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HomeMy WebLinkAbout022-210-045I 22- =1-45 _ Q GEORGE JANUARY F� n/IS /D 390 Cherry Blossom Lane, Gridley Permit#3548-84B(reroof/SF) l 022=21 .0':045 91-4079' CALLAWAY,, BILL!, CONT.R:" OWNER�� 384 CHERRY BLOSSOM LN, GRIDLEY ELEC SERV I CES/MH a -93 y?M''Ie..w°:..:"Li.' �'r`. `fF!'„,. r Y��� T9i -M ..r _...^.f..a-s..eFe•r t.4a� lsryrrr�.. � . g ivt�S:`?��:�':itt'�d' .':.;��'i}: �-�`S`"`"',it ?�f;.� •'^, , 'v�7d:�'.nnit;.,, S,( .My..{�,.. `,3'.v..,r�.- t+ ,r �. f 022-21-0-045 91-4079 CALLAWAY, BILL CONTR: OWNER A. { 384 CHERRY BLOSSOM LN, GRIDLEY ! ELEC SERVICES/MH ell • i i� • I COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT No. 7 County Center Drive - Oroville, California 95965 - Telephone: 916,'538-7541 91-4079 r APPLICATION AND PERMIT ASSESSOR PARCEL NUMBTR 22-21-45 zOr9NG - BUILDING PERMIT OWNER Bill Callaway TELEPHONEr- 868-5362 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS PO Box 513 Biggs CA 95917 CONTRACTOR'S NAME owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 384 Cherry Blossom Ln, Gridl Permit fee $ ' PLUMBING PERMIT FilingFee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP t Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE ASF [:1Duplex❑ Mobilehome� Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer Mobile Home S G W El TYPE OF WORK New F1 Addition Remodel❑ Utilities❑ InstallationE Other❑ Describe work: split main service to pump Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 18.50 B 200A OR LESS . Main service 200A TO IOOOA) 37.50 CONTRACTORS LICENSE LAW I declare under penalty 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- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.& 3.64sq.ft. OR ADDN5. (ACC. BLDGS. NEW CQN5TRESID, RANCHUTLET 5.00 NON•R ESID BRANCH CIRC ITS @ POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76 Ex. Occup. OUTLETS ((RESID )RE A.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. byirin g 15.00 S 15.00 Permit Fee $ 63.50 - WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I hay3,,placed on file with the County of Butte Building Department a C rtificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. a 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 FilingFee 15.00 Heating Cooling g Hood 6.50 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. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which4fiay in any way accrue against said County in consequenncce of the'grant.ng of'thi.s,permit. X -=`l �" f �' �` Date Signature of Applicant — V Owner . f contractor Agent ❑' An OSHA permit is required for excavations over 5'0" deep and demolition or construct - ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $`� 63• 50 , ! HAz DFEES IMP I FLOOD I CDF I PARCEL PD HD I ISSUE 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 have1been paid. DI EC R OF PUBLIC.WORKS ="; s. ! Date �J c♦�y/ BY P>RMIT EXPIRES Date.,-` 103324 Receipt No. WHITE-O.P.W.. YELLOW-ASSESSOR,(PINK-INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/536-7541 APPLICATION AND PERMIT PERMIT NO. 91-4079 ASSESSOR PARCEL NUMBER 22-21-45 ZONING 1 BUILDING PERMIT - OWNER Bill Callawa TELEPHONE 868-5362 SO. FT. OCC. BUILDING VALUATI OWNER'S MAILING ADDRESS PO Box513 Bi s CA 95917 CONTRACTOR'SNAME. owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER r UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$' Energy Plan Checking Fee$ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 384 Cherry Blossom Ln, Gridl Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 1 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex[] MobilehomeX2 Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑ Describe work: split main service to pump Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200V OR LESS 00AOR LESS 18.50 18,50 Main service 200ATO1000A) CONTRACTORS LICENSE LAW I declare under penalty 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- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. ( DWELLING OCCUPM OR ADONS. 1 ACC. BLDGS. _37.50 3.64 sq.ft. NEW CON5TR ULTI-OUTLET NON.RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS & (SINGLE OUTLET CIR. Ex. OCOup(OUTLETS OR FIXTURES 20 76 Ex. Occup. OUTLETS ED APPIRESID ILNS.REAJ I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. bYirin g 15.00 1 nn 15.00 Permit Fee $ 63.50 — 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 Filing Fee 15.00 Heating Cooling g Hood 6.50 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. 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 consey�ence of the granting of this permit. X {�. Date �/ Signature of Applicant — Owner ontractor E]Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct - ion of structures over 3 stories in height. Mobile Home Installation Fee S Ener Inspection Fee $ Energy P OCC CONST TYPE TOTAL FEE $ 63.50 HAz DFEES IMP FLOOD COF PARCEL PD HD ISSUE This permit is hereby issued under the Bions of the Butte County Code and/or work indicated above for which fees �CR OF PUBLIC BDateReceipt P MITE PIRate applicable provi- resolutions to do have been paid. WORKS103324 No. WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT t . COUNTY OF BUTTE - DkP.&RJMENT OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916%538-7541 PERMIT APPL16A14-DN DATA SHEET j / n LL Permit No.OWNER — � 4 ^w � A. P. o. 7. Z Proposed Building Use Building Inspector Date Pi"�r.;ryy / 77 At time o permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: 1. All items have been submitted. DATE RECEIVED APPROVED 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. Hazardous Material Form ............................................ 6. Energy Design Compliance and supporting documentation .......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions ................................... ................ . 10. Fees of $ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit . ....................... 16. Plot plan and business license approval from City of (see City for other requirements) ' 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (cons�lctpn_a pyal required prior to occupancy) — lam-` C___ Pre -Ins Pre -Inspection for required �� �% 21. ... BuildingeInspe torttc^ (Dite) Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ..... 24. Recorded copy of Agricultural Acknowledgment Statement ......... u, 25. Letter of signature authorization ................................... 26. 27. When yISSUe, the permit, process as follows: Mail toer. Mail to contractor. Telephone Ind hold for pickup at office. Deliver w/inspector. %SILL Other O �L W Z'� Applicant � .Date Copy of Hlaz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health.Dept. Fire Dept. Other Date By. 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_countereby - .date Contractor, designer, owner, was advised of above required data by —phone _maII—counter ¢y date Plans checked by Sets of plans on hold in Copy—DPW Date Plans approved by File -cabinet AP folder Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive'- OrovMe, Callfornla 85885 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL. NUMBER O — d O U Z NTN . BUILDING PERMIT OWNER - TELEPHONE fJGB-S�/a2 S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CON�AGTO�R S yA TELEPHONE CONTRACTOR'S M (LING ADDRESS Fireplace CONSTRUCTION LENDER - UNKNOWN Total Valuation is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee i S ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS r, c$ Permit fee PLUMBING PERMIT Filing Fee 15.00 ev Each Trap 5.001 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each pas water heater or vent 7.00 USE,OF STRUCTURE SF SF eS�`(, Other [I SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK Newt Addition ❑ Remodel ❑ hhU^,ti��lities Insall t�io/n❑ Other Describe work: (f"1-i� Iyl�f %� ��/V l �-� �% JM Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 18.50 Main service 200A TO t000A1 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): FlNON-RESID 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- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. ( DWELLING OCCUP.(ti\ 3.64sq.ft. OR ADDNS. ACC. BLDGS. // NEW CONSTRULTI.OUTLET @ 5.00 BRANCH CIRC ITS POWER APPARATUS & (SINGLE OUTLET CIR. 764 Ex. Occup( OUTLETS OR FIXTURES RAL. FIXED APPLN S.❑ Ex. Occup. OUTLETS RESID IREA.� I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. IYirin g 15.00 Permit Fee $ — 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 1 15.00 Heating Cooling Hood 6.50 Ventilation penult 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. 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. XDate Signature of Applicant — Owner ED Contractor [D Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures overstories in height. Mobile Home Installation Fee S Energy Inspection Fee $ OCC I CONST TYPE TOTAL FEE $ S� HAz I DFEES I IMP FLODD CDF I PA EL PD HD ISSUE 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 r33 Receipt No. > > �i'-i WHITE-D.P.W.. YELLOW-ASStSSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive;-groville, CA 95965 Phone: 916-538-7541'. OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. /1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) pe.� /2. I (have/have not) a' signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. J plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address . Phone Type of Work Signed: / Property Owner cx w Social Security umber Date // 9/ NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. PRE -INSPECTION OWNER: Z_ �– CA L4�A WA � DATE LOCATION : CONTRACTOR: �i%� ZONING ------- ---- — ' / ----------- - -----.,-Q PRE -INSPECTION FOR: e� fz- e� fiI14 It) / -------------- PERMIT HISTORY: _:jg-NONE TYPE OF OCCUPANCY BUILDING USAGE: TENNANT: AS FOLLOWS: DATE TO INSPECTOR o�� R -0o - e �3: S -V R FIELD - INFORMATION [� OCCUPIED [] HAS ELECTRIC HAS GAS [] HAS SANITATION FACILITIES [� HEATED -COOLED PERSON CONTACTED OTHER COMMENTS: ACTION -RECOMMENDED: I lJSUE [] OTHER: ' j HOLD FOR �3 G �a Permit#3548-84B George January, 390 Cherry Blossom Gridley P COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATIAON AN PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE ,SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home ISI GJWJ 10.00 e TYPE OF WORK New Addition❑ Remodel❑ utilities EJ Installation❑ Other ❑ Describe work: — Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 21/20sq ft CONTRACTORS LICENSE LAW I declare under penalty 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 ❑ 1, 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 CONSTR ULTI.OUTLET 2,50 ea NON-RESID BRANCH CIRCUITS) NEW NON -CONSTRESID, R SINGLE OUTLET CIRPOWER APPARATUS .&) & ( 20e50e Ex. Occup(OUTLETS OR FIXTURESSALO 30Q FIXED APLNS. EX. OCCup. OUTLETS P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 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. 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 against said County in consequence of the granting of this permit. XDate Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST, PARCEL PD MD 3suE 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 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT I COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS i rti 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPL'ICATWN`AND PERMIT • PERMIT //NO. dv� ASS ESSO PARCEL NUMBER •. — ZONING BUILDING PERMIT O WNE TELEPHONE SQ. FT. OCC. BUILDING VALUATION •sem OW 'S MAILING DRESS - 0 I CON RACTOR'S NIAME TEL PHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ^Q ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING AD R SS Permit fee $ BUILDING ADDRESS �'V^^ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 ' Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MA Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF U/buplex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home T_SGJ W 10-00e TYPE OF WORK New ❑ Additio Remode U I lities ❑ Instal ation❑ Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1000V OR 0 AMP ORLESS10.00 - Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ACDNS. ACC. BLDGS. 2h�SQft CONTRACTORS LICENSE LAW I declare under penalty 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) l] 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 CONSTR ULTI-OUTLET 2.50 ea NON•RESID BRANCH CIRC ITS NONNEW CONSTD. SINGLE OUTLET CIRR POWER APPARATUS .&) .RESI . ExOccu zoesoa . P�OUTLETS OR FIXTURES BAL®30 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA./ `` 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ 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 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 County of 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 aid County in consequence of the granting of this permit. ,�^,F_ �L X Dater Signature of ppIi — Owner Contractor ❑ Agent ❑ r An OSHA permit is required for excovations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST, PARCEL PD HD IssuE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which CT OF PUBLIC By.yDate PERMIT EXPIRES D to 1 I. — the applicable provi- resolutions to do fees have been paid. WORKS �— Y K1 —4= Receipt NO. -3%�A 2 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT