The URL can be used to link to this page

Home My WebLink About043-682-055043-682-055 AL O; LARRY PL 011 1-1843 2 VIAL RBOLES �HICO CONT: JESS -ATING & AIR CHANGE HVAC I CLAIMANT ADDRESS: COUNTY OF BUTTE Oroville, Califomia I GENERAL CLAIM CITY & STATE: C�LCll 41- "1) DATE OF CLAIM:___ IMPORTANT: SEE INSTRUCTIONS SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES ON RFVFR.qF cinc DATE_ DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT 3ERI�lIS CITY OF CHICO. AP 041-682-0559 BP# 01-1843, RECEIPT# 331410, ATED: TOTAL AMOUNT PAID: 60. TOTAL AMOUNT REFUNDED: 60. E-7 TOTAL ( I, the undersigned, declare under penalty of perjury that the services or articles claimed lave een Wqormed or delivered, and that this claim is true and correct a stated. Dated this 14 day of AUG , 2001 at OROVILLE Calif. Signature o ai I, the undersigned, hereby certify that, to the best of my knowledge, the services icl specified a e ve n performed or delivered and that there is a Budget Appropriation ( I or Specific Board Approval ( ) (Check one) for the e. `► Dated this 14 day of AUG , 200j at OROVI I E , Calif. Departmdnt Head or Authorized Deputy Dept. Code 440-002 Exp. Code 4210500 PAYABLE F OM R11TT DING PEgMITS Dept. Code Exp. Code PAYABLE ROM Dept Code Exp. Code PAYABLE FROM FUN FUN, FUN DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT FOR BUILDING DIVISION USE: Receipt` Information: Numbers_ p Date: Issued To: Amount: 8 100.00 Fees Retained:., Processing Fee: $ _B1d� Filing Fee $ Plbg Filing Fee $ E1ec Filing Fee $ Mech Fi 1 ing Fee Energy P/C Fee $ Plan Check Fee S Inspection Fee $ Total Amount Retained S TOTAL REFUND DUE S 'v- REFUND CLAIM APPLICATION CLAIMANT'S NAME iixh- * -Atce, �C1T MAILING ADDRESS L_ ASSESSOR PARCEL # PERMIT # RECEIPT NUMBER (S) -33141n Request a. refund of flea paid on the above receipt . number(s) for the following reasons: (Check those categories which you wish to have refunded. [ ] Plans returned to me at counter. [ ] Please mail plans to me at above address. [ ] Please dispose of plans. SIGNATURE DATE r� Building Permit Fees [ ] Sheriff Fees [ ] SRA Fee (CDF Fire Planning) [ ] Urban Area'Fees [ ] Plans returned to me at counter. [ ] Please mail plans to me at above address. [ ] Please dispose of plans. SIGNATURE DATE r� � COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION Y 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT Ln 3 ASSESSORPAij� M96iiit, ^ �gr� `(1.1/, V ZONING BUILDING PERMIT 1(\/- OWNE I't /�1O SO. FT. OCC. BUILDING VALUATION OWNERS MAILI AD KyESS� COM R NAME d . HI COM R5 RJ DR, CONSTRUCTION LENDER Fireplace LENDERS MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS 11� n ` C Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 12MJ Each Trap 7.00 USEOFSTRUCTURE SFX Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation /0 /O+ther Describe Work: �!�\G�v�-C ? M V / t li (� YL 6 Gas piping stem - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G @20.00 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 600V OR LESS 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 force and effect. �� License Class �C� Lic. No. OWNER -BUILDER D— C�ATIO 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 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. 411"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' compensation insurance Barrier and policy number are: Carrier Policy Number zly;� -- (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 employ any person In any manner so as to become subject to workers' compensation laws'o California, and agree that if I should become subject to the worker §-' compens provisions of section 3700 of the Labor Code, I shall forth It c p wikh ftVse provisions. X Date �"�� Signatur o Appll nt - ❑ Own ontractor Vgerit An OSHA mit is required for excavation silover 60" deep and demolition or construction of structures over 3 stories i height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. So OR ADDNS. ( a ACC. Bins. 3.50FT; NEW CONS MULTI.OUTLET NONRESID. @7.50 POWER APPARATUS a swGLE ounEr cIR. OUTLET Ex. Occup. SAL @':w Ex. Occup.. DFIxF oR A. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE i MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt S Mobile Home Installation Fee $ Energy Inspection Fee $ .c- VTYPEOTALFEE$not HA2.MP I=. CDF PARCEL PO HD UE 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. By Date7,. V PERMIT EXPIRES ON � r (,5,, a 2- Dale Receipt No. -/D , DO WHITE-D.D.S.-B.D. CAN Y -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT l