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HomeMy WebLinkAbout026-270-002 I 26-27-02 MI ELLE GILLEY 2435��Ja, Palermo cI-NTYRE,,' J.B. 250-67B. Contr: Fox E e 206-67E rmjt#30-87ik(fieat pump 2435 So. Villa, Palermo Contr:Si' 26-27-02 (new detached garage) Mons Perm�-- 609-88B(rer0of/SF) 0267276-002 BP040659- ALEXANDER, RHONDA8,_JOHN 2435 SOUTH VILLA AVE., PALERMO REROOF/SF. PURVIS, Leroy 5228B 4036P 4M-270- 2435 So. Villa, Palermo (OONTR: Harmony Build (new single family) i BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP040659 LICENSED CONTRACTORS 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 Issued Date: 03/10/2004 APN: 026-270-002-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 2435 SOUTH VILLA AVE PAL Date: Contractor: Map Index: 20 Description: TEAR OFF AND REPL W/COMP p ( SQ) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior Owner: ALEXANDER RHONDA L & JOHN G-;" to its issuance, also requires the applicant for such permit to file a '. +• ' r,,' , signed statement that 'he or she is licensed pursuant to the, -provisions of : + - E the Contractor's State License Law (Chapter 9 commencing' with Section' 12435 S. VILLA AVE 7000),bf-Division 3,of4he Business and Professions Code) or that he: or; •. •' PALERMO, CA i she'is"exempt therefrom and the basis for. the alleged, exemption., An �- 9.5968=9619' Section 7031.5 by any applicant fora permit,sublects the:' applicant.to a civil penalty of not more than five hundred dollars (tW0).):., s � �'A�.� Y � - � 'N:. - ..1. rL •n..w I, :y as owner of the property, or my employees with wages as their �.. ...-..se•.r.s seursa wrr•t sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or, improves thereon, and. who does Applicant: ALEXANDER RHONDA L & JOHN G such work himself or herself or,through his or her own employees, provided that such improvements are not intended or offered for safe. If however, the building or improvements are sold within one 2435 S. VILLA AVE year of completion, the owner -builder will have the burden of PALERMO CA .,proving that he or she did not build or improve for the purpose of sale.). 95968-9619 ❑.. ,h as, owner., of,.the,,property„_am„exclusively contracting with. licensed contractors to.construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, :,and who contracts for such projects with .a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: ❑ 1 am Exempt under Article 3 of the Business and Professions Code Owner: WORKERS',COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - ❑ '°,l.have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the License #: Labor Code, for the performance of the work for which this permit is issued. ❑ •""` I'Have and will' maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of Architect: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Engineer: Carrier: Policy #: I certify that in the performance hof the work for which this permit is Total Square Ft: 0 S. F. .issued, I shall not employ any person in any manner so as, to Valuation: $0.00 become subject to the workers' compensation laws of California , Census Code: and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. i O� Date:. 7 " Applicant: - WARNING: Failure to 'secure workers' compensation coverage is unlawful, ,and shall subject an employer to criminal penalties and one hundred thousand- dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attomey's fees. _ CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resoluti n o dq�work indicated abo for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) ?41 B Name: Date: �7 _k040 Address: PERMIT EXPIRES ON: ate ❑ ' f hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection pu s S. . a/ A—I—EK AA 00— l/. Print Name: Signatur Date:. Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION -24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BPo40659 DATE: - ^D APN: i ZONING: O ER'S LAST NAME:- OW ER'S FIRST NAML: Sz L-nz& PHONE: '3 V— 0-�Z) STREET ADDRESS: p� —1 FAX CITY, ZIP: f?/1 E-MAIL: SITE ADDRESS- 01 y3 5 Ll l� CITY, ZIP: NEAREST CROSS STREET: TRACTILOT It. APPLICANT NAME: PHONE: STREET ADDRESS: FAX CITY, ZIP: E-MAIL: CONTRACTOR NAME: PHONE: STREET ADDRESS: FAX: CITY, ZIP: E-MAIL: LICENSE NUMBER: LICENSE TYPE: ARCHITECT/ENGINEER NAME: PHONE: STREET ADDRESS: FAX CITY, ZIP: LICENSE NUMBER: E-MAIL: DESCRIPTION OR SCOPE OF WORK: 20 ❑ Structure Built without permits ❑ Proposed Change of Occupancy (note previous use) EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. For office use only: Notes: Olt 'Ta t SS LI.E p��en� I -r PEi2 SGoT -10 t->fnlso►.! Application Received by: Date: 3110/04 - Receipt number: 3q5 13 8 Amount Received: $ 110.— Master application 34-04 . f'V"�`+'^y{S��',rVr�"'�..d'9�+�`�,,+%�r+r�",�Y*'+'rr"+""�u""ti`✓M'r.�'y''►+ia....-.—...�;�.w�.•-..+..-....�..+.•z--..--:t..,.-rr��,v+�'"^nf: 4. i'`e'yu't"y�;,.,,"`%r^'Y.:.;h :�'.,:4 W .., <� 1 r 392-87 Permit#609-88 DAVE GILLEY 2435 S Villa, Palermo . ,s • i S iA:'��5 � /f:���� '(.i�Z'%,� r�% `�lL:�e�- rf% /�j�`✓s�s.� d f c i . i COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N0. 7 County Center Drive - Oroville, C�Olifofnia 95965 - Telephone: 916/538-7541 / /) APPLICATION AND PERMIT (l ASSESSOR PARCEL NUMBER ZONING ,. BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC, BUILDING VALUATION '� ' OWNER'S MAILING ADDRESS •• i CONTRACT,OR'S NAME` TELEPHONE 'CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00' LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICEf?SE N0. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty E BUILDING ADDRESS Permit fee $ { PLUMBING PERMIT Filing Fee 10.00' Each Trap 2.00 `• Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF•E� Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00' T Building sewer 5.001 Mobile Home S 1 (31 =T 10.00ea TYPE OF WORK New❑ Add ition❑ Remodel❑ Utilities❑ Installation[ Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6OOV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 ' CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): Er I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification �• El 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason oR ADDNST DWELLIN GSCCUP.EI\ '/zQsgft NEW CONSTR U TI.OUTLET 2.50 ea NON.RESIC1.BRA CH CIRC ITS /POWER APPARATUS e) `SINGLE OUTLET CIR. (SINGLE Ex. 0 OR FIXTURES DAL@3t ewl9 30 FIXED Ex. Occup. PR OUTLETS (RESID IEA.7 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ t Contractor ` WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation penult Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories In height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ ' occuP. I CONST.TYPIJ JSCNOOL I FLOOD PARCEL P11 MD 139UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By., /�� ::. ,l .. , PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date - l �, Receipt No. WHITE-D.P.W.. YELLOW-ASBC330R, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO./ 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541, U G APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER GY ZONINy,, BUILDING PERMIT - OWNER a bA 6,,We TE EP ONE ao�a SO. FT. OCC. BUILDING VALUATION 700 OWNER'S MAILING ApDR E§.$ CONTR ACTOR' N/rMrh. 0� TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LEN R UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ , Qv ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ +, Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS _ Permit fee = PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each pas water heater or vent 5.00 � / USE OF STRUCTURE SFJ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Describe work: i�%'Nil Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 10001 OR 0 AMP ORLESS10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. " ,C�',25� �;� License No. Classification !-' Q I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.EI , OR ADDNS. ACCBLDGS. b0sgft NEW CONSTR.. TI.OUTLET 2.50 ea NON-RESID BRANCH CIRC ITS POWER APPARATUS e SINGLE OUTLET CIR. ) ( Ex. Occup\OUTLETS OR FIXTURES 5AL93t 2ALvsD FIXED ALNS Ex. OCCup. OUTLETS P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �yirin 15.00 g Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement,. should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating .Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue againstsaid County in consequert6b of the granting of this permit. �? �_ 2 X - P S X oz�---^--�- Date Signature of Applicant — Owner ❑ Contractor E!I- Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ 4 06 OCCUP. CONST.TYPC SCHOOL PLOOD PARCEL P11 I ND I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work Indicated above for which DIREC R OF PUBLIC B PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date 2 —_�Q ' — v Receipt No. WHITE-D.P.W.. YELLOW-ASSr39OR. PINK -INSPECTOR. GOLDENROD -APPLICANT v 'Permit#392-87M M Gilley 2435 S Villa, Pal 1211 5, ejll r� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 f`7 APPLICATION ANE'PERMIT f ASSESSOR PARCEL NUMBER cw_� -^ "�. ZONING j 1 BUILDING PERMIT OWNER j,i i/ r^ i/ TELEPHONE SO. FT. OCC. BUILDING VALUATION - OWNER'S MAILING` ADDRESS gg Ae r 01 In CONTRACTOR'S NAME / TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS % Permit fee $ PLUMBING PERMIT Filing Fee 10.00 - Each Trap 2.00 -� b r n Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF ISI Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 0.00 ea' TYPE OF WORK New❑ Addition❑ Remodel Utilities'© Installation[] Other Describe work: / F/� f /// f Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 10.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BuSlnesS and Professions Code and my license is in full force and effect. License No. Classification EJ 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.tY , OR ADDNS. ( ACC. SLOGS. 20sq ft NEW CONSTR.MULTI-OUTLET 2,50 ea NON•RESID BRANCH CIRC ITS POWER APPARATUS Q\ SINGLE OUTLET CIR. / Ex. Occup OUTLETS OR FIXTURES e20950t AL030 FIXED APLISIS Ex. Occup. OUTLETS (PRESID.IREA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. pI shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating _ / 77 Cooling �7 G•�i% Hood 3.00 Venti+ateofl -t perrnit Fee $ /} Contractor 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 authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County iniconsequence of the'granting of this permit. -I� J +� 115. \__X ` ` %�% �,c X �� _ r 1 Date ..i rJ r Signature of Applicant — Owner ❑- Contractor � Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occup. CON ST.TTPC I FL00aJ PARCEL I PD I ND I ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been aid. p DIRECTOR OF PUBLIC WORKS / PERMIT EXPIRES Date _, Receipt No.�, WHITE-D.P.W., YELLOW-ASSE330R, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PE MIT N . �� ASSES 90PARCE �UMBER� -- /�`/ / ZONING BUILDING PERMIT . OWNER irAelle,OWNER'S TELEP o SQ. FT. OCC. BUILDING VALUATION MA ING/{DORES J r"i CO ACTOR'S NA TELEPHONE ,/ e �) CONTRAC R'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS , Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL M P Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF V Duplex Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home is G W O.00ea TYPE OF WORK New❑ Addition [I Remo_el Uti I itieA Installation❑ Other Describe work: 6 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El am licensed under provisions Of Chapt. 9, Div. 3 of the BuslneSS and Professions Code and my license is in full force and effect.SINGLE License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.Ed , h2sgft New CONSTR(AMULTI-OUTLET'B NON.RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS 6 OUTLET CIR. Ex. Occu 20050e Occup(OUTLETS OR FIXTURES aALO 30 FIXED APLNS Ex. Occup. OUTLETS P(RESID )KEA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. 6yirin 15.00 9 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. iJf I shall not employ any person in any manner so as to become subject J� to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling 17 Hood 3.00 V Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue againsts aidounty i conseque oftJranting of this permit. X Date — Signature of Applicant — Owner ❑ Contractor Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occu P. CONST.TYPc I FLOOD= PD ND 590E This permit is hereby issued under sions of the Butte County Code and/or work indica d above for ich IRECT UBL By P PIKES Date the applicable provi- resolutions to do fees have been paid. ORKS Dae Receipt No. WHITE-O.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT