HomeMy WebLinkAbout061-490-007I
Doroth Cameron
NIS pri.rd.,app.1000'W.of Foreman Crk.
Rd., app.12001S.of Oro -Quincy Rd.
contr: Mountain Devlop. Co., Orovill,e
Permit #3773-76B,P,E,M(new single
family).]
dol -4g p'`T .
contr: Duke Sherwood, Oroville
Permit #3505-78B(new private.
detached garage)
061-490-007
CAMERON, DOROTHY
72 GEORGE CAMERON, BE
Cont: CHRISTENSEN
RE -ROOF
�r
Doroth Cameron
NIS pri.rd.,app.1000'W.of Foreman Crk.
Rd., app.12001S.of Oro -Quincy Rd.
contr: Mountain Devlop. Co., Orovill,e
Permit #3773-76B,P,E,M(new single
family).]
dol -4g p'`T .
contr: Duke Sherwood, Oroville
Permit #3505-78B(new private.
detached garage)
061-490-007
CAMERON, DOROTHY
72 GEORGE CAMERON, BE
Cont: CHRISTENSEN
RE -ROOF
.'is7r rbr..,r-N,,w.l.{;r+,+t.c��+«.-n � ,_ ..-. r- ,�W;j«;-•.i, ..--..-,..... i. ,s;
't
061-490-007 403-1774
CAMERON, DOROTHY
72 GEORGE CAMERON, BERRY CREEK
Cont: CHRISTENSEN`
RE -ROOF
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - B LDING DIVISION
7 County Center Drive - Oroville, California 95965 • Telephone ( 0) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT�-
ASSESSOR PARCEL NUMBER
061 -490 -►007
ZONING
BUILDING PERMIT
OWNER Cameron Dorothy 589-1647
TELEPHONE
SO, Fr, OCC. BUILDING VALUATION
- OWNERS MAIUNG ADDRESS
72 o Dr Berry Creek
5heathir g 80• 00
31 s 1860.00
CONTRACTOR'S NAME ~' l
i
Christimsen RoafnsZ 5-12-9 43R
TELEPHONE
CONTRACTORS MAILING ADDRESS
1966 12th ornidlit*9S
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $ 3840.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filen Fee $
20.00
Permit Fee $
63.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDINGADDRESS
7OCreek
Energy Plan Checking Fee $
Y
$
PERMIT FEE $83.00
LOT NO.
SUBDMs ION'S NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 1
7.00
Solar or heat pump water heater 1
23.00
Water piping 1
15.00
Each as water heater or vent
15.00
t TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: tmr off shakes, re—shpAth And rPrmf
Gas piping system 1 - 5 outlets 1
15.00
Building sewer
15.00
Mobile Home S G W
@20.00
PERMIT FEE $
ELECTRICAL PERMIT
I Filing Fee 20.00
Main Service 200, OR LESS
1 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 iinf full force and effect. /�
License Class ,/ •s '_� `+1' Lic. No. _�2/'.-SIF _-�
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.
❑ 1, 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
Main Service 200A TO 1000A
1 46.00
NEW CONST. DWE ff OCC
OR ADONS. ( a ACC. BLDSUP. S.
SO
3.5¢FT.
T.
RESID. MULTI -OUTLET
@7,50
POWER APPARATUS
a SINGLE oun.ET CIR.
Ex. Occup. OUTLET OR FDrTURES
SAL @1.0
Ex. Occup. DUTF°S',g DER,
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.
❑oPOI'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 .S ,if lE,.,.
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
forthwith comply with those provisions.
X f - f Date ,�o/%%� '3i
Signature of Applicant - ❑ Owner Qntractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and d olition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 83.00
HAZ.
FEES
IMP
FLOOD
CDF PARCEL
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.
I /�.JrJ
By t Date i
PERMIT EXPIRES ON ^`�
Dale
rReceiptNo. (.,uu(
WHITE-D.D.S.-B.D. CANARY-ASSESSO PINK -INSPECTOR GOLDENROD -APPLICANT
.. ,-COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT 42 . I 11 -LL
ASSESSOR PARCEL NUMBER
061-490-007
ZONING
BUILDING PERMIT
OWNER Cameron Doroth 589-1647
TELEPHONE
SO. Fr, OCC. BUILDING VALUATION
Sheathi 1980.00
. OWNERS MAILING ADDRESS
72 Geo
31 s 1860.00
CONTRACTORS NAME
Christiansen RoofinR 512-9118
TELEPHONE
CONTRACTORS MAILING ADDRESS
1966 12th Oroville CA 95965
CONSTRUCTION LENDER
Fireplace
LENDERS MAILING ADDRESS
Total Valuation $ 3840.
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $ 63.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
72 G
Energy Plan Checking Fee $
$
PERMIT FEE $83.00
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF ❑ 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 ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: tear off shakes, re -sheath and rArnof
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home ISI GI W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Fling Fee 20.00
Main Service zoOA OR LESS 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 i full force and effect.
License Class =- 3 Lic. No. �e��Sr/�j/�S
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.
Q—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' comp�ensation insurance carrier and policy number are:
Carrier -5721, Gsa«p
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.)
[31 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 1 should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X /y ���st! Date �D� 3
Signature of Applicant - ❑ Owner j�ntractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service TD 46.00
NEW CONST. DWEl1.I
EE NG OCCUCUP. SO
OR ADDNS. & ACC. BLDS. 3.5¢NT.
NOI4R61D MULTI-OUTLETU. @7.50
POWER APPARATUS
8 SINGLE OURET CIR.
L
EX. OCCU OUTLET OR PD=RES B20 ( .00
Ex. Occup. GFlrLE SA R p OR 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 FEI= $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 83, 00
HAZ.
PEES IMP FLOOD CDF PARCEL Po HD
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicat ove for wh' ees ave been paid.
J �%
By Date
^-�
PERMIT EXPIRES ON
ate
Receipt No. D
WHITE-D.D.S.-B.D. CA ARY•ASSESS R PINK -INSPECTOR GOLDENROD -APPLICANT
{
PERMIT NO. 3773-76B,P,E,M
PERMIT EXPIRES
OWNER DOROTHY CAMERON
CONTR. Mountain Develop Company
t } LOCATION (A.P. 71-08-10 )
NIS of pri. rd, app 1000' W of
kForeman Creek Rd, app 1200' S.of
Oroville Quincy Rd. ,
t ,
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r .s
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s
t
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i
7
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y
~� Temp. Power Pole ` 741
Called PG&Er
' Temp. Elec. SS v. Y6 �' -7 C
Called �'.ZrE / D L �% G
Temp. G;1 Serv.
-� d PG&E '
JOB'
FINALED L`
(Date) �-
(Signature)
COUNTY'OF BUTTE — DEPARTMENT OF PUBLIC WORKS
.r BUILDING INSPECTION RECORD
BUILDING IBUILDING (Cont'd) I PLUMBING
Setback
Forms
Main Bldg.
Footings
Stemwa I I
Slab
Piers
Garage
Footings
Stemwal I
Scratch
Brown
Finish
Interior JON
Door Closer
DATE REMARKS OR CORRECTIONS
Water Htr.
Heaters �--
Appliances t —
�%7-8"7� —
4(o,e, /
3 7` ,,p/�cs ®� --15 ! 2 C _
3> -76 fur/ J � �c�� / rtclGt��
6 0-A" 7-€,x s Pr/ r
DEC
(NOTE: An entry must be made on this form each time you visit the job site.)
' - 7 7 ,3
TO: Huildin.; Department
r'ROP, : 'nvironrnental ..ealtn
sewa6e and/or :;s*.,er Clearance
Do 0eax, &.z
Has been a_ -,proved for:
uzSPOSAL
A I :iii .S?J'r'LY
595-775
TO: Building Department / / *3 — 7L
�4R0I'!: Lnvironmental Healtn
RB: Sewage and/or :dater Clearance
OudiQLR LOCAT 1"'N A .P#
Has been approved for:
S ssdAu �; DISPOSA
iASU:'PLI
S95-775
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT REGULA-
TIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
o FP rpcmxbv dW n� A PW -0 0
Street Lot Number Tract No.
EXTERIOR WALLS 4
Manufacturer' Thickness/Type Z91 �� R Value.
CEILINGS '`
Batts: Manufacturer £� Thickness R Value_
Blown: Manufacturer Thickness No. Bags Wt./Bag
Sq. Ft. Covered R Valu -
FLOORS!,
Manufacturer �! Thickness/Ty v R Value 4
SLAB ON GRADE
Manufacturer Thickness/Type R Value
Width of Insulation inches
FOUNDATION WALLS
Manufacturer �ess/Type R Value
GENERAL CONTRACTOR E LICENSE No.� :5 --
BY TITLEDATE
INSULATION CONTRACT, R: HAWKINS INSULATION CO. LICENSE No. 215-925
BY TITLE DATE ! 7 2
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS /
7 County Center DrivB" t7Tov411e, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
...icc �cNic acid ail vca UI Li %,OUIIty UI buiiu to enter upon the
above-mentio property for inspection purposes.
X Date
Signature of Permiteee or Agent
Receipt No.
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.
DIRECTOR OF PJQLIC WORKS
BY � Date�,L
Building permit expires Date —lT
BUILDING
Owner ���•Th/ G/9�Q�
SQ. FT. OCC. BUILDING VALUATION
13qo T, c O 0
Mailing Address
41160 T ZO
Telephone No.9
L
3 � 3 Q.w 6pi
Fireplace fiP�STA.~acvU6 7✓C�=
Contractor 1"04j417.4 JdE
Total Valuation pyjo___ 14 Z 113 6
Mailing Address 2-11 C'4A,>e-o" -OR,
Permit Fee
Plan Checking Fee &/or Penalty
019bL1lLLL C
Telephone O /
Permit Fee /bY•DO $
/V 0(
Building Address - Rd. A tom• 000`
PLUMBING No.1 @ FEE
PERMIT FILING FEE J$3.00 3.00
/
10OF 1--0R_,6M4 Cgg.d • "� 4,e,0 2 c7 (�
Each Trap 1.50 .s 0
/�
�. c704,01 -'a -LQ ��
Repair drainage or vent piping 1,50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. J _ _`
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F s
*</
S4J44+dn
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
PPlans DI_Declaration
I Parcel
60' R/W
Improvements
Lawn sprinkler system 2.00
Bldg. Pli}ns Recd
�Map
Parcelpp/� roval
Pla s Approval
Permit Fee $ 5
$ It 0
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3.00 3.00
Main service 100 AMP ORV OR LESS5.00
Main service EA. ADD'L too AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
0 OEAMP OR LESS 25.00
Main service 1
Main service EA. ADD'L too AMP 1,00
NEW CONST. DWELLING OCC11��&
OR ADDNS. ( ACC. BLDGS. 1§1,3) 22sgft 36 ID
NEW CONSTR MULTI -OUT L'ET
NON•RESI D, BRANCH CIRCUITS) 2.50ea
NEW CONSTPOWER APPARATUS &
NON.RESI R D. (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:x.
Ex, Occup(OUTLETS OR FIXTURES) BAL@t¢
E Occup. FIXED APPLNS. OR
p'(0UTLETS (RESID,) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
�7 / 6 , ' 6
License No._G [ % 3 Classification �� r
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ ,yO
$ 37 14Z
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
Xy 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 3,00
Heating /00000 , UO
Cooling 2 7'0"rJ0
Ventilation
Hood 2.00 :Z. 'D
Permit Fee $ Q
$ 73 o0
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County OrdinancesFEE
and State Laws relating to building construction, and hereby=TOTAL
PERMIT
$
...icc �cNic acid ail vca UI Li %,OUIIty UI buiiu to enter upon the
above-mentio property for inspection purposes.
X Date
Signature of Permiteee or Agent
Receipt No.
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.
DIRECTOR OF PJQLIC WORKS
BY � Date�,L
Building permit expires Date —lT
• � .- a `.
r
PERMIT NO. 3505-78B
PERMIT EXPIRES
OWNER Dorothy Cameron
CONTR. Duke Sh wood .nn _ , nrnvi 1 1 a
71-08-10
LOCATION (A.P. )
NE/S pr i.rd., app. -1-4 mi.N.of Foreman Creek
Rd., Oroville
i
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1
tit
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Y
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Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
s Called PG&E
Temp. Gas Serv.
Called PG&E
JOB c
FIINALED
(Date)
i
(Sig to )
b
Stucco /
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION, RECORD
., . • R•
Subpanels
BUILDING BUILDING (Cont'd)
PLUMBING
Setbacki
Firewall
Soil Piping
Forms
Parapets
list Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Siding
To out
Slab
Roof Sheathing
Water Pi in
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwall '
Garage Vents
' Insulation
Water Htr.
Heaters
Slab
Carport Car
p
Footings
-Prov. for phsically
handica edy
Conformance of ex.
structure
A liances
Gas Pi in & Test
Temp. Gas
Slab
Final
Sanitation
Patio
V FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rou h
Reinf. Steel
Final
Fixtures
Bond Beam_
/ n ., FIR RINKLERS
Motors
Stucco /
Finalil
Subpanels
Mesh
MECHAICAL
Gird. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. e
Finish
Ducts^
er round
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
MOBILEHOME UTILITIES ------------------
Elec. Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
081LEHOME INSTALLAL ION - - - - - - - - - - - - - -
Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE
REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATICIA AND PERMIT nA
BUILDING
Owner
,�
SQ. FT. OC . BUILDING VALUATION
Mailing Address
Telephone No.
Contractor
Mailing Address PM
Fireplace
Total Valuation
I pho No
Permit Fee
Bu i I di ng Address r 1
Plan Checking Fee &/or Penalty
Permit Fee 0
For ie.,^nzrmn, r ,
PLUMBING No. @ I FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
rpyJ119
Repair drainage or vent piping 1.50
A. P. No.
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F s
i ion Fire Dept.
FireZone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
arcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet 30
Building sewer 5.00
Bldg. PI ns Rec'd
Parcel Approval
Plansl4opooproval
Lawn sprinkler system 2.00
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $
$
ELECTRICAL No.1 @ FEE .
PERMIT FILING FEE $3.00
Single Family ❑ Duplex ❑ Mobil Home ❑ Others
Main service 600V OR LESS
100 AMP OR LESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Main service OVER 600V100 AMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. DWELING
OR ADDNS. ( ACCLBLDGS CCUP. 1:\ 20sq ft
/
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 oof:
T
NEW RESID,CONSTBRANCH CIRCUITS
NON-RESID ( BRANCH CIRCUITS) 2.50ea
NEW CONSTF7. (POWER APPARATUS 8
NON.RESID. SINGLE OUTLET CIR.
EX. Occuo(OUTLETS OR FIXTIIRES BAL@ 254t
2j
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. SZ � a 7_1 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.
dI 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. FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
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
Land Development Fee
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
L
0
X - Date
Signature of ermitee or Agent
Receipt No. 1:77 W1
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 tions to do work indicated
above for which fees have be paid
DIRECTOR PU LIC WORKS
Zilingppermit expires Date Z� 79
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