HomeMy WebLinkAbout030-212-03930-212-39
TERRY A. O'CONNELL
882 Harlan Ave., Oroville
Permi #1321-76P(bldg. sew.inst)
030-212-039 02=0744
ALBERSON, KENT
882 HARLAND AVE.; OROVILLE
RE -ROOF
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JOHNSON, Jack 5595B
882 Harlan Ave., Oroville
CONTR: Aluminum Builders, P.O.'Box 845,
(alum. siding) Marysville '
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oll 02-0744
ALBERSON, KENT
882 HARLAND, AVE., OROVILLE
RE-ROOF r
Ct6 //- :-- - r
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 02-41744
ASSESSOR PARCEL NUMBER
030-212-039
ZONING
AR
BUILDING PERMIT
OWNER
KENT ALBERSON
TELEPHONE
534-1725
SO. FT. OCC. BUILDING VALUATION
780.00
OWNERS MAILING ADDRESS
882 HARWD AVE 01MI= 95965
CONTRACTOR'S NAME
0" F3
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 780.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 21.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
882 HA DAVE,OR V $
Energy Plan Checking Fee
$
$
PERMIT FEE
$ 41.00
LOT NO.
SUBDIVISIONS NAME -
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
9
Each Trap
7.0023.00
USEOFSTRUCTURE
SF Q Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat um water heater
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other [;
Describe Work: RERDOF W/CW
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
920.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
I'00VOR LE
Main Service 20.A 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.
License Class LIC. NO.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law fob�-the following reason:
Z; 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
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 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 zooA To ,IIIA
46.00
NEW CONST. DWELLNJG OCCUP.
OR ADDNS. DWT.L
SO
3.50 FT.
IN Z.C.OID, MULTI -OUTLET
1H CIRCUITS
@7.50
PowER APPARATUS
d SINGLE OUTLET CIA.
Ex. Occu OUTLET OR FIXTURES
20 @ 150
SAL .
Ex. Occup. DEDTSR� .D�
T
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
$
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
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.)
–E -'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 r �` / I % i/ —" Date
Signature of Applicant -V%OWner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 41.00
HAZ.
I D. FEES IMP
I FLOOD
I CDF
PARCEL
I PD
I HD
I ISIUE
This permit is hereby issued under
of the Butte County Code and/or
indicated ab for which fees have
By _
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date
Date
Receipt No.
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 02-0744
ASSESSOR PARCEL NUMBER
030-212-039
ZONING
AR
BUILDING PERMIT
OWNER
KENT ALBERSON
TELEPHONE,
534-1725
SO. FT. OCC. BUILDING VALUATION
780.00
13 S
. OWNERS MAILING ADDRESS
882 HARLAND, AVE OROVILLE 95965
CONTRACTOR'S NAME
OWNER
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $ 780.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 21.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
882 HAR AND AVE OROVILLE
Energy Plan Checking Fee $
$
PERMIT FEE S 41.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
USEOFSTRUCTURE
SF EX 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 EX
Describe Work: REROOF W/COMP
Gas piping system 1 - 5 outlets 15.001
Building sewer 15.00
Mobile Home I S I G I W 920.00
PERMIT FEE $
ELECTRICAL PERMIT Fling Fee 20.00
LE
Main Service A 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.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law foythe following reason:
4Er' 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.
❑ I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed If the permit is for work of a valuation
of one hundred dollars ($100) or less.)
'l -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 ose provisions.
4 B
X Date �T Z�
Sigfiaturerof Applicant - wner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP. so
OR ADDNS. ( d ACC. BUDS. 3.5¢FT:
NON.CONST. SI.MULTI.OUTLET
UITS @7.50
APPARATUS
8SIPOWERNGLE OUTLET CIR.
Ex. Occup. °UTLEr OR FrocruRS zo @ 1.00BAL @ .50
FIXEDLNS
Ex. Occup. ..APP
Urrs AEs1o.°EA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
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 $ 41.00
HAZ.
D. FEES IMP
FLOOD
CDF
pgRCEI
pD HD
IS E
X
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated ab a for which fees have been paid.
Date T
rPERVM1EXPIRE�J
4' 0,
I Date
ReceiptNo. UU
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
Y-
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541
I,Rev.12/96) APPLICATION AND PERMIT i►a
A'SES^ORPARC N
EL UMBERV ✓ y - ) ,1 ZONING
V I U BUILDING PERMIT
-OWNERP� OCC. BUILDING VALUATION
OWNER'S MJAIUDIO67
SS
CONTRACTOR'S NAME
n)� h Ll
CONTRACTORS MAILING ADDRESS
CONS TRUCTION LENDER
LENDER'S MAILING ADDRESS
ARCHrTECT OR ENGINEER
ARCHITECT OR ENGINEER'S MAILING ADDRESS
BUILDING ADDRESS r- , /, r\ 1
LOT NO. I SUBONISION'S NAME
S
LICENSE NO.
MAP
USEOFSTRUCTURE
SF j Duplex ❑ Mobilehome ❑ Other
TYPE OF WORK
New ❑ Addition ❑ Rem ❑ Utilities fl I Ilationn 0 er
Describe Work: ` ''
"PE.RAUT FEE PAlb
SRI • •
SHERIFF
OTHER
AA bVW RECE1Wb
s
"REICH n NV&%M ...�4-Z2i
" TO a SVT mw toiM vm
ReceiptNo.
WHITE •O.O.S.•S.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
I9 --TC'i/ice —
1,10.
Fireplace
PERMIT FEE S
Total Valuation Is
Filing Fee' 20.00
—�
Filing Fee
$
20.00
Permit Fee
$
NEW CONST.
OR ADDNS.
Plan Checking Fee
$
NEW CONS-
NON-RESID.
Energy Plan Checking Fee
$
POWER APPARATUS
dSINGLE OUTLET CIR.
I _—
EX. OCCU.50
PERMIT FEE
$
EX. OCCU
PLUMBING PERMIT
I 5.00
Filing Fee 20.00
Each Trap
Mobile Home Facilities
7.001
Solar or heat pump water heater4
23.00
Water piping
15.00
Each gas water heater or vent
1 5.00
Gas piping system 1- 5 outlets
15.00
Building sewer
15.00:
��—
Mobile Home I S G �W I
@20.00!
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 1 20.0_0_
Heating
Cooling
Hood 6.50 I
Ventilation
PERMIT FEE 1 $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ CONST. TYPE TOTAL FEE $
HAZ. I D. FEES I IMP I FLOOD I COF IPARCEL PD 1 HD 165LE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
By Date
PERMIT EXPIRES ON
PERMIT FEE S
ELECTRICAL PERMIT
Filing Fee' 20.00
Main Service
eaov oR ss
200AOR:ESS
—
23.00;
Main Service
200A TO 1000A
I 46.001
NEW CONST.
OR ADDNS.
DWELLING OCCUP.
( 8 C.S.
3.5CF7,SO.
NEW CONS-
NON-RESID.
MULTI -OUTLET
I
1
@7.5DI
POWER APPARATUS
dSINGLE OUTLET CIR.
I _—
EX. OCCU.50
OUTLET OR FDCTURES
20 I'o0
SAL 20
.
EX. OCCU
FIXED APPLNS. OR (
OUTLETS RESID. EA
I 5.00
Temporary Service
1 23.00
Mobile Home Facilities
1 20.00
Misc. Wiring
1 23.00;
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 1 20.0_0_
Heating
Cooling
Hood 6.50 I
Ventilation
PERMIT FEE 1 $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ CONST. TYPE TOTAL FEE $
HAZ. I D. FEES I IMP I FLOOD I COF IPARCEL PD 1 HD 165LE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
By Date
PERMIT EXPIRES ON
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 May
in processing and issuing your building permit. No building permit will be issued until this
verification is received.
1. I personally plan to provide the major labor and materials for construction of the proposed
property improvement: YES NO O
2. I HAVES—HAVE NOT 0 signed an application for a building permit for the proposed WO&
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 w411 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:
SOCIAL S, ECURITY NUMBER:
J
DATE: `� — 2 & 2—_
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
OVER
64
OWNER BUILDER INFOXNIATION
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 parry of record on such
a permit. Building permits are not required to be sighed 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 S300 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 emplover, 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,
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 limited
conditions.
A frequent practice of unlicensed persons professing to be contactors 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 1030 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.
I+N1ge'rC,BVuii1d'Znz
i�
C.B.O.
Inspection
NOTE: This Owner -Builder Information is required by Section 198.14 of ilie California Health and Safety Code-
OVER
oda
OVER
a
Fa RMIT NO,
1321-76P
PERMIT EXPIRES 14 3/22/77
OWNER TERRY A. O' CONMLL
CONTR. owner
LOCATION (A.P. 30-212-39
882 Harlan Ave., Oroville
1
P
i
+' Temp. Power Pole
Called PG&E
' Temp. ec. Serv.
C Ied PG&E
/Tep. Gas Serv.
alled PG&E
FINALED -76
(Date)
r
( i nature)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION, RECORD
BUILDING I BUILDING (Cont'd) PLUMBING
Setback
Firewall
Forms
Parapets
Main Bldg.
Restroom Finish
Footings
Windows .
Stemwal I
Siding
Slab
Roof Sheathing
Piers
Roofing
Garage
Fdn. Vents
Footings
Gara a Vents
Stemwall
Slab
Prov. for physically
handicapped
Carport .
Footings
Conformance of ex.
structure
Slab
Final
Patio
FIREPLACE
Footings
Footing
Masonry Walls
Throat
Reinf. Steel
Final
Bond Beam
FIRE SPRINKLERS
Framing
Test
Stucco
Final
Mesh
MECHANICAL
Scratch
Heating
Brown
Cooling
Finish
Ducts
Interior Lath
Ventilation
Door Closer
Final
DATE
REMARKS OR CORRECTIONS_
Soil Piping
1st Floor
2nd Floor
3rd Floor
Topout
Water Piping
Sewer
Fixtures
Water Htr.
Heaters
Appliances
Gas Piping & Test
Temp. Gas
Sanitation
Final
ELECTRICAL
Rough
Fixtures
Grd. Fault Pri
Service
Temp. Pole
Undergrouni
Permanent
Final
(NOTE: An entry must be made on this form each time you visit the job site.)
THERMALITO IRRIGATION DISTRICT .289
410 GRAND AVENUE +
OROVILLE. CALIFORNIA 95965
TELEPHONE 533-0740
CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT
Service Address: $8a `��o� G' n _jj
Owner's Name:'f-_",,-.�aw
Date: '4,14,A 17t,
Address: yr.I&W
Acct. No: /,;/0
��1�9�
9s- 9G Sr
A.P. No.: -30 - -,?/,�2 '39
Phone:
No. Units:
Applicant/Agent: /
Agents Proof: Aj /,4
Address:
Fees:
Phone:
Application $ '
/ ���/`�G
Arrearage
Preliminary Review By: ��-x-aL�..Cl' Date: .
CSA 26
Remarks:
SC -OR
1st mo. S.C.
Other
Total Fees /t1 nti�
Collected By:
Date:
Field Review By: -rit Date: 3
Remarks:
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 - TID, YELLOW - APPLICANT, PINK - DPW, GOLDENROD - DPW to TIO
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
• 7 County Center Drive — Uroville, California 95965 �y
Telephone: 534-4541 131
APPLICATION AND PERMIT
.+uuwi iVPIV0VIILaLIves UI Ule County of Butte to enter upon the
above-mentioned pr perty for inspection purposes.
X — Date -76
Signature
Signature of Permitee or Agent
Receipt No. /Y r— z
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By � b %�^''° Date 3,-2 L— 7 (�
Bq permit expires Date 3 -- '2—z '-7 %
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
' a 66
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan hecki g'Fee&/or Penalty
Telephone No.
PermiVWe
Building Address Fg
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 pv
`
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. 2 f 7. — 3 9Gas
Zoning & Planning
piping system 1 - 5 outlets 1.50
Each additional outlet .30
F s
W
400,i""n
Fire Dept.
Fire Zone
Use Permit
Building sewer b.00
EQA Parking
Plans
Parcel
Declaration
Parcel Ma P
60' R/W
ImprovementsLawn
sprinkler system 2.00
B d
Parcel Approval
Plans Approval
Permit Fee $ 00
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER EL
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
12 '
Main service 600 AMP OR LESS
OR LESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADG'L 100 AMP 1.00
NEW CONST. DWELLING OCCUP. &
OR ADDNS. ACC. BLDGS. ) 2¢sgft
NEW CONSTR. MULTI -OUTLET
NON•RESID. BRANCH CIRCUITS) 12.50ea
NEW CONSTR. /POWER APPARATUS &
NON.RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Ex. Occup(OUTLETS OR FIXTURES)@2511
BAL M
Ex. Occup. ( OUT ETS ((RESID )REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No.Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
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.1 @ I FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
TOTAL PERMIT FEE
$ QF
.+uuwi iVPIV0VIILaLIves UI Ule County of Butte to enter upon the
above-mentioned pr perty for inspection purposes.
X — Date -76
Signature
Signature of Permitee or Agent
Receipt No. /Y r— z
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By � b %�^''° Date 3,-2 L— 7 (�
Bq permit expires Date 3 -- '2—z '-7 %