches at Doors 92 Vntltn thru House 42 Sz Boxes & No Of Cndctrs Stapled 93 Glass Prtctn 43 Romex Installed Close to Edge of Studs & CJ 94 Corrections from previous Inspctns 44 Eqp Grnd made up w/Mech Fstnrs 95 Gas Test -Meters Tagged, Gas-Elec 45 Grndng Electrode Bond Gas & Wtr 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 46 2 Appinc Cires in Ktchn & Cndctr Sz GFI 97 Energy Cmpinc Cert -Other Certs 47 Subfeed Wire Sz , OCU or DAL 98 Address Posted AC Wire Sz , [::ICU or D AL 99 Fire Sprinkler 48 Range Circ Qa OCU or D AL Oven Circ ga 0 C or DAL Insulated Neutral OYes ONO 90 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrncs pnls-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector e 0 9 BUTTE COUNTY . DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 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 the Business and Professions Code, and my license Is In full force and effect. License Class: License Number: �L /�� Date: Contractor, r%A �P 2 1", 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 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 the Contractors Slate License Law (Chapter 9 commencing with Section 7000) 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 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 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 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.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: Owner: 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 the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy #: ❑ 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: Z • — "' 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 3706 of the Labor code, interest, and attorney's fees. PERMIT NO. BP061235 Issued Date: 05/24/2006 APN: 064-500-069-000 Site Address: 14031 PINELAND CIR MAG Map Index: Description: re roof (15) Owner: FREEBORG ROBERT M & BETTIE L FAMILY TRUST FREEBORG ROBERT M & BETTIE L TRUSTEES P O BOX 819 MAGALIA, CA 95954 Applicant: GREENE & SON ROOFING PO BOX 2467 PARADISE, CA 95967-2467 530-873-3940 Contractor: GREENE & SON ROOFING PO BOX 2467 PARADISE, CA 95967-2467 530-873-3940 License #: 275057 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: �667� 0 "" �i CONSTRUCTION LENDING AGENCY This per is hereq# ssGed u der the pplicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolu ' ns to do w rlilndicat d abo for which fees have been paid. % performance of the work for which this permit is issued (Sec 3097 Civ.), .' By. ( Date: -- Z / "6 l7 Name: . PERMIT EXPIRES ON: �— 2 C/� �/ / a 7 Address: (Date) I- 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 1 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 repr_6sentalives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: ` G-� �r/��i( ��- Signature: E Date: J 7�7 w ❑ Owner 9LIcontractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-U4 pg 1 BUTTE COUNTY . DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP061235 B. C. Building Permit 01-16-04 pg 1 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: 05/24/2006 APN: 064-500-069-000 the Business and Professions Code, and my license is in full force and effect. 2/ D Site Address: 14031 PINELAND CIR MAG License Class: License Number: Date: Contractor: Map Index: Description: re roof (15) OWNER -BUILDER DECLARATION 1 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: FREEBORG ROBERT M & BETTIE L FAMILY permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a TRUST signed statement that he or she is licensed pursuant to the provisions of FREEBORG ROBERT M & BETTIE L the Contractor's State License Law (Chapter 9 commencing with Section TRUSTEES 7000) 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 P O BOX 819 violation of Section 7031.5 by any applicant for a permit subjects the MAGALIA, CA 95954 applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the properly, 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 owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, Applicant: GREENE & SON ROOFING provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one PO BOX 2467 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 PARADISE, CA 95967-2467 sale.). 530-873-3940 ❑ 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: GREENE & SON ROOFING ❑ 1 am Exempt under Article 3 of the Business and Professions Code PO BOX 2467 Date: Owner: PARADISE, CA 95967-2467 530-873-3940 WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for License #: 275057 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 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: ynV a �Q Carrier: -ST f O 3 9 ?' Policy #: / 6 Total Square Ft: 0 S. F. is ❑ I certify that in the performance of the work for which this permit issued, I shall not employ any person in any manner so as to Valuation: $0.00 Census Code: 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:z. 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 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This per is here ss ed u der the pplicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolu ' ns to do w indicat d abo for which fees have been paid. % performance of the work for which this permit is issued (Sec 3097 Civ.),��-� Date: Name: By 25'" a'7 PERMIT EXPIRES ON: ,C-- 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 repnAserita�tiv�es of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: / 1 �4/ Signature: �7 Date: ❑ Owner ntractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 to 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 OFAPPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY* APPLICANT SIGNATURE X For office use only: OWNER INFORMATION Last Name L irst Name rig A Address C2 City , States ,r (moi , Zip J Phone .� 3 Fax E-mail Lic. #,73DS APPLICANT SIGNATURE X For office use only: CONTRACTOR Name L Address I Yes CityII hY4 C� ,� State . F14 Zi 9 /, 7 2, Phone _ 3 9 D Fax E-mail Date Approved: Lic. #,73DS CG'S3 APPLICANT SIGNATURE X For office use only: ARCHITECT/ENGINEER Name L Address I Yes City Occ. State Zip Phone Page Fax E-mail Date Approved: State License Number APPLICANT SIGNATURE X For office use only: APPLICANT INFORMATION Name L Address I Yes City Occ. State Zip Phone Page Fax E-mail Date Approved: APPLICANT SIGNATURE X For office use only: Zoning Property Address Flood Zone SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BPO 6 BIN # PROJECT LOCATION AP# 0 / 5/- ,_ 50© .06 Property Address City Cross Str et o N dp,0 r3 'W WORKER'S COMPENSATION Policy Number 2-4-319 Z 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 Page 1 of 2 Description or Scope of Work: % —a 4 Ayoa,p S S Sq FT- Living Garage Open Cov ❑ Structure Built without 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: Q:�' Receipt #: Date: " Amount: ���< 1 Bldg SRA Sheriff SMIP Other Total REV 8-12-05 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 paper! ❑ 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 A/C 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 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. 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 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. ❑ 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 KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05 COUNTY OF BUTTE - DEPARTMENT OF DEVEi;. RVICES - BUILDING DIVISION 7 .County Center Drive - Oroville, California 9 65 - Telephone (916) 538-7541 PE�RVI NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 1004-5UU-069 ZONING ,, BUILDINGPERMIT V. OWNER 13ob k'reebor€; TELEPHONE 873-2931 ',SQ- FT. OCC. BUILDING VALUATION �ioU OWNERS MAILING ADDRESS PU Box 819 Magal.ia CA 95954 • ,ctidU CONTRACTOR'S NAME C Ely Roofing Inc TELEPHONE 343-7663 CONTRACTORS MAILING ADDRESS - 13l91 Contractors Dr Ciiico CA 95973 Fireplace CONSTRUCTION LENDER UNIPIOWN Total Valuation $ LENDER'S MAILING ADDRESS rb Fling Fee $ 20.00 Permit Fee $ 39 . -OU ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS ,r Energy Plan Checking Fee $ Penalty $ • BUILDING ADDRESS 'qtr 14031 Pinelac Cir - �18 t111£t PERMITFEE $ PLUMBINGPERMIT Filing Fee 20.00 Trap, _ .... ,.7.00, .. .. er.- .:.- :. ,, ... ,.a, c; :. ,;�., 1 _ �.,> - ,. _ _x�.,.Each - . LOT NO. SUBDN510NS NAME , PARCEL MAP" ... Solar or heat pump water heater __ 23.00 USEOFS. UCTURE e SF Q DuplexJi Mobilehome ❑ Other:`' SPECIFY TYPE OF WORK Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets P�P� 9 Y 15.00 _ Building sewer 15.00 Mobile Home S G W @20.00 New ❑ Addition ❑ Remodel ❑ Utilities ❑ E Installation ❑ Other O ra Describe Work: ovaria > y roofing, � 2 5 y r arch c h w PERMITFEE $ Contractor 28 sqs ELECTRICAL PERMIT FilinQ Fee 20:00 Main ServiceEOOV 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 NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. BUDS. ) SO. 3.50 FT. .NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force ar3d effect. -14 C-� 607386 License Class � � Lic. No. OWNER -BUILDER DECLARATION S f,� ( POWER APPARATUS ) 8 SINGLE OUTLET UCIR Ex. Occup. ( OUTLET OR FIXTURES) P• 20 @ RAL .SO Ex. Occup.FIXED APPLNS. OR ( OUTLETS (RESID.) E0.) 5.00 Temporary Service 23.00 I 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. Mobile Home Facilities 20.00 Misc. Wiring 23.00 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. PERMITFEE $ ❑ 1 am exempt under Sec. Business and Professions Code for this X reason --- - - = ' WORKERS' COMPENSATION •DECLARATION t Contractor - MECHANICAL PERMIT Filing Fee 20.00 1 hereby affirm under penalty of perjury one of the following declarations: Heating ❑ 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. Cooling Hood 6.50 Ventilation 0 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. carrier and policy number are: My workers' compensation insurance, ullu Carrier PERMITFEE $ Contractor Mobile Home Installation 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.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall Energy Inspection Fee $ OCC '. CONST. TYPE TOTAL FEE $ 59.00 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 HAZ. 1 D. FEES I IMP I FLOOD I COF PARCEL I PO HD SSUE workers' compensation provisions of section 3700 of the Labor Code, I shall This permit is hereby issued under the applicable provisions forthwith comply with those provisions. ry X �%(,/,;(t ,� f_. fes= Date 7— ... of the Butte County Code and/or Resolutions to do work indicated bove for which fees have been paid.. _ _ Signatu' of Applicant - ❑ Owner iEl Contractor ❑ Agent r An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. B ��, X PERMITEXPIRESON �1 ��( Date a� 7 (D e) .ReceiptNO.r` �li, / `' :" -• WHITE-D.D.S.-B.D. ) CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �M+o COUNTY OF BUTTE- DEPARTMENJOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive Oroville, California 95965 - Telephone (916) 538-7541,q/ /�PERY7 No. APPLICATION AND PERMIT ��,— ASUgZPAOOMBER ZONING Q /� BUILDINGPERMIT OWNER Bob Freebor TELEPHONE 873-2931 SO. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS FO Box 819 Ha alfa CA 95954 CONTRACTOR'S NAME Ely Roofing Inc I TELEPHONE 343-7663 CONTRACTORS MAIUNG ADDRESS 13291 Contractors Dr Chico CA 95973 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Fling Fee $ 20.00 Permit Fee $ 39.00 ARCHITECT OR ENGINEER UCENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDINGADDRESS 14031 Pineland Cir - Lagalia PERMITFEE $ PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDNISIONSNAME PARCEL MAP Solar or heat pump water heater 23.00 USE OF STRUCTURE SF N Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Add -Rion ❑ Remodel ❑ Ublities ❑ Installation ❑ Other Describe Work: Overlay roofing w/25 yr arch — 28 sgs Mobile Home ISI GI W1 920.00 PERMITFEE g Contractor ELECTRICAL PERMIT Filinq Fee 20.00 Main Service EOOV oR LESS ( zooA oR LEss ) 23.00 Main Service ( 200A TO 1000A ') 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 is in full force and effect. License Class C –14 , C - 3 9 Lic. No. 607386 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 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. jD 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 insuranc carrier and policy Carrier stare e'un�cy number are: d NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. )+97.50 SO. 3.S¢ FT. NEW CONST. MULTI.OUTLET UTLI: NON-RESID. ( BRANCH CIRCUITS ) ( POWER APPARATUS ) a SINGLE OUTLET CIS. Ex. Occup. (OUTLET OR FIXTURES ) a4L @ 150 Ex. Occup. OUTLETS FIXED (RESID.OEA ( ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number 538-148 (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 provisions. ry X — —_ Date /� �3 --��— Signat a of Applicant - ❑ Owner V Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction,[ of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ nerCONST. Occ TYPE TOTAL FEE $ 59 .00 HA2. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have y 11V PERMITEXPIRESON_�/-��j(/�_ applicable provisions Resolutions to do work been paid. Date (Ddte) Receipt No. -De-) 15J WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD•APPLICANT I 61;z