HomeMy WebLinkAbout029-250-001-- A.P.
WYNOKA HOMES
s/s'Lindale Ave. 1001-east 'of-2iid-`St:
Richvale - (Lot 1) Q.-r
Permit 3087-72B 6--1 D
(new single farm
029-250-001. .- PERMIT#98-0607 0 ,-
SILVERNAIL, Larry
1215 Lindale, Richvale
Cont:- Wood.Heat•& Spa
Woodstove/SF
a
i
H
3
I.
-- A.P.
WYNOKA HOMES
s/s'Lindale Ave. 1001-east 'of-2iid-`St:
Richvale - (Lot 1) Q.-r
Permit 3087-72B 6--1 D
(new single farm
029-250-001. .- PERMIT#98-0607 0 ,-
SILVERNAIL, Larry
1215 Lindale, Richvale
Cont:- Wood.Heat•& Spa
Woodstove/SF
a
i
H
,.r. � .�:�- .. .. ' -"+'6�:€�s7�.<Lr4j.�'�:Sy�.• it�R7"v+'�+i�-Zra�„!^�71c.�+flf�r•'hi"r�c-�.ct%: _#,��>r.: — ,c•?:nt*.'.r•w _ .. ���-.�y;:
029-250-001 PERMIT#98-0607
�' .• SILVERNAIL, Larry. . ,
'1215 Lindale, Richvale .,
-. Cont: Wood Heat & Spa
Woodstove/SF
' ; 3
vo
i
f
v,
. i
t
i•
4
rr
COUNTY OF BUTTE- DEPtARTMENMF DEVEUMVIENTSERVICES- BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541,PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT �� n(lee
ASSESSOR PARCEL NUMBER
ITA ffi
BUILDING PERMIT
NER
LV4&IQAJA
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
DW ER ILI ADDREne �ey
;ACTOR'S NAME
Cow
TELEPHONE ry
S'S'MAILI ADDRESS / �iQ�s
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
OQ
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
�15;S�77dl
Energy Plan Checking Fee $
$
PERMIT FEE S
$��j, 00
LOT NO.
SUBDNIS 'S NAME f/
1 1I�
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF B" 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 Q-,
Describe Work: L��%dtt W[�O�STdt��E /�/,s
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
Filing Fee 20.00
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 Chapfer
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is In f II force and effect.(
License Class Lic. No. el-% I g
OWNER -BUILDER DECLARATION
1 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, 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.
JZ 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 IC
Policy Number �*c
(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' compensation , provisions of section 3700 of the Labor Code, I shall
folowith comply with lose provisions;
-- — j
X ',? r�,�% }/G Date
Signa uTe of Applican - ❑`Owner f%Contractor Wgepf
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Main Service ( To
46.00so
CCU000A
NEW CONST. DWELLING LD.. SO
W
FT:
OR ADDNS. ( s Acc. erns. 3.5QNEW
CONST.
NON -R SIO. R UITI.OUTLET 97.50
POWER APPARATUS
d SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURE
a4L ,_S50
Ex. Occup. oui Ts PEES NS OR 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 FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
f
CONST. TYPE
tt(
TOTAL FEE $ 5S,00
HAZ.
`D FEES
I IMP
I FLOOD
I CDF
PARCEL I PD
I HD
I IS 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.
By f +k i r I Date -
PERMIT EXPIRES ON T f
I DatL
Receipt No. S "0
WHITE-D.D.S.-B.D. ANARY-ASS R PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE
1.4 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
/Ve— 51F -bo 7
OWNER PERMIT NO.
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.
Date!!$�J/!5� Z r X Inspector
REV 10A942 J
COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541� c J O PERMIT NO.
(Rev.12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER _
z ;4N
BUILDING PERMIT
22"y NER ��ve-p—A
TELEP/`T Z'
SO. FT. OCC. BUILDING VALUATION
MERILI ADDRESS �^
CONT CTO R'S NAME
CONTRACTORS MAILI ADDRESS 7ti
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS�
z s �� IV
Energy Plan Checking Fee
$
$
PERMIT FEE
$ 615. Ct>
LOT NO.
I SUBDNISI 'S IIjPMEPARCEL
MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
/
SF Ef Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat um 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 21--
Describe Work: IAJ:rrri6L W00,6 _6%iLAI-0 /�/s
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 II force and effect.�3$
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:
❑ 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
Main Service 200A TO ,000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( 8 ACC. BUDS.
s0
3.5¢FT.
NEW CONS
NON -RES DT MULTI-CW11IRCUT
97.50
a PSINGLE OWER APPARATUS
OUTLET CIR.
OUTLET OR FarURES
Ex. Occup.BAL.
20 �'•0O
9 .so
Ex. Occup. °FIxLITs AE�sooR�
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 S
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.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
/otr/eloy any person in any manner so as to become subject to workers'
sation laws of C lifornia, and agree that if I should become subject to the
compensao provisions of section 3700 of the Labor Code, I shall
comply with t ose provision
X Date % �(J
na of pplic Owner ontractorge
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
Coolin
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC.
�•
CONST. E
TOTAL FEE $
�.A
IMP
FLOOD
CDF
PARCEL
PO
HD
ISV;
This permit is hereby issued under
of the Butte County Code and/or
indicate , above for which fees have
By
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date "J�9
q-`3
Dale
Receipt No. ✓ S 1y
WHITE-D.D.S.-B.D. ANARY-ASS R PINK -INSPECTOR GOLDENROD -APPLICANT
44
r .
PERMIT NUMBER - B 3087-72B
P
E
IPERMIT EXPIRES
OWNER Wynoka. Homes
Y
d_
CONTR-.owner
LOCATION (A.P. 29-25-1
s1s Lindale Ave. 100.1 east of 2nd St . , Richvale
k
COUNTY OF BUTTE
Department of Public Works
BUILDING INSPECTION RECORD
Zoning
Setback�!Z—�- -�''— Forms C/T�l i2—ids
— d
Foundation
Piers & Girders
Fireplace
Rgh. Plumbing,
E' AzA% ;5 ��
Bond Beam
Lath.& Plaster
Rein. Steel
Gas Piping & Test
Found. Vents
Framing/
_„Z.. / — %rT_
Plmg. Topout 014/- \
Rough Elec.
Wtr. Htr. O.Z-
;!5--1 0 ` `%
Furnace o — 3
Kitchen Vent
Firewall _ n.�G.
�r�% O "' ��
Garage Vents An 23
Sanitation & Water
ELECTRIC
GAS
BUILDING
Temporary
Temporary
Cert. of Occup.
Final
Final
Final
_
DATE
REMARKS OR CORRECTIONS
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WOKS �%,��
7 County Center Drive — Orovi Ile, California 95965 /
Telephone: 533-1230, Ext. 259
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property f inspec 'on purposes.
X Z"` Date,
ignature of a mitee or Agent
Receipt No. 10,5) 3S% _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By.-- Date
Building Permit Expires Date f/
BUILDING
Owner
SO. FT., OCC. BUILDING VALUATION
Mai I i ng Address
000,
e � _
Fireplace
Contractor
Total Valuation 0 Z/
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
Building Address
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
Each Trap 1.50
r
Repair drainage or vent piping 1.50
Water piping 1.50
"s
Each gas water heater or vent 1.50
A. P. No. r"''„
Zoning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone
Fire Dept.
Sanitatio
Planning
Building sewer 5.00
Plans
I Fees J
W. C.'
I R/W
I Encroachment
Lawn sprinkler system 2.00
NEW,0 ADDITION ❑ OTHER ❑
Permit Fee $
$
ELECTRICAL No. @ FEE
,
PERMIT FILING FEE $3.00
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURE Single Fami I Duplex ❑ Others ❑
Range, dryer or water heater 1.00
Oven, Cook -top or space heater 1.00
Light fixtures
Receps., switches & fix outlets —09
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Profession Code under the name
style of:
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
Misc. wiring
License No. /i rsU_C_lassification
1:11 am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
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
$$Permit
Instrumentotiontrpn gromion $0.07/$1000 Evaluation
$
TOTALY PERMIT FEE
$ �-'
authorize representatives of the County of Butte to enter upon the
above-mentioned property f inspec 'on purposes.
X Z"` Date,
ignature of a mitee or Agent
Receipt No. 10,5) 3S% _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By.-- Date
Building Permit Expires Date f/
TheNSCS v. A l l Tal,cT
um*,T OK/e- LaT 1
OM EES INC.
�aG3 Qrov I I le, C�a 1.
I
/A n c ' Z'L /' T . 1. ,++ C) R / •�
SCR IG
phis Of of p;.;,ns and specifications MUST be
at all times it
and is unlawful to
GAR.,
c',-,:ncges or alterations on same without
writt {n
p,�r�nisson from. the Department of. Public
Works, County of Butte.
i
/roRth
90.00
The Bldg. Setback shaII be 5 ft. frJm
the side property line and 50 ft. frdm
the centerline of. the road, permitting
- •a maximum of a 2 .ft. eave.-overhanig.
;*1
y
See Master Plan on file for building
3
N
plans.
- 2
9-
_140,0
14 011 0
BUTTE COUNTY
4d
oIw.�
. 30 ,
TheNSCS v. A l l Tal,cT
um*,T OK/e- LaT 1
OM EES INC.
�aG3 Qrov I I le, C�a 1.
I
/A n c ' Z'L /' T . 1. ,++ C) R / •�
GAR.,
i
Z�
;*1
See Master Plan on file for building
O�(
plans.
�. • �
R. 9�o,ov
BUTTE COUNTY
BUILDING DEPARTMENT
. 30 ,
APPROVED
TheNSCS v. A l l Tal,cT
um*,T OK/e- LaT 1
OM EES INC.
�aG3 Qrov I I le, C�a 1.
I
/A n c ' Z'L /' T . 1. ,++ C) R / •�
X
COUNTY,OF BWTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Orovi Ile, California 95965
Telephone: 533-1230, Ext. 259
Db APPLICATION AND PERMIT
Owner
/* C
Total Valuation
Mailing Address
Permit Fee
$3.00
Plan Checking Fee&/or Penalty
Permit Fee
Contractor
PLUMBING
No. @ FEE
Mailing Address
$2.00 C
1.50
Repair drainage or vent piping
1.50
Building Address
1.50
Each gas water heater or vent
1.50 e
Gas piping system 1 - 5 outlets
1.50
Each additional outlet
50
Building sewer
5.00
Lawn sprinkler system
A. P. No. O�
— �-S~ (
Zoning
Fire Zone
Fire Dept.
Sanitation
Planning
Plans
I Fees
W. C.
I R/W
Encroachment
NEW ❑
ADDITION ❑ OTHER
USE OF STRUCTURE Single Family Duplex ❑ 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: 7
License No. ,2 3 IP Classification C 3 6
❑ i 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.
fel I have placed on file with the County of Butte a certificate of
1Y Workmen's Compensation Insurance.
le
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 Date % -Z—/Y— 7 L
Signature of Prermitee or Agent
Receipt No. w _
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
BUILDING
SQ. FT. I OCC. I BUILDING VALUATION
Fireplace
$
Total Valuation
No. @ FEE
Permit Fee
$3.00
Plan Checking Fee&/or Penalty
Permit Fee
$
PLUMBING
No. @ FEE
PERMIT FILING FEE
$2.00 C
Each Trap
1.50
Repair drainage or vent piping
1.50
Water piping
1.50
Each gas water heater or vent
1.50 e
Gas piping system 1 - 5 outlets
1.50
Each additional outlet
50
Building sewer
5.00
Lawn sprinkler system
2.00
Permit Fee
$
ELECTRICAL
No. @ FEE
PERMIT FILING FEE
$3.00
Main service incl. 1 meter
Additional meters, each
1.00
Sub -panel (12 or less) (more than 12)
Range, dryer or water heater
1.00
Oven, Cook -top or space heater
1.00
Light fixtures
Receps., switches & fix outlets
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
Misc. wiring
Permit Fee $
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heatinq
Cooling
Ventilation
Permit Fee $ $
Ptate Fee for Strpng Motion $0.07/$1000 Evaluation $
nstru ment atio n rogram
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.
DIRECT OF PUBLIC WORKS
ByDate /
61 Buildi g Permit Expires Date
Y\
COUNTY OF.BUTTE - DEPARTMENT OF PUBLIC WORKS��
7 County Center Drive - Oroville, California 95965
Telephone: 53aymooffatKM 534-4541
3 0 8 7ZJ3_ APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date
Signature of Permitee or Agent
Receipt No. 1)23
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By -Date %Z' -z%-
Building Permit Expires Date /2-27-i3
BUILDING
Owner UO/
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Fireplace
Contractor Y- / E
Total Valuation
Mai I i ng Address 3 3-11 01-1416-
Permit Fee
Plan Checking Fee &/or Penalty
G /7av1.CL
Permit Fee
$
$
Building Address /DUB EOF
PLUMBING
No.
@
FEE
PERMIT FILING FEE $2.00
Z S ,-
Each Trap 1.50
Repair drainage or vent piping
1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No.9�� -
Zoning
Gas piping system 1 - 5 outlets
1.50
Each additional outlet .50
Fire Zone
Fire Dept.
Sanitation
Planning
Building sewer 5.00
Plans
Fees C/
W. C.
/W
Rcroachment
En
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ OTHER ❑
Permit Fee
$
$
A5�G % Pi
ELECTRICAL
No.
@
FEE
PERMIT FILING FEE $3.00
d
Main service incl. 1 meter
d
Additional meters, each
1.00
Sub-panel(12r an , 2 ,
2. D
USE OF STRUCTURE Single Family ® Duplex ❑ Others ❑
Range, dryer orwater heater 1.00
Oven, Cook -top or space heater
1.00
Lig t fixtures
0
2.2-
ec ps., switches & fix eutlets
O
CONTRACTORS LICENSE LAW
1 am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of: /
SLe/a-'e
JU924LEx. Fan or F.A. Furn. Motor
/
1.00
_Evap. cooler, gar. disp. or D.W. / 1.00
, Q
Air conditioner or heat pump
Water pump
Misc. wiring
_ lei -! P i c -A I C 0-07LP . e-4 0-S
License No. 2-y3l16T1 Classification 't
❑ i am exempt from the Contractors License Laws of the State of California.
Permit Fee
� Of
$ 0 b
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.
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
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
�SPermit
Inst umote e"ntotiontr�� warn on $0.07/$1000 Evaluation
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date
Signature of Permitee or Agent
Receipt No. 1)23
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By -Date %Z' -z%-
Building Permit Expires Date /2-27-i3