HomeMy WebLinkAbout025-240-0786
25-24-78 025-240-078 PERMIT#96-127A
JACQ INE C. ARNOLD BOLT, ' David
W/S Lone e_ Rd, app 1 mi N of 304 Lone Tree Rd Oroville f
Palermo Rd, Or le Ag Exempt Permit -Tractor &'Equip
Permit#5519-80E (ele r for well
& future 1pt d velop ent
��"_- 025-240-078 02AG234
25-2478 801t, David
t .
W/S Lo�. Tree Rd., app.l mi.N.of Palerm 3Q4 Lone Tree Rd Oroville
Rd . , Orov' Ag exempt
contr• Linco n Village MH/Oro.Permit
Permit #409-81P (uti�MH)
ELEC.
GAS 7-/0 - S/
SUPPORT STRUCTURE REQ.+
COMPAMON TEST REQ.
25-24-78
contr• incoln Village MH's, Oro.
Pew it#410-81MHI
..O
ssued
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•
r1 BUILDING DIVISION
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: (530) 538-7541
AGRICULTURAL BUILDING EXEMPTION PERMIT
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public. -
ASSESSOR PARCEL NO. �� r �' ®��
ZONING fik A 1/^ —
Aor
INEIV
) IP� �(vfi
6h
PH GOME OS.3-3' 139
OWNER1 'S ADDRESS i
"6 • VipxSS-9_
LOCATION OF BUILDING &-4
e U. 6
USE OFf BUILDING
SIZE OF STNUCTURE r
X SQ. FT.
TYPE OF CONSTRUC ION:
WOOD FRAME STEEL CONCRETE OTHER (Specify)
TYPE OFS IDI G
ROOF COVERING
FLOOR TYPE
S
ESTIMATEK COST F CONSTRUCTION
AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County
Ordinances as follows:
&w``/ 24 12�
FRONT SIDES REAR REAR
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building.
AG Buildings greater than.1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a
mobilehome, and 40 feet from a commercial building.
AG Buildings must comply with Flood Zone requirements. Finish floor elevation must be at or above elevation
USGS Datum.
I declare under penalty of perjury that the building will be used as stated above and the purposed use confirms with the
AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and
obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before
occupancy.
Date ) a Signature of Owner(ode-2
Permit Fee - $60.00 The above described AG Building is exempt from a building pe it.
r PARQEL P.D ROOF G ISS
Receipt No. ✓
• Manager Building Division
By
White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant
Date 2 ®�
i
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES, BUILDING DIVISION
7 COUNTY CENTER DRIVE, OROVILLE CA 95965
Phone: (530) 538-7541
David Bolt
PO Box 5817 Date: 1/2/03
Oroville CA 95965 RE: AA_g Exempt Permit
APN# 042-100-053
With reference to the above subject:
Attached is:
Application for permit Mobilehome Utilities Installation Sheet
Building Plans Mobilehome Installation Information Sheet
Enigineered Calculations Typical Plan Sheet
Owner -Builder Verification Form List of Codes Enforced
We need the following information prior to permit processing and/or issuance:
Permit application signed and completed where indicated with all copies returned.
- Plot plans, % sets, signed by preparer of plans.
Complete plans and calcs, % sets, signed by preparer of plans.
Engineered plans and calcs, % sets, with wet signature on plans.
Hazardous Material Form
Statement of Intent for Non -Heated and A/C Buildings.
Engineered truss details and layout in duplicate.
Mobilehome data and manufacturer's installation instructions, 2 sets.
Fees of $ , payable to Butte County Treasurer.
Impact fees paid.
California Department of Forestry plan approval/fees.
FEMA National Flood Insurance Program Elevation Certificate prepared by a licensed land surveyor,
architect or engineer.
Sanitation and plot plan approval Health Department.
City of Chico plumbing permit.
Plot plan and business license approval from City of Biggs/Gridley.
Planning approval for
Land Development (a) Improvements (b) Drainage.
Contractor's license information (No. Name Style,Class) or exemption statement.
Owner -Builder Verification Form
Recorded copy of Agricultural Acknowledgment Statement
Letter of signature authorization
Copy of recorded deed of parcel creation and 60' right of way to a public road
Letter of intent on building use.
Mobilehome utility clearance
Documentation of legal access.
Documentation of 50% subdivision developed of a) Road improvements completed and (b) Parcel meets
zoning area and frontage requirements
Existing violations/expired permits resolved.
Plan check list data and revisions
sets of plans in accordance with changes marked in red
Copy of recorded 60" right of way to a public road
Other: Please see attached.
Should you have any questions concerning the above,
dk
An Agricultural Exempt Building Permit in Butte County may be issued for very specific
purposes. The use you have described for your proposed Agricultural Exempt Building is
not an allowed use. Please provide complete plans, and obtain permits for a storage
building.
J
dk
An Agricultural Exempt Building Permit in Butte County may be issued for very specific
purposes. The use you have described for your proposed Agricultural Exempt Building is
not an allowed use. Please provide complete plans, and obtain permits for a storage
building.
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES, BUILDING DIVISION
7 County Center Drive, Oroville CA 95965
Phone: 916-538-7541
RE : ,✓ DATE : �` D•S
A.P. # 0 l 00 `� 0<3
With reference to the above subject:
Attached is:
Application for permit Mobilehome Utilities Installation Sheet
Building Plans Mobilehome Installation Information Sheet
Engineered Calculations Typical Plan Sheet
Owner -Builder Verification Fm List of Codes Enforced
We need the following information prior to permit processing and/or issuance:
Permit application signed and completed where indicated with all copies returned.
Plot plans, 3/4 sets, signed by preparer of plans.
Complete plans, 3/4 sets, signed by preparer of plans.
Engineered plans and calcs, 3/4 sets, with wet signature on plans.
Hazardous Material Form
Energy Design Compliance and supporting documentation.
Statement'of Intent for Non -Heated and A/C Buildings.
Engineered truss details and layout in duplicate.
Mobilehome data and manufacturer's installation instructions, 2 sets.
Fees of $ , payable to Butte County Treasurer.
Impact fees paid.
California Department of Forestry plan approval/fees.
F.E.M.A. National Flood Insurance Program Elevation Certificate prepared by a licensed
land surveyor, architect or engineer.
Sanitation and plot plan approval Health Department.
City of Chico plumbing permit.
Plot plan and business license approval from City of Biggs/Gridley.
Planning approval, for
Land Development (a) Improvements (b) Drainage.
Driveway permit (approval of construction required prior to occupancy).
Contractor's license information (No. Name Style, Class) or exemption statement.
Owner -Builder Verification Form.
Recorded copy of Agricultural Acknowledgement Statement.
Letter of signature authorization.
Copy of recorded deed of parcel creation and 60' right of way to a public road.
Letter of intent on building use.
Mobilehome utility clearance.
Documentation of legal access.
_ Documentation of 50% subdivision developed or (a) Road improvements completed and
(b) Parcel meets zoning area and frontage requirements.
Existing violations/expired permits resolved.
Plan check list data and revisions.
sets of plans in accordance with changes marked in red.
Copy of recorded 60' right of way to a public road
Other: - f "tu 4�
Should you have any questions concerning the above, please contact
of this office.
Yo- rs very trt- v,
MiblYael C� Vieira, C.B.O.
MCV:ahb Man ger, uilding Inspection
BUILDING DIVISI(!41
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: (916) 538-7541
AGRICULTURAL BUILDING EXEMPTION PERMIT
Agricultural building is defined as follows: Agricultural building is a structure designe d constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This re shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public.
ASSESSOR PARCEL NO. 0 /1S _ s IQ a'� G
ZONING A e)o /1 �o S
OWNER )011(/0 6 O L`
PHONE NO. S3 3 s—? --s
OWNER'S ADDRESS 3®L/ �N=
LOA )f OF BUILDING
_ ULl�
tcx& \A -P e ` e e el
USE CkF BUILDING
SIZE OF STRUCTURE I �-
J_ — ' X = O SO. FT.
TYPE OF CONSTRR TION:
WOOD FRAME y STEEL CONCRETE-- OTHER (Specify)
TYPg OF SIQING
ROOF COVERING
TFLOOR TYPE
ESTIMATED C�T OF CONSTRUCTION
$ 42LO ft
AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the a?plicable County
Ordinances as follows: / -- -
FRONT SIDES �0 AM44V REAR � '4P6Af
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building.
AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a
mobilehome, and 40 feet from a commercial building.
AG Buildings must comply with Flood Zone requirements. Finish floor elevation must be at or above elevation '
USGS Datum.
I declare under penalty of perjury that the building will be used as stated above and the purposed use confirms with the
AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and
obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before
occupancy. /')
Date f0— 10 --Iy 11�1 Signature of Owner
Permit Fee - $60.00
Receipt No.406 -(C?
The above described AG Building is exempt from a building permit.
F- FLOOD PARCEJ! P.D. ROOF G ISS
Manager Building Division
By
White — DPW, Yellow — Assessor, Pink — B. I., Goldenrod — Applicant
Date
... •.� ..w.y+y-. .. ti :.Y..:�.1.-... ..� -•�; .. .. � � �y-..,,�_ltYr••Y4-n�4-Y'rT•yy.-.+•-.�^: +:.�,,`rJ�� .+.rr .........••.. r... � y ��. w.r' ...•sin � _
-COUNTYOF BUTTE - DEPARTMENT OF DEVELOPMir,-,NTSERVICES - BUILDING -DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 - TELEPHONE (916) 538-7541
OWNER _D A V
Proposed Building Use
PERMIT APPLICATION DATA SHEET
L
Building Inspector
0
No 0 O_S_ C�140'O
Date /a O Co
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1. All items have been submitted.........................................
2. Plot plans, 3/4 sets, signed by preparer of plans . ......................... .
3. Complete plans, 3/4 sets, signed by preparer of plans . ..................... .
4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5. Hazardous Material Form . ............................................
6. Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check). ....
9. Mobilehome data and manufacturer's installation instructions, 2 sets. ...........
10. Fees of $....................................... .
11. Impact fees as shown on attached schedule . ............................. .
12. California Department of Forestry plan approval/fees. ....................... .
13. Flood elevation letter (100 year flood) by California Engineer . ................. .
14. Sanitation and plot plan approval Health Department . ........... .
15. City of Chico plumbing permit. .............
16. Plot plan and business license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking: . ........
18. Contact Land Development about (A) Improvements (B) Drainage. .......... .
19. Driveway permit (construction approval required prior to occupancy). .. .. .. .
20. Pre -inspection for Pia"'e6UO" `eQO�
required. .. to Bu iai"9 Inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ......................... .
23. Owner -Builder Verification (Given to owner , Mail to owner _�. .......... .
24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . ....................................... .
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
27. Letter of intent on building use . ........................................ .
28. Mobilehome utility clearance . ......................................... .
29. Documentation of legal access . ..................... :.............
.... .
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . ......................................................
33.
34.
When you issue the permit, process as follows: to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver with inspector.
Other
/�, r ge O � � Applican 0'A;0&Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance
1. Index permit for above items No.
2. Additional items required:
(Circle new item not checked above).
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
y, 81P,E
PERMIT NO.
PERMIT EXPIRES A&
Gordon Bennett
• OWNER
CONTR. Lincoln Village NH's, Oroville
25-24-78
ASSESSOR PARCEL
LOCATION W/S Lone Tree Rd... app.l mi.N.of
Palermo Rd., Oroville
r
Temp. Pol er Pole
F Called PG&E
i
Temp. Elec. Service
i
Called PG&E A/�`.Ctic�i�J►.i�/�Gs^cdcao
t' Temp. Gas Servi e
i
CalledP &E
J
JOB
VFIN ED (Date) �
j
I
,1
i
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with the requirements
of the California Administrative Code, Title 25, Chapter 5, under permit
number for the following location:
Owner
Owner's Address
Mobilehome Mfg. Model Year
Insignia No. Serial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
Date _ By
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow - Installer, Pink - D.P.W.
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 534-4541
j 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.
/1)
�f' LSA ./�"1✓�/.lr_ .1 "' - v2:✓ �L .,.-(_.-.-�c� f/�/-'�i'�'— ��. G''.7�
G' ✓� ,� =/..—moi .G�..v�� .
Inspector \ ` •'/ �����' �-��1 2 -AV
Date �
V = OK
0 = Not OK
= Not Applicable
* = Not Ready RESIDENTIAL,(Sin gle and Duplex)
Date
UNDETtFLOOR Plans OK except #'s
Date
FRAMING (Continued)
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth I'
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4.
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 1
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
9. Gas Pipe; Size -Anchors
55.
Shear Walls; Nailing -Bolts
10.
11.
Water Pipe; Test -Anchors -Regulator -Service Test
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 Card -BI Date
Card -BI
Date Card -BI Date
Date
FINAL (Plans) OK except #'s
56. Ext. Steps -Door & Sidelight Protection Landings -
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except #'s
57.
Smoke Detector
14.
Water Ht.; Vent -Access -Combustion Air
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access _
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
64.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except #'s
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21. Elec. Receptacles Spacing -Lights &Switches at Doors
22.
Size Boxes & No. of Conductors -Stapled
70.
Plb., Elec. & Mech. Equip. Listed for Location
23.
Romex Installed Close to Edge of Studs & C.J.
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water
72.
Insulation -Foam -Looked in Attic E] Yes
25.
2 Appliance Circuits in Kitchen & Conductor Size
Guard Rails &Deck Construction -Post Caps
26,
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral ❑Yes ❑No
75.
76.
Following instld.: Drive E] Yes E]No; Walks El Yes ❑ No;
Planters El Yes 11 No
Stucco; Brown -Finish
28. Service -Riser Conductors & Ground -Main Disconnect
29. Equip. Clearances; Panels-Motors-Mech. Equip.
30.
Clothes Closet Light -Shower Light
77,
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
80.
Water Well; Disconnect, Electrical, Plumbing _
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Date Card -BI Date
81.
Ventilation throughout House
Card B -I
Date Card -BI Date
82.
Glass Protection
Date
MECHANICAL (Perrr,it) OK except #'s
31. A.C. Ducts; Insulation & Support
83.
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/0 to Grade -HD Approval
32.
Vent Fan; Exhaust above Insulation
gg,
Energy Compliance Certificate -Other Certificates
33.
Condensate Drain & Overflow; Size & Grade
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
X35.
Attic Access & Platform if Furnace in Attic
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FRAMING(Plans) OK except #'s
Comments at Final:
36.
Sills; Proper Material & Anchors
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38.
Bearing Walls over Girders & Floor Nailing
39.
Draft Stop in Walls (rat proof)
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
Header & Beam -Size & Bearing
+
42.
Hangers -Post Caps -Anchors -Connectors
43.
44.
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthnq.-Ring. _
Fireplace Ties or Type A Flue -Fireplace Throat
45.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
46.
Bdrm. Windows or Exiling Doors -Sill Hgt. & Dimensions
47.
Garage Fire Protection Framing
(NOTE: An entry must be made each time youvisit jobsite).
J = OK
0 = Not OK
= Not Applicable MOBILEHOMES MISCELLANEOUS
= Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except q's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
Zoning Requirements -Setbacks -Easements
1. Zoning Requirements -Setbacks -Easements
moils; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors
e r; Location -Test -Fall -C/0 o :2
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
at ocation-Test-Easement Needed Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rig.-Bracing
le'lflectricity; Location -Clea es- d.-/Z-OAmp-euncrete�,
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
-&r -@as; Location -Test -Wrap:/ /"L"ft./ /"Nat.or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
a—Villity Clearance
7. Elec.
Card -BI
Date !d Card -BI Date
Card -BI
Date Card -BI Date
Card-BIS42
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
MOBILEHOME INSTALLATION (Plans) OK except q's
Date
POOLS (Plans) OK except q's
oning Requirements -Setbacks -Easements
1. Setbacks -Easements
ooti gs; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
_ pReGigr-
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4--IE'rectricity; MH Test -Crossovers -Breakers -Clearances
4, Elec.; Receptacles and Lighting; Distances-GFI
!g 'n; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
ater; MH Test -Regulator -Connector
meter and Sewer C cted-C/0 to Grade -HD Approval
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7, Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
. &a nd le it agged
8. Elec.; Grounding; Equip. w/5' -.Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
xits; Insp.-Sketch
1 ert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B-10
Date 1,,71;91' Card -BI Date
Card -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
5W
OK
COUNTY OF,BUT�'E - DEPARTMENT OF PUBLIC WORKS PERMV
.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-45 /
APPEICATITIN AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMI��
OWNERyy��
le J) ,L JJ
TELEPHONE
SO. FT. OCC. BUILDING V UATION
OWNER'S MAILING ADDRESS
ONTRA TOR'S NAME /'
/ N G L ikk 1A L Ln g. e- hIL.&A t Han �a�� .
TELEPHONE
U7 -)71�
��• Q.li
CNTRf 6,N LLNGfA.tESSiZ
u'1/r i.
CONSTRUCTION LENDER
UNKNOWN
Fireplace
Total Valuation $S
'
LENDER'S MAILING ADDRESS
Permit Fee
0,,00
ARCHITECT OR ENGINE
LICENSE NO.
Plan Checking Fee M14
$ 10 d
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRIESS _
PLUMBING PERMIT
Filing Fee 3.00
L/IC
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
LOT NO.SUBDI
VISION NAME
PARCEL MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehomeX] Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installations Other ❑
Describe work:
(j ]—/ L d '66/
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service 1000 AMP ORV OR LESS5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELING
OR ADDNS. ( ACCLBLDGS.CCUP,&)
20sgft
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 fore and effect.
•� �yFIXED
License No. �7�Z% �/ Classification tJ
❑ 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
NEWCONSTNON-RESIT R BRANCH CIRCTITS) 2.50 ea
NEW NON-RESID, CONSTR.SINGLE OUTLET CIRPOWER APPARATUS
.&)
Ex. OCcup(OUTLETS OR FIXTURES 50@�
BAL�10Q
APPLNS, OR
Ex. Occup. OUTLETS (RESID,) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
!`-' I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
Filing Fee 3.00
Heating
Cooling
Hood
2.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabi ities, judgments, costs, and expenses which may in any ay accrue
st aid County in conse of a granting of this permit. S�
X Date J
Signature of Appli ant — Owner ❑ Contractor Agent ❑
An OSHA permit is required for excavations over 5' " deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $ ,(,�
Land Development Fee $
TOTAL PERMIT FEE $ 50.00
OCCUP. GROUP
TYPE OF CONST.
PARCEL
PD
HD
SSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
ECTO PUBLIC
+'
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date a
Receipt No. 79 Z -z—
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE
Departmerlt' of 'public Works `
7 County Center Drive
Oroville ----- 534-4541
ELECTRICAL INFORMATION -FOR DE -RATING MOBILEHOMES
Owner l—.1 d k JJ U N n8L NN E TT
Location
Mobilehome Installation Permit No.
FILL IN INFORMATION FOR ITEMS 1 THRU 10
Watts
1. Width I v?: x Box Length x 3 = 314 8
2. 2 Kitchen Appliance Circuits = 3,000
3. 1 Laundry Circuit ............................... = 1,500
4. Ovens = -
5. Cook Stove Top ......................`. ..... - l
6. Hot Water Heater .............................
7. Dishwasher & Disposal .......
8. Clothes Dryer ................................
9.
Other '(specify, i.e., motors, exhaust fans,
etc,)
Sub -total - Watts .....
First 10,000 watts @ 100% ................................ = 10,000
Remaining 0 61 watts @ 40% ....................... _
10. Air Conditioner ' watts @100%.. _) p
Largest Demand
rl Central Heat System M b b watts @ 65%.. - )
TOTAL DEMAND WATTS REQUIRED ........... CC U% o
"Demand Watts Required" + 230............ AMPS
De -rate Mobilehome to ..... ...................l�:�4?. T AMPS
BUILDING NPARTReN .
APPROVED
f
_ • : BUTTE COUNTY -DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
= PHONE:+534-4541
MOBILEHOME INSTALLATION SHEET
)v
1.
Owner's name: (Q/��n ►J�11�
2.
Installer's name: /%U 491 LC
3.
Is the site,. currently under permit? Yet / el No
(If yes, furnish permit number
) OR
Is the site an existing site? Yes / / No
(If yes, furnish two (2) plot plans.)
4.
Will the mobilehome be located at least 5 ft. away from
septic tank
and leach fields and
clear of all setbacks and easements? Yes No
(If no, clarify
)
5.
What is the mobilehome electrical rating? -----------------------
���
Amps
6.
What is..the mobilehome site service rating? ---------------------
Amps
7..
What is the mobilehome site circuit breaker rating? ----
--------
A ®
Amps
8.
Is there any other electric load to be served by the mobilehome
site service? ---------------------------------------------------
Yes cl No
/ /
7
0
(If yes, identify the load and size: U Pj/1
(Load)
(Amps)
9.
What is the mobilehome site gas pipe size? ----------------------
10.
What is the type of gas service? -----------------------------
Natural— LPG f--
11.
What is the gas pipe length from meter or tank to the mobilehome?
(ft o
demand?
(BTU)
12.
What is.the mobilehome gas ------------------------------
(This information not required if pipe length less
than 6 ft.
on natural gas
or less than 50 ft, on LPG.)
r 1 -
t
MOB ILEHOME'SUPPbRT DATA
�.
If other'than single wide,
Mobilehome Mfr._ U4/7 furnish Setup Model No. j0 0 ear
Width,- (ft.) Box Length=�W(ft.) Tagalong or Expando Size ft. x ft.
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets (if not on file with the County of Butte).
All center supports measured from front' of
mobilehome unless otherwise specified.
pV0 vi Dc C C 1,111W l PCE
L.i6C_t'5 -,CK)- /LI. -q - , �"^� Single
(ft.)(in..) (in.) (in
Footings (check one)
(Q- 1. Wood either.
77�c pressure treated or
foundation grade.
D 2. Other (specify)
Center support Cente support �11
locations* foo ng sizes Supports (check one)
(in.)
1: Concrete block.
(e 6 x 2. Other (specify)
(ft.)(in.) (in.) (in.)
Tagalong or Expando,'
show support details.
Jill I
��21 xo -- Typical Support
(in.) (in.) Footing Size
L�J �x-1
(ft.)(in.) (in.) (in.) �- -- Max. Pier Spacing
(ft.)(in.)
.J O -- Max. Overhang
(ft.)j(in.) (in.) (in.) (ft.)(in.)
BUTTE COUNTI
9UILDiNG DEPARTMtN.�
APPPOVeD
*If center piers are other than drawn above,
draw in -locations, spacing, and dimensions.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE IT j
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
ASSESSOR PA CE N B�
ME
2 -�
ZONI
�-
BUILDING PER IT
O NER
'D91DON �iENNt'TT
TEL•�PHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
YNTRACTOR'S NAME I
14 CO 04 Ulan Cc hu61IN 140 men
TELEPHONE
Z-3477?IJ
CONTRACT R'S MAILING ADDRESS -
ri & I m & Luo, oxo vIC&E - 4C, :
CONSTRUCTION LENDE
UNKNOWN
4
Fireplace
Total Valuation $
LENDER'S MAILING AD.DR ESS
Permit Fee
$
ARCHITECT OR EN GI ER
LICENSE NO.
Plan Checking Fee M, �U $ 0.00
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUIL I G ADDR S �
s SIJ P /1�1 / -
PLUMBING PERMIT
Filing Fee x,,00
y�
r D (= IQ /�-ay � G /`—D•
Each Trap
2.00
Repair drainage or vent piping
2.00
°I�/
Water piping
�p0
LOT NO. SUBDIVISION NAMEPARCEL
MAP
OZ-t5—,
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex❑ Mobilehome5a Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New Addition El Remodel❑ Utilities Installation❑ Other E]
Describe work:
Permit Fee
$ 30,00
Contractor
ELECTRICAL -PERMIT
Filing Fee /000
Main service 100 AMP ORSLESS'
5.00 6 -OO
Main service EA. ADO'L 100 AMP
2.50 ,5b
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ACC, SLOGS.
20 sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full; fore nd effect.
^3 G �
License No.32 (63 ` � 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 ULT' -OUTLET 2,50 ea
NO N.RESID BR A.C. CIRC ITS
NEW CONSTR. ( POWER APPARATUS &�
NON-RESID. SINGLE OUTLET CIR.
50 @ 25¢
Ex. Occup(O TS OR FIXTURES BAL N'10C
FIXED APP LNS. OR
(FIXED
Ex. Occup. OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 /s co
Misc. Wiring d/ii� 3 6.25 �� 96❑
_
Permit Fee $ rS O
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 3.00
Heating
Cooling
Hood
2.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application'and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
way accrue
all liabilities, judgments, costs, and expenses which may in �it
a aid County in co se ence o the granting of this perm
X may` Date
Signature of A plicant — 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 $
Land Development Fee $
TOTAL PERMIT FEE $ /
73 so
/
occUP. GROUP
I TYPE OF CONST.
PARCEL Pl
f�
No
5s0
This permit is hereby issued under
sions of the Butte County Code and/or
work. indicated above for which
DIR T R OF PUBLIC
By
P ll/EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date �(_�%ap�
::Z%—O
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
'NOTE --All Materials & Workmanship Shall Be in
Accordance with °econnized Good Practices anc4
of a quality prescribed for the Specified use in the
Uniform Building, Plumbing & Mechanical Codes
and the National Electrical Code. .
A setback of 5 ft. from the
-property lines and a setback
` =of 50ft. from the road
centerline shall be''dear of
structures or equipment ex�ept
for. a 2 ft. eave overhang. (n
Tis set of plans and'specifications MUST be
kept on the job at all times and it '
is un awful tc
make any changes or alterations on same with-
out written permission from the Depart ent of
Public Works, County of Butte. -
lie A�s
utte.-lie,el�5s ,
Utility connections shall be within
"�4 ft. of the mobil.ehome, either \
directly behind orwithin the rear
half of the roadside (left) of the b
� mobilehome.
A permit will be requir d. - for the e
in 14.1lation of the mobi hoa'i 4- � �
BUTTE COUNTY
BUILDING DEPARTMENT
_ t
ass. APPROVEP IL
� ,n iR l* • u.
4 �
aloft,
y
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATICIN ARD PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENDER UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER 11
LICENSE NO.
Plan Checking Fee
,$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 3.00
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
LOT NO. SUBDIVISION NAMEPARCEL
MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex❑ Mobi'ehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ❑ Addition u Remodel Ejj Utilities ❑ Installation[. Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service i610001 MP ORsLESS
5.00
Main service EA. ADD'L too AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS.
20 sq it
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1NON-RESID-
I am licensed under provisions Of Chapt. 9, Div. 3 of the BUSIneSS
and Professions Code and my license is in full force and effect.LN
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 I am exempt under Sec. , Business and Professions Code
for this reason
NEW CO ID R BRANCO CTRCTITS
2.50 ea
NEW CONSTR. /POWER APPARATUS d)
SINGLE OUTLET CIR . /
Ex. Occup( OUTLETS OR FIXTURES B Ca'SC
ALc�tos
FIXED A S.
Ex. Occup.(OUT ETSP(RESID )KEA.)
2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $
Contractor
MECHANICAL PERMIT
FiIingFee 3.00
WORKMEN'S COMPENSATION INSURANCE
1 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 emoloy 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 perm t shall be deemed revoked.
Heating
Cooling
Hood _
Ventilation
2.00
permit Fee
___._—___
Contractor
$
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Signature of Applicant — Owner G Contractor G 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 $
Land Development Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No.
WHITE-D.P.W., YELLOW-AS£F.SSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WO
7 County Center Drive - Oroville, California 95965 - Telephone 91 34-4541
. _ APPLICATION AND PERMIT
P/ II N 0
Af
AS; S R�y� L -y-up6pZ�A2>
BUILDING PE
OW �0VELJA I5 0 • n�OL�
//T
=�
SQ. FT. OCC. BUILDING VALUATION
N Fri `S M?5L I y D D R T ^ „ /�/ / /r►
/—�� /(`�+V�U /W!/!V.
CONTRACTOR'S NAME /V
.CA
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LE R
UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINE
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGIN ER'S MA`I-(LIIINVrG ADDRESS
Permit fee
$
BUI ING ADDR S
7 14 IPP.
PLUMBING PERMIT
Filing Fee 3.00
1b
r iTI'Le4 l0 P -D ,
Each Trap
2.00
Repair drainage or vent piping
2.00
Opt VILLIC
Water piping
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE,!
SF ❑ Duplex❑ Mobilehome❑ Other �G� r UMP
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New ® Addition ❑del [:1 s a� Inst�Dati� ❑ Other
Describe work: Lam'° (/C�� Irv'`—
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee '0.00
service OR LESS
1 00
100 AMP OR LESS
5•00 .00
Main service EA. ADD'L 100 AMP
2.50 ?ySv
NEW CONSDWELING O
OR ADDNST ( ACCLBLDGS.CCUP,&)
20 sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
�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)7-1419
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR ULTI-OUTLET
NON-RESID BRANCH CIRC ITS 2.50 ea
NEW CONSTR.POWER APPARATUS g
NON-RESID. (SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 50 25a
BAL�10Z
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
A4 J-00
Permit Fee $ 171,190
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 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
f Consent to Self -Insure.
fi 1 shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 3.00
Heating
Cooling
Hood
2.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
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
agains said County in consequence of the granting of this permit.
%� ' Date
-
I attire o pplicant — Owner El Contractor [DAgent❑
n OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 st ries in height.
Mobile Home Installation Fee $
Land Development Fee $
cb
TOTAL PERMIT FEE S7
OCCOP. GROUP
I TYPE OF CONST,
I
PARCEL
PD
HD
ssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
A
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date f'
��
Receipt No. 5I
WNITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT