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HomeMy WebLinkAbout022-340-014AP 22-34-14. 'ANDERSON & BIHL n/s Juste son Ave., 4 mi. W. of W. Biggs Gridley Hwy, lot 12, Gridley Perit## 4404-75B(new - CONTR: Gridle-y P1=nmbing & Heatinc Permit #4612-75P ( for #4404=:75) r 22-34-14 CONTR: Cody's Elec., Paradise. Permit #4861-75E(eec, only for '_eF75 it404-75) 22-34-14 eem's A/C & Hting, Oro. 784-7a-{1fo=<permit-- #4404-175)%//1�1 / 5 022-3'10.014 fi� 5 -, ow De "2�-o-014+cson k0ad 6681-ty. F & ! �j, a AP 22-34-14. 'ANDERSON & BIHL n/s Juste son Ave., 4 mi. W. of W. Biggs Gridley Hwy, lot 12, Gridley Perit## 4404-75B(new - CONTR: Gridle-y P1=nmbing & Heatinc Permit #4612-75P ( for #4404=:75) r 22-34-14 CONTR: Cody's Elec., Paradise. Permit #4861-75E(eec, only for '_eF75 it404-75) 22-34-14 eem's A/C & Hting, Oro. 784-7a-{1fo=<permit-- #4404-175)%//1�1 / 5 022-3'10.014 fi� 5 -, ow De "2�-o-014+cson k0ad 6681-ty. F & ! �j, 6 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds Y9, PROJECT INFORMATION Site Address: 480 JUSTESON RD Owner: Permit No: B08-1835 APN: 022-340-014 DIN, HENRY F & BETTY J Permit type: MISCELLANEOUS 480 JUSTESON ROAD Issued Date: 09/08/2008 By KCG Subtype: Re -Roof GRIDLEY, CA 95948 Expiration Date: 09/08/2009 Description: RE -ROOF (25 SQ) (530) 846-5744 Occupancy: Zoning: SR1 BILL'S ROOFING BILL'S ROOFING Building Garage RemdUAddn 1770 KOFFORD RD 1770 KOFFORD RD GRIDLEY, CA 95948 GRIDLEY, CA 95948 Other Porch/Patio Total (530) 846-3981 (530) 846-3981 ` ,5 FE P. E INFORMATION DBMSC Re -Roofing $147.50 KLICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires BILL'S ROOFING 801512 / C39 / 11/30/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Di 'sion 3 of the Business and Professions Code, and my license is in full force and effect. eX =zj lov 2, 09/08/2008 Signature: Date 1;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 WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Wf HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; X Carrier: State Fund Policy Number: 238-0004005 Exp. 0,102/01112008(This section need not be completed if the permit is tor one hund�llars ($100) or es—f s.) 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I. // / 09/08/2008 Signature - Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lender's Address City State Zip Total Charged: $147.50 Fees Paid: Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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]; Please check one of the following: ❑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 Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 improvement is sold within one year of completion, the owner -builder will have the burden of proof 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 Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ElI AM EXEMPT under Section B. & P.C. for this Owner's Signature 09/08/2008 Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above me)tioned property for inspection purposes. I hereby certify that I am the propen"wndr oram authoWed to aCt on the property owners beValf. A E Owner 4 Contractor OR; Agent for Owner ❑Agent for Contractor T DT or COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION" OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. UD ` BIN # "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is'subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Last Name % First Name Mailing Address D 0 City S at Zip S r� Phone Fax E-mail APPLICANT INFORMATION CONTRACTOR Name Ll Address D City 2Z -// ce StateZ Zip S Phone �` �' Fax E-mail E mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Fax E mail State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail PLICA T S/ NATURE X PROJECT LOCATION AP# Ulan - O.OIA vkw 004- 2180-01 Property Address City WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than licensed contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTIO OR SCOPE OF WORK: �d D S Scl FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. Type Const. PERMIT NO. 440 t P E M MH UTIL. 'PERMIT NO. - ► PERMIT EXPIRES r OWNER Anderson & Bin CONTR.- LOCATION ONTR.LOCATION (A.P. 22-34-14 ) P n/s- Justeson Ave., 4 mi. W. of W. Biggs Gridley ` Rd., lot 12, Gridley .t' i t , Temp. Power Poled Called PG&E Temp. Elea Serv. Called PG&E Temp. s Serv. —� s/FINALED Iled PG&E �%U J f ( t i 9 nature) ( I�, -- THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT REGULA- ' TIONS, CALIFORNIA ADMINISTRATIVE CODE, JITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: J Street Lot Number Tract No. EXTERIOR WALLS < Manufacturer ��- Thickness/Type R Value. CEILINGS, ,t Batts: Manufacture r?✓5�� Thickness R Value Blown: Manufacturer Thickness No. Bags Wt./Bag Sq. Ft. Covered R Value _— "FLOORS • FLOORS Manufacturer Thickness/Type R Value SLAB ON GRADE Manufacturer Thickness/Type R Value Width of Insulation ' --inches FOUNDATION WALLS GENERAL BY. Thickness/Type R Value LICENSE No. 3 a - "//z/ 3� TITLE — DATE INSULATION CONTRACTOR: HAWKIN'S INSULATION CO. LICENSE No. 215-925 BY L / _ TITLEO 6�...-f-� DATE %�'/% 5 r COUNTY OF BUTTE, DEPARTMENT OF PUBLIC WORKS BUILDIN6fINSPECTION RECORD 924 BUILDING BUILDING (Cont'd) PLUMBING Setback 5 Firewalls Soil Piping Forms Parapets 1st Floor -�-__ Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd F Sternwaill Siding To out Slab Roof SheathinWater Pi in Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin ra a Vents Water Htr.0-91-11 Stemwall Prov. for physically Heaters Slab handicapped Appliances Carport Conformance of ex. Gas Piping & Tes Footings structure Temp. Gas`�-- Slab Final J " Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framin Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heatin Service Brown Coolin Temp. Pole Finish Ducts Underground Interior Lath Ventilati - Permanent Door Closer.,1113_7A'`` Final � Final DATE REMARKS OR CORRECTIONS f� G� / / ,� 3 _"7 -J • COUNTY OF BUTTE — DEPARNENT OF PUBLIC W K 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT !� BUILDING' Owner SQ. FT. OCC. BUILDING VALUATION 91f0 Mailing Address 7�/ j�� _ �' ,rfJX .7- //, '7:)— ,4% L I _c t r i Contractor Mai I ing Address Building Address vUJ epnon A— ' elephone No. A. P. No. � — Zoning & Planning F Akl-' Sa i tion Fire Dept. Fire Zone Use Permit EOA I Parking I ParcelA� 60' R/W I Improvements Plans Declaration .�u�ry 11y" p r 'Brd--'Isf KVec_'d . `I Parcel oval Pi-e�s Approval NEW 10 ADDITION ❑ UTILITIES ❑ OTHER ❑ Single Family Duplex ❑ Mobil Home ❑ Others ❑ CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of:� License No.2 [2 7 - C% )Classification I am exempt from the Contractors License Laws of the State of California. WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability Xl rkmen's Compensation. have placed on file with the County of Butte a certificate of orkmen's Compensation Insurance. I certify that in the performance of the work for which this permit .is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. 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. X �Date' �J -' Signature of Permitee or Agent Receipt No.��— White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Fireplace Total Valuation a :;l,— Permit Fee Plan Checking Fee &/or Penalty Permit Fee PLUMBING No. PERMIT FILING FEE Each Trap Repair drainage or vent piping Water piping Each gas water heater or vent Gas piping system 1 - 5 outlets Each additional outlet Building sewer Lawn sprinkler system Permit Fee ELECTRICAL PERMIT FILING FEE Main service incl. 1 meter Additional meters, each Sub -panel (12 or less) (more than 12) Range, Cook -top or Oven Water Heater or Space Heater Light fixtures Receps:, switches & fix outlets Hood, Ex. Fan or F.A. Furn. Motor Evap. cooler, gar. disp. or D.W. Air conditioner or heat pump Water pump Mobil Home Facilities Temp. Power Pole Misc. wiring @ $3.00 1.50 1.50 1.50 1.50 1.50 .30 5.00 2.00 ;- FEE @ FEE $3.00 1.00 1.00 1.00 2u la 2 0,1010 1.00 1.00 5.00 5.00 1 Permit Fee $ MECHANICAL No. @ I FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ TOTAL PERMIT FEE $ a This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OFP LIC WORKS ;��ilding Date permit expires Date ° 17 �s COUNTY OF BUTTE — DEPARUENT OF PUBLIC WORKS 7 County Center Drive – Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT �� / Z -- -7J ' v/ authorize representatives of the C unty of Butte to enter upon.the This permit is hereby issued under the applicable provisions of above-mentione property for insp, c 'on purposes. the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. X. 4ate—/a->`s DIRECTOR 0 PUBLIC WORKS �ture of Permitee or Agent v1r� By Date-2!�d Reci3ipNo. White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit ex'plres-Bate BUILDING Owner P4 SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee P I an Checki ng Fee &/or Penalty tTel one No. Permit Fee a Building Address l �j►tti• PLUMBING No. @ FEE PERMIT FILING FEE $3.00 y�oa Each Trap1.50 /-7,-00 op Repair drainage or vent piping 1.50 Water piping 1.50 Z. Each gas waterAwarCer or vent 1.50 A. P. No. Z Z-- –3V—/4/ Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fok4W<Sametata n I Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Ma P 60' R/W Improvements_Lawn sprinkler system 2.00 '& P`Rgc.'d Parcel Approval Plans Approval Permit Fee NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter -,:211–.7S Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) – Single Family 5rDuplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures b 2 d E Receps„ switches & fix outlets bm 'a J n CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business p&P fes Code under the name style9fq Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar, disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. Classification Misc. wiring— ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Wor en's Compensation. have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit ,is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ authorize representatives of the C unty of Butte to enter upon.the This permit is hereby issued under the applicable provisions of above-mentione property for insp, c 'on purposes. the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. X. 4ate—/a->`s DIRECTOR 0 PUBLIC WORKS �ture of Permitee or Agent v1r� By Date-2!�d Reci3ipNo. White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit ex'plres-Bate V .. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Orovi lie, California 95965 lJ l0 Telephone: 534-4541 APPLICATION AND PERMIT X Date 3gnat a of Permit ece' o. ite-D.P.W. _ Yel ssessor — Pink -Inspector — Goldenrod -Applicant DIRECTOR OF PUBLIC WORKS c By Date SMIUMig-permit.0"Fes Date BUILDING OwnerN LS{Q$0,1 ' �f NL SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor © S t;1� ^-, Total Valuation Mailing Address/PO, 00 1734, Permit Fee Plan Checking Fee &/or Penalty f�.� elephon , o irf4- Permit Fee Building Address J 0 S -r Oy1 AUS X !99 / PLUMBING No. @ FEE PERMIT FILING FEE $3.00 of 0 P, f 06 -k 41C r Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. - `l�, Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F W. Saftitertirnr I Fire Dept. FireZone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Map' P. R/W Improvements p ovements Lawn sprinkler system 2.00 Parcel Approval Plans Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHERELECTRICAL No. @ FEE PERMIT FILING FEE $3.00— �! C/,&CTS G < 2 t; � !T /'` Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 ams) (more than 12) - Single Family,n Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures t4b.11@2 �� s., swVq7es & fix pfets-- CONTRACTORS LICENSE LAW I am licensed under the,provisions of Chapter 9, Div. 3, of the State of California Business & Profe sions Code under the name style of: C Ho d, Ex. Fan or F.A. Fur . Motor 1 1.00 "- Evap.cooler, gar disp.or Y.W. Izi 1.00 a — Air conditioner or heat pumpla. Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 2 License No. 0� Classification Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of Cal ifomia. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of' the work for which this ermit .is issued I shall not employ any person in any manner so ag to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 1 1 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and aws relati building construction, and hereby au t rize repr en es of a County of Butte to enter upon the ab a mentione roperty inpurposes. TOTAL PERMIT FEE a� $ aS This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. X Date 3gnat a of Permit ece' o. ite-D.P.W. _ Yel ssessor — Pink -Inspector — Goldenrod -Applicant DIRECTOR OF PUBLIC WORKS c By Date SMIUMig-permit.0"Fes Date I COUNTY OF BUTTE — DEPARYMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 VV v APPLICATION AND PERMIT f� BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address 3�0 Permit Fee Plan Checking Fee&/or Penalty I Telee h °ne No. Permit Fee Building Address ��y ``aa j NI -5- !�'�y "fes`- PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 . / z ` w Each gas water heater or vent 1.50 A. P.,No. Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F661 •SaaUa� Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Lawn sprinkler system 2.00 Sldg�larrs Recd' Parcel Approval Plans Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE , PERMIT FILING FEE $3.00 4,11d4l --7S— Main service incl. 1 meter - Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family Duplex ❑ Mobil Horne.[:] Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixturesb Receps., switches & fix outlets CONTRACTORS LICENSE LAW I am 'licensed under the provisions of Chapter 9, Div. 3, of the' . State ofzBusiness & Professions Code under the name style'of: / Hood, Ex. Fan or F.A'. Furn. Motor 1.00 Evap. cooler, gar. d i sp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 .3L �. �� License No. Classification Misc. wiring , ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ❑I certify that in the performance of the work for which this permit ,is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE _ $3,00 30dv Heating Cooling Ventilation Hood 2.00 �.0�► Permit Fee $ %QO $ 4, 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. X Date g ture of Pe m' ee or Agent Receipt �o. '4-4� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant TOTAL PERMIT FEE 0 1$ 610 This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for.which fees have been paid. DIRECTOR OF PUBLIC WORKS By / Date iB ding permit e*p4es_Dat9-_ 7