HomeMy WebLinkAbout040-170-119TF�-
SI I I GORE, Gus, Sons L 189-68B
189-68P i!
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040-170-119 02.2154 e/s Cummings Rd. 15001 no. of Durham roville
PORTER, LARRY Hwy., Durham
9512 CUMMINGS RD., DURHAM (new single family)
CONT: JIM WATTS
WATER HEATER
-- I .. ---.; --- --.- --..1 81
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 RMIT Ing, e
(Rev. 12/96) APPLICATION AND PERMIT �� "/�-,�`
ASSESSOR PARCEL NUMBER IJ'� / . �� e
ZONINA
BUILDING PERMIT
OWNER .� ��z �.��
/.
T LEPII"�003+
LN•
SO. FT. OCC. BUILDING VALUATION
. OWNERS OREL_ � ;
-n Al. /J,! S �'� �.%A-� I�I �w /
CONTRACTOR'S NAME
J d� &r
TELEPHONE
Z- 7,62
COM T �i 5 MAILI DRESS
U
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Fee $
20.00
—Filing
Permit Fee $
ARCHITECT OR ENGINEER'S MAIUNG ADDRESS
Plan Checking Fee $
BUILDING ADDRESS `
J
Energy Plan Checking Fee $
PI , M
PERMIT FEE $
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
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 ❑ Addition ❑/ Remodel ❑ Utilities ❑ Installation 10Other fg1
Describe Work: W '?re, //G//�'L'� /Q
Gas piping system 1 - 5 outlets
15.00
Buildin sewer
1 5.00
Mobile Home I S I G I W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT I
Fling Fee 20.00
600VOR 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 "ll fand effect.
License Class (i��(O Lic. No. /� �i
OWNER -BUILDER DECLARATION
I 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'
C
compensation, as provided for by section 3700 of the Labor ode, for the
/performance of the work for which this permit is issued.
141111 have and will maintain workers' compensation insurance, as required by Section
3700 of the labor Coob, for the performance of work for which this permit is issued.
My workers'co insu carrier and policy number are:
Carrier
Policy Number
(The above sections need not be co late if'Me 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, an agree that if I should become subject to the
rs' compensation provision of section 3700 of the Labor Code, I shall
forthwl comply with vi • ns.
__ Date
f App 'can - wner ontractor ❑ Agent -
S'(natur of/App,
n OSH p rmit is squired for excavations over 60" deep and demolition or construction
f struct es over 3 stories in height.
Main Service WELL To 46.00so
NEW CONST. DWELLING .
OCCUP.CCU
OR ADDNS. ( 3 SQSOFT.
NEW CONST. MUL�TICOU�TLET
NON•RESID.
@7.50
POWER APPARATUS
BSINGLE OUR ET CIR.
00
EX. Occup. OUTLET OR FIXTURES BAL @ I 0
Ex. Occup. oUTiFTs RE,D.DE. 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
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 $ 3
HA2. D. FEES IMP FLOOD
CDF
PARCEL
PD
HD
SUE
This permit is hereby issued under the ap le provisions
of the Butte County Code and/or Resolutions to do work
indicated above for which fees have been paid.
v v t
Bye, Date
PERMIT EXPIRES ON
Date
Receipt No. J�B%z
WHITE-D.D.S.-B.O. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT