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HomeMy WebLinkAbout042-170-04242-17-42 BRUCE NICOLA -N/S Sacramento Ave, app 600' W of Rd, Chico , Contr Floyd Stober, Chic6p % , 0 Permit#4166-80B(reroof/SF) 042-170-042 02- 66 NICOLA, BRUCE ���'�� 3416 W. SACRAMENTO A E RE -ROOF G 1` r To:5382140 P.2'2 ,T-08-2007 11:19 From: -r 1020 SKYWAY u PARA 1)1 1-. (.A 95Ocit) MIC (330) I.M." 2+1 ' TOI 1, FRIT I•H00.M-1 lug POND'E'ROSA FAX (530) 977-5460 R'EAL ESTATE Butte County Building DeparMe t 3 vVvt?vy Drive RE; Permit, l3mvllrest 341-6 W. Sacramento Ave. c� •..- icC o5®1 4pp rrI r•/'. �V®®S7IV V t��11V 1�1 �V Irl {�� Vo•�•��i.�li• I ; eA7j egQ'eaa lab& "eeiier of '-he9bove' re feaanCAJ4 nPnn�•r�v T inslerl roniAc of 1/I V {•I IY YI IV JV.•Y. V Y..r M V.1 VM p• v/I Y� • �r•�� LIIC OU114111y Fermin we Reco14 we 4l obt we wvquty IFIGG9/JG IVu Ilio nAVi�� i����ho•�• >L a L_ -a "e__ .1 these copies win be 1couy 1v1 pickup. Property: 3416 W Sacramento Ave ' C141�.6 A --" 0lJ�l73- PAPP* 042_'-7n_nA,:i Y enn 'b-.% "Paz. -m lPl 'a4 -(S3nN B7')_1CGnn Y!' =nL, y 1 very much for your /� v vMv•v� �v cooperation, Sincerely; `r• Lam Vnifrknn/ C`pic • Dr okel `PAssociate. Coldwell Banker Ponderos-3 e K/jil F:aett 011ico is IiulCl:uirtttentty Ownad And 011eral$d � � Y 042-170042 li' 02-2566 NICOLA, BRUCE 3416 W. SACRAMENTO AVE., CHICO RE -ROOF fes 7 i � � r• ' Y COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville,. California 95965 • Telephone (530) 538-7541 _ PERWT'NO. (Rev. 12/96) APPLICATION AND PERMIT Ct, V ASSESSOR PARCEL NUMBER a (4(p _ I _ a ` ZONIN _ / BUILDING PERMIT OWNER f} -a//�w�J!/C) TELEPHONE KQ.FOCC.BUILDING VALUATION . OW 5 MAI ADDR SS a ftaJnW A `150 CONTRACTOR'S NAME TELEPHONE SKQO CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 0 ARCHITECT OR ENGINEER LICENSE NO. Fee $ 20.00 —Filing Permit Fee $ 109-00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS �- Ili (� ., .�a.c Energy Plan Checking Fee $ $ Ckt3 PERMIT FEE LOT NO. SUBO. .IONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.0023.00 USEOFSTRUCTURE SFX Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: q IQ 0p. 3600 . QU v ( X3 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service 200A OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is I full force and effect. /" / /i (r c.� %�' License Class y Lic. No. r Tr' ii l3� /r_ OWNER -BUILDER ECLARATION 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. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUR OR ADDNS. ( & ACC. BLDS. so 3.5¢FT. NON -RID. T. MULTI- CIRCUITS OUTLET @7.50 POWER APPARATUS a sIN OurLET CIR. - Ex. Occup. OUTLET OR FixrURES �� @': 0 Ex. Occup. DUTLEEOTS pp °Ep 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. %I 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' orr??p�ensation insure carrier a d poli - number are: Carrier I/Vf t ✓ ((A h ( �� �/ /• Policy Number X44 r Z f/'7 e,','�r'"yV 7 7 1 (rhe above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit islissued, 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' crimp nsation Prov}}ssions of section 3700 of the Labor Code, I shall forthwlt �o)y w' h os�rovisi s. X _Z/_ ����� Date / /f C- Signature of Applicants ❑ Owner ©Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Dcc C. T. TYPE TOTAL FEE $ S, HA2. D. IMP FLOOD CDF PARCEL PD HD ISSUE tri° 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. t /f n t A ,, I /�1 By ��'l�f �! X/� Date 9`��O -t7d PERMIT EXPIRES ON 9-16-03 Dere ReceiptNo. e%'Pig. dU WHITE-D.D.S.-B.D.� CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT VJ COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ;✓' 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 _ pF ya• (Rev. 12/96) APPLICATION AND PERMIT C ASSESSOR PARCEL NUMBER O / /� ZONIN —/ BUILDING PERMIT OWNER TELEPHONE SQ. FT. OCC. BUILDING VALUATION too .Ow 5 IIIUDRISS 1 CONTRACTOR'S NAME TELEPHONE r CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation $ , ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 109-00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 3 ' W, S Energy Plan Checking Fee $ PERMIT FEE $ . Q LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 Each Trap 7.00 USEOFSTRUCTURE SFX Duplex ❑ Mobilehome ❑ Other SPECIFY 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 ❑ Describ/e- Work:%` �w & �/ 3(oCJCJ . 3 JC Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 V OR LESS Main Service . "OR LESS 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is i ull f r and effect. License Class Lic. No. `D OWNER -BUILDER ECLARATIO 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors . to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason 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' co pensation, as provided for by section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the bor Code, for the performance of work for which this permit is issued. My worker ' o ens tipn insure carrier a R li number are: Carrier � I�/ Gin h (/ /� Policy Num er (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 workers' compensat' n la of California, and agree that if I should become subject to the workers' m sation pro ' ions. of section 3700 of the Labor Code, I shall forth y w' h provi ' S. X Date (� Signature of Applican - ❑ 0 er Contractor ❑ Agent An OSHA permit is re ired for excavations over 60" deep and demolition or construction of structures over 3 stories in height. 64 Main Service zoOA TO 1 46.00 NEW CONST. OWEWNG OCCUP. SO U OR ( a Acc. 3.50 ONS NEW CONST. MULTI.OUTLET UTLIE NON•RESIo. , La POWER APPARATUS 8 SINGLE OUTLET CIR. 20 @IOD EX. Occup. OUTLET OR FIXTURES BAL @ .50 Ex. Occup. GuT,EF°,s" PR ) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ IEC3 . TYPE TOTAL FEE $ 1(98,(p Im HA2. D. IMP I FLOOD I CDF PARCEL I PD HD ssuE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicate bove for which fees have been paid. (�_��'t7a By Date 1 PERMIT EXPIRES ON 1- 7 9-16-03 Date Receipt No. , 60 WHITE-D.D.S.-B.D.- CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ;PERMIT NO. 4106—$0B" F PERMIT EXPIRES OWNER BRUCE NTCQT.A CONTR. Flo;rd Etcher, Chico ASSESSOR PARCEL 42-17-42 LOCATION NIS Sacto Ave, 600'W Dairy Rd, Chico '1 f i F �111� Temp. Power Pole_ i Called PG&E _ Temp. Elec. Service Call/PG&E— Temp. G Cal ed PG&E 1 JQ FINALEI ! Signature i V = OK 0 = Not OK - = Not Applicable RESIDENTIAL (Singl.9 and Duplex) * = Not Ready Date UNDERFLOOR Plans OK exce t#'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /'' Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 1 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except N's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except q's 14. Water Ht.; Vent -Access -Combustion Air 15. Water Pipe; Test & Anchors -Nail Protection 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 19. Gas Pipe; Size & Anchors 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except q's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 69. 70. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection Plb., Elec. & Mech. Equip. Listed for Location 21. Elec. Receptacles Spacing -Lights & Switches at Doors 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G. F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. 72. Insulation -Foam -Looked in Attic E) Yes 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas &water 73. Guard Rails &Deck Construction -Post Caps 25. 2 Appliance Circuits in Kitchen & Conductor Size 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or AI, Insulated Neutral ❑Yes El No 75, Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters El Yes E] No 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77, A.C. Unit; Disconnect-Cirnces-Brkr. & Cond. Size -115V Outlet 30. Clothes Closet Light -Shower LightZoe-1-encs Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. ---- Card B -I Card B-1 _ --- -.--- - _ Date Card -BI Date _ _._. Date Card -BI Date 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. Ventilation throughout House 82. Glass Protection Date MECHANICAL (Permit) OK except N's 83. 84. Corrections from Previous Inspections Gas Test -Meters Tagged; Gas -Electric 31. 32. 33• A.C. Ducts; Insulation &Support Vent Fan; Exhaust above Insulation Condensate_ Drain & Overflow; Size & Grade 85. Water & Sewer Connected -C/0 to Grade -HD Approval 86. Energy Compliance Certificate -Other Certificates Card -BI Card -BI 34. 35. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet Attic Access & Platform if Furnace in Attic Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date _ FRAMING(Plans) 36. 37. 38. 39. 40. OK except q's Sills; Proper Material & Anchors_ Walls: Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders &_F_loor_Nailing__ Draft Stop in Walls (rat proof) _ Fire Stops; Furred Ceilings -Stairs -Chases -Tub _ 41. Header & Beam -Size & Bearing %� - -_ __ _ - •C 42. angers -Post Caps-Anchors-Connectorsdo 4444.. Fireplace Ties or Type A Flue -Fireplace Throat R(� 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing (NOTE: An entry must be made each time you visit jobsite) J r- OK (J - Not OK = Not Applicable MOBILEHOMES = Not Ready MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts- Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except q's 1. Zoning Requirements -Setbacks -Easements Card -BI Date Date Card -BI Date POOLS (Plans) OK except q's 1. Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Gas; MH Test -Demand -Valve -Connector. 3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining 4. Electricity; MH Test -Crossovers -Breakers -Clearances 4, Elec.; Receptacles and Lighting; Distances-GFI 5. Drain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Water and Sewer Connected -C/O to Grade -HD Approval 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Panel boards -Ins. to Main in Conduit 9. Exits; Insp.-Sketch 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date :cJ �. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville„California 95965 -Telephone 916/534-4541 ” APPLICATION AND PERMIT PERMIT NO. ASSESS4ARCEL NUM ER ZZ •- :04ING BUILDING PERMIT OWNER L TELE -PHONE SQ. FT. OCC.1 BUILDING UATION OWNER'S SMMAILING ADDRESS / r /\ CONTRACTOR'S NAME )51 O TELEPHONE CONTRACTO'R'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN ft----"' f Fireplace Total Valuation $ LENDER'S MAILING ADDRESS _ - `-- Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS --- Permit fee* $ —j2 no BUILDING ADDRESS / PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 l�U Water piping LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent .2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF D!�'_ Duplex ❑ Mob lehome ❑ Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other E Describe work: 09aIe®d4I= Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service jp0 AMP ORV OR LESS5.00 Main service EA. ADD'L too AMP 2.50 NEW CONST. DWELING OR ADDNS. ( ACCLBLDGS,CCUP,&) 20 sq ft 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 rce and effect. License No. -26E OII 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. ULTCI OUTLET 2.50 ea NC,N•RESID BRANCH CIRC ITS NEW CONSTR POWER APPARATUS & NON.RESI D. (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES BALI BAL�to¢ FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6,25 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE 1 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. MECHANICAL PERMIT FiIingFee 3.00 Heating Cooling Hood 2.00 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 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 �,�dou y onsequence of the granting of this per it. �] % %� 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 $ "---- Land Development Fee $ -�-- TOTAL PERMIT FEE �[w OCCUP. GROUP I TYPE OF CONST, PARCEL PD T—;771 E This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF P BLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date .� Recei t No.� JF P !VM' � DENROD WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOL -APPLICANT