HomeMy WebLinkAbout027-300-064AT . 27-30-64
WYNOKA HOMES
7230 Palermo-Honcut, Hwy., Palermo
Permit 3086-72B
(new single famlay)
rc
027-300-064 0 3 - 0 9� 306
ARCHULETA, SUSAN
7230 PALERMO HONCUT, PAL' E
RE -ROOF
BUTTE COUNTY INTER -DEPARTMENTAL CORRESPONDENCE
DELIVER TO LAST PERSON NAMED
DATE NAME I DEPT. 11 DATE I NAME DEPT.
[027 -3o6 -o664 03-0936
ARCHULETA, SUSAN
- P 0 CUT, PALERMO
7230 PALERMO HONCUT, PALER'
RE -ROOF
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - UILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT �-
ASSESSORPARCEL NUMBER
027-300-*"
ZONING
U
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
P0 Mmeiq114 Orfy-illa CA 95965
16 s
CONTRACTOR'S NAME
StmAn M Archuleta 370-5650
TELEPHONE
CONTRACTORS MAILING ADDRESS
Po Pox iqu ornvillp- CA 95%5
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $ •
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
%2:3U Palermo Homut Pale w
Energy Plan Checking Fee
$
$
PERMIT FEE
S •
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ 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: qft reproof
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
920.00
PERMIT FEE
$ _-
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service A OR LESS
23.00
CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.P
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:
,Q; I, as owner of the property, or my employees with wages as their sole compensation,
.'N%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 To
200ALICENSED
46.00
NEW CONST. DWELL
WEE ING OCUP.
CCU
OR ADONS. 8 ACC. BLDS.
SO
3.5¢FT.
T.9
NON•RESID. MULTI.OUTLET
97,50
OWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIKTURES
BAL Q'; o
Ex. Occup. OUTLEEDTSA .ES,6•LNSGEA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00
PERMIT FEE
S
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
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.)
❑ 1 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
forthwith comply with those provisions.
X - �i 1 � ,) % /Date ! .��
Signature of Applicant'f IOw er' ❑ Contrac or ❑ Agent
An OSHA permit is required or excavations over 5'0"deep and demolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE 45• W
TOTAL FEE $
HA2.
D. FE IMP FLOOD CDF PARCEL PD HD
---- .�
IS U
This permit is hereby issued under the
of the Butte County Code and/or Resolutions
indicated abose for which fees have
( �
By\. _ r/il�f '• ,I V"4-,
PERMIT EXPIRES ON
applicable provisions
to do work
been paid.
Date
Date
Receipt No. `� _�
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
W -COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
027-300-064
ZONING
U
BUILDING PERMIT
OWNER
Susan M Archuleta
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
. OWNERS MAIUNG ADDRESS
PO Box 1914 Oroville CA 95965
16 sq 960.00
CONTRACTORS NAME
Susan M Archuleta 370-5650
TELEPHONE
CONTRACTORS MAILING ADDRESS
PO Box 1914 Droville CA 99965
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation 1$960.00
ARCHITECT OR ENGINEER
LICENSE NO.
Fee
$ 20.00
—Filing
Permit Fee
$25.00
ARCHITECT OR ENGINEERS MAIUNG ADDRESS
Plan Checking Fee
$
BUILDING
��`�� Palermo Honcut Palermo
Energy Plan Checking Fee
$
$
PERMIT FEE
$ 45.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: comp re -roof
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
Filing Fee 20.00
Main Service p A 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.
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:
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
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 permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
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 I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date__ U
�ignatureof Applican - caner ❑ Contractor ❑ Agent
n OSHA permit is require for excavations ov 0" deep and demolition or construction
of structures over 3 stories in height. 111V
Main Service 200A TO 1000A
46.00
NEW CONST. DW8 ACCEwNG OCCUP. so
OR ADONS. . BLDS. 3.50FT;
NoµRESD ' MULTI.OU CUT
97,50
POWER APPARATUS
a SINGLE OUTLET cIR.
20
1
Ex. Occup. OUTLET OR FIXTURES BAL
FIXED APPLNS. OR 5.00
Ex. Occup. OUTLETS RES1D. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEES
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ 45.00
HAZ. D. FEES IMP FLOOD CDF PARCEL PO HD SUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated a ve for whic fee have
B
EXPIRES ON
applicable provisions
Resolutions to do work
been paid.
Date
Defe
Receipt No.PERMIT
WHITE-D.D.S.-B. D. CANARY-ASSESSOR/PINK-INSPECTOR GOLDENROD -APPLICANT
t
i'
PERMIT NUMBER - B 306-728
j�.
P
4
t ,
E
PERMIT EXPIRES
1,OWNER Wynoka Homes
CONTR: owner
w
LOCATION (A.P. X73� 27-30-64 j
7230 Palermo-Honcut Hwy., Palermo
r
Zoning
Foundation
Rgh. Plumbing ��C i� o"l �' % c�
Rein. Steel
Framing —S
Wtr. Htr.
Firewall Ot S o24!/ 73
ELECTRIC
Temporary -
Final,
Final.
DATE
COUNTY OF BUTTE .:
Department of Publtc Works
BUILDING INSPECTION RECORD
_ ? v
Setback4 & *j�- / 2 � 2— --
Forms
Piers & Girders
Fireplace
Bond Beam
Lath & Plaster f�
Gas Piping & Test
Found. Vents "�—
Plmg. Topout-2
5Rough Elec.
Furnace Com'" ��
Kitchen Vent
Garage •�� zS
Vents,
g "% �
Sanitation &Water
GAS
BUILDING
Temporary — ---7.
Cert. of Occup.
Final
Final
REMARKS OR CORRECTIONS
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORK
7 County Center Drive — Oroville, California 95965
Telephone: 533-1230, Ext. 259
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above -menti ned property , inspection purposes.
X Date J/- —
Signature of Permitee or Agent
Receipt No. '16,03-5-7
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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.
DIRECTPR OF PUBLIC WORKS
By � Date
Building Permit Expires Date
BUILDING
Owner/_
SO. FT. OCC. BUILDING VALUATION
6 r Az 1; 1P
Mailing Address `� clo'
Fireplace
Contractor
Total Valuation L
Mai I i ng Address
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee $
$
Building Address
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
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. v — --
Zoning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone
Fire Dept. I
Sanitation
Planning
Building sewer 5.00
Plans
Fees
W. C. ---
R/W
I Encroachment
Lawn sprinkler system 2.00
NEW ADDITION ❑ OTHER ❑
Permit Fee $
$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURE Single Family Duplex ❑ Others ❑
Range, dryer or water heater 1.00
Oven, Cook -top or space heater 1.00
Light fixtures bal (d
Egg
Receps., switches & fix outlets
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
Misc. wiring
License No. h Classification
❑ 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.
�j I have placed on file with the County of Butte a certificate of
v� 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
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
r�Permit
Inst umentatate Fee iosnr`� a onion $0.07/$1000 Evaluation Is
f%
TOTALF PERMIT FEE
$ f%
authorize representatives of the County of Butte to enter upon the
above -menti ned property , inspection purposes.
X Date J/- —
Signature of Permitee or Agent
Receipt No. '16,03-5-7
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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.
DIRECTPR OF PUBLIC WORKS
By � Date
Building Permit Expires Date
x
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534.-4.5.41
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x Date Z -G
Signature of Permitee or Agent
Receipt No. _�-.3 d!5=1 —
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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
Building Permit Expires Date
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Addres
Fireplace
Contractor `
Total Valuation
Mailing Addr ss
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee $
$
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $2.00
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. _Gas
O.
Zoning
piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone
Fire Dept. i
Sanitation
Planning
Building sewer 5.00
Plans
Fees
W. C!-�
I R/W
Encroachment
Lawn sprinkler system 2.00
NEW,a ADDITION ❑ OTHER ❑
Permit Fee $
$
ELECTRICAL No. @ FEE
PERMIT FILING FEE r $3.00 a
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more ban 12) e— Zxo
USE OF STRUCTURE Single Famil Duplex ❑ Others ❑
Pamgl dryer or water heater 1.00
Oven, Cook -top or space heater 1.00
Light fixtures
swit es & fix ets j C'
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:
-�- o%�-iv ��
Hea� Ex. Fan or F.A. Furn. Motor 1.00
EvapKooler,gar.disp.orD.W. 1.00 eai
Air conditioner or heat pump
Water pump
Misc. wiring
License No. 205 qS--`/ Classification 50 --fin
❑ 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
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
$$Permit
In;trurnentatti forn r a anion $0.07/$1000 Evaluation
$
TOTALY PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x Date Z -G
Signature of Permitee or Agent
Receipt No. _�-.3 d!5=1 —
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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
Building Permit Expires Date
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Orovi Ile, California 95965
Telephone. 534-4541-
APPLICATION
34-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X t/� -aA�=Date / —3 /_ 73
Signature of P49mitee or Agent
Receipt No. _r,4(o S- _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
abover which fees have been paid.
ifpDIRECTOR OF PUBLIC WORKS
By Date
Building P rmit Expires Date
BUILDING
Owner
b
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Fireplace
Contractor S
Total Valuation
Mailing Address 2!" /
(�
Permit Fee
Plan Checking Fee&/or Penalty
s—
Permit Fee $
$
Building Address) : 3
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
L —
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. v P 6
Zoning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone
Fire Dept.
Sanitation
Planning
Building sewer 5.00
Plans
Fees
W. C.
R/W
Encroachment
Lawn sprinkler system 2.00
NEW ADDITION ❑ OTHER
Permit Fee $
$
'
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURE Single Family Duplex ❑ Others ❑
Range, dryer or water heater 1.00
•
Oven, Cook -top or space heater 1.00
Light fixtures
Receps., switches & fix outlets
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: /
S"w «""—s' .4 ' C '
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
Misc. wiring
License No. I -s 3 1- 99' Classification fl— ° C y3
❑ i am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
❑ 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 (o
Cooling .,GO
Ventilation (jd
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
jjPermit
Instrumentaoi $lrpf q Motion $0.07/$1000 Evaluation
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X t/� -aA�=Date / —3 /_ 73
Signature of P49mitee or Agent
Receipt No. _r,4(o S- _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
abover which fees have been paid.
ifpDIRECTOR OF PUBLIC WORKS
By Date
Building P rmit Expires Date
x
*V6- % A
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC
7 County Center Drive — OroviIle, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
WORKS
autnorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
v
X /i - Date Z-2-2 7- 23—
Signature
1.Signature of Permite or Agent
Receipt No. 'e0 _ 3 CQZ d _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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
Building Permit Expires
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Adds
Fireplace
Contractor '
Total Valuation
Mailing Address d
Permit Fee
Plan Checking Fee&/or Penalty
Permit Fee $$
Building Address ,� 3 v
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
.�
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50 s"
Each gas water heater or vent Q 1.50 J"r'
A. P. No. a
Zoning
Gas piping system 1 - 5 outlets 1.50 ctV
Each additional outlet .50
Fire Zone
Fire Dept.
Sanitation
Planning
Building sewer 5.00
Plans
FeesQ.,--
W. C. /W
Encroachment
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ OTHER ❑
Permit Fee $
A
ELECTRICAL No. @ EE
PERMIT FILING FEE $3.00
d
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURE Single Family Duplex ❑ Others ❑
Range, dryer or water heater 1.00
Oven, Cook -top or space heater 1.00
Light fixtures .20025
Receps., switches & fix outlets
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: _
�X ze dip
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
Misc. wiring
tl
License No. c? 3t 4, 3 g R Classification
❑ 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
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
(SnStrumentot o�frlq g Motion$0.07/$1000 Evaluation
$
TOTAL PERMIT FEE
$
autnorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
v
X /i - Date Z-2-2 7- 23—
Signature
1.Signature of Permite or Agent
Receipt No. 'e0 _ 3 CQZ d _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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
Building Permit Expires
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See Master Plan on file for building
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