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HomeMy WebLinkAbout028-062-02828-062-28 T.M.L.,Inc. W/S Palermo Hncut Rd., app.360'N.of Brown Rd., oroville- Permit #1927-78B,P,E,M(newl ingle family) Q 28=062-28- - �LU� 1 a10 W/S Pal -Hon Rd, 360'N Brown Rd, Honcut Permit#1454-83B(wood burning stove/SF) 028-062-028 _' •06-1276a ROJAS, JORGE 10130 PALERMO HONCUT HWY,,.�, j HONCUT Cont: OWNER STUCCO _ _ p . �,-I „p 028-062-028 064277'•.] ROJAS, JORGE 10130,PALERMO HONCUT HWY, 'HONCUT Cont: " v 71 HVAC ROOF MNT '' . /:-S-:--07 ' 1028,062-028 _ 06-1277 NOTES ; IROJAS, JORGE 10130 PALERMO HONCUT Hti'✓,Y, HONCUT 1,Y ' O WNERCont HVAC ROOF MNT - • . - - .. ...... '.. . r. d. APN: Permit No. 'r Owner. Site Address: f Contractor. :) Type of Permit: • Y • Z P l t CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: (�� r l oTl-►�(��� s . x x f� r: 'r ' 1 r t CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUBSTANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE DATE JOB FINALED: SIGNATURE: (�� r l oTl-►�(��� COUNTY OF BUTTE ... 'BUILDING DIVISION ' DEPARTMENT OF DEVELOPMENT SERVICES 7 County Center Drive • Oroville, CA • (530) 538-7541 i CORRECTION NOTICE d(p - 1? -7 7 0�� 07 4-S OWNER PERMIT N0. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please call for re -inspection when correction of work is completed. If you have any questions pertaining to this matter, or need additional s -11 Date r/ — 07 - V & .l%�1Lt�� \,/�i /� c1/l/ /es/L f Inspector- REV 4/05 Phone # 5 311 FOR RE -INSPECTION CALL: 538-7636 OR 891-2834 i CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4111 1.,0130 Honcut/Palermo Highway,- Palermo, CA 95968 J.V. Heating and Air / 866410 Project A ddreess Contractor Name License No. 06-1277 Contractor Contact Te ep one Permit Number Jeff Herboldshimer 530-713-9393 49356 HERS Rater Telephone Sample Group Number November 12, 2006 CC14-1798389938 Certi ing Signature Date Certi nate Number Firm: Associated Inspection Services HERS Provider:CaICERTS, Inc. Street Address: 10329 Township Road City/State/Zip: Live Oak / CA / 95953 Copies to: Homeowner, HERS Provider and Building Department This CF -4R has been registered with the CaICERTSO registry in accordance with the Title 24 & Title 20 of the CCR. CaICERTS@ is an approved HERS provider by the California Energy Commission. HERS RATER COMPLIANCE STATEMENT The house wast Tested❑Approved as part of sample testing, but was not tested. As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. The installer has provided a copy of the CF -6R (Installation Certificate). New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). New systems where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. RMINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT: NEW CONSTRUCTION Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 F!Rke-T__•_d 6 _wl__..e Flew ....-1544 N/A 2 ` Fan Flow: Calculated (Nominal QQ Cooling 0 Heating) oro Measured ' Enter Total Fan Flow in CFM: 1200 3 1 :c i f. PeFeeRtage Q 6 r 199 ._ ( 6iRe i 6iRe 2 ., N/A N/A ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration .and/or Equipment Change -Out. j 5 . Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 177 6 Enter Reduction in Leakage for Altered Duct System j jLine 4 - Line 5 y 'Applicable) [ ] - (Onl if � 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) 8 Entire New Duct System - Pass if Leakage Percentage < 6% [ 100 x ( Line 5 / Line 2 )]: i r Pass r— Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out, use one of the following four Test or Verification Standards for compliance: l 9 Pass if Leakage Percentage <= 15% [ 100 x (Line 5 /Line 2 14:75% pass r Fail 10 Pass if Leakage to Outside Percentage <= 10% [ 100 x ( Line 7 / Line 2 )]: { r Pass r Fail 11 Pass if Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 / Line 4 i r Pass r and Verification by Smoke Test and Visual Inspection Fail 12Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection (— Pass r Fail Pass if One of Lines #9 through #12 pass I P Pass r Fail h- . BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 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 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Date: Contractor: 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, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Stale License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).): ❑ 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 (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 such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). T I, 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.). ❑ I am Exempt under Article 3 01 the Business and Professions Code Date: ,S'.3U-OCOwner: l/ WORKERS' COMPENSA ON DECLARATION I 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. ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy 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 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: 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 attorney's fees. PERMIT NO. BP061277 Issued Date: 05/30/2006 APN: 028-062-028-000 Site Address: 10130 PALERMO HONCUT HWY HON Map Index: Description: NEW HVAC ROOF MOUNT Owner: ROJAS, JORGE AND IRMA 11006 DALEROSE AVE LENNOX, CA 90304 310-412-7120 Applicant: ROJAS, JORGE AND IRMA 11006 DALEROSE AVE LENNOX, CA 90304 310-412-7120 Contractor: License #: Architect: Engineer: Total Square Ft: Valuation: Census Code: CONSTRUCTION LENDING AGENCY This permit is heret I hereby affirm that there is a construction lending agency for the Resolutions t dol performance of the work for which this permit is issued (Sec 3097 Civ.) . Name: By' PERMIT EXPIRES Address: 111 0 S.F. $0.00 under the for which fees have been paid. Date: Code and/or ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely 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 purposes. Print Name: ��i������ Signature: Date: 11 __04 ❑ Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor b. G. buuoing Fermi[ ui-ib-u4 pg 1 o=OK 0 = Not OK MANUFACTURED HOMES MISCELLANEOUS- DATE PERMANENT FOUNDATION SOFTSET X 1 ZoningSetbacks-Easements ' 2 Soils; Special MH Support Sketch 3 Sewer; Loctn-Test; FaIUC/0-Concrete 4 Wtr; Loctn-Test-Easement Needed -Regulator 5 Elec Loctn-Clrncs-Grad Am -Concrete 6 Yard Gas; Loctn-Test-Wrap Nat [� or LP❑ Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage tine 8 Gas; MH Test -Demand Valve-Cnnctr 9 Elec MH Cntnty Test-Crossovers-Breakers-Cimcs 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer Connected -C/O to Grade 12 Gas and Electricity Tagged - 13 Tie Downs _ ❑ Foundation ❑ • 14 Exits IS Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers "••DATE D E C K RQ V E R S'C A R P O R T S'G A R A G E S 1 Zoning -Setbacks -Easements 2 Ftgs; SoilsSz-DpthSpacing-CnnctrsSteel 3 Decks, Glyders/Joists-Dcking-Brcing Stairs-GuardlHandrails 4 Wood Awn; Posts-Beams4bVs-CnnctrsShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSpiice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Frmg; Sills-AnchrsStuds4btrs Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Roofing 11 Ext; Steps -Doors -Landings 12 Braced Wall pnls DATE POOLS 1 Setbacks -Easements 2 Soils; Compaction -Structure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men -Lining 4 Elec Rcptcls/Lting; Distance-GFI 5 Elec Pool Lung; 15 volts-GFI 6 Elec.Encisrs; Conduit Entries -Terminals -Listed 7 Elec Bonding; Metal w/5'-Crcltng Egp-Htr 8 Elec Gmdng; Eqp w/5' Crcltng Eqp-Pool Ightg Boxes-Enclsrs-pnlboards4nsultn-to Main Conduit 9 Health Not Apprvl 10 Plmb; Cir Test Wtr Supply Test 11 Lt Niche , 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide o� Pool Drawing 0 - Not OK .RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR I DATE PLUMBING: - 1 ZoningSetbacks-Easements-FloodSlope 2 Ftg Main; Soils-Elec Grnd Ftl Dplth 3 Fig Garage; SoilsSteel-Elec Grnd Ftg Dpth 4 Fig Porches/Decks; Soils -Steel Ftg Dpth 5 Stemwalls Wain; Steel-Blockouts Wrapped 6 Stemwalls Garage; Steel-Blockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frpic Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgltrService Test 12. Elec Undrgrnd 13 Plenums & Ducts; Clmc-MaterialSupport4nsultn 14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples 15 Acc & Vntftn 16 Insulation o7A m`y, 00 #s• DATE JFRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs -Nailing Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders 8 fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops; Furred CeilingsStairs-Chasers-Tubs 22 Headers & Beams -Si &'Bearing' 23 Hangers-PosfCaps-Anchrs-Cnnctns 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac-TrussShthg 25 Frpic Ties or Type A Flue=Frpic Throat Clmc 26 Attic Acc; Sz & Rnui f'rtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctn Framing -RC Channel 29 Prprty Line Firewall & Opngs . . 30 Ext Doors -One 3' -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 32 Plywd on Roof Ovrhng-Attic Vnts-ft Outrgrs _ 33 Siding-Nalling Veneer 34 Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace Int)Ext Wall pnis 38 Insultn-W a I Is -Ceilings 39 I nfiitration-Walls-W ndws DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Meth Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires In Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz ya ❑ CU or ❑AL AC Wire Sz ga ❑ CU or ❑ AL 48 Range Circ oa ❑ CU or ❑ AL Oven Circ oa ❑ CU or El AL Insulated Neutral ❑Yes [_1 No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Cirncs pnis-Motors-Meth Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr_Nall Prtctn 56 Shwr Pan; Test, Fust fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub Ace 58 Gas Pipe; Sz & Anchrs ' 59 Fire Sprinkler; Test 60 Yard Gas Piping DATE IMEC NICAL AC Ducts Insultn & Support " 62 V an, Exhaust abv Insulin WCaTfionsate Drain & Ovnilw, Sz & Grad maceVent Acc-Comb Air RtrnNe 115 Outlet 65 Attic Acc & Pltfrin if Furnace in attic FINAL 66 Ext Steps -Door & SldeLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Clmc-Comb, Air-Dnnctr In Garage; abv-flr-Ducts-Meth Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub AccSpa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handralis 74 Frplc or Stove, Clmc-Hearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; GmdAir-Gap-Cooking Clrnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door, Swing -Landing -Closure 79 AC Duct In Garage -Damper. 80 Wtr Htr, Vnts-Cimc-Com Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Plmb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcis in Garage (GFQ Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 Clmc Drnge Planters ❑ Yes ❑ No 8 Stucco Brown -Finish C Unit Dscnnct, Elec-Plmb Vnts abv Roof, PImb-Appinc-Frpic-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Plmb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 VnUtn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns 95 Gas Test -Meters Tagged, Gas-Elec tr 8 Sewer Cnnctd-C/O to grade -HD Apprvl 9 ergy Cmpinc Cert -Other Certs /4 C—/Z$' VF Address Posted 99 Fire Sprinkler oma. 0`y` o+.• E T 028-062-028 06-1276 , „T NOTESROJAS, JORGE s } I 10130 PALERMO HONCUT HWY, %HONCUT Cont: OWNER STUCCO ` APN: Permit No. Owner. Site Address: . Jr Contractor. Type of Permit: t :ONDITIONS CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE tjC-14(Z eowe/z ReAte:uT Z DATE JOB FINALED: 10 (�/ SIGNATURE:e�l� og. �,./L(2S, Ir1�XAJL 4 f sII'� i f 1 k 1 :ONDITIONS CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE tjC-14(Z eowe/z ReAte:uT Z DATE JOB FINALED: 10 (�/ SIGNATURE:e�l� og. �,./L(2S, Ir1�XAJL 4 f sII'� i f 1 :ONDITIONS CHECKED BY SRA FLOOD CERTIFICATE EQUIRED FIRE SPRINKLERS REQUIRED SPECIAL INSPECTION ITEMS VERIFY USE PERMIT CONDITIONS SUB -STANDARD HOUSING LETTER ENCROACHMENT PERMIT REINSPECTION FEE PAID ENV HLTH CLEARANCE tjC-14(Z eowe/z ReAte:uT Z DATE JOB FINALED: 10 (�/ SIGNATURE:e�l� og. �,./L(2S, Ir1�XAJL 4 BUTTE COUNTY PERMIT NO. DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT BP061276 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. L10ENSED 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: 05/30/2006 APN: 028-062-028-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 10130 PALERMO HONCUT HWY HON Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: STUCCO HOUSE AND GARAGE(130) 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, alter, improve, demolish, or repair any structure, prior Owner: ROJAS,JORGE AND I RMA to its issuance, also requires the applicant for such permit to file a 11006 DALEROSE AVE signed statement that he or she is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 commencing with Section LENNOX, CA 7000) of Division 3 of the Business and Professions Code) or that he or 90304 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the 310-412-7120 applicant to a civil penalty of not more than five' hundred dollars ($500).): 1, 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 (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: ROJAS,JORGE AND IRMA owner of property who builds or improves thereon, and who does 11006 DALERbSE AVE such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for LENNOX, CA sale. If however, the building or improvements are sold within one 90304 year of completion, the owner -builder will have the burden of 310-412-7120 proving that he or she did not build or improve for the purpose of sale.). ❑ I, 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, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of he Business and Professions Code -30� Date: Owner: License #: WORKERS' COMPt4SATION 69CLARATION I 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. Architect: ❑ I have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy u: Valuation: $0.00 ;!9' I certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the 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: a Applicant: - WARNING: Failure to ecure 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 attorney's fees. � �•�C ��� � I � r ` ��. - CONSTRUCTION LENDING AGENCY This permit isJJ reby is ed under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolution sto d o indicated ove for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) _ C- /� // ( _ 8y: '` Date: �/ ' U Name: Address: PERMIT EXPIRES O Date O 1 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. 1 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 purposes. Print Name: G rci 2 a A Signature: /If— Date:,=� Nf Owner 13 Contractor ❑ Agent for Owner ❑ Agent for Contractor 7"1 B. C. Building Permit 01-16-04 pg 1 +=OK 0 = Not OK MANUFACTURED HOMES MISCELLANEOUS. DATE PERMANENT FOUNDATION Lj SOFT -SET 1 Zoning -Setbacks -Easements 2 Solis; Special MH Support Sketch 3 Sewer; Loctn-Test; FaIIICIO-Concrete 4 Wtr; Loctn-Test-Easeinent Needed -Regulator 5 Elec Loctn-Clrncs-Grnd 'Am -Concrete 6 Yard Gas; Loctn-Test-Wrap Nat or LP[::] Inch Sz Ft Lngth 7 Blckng; SzSpacing-Marriage Une 8 Gas; MH Test-Demand-Valve-Cnnctr 9 Elec MH Cntnty Test-Crossavers-Breakers-Cimes 10 Drain; MH Test -Fall -Flex Cnnctr 11 Wtr & Sewer. Connected -CIO to Grade 12 Gas and Electricity Tagged 13 Tie Downs . ❑ Foundation ❑ 14 Exits 15 Cert of Occupancy 16 HUD Label/Insignia Numbers Serial Numbers ' —DATE D E C K S'C O V E R S'C A R P O R T S'G A R A G E S 1 ZoningSetbacks-Easements 2 Figs; SollsSz-DpthSpacing-CnnctrsSteel 3 Decks, GirderslJoists-Dcking-Brcing Stairs-Guard/Handrails 4 Wood Awn; Posts-Beams-RRrs-CnnctrsShthg. Frmg-Brcng 5 Alum Awn; Columns-CnnctnsSplice-Decal-Enclsrs 6 Carports; Wndws-Doors 7 Electric 8 Fang; Sills-AnchrsStuds-Rftrs-Trusses 9 Siding; Nailing -Veneer -Stucco -Lath 10 Roof; Shthg-Rooting 11 Ext; Steps -Doors -Landings 12 Braced Wail pnls DATE IP O O L S 1 Setbacks -Easements 2 Soils; CompactlonStructure Stability 3 Pool Structure; Steel-Cnnctns-Thickness Dead Men4 fining 4 Elec Rcptcis/Lting; Distance-GFi 5 Elec Pool Lting; 15 volts -GR 6 Elec.Enclsrs; Conduit Entries-Terminals4Jsted 7 Elec Bonding; Metal wl5'-Crcitng Egp-Htr 8 Elec Grndng; Eqp w/5'. Crcitng Eqp-Pool Ightg Boxes-Enclsrs-pnlboardsansultn to Main Conduit 9 Health Dept Apprvl 10 Pimb; Cir Test-Wtr Supply Test 11 Lt Niche 12 Enclsr; Fencing -Alarms 13 Bonding, Diving board or Slide �'� e`er o'er m,s' • Pool Drawing 0 = Not OK 1 ZoningSetbacks-Easements-FloodSlope 2 Ftg Main; Soils-Elec Grnd Ftg DRth 3 Ftg Garage; SoilsSteel-Elec Grnd Ftg Dpth 4 Ftg PorcheslDecks; Soils -Steel Ftg Dpth 5 Stemwalls Wain; Steel-Blockouts Wrapped 6 Stemwalls Garage; Steel-Biockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgitrService Test 12. Elec Undrgrnd 13 Plenums & Ducts; Clmc-MaterialSupportansultn 14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples 15 Acc & Vntltn 16 Insulation DATE FRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs-Nailirig Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders 8 fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops; FUrre"d Ceilings -Stairs -Chasers -Tubs 22 Headers & Beams -ti &' Bearing 23 Hangers-Posf Caps-Anchrs-�Cnnctns 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac TrussShthg 25 Frpk Ties or Type A Flue=Frplc Throat Cimc 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctri Framing -RC Channel 29 Prprty Line Firewall & Opngs 30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 32 P"on Roof Ovrhng Attic Vnts-Rftr Outrgrs 33 ng -Nailing Veneer Co I Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Wall pnls 38 Insultn-W a IIs -Ceilings 39 Infiltration Walls-Wndws DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires In Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz 4a ❑ CU or DAL AC Wire Sz 9a ❑ CU or E:1 AL 48 Range Circ 9a ❑ CO or ❑ AL Oven Circ 9a ❑ CU or ❑ AL Insulated Neutral ❑ Yes ❑ No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrnes pnis-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr_Nail Prtctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub Ace 58 Gas Pipe; Sz & Anchrs ' 59 Fire Sprinkler; Test 60 Yard Gas Piping DATE IMECHANICAL 61 AC Ducts Insulin & Support 62 Vent Fan, Exhaust abv lnsultn 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air RtrWent 115 Outlet 65 Attic Acc & Pltfrin If Furnace In attic DATE IFINAL 66 Ext Steps -Door & S1deLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Meth Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, ClrnaHearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Gmd-Air-Gap-Cooking Cirnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door; Swing -Landing -Closure 79 AC Duct in Garage -Damper. 80 Wtr Htr; Vnts-Cimc-Com Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Pimb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 CjPdc Dmge Plan ❑ Yes ❑ No 2 -?2 -oro QeQ)C. tuceo Brow 88 AC Unit Dscnn ec-Plmb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntitn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler /,o-27 - 0 c0 ado C • a• s` s` 0 0` o'` m• RESIDENTIAL (Single & Duplex) DATE JUNDERFLOOR I DATE IPLUMBING 1 ZoningSetbacks-Easements-FloodSlope 2 Ftg Main; Soils-Elec Grnd Ftg DRth 3 Ftg Garage; SoilsSteel-Elec Grnd Ftg Dpth 4 Ftg PorcheslDecks; Soils -Steel Ftg Dpth 5 Stemwalls Wain; Steel-Blockouts Wrapped 6 Stemwalls Garage; Steel-Biockouts Wrapped 6a Hold Downs and Special Anchrs 7 Slab, Steel Wrapped 8 Piers-Frplc Ftg-Steel 9 DWV; Fall -Fitting -Test -2 -way CIO -Sewer Test 10 UF, Gas Pipe; Sz Anchrs-Sz Test 11 Wtr Pipe; Test-Anchrs-RgitrService Test 12. Elec Undrgrnd 13 Plenums & Ducts; Clmc-MaterialSupportansultn 14 GirdersSills-Anchr Bolts-Joists-Vnts-Cripples 15 Acc & Vntltn 16 Insulation DATE FRAMING 17 Sills Proper Materials & Anchrs 18 Walls Studs-Nailirig Spacing & Braces -Plates -Sound 19 Bearing Walls over Girders 8 fir Nailing 20 Draft Stop in Walls (rat proof) 21 Fire Stops; FUrre"d Ceilings -Stairs -Chasers -Tubs 22 Headers & Beams -ti &' Bearing 23 Hangers-Posf Caps-Anchrs-�Cnnctns 24 Ceiling Joist-Rftr Ties-Purlin-Roof Brac TrussShthg 25 Frpk Ties or Type A Flue=Frplc Throat Cimc 26 Attic Acc; Sz & Rmx Prtctn-Draft Stop -Ins Baffles 27 Bdrm Wndws or Exiting Doors -Sill Ht & Dimensions 28 Garage Fire Prtctri Framing -RC Channel 29 Prprty Line Firewall & Opngs 30 Ext Doors -One X -Check Garage 3rd Story, 2 Exits 31 Stairs; Width-Hdrm-Rise-Run-Landing-Fire Prtctn 32 P"on Roof Ovrhng Attic Vnts-Rftr Outrgrs 33 ng -Nailing Veneer Co I Stucco Lath -Weep Screed-Fndtn Vnts-Undrflr Acc 35 Glazing Area -Glass PrtctnSkyLts-Plastic . 36 Shear Walls; Nailing -Bolts 37 Brace Int/Ext Wall pnls 38 Insultn-W a IIs -Ceilings 39 Infiltration Walls-Wndws DATE JELECTRICAL 40 Fxtr & Trnsfrmr Clrnc4ns Prtctn 41 Elec Rcptcls Spacing-Lts & Switches at Doors 42 Sz Boxes & No Of Cndctrs Stapled 43 Romex Installed Close to Edge of Studs & CJ 44 Eqp Grnd made up w/Mech Fstnrs 45 Grndng Electrode Bond Gas & Wtr 46 2 Appinc Cires In Ktchn & Cndctr Sz GFI 47 Subfeed Wire Sz 4a ❑ CU or DAL AC Wire Sz 9a ❑ CU or E:1 AL 48 Range Circ 9a ❑ CO or ❑ AL Oven Circ 9a ❑ CU or ❑ AL Insulated Neutral ❑ Yes ❑ No 49 Service -Riser Cndctrs & Grnd Main Dscnnct 50 Eqp Clrnes pnis-Motors-Mech Eqp 51 Clothes Closet Lt-Shwr Lt -Spa Lt 52 Smoke Detector 53 Wtr Htr; Vent Acc-Cmbstn Air Baffle 54 Wtr Pipe; Test & Anchr-Nail Prtctn 55 DWV; Test Fittings & Anchr_Nail Prtctn 56 Shwr Pan; Test, First fir -Tub Acc 57 Test Tub & Shwr, 2nd fir - Tub Ace 58 Gas Pipe; Sz & Anchrs ' 59 Fire Sprinkler; Test 60 Yard Gas Piping DATE IMECHANICAL 61 AC Ducts Insulin & Support 62 Vent Fan, Exhaust abv lnsultn 63 Condensate Drain & Ovrflw, Sz & Grade 64 Furnace -Vent Acc-Comb Air RtrWent 115 Outlet 65 Attic Acc & Pltfrin If Furnace In attic DATE IFINAL 66 Ext Steps -Door & S1deLt Prtctn-Landings 67 Smoke Detector 68 Furnace Vnts-Cimc-Comb, Air-Cnnctr In Garage; abv-flr-Ducts-Meth Prtctn 69 Bedroom Exiting 70 GFI & Bath Fxtrs & Tub Acc-Spa 71 GFI Arc Fault 72 Elec Trim & Subpnl, Breaker Szs & Labels 73 Stairs, Guard/Handrails 74 Frplc or Stove, ClrnaHearth 75 Elec Outlets at Wood Pnl, Int & Ext 76 Ktchn, Fxtr & Appinc; Gmd-Air-Gap-Cooking Cirnc 77 Elec Outlets & Rcptcls at Ktchn Counter 78 Garage Fire Door; Swing -Landing -Closure 79 AC Duct in Garage -Damper. 80 Wtr Htr; Vnts-Cimc-Com Air Cnnctr-PRV; abv fir Mech Prtctn; LPG Appince Undr House 3" drain 81 Pimb; Elec & Mech Eqp Listed for Loctn 82 Elec Rcptcls in Garage (GFI) Romex Prtctn 83 Insultn-Foam-Looked in Attic 84 Guard Rails & Deck Cnstrctn-Post Caps 85 Fndn Vnts & Crawl Hole Door Dmge & Wood -Earth 86 CjPdc Dmge Plan ❑ Yes ❑ No 2 -?2 -oro QeQ)C. tuceo Brow 88 AC Unit Dscnn ec-Plmb 89 Vnts abv Roof, Pimb-Appinc-Frplc-Clrnc to Opngs 90 Wtr Well, Dscnnct, Elec, Pimb 91 Ext Elec Trim, GFI Rcptcl-Undrgrnd 92 Vntitn thru House 93 Glass Prtctn 94 Corrections from previous Inspctns 95 Gas Test -Meters Tagged, Gas-Elec 96 Wtr & Sewer Cnnctd-C/O to grade -HD Apprvl 97 Energy Cmpinc Cert -Other Certs 98 Address Posted 99 Fire Sprinkler /,o-27 - 0 c0 ado C • a• s` s` 0 0` o'` m• BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION M (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M (530) 538-7541 PERMIT NO. BP061276 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. 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: 05/30/2006 APN: 028-062-028-000 the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Site Address: 10130 PALERMO HONCUT HWY HON Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: STUCCO HOUSE AND GARAGE(130) 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, alter, improve, demolish, or repair any structure, prior Owner: ROJAS,JORGE AND IRMA to its issuance, also requires the applicant for such permit to file a 11006 DALEROSE AVE signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section LENNOX, CA 7000) of Division 3 of the Business and Professions Code) or that he or 90304 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the 310-412-7120 applicant to a civil penalty of not more than five hundred dollars ($500).): 1'. 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 (Sec. 7044, Business and Professions Code: The'Contractors' State License Law does not apply to an Applicant: ROJAS,JORGE AND IRMA owner of property who builds or improves thereon, and who does 11006 DALEROSE AVE such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for LENNOX, CA sale. If however, the building or improvements are sold within one 90304 year of completion, the owner -builder will have the burden of 310-412-7120 proving that he or she did not build or improve for the purpose of sale.). O 1, 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, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.',. ❑ 1 am Exempt under Article 3 of he Business and Professions Code Date: 30' Owner: License M WORKERS' COMPtASATION CffCLARATION I 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. Architect: ❑ I have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Policy u: Valuation: $0.00 . I certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the 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: — d CO Applicant: - WARNING: Failure to ?cure 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 attorney's fees. j -45 CONSTRUCTION LENDING AGENCY This permit is hereby is ed under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutions to 0 o indicated ove for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) <—, By: Date:U Name: Address: PERMIT EXPIRES O Date ❑ I 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 purposes. Print Name: ; rl til �- is U Q Signature: Date:— a — Fd Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION "PLEASE PRINT CLEARLY" OWNER Last Nameirst Name Address/ ./3od� n L''--!Wr City0 wle State Zip G, Phone ,y /�O Fax E-mail APPLICANT SIGNATURE For office use only: CONTRACTOR Name Flood Zone Address &1e I'OS e C. City \ State Zip Phone pry 105 by Fax E-mail PlannerDate Lic. # Class APPLICANT SIGNATURE For office use only: ARCHITECT/ENGINEER Name Flood Zone Address &1e I'OS e C. City \ State Zip Phone pry 105 by \Fax E-mail PlannerDate State License Number APPLICANT SIGNATURE For office use only: APPLICANT NAME Name Flood Zone Address 11ge &1e I'OS e C. City INo Stat Zp �a Ph T310) 3/O pry 105 by Fax E-mail PlannerDate APPLICANT SIGNATURE For office use only: Zoning Flood Zone SRA I Yes INo Occ. Type Const Subdivision Name Map Book Page Lot # PlannerDate Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. 4 BIN # LOCATION AP# V!% Property Addresg 1�0 p Ci IMA Cross Street U WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address *Description or Scope of ork: Sq. Footage ❑ 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 fee 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. I I Received by: Amount V ~' Bldg I SRA Keceipt- Sheriff LI SSs� SMIP Other Date 5J r )/1 / Ute- Total SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. .3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ .2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ S. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). 0 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ ' 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: o 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION K•\Ff)RMS\R111LD1NG F0RMS1B1daAoo1SubRamts.doc Paoe 2 of 2 REV 6-16-04 OWNER -BUILDER VERIFICATION 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 opportunity 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 material for construction of this proposed property improvement: YES [�4 ] NO[ ]. 2. I HAVE [A] HAVE NOT [ ] signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: 71� DATE: S ?0 —09 NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services TIM SNELLINGS, DIRECTOR 1 PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-7785 Facsimile www.buttecounty.netldds OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the 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 be signed 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 your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information 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 contractor is to secure an "owner-builder"=liuilding 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 own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321-CSLB (2752) or by accessing their website at www.CSLB.,ca.gov. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, 4 Scott -Rutherford Manager, Building DIM NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP061277 B. C. Building Permit 01-16-04 pg 1 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: 05/30/2006 APN: 028-062-028-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 10130 PALERMO HONCUT HWY HON Date: Contractor: Map Index: Description: NEW HVAC ROOF MOUNT 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 Owner: ROJAS, JORGE AND IRMA permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 11006 DALEROSE AVE signed statement that he or she is licensed pursuant to the provisions of LENNOX, CA the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 90304 she is exempt therefrom and the basis for the alleged exemption. Any 310-412-7120 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 (Sec. 7044, Business and Professions Applicant: ROJAS, JORGE AND IRMA Code: The Contractors' State License Law does not apply to an 11006 DALEROSE AVE owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, LENNOX, CA provided that such improvements are not intended or offered for 90304 sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 310-412-7120 proving that he or she did not build or improve for the purpose of sale.). 7' I, 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 Contractor: 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.). ❑ I am Exempt under Article 3 o the Business and Professions Code Date: S. 3a-o�Owner: License #: WORKERS' COMPENSA ON DECLARATION I 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 Architect: is issued. Engineer: ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Total Square Ft: 0 S. F. Policy#: Valuation: $0.00 Census Code: 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 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: Applicant: V 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 attorney's fees. ✓� _ CONSTRUCTION LENDING AGENCY This permit is herebykissued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Resolutions t o coo indicated above for which fees have been paid. �. Name: By: )} ,,Date: _Jy 7w Address: PERMIT EXPIRES ON: Date ❑ 1 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 purposes. Print Name: r Y C1 �C% l Gc� Signature: V Date ❑ Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION **PLEASE PRINT CLEARLY** OWNER Last Name irst Name a Address Address U City G1' e State �'� C Zip Phone 3 Fax E-mail APPLICANT NAME CONTRACTOR Name City Address Zip City Fax State Zip Phone Book Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Book Fax E-mail Planner State License Number APPLICANT NAME Name Address �l City State Zip Phone _69,�`�,5, ` Fax E-mail APPLICANT SIGNATURE For office use only: Zoning Property Address Flood Zone Cross Street SRAYes WORKER'S COMPENSATION No Occ. Type Const Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT O. BP BIN # LOCATION AP# eke 411^ [ . Property Address City Cross Street SMIP WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address 4 -Description or Scope of Work: Wm 14VA-C, S Sq. Footage ❑ 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 fee 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. 11 Received by. Amount Bldg SRA Receipt #: Sheriff SMIP Date �' C� Other - Total SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. .3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ .2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). O 7. Detached Accessory Building Form, filled out by the property owner (if required). O 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ * 3. 2 Marriage line information. 3 . ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: 0 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION K•\F(1RMS\R1 JILDING FORMS\BIdaAoolSubRamts.doc Paae 2 of 2 REV 6-16-04 RECORDING REGUFSTM BY: MID VAU.EY TInEo.. Placer Title Company Escrow Number. 1201-20325 AND WHEN RECORDED MAIL TO JORGE ROJAS AND IRMA ROJAS 11006 DALEROSE AVENUE LENNOX, CA. 903042226' SPACE GRANT DEED 2006-0023461 Recorded I REC FEE 13.88 Official yRecords I TAX 247,58 Coantteof I MNDAM L BRIM I County Clerk-Recorderl as 89:88AN 89 -Nay -M I Page 1 of 3 Nlllllllllll!l111i!!IlIIIIIIIIIlI THIS LINE FOR RECORDER'S The undersigned grantor(s) declare(s):, Documentary transfer taxis $247.50 City Transfer Tax $0.00 (X) computed on full value of property conveyed, or 0 computed on full value less value of liens and encumbrances remaining at time of sale. FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ROGELIO OCHOA MARTINEZ AND ANTONIA OCHOA , HUSBAND AND WIFE, AS JOINT TENANTS Hereby GRANT(S) to JORGE ROJAS AND IRMA ROJAS, HUSBAND AND WIFE, AS JOINT TENANTS PLEASE SEE "LEGAL DESCRIPTION" ATTACHED HERETO AND MADE A PART HEREOF Dated: April 20, 2005 M MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE SAME AS ABOVE Name Street Address City & State 3 cLp}g.doo(6PoI) Page 1 of 2 - 4/20/06 13 V i Y" SIGNATURE PAGE FOR GRANT DEED By: JdA AAa)a. .filar �n� OGEL IO OCHOA MARTINEZ By: _gA"Tr111 1 C ar-� O Com_ ANTONIA OCHOA STATE OFF;' O (Z�b oN COUNTY OF `h On d 22 before me, l3R�A ��Sf , Notary Public, personally appeared tZ. oa te t' o O C -k QA ehAPUL KIL. A A, rAu(A mown.Ac-L OLncs.4. personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within Instrument an acknowledged to me that he/sheRhey executed the same in his/herAheir authorized capaaty(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument WITNESS my hand and official seal. Signature: Commission Expiration Date: IP -lit 12.009 MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE SAME AS ABOVE Name Street Address City & State .a�.a.o cdoi� ' Page 2 of 2 - 4/20/06 LEGAL. DESCRIPTION Real property in the unincorporated area of the County of Butte, State of California, described as follows: , PARCEL I: LOTS 112 AND 113, AS SHOWN ON THE MAP OF THE TOWN OF HONCUT, WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, IN BOOK 7 OF MAPS, AT PAGE(S) 85. PARCEL II: ALL THAT PORTION OF LOT 97, AS SHOWN ON THE MAP OF THE TOWN OF HONCUT, WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, IN BOOK 7 OF MAPS, AT PAGE(S) 85, LYING EASTERLY AND NORTHERLY OF THE FOLLOWING DESCRIBED LINE: COMMENCING AT THE NORTHEAST CORNER OF LOT Ill OF SAID TOWN OF HONCUT AND RUNNING THENCE NORTHERLY ALONG THE NORTHERLY EXTENSION OF THE EASTERLY LINE OF SAID LOT 111, A DISTANCE OF 50 FEET TO THE TRUE POINT OF BEGINNING FOR THE LINE HEREIN DESCRIBED; THENCE FROM SAID TRUE POINT OF BEGINNING AND AT RIGHT ANGLES FROM SAID EXTENDED LINE WESTERLY 200 FEET TO A POINT BEING SO FEET NORTH OF THE NORTHERLY LINE OF SAID LOT ill AND BEING LOCATED ON THE NORTHERLY EXTENSION OF THE WESTERLY BOUNDARY LINE OF SAID LOT 111; THENCE NORTHERLY TO THE SOUTHWEST CORNER OF LOT 112 AND THE END OF SAID LINE. APN: 028-062-028-000 Mid Valley Title & Escrow Company COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER ©.2&9-06 -7-oze ZONING BUILDING PERMIT WNER ^ ^ 6rl+ u ILl1 TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING /DRESS •,, -. / O 9O lql fN09D pr&0 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S M (LING ADDRESS- ��%�� IGh i-ei' ©ilQdUi I IQ— Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 155,00 Permit Fee $ ARCHITECT OR ENGINEER , LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S_ MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SIN Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G W @ 15.00 TYPE OF WORK New Addition -0 Remodel El Utilities Installation Ci Other ❑ Describe work:W,9_1& AAW r�l G��i — Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200A OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El 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 ❑ 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)• ❑ 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. Business and Professions Code for. this reason Main service 200A TO 10o0A) 37.50 NEW CONST. DWELLING OCCUP.s OR ADDNS, l ACC. BLDGS. \ 3.64sq.ft. NEW CONSTR UL I -OUTLET NON.RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS e� SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 20 X 76d FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 is . Wiring '15.00 , XtLb — _s1 2or Oa Permit Fee $ 53.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed ori 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. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling g Hood 6.50 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. 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 — OwnerContractor ❑ Agent ❑ ❑ An OSHA ion of structuresover39 stories in excavations over 5'f)" deep and demolition D. construct- Mobile Home Installation Fee S Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $ HAz DFEES IMP -7 COF PARCEL I PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By EXPIRES Date applicable provi- resolutions to do have,been paid. WORKS DatePERMIT Receipt No. WNITE•D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT �v2- COUNTY OF BUTTE-GVPARTMENT OF PUBLIC WORIS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER ZO-Sh 17✓ 01 ✓' fj- A. P. No. 0a,9- 0C47- - C>2 -S' Proposed Building Use5�x' 1iU%jC?_C GtJt'/'/iU%1, Building Inspector Date 2110427-, Z. At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: 1. All items have been submitted. 2. Plot plans, 3/4 sets, signed by preparer of plans. 3. Complete plans, 3/4 sets, signed by preparer of plans. 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. 5. Hazardous Material Form. 6. Energy Design Compliance and supporting documentation. 7. Statement of Intent for Non -Heated and A/C Buildings. 8. Engineered truss details and layout in duplicate (required prior to plan check). 9. Mobilehome data and manufacturer's installation instructions, 2 sets. 10. Fees of $ 11. Impact fees as shown on attached schedule. 12. California Department of Forestry plan approval/fees. 13. Flood elevation letter (100 year flood) by California Engineer. 14. Sanitation and plot plan approval Health Department. 15. City.of Chico plumbing permit. 16. Plot plan and business license approval from City of Biggs/Gridley. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. 19. Driveway permit (construction approval required prior to occupancy). 20. Pre -inspection for r' required. 21. Contractor's license information. (No., Name S le, Classification). 22. Certificate of Workmans Compensation Insurance. 23. Owner -Builder Verification (Given to owner , Mail to owner �. 24. Recorded copy of Agricultural Acknowledgement Statement. 25. Letter of signature authorization. 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. 27. Letter of intent on building use. 28. Mobilehome utility clearance. 29. Documentation of legal access. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements. 31. Existing violations/expired permits. 32. Plan check list. 33. 34. When you issue the permit, process as follows: Mail to owner Telephone and hold for pickup at Other Mail to contractor. office. Deliver with inspector. Applicant Date EXPIRATION OF APPLICATION Applications for which a permit has not been issued, will expire by limitation one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. FEE REFUNDS Refunds can only be made upon writtten request by the person who paid the fee. The request must be made within one year from the date of fee payment on permits not issued, and one yearfrom the date of permit issuance -for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan checking fees for work plan checked and other department costs are not refundable. Original - Applicant COUNTY� OF BUTTES 1"PARTMENT OF PUBLIC WO `� BUILDING DIVISION �t y�:>'•- 't : 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 =` TELEP.HONE (916) 538-7541 u: PERMIT APPLICATION DATA SHEET OWNER �� � 'Olt /`.Q 5. P. No. 0'28- O(9Z - C> 28 1 Proposed Building Use 15r 10160 �itJi/'iil/� Building Inspector Date % /0 9Z. At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted . ........................................ . 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3. Complete plans, 3/4 sets, signed by preparer of plans . ...................... 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ............................................. 6. Energy Design Compliance and supporting documentation . ................. . 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of$ ........................................... 11. Impact fees as shown on attached schedule . ..............................' 12. California Department of Forestry plan approval/fees. ........................ 13. Flood elevation letter (100 year flood) by California Engineer . ................ :. .- 14. Sanitation and plot plan approval Health Department . ....... ..... . 15. City of Chico plumbing permit. ................................... t...... . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (co�,strue ion approval required prior to occupancy). . . Z 20. Pre -inspection for fFot 1 SG (JJ l� required. .. to BuildinggI�spector (Date) 21. Contractor's license information. (No., Name S le, Classification) . ............. . 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner ).' ........... 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ......................................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................... ! ............... 28.. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ........................................ 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ...:.......... . 31. Existing violations/expired permits . ...................................... . 32. Plan check list . ....:................................................ 4 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: ` Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date , Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works _ j ' �.sr.,�' _ k..nnr,r.^�rrF.�:ts,.✓.--..r.,.,:. u: {e.:•Yj�if „�,a.,�,,;:' u�,a� • +-, r'"�+>•�-„�.,� t ” :. Permit#1454-83B Eugene Lucero r ' r E COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATAON AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER a _ � � ZONING BUILDING PERMIT OWNE �) .� Pa � rex TELEPHONE SO. FT. OCC, BUILDING VALUATION OWNER'S KAJLING ADDRESS ^� / VA CONTRACTOR'S NAME � wnr TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDERUNKNOWN o Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER �r LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUIL � KG AD,D�ES� / � � It 11 'a PLUMBING PERMIT Filing Fee 10.00 , , �. j t r.A? Y1V Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 �/ USE OF STRUCTURE SF u Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I W 10.00 e TYPE OF WORK New ❑ Addition ❑ del [:1 Utilities [:JI tallation❑ Other � Describe work: —Re bo rm I +\ o h a P_ — 4 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 11' OV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 2t/20sgft 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 m license is in full force and effect. y 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 CONSTR MULTI -OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS NEW CONSTR. I POWER APPARATUS & NON-RESID. t SINGLE OUTLET CIR. Ex. Occup(2060` P\o Ts OR FIXTURES BAL�30Q FIXED APP LNS, OR Ex. Occup. OUTLETS (RESID,) EA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 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. © 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. 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 County of 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 consequ nce of the granting of this permit. 4w= Signature of Applicant — Owner R? 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 $ r TOTAL PERMIT FEE $ �� , oz) OCCUP. GROUP I TYPE OF CONST. -I PARCEL PD I ND I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which rMECTOR OF PUBLIC By_ Q PERMIT EXPIRES ate the applicable provi- resolutions to do fees have been paid. WORKS / �r Date ��b'0 ��19 - �•-� Receipt No. F_0 ?',� 9 WRITE-D.P.W., YELLOW -ASSESSOR, 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 PERMIT NO. ASSESSOR PARCEL NUMBER ..r ZONING BUILDING PERMIT OWNS TELEPHONE ,SQA FT. OCC. BUILDING V8AATION OWNER'S LING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace ' 14zo 0 CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER 0�Y1 LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ 5� BUILDI G A ES CU PLUMBING PERMIT Filing Fee 10.00 b f r 1 �( Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5,00 Gas piping system 1 - 5 outlets 5.00 �� USE OF STRUCTURE SF LJ Duplex ❑ Mobi lehome ❑ Other ' SPECIFY Building sewer 5.00 Mobile Home JSJGJWJ 10.00 e TYPE OF WORK New ❑ Addition ❑ Re del ❑ Utilities ❑ I tai lation El Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2t/Z0sgft 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. License No. Classification n 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 CONSTF MULTI -OUT LET NON-RESID. BRANCH CIRCUITS) 2,50 ea NEW CONSTR. / POWER APPARATUS &1 NON-RESID, `SINGLE OUTLET CIR, 1 RES 6AL®30Q Ex. Occu 2ALO30 p�OF(IXED APPRLNSXOR EX. Occup. OUTLETS (RESID,) EA.� 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 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. �j I shall not employ any person in any mariner 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. 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. 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 con nce of the granting of this permit. f / X -�--� Date) , l6 - 9- 3 Signature of Applicant — Owner [9" 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 $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST, PARCEL PD ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which ti5tIRECTDR OF PUBLIC By PERMIT EXPIRES ate�. the applicable provi- resolutions to do fees have been paid. WORKS Date' b� Receipt No. li a WHITE-D.R.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT F COUNTY OF BUTTE - Do-partilent of Public Works 7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541 OWNER -BUILDER VERIFICATION 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 in the envelope provided at your ` earliest opportunity to avoid unnecessary delay in processing And issuing your build- ing 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 or no) JC42��; 2. I (have/have not)'/17r4 %- , signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address. City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed : Property Owner Social Security number - Date �' — C - NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. �y'C�iirti J PERMIT NO. 1927-78B,P,E,M PERMIT EXPIRES 4 ^t. t T.M.L.,INC. OWNER CONTR. owner LOCATION (A.P. 28-062-28 W/S Palermo Honcut Rd.,app.360'N.of Brown Rd., Oroville Temp. Pow6r Pole Called PG&E Temp. Elec. Serv. `Called PG&E Temp. Gas Serv. Called PG&E x JOB FINALED (Date) (Signature) I r, THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT REGULA- TIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: Palermo Honcutt Road Street Lot Number EXTERIOR WALLS Tract No. Manufacturer Certainteed Thickness/Type�R Value 11 CEILINGS Batts: Manufacturer Thickness R Value Blown: ' Manufacturer Certainteed Thickness 8 3/4" No. Bags Zl— Wt./Bag `, Sq. Ft. Covered- 1150 R Value 19 FLOORS ^ Manufacturer 'Certainteed Thickness/TypeR Value 11 SLAB ON .GRADE Manufacturer Thickness/Type R Value Width of Insulation inches FOUNDATION WALLS Manufacturer Thickness/Type q R Value GENERAL CONTRACTOR !' ° LICENSE No. BY. TITLE — DATE INSULATION CONTRACTOR: HAWKINS INSULATION CO., INC. LICENSE No. 215-925 �TTTLE Owner DATE August 30, 1978 t•- ..y --Y S.E�` ��- D c2/03 e+ F Mean COUNTY.OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD Scratch BUILDING BUILDING (Cont'd) Service P UMBI G Setback Firewall Soil Piping�. Ducts Forms Parapets 1st Floor Permanent Main Bldg. Restroom Finish 2nd Floor MOBILEHOME UTILITIES Footings /� Windows 3rd Floor - Stemwail Siding To out Slab Roof Sheathing Water Piping�j Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings StemwaI IIL114Insulation Garage Vents Water. Htr. Heaters Slab Carport Footings Prov. for physically hand, ca ed Conformance of ex. structure Appliances Gas PI in &Test Temp. Gas Slab Final Sanitation Patio (REPLACE Final 'L{ Footings Footing ELE RICAL Masonry Walls Throat Rou h :1- Reinf. Steel Final Fixtures If f Bond Beam FIRE SPRINKLERS Motors Framin Test Water Htr. Stucco Final Snhnanplc Mean MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground IF Interior Lath Ventilation Permanent Door Closer Final Final 1114 412h MOBILEHOME UTILITIES Elec_ Service MMMMA Elec. Pedestal Water Piping Sewer Gas Piping MQBILEHOME Isla I AlLLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATEi� REMARKS OR CORRECTIONS I � P J' (Y) (NOTE: An entry must be made on this form each time you visit the job site.) � ���" �� y ��� .�. .., J .,. r 7 c3 SY 14 4h. le { Owner I .COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Telephone: 534-4541 x7 / APPLICATION AND PERMIT . /L . _L_ h _ BUILDING SQ. FT.7 OCC. I BUILDING VALUATION Mailing Address 0 Telephone No. Contractor c, Mailing Address V Fireplace Total Valuation �,� ` I 1 Tel hone No _ Permit Fee Building Address Plan Checking Fee &/orPenalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 (c$t on Qnly j' ti 6 \ Repair drainage or vent piping 1.50 A. P. No. - (0o , ZWater �Zon' ng, piping 1.50 Each gas water heater or vent 1.50 F& -<M,4 Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 Parking Parcel EQA Plans Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 C. Pla Approval Lawn sprinkler system 2.00 NEW ADDITION UTILITIES ❑ OTHER ❑ Permit Fee $ IR11 00 ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 gr© Main service 600V OR LESS 100 AMP OR LESS 5.00 Single FamilyDuplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD•L 100 AMP 2.50 Main service OVER 600V 100 AMP OR .LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 NEW C OR ADDNST (ACOWE C I S CUP. Y) 20sgft 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: �•� NEW CONSTR M T NON.RESID (BRANCANCHH CIRCUITS) 12.50ea NEW CONSTR. (POWER APPARATUS & NON.RESID. SINGLE OUTLET CIR. 250 Ex. OCCUI)(OUTLETS OR FIXTI IRES 50 @11 ISAL@1 FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No.!L3 IC 16 Classification o6 Misc. Wiring 6.25 1 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. 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 County of Butte to enter upon the above-mentioned property for inspecti n purposes. X Date Signature of Permitee or Agent Receipt No. 1 77 �1701 White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant MECHANICAL PERMIT FILING FEE Heating -rA 1711—it) $3.00 Ventilation Hood 2.00 Permit Fee $ . Ofj $ 1<j Land Development Fee $ '",01 TOTAL PERMIT FEE $ pgr 161 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 bee aid. DIRECTOR P BLIC WORKS By �- Datec S % i i —`— , --F-,7 ding permit expires Date