The URL can be used to link to this page

Home My WebLink About063-160-006A. Kenneth Raby STRE . Lot 13 at end of Forest Ranch Way, -- Forest Ranch CONTR: Gus Gore Sons, Durham Permit 331-71B (new single family ..i noon Il LOT BLOCK SUBDIV. 063-16-u-uue- BUZZINI, Tom TYPE OF 15277 Forest Ranch Way, FR PERMIT PERMIT NO. PLAN NO. DATE ISSUE Four Seasons Rf (reroof /SF) g REMARKS PERMIT DESIGNATION: B -BUILDING E -ELECTRICAL U -USE PERMIT HM -HOUSE MOVING DEPARTMENT OF P -PLUMBING TV -RADIO -TV ANTENNA V -VARIANCE EP -ENCROACHMENT BUILDING AND SAFETY T -TRAILER S/W-SIDEWALK NOTICE S- SIGN PERMIT D - DEMOLITION 600.1 31VO '018 31VO ''DIS 31VO 'flIS 31VO fl13 31VO flIS NOIIVNVIS3(1 =U38Wf1N 11WU3d �'L v'dv2ldd d S'11U,V)VV773OSIM lVNld SH313 W S30NVIlddV V S3MnlXld NI-HOf1OH 31VO flIS 31VO ''DIS 31VO VIS 31VO DIS 31VO flIS BL138Wf1N llPYH3d a"l ndUNdd V 'I VJI?I,LJ37M 1VNId S1N3A V S33NVIlddV 3NIl 213M3S VNldld U31VM 1S31 3Mf1SS3Nd SVD NI-HDIIOti 31Va 'DIS 31VO 'DIS 31Va 'VIS 31VO ''DIS 31VO 'DIS lb138wnN 11WL13d S7T�'An?1da6' �n»s�wn�.;' 87VAOUdcrV DiVIQ71128 atjoMl NOI.L33dSNI �Cfl l Cy7i.,.r Cfll 31VO 'flIS 31VO 'VIS 31VO 'VIS 31VO 'VIS 3J6VO VIS 31VO 'flIS 31VO VIS 31VO 'FJIS 31VQ 'VIS 31VO VIS 31VO 'VIS 31VO- i _I I r ` i n mD �D r m �Z On m �- f D tn� I A 5� H� p p Sicl 5� X t -i 5z 3 A rnZ m0 r n � C+IrO O�> i y Z Z Z� 3� 87VAOUdcrV DiVIQ71128 atjoMl NOI.L33dSNI �Cfl l Cy7i.,.r Cfll PERMIT NUMBER _ B 331-71 P 325-71 E 279-71 PERMIT EXPIRES �— ,OWNER Kenneth Raby �;'CONTR: Gus Gore & Sons, Durham aL0CATION (A.P. 57-48-6 Lot 13 at end of Forest Ranch Way, 4 Forrest Ranch 1,. { s x , Zoning m/54 "— , =z% FoundationG,�lGS^ �o "� :zz_ Rgh. Plumbing —G Rein. Steel Framing 0S Wtr. Htr. Firewall ELECTRIC Temporary _ sr " --;k 42:1 Final DATE D COUNTY OF BUTTE Department of, Public Works BUILDING INSPECTION RECORD Setback Q41-5% Piers & Girders Bond Beam Gas Piping & Test Plmg. Topout Furnace Garage Vents GAS Temporary Final Forms�'��/ Fireplace Lath & Plaster_ Found. Vents•_ Rough Elec. Kitchen Vent Sanitation & Water BUILDING Cert. of Occup. _ Final REMARKS OR CORRECTIONS COUNTY OF BUTTE DEPARTMENT OF ..PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Phone: 533-1230, Ext. 259 APPLICATION AND BUILDING PERMIT Permittee Owner s �J� t� t Mailing Address A. P. No. Fire Zone Zoning Contractor i-. . 1 / ., t y r ' Mailing Address / Sanitation Planning Plans Fees W.C. BLDG. Address _01 W Encroachment NEW ADDITION 0 REPAIRSED OTHER 0 Others Single Multi USE OF STRUCTURE Family Duplex 0 Dwelling 0 Others F O U N D A T I O N MATERIAL EXTERIOR PIERS W1dth at Top Width at Bottom Depth in Ground SQ. FT. OCC. BUILDING VALUATION R.W. PLATE (Sill) SIZE SPACING SPAN - G Girders ?,v � J C1 U joists - 1st Floor i J joists- 2nd Floor Fireplace G'U sr -J joists - Ceiling - Total Valuationz / �'7 / i J Exterior Sttlds Permit Fee Interior Studs Plan Checking Fee &/or Penalty Roof Rafters Total Permit Fee r" LSU Bearing Walls UUMTRACTORS LICENSE LAW A. LICENSED CONTRACTORS COMPLETE THE FOLLOWING: I am licensed under the provisions of Chapter. 9, Div. 3, of the State of California Business & Professions Code under the name style of ................... j ........................................................ .................................................................................................................................................. ...... ............. License No. ,,,,, .... ......... . Classification ........................ ................. and certify that the aforesaid license is in --full force and effect. B. OWNER -BUILDER & OTHERS COMPLETE THE FOLLOWING: I am exempt from the Contractors License Laws of the State of California under Sec. 7031.5 because (check one): I am the owner of the above property and I will contract to have all of the above work performed by licensed contractors, (Sec. 7044). 0 I am the owner of the above property and do not intend to offer it for sale for one year from the date of completion of the improvements. (Sec. 7044). 0 Basis, if any, for other statutory exemption.................................................................................................................................................................. WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liabil- ity for Workmen's Compensation. I have placed on file with the County of Butte a certificate of compliance or proof of exemption pursuant to Section 3800. 