HomeMy WebLinkAbout029-240-047r
29-24-47
Ger Id Mattson
S/S Richvale West, opposite 4th St.,
Richvale�
ermit #391-7a713P,E(rep al ce foundation
under existing &V-rructure, r air laste
029-240-047 AG 01-118
MATTSON, GERALD
1269 RIC14VALE HWY. RICHVALE
AG EXEMPT PERMIT
& new fireplace/SF)
29 24-4 �iZd Q
Permit #307-78B .t WAL)
Permi 29-24-47
3005-798 (2nd
7 . renewal/391
7
9-24-47
contra Grand Oaks C
- Permit ��4376-g con t., Carmichael. •
1B(inst.new :siding/�F
�-� J//
029-24-0-047 -- #98-2226
MATTSON, GERALD
1269 RICHVALE HWI'.RICHVAL
OWNER L /Z -ZZ
GAS PIPE & GAS STOVE
029-240-047 99-1778
MATTSON, Gerald
1269 Richvale Hwy., Richvale
Contr: Miller Construcdon
Re Roof
029-24-0-047
MATTSON, GERALD
1269 RICHVALE HWY., RICHVALE
CONTR. OZZIE ELECT
NEW SERVICE PANEL ���3
'r � ---Y --_
,��I!Com; ��
019-24-0-047 01-0102
MATTSON, GERALD
1269 RICHVALE HWY., RICHVALE
CONTR: OZZIE ELECTRIC
W, SERVLCE PANEL
i�
r '
'r
OFFICE COPY ,
Address
GAS
Meter By Date
• ELECTRIC /^
.Meter By DajkC�
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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 029-240—(A7
ZONING
BUILDING PERMIT
OWNER
HAITSON, GF
TELEPHONE
882-4462
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
1 2AQ RT 1!A7 r tff D T T G' A Q Q /,
CONTRACTOR'S NAME ' U
OZZIE ElFj=C
TELEPHONE
CONrRACTOiS MAILING ADDRESS
MIM CA
CONSTRUCT ON LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filen Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
1269 RICHVALE HWY RICHVALE: CA 95974
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS MIME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
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 ❑
Describe Work: NEW SERVICE PANM (elmtric)
Gas piping systern 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service �. oa mss 23.00
Q ("
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:
❑ 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.
.0'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
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.)
�O 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 if I should become subject to the
forthwith comp) with those provisions.
X79compensation provisions of section 3700 of the Labor Code, I shall
//��
X 59. 1' l Date O/A/-6/ // _
Si nature of Applicant - ❑ Owner 13 Contractor ❑ Agent
9 PP
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service s
46.00
Eo NG CCU000A
NEW CONST. DWEWNG OCCUP. SO
OR ADDNS. ( a ACC. S. 3.5QFT:
EW NON-RESID.' MULT.1 CIRLUT 97,50
POWER APPARATUS
a SINGLE OUrLEr CIR.
j 20 a4L Q 1.
EX. OCCU OUTLET OR FwrURES o
Ex. Occup. DFlxuT�is AM DeA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring23.00
PERMIT FEE s 43.00
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
C. TYPE
TOTAL FEE $ 43,00
:.A].p.
FEES IMP
I FLOOD
I CDF
PARCEL
PD
HD
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.
ye4 Date 7
PERMIT EXPIRES ON / dC;L—
ata
Receipt No. 314459
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 ANDIP ERM(T
ASSESSOR PARCEL PARCEL NUMBER
029-240-047
ZONING
BUILDINGPERMIT
OWNER
TELEPHONE
882-4462
SO. FT. OCC. BUILDING VALUATION
. OWNERS MAILING ADDRESS
1969 R112WAIR 94Y, RICIA14—IR C4 9597A
CONTRACTOR'S NAME TELEPHONE
OZZIE ELECIRIC
CONTRACTORS MAILING ADDRESS
CHIM CA
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
1269 RICHVALE HWY RICHVALE CA 95974
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: NEW SERVICE PANEL (electric)
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I G1 W
920.00
PERMIT FEE S
ELECTRICAL PERMIT
Fling Fee 20.00
RLE
Main Service 200A OR LESS
23.00 93 C
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.FOWER
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:
❑ 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.
2`1I, 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
Policy Number
(The above sections need not be completed N the permit is for work of a valuation
of one hundred dollars ($100) or less.)
O 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 if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
Orthwith c mpI with those provisions.
X Date Qt' O
Signature of Applicant - ❑ Owner ❑ Contractor ❑ Age
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service sow TO L000A 46.00
NEW CONST. OCCUP. 3.50 FT.
aCDCST
NOR EW COS MULTI -OUTLET
NON -REBID. I. 97.50
APPARATUS
8 SINGLE OUTLET CIR.
.00
EX. OCCU . OUTLET OR FD(TUREs BAL @ 20 Q I.so
Ex. Occup. OLIT MED Rte) EA.
5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring23.00
PERMIT FEE S
4-3.00
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEI: $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 43.00
HAZ.
I D FEES IMP
I FLOOD
I CDF
PARCEL
I IM
HD
SU
This permit is hereby Issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for hich fees have been paid. ,
PERMIT EXPIRES ON
Tfe
Receipt No. 314459
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 a Oroviller Chlifornia 95965 • Telephone (530) 538-7541 PERWT NO.
(Rev 12AG) APPLICATION AND PERMIT
A.9Eseoa,��a� D � �: _�" BUILDING PERMIT
nn ?i01ti /�//_� SO. FT. OCC. BUILDING VALUATION
I
rr a,w ADOFMS
�Old p10� DM'S PALM AoOFsse
7
LOT N0. elleWV19GN1 NA►! ` I.w=
USEOFSTRUCTURE
SF O Duplex O Mobilehome O Other
9FS/Y
TYPE OF WORK
Now O Addition O Remodel O Utilities O Insulation O Other Q
*PERMIT FEE PAID
SRA --
SHERIFF
OTHER
AMOUNT RECEIVED
Total Valuation _
Film Fee i
Permit Fee =
Plan Checking Fee =
Energy Plan Checking Fee =
00
ELECTR
n
Main Sei
Mein Se
taw colas
ON AD".
*RECEIPT NUMBER ( Q q
* TO BE PUT INTO COMPUTER
Ex.
PERMIT FEE _
i
PERMIT FEE
_
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00 •-
or heat pump water heater
29.00
-Solar
Water piping
15.00
Each gas water heater or vent
15.00
Gas piping *"tern i - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
(&20.00
ELECTR
n
Main Sei
Mein Se
taw colas
ON AD".
*RECEIPT NUMBER ( Q q
* TO BE PUT INTO COMPUTER
Ex.
PERMIT FEE _
ERMIT
Filing Fee 20.00
000v OR 1f.99
200A OR LESS
29.00
200A To 10MA
46.00
VW8.LM OGCuv.
A NCC. KOO.
3.Sisa
W01--cuTLET
@7.50
FOYMEA AMAMnA
ouncr all F9mon 1
aw i
Mobile Home Facilities 20.00
' PERMIT FEE= r' .,
I MECHANICAL PERMIT Filing Fee 20.00
Hood a.50
ventilation
PERMIT FEIE S
Moble Home Installation Fee $
Energy Inspection Fee S
occ CONST' Tr7E TOTAL FEES r ��
NAL 0. FEES -F KA00 COF MR FD OA
This permit Is hereby lamed under the applicable provisions
of the Butte County Code and/or Resolutions to do work
Indicated above for which fees have been paid.
By Date
PERMIT EXPIRES ON
(Wal
_ ._ ....... _ _. ,,._ w. ^rLs FtF,4,:ra,efS,::::P��•��.q(�:viPZ+�l;:.irc!'.��5 �'i7�R`- 'ai.7+C1�EM,y�; . �-w �r. ..r'_ —� �
r12
9-240-047 y 99-1778
ATTSON, Gerald
69 Richvale Hwy., Richvale �f-
t ontr: Miller Construction
Re Roof pv
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I
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 A�
i
ASSESSOR PARCEL NUMBER
029 -
ZONING
BUILDING PERMIT
OWNER GERALD %'iA1TWN
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
22 1,320.00
OWNER'S MATING ADDRESS 1269 RICHV,1A-LL VW, RIC"ALE
CONTRACTOF'S NAME MILLER CONSTRUCTION
TELEPHONE
CONTRACTOFS MAILING ADDPsb, BOX 400, xICAVALE 95974
�J
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation is
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 33.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
1269 RICHVALE ETWY
Energy Plan Checking Fee $
$
PERMIT FEE $ 53.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF Ci Cuplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each as water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: ROOF OF
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
600V OR LF
Main Service 20..0. 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.Z!
License lass 4y
>�, Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for he following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
ovll 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
tc construct the project.
❑ 1 ram exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjuiy 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
Policy Number
(The above sections need not be completed 0 the permit is for work of a valuation
of one hundred dollars ($100) or less.)
09 I certify that in the performance of the work for which this permit is issued, I shall
riot 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
forthwit c ply with those provisions.
X Date _�
Signatu-e of Applicant - ❑ Owner XContractor ❑ Agent
An OSFK permit is required for excavations over 5'0" deep and demolition or construction
structures over 3 stories in height.
To
Main Service 200A 1000A 46.00
NEW CONST. DWELLING CUP. SO
OCCUR
OR ADONS. ( a ACC. BLDS. 3.5¢Fr:
RESINEW U T. MULTI -OUTLET @7,50
POWER APPARATUS
8 SINGLE OUTLET CIS.
GunE U
Ex. Occup. BAL ° ': o
FIXED APPLNS R
Ex. Occup. OUTLETS A DORA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE 5 .IUIU
TOTAL FEE $
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
PD
HO
1 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.
:' 41A
Date
By . 7Date
PERMIT EXPIRES ON //////
ale`s /T -fes Li.'
ReceiptNo. A 7!3&" .
WHITE -DL D.S.-9.D. CANARY -ASSESSOR— PINK -INSPECTOR GOLDENROD -APPLICANT
I--,
"kCOUNTY 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 qV._ Z.
ASSESSOR PARCEL NUMBER
099-94-0-047
ZONING
BUILDING PERMIT
OWNER GERALD MATTSON
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
22 1,320.00
OWNERS MAILING ADDRESS 1269 RICHVAL HWY , RICHVALE
CONTRACTOR'S NAME MILLER CONSTRUCTION
TELEPHONE
CONTRACTORS mA1uNG ADDYESSO. BOX 40' "' - "'-"' ' T F 95974
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
33.00
ARCHITECT OR ENGINEERS "UNG ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
1269 RICHVALE HWY
Energy Plan Checking Fee
$
PERMIT FEE $
53.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF R Duplex ❑ Mobilehome ❑ Other
sPECIFv
Solar or hest 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 ❑
Describe Work: RE ROOF
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service .OA 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.POWER
License Class Lic. No. Z&Ex,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, army 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 TO
46.00so
Yn200A
CCU000A
NEW CONST. DW0.UNG OCCUP.
OR ADDNS. ( a ACC. S.
SO
3.5QFT.
HOµR6,U ' MULTI-OUTLC.ET
@7.50
APPARATUS
a SINGLE OUTLET CIR.
OCCU OUTLET OR FIXTURES
20 @ I.50
BAL so
Ex. Occup. O.FIXED R�) E
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE S
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.
❑ 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' 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.)
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 if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwit ply with those provisions.
X Date
Signature of Applicant - ❑ Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 60" 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 $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE 53.00
TOTAL FEE $
HAZ.
I D. FEES IMP
I FLOOD
COF
pARC0.
Po
HD
SSUE
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 to
PERMIT EXPIRES ON
Dete
Receipt No.
WHITE-D.D.S.-B.D. CANAR -AS ESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
I
`COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 q �E"/4%7
(Rev.12/96) APPLICATION AND PERMIT /I -,
ASSESSOR PARCELNUMBER
IZZ
ZONING
BUILDING PERMIT
OWNER /+e��L x
SO. FT. OCC. BUILDING VALUATION
14
�TELEPHONE
S U
DINNERMANG AooaEsa � /C
J�
CONrRACTOITS NAME �-y�
TELEP'/10NE
CONTRACTOR'S MAILING AD SS
e
-
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation S
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee S 0"
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee S
aU0.DW0 ADORESS
-
Energy Plan Checking Fee S
S
PERMIT FEE i ,Q�
LOT NO.
BUBDIv61DNSNAME
PARCEL YAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF PeDuplex ❑ Mobilehome ❑ Other
SPECFY
Each Tr 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 ❑
Describe Work: /\ /
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S G W 020.00
PERMIT FEE _
ELECTRICAL PERMIT Fling Fee 20.00
ES
Main Service z�o'vw oa s 23.00
V
6D
f� ✓
1
Main Service 200A TO 1000A 48.00
NEW CONST. owEu.ING OCCUP. 3.50so.
OR ADDNS. 8 ACC. OCC.
NEW CONST. MULTFOVTLET
NON"RESID. @7.50
POWER APPARATUS
L SINGLE OUTLET CIR
Ex. Occup. OLRLEr OR FuTUREa eA0 ® 1.00
PP6 5.00
Ex. Occup. oAOil
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE _
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hoodd 8.50
Ventilation
PERMIT FEE S
Mobile Home Installation Fee $
Energy Inspection Fee L
occ
coNsr. TYPE TOTAL FEE
HAZ. D. FEES I IMP
I FLO00
I CDF
PARCEL
PO
NO 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.
By Date
PERMIT EXPIRES ON
D�TaI
Its
029-24-0-047 #98-2226
MATTSON, GERALD
1269 RICHVALE HWY.RICHVAIL
OWNER
GAS PIPE & GAS STOVE
OFFICE COPY
Address
GAS
Dat
Meter By
ELECTRIC
Meter By
Date
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 �
qgl
ASSESSOR PARCEL NUMBER 029-240-047
ZONING
BUILDING PERMIT
OWNER A'J"MN,GERALD
jL
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 1269 Richyale Hwy., Richvele
CONTRACTOR'S NAME Owner
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Flim Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE S
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7.00
USEOFSTRUCTUREj
1
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY `
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORKGas
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: Gas Pipet and Gas Stove in Family
+
piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE
ELECTRICAL PERMIT Fling Fee 20.00
600VOR LE
Main Service 2o.A OR LESS 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 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:
8' 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
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 2IIA TO 1000A 46.00So
NEW CONST. DWELUNO OCCUP. SO
OR ADDNS. a Acc. sLos. 3.5QFT:
NONNEW 1D MULTI-OUTC.LET 97,50
APPARATUS
PSOINDLE OUTLET CIR.
8 B
Ex. Occup. OUTLET OR FIXTURES Bu p I.w
FIXED ALNS. OR
Ex. Occup. PP5.00
oLmFrs RESID. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Policy Number 'v
(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
IN forthwith comply with 'those provisions.
C
Date ��'��' 7(�
ligtu a of Applicant - owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 70.00
HAZ.
I D. FEES IMP
I FLOOD
CDF
PARCEL
PD
HD
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.
By ((( Date _
PERMIT EXPIRES ON'J✓ L� /
Data
ReceiptNo. 7'ro
WHITE- D.D.S.-B.D ._., CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
=t.
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street • Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
CORRECTION NOTICE
ER
��- :fi
PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
above address and should be corrected. Please notice 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.
d
REV 10/92
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754 IT No.
(Rev. 12/96) APPLICATION AND PERMIT
�����G
ASSESSOR PARCEL NUMBER 029-240-047
ZONING
BUILDING PERMIT
OWNER MA'TTSON . GERALD
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS 1269 Richvale Hwy . , Richvale
CONTRACTOR'S NAME Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each as water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe work: Gas Pipe and Gas Stove in Family
Gas piping system 1 - 5 outlets 15.00 15.0
Building sewer 15.00
Mobile Home I S I G I W 1@20.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
600VMain Service 20.AORLESS 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 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:
Q"l, 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
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.)
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 if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
on 0 FOP
Date �—� <O
Si atu a of Applicant - Owner ❑ Contractor ❑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 ,DDDR 46.00so
NEW CONST. DWEWNG OCCUP. S°
OR ADDNS. ( DY;
ACC. eLnS. 3.50 Fr.
r10µ. °.IDT' MULTI -°U CLFf @7.50
POWER APPARATUS
a SINGLE ourLET cIR.
TU
Ex. Occup. OUTLET OR FIXTURES SAL p 1: 0
FIXED APPLNS. OR
Ex. Occup. S.00
Dun. RESIO. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirina 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating 15.00
Cooling
Hood 6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
PD
I HD
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.
By����ate?
PERMIT EXPIRES ON ! /
pate
Receipt No. 250653
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit/has been applied for in your name and bearing your signature,:
Please complete and return this information at your earliest opportunity to avoid unnecessary delay
in processing and issuing your building permit. No building permit will be issued until this,
verification is received.
1. I personally plan, to provide the major labor and materials for construction of the proposed
property improvement : YES 0' NO a
2• I HAVE SHAVE NOT ❑ signed an application for a building permit for the proposed w6
3. I have contracted with the following person (firm) to provide the proposed construction:"',
NAME: = .
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. Irovide to lan
p p portions of this work, but I have hired the following person to coo .
supervise, and provide the major work: ;
NAi�:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
5. I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER:
4,ja� a -6Z -
SOCIAL SECURITY NUMBER:
DATE:-(f7)
ATE —N
NOTE: This Owner Builder Verification is required by Section 19831 and 19832 of the
California Health and Safety Code. This verification must be completed oitd
returned to our office before we are permitted to issue the permit.
OVER
OWNER BUILDER INFORMATION -1
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property;
improvements specified.�,€;s_tth
For your protection, you should be aware that as "owner -builder" you are the responsible parry offeeord on its <-
a permit. Building permits are not required to be signed by property owners unless they are personally performing dheir�'
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business
license from the city or county. They are also required by law to put their license number on all permits for,which they
apply' :.:::*:
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you;4
be aware of the following information for your benefit and protection:
♦ if you employ or otherwise engage any persons other than your immediate family, and the work (including m,
and other costs) is 5300 or more for the entire project, and such persons are. not licensed as contras
subcontractors, then you may be an employer. _
♦ If you are an employer, you must register with the State and Federal Governments as an employee aad'3
subject to several obligations including state. and. federal income tax.withholding, federal social sectgity
workers compensation insurance, disability insurance costs; and unemployttient a mpensation contrt'bittioi
♦ There may be financial risks for you if you do not carry out these obligations; and these risks are especially:
with respect to worker's compensation insurance. t
♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Serviee;(aad,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. `
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perfbt their
work personally or through their own employees, without a licensed contractor or subcontractor,'oMy under', HOW
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building _
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Buildimg`� '
permits are not required to be sighed by property owners unless they are performing their own work personally:
Information about licensed contractprs may be obtained by contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm dw.you..,
are aware of these matters. The building permit will not be issued until the verification is returned.
4irely,
l C. Vi ira, C.B.O.
r, Building Inspection
NOTE: This Owner-Builder.Informatlon is required by Section 19830 of the California Health and Safety Code.
OVER
380-C-7 9O
i PERMIT NO. 391-77B,P,E
. PERMIT EXPIRES�.��_
OWNER Gerald Mattson
CONTR. outer
LOCATION (A.P. 29-24-47
S/S Richvale West, opposit ., Richvale
,s
' �k
V
6V U
3E
eV
,t
f
t
Temp. Power Pole
}` Called PG&E
Temp. Elea Serv.
S,
Called PG&E
Temp. Gas Serv.
Called PG&E °
�r
JOB
+I: FINALED
(Date)
�m
t
i' (Signature)
Reinf. Steel Final r' Fixtures
Bond Beam FIRE SPRINKLERS Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Under round
Interior Lath Ventilation h I Permanent
Door Closer Final Final /
DATE REMARKS OR CORRECTIONS
V
(NOTE: An entry must be made on this form each time you visit the job site.).
COUNTY OF BUTTE — DEPARTMENT OF'PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING • BUILDING (Cont'd)
PLUMBING
Setback
_ Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwal l
Siding
To out
- 2
Slab
Roof Sheathing
Water Piping
Piers::�/72cJ
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwal I
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for physically
handica ed
Conformance of ex.
structure
Appliances
Gas Piping
Temp. Gas
&Test
Slab
Final
Sanitation
Patio
. FIREPLACE
I,
Footings
F otin
ELECTRICAL
Masonry Walls
Throat c23I k
Rou h
—2,P'- 7Srl
Reinf. Steel Final r' Fixtures
Bond Beam FIRE SPRINKLERS Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Under round
Interior Lath Ventilation h I Permanent
Door Closer Final Final /
DATE REMARKS OR CORRECTIONS
V
(NOTE: An entry must be made on this form each time you visit the job site.).
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965 f
` Telephone: 534-4541
APPLICAtION AND PERMITABL—
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x X �� ' r-^"�Date ZZ
Signature of Permitee or Agent
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.4ar which fees have been paid.
IRECT OF P BLIC WORKS
DatoT-Wr "
Building permit expires Da e go
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATIO
Mailing Address
� e
Telephone No.
z
Contractor 14CA - gg),- IJ(J6
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee 0
Building Address
Plan Checking Fee&/or Penalty
Permit Fee .1k,6.0,0
(Q 42 IN
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
G V L
Repair drainage or vent piping 1.50
j�
A. P. No. - ' �% Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
�F
We9antt3Trdn'
Fire Dept.
Fire Zone Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking
Plans
ParcelEach
Declaration
I Parcel Map
60' R/W
Improvements
additional outlet .30
Building sewer 5.00
ec
Parcel A roval
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ®
Permit Fee $
3
ELECTRICAL No. @ FEE
97
PERMIT FILING FEE $3.00
Main service 100 AMP 10V OR ORSI- 'S 5.00
Single Family ® Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
Main service OVER 25.00
100 AMPP OR LESS O
Main service EA. ADD'L 100 AMP 1.00
NEW CONST.! DWELLING OCCUP. �) 2�sgft
OR ADDNS. 1 ACC. BLDGS.
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:
TLET
NEW CONSTR BRANCH CIRCUITS)
NON.RESID (MULTI BRANCH CIRCUITS) 2.50ea
NEW CONST R. (POWER APPARATUS .&,
NON.RESID. SINGLE OUTLET CIR.
Ex. OCCUD(OUTLETS OR FIXTURES B L0;
FIXED ALNS
Ex. Occup. (OUTLETSP(RESID.)REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
X I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ 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
X 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.
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
Land Development Fee
$
TOTAL PERMIT FEE
$ --'
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x X �� ' r-^"�Date ZZ
Signature of Permitee or Agent
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.4ar which fees have been paid.
IRECT OF P BLIC WORKS
DatoT-Wr "
Building permit expires Da e go
COUNTY OF BUTTE —DEPARTMENT RTMENT OF PUBLIC WORKS
7 County-k-nter Drive — UroviIle, California 95965 /)
Telephone: 534-4541J07-t/
APPLICATION AND PERMIT Ad /
...r......^•.- • � vuay vi uu ,v cnici uNvn ula
above-mentioned property for inspection purposes.
XCc w� !�'�� Date
Signature off Peermitee or Agent
Receipt No. Z"/L-'
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.
PIREfCTIOR OF P1d3LIC WORKS f
Building permit expires Date
BUILDING Iv
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Addres
091040
X
6W (Z
Telepphone No.
Sf-S-vO
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
..
Building Address -�SI
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
.rL
O �-
A. P. No. 4 q
Zoning 8 Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Sanitntiet�
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Plans Parkin
Declare ion
Parcel Map
60' R/W
Improvements
Lawn sprinkler system 2.00
Bldg-;4m7ls Recd
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
40-1
Main service 1000 AMP ORS
SLESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
OR 600V
Main service 1100EAMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
NEW OR ADDNS%// CONST.DWEACC. BLDGS.LING CCUP. &) 22sq tt
NEW CONSTR. MULTI -OUTLET
NON-RESID. BRANCH CIRCUITS) 2.50ea
NEW CON ST R. POWER APPARATUS &
NON-RESID. (SINGLE OUTLET CIR.
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:
Ex. Occup(OUTLETS OR FIXTURES)@�25C
109
Ex. Occu FIXED APPLNS. OR
p•(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
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.
lidI 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
TOTAL PERMIT FEE
$
...r......^•.- • � vuay vi uu ,v cnici uNvn ula
above-mentioned property for inspection purposes.
XCc w� !�'�� Date
Signature off Peermitee or Agent
Receipt No. Z"/L-'
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.
PIREfCTIOR OF P1d3LIC WORKS f
Building permit expires Date
• COUNTY OF BUTTE — P TMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X w- fla_Date 1, .1
Signature of Permitee or Agent i
Receipt No. / r 5l9 T(�4 (.
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 hav een paid.
DIRECT 0 PUBLIC WORKS
By %
Date—Date %
uilding permit expires Date—��`7�
BUILDING
OwnerGendd
SO. FT. OCC. BUILDING VALUATION
Mailing Address Q 130 0�
p�
P3T
I"
'O;
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
o
Building Address S Ric-
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 ,dp
0
Each Trap 1.50
C U
Repair drainage or vent piping 1 .50
Water piping 1.50 '
Each gas water heater or vent 1.50
A. P.
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50��
Each additional outlet .30
F s
S'aRt'PtTit7ft'
FireDept.
Fire Zone
Use Permit
Building sewer
EOA
Parking
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Im rovements
p
Lawn sprinkler system 2.00
ans ec d I
Parcel Approval I
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER 1Z
ELECTRICAL No. @ FEE
PERMIT.FILING FEE $3.00 3,e
CIO C (,(, e /
Main service 100 AMP 600V OR LOR ESS 5.00
''`
s C AD) �p G r gvfrVG `
Main service EA. ADD'L 100 AMP 2.50
OVER 600V
Main service 100 AMP OR LESS 25.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD•L 100 AMP 1.00
NEW CONST. ( DWELLING &\
OR ADDNS. ACCBLDG / 2¢Sgft
NEW CONSTR. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS) 2.50ea
NEW CONSTR. /POWER APPARATUS &)
NON.RESI D. \SINGLE OUTLET CIR.
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:
Ex. Occup(OUTLETS OR FIXTURES) ' BAL@1
FIXED APP LNS. OR
Ex. Occup. (OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
4
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ , 2
$
MECHANICAL No. @ 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.
Elhave placed on file with the County of Butte a certificate of
'workmen's Compensation Insurance.
certify that in the performance of the work for which this
I_%permit
w% 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.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 1 1 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
State Laws relating to building construction, and hereby
TOTAL PERMIT FEE
1-75
$ 5Z,and
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X w- fla_Date 1, .1
Signature of Permitee or Agent i
Receipt No. / r 5l9 T(�4 (.
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 hav een paid.
DIRECT 0 PUBLIC WORKS
By %
Date—Date %
uilding permit expires Date—��`7�
COUNTY OF BUTTE – DEPARTMENT OF PUBLIC WORKS —��
•� 7 Count Center Drive — Oroville, California 95965 %��
,Telephone: 534-4541 l/
6
APPLICATION AND PERMIT
BUILDING
Owner SQ. FT. OCC. BUILDING VALUATION
Mai I ing Address r
Telephone No.
C r� %319- r —0 O
Contractor Cn>
Mai I ing Address
Building Address �X44
ephone No.
0-ka
A. P. No. —aq 7 Zoning & Planning
Fees W.C. Sanitation FireDept. Fire Zone Use Permit
EQA I Parking I Parcel Parcel Ma 60' R/W I Improvements
Plans Declaration P p ovements
Bldg. Plans Recd I Parcel Approval I Plans Approval
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER tR
Single Family C9 Duplex ❑ Mobil Home ❑ Others ❑
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:
License No. Classification
eXI am exempt from the Contractors License Laws of the State of California.
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the.
above-mentioned property for inspection purposes.
X �1_,(X LIj �,CX .�� DateiU
Signature of Permitee or Agent
Receipt No. / 7 Zee3,Z 7
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
Fireplace
Total Valuation
@
Permit Fee
$3.00
Plan Checking Fee &/or Penalty
5.00
Permit Fee
2.50
PLUMBING
No.1 @ FEE
PERMIT FILING FEE
$3.00
Each Trap
1.50
Repair drainage or vent piping
1.50
Water piping
1.50
Each gas water heater or vent
1.50
Gas piping system 1 - 5 outlets
1.50
Each additional outlet
.30
Building sewer
5.00
Lawn sprinkler system
2.00
Permit Fee
ELECTRICAL No•
@
PERMIT FILING FEE
$3.00
0V OR L
Main service 100 AMP ORSLESS
5.00
Main service EA. ADD'L loo AMP
2.50
Main service OVER
100 AMPP OR LESS O
25.00
Main service EA. AOD'L 100 AMP
1.00
NEW CONST. // DWELLING OCcup-Q+
OR ADDNS. % ACC. BLDGS.
2�sgft
NEW CONSTR. /MULTI.OUTLET
NON.RESID ` BRANCH CIRCUITS)
2.50ea
NEW CONSTR. POWER APPARATUS &
NON-RESID. SINGLE OUTLET CIR.
Ex. OCcuo(OUTLETS OR FIXTURES
50@254
BAL@l04
Ex. OCCU FIXED APPLNS. OR
P• OUTLETS (RESID.) EAJ
2.00
Temporary .service
10.00
Mobile Home Facilities
1
15.00
Misc. Wiring
6.25
Permit Fee $
MECHANICAL No @
PERMIT FILING FEE J$3.00
Heating
Cooling
Ventilation
Hood 1 1 2.00
Permit Fee $ $
Land Development Fee $
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 been paid.
DIR,E59TOR OF PUB IC WORKS
By Date 7
Buiid'iog permit expires Date ,
r-..., ,.. .. -. _+�.-.. -.; . ti _.. .. .'AMw..a:I `i/ ,.^ya. .S,v .+ ��,�....-� - ,.....mow... ...a+ --•y -.: �-+�'ti .._ r-+'.+�...._.,� t--'- -
��_30�-�f_.
�i
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
V ' 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT NO.
1
ASSESSOR P RCEL NUMBER
ZONING
BUILDING PERMIT
OWNER' -�
TELEPHONE
SQ. Fl. OCC. BUILDING VALUATION
/
OWN 'S MAI G -ADDRESS
CON -?'ACTOR'S NAME .-1
(
TELEPHONE
CO iACTADD
� n /,,I
Fireplace
CONSTRUCT ON LEIJDIE R
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING' ADDRESSf
PLUMBING PERMIT
Fill ngFee 10.00
-
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO.SUBDI
VISION NAME I
PARCEL MAP
Each pas water heater or vent
5.00
Gas piping system 1 - 5 outlets
�/ USE OF STRUCTURE
SF IJ Duplex] Mobilehome❑ Othe.
SPECIFY
Building sewer
Lawn sprinkler system
5.00
.. TYPE OF WORK
New ❑ Addition ❑ R model ❑ Utilities Installation Other ❑
Describe. work: ��"�C �� I r `�I J'� Li
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service DooV OR LESS
100 AMP OR LESS
5.00
Main service EA_ ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.51
OR ADDNS. ACC. BLDGS.
/ 2�sgft
CONTRACTORS LICENSE LAW
I declare undgr. pe a -it 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. �,F014f63 Classification 4 � ��
❑ 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 th i reason
NEW CONSTR. (MULTI. U LET 2,50 ea
NON•RESID BRANCH GIRO ITS
NE,Vj[ QAI ,SS_TR •/, POWE.R OU�A RATUS D
S
N.ESID. DINGLE OUTLET CIR.
Ex. OC "OUTLETS OR FIXTURES 50@�
BAL@10C
F
IXED AP ;"1r:NS, OR `
EX. Occup.�OUTLETS (RESID•) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PER
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare unZ5enalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
VentilationIT
Permit Fee `
5
Contractor f;
,•-
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against sai County in consequence of the granting of this permit.
X 1�0d� fL-� ��i
00/A.f (�� "�i- �1a--C Date r� " /
y / [A
Signature of Applicant Y Owner' fl 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 $ 1
OCCUP. GROUP
I TYPE OF CONST.
I
PARCEL
PD I NO
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
/ \
f D RE.0 OF PUBLIC
�/"y - -
By0 �-
PERMIT EXPIRES •ate j
the applicable provi-
resolutions to do
fees have been aid.
p
WORKS
)
Date
3
Receipt No. � J
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
it
COUNTY OF BLjTTq- DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 --J/
' APPLICATION AND PERMIT
ASSESSO P RCFLL NUMBERZONING
r
BUILDING PERMIT
OWNER
OA
TELEPHONE
SQ. F OCC. BUILDING VALUATION
/
OW 'S MAI G ADDRESS
CL ki✓
Q11�(J
CON CTOR'S NAME
s �•.
TELEPHONE
Fireplace
CO ALTO ING A DR S
oL
CONSTRUCT ON L N R UNKNOWN
an4 !e
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS`
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
� p
IChV v1 K,
Water piping
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF IJ' Duplex❑ Mobilehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ AdditionED_ model ❑ti lities Inst Ilation Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL'PERMIT
Filing Fee 10.00
Main service 60 OV OR LESS
100 AMP OR LESS
5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST./ DWELLING OCCUP.Ei�
OR ADDNS. \ ACC. BLDGS. _
2¢ sq ft
x CONTRACTORS LICENSE LAW
I declare under pe of perjury (check one):
Lr4� I am licensed under provisions of Chapt._9, Div. 3 of the Business
and Professions Co / 1dee and my license is in full force and effect.
License No -11447f3 Classification l— t,,
EJ 1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for th' reason
NEW CONSTR. I-Ou L T 2,50 ea
NON.RESID BRANCH CIRCUITS)
NEW CONSTR. ( POWER APPARATUS e)
NON-RESID. SINGLE OUTLET CIR.
(OUTLETS
Ex. Occup OUTLETS OR FIXTURES BA ot
FIXED APPLNS, OR
EX. Occup.(OUTLETS (RESID,) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare un enalty of perjury (check one):
The permit is for $100.00 (valuation) or less Ig�rjPt=ji��f�l�e�„xI
I have placed on file with the County of t e Bu-ildin ' Depdrtmerit'
a Certificate of Workmen's Compensation I�r"'Surance or a CertificateHood
of Consent to Self -Insure. I/1n.4
F -]I shall not employ any person in any manner so as'to'becorhe 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. f)rbr Ck t,nr iG M:)%,;
Heating
;Cooling
3.00
Ventilation
Permit Fee
S
Contractor
I certify that I have read this application and state that the shove 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 sai County in cons uence of the granting of this permit.
rThis
X Date'/'' �U /
Signature of Applicant Owner 7"+ Contractor ElAgent ❑
An OSHA permit is required for excavations over 5'0” deep and demolition or construct-
ion of structures over in height.
Mobile Home Installation Fee $
,
TOTAL PERMIT FEE $
occuP. GROUP
I TYPE OF CONST.
PARCEL
D I
HD
I ISSUE
permit is hereby issued under
sions of the Butte County Code and/or
work indicat2d above for which
D CT OF PUBLIC
By '
PERMIT EXPIRES ate
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
r33�stories
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
kid m
1861 C 3 AON
il"Q* allmim to lm
au"
ion
11
BUILDING DIVISION
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE,.CALIFORNIA 95965 - TELEPHONE: (530) 538-7541
AGRICULTURAL BUILDING EXEMPTION PERMIT
PERMIT NO. p/
D _ 'D
Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to house farm
implements, hay, grain, poultry, livestock, or other horticultural products. This structure shall not be a place of human
habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a
place used by the public.
ASSESSOR PARCEL NO.'
ASSESSO P EL NO.
_
6 Vo
OWNER
PHOAENO.
OWN�4 ADD ESS L`
LO�ATITION OF BU14ING
Q
USE OF BUILDING
STORtRGI= FoR RTCE FA1L*,tYU(,^ C6kutPn%E►)T'
SIZE OF STRUCTURE 20
��
X 80(�
- SO. FT.
TYPE OF CONSTRUCTION:
WOOD FRAME STEEL CONCRETE OTHER (Specify)
TYPE OF SIDING
ROOF COVERING
FLOOR TYPE
2(-' GItV&C ST"L
Z& GAv(rl= Si"F-r-L
ESTIMATED COST OF CONSTRUCTION
$ Z3,00a
AG Buildings shall comply with the minimum front, side, and rear yard setback requirements of the applicable County Ordinances as
follows:
s� r,
S � � �� �''t"a
FRONT SIDES REAR
AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields.
AG Buildings less than 1000 sq. ft. in floor area shall be located a minimum of 6 feet from a residence, 10 feet from a
mobilehome, and 23 feet from a commercial building.
AG Buildings greater than 1000 sq. ft. in floor area shall be located a minimum of 23 feet from a residence and a
mobilehome, and 40 feet from a commercial building.
I declare under penalty of perjury that the building will be used as stated about, and the purposed use confirms with the
AG Building definition. If any change in use or occupancy of the building is made, I will contact the Building Division and
obtain any necessary permits, inspections, and approvals to co ly with the requirements in effect at that time and before
occupancy.
—�LoDate Signature of Owner
Permit Fee - $60.00 I The above described AG Building is exempt from a b ilding permit.
()) F 00 PAR L rv_ I P.D. ROOFI ISSU
Receipt No.
Manager Building Division
.S �3 By Date �' 0
White —DPW, Yellow —Assessor, Pik B. I., o rod —Applicant
--o P La- Up 0,-t- -