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Home My WebLink About063-040-104� + J• T`!n;"�"®'^T'._:"'."af+�'�;..R...(t^••--�• + � f Y �r .i 'rr35�t j��,t + r "+ ri � 7t�'.j1,• }S� �p{i tt r t €• ttfi n x, -`r -'Z 2 } �st fntr ..rt x'3`'4 2.. €a y int€1f-}£`j{{�litr[[,y.•�4 q :t * o i 1 t• i j Yj 3' i t 063-040-104 U3 3 -7 FERGUSON, FRAT 12883 D• •' t'r t t'i tit S, 1, FERGUSONC/O ELEC SERV PANEL 063-0 40-104 a 12883 D•FORESTRAN • . • ys�s v i 1✓ fi , lo 03-3706. i� 063-040-104 `- O ✓�S 't FERGUSON, FRANK " C ✓l h 12883 DOE MILL RD, FOREST RANCH (�WSON °' +' �^ c� Cont. LOREN DA r x a `1 CIO ELEC SERV PAN EL D t t . 1 o � - i . 1 1 1 i 1 e �s I% a, OFFICE COPY " Address- GAS Meter By Date ELECTRIC Meter By a d OFFICE COPY " Address- GAS Meter By Date ELECTRIC Meter By COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES - BUIL'D�N,�' DIVfSIO ^ _ 7 County Center Drive • Oroville, California 95965 • Telephone (530 538-+ 541 V u4 T� (Rev. 12�s6) APPLICATION AND PERMITS' - . . r r ASSESSOR PARCEL NUMBER 063-040'-104 ZONING D110 I IN ER IT� OWNER FERGUSON FRANK TELEPHONE g0, OCC. 9LALAM VA0UA`eICL#jV OWNER'S MAILING ADDRESS B^X 67 PnRFST RANCH CA 95%2 CONTRACTOR'S NAME LOREN DIAWSON 891-6506 TELEPHONE CONTRACTORS MAIUNG ADDRESS PO BOX 6073 CHICO CK 95927 CONSTRUCTION LENDER iN •1 LENDER'S MAILING ADDRESS Fireplace •;.,w Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. ` y Filing Fee - $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BLIWas S DOE MIU ROAD Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDNISIOW!*ME 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 as water heater or vent 15.00 TYPE OF WORK ;New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ _ Describe ;Work: CIO �]lC SERVICE Mk"TF�t pq�, T Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 PERMIT FEE S ELECTRICAL PERMIT I Fling Feel 20.00 1l4 a00V OR LESS Main Service 200A OR LESS 23.00 • 00 LICENSED CONTRACTOR'S DECLARATION „ Ithereby 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,rb and my license is inn full force and effect. / N License Class C -� � 0 Lic. No. 3 S 16 / OWNER -BUILDER DECLARATION I 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 Main Service 200ATO t000A 46.00 NEW CONST. DWELLMIGOCCUP. EL OR ADDNS. ( a Acc. BLns. SO 3.50FT: RO�Ip MULTI -OUTLET @7,50 POWER APPARATUS a SINGLE OUTLET CIR. EX. Occup. ounEr OR FD(TURES 20 @ I BAL. @ .50 .50 Ex. Occup. OflLn>Frs R� 6.)o EPA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE-INSP=ON 23.00 PERMIT FEE =66.00 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. ❑ 1 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 MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ 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.) jEl 0 %I certify that in the performance of the work for which this permit is issued, I shall / not employ,`any person i any manner %as to become subject to workers' ccoorr�r�ppensation,la of Calif an a, and agree t ff I should become subject to the ortreis' c enation •pr vi ' ��4f recti 3700 of the Labor Code, I shall forthwit ply w' se ovis o s. -^� X ` e e _ SignatLt � e ofApI51i eptu❑ w eF htractor ❑ Agent �.� �'-cam An OSHA permit is required for excavatio 944 r 5'0" deep and demolition or construction� of structures over -3 stories,iniheighr ^/ ! Mobile Home Installation Fee $ Energy Inspection Feef5 U OCCCONST. TYPE TAL FEE $ 66.00 HAZ. F - IMP FLOOD CDF PARCEL, PD HD ISSUE L This permit is hereby_i1�su��ed.un¢ktfie of the -Butte County Comae Vd/or• indicated above/for which fees have �• By R� PERMIT EXPIRES ON applicable provisions Resolutions to do work been paid, a"' ` JT .' Date Date Receipt No. V f �' �� L It WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ,. .�,................'..!. :. .:......�...... iii! :; COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 411 'Main Street • Chico, CA • (530) 891-2+751 7 County Center Drive • Oroville, CA • (530) 538=7541 a� 'G CORRECTION NOTICE 2-�7 OL WNER f PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the j above address and should be corrected. Please notice this office when correction of work is comp ted. If you have any questions pertaining to this matter, or need additional explanation, pleaa contact this office immediately. e'_ t. -- REV REV 10/92 1--� I i �� COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 603,MA�) (Rev.12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 063-040-104 ZONINGBUILDING TM10 PERMIT OWNER FERGUSON FRANK TELEPHONE SO. FT, OCC. BUILDING VALUATION . OWNER'S MAILING ADDRESS PO BOX 67 FOREST CONTRACTOR'S NAME LOREN DAWSON 891-6506 TELEPHONE CONTRACTORS MAIUNG ADDRESS PO BOX 6073 CHICO CA 95927 CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ Plan Checkin Fee $ BUILDI-yc�q�,ss DOE MILL ROAD .LLZS 3 Energy Plan Checking Fee $ $ PERMIT FEE $ LOT 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 as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: C ELECTRIC SERVT('F. METER PANF.T. Gas piping system t - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT I Filing Feel 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 in II force and effect.` ` �� -3/ License Class '� / O Lic. No. / (p OWNER -BUILDER DECLARATION 1 herebyaffirm under penalty of perjury that I am exempt from the Contractors License p tY P 1 rY P 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. ❑ 1 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 Main Service 200A TO 1000A 46.00NEW CONST. DWELLING OCCUP. SO OR ADDNS. ( & ACC. BLDS. 3.5¢FT. NEW NON-ROSID MULTI -OUTLET BRANCH CIRCUITS- CG 7,50 PID APPARATUS a sINGL E �fLEr oC1R. Ex. Occup. OUTLET OR FIXTURES BA� 9'; 0 EX. OCCU FIXED APPLNS.OR ounErs RESID. E0. L 1 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE—INSPECTION 23.00 PERMIT FEE $ 66�QQ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ 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.) I 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' c — ensatnft section 3700 of the Labor Code, I shall forthwit ply wi X a e Signature of Applicant - ❑ Owner Contractor ❑ Agent An OSHA permit is required for excavatio o er 5' " deep and demolition or construction of structures.W i n Receipt No LVLPERMIT WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT I Mobile Home Installation Fee Is Energy Inspection Fee $ occ coNsr. TYPEcertify TOTAL FEE $ 66.00 HAZ. IMP FtOOD CDF pggCEL pD HD ISSUE 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. ! )� By / to ` jr, EXPIRES ON efe i PRE-TNSPECTI ORT OWNER: LOCATION: PRE-INSPETION FOR: DATE TO INSPECTOR: Building Description: Commercial/Usage: Residential/# of Units: L^ Currently Occupied IlAd Abando7NO t i0 Electric: Yes Condition of Electric DATE: rA.P. # "X�� _ ZONING:_ :MIT HLSTORY:P4 NONE:) K) AS FOLLOWS: BUE.DING INSPECTOR'S REPORT - Electric currently On Off _ Gas: / - - Natural Propane v/ None Currently On I/ h Off Obvious Problems: �— . Sanitation: Plumbing Working_ Y Well Working .J - Potable Water ti Obvious SewageProblems k&()3 e- I yr22M air' g` n.� ( dlr2y- ACTION RECOMMENDED: ISSUE:—V HOLD FOR Inspector. Date Ile Sketch buildings on reverse and indicate location onro ert . P P Y S J -,r 1 - . r �4..�-..vt 4-c,.� i- rt:�r�.+��t+: i3^+f�.?t^`!,'.^y'1✓'.r�""✓+v' ...,r'."*'NS�,.� �., :f:�iy�ii�K...r:�q;yr iii;,."-01�-�-�"-J�'F.%�.n.��•�]Y/.'l1 ��/;//�`a.•w'�f�`1,. s mow- ..n, . COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: ASSESSOR PARCEL NUMBE �� ✓ '! �/� /O Proposed Building Use: Counter Technician: A Date: Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in rder to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. i ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: .............. ❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form............................................................................. ❑� 27. Encroachment P it rl w y o t PuMocl D. p ........................... -E 28. Pre -Inspection fo (/ (� required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number ........................................... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... ❑ 32. Letter of Signature authorization.................................................................... ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ........:........................ _. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone - and hold for pickup. I have been inf rmed • e a ite d requirements for obtaining a building permit. Applicant: Date: 1. Index permit application for the above items numbered: Plan Check Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division �.«-,y •,-.-....• -..---�-r:.-y :..,,�+.l.r,-..�.s-�.-ti.,�-- ,..'.*+.� -�-�-+.. -,r�� 'e:. .... , r M _... - � r. e� . - .:� , ..,...--ti.. ,-.nr r- -^.+r_h�+.v:.f'r.- .. ... -w +-�-.-'+..:•-",.�•.+-+'ti^ s�..v '� f - k, 1 ` 063-040-104 03;3847. FERGUSON, 12883 DOE MILL RDF r, sca' FOREST RANCH F y Cont: LOREN DAWSON MISC WIRING FOR#03-3706 - COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 .—PERM) No. (Rev. 12/96) APPLICATION AND PERMIT C --6 - '2 `11 ASSESSOR PARCEL NUMBER ()I 3 , 01_40_ I L)V I ZONING BUILDINGPERMIT OWNER - n U �/V TELEPHONE SO. FT, OCC. BUILDING VALUATION OW �J MOILING OR CONTRAST) ME DlI 1' " —0,1 ` WT /°{,Q,-) -5[, '..2 -7 CONiRACTQIR•5'�AAIUNO DR 0 31 �� I ?-5-/ CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. —Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS u Zv�� (x I (eel(-(; Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIOWS 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:1^ ' n` r i 15C t j/ r r 111 1 l 0/ r f,_-47 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @ 20.00 PERMIT FEE S U% • / c%2 ELECTRICAL PERMIT Fling Fee 20.00 600V ORLESS Main Service 20.AORLESS 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%/ �full f re and effect. License Class [/ ✓ Lic. No. �% / 7 /Q � OWNER -BUILDER DECLARATION I 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 Main Service zooA To ,000A 46.00 NEW CONST. DWELLING OCCUR OR ADONS. ( 8 ACC. S. SO 3.5¢FT. NEW CONS MULTI- OUTLET NON-RESID. 97,50 POWER APPARATUS a sINGLE OvrLET CIFL Ex. Occup. OUTLET OR FDCTURES j 20 @'•50 BAL @ .50 FIXPP Ex. Occup. oun�°S .=.OEl 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 2J PERMIT FEE $ 4 � l 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. ❑ 1 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 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.) 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 workers' Compensation laws of CaliforNa, and agree that if I should become subject to the workers' compensations provisions of section 3700 of the Labor Code, I shall forthwith'comply`W"ith-those provisions. F X v Date G- C Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agen—,- An OSHA permit is required for excavations over 60" deep and demolition 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 $ 71 .� HA2. TFEES IMP FLooD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have / �,%� 1 By -i if ERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. Date�� , <. Date Receipt No. J (%;,J WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ' 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 I NO. (Rev.12/96) APPLICATION AND PERMIT C, ASSESSOR PARCEL NUMBER_ 0440 r 1 .(�(-1 ZONING BUILDING PERMIT OWNER �r O� J TELEPHONE SO. FT, OCC. BUILDING VALUATION . OW S OR FD r.2 54- ek4A C-? c-9 CONTRACTOR'S NAME pa '1/�� ^ HO[JE 1677/ (/O C ORS IL1.DRE S -7 J f IV\05 CONSTRUCTION LENDdR LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filen Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ Plan Checkin Fee $ BUILDING ADDRESS/ Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDNISIOWS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap I 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: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G IW @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service '..AoALEss 2o0A 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 j9 full f rCe and effect. f License Class '0 Lic. No. _ / OWNER -BUILDER DSA TI N I 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. ❑ 1 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 Policy Number (The above sections need not be completed if the permit is for work of a valuation one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall t employ any person In any manner so as to become subject to workers' compensation laws of Califo 'a, and agree that if 1 should become subject to the workers' c ensation - .I ions of section 3700 of the Labor Code, I shall f hwit p1 ose pr visions. X Date / Z Signature of Applicant - 13 Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition o construction of structures over 3 stories in height. Main Service 200A TO IOooA 46.00 NEW CONST. DWEWNG OCCUP.O OR ADDNS. ( a ,ins. 3.5,sS NON -RID. MULTI -OUTLET @7,50 BRANCH IRCUITS POWER APPARATUS & SINGLE OUTLET CIA. Ex. Occup. OUTLErOR FIXTURES �� @': o Ex. Occup. oFIxLI R�sID.oEE 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ HAZ. D. FEES IMP I FLOOD I CDF PARCEL PO HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work ind' at above for w ich fees have been paid. t �Z� By Date I " PERMIT EXPI ES ON Dale J Receipt No. Ci . v WHITE-D.D.S.-B. D. CANARY -A SES OR PINK -INSPECTOR GOLDENROD -APPLICANT