HomeMy WebLinkAbout005-405-011JOE SCHIC
O
Co :Vfa'i� y Electric, Chico
Permit#517-81E (replace storm dam-
age electric servi.c,-e)hobby_ shop
'005-40-5-01f 93-3889 ,
FAIRCHILD, ROBB
CONTR.- UNKNOWN r
752 CALIFORNIA ST., CHICO
ELE SER SHOP
F1
I
a
✓ '
on
005-40-5- ,r
93-3889
FAIRCHILD, ROBB
CONTR. UNKNOWN
-- 752.CALIFORNIA ST., CHICO
ELE SER SHOP
DF I ECO
Address r
GAS
Meter By Date
ELECTRIC 1 (�
Meter, By
Frn�a.Pa�e a/�/vy
/34buA:N-
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES BUILDING DIVISION
7 County Center Drive - Oroville,,California 959x65 -'Telephone (916) 538-7541 PERMIT NO.
....... owe APPLICATION AND PERMIT l'�
' ss=4�Lt4=10ZONING
1
I
BUILDING PERMIT
°WNr;JBB FAIRC�iILD
Tis32i
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS-
CONTRACTOR'S NAME
Unknown
TELE E
L.
�� •'
CONTRACTOR'S MAILING ADDRESS•'
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
Filing Fee $
20.00
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 $
B1ING_ Z%ftifornis St:,Chico
JJSS''LLII
PERMIT FEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
LOT NO.
SUBDIVISION'S NAME
pgRCE qp
Each gas water heater or vent
15.00
USE OF STRUCTURE Jor
SF 13 Duplex ❑ Mobilehome ❑ Other shop/studio
SPECIFY
Gas piping system 1 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel `O Utilities O1:Installation ❑' Other 1:1
Describe Work: re- s6rwice main
PERMIT FEE $
Contractor'
ELECTRICAL PERMIT
Filing Fee 20.00
. _ 1
_ -
Main Service ( 22000A0A OR LESS OR LESS )
23.00
Main Service ( 200A TO 1000A )
46.00
'
NEW CONST. DWELLING OCCUP.
OR ADONIS. ( s ACC. BLDS. )
s0.
3.50 FT.
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. Classification
-0 I,'as the owner, 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)
)KI, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ I am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
-NON-RESID. ( BRANCH CIRCUITS )
@7.50
( POWER APPARATUS ,
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES'
BAL. 0@1.50
Ex. Occu FIXED .OR
p' ( OUTLETS (RESTRESID.) EA. 1
5.00
Temporary Service
23,00
Mobile Home Facilities
20.00
Misc. Wiring
23,00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division 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 Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE S
43.00
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE S
Contractor
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of 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 against said
County in consequence f th granting -of this permit.
O 0�"_
X / Date
Signature of Applicant'- ❑ Owner ❑ Contractor Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
ocC
CONST. TYPE
TOTAL FEE $ 43.00
HAZ.
1 D. FEES
I IMP
I F1000
CDF
PARCEL PO
HD
ISSUE
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.
21 DIRECTOR OF PUBLIC WORKS
BY i��z%�/ /Ii Date
Z!
PERMIT EXPIRES ON Iz��J//'1'
(Date) '
153391
Receipt No. 1
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT,,
JCOUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Orovllle;,Callfornla 95965 - Telephone (916) 538-75 PERMIT NO.
APPLICATION AND PERMIT5��'
AStS()LR PA4bLN.rfI i10
ZONING
BUILDING PERMIT
own, BB FAIRCHILD
TMI321
SQ. FT. OCC. BUILDING VALUA ION
OWNER'S MAILING ADDRESS
T
I
-299
CONTRACTOR'S NAME
Unknown
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $
20,00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
752 California St,Chico'
PERMIT FEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other shop/studio
SPECIFY
Gas piping system 1 5 outlets
15.00
Building sewer
15.00
Mobile Home S G I W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities CIXInstallation ElOther O
Describe Work: re—service Plain
PERMIT FEE $
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service ( IIIOR LESS )
200A
200AOR LESS
23.00 •
Main Service ( 200A TO 1000A )
46.00
NEW CONST. DWELLING OCCUP.
OR AODNS. ( 8 ACC. BLDS. )
S0.
3.50 FT.-
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
❑ 1 am a licensed underrovisions of Chapter 9, Division 3 of the Business and
P P
Professions Code and my license is in full force and effect.
License No. Classification
O I, as the owner, 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)
I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ lam exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
NON.RESID. ( BRANCH CIRCUITS )
@7.50
( POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
20 @ 1.00
BAL. @ .50
Ex. Occup. ( OUT EDTS 1 ES D:OEA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the County of Butte Dept. of Development Services,
Building Division 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 Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE $
43.00
Contractor
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
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 Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of 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 said
County in con equence f th grantiin of this permit.
a GT "�
X Date
Signature of Applicant-- ❑ Owner El Contractor Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
GCC
CONST. TYPE
TOTAL FEE $ 43.00
HAZ•
I D. FEES
I IMP
I FLOOD
CDF
PARCEL PD
I HD
I ISSUE
This ermit is hereb
P y issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By ''` Date I;Z/S
PERMIT EXPIRES ON
Detel
153391
Receipt
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
r .! `� '�/�.. my-`s.r �-""'I- r.y.,--w•�f",ti...-'r"',✓.i`..'"�'.'.'11''^v.-..--.�'rn". i�w',,�c..- .. - ,-�_ �,i•,---r�,yrs°�+,�'*+.v�"'K'+.-n..T..+'*^'Y�t..•�.:yY r.. ,,�'.`' ..._ .....,r....._ ,
s 'vf
COUNTYOF BUTTE - DEPARTMENTQFDEVELO M ENTSERVICES -BUILDING , DIVISION
7 COUNTY CENTER Dlvxj!�-.-PROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541
PERMIT APPLICATION DATASHEET
•. i
ri -r
OWNER I Gt+/Lo , A. o.Qf7<"7'629 �D
Proposed Building Use Building Inspector Date
75
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
1. All items have been submitted. DATE RECEIVED By
2. Plot plans, 3/4 sets, signed by preparer of plans . ..........................
3, Complete plans, 3/4 sets, signed by preparer of plans . ......................
.4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5,, ',Hazardous Material Form. ..... ............................... .
6. Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check). ... .
9. Mobilehome data and manufacturer's installation instructions, 2 sets. .........: .
10. Fees of $.........................................
11. Impact fees as shown on attached schedule. ............................. .
12. California Department of Forestry plan approval/fees. ....................... .
13. Flood elevation letter (100 year flood) by California Engineer . ................. .
14. Sanitation and plot plan approval Health Department . ............
15. City of Chico plumbing permit . ........................................ .
16. Plot plan and business license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking:
18. Contact Land Development about (A) Improvements (B) Drainage. ......... .
19. Driveway permit (construction approval required prior to occupancy). . .
20. Pre -inspection for required. .. a ";� ���pa�;�-
(oate)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23. Owner -Builder Verification (Given to owner , Mail to owner ). ...........
24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . ........................................
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
27. Letter of intent on building use . ........................................ .
28. Mobilehome utility clearance ..............................
'29. Documentation of legal access . ..................... :..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
34.
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector.
Other
Parcel Creation
Acreage Applicant Date
Copy of Haz-Mat form sent HealtKDept. 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: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
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
1299 East Avenue
Suite B
.: Chico, CA 95926
(916) 342-8321
FAX 342-8324
December 6, 1993
ie: 752 California Street, Chico
Michael Towne, Tenant
To Whom It May Concern:
Michael Towne has my permission (Robb Fairchild, as owner of 752
California Street) to apply for permit(s) for the purpose of having
....electric service installed at the subject property.
'All costs for the permits, and any electrical material.inst;allation
will
be at .Michael Towne's expense.:
S.i ly,
R BB. FAIRCHILD
REALTOR :'CRS
"A Certified Residential Specialist"
0
r
0
�y
Ikea
I'
r'
J
OWNER
LOCATI
PRE-INS?ECTSON
t lr I G l t-.. ,xl N .A.
MWOMM
TL
__.zz ) �� A-7-
#- (16 -t5- --4 0
ZONING A
CONTRACTOR:
PRE -INSPECTION FOR:�`L -5 ri /?-- V/ c—C�
DATE TO INSPECTOR
-PERMIT HISTORY:
yam.
TYPE OF OCCUPANCY __ j
FIELD - INFORMATION
BUILDING USAGE:
OCCUPIED ] HAS ELSCTZIC �ZZ HAS GAS HAS SANITATION FACILITIES
Q HEATED -COOLED =✓r PERSON CONTACTED /A/ b
OTHER COMM XTS : Mtuat .Aj-/ncn-� Cr -I l
OTHER:
BY� / �L'� DATE
�
-7. ft�TEK
vPG F
PRE -INSPECTION
OWNER: OLDATZ
LOCATION: t ED kA&I'-\A.P. o (16 �7—�
CONTRACTOR:' , L2 I� I I - ZONING 4 K_
--- — ----------- -----------
BUILDING USAGE: QzL&P
TENNANT: kwt--k
OCCUPIED HAS ELECTRIC HAS GAS HAS SANITATION FACILITIES
HEATED -COOLED PERSON CONTACTED A/o
41 OTHER COrOMNTS: - &941'l) K4/.L�
ACTION RECOMMENDED:
ISSUE HOLD FOR
A ZJ .
-,-mom.. .k...-. ...... ,�.�-•--.,._ .,,.,,-,.,.,. _ _._.... �.. _ �. ��. _ �._ ._....� �. r
-7 41
0
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Orovill.0, California 95965 - Telephone 916/534-4541
APPLICATION'AND PERMIT
ASSESSORPARCEL NUMBER
I / ;' -
ZONING
!�_
BUILDING PERMIT
OWNER• / ' /
r
TELEPHONE
S0. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTO 'S NAME
TELEPHONE
CONTRACTOR'5 MAILING ADDRESS
�,, r .-4 ell ',- '";,y /- I' /� r
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO. SUBDIVISION NAME,
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 -5 outlets
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other � � : �/� - r jx�-.!_/
/ SPEC)FY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other J,
Describe work: /�� ���'+� S �'=�.-''-'r! A;
F �'✓ i- ,�^- ,l���,
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 1001 01 00 AMP ORLESS5.00
jO
__
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&)
OR ADDNS. ACC. BLDGS. /
20 sq it
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business50
and Professions Code and my license is in full force and effect.
L, r ri {
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)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR - U L T 2,50 ea
NON-RESID BRANCH CIRC TS
NEW CONSTR IPOWER APPARATUS e1
NON-RESID. SINGLE OUTLET CIR. /
@ 2W
Ex. Occup(OUTLETS OR FIXTURES BAL@1100
Ex. OCCUp.�OUTLETS (RESID IREA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee
$
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
Ej 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.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
S
Contractor
1 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 said County in consequence of the granting of this permit. /
r' J
X l �� Date
Signature of Applicant — Owner ❑ Contractor fl Agent Q
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
$
TOTAL PERMIT FEE $ 1)o
occuP. GROUP
I TYPE OF CONST.
I
PARCEL
PD
ND
ssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS MIT y4.
7 County Center Drive - Oroville, Californie�95965 - Telephone 916/534-4541 e/
APPLICATION AND PERMIT lyl
ASSES 6 F�PARCE UMBEg
— '� (�
ZONING.
A i
BUILDING PE
MI
OWN RLEPHONE
d � G
SO. FT. OCC. BUILDING VALUATION
OWNE 'S MAILING XDDRESS
CON C 'S NAME LTELEPHONE
17 f r sJy
CONT CTOR' MAILI G ADDRESS
610 g9X 7,7V7
Fireplace
CONSTRUCTION LENCMER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILINGADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
PLUMBING PERMIT
Filin Fee 10.00
9
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT,NO. SUBDIVISION NAME / PARCEL MAP
if L = �� p1
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTU��RE
SF ❑ Duplex❑ Mobilehome❑ Other -A262 g" `f
SPECYPY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities ❑ Installation[] Other
Describe work:
Permit Fee
$
Contractor
ELECTRICAL\PERMIT
Filirig Fee 10.00
Main service eoo100vAOR LESS
MP OR LESS
—
5'0006
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. (DWELLING OCCUP.51)
OR ADDNS. ACC. BLDGS. /
20 sq
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
Nr I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and y license is in full force and effect.
License No. c Classification i
❑ 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)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR. f MULTI -OUTLET 2,50 ea
NON.RESID BRA CH CIRC S
NEW CONSTR. POWER APPARATUS el
NON.R ESID. SINGLE OUTLET CIR, I
so 0 zs¢
Ex. Occup(OUTLETS OR FIXTURES BALA1
Ex, Occup. �O PIUTLE TS XED P(RESID.)REA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
Filirig Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
IRjai 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.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
S
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 liabiliti s, judgments, costs, and expenses which may in any way accrue
ns s d County in consequence of the granting of this permit.
/
X Date 7/
Signature of Applicant - Owner El Contractor Agent
An OSHA permit is required for excavations over 5' deep an demolition or construct-
ion of structures over3 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $ v
OCCUP. GROUP
I TYPE of CONST.
I
JPARCELJ
PD
ND ISSUE
This permit is hereby issued under.the
sions of the Butte. County Code and/or
work indicated above for which
DIREC O OF PUBLIC
By
PE EXPIRES Date
applicable provi -
resolutions to do
fees have been paid.
WORKS
Date �lF�
Receipt No. /
Y"
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
BUTTE COUNTY DEVELOPMENT SERVICES
Complainant: -Z -.2: -,--
Address: mplainant: 2:
Address•
Phone Number.
Other Comments:
Inspector must draw a plot plan with all building locations:
Additional Comments from inspector.
2
BUTTE COUNTY DEVELOPMENT SERVICES
Complainant:
Address
Phone Number:
Other Comments:
Inspector must draw a plot plan with all building locations:
Additional comments from Inspector:
.� .
0
4
s%
1.O
. � U
UC(Cf l� a
-} r
1 Yl o tj-
®� comb /a;�,fi.
ce) z4-ld n o t
4
P'
Ile i t�►� 1I''Co�v��la;�� j
Y
i /Icruav�9�
he
h y fo sep-
/kwlj
0
4
}