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028-063-014
28-063-14 � LUCY LEE CURRENT 6•h 16-07' Ahart Rd, Honcut hermit#2419-804(ele ser ch) S8 r 28-063-14 Jo "'-& ROXANNE MEDINA'---- _ 1OW& It t Rd, Oroville Permit��575 �7 E(util, MH) ELEC [.t� CAS SUPPORT STRUCTURE REQ COMPACTION TEST REQ - .28-�} 3-14 Contr: Feather - ver Homes Permit#1Q 2 "7MHI Issued -.'PERMIT NO. - PERMIT EXPIRES+� FRANK & ROXANNE MEDINA OWNER CONTR. unknown ASSESSOR PARCEL 28-063-74 LOCATION 10096 Ahart Rd, Oroville 'I 7• f t FOFFICE COPY �'' y ' } 9 Address�a ��. • y.5^ " j GAS s, $ Meter By Date � ELECTRIC Oa Meter By e v •,C+ �} ° �� Tem" P11%:.- Called PG&E Temp. Elec. Service y Called Pr_n.c % i Temp. Gas Se Cal led Pi JOB FINALE Signature 1 V OK. . 0 = Not OK - = Not Applicable * = Not Ready 1 I 1 J � 1 t MOBILEHOMES MISCELLANEOUS Date MO 1LEHOME UTILITIES (Plans) OK except H's Zoning Requirements -Setbacks -Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fa /O -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails - Water; Locatio -T asement Needed (Sketch) 4, Wood Awn.; Posts- Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing E ctricity; Location -C ar nces-Grnd.- Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures - s; Locatio T r� /"L"ft./ /"Nat.of eCVL"ft./ LPG 6. Carports; Windows -Doors 7. Utility Clearance _ 7. Elec. Card -BI Date Card -BI Date Card -BI Da Card -BI Date �— Card -BI Dat r Card -BI V Date Card -BI Date Card -BI Date Date B EHOME INSTALLATION (Plans) OK except H's Dare POOLS (Plans) OK except N's mooning Requirements -Setbacks -Easements 1. Setbacks -Easements Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Vis; MH Test -Demand -Valve -Connector 3. Pool Structure; Steel-C01_onnections-Thickness-Dead Men -Lining 0<7 -.gMH Test -Crossovers -Breakers -Clearances _ 4, Elec.; Receptacles and Lighting; Distances-GFI P-f.gain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI ._Yater; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed #117. Water and Sewer Connected -C/0 to Grade -HD Approval 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged B. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Exits; Insp.-Sketch 0, :Cert. of Occupancy 9. Health Department Approval " 10. Plumb; Cir. Test -Water Supply Test Card B-1 Date4__1 ^ and -BI Date Card -BI Date Card -BI Date Card B-1 Date Card -BI Date Card -BI Date Card -BI Date V = OK 0 = Not OK NgtApplicable RESIDENTIAL (Single and Duplex) k = Not Ready Date UNDERFLOOR (Plans) OK except #'s Date FRAMING (Continued) Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings _ _1. 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection- rotection_4. _ 4. Ftg., Porches & Cecks: Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -.Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Ste_mwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access_ - 7. 8. Piers -Fireplace Ftg.-Steel D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 54. 55. Glazing Area -Glass Protection -Skylights -Plastic Shear Walls; Nailing -Bolts - _ -9. Gas Pipe; Size -Anchors _ 10. Water Pipe: Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums &_Ducts; Clearance -Material -Support -Ins. 13. - Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except #'s 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Card -BI Card -BI Date Card -BI Date PLUMBING (Permit) OK except N's 14. Water Ht.: Vent -Access -Combustion Air 15. Water Pipe: Test & Anchors -Nail Protection 16. D.W.V.: Test-Fttngs & Anchors -Nail Protection 17. Shower Pan: Test, First Floor -Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 19. Gas Pipe: Size & Anchors -- Date__ _ Card -BI Date Date Card -BI Date 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 59. Bedroom Exiting 60. G.F.I. & Bath Fixtures & Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except k's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper Cacti B -I Card B-1 _ 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. _ Fixture &Transformer Clearance - Ins. Protection Elec. Receptacles Spacing -Lights & Switches at Doors Size Boxes & No. of Conductors -Stapled Romex Installed Close to Edge of Studs & C.J. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 2 Appliance Circuits in Kitchen & Conductor Size Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At Range Circ. / ; ga. Cu or AI -Oven Circ. / / ga. Cu or At, Insulated Neutral Yes �No _ _ Service -Riser Conductors & Ground -Main Disconnect_ _-_ Equip. Clearances: Panels-Motors-Mech. Equip. Clothes Closet Light -Shower Light Date Card -BI Date Date Card -BI Date 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 70. Plb., Elec. &Mech. Equip. Listed for Location 71, Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 72. Insulation -Foam -Looked in Attic ❑Yes 73. Guard Rails & Deck Construction -Post Caps 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 75, Following instld.: Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No; Planters Dyes [J -No 76, Stucco; Brown -Finish 77, A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. Ventilation throughout House 82. Glass Protection Dale MECHANICAL (Permit) OK except N's 83. _ Corrections from Previous Inspections _ 84. Gas `est -Meters Tagged; Gas -Electric Card -BI Card-Bi #31. 32. 33• 34. 35. A.C. Ducts. Insulation & Support _ _ - Vent Fan: Exhaust above Insulation _ Condensate Drain & Overflow: Size_& Grade Furnace -Vent: Access -Comb. Air -Return Air Vent -115V outlet Attic Access & Platform if Furnace in Attic Date Card -BI Date - Date Card -BI Date 85. 86, Water & Sewer Connected -C/0 to Grade -HD Approval Energy Compliance Certificate -Other Certificates _ -- --- - - --- Card -BI Date Card -BI Date Card -BI Card -BI _ Date Card -BI Date _--_- Date Card -BI Date Date FRAMING(Plans) OK except N's 36. Sills. Proper Material & Anchors 37. Walls: Studs-Na.ling, Spacing & Bracing -Plates -Sound _ 38. Bearing Walls over Girders & Floor Nailing 39. Draft Stop in Walls (rat proof) 40. Fire Stops: Furred Ceilings -Stains_ -,Chases -Tub 41 Header & Beam -Size & Bearing 42. Hangers -Post Caps -Anchors -Connectors 43. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthnq.-Rfnp. 44. Fireplace Ties cr Type A Flue -Fireplace Throat 45. Attic Access: Size & Romex Protection -Draft Slop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing Com lents at Final: - _ (NOTE Anentry must be made each time you visit job site) COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS i 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 538.7541 747 Elliott Road,- Paradise — Phone: 872-6307 CORRECTION NOTICE OWNER — `PE TIMR NI A routine inspection Indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector \4���� ` Date 19 — a j �- ? q COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 534-4541 Skyway and Elliott Road, -Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. '�';. InspectorC .Q Date—a— 1..- - - - )., MOBILEHOME INSTALLATION ACCEPTANCE 1. COUNTY OF BUTTE �?EPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE f, OROVILLE, CALIFORNIA — 534-4541 l r"t 'PERMIT`NO. .a ,w Address or loc w' ,,;.Owner's name -Owner's addre nsignia or hud number !Manufacturer's name /i"//V �h/ --MA �-./ i/ C, r R 1 �iF /4 Year of manufacture -7� % Serial number of V.I.N. O / T ?'(Offi C-ral Approving Installation) (Date) lj a IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION �O,CCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED, WHEN THE &:MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. r� 5136 White - Owner, Yellow - Installer, Pink - D.P.W. -� COUNTY OF BUTTE - DEPART-NENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 959605 - Telephone 916/534-4541 (01-:1-77—k APPLICATION AND PERMIT ASSESS f PAR L NUMBER. `oy / ZON N BUILDING PERMI ow R TELEP o SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADO S 6096 ✓' v 'An q10 CON RAC TO R'S NA E � q k W • 1 TELEPHON CO RACTOR'S MAILING RESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $e-� LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Y 1 Permit fee $ J D PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 0 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5,00 USE OF STRUCTURE SF❑ Duplex[]Mobilehome� Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home 10.00ea TYPE OF WORK New❑ Addition❑ Remodel[] Utilities Installation❑ Other ❑ Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 110.00 Main service 60OV OR LESS 100 AMP OR LESS 10.00 Main service EA. ADO'L 100 AMP 2.50 a CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F-1NON.RESID I am licensed under provisions of Chapt. 9, Div. 3 of the BuslneSS and Professions Code and my license is in full force and effect. License No. Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.a OR ADDNS. ( ACC. BLDGS. , 20sgft NEW CONSTR ULT' -OUTLET 2.50 ea BRANCH CIRC ITS POWER APPARATUS tl (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20®S00 eAL030 FIXED APPLNS. Ex. Occup. OUTLETS ((RESID,)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 JZ 0,0 Misc. Wiring 9 15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g 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 agai said County in conseque a of the granting of this ermit. %� Date I Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP, CONST.TYP! I Fo PARCEL �-// PD ND I UE This permit is hereby issued under sions o the Butte County Code and/or ve for which wor In icated a11T OF3�OF PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date 13AVAIle 1.3 Mwz ifl Receipt No. WNIT!-D.P.W.. YELLOW-ASSBOR, PINK -INSPECTOR, GOLDENROD -APPLICANT I COUNTY OF BUTTE - DEPARTMENT OF KUB41,C WORKS - BU•ILDING DI.VIS'ION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534-4541 r PERMIT APPLIOATI`ON DATA SHEET _ %� Permit No. OWNER k C-14 h A. P. No. 0�3` Proposed Building Use Building Inspector Date At time of permit application, I was advised the.following data must be submitted prior to permit processing and:/or issuance: DATE RECEIVED APPROVED --2. All items have been submitted . ... . . . ... . . . . am Plot plans in duplicate./iplicate, Igned by preparer of plans. 1 8 3. Complete plans in duplicate. /triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan . . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ , . , , , , Letter of signature authorization. 10. Sanitation approval from ' / e. Health Dept. 3 11. Pl.anriing approval for (A) Use: (B) Parking: t 12. Certificate of Workmen's Compensation Insurance. 13. Contractor's License, Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner[], Mail to owner ❑•), _15. Improvements may be required. . . . . . . . . , . , • F 16. Mobi lehome Installation Data. . . . . . . . . . Prednspec. requ st to (Date) . Pre -Inspection for Required. Building Ins A08. pe t corded copy of Agricultural Acknowledgment Statement. 7 riveway Permit. g� . Plot plan approval from city of 21. 22. When ou issue tMpit, pocess as fol lows: Mai I to owner, Mai i to contractor. Telephone'Q/4 and hold for pickup atOOffice, Deliver w/inspector. Other o,eEA71oAj S- 2 -/ 9G I glal - Applicant � f` fie- fl +�C_ e C;)- 1�1_ 3 - Copy Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted prio to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. r 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone---nall—counter by date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date �l Plans checked by Date Plans approved by f Date Sets of plans on hold in File cabinet AP folder x — Hours: 10:00 a.m. - 3:00 p.m. Copy—DPW TO Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP# Plan Approved for: Sewage Disposal _ Water Supply Hold final for: \ Water Supply Final clearance O.K. for: Water Supply Clearance for'"-' bedroom mobile home. Other NOTE 4 Li Sanitaria Date n TO: Building Department FROM: Encroachment Permit Section RE: Driveway Clearance owner location Driveway permit / signat e L d - X63 - AP # has been issued for the above property. 3- _ z�- date AP # ")Z -D6 3--7V OWNER PERMIT MR UTIL.CLEARANCE DATE INSPECTOR ELECTRIC GAS Support Compaction Struc. Test Req. Service Size Other Load Tq e. Pipe Size Length YES NO YES NO �Q Vh COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ASSE 5 ARCrc NUMBER— BUILDING PERMIT 0 ER ' /ZZO�J(N�IIy�G��0. SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING A D ESS I C) C)q L, cw)l/1 C TRACT 'S NAMEZ�IAO /,,/ C//� TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS D 11100 Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 / Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5,00 USE OF STRUCTURE SF ❑ Duplex❑ MobilehomeOther SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installations Other ❑ Describe work: -%S—(Y Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 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 ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered `for sale. (Sec. 7044) I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.& , OR ACDNS. ACC. BLDGS. /z ¢sq ft NEW CONSTR ULTI.OUTLET 2,50 ea NO N.RESID BRANCH CIRCUITS POWER APPARATUS tr SINGLE OUTLET CIR. Ex, OCCUp(OUTLETS OR FIXTURES BAL0AL03030 Ex. OCCUp. OUTLETS P(RESID )FIXED ALNS.REA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Oyirin g 15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g 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 aga n ti�s//aid County in co segue ee of the granting of this permit. x 1(/R N Date Signature of Applicant — Owner ❑ Contractor C3Agent❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in h fight. Mobile Home Installation Fee $ t�l� Energy Inspection Fee $ TOTAL PERMIT FEE $ ` fD,IM OCCUP. CONST.TYP! I IFI.001PARCELI PD 1�!! IsBu This permit is hereby issued under sionsof Butte County Code and/or work i ica ed above for which CT R pF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS ate Receipt No. WNIT!-D.P.W., TELLOW-AS8E3SOR. PINK -INSPECTOR, GOLDENROD -APPLICANT j .Z v COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVIISJ,0N t 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/5,84541 PERMIT APPLI'CATI'ON DATA SHEET L14 ;tPermit No. OWNER YC@YI vu� Kc(I A. . No. _a?-' ��03' / L� Proposed Building Use In Y Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and:/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . 2. Plot plans in duplicate./triplicate, signed by preparer of plans. . 3. Complete plans in duplicate./triplicate, signed by preparer of plans. 41 Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan . . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ , , , , , , , 9. Letter of signature7 authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen,'s Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner0, Mail to owner ❑ ), O&ff�pvements may `be required. obriolehome Installation Data. • . • . • . • . • .2�, 17. Pre -Inspection for Pre-Inspec, requ st t (Date) Required. Building Inspector 18. Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. • 1 .�. When ou issue 'the permit, process as follows: Mail to owner, Mail to contractor. 7Telephone and hold for pickup atLe-72 of f i ce, Deliver w/inspector. Other Applicant G�`C�"U �� I�r�V �a�te / ` Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitt e pr 1. Index permit for above items No. 2. Additional items required: o permit issuance: (Circle new item not checked above). Contractor, designer, was advised of above required data by_phone---jnail—Vounter by date ,, -sr -7 Contractor, designer, owner, was advised of above required data by—phone —ma il—counter by date Plans checked by Copy—DPW Date Plans approved by Sets of plans on hold in File cabinet AP folder Date — Flours: 10:00 a.m. - 3:00 p.m. 1. Owner's Name: BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET G 4 /�6 \,/ 1-,t n a'L 2. Installer's Name:- %ZA_rf11 ,►Ay`� �/ f -1O %yl -e < 3. Is•the site currently under permit? Yes No F] _ (If yes, furnish permit number -41 QF(A 0OR Is the site an existing site? Yes No a (If yes, furnish two plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic. tank and leach fields and clear of all setbacks and easements? Yes � No F] (If no, clarify C 0 5. What is the mobilehome electrical rating? --------------- y��l. Amps 6. What is the mobilehome site service rating? --- - ----.----- �V V Amps 7. What is the mobilehome site circuit breaker rating? ----- Amps 8. Is there any other electric load to be served by the mobilehome site service? -------------------------------- Yes No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? -------------- 17 (in.) 1. 10. What is the type of gas service? --=---------------- Natural F LPG -:© 11.' What is the gas pipe length from meter or tank to the r/ --------------------------- -------- ri C/ mobilehome? --��;------ � (ft.) S/ 1 * 12. What is the mobilehome gas demand? ---=--=--------------- n.z- (BTU) *(This information not required if pipe .length less than 6 ft, on .natural gas or less than 50 ft. on LPG.) riuni"nuivm Jurrukg UA',LA If other than single wide, -I- AtIO** Mobilehome Mfr. 401,11A furnish Setup Model No. Year Width�(ft.) Box Length (ft.) Tagalong or Expando Size ft. x ft. On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). W:X j FOOTINGS (check one)' 1. ood-pressure treated or foundation grade. 2. Other (specify) $XgX/ SUPPORTS (check one) 1. Concrete block 942. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE MULTI -WIDE �— ,P�em/l DE �_ S'G( P%� /2 7-S 4T OK TX4 S . Line 1 Piers: Size-Min.------------ Spacing-Max - ----------- Spacing-Max- --------- From Ends -Max. ------- �_ r Line 2 Piers: Size-Min------------- Spacing-Max ---------- From Ends -Max .------- Line 3 Roof Loade: Size -Min. ---------- Location (From Front) Size -Min ------------- 'k Spacing -Max. -------=- From Enda-Max-------- Line 1 OpeninRa: Size -Min- ------------------ „x „ Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wali Only) Size -Min ------------------- k r, Spacing -Max,_______________ From Ends -Max --------------r_ x7U „ „x n r,x „ „x „ k „ r, Size -Min------------------- Spacing -Max---------------- r_ u From Ends -Max -------------- '- Size-Min.----------- ux a nx r,x a ux a ,rx. , ux a nx rr ox u Location (From Front) - 'gF COUNTY e01LOWG DEPARTMENT A ROVED 2 �Z This set of plans and specifications MUST be kept on the job at all times and it is -unlawful to make any changes or alterations on same with- out writfen•permission from "the Department of Public Works, County of Butte. NOTE:—All Materials & Workmanship Shall Be t, Accordance with Recognized Good Practices a• - of a quality prescribed for the Specified use In t', . Uniform Building, Plumbing & Mechanical Code,: and the National Electrical Code. Z ez�C'A Z_ 9 y COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA 95965 Frank & Roxanne Medina 10096 Ahart Rd. Oroville, CA 95966 With reference to the above subject; " Attached is: OTHER PHONE:(916)538-7541 DATE F.b 26,-1987 RE: Building Application Permit #575-87 for M bile Home Utility A.P. ? 28-063-14 Application for permit Mobilehome Utilities Installation Sheet Building Plans Mobilehome Installation Information Sheet Engr. Calcs Typical Plan Sheet Owner -Builder Verification Form List of Codes Enforced We need the following information: Permit application signed and completed where indicated with all copies returned. Fees of $ payable to Butte County Treasurer. Certificate of Workmen's Compensation Insurance or check exemption statement. Contractor's License Law information or check exemption statement. Complete plans in including plot plans. Plot plans in Structural details in Complete plans and calcs in by registered engineer or architect. Energy design including Street and drainage improvement plan approval from Land Development Section (DPW). sets of plans in accordance with the changes marked in red. Sanitation approval from Butte County Health Department at: 196 Memorial Way, Chico 7 County Center Dr., Oroville Skyway & Elliott Rd., Paradise Planning approval from Butte County Planning Department, 7 County Center Drive, Oroville, for Completed Owner -Builder Verification form. Recorded copy of deed showing Recorded copy of agricultural acknowledgement statement. X/ OTHER Our records, and the Assessors records indicate an existing single family dwelling on this porperty. Current zoning of U allows only one dwelling per parcel. Should you have any questions concerning the above, please contact this office. Yours very truly, William Cheff Director of Public Works .F. Glander JFG/aj Chief Building Inspector MV 1k. teturn to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT 0FF1Cj.a►�� ART-( s}r FOR RESIDENTIAL DEVELOPMENT �Y � �'(e;.Aih, lection 26-8.1 of the Butte County Code requires this acknowledgement ie recorded prior to issuance of a building permit. - ;;Iiia FEB 27�j $: 50 The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this F property may be subject to inconveniences or discomfort arising from CLERK-R£CO4GER the use of agricultural chemicals, including, but not limited to herbicides, pestic �e�;`� and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate duet, M, smoke, noise, and odor. Butte County has established agricultural zones which have as a Pa C." priority use for productive agricultural purposes, and residents within said zones and on , adjacent property should be prepared to accept such inconvenience or disconform from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: L 701JD Vi, CL . ,1v (?'} �, -l1s_ (�5 to o L: r�I�,� r_�✓�� C� i 5 t(�'� J cI� C\ .l. lt: I v Or -(—l-\ K.�(��(.ls'C' �',' t— S �d �C! �i I " Date PROPERTY OWNERS: (� ) On this the •-,Z % day of = k _, 19__21, , before State of ��_ :� 1 ) SS. me, the undersigned Notary Public, per onally appeared County of T OFFICIAL SEAL q BETTY JEAN MIRANDA personally known to me. L/ Proved to me on the basis - NOTARY PUBLIC• CALIFORNIA Of satisfactory evidence. BUTTE COUNTY My Comm Expires Nov. 11, 1985 to be the person (s) whose names) subscribed to the within instrument and acknowledged that executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public Present A.P. No. 8 DECLARATION REGARDING ACCESS I, i�Xc�rin 2 I1PJ 1 n 6 , applicant for a - permit from the County of Butte for the parcel of land identified as Assessor's Parcel No. D ' 663 _JV , declare that said parcel was created on 19 �J, by deed recorded in Book of Official Records at Page_ in the office of the County Recorder of the County of Butte, wand that I first purchased an interest in said parcel on or about J an� (� , 19 &-7, and that at that time I was not aware of any facts that would cause me to suspect that said parcel may have been created without the access thereto required by law. I declare under penalty of perjury that the foregoing is true and correct. Executed this � � day of 11 6L19� , at' C)fn01 I, , California. Signed 4D Cwifeas shown on that certain map entit.;ed "Official Map of Honctit, Butte;,,,%County Californi�"-Filed in the County Recorder , 6 Office, ButteCounty:-- California.- - This -part of -Lot,83 deeded to Paul:Currentand Lucy Lee Current on April 10, 1952, recorded May 29 1952P.�.Book.631 page 474 Recorder's Office, Butte County, Ca�lforniSaid, portipri of Lot 83 being follows.asC40 c1nj at a point which said p6int-is 150 feet!.West of the iEa t b ary of'said.LDt anjr3309 feet South of the North Boundary.-,,fof irsa d Lot; thence from said point of beginning North'50 feet;' ' 'thence25 feet; thence South 50 feet; thence East 125 feet to thepoint of beginning.-�lpro Its I/1"IVOf.Signed and Defiveredin A �;;::,,.. ,M. .[.:.�t;ttr nf.�alif�trtti.t• 1 .._�..w_.,.w�.....y....�;..w:., ,'� .,�.,.� '>,��i y r.: Co:!1:•; „f Butte.. ... third ca} 0; --.September.: § n: n:1,'n fifty—nine :�1: 1' ''I '::. ..' 1. ....... y�. r., MILDRED M. McMAINS < o, said. Butte - is PAUL-CURRENT, and.LUCY. LEE .CURRENT, .his wife,.._. .. ._ .. _. .. _... ......... 1 r 1,. '.....:..: ....••.. are they' i'. ' :ul:i•,: w:ii , �. .1: ..> na .,:.. .:.. they _ r : : ` t+ +lu TTliittr�,!, !Tllrrt riff +1 ,, r i�t :;:,..._saidButte is ( �..... ... r. „• :.,: +',11'x;:1,.. ssiii_ �;,,.,E. s: Butte /urnnn v'*x B _ 24/Dec/6 0 •n t 1u, rk.._ ...- ___ ... .�._. .--._..._ .. ._. - _ - i II ! o S oK a hoz 3)+�J �I_ I oo i z cy r; w y ' t aO`� :1 U U C > MW �� t 1 2 is im W..: J V r COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ � LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS i PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationC Other ❑ Describe work: — Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 1000 AMP ORV OR LESS5.00 Main service EA. ADO'L 100 AMP 2.50 NEW CONST.(DWELLING OCCUP.& OR ADONS. ACC. BLDGS. 22 sq ft 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 I, as the owner, or my employees with wages as th=_ir 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 ULTI-OUTLET 2,50 ea NON-RESID. BRANCH CIRCUITS) NEW CONSTR / POWER APPARATUS & 1 NON-RESID. %SINGLE OUTLET CIR. / Ex. Occup(OUTLETS OR FIXTURES BAL@a BALc�1os FIXED APLNS. OR Ex. Occup.(OUTLETS (RESIPD.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 3.00 WORKMEN'S COMPENSATION INSURANCE 1 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 2.00 _ 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 consequence of the granting of this pernit. X Date Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP TYPE OF CONST. PARCEL PD ND SSDE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date` Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT .1 _7.1 ?7 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER -- Zft I d` BUILDING PERMIT OWNER U G l- � —� TELEPHONE �33 77e.� SO. FT. OCC. BUILDING ALUA OW R'S MAILING ADDPIE SS ^ CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER V/-vV UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER b� �^ LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filin Fee 3.00 Filing Fee Trap 2.00 Repair drainage or vent piping 2.00 ��— Water piping LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 2,00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SFS Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ® Describe work: �?L� C✓�� C�ta G Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 100 AMP OR0V OR LESS5.00 Main service EA. ADD'L 100 AMP 2,50 NEW CONST.(DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 2�sgft 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 ' 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 CONSTR TI-OUHTLET NEW NON-RESID BRNCCIRC ITS 2.50ea A NEW CONSTR POWER APPARATUS &\ NON-RESID. (SINGLE OUTLET CIR, / Ex. Occup(OUTLETS OR FIXTURES 50 m28C BAL@101 EFIXED APP LNS. OR \ x. Occup.(OUTLETS (RESID.) EA./ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6,25 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE 1 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. MECHANICAL PERMIT Filing Fee 3.00 Heating Cooling Hood 2.00 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against s 0 County i 11onse uence of the gr nting of this permit. X Date Signature Of Aicant — OwnerlX Contractor 11 Agent An OSHA per it is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE Occup. GROUP I TYPE OF CONST. PARCEL PD HD ssuE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIREC R OF PUBLIC By P IT EXPIRES Date_ the applicable provi- resolutions to do fees have been paid. WORKS Date.<2 S - / Receipt No. `! g- �� 9 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEF7�?-ib1�NT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 L APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER -_ Z I.1 �, BUILDING PERMIT OWNER ELEPHONE SO. FT. OCC. BUILDING VALUATION OW -R'S MAILING ADD SS 6' T �6 �' • L tfc i',/� v r!6 CONTRACTOR'S NAME �� � TELEPHONE -- ---- �--.---�- CONTRACTOR'S MAILING ADDRESS CCNSTRUC TION LENDERUNKNOWN (/ Fireplace—f Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $. ARCHITECT OR ENGINEER'S MAILING .ADDRESS Permit fee $ BUILDING ADDRESSO�C 7 9 D !�/}'rf�L/ �. PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 • 1 Water piping , LOT NO.. SVBDIVISION NAME PARCEL MAP USE OF STRUCTURE SFI'S Duplex❑ Mobilehome❑ Other SPECIFY Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets j Building sewer _ - Lawn sprinkler system _ 2.00 1 'TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationC Other® Describe work:5-cri - G�v� a ` Permit Fee $ } Contractor , 1 ELECTRICAL PERMIT - FilingFee 3.00 ESS Main service 100V OR LESS- 100 AMP OR LESS 5.00 100 Main service EA. ADD'L 100 AMP 2.50, NEW CONST. DWELLING OR ADONS. ( ACC. SLOGS.CCUP,&\ / 20 sq ft 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 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) 1 ❑' 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 OUTL T NON-RESID. BRANCH. CIRCUITS 2.50 ea NEw CONSTR. POWER APPARATUS &) NON -R E51D. (SINGLE OUTLET CIR. ' Ex. Occup(OUTLETS OR FIXTURES 50 @ 25* SAL@1 FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 'Misc. Wiring 6.25 permit Fee $ Contractor y WORKMEN'S COMPENSATION INSURANCE 1 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. h�nl 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 becorre subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 3.00 Heating Cooling Hood 2.00 Ventilation' Permit Fee $ Contractor I certify than I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against s � Coun7ii"onse uence of the . nting of this permit. �(_ 170 Date. Signature of A icant — Owneryl Contractor 11Elwork An OSHA per' it is required for excavations over 5p— deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Land Oevelopment Fee $ 64 TOTAL PERMIT FEE $ CCCUP. GROUP I TY -E OF CONST. PARCEL PO I HD ISSVE This permit is hereby issued under sions of the Butte County Code and/or indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. �' S 7 ! t �:xtskjrx zerv`c-*—, ?"wdes 4/d SP.ry i c � '� 0 � �.o tiv,es v l c 9" -�o W � t �o \z*_2 vccv�t�(1, OWv\er 23dul-e"a- -�-o o6t:L�tr re-qu tre ik h- %. , oz 9