HomeMy WebLinkAbout030-192-01530-192- /5"�
Alex W. Mingus
1154 Dodge Avea To'fwlb , 'Oroville
Permit #2369-81B(new pri.det.garage)
030-192-015 03-rL D
SCRUBY, DAVID M.
1154 DODGE AVE., OROVILL
REROOF/SF
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030-192-015 h 03:1994
SCRUBY, DAVID M. f
1154 DODGE AVE., OROVILLE
REROOF/SF '
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 0s - 1"4.y
ASSESSOR PARCEL NUMBEF�,
U3U-1�!L -U15
ZONING
BUILDING PERMIT
OWNERTEEPHONE
SCRUBY DAVID M.
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
50 WALLY B LANE OROVILIE CA 95966
11 NRFS
660.00
CONTRACTOR'S NAME
OWNER
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $ 660.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 19.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
1154 DODGE AVE. OROVIUE9 CA 95966
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF El 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 [a
Describe Work: RE ROOF WITH WMP
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I G I W
@20.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
aOLE
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 Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.POWEPPARATUS
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law Jor 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.
❑ 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 200A TO I000A
46.00
NEW CONST. DWE UNG OCCUP.
OR ADDNS. ( 6 ACC. BLDS.
sO
3.5¢FT.
CONST.MULTI-OUTLET
@7,50
6 SINGLER AOUTLET CIR.
EX. OCCU OUTLET OR FIXTURES
BAL Q I. 0
Ex. Occup. (OUTLETSas °�
5.00
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 FEE
S
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
!4, 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.
X Date 0 15 10indicated
Signature of Applicant - Owner Of Conactor ❑ Agent
An OSHA permit is required for excavations ova 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 $ 39.00
MAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
I PD
HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
above for which fees have been paid.
y 3�
-1l //, % 40, Date
ay 1�-t/�-�f
PERMIT EXPIRES ON
Date
Receipt No.823t/t9.0ii
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 AND PERMIT
cx3-I -w
ASSESSORPARCEL NUMBER
030-192-015
ZONING
BUILDING PERMIT
OWNER
SCRUBY DAVID M.
TELEPHONE
89-3046
SO. FT. OCC. BUILDING VALUATION
11 SQUARES -
660.00
. OWNERS MAILING ADDRESS
WALLY LANE OROVILLE CA 95966
CONTRACTORS50
B
OWNER
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $ 660.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 19.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
1154 DODGE AVE. OROVILLE CA 6
Energy Plan Checking Fee
$
$
PERMIT FEE
S 39,00
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF 10 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 1%
Describe Work: RE ROOF WITH COMP
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I G I W
920.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service z�oon oA '.ss
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.P
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law or 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 To
46.00
NEW CONST. DWEW
EE NG OCCUCUP.
OR ADONS. ( & ACC. BUDS.
SO
3.50FT.
NON•RESIO MULTI.OUTLET
97,50
SOWER APPARATU
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FDMAES
20 @ 1.00
BAL @ .SO
Ex. Occup. DFIxLITE�D�ARa oE.,
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.
❑ 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.)
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' ce mpensation provisions of section 3700 of the Labor Code, I shall
forthwith ply with a provisions.
n
X Date 1
Signature of Applicant -AOv7ner EVCo actor ❑ Agent
An OSHA permit is required for excavations ov 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 FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IMP
FLOOD
CDF
PARCEL
pO
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
I
the applicable provisions
Resolutions to do work
been paid.
Date 3
-3
I ate
Receipt No. _lag 3Ii(�$39.nn
WHITE-D.D.S.-B.D. C NARY -AS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT
O.B.-1
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.
Y. I personally plan to provide the major labor and materials for construction of the proposed
property improvement : YE NO ❑
`2. I HAVE 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: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to provide portions of this work, but I have hired the following person to coordinate,
supervise, and provide the major work:
NAME:
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:
DATE:
03
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
O.B.- I
I OWNER BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of 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 '$300 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 Governments 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 for you if you do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and,
ifyou 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 limited
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. 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 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 that you
are aware of these matters. The building permit will not be issued until the verification is returned.
r
rely,
Mc 1 C. Vi ira, C.B.O.
M ger, Building Inspection
NOTE. This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
OVER
PERMIT NO. 2369-81B
PERMIT EXPIRES
OWNER Alex W. Mingus
CONTR. owner
ASSESSOR PARCEL 30-192-7
LOCATION 1154 Dodge Ave., oroville
Temp. Power Pole_
CalledPG&E/—
Temp. Elec. Service
Called /G&E—
Temp. Ga.-P4kv-ice'
Ca/ed PG&E
) te
(D
JO FINAL D D (D te
Signatur
4
J = OK
0 = Nqt OK 1
- = Not Applicable MOBILEHOMES MISCELLANEOUS
= Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except p's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors -
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.Water; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ P'L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card -BI Date `.gin Iv?
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except N's
Card -BI
Date
Date Card -BI Date _
POOLS (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH.Test-Demand-Valve-Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances•
4, Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip.w/5'-Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card -BI
Date Card -BI Date
Card B -I Date Card -BI Date
Card B -I
Date Card -BI Date
Card -131
Date Card -BI Date
t
4
J OK
O = Not OK
- = Not Applicable RESIDENTIAL (Single and
= Not Ready
Duplex)
' Date
UNDE LOOK Plans; OK except #'s
Date
FRAMING -(Continued)
Zoning requirements -Setbacks -Easements
48�erty
Line Firewall & Openings
2.
F g., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
C,VFtg.,
Garage; Soils -Steel- / /" Ftg. Depth
f! .
W, dth-Headroom-Rise-Run-Landing-Fire Protection
4.
ks; Soils -Steel- / /"Ftg. Depth
wood on Roof Overhang -Attic Vents -Rafter Outriggers
ain; I-Blockouts-Wrapped-Slab
.
Siding -Nailing -Veneer
s, Garage; lab
63.
Sturr-o Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. SteelS4_rea-
lass Protection -Skylights -Plastic
8.
gs-Test-2 way C/O -Sewer Test
ling -Bolts
9.
ipe; S _iz-e--7Gnchors
10. es - nchors-Regulator-Service Test
11c
rrc; nderground
'
12-Rlemrms&-Ducts;
13
Clearance -Material -Support -Ins.
- - Bolts -Joists -Vents -Cripples
Card1jfj#V
Date ' Card -BI Date
Card -B
Date Card -BI Date
'
Card -BI
Date Card -BI Date
Card-B!g
Date 7 Card -BI Date
Date
FINAL (Plans) OK except N's
Card -BI Date I Card -BI Date
Date
PLUMBING (Permit) OK except p's
14. Water HL; Vent -Access -Combustion Air
56.
Ext. Steps -Door & Sidelight Protection -Landings
57.
58.
Smoke Detector
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15.
16.
Water Pipe; Test & Anchors -Nail Protection
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
.
19.
Gas Pipe; Size & Anchors
62.
63.
64.
Stairs & Rails
Fireplace or Stove; Clearances -Hearth
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles at Kit. Counter
.
Date
ELECTRICAL Permit OK except p's
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture &Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
l 21. Elec. Receptacles Spacing -Lights & Switches at Doors
22.
Size Boxes & No. of Conductors -Stapled
70.
Plb., Elec. & Mech. Equip. Listed for Location
-
23.
Romex Installed Close to Edge of Studs & C.J.
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Insulation -Foam -Looked in Attic E] Yes
25.
2 Appliance Circuits in Kitchen &Conductor Size
73.
Guard Rails & Deck Construction -Post Caps
_
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral []Yes (:1 No
75.
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
28.
Service -Riser Conductors & Ground -Main Disconnect
76.
Stucco; Brown -Finish
29.
Equip. Clearances; Panels-Motors-Mech. Equip.
77.
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
30.
Clothes Closet Light -Shower Light
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
Water Well; Disconnect, Electrical, Plumbing
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B-1
Date Card -BI Date
81.
Ventilation throughout House
£ Card B-1
Date Card -BI Date
82.
Glass Protection
- Date
MECHANICAL (Perrnit) OK except N's
31. A.C. Ducts; Insulation & Support
83.
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/O to Grade -HD Approval
_-
32.
Vent Fan; Exhaust above Insulation
86.
Energy Compliance Certificate -Other Certificates
_
33.
Condensate Drain & Overflow; Size & Grade
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI
_
Date _ Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FRA
NG(Plans) OK except N's
Comments at Final:
S' s; Proper Material & Anchors
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
_
--
in a s over Girders & Floor Nailing
---- proof)
49. --Fir
-f=aREtJ'C'e,Tings-Stairs-Chases-Tub
42r
eader &_B_eam-Size & Bearing
nc o�nnectors
otst -M ti, rae runrn-Root-Bt'3c.-Truss-ShI . -q
p ace ie e -Fireplace Throat
455-.
ccess: Size & Romex Protection -Draft Stop -Ins. Baffles
_
4
n ows or Exiting Doors -Sill Hgt. & Dimensions
ro ecuon rammg
(NOTE: An entry must be made each time youvisit jobsite)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT .
r - 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND. PERMIT r fl
ASSESSOR PARCEL NUMBER
3 a —/?p,—o7
ZON G
--Z
BUILDING PERMIT
OWNS
4-414
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
0
OWNER'S MAILING DRESS
L01 NVE!
CON RACTOR'S NAME
' her
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ ,VrO
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
Water piping
LOT NO.SUBDIVISION
b
NAME
$G
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRU URE
SF ❑ Duplex❑ Mobilehome❑ Other f
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New Ka' Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP OROR LESS5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST.( DWELLING OCCUP.(!11
OR ADDNS. ACC. BLDGS. I
2Q sq ft
CONTRACTORS LICENSE LAW
I declare under penaltyof perjury
p f y (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. Classification
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 CONSTR I -OUTLET 2.50 ea
NOW BRANCH PIRA IS
CONREST
NEW RESID. (POWER APPARATUS D�
NON -R ESI D. SINGLE OUTLET CIR.
Ex. Occup OUTLETS OR FIXTURES a 10C kt
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
FiIirig Fee 10.00
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.
PQ1 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
Ventilation
permit Fee
$
Contractor
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 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 wa accrue
against s id Count in conse5pence of the granting of this perTA.
X DateG f
Signotur. of Applicant 0 er [� Contractor ❑ Agen.
An OSHA permit is required for exca'v'ations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
TOTAL PERMIT FEE $
occ P GROUP
I TYPE OF CONST.
F
PARCEL
PD
NO ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECT OF PUBLIC
PE EXPIRES Date_
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date G [ �^y�
�•-Z7�0
Receipt No.Jso3 23 —2 --BY
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, OroviIle — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext' 57
CORRECTION NOTICE
s- Ll E),n Ave
BUILDING OR PROP -ERI ADDRESS
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
matter, or need additional explanation, 'please contact this office immediately.
n
Inspector ' �'Ar��`� ' 1 . �:r Date �'