HomeMy WebLinkAbout040-170-107COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BU LDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone ( 0) 538-7 P I NO.
(Rev.12/96) APPLICATION AND PERMIT��"!
ASSESSOR PARCEL NUMBER 0 go — R0 —
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BUILDING PERMIT
OWNER
TELEPHONE
! %OWNERS
FSQ.Fr.OCC. BUILDING VALUATION
CT O
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MAILING ADDRESS
qila-1/,.Cry Rd, oUR �,►�
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING AD ESS
v g R C ;Co C4- J 73
CONSTRUCTION LENDER
LENDER'S MAIUNG ADDRESS
Fireplace �-
Total Valuation $
ARCHITECT OR ENGINEER
UCENSE NO.
Filin Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE $
&0
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF IV1 Duplex ❑ Mobilehome ❑ Other R. E5,
SPECIFY
Each Trap
7.00
Solar or heat pump water beater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other jld
Describe Work: R F—Roo C� qlp io F/L
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
920.00
PERMIT FEE S
ELECTRICAL PERMIT
Filing Fee 20.00
UES
Main Service . AOR 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.�-L
License Class C-3 ( Lic. No. 2_f 4}s -Sy
OWNER -BUILDER DECLARATION
1 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:
❑ 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& I 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 carper and policy number are:
Carrier S7`/J �.x PLIAla
Policy Number 27 Z.o Z
(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
forthw' ' comply with those provisions.
X _ Date 5__-S-- O 3
Signature of Applicant - Owner Ek Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service TO 46.00
CCU000A
NEW CONST. DWEWNO OCCUP. SO
DWE200ALLING
OR ADDNS. ( 8 ACC. BLDS. 3.5¢'.
NEW °E
SID. MULTI.OUTLET
@7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
EX. Occup. OUTLET OR FIXTURES
-00
BAL O I.50
Ex. Occup. .F',LEjE7g qp °Ep 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring
23.00
PERMIT FEE S
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
Gcc
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
indicated above for which fe have been
Date
PERMIT EXPIRES ONIY7(Q&b
I ffe
provisions
to do work
paid.
&/5/03
41
Receipt No.
WHITE-D.D.S.-B.D. C A - SSOR PINK -INSPECTOR GOLDENROD -APPLICANT