HomeMy WebLinkAbout029-240-019029-24G-019 PERMIT#97-1731
LUNDBERG, Eldon
1245 Richvale Hwy , Richvale
Cont: Baker Elect'i S4�e�jlw
Ele Ser Ch/SF
029-240-019 01-2624
LUM5BEP�G, ELDEN .. 15" 1
1245 RICH �, CHVA)TV*
P
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CONT: 1=��LIMBiXQ 21,
REPLACE SEWER LfNES
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COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Ciroville, California 95965 * Telephone (530) 538-7541 PERMIT NO.
?'-? / � /, -) el
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
ZONING
BUILDINGPERMIT
OWNER
Ll,a: u, n � 21,)"2;
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
1:7,-� aic-mu: aiawu
CONTRACTORS NAME
TELEPHONE
1751-51CO
CONTRACTORS MAILING ADDRESS
�;j_20 LCJSfRIAL YWAA CITY, CA 959013
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filina Fee $ 20.00'
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDINGADDRESS
1245 1.11C.-WaZ 14.X. JIMMALE, CA
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF b: Duplex 0 Mobilehome 0 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 0 Addition 0 Remodel 0 Ublities 0 Installation 13 Other 0
Describe Work: TL -PLACE SLI:Q, LIWES
piping system I - 5 outlets 15.00
—Gas
Building sewer 15.00
Home ISI GI W1 I Lo)20.00 1
4"
—Mobile
PERMIT FEE $ 35.Co
ELECTRICAL PERMIT Filing Fee 20.00
OOOV 0 23.00
R LE::
Main Service .A OF LE
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 J(-, Lic. No. 7-(' T-11 3
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, as owner of the property, ormy employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 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:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is Issued.
I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, forthe performanceof workforwhich this permitis Issued.
My workers' compensa on.inturance carrier and policy number are:
Carrier (AcJ L 9".
Policy Number
(The above section ie completed If the permit Is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person In any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comp�y with those provisions.
,-e - I
X Date /I, e,, + n
Signature','&JAPPOcant - 0 Owner 13 Contractor 13 Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A TO 1000A 46.00
NEW CONST. DTUNG OCCUP. So.
OR ADDNS. C. S. 3.50FT.
NEW CONST.
NON-RESID. =LT.1 @7.50
WER APPARATUS
P.OINGLE OUTLET CIR.
j 20 1.00
Occup. OUTLET OR FIXTURES BAL .50
—Ex.
FIXED AP - OR
Ex. Occup. . (PRZ 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEP_
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $35.00
—
FEES IMP
I FLOOD
I CDF
I PARCEL
PC)
HD
ISSUE
_:�LO -
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 92wr Date/4 C/
PERMIT EXPIRES�ON
L Receiptllo.
WHITE -D. D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive Oroville, California 95965 9 Telephone (530) 538-7541 PER N
��Z—a
(Rev.12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
029-240-019
ZONING
BUILDINGPERMIT
OWNER
LMDBURG, ELDEN
TELEPHONE
SO. Fr. OCC. BUILDING VALUATION
OWNERS MAILING'ADDRESS
1245 RICHVALE HWY. RICHVALE
CONTRACTORS NAME
IDEAL PLUMBING
TELEPHONE
751-5100
CONTRACTORS MAILING ADDRESS
3120 INDUSTRIAL YUBA CITY, CA 95993
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
—Permit
Plan Checking Fee
$
BUILDING ADDRESS
1245 RICHMALE HWY. RICHYALF, CA
Energy Plan Checking Fee
$
_7�1.
$
PERMIT FEE
$
LOT NO.
SUBDfVtS IONS NAME
MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF IX Duplex 0 Mobilehome 0 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 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Other 1)
Describe Work: —REPLACE SEWER LINES
Gas piping system I - 5 outlets
15.00
Building sewer
15.0015.00
Mobile Home I S I G I W
020.00
iE7!
PERMIT FEE
35.0
ELECTRICAL PERMIT
I Filing Feel 20-00
R LE::
600V 0 LE
Main Service OA OR
23.00
LICENSED CONTRACTOR'S DECLARATION
1 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 11 fitand effect.
License Class Lic. No. 70/5-1/3
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 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.
E3 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 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:
0 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit Is issued.
I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' om sation in urance carrier and policy number are:
Carrier ME P:W10
Policy Number
(The above sectionht�ot leMcompleted if the permit Is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 cer* 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 0 1 should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith com with those provisions.
117
X Date ffa 0
Signatu?rFcE/AprAcant - 0 Owner 0 Contractor 0 Agent
D
AnOSH permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories ir� height.
Main Service 200A TO f000A
46.00
NEW CONST DWELLING OCCUP. 3.50SQ.
OR ADONS. & ACC. BIDS. Fr.
=,CONS MULTI -OUTLET 97.50
ESIDT BRANCH CIRCUITS
POWER APPARATUS )
& SINGLE OUTLET CIR.
EX. OCCUp. OUTLET OR FIXTURES ) 20 @ 1.00
BAL @ .50.
..FIXED APP
I. a. OR.
Ex. Occup. .1 E 1 5.001
Temporary Service 23.001
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEP_ $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $35. 00
HAZ.
I D. FEES IMP I
FLOOD
I COF I PARCEL
PO
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.
B:Y'\\�l Datv/��,
P /0
pate)
ReciiIiptNo.
WHITE-D.D.S.-B.D. C"ARY-ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive * Oroville, California 95965 * Telephone (530) 538-7541 PE IT
(Rev. 1096) APPLICATION AND PERMIT n /-,� 6 �� (7.
ASSESSOR PARCEL NUMSEb
ZONING
BUILDING PERMIT
OWNER � ,
TELEPHONE
SQ. Fr. OCC. BUILDING VALUATION
_0dA_P1
,1,2 10 ADD_RESSk
OWNERS "L17.
CONTRACTqWI!k
_&
CY C Lcz_�
TEVPAONE
75 / -5-16, D
.Oln7ll-S .7; �RESS
1)_0 ��
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation Is
ARCHITECT OR ENGINEER
0.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS —
Plan Checking Fee $
allILDINGADDRESS,
5
Energy Plan Checking Fee $
IL-ilEach
$
PERMIT FEE $
LOT NO.
SLISOMS IONS NAME
I
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF Duplex 0 Mobilehome 0 Other
SPECIFY
Trap 1
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 0 Addition 0 Remodel 0 Utilities 0 Installation 0,11M
Describe Work: A j_ -O
Gas piping system I - 5 outlets
15.00
Building sewer
15.00 137. 0 C)
6
Mobile Home I S I G I WT_
(920.00
PERMIT FEE
ELECTRICAL PERMIT
Filing Feel 20.001
R LESS
600V 0 LESS
Main Service . OR
23.0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, as owner of the property, or my employees with wages as their sole COMPEinsdu0n,
will do the work, and the structire is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 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:
0 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.
0 1 have and.will maintain workers' compensation Insurance, as required by Section
3700 ofthe Labor Code, forthe performance of work for which this permitis issued.
My workers' compensation Insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit Is for work of a valuation
of one hundred dollars ($100) or less.)
0 1 certify that In the performance of the work for which this permit is Issued, I shall
not employ any person In any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X Date
Signature of Applicant - 0 Owner 0 Contractor 0 Agent
An OSHA permit is required for excavations over 60* deep and demolition or construction
of structures over 3 stories In height
Main Service 200A TO 1000A 46.00
NEW CONST. - so.
.. 211 ADDNS. OCCSUP. ) 3.50FT.
MW GUNS F. MULTI-OLITLET
NON-FIESiD. BRANCH CIRCUITS ) @7.50
POWER APPARATUS ) —
SINGLE OLITLIFT CIA.
20 @ 1.00
Ex. Occup. oun.ET OR FIXTURES BAL @ .50
FIXED APPLNS. OR
Ex. Occup. OLITLETS (RESIO.) FA-) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 8.50
Ventilation
PERMIT FEIE. $
Mobile Home Installation Fee
Energy Inspection Fee
occ
OCONST. TYPE
TOTAL FEE $ , 0
IMP
I FLOOD
I COF
PARCEL
J
-P6
NO
ISSUE
This permit is hereby Issued under the applicable
of the Butte County Code and/or Resolutions
Indicated above for which fees have been
By Date
PERMIT EXPIRES ON
11261110)
provisions
to do work
paid.
Receipt No. _ __� _!:yo 6 -5 �/ 3 `:�_
WHITE-O.D.S.-B.D. CANXRY-ASSESSOR PINK -INSPECTOR GOLDENROD -Al
029-240-019� PERMIT#97-1731,-
LUNDBERG'
Eld
on
1245 Richvale Hwy, Rich'vale
Cont: Baker Electric
Ele Ser Ch/SF
L
f
OFFICE Copy
A
"'4
AddresS
i tl
GAS
�W
meter BY 9-7
:LECTR Date
eter BY
-DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
,_ZUNTYOFBUTTE - Oroville, California 95965 - Telephone (916) 538-7541
7 County Center Drive PERMIT NO.
(Rev. 1 2/9N APPLICATION AND PERMIT q7- 1:7,::S1
ASSESSOR PARCEL NUMBER
029-240-014
ZONING
BUILDINGPERMIT
OWNER
R1 DON UNDBERG
TELEPHONE
SQ. Fr. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
" B'�,s��, MNAIE. CA 95974mmOM
CONTRACTOR
RATER F"FIT.PIC
TELEPHONE
*143=3210
CONTRACTOR'S "UNG ADDRESS
1387 VATIOMOSA AM9 CMOC
CONSTRUCTION LENDER
LENDER'! MAILING ADDRESS
Fireplace
Total Valuation is
ARCHITECT OR EUGINEER
E NU.
—Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR EWGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS 1245 RIMMY, IM, RICRAU
Energy Plan Checking Fee
PERMIT FEE $
LOT NO.
SUBDIVISION'S NAME
IPARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SFX 3. Duplex 0 Mobilehome [I 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 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Other bY
Describe Work: _ELE SER CH
piping system 1 - 5 outlets 15.00
—Gas
Building sewer 15.0-0
Mobile Home I S I G I W @D20.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20-00
( 800V OR UE.S.9
Main Service ..0.. 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affir-n under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing .Wh Section 7000) of Division 3 of the Business and Profe6sions Code,
and my license is in full force and effect.
License Class Lic. No. 77 ;7
OWNER -BUILDER DECLARATION'
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, asowner of the property, ormy employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
0 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP. a
OR ADDNS. 8. BLDS. 3.,,s
-.-.ACC. FT.
CONS
—=.E 'IDT =`O;U,,,TS @17.50
r
OWELR APPALRATTUS
IPSI.G E 0 E ,. )
OUTLET OR FIXTURES 20 @ 1.00
Ex. Occup. ( . BAL @ .50
( OUFITX.ED APPLNS 0"
Ex. Occup. C.ES,6.) E.A. 5.00
Temporary Service 23.00
-
- Mobile Home Facilities 20.00
Misc. Wiring 23.00 23.W
PRE-1NSP=0N 7.3.(X)
PERMIT FEE $ 69*UU
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700 &the Labor Code, for the performance of work for which this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
0-1'certify that in the performance of the work for which this permit is issued, I shall
not en -ploy any person in any manner so as to become subject to workers'
compeisation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X -1' '7, Date
S i �_n_a_tu ant - 0 Owne�r' 0 Contractor 0 A6 -
An OSHA perr-.dt is required for excavations over 60" deep and demolition or construction
of structures cver 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 89.00
IMP
I FLOOD
I COF
PARCEL
I PD
I HE)
I ISSUE
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.
4:7
By ;I Date
09 4
PERMIT EXPIRES ON
(Data)
ReceiptNo. zzzood
—1
WHITE-D.D.S.-B D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
�j
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES -
411 Main Street, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
CORRECTION NOTICE
OWNER
— I /
PERMIT N
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
is completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
ol
6,9-01.0 A, A.- ZIA)
oo�a L" 6e r Lf Ir
Date T - 2 o 1 nspec,46'r
REV '10/92 . /
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT 1 "7 -31,
z
ASSESSOR PARCEL NUMBER
029_'240-0�9
ZONING
BUILDINGPERMIT
� /C -1
OWNER
FIDON IJIMIMERG
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
PO BOX 216, RICHMALF, CA 95974-0216
CONTRACTORS NAME
BAKER ET,FCTRTC
TELEPHONE
343-3210
CONTRACTORS MAILING ADDRESS
1382 VAT,T,nMRRO';A AVE., 04TOC,
CONSTRUCTION LENDER
LENDERS MAILING ADDRESS
I
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE Nu.
Fee
$ 20.00
—Filing
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS 1245 RICHVALE HW RICHVALE
Energy Plan Checking Fee
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
I
PARCEL MAP
I
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF)(X Duplex 0 Mobilehome 0 Other
SPECIFY
Each Trap
1 7.00
I —
Solar or heat'pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New 0 Addition 0 Remodel 0 Utilities 0 Installation 0 Other
Describe Work: ELE SER CH
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@D20.00
_T
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20-00
a OVO R LE:9
Main Service Zo..A OR
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing v�ith Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
License Class e-1,6 :ftgj� Lic. NO. 37
OWNM-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
0 1, asownerof theproperty, ormy employeeswith wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
0 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
13 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:
0 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.
0 1 have and will maintain workers' compensation insurance, as required by Section
3700of the Labor Code, forthe performanceof workforwhich this permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
qf,one hundred dollars ($100) or less.)
0--rcertify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
f rth ith comply with those provisions.
X Date
Si tu o Ap i ant O-Contract—or 0 AA R
An OSHA per is required for excavations over 60" deep and demolition or construction
of structur o er 3 stories in height.
Main Service 200A TO I 000A 46.00
NEW CONST. DWELLING OCCUR a
OR.ADDNs.--- & ACC. BLDS. I 3.50FT.'
—
NEW CONS MULTI -OUTLET C@7.50
N..-RE�IDT BRANCH CIRCUITS
ER RJ4TUS
&P.01NGLEA0P1PArLE7 CIR.
OUTLET OR FD(TURES 20 @ 1.00
Ex. Occup. ( BAL 9 .50
( .,FIX.ED A P NS OR
—Ex. Occup. P(RLES,15.) EA_ 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 1 23.00 23.00
PRE—INSPECTION 23.00
PERMIT FEE 9.00
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee Is
Energy Inspection Fee is
Occ
�CONST. TYPE
TOTAL FEE $ 89.00
7—
IMP
I FLOOD
I CEFT;Z;�71
HD
I ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By �M
V
PERMIT EXPIRES ON
I
the applicable provisions
Resolutions to do work
been paid.
Dat
- (6a to)
Receipt No. 222668
WHITE-D.D.S.-E.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT
M
COUNTYOF BUTTE -DEPARTMENT OFD.E�Y.E,�OPM ENT SERVICES -BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541
PERMIT APPLICATION DATA SHEET V(
OWNER L u tt f (2, G A. P No
Proposed Building Use Fb� Building Inspector (:�Ly Date
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
.1. All items have been submitted . .......................
2. Plot plans, 3/4 sets, signed by preparer of plans . ..........
3. Complete plans, 3/4 sets, signed by preparer of plans . ........
4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............ P.
5. Hazardous Material Form . ............................................
6. Energy Design Co mpliance and supporting documentation . ............... 1. . .
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check) . ....
9. Mobilehome data and manufacturer's installation instructions, 2 sets . ..........
10. Fees of $ . ........... ; .............................
11. Impact fees as shown on attached schedule ...............................
12. California Department of Forestry plan approval/fees .........................
13. Flood elevation letter (100 year flood) by California Engineer ...................
14. Sanitation and plot plan approval Health Department . ............
15. City of Chico plumbing permit ..........................................
16. Plot plan and business license approval from City of Biggs/Gridley . .............
17. Planning approval for (A) Use: (B) Parking:
18. Contact Land Development about (A) Improvements (B) Drainage ............
19. Driveway permit (constrqction approval required prior to occupancy).
F;�AsWc�o;pe4u_��6
5?__ 20. Pre -inspection for required. to Building Ins �..t.
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23. Owner -Builder Verification (Given to owner Mail to owner . ...........
24. Recorded copy of Agricultural Acknowledgement Statement . ...................
25. Letter of signature authorization . ........................................
26. Cop of recorded deed of parcel creation and 60 right of way to a public road ......
27. Letter of intent on building use ..........................................
28. Mobilehome utility clearance . ..........................................
29. Documentation of legal access . ..................... ; ..................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ............. %. .-
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
34.
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone. .3 � 3- -3?-(0 and hold for pickup at Cif (C6 office. Deliver with inspector.
Other I
Parcel Creation 4�r/l
Acreage Applicant /nX_&_Vsr/ �� 3 ) ?,
X: . 4"ate Oj/
Copy of Haz-Mat form sent Health . Dept. Fire Dept. _ Air �Pltiu`flon Date
Copy of plans sent Health Dept. _ Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by phone - mail -Counter by _ Date
Contractor, designer, owner, was advised of above required data by phone - mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
OWN ER:
LOCATION:
CONTRACTOF,
PRE -INSPECTION FOR:
PERMIT I-IISTORY. ( ]NONE ]AS FOLLOWS:
TYPE OF OCCUPANCY:
DATE: 9— K'— ?
A.PA jq
ZONING:
DATE TO INSPECTORL
BUELDING INSPECTOR'S REPORT
ilding Description:
( j Commercial/Usage:
(4-rResidential/4 o*f Units:
Currently Occupied.
Abandoned/Vacant.
ctric:
]No
Electric is currently:( vj--0n Off
. . Mobile Home: Yes( . ] Nol�l
Condition of electrical?.
Natural Propane[] None( Currently On( Off[
Obvious problems:
itation:
Plumbin * working Yes(t-�No(
9
Well: Yes( j No( Potable water: Yes[4,1'No(
Obvious Sewage Problems:
on Recommended: t-�ssue ]Hold for:
S Cj- -,a V e-
iector: Date:
0