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HomeMy WebLinkAbout024-290-023A.P. 24-29-23 FHorllis HALE.. STRELane, 300' E. of Hwy. 99 514-74B,P,E,M (New sf) 24-2$-23 < r ILLIAM DUBOIS LOT �LOEK• eDI�. I �u Hollis Lane, t;ritiley (/ (�,2�' j •. I i l i l Permit#2575-88B(reroof/SF) ` j TYPE F, FllfaMl-t NO P4ANI N 1 DATE ISS ED i P 024-290-023 03-3501 ED t I I I R' E M A RIK S PERMIT BUBOIS FAMILY TRUSTCFINALE;11'�.% 30 HOLLIS LN, GRIDLEY _ _ r —_ . I---• Cont: RRR ROOFING RE ROOFMOP ! ! i 1 c•Y : p::a,> { ! ! I ! L+ I s �_ L! I! -- — --t— J 1 —i ( 1 I i ' ►w T w' � � ' i !'i { 1 �� I f j r :7 I ' I I I ( � ! I I �L..d'v -16 , s ' 1 >< ,� lam♦ 1 i 1 t i i .:.Ea1O�T � �- . ry L T i r; 1 I t ! b I I �i i t I r. ' :+ I , I � I I I i I ! i I ' , F.iClf.%Ic:?i ! i,� •€ 1_ , k -- { I r I 1. I I l— 1 ' I � I � � { ! i I + j I � ' � �- y,„•; ! I i � t I I 1 fb'.JF•! 3r4 f s� :ZSI ' -, ;4--j 4 FTI S I , _{ . I w:.' i i i 1 -y I ! I 1 I � I -` ' � i � I I I j I i I i I t I kiib±�1✓lv i I 1 ! ' , • r I I •a � ' I I � ! + � , ' , t 6 [ lL.r.rJkSCiLtt3 ' ' r I r 1 i ! kOx5iV2• , 'ocV.-LI w r le';' -i c�l�te + PERMIT DESIGNATION_: El -BUILDING E -ELECTRICAL U -USE PERMIT HM -HOUSE (MOVING DEPARTMENT OF P -PLUMBING TV -RADIO -TV ANTENNA V -,VARIANCE EP -ENCROACHMENT BUILDING AND SAFETY T -TRAILER S/W-SIDEWALK NOTICE S_ SIGN PERMIT D -DEMOLITION • 600.1 Q ,1 nnuaiaad snn�w�������w 7VNId SE1313 W 833NVIlddV V 83unixls1 NI-Hflf10M 31VO flIS 31VO flIS 31VO 'flIS 31VO 913 31V0 'flIS sId39Wi1N IIWE13d 1VNId S1N3A 9 S37NVIlddV 3NIl M3M3S ONIdld Id31VM LS31 3LIi184mid SVfl NI-HonoEi 31VO '0I9 31VO 'CIS 31VO 'CIS 31VO ''DIS 31VO flIS IM38Wi1N 1IWH3d `N/%F/1 PPAfil.VRJfPIILR 87VAOUddV OMM7I129 CH1033H NOLOUSNI 31VO 'DIS 31VO 'flIS 31VO ' 'flIS 31VO 'flIS 3JVO • ''DIS 31VO 'fl14 31VO 'DIS 31VO 'IDIS 31Va 'VIS 31VO 'flIS 31VO 'flIS 31VO• 'flIS . r� n �y �m rZ 0X 7tm 1- �1 Dm 1� I MA 1' D 1� In0 t� �n 5°m '�9 _0 11�� Dm -1� _0 D 3 z A �Z m0 r0 61 ZOn ax' �w0 Z Z Cm CD3 p=1 87VAOUddV OMM7I129 CH1033H NOLOUSNI COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 P RMIT No. (Rev. 12/96) APPLICATION AND PERMIT �jiJl ASSESSOR PARCEL NUMBER Qlq - -ZR 0 - 0`0 ZONING BUILDINGPERMIT OWNER I �� �/�(� °N I� NG VALUATION SO. Fr. OCC. BUILDI10 . OWNERS DRE 1 tl�S ' I,� . V_IJ1KY n,5n ' B Il `,/(/l 7 YONE CO S E U� T`�/ -I r COWli@Ci 5 MAIU41G //11 j�DR S ` l�f CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation Is ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 7-�' ARCHITECT OR ENGINEERS "UNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS D 3 Wl ' Energy Plan Checking Fee $ PERMIT FEE $ -7 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF/Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities' -❑ Installation 0 Other ❑ Describe Work: �C- V-0OfW (4+ W ('►/�asl U l V {' J S ► 1-� �� Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 MOOOV OR LESS Main Service 200" OR LESS 23.00 LICENSED CONTRACTOR'S 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 the Business and Professions Code, and my license isj�+]�full force and effect. License Class 6 Lic. NO. 9193C-111 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO iOOOA 46,00 NEW CONST. DWELLING OCCUP, OR ADDNS. ( a ACC. BLDS. S° 3.5QFT: NON.RE°SID. MULTI.OUTLETIT. 97,50 PowER APPARATUS a SINGLE ourLET cIR. Ex. Occup. OUTLET OR FDRURES .00 B20 OI50 Ex. Occup. OUrTs Aalo.°EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirino 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 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 I performance of the work for which this permit is issued. p! 1 have and will maintain workers' compensation insurance, as required by Section Ir 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier 0F_- 0 59fr l8 =Vos Policy Number =15 [lU0 1 3 (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 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 fohwith comply with those provisions. X �_{�27L{....� Dat 1�_Ll�Q3 _ —T— Signature of Applicant - ❑ Owner ❑ Contractor Agent An OSHA permit is required for excavations over 60" de nd demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 51ter IMP I FLOOD CDF PARCEL Po HD ISSUE This permit is hereby issued under of the Butte County Code and/or indica above for w h fees have By PERMIT EXP ES ON _ the applicable provisions Resolutions to do work been paid. I -7 Date / f Dafe �— Receipt No., L WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER uz .�(j !'1 , /'�- _J f•/ `J ZONING BUILDING PERMIT C r OWNER _)o S f—A 1 f V1''lt � /��i J t` e jHO� , n � r.Q•i SO. FT. OCC. BUILDING VALUATION .OWNERS ILING °�1DDRES { ,. rbtl1S CONTr TELEPHO ti/Ij , `` ) CGNFR/aCJD_RS MAIUNOaAC} RESSC �-• C! , G! 7 7 L '!f{' C/' Jl UVJ CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ (O U Ci ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ -?7. ,..� ARCHITECT OR ENGINEERS MAJUNG ADDRESS Plan Checking Fee $ BUILDINGADDRESS 0 -yo[ ,,, - Yet �.) _ Ef77nergy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBONISION5 NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF,.El Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 1 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel emodel ❑ UtijtiesO Installation ❑Other ❑ � Describe Work: A -Y,004 L + �V pslto/ Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S I G IW @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 8.0.0.v OR LESS 23.00 LICENSED CONTRACTOR'S 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 the Business and Professions Code, and my license Ifull force and effect. t� 1 73`� I License Class � Lic. No. � � OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason 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. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier CI(�1� l��t cJr t- _ 70C L k a l- Q j__ %v5 Policy Number 00tt> CLIC) t (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manlier so as to become subject to 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 fo hwith comply with those provisions. r""' X -2, 1`-' LL=c JDae 1 / t t �3 Signature of Applicant - ❑ Owner ElContractorAgentAn OSHA permit is required for excavations over 5'0" dand demolition or construction of structures over 3 stories in height. Main Service 46.00so WEIL NG CCU000A NEW CONST. DWELLING OCCUP. SO OR ADONS. ( a ACC. BUDS. 3.5¢FT, NOµH°EStO. MULTI.OUT I TS @7.50 POWER APPARATUS a SINGLE OUTLET CIR. 20 Q ''0° Ex. OCCU OUTLET OR FIXTURES SAL @ .50 Ex. Occup. ouxTiFrs AEs o.) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ coNsr. TYPE TOTAL FEE $ '?' a7 HAZ. p. PEES IMP FLOOD CDF PARCEL PD HD ISSUE 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. / Date �l ' / L -`�% By /// PERMIT EXRES ON Date Receipt No. 7775-7517S9 r,-50 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT X024-290-023 03-3501 BUBOIS FAMILY TRUST, 30 HOLLIS LN, GRIDLEY Cont: RRR ROOFING RE ROOF t e I r :� t' COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ' 7 ASSESSOR PARCEL NMB -ER ZONIN ' BUILDING PERMIT . OWN R T t TELEPHONE �( 51,E SO. FT. OCC. BUILDING VALUATION OWN R'S MAILING ADDRESS E —' CONTRA-CTOR'S NAM/ Al C 1 TE LEPHONE CONTR/i:C"TOR'S MAILING ADDRESS ` Fireplace CONSTRUCTION LENDER VNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS. Permit Fee $ ARCHITECT OR ENGINEER' LICENSE NO. Plan Checking Fee I` $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT FiIingFee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PAR EL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF 4 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer ; 5.00 Mobile Home S I G I W 0.00ea J TYPE OF WORK New ❑ Addition ❑ F14model ❑//Utilities ❑ Installation❑ Other ❑ Describe work: r 1f -b0 i" Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 60OV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW of p y (check one): I declare under penaltyperjury ) ❑ 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 D-1-1, 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.a� ��z0sgft OR ADDNS. \ACC. BLDGS. NEW CONSTR. I.OUTLET 2.50 ea NON.RESID BRANCH CIRCUITS) POWER APPARATUS a SINGLE OUTLET CIR. I EX. OCCup(OUTLETS OR FIXTURES 200 030 FIXED APPLNS. OR Ex. Occup, OUTLETS (RESID.) EA.I 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate A., of Consent to Self -Insure. O' 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 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. 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 pf this permit. X ,� l / ,IAl� _ , / � / � IS� ate 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 $ Energy Inspection Fee $ TOTAL PERMIT FEE $ a , OCCUP. CON3T.TTPEJ ISCHOOLIFLOO= ND s9UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR * PUBLIC / r .� By `+ —�� PERMIT EXPIRES Date the applicable to do resolutions to do fees have been paid. WORKS 'j / Z Cj� Date �j (y Receipt No. WNIT[-D.P.W.. T[LLa W-078!23011, PINK -INSPECTOR. GOLDENROD -APPLICANT I 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 Energy Inspection Fee $ to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. TOTAL PERMIT FEE $ L4 g. I also agree to save, indemnify and keep harmless the County of Butte against OCCUP. CONST.TYPC SCHOOL FLOOD PARCEL PD I ND I ISSUE all liabilities, judgments, costs, and expenses which may in any way accrue against said County in Fonsequence of t grting pf this permit. X ate -" This permit is hereby Issued under the applicable provi- sions of the Butte Count Code and/or resolutions to do Signature of Applicant — Owner Contractor ❑ Agent ❑ work indicated ab ve for which fees have been paid. An OSHA permit is required for excavations over 5'0" deep and demolition or construct- TOF1,0 PUBLIC WORKS ion of structures over 3 stories in height. ._./ Receipt No. r���t/� & BY Date WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT PERMIT EXPIRES Date jr COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Orovilli�, California 959f5 - Telephone: 916/538-7541 V. AND PERMIT APi'LICA ASSESSOR P=RCNM±ER ZONI�rTG BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWN R'S AI 'I G ADD ESS CONTRACTOR'S NAME TELEPHONE y C, CONTRA OR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee LENDER'S MAILING ADDRESS $ 10,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee - $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 30 A. IV Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 o Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PAR EL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE Gas piping system 1 - 5 outlets 5.00 SFX Duplex❑ Mobilehome❑ Other Building sewer 5.00 SPECIFY Mobile Home S I G I W 10.00 ea TYPE OF WORK New ❑ Addition ❑ Flqmodei ❑ a,(tiIities ❑ Installation[] Other ❑ Permit Fee $ Describe work: r 11-0 0 F!"' Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service eoov OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW NEW CONST. DWELLING OCCUP.Ei) y:¢sgft I declare under penalty of perjury (check one): OR ADDNS. ACC. SLOGS. NEW CONSTR. MULTI -OUTLET 2,50 ea ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER NON.RESIO BRANCH CIRC ITS APPARATUS &) CIR. and Professions Code and my license is in full force and effect. (SINGLE OUTLET License No. Classification Ex. Occu p�O OR FIXTURES 20e50e SAL030 FIXED A Ex. Occup. OUTLETS P(RESID )REA.Y 2.00 [�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 Temporary service 10.00 for sale. (Sec. 7044) Mobile Home Facilities 15.00 ❑ I, as the owner, am exclusively contracting with licensed contract- Misc. Wiring 15.00 ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Permit Fee $ i Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): MECHANICAL PERMIT FiIingFee 10.00 ❑ 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 Consent to Self -Insure. �f' Cooling LTJ shall not employ any person in any manner so as to become subject Hood 3.00 to the W. C. laws of California. Ventilation 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 I 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 Energy Inspection Fee $ to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. TOTAL PERMIT FEE $ L4 g. I also agree to save, indemnify and keep harmless the County of Butte against OCCUP. CONST.TYPC SCHOOL FLOOD PARCEL PD I ND I ISSUE all liabilities, judgments, costs, and expenses which may in any way accrue against said County in Fonsequence of t grting pf this permit. X ate -" This permit is hereby