HomeMy WebLinkAbout039-270-114�. f
-39-27-114
LARRY LAMBERT)
9454 Perkins -Road, Dayton Ot117Contr: Larry Lambert, Chico
Permit #1.397-83B,P,E,M(new singlefamily
29-27-114 •
NEW OWNER
JACK HAWKINS aim►
9454 Perkins Rd, Chico
Contr: Servamatic Solar System
Permit#4045-83P(solar water heater)SF
039-270-114' PERMIT#94-1742
HAWKINS, JACK & KATHLEEN
9454 PERKINS ST., DAYTON
GAS LINE FOR -RANGE/SF 7 I7 7
039-270-114 05-1409
HAWKINS, JACK
9454.PERKINS RD, DAYTON
Cont: G&R ROOFING
REROOF 25 SQ
f,.;
•a
�. f
-39-27-114
LARRY LAMBERT)
9454 Perkins -Road, Dayton Ot117Contr: Larry Lambert, Chico
Permit #1.397-83B,P,E,M(new singlefamily
29-27-114 •
NEW OWNER
JACK HAWKINS aim►
9454 Perkins Rd, Chico
Contr: Servamatic Solar System
Permit#4045-83P(solar water heater)SF
039-270-114' PERMIT#94-1742
HAWKINS, JACK & KATHLEEN
9454 PERKINS ST., DAYTON
GAS LINE FOR -RANGE/SF 7 I7 7
039-270-114 05-1409
HAWKINS, JACK
9454.PERKINS RD, DAYTON
Cont: G&R ROOFING
REROOF 25 SQ
BUTTE COUNTY PERMIT NO.
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) BP051409
OFFICE #: (530) 538-7541
PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS.
LICENSED CONTRACTORS 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 Issued Date: 05/31/2005 APN: 039-270-114-000
the Business and Professions Code, and my license is in full force and
effect. c
License Class: 3 7 License Number: Site Address: 9454 PERKINS RD DAY
Dater Contractor: 6 Z 2 Map Index:
OWNER -BUILDER DECLARATION -
I hereby affirm under penalty of perjury that I am exempt from the Description: re roof 25 squares
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior Owner: HAWKINS JACK L & KATHLEEN M
to its Issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
the Contractor's State License Law (Chapter 9 commencing with Section 9454 PERKINS RD
7000) of Division 3 of the Business and Professions Code) or that he or CHICO, CA
she is exempt therefrom and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the 95928
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does Applicant: G & R ROOFING
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or Improvements are sold within one 2587 NORD AVENUE
year of completion, the owner -builder will have the burden of CHICO CA 95973
proving that he or she did not build or Improve for the purpose of
sale.). (530) 894-6537
❑ I, as owner of the property, am exclusively contracting with
licensed contractors. to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or Improves thereon,
and who contracts for such projects with a contractor(s) licensed Contractor: G & R ROOFING
pursuant to the Contractors' State License Law.).
❑ 1 am Exempt under Article 3 of the Business and Professions Code 2587 NORD AVENUE
Date: Owner: - CHICO, CA 95973
WORKERS' COMPENSATION DECLARATION (530) 894-6537
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self -insure for License #: 773913
workers' compensation, as provided for by Section 3700 of the
Labor Code• for the performance of the work for which this permit
)s'issued.
9--.1 have and will maintain workers' compensation insurance, as Architect:
required by Section 3700 the Labor Code, for the performance of Engineer:
the work for which this permit is issued. My workers' compensation g
insurance carrier and policy number are:
Carrier:
Policy#: �D �C)_(a4_1 `-6Vf Total Square Ft: 0 S. F.
❑ 1 certify that In the performance of the work for which this permit is Valuation: $0.00
issued, I shall not employ any person in any manner so as to Census Code:
become subject to the 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 12
forthwith comply/with those provisions. /
Date: %!'. U• `7>
Applicant.
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY This permit is hejd6y Issued under -t appli able pro,visions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the Resolutions to o work ingic ve f w 'ch f s have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.) S
Name: l �b
BY Date:
PERMIT EXPIRES ON:
Address: Date
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
M'Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
O Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
..all county and state laws relating to building construction. I acknowledge It Is unlawful to alter the substance of any o 'cial form or document of Butte County. I hereby
'2uthorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.'
Z
Print Name: F _ nr 0_�, Signature:
Date: /3-) 6
O Owner Contractor El Agent for Owner ❑ Agent for Contractor
VErAKTMEN'1' OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECnON#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE il:. (530) 538-7541 •.. .
A FEE WILL BEREQUIREDAT.TIME OFAPPLICA.TION. .
Website•. VAM.butteeounty.net/dds
*PLEASE PRINT CLEARLY**
OWNER
ARCtIMSCTIENGINEER
A �
City
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Zp
Phone
Fax
E-mail
APPLICANT SIGNATURE
Xi
ror omee use onV,
Zoning' Flood Zone SRq Yes
00C. ZC
Const
Subdivision Name::!7 ok Page Lot
Planner Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:IFORMSSUiLDING FORMSXBIdoAooiSuhRnmte dnr.
No
Pana 1 n1
NO.
qo�
1 BIN. N
LOCATION
ARCtIMSCTIENGINEER
CONTRACTOR,
Name
Address
O Iiia`
Address
Cam
State Zp
Phone
Fax el 2
5 -'
Fax
E-mail
Phone
_ &S
-7
Fax 3 — -71e
E-matl
Li CIL
73 9Z 31
APPLICANT SIGNATURE
Xi
ror omee use onV,
Zoning' Flood Zone SRq Yes
00C. ZC
Const
Subdivision Name::!7 ok Page Lot
Planner Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:IFORMSSUiLDING FORMSXBIdoAooiSuhRnmte dnr.
No
Pana 1 n1
NO.
qo�
1 BIN. N
LOCATION
ARCtIMSCTIENGINEER
Name
i>
Ablr O � .
Address
WORKER'S COMPENSATION
city
Cam
State Zp
Phone
Fax el 2
5 -'
Fax
E-mail
Slate Lio nse Number
APPLICANT SIGNATURE
Xi
ror omee use onV,
Zoning' Flood Zone SRq Yes
00C. ZC
Const
Subdivision Name::!7 ok Page Lot
Planner Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:IFORMSSUiLDING FORMSXBIdoAooiSuhRnmte dnr.
No
Pana 1 n1
NO.
qo�
1 BIN. N
LOCATION
APPUCANT NAME
Name.
Address
i>
Ablr O � .
Ju
WORKER'S COMPENSATION
Policy Number
' /.3 O to
Cam
Phone
- S
Fax el 2
5 -'
E-mail
APPLICANT SIGNATURE
Xi
ror omee use onV,
Zoning' Flood Zone SRq Yes
00C. ZC
Const
Subdivision Name::!7 ok Page Lot
Planner Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
K:IFORMSSUiLDING FORMSXBIdoAooiSuhRnmte dnr.
No
Pana 1 n1
NO.
qo�
1 BIN. N
LOCATION
Prope A
L1 `/ R,alcrUUS
CRY
Cross Street
WORKER'S COMPENSATION
Policy Number
' /.3 O to
Cam
NhMg anyone other than license cor►tractom. a ceMcate of worker's
c0mpense6ton must be shown at:the time of permit Issuance.
LENDING AGENCY
.Name
Address.. .
Description or Scope of We
��l r OJ C li C�itJ 60 `' I. xk
Sq. footage ��
0
❑ Structure Buift.wkhout Permits
❑ Proposed Change of 00Wpancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on. an
application after expiration, a new application, plans and fee will be
Refunds can only be made upon written request by the person who
paid the fee: The request must be made prior to -the expiration of the
permit and no construction work has been done. Filing fees, plan
.check fees for work plan checked and other department costs are not
� ,CG J_L
Received b�
Receipt M
Date:
Amount / Bldg
SRA
Sheriff
SMTP
Other
7
om" o o7 n•
��'1
9454, -
-1,1
4
PE
R'M
I.T
#94-17412039-
HAWKINS,JACK'SKATHLEEN
945PERKINS ,ST .i DAYTON
G SLINE FORRANGE/SF. �/��/�S-I
fi
r7c,
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, Cayfornia 95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICATION 'ASVD PERMIT
ASSESSOR PARCEL NUMBER
—270-114
ZONING
SRI
UZDING PERMIT
OWNER
TELEPHONE
342-0827
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
NNER
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
9454 PERKINS ST, DAYTON
PERMIT FEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15,00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF ,@ Duplex ❑ Mobilehome C)Other
SPECIFY
Gas piping system 1 5 outlets
15.00 255.00
Building sewer
15.00
Mobile Home S G I W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities F1 Insiallation ❑ Other O N
Describework: GAS LINE — M INTERIOR FOR RANGE
PERMIT FEE $
35.00
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
j
Main Service ( 101 01 LESS IF
200A OR LESS
23.00
Main Service ( 200A TO 1000A )
46.00
'-`
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( 8 ACC. BLDS. )
3.50 FSTD..
CONTRACTORS LICENSE LAW(
I declare under penalty of perjury (check one)
❑ 1 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
79 I, 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)
O 1 am exempt under Sec. Business and Professions Code
forthis reason t
NEW CONST. MULTI -OUTLET
•NON-RESID. ( BRANCH CIRCUITS )
@7.50
POWER APPARATUS )
6 SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
BA20 @ 1.0000
Ex. Occup.FIXED APPLNS. OR
( OUTLETS (RESID.) EA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
WORKER'S COMPENSATION INSURANCE i
1 declare under penalty of perjury (check one): I
❑ 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
IX 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 $
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.
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
C)1u)nty in con equencg of the grantin of ;his permit.
X ' ~,✓ Date 6
Signature of Applic nt , Owner O Contractor ❑Agent
An jOSHA 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
CONST. TYPE
TOTAL FEE $ 35.00
HAZ-
I D. FEES
IMP
I FLOOD
CDF
PARCEL PD
I HD
I ISSUE
This permit is hereby issued under the applicable
of the Buttq County Code and/or Resolutions
indicated abgve for which fees have been
By � �-4-y1,
I PERMIT EXPIRES ONn"
lDetel
provisions
to do work
paid.
Date
L(�
v
Receipt No. 162993
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 - Orovit%, Cai%*arn a 95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICATION AND PERMIT
ASSESSOR PARCELNUMBER
— —
ZONING
SR1
,19GUILDING PERMIT
OWNER
JACK & KATHLEEN HAWKINS
TELEPHONE
342-0817
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
9454 PERKINS, CHICO 95998
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee $
20.00
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
9454 PERKINS ST DAYTON
PERMIT FEE $
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF §P Duplex ❑ Mobilehome ❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
15.00 15 , 00
Building sewer
15.00
Mobile Home S G W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities N Installation ❑ Other ❑
Describework: GAS LINE — INTERIOR FOR RANGE
PERMIT FEE $
35.00
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service ( BOOV OR LESS )
200A OR LESS
23.00
Main Service ( 200A TO 1000A )
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( & ACC. BLDS. )
3.5C SO ,
FT.
CONTRACTORS LICENSE LAW(
I declare under penalty of perjury (check one)
❑ 1 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)
❑ 1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
O I am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET
•NON.RESID. ( BRANCH CIRCUITS )
@7.50
POWERAPPARATUS )
B SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
e2a @ 1.00
Ex. Occup.FIXED .OR
( OUTLETS (RESTRESID.) EA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring j
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 $
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.
1 also agree to save, indemnify and keep harmless the County of Butte against all
li lilies, judgments, costs, and expenses which may in any way accrue against said
C ty in con equenc of the grantin ofiis permit.
XDate V
S' ature of Applic t Owner ❑ Contractor ❑ Agent
n OSHA permit is required for excavations over 5"0" deep and demolition or
o truction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 35.00
HA2•
D. FEES
IMP
F100D
COF
PARCEL PD
HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Bu County Code and/or Resolutions to do work
indica dab a for w I h fees have been paid.
By .Date
Q�
PERMITEXPIRESON -ZI-7
IDatel
Receipt No. 162993
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE
Departme-nt of Development Services
Building Division
Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541
Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751
OWNER -BUILDER VERIFICATION
Attentiou 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.
1. I personally plan to_provide the major labor and materials for construction of the proposed property improvement
(yes or no) ,-
2. I (have/have not) O-15 signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone Contractor's License No.
4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and
provide the major work:
Name
Address City
Phone Contractor's License No.
5. I 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:
Property Owner
Social Se�,urit� N ber 21
Date /� I � Q
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 permitted to issue the
permit.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
_ APPLICATIbN AND PERMIT . . r
PERMIT NO.
f l
ASSESSOR PARCEL NUMBERZONING
/ - 1 11 y'
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC.1 BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
/f rel l� i1: :END:1 -„ f.•.! i ) ., " /�
Fireplace
CONSTRUCTION LER-
UNKNOWN
Total Valuation is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
'�' !ter ' ril, ! ✓,
PLUMBING PERMIT
Filing Fee 10.00
.�
Each Trap
2.00
Solar Water Heater
20.00
j -
Water piping
5.00
LOT NO.
SUBDIVISION NAMEPARCEL
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 I S I G W
10.00 e
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti Iities'0 Instal lation ❑ Other ❑
Describe work: . -
Permit Fee
$ ^
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ACC. BLDGS.
2Ih¢sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Bus ness
and Professions Code and m licese is in full force and effect.
y n
License No. ' %''�AClassification t --�
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)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR ULTI-OUTLET 2.50 ea
NON-RESID BRANCH CIRC ITS
NEW CONSTR. (POWER APPARATUS &)
NON-RESID. \SINGLE OUTLET CIR.
Ex. Occu / 20@50t
P\ o Ts OR FIXTURES BAL@30
FIXED
Ex. Occup. our ETS PR
(RESID•)EA.� 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee
$
Contractor
MECHANICAL PERMIT
FiIirig Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue[
against said County in consequence of the granting of this permit.
X o Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
TOTAL PERMIT FEE $ 1 "',, n
OCCUP. GROUP
I TYPE of CONST.
-I
PARCEL
I PD
ND
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
.i
By,
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
l l'
Receipt No. �: , /
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATIONAD .PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
-"2'--7 —J/ f
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
Alem
T LEP=ONE
CJJQQONTTTRRACTOR S AILING ADDRESS
JZ)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
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
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 yDuplex❑ Mobilehome❑ Other
SPECIFY
Building sewer
5.00
Mobile Home S I G I W
10.00e
TYPE OF WORK
New❑ Addition F1 Remodel❑ Utilities Installation❑ Other
Describework: z—�('e 2%.
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service BOOV OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ACC. BLDGS.
2/20sgft
CONTRACTORS LICENSE LAW
I declare der penalty of perjury (check one):
Ln 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. �1c��a Classification C.
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR L
UTI.OUTLET 2,50 ea
NON.RESID BRANCH CIRC ITS
NEW CONSTR ( POWER APPARATUS .&')
NON-RESID. (SINGLE OUTLET CIR.
Ex. OccuP ( 20050¢
OR FIXTURES BAL030
FXA PP LHS
FIXED A OR
Ex. OCCUp.IED OUTLETS (RESI,D,) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare un er penalty of perjury (check one):
❑ e permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
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 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, c st and expenses which may in any way accrue
agai t i Co my i c u ce of the granting of this permit.
X Date
Signatureplicant — Owner❑ Contractor ❑ Agent
An OSHA per it 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 $j��gp
OCcUP. GROUP
I TYPE of CONST.
PARCEL
PD
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
BY
PER PIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date "S
Receipt No. ���D /
WHITE-D.P.W., YELLOW-ASSeSSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
LU
PERMIT NO. j97=�v
PERMIT EXPIRES
OWNERrF�t$Ft�
CONTR. Larry Jay Lambert
1 ASSESSOR PARCEL 39-27-114
w
LOCATION 9454 Perkins Rd, Dayton _
V ,7
I
Temp. Power Pole
Called Pr -AF
Tem . Elec.
Called P
Temp. Gas Se
Cal led Pi
JOB FINALE
Signature
J = OK
0 = Not rJK
= Not Applicable MOBILEHOMES MISCELLANEOUS
* = Not Ready
Date
MOBILEHOME UTILITIES (Plans) OK except k's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors _
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4, Wood Awn.; Posts-Beams-Rfirs.-Connec.-Shthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L" ft./ /"Nat.or/ /"L"ft./ /"LPG
- ---
6. Carports; Windows -Doors ,
7. Utility Clearance
7. Elec.
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date _
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
Card -BI
Date
Date Card -BI Date _
POOLS (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
'2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining _
4. Electricity; MH Test -Crossovers -Breakers -Clearances
4. Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date,
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
J -SOK
0,,_ PWt OK t
= Not Applicable
Not Ready RESIDENTIAL (Single and Duplex)
:$ =
Date
UNQEp�!COOR (Plans) OK except N's
Date FRAMING (Continued)
1. on' equirements-Setbacks-Easements
•4&3,.Property Line Firewall & Openings
2 g., Main; Soils-Steer-F�d.- / Ftg. Depth
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3. Garage; Soils -Steel- / /" Ftg. Depth
jf6s Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth.5&v--Plywood
on Roof Overhang -Attic Vents -Rafter Outriggers
5. temwalls, Main; Steel-Blockouts-Wrapped-S140h�
62-etzling-Nailing-Veneer
6. emwalls, Garage; Steel - Bloc kouts-Wrapped-S
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. Piers -Fireplace Ftg.-Steel '
-Vg'.-Glazing Area -Glass Protection -Skylights -Plastic
_-
ViB V.V.: -Fit s -T r- 2 L-4 C/ a est
S5 Shear Walls; Nailing -Bolts
9. Gas Pipe; Size -Anchors
10. ater Pipe; Test -Anchors -Regulator -Service Test
—,dElectric:
Underground
)
12. Plenums & Ducts; Clearance -Material -Support -Ins.
13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI Date -71-L,43 Card -BI Date
Card -B Date 9- Card -BI Date
Car I Date Card -BI Date
Card -BI
Dat / Card -BI Date
Date FINAL (Plans) OK except N's
ppb Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except td's
512,-SThoke Detector
_
^i��Vater Ht.; Vent -Access -Combustion Air
6*--1iJrnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Meeh. Protection
jio. Bedroom Exiting
t& --Water Pipe T Anchors -Nail Protection
D.W.V.: st- ttngs & Anchors -Nat Pr tection
17. Shower Pan; Test, First Floor u ccess
.F.I. & Bath Fixtures & Tub Access
4S, -Test Tub & Shower, 2nd Floor -Tub Access
fi Qe= Trim & Subpanel; Breaker Sizes -Labels
_
49---6as Pipe; Size & Anchors
_
Fireplace or Stove; Clearances -Hearth
4�ec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date1 1,1 Card -BI Date
• Kit. Ftxt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
Elec. Outlets &'Receptacles at Kit. Counter r
DateELECTRICAL
Permit OK except N's
gage Fire Door; Swing -Landing -Closer
60. arage-Damper
Fixture &Transformer Clearance -Ins. Protection
Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor -Meth. Protection
- _
22 -Tlec. Receptacles Spacing -Lights & Switches at Doors
p Elec. &Mech. Equip. Listed for Location -
_
Sze Boxes & No. of Conductors -Stapled
; Receptacles in Garage; F.I.)-Romex Protec.
2�Romex Installed Close to Edge of Studs & C.J.
—
/Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
nsu lat ion- Foam- Looked in Attic s
°Deck Construction -Post Caps
2 Appliance Circuits in Kitchen & Conductor Size
_
tJ-ubfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al'
7-q, d V4a& & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
2j_-.�ange Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or AI,
Insulated Neutral ❑Yes ❑No
25r -Following instld.: Drive esNo; Walks E&, -Y9 -s ❑ No;
Planters ❑C�Yes ❑
2$/Service-Riser Conductors & Ground -Main Disconnect
aDt'Equip. Clearances; Panels-Motors-Mech. Equip. -
C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
-__
ZW.Clothes Closet Light -Shower Light —
--9P-Water
U ents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
Well; Disconnect, Electrical, Plumbing
----
69 erior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
�(�d�— Date7�_
j ` Card -BI Date
entilation throughout House
Card B -I
Date Card -BI Date
ass Protection
Date
MECHANICAL (Perrr,it) OK except dd's t
_
9&"-1rom Previous Inspections )�
agged; Gas -Electric
Ducts: Insulation &Support
85. r & Se r onnected-C/O to Grade -HD Approval
_
fVieon�r�Fan; Exhaust above Insulation
86. Energy Compliance Certificate -Other Certificates
- i
densate Drain _& Overilow; Size & Grade
44.• Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
•2Y Attic Access & Platform if Furnace in Attic
Card -BI
Card -BI
//
` _DaIC7 /, d 1 rV Card -BI Date
Date Card -BI Date
Card -BI Date Card -BI Date
C - Date Card -BI Date
C I Date Card -BI Date
Comments at Final:
Date FRING
A (Plans) OK except q's
Siits; Proper Material &Anchors
t
,y
_ __
_
�4�-_Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38, Bearing Walls over Girders & Floor Nailing___ -
3U!Draft Stop in Walls (rat proof)
_
_448- Fire Stops; Furred Ceilings -Stairs -Chases -Tub
-
i� Header _&_Beam -Size & Bearing
42! Hangers -Post Caps -Anchors -Connectors
4t,;ng. Joist-Rftr. Tie - -Roof Brac.-Truss-Shthng.-Ring.
Fireplace Ties or Flu Fi place Throat
_
-
Attic Access: Size & R_ ex Pr ction Draft Stop -Ins. Baffles
._Windows or Exiting Doors -Sill Hgt. &_Dimensions
Garage Fire Protection Framing
(NOTE: Anentrymust be made each time you visit jobsite)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-27..51
7 County Center Drive, Oroville — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
CORRECTION NOTICE
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or need additional explanation, please contact this office immediately.
Inspector, r ZO Date `
RESIDENT IAL
ENERGY CONSERVATION STANDARDS
CONSTRUCTION COMPLIANCE CERTIFICATE
THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN
STALLF,Dx/IL�"WiV3 LS E�AREGULATIONS
��AT3�i A
(location
BUILDING PERMIT N0. 7— 4 A.P. NO,,37 oZ% 11Y%
THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS:
(Check each item or write N/A if not applicable)
INSULATION:
Slab Edge_
Fdn. Walls 0
Floors - 6►
Walls_
Ceiling/Roof 00 —
Ducts .
L +sL�
Circulating Pipes 1
APPROVED HF_aTER
APPROVED 14TR.HTR.
