HomeMy WebLinkAbout062-340-01662-34-16
Vernon .E. Buckner
E/S Sugar Pine Dr., app.600'S.of Oak
Dr., lot 74, Berry Creek
Permit #2693-78B,E(new private detached
garage) ��� e,/ 7S
62=34'16 2777=91P,E,M
BUCKNER,,Vernon
78 Sugar Pine Dr, Berry Creek
cont; La Grone MAC l
(dual pak/sf)
SZARVOS, *4829B 4587B
269-66E 3622P
4461E
2-34-16 -
Lot 74, Ponderosa.Pines Sub., Bald Rock
CONTR: Gene Dill, 445 Oakvale, Oroville
(new single family) o
—�7
*addition
III
.an-:..r-\Y7"s•--•'w :y.,•rer o'-..�Y.: 7J. "W.h'."r%� i 3f. r,W..A' f�
62-34-16 2777-91P,E,M
BUCKNER, Vernon
78 Sugar Pine Dr, Berry Creek
cont; La Grone H&AC
' 'r'���'ry"")`?-^y,� ��7'x -►1� 5��-�,:.f`'ri'i�"�. ti,..2. f,^;:,N e`: TrSsi;. Yy.!-^, '�v,�s':; yK +;y."•%:h.::"'WPKJ ry ..+ ., OF
"s .X-'�•.
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Orovlllet Celifornla�95965 • Telephone: 916/538.7541 Z-7 :2 2*
- APPLICATION .AND PERMIT
ASSESSOR PARCEL NUMBER
62-34-16
ZONING
,U
'
BUILDING PERMIT
OWNER
VERNON BUCKNER
TELEPHONE
SQ. FT. OCL`, BUILDING VALUATION
OWNER'S MAILING ADDRESS
78 SUGAR PINE DR BERRY CREEK
_
CONTRACTOR'S NAME
' LaGRONE
TELEPHONE
53-3-7811
CONTRACTOR'S MAILING ADDRESS
1051 SIERRA AVE OROVILLE
Fireplace
CONSTRUCTION LENDER
1
UNKNOWN
I
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
NO
LICENSE NO.
I
Plan Checking Fee
J
$'
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS 1
Penalty
$
BUILDING ADDRESS
78 SUGAR PINE DR BERRY CREEK,
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE I
SF `J Duplex❑ Mobilehome❑ Other
.SPECIFY I
Gas piping system 1 - 5 outlets
5.00 5.00
Building sewer
5.00
Mobile Home S G W
O.00ea
TYPE OF WORK i
i
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation %t Other ❑
Describe work: TNfiTAT.T. DIM. PACT _
#
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 1100V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the BUslnes$
and Professions Code and my license is in full force and effect.
License No. Classification.
Fl 1, 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-
ontract-
ors.(Sec. 7044)
ors.
❑ I am exempt under Sec. , Business and Professions Code
for this reason
oa ADDNST C DWEACCLLIN GOCCUP.�\
/
+/4sgft
NEW CONSTR ULTI.OUTLET
NON.RESID BRANCH CIRC ITS
2.50 ea
POWER APPARATUS 6)
SINGLE OUTLET CIR.
Ex. OCCUp(OUTLETS OR FIXTURES
"Lu
BALI 30
FIXED PR
Ex. Occup. OUTLETS (RESID IEA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Iyirin g
15.00
Permit Fee
$ 25•
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
1 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 DUAL PACK
6.00
Cooling
6.00
Hood
3.00
'Ventilation
permit Fee i
$ 24.00
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, judgment , costs, and expenses which may in any way accrue
against said County i onsequence of the gra ing of this p r/ry�iyV
X 1 A Date/ /� /
`c
Signature of Applicant — Owner Contractor ❑ AgenY❑
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 $
, Energy Inspection Fee $
c
FFHIAZ.
CONST TYPE
TOTAL FEE $
64.00
CUA
PARK
SCHL
FLD
cDF
PAR
PD
) HD.
ISSU
This permit is hereby issued unser the applicable provi-
sions or the Butte County. Code and/or resolutions to do
work indicated above for which fees have been aid.
� ^ � p
F)DIREGTO,R OF PU,6LIC WORKS
r
PERMIT EXPIRES Date 1/rR-/ I /// r
BY� Date 1F sQ
,?
Receipt No. 97150 64.00
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATIOV,ANDiPERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
62-34-16
ZONING
U
BUILDING PERMIT
OWNER
VERNON BUCKNER
TELeP'HONE
S0. FT. OCC.. BUILDING VALUATION
OWNER'S MAILING ADDRESS
78 SUGAR PINE DR BERRY CREEK
CONTRACTOR'S NAME
LaGRONE
TELEPHONE
533-7811
CONTRACTOR'S MAILING ADDRESS
1051 SIERRA AVE OROVILLE
Fireplace
CONSTRUCTION LENDER
NONE
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
NQNF
LICENSE NO.
Plan Checking Fee
.$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
78 SUGAR PTNE DR BERRY CREEK
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME 7PARCEL
MAP
Water piping ,
5.00
Each Qas water heater or vent
5.00
USE OF STRUCTURE
SF Y Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ installation[] Other ❑
Describe work: INSTALL DUAL RACK _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 8001 OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check One):
y�L 1 am licensed under provisions of Chapt. 9, Div. 3 of the BUslnes$
//--Hand Professions Code and my license Is In full force and effect.
License No. Classification.
Fl 1, 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)
ontract-
❑ I, as the owner, am exclusively contracting with licensed contract-
ors.(Sec. 7044)
ors.
❑ I am exempt under Sec. , Business and Professions Code
for this reason
OCCUP.N\
NEW CONST. DWELLING OR AODNS. ACC. BLDGS. /
+/Z�sgft
NEW CONSTR. MULTI -OUTLET
NON.RESID BRANCH CIRC ITS
2,50 ea
POWER APPARATUS &)
SINGLE OUTLET CIR.
EX. OCCUp(OUTLETS OR FIXTURES
2AL@050C30
2ALso
FIXED PR
EX. Occup. OUTLETS (RESID )EA.1
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00 15.00
Permit Fee
$ 2
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
gI 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 10.00
Heating DUAL PACK
6.00
Cooling
6,QQ
Hood
3.00
Ventilation
Permit Fee
$ 24.00
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, and expenses which may in any way accrue
against said County i ns uence of the gra ing of this p r it.
f
X Date
Signature of Applicant — Owner Contractor ❑ Age n
i
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 $
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $ 64.00
HAL
CUA PARK
I SCHL
FLD
I GDF
I PAR
I PD
j HD,
Issu
This permit is hereby issued unoer the applicable provi-
sions of the Butte County. Code and/or resolutions to do
work in ted above for which fees have been paid.
DI XPLWORKS
4-Q
By Date
PERMIT EXPIRES Date
Receipt No.71 90 64.00
9
-R, E-D.r.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
*�;
COUNTY OF BUTTE - DEPARTMENT OF; PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE,jp�AIsI FIN A 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.
OWNER V CjrA ah U L in -e A. P. No. K'2 -3C/ -
Proposed Building Use S.r 11�e.� ()ctckBuilding 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, signed by preparer of plans........
3. Complete plans in duplicate/triplicate, signed by preparer. of plans . .
- 4. Complete engineered plans and calcs, with wet signature on plans ..
5. Hazardous Material Form ......................................... .
6. Energy Design Compliance and supporting documentation .........
- 7. Statement of Intent for Non -Heated and AC Buildings ..............
- 8. Engineered truss details and layout in duplicate (required prior to plan check)
- 9. Mobilehome installation data including manufacturer's installation
instructions.......................................................
10. Fees of $ ........................
- 11. Chico Urban Area fees paid .......................................
12. Park fees paid ....................................................
- 13. School District fees paid ..............
_ 14. Sanitation approval from Health Department
_ 15. City of Chico plumbing permit .....................................
_ 16. Plot plan and business license approval from City of
(see City for other requirements)
17. Planning approval for (A) Use: (B) Parking: ......
18. Improvements may be required. Contact Land Development Section DPW
19. Driveway permit (construction approval required prior to occupancy)
_ 20. Pre -Inspection for required . Pre-Inspec. request to
Building Inspector
_ 21. Contractor's license information (No., Name Style, Classifications ...
-22. Certificate of Workmans Compensation Insurance ...................
-23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .....
24. Recorded copy of Agricultural Acknowledgment Statement .........
25. Letter of signature authorization ...................................
-26.
-27.
When you issue the permit, process as follows
Telephone
Other
Mai I to owner. Mail to contractor.
and hold for pickup at office. Deliver w/inspector.
Copy of Haz-Mat form sent Health Dept. Fire Dept. —fir Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other \\ Date By.
The following data must.be-submitted prior to permit issuance: (Circle
1. Index permit for above items No.
2. Additional items required:
Ate.m-not_,checked above).
Contractor, designer, owner, was advised of above required data by_phone_maiI—counter by date
Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date
Plans checked by Date Plans approved by Date
Copy—DPW
Sets of plans on hold in File cabinet AP folder
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916.538-741
APPLICATION AND PERMIT
PERMIT NO.
ASSESSOR P,9RCE= NUMBER �
ZONw
fVG•, � / �
BUILDING PERMIT
OWNER
e 6 Uc,
TELEPHOt•!E
. .
S0. FT. I OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
yr Q ✓L� Seri'
CONTRACTO 'S NAME TELEPHONE
+/
811
CONTRACTOR'S MAILING ADDRESS
0 'S IF-_Ircra C v e �6�
Fireplace
CONSTRUCTION LENDER
C) V\"
UNKNOWN
Total Valuation S
FilingFee
S 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGI .EER
h O V^1Energy
LICENSE NO.
Plan Checking Fee
$
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDs5s av
u - Rme Dr, _
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
%%��
"'��� C ree
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
�� USE OF STRUCTURE
SIXDuplex❑ Mobilehome❑ Other
!T� SPECI FY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G W
h0.00 ea
TYPE OF WORK
New ❑ Addition Remodel Utilitie//s�� ❑ Installations Other ❑
Describe work: Ins fat Doc,( l�k"•tG�C
Permit Fee
5 —�
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
1 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.
❑ 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. DWELLINGoCCUP..)
OR A.O.S. ACC. SLOGS. /
lGn,�Z¢SQ ft
i
NEW CONSTR. ULTI.OUTLET
NON-RESID BRANCH CIRC ITS
12.SOeal
POWER APPARATUS d
(SNGLE OUTLET CIR. )
I
Ex. Occup( OUTLETS OR FIXTURES
I209�O0t
°AL. 30Q
FIXED
Ex. Occuo. OUTLETS PLNS R
IRESID IEA.)
I 2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
g
15.00 c
Permit Fee
S uo
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for S100.00 (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 10.00
Heating Dclvt• 7 c is
6.UJ
Cooling '3�� i✓
=G J
Hood
3.00
Ventilation
permit Fee
$
LContractor
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 County oT
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnityand keepharmless the Count of Butte against
all liabilities, judgments, coss, and expenses which may In any way accrue
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 $
Energy Inspection Fee g
occ
CONST TYPE -
/
TOTAL FEES 6
HAS i CUA 1 PARK I SCHL i FSO i GDF PAR PD i, HD•:ISSU=
i
This permit is hereby issued unser
sions oT the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provl-
resolutions to do
have been paid.
WORKS
Date
(� l �� Gy Of
Receipt No.
wNITC•O.I. W., 7CL7L0W•A5e 0730 A, PINK -INSPECTOR. GOL OCN ROO-AO►LICANT
2693-78B,E
PERMIT NO.
PERMIT EXPIRES
Vernon E. B ckner
OWNER
CONTR. owner
LOCATION (A.P. 6-34-16
E/S Sugar Pine Dr., app.600'S.of Oak Dr.,
lot 74, Ponderosa Pines, Berry Creek
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JOB r�
• FINALED
(Date)
(Sig atu )
i
C
i
I
i -
1
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JOB r�
• FINALED
(Date)
(Sig atu )
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
)'
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Flook
Main Bldg.
Restroom Finish
2nd Floor\
Footings
Windows
3rd Floor
Stemwall
Siding
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwa I I
Insulation
Heaters `
Slab
Carport
Footings
Prov. for phsically
handicapped
Conformance of ex.
structure
Appliances
Gas Piping & Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECT CAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
FlYturac
pond Beam
FIR SPRINKLERS
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MEC NICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final 2 ^
MOBILEHOMEUTILI IES ------------------
Elec_ Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
MOBILEHOME INSTALLATION - - - - - - - - - - - - - - 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.)
J: COUNTY OF BUTTE — 'DEPARTMENT OF PUBLIC WORKS
7 County CentePDrive — Oroville, California 95965
(.1.. Telephone: 534-4541 /
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspecti n purposes.
X Date
Signature of Permitee or Agent
Receipt No. L3 CZE
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 be aid.
DIRECTO F BLIC WORKS
By Date _'S -
Building permit expires Date
BUILDING IVA
Owner
SQ. FT. OCC. BUILDING OALUATION
Mailing Address �-
Telephone No.
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee
Building Address 1 ,n r
Plan Checking Fee&/or Penalty
Permit Fee
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
A. P. No. �-' ;3 '�
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
s
S i ion
FireDept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
claration
Parcel Map
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Bldg. Planec'd
Parc roval
PI pprovaI
Lawn sprinkler system 2.00
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $
,$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600 AMP 00V OR LOR ESS 5.00
Single Family ❑ Duplex ❑ Mobil Home ❑ Others
Main service EA. ADD'L 100 AMP 2.50
"
Main service OVER 1300 O 25.00
100 AMP OR LESS
Main service EA. AOD'L 100 AMP 1.00
NEW CONST. DWELLING OC B
OR ADDNS. ACC: BLDGS. 2¢Sgft D
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:
NEW CONSTR. /MULTI-OUTLE
NON.RESID (MULTI
CIRCUITS) 12.50ea
NEW CONSTR. POWER APPARATUS a
NON-RESID. SINGLE OUTLET CIR,
Ex. Occup{OUTLETS OR FIXTtIRES 5 L ,r
�FUIXED APPLNS. OREx. Occup•DTETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ ZZ -901
21
MECHANICAL N04 @ FEEPERMIT
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
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.
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
Land Development Fee
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspecti n purposes.
X Date
Signature of Permitee or Agent
Receipt No. L3 CZE
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 be aid.
DIRECTO F BLIC WORKS
By Date _'S -
Building permit expires Date