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HomeMy WebLinkAbout040-200-083040-20-0-083 0( KEENEY, Bud 2243 Durham Dayton 1 (reropf/SF) Johnson F/N� 4-/4- zaoo -• i A ' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILD DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (53 38-7�4a''!_ 0 C/ P IT NO. (Rev. 12/96) APPLICATION AND PERMIT ((�1((JJ V/� / ASSESSORPARC0. O Z N° BUILDING PERMIT OWNER TELEPHONESO, r Fr. OCC. BUILDING VALUATION . OWNER'S M4f DRE .� WS 01,710% noanb. CONTRACTOR 'S''NAME i- 7 TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ I` 0 ARCHITECT OR ENGINEERS MAILING ADDRESS -. Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ U ko $ PERMIT FEE $ LOT NO. SUB DIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Feel 20.00 USEOFSTRUCTURE SF,,© Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 1 7-00 Solar or heat pump water heater 23.00 Water piping 1,.5.00 Each as water heater or vent�''5..DD TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ 1 stallation ❑ Other ❑ _ Describe Work: (' j� v " Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home I S G W @20.00 PERMIT FEE $ r ELECTRICAL PERMIT Filing Fee 20.00 80OV LE Main Service 2o0.OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am license , 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. License Class Lic. No. 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. O 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permitis issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (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 �j4 Date • �` '�'� d Signature of Applicant - l Ownor ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over) 3Ls�tories in height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( a ACC. BLDS. s0 3.5¢FT, NjON•RESID. RANCHO RCUT rUITS @7,50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. OCCU OUTLET OR FDRUREs 20 Q 1.00 BAL ® .SO Ex. Occup. O.RES ) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ nDc .� TOTAL FEE $ HAz. D. Mp .... FLOOD i cDF PARCELPD .�- HD SUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work Indicat above for which fees have been paid. B n ;) t,�,�I �:C.GGo Date 7 y U ,,, PERMIT EXPIRES ON �� 1 42)�'� ata Receipt No. C; t_T WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT f OWNER A /econti a co pl COUNTY OF BUTTE ' r BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street• Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE PERMIT NO. pection indicates that the following violations of butte county Ordinances exist at the ss and should be corrected. Please notice this office when correction of work is If you have any questions pertaining to this matter, or need additional explanation, Icythis off' a immediately. ✓ lZ LT .L. Date !�/ ©� Inspector REV 10/92 u3S P/ / +.. � .. v.: *-+..x�. -.,J x �� -: 't=•'t�L7."'Fvh= ice''".;.'-�.JT�:s ��+'�=.z,Z„y'�''e="".+^ COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE OWNER Oyt 7 PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. v S' AIA oA.--c, -!-u Dater+ " i — a O Inspector REV 10/92 .' fi"..--. �`.51:.. �'1lY"r!•rb'1�+X',./�7CJ�..f�jt?a�.+`Yr'�t�+:'�9wr. yG _ .wil COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES` 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541 CORRECTION NOTICE KC G 6'r"A 0c-)�7 oql % OWNER f PERMIT NO. A routine inspection indicates that the following violations,of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have;any questions pertaining to this matter, or need additional explanation, please coma fhis office immediately. 1 N/*a tlAiA-r 42fh 7e..1/eA ea"z /2%"/ G° ©- N -C 1 ri 'I.-I�g 4 ,10'-141 A Pw%Eq2 ni V e, dt'� 9j— b� IujJs Irin....r..�o�w �c. - Date A ^ �� '- Inspector REV 10 92 u�j "' 8, COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILD DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (53538-7((J�it9_ /10� / IT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSORPARZ p� BUILDINGPERMIT OWNER TELEPHONE. SQ. FT. OCC. BUILDING VALUATION MotsonJ OWNERS MA ORES CONTRACT. E 1 1 TELEPHONE CONTRACTORS "UNG ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCH'TECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ $ kU PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Feel 20.00 USEOFSTRUCTURE SFX 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 ❑ I Ration ❑ Other ❑ Describe Work: V v Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service ".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 in full force and effect. License Class Lic. No. 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 Main Service 200A T. 46. NEW CONST. DWELLING O DWELLING CC P. CU OR ADDNS. ( 6 ACC. BIDS. o SO s 3.5¢FT. RpµgaI.T' MULTI-EIRANC.OUTLETUrs @7.50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR PlxruREs 20 @ 1.00 BAL @ .50 Ex. Occup. oui�iE Ao .OE 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. ❑ 1 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 carrier and policy number are: Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I 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 W"__ Date �� Wd" Signature of Ap lic nt - Own r ❑ Contractor ❑ Ag n� An OSHA permit is required for ex avations over 5'0" deep and demolition or construction of structures over 3 stories in hei ht. Mobile Home Installation Fee $ Energy Inspection Fee $ Occ -� PE t - TOTAL FEE $ , HAZ D fEI -fMP I FLOOD I CDP pggCEL poiHD ISSUE This permit is hereby issued under the applicable provisions of the B,�e County Code and/or Resolutions to do work indicat 8 above for which fees have been paid. //jj By j'�Q _ j�, &a `Date PERMIT EXPIRES ON Date Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT I COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION, 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-754)9D,O 11170. tRev.12/96) APPLICATION AND PERMIT O / / ASSESSOR PARCEL NUMBER 1 ZO IG BUILDING PERMIT OWNER _ TELEPHONE 34 3--3`� SO. FT. OCC. BUILDING VALUATION - _� _ -[j0 I —. OWNER'S MAI R SS \� 7Q S_ ] JLC) Alu E, CONTRACTOR' f 'LJJ`/I TEI.EP O E L I I CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MA,UNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ N 6' O ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ $ PERMIT FEE $ IDT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SFA Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ,❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: 62 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W Co) 20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service ".*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,NowAalo and my license is in full force and effect. License Class IL No. 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. ❑ 1 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 carrier and policy number are: , Carrier Policy Number (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 Date _ Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structuresov rie i Main Service Zoog To ,000A 46.00 NEW CONST. OWEWNG OCCUP. SO OR ADONS. a Acc. BLns. 3.5¢FT; MULTI -OUTLET 97.50 POWER APPARATUS 8 SINGLE OUTLET CIR. ovrLErORFocruREs Ex. Occu ani x:50 Ex. Occup. GimtDrs PR=.GEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEI: $ Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $� HAZ. D. FEES IMP I FLOOD I COF PARCEL PO 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 Date PERMIT EXPIRES ON Dale ReceiptNo. 60 WF'ITE-D.O.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT' .+yr.:..{;+,: �•aF:,.s-,-....�.��. a.--.,sv�•e.+F:x�z:a:S..�T:,.ra��,�.�..c:,,,s...,a..--•,_. ,..�r-y ��-•c.�{;y"k3F?9S�v�"''�,: �s,•�5,,�'wv:� .._:x,s•..._:s:`►F.'"t� E 0-20-0-083 ENE 00-0470 BI Y, Bud43 Durham Dayton Hwy, Durham roof/SF) Johnson Roofing i I :. .,a�agylRwr,+wye^�re'vaw+� A-aDR•�rser=;pa-ts- a COUNTY OF BUTTE -,DEPARTMENT OF, DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-74j, PERfyjIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER � t^ ZONING: BUI ING PERMIT OWNERTELEPHONE r,,,I .. y3- o� SO. Fr, OCC. BUILDING VALUATION OWNERSMAILING ADDRES51 i _ 1 +. `/ -2)rl - , 1 f 1 CONTRACTOR'S NAME 1 TELEPHONE CONTRACTORS MAILING ADDRESS .4 CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ .� ARCHITECT OR ENGINEER LICENSE NO. Flin Fee $ 20.00 Permit Fee $ , O"0 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ PERMIT FEE S o0 LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF O --'-Duplex ❑ Mobilehome ❑ Other sPECIFv ` 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 t New ❑ Addition ❑ nRemodel ❑ `Utilities ❑ Installation ❑ Other jK Describe Work: !C ([� C"� T 1,t�� /'�►yyC� 1 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ? ELECTRICAL PERMIT Fling Fee 20.00 Main Service zoOAOOOvA OR LESS 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.I I License Class Lic. NO. ' OWNER -BUILDER DECLARATION y I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: l ❑ 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 Co a for this reason ( Main Service 200A To 1000A 46.00NEW CONST. DWELLMK9 OCCUP. OR ADDNS. ( DW: Acc. BLns. SO 3.5¢FT: MUET IpµR�lp T.LTI-OUTL 97.50 POWER APPARATUS a SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES SAL ®`, 0 SPPA FIXED ALNS. OR Ex. Occup. GUTRID, EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 PERMIT FEE S 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 Cod, for the performance of the work for which this permit is issued. ❑ 1 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 carrier and policy number are: I Carrier MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) I 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. 1f %% , X , 1, A .r. r �1f�1.h Date `moi .0" j� (:41' Signature of Applicant - ❑'Owner ❑ Contractor ❑ Agent r 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 $ �p HAZ. D. FEES IMP I FLOOD I COF PARCEL PO 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. I( !y� t —� By N Y 3S 1_- _,A.1 _--_ ' Date -3/W PERMIT EXPIRES(ON / / Date Receipt No. �1 �] �� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DI ISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7.V41_ ER T NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER p --ava - ZONING BUI ING PERMIT OWNER ;,� TELEPHONE 35!3-8'x7 SO. FT, OCC. BUILDING VALUATION no OWNERS MAILING ADDRE$,S_ dill V1./) d7tI / CLWL CONT CTOR'S NAME S 1 A.- TELEPHONE CONfCTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ , &0 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checkin Fee $ BUILDING ADDRESS 9-..2-q3 Energy Plan Checking Fee $ I $ PERMIT FEE S Oo LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE *--Duplex SF Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat um water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK / New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other a -," Describe Work: %Z �� p [7 T W/ CB- Gas piping stem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G 1 @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service %.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 in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION.50 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. kitj 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 ( 8 ACC. SO 3.5,s CNS. NEW OUTLET ReSID T.MULTI-OUTLET CIRCUITS @7,50 POWER APPARATUS 8 SINGLE OUTLET CIR. EX. Occu OUTLET OR FIXTURES en0 g 1.00 Ex. Occup. OUTLEEOTs RESID.) OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE S 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. ❑ 1 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 carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) -- I 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 wi h those provisions. X _ Date LO) _ Signatur'e of Applicant - rTowner ❑ Con actor ❑ Age6t An OSHA permit is required for excavations ov60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ , o v HAZ. I D. FEES IMP I FLOOD I COF PARCEL I PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date -3464 a efe Receipt No. WHITE-D.D.S.-B.D. CANARY• S SSOR PINK -INSPECTOR GOLDENROD -APPLICANT a