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HomeMy WebLinkAbout040-180-004ANITA M `-40-18-04 9487 Midway, Du P6rmit#1-89P(insffall.g t�l-1 - �g ip'n Cont: Artic 40- Per I 8-89P,E(installattic urnace) 3825--:-90P.- *').'MILLER, Anita 9487 Midway, Durham---, n,tr:,James Watts Sgas 040-180-oj+'991202'. � DURHAM UNIFIED Scl-1001.' 1 DIS'l, 9487 MIDWAY; bului,,�m,'c rl CONTR: GEORGE ROOFING RE RooF ,� t. .. - ; C' � - i k' � `k�� ' c it , __. l j� .. � � A � � �.. '' . COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 479-7- ASSESSOR 9 ASSESSOR PARCEL NUMBER ../ Q OD ZONING BUILDING PERMIT OWNER ..'Urham Unified School District TELEPHONE 89'i-4675 SO.'FT. OCC. BUILDING VALUATION 2000 com 1200.00 OWNERS MAILING ADDRESS 'o Fox 30U, Durham, CA 95938 CONTRACTOR'S NAME Gorge Roofing TELEPHONE 533-6393 CONTRACTORS incADDRESSBlvd Oroville CA 95966-7716 CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS. Total Valuation $ 1200.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 29.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan CheckingFee $ BUILDING ADDRESS 9437 Midwa Durham CA 95938 Energy Plan Checking Fee $ $ PERMIT FEE S 49.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SFJb Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK v New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Composition Shingles Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 1 @20.00 PERMIT FEE S d600V ELECTRICAL PERMIT Fling Fee ,� 20.00 OR LES9 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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 fq rhe and effect. License Class t'—'� i14, 9L LIC. No. 452266 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: I ❑ 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. ❑ 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 Io00A • 46.00 ,DWELLING NEW CONST. OCCUP SO ORIADONS. ('.. .78 ACC. BLD S. rNION-REgNpT MULTSRANCI- OUTLET • CIRCUITS 97.50 POWER APPARAT B SINGLE OUTLET CIq, Ex. Occup. 91ALETOR FIXTURES 20 @ 1.00 SAL @ .50 WLNS . ETs R..6.OEA 5.00 —Ex. Occup. ..FI 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 conseh)fAo self -insure for workers' compensation, as provided for by section 3700f the Labor Code, for the performance of the work for which this permit is i ed. 1 have and will maintain workers' compensation instrance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Cawork com,epsa p� i T�oF ca • oli u leer are: rrieriiii4►/vf'd rliirs�Y ap_,grid,r�.pvu�1J�tr Policy Number"�-+ 3 (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 forthwith comply with those provisions. / X _ i':!' ,_',Z a tin Signature Applicant - ❑ Owner c[_3:Pontractor Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 49.00 HAZ. 0. FEES IMP FLOOD COF PARCEL I PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By `�-t Date _ PERMIT EXPIRES ON 7 ` Z" v Date Receipt No. WHITE-D.D.S.-B.D. CANARY -ASS SOR PINK -INSPECTOR GOLDENROD -APPLICANT} COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. (Rev. APPLICATION AND PERMIT 99 JQ,� i ASSESSOR PARCELNUMBER % O ^ DVy , / 7Vl ZONING BUILDING PERMIT OWNER Durham Unified School District TELEPHONE 895-4675 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS Po Box 300, Durham, CA 95938 2000 Com 1200.00 CONTRACTOR'S NAME George Roofing TELEPHONE ' 533-6393 CONTRACTORS MAILING ADDRESS 6810 Lincoln Blvd, Oroville CA 95966-7716 CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ 1200.00 ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 29 .00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 9487 Mi dwa Durham CA 95938 Energy Plan Checking Fee $ $ PERMIT FEE $ 49.00 LAT NO. SUBDNISIOWS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF X] 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 tv9 Other ❑ Describe Work: Composition Shingles Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 Main Service zoonORLEss 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license s i II f rae a effect. License Class — r `� r Lic. No. 452266 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BLOB. SO 3.Sa FT. NEWCONS9 NON FIESID? = OUTLET cIR @7.50 a OWELR ovi qR. Ex. Occup. OUTLET OR FIXTURES 20@'.00 BAL @ .SO Ex. Occup. ouiEi TS RE�SO°ER" 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. 0 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for theperformanceof work for which this permit is issued. My work V illaIlOV3 i 1nsurarnceand-policy number are: Carrier V ompany MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy NumberWC1 20537019 (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 forthwith co ply with t ose rovisions. X _ a Signa ure pplicant - ❑ Owner ontractor Agent O An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 49.00 HAZ. D. FEES imp FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have c By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. /� /_�/Q Date Date Receipt No. X i WHITE-D.D.S.-B.D. CANARY -ASS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT +`t r *4jV'' f' rXvP • . fx e � i�ik� 'i�r�.F�117 1 +`' e-` ' A 40-18-04 3825-90P MILLER, Anita 9487 Midway, Durham Contr: James Watts i (gas',P1Pe/sf ) 4 1 OFFICE COPY t Address M Iyt GAS `h { Meter_ By %-7 "'^ ELECTRIC Meter By Date / COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT f� ASSESSOR PAR E'_ NUMBER # _180-004 ZONING _ BUILDING PERMIT OWNER Anlita Mi TELEPHONE 342-5890 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS Box 97, Durhnm 95938 CONTRACTOR'S NAME WattsJames TELEPHONE CONTRACTOR'S MAILING ADDRESS 4 R Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 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 9487 MUway, Purahm 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 E9 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 J. Building sewer 5.00 Mobile Home S I G W 110.00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other] Describe work: Gas Piping _ Permit Fee $25 Minimum fee$ 25.00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1001 OR 0 AMP ORLESS10.00 Main service EA. ADO'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare der penalty of perjury (Check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Profession C de _and my license is in full force and effect. License No. Classification �y � ❑ 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 CONST. DWELLING OCCUP.&\ OR ADONIS. ( ACC. BLDGS. I Z�,20sq ft NEW CONSTR MULTI -OUTLET NON•RESID BRANCH CIRCUITS 2.50 ea POWER APPARATUS e (SINGLE OUTLET CIR. I Ex. Occup(OUTLETS OR FIXTURES 20@50QeAL@30 FIXED AP Ex. OCCUp. OUTLETS P(RESID.)LNS.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 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 Cooling 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,-casts,/abd expenses which may in any' way accrue against said County in cons�4 ' e oft granting of this per it - ' / X \ �''� Date �� Q Signature of App icant — Owner❑ Contractor g��AgentEj/ 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 $ occ CONST TYPE TOTAL FEE $ O HAz I CUA PARK SCHL I FLD I PAR I PD HD Issu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees DIRECT9R OF PUBLIC By / PERMIT EXPIRES Date _ r the applicable provi- resolutions to do have been paid. WORKS Date ZA A`'Fo /f'/4- 9/ Receipt No. 84016 WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE -APABE TMENT OF PUBLIC'WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL,NUMBER 040-180-004 ZONING _ BUILDING PERMIT OWNER Anita TELEPHONE SO. FT. DCC. BUILDING VALUATIQ, OWNER'S MAILING ADDRESS DUr ham ()5938 CONTRACTOB RS NAM TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace LR CONSTRUCTION E DE UNKNOWN Total Valuation $ 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 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 © Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 -,5 outlets 1 5.00 5.00 Building sewer 5.00 Mobile Home S I G I W 10-00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other g] Describe work: Gas Piping _ Permit Fee $25 Minimum fee$ 25.00 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare der penalty of perjury (check one): I am licensed under provisions Of Chapt. 9, Div. 3 of the BuSlnesS and Profession de and my license is in full force an effect. License No. Classification C 3 ❑ 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 CONST. DWELLINGoCCUP.& OR ADDNS. ACC. BLDGS. I , /iosgft NEW CONSTR MULT'-OUTLET NON-RESID BRANCH CIRC ITS 2,50 ea /POWER APPARATUS .&) (SINGLE OUTLET C'R. ( Ex. Occu p\OUTLETS OR FIXTURES 20®g0` sAL®30 FIXED APLNS. Ex. Occup. OUTLETS (RESID,)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): ❑ Th ermit is for $100.00 (valuation) or less. 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 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 -menti ned property for inspection purposes. i (tie , judgments sts nd expenses which m*nan way ccrue aid ounty in ns granting of thThis knOagr to save, indemnify a keep harmless the County of Butte against P�,20'24EA IV 'VD f Ap icant — Owner❑ Contractor age permit is required for excavations over 5'0" deep and demolition or construct- tructures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ HAz CUA PARK SCHL FLD PAR PD HD Issu permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees DIRECT R OF PUBLIC By PEFXT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date Receipt No. 84016 WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPAFvT 0�= PUBLIC WORKS - BUILDING DIVISION y. 7 COUNTY CENTER DRIVE - OROVIL�E„CALIFORNIA 95965 - TELEPHONE: 916/538-7541 r. PERMIT APPLICATION DATA SHEET Permit No. , OWNER T`-1: l / A. P, .No. Lfa — o ^ ® GI Proposed Building Use S Building Inspector _ Date ZZ –%Z _i'10_. At time of permit application, I was advised the following data'mLst be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted . .................................... 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form .......................................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings .............. 8. Engineered truss details and layout in duplicate (required prior to plan check) 9. Mobilehome installation data including man ufacturer'.s;-installation instructions ..................................... = ”".............. 10. Fees of $ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec. request to Building Inspector (Date) 921. Contractor's license information (No., Name Style, Classifications ... 2. Certificate of Workmans Compensation Insurance ................... 4V6 23. Owner -Builder Verification (Given to owner ❑, Mail to owner 24. Recorded copy of Agricultural Acknowledgment Statement .... i 25. Letter of signature authorization .................................. 26. 27. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other Applica Date Copy of plans sent Health Dept., FirD t., Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone----naiI—counter by ..date Contractor, designer, owner, was advised of above required data by—phone—mail—counter by date 't Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW COUNTY OF BUTTE.- DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive Orov re, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER Q e_ ZONING BUILDING PERMIT OWNER z4.",en TELEPHONE � 4/2 _5 70 . SO. FT. 0%C. BUILDING VALUATION OWNER'S MAILING ADDRESS Y' aA0 CONTRACTOR'S NAME - :S,o W"P s /As TELEPHONE CONTRACTOR'S MAILING ADDRESS 4 /0p � C�xtKC0 Fireplace CONSTRUCTION LENDS UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee$ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 ,S 93 9 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 55,00 Each qas water heater or vent 5,00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 S' Q -- Building sewer 5.00 Mobile Home S G W 0.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Describe work: G 112 G Permit Fee Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1000V OR 0 AMP ORLESS10.00 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. 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) ❑ 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 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING oc CUP.B, OR AODNS. ( ACC. BLDGS. !z¢sgft NEW CONSTIRULTI.OUTLET NON-RESID BRANCH CIRCUITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20I50t BALI 30t FIXED Ex. Occup. OUTLETS P(RESID,)REA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 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. Contractor MECHANICAL PERMIT Filing Fee - 10.00 Heating Cooling g Hood 3,00 r 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. 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 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 $ occ CONST TYPE L� p TOTAL FEE $ HAz I CUA PARK I SCHL FLo I PAR Po HD ISSUE Th;s permit is hereby issued under sions or the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS Date Receipt No. WHITE-O.P.W.. YEL,OW-ASSESSOR, PINK -INSPECTOR, SOLDENROO-APPLICANT COUNTY OF BUTTE - DEPARTMENT—OF PUBLIC VORKS� PERMIT NO. " 7 County Center Drive - Oroville, California 95965' - Telephoner 9i�e/538 7541 I APPLICAYIOWAND PERMIT + ASSESSOR PARCEL NUMBER / 4,/ ZONING - 'BUILDING PERMIT OWNER ,4 Al�'f�,. 41, filer TELEPHONE 3Y)- 58`tD SO. FT. OCC .• BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME e,), TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation ls Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee IS ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 w Each Trap 2.00 .-- k T Q 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❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 °�i S v Building sewer 5.00 Mobile Home S G W 0.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Lj Installation ❑ }Other ❑ Describe work: �� , J r /, 1 /,'.v e- 2-e I V Permit Fee /YJ,.v {e _ $ 10"S.?—D Contractor ELECTRICAL PERMIT Filing Fee 10.00 • I 600V OR LESS Main service 100 AMP OR LESS 10.00 Main service EA. ADD'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 theBUslness 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 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.a , OR ACDNS. ACC. BLDGS. �z¢sgft NEW CONSTR. MULTI -OUTLET NON.RESID .BRANCH CIRC TS 2.50 ea /POWER APPARATUS e (SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES 5AL0ALe30 FIXED APPLNS. OR11 Ex. OCCUp. OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 9 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 Filing Fee 10.00 Heating Cooling 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 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,jcosts, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X "• Date �i �, / 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 $ TOTAL PERMIT FEE $ '25, occuP. CONST.T7 SCHOOL FLOOD PARCEL I PD I HD 1 lssu This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which - DIRECTOR OF PUBLIC l BY 1 ' ': I V f r _ / PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date -� Receipt No. -7 % WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD-AP►LI CANT ,to -1G-9b COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California85965 - Telephone: 916/538-7541 I [) 1 APPLICATION AND PERMIT V [) / ASSESSOfa CE'NUMBER \"C'_ is V ZONING I BUILDING PERMIT OWNER ` �4� /• { /" A,vOWNER'S TELEPHONE 3q; 7 y( S0. FT. OCC. BUILDING VALUATION MAILING ADDRESS D CONTRACTOR'S NAMETELEPHONE ff s r CONcTIACTCO�R'S MING ADDRESS 011 O �1'i ,C D /� j/��► (,a Fireplace CONSTRUCTION LENDE 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 ' f ` Each Trap 2.00 Zr DA reJLAA Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PA CEL MAP Water piping 5.00 Each qas water heater or vent 5.00 , /' USE OF STRUCTURE SF" Duplex❑ Mobilehome❑ Other S SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W O.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ In�fallation Other Describe work: r' /Jill! `1 .4V,X/ C m'rA-1to4r 'C toe. .0 w. w f ( • Ll t'Nd C C A r a1 fi' Permit Fee $_/5 Contractor ELECTRICAL PERMIT Filing Fee 10.00 s1 Main service SS 1100 AMP OOR R LESS 10.00 Main service EA. ADO'L too 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 Business and Professions Code and my license is in full force and effect. License No. Classification EJ 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 r NEW CONST. DWELLING OCCUP.0i , OR ACDNS. ACC. BLDGS. /z¢sgft NEW CONSTR.MULTI-OUTLET NON.R ESID 2,50 ea BRANCH CIRCUITS) CM CRC ITS POWER APPARATUS6) SINGLE OUTLET CIR.) + Ex. OCCUp(OUTLETS OR FIXTURES 20050t eAL030 Ex. Occup. OUTLETS (RESID.)REAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. IYirin g 15.00 Permit Fee $ 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,0e Labor Code, you must forthwith comply with such provisions or this permit;sftalI-be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating ao d 0 ' Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read.tpfs,lapp,+tcation and state that the above information is correct. I agree to comply to'aH•Oounty 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. Signature of Applicant — Owner ❑ Contractor Q 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 $ TOTAL PERMIT FEE $ Occup. CONST.TYPC JSC.00LJ FLOOD PARCEL PD ND s5 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 paid. DIRECTOR OF PUBLIC WORKS ByM, Date 2 ,1 U PERMIT EXPIRES Date r Receipt No. k LG%1 3a a_ "'�? _ WNIT[-D.P.W.. YCLLO W-Aee Ce eO R, PINII-IN eP6CTOR, GOLD IN ROC -APPLICANT 4 COUNKY OF BUTTE k..DEPARTMENT OF PUBLIC WORKS 196 Memo i.al Way,Chico — Phone: 891-2751 7 County Centert 04. OroviIIe — Phone: 538-7541 747•EIliottRoad, Paradise—Phone: 872-6307 CORRECTION NOTICE 3fi OWNER, PERMIT NO. A. routine inspection indicates that the following violations of County Ordinance exis.tJat'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 s matter, need additional expl"enation, please contact this office immediately. ? OA .. .. n • .rte / A. If 82 U,,t.0 r t. r Inspector Date �� COUNTY OF BUTTE DEPARTMENT OF PUBLIC�WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 .F CORRECTION NOTICE J 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 Date COUNTY OF BUTTE y, DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — PYvone: 891-2751 7 County Center Drive, Orovi Ile — Phone 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE lei -2 7 89 OWNER / 49-p?ERMIT NO 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. PIDU/c�C �o/, t ec `i(7 iI S RPGL. -j-?Ie Q •� o! l� Q 91,E oS � �r� a � ,L k SAO r c f e �. d r Aor C asaC- a," Q," o� _fin �' �U 0"l oil -e TQa /'C'- W -P �lPa u �C' a Date A-> �� Inspector COUNTY OF BUTTE -ZEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION'AND PERMIT j C� ASSESSOR PAR L NUMBER Q �- / —O ZONING BUILDING PERMIT OWNER AAj;4,a__ r e TELEPHON 315��1,0 SO. FT. OCC. BUILDING VALUATION OWN R'S MAILING ADDRESS - CONTRACTOR'S NAME i` c. TELEPHONE 5 3''✓3C� CONS,RACTOR'S MAi ING ADDRESS 47- V3 (Q// w 2 C�;�a Fireplace CONSTRUCTION LENDS UNKNOWN Total Valuation .� LENDER'S MAILING ADDRESS Filing Fee $ 10.00 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 Q Each Trap 2,00 DIA�-� 6LAA Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PA EL MAP Water piping 5.00 Each qas water heater or vent 5.00 1, USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 0.00 ea TYPE OF WORK llation Other [ New ❑ Addition[] Remodel ❑ Utilities ❑ IXw' Describe work: ;C e �/d ! -e— /�y11Zc_ r,&A Lie— alcre_ wa_ct :fu.rwace_ 41-e.AJ4— Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 OR Main service 1DD°o AMP ORSLESS 10.00 Main service EA. ADD'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 BUSIneS$ and Professions Code and my license is in full force and effect. License No. Classification ❑ 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) ❑ a e owner, am exclusively contracting with licensed contract - o (Set 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.8', OR ADDNS. � ACC. BLDGS. Aesgft WCOBRANCHCONSTR '.OUTLET 2.50 ea POWER APPARATUS tr SINGLE OUTLET CIR. Ex. OCcup(OUTLETS OR FIXTURES 200902 eALO 30 FIXED Ex. OCCUp. OUTLETSP(RESID•ILNS.REA.� 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. qa I have placed on file with the County of Butte Building Department W 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Zf O 0 O "a Cooling g Hood 3.00 Ventilation permit Fee $ , p1L� 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� 7Date a Z Signature of Applicant - Owner ❑ Contractor LK Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion ofstructure r 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.TYPE JSCI100LJ FLOOD PARCEL I PD 1139 This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which REC 110 PUBLIC By ZI PERMIT EXPIRES ate �- the applicable provi- resolutions to do fees have been paid. WORKS ate Z Receipt No WHITE-D.P.W.. 7 3 a27=2 LOW-ASGE330R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS >M 7 County Center Drive - Oroville,•Cal'ifornia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT P ; IT r ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT\J OWNE TELEPHON 3y�-58{� SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS /� f1b 1B » � D I& r G>, CONTRACTOR'S NAME O 1.19 .V t f - TELEPHONE _ CONTRACTOR'S MAILING ADDRESS 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 I Each Trap 2.00 Solar or heat pump water heater 20.00 _ LOT NO. SUBDIVISION NAMEPARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S G W 0.00ea . TYPE OF WORK New ❑ Addition❑ Remodel❑ Utilitiese Installation❑ Other ❑ Describe work:aa25 /,,,v e__ e 42I'a Permit Fee j'YI;•v e $ q,'w 0`0 Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 10ov OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD•L 100 AMP -LIP. 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I am licensed under provisions of Chapt. 9, Div. 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 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 OCC , OR ADDNS. 1 ACC. BLDGS. / �22Sq ft NEW CONSTR. LTI- OUTLET NON.RESID .BRANCH CIRC ITS) 2,50 ea POWER APPARATUS 6 (SINGLE OUTLET CIR. 200305 Ex. Occup(OUTLETS OR FIXTURES eALO 30 FIXED APPLNS. OR Ex. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �Yirin 15.00 g Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): The permit is for $100.00 (valuation) or less,. ❑ 1 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 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 said County in consequence of the granting of this permit. X (�(i�,i 7r? ��� Date / �/ 7 �� % '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 $ TOTAL PERMIT FEE $ o25,� Occup. CONST.TYPE SCHOOL FLOOD PARCEL PD ND 39U This permit is hereby issued under sions of the Butte County Code' and/or work indicated ab ve for which R TMFPUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date /_` 2 �jr� /'— / / — / D Receipt No. -'-) J � I WHITE-O.P.W.. YELLOW -ASSESSOR. PINE -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965- Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention 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 theV labor and materials for construction of the proposed' property improvementor no) 2. I �tiav /have not) signed an application for a building permit for `fhero osed work. P P 3. I have contracted with the following person (firm) to provide the proposed construct'on: C Name J Address tL. city C-0 Phone Contractors 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 7— Address Address City t C'C� Phone Contractors 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 IZ vim d S Gess Signed: Property Owner Social Security Number Date/�� /�' 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 per- mitted to -issue the permit.