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 County of Butte to enter upon the above-mentioned property for inspection purposes. • r X.............................................................................. Date ......................:......... SIGNATURE OF PERMITTEE OR AGENT This BUILDING PERMIT is hereby issued under the appli- cable provisions of County resolutions and/or ordinances. DIRECTOR OF PUBLIC WORKS By................................................................................ Date ................................ ReceiptNo........................................................................................... ............ Permit Expires Date COUNTY OF BUTTE DEPARTMENJ OF- PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Phones 533-1230, Ext. 259 APPLICATION AND PLUMBING P E R M I T Permittee Owner A.P. No. ' Mailing Address Contractor Mailing Address i /" ✓. �.�✓ / .�_r:�� -.�,, 1 BLDG. Address�� !� f .eft' DESCRIPTION OF WORK No. @ Fee NEW 0 ADDITION REPAIRS 0 PERMIT FILING FEE 52.00 � Each fixture or trap or set of fixtures on one trap �� 1.50 OTHERS: Repair or alteration drainage or vent piping 1.50 Remarks: Installation or repair water piping 1.50 Each gas water heater or USE OF STRUCTURE gas heater vent 1.50 Gas piping system 1 - 5 outlets 1.50 Single Multi RESIDENTIAL Family EE Duplex Dwelling Gas piping 6 or more - Each .30 House Sewer 5.00 Lawn Sprinkler system 2.00 OTHERS: Remarks: TOTAL FEE $ CONTRACTORS LICENSE LAW A. LICENSED CONTRACTORS COMPLETE THE FOLLOWING: I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of ............�l....�..� J5 t�`eYf .............................................................................. .................................................................................................................................................... License No. -;,5,,,,y � , Classification.......... r ,,,,,,,,,,,,,,,,,, and certify that the aforesaid license is in full force and effect. B. OWNER -BUILDER & OTHERS COMPLETE THE FOLLOWING: I am exempt from the Contractors License Laws of the State of California under Sec. 7031.5 because (check one): Q I am the owner of the above property and I will contract to have all of the above work performed by licensed contractors. (Sec. 7044). I am the owner of the above property and do not intend to offer it for sale for one year from the date of completion of the improvements. (Sec. 7044). QBasis, if any, for other statutory exemption.................................................................................................................................................................I ............................................................................................ WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liabil- ity for Workmen's Compensation. I have placed on file with the County of Butte a certificate of compliance or proof of exemption pursuant to Section 3800. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above mentioned property for inspection purposes. ....................................:. ' ............................ Date - SIGNATURE OF PERMITTEE OR AGENT ReceiptNo . ...... .::................ ........................................... This PLUMBING PERMIT is hereby issued under the appli- cable provisions of County resolutions and/or ordinances. DIRECTOR OF PUBLIC WORKS By................................................................................ Date .............................. l � _ COUNTY OF BUTTE / DEPARTMENT OF PUBLIC WORKS 7 County Center Drixe - Oroville, California 95965 PHONE: 533-1230, Ext. 259 APPLICATION AND ELECTRICAL PERMIT z� Permittee Owner A. P. No. i I Mailing Address Contractor _A Mailing Address - - l _•-� r + ..�� BLDG. Address r DESCRIPTION OF WORK No. Fee 12.00 ' J PERMIT FILING FEE NEW F_,_1 ADDITION F-1 METER SERVICE Supplementary Filing Fee 1.00 Main Service r OTHERS: Sub -panel (12. (more than P less) 12) + Each Range, Dryer or Water .Heater _ Each Loo Remarks: Oven, Cook -Top or Space Heater Each :.50 Light Fixtures First 20 .20 Each Additional .10 1 USE OF STRUCTURE + First 20 .20 Receptacles., Switches & Fixture Outlets Each Additional .10 Hood, Exhaust Fan or F.A. Furn. Motor Each .50 Single Mulct Family 0 Duplex 0 Dwelling 0 Evap, Cooler, Gar. Disp. or Dishwasher Each .50 �) Air Conditioner or Heat Pump OTHERS: - Remarks: Misc. Wirine I I TOTAL FEE I , , , c, CONTRACTORS LICENSE LAW A. LICENSED CONTRACTORS COMPLETE THE FOLLOWING: I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of......................................................................................................................................................................................._................................................._.. . License-No.Classificacion,,,,,,,,,;;,,,„,,,,,,,,,,,,,,,,,,,,,,,,,,,,, , and certify that the aforesaid license is in full force and effect. B. OWNER -BUILDER & OTHERS COMPLETE THE FOLLOWING: I am exempt from the Contractors License Laws of the State of California under Sec. 7031.5 because (check one). I am the owner of the above property and I will contract to have all of the above work performed by licensed contractors, ( Sec. 7044). I am the owner of the above property and do not intend to offer it for sale for one year from the daze of completion of the improvements. (Sec. 7044). 0 Basis, if any, foLother statutory exemption....................................................................................................._........_............._ ........_._.. ...._.».. WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liabil- ity for Workmen's Compensation. I have placed on file with the County of Butte a certificate of compliance or proof of exemption pursuant to Section 3800. I certify that I have read this application and state that the above in- formation is correct. I agree to comply with all County ordinances and State Laws relating to building construction, and hereby authorize repre- This ELECTRICAL PERMIT is hereby issued tinder the appli- sentatives of the County of Butte to enter upon the above mentioned cable provisions of County resolutions and/or ordinances. property for inspection purposes. DIRECTOR OF PUBLIC WORKS r S X...................................................................................... Dace ..... ................ ........... !........ SIGNATURE OF PERMITTEE OR AGENT B ........ Date ” r Receipt No. ' 7 063-16-0-606 96-2860 B' BUZZINI, Tom 15277 Forest RAnch Way, FR (reroof/SF) Four Seasons Rfg lk- IS( COUNTY OF BUTTE- DEPARTMENT•OF DEVELOPMENT SERVICES- BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-754-1 E T No. APPLICATION AND PERMITS ASSESSOR PARCEL NUMBER 063-160-006? ZONING BUILDING PERMIT OWNER TOM BIZZINI TELEPHONE 2744 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 15277 EST RNACH WAY 2,90 CONTRACTOR'S NAME KNU FOUR SEASONS ROOFING TELEPHONE :3`,, 7 -041 CONTRACTOR'S MAILING ADDRESS RD STE C Fireplace CONSTRUCTION LENDER UNXNOWN Total Valuation $ Fling Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 37.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDINGADDRESS 15277 FOREST RANCH WAY• PERMITFEE $ PLUMBINGPERMIT Fling Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF 5 Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Ublites ❑ Installation ❑ Other ib Describe Work: REROOF COMP Mobile Home I S I GI W @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.'00 Main Service / 800V OR LESS 200A OR LESS ) 23.00 Main Service ( 200A TO I000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I( 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 full force and effect. // a- fJj e-1Ex. License Class - �' j LIC. NO. !� / .. 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 NEW CONST. DWELLING OCCUR OR ADDNS. ( a ACC. BLOB. ) SO. 3.5¢ FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) a SINGLE OUTLET CIR. Occup. ( OUTLET OR FIXTURES) 20 @ 100 BAL s0 FIXED APPWS. OR Ex. Occup. (OUTLETS (R Ess EA) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE S Contractor WORKERS' COMPENSATION DECLARATION I 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: T-- Carrier i /^ '- -cr., , ) MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number 17 2 - S (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 fgtthwith comply with those provisions. X Date / Signature of Applicant - ❑;Ccaner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee is Energy Inspection Fee Is OCC CONST. TYPE TOTAL FEE $ 57.00 HAZ. D. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have ts By ` y tit \ PERMITEXPIRESON ( - % applicable provisions Resolutions to do work been paid. Date f 2 - &- -7 (Date) Receipt No. INNS 206953 WHITE-D.D.S.-R.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 .County Center Drive - Oroville, California 95965 - Telephone (916) 538-754,1, / _� �EfiN�T NO. APPLICATION AND PERMIT `7[ `!T ASSESSOR PARCEL NUMBER 063-160-006 ZONING 1 BUILDING PERMIT OWNER TOM BIZZINI TELEPHONE 894-2744 SQ. FT. OCC. BUILDING VALUATION 98 AT 671 1680 OWNER'S MAILING ADDRESS FOREST15277 RNACH WAY CONTRACTOR'S NAME KRMNX FOUR SEASONS ROOFING TELEPHONE 895-0418 CONTRACTORS MAILING ADDRESS 4990 COHASSET RD STE 10 Fireplace CONSTRUCTION LENDER UNIwOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 37.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS 15277 FOREST RANCH WAY PERMITFEE $ 57.00 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO.SUBDNISIONS NAME PARCEL MAP Solar Or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF [$ Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ] Describe Work: REROOF COMP — Mobile Home S G W 920.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filinq Fee 20:00 Main ServiceOOev OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 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 full force and effect./ � License Class (_ �� Lic. No. / 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 NEW CONST. DWELLING OCCUP. SO. OR ACDNS. ( a ACC. BLDS. ) 3.Sa FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) 8 SINGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES) 2L Q I.50 BAIL .SO Ex. Occup. ( OUTLETS RESID.OEA ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor 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 4-1- 1—r— CDIrTM MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number 272-� 8 (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 fggg{{{ttthwith comply ith those provisions. l X Date 470 _ Signaturef Applicant - ❑ wner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 50" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee Is Energy Inspection Fee Is occ CONST. TYPE TOTAL FEE $ 57.00 HAZ. I D. FEES I IMP I FLOOD I COF PARCEL PD I HD I ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for whi fe s have been paid. 9 BY Date 1 2 —4-9 PERMITEXPIRESON ( / (�—�✓ (Date) ReceiptNo.�('0910OW$ 206958 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �t COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ` j / r / (, l bU o ZDNi ^, BUILDING PERMIT OWNER .� 1 Z Z 1 IJ "^27t,I SO. FT. ( OCC. I BUILDING VALUATION OWNERS MAIL! NDRE F6 L/ K ` \ l- 'fiME//^� CONTRA CiO t—D u1 _,o/JS �O� 1-1 �J TELEPHONE �9S�4G/> CONTRALTO OJNG ADDRESS ��67_5 e!/ /o /j� G% Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Fling Fee $ 20.00 LENDERS I,WLING ADDRESS Permit Fee $ ---�- - ARCHITECT OR ENGINEER LICENSE"D• Plan Checking Fee $ Energy Plan Checking Fee S ARCHITECT OR ENGINEERS MMUNG ADDRESS Penalty $ BULDINGADDRESS _5ZPERMITFEE S —� PLUMBING PERMIT Fling Fee 20.00 - Each Trap 7.00 LOT NO. SUBONISgNS NAME P CEL MAP Solar or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF , Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer j 15.00 TYPE OF WORK New ❑ Addition ❑ Rem ❑ Utilities ❑ Installation D Other ❑�� l� C Describe Work: - lJ Mobile Home I S I GI W 1 @20.00 PERMITFEE S Contractor ELECTRICAL PERMIT Flino Fee 20.00 Main Service ( e0ov200A OOR R LESS LESS ) 23.00 Mein Service ( 200A TO 1000A ) NEW CONST. DWELLING OCCUP, OR ADONS. ( & ACC. BLDS. ) 45.00 so. 3.5O FT. 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 full force and effect. C License Class G "� I Lic. No. v �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, 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 D 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: D 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 arrier and policy number are: Carrier STA 1`E_ COM Policy Number -2-72- 3 759 (The above sections need not be completed if the permit is for work of a valuation o f 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 d I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forth � h comp) with ose provisions. X Date _ Signature of II ant - D er D Contractor ❑ Agent An OSHA per it' required for excavations over 5'0" deep and demolition or construction of structures er 3 stories in height. NEW CONST. MULTI.OUTLET NON RESID. ( BRANCH CIRCUITS ) @7.50 POWER APPARATUS (a SINGLE OUTLET CIA. ) 00 Ex. Occup. (oFIXEToRFORURES ) L p x.50 BAL .SO Ex. Occup. (OUTLETS R6 oR2) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE S Contractor MECHANICALPERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S Contractor Mobile Home Installation Fee Is Energy Inspection Fee $ occ Co NS T. TYPE TOTAL FEE $ I HAZ. 10. FEES I IMP I FLOOD I COF I PARCEL I PO I HD I ISSUE This permit is hereby issued under the of the Butte County Code and/or indicated above for which fees have By PERMITEXPIRESON applicable provisions Resolutions to do work been paid. Date (Orae)) Receipt No. (%q WHITE-O.O.S -B.D CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT