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�O' Stanley Avenue, 'D"jcrham
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICA-KON AID PERMIT
ASSESSOR PAR%EL NUMBER,
=<
ZONING
BUIL' DINGaP'ERMIT
OWNER -
TELEPHONE
SQ. FT. OCC. BUII,LDING VALUATION
l 'T _
OWNER'S MAILING ADDRESS -
CONTRACT._,O,.R''.S_ NAME ,%
,ADDRESS
TELEPHONE
CONTRACTOR'S MAILING
r —T l.' •i I �
Fireplace
CONSTRUCTION LENDER -
UNKNOWN
Total Valuation is
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$ r
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
USE OF STRUCTURE
SF Q Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G W
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe work: t !r =r ' - rt <-t :it ,�-2.- _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 80000'100AMP OR LESS OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
QX I am licensed under provisions of Chapt. 9, Div. 3 of the BuSlnesS
and Professions_ Code and my license is in full force and effect.
License No. j h � Classification r. - 3
Fl 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 CONST. DWELLING OCCUP.N ,
�z2SQh
New
CCONSTR.(A ULTB OUT@ T
NON.RESID BRANCH CIRCUITS2.50 ea
POWER APPARATUS &)
(SINGLE OUTLET CIR.
00
Ex. Occup(OUTLETS OR FIXTURES20@090
Ex. Occup. OUTLETS (RESID )FIXED APPLNS. REA.1 2.00
Temporary service , 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Dgpartment
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
$
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 '��� / ✓/
.. - 1t t if f,{�J-� �+ Date /�- mal -f (�
Signature of Applicant - Owner
g pp ❑ 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 $
, ST
TOTAL PERMIT FEE $ (J
occu P.
CON5T,TYPEJ
IFLOOIDIPARCELI
PD
1 NO
ISSUE
This permit is hereby issued under the applicable provi-
sions of the Butte County Code and/or resolutions to do
work indicated above for which fees have been aid.
p
%DIRECT R OF PUB�C�WORKS
���
By. �+ �' � ' ' Date
PERMIT EXPIRES Date
Receipt No.
WHITE-D.P.W., YELLOW-ASSE9S`` iORJPINK-INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATIi1N Aft PERMIT
PERMIT No.
E
ASSESSO}i PAR E� NUMBER
f`v�(
ZONING
BUILDING PERMIT
OWNER �vJ}-^
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDR SS
S
CONTRACTOR AME
LEPHO E
St y�
CONTRACTOR'S MAILING A RESS �y
�
Q � �� �C�
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
• S,
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 F-1 Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home is G W
10.00 ea
TYPE OF WORK
New [-I Addition Remodel❑ Utilities❑ Installation[] Other ❑
Describe work: LO"�i " c : ��
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 8001 OR LESS
100 AMP OR LESS
10.00
Main service EA. AOD'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 Buslnes$
and Professions C de nd my license is in full force and,effect.
License No. Classification p
Fl 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 CONST. DWELLING OCCUP.tr ,h¢sgft
A CC.BLDGS. )
New
CONSTR. MULTI -OUTLET
NO N.R ESID BRANCH CIRC ITS 2.50 ea
POWER APPARATUS tr
SINGLE OUTLET CIR.
EX. Occu 20050a
po UTLETS OR FIXTURES SAL®30
FIXED APLNS.
Ex. Occup. OUTLETS (PRESID )REA.) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
g 15.00
Permit Fee
$
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
�( I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate.
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Coolin g
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 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 saA County in cense ace of the granting of this permit.
X /%/ ,- (� ��� ��~���
b1 (�T 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 $
Energy Inspection Fee $
L
TOTAL PERMIT FEE $ i
OCCUP.
CONST.TYPC
IT
[FLOODIPARCELI
PD
I ND
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRE C PU
A
B
P MI EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
D e
0J
Receipt No.
WNITE-D.P.W.. YELLOW -ASSESS . PINK -INSPECTOR. GOLDENROD -APPLICANT
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