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HomeMy WebLinkAbout030-131-022A.P. 30-131-22- ---., Ls, F. A. STURGEON 1239"12th--St-.', 'Oroville COIV'I'R: Foothill Const. p Palermo Permit 2067-7ZB (reroof ),,-Z 0.3 - /3- LOT - BLOCK SUBew. NEW OWNER 30-131-22 0. D. Mr;DONALD �-/.7 1239 12TH. ST THERMAL I TO # 12-7 P(1 NST. BLDG. SEW SF TYaEpp PERKS MIT PERMIT NO. PLAN NO. DALE ISS REMARPERMITPERMIT B07-0637 030-131-022 MISCELLANEOUS Re -Roof REROOF W/COMP (20) 1239 12TH ST OLRY, SCOTT D & JANIE E z 1 .I !I PERMIT DESIGNATION: B—BUILDING DEPARTMENT OF P—PLUMBING T—TRAILER BUDDING AND SAFETY E—ELECTRICAL U—USE PERMIT TV — RAD 10 -TV ANTENNA V — VARIANCE S/W—SIDEWALK NOTICE S—SIGN PERMIT HM —HOUSE MOVING EP—ENCROACHMENT D— DEMOLITION 600.1 INSPECTION RECORD BUILDING APPROVALS FW im of W> ttiZ Z O Oml- FIQ QaD UOZ OU.D J LL z UJ IC W OW WN Z D Z 4 a 2I al W I -g Z 2Z al' W IX -g W as �IW.,W a Wy g y as W AXXI Wa W �U VO zM V WJ �Q Q DLL QV J d W a LL Q z a SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE PERMIT NUMBERt SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE ROUGH -IN GAS PRESSURE TEST WATER PIPING SEWER LINE APPLIANCES & VENTS FINAL ! FT.FPTRIVA/, APPROVAL..1 PERMIT NUMBERS SIG. DATE SIG. DATE SIG. DATE SIG. DATE SIG. DATE ROUGH -IN FIXTURES & APPLIANCES METERS FINAL MISCELLANEOux At'rxuVALIJ PERMIT NUMBER: DESIGNATION l BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES •BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 . WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 1239 12TH ST Owner: Permit NO: B07-0637 APN: 030-131-022 OLRY, SCOTT D & JANIE E Issued Date: 03/28/2007 By KEJ Permit type: MISCELLANEOUS 171 N KAREN AVE Subtype: Re -Roof CLOVIS, CA 93612 .Expiration Date: 03/27/2008 Description: REROOF W/COMP (20) (530) 370-1092 Occupancy: Zoning: AR Contractor Applicant: Square Footage: OLRY, SCOTT D & JANIE E OLRY, SCOTT D & JANIE E Building Garage Remdl/Addn' 171 N KAREN AVE 171 N KAREN AVE CLOVIS, CA 93612 CLOVIS, CA 93612 Other Porch/Patio Total (530) 370-1092 (530) 370-1092 FEE INFORMATION DBMSC Re -Roofing $110.00 Total Charged: $110.00 Fees Paid: $110.00 Balance Due: $0.00 Receipt No: B2389 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License OLRY, SCOTT D & JANIE E OL:CRW_00363603 / / Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed 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 pursuant to the provisions of the Contractors License Law [Chapter 9 (commencing with Section 7000) is in full force and effect. of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 03/28/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractor's Signature Date I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK; AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec, 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself orherself, or through his or her own employees, provided that such improvements I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR ❑ are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). I'HAVE AND WILL MAINTAIN WORKER'S.COMPENSATION INSURANCE, as required by ❑❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; The Contractors Licensb Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensedpursuant to the ' Contractors License Law.). Carrier. Policy Number: Exp. Date: (This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ I AM EXE T under Section B. & P.C. for this reason: 54 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 Workers' Compensate of California, and agree that if I should become subject to the workers' 03/28/2007 compen ion rovisions of S ion 3700 of the Labor Code, I shall forthwith comply with those Owne s Signature Date provisio s. X 03/28/2007 I hereby certify that I have read this application and state that the above information is cored. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and Lability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, injury, including death, and property damage caused by, arising out of, or in any way connected with DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occu y of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEYS FEES. bMdcproperty for inspection purposes. I hereby.certity that I am the pon the property ownees'behalf. CMfPLrfmRtee1S1GR] CONSTRUCTION LENDING AGENCY 03/28/2007 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) rintDate r9e`!'rT 1D C9I e / Owner 1:1 Contractor OR. ElAgent for Owner �Ag(eenttffor rContractor FILE COPY Lender's Address City State zip .1% Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their 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 should 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 materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal ° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks to you if you do not cavy out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, 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 perform their work personally or through thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN T14E ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. I PERSONALLYPL TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT�R NO) 2. I (HAV VE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: ADDRESS CITY PHONE CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED: NAME ADDRESS PHONE TYPE OF WORK Description: REROOF W/COMP (20) Reference Number: B07-0637 Applicant Name: OLRY, SCOT JANIE E Owner's Name: OLRY, SC TT D & JAN AP h Signature of Property Owner- Date: :030-131-022 Z 09 7,2 4 �� t BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530)5')8-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.b.uttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last Name C / D First Nam Mailing Address t -7 q G 1 City vC State C' Zip n / 7 66 '� ' () q Fax - U "4Dcy APPLICANT INFORMATION CONTRACTOR Name %t City G Address City Fax State Zip Phone Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City G Address City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address t City G Stat Phnn _ I _0 Fax mail APPLICANT 1'.;NATUl1E PERMIT NO. bj •�� BIN # PROJECT LOCATION AP# Property Address 1 /� I, --A �-- City !WV 1z1U^ I WORKER'S COMPENSATION I Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name f r N Address DESCRIPTION OR SCOPE OF WORK.; ZE;4o Sal U !Z� Sc FT- Living Garage Open Cov ~� i? St ucture Built without Permits 0 Proposed Change of Occupancy (Note previous use)- For office use only: Zon:ng Flood Zone SRP, ves 1 ro �c.c. Type Const PERMIT NUMBER _ B 2067-72B P E PERMIT EXPIRES c2 -73 OWNER F. A. Sturgeon CONTR:. Foothill Const., Palermo i LOCATION (A.P. 30-131-22 J 1239 12th St., Oroville 1 c-3 J � i :t �i T 1 Q DATE REMARKS.,OR CORRECTIONS COUNTY OF BUTTE' Department of Public Works BUILDING IN•SP-ECT.ION RECORD Zoning Setback Forms Foundation Piers & Girders Fireplace Rgh. Plumbing Bond Beam Lath & Plaster Rein. Steel Gas Piping & Test Found. Vents Framing Plmg. Topout Rough Elec. Wtr. Htr. Furnace Kitchen Vent Firewall Garage Vents Sanitation & Water ELECTRIC GAS BUILDING Temporary Temporary Cert. of Occup. Final Final Final DATE REMARKS.,OR CORRECTIONS COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 533-1230,'Ext. 259 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the This permit is hereby issued under the applicable provisions of above-mentioned property for inspection purposes. the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. X Date 2L ,7 DIRECTOR OF UBLIC WORKS Signature of Permi ee or Agent BYDate � Z , Receipt No. —/ I - Building Permit Expires Date X—Z, 73 White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant BUILDING Ow�/� l.� SQ. FT. OCC. BUILDING VALUATION ©4 Mailing Address Fireplace Contract Total Valuation ® O Mailing Address �� Permit Fee Plan Checking Fee &/or Penalty Permit Fee $ $ Building AddressPLUMBING No. @ FEE PERMIT FILING FEE $2.00 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. 2of — 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 W. C. R/W Encroachment Lawn sprinkler system 2.00 NEW 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 Family Duplex ❑ Others ❑ Range, dryer or water heater 1.00 Oven, Cook -top or space heater 1.00 Light fixtures Receps., switches & fix outlets AM 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 o : CXt 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. 9Y %.5 S Classification L ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. YFave 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 j5Permit Instrumentotion r groonion $0.07/$1000 Evaluation $ .07 TOTAL PERMIT FEE $ (O • O authorize representatives of the County of Butte to enter upon the This permit is hereby issued under the applicable provisions of above-mentioned property for inspection purposes. the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. X Date 2L ,7 DIRECTOR OF UBLIC WORKS Signature of Permi ee or Agent BYDate � Z , Receipt No. —/ I - Building Permit Expires Date X—Z, 73 White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant +� PERMIT NO. 712-76F• P E M MH UTIL. PERMIT NO. PERMIT EXPIRES 2/12/77 I OWNER 0. D. McDONALD t CON TR. OWNER LOCATION (A.P. 30-131-22 1239 12TH. ST., THERMALITO 1 Y 1 {{(t r{ Ar �l r' I Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINALED (DZa� e7W4� (Signature) ' THERMALITO IRRIGATION DISTRICT 410 GRAND AVENUE OROVILLE, CALIFORNIA 95965 b TELEPHONE 533-0740 CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT Service Address: o :r r,) 1 7 -TA �,-�-- Owner's Name: 72 0- :-A A N, ( A,1 i1 Date : +"") Z O, Address: +j t^'h 07-i•!I GT Acct. No:7'E P��� ��� k �l1 rte A.P. No.:7-,,/7- 1 a0 *7`Z_. Phone: ►-: er ) en No. Units: i �. .. Applicant/Agent: r♦ Agents Proof: 1+1. Address: Fees: Phone: Application $ r n Arrearage Preliminary Review By f `\ til1'`�.,:. ,,�� Date:y�r ^ 1A%t CSA 26 .- Remarks: v v SC -OR 1st mo. S.C. Other �I Field Review By: Remarks: i Date: Total FeesC:N Collected By: Date: MONTHLY SERVICE CHARGES WILL COMMENCE AUTOMATICALLY UPON: Date of TID approval of completed building sewer (early connection). ❑ 30 days after date above, or on date of D.P.W. approval of completed building sewer, which ever comes first ("existing construction", prior to Mar. 5, 1974). ❑ 180 days after date above, or on date of D.P.W. approval of completed building sewer, which ever comes first ("new construction", after Mar. 5, 1974). DISTRIBUTION: WHITE Ai[O, YELLOW - APPLICANT, PINK - DPW, GOLDENROD - DPW to TID 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 Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer 'J2 Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structure Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final 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 Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 Colinty Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND ,PERMIT iia -7G auuwiice rep eaeFIM Ves VI the Gauniy or Butte to enter upon the above-mentioned property for inspection purposes. X.l'A , Date Id 47 VA Signature oaf%Permitteee,ynt Receipt No. 7 �`� 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 w 'ch fees have been paid. CTOR F PUBLIC WORKS BY Date �t=t rg permit expires Date BUILDING Owner v SQ. FT. OCC. BUILDING VALUATION Mailing Address rL Telephone No. `5 Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/orPenalty Telephone No. Permit Fee Building Address PLUMBING No. @ 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 A. P. No. ate/ h e� _ J' d— Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F Fire Dept. Fire Zone Use Permit Building sewer 5.00 Sd U EQA Parking Plans I Parcel Declaration Parcel Ma P 60' R/W provements Improvements Lawn sprinkler system 2.00 aW-PfT�d Parcel Approval Plans Approval Permit Fee $ -- $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER (K ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 5.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 Single Family ry Duplex ❑ Mobil Home ❑ Others ❑ Main service OVER 600V 25.00 100 AMP oRA. Main service E ADD•L 1000 AMP 1.00 NEW CONST. DWELING O OR ADDNS. ( ACCLBL GSCCUP, &) 20sgft NEW CONSTR. MULTI.OUTLET NO N.RESIO. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR POWER APPARATUS & NON-RESIDSINGLE 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)50 OD25a BAL@104 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 rVI aJArJm exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑ I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE _ auuwiice rep eaeFIM Ves VI the Gauniy or Butte to enter upon the above-mentioned property for inspection purposes. X.l'A , Date Id 47 VA Signature oaf%Permitteee,ynt Receipt No. 7 �`� 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 w 'ch fees have been paid. CTOR F PUBLIC WORKS BY Date �t=t rg permit expires Date