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Home My WebLink About031-253-005;�_... _ _ .�•_. � _� ...._ , ..� .. �. � w .. _ � :.ash y 31-253-05 +` W. G. BLACKSTEN 5 1681 10th St., Orovillei Permit #$4835-75P(install ewer C_line/SF) : -2535�Ho1 �r�cn IAO— lme Elec., Oroville �---_� c Permit #2687-81E(replace 60-amp,_ serv.w/100amp serv. & dryer feed/SFS 31-253-5 PIriaQ - Permit#2996-84B(reroof/SF) ' a 1 1 A � V V �a 7��TI-777- j=rPermit#2996-84B W.G. Blacksten 1681 10th St, Oro C -T COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER - - ; ZONING BUILDING PERMIT OWNER 1- TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS ' CONTR ACTOR'S NAME TELEPHONE ' CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER i C') UNKNOWN Total Valuation $ Filing Fee S 10.00 LENDER'S MAILING ADDRESS Permit Fee S , ARCHITECT OR ENGINEER 1 LICENSE NO. Plan Checking Fee .S Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ) BUILDING ADDREISS �1 ,- / t PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 I Water piping 5.00 LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑i Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home JSJGJWJ 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lilies ❑ Installation ❑ Other,0 Describe work: `t I< Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1 S 00 AMP OR LESS 10.00 4 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. (( DWELLING OCCUP.& OR ADDNS. l ACC. BLDGS. t 2/20Sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Bus ness and Professions Code and m 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 ULTI.OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS NEW CONST R. ( POWER APPARATUS &) NON -RESID. SINGLE OUTLET CIR. Ex. OCCu Ts OR FIXTURES 20e8oC P�oX 5ALe30 FIXEEDD APP LNS, OR Ex. OCCUp. OUTLETS (RESID,) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing 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. ❑ 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. 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 way accrue against said County in consequence of the granting of this permit. 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 $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST. PARCEL PD I HD I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC - ! / . By ` PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS 1 Date Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT JCOUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATIQN AND PERMIT PE MIT NO.� ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER 1 TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING A DR'S no .� CONTRACTOR'S NAMETELEPHONE Y1 r CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ S" ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ^. BUILDING DDRE s O PLUMBING PERMIT FilingFee 10.00 Each Trap 2.00 Solar Water Heater 20.00 r Water piping 5.00 LOT NO.SUBDI VISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I W 10-00e TYPE OF WORK New [:1 AdditioRemodel .t lities Installation❑ Other Describe work: — i7 L 'e pA lU� t10� Permit Fee $ Contractor ELECTRICAL PERMIT FilingFee 10.00 M600V OR LESS Main service 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2t/2PSgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑ I 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 1 I, as the owner, or my employees with wages as their sole compen- LIV 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 U TI -OUTLET 2,50 ea NO N.RESID BRANCH CIRC ITS NEW CONSTR POWER APPARATUS .&) NON-RESID. SINGLE OUTLET CIR. Ex. Occu z0@80C P�o FIXTURES 8AL®30 FIXED FIXED APP LHS, OR A P Ex. OCCUP. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 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 FilingFee 10.00 Heating Cooling 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 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 way accrue against said County i conseqUnce of a granting of this permit %� ' I Date /? �C Signature of Applicant — OwnerX 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 $ TOTAL PERMIT FEE OCCUP. GROUP I TYPE OF CONST, PARCEL PO ND I ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. 1 CT OF PUBLIC WORKS BY Date PERMIT EXPIRES ate r Receipt No. ^ • 3 WHITE-D.P.W., YELLOW-ASSFSSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT r y PERMIT NO. w P s E M MH UTIL. PERMIT NO. 4835-75P Y PERMIT EXPIRES OWNER W. G. Blacksten ,CONTR. owner LOCATION (A.P. 31-253-05 .j. ,.1681 10th st., Oroville (Thermalito) a x Temp. Power Pole Called PG&E _ Temp. Elec. Serv., Called PG&E _ Temp. Gas Serv. _ Called PG&E _ JOB FINALED COUNTY- OF'BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING . Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer d Garage Fdn. Vents, Fixtures Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structure Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rou h Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh. MECHANICAL Grd. Fault Prot. Scratch ' Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS THERMALITO IRRIGATION DISTRICT 410 GRAND AVENUE iv OROVILLE. CALIFORNIA 95965 TELEPHONE 533-0740 CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT Service Address: t r 4 1 1 n T, 14-- -1- Owner's t Fees: Phone: Application $ Arrearage Preliminary ReviewBy: (. - r. � _ -'. '�'',�.:. Date:, -,,-1,- ► 11 � CtTCSA 26 . Remarks: ` I SC -0 R 1st mo. S.C. Other Total Fees Collected By: Date: Field Review By: Date: Remarks: MONTHLY SERVICE CHARGES WILL COMMENCE AUTOMATICALLY UPON: Q 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 TID Owner's Name: r, . t_; w ., ,�..� ; r_ w 1 Dat 1-" cnJt Address: v cy , �,- •„ A ; .j Acct. No: n �.t �� e 7-7- `- -A.P. Noni1-7_,-1�- A.P. Phone: No. Units: Applicant/Agent: +� Agents Njl • 7 , Proof: Address: Fees: Phone: Application $ Arrearage Preliminary ReviewBy: (. - r. � _ -'. '�'',�.:. Date:, -,,-1,- ► 11 � CtTCSA 26 . Remarks: ` I SC -0 R 1st mo. S.C. Other Total Fees Collected By: Date: Field Review By: Date: Remarks: MONTHLY SERVICE CHARGES WILL COMMENCE AUTOMATICALLY UPON: Q 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 TID l Owner 6u , 0 aL Mailing Address /C, P/ COUNTY OF BUTTE — DEPARTNENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 '�lJ ry Telephone: 534-4541 APPLICATION AND PERMIT (I/� BUILDING SQ. FT. OCC. BUILDING VALUATION D jy, Sy G/20U1 -(ieS` Telephone No. -o7 4• Fireplace Contractor ow tvoA . Total Valuation Mai l i ng Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address1 �, PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. ^,?53^ OS Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F e agi&lion Fire Dept. Fire Zone Use Permit Building sewer 5.00 45 EQA Parking Plans I Parcel Declaration Parcel Ma P 60' R/W p ovements Improvements Lawn sprinkler system 2.00 - B Parcel Approval Plans Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 ewe /Z //✓Cc— Main service incl. 1 meter �LL Additional meters, each . 1.00 Sub -panel 02 or less) (more than 12) — Single Family Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures b 2 Receps., switches & fix outlets 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: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. d i sp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. Classification Misc. wiring I am exempt from the Contractors License Laws of the State of California. Permit Fee $ MECHANICAL No. @ 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 ermit ,is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. 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. 1 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. �G II q x .Vit Date Signature of Perm�iittee or Agent Receipt No. 'UE P? . White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant TOTAL PERMIT FEE $ This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DC,TJn�/,j(R OF PUBLIC WORKS � P� BY �' _ Date ` �7 permit expires Date -?///g . d, COUNTY OF BUTTE —DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 +LiCkATION AND PERMIT ASSESSOR PARCEL NUMBER- 3 S ZONING BUILDING PERMIT OWNER / • /It%tf /�'-r /��r/. �i> f �r / � TELEPHONE �• ;. �.ti_ � SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME _TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN v Fireplace Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS — Permit Fee $ ARCHITECT OR ENGINEERLICENSE 'f /' '" 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 C/u Water piping LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF & Duplex❑ Mobilehome❑ Other ' SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ Addition ❑ �,RemodeI ❑ Utilities ❑ Installation❑ Other [0 Describe work:, ��' l '� t: �+.. s• - Y" ��' 4 r ,r �� t� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 101 O�� Main service 100 AMP ORSLESS 5.00 LG Main service EA. ADD'L 100 AMP 2.50 DWELLING OCCUP.) NEW CONST. ( y OR ADDNS. \ ACC. BLDGS. 