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Home My WebLink About035-213-033_;, a- I - 035-213-033 ''03-0385, LWAYNE CARLSON E--i()45�2'5 'lin'coln blvd, oro .cot�: OWNER REPLACE GAS LINE OFFICE COPY Address GAS B Meter y Date ELEC RIC Meter By 41 --Date A Meter er T COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NCS. (Rev. 12/96) APPLICATION AND PERMIT 0'5— 03 ASSESSOR PARCEL NUMBER rM-91 1_(111 ZONING BUILDING PERMIT OWNER — _ y TELEPHONE SO. FT. OCC. BUILDING VALUATION . OWNEfi'S MAILING AUDRESS�y 35 Jt.tgti.n Laine. Olrnvi 1 A CA CONTRACTOR'S NAME 04mer TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS li I`f1 l or i ) Energy Plan Checking Fee $ $ �Va. m� PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 • USEOFSTRUCTURE SF .dk,Duplex ❑ Mobilehome ❑ Other SPECIFY 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 ❑ OtherX3, ,Describe Work: ReOlace Gas Line Gas piping system f - 5 outlets 15.00 1 r, Building sewer 15.00 ._._. Mobile Home S G W @20.00 PERMIT FEE t 'SHOO ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200AOR".ss 23.00 I 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 for the following reason: f 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 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. 8 ACC. BLDs. SO 3.5QFT: N" '.R.'. MULTI.OUTLET @7.50 POWER AP=US b SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FDCTUREs SAL (P 1.00 FlXED APPLNS. OR Ex. Occup. otmETs RESID. EA S.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner, so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the . workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. /'; .l rt /1 qX ;� , .,- r, �t " _ .,,, I _ Date # I f / 1 �Signatu�e 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. MECHANICAL PERMIT Filing 'Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 35.00 HAZ. p. FEES IMP I FLOOD I CDF PARCEL Po HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have B / C�# v � -� PERMIT EXPIRES ON e9 TDafe the applicable provisions Resolutions to do work been paid. f i"1/0 Date Vr r1 %,,%r r 1V /�_d i r Receipt No. �, 17CQ( � �J WHITE-D.D.S.-.B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 1 • COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530)53 541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT �� 's— 013ys ASSESSOR PARCEL NUMBER rlZ 5— 2 1_3_ < ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION WaV.OWNER'S Mir,A�, 35 Justin T CONTRACTOR'S NAME a-.7ner TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER [Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDNISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Trap 7.00 USEOFSTRUCTURE SF -; Duplex ❑ Mobilehome ❑ Other SPECIFY —Each 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,,J0 Describe Work: ;=--' -:^� ^�� T ;,a r Gas piping system 1 - 5 outlets 15.00 , c Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 R LESS 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.POWERA License Class 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**, I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. • ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service TO tOooA 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( DT T ACC. BLD S. SO 3.5¢Fr_ Noµa6IDT MULTI.OUTLET @7,50 PPARATUS a SINGLE 011TLE7 CIR. EX. OCCU OUTLET OR FDRUREs 20 O 100 BAL@ .50 MED Ex. Occup. ouT RES o.) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE t WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier 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.) 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. Date () /03 ture p licant - r 7Owner ❑ Contractor ❑ Agent EAn SHA p it is required for excavations over 5'0" deep and demolition or construction,® over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $.00 HAZ. I D. FEES IMP I FLOOD I COF PARCEL PD HD 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. nuctures BJtF �Dlate V EXPIRES ON V ate Receipt No. 6 /7004S PERMIT WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT