HomeMy WebLinkAbout061-340-027`1-3�t..Z� A.P.
K.G. MALLOUGH
! I e/s Oro Quincy Hwy, 1/3 mi. so.
! of Mountain Houseile
r Vjille
Permit -1246-'72E , ,�^-,?�7f�
(utilities for a home
_. 61-34-27
Contr: Mountain bevelo.pment
Permit.3B,E ew garage)
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BUTTE COUNTY INTERDEPARTMENTAL CORRESPONDENCE
DELIVER TO LAST PERSON NAMED
_ATE NAME I DEPT. I DATE I NAME DEPT.
M
r1 7
2697-83B,E
PERMIT NO.
PERMIT EXPIRES et i
1 OWNER KENNETH G. MALLOUGH
CONTR. Mountain Development
ASSESSOR PARCEL 61-34-27
LOCATION NE/S Oro Quincv Hwy 22 mi N Brush
Creek Ranger Sta, Brush Creek
i
t
!
i
t
Temp. Power-Pole—
Called PG&E _
Temp. Elec. Service
I
Called PG&E_
Temp. Gas Service _
i Cal led PG
E
JOB FINALE[
k
1
S
Signature
a
V=OK
0 = Not OK
- = Not Applicable -. Not Ready v hSIDENTIAL (Single and Duplex)
Date
UNDE LOOK (Plans) OK except#'s
Date
FRAMING (Continued)
Celt 9-
Dg requirements -Setbacks -Easements
48.-Propeay
Line Firewall & Openings
t - eel -Flet. Grnd.- / /" Ftg. Depth
xi. Doors -One 3' -Check Garage -3rd story, 2 exits
g., Garage; Soils -Steel- / Ftg. Depth
fairs; - eadroom-Rise-Run-Landing-Fire Protection
4.
orches & Decks; Soils -Steel- / /" Ftg. Depth
5
ywoo oof Overhang -Attic Vents -Rafter Outriggers
5.,
atn; Steel-Blockouts-Wrapped-Slab
52,--
niing-Nailing-Veneer r
6. St , arage; Steel-Blockouts-Wrapped-Slab
53!::ucco
^"� �h �r'p Screed-Fdn. Vents-Underfir. Access
7.
8.
Piers- ' p ace Ftg.-Steel
W.V.: Fall -Fittings -Test -2 way C/0 -Sewer Test
54,
55.
ss Protection -Skylights -Plastic
ming -Bolts
9. Gas i nchors
10.at
pe; Test -Anchors -Regulator -Service Test
-
11,
let ' ' nderground
12. Hums cis; Clearance -Material -Support -Ins.
13.
s -Sills -Anchor Bolts -Joists -Vents -Cripples
Cet I
ate Card -BI Date
Card -BI
bate Card -BI Date
Card -BI
Date Card -BI Date
®rd'
ate Card -BI Date
Date
FINAL, (Plans) OK except #'s
Card -BI Date Card -BI Date
Date
PLUMBING (Permit) OK except #'s
$KEY,I�Steps-Door
& Sidelight Protection -Landings
6dj5fPrb
ee eta
14.
15.
Water Ht.; Vent -Access -Combustion Air
Water Pipe; Test & Anchors -Nail Protection
58.
Furnace; Ven arance-Comb. Air -Connector -
I e; Above Floor -Ducts -Meth. Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
xt tng
Shower Pan; Test, First Floor -Tub Access
60•
u Access
___17.
18.
Test Tub & Shower, 2nd Floor -Tub Access
61 .
ec. Trim & Subpanel; Breaker Sizes -Labels
_
Gas Pipe; Size & Anchors
62.
Stairs-&-Rtrts1
_-__19.
learances-Hearth
Card -BI
Date Card -81 Date
64.panel; Int. & Ext.
65.144+, �', �; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Iles at Kit. Counter
Date
ELE
ICAC Permit OK except #'s
67.
oor; Swin -Landing-Closer
68•
- per
'-
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr • -Clearance-Comb. Air-Connector-P.R.V.-
arage; Above Floor-Mech. Protection
21. EJee-REL'2ptacles Spacing -Lights &Switches at Doors
22. '3FZS oyes & No. of Conductors -Stapled
70.
uip. Listed for Location
23. 9MeA L"talled Close to Edge of Studs & C.J.
24. Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water
ec. Rete tacles in Garage; G.F.I. -Romex ec.
p 9 ( )
72.
-oam-Looked in Attic ❑Yes73.
-
_
25.
26.
ante ircuils in Kitchen & Conductor Size
Subieed Wiese / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI
ec Construction -Post Caps
74.
Fdn. Ve wl Hole Door -Drainage & Wood -Earth Clearance
Looked uriaer Floor ❑ Yes
_-
27.
28.
irc. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At,
Insulated I ❑Yes ❑No
ervice- onductors & Ground -Main Disconnect
75•
Fol Drive ❑Yeslo; Walks ❑Yes
anters LJ Yes 'RPfo
76.
- inish
29.
uip. Clearances; Pane I Equip.
7
tsconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
-_-
30.
Ligh-Mech.
C - oset Light -Shower Light
Light -Shower
78,E Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79. Water Wall• D_ isconnect, Electrical, Plumbing
-
--- --- ----
--
-----
Card B-I�fat f I - Card -BI Date
80
E -4-- & Trim; G.F.I. Receptacle -Underground
g�ughout
House
Card B -I
Date Card -BI Date
82
n
Date
MECHANICAL (Perrc,it) OK except #'s
erections from Previous Inspections
84"_ Gas Test -Meters Tagged; Gas -Electric
A.C. Ducts: Insulation & Support
85.--Weler-&-Sewer
Connected -C/O to Grade -HD Approval
y
-
32.
_ 33.
Vent Fan_Exhaust above Insulation
Condensate Drain &. Overilow; Size & Grade
8
pliance Certificate -Other Certificates
-_-
34.
Furnace -Vent: Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
-
Card -BI
---
_ Date----- Card -BI Date
BI
ate _ Card -BI Date
Card -Bl -Date
Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FRA
(Plans) OK except #'s
Comments at Final:
_ _.
Si roper Material & Anchors _
-
37. a _ Studs -Nailing, Spacing & Bracing -Plates -Sound
38. e_a_ring Walls over Girders & Floor Nailing
o in Walls (rat proof)
-
40.
�4
ei l ings-Stairs-Chases-Tub
_-__4gieplaee-i�es�r
_
42r -Id
4
45._
_eader & Beam -Size & Bearing __
Caps -Anchors -Connectors -
Ing. Joist -Rite. Ties-Purlin-Root Brat.-Truss-Sh ntt"i g.-R(I
Type A Flue -Fireplace Throat
ize &__Romex Protection -Draft Stop -Ins. Baffles
jjdr Exiting Doors -Sill Hgt. & Dimensions
-
rotection Framing - -_
(NOTE: An entry must be made each time youvisit jobsite)
J =OK
0 = Not OK
= Not Applicable MOBILEHOMES
* = riot Ready
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except k's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rig.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec. -
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except H's
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date
POOLS (Plans) OK except N's
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances
4. Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding: Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enclosures -Panel boards -Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS _
196 Memorial Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 534-4541
Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57
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. If you have any question pertaining to this
�r matter, or need additional explanation, 'please contact this office immediately.
Fu Fo RAF
Lt. 5PLr c rz l
WEI
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Inspector �aj)' / f Yj j Date 'V
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COUNTY OF BUTTE - DERARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION -AND PERMIT
PERMIT NO.
e -0(O Z
ASSESSOR PARCEL NUMBER-
Z,
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
-2 = s o a J
CONTRACTOR'S NAME
bE1/E o - co,
TELEPHONE
s �- 97
CONTRACTOR'S LING ADDRESS
S
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ 2j
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$76-160
ARCH TECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ 7, SEC)
Penalty
$
ARCHITEC OR ENGINEER'S MAILING ADDRESS
Permit fee
$ �Zes
BUILDING ADDRESS
s c
PLUMBING PERMIT
Filing Fee 10.00
_
2� U
Each Trap
2.00
Solar Water Heater
20.00
_ Lo
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 11 l4 6 F-7
SPECIFY
Building sewer
5.00
Mobile Home I S I G I W
10.00 e
TYPE OF WORK
Newt Add ition❑ Remodel EJ Utilities❑ Installation[]Other❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP ORV OR LESS10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OC P `
OR ACDNS. ( ACC. BLDGS. '
/ 2h2sq ft C7C/
� o
,CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
/I�YF'I I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full fo a and effect.
License No. 2Classification
❑ 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
NNOEW CONN.RESI5D BRANCH CIRCITS.TR u TI.OUTL T 2,50 ea
NEW CONSTR POWER APPARATUS &')
NON.RESID. (SINGLE OUTLET CIR,
Ex z0®s0e
. Occup(o OR FIXTURES 9AL®ao
IXEDTs
Ex. OCCup. OUTLETS P(RESID )REA.)
2.00
Temporary service 10.00
Mobile Home Facilities
15.00
Misc. Wiring 15.00
Permit Fee $ ego
Contractor
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.
MECHANICAL PERMIT
FiIingFee 10.00
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 ave, indemnify and keep harmless the County of Butte against
all liabilitie dgments, co and a nses which may in any way accrue
against said my in cons que ce granting of this permit.
X Date
Signature o Applicant — Owner Contractor Agent
An OSHA permit is required For excavations over 5'0" deep and demolition or construct-
ion of structures over 3 storiesinheight.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $ %$70, Q
occui./GR.uP
�',
TYPE of CpNST.
r
"7L
PD
ND 15Su�r
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
D=R:�FtOF P BLIC
BY `
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No. &�� / O
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
r
COUNTY OF BUTTE —DEPARTMENT OF OUBLIC µWORKS - BUILDING DIVISION
A. 7 COUNTY CENTER DRIVE - OROVILLE,. CAL•IFBRNIA 95965 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET
Permit No.
OWNER ,tJ��{ )�l l / ,/ l I n 0 Q14 A. P. No.
Proposed Building Use 4-AA24�5::
Permit Fee Based Upon: Complete Contract Price DPW Valuation
Other (Explain) •
Building Inspector- Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or issuance: DATE RECEIVED APPROVED
1. All items have been submitted.
2. Plot plans in duplicate./triplicate. . . . . . . . .
3. Complete plans in duplicate. /triplicate. . . . . . . . .
4. Complete engineered plans and calcs. . . . . . . . . .
5. Plans with Energy Design Compliance Statement. . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorization. . . . . . . . . .
_SC OAO. Sanitation approval from 4x004/XZ / Health Dept. I
11. Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance.
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner[], Mail to owner ❑•)
15. Improvements may be required. . . . . ...
16. Mobilehome Installation Data. . . • . . • .
17. Pre -inspection for Required. Pre-Inspec. request to (Date)
p q Building Inspector
18. Other
When you issue the permit, process as follows: Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other _ ,9
Applicar��,/�!!�/,r'., .��! Date
Copy of plans sent Health Dept., Fire Dept., Other Date_;
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of application, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by
By.
Plans checked
Plans approves
Other
Copy—DPW
Telephone Mail
Date
Date _
6.3
Date
Other
TO: Building- Depart, .ent
Fror:,:-hvi.rormtental Health
Su'o ect: Sanitation Clearance
Plan '!.poroved for: Sewage disposal.
Hold final for:
Final clearance .O.K. for:
Clearance 'for bedroom mobile home. Other
NOTE
S anit avian
p2
water
>
water suppl-r
water supply
water supply .
Da
t,
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORK/ ,/ _7"_7 County Center Drive — Oroville, California 95965
Telephone' 533-1230, 'Ex4. 259
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x 1� x1 --2G- 7'z
Date
Signature of Permitee or A�ggey'
Receipt No. ;7'r
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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.
DIIRREC R F PUB WORKS
By 4 • DateR— --20 Z__
Building Permit Expires Date 2-60-7 3
BUILDING
Owner A/_ x92
SQ. FT. OCC. BUILDING VALUATION
Mailing Address �Lr
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee&/or Penalty
Permit Fee $
$
Building Address
'
PLUMBING No. @ FEE
PERMIT FILING FEE J$2.00
—_Fach
Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. ('p�— r� —
Zoning _Z
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .50
Fire Zone
Fire Dept.'
Sanitati
Planninguilding
sewer 5.00
ans
/
Fees f/
W. C. R/W
od
Encroachment
Lawn sprinkler system2.00
NEW ❑ ADDITION ❑ OTHER ❑.
Permit Fee $
$
'611/1
ELECTRICAL No. @ I FEE
PERMIT FILING FEE J$3.00 S Oo
Main service incl. 1 meter
Additional meters, each 1.00
USE OF STRUCTURE . Single Family ❑ Duplex ❑ Others ❑
Sub -panel 02 or less) (more than 12)
Range, dryer or water heater 1.00
Oven, Cook -top or space. heater 1.00
Light fixtures
Receps., switches & fix outlets
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:
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap, cooler, gar, disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Misc. wiring
.4
License No. Classification
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.
M 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. @ FEE
PERMIT FILING FEE $3.00
Heating
_
Cooling
Ventilation
Permit Fee $
$
I certify that I have read this application and state that the above
information is correci. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
tate Fee for Str ng Motion $0.07/$1000 Evaluation
nstrumentation ♦4rogram
$
TOTAL PERMIT FEE
$ . ('
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x 1� x1 --2G- 7'z
Date
Signature of Permitee or A�ggey'
Receipt No. ;7'r
White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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.
DIIRREC R F PUB WORKS
By 4 • DateR— --20 Z__
Building Permit Expires Date 2-60-7 3
COUNTY OF BUTTE — DERART,M,ENT OF PUBLIC WORKS
7 County Center Drive — OroviIle, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned roperty for inspection purposes.
X Date
Signature of Per ite�e oar Agent
Receipt No./ 1 -3
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.
DIREC OR OF PUBLIC WORKS
BY ADate f eL ;;I— 3
Building permit expires Date
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mai I i ng Address
Telephone No.
Fireplace
Contractor 0.
Total Valuation
Mailing Address �cJa—
Permit Fee
Plan Checking Fee &/or Penalty
Q
S / 3
Telephone No.
Permit Fee
-7—$ $
Building Address v�EXsr .GG
PLUMBING
No.
@
FEE
PERMIT FILING FEE $2.00
s .� o p
Each Trap 1.50
LG A
Repair drainage or vent piping
1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. " ®2 — 1p
Zoning & Planning
Gas piping system 1 - 5 outlets
1.50
Each additional outlet .30
F
grrrFtati M
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
I ParcelParcel
Declaration
Ma P
60' R/W
Imp rovements
P
Lawn sprinkler system 2.00
Bldg. Plans Rec'd
Parcel Approval
Plans Approval
Permit Fee
$
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER 2—
ELECTRICAL
No.
@
FEE
PERMIT FILING FEE $3.00
/
—eh or- Z- /LIs .�rh, iT
Main service incl. 1 meter
i3Additional
meters, each
1.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Sub -panel (12 oress) (more than 12)
Range, Cook -top or Oven 1.00
Water Heater or Space Heater
1.00
Light fixtures bal__ X1.0
R s.,sw' es & f outlets ZZ�o((�a22S5
O
! c�
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: /
Pt 12v't3��ta`i o�J -1 -tytJC- ov-i
Hood, Ex. Fan or F.A. Furn. Motor
1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
V. O , l 0 AA 4 01 -L- 6A p
Temp. Power Pole 5.00
License No. _ZC74' 2011 Classification 3
Misc. wiring
❑ 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 Io an certify that in the performance of the work for which this
ermit is issued I shall not em
P employ y 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
Is
e
authorize representatives of the County of Butte to enter upon the
above-mentioned roperty for inspection purposes.
X Date
Signature of Per ite�e oar Agent
Receipt No./ 1 -3
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.
DIREC OR OF PUBLIC WORKS
BY ADate f eL ;;I— 3
Building permit expires Date