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HomeMy WebLinkAbout035-222-0124 --- - - - 35-222-12 `tDELBERT A. MANN - j ' 850 Virginia.-Avenue;--Orovirle - Contr: A Electric, Permit#3575-82E(ele ser ch & wire -for dryer)SF / z o1 G!` 035-222-012 ` 99-2421 SOLANSKY, DEBBIE 4850 VIRGINIA AVENUE, OROVILL CONTR: OWNER RE ROOF 7 035-222-012 ' �` 99-2421 SOLANSKY, DEBBIE 4850 VIRGININ AVENUE, OROVILLE CONTR:- .OR� RE ROOF ' r / 0'i d r r • I r � S S� I:! i� r 035-222-012 ' �` 99-2421 SOLANSKY, DEBBIE 4850 VIRGININ AVENUE, OROVILLE CONTR:- .OR� RE ROOF ' r / 0'i d —r voc" i r r —r voc" i 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 NUMBER nv5_m-n19 ZONING BUILDING PERMIT OWNER T)VnATV G .Auer TELEPHONE 531 .9341 SO. FT. OCC. BUILDING VALUATION 747 . OWNERS MAILING ADDRESS 4850 WRCTNT.A AVE.. 0R0VTT,T,F. CA 95966 FST 1,500. CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ 2.247 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 54.00 ARCHITECT OR ENGINEERS MAILING ADDRESS `- Plan Checking Fee $ BUILDING ADDRESS 4850 VIRGINIA AVT?.. t7RnVTT_ 1? I Energy Plan Checking Fee $ $ PERMIT FEE $ 74.00 LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.0023.00 USEOFSTRUCTURE SFA? Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work F.FR00F HOUSE 11 SQ) COREROOF CARPORT 2.5 SQ P.OI�LrI?. 3HFA't�'eTTNf3 FAT'.�'IAL SInI'�`G i Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 EOV LESS Main Service *.ADR.:: OR LESS 23.00 a - LICENSED CONTRACTOR'S DECLARATION I 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. fit. License Class :)' , Lic. No. OWNER -BUILDER DECLARATION IFIX I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I ¢*"1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. I ❑ 1 am exempt under Sec. Business and Professions Code for this reason L WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I ❑ 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 ' ' I 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 fo�rthw'th comply with those p ovviisions. ��t��, 9� X e.. z,� ��/ ,.,,/ Date 119 - ,Qla � i —� Signature of ApplicanO '0—wrier-0— Con r ❑Agent An OSHA permit is required for excavations 6ver 60" deep and demolition or construction of structures over 3 stories in height. Main Service TO 46.00 CCU000A NEW CONST. DWEWNO OCCUP. SO W:0 OR ADONS. a ACC. BLDS. 3.5Q�: NON-RE0S10T. , MULTI.OUTLET ; @7,50 POWER APPARATUS v a SINGLE OUTLET CIR. Ex. Occup. s20 @ 1 0 OUTLET OR FIXTURES Ex. Occup. OUTS PR °FR,p 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 74.00 HAZ. D. FEES IMP FLOOD COF PARCEL PD HD SSUE This permit is hereby issued under the applicable provisions of the Butte County Code ani/or Resolutions to do work indicated above for which fees have been paid. ((%t . /f 10/20/99 By /l // 111�fDate PERMIT EXPIRES ON :✓/ 10/20/2000 ate Receipt No. 280471 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) 538-7541 P M • NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 035-222-012 ZONING 1 BUILDING PERMIT OWNER TELEPHONE 534-9341 SO. FT. OCC. BUILDING VALUATION 747 . OWNERS MAILING ADDRESS 4850 VIRGINIA AVE.. OROVILLE CA 95966 EST 1,500. CONTRACTOR'S NAME 0?,,INER TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MaUNG ADDRESS Total Valuation $ 2,247 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 54.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS VIRGINIA4850 Energy Plan Checking Fee $ $ PERMIT FEE $ 74.00 LAT NO. SUBDNISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SF' (y' Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um 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 HOUSE 11 SQ COMP, REROOF CARPORT 2.5 SQ ROLLED, SHEATHING & PARTIAL SIDING Gas piping system 1 - 5 outlets 15.00 Building sewer -15.00 Mobile Home I S I G IW 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 20 A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.POWERA License Class Lic. No. OWNER-BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License w for the following reason: J , 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. ❑ 1, 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. ( DIT ACC. BLDS. SO 3.50FT• NoµaaD ' MULTI -OUTLET g7.50 PPARATUS 8 SINGLE OULET TCIR. Ex. Occu RES OFIXEDA an0 p 1.00 PLN.. Ex. Occup. OUTLETS OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 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 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 f one hundred dollars ($100) or less.) 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 fo th comply with those ov' ' ns. ate Oignatureo pplica ❑ wrier ❑ Co r ❑ Agent An OSHA permit is re uired for excavations r 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEP_ $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ 74.00 HAZ. p. FEES IMP FLOOD COF pARC0. PD HD 5 U This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicate bove for which fees av been paid. B Date 10/20/99 PERMIT EXPIRES ON 10/20/2000 Date Receipt No. 280471 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT M OWNER -BUILDER VERIFICATION Attention Property Owner: An "ownerbuilder" 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 unn try da1sY in processing and issuing your building permit. No building permit will be issued until this verification is received. 1� I personally plan to provide the major labor and materials for construction of the proposed property improvement: YES � NO C3 2. I HAVE NAVE NOT 13 signed an application for a building permit for the proposed wc" . I have contracted with the following person (firm) to provide the proposed eowtraction::.;�::' NE: - — — – - - - - --- ADDRESS: . CTTY• .. .. . PHONE: CONTRACTOR'S LICENSE NO. r -I." t 4. I plan to rovide ...:�;�`:, , p p portions of this work, but I have hired the .following person to coordimne, supervise, and provide the major work: NAME: ADDRESS: CITY• , PHONE: CONTRACTOR'S LICENSE NO. - 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: ; NAME ADDRESS PHONE TYPE OF MiQ S NED: PROPERTYOWNER:` SOCIAL SECURITY NUMBER: DATE:_ D `% Owner -Builder Verification is required by Section 1983 and79U2 0J'&e California Health and Safety Code. This verification must be -completed oxd returned to our office before we are permitted to issue the permit OVER I OWNER BUILDER INFORMATION .I Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of property.:, improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such '. a permit. Building permits are not required to be signed by property owners unless they are personally performing their ' own work.' If your.work is being performed by someone other than yourself, you may protect yourself Brom possible ' liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. . ' r If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ♦ If you employ or otherwise engage any persons other than your immediate family, and the work'('including materials and other costs) is 5300 or more for the entire project, and such persons are not licensed as contra_etors`or subcontractors, then you, may be an employer. ♦ If you are an employer, you.must register with the State and Federal Governments as an employer and you -ire subject to several obligations including state and federal income tax withholding; federal social security�taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contn'butions,_'•.;: ♦ There may be financial risks for you if you do not c out these obligations; and these risks are es'ecial'1 Y Y Y any b P ly sertous with respect to worker's compensation insurance.. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Serviee.(and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. 3 If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or,through their'own employees, without a licensed contractor or subcontractor, only undet'limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder 'building.. permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building ` permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contmc9rs may be obtained by contracting the Contractors State License Board in your . community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, Mic el C. Vi iia, C.B.O. M ger, Building Inspection NOTE: This Owner-Builder,Injormatlon is required by Section 19830 of the Cal rornia Healdr andSafely Code. OVER COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 - Telephone (530) 538-7541 P RMrr, N (Rev.12/96) APPLICATION AND PERMIT - } This permit is hereby Issued under the applicable provision! of the Butte County Code end/or Resolutions to do wor, indicated above for which fees have been paid. By PERMIT EXPIRES ON Date ___- BUILDING PERMIT SO. FT. OCC. BUILDING VALUATION c�(� Vr1 J OoN1MCTO" WAR T0.911401411 OOIeTRNCTM UMOt LINnOM MARM Aoonas Fireplace Total Valuation E AACWrECTOR ENMNM 10EME NO. Filing Fee S 20.0- Permit Fee i AnaarEaT OR EMMIMAs wu►a AooaEas Plan Checking Fee S sua0�loADOKa! - Ma Energy Plan Checking Fee i i ;A8 PERMIT FEE _ LOTNo etleDMOlON7TiAlat PARCEL kW PLUMBING PERMIT Filing Fee 20.0( USEOFSTRUCTURE SF , Duplex O Mobllehome O Other °Pmory Each Tr 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 O Addition O Remodel O UBrNes O Installation O OtherA Describe Work: / I 4 V Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S G W @20.00 _ PERMIT FEE4P OF ELECTRICAL PERMIT Filing Fee 20.0( Main Service ao=Oo"R(Tt a 23.00 Main Service 2WA TO 1000A 40.00 NEW CONST, oWEt11A occuP. 3.5Qso. OR ADONS. i /ICC. aU)9. QWUM NON.RESIO. • NNL N UTLEr MICUl @7.50 POWER APPAMTUa a s o art EX. Occup. OUTLET OR FTKTURES m O I.ao aAL a .50 Ex. Occup. VTLEIS �IE4 D.�Fit 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.0( Heating Cooling Hood 6.50 Ventilation PERMIT FEt ! Mobile Home Installation Fee I $ Energy Inspection Fee s- ? - occ cora T. TYPE TOTAL FEE $ -Z. 1 D. FEES IMP I mwo COF PARCEL This permit is hereby Issued under the applicable provision! of the Butte County Code end/or Resolutions to do wor, indicated above for which fees have been paid. By PERMIT EXPIRES ON Date ___- r� Rermit#3575-82E �` Delbert A. Mann • ' - •. � �` ,,- �. -yl f :. ..-- '. . , �.::. :KrF-....:.�; t��..`--'�h•'w ,lT ..-,- � : i�. �w-..n_ _'i...�. Ny .,j,.,.• , � �.: J...+ �.» •, .+..+ar ....-. w-,. _ ,.., ... _+Ix+•r:+,rw�.!.�a. COUNTY OF BUTTE -j.'-DEPARTMENT OF PUBLIC WORKS - PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-454,1M 3 - - APPLICATION AND PERMIT f ASSESSOR PARCEL NUMBER :3.5 - 2�1-2 -. 1 Z ZONINZ�4 BUILDING PERMIT OWNER VC t- 3Elz:�57- /A . MAMA% TELEPHONE 15'?3-'12&S S0. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS lie SvI24Irt/ !) /7vc ayll-C L . C CON RACTOR'S NAME - ✓ TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENIG NEER LICENSE No. Plan Checking Fee Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILgyr,�G ACIJRESSV/Re,' /A/ Av,- 7� PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater _20.00 0/001//LGC 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 Lys D/ uplex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home ISI GjWJ 10.00e TYPE OF WORK New❑ Addition El Remodel❑ Utilities [I Installation❑ Other Describe work: �!� 4/y L) lf/�� — Permit Fee $ -Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 00v OR LESS 1 100 AMP LESS S 10.00 10. v0 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. // DWELLING OCCUP.& OR ADDNS. l ACC. SLOGS. 2Ih¢sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and m license is in full force and effect. y 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) &?11I, 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 CONST11 ( MULTI -OUTLET NON•RESID `BRANCH CIRC ITS 2.50 ea NEWCONSTR. POWER APPARATUS &\ NON -RESID. SINGLE OUTLET CIR. / Ex. Occu zA�sOe P�o OR FIXTURES 9AL®so4 FIXED FIXED APP LNS. OR Ex. Occup. OUTLETS (RESID.) EAJ 2.00 + (� Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 / GO Pec—, �N�� Permit Fee $ 5 00 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. ©opl 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 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. 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 [ + - �p �P f��- t — Date - 7 '� �- Signature of Applicant — Owner Q' 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 HD ISSUE siolns of lthe it (Butte County ued under Code and/or resolutions ions icable Provi- to do work indicated above for which fees have been paid. _ DIRECTO 0 PUBLIC WORKS By Date/ 4 - k'� Y a �/ PER{,WT EXPIRES Date /�C l� p Receipt No. / fa WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE --DEP A-RTMEN7 OF PUBLIC WORKS PERMIT NO. 7 Count)rCenter Drive - Oroville, Zalifornia 95965 - Telephone 916/534-4541 S 5 APPLICATION AND PERMIT ASSE SOP PARCEL NUMBER �Z2:2-_1 7— — ZONIN16''• ' BUILDING PERMIT A MA-N/v3�°,�j2� `/ SQ. FT. OCC. BUILDING VALUATION OW S t�ILING ADDRESS S v i//2 /111/1A AvC 3 ea011LE C+ /RACTOR'S NAME � CON,7 TEL PHONE , CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LdEJNDER - UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS - Permit Fee $ ARCHITECT OR E NEER LICENSE NO. Plan. Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUIL,F PM RESP/�� WiR Avi� - PLUMBING PERMIT' Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 0P00V/ultff Water piping 5.00 LOT NO. SUBDIVISION NAME 1 7 PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S I G I IN _10.00e - TYPE OF WORK New ❑ Addition ,❑rr Remodel ❑ UtilitiesInstallatiopnll/U Other [L]/Contractor Describe work: C'L�%% S/G /T�y� W�'"`� — Permit Fee $ ELECTRICAL PERMIT Filing Fee 10.00 Main service 10ov OR LESS 100 AMP OR LESS 10.00 Q RC1 , - Main service EA, ADO'L 100 AMP 2.50 NEW CONST. I DWELLING OCCUP.& OR ADDNS. % ACC. SLOGS. 2th Osq ft .. 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 m license is in full force and effect. y 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) Uv 1, 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 CIRCUITS) NEW CONSTR. (POWER APPARATUS & NON.RESID. (POWER OUTLET CIR. - Ex. Occu 20@500 Ex. p�o OR FIXTURES 1.20@500 FIXED A Ex. Occup. OUTLETS P(RESID IREA.� 2.00 Z VV � Temporary service 1 10.00 Mobile Home Facilities 1 15.00 Misc. Wiring t 15.00 /S .OD �—�/J'SP AS_ Permit Fee $ , vo 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 $ 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. 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 again t said County in consequence of the granting of this permit.. X • �' Q-�-�i� Date 1,2 _ % — a Z Signature of Applicant — Owner [Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ories in height. ion of structures over 3 stReceipt Mobile Home Installation Fee $ TOTAL PERMIT FEE $ .52,00 OCCOP. GROUP TYPE OF CONST, PARCEL PD I HD 550E This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTO O PUBLIC By PER PEREXPIRES Date the applicable provi- resolutions to ,do fees have been paid. WORKS Date/ Z '�� a-- �� - NO. a WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT -APPLICANT