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Home My WebLink About026-181-007� ^ � Elmer Elam @ Y 2110 William im 91NIP7 e. , Palermo PermitJ NT c OR KV 0] GAS SUPPOI(T STRUCTURE COMPACTION TEST REQ. tc: - 26-181-7 Permit #3901-76mHi ---___-_---------_-,�~.-_d � ` r � \ � � ' _-..--� - .,.. - _1� f ' . .. COMPLAINT TO INSPECTOR Elmer Elam �'/ .fIAJ/$ 2110 William Av i'alerm Permit 3900-76 ,E(util,,, � ELEC. �• _ J GAS �.- . -- SUPPO T STRUCTURE COMPACTION TEST REQ. • `je^, 26-181-7 Permit #3901-76MHI Issued c"P -/ P. CRONK, J. C. 216-6`6B* 788-67•B** 1023-6eB*** 26-] 2122 Williams Ave, Palermo (addition) (*RENEWAL) '",2nd Renew a� 3RD RENEWAL) ga 'M �� i� •,�;r�;t.. r ,tis ,£ � Y' S_.� 1{ �K � � � �'-� �t,H' . � s �. �, � .� in'xt 3r Is fx` _5Si': ' - rr r 't�!r 9: . +fit d . r; # a y;.v lv 4:..s R 4 +5• BUTTE COUNTY DEVELOPMENT SERVICES COMPLAINT FORM This information is not available to the public!!!!!!! DO NOT COPY FOR THE PUBLIC OR THE FIELD INSPECTOR!! The following information is required for Housing Complaints and the Complainant MUST BE the person living at the complaint address! Complainant: Address: Phone Number: The above information is not available to the public!!!!!!! (Z) PERMIT NO. 3900-76P,E PERMIT EXPIRES OWNER Elmer Elam , CONTR. owner LOCATION (A.P. 26-181-7 2110 William Ave., Palermo ti Temp. Power Pole Called PG&E Temp. Elec. Serv.�� Called PG&E Temp. G�PSery j . CaCai ed PG&E ' UB t/ (B D (Date (Sig ature) DATE REMARKS OR CORRECTIONS ff � 3Iq Jk" -V 00, (NOTE: An entry must be made on this form each time you visit the job site.) 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 StemwaII Siding To out Slab Roof Sheathing Water Pipingl Piers Roofing Sewer p Garage Fdn. Vents Fixtures Footings Stemwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica ped 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 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' "t Permanent Door Closer Final I Final 6Y %' DATE REMARKS OR CORRECTIONS ff � 3Iq Jk" -V 00, (NOTE: An entry must be made on this form each time you visit the job site.) II��f f J 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 reqquirements of the California Administrative Code, Title 25, Chapter -5,. under permit number— !Z for the following location: Owner 4`,--y--Z-" Owner's Address 1119 Mobilehome Mfg. Model Year��i Insignia No. Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director�of Public Works ,- Date �/ / $yf//...c ° V THIS CERTIFICATE IS VOID W;HEN'MOBILEHOME IS RELOCATED MOBILEHOME INSTALLATION INSPECTION CHECK LIST . 1: Is the mobilehome located 1 ith 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) Yes No 3. Are footings and supports properly sized, spaced, and braced a er approved plans? (Note possible variation at spring shackles.) (Sec.. 5082 & 5083) Yes No 4. Is the mobilehome level? (Sec. 5088) YesNo+ 5.ImnrP than leun it, are crossover connections properly installed? (Sec. 5088) Yes No 6. Water A-•. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No B.*1 Test - Does water piping withstand working pressure or.50 lbs. air test? Yes No C. Ba - ate of Cal— ifornia 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 running -gallons of water through each fixture including washing machine standpipe? Yes NoV D.of S . a i ornia approved, does 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 mobij,ehome gas line inlet without reductions other than the mobilehome connector. Yes No B. Test OK as per following procedure? YesJC 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. k 4. Connect gas meter to mobilehome with connector, turn On gas, test connections with . soapy water. C. Are all appliance vents properly installed? Yes 42 No MOBILEHOME DATA Manufacturer and/or Namestyle lej27 / �3 Length 70 WidthZ2 Vehicle Serial No. State Identification No. Additional.Information or Comments: 9. Electrical A. Is service large enough to provide adequte 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- No B. Is there proper clearances around panels? -Ye sk No C. Is power supply cord or feeder assembly properly fused? Yes_ 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. G. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each rOAbilehome 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 conduc:tors.shall be connected to the site service equipment. A further continuity tesi '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 lej27 / �3 Length 70 WidthZ2 Vehicle Serial No. State Identification No. Additional.Information or Comments: 1 COUNTY OF BUTTE DERARTMENT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 Tel ephdne: 534-4541 APPLICATION AND PERMIT ,3?oo-76 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X _ 12^Yt.Aat!!.td •hate SignatureofPermitee or Agent Receipt No. I` ,01 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 UBLIC WORKS li�ling Date permit expires Date __ �'Z— 77 BUILDING Owner • L m c SQ. FT. OCC. BUILDING VALUATION Mailing Address E,17 0, a ` Tele hon N�V�L Fireplace Contractor ® Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty 14 Shone o. Permit Fee $ Building Address_ .2 1I PLUMBING No. @ FEE PERMIT FILING FEE $3.00:&FZ OU Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 A6,OD Zoning Verificafion Only' Each gas water heater or vent 1.50 A. P. No. a� — '7 U2i �Zonl Gas piping system 1 - 5 outlets 1.50 Each additional outlet 30 Fees I VV.C. S ion FireDept. FireZone Use Permit Building sewer 5.00 Q.(� EQA Parking Plans Parcel Declaration Parcel Ma 60' R/W Improvements p Lawn sprinkler system 2.00 Bldg. Plans Recd Parcepproval Plans pproval Permit Fee $ _3 B-6 $ NEW ❑ ADDITION ❑ UTILITIES 14 OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP OR00V On LESS5.00 Main service EA. ADO'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 1.00 NEW CONST. DWELING OR AODNS. ( ACCLBLDGS.CCUP. &) 20sgft NEW CONSTR. MULTI -OUTLET NON-RESID. BRANCH CIRCUITS) 2.50ea ' NEW CONSTR. POWER APPARATUS NON•RESID. (SINGLE OUTLET CUR,& 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)LL@1 BAL�1 Ex. Occu FIXED APPLNS. OR p• OUTLETS (RESID•) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /(S7,ap 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. IWI 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 _ 12^Yt.Aat!!.td •hate SignatureofPermitee or Agent Receipt No. I` ,01 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 UBLIC WORKS li�ling Date permit expires Date __ �'Z— 77 �I Lo 7- All utilitY connoctions OL,)45�, shale located within 4 ft outside thel reabr third section of the mobile home on the left (road) side of the mobile home. Septic stem and location-e6hoid. Q i to be as per —Butte Zounty Health Dept. Re- quirermh nts. J for the required U r will 6e r4A I -(c V, -7- of the mobili me. L o �-S The 9M Setback shall 6e 5 ff. from �o the side property line and 50 ft. from the centerline of the road, permitting O t Z a M'Wdmum of a 2. ft. eave over 6=19., (yV Z- IA. rv, NOM—All Mafer;61s & Workmanship qhtallf Be in -IUM. COUNTY this set of plans MUST ba Accordance with Recognize d G a p I � I . - Kept on the job at all *:Fn_,.3,6 ractirces -on-a' 'and, it is unlawful to If, Of 0 qucvl;fv nre!;cr;b,-n' 'for +he Speelfied t make any changes or alterations on same Uniform l3v;!d;' use in he �WUINGI makeany permi 'on from ... me without & Machanical Codes and the Department of Pjjj* ss '.the _N Works, e . a.tional Electrical I Code. County of Butte. APPROVFD v4Ld 4G k COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — • UrovVile, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT�0; authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X e Date Signature �off Permittee or ent /`z Receipt No. � ssA> 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 F UBLIC WORKS � C By Date ilding permit expires Date 7 BUILDIN Owner�/ S0. FT. OCC. BUILDING VALUATION Mailing Address �� , 11 3 3 P 1^ 12M-;0 tI Telephone No Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Tel phone N.o� 6�s Permit Fee $ ' Building AddressI A&4 AVE- PLUMBING No. @ FEE PERMIT FILING FEE $3.00 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. �' ^� l6 Zoning &Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W.C. Fire Dept. Firezone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration I Parcel Map 60' R/W Improvements Lawn sprinkler system 2.00 (lans ec' Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 JAJ�Tnn&�j-bj Fop_— Main service j00 01vAMP OR LESSOR 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Is Others ❑ ER 60 0 0 AMP OR LESS 25.00 Main service 1 Main service EA. ADD'L too AMP 1.00 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. ) 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 style of: Ex. Occup(OUTLETS OR FIXTURES)9250 BAL@t Ex. OCCU FIXED APPLNS. OR f)• 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. 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 'T TOTAL PERMIT FEE $ a3o authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X e Date Signature �off Permittee or ent /`z Receipt No. � ssA> 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 F UBLIC WORKS � C By Date ilding permit expires Date 7 BUTTE COUNTY DEPARTMENT 'OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 'MOBILEHOME INSTALLATION SHEET 1. Owner's name: 2. Installer's name: .1 2. Installer's name: 3. Is the site currently under permit? Yes / 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 ) f 5. What is the mobilehome electrical rating? -----------------=-- / ! (% O Amp s 6. What is the mobilehome site service rating? ------------ - --- /��5��ps 7. What is the mobilehome site circuit breaker rating? - 7 -'-dam- n s ----------- Z' P 8. Is there any other electric load to be served by the mobilehome .site service? --------------------------------------------------- Yes // No (If yes, identify the load and size: (Load) (Amps) P ) 9.' What is the mobilehome site gas pipe size? ---------------------- (in.) 10. What is the type of gas service? ------------------=-=-------- Natural'// 11. What is the gas pipe length from meter or tank to the mobilehome? (ft,) '12. What is the mobilehome gas demand? -----------=---------------- 410 (B :) (This information not required if pipe length less than 6 ft. on na rat -gas or less than 50 ft. on LPG.)Id MOBILEHOME SUPPORT DATA Mobilehome Mfr. � 0 coed Setup Model No., Year Width (ft.) Length —7 (ft.) Expandq 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). in. Center SuPPPP Ft* g�RE n.) [Win-. ) din. xi in.) (tin. - -- -- --- +in. L U J (in.) (in.) *If center piers are other than drawn above, draw in locations, spacing, and dimensions. Footings (check.one) / 1. Wood either pressure treated or fdn. grade. ,L 1 2. Concrete pad. 3. Other,: specify Supports (check one) Concrete block 2. Concrete piers 3. Steel piers 4. Other, specify Topical Support �x Footing Size in. in. Max. Pier LS Spacing 1 -r � Overhang BUTTE COUNTY BUILDING DEPARTMENT, APPROVED. ou& ! OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: Ddrothy ADDRESS: --V,0. 1q, 33 CITY & STATE: • P.6t0ft, CA. 95-969 IMPORTANT: DATE OF CLAIM: Aupat Ot 1976 SEE INSTRUCTIONS ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE. DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT �I�t�� iQ�3it� �$� w.n+►s...,ww. �yara�risbiry►+e►ii.:,.a±�..i+rr��► :�}�Fi. TOTAL $30.00 I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. ' Datedthis .................................. day of ............................. 19....... at................................. Calif..................................................................................... Signature of Claimant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or de. livered and that t�h(e+rr{�e�is a Budget Appropriea�ti,on ❑ or Specific Board Approval(Check one) for the some. Dated this .................................... day of ............................. 19 ..., at .........Oil........1......... , Calif..................................................................................... Department Head or Authorized Deputy Dept. Exp. Code............................................ Code ................................................PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE _ AUDITOR'S USE ONLY VENDOR CODE DEPT. & SUB. PROD• SUB. 0BJ. CLAIM NO. I INVOICE NO. INVOICE DATE DISC. GROSS AMOUNT ENCUMB. SUB -DIST. In All claims against the county must be itemized, giving dates and character of service rendered or work performed, quantities, de- scription and unit prices of articles furnished or delivered. Claims must be certified by the claimant and submitted to the De- partment head for approval. Upon approval the Department head will forward claim to County Auditor for payment procedure.. Do not file with the County Auditor first. Claims should be presented to officials for approval immediately upon completion of services requested or material ordered. Claims are paid every Tuesday; however, same must be approved by officials and in Auditor's office before preceeding Wednesday noon. Compliance with above will expedite payment of claim, failure to do so may delay payment considerably. A ra K' COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS if 11 Q`�/` 7 County Center Drive — Oroville, California 95965 �`'C>),--/ 6 Telepho e: 534-4541 APPLICATION AND PERMIT au a--- IcFl coon.au vca U1 L11 IjVUIIIY U1 OUllc N CIIICI Upu[I.11lc above-mentioned property for inspection purposes. X ' Ile X21121 / Date v Signature of Perrmittee�orAgent Receipt No.`ygg''v y 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 Building permit expires Date Date BUILDING Owner L m 12-,L SQ. FT. OCC. BUILDING VALUATION t Mailing Address 1 LTelephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee $ Building Address ® PLUMBING No. @ FEE PERMIT FILING FEE $3.00 POE, % 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. ! �I -Gas ZT' Zoning & Planning piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees -W.C. I Sanrtatren Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking 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 e-- ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 � I ��BOOV NS � %�• �o V�� OR LESS Main service 100 AMP OR LESS 5.00 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 NEW CONST. LING OR ADDNS. ( OACCLBLDGS.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 style of: Ex. Occup(OUTLETS OR FIXTURES) 50 BAL21 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. 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 aboveC4.) information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby `TOTAL PERMIT FEE $ '� Q au a--- IcFl coon.au vca U1 L11 IjVUIIIY U1 OUllc N CIIICI Upu[I.11lc above-mentioned property for inspection purposes. X ' Ile X21121 / Date v Signature of Perrmittee�orAgent Receipt No.`ygg''v y 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 Building permit expires Date Date FILE MEMO &NER AP NO At time of permit application, the applicant was advised the following data or information must be submitted prior to permit processing and/or issuance: 1, 2. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15, 16. 17. 18, By. All items have been submitted. Plot plans in duplicate/triplicate. Complete plans in duplicate triplicate. Complete engineered p ans and calcs. Fees of $ Letter of signature authorization. Sanitation approval. Planning approval Workmen's.Compensation Insurance Certificate. Contractors license information. Parcel declaration. Access declaration, Aunt Minnie information. Deed of access: Deed of parcel creation. Parcel map. - Pre -inspection request for Y: - Other Date' U _ 1'�, Bldg: Inspector aaaaaaamammammmmmmmaaommaoaaamamaamaamomoaaaaaamamoaaaaaammoamaaamaaaaaamammaeoaaammamaammmamm�mm When permit is issued, process as follows: 1. 2, 3. 4. 5. Mail to owner. Mail to contractor. Deliver with inspection. Telephone Other and hold for pickup. r_ a maaaasaaoaaaaaaaasaaaaans�acaamacaaocmaaaaaacoaaoaaoaoaaa�oaaoaoaeeoaaaaaaaaaaoaaaaaamoaaaaaa�aa During plan checking process, the following data or information must be submitted prior to permit issuance: 1. Index permit for items numbered above. 2. Applicant advised by telephone we need 3. Send letter to applicant. We need 4. Pre -inspection for NOT verified. (Index) 5. Other 6. Plans checked and/or approved by Date ----=----------------cc.ca..aaaaacoaaaaoaaaaaccaaaaaaaaaaaaoaaaaaamaamamaeaaamoaaomaomamo.aamamam: --------------------- Additional Processing or Notes: