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HomeMy WebLinkAbout030-131-0280 a ' 30=131`=28 3691=89B;P,E,M KEENE; Rodfiey� 1260 Bi s Ave 8g Oroville a G -�/-'� Contr.: Caton Const << (reroof install 'shower,& wtr htr) 030-131-028 05-2071 KENNE,RODNEY ~ �� 1260 BIGGS AVE, OROVILLE Cont: MICHAEL ERNEST JAMES ELEC (dO SERV PANEL) 030-131-028 05-2489 PACATTE, HELEN 1260 BIGGS AVE, OROVILLE Cont: OWNER HEATER & A/C 0 a t - BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE M, (530) 53877541 PERMITS BeCOME NULL AND VOID 1 YEAR FRONI'THE DATE OF LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) ofOivision 3 of the Business and Professions Code, and my license is in full'force and effect. License Class : License Number: Date: Contractor:~ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which 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 pursuant to the provisions of the Contractor's Slate License Law (Chapter 9 commencing with Section 7000) 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, will do, the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself -or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will' have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor_(s) licensed pursuant to the Contractors' State License Law.). ❑ 11aam��Exempt under Article 3/ofitIusiness and Professions Code Date: /_/_AZ h1tu— Owner: WORKERS' COMPENSATION DECLARATION I 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 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy #: 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 the 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. Date: Applicant, � _,t �V __> WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred' thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Name: Address: ,­RERMIT--N,O. IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. Issued Date: 10/26/2005 APN: 030-131-028-000 Site Add ress:,,.1.260.BIGGS,AV.E ORO�� .�.-•� n .- ,�.-- �.-� Map Index:. Description: HVAC UNIT &"DUCTWORK Owner: PAATTE, HELEN.M­_•`__ 1260 BIGGS AVE OROVILLE, CA 95965-4322 (530) 315-3880 Applicant: BILL SCOTT 13001 STREET RIO LINDO CA 95673 . (916) 730.0770 (916) 991-0772 SCOTTWAS@COMCAST.AE-C -` ' Contractor: License #: Architect: Engineer: Total Square Ft: _ .0 ,S.F. - Valuation: $0.00 Census Code: Gd This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutio s t w,do work indicatedabovq for which fees have been paid. By: (uVon J�111 Date: PERMIT EXPIRES ON: 10 -ZGl' b ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ - Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly autho ized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any offs ' or document of Butte County. I hereby 'authorize represent afivess of Butte County to enter upon the above mentioned property for inspection purposes. Print Name:// <�e4i%% ( Signature: Date:1�j�/ d� ,❑ Owner ❑ Contractor Agent for Owner ❑ Agent for Contractor �urrF BUTTE COUNTY 0 0 DEPARTMENT OF DEVELOPMENT SERVICES 0 0 BUILDING PERMIT APPLICATION 0 0 AND SUBMITTAL REQUIREMENTS 0 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 0== ?�_: , a� 0 OFFICE #: (530) 538-7541 - A FEE WILL BE REQUIRED AT TIME OFAPPLICATION �0(JJ Website: www.buttecounty.net/dds +*PLEASE PRINT CLEARLY** F — OWNER Last Nam Address First Name Address f Z � ' State /� (% State State Zip Phonet� Fax Fax 4I 1 E-mail L_ Lic. # F — APPLICANT NAME CONTRACTOR Name Address Address C' c7 _ City State /� (% State Zip Phone ax Fax E mail Planner Lic. # Class APPLICANT NAME APyCHITECTIENGINEER Name Address Address C' c7 _ City State /� (% State Zip Phone ax Fax E-mail Planner State License Number APPLICANT NAME Nam' AP# Address Property Address C' c7 _ Yes State /� (% Zip L5 7 Ph a Subdivision Name ax E-mail 7#1 For office use only: Zoning AP# Flood Zone Property Address SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page 7#1 Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. 1 BIN # escription or cope of Work � f l © i Gt Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. II Received by: -TPI Amount: Bldg Page 1 of 2 Receipt #: S'54 ' /J eq&� Date: SRA Sheriff SMIP Other Total REV 2-24-05 LOCATION AP# r —.08 Property Address - t S >e-40— C* Cross Street WORKER'S COMPENSATION 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 tV Address escription or cope of Work � f l © i Gt Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. II Received by: -TPI Amount: Bldg Page 1 of 2 Receipt #: S'54 ' /J eq&� Date: SRA Sheriff SMIP Other Total REV 2-24-05 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED.. ALL PLANS MUST BE LEGIBLE AND /N INK ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bidgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 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 material for construction of this proposed property improvement: YES [ NO [ ]. 2. I HAVE [ 14 HAVE 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: NAME: _ ADDRESS: PHONE: CONTRACTOR'S 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: 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: PROPERTY OWNER: DATE: NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services ADMINISTRATION * BUILDING * GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile OWNER -BUILDER INFORMATION Dear Property Owner: 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 pernut. 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 your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o 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. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o 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 their own employees, without a licensed contractor or subcontractor, only under hinted 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 in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these inatters. The building permit will not be issued until the verification is returned. Sincerely, C - Scott Rutherford Chief Building Inspector NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. 10/26/05 12:32 FAX BTEC OROVILLE Z002 Now stma A•dffP flq. Porro WO oAe• Y. RECORDING RBQUI?iIRD yY 51dwell'1'itic & EWMW Company A,iD%VljR n AEC:)iti)F1k MAILTO Mary it King 1160 Him Avenue OroviOe, i A m6s 00211491 :Y AZO pE pYQ 2005-0041327 Recorded I FE FEE 11L Official Rrcotdc 6 TRI 2*% Comt ®utteaf i mail J. Ps.9!l M I County C 2mr-11worderl f 110 e-'% M 1wal-M I Palo ! of 2 1111111111111111111111111 h 1111111 SPAElf ABOVE THIS I.1NB FOR AT DEED ParcolNo 1•Pti 70-131-usod 'rills FORM Ftrnrtltiu _ v >)n)U�l':1.� Tii1.6 � rgcRow COMPANY DOeumentury Trangfer Tax is $24 o .90 11a tfi,&rAllicreignad Graratu s) t)eetmaKx) conveyed, or D Ci nn of i ✓ computed on full value of intra=st of propcAy ✓ Unincorporated Arca 13 full value less value of liens or encumbrances m reaining of the lima of sale O Monument Fee ufS1MOO FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged. Rodney Keene, a married man h=by GW -Rs) to Mary E. King, an unmarried woman and Helen M. Pacatte, an unmarried woman, as joint tenants the fbilowirts real property in the O Cita of ✓ Unincorponucd Area County of Butt o. Stale of California: SEB EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF Document Date: July B 2005 Stat ofCalif*mia l Counly of BtrTi- 9 s5. On 2rl)Liiq--Ms U5 , beram rite, the undersigned, 9 Notary Public in and fbr said County anJ SLW, personally appeal gnQncy Keenc Personally known to me (or prvvcd to me on Ike basis or satisfactory evidence) t0 be the psr$oo(s) whose name(:) idRilesubscribed to the within instrument and acknowicdgod to me that hatsbeAkey eKecuted the aume in hislhen#tlteir authotized copaci4(fes), and that by his/hrr-Wf siOaature(s) on (he instrument the 11ete0n(s), or the entity upon deh0lf of which the person(s) acted. executed the instrument. wl'rNInS my hand ando fficialseal. Signature k I FOR NOTARY SEAL OR STAMP ODrtorrll/af ty1nA 406®0 n Woftsry P'ablic •Callpa(rda Stan f<ia11 um Coft 1i11r oma. Este. Apt 1. MAIL TAX STATEMEMt>s TO' -8-3M 06 i trrf�ClowwrOEt:D 10/26/05 12:32 FAX BTEC OROVILLE _ _ _ _ fm003 Order No. 00222498-001 EXHIBIT A THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: ALL. THAT CERTAIN REAL PROPERTY SITUATE IN THE COUNTY OF BUTTE, STATE OF CALIFORNIA, DESCRIBED AS FOLLOWS: A PORTION OF LOT 7,`BLOCK 100 AS SHOWN ON THAT CERTAIN MAP ED ENTITLED, THE OFFICE OF "THERMALITO, BUTTE COUNTY'* CALA, , WHICH MAP WAS THE RECORDER OF THE COUNTY OF BUTTEt STATE OF CALIFORNIA, ON JUNE 9, 1897, AND BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT A POINT ON THE SOUTHERLY LINE OF SAID LOT 7, SAID POINT BEING EASTERLY 182.5 FEET FROM THE SOUTHWEST CORNER EOF OF ID L OT 7 2ENCE FEET TO A NORTHERLY AND PARALLEL WITH THE WESTERLY POINT ON THE SOUTHERLY LINE OF THAT CERTAIN PARCEL OF LAND DESCRIBED IN DEED TO JAMES L. JONES, RECORDED AUGUST 26,1955 IN BOOK 771 OF OFFICIAL RECORDS, AT PAGE 558; THENCE EAS'T'ERLY ALONG THE SOUTHERLY LINE OF SAID JONES PARCEL, 74.5 FEET;THENCE SOUTHERLY AND PARALLEL WITH THE WESTERLY LINE OF SAID LOT 7, 209.8 FEET TO A POINT ON THE SOUTHERLY LINE OF SAID LOT 7; THENCE WESTERLY 75 FEET TO THE POINT OF BEGINNING. AP NO. 030-131-028 10/26/05 12:32 FAX BTEC OROVILLE001.. --'—•-i3X3'L{aX(dX�oXi2XlitiaX�iaXiet(2t(aX�axi2Xfd,L�27�3XiaXia(i3;(felreliL(31�e%.IoA�e�ia�a.(id1�dAldll��iTd;aila'CP.tjatiai�Ir•.t�^"•.,_. • ._.. FA -X -From the desk of gIDWEi L Escrow Officer Title& sc1c®�v ]3�dwell. i %e &Escrow. Company ��.GIO�Gt phone: (530) 533-2414. (530) 533-1589 ille jeannie@bidwe11tit1e-c0m orov 1835 Robinson St. Oroville, CA 95965 (530) 533:2414 FAX: (530) 533-1589 a c6ico [AT T E N T 1O0N Main Office 500Nvallt95928 # of FNGES:Chico. CA - • (530) 894-2611 FAX: (530) 894.0713 Y1 A TE : Paradise - • . 145 Pearson Rd. - Paradise, CA 95969 1 (53D) 877-6262 JFAX= (530) 872-5129 Gridley 560 Kentucky St. Gridley, CA 95946 (530) 846.4005 ITFAX: (530) 846-0584 FAX TO PHONE: III, NOTES: f Bidwell Title '.'& Escrow -Comp -Any.: Bf .-.YOUR ST C11010Et �thxfzilaCfzcfazfrxf�tifaz�cfaxfaxFaxfazfax faxfrxfalialfasfufaxfSfax(ax(a�cEazfauEa�fa�ci2r�Cf��zfai�tazfazfazfa�chxfaz�azfaxh�i�tfaX�Cfa,cfazhztaxF�kifax�4faziac[axfaXFtcf�� AS0100INQ039: Main Assessor Sep 23, 2005 12:35 pm; •i i Name KEENE RODNEY Asmt # � Fee # 030-131-028.000 ' I Status ACTIVE '� Status Date Addrl 264 SPUR AVE - - - - — — -- - --- --- __ -- — ' Tax 90l7_,, NORMAL OWNERSHIP - TRA 104.010 4 Addr2 OROVtLLE CA 95966,�_�T Situs 11260 BIGGS AVE OROVILLE Addr3 ----- =--------� - 1� Base Dt Addr4 Land 15,838[ _i� Timber Preserve 'Structure 48,833`) AgPres 3. { Fixtures Comments 3013102800 CONVERTED 05/08/88 �; Etal __ - 1 Growing 0 Creating Doc# 197682075684 Date --Total L&I 6_4,671j1 I Current Doc# 2001 8 001 71.75-T Date 04I2712001j !M Bonds Fix. RF Q( r Multi Situs i I Killing Doc# T - Date F_ 1:'Flag1 MH PP 0� Asmt Desc I 1260 BIGGS AVE M SuplCnt 07 ^ Flag2 PP 0� l Zoning AR I Dwell F. 910 MH Exempt _ 0� _ Acres/Sq Ft 0 _ INIC 030 l� Asmt PP Pen R C# 64,671 _ - Tax PP Pen l- 117. Appeal Pending' T/R 'D t Split Pending R!C S tat F PH Y- OWN _ EXP TAXHON ATT SIT APR, PCL f' 1 ► �i ' Find J;j2005Isa, 0712512001 3.27;21 PM WVA-d- 07 t �Da of - D� 03D • �3/� oa8' 0� �D �� I "a'Sov-29 iv Nest memo Add" M. - Sem ..p 2005-10:48AM532CAPITOL FINANCIAI�-010.-p°ISLE MCO1tt)ING AEQUft rtD MY Bldwdi *nue & Escrow Contpoay AND WNBN neCOIWW %L*Jl. TO Mary F- K" 1260 Diego Avenue Oroviihk CA 95965 t6brlf 00222498-01 CAP UP!No • 2332 P 2102/003 2005-0041327 21coMed I NEC 1M 19.0 Off Cid 11afWt I = tag Butte 1 Eouet CleCNIM m. FI 1 12--s 11 1S -Jul -m I gave 1 of z �III��IIa�loll INl01upIII SPAT ABOVE THIS UNE itnt kFCORDRR*9 USE Pateel N.F!CR.ANT DEE VM ICBM FUJtXMI))iD BY DIDW RL TMF & ESCROW CO-NIPANY 71te lhaladped t3rm1pr(s) naia"sl Dwirtitmmy Transfer Tull is $24 0.90 17 Chyrrown of ✓ eomputed on roll vuluc orintctm or properly tonvCyW. or ✓ Unincorporated Arm 0 rail slue less vahtc of lista or enedmbraneee tatmining at the lime of sole O MonutoeetFenof510.00 FOR A VALUABLE CONSIDBRATION, raeeipt of which is hereby ocltnowledged, Rodney rmene, a married man hemby GRANT(s) to Mary S. King, an unmarrLed woman and_Xelem—t4.—Pacatte, an unmarried woman, as joint tenanto the ibllowing neral property in the 0 City of ✓ Unincotporuct! Area ' County prDut[e. Scute of C*lifmni& SELF EXWBIT A ATTACHED HER9TO AND MADE APART HEREOF Document Date: _July e. x005 State ofCnlilbrnin Courcy of 8llfte )SS. On M&Y i uIrm I A Ipra , before me, the undff5i9"M. a Notary Public in and for said County and State, Personally opptared Bonney Ketone Persomily knom to me for proved to nit on the basis of sudsfactocy FOR NOTARY SEAL OR STAMP evidglce) to be the pemn(*) whose nione(s) isfaem&scribed to the within tn%n n3lnt and aeknoxlsedged to rale that 11041041bey execUted the same in hisAmod stir authorized copwitAic4 tout " by hWherAheir signgUore(s) an the instr4rmnt lk penon(s). or the entity upon behalf of which the persalt(s) aacd, txceuted the instnuttent. K LARKIN Oattrolesgt tn1011101 WITNIM my hand and ol1'rcial seal. Nd" Pstllt: Iso cu. 5W Apr t1. Signature NJ *'�LA 10'ffT'h MNL TAX BTATEM9= 7v ' BaMe�oye arr�-.r+rtstrlTot�n 09,'Sev-29. 2005_:10:48AM5337-CAPITOL FINANCIAL' 01?0vz l.a CAP UPICNo 2332._,,P 1101./003... ai�.x Cro��lx�c►�l ttaxtaz��zr tZ,azr�zfuf f:x l�e�►ai>atl�r�r<<ra�� cjAla IErauiu►aMIUF40kIdAldk�►IGAIr CO v SHEV_j,Y. AD ELL 'Irate 8 Escxovw oroville 1835 Robinson St- Omville, CA 95965 (530) 533-2414 ):AX, (530) 533-1589 Cblco Main Office 500 Wall SI. Cfiiw, CA 95929 (530) 894-2612 y FAX: (530) 894-0713 Paradise 145 Pewson ltd' . Paradise, CA 95969 (530) 877.6262 FAX: (530) 97"M Gridley 560 Kentucky St. Gridley. CA 95948 (530) 846-4005 FAX: (530) 946.0594 From the desk of Jeannie Brown -Fscrow Officer :_ �3idwell_Title' & escrow. Corripany Phone: (530) 5332414 . Fag: (530) 533.1589 je=ie@bidwelltitle,c0M. # of PAGES: .. _...-- ...... DATE: FAX TO PHONB: 5 NOTES: k Bidvyell Title.-&scrow,Company` ; - YOUR BEST CHOICEt facc�C�z�tfzt�It�t�Cf�ck�cCazfa�tfax.kw- f�kxkxkx�ittalfaz�ic�C�Zfaxt�k�iWc�tF�faicfazf��cFdzf�ibirbirF�ifazhzlaifaz�Zf�riiocfaxhx �tb�tblfal�C�ftt��ck Asmt # rMM.p Fee # 030-131.028 000 Name KEENE RODNEY �� = A I Status ACTIVE y_ _ Status Date Addr1 1264 SPUR AVE, Tax 000' NORMAL OWNERSHIP J TRA 104.010 — f Situs 126 __� . _____ M � _ _ Addr2 OROVILLE CA 95966 _�' 0 BIGGS AVE OROVILLE Base Dt Addr4 y v Land _ 15,838 --- -; Timber Preserve `Structure ~ 48,83.3, J AgPres Fixtures 0 Comments 13013102800 CONVERTED 09/08/88_ `r Etal Growing 0 Creating Doc# 197682.075684 �� DateF- Bonds Notal L&I _ 6.4_,671] Current Doc# 2001 8 001 71 75 �� Date 04/27I200J --, Fix. RP Killing Doc# Date0 } Multi Situs d _ ----�--_-------�---- � _ I��,--J -_ Fla 1 0 MH PP Asmt Desc 1260 BIG_ GS AVE�a SuplCnt 0 ' g PP Ali _ -_ LTJ �_h Flagg Zoning Dwell 0 r.7, 910 MH Exempt 0 ' :_ Net Asmt PP Pen 64,671: Acres/Sq Ft +jNIC03� R/C#� �_i Tax PP Pen L_ -1r F, Appeal Pending T/R Dt I Split Pending RIC Stat - �� PHY 0 N IEXP ��i� TAXV`� HON �� ATT SIT ��YAPR- �'~ PCL t -13 Find - -I 2005 ; sa, 07/2512001 3.27,21 PM � (fad I, Helen Pacatte, hereby authorize Bill Scott to obtain a permit for installation of heating and air, for 1260 Biggs Ave, Ororville 95965. Thank you Helen Pacatte BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BPO52071 B. C. Building Permit 01.-16-04 pg 1 LICENSED_ CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 08/03/2005 APN: 030-131-028-000 the Business and Professions Code, and my license is in full force and effect. License Class: C r0 License Number:,_ 12!33 Site Address: 1260 BIGGS AVE ORO U / Date: l� ^ ©y Contractor: Map Index: Description: CHANGE OUT SERVICE PANEL OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: KEENE RODNEY permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 1260 BIGGS AVE signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA the Contractor's State License Law (Chapter 9 commencing with Section 95965-4322 7000) 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 the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 Applicant: MICHAEL ERNEST JAMES Code: The Contractors' State License Law does not apply to an MIKE JAMES ELECTRIC owner of property who builds or improves thereon, and who does 50 OAK AVE such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for OROVILLE, CA 95966 sale. If however, the building or improvements are sold within one 530-532-4446 year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: MICHAEL ERNEST JAMES not apply to an owner of property who builds or improves thereon, MIKE JAMES ELECTRIC and who contracts for such projects with a contractor(s) licensed 50 OAK AVE pursuant to the Contractors' State License Law.). OROVILLE, CA 95966 ❑ I am Exempt under Article 3 of the Business and Professions Code 530-532-4446 Date: Owner: License #: 329933 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 Architect: Labor Code, for the performance of the work for which this permit is issued. Engineer: ❑ I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Total Square Ft: 0 S. F. Valuation: $0.00 Policy #: Census Code: ($� 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' 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. Date: n 3 S Applica�/� � WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. , ^ CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Pde a d/or I hereby affirm that there is a construction lending agency for the Resolutions to d w �dica d above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) BY Date: Name: PERMIT EXPIRES ON Q Address: Dat ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: /%/,- /L 4`—cJ /�f�I t� S Signature: Date: ❑ Owner >14--ontractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01.-16-04 pg 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" APPLICANT SIGNATU E X For office use only: OWNER Last Name C irst N P _ Address / v City /—z /MateC L Zip Phone 5-33 , 108 Fax r— E-mail E mail APPLICANT SIGNATU E X For office use only: CONTRACTOR Name ;k J z!=:1s 2� C Address O k I No City L State Zip S �� Phone 2 Fax �--- E mail 3 CICS. b APPLICANT SIGNATU E X For office use only: ARCHITECT/ENGINEER Name --�-- O �/ c Address SRA City I No State Zip Phone Map Book Fax E-mail Planner State License Number APPLICANT SIGNATU E X For office use only: APPLICANT NAME Name --�-- O �/ c Address SRA City I No State TZ-0 Type Cons;. Phone Map Book Fax E-mail Planner APPLICANT SIGNATU E X For office use only: Zoning Property Address Flood Zone Cross Street C2 Ir SRA I Yes I No Occ. Type Cons;. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. 05, 201 BIN # LOCATION AP# Property Address City Cross Street C2 Ir Sheriff WORKER'S C MPENSATION 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 A ENCY Name 17, Address Description or Scope of Work: 1-0216 6 � !� �u Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Re ' db Amount: Bldg SRA eti#' � Sheriff SMIP I I Date:�-3 I 6---'2 Total Page 1 of 2 REV 2-24-05 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0R1v1S\131dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 .r { ���',.-^�an�..�y�r!�74'!`4=�` �vt? '� �:"a!r.N' :r s1'�.�� �.,.p .N,.�i�,.�.r ._.� fir..,��.��i.;,�.Ts.,�-���i�':r�...�N �i�r.ltiiN,�'rf'���.� "'V'ryw`'f7'i`c..�i..?. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 - _ APPLICATI91 AND, PERMIT ^P�RMIT N0� ASSESSOR PARCEL NUMBER 30 _ 1711 -28 ZONING A BUILDING PERMIT OWNER a � NC ke eJrZ TELEPHONE 533 - 36.1y S0. FT. OCC, BUILDING VALUATION :(3 sa, CJMP I2 6 OWNER'S MAILING ADDRESS 6 020 CONTRACTOR'S NAME CAro.� Ccw.5 +��crI,o j TELEPHONE &771-2.370 CONTRACTOR'S MAILING ADDRESS P CS D �A�G02 `ts 1 Fireplace CONSTRUCTION LENDER NoNry UNKNOWN Total Valuation $ Filing Fee g $ 10•00 LENDER'S MAILING ADDRESS Permit Fee $ Z2. 00 ARCHITECT OR ENGINEER Kk))JC LICENSE NO. Plan Checking Fee ,$' Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESSPermit �z�o �tGcs AVF� T4(!(ZA,\AL1ro fee $ 32_�� PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 00 f Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 DO Each qas water heater or vent 5.00 5. C-10 USE OF STRUCTURE ! SFX Duplex❑ Mobilehome❑ Other i SPECIFY ; Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 1:.00 Mobile Home S I G I W 10.006 TYPE OF WORK New EJ Addition [I Remodel® Utilities❑ Installation❑ ,Other ❑ Describe work: RR —Roo F AM, 4q-ecMT+'1, L i05 ALtil Permit Fee $ 27, 00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 [ t ` Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD -L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check One): [4 -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. Classification License No..3J ❑ 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 this reason NEW OR ACDNS, CONST. \( DWELLING OCCUP.&ACC. BLDGS. / ) Yz2sgft NEW CONSTR.MULTI-OUTLET NON.RESID BRANCH CIRC ITS 2.50 ea /POWER. APPARATUS e (SINGLE OUTLET CIR. Ex. Occup( OR TURES e^L@ DAL030 FIXED APPLNS. oR Ex. OCCUp- OUTLETS IRESID,)'E. .) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.0 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty 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. MECHANICAL PERMIT Filing Fee 10.00 Heating WNL_ kA VL N C Ci irt Cooling Hood 3.00 Ventilation Permit Fee $ D0 Contractor 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, indem ify and keep harmless the County of Butte against all liabilities, j dgments, osts, and expenses which may in any way accrue against sa�iid C® my in sequence of the granting of this per iL X�y / Date Signature of Applicant — Owner ❑ Contractor Agent Ll 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 $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ . HAZ CUA PARK SCHLJ FLD PAR JPDJHD ISSUE/ This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees C OR OF UBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date L Y Receipt No. 1 8r rt 7S Jp WHITE•O.P.W., YELLOW -ASSES OR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751, N 7 County Center Drive, Oroville — Pl 6&: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this mattar nr nPPri ariditinnal PYnlanatinn_ nIPaSP rnntart this nffira immadiataly_ Inspector Date—) ! COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville,_California 95965 - Telephone: 916/538-7541 APPLICAMON AND PERMIT P RMIT NO. �� w ASSESSOR PARCEL NUMBER 3 cro - 3 I -as ZONING 1?1 BUILDING PERMIT OWNER a � ge 1�E U/r TELEPHONE 533 -3 087 SO. FT. OCC. BUILDING VALU ION 6 Sa- comp 1 2 O Z5 OWNER'S JMAILING ADDRESS n 1 ` 6 '�1 ��L C� Ilo CONTRACTOR'SNAME CAT -04 Ca^1sT- 2L,LT-10^J TELEPHONE 7`i-2376 CONTRACTOR'S MAILING ADDRESS BO)c 23(::;; aA,-]GoP, E 11 Fireplace CONSTRUCTION LENDER NONr UNKNOWN Total Valuation Is FilingFee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER Nvtf0 LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 1z o GG -5 A-U� (z12M/�f_iro Permit fee $ 3c''aa PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 ?_Oo Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 5,06 Each qas water heater or vent 5.00 S. 007 USE OF STRUCTURE SFXJ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 5,00 Mobile Home S I G W 10.00e TYPE OF WORK New❑ Addition❑ Remodel] Utilities[] Installation❑ Other❑ Describe work: ?PC.— (too F AN'�N R4&1Cd'h-q L fNTMLe, � jwt2y) , kA-, Permit Fee $ 27, e Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check One):NEW ©--1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code andmy license is in fullforce and effect. License No S31� �! Classification is ❑ 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) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW . CONS DWELLING OCCUP.8j) OR ADONSACC. BLDGS. '/20sgft CONSTR ULTI.OUTLET NON.RESID B NCH CIRC ITS 2,50 ea POWE APPARATUS e GSWGLE TLET CIR. J EX. OCCup(OUTLETS OR TURES 02AL 530 Ex. PRESI D.1 A.) EX. DCCUp. OUT LE 2.00 Temporary service 10.00 Mobile Home Facilities X15.00 Misc. �yirin 9 15:00 r Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. Uklhave 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. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating _ DO WAIL ��t fi Cooling g Hood 3.00 Ventilation Permit Fee $ Contractor 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. I also agree to save, indem if y and keep harmless the County of Butte against all liabilities., judgments, sts, and expenses which may in any way accrue again C my in equence of the granting of this per it. Date Signature of Applicant — Owner ❑ 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 $ Energy Inspection Fee $ occ CONST TYPE AL i7d TOTAL FEE $ S, HAz CUA PARK EE PAR HD ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees C OR O UBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS f Date Receipt No. 9 8�c1 % 7S 00 WHITE-D.P.W.. YELLOW -ASSES OR. PINK -INSPECTOR. GOLDENROD -APPLICANT