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Home My WebLink About021-040-00121-04-01 STATE OF CALIFORNIA 3214 Rutherford Rd,: Gr•idl_e_y L North# Va11ey�Elet#300-0E(ele-,ser ch/SE) • f , ' • - f �• f C tiY • c, •� r 4 _ • a I , , r �� o "� 1 J COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 91.6/534-4541 APPLICATION AND PERMIT P IT NO. �� AS�SE SSOR PARCEL NUMBER ZONING BUILDING PERMIT O WLJ EFS / ��-�j(- TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING A DRESS O'NTR CTOR'S NAM /� TELEPHONE Y�6 -Zoe./ C NT R ACTO 'S MAILING RESSp Fireplace CONS RUCTI`O LEN ER UNKN N Total Valuation $ Filing Fee $ 10.00 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 $ BUILDING ADDRESS / L Permit fee $ PLUMBING PERMIT Fi ling Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARC L MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF r91Duplex❑ Mobilehome❑ Other IN SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I 0.00eaTYPE TYPEOF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ❑ Describe work: ,-,pti �iE __10.00e- Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR LESS 100 AMP OR LESS 10.00 (� •� Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): 09�-1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Profess iCQJ� s d a my license is in full fo ce and effect. .R� C/,t� 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 CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS./2 Osq ft , NON.RESID R.11 ULT'-OUTL BRANCH CIRCTITS 2.50 ea POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20®50S sAL030 FIXED APLINIS Ex. Occup. OUTLETS PRESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Iyirin 15.00 g bc I)_D Permit Fee $ S 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 FiIingFee 10.00 Heating Cooling Hood 3.00 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 t id C un in consequence of the granting of this permit. X Date nt — OWL ElContractor® Agent ❑ Sign ture of Ap liIryuired An OSHA permit for excavations over 5'0" deep and demolition or construct- ion of structures over�jstories lin height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.TYPe JFLOOOJPARCELJ PD HD 59UE 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 Feceipt No. r (7 HITE-D.P•W., YELLOW-ASSFSSOR, PINY. -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT.OF t UBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET Permit No. OWNER /%04 P. No. c� Proposed Building Use Building Inspector Date 3 At time of permit application, I was advised the following data must be submitted prior to permit processing . and:/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate/triplicate, signed by preparer of plans. , 3. Complete plans in duplicate./triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans., 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan ,. . . . . . . . ' 7 Statement of Intent for Non -Heated and AC Buildings. f 8. Fees of $ . . . . . . . . 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) 14., Owner -Builder Verification (Given to owner❑, Mail to owner ❑•). _15. Improvements may be required. . . . . . . . . . . . 16. Mobi lehome Installation Data.. .. . . . . . . . . . . 7. Pre-Inspec. request to (Date) Pre -Inspection for Required. Building Inspector 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. .' When you issue the permit, process as follows: Mai I to owner, Me to contractor. Telephone and hold for pickup at office, Deliver'w/inspector,. Other Applicant ,ate Copy of plans sent Health Dept., Fire Dept., Other Date 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----nail—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 - Flours: 10:00 a.m. - 3:00 p.m. Copy—DPW CLAIMANT: ADDRESS: &UW* Of i"Bufte OROVILLE, CALIFORNIA GENERAL CLAIM ` North Valley Electric P.O. Box 911 CITY & STATE: Gridley; CA 95948 IMPORTANT: February 10, 1987 SEE INSTRUCTIONS DATE OF CLAIM: ON REVERSE SIDE' SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT INV. NO. INV. DATE Electrical permit application taken due to clerical error. Permit GROSS AMT. not required. Bldg permit application Receipt , dated 2/3/87, A.P. #21-04-01. Owner: State of California. Total fees paid -------------------------------- $50.00 TOTAL REFUND DUE -------- =------------------------------------ $50.00 $50.00 ' TOTAL $5 .00 I, the undersigned, declare under penalty of perjury that the services or articles claimed ha or de ' and his claim is true and correct as stated. Dated this ......�.�.�......... day of L'{..�.�..L:.bf:/. 19d..% at..bi1.SS.4�.�,/............. Calif. ..... invent I, the undersigned, hereby certify that, to -the best of my knowledge, the services or articles specified above have been performed or de- livered and that there is a Budget Appropriation O or Specific Board Approval 0 (Check one) for the ma. Dated this 10th day of February 19 87at Oroville Calif ��/ .. .................................... ............... _ ......................... per D t ant Head or Authorize utv Dept. Exp. % --- -- CodeCode ................................................PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT.