HomeMy WebLinkAbout064-190-011`
AP 64-19-11
Thomas Johns^ ~°r50 Lafayet C*ircle, lot 258, PP#14,
- ^Magalia jr%j *Z
�R: He's *dk�70�7e/rv/!,�- a*disesBaclk�dleo --Par dise-
LEC. 2
GAS
/
COMPACTION TEST Z132
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Ke twood Mobile Home Sales
/ |
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Issued
64-19-11Permit #2831-78B(new private garage)
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AP 64-19-11
Thomas Johns^ ~°r50 Lafayet C*ircle, lot 258, PP#14,
- ^Magalia jr%j *Z
�R: He's *dk�70�7e/rv/!,�- a*disesBaclk�dleo --Par dise-
LEC. 2
GAS
/
COMPACTION TEST Z132
`
]
|
Ke twood Mobile Home Sales
/ |
/
Issued
64-19-11Permit #2831-78B(new private garage)
|
/
/
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is PERMIT NO. 2831-78B
PERMIT EXPIRES ���✓ O/�/
OWNER Thomas Johns
CONTR. -owner '
LOCATION (A.P_. - 64-19-11 )
50 LaFayette Cir., lot 258, PP#14, Magalia
4
r.
E
Temp. P
Calle
Temp. EI
Calle
Temp. G
Calle
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
MOBILEHOME INSTALLATION .............. Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS
(
II
I
(NOTE: An entry must be made on this form each time you visit the job site.)
BUILDING
BUILDING (Cont'd)
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Siding to
To out
Slab
Roof Sheathing/
Water Piping
Piers
Roofing 6P
Sewer
Garage
Fdn. Vents
Fixtures
Footing s — —
Garage Vents
Water Htr.
Stem wall
Insulation
Heaters
Slab
Carport
Footings
Prov. for physically
handicapped
Conformance of ex.
structure
Appliances
Gas Piping & Test
Temp. Gas
Slab
Final i
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SP INKLERS
Motors
Framing—
Test Z,Water
Htr.
Stucco
Final
Subpanels
Mesh
MECAANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
MOBILEHOME UTILITIES ------------------
Elec. Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
MOBILEHOME INSTALLATION .............. Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS
(
II
I
(NOTE: An entry must be made on this form each time you visit the job site.)
�• COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, - 4roville, California 95965
`
Telephone: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X / Date / - 2w -
Signature off Permitee ant
/Z Receipt No. ZZM
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.
DIRECTOR F PUBLIC WORKS
ByD,ate.�fao- 7Z
wilding permit expires Date
BUILDING
Owner ��
SQ. FT. OCC. BUILDING VALUATION
D
Mailing Address Q C
elephone No. 7
Contracto
Mailing Address
Fireplace
Total Valuation 17 60
Telephone No.
Permit Fee O O
Building Address 0 ,
Plan Checking Fee &/orPenalty
Permit Fee pp
Q
PLUMBING No.1 @ FEE
!�[
PERMIT FILING FEE $3.00
Each Trap 1.50
,;;e# �g— /��
Repair drainage or vent piping 1.50
l _ //
A. P.
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F s
p
S ita
FireDept.
Fire Zone
Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking ParcelEach
Plans I Declaration I
Parcel Map
1 60' R/W
Improvements
additional outlet .30
Building sewer 5.00
BI ans Recd I
Parcel A
s Approval
Lawn sprinkler system 2.00
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $
$
ELECTRICAL NO -1 @ FEE
PERMIT FILING FEE J$3.00
Main service 100 AMP LOR ESS 5.00
Single Family ❑ Duplex ❑ Mobil Home ❑ Others
Main service EA. ADD'L 100 AMP 2.50
n
Y
Main service OVER 600v 25.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW OR ADDNST % ACCLBLDGS.LING OCCUP. s) 20sgft
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 RESID. BRANCH CIR T
NON.CONST (. BRANCH CIRCUITS) 12.50ea
NEW CONSTR. (POWER APPARATUS B
NON-RESID. `SINGLE OUTLET CIR.
EX. OCcup{OUTLETS OR FIXTIIRES BAL@1
FIXED APPLNS. OR
Ex. Occup. ( 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. $
$
MECHANICAL No. @ FEE
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.
ol 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 the Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
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
Land Development Fee
$
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X / Date / - 2w -
Signature off Permitee ant
/Z Receipt No. ZZM
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.
DIRECTOR F PUBLIC WORKS
ByD,ate.�fao- 7Z
wilding permit expires Date
... ,i
PERMI$ NO. 5791-77 P,E
i
PERMIT EXPIRES ----C,+/,//
OWNER Thomas Johns
t CONTR. Hess Backhoe -Service, Paradise
LOCATION (A.P. 64-19-11 )
50 Lafayette Circle, Lot 258, PP#14, Magali,
Y ,
Temp. Power Pole
Called PG&E
Temp. Elec. Serv. Z
Called PG&E
Temp. Gas Serv.
/Called PG&E
UJ
OBINALED
(Date)
(Signature)
/rf
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION"RECORD
_ r
BUILDING BUILDING (Cont'd) PLUMBING
'p,
Set ckF
ewall
Sit Pipim
For4
Pa ets
1W Floor
MA Bldg.
Rest om Finish
2n Floor
Fo tins
Windovh
3rd loor
Stem all
Siding
To out
Slab
Roof Shealhing
Water Pi n
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwa I I
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for ph sically
handicappedy
Conformance of ex-
structure
Appliances
Gas Piping & Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPL CE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
.Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Under round
oInterior Lath
Ventilation
Permanent
Door Closer
Final
Final
MOBILEHOME UTILITIES -------- ------
ti
Elec_ Service ;L- XD -o
Elec. Pedestal ). - i' %7 j
Water Piping �,Z-,7�- )^�
Sewer 7
Gas Piping
E OME INSTALLATI N --- • Support • 11W
Elec. Continuity
Water Piping 1
a
DATE
Drainage
REMARKS OR CORRECTIONS
Gas Piping
(NOTE: An entry must be made on this form each time you visit the job site.)
MOBILEHOME INSTALLATION INSPECTION CHECK LIST .
1. Is the mobilehome located with,;required separation from lot lines and buildings and generally
conform to plot plan? Yes�� No ,
2. Does the mobilehome have.required clearances above ground? (Sec.5085) Yes "' No
3. Are footings and supports properly sized, spaced, and braced as per approved plans? (Note
possible variation at spring shackles.) (Sec. 5082 & 5083) Yes A��No
4. Is the mobilehome level? (Sec. 5088) Yes No
5. If more than a single unit, are crossover connections properly installed? (Sec. 5088)
Yes.-' No
6. Water
A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566)
Yes --'No
B. Test - Does water piping withstand working pressure or'50 lbs. air test? Yes ---No
C. Backflow - If coach is not State of California approved, does station have backflow device
and pressure -relief valve? Yes— No
7. Wastes and Drains
A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes -`No
B. Does it have minimum" per foot slope and is it properly supported? Yes No
C. Are any leaks detected in drainage system after running 3 -gallons of water through each
fixture including washing machine standpipe? Yes No
D.! If coach is not State of California approved, does station have required trap and vent?
Yes No
8. Gas Piping and Gas Vents
A. Connector - Is mobilehome con ected to the gas supply with an approved 3/4" minimum
mobilehome connector not mor than 6 ft, long? Note: All piping is to be at least as
large as the mobilehome gas line inlet without reductions other than the mobilehome
connector. Yes No
B. Test OK as per followinV procedure? Yes— No
1. Open all appliance connector valves.
2. Shut off appliang'e burner and pilot valves.
3. Air test with jnanometer to 10"-14" water column, or test with slope gauge (minimum
6oz.-maximum,8 oz.) calibrated in tenth pound increments. Test for 10 min. without
drop.
4. Connect gas meter to mobilehome with connector, turn on gas, test connections with
soapy water.
C. Are all appliance vents properly installed? Yesy No
9. Electrical
A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of
mobilehome with.a minimum of100 amp) and other facilities on lot, i.e., water pumps,
garage, cabana, etc.?- Yes No °
B. Is there proper clearances around panels? Yesy No /
C. Is power supply cord,or feeder assembly properly fused? Yes
D. Is continuity test satisfactory as per the following procedure? Yes ---No
1. De -energize electrical wiring system of the mobilehome at the pedestal.
2. Make sure that the power supply cord or feeder assembly conductors, including neutral
conductor, have been disconnected.
3. Switch all breakers and switches in the mobilehome to the "on" position.
4. Connect one lead of a test instrument to the mobilehome grounding conductor and
apply the other lead to each mobilehome supply conductor, including neutral.
5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line,
water line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon completion of the above procedure, the power supply cord'or feeder assembly
conductors shall be connected to the site service equipment. A further continuity
test shall then be made between the grounding electrode and the chassis of the
mobilehome. Upon satisfactory completion of the electrical tests, the lot or site
service equipment may be approved for energizing.
10. Is job card signed by Health Department for water and sanitation?
11. If everything okay, sign off card and tag services.
MOBILEHOME DATA
Manufacturer and/or Namestyle
0
Length__ ^ % Width 2-0
Vehicle Serial No. 2 //
State Identification No. CSP.yg5 9/Ci — :;?-n
Additional Information or Comments:
.r's COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-$541, 3
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with the requirements
of the California Administrative Code, Title 25, Chapter S. under permit
number.1_2 �'z1-72 for the following location:
r� n�a.,lirh,A�i liZ-•
Owner Gv
Owner's Address
Mobilehome Mfg. Model Year.
Insignia No.?-ett, OX5-71;x-- Z-0 Serial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
Date ? — Z -;, -7 e By
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow - Installer, Pink - D.P.W.
J. i -
COUNTY OF BUTTE • — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date 2 ` 4
Sig ture off Peerrmitee or Age
Receipt No. J[�
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 bpw,�paid.
DIRECTOR IDF PUBLIC WORKS
BY Date
Building permit expires Date l'�'7
BUILDING
_
Owner M1
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
•
Contractor
Total Valuation
Mailing AddressPermit
Fee
Plan Checking Fee &/or Penalty
T leph one No.
3
Permit Fee
Building Address
0411
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. N9,,- /
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fees nnitation
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma P
60' R/W
Im rovements
P
Lawn sprinkler system 2.00
Bldg. Plans Recd Parcel Ap oval
Pldkf Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTIWM& OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
I
1 OR
Main service 100 AMP ORSLESS 5.00
Main service EA. ADO'L too AMP 2.50
Single Family ❑ Duplex ❑ Mobil Home Others ❑
Main service OVER 600V
00 AMP OR LESS 25.00
Main service EA. ADD'L too AMP 1.00
NEW CONST. DWELING
OR ADDNS. ( ACCLBLDGS,CCUP. &) 20 sq ft
NEW CONSTR. MULTI.OUTLET
NON-RESID. BRANCH CIRCUITS)2.50ea
NEW CONST. POWER APPARATUS &)
NON- R
RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of Cali ornia Bu ness & ro essi s Code under the name
styl O :.
KNOW
Ex. Occup(OUTLETS OR FIXTURES) BA`L�t
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No._37_157 l� 3 Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$77—
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.
14 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.
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
30
OTAL PERMIT FEE
sad I—
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Date 2 ` 4
Sig ture off Peerrmitee or Age
Receipt No. J[�
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 bpw,�paid.
DIRECTOR IDF PUBLIC WORKS
BY Date
Building permit expires Date l'�'7
COUNTY OF BUTT,
DEPT. OF PUBLIC WORKS
1�1 DEC 29 1977
AM
n
-- t
MOBILEHOME SUPPORT DATA
If other than single wide,
Mobilehome Mfr. tj= V�+�� furnish Setup Model No. Year 7S
Width an (ft.) Box Length %.5--7 (ft:) Ta .
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes manufactured after October 7, 1973; furnish manufacturer's installation
manual and structural setup sheets (if not on file with the County of Butte).
All center
supports measured from front of
mobilehome
unless otherwise specified.
Footings (check one)
Single
1. Wood either
A.
pressure treated or
13-0
x •
foundation grade.
(ft.)(in:)
(in.) (in.)
2. Other (specify)
Center support
Center support
Supports (check one)
locations*
footing sizes
(in.)
1: Concrete block.
j
[:].2.
Other (specify)
(in.) (in:)
12'
(in.) (in.)
6�
(in.) (in.)
*If center piers are other than drawn above,
draw in—locations, spacing, and dimensions.
Tagalong or Expando,
show support details.
/ZxJO -- Typical,Support
in.) (in.) Footing Size
1 S 6 I -- Max. Pier Spacing
(ft.) (in.)
Max. Overhang
(ft.)(in.)
BUTTE COUNTY
BUILDING DEPARTMENT
APPROVED
a-
1. Owner's name:
2. Installer's na
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
PHONE: 534-4541
MOBILEHOME INSTALLATION SHEET
3. Is the site currently under permit? Yes /py�/ No
(If yes, furnish permit number S / 7Z ) OR
Is the site an existing site? Yes / / No YX—/
8. Is there any other electric load to be served by the mobilehome
site service? --------------------------------------------------- Yes / /
(If yes, identify the load and size: (Load)
9. What is the mobilehome site gas pipe size? ----------------------
10. What is the type of gas service? ------------------------------ Natural
11. What is the gas pipe length from meter or tank to the mobilehome?
12. What is the mobilehome gas demand? ------------------------------
LPG
(ft.)
�(BTU)
(This information not required if pipe length less than 6 ft. on natural gas
or less.than 50,ft. on LPG.)
(If
yes, furnish two (2) plot plans.)
4.
Will
the
mobilehome
be
located at least 5 ft. away from septic
tank and leach fields and
clear
of
all
setbacks and easements? Yes/ No'/ /
)
(If
no,
clarify
)
(
5.
What
is
the
mobilehome
electrical rating?-----------------------�
Amps
6.
What
is
the
mobilehome
site service rating? ---------------------
Amps
7.
What
is
the
mobil ehome.site
circuit breaker rating? -------------
�2e-De�� Amps
8. Is there any other electric load to be served by the mobilehome
site service? --------------------------------------------------- Yes / /
(If yes, identify the load and size: (Load)
9. What is the mobilehome site gas pipe size? ----------------------
10. What is the type of gas service? ------------------------------ Natural
11. What is the gas pipe length from meter or tank to the mobilehome?
12. What is the mobilehome gas demand? ------------------------------
LPG
(ft.)
�(BTU)
(This information not required if pipe length less than 6 ft. on natural gas
or less.than 50,ft. on LPG.)
'` COUNTY OF -BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone' 534-4541
APPLICATION AND PERMIT
authorize representatives or the c;ounty or L3utte to enter upon the
above-mentWned property for inspection purposes.
X oA /tu Date `'
Signature of Permitee or Agent
Receipt No. t 7 O %-3
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.
IRECT F PUB BCC
Bate/
Building permit expires Date
BUILDING
Owner ONt4
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor filess A.Cf q0, u(
Total Valuation
Mailing Address 6, Q 8 ,
Permit Fee
Plan Checking Fee &/or Penalty
11'rA7
Permit Fee $
Building Address
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
So j /12.r
Each Trap 1.50
X ! �-B n
�f /
Repair drainage or vent piping 1.50
Water piping 0—
CAIJ
Each gas water heater or vent 1.50
A. P. No. 6, 7 9i��
T _n
Gas piping system 1 - 5 outlets 1.50
-Each additional outlet .30
F
/
IWC.ti
Fire Dept.
FireZone
Use Permit
Building sewer 6.99- /O
EQA
Parking
Plans
Parcel
Declaration
Y- 141
arcel Ma P
60' R/W
ImprovementsAl
Lawn sprinkler system 2.00
l4�
.4'ons Recd
o
Par a Approval
Plans Approval
Permit Fee $ 3 —
$ 07
NEW ❑ ADDITION ❑ UTILITIES OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 100 AMP ORV OR SL_SS5.00 �—
Main service EA. ADD -L too AMP 2.50 a
Single Family ❑ Duplex ❑ Mobil Home
Others ❑
OVER 600V
Main service tOEAMP OR LESS 25.00
AMP
Main service EA. ADD'L too AMP 1.00
�•{
SW SQ. FT. MINIMUM
NEW CONST. ( DWELLIN GOCCUP. &) 2¢Sq ft
OR ADDNS.
NEW CONSTR. MULTI -OUTLET
NON•RESID. BRANCH CIRCUITS) 2.50ea
•
NEW CONST. POWER APPARATUS &)
NON•RESI R
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:
y� / n
A s t�7l�C.0/19 JC/df>/C
Ex. Occup(OUTLETS OR FIXTURES) BALD;
Ex. Occu FIXED APP LNS. OR
P• OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 , ^
License No.3066 i'% Classification Ad
Misc. Wiring 6.25
[:]I am exempt from the Contractors License Laws of the State of California.
Permit Fee $1:016
$ � 31
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.
MECHANICAL No. @ I FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
State Laws relating to building construction, and hereby
T , / vis'
9
o�S
TOTAL PERMIT FEE
$ Pand
%3
authorize representatives or the c;ounty or L3utte to enter upon the
above-mentWned property for inspection purposes.
X oA /tu Date `'
Signature of Permitee or Agent
Receipt No. t 7 O %-3
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.
IRECT F PUB BCC
Bate/
Building permit expires Date