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APN: 043-682-010
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PROJECT: SME:
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PROPOSED CATV DATE:
comcast communications :
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LOCATION:
CH66-POI
APN: 043-682-010
26 ROSE AVE
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PROJECT: SME:
NONE
PROPOSED CATV DATE:
comcast communications :
%11:/- 08ZOZZ03
REGIOK& OFFIM* 4WO KU OR, SACPAMEMM CA MM POLE MOUNTED POWER SUPPLY APPROVED W
REVISION:
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REGWNAL OFFICE: 4350 PELL OR_, SACRAMENTO, CA 95838
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REGWNAL OFFICE: 4350 PELL OR_, SACRAMENTO, CA 95838
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(::096NTY ' -;,� E - DEPTMENT OF DEVELOPMENT SERVICES - BUILDIN
n Center Driv. • Oroville, California 95965 • Telephone (530) 538- 75
11SION PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
SEE ATTACHED ZONING
OWNER BUILDING PERMIT
COMCAST COMMUNICATIO TELEPHONE SO. FT. OCC. BUILDING VALUATION
- OWNERS MAILING ADDRESS
D4350RPELL DR SA A 951831p,
CONTRACTORS MAILING
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
[ARCHITECT OR ENGINEER Total Valuation $
LICENSE NO,
Filing Fee $ 20.00
ARCHRECT OR ENGINEERS MAILING ADDRESS
:Permit Fee $
BUILDINGADDRESSSEE ATTACHED Plan Checking Fee
Energy Plan Checking Fee $
LAT NO. SUBDIVISIONS NAME PARCEL MAP PERMIT FEE $
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE Each Trap 7.00
SF ❑ Duplex ❑ Mobilehome ❑ Other Solar or heat Pump water heater 23.00
spECIFv Water piping 15.00
TYPE OF WORK Each gas water heater or vent 15.00
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Gas Di in istem 1 - 5 outlets 15.00
PLACE CATV POWER SUPPLY Buildingsewer ? 15.00
Describe Work: Mobile Home S G W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT `' Fling Fee20.00
Main Service 2000A0A OR LESS OR LESS 1 23.00 230.0
2
LICENSED CONTRACTOR'S DECLARATION Main Service 200A TO 1000A
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter NEW CONST. 46.00
OR ADONS. °W�� ODS. SO
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, MULTI oLr�nEsr 3.5¢FT:
and my license isLJfull fore and effect./J N coNs .
--IrJ�� / I NON•RE51D. @7.50
License Class � � Lic. No. PowER APPARATUS
OWNER -BUILDER DECLARATION a SINGLE OUTLET CIR
EX. OCCLI . OUTLET OR FIXTURES 20 ® 1.00
I hereby affirm under penalty of perjury that I am exempt from the Contractors License Ex. Occu saL •50
Law for the following reason: FD�DAPp� °R
ounETs RESID. EA 5.00
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Temporary Service
will do the work, and the structure is not intended or offered for sale. 23.00
❑ I, as owner of the roe Mobile Home Facilities 20.00
property, rty, am exclusively contracting with licensed contractors Misc. Wiring to construct the project. 23.00 •
❑ I am exempt under Sec.
reason Business and Professions Code for this
WORKERS' COMPENSATION DECLARATION PERMIT FEE S
I hereby affirm under penalty of perjury one of the following declarations: MECHANICAL PERMIT Fling Fee 20.00
❑ 1 have and will maintain a certificate of consent to self -insure for workersHeating
compensation, as provided for by section 3700 of the Labor Code, for the Cooling
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by Section Hood 6.50
3700 of the Labor Code, for the performance of work for which this permit is issued. Ventilation
a workers' compensation insurance carrier and Policy number are:
Carrier
Policy Number PERMIT FEt $
(The above sections need not be completed if the permit is for work of a valuation Mobile Home Installation Fee $
of one hundred dollars ($100) or less.) Energy Inspection Fee $
❑ 1 certify that in the performance of the work for which this permit is issued, I shall °C° CONST. TYPE
not employ any person in any manner so as to become subject to workers' TOTAL FEE $250.00
compensation laws of California, and agree that if I should become subject to the "
workers' compensation isions Of section 3700 Of the Labor Code, I shall
D FEES IMP FLOOD COF pARCd Po HD E
forth ' h Tom h revisions.
This permit is hereby issued under the applicable provisions
X Date _j-� of the Butte County Code and/or Resolutions to do work
Applicant - ❑Owner
Signature Of �� V indicated above for which fees have been paid.
Contractor ❑Agent
An OSHA permit is required for excavations over deep and demolition or construction
of structures over 3 stories in height.
911111 0By Date
ReceiptNo.
WHITE-D.D.S.-B.D. AN Y -ASSES OR N - SPE OR oI Monn_woe PERMIT EXPIRES ON