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HomeMy WebLinkAbout007-340-023Dan 1lrake rr-r - w— •- �- 3173.Coronado Rd., lot 90, Joshua Tree #2,-.Chico' - Permit # q04w-78B(nesingle family) Permit ##7268-78 (0 clearance fireplace) SF q % dd 0 0 o r. 0 0 (��J�'OZ���� T—U� r�2��r"cC ��� �� ease � ���� ' . �Io ��� ��r�� � = Ti:_!': i.'.•v i la�;��'1�,:�' :�L i''.b:1� 3 ii 5-_waw—e andlor Water and/or 3& ition-Cle--ar.C.e(s) r " h—A LOC (JA I ON 2-,e alproved 'or: Sewage Disposal /-" !`3a�mi' ,iaIM .up rirzl for: wa.eer Sappl) i5 1®i y n° v-C�aiGa7 e 0::hal. -c,' - On cs) will. b -z Seitz: an Daze E F T. COMPANY.H 4 , LICHNREC CONTRACTOR Insulation — Weatherstripping - Accoustical Tile P. 0. Box 3506 Chico, California Phone 342-4764 (Purchaser) and Street) (City and State) THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOC�TTED AT: Street Lot Number EXTERIOR WALLS / Manufacturer Thickness/Type R Value )Tract No. CEILINGS Batts: Manufacturer Thickness R Value Blown: Manufacturer Thickness Z " �N- / o. �+Ba �L Wt./Ba� Sq. Ft. Covered R Value FLOORS Manufacturer Thickness/Type R Va!ue SLAB ON GRADE Manufacturer Thickness/Type R Value Width of Insulation Inches FOUNDATION WALLS Manufacturer Thickness/Type R Value GE ONT TO LICENSE NUMBER BY Q TIT E DATE INSULL IONygO RAC LICENSE NUMBER a B / TTITLE DATE L c+ SAVE ENERGY - INSULATE! ( DATE) ACCEPTED IHERSE!Tly COMPANY (Authorized Representative) r T t 3804-788 4\ PERMIT NO. y PERMIT EXPIRES 2 I� Dan Drake OWNER 4,c, ONTR. owner, ' 3 LOCATION 44 -43 -18' -port. (A.P. ) 3173 Coronado Rd., lot 90, Joshua Tree#2,. = Chico fj 1 , l< Temp. Power Pole `{; Called PG&E ' Temp. Elec. Serv. — - - F• Called PG&E — o2•y — 78' • l- Te p: Gas Serv. " a Called PG&E • JOB FINALED (Da (Signature) COUNTY OF BUTE DEPARTMENT OF PUBLIC WORKS e BUILDING INSPECTION RECORD. 4 BUILDING BUILDING (C nt'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor 2 117 Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor StemwaII - Siding To out Slab Roof Sheathing • : —? _ Water Piping .► Piers Roofing Sewer Garage Fdn. Vents - Fixtures Footings Garage Vents "—`�� Water Htr. Stemwall Insulation ` - s Z 0 Heaters Slab Prov. for physically _ Appliances Carport handica ed Gas Piping &Test `- Conformance of exc Footings structure Temp. as Slab Final Sanitation '' ` Patio FIREPLACE , ( Final -Ace — Footin s Footin ELECTRI MasonryWalls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test - Water Htr. Stucco'- Final Subpanels ' Mesh 9,-� MECHANI AL Grd. Fault Prot. Scratch Heating Service Brown r Cooling g Temp. Pole �— Finish Ducts ✓ — 7 Underground ---•------' Interior Lath --G— Ventilation Permanent Door Closer - Final ,�J—Z Final - MOBILEHOME UTILITIES ---------•----•--- Elec_ Service Elec. Pedestal Water Piping Sewer Gas Piping 0816EHOME INSTALLATIQN - - - - - - - - - - - - - • Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS P. ! r 7 County Center Drive - Oroville, California 95965 �- Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above- entioned property for ins ction purposes. X Date Signature ofn!77� Agent Receipt No. IL-� White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant 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. DIRECTOR OF PUBLIC WORKS By Date Z_/ Z -gyp Bui ding permit expires Date 7 —12-- 7 BUILDING Owner SQ. FT. OCC. BUILDING VALUATION ao 00 p Mai I i ng Address p D r Q, O C Telephone No. Contractor uie lFireplace Mailing Address Total Valuation Q Telephone No. Permit Fee Building Address A CIL Plan Checking Fee&/or Penalty Permit Fee S. f 04 1-6n a 0/0 PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trao 1.50 Repair drainage or vent piping 1.50 A. P. No. —0 F s W.C� n Fire Dept. Fire Zone A Z� 1 Use Permit Water piping 1.50 Each gas water heater or vent 1.50 Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvem is Each additional outlet .30 Building sewer 5.00 Parcel Ap oval Plans Approval Lawn sprinkler system 2.00 NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ Permit Fee $ is ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5•�� Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADO'L 100 AMP 2.50 Main service OVER a O 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1 1.00 NEW OR ADDNST ( ACC. BLDGS.DWELLING CCUP. 4\ 22sgft I 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 style of: NEW CONSTR BRANCH CIRCUITS) NON.CONS ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS B NON.RESID. (SINGLE OUTLET CIR. Ex. OCCUP(OUTLETS OR FIXTIIRES B L@; FIXED APPLNS. OR Ex. Occup. (OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 1 am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 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. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner Foas to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE J$3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 buildinq construction, and hereby Land Development Fee $ cit TOTAL PERMIT FEE $ OC authorize representatives of the County of Butte to enter upon the above- entioned property for ins ction purposes. X Date Signature ofn!77� Agent Receipt No. IL-� White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant 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. DIRECTOR OF PUBLIC WORKS By Date Z_/ Z -gyp Bui ding permit expires Date 7 —12-- 7 J0SNUA TREE 5U8,D / V15 / ON f 78.00 { Th s set of plans and specifications MUST bs kept on the job at all times and it is unlawful to makE any changes or alterations on same without writt n permisson from the Department of Public +! Worcs, County of Butte. t //3 ALT. UN 1 7" 2 i F -I t;c system and location I drain of build - ) I N to stub -out to be as per County Health C 4�ements. Dent. p,, Z N E:—All Materials & Workmanship Shall Be in Acc rdance with Recognized Good Practices and of ; qualit prescribed for the Specified use in the Uni orm Bui ding, Plumping & Machanical Codes and the Nationc Electrical Code. 1 17 i Se* Master plan on file for strut- tural details. i The -Bldg Setback shall [ie 5 ft. from the side pro erty line and -B".- frem the_. cente►lin of the road, permitting a maxi. mum of 2 ft. eave overhang but entirely, out of a I easements. BUTfE COUNTY 3 IMN DEPARTMENT APPROVED _I o • 0 N i F -I t;c system and location I drain of build - ) I N to stub -out to be as per County Health C 4�ements. Dent. p,, Z N E:—All Materials & Workmanship Shall Be in Acc rdance with Recognized Good Practices and of ; qualit prescribed for the Specified use in the Uni orm Bui ding, Plumping & Machanical Codes and the Nationc Electrical Code. 1 17 i Se* Master plan on file for strut- tural details. i The -Bldg Setback shall [ie 5 ft. from the side pro erty line and -B".- frem the_. cente►lin of the road, permitting a maxi. mum of 2 ft. eave overhang but entirely, out of a I easements. BUTfE COUNTY 3 IMN DEPARTMENT APPROVED _I COUNTY OF BUTTE — DEPARTM,ENT OF PUBLIC WORKS t 7 County Center Drive - Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date 101, Signature o`f'�Permitee or Agent 1 :2 Receipt No. 2 t - White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 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. DI )TOR OF PUBLIC WORKS By Date B�rild+ag permit expires Date_�?J/1179 12 BUILDING Owner Dam ID rake SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor .� Mailing Address IT Fireplace Total Valuation Permit Fee Building Address Plan Checking Fee&/or Penalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 3,00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. 4--nZoningWater & Planning piping 1.50 Each gas water heater or vent 1.50 F W Set:itRtiesl I Fire Dept. Fireone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans I Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 l3 Parcel A royal Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER �� Permit Fee $ $ ELECTRICAL No.1 @ I FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP ORLESS 5.00 Single Family Duplex Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 100100 AMPsoov OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONST DWELING OR ADDNS. ACCLBLOGSCCUP. 51 20sgft 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 style of: //�� P �4a . NEW RESID. BRANCHMULTI-O CIR T NON RESID. `BRANCH CIRCUITS( 2.50ea NEW CONSTR. (POWER APPARATUS e NON RESID. (SINGLE OUTLET GIR. Ex. OCCUO(OUTLETS OR FIXTURES)B L@; FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EAY 2.60 ©�iLRIs 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 $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Wor n's Compensation. ave placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ❑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 the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 herebyI Land Development Fee $ TOTAL PERMIT FEE $ If 1b I authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date 101, Signature o`f'�Permitee or Agent 1 :2 Receipt No. 2 t - White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 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. DI )TOR OF PUBLIC WORKS By Date B�rild+ag permit expires Date_�?J/1179 12 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS �.�. 7 County Center Drive - Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authoripresentative of th County of Butte to enter upon the above tinned prop e y or i sp c ' n purposes. G� Date D 7� 141. ` Itee or Agen Receipt No. / � / White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant 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. CTO OF PUBLIC WORKS By MDate �BuODUWpermit expires Date 2 l BUILDING Owner L&Le SQ. FT. OCC. BUILDING VALUATION Mailing Address 'Pig `I/AC J_ Z � [ Telephone No. Contractor C' � Mailing Address �a Fireplace Total Valuation nn n Tal hone No . _ Permit Fee Building Address ( Plan Checking Fee&/or Penalty Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1,50 aa A. P No. - JP02f� Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 es I VV. I Saal "ion Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans I Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 I3IJq-P+aWT-R-ec'd I Parcel Approval Plans Approval Lawn sprinkler system 2.00 NEW ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ �Q 7S ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 0V OR LE Main service 100 AMP ORSLESS 5.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 �cJ Main service OVER soov 25.00 100 AMP OR LESS Main service EA. AOD'L 100 AMP 1,00 NEW CONST DWELLING OR ADDNS. ACC. BLDGS,CCUP. Y) 22sgft LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Profe ions Code under the name le of: ' CIa - I ��d, NEW.NONRESID. MULTI -OUTLET ESIT, � BRANCH CIRCUITS) 12.50ea CON SCONTRACTORS NEW CONSTR. POWER APPARATUS & NON-RESID. SINGLE OUTLET CIR, Ex. Occup{OUTLETS OR FIXTURES B LO; Ex. OCCU FIXED APPLNS, OR p•(OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 S 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 $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aw a of the provisions of Section 3700 of the California Labor Code hich requires every employer to be insured against liability for orkmen's Compensation. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. r -1I 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 Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating . i Cooling 977 Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this aFliclion aand state that the above correct. Iagree comply to all County Ordinances Sta aws relating to dding construction, and hereby Land Development Fee $informatio64 TOTAL PERMIT FEE $and authoripresentative of th County of Butte to enter upon the above tinned prop e y or i sp c ' n purposes. G� Date D 7� 141. ` Itee or Agen Receipt No. / � / White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant 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. CTO OF PUBLIC WORKS By MDate �BuODUWpermit expires Date 2 l ✓ COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for ins ' n purposes. 11J­�— XDate Signature of Peree -V,/j, Receipt No. / / / / o (r_,- White-D.P.W. White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above fo hich fees have been paid. DIGECT eUBLAfl WORKS J V Building permit expires Date — % ' 7 BUILDING Owner ..� � / e SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor .p Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address Plan Checking Fee&/or Penalty Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 r Repair drainage or vent piping 1.50 A. P. No. � s ,?— IeP Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 Fees Wim. Sartttutron FireDept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans I Parcel Declaration Parcel Map 60' R/W I Improvements Each additional outlet .30 Building sewer 5.00 BWQ_ 121 'd val Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Rr Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW CONS, OR ADONST ( ACCLBLDGS.0 UP Y 22 sq ft T l/ 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 style of: .G NEW CONSTR. (MULTI -OU LET NON.RESID. ` BRANCH CIRCUITS) 12.50ea NEWCONSTR. POWER APPARATUS B NON .RESID. (SINGLE OUTLET CIR. Ex. Occup (OUTLETS OR FIXTIiRES g 250 L 11 Ex. Occup. (OUTLETS IXED AP(RESID.)LNS.REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. 3o.S-36.j" Classification C O Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ ' MECHANICAL No. @ FEE 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 forWor men's Compensation. have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ElI certify that in the performance of the work for which this permitis issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 Land Development Fee $ TOTAL PERMIT FEE authorize representatives of the County of Butte to enter upon the above-mentioned property for ins ' n purposes. 11J­�— XDate Signature of Peree -V,/j, Receipt No. / / / / o (r_,- White-D.P.W. White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above fo hich fees have been paid. DIGECT eUBLAfl WORKS J V Building permit expires Date — % ' 7 ' COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS - 7 County Center Drive - Oroville, California 95965 Telephone: 534-4541y.— APPLICATION AND PERMIT BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address 4 l� Telephone No. Contractor- Mailing Address Fireplace pp Total Valuation Tlephone No. e Permit Fee S AO Building Address armT Plan Checking Fee&/or Penalty $ Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each TraD 1.50 �" 1C.0 Repair drainage or vent piping 1.50 A. P. No. 3— pi �A Zortin93'Planning Water piping 1.50 Each gas water heater or vent 1.50 Fe . . .SaR4@+k" Fire Dept. Fire Zone Use Permit Gas piping system 1 -5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Plans Approval Lawn sprinkler system 2.00 ___Lorcel_Approvol NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Jk.1 Permit Fee $ e1CDO I ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5•00 Single Family & Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVEAMP OR P OR LESS 25.00 100 Main service EA. ADD'L 100 AMP 1.00 NEW CONST. ( DWELING OR ADDNS. ACCLBLDGS.CCUP. Y\ 22sgft 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 style of: NEW CONSTR BRANCH CIR T NON.CONS / BRANCH CIRCUITS/ 2.50ea NEW CONSTR. POWER APPARATUS B NON.RESID. SINGLE OUTLET CIR. Ex. Occup (OUTLETS OR FIXTURES, gALFIXED APLNS.�j Ex. Occup. ( OUTLETS P(RESID )REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Licen No. Classification Misc. Wiring 6.25 am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor PERMIT FILING FEE J$3.00 ��::l I IHeating I Code which requires every employer to be Insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. 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 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 aut riz presentatives of t e County of Butte to enter upon the ab ve-menu ned property fo In g@ction purposes. P Date 62- �'--Signature of Permit 7071V rt Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Cooling Ventilation Hood 1 1 2.00 Permit Fee $ $ Land Development Fee $ TOTAL PERMIT FEE $ $' This permit is hereby issued under the applicable provisions of the Bu ounty Code and/or resolutions to do work indicated abov for hich fees ave been paid. TOR OF PUBLIC WORKS �% By rC� Date 74 Building permit expires Date —Z 2 —77 If