HomeMy WebLinkAbout007-260-034COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
SFS; ATTACHED
ZONING
BUILDING PERMIT
OWNER,
COMCAST COMMUNICATIONS
TELEPHONE
SO. Fr, OCC. BUILDING VALUATION
. OWNERS MAIUNG ADDRESS
4350 PELL DR
CONTRACTOR'S NAME
WESTCOAST COMMUNICATIONS
TELEPHONE
CONTRACTORS MAILING ADDRESS
140 MEYER
CONSTRUCTION LENDER
LENDER'S MAILING 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
SEE ATTACHED
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 ❑ Unities ❑ Installation ❑ Other ❑
Describe Work: PLACE CATV POWER SUPPLY
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home ISI GI W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service "m,R, Less
8 23.00 184.0
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 i II force and effectPOWER
License Class C — 10 Lic. No. 769;51_7 110
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.
❑ 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
Main Service 200A To 100IA
46.00
NEW CONST. DWELLING OCCUP.s0
OR ADONS. ( a ACC. BLDS,
3.5QFT:
NOON,p °SID MULT,OUTLET
@7,50
APPARATUS
8 SIN OLm ET CI0.
EX. Occup. OUTLET OR FIXTURES
20 t. 00
BAL.@ •s050
Ex. Occup. p D.°
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
$204.00
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEI:
$
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 I should become subject to the
workers' c mpensa' rovisions of section 3700 of the Labor Code, I shall
forth c mply h se provisions.
X Date Go 15-��
Signature of Applicant - ❑ Owner # Contractor ❑ Agent
An OSHA permit is required for excavations pver 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE _
FEE $ 204.0e
_Z.
ETOTAL
D FEESOD
COF
I PARCEL
I PD
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By''yZ/'�'"
PERMIT EXPIRES ONAQ
the applicable provisions
Resolutions to do work
been paid.
Date
ere
ReceiptNo.
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