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Home My WebLink About028-400-0461 r ob / App.1300'off SIS of Bangor` Park Rd':, appl 2200' W. of, Oro Bangor Hwy Permit #5079-76B,P,E,M(new sngle f fly) 'b v 028=40-0 046``"F .'' E� r92'3283P,,M •I Maurice " BERCHDORF, . r . t a ' 100 Quartz Mine., Bangor ,, �. contra 'R B ;Spencer .y=� (� hvac/sf 01 w: (� , CD C:) air ' - COUNTY OF..BUTTE DEPsARTMENT.OF PUBLIC WORKS 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE OWNER PERMIT NO. `? A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. j i REV 11/81 028-40-0-046 92-3283P,E,M r ~. BERCHDORF, Maurice 100 Quartz Mine,. Bangor contr: R.B. Spencer hvac/sf I(V[' i r L COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 n V-0 -.. e!y APPLICATION AND PERMIT ASSES OR PARCEL NUMBER 028-400-046 ZONING - A:5 . BUILDING PERMIT OWNER Maurice D. Berchdorf TELEPHONE 4 679-2281 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 145` Bangor 95914 CONTRACTOR'S NAME R. B., . S ncer 483477 TELEPHONE 674--8307 CONTRACTOR'S MAILING ADDRESS Yuba Cit , 95991 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 15.00 100 OUarLlL Mine Rd. Bangor Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00l 7.00 USE.OF STRUCTURE SF [)f Duplex❑ Mobilehome❑ Other SPECT FY Gas piping system 1 - 5. outlets 5.00 5.00 Building sewer 15.00 Mobile Home I S G W @ 15.00 . TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other N Describe work: HVAC _ New Propane Permit Fee $ 20.00 Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200A OR LESS 18.50 Main service 200A TO 1000A) _ 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the BusinessPOWER and Professions Code and my license is in full force and effect. License No. Classification ❑FIXED as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST./ DWELLING OCCUM P OR ACDNS. 1 ACC. BLDG S.I/ 3.60 sq.ft. NEW NON•RESID R. BRANCH CIRCUITS @ 5.00 APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(ouTLETs OR FIXTURES 20 76 APLNS. Ex. Occup. OUTLETS PRESID .)OR EA.) q /�� IT 3.00 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ 18.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating 119.00 9.00 Split Cooling 1 9.00 9.00 Hood 6.50 Ventilation permit Fee $ 33.00 Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against saidd CCounty in consequence of the granting of this permit. X Date /7/ -?z- Si nature of Applicant - /Owner g pp Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct - ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEES 71 .00 HAz 1 DFEES I IMP I FLOOD I CDF I PARCEL I PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicat enbo�p4br which fees have been paid. Df TOF(OF PUBLIC WORKS By PERMIT EXPIRES Date -P' - !8'- 3e f'-�� 3282 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. z "�8 ASSES OR PARCEL NUMBER „„ 028-400-046 ZONING 4-5" 1 BUILDING PERMIT OWNER Maurice D. Berchdorf TELEPHONE L79-2281 SQ. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. Box 145 Bangor 95914 1 CONTRACTOR'S NAME R. B. Spencer 483477 TELEPHONE 674-8307 CONTRACTOR'S MAILING ADDRESS Yuba City, 95991 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 1 15.00 100 Quartz Mine Rd., Bangor Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 1 7.00 7.00 USE OF STRUCTURE SF[I Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 5.00 Building sewer -7 15.00 Mobile Home S G W 1@ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Otherg] Describe work: HVAC New Propane Permit Fee $ 20,00 Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 Main service 200ATO1000AI 37,50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license Is In full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- FlE sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUP. f\ OR ADDNS. l AGC, BLDGS. II 3.6d sq.ft. NEW CONSTR ULTI.OUTLET NON-RESID BRANCH CIRCUIT @ 5.00 POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76 PR) FIXED X. Occup. OUTLETS IRESID,)EA. 1 I 3.00 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Permit Fee $ 18.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. 1 shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling 9 Hood #6.50 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue again s ty in consequence of the granting of this permit. X Date Signature of Applicant — Owner - Contractor ❑ Agen ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ DCC CONSTTYPE TOTAL FEE $ 71.00 HAz DFEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicat boy or which fees have been paid. OF PUBLIC WORKS By Date PERMIT EXPIRES Date 7 Receipt No. 1A282 WNITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT �"if'� ,", lr .. _, vr� �.: i'Ys;• ;[�II:Ifti•':l�th� :may: ,. ,.. ,.. .: '.'1' .. i:. �.. �.;._yy�p,,f: qi .�'. . .. .. .. COUNTY OF BUTTE, w,PARTMENT OF PUBLIC WO BUILDING BUILDING DIVISION 7 COUNTY CENTER DRIVE - OR00tE,.CAUFORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER Proposed Building Use /l d Building Inspector Date �7 Z At time of per application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. All items have been submitted . ........................................ Plot plans, 3/4 sets, signed by preparer of plans . .......................... Complete plans, 3/4 sets, signed by preparer of plans . ..................... . Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. Hazardous Material Form . ............................................. Energy Design Compliance and supporting documentation . .................. Statement of Intent for Non -Heated and A/C Buildings . ..................... . Engineered truss details and layout in duplicate (required prior to plan check). ... . Mobilehome data and manufacturer's installation instructions, 2 sets. ........... Feesof $ ........................................... Impact fees as shown on attached schedule . .............................. California Department of Forestry plan approval/fees. ....................... . Flood elevation letter (100 year flood) by California Engineer . ................. . Sanitation and plot plan approval Health Department . ............. City of Chico plumbing permit. ........................................ . Plot plan and business license approval from City of Biggs/Gridley. ............. Planning approval for (A) Use: (B) Parking: . ........ Contact Land Development about (A) Improvements (B) Drainage. .......... . Driveway permit (construction approval required prior to occupancy). . . Pre -Inspection request - Pre -inspection for required. .. to Building Inspector Contractor's license information. (No., Name Style, Classification) . .............. Certificate of Workmans Compensation Insurance . .......................... Owner -Builder Verification (Given to owner , Mail to owner_) ........... . Recorded copy of Agricultural Acknowledgement Statement . ................. . Letter of signature authorization . ....................................... . Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use . ......................................... Mobilehome utility clearance . .......................................... Documentation of legal access . ........................................ Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... Existing violations/expired permits . ...................................... Plan check list . ..................................................... When yo sue the permit, ce s as follow�'��ail to w elepho and hold for pickup at Other Parcel Creation Acreage Applicant Mail to contractor. - office_ Deliver with inspector. Date y// ;�/� Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance 1. Index 11 permit for above items No. 2. Additional items required: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone -mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916.1538-7541 APPLICATION AND PERMIT ASSESSORP CEL� UMBER `n� • p• [//r(� —d 20NINC��/ (4,f BUILDING PERMIT OWNER ��-•-'��D 1 ELEPHor,€ SO. FT. OCC. BUILDING VALUATION OWNE )p VLING DDRESS U L CON AC OR'S AM TELEPHONE CONT b -f MAILING DRESS U G Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDIN ADDRESS Z)$ Permit fee PLUMBING PERMIT Filing Fee 15.00 -�� Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00. , USE OF STRUCTURE SIX DuplexU Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remod I I Utilities ❑ Installation ❑ Other)k Describe work: // \\ Permit Fee $ O Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS I 18.50 Main service 200A TO 1000AI 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El am licensed under provisions of Chapt. 9, Div. 3 Of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. ( DWELLING OCCUP.�\ OR ACDNS. ACC. BLDGS. / 3.60sq.ft. NEW CONSTR. ULTI.OUT LET NON.R E51D BRANCH CIRC ITS @ 5.00 POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 @ 76xFIXED ALNS.1 Ex. Occup. OUTLETS P(RESID )REA.) 3.00 O O Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Permit Fee $ ! WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. -laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling g , Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in an way crue against said County in consequence of the granting of this permi . X Date ❑ Contractor ❑ Agent Signature of Applicant — Owner - / An OSHA permit is required For excavations over 5'0" deep andVolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ , HAz DFEES IMP FLOOD CDF PARCEL PD MD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. ?% �� WHITE-D.P.W., YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD -APPLICANT • -4 t � PERMIT NO. 5079-76B,P,E,M ; PERMIT EXPIRES TOWNER Fred Osguthorpe CONTR. owner LOCATION (A.P. 28-27-148 � App. 1300'off SIS Bangor Park Rd.,app. 2200'W.o Oro Bangor Hwy i t �s < A Temp. Power Pole Called PG&&,,.� Temp. Elec!Serv._ �� Callld PG&E /Te. Gas Serv. alled PG&E -93/7FINALED _ n COUNTYOF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) BUILDING BUILDING (Cont'd) PLUMBING Setback Z Firewall Soil Piping Forms Parapets 1st Floor 3 Main Bldg. Restroom Finis 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab1 ?i Roof Sheathin Water Piping- Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. StemwaI l insulation Heaters Slab Prov. for physically Appliances handica ed Carport Conformance of ex. Gas Piping & Test Footings structure Temp. Gas Slab Final anitation Patio FIREPLArE. Final Footings Footing oZ� ELECTRI Masonry Walls Throat O Rou h O .� Reinf. Steel Final Fixtures / Bond Beam FIRE SPRINKLERS -,-'Motors Framing ✓� Test Water Htr. �- Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Pr t. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Under round/ Interior Lath Ventilation Pennanen �-.--- Door Closer s Final Final DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) t A M m CD 0 I i This is to certify that insulation has been installed in conformance with the current energy regulations, California Administartive Code, Title 25, State of California, in the Building located at: ��%%,�✓�1' ;'� A.P. .� 7 2'71 Street Lot Number Tract No. A EXTERIOR WALLSP44eez�--�� i J4z--// Manufacturers/Type��Az-404l,e CEILINGS __ Batts_Manufacturef Thickness !1 R Value Blown: Manufacturer Thickness No. Bags Wt./Bags Sq.Ft.Covered R Value FLOORS Manufacturer SLABS ON GRADE Manufacturer FOUNDATION WALLS Manufacturer '7 A BUILDER _ BY INSULA APP '`BY� Thickness/Type Thickness/Type Width of Insulation Inches 4 - LE /Type White Sheet - Return t Ruildine /nsnertion Denartment •K• R Value R Value COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Cent@r Drive' — OroviIIe, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT S�P79� Receipt No. "'s- 406 Rv Date White-D.P.W. — Yellow -Asses or — Pink -Inspector — Goldenrod -Applicant Ilding permit expires Date BUILDING Owner"' S6v�� SQ. FT. OCC. BUILDING VALUATION Mai I ing Address �R COU H l hone No. 7 4.7 Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address/3Q ' FF + u7I1 PLUMBING No. @ FEE PERMIT FILING FEE $3.00 dt� 1Wepic is RAgod Each Trap 1.50 eS7% OF OR ® G82 i4w 11 Repair drainage or vent piping 1.50 Water piping 1.50 , Each gas water heater or vent 1.50 a j A. P. No. — / i Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W. C. San' n. Fire D pt. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration P109 60' R/W Im rove nts P Lawn sprinkler system 2.00 L -B-71 d 9. Plans Recd arce pproal Plans pproval Permit Fee $ Clj7 NEW � ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 .0) Main service 60000 AMP 1 OR ORSLSESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family 5Q Duplex ❑ Mobil Home ❑ Others ❑ Main service OVER 600V100 AMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONS. DWELING OR ADDNST ( ACCLBLDGSO. C T -t) 22sgft I J Qp NEW CONSTR. (MULTI -OUTLET NON.RESID• BRANCH CIRCUITS) 12.50ea NEW CONST. POWER APPARATUS & NON-RESIR D. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name $t le of: y Ex. Occup(OUTLETS OR FIXTURES)50 @25Q BAL@1 Ex. Occu FIXED APPLNS. OR ` P• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee . $ J 46 0d $ WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ 1 have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 101 I certify that in the performance of the work for which this PJ permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentiorLed property for inspection purposes. 46�'X Date Signature of Permiree or gent . MECHANICAL No. @ FEEPERMIT FILING FEE $3.00 4`0 Heating Cooling Ventilation Hood 2.001 10 Permit Fee $ $ TOTAL PERMIT FEE $ 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 id. DIRECTOR 0 PU LIC WORKS �' Receipt No. "'s- 406 Rv Date White-D.P.W. — Yellow -Asses or — Pink -Inspector — Goldenrod -Applicant Ilding permit expires Date