22 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): 1❑� 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Profession Code d my license is in full force and effect. License No. Classification `-�}i ❑ 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 CONSTR. MULTI -OUTLET 2,50 ea NON-RESID BRANCH CIRC ITS NEW CONSTR. POWER APPARATUS s\ NON-RESID. (SINGLE OUTLET CIR. I 0* 250 Ex. Occup OUTLETS OR FIXTURES BALP100 FIXED APPLNS. OR Ex. Occup.(0UTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 f 0 1 1 c. r• t r r 7 ��- Permit Fee f $ T�U. ` L' Contractor MECHANICAL PERMIT FiIingFee 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. `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. Heating Cooling Hood 3.00 Ventilation Permit Fee S 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, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs,iand expenses which may in any way accrue agains�aia County in'consetluence of the granting of this permit. ! �7�i �,�� /"''I-_ / X Date Signature of A>pldant — OLer 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 $ TOTAL PERMIT FEE $ ifs', - OccUP. GROUP I TYPE OF CONST. PARCEL PO ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC - I/ By r - _ _ .. PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. 3 L --I',;, % WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT J COUNTY OF BUTTE - f`�'E�'ARTMENT OF PUBLIC WORKS PE IT NO. 7 County Center Drive - Oroville'California 95965 -Telephone 916/534-45 APPLICATION Aha'PEj9MIT 11 ASSESSOR PARCEL NUMBER- ZONING 3l- Z S�_3 BUILDING PERMIT OWNER TELEPHONE 6, -33-02" SO. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS 168 / !— CONTRACTOR'S NAME B L° < TELEPHONE - l CONTRACTOR'S MAILING /°DDRESS 6 oyp?syatripv7V10 Fireplace Total Valuation $ CONSTRUCTION LE DER B UNKNOWN FilingFee $ 10.00 LENDER'S MAILING ADDRESS �- Permit Fee $ ARCHITECT OR ENGINEER K LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS • Permit fee $ BUILDING ADDRes D ?,... �- PLUMBING PERMITFilin F g ee 10.00 Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF 5? Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ Addition ❑ emode1 ❑ Utilities ❑ InstallatioFl❑ Othqr X Describe work: Ldee 0 AArt D X00 atc .S Cir Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10./^0,0 Main service j00 AMP OROR LESS5•�0 �VG, Main service EA. ADD'L 100 AMP 2.50 NEW CONST. (DWELLING OCCUP.y) OR ADDNS. ACC. BLOGS. 20 sq ft CONTRACTORS LICENSE LAW I declare under penaltyperjury of p i y (check One): I am licensed under provisions of Chapt. 9, Div. 3 of the Business 19 and Profession Code d my license is in full for and effect. License No. Classification -/0 ❑ 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 CONSTRMULTI-OUTLET 2,50 ea NON-RESID BRANCH CIRC Ts NEW CONSTR. (POWER APPARATUS SJ NON-RESID. (SINGLE OUTLET CIR. so @ 250 Ex. Occup OUTLETS OR FIXTURES BAL@1 Ex. Occup.�OU IXTLE TS ED P(RESID )R EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 P1.4 S -a o co C4 7.3e., 7. S 1D Permit Fee 1 $ CP Contractor MECHANICAL PERMIT Filing 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. >��shall not employ any person in any manner so as to become subject 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 penult Fee S Contractor I certify that 1 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, indemnify and keep harmless the County of Butte against all liabilities, judgme ts, co is d expenses which may in any way accrue against County i con u e of the granting of this permit. - X Date 17 Signature of A pli t — Own Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep a d demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ occu P. GROUP I TYPE OF CONST. PARCEL PD HD 59UE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF UBLIC •o By PERMIT EXPfRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date '' Receipt No. 3z� WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT