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028-180-052
R LE FEVRE, Clara Mae -72E'L/s Upham Ra. 8/10 mi. no. of La Porte Rd., ' ,i � fir � i AGRICULTURAL AFFIDAVIT EMPLOYEE Employee ' CL. J U-1.6 &A �Ay Lo sj!�, Phone72 -.2 y S`S- Employee's Address (Present) Name of Owner .N I'( , Owner's Address' 6jTAr2 i 0v' HAs,e A. i..AAroc,& r- OA 96-71q Owner's Assessor's Parcel No. 0,49- Zdo-Q - 00,Z--0 Building/Environmental Health Permit Description and.Number Date issued By Planning Department Approval: Date_ '7 Zone -. Dwelling on AP#_,- STT/ By.. do declare, subject to the penalty of perjury, that I am the employee ofE Eyr2 address (present) yZ -v PAAr1 oA2 -&iuelor C on AP# and th at.I will be employed under Section 24-21.2 c for at least J(a) o g thirty-two (32.). hours per week for at least sixteen (16) weeks per year on. Signed " Dated % 1 3733-83MHI PERMIT NO. LOA //R- OWNEREXPIRES LOA// OWNER ClintonLong owner CONTR. ASSESSOR PARCEL 98-18-52 LOCATION to.11, 1113ham Rd., npp 8.110 mi N nf-_ 1 LA Porte Rd Bangor OFFICE COPY, A ress GAS Meter By Dati , ELECTRIC` Meter By Date Temp. Power Pole _ Called PG&E _ Temp. Elec. Service Called PG&E_ Temp. Gas Service _ Cal led PG&E JOB FINALE[ Signature V OK O „Not OKE - Not Applicable Not Ready MOBILEHOMES MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements 2. Soils; Special MH Support—Sketch 2. Footings; Size—Depth—Spacing—Connectors 3. Sewer; Location—Test—Fall-C/0—Concrete 3. Decks; Girders and/or Joists—Decking-Bracing—Stairs—Rails 4. Water; Location—Test—Easement Needed (Sketch) 4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing_ 5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete _ 5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures 6. Gas; Location—Test—Wrap:/ /"L"ft./ /"Nat. or/ P'L"ft./ /"LPG 6. Carports; Windows—Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI _ Date Card -131 Date Date MOBILEHOME INSTALLATION (Plans) OK except s's Zoning Requirements—Setbacks—Easements Date POOLS (Plans) OK except tt's 1. Setbacks—Easements Footings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability �; MH Test—Demand—V&,—Coq 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining Ot Electricity; MH Test—Crossovers—Breakers—Clearances _ 4, Elec.; Receptacles and Lighting; Distances—GFI grain; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6. Water• H Test tAswdatur�Connector 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed ter and Sewer Connected—C/O to Grade—HD Approval 7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater Gas and Electricity Tagged 8. Elec.; Grounding; Equi'p.w/5'—Circulating Equip.—Pool Lghtg. Boxes—Enc losures— Pane lboards—Ins. to Main in Conduit xits; Insp.—Sketch 1V Cert. of Occupancy 9. Health Department Approval — 10. Plumb; Cir. Test—Water Supply Test Card -BI Date Card -BI Date Card B -I Date Card -BI Date 11 Card B -I Date Card -BI Date Card -BI Date Card -BI Date R V = OK - 0 = Not OK - = Not Applicable. = Not Ready RESIDENTIAL (Single and Duplex) - Date UNDERFLOOR Plans OK except N's Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Fig., 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 4. Ftg., Porches & Decks; 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. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic _ 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. 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 Card -BI Card -81 Date Card -BI Date Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except N's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except N's 57. Smoke Detector _ 14. Water Ht.; Vent -Access -Combustion Air 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meeh. Protection 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting _ 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access _ 18. Test Tub & Shower, 2nd Floor -Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels Gas Pipe; Size & Anchors 62. Stairs & Rails _ ___1.9. 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except p's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor -Meth. Protection 70. Plb., Elec. & Mech. Equip. Listed for Location 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. _-_ 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 72, Insulation -Foam -Looked in Attic ❑Yes - 25. 2 Appliance Circuits in Kitchen & Conductor Size 73. Guard Rails & Deck Construction -Post Caps - 26. 27. 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 AI, �-, Insulated Neutral `Yes ❑No 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 75. Following instld.: Drive g El Yes ❑ No; Walks El Yes ❑ No; Planters [__1 Yes 0 N - 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish --- 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 30. Clothes Closet Light -Shower Light 78. 79. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. Water Well; Disconnect, Electrical, Plumbing ------------------- Card B -I - ------ ----.--.- _ Date Card -BI__ Date -Card-BI 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. Ventilation throughout House Card B -I Date Date 82. Glass Protection Date MECHANICAL (Perrr,it) OK except q's 83. 84. 85. _ Corrections from Previous Inspections Gas Test -Meters Tagged; Gas -Electric Water & Sewer Connected -C/O to Grade -HD Approval - 31. A.C. Ducts: Insulation & Support - _ 32. 33. ent VFan; Exhaust above Insulation Condensate Drain _& Overilow; Size & Grade 86, Energy Compliance Certificate -Other Certificates 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access -&-Platform if Furnace in Attic Card -81 Date Card -BI Date Card -BI Card -BI - - - --- - - --. - ---- -- -- - -.-------------- Date _ Card -BI Date Date Card -81 Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRAMING(Plans) OK except q's Comments at Final: _ 36. 37. 38. 39. 40. Sills; Proper Material & Anchors _Walls; _Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing _ Draft Stop in Walls (rat proof) _ _Fire Stops; Furred Ceilings -Stairs -Chases -Tub _ 41. 42. 43. 44. 45 46. 47. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties - Purl in - Roof Brac.-Truss-Shthng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat - Attic Access: Size &Romex Protection -Draft Stop -Ins. Baffles Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions Garage Fire Protection Framing (NOTE: An entry must be made each time youvisit jobsite) COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with therequirements of the California Administrative Code, Title 25, Chapter 5, under permit number X7931- for the following location: Aza / /i M/. CJ I. I.If f t 11 c1A \,o, Owner �'� ^ ° �� Owner's Address Mobilehome Mfg. sf�/%/,L� Model —Year W6 Insignia No. Lik�+k'J i-��4/l 6) Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Date Director of Public Works By I THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White- Owner, Yellow- Installer, Pink - D.P.W. 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 CORREC_TI;ON. NOTICE y4'- r� l 7--1&--_,ri Uwivtrt PERMIT NO. t 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. V-1 1 -1,69 l e7 6 a Inspector_.__ Date „ COUNTY OF BUTTE - DEPARTMENT -OF PUBLIC WORKS 7 County Center Drive - Oroville, Califorr,'t 95965 - Telephone 916/534-4541 APPLICATION RMIT PERk MT NO. ASSESSOR PA CEL NUMBER ZONING BUILDING PERMIT OWNER a —�� TELEPHONE SQ. FT. OCC. BUILDING VA ION OWNER'S MAILING ADDRESS f . a I CONTRACTORS NAME TELEPHONE � 1 ' 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 $ J Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS - Permit fee $ BUILDING ADDRESS G ` /� PLUMBING PERMIT Filing Fee 10.00 f Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex[] Mobilehome Other ' SPECIFY Building sewer 5.00 Mobile Home S I G W" 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Instal latiorijQ( Other ❑ Describe work: :XQ/_(M,1_ r &044-r IZ�6� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service i$o AMP V OR ORSLESS 10.00 Main service EA. ADD'L too AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. SLOGS. 2I/20sgft ' CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 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, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEWNON-RESIT FL BRANCH CIRCUITS2.50 ea NEw CONSTFL / POWER APPARATUS W) NON-RESID. -(SINGLE OUTLET CIR, Ex. Occu / BALO30 P\o Ts OR FIXTURES BAL®30 FIXED FIXED APP LHS, OR EX. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ ' Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 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. 1 shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 1 certify that I have read this application and state `that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 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. /0 "9��p ? X ` Date_ a Signature of Applicant — Owner ❑ Contr for ❑ 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 $ 90 TOTAL -PERMIT FEE $ OCCUP, GROUP I TYPE OF CONST, I PARCEL PD 1 ND 1 IBS This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF LIC IV By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date �!� i� Receipt No. � WHITE-O.P,W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT \ COUNTY OF BUTTE - DEPARTMENT OF RUBUC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CA;VlF0 *A 95965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET Permit No. OWNER eP� G /> A. P. No. Proposed Building Use Permit Fee Based Upon: Complete Contract Price DPW Valuation Other- (Explain) Building Inspector Date�0 --7,x,2- At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED \j 1. All items have been submitted. . . . . . . . . . . 2. Plot -plans in duplicate./triplicate., . . . . . . . . . 3. Complete plans in duplicate. /triplicate. . . . . . . . . 4. Complete engineered plans and calcs... . . . . . . . . 5. Plans with Energy Design Compliance Statement. . . . . . 6. State Energy Forms No. 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . . . 9. Letter of signature authorization. 10. Sanitation approval from Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Cofipensation 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. . . . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . . . Pre-Inspec. request to (Dote) . 17. Pre -Inspection for Required. Building Inspector 18. Other When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. 1— Other ��,i ����/� / n5e-- Z:7/tea Applicant Date Copy of plans sent Health Dept.,- Fire Dept., Other Date During the plan checking process, the following data must be submitted prior to permit issuance. -(For required items not checked above at time of application, circle item.) 1. Index permit for above Items No. 2.i Additional items required: (Contractor, Designer, Owner) was advised of above required data by Telephone Mail Other By Plans checked by Date Plans approved by Date Other: Copy—DPW Date BUTTE COUNTY.DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: ( i ►/A jr, Ql 2. Installer's name: 0 1 n 4r d r\ b fl1 3. Is the site currently under permit? Yes 77Q No (If yes, furnish permit number l 7 %'3 ) OR t Is the site an existing site? Yes] / No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of.all setbacks.and easements? Yes / / No (If no, clarify S. What is the mobilehome electrical rating? ----------------------- !o Amps 6. What is the mobilehome site service rating? ---------- 20 ® Amps 7.. What is the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome siteservice? --------------------------------------------------- Yes No . (If .yes, identify the load and size: (Load) (Amps) l 9. What is the mobilehome site gas pipe size? ----------------- ------ L (in.) 10. What is the type of gas service? ----------------------------- Natural 7-7 LPG XV 11. What is the gas pipe length from meter or tank to the mobilehome? 12. What is the mobilehome gas demand? ------------------------------ (BTU): (This information not required if pipe length less than 6 ft. on natural gas.. or less than 50 ft. on LPG.) F. MOBILEHOME SUPPORT DATA If other than single wide, Mobilehome Mfr.furnish Setup Model No. Yea;O Width jo7, _(ft.) Box Length 60 (ft.) Tagalong or Expando Size ft. x ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973; furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). All center supports measured from front of mobilehome unless otherwise specified. Footings (check one) • Single 1. Wood either pressure treated or ._ foundation grade. (ft.)(in.) (in.) (in .) ❑ 2. Other: ( specify) Center support Center support '. Supporta (check one) locations* footing sizes (in.) 1: Concrete block. X ❑ ,2: Other.(specify) (ft.)(in.) (i�-n-.) (in.) (in.) (in.) I I X J (ft.)(in.) (in.) (in.) I . (ft.)l(in.) (in.) (in.) *If center piers are other than drawn above, -4 raw im-iocations, spacing, and dimensions. ragalong or Expando,' show support details. 12_ x2Q -- Typical Support in. (in.) Footing Size 411 -- Max. Pier Spacing (ft.)(in.) -- Max. Overhang (ft.)(in.) 3733-83 BUTTE COUNTY V 111 -DING DEPARTMENT APPROVED COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA. 95965 Phone: 916-,534-4541 OWNER -BUILDER VERIF ICAT ION 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) 2. I (have/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. 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 1 % - 2 9 1 9'3 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. AGRICULTURAL AFFIDAVIT EMPLOYER Employer AKO,�c �cy1�(= Phone �7�1-ay5 5 Employer's Address (Present) 15 Ar?_ OT. 1).PHpr( -Pa, OAS DY' GA Name of Owner _e m, c" ti 1_EJ"F_ v e,5 _ Owner's Address n67A W_ i r U e"A M B<W ell 0 R Owner's Assessor's Parcel No. Building/Environmental Health Permit Description and Number Date Issued By Planning Department Approval: Date (u pone -S Dwelling on AP# By" (- I,y�eu Bio declare,. subject to the penalty of perjury, address (present) that I am the employer of C LNTo N AS dna GE on AP# —CEL -1 L0-00 4 and that I will be employer under Section 24-21.2 E for at least a t g thirty-two (32) hours per week'for at least sixteen (16) weeks per year on Signed Dated — g 3 i PERMIT NO. 1975183P..,E MH PERMIT EXPIRES OWNER RAYMON M. LEFEVRE ` CONTR. owner ASSESSOR PARCEL 28-1852 LOCATION W/s Uphan Rd, 8/10 mi N LaPorte Rd . i Bangor { 9 s i l t Temp. Power Pole— Called ole_Called PG&E ' Temp. Elec. Service_ Called PG&E_ t Temp. Gas Service _ Called PG&E k ' F + JOB FINALED (Date) i Signature J = OK 0 = Not OK — = Not Applicable MOBILEHOMES = Not Ready l r MISCELLANEOUS Date MOB( HOME UTILITIES (Plans) OK except N's Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except H's 1/'Zoning Requirements—Setbacks—Easements 1• Zoning Requirements—Setbacks—Easements eft^ ils; Special MH Support—Sketch 2. Footings; Size—Depth—Spacing—Connectors 000'sewer; Location—Test—Fall-C/0—Concrete 3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails VWater; Location—Test—Easement Needed (Sketch) _ 4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing lectricity; Location—Clearances—Grnd.— / Amp—Concrete 5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures t§/Gas; Location—Test—Wrap: "L"ft./ /"Nat.or/ /"L"ft./. ' LPG 6. Carports; Windows—Doors— Utility Clearance _ 7. Elec. Card -BI Date Card -BI Date Card -BI " Date 4% • ;:rj Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements—Setbacks—Easements Card -BI Date Date Card -BI Date _ POOLS (Plans) OK except tt's 1. Setbacks—Easements 2. Footings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability 3. Gas; MH Test—Demand—Valve—Connector 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining__ 4. Electricity; MH Test—Crossovers—Breakers—Clearances 4• Elec.; Receptacles and Lighting; Distances—GFI 5. Drain; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6. Water; MH Test—Regulator—Connector 6. Elec.: Enclosures; Conduit Entries—Terminals—Listed 7. Water and Sewer Connected—C/0 to Grade—HD Approval 7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg. Boxes—Enclosures—Panel boards—Ins. to Main in Conduit 9. Exits; Insp.—Sketch 10. Cert. of Occupancy 9. Health Department Approval Card B-1 Date Card -BI . Date 10. Plumb; Cir. Test—Water Supply Test Card -BI Date Card -BI Date Card B-1 Date Card -BI Date Card -BI Date Card -BI Date I I V OK 4 0 Not OK Not Applicable Not Ready RESIDENTIAL (Single and Duplex) - Date UNDERFLOOR (Plans) OK except N's Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /'' Ftg. Depth 48. 49. Property Line Firewall & Openings 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 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/0 -Sewer Test 55. 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 11's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except q's 57. Smoke Detector 14, Water Ht.; Vent -Access -Combustion Air 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.: Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 61. 62. Elec. Trim & Subpanel; Breaker Sizes -Labels Stairs & Rails 19. Gas Pipe; Size & Anchors _ 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except M's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper -- 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 21. _Flet. Receptacles Spacing -Lights &Switches at Doors 70. 71. Plb., Elec. &Mech. Equip. Listed for Location Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 22. Size Boxes & No. of Conductors -Stapled - - 23. 24. Romex Installed Close to Edge of Studs & C.J. Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water 72. 73. Insulation -Foam -Looked in Attic E3 Yes Guard Rails &Deck Construction -Post Caps 25. 2 Appliance Circuits in Kitchen &Conductor Size _ 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes - 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Neutral 7 -Yes [-j No 75. 76. 77, Followinginstld.: Drive Yes No; Walks ❑ ❑ ❑Yes ❑ No; Planters ❑Yes ❑No Stucco; Brown -Finish A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 28. Service -Riser Conductors & Ground -Main Disconnect _- -- 29. 30. Equip. Clearances; Panels-Motors-Mech. Equip_ Clothes Closet Light -Shower Light _ 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. ------ Card B -I ------------ --- __Date_ --__ Card -BI Date 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. 82. Ventilation throughout House Glass Protection Card B -I Date Card -BI Date Date MECHANICAL (Permit) OK except q's 83. _ Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric - 31. A.C-.-Ducts; Insulation & Support 85. Water & Sewer Connected -C/O to Grade -HD Approval _ 32. 33. Vent Fan; Exhaust above Insulation Condensate Drain _& Overilow; Size & Grade 86. Energy Compliance Certificate -Other Certificates --35.-Attic 34. Furnace-Vent;_Access-Comb._Air-Return Air Vent -115V outlet Access -&-Platform it Furnace in Attic -------_ Card -BI Card -BI --- _- -_--_--__ ---- _____--_-___- Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Card -BI Card -BI Date Card -BI Date Date Card -BI Date Date FRAMING(Plans) OK except q's Comments at Final: 36. Sills; Proper Material & Anchors _37. 38. 39. _Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Flo o_r_Nailing _ Draft Stop in Walls (rat proof) 40. _Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. 45 46. 47. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rflr. Ties- Purlin-Roof Brac.-Truss-Shthnq.-Rfnq Fireplace Ties or Type A Flue -Fireplace Throat At Access: Size & Romex Protection -Draft Stop -Ins. Baffles Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions Garage Fire Protection Framing (NOTE: An entry must be made each time you visit jobsite) • i - 1 , • I COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKSt 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 s CORRECTION NOTICE Uwivtrt All PERMIT NO. 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. l I' L r Inspector Date COUNTY OF BUTTE - APARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville„ !`alifornia•95965 - Telephone 916/534-4541 APPLICATION AND PERMIT �1 ASSESSOR PARCEL NUMBER Z, _- /S ZONING BUILDING PERMIT owN A ���� T�LEPH?e�f/ SO. FT. OCC. BUILDING VALUA ION O WN�%MAILG ADDRESS V NAME CONTTTRACTOR((''SS 1 TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation is Filing Fee $ 10,00 LENDER'S MAILING ADORE Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. an Checking Fee Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUIL,DIN ADDRESS /�l/[ W S /f/9`�r PLUMBING PERMIT FiIIng Fee 10.00 Al " ©F '� Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PA FEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USEORUCTURE SF ❑ Duplex❑ Mobilehome Other SPECIFY Building sewer 5.00 Mobile Home 110-00ea 30--2 TYPE OF WORK New Addition E:1 Remodel❑ Utilities Installation❑ Other❑ Describe work: Permit Fee $ Apr) Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS AMP OR LESS 10.00 /,0,00100 Main service EA. ADD'L 100 AMP 2.50 L NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 21/20sgft 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 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 NEWCONSTR ULT' -OUTLET NON-RES'D BRANCH CIRCUITS) 2.50 ea NEW CONSTR. (/ POWER APPARATUS V NON-RESID, 1 SINGLE OUTLET CIR. Ex. Occu 20e50e P�o XTS OR FIXTURES SAL®30 FIXEEDD APPLNS, OR EX. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 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 shal I be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all Ii 1 s, judgments, cost and expenses which may in any way accrue agai st e nce of the granting of this permit. X�GK��- Date /y� 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 $ TOTAL PERMIT FEE OCCUP, GROUP TYPE OF CONST, PARC PD ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRE OR OF PUBLIC By P T EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date -, Receipt No. Receipt No. / YELLOW-ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT n.. r a ' MOTE:—dill Materials & Workmanship Shall Be *id i' Accordance with Recognized Good Practices and,' .of a quality prescribed for,the Specified use in the Uniform Building, Plum. Bing &Mechanical Codes and the National Electrical Code. This set of plans and specifications MUST be kept on the job et al ti~ tos end it is uF:lawf�l tc make any chc?n les 9 a l rat�icns on same witih w; itten pe;rr;issicn from i he Department of Pu: lic Works, County of Butte. ed iOT he muobil home g Pallet on ►10{ t on ZCO P.Le C5 } E s' f Utility connections shall be witbii, 4 ft. of the mobile e- either /'t�h►A Ver 'XWelleft) or w hin the rear half of t of the Ur, . T2p\mori Le5cveE s A`setback of 5Jt. from the property lines and a setback of 50ft..from the road centerline shall be clear of structures or equipment except for a 2 ft. eave overhang. BUTTE COUNTY BUILDING DEPART'I1 Ep4T- APPROVM Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR RESIDENTIAL DEVELOPMENT Section .26-8.1of the Butte County Code requires this acknowledgement `�►.s`�T''i'I'� �- be recorded prior to issuance of a building permit. �•'; •sir, ,gT. , ��,. DARTY SHOWN The property described herein is adjacent to land or included i 19 ( 1. withiri an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort arising from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occa- sionally generate dust, smoke, noise, and odor. Butte County has established. agricul- tural.zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. 83-2159' . All that real property situate in the County of Butte, State of California, described as follows: The North half of the Northwest quarter; the Southeast quarter of the Northwest quarter; the Northeast quarter of the Southwest quarter and the Southwest quarter of the Northwest quarter, all being Section 12, Township 18 North, Range 5 East, I.D.B. &M. D. PROPERT, State of California ) Butte ) SS. County of ) OFFICIAL SEAL DOLORES M LINDELL m A NOTAFY PUBLIC - CALIFORNIA BUTTE COUNTY My comm, expires SEP 19, 1983 � Present A.P. NO. 7i� 0 � On this the 29th day of June 19 83 before me, the undersigned Notary Public ersonally appeared 1' 4 Pl0AJ � (,e� £ X,611VL1 M known to me to be the person(s) whose name(s) are subscribed to the within instrument and ackpowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Z,/," � `rL -'e. e Notary Public L%333�7� .l - . COURTY OR BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County~Center Drive — Oroville, California 95965 TelephonV5V-4541 .0 - APPLICATION AND PERMIT autnorize representatives or the county of tsutte to enter upon the above-mentioned property for inspection'purposes. (� x X t / �., ,u. 1/, r�/q Date Signature of Permitee or'Agent U Receipt No. I Z-204 77 White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. ,�//`, DIRECTOR OF PUBLIC WORKS By6iW� D.Date %A/f7 -7 Building permit expires Date 3/ '� BUILDING Owner 10,-L���l./ �'�/. � � /"�f///�E SO. FT. OCC. BUILDING VALUATION Mailing Address �%����.� /��/ / ,Telephone No. _ 77Y . � -5,5 Contractor f Mailing Address Fireplace Total Valuation Telephone No. Permit Fee yr Building Address f 7C//JOil��� a ? .� Plan Checking Fee&/or Penalty Permit Fee _ _ _ Z 14-7 /l`r)Y PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 r / Repair drainage or vent piping 1.50 i A. P. No. +� — `'' Zonin & Planning Water piping 1.50 Each gas water heater or vent 1.50 Fees W.C. Sani-tation Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EOA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Bldg:-Plans-Rec d- Parcel I Plans Approval Lawn sprinkler system 2.00 _AEproval NEW,] ADDITION ❑ UTILITIES ❑ OTHER ❑j Permit Fee $ $ ELECTRICAL No. @ FEE 44 /iV-i PERMIT FILING FEE $3.00 (1U 600V OR LESS�7 Main service 100 AMP OR LESS 5.00 - `, Single Family 0 Duplex E]Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 A r � h \ Main service OVER 25.00 100 AMPP OR LESS O Main service EA. ADD -L 100 AMP 1.00 NEW CONST. DWELLING OCCUP. S OR ADDNS. � ACC. BLDGS. � 20sgft ° CONTRACTORS LICEN_ SE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Businesst& 'Professions ',Code under the name style of: fa \ { \� \ f �.• NEW CONSTP_ MULTI.OUTL T NDN.RESID BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS a NON-RESID. SINGLE OUTLET CIR., ES e L ,� Ex. Occuo(OU LE APPLNS. OR Ex. OCCup.(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 0 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ®I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $ TOTAL PERMIT FEE autnorize representatives or the county of tsutte to enter upon the above-mentioned property for inspection'purposes. (� x X t / �., ,u. 1/, r�/q Date Signature of Permitee or'Agent U Receipt No. I Z-204 77 White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. ,�//`, DIRECTOR OF PUBLIC WORKS By6iW� D.Date %A/f7 -7 Building permit expires Date 3/ '� COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive. - Oroville, California 95965 Tel ephone:.53.4-4541 APPLICATION AWPERMIT authorize representatives of the county of Butte to enter upon the above- 7oneproperty for i.n cti p rposes. �( X nt VAD Date 236 J IT�� Signature of Permite; o�r7Aggent Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIR R OF ELIC WORKS B Date 7 A Building permit expires Date 7 Ad BUILDING ' Owner ��� 2� SQ. FT. OCC. BUILDING VALUATION Mailing Address ele one No. s Contract4' Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address �'�£ Q _/ c� Plan Checking Fee&/or Penalty Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 F s 0,15- 66A 4aUQn Fire Dept. Fire Zone Use Permit Gas piping system 1 -5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 B Parcel Approval Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 71, 800V OR LESS O Main service 100 AMP OR LESS 5.00 Single Family ® Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW CONST OR ADDNS. ACCLLING BLDGS.CCUP. 5)22sgft CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name st le of: Y NEW RESID,CO N MBRANCULTI-OUTL T NON.RESID � BRANCH CIRCUITS 12.50ea NEW CONSTR. (POWER APPARATUS 8 NON.RESID. SINGLE OUTLET CIR. Ex. Occup{OUTLETS OR FIXTIIRES 5 L 254 , Ex. OCCU FIXED APPLNS. OR p.�OUTLETS (REBID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 , 3 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ S WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEEPERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $ TOTAL PERMIT FEE $ authorize representatives of the county of Butte to enter upon the above- 7oneproperty for i.n cti p rposes. �( X nt VAD Date 236 J IT�� Signature of Permite; o�r7Aggent Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIR R OF ELIC WORKS B Date 7 A Building permit expires Date 7 Ad