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Home My WebLink About062-320-0144 eounf* of Xutte ' OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: ADDRESS: & S #S CITY & STATE: j/ , IMPORTANT: SEE INSTRUCTIONS DATE OF CLAIM: �1 ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT J -�! `f Too It �. 7 �3- � 6 SD a,, ot, 7- 93 m (moo. -1c we °'l Z_ 4. B.P.#93-2280,A.P.#062-320-014 RECEIPT#143633 DATED 7 3 OWNER.DON 30EGAARD TOTAL AMOUNT PAID.. $56.50 ................. RETAIN ELE .PRMT FIL.FEE $15.00 RETAIN ELEC.PRE INSP.FEE $16.00, RETAIN REFUND PROC.FEE 25.0 TOTAL AMOU T TO BE RETAINED - 60.00 TOTAL AMOUNT REFUNDED TOTAL -$00. Do =' I, the undersigned, declare under penalty of perjury that the services or articles claimed havG d or delivered, and that this claim is true and correct as stated. Dated this .... " .................. day of ..If.'.." „1....... • 19 9. et ... ��.�........., Calif. ....... .... Clalment I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or de- livered and that there is a Budget Appropriation ❑ or Specific Board Approval0 (Check one) for the same. Dated this.................................... day of ............................. 19......, at .............................. I Calif..................................................................................... Department Head or Authorized Deputy Dept. Exp. Code............................................ Code ................................................PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE _ AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. KISRUCTES te UAIMUTS All claims against the county must be itemized, diving dates and character of service rendered or .pork performed., quantities, de- scription and unit prices of articles furnished or delivered. Claims must be certified ,by the claimant and submitted to the De- partment head for approval. Upon approval the Department head will forward claim to. County Auditor for payment procedure, Do not filet with the County Auditor first. Claims should be , presented to officials for approval immediately upon completion of services requested or material ordered. . Claims are paid every Tuesday; however, same must be approved by officials and in Auditor's office before preceeding Uednesday noon. Compliance with above 'sill expedite payment of claim, failure to do so may delay payment considerably. V r � t KISRUCTES te UAIMUTS All claims against the county must be itemized, diving dates and character of service rendered or .pork performed., quantities, de- scription and unit prices of articles furnished or delivered. Claims must be certified ,by the claimant and submitted to the De- partment head for approval. Upon approval the Department head will forward claim to. County Auditor for payment procedure, Do not filet with the County Auditor first. Claims should be , presented to officials for approval immediately upon completion of services requested or material ordered. . Claims are paid every Tuesday; however, same must be approved by officials and in Auditor's office before preceeding Uednesday noon. Compliance with above 'sill expedite payment of claim, failure to do so may delay payment considerably. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916.538-7541 APPLICATION AND PERMIT PERMIT NO. 7 ASSESSOR PARCEL NUMBER 062-320-014 ZONING 1 BUILDING PERMIT OWNER Don Soegaard TELEPHONE 751-1942 SO. FT. OCC. BUILDING VALUA ION OWNER'S MAILING ADDRESS 1166 B. St. #5 Yuba City 95991 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15,00 LENDER'S MAILING ADDRESS - Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Sand Creek Dr Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other Power SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New J Addition [I Remodel ❑ Utilities Installation❑ Other ❑ Describe work: Electric Service for Lot Development _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service ?OOA OR LESS 1 18.50 18.50 Main service 20CcATO 1000A1 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): Fl 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 Ao. Classification 91 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 CONST./ DWELLING OCCUP.&\ OR ADDNS. ( ACC. BLDGS. II 3.64sq.ft. NEW CONSTR.ULTI.OUT LET NON.RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS & (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES\\ 20 76d FIXED APLNS. EX. Occup. OUTLETS PRESID IREA.J 11 3.00 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. byirin g '15.00 tion 1 20.0 20.00 Permit Fee $ 56.50 — 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. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 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 agreeAO sa e, indemnify and keep harmless the County of Butte against all liabilit* gments, costs,Ad expenses which may in any way accrue against I C my in consequen of the granting of this permit. X Date 2A 3 Signature of PPlic nt — Owner Contractor ❑ 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 S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 56.50 HAz D 111 IMP FLOOD CDF PARCEL PO HD ISSU This permit is hereby issued under the sions of the B Coun ode and/or work indi to a v f which fees �() OF PUBLIC BY P MI EXPIRES Date applicable provi- resolutions to do have been paid. WORKS to 7 143633 Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916)538-7,541 PERMIT APPLICATION DATA SHEET OWNER c%/ A. P. No. tv Proposed Building Use 42ir �r C d Building Inspector Date 7 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 . ...................................... . 1.6. 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 (cons ructi n approval required prior to occupancy)... . . 20. Pre -inspection for .��''(/y��- required. .. s�;, 9 �n request - 21. Contractor's license information. (No., Name Style, Classification) . ............. *I. W191-110 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 checklist. ................................................... . 33. .34. When yp_u issue the permit, process as follows: Mail to owner. Mail to contractor. elephone and hold for pickuh at if office. Deliver with inspector. )Other Parcel Creation - Acreage Applicant 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 COUNTY OF BUTTE - Department of Public Works 7.County Center Drive, Oioville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property -Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to.provide the major labor and materials for construction of the proposed property improvement (yes or no) S 2. I (have/have not) kAx-- signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed .construction: Name Address City Phone 'Contractors License No. 4: I plan to provide portions of this work,.but I have hired' the following person to coordinate', supervise, and provide the major work: Name Address City Phone Contractors License No'. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property Owner ` Social Security Number Date -7 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832.of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. '? — =1 —cat e3 j2- CL- OWNERS NAME: ADDRESS: BUILDING SIZE/AREA: CERTIFICATE OF ROOF COVERING A. P. #: PERMIT #: BUILDING USE: FIRE HAZARD ZONE ALLOWED ROOFING FROM LISTS BELOW ❑ VERY HIGH #1, #2 ❑ HIGH , #1, #2, #3 ❑ MODERATE #1, #2, #3, #4 LIST #1 LIST #3 ❑ CLASS 'A' ASSEMBLY ❑ CLASS 'B' ASSEMBLY ❑ CLASS 'A' PREPARED ROOFING ❑ BUILT-UP ROOF PER 3203(e) ❑ CLASS A OR B PREPARED ROOFING LTST #2 ❑ ASBESTOS CEMENT SHINGLES ❑ METAL ROOFING ❑ CONC. OR CLAY TILE ❑ (OTHER FIRE RETARDANT ROOFING) ❑ SLATE SHINGLES LIST #4 ❑ (0'1'111?IZ NON -COMBUST H1 1J,; IWOFING) ❑ CLASS 'C' 235# ASI'IIAL-I.' SIIINGLI?S 1 HEREBY CERTIFY, I INSTALLED ROOF COVERING AS INDICATED ON THE ABOVE BUI.L.DING, IN CONFORMANCE WITH STATE AND LOCAL REQUIREMENTS. FIRM NAME/OWNER (Please Print) SIGNATURE OF GENERAL CONTRACTOR/OWNER STATE CONTRACTOR'S LICENSE NO. DATE THIS CERTTFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL INSPECTION APPROVAL. January 1988 COUNTY OF BUTTE-bEPARTMENT OF PUBLIC WORK PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone -916 538-7541 APPLICATION -AND PERMIT ASSESSOR PARCEL NUMBER 6 - 32 Q ZONING BUILDING PERMIT OWNER�Q�� J)o757- TELEPHONE /9 S Z- SQ. FT. OCC. BUILDING VALUATION OWNER6MAILIN ADDRESS .116 ^/'±911 CONTRACTOR'S NAMES TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN_ Total Valuation Is Filing Fee $ 15.00 LENOER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Pian Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS a Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME _ PARCEL MAP • Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Otht. 6cuce - PECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK ncn New ❑ Addition L Remodel Utilities(, Installation❑ Other Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 T ! MP Main service 200A OR 2000A OR LESS 18.50 as� Main service 20CATO 1000A1 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business/POWER and Professions Code and my license is in full force and effect. License No. Classification 17I, 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 forthis reason NEW CONST./ DWELLING OCCUP.&) OR ACDNS. 1 ACC. BLDGS. - // 3.6Ssq.ft. NEW COESN D R BRANCH MULTI-OUTLET ITS% NON@ 5.00 APPARATUS e1 (SINGLE OUTLET CIR. / Ex. OCCUp(OUTLETS OR FIXTURES AL 4r 4 20 76FIXED 4 Ex. OCCUp. OUTLETS P(RESID.)REA.) I I 3.00 ,.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 (`� 20-cc Permit Fee $ 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 Filing Fee 15.00 Heating Cooling Hood 6.50 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 Countyo 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 ay crue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ 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 S Ins SO Energy gY p ection Fee $s / occ CONST TYPE TOTAL FEE $ HAZ 0FEES IMP FLOOD COF PARCEL PO HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- resolutions to do have been paid. WORKS Date Receipt No. /7 WHITE-O.P.W., YELLOW-ASSC730R. PINK -INSPECTOR. GOLDENROD -APPLICANT O O CA I y W ri c y PRE -INSPECTION OWNER: Dw(,SomtiqrW , LOCATION: r, g 66 K b c ( o e - CONTRACTOR: PRE -INSPECTION FOR: -� c DATE 0-3 A. P. # 06a ' -3^-?0 - D � L/ ZONING are. a12�, /(/0 *Oijl&�. (.L DATE TO INSPECTOR ------------------- PERMIT HISTORY:NONE AS FOLLOWS: TYPE OF OCCUPANCY FIELD - INFORMATION BUILDING USAGE: TENNANT: [� OCCUPIED [] HAS ELECTRIC Q HAS GAS HAS SANITATION FACILITIES Q HEATED -COOLED L_j PERSON CONTACTED OTHER COMMENTS: d�p i c> Le o S b r mA o 5 ACTION RECOMMENDED: 0 ISSUE 0 OTHER: HOLD FOR BY �� ,�� DATE 17/L- own4 4 Xude OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: ADDRESS: CITY & STATE: IMPORTANT: SEE INSTRUCTIONS DATE OF CLAIM: ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) AMOUNT AJ„, o � 61.4611 Kf Witt IV TOTAL I, the undersigned, declare under penalty of perjury .that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. //jj X Dated this ..............1.. ......... day of ...: . 19 �� ea(�f - L. ...• Calif. ......:: ..�•W..F. ... ((// 0in-.eture-A0fC-1-aiMant I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or de. livered and that there is a Budget Appropriation O or Specific Board Approval ❑ (Checkone) for the same. Dated this .................................... day of ........ .,................... 19......, at .............................. , Calif..................................................................................... Department Head or Authorized Deputy D ept. Exp. Code............................................Code ................................................ PAYABLE FROM............................................................................................ FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. INSTRUCTIONS to CLAIMANTS All claims against the county must be itemized, giving dates and character of service rendered or work performed, quantities, de- scription and unit prices of articles furnished or delivered. Claims must be certified by the claimant and submitted to the De- partment head for approval. Upon approval the Department head will forward claim to County Auditor for payment procedure.. Do not file with the County Auditor first. Claims should be presented to officials for approval immediately upon completion of services requested or material ordered. Claims are paid every Tuesday; however, same must be approved by officials and in Auditor's office before preceeding Wednesday noon. Compliance with above will expedite payment of claim, failure to do so may delay payment considerably. y-q,,t�SS',' _�e�7 „ . COUNTY OF BUTTE. - DEPARTMENT OF PUBLIC WORKS PERMIT No. �• 7 County Center Drive - Oroville, ;California 95965 - Telephone: 916.538-7541 , APPLICATION AND PERMIT .. �o -"CEL NUMBER- 062-320--014 OWNER ZONING BUILDING PERMIT SO. FT. OCC. BUILDING VALUATION Don aard TELEPHONE 51-1942 OWNER'S MAILING ADDRESS 1166 B. St. 15, Yuba City 95991 CONTRACTOR'S NAME Otaner TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER Filing Fee $ 15.00 Permit Fee $ LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS BUILDING ADDRESS Energy Plan Checking Fee $ Penalty $ Permit fee $ Sand Cree DrPLUMBING PERMIT Filing Fee 15.00 LOT NO. SUBDIVISION NAME P MAP Each Trap 5.00 Solar or heat pump water heater 20.00 WaterP�P� I In 9 7.00 Each gas water heater or vent 7.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other Power SPECIFY Building sewer 15.00 Mobile Home S G W @ 15.00 . TYPE OF WORK New:r Addition ^ Remodel`! Utilit es Inst Ilatio ❑ Other ❑ Describe work: fleCtftc Service ) or t Development Permit Fee a Contractor ELECTRICAL PERMIT Filing Fee ;;15.00Main service 200A OR LESS 1OR LESS 8.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I 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. Classification _j 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 20CATO 1000AI 37.50 NEW CONST. DWELLING OCCUP.� OR ADONS. ACC. BLOGS. ) 3.60sq.ft. NEWCONSTR rAULT LOUT LET NON.RESID BRANCH CIRC ITS @ 5.00 (POWER APPARATUS e) SINGLE OUTLET CIR, EX, OCcup(OUTLETS OR FIXTURES 20 76, AL 491 I -0 XED APPLNS. OR EX. Occup. OUTFLETS (RESIO.) EA.) I 3,00 J-UU Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 Pre—Inspection Permit Fee s • 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. 21I shall not employ any person in any manner so as to become subject to the W. C. laws of California. PP g Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwitcomply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling Hood 6.50 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, lVdgments, costs,nd expenses which may in any way accrue against C my in consequen a of the granting of this permit. Date /' l ? signature of Applicpnt — owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ 5$•50 HAZ DFEES IMP FLOOD COF PARCEL PD HD ISS This permit is hereby issued under the applicable provi- sions of the By► County9ocle and/or resolutions to do Work ind to a..46ve' which fees have been paid. / 8tE TO OF PUBLIC WORKS, By 1 : c. to P EXPIRES Date MI ? / Receipt No. WNITE-D.P. W,. TE6LOW-A9S[9SOR, P{Nx-IN9PCCTOR, GOLDENROD -APPLICANT I 14�1 062-32-0-014 93-2280 E ..S OEGAARD, DON SAND CREEK DR, BERRY CREEK.' ELEC FOR LOT DEVELOPMENT 'COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916.'538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 062-320-014 ZONING 1 BUILDING PERMIT OWNER Tion SoeRaard TELEPHONE 751-1942 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS _ 1166 B. St. #5, Yuba City 95991 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Sand Creek Dr Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other Power SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S G W @ 15.00 TYPE OF WORK New ❑ Addition [] Remodel ❑ Utilities [I Installation❑ Other ❑ Describe work: Electric Service for Lot Development _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 ' Main service 200V OR LESS 00A OR LESS 1 18.50 18.50 Main service 20CATO 1000AI 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury ccone p y p l y hek . ( ) ❑ I 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 ;Jo. Classification ® 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 CONST. ( DWELLING OCCUP.&) 3.6dsq.ft. OR ACDNS. ACC. BLDGS. — MULTI -OUTLET NON•RESID NEW FL BRANCH CIRCUITS @ 5.00 IPOWER APPARATUS 6) ISINGLE OUTLET CIR. 20 76d Ex. Occup(OUTLETS OR FIXTURES FIXED APLNS q Ex. OCCup. OUTLETS P(RESID.)REA.) 11 3.00 3.00 Temporary service j 15.00 Mobile Home Facilities 15.00 Misc. Iyirin g 15.00 Pre -Inspection 1 ". 2&00 Permit Fee $ 56.50 — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. E] 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. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling g Hood 6.50 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, nd expenses which may in any way accrue against safd Co6ty in consequen a of the granting of this permit. X �� '�- • ' Date /" ty ' � ❑ ❑ Signature of Applic nt — Owner Contractor 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 S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE$56,50 HAz DFEES IMP FLOOD CDF PARCEL PD HD ISS This permit is hereby issued under the applicable provi- sions of the ButFe County -Code and/or resolutions to do work indid/abtive fowhich fees have been paid. �� / Z DIRECTOR OF PUBLIC WORKS// By � /�� Date �/�' PE M19''�EXPIRES Date -711 %9 f " I 144633 Receipt Na WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD-APPLI CANT i