HomeMy WebLinkAbout040-211-003r-
- AP 40=271-3 _
RUTH COLE
2121 Putney. Dr.._,..D .` ham --
/2h7Permit# 3986-74B
040-21-1-003 91-3773
= MCCL-UMON-",• -R-UTH _
CONTR: JENNINGS ELE.0
9415 PUTNEY DR, DURHAM
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BUTTE COUNTY INTERDEPARTMENTAL CORRESPONDENCE
DELIVER TO LAST PERSON NAMED
DATE
NAME
DEPT.
I DATE
NAME
DEPT.
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r 40-21-1-003 91-377+3
MCCLUMON, RUTH
CONTR: JENNINGS ELEC
9415 PUTNEY DR, DURHAM
UNDRGRND•ELEC/SF
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OFFICE COPY
Address "
GAS Dates
Meter BY
ELECTRIC
Meter BY, '
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
' 7 County Center Drive - Orovllle, California 96985 - Telephone: 918,'538.7541
APPLICATION AND PERMIT
PERMIT NO.
40 -211 -Ml
ZONING
I -
BUILDING PERMIT
OWNER
$91 13$1
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
n ham 95938
CONTRACTOR'S NAM
TELEPHONE
898-1421
CONTRACTOR' MAILING ADDRESS
2321 Honey Run R 3 Chico 95928
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee $ 15.00
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 I
Permit fee $
PLUMBING PERMIT Filing Fee 15.00
I
4415 Putney Dr., %rhm
Each Trap 1 5.00
Solar or heat pump water heater 1 20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
t
Water piping 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF ® Duplex[] Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 15.00
Mobile Home S I G I W @ 15.00
TYPE OF WORK
New a Addition _] Remodel ❑ Utilities [�] InstallationC Other ❑
Describe work: D.U.U•D.
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee 15.00
Main service 200AORLESS 1 18.50
2008 OR LESS 18.50
Main service 200A TO 1000A)
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 Codeandand my license is in full force and effect.
License 'Jo.T91SI 6Classification - C- 10
❑ 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
_37.50
NEW CONST. DWELLING OCCUP.h` 3.54 sq.ft.
OR ACDNS. ( ACC. BLDGS. I
NEW CONSTR. OUTLET
NO N•R ESIU BRANCH CIRC ITS @ 5.00
/POWER APPARATUSe
\SINGLE OUTLET R.
Ex. Occup(OUTLETS OR FIXTURES AO 76d
FIXED APPLNS.
Ex. Occup. OUTLETS iRESID .)OR EA.) I 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring 1 15.00 15.00
Permit Fee $48.50
—
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 becomesubject
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 15.00
Heating
Cooling
g
Hood 6.50
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
again$t said County in consequence of the granting of this permit.
X ----- '� Date ,l0 ' a2 3' 9%
si nature of Applicant - owner
g pp ❑ Contractor N Agent [:]permit is required for excavations over S'�" deep and demolition or
An OSHA YYYY`"���'� construct -
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC CONST YPE
TOTAL FEE $ 4$.50
HAz
1 0FEES I
IMP
I FLOOD
COF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under the applicable provi-
Bions of the Butte County Code and/or resolutions to do
work indicated above'fbr which fees have been paid.
//DIRECT& .OF PUBLIC WORKS
By �'"' 1,, , Date
PERMIT EXPIRES Date /G - 'si-7
Receipt No. 100965
WNITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS R
196 Memorial Way, Chico — Phone: 891-2751 .^
7 County Center Drive, Oro viIle — Phone: 538-7541 = -
747 Elliott Road, Paradise — Phdne: 872-63e
CORRECTION NOTICE
l`(�cCt-�mo�i 3773-9/
OWNER PERMIT 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.
�tRMIrJAIC All rrL- C0- C�Rc�.�rs A,JA
Date ) / — G1 - ci / Inspector /J
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Orovi Ile — Phone: 53¢-7541lip
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
R
PERMIT
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.
Lnspector
t
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916,`538-7541
APPLICATION AND PERMIT
PER �
ASSESSOR PARCEL NUMBER
40-211-003
ZONING
'
BUILDING PERMIT
OWNER
Ruth McClumon
TE_EPHONE
891-1381
S0. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
Durham 95938
CONTRAC TOR'S NAM
TELEPHONE
.TpnnlD898-1421
CONTRACTOR' MAILING ADDRESS
2321 Honey Run Rd.. #33 Chico 95928
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation 4$
LENDER'S MAILING ADDRESS
Filing Fee
$ 15,00
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 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.SUBDIVISION
NAME
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SF ® Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home S I G I W
015.00
TYPE OF WORK
New Lj Addition ❑ Remodel ❑ Utilities ® Installation❑ Other ❑
Describe work: D.U.U.D.
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 200AORLESS
1 18.50 18.50
Main service 200A TO 1000A,
37.50
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 ,do. y93� g -7 Classification t.^10
❑ 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.tr�
OR ADDNS. ( ACC. BLDGS.
3.60 sq.ft.
NEW CONSTR. ULTI.OUTLET
NO N•R ESID. BRANCH CIRC ITS
` 5.00
POWER APPARATUS tr
(SINGLE OUTLET cIR. )
Ex. Occ Up(OUTLETS OR FIXTURESED
20 76
APLNS.
Ex. Occup. FI LETS P(RESI D.)RE A.)
I 3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Iyirin g
1 15.00 15.00
Permit Fee
$ 48.50
—
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.
Contractor
MECHANICAL PERMIT
Filirig Fee 15.00
Heating
Cooling
g
Hood
6.50
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, judgloents, costs, and expenses which may in any way accrue
again t said County 'n consequence of the granting of this permit.
XDate %d -:92 3- 9/
Signature of Applicant — Owner ElContractor Agent Elsions
An OSHA permit is required For excavations over S' "deep and demolition or construct -
ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
occ
CONST TYPE
I TOTAL FEE
$ 48.50
HAz
I DFEES I
IMP
I FLOOD
CDF
I PARCEL
I PO
HDISSUE
This permit is hereby issued under the applicable provi-
of thtte County Code and/or resolutions to do
work in 'c ecl ovr which fees have been paid.
UBLIC WORKS
/ll�-p/
By Date_FO— z3r1Z
PERMIT EXPIRES Date
Receipt NO. 100965
WNITE-D.P.W., YELLOW -ASSESSOR. PINIt-INSPECTOR, GOLDENROD -APPLICANT
_. .+.., .,,,,�--.•"�F7C4F��+r'a�*ryt'+re��.�v{,'�'�$,�y:'",+•eFo.+w�wi,awrprlly:4���Y.7iFjF��jFs;J�yi:Y€ ,ice. E'F r � t i, ms`s' +�..
z
COUNTY OF BUTTE -1 -DEPARTMENT OF PUBLIC,WORKS i BUILDING DIVISIO
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT AP�16X_-T,10N DATA SHEET
Permit No.
,p 1t/ 17�L
OWNER TL `64-0 SC/ (% A : -
RP o. GIQ
Proposed Building Use t1>/J()D i Building Inspector Date
31 AMP
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1. All items have been submitted.
Y.
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 manufacturer's installation
instructions.......................................................
- 10. Fees of $ Y
- 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
-21. Contractor's license information (No., Name Style, Classifications ...
-22. Certificate of Workmans Compensation Insurance ..................
-23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .....
-24. Recorded copy of Agricultural Acknowledgment Statement .........
-25. Letter of signature authorization ...................................
-26.
-27.
(Date)
When you Issue the permit, process as follows: Mail to owner. Mail to -contractor.
Telephone and hold for pickup at office. __D ver w/inspector.
Other w t
Applican
Date 1a12_31,'-71
u
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By
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__nail_counter by ..date
Contractor, designer, owner, was advised of above required data by—phone _maII_coui ter by date
Plans checked by
Sets of plans on hold in
Copy—DPW
Date Plans approved by
File cabinet AP folder
Date
Io COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
OO 3
ZONING
BUILDING PERMIT
OWNERA
,��1
Ro 4* 1 I e- M o.0i
TELEPHONE
F'/ -/ 39-/
SO. FT. OCC.1 BUILDING VALUATION
OWNER/'S MAILI ADOREW-,,-
CONTRACTOR'S NAME
-TGNNtlfj S li(-C C-4-^
TELEPH NE
y/2/
CONTRACTOR'S MAILING ADDRESS
9321 n►< l'2uN 3 t -LV �!S"lZS�
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation is
LENDER'S MAILING ADDRESS
Filing Fee
$ 15,00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDI A KESS / Vol ^__1
!�Av ,
Permit fee
$
PLUMBING PERMIT
Filing Fee 15.00
Each Trap
5.00
Solar or heat pump water heater
1 20.00
LOT NO.
SUBDIVISION NAME
7
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SFXDuplex❑ Mobilehome❑ Other
J!SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home S G W
@ 15.00
TYPE OF WORK{
New 7 Addition i! RelmodjeI El Utilities,} Installation❑ Other ❑
Describe work: �(/y
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service ZOOAORIESS
Main service 200A TO 1000AI
18.501 acz
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I I am licensed under provisions of Chapt. 9, Div. 3 of the Business
LL4�
and Professions Code and my license is in full //force and effect.
License Ao. Y93-? AQ -7 Classification L /D
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 OR ADONS. CONST. ( ACC. SLOGS. DWELLING OCCUP.&)
3.6d sq.f[.
NEW CONSTR MULTI -OUTLET ITS
NON -REST D BRANCH CIRC
la 5.00
(POWER APPARATUS tri
SINGLE OUTLET cIR. /
Ex. Occup(OUTLETS OR FIXTURES
20 75d
FIXED APLNSU
Ex. Occup. OUTLETS PIRESID.IREA.�
3.00
Temporary service
1 15.00
Mobile Home Facilities
1 15.00
Misc. Wiring
x1 15.00
Permit Fee
$
—
WORKMEN'S COMPENSATION INSURANCE
I deciare 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.
F.—el I shall not employ any person in any manner so as to become subject
J"' 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
FiIingFee 15.00
Heating
Cooling
g
Hood
6.50
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 Iia¢¢ilities, judgments, costs, and expenses which may in any way accrue
against said Count in consequence of the granting of this permit.
X J Date /o
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 TOTAL FEE 0r
1
HAz
0FEES IMP
FLOOD
I CDF PARCEL
PD
HD
ISSUE
This permit is hereby issued under
sions of 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.
WMITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
t o c) 3i �3G /z�
PERMIT;NO. 3986-74B
P
E
M
MH UTIL.
PERMIT NO.
PERMIT EXPIRES
OWNER Ruth Cole
CONTR. i
'S
tOCATION (A.P. 40-211-3 )
2121 Putney Dr., Durham
F
Y a
_r
N
1'
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
T mp. Gas Serv.
Called PG&E
JOB
FINALED
(Date)
(Signature)
Setback
Forms
Main Bldg.
Footings
Stemwa l l
Slab
Piers
Garage
Footings
Stemwa I I
Slab
Carport
Footings
Slab
Patio
Footings
Masonry Walls
Reinf. Steel
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION; RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Firewall
Soil Piping
Parapets
1st Floor
Restroom Finish
2nd Floor
Windows
3rd Floor
Siding
To out
Roof Sheathing
Water Piping
Roofing
Sewer
Fdn. Vents
Fixtures
Garage Vents
Water Htr.
Prov. for physically
handicapped
Heaters
Appliances
Conformance of ex.
structure
Gas Piping & Test
Temp. Gas
Final
Sanitation
FIREPLACE
Final
Footing
ELECTRICAL
Throat
Rough
I
Final
FivhorPs
Stucco Final Subpanels
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
DATE REMARKS OR C RRECT ONS'
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WOR ffJJ%
7 County Center Drive — Orovi Ile, California 95965 �0�4
Telephone: 534-4541
APPLICATION, AND PERMIT
auuwrize representatives or the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X a Date -9h?*,/V
'gnature of Permitee or Agent
Receipt No. /F gs:i� S
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
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.
DIRECTOR OF.PUBLIC WORKS
BY r ate l C --J — 7 S/
Iding permit expires Date. ���� —7'�J
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address() , d3s
c_ f �
Tel hone No.
�— •S—�d
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee&/or Penalty
Telephone No.
Permit Fee $
Y
$J
Building Address / `D
PLUMBING No.1 @ FEE
PERMIT FILING FEE $2.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. O
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
W
San' ion
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
I Parcel
I Declaration
Parcel Ma P
60' R/W
—improvements
provements
Lawn sprinkler system 2.00
Bldg. Plans efr'c'd
Parcel Approval
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER (
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
EP -0 1=
Main service incl. 1 meter
Additional meters, each 1.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Sub -panel (12 or less) (more than 12)
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
Light fixtures bal(010
Receps., switches & fix outlets 25
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap, cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No. Classification
Misc. wiring
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
.
5jLl certify that in the performance of the work for which this
ermit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No.1 @ FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 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
TOTAL PERMIT FEE
$ C3
auuwrize representatives or the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X a Date -9h?*,/V
'gnature of Permitee or Agent
Receipt No. /F gs:i� S
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
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.
DIRECTOR OF.PUBLIC WORKS
BY r ate l C --J — 7 S/
Iding permit expires Date. ���� —7'�J