Issued under the applicable provi- sions of the Butte Count Code and/or resolutions to do Signature of Applicant — Owner Contractor ❑ Agent ❑ work indicated ab ve for which fees have been paid. An OSHA permit is required for excavations over 5'0" deep and demolition or construct- TOF1,0 PUBLIC WORKS ion of structures over 3 stories in height. ._./ Receipt No. r���t/� & BY Date WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT PERMIT EXPIRES Date COUNTY OF BUTTE - Depaitment of Public Works 7 County Center Drive Oroville, CA 95965 Phone: 916-538-7541' OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner-builder"'building permit has-been applied for in your name'and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. .' 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) 2. I (have/have not) �_ B\? E signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. 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 Contractors License No. 5. I.will provide some of'the work but I have contracted (hired) the following persons to provide the work indicated: Name Address . Phone Type of Work Signed: Property. Owner. 7'V_01 �tAIM(f ' ep • I,J d� Social Security Number `.�^�- Date �^ /`1 QQ 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. PERMIT NUMBER _ g 514=74B,�P,E,M 1� v P )r 1L y E PERMIT EXPIRES —�— 75— OWNER Curry Hale �14A CONTR: Owner 5 LOCATION (A.P. 24-29-23 Hollis Lane, 300' E. of Hwy. 99 i COUNTY OF BUTTE Department of _Public Works BUILDING INSPECTION RECORD —moo _7dZ'.. Zoning Setback Forms'ie2Z -2�, l9 O Foundation �/_ Piers & Girders C4244 Fireplace Rgh. Plumbing��m—a? Bond Beam Lath & Plaster Rein. Steel Gas Piping & Test Found. Vents Framing —/ 7-i Plmg. Topout r0 —/ ''% Rough Elee. Wtr. Htr. Furnace Kitchen Vent Firewall Garage Vent. Sanitation & Water ELECTRIC GAS BUILDING Tem— Tempor r ` Cert ccup. Fina Final Fina . 137 DATE REMARKS OR CORRECTIONS COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WOR 7 County Center Dive Oroville, California 95965 li Telephone: 534-4541 APPLICATION. AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X k" -Date 212,5/7 Signature .rmiteeeorr Agent / Receipt No. ! / ! d� _ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provi ions 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 Bu Ing permit expires Date .............. BUILDING Owner (1 -ti V A aSO. FT. OCC. BUILDING VALUATION Mailing Address op Telephone No. Fireplace 00 ®o Contractor Total Valuation Mailing Address Permit Fee PI an Checki ng Fee &/or Penalty Telephone Na. Permit Fee $ $ Building Address D PLUMBING No.1 @ FEE PERMIT FILING FEE $2.00 .QZ) / Each Trap 1.50 Repair drainage or vent piping 1.50 Water pipin 1.50 # Each gdswater heater or vent 1.50 A. P. No.Gas Zoning & Planning piping system 1 - 5 outlets 1.50 Each additional outlet .30 FW Sa p Fire Dept. Fire Zone Use Permit Building sewer 5.00 EGA Par g Parcel P ns Declaration parcel Ma P 60' R/W improvements P Lawn sprinkler system 2.00 Bldg. P ons Rec'd Parcel pproval Plans Approval Permit Fee $ $ NEW UK ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meter ach 1.00 Sub -pane (12 r less) (more than 12) Single Family [P""*' Duplex ❑ Mobil Home ❑ Others ❑ Ran4T Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light flxWres. _bal_ aio (�25 Re!", switfiTes & fix ow6tiji6ts 1lu . 1HqpdE CONTRACTORS LICENSE LAW 1 am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: X. Fan or F. . Furn. Moto 1.00 Evap. cooler ga .lisp. of 1.00 Air con inner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No.!70=aClassification Misc. wiring am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ C WORKMEN'S COMPENSATION INSURANCE I 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 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 $ $43 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 TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X k" -Date 212,5/7 Signature .rmiteeeorr Agent / Receipt No. ! / ! d� _ White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provi ions 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 Bu Ing permit expires Date ..............