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Home My WebLink About044-020-024'1 COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orov14-le,California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT Q4_gQQ PERMIT NO � i 'Wo ASS S OR PARE `MB R - _ - ZO .NG BUILDING PERMIT 0 j�/'/� �'•� �y TELEPHONE SQ. FT. OCC. BUILDIN - V AT ION OWN 'S MAILIN ADDR CONTRACTOR'SNAME TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER_ UNKNOWN .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 $ BUILDING ADDRE �✓ �� PLUMBING PERMIT Filing Fee 3.00 rEach Trap 2.00 Repair drainage or vent piping 2.00 fCC) Water piping LOT NO. SUBDIVISION NAMEPARCEL MAP �— Each pas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTUR57 SF ❑ Duplex ❑ Mobi lehome ❑ Other_ P56 1 Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition n RRemodeI ❑ Utilities ❑ Installation❑ Other Describe work: �/��%S`��C,� U i��'L C�/L/tC �� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.0 Main service 00V OR LESS 1 100 AMP OR LESS mm 5.00 - V Main service EA, ADD'L 100 AMP 2.50 NEW CONST. ( DWELLING OCCUP.&) OR ADDNS. ACC. BLDGS. 2�sgft 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 y license is in full force and effect. License No. Classification El 1, 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 CIRC ITS NEW CONST R. ( POWER APPARATUS & 1 N0N.R ESI D. SINGLE OUTLET CIR. I Ex. Occup(OUTLETS OR FIXTURES BAL@1 BAL@lOs Ex. Occup.(OUTLETSP(RESID )REA.) 2.00 Temporary service 10.00. Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ J Contractor MECHANICAL PERMIT Filing Fee 3.00 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. 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 �agai t id County in consequence of the ranting of this permit. ,/ X !� Dat Signature of Applicant — OwnerK, Contractor ❑ , Age r ❑ An OSHA permit is required for excavations over 5'0" deep a d demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ r TOTAL PERMIT FEE $ OCCUP. GROUP TYPE OF CONST. PARCEL PD HD ISSUE I/ This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR Off PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date �- '� Receipt No. WHITE-D.P.W., EL SE I K -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE — DEPARTWENrOF PUBLIC WORKS — BUILDING DIVISION 7 County Center MCrive—~Olroville, California 95965 — Telephone 534-4541 PERMIT APPLICATION DATA SHEET OWNER ' 0, n Proposed Building Use Permit fee based upon: Complete Contract Price Other (explain) Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED Permit No 'A. P. No. DPW Valuation 1. All items have been submitted................................................................... 2. Plot plans in duplicate/triplicate............................................................... 3. Complete plans in duplicate/triplicate................................................... 4. Complete engineered plans and calcs...................... :.............................. 5. Plans with Energy Design Compliance Statement ............................ 6. State Energy Forms No. .................... 7. Statement of Intent for Non -Heated & AC Buildings.,.:-:`.............. 8'. Fees of $.................................................. 9.' 'Letter of signature authorization............................................................. `110 __�Sanitation approval from Health Dept.... 11. Planning approval for ............. 12. Certificate of Wor eq�' �ippensation Insurance 13. 6e rifo, atioq (no., name style, �?iGYK 1%i rea"PWification) ............................... 14. Improvements may be required. Contact Land Development Section of Dept. Public Works (see - add ess b I ) re ow......................................................................................;.......... 15. Pre -inspection for required. ?re.nspec.request to bldg.inspector (date) 16. Other When you issue the.permit, process as follows: Mail to owner Mail to contractor. Telephone and hold for pick-up at office. Deliver w/inspection. Other Applicant Date Copy of plans sent Health Dept., Fire Dept., Other Date— During the plan checking process, the following data must be submi d prior to permit issuance: (For required items not checked above at time of appli , circle item.) 1. Index permit for above Items No. 2. Additional items required: j,5,5eeve'V-ary (Contractor, Designer, Owner) was advised of above required data by 0 Plans checked by_ Plans approved by OTHER: Cnnv/DPW 0- )ate Date Telephone Mail Other Date COUNTY OF BUTTE -"Department of Public Works 7 County.Center Drive, Oroville, CA. 95965 Phone: 916-534-4541 OWNER -BU ILDER VERIFICATION Attention -Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your i. earliest opportunity to avoid unnecessary delay in processing and issuing. -your build- ing permit. No building permit will be issued'until this verification is received. 1. I personally plan tq provide the major labor and materials for construction of the'proposed property improvement (yes or no) 2. I (have/et) signed an application for a building permit for the proposed work. 3. I have contracted with'the following person (firm) to provide the proposed constructio Name Address City Phone' Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name�✓y►�� Address City Phone Contractors License No. 5. I will provide some of the work but I have -contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work S igned : % } Property Owner Z✓ Social Seurity number V Date .[.�,.,. NOTE This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before.we are permitted to issue the permit.