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HomeMy WebLinkAbout021-132-058• r 21-132-"ha/�-7 i TRAVIS, & NANCY•-POWELL: 516 W. Liberty Rd, Grid Gridley �tContr: Blankenship Pools, y.' Permit��788-85B,P,E(new rivat � private pool) ' A i; t Y�Y ,ytF • �et� 1 PERMIT NO. 788-85B, P, E <" PERMIT EXPIRES 7 O ` F' OWNER TRAVIS & NANCY POWELL i CONTR.. Blankenship,Pools, Y.C. x ASSESSOR PARCEL 21-132-58 i r; LOCATION 516 W. Liberty Rd, Gridley 4' 111111".I 1 9 ' .u1�u1A � T �1 H Temp. Power Pole_ Called PG&E _ Temp. Elec. Service Called PG&E_ Temp. Gas Service _ ACalled PG&E_ JOB FINALED (Dab r �� Signature J ._ ,OK,' 1�9 0 Not OK = Not Applicable MOBILEHOMES MISCELLANEOUS = Not Ready Date MOBILEHOME UTILITIES (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except p's 1. Zoning Requirements—Setbacks—.Easements 2. Soils; Special MH Support—Sketch 2. Footings; Size—Depth—Spacing—Connectors 3. Sewer; Location—Test—Fall-C/0—Concrete 3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails 4. Water; Location—Test—Easement Needed (Sketch) 4, Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing 5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete 5. Alum. Awn.; Columns—Connections—Splice—Decal—Ehclosures 6. Gas; Location—Test—Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows—Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except N's Card -BI Date Date Card -BI Date POO Plans) OK except p's 1. Zoning Requirements—Setbacks—Easements Setbac —Easements 2. Footings; Size—Spacing—Marriage Line 3. Gas; MH Test—Demand—Valve—Connector 2. ;Compaction -Structure Stability Pool Structure; Steel—Connections—Thickness—Dead Men—Lining 4. Electricity; MH Test—Crossovers—Breakers—Clearances '`4. Elec.; Receptacles and Lighting; Distances—GFI 5. Drain; MH Test—Fall—Flex Connector -•75. Elec.; Pool Lighting; 15 volts—GFI 6. Water; MH Test—Regulator—Connector 6 Ele .; Enclosures; Conduit Entries—Terminals—Listed 7. Water and Sewer Connected—C/0 to Grade—HD Approval B. Gas and Electricity Tagged �� lec.; Bonding; Metal w/5'—Circulating Equipment—Heater �/ 8. lec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg. / Boxes—Enclosures—Panel boards—Ins. to Main in Conduit th Department Approval 9. Exits,; Insp.—Sketch 10. Cert. of Occupancy Plumb; Cir. Test—Water ' pply Test Card B -I Date Card -BI Date Card -BI psi Date �., Card -BI Date Card B -I Date Card -BI Date -Card-BIX,4 Date ff Card -BI Date FA J = OK 0 = Not OK k Not Applidable RESIDENTIAL (Single and Duplex) * = Not kleady Date UNDERFLOOR Plans OK exce t#'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic 8. O.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test-Anchors-Regulator-Seryice Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Card -BI Date Card -BI Date Date Card -BI Date Date FINAL (Plans) OK except H's Date PLUMBING (Permit) OK except N's 14. Water Ht.; Vent -Access -Combustion Air 56. 57. 58, 59. Ext. Steps -Door & Sidelight Protection -Landings Smoke Detector Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection Bedroom Exiting 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 19. Gas Pipe; Size & Anchors 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth Card -BI Date Card -BI Date 64. 65. Elec. Outlets at Wood Panel; Int. & Ext. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Date Card -BI Date ELECTRICAL Permit OK except q's 66. Elec. Outlets & Receptacles at Kit. Counter 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 21. Elec. Receptacles Spacing -Lights &Switches at Doors 70. Plb., Elec. & Mech. Equip. Listed for Location 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 72. Insulation -Foam -Looked in Attic ❑Yes73. 74. Guard Rails & Deck Construction -Post Caps Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 25. 2 Appliance Circuits in Kitchen &Conductor Size 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At, Insulated Neutral ❑Yes ❑No 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑Yes 0 N 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77. A.C. Unit; Disconnect-Clmces-Brkr. & Cond. Size -115V Outlet 30. Clothes Closet Light -Shower Light 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground Card B -I Card B -I Date Date Card BI Date Date Card -BI Date MECHANICAL (Permit) OK except q's 31. A.C. Ducts; Insulation & Support 81. 82. Ventilation throughout House Glass Protection 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 85. Water & Sewer Connected -C/O to Grade -HD Approval 32. Vent Fan; Exhaust above Insulation 86. Energy Compliance Certificate -Other Certificates 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date FRAMING Plans OK except q's 36. Sills; Proper Material & Anchors 37. 38. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing 39. Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. Header & Beam -Size & Bearing 42. Hangers -Post Caps -Anchors -Connectors 43. 44. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng_.--Rfng. _ Fireplace Ties or Type A Flue -Fireplace Throat 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing (NOTE:Anentrymust be made each time youvisit jobsite) F COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS ' 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 534-4541 Skyway and Elliott Road, Paradise -- Phone: 872-2961, Ext. 57 RRUTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector_,/.� / Date' �____ COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961. Ext. 57 CORRECTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector_ _ Date_ _ COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS' 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE R MIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of.work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector r Date J COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Caltfornia 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. 7O ASS5 R PA C L NUMrF�1E —v ZONING BUILDING PERMIT ow R 1rQ Ul HONE Pr -6 S0. FT. OCC. BUILDING VALUATION OWNER'S MAIL NG DD ESS � / v, y C ACT R'S NAMET :fit. ` LEPHONE C N RACTOR'S MAIL A DRE I�,( t r Fireplace P C N RUCTION LENDER UNKNOWN Total Valuation $ Q Filing Fee $ 10,00 LEN ER'S MAILING ADDRESS - Permit Fee $ M, ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,�f�� $ /SV C © Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT FiIIng Fee 10.00 Each Trap 2.00 Solar Water Heater 20:00 `4 Ica (Z Water piping 5.00 $ 0© LOT NO. SUBDIVISION NAME PA CE MAP Each qas water heater or vent .5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTUR SF ❑ Duplex❑ Mobilehome❑ Other �tl� �� SPECIFY Building sewer 5.00 Mobile Home S I G I W 110.00 e TYPE OF WORK New Addition ❑ Remodel❑ Utilities El installation EJ Other EJ Describe work: — ast�Ve- Permit Fee $ 00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service jp0 AMP ORV OR LESS10.00 e o *�- /o FrIMain service EA. ADO'L too AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2I/2Qsq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): �-y I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. �� (,01,6,3 Classification C-- S� ❑ 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 CON5TR ULTI.OUTLET NO N.RESID BRANCH CIRC', TS2.50 ea NEW -CONSTR POWER APPARATUS .&) & NONRESID, SINGLE OUTLET CIR Ex. Occu BAL@30 P�o rs OR FIXTURES BAL®30 FIXED Ex. Occup. OUTLETS P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 M'c. Wi ing 15.00 Permit Fee $ , QQ Contractor 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ 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. GlA ) , X - Q Date � � a Signature of Applicant — OwnerEj�'*�ontractol(:E!� Agent ❑ An OSHA permit is required for excavations over d demolition or construct- ion of structures over 3 stories in heights. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ /�^t OCCUP. GROUP I TYPE OF CONST, PARCEL PD Ho ssu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECT OF PUBLIC PEdmilT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. 3�4By WRITE-D.P.W., YELLOW -ASSESSOR, PINK -INS C LI CANT COUNTY OF BUTTE - DEPARTMENVOF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534,�-4541 ' PERMIT APPLICATION DATA SHEET _ Permit No. OWNER VC! U �0t A A. P. No. C Proposed Building Use no I Permit Fee Based Upon: ^ Complete Contract Price DPW Valuation / Other (Explain) Building Inspector 17/ Date 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. . . . . . . . . . . 3. Complete plans in duplicate./triplicate. . . . . . . . . 4. Complete engineered plans and calcs. . . . . . . . . . 5. Plans with Energy Design Compliance Statement. . . . . . 6. State Energy Forms No. 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . . . v Letter of signature authorization. 4,Sanitation approval from ! /VO v i0- Health Dept.. 1,1. Planning approval for (A) Use: (B) Parking: - C-ertificate of Workmen's Compensation Insurancep." - 3. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner0, Mail to owner[]) 15. Improvements may be required. . . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . . •Pre-Inspec. request to 17. Pre -Inspection for Required. Building Inspector (Date) 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Other When you issue the permit, process as follows: Mail to owner. Mail to contractor. i TTelephone 6P -,9441 and hold for pickup at n s ED office. Deliver w./inspector. Other_ /* e - o d e C0 o v C-- e� ( ( © u-) ti e V- �^ Applicant �x�. ,.A Date3���'�J Copy of plans sent Health Dept., Fire Dept., Other V Date During the plan checking process, the following data must be submi ted prior to permit issuance. (For required items not checked above a ti a of (cation, circle item.) 1. Index permit for above Items N,. 2. Additional items required: (Contractor, Designer, Owner) was advised of above required data by Tele hone T -Mail-Other ,./ By•J. Date 3 - 3�% "O40 Plans checked by Date Plans approved by Date___3 '-.1* Other: Copy—DPW 4 To: Building Department From: Environmental Health L, SqbJect: Sanitation Clearance 2 -171.32 -ST NE�WZ ca R:LE- Plan Approved for: Hold Final for: Final Clearance O.K. for; Sewage Disposal Water Supply _,. Clearance for bedroom ouse/mobilehome or other NOTE V Water Supply Water Supply �,J`Sii►- I tSj- -r — - ��e-� I ;-a-; I � ' �- !--!!-' -! 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'_j_ -I �N�/VS/!%P., .r � I �_ � I-4 i � -� � � i � ! ► -, , ;-.- ! i .:/!•'moi ! , Ir--- 1_ ; ?fj_i. ! i I I I - --- I i ' I I ► I I I. -I 'iI,I . - }_1 ; 1 I I_± -I i I 1 I ! I I } f_I f I l! I! I! TJ _.I I ! ! __1_I I I i ! ; ; ' ; ► I i i _l f rloD'i'lT=��1oMl_� ! i j : ; ' j _;_? �_� - �:_..�!-j��i -_;!► -_' -'--.j 'I'! -i� _II--' T_S.t`L�ci-i__�__'_!!_�_1=f 1 ,—I? fill JIM I i , , - l T_il 1_., , -i-� 1 t I 1_j r _�__�_l -I-;_1 I -'� - -I_I_ _I_ i { _!_! .I j1;1 r _ ; I ! I !_}- .j , -j .1___ 1I- .I_! ! i �.!� I� i :j1 ,_?��:,: _ _iJi_ ! ! .r_i I_ j-' I _� --- I�= .► ., _1- I �0x S0�: a -I ! I �_� ! i j I i: -i i -i I !-� - - _'- _i ..__; I ? ,_'= ! i i=i i � ! i"j ! I! h! t I t i t i_� -1 I_ I , I i ; I I I t i_, I I j -i- i- i _-� _ ► I i _ I i j I, - _ _l-I-�- !- _ I- =i - -- i - __ ! ' _I_j_I _=i ' 1-1-- _ -f f. l i I I I i I I ; I _� -� ! I ' -!-f r I -i- ; , I i:I i ? I i ! I ; ; i I , ' !! j I I_� 1 ' i i _BUTTE COUNTY -; , ; ,- i I ,I L®! NG ®EPARTMENI ,B -I_�_!_l _ I _I �_ I_ _I I •i I •_ • .:: ; , . ... � .. _' _ �_' i I;. i.I _i_.i I I_ -' ! ' i .[ + r I 1 r_, { I- - -I -�- - l_i" ; ' _ i i ! i ! _ _ , ; i ( - - - ' ' _ ;_I_} , ! , ; I , } _f � _f- .f--,-_ i I ► ,J t 1 � 1 !-;-i__1__1 ;-�i_i�_ -;-� -!__,� _.� _ _i i-; � � i_j-�-I �--f .� _�-! j I I - j _� _ I _}- i• �i- - I I i I� I I 1 l ; _ _ =1- ! ; _ f• i --j I� _- _; _� I� 1 � ��- C� I j I (� i -� j I i I i -� � -I j� -;j lila COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, CNiforniat95965 - Telephone 916/534-4541 APPLICATION AND PERMIT P MIT 31,,-26 N ASSESSOR PARCEL NUMBER 21-132-58 ZONING BUILDING PERMIT OWNER Travis & Nancy Powell TELEPHONE 846-6554 SO. FT. OCC. BUILDING VALUATION , OWNER'S MAILING ADDRESS 516 W. Liberty Rd. Gridley CONTRACTOR'S NAME BlankenshipPools TELEPHONE 671-2641 1st reneeal ermit CONTRACTOR'S MAILING ADDRESS 635 Lincoln Rd. , Yuba City 95991 Fireplace CONSTftfi&ON LENDER [] UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 37,25 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee Energy Plan Checking Fee E$. $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 47 25 PLUMBING PERMIT Filing Fee 10.00 516 W. Liberty Rd., Gridley Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other pri. pool SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installation❑ Other ❑ Describe work: _ ! 1st renewal of permit #788-85 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 CONTRACTORS LICENSE LAW I declare under pens t of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BusinesS and Professions Code and my license Is In full force and effect. 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- j ors. (Sec. 7044) j ❑ I am exempt under Sec. , Business and Professions Code for this eason Main service i00 AMP OR ORSLESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.d`` ,�2¢sgft OR AODNS. ( ACC. BLOGS. f NEW CONSTR. LOUT LET NO N•RESID BRANCH IR S 2.508a POWER APPARATUS S (SINGLE OUTLET CIR, I 20050t Ex. Occup(OUTLETS OR FIXTURES 5AL0AL030 FIXED Ex. Occup. OUTLETS ( R RESID IEA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �yirin 15.00 9 Permit Fee $ —YrWORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): i ❑ 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 1to 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 Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I 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 ( against said County in consequence of the granting of this permit. X ignature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An CISA permitis required forexcavations over 5'0" deep and demolition or Construct- on of s Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ 47.25 accu P. CONST:TYPc I I IrLoop PARCEL I PO ND 1990[ This permit is hereby issued under the applicable provi- sions 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 PERMIT EXPIRES Date 4-1-87 ! Receipt No. WHITE-D.P.W., YELLOW-ASSE990R. PINK -INSPECTOR, GOLD ENROO-APPL I CANT