HomeMy WebLinkAbout031-253-006C ' ALDRICH 31-253-6 fi� ---
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p 1671 10TH. ST.9 OROVILLE
PERMIT #5555-75P(IN T LDG. SEWER ' !
31-253-6 -
Permit #3 64-78B(reroof)F
31=253 -ti..
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Permit#1872-88E(elec/SF)
031-25-3-006 93-583 BPEM
SMITH, EDWIN
1671 10TH ST, OROVILLye T v
ADDITION/SF �L l
031-25-3-006 93-3362 B,E
SMITH, EDWIN
1671 10TH ST, OROVILLE
GARAGE
031-253-006 00-2577
SMITH, EDWIN F//JAG
1671 TENTH ST., OROVILLE
CONTR: GREENE/SON ROOFING
RE ROOF COMP 16, RE ROOF FLAT 7 i
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anmtt�.q J3utte
OROVILLE, CALIFORNIA
GENERAL CLAIM
Edwin Smith
CLAIMANT:
ADDRESS: 1671 10th St.
CITY & STATE: Oroville. CA 95965 IMPORTANT:
SEE INSTRUCTIONS
DATE OF CLAIM: March 23, 1993 ON REVERSE SIOE
SUBMIT CLAIM TO DEPARTMENT- RECEIVING GOODS OR SERVICES
DATE
DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)
AMOUNT
Owner has decided not to do work. Permit #93-583B,P,E,M,
AP#031-253-006, Receipt #135815, dated 3/9/93.
Total Permit Fees Paid ------------------------------ $514.80
Retain Building Permit Filing Fee --------
a
Retain Plumbing Permit Filing Fee--------- 15.00
Retain Electrical Permit Filing Fee------- 15.00
i
Retain Mechanical Permit Filing Fee------- 15.00
Total Permits Fees Retained------------------------- 60.00
TOTAL REFUND DUE ------------------------------------$454:80
...
I
I
I
TOTAL
I
$454180
I
I, the undersigned, .ieclare under penalty of perjury that—the services or articles claimed have bfppe ormed or deli d_end that this
claim is true and correct as stated.
Dated this �%................ day of �_C�Z 19 �� iCalif.
1...� /::........... .. ...... at......:................ ..... �........... z.�- ...........
Signature of leiment
I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified''abovo!.ha.ve been performed or de-
livered and that there is a Budget Appropriation or Specific Board Approvall� (Check one) for the same.
/�.
Dated this 23rd ............... day of .March 19.93 at Oroville Calif. ...,:::;�:��............................._.....................
Department Head or Authorized Deputy
Dept.
........4..40.-002................. c de ....42105QO........................ PAYABLE FROM ..... r_QASt..... F.e.rMj.t,5.............................................. FUND
DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY
DEPT. & SUB. PROJ.
SUB. OBJ.
CLAIM NO.
INV. NO.
INV. DATE
ENCUMB.
GROSS AMT.
AN
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
' 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLIC&TIOW AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER •"
031-253-006 y
ZONING
AR
BUILDING PERMIT
OWNER
Mr. Edwin H. Smith
TELEPHONE
533-8304
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
1671 10th St., Oroville 95965
494 R 26,676.00
CONTRACTOR'S NAME
nwnpr
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation 1 $ 26,676.00
LENDER'S MAILING ADDRESS
Filing Fee $ 15,00
Permit Fee $ 223.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $111.50
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee $ 20.00
Penalty $
BUILDING ADDRESS
Permit fee $369.50
1671 loth St ornyillp
PLUMBING PERMIT Filing Fee 15.00
Each Trap 31 5.00 15.00
I
Solar or heat pump water heater 20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping 1 7.00 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF] Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 1 15.00 15.00
Mobile Home S I G I W @ 15.00
TYPE OF WORK
New ❑ Addition ® Remodel ❑ Utilities ❑ Installation[] Other ❑
Describe work: Remove Existing Wall and Add Bedroom,
Bath with Game Room
Permit Fee $ 52.00
Contractor
ELECTRICAL PERMIT FiIingFee 15.00
Main service 200AORLESS 18.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury
p y p i y (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, 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
Main service 200A TO IOOOAI 37.50
NEW CONST. / DWELLING OCCUP. N� V 3.64 sq.ft. 17.30
OR ADDNS. \ ACC. BLDGS. / A
NEW CONSTF MULTI -OUTLET
NON.R ES ID, BRANCH CIRCUITS) @ 5.00
(POWER APPARATUS e)
(SINGLE OUTLET CIR.
Ex, Occup(OUTLETS OR FIXTURES 20 @ 76
FIXED APPLNS. OR
Ex. DCCUp. OUTLETS (RESID.) EA.) 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring -15.00
Permit Fee
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
F-1 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.
Contractor
MECHANICAL PERMIT Filing Fee 1 15.00
Heating Duct. 116. 00 1 677-
Cooling
Hood 6.50
Ventilation
$ --
Penult 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
agains Id ounty in on"quence of the granting of this permit.
X �j�, Date
Slgnature of Applicant - Owner�7 Contractor E]Agent ❑
An OSHA permit is required for exc'av`ations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $ 40.00
occ
CONST TYPE
I TOTAL FEE $ 514.80
HAz
1 0FEES I
IMP
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I FLOOD
I COF
PARCEL
,
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ISSUE
This permit is hereby issued under the applicable provi-
n
sios of the Butte County Code and/or resolutions to do
Work indicated above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
Receipt No. 135815
WHIT!-D.P.W., YELLOW-A98C990R, PINK -INSPECTOR, GOLDENROD -APPLICANT
r'.-.:"`"`-`.'ti'`=�i'r.-�•'^.'�:'�t5.-.-.�.-.r.:..-.a-'^'^",-r''.--..+-.r�7r-+*""`�r-�lr°`.�-!)<''�rh�`t�`�.L,,.'i✓l'.`�,~�V��'T '�+......C�`""`ri.l^�'�T `l:•"Y"•.'r-7�-.. ... _.
COUNTY OF BUTTE - DEPARTMENT OF DEi/ELOPMENT SERVICES - BUILDING DIVISION
» 7COUNTY CENTER DRIVE -OROSylitE CALIFORNIA95965-TELEPHONE(916)538-7541
t
PERMIT APPLICATION DATA SHEET
OWNER'207 Z /1-1 A. P3 oiS� d ,U
Proposed Building Use Building Inspector Date 3
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED BY
1. All items have been submitted. ........
2. Plot plans, 3/4 sets, signed by preparer of plans. .
3_ Complete plans, 3/4 sets, signed by preparer of plans . ..................... .
A. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............ .
5. Hazardous Material Form . ..............................................
6. Energy Design Compliance and supporting documentation . ..................
Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan, check). ....
9. Mobilehome data and manufacturer's installation instructions, 2 sets.
10. Fees of $.........................................
11. Impact fees as shown on attached schedule . ..............................
12. California Department of Forestry plan approval/fees. ....................... .
13. Flood elevation letter (100 year flood) by California Engineer . ................. .
14. Sanitation and plot plan approval Health Department . ............
15. City of Chico plumbing permit . .........................................
16. Plot plan and business license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking:
18. Contact Land Development about (A) Improvements (B) Drainage. ......... .
19. Driveway permit (construction approval required prior to occupancy) . ............
req St
20. Pre -inspection for required. . . to Building Inspector (Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ......................... .
23. Owner -Builder Verification (Given to owner , Mail to owner _ ) ............
✓'24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . ........................................
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
27. Letter of intent on building use . .........................................
28. Mobilehome utility clearance . .........................................
29. Documentation of legal access . .....................
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements . ...............
31. Existing violations/expired permits . ......................................
32. Plan check list . .....................................................
33.
.34.
When you issue theermit proces as follows: Mail to owe�rr er. Mail to contractor.
Telephone -,533 30 nd hold for pickup at (2(J office. Deliver with inspector.
Other
Parcel Creation 4�k���_�ate Acreage Applicant
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone -mail Counter by _ Date
Plans checked by Date Plans approved by Date
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
V=OK °
O = Not OK
Not =
Not Ready MOBILE
MOBILE HOMES
Date/Initials MOBILE HOME UTILITIES (Plans) OK except #'a
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Teat -Fall -C/O Concrete
4. Water; Location -Teat -Easement Needed (Sketch)
5.' Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Teat -Wrap: / /" L" ft.
/ /"Nat. or/ PVft./ /"LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date/Initials MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks Easements
2 Footings; Size -Spacing -Marriage Line
3.. Gas; MH Test-Demand-Valve—Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fell -Flex Connector
6. Water; MH Test -Regulator -Connector
7. Water, and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
MISCELLANEOUS
Date/I itial DE 8 COVERS CARPORTS GARAGES Plans OK except #'a
3tef Zqdlng Requirements -Setbacks -Easements
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Griders and/or Joista-Decking-Bracing-Stairs-Rails
4:' Wood Awn.; Posts-Beams-Rftrs -Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columna-Connections-Spllce-Decal-Enclosures
6. C_Jmp rts; Windows -Doors
A--T.'Electric `
Frm ; Sils-Anchors-Studs-Rftrs-Trusses
Siding; Nailing -Veneer -Stucco -Mesh
L_10r-Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
i
T
Date/Initials POOLS (Plana) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures-Panelboards-Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
V=OK
O = Not OK
- = Not Applicable
= Not Ready
RESIDENTIAL (Single & Duplex)
Date/Initials UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Grnd.-/ P' Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -teat
11. Water Pipe; Test -Anchor -Regulator -Service Test
12. Electric; Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Access & Ventilation
16. Insulation
Date/Initials PLUMBING (Permit) OK except #'a
16. Water Htr.; Vent -Access -Combustion Air -Baffle
17. Water Pipe; Test & Anchor -Nail Protection
18. D.W.V.; Test -Fittings & Anchor -Nail Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower, Second Floor -Tub Access
21. Gas Pipe; Size & Anchors
Date/initials ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Elec. Receptacles Spacing -Lights & Switches at Doors
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Meth. Fastners-Bond Gas & Water
27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga.
Cu or Al
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral ❑ Yes ❑ No
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panels -Motors -Meth. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
33. Smoke Detector
Date/Initials MECHANICAL (Permit) OK except #'s
34. A.C. Ducts Insulation & Support
35. Vent Fan; Exhaust above insulation
36. Condensate Drain & Overflow; Size & Grade
37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet
38. Attic Access & Platform if Furnance in Attic
Date/Initials FRAMING (Plans) OK except #'a
39. Sils, Proper Material & Anchors
40. Wells Studs -Nailing, Spacing & Bracing -Plates -Sound
41. Bearing Wells over Girders & Floor Nailing
42. Draft Stop in Walls (rat proof)
43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
44. Headers & Beam -Size & Bearing
Date/Initials FRAMING (Continued)
45. Hangers -Post Caps -Anchors -Connectors
46. Ong. Joist-Rftr. ties-Purlin-roof Bmc-Truss-Shthng.-Ring.
47. Fireplace Ties or Type A Flue -Fireplace Throat clearance
48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
50. Garage Fire Protection Framing
51. Property Line Firewall & Openings
52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits
53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers
55. Siding -Nailing Veneer
56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
57. Glazing Area -Glass Protection -Skylights -Plastic
58. Shear Walls; Nailing -Bolts
59. Insulation -Walls -Ceilings
60. Infiltration -Walls -Windows
Date/Initials FINAL (Plans) OK except #'a
61. Ext. Steps -Door & Sidelight Protection -Landings
62. Smoke Detector
63. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
64. Bedroom Exiting
65. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes & Labels
67. Stairs & Rails
68. Fireplace or Stove; Clearances -Hearth
69. Elec. Outlets at Wood Panel; Int. & Ext.
70. Kit.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
71. Elec. Outlets & Receptacles at Kit. Counter
72. Garage Fire Door, Swing -Landing -Closer
73. A.C. Duct in Garage -Damper
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage; Above Floor -Mach. Protection
75. Plb., Elec. & Mach. Equip. Listed for Location
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection
77. Insulation -Foam -Looked in Attic ❑ Yes
78. Guard Rails & Deck Construction -Post Caps
79. Fdn. Vents & Crawl Hole Door-Draina e & Wood -Earth
Clearance Looked under Floor Yes
80. Following instid.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑ Yes ❑ No
81. Stucco; Brown -Finish
82. A.C. Unit; Disconnect, Electrical, Plumbing
83. Vents Above Roof; Plbg.-Appliance-Fireplace -Clearance to
Openings
84. Water Well; Disconnect, Electrical, Plumbing
85. Exterior Elec. Trim; G.F.I. Receptacle -Underground
86. Ventilation Throughout House
87. Glass Protection
88. Corrections from Previous Inspections
89. Gas Test -Meters Tagged; Gas -Electric
90. Water & Sewer Connected -C/O to Grade -HD Approval
91. Energy Compliance Certificate -Other Certificates
Commanta at Flnal:
COUNTY/OF BUTTE - DEPARTMENT OF DENELOPMENT SERVICES - BUILDING DIVISION 1
7/County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541
APPLICAPERMIT N0.
TION AND PERMIT
R3-33�Z
ASSESSOR PARCEL NUMBER
031-253-006
ZONING
AR
BUILDING PERMIT
OWNER
EDWIN SMITH
TELEPHONE
—8304
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
1671 10TH ST OROVILLE 95965
364 6 552
CONTRACTOR'S NAME
OWNER
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee $ 20,00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
1671 10TH ST OROVILLE
PERMIT FEE $ 168. 5
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
Solar or heat pump water heater 23.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Water piping 15,00
Each gas water heater or vent 15.00
USE OF STRUCTURE
SFX❑ Duplex ❑ Mobilehome O Other
SPECIFY
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G I W @20.00
TYPE OF WORK
New ElAddition 4 Remodel ❑ Utilities ❑ Installation ❑ Other ElContractor
Describe Work: GARAGE
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
Main Service ( 101 OR LESS ) 23.00
200A OR LESS
Main Service ( 200A TO 1000A ) 46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( & ACC. BLDS. ) 3.50 FT.BO-
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. Classification
�1, as the owner, 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)
❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
❑ I am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
.NON-RESID. ( BRANCH CIRCUITS ) @7.50
( POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES ) BAL @ 1.`050
Ex. Occu FIXED APPLNS.0
p ( OUTLETS IRESID.1 0E
EA. ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
WORKER'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ This permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Dept. of Development Services,
Building Division 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 Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE S 32.75
Contractor
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
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 Butte County Ordinances and California 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, and expenses which may in any way accrue against said
Count co sequence of granting o this permit.
X_ % Date��
Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee
occ
cos • T
TOTAL F $ 201.25
HV
D. FEES
I IMP
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CDF
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PARCEL PO
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HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Butte P-91ty Code and/or Resolutions to do work
indicated qbr6vefQr which fee he a been paid.
IR CTO OF U IC WORKS
By ,
PERMIT EXPIRES ON
(betel
Receipt No. 153201--98.50 ,55 '"-/Q :
WHITE-D.D.S.-B.O. CAN,? CAS SOR PINK -INSPECTOR GOLDENROD -APPLICANT
0
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COUNTY OF BUTTE -DEPARTMENT OF DE�/ELOPMENTSERVICES -BUILDING DIVISION
OUNTYCENTER DRIVE - OROVILL'E, CALIFORNIA95965 -TELEPHONE (916) 538-7541
PERMIT APPLICATION DATASHEET
OWNER `I r� �' " t 1� A. P. No. 03 / - 07,S3 - 00 G
Proposed Building Use d:ftr,,�6E A QD\'ti0 Building Inspector Date d /
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECENED BY
1. All items have been submitted . ....................................... .
2. Plot plans, 3/4 sets, signed by preparer of plans . ..........................
3. Complete plans, 3/4 sets, signed by preparer of plans . ......................
.4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . .............
5. Hazardous Material Form . ............................................
6. Energy Design Compliance and supporting documentation . ..................
7. Statement of Intent for Non -Heated and A/C Buildings . ......................
8. Engineered truss details and layout in duplicate (required prior to plan check). ....
9. Mobilehome data and manufacturer's installation instructions, 2 sets. .
10. Fees of $ f0 Q,, i S ......................................... ,eo
11. Impact fees as shown on attached schedule. ............................. .
12. California Department of Forestry plan approval/fees. ....................... .
13. Flood elevation letter (100 year flood).by California Engineer. .. ............ .
IVA 14. Sanitation and plot plan approval 1'1Health Department . ............
15. City of Chico plumbing permit . ...................................... .
16. Plot plan and business license approval from City of Biggs/Gridley. .............
17. Planning approval for (A) Use: (B) Parking: . .........
18. Contact Land Development about (A) Improvements (B) Drainage. .......... .
19. Driveway permit (construction approval required prior to occupancy). . .
20. Pre -inspection for required. .. os4u 9 ospect;
(Date)
21. Contractor's license information. (No., Name Style, Classification) . ..............
22. Certificate of Workmans Compensation Insurance . ..........................
23. Owner -Builder Verification (Given to owner , Mail to owner . ...........
24. Recorded copy of Agricultural Acknowledgement Statement . ..................
25. Letter of signature authorization . ........................................
26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... .
27. Letter of intent on building use . ........................:................ .
28. Mobilehome utility clearance . .......................... .............. .
29. Documentation of legal access . .....................:.. ' ..............
30. Documentation of 50% subdivision developed or (A) Road improvements completed
and (B) Parcel meets zoning area and frontage requirements. ..............
31. Existing violations/expired permits . ......................... `\........ .
32. Plan check list . ...................................... ............
33.
34.
When youissue the permit, process as follows: Mail to owner. Mail to contractor.
- -(Telephone 533- 01-/ and hold for pickup at office. `R Deliver with inspector.
Other k
Parcel Creation
Acreage Applican Date
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
The following data must be submitted prior to permit issuance: (Circle new it ecked above).
1. Index permit'for above items.=No.
2. Additional items required -
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date
Plans checked by Date Plans approved by., 11 � �� Date -,Z,2-
Sets of plans on hold in File cabinet AP folder
Copy - Department of Public Works
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
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.
I personally plan to provide the major labor and materials for construction of
the proposed property imp ovement 'h- ,� (yes or no)
2. I (have/ ) signed an application for a building permit
�for thero osed work.
P P
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name'
Address. City
Phone Contractors 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 Contractors License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name. Address . Phone Type of Work
Signed:
Prope
Socia
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be*completed and returned to our office before we are per-
mitted to issue the permit.
IN
yPERAIT NO. 3064-78B
PERMIT EXPIRES _ 6/2/79
OWNER C T AT. R TCH
1%
E.coNTR. owner
LOCATION (A.P. 31-253-6
1671.10t1j. St., Oroville
l
Temp. Power Pole _
Called PG&E
/TempElec. Serv.
ed PG&E
Gas Serv.
ed PG&E
JOB
FINALED
t
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION' gCORD ,
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
Garage
Fdn. Vents
Fixtures
Footings
r Stemwall
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
p
Footings
Prov. for phsically
handica ed
Conformance of ex.
structure
Appliances
Gas Piping &Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footina
ELECTRICAL
Masonry Walls
Throat
Rough
Relnf. 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
MOBILEHOME UTILITIES ------------------
Elec_ Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
MOBILEHOME INSTALLATION .............. Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE
REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephonee-534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
0
X1 Date
ignature of Permitee or Agents
Rece pt No. T7? 4 0 p
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.
RE OF PUBLIC WORKS
Q
BYD1J_31?__
12v—Date
a11ille0di"-permit expire Date 4V Z'
BUILDING
OwnerC, Q t+
SQ FT. OCC. BUILDING VALUATION
Mailing Address o l� ,
Ov � LLQ G. tR I
Telephone No.
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee ; QO
Building Address /U - —
Plan Checking Fee&/or Penalty
Permit Fee , O C)
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
��lft)iL-�-LC
Repair drainage or vent piping 1.50
A. P. No. —��
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
qees
1keSmTiFire
Dept.
Fire Zone
Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet .30.
Building sewer 5.00
g.
Parcel A roval
Plans ApproLal
Lawn sprinkler system 2.00
NEW ❑ ADDITION UTILITIES ❑ OTHER jo
Permit Fee $
$
ELECTRICAL NO. @ FEE
'4F
PERMIT FILING FEE $3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Single Family 119Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
Main service OVER 25.00
100 AMPP OR LESS O
Main service EA. ADD'L 100 AMP 1.00
NEW CONST OR ADDNS. ( ACCLBLDGS.LING CCUP. h\ :20 sq ft
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.
NEW CONSTR BRANCH CIRCUITS) NO N.RONS (-BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS a
NON-RESID. SINGLE OUTLET CIR.
Ex. Occup {OUTLETS OR FIXTIIRES 50@25,t
BAL@1
Occup. ( OUT ETS P(RESID )KEA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
KII 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.
have placed on file with the County of Butte a certificate of
F-1 '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. FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
0
X1 Date
ignature of Permitee or Agents
Rece pt No. T7? 4 0 p
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.
RE OF PUBLIC WORKS
Q
BYD1J_31?__
12v—Date
a11ille0di"-permit expire Date 4V Z'
031-253-006 00-2577
SMITH, EDWIN
1671 TENTH ST., ORO VELLE
CONTR: GREENE/SON ROOFING
RE ROOF COW 16, RE ROOF FLAT
1
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 j;l - 16'
ASSESSOR PARCEL NUMBER
/-
031-253-00-5
ZONING
1
BUILDING PERMIT
OWNE
OWNER
^-T r
TELEPHONE
•'��1� I
SQ. Fr, OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
�+ s•
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
•
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 31.C3
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGPDD s ,.,..,...,....
f� !.::..'d'►i �d O.,ati'�lJ.ls
Ener Plan Checking Fee
9Y 9
$
$
PERMIT FEE
$ SIX3
LAT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF ,f] Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
-
Solar or heat um 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 7
Describe Work: 13, `77CO : •' 7
Gas piping system 1- 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
920.00
PERMIT FEE
$
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service zo.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.
�r C� I
License Class -- f Lic. No. . /� _�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for 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 200AWEE To ,000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( a ACC. BLDS.
SO
3.50FT.
T.
LNpµq�lp, MULTI-OUTBRANCH LET
97,50
POWER APPARATUS
6 SINGLE OUTLET CIR.
OCCU CUTLET OR FD(TURES
�L ®';�
Ex. Occup. GLmEE°s R6�SIO.OEA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring23.00
PERMIT FEE
$
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 insuranc carrier and policy number are:
Carrier fi% s�tf 29 _
C, �-- ,/may%
Policy Number <,:�/�1�7 :lam— �7 di'
(The above sections neet3 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' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
�y� 4
X - , . �;- !-V " Date C> _
f ,
Sig_natufe of Applicant - ❑ Owner -Contractor ❑ Agent
An OSHA permit is required for excav tions over 5'0" 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 FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE �� •C�
TOTAL FEE $
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
I PD
I HD SSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
/ ff4
IV- 4!
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
92 �)C
ate
Receipt No. --. �J/''� '+t'�
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
CaUNTY 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 ad -0?577
ASSESSOR PARCEL NUMBER
031-253-006
ZONING
BUILDING PERMIT
OWNER
EDWIN SMITH
TELEPHONE
522-8204—
SO. FT. OCC. BUILDING
VALUATION
16 96000
. OWNERS MAILING ADDRESS
CONTRACTOR'S NAME
GREENRISON ROOFING
TELEPHONE
873-3940
CONTRACTORS MAILING ADDRESS
PQ B, 9467 P-A-R.A.DISE 95967
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $ 1205.00
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee $
20.00
Permit Fee $
31.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDINGAjD 7 f TENTH ST, OROVILLE
Energy Plan Checking Fee $
$
PERMIT FEE $
51.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF P Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 1
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
Describe Work: REROOF COME 16, RFROOF FLAT 7
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT
Fling Fee 20.00
800VOR LE
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 inII force and effect.
�
License Class C-9 Lic. No. —2 �%�(�i%
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors license
Law for 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:
❑ I 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' com ensation insuranc carrier/and policy number are:
Carrier /3 p 16641<1
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUR
OR ADONS. ( a ACC. BUDS.
SO
3.5QFT.
ppµpE°S,p Y.MULTI.OUTLET
@7,50
POWER APPARATUS
8 SINGLE OUTLET CIR.
EX. Occup. OUTLET OR FD(TURES
j
20.00
aAL O I.w
Ex. Occup. oFunFTs Ro .OERA 1
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00
PERMIT FEE $
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Policy Number _ZZ6e — Al 2_ ,3 C) — & A9
(The above sections need not be completed 4 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' compensation provisions of section 3700 of the Labor Code, I shall
forthwith compjy with those provisions.
�i
XLH= Date 1® ,e 'L� _
Signatu e -of-Applicant - ❑ Owner�ontractor ❑ Agent
An OSHA permit is required for excav tions over 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 $ 51.00
HAZ.
D. FEES I IMP
I FLOOD
I CDF
PARCEL
I PD
I HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
n paid. .
indicated above for fe::t
PERMIT EXPIRES ON a�� 3 —
efe
Receipt No. 308836/$51.00
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 " ''
ASSESSOR PARCEL Nuleal
1
:AMNO
BUILDING PERMIT
TEIgAIONjCj
Sa. FT. OCC. BUILDING VALUATION
Ll
CONT RS
TELEPNON!
CO S ADDRESS
7-119, a1
COPOTRUCTION 1E1OER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation E 1 r4
ARpIRECTOft ENaNE�.
UCE16E"°.
—Filina Fee S
20.00
Permit Fee $
ARCKTECT OREINGINEER9 I,N{JNO ADDRESS
Checking Fee $
�-yPlan
w
BuLAoADDRESs / s ,
Energy Plan Checking Fee E
��
//
L/7r
$
PERMIT FEE _
IAT NO.
SUBONISIONS NAW
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF1,0' Duplex O Mobilehome ❑ Other
sP� FV
Each Trn
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 O Addition ❑ Remodel ❑ Utilities ❑ /Installation ❑
Describe Work: ydYJ/- G���rt ►LlD�7
Other O
�" %G
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
Q20.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
Main Service 00.00 oa ft:s
23.00
!9
*PERMIT FEE PAID $
SRA _ $
SHERIFF $
OTHER $
$
$
0�
AMOUNT RECEIVED $
2\
*RECEIPT NUMBER
* TO BE PUT INTO COMPUTER
Main Service 20" TO IOWA
46.00
NEW CONST. OVYE11110 OCCUP. 3.5Qso.
OR ADDNS. ♦ ACC. BLDS.
ONS T. MULTEOUTLEr
NO"ESIO. @7.50
POWER MPARATUS
SPIOLE OUTLET CIR
EX. OCCU . OUT ET OR PD(TURES DAL 0 I.50
Ex. Occup. unETs Pio�Ew 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE _
MECHANICAL PERMIT Fling Fee 1 20.00
Heating
Cooling
Hood 8.50
Ventilation
PERMIT FEt it
Mobile Home Installation Fee $
Energy Inspection Fee E
°`c
CONST. r`PE TOTAL FEE _
RAZ.
D. PEES N,P
I R°°°
I COF
PARCEL
I PO
ND
ISSUE
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
ra
PERMIT NO.K_7KP
P
.r
E
M -
H
MH UTIL.
PERMIT NO.
PERMIT EXPIRES 10/28/76
OWNER C.J. ALDRICH
CONTR. OWNER
'LOCATION (A.P: 11-253-6o
)
1671 10TH. -ST., OROVILLE
Temp. Power Pole
Called PG&E _
Temp. Elec. Serv..
Called PG&E _
Temp. Gas Serv. _
Called PG&E _
JOB
FINALE
Stucco
COUNTY OF BUTTE — DEPARTMENT OF`PUBLIC WORKS
BUILDING INSPECTION RECORD
Subpanels
BUILDING BUILDING (Cont'd)
PLUMBING
Setback
Firewall '
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Sidinq
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwall
Slab
Prov. for physically
handicapped
Heaters
Appliances,
Carport
Footings
Conformance of ex.
structure
Gas Piping & Test
(Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
•Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
DATE REMARKS OR CORRECTIONS
••�� A 6 5 Ad 7 w. D. GJ
THERMALITO IRRIGATION DISTRICT
410 GRAND AVENUE
OROVILLE, CALIFORNIA 95965
TELEPHONE 533-0740
CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT
Service Address: 1•r-7 1 1 QTI) Sf
Owner's Name: Q - NY, .A LD R 1 r -A Date: UG1 25 117
Address: i G-71 > TSI Sir Acct. No:
lyL L.0 - I., A rA. P. No.: I ZA,e-
Phone: ev HZ No. Units:
Applicant/Agent: Agents Proof:
Address:
Fees:
1
Phone: Application $ /
Arrearage
}
Preliminary Review By: +,innA.f � Date: Jkrl?-g 11 CSA 26
Remarks: SC -0 R
1st mo. S.C.
Other
Total Fees
Collected By:
Date:
Field Review By: Date:
Remarks:
ZZ 6tj
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 TID
Owner ' W r
Mailing Address `/_ `
Contractor
Mailing Address
Building Address
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
0
BUILDING
r _ SQ. FT. I OCC. I BUILDING VALUATION
ephone No.;
eiephone
A. P. No. �- d �— r�Q V Zoning & Planning
FOS' Saff"aii" Fire Dept. Fire Zone Use Permit
EOA Parking I Parcel parcel Ma 60' R/W Im rovement
Plans Declaration P p
°_�'a Parcel Approval Plans Approval
NEW r-1ADDITION❑ UTILITIES ❑ OTHER
Single Family Duplex ❑ Mobil Home ❑ Others ❑
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:
License No. Classification
Fireplace
Total Valuation
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping '
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
s
Permit Fee
ELECTRICAL
PERMIT FILING FEE
Main service incl. 1 meter
Additional meters, each
Sub -panel (12 or less) (more than 12)
Range, Cook -top or Oven
Water Heater or Space Heater
Light fixtures
Receps.., switches & fix outlets
Hood, Ex. Fan or F.A. Furn. Motor
Evap. cooler, gar. disp. or D.W.
Air conditioner or heat pump
Water pump
Mobil Home Facilities
Temp. Power Pole
Misc. wiring
I am exempt from the Contractors License Laws of the State of California. Permit Fee
MECHANICAL
WORKMEN'S COMPENSATION INSURANCE PERMIT FILING FEE
I am aware of the provisions of Section3700 of the California Labor Heating
A h' h 1 b d I' ' I'
Co e w is requires every emp oyer to a insure against iabi 1 L
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
ISI I certify that in the performance of the work for which this
IOCI'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.
Cooling
Ventilation
Hood
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
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date/0 —;2-8 1�
ign Lure of Permittee or Agent
Receipt ' 3 /%,3 a
White-D.P.W. — Yellow -Assessor -Pink -Inspector — Goldenrod -Applicant
@ FEE
$3.0o . OCJ
1.50
1.50
1.50
1.50
1.50
.30
5.00 -,SOC)
2.00
$ le, — .$ U
@ FEE
$3.00
1.00
1.00
1.00
1.00 .
1.00
5.00
5.00
$ $
@ FEE
$3.00
2.00
$ --Fs-
TOTAL
TOTAL PERMIT FEE r 1$ IF 10
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.
CTOR OF PUBLIC WORKS c
ByDate S
- permit expires Date —.49,6x A7
Permit#1872-88
l�]
l y q, COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION ASID PERMIT
ASSESSOR PARCEL NUMBER
-- 1_� 3 ..61
ZONING
1
BUILDING PERMIT
OWNER
,56cl r,+
TELEPHONE
115 3 :3` 3
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAIL'IN'G ADDRESS
/ l( U )A df r s:.v.
. CONTRACTOR'S NAME' -
1A .t/ " O A
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS _
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
, �
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
I USE OF STRUCTURE
E5 ---
SF u Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home I S I G I W
10.00ea
TYPE OF WORK,--,,/
New❑ Addition`❑ Remodel❑ UtiIities2 Installation❑ Other
Describe work: ! til • 1/ B 440 5irr I C 4 F -o l AC r'
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP OROR LESS✓
10.00 6, CO
Main service EA. ADD'L 100 AMP
2.50
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
El 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)
®rl, 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 CONST. / DWELLING OCCUP.EI) '/z2Sgft
OR ADDNS. l ACC. BLDGS.
NEW CONSTR. MULTI -OUTLET 2,50 ea
NON.RESID .BRA CH CIRC ITS
POWER APPARATUS e
(SINGLE OUTLET CIR. )
EX. OCCUp 201950,OUTLETS OR FIXTURES SALO 30
FIXED PR
Ex. Occup. OUTLETS (RESID )EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00 Lf
*� - ►7C I 1 1/S
Permit Fee $ 11W. 00
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 shal I be deemed revoked.
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application 11 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.
1 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.
�, -
X �� f t f + Date �' -"�r �1f +
Signature of Applicant - Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
eight.`
ion of structures over 3 stories in height.;--I
Mobile Home Installation Fee
$
Energy Inspection Fee $
TOTAL PERMIT FEE $
occu P.
CONST.TYPC
SCHOOL
FLOOD
PARCEL
I PD
I NO
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 � I. / ���
r - -
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
,
Date �
� �
Receipt No. I�
WNIT[-D.P.W.. YlLLOW-ASSESSOR. PINK -INSPECTOR, aOLDENROD-APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
r 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION'ANb PERMIT
P7MIT NO.
��
ASSESSOR PARCEL NUMBER
1, I .— a -
ZONING
,
BUILDING PERMIT
O WNETELEPHO
(caber- r1c
E
3 �3 �
SO -FT. OCC. BUILDING VALUATION
OW E 'S MAILING ADDRESS
Aldlel-a.
CONTRACTOR'SNAME
r" o 40
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
n
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
V
Solar or heat pump water heater
20.00
.LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
Mobile Home S G W
Oea
JEK5,00
TYPE OF WORK i
New ❑ Additioi Remodel ❑ UtilitiesInstallation❑ Other ❑
Describe work: e- AlaiAl -5er V1,e ac
w -41 ,ue,,j se.1-y % L
Penult Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AOR S
MP ORLESS
10.00
Main service EA. ADD'L 100 AMP
2.50
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
❑ 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)
0 , 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 CONST. DWELLING OCCUP,y ,
OR ADDNS, ( ACC. BLDGS. hosgft
NEW CONSTR. U '.OUTLET 12.50 ea
NON-RESID BRANCH CIRC ITS
POWER APPARATUS e\
(SINGLE OUTLET CIR. /
Ex. Occup( OR FIXTURES 200Sot
eAL030
FIXED LNS.
Ex. Occup. OUTLETS APP
(RESID )REA.1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
M' c. �yirin 15.00
g
!S`
Permit Fee 1 $
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.
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 becomesubject
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
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 County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 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
ag nst said C unty in �=erte granting of this permit. fig?
X � (!t7 Date �-16 9
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 $
TOTAL PERMIT FEE $
Occup.
