HomeMy WebLinkAbout063-430-057REROOF WITHOUT PERMITS
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RILEY; JERRY
50 LA MIRADA,' OROVILLE' f%i lila II
REROOF/SF
69-43`S`7 34-45-57
JERRY RILEY
50,LaMirada, Oroville % T
Permit ##6458-77E (ele ser ch) SF
0
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916.538-7541
APPLICATION AND PERMIT -
ASSESSOR PARCEL NUMBER
069-430-057
ZONING
AR -1
BUILDING PERMIT
OWNER
Jerry R. Riley
TELEPH E
589-2��i2
SQ. FT. OCC. BUILDING VALUATION
�y y
24 1,440.00
OWNER'S MAILING ADDRESS
50 Le Mirada Ave., Oroville 95966
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation 1$1.440.00
Filing Fee $ 15.00
LENDER'S MAILING ADDRESS
Permit Fee $30.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
Permit fee $45.00
PLUMBING PERMIT Filing Fee 15.00
50 IAMtreda Ave., Oroville
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 I Duplex❑ Mobilehome❑ Other
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[ Addition;_; Remodel❑ Utilities❑ Installation❑ Other®
Describe work: Reroof w/Contli.
Permit Fee $
Contractor
ELECTRICAL PERMIT FilingFee 15.00
Main service 600VORLESS 18.50
200A OR LESS
_
Main service 200A TO IOOOAI 37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of thejBusinessPOWER
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)
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.E 3.60 sq.ft.
OR ADDNS. (ACC. BLDGS.
NEW CONSTRULTI-OUTLET
NON.RESID BRANCH CIRCUITS @ 5.00
APPARATUS
(SINGLE OUTLET CIR.e
Ex. Occup(OUTLETS OR FIXTURES 20 @ 761
ED APPLNS.
Ex. Occup. OUTLETS (RESID )REA) I 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. Wiring
9 15.00
'
Permit Fee $
—
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 ai Certificate
of Consent to Self -insure.
25 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. f
Contractor
MECHANICAL PERMIT FilingFee 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 Ltews relating
to building construction, and hereby authorize representatives of t& County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in anyway accrue
against said County in consequence of the granting of this permit.yl
-- ._ G�-(a.J�C, Date ti 3
--' Dsions
Signature of Applicant — Owner ❑ Contractor ElAgent❑
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 $45.00
HAz
0FEES
IMP
FLOOD
CDF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under the applicable provi-
of the Butte County Code and/or resolutions to do
Work indicated above for which fees have been paid.
IRECTOR..�OE PUBLIC WORKS
By A-04 � J ` Date
PERMIT EXPIRES Dates/L1
f
Receipt No. 43188
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
APPLICATION AND PERMIT
PERMIT 140.
ASSESSOR PARCEL NUMBERZONING
069-430-057
AR -1
BUILDING PERMIT
OWNER
Jerry R. Riley
TELEPHONE
589-2142
; S0. FT. OCC. BUILDING'VALUATION
24 1,440.00
OWNER'S MAILING ADDRESS
50 La Mirada Ave., Oroville 95966
CONTRACTOR'S NAME
Owner
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation 1$1,440.00
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$30,00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$45.00
PLUMBING PERMIT
Filing Fee 15.00
50 LaMirada Ave. Oroville
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
��Yy USE OF STRUCTURE
SF[J Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
Building sewer
M15.00
Mobile Home S G W
TYPE OF WORK
New � Addition u Remodel ❑ Utilities ❑ Installation❑ Other ®
Describe work: Reroof w/Comp. _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600V OR LESS
200A OR LESS
_ 18.50
Main service 200ATO1000A)
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
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)
Pej,-am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST.( DWELLING OCCUPM
OR ADDNS. ACC. BLDGS. /
3.50 sq.ft.
NEW CONSTRULTI-OUTLET
NON•RESID BRANCH CIRC ITS
@ 5.00
/POWER APPARATUS e
I SINGLE OUTLET CIR.
Ex. OCCUp(OUTLETS OR FIXTURES
20 75d
FIXED
Ex. OCCUp. OUTLETS (RESID )LNS REA.)
I 3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
g
15.00
Permit Fee
$
—
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.
y'j 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
FiIingFee 1 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, judgments, costs, and expenses which may in any way accrue
agains�buntycqaseqtreftpof the granting of this permit.
X Date �^ % ��
$• ure of Applicant - owner
pp ❑ C ractor ❑ 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 $45.00
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
LIC
BY
PERMIT EXPIRES DJAe
applicable provi-
resolutions to do
have been paid.
ORKS
Date
Receipt No. 143188
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - Department of Public Works
7.Ceinty Center Drive, Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention :Proper.ty Owner:
Phone: 916-538-7541
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.
( 1.1 I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
C2). I (have/have not) ��c�� 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
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.
COUNTY OF BUTTE - DEPARTMENT OF PUBLiC WORKS
7 County Center Drive - (3roville, California 95965 - Telephone: 916 538-7541
APPLICATION A -MI) PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
0 _ ^65 —7
ZONILJG
BUILDING PERMIT
OWNER
E JAZ � T `
TELEPHONE
y2
SO. FT. OCC. BUILDING VALUATION
Iwo
OWNER'S MAILING ADDRESS
,70 e -p v
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
D
Filing Fee
$ 15.00
LENDER'S MAILING ADDRESS
Permit Fee
$ Q_Un
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
So 4 -AM -7-M,06 ALE a O
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 Ly' Duplex❑ Mobilehome❑ Other
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 77 AdditionnL_Remodel i: Utiliticcess ❑ Installation[ Other ❑
Describe work: RL.Rdt4:,
_
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600VORLESS
200A OR LESS
18,50
Main service 200A TO 1000AI
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
El 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 No. Classification
_f 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)
❑ 1, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ 1 am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST./ DWELLING OCCUPM
OR ACDNS. ( ACC. BLDGS. //
3.64sq.ft.
NEW CONSTR. MULTI -OUTLET
NON-RESID BRANCH CIRC ITS
@ 5.00
(POWER APPARATUS6)
SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
20 @ 76
A
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
15.00
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 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 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 $
occ CONST TYPE TOTAL FEE $ yS'mD
HAz
1 0FEES
I IMP
I FLOOD
I COF
I PARCEL
Po
I HD
I 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.
WHITC-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLD ENROO-APPLICANT
��
COMPLAINANT:
ADDRESS:
PHONE NUMBER:
OTHER COMMENTS•
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
1469 Humboldt Road, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
747 Elliott Road, Paradise, CA - (916) 872-6307
CORRECTION NOTICE
OWrim So � vj�PERMIT NO.
Anxxtneispection indicates that the following violations of Butte.County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
iiscoebpbtedl- Ffyou have any questions pertaining to this matter, or need additional explanation,
pkae contact this office immed'tely.
!TiQ oec-/1"p F 71fit f
D v1i
Date Z r Inspector
Fail/ low
Eczr�y ?, u e\�
A- ., I
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Tel epl 9ne: 534-4541.
APPLICATION AND PERMIT
•^�..r,...,a.nwuvvo v� u,c vvuniy vi �u V U CIIICI upun tilt!above-mentioned property for inspection purposes.
Date J7—i?-`77
e�
,SignatureOf Yermitee or Agent ~
Re eipt No. 1 L I, 13Y
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
D,I•R`ECTO.RoOF PUBLIC WORKS
By Date I
Bu44clli)nrgLpermit expires Date 0-1 j —L- %
BUILDING
Owner
I
SQ. FT. OCC. BUILDING VALUATION
Mailing Address SD
T lephane N
Z
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE J$3.00
Each Trap 1.50
1
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
f , .�
A. P. No. J "7 ��
Zoning &Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fres'
*,el
•San•itation-•FireDept.
FireZone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Improvements
provements
Lawn sprinkler system 2.00
.-13ldg—RI-ams-Re-c,6d'--
Parcel,Approval
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER 0
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 Do
1 y
Main service 1000V OR 0 AMP ORSLESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family �� Duplex ❑ Mobil Home ❑ Others ❑
OV
Main service 1000EAMV OR LESS 25.00 ,
Main service EA. AOD'L 100 AMP 1.00
NEW CONST. DWELING
OR AODNS. ( ACCLBLDGS. OCCUP. &) 20sgft
NEWCONSTR. [MULTI -OUTLET
NON -RESID. I BRANCH CIRCUITS) 2.50ea
NEW CONST. POWER APPARATUS &
NON-RESIR
D. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Ex. Occup(OUTLETS OR FIXTURES)@�C
BAL@1
Ex. Occu FIXED ALNS. OR
p'(OUTLETS (PPRESID,) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25,
VI am exempt from the Contractors License Laws of the State of California.
Permit Fee $ 162S
ry
WORKMEN'S COMPENSATION INSURANCE
I 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.
have placed on file with the County of Butte a certificate of
F-1 'Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not em
41 p to an employ y person in any manner
sous to become subject to the Workmen's Compensation Laws of
California.
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
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
TOTAL PERMIT FEE
�r
•^�..r,...,a.nwuvvo v� u,c vvuniy vi �u V U CIIICI upun tilt!above-mentioned property for inspection purposes.
Date J7—i?-`77
e�
,SignatureOf Yermitee or Agent ~
Re eipt No. 1 L I, 13Y
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
D,I•R`ECTO.RoOF PUBLIC WORKS
By Date I
Bu44clli)nrgLpermit expires Date 0-1 j —L- %
s
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS ��
7 County Center Drive — Oroville, California 95965 jQQ�/
Telephone: 534-4541
APPLICATION AND PERMIT
.UU1U11LC ICt/1CJC11lGUVCJ UI lllU I,UUllly UI 01.11.1t!tU enter UPUn the
above-T_era+erten property for inspection purposes.
w
(a, Date ) �)^ 12-77
Ignature oTPermitee or Agent
eceipt N /
No. I(� to—r?
White-D.P.W. —ellY ow -Assess r — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
Q11 TOR OF. PUBLIC WORKS
By _ Date
permit expires Date "L-
BUILDING
OwnerTip"r-ru
SQ. FT. OCC. BUILDING VALUATION
Mailing Address J
Iephoneda�
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Tlephone No.
e
Permit Fee $
$
Building AddressPLUMBING
raja
No.1 @ FEE
PERMIT FILING FEE J$3.00
Each Trap 1.50
lJ U 1 1
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No. 3
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F'
FI re Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Parcel Map P
60' R/W
Improvements
Lawn sprinkler system 2.00
Parcel Approval I
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 100 AMP ORSLE55 5.00
Main service EA. ADD -L 100 AMP 2.50
Single Family 000'Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V
1100 AMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
OR ADDNS. NEW CONST.
( DWEACCLBLDGS.LING CCUP. &) 22sgft r
NEW CONSTR. MULTI -OUTLET
NON.RESID. BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS &
NON -REST D. SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
st le of:
y
Ex. Occup(OUTLETS OR FIXTURES)50 @2rX
109
Ex. Occup. FIXED APPLNS. OR
P. OUTLETS (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 $ A IS$
WORKMEN'S COMPENSATION INSURANCE
I 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 s to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
'
PERMIT 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
TOTAL PERMIT FEE
$
.UU1U11LC ICt/1CJC11lGUVCJ UI lllU I,UUllly UI 01.11.1t!tU enter UPUn the
above-T_era+erten property for inspection purposes.
w
(a, Date ) �)^ 12-77
Ignature oTPermitee or Agent
eceipt N /
No. I(� to—r?
White-D.P.W. —ellY ow -Assess r — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
Q11 TOR OF. PUBLIC WORKS
By _ Date
permit expires Date "L-
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