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HomeMy WebLinkAbout024-010-098I 1 024'01'0--'09_8-'_ �. �, 92"2329B, - :? KEEN, Curt. 292>,,Arche' r,,,Ave , Gridley ' woodstove/sf :RAMSEY,: Lester 1145 024 .southwest corner Gilstrap 1205E and Archer, Gridley .2q C) 9 7, Q CENCRROkElMENT ERMIT 7 Z7Ir�� 4 0 fo-/� � �V ENCROACHMENT PER.MIrT ,, County of Butte Department of Public Works 7 Count Center Drive Oroville, CA 95965 Phone (530) 538-7157 Ext. 2016 Fax: (530) 538-4356 Download Forms: www.buttecounty.n79publicworks/forms.html NOTIFY COUNTY 24 HOURS BEFORE WORK IS TO BE DONE Phone (530) 538-7157 Ext. 2016 Permit Number G 4/// 63 E District - APPLICATION / WE, the undersigned, hereby apply to the County of Butte for an encroachment permit to do the following work under or over the County roads id highways, all in accordance with County ordinances and general laws. All information except signature must be typed or legibly rinted. Applicant's Name: ✓tJ! sow la. Company Name: .Address: q� Phone:25�� i S� 4. Assessor's O eZl N m d/6 d g? Location of Work to be Done-�j� /' /' Applicant's Signature 7. Date: Z--C()NT'P INFORMATION Contractor's Name -a �s�N e . Address rc-it�a RcVL�`} 'JV4-B 0. Phone: 11. Fax: 2. Contractor's License Number: G, �? J 13. Certificate of Insurance: Yes No: ❑ 4. Contractor's Signature: , 14a. Date Signed: S. Authorized Agent: TYPE OF WORK TO BE DONE 6. Please Check: Curb: El 11Sidewalk: ❑ 17. 1f Driveway List Type: S. Other Work - Describe: 19. Plans Attached: ❑ Yes ❑ No PERMIT GRANTED n compliance with the above request, and subject to all terms, conditions (including those on page 2 of this permit form) and special conditions written below, ,ermission is hereby, granted. .0. Conditions ", . r—,4 -7p o f T S:,-7' td -VIA, % 7' <- - v/,, G T .3 7b /Lo 4. a wel S u , `< Y P% - .t 6 F PA tge Axt 4. i' 76 Cm u A,- L7* �. )nder round Service Alert(U.S.A.) must be notified two working days prior to any excavation. 800-227-2600 :1. ® All work shall conform to accompanying: Detail N Plans ❑ Special Conditions 0 :2. Date Issued J� 7 G / 7 23. Expiration Date: 7 Ja � AY l 24. Surety: :5. Date Paid: Z l G 26. Amount Paid: G G $C/id B� ]� �� 28.1 eceipOo9 4-/4 vlike Crump, Director of Public Works By: ZorCounry 29. Final Inspection Date: 30. Inspected By: ❑ Completed - OK Completed — Not OK ❑ Additional Comments Attached Use Only: 31. Comments: 4ote: If permits are faxed to any number besides (530) 5384356, they can be delayed up to one week. Page 1 of 2 GENERAL CONDITIONS It is understood.and agreed that the County has prior right to the use of its rights of way. It is further understood and agreed by the Permittee that the I of any work under this permit shall constitute an acceptance of all the provisions contained herein and failure on the Pemhittee's part to comply with any >ion will be cause for revocation of this permit Except as otherwise provided for pubfic agencies and franchise holders, this permit is revocable at any time. permit is to be on job at all limes while the work is being done. All work shag be done subject to the supervision of and to the satisfaction of the Public Works Department of the County of Butte. The Permittee shall, times, during the progress of the work, keep the County Highway in as neat and clean a condition as is possible and upon completion *of the work granted h, shag leave the County Kghway in a thoroughly neat, dean, and usable condition. The Permittee agrees by the acceptance of this permit to property maintain any encroachment placed by the Permittee on any pad of the County fray and to immediately repair any injury to any portion of the highway, Which occurs as a result of the encroachment, until such time as the Permittee may ieved of the responsibility of such encroachment by the County Department of Public Works. It is further agreed by the Permittee chat whenever constriction, reconstruction, or maintenance work upon the highway may require the installation led herein shag, upon request of the County Department of Public Works, be immediately moved by and at the sole expense of the Permittee. No material used for fig or backfill in the construction of the encroachment shall be borrowed or taken from within the County right of way. At least one lane of any public road, eundeir the«jurisdiction of the Board of Supervisors of Butte County, and other public roads junctioning or :ding therewith, shag be kept open for travel by the general public at all times. No public road under the jurisdiction of the Board shag be dosed b travel by :neral public without special permission, in writing, from the Board of Supervisors. The Permittee, by the acceptance of this perrnit, shag assume fug responsbirity for all liability for personal injury or damage to property which may arise the work herein permitted or which may arise out of the failure on the part of the Permittee to do the work provided for under this permit In the event any of such liability is made against the County of Butte or any department, official, or employee thereof, the Pernittee shag defend, indemnify, and hold them ich of them harmless for such claim, '•' ' ' n::°''t.'"� � .0 :, .. _ � `:a .r.:.. 'M,�. 're.� � .>n.. .. t..;.';i11 �y�y.� v'.X:C� Ag excavations shag be backfilled and compacted immediately after work therein has been completed Trenches shag not be left open farther than 300 advance of pipe laying operations or 200 feet to the rear thereof, unless otherwise permitted by the Engineer. Unless otherwise permitted under the d Conc ifions, backfill shag be place and mechanically compacted in such a manner that the relative compaction throughout the entire fig within the County ght of way shag conform to the percentage of compaction as stated below. Permittee shag notify foreman 24 hours before backfilling and/or paving. a. The relative compaction from the bottom of excavation b a plane five feet (6) below finish surface grades shag be no less than ninety percent (9D%) as determined by Test Method No. Calif. 216-C of the Materials and Research department, State of California, Transportation Department, Division of Highways, or other approved test method. b. The relative compaction from a plane five feet (5) below the finish surface grade to said finish surface grad shag be no less than ninety-five percent (95%) as determined by the above testing method. Permittee shag bear all costs and responsibility for compaction tests. a The relative oompacfion from a plane five feet (5) below the finish surface grade to said finish surface grad shag be no less than ninety-five percent (95%) as determined by the above testing method. Permittee shag bear all costs and responsibility for compaction tests. Material for use as trench backfin in any existing or proposed roadway section shag be sand, shag be place in 8° Otis, and be compacted to a relative compaction of not less than 95°/a Material for use as backfin in roadside gutter excavations shag be the native material and be compacted to a relative compaction of not less than Any pavement cuffing shag be scored, or saw cut before trenching. Minimum depth of cover over all underground faaTr6es shag be 30 inches, except drainage cutveris An Installations, parallel with roadway, shag be placed as dose b the right -0f -way One as possible. No portion of the bad3ig(s) shag be compacted by pondvhg or jetting. An pavements, curbs, gutters, sidewalks, borrow ditches, pipes, headwalls, road signs, bees, shrubbery. and/or other permanent road facNes impaired by or as a result of construction operations at the construction sfte(s), or at other grounds) occupied by materials and/or equipment, shag be restored immedstely upon badm-Eng or the excavation to the original grades and aoss sections, and to a condition as good as, or better than, existed prior b the construction. All surfacing materials of roadways and driveway approaches aA or damaged by or as a result of construct]operations, shah be replaced within ONE WEEK fonowIng the baddrlimg of excavation, weather permitting, with compacted layers of surfacing materials at least as thick as the existing; and no less than two inches M of asphalt concrete over eight inches (8' of aggregate base, according to current California State Spea Mfions. Whenever necessary b secure p-mnssion from abutting property owners, such authority must be secured by the Permittee prior b starling work. The future safety and convenience of the traveling public shag be given every consideration in the location and type of construction. Permittee shall b be placed, erected, and maintained an warning signals, fights. barricades, signs, and other devices or measures essential b safeguard travel by the I public over and at the site of work aul horized herein. 4 the construction work covered by this permit is to be done by a private contractor hired by the applicant, applicant shall notify contractor as b the conditions and requirements contained herein. Page 2 of 2- 4L -z \ • .00ATION' Un Gi; rAp Ave Next to z92 Arcbcy- Ayrt. --OREMAN: 'B• J a c.q u vt )ISTRICT: 'ERMITV-'L-: DATE 7 /,;Z) loq MIN. DISTANCE: 3PEED LIMIT OF. ROADWAY n ' DRIVEWAY LOCATION:._. DISTANCE TO NEAREST INTERSECTION: ,Soo Ti SIGHT DISTANCE Or GOOD ❑ POOR IF POOR -- RECOMMENDATION TO IMPROVE: ❑ CUT BANK';--: ❑ REMOVE. VEGETATION (TEMPORARY) ❑ OTHER (EXPLAIN) ADJACENT TOPO Dr"FLAT ❑ CUT SLOPE FT. ❑ FILL SLOPE FT. ❑ CURB AND GUTTER ❑ AC DIKE ❑ EXIST. DIST. I TO EP FT. DRAINAGE RECOMMENDATIONS ❑ NONE ❑ SWALE 0 --"CULVERT MIN. DIST. - EDGE OF EXISTING PAVEMENT (EP) c� z Lu J 0 12' MIN. \AREA 20' MAX. TO BE ---- PAVED R/W 10' MIN. .NOTE: tF GREATER THAN 107 UP- OR DOWN REFER TO ENGINEERING. MAX. 1 FOOT VERT. RISE DR DROP PER 10 FEET HORIZ. DISTANCE— MIN. DEPTH TO �, V FT. EP DIAMETER 3o IN. LENGTH eZ o FT. EXIST. DIST. MIN_ I I I DIST.- 0 IS i.O OTHER (EXPLAIN) 29; NOTE: MIN. DEPTH ' PAVEMENT TO EXTEND AT 27 CROSS SLOPE OR MATCH EXISTING ROADWAY CROSS SLOPE. ALTr3 PRIVATE DRIVEWAY I i t I � MAx 10� FIELD REVIEW i� �:�f �?`7i K.�a.: +.l �- "`+4-�P54'?"h`��`��i:'' `!t�'F��f�'de:+"td'�+ia�„r"'N �sY�K 7 i.. `V^►- �`1, _y,�.Y""x!4,.�..^y�,r�:rA;�.^`s'!.r�Yi!��!-' , +f'?Y� w!r,:� -.t _ ' t COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 4; 7 County Center Drive - Orovllle° California 95965 - Telephone: 916/538-7541 APPLICATIONIAND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER- 024-010-098 ZONING A5' ' `R F BUILDING PERMIT r� OWNER CURT KMI TELEPHONE 846--6469 SO, FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 292 ARCHER AVE GRIDLff 95948 CONTTR��ACC �T}}OR'S NAME __7 %JRR ._ . ELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace A 1500 CONSTRUCTION LENDER UNKNOWN Total Valuation $ - 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 292 ARCHER AVE GRIDLEY Permit fee $ 5.00 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF9' Duplex❑ Mobilehome❑ 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 New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installatio ❑ Other',® Describe work: INSTALL WOODSTOVE 4.1S7 ( Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 18.50 200A OR LESS Main service 200A TO 1000A, 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 OCCUPM 3.64 sq.ft. OR ACDNS. ACG. BLDGS. NEW CONSTR ULTI.OUTLET NO N.R ESID BRANCH CIRCUITS) @ 5.00 POWER APPARATUS & (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 @ 76 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.1 I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 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 Filing Fee 15.00 Heating Cooling 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 liab i ities, judgments, costs, and expenses which may in any way accrue against said County in onsequence of the granting of this permit. X� / / Date 7-7- J Signature of Applicant,;7 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 Ener Inspection Fee $ Energy P occ, CONST TYPE iTOTAL FEES 45.00 I HAz DFEES IMP I FLOOD CDF I PARCEL I PD I HD ISSUE This permit is hereby issued under the applicable provi sions of the Butte County Code and/or resolutions to do f work indicated agb�ve for which fees have been paid. Dl CTORlOF P BLIC WORKS By ,j t- �� _ Date 9_7 PERMIT EXPIRE §/ Date / 1-- � Receipt No. 117336 WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT f3!9C6 �) C. -..l :.. - � r • �. �. tet... ,. .. - R -�. . . COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE ->9. 1 6WNER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If ave any questions pertaining to this matter, or need additional explanation, plea5"nyoefthis office immediately. oilp Date 7—Inspector REV 11/91 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Califc,-nia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 024-010-098.'-.5 IZONING BUILDING PERMIT OWNER CURT KEEN TELEPHONE 846-6469 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 292. ARCHER AVE GRIDLEY 95948 CONTRACTOR'S NAME 014NER TELEPHONE CONT,RACTOR'S MAILING ADDRESS Fireplace I A 1500 CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ 30. ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 292 ARCI'ER AVE GRIDLEY Permit fee $ 45.00 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF P Duplex Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home I S I G JW I @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installatio ❑ Other,' Describe work: INSTALL 1,100DSTOVE J 'QSI h� _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 200A OR LESS 18.50 Main service 200A TO 1000AI 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 BUS)neSS 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 CONST. DWELLING OCCUP.tr OR ADDNS. (ACC. BLDGs. ) 3.64sq.ft. NEW CON5TR MULTI -OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS tr (SINGLE OUTLET CIR. ) Ex. Occup(OUTLETS OR FIXTURES 20 76d FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. bVirin 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. ❑ 1 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 aliaies, judgments, costs, and expenses which may in any way accrue County in •onsequence of the granting of this permit. Date _ I signDture of Applicen Owne 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 Ener Inspection Fee $ Energy P occ CONST TYPE TOTAL FEE $ 45.00 HAz DFEES IMP FLOOD CDF PARCEL PDid This permit is hereby issued under the sions of the Butte C unty Code and/or work indicate a e fo which fees 0 F P BLIC PEWIT tkPIREV Date applicable provi- resolutions to do have been paid. WORKS Date' Receipt No. 117336 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDEN ROD-APPL I CANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville. California 95965 - Telephone: 916-'538-7541 APPLICATION NO PERMIT - v i C_/ OWNER C It_ ee0 OWNER'S MAILING ADDRESS 2`�2 1f/t^L CONTRACTOR'S NAME W K ell— CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER ARCHITECT OR ENGINEER'S MAILING ADDRESS BUILDING ADDRESS 29Z AQr e u�. SUBDIVISION NAME PERMIT NO. BUILDING PERMIT HONE SO. FT. OCC. BUILDING VALUATION HOP UNKNOWN PARCEL M USE OF STRUCTURE SFO Duplex❑ Mobilehome❑ Other SPECIFY TYPE OF WORK New ❑ Addition ❑ RRLemodel ❑ Utilit�ies ❑] Installation❑ Other Describe work: Z/151w�( IA)b-D,iC/n.7t6Je-- 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Fireplace I -;A Total Valuation $ Filing Fee Permit Fee Plan Checking Fee Energy Plan Checking Fee Penalty Permit fee PLUMBING PERMIT Each Trap Solar or heat pump water heater Water piping Each qas water heater or vent Gas piping system 1 - 5 outlets Building sewer Mobile Home I S 7G W I Permit Fee $ 15.00 15.00 Contractor Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 200A OR LESS 18,50 Main service 200A TO 1000A1 37.50 NEW CONST. DWELLING OCCUP.N) OR AODNS. ACC, SLOGS. 3.64 Sq.ft. NEW CONSTNON.RESIO R BRANCH CIRCUITS @ 5.00 (POWER APPARATUS tr (POWER OUTLET CIR. Ventilation Ex. Occup(OUTLETS OR FIXTURES 2076d FIXED APLNS Ex. Occup. OUTLETS (RESID )REA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 11 FEES I IMP I Permit Fee $ — WORKMEN'S COMPENSATION INSURANCE Contractor I declare under penalty of perjury (check one): MECHANICAL PERMIT FiIingFee 15.00 ❑ The permit is for $100.00 (valuation) or less. Heating ❑ 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. Cooling g Hood 6.50 ❑ 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. Ventilation penult Fee $ LContractor 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. Mobile Home Installation Fee S Energy Inspection Fee $ DCC CONST TYPE TOTAL FEE $ HAz 11 FEES I IMP I FLOOD I COF I PARCEL PO HO ISSUE X Date Si nature of Applicant - Owner g pp ❑ 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. 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 DatePERMIT EXPIRES Date 7136R�) eceipt No. ! WHITE-D.P.W.. YELLOW-ASDE330P. PINK -INSPECTOR, GOLDENROD -APPLICANT W COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 014NER-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) 2. I (have/have not) signed an application fora 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. 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 Cit, _ .. .P .one - �..w_ Contracto.rs. 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 Social Security Number Date -Z Z 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.