CONST.TTPC
ISCHOOLIFLOOD
PARCEL
PD
I No
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 QEA
PE IT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Dat%e��/f �I� ry
�•
�7
Receipt No. 1-1 AD �
WHITE-D.P.W.. TILL LOW-ASSC3 SOR. PINK-INSPILCTOR. GOLDENROD -APPLICANT
'-��('f.i��[.'r �7 r7d j,.�= ` }•Ml�:•rtu"n '��F���T' _•-'�'r�:�i^.�'f�u ..y+_����f,�1i •'h'�4►�t:+'A �LI � `+��+i��i+G'�. „i-; }S''�.�,y !.F �'';1' ,; • ��. � }� v°� eF} , �5�i
�r I'• I "'� 7+iY• r'{�. +�h1 �.`. �Y w, t1r.� I,`,�y:�,'Fy'
COUNTY OF BUTTE - DEPARTMENVOF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DR VE - OROVILLE, ALIFORNIA 95965 -TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.
J %�
OWNER FD65Ff
/ �I`i Cyl._ A. P. No.31 - -2,<
Proposed Building Use ee6 - CUA Building Inspector Date
At time of permit application, I was adviEed the following data must be submitted prior to permit processing
and/or Issuance: DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . . . . .
2. Plot plans in duplicate/triplicate, signed by preparer of plans. .
3. Complete plans in duplicate/toiplicate, signed by preparer of plans.
4. Complete engineered plans and calcs, with wet signature on plans.
5. Plans with Energy Design Conpliance Statement. . . . . .
6. School District 'Fees Paid" Stamp on Floor Plan.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorization. . . . . . . .
10. Sanitation approval from _ Health Dept. . .
11. Planning approval for (A) Use (B) Parking:
12. Certificate of Workmen's Compensation Insurance. . . . . .
�3. Contractor's License Informat on (no., name style, classif.)
-14. Owner -Builder Verification (G ven to owner❑, Mail to owner ❑ )
_.—_..._15. Improvements may be required . . . . . • , , , ,
16 Mobilehome Installation [data. . . . . . . . . .
. r 1
Pre -inspection for—&7e C t y') -'k C� Required. Pre-Inspec. request to /
ate)
p - --- — - - ---- -- Q Building Inspector
18. Recorded copy of Agricultural Acknowledgment Statement.
19. Driveway Permit.
20. Plot plan approval from city o _
21. - - 22.
_—
When ou issue the ^ per it, pro esu -as follows: Mail to owner, Mail to contractor_
Telephone<<J 3 and hold for pickup at Erb office, Deliver w/inspector.
Other em
APPIic.anz-Cslt,
�A)E
Copy of plans sent Health Crept.; Fire Dept., Other Date.
The following data must be submit:ed prior to permit issuance;: (Circle new -item not checked above).
,.1., Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by_p//ne�
honail_counter by date
Contractor, designer, owner, was advised c? above required data b/phone_mail_counter by date
Plans checked by Gate Plans approved by. Date
Sets of plans on hold in File cabinet AP folder t
Copy—DPW
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION .AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
"
ZONING
BUILDING PERMIT
OWNS c+ b %
TELEPH,OE
5.3 Y 3
SO. FT. OCC. BUILDING VALUATION
OW)Z'S 'S MAILING ADDRESS
1VtyVC1,Pr-- / "v, erg t , y
CONTRACTOR'S NAM
e
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
r�
Fireplace
CONSTRUCTION LENOER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2,00
/_
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each gas water heater or vent
5.00
USE OF STRUCTURE
SF Duplex[] Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00ea
TYPE OF WORK
New ❑ Addition Remodel[:] UtilitiesInstallation❑ Other ❑
Describe work: ' E_ /Pl /Lu
W fh wdc.1 se,-yi c !:4
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 0001 OR 100 AMP LESS
✓ 10.00
CONTRACTORS LICENSE LAW
I declare under enalt of ur
P y p er J y (check One):
F-1ON.RESID
1 flm 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, 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 CodeI
for this reason
Main service EA. ADD -L 100 AMP
1 2.50
NEW CONST. DWELLING OCCUP.6) ,
OR ADDNS. ACC. BLOGS. / �2¢sgft
NEW CONSTR -OU LET
BRAIRC S 2.50 ea
POWER APPARATUS e
SINGLE OUTLET CIR.
Ex. OCCU OUTLETS OR FIXTURES 2AL@30
p 2ALe90
FIXED APPLN . OR
EX. Occup. OUTLETS (RESIO.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Mc. Wiring 15.00 i
IL6
Permit Fee $
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.
[Bel 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
Filing Fee 10.00
Heating
Cooling
Hood
3,00
Ventilation
Permit Fee
$
Contractor
1 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.
1 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
a nst said C unt in co e u nce oft a granting of this permit.
Xt ����i, (����� �p�
L Date — -n
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 $
TOTAL PERMIT FEE $
Oc CUP.
COH7T.TYP[
SCHOOL
PL000
PARCEL
I Po
Ho
Issue
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
By
DFQUIT FXDI93PQ rinro
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No. l I I
w TV1.P.P.... »•,-.-_.-..-__.,_ ....._ .. ..._„_.. __.