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Home My WebLink About005-466-027kY� CLAIMANT: ADDRESS: CITY & STATE: DATF OF CI AIM. County of Butte Oroville, Califomia GENERAL CLAIM Jack Wally - Wally's Electric 1086 Vallombrosa Ave Chico, CA 95926 11191 /171114 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM DESCRIBE FULLY TO AVOID DELAY AMOUNT Refund Claim - See attached calculation sheet APN: 055-540-006 Perrnit No.: 03-2837 PAID RETAINED REFUND Development Services $ 66.00 $ - $ 66.00 SRA $ _ $ _ $ _ Sheriff $ _ $ _ $ _ Other: $ _ $ - $ - TOTAL $ 66.00 $ - $ 66.00 .. :::::BR) AiCDiE i?V1Vc : ............ ............... :A : : :::: .:::::.:....•.. .. CGOU�TT . . . AMOIl1tii... . Development Services 440-001 4210500 $ 66.00 SRA 0100 4617240 $ Sheriff 280 1011811 $ - Other $ _ TOTAL $ 66.00 $ 66.00 — ---- --• ----•- -••--• r�• �••, rw�•r ,• o, _ oci r,uco u o„wros adnneu neve open errormea or oeuverea, and that this claim is true and correct as stated. Dated this412 day of , 2003, at C ' . Signature of Clai nt .. wiucimy,icu, neieuy ceimy uim. w me gest of my Knovneage, the services7eck es specified above have been perfort)(ed or delivered and that there is a Budget Appropriation or Specific Board Approval one) for t ame. Dated this T�� l day of. 2003, at Oroville Calif. Department Head or Authorized Deputy Dept. SEE Exp, Code BREAKDOWN Code PAYABLE FROM FUND DO NOT WRITE BELOW THIS LJNF _ At nITnR'R I ISP null v DEPT &SUB PROD SUB. OBJ CLAIM NO. INV NO. INV. DATE ENCUMB. GROSS AMT. /0,3 County of Butte Oroville, California GENERAL CLAIM CLAIMANT: Jack Wally - Wally's Electric ADDRESS: 1086 Vallombrosa Ave CITY & STATE: Chico, CA 95926 DATF f)F rl AIM- 11 /71 R)II SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT ' PROJ Refund Claim - See attached calculation sheet APN: 055-540-006 CLAIM NO. 3 urvc - AUUI INV NO. Permit No.: 03-2837 PAID RETAINED REFUND Development Services $ 66.00 $ - $ 66.00 SRA $ $ $ - Sheriff $ $ $ Other: $ - $ - $ - TOTAL $ 66.00 $ - $ 66.00 ;...•...• o....•.. ::: 1=.c :•:::•;• ........ BREAKDOi?V.N,*::::::::::'::::: ........................ ....... � .•. • �.•. ..B>E�D0. :: ' :::':'*: .ACG(JUJ-VT..:.AlVI0UW- : ' :::: ;.; Development Services 440-001 4210500 $ 66.00 SRA 0100 4617240 $ - Sheriff 280 1011811 $ _ Other $ _ TOTAL $ 66.00 $ 66.00 I •.-• •• •� ��. - � a� �� mrd rr,eu nave peen pertorrned or delivered, and that this claim is true and correct as stated. Dated this day of , 2003, at Calif. Signature of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or delivered and that there is a Budget Appropriation or Specific Board Approval (Check one) for the same. Dated this day of 2003, at Oroville Calif. Dept. SEE Exp.Department Head or Authorized Deputy - Code BREAKDOWN Code PAYABLE FROM FUND ' AA AIAT ��in T� n DEPT &SUB ' PROJ SUB. OBJ CLAIM NO. 3 urvc - AUUI INV NO. I UK'S USL INV. DATE ONLY ENCUMB. GROSS AMT. I REFUND CALCULATION SHEET I CLAIMANT: Jack Wally - Wally's Electric ADDRESS: 1086 Vallombrosa Ave CITY & STATE: Chico, CA 95926 DATE OF CLAIM: 11/21/03 NUMBER: 376198 DATE: 9/15/2003 ISSUED TO: Wally's: Electi CHECK #: 7321 AMOUNT: $66.00 PERMIT #: 03-2837 Yes PRIOR REFUNDS: FEES VERIFIED X APN: 055-540-006 RECEIPT INFORMATION 0 No I Yes I No Michael Vieira Building Manager REFUND BREAKDOWN BLDG SRA SHERIFF DETAIL PAID RETAIN REFUND 440-001 0100 280 4210500 4617240 1011811 BLDG FILING FEES Building Plumbing Electric 20.00 20.00 20.00 ::.:.:.:.:.:.:.:.:.:::.: Mechanical ............................ ........... PLAN CHECK Plan Check Ener INSPECTION Energy SRA -BLDG Building $46 PERMIT FEES Building Plumbing Electric 23.00 23.00 23.00 ::::: :::::::::::::::::::::::::::::: Mechanical .............. .......................... OTHER BLDG Overcharge Pre -Inspection 23.00 23.00 23.00 ':':'::* .............. :::::::::::::::::.:::........:::::::::::..... . REFUND PROCESS FEE .......................... BUILDING TOTAL 66.00 66.00 66.00:.::.:.:.:.:.::::::.:::::::::::::::::::....:.........::.. .............. .......................... . SRA - FIRE SRA _FIRE Fire $43 .............. .............. SHERIFF - $360 SHERIFF Sheriff OTHER NON -BLDG OTHER $ 66.00 $ - $ 66.00 $ - $ - $ @ 00.1,1111.11 BLDG BLDG SRA SHERIFF 440-001 0100 280 4210500 4617240 1011811 CHECK: $66.00 DIFFERENCE: (Should be blank) APPROVAL Date Reviewed 11/21/2003 Michael Vieira Building Manager I- REFUND CALCULATION SHEET I LAIMANT: Jack Wally - Wally's Electric DDRESS: 1086 Vallombrosa Ave & STATE: Chico, CA 95926 OF CLAIM: 11/17/03 APN: 005-466-027 RECEIPT INFORMATION NUMBER: 376198 DATE: 10/17 03 C ISSUED TO: Wall)es Electric CHECK #: AMOUNT: $66.00 PERMIT #: 03-2837 Yes PRIOR REFUNDS: FEES VERIFIED X DETAIL BLDG Plumbing Electric Mechanical LAN CHECK Plan Check SRA - PERMIT FEES Building Plumbing Electric Mechanical OTHER BLDG Overcharge Pre -Inspection REFUND PROCESS FEE BUILDING TOTAL SRA - FIRE Fire $43 SHERIFF - $360 Sheriff OTHER NON -BLDG PAID I R $ 66.00 1$ Yes I No X REFUND BREAKDOWN BLDG 440-001 ETAIN REFUND 4210500 SRA SHERIFF .............. ::::::::::::::::::: 0100 280 4617240 1011811 ............. .......................... 23.00 CHECK: $66.00 .............. ::::::::::::::::::: .......................... (Should be blank) APPROVAL Date Reviewed Michael Vieira 23.00 23.00 Building Manager ��""'_' .............. .......................... 23.00 23.00.......................... 66.00 66.00 .............. ::::::::::::::::::::::::::::: .......................... SRA - FIRE .............. ........... SHERIFF OTHER - $ 66.00 $ - $ - $ - @ .p 66.0U BLDG SRA SHERIFF 440-001 0100 280 4210500 4617240 1011811 CHECK: $66.00 DIFFERENCE: (Should be blank) APPROVAL Date Reviewed Michael Vieira 11/17/2003 !11713 Building Manager ��""'_' Butte County Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 REFUND REQUEST APPLICATION REFUND POLICY -Butte County Code 3-41(t) 1. Refunds can only be made upon written request by the person who paid the fees, whose name is on the receipt issued for the fees paid. Any refund checks will be made payable to the name on the receipt. 2. The request must be made within two years from the date of fee payments on permits not issued, and two years from the date of permit issuance for permits issued - if no construction work has been done. 3. Filing fees and plan check fees for work plans checked are not refundable. 4. Fees paid to other County Departments are not covered by this claim. INSTRUCTIONS: Submit this application to Development Services for determination of refundable fees. A claim will be generated for any fees to be refunded and sent to the address below for signature (by the person whose name is on the receipt) and return to Develo ment Seivices for payment processing. CLAIMANT'S NAME: Wally's Electric MAILING ADDRESS: 1086 Vallombrosa Avenue, Chico, CA 95926 PHONE: (530) 893-4242 ASSESSOR'S PARCEL NO.: 005-466-027 [Please use one claim form per permit.] BLDG PERMIT NO.: - - -- Ma $66.00 RECEIPT NO.: Receipt No. 1 Receipt No. 2 Receipt No. 3 3761-98* 09/15/03 RECEIPT DATE: 66.00 RECEIPT AMOUNT: REASON FOR REFUND REQUEST: Property is in the City of Chico (Santos - 2118 Elm Street) Check those fees which you wish to have considered for refund: OBuilding Permit Fees OSheriff Fees OSRA Fees (CDF Fire Planning) DOther (specify): - - Plans for cancelled permits will be disposed of -within -10 working days upon submission of a Re uesf for Refund. If you want the plans, you may ick them u prior to that time. Date i �UTtF o Butte County Department of Development Services °° ° - ° Building Division c�U N �y REFUND CLAIM APPLICATION REQUEST FOR REFUND Refunds can only be made upon written request by the person who paid the fee(s). 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 are not refundable. Fees paid to other County Departments are s� not covered by this claim. [Butte County Code Section 341(t)) CLAIMANT'S NAME: W MAILING ADDRESS: ASSESSOR'S PARCEL #: d C-�) —5-- q & & -1-D 2 BUILDING PERMIT # : 3— -7 RECEIPT NUMBER(S): A request for refound o f fees paid on the above receipt number(s) is for the following reasons: Pa7le� o4i Please refund any applicable fees in the following categories: (Check those fees which you wish to have refunded.) Building Permit Fees ( ) Sheriff Fees ( ) SRA Fees (CDF. Fire Planning) ( ) Other (specify): Disposition of Plans: ( ) Plans returned to me at counter ( ) Please mail plans to me at above address . ( ) Please dispose of plans Signat4-2K-- Date � A COUNTY OF BUTTE GENERAL CLAIM FORM WILL BE MAILED TO YOU FOR SIGNATURE AFTER REVIEW BY BUILDING OFFICIAL. J:\My Documents\REFUND CLAIM APPLICATION.doc 12/17/02 FOR BUILDING DIVISION USE ONLY.- Receipt NLY: Receipt Information: Number: Date: Issued To: Amount: Fees Retained: BP# $ Processing Fee: $ Bldg Filing Fee: $ Elec Filing Fee: Plbg Filing Fee: $ Elec Filing Fee: $ Mech_ Filing Fee: $ Energy P/C Fee: $ Plan Check Fee: $ Inspection Fee: $ $ SRA P/C Fee: $ Other: $ Total Amount Retained: $ TOTAL REFUND DUE: $ Amount from 440-001 $ Amount from $ BP# Processing Fee: $ Bldg Filing Fee: $ Plbg Filing Fee: $ Elec Filing Fee: $ Mech Filing Fee: $ Energy P/C Fee: $ Plan Check Fee: $ Inspection Fee: $ SRA P/C Fee: $ Other: $ Amount from $ Amount from $ J:\My Documents\REFUND CLAIM APPLICATION.doc 12/17/02 OUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 9 County Center Drive * Oroville, California 95965 * Telephone (530) 538-7541 R RMIT NO. (Rw . .. 1* '2/1 , APPLICATION AND PERMIT .3-7 0D5 (k ZONING BUILDING PERMIT jo + b ebb( t TELEP11NE SQ. FT. OCC. BUILDING VALUATION .OWNERSMA1.115�_4EI �7 (/TI coumrW ONE VrL CONTS L_n= Xbrv�_ ftule• a. C60 1 CONSTRUCTION,LENDER 1\s 4,A i Akk LENDERS MAJUNd ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER I LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS -ZJC�l I -(Ir_ C?e5 Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF Duplex 0 Mobilehome 0 Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Othepod Describe Work: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W @D20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 800V OR LE:: Main Service .A OFILE 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' in full force and effect.P License Class 66-1 L9 Lic. No. Tda OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 0 1, 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. 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 0 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00NEW CONST. DW .%NG UP. OR ADDNS. S. C. ff so 3.50FT. CONS =R.,D.T g7.50. OWER APPARATUS SINQLE . CSIR. Ex. Occup. OUTLET OR FDn`URES 20 @ I. SAL @ .50 - O Ex. Occup. ..ED A -(R M.) EA.R 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 ry e- - I V-1%PC6J)Dn I PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 0 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. 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. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing 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 ofone 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 if I should become subject to the sa on provisio 'ers' compensation . . s of section 3700 of the Labor Code, I shall t lortrh 'ith/09?y wi th Be isions. th eZ,/ 0'r __ Date S atur F Sig ture of Applicant - " Ow ne 11 Contractor 0 Agent v, A OSHA permit is required for,.' vations over 60" deep and demolition or construction f t. structures over 3 stories in hi �ht. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ HAZ. I D. FEES IMP I FLOOD I COF PARCEL PD HD SSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON I the applicable provisions Resolutions to do work been paid. Date Date Receipt No. 7777757 77 . o o 77 To 1 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES -,BUILDING DIVISION ` 7 County Center Drive Oroville, California 95965 • Telephone 538-7541 P--RMIT NO. (Rev. 12/96) APPLICATIONAND�PERMIT 037 ASSESSOR PARCEL NUMBER 005 - Y/b- /�'� �,fi/� ZONING BUILDING PERMIT OWNER ^ ^ I/, .V'1/v.{L/�_S lit bbr L TELEPHONE SO. FT. OCC. BUILDING VALUATION �+ . OWNEAS MAILING ApORESS _ 1 C�. (, lee- �'jL,n 1,1 ,y/9 • t �� I CONTRACT•RS E I�/ 166 +�`�`•� (✓SI! r I T O E I� CONT R5 MAN ADDfiEeSSxnw x� AV -e-. co I ^ CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Klin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS I 1 Q Sf-- C ('CD 9517 Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing 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 ❑ Othero Describe Work: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home IS I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 vo Main Service zo A OR LESS 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 ' In full force and effect. / License Class i(% Lic. No. ��3D0 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 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. a ACC. S. 1 So. 3.50 so NON-RESID.. OUTLET 97,50 POWER APPARATUS a.IN.. OUTLET CIR. I EX. OCCu OUTLET OR FIXTURES BAL @ I. 0 Ex. Occup. ourLEEDrsA A�sE1D,oEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 F11it — t rl C'nD PERMIT FEE $ 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 j 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 d I should become subject to the porkers' compensation provi/si1ons of section 3700 of the Labor Code, I shall forthwith om ly w" th se f Cions. _ /X Date _ Signature of Applicant - ❑ Owne ❑ Contractor ❑ Agent An OSHA permit is required for ex vations over 5'0"deep and demolition or construction of structures overj3 stories in height`'F'`. a f .Lv iL t Mobile Home Installation Fee $ Energy Inspection Fee $ I occ ' CONST. TYPE TOTAL FEE $ HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date Date �� tt}F (,� ReceiptNo. 3 ��( �� f t WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT (Rev. 12/96) - Y - COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 P RMIT NO. APPLICATION AND PERMIT �3 "Z0--37 ASSESSOR PARCEL NUMBER . ,,. - /q-� (��`/•rh ZONING BUILDING PERMIT OWNERSC,n ,�J,,y C r,(^(� t�,j TELEPHONE SO, Fr, OCC. BUILDING VALUATION .OWNERS MAIUJN(`, ADDRESS I `� �L 9 1_ I ee�i�%1.. i -t— ( �- I 1 23 CONTRACTORSC(, (I E ' ' l.C.. � TV " NE /Z CONT EiACdTQR �llll I� M �R �-Y, o /�e. (2 ,-tea �52G CONSTRUCTION LENDER LENDER'S MAIUNG ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS" f"'�-I !`.r✓f-. /� � I CY� 9�� r �.J Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S 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 gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ lfblities ❑ Installation ❑ Others Describe Work: /� ✓ ,� 0 1 / / �r (� r Gas i in system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S J ELECTRICAL PERMIT Filing Fee 20.00 A OR LESS Main Service 20000.' OR LESS 23.00 -2-,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. ��)) ` n License Class (� .�` (i Lic. No. � (o��/ OWNER -BUILDER DECLARATION 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. ❑ 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 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BLOB. SO 3.50FT. NEW CONST.OUTLET MULTI. NON•RESID. c 97.50 POWER APPARATUS 8 SINGLE OUTLET CIR. EX. OCCU OUTLET OR FD(TURES 20 @ 1.00 @ .50 Ex. Occup. oFlxurLEEDTSA RLNS oEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 - t Ir1 IPERMIT 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. ❑ 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 insurance carrier and policy number are: Carrier 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 not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if.1 should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply, with those •prgvisions. C_ `5:',•02 Date �r" Signature of Applicant - ❑ Owner, ❑ Contractor ❑ Agent An'OSHA permit is required for excavations over 60" deep and demolition or construction sof structures over,3 stories in height. t MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE � r TOTAL FEE $ (JO . HAZ. D. FEES IMP FLOOD I CDF PARCEL p0 HD ISSUE This permit is hereby issued under in the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date Date Receipt No. 77 17 ! -to/ 7 ., ,77 ( 77177 1"' WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541PE�RMIITNO. (Rev. 12/96) APPLICATION AND PERMIT 93 ASSESSOR PARCEL NUMBER / %�'�� — � v�� ZONING G�1 Zi ONXI�N7!7 BUILDINGPERMIT OWNER �C� i t Li)4!•`it s TELEPHONEJr, SO• Fr. OCC. BUILDING VALUATION . OWNERS MINADDRESS f<J`Z-Lii1c.. c l/ CONTRACTORS' I J/i M.1S rJpCtyi_ TELEPHONE WADDRESS COI IJ 1--.7UY i I ` a • f'J' N.Y r tC• C( I CONSTRUCTION LENDER LENDER'S MAILING ADDRESS - Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filin Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 2115 _ I Y} -) S I`, C I I I fJ r ?-7 / Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT ,Filing 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 ❑ Otherod Describe Work: �7 �f r� �J. ! 0 t r6, dt VJ I t( j ") �tp y 1! 16c f-'�ify Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE S L 1 ' ELECTRICAL PERMIT I Fling Fee 20.00 Main Service OOOV oR tESS 2o0A OR LESS 23.00 -2.3. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 commencin with Section 7000 of Division 3 of the Business and Professions Code, ( g ) and my license is in full force and effect. License Class J_v"" ¢ 0 Lic. NO./ ~%f L� (! h. OWNER -BUILDER DECLARATION 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 111 am exempt under Sec. Business and Professions Code for this reason Main Service zooA To L000A 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. a ACC. BLos. SO 3.5¢x. NEIN CONS ' MULTI.OUTLET NON-RESID. 97.50 POWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES BAIL p'. 1.00 R Ex. Occup. oFT'LUT,E. "a.1EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 V l!_ PERMIT FEE $ 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. ❑ 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 insurance carrier and policy number are: Carrier MECHANICAL PERMIT ' Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation f 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 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 ' �i / Gf/ I• C/'i All Date M' Signature of Applicant - ❑ Owner ❑ 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 $ occ CONST. TYPE TOTAL FEE $ HAZ. D. FEES IMP FLOOD I COF PARCEL Po HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date Date Receipt No. -� , 1 70 V-1.',' }!f !r WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT • ` I PRE -INSPECTION OWNER. <J LOCATION: �� (� 2- ►�'t CONTRACTOR:__ CJ�� g►K �-2�' PRE-INSPETION FOR U 2 C�2 q+y -( c - DATE: �j i S" 03 A.P. # ZONING.- DATE ONING: DATE TO WSPECTOX. pZR • iRSTORY. NONE ( FouloWS_ IIS v l BdilftX Daer4Wons k ' Reaideatiatliriotvaitx Currently occwiv�� Abandow&Vac ant Electric: Yes No Condition of Electric --",% "NorM.TOR'SRZPM Electric =ready On off Gas: '*Na Prop - None Currently OIL-- Off_ Obvious Problems: Sanitation: Plumbing Working Well Working - Potable Water Obvious Sewagepnoblems ACTION RECOMMENDED: ISSUE: HOLD FOR Inspector: Date Sketch buildings on reverse and indicate location on - ropert . P A y COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 2 7 County Center Drive - Oroville, California 95965 * Telephone (530) 538-75416 -3 _ Z�MIT NO. -7 (Rev. 12/96 APPLICATION AND PERMIT I wl . ASSES�! NLIMBER'�' tAab ZONING BUILDING PERMIT10/ OWNE*'t.",;, _, ",S tosl)(AMIC-S +b_CJ9b(_C TELEPHONE - SO. Fr. OCC. BUILDING VALUATION OWNERS NOIAIIJN� '� k Ot. ID [<�Scwt- (+ V-11 4 - ITS - 11 F7 CONTRACTIR' - S "E Eje_cty 1�_ ONE T CONT C 'L'A ILI AD llsllbrrlloALY_ ch 111(�z 1 S15�2 � CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS -Z) 15 Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF Duplex 0 Mobilehome 0 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 0 Addition 0 Remodel 0 Utilities 0 Installation 0 OtheLAJ Describe Work: mmad.c rn&t�-) Sev-vke P�4&J_ Gas piping system I - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I WF- (_a20.00 PERMIT FEE ELECTRICAL PERMIT Filing Fee 20.00 Main Service . '0.v0 A o,A, s' 23.00. Q) 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 full force and effect. License Class Lic. NO. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 0 1, 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. •. 0 1, as owner of the property, am exclusively contracting with licensed contractors . to construct the project. 0 1 am exempt under Sec. Business and Professions Code for this reason 200A 1000A Main Service TO 46.00 NEW CONST. DWELLINO OCCUP. R ADDNS. & ACC. BLDS NRA SO. 3.50FT. NEW CONS MULTI -OUTLET ..ESIDT BRANCH CIRCUITS @7.50 POWER APPARATUS & SINGLE OUTLET CIA Ex. Occup. ounET OR FD=RES 20 g1 00 BAS 9 �50 Ex. Occup. MD.'(P'.s,6.)ER. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 rv, e- I PERMIT FEE $ (O(O.Oj WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 0 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. El 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 insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing 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 if I should become subject to the 'k , compensation em ' c 0 orkers' compensation provi ions of section 3700 of the Labor Code, I shall f rthwith o I with ttOse isions. Date Sig ature of Applicant vne 0 Contractor [3 Agent u v A OSHA permit is required for ex vations over 60" deep and demolition or construction ) permit f structures over 3 stories in hei �ht. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE ITOTAL FEE $ KAZ- I D. FEES I IMP I FLOOD I CDF PARCEL Po F17suE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON I the applicable provisions Resolutions to do work been paid. Date (Data) Receipt No. a? �O I -Q 0 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT