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HomeMy WebLinkAbout041-400-061Ii eount* Xutk OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: Byron B. Blake 2 SW-. ADDRESS: 7L5§OOiMuscott #20 CITY & STATE: San Bernardino, CA 92411 IMPORTANT: DATE OF CLAIM: A -u st 22 1978 SEE INSTRUCTIONS $u � ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT (Permit #2881-78P,E--Receipt ,1177450--A.P. IP41-40-7) _ Total permit fee $84.50 (should have been $74.50) TOTAL REFUND DUE $10.00 $10 00 0 ' TOTAL $1000 ' I, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Datedthis .................................. day of ............................. 19....... at................................. Calif..................................................................................... Signature of Claimant I. the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or de- livered and that there is a Budget Appropriation ❑ or Specific Board Approval F-1 (Check one) for the same. Datedthis .................................... day of ............................. 19....... at .............................. . Calif..................................................................................... Department Head or Authorized Deputy' Dept. Exp. Code Code PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE'- AUDITOR'S USE ONLY VENDOR CODE DEPT. & SUB. PROD. SUB. OBJ. CLAIM NO. INVOICE NO. INVOICE DATE DISC. GROSS AMOUNT ENCUMB. SUB -DIST. 3 I INSTRUCTIONS to CLAIMANTS All claims against the county must be itemized, giving dates and character of service rendered or work performed, -quantities, de- scription and unit prices of articles furnished or delivered. Claims must be certified by the claimant and submitted to the De- partment head for approval. Upon approval the Department head will forward claim to County Auditor for payment procedure.. Do not file with the County Auditor first. Claims should be presented to officials for approval immediately upon completion of services requested or material ordered. Claims are paid every Tuesday; however, same must be approved by officials and in Auditor's office before preceeding Wednesday noon. Compliance with above will expedite payment of claim, failure to do so may delay payment considerably. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 aunty nter Drive — Oroville, California 95965 -�2 �2 ?� Telephone: 534-4541 APPLICATION AND PERMIT A authorize representatives of the county of Butte to enter upon the above-mentioned property for inspection purposes. �j.� r X e W —Date r/l ( v Signa re of Perm�iiteee or Agent D Receipt No. _�z / A 41/ a 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. DIRECTOPI 0 PUBLIC WORKS By / Date 7'�-�p B ding permit expires Date BUILDING Owner 1 L A SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor o ['ra C- a M e ��✓d(L Mailing AddressFireplace � Total Valuation '044 ,V a,009L7 4 T�� =e No. Permit Fee Address Building .� of cJA'T� 'pro k, PI an Checki ng Fee &/or Penalty Permit Fee 000 40,0EE ,fit/ r!c le PLUMBING No. @ FEE 6 PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. /— o►- % Zoning 8 Planning Water piping 1.50 Each gas water heater or vent 1.50 F s >iaRket+eR Fire Dept. Fire Zone Use Permit Gas piping system 1 -5 outlets 1.50 EQA Parking Plans ParcelEach Declaration Parcel Map 60' R/W Improvements additional outlet .30 Building sewer 5.00 Bldg. Plans Recd Parcel royal Plans Agpooroyal Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ $ p �RrKive _ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service e00V OR LESS 100 AMP OR LESS S.OD Single Family ❑ Duplex Mobil Home;ff Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER eoov 25.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 1.00 NEW OR ADDNST % ACC. BLDGS,LING CCUP. 4\ 20sq ft / 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 Sty O NEW CONSTR -OUTLET NON-RESID (MULTI CIRCUITS 2.50ea NEW CONSTR. POWER APPARATUS e NON-RESID• SINGLE OUTLET CIR, Ex. Occuo(OUTLETS OR FIXTIIRES 5 L FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 << Mobile Home Facilities 15.00 License No-� g2f ' Classification Misc. Wiring 6.25 0 1 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. 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 $ $ 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 TOTAL PERMIT FEE $ O authorize representatives of the county of Butte to enter upon the above-mentioned property for inspection purposes. �j.� r X e W —Date r/l ( v Signa re of Perm�iiteee or Agent D Receipt No. _�z / A 41/ a 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. DIRECTOPI 0 PUBLIC WORKS By / Date 7'�-�p B ding permit expires Date MOBILEHOME SUPPORT DATA If other than single wide, Mobilehome fr.��ee %Leib �, furnish Setup Model No. � �� Year /. .Zr Width (ft.) Box Length�C)__ (ft.) 'Tagalong or.Expando Size ft. x?b ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets'(if not.on file with the County of Butte). All center supports measured from -front of mobilehome unless otherwise specified. Footings (check one) (ft.)(in:)_ Center support locations* � O . (ft.)(in.) (in.) (in.) Center support footing sizes (in.) ( in`�^K/w/ (ft.)(in.) (;11(iZ4t4,-U) x 1?0 s6) x (ft.)I (in.) (in.) (in.) Single A n *If center piers are other than drawn above, draw in locations, spacing, and dimensions. L2 1. Wood either pressure treated ox foundation grade. 2. Other (specify) Supports (check one) 1. Concrete block. 2. Other (specify) <--Tagalong or Expando, show support details. /�� -- Typical Support in.) (in.) Footing Size -- Max. Pier Spacing (ft.)(in.) -- Max. Overhang (ft.) (in.) BUTTE COUNTY BUILDING DEPARTMENT APPROVED PO. BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBII,EHOME INSTALLATION SHEET .1. Owner's name: p 2. Installer's name: /rn,>�y ,,� 1]-,ojy,e- e e- 3. 3. Is the site currently under permit?, Yes/ No ( If yes, furnish permit number �'�% 7&f S ) OR Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft, away from septic tank and leach fields and clear of all setbacks and easements? Yes 2ZZ No ( If no, clarify service? --------------------------------------------------- ) Yes / / No /, 5. What is the mobilehome electrical rating? ----------------------- j' S Amps 6. What is the mobilehome site service rating? --------------------- is the Amps 7. What is the mobilehome site circuit breaker rating? ------------- Z b Amps 8. Is there any other electric load to b'e served by the mobilehome (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) site service? --------------------------------------------------- Yes / / No /, (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- (in.) 10. What is the type of gas service? ----------------------------- Natural / / LPG 11. What is the gas pipe length from meter o J ank to thhep /mobilehome? r Z (ft.) 12. What is the mobilehome -- gas demand'? -� -- �- 111_L - (BTU) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) Permit #3488-83 Robert More li COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER - /4.-f7 ZONING At BUILDING PERMIT OWNER TELEPHONE SO, FT. OCC, BUILDING VALUATION OWNER'S MAILING ADDRESS :) 1 1 l l ,�L f� F' •c , L CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS / " ,;f ) (� / -7 I r �, C '[ !C 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 $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome ❑ Other ' - SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ❑ Describe work: 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 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 21/20sgft 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 m license is in full force and effect. Y _ License No. r f r / 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 CONSTR. MULTI -OUT LET 2.50 ea NON.RESID BRANCH CRC ITS NEW CONSTR POWER APPARAITUS &' NON.R ESID. ( SINGLE OUTLET CIR. 20050a Ex. Occu- Ts OR FIXTURES BAL@300 FIXED APP LNS. OR FIXED EX. OCCUp. OUTLETS (RESID,) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 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. 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. ,_ 11• /r—.r ,// 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 $ TOTAL PERMIT FEE $ ' OCCUP. GROUP I TYPE OF CONST. PARCEL PD ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date /" L Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 i'_ APPLICATION AND PERMIT ERMIT NO r ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE �S SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS /'� c L V L RID olu_, / CONTRACTOR'S NAME s s TELEPHONE s3 (tr7i CONTRACTOR'S MAILING ADDRESS O !%jLLE 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 $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS l9 � � _ — �� PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 6� Water piping 5.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome ❑ Other 50)K SPECIFY Building sewer 5.00 Mobile Home TSTG W 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti Iities ❑ Instal lation ❑ Other ❑ Describe work: -:Se%1 A,A2 —J.6,14- Permit Fee $ 3A Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 800v OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 21/20sgft 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. ` `j (, - 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 CONSTR ULTI.OUTLET 2.50 ea NON.RESID BRANCH CIRC ITS NEW CONSTR.( POWER APPARATUS &'1 NON-RESID. %SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES gA 0 OC FIXED APPLNS. OR EX. Occup. OUTLETS (RESID,) EA.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 J�2 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 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 again t said County i cons quen of the granting of this permit. X Datele/J '93 Signature of Applicant — caner ❑ ontrOOror� Agent ❑ An OSHA ,, \\permit is required for excavations over 5'0" deep and demolition Or construct-CTOR ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ Occu P• GROUP TYPE OF CONST. PARCEL PD HD ISSUE Thi ermit is her by issued under sosi f th Butte County Code and/or Wrkt a ovefor which OF PUBLIC PERMIT EXPIRES Date©� the applicable provi- resolutions to do fees have been paid. WORKS Date '� Receipt No. d ��5� WHITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT O COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, under permit number 'f�!� -- �_� —for f or the following location: r.�� �� ..� n ..., 7 /S! i.. �� p !i j,..�,".l /J✓ J _ i.s_. n , G n n �./� .�� ; �L�U -`.� + �. �'�.✓Ls-r.://,� Owner Owner's Address -;r,-6 _ Mobilehome odel Year L7';" Insignia No: �— %n� ry'9.,/n/ d3A,lrc�iy�Serial No�`A �' j " r/1'9D4 It is hereby certified for occupancy at the above described location and may be occupied. , Directorr'of Public Works Date !.a t!l u,Qi!_ �� 1 �1i7� By �y THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED �\ White -Owner, Yellow -Installer, Pink -D.P.W. I 2881-76PE PERMIT NO.. PERMIT EXPIRES/+I�• Q R. Byron B. Blake ,CONTR. owner 41-40-7 .'.LOCATION (A.P. ) SIS pri.rd., app.2000'off W/S clark Rd.,app. 800'N.of Addy Lane, G___irin paredise1 c 4� Al. y. ir v d 1 Temp. Power Pole Called PG&E Temp/Elec. Serv. ailed PG&E / T mp. Gas Serv. Called PG&E JIB FINALED / (/ (Date) Si ature) j COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 1 BUILDING. INSPECTION RECORD BUILDING BUILDING (Cont'd) / Setb@ck Form Main Idg. Foo gs Stemv i I Stab Piers Garage Footin s Stemwa I I Slab Carport Footings Slab Patio Footings Masonry Walls Relnf. Stee Bond Bea Framin Stucco Mesh Scr ch B n nish In rior Lath or Closer MOBILEHOME U1 Water Piping 7 r- MOBILEHOME IM Water Piping •7 Rest om Finish Windo Sidin Roof Shea in Roofing Fdn. Vents Garage Vents Insulation Prov. for ph sica handicapped Conformance of ex. FIJ1EP1k.ACE Footing Throat Final RE SPRINKLEI Test Final MECHANICAL Heatin Cools \I -Final ............ . . . . . . Elec. Service Sewer) / _��j.�� --------------Support Drainage Dol rlpin 7s loor 2nd ooi 3rd F116 Water Pi Sewer Fixtures 4 PLUMBING Heaters Appliances Gas Piping & Test Temp. Gas Sanitation Final / Motors Pole Permanent final Elec. Pedestall-�J Gas Piping Elec. Continuity — Gas Piping DATE REMARKS OR CORRECTIONS 61 t. N TE: An entry e . ade his form each time you visit he job site.) 1 Iv�-2I 9 h 9. Electrical - A. Is service large enough'to provide adequate amperage�to mobilehome (must equal rating of ,mobilehome with a minimum of 1 amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes No_ B. Is there proper clearances around panels?- Yes_ No_ �� C. Is power supply cord or feeder assembly properly fused? Yes J' No_ D. Is continuitytest satisfactory as per the following procedure'? Yes No Y 1. De -energize .electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 5. All non-current, carrying metal parts of the mobilehome (aluminum siding', gas line, water line)., including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the.electrical tests, the lot or site. service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? r/`v 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle Length e 1�0 Width Vehicle Serial No.FIA �0 6 fl 0 boa P -/o State Identification No. �-oLL �D 7 ?J� Additional Information or Comments: V MOBILEHOME INSTALLATION INSPECTION CHECK LIST 1. Is the mobilehome located wit equired separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yest"I 3. Are footings and supports properly sized, spaced, and braced as p1 approved plans? (Note possible variation at spring shackles.) (Sec. 082 & 5083) Yes= No 4. Is the mobilehome level? (Sec. 5088) Yes_ No 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes 6. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes,/ No B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes 4 ---'No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes_ No_ Ji 7. Wastes and Drains IV /�` A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes�o B. Does it have minimum 4" per foot slope and is it properly supported? Yes LI No_ C. Are any leaks detected in drainage system after running 3-gllons of water thropgh each fixture including washing machine.standpipe? Yes - No D. If coach is not State of California approved, does station have required trap and vent? Yes No_ / /d 8. Gas.Piping and Gas Vents A. Connector -'Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome_ gas line inlet without reductions other than the mobilehome connector. Yes No VO 914t5_ B. .Test OK as per following procedure? Yes_ No ' :1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10":14" water column or test with slope gauge (minimum ® 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehorqe with connector, turn on gas, test connections with .soapy water. C. Are all appliance vents properly installed? Yes No IG MOBILEHOME INSTALLATION INSPECTION CHECK LIST 1. Is the mobilehome located wit equired separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yest"I 3. Are footings and supports properly sized, spaced, and braced as p1 approved plans? (Note possible variation at spring shackles.) (Sec. 082 & 5083) Yes= No 4. Is the mobilehome level? (Sec. 5088) Yes_ No 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes 6. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes,/ No B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes 4 ---'No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes_ No_ Ji 7. Wastes and Drains IV /�` A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes�o B. Does it have minimum 4" per foot slope and is it properly supported? Yes LI No_ C. Are any leaks detected in drainage system after running 3-gllons of water thropgh each fixture including washing machine.standpipe? Yes - No D. If coach is not State of California approved, does station have required trap and vent? Yes No_ / /d 8. Gas.Piping and Gas Vents A. Connector -'Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome_ gas line inlet without reductions other than the mobilehome connector. Yes No VO 914t5_ B. .Test OK as per following procedure? Yes_ No ' :1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10":14" water column or test with slope gauge (minimum ® 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehorqe with connector, turn on gas, test connections with .soapy water. C. Are all appliance vents properly installed? Yes No I. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS O id .�., 7 County Center Drive - Oroville, California 95965 Telephone: $34-4541 C APPLICATION AND PERMIT A / �ct/�cJCIROU Vco VI Ulc I,VUllly vi OU HG lV clllcl U1JVI1 UIC above-mentioned property for inspection purposes. X Date Signa re of Permiteee or Agent Receipt No. ! , 7 VI v 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/PU®LIC WORKS By Datess_%dl__ B ing permit expires Date BUILDING Owner e SQ. FT. OCC. BUILDING VALUATION Mailing Address�� Telephone No. Contractor 001 KW Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address Pf') R� Plan Checking Fee&/or Penalty Permit Fee gQQ PLUMBING No. @ FEE - PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 AA7M A. P. No. `— Zoning & Water piping 1.50 d Each gas water heater or vent 1.50 F Sa4Aeion I Fire Dept. Fire Zone Use Permit Gas piping system 1 -5 outlets 1.50 EQA Parking Plans I Parcel Declaration Parcel Ma 60' R/W Improv nts Each additional outlet .30 Building sewer 5.00 Bldg. PI s Recd Parce ravel Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ permit Fee $ $ : It ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 e0 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service eooV OR LESS 100 AMP OR LESS 5.00 �y l! Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1,00 NEW OR ADDNST % ACCLBLDGS.LING CCUP. 51)22sgft 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 st le of: y NEW CONSTRES'D, ULTI.OUTLET NON-RESID BRANCH CIRCUITSI 2.50ea NEW CONSTR. POWER APPARATUS 8 NON-RESID. SINGLE OUTLET CIR. Ex. OCCUO(OUTLETS OR FIXTURES g L1C Ex. OCCU FIXED APPLNS, OR p• OUTLETS (RESID•) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 1 . 6.25 RfI am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ IS, 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 1 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 Land Development Fee $ 0( TOTAL PERMIT FEE $ �ct/�cJCIROU Vco VI Ulc I,VUllly vi OU HG lV clllcl U1JVI1 UIC above-mentioned property for inspection purposes. X Date Signa re of Permiteee or Agent Receipt No. ! , 7 VI v 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/PU®LIC WORKS By Datess_%dl__ B ing permit expires Date 5 ti SAS 00 l A`permit will be required for the tollafion of the mobilehome. V -he Setback shall be 5 ft. from the � ide propeeriy line and 50 ft. from the/cs X d centerline of the road, permitting amaxi- ►rsuris of a 7 $t, eave overhand but entirely cut of all easements. All utility connections shall /4e-(-4 located within 4 ft. outside the rear third section of the mobile home (road) side of the mobile L 330 Septic system aid-leearffvn- Ls beFsper Butte County Health D - quirements. BUILDING Dr -P ;RTMNY APPROVE® �I l Ra�Mai farials & Workmanship ShnO of plans and spec;f-c!MUST be -�. - r So In kept on he job at all times and it is unlawful to w�AJ" r�eacrl< "ya'r'd f'raci i . and mdke an changes or alterations on some without off a qarw"`Ay ;�esvi'h�-J for Vhe Specified us in the written p Works, rmission from the Department of Public U.-AOM''W'Ving,, Plumbing & Mechanicail Co it+ 4 GecWjccd Code' as and ounty of,'Butte. SAS 00 l A`permit will be required for the tollafion of the mobilehome. V -he Setback shall be 5 ft. from the � ide propeeriy line and 50 ft. from the/cs X d centerline of the road, permitting amaxi- ►rsuris of a 7 $t, eave overhand but entirely cut of all easements. All utility connections shall /4e-(-4 located within 4 ft. outside the rear third section of the mobile home (road) side of the mobile L 330 Septic system aid-leearffvn- Ls beFsper Butte County Health D - quirements. BUILDING Dr -P ;RTMNY APPROVE® �I l COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - OrovIIIe, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. 1143-91 A41340-61 PARCELSOR NUMBER ZONING ARMH3 BUILDING PERMIT OWNER Robert Morrelli TELEPHONE SO. FT. OCC. BUILDING VALUATION 35 @ 60 2,100 OWNER'S MAILING ADDRESS 3737 Dulcinea Dr, Oroville 12 @ 100 1,200 CONTRACTOR'S NAME Bi us Roofing TELEPHONE CONTRACTOR'S MAILING ADDRESS PO Box 236, Orland CA 95963 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 3,300 Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee .$ ergy n Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS P e ally $ BUILDING ADDRESS Perm fe ,$ 54 50 P_ =MBING PERMIT Filing Fee 10.00 ach rap 2.00 I r heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCE MAP Water piping 5.00 ach qas water heater or vent 5.00 USE OF ST. RTUR N. SFff Duplex[]Mobilehome Other SP I FY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G W 0.00 ea ' PE yOF WORK el jLUtilit es ElInstallation❑ Oth r dX New ❑ Addition[] I NOX, Describe work: oofr Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main seryice 100 OR LESS 10.00 100 AMP OR LESS Main service EA. ADO'L 100 AMP 2.50 CO RAC LICE LAW 1 declare order penalty of per y (check one): rL,�,/ I am licensed under provisions of Chapt. Div. 3 of the Business and Professions Code and my license is i full force �jann/ effect. License No. ����� Classification. C- i i � ❑ 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.ad\ 'hQSgft OR ADDNS. l ACC. BLDGS. // NEW CONSTR.OUTLET 2,50 ea N0N.RESID BRANCH CIRC ITS POWER APPARATUS .&) (SINGLE OUTLET CIR. OF Ex. Occup(O OR FIXTURES 5AL030 FIXED APPLNS. OR FIXED A 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): ;,4e—permit is for $100.00 (valuation) or less. 1 ❑ I have placed on file with the County of Butte Building Department Ey 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 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 1 to building construction, and hereby authorize representatives of the County of j 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, ju*dg ents, costs, and expenses which may in any way accrue against said unty) onsequence of the granting of this per ` Date �� ! Sig atur n — Owner El Contractor El Agent F1work 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 $ 54.50 HAz. I CUA-1PARK F771 -570F I PAR PD ) HD• ISSUE. This permit is hereby issued unser the applicable provi- sions of the Butte County. Code and/or resolutions to do indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. 88688 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF~PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILL'E AC49ORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET " Permit No. OWNER %Z7 /�(� �C L Z A. `f /—/��J C Proposed Building Use >P��i%� M Building Inspector Date 7" 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. :' 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, -wi.th-wet signature on plans .. 5. Hazardous Material Form ........................... ` 1 .... 6. Energy Design Compliance and sup_` ,orting 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............ , ...�S,wj.................................. 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 businessflicense approval from City of (see City for othe`r,,requirements) 17. Planning approval for (A) Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway, perm it (construction approval required prior to occupancy) 20. Pre -Inspection forrequired ... Pre-Inspec. request to Building Inspector (Date) T 21. Contractor's license information. (No., Name Style, Classification) ... 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. When you issue the permit, process as follows: Ma er. _ Mail to contractor. Telephone and hold, -for ickup at office. ~� Deliver w/inspector. Other Date Copy of Haz-Mat form sent Health'Dept. Fir Dept. Air Pollute Date Copy of plans sent Health Dept. �F�ire Dept Other ate By The following data must be submitted prior to permit issuance 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by_phone_—mail counter by .date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date 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 - Oroville, CaliforniA 95965 - Telephone: 916%538-7541 -el %I f l APPLICATION AND PERMIT r / ASSESSOR PARCEL NUMBER ,I 4 _ _ AAA BUILDING PERMIT OWN/ERR N �TELEPHONE SQ. FT. OCC- BUILDING VALUATION OWNER'S MAILING ADDRESS C t _� '► CONTRA C TOR'S NAME 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 7-7 90t2A Permit fee .$' PLUMBING PERMIT FiIingFee 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 USEOF RUCTURE SF ❑ Duplex❑ Mobilehome Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home Is G W 0.00 ea TYPE OF WORK New Addition❑ Remodel[]Utilities Installation❑ Other❑ Describe work: Z4 Z«er=*!�ira.t.� [� r A"ri, Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP V OR ORS LESS J'J10.00 Main service EA. ADO'L 100 AMP 2.50 3V CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of thej Business and Professions Code and my license is in full force and effect. .J 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_ r offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ Iam exempt under Sec. , Business and Professions Code for this reason t NEW CONST. / DWELLING OCCUP.tI,\/zQsgft OR ADDNS. \ ACC. BLDGS. / NEW CONSTR U NON.R ESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS &) SINGLE OUTLET CIR. Ex. OCcup(OUTLETS OR FIXTURES 20@50C ALeso B 30AL@ FIXED APPLNS. OR Ex. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Allte- X1) , Ck; Permit Fee �) S Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): rl 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 �f Consent to Self -Insure. ll� ' 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 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. 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 C.oenty'in consequence of the granting of this permit. Pf - . / 3/ X - --E- i �'�'� Date Signature of Applicant — Owner�ntroctor ❑ 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 S Energy Inspection Fee $ TOTAL PERMIT FEE ✓ $ OccUP. CONST.TYPE SCHOOL FLOOD PARCEL PD- AHD 159UE This permit is herebyissued under sions of the Butte Cunty Code and/or work indicated above for which fees DIRECTOR OF PUBLIC / By - J/�' fir., PERMIT EXPIRES Date thea applicable rovi- resolutions to do have been paid. WORKS )r Date—,r- , Receipt No.Q��-- WNITE-D.P.W., YELLOW-Aee EDOOR., PINK -INSPECTOR. GOLDENROD -APPLICANT V COUNTY OF BUTTE - CAEPARTMENT OF PUBLIC WORKS , O PERMI O. ,,/ 7 County Center Drive - Oroville,;CalifomO ia 95965 - Telephone: 916/538-7541 �d r Y APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER Z NG •TELEPHO BUILDING PERMIT OWNE E SQ. FT. OCC. BUILDING VALUA"N OWNER'S MAILING ADDRESS CO NTRAC TOR'S NAME aam TELEPHONE CON TRACTOR'S MAILING ADDRESS 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 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 5.00 Building sewer 5.00 Mobile Home T S TGTW` T 10-00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Installation❑ Other ❑ Describe work:? Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 �. Main service 100 DR LESS 100 AMP OR LESS 10.00 t Main service EA. ADD'L 100 AMP 2.50 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) ❑, a (Seo. owner, am exclusively contracting with licensed contract- 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.a OR AODNS. AGC. BLDGS. , hosq ft NEW CONSTR (.OUTLET 2,50 ea NON-RESID .BRA CH CIRC TS POWER APPARATUS e SINGLE OUTLET CIR. EX. OCCup(OUTLETS OR FIXTURES eAL930 eAL030 FIXED APPLES. OR EX. Occup. OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee 2 0 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 Consent to Self -Insure. 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 shal I 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. I also agree tea indemnify and keep harmless the County of Butte against all liabili ' s, lu ments, costs, and expenses which may in any way accrue against id C n in onsequen of the granting of this permit. ✓L' Date �/ .� Signature of Applicant - Owner Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct -(RECTOR ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEEC-^� OCCUP. CONST.TTP! SCHOOL FLOOD PARCEL PD ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which OF PUBLIC BY�Al PERMI XPIRES Date— the applicable provi- resolutions to do fees have been paid. WORKS Date i2—e 4(, �L v Receipt No. R , WNIT!-D.P.W.. YELLOW-ASDESeOK. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovil'fe, Calitbrnia 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER W - - - dG/— O 2 NG l G BUILDING PERMIT OWNE TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 3 7 CONTRACTOR'S NAME i 14412 TELEPHONE CONTRACTO_R'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation , LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 10.00 Permit Fee Plan Checking FeeE $ S 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 Solar or heat pump water heater 20.00 LOT NO. UBDIVISION NAME is PARCEL MAP Water piping 5,00 Each qas water heater or vent 5,00 USEOF STRUCTURE SF ❑ Duplex[]Mobilehome Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ UtilitiesInstallation ❑ Other ❑ Describe work:_0-1ZAA 49&4 ? Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee e10.00 Main service 100 AMP V OR LESS RSLESS 10.00 CONTRACTORS LICENSE LAW I declare under penalty of p y perjury y (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 OV 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 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.y OR ADDNS. ACC. BLDGS.21/2 ¢sgft NEw CONSTP U LOUT LET NON.RESID BRANCH CIRCU ITS 2.50 ea (POWER APPARATUS 61 (SINGLE OUTLET CIR. I Ex. OCCU OUTLETS OR FIXTURES p 20050!5ALs30 FIXED APPLNS. OR Ex. Occup. OUTLETS IRESID.I EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 r� /lr< IMSP, Permit Fee 2 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 Consent to Self -Insure. 21 1 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 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. I also agree tt indemnify and keep harmless the County of Butte against all liabilities, ju gments, costs, and expenses which may in any way accrue againsUs id C n in onsequen of the granting of this permit. X/�j - 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 $ TOTAL PERMIT FEE OCCU P. CONST.TYPc SCHOOL FLOOD PARCEL PC ] -_-W5 ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date _ the applicable provi- resolutions to do fees have been paid. WORKS Date _ Receipt No._4Qr �?� -WHITE-D.P.W., YELLOW -ASSESSOR. PINK -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. /-,l. I personally plan to provide the major labor and materials for construction of the proposed property .mprovement (yes or no) C/ 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City 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 Address City 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 Signed: Property Owner Social Securi 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.