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Home My WebLink About056-220-013HUBBARD,Ch PERMITN9 7g9 HUBBARD, Chuck 17110 Kolar Rd., Magalia Cont: Donald Carr 7 "1/p/R Repair Storm Damage/SF U / RESIDENTIAL 056-220-013 PERMIT#97-0789 HUBBARD, Chuck 17110 Kolar Rd., Magalia Cont: Donald Carr Repair Storm Damage/SF JOB FINALED ) (DataI Signature V=OK O = Not OK '=Not t Applicable NoReady HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 1. Zoning Requirements - Setbacks - Easements 2. Footings; Soils-Size-DepthSpacing-Connectors-Steel 2. Soils; Special MH Support Sketch 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 3. Sewer, Location -Test -Fall -C/O -Concrete 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Rfg.-Bracing 4. Water, Location -Test -Easement Needed (Sketch) 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete 6. Carports; Windows -Doors 6. Gas; Location -Test -Wrap; / fl.2ft. / /Nat. or/ ) L°ft./ /LPG 7. Electric 7. Well Clearance & Disconnect 8. Frmg.; Sils-AnchorsStuds-Rftrs-Trusses 8. Utility Clearance 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s Card B-1 Date Card B-1 1. Zoning Requirements -Setbacks Easements Card B-1 Date Card B-1 POOLS (Plans) OK except #'s 2. Footings; Size -Spacing -Marriage Line 1. Setbacks -Easements 3. Gas; MH Test -Demand -Valve -Connector 2. Soils; Compaction -Structure Stability 4. Electricity; MH Test -Crossovers -Breakers -Clearances 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 5. Drain; MH Test -Fall -Flex Connector 4. Elec.; Receptacles and Lighting, Distance-GFI 6. Water; MH Test -Regulator -Connector 5. Elec.; Pool Lighting; 15 Volts-GFI 7. Water and Sewer Connected -C/O to Grade -HD Approval 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 8. Gas and Electricity Tagged 7. Elec.; Bonding; Metal w/6 -Circulating Equip. -Heater 9. Tie Downs -Type -Installation Cert. 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 10. Exits; Insp.-Sketch 9. Health Department Approval 11. Cert of Occupancy 10. Plumb.; Cir. Test -Water Supply Test Date Card B-1 Date Card B-1 Date Card 8-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-DepthSpacing-Connectors-Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sils-AnchorsStuds-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Date Card B-1 Date Card B-1 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/6 -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 _ OK O = Not No OK RESIDENTIAL (Single & Duplex) = Not Appl cable Not Ready Date 46. UNDERFLOOR (Plans) OK except #'s 1. Zoning-Setbacks-Easments-Flood-Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ P Ftg. Depth 3. Fig. Garage; Soils-Steel-Elec. Grnd/ P' Ftg. Depth 4. Ftg. Porches & Decks; Soils -Steel-/ P Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts4Nrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 3a. 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 12. Electric Underground 13. Pienums & Ducts; Clearance-Mater:al-Support-Ins. 14. Girders -Sills -Anchor Bolts -Joists Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card E-1 Date 63. PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle Smoke Detector 18. Water Pipe; Test & Anchor -Nail Protection Furnace; Vents -Clearance -Comb, Air-Conector- 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 70. Date Card B-1 Date Card 3-1 Date Card B-1 Date Card 3-1 Date ELECTRICAL (Permit) OK except #'s Elec. Outlets & Recepticales at Kit. Counter 23. Fixture & Transformer Clearance -Ins. Protection Garage Fire Door; Swing -Landing -Closure 24. Elec. Receptacles Spacing -Lights & Switches at Doors A.C. Duct in Garage -Damper 25. Size Boxes & No. of Conductors Stapled Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. In Garage; Above Floor-Mech. Protection 26. Romex Installed Close to Edge of Studs & C.J. Plb., Elec. & Mech. Equip. Listed for Location 27. Equip. Ground made up w/Mech Fastners-Bond Gas & Water Elec. Receptacles in Garage (G.F.I.)-Romex Protection 28. 2 Appliance Circuts in Kitchen & Conductor Size GFI Insulation -Foam -Looked in Attic 29. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or Al Guard rails & Deck Construction -Post Caps 30. Ran je Circ. / / ga Cu or AI -Oven Circ. / / ga Cu or Al Insulated Neutral 0 Yes 0 No Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes 31. Service -Riser Conductors & Ground -Main Disconect Following Instld./Drive 0 Yes 0 No/1Nalks 0 Yes 0 No/Planters 0 Yes 0 No 32. Equip. Clearances Panels-Motors-Mech. Epuip. Stucco Brown -Finish 33. Clothes Closet Light -Shower Light -Spa Light A.C. Unit Disconnect, Electrical -Plumbing 34. Smoke Detector Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 86. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s Glass Protection 35. A.C. Ducts Insulation & Support Corrections from Previous Inspections 36. Vent Fan, Exhaust above insulation Gas Test -Meters Tagged, Gas -Electric 37. Condensate Drain & Overflow, Size & Grade Water & Sewer Connected -C/O to Grade -HD Approval 38. Furnance-Vent Access -Comb. Air -Return Air Vent 115 outlet Energy Compliance Certificate -Other Certificates 39. Attic Access & Platform if Furnace in Attic Date Date Date Date Card B-1 Date Card B-1 Date Comments at Final: Card B-1 Date Card B-1 Date FRAMING (Plans) OK except #'s 40. Sits Proper Materials & Anchors 41. Walls Studs -Nailing Spacing & Braces -Plates -Sound 42. Bearing Walls over Girders & Floor Nailing 43. Draft Stop in Walls (rat proof) 44. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 45. Headers & Beams -Size & Bearing Date 46. FRAMING (Continued) Hangers -Post Caps -Anchors -Connectors 47. Cling. Joist-Rftr. Ties-Pullin-roff Brac.-Truss-Shting: Rfng. 48. Fireplace Ties or Type A Flue -Fireplace Throat clearance 49. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 50. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 51. Garage Fire Protection Framing 52. Property Line Firewall & Openings 53. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 54. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 55. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 56. Siding -Nailing Veneer 57. Stucco Mesh -Drip Screed -Fd. Vents-Underfir. Access 58. Glazing Area -Glass Protection -Skylights -Plastic 59. Shear Walls; Nailing -Bolts 60. Brace Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Walls -W indows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 63. Ext Steps -Door & Sidelight Protection -Landings 64. Smoke Detector 65. Furnace; Vents -Clearance -Comb, Air-Conector- In Garage; Above Floor-Ducts-Mech. Protection 66. Bedroom Exiting 67. G.F.I. & Bath Fixtures & Tub Access -Spa 68. Elec. Trim & Subpanel, Breaker Sizes & Labels 69. Stairs & Rails 70. Fireplace or Stove, Clearance -Hearth 71. Elec. Outlets at Wood Panel, Int. & Ext. 72. Kit. Fixt. & Appliance; Ground. -Air Gap -Cooking Clearance 73. Elec. Outlets & Recepticales at Kit. Counter 74. Garage Fire Door; Swing -Landing -Closure 75. A.C. Duct in Garage -Damper 76. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. In Garage; Above Floor-Mech. Protection 77. Plb., Elec. & Mech. Equip. Listed for Location 78. Elec. Receptacles in Garage (G.F.I.)-Romex Protection 79. Insulation -Foam -Looked in Attic 80. Guard rails & Deck Construction -Post Caps 81. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor 0 Yes 82. Following Instld./Drive 0 Yes 0 No/1Nalks 0 Yes 0 No/Planters 0 Yes 0 No 83. Stucco Brown -Finish 84. A.C. Unit Disconnect, Electrical -Plumbing 85. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 86. Water Well, Disconnect, Electrical, Plumbing 87. Exterior Elec. Trim, G.F.I. Receptacle -Underground 88. Ventilation Throught House 89. Glass Protection 90. Corrections from Previous Inspections 91. Gas Test -Meters Tagged, Gas -Electric 92. Water & Sewer Connected -C/O to Grade -HD Approval 93. Energy Compliance Certificate -Other Certificates Date Date Card B-1 Date Card B-1 Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, Zalifornia 95965 - Telephone (916) 538-7541 P (Rev. 12/96) APPLICATION AND PERMIT 1 As V.�O 2YLVIM3 20NIN0 pz,4� BUILDING PERMIT OwffRUCK HUBBARD T'LTITE5583 SO. FT. OCC. BUILDING VALUATION VVV OWNERS MAILING ADDRESS O'bbffAt'`'fARR TEL,FPi�7E 6094 j� / / COT!ffQR's TKV"'kOAD, PARADISE 95969 CONSTRUCTION LENDERx Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ 207.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ 134-55 BUILDINGADDRJS 110 KOLAR ROAD, MAGALIA / Ener Plan Checking Fee sY 9 $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑X Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 15.012 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other CNX Describe Work: REPAIR STORM DAMAGE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service zoo, oa mss 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 effect.POWER License Class- Lic. No. S-1?6 9 I/ z 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. O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. O 1 am exempt under Sec. Business and Professions Code for this reason Main Service ( 200A TO ,000A 46.00 NEW CONST. DWELLING OCCUP. OR AODNS. ( & ACC. BUDS. SO 3.5QFT. NON-RESIDT STI-OUTLETTs @7,50 APPARATUS b SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FOCTURES ao p I.oa BAL- p .so PLNS D APEA Ex. Occup. OUTELETSRES D.O 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: O 1 have and will maintain a certificate of consent to self -insure for workers' - pensation, 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 of the Labor Code, for the performance of work for which this permit is issued. My workers' c m e sation insurance carrier and policy number are: CarrierPERMIT Policy Number (The above sections need not be comple ed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 'DI 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 W rscompensation provisions of section 3700 of the Labor Code, I shall orth ith comply with those provisions. gnature of Applicant-- 13Owner n actor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 411.55 HAZ.12E D. FE I FL00 CDF pAgC pp HD ISSU This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date S Da h? Receipt No. 218884 WHITE-D.D.S.-B.O. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .. r i Kr"'r-y./yk'e-.�:��-ems-:I•r�-i,,�.J�\�"''r��"�.bE�li�S';v`�''�',t Y�...'_ .. "'� ��'�~•t4y- , �.,',;: �, t'�t '� �'_ r ,^.r J Wi COUNTY OF BUTTE DEPARTMENT OF P,&W OPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVRIE;''CAL FORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER: 46&,j ASSESSOR PARC ER: 0S( - P90 --o 3 LIZ Proposed Building Use: Building Inspector: Date: At time of permit applicatio , I w advised the following data must be ;-ug witted prior to permit ces ing and/or issuance: Date Received By shave been submitted-------------------------------------------------------------------------------------- *Plot plans, 3/4 sets, signed by the preparer of plans. ------------------------------------------------------------ 03. Complete plans, 3/4 sets, signed by the preparer of plans. ----------------------------------------------------- ❑4. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. -------- ❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------ 06. Energy Design Compliance and supporting documentation. ---------------------------------------------------- ❑ 7. Statement of Intent for Non -Heated and A/C Buildings. --------------------------------------------------------- ❑ 8. Hazardous Material Form. ------------------------------------------------------------------------------------------ ❑9. Manufactured Home data and installation instructions including Tie Down Specifications ------------------- 0 10. Fees of $ ------------------------------------------------------------------------------------- ❑ 11. Impact fees as shown on the attached schedule. ----------------------------------------------------------------- ❑ 12. California Department of Forestry plan approval/fees. --------------------------------------------------------- ❑ 13. Flood elevation certificate. ---------------------------------------------------------------------------------------- ❑ 14. Sanitation and plot plan approval Health Department. ------------------------------------------- ❑ 15. City of Chico plumbing permit. ----------------------------------------------------------------------------------- ❑ 16. Plot plan and business license approval from the City of Biggs. ---------------------------------------------- 1117. --------------------------------------------- ❑17. Planning approval for (A) Use: (B) Parking: --------------- ---------- F-1 18. Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel. ----------------- ❑ 19. Encroachment Permit for driveway (construction approval prior to occupancy). --------------------- ❑20. Pre -inspection for required. Request to Building Inspector on 02 1. Contractor's license information. (Number, Name Style, Classification). ----------------------------- ❑22. Workers' Compensation carrier and policy number. ----------------------------------------------- 023. Owner -Builder Verification (Given to owner ❑, Mailed to owner 1:1) - -------------------------- ❑24. Letter of signature authorization. -------------------------------------------------------------------- ❑25. Recorded copy of Agricultural Acknowledgment Statement. -------------------------------------- ❑26. Letter of intent on building use.----------------------------------------------------------------------. ❑27. Manufactured Home utility clearance. --------------------------------------------------------------- ❑28. Existing violations and/or expired permits. ---------------------------------------------------------- 0 29. ❑433 A, 11 Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $ -- ❑30. Other: When you issue the permit, process as follows ❑ Mail to owner, Mail to contractor. ❑Telephone and hold for pickup at ,---N office. ❑ Deliver with inspector (Date) Applicant:(�"�U�ate: 1 7 Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ Air Pollution Date: By - Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ Other: Date: /By: 1. Index p "t application for the above items numbered: ❑ Plan Check List 2. Addi ' nal items required: C&I64 - I"t f t/ Q`i- '( ��/LE Con tor, designer, owner, was advised of the above required data by phone, ❑ mail, ❑ Building Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ BuiKl Plans reviewed by: Date: Plans approved by:/ /G Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Yellow Copy - Department of Development Services, Building Division. Division counter, by OPvDate: counter, by Date: co ter, by Date: counter, by Date - Date: Date: 1 „ r COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES- BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 -.Telephone (916) 538-7541 PERMIT NO. (Rev. 12/96). APPLICATION AND PERMIT ASSESSOR PARCEL NUMER oo ZONING BUILDING PERMIT OWNER TELEPHONES SO. FT. OCC. BUILDING VALUATION OWNER? YALINO ADDRESS . RACIORY TELEPHONE f � CO NG ADORESB eorPTWlcnpN-�►oER , Fireplace MNCE” awu+G ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee S 20.00 Permit Fee $ ARCHITECT OA ENGWEER9 MAILING ADDRESS Plan Checking Fee $ SUIDINGADORESS T Energy Plan Checking Fee $ b PERMIT FEE S for NO. SUSONMONSXWE PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 . _ USEOFSTRUCTURE SF Duplex ❑ Mobilehome Cl Other $PEC"v Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New O Addition O Remodel ❑ Utilities O Installation O_ Other Describe Work: Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W @20.00 - PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service 200' OR IES.' 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000 cf Civisic—n 3 ct the Business and Professions Cade, and my license is in full force and effect License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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. O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. O 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 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. Q 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.) O 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 forthwith comply with those provisions. X __ Date Signature of Applicant - ❑ Owner O Contractor ❑ Agent An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO I000A 46.00 NEN CONST. OWE11a10 OCCUP. so OR ADONS. ( a ACC. 1505. I 3.5¢FT; =aOE.'a' MULTI -OUTLET 27.50 PS0=LE APPARATLJ a SINGOUTLET CIR. OUTLET Ex. Occu 9A200 V `:w , PoCEO APPLNS. Oil 5 00 Ex. Occup. olmETs REs10. ENI Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE _ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEES HA1. I D. FEES I IMP FLOOD I COF PARCEL PO NO 6SUE This permit is hereby Issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXPIRES ON provisions to do work paid. Tal ReceiptNo. WHITE-O.O.S.-8.0. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT