HomeMy WebLinkAbout042-160-038v
0
42-16-38
t^ZES. MERCER —
NW cor of Gle� �ood & . Sacramento
Ave., Chico
Contn
r Y Grag e�Ie Electric
Permit #6"512-76E (ele ser ch) SF
42-16-38
Permit #4480-79Bi t. wood stove
SF
42-16-38
Cntr: Harold Urness
ermit#2932-83B rero k
f smoke detectors
/SF)p���Q� f
R
. �
I
v
0
42-16-38
t^ZES. MERCER —
NW cor of Gle� �ood & . Sacramento
Ave., Chico
Contn
r Y Grag e�Ie Electric
Permit #6"512-76E (ele ser ch) SF
42-16-38
Permit #4480-79Bi t. wood stove
SF
42-16-38
Cntr: Harold Urness
ermit#2932-83B rero k
f smoke detectors
/SF)p���Q� f
R
C%q
41
1•
COUNTY OF BUTTE - DEPAR ENT OF PUBLIC WORKS
7 County Center Drive - Oroville, Calif is 95965 - Telephone 916/534-4541
"� ' • . APPLICAT40N D PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
_
ZONING
BUILDING PERMIT
OWNER / •,
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ )F • r r✓
ARCHITECT OR ENGINEER
.!
"
LICENSE NO.
Plan Checking Fee ",,1'14$
Penalty
$
ARCHITECT OR ENGINEER'S MAI,LIN5 ADDRESS
•
Permit fee
$
BUILDING % DDRESS
4/v � 'i,'rt/f t !.%/~ ' �, _� ,, .+ ' ��
PLUMBING PERMIT
Fili Fee 10.00
n9
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 JSJGJWJ
4:r -0:0e
TYPE OF WORK
.0
New ❑ Addition ❑ Remode JQ ' Utilities ❑ Installation❑ Other �]�
Describe work: / � A/ 4_5
!iv (/e r
'
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
00V OR
Main service 100 AMP ORSLESS
10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. (/ DWELLING OCCUP.&
OR ADDNS. 1 ACC. BLDGS.
7
2/20sgft
CONTRACT LICENSE LAW
•
I declare under penalty of perjury(Che
Q I am licensed under provisions of Chapt. 9, Div. 3 of the BusinessBL0
and Professions Code and m license is in full force and effect.
y L -
License No. Jl t_-�� - "l—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 '
SINGLE OUTLET CIR.
NON-RESID, (&
Ex. Occup(o TS OR FIXTURES 30 2AL@ Q
IX
ED PR
Ex. Occup. OUTLETS (RESID )EA.1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 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.
�a 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 l permit.
�. , ' / - ' 0
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
$
y
TOTAL PERMIT FEE $ , 0
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
j DIRECTOR OF PUBLIC
`!
By r r �� '
-
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
r
Receipt No.
WHITE-D.P.W., YELLOW-A55E9SOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPAR,7'� "tNT OF PUBLIC WORKS
7 County Center Drive - Oroville, Ca jf95965 - Telephone 916/534-4541
APPLICATI -AIS PERMIT
PERMIT NO.
ASSESSOR PARCE NUMBER -
ZONING
BUILDING PERMIT
OWNEA
4,le
TELEPHONE
SQ. FT. OCC. BUILDING
VALUATION
, 7
5,00
OWNER'S MAILING ADDRESS
CON ACTOR'S NA E IIELEPHONE
1411' de ss
d
C NTRACTOR'S M ING ADDRESS
L 'oot/ (
Fireplace
CONtTRUCTION LENDER
UNKNOWN ;
Total Valuation is -
a
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
$ v
BUILDING Ess ,
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❑ Mobilehome❑ Other
SPECIFY
Building sewer
5.00
Mobile Home S G W
10.00e
TYPE O WORK
New Addition Remode�tilities❑ Install tion❑ Other V1
Describe work' /f =C A
dlESS
.�����
�! Ci/�•
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
600V OR LESS
Main service 100 AMP OR L
10•00
viNEW
Main service EA. ADD -L 100 AMP
2:50
CONST. DWELLING OCCUP,&
OR ADDNS. ACC. BLDGS.
1
22QSQft
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. *i�7!71.3`J Classification t , `�
❑ 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
NO N.RESID BRANCH CIRC ITS
NEW CONSTR. ( POWER APPARATUS &�
NON-RESID, SINGLE OUTLET CIR.
Ex. Occu DAL030
P.DUTLDTs OR FIXTURES BAL030
FIXED APPLNS. OR
EX. QCCUp. OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
F1
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 Countyot
Butte to enter upon the above-mentioned property for• inspection purposes.
I also agreelo save, indemnify and keep harmless the County of Butte against
all liabil;' s, judgments, costs, and expenses which may in any way accrue
again id Coun in consequence of the granting of this permit.
�Ct_ g2
X Date
Signature of Applicant — Owner ❑ Contractors 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
TYPE OF CONST.
I
JPARCFLJ
Pb
I NO
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRE OR OF PUBLIC
By —
PERMIT EXPI e
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Dat `� -
Receipt No. i� r� �/
WHITE-D.P.W., YELLOW-ASSeSSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
-91
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Uroville, California 95965
Telephone: 534-4541
1
APPLICATION AND PERMIT
QUUIU1 &V ICIJIUaUIIIaUVVo UI ule l.Uunly UI rsuue 1U enter upon me
above-mentioned property for inspection purposes.
X� Date ' 4,
Signature of Perm"itee 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
% A
Building permit expires Date
BUILDING
Owner
SO. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
Building Address d'
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. q�.y
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fes
W.,
FireDept.
FireZone
Use Permit
Building sewer 5.00
EOA
Parking
Plans
Parcel
Declaration
parcel Ma P
60' R/W
ImprovementsLawn
sprinkler system 2.00
-��
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER4/
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 ='
600V OR LESS
Main service 100 AMP OR LESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family ® Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V 25.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW CONST.
OR ADDNS. ( DWEACCLBLDGS.LING CCUP. &\ 20Sgft
/
NEW CONSTR MULTI -OUTLET
NON-RESID. BRANCH CIRCUITS) 2.50ea
NEW CONSTR /POWER APPARATUS &)
NON-RESID, (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisionE of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:Ex.
Ex. Occup(OUTLETS OR FIXTURESLf BAL� ,
Occup. FIXED APPLNS. OR
P•(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. � Classification %' �'
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certi'icate 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 $
$
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
$ `
QUUIU1 &V ICIJIUaUIIIaUVVo UI ule l.Uunly UI rsuue 1U enter upon me
above-mentioned property for inspection purposes.
X� Date ' 4,
Signature of Perm"itee 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
% A
Building permit expires Date
COUNTY -OF BOTTE = DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541 / ^ /� —76
APPLICATION AND PERMIT
cr,cacn , au vca vi Me liUUFIty UI DULte tv enter upon [ne
above-mentioned property for inspection purposes.
XDate 2
�1_ '],
�,gn�ur. of Per itee or Agent
Receipt No.
7'
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 2
Building permit expires Date 7
BUILDING
OwnerSQ.
GU -e c'
FT. OCC. BUILDING
rALUATION
Mailing Address b
Telephone No.
Fireplace
Contractor rA, c;le G
Total Valuation
Mailing Address C S
Permit Fee
Plan Checking Fee&/or Penalty
C
Telephone No.
zA/.?�Oo3
Permit Fee
$
Building Address
PLUMBING
No.1
@ I
FEE
PERMIT FILING FEE 1$3.00
S
Each Trap 1.50
CyIG a
Repair drainage or vent piping
1.50
Water piping 1.50
Each gas water heater or vent 1,50
A. P. No. 1, O
y Z .�� / - 3 b
Zoni& Pl
ng Planning
Gas piping system 1 - 5 outlets
1.50
Each additional outlet .30
F
W.
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parkin
PlansParcel
Declaration
Parcel Map
60' R/W
Improvements
Lawn sprinkler system 2.00
Approval
Plans Approval
Permit Fee
$
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER J4
ELECTRICAL
No.1
@
FEE
PERMIT FILING FEE 1 $3.00
". OJ
Main service 100 AMP OR LESSLESS 5.00
00
Main service EA. ADD'L too AMP
2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service tO OEAMP oR LEss 25.00
Main service EA. ADD•L too AMP 1.00
NEW CONST. DWELLING OCCUP. &
OR ADDNS. ( ACC. BLOGS.
21tsgft
NEW CONSTR. MULTI -OUTLET
NON.RESID. BRANCH CIRCUITS) 2.50ea
NEW CONSTR, POWER APPARATUS &)
NON-RESID, (SINGLE OUTLET CIR,
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: t
Ex. Occup(OUTLETS OR FIXTURES BAL@
,I{
V
EX. QCCU ( FIXED APPLNS, OR
P• 1 OUTLETS (RESID) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. L-3 Zd Classification L' —� �
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee
$
$ -62
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.
PUR I have placed on file with the County of Butte a certificate of
Vf 1' Workmen's Compensation Insurance.
FJ 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,
@
FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
,h
TOTAL PERMIT FEE
$ Q
cr,cacn , au vca vi Me liUUFIty UI DULte tv enter upon [ne
above-mentioned property for inspection purposes.
XDate 2
�1_ '],
�,gn�ur. of Per itee or Agent
Receipt No.
7'
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 2
Building permit expires Date 7
` y
r
PERMIT NO., 4480. 79B 1
--
It PERMIT EXPIRES
7/24/80
p
(OWNER SANDRA MERCER
CONTR. owner r.
Ar LOCATION (A.P. 42-16-38 )
NW cor W Sacto & Glenwood Ave, Chico
i
'r
. i
°4
r
r Temp. Power Pole
I Called PG&E
Temp. Elec. Serv.
i Called PG&E
Temp. Gas Serv.
Called PG&E "
Jo FMA E
(Date)
(Sig ture)
�e (V0 1A.'5lCLI,
i
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback Firewall Soul Pipin
Forms Parapets 1st Floor
Main 13ldg. Restroom Finish' 2nd Floor
Footings Windows 3rd Floor
Stemwall Siding To out
Slab Roof Sheathing Water Piping
Piers ` Roofing Sewer
Garage Fdn. Vents Fixtures
Footings Garage Vents Water Htr.
Stemwa l l Insulation Heaters
Slab Prov. for physically Appliances
Carport handica ed
Conformance of ex. Gas Piping & Test
Footings structure Temp. Gas
Slab Final Sanitation
Patio r FIREPLACE Final
Footings Footing ELECTRICAL
Masonry Walls `' Throat Rough
Reinf. Steel Final Fixtures
Bond Beam FIRE SPRINKLERS Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MECHANICAL Grd. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal
Water Piping Sewer Gas Piping
MO6I6EHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE
ff REMARKS OR CORRECTIONS
Ald
P
1 111s 4<<. ll-e�,
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
y Signature of Permitee or Ag nt —
J5_ f � BY Date C�
Receipt No. tt/
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Building per6 expires Date - :7 `�Y`'�
BUILDING '
Owner "
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Tele hone No3
Contractor
Mailing Address
Fireplace QZ�
Total Valuation
Telephone No.
Permit Fee
'
Building Address Z��L, GVo
Plan Checking Fee &/or Penalty
Permit Fee
G
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trap 1,50
Gb,
Repair drainage or vent piping 1.50
iio d�
A. P. No. 2 —� f—�l�
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F
VY�Cr'
.S
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60 R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Bldg. Plans Recd
Parroval
cel A
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION UTILITIES ❑ OTHER
Permit Fee $
$
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3,00
Main service 600v OR LESS
100 AMP OR LESS 5.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
Main service OVER
100 AMPs0ov OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. ( DWELING
OR ADDNS. ACCLBLDGS.CCUP. Y� 20sgft
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:
Y
-OUTLET
NEW CONSTR BRANCHCIRCUITS
NON-RESID BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS .&
NON -RES,D. SINGLE OUTLET CIR,
Ex. Occup{OUTLETS OR FIXT11RES s L@
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 6.25
X=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.
1 certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
@
MECHANICAL No. FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorizehrepresentatives of the County of Butte to enter upon the
above -m tioned property for inspection purposes.
{�
JAI a _ r,s.e 7,,-2W, 7q
Land Development Fee
$
TOTAL PERMIT FEE
$ az
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.
n D/ iEgTOR OF PUBLIC WORKS
y Signature of Permitee or Ag nt —
J5_ f � BY Date C�
Receipt No. tt/
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Building per6 expires Date - :7 `�Y`'