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HomeMy WebLinkAbout040-260-0800 b U .,"2140=91B r•., ,,. 40-26-80 'MARION, Gerald_. 9344 Lott Rd, Durham cont: AMRE (vinyl siding/sf) 8 040-260-080-,- 03-3489 MARION; RUTH & GERALD 9344 LOTT RD, DURHAM INALED Cont: JENNINGS ROOFING RE ROOF 0 ro L� ,i 0 ro ,i q, MQ- r� --�•r...-.-.-�,c:�.f^+C'hif'w-'.y,3,:i[;r����r'I+`f'.�^'`�i�%,;!�1?•"+'i't,.�`:r i..."Abs.�..A�Yt.'i/'•,"��;��/7%�R'!�'��'�s°zro�.���.d1,,�ii.'�C.�;tC*J�ir `• ' i 03- ' 040-260-080 3489 MARION, RUTH & GERALD 9344 LOTT RD, DURHAM Cont: JENNINGS ROOFING, RE ROOF COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville,,Califo;nia 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT rl --� -,--v/ _ Q ASSESSOR PARCEL NUMBER 040-260-080 ZONING A5 BUILDING PERMIT OWNER RUTH & GERALD M BION 342-2 TELEPHONE 17 SO, FT, OCC. BUILDING VALUATION OWNERS MAILING ADDRESS ROAD DURHAM CA 18 SO 1080.00 CONTRACTORS NAME ADAM JENNINGS JENNINGS ROC/ING 899-9 TELEPHONE 6 CONTRACTORS MAILING ADDRESS TRIM CO QM5928 CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ 1080.00 ARCHITECT OR ENGINEER LICENSE NO. —FilingFee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ • Plan Checking Fee $ BUILDING ADDRESS DLMHM Energy Plan Checking Fee $ PERMIT FEE $47.00 LAT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 1 7.00 Solar or heat pump water heater 1 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: RE ROOF Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 800VOR UES Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9N= with Section 7000 of Division 3 of the Business and Professions Code, (commencing ) and my license is in full force and effect. /' License Class Lic. No. 74(�. ___ 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 ADONS. ( 6 ACC. BLDS. SO 3.5,s " CONS ' MULTI -OUTLET NON-RESID. @7.50 PowER APPARATUs 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES BAL ° 1: 0 Ex. Occup. GnxU EosA F,' PR=ORJ 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 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. ❑ 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.) T1 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 1 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'& Applicant- Owner ❑ Contractor ❑ Agent An OSHA permit is-rEI2i d 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 $ 47.00 HAZ. 1 D. FEES IMP I FLOOD CDF 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 i ii i % PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date ale Receipt No. % {( y %��, WHITE-D.D.S.-B.D. CANARY -ASSESSOR' PINK -INSPECTOR GOLDENROD -APPLICANT .. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMITrim -1 XQ ASSESSOR PARCEL NUMBER 040-260-080 ZONING A5 BUILDING PERMIT OWNER RUTH & GERALD MARION 342-2 TELEPHONE 17 SO, Fr, OCC. BUILDING VALUATION . OWNERS MAILING ADDRESS 9344 LOTT ROAD DURHAM CA 18 SQ 1080.00 CONTRACTOR'S NAME ADAM JENNINGS JENNINGS ROOFING) 899-93d8 TELEPHONE CONTRACTORS FLYING VSSTR.EET CHICO CA '95928 CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ 1080.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checkin Fee $ BUILDING ADDRESS 9344 = ROAD DURHAM Energy Plan Checking Fee $ $ PERMIT FEE $ 47.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE 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 O Other ❑ Describe Work: RE ROOF Gas piping stem 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service?DDA 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.POWER License Class Lic. NO. y y 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, army 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.) 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 forthwit comply with those provisions. O / 2 —L9 X Date ( Signature of Appli Owner ❑ Contractor ❑ Agent An OSHA permit' squired for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUR so OR ADDNS. ( 6 ACC. BLDS. 3.5ttFT. NEW ReSIM ' MULTI.OUTLET 97,50 APPARATUS 8 SINGLE OIJrLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ 1'00 SAL @ .so Ex. Occup. ounEED,sA REES,D.OEEA 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 FEt $ Mobile Home Installation Fee I $ Energy Inspection Fee $ Occ CONST. TYPE HAZ. D. FEES IMP FLOOD CDF I 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 a ove for whic have been paid. B Date PERMIT EXPIRES ON Date Receipt No. WHITE-D.D.S.-B. . CANARY -A S SOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE _ DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - OroYille, California 95955 - Telephone: 916/538-7541 APPLICATION AND -PERMIT ASS SSQR PARCEL NUMBER � iC}-26—$0 ZONING A5 BUILDING PERMIT OWNER GERALD MARION TELEPHONE 342--2917 SO. FT. OCC. BUILDING VALUATION • 13� `� 37 OWNER'S MAILING ADDRESSCUM 9344 LIOTT RD DURHAM 95938 ` CONTRACTOR'S NAME AME REMODELING INC. TELEPHONE 371-6151 CONTRACTOR'S MAILING ADDRESS 1400 ENTERPRISE BLVD #D SACRAMENTO Fireplace CONST_ RUCTION LENDER NO UNKNOWN Total Valuation Is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ 104.50 ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 9344 LOTT RD DURHAM Permit fee $ 114.50 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 [�k Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W I 1 110-00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lilies ❑ Installation❑ Other Describe work: VINYL SIDING _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 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): ® 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Prof essio �/ Code and my license is in full force and effect. License No. f 30yZ Classification. C -Io1 ❑ 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- ontract- ors.(Sec. 7044) ors. ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUP.R OR ACDNS, C ACC. BLDGS. / , /zQsgft NEW RES'O R ULT' -OUTLET NON-RESID BRANCH CIRC ITS 2,50 ea POWER APPARATUS .&) SINGLE OUTLET CIR. EX, Occup( OUTLETS OR FIXTURES 0 50t .2A0 30 2AL030 FIXED APLNS. EX. OCCUp- OUTLETS P(RESID.)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. byirin 9 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. XT 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. ❑ Ishall 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 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 Co my in conse ue a of the granting of this permit. X C Date `� �to —�� Signature of Applicant — Owner El 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 $ EHAZ CONST TYPE TOTAL FEE $ E - 114.50 CUA PARK SCHL FLo PAR PD ) HD. ISSUE This permit is hereby issued unser the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated bove for which fees have been paid. DI. CT R PUBLIC WORKS 1 BY D(aat+e G_ 6'q PERMIT EXPIR S Date 26 ■ �L— Receipt No. 94403 WHITE-D.P.W., YELLOW-A58l370R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — P,hone: 891-2751 v 7 County Center Drive, Oroville — Phone: 538-7541' 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE Mditfor% 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 mat or needadditional explanation, please contact this office immediately. % T {//� S C Q to ties C.e II i �. L'T c w . -0 r C , .-J� N AN �1 cQ�SO CS4CA/L Y 1 -? r'Ou "ef .F A !2.0.. r -0" Glp /_ -7`- R i r/ ..Cm,7 a/, X0..4 '4 '('-z -- , K IJ e"" r rov a V� rOvC><'� p� f li �/� a•4 =°, �• � 5 i Q t � d° {.a-i�ti , s� 2 �� r�-F �. ✓' N � c.Q. At Date 7-23-9it Inspector��� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N0. 7 County Center Drive • Orovllle, California 95988 - Telephone: 918/538.7541 APPLICATI©N''AND PER97 A88931 CKL NUMOKR 40-26-80 ZONING A5 BUILDING PERMIT GERALD MARION T 342-2917 SO. FT. OCC. BUILDING VALUATION CONTR. ST. 13,637 wNER'3 M NG ADORaae 9344 LOTT RD DURHAM 95938 CONTRAC OR'5 NAME AMRE REMODELING INC. TELEPHONE 371-6151 CONTRACTOR'S MAILING ADDRESS 1400 ENTERPRISE BLVD #D SACRAMENTO Fireplace CONSTRUCTION LENDER NONE UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING .ADDRESS Permit Fee $ 104.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 9344 LOTT RD DURHAM Permit fee $ 114.50 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 5 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 10.00 PA TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other XA Describe work: VINYL SIDING Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service eoov OR LESS 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 the Business and Profess* Sy Code and my license is in full force and effect. License No. 4 `30q� Classification. C�bf ❑ 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.8d) OR ADDNS. ACC. BLOGS. / yzQsgft NEW CONSTR. U TI.DUTLET NO N.RESID BRANCH CIRCUITS .2.50 ea, /POWER APPARATUS .&) ISINGLE OUTLET CIR. / / EX. Occup\OUTLETS OR FIXTURES 20®30C e ALO 30 FIXED APLNS. Ex. Occup. OUTLETS P(RESID )REAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 . MiscWiring 15.00 Permit Fee $ i 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. ❑ Ishall 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 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 ag 'ns said Co my in conse e e of the granting of this permit. X .-�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 $ occ CONST TYPE E TOTAL FEE $ 1 4. 50 HAz. CUA PARK scHL FLD PAR PD ) HD. ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County -Code and/or resolutions to do work indicated bove for which fees have been paid. 1 CT R F PUBLIC WORKS By Datee PERMIT EXPIR S Date -1117-7 Receipt No. 94403 WHITE-D.P.W.. YELLOW-ASDE330R. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT CiF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 Telephone: 916/538-7541 APPLICATION ANQ,°ERI#IT ASSESSOR PARCEL NUMBER QZIO- 6Q—O 0 ZONING � BUILDING PERMIT OWNER-�1 v TEL PHONE 3 SQ. FT. OCC. BUILDING VALUATION %� Cunt E -ST 3 O NER'S MAILING ADORES �r - !�^^ ^ �. V�y/��S2 �—a `�./ V''� t W�Y� C./ • /'i /i/ 60 C NTRACTOR'S NA ry,�E `7ho'a �Z i �! � 11U C TELEPHONE - CA Ug_ 1 CONTRACTOR'S MAILING ADDRESS P4vil D 574L7'0 CA Fireplace ONSTRUCTION LEND R ,,(( CENT U KNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ Q L -50 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 67 38 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 SFX Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00e TYPE OF WORK New ❑ Addition El Remodel❑ Utilities [:1IInstallation[--]Other Describe work: /1125W �/ ti LI J� iGE i ►.5 c.� _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADO'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 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 NEW CONST. DWELLING OCCUP.5 OR ACDNS. (ACC. BLDGS. ,h¢sgft NEW CONSTR.MULTI-OUTLET NON.RESID BRANCH.CIRCL" C ITS 2,50 ea POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES DAL0ALo30so EX. Occup. OUTLETS P(RESID )FIXED APLNS.REA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �yirin 9 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 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 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, 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 g pp Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE j TOTAL FEE $ ALSCHL HAz CUA PARK I FLD I PAR 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 aid. p WORKS Date Receipt No. j (/3—/ WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT