HomeMy WebLinkAbout029-132-003E. SAMUELSON
n/s Main St., app. 250' E. of Lith St.<
Richvale
m ntr: Dnnohn refrig., Gridley'
Permit# 2735-75B(rer2of) �s'
029-132-003 01-2540r—
FULL WIGHT
1260 RICE RICHVALP )
CONT: IDEAL PL ING
REPLACE TIGHT LINE
029-132-003 05-1267
SCHNEIDER, KELLY ;.
1260 RICE AVE, RICHVALE�
CONT: ABLE PLLIlVIBNG Os
REP ELEC PANEL 5 X13'
i
.a
1
E. SAMUELSON
n/s Main St., app. 250' E. of Lith St.<
Richvale
m ntr: Dnnohn refrig., Gridley'
Permit# 2735-75B(rer2of) �s'
029-132-003 01-2540r—
FULL WIGHT
1260 RICE RICHVALP )
CONT: IDEAL PL ING
REPLACE TIGHT LINE
029-132-003 05-1267
SCHNEIDER, KELLY ;.
1260 RICE AVE, RICHVALE�
CONT: ABLE PLLIlVIBNG Os
REP ELEC PANEL 5 X13'
I_
C114 i C"I
' NOTES RESIDENTIAL
PERMIT NO.
VSCH029-1-32-003 05-1267
NEIDER, KELLY',.'- r
1260 RICE AVE, RICHVALE
CONT: ABLE PLUMBING
REP ELEC PANEL -
SPECIAL CONDITIONS
t CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
' SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY
Address M C C> Rk Lz
GAS
Meter By Date -
ELECTRIC i
Meter By Date
l
j
JOB FINALED (Date) S
I Signature �--~�
4=OK
0='Not OK
- = Not ApplReady
. =Not Ready
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Date
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer, Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or/ /" L °ftJ P LPG
7. Well Clearance & Disconnect
8. Utility Clearance
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Date
2. Footings; Size -Spacing -Marriage Line
Date
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test -Regulator -Connector'
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert. of Occupancy
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PERMANENT END SYSTEM (ONLY)
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Blocking
4. Gas; MH Test -Demand -Valve
5. Electricity; MH Test
6. Water, MH Test
7. Water and Sewer Connected
8. Gas and Electricity Tagged
9. Exits
10. License Decals
11. Verify #'s with Office
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs-Connectors
Shthg- Frg- Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
12. Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance -GA
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
12. Enclosure; Fencing -Alarms
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
= OK
= Not OK
= Not Applicable
= Not Ready
RESIDENTIAL, (Single & Duplex)
Date UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Gmd. / /" Ftg. Depth
3_ Ftg., Garage; Soils-Steel-Elec. Gmd.-/ P' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Botts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Duct in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
83. Following InstldJDrive 0 Yes 0 No/Walks O Yes 0 No O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compl;ance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
19. D.W.V.; Test Fittings & Anchor -Nail Protection
20. Shower Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler, Test
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
24. Fixture & Transformer Clearance -Ins. Protection
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or AI
31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI
Insulated Neutral O Yes 0 No
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels -Motors -Meth. Equip.
34. Clothes Closet Light -Shower Light -Spa Light
35. Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform H Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41. Sills Proper Materials & Anchors
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44. Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Botts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Duct in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor 0 Yes
83. Following InstldJDrive 0 Yes 0 No/Walks O Yes 0 No O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compl;ance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION M (530).538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BPO51267
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 penally of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
Issued Date: 05/12/2005 APN: 029-132-003-000
the Business and Professions Code, and my license is in full force and
effect.
: LicenseNumber:
License Class se D
Site Address: 1260 RICE AVE RIC
Date: Q�/ 3/� Contractor: A&5 5Z. P I 4C—
7
Map Index:
Description: replace electrical panel
OWNER -BUILDER DECLARATION
I hereby affirm under penally 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: SCHNEIDER KELLY A &SUSAN ROSE
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for sucli permit to rile a
signed statement that he or she is licensed pursuant to the provisions of
P O BOX 406
the Contractor's State License Law (Chapter 9 commencing with Section
RICHVALE,
7000) of Division 3 of the -Business and Professions Code) or that he or'
CA
she is exempt therefrom and the basis for the alleged exemption. Any
95974-0406
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 (8500).):
❑ 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: ABLE PLUMBING AND ELECTRIC ,
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
P.O. BOX 7909
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
CHICO, CA.
proving that he or she did not build or improve for the purpose of
95927
sale.).
530-899-9009
❑ 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' Stale License Law.).
Contractor: ABLE PLUMBING AND ELECTRIC
❑ 1 am Exempt under Article 3 of the Business and Professions Code
P.O. BOX 7909
Date: Owner:
CHICO, CA.
95927
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
530-899-9009
❑ 1 have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the
License #: 627760
Labor Code,.for the performance of the work for which this permit
is issued.
❑ 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Architect:
insurance carrier and policy number are:
Engineer:
Carrier:
Po1ic
I certify that in the performance of the work for which this permit is
Total Square Ft: 0 S. F.
issued, I shall not employ any person in any manner so as to
Valuation: $0.00
become subject to the workers' compensation laws of California,
and agree that. if I should become subject to the workers'
Census Code:
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNI Failure to secure workers' compensation coverage is
�
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars (8100,000), 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 horeby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Reso s ' do work indicated above for which fees have been paid:` -
performance of the work for which this permit is issued (Sec 3097 Civ.)
,
Date:
Name:
B J
�
PERMIT E) IR ON: /
Address:
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 or 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 representali s of'Butte County to enter theabovementioned property for inspection purposes.
ruupon
Print Name. n S-f/i4�%✓ ;k;Y LenSignature:
Date:
,❑ Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor
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.
BPOS1267•
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: 05/12/2005 APN: 029-132-003-000
the Business and Professions Code, and my license is in full force and
effect'
License Class : License Number: ��,2 7-76DSite
D
Address: 1260 RICE AVE RIC :.
Date: �oK Contractor: A&r 9Z4' P, I
Map Index:
Description: replace electrical panel
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: SCHNEIDER KELLY A &SUSAN ROSE
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
P O BOX 406
the Contractor's State License Law (Chapter 9 commencing with Section
RICHVALE,
7000) of Division 3 of the•Business and Professions Code) or that he or'
CA
she Is exempt therefrom and the basis for the alleged exemption. Any
95974-0406
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).):
❑ 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 anABLE
Applicant: PLUMBING AND ELECTRIC
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
P.O. BOX 7909
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
CHICO, CA.
proving that he or she did not build or improve for the purpose of
95927
sale.):
530-899-9009
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,
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
Contractor: ABLE PLUMBING AND ELECTRIC
❑ 1 am Exempt under Article 3 of the Business and Professions Code
P.O. BOX 7909
Date: Owner:
CHICO, CA.
95927
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
530-899-9009
❑ 1 have and will maintain a certificate of consent to self -Insure for
workers' compensation, as provided for by Section 3700 of the
License #: 627760
Labor Code• for the performance of the work for which this permit
is issued.
❑ 1 have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
Architect:
insurance carrier and policy number are:
Engineer:
Carrier:
Polis
I certify that in the performance of the work for which this permit is
Total Square Ft: 0 S. F.
Issued, I shall not employ any person in .any manner so as to
Valuation: $0.00
become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers'
Census Code:
compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date:
Applicant:
WARNIZ 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 h eby Issued under the applicable provisions of the Butte. County Code and/or_. _
I hereby affirm that there is a construction lending agency for the
Resoled ' s ' do work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
,'
5
Name:
B • """" Date: -.566
PERMIT E 3IRON: I
(Date)
Address:
O 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the Callfornla Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
O' Notification in accordance with Section 19827.5 of California Health & Safety Code Is not applicable to the scheduled construction of this project.
O 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. 1 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 repres�entativ s of Butte County to enter upon theabovementioned property for inspection purposes.
Print Name:%✓ -,ValtLenSignature:
Date:
,❑ Owner 0 Contractor 0 Agent for Owner 0 Agent for Contractor
0
Last Name
Address
Ic
City e I
Phone
c
E-mail
Name
Address
City 0—
Phone Phone
__1__
E-ma
—
E-mail
Name
Address
City
Phone
E-mail
Name
Address
City
Phone
E-mail
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 OFAPPLICA TION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
OWNER LOCATION
First Name
aP#`�2--�2
vE' Property Address
Fax
`" I Cross Street
CONTRACTOR
215 Gv L #'/ C
State Z'
n
Fax
Lic # Class
ARCHITECT/ENGINEER
State Zip
Fax
State License Number
APPLICANT NAME
Slate Zip
Fax
APPLICANT SIGNATURE
�X I
For office use only:
Zoning Flood ZoneSRA ves No
Occ. Type Const.
Subdivision Name Map Book Page Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc
Page 1 of 2
City
WORKER'S COMPENSATION
Policy Number
Carrier
PERMIT
NO.
BIN #
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 Work:
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
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.
Received b
C�
Receipt #:
Amount: Bldg
Date: S5/OV
SRA
Sheriff
SMIP
Other
Total
REV 2-24-05
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes!
❑ 4. Energy compliance design and supporting documentation in duplicate.
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings:
❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
❑ 7. Metal bldgs: (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.
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑ 9. Site plan and business license approval from the City of Biggs.
❑ 10. Letter of intent for non-residential buildings.
❑ 11. Detached Accessory Building Form filled out by the owner (if required).
❑ 12. Hazardous Material Form (for Commercial Buildings only).
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review (May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification).
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts.
❑
12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire 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.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from 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
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05
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V
(Rev. 12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7-541-
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
029-132-003
ZONING
ARMH
BUILDING PERMIT
OWNER
FULLER DWIGHT
ITELEPHONE
882-4208
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
1260 RICE WAY RICHVALE rJ�
CONTRACTOR'S NAME
IDEAL PLUMBING
TELEPHONE
751-5100
CONTRACTORS MAILING ADDRESS
. 3120 INDUSTRIAL DR YUBA CITY 95993
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE No.
Flin Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAKING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Kling Fee 20.00
USEOFSTRUCTURE
SF IX Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK _
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other IX
Describe Work: REPLACE TIGHT LINE
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00 L3.00
Mobile Home S G W
Q20.00
PERMIT FEE $
35.00
ELECTRICAL PERMIT
Fling Fee 20.00
OR
Main Service 200A OR LESS
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
^T: Po Lic. No. (�'^"
License Class (? - - I t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason: 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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is Issued.
1 have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUP,
OR ADDNS. ( A ACC. BLAS.
So
3.50 FT.
T.
N,NO"ESID. MULTI -OUTLET
NBRANCH IRCUITS
@7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES
20 BAL .50 @@ I:.
Ex. Occup. OFIx�LEED�A Aa DR.
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE $
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEt S
Policy Number �142- V f !�
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compe tion provisions of section 3700 of the Labor Code, I shall
forthwith ompl ith those provisions.
X Date re, I-
Signature pp ant - ❑ Owner t Contractor ❑ Agent
An OSHPf permit is required for excavations over 60" deep and demolition or construction
structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
013
TYPE
TOTAL FEE $ 35.00
4HA
, FE P
�'
FLOOD
CDF
PARCEL
PD
HD
' E
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.
IBy / ! Dat
,of
Ili
7
PERMIT EXPIRES 0w >✓ •I f
eta
Receipt No. '
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
ON
(Rev. 12/96)
,COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-70 R!1540
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
029-132-003
ZONING
ARMH -
BUILDING PERMIT
OWNER
FULLER DWIGHT
TELEPHONE
882-4208
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS n ��
1260 RICE WAY RICHVALE
CONTRACTOR'S NAME
IDEAL PLUMBING
TELEPHONE
751-5100
CONTRACTORS MAILING ADDRESS
. 3120 INDUSTRIAL DR YUBA CITY 95993
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
1260 RICE. WAY, RICHMALE
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF EX Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition O Remodel ❑ Utilities O Installation ❑ Other Ck
Describe Work: REPLACE TIGHT LINE
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00 5.00
Mobile Home ISI GI W
@20.00
PERMIT FEE S
35.00
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service 200A OV OR LESS
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect. /
License Class e- 36 Lic. No. 7651 1 1 3
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO I000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( & ACC. BLDS.
SO
3.5¢FT.
I,pN µ'.R SID MULTI.OUTLEr
97.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES
.00
BA.50 2L @ .50
Ex. Occup.. DUTIEEDTS pp OE
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE $
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
O 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.
X I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' crompensation Insurance carrier and policy number are:
Carrier gT4tL compensation
Policy Number1 R� aIa0a
(The above sections -need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall
not employ any person In any manner so as to become subject to workers'
compensation laws of California, and agree that f I should become subject to the
workers' comp sation provisions of section 3700 of the Labor Code, I shall
forthwit Corn ith those provisions.
X Date
Signature pp an - ❑ Owner -Contractor ❑ Agent
An OSH permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEP S
Mobile Home Installation Fee $
Energy Inspection Fee $
oc�
x3
CONST TTPE
TOTAL FEE $ 35.00
f.AZ.
p, PE IMP
FLOOD
CDF
PARCEL
PD
HD
1SyE
x
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
4indicatbove for which jeephave been paid.
AM
at o
RMIT EXPIRES O Uaj
Date
ReceiptNo. 332386/$35.00
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER Ulf �1 UG zONAM BUILDING PERMIT
OWNER _ e1 nv' tel_ Ne 80 FTOCC. BUILDING VALUATION
awNEAs AIN ADDRESS j�} (1_ /�� /�
O/1� CjJ, Q / )w�•- ^i LJ QJ�s (�[LX� , C�&_
CUA -V N
OUTLET OR FOCTURES
�v W �.w
DAL 0 .SO
X51- l 00
MED '��• OR
OvnErs CRESID.1 EA
5.00
Temporary
Service
CONTRACTORS MAJUNG'pDQEss
Mobile Home Facilities
20.00
Misc. Wiring
23.00
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fire lace
Total Valuation b
MCNRECT OR ENGINEERLICENSE
NO.
Filing Fee
$20.00
ARCHITECT OR ENGINEERS MAl1NG ADDRESS
BUILDING ADDRESS
O ^
Permit Fee
$
Plan Checking Fee $
Energy Plan Checking Fee E
V o.Q.R_
s
PERMIT FEE
f
.OT NO.
SUBONIS IDN8 NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee
20.00
USEOFSTRUCTURE
SF,X� Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater 23.00
Water piping 15.00
New ❑ Addition ❑ Remodel ❑
Describe Work: fp,C4
TYPE OF WORK
Utilities ❑ InsEdllntion ❑
Other �
(1nt Q�
Each gas water heater or vent
15.00
Gas i in stem 1 - 5 outlets 15.00
pg
sewer
, p0
P5.00
Mobile Home S G W 20.00
PERMIT FEE
t
ELECTRICAL PERMIT
Fling Feel
20.00
Main Service000V DR LESS
sooA oR LEss
23.00
Main Service 200A TO 1000A
48.00
NEw CONST. ( p a � SUP. 3.5¢sG.
OR ADONS. FT
NON-RESID. BRANCH CIRCLATR ) @7.50
*PERMIT FEE PA2b
SRA
SHERIFF
OTHER
AMOVNT RECEIVEb
""RECIEZ"WAM
* To 9E Pir n4ro CoA vm
tx. OCCU .
OUTLET OR FOCTURES
�v W �.w
DAL 0 .SO
EX. OCCU
MED '��• OR
OvnErs CRESID.1 EA
5.00
Temporary
Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
I Cool
PERMIT FEE i
MECHANICAL PERMIT Fling Fee _ 20.00
6.50
PERMIT FEt S
Mobile Home Installation Fee $
Energy Inspection Fee $
_. -PE TOTAL FEES 35,00
-Z-
5,pyo
. D. FEES FLOOD I COF PARCEL I PO ND 6SUE
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.
By
PERMIT EXPIRES ON
Date
A
PERMIT NO. 2735-75B
P
'MH UTIL.
PERMIT NO.
PERMIT EXPIRES 7(0
�OWNER E. Samuelson
,�CONTR. Dongho Refrig., Gridley
,LOCATION (A.P. 29-13-03
it
n/s Main St., app. 2501 E. of Lith St., Riahvale
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JJOB
FINALED
(Dat
(Sig
S' g; ,e)
Setback
Forms
Main Bldg.
Footings
Stemwal I
Slab
Piers
Garage
Footings
Stemwa I I
Slab
Carport
Footings
Slab
Patio
Footings
Masonry Walls
Reinf. Steel
Stucco
Mesh
Scratch
Brown
Finish
Interior Latl
Door Closer
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd)
Firewall
Parapets
Restroom Finish
Windows
Siding
Roof Sheathing
Roofing
Fdn. Vents
Garage Vents
Prov. for physically
handicapped
Conformance of ex.
structure
FIREPLACE
Footing
Throat
Final
FIRE SPR KLEI
Test
Final
MECHAVfCXL
Heating
Cooling
Ducts
Ventilation
Final
DATE REMARKS OR CORRECTIONS
�� 3 - 75-
PLUMBING
Soil Piping
1st Floor
2nd Floor
3rd Floor
To out
Water Piping
Sewer
Fixtures
Water Htr.
Heaters
A pliances
Gas Piping & Test
Temp. Gas
Sanitation
Final
ELECT I
F
Subpanels
Grd. Fault Pn
Service
Temp. Pole
Under rou
Perrnane i
Final
JCOUNTY OF BUTTE rDEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 9596
Telephone 534-4 Al
APPLICATION AND PERMIT
By Date-corf 4- 'J
Receipt No. � 3� ��� �«/ -Z_White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant uilding permit expires Date
BUI DING
Owner �-, .14hLL-Z_5o N
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor �o �p
Total Valuation /
Mailing AddressPermit
�T
Fee--
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee
/6
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
% O • p
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A
A. P. No. v� 9 /3 O3
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
6aaitai+en
Fire Dept.
Fire Zone
I Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma P
60' R/W
provements
Improvements
Lawn sprinkler system 2.00
Bldg. Plans Rec'd
Parcel Approval
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER 0
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
J
Main service incl. 1 meter
Additional meters, each 1.00
Single Family ® Duplex ❑ Mobil Home ❑ Others ❑
Sub -panel (12 or less) (more than 12)
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
Light fixtures b I�
Receps., switches & fix outlets
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of: j
-IJ
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner_ or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No.94�' ClassificationC�3�',_�,CSL3r}i.
Misc. wiring
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit ,is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
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
authorize representatives of the County of Butte to enter upon the
above- 66 tioned propert fo inspection pu oses.
�'
r
X 'Date o uNF
Signatu of Pfirmitee or Agent
TOTAL PERMIT FEE
$
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 UBLIC WORKS
By Date-corf 4- 'J
Receipt No. � 3� ��� �«/ -Z_White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant uilding permit expires Date