GLAZING:
S Z!z _
Special (Insulated)
CERT. & LABELED WDS . 71
& SLID ItiG DRS.— t
WEATHERSTRIPPED DRS.' 094 144
BACK: D.M.[PERED FANS
INTEM-1-IT d ENT IGN IT IONIDEV ICES
CERT. APPLIANCES
I DECLARE THAT ALL REQUIRED ITEMS AS NOTED -ABOVE HAVE -BEEN INSTALLED
IN ACCORDANCE WITH'THE ENERGY CONSERVATION REQUIREMENTS AND.AGREE TO
THE COMPLETENESS OF THIS CERTIF ICATE .AS SUBMI-TTED.
Insulation Applicator. Name L,A __J.
Signature of (pl se print)
Insulation Applicator
State Contractors
License No. A,�6
General Contractor/Owner Name
(pl ase rint)
S igi _ ture of
General Contractor/Otmer_ ate . 7 '0 7 .
State Contractors
License No.
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO
REQUESTING FINAL INSPECTION AND SIL.�LL BE POSTED IN A CONSPICUOUS. LOCATION
WIT117SI THE DWELLING.
COUNTY OF BUTTE - DEIPARTIIAENT OF PUBLIC WORKS
_ . 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND -PERMIT
ASSES O PARCEL NUMBER
a ZL
ZO INJG
O
BUILDING PERMIT
OWNER
T LEPHONE
S0. FT. OCC, BUILDING VALUATION
<Od
OWNEPt'SMAILINGIDDREpts
Om
0, DO
CONT ACTOR'S NAME TELEPHONE
CONTRACTOR/ MOILINt DDRES ��
A ��~:
Fireplace A Z 000, co
CON RUCTION LENDEij„ UNKNOWN
r
Total Val Ion 1 $
Filing Fee
� 10.00
LENDER'S MAI LAADDRESS
Q
Permit Fee
$
ARCHITECT OR NGINEER
LICENSE NO.
Plan Checking Fee
$ .S
Penalty
$
ARV. I E OR ENGINEER'S MAILING ADDRESS
Permit fee
$ s
BUILD�G DR�aSS f'
Com'./
Ae
PLUMBING PERMIT
Filing Fee 10.00
- r �
i�
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00 p
LOT NO.
SUBDIVISION NAME ARCEL 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 rv�j
Mobile Home S G W
10.00 e
TYPE OF WORK
New Addition E:1 Remodel❑ Utilities❑ Installation[] Other❑
Describe work:
J /7
C &J f
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
BOOV OR LESS
Main service 100 AMP OR LESS
10.00 OO
Main service EA. ADD'L 100 AMP
2.50 117, J-0
NEW CONST.DWELLING
OR ADDNS. (ACC. BLD
21/2(tsqft1X 11, U
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check One):
�I am licensed under provisions of Chapt. 9, Div. 3 of the Bus inessX
and Professi ns Code and m license is in full force and effect.
y
License No. Classification 9-1
❑ 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)
❑ 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 CONSTIRU TI.OUT E 2.50 ea
NON.RESID BRANCH CIRCUITS)
NEW CONSTR. POWER APPARATUS &)
/
NON-RESID. (SINGLE OUTLET CIR. /
20050a
Ex. Occup(o OR FIXTURES BAL080
IED APPLNS OR
EX. OCCUp- OUTLETS (RESID.I EA.) 2.00
Temporary service g' 10.00
Mobile Home Facilities
15.00
Misc. Wiring 15.00
Permit Fee $ vo—
Contractor b CrIsC
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
e 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 0
O
£' �j
Cooling
Hood
3.00 a
Ventilation ,,/
permit Fee
$
Contractor7%e—_,/,/
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, indemni and keep harmless the County of Butte against
all liabilit' judgments, ts, and expenses which may in any way accrue
against County ' co. n Ing of this permit.
S �3
X Date 0
Signature of A i t — owner ❑ Contractor Agent ❑
An OSHA per it 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
TYPE OF CONST,
PARCEL
PD
HD ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIR F ft OF PUBLIC
By
P IT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date`s r 2-21-F-3. �-^ Q
v ��� /
Receipt No. JU S727
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
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