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Home My WebLink About025-310-003■ 2 5 -29SEM 3:1--03 Willard R. Campbell W/S Pyr House Hill Rd., app.3/8 mi.S. Palermo Rd., Palermo #2 Permit 3 �8-77P,E(u .MH ELEC . 6 • GAS l! SUPPORUCTU �IK EQ. CON E REQ. ZD 25-23-40 Permit #23 - 7MH� ISSued _ _ ---- 25-23-40--_-_--.__ erwit #4606-77D(,reinstell awning/ldj) 2 5 PERMIT NO. 2388-77P,E - PERMIT EXPIRES j !OWNER Willai R. Campbell ',CONTR. owner %LOCATION (A.P. 25-23-40 W/S. Power House Hill Rde app.3/8 mi.S.of.Palermc Rd., Palermo •V r I Jo e f Temp. Power Pole ` , Called PG&E Temp. Elec. Serv._; Called PG&E ! Temp. Gas Serv. Called PG&E 4•'�� JOB FINALED ` t (Date) j (Signature) • Y t 9. 'Electrical A: Is service large enoilgh to provide adcquat:e amperage to mobilchome (must equal rating of mobi_lehome (iith a ,:ii-nL;1um of 1000 -'P) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes (►, o� 1;. is there proper clearances around panels? Yes_r/No_ C. Is power supply cord or feeder assembly' properly fused? Yes o . D. Is continuity test satisfactory as per tilesfollowing procedure? Yese- __st 1. De -energize electrical wiring system of the mobilchome at the pe 2. Make sure that the power supply cord or feeder assembly conductors, including neutral c.onduc•tor, have been disconnected, 3. Switch all breakers and switches in the mobilchome to the "on" position: 4. Connect one lc:ad of a'test instrument to the mobilehome grounding conductor and apply tiie lean t.0 each Cl1u i'leilulfLe Siippty CunUa'ctor, ilicli.iditig netjLrai.. 5. All nor.-cllrrent, carrying metal parts of the mobiiehome (aluminum siding, gas line, water line), including fixtures and -appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon coripleticn of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity te;L ;hall then be made between thea grounding electrode and the chassis of the Mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. job card si-ned by health Department for water. and sanitation? 11. If everything olray, sign off card and ta; services. iUBTLi ;tUt?L DATA Manufacturer and/or Namestyle Length Width Vehicle Serial No. State Identification No. Adel,itional Infoz-nation or Comments: 10 M0BTi,laiUitG IPdS7'ALLATION INSPECTION CHECK LIST 1. Is the. mobilehome: locatcd wi.!-hrequired separat-ion from lot lines and buildings and generally conform to plot plan? y(!S f/No 2, hoes the mobilehome have required clearances above ground? (Sec.5085) Yes,/ No 3. Are foot.in�,s and supports properly sized, spaced, and braced as per approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes-- No_ 4. Is the mobilehome level.? (Sec. 5088) Ycsl/— No 5. If morj'than a single unit, are crossover connections properly installed? (Sec. 5088) Yes: No a. Water A. Is flexy5le connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes t__140 C. Backflow - If coach s/ State of California approved, does station have backflow device and pressure-relie /al e. Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes 4�No B. Does i.t have minimum per foot slope and is it properly supported? Yes_ vo_ C. Are any leaks detected in drainage system after running 3- llons of water through each fixture including washing machine standpipe? Yes_ No D. If coac i. t State of California approved, does station have required trap and vent? Yes 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas siipply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobile' e gas line inlet without reductions other than the mobilehome connector. Yes No B. Test OK as per following procedure? Yesy Ydo 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. :3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes No COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD \ BUILDING /1\ BUILDING (Cont'd) n\ PLUMBING Settack F ewall S 1 Piping For Par pets 7 t Floor Mai Bldg. Rest om Finish 2n Floor Fo tins Windo 3rdNoor Stem all Sidin To out Slab Roof Shealbing Water Pi i Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwa I I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings V Prov. for phsical handica ed Conformance of ex. structure V Appliances Gas Piping &Test Temp. as Slab. A Final A Sanitation Patio FVIREP 'ACE Final Footings Footin E ECTRIC L Masonry Walls Throat 4 Rough Reinf. Steel I Final FlYtoras S d. FaAlt Prot. rvi T p. Pole nderaround � oor Closer Final inaI MOBILEHOME UTILITIES ----------------- Elec_ Service Elec. Pedestal Water Piping ' Sewer Gas Piping vZ E ME INSTALLATI N - - - - - - - - - - - - - Support Elec. Continuity _ Water Piping y Drainage Gas Piping ri /6f j DATE REMARKS OR CORRECTIONS /%A jr 0040— *.L uw (NOTE: An entry must be m de on this form each time you visit the job site.) ? COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Orovi Ile, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT �U.I IVIILO IcNlwcn wu vao UI lI Ic l�Uunly UI DUMC w enter upon 1ne above-mentioned property for inspection purposes. X DateS-17-71- 114 Signature o rmitee or�Agent Receipt No. / ��por White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0 PUBLIC WORKS By Date 6 —7 — 7 % rlding permit expires Date 6 —7— 7Z BUILDING Owner �J SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address lot I -5- Tel hone. Fireplace Contractor Total Valuation Ln Mailing Address Permit Fee Plan Checking Fee &/or Penalty Tlephone No. e Permit Fee $ $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 .2 t ✓ Each Trap 1.50 l ! Repair drainage or vent piping 1.50 �q Water piping 1.50 Or:3••r) Each gas water heater or vent 1.50 A. P. No � 3 " Lo-Zoni Gas piping system 1 - 5 out 1.50 Each additional outlet 30 Fees W. . S i on Fire Dept. Fire Zone Use Permit Building sewer 5.00 d ,� EQA Parking Plans Parcel Declara ' 'Parcyl Ma P 60' R/W improvements P Lawn sprinkler system 2.00 Bldg. Plans Recd Al UoYIE1*1 A p p r:o:v:o= P I a proval Permit Fee $ 49e - NEW NEW ❑ ADDITION ❑ UTILITIES, OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 5.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home ® Others ❑ Main service R 600V 1100EAMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 CONST.NEW ( DWELLING & OR ADDNSACCBLDGS.\ 2¢sgft / NEW CONSTR. MULTI.OUTLET NON-RESID. BRANCH CIRCUITS) '2.50ea • ' NEW CONSTR. ( POWER APPARATUS 8 NON-RESID. l SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: ' Ex. Occup(OUTLETS OR FIXTURES)@2`# BAL@1 Ex. Occu FIXED APPLNS. OR P• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. Elhave placed on file with the County of Butte a certificate of 'workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner �so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the aboveot information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TO AL PERMIT F E $ �U.I IVIILO IcNlwcn wu vao UI lI Ic l�Uunly UI DUMC w enter upon 1ne above-mentioned property for inspection purposes. X DateS-17-71- 114 Signature o rmitee or�Agent Receipt No. / ��por White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0 PUBLIC WORKS By Date 6 —7 — 7 % rlding permit expires Date 6 —7— 7Z t 47 The �. Setback shall be 5 ft. from ffie side property line and 50 ft. from the centerline of the road, permitting a maxi- mum of a 2 ft. eave overhang but entirely ut of a�lj easements. - NOTE:—AII Maerials & Workmanship Shall Be in Accordance wiff Re ognized Good Practices and 3p of- a quality pre crib d for the Specified use in the Uniform Building, Plumbing & Mechanical Codes and q, the National Bec trio l Code.. \ 'kill 6- .14.9 70; A An This'set of p) ns and specifications MUST be o�,00� fie kept on the iob t all times and it is unlawful to make any'ch nq s or alterations on some without wriften per issio T from the Department of Public Works,' Cou 4y Butte. Septic system and location 4�_.- .�s.,�,e to He as per Butte County Health Dept. Re- quirements. � D 0141 All utility connections shall be located Me4in 4 ft, outside the rear third section of the mobile home on the left (road), side of the mobile home. BU 17E COUNTY zUIL�l G D► PARTMENT P:R R O V E D r�Y , R COGNTY OF BUT—TE' — DEPARTMENT OF PUBLIC WORKS - - 7 County Center Drive — 'OroviIle, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT �-) 2P? -, 7 7 authorize representatives of the County of Butte to enter upon the above-mentioned propertyyfffoorr inspection r - X "'6 p 7-27 " Signature epi g Agent Receipt No. Sal/Q(' White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF ELIC WORKS By Date --6 Bu ding permit expires Date % %P BUILDIN OwnerVA4 fli CA6��0�1 SQ. FT. OCC. BUILDING VALUATION Mailing Address rlez Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address 9641.,W PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 t 3 %ini% s Each Trap 1.50 ir Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. n // sc 2 3 '" "� Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Feekf W. Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W ImprovementsLawn sprinkler system 2.00 Bld n c' P a r c e proval Plans q proval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 �® 0V OR LE Main service 1000 AMP ORSLESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 25.00 100 AMPP OR LESS O Main service EA. ADD'L 100 AMP 1.00 NEW CONST. ODWELING R ADDNS. ( ACCLBLDGS.CCUP. &) 22 sq ft NEW CONST. MULTI.OUTLET NON- RRESID. BRANCH CIRCUITS) 2.5Oea NEW CONSTR. (POWER APPARATUS &), NON RES D. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name st le of: y Ex. Occup(OUTLETS OR FIXTURES)50 @250 109 Ex. Occu FIXED APPLNS. OR p•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 FT I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ 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. jj I certify that in the performance of the work for which this /", "••permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 30 I TOTAL PERMIT FEE $ O �Z authorize representatives of the County of Butte to enter upon the above-mentioned propertyyfffoorr inspection r - X "'6 p 7-27 " Signature epi g Agent Receipt No. Sal/Q(' White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF ELIC WORKS By Date --6 Bu ding permit expires Date % %P MOBILEHONE SUPPORT DATA Mobilehome Mfr. ZZIX-Y4 -A Setup Model No. Year/ Widthf .(ft.) Length (ft.) Ex:�� Size ft.X ft. (Draw support� details below),' - On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's instatil'ation manual.and.structural setup sheets (if not on file with the (;ounty of But .jte).. Sin le Footings (check one) x in. ) )'In. -Tin.) 'X I *If center piers are other than drawn . above, draw in locations, spacing, and dimensions. Wood either pressure treated or fdn. grade. LL 2. Concrete pad. 3. Other,_ specify j Supports (check one)* 7're - l..Concrete block TT A Concrete piers 3.. Steel piers 4. Other, specify - 2.L Typical Support Footing Size k in. k in. Pier Spacing (ft.) Cifi'.0 Max. (ft.* in. I Pic WV SnOm 011and dO -1d3(3 3—i,n8 JO kiNnoo M, Center Centerupport Support Foot' g Sizes Locationsl f E. -I 2, n (i (in.) x in. ) )'In. -Tin.) 'X I *If center piers are other than drawn . above, draw in locations, spacing, and dimensions. Wood either pressure treated or fdn. grade. LL 2. Concrete pad. 3. Other,_ specify j Supports (check one)* 7're - l..Concrete block TT A Concrete piers 3.. Steel piers 4. Other, specify - 2.L Typical Support Footing Size k in. k in. Pier Spacing (ft.) Cifi'.0 Max. (ft.* in. I Pic WV SnOm 011and dO -1d3(3 3—i,n8 JO kiNnoo M, r W/9Y'PARTMENT OF PUBLIC WOR ress �� ler Drive, Oroville, CA �l (� /9 9 % JE: 534-4541 ION SHEET e 1. Oumer's name: tAI1L.,Lk.,4LVN NL 2. Installer's name: t .E'er•` 3. Is the site currently under permit? Yes /' / No .(If yes, furnish permit number ) Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) OR 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) clear of all setbacks and easements? Yes /' / No (If no, clarify ) 5. What is the mobilehome electrical rating?�/ -� Amps 6. What is V the mobilehome site service rating? --------------------- Amps 7. What is the mobilehome site circuit breaker rating? --- Amps 8. Is there any other electric load to be served by the mobilehome Z-1�----------------------- `r/ site service? ------------------ Yes / No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? -------- -------------- (in.) 10. What is the type of gas service? ----------------------------- Natural / / LPG 11. What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. What is the mobilehome gas demand? ------------------------------ (BTU) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) FRANK V. CAMPBELL (1892-1971) FRANK L. CUSTER (1902-1962) AUSTEN D. WARBURTON A. B. BRITTON, JR. WILLARD R. CAMPBELL JOHN R. FITZSIMMONS, JR. C. MICHAEL SMITH WILLIAM T. -BROOKS RALPH E. MENDELL LAURENCE J. Mc EVOY MICHAEL G. ACKERMAN TERRENCE P. Mc MAHON I CAMPBELL,WARBURTON, BRITTON, E s ". FITZSIMMONS 8 .SMITH AREA CODE 408 ATTORNEYS AT }LAW TELEPHONE 295-7701 EIGHTH FLOOR, FIRST NATIONAL BANK BLDG. P. O. BOX 1867 SAN JOSE, CALIFORNIA 95109 May 13., 1977 TO WHOM IT MAY CONCERN: This is to authorize LEROY McKEE to make. any necessary inquiries and to execute any necessary documents on behalf of.the undersigned for the purposes of obtaining the necessary permit, licenses and any other type of permission to place a habitable mobile home on property of the undersigned, which property bears assessor's parcel no. 25-23-0-40-0 and is located on the westerly side of Powerhouse Hill Road, approximately 11'300 feet south of its intersection with Palermo. Dated: WILLA D R. CA14PBELL WEVE' A. .. 4 FRANK V. CAMPBELL (1892-1971) FRANK L. CUSTER (1902-1962) AUSTEN D. WARBURTON A. B. BRITTON, JR. WILLARD R. CAMPBELL JOHN R. FITZSIMMONS, JR. C. MICHAEL SMITH WILLIAM T. -BROOKS RALPH E. MENDELL LAURENCE J. Mc EVOY MICHAEL G. ACKERMAN TERRENCE P. Mc MAHON I CAMPBELL,WARBURTON, BRITTON, E s ". FITZSIMMONS 8 .SMITH AREA CODE 408 ATTORNEYS AT }LAW TELEPHONE 295-7701 EIGHTH FLOOR, FIRST NATIONAL BANK BLDG. P. O. BOX 1867 SAN JOSE, CALIFORNIA 95109 May 13., 1977 TO WHOM IT MAY CONCERN: This is to authorize LEROY McKEE to make. any necessary inquiries and to execute any necessary documents on behalf of.the undersigned for the purposes of obtaining the necessary permit, licenses and any other type of permission to place a habitable mobile home on property of the undersigned, which property bears assessor's parcel no. 25-23-0-40-0 and is located on the westerly side of Powerhouse Hill Road, approximately 11'300 feet south of its intersection with Palermo. Dated: WILLA D R. CA14PBELL WEVE' A. .. PERMIT NO. 4686-7.7B is PERMIT EXPIRES Willard R. Campbell OWNER CONTR. owner LOCATION (A.P. 25-23-40 W/S Power House Hill Rd.,app.3/8 mi.S.of Palermo Rd., Palermo I t Temp. Power Pole Called PG&E Temp. Elea. Serv. Galled PG&E Te p. Gas Serv. Called PG&E JOB FINALED n COUNTY OF BUTTE = DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING I BUILDING (Cont'd) I PLUMBING Setback CzFirewall Soil Piping Forms V Parapets list Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor StemwaII Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for phsically handicaped Conformance of ex. structure Appliances Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors awcco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping BILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) ' COUNTY OF BUTTE' — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 1900,� Tel2ptione:o534-4541 -APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date f- / Signatur of Perrimitee or Agent Receipt No. X /5 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 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. DIRECT O)� PU IC WORKS / BY Date �d Building permit expires Date BUILDING Owner e� �/ SQ. FT. OCC. BUILDING VALUATION Mailing Address P _telephone J--�--- No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address.S PLUMBING No. @ FEE PERMIT FILING FEE $3.00 3 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. L5 —,23 — a Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W.C. S tion FireDept. FireZone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Im rove is P Lawn sprinkler system 2.00 Bldg. Plans Recd Parcel Ap oval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP OR00V OR LE LESS5.00 Main service EA. ADD'L too AMP 2.50 ER 60 Main service 10 0 AMP OR LESS 25.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 1.00 NEW OR ADDNST ( ACCLBLGLING OCCUP. &) 2¢sgft NEW CONSTR. MULTI.OUTLET NON.RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS & NON.RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name st le of: Y Ex. Occup(OUTLETS OR FIXTURES) BALL1 Ex. Occu FIXED APPLNS. OR P•(OUTLETS (RESID.1 EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 IN I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE ' PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 Date f- / Signatur of Perrimitee or Agent Receipt No. X /5 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant 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. DIRECT O)� PU IC WORKS / BY Date �d Building permit expires Date