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HomeMy WebLinkAbout058-340-01758-34-17 Gil & Helen Hislop S/S Schwyhart Lane, app. --4 mi.E.of Oro I Concow Rd . , ConcowN - --=� Permit #2274-80P,E ( til QMH) GASte— AC - l lea y. SUPPORT STRUCTURE REQ. 0 COMPACTION TEST HWQ .Lf 1/ s 8-34-17 f' ontr: Mobile Home Center, Inc., Oroville 'R t ermit #2075 I E � .. ssued. �� — Yr',��F i^4• 4 l' 1 i 1 r ' �� ` LM `_�c:J cn �,o ►�. �/���q� SGL ,vim 4,1A -4 \ ""r v fi�r 'rcr..-.�,y�w+o•�>7`rar+ "`a -q, ey [ t.I't'��V`'yy r•t+:.w,..tr v1J':- • ., � t ._ e � �'... i'� .. .I 4 k`r COUNTY OF'BUTTE =' DEPARTMENT 7 County: Center Drive., IOroville, OF PUBLIC WORKS California 95965 �,! • " Telephone: 538-7541 APPLICATION FOR SPECIAL INSPECTION Owner v A.P. No. Mailing Address j / or "r0 r C. ltl IkO � t an Telephone No. ,1 ^ f -44,3 oe\©vdle If J - Applicant ,20 Me, e Jelephoneh No. a Mailing Address Building Location &tl %0 I -hereby request a special inspection of the following building: 1. Dwelling (if only a portion,'specify) 2. Apartment House (if only a portion, specify) 3. Commercial (specify present occupancy) 4. ' Other (specify)' i/,t[-�'�'�" I am requesting a special inspection for the purpose of: T� 1:._ Moving the building. U2. Financing (specify agency) 3. Change of occupancy to 4. Other (specify) Case No. M j I hereby certify that I will obtain the necessary permits and make any necessary correc- tions, alterations, or repairs required by the County of Butte, as a result of this inspec- tion, to comply with building and housing code' requirements. I also certify that prior to the use or occupancy of this -'building, I will complete, the above 1�equired'%-corrections, alterations, or repairs, or, if the building is presently occupied',I will comptilete the above required corrections, alterations, or repairs within 30 days.-'' ew I certify that I have read this application and state the above information is correct and hereby authorize representatives of the= County of Butte to enter upon the above- mentioned property for inspection purposes. Signature of 0 \r Fee Paid $ lst-DPW/2nd-Inspector/3rd-Applicant 8 Date Receipt No. COUNTY OF BUTTE,= bEPARTMENT OF PUBLIC WORKS 7 County!Center Drive-,�Oroville, California 95965 ,Telephone: 538-7541 APPLICATION FOR SPECIAL INSPECTION Mailin Mailing Address \ Building Location 1,+14 i' I hereby iequestAa•'special inspection of theffollowing building: ' t /� !rs 0 1. Dwelling (if only a portion.,` specify) ' 0 2. Apartment House (if only a�portion, specify) Q3. Commercial (specify present occupancy) n .FV 4% Other ( specif Y )` f���s��`' �(i Gf � p � �• � I am requesting a special inspection for the purpose of: =� 0 1.- Moving the building. �`2.. Financing (specify agency) Case No. F_ Q 3. Change of occupancy to ; `V_1 4. Other (specify) 'AIA I V r U I/hereby certify that I will obtain the necessary permits and make any necessary correc- tions, alterations, or repairs required by the County of Butte, as a result of,�.this inspec- tion, to comply with building and housing code' requirements,. I also certify that prior to the use or occupancy of this.�building, I will complete the aboveequired•rcorrections, alterations, or repairs, or, if the building is presently' occupied,I will complete the above required corrections, alterations, or repairs within 30 days. c. .s I certify that I have read this application and state the, above information is correct' and hereby authorize representatives of the County of Butte to enter upon the above- mentioned property for inspection purposes. Date "' J Signature of 0 ner Fee Paid $ Z.00 Receipt No. 1st-DPW/2nd-Inspector/3rd-Applicant t ? toll , - �J'y.. �..^r'�iJ.-...r.::v----.•..-a,...,-,..--•^^�,..�.-�a--...: . n,�-'ti.�•-•,�.� �w,��-'r+.,^i'"7,,;w'i;'�'�-11,-.yr-a� „�'r.^^' , , � . . - f^ri,r+� .- r ,: COIINTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 - TELEPHONE (916) 538-7541 OWNER MUi(Y Proposed Building Use PERMIT APPLICATION DATA SHEET A. P. No. 6-51? -,54/0 - 617 Building Inspector Date 5 /Zh,/9 -� At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED By 1. All items have been submitted . ....................................... . 2. Plot plans, 3/4 sets, signed by preparer of plans . ......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans . ....................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form . ........................................... . 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ .......................................... 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department . ............ 15. City of Chico plumbing permit. ........................................ . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy)... ... �Preanspedion req.uest 20. Pre -inspection for required. . to Building inspector 21. Contractor's license information. (No., Name Style, Classification) . ............... 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner _). .......... . 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . .......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. br--1A 1A Al 34. When ygu issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone 53'-(, q� and hold for pickup at io,eg �; ,/!i, office. Deliver with inspector. Other Parcel Creation (� Acreage AppIicantt t- Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works With regards to your Special Inspection on A.P.# . Please call Bill Barron at 535-7541 between 5:00 & 8:30 to schedule a inspection. I have calle u three times and received no answer. _BUTTECOUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. " PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1, Owner's name: 2. Installer's name: AloySt�� t CZL7U �L 3. Is the site currently under permit? Yes No (If yes, furnish permit number ) OR Is the site an existing site? Yes / / No / (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from -septic tank and leach fields and clear of all setbacks and easements? Yes /TT No (If no, clarify ) ( ) 5. What is the mobilehome electrical rating? ----------------------- /,00 Amps 6. What is the mobilehome site service rating? --------------------- Amps a 7. What is the mobilehome site circuit breaker rating. --- /D U Amps 8. Is there any other electric load to be served by the mobilehome siteservice? ----------------------------------- .----------------- Yes :El� No (If yes, identify the load and size: (Load). (Amps) 9. What is the mobilehome site gas pipe size? ---------- ------------ '3�ti' (in.) 10. What is the type of gas service? ----------------------------- Natural / / LPG / i 11. What is the gas pipe length from meter or tank to the mobilehome?. (ft.) 12. :What is the mobilehome gas demand? ------------------------------ (BTU) (This information not required if pipe length less than 6 ft.'on natural gas or less than 50 ft. on'LPG.) .. 6UTTE, COU NTY' . . DEPARTMEN BUILDING { APPROVE • MOBILEHOME SUPPORT DATA / If other than'single wide, Mobilehome Mfr. .0 ,S. furnish Setup Model No. • Year WidthC1,41 (ft.) Box Length 16g.) (ft.). Tagalong or"Expando Size y- ft. x ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 1973; furnish manufacturer's installation manual and structural setup sheets.(if not on file with the County of Butte). All center supports measured from front of mobilehome unless otherwise specified. Footings (check one) Single 1. Wood either pressure treated or foundation grade. (in.) (in.) E2. Other (specify) Center sup ort Center support locations* footing sizes Supports (check one) (in.) Concrete block. �iZ) ay 6000 E] L Other (specify) (ft.)( n.) (in.) (in.) <----Tagalong or Expando,' �* .•- ' show support details. �� yi al3id, Go (ft.)(i .) (in.) (in.) Typical Support (in.) (in.) Footing Size G eoe (OV au xa�3� (ft.)(i .) (in.) (in.) /' v -- Max. Pier Spacing Max. Overhang - (ft.) (in.) (in.) (in.) • .3500 � '�/1 / `r ��D i✓ore.• IV+rAj3. %Nt • :-S,opetrs us- v",o eera ,By to /iReow ✓ a o6*4ss►s /3fIFM ret Ae one;d . 7 �(CF bU t ' C UN i v KADING DEPARTMER! A PPROV *If center piers are other than drawn above, Arace 4n. 1^natinna aim arrina n -A ai.nnr 4-0 COUNTY OF BUTTE 6— DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE -0F OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, under permit number 2( 7 S 5<—nfor the following location: S 11.'i"cW; r.�>> . - ' ` �I Al �snss QCs � �f :nt� w-...• h�Y Owner Owner's Address � f Mobilehome Mfg. 1�Model �yx%n Year Insignia No.ls�L���� l A9923 Serial No. 1j'jrV7CS7/ * rQ It is hereby certified for occupancy at the above described location and may be occupied. Date By— / Director of,Pu(bliicc Works' THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. PERMIT NO. 2274-80P,E PERMIT EXPIRES N:5— OWNER Gil & Men Hislop CONTR. owner 58-34-17 LOCATION,, (A.P. ) Schwyhart Lane, app.4 mi.E.of Oro Concow Rd., Concow `j N• 7 . F' a `k e V i` G Temp. Power Pole Called PG&E Elea Serv. o✓ Called PG&E Te Gas Serv. O Called PG&E JOB r FINALED O `� (Date) (Signature) Stucco UL.Closer MOBILEHOI Water Piping a B Water Piping DATE Final 4 MINTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS •e" - . BUILDING INSPECTION RECORD -' MECHANICAL BUILDING BUILDING (Cont'd) PLUMBING S back IrewaII SAPiping For s 011trapets 1s Floor Ma Bldg. Re room Finish 2nd loor F tins Wind s 3rd F or Ste wall Siding To out Slab Roof Sh thing Water Pi in Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwa l l Garage Vents Insulation NHeaters Water Htr. Slab Carport Footings N Prov. for physichily handica ed Conformance of ex. V structure Appliances Gas Piping & Test Temp. Gas Slab Final V Sanitation Patio FI LACE Final Footings Footing EI.JECTRicAL Masonry Walls Throat Rough Reinf. Ste Final Fixtures Bond BeaA I ARE SPRINKL Motors Stucco UL.Closer MOBILEHOI Water Piping a B Water Piping DATE Final 4 Subpanels MECHANICAL Grd. Fa4AProt. Heatin Service/ Cools Te p. Pole Duc U der round S Ve tllation emianent nal Anal LITIES ------------------ lec_ Service 200 Elec. Pedestal 'ar Sewer —rA — aim Gas Piping ' 30 � rALLATION - - - - - - - - - - - - - - Supportc. Continuity Drainage Gas Piping REMARKS OR CORRECTIONS (NOTE: An entry.must be made on this form.each time you visit the job site.) MOBILEHOME INSTALLATION INSPECTION CHECK LIST 4 1. Is the mobilehome located with _rnfired separation from` -rot lines and buildings and generally conform to plot plan? Yes _�o_ 2. Does the mobilehome`have required clearances above ground? (Sec.5085) YesNo 3. Are footings and'supports properly sized, spaced, and braced ajpP& -approved plans?. (Note possible variation at spring shackles.) (Sec. 50 & 5083) Yes_ No 4. Is the mobilehome level? (Sec. 5088) Yes_ No 5. If 7Z, -than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No 6. Water A. Is f ex' e connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566)' Yes N No B. Test -.Does water piping wi stand working pressure or 50 lbs, air test? Yes �o_ C. Backflow - If coach is of California approved, does station have backflow device and pressure -relief va s_ No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes= No B. Does it have minimum k" per foot slope and is it properly supported? Yes No C. Are any leaks detected in drainage system after running 3- lions of water through each fixture including washing machine standpipe? Yes_ No D. If coach is not St ifornia approved, does station have required trap and vent? Yes No - 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with'an-approved 3/4" minimum mobilehome connector not more than 6 ft, long? Note: All piping is to beat least as large as the mobile me gas line inlet without reductions,other than the mobilehome connector.' Yes_ B. Test OK as per following procedure? Yes No 1, Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz,-maximum 8 oz,) calibrated in tenth pound increments., Test for 10 min. without drop. 4. Connect gas meter to mobilehome with connector; turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes— N_ L' 9. Electrical A. Is service large enough to provide adequate amperage -to mobile�lonre (•must equal rating of mobilehome with a minimum of 100 amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes_ I-10 B. Is there•proper clearances around panels? Yes N _ C. Is power supply cord or feeder assembly properly fused? Yes No_ D. Is continuity test satisfactory as per the following procedure? Yes `1�0 1. De -energize electrical wiring system of the mobilehome at the pedestal, 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 1 All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances,,,shall be tested for continuity from such equipment and the grounding conductor. V 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing, 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle Length lG� Width_ 1? -4_ Vehicle Serial No. tL ® State Identification No. % �2iD rs `i �t� St7 Additional Information or Comments: COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS, ' 695 Oleander Avenue, Chico = Phone 343-4211. Ext. 70 7 County Center Drive, Oroviile — Phone 534-4541 Skyway and Elliott Road, Paradise — Phone 877-3435 CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. It you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. X Ce) A.0i�Dtie AA, !A� G C& 40"'d oe� 60 0 Inspector r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS "F '; �Councy Center Drive — Oroville, California 95965 �+Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 6,',z,— Date Signa ure of ermitee or Agent Receipt No. —.373k9— White-D.P.W. .373k9—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 r which Date fees have been paid. IR P LIC WORKS / ^!` —0 U Building perml expires Date —6 O 1 A BUILDING Owner49 SO. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor Mailing Address/1*/pFireplace Total Valuation �Q Te ephone No. d� Permit Fee Building Address S s S�NZJYffa"r LANE 4fp Plan Checking Fee&/or Penalty Permit Fee M/. PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 I / dOA)�'QGV Repair drainage or vent piping 1.50 A. P. No. / Zan n �lanning Water piping 1.50 Each gas water heater or vent 1.50 Fe`s W6. -ffffft tForr I FireDept. I FireZone Use Permit Gas piping system 1 - 5 outlets 1.50 EOA Parking plans Parcel Declaration Parcel Map 60' R/W Improveme s Each additional outlet .30 Building sewer 5.00 Bldg. PI s Rec'd Parcel A roval Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ ELECTRICAL No.1 @ FEE %/2. 1/7-/ L, PERMIT FILING FEE $3.00 00V OR LE Main service 100 AMP ORSLESS 5.00 Single Family ❑ Duplex ❑ Mobil Home 2" Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 100 AMPe0ov OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONS. I DWELING OR ADDNST %ACCLBLDGSCCUP. Y) 20sgft 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: %� /'Y1nB.lt / E OCA)rz, ,r TLET NEW RESID.CONSTRANCH CIRCUITS) NON.RESI D, (BRANCH CIRCUITS/ 2.50ea NEW CONSTR. POWER APPARATUS e NON.RESID, SINGLE OUTLET CIR, Ex.OccuDOUTLETS OR FIXT11PES ) 50@25¢BAL@1 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID•) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. o?G /90-S Classification G' G Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ 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. E5' 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 1 shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. 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 PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ Land Development Fee $ $ TOTAL PERMIT FEE $ (� authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 6,',z,— Date Signa ure of ermitee or Agent Receipt No. —.373k9— White-D.P.W. .373k9—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 r which Date fees have been paid. IR P LIC WORKS / ^!` —0 U Building perml expires Date —6 O 1 A COUNTY OF BUTTE -'DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSES$Slft PARS(LiL 7 Ey NUM�ER_ ✓ ZONItJ/6� BUILDING PERMI OwNlL /-��Fit) 11S i-LO�' TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWN 'SALINXOCXESS X Z3 9 CONTR ACCTOR•S NAME TE LE PFIONE CONTRACTOR'S MAILI G DDRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRES Permit Fee $ ARCHITECT OR ENGI EER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDI ADDRESS L . I' APR � / ��► S /V PLUMBING PERMIT Filing Fee 3.00 /n�,�., /n�7��, O� 0I� W�aw Each Trap 2.00 Repair drainage or vent piping 2.00 66NW iv Water piping ILI, 049 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehomep?e'-Other SPECIFY Building sewer Q Lawn sprinkler system 2.00 - TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Installation❑ Other ❑ Describe work: — Permit Fee $ 3,400 Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 100 AMP OR11V OR LESS5.00.QJ6 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADONS. ACC. BLOGS. 20 sq ft 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 m license is in full force and effect. y License No. Classification I, as the owner, or my employees with wages as their sole compen- cation, 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. MULTI -CUTLET 2,50 ea NON-RES,.BRANCH CIRCUITS) NEW CONSTR. ( POWER APPARATUS &) 1 NON-RESID. SINGLE OUTLET CIR. 50@254 Ex. Occup(o XTS OR FIXTURES BAL@104 FIXEEDD APP LHS. OR Ex. Occup.(OUTLETS (RESID,) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /5. OC) Misc. Wiring 6.25 /(/j O Permit Fee $ 6,J� Contractor MECHANICAL PERMIT FiIingFee 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. 19 ill 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 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 against said ounty in consequence of the granting of this permit. ' �' �..QD X Date U Signature of Applicant — Owner9f Contractor ❑ Agent ❑ An OSHA permit is required for ex/covations over S'0" deep and demolition Or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ -00 TOTAL PERMIT FEE $ ,S o OCCUP. GROUP I TYPE OF CONST, PARCEL PD D ISSD This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTO OF PUBLIC B 064T EXPIRES Date. the applicable provi- resolutions to do fees have been paid. WORKS Date �r� / Receipt No. `3-7337 O WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT S�- -,HTr.. COMM USS VyS� r - OF OUTTE SU"WG,DEPT JUN I _- 19 - i. -- 4. _ - - — - - - - .__ -- -_ ti, 'i c., i `�• - i. -- 4. _ - - — - - - - .__ -- -_ ti, i 1 Y +� � � �� :. ' - i. -- 4. _ - - — - - - - .__ -- -_ w INN co� - bulum" 2� .M i - Y �f AFI c 1 ' t AFI i i 1 ' t 1 Yc�at1 �11A1;i}Wb i i i 1 Yc�at1 �11A1;i}Wb s-chw y`I.91�L ClfSeWe)t / O/ gRNkk JA This set of plans and specifications MUST be kept on the job at all ti a it is unlawful to make any changes from tl a Department of Public written permissioof Butte Works, County A, setback of 5 ft. from the lines and a setback Propel - of !oft. from the road centerlineshall be clear of structures or equipment exeW for a 2 ft. eave overhang. NOTE:—All Materials & Workmanship Shall ge fit' accordance with R.ecoo�nized Good Practices and of actuality prescribed for the Specified use in the Uniform Building, Plumbing & Machanicol Codes and the National Electrical Code. Utility connections shall be within 4 ft. of the mobilehome, either directly behind or within the rear half of the roadside (left) of the mobilehome. I BUTTE oUNTY ING DEPARTMEN PPR® V FD G►'l 4N. #e-k-A)COP