HomeMy WebLinkAbout022-340-010I
22-34-10
-ROBERT HENDERSON
456 Justeson Rd, Gridley
Per it#2940-81B(reroof/SF)
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22-34-10
Permit # 2620-82B(woodstove/SF)
contr: Sunway B1drs,Oroville
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22-34-10
EPErmit#
ntr: cas
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01 022-340-010 QI�NALED
HENDERSON, ROBERT 456 JUSTESON RDN, GRIDLEYCont: OWNER
REPLACE WTR HTR 4
0
SKIDMORE, Waine 713-67B
594-67E
� 120 0 -
Lot,$, Justeson Ave., J nsen Sub., Gridleyl
(new single family) ,
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a
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WEBSITE: www.buttecounty.netldds
LICENSED CONTRACTORS DECLARATION
1 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 in full force and
effect.
License Class: License Number:
Date: Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law. for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
EJJ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' Stale License Law.).
❑ I am Exempt under Article�.c�tsiness�d Pr, ass ons Code
Date: Owner: 1
WORKERS' COMPENSATION DECLARATION
I 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.
PERMIT NO.
BP040854
Issued Date: 03/29/2004 APN: 022-340-010-000
Site Address: 456 JUSTESON RD GRI
Map Index:
Description: REPLACE WATER HEATER
Owner: HENDERSON ROBERT N & NANCY J
456 JUSTESON ROAD
GRIDLEY, CA
95948
3 �f�
Applicant: HENDERSON ROBERT N & NANCY J
t
Contractor:
License #:
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of 1 Architect:
the work for which this permit is issued. My workers' compensation Engineer:
insurance carrier and policy number are:
Carrier:
Policy #:
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 workers' compensation laws of California,
1 and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply wit those provisions.
Date: /^Z 6 y, i
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
456 JUSTESON ROAD
GRIDLEY, CA
95948
s- •.
Total Square Ft: 0 S.F
Valuation: $0.00
Census Code:
cn
CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the Resolutiqnq to do work inMtedaboforwhich fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.) Q
Name: B • Date:
Address: PERMIT EXPIRES ON:
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. 1 hereby
authorize represe as of Butte County to nter upon the above mentioned property for inspection pu
Print NBE�t'T � ✓G�/�y Signaturj7,4
ame: M. d
Date:.3�>/U
❑ Owner 0 Contractor I ❑ Agent for Owner
❑ Agent for Contractor
COUNTY OF BUTTE w
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
` CORRECTION NOTICE
Off
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice this office when correction of work is
r completed. If you have any questions pertaining to this matter, or need additional explanation,
4 please contact this office immediately.
["'U
n= _
;k;
44z 4
Date 7- G rG
REV 10/92
specfo
Date 7- G rG
REV 10/92
specfo
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netWds
PERMIT NO.
BP040854
LICENSED CONTRACTORS 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
Issued Date: 03/29/2004 APN: 022-340-010-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:
Site Address: 456 JUSTESON RD GRI
Date: Contractor:
Map Index:
Description: REPLACE WATER HEATER 1
OWNER-BUILDERDECLARATION
I hereby affirm under penaltyenaltyoffperjury that I am exempt from the
,
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
HENDERSON ROBERT N &NANCY J
permit to construct, alter, improve, demolish, or repair any structure, prior
Owner:
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
456 JUSTESON ROAD
the Contractor's State License Law (Chapter 9 commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
GRIDLEY, CA
she is exempt therefrom and the basis for the alleged exemption. Any
95948
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
Applicant.. HENDERSON ROBERT N &NANCY J
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
456 JUSTESON ROAD
year of completion, the owner -builder will have the burden of
GRIDLEY, CA
proving that he or she did not build or improve for the purpose of
95948
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor:
❑ I am Exempt under Article th Business a d Pr essions Code
`y
Date: '=y Owner:IV
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -insure for
License #:
workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
Engineer:
insurance carrier and policy number are:
Carrier:
Total Square Ft: 0 S. F.
Policy #:
I certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
Census Code:
and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply wit those provisions.
Date:
rr��
�V
Applicant:
WARNING: Failure to secure workers' compensation coverage is
, (J�
57T.
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable provisions of the Butte County Code and/or
'I hereby affirm that there is a construction lending agency for the
Resolutio s o do work in 'c ted ab for ich fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
O
Name:
By ate:
PERMIT EXPIRES ON:
Dat
Address:
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project.
❑ Attached'are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby
authorize represe es of Butte County to nter upon the above mentioned property for inspection pu
Print Name: QB��2.T lilJFir'�J?iiiJ Signatur�.
Date: 39,0 t%
0 Owner 0 Contractor 0 Agent for Owner ❑ Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHIC O)
OFFICE #: (530) 538-7541
PERMIT NO.
BP
(34dK5�
DATE:
APN:O� V
ZONING:
OWNER'S LAST NAME:
O ER'S FIRST NAME:
PHONE
STREET AD RESS: -
FAX.
CITY, ZIP:
E-MAIL:
SITE ADDRESS: S
CITY, ZIP:
NEAREST CROSS STREET:
TRACT/LOT P
APPLICANT NAME:
PHONE:
STREET ADDRESS:
FAX.
CITY, ZIP:
E-MAIL:
CONTRACTOR NAME:
PHONE:
STREET ADDRESS:
FAX
CITY, ZIP:
E-MAIL'
LICENSE NUMBER:
LICENSE TYPE:
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX
CITY, ZIP:
LICENSE NUMBER:
E-MAIL'
DESCRIPTION OR SCOPE OF WORK:
❑ Structure Built without permits
❑ Proposed Change of Occupancy (note previous use)
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after the date of application. In order to renew
action on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to
the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan
checked and other department costs are not refundable.
For office use only:
Notes:
Application Received by: Date:
Receipt number: 515P—a Amount Received �� ��
O.B.-1
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.*
I personally plan to provide the major labor and materials for construction of the proposed
property improvement: YES 'O" NO 0
I HAVE X HAVE NOT ❑ signed an application for a building permit for the proposed work
I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: may:
PHONE: CON'TRACTOR'S LICENSE NO. .
4. I 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: CONTRACTOR'S LICENSE NO.
5. 1 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:
PROPERTYOWNER:5
SD
DA
NOTE.
This Owner -Builder Verification is required by Section 19531 and 19532 of the
California Health and Safety Code. This verification must be completed and
returned to our office before we are permitted to issue the permit.
OVER
I OWNER BUILDER INFORMATION
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such
a permit Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business
license from the city or county. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should
be aware of the following information for your benefit and protection:
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
rely,
A/%%�
M I C. Vi ira, C.B.O.
er, Building Inspection
NOTE: Ibis Owna Builder Information is required by Secxion 19830 of the California Health and Safety Code,
OVER
J
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE i
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
ASSESSOR PA EL UMB
ZO
a
BUILDING PERMIT
OWNERo
V
TEL PHON
SO. FT. O C. BUILDING VALUATION
- I�i �.Sg 1L (/
OWNER'S MAILING ADORE q,
2.50 ea
CONTRALTO AME
r
TELCP(7NE
EX. Occup(OUTLETS OR FIXTURES
zDssoe
SALO 30
CONT ACTOR'S MAILIN DDRESS
Ov R-5
Fireplace
CONSTRUCTION LENDER
UNKNOWN
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
' I
Penalty $
nalJVrmIt
BUILDING ADDRESS
S �cS Q 4V
fee $
PLUMBING PERMIT Filing Fee 10.00
Ea Trap 2.00
r or heat pump water heater 20.00
LOT NO.
SUBDIVISION NAME
JPAnEL AP
ter piping 5.00
actgas water heater or vent 5.00
USE OF STRUCTURE
SFJ Duplex❑ Mobilehome❑ Other
I SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 5.00
Mobile Home S I G I W 0.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation Other
Describe work:
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
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.
ISI 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.
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.
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
a Co ty in co zlue a of the granting of this permit.
X=11 W_,/1f"iLY/ Date
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.
Receipt NU 14Y_ a 70C-4 ) //
WHITE-O.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
Permit Fee $
Contractor
I
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADO'L 100 AMP
2.50
NEW CONST. / DWELLING OCCUP.y\
OR ADONS. l ACC. BLDGS. I
- I�i �.Sg 1L (/
NEW CONSTRI.OUTLET
NON.RESID BRANCH CIRC TS
2.50 ea
POWER APPARATUS e
SINGLE OUTLET CIR.
EX. Occup(OUTLETS OR FIXTURES
zDssoe
SALO 30
FIXEAPLNS
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 Filing Fee 10.00
Hestina
Cooling
Hood 3.00
Ventilation
Permit Fee $
Mobile Home Installation Fee $
Energy Inspection Fee $ , (J
TOTAL PERMIT FEE $ ,� /�%< .5Z
)CCUP-1 CONST.TYP�NO L FLOODI PARCEL ND 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 have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
.r .� .. ,. t ... y /. ,�. �. .- wh: s 1.:t7R7r°� n •* .! i ? ., a� ( JP+�' Vt f�(;
_- j)'COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
"' ry 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATfON'DATA SHEET
Permit No.
OWNER /�/o4�U A. No.
Proposed Building Use dy, Building Inspector 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.
3.
4.
5.
�6.
7
8.
9.
L-'10.
11,
12.
13.
-14.
_ 15,
16.
All items havebeen-submitted. . . . . . . . . . . .
Plot plans i duplicate tri licate, signed by preparer of plans. _
Complete plans duplicat. /triplicate, signed by preparer of plans.
Complete engineered plans and calcs, with wet signature on plans.
Plans with Energy Design Compliance Statement. . . . . .
Y5 School District "Fees Paid" Stamp on Floor Plan.
Statement of Inten for Non -Heated and AC Buildings.
Fees of $ ��o• o�S� .
Letter of signature authorization. . . . . . . .
Sanitation approval fromUQ111-e_- Health Dept. r
Planning approval for (A) Use: (B) Parking:
Certificate of Workmen's Compensation Insurance. . . . . .
Contractor's License Information (no., name style, classif.)
Owner -Builder Verification (Given to owner❑, Mail to owner ❑ )
Improvements may be required. ,
Mobilehome Installation Data. . . . . . . . .
Pre-Inspec.request to
Required. Building Inspector
17. Pre -Inspection for_._..-__ _
18.
19.
20.
21.
22.
Recorded copy of Agricultural Acknowledgment Statement.
Driveway Permit.
Plot plan approval from city of
I
(Dote)
k
When you issue th p rrmit, pros ss as follows: Mail to owner; Mail to contractor_
Telephone_L1- and hold for pickup a@-40—office, Deliver w/inspector.
Other
Applicant/ 1/ate 7
Copy of plans sent Health Dept.; Fire Dept., Other Date
The following data must be submitted prior to permit 4ssuaye:r( rcle new item not checked above).
1. Index permit for above items No. Z • (P�—T ---
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone _--nail—counter by date
Contractor, designer, owner, was advised c? above required data by—phone —ma il—counter by date
Plans checked by
Copy—DPW
Date Plans approved by
Sets of plans on hold in File cabinet AP folder
Date
J
K
{
T N0. 2940-81B
ERMI
P
PERMIT EXPIRES
I
OWNER ROBERT HENDERSON
CONTR. owner
ASSESSOR PARCEL . 22-34-10
LOCATION 456 Justeson Rd, Gridley
I ,
I
Temp. Power Pole_
Called PG&E
Temp. Elec. Service_
Called PG&E_
Temp. Gas Service _
Cal led PG&E
JOB FINA D (Date) _
Signature
i
V=OK
0 = Not OK
- = Not Applicable MOBILEHOMES
= Not Ready
MISCELLANEOUS
Date
MOBILEHOME UTILITIES '(Plans) OK except H's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except k'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.-Con nec.-Shthg. -Rig.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
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
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date
POOLS (Plans) OK except p's
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector y
3. 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
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6; Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enc losures- Pane lboards- Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Date Card -BI Date
Card -BI
-Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
J = OK
0 = Not OK
- = Not Applicable RESIDENTIAL, (Si
�E = Not Ready
Date
UNDERFLOOR Plans OK except H's
48.
1. Zoning requirements -Setbacks -Easements
58.
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
In Garage; Above Floor-Ducts-Mech. Protection
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
60.
4.
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
Elec. Trim & Subpanel; Breaker Sizes -Labels
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
53.
7.
Piers -Fireplace Ftg.-Steel
54.
8.
D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
55.
9. Gas Pipe; Size -Anchors
10.
Water Pipe; Test -Anchors -Regulator -Service 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
Date Card -BI Date
PLUMBING (Permit) OK except q's
14. Water Ht.; Vent -Access -Combustion Air
15. Water Pipe; Test & Anchors -Nail Protection
Date Card -BI Date
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
17.
Shower Pan; Test, First Floor -Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
19.
Gas Pipe; Size & Anchors --
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
_Date
ELECTRICAL (Permit) OK except f1's
20.
Fixture & Transformer Clearance -Ins. Protection
21.
Elec. Receptacles Spacing -Lights & Switches at Doors
22.
Size Boxes & No. of Conductors -Stapled
23.
Romex Installed Close to Edge of Studs & C.J.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
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 El No
28.
Service -Riser Conductors & Ground -Main Disconnect
29.
Equip. Clearances; Panels-Motors-Mech. Equip.
30.
Clothes Closet Light -Shower Light
Card B -I
Date Card -BI Date
Card B -I
Date Card -BI Date
Date
MECHANICAL (Permit) OK except q's
31.
A.C. Ducts; Insulation & Support
32.
Vent Fan; Exhaust above Insulation
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
Date
FRAMING(Plans) OK except q's
36.
Sills; Proper Material & Anchors
37.
Studs -Nailing, Spacing & Bracing -Plates -Sound
_
38.
39.
_Walls;
Bearing Walls over Girders & Floor Nailing
Draft Stop in Walls (rat proof)
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
_40.
41.
Header & Beam -Size & Bearing
42.
43.
44.
Hangers -Post Caps -Anchors -Connectors
Cl ng-. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Ring.
Fireplace Ties or Type A Flue -Fireplace Throat
45.
46.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
_
47.
Garage Fire Protection Framing
ngle and Duplex)
Date
FRAMING (Continued)
Ext. Steps -Door & Sidelight Protection -Landings
48.
Property Line Firewall & Openings
58.
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
In Garage; Above Floor-Ducts-Mech. Protection
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
60.
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Elec. Trim & Subpanel; Breaker Sizes -Labels
52.
Siding -Nailing -Veneer
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
54.
Glazing Area -Glass Protection -Skylights -Plastic
55.
Shear Walls; Nailing -Bolts
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date FINAL (Plans) OK except k's
56.
Ext. Steps -Door & Sidelight Protection -Landings
57.
Smoke Detector
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
59.
Bedroom Exiting
60.
G.F.I. & Bath Fixtures & Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
62.
Stairs & Rails
63. Fireplace or Stove; Clearances -Hearth
64. Elec. Outlets at Wood Panel; Int. & Ext.
65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
66. Elec. Outlets & Receptacles at Kit. Counter
67. Garage Fire Door; Swing -Landing -Closer
68. A.C. Duct in Garage -Damper
69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
70. Plb., Elec. & Mech. Equip. Listed for Location
71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
72. Insulation -Foam -Looked in Attic ❑Yes
73. Guard Rails & Deck Construction -Post Caps
74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
76. Stucco; Brown -Finish
77. A.C. Unit; Disconnect-Cirnces-Brkr. & Cond. Size -115V Outlet
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
81. Ventilation throughout House
82. Glass Protection _
83. Corrections from Previous Inspections
84. Gas Test -Meters Tagged; Gas -Electric
85. Water & Sewer Connected -C/O to Grade -HD Approval
86. Energy Compliance Certificate -Other Certificates
f
f31 ate and -BI Date
ard-BI Date Card -BI Date
ard-BI Date Card -BI Date
Comments at Final:
(NOTE: Anentry must be made each time you visit job site)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P R NO. /
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 --�
APPLICATION AND PERMIT
ZONING
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGINEER
OcC2 -
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Sgt °J uS' hos.-_ i /r./,
LOT NO. I SUBDIVISION. NAME I PARCEL MAP
USE OF STRUCTURE
SFX Duplex ❑ Mobi lehome ❑ Other
SPECIFY
TYPE OF WORK
New ❑ Addition ❑ e del Uti ' ies ❑ Installation ❑ Other,
Describe work:Dd
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El 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)
Fireplace '
ELECTRICAL PERMIT
BUILDING PERMIT
OWNERCJ1
o ,e
-e evsati
ITELEPHONE
6-Z/3
SO. FT. OCC. BUILDING VALUATION
o
OWNER'S MAILIN ADD
P �
S
ES
� •
Plan Checking Fee
CONTRACTOR'S NAME
�� ♦
TELEPHO
$
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGINEER
OcC2 -
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Sgt °J uS' hos.-_ i /r./,
LOT NO. I SUBDIVISION. NAME I PARCEL MAP
USE OF STRUCTURE
SFX Duplex ❑ Mobi lehome ❑ Other
SPECIFY
TYPE OF WORK
New ❑ Addition ❑ e del Uti ' ies ❑ Installation ❑ Other,
Describe work:Dd
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El 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)
Fireplace '
ELECTRICAL PERMIT
Total Valuation $ l
Main service 6101 OR LESS
100 AMP OR LESS
5.00
Filing Fee
$
10.00
Permit Fee
$
,�''j.00
Plan Checking Fee
$
Ex. OCCUp OUTLETS OR FIXTURES
Penalty
$
2.00
Permit fee
$
6,00
PLUMBING PERMIT
Filing Fee
10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
Building sewer
Lawn sprinkler system
5.00
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Fi)ingFee 10.00
Main service 6101 OR LESS
100 AMP OR LESS
5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.y\
OR ADONS. ACC. BLDGS.
2�sgft
NEW CONSTR I.OUTLET
NON -RES,., CIRCUITS)
2,50 ea
NEW CONSTR (POWER APPARATUS &I
'NON-RESID. SINGLE OUTLET CIR.
permit Fee
Ex. OCCUp OUTLETS OR FIXTURES
BAL@;
EX. (FIXED APPLNS. OR -
OCCU
Ex. (RESID.) EA.
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
7.50
❑ I am exempt under Sec. , Business and Professions Code Permit Fee
for this reason Contractor
WORKMEN'S COMPENSATION INSURANCE MECHANICAL PERMIT
I d la d e It f e' r ( h k Heating
ec re un er p n y o p rlu y c ec one).
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
Cooling
a Certificate of Workmen's Compensation Insurance or a Certificate
Hood
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
Ventilation
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
permit Fee
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked. Contractor
Filing Fee 1 10.00
3.00
1 certify that I have read this application and state that the above information Mobile Home Installation Fee $
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. TOTAL PERMIT FEE $ 00
1 also agree to save, indemnify and keep harmless the County of Butte against OCCUP. GROUP I TYPE OF CONST, PARCEL PD I ND I IS5U
all liabilities, judgments, costs, and expenses which may in any way accrue W-1
against said County in consequence of the granting of this permit.
This permit is hereby issued under the applicable provi-
X Date sions of the Butte County Code and/or resolutions to do
Signature of Ap li ant — Owner Contractor ❑ Agent ❑ work indicated above for which fees have been paid.
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-` O 1 O OF PUBLIC WORKS /
ion of structures over 3 stories in height.
(y — '-49
Receipt No. � � � ByL� ate �Z
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT PERMIT EXPIRES ate
.:fi.�.r ..� •rte. ��-T.r '»s_. -_r . ,}r C.� .. �l7'a. _. ..}-:�"-'. Fi,�--µ-,. .' .1 .��. _ � r �1
p .n
4 Y
4
{
� 1
r
k
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICA 10WAND PERMIT
ASSESSOR PARCEL NUMBER ZONING
BUILDING PERMIT
OWNER TELEPHONE S0. FT. I OCC.1 BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGINEER
ARCHITECT OR ENGINEER'S MAILING ADDRESS
T NO. I SUBDIVISION NAME
UNKNOWN
PARCEL MAP
USE OF STRUCTURE
SF ❑_' Duplex ❑ Mob! Iehome ❑ Other
SPECIFY
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe work:
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)
Fireplace
'
Total Valuation $
Filing Fee 10.00
Filing Fee
$ 10.00
Permit Fee
$
Plan Checking Fee
$
Penalty
$
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
15.00
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
Mobile Home Installation Fee
Building sewer
Lawn sprinkler system
5.00
Permit Fee
$
Contractor
Permit Fee
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 1100V OR LESS
100 AMP OR LESS
5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. ( DWELLING OCCUP.y\
OR ADDNS. \ ACC. BLDGS. I
2C Sq ft
NEW CONSTR MULTI -OUTLET
LET
NON.R ESID BRANCH CIRC ITS
2,50 ea
NEW CONSTR POWER APPARATUS 9
NON- lRESID. SINGLE OUTLET CIR,
EX. OCCUROUTLETS OR FIXTURES
BAL@;
IXED APPLNS. OR
EX. OCCU p.(OUTLETS (RESID.) EA.
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
7.50
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 County of
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.
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
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Permit Fee
$
Contractor
MECHANICAL PERMIT
Filing Fee 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
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 County of
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.
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.
I
PARCEL
'7
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
Q1REC OR OF PUBLIC
By ✓ „= ,� 4 -
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
r ..
a " COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751 `
7 County Center Drive, Orovi Ile — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE
BUILDING OR PROPERTY ADDRESS
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.
- Y
Inspector-/j/0"1�&Ifzlv'��
ir c%pate7�
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION'AND'PERMIT
PERMIT NO.
z6 -SZ.
ASSESSOR PARC L NUMBER
22 f
ZONING
BUILDING PJF6MIT
U
HZ�
SQ. FT. 0 C. V61LDING VALUATION
OWNER'S MAILING ADDRESS
- ^ _
C O T R A � 1•+0 / AMIE ^aING
(/,�K//�'c
T J O II,E
�l 5�/
C�94,VR ' S M A(r{/�W {�/ ✓
LVA O,eo f//LLC
Fireplace_
C2 e) O o v
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
(4000,60
(4000 X60
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ /�,OO
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ koc?
BUILD N^ADDRESS^
_
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
vLL��
Water piping
LOT NO. SUBDIVISION NAME PARC f- MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
-,� USE OF STRUCTURE
SFR Duplex❑ Mobilehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New❑ Add itions❑ Remodel❑ Utilities El Installation❑ Oiher
Describe work: IX ��L %i�'O� gu �NCi
��✓�
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP ORSLESS
5.00
'
Main service EA. ADD'L 100 AMP
2:50
NEW CONST. DWELLING OCCUP.sj)
OR ADDNS. ACC. BLDGS.
2Q Sq ft
CONTRACTORS LICENSE LAW
I declareunder penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the'Businessso
and Professio. a and my license is in to 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 cONSTR .Ou LET 2,50 ea
NON.R ESID BRANCH CIRC ITS
NEW CONSTR. (POWER APPARATUS e\
NON-RESID. `SINGLE OUTLET CIR. 1
@ 250
EX. Occup( OUTLETS OR FIXTURES BAL01
EX. OCCUp.�OUTLE TS (RESID )REA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑7hipermit is for $100.00 (valuation) or less.
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 County of
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 liab' ' j gm nts, costs, and expenses which may in any way accrue
ag ins i n i c nsequence of the granting of this per it.
X Date •
Signature of Applicant — Ow e,❑ ContractorEl, Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structuress/over 33 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $,aCU
OCCUP. GROUP
I TYPE OF CONST.
I
PARCEL
PD
I NO
I ISSUE
This pe i is hereby issued under
sions t e Butte Co ty Code and/or
work nd ed abfor which
R OR OF PUBLIC
BY
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
�/ a �^
Date'? r(�
—/�v
Receipt No. /
WHITE-D.P.W., YELLOW -AS ESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT