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HomeMy WebLinkAbout026-100-004F_ - AP 26-10-04 STRI LNERDIN, Glen 1830 North Villa, Palermo Permit $# 1993-74 P,E ' (u t i 1.. 26-10-4 LOT BLOCK SUBDIV. contr: Oroville TraAer Sales, Orovill A Permit �Qk4�5-76MHI(exist ing site) TYPE IT PERMIT NO. PLAN NO. DATE IS Issued a' -02 - /% �/O�/Jl%� � REMARKS PERMIT -` - -- - .-. __ _ .�-.....---. 26-10-4 Permitt#4938-76P,E(relocate util.',MH)% PERMIT DESIGNATION: B -BUILDING DEPARTMENT OF P -PLUMBING T -TRAILER BUILDING AND SAFETY E -ELECTRICAL U -USE PERMIT TV - RADIO -TV ANTENNA V - VARIANCE S/W-SIDEWALK NOTICE S- SIGN PERMIT HM- HOUSE MOVING EP -ENCROACHMENT D - DEMOLITION 600.1 4 I PERMIT DESIGNATION: B -BUILDING DEPARTMENT OF P -PLUMBING T -TRAILER BUILDING AND SAFETY E -ELECTRICAL U -USE PERMIT TV - RADIO -TV ANTENNA V - VARIANCE S/W-SIDEWALK NOTICE S- SIGN PERMIT HM- HOUSE MOVING EP -ENCROACHMENT D - DEMOLITION 600.1 4 I INSPECTION RECORD BUILDING APPROVALS w W D aZ OZ 0(111- UOZ JLLO W UJ IL W y 2 Q IL O= Fg = 0 F(J W Ow F QJN ZIL Ow I F< 1�IL W �IY ZJ 0m Ul Q< KW l'1LL W Q IL E LL Q Z IL SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DAVE SIG. DATE SIG. DATE SIG. DATE SIG. DATE ,IIIII; 1.11lefw. rmi' I O]W., PERMIT NUMBERt SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE ROUGH -IN GAS PRESSURE TEST WATER PIPING SEWER LINE APPLIANCES Q VENTS FINAL ELECTRICAL APPROVALS PERMIT NUMBER SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE ROUGH -IN FIXTURES & APPLIANCES METERS FINAL MISUELLANEOUS APPROVALS PERMIT NUMBERt DESIGNATION SIG. DATE SIG. DATE SIG. DATE SIG. DATE 810. DATE PERMIT NO. 4938-76P,E PERMIT EXPIRES ;OWNER Glen Nerdin CONTR. owner LOCATION (A.P. 26-10-4 � .1830 N. Villa, Palezmo h. 1% Y. k ?jam Temp. Power Pole Called PG&E Temp. Elec.. Serv. '/FINALED �PG&E as Serv. %O_ /✓�� %l , pd PX4X- K lD/l✓�/� (D -ate) (Sig ature) �` Mesh MECHANICAL Grd. Fault Prot. ' Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Pennanen Door Closer Final Final Q DATE REMARKS OR CORRECTIONS z ��%� (NOTE: An entry must••be made on this form each time -you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS .y BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Pi in i Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwall Garage Vents Insulation Water Htr. Heaters ' Slab.. Carport Footings Prov. for physically handicaped Conformance of ex. structure Appliances Gas Pi in &Test Temp. Gas O /S" Slab Final Sanitation Patio FIREPLACE ' F I n a I /9r" Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures ' Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. ' Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Pennanen Door Closer Final Final Q DATE REMARKS OR CORRECTIONS z ��%� (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 OROVILLS, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapt. 5, .under permit number a �— %G` for the following location: �z Owner +'c. - --Owner's Address Mobilehome Mfg. Model Model Year Insignia No. 1.S6_ Ted / Serial No. 3 u �-X It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date —�/ /lam By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED 9. Electrical A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minimum of 100 amp) and other facilities on lot, i.e., water pumps, .!,"garage, cabana, etc.? . Yes X( No B. Is there proper clearances around panels? Yes_X No C. Is power supply cord or feeder assembly properly fused? YesX No D. Is continuity test satisfactory as per the following procedure? Yes No 1. De -energize electrical wiring system of the mobilehome at the pedestal. '2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test. instrument to the mobilehome grounding conductor and apply the other lead to each ra.obilehome supply°conductor, including neutral. 5. All non-current., carrying metal parts of the mobilehome (aluminum siding, gas line, water line) ,• including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder.assembly condu.6'tors. shall be connected to the site service equipment. A further continuity test 'shall then be made between the 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. 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle S,4 Length•Width%�_ Vehicle Serial No. State Identification No. O �� l% 4"X Additional.Informati_on or Comments: MOBIL EHOME INSTALLATION INSPECTION CHECK LIST 1; I's the mobilehome located with required separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.5085) YesX' No 3. Are footings 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) Yes 74 No 5. If m re than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No 6. Water A. Is fl xible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes -.2L No B: Test - Does water piping withstand working pressure or.50 lbs. air test? Yes No C. Backftow- is approved, does station have backflow device and pressure -relief valve? Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes No B. Does it have minimum 4' per foot slope and is it properly supported? Yes No C. Are any leaks detected in drainage system after runnin 3 -gallons of water through each fixture including washing machine standpipe? Yes No D. If Seach is nat' Srate ofCaliforniaa�roved doe.s_.station have required trap and vent? Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply 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 mobilehome gas Wine inlet without reductions other than the mobilehome connector. YesXNo B. Test OK as per following procedure? Yesx No 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 411 appliance vents properly installed? YesNo I .COUN,TY OF BUTTE — DEPARTMENT OF PUBLIC WORKS �� 7 County Center Drive — OroviIle--California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned pro for inspection purposes. X Date ignature of �Peermmiiteee or gentOF Receipt No. 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 PUBLIC WORKS BY R a " Date Building permit expires Date BUILDING Owner fry ��� SQ. FT. I OCC. BUILDING VALUATION Mailing Address 33 n LJi �YVVI� Rv O - ^A �� h� r Tel ,o -e Naa.. Fireplace Contractor Ow ki JEP Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address �7� >N PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 . W Each Trap 1.50 Repair drainage or vent piping 1,50 Water piping -9-59. Each gas water heater or vent 1.50 A. P.No. /0-- Zoning & Planning Gas piping system 1 - 5 outlets ^"fib oQ Each additional outlet .30 Fees W.C. Fire Dept. Fire Zone Use Permit Building sewer 4-e6 C-11, e EQA Parking Plans Parcel Declaration Parcel Ma 60' R/W Im provements Lawn sprinkler system 2.00 !' ��P Parcel �Opp�oval Plans royal Permit Fee $ O d NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE J$3.00 . 70 Main service 100 AMP ORSLESS 5.00 eo Main service EA. AOD'L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home F�l Others ❑ Main service OVER 600V 1100 AMP OR LESS 25.00 Main service EA. ADO'L 100 AM.P 1.00 NEW CONST. DWELLING OR ADDNS. ( ACC. BLDGS.CCUP, &) 20sgft NFW 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 the254 State of California Business & Professions Code under the name style of: • G23 E . Occup(OUTLETS OR FIXTURES) 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. 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. 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 MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ TOTAL PERMIT FEE $ �r C authorize representatives of the County of Butte to enter upon the above-mentioned pro for inspection purposes. X Date ignature of �Peermmiiteee or gentOF Receipt No. 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 PUBLIC WORKS BY R a " Date Building permit expires Date W S61 This set of plans ase MUST be kept on the ;^I-) at all times and it is unlawful to Make anv chancres or alterations on some without written permission from the Department of Public Works, Cour:fy of Butte. All utility connections shall be located within 4 ft, outside the. rear thin! section of the mobile home. on the left (road) side of the mobile home. BU.'ITE COUNTY BUILDING DEPARTIV W Art KO'VE® A permit wiff 6e1 required for t e A a irtctnllntinn �t.;�e .t to%iIF��, rho 4 . Setback hall be 5 ft..frorr rhe side property lie and 50 ft. from system and location &S' rhe centerline of tke road, .permitting to be as per maximum of a 2 ft. eave overhang County Health Dept. Re- encs. NOTE -,All .Materials .&' Workmanship Shall Be in V Accordance a�:ith _ Recognized Good Practices and of a quality- p'r�g cr��b,ed for the Specified use in the Uniform; Buils-i" ~P��imbinq & Machanical Codes and GI1011) the National-:E�ectrical..'Code. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS { 7 County Center Drive — Oroville, California 95965 Tel ephOne: 534-4541 APPLICATION AND PERMIT above BUILDING OwnertJ SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace ` Contractor O� 1 e s itia. Total Valuation Mai l i ng Address P P� 21V Permit Fee Plan Checking Fee &/or Penalty _ I✓ � 'P C'/�- � � phone e h� on N e. n , �o r Permit Fee $ $ / j Building Address 5 MOM- V 1 PLUMBING No. @ FEE PERMIT FILING FEE $3.00 ry� 00 r-. (:t) C C/clepJ1 %4 6 Each Trap 1.50 �601*k v o I, ( 1 Repair drainage or vent piping 1.50 Water piping 1.50 _ Each gas water heater or vent 1.50 ^ A. P. No. C;2 0 Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fes W.C. , on Fire Dept. Fire Zone I Use Permit Building sewer 5.00 EQA Parking—T—Parcel Plans Declaration parcel Ma P 60' R/W ImprovementsLawn sprinkler system 2.00 Bldg. Plans Recd Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 IuS'7ft i ah,) Main service 100 AMP 00V OR LESS RSLESS 5.00 (v'9E2 J Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home ® Others ❑ VER 600V Main service 0 0 AMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONST. DWELING OR ADDNS. ( ACCLBLDGS.CCUF. &) 2tsgft NEW CONSTR. MULTI.OUTLET NON-RESID. BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS & NON-RESID. SINGLE OUTLET C'R. CONTRACTORS LICENSE LAW 1 am licensed under the provisi s of Chapter 9, Div. 3, of the State California in rofes ons a under he name SL t Y -A 't Ex. Occup(ourLETs OR FIXTURES) BAL EX. OCCU FIXED APP LNS. OR P'(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No=24 /,940-4-Classificatio "` 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. 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 El 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 1 1 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to_4uilding construction, and hereby TOTAL PERMIT FEE $ aUL"or14U rC rederpt[a[er y 60nspection purposes, to enter upon the Date 7% Sign ture of itee/or Agent Receipt No. / j 7v 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 -PUBLIC WORKS li'lding permit expires Date This set of plans and s'Pocificafiont MUST kept on the job at all times and it is unlawful % make any changes or altercOinns on same w1fha t ritten permission from the Department of Public Works, County of Butte. V1 q /E(D�tte, -1 ' The W7. -Setback shall be 5 ft. fro W the side property line and 50 ft. fro the centerline of the road, permitting fla maximum of a 2 ft. eave overhang. IV) a t . 3 Septic system and location ii, n of Jw+IJ- 4� to be aser quirements, Bute CQunty Health Dept. Re- �v o o Vi d4 V `7 BUILD NGS DEPAR11aE 4 APPROVED �q_ `a- �' _ � ! � ••. .Tn -� ice, #�, ,. r BUTTE COUNTY.DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville,.CA. PHONE: 534-4541 MOBILEHOMEINSTALLATION SHEET 1%, Owner's name O 2. Installer's name: Is the site currently under permit? Yes / / No (If yes, furnish permit number )' OR Is the site an existing.site? Yes /ls/'' No e . . OROVILLE TRAILER SALES yeralva (916b334�68 Oroville. Calif. P (If yes, furnish two (2) plot plans.) i ,. 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 / '7 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? /�QG' Amps 8. ­Is there any other electric load to be served by the mobilehome sites service? ----------------------------------==.--------------- Yes / / No. ,.. (If yes, identify the load and size: (Load) (Amps) ' 9: What is the mobilehome site gas pipe size? 4.10. What is the type of gas service? ----------------------------- Natural / / LPG / 11. What is the gas pipe length from-meter.or tank to the mobilehome? AD (ft.) 12. Wha'Cis the mobilehome gas demand? -------------------- 7-7-- (BTU) (This information not required"'i'f pipe -length less than'6 ft. on natural gas or less than 50 ft. on LPG:) MOBILEHOME SUPPORT DATA Mobilehome MfrAU_a.i 4Setup Model No. Year Width (ft.) Length . �.�f- (ft:) Expando Size' ft.x ft. (Draw 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) . 9,Center Support Locations 1n . Cent r Support,. s Footing Sizes 4 (in.) J x in. 41 (ft lnl ..... 1e-- Single . , - ...... . . .. Footings--(check.one) %1. Wood :either , pressure treated or . .... fdn. '-grade.: /1` .2.:Concrete pad. 3. Other, specify Supports (check one) Concrete block 2. Concrete piers ��:.. 3. Steel piers / /.4'. Other, specify Typical Support /fix 3 Footing Size a in. .) . `in.) (in.) ' *If center piers are other than drawn above, draw in locations, spacing, and dimensions. Max. Pier. Spacing in. MOverhang in.) BUTTE COUNTY BUILDING DEPARTMENT APPROVED 7/ I W !PERMIT NO. P E M MH UTIL. !PERMIT NO. 1991-74P.,F. PERMIT EXPIRES -7 -7 �7 OWNER Glen Nerdin I CONTR. LOCATION (A.P. 26-10-04 1830 4koeibb-VUla, Palermo CID IV—` AtTA L- Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E i. JOB FINALED (Date) (Signature) I COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structure 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 Framing Test Water Htr. Stucco 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 DATE REMARKS OR CORRECTIONS COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORK 7 County Center Drive — Oroville, California 95965 / Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property or inspection purposes. X -Date S�—�%Al Signature of Per mitee or�;;L Receipt No. -z,�- 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 TUBLIC WORKS �r BY Date -6-7-7 -/ fading permit expires Date ........................? .�`� BUILDING Owner E X SO. FT. OCC. BUILDING VALUATION Mai l i ng Address 3 3 S G dS �/o/,1 0 A Telephone No. Fireplace v Contractor 404wov,!57 Total Valuation Mai I i ng Address Permit Fee Plan Checking Fee &/or Penalty Tlephone No. e Permit Fee Building Address/8 30 r PLUMBING No. @ FEE PERMIT FILING FEE $2.00 Q Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 1,S-6 Each gas water heater or vent 1.50 A. P. No. _ -�Z ZOn, n � g' Gas piping system 1 - 5 outlets 1.50 , Each additional outlet .30 F s ion Fire Dept. FireZone Use Permit Building sewer 5.00 S'.0 EQA Parking Parcel Plans Declaration parcel Ma P 60' R/W Imp rovements P Lawn sprinkler system 2.00 A/� I'dg. Plans Recd v Parcel At q Parcel A�.e�vet" Pla pproval Permit Fee $ $ QC NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 3.0 Main service incl. 1 meter`DD/l; ®p Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family ❑ Duplex ❑ Mobil Home Uff Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures1410 Receps., switches & fix outlets oT�25 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: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump , qct Mobil Home Facilities 5.00 e© Temp. Power Pole 5.00 License No. Classification Misc. wiring C 4 1 am exempt from the Contractors License Laws of the State of Califomia. Permit Fee $ C 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 x permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE ��J $e oC authorize representatives of the County of Butte to enter upon the above-mentioned property or inspection purposes. X -Date S�—�%Al Signature of Per mitee or�;;L Receipt No. -z,�- 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 TUBLIC WORKS �r BY Date -6-7-7 -/ fading permit expires Date ........................? .�`