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Home My WebLink About040-290-052JOHN KIRLIN 9;j e/s Stanford Lane a of Durham Oro H ppPermit 1390-72B�'DuPorch for mobil hom LI A.P. 40-29-52 JOHN L. KIRLIN e/s Stanford Ln. app. 1 1/8 mi. from Durham Oro Hwy., ,hamPermit 1581-73B,E 7lal%7� (utility bldg. & wdrkshop for m. home) 2 AlMlk ITS �} a 040-290-052 02-0303 ARMSTEAD, KATHERINE 9140 STANFORD DURH_ CONT: DURHAM ELEC�V�`y1 %15 REPLACE EX ELEC SERVICE � 1 3 a E f , r} i } `i , s f .. . .Y r • .`a'Plrr y"�-rte .,. fi.++� ti n �'w s 040-290-052 02-0303 ARMSTEAD, KATHERINE 9140 STANFORD, DURHAM " CONT: DURHAM ELEC REPLACE EX ELEC SERVICE OFFICE COPY Address ' O� GAS Meter By Dated, ELE Meter B, _ Dace A 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 PERMIT C G:) .c 3'r -) ASSESSOR PARCEL NUMBER — 0 5 ^ PJ zGNIN BUILDING PERMIT OWNER - . a TELEPHONE 14 - SO. FT. OCC. BUILDING VALUATION OWN MAIUNG DRE;% �. 93 CONTRACT 'S NAME �� tj I r 1 TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.0023.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome..* Other SPECIFY Solar or heat um water heater Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK 13 ` New ❑ Addition ❑ Remodel r❑ Utilities ❑ Installation ❑ Other 13 Describe Work: 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 ' A OR IESs J 23.00 , J 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. 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.33bo ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION I 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWErIG UP. OR ADDNS. ( 8 ACC. BLD S. SO 3.5QF7. 1NjON-pa,p. MULTI -OUTLET 97.50 APPARATUS 8 SINGLE 011ILEr CIS. EX. Occu . OUTLET OR FDRUREs .00 aAL ®1. 0 Ex. Occu . DFIx�E�DTSA AM ORS 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirina 23.00 Al -0 PERMIT FEE $ U MECHANICAL PERMIT Filing Fee20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number he above sections need not be completed if the permit is for work of a valuation 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. rof Xl.�111 C x 1A. . Date x ' i Sign inure of Applicant -ITOwner ❑ Contractor ❑ Agent 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 $ �c� JYPE TOTAL FEE $ lfr HAz D E IMP I FLOOD I CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions the Butte County Code and/or Resolutions to do work indicated ab11 ove for which fees have been paid. By 4ff �/4r Date 7 r i PERMIT EXPIRES ON Il' ' (Data) Receipt No. } -GO WHITE-D.D.S.-B.D. CANARY -ASS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT J 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 PERMIT C 0;2, 6 R 03 ASSESSOR PARCEL NUMBER _ oC 5a Q 1)OWNER zGNI - BUILDING PERMIT .- TELEPHONE 3g3— SO. FT. OCC. BUILDING VALUATION . OWN:qMAIUNG 600RE 5938 CONTRAC 'S NAME r_QjQ r TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT -OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS / D , C�JV,M' Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome)X 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 ❑ Other ❑ Describe Work: A JAaQDuSk Gas piping system t - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service 2o0A OR LESS 23.00 3 •Db LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 commencin with Section 7000 of Division 3 of the Business anroessons oe, . ( g ) d PfiCd and my license is in full force and effect.P License Class Lic. 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. C5 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. S. SO 3.5¢FT. NEW CO IDD.. NON CO BRANCH MULTI -OUTLET ITS @7.50 OWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES BAL Q'. 0 Ex. Occup. o Xu�EED A RE.SID.OEA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirino 23.00 c93,600 PERMIT FEE $ (06 00 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 he above sections need not be completed if the permit is for work of a valuation 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 fo hwith comply with those provisions. Date Da �0 " 0 Ign ure of Applicant - ff Owner ❑ Contractor ❑ Agent 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� PE TOTAL FEE $ (0(0, a-) HAz 0 E IMP FLooO COF PARCEL PO HD SSUE This permit is hereby issued under of the Butte County Code and/or indicated above for whichs have BDate PERMIT EXPIRES ON p�' 1'1-�� the applicable provisions Resolutions to do work been paid. ate Receipt No. -go WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT i COUNTY OF BUTTE -DEPARTMENT OAF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA -95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: I ASSESSOR PARCEL NUMBER CA40- Qq 6-05 a Proposed Building Use: V�'J , C; ( Counter Technician: U6 Date: -9 -G� Items required in order to apply for a permit. All lgxes MUST be checked OR marked NA in order to apply. 1.. Plot plans, 3 or 4 sets, signed by the preparer of the plans. 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. u 4. Engineered truss details and layouts in duplicate. No faxes! j" 5. Energy compliance design and supporting documentation in duplicate. 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or foundation plans, all in duplicate. T. Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be indexed and returned to the plan review line-up when required items are received. Date Received By 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................ 9. Plot plan and business license approval from the City of Biggs .................................... 10. Letter of intent for non-residential buildings......................................................... 11. Detached Accessory Building Form filled out by the owner ..................................... 12. Hazardous Material Form............................................................................... ❑ 13. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) 14. Fees as shown on the attached Schedule of fees Due Sheet ............................:.......... 15. Statement of Intent for Non -heated and A/C Buildings...` .......................................... 16. Sanitation and plot plan approval from the Environmental Health Department in 17. City of Chico Plumbing permit ............................ ...................................... :...... 18. California Department of Forestry plan approval ❑ paid. Sent by: ...................... 19. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: 20. Contact Land Development about ❑ Improvements, ❑ Drainage ............................... 21. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). 22. Pre -Inspection for required ................ 23. Contractor's license information. (Number, Name Style, Classification) ...................... 24. Worker's Compensation Carrier and Policy Number ..............:.............................. 25. Owner -Builder Verification (❑ Given to owner, ❑ Mailed to owner) ..................... 26. Letter of Signature authorization.................................................................... 27. Recorded copy of Agricultural Acknowledgment Statement .................................... 28. Manufactured home utility clearance............................................................... 29. Existing violations and/or expired permits.......................................................... ❑ Grant DE,qd, 0 M. . Title/SWement bf F ts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ Yf 31. Other:'j�4 When issueda ei'T pp n'eand hold for pickup. I have been infor ed of the above items and requirements for obtaining abuilding permit. Applicant '�"'"CGU ' Date: �/a - /a— 0 o�— 1. Index permit application for the above items numbered: 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Plans reviewed by: Date:. Plans approved by: Structural reviewed by: Date: ,. ''x;: Structural approved by: Note transfer by: Yellow: Building Division Plan Check Letter _Date: Date: Date:_ Date: Name JARMSTEAD KATHERINE Addr1 PF40-STANFORD LONE Addr2 I DURHAM CA 95938 Addr3 Addr4 Comments 14029005200 CONVERTED 09/08/88 Creating D oc#1 1986R 2990700 D ate Current D oc# 1994R 21673 Date 05/19/1994 Killing Doc# D ate F Asmt D esc 9140 STANFORD S uplCnt Zoning JA5 D well Acres 0.37 N/C 040 Asmt # 1040-290-052-000 Fee # 1040-290-052-000 Status JACTIVE Status Date Tax 000 INORMAL OWNERSHIP TRA 1070-002 Situs 19140 STANFORD LN D U R Base D k 101 /01 /1987 Land S tructure Fixtures G rowing Total L&I Fix. R F MH PP PP Exemptl AgPres 40,682 Etal 0 N otes 0 Bonds 0 Multi Situs Flag1 Flagg Asmt PP Pen Tax PP Pen Appeal. Pending Split Pending Land S tructure Fixtures G rowing Total L&I Fix. R F MH PP PP Exemptl 94,994 40,682 0 0 75,016, 0 0 0 7,000 Net I 68,016 R/C#j T!R Dtj- R!C Stat I-PHY-1 OWN I EXP I TAX 1, HRN I ATT I SIT I ,SPR. I PCL � iij' Find n�na rti� 117.r innn-i n n-7 n-1 r%L J PRE -INSPECTION REPORT - OWN �� l� � DATE. ' I C OP, LOCATION: ORO, ��,�, A.P. # '0(40 alb-C�S,� J CONTRACTOR: .L Jl� �»-, �'�o.r ZONING: %' "5 PRE-INSPETION FOR DATE TO INSPECTOR: -0 ' 13' C> a PERMIT HWORY:( ) NONE (LT9'FOLLOWS: BUQ.DEKG INSPECTOR'S REPORT Building Description: commercial/Usage: ResidentiaW of Units: Currently Oocupied Abandone"acant Electric: � . Yes No t Electric currently On ` rS Off Condition of Electric Gas: Natural Propane None Obvious Problems: Sanitation: Currently On Off Plumbing Working t�S Well Working Potable Water Obvious Comments: ACTION RECOMMENDED: ISSUE:, HOLD FOR Inspector: 49CL& Date 2 • 3, t) Z . Sketch buildings on reverse and indicate location on property. � tiw�cs,1 U:, INIFFb A PERMIT NUMBER _ B 1581-73B2E fi• P i - a 1 E 9f PERMIT EXPIRES a J.OWNER John L. Kirl' CONTR: Owner ,,LOCATION (A.P. 40-29-52 ) f{ e/s Stanford Ln. app. 1 1/8 mi. from Durham- Oro. Hwy., Durham r, t • �I. a COUNTY OF BUTTE J t Department of-' Public Works BUILDING INSPECTION RECORD Zoning SetbackZ'� Forms Foundation _� �— -2 Piers & Girders Fireplace Rgh. Plumbing Bond Beam Lath & Plaster S ,1 exe Rein. Steel Gas Piping & Test Found. Vents Framing Plmg. Topout Rough Elec. 7 // -23, Wtr. Htr. Furnace Kitchen Vent Firewall Garage Vents - Sanitation & Water --- ELECTRIC GAS BUILDING Temporary Temporary Cert. of Occup. Final Final .� Final � 7 DATE REMARKS OR CORRECTIONS �I 474-1 /X u COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, — ClroviIle, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT au41011Ge IeP1VSe11lCU1Ve5 UI ine Gauniy of Butie to enter upon the above- ntioned property for inspection purposes. XZDate "y —73 Signature of Permitee or Agent Receipt No. 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 Date �� F—% Building permit expires Dab-1-�_,:__.W„ . BUILDING Owner - J SQ. FT. OCC. BUILDING VALUATION tri Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ tX Building Address If PLUMBING No. @ FEE PERMIT FILING FEE $2.00 1.17 IV 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. ®-' q.. '� Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 es anitat Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA I Parking Plans ParcelParcel Declaration Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 Bldg. Plans Kec'd `__ +— Parcel Approval Plans Approval Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Single Family Duplex ❑ Mobil Home ❑ Others El Sub -panel (12 or less) (more than 12) Range, Cook -top or Oven 1.00 1 _ T Water Heater or Space Heater 1.00 Light fixtures 1 pal ago .2, Rec s., swi tc1hes & fix oui ets 1.'ro 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 $ r J WORKMEN'S COMPENSATION INSURANCE I 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. 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 the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT 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 P PERMIT FEE $ S au41011Ge IeP1VSe11lCU1Ve5 UI ine Gauniy of Butie to enter upon the above- ntioned property for inspection purposes. XZDate "y —73 Signature of Permitee or Agent Receipt No. 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 Date �� F—% Building permit expires Dab-1-�_,:__.W„ . � t i - I PERMIT NUMBER - B f P E PERMIT EXPIRES OWNER John Kirlin CONTR: owner LOCATION (A.P. 40-29-52 e/s Stanford Lane app.12 mi. so . of Dur- ham Oro Hwy, Durham COUNTY OF BUTTE Department of. Public Works DATE REMARKS OR CORRECTIONS 4 BUILDING INSPECTION RECORD Zoning _ Setback Forms Foundation � � /_S ��-_- Piers & Girders �� /: �-' 7 �� — Fireplace Rgh. Plumbing Bond Beam Lath & Plaster �— Rein. Steel _ - Gas Piping & Test �^ Found. Vents "�— Framing *- — l Plmg. Topovt.-- Rough Elec. -�- Wtr. Htr. Furnace Kitchen Vent Firewall cam— Garage Vents---------- Sanitation & Water ELECTRICGAS BUILDING Temporary Temporary _ ^� Cert. of Occup. r� '� �5 7z— Final Final Final DATE REMARKS OR CORRECTIONS 4 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS %g _�A 7 County Center Drive ti — GYoville, California 95965 Telephone: 533-1230, Ext. 259 APPLICATION AND PERMIT authorize repreaeniauves UI ine County of Butte to enter upon the abov mentioned property for inspection purposes. X `•X�litiL. Date Signature of PermiQitee or Agent Receipt No. 9 L )34.� White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 —Date -7-7-Y-7 I— // Building ..Date 7 -7 -1 -7I -- Building Permit Expires Date 7 3 BUILDING Owner f SQ. FT. OCC. BUILDING VALUATION Mailing Address Fireplace Contractor G Total Valuation 3-0 Mailing Address Permit Fee 00 Plan Checking Fee&/or Penalty Permit Fee $ $ p Building Addresst PLUMBING No. @ FEE PERMIT FILING FEE $2.00 (j�-p e7dRepair Each Trap 1.50 drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. 146— 2 9 —' �� Z Zoning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .50 Fire Zone Fire Dept. Z)//� Planning Building sewer 5.00 Plans / Feesr/ W. C. R/W I Encroachment Lawn sprinkler system 2.00 NEW ❑ ADDITION OTHER ❑ Permit Fee $ $ /^ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 ti USE OF STRUCTURE Single Family 9L Duplex ❑ Others ❑ Sub -panel (12 or less) (more than 12) Range, dryer or water heater 1.00 Oven, Cook -top or space heater 1.00 Light fixtures Receps., switches & fix outlets 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 Misc. wiring License No. Classification I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE I 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. MI 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 the Workmen's Compensation Laws of California. MECHANICAL No. @ I FEEPERMIT FILING FEE $3.00 Heating Cooling Ventilation Permit Fee $ $ 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 tate Fee or Strppg Motion n;tentfor S prrogram $0.07/$1000 Evaluation $ d7 TOTAL PERMIT FEE $ `r e> authorize repreaeniauves UI ine County of Butte to enter upon the abov mentioned property for inspection purposes. X `•X�litiL. Date Signature of PermiQitee or Agent Receipt No. 9 L )34.� White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 —Date -7-7-Y-7 I— // Building ..Date 7 -7 -1 -7I -- Building Permit Expires Date 7 3