HomeMy WebLinkAbout042-320-015l
A.P. 42-32-15
COLEEN SMITH SIV _
2223 Nord Ave.., Chico s/ COMPTON, 'Darrell J. 528-66B
Permit 3230-/'2B,P,E,M Q ,K _ 416-66E
convert arae to a a m e��i�-ant)/ /�
42-32-'tir
,2 42-32-15
Ave., `
-
Contr: Four Co Roofing (convert offic to beauty shop in single.n
Permit#1411-84B (reroof /SF) ,ft residence)
042-320-015 02-1161
SMITH, COLLEEN `f
2223 NORD AVE., CHICO (--
CONT: GEORGE & SONS ROOFING t
RE -ROOF
BUTTE CONSTRUCTION CO. 3420B
i
42-32-15
Corner Nord & Arbor, Chico `.
1 (remodel kitchen)
' r
PERMIT NUMBER _ B 3230-72B2F,E,M
P
E
i PERMIT EXPIRES
OWNER Coleen Smith
"CONTR: owner
LOCATION (A.P. 42-32-15 j
2223 Nord Ave., Chico
oe
I
f
e
i
COUNTY OF BUTTE
Department ofxPublic Works
BUILDING INSPECTION RECORD
Zoning
Setback''.
Forms
Foundation -
Piers & Girders
Fireplace
Rgh. Plumbing
Bond Beam
Lath & Plaster Q a.
Rein. Steel
Gas Piping &Test _!'L, " 7 P
Found. Vents
Framing
Plmg. Topout
Rough Elec. m �y
Wtr. Htr. _� "�%_
Furnace °�., ^"_
Kitchen Vent_��, 7
Firewall
Garage Vents
Sanitation & Water
ELECTRIC
GAS
BUILDING
Temporary
Temporary
Cert. of Occu x'16 * 3
Final �� -- L - 7�J
Final "% _
Final —
DATE REMARKS OR CORRECTIONS
a� ;,40(4:;0 .4op ,
-75 = ?3
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WO
�� i '%
7 County Center Drive - Oroville, California 95965 l
Telephone: 533-1230, Ext. 259
APPLICATION AND PERMIT
authorize repre ntatives of the ounty of Butte to enter upon the
above mentione property for in ection purposes.
X Date
Signature of Permmitee r Agent
Receipt No. 10 i:3 7 3 _
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 01i1 PUBLIC WORKS
BY Date 17--7 2-7 -1--
Building
Building Permit Expires to/y— /7'73
BUILDING
Owner s
a �c
SO. FT. OCC. BUILDING VALUATION
DZ-,
Mailing Address V
Nord
Z. DI"
03-Ibl
Fireplace
Contractor Q 31
Total Valuation �� 161
Mailing Address S'CL
Permit Fee
'
2,v'
Plan Checking Fee &/or Penalty
Permit Fee
$~--
Building Address /" �--
PLUMBING
No.
@
FEE
PERMIT FILING FEE $2.00 2.
Each Trap 1.50 3
Repair drainage or vent piping
1.50
Water piping 1.50
Each g water heafer o vent 1.50
A. P. No. Z - Z - , / 5�
Zoning &4,4
Gas piping system 1 - 5 outlets
1.50
f ��
Each additional outlet .50
Fire Zone
Fire Dept.
Planning
Building sewer 5.00
rrj,
Plans
i___Lawn
Fees
W.
R/W
Encroachment
sprinkler system 2.00
NEW ❑ ADDITION ❑ OTHER
Permit Fee
5 0
$
ELECTRICAL
No.
@
FEE
PERMIT FILING FEE $3.00 3�-
adr-tl2f oil
Main service incl. 1 meter
Additional meters, each
1.00
Sub -panel (12 or less) (more than 12)
USE OF STRUCTURE . Single Family ❑ Duplex 9 Others ❑
Range, dryer or water heater 1.00
Oven, Cook -top or space heater
1.00
Light fixtures a bal fd2
Re s., swit hes & fix o tlets X
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
1,Aja
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Misc. wiring
Lice se No. Classification
I am exempt from the Contractors License Laws of the State of California.
Permit Fee
$16. 1 d
p,
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.
ICl certify that in the performance of the work for which this it i
perms issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
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 b I ding construction, and hereby
MECHANICAL No.
@ FEE
PERMIT FILING FEE $3.00 3!
Heating I `-
Cooling
Ventilation oC 2, Ud
Permit Fee v0
�n5lrumentati for �t` s om1Oa $0.07/$1000 Evaluation
$ =
$ yS
TOTAL PERMIT FEE
D b
authorize repre ntatives of the ounty of Butte to enter upon the
above mentione property for in ection purposes.
X Date
Signature of Permmitee r Agent
Receipt No. 10 i:3 7 3 _
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 01i1 PUBLIC WORKS
BY Date 17--7 2-7 -1--
Building
Building Permit Expires to/y— /7'73
. o
/e.141 �—
• f .
< COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 /� f ' 77! /
APPLICATIDN,AND PERMIT / \
ASSESSOR PARCEL NUMBER
A 9_Z1_1 S
ZONING
BUILDING PERMIT
OWNER
r01.RFN V. RMTTif
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
liQ n�1lrn-•n CL,nLn An_.......t
OWNER'S MAILING ADDRESS
9?71 Mnr.i A%ra, r1^ nn re Q;oiA
2 C
CONTRACTOR'S NAME-
rnTm r0T7NTTFq POOPTmr. rn-
TELEPHONE
161-1616
CONTRACTOR'S MAILING ADDRESS
1060 Marauder St.. rhico. rA 45926
Fireplace
CONSTRUCTION LENDER
M/A
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ iC nn
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
.$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS -
Permit fee
$ AS lin
BUILDING ADDRESS
SRmR
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 E1 Duplex❑ Mobilehome❑ Other
SPECIFY
Building sewer ,/
5.00
Mobile Home ,/1 S I G W
10.00e
/
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other 0
Describe work: lRboIkra Re.—rnnF —
Permit„Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 500V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMPS
2.50
NEW CONST. DWELINGOR ADONS. ( ACCLBLDGS.C� &)
21h0Sq 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 force and effect.
License No. 275965 Classification r-39
❑ 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 CTRL ITS
NEW CONSTR. ( POWER APPARATUS &)
NON.RESID. SINGLE�OUTLET CIR.
Ex. Occu 'e 20®50a
aALmao
p�OFLIXED' L
NSXORRES
APPTS
Ex. OCCUp. OUTLETS (RESID.) EA•) 2.00
TemporaryFservice 10.00
Mobile Home Facilities. 15.00
Misc: Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
~ ffilingFee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
a 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 shal I be deemed revoked.
Heating %
Cooling
Hood 3.00
Ventilation
Permlt,Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Y + f %' j Date 5�4�84
q, q�� 11�
Signature of Applicant — Owner❑ Contractor ❑ Agent:N
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 $ 45.00
occUP. GROUP
I TYPE OF CON S7.
PARCEL
PD I
HD
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
��� (PRRECTOR OF. PUBLIC
` rr 1•
By Of
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
3
Receipt No.
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
8y,
#A -
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATI it -AND PERMIT
PERMIT N0.
/—
ASSESSOR PARCEL NUMBER
42-32-15
ZONING
BUILDING PERMIT
OWNER
COLEEN V. SMITH
TELEPHONE
343-7406
S0. FT. OCC, BUILDING VALUATION
39 square RP—roof
OWNER'S MAILING ADDRESS -
2223 Nord Ave. Chico CA 95926
CONTRACTOR'S NAME
FOUR COUNTIES ROOFING CO.
TELEPHONE
343-1416
CONTRACTOR'S MAILING ADDRESS
1060 Marauder St., Chico CA 95926
Fireplace
CONSTRUCTION LENDER
N/A
UNKNOWN
Total Valuation Is
'
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 35.00
ARCHITECT OR ENGINEER
LICENSE No.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ 45.00
BUILDING ADDRESS
Same
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION NAMEPARCEL MAP
Each Qas water heater or Vent, --'5.00
Gas piping system 1 - 5 outfets
5.00
USE OF STRUCTURE
SF JR Duplex ❑ Mobi lehome ❑ Other
SPECIFY
Building sewer
5.00
Mobile Home S I G W
10.00 e
TYPE OF WORK
New ❑ Addition ❑ RemodeI ❑ Utilities ❑ Installation ❑ Other X❑
Describe work: - Shake Re—roof
Perms ee
$
Co tractor
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. DWELLINGOCC •P.&
OR ADDNS. ( ACC. BLDGS.
1
/ 2�z2SQft
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. 275945 Classification C-39
❑ 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 ON R, ULT'-OUTL1�E2,50 ea
NON-RESID BRANCH CJrCT TS.
NEW CONSTPOWER APPARATUS &
NON- R RESID. (SINGLE�OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 9AL®S30
FIKED APPLNS. OR
Ex. OCCUp. OUTLETS (RESID.) EA,) 2.00
Temporary ervice 10.00
Mobile ome Facilities 15.00
Misc Viring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
fHIng 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.
❑ 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.',, - " "� �: ", � rr , i .
Heating
Cooling
Hood
3.00
Ventilation
permit ee
$
CoFffractor
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.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against/saj*A County ' on a ce of the granting of,this permit.-
X Date 5/4/84!
Signature f Applicant — Owner❑ Contractor ❑ AgentJR
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 $ 45.00
OCCUP. GROUP I
TYPE OF CONST,
I PARCEL
PD
I HD
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
ECT9P OF PUBLIC
BY -R^
PERMIT EXPIRES ate
the applicable provi-
resolutions to do
fees have been paid.
WORKS
n
Date
Receipt No. 7
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
�A "'r0
�a6d
0
f"4-60^► odsoa "I no-.,)
14.,:. �7;3,cf;Y'nrs+:�a►Cts`,i�.��,:�'�-�t��r:r�s,:.....:.. _. ,, d .... -. ., _ .. _. r. w ,.�,,. �.: ,,. .K ... , ..�..-.
F s =-
4
02- 116
i - /
CHICO ' V SONS ROOFING .
a
2
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) APP LICArTIONAND PERMIT 02-1161
ASSESSO PARCELNUMBER
{�k2—�2C�i25
ZONING
BUILDING PERMIT
OWNER
COUEEN SMITH
TELEPHONE
SO, Fr, OCC. BUILDING VALUATION
40 2400.00
.OWNERS MAILING ADDRESS
2223 NORD AVE, CHICO 95928
CONTRACTOR'S NAMETELEPHONE
GEORgE & SONS ROOFING
584--4443
CONTRACTORS MAILING ADDRESS
1090 HURLTON RD, OROVILLE 95966
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 2400.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 54.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
2223 10RD AVE CHICO
Energy Plan Checking Fee $
$
f
PERMIT FEE $ 74.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SFA Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK XX
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other O
Describe Work:REROOF W/CW '
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
800V 0 R UES
Main Service( .AORLESS 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,µq.lpT'
and my license is in full force and effect. // may, /
License Class t� Lic. No. 19 7,r 7
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.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason f
Main Service 200A TO 1000A 46.00
NEW CONST. DWELLING OCCUP, SO
OR ADONS. ( & ACC. BLDS. 3.50FT.
MULTI.OUTLET @7,50
PoWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occu oLmFr OR FocruREs BAS @':s000
FlXED APPLNS.) E 5,00
EX. Occup.ounErs RESID. EA
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE t
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
P,erformance 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 thisipergmit is issued.
My workers' co�mpe_n"sa,ton insurance carrier and policy number are:
Carrier
Policy Number —7 I'Vl- C f "-
(The above sections need not be completed if the permit is for work -of a valuation
of one hundred dollars ($100) or less.) I
❑ 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'
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.
/
X Date G- Cl /t)72,
Signature `of Applicant -10 Owner 13. Contractor 13 Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEECA�LfiS
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE 74.00
TOTAL FEE $
FEES IMP
FLOOD
I CDF
PARCEL
I PD
HDALSSUE
it
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated 4bove for which fees have been paid.
By Date
PERMIT EXPIRES�'ON ��~� 0l,
I te "�
ReceiptNo. 3534591 $74:00
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR 'GOLDENROD -APPLICANT
(Rev. 12/96)
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 PERMIT NO.
APPLICATION'AN® PERMIT 02-1161
�s4EsoP20� 015
ZONING
BUILDING PERMIT
COOWNERLLEEN SMITH
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
40 SQ 2400.00
. OWNERS MAILING ADDRESS
2223 NORD AVE, CHICO 95928
CONTRACTOR'S NAME
GEORGE & SONS ROOFING
TELEPHONE
589-4443
CONTRACTORS MAILING ADDRESS
1090 HURLTON RD, OROVILLE 95966
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 2400.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 54.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS 2223 NORD AVE CHICO
Energy Plan Checking Fee $
PERMIT FEE $ 74.00
LAT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee • 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF X' Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK Xg
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other O
Describe Work:REROOF WCOMP
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G W 920.00
PERMIT FEE $
ELECTRICAL PERMIT Filing Fee 20.00
"OOVOR LE
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 in full fore and effect.
License Class 3 I 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 astheir 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'
erformance of the work for which this permit is issued.
pIompensation, as provided for by section 3700 of the Labor Code, for the
have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for whichthis mit is issued.
My worker ' c pe sa�tlon insurance carrier and policy num r a e:
Carrier .
Policy Number —7/'2... 01
(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'
compensation laws of California, and agree that if I should become subject to the
workers' compensa on provisions of section 3700 of the Labor Code, I shall
fort with comp ` Ali those provisions.
X t✓ Date "1 Z) _2-s
Signaturef A p i nt - ❑ Owner � ontractor ❑ Agent
An OSHA ermit Is r wired for excavations over 60" deep and demolition or construction
of structur s over 3 stories in height.
Main Service 200A TO 1000A 46.00
NEW CONST. DV=NG OCCUP. SO
OR ADDNS. ( 8 ACC. S.3.5QFT:
NON -ID. T. MULTI -OUTLET RANCH CIRCUITS @7,50
POWER APPARATUS
a SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURE" aAL o 1 0
Ex. Occup. ount�APP
ALINIS°eA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FES $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 74.00
HAZ.
I D. FEES
IMP
I FLOOD
I COF
PARCEL
I PD
I HD
UE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated bove for which fees have been paid.
y Date ✓✓ Q�
PERMIT EXPIRES N CIV .9
Date
Receipt No. 353459/ $74.00
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT