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HomeMy WebLinkAbout056-120-03156-12-31 ROY MORTENSEN Cohasset Rated ^ ~ \ . / 56-12-31 ROY MORTENSEN Cohasset Rated ^ '-- '------ ----- -�r .~��� ` row- ^ � � ` | ' ` t | � � -- � - � . -- ~~~ '-- '------ ----- -�r .~��� ` row- MCN NO COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AD PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER j% -/ _ ZONING BUILDING P RMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION 9 OWN'ER'S/MAILING ADDRESS _ CONTRACTOR'S NAME TELEPHONE CONTkiACTOR'S MAILING ADDRESS lJ� *cV 4'1 ..0 Fireplace C NSTRUCTION LENDER UNKNOWN Total Valuation $ r o U Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ t7/40, 00 ARCHITECT OR ENGINEER I!/Q LICENSE NO. Plan Checking Fee $ Penalty $ 0 _I00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADD ESS Wk '- X,70/�? �, PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 S 7'' 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 SF Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK ❑ ❑ ❑ Installation❑ Other [v]''Contractor New Addition Remodel Utilities Describe work: � /jii� �a rC� f+/���i� r/i f' 5 Permit Fee $ ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service/EA. ADD'L 100 AMP 2.50 NEW CONST. OR ADDNS. \ ACCLBLDGS.DWELINGCCUP.&\ / 'z1/ZQsq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): © I am licensed under provisions of Chant. 9, Div. 3 of the Business and Professions Code and m license is in full force and effect. Y '7 �''�n � _ , Classification License No. - ❑ 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.ULTI.OUTLET NON.RESID. BRANCH CIRC ITS 2,50 ea NEW CONSTR. (/POWER APPARATUS .&) NON.RESID. (SINGLE OUTLET CIR. Ex. Occup(o XTs OR FIXTURES 20@50CAL®300 B IED Ex. OCCUp. OUTLETS P(RESID )R 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): ❑ 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 3.00 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 against said County in consequence,of the granting of this permit. X 1� yyp�r�' r ',�ri'�' a-�+Plw°�"�� Date / �' � � Signature of Applicant — Owner ❑ Contractors Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP I TYPE OF CONST, PARCEL PD HD ISSUE his permit is hereby issued under sions of the Butte County Code and/or work indicated above for which fees. IRECTOR OF PUBLIC BY PERMIT E)AES••..Date / // the applicable to do resolutions to do have been paid. WORKS Date /1 -f L n )in Receipt No. �� / CTy WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT ,l COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICAT16WAND PERMIT PERMIT N0. S ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER_ �- TELEPHONE SQ. FT. OCC. BUILDING VALUATION oc OWNER'S ,, AILING ADDRESS C TRACTOR'S ME TELEPHONE CONT ACTOR'S MAILING ADDRESS W-4 Fireplace cc5NSTRUCTION LENDER �ILING UNKNOWN Total Valuation $ Q (� Filing Fee $ 10.00 LENDER'S ADDRESS Permit Fee $ 0& ARCHITECTI,OR ENGINEER / LICENSE NO. Plan Checking Fee $ Penalty $ ECT OR ENGINEER'S MAILING ADDRESS ARCHITECT Permit fee $ zn 4Q C7 BUILDING ADD SS ,� PLUMBING PERMIT Filing Fee 10.00 ®` ILI,Solar Each Trap 2.00 Water Heater 20.00 7" Water piping 5.00 LOT NO.SUBDIVISIONNAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New ❑ Addition Remodel ❑.Utilities ❑ Installation❑ Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V 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. Z1h0sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check One): 1 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,,,2�I\T%r/?� C lassi f i cation ❑ 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 ULT' -OUTLET 2,50 ea NON.RESID. BRANCH CIRCUITS) NEWCONSTR (POWER APPARATUS &1 NON •RESID. l SINGLE OUTLET CIR, / EX. OCCup(OUTLETS OR FIXTURES BAL(T 0C FIXED APPLNS. OR 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 FiIingFee 10.00 WORKMEN'S COMPENSATION INSURANCE I 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 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 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 st said Co ty in conse e e of the granting of this permit. t �_ X Date ��� ` gnature of Applicant — Owner ❑ LntractorK Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ Oc-) OCCUP. GROUP I TYPE OF CONST, I PARCEL PD I HD I ISSUE is permit is hereby issued under sions of the Butte County Code and/or work indicated above for which IREC�TOR OF PUBLIC By PERMIT EXPMES Qate the applicable provi- resolutions to do fees have been paid. WORKS Date��%Z�fL Receipt No. ; CP6 m WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT v