HomeMy WebLinkAbout026-122-007�. 26-122-7
F17,131
Stanhope"
vina, Palermo4712-77B,P,E,M(ne sing e
p74�t,01�-0237 M
SPERLING LIV TRUST._ A
x .%7131'PMELVINA; PA RM
OWNER .
WOOD BURNING STOVEof
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026'1 22-obl! t '+ f' 01 0237_ ,
SPERLING LIVING TRUST + f
`7131 1MELVINA, PALERMO 95968
y XONTR OWNER't
WOOD BURNING STOVE 4.
IF
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754f r ' " P IT NO.
(Rev. 12/96) APPLICATION AND PERMIT C11, -
ASSESSOR PARCEL NUMBER 026-122-7
ZONING
BUILDINGPERMIT
OWNER SPERLING LIVING TRUST
TAPS138
SO. FT. OCC. BUILDING VALUATION
OWNERS rM AWEVINA, PALERMO 95968
CONTRACfM12E
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $
00
ARCHITECT OR ENGINEER
LICENSE NO.
-
$ 20.00
—FilingFee
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Pian Checking Fee
$
BUILDING,n ji! MELVINA AVE, PALERMO
�11J11
Energy Plan Checking Fee
$
$
PERMIT FEE
$ rn
LOT No.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF XX 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 ❑ Other
Describe Work: WOOD BURNIGN STOVE
Gas piping stem 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service A OR ss ss
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 is in full force and effect.F0
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
5• 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 zooA TO
46.00
NEW CONST. WNG OCU
DWEOCCUP.
OR ADDNS. ( 8 ACC. S.
SO
3.50FT.
T.
NON-REOSID. MULTI -OUTLET
97.50
EPPARATUS
8 SINGIER AOUTLET CIR.
Ex, Occup. OUTLET OR FIXTURES
BAS @.5000
Ex. Occup. ORESID.OEA
FunEis
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
S
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
❑ 1 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
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
)I& 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 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
fort4with comply with those provisions.
Xt' r �7 -rte iT Date r /
Sigriature of Applicant - ❑ Owner. ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in
Mobile Home Installation Fee
$
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $55.00
HAZ.
D. FEES IMP
I FLOOD
I CDF
I PARCEL
PD
HD
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
/
By
PERMIT EXPIRES ON art
the applicable provisions
Resolutions to do work
been paid.
Date.
- 7
eta
1height.
Receipt No. CY �/
WHITE-D.D.S.-B.D. CANARY -ASSESS R PINK -INSPECTOR GOLDENROD -APPLICANT
-_ `i
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
.11 t. County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 026-122-007
L
ZONING
BUILDING PERMIT
OWNER SPERLING LIVING TRUST
X11138
SO. FT. OCC. BUILDING VALUATION
OWNERS-MIJ AMITsVINA, PALERMO 95968
CONTRALMN{1g1,1E
LMAILING
TELEPHONE
CONTRACTORS ADDRESS
CONSTRUCTION LENDER
[Fireplace
1900-00
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 35-00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING Tr MELVINA AVE, PALERMO
Energy Plan Checking Fee
$
PERMIT FEE
$ 55.00
LAT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 1 20.00
USEOFSTRUCTURE
SF M 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 ❑ Other
Describe Work: WOOD BURNIGN STOVE
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
V OR LES
Main Service . ' 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 is in full force and effect.POWER
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
Main Service 200A To 1000A
46.00
NEW CONST. DW rG OCCUR
(
3.5Qso
NEW CONST. MUiTCou�SS.
NON -REBID. TL
@7.50
APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FDRURES
.00
BAL @ 1. 0
Ex. Occup. DFIx
ux,EEDA As ORS
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
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
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
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
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
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 workers'
compensation laws of California, and agree that if 1 should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
fol with comply with those provisions.
X,_ s� Date
Si ature of Applicant - ❑ Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 55.00
HAZ.
1 D. FEES IMP
I FLOOD
I CDF
I PARCEL
PD
HD
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.
By Date
PERMIT EXPIRES ON �'�
(Date)
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
LLQ^
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
- ',County Center Drive a Oroville. California 95965 • Telephone (530) 538-7541 PE!!f
IRay.12/96l APPLICATION AND PERMIT `" '
asnam►,r>eeLWAS ' -- 9L 09 7
Solon
BUILDING PERMIT
6Pa�LIA/ j 4101A)67 u5 T
E
SC. FT. OCC. BUILDING VALUATION
'75a""u
w..b ,tee.
4V ImaAJ19, A - l >) 9o7 &
co"nuw"I ,w�a �oorrQe
ao►rins+c+rorr uaoa
uvoors Asa AM=$
Fireplace
Total Valuation S
""01dn= OR DOWN=
uCVAQ "o'
Firina Fee = 20.00
Permit Fee
Rik+eeat an Zmo&MV YAaaa „oma
Plan Checkina Fee i
Energy Pian Checking Fee i
i
PERMIT FEE : ,Q 61
�T Ro
sueavrssrrs wue
Huta MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF Duplex O Mobilehome O Other
Each Trap 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 O Addition O Remodel O LN11dess 0 IndRlation O Oh/eryy0
Describe Work:
Gas piping system 1 -5 outlets 15.00
Building sewer 15.00
Moble Home S G W 19120.00
PERMIT FEE S
ELECTRICAL PERMIT Fiting Fee 20.00
Main Service =LUES's 23.00
j�PERMIT
*PERMIT FEE PAID �c7 ��C/
SRA $
S
SHERIFF
OTHER $
$
$
AMOUNT RECEIVED $ L��d�
*RECEIPT NUMBER
* TO BE PVT INTO COMPUTER
rvice 20" TO 1~ 48.00
.ownA.04 occua. a AM. erns.
MW GUM YuLnoun.eTRANCH CIRCUM @7.50
.00
u . oun" OR RnuRO y� a �M
r
u . ounm p a 5.00
Service 23.00
ome Facilities 20.00
irin 23.00
FEE _
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood e.so
Ventilation
PERMIT FEI: S
Mobile Home Installation Fee $
Energy Inspection Fee i
"`
`°"�T n�
TOTAL FEE $
""Z
o. rfa
"'
RM0
`°`
'""a
'°
HD
%A
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.
By Date
PERMIT EXPIRES ON
Date)
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 . oppoitunity : 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(} NO[ I
I HAVEI,] HAVE NOT[ ] signed an application for a budding permit for the
r proposed w" of .
3. 1 have contracted with the following person. (firm) to provide.:. -the 'proposed
construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO:
4. I plan to provide portions of this work, - but I have ' hired the following peisow to
coordinate, supervise, and provide the major work: '
NA11IE: 7
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
5. I will provide some of the work but I have contracted (hired) the following. wsons to
provide the work indicated: `=>
NAME ADDRESS PHONE TYPE OFVOLK=
SIGNED: - --
PROPERTY OWNER:
SOCIAL SECURITY.. NUMBER:_
DATE:
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California Health and Safety Code. ...':s �,.
This verification must be completed and returned to our office before
we are permitted to issue the permit.
.f'
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
property improvements specified
For your protection, you should be aware that as "owner -builder" you are the responsible party of. record
on such a permit. Building permits are not required to besigned by property owners unless they are personally
performing their own work. If your work is being performed by someone other than yourself, you may protect
yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all permits
for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to'subcontract, you
should be aware of the following information for your benefit and protection:.
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including
materials and other costs) is $300 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social saarrity taxes,
workerscompensation insurance, disability insurance costs, and unemployment compensation contbutions.
0 There may be financial risks for'you if you do not carry out these obligations,°and these risks are especially
serious with respect to worker's compensation insurance. `
0 For more specific information about your obligations under Federal Law, contract the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific informarion'about your
obligations under State Law, contact the Department of Benefit Payments and the Division'of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors. are allowed to
perform their work personally or through their own employees, without a licensed contractor or subcontractor, only
under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbuilder"
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing their ow'n'
work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License
Board in your community or at 1020 N Street, Sacramento, CA. 95814.
PIease complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm.
that you are aware of these matters. The building permit will not be issued until the verification is returned
i ly,
Mic el C. Vi ira, C.B.O.
Madager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
4 7 2,Z _77 P','E
PERMIT NO.
—:i
PERMIT EXPIRES 7/71
OWNER William Stanhope
CONTR. owner
LOCATION (A.P. 96-199-7
7131 Melvina, XHK, Palermo
Temp. Power Pole
Called PG&E
Temp. Elec. Serv-
Called PG&E
I P
Te, . Gas Serv.
Calfed PG&E
OB a0/��
INALED
(Date)
Ze,
(Signature)
COVNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Under round
Interior Lath Ventilation Permanent
Door Closer 1 V Final ..7 7 gVfiW IFinal
MOBILEHOME UTILITIES ------------------ Elec- Service Elec. Pedestal
Water Piping Sewer Gas Piping
MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE —REMARK_S OR CORRECTIONS
Oen",l �/ -
/001
1/.2/7
(NOTE: An entry must be made on this form each time you visit the job site.)
BUILDING
BUILDING (Con '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
1r/4Wx,
Roof Sheathing�,
Water Piping
Piers
Roofing 7
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwall
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for ph sical y
handica a --��
Conformance of ex.
structure
Appliances
Gas Piping
Temp. Gas
&Test
Slab
Final
Sanitation
l 24 7
Patio
FIREPLACE
Final
Footings
Footina
ELFCTRICA1—
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLE
Motors
Framing
Test
Water Htr.
Stucco
/
Final
Suhnannit
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Under round
Interior Lath Ventilation Permanent
Door Closer 1 V Final ..7 7 gVfiW IFinal
MOBILEHOME UTILITIES ------------------ Elec- Service Elec. Pedestal
Water Piping Sewer Gas Piping
MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE —REMARK_S OR CORRECTIONS
Oen",l �/ -
/001
1/.2/7
(NOTE: An entry must be made on this form each time you visit the job site.)
A
Fiber' ass l nsu Anion
BUILDERS INSULATION STATEMENT
BLOWN INSULATION
Manufacturer's minimum thickness to provide the level of insulation
resistance (R) Values as shown: ,
' R Values are determined in accordance with ASTM C-687 and C-236.
Conforms to Federal Specification HHI-1030A.
This insulation has been installed in c of rmance with the above recom-
mendations to provide a value of R '" usingbags of insula-
tion to cover square feet. of area:
Insulation' Contractor (Sign) Builder
Company Name Company Name
' �l-3 - 7%
BATTS AND BLANKET ; Date
R
INSULATION
'R
INSULATION
VALUE
THICKNESS
VALUE
THICKNESS
R-22
61/2"
R-13
35/e"
R-19
6"
R-11
31/x"
Meets Federal
Specification HHI-521E
Fiber glass Batts or rolls have been installed in accordance with the
manufac urer's recommendation to provide an R. -Value of ! in the
ceiling,in the exterior walls, in the floor or crawl space
.perimeter. o
Insulation Contractor (Sign) Builder (5 6'
4
Company Name Company Name
7
CSG -32-11-C Date
.�
.,16,
1 : 1
CERTAIN -TEED PRODUCTS CORPORATION.. 60X•860 VALLEY FGE*PA X482
-• • ,� ` `' CERTAIHIEE0
COUNTY OF BUTTE '= DF-PARTMENT OF PUBLIC WORKS
7 County Center Drive - Uroville, California 95965 ---777
-7
Telephone: 534-4541�
APPLICATIQN•AND PERMIT
auuIU[ rcC IePluzcniauves or tfle t,ounty or butte to enter upon the
above-mentioned property for inspection purposes.
X r� Date l�
Signatureof Peerrmitee or Agent
Receipt No. ✓/� /�9r
White-D.P.W. — Yellow-Asse sor — 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 G'F)PUBLIC WORKS
BY Date__:Z- %-7 - 7 7
Building permit expires Date %- 7- 1 d7
im
BUILDING
Owner a e
OCC. BUILDING VALUATION
va
Mailing Address as'�
XFireplace
Teleph ne No
Contractor-, i , 14 n `
Total Valuation Z 68
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
Building Address 3 /PLUMBING
No.1 @ FEE
PERMIT FILING FEE $3.00 ,O'$
Q V111A Sd
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50 ,S
y� -,y�
�G (> Zonbg Verific ion IY
`lr
Each gas water heater or vent 1.50 ,
A. P. No (p
- , r
g
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F e elsl
W.is t
ire Dept.
FireZone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
I Parcel
Declarati
parcel Ma P
60' R/W
Im rove is
P
Lawn sprinkler system 2.00
Bldg. Plans Rec'd T Parcel A proval
Plan . Approval
Permit Fee $
$ If
NEW 54 ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
i
PERMIT FILING FEE $3.00
Main service 600V OR LESS5•00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
OVR Main service 100E
EAMP oR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00NEW
'
q
OR ADDNS. ( DWEACCLBLDGLING SO. ) 20Sq ft
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
style of:
Ex. OCCUp(OUTLETS OR FIXTURES) 50 BAL�
FIXED APP LNS. OR
Ex. Occup. (OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. �- Classification_
Misc. Wiring 6.25
0 f am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$'s, Q`
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.
1I 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 "3,00
Heating
Cooling
47 Ll ,i P3�or�
Ventilation
Hood T 2.00 d�'O
Permit Feq $ �,c-o
$ /,,7 T&z
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
A4 4/�
Ot
TOTAL PERMIT FEE
$f 79f I
auuIU[ rcC IePluzcniauves or tfle t,ounty or butte to enter upon the
above-mentioned property for inspection purposes.
X r� Date l�
Signatureof Peerrmitee or Agent
Receipt No. ✓/� /�9r
White-D.P.W. — Yellow-Asse sor — 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 G'F)PUBLIC WORKS
BY Date__:Z- %-7 - 7 7
Building permit expires Date %- 7- 1 d7
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