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HomeMy WebLinkAbout047-330-028047-330-028 05-0024 L476 SES, ROBERT.,; ' KEEFER RD, CHICO t: RELIANCE'PROPANE W PROPANE TANK H_ VAC -I I t f. t a 0y7- 33oilao 47-33->� � rY 4176 KEEFER, CHI O :23 , REROOR 047-330-028 05-0024 L476 SES, ROBERT.,; ' KEEFER RD, CHICO t: RELIANCE'PROPANE W PROPANE TANK H_ VAC -I I t f. t a 0y7- 33oilao cn cn a NOTES {;� RESIDENTIAL PERMIT N0.0477330-028 .*..�. ,,, •� ____-.....05-0024..._ MOSES, ROBERT F 4176 KEEFER RD, CHICO' s Cont: RELIANCE PROPANE NEW PROPANE TANK HVAC' t r - - - J i Y SPECIAL CONDITIONS r CHECKED Y ' BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS t VERIFY USE PERMIT CONDITIONS y SUB -STANDARD HOUSING LETTER " } € OFFICE COPY Address y' GAS Meter By Date 1 ELECTRIC Meter By Date JOB FINALED (Date 4iS. Signature :.'I,. �+:. ,.. , •. - ' -` w -,C. .,y... s.'itea...-�'. ti. ._ `. w. ..L J=OK 0 = Not OK Not . = NotReadyable MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except ff's 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer; Location -Test -Fall -C/O -Concrete 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ /" L'ft. / P Nat. or / /" L "ft./ P LPG 7. Well Clearance & Disconnect 8. Utility Clearance Carports; Windows -Doors 11. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector MISCELLANEOUS Date 6. Water; MH Test -Regulator -Connector 1. Zoning Requirements -Setbacks -Easements 7. Water and Sewer Connected -C/O to Grade -HD Approval Footings; Soils -Size -Depth -Spacing -Connectors -Steel 8. Gas and Electricity Tagged Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 9. Tie Downs -Type -Installation Cert. 5. 10. Exits; Insp.-Sketch 6. Carports; Windows -Doors 11. Cert. of Occupancy Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Date Card B-1 Date Card B-1 Date 12. Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) Date 1. Zoning Requirements -Setbacks -Easements Card B-1 Date Card B-1 2. Footings; Size -Spacing -Marriage Line 1. 3. Blocking 2. 4. Gas; MH Test -Demand -Valve 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 5. Electricity; MH Test Elec.; Receptacles and Lighting, Distance-GFI 6. Water; MH Test 6. 7. Water and Sewer Connected 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Gas and Electricity Tagged Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main Conduit 9. Exits 10. 10. License Decals 11. Light Niche 11. Verify #'s with Office Enclosure; Fencing -Alarms Date Date Card B-1 Date Card B-1 Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts- Beams-Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK - = Not Applicable . = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /' Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 12. Electric Underground Glazing Area -Glass Protection -Skylights -Plastic 13. Plenums & Ducts; Clearance -Material -Support -Ins. Shear Walls; Nailing -Bolts 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies Brace Interior/Exterior Wall Panels 15. Access & Ventilation Insulation -Walls -Ceilings 16. Insulation Infiltration -Walls -Windows Date Date Date Card B-1 Date Card B-1 Date Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s Ext. Steps -Door & Sidelight Protection -Landings 17. Water Htr.; Vent -Access -Combustion Air Baffle Smoke Detector 18. Water Pipe; Test & Anchor -Nail Protection Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection Bedroom Exiting 20. Shower Pan; Test, First Floor -Tub Access G.F.I. & Bath Fixtures & Tub Access -Spa 21. Test Tub & Shower, Second Floor -Tub Access Elec. Trim & Subpanel, Breaker Sizes & Labels 22. Gas Pipe; Sixe & Anchors Stairs & Rails 23. Fire Sprinkler; Test Fireplace or Stove, Clearance -Hearth 72. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 75. 24. Fixture & Transformer Clearance -Ins. Protection 76. 25. Elec. Receptacles Spacing -Lights & Switches at Doors 77. 26. Size Boxes & No. of Conductors Stapled 78. 27. Romex Installed Close to Edge of Studs & C.J. 79. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 80. 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 81. 30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or AI 82. 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral 0 Yes 0 No 32. Service -Riser Conductors & Ground Main Disconnect 83. Following Instld./Drive O Yes O No/Walks 0 Yes O No/Planters 0 Yes 0 No 33. Equip. Clearances Panels-Motors-Mech. Equip. Stucco Brown -Finish 34. Clothes Closet Light -Shower Light -Spa Light A.C. Unit Disconnect, Electrical -Plumbing 35. Smoke Detector Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 90. 36. A.C. Ducts Insulation & Support 91. 37. Vent Fan, Exhaust above insulation 92. 38. Condensate Drain & Overflow, Size & Grade 93. 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 94. 40. Attic Access & Platform if Furnace in Attic Date Address Posted Card B-1 Date Card B-1 Date Fire Sprinkler Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s Date 41. Sills Proper Materials & Anchors Date 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound Comments at Final: 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties- Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type A Flue -Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Bolts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door; Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor-Mech. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes _ 83. Following Instld./Drive O Yes O No/Walks 0 Yes O No/Planters 0 Yes 0 No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: i COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530) 538-7541. CORRECTION NOTICE IV OWNER PERMIT NO. a A routine inspection indicates that the following violations of butte county Ordinances exist at the iJ above a ress and should be corrected. Please notice this office when correction of work is comple d. If you have any questions pertaining to this matter, or need additional explanation, please ontact this office immediately. 9 HtV 10/92 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVIL'LE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds 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 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Date: Contractor. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 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 the Contractor's State License Law (Chapter 9. commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any 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 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 sale. If however, the building or Improvements are sold within one year of completion, the owner -builder. will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project'(Sec. 7044, Business and Profdssions 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 pursuant to the Contractors' State License Law.). ❑ 'I am Exempt under Articlef3 of the Business and Professions Code Date: ` S Owner: A WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. ❑ I have and will maintain workers' compensation insurance, as 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: Policy #: iv I 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 the 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, 1 shall forth/with comply with those provisions. Date: Applicant: fJ� ZGt� WARNING: Failure 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. 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec 3097 Civ.) Address: PERMIT NO. BP050024 Issued Date: 01/05/2005 APN: 047-330-028-000 Site Address: 4176 KEEFER RD CHI Map Index: Description: NEW PROPANE INSTALLATION, HVAC & TANK Owner: MOSES ROBERT L & LORENA M 4176 KEEFER RD CHICO, CA 95926 Applicant: MOSES ROBERT L & LORENA M Contractor: RELIANCE PROPANE 6426 SKYWAY PARADISE, CA 95969 530-872-9200 x206 License #: 734318 Architect: Engineer: Total Square Ft: 0 S. F. Valuation: $0.00 Census Code: a /l7 1402"Jddl� 116, 619 This permit is hefr eby issued under the applicable provisions of the Butte County COdr+ anrUor Resolutions to db work indicated abpveifor which fees have been paid. PERMIT EXPIRES ON: ---,Z—,6 . Date:��� ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. (3 Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and thal'I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge It is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name: . /-) 4)fJE2 % / "/ SFS Signature: Date: )d -Owner 0 Contractor ❑ Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER CONTRACTOR Last Name c, S First ame vhr27— Address y 76 &�6,$L FF 2 ✓�� City i_' f ` Statee,, Zip 71134; °77 3 Phon b .3 ,� n Fax E-mail E-mail Lic. # APPLICANT SIGNATURE X /C� oe - For office use only: CONTRACTOR Name rJ/SFi2T Address SRA City No State Zip Phone Book Fax E-mail Planner Lic. # CIass�j APPLICANT SIGNATURE X /C� oe - For office use only: ARCHITECT/ENGINEER Name rJ/SFi2T Address SRA City No State Zip Phone Book Fax E mail Planner State License Number APPLICANT SIGNATURE X /C� oe - For office use only: APPLICANT NAME Name rJ/SFi2T Address SRA City No State Zip Phone Book Fax E-mail Planner APPLICANT SIGNATURE X /C� oe - For office use only: Zoning ddress Prop:%N"�. . Flood Zone Cross Street SRA Yes No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. O,S-o-6 P BIN # LOCATION AP# V _' /} _ ;� K CJ c� ddress Prop:%N"�. . Ci l Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than 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: r O. AS" : "cL % 4a K Sq. Footage ❑ Structure Built without Permits O 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 required. 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. Page 1 of 2 Received by—*1- Amount: /100 Bldg SRA Receipt Receipt # ` v (7 Sheriff c � SMIP Other Date: �' _ ��r� Uv Total REV 7-27-04 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a' permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations, ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and AIC for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (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. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 f�'7fti.+_�.1�1P'?'r'TxGu�-,,*�-�'YNasvy�jp�i��J'B�rf°.�'R�'[`'C'�..-..i"3r -.F. .':.crrfn,..-.�.. .-x., .:_ _ _. .: ... .i. _ .. „ ., m s 'sH+T:A3�'�' �'.'��"� AFP. .�..• �3�� �:,,�•a.r;.�.y:,v. ,:r+.,�i5cni w-s� L� . } � . J.-..,, ��. t.. V •- i � .. ;I' I , � � 'Y � � ., ,� "1 y� + .� 1 , .. • •.r _ ....,. y ;G. -. `.. -"'�; .... .. .. .: . , .. r .-t•;•te:•r 4.ir.....��., �:"4?S `.9'�u a • f 7 Y COUNTY OF BUTTE - DEPARTMENT OF•DEVELOPMENT SERVICES - BUILDING DIVISION ' 7 �ouhty Center Drive • Oroville;., California 95965 • Telephone (530) 536-15414 PERMIT NO. (Rev. 12/96) APPLICATfON AND PERMIT GV DI_11' 14 ASSESSOR PARCEL NUMBER r^/ r V ZONING BUILDING PERMIT OWNER a s 1r.ELFP i o ASO. f• FT. OCC. BUI DING VALUATION . OWNERS MAID f�ESS �" Ti�l , CONTRACTOR'S J ( lL A TELEPHONE' CONTRACTORS MAIUNG ADDRESS - CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAF PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF 6 Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Rem el ❑ Utilities • Installation ❑ Other Describe Work: Q 1 ©i� Q ✓► t f Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G IW Q20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service '.A os'ss 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 Lic. No. 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 TO Main Service 200A 1000A 46.00 NEW CONST. DWELLING OCCUP. CU OR ADONS. ( a ACC. BLDS. SO 3.50 FT. p10= ESIp MULTI -OUTLET RANCH CIRCUITS I @7,50 POWER APPARATUS & SINGLE OUTLET CIR. Ex. Occup. OUTLET ORFDTTUREs 20@''00 SAL @ .so Ex. Occup.DUTtEtDrsA q PPLNSp.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 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. ❑ 1 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 carrier and policy number are: Carrier Policy Number (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' compensation provisions of section 3700 of the Labor Code, I shall fo with comply with those provisions. �� Q/J X i..A�� =- /`"fit Lam..-' Date, 2. 7- 6) _ Signature of Applicant - ❑ Owner ❑ Contractor ❑ 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 FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ D. T Tri TOTAL FEE $ —74- ' AZ. D. FEES IMP I FLOOD I CDF pARC0. pD HD IS 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. J, �' q `�/ j/����i�'"Y / / 2— V 1 By i( , Date PERMIT EXPIRES ON �Z7 Data Receipt No. 47 (� WHITE-D.D.S.-B.D. -A AR -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT J COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 (5) ��NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBEROLI _ 0 ZONING BUILDINGPERMIT °`""E.0 SQ. FT. OCC. BUI G VALUATION OWNERS Mau e i CONTRACTOR'S �q2�5 ELEPHONE �WA CONTRACTOR'S VAUNG ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filin Fee $ 20.00 Permit Fee $ ARCHRECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS ` Energy Plan Checking Fee $ $ R7� PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF 6 Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Re el ❑ UBlibes Installation ❑ Other Describe Work: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W Q20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service '.*.v.RR 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.8 License Class 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 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. ❑ 1 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 carrier and policy number are: Carrier Policy Number (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' compensation provisions of section 3700 of the Labor Code, I shall fort with comply with those provisions. �} X ��Date Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. V,By Main Service 200A TO I000A 46.00 NEW CONST. DWELLING OCCUP. SO OR ADDNS. ( ; ►NONN,A¢lu MULTI.OUTLEr 97.50 R A PoSINGOIm.ET CIR. wELEPPARATUS 20 ° 1.00 Ex. Occup. oLmFr OR FaTUREs BAL p .50 Ex. Occup..DUREfB Aa oEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEP_ $ Mobile Home Installation Fee $ Energy Inspection Fee $ �� T r TOTAL FEE $ —HAZ. D, FEES IMP I FLOOD I CDF PARCEL PD HD IS 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. ' Q'� Date% PERMIT EXPIRES ON �� / v o ate Receipt No. 01? WHITE-D.D.S.-B.D. A AR -ASSESS R PINK -INSPECTOR GOLDENROD -APPLICANT I OWNER-BUILDER.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 at your earliest opportunity to avoid unnecessary dela; in processing and issuing your building permit. No building permit will be issued until this verification is received. L" I personally plan to provide the major labor and materials for construction of the proposed property improvement : YES 0. . NO 0 . . . , . 2. I HAVE 93 HAVE NOT 0 signed an application for a building permit for the proposed work, 3. I have contracted with the following person. (firm) to.pmvic0. fere• proposed construction: NAME: ADDRESS: 'f / 7 ly /T -/'c f f CIL /� � CITY:_ 4�-W/ C" o PHONE: s;o) 3 z- /-5V1>': CONTRACTOR'S 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: ADDRESS: CITY: _ PHONE: CONTRACTOR'S LICENSE NO. t 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 SIGNED: PROPERTYOWNER: 6 / SOCIAL SECURITY NUMBER: DATE:- Z- a Z- D / NOTE: This Owner -Builder Verification is required by Section 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. OVER OWNER BUILDER INFORMATION Dear Property Owner: vy An application for a building permit has been submitted in your name listing yourself as the builder of property improvemeats specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors aro required by law to be licensed and bonded by the State of California ,and to have'a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. , �Ifyod ptah to M jmio r own'woik, with the ex4don of various trades that you plan to suticontrac� you should be aware of the following Information for your benefit and protection: ' ♦ If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $300 or more for the entire.project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ♦ If you are an employer,, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security. taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. ♦ There may be financial risks for you ifyou do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 1020 N Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. rely, �CIJ`�, qMa el C. Vi ira, C.B.O. ger,Building Inspection NOTE. This Owner -Builder information is required by Section 198.10 of the Colll%rnla Health and Safety Coda OVER o kk� PERMIT NO. 6443-76B,P,E PERMIT EXPIRES OWNER Lorena Moses CONTR. owner LocaTloN (A.P. SURM 47-33-28 r N/S Keefer Ln.,app.1 mi.E,of Hwy 99E, Chico Ire r If iF Rf �k y; N? F r j { Temp. Power Pole Called PG&E Temp. Elec. Serv. 6 -7 Called PG&E Temp. Gas Serv. Called PG&E jB FOINALED / (Date) (Signature ,I> .i a Fiber -Glass Insulation BUILDERS INSULATION STATEMENT BLOWN INSULATION Manufacturer's minimum thickness to provide the level of insulation resistance (R) Values as shown: * R Values are determined in•accordance with ASTM C-687 and C-236. Conforms to Federal Specification HI-111-1030A.This insulation has been installed in conformance with the above recom- mendations to provide a value of R using' bags of insula- tion to cover , square feet of area.-- . r Insulation Contractor (Sign) Company Name BATTS AND BLANKET R INSULATION R INSULATION VALUE THICKNESS VALUE THICKNESS R-22 , 6t/i" R-13 35/a" R-19 6" R-11 31/21, Builder (Sign) Company Name Date CERTAIN -TEED' PRODUCTS CORPORATION. P.O. BOX 860 C , VALLEY FORGE, PA. 19482 CEBTAINTEED Meets Federal Specification HHI-521E Fiber glass balls or rolls have been installed in accordance with the manufacturer's recommendation to provide an R -Value of/9 in the -, 'ceiling in the exterior Walls, -in the floor or crawl space perimete%. � 1 f I/nsu ation Contractor (Sign) Builder ( ign) —� ✓✓ Company Name Company Name CSG -32-11-C Date CERTAIN -TEED' PRODUCTS CORPORATION. P.O. BOX 860 C , VALLEY FORGE, PA. 19482 CEBTAINTEED DATE `i- REMARKS OR CORRECTIONS (%le v�v //�' 1,�'dov• r A (f3 �< (NOTE: An entry must be made on this form each time you visit the job site.) COUISTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Z7 irewall Soil Piping Forms - 7 Parapet 1st Floor Main Bldg. Restroom Finish -----------2nd Floor Footings Windows • �� 3rd Floor Stemwal I - 77 Siding L To out Slab Roof Sheathing Water Piping Piers 2- - 7 7, Roofing 5--27-c/ Sewer Garage Fdn. Vents 5,- av -- Fixtures Footings Stemwa l) Garage Vent nsu IatIon Water Htr. , Heaters Slab Carport Footings Prov. for physically handica pea. Conformance of ex. structur Appliances - - Gas Piping & Test -------- Temp. Gas Slab Final % Sanitation Patio FIREPLACE final Footings Footing eo, ELECTRICAL Masonry Walls 7 Throat 2 — 7 Rough - 2. Relnf. Steel AFinal r Fixtures 6 r -77 • Bond Beam FIRE SPRINKLERS Motors Framing -'.Z %% Test Water Htr. - aLl - 7 Stu - p r 7 ` al Subpanels Mesh MECHANICAL Grd. Fault Prot. r Scratch Heatin��-" - �j Service v Brown Cooling �j'.- j-�j . -% Temp. Pole Finish Ducts 2 — -, 6 - i Underground Interior Lath Ventilation i '2_ .Permanent• Door Closer i ;-�/ i Final A<'- -IL/ - --11i inal 112 i to DATE `i- REMARKS OR CORRECTIONS (%le v�v //�' 1,�'dov• r A (f3 �< (NOTE: An entry must be made on this form each time you visit the job site.) I COUNTY OF BUTTE —, DEPARTMENT.OF PUBLIC WORKS 7 CoUnty Center Drive — Oroville, California 95965 Tel eptiorie: 534-4541 APPLICATION AND PERMIT .57o- zo- 77 autnunce representatives of the county of tsutte to enter upon the above-mentioned property for inspection purposes. X ��� Date Signature of Permitee or Agent �/ Receipt No. _ �� 7"� 9 White-D.P.W. — Yellow -Assessor — Pink -Inspector _f Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or oI tions to do work indicated above for wh�ic ee have en aid. I 0 PUBLIC WORKS BYA Date Co S�ie 7lp -i++�.permit expires D e BUILDING ~� Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. —�� Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 2 _ Q A. P. No. do Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Flies Serri� FireDept. FireZone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Ma P 60' R/W Im r p ovements Lawn sprinkler system 2.00 Bldg P� ^= pis d I Parcel Approval Plans Approval Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 OR L Pain service i°o°o AMP ORSLESS 5.00 Main service EA. ADD'L too AMP 2.50 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service 00 AMPOOR LESS 25.00 Main service EA. ADD'L too AMP 1.00 NEW CONST LING OR ADDNS. ( DWEACCLBLOGS.CCUP. &) 22sgft NEW CONSTR. (MULTI -OUTLET NON.RESID. BRANCH CIRCUITS)2.50ea NEW CONSTR. (PO NON -RESWER APPARATUS & ID. SINGLE OUTLET CIR. 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: Ex. Occup(OUTLETS OR FIXTURES) BALai Ex. Occu FIXED APP LNS. OR P'(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 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. I 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 the Workmen's Compensation Laws of California. MECHANICAL No.1 @ FEEPERMIT FILING FEE $3.00 -0 Heating Cooling Ventilation Hood 2.00 OC Permit Fee $ $ 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 State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ C autnunce representatives of the county of tsutte to enter upon the above-mentioned property for inspection purposes. X ��� Date Signature of Permitee or Agent �/ Receipt No. _ �� 7"� 9 White-D.P.W. — Yellow -Assessor — Pink -Inspector _f Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or oI tions to do work indicated above for wh�ic ee have en aid. I 0 PUBLIC WORKS BYA Date Co S�ie 7lp -i++�.permit expires D e COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive U,oville, California 95965 /V /0` Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Signature of Permitee or Agent Receipt No. ,LS� 7 White-D.P.W. — Yellow -Assessor— Pink -Inspector — Goldenrod -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. DIRECTORUBLIC WORKS /uilding�permit Date 1Z-1 expires Date _ -2-r BUILDING Owner OO5,4 SO. FT. OCC. BUILDING VALUATION o Z _ Mailing Address 9-3,5— 67Z P 2- - 0 G -P Telephone No. Fireplace Contractor Total Valuation. 0 Mai I Ing Address Permit Fee 0 Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address o �� G� PLUMBING No. @ FEE PERMIT FILING FEE $3.00 O /� C• O F �'" Each Trap 1.50 .0 Q � eAl C/o Repair drainage or vent piping 1.50 Water piping 1.50 f S Q Zgning Verjf1caf; Each gas water heater or vent 1.50 % A. P. No. 3 �� PAA 72 & Planning Gas piping system 1 - 5 outlets 1.50 tional outlet 30 F S ion Fire Dept. FireZ ne Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration aeT 60' R/W Im rovements P Lawn sprinkler system 2.00 Bld . Plans Recd dPermit d arcel proval Plan pproval Fee $ S $ NEWADDITION ❑ UTILITIES ❑ OTHER ❑ IndPERMIT ELECTRICAL No. @ FEE FILING FEE J$3.00 _OO Main service 100 AMP OR001 OR LESS5.00 Main service EA. ADD•L 100 AMP 2.50 Main service OVER s 25.00 100 AMP O OR LESS Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 1.00 NEW CONST. DWELLING OCC P. O OR ADDNS. ( ACC. BLDGS.� Q ) 20sgft S NEW CONSTP_ MULTI.OUTLET NON•RESID. ( BRANCH CIRCUITS) 12.50ea NEW CONSTR. POWER APPARATUS &) NON-RESID. (SINGLE OUTLET CIR. 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: Ex. Occup(OUTLETS OR FIXTURES) 6AL2@51 FIXED APP LNS. OR Ex. Occup. (OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 FT EfI am exempt from the Contractors License Laws of the State of California. Permit Fee $ SIL7190 $ j WORKMEN'S COMPENSATION INSURANCE 1 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. I certify that in the performance of the work for which this EJ permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 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 State Laws relating to building construction, and hereby TOTAL PERMIT FEE $�Z� C authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Signature of Permitee or Agent Receipt No. ,LS� 7 White-D.P.W. — Yellow -Assessor— Pink -Inspector — Goldenrod -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. DIRECTORUBLIC WORKS /uilding�permit Date 1Z-1 expires Date _ -2-r