HomeMy WebLinkAbout043-253-01743-253-17
CLEMENT C. SCHWARTZ
720 Bidwell Drive, Chico
Contr; Northstate Aluminum
Permit#2547-83B(new awning over patio
043-253-017 05-3280
SCHWARTZ, CLEMENT
720 BIDWELL DR, CHICO
Cont: FOUR SEASONS ROOFING
RE ROOF
BUTTE COUNTY ,
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP053280
B. C. Building Permit 01-16-04 pg 1
LICENSED CONTRACTORS 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
Issued Date: 12/16/2005 APN: 043-253-017-000
the Business and Professions Code, and my license is in full force and
effect.Site
License Class: License Number:
Address: 720 BIDWELL DR CHI
Date: i Z Contractor:
Map Index:
Description: RE -ROOF (19 SQ)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
Owner: SCHWARTZ CLEMENT C & HELEN E
permit to construct, alter, improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to file a
signed statement that he or she is licensed pursuant to the provisions of
720 BIDWELL DR.
the Contractor's State License Law (Chapter 9 commencing with Section
he
CHICO, CA
7000) of Division 3 of the Business and Professions Code) or that or
she is exempt therefrom and the basis for the alleged exemption. Any
95926
violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 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 (Sec. 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an
Applicant: FOUR SEASONS ROOFING
pp
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
#11 COMMERCE COURT
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
SUITE #1 95928
proving that he or she did not build or improve for the purpose of
530-895-0418
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' State License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor: FOUR SEASONS ROOFING
pursuant to the Contractors' State License Law.).
❑ I am Exempt under Article 3 of the Business and Professions Code
#11 COMMERCE COURT
SUITE #1 95928
Date: owner:
530-895-0418
WORKERS' COMPENSATION DECLARATION
I her by affirm under penalty of perjury one of the following declarations:
License #: 659073
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.
Architect:
❑ I have and will maintain workers' compensation insurance, as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier: L, Nit 51
NZrl
Square Ft: 0 S. F.
Policy #:
Valuation:
Valuation: $0.00 .
❑ I certify that in the performance of the work for which this permit is
Census Code:
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California,
O
and agree that if I should become subject to the workers'
e i Io o�
compensation provisions of Section 3700 of the Labor Code, I shall
y� I
forthwith comply with those provisions.
Date: I
y 3 g q
�J
Applicant: Z_
WARNING:ailure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
This permit is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutions o do work indicated ove for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name:
BY rnDate:
Address:
PERMIT EXPIRES ON: ll�
Date
❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project.
❑ Attached are copies of the required E.P.A. notification forms.
I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. 1 hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: —JD b, L� I irAtA Signature:
Date:
❑ Owner ❑ Contractor ❑ Agent for Ownernt for Contractor
B. C. Building Permit 01-16-04 pg 1
%JTr BUTTE COUNTY
o o DEPARTMENT OF DEVELOPMENT SERVICES
O BUILDING PERMIT APPLICATION
O AND SUBMITTAL REQUIREMENTS
0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
o io -�' o
�OU�OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICA TION
"PLEASE PRINT CLEARLY* X - .
OWNER
Last Name Z
First Name We-
eAddress
Address
7zo (3 1d w e_I (
City C W State C
T_rp
Phone _ G/Fax
E-mail
CONTRACTOR
Name
Address it
City C
StateC
Zip cj
Phone rid (.� I
DD
Fax
E-mail
Lic. #/!�; 0 73
Clt 3q
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City ,• C�
Address
SRA
City
Fax
State
zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City ,• C�
State
SRA
Phone
Fax
E-mail
A P ICANT SIGNATURE
X
For office/use only:
Zoning
Property Address pp aa
C71dw l(
Flood Zone
Cross Street
SRA
I Yes
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
NO.
B P 0 5'5
BIN 9
LOCATION
AP#
�) 53 -
Property Address pp aa
C71dw l(
City
C�,,cCU
Cross Street
WORKER'S COMPENSATION
Policy Number(—/
umber( i.7� 1 79 Z
Carrier!
Vother -than
If hiring anyone license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of Work:
>% of-'FCa
Sq. Footage S
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application.- In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS .
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
I I Received by: �, 6. Amount 't t O 6 Bldg I I
Receipt #: I T3 PQ
I Date: 12 -16 -OS
OVER FOR SUBMITTAL REQUIREMENTS, L`
...-... .-...-,.-. ... .. ..... �..... .......�_. __fin _�r._�._ J__ n... 4 7
SRA
Sheriff
SMIP
Other
9 W Total
DCA/ 9_1 C_nA
SUBMITTAL REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to.sapply
fora permit. INCOMPLETE SUBMITTALS WILL NOT BEACCEPTED. ALL PLANS MUST BE,. `
LEGIBLE AND IN INK. _
'
Residential, New, Remodels, Additions, and Accessory Structures:
❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑ .2. . 3 Complete sets of.plans, signed by the preparer. NO GRAPHPAPER! ,n
OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed
calculations.
❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!).
❑ 4. Letter from Engineer or Architect for truss design review. ,_ '
❑ 5. 2 Energy compliance_design•and supporting documentation. (Note: Not required for additions td.
mobile or modular homes.)
❑ 6. 2 Flood Elevation -.Certificate, wet -stamped and signed (if required). �
❑ 7. Detached Accessory Building Form, filled out by the property owner (if required).
❑ 8. Sanitation and site plan approval from the Environmental Health Department.
❑ 9.. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevationsin
triplicate, (D)'Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
Mobile, Manufactured, or Modular Homes:
❑ 1.. 3 Site Plans, signed by the preparer. NO GRAPHPAPER!
❑. 2. 2 Data sheets and installation instruction manual.
❑ 3. 2 Marriage line information.
o 4. 2 Floor plans.
❑ 5. 2 Engineered Tie Downs or Foundation plans.
❑ 6. Sanitation and site plan approval from the Environmental Health Department.
❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required).
Commercial, New, Additions and Remodels:
❑
1.
4 Site Plans, signed by the preparer. NO GRAPH PAPER! ,..
❑
2.
4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, '
with code analysis. r .
❑
3.
2 Engineered truss details and layouts (if required) (NO FAXES!). ?
❑
4.
Letter from Engineer or Architect for truss design review.
❑
5.
2 Energy compliance design and supporting documentation (if required). -
❑
6.
2 Flood Elevation Certificate, wet -stamped and signed (if required).
❑
7.
Statement of Intent for Non -heated and A/C (if required).
❑
8.
Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in .
triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer.
❑
9.-
Letter of intent.
❑
10.
Hazardous Material Form.
❑
11.
Sanitation and site plan approval from the Environmental Health Department. -
• ti r.
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530) 538-7541.
OVER FOR BUILDING PERMIT APPLICATION
K:\FORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2
Dec 16 05 02:12p Reception 530-895-9201 p.1
40POWSZ-1460%6joOns-,
ROOFING
11 COMMERCE COURT, SUITE #1
CHICO, CA 95928
(530) 895-0418
(530) 895-9201 -
'AYLOR@FOURSEASONSROOFINGCHICO.COM
AX TRANSMITTAL COVER SHEET
DATE: 11/16/05
TO: COUNTY OF BUTTE
LOCATION:
# OF AGES: .1 (INCLUDING COVER SHEET)
FRO LISA TAYLOR
S U BJ CT:
J MILL HAS PERMISSION TO PULL PERMITS FOR OUR
OM LANY.
A AYLOR
R
k
t
r
PERMIT NO. 2547-83B
PERMIT EXPIRES
OWNER CLEMENT C. SCHWARTZ
`
CONTR.North StateAlum
ASSESSOR PARCEL 43-253-17
LOCATION 720 Bidwell Drive, Chico _
F•"
Temp. Power Pole
Called PG&E
Temp. Elec. Servi
J+
Called PG&E
aJ Temp. Gas Service
Called PG&E
JOB FINALED (Date) 10o A)
Signature
J ok
O = Not OK
- = Not Applicable
* = Not Ready
MOBILEHOMES
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except#'s
Date
DECK§,.,'OVERS, CARPORTS, ETC. (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
1, Zo ' g Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
ootings; Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete
_
decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)4__Weo'd
Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing__
5. Electricity; Location-Clearances-Grnd.-/ /. Amp -Concrete
lum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
_-6.-Garports; Windows -Doors
7. Utility Clearance
3r�lec.
Card -BI
Date Card -BI Date
Card-13I'1L
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date
POOLS (Plans) OK except #'s —
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining _
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/0 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 Lghig.
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 B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
= OK
= Not OK
Not Applicable RESIDENTIAL.)SiK'§ a and Duplex)
= Not Ready,
Date
UNDERFLOOR Plans OK except #'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.
Fig., 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-Blockou!s-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
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
57.
Smoke Detector
14.
Water Ht.; Vent -Access -Combustion Air
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
15. Water Pipe; Test & Anchors -Nail 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
- -
Card -BI
Date Card -BI Date
64.
Elec. Outlets at Wood Panel; Int. & Ext.
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 p's
67.
Garage Fire Door; Swing -Landing -Closer
68.
69.
A.C. Duct in Garage -Damper
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor -Meeh. Protection
20. Fixture & Transformer Clearance -Ins. Protection
---
21.
Eiec. Receptacles Spacing -Lights & Switches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
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 ❑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 r / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
-----Insulated
27.
28.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Neutral ❑Yes ❑No
Service -Riser Conductors & Ground -Main Disconnect
75.
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
76.
Stucco; Brown -Finish
__-
29.
30.
Equip. Clearances; Panels-Motors-Mech. Equip.
Clothes Closet Light -Shower Light
77,
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
Water Well; Disconnect, Electrical, Plumbing
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Card B -I
--------Date
-__ Card -BI Date
Date Card -BI Date
81.
Ventilation throughout House
82.
Glass Protection
Date
MECHANICAL (Permit) OK except N•s
83.
_
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
31.
A.C. Ducts; Insulation & Support
85.
Water & Sewer Connected -C/O to Grade -HD Approval
32.
33.
Vent_Fan_Exhaust above Insulation -_
_Condensate Drain _& Overilow; Size & Grade
86.
Energy Compliance Certificate -Other Certificates
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI
Card -BI
-_
Date__- - Card -BI Date
Dale Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FRAMING(Plans) OK except H's
Comments at Final:
Sills; Proper Material & Anchors
_
_
_36.
-37.--Walls:
38.
39.
Studs -Nailing, Spacing & Bracing -Plates -Sound
Bearing Walls over Girders & Floor Nailing___
Draft Stop in Walls (rat proof)
_
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
42.
43.
44.
Header & Beam -Size & Bearing
Hangers -Post Caps -Anchors -Connectors _
Cing. Joist-Rftr. Ties-Purlin-Roof Brat.-Truss-Shthng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat
_
45
46.
47.
Attic Access: Size & R_omex Protection -Draft Stop -Ins. Baffles _
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions__ _
Garage Fire Protection Framing
(NOTE: Anentrymust be made each time you visit jobsite)
• r
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
- 7 County Center. Drive - Oroville, Californiah95965 - Telephone 916/534-4541
14 - :.
APPLICATIONAND PERMIT
ASSESSOR PARCEL NUMBER
.043-25-3-017-0
z NIN
BUILDING PERMIT
OWNER
Clement C. achwartz
TELEPHONE
342-4064
SO. FT. OCC. BUILDING V LUATI
22 10350.00
OWNER'S MAILING ADDRESS
.,,320 Bidwell Drive Chico, CA 95926
CONTRACTOR'S NAME
North State Aluminum Inc.
TELEPHONE
343-7956
CONTRACTOR'S MAILING ADDRESS
3029A The Esplanade Chico CA 95926
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ 1 0 00
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 25.00
ARCHITECT OR ENGINEER
pT
lippel
LICENSE NO.
6
Plan Checking Fee
$ 15.00
'Penalty
$
E OR ENGINEER'S 5 MAILING ADDRESS
ARCHITECT
1525 U Street Sacramento CA 95818
Permit fee
$ 50-01
BUILDING ADDRESS
720 Bidwell Drive Chico CA
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
SF0 Duplex❑• Mobilehome❑ Other
SPECIFY
Building sewer
5.00
Mobile Home S I G I W 1
1 110.00e
TYPE OF WORK
New]a Addition ❑ Remodel ❑ Utilities ❑ Instal lationU1 Other ❑
Describe work: Install 9' x 25' Awning over Patio _
Permit Fee
$
Contractor
ELECTRICAL PERMIT-
Filing Fee 10.00
Main service s0Uv 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. 424499 Classification R-1
❑ 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 -OUTLET
NON.RRESID. `BRANCH CIRC ITS
2.50 ea
NEW CONSTR POWER APPARATUS &
NON-RESID. � SINGLE OUTLET CIR. )
Ex. Occu 20@50a
eAL®300
p(OUTLEXED
APPLNSXTURES
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
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):,s�; ;
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building 1Department
a Certificate of Workmen's Compensation Insurance :.or a rtificate
of Consent to Self -Insure. r,
❑ I shall not employ any person in any manner so as to `become�ubject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, spould you be6ome subject
to the W. C. provisions of the Labor Code, you must forthwith compl.y'with 9 ',h
provisions or this permit shall be deemed revoked. '�,) '
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
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'Sfate 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
liabilities, .judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X !S: 1%� �SbS'1 "S:S L� Date 7�26�83
—�.
Signature of Applicant — Owner ❑ Contractor ❑ Agent K]
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
of structures over 3 stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE 90.00
occuP. GROUP
A/_/
TYPE OF C NST.
iv
1 PARC
PD
No Zall
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRE R OF PUBLIC
By
PE IT EXPIRES Date
the applicable to do
resolutions to do
fees have been paid.
WORKS
Date /�-r�Q��Y
4Z> �
ceipt No. ® /.1&S"
LWio,n
TE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
11
